Faculty Bibliography

STUDY DESIGN/METHODS:Retrospective cohort study. OBJECTIVE:Due to proximity of the surgical site to important respiratory structures, patients may undergo delayed extubation after adult cervical deformity (ACD) surgery to manage postoperative airway edema/obstruction. Herein, we evaluate relevant relationships with delayed extubation. SUMMARY OF BACKGROUND DATA/BACKGROUND:Delayed extubation is an underreported perioperative occurrence, with only a few studies conducting case-by-case reviews of prolonged intubation. METHODS:Operative ACD patients with baseline (BL) were grouped based on whether they experienced delayed extubation (DE), or leaving the OR while still intubated, versus those who were extubated successfully in the OR (non-DE). Means comparison and regression analyses identified predictors of delayed extubation and associations with peri-operative complications and outcomes. RESULTS:82 patients met inclusion criteria (mean age 62.4±13.0 y, 52.4% female, Edmonton frailty score: 5.10±2.97, ACFI score: 0.30±0.16, CCI: 1.41±1.73). 14 patients left the OR intubated, and 1(1.2%) required reintubation. DE cohort demonstrated greater Edmonton frailty scores (P=0.017) and smoking histories (P=0.031). Intraoperatively, there was a significant difference EBL (P=0.021) and rate of transfusions (DE: 27.3% v non-DE: 4.8%, P=0.12). Upper instrumented vertebra (UIV) was not associated with DE, while lower LIV increased the likelihood of DE (OR 1.1, P=0.029). Post-operatively, as expected, there was a significant difference in rate of SICU admissions (DE: 90.9% v. non-DE: 49.2%, P=0.01), although no significant differences in LOS. Greater cSVA and MGS correction from baseline was associated with increased likelihood of delayed extubation (OR 1.1, CI 95% 1.05-1.17, P<.001; OR 1.14, CI 95% 1.05-1.24, P=0.003). Furthermore, delayed extubation was a significant predictor of increased VR-Physical Component Scores (P=0.013) at 6W, and DE cohort demonstrated significantly higher VR-PCS and VR-MCS Scores at 6W (P=0.01, both). CONCLUSIONS:Baseline frailty and larger radiographic correction can be associated with delayed extubation, which can impact quality of life perioperatively. Considerations like minimizing intraoperative blood loss and degree of correction could minimize delayed extubation.

OBJECTIVE:To examine the effects of drug treatment for attention deficit/hyperactivity disorder (ADHD) on suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality. DESIGN/METHODS:Emulation of target trials. SETTING/METHODS:Linkage of national registers in Sweden, 2007-20. PARTICIPANTS/METHODS:People aged 6-64 years with a new diagnosis of ADHD, who either started or did not start drug treatment for ADHD within three months of diagnosis. MAIN OUTCOME MEASURES/METHODS:First and recurrent events of five outcomes over two years after ADHD diagnosis: suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality. RESULTS:90.1 per 1000 person years; incidence rate ratio 0.98, 0.96 to 1.01). The reduced rates were more pronounced among individuals with previous events, with incidence rate ratios ranging from 0.79 (0.72 to 0.86) for suicidal behaviours to 0.97 (0.93 to 1.00) for accidental injuries. For recurrent events, drug treatment for ADHD was significantly associated with reduced rates of all five outcomes, with incidence rate ratios of 0.85 (0.77 to 0.93) for suicidal behaviours, 0.75 (0.72 to 0.78) for substance misuse, 0.96 (0.92 to 0.99) for accidental injuries, 0.84 (0.76 to 0.91) for transport accidents, and 0.75 (0.71 to 0.79) for criminality. CONCLUSIONS:Drug treatment for ADHD was associated with beneficial effects in reducing the risks of suicidal behaviours, substance misuse, transport accidents, and criminality but not accidental injuries when considering first event rate. The risk reductions were more pronounced for recurrent events, with reduced rates for all five outcomes. This target trial emulation study using national register data provides evidence that is representative of patients in routine clinical settings.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Unaccompanied migrant youths often confront traumatic experiences elevating their risk for mental health symptoms. However, United States-based research on mental health services for this population, particularly Indigenous youths, is limited. Objectives were to examine mental health screening and referral, characteristics associated with referrals, and clinical rationale for screening result/referral discordance. METHODS:All unaccompanied migrant youths with pediatric intake visits at a healthcare-legal clinic between 3/2020-2/2023 were included (N=100). Retrospective cohort data were extracted from medical chart and program registry, including pediatricians' rationale for referrals. Chi-square and t-tests were used to compare rates of screening, evaluation, and discordant referrals by sociodemographic characteristics. Logistic regression was used to identify associations with mental health referral. Exploratory analyses examined referrals by Indigenous group. RESULTS:Youths had a mean (SD) age of 17.5 (2.5) years, most were assigned male at birth (66 [66%]), from Central America (83 [83%]), and one-third were Indigenous. Odds of mental health referral were higher for youths who were assigned female at birth (adjusted OR, 3.00 [95% confidence interval, 1.13-7.87), non-Indigenous (adjusted OR, 2.73; 95% confidence interval, 1.01-7.40), and reported more trauma types (adjusted OR, 1.38; 95% confidence interval, 1.02-1.87). One-third of referrals were for trauma or mental health symptoms identified by pediatricians, but not screeners. CONCLUSION/CONCLUSIONS:Most unaccompanied migrant youths had mental health referrals, one-third of which were for mental health symptoms undetected by screeners at pediatric visit. Findings highlight sociodemographic differences in mental health referrals, with non-Indigenous and female youths having higher odds of referral.

BACKGROUND:The maternal experience of intimate partner violence is associated with a range of emotional and behavioural problems in young children. OBJECTIVE:To prospectively examine the impact of maternal perinatal intimate partner violence experiences on children's risk trajectories of social-emotional development, including theoretically relevant social, economic, maternal mental health and trauma factors, as well as refugee status. PARTICIPANTS/METHODS:870 mother-child dyads in the WATCH mental health cohort study, half from refugee background. METHOD/METHODS:Multigroup trajectory modelling of annually collected longitudinal data at 5 timepoints, from when the children were 18-24 months to 60 months of age. RESULTS:The trajectory modelling revealed 4 distinct trajectories of child social-emotional development: (1) "none or low risk" trajectory (n = 710, 81.6 % of the sample); (2) "declining risk" trajectory (n = 66, 7.6 %); (3) "intermittent risk" trajectory (n = 64, 7.4 %); and (4) "high increasing risk" trajectory (n = 30; 3.4 %). Compared to the group 1 "none or low risk", maternal IPV exposure to physical abuse at baseline was associated with 2.45 times greater odds of children following the "intermittent risk" development trajectory, and 4.90 times greater odds of children following the "high increasing risk" trajectory. Children in trajectory 4 "high increasing risk" were more likely to be male, and mothers were more likely to be born in Australia, have no tertiary education, and experience social and economic difficulties. CONCLUSIONS:The study contributes significantly to understanding the deleterious impact of IPV on child development over time, including unique evidence that socially relevant and modifiable risk factors are more strongly associated with adverse child development than traditionally emphasised factors such as maternal mental health and child attachment factors.

While prior research has explored the neurobiological mechanisms underlying adolescent school performance, these mechanisms remain poorly understood in college students. Impulsivity has been highlighted as a key factor affecting academic success; however, its influence on the relationship between school performance and brain structure remains underexplored. In this study, we used a sample of college students to investigate which gray matter volume (GMV) in brain regions was associated with grade point average (GPA), and whether impulsivity mediates these relationships. Our findings revealed correlations between GMV in the caudate nucleus (CN) and cerebellum with GPA. Increased CN was correlated with poorer GPA through higher impulsivity, whereas higher cerebellum was associated with better GPA through lower impulsivity. These results indicate that CN and cerebellum play crucial roles in school performance and associated impulsivity. Various interventions targeting impulsivity, such as therapy, counseling, and medication, could improve educational outcomes by addressing the underlying neurobiological factors.

Down syndrome (DS), stemming from the triplication of human chromosome 21, results in intellectual disability, with early mid-life onset of Alzheimer's disease (AD) pathology. Early interventions to reduce cognitive impairments and neuropathology are lacking. One modality, maternal choline supplementation (MCS), has shown beneficial effects on behavior and gene expression in neurodevelopmental and neurodegenerative disorders, including trisomic mice. Loss of basal forebrain cholinergic neurons (BFCNs) and other DS/AD relevant hallmarks were observed in a well-established trisomic model (Ts65Dn, Ts). MCS attenuates these endophenotypes with beneficial behavioral effects in trisomic offspring. We postulate MCS ameliorates dysregulated cellular mechanisms within vulnerable BFCNs, with attenuation driven by novel gene expression. Here, choline acetyltransferase immunohistochemical labeling identified BFCNs in the medial septal/ventral diagonal band nuclei of the basal forebrain in Ts and normal disomic (2N) offspring at ~11 months of age from dams exposed to MCS or normal choline during the perinatal period. BFCNs (~500 per mouse) were microisolated and processed for RNA-sequencing. Bioinformatic assessment elucidated differentially expressed genes (DEGs) and pathway alterations in the context of genotype (Ts, 2N) and maternal diet (MCS, normal choline). MCS attenuated select dysregulated DEGs and relevant pathways in aged BFCNs. Trisomic MCS-responsive improvements included pathways such as cognitive impairment and nicotinamide adenine dinucleotide signaling, among others, indicative of increased behavioral and bioenergetic fitness. Although MCS does not eliminate the DS/AD phenotype, early choline delivery provides long-lasting benefits to aged trisomic BFCNs, indicating that MCS prolongs neuronal health in the context of DS/AD.

The directionality of the relationship between adolescent alcohol consumption and mental health difficulties remains poorly understood. This study investigates the longitudinal relationship between alcohol use frequency, internalizing and externalizing symptoms from the ages of 11 to 17. We conducted a random-intercept cross-lagged panel model across three timepoints (ages: 11yrs, 14yrs, 17yrs; 50.4% female) in the Millennium Cohort Study (N = 10,647). Survey weights were used to account for attrition. At each timepoint, past month alcohol use frequency was self-reported, parents and cohort members reported internalizing/externalizing symptoms using the Strengths and Difficulties Questionnaire. We controlled for alcohol expectancies, sex, and four cumulative risk indices (perinatal risk, early childhood adverse parenting, longitudinal parent-level risk occurrence, and persistent household socioeconomic deprivation). More frequent past month alcohol use at age 11 predicted increased internalizing symptoms at age 14 (β = 0.06; p =.01). More frequent past month alcohol use at age 14 predicted increased externalizing symptoms at age 17 (β = 0.11; p <.001). Increased internalizing symptoms consistently predicted reduced alcohol use at the next timepoint throughout the study period (11 years: β= -0.04; p =.03; 14 years: β= -0.09; p <.001). Increased externalizing symptoms at age 11 predicted increased alcohol consumption at age 14 (β = 0.06; p =.004). Frequent adolescent alcohol consumption represents a significant risk for subsequent mental health difficulties. Externalizing symptoms and alcohol use frequency appear to exacerbate one another. Internalizing symptoms may reduce the risk of frequent alcohol consumption. Incorporating routine alcohol screening into adolescent mental health treatment settings could reduce the risk of comorbid externalizing and alcohol use disorders.

We carried out the first systematic review to gauge if assessment of blinding was conducted in RCTs investigating medications for ADHD. Put of 161 RCTs form the dataset MED-ADHD (https://med-adhd.org/), we found only one RCT that reported blinding integrity, indicating that assessments of blinding integrity are very rarely conducted in the field. While our findings are not meant to invalidate the evidence on the benefits of ADHD medications, they suggest an opportunity to improve reporting of clinical trials in ADHD.

We investigated whether there is an emotional processing deficit in ADHD and whether this only applies to specific emotional categories. In this PRISMA-compliant systematic review based on a pre-registered protocol ( https://osf.io/egp7d ), we searched MEDLINE, PsycINFO, ERIC, Scopus and Web of Science databases until 3rd December 2023, to identify empirical studies comparing emotional processing in individuals meeting DSM (version III to 5-TR) or ICD (version 9 or 10) criteria for Attention Deficit/Hyperactivity Disorder (ADHD) and in a non-psychiatric control group. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS). Eighty studies were included and meta-analysed (encompassing 6191 participants and 465 observations). Bayesian meta-analyses were conducted to compare individuals with ADHD and non-psychiatric controls on overall emotional processing measures (meta-analysis 1) and across emotional categories (meta-analysis 2). The type of stimulus employed, outcome measurement reported, age, sex, and medication status were analysed as moderators. We found poorer performance in both overall emotion processing (g =  - 0.65) and across emotional categories (anger g =  - 0.37; disgust g =  - 0.24; fear g =  - 0.37; sadness g =  - 0.34; surprise g =  - 0.26; happiness/positive g =  - 0.31; negative g =  - 0.20; neutral g =  - 0.25) for individuals with ADHD compared to non-psychiatric controls. Scales items and accuracy outcome being the most effective moderators in detecting such differences. No effects of age, sex, or medication status were found. Overall, these results show that impaired emotional processing is a relevant feature of ADHD and suggest that it should be systematically assessed in clinical practice.