The DSM-5 recognized that the separation anxiety disorder (SEPAD) may span the entire life course or have an adult-onset. Epidemiological data indicated a 23%–69% prevalence of SEPAD in clinical settings and a high comorbidity with both prolonged grief disorder (PGD) and post-traumatic stress disorder (PTSD). Some authors hypothesize that while life threat represents the key trigger of PTSD, disruptions or threats to interpersonal bonds lead to PGD and SEPAD. This study aims to test the hypothesis that adult-onset SEPAD might be a trauma-related disorder, triggered by events threatening to interpersonal bonds.

The sample included 106 consecutive adult outpatients with anxiety and/or mood disorders. SEPAD was diagnosed according to DSM-5 criteria by means of the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS). The Adult Separation Anxiety Checklist (ASA-27) was used to assess symptoms severity. To assess exposure to trauma, the SCID-5 criterion A form for PTSD was administered. Traumatic events were coded as directly experienced (self) or involving close ones (others). Lifetime exposure to separation events was also assessed.

60.4% of participants were categorized as not having SEPAD in adulthood or in childhood (NO-SEPAD), 18.9% as childhood-onset SEPAD, and 20.8% as adult-onset SEPAD. Controlling for comorbid disorders, lifetime traumatic events involving self and separation events, traumatic events involving others significantly predicted adult-onset SEPAD. A significant correlation between the age at trauma exposure and the age of SEPAD onset was found.

Our results are consistent with the hypothesis that adult-onset SEPAD may represent an event-related disorder.

Value frameworks play a crucial role in bridging the gap between evidence and decision making in health care, particularly in settings with limited resources as low- and middle-income countries (LMIC). In this study, we present the development of a value framework (VF) targeted to provide coverage recommendations in rapid health technology assessment reports (rHTA) as well as its first 5 years of implementation.

We performed an exhaustive literature search with the aim to identify existing VFs and their dimensions followed by the generation of a VF proposal through a mixed methods, qualitative–quantitative approach including a Delphi panel to weigh the criteria and correlate them with the subsequent recommendations. To describe its implementation, we present the results of 264 rHTA reports from 2017 to 2022.

The value framework has three main domains (quality of evidence, net benefit, and economic impact). We adapted widely used methodologies for quality of evidence and net benefit domains. The economic impact domain was the most complex to assess, so an ad hoc method was developed. Analysis of 265 HTAs revealed the distribution of recommendations across different criteria and technology types. Most were for drugs (40.5 percent) or therapeutic procedures (36 percent). With a five-category final recommendation, 0.8 percent were favorable, 19.7 percent were uncertain, and 44 percent were unfavorable.

The VF demonstrated its versatility and practicality in meeting the needs of rHTA audience, and can facilitate evidence-informed decision making. This VF serves as a valuable tool for conducting adaptive rHTAs and supports decision-making processes in Argentina and similar LMIC contexts.

Limited longitudinal research examining developmental changes in visuospatial working memory (WM) among children and adolescents with autism spectrum disorder (ASD) has prompted our investigation.

We assessed 123 autistic children and adolescents and 145 typically developing controls (TDC) using the Cambridge Neuropsychological Test Automated Battery at baseline (Time 1 [mean age ± SD]: ASD: 13.04 ± 2.86; TDC: 11.53 ± 2.81) and 2–9 years later (Time 2: ASD: 18.08 ± 3.17; TDC: 16.41 ± 3.09) to measure changes of visuospatial (working) memory over time. The linear mixed model was used to compare the differences between ASD and TDC and estimate the effect of changes over time, age, ASD diagnosis, and interactions of Time×Age×ASD. The overall Age×ASD effect was calculated in the spline regression.

Autistic children and adolescents exhibited significantly poorer performance on all spatial tasks and some visual tasks than their TDC counterparts at Time 1 and Time 2, after adjusting for sex, age, attention deficit/hyperactivity disorder (ADHD), and full-scale intelligence quotient. There was an overall improvement from Time 1 to Time 2 across all tasks with significant Age×Time interactions. Significant Age×ASD interactions were observed in the delayed matching to sample, pattern recognition memory (PRM), spatial span (SSP), and spatial working memory (SWM) tasks with no significant Time×ASD interactions. In the quadratic nonlinear model, Age×ASD interactions were significant in PRM and SSP.

Despite significant improvements during the follow-up period, autistic children and adolescents continue to experience persistent deficits in SWM, with a weaker age-related improvement in visuospatial WM than TDC.

There are few economic evaluations of adjunctive psychosocial therapies for bipolar disorder.

Estimate the cost–utility of in-person psychosocial therapies for adults with bipolar disorder added to treatment as usual (TAU), from an Australian Government perspective.

We developed an economic model, estimating costs in 2021 Australian dollars (A$) and outcomes using quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted. The model compared psychoeducation, brief psychoeducation, carer psychoeducation, cognitive–behavioural therapy (CBT) and family therapy when added to TAU (i.e. pharmacotherapy) over a year for adults (18–65 years) with bipolar disorder. The relative risk of relapse was sourced from two network meta-analyses and applied to the depressive phase in the base case. Probabilistic sensitivity analysis and one-way sensitivity analyses were conducted, assessing robustness of results.

Carer psychoeducation was preferred in the base case when the willingness-to-pay (WTP) threshold is below A$1000 per QALY gained and A$1500 per DALY averted. Brief psychoeducation was preferred when WTP is between A$1000 and A$300 000 per QALY gained and A$1500 and A$450 000 per DALY averted. Family therapy was only preferred at WTP thresholds above A$300 000 per QALY gained or A$450 000 per DALY averted. In sensitivity analyses, brief psychoeducation was the preferred therapy. Psychoeducation and CBT were dominated (more costly and less effective) in base-case and sensitivity analyses.

Carer and brief psychoeducation were found to be the most cost-effective psychosocial therapies, supporting use as adjunctive treatments for adults with bipolar disorder and their families in Australia.

The objective of this paper is to present the Environmental Sustainability in Health Technology Assessment (ESHTA) Working Group’s (WG’s) opinion on the definition and scope of early Health Technology Assessment (HTA) developed by a WG under HTA International. The aim is to provide suggestions on how early HTA can support the goals of enhancing environmental sustainability in healthcare.

The HTAi ESHTA WG presents our opinion on the proposed definition and scope of early HTA. This includes a broad range of perspectives from stakeholder groups including patient experts, a policy maker, a statistician, HTA researchers and a healthcare professional, located across lower to higher resource settings and several jurisdictions. We suggest how early HTA can support the goals of enhancing environmental sustainability in healthcare.

HTA agencies play a crucial role in embedding sustainability into their evaluations and practices. Integrating environmental sustainability into HTA at three critical stages – product conceptualization, reimbursement decisions, and point of care – can optimize resource use and reduce environmental impacts. Developing sustainability metrics, defining environmental impact categories, and identifying suitable methods for assessing health technologies are essential steps. Early engagement is also vital for optimizing trade-offs and increasing acceptance by diverse stakeholders.

Incorporating environmental sustainability into early HTA can enhance the likelihood of regulatory approval and reimbursement, ultimately benefiting patients and healthcare systems. By integrating sustainability considerations at the design stage, the potential for environmental impact reduction is maximized. Future efforts should focus on developing comprehensive guidelines and methods, ensuring collaboration between early HTA and ESHTA WGs.

Physical exercise improves mental and physical health of individuals with severe mental illness (SMI); however, its impact on metabolic syndrome remains unclear.

To evaluate the effects of exercise interventions on metabolic syndrome components in individuals with SMI and explore interactions between exercise and antipsychotic medications on metabolic outcomes.

Following PRISMA guidelines, we systematically searched PubMed, CINAHL, Web of Science, and APA PsycINFO through October 10, 2023, for randomized controlled trials (RCTs) assessing the effects of exercise on waist circumference, blood pressure, glucose, triglycerides, and HDL cholesterol in SMI. Risk of bias was evaluated using the Cochrane RoB-2 tool. Data were pooled using random-effects models in Comprehensive Meta-Analysis and JASP.

Ten RCTs (N = 773; mean age 39.9 ± 7.36 years; 38.7% female; 71.5% schizophrenia spectrum disorders) met inclusion criteria. Pooled analyses revealed no significant effects of exercise on waist circumference (SMD = 0.206, 95% CI [−0.118, 0.530], p = 0.171), systolic blood pressure (SMD = 0.194, 95% CI [−0.115, 0.504], p = 0.219), diastolic blood pressure (SMD = −0.21, 95% CI [−0.854, 0.434], p = 0.522), HDL (SMD = 0.157, 95% CI [−0.36, 0.674], p = 0.551), triglycerides (SMD = −0.041, 95% CI [−0.461, 0.38], p = 0.849), or glucose (SMD = −0.071, 95% CI [−0.213, 0.071], p = 0.326). Heterogeneity was moderate to high.

Exercise interventions did not significantly improve metabolic syndrome components in SMI. Future trials must prioritize tailored regimens, adjunctive therapies, and rigorous control of medication effects.

To evaluate performance of registered nurse assessments of the PEN-FAST penicillin allergy clinical decision rule compared to antimicrobial stewardship pharmacists.

Prospective, blinded, non-interventional, quality assurance study.

This study took place across 4 inpatient hospitals within a large health system in Houston, Texas.

We implemented PEN-FAST rule questions into the electronic health record (EHR) for registered nurses to perform. Patients were randomly selected in a prospective fashion, with nurse documented scores hidden, for re-assessment by antimicrobial stewardship pharmacists to compare risk stratification and scores.

Overall agreement of high risk and low risk results was 84.3%. Registered nurse evaluations with the PEN-FAST clinical decision rule for detecting a high-risk patient demonstrated a sensitivity of 67%, specificity of 89.8%, positive predictive value of 67.9%, and negative predictive value of 89.5%. Additionally, 34.4% of patients with a documented penicillin allergy admitted to tolerating amoxicillin or amoxicillin/clavulanate since their last recalled reaction to penicillin.

Registered nurse assessment of the PEN-FAST clinical decision rule demonstrated good performance and can effectively be used to screen for low-risk penicillin allergy patients. Incorporation of the PEN-FAST rule into EHR can be scaled into large health systems to help appropriately stratify patients with low- and high-risk penicillin allergies and improve documentation.