Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.

T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).

PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).

PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.

People with opioid use disorder (OUD) have substantially higher standardised mortality rates compared with the general population. However, lack of individualised prognostic information presents challenges in personalisation of addiction treatment delivery.

To develop and validate the first prognostic models to estimate 6-month all-cause and drug-related mortality risk for people diagnosed with OUD using indicators recorded at baseline assessment in addiction services in England.

Thirteen candidate prognostic variables, including sociodemographic, injecting status and health and mental health factors, were identified from nationally linked addiction treatment, hospital admission and death records from 1 April 2013 to 1 April 2022. Multivariable Cox regression models were developed with a fractional polynomial approach for continuous variables, and missing data were addressed using multiple imputation by chained equations. Validation was undertaken using bootstrapping methods. Discrimination was assessed using Harrel’s C and D statistics alongside examination of observed-to-predicted event rates and calibration curve slopes.

Data were available for 236 064 people with OUD, with 2427 deaths due to any cause, including 1289 due to drug-related causes. Both final models demonstrated good optimism-adjusted discrimination and calibration, with all-cause and drug-related models, respectively, demonstrating Harrell’s C statistics of 0.73 (95% CI 0.71–0.75) and 0.74 (95% CI 0.72–0.76), D-statistics of 1.01 (95% CI 0.95–1.08) and 1.07 (95% CI 0.98–1.16) and calibration slopes of 1.01 (95% CI 0.95–1.08) and 1.01 (95% CI 0.94–1.10).

We developed and internally validated Roberts’ OUD mortality risk, with the first models to accurately quantify individualised absolute 6-month mortality risks in people with OUD presenting to addiction services. Independent validation is warranted to ensure these models have the optimal utility to assist wider future policy, commissioning and clinical decision-making.

Physical health checks in primary care for people with severe mental illness ((SMI) defined as schizophrenia, bipolar disorders and non-organic psychosis) aim to reduce health inequalities. Patients who decline or are deemed unsuitable for screening are removed from the denominator used to calculate incentivisation, termed exception reporting.

To describe the prevalence of, and patient characteristics associated with, exception reporting in patients with SMI.

We identified adult patients with SMI from the UK Clinical Practice Research Datalink (CPRD), registered with a general practice between 2004 and 2018. We calculated the annual prevalence of exception reporting and investigated patient characteristics associated with exception reporting, using logistic regression.

Of 193 850 patients with SMI, 27.7% were exception reported from physical health checks at least once. Exception reporting owing to non-response or declining screening increased over the study period. Patients of Asian or Black ethnicity (Asian: odds ratio 0.72, 95% CI 0.65–0.80; Black: odds ratio 0.86, 95% CI 0.76–0.97; compared with White) and women (odds ratio 0.90, 95% CI 0.88–0.92) had a reduced odds of being exception reported, whereas patients diagnosed with ‘other psychoses’ (odds ratio 1.19, 95% CI 1.15–1.23; compared with bipolar disorder) had increased odds. Younger patients and those diagnosed with schizophrenia were more likely to be exception reported owing to informed dissent.

Exception reporting was common in people with SMI. Interventions are required to improve accessibility and uptake of physical health checks to improve physical health in people with SMI.

1. (1) Following reading this paper, readers will better understand the diagnostic and practice-based complexities involved in assessing traumatic events as a Psychological Wellbeing Practitioner (PWP) in an NHS Talking Therapies service.

2. (2) Readers will also be aware of the emotional challenges PWPs in this service have reported experiencing as a result of assessing service users that report having experienced traumatic events.

3. (3) The reader will also learn about PWPs’ perspectives on what could improve this NHS Talking Therapies service’s processes involved in assessing traumatic events and reflect on whether this might be generalisable across other, similar services.

Evaluate impact of COVID-19 prevention training with video-based feedback on nursing home (NH) staff safety behaviors.

Public health intervention

Twelve NHs in Orange County, California, 6/2020-4/2022

NHs received direct-to-staff COVID-19 prevention training and weekly feedback reports with video montages about hand hygiene, mask-wearing, and mask/face-touching. One-hour periods of recorded streaming video from common areas (breakroom, hallway, nursing station, entryway) were sampled randomly across days of the week and nursing shifts for safe behavior. Multivariable models assessed the intervention impact.

Video auditing encompassed 182,803 staff opportunities for safe behavior. Hand hygiene errors improved from first (67.0%) to last (35.7%) months of the intervention, decreasing 7.6% per month (OR = 0.92, 95% CI = 0.92–0.93, P < 0.001); masking errors improved from first (10.3 %) to last (6.6%) months of the intervention, decreasing 2.3% per month (OR = 0.98, 95% CI = 0.97–0.99, P < 0.001); face/mask touching improved from first (30.0%) to last (10.6%) months of the intervention, decreasing 2.5% per month (OR = 0.98, 95% CI = 0.97–0.98, P < 0.001). Hand hygiene errors were most common in entryways and on weekends, with similar rates across shifts. Masking errors and face/mask touching errors were most common in breakrooms, with the latter occurring most commonly during the day (7A.M.–3P.M.) shift, with similar rates across weekdays/weekends. Error reductions were seen across camera locations, days of the week, and nursing shifts, suggesting a widespread benefit within participating NHs.

Direct-to-staff training with video-based feedback was temporally associated with improved hand hygiene, masking, and face/mask-touching behaviors among NH staff during the COVID-19 pandemic.

Culture data may help determine antibiotic administration options for nonoperative complicated appendicitis. Variability exists in treatment strategies, from solely using intravenous therapy, including outpatient parenteral antibiotic treatment (OPAT), to transitioning to oral (PO) antibiotics. We hypothesize that most patients have an oral antibiotic option based on culture results and that there is no increased rate of readmission due to treatment failure with oral antibiotics.

This was a single-center retrospective cohort study reviewing antibiotic treatment of pediatric patients treated with nonoperative management for complicated appendicitis with abscesses percutaneously drained by Interventional Radiology (IR). We compared case-mix demographic variables, choice and route of antibiotic therapy, culture data, and clinical outcomes between those who exclusively received parenteral antibiotics therapy (PAT) and those who were switched to oral therapy (PO).

We identified 54 cases of nonoperative complicated appendicitis who underwent IR abscess drainage from 2014 to 2019. Forty-five [83%] patients completed therapy with PAT and 9 with PO; forty-six of 54 patients (85%) patients had an oral antibiotic(s) option based on sensitivities. Readmissions and complications included 6 (11%) patients. Three (50%) patients were readmitted due to antibiotic treatment failure with worsening of abscess formation, 2 due to PICC (peripherally inserted central catheters) issues, and 1 due to a drug reaction.

Most patients with nonoperative complicated appendicitis can be transitioned to oral antibiotic options based on the culture susceptibility profiles.

Hallucinations are common and distressing symptoms in Parkinson’s disease (PD). Treatment response in clinical trials is measured using validated questionnaires, including the Scale for Assessment of Positive Symptoms-Hallucinations (SAPS-H) and University of Miami PD Hallucinations Questionnaire (UM-PDHQ). The minimum clinically important difference (MCID) has not been determined for either scale. This study aimed to estimate a range of MCIDs for SAPS-H and UM-PDHQ using both consensus-based and statistical approaches.

A Delphi survey was used to seek opinions of researchers, clinicians, and people with lived experience. We defined consensus as agreement ≥75%. Statistical approaches used blinded data from the first 100 PD participants in the Trial for Ondansetron as Parkinson’s Hallucinations Treatment (TOP HAT, NCT04167813). The distribution-based approach defined the MCID as 0.5 of the standard deviation of change in scores from baseline at 12 weeks. The anchor-based approach defined the MCID as the average change in scores corresponding to a 1-point improvement in clinical global impression-severity scale (CGI-S).

Fifty-one researchers and clinicians contributed to three rounds of the Delphi survey and reached consensus that the MCID was 2 points on both scales. Sixteen experts with lived experience reached the same consensus. Distribution-defined MCIDs were 2.6 points for SAPS-H and 1.3 points for UM-PDHQ, whereas anchor-based MCIDs were 2.1 and 1.3 points, respectively.

We used triangulation from multiple methodologies to derive the range of MCID estimates for the two rating scales, which was between 2 and 2.7 points for SAPS-H and 1.3 and 2 points for UM-PDHQ.

This study aims to identify fathers’ profiles integrating food parenting practices (FPP) and physical activity parenting practices (PAPP).

We analysed cross-sectional data. The fathers completed the reduced FPP and PAPP item banks and socio-demographic and family dynamics (co-parenting and household responsibility) questionnaires. We identified fathers’ profiles via latent profile analysis. We explored the influence of social determinants, child characteristics and family dynamics on fathers’ profiles using multinomial logistic regression.

Online survey in the USA.

Fathers of 5–11-year-old children.

We analysed data from 606 fathers (age = 38 ± 8·0; Hispanic = 37·5 %). Most fathers self-identified as White (57·9 %) or Black/African American (17·7 %), overweight (41·1 %) or obese (34·8 %); attended college (70 %); earned > $47 000 (62·7 %); worked 40 hrs/week (63·4 %) and were biological fathers (90·1 %). Most children (boys = 55·5 %) were 5–8 years old (65·2 %). We identified five fathers’ profiles combining FPP and PAPP: (1) Engaged Supporter Father (n 94 (15·5 %)); (2) Leveled Father (n 160 (26·4 %)); (3) Autonomy-Focused Father (n 117 (19·3 %)); (4) Uninvolved Father (n 113 (18·6 %)) and (5) Control-Focused Father (n 122 (20·1 %)). We observed significant associations with race, ethnicity, child characteristics, co-parenting and household responsibility but not with education level, annual income or employment status. We observed significant pairwise differences between profiles in co-parenting and household responsibility, with the Engaged Supporter Father presenting higher scores in both measures.

Understanding how fathers’ FPP and PAPP interact can enhance assessments for a comprehensive understanding of fathers’ influences on children’s health. Recognising the characteristics and differences among fathers’ profiles may enable tailored interventions, potentially improving children’s health trajectories.

Patients with hematological malignancies are at high risk of infections due to both the disease and the associated treatments. The use of immunoglobulin (Ig) to prevent infections is increasing in this population, but its cost effectiveness is unknown. This trial-based economic evaluation aimed to compare the cost effectiveness of prophylactic Ig with prophylactic antibiotics in patients with hematological malignancies.

The economic evaluation used individual patient data from the RATIONAL feasibility trial, which randomly assigned 63 adults with chronic lymphocytic leukemia, multiple myeloma, or lymphoma to prophylactic Ig or prophylactic antibiotics. The following two analyses were conducted to estimate the cost effectiveness of the two treatments over the 12-month trial period from the perspective of the Australian health system:

(i) a cost-utility analysis (CUA) to assess the incremental cost per quality-adjusted life-year (QALY) gained using data collected with the EuroQol 5D-5L questionnaire; and

(ii) a cost-effectiveness analysis (CEA) to assess the incremental cost per serious infection prevented (grade ≥3) and per infection prevented (any grade).

The total cost per patient was significantly higher in the Ig arm than in the antibiotic arm (difference AUD29,140 [USD19,000]). There were non-significant differences in health outcomes between the treatment arms: patients treated with Ig had fewer QALYs (difference −0.072) and serious infections (difference −0.26) than those given antibiotics, but more overall infections (difference 0.76). The incremental cost-effectiveness from the CUA indicated that Ig was more costly than antibiotics and associated with fewer QALYs. In the CEA, Ig costed an additional AUD111,262 (USD73,000) per serious infection prevented, but it was more costly than antibiotics and associated with more infections when all infections were included.

These results indicate that, on average, Ig prophylactic treatment may not be cost effective compared with prophylactic antibiotics for the group of patients with hematological malignancies recruited to the RATIONAL feasibility trial. Further research is needed to confirm these findings in a larger population and over the longer term.