This study compares outcomes of open versus percutaneous tracheostomies in coronavirus disease 2019 patients to guide clinical decision-making based on disease severity.

A retrospective cohort study using the 2020 National Readmissions Database identified 4810 coronavirus disease 2019 patients (International Statistical Classification of Diseases and Related Health Problems 10th Revision code U071) who underwent tracheostomy. Of these, 2061 had open and 2749 had percutaneous tracheostomies. Patient demographics, severity (All Patient Refined-Diagnosis Related Groups) and outcomes (mortality, readmission, complications) were analysed using chi-squared tests, both overall and by severity.

Mortality was higher in the percutaneous group (29.25 per cent) compared to the open group (26.35 per cent) (p = 0.0265). For severe cases (All Patient Refined-Diagnosis Related Groups 3–4), open tracheostomies had significantly lower mortality, readmission and complication rates (p < 0.05).

Open tracheostomies are associated with better outcomes in severe coronavirus disease 2019 cases. Percutaneous tracheostomies are effective in mild cases, but patient selection and procedural planning should consider disease severity. Future research should validate these findings.

This study investigates the seasonal and regional distribution of paediatric laryngomalacia admissions in the United States, hypothesizing higher admission rates in winter and colder regions due to reduced sunlight exposure affecting vitamin D levels.

We analyzed data from the 2016 Kids’ Inpatient Database (KID), focusing on children under three years old. Laryngomalacia cases were identified using International Classification of Diseases and Related Health Problems 10th Revision (ICD-10) code Q31.5. Seasonal and regional differences in admission rates were assessed using Pearson’s chi-squared test, with a significance level of p less than 0.05.

Of 4,512,196 estimated national admissions, 11,638 were due to laryngomalacia. Admissions increased by 10.0 per cent in winter and decreased by 10.9 per cent in summer (p < 0.005). Regionally, admissions were higher in the Midwest/Central (18.6 per cent) and Northeast (9.3 per cent) and lower in the South (7.4 per cent) and West (11.1 per cent) (p < 0.005).

Laryngomalacia admissions are significantly influenced by seasonal and regional factors, likely related to environmental conditions affecting vitamin D synthesis.

This study investigated the influence of socioeconomic factors on the incidence of laryngomalacia in paediatric in-patients.

Data from the 2016 Healthcare Cost and Utilization Project Kid Inpatient Database were analysed. Variables included zip code median income, race and/or ethnicity, primary expected payer and associated International Statistical Classification of Diseases and Related Health Problems 10th Revision codes in admission.

Lower median income zip codes showed a 6.4 per cent increase in laryngomalacia admissions, while higher-income zip codes had an 8.0 per cent decrease. Black patients exhibited a 24.5 per cent increase and Asian or Pacific Islander patients showed a 42.5 per cent decrease in laryngomalacia admissions. Medicaid and other government programme payers had a 22.1 per cent increase, while Medicare, private insurance and self-pay patients had decreases of 35.5, 20.9 and 55.7 per cent, respectively. Laryngomalacia was associated with a number of disease processes from a multitude of organ systems in a statistically significant manor.

Socioeconomic status, race, primary expected payer and co-morbid disease process significantly impact laryngomalacia admissions.

Forensic psychiatric services address the therapeutic needs of mentally disordered offenders in a secure setting. Clinical, ethical, and legal considerations underpinning treatment emphasize that the Quality of Life (QOL) of patients admitted to forensic hospitals should be optimised.

This study aims to examine changes in the QOL in Ireland’s National Forensic Mental Health Service following its relocation from the historic 1850 site in Dundrum to a new campus in Portrane, Dublin.

This multisite prospective longitudinal study is part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST). Repeated measures were taken for all inpatients in the service at regular six-monthly intervals. The WHOQOL-BREF questionnaire was offered to all inpatients and an anonymised EssenCES questionnaire was simultaneously used to measure atmosphere in the wards. Data were obtained at five time points for each individual patient and ward. WHOQOL-BREF ratings were obtained across five time points with comparisons for four time intervals, including immediately before and after relocation. For 101 subjects across the four time intervals, 215 sets of data were obtained; 140 before and 65 after relocation with 10 community patients who did not move. Using Generalised Estimating Equations (GEE) to correct for multiple comparisons over time, the effect of relocation, with community patients as a control, was analysed by ward cluster and whether patients moved between wards. Observations were categorised according to security level — high dependency, medium secure, rehabilitation, or community — and trichotomised based on positive moves to less secure wards, more secure wards (negative moves), or no moves.

The hospital’s relocation was associated with a significant increase in environmental QOL (Wald X2=15.9, df=1, p<0.001), even when controlling for cluster location, positive and negative moves. When controlling for ward atmosphere, environmental QOL remained significantly increased after relocation (Wald X2=10.0, df=1, p=0.002). EssenCES scores were obtained within the hospital for three time points before relocation and two time points afterward. No significant differences were found in the three subscales before and after the relocation. All three EssenCES subscales progressively improved with decreasing security level (Patient’s Cohesion: Wald X2=958.3, df=1, p<0.001; Experienced Safety: Wald X2=152.9, df=5, p<0.001; Therapeutic Hold: Wald X2=33.6, df=3, p<0.001).

The GEE model showed that the hospital’s relocation improved self-reported environmental QOL. The cluster location made significant differences, as expected for a system of stratified therapeutic security, with a steady improvement in scores on all three atmosphere subscales.

None Declared

Forensic psychiatric services serve a dual purpose: treatment of mental disorders and prevention of associated violent reoffending. Progression along the secure care pathway is often impeded by impaired insight, mainly as a result of treatment-resistant psychoses.

We assessed levels of insight among patients in Ireland’s National Forensic Mental Health Service before and after its relocation from the historic 1850 campus in Dundrum to a modern facility in Portrane, Dublin.

The VAGUS insight scale was used in this repeated measures study before and after the relocation at two time points 42 months apart. All inpatients were invited to participate in completing the self-report (VAGUS-SR) and clinician-rated (VAGUS-CR) versions on both occasions. Total scores of both versions were averaged to obtain a combined VAGUS insight score. Corresponding Positive and Negative Syndrome Scale (PANSS) scores were used to ascertain correlations between the insight and symptomatology scales. This study is part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST)

40 pairs of observations were available for legal capacity to consent to medication, combined VAGUS-CR and VAGUS-SR assessments of insight (Cronbach’s alpha=0.927), and PANSS. VAGUS-CR insight and PANSS scores were progressively better from admission and high dependency wards through medium-term medium secure wards to rehabilitation and pre-discharge wards. Mean scores did not change significantly over this time interval. Those legally certified fit to give or withhold consent by their treating consultant psychiatrists scored significantly better on the VAGUS combined insight scale: 8.3 (SD 1.7) v 5.3 (2.2) at baseline, paired t=25.9, p<0.001; and also 42 months later: 8.2 (1.4) v 5.7 (3.9), paired t=5.2, p=0.022. PANSS subscales were all significantly better for those assessed as being capacitous. Change in combined VAGUS score correlated with change in all PANSS subscales. Binary logistic regression with legal capacity as the dependent variable yielded a model in which combined VAGUS score and PANSS positive symptom score were independent determinants of assessed capacity status. Receiver operating characteristic area under the curve was 0.873, 95% CI 0.760-0.986, at baseline and 0.856, 95% CI 0.720-0.991, at 42 months. A score of 7.3 yielded a sensitivity of 0.8 and a specificity of 0.8.

The combined VAGUS score is a reliable and valid measure of insight relevant to functional mental capacity to consent to treatment with sensitivity and specificity sufficient to guide but not bind clinical decision-making. It measures a quality that varies with symptom severity but is also partly independent of symptom severity; the constructive inclusion of self-reported insight is notable.

None Declared

The Central Mental Hospital is the Republic of Ireland's only secure forensic hospital and the seat of its National Forensic Mental Health Service (NFMHS). We scrutinised admission patterns in the NFMHS during the period 01/01/2018–01/10/2023; before and after relocating from the historic 1850 site in Dundrum to a modern facility in Portrane on 13/11/2022.

This prospective longitudinal cohort study included all patients admitted during the above period. The study initially commenced in Dundrum and continued afterwards in Portrane. Data gathered included demographics, diagnoses, capacity to consent to treatment, and the need for intramuscular medication (IM) after admission. Therapeutic security needs and urgency of need for admission were collated from DUNDRUM-1 and DUNDRUM-2 scores rated pre-admission. Hours spent in seclusion during the first day, week, and month after admission were calculated. Data were collected as part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST).

There were 117 admissions during the 69-month period. The majority were male (n = 98). Most were admitted from prisons (87%). Schizophrenia was the most common diagnosis (55.8%). Mean DUNDRUM-1 triage security scores were in the medium-security range (2.84–3.15) during this period. At the time of admission, 53.8% required seclusion, 25.6% required IM medication, and 79.5% lacked capacity to consent to treatment. Those who required seclusion on admission had worse scores on the DUNDRUM-2 triage urgency scale (F = 20.9, p < 0.001). On linear logistic regression, the most parsimonious model resolved with five predictors of hours in seclusion during the first day and week, which were: D1 item 8 – Victim sensitivity/public confidence issues, D1 item 10 – Institutional behaviour, D2 item 2 – Mental health, D2 item 4 – Humanitarian, and D2 item 6 – Legal urgency. 50% required IM medication during their first week of admission and these patients had significantly worse scores on: D1 item 8 – Victim sensitivity/public confidence issues, D1 item 10 – Institutional behaviour, D2 item 2 – Mental health, and D2 item 4 – Humanitarian (all p < 0.05).

There was an increase in the frequency of admissions since relocating to Portrane. The results suggest that there was no change in overall triage security and urgency needs during the time period in question. Major mental illness related factors impacted the need for seclusion early in the admission, whereas factors linked to prison behaviour or personality-related factors were more associated with an ongoing need for seclusion at month one.

Forensic psychiatric services address the therapeutic needs of mentally disordered offenders in a secure setting. Clinical, ethical, and legal considerations underpinning treatment emphasize that the Quality of Life (QOL) of patients admitted to forensic hospitals should be optimised. This study aims to examine changes in the QOL in Ireland's National Forensic Mental Health Service (NFMHS) following its relocation from the historic 1850 site in Dundrum to a new campus in Portrane, Dublin.

This multisite prospective longitudinal study is part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST). Repeated measures were taken for all inpatients in the service at regular 6 monthly intervals. The WHOQOL-BREF questionnaire was offered to all inpatients. An anonymised EssenCES questionnaire was used to measure atmosphere in wards. Data were obtained at 5 time points for each individual patient and ward. WHOQOL-BREF ratings were obtained across 5 time points with comparisons available for 4 time intervals, including immediately before and after relocation. For 101 subjects across 4 time intervals, 215 sets of data were obtained; 140 before and 65 after relocation with 10 community patients who did not move. Using Generalised Estimating Equations (GEE) to correct for multiple comparisons over time, the effect of relocation, with community patients as a control, was analysed by ward cluster and whether patients moved between wards. Observations were categorised according to security level – high dependency, medium secure, rehabilitation, or community – and trichotomised based on positive moves to less secure wards, negative moves to more secure wards, or no moves.

Relocation of the NFMHS was associated with a significant increase in environmental QOL (Wald X2 = 15.9, df = 1, p < 0.001), even when controlling for cluster location, positive and negative moves. When controlling for ward atmosphere, environmental QOL remained significantly increased after the move (Wald X2 = 10.0, df = 1, p = 0.002). EssenCES scores were obtained within the hospital for 3 time points before relocation and 2 time points afterwards. No significant differences were found on the three subscales before and after the move. All three EssenCES subscales progressively improved with decreasing security level (Patient Cohesion: Wald X2 = 958.3, df = 1, p < 0.001; Experiencing Safety: Wald X2 = 152.9, df = 5, p < 0.001; Therapeutic Hold: Wald X2 = 33.6, df = 3, p < 0.001).

The GEE model demonstrated that the move of the NFMHS improved self-reported environmental QOL. The cluster location made significant differences, as expected for a system of stratified therapeutic security, with a steady improvement in scores on all three atmosphere subscales.

n-3 fatty acid consumption during pregnancy is recommended for optimal pregnancy outcomes and offspring health. We examined characteristics associated with self-reported fish or n-3 supplement intake.

Pooled pregnancy cohort studies.

Cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) consortium with births from 1999 to 2020.

A total of 10 800 pregnant women in twenty-three cohorts with food frequency data on fish consumption; 12 646 from thirty-five cohorts with information on supplement use.

Overall, 24·6 % reported consuming fish never or less than once per month, 40·1 % less than once a week, 22·1 % 1–2 times per week and 13·2 % more than twice per week. The relative risk (RR) of ever (v. never) consuming fish was higher in participants who were older (1·14, 95 % CI 1·10, 1·18 for 35–40 v. <29 years), were other than non-Hispanic White (1·13, 95 % CI 1·08, 1·18 for non-Hispanic Black; 1·05, 95 % CI 1·01, 1·10 for non-Hispanic Asian; 1·06, 95 % CI 1·02, 1·10 for Hispanic) or used tobacco (1·04, 95 % CI 1·01, 1·08). The RR was lower in those with overweight v. healthy weight (0·97, 95 % CI 0·95, 1·0). Only 16·2 % reported n-3 supplement use, which was more common among individuals with a higher age and education, a lower BMI, and fish consumption (RR 1·5, 95 % CI 1·23, 1·82 for twice-weekly v. never).

One-quarter of participants in this large nationwide dataset rarely or never consumed fish during pregnancy, and n-3 supplement use was uncommon, even among those who did not consume fish.

Identifying neuroimaging biomarkers of antidepressant response may help guide treatment decisions and advance precision medicine.

To examine the relationship between anhedonia and functional neurocircuitry in key reward processing brain regions in people with major depressive disorder receiving aripiprazole adjunct therapy with escitalopram.

Data were collected as part of the CAN-BIND-1 study. Participants experiencing a current major depressive episode received escitalopram for 8 weeks; escitalopram non-responders received adjunct aripiprazole for an additional 8 weeks. Functional magnetic resonance imaging (on weeks 0 and 8) and clinical assessment of anhedonia (on weeks 0, 8 and 16) were completed. Seed-based correlational analysis was employed to examine the relationship between baseline resting-state functional connectivity (rsFC), using the nucleus accumbens (NAc) and anterior cingulate cortex (ACC) as key regions of interest, and change in anhedonia severity after adjunct aripiprazole.

Anhedonia severity significantly improved after treatment with adjunct aripiprazole.

There was a positive correlation between anhedonia improvement and rsFC between the ACC and posterior cingulate cortex, ACC and posterior praecuneus, and NAc and posterior praecuneus. There was a negative correlation between anhedonia improvement and rsFC between the ACC and anterior praecuneus and NAc and anterior praecuneus.

Eight weeks of aripiprazole, adjunct to escitalopram, was associated with improved anhedonia symptoms. Changes in functional connectivity between key reward regions were associated with anhedonia improvement, suggesting aripiprazole may be an effective treatment for individuals experiencing reward-related deficits. Future studies are required to replicate our findings and explore their generalisability, using other agents with partial dopamine (D2) agonism and/or serotonin (5-HT2A) antagonism.

To examine patterns of cognitive function among a clinical sample of patients seeking treatment for Post-Acute Sequelae of COVID-19 (PASC).

One hundred nineteen patients each completed a baseline neuropsychological evaluation, including clinical diagnostic interview, cognitive assessments, and a comprehensive battery of self-report questionnaires. Patients had a mean age of 50 years (range:18 to 74, SD=10.1) and a mean of 15.5 years (SD=2.54) of formal education. Patients were primarily female (74%) and of White/Caucasian race (75%). Hierarchical agglomerative clustering was used to partition the data into groups based on cognitive performance. Euclidean distance was used as the similarity measure for the continuous variables and within-cluster variance was minimized using Ward’s method. The optimal number of clusters was determined empirically by fitting models with 1 to 15 clusters, with the best number of clusters selected using the silhouette index. All analyses were conducted using the NbClust package, an R package for determining the relevant number of clusters in a data set.

Clustering yielded two distinct clusters of cognitive performance. Group 1 (n=57) performed worse than Group 2 (n=62) on most cognitive variables (including a brief cognitive screener and tests of attention/working memory, executive function, processing speed, learning and delayed recall). Of note, there were no significant differences between groups on an infection severity scale, hospitalizations/ICU admissions, initial or current COVID-19 symptoms, or prior comorbidities. Groups did not differ in age or gender, but Group 1 had a lower education level than Group 2 (M=14.7, SD=2.45 vs. M=16.2, SD=2.42; p=.001). Group 1 also had significantly more minorities than Group 2 (40% vs. 8%; p<.001). No other demographic differences (income, living arrangement, or marital status) were observed. In comparison to Group 2 patients, Group 1 patients self-reported significantly higher levels of anxiety and depression and functional impairment (Functional Activities Questionnaire: M=11.3, SD=8.33 vs. M=7.65, SD=7.97), perceived stress (Perceived Stress Scale: M=24.7, SD=7.90 vs. M=20.3, SD=7.89), insomnia (Insomnia Severity Index: M=16.0, SD=6.50 vs. M=13.1, SD=6.76), and subjective cognitive functioning (Cognitive Failures Questionnaire: M=58.8, SD=16.9 vs. M=50.3, SD=18.6; p’s<.05).

Findings indicate two predominant subtypes of patients seeking treatment for PASC, with one group presenting as more cognitively impaired and reporting greater levels of anxiety, depression, insomnia, perceived stress, functional limitations, and subjective cognitive impairment. Future directions include follow-up assessments with these patients to determine cognitive trajectories over time and tailoring treatment adjuncts to address mood symptoms, insomnia, functional ability, and lifestyle variables. Understanding mechanisms of differences in cognitive and affective symptoms is needed in future work. Limitations to the study were that patients were referred for evaluation based on the complaint of “brain fog” and the sample was a homogenous, highly educated, younger group of individuals who experienced generally mild COVID-19 course.

To assess how well national sentinel lists of the most frequently consumed foods in each food group capture data at subnational levels to measure minimum diet diversity (MDD).

We analysed data from seven surveys with 24-h open dietary recalls to evaluate: (1) the percentage of reported foods that were included in each sentinel food list; (2) whether these lists captured consumption of some food groups better than others and (3) differences between estimates of dietary diversity calculated from all food items mentioned in the open 24-h recall v. only food items included in the sentinel lists.

Seven subnational areas: Bangladesh (2), Benin, Colombia, Kenya, Malawi and Nepal.

8094 women 15–49 years; 4588 children 6–23 months.

National sentinel food lists captured most foods reportedly consumed by women (84 %) and children (86 %). Food groups with the highest variability were ‘other fruits’ and ‘other vegetables.’ MDD calculated from the sentinel list was, on average, 6·5 (women) and 4·1 (children) percentage points lower than when calculated from open 24-h recalls, with a statistically significant difference in most subnational areas.

National sentinel food lists can provide reliable data at subnational levels for most food groups, with some variability by country and sub-region. Assessing the accuracy of national sentinel food lists, especially for fruits and vegetables, before using them at the subnational level could avoid potentially underestimating dietary diversity and provide more accurate local information for programmes, policy and research.