Youth with spina bifida (SB) are at increased risk of neuropsychological deficits, including executive dysfunction and inattention. While these deficits are well-documented cross-sectionally, little research has considered the development of these difficulties longitudinally. The limited research on executive dysfunction over time in youth with SB has been mixed, with some studies suggesting stable, elevated executive dysfunction (Tarazi et al., 2008) and others demonstrating improvements in inhibition and shifting in particular (Zabel et al., 2011). In contrast, no research has examined inattention over time in SB. Understanding the development of these constructs is critical for early identification of dysfunction and intervention development. This study thus aims to characterize the development of executive dysfunction and inattention in youth with SB.

One hundred forty youth with SB were recruited as part of a larger, longitudinal study. Mothers, fathers, and teachers of participants (Time 1: Myouth age = 11.4 years, 53.6% female) completed questionnaire-based measures of executive dysfunction (Behavior Rating Inventory of Executive Function, BRIEF; inhibit, shift, working memory, plan/organize subscales) and inattention (Swanson, Nolan, and Pehlam Teacher and Parent Rating Scale - Fourth Edition, SNAP-IV). Data were collected over five time points occurring at two-year intervals. Growth curves were estimated using linear mixed effects models to estimate development over time.

Difficulties with inhibition decreased across age in youth with SB according to mother, father, and teacher reports (p=.000-.007). Mother and father reports of shifting problems decreased across age (p=.009), while teacher reports showed no significant change (p=.799). Working memory problems also significantly decreased over time, but only according to fathers and teachers (p=.004-.005). Difficulties with planning/organizing remained stable across age for all reporters (p=.076-.935). With regards to inattention, symptoms decreased across age according to mothers and teachers (p=.000-.017), but not fathers.

Overall, inhibition, shifting, and inattention improved across age in this sample of youth with SB according to at least two reporters. Contrary to existing literature, working memory also improved over time in this sample. Planning/organizing was the only area of executive functioning that remained stable over time across reporters. These results support previous findings of improvements in behavioral regulation (i.e., inhibition, shifting), and stable, elevated planning/organizing difficulties. These findings also highlight the importance of considering different contexts and reporters’ perspectives when examining change over time. Predictors of the development of executive dysfunction and inattention should be considered, as this information may aid with increased understanding of neuropsychological function in SB and identifying which individuals may be most likely to benefit from early intervention. Examining predictors may also help explain differences in working memory development demonstrated in the current study compared to extant literature.

Most students in MD-PhD programs take a leave of absence from medical school to complete PhD training, which promotes a natural loss of clinical skills and knowledge and could negatively impact a student’s long-term clinical knowledge. To address this concern, clinical refresher courses in the final year of PhD training have traditionally been used; however, effectiveness of such courses versus a longitudinal clinical course spanning all PhD training years is unclear.

The University of Alabama at Birmingham MD-PhD Program implemented a comprehensive continuing clinical education (CCE) course spanning PhD training years that features three course components: (1) clinical skills; (2) clinical knowledge; and (3) specialty exposure activities. To evaluate course effectiveness, data from an anonymous student survey completed at the end of each semester were analyzed.

Five hundred and ninety-seven surveys were completed by MD-PhD students from fall 2014 to 2022. Survey responses indicated that the majority of students found the course helpful to: maintain clinical skills and knowledge (544/597, 91% and 559/597, 94%; respectively), gain exposure to clinical specialties (568/597, 95%), and prepare them for responsibilities during clinical clerkships. During semesters following lockdowns from the COVID-19 pandemic, there were significant drops in students’ perceived preparedness.

Positive student survey feedback and improved preparedness to return to clinic after development of the course suggests the CCE course is a useful approach to maintain clinical knowledge during research training.

The increasing global burden of mental disorders has led to rising demand for mental healthcare services. Effective resource management is essential to ensure safe and timely access to care. Electronic health records (EHRs) provide a real-time source of data on clinical presentation and prognostic factors that could be harnessed to provide clinicians with actionable insights to prioritise mental healthcare delivery. We describe the development and evaluation of MaST, an EHR data visualisation tool that provides information to clinicians on risk of mental health crisis defined as an admission to a psychiatric hospital or acceptance into a community crisis service.

(i) To develop an EHR-data driven risk prediction tool for risk of crisis. (ii) To evaluate predictive performance in a real-world clinical setting.

The risk of crisis algorithm was developed and evaluated with EHR data from six UK NHS mental health providers using Ordered Predictor List propensity scores grouped into 5 quintiles. The predictor variables were clinical and sociodemographic factors including previous mental health service contacts.

Data from 2,620 patients contributed to algorithm development which was subsequently tested on data from 107,879 patients. The risk of crisis algorithm performed well with an overall accuracy for predicting the greatest risk of crisis (top quintile) ranging from 64% to 80%.

The MaST algorithm accurately predicted risk of mental health crisis in UK community mental health services. EHR data visualisation tools can provide actionable insights to clinicians to prioritise mental healthcare delivery in real-world clinical practice.

This study was funded in full by Holmusk.

Reading difficulties are one of the most significant challenges for children with neurofibromatosis type 1 (NF1). The aims of this study were to identify and categorize the types of reading impairments experienced by children with NF1 and to establish predictors of poor reading in this population.

Children aged 7–12 years with NF1 (n = 60) were compared with typically developing children (n = 36). Poor word readers with NF1 were classified according to impairment type (i.e., phonological, surface, mixed), and their reading subskills were compared. A hierarchical multiple regression was conducted to identify predictors of word reading.

Compared to controls, children with NF1 demonstrated significantly poorer literacy abilities. Of the 49 children with NF1 classified as poor readers, 20 (41%) were classified with phonological dyslexia, 24 (49%) with mixed dyslexia, and 5 (10%) fell outside classification categories. Children with mixed dyslexia displayed the most severe reading impairments. Stronger working memory, better receptive language, and fewer inattentive behaviors predicted better word reading skills.

The majority of children with NF1 experience deficits in key reading skills which are essential for them to become successful readers. Weaknesses in working memory, receptive language, and attention are associated with reading difficulties in children with NF1.

Cigarette smoking is strongly associated with major depressive disorder (MDD). However, any genetic etiology of such comorbidity and causal relations is poorly understood, especially at the genome-wide level.

In the present in silico research, we analyzed summary data from the genome-wide association study of the Psychiatric Genetic Consortium for MDD (n = 191 005) and UK Biobank for smoking (n = 337 030) by using various biostatistical methods including Bayesian colocalization analysis, LD score regression, variant effect size correlation analysis, and Mendelian randomization (MR).

By adopting a gene prioritization approach, we identified 43 genes shared by MDD and smoking, which were significantly enriched in membrane potential, gamma-aminobutyric acid receptor activity, and retrograde endocannabinoid signaling pathways, indicating that the comorbid mechanisms are involved in the neurotransmitter system. According to linkage disequilibrium score regression, we found a strong positive correlation between MDD and current smoking (rg = 0.365; p = 7.23 × 10−25) and a negative correlation between MDD and former smoking (rg = −0.298; p = 1.59 × 10−24). MR analysis suggested that genetic liability for depression increased smoking.

These findings inform the concomitant conditions of MDD and smoking and support the use of self-medication with smoking to counteract depression.

Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.

Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.

Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) < 0.01]. The structure of EPDS responses significantly differed between Europe and the USA (∆*CFI > 0.01), but not between European countries (∆*CFI < 0.01).

Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.

Papillary microcarcinoma of the thyroid has been described as either a normal variant or a serious malignancy. We describe our experience with papillary microcarcinoma and lymph node metastases.

A total of 685 consecutive total thyroidectomies with central compartment neck dissection were reviewed for papillary microcarcinoma. Association of central compartment lymph node metastases with age, gender, tumour multifocality, bilaterality and extrathyroidal extension was analysed.

Out of 170 papillary microcarcinoma cases, multifocality was found in 72 (42.4 per cent), bilaterality in 49 (28.8 per cent) and extrathyroidal extension in 16 (9.4 per cent). In all, 23 patients (13.5 per cent) had lymph node metastases. There was a significant association (p < 0.05) between extrathyroidal extension (but no other tumour characteristics) and lymph node metastases.

In all, 13.5 per cent of papillary microcarcinomas in our series showed lymph node metastases. Lymph node metastases were associated with extrathyroidal invasion of the papillary microcarcinoma.