Low- and middle-income countries (LMICs) bear a disproportionate burden of mental illness, with limited access to biomedical care. This study examined pathways to care for psychosis in rural Uganda, exploring factors influencing treatment choices.

We conducted a mixed-methods study in Buyende District, Uganda, involving 67 in-depth interviews and 4 focus group discussions (data collection continued until thematic saturation was reached) with individuals with psychotic disorders, family members, and local leaders. Structured questionnaires were administered to 41 individuals with psychotic disorders.

Three main themes emerged: (1) Positive attitudes towards biomedical providers, (2) Barriers to accessing biomedical care (3) Perceived etiologies of mental illness that influenced care-seeking behaviors. While 81% of participants eventually accessed biomedical care, the median time to first biomedical contact was 52 days, compared to 7 days for any care modality.

Despite a preference for biomedical care, structural barriers and diverse illness perceptions led many to seek pluralistic care pathways. Enhancing access to biomedical services and integrating traditional and faith healers could improve mental health outcomes in rural Uganda.

While previous research has repeatedly indicated that greater BMI was associated with reduced cognitive performance, emerging literature on BMI and cognition in late life (age 65 and above) shows conflicting results. Recent studies (Luchsinger et al., 2013; Arvanitakis, Capuano, Bennett, & Barnes, 2018) have found that high BMI was associated with improved processing speed and verbal memory performance in older adults, but further research is needed to examine this relationship across additional aspects of cognition. The current study aims to build upon recent literature by exploring the relationship between BMI and four cognitive domains across the adult age span.

Adults between the ages of 25-84 (n=217) were recruited for the Loma Linda University Healthy Avocado Trial study. Participants had a mean age of 49.61 (SD=13.13), mean education of 14.66 years (SD=2.44), and a mean BMI of 33.87 (SD=5.48). Cognition was measured using a two-hour neurocognitive battery divided into four discrete domains: attention/working memory (Digit Span, Auditory Consonant Trigrams), processing speed (Trail Making Test Part A, Stroop Color, Stroop Word, Symbol Digit Modalities Test), executive function (FAS/Phonemic Fluency, Stroop Word-Color, Trail Making Test Part B), and learning/memory (Rey Auditory Verbal Learning Test [RAVLT], Brief Visuospatial Memory Test-Revised [BVMT-R]). Individual test scores were standardized around the sample means and standard deviations, and cognitive domain scores were calculated as an average of the relevant standardized scores; a global cognition score represents the average of tests across all four domains. Participants were divided into three age groups (25-40, 41-60, and 61-84). Correlational analyses were performed between BMI and cognitive domain scores within each age group, while controlling for age, sex, and education.

No significant correlations were observed between BMI and any of the cognitive domains among adults aged 25-40 and 41-60. Among adults aged 61-84, a significant association was found between BMI and learning and memory (r=0.390, p=0.011). An examination of individual subtests within the domain revealed significant positive correlations between BMI and RAVLT short delay recall (r=0.338, p=0.029) and long delay recall (r=0.353, p=0.022), and between BMI and BVMT-R immediate- (r=0.351, p=0.023) and delayed recall (r=0.332, p=0.032). A trend for the association between BMI on global cognition was also observed in the oldest age group (r=0.275, p=0.078). No significant associations were observed between BMI and the domains of attention/working memory, processing speed, or executive function.

No significant associations were observed between BMI and cognitive performance among young- and middle-aged adults. However, among older adults aged 6184, higher BMI was associated with higher scores on both verbal and nonverbal learning & memory. These findings support the 'obesity paradox,' suggesting that increased BMI may be protective for elderly adults. Multiple explanations for this relationship have been proposed, including the role of BMI in the body’s inflammatory response system, as well as observations of dementia-related weight loss. Further research is needed to determine whether BMI has a protective benefit, or if it is simply a clinical marker of underlying disease.

We developed the Shell Game Task (SGT) as a novel Performance Validity Test (PVT). While most PVTs use a forced-choice paradigm with “memory” as the primary domain being assessed, the SGT is a face-valid measure of attention and working memory. We explored the accuracy of the SGT to detect noncredible performance using a simulatordesign study.

Ninety-four university students were randomly assigned to either best effort (CON) (n=49) or simulating traumatic brain injury (TBI) (SIM) (n=45) conditions. Participants completed a full battery of neuropsychological tests to simulate an actual evaluation, including the Test of Memory Malingering (TOMM) and the SGT. The SGT involves three cups and a red ball shown on the screen. Participants watch as the ball is placed under one of the three cups. Cups are then shuffled. Participants are asked to track the cup that contains the ball and correctly identify its location. We created two difficulty levels (easy vs hard, 20 trials each) by changing the number of times the cups were shuffled. Participants were given feedback (correct vs incorrect) after each trial. At the conclusion of the study, participants were asked about adherence to study directions they were given.

Participants with missing data (CON=1; SIM=2) or who reported non-adherence to study directions (CON=2; SIM=1) were removed from analyses. Twenty-five percent in SIM and 0% in CON failed TOMM

Trial 2 (<45) suggesting adequate manipulation of groups. Groups were not different in age, gender, ethnicity, or education (all p’s>.05). There were 9 participants in each group with concussion/TBI history. TBI history was not significantly related to performance on the SGT in either group, although participants with TBI history tended to do better. Average performances on TOMM Trial 1 (36.62 vs 47.91, p<.001) and TOMM Trial 2 (37.50 vs 49.71, p<.001) were significantly lower in the SIM group. Performance on SGT was also significantly lower in the SIM group across SGT Total Correct (20.17 vs 24.65 of 40, p=.008), SGT Easy (10.60 vs 13.52 of 20, p=.002), and SGT Hard (9.57 vs 11.13 of 20, p=.068). Mixed ANOVA showed a trend towards significant group by SGT difficulty interaction (F(1,86)=3.41, p=.052, np2=.043). There was steeper decline in performance on SGT Hard compared to SGT Easy for CON. ROC analyses suggested adequate but not ideal sensitivity/specificity: scores <8 on SGT Easy (sensitivity=26%; false positive=11%), <7 on SGT Hard (sensitivity=26%; false positive=7%), and <15 on SGT Total (sensitivity=24%; false positive=9%).

These preliminary data indicate the SGT may be able to detect malingered TBI. However, additional development of this measure is necessary. Further refinement of difficulty level may improve sensitivity/specificity (e.g., CON mean performance for SGT Easy trails was 13.52, suggesting the items may be too difficult). This study was limited to an online administration due to COVID, which could have affected results; future studies should test inperson administration of the SGT. In addition, performance in clinical control groups (larger samples of individuals with mild TBI, ADHD) should be tested to better determine specificity for these preliminary cutoffs.

One common concern amongst the aging population is that of worsening memory. Speed of processing and executive functions are also areas of age-related decline that affect daily living. Lifestyle modifications such as diet, exercise, and sleep have garnered intense interest as potential methods to prevent or delay cognitive decline. Among dietary factors, omega-3 fatty acids (FAs) have been documented as containing a myriad of health benefits, including neuroprotective effects. The aim of this study is to examine the associations between omega-3 FAs, cognitive function, and neuroanatomical regions of interest in a healthy aging population.

Adults aged 65 and older (n=40, 48.9% Female) were recruited for the Loma Linda University Adventist Health Study-2 Cognitive and Neuroimaging Substudy. Participants had a mean age of 76.25 years (SD=8.29), 16.78 years of education (SD=2.53), and were predominantly White (85.0%). Participants received a two-hour neurocognitive battery, including measures of immediate and delayed memory (Rey Auditory Verbal Learning Test, RAVLT; WMS-IV Logical Memory, LM), processing speed (Stroop), and executive functions (Stroop Color/Word). Participants underwent brain imaging on a 3T Siemens MRI, including a 3D T1-weighted MPRAGE sequence. Cortical reconstruction and volumetric segmentation were performed using FreeSurfer software. Blood samples were collected for fatty acid analysis. Individual FAs were expressed as a percent of total FAs. An omega-3 index was constructed as the sum of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) FAs. Correlational analyses, controlling for age, sex, and education, investigated relationships between omega-3 levels (individual and index) and (a) cognitive function (immediate and delayed memory, processing speed, executive functions), and (b) brain volumes in specific regions of interest (hippocampus, entorhinal cortex, frontal pole, white matter).

EPA was significantly positively correlated with Stroop Color (r=.34, p=.048). Although not statistically significant, trends were observed between the omega-3 index and Stroop Color (r=.30, p=.08), and between both DHA and the omega-3 index with RAVLT – delayed recall (r=.29, p=.095; r=.30, p=.08, respectively). With regards to regional brain volumes, EPA and the omega-3 index were both significantly positively correlated with the entorhinal cortex (r=.34, p=.041; r=.41, p=.01, respectively) and white matter volume (r=.36, p=.028; r=.34, p=.038, respectively). DHA was significantly positively correlated with white matter volume (r=.34, p=.044).

Blood levels of EPA were positively correlated with a measure of processing speed, and trends were observed between DHA, the omega-3 index and[GN1] verbal memory, and between the omega-3 index and processing speed. We also found that omega-3 FA values were associated with greater brain volume in the entorhinal cortex and white matter in our sample of healthy older adults. Atrophy of the entorhinal cortex has been associated with pathological processes. Additionally, white matter is known to effect processing speed. These findings may offer support for the idea that omega-3 FAs exert their neuroprotective effects by fortifying areas of the brain, specifically the entorhinal cortex and white matter, that promote maintenance of cognitive function in late life.

There has been a surge in individuals seeking neuropsychological assessment for attention-deficit/hyperactivity disorder (ADHD) after watching social media created by people claiming to have ADHD. While online content may promote destigmatization of ADHD, self-diagnoses derived from social media use may contribute to the development of inaccurate illness beliefs. Individuals who feel strongly connected to social media that mentions personal anecdotes of ADHD might be more likely to believe they also have ADHD. We examined associations between social media search for ADHD and beliefs about everyday experiences being diagnostic of ADHD among adults concerned about having ADHD, as compared to a control group.

A cross-sectional online study included 320 university students (Mage=19.56±2.92; 72% female; 81% White) without history of ADHD. Participants who reported concern about having ADHD, with (n=43) or without other psychological history (n=73) rated whether 100 experiences taken from social media were diagnostic of ADHD, and then rated the amount of time they spent on social media searching for ADHD content. They then rated how often they personally experienced the symptoms. Participants who reported no concern about having ADHD (n=184) only rated how often they personally experienced the symptoms.

Social media search for ADHD was related to total number of experiences believed to be diagnostic of ADHD among participants concerned about having ADHD without psychological history (r=.28, p=.03), but not for those with psychological history (r=.09, p=.57). For participants concerned about having ADHD (regardless of psychological history), social media search for ADHD was related to total number of symptoms personally experienced (rs=.48-.56, ps<.001) and to the number of symptoms endorsed at a clinical level (rs=.48, ps<.001). Total number of experiences believed to be diagnostic of ADHD was related to the number of symptoms personally experienced among participants concerned about having ADHD with psychological history (r=.53, p<.001; clinical level .47, p=.002), but not for those without psychological history (r=.14, p=.31; clinical level .19, p=.15). Of the 100 symptoms, 56 were believed to be diagnostic of ADHD by at least 50% of participants concerned about having ADHD. Of the 56, 43 were personally experienced at a clinical level by controls. For the 13 remaining symptoms not endorsed at a clinical level by controls, symptoms believed to be diagnostic of ADHD was related to symptoms personally experienced among participants concerned about having ADHD with psychological history (r=.53, p<.001; clinical level .52, p<.001), but not for those without psychological history (r=.14, p=.30; clinical level .19, p=.15).

Greater social media search for ADHD is related to higher symptom report among individuals concerned about having ADHD regardless of psychological history. However, individuals concerned about having ADHD without psychological history who engage in greater social media use appear to be more likely to believe that general symptoms are specifically due to ADHD. These individuals may be more prone to misattribute symptoms to ADHD. Nearly 77% of symptoms rated as diagnostic of ADHD were frequently experienced by individuals without concern about having ADHD, which demonstrates the high base rate of ADHD-like symptoms in the general population.

Long-term exposure to the psychoactive ingredient in cannabis, delta-9-tetrahydrocanabinol (THC), has been consistently raised as a notable risk factor for schizophrenia. Additionally, cannabis is frequently used as a coping mechanism for individuals diagnosed with schizophrenia. Cannabis use in schizophrenia has been associated with greater severity of psychotic symptoms, non-compliance with medication, and increased relapse rates. Neuropsychological changes have also been implicated in long-term cannabis use and the course of illness of schizophrenia. However, the impact of co-occurring cannabis use in individuals with schizophrenia on cognitive functioning is less thoroughly explored. The purpose of this meta-analysis was to examine whether neuropsychological test performance and symptoms in schizophrenia differ as a function of THC use status. A second aim of this study was to examine whether symptom severity moderates the relationship between THC use and cognitive test performance among people with schizophrenia.

Peer-reviewed articles comparing schizophrenia with and without cannabis use disorder (SZ SUD+; SZ SUD-) were selected from three scholarly databases; Ovid, Google Scholar, and PubMed. The following search terms were applied to yield studies for inclusion: neuropsychology, cognition, cognitive, THC, cannabis, marijuana, and schizophrenia. 11 articles containing data on psychotic symptoms and neurocognition, with SZ SUD+ and SZ SUD- groups, were included in the final analyses. Six domains of neurocognition were identified across included articles (Processing Speed, Attention, Working Memory, Verbal Learning Memory, and Reasoning and Problem Solving). Positive and negative symptom data was derived from eligible studies consisting of the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), Self-Evaluation of Negative Symptoms (SNS), Brief Psychiatric Rating Scale (BPRS), and Structured Clinical Interview for DSM Disorders (SCID) scores. Meta analysis and meta-regression was conducted using R.

No statistically significant differences were observed between SZ SUD+ and SZ SUD-across the cognitive domains of Processing Speed, Attention, Working Memory, Verbal Learning Memory, and Reasoning and Problem Solving. Positive symptom severity was found to moderate the relationship between THC use and processing speed, but not negative symptoms. Positive and negative symptom severity did not significantly moderate the relationship between THC use and the other cognitive domains.

Positive symptoms moderated the relationship between cannabis use and processing speed among people with schizophrenia. The reasons for this are unclear, and require further exploration. Additional investigation is warranted to better understand the impact of THC use on other tests of neuropsychological performance and symptoms in schizophrenia.

To assess the proportion of inpatients who received guideline-concordant antibiotics for community-acquired bacterial pneumonia (CABP) in special populations of the All of Us database.

CABP contributes significantly to healthcare burden worldwide. The American Thoracic Society and Infectious Disease Society of America jointly published guidelines for the treatment of CABP. Guideline-concordant antibiotics for CABP are associated with better patient and cost outcomes.

This was a retrospective cohort study of patients with pneumonia (n = 1608; SNOMED 233604007) from 10/1/2018 to 1/01/22 in the All of Us database. Cases were excluded for treatment setting other than inpatient, prior (within 90 days) pneumonia, receipt of intravenous antibiotics, respiratory isolation of methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa, and/or other non-community-acquired types of pneumonia. Patients were grouped based on patient age, sex, race, and ethnicity. The proportion of patients on guideline-concordant therapy was compared within groups using chi-square statistics. Significant associations were assessed using multivariate logistic regression models.

A total of 1608 cases were included, and 45% of these patients received guideline-concordant antibiotics. Non-Hispanic White (NHW) patients vs. Black patients were associated with a 36% higher likelihood for receiving guideline-concordant antibiotics (adjusted OR, 1.36; 95% CI 1.02–1.81), whereas NHW vs. Hispanic patients were associated with a 34% lower likelihood for receiving guideline-concordant antibiotics (aOR 0.66; 0.48–0.91).

Black patients with CABP in the All of Us database were less likely to receive guideline-concordant antibiotics, and Hispanic patients were more likely to receive guideline-concordant antibiotics, than NHW patients.

To characterize antifungal prescribing patterns, including the indication for antifungal use, in hospitalized children across the United States.

We analyzed antifungal prescribing data from 32 hospitals that participated in the SHARPS Antibiotic Resistance, Prescribing, and Efficacy among Children (SHARPEC) study, a cross-sectional point-prevalence survey conducted between June 2016 and December 2017.

Inpatients aged <18 years with an active systemic antifungal order were included in the analysis. We classified antifungal prescribing by indication (ie, prophylaxis, empiric, targeted), and we compared the proportion of patients in each category based on patient and antifungal characteristics.

Among 34,927 surveyed patients, 2,095 (6%) received at least 1 systemic antifungal and there were 2,207 antifungal prescriptions. Most patients had an underlying oncology or bone marrow transplant diagnosis (57%) or were premature (13%). The most prescribed antifungal was fluconazole (48%) and the most common indication for antifungal use was prophylaxis (64%). Of 2,095 patients receiving antifungals, 79 (4%) were prescribed >1 antifungal, most often as targeted therapy (48%). The antifungal prescribing rate ranged from 13.6 to 131.2 antifungals per 1,000 patients across hospitals (P < .001).

Most antifungal use in hospitalized children was for prophylaxis, and the rate of antifungal prescribing varied significantly across hospitals. Potential targets for antifungal stewardship efforts include high-risk, high-utilization populations, such as oncology and bone marrow transplant patients, and specific patterns of utilization, including prophylactic and combination antifungal therapy.