Course of Stress during the Neonatal Intensive Care Unit Stay in Preterm Infants

<b><i>Introduction:</i></b> Understanding the course of stress during the neonatal intensive care unit stay may provide targets for interventions. Our aim was to describe the course of stress in preterm infants during the first 28 days of life, the influence of gestational age, and associations with clinical characteristics. <b><i>Methods:</i></b> In a single centre prospective cohort study, we included infants with a gestational age &#x3c;30 weeks and/or birth weight &#x3c;1,000 g. We measured stress over the first 28 days using the Neonatal Infant Stressor Scale (NISS). We plotted daily NISS total and subcategory scores by gestational age. The subcategories were (1) nursing, (2) skin-breaking, (3) monitoring and imaging, and (4) medical morbidity-related scores. We assessed associations of cumulative NISS scores over the first 7, 14, and 28 days with clinical characteristics using regression analyses. <b><i>Results:</i></b> We included 45 infants, with a median gestational age of 27 weeks. The mean daily NISS score was 66.5 (SD 8.7), with highest scores in the first 7 days of life. Scores decreased the slowest for the lowest gestational ages, in particular for nursing scores, rather than skin-breaking, monitoring and imaging, and medical morbidity-related scores. Adjusted for gestational age, infants with lower Apgar scores, sepsis, intraventricular haemorrhages, and on mechanical ventilation had significantly higher cumulative NISS scores at 7, 14, and 28 days. <b><i>Conclusion:</i></b> NISS scores varied greatly within infants and over time, with the highest mean scores in the first week after birth. The course of declining NISS scores in the first 28 days depended on gestational age at birth.

Clinical Science Can Address Rising Eating Disorder Psychopathology during the Covid-19 Pandemic: Comment on Gruber et al., 2020

Eating disorders (EDs) are serious psychiatric disorders that affect 13-18% of young men and women. EDs are associated with substantial psychiatric and medical morbidity and mortality, indicating a critical need for improved identification and treatment. Despite the relatively high prevalence and severity of EDs, they are often omitted from discussions of mental health. This comment is in response to Gruber et al. (2020), who wrote an important article on the challenges and opportunities facing clinical scientists in the time of COVID-19. Our response article extends Gruber et al.’s (2020) paper by noting additional challenges facing people with an eating disorder during COVID-19 and recognizing opportunities for improved evidence-based assessment and treatment of this important population.

Cardiovascular Risk Factors and Screening Modalities in Firefighters

Within the field of primary care, preventative medicine represents a novel approach to medical care that promotes health and well-being while simultaneously attempting to prevent disease, disability and death. Cardiovascular disease is one of the leading causes of medical morbidity and mortality in the United States. Certain lifestyle factors have been linked to increased risk of cardiovascular disease and, as such, are topics of focus for the prevention of cardiovascular disease. Various studies show that firefighters have an increased risk for premature cardiovascular disease compared to the general public. Risk assessment remains a paramount focus for the family physician so screening modalities are needed that accurately depict each patient’s risk without performing unnecessary testing. Specific testing modalities that should be considered are coronary artery calcium scoring, carotid artery ultrasound and EKG assessment.

Cortisol and Racial Health Disparities Affecting Black Men in Later Life: Evidence From MIDUS II

In the United States, Black men have poorer overall health and shorter life spans than most other racial/ethnic groups of men, largely attributable to chronic health conditions. Dysregulated patterns of daily cortisol, an indicator of hypothalamic–pituitary–adrenal (HPA) axis stress–response functioning, are linked to poor health outcomes. Questions remain regarding whether and how cortisol contributes to Black–White differences in men’s health. This exploratory study compared early day changes in cortisol levels (diurnal cortisol slopes from peak to pre-lunch levels) and their associations with medical morbidity (number of chronic medical conditions) and psychological distress (Negative Affect Scale) among 695 Black and White male participants in the National Survey of Midlife in the United States (MIDUS II, 2004–2009). Black men exhibited blunted cortisol slopes relative to White men (−.15 vs. −.21, t = −2.97, p = .004). Cortisol slopes were associated with medical morbidity among Black men ( b = .050, t = 3.85, p < .001), but not White men, and were unrelated to psychological distress in both groups. Findings indicate cortisol may contribute to racial health disparities among men through two pathways, including the novel finding that Black men may be more vulnerable to some negative health outcomes linked to cortisol. Further, results suggest that while cortisol may be a mechanism of physical health outcomes and disparities among older men, it may be less important for their emotional health. This study increases understanding of how race and male sex intersect to affect not only men’s lived experiences but also their biological processes to contribute to racial health disparities among men in later life.

A rare case of polyembolokoilamania of nose in a neuropsychiatry patient

<p class="abstract">Nasal foreign body is common in children. In adults it is common among mentally retarded, psychiatric patients or is iatrogenic. As most of foreign body in a neuropsychiatry patient goes unnoticed, by the time the patient reaches the surgeon, it will be associated with its complications. So we as doctors should have this in back of mind when we examine a psychiatry or a mentally retarded patient and thorough clinical examination should be done irrespective of the patient’s complaints. We encountered a 25 year old male psychiatric patient presented with complaints of fullness and pain in both ears for three days. The patient had drug abused to cannabis, nicotine, alcohol and inhaling fevibond for four years. On examination bilateral tympanic membrane was intact with no signs of bleeding. Throat was clinically normal. Anterior rhinoscopy visualised a blackish hard mass with a yellowish green mucopurulent discharge in both the nasal cavity. On removal there were multiple variant foreign bodies and a large septal perforation in anterior aspect of septum was visualised. In psychiatry patients, there is a risk of foreign body insertions. This is a great challenge from clinical examination, diagnosing, removal to treating complications if any. Timely detection and prompt treatment will reduce medical morbidity. In this report we try to emphasize the importance of meticulous clinical examination in a psychiatric patient.</p><p> </p>

Childhood maltreatment and adult medical morbidity in mood disorders: comparison of unipolar depression with bipolar disorder

BackgroundThe medical burden in mood disorders is high; various factors are thought to drive this pattern. Little research has examined the role of childhood maltreatment and its effects on medical morbidity in adulthood among people with unipolar depression and bipolar disorder.AimsThis is the first study to explore the association between childhood maltreatment and medical morbidity in bipolar disorder and in unipolar depression, and examine whether the impact of abuse and neglect are distinct or combined.MethodThe participants consisted of 354 psychiatrically healthy controls, 248 participants with recurrent unipolar depression and 72 with bipolar disorder. Participants completed the Childhood Trauma Questionnaire and received a validated medical history interview.ResultsAny type of childhood maltreatment, child abuse and child neglect were significantly associated with the medical burden in bipolar disorder, but not unipolar depression or for controls. These associations worked in a dose–response fashion where participants with bipolar disorder with a history of two or more types of childhood maltreatment had the highest odds of having a medical illness relative to those without such history or those who reported one form. No such significant dose–response patterns were detected for participants with unipolar depression or controls.ConclusionsThese findings suggest that childhood maltreatment may play a stronger role in the development of medical illnesses in individuals with bipolar disorder relative to those with unipolar depression. Individuals who had been maltreated with a mood disorder, especially bipolar disorder may benefit most from prevention and intervention efforts surrounding physical health.Declaration of interestNone.