Subcortical brain volume, regional cortical thickness, and cortical surface area across disorders: findings from the ENIGMA ADHD, ASD, and OCD Working Groups

Objective Attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and obsessive-compulsive disorder (OCD) are common neurodevelopmental disorders that frequently co-occur. We aimed to directly compare all three disorders. The ENIGMA consortium is ideally positioned to investigate structural brain alterations across these disorders. Methods Structural T1-weighted whole-brain MRI of controls (n=5,827) and patients with ADHD (n=2,271), ASD (n=1,777), and OCD (n=2,323) from 151 cohorts worldwide were analyzed using standardized processing protocols. We examined subcortical volume, cortical thickness and surface area differences within a mega-analytical framework, pooling measures extracted from each cohort. Analyses were performed separately for children, adolescents, and adults using linear mixed-effects models adjusting for age, sex and site (and ICV for subcortical and surface area measures). Results We found no shared alterations among all three disorders, while shared alterations between any two disorders did not survive multiple comparisons correction. Children with ADHD compared to those with OCD had smaller hippocampal volumes, possibly influenced by IQ. Children and adolescents with ADHD also had smaller ICV than controls and those with OCD or ASD. Adults with ASD showed thicker frontal cortices compared to adult controls and other clinical groups. No OCD-specific alterations across different age-groups and surface area alterations among all disorders in childhood and adulthood were observed. Conclusion Our findings suggest robust but subtle alterations across different age-groups among ADHD, ASD, and OCD. ADHD-specific ICV and hippocampal alterations in children and adolescents, and ASD-specific cortical thickness alterations in the frontal cortex in adults support previous work emphasizing neurodevelopmental alterations in these disorders

Mindfulness based stress reduction for medical students: optimising student satisfaction and engagement

Background: Medical practitioners and students are at increased risk of a number of personal and psychological problems. Stress and anxiety due to work-load and study requirements are common and self-care methods are important in maintaining well-being. The current study examines perceptions of and satisfaction ratings with a mindfulness based stress reduction (MBSR) programme for 1st year (compulsory) and 2nd year (optional) Graduate Entry Medical School students. Methods: A mixed method pre and post study of Year 1 (n = 140) and Year 2 (n = 88) medical students completing a 7 week MBSR course compared student satisfaction ratings. Thematic analysis of feedback from the students on their perception of the course was also carried out. Results: Year 1 students (compulsory course) were less satisfied with content and learning outcomes than Year 2 students (optional course) (p < .0005). Thematic analysis of year 1 student feedback identified themes including great concept, poorly executed; and less discussion, more practice. Year 2 themes included session environment and satisfaction with tutors. Conclusions: The MBSR course was associated with high levels of satisfaction and positive feedback when delivered on an optional basis. Catering for the individual needs of the participant and promoting a safe environment are core elements of a successful self-care programme

Additional file 1: Figure S1. of Mindfulness based stress reduction for medical students: optimising student satisfaction and engagement

Qualitative Feedback Questionnaire. Open ended feedback questionnaire. (DOCX 69 kb

Additional file 2: Practice Points. of Mindfulness based stress reduction for medical students: optimising student satisfaction and engagement

List of practice points relevant to the study. (DOCX 51 kb

Enhancing acute stroke services: quality improvement project

Background In a busy stroke centre in Ireland, care for acute stroke was provided by a mixture of general physicians. In acute ischaemic stroke, speed is essential for good outcomes. Aim To improve acute stroke services and decrease doorto- needle (DTN) time to less than 60 min by December 2016 in patients with acute ischaemic stroke who are eligible for intravenous thrombolysis. Design: A quality improvement (QI) project was undertaken in a 438 bed, acute, university hospital. Methods Mixture of qualitative and quantitative data collected. A process map and driver diagram were created. Interventions tested with Plan-Do-Study-Act cycles. Times compared between July and December 2015, January and July 2016, July and December 2016, when a new stroke team and pathway were introduced. Results Between July and December 2015, the total number of ischaemic strokes was 216. 17 were thrombolysed (7.8%). Median door-to-CT (DTCT) time was 36 min (range 21–88). Median DTN time was 99 min (range 52–239). Between July and December 2016, there were 214 ischaemic strokes. 29 were thrombolysed (13.5%). 9 were seen directly by the stroke team during normal hours. With stroke team involvement, median DTCT time was 34 min (range 14–60) and DTN time was 43.5 min (range 24–65). Conclusions This project led to a significant and sustained improvement in acute stroke care in our hospital with the use of quality improvement techniques. A comprehensive protocol, recurrent and ongoing staff education, and good communication helped to mitigate delays and further enhance care provided to patients presenting with stroke. The approach described may be valuable to the improvement of other services.

Developing a core outcome set for childhood obesity prevention: a systematic review

Synthesis of effects of infant feeding interventions to prevent childhood obesity is limited by outcome measurement and reporting heterogeneity. Core outcome sets (COSs) represent standardised approaches to outcome selection and reporting. The aim of this review is to identify feeding outcomes used in infant feeding studies to inform an infant feeding COS for obesity prevention interventions. The databases EMBASE, Medline, CINAHL, CENTRAL, and PsycINFO searched from inception to February 2017. Studies eligible for inclusion must examine any infant feeding outcome in children ≤1 year. Feeding outcomes include those measured using self‐report and/or observational methods and include dietary intake, parent–child interaction, and parental beliefs, among others. Data were extracted using a standardised data extraction form. Outcomes were assigned to outcome domains using an inductive, iterative process with a multidisciplinary team. We identified 82 unique outcomes, representing nine outcome domains. Outcome domains were “breast and formula feeding,” “introduction of solids,” “parent feeding practices and styles,” “parent knowledge and beliefs,” “practical feeding,” “food environment,” “dietary intake,” “perceptions of infant behaviour and preferences,” and “child weight outcomes.” Heterogeneity in definition and frequency of outcomes was noted in reviewed studies. “Introduction of solids” (59.5%) and “breastfeeding duration” (55.5%) were the most frequently reported outcomes. Infant feeding studies focus predominantly on consumption of milks and solids and infant weight. Less focus is given to modifiable parental and environmental factors. An infant feeding COS can minimise heterogeneity in selection and reporting of infant feeding outcomes for childhood obesity prevention interventions.ACCEPTEDpeer-reviewe

Development of an infant feeding core outcome set for childhood obesity interventions: study protocol

Background: Childhood obesity is a significant public health challenge that affects approximately one in five children worldwide. Infant feeding practices are implicated in the aetiology of childhood obesity. Infant feeding interventions for childhood obesity are increasingly popular but outcome reporting is inconsistent across trials. Lack of standardisation limits examination of intervention effects and mechanisms of change. The aim of the current project is to develop a core set of infant feeding outcomes for children &amp;lt;= 1 year old, to be evaluated in childhood obesity intervention trials. Methods: This project will use similar methodology to previous core outcome development research. An infant feeding core outcome set (COS) will be developed in four stages: (1) a systematic review of the literature, (2) discussion and clarification of outcomes in a meeting involving multiple stakeholder perspectives, (3) prioritisation of outcomes using the Delphi technique with an expert panel of stakeholders, and (4) achieving consensus on the COS using the nominal group technique (NGT) consensus meeting. An online Delphi survey will be conducted following the NGT meeting to prioritise outcomes identified in the systematic review. An NGT meeting will be conducted with groups of health professionals, non-clinician researchers, and parents of infants &amp;lt;= 1 year old, to achieve final consensus on the infant feeding COS. Discussion: This study aims to develop a core outcome set of infant feeding outcomes for randomised infant feeding studies to prevent childhood obesity. This research will improve examination and syntheses of the outcomes of such studies to prevent and reduce childhood obesity

Development of an infant feeding core outcome set for childhood obesity interventions: study protocol

Background: Childhood obesity is a significant public health challenge that affects approximately one in five children worldwide. Infant feeding practices are implicated in the aetiology of childhood obesity. Infant feeding interventions for childhood obesity are increasingly popular but outcome reporting is inconsistent across trials. Lack of standardisation limits examination of intervention effects and mechanisms of change. The aim of the current project is to develop a core set of infant feeding outcomes for children &amp;lt;= 1 year old, to be evaluated in childhood obesity intervention trials. Methods: This project will use similar methodology to previous core outcome development research. An infant feeding core outcome set (COS) will be developed in four stages: (1) a systematic review of the literature, (2) discussion and clarification of outcomes in a meeting involving multiple stakeholder perspectives, (3) prioritisation of outcomes using the Delphi technique with an expert panel of stakeholders, and (4) achieving consensus on the COS using the nominal group technique (NGT) consensus meeting. An online Delphi survey will be conducted following the NGT meeting to prioritise outcomes identified in the systematic review. An NGT meeting will be conducted with groups of health professionals, non-clinician researchers, and parents of infants &amp;lt;= 1 year old, to achieve final consensus on the infant feeding COS. Discussion: This study aims to develop a core outcome set of infant feeding outcomes for randomised infant feeding studies to prevent childhood obesity. This research will improve examination and syntheses of the outcomes of such studies to prevent and reduce childhood obesity

Keratin 9 Is Required for the Structural Integrity and Terminal Differentiation of the Palmoplantar Epidermis

Keratin 9 (K9) is a type I intermediate filament protein whose expression is confined to the suprabasal layers of the palmoplantar epidermis. Although mutations in the K9 gene are known to cause epidermolytic palmoplantar keratoderma, a rare dominant-negative skin disorder, its functional significance is poorly understood. To gain insight into the physical requirement and importance of K9, we generated K9-deficient (Krt9−/−) mice. Here, we report that adult Krt9−/−mice develop calluses marked by hyperpigmentation that are exclusively localized to the stress-bearing footpads. Histological, immunohistochemical, and immunoblot analyses of these regions revealed hyperproliferation, impaired terminal differentiation, and abnormal expression of keratins K5, K14, and K2. Furthermore, the absence of K9 induces the stress-activated keratins K6 and K16. Importantly, mice heterozygous for the K9-null allele (Krt9+/−) show neither an overt nor histological phenotype, demonstrating that one Krt9 allele is sufficient for the developing normal palmoplantar epidermis. Together, our data demonstrate that complete ablation of K9 is not tolerable in vivo and that K9 is required for terminal differentiation and maintaining the mechanical integrity of palmoplantar epidermis

Using the COM-B framework to elucidate facilitators and barriers to COVID-19 vaccine uptake in pregnant women: a qualitative study

Abstract Since April 2021, COVID-19 vaccines have been recommended for pregnant women. Despite this, COVID-19 vaccine uptake in this group is low compared to the non-pregnant population of childbearing age. Our aim was to understand barriers and facilitators to COVID-19 vaccine uptake among pregnant women in Northern Ireland using the COM-B framework, and so to make recommendations for public health interventions. The COM-B proposes that human behaviour is influenced by the extent to which a person has the capability, opportunity, and motivation to enact that behaviour. Understanding the factors underpinning behaviour through this lens helps discern what needs to change to change behaviour, therefore supporting the development of targeted interventions. This study consisted of eight semi-structured interviews with new/expectant mothers who did not receive a COVID-19 vaccine dose while pregnant since April 2021, and a focus group with five participants who received at least one COVID-19 vaccine dose while pregnant. Interview and focus group data were analysed using semi-deductive reflexive thematic analysis framed by a subtle realist approach. The COM-B was used to categorise codes and subthemes were developed within each COM-B construct. Within Psychological Capability, subthemes captured the need for consistent and reliable COVID-19 vaccine information and access to balanced and jargon-free, risk–benefit information that is tailored to the pregnant individual. The behaviour/opinions of family, friends, and local healthcare providers had a powerful influence on COVID-19 vaccine decisions (Social Opportunity). Integrating the COVID-19 vaccine as part of routine antenatal pathways was believed to support access and sense of familiarity (Physical Opportunity). Participants valued health autonomy, however experienced internal conflict driven by concerns about long-term side effects for their baby (Reflective Motivation). Feelings of fear, lack of empathy from healthcare providers, and anticipated guilt commonly underpinned indecision as to whether to get the vaccine (Automatic Motivation). Our study highlighted that the choice to accept a vaccine during pregnancy generates internal conflict and worry. Several participants cited their concern was primarily around the safety for their baby. Healthcare professionals (HCPs) play a significant part when it comes to decision making about COVID-19 vaccines among pregnant women. HCPs and pregnant women should be involved in the development of interventions to improve the delivery and communication of information