Impact of language proficiency on mental health service use, treatment and outcomes: "Lost in Translation"

Background Mastery of a language is bound to place of origin; low language proficiency is thus related to migration and cultural differences, all of which influence access to mental health care, treatment and outcomes. Switzerland, being multilingual, allows the disentangling of language proficiency from migration and, to some extent, culture. This study uses propensity score matching to explore how language proficiency relates to help-seeking behaviour, service use, treatment and outcomes in patients with mental health disorders. Methods We used the first admission of patients admitted to and discharged from an academic psychiatric hospital in Switzerland between January 1st, 2013 and December 31st, 2019, with an observation period of one-year post-discharge (until December 31st, 2020). We paired 2101 patients with low language proficiency to 2101 language proficient patients, balancing baseline sociodemographic and clinical characteristics using propensity score matching. Results Patients with low language proficiency had a higher probability of compulsory admission (OR: 1.79, 99%CI: 1.60–2.02); which remained after adjustment for confounders (OR: 1.51; 99%CI: 1.21–1.89). Whilst in treatment, they had higher rates of compulsory medication (OR: 1.73, 99%CI: 1.16–2.59) and seclusion/restraint (OR: 1.87, 99%CI: 1.25–2.79). Furthermore, patients initially admitted voluntarily had a higher probability of being compulsorily retained (OR: 1.74, 99%CI: 1.24–2.46). Both groups showed similar clinical improvement rates and service use parameters. Conclusions Our results demonstrate that low language proficiency constitutes a risk factor for coercive measures throughout hospitalisation. The results demonstrate the need for an increase in language sensitivity in psychiatric care

Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: “From Dusk Till Dawn”

Introduction: Day and time of admission influence treatment outcomes and prognosis in several medical specialties; this seems related to resources' ability. It is largely unknown whether this also applies to mental health services. We investigate the relationship between time of admission, patients' demographic and clinical profile, and treatment outcomes. Methods: Demographic and clinical profiles of admitted and discharged patients to a general psychiatric ward between January 1st, 2013 and December 31st, 2020, were analyzed. In addition, we used the last year (i.e., 2020) to monitor rehospitalization. Time of admission was defined as weekdays (working day, weekend) and dayshifts (daytime, dusk, and dawn). Results: During the study period, 12,449 patient admissions occurred. The mean age of the sample was 48.05 ± 20.90 years, with 49.32% (n = 6,140) females. Most admissions (n = 10,542, 84%) occurred on working days. Two-fifths of admissions (39.7%, n = 4,950) were compulsory, with a higher rate outside daytime hours. Patients had slight differences in the clinical profile, resulting from evaluating the different items of the Health of Nation Outcome Scale (HoNOS). Patients admitted on night shifts, weekends, and holidays showed a shorter length of stay; patients compulsorily admitted during daytime (disregarding the day of the week) had a longer length of stay. All patient groups achieved a robust clinical improvement (i.e., an HoNOS score reduction of around 50%), with similar readmission rates. Discussion: The main finding of our study is the relationship between "daytime hours" and fewer compulsory admissions, a result of the interplay between demographics, clinical characteristics, and out-of-clinic service availability (such as ambulatory psychiatric- psychological praxis; day-clinic; home-treatment). The differing clinical profile, in turn, determines differences in treatment selection, with patients admitted after office hours experiencing a higher rate of coercive measures. The shorter length of stay for out-of-office admissions might result from the hospitalization as an intervention. These results should encourage the implementation of outpatient crisis-intervention services, available from dusk till dawn. Keywords: coercive measures; day and time of admission; help-seeking behavior; psychiatric outcomes; service use

Genetic and Epigenetic Factors in Risk and Susceptibility for Childhood Asthma

Asthma is a common respiratory disease that affects people of all ages, characterized by considerable heterogeneity in age, clinical presentation, genetics, epigenetics, environmental factors, treatment response, and prognostic outcomes. Asthma affects more than 330 million people worldwide, of which 33% are children under 14 years, and 27% are adults whose first symptoms occurred in childhood. However, the genetic and epigenetic mechanisms of childhood allergic diseases and asthma are still not fully understood. Here, we conducted a biomedical narrative review of genes associated with the risk, severity, and susceptibility of childhood asthma since it differs from asthma in adults regarding their pathophysiology, development, and outcomes. We also systematized the available information on epigenetic changes associated with childhood asthma

Intravenous Immunoglobulins: Mode of Action and Indications in Autoimmune and Inflammatory Dermatoses

Intravenous immunoglobulins (IVIGs), a mixture of variable amounts of proteins (albumin, IgG, IgM, IgA, and IgE antibodies), as well as salt, sugar, solvents, and detergents, are successfully used to treat a variety of dermatological disorders. For decades, IVIGs have been administered for treatment of infectious diseases and immune deficiencies, since they contain natural antibodies that represent a first-line defense against pathogens. Today their indication has expanded, including the off-label therapy for a variety of autoimmune and inflammatory diseases. In dermatology, IVIGs are administered for treatment of different disorders at different therapeutic regimens, mostly with higher doses then those administered for treatment of infectious diseases. The aim of this prospective review is to highlight the indications, effectiveness, side effects, and perspectives of the systemic treatment with IVIGs for patients with severe, life-threatening, and resistant to conventional therapies autoimmune or inflammatory dermatoses

In Silico Probiogenomic Characterization of <i>Lactobacillus delbrueckii</i> subsp. <i>lactis</i> A4 Strain Isolated from an Armenian Honeybee Gut

A Lactobacillus delbrueckii ssp. lactis strain named A4, isolated from the gut of an Armenian honeybee, was subjected to a probiogenomic characterization because of its unusual origin. A whole-genome sequencing was performed, and the bioinformatic analysis of its genome revealed a reduction in the genome size and the number of the genes—a process typical for the adaptation to endosymbiotic conditions. Further analysis of the genome revealed that Lactobacillus delbrueckii ssp. lactis strain named A4 could play the role of a probiotic endosymbiont because of the presence of intact genetic sequences determining antioxidant properties, exopolysaccharides synthesis, adhesion properties, and biofilm formation, as well as an antagonistic activity against some pathogens which is not due to pH or bacteriocins production. Additionally, the genomic analysis revealed significant potential for stress tolerance, such as extreme pH, osmotic stress, and high temperature. To our knowledge, this is the first report of a potentially endosymbiotic Lactobacillus delbrueckii ssp. lactis strain adapted to and playing beneficial roles for its host

Clinical and Laboratory Manifestation of Gastrointestinal Involvement in MIS-C: A Single-Center Observational Study

Background: Digestive symptoms and gastrointestinal issues in children with coronavirus 2019 disease (COVID-19) and Multisystem Inflammatory Syndrome in Children (MIS-C) are commonly reported in pediatric studies from different countries. Our retrospective observational study aimed to summarize the main digestive symptoms and objective data on gastrointestinal involvement in children with MIS-C. Methods: We present the clinical, laboratory, and imaging data of 51 children with MIS-C hospitalized in a single center from 25 November 2020 to 24 April 2021, focusing on gastrointestinal involvement. Results: A total of 46/51 children (90.2%) reported at least one abdominal symptom (abdominal pain (86%, N = 44), vomiting, nausea, diarrhea), predominantly at presentation. Most children were older than 5 years (N = 40, 78%), predominated by the male sex (N = 37, 72.5%), and with a mean age of 8.82 ± 4.16 years. We found a tendency for lymphopenia, neutrophilia, and higher levels of CRP, d-dimer, and ferritin in MIS-C patients with abdominal pain (R-squared 0.188, F-statistic vs. constant model: 11.9, p-value = 0.00122, 20% explanation of variation with p = 0.001). We found a statistically significant linear relationship (regression) between neutrophile percentage (NEU%) and hospital stay and a tendency for elevated transaminases to be more frequent in older children (27.3% under 5 years and 65% over 5 years; p = 0.0583). We found no significant associations between digestive symptoms and age or the predominant SARS-CoV-2 variant. Conclusions: Most of our MIS-C patients presented with abdominal pain, usually along with other GI symptoms, which could be applied in clinical practice to MIS-C in children visiting the emergency room with abdominal pain and evidence of recent COVID-19 contact or infection. Further information from larger cohorts of MIS-C patients is needed to better understand the epidemiology of gastrointestinal involvement in these patients

Endothelial Dysfunction and Pregnant COVID-19 Patients with Thrombophilia: A Narrative Review

Pregnancy with SARS-CoV-2 infection can raise the risk of many complications, including severe COVID-19 and maternal–fetal adverse outcomes. Additionally, endothelial damage occurs as a result of direct SARS-CoV-2 infection, as well as immune system, cardiovascular, and thrombo-inflammatory reactions. In this narrative review, we focus on endothelial dysfunction (ED) in pregnancy, associated with obstetric complications, such as preeclampsia, fetal growth retardation, gestational diabetes, etc., and SARS-CoV-2 infection in pregnant women that can cause ED itself and overlap with other pregnancy complications. We also discuss some shared mechanisms of SARS-CoV-2 pathophysiology and ED