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Terminal delirium is a common occurrence in patients at the end of life, and its presence is widely accepted as a poor prognostic indicator. The hyperactive subtype is characterized by psychomotor agitation that is distressing to patients, caregivers, and providers. The purpose of this study was to determine whether physical, psychosocial, or spiritual data collected at hospice admission are associated with development of hyperactive terminal delirium. In this retrospective cohort study, 154 patients were assigned to one of two cohorts depending on whether or not they had signs of hyperactive terminal delirium. Hospice admission data from the Hospice Item Set, psychosocial assessment, and spiritual assessment were analyzed using descriptive statistics, inferential statistics, and logistic regression. Although there were no statistically significant relationships among the physical, psychosocial, and spiritual variables and hyperactive terminal delirium, there were some findings that are clinically significant for nurses caring for patients at the end of life. Specifically, this study highlights the importance of ongoing physical, psychosocial, and spiritual assessment throughout the end-of-life trajectory, as well as prompt management of symptoms.PURPOSE OF REVIEW Antiamyloid therapy of Alzheimer's disease tackles the overproduction and clearance of the amyloid-beta peptide (Aβ). Immunotherapeutic compounds were tested in large-scale trials. We revisit the recent literature focusing on randomized-controlled trials (RCT) using monoclonal anti-Aβ antibodies. RECENT FINDINGS Forty-three articles on anti-Aβ passive immunotherapy for Alzheimer's disease were published between January 2016 and October 2019 regarding 17 RCTs 13 phase III trials using the monoclonal antibodies bapineuzumab, solanezumab, gantenerumab, crenezumab, and aducanumab; three phase II with crenezumab and aducanumab; and one phase I trial with BAN2401. Studies resulted largely negative considering the effect of the treatment on primary and secondary outcome variables. The incidence of the most important adverse effect, amyloid-related imaging abnormalities (ARIAs) ranged between 0.2 and 22%, in treatment groups. Primary endpoints were not met in eight trials, and five trials were discontinued prior to completion. SUMMARY Passive immunotherapy RCTs failed to show clinically relevant effects in patients with clinically manifest or prodromal dementia. The high incidence of ARIAs indicates that the risk of adverse events may outweigh the benefits of these interventions. Ongoing studies must determine the benefit of such interventions in preclinical Alzheimer's disease, addressing the effect of antiamyloid immunotherapy in samples of asymptomatic carriers of autosomal-dominant mutations related to early-onset Alzheimer's disease.PURPOSE OF REVIEW The association between hallucinations and sensory loss, especially vision- and hearing-impairment, has been firmly established over the past years. The deafferentation theory, a decrease of the threshold for activation in the brain and the consequential imbalance between excitatory and inhibitory brain networks, is hypothesized to underly this relationship. Here we review the studies investigating this theory with a focus on the most recent literature to better understand the contribution of sensory loss to hallucinations. RECENT FINDINGS A large cross-sectional study has recently confirmed the relationship between auditory impairment and deafferentation. However, the underlying mechanisms of deafferentation are still under debate, with hyperexcitability and deviations in bottom-up and top-down processes being the most likely explanations. Social isolation following sensory impairment increases the risk for hallucinations. Better knowledge and awareness about the contribution of deafferentation and loneliness would benefit diagnosis and treatment of hallucinations. SUMMARY Studies imply activity in higher order areas, corresponding to the functional mapping of sensory system, and a general state of higher excitability as neurobiological explanation. Auditory deafferentation, tinnitus and other auditory hallucinations, likely lie on a continuum. Social isolation mediates psychotic symptoms in sensory-impaired individuals. Currently, there is no standard treatment for deafferentation hallucinations.PURPOSE OF REVIEW To provide an update of recent or relevant studies on posttraumatic stress disorder (PTSD) in urban women, with a special focus on biopsychosocial risk factors. RECENT FINDINGS Urbanization itself can increase the risk for PTSD due to the concentration of poverty, substance use and crime. Women are usually at a greater social and economic disadvantage and are victims of collective and domestic violence more often than men. Accordingly, urban women are more exposed to traumatic events that increase the prevalence of PTSD than rural women and both rural and urban men, especially those with lack of social and family protection and support (including refugees) and/or with a history of interpersonal violence. This type of events has sensitizing effects on the PTSD response to other traumatic experiences even if they are of a lesser magnitude, which may reflect women's biological susceptibility to PTSD, and could explain their higher risk of developing chronic PTSD. SUMMARY A complex interaction of biopsychological factors may contribute to the ultra-high-risk for PTSD among urban women. The socially modifiable factors involved highlight the importance of strategies focused on women's social development that could reduce their social suffering and its negative mental health outcomes.PURPOSE OF REVIEW One of the defining trends of population movement in the last half century has been global urbanization. Depression is the most common mental disorder in the world, but it is unclear how urbanization and urban living affect depression outcomes. Grounded in a previously articulated conceptual framework, we systematically reviewed recently published studies on urbanization, urbanicity, and depression. RECENT FINDINGS Eleven articles were included in this review. Four studies found that living in urban areas was associated with elevated odds or more symptoms of depression. Three studies - all done in China - estimated protective effects of urbanization or urbanicity on depression. Two studies concluded no overall clear association. The remaining two articles stratified by urbanicity and found that greenspace was inversely associated with depression in more densely populated areas relative to rural areas. Other themes discussed included global and national trends such as aging, immigration, and planned urbanization in China, as well as urban living conditions such as traffic noise, air pollution, proximity to roadways, neighborhood social capital, and social cohesion. SUMMARY Urbanization may affect depression differentially across geographic regions and income levels. More research is needed, particularly in low-income and middle-income countries, and on intersections between urbanization and other emerging global trends.PURPOSE OF REVIEW This review highlights what current research says about how local beliefs and norms can facilitate expansion of mental healthcare to meet the large unmet need for services in Africa. RECENT FINDINGS In contemporary Africa, religious beliefs exert important influences on mental health as well as the way people with mental illnesses are viewed and cared for. Mental healthcare practices based on traditional and other religious beliefs, and offered by complementary and alternative health providers (CAPs), reflect the people's culture and are often preferentially sought by a majority of the population. Roxadustat Despite important differences in the worldviews of CAPs and biomedical mental healthcare practitioners in regard to causal explanations, there are nevertheless overlaps in the approaches of both sectors to the management of mental health conditions. These overlaps may provide a platform for collaboration and facilitate the scaling-up of evidence-based mental health services to underserved African populations, especially those residing in ever-expanding urban centres. SUMMARY Faith-based mental healthcare is an important but informal component of the mental health system in much of Africa. Collaboration between its practitioners and biomedical practice may help to bridge the large treatment gap for mental health conditions on the continent.BACKGROUND Rates of low-birth weight and prematurity vary 2-fold across states in the United States, with increased rates among states with higher concentrations of racial minorities. Medicaid expansion may serve as a mechanism to reduce geographic variation within states that expanded, by improving health and access to care for vulnerable populations. OBJECTIVE The objective of this study was to identify the association of Medicaid expansion with changes in county-level geographic variation in rates of low-birth weight and preterm births, overall and stratified by race/ethnicity. RESEARCH DESIGN We compared changes in the coefficient of variation and the ratio of the 80th-to-20th percentiles using bootstrap samples (n=1000) of counties drawn separately for all births and for white, black, and Hispanic births, separately. MEASURES County-level rates of low-birth weight and preterm birth. RESULTS Before Medicaid expansion, counties in expansion states were concentrated among quintiles with lower rates of adverse birth outcomes and counties in nonexpansion states were concentrated among quintiles with higher rates. In expansion states, county-level variation, measured by the coefficient of variation, declined for both outcomes among all racial/ethnic categories. In nonexpansion states, geographic variation reduced for both outcomes among Hispanic births and for low-birth weight among white births, but increased for both outcomes among black births. CONCLUSIONS The decrease in county-level variation in adverse birth outcomes among expansion states suggests improved equity in these states. Further reduction in geographic variation will depend largely on policies or interventions that reduce racial disparities in states that did and did not expand Medicaid.BACKGROUND The overlapping human immunodeficiency virus (HIV) and hepatitis C virus (HCV) epidemics disproportionately affect people with substance use disorders. However, many people who use substances remain unaware of their infection(s). OBJECTIVE The objective of this study was to examine the efficacy of an on-site bundled rapid HIV and HCV testing strategy in increasing receipt of both HIV and HCV test results. RESEARCH DESIGN Two-armed randomized controlled trial in substance use disorder treatment programs (SUDTP) in New York City. Participants in the treatment arm were offered bundled rapid HIV and HCV tests with immediate results on-site. Participants in the control arm were offered the standard of care, that is, referrals to on-site or off-site laboratory-based HIV and HCV testing with delayed results. PARTICIPANTS A total of 162 clients with unknown or negative HIV and HCV status. MEASURES The primary outcome was the percentage of participants with self-reported receipt of HIV and HCV test results at 1-month postrandomization.
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