Mood and anxiety disorders are heterogeneous conditions with variable course. Knowledge on latent classes and transitions between these classes over time based on longitudinal disorder status information provides insight into clustering of meaningful groups with different disease prognosis.

Data of all four waves of the Netherlands Mental Health Survey and Incidence Study-2 were used, a representative population-based study of adults (mean duration between two successive waves = 3 years; N at T0 = 6646; T1 = 5303; T2 = 4618; T3 = 4007; this results in a total number of data points: 20 574). Presence of eight mood and anxiety DSM-IV disorders was assessed with the Composite International Diagnostic Interview. Latent class analysis and latent Markov modelling were used.

The best fitting model identified four classes: a healthy class (prevalence: 94.1%), depressed-worried class (3.6%; moderate-to-high proportions of mood disorders and generalized anxiety disorder (GAD)), fear class (1.8%; moderate-to-high proportions of panic and phobia disorders) and high comorbidity class (0.6%). In longitudinal analyses over a three-year period, the minority of those in the depressed-worried and high comorbidity class persisted in their class over time (36.5% and 38.4%, respectively), whereas the majority in the fear class did (67.3%). Suggestive of recovery is switching to the healthy class, this was 39.7% in the depressed-worried class, 12.5% in the fear class and 7.0% in the high comorbidity class.

People with panic or phobia disorders have a considerably more persistent and chronic disease course than those with depressive disorders including GAD. Consequently, they could especially benefit from longer-term monitoring and disease management.

We describe a retrospective assessment of practitioner and patient recruitment strategies, patient retention strategies, and rates for five clinical studies conducted in the National Dental Practice-Based Research Network between 2012 and 2019, and practitioner and patient characteristics associated with retention.

Similar recruitment strategies were adopted in the studies. The characteristics of the practitioners and patients are described. The proportion of patients who either attended a follow-up (FU) assessment or completed an online assessment was calculated. For studies with multiple FU visits or questionnaire assessments, rates for completing each FU were calculated, as were the rates for completing any and for completing all FU assessments. The associations of practitioner and patient characteristics with all clinic FU visits, and with the completion of all assessments for a study were ascertained.

Overall, 591 practitioners and 12,159 patients were included. FU rates by patients for any assessment varied from 91% to 96.5%, and rates for participating in all assessments ranged from 68% to 87%. The mean total number of patients each practitioner recruited was 21 (sd = 15); the mean number per study was 13 (sd = 7). For practitioners, practice type and patient enrollment were associated with greater clinic retention, while only race was associated with their patients completing post-visit online assessments. For patients, age was associated with clinic retention, while female gender, age, race, and education were all associated with greater completion of post-visit online assessments.

The Network efficiently recruited practitioners and patients and achieved high patient retention rates for the five studies.

In the UK, guidance recommends ultrasound scanning alone or in combination with sestamibi scintigraphy to guide surgery in patients with primary hyperparathyroidism. If an adenoma is localised on imaging, this can facilitate targeted or minimally invasive surgery. Surgeon-performed ultrasound scan on the operating table benefits from being performed on an anaesthetised patient with optimal positioning. The aim of this study was to investigate the efficacy of intra-operative, blinded, surgeon-performed ultrasound scan in localisation of parathyroid adenomas.

Prospective data were collected on consecutive patients undergoing surgery for primary hyperparathyroidism at a single tertiary centre from November 2019 to June 2021. Patients underwent blinded, surgeon-performed ultrasound scan under general anaesthesia immediately prior to surgery. Localisation results from pre-operative imaging and surgeon-performed ultrasound scan were then compared with the intra-operative findings.

Forty-nine patients underwent surgery and were found to have single-gland disease. Sestamibi scintigraphy, radiologist-performed ultrasound scan and surgeon-performed ultrasound scan had sensitivities of 59.4, 43.75 and 73.8 per cent, respectively. Surgeon-performed ultrasound scan had a statistically significantly increased sensitivity compared with radiologist-performed ultrasound (p < 0.05).

Intra-operative, surgeon-performed ultrasound scan is effective in localising parathyroid adenomas and may be a useful adjunct to facilitate minimally invasive parathyroid surgery.

Osia is a new, transcutaneous, active bone-conduction implant. This study aimed to compare the BAHA Attract and the first-generation Osia system after BAHA Attract to Osia conversion surgery.

Five patients who had previously used the BAHA Attract system were converted to the first generation of the Osia system. Surgical aspects of the two different systems, audiological performance and subjective opinions of the patients were investigated. Pure tone audiometry and speech audiometry in quiet was performed with each patient's BAHA 5 sound processor on Attract, and the test battery was repeated six weeks after the Attract to Osia conversion and at different time points after the first fitting. Details of the surgery and patients' feedback were analysed.

Audiology tests showed significant improvement when using either system; however, the Osia system performance was better. Based on patient feedback, all the five implantees preferred the Osia system.

The study results suggest that the Osia system is a safe and powerful hearing implant that provides good clinical outcomes.

The continuum of social threat ranges from anxiety to paranoia. Examining the factors that predict and mediate the relationship between social anxiety and persecutory paranoia will help with the development of interventionist-causal theories that can guide the development of new treatments.

To investigate mediators between social anxiety and persecutory paranoia in a prospective cross-cultural analogue sample.

A 3-month follow-up online survey included participants aged ≥18-years-old in Thailand and the UK. Recruitment was via advertisements on websites and social media. Participants completed questionnaires at baseline (T1) and 3-month follow-up (T2) measuring social anxiety, paranoia, depression. Mediators were: stigma; internal and external shame; social rank; self-esteem; and safety behaviours. We used linear regression to examine predictors of paranoia and mediation analysis to test indirect effects. Estimating the indirect effects was calculated by 10,000 bootstrapping bias-corrected 95% confidence intervals.

At follow-up, 186 (70.4%female; mean age 34.9±9.1) Thai and 236 (81.4%female; 35.7±12.7) UK respondents completed the survey. Regarding change scores (T2-T1), higher paranoia was significantly predicted by higher social anxiety and external shame controlling for age, gender, depression. A simple mediation model controlling for depression showed significant indirect effects for external shame (ab=0.06, 95%CI=0.018 to 0.105) and safety behaviours (ab=0.06, 95%CI=0.002 to 0.127). A multiple mediation model found external shame was a significant mediator (ab=0.06, 95%CI=0.020 to 0.110).

These cross-cultural data suggest that external shame may mediate the prospective relationship between social anxiety and paranoia. These data suggest the potential for treatment of persecutory fears and social anxiety in psychosis by targeting shame-related cognitions.

To compare the predictive validity of learning and retention measures from the picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT + IR) for identifying incident mild cognitive impairment (MCI).

Learning was defined by the sum of free recall (FR) and retention by delayed free recall (DFR) tested 15–20 min later. Totally, 1422 Baltimore Longitudinal Study of Aging (BLSA) participants (mean age 69.6 years, 54% male, mean 16.7 years of education) without dementia or MCI received the pFCSRT + IR at baseline and were followed longitudinally. Cox proportional hazards models were used to evaluate the effect of baseline learning and retention on risk of MCI.

In total, 187 participants developed MCI over a median of 8.1 years of follow-up. FR and DFR each predicted incident MCI adjusting for age, sex, and education. Also, each independently predicted incident MCI in the presence of the other with similar effect sizes: around 20% decrease in the hazard of MCI corresponding to one standard deviation increase in FR or DFR.

The practice of preferring retention over learning to predict incident MCI should be reconsidered. The decision to include retention should be guided by time constraints and patient burden.

To evaluate otorhinolaryngological manifestations of coronavirus disease 2019 infection and the time required for their resolution.

A prospective analysis was conducted of coronavirus disease 2019 patients presenting from 1 April 2020 to 30 July 2020. The otorhinolaryngological manifestations were evaluated based on patient history. The time required for symptom resolution was evaluated separately for intensive care unit and non-intensive care unit patients.

A total of 600 patients were included in the study; 13.3 per cent required the intensive care unit and 2.2 per cent expired. The otorhinolaryngological manifestations were: sore throat (88 per cent), fever (78.8 per cent), anosmia or hyposmia (63.6 per cent), ageusia or hypogeusia (63.5 per cent), rhinorrhoea (51.3 per cent), nasal obstruction (33.5 per cent), sneezing (30.3 per cent), and breathing difficulty (18.6 per cent). The time required for symptom resolution was longest for breathing difficulty (23.6 days for intensive care unit and 8.2 days for non-intensive care unit patients).

Otorhinolaryngological symptoms are one of the main presentations of coronavirus disease 2019 infection. The increased prevalence of medical co-morbidities in patients requiring intensive care unit and in deceased patients is also highlighted.

Rate of learning is often cited as a deterrent in the use of endoscopic ear surgery. This study investigated the learning curves of novice surgeons performing simulated ear surgery using either an endoscope or a microscope.

A prospective multi-site clinical research study was conducted. Seventy-two medical students were randomly allocated to the endoscope or microscope group, and performed 10 myringotomy and ventilation tube insertions. Trial times were used to produce learning curves. From these, slope (learning rate) and asymptote (optimal proficiency) were ascertained.

There was no significant difference between the learning curves (p = 0.41). The learning rate value was 68.62 for the microscope group and 78.71 for the endoscope group. The optimal proficiency (seconds) was 32.83 for the microscope group and 27.87 for the endoscope group.

The absence of a significant difference shows that the learning rates of each technique are statistically indistinguishable. This suggests that surgeons are not justified when citing ‘steep learning curve’ in arguments against the use of endoscopes in middle-ear surgery.

To investigate predictors for repetition of suicide attempts 1–12 months after a suicide attempt.

Two hundred and sixteen patients who had made a suicide attempt were investigated after 1 month, and 178 were followed up again after 12 months.

During 1–12 months after the suicide attempt, 30 patients reattempted suicide (repeaters). During 0–1 month 13 patients had reattempted suicide (early repeaters), and nine of them also repeated between 1 and 12 months. Repeaters had more often made three or more attempts before index attempt, they more often were in treatment at the index attempt and at 1 month they had lower global functioning and higher suicide ideation. In a Cox Regression analysis two predictors for repetition between 1 and 12 months remained significant; early repetition (OR 6.7, 95% CI, 3.0–14.9) and having GAF-scores below 49 (median cut-off) (OR 3.4 (95% CI, 1.5–7.5).

Our findings suggest that repetitive behaviour in itself is a strong predictor of future attempts. Strategies focusing on the repetitive behaviour are warranted.

This article presents the long-term results in terms of antipsychotic medication maintenance and factors influencing it in a representative sample of patients with schizophrenia recruited in the SOHO study within Spain.

The SOHO was a prospective, 3-year observational study of the outcomes of schizophrenia treatment in outpatients who initiated therapy or changed to a new antipsychotic performed in 10 European countries with a focus on olanzapine. The Kaplan–Meier method was used to analyse the time to treatment discontinuation and the Cox proportional hazards model to investigate correlates of discontinuation.

In total, 1688 patients were included in the analyses. Medication maintenance at 3 years varied with the antipsychotic prescribed, being highest with clozapine (57.6%, 95% CI 39.2–74.5), followed by olanzapine (48.3%, 95% CI 45.1–51.5); and lowest with quetiapine (19.0%, 95% CI 13.0–26.3). Treatment discontinuation was significantly less frequent with olanzapine than with risperidone (p = 0.015), depot typical (p = 0.001), oral typical antipsychotics (p < 0.001) or quetiapine (p < 0.001); but not than with clozapine (p = 0.309). Longer maintenance was also associated with higher social abilities and better cognitive status at baseline; in contrast, a shorter time to discontinuation was associated with the need for mood stabilisers during follow-up. This study emphasises the different value of antipsychotics in day-to-day clinical practice, as some of them were associated with longer medication maintenance periods than others. This study has some limitations because of possible selection and information biases derived from the non-systematic, non-randomised allocation to treatments and the existence of unobserved covariates that may influence the outcome.

Determining prognostic factors for the probability of tracheostomy decannulation is key to an adequate therapeutic plan.

A retrospective cohort study of 160 paediatric patients undergoing tracheostomy was conducted. Associations between different parameters and eventual tracheostomy decannulation were assessed.

Mean follow-up duration was 27.8 months (interquartile range = 25.5–30.2 months). Median age at tracheostomy was 6.96 months (interquartile range = 3.37–29.42 months), with median tracheostomy maintenance of 14.5 months (interquartile range = 3.7–21.5 months). The overall tracheostomy decannulation rate was 22.5 per cent. Factors associated with a higher probability of tracheostomy decannulation included age at tracheostomy (hazard ratio = 1.11, 95 per cent confidence interval = 1.03–1.18) and post-intubation laryngitis as an indication for tracheostomy (hazard ratio = 2.25, 95 per cent confidence interval = 1.09–4.62). Neurological (hazard ratio = 0.30, 95 per cent confidence interval = 0.12–0.80) and pulmonary (hazard ratio = 0.41, 95 per cent confidence interval = 0.18–0.91) co-morbidities were negatively associated with tracheostomy decannulation. The probability of tracheostomy decannulation decreased significantly with increasing numbers of co-morbidities (p < 0.001).

Age, post-intubation laryngitis, and number and type of co-morbidities influence tracheostomy decannulation rate in the paediatric population.