Relationship between the severity of emphysematous change in the lung and morbidity after esophagectomy for esophageal cancer: A retrospective study on a novel strategy for risk prediction.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) prevalence increases post-esophagectomy morbidity. However, the association between COPD severity and post-esophagectomy morbidity remains unclear because of the lack of an objective method to classify COPD severity. Low attenuation volume ratio (LAVR) estimated using Ziostation2 may reflect the extent of emphysematous changes in the lungs and COPD severity, thereby predicting post-esophagectomy morbidity. METHODS: A total of 776 patients who underwent curative McKeown esophagectomy for esophageal cancer between April 2005 and June 2021 were included. The patients were divided into high and low preoperative LAVR groups. Short-term outcomes between the groups were compared for patients who underwent open esophagectomy (OE) and minimally invasive esophagectomy (MIE). RESULTS: A total of 219 (28%) patients were classified into the high LAVR group. High LAVR was significantly associated with disadvantageous patient characteristics such as advanced age, heavy smoking, and impaired respiratory function. Patients with high LAVR had a significantly higher incidence of severe morbidity and pneumonia after OE. High LAVR was an independent risk factor for severe morbidity (odds ratio [OR], 2.52; 95% confidence interval [CI]: 1.237-5.143; p = 0.011) and pneumonia (OR, 2.12; 95% CI: 1.003-4.493; p = 0.049) after OE. Meanwhile, LAVR was not correlated with the incidence of post-MIE morbidity. CONCLUSIONS: LAVR may reflect COPD severity and predict severe morbidity and pneumonia after OE, but not after MIE. Less invasiveness of MIE may alleviate the effects of various disadvantageous backgrounds associated with high LAVR on worse short-term outcomes.

Evaluating the Relationship Between Intimate Partner Violence-Related Training and Mental Health Professionals' Assessment of Relationship Problems.

Intimate partner violence (IPV) is a serious public health problem associated with increased risk of developing mental health conditions. Assessment of IPV in mental health settings is important for appropriate treatment planning and referral; however, lack of training in how to identify and respond to IPV presents a significant barrier to assessment. To address this issue, the World Health Organization (WHO) advanced a series of evidence-based recommendations for IPV-related training programs. This study examines the relationship between mental health professionals' experiences of IPV-related training, including the degree to which their training resembles WHO training recommendations, and their accuracy in correctly identifying relationship problems. Participants were psychologists and psychiatrists (N = 321) from 24 countries who agreed to participate in an online survey in French, Japanese, or Spanish. They responded to questions regarding their IPV-related training (i.e., components and hours of training) and rated the presence or absence of clinically significant relationship problems and maltreatment (RPM) and mental disorders across four case vignettes. Participants who received IPV-related training, and whose training was more recent and more closely resembled WHO training recommendations, were more likely than those without training to accurately identify RPM when it was present. Clinicians regardless of IPV-related training were equally likely to misclassify normative couple issues as clinically significant RPM. Findings suggest that IPV-related training assists clinicians in making more accurate assessments of patients presenting with clinically significant relationship problems, including IPV. These data inform recommendations for IPV-related training programs and suggest that training should be repeated, multicomponent, and include experiential training exercises, and guidelines for distinguishing normative relationship problems from clinically significant RPM.

Global Collaborative Team Performance for the Revision of the International Classification of Diseases: A Case Study of the World Health Organization Field Studies Coordination Group.

Background/Objective: Collaborative teamwork in global mental health presents unique challenges, including the formation and management of international teams composed of multicultural and multilingual professionals with different backgrounds in terms of their training, scientific expertise, and life experience. The purpose of the study was to analyze the performance of the World Health Organization (WHO) Field Studies Coordination Group (FSCG) using an input-processes-output (IPO) team science model to better understand the team's challenges, limitations, and successes in developing the eleventh revision of the International Classification of Diseases (ICD). Method: We thematically analyzed a collection of written texts, including FSCG documents and open-ended qualitative questionnaires, according to the conceptualization of the input-processes-output model of team performance. Results: The FSCG leadership and its members experienced and overcame numerous barriers to become an effective international team and to successfully achieve the goals set forth by WHO. Conclusions: Research is necessary regarding global mental health collaboration to understand and facilitate international collaborations with the goal of contributing to a deeper understanding of mental health and to reduce the global burden of mental disorders around the world.

Antecedentes/Objetivo: El trabajo de equipo colaborativo en salud mental global presenta retos particulares, incluyendo la formación y el control de grupos internacionales integrados por profesionales multilingües y multiculturales con diferentes antecedentes en términos de entrenamiento, competencias científicas y experiencias vitales. El propósito del estudio fue analizar el funcionamiento del Grupo de Coordinación de Estudios de Campo (GCEC) de la Organización Mundial de la Salud (OMS) utilizando un modelo científico de entrada-proceso-salida (EPS) para mejorar la comprensión de los retos, limitaciones y logros del equipo en el desarrollo de la onceava revisión de la Clasificación Internacional de Enfermedades (CIE). Método: Se llevó a cabo un análisis temático de una colección de textos, incluyendo documentos del GCEC y cuestionarios cualitativos de preguntas abiertas, acordes con la conceptualización del modelo de rendimiento de equipos de entrada-proceso-salida. Resultados: El liderazgo y los miembros del GCEC experimentaron y superaron numerosas barreras para convertirse en un grupo internacional efectivo y lograr exitosamente los objetivos establecidos por la OMS. Conclusiones: Se requiere de investigación sobre la colaboración en salud mental global a fin de entender y facilitar las colaboraciones internacionales dirigidas a comprender a profundidad la salud mental y reducir la carga de los trastornos mentales en el mundo.

Categories that should be removed from mental disorders classifications: perspectives and rationales of clinicians from eight countries.

OBJECTIVE: To explore the rationales of mental health professionals (mainly psychiatrists and psychologists) from 8 countries for removing specific diagnostic categories from mental disorders classification systems. METHOD: As part of a larger study, 505 participants indicated which of 60 major disorders should be omitted from mental disorders classification systems and provided rationales. Rationale statements were analyzed using inductive content analysis. RESULTS: The majority of clinicians (60.4%) indicated that 1 or more disorders should be removed. The most common rationales were (a) problematic boundaries between normal and psychopathological conditions (45.9% of total removal recommendations), (b) problematic boundaries among mental disorders (25.4%), and (c) problematic boundaries between mental and physical disorders (24.0%). The categories most frequently recommended for deletion were gender identity disorder, sexual dysfunction, and paraphilias, usually because clinicians viewed these categories as being based on stigmatization of a way of being and behaving. A range of neurocognitive disorders were described as better conceptualized as nonpsychiatric medical conditions. Results were analyzed by country and country income level. Although gender identity disorder was the category most frequently recommended for removal overall, clinicians from Spain, India, and Mexico were most likely to do so and clinicians from Nigeria and Japan least likely, probably because of social and systemic factors that vary by country. Systematic differences in removal rationales by country income level may be related to the development, structure, and functioning of health systems. CONCLUSION: Implications for development and dissemination of the classification of mental and behavioral disorders in WHO's ICD-11 are discussed.