PSYCOGENIC POLYDIPSIA AND SEVERE HYPONATREMIA IN BIPOLAR AFFECTIVE DISORDER.

Psychogenic polydipsia, primary polydipsia or potomania is a disorder of multifactorial etiology which is associated with substantial morbidity and mortality. It occurs frequently in patients with psychiatric diseases, particularly those with schizophrenia, however, it is not exclusive, it has been reported in a lower proportion in patients with anxiety disorders and mood disorders. Although, is still poorly understood and therefore underdiagnosed condition.

Caregiver Use of the Core Components of Technology-Enhanced Helping the Noncompliant Child: A Case Series Analysis of Low-Income Families.

Children from low-income families are more likely to develop early-onset disruptive behavior disorders (DBDs) compared to their higher income counterparts. Low-income families of children with early-onset DBDs, however, are less likely to engage in the standard-of-care treatment, behavioral parent training (BPT), than families from other sociodemographic groups. Preliminary between-group findings suggested technology-enhanced BPT was associated with increased engagement and boosted treatment outcomes for low-income families relative to standard BPT. The current study used a case series design to take this research a step further by examining whether there was variability in use of, and reactions to, the smartphone enhancements within technology-enhanced BPT and the extent to which this variability paralleled treatment outcome. Findings provide a window into the uptake and use of technology-enhanced service delivery methods among low-income families, with implications for the broader field of children's mental health.

Technology-enhanced program for child disruptive behavior disorders: development and pilot randomized control trial.

Early onset disruptive behavior disorders are overrepresented in low-income families; yet these families are less likely to engage in behavioral parent training (BPT) than other groups. This project aimed to develop and pilot test a technology-enhanced version of one evidence-based BPT program, Helping the Noncompliant Child (HNC). The aim was to increase engagement of low-income families and, in turn, child behavior outcomes, with potential cost-savings associated with greater treatment efficiency. Low-income families of 3- to 8-year-old children with clinically significant disruptive behaviors were randomized to and completed standard HNC (n = 8) or Technology-Enhanced HNC (TE-HNC; n = 7). On average, caregivers were 37 years old; 87% were female, and 80% worked at least part-time. More than half (53%) of the youth were boys; the average age of the sample was 5.67 years. All families received the standard HNC program; however, TE-HNC also included the following smartphone enhancements: (a) skills video series, (b) brief daily surveys, (c) text message reminders, (d) video recording home practice, and (e) midweek video calls. TE-HNC yielded larger effect sizes than HNC for all engagement outcomes. Both groups yielded clinically significant improvements in disruptive behavior; however, findings suggest that the greater program engagement associated with TE-HNC boosted child treatment outcome. Further evidence for the boost afforded by the technology is revealed in family responses to postassessment interviews. Finally, cost analysis suggests that TE-HNC families also required fewer sessions than HNC families to complete the program, an efficiency that did not compromise family satisfaction. TE-HNC shows promise as an innovative approach to engaging low-income families in BPT with potential cost-savings and, therefore, merits further investigation on a larger scale.

Neighborhood context and adjustment in African American youths from single mother homes: the intervening role of hopelessness.

African American youths from single mother homes are more likely to live in neighborhoods characterized by greater risk and fewer resources than youth from two parent homes or European American youths; in turn, such adverse conditions are associated with increased adjustment problems. Despite this well-established vulnerability, relatively little is known about variables linking neighborhood context to youth adjustment. With the aim of identifying a potential youth-focused intervening variable amenable to intervention, this study examined the intervening role of hopelessness in the association between neighborhood context and adjustment problems in a sample of 171 African American youths (11-16 year olds) from single mother homes. Findings revealed direct associations between neighborhood context and youth adjustment, as well as indirect associations through youth hopelessness, although findings varied by the marker of neighborhood context (sense of community or perceived crime) and adjustment (internalizing or externalizing problems). Building on prior work noting that hopelessness is amenable to psychosocial intervention, the present findings suggest that hopelessness may afford a valuable target for prevention and intervention programming among African American youths from single mother homes in the context of adverse neighborhood conditions.

Toxicological diagnosis in the critical patient: The challenge

Abstract Introduction: A high percentage of patients who survived poisoning will be transferred to the Intensive Care Unit (ICU) to continue their management in relation to the severity of the poisoning, and possible complications that arise in this scenario. The clinical results will depend on several factors, such as the ingested dose, the characteristics of the substance, the time of medical attention, and the pre-existing state of health of the patient. Objective: To review the clinical behavior of poisonings in the critically ill patient. Recent findings: The data bases that yielded relevant bibliographical results were Web of Sciences, Scopus, PubMed, SciELO, and bibliographic references published between 2012 and 2020 were chosen. Conclusions: The clinical behavior of poisonings in the critically ill patient is atypical. The intensivist must have an in-depth knowledge of the behavior and pathophysiology of the toxins since making a medical diagnosis on the stage of the critically ill patient is challenging. The integration of all possible medical tools is required to achieve this in the absence of clinical history, and the implementation of early management strategies is necessary to reach physiological restoration by using a continuous evaluation approach. The severity of poisoning in the critically ill patient demands interdisciplinary management that includes assessment by Clinical Toxicology.

Examining Parenting in the Neighborhood Context: A Review.

Positive parenting behavior is a robust predictor of child and adolescent psychosocial adjustment; however, contextual factors that relate to parenting itself are not well understood. This limited understanding is, in part, related to the fact that although theories have been put forth to explain the link between ecological context and parenting, there has been little integration of key concepts across these theories or empirical examination to determine their soundness. This review aims to begin to fill this gap by focusing on one contextual influence on parenting in particular, neighborhood context. Specifically, this review utilizes three constructs to provide a framework for integrating and organizing the literature on parenting within the neighborhood context: Danger (capturing crime and concerns for safety), Disadvantage (assessing the absence of institutional and economic resources), and Disengagement (noting the absence of positive social processes in the community). Findings from this review suggest evidence for an association between neighborhood context and positive parenting. Yet these results appear to vary, at least to some extent, depending on which neighborhood construct is examined, the way positive parenting is assessed, and specific sample demographics, including family income and youth gender and age. Findings from this review not only summarize the research to date on neighborhood and parenting, but provide a foundation for future basic and applied work in this area.

Helping the Noncompliant Child: An Assessment of Program Costs and Cost-Effectiveness.

Disruptive behavior disorders (DBD) in children can lead to delinquency in adolescence and antisocial behavior in adulthood. Several evidence-based behavioral parent training (BPT) programs have been created to treat early onset DBD. This paper focuses on one such program, Helping the Noncompliant Child (HNC), and provides detailed cost estimates from a recently completed pilot study for the HNC program. The study also assesses the average cost-effectiveness of the HNC program by combining program cost estimates with data on improvements in child participants' disruptive behavior. The cost and effectiveness estimates are based on implementation of HNC with low-income families. Investigators developed a Microsoft Excel-based costing instrument to collect data from therapists on their time spent delivering the HNC program. The instrument was designed using an activity-based costing approach, where each therapist reported program time by family, by date, and for each skill that the family was working to master. Combining labor and non-labor costs, it is estimated that delivering the HNC program costs an average of $501 per family from a payer perspective. It also costs an average of $13 to improve the Eyberg Child Behavior Inventory intensity score by 1 point for children whose families participated in the HNC pilot program. The cost of delivering the HNC program appears to compare favorably with the costs of similar BPT programs. These cost estimates are the first to be collected systematically and prospectively for HNC. Program managers may use these estimates to plan for the resources needed to fully implement HNC.

Caracterización clínico-epidemiológica de pacientes con fracturas por fragilidad ¿Estamos haciendo las cosas bien? / Clinical and epidemiological characteristics of patients with fragility fractures: Are we doing things right?

Resumen Introducción: la osteoporosis es una enfermedad que se incrementa conforme nuestra población envejece; ésta se asocia a mayor riesgo de fracturas por fragilidad, conllevando a pérdida de la independencia, dolor crónico e incluso la muerte. Con el fin de evitar dichas complicaciones, es importante caracterizar la población con diagnóstico de fractura por fragilidad e identificar si se está realizando un adecuado tamizaje y abordaje del paciente con riesgo o diagnóstico de osteoporosis. Material y métodos: estudio prospectivo realizado en pacientes ingresados con fractura por fragilidad en un hospital de alta complejidad, en el periodo entre marzo-septiembre del 2018. Se realizó una caracterización según variables clínico-sociodemográficas y se aplicó criterios de tamización según diferentes guías con el fin de determinar si se está realizando un adecuado tamizaje y abordaje del paciente con fractura por fragilidad. Resultados: se identificaron 70 pacientes con fracturas por fragilidad, la edad promedio fue de 80.01 ± 10.73 años. Se encontró que 81.43% de los pacientes había sido evaluado por médico general, pero tan sólo 50% había sido educado sobre prevención de caídas. Además, el 97.14%, 95.71% y 90.0% de los pacientes cumplían criterios de tamización para osteoporosis según las guías NOF, ISCD y OSC respectivamente y sólo 11.43% habían sido tamizados. Conclusión: las fracturas por fragilidad son frecuentes en nuestro medio; sin embargo, los tiempos de atención e intervención son lentos y los esfuerzos en prevención tanto primaria como secundaria están siendo insuficientes.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1319).

Abstract Introduction: Osteoporosis is a disease which increases as our population ages. It is associated with a greater risk of fragility fractures, leading to a loss of independence, chronic pain and even death. In order to avoid these complications, it is important to describe the population diagnosed with fragility fractures and determine if patients at risk for or diagnosed with osteoporosis are being screened and managed appropriately. Materials and methods: A prospective study of patients hospitalized due to fragility fractures in a tertiary care hospital from March-September 2018. The patients were described according to clinical and sociodemographic variables, and screening criteria from various guidelines were applied to determine if patients with fragility fractures are being adequately screened and managed. Results: Seventy patients with fragility fractures were identified, with an average age of 80.01 ± 10.73 years. Of these, 81.43% had been seen by a general practitioner, but only 50% had been educated on fall prevention. In addition, 97.14%, 95.71% and 90.0% of these patients met the osteoporosis screening criteria according to the NOF, ISCD and OSC guidelines, respectively, and only 11.43% had been screened. Conclusion: Fragility fractures are common in our setting. However, turnaround times for care and intervention are long and both primary and secondary prevention efforts are currently insufficient.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1319).

The role of coparents in African American single-mother families: the indirect effect of coparent identity on youth psychosocial adjustment.

The majority (67%) of African American youth live in single-parent households, a shift in the family structure that has been linked to increased risk for both internalizing and externalizing problem behaviors. Although the majority of single mothers endorse the assistance of another adult or family member in child rearing, relatively little is known about who is engaged in this nonmarital coparenting role (i.e., grandmother, father/social father, aunt, and female family friend) and how it relates to coparenting quality, maternal parenting, and youth psychosocial outcomes (i.e., internalizing and externalizing problems). This question, which is critical to the advancement of family focused programming for youth in these families, is addressed in this study. The participants examined in the current study were 159 African American single-mother child dyads. Adolescents' maternal grandmothers constituted the largest proportion of coparents in the sample (37.2%), followed by the mothers' female family friends (22.5%), adolescents' maternal aunts (12.7%), and adolescents' fathers/social fathers (11%). Differences emerged among groups of coparents in support and conflict with the mother. Specifically, grandmothers, aunts, and female family friends provided significantly more instrumental support than fathers. Furthermore, grandmothers and fathers had more conflict with the mother, both generally and specifically in front of the child, than aunts or female family friends. In turn, these differences were associated directly and indirectly through maternal parenting with internalizing and externalizing problems. Clinical implications and future directions are discussed.

Harnessing innovative technologies to advance children's mental health: behavioral parent training as an example.

Disruptive behaviors of childhood are among the most common reasons for referral of children to mental health professionals. Behavioral parent training (BPT) is the most efficacious intervention for these problem behaviors, yet BPT is substantially underutilized beyond university research and clinic settings. With the aim of addressing this research-to-practice gap, this article highlights the considerable, but largely unrealized, potential for technology to overcome the two most pressing challenges hindering the diffusion of BPT: (1). The dearth of BPT training and supervision opportunities for therapists who work with families of children with disruptive behaviors; and (2). The failure to engage and retain families in BPT services when services are available. To this end, this review presents a theoretical framework to guide technological innovations in BPT and highlights examples of how technology is currently being harnessed to overcome these challenges. This review also discusses recommendations for using technology as a delivery vehicle to further advance the field of BPT and the potential implications of technological innovations in BPT for other areas of children's mental health are discussed.

Youth Externalizing Problems in African American Single Mother Families: A Culturally-Relevant Model.

African American youth, particularly those from single mother homes, are more likely to evidence externalizing problems than European American youth and youth from two parent homes; however, relatively little empirical attention has been devoted to identifying the contextual variables associated with externalizing problems within this at-risk group. Accordingly, this study examined the family as a context for youth externalizing problems among 194 African American single mother-youth dyads. Findings demonstrated that higher levels of mother-coparent conflict were associated directly, as well as indirectly via compromises in coparent (but not maternal) warmth, with youth externalizing problems. The spillover from mother-coparent conflict to coparent warmth to child externalizing problems did not vary depending upon family income. Findings suggest that prevention and intervention programs targeting African American youth from single mother homes may be strengthened with greater attention to variability in family processes, as well as a more sensitive assessment of which adults are centrally involved in childrearing.