Psychosocial experiences of selected pediatric occupational therapists in the Philippines on the shift to Telehealth Practice during the COVID-19 pandemic

BACKGROUND@#At the beginning of the COVID-19 pandemic, healthcare professionals including pediatric occupational therapists (OTs) mandatorily had to shift to the practice of telehealth in the absence of a safe in- person setup caused by the outbreak.@*OBJECTIVE@#This study aims to determine the psychosocial experiences encountered by selected pediatric OTs in the Philippines brought by the shift to telehealth practice during the COVID-19 pandemic@*METHODOLOGY@#Purposive sampling was used in the study to gather six (6) licensed pediatric OTs who provide occupational therapy (OT) services via telehealth in the Philippines, and the respondents were not personally connected to any of the researchers. A semi-structured one-on-one interview with the participants through a Zoom call was conducted to obtain their psychosocial experiences. A thematic analysis was used and four (4) themes emerged by the end of the study: consequences of the shift to telehealth practice, changes during telehealth provision, increased resilience, and increased psychological strain.@*CONCLUSION@#In conclusion, the transition to provision of telehealth services to pediatric clients has challenged the practices of the selected pediatric OTs in terms of preparing for the session, where one of the main prevalent concerns was toward collaboration and communication with the caregivers; conducting of telehealth sessions, where communication interruption was one of the main concerns; and in ethical considerations, where OTs made it a point that they rectified ethical dilemmas amidst telehealth provision. These experienced challenges also included increased workload and psychological distress, while improved occupational balance and adaptability were most commonly experienced by OTs

Antibiotics in the times of COVID 19’- A Mixed-Methods study among patients attending OPD of an Urban Health Centre of West Bengal

Introduction: Antibiotic Resistance has become a global threat attributable to the overuse and misuse of Antibiotics and exacerbated by the ongoing COVID19 pandemic. Objective: Present Mixed Methods study, envisages finding out the knowledge and practice regarding Antibiotic usage and exploring changes if any brought about due to the pandemic among patients attending OPD of an Urban Health Centre in Kolkata. Method: Study was conducted from May to July 2021, in the urban field practice area of the institute. The quantitative component was evaluated by interviewing 200 patients using a pretested questionnaire and the Qualitative component was evaluated up to the point of data saturation in 3 FGDs. SPSS was used to analyze the Quantitative component, while the Qualitative component was analyzed thematically. Results: Among the 200 participants, self-medication with Antibiotics was seen in 74.0%; 26.0% had satisfactory Knowledge regarding Antibiotics and their use, whereas only 19.5% had satisfactory Practice regarding the same. Education and Health Literacy Score were significant predictors associated with unsatisfactory Knowledge and Practice regarding Antibiotic usage patterns. Economic constraints, Lack of transportation during the lockdown, and fear of institutional quarantine were some of the major factors which further contributed to Antibiotic misuse during the COVID19 pandemic. Conclusion: Advocacy for increasing health literacy, overall literacy status, and awareness regarding the perils of Antibiotic Resistance using appropriate IEC by health providers would be beneficial in the long run to prevent Antibiotic resistance. With that said, strict government regulations along with curbing the fallacies in the health system would further aid in making people use Antibiotics wisely.

Thrombus in transit – A case series on dilemma in management

Thrombus in transit (TIT) is a rare but potentially fatal condition. Transthoracic echocardiography is the diagnostic modality of choice. The major complications of TIT are pulmonary embolism, right ventricular dysfunction, obstructive shock, and paradoxical embolism through patent foramen ovale. We hereby present a case series of four patients with TIT and the challenges faced while managing them

Screening extracts of seven edible mushrooms for reduction of regeneration time in the Planarian Dugesia hymanae

Objective@#This study aimed to determine the effect of seven edible mushrooms in the regeneration rate of planarian Dugesia hymanae (D. hymanae). @*Methods@#The ability of D. hymanae to regenerate was used to test extracts of seven mushrooms to reduce regeneration time, using eyespot and tail formations as endpoints. The planarians were amputated and were allowed to heal and regenerate in planarian water (control) and varying concentrations of Crude Ethanolic Extracts (CEE) of the seven edible mushrooms. The CEE with the most significant effect in reducing the regeneration time will be further sub-fractionated into hexane, ethyl acetate, and ethanol solvent extracts. @*Results@#In untreated planarian water, amputated planarians' eyespot and tail formations took 4.65 (SD 0.34) and 4.1 (SD 0.21) days, respectively. The CEE of four mushrooms (Shiitake var Benguet, Tea tree, Shiitake var flower, and Black & White) significantly reduced the regeneration time, with Shiitake var Benguet extract reducing the regeneration time the most at 2.56 (SD 0.30) days and 2.61 (SD 0.22) days for both eyespot and tail formations (P<.0001) respectively. The solvent extracts of the Shiitake (Benguet variety) did not reduce the planarian regeneration time relative to the control (P>.05). @*Conclusion@#Lentinula edodes (L. edodes) [Benguet variety CEE] had reduced the regeneration time most significantly for both the eyespot and tail formations compared to the other six tested fungi extracts. The L. edodes (Benguet variety) CEE may contain compounds that can hasten the regeneration of the planarian D. hymanae.

Metabolic syndrome and its correlates: A cross-sectional study among adults aged 18� years in an Urban Area of West Bengal

Background: The prevalence of metabolic syndrome (MetS) is increasing dramatically of late, across all ages irrespective of gender, socioeconomic status, and ethnicity. People with MetS have twice the likelihood of developing and dying from cardiovascular disease and more than seven times the risk of developing diabetes. Objectives: This study was undertaken to determine the prevalence of MetS among adults who were in their first three decades of adulthood and to find out the risk factors of MetS among them. Methods: This was a community based cross-sectional study among 388 subjects aged 18� years selected by multistage random sampling in an area of Kolkata, India, from November 2016 to October 2018 over 2 years. Data collection was done using a structured questionnaire along with anthropometry, blood pressure measurement, and relevant blood tests. Physical activity was classified by the International Physical Activity Questionnaire Short-Form questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (version 16.0), and descriptive statistics were calculated as frequency and percentage. Logistic regression was done to determine the strength of association between MetS and different risk factors. Results: The prevalence of MetS was 44.6% (35.4% in males and 55.6% in females), and female gender, poor economic status, sedentary lifestyle, poor diet, and addiction of tobacco were found to be the risk factors of MetS in the final model using multivariable logistic regression. Conclusion: This research revealed the high prevalence of MetS in the community. The effective primordial and primary level of prevention along with prevailing secondary or tertiary level of prevention should have been employed to curtail the epidemic of MetS.

An epidemiological study on sociodemographic and antenatal factors associated with low birth weight in a tertiary care hospital of Kolkata, West Bengal

Background: Birth weight is a critical determinant of child survival and growth and a valuable indicator of maternal health, nutrition, and quality of life. Antenatal care (ANC) provides an array of available medical, nutritional, and educational interventions intended to reduce the incidence of low birth weight (LBW). Objective: This study was done to find out the sociodemographic and antenatal factors associated with LBW among babies delivered in a tertiary care health facility in Kolkata. Materials and Methods: It was a cross-sectional institution based observational study conducted from November 2016 to October 2018 among 410 postnatal mothers in the postnatal ward of the Department of Obstetrics and Gynaecology, Medical College, Kolkata, West Bengal. Data were obtained by interview method along with record analysis (medical and hospital records). Dependent variable was LBW (<2.5 kg). Ethical clearance was obtained from Local Ethics Committee of All India Institute of Hygiene and Public Health Kolkata and Medical College, Kolkata. Results: Out of 410 babies, 112 (27.3%) were LBW. Out of 112 LBW babies, 59 (52.7%) were preterm (<37 weeks); 51(45.5%) were term (37–42 weeks), and 2 (1.8%) were post-term (>42 weeks). Multi-variable logistic regression showed LBW to be significantly associated with poor economic status (below middle class), mothers who belonged to nuclear family, delayed registration (≥12 weeks), anemia in pregnancy, pregnancy-induced hypertension, gestational diabetes mellitus, weight gain in kg less than normal (i.e., below 9 kg), and poor consumption of specific nutritional supplements. Conclusion: Poor economic status and inadequate ANC continue to remain the most important factors for LBW. A good quality ANC package will ensure prevention of LBW babies.

Community perception and risk reduction practices toward malaria and dengue: A mixed-method study in slums of Chetla, Kolkata

Background: Globally, vector-borne diseases account for 17% of infectious disease burden. In India, despite accelerated efforts, both malaria and dengue are major public health concern. Understanding local community perspectives is essential to strengthen ongoing program activities. Objectives: The study aimed to assess the community perceptions and risk reduction practices toward prevention and control of malaria and dengue at slums of Chetla in South Kolkata and to explore the perspectives of relevant local stakeholders in this regard. Methods: This cross-sectional study with mixed-method design was conducted from June to September 2018. Quantitative data were collected in 288 sampled households through face-to-face interview of respondents and environmental checklist, whereas, qualitative exploration was done with five key informant interviews. Quantitative data were analyzed using SPSS version 16 Software. Qualitative data were analyzed thematically using “cut and sort” processing technique. Results: In household survey, majority had unsatisfactory knowledge (68.4%), attitude (64.2%), and practices (62.8%) regarding diseases prevention/control, which was further substantiated by qualitative findings. The use of electric fans (79.5%), mosquito repellents (53.8%) were predominant practices; however, only a few used bed nets regularly (26.0%). Reportedly, “heat” and “poor ventilation” were key reasons behind reluctance to use bed nets. Multivariable regression analysis revealed that increasing age, proximity to a nearby canal, and unsatisfactory knowledge significantly predicted unfavorable attitude, whereas, respondents' gender and unfavorable attitude significantly predicted poor practices. Conclusions: Intensified social behavior change communication with active community participation is the need of the hour to prevent malaria and dengue occurrence and future outbreaks.

Technique of external ventricular drainage with intraventricular administration of recombinant tissue plasminogen activator for patients with secondary intraventricular hemorrhage - Case series in a single institution

INTRODUCTION@#Intraventricular hemorrhage (IVH) as an extension of spontaneous intracerebral hemorrhage is an independent predictor of mortality. The Clot Lysis: Evaluating Accelerated Resolution of IVH phase 3 (CLEAR III) trial is a randomized, double-blinded, placebocontrolled, multiregional trial recently conducted to determine whether external ventricular drainage (EVD) plus intraventricular recombinant tissue plasminogen activator (rtPA, alteplase) improved outcome, in comparison to EVD plus saline. This study is an application of the rationale and principles of management in CLEAR III trial and related literature.@*METHODS@#There are five patients described in this case series. Report followed the PROCESS guidelines.@*RESULTS@#30-day mortality in this series is 2 out of 5 while actual allcause mortality is 4 out of 5. Modified Graeb scores and IVH scores of all subjects have decreased after the intervention. However, good functional status defined as modified Rankin scale (mRS) score of 0-3 has not been achieved with the intervention. Efficacy of completely resolving IVH and hydrocephalus has been achieved in 2 out of 5 which translated to a benefit of survival to one of the two. Shunt dependence has been avoided by the subjects except for the one with the caudate intracerebral hemorrhage. Complications related to the intervention have been noted and discussed@*CONCLUSION@#In this single-institution study, patients for which rtPA was used for intraventricular fibrinolysis of IVH clot in addition to EVD as surgical treatment for hydrocephalus resulted to a 30-day survival of 3 out of 5 in this series, while actual survival is 1 out of 5. The intervention was efficacious in decreasing the Modified Graeb scores and IVH scores of all study subjects at end of treatment. Functional status of mRS 5 is the highest score achieved among survivors.

Racecadotril (Acetorphan) for diarrhea in adults infected with HIV/AIDS: A meta-analysis and systematic review

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Diarrhea is a common and disabling symptom seen in patients with Human Immunodeficiency Virus (HIV) infection and the Acquired Immune Deficiency Syndrome (AIDS). The diarrhea is chronic and results in malabsorption contributing to cachexia. Symptomatic treatment can improve the quality of life and nutritional status of these patients.</p><p style="text-align: justify;">The endogenous group of opiates known as enkephalins function as anti-secretory agents without affecting intestinal transit. Racecadotril (acetorphan) is an orally active enkephalinase inhibitor. Available studies have focused on the use of racecadotril in healthy adults and children with acute infectious diarrhea.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong>To assess the efficacy of racecadotril (acetorphan) in reducing the duration and frequency of bowel movement in adult HIV patients with chronic diarrhea.</p><p style="text-align: justify;"><strong>METHODS: </strong> Electronic databases were searched for randomized controlled trials which used racecadotril for chronic diarrhea in HIV patients. Three independent reviewers assessed the quality of the two studies based on the Cochrane Infectious Disease Group prior to inclusion in study. Data extracted were analyzed using Revman Version 5. Test for heterogeneity was performed using the chi square test.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Results showed the standardized mean difference for the two trials comparing racecadotril to placebo and octreotide in reducing bowel movements from baseline was -1.00 (95% CI -1.16 to -0.84, Z=12.08, p<0.00001), showing a beneficial effect. Response rate for the two trials comparing racecadotril to placebo or octreotide in reducing bowel movements from baseline was -0.13 (95% CI -0.26 to 0.01, Z=1.84, p<0.07), showing a trend towards benefit in terms of response rates. Heterogeneity was statistically insignificant (p=1, I2=0%).</p><p style="text-align: justify;"><strong>CONCLUSIONS:</strong> There is evidence pointing to a benefit in using racecadotril in HIV and AIDS-associated, non-infectious diarrhea by decreasing the frequency of loose stools. An individualized approach is still recommended in its use for HIV patients with chronic diarrhea.</p>

Exposure to indoor air pollution and its perceived impact on health of women and their children: A household survey in a slum of Kolkata, India

Background: One's house is believed to be the safest and the healthiest place to live in. Indoor air pollution (IAP) means the presence of unwanted substances in the indoor air at concentration toxic to health. Objective: The objective of this study is to study the presence of IAP, its associated factors and impact on health of women residing in an urban slum of Kolkata, West Bengal, India. Methods: It was a cross-sectional study done from January 2017 to March 2017 among 120 households of a slum. Data were collected using a pre-designed pre-tested schedule from the homemaker of the households. All analyses were conducted with R: A Language and Environment for Statistical Computing. Results: About 60% households used kerosene as cooking fuel predominantly. Smoke from the neighbouring houses troubled 57.5% respondents. More than 60% houses were overcrowded and more than 70% houses were poorly ventilated. IAP-related symptoms such as irritation in the eye, suffocation, dry cough significantly correlated with the presence of IAP sources and its contributory factors. Of 120, 78 (65%) perceived the presence of IAP in their houses. Lower per capita income (PCI), ground floor, and joint family were found to have higher odds of sources of IAP. Younger age, lower PCI, and ground floor were found to be strongly associated with higher contributory factors of IAP. Conclusion: The present study found that the majority of the households were exposed to IAP due to kerosene, neighborhood smoke while overcrowding and ill-ventilation accentuated it. Effective intervention with intersectoral coordination is the need of the hour.

Sun exposure and Vitamin D in rural India: A cross-sectional study

Background: Vitamin D deficiency/Vitamin D Insufficiency (VDI) is now recognized as a pandemic. Cutaneous exposure to ultraviolet-B causes photolysis of epidermal 7-dehydrocholesterol, converting it to pre-Vitamin D3 (precholecalciferol), which then undergoes isomerization to form the stable hormone Vitamin D3. Objectives: The objectives of the study is to determine the status of Vitamin D level among the adults residing in a rural area of West Bengal and to find out the optimal cutoff of the sun exposure for Vitamin D sufficiency. Methods: This study was a rural community based cross-sectional study. It was done from May 2016 to April 2017 among 197 adults residing in a rural block of West Bengal. Data were collected by interviewing the respondents with the help of a structured pre-tested pre-designed schedule. After interviewing, every individual was examined for height and weight and blood was collected for serum Vitamin 25-(OH) D. Receiver Operating Characteristic (ROC) curves were utilized to find out optimum cut-off for sun exposure using Youden's index. Binary logistic regression was performed to find out the associates of high sun exposure. All analysis was done using R. Results: Overall VDI was found in 133 (67.5%). Among them, 102 (51.8%) were female. On ROC curve for veritable sun exposure for Vitamin D sufficiency, area under curve was 0.7841 which signifies veritable sun exposure as a good screening tool. Conclusion: Proper information, education, and communication material regarding various aspects of sun exposure and Vitamin D should be prepared with due consultation of field experts and disseminated to increase awareness among the community.

A study of spectrum of pulmonary pathology and expression of thyroid transcription factor-1 during neonatal period

Context: Neonatal period is the single most hazardous period of life. The major causes of neonatal death are prematurity and respiratory distress syndrome. We report a series of neonatal autopsies in our Neonatal Intensive Care Unit with special emphasis on pulmonary pathology. The spectrum of pathological changes in the lungs and thyroid transcription factor-1 (TTF-1) expression was studied in detail with reference to its spatial distribution. Aims: This study aims to analyze the causes of neonatal death with special attention to pulmonary pathology along with associated histopathological changes in lungs. We also evaluated the expression of TTF-1 at different levels of the airway. Materials and Methods: After taking consent and anthropometric measurements, autopsy was performed. Weights of all organs were taken, and histological sections were examined under hematoxylin and eosin stain. TTF-1 immunostaining was done on lung sections. Localization of TTF-1 was evaluated at the intrapulmonary level of terminal bronchioles (TBs), distal bronchioles, and alveoli. Results: We performed a series of 25 autopsies in neonates. In our series, most of the neonates were preterm (64%), had low birth weight (44%), and died within the first 7 days of life (80%). Majority (60%) of the neonates died due to pulmonary causes, followed by septicemia (24%), congenital anomalies (12%), and birth injury (4%). Among the respiratory causes, hyaline membrane disease (HMD) was diagnosed in maximum number of cases (32%), followed by pneumonia (12%) and pulmonary hemorrhage (12%). The TTF-1 expression in TBs, distal airways, and alveoli was significantly reduced or absent in cases of HMD compared to the control group. Conclusions: In this study, we observed that HMD is the most common cause of perinatal death among respiratory disorders, and in this disease, the expression of TTF-1 is significantly reduced in TBs, distal airways, and alveoli compared to the control group.

War against tobacco: Where do we stand?

India has launched war against tobacco epidemic for the past few decades but with partial success; hence, challenges are still there which need to be identified and addressed for winning the battle. Targeted approach directed at motivating smoking cessation of female smokers, frequent changing of pictorial warnings depicting variety of health consequences in cigarette packets and devoid of logos and colors in conjunction with plain packaging, and display of toll-free number for quitting are expected to dissuade tobacco consumers to quit and save themselves from the devastating health, social, environmental, and economic consequences of tobacco consumption. Online reporting system for violating legal enforcements can also be implemented easily. Moreover, guidance from success stories of countries/states who have achieved smoke-free status along with concerted efforts such as innovative anti-tobacco campaigns, involvement of religious leaders in anti-tobacco propaganda, strict legislations, and overall strong political commitment would further aid in winning the war.

Potency dependent activity of homeopathic nanomedicine- classical and quantum electrodynamical approach

The effect of homeopathic medicine on biological and physical system is directly related to its potency [1]. However, from physico-chemical point of view it is difficult to explain this effect at such high dilution, as then the existence of even trace amount of particle is questionable. It has been reported that during the process of potentization, a large amount of mechanical energy gets transferred to the medium due to succussion [2]. This energy in all probability reduces the size of the drug aggregates. The drug then penetrates easily through the membrane barrier, and thereby gives rise to enhanced activity of the medicine. It has been experimentally proved by us and supported by others that indeed a reduction of size of the aggregates takes place with increase in potency [3]. Using five different homeopathic medicines, their sizes at three different potencies have been estimated and a general mathematical expression relating the size of the particle (Y) and the corresponding potency (X) has been derived as follows Y = a X -n. (AU)

The Openness/Intellect Model on the M5-50: Supporting the Flexibility of IPIP-Based Instruments / El Modelo Apertura/Intelecto en M5-50: apoyando la flexibilidad de instrumentos basados en IPIP

This study examined ways to improve fit and interpretive capacity of the M5-50, an IPIP-based personality instrument, using the Openness/Intellect model (O/I) given a history of poor performance of the M5-50 Openness scale (Socha, Cooper, & McCord, 2010). With participants from Amazon's MTurk (n = 305), theoretical models for the five-factor model, Openness as a 10-item single factor, and the O/I model were tested and fitted poorly. After removing one problematic item, the O/I model showed acceptable fit. Findings indicate that the O/I model improved psychometric validity and interpretive capacity for the M5-50. The flexibility and open access of IPIP-based instruments such as the M5-50 makes the IPIP an optimal choice for instrument adaptation and construction in Latin America.

Este estudio examinó maneras de mejorar el ajuste y la capacidad interpretativa del M5-50, un instrumento de medición de la personalidad basado en el IPIP, utilizando el modelo Apertura/Intelecto (O/I por sus siglas en inglés) dado el historial de desempeño pobre de la escala de Apertura del M5-50 (Socha, Cooper, y McCord, 2010). Con participantes de Amazon MTurk (n = 305), se analizaron modelos teóricos para los cinco factores de la personalidad, Apertura como un factor individual de 10 ítems, y el modelo O/I; todos los análisis tuvieron ajustes deficientes. Luego de remover un ítem con problemas, el modelo O/I demostró ajuste aceptable. Los resultados indican que el modelo O/I mejoró la validez psicométrica y la capacidad de interpretación del M5-50. La flexibilidad y el acceso libre a los instrumentos basados en el IPIP, como ser el M5-50, hacen del IPIP una elección óptima para la adaptación y construcción de instrumentos en Latinoamérica.

Spinal Cord Injury Functional Impairment and Caregiver Mental Health in a colombian sample: An exploratory study / Deficiencias funcionales en pacientes con lesiones de la médula espinal y la salud mental del cuidador: un estudio exploratorio en una muestra colombiana

Limited literature has examined the connections between caregiver mental health and the physical and psychosocial functioning of individuals with spinal cord injury (SCI) in Latin America, despite the dearth of services and unique needs of this population. The purpose of the current study was to examine the relationships between caregiver mental health (anxiety, burden, depression, satisfaction with life, and self-esteem) and SCI physical and psychosocial functional impairments in a Colombian sample. Forty SCI caregivers were recruited from Neiva, Colombia, and completed measures of SCI impairments and their own mental health. Greater SCI impairments, and caregiver stress due to those impairments, were associated with higher caregiver depression and anxiety, although only patient psychosocial functional impairments and related caregiver stress were uniquely associated with caregiver depression. Due to the collectivist nature of and the importance of family in many Latino cultures, mental health interventions for family members who provide care for an individual with SCI having greater psychosocial impairments may be particularly important.

Poca literatura ha examinado las relaciones entre salud mental del cuidador y funcionamiento físico y psicosocial de las personas con traumatismo de médula espinal en América Latina, a pesar de la escasez de servicios y necesidades únicas de esta población. El propósito del presente estudio fue examinar las relaciones entre la salud mental del cuidador (ansiedad, sobrecarga, depresión, satisfacción con la vida y autoestima) y las discapacidades físicas y psicosociales de personas con traumatismo de médula espinal en una muestra colombiana. Cuarenta cuidadores de personas con traumatismo de médula espinal fueron reclutados en Neiva, Colombia, quienes completaron medidas de discapacidad del traumatismo de médula espinal y de su propia salud mental. Mayores niveles de discapacidad en personas con traumatismo de médula espinal y niveles de estrés del cuidador debido a esas discapacidades, fueron asociadas con mayores niveles de depresión y ansiedad en el cuidador, aunque sólo las discapacidades psicosociales de los pacientes y el estrés relacionado con el cuidador fueron asociados con la depresión en el cuidador. Debido a la naturaleza colectivista y la importancia de la familia en la mayoría de las culturas latinas, las intervenciones centradas en la salud mental de los familiares que cuidan de personas con traumatismo de la medula espinal pueden ser particularmente importantes.

Impact of Cannabis Use on Long-Term Remission in Bipolar I and Schizoaffective Disorder

OBJECTIVE: To investigate the impact of regular cannabis use on long-term remission of mood symptoms in bipolar spectrum disorders. METHODS: The 24-month prospective observational study included patients (n=239) with bipolar I disorder and schizoaffective disorder, bipolar type. Participants were classified as regular cannabis users (three times or more per week) or non-users. The primary outcome measure was the achievement of remission on the evaluations during the 24 months. RESULTS: Of the 234 participants for whom data was available, 25 (10.7%) were regular cannabis users, and the group comprised significantly more males than females. In the total population, cannabis use was significantly associated with decreased likelihood of remission during the 24-month follow-up period. Subgroup analyses showed that cannabis use was significantly associated with lower remission rates on the Hamilton Depression Rating Scale in females (n=139) and patients prescribed mood stabilizers alone (n=151), whereas in males (n=95) and patients prescribed olanzapine and/or a mood stabilizer (n=83), cannabis use was significantly associated with lower remission rates on the Young Mania Rating Scale. Remission rates were lowest in the concurrent cannabis and tobacco smoking group (n=22) followed by the tobacco smoking only group (n=97), and the non-smoker group (n=116). The post-hoc analysis revealed that all remission rates were significantly lower in the concurrent cannabis and the tobacco smoking group compared to the non-smoker group. CONCLUSION: Cannabis use negatively affects the long-term clinical outcome in patients with bipolar spectrum disorders. A comprehensive assessment and integrated management of cannabis use are required to achieve better treatment outcomes for bipolar spectrum disorders.

Financial Disclosures in Academic Publications and the Sunshine Act: A Concordance Study.

Aims: To assess the concordance between conflicts of interest reported by physicians in three major scientific journals and industry-reported payments available through the Open Payments Program (OPP) database. Study Design: Comparative cross-sectional surveys. Place and Duration of Study: United States allopathic and osteopathic physicians with publications in American Journal of Ophthalmology, JAMA Ophthalmology, and Ophthalmology accepted after January 1, 2014 and published from May 2014 through October 2014. Methodology: We compared physicians’ self-reported conflicts of interest in their academic publications to industry-reported payments in the Centers for Medicare & Medicaid Services OPP database. Authors were categorized based on concordance between self-reported disclosures and payments listed in the database. Payments were designated as disclosed or undisclosed. Results: Of the 670 authors surveyed, 367 (54.8%) were in perfect concordance with the OPP database; 68 (10.1%) authors made disclosures beyond those in the database but had no undisclosed ties; 235 (35.1%) authors had one or more undisclosed payments. Disclosed and undisclosed payments totaled $1.46 million and $1.81 million, respectively. Conclusion: In three major ophthalmology journals, a significant discrepancy exists between conflicts of interest reported by physician authors and payments found in the OPP database. This lack of concordance raises concerns about incomplete physician disclosure, inaccurate reporting, inadequate vetting, and ambiguity over financial relevance, all of which undermine confidence in the disclosure process.