Search results for: Kamilla Miskowiak

Authors: Nikolas Aasheim, Laura Sakalauskaitė, Julie Dubois, Malina Ploug Larsen, Paul Michael Petersen, Marcus S. Carstensen, Marcus S. Carstensen, Mai Nguyen, Line Katrine Harder Clemmensen, Kamilla Miskowiak, Klaus Martiny

Abstract:

Background: Major depressive disorder (MDD) is a debilitating condition that affects more than 300 million people worldwide and profoundly impacts well-being and health. Current treatments are based on a trial-and-error approach, and reliable biomarkers are needed for more informed and personalized treatment solutions. One potential biomarker is aberrant gamma-frequency (30-80 Hz) brainwaves, hypothesized to originate from deficiencies in the excitatory-inhibitory interaction between the pyramidal cells and interneurons. An imbalance within this interaction is described as a crucial pathological mechanism in various neuropsychiatric conditions, including MDD, and the modulation of this pathological interaction has been investigated as a potential target. A specific type of steady-state visually evoked potential (SSVEP) in the gamma frequency band, referred to as gamma entrainment using sensory stimuli (GENUS), particularly around the 40Hz spectrum, entrains large scale, fast-spiking PV+ interneurons, facilitating coordinated activity in key brain regions, reduced neuronal and synaptic loss, and enhanced synaptic stability and plasticity. GENUS has shown promise in improving sleep, offering neuroprotective effects in Alzheimer's disease (AD), and reducing pathological markers like Amyloid Beta and TAU proteins, as seen in animal models. In this study, we explore the antidepressant, cognitive, and electrophysiological effects of a novel, non-invasive brain stimulation (NIBS) approach utilizing a 40 Hz invisible spectral flicker to induce gamma activity in patients diagnosed with Major Depressive Disorder (MDD). This non-invasive targeted stimulation of lower gamma band activity (40 Hz) is designed to modulate neural circuits associated with mood and cognitive functions, providing a potential new therapeutic avenue for MDD. Methods and Design: 60 patients with a current diagnosis of a major depressive episode will be enrolled in a randomized, double-blinded, placebo-controlled trial. The active treatment group will receive 40 Hz invisible spectral flickering light stimulation while the control group will receive continuous light matched in colour temperature and brightness. Patients in both groups will get an hour of daily light treatment in their own homes and will attend four follow-up visits to assess depression severity measured by Hamilton Depression Rating Scale (HAM-D₆), several aspects of sleep, cognitive function, quality of life. Additionally, exploratory EEG is conducted to assess spectral changes throughout the protocol. The primary endpoint is the mean change from baseline to week 6 in depression severity (HAM-D₆ subset) between the groups. Current state of affairs/timeline: The FELIX study was initiated in the beginning of 2022, planning to reach stage of publication in December 2025. 21 participants have been enrolled in the protocol thus far, expecting to be finished with trials and recruitment by the end of 2024.

Keywords: major depressive disorder, gamma, neurostimulation, EEG

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Authors: Dmitriy Syssoyev, Aslan Seitkamzin, Natalya Lim, Kamilla Mussina, Abduzhappar Gaipov, Dimitri Poddighe, Dinara Galiyeva

Abstract:

Background: Data on the epidemiology of congenital heart defects (CHD) in Kazakhstan is scarce. Therefore, the aim of this study was to describe the incidence, prevalence and all-cause mortality of patients with CHD in Kazakhstan, using national large-scale registry data from the Unified National Electronic Healthcare System (UNEHS) for the period of 2014-2020. Methods: In this retrospective cohort study, the included data pertained to all patients diagnosed with CHD in Kazakhstan and registered in UNEHS between January 2014 and December 2020. CHD was defined based on International Classification of Diseases 10th Revision (ICD-10) codes Q20-Q26. Incidence, prevalence, and all-cause mortality rates were calculated per 100,000 population. Survival analysis was performed using Cox proportional hazards regression modeling and the Kaplan-Meier method. Results: In total, 66,512 patients were identified. Among them, 59,534 (89.5%) were diagnosed with a single CHD, while 6,978 (10.5%) had more than two CHDs. The median age at diagnosis was 0.08 years (interquartile range (IQR) 0.01 – 0.66) for people with multiple CHD types and 0.39 years (IQR 0.04 – 8.38) for those with a single CHD type. The most common CHD types were atrial septal defect (ASD) and ventricular septal defect (VSD), accounting for 25.8% and 21.2% of single CHD cases, respectively. The most common multiple types of CHD were ASD with VSD (23.4%), ASD with patent ductus arteriosus (PDA) (19.5%), and VSD with PDA (17.7%). The incidence rate of CHD decreased from 64.6 to 47.1 cases per 100,000 population among men and from 68.7 to 42.4 among women. The prevalence rose from 66.1 to 334.1 cases per 100,000 population among men and from 70.8 to 328.7 among women. Mortality rates showed a slight increase from 3.5 to 4.7 deaths per 100,000 in men and from 2.9 to 3.7 in women. Median follow-up was 5.21 years (IQR 2.47 – 11.69). Male sex (HR 1.60, 95% CI 1.45 - 1.77), having multiple CHDs (HR 2.45, 95% CI 2.01 - 2.97), and living in a rural area (HR 1.32, 95% CI 1.19 - 1.47) were associated with a higher risk of all-cause mortality. Conclusion: The incidence of CHD in Kazakhstan has shown a moderate decrease between 2014 and 2020, while prevalence and mortality have increased. Male sex, multiple CHD types, and rural residence were significantly associated with a higher risk of all-cause mortality.

Keywords: congenital heart defects (CHD), epidemiology, incidence, Kazakhstan, mortality, prevalence

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Authors: Chang Liu, Hanwen Zhang, Vikash Sharma, Don Eliseo Lucerno-Prisno III, Emmanuel Yujuico, Maulik Chokshi, Prashanthi Krishnakumar, Bach Xuan Tran, Giang Thu Vu, Kamilla Anna Pinter, Shenglan Tang

Abstract:

Background and Aims: Globally, many health systems focus on hospital-based healthcare models targeting acute care and disease treatment, which are not effective in addressing the challenges of ageing populations, chronic conditions, multi-morbidities, and increasingly unhealthy lifestyles. Recently, integrated care programs on chronic diseases have been developed, piloted, and implemented to meet such challenges. However, integrated care programs in the Asia-Pacific region vary in the levels of integration from linkage to coordination to full integration. This study aims to identify and analyze existing cases of integrated care in the Asia-Pacific region and identify the facilitators and barriers in order to improve existing cases and inform future cases. Methods: The study is a comparative study, with a combination approach of desk-based research and key informant interviews. The selected countries included in this study represent a good mix of lower-middle income countries (the Philippines, India, Vietnam, and Fiji), upper-middle income country (China), and high-income country (Singapore) in the Asia-Pacific region. Existing integrated care programs were identified through the scoping review approach. Trigger, history, general design, beneficiaries, and objectors were summarized with barriers and facilitators of integrated care based on key informant interviews. Representative case(s) in each country were selected and comprehensively analyzed through deep-dive case studies. Results: A total of 87 existing integrated care programs on chronic diseases were found in all countries, with 44 in China, 21 in Singapore, 12 in India, 5 in Vietnam, 4 in the Philippines, and 1 in Fiji. 9 representative cases of integrated care were selected for in-depth description and analysis, with 2 in China, the Philippines, and Vietnam, and 1 in Singapore, India, and Fiji. Population aging and the rising chronic disease burden have been identified as key drivers for almost all the six countries. Among the six countries, Singapore has the longest history of integrated care, followed by Fiji, the Philippines, and China, while India and Vietnam have a shorter history of integrated care. Incentives, technologies, education, and performance evaluation would be crucial for developing strategies for implementing future programs and improve already existing programs. Conclusion: Integrated care is important for addressing challenges surrounding the delivery of long-term care. To date, there is an increasing trend of integrated care programs on chronic diseases in the Asia-Pacific region, and all six countries in our study set integrated care as a direction for their health systems transformation.

Keywords: integrated healthcare, integrated care delivery, chronic diseases, Asia-Pacific region

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