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BackgroundPredictive eHealth tools will change the field of medicine, however long-term data is scarce. Here, we report findings on data collected over 6 years with an AI-based eHealth system for supporting the treatment of alcohol use disorder.MethodsSince the deployment of Previct Alcohol, structured data has been archived in a data warehouse, currently comprising 505,641 patient days. The frequencies of relapse and caregiver-patient messaging over time was studied. The effects of both introducing an AI-driven relapse prediction tool and the COVID-19 pandemic were analyzed.ResultsThe relapse frequency per patient day among Previct Alcohol users was 0.28 in 2016, 0.22 in 2020 and 0.25 in 2022 with no drastic change during COVID-19. When a relapse was predicted, the actual occurrence of relapse in the days immediately after was found to be above average. Additionally, there was a noticeable increase in caregiver interactions following these predictions. When caregivers were not informed of these predictions, the risk of relapse was found to be higher compared to when the prediction tool was actively being used. The prediction tool decreased the relapse risk by 9% for relapses that were of short duration and by 18% for relapses that lasted more than 3 days.ConclusionsThe eHealth system Previct Alcohol allows for high resolution measurements, enabling precise identifications of relapse patterns and follow up on individual and population-based alcohol use disorder treatment. eHealth relapse prediction aids the caregiver to act timely, which reduces, delays, and shortens relapses., CC BY 4.0 DeedCORRESPONDENCE Markku D. Hämäläinen markku.hamalainen@kontigocare.comThe author(s) declare that no financial support was received forthe research, authorship, and/or publication of this article.

BACKGROUND: Collegial conversations are important for sustainable learning to last beyond a course. Research on collegial conversations and peer learning in the workplace during psychiatric residency courses remains sparse, however. In this study, the aim was to explore residents' opportunities for collegial conversations during and after national courses in psychiatry. METHODS: Residents in psychiatry completed an online survey including questions on opportunities for collegial conversations in their workplaces. Logistic regression was used for multivariate analysis and thematic content analysis was used for the open-ended answers where a theoretical framework of communities of practice was employed for the interpretation of the findings. RESULTS: The survey was completed by 112 residents out of 725 (15,4%). The participants reported few structured forums for collegial discussion. The results of multivariate analysis suggest that more women than men feel it is advantageous to attend courses with others from the same workplace or from the same group of residents, described here as a team. The analysis of qualitative data identified how opportunities for collegial conversations differ across contexts and the type of values that are attached to team participation in residency courses. CONCLUSIONS: This study highlights the importance of collegial conversations as a way to sustain the learning from residency courses into the workplace. By learning about residents' perceptions of collegial conversations during and after courses, teachers and directors may be more able to support residents' lifelong learning and professional development., CC BY 4.0 DeedCONTACT Klara Bolander Laksov klara.bolander.laksov@edu.su.se Department of Education, Stockholm University, Stockholm SE-106 91, Sweden

Background: Globally, the digital sources developed and available in antenatal care differ, and infrastructure challenges may impede the further development of such sources. Challenges accompanying digital developments can include the commonly occurring high workload, which affects healthcare professionals' ability to acquire professional knowledge about how to best support parents in using digital sources. Including healthcare professionals in the development process of digital sources may increase the likelihood that such sources will be adopted and employed by these professionals in their future care work. Therefore, the present research explored healthcare professionals' perceptions of the digital support intervention Childbirth Journey, which was constructed as a serious game for expectant parents. Methods: Data were collected through semi-structured focus-group interviews with 11 midwives at antenatal, labour and postnatal clinics as well as with child healthcare nurses. Prior to the interviews, all participants were provided the intervention, Childbirth Journey, which is a serious game in a mobile application format consisting of two distinct parts: (1) a story-driven game and (2) a Knowledge Portal. The data were analysed using phenomenographic methods. Results: The perceptions of Childbirth Journey by healthcare professionals, midwives and child healthcare nurses are presented in four descriptive categories: extended professional support, trustworthy contents, diversity or individuality, and both appealing and in need of development. Conclusions: Current study revealed that Childbirth Journey may be utilised as a digital support for parents, allowing healthcare professionals to offer a digital solution as a complementary support to standard, face-to-face meetings with caregivers. However, the research results also revealed that some elements of Childbirth Journey must be improved, thereby representing a main contribution of this study: insights into how to

The prevalence of pain in children and adolescents with psychiatric conditions is rarely investigated. The aims of the current study were to (a) describe the prevalence of headaches and abdominal pain in children and adolescents with psychiatric conditions, (b) compare the prevalence of pain in children and adolescents with psychiatric conditions with that in the general population, and (c) investigate the associations between pain experience and different types of psychiatric diagnoses. Families with a child aged 6-15 years who had been referred to a child and adolescent psychiatry (CAP) clinic completed the Chronic Pain in Psychiatric Conditions questionnaire. Information about the child/adolescent's psychiatric diagnosis(es) was extracted from the CAP clinic's medical records. The children and adolescents included in the study were divided into diagnostic groups and compared. Their data were also compared with data of control subjects collected during a previous study of the general population. Abdominal pain was more common among girls with a psychiatric diagnosis (85%) than in the matched control population (62%, p = 0.031). Children and adolescents with neurodevelopmental diagnoses had a higher prevalence of abdominal pain than children and adolescents with other psychiatric diagnoses. Pain conditions in children and adolescents with a psychiatric diagnosis are common and must be addressed., CC-BY 4.0Funding information: Fonden för rehabilitering och forskning

The coronavirus disease 2019 (COVID-19) pandemic has challenged and almost completely disrupted the previous teaching system, based mainly on teachers’ and learners’ physical presence. This impact has forced educators to identify alternative learning models and begin utilizing new approaches, often without detailed analysis or thorough, systematic planning. The current literature review aims to reveal some of the greatest pedagogical challenges in remotely teaching psychiatry residents during the pandemic. This mini-review’s results may help in developing additional pedagogical techniques and key applications for educational activities to teach psychiatry residents, as well as to suggest directions for future psychiatry resident education., Pandemija koronavirusne bolesti 2019. (COVID-19) u značajnom je obimu onemogućila provođenje uobičajenih edukacijskih aktivnosti što je, izmedu ostalog, rezultiralo i primjenom novih modela učenja. Međutim, promjene koje su uslijedile često su implementirane bez detaljne prethodne analize i temeljitog, sustavnog planiranja njihovog provođenja. Ovaj kratki pregled literature ima za cilj identificirati neke od glavnih pedagoških izazova u edukaciji specijalizanata psihijatrije tijekom aktualne pandemije. Rezultati ovog preglednog članka mogu pomoći pri razvoju dodatnih pedagoških tehnika i inovativnih alata za korištenje u budućim obrazovnim aktivnostima te pridonijeti planiranju organizacije specijalističkog obrazovanja iz psihijatrije.

Objective: The aim of this study was to explore expecting parents’ perceptions of the Childbirth Journey as an intervention that includes medical information for parental support, constructed as a serious game. Methods: In this qualitative study, semi-structured interviews were held with expecting parents in Sweden who were able to talk about specific parts of the Childbirth Journey they appreciated or found difficult to understand. A phenomenographic methodology was employed for data analysis. Results: Participants perceived the Childbirth Journey to be easily accessible and customized with reliable information. The design and features of the intervention were perceived by the expecting parents to enhance the intervention’s usability, appeal, and trustworthiness. When parental couples used the Childbirth Journey together, it gave them an opportunity to discuss and better understand each other’s situation. The participants proposed several changes to the existing version of the game, mostly related to extending practical information and illustrated scenarios but also to the further development of the game’s design and animations. The participants found the Knowledge portal to be the most appealing part of the Childbirth Journey. Conclusions: The Childbirth Journey intervention was concluded to be a valuable digital complement to in-person profes- sional support, especially given the current COVID-19 pandemic restrictions in place in Sweden, which do not allow antenatal visits by partners. However, in its current form, the Childbirth Journey has some deficiencies and would therefore benefit from further development and exploration., CC BY 4.0First published online May 16, 2022Corresponding author: Caroline Bäckström, School of Health Sciences, University of Skövde, Postbox 408, S 541 28, Skövde, Sweden. Email: caroline.backstrom@his.seFunding: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the School of Health Sciences and the Research Group Family Centered Health (FamCeH), University of Skövde, Sweden; Regionhälsan Midwifery Unit, Västra Götalandsregionen, Sweden; School of Informatics, University of Skövde, Sweden; Skaraborgs Hospital, Skövde, Sweden; Chalmers Innovationskontoret, Sweden.

Takotsubo syndrome (TTS) is an acute heart failure syndrome. Emotional or physical stressors are believed to precipitate TTS, while the pathophysiological mechanism is not yet completely understood. During the coronavirus disease (COVID-19) pandemic, an increased incidence of TTS has been reported in some countries; however, the precise pathophysiological mechanism for developing TTS with acute COVID-19 infection is unknown. Nevertheless, observing the symptoms of COVID-19 might lead to new perspectives in understanding TTS pathophysiology, as some of the symptoms of the COVID-19 infection could be assessed in the context of an orexin/hypocretin-system dysfunction. Orexin/hypocretin is a cardiorespiratory neuromodulator that acts on two orexin receptors widely distributed in the brain and peripheral tissues. In COVID-19 patients, autoantibodies against one of these orexin receptors have been reported. Orexin-system dysfunction affects a variety of systems in an organism. Here, we review the influence of orexin-system dysfunction on the cardiovascular system to propose its connection with TTS. We propose that orexin-system dysfunction is a potential novel explanation for the pathophysiology of TTS due to direct or indirect dynamics of orexin signaling, which could influence cardiac contractility. This is in line with the conceptualization of TTS as a cardiovascular syndrome rather than merely a cardiac abnormality or cardiomyopathy. To the best of our knowledge, this is the first publication to present a plausible connection between TTS and orexin-system dysfunction. We hope that this novel hypothesis will inspire comprehensive studies regarding orexin's role in TTS pathophysiology. Furthermore, confirmation of this plausible pathophysiological mechanism could contribute to the development of orexin-based therapeutics in the treatment and prevention of TTS. Copyright, CC BY 4.0© 2022 Knez, Niksic and Omerovic.Correspondence: Rajna Knez, rajna.knez@gu.seThis study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement, the Swedish Heart-Lung Foundation and the Swedish Scientific Council.

Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE) is an umbrella term covering a wide range of neurodevelopmental difficulties and disorders. Thus, ESSENCE includes attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other neurodevelopmental disorders (NDDs) and difficulties, with a variety of symptoms in cognitive, motor, sensory, social, arousal, regulatory, emotional, and behavioral developmental domains, frequently co-occurring and likely having partly common neurobiological substrates. The ESSENCE concept is a clinical paradigm that promotes organizing NDDs in everyday clinical practice according to their coexistence, symptom dimensions overlapping, and treatment possibilities. Despite increased knowledge regarding NDDs, the neurobiological mechanisms that underlie them and other ESSENCE-related problems, are not well understood. With its wide range of neural circuits and interactions with numerous neurotransmitters, the orexin/hypocretin system (Orx-S) is possibly associated with a variety of neurocognitive, psychobiological, neuroendocrine, and physiological functions and behaviors. Dysfunction of Orx-S has been implicated in various psychiatric and neurological disorders. This article provides an overview of Orx-S dysfunctions' possible involvement in the development, presentation, and maintenance of ESSENCE. We provide a focused review of current research evidence linking orexin neuropeptides with specific clinical NDDs symptoms, mostly in ADHD and ASD, within the Research Domain Criteria (RDoC) framework. We propose that Orx-S dysfunction might have an important role in some of these neurodevelopmental symptom domains, such as arousal, wakefulness, sleep, motor and sensory processing, mood and emotional regulation, fear processing, reward, feeding, attention, executive functions, and sociability. Our perspective is presented from a clinical point of view. Further, more thorough systema, CC BY-NC 3.0© 2022 Knez et al.Dove Medical Press is part of Taylor & Francis Group, the Academic Publishing Division of Informa PLCCorrespondence: Rajna Knez, Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, vån 2, Göteborg, 41119, Sweden, Email rajna.knez@gu.se

Objective: To explore parents’ experiences using digital tools in relation to pregnancy, labor and birth, and the child’s first 18 months. Background: Parents find relevant information using digital healthcare tools, material obtained from professionals, as well as personal opinions and experiences that vary in quality. Method: Fifteen parents were interviewed and data were analyzed beginning with content analysis and followed by thematic analysis. Results: The main theme was insecurity and responsibility for own choices and knowledge. Parents use digital tools to take responsibility for their insecurity and need for knowledge when entering parenthood. Conclusion: The parents’ experiences highlighted that (1) insecurity can be both eased and enhanced using digital tools, (2) they took responsibility for feelings of insecurity and the search for knowledge, and (3) they needed knowledge to make the right choices and feel secure that these choices are made in the best interest of their new family., CC BY 4.0CC0 1.0© 2022, The Author(s).© 2022 BioMed Central Ltd unless otherwise stated. Part of Springer Nature.Correspondence: caroline.backstrom@hb.seOpen access funding provided by University of Borås. Funding was received from the University of Skövde, Sweden.

New research shows that the prevalence of neurodevelopmental disorders, such as attention-deficit/hyperactivity disorder (ADHD), is increased in children and adolescents as well as in adults with chronic pain, compared to those without chronic pain. Children and adolescents with ADHD also have an increased incidence of various physical conditions associated with pain, and they more frequently suffer from inflammatory diseases. Moreover, parents of children with ADHD can often suffer from pain conditions. These epidemiological and clinical observations form the scientific basis of our study, which aims to map the relationships between ADHD, altered pain experiences/central sensitization, and inflammation in children and adolescents. We will investigate the presence of central sensitization in children and adolescents with newly diagnosed ADHD and compare it with those who have not been diagnosed with ADHD. Participants (and their biological parents) will complete surveys about their somatic health, pain experience, and quality of life. Biological samples (saliva and stool) will be collected, aiming to utilize proteome and metabolome data to discover disease mechanisms and to predict, prevent and treat them. The results from our investigation should enable an expanded understanding of the pathophysiology behind both ADHD and pain/central sensitization. Presently, there are no established protocols for addressing psychiatric symptoms when examining patients with pain conditions in a somatic care setting, nor is there any knowledge of offering patients with ADHD or other neurodevelopmental disorders adapted treatments for pain conditions. Our results, therefore, can contribute to the development of new treatment strategies for pathological pain conditions in children and adolescents with ADHD. They may also increase awareness about and provide opportunities for the treatment of attention and impulse control problems in children and adolescents with pain syndromes.

Valdemar Landgren,1,2 Leif Svensson,3 Rajna Knez,1,3 Michail Theodosiou,1 Christopher Gillberg,1 Elisabeth Fernell,1 Magnus Landgren,1 Mats Johnson1 1Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; 2Department of Psychiatry, Skaraborg Hospital, Skövde, Region Västra Götaland, Sweden; 3Department of Pediatrics, Skaraborg Hospital, Mariestad, Region Västra Götaland, SwedenCorrespondence: Valdemar Landgren, Department of Psychiatry, Skaraborg Hospital, Lövängsvägen, Skövde, Region Västra Götaland, 541 42, Sweden, Email valdemar.landgren@gu.sePurpose: To determine the prevalence of parent-rated developmental concern using the ESSENCE-Q (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations-Questionnaire, 12-items, score range 0– 24) and to ascertain the predictive validity and optimal cutoff level of the instrument in a school-based sample of 11-year-old children.Methods: In a cross-sectional, school-based study, participants underwent a clinical assessment by a physician and a psychologist, teachers and parents completed the SDQ (Strength and Difficulties Questionnaire), medical health records and national tests were reviewed, and parents independently completed the ESSENCE-Q. In a case-conference outcomes were defined as a) the need for further clinical work-up due to suspected neurodevelopmental problems (NDPs) and b) degree of investigator-rated symptoms/impairment from NDPs on the CGI-S (Clinical Global Impression-Severity instrument, range 1– 7, 4– 7 defined as clinically symptomatic). Classification and optimal cutoffs of the ESSENCE-Q were determined using ROC (Receiver Operating Characteristic) analysis.Results: Out of 343 eligible children, 223 enrolled, of whom 173 (50% of all eligible) had a parent-rated ESSENCE-Q. At least one of the 12 possible concerns was

Rajna Knez,1– 3 Dejan Stevanovic,1 Elisabeth Fernell,1 Christopher Gillberg1 1Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 2Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden; 3School of Health Sciences, University of Skövde, Skövde, SwedenCorrespondence: Rajna Knez, Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, vån 2, Göteborg, 41119, Sweden, Email rajna.knez@gu.seAbstract: Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE) is an umbrella term covering a wide range of neurodevelopmental difficulties and disorders. Thus, ESSENCE includes attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other neurodevelopmental disorders (NDDs) and difficulties, with a variety of symptoms in cognitive, motor, sensory, social, arousal, regulatory, emotional, and behavioral developmental domains, frequently co-occurring and likely having partly common neurobiological substrates. The ESSENCE concept is a clinical paradigm that promotes organizing NDDs in everyday clinical practice according to their coexistence, symptom dimensions overlapping, and treatment possibilities. Despite increased knowledge regarding NDDs, the neurobiological mechanisms that underlie them and other ESSENCE-related problems, are not well understood. With its wide range of neural circuits and interactions with numerous neurotransmitters, the orexin/hypocretin system (Orx-S) is possibly associated with a variety of neurocognitive, psychobiological, neuroendocrine, and physiological functions and behaviors. Dysfunction of Orx-S has been implicated in various psychiatric and neurological disorders. This article provides an overview of Orx-S dysfunctions’ possible involvement in the development, presentation, and maintenance of ESSENCE. We p

Valdemar Landgren,1,2 Zohar Raanan Soltis,1 Emma Svensson,3 Michail Theodosiou,2,4 Magnus Landgren,2 Rajna Knez2,5 1Department of Psychiatry, Skaraborg Hospital, Skövde, Sweden; 2Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Department of Child Psychiatry, Skaraborg Hospital, Skövde, Sweden; 4School Health Services, City of Gothenburg, Gothenburg, Sweden; 5Department of Pediatrics, Skaraborg Hospital, Skövde, SwedenCorrespondence: Valdemar Landgren, Department of Psychiatry, Skaraborg Hospital Skövde, Lövängsvägen, Skövde, 541 45, Sweden, Tel +46702960450, Email valdemar.landgren@gu.sePurpose: Determine the prevalence of symptoms of neurodevelopmental problems (NDPs) with a semi-structured review of fourth grade students’ medical records, its interrater agreement and validity as compared with clinical assessment.Methods: A school-based sample of 11-year-old children provided child health care (CHC) records and school health care (SHC) records. A pediatric neurologist, child psychiatrist and an adult psychiatrist scored the records, with the “Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations-Questionnaire” (ESSENCE-Q, 12 items scored 0– 2, summary score range 0– 24). Agreement was measured with model-based kappa and intraclass correlation coefficient (ICC). Ratings were validated against a multidisciplinary assessment involving a physician, psychologist, teacher- and parental behavioral rating scales rendering a clinical global impression severity rating (CGI-S, range 1– 7) of NDPs.Results: Out of 223 participants, medical charts were available from 201, of whom 169 were rated by all three raters. Kappa agreement was moderate/strong (~0.8) for 7 of the 12 questionnaire items. Measured with the ICC, concordance in the summary score was good for agreement (~0.8) and excellent (~0.9) for consistency. Test–retest reliability

Background: The access to digital tools for parents is increasing, and further exploration is needed to gain knowledge about parents' experiences in using such tools, for example, when preparing for childbirth and parenthood. This study protocol describes a prospective study that will explore serious games as digital tools for parental support, and both parents' and healthcare professionals' views will be included. The objectives of the prospective study are to explore two different serious games: (1) Childbirth Journey (Swedish: Förlossningsresan), relating to pregnancy, childbirth and parenthood; and (2) Interplay (Swedish: Samspel), relating to parental couple relationships and parenthood. Methods: An intervention study will be conducted. The study will include four different sub-studies (A–D) with both qualitative and quantitative methods and a longitudinal design. Both parents (A, B and D) and healthcare professionals (C) will be included, and data will be collected through interviews (A–C) and repeated web-based questionnaires (D). Data will be analysed using phenomenography and qualitative content analysis (A–C), and descriptive and analytical analyses will be performed for comparisons and associations (D). Discussion: The value of monitoring and reporting on developments and trends in digital innovation for public health has been stipulated by the World Health Organization. The prospective study will contribute further knowledge about multidisciplinary development of digital tools as professional support for parents, as well as knowledge about parents' and healthcare professionals' experiences using digital tools concerning pregnancy, labour, parenthood and parental couple relationships. Trial Registration: This study was retrospectively registered (02/10/2020) within the ISRCTN with ID: ISRCTN18017741. http://www.isrctn.com/ISRCTN18017741., CC BY 4.0Correspondence: Caroline Bäckström, caroline.backstrom@his.seThis study has been funded by the University of Skövde, Sweden and Skaraborg Hospital, Skövde, Sweden.

Introduction: Hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) are both characterized by generalized hypermobility, in combination with pain, affected proprioception, and pronounced fatigue. Clinical observation indicates that behavioral problems, hyperactivity, and autistic traits are overrepresented in children with those conditions. The purpose of this retrospective study was to establish the prevalence of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) among children with HSD and hEDS treated in our clinic since 2012. Subjects and Methods: Since Ehlers-Danlos syndrome (EDS) diagnostic criteria and international classification were changed in 2017, we equate the older diagnosis EDS hypermobility type with the newer hEDS and the older hypermobility syndrome with HSD. A registry search from the computerized medical record system found 201 children (88 boys, 113 girls) aged 6-18 years who were treated at our pediatrics department with the diagnoses HSD or EDS. All medical records (113 with HSD, 88 with EDS) were reviewed, and key symptoms such as fatigue and pain, as well as diagnosis of ADHD/ASD, were recorded. Results: All EDS cases could be classified as hEDS. Of the entire study cohort, 16% had a verified ADHD diagnosis and a further 7% were undergoing ADHD diagnostic investigation. Significantly more children with hEDS had ADHD compared to children with HSD (p=0.02). In the age group 15-16 years, 35% of those with hEDS had ADHD and, among those aged 17-18 years, ADHD was present in 46%. Children with coexisting ADHD showed a significantly higher proportion of associated symptoms such as fatigue, sleep problems, and urinary tract problems. ASD had been verified in 6% of the children. Of those with ASD, 92% had sleep problems. Conclusion: This study shows a strong association between HSD or hEDS and ADHD or ASD. Therefore, children with HSD or hEDS may need to be routinely screened for neurops, Funding Agencies|Research & Development Centre, Skaraborg Hospital