bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying Children With Hearing Loss: The Key Role of School Nurses in Evidence-Based Screenings
Authors: Eiserman William D. , Shisler Lenore
Published: August 2024

Undetected hearing loss in school-aged children can impact academic and social functioning and have a life-long impact on the student. The prevalence of hearing loss increases as children reach school age, which highlights the importance of regular, evidence-based hearing screening. This article identifies the barriers to screening that school nurses may face, reviews the two evidence-based methods for childhood hearing screening, and reinforces the need for school nurses to conduct and advocate for regular hearing screening for all students.
Introducing NASN’s School Nursing Evidence-Based Clinical Practice Guideline: Allergy and Anaphylaxis CPG and Implementation Toolkit
Authors: Stanislo Kimberly J. , Neumann Linda S.
Published: August 2024

Clinical Practice Guidelines (CPGs) are statements informed by a systematic review of research/evidence and provide recommendations for clinical practice to improve healthcare quality and patient outcomes. The National Association of School Nurses (NASN) released School Nursing Evidence-Based Clinical Practice Guideline: Students with Allergies and Risk for Anaphylaxis, in 2023, to provide evidence-based recommendations specific to school nursing practice and support the role of the school nurse in providing high-quality care for school-age children with allergies and risk for anaphylaxis. This article will provide an overview of the CPG and Implementation Toolkit. The implementation toolkit is designed to provide school nurses with tools and resources to implement the recommendations into practice. These tools and resources include school policies; nursing assessments and intake; planning, training, implementing, and evaluating care; and data collection. Examples are discussed, including how to customize the toolkit resources to your current practice needs.
Hereditary angioedema presented as isolated ascending and transverse colon swelling mimicking acute abdomen
Authors: Marrawani Mohammad , Alatawneh Mustafa , Asafra Fouad , Salloum Omar H , Abuayash Ahmad M. , Samamra Mosab
Published: August 2024

Hereditary angioedema (HAE) is a rare autosomal dominant condition characterized by C1-INH gene mutations, leading to recurrent angioedema episodes affecting various body parts, including the gastrointestinal tract. This case report describes a 24-year-old female presenting with symptoms mimicking an acute abdomen, characterized by severe abdominal cramps, anorexia, and diarrhea, with a significant past medical history of angioedema flares and emergency intubation for asphyxiation at age 11. Despite initial treatment with antihistamines showing no improvement, her symptoms spontaneously resolved. Further investigation revealed low complement C4 levels and reduced C1-INH function, confirming HAE with an unusual isolated involvement of the ascending and transverse colon. This case underscores the importance of considering HAE in patients presenting with acute abdominal symptoms, especially with a history suggestive of angioedema. It highlights the need for emergency physicians and gastroenterologists to be aware of HAE’s clinical manifestations to avoid misdiagnosis and unnecessary interventions. Moreover, the case emphasizes the significance of patient education on recognizing symptoms and seeking timely medical attention to prevent severe complications. This report adds to the existing literature by detailing an uncommon presentation of HAE, aiming to enhance early diagnosis and management of this potentially life-threatening condition.
A novel STAG1 variant associated with congenital clubfoot and microphthalmia: A case report
Authors: Bregvadze Kakha , Sukhiashvili Anastasia , Lartsuliani Megi , Melikidze Elene , Tkemaladze Tinatin
Published: August 2024

The cohesin protein complex plays a vital role in various cellular processes such as sister chromatid cohesion, chromosome condensation, DNA repair, and transcriptional regulation. It is constituted by SMC1, SMC3, RAD21, STAG1/STAG2 subunits, and several regulatory proteins. Pathogenic variants in these components cause cohesinopathies, with common clinical features including facial dysmorphism, delayed growth, developmental delay, and limb anomalies. Pathogenic variants in the STAG1 contribute to an emerging syndromic developmental disorder with only 21 reported cases in the literature. We describe a 3-year-old girl presenting with congenital bilateral clubfoot and unilateral microphthalmia—clinical manifestations not previously reported in the literature. Whole exome sequencing revealed a novel de novo nonsense variant (c.1183C>T, p.(Arg395*)) in the STAG1, expanding the clinical and molecular spectrum of STAG1-related cohesinopathy. This patient’s unique phenotype highlights the clinical diversity within cohesinopathies, emphasizing their relevance in cases of developmental delay and dysmorphic features. Further studies, including genotype–phenotype correlation analyses and functional investigations, are essential for enhancing our understanding of STAG1-related cohesinopathy.
A case of primary osteosarcoma in the occipital bone: A relatively common tumor in an uncommon location
Authors: Xing Kezhou , Ren Guoli , Liu Shuning , Zhang Chuanchen
Published: August 2024

Osteosarcomas predominantly manifest in the long bones of the extremities, with rare occurrences in the skull. A case involving of a 53-year-old female who presented to the authors’ hospital for examination due to dizziness was incidentally found to have an occipital bone mass, which was initially diagnosed as a benign tumor and did not receive sufficient attention. Two years later, owing to tumor enlargement, the patient underwent further evaluation at the same institution, which revealed evidence of occipital bone destruction. Pathological analysis confirmed the diagnosis of osteosarcoma. The patient underwent surgical resection followed by radiotherapy. Despite its infrequency and uncharacteristic initial presentation, skull osteosarcomas should not be overlooked.
Research rivers: Flows of agency through crisis
Authors: Meckin Robert , Coverdale Andy , Nind Melanie
Published: August 2024

From early 2020, as the spread of COVID-19 and related restrictions intersected with everyday lives and, inevitably, social research practices, the ability to act and continue research was a significant concern in the social research community. In a project aimed at supporting methodological responses to the pandemic context the authors ran a series of online knowledge exchange workshops. The invitation to participate suggested researchers convey recent times of their research experiences by drawing and presenting a river sketch. The paper critically engages with the research rivers by creating a new interference pattern of a new materialist approach combined with experiences and project artefacts. The compatibility of new materialism and qualitative inquiry is discussed. Through an analysis focussed on two of the rivers, the ways the research river activity entangled matter and meaning is examined and the paper shows how a new materialist understanding of exclusion transforms the ethical dimensions of researchers’ methodological decisions. We conclude that research rivers produce particular forms of retrospective agency that highlighted affect throughout the pandemic and reframes the ethics for choosing and developing methods along an axis of inclusion and exclusion.
Clinical Case Review of Bilateral Retinal Metastasis
Authors: Nigam Antara , Patel Kashvi , Garg Anu
Published: August 2024

Bilateral retinal metastasis is a rare disease that represents less than 1% of ocular metastases. Additionally, the prevalence of ocular metastases overall is only 5% to 10%. It is uncommonly found due to the absence of a lymphatic system in the eye. Ocular metastasis is spread hematogenously and the retina only receives 5% of blood flow, contributing to the rarity of this condition. Retinal metastasis has been reported to mimic symptoms of retinitis which include watery eye discharge, conjunctival injection and pain with ocular movement which leads to a harder diagnosis. Treatment options for retinal metastasis include systemic chemotherapy, intravitreal chemotherapy, and plaque radiotherapy. However, despite treatment, retinal metastasis often has a poor prognosis. This is a case of a 65-year-old woman with a history of breast carcinoma status post mastectomy who initially presented with metastatic infiltration of the lung and liver. However, she later developed an interesting case of retinal metastasis, which presented as symptoms of retinitis and indicated widespread dissemination of an unknown primary neoplasm.
Pembrolizumab Combined With GDP Regimen Inducing Sustained Remission in Histiocytic Sarcoma: A Case Report
Authors: Gao Jinjie , Li Min , Liu Cuiling , Jing Hongmei
Published: August 2024

Histiocytic sarcoma (HS) is a rare hematopoietic neoplasm with an aggressive clinical course and a poor response to conventional chemotherapy. Currently, no standard treatment paradigms are available. Herein, we present a case of de novo HS treated with pembrolizumab combined with a GDP regimen (gemcitabine, cisplatin, and dexamethasone) that resulted in sustained complete remission with progression-free survival exceeding 4 years. Immunohistochemical analysis demonstrated significant overexpression of programmed death ligand 1 (PD-L1) on biopsy samples. Additionally, fluorescence in situ hybridization (FISH) with a JAK-2 probe indicated 9p24.1 amplification, suggesting reliance on the JAK-STAT pathway. Polymerase chain reaction (PCR) analysis did not reveal any BRAF-V600 mutations. Consequently, an immune checkpoint inhibitor (ICI) was administered alongside chemotherapy, resulting in sustained complete remission and progression-free survival for over 4 years. Our findings suggest that a combination of ICI and chemotherapy could represent a promising therapeutic approach for HS.
Rent Burden and Demographic Change Among Veterans: A Research Brief
Authors: Hess Chris , Horan Kristin , Collette Tyler , Sanchez Cardona Israel , Channer Bianca , Moore Brian
Published: August 2024

Housing affordability has worsened considerably over recent decades, and despite some progress, veterans remain relatively overrepresented among the unhoused. Nevertheless, veterans have historically been less impacted by housing affordability problems, whether this stems from factors such as greater access to homeownership, differential labor market returns related to veteran status or differences in the composition of the veteran population compared to non-veterans. In this study, we use data from the Panel Study of Income Dynamics (PSID) from 1976 to 2021 to document how housing unaffordability has become a growing problem among veterans who rent. We first demonstrate how the prevalence of housing cost burden among veteran renters has converged with that of the general population over the past four and a half decades. Second, we use a decomposition analysis to identify the factors most relevant to these trends observed over the span of our data, observing that changes in household composition and growing representation of veterans across disability status, race, and gender account for significant components of rising cost burden prevalence. We conclude by reviewing policy solutions tailored to groups who are overrepresented among cost burdened veterans. Overall, we find that “rent eats first” for everyone—veterans and their families included.
Understanding Pandemic Increases in Long-Stay Psychotropic Prescribing for Dementia Symptoms: A Survey of Nursing Home Clinicians
Authors: Kerns John William , Winter Jonathan D. , Winter Katherine M. , Etz Rebecca , Reves Sarah , Bergman C. J. Christian
Published: August 2024

Objective: To explore the perceptions of nursing home (NH) clinicians regarding factors underpinning known increases in psychotropic prescribing over the COVID-19 pandemic. Methods: Three iterative online surveys were fielded to Virginia NH prescribing clinicians (11/2021–6/2022) to assess their perspectives regarding factors driving pandemic increases in NH psychotropic use. Existing literature and emerging survey data informed survey content. Sampling was for convenience and achieved through crowdsourcing, leveraging collaborations with Virginia NH clinician professional organizations. Results: A total of 89 surveys were collected. Clinicians noted simultaneous surging of dementia symptoms with decreased availability of non-pharmacologic measures to remedy them, leading to increased prescribing of all psychotropics. Staff shortages and turnover, isolation from family and community, and personal protective equipment protocols were identified as key pandemic factors contributing to this mismatch. Conclusions: Virginia NH clinicians explicitly linked increased NH psychotropic prescribing to known pandemic phenomena, associations previously hypothesized, but not, to our knowledge, directly confirmed.
Survival Status and Predictors of Mortality Among Pediatrics Burn Victims Admitted to Burn Centers of Addis Ababa Public Hospitals, Ethiopia: A Retrospective Cohort Study
Authors: Bushen Zerihun Demisse , Ashine Taye Mezgebu , Teshome Girum Sebsibie , Tesfaye Kebede Tewodros , Adeba Tadesse Sahle
Published: August 2024

Background. Burn is a major public health problem in pediatric populations worldwide. This study aimed to determine the survival status and predictors of mortality among pediatric burn victims admitted to burn centers in Ethiopia.  Methods. A retrospective cohort study was conducted on the patient charts of 412 pediatric patients with burn injuries at burn centers in Addis Ababa from the 1st of January 2016 to the 30th of December 2019. Data was entered into the Epi-Data manager. Then, the data was exported to STATA V-14 for cleaning and analysis. For the analysis, the proportional hazard model was used. After the model fitness test, variables with a P-value of <.25 in the bivariate analysis were fitted to the multivariate analysis. Finally, statistical significance was decided at a P-value of <.05, and the hazard ratio was used to determine the strength of the association.  Result. The study reported an overall incidence rate of 2.4 per 1000 child days. Additionally, it revealed that the median hospital length of stay was 25.00 days (95% CI: 21.57, 28.45). During the follow-up period, 8.25% of deaths occurred among pediatric patients with burn injuries. Specifically, having a full-thickness burn (adjusted hazard ratio [AHR] 2.51, 95% CI: 1.12, 5.62) and neck burn (AHR 2.82, 95% CI: 1.04, 7.68) were identified as significant predictors contributing to increased mortality among burn-injured pediatric individuals.  Conclusion. The study highlighted significant mortality rates among pediatric patients suffering from burn injuries. Based on the findings a full-thickness burn injury and burns in the neck area are independent predictors of mortality in pediatric burn patients. Based on the identified predictors of mortality in pediatric burn patients, clinicians should prioritize early recognition, prompt intervention, multidisciplinary management, vigilant monitoring, and preventive strategies to optimize outcomes and reduce mortality rates in this vulnerable population.
Traumatic Renal Artery Occlusion in Children: A Case Report
Authors: Zouirech Yacine , Manni Abir , Rouijel Badr , Aqqaoui Loubna , Zerhouni Hicham , Oubejja Houda , Erraji Mounir , Ettayebi Fouad
Published: August 2024

Blunt trauma is a major cause of death in children, with renal arterial injuries occurring in less than 1% of cases. Traumatic renal artery occlusion (RAO) in children is rare and results in the loss of ipsilateral renal perfusion. Clinical signs are often nonspecific, and there is a lack of information on the exact incidence and management outcomes of these rare cases in children. We report a case of unilateral RAO in a 13-year-old boy with polytrauma. He was diagnosed with right RAO and hepatic laceration after a fall. A conservative approach yielded favorable outcomes despite the loss of function in the right kidney. In stable polytrauma patients, prompt diagnosis of RAO is crucial for treatment optimization and potential kidney salvage.
Knowledge, Attitude, and Practice on Cervical Cancer Prevention among Female University Students in Al-Kharj, Saudi Arabia
Authors: Abdel-Aziz Hassanat Ramadan , Mohamed Nermen Abdelftah , Elsehrawy Mohamed Gamal
Published: August 2024

Background

Cervical Cancer (CC) is the fourth most frequent malignancy worldwide among females with significant death rates. It ranks as the 8th most frequent cancer in Saudi female. CC is preventable, with likelihood of full treatment by early detection, because of its long pre-invasive period. Lack of awareness and practice on CC prevention and screening increase the risk of disease.

Objective

to examine knowledge, attitude, and practice on CC prevention among Saudi female university students.

Methods

A facility-based cross-sectional study with a convenience sample included 594 female university students studying at health and non-health colleges of Prince Sattam bin Abdulaziz University in Al-Kharj City, Saudi Arabia. All female students were asked to complete an online questionnaire on knowledge, attitude, and practice on CC prevention.

Results

A total of 594 respondents to the questionnaire, 88.7% of them had unsatisfactory knowledge about CC. Out of a total of 27 points, students’ knowledge mean score was 9.3 ± 6.4. Conversely the majority of students (94.4%) had positive attitude toward CC; the mean attitude score was 34.52 ± 5.04 out of 45. Regarding students practice, less than 7% of students were vaccinated against HPV and only 3.7% were screened for cancer cervix. Married females, health colleges students, and high attitude score were significant predictors for the students’ knowledge about cancer cervix (P < 0.05).

Conclusion

Majority of the respondents displayed lack of knowledge; however, they had a positive attitude toward CC. Very alarmingly, almost all of students had inadequate practice regarding CC prevention. So, the study recommends developing and implementing educational programs and strategies for female university students to improve their knowledge and practice related to cervix cancer. Results of this study provide evidence that can help in formulating effective awareness strategies and educational programs for women that would help in CC prevention.
Flow restoration during mechanical thrombectomy for large vessel occlusion is associated with an immediate reduction of systemic blood pressure
Authors: Kyselyova Anna Andriana , Brekenfeld Caspar , Meyer Lucas , Guerreiro Helena , Broocks Gabriel , Klapproth Susan , Faizy Tobias , Heitkamp Christian , Issleib Malte , Fiehler Jens , Flottmann Fabian
Published: August 2024

Introduction:

Managing blood pressure in patients with large vessel occlusion affects infarct size and clinical outcomes. We examined how restoring blood flow impacts systemic blood pressure during mechanical thrombectomy.

Patients and Methods:

Patients with large vessel occlusion in the anterior circulation undergoing mechanical thrombectomy between June 2016 and January 2018 were screened. We included those treated under local anesthesia or conscious sedation and analyzed standardized anesthesia protocols to assess systolic and diastolic blood pressure levels throughout the procedure. The primary outcome was the change of blood pressure, compared 5 min before versus 5 min after the last recanalization attempt. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction score ⩾ 2b.

Results:

Of 134 patients, 117 (87%) achieved successful angiographic reperfusion, showing a notable systolic blood pressure drop 5 min after flow restoration (10.2 ± 14.6 vs 3.24 ± 8.65 mm Hg, p = 0.009). Successful angiographic reperfusion was a significant predictor for this decrease in multivariable logistic regression: OR = 1.34 (95% CI: 1.03–1.73, p = 0.0299). Among 66 patients not given circulation-affecting meds, a significant systolic pressure reduction was also observed (155 ± 17 mm Hg to 148 ± 17 mm Hg ; p < 0.001). No diastolic pressure changes were significant.

Discussion and Conclusions:

Flow restoration was associated with an immediate reduction of systolic blood pressure values in patients undergoing mechanical recanalization under local anesthesia or conscious sedation. This suggests a complex interplay between endovascular stroke therapy and cardiovascular hemodynamics.
Retinal Toxicity Secondary to Suprachoroidal Migration of Mitomycin-C
Authors: Dirani Karim , Alfaro Cesar , Ridha Al-Timimi Faisal , Juzych Daniel , Yoganathan Pradeepa
Published: August 2024

Purpose: To report a case of suprachoroidal migration of mitomycin-C (MMC) with ensuing retinal toxicity after trabeculectomy. Methods: A case report of retinal toxicity is described with multimodal imaging. Results: A patient developed occlusion of the retinal and choroidal vasculature in a segmental fashion that could be explained by suprachoroidal diffusion. Fundus autofluorescence showed a stippled pattern over an area of hypofluorescence in the superonasal quadrant, and a late fluorescein angiogram image showed staining of the superonasal quadrant with dependent leakage toward the optic nerve and macula. Conclusions: MMC is commonly used in glaucoma-filtering surgical procedures, and few cases of postoperative posterior segment toxicity have been reported. To our knowledge, we are the first to describe suprachoroidal migration of MMC with subsequent retinal toxicity.
Resolution of Anterior Uveal Infiltration of Acute Lymphoblastic Leukemia After Chimeric Antigen Receptor T-Cell Therapy
Authors: Takhar Jaskirat S. , Mehra Ankur A. , Kurup Shree K. , Sobol Warren M. , Aslam Rabail , Oduro Kwadwo A. , Echegaray Jose J.
Published: August 2024

Purpose: To present a case of acute B-cell lymphoblastic leukemia (B-ALL) ocular relapse treated with chimeric antigen receptor T-cell (CAR-T) therapy. Methods: A retrospective case review was evaluated. Results: A 69-year-old woman with a history of B-ALL presented with bilateral hypopyons and 3+ anterior chamber cells that responded to topical prednisolone. Six months later, she developed recurrent hypopyons, iris neovascularization, and iris nodularity in both eyes. A fine-needle aspiration biopsy confirmed ocular infiltration of B-ALL. A single infusion of CAR-T therapy resulted in remission of the systemic and ocular findings. The clinical course was complicated by cytokine release syndrome and neurotoxicity, which improved with medical management. The patient remained in remission for 7 months after a single CAR-T infusion. Conclusions: CAR-T therapy may be effective in treating systemic leukemia and uveal infiltration, with a favorable ocular side-effect profile and visual outcomes. The systemic side effects of CAR-T therapy may be managed medically.
Resolution of Lipemia Retinalis With Lifestyle Modification
Authors: Prairie Michael L. , Rubino Shaina M. , Tang Peter H.
Published: August 2024

Purpose: To describe a case of lipemia retinalis, a rare ocular manifestation of hypertriglyceridemia that is characterized by a creamy-white to salmon-colored appearance to the fundus. Methods: A 55-year-old man was referred for an evaluation for diabetic retinopathy and was subsequently found to have marked lipemia retinalis. Results: The patient’s triglyceride levels were 3141 mg/dL; therefore, treatment was initiated with high-intensity statin therapy and lifestyle modifications. At the 3-month follow-up, the patient had significantly reduced triglyceride levels (689 mg/dL) and full resolution of lipemia retinalis. Conclusions: Lipemia retinalis may be an initial finding of a severe systemic problem and a harbinger for more severe, and potentially fatal, consequences. Thus, a complete systemic assessment is warranted for any patient with signs of lipemia retinalis.
Oil, gold, and guns: The violent politics of Sudan’s resource re-curse
Authors: Patey Luke
Published: August 2024

The green transition and slowdown of global fossil fuel demand present an intriguing question for the future of oil-rich developing countries where less democracy, unstable and inequitable economics, and conflict have long been prevalent. Sudan offers an ex-ante look at the consequences of this transition to a post-oil world. In 2011, Sudan lost three-quarters of its oil resources after South Sudan’s separation. This article explores the impact of decarbonization on Sudan’s political economy and the role of natural resources in shaping its elite politics and foreign relations. It argues that in the short term and mid-term, the Sudanese state was able to weather the loss of most of its oil, with incumbent political elites demonstrating staying power beyond the expiry date of high oil rents. In the long term, however, rather than a diversified economy and democratic alternative emerging, both Sudan’s longstanding predatory political economy and its external exploitative links endured the decline of oil. The rising economic importance of gold, and its political ecology as a dispersed and lootable resource, coupled with opportunities for regional extraversion facilitated the violent rise of new political elites and shaped a shift in Sudan’s main foreign economic partners from China to the Gulf states.
Unraveling neuronal and metabolic alterations in neurofibromatosis type 1
Authors: Botero Valentina , Tomchik Seth M.
Published: August 2024

Neurofibromatosis type 1 (OMIM 162200) affects ~ 1 in 3,000 individuals worldwide and is one of the most common monogenetic neurogenetic disorders that impacts brain function. The disorder affects various organ systems, including the central nervous system, resulting in a spectrum of clinical manifestations. Significant progress has been made in understanding the disorder’s pathophysiology, yet gaps persist in understanding how the complex signaling and systemic interactions affect the disorder. Two features of the disorder are alterations in neuronal function and metabolism, and emerging evidence suggests a potential relationship between them. This review summarizes neurofibromatosis type 1 features and recent research findings on disease mechanisms, with an emphasis on neuronal and metabolic features.
Role of the central nervous system in cell non-autonomous signaling mechanisms of aging and longevity in mammals
Authors: Urushihata Takuya , Satoh Akiko
Published: August 2024

Multiple organs orchestrate the maintenance of proper physiological function in organisms throughout their lifetimes. Recent studies have uncovered that aging and longevity are regulated by cell non-autonomous signaling mechanisms in several organisms. In the brain, particularly in the hypothalamus, aging and longevity are regulated by such cell non-autonomous signaling mechanisms. Several hypothalamic neurons have been identified as regulators of mammalian longevity, and manipulating them promotes lifespan extension or shortens the lifespan in rodent models. The hypothalamic structure and function are evolutionally highly conserved across species. Thus, elucidation of hypothalamic function during the aging process will shed some light on the mechanisms of aging and longevity and, thereby benefiting to human health.
Correlates of low resilience and physical and mental well-being among Black youths in Canada
Authors: Oluwasina Folajinmi , Henderson Jo , McKenzie Kwame , Mullings Delores V. , Renzaho Andre M.N , Sajobi Tolulope , Rousseau Cecile , Senthilselvan Ambikaipakan , Hamilton Hayley , Salami Bukola
Published: August 2024

Background

Resilience has gained considerable attention in the mental health field as a protective factor that enables individuals to overcome mental health issues and achieve positive outcomes. A better understanding of resilience among Black youth is important for supporting the strengths and capacities within this population. This study seeks to investigate the correlates of resilience among Black youths in Canada.

Methods

The survey was conducted online through REDCap between November 2022 and March 2023. The Brief Resilience Scale (BRS) was utilized to measure the capacity of participants to recover from or bounce back from stress. The BRS comprises six five-point Likert scale items. Data were analyzed employing a bivariate analysis followed by a multivariable binary logistic regression.

Results

A total of 933 Black youths participated in the study across all Canadian provinces, of which 51.8% (483) identified as female and 46.7% (436) as male. Most respondents 51.3% (479) were between the ages of 16 and 20 years, with 28% (261) between the ages of 21 and 25 years, and 20.2% (188) between the ages of 26 and 30 years. In terms of employment, 62.0% (578) were working part-time, 23.7%, (220) were unemployed, and 9.8% (91) were working full-time. Over a third of participants (39.3%, 331) rated their mental health over the last month as good, with 34% (317) giving a rating of poor and 20.9% (195) giving a rating of fair. Black youths who were working part-time had four times greater odds of expressing low resilience (OR: 4.02; 95% CI: 1.82–11.29) than those who were not working. Black youth who ranked their mental health as poor were about nine times (OR: 8.65; 95% CI: 1.826–21.978) more likely to express low resilience.

Conclusion

In this study, the Black youth participants reported relatively low resilience scores. Employment, physical health, and mental health status were factors that contributed to low resilience. Further studies are needed to examine the causal link between resilience and its dynamic effect on health outcomes among Black youth. More interventions are needed to make mental health services accessible to Black youth in a more culturally sensitive way with cross-culturally trained professionals.
Measuring breastfeeding prevalence using demographic and health surveys
Authors: Chabé-Ferret Bastien
Published: August 2024

Background

This study aims to investigate the measurement of breastfeeding prevalence indicators using Demographic and Health Surveys (DHS) data, focusing on early initiation, exclusive breastfeeding, and continued breastfeeding indicators as reported by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) and on the discrepancies arising from small changes in their definition.

Methods

Two hundred sixty DHS samples from 78 countries were analyzed to re-calculate usual indicators reported by WHO and UNICEF: early initiation of breastfeeding (EIB), exclusive breastfeeding under 6 months (EBF), and continued breastfeeding between 1 and 2 years (CBF12 and CBF24). Additionally, alternative estimates of the same indicators, slightly changing their definition, were calculated to test their robustness.

Results

The WHO and UNICEF indicators for early initiation (EIB) primarily capture cases where breastfeeding is initiated “immediately” after birth, omitting those initiated within 0 or 1 hour. This discrepancy leads to substantial underestimation of levels in some regions, particularly South Asia, and in trends. Furthermore, sizable discrepancies between exclusive breastfeeding (EBF) indicators arise from the inclusion or exclusion of plain water in the definition, with significant variations across regions, especially in West and Middle Africa. However, continued breastfeeding indicators showed consistency across definitions, proving them robust for international comparisons and time trend estimations.

Conclusion

This study highlights the importance of understanding how breastfeeding indicators are defined and calculated using DHS data. Researchers should be cautious when using WHO and UNICEF indicators for early initiation and exclusive breastfeeding, as they may underestimate prevalence due to their narrow definition. Continued breastfeeding indicators, on the other hand, are less affected by small changes in definitions and provide reliable measures for cross-country comparisons and trend analyses. These findings underscore the need for standardized robust definitions and transparent reporting of breastfeeding indicators in global health assessments.
Accessibility, neighborhood socioeconomic disadvantage and expenditures on electronic gambling machines: a spatial analysis based on player account data
Authors: Selin Jani , Okkonen Pasi , Raisamo Susanna
Published: August 2024

Background

Gambling and its harmful effects on human health and well-being represent a significant public health concern in many countries, with electronic gambling machines (EGMs) recognized as one of the most detrimental forms of gambling. Previous research has established an association between EGM accessibility, expenditure, gambling harm, and the socioeconomic status (SES) of neighborhoods. However, there is limited understanding of the direct impact of SES and EGM accessibility on individual player expenditures. Prior estimations of expenditure often rely on self-reported data or venue-level revenue statistics. This study uses high spatial resolution socioeconomic data together with individual-level account-based location and expenditure (point of sales) data (71,669 players, 745 EGM venues) to explore the association between EGM accessibility and neighborhood SES and to examine whether the EGM expenditure of neighborhood residents is associated with EGM accessibility and neighborhood SES.

Data and methods

Player account data include information on the home location and expenditure of the entire EGM gambling population across every EGM venue located in the Helsinki region, Finland. High-resolution (250 × 250 m) grid-level data on socioeconomic variables were used to obtain the local socioeconomic conditions of the players. EGM accessibility was estimated for every grid cell using a calibrated gravity model derived from the player account data. Statistical analyses included correlation analysis, spatial autocorrelation analysis, and regression models.

Results

First, significantly higher levels of EGM accessibility were found in areas with lower local SES. Second, regression analysis revealed that both higher EGM accessibility and lower local SES were associated with higher annual losses per adult. These results, in combination with visual and spatial autocorrelation analyses, revealed that accessibility to EGM gambling is highly concentrated, especially in lower socioeconomic neighborhoods with higher levels of EGM expenditure.

Conclusions

The results lay the groundwork for future spatial research on gambling harm, expenditure, accessibility, and SES utilizing detailed account data on the interaction between players and venues. The results underscore the importance of spatial restrictions when regulating EGM accessibility, particularly in areas with vulnerable populations, as a crucial measure for public health and harm prevention. The results also enable targeted gambling harm prevention actions at the local level.
Altered methylation of imprinted genes in neuroblastoma: implications for prognostic refinement
Authors: Suman Medha , Löfgren Maja , Fransson Susanne , Yousuf Jewahri Idris , Svensson Johanna , Djos Anna , Martinsson Tommy , Kogner Per , Kling Teresia , Carén Helena
Published: August 2024

Background

Neuroblastoma (NB) is a complex disease, and the current understanding of NB biology is limited. Deregulation in genomic imprinting is a common event in malignancy. Since imprinted genes play crucial roles in early fetal growth and development, their role in NB pathogenesis could be suggested.

Methods

We examined alterations in DNA methylation patterns of 369 NB tumours at 49 imprinted differentially methylated regions (DMRs) and assessed its association with overall survival probabilities and selected clinical and genomic features of the tumours. In addition, an integrated analysis of DNA methylation and allele-specific copy number alterations (CNAs) was performed, to understand the correlation between the two molecular events.

Results

Several imprinted regions with aberrant methylation patterns in NB were identified. Regions that underwent loss of methylation in > 30% of NB samples were DMRs annotated to the genes NDN, SNRPN, IGF2, MAGEL2 and HTR5A and regions with gain of methylation were NNAT, RB1 and GPR1. Methylation alterations at six of the 49 imprinted DMRs were statistically significantly associated with reduced overall survival: MIR886, RB1, NNAT/BLCAP, MAGEL2, MKRN3 and INPP5F. RB1, NNAT/BLCAP and MKRN3 were further able to stratify low-risk NB tumours i.e. tumours that lacked MYCN amplification and 11q deletion into risk groups. Methylation alterations at NNAT/BLCAP, MAGEL2 and MIR886 predicted risk independently of MYCN amplification or 11q deletion and age at diagnosis. Investigation of the allele-specific CNAs demonstrated that the imprinted regions that displayed most alterations in NB tumours harbor true epigenetic changes and are not result of the underlying CNAs.

Conclusions

Aberrant methylation in imprinted regions is frequently occurring in NB tumours and several of these regions have independent prognostic value. Thus, these could serve as potentially important clinical epigenetic markers to identify individuals with adverse prognosis. Incorporation of methylation status of these regions together with the established risk predictors may further refine the prognostication of NB patients.
Experiences of breast milk donors in Sweden: balancing the motivation to do something good with overcoming the challenges it entails
Authors: Blomqvist Ylva Thernström , Olsson Emma
Published: August 2024

Background

Infants requiring neonatal care often face initial breastfeeding challenges, leading them to receive expressed breast milk from their mother or donor milk. While emphasizing the mother’s own milk as the gold standard for infant nutrition, the utilization of donor milk stands as the preferred alternative over infant formula due to its numerous benefits. To facilitate the provision of donor milk to preterm and ill infants in neonatal units, the active participation of women willing to contribute their breast milk is crucial. This study aims to enhance the understanding of women’s experiences in the donation process, thereby contributing to efforts aiming at alleviating the shortage of donated breast milk by improve the care and support for breast milk donors.

Methods

This descriptive qualitative study took an inductive approach based on individual semi-structured interviews conducted during 2021 with 15 breast milk donors in Sweden. The data were analysed with thematic analysis.

Results

Two themes were identified in the analysis: motivation to donate and challenges to overcome. Many of the women struggled to overcome the apparent challenges of not only starting the process of donating breast milk but also maintaining it. Despite the strain, they were motivated to donate their breast milk and seeking information by themselves to do something important for someone else. Only a few of the women talked about the financial benefits of donating breast milk; donating seemed to be mostly based on altruistic reasons.

Conclusions

Despite the challenges posed by COVID-19 restrictions, time consumption, and the hard work of sterilizing pump utensils, women continued to donate their milk driven by altruism. To enhance donor support and increase milk donation, several improvements are suggested: providing comprehensive information and resources, simplifying the donation process, offering flexible scheduling, and recognizing donors’ contributions.
Experiences of quality of life and access to health services among rare disease caregivers: a scoping review
Authors: Černe Tina , Kragelj Lijana Zaletel , Turk Eva , Pavlič Danica Rotar
Published: August 2024

Background

Research on rare diseases focuses less on caregivers, who play an important role in meeting the medical and social needs of the people they care for. Caregivers of people with rare diseases face negative outcomes due to problems with diagnosis, caring for complex conditions and expensive treatments. However, the factors that affect their quality of life are poorly understood. Poor mental and physical health of caregivers has a direct impact on the person they are caring for.

Methods

To explore the literature on this topic, we conducted a scoping review in which we identified and analysed relevant studies to find out how extensively this topic has been researched. The articles were retrieved from the bibliographic databases PubMed, Ovid Medline and Ebsco Cinahl.

Results

We initially identified 299 references and then included thirty-four articles. The included articles address three main topics, namely caregiver quality of life, health care accessibility, and the impact of health care accessibility on caregiver QOL.

Conclusion

This study provides information that is important to multiple providers of services as it can help to better understand caregivers and people with rare diseases and improve the quality of services offered. It highlights areas with the greatest need for change and offers insight into the complexity of caring for people with rare diseases, assisting policymakers in developing policies to support informal caregivers.
Effectiveness of a cognitive behavioural therapy (CBT)-based intervention for reducing anxiety among adolescents in the Colombo District, Sri Lanka: cluster randomized controlled trial
Authors: De Silva Sinha , Peris Renuka , Senaviratne Sudharshi , Samaranayake Dulani
Published: August 2024

Anxiety disorders are found to be the most prevalent psychological problems among children and adolescents. Cognitive behaviour therapy (CBT) was found to be effective at reducing anxiety. The purpose of this study was to assess the effectiveness of a universal school-based intervention for reducing anxiety among Grade 9 schoolchildren. A randomized controlled cluster trial was conducted by randomly assigning 36 schools in the Colombo district in Sri Lanka into study and control arms, each comprising 18 schools with 360 students. The levels of anxiety, self-esteem and depression status were assessed using the validated Screen for Child Anxiety Related Disorders (SCARED) tool and the Rosenberg self-esteem scale, respectively, and the Depression, Anxiety and Stress Scale 21 (DASS-21) at baseline, after intervention, and after 3 months. A CBT-based universal intervention package was administered weekly by a trained teacher for eight weeks with a one-month self-practice period to a randomly selected Grade 9 class in each school in the study arm. The control arm received routine care. Anxiety and self-esteem scores and depression status were compared between the two arms after the intervention and at 3 months of follow-up using the generalized estimation equation (GEE), controlling for confounding and clustering. The nonresponse and loss to follow-up rates were < 1%. When comparing the study arm with the control arm using GEE, anxiety levels were significantly lower [β = (-0.096), 95% CI = (-0.005) − (-0.186), p = 0.038] at follow-up but not postintervention [β = (-0.024), 95% CI = 0.006 − (-0.055), p = 0.115]. There were no significant differences in depression status after intervention (OR = 0.257, 95% CI =0.052–1.286; p = 0.098) or follow-up (OR = 0.422, 95% CI 0.177–1.008; p = 0.052), and self-esteem significantly increased after intervention (β = 0.811, 95% CI = 0.314–1.309; p = 0.001) but not at follow-up [β=0.435, 95% CI=(-0.276)-1.145, p=0.231]. This study revealed that the universal package based on CBT is effective at reducing anxiety and improving self-esteem among adolescents. The trial registration number and date were SLCTR/2018/018 and 19th of June 2018 respectively.
USP36 promotes tumorigenesis and tamoxifen resistance in breast cancer by deubiquitinating and stabilizing ERα
Authors: Zhuang Ting , Zhang Shuqing , Liu Dongyi , Li Zhongbo , Li Xin , Li Jiaoyan , Yang Penghe , Zhang Chenmiao , Cui Jiayao , Fu Mingxi , Shen Fangyu , Yuan Lei , Zhang Zhao , Su Peng , Zhu Jian , Yang Huijie
Published: August 2024

Background

Breast cancer is the most prevalent cancer in women globally. Over-activated estrogen receptor (ER) α signaling is considered the main factor in luminal breast cancers, which can be effectively managed with selective estrogen receptor modulators (SERMs) like tamoxifen. However, approximately 30–40% of ER + breast cancer cases are recurrent after tamoxifen therapy. This implies that the treatment of breast cancer is still hindered by resistance to tamoxifen. Recent studies have suggested that post-translational modifications of ERα play a significant role in endocrine resistance. The stability of both ERα protein and its transcriptome is regulated by a balance between E3 ubiquitin ligases and deubiquitinases. According to the current knowledge, approximately 100 deubiquitinases are encoded in the human genome, but it remains unclear which deubiquitinases play a critical role in estrogen signaling and endocrine resistance. Thus, decoding the key deubiquitinases that significantly impact estrogen signaling, including the control of ERα expression and stability, is critical for the improvement of breast cancer therapeutics.

Methods

We used several ER positive breast cancer cell lines, DUB siRNA library screening, xenograft models, endocrine-resistant (ERα-Y537S) model and performed immunoblotting, real time PCR, RNA sequencing, immunofluorescence, and luciferase activity assay to investigate the function of USP36 in breast cancer progression and tamoxifen resistance.

Results

In this study, we identify Ubiquitin-specific peptidase 36 (USP36) as a key deubiquitinase involved in ERα signaling and the advancement of breast cancer by deubiquitinases siRNA library screening. In vitro and in vivo studies showed that USP36, but not its catalytically inactive mutant (C131A), could promote breast cancer progression through ERα signaling. Conversely, silencing USP36 inhibited tumorigenesis. In models resistant to endocrine therapy, silencing USP36 destabilized the resistant form of ERα (Y537S) and restored sensitivity to tamoxifen. Molecular studies indicated that USP36 inhibited K48-linked polyubiquitination of ERα and enhanced the ERα transcriptome. It is interesting to note that our results suggest USP36 as a novel biomarker for treatment of breast cancer.

Conclusion

Our study revealed the possibility that inhibiting USP36 combined with tamoxifen could provide a potential therapy for breast cancer.