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Rheumatology (Oxford, England) Jul 2024SLE presents significant challenges for patients and health-care professionals (HCPs), both across Europe and worldwide. Improving health-care outcomes for patients with... (Review)
Review
SLE presents significant challenges for patients and health-care professionals (HCPs), both across Europe and worldwide. Improving health-care outcomes for patients with SLE requires a comprehensive understanding of patient disease pathways. In particular, the geographical distance between SLE patients and specialized care centres, combined with the scarcity of rheumatologists, exacerbates delays in diagnosis and management. Also, the initial SLE symptoms can often be non-specific, and providing guidelines for primary HCPs and other non-specialists is extremely important. Improvement in access to treatment is also important, with several recently approved therapies for SLE not being available in several European countries and many low- and middle-income countries (LMICs). Furthermore, in the LMICs in which these treatments are available, they are not always covered by the health-care system, making their access almost impossible for those of lower socio-economic status. A number of provisions are already in place within the European Union, to improve access to care for patients with rare and complex diseases, including those with SLE. In particular, European Reference Networks (ERNs), such the ERN for Autoimmune Diseases ReCONNET, are virtual networks involving HCPs across Europe with the aim of improving the care of patients with rare and complex diseases that require highly specialized treatment and a concentration of knowledge and resources. In addition, lupus patient organizations such as Lupus Europe play a crucial role in raising awareness of SLE and advocating for improved access to care. Together, we can work towards a future where all people living with lupus receive the comprehensive and timely care they deserve.
Topics: Humans; Lupus Erythematosus, Systemic; Health Services Accessibility; Europe; Global Health
PubMed: 38949781
DOI: 10.1093/rheumatology/keae227 -
ASAIO Journal (American Society For... Jul 2024We report the largest pediatric multicenter experience with Impella pump use and peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support....
We report the largest pediatric multicenter experience with Impella pump use and peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. Utilizing the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) collaborative database, we conducted a retrospective, multicenter study of all patients with cardiogenic shock requiring VA-ECMO support with subsequent Impella implant between October 2014 and December 2021. The primary outcome was defined as death while on Impella support. Secondary outcomes were recovery, transplantation, and transition to durable ventricular assist device (VAD) at the time of Impella explantation. Adverse events were defined according to the ACTION registry criteria. Twenty subjects were supported with Impella; Impella 2.5 (n = 3), CP (n = 12), 5.0/5.5 (n = 5). The median Interquartile range (IQR) age, weight, and body surface area at implantation were 15.6 years (IQR = 13.9-17.2), 65.7 kg (IQR = 53.1-80.7), and 1.74 m2 (IQR = 1.58-1.98). Primary cardiac diagnoses were dilated cardiomyopathy/myocarditis in nine (45%), congenital heart disease in four (20%), graft failure/rejection in four (20%), and three (15%) others. Most common adverse events included hemolysis (50%) and bleeding (20%). There were two deaths (10%) in the cohort. Nine patients (45%) were explanted for recovery, eight (40%) were transitioned to a durable VAD, and one (5%) underwent heart transplantation. Impella percutaneous pump support should be considered in the older pediatric population supported with peripheral VA-ECMO, as a means of left heart decompression, and a strategy to come off ECMO to achieve endpoints of myocardial recovery, transition to a durable VAD, or transplantation.
Topics: Humans; Extracorporeal Membrane Oxygenation; Heart-Assist Devices; Retrospective Studies; Male; Female; Adolescent; Shock, Cardiogenic; Child; Child, Preschool; Treatment Outcome
PubMed: 38949774
DOI: 10.1097/MAT.0000000000002150 -
ASAIO Journal (American Society For... Jul 2024Extracorporeal carbon dioxide removal (ECCO2R) devices are increasingly used in treating acute-on-chronic respiratory failure caused by chronic lung diseases. There are...
Extracorporeal carbon dioxide removal (ECCO2R) devices are increasingly used in treating acute-on-chronic respiratory failure caused by chronic lung diseases. There are no large studies that investigated safety, efficacy, and the independent association of prognostic variables to survival that could define the role of ECCO2R devices in such patients. This multicenter, multinational, retrospective study investigated the efficacy, safety of a single ECCO2R device (Hemolung) in patients with acute on chronic respiratory failure and identified variables independently associated with intensive care unit (ICU) survival. The primary outcome was improvement in blood gasses with the use of Hemolung. Secondary outcomes included reduction in tidal volume, respiratory rate, minute ventilation, survival to ICU discharge, and complication profile. Multivariable regression analysis was used to identify variables that are independently associated with ICU survival. A total of 62 patients were included. There was a significant improvement in pH and partial pressure of carbon dioxide in arterial blood (PaCO2) along with a reduction in respiratory rate, tidal volume, and minute ventilation with Hemolung therapy. The complication profile did not differ between survivors and nonsurvivors. Multivariable analysis identified the duration of Hemolung therapy to be independently associated with survival to ICU discharge (adjusted odds ratio = 1.21; 95% confidence interval [CI] = 1.040-1.518; p = 0.01).
Topics: Humans; Retrospective Studies; Male; Female; Middle Aged; Respiratory Insufficiency; Carbon Dioxide; Aged; Extracorporeal Membrane Oxygenation; Intensive Care Units; Treatment Outcome; Adult; Tidal Volume
PubMed: 38949772
DOI: 10.1097/MAT.0000000000002155 -
Law and Human Behavior Jun 2024The presence of callous-unemotional (CU) traits in adolescence predisposes youth to negative behavioral and social outcomes and may be particularly damaging to youth...
OBJECTIVE
The presence of callous-unemotional (CU) traits in adolescence predisposes youth to negative behavioral and social outcomes and may be particularly damaging to youth involved in the justice system. Whereas research has shown that CU traits predict later arrest, it remains unknown whether rearrest predicts changes in CU traits and whether these associations may be modified by maternal relationship quality. The present study assessed whether being rearrested predicted changes in CU traits and whether these associations varied by maternal warmth and maternal hostility.
HYPOTHESES
We hypothesized that self-reported CU traits would increase at data collection time points following rearrest. Further, we hypothesized that maternal warmth would buffer the negative effects of rearrest, whereas maternal hostility would not have a significant moderating effect on the associations.
METHOD
Hypotheses were tested using a large, multisite longitudinal data set of 1,216 justice-involved male youth (Mage = 15.82 years at baseline; 47% Latino, 38% Black/African American, 15% White). Data from a series of nine interviews (across a 7-year period) were used to determine associations between rearrest at one-time point and CU traits at the subsequent time point.
RESULTS
Rearrest is associated with a significant increase in CU traits. However, these associations are not moderated by either maternal warmth or maternal hostility.
CONCLUSIONS
Rearrest predicts increases in a known risk factor for healthy socioemotional development among justice-involved youths (CU traits). Moreover, the way rearrest is associated with CU traits does not change depending on maternal warmth; rearrest is associated with increases in CU traits irrespective of the quality of a youth's relationship with their mother. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Topics: Humans; Male; Adolescent; Mother-Child Relations; Female; Juvenile Delinquency; Longitudinal Studies; Hostility; Emotions; Antisocial Personality Disorder
PubMed: 38949766
DOI: 10.1037/lhb0000567 -
Journal of Fluorescence Jul 2024One of the exciting developments in contemporary luminescence research is the development of rare earth triggered luminescent glasses, which are a type of lanthanide...
One of the exciting developments in contemporary luminescence research is the development of rare earth triggered luminescent glasses, which are a type of lanthanide activated luminous material. For the first time, Ce, Eu activated/co-activated MgCaNa(PO) orthophosphate glasses have been synthesized using the proposed work's melt quenching technique. The proposed glass sample's XRD pattern has an amorphous character, although its most prominent peak matches data from the MgCaNa(PO) standard ICSD database. FT-IR analysis was used to analyze the proposed glass sample's vibrational characteristics. Co-activated MgCaNa(PO) glass exhibits large emission peaks under UV excitations that cover the far red area during a photoluminescence examination. These outcomes demonstrate the proposed sample's value in applications such as WLEDs and plant cultivation.
PubMed: 38949754
DOI: 10.1007/s10895-024-03783-w -
Drug Delivery and Translational Research Jun 2024Parkinson's disease (PD), affecting millions of people worldwide and expected to impact 10 million by 2030, manifests a spectrum of motor and non-motor symptoms linked...
Parkinson's disease (PD), affecting millions of people worldwide and expected to impact 10 million by 2030, manifests a spectrum of motor and non-motor symptoms linked to the decline of dopaminergic neurons. Current therapies manage PD symptoms but lack efficacy in slowing disease progression, emphasizing the urgency for more effective treatments. Resveratrol (RSV), recognized for its neuroprotective and antioxidative properties, encounters challenges in clinical use for PD due to limited bioavailability. Researchers have investigated lipid-based nanoformulations, specifically solid lipid nanoparticles (SLNs), to enhance RSV stability. Oral drug delivery via SLNs faces obstacles, prompting exploration into transdermal delivery using SLNs integrated with microneedles (MNs) for improved patient compliance. In this study, an RSV-loaded SLNs (RSV -SLNs) incorporated into the MN patch was developed for transdermal RSV delivery to improve its stability and patient compliance. Characterization studies demonstrated favorable physical properties of SLNs with a sustained drug release profile of 78.36 ± 0.74%. The developed MNs exhibited mechanical robustness and skin penetration capabilities. Ex vivo permeation studies displayed substantial drug permeation of 68.39 ± 1.4% through the skin. In an in vivo pharmacokinetic study, the RSV-SLNs delivered through MNs exhibited a significant increase in C, T, and AUC values, alongside a reduced elimination rate in blood plasma in contrast to the administration of pure RSV via MNs. Moreover, an in vivo study showcased enhanced behavioral functioning and increased brain antioxidant levels in the treated animals. In-vivo skin irritation study revealed no signs of irritation till 24 h which permits long-term MNs application. Histopathological analysis showed notable changes in the brain regions of the rat, specifically the striatum and substantia nigra, after the completion of the treatment. Based on these findings, the development of an RSV-SLN loaded MNs (RSVSNLMP) patch presents a novel approach, with the potential to enhance the drug's efficiency, patient compliance, and therapeutic outcomes for PD, offering a promising avenue for advanced PD therapy.
PubMed: 38949746
DOI: 10.1007/s13346-024-01656-0 -
Supportive Care in Cancer : Official... Jun 2024This study aimed to investigate the effect of the presence of metabolic syndrome (MetS) on the limb volume and quality of life (QoL) of patients who underwent complex... (Comparative Study)
Comparative Study
A comparative evaluation of the efficacy of complete decongestive therapy in the treatment of unilateral breast cancer-related lymphedema with and without metabolic syndrome.
AIM
This study aimed to investigate the effect of the presence of metabolic syndrome (MetS) on the limb volume and quality of life (QoL) of patients who underwent complex decongestive therapy (CDT) due to unilateral breast cancer-related lymphedema (BCRL).
METHODS
Forty female patients with unilateral BCRL, of whom 20 had MetS (MetS group) and 20 did not have MetS (control group), were included in the study. The participants received CDT 5 days a week for 3 weeks. The participants' limb volume (percentage of excess volume (PEV) and percentage reduction of excess volume (PREV) was determined using a tape measure, and their QoL was assessed using the Lymphedema Quality of Life questionnaire (LYMQoL) before and after treatment.
RESULTS
After the treatment, the PEV and PREV values and LYMQoL-symptoms scores of the patients improved (p < 0.05); however, the LYMQoL-function, appearance/body image, mood/emotions, and overall QoL scores did not change in the MetS group (p > 0.05). In the control group, the PEV and PREV values and the LYMQoL-appearance/body image, mood/emotions, and overall QoL scores improved (p < 0.05), but the LYMQoL-symptoms and LYMQoL-function scores did not change (p > 0.05). There was a greater increase in the post-treatment PEV and PREV values of the control group compared to the MetS group (p < 0.001).
CONCLUSION
The study yielded that CDT was an effective treatment in BCRL with and without MetS; however, the improvement was greater in BCRL cases without MetS than in those with MetS. Therefore, the presence of MetS should be taken into account in the treatment of lymphedema in patients who develop BCRL.
TRIAL REGISTRATION
ClinicalTrials.gov, identifier: NCT05426993. Registered 2022-06-16. https://clinicaltrials.gov/search?cond=NCT05426993.
Topics: Humans; Female; Quality of Life; Middle Aged; Metabolic Syndrome; Breast Cancer Lymphedema; Adult; Surveys and Questionnaires; Breast Neoplasms; Treatment Outcome; Aged; Lymphedema
PubMed: 38949715
DOI: 10.1007/s00520-024-08676-z -
Journal of Youth and Adolescence Jun 2024Schools in the United States are increasingly offering ethnic studies classes, which focus on exploring students' ethnic-racial identities (ERI) and critical analysis of...
Schools in the United States are increasingly offering ethnic studies classes, which focus on exploring students' ethnic-racial identities (ERI) and critical analysis of systemic racism, to their diverse student bodies, yet scant research exists on their effectiveness for students of different ethnic-racial backgrounds in multiracial classrooms. A policy change to require all high school students in one school district to take an ethnic studies class facilitated a natural experiment for comparing the effects of quasi-random assignment to an ethnic studies class (treatment) relative to a traditional social studies class (control; e.g., U.S. Government, Human Geography). Student surveys and school administrative data were used to compare students' ERI development, well-being, and academic outcomes across ethnic studies and control classes. Participants (N = 535 9th graders; 66.1% ethnic studies) had diverse ethnic-racial (33.5% non-Latine White, 29.5% Black, 21.1% Latine, 10.7% biracial, 2.8% Asian, 2.2% Native American) and gender identities (44.7% female, 7.1% non-binary). Ethnic studies students reported marginally higher ERI exploration and resolution than controls, and sensitivity analyses showed a statistically significant effect on ERI among participants with complete midpoint surveys. Higher resolution was associated with better psychological well-being for all students and higher attendance for White students. Students with low middle school grades (GPA < 2.0) had better high school grades in core subjects when enrolled in ethnic studies than the control class. Overall, the results of this natural experiment provide preliminary support for ethnic studies classes as a method for promoting ERI development, well-being, attendance, and academic achievement for students from diverse ethnic-racial backgrounds.
PubMed: 38949674
DOI: 10.1007/s10964-024-02039-x -
Global Health Action Dec 2024The COVID-19 pandemic prompted varied policy responses globally, with Latin America facing unique challenges. A detailed examination of these policies' impacts on health...
BACKGROUND
The COVID-19 pandemic prompted varied policy responses globally, with Latin America facing unique challenges. A detailed examination of these policies' impacts on health systems is crucial, particularly in Bolivia, where information about policy implementation and outcomes is limited.
OBJECTIVE
To describe the COVID-19 testing trends and evaluate the effects of quarantine measures on these trends in Cochabamba, Bolivia.
METHODS
Utilizing COVID-19 testing data from the Cochabamba Department Health Service for the 2020-2022 period. Stratified testing rates in the health system sectors were first estimated followed by an interrupted time series analysis using a quasi-Poisson regression model for assessing the quarantine effects on the mitigation of cases during surge periods.
RESULTS
The public sector reported the larger percentage of tests (65%), followed by the private sector (23%) with almost double as many tests as the public-social security sector (11%). In the time series analysis, a correlation between the implementation of quarantine policies and a decrease in the slope of positive rates of COVID-19 cases was observed compared to periods without or with reduced quarantine policies.
CONCLUSION
This research underscores the local health system disparities and the effectiveness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabamba region. The findings stress the importance of the measures' intensity and duration, providing valuable lessons for Bolivia and beyond. As the global community learns from the pandemic, these insights are critical for shaping resilient and effective health policy responses.
Topics: Humans; COVID-19; Bolivia; Quarantine; Interrupted Time Series Analysis; SARS-CoV-2; Health Policy; COVID-19 Testing; Pandemics
PubMed: 38949664
DOI: 10.1080/16549716.2024.2371184 -
The Journal of Nervous and Mental... Jul 2024The study was set out to establish the potential for psychotherapy to effect improvements in patients with narcissistic personality disorder (NPD). Eight patients with...
The study was set out to establish the potential for psychotherapy to effect improvements in patients with narcissistic personality disorder (NPD). Eight patients with NPD who improved in treatment were identified. Consensus clinician/investigator diagnostic scores from before and after the psychotherapies were retroactively established on the Diagnostic Interview for Narcissism (DIN) and the Diagnostic Statistic Manual for Psychiatric Disorders, 5th Edition (DSM-5) Personality Disorder Section II criteria. Psychosocial functioning (work or school, romantic relationships) before and after the psychotherapies was retroactively evaluated as well. At the completion of the therapies after 2.5 to 5 years, all patients had improved, no longer met DIN or DSM-5 criteria for NPD, and showed better psychosocial functioning. Symptomatic improvements were associated with large effect sizes. In conclusion, changes in NPD can occur in treatment after 2.5 to 5 years. Future research should identify patient characteristics, interventions, and common processes in such improved cases that could help with development of treatments.
Topics: Humans; Personality Disorders; Adult; Female; Male; Middle Aged; Psychotherapy; Treatment Outcome; Narcissism; Young Adult; Diagnostic and Statistical Manual of Mental Disorders; Psychosocial Functioning; Narcissistic Personality Disorder
PubMed: 38949659
DOI: 10.1097/NMD.0000000000001777