Search Results (67)

Background: Breast cancer-related lymphedema (BCRL) is a common and debilitating treatment-related adverse event that can profoundly impact quality of life and financial well-being. Although prospective surveillance and early intervention for BCRL have been shown to reduce the incidence and severity of this chronic condition, diagnostic accuracy of screening, programmatic utilization and efficacy vary widely. We describe the protocol for the BCRL Prospective Surveillance Model (PSM) and Early Intervention Program at the Dana-Farber Brigham Cancer Center that aims to address these issues by augmenting arm measurements (standard of care) with use of patient-reported outcome metrics (PROMs). Methods: Women with newly diagnosed stage I-III breast cancer at high risk for developing BCRL based on tumor and treatment characteristics are eligible for inclusion in our PSM care pathway, which uses both the Breast Cancer and Lymphedema Symptom Experience Index PROMs and arm measurements for screening. Screening begins prior to the initiation of neoadjuvant therapy and continues at regular intervals postoperatively. A positive screen, defined as new patient-reported arm swelling/heaviness and/or relative volume change (RVC) ≥ 5% in the affected limb, triggers consideration for multidisciplinary early intervention. Analysis: The BCRL detection rate will be compared to years previous to protocol development. PSM feasibility will be determined according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Efficacy of the PSM will be gauged by comparing change in patient-reported outcomes of interest and arm volume measurement pre and post early intervention. Feasibility will be determined by calculating the percentage of PSM-eligible individuals who complete all PSM activities in a 1-year span. Characteristics of participants versus non-participants in the target population will be compared. Furthermore, 1:1 semi-structured interviews with enrolled patients will be performed to understand facilitators and barriers to implementation. Conclusions: The findings from this study will be used to develop a standardized approach to PSM and early intervention that can be adapted to both resource-modest and resource-abundant healthcare infrastructures. Full article

Background: Malnutrition is common in chronic hemodialysis (HD) patients and often remains underdiagnosed. While body composition, functional status, and anthropometric measures can support nutritional assessment, their associations with nutritional status are not fully established in this population. This study aimed to evaluate the diagnostic performance of various measures for assessing malnutrition in chronic HD patients, using the Subjective Global Assessment (SGA) as the reference standard. Methods: This cross-sectional study involved chronic HD patients, stratified by nutritional status using the SGA. Data collection consisted of clinical interviews, anthropometric and functional measurements, bioelectrical impedance analysis (BIA), and biochemical analyses. Statistical analysis included Spearman’s correlation, logistic regression, receiver operating characteristic (ROC) curve analysis with area under the curve (AUC) to assess predictive accuracy, standardized effect sizes to show the magnitude of differences, and kappa statistics to evaluate concordance between variables. Results: This study included 103 chronic HD patients. Malnutrition was diagnosed in 50.5% of patients based on the SGA. Phase angle (PA) was the strongest single predictor of malnutrition (AUC = 0.79; specificity 0.88; sensitivity 0.58). PA ≤ 5.1° was significantly associated with higher malnutrition risk (OR: 10.23; 95% CI: 3.93–30.61; p < 0.001). Handgrip strength (HGS) also demonstrated good diagnostic value (AUC = 0.71; specificity 0.84; sensitivity 0.59). A multivariable model incorporating eight parameters—gender, post-dialysis ECW/ICW ratio, post-dialysis lean and fat mass, serum albumin, normalized protein catabolic rate (nPCR), arm circumference (AC), and HGS—achieved an AUC of 0.88 (95% CI: 0.81–0.95) and pseudo-R² of 0.46, demonstrating improved predictive performance. Conclusions: An integrated panel of anthropometric, bioimpedance, functional, and biochemical markers provides superior diagnostic accuracy compared to individual predictors, supporting a holistic diagnostic approach in HD patients. Full article

Infectious diseases remain a global threat, with low- and middle-income countries disproportionately affected due to socio-economic and demographic vulnerabilities. Robust laboratory systems are critical for early detection, outbreak containment, and guiding effective interventions. This study aimed to map and evaluate Jordan’s laboratory diagnostic network for communicable diseases, identify gaps, and recommend strategies to strengthen capacity, harmonization, and alignment with international standards. A multi-method approach was employed in 2023 through collaboration between the Jordan Center for Disease Control and the Health Care Accreditation Council. Data were collected via (i) a desktop review of 226 national and international documents; (ii) 20 key informant interviews with stakeholders from the public, private, military, veterinary, and academic sectors; and (iii) 23 field visits across 27 laboratories in four Jordanian governorates. Data were analyzed thematically and synthesized using the LABNET framework, which outlined ten core laboratory capacities. Findings were validated through a multi-sectoral national workshop with 90 participants. The mapping revealed the absence of a unified national laboratory strategic plan, with governance dispersed across multiple authorities and limited inter-sectoral coordination. Standard operating protocols (SOPs) existed for high-priority diseases such as T.B, HIV, influenza, and COVID-19 but were lacking or outdated for other notifiable diseases, particularly zoonoses. Quality management was inconsistent, with limited participation in external quality assurance programs and minimal accreditation uptake. Biosafety and biosecurity frameworks were fragmented and insufficiently enforced, while workforce shortages, high turnover, and limited specialized training constrained laboratory performance. Despite these challenges, Jordan demonstrated strengths including skilled laboratory staff, established reference centers, and international collaborations, which provide a platform for improvement. Jordan’s laboratory network has foundational strengths but faces systemic challenges in policy coherence, standardization, quality assurance, and workforce capacity. Addressing these gaps requires the development of a national laboratory strategic plan, strengthened legal and regulatory frameworks, enhanced quality management and accreditation, and integrated One Health coordination across human, animal, and environmental health sectors. These measures will improve diagnostic reliability, preparedness, and alignment with the global health security agenda. Full article

Background: Anal squamous cell carcinoma is a rare disease strongly associated with the human papillomavirus (HPV) and preceded by the premalignant anal squamous intraepithelial lesion (ASIL). High-resolution anoscopy (HRA) using a colposcope is considered the gold standard for detecting and managing ASIL. Despite being recommended in current guidelines for anal cancer screening, HRA availability remains limited. Although generally well tolerated, concerns about follow-up adherence persist. We have developed an endoscopic technique using high-resolution flexible endoscopes for detection, resection, and screening of ASIL. Our previous research suggests that this method is effective and gentle, but patients’ experiences of this approach remain underexplored. The aim of this study was to explore patients’ experiences of endoscopic detection, treatment, and screening of anal squamous intraepithelial lesions. Method: A qualitative approach was used involving semi-structured interviews and abductive qualitative content analysis. The 32-item COREQ checklist guided the reporting of the study. All participants followed a standardized protocol for treatment and follow-up. Results: Analysis of 16 interviews (female n = 7, male n = 9, age 19–72 years) yielded four categories: a comforting encounter in an exposed situation (with four subcategories); impact on intimate relationships (with one subcategory); living with uncertainty (with four subcategories); and physical discomfort (with two subcategories). Conclusions: High-resolution endoscopy is a well-tolerated and effective diagnostic and therapeutic modality for ASIL. However, the psychological impact of HPV-related conditions highlights the need for appropriate psychosocial support. These findings underscore the importance of integrating patient-centered care principles into the implementation of novel diagnostic and therapeutic technologies. Full article

Background: Pain is a complex phenomenon characterized by unpleasant experiences with profound heterogeneity influenced by biological, psychological, and social factors. According to the National Health Interview Survey, 50.2 million U.S. adults (20.5%) experience pain on most days, with the annual cost of prescription medication for pain reaching approximately USD 17.8 billion. Theranostic pain nanomedicine therefore emerges as an attractive analgesic strategy with the potential for increased efficacy, reduced side-effects, and treatment personalization. Theranostic nanomedicine combines drug delivery and diagnostic features, allowing for real-time monitoring of analgesic efficacy in vivo using molecular imaging. However, clinical translation of these nanomedicines are challenging due to complex manufacturing methodologies, lack of standardized quality control, and potentially high costs. Quality by Design (QbD) can navigate these challenges and lead to the development of an optimal pain nanomedicine. Our lab previously reported a macrophage-targeted perfluorocarbon nanoemulsion (PFC NE) that demonstrated analgesic efficacy across multiple rodent pain models in both sexes. Here, we report PFC-free, biphasic nanoemulsions formulated with a biocompatible and non-immunogenic plant-based coconut oil loaded with a COX-2 inhibitor and a clinical-grade, indocyanine green (ICG) near-infrared fluorescent (NIRF) dye for parenteral theranostic analgesic nanomedicine. Methods: Critical process parameters and material attributes were identified through the FMECA (Failure, Modes, Effects, and Criticality Analysis) method and optimized using a 3 × 2 full-factorial design of experiments. We investigated the impact of the oil-to-surfactant ratio (w/w) with three different surfactant systems on the colloidal properties of NE. Small-scale (100 mL) batches were manufactured using sonication and microfluidization, and the final formulation was scaled up to 500 mL with microfluidization. The colloidal stability of NE was assessed using dynamic light scattering (DLS) and drug quantification was conducted through reverse-phase HPLC. An in vitro drug release study was conducted using the dialysis bag method, accompanied by HPLC quantification. The formulation was further evaluated for cell viability, cellular uptake, and COX-2 inhibition in the RAW 264.7 macrophage cell line. Results: Nanoemulsion droplet size increased with a higher oil-to-surfactant ratio (w/w) but was no significant impact by the type of surfactant system used. Thermal cycling and serum stability studies confirmed NE colloidal stability upon exposure to high and low temperatures and biological fluids. We also demonstrated the necessity of a solubilizer for long-term fluorescence stability of ICG. The nanoemulsion showed no cellular toxicity and effectively inhibited PGE2 in activated macrophages. Conclusions: To our knowledge, this is the first instance of a celecoxib-loaded theranostic platform developed using a plant-derived hydrocarbon oil, applying the QbD approach that demonstrated COX-2 inhibition. Full article

Bipolar disorder (BD) and schizophrenia (SCH) are results of the complex interactions between genetic and environmental factors, and the underlying pathophysiology is not yet completely understood. The current diagnostic criteria for psychiatric diagnosis are based purely on clinical phenomenology and they are limited to psychiatrist judgment after a standardized clinical interview, with no precise biomarkers used to discriminate between the disorders. Besides gaps in the understanding and diagnosis of these diseases, there is also a need for personalized and precise approaches to patients through customized medical treatment and reliable monitoring of treatment response. To fulfill existing gaps, the establishment of disorder biomarker sets is a necessary step. LC-MS lipidomic blood sample analysis is one of the ongoing omics approaches. In the last ten years, several studies have identified alterations in lipid metabolism associated with BD and SCH, and this review summarizes current knowledge on their lipidomic patterns, which is essential for identifying lipid biomarkers. Currently, findings indicate decreases in plasmalogens and acyl-carnitines, along with increases in certain triacylglycerol species, shared by both conditions. In contrast, serum LC-MS lipidomic profiles of sphingolipids including ceramides could be unique to BD, indicating the need for further investigation in future studies. Full article

Background: The digital transformation in dentistry is increasingly reshaping treatment procedures, offering new opportunities and advancements. While digitalization promises enhanced efficiency and quality of care through the standardization, acceleration, and simplification of workflows, it also introduces challenges related to mental health. Studies investigating digitization-associated stressors and resources, as well as health- and work-related outcomes, in the dental sector are still rare. In the context of ongoing digitalization, further studies are needed to examine the need for and the current status of the implementation of measures preventing techno-stress and stress-related outcomes. This study explores the use of digital tools in dental practices and their relationship to the techno-stress among German dentists. It identifies key stressors and resources associated with digital technologies, aiming to inform preventive measures, as well as training and support strategies to mitigate digital stress. Methods: A qualitative study was employed, involving ten problem-centered, guideline-based expert interviews with German dentists. The interviews were analyzed using MAXQDA software, following the focused interview analysis framework by Kuckartz and Rädiker. Coding and thematic analysis adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and qualitative research quality criteria by Mayring. Results: This study identified a dual impact of digitalization in dentistry. On the one hand, digital tools significantly enhance workflow efficiency, diagnostic accuracy, and patient outcomes. On the other hand, they pose challenges like technostress, high financial costs, and the need for continuous learning. Findings reveal that the perceived usefulness of digital technologies is closely linked to the level of techno-stress experienced, while the amount, intuitiveness, and ease of use significantly influence stress levels. Conclusions: Digital transformation offers substantial benefits for dental practices but requires a balanced approach to implementation. Participants highlighted the need for proactive measures, such as targeted training, technical support, and stress-reducing interventions to reduce techno-stress levels. The digital transformation must be supported by coordinated efforts across academia, industry, and policy to strengthen digital competencies—creating a healthier, more resilient digital work environment. Future research should focus on the causal relationship between techno-stress and adverse long-term consequences, such as burnout or mental disorders, among dentists. Full article

Background: Our research problem mainly concerns the following question: what are the consequences of an autism spectrum condition diagnosis for everyday functioning and self-understanding? Method: The research methodology is based on a semi-structured interview, which allows respondents to share their experiences freely while maintaining the structure and standards necessary to collect consistent data. The research was conducted remotely, using the ZOOM platform and the Messenger application. Six individuals with autism spectrum condition (ASC) diagnosed in adulthood, selected intentionally, participated in the study. Interviews lasted between 20 and 60 min. Results: The analysis of the experiences of individuals with ASC diagnosed in adulthood highlights the complexity of the diagnosis process and its far-reaching consequences. The diagnostic process, which varied in time and depended on the availability of specialists, was often evaluated positively. Obtaining an ASC diagnosis proved to be a crucial moment for the interviewees, enabling them to better understand themselves and their needs. It led to a better adjustment of their work, education, and private life environment. Relationships with loved ones tended to remain unchanged or improved, highlighting the importance of the diagnosis in improving the understanding and acceptance of individuals with ASC. Conclusions: The study sheds light on the positive impact of diagnosis on self-awareness and quality of life for individuals with ASC, revealing the need to improve the availability of specialised diagnostic and support services. Further research should focus on the development and adaptation of support methods to meet the individual needs of individuals with ASC and on promoting awareness of ASC in the community and among mental health professionals. Full article

Objectives: This study aimed to assess the concordance between depression and anxiety case definitions derived from algorithms based on medico-administrative data and structured interviews aligned with the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria in older adults. Methods: We analyzed data from 1405 primary care older adults (≥65 years) from the Étude sur la Santé des Aînés (ESA)-Services cohort (2011–2013) in Quebec, Canada, who had available survey and medico-administrative data. Cases of depression and anxiety were identified using algorithms incorporating combinations of hospitalization records, physician-visit claims, and medication claims for antidepressants or anxiolytics. The agreement was assessed with the kappa statistics (κ), and the algorithms’ sensitivity, specificity, and positive and negative predictive values were calculated using the case definitions derived from the DSM-IV-aligned ESA-Services interviews as the gold standard. Results: Agreements between the algorithms and the interviews were fair (κ: 0.06–0.22) for depression gooand slight (κ: 0.02–0.09) for anxiety. The algorithms had low sensitivity (2–39.7% for depression and 1.4–39.9% for anxiety) but high specificity (84.5–99.6% for depression and 73–99.2% for anxiety), depending on the algorithm. Conclusions: The agreement between algorithms based on administrative data and DSM-IV-aligned interviews for anxiety or depressive disorders was low. The two methods identified older adults with different characteristics. Despite these discrepancies, algorithms with high specificity provide valuable insights into healthcare utilization patterns associated with these disorders. Full article

The multi-faceted nature of Selective Mutism (SM), and its comorbidity with other disorders, necessitates a comprehensive assessment process. However, evaluating children with SM presents significant challenges, including difficulties in building rapport, establishing an accurate diagnosis, and conducting formal psychological and neuropsychological assessments. This paper explores the key obstacles in assessing children with SM and provides practical recommendations for overcoming these challenges. Effective strategies for reducing anxiety during assessments include extended rapport-building phases, playful and engaging interactions, and the strategic use of parental involvement. Additionally, given the variability in SM symptoms across different settings, a multi-informant and multi-method assessment approach—including clinical observation, structured interviews, and standardized parent- and teacher-report measures—is recommended. This paper also discusses adaptations for formal testing, particularly in cognitive, language, and neurodevelopmental assessments, where SM-related speech avoidance can interfere with standardized evaluations. Nonverbal assessment tools, modifications to testing environments, and alternative response formats are proposed as potential solutions. Furthermore, we highlight the importance of differentiating SM from overlapping conditions, such as autism spectrum disorder and language impairments, to ensure accurate diagnosis and intervention planning. By implementing tailored assessment strategies, clinicians and researchers can improve diagnostic accuracy and better understand the unique needs of children with SM. This, in turn, can inform individualized treatment plans, enhance educational placement decisions, and support the overall well-being of children with SM. Full article

Disordered eating, such as binge-eating and loss of control eating (LOCE), contribute to suboptimal weight loss and weight regain in some patients who undergo weight loss surgery (WLS). Despite robust evidence linking disordered eating and poor WLS outcomes, there is no consensus on standardized screening and treatment practices for this population. To address this gap, our team conducted a literature review using Ovid MEDLINE, Scopus, CINAHL, EMBASE, and Cochrane CENTRAL, focusing on studies examining screening and treatment of disordered eating in WLS populations. Our review identified key findings related to (a) screening and diagnostic tools, including semi-structured interviews and self-report measures, and (b) psychotherapeutic interventions, including cognitive behavioral therapy (CBT) and other modalities. Findings are inconclusive but suggest avenues for future research examining the routine implementation of post-WLS screening and treatment protocols (including adjunctive pharmacotherapy) for disordered eating. Full article

We aimed to assess the efficacy, safety, and pharmacokinetics of an oral risperidone solution and two types of supplementations with PUFAs. We assigned 39 participants with mild ASD (mean age ± standard deviation = 14.6 ± 6.0 years) to three treatment groups (each n = 13): RIS-OS; equal doses of 240 mg of omega-3 PUFA docosahexaenoic acid and omega-6 PUFA arachidonic acid (1:1) (aravita); and omega-6 precursor linoleic acid (480 mg) and omega-3 precursor alpha-linolenic acid (120 mg) (4:1) (awake). The primary outcome was the Autism Diagnostic Interview—Revised score. The secondary outcomes were the Social Responsiveness Scale (SRS) and Aberrant Behavior Check scores. The results of the linear mixed-effects model revealed that the RIS-OS group exhibited significant improvement in the SRS subscale scores of social motivation at weeks 8, 12, and 16 compared with the aravita and awake groups, as well as in the SRS subscale score of social mannerisms at weeks 12 and 16 compared with the aravita group. Moreover, the RIS-OS group showed a trend towards significantly lower plasma ceruloplasmin (Cp) levels. Their plasma insulin-like growth factor (IGF) levels were significantly higher at week 8 than in the subsequent weeks. The high Cp and IGF levels may be attributed to reduced neuroinflammation. These findings demonstrate, firstly, that reduced inflammation through increased anti-inflammatory proteins such as Cp and IGF has clinical effects on the motivation–reward system and mannerisms in patients with ASD through the amelioration of dopamine D2, 5-HT2a, and 5-HT2b dysfunction. Full article

Smallholder potato farmers in Ethiopia do not realize the theoretical yield potential of the crop because they do not benefit from the advantages of using quality seed potato of improved varieties. The high disease incidence in seed potatoes has large implications on the potato farming system since the country lacks appropriate seed quality assurance mechanisms. Seed potato quality assurance relies more on the technical support provided by the national research and extension systems than the official seed certification agency. This paper elaborates systematic challenges and opportunities within the potato seed system and poses two research questions: (1) What type of seed quality assurance mechanisms (informal, quality declared, certified) are under implementation in Ethiopia? (2) How does the current seed quality assurance system operate in terms of reliability, accessibility, and quality standards to deliver quality seed potato? The data were collected through face-to-face in-depth key informant interviews with various seed regulatory laboratory managers and technicians in the Oromia, SNNP, and SWEP regions in the main seed- and ware-producing areas of Ethiopia. This was complemented by a comprehensive analysis of relevant documents. The findings show that currently there is no established procedure in place to officially certify early-generation seed potatoes. Two out of six seed quality control laboratories assessed for this study inspected seed potato fields in 2021 but as quality declared seed (QDS), and approved the fields inspected based on visual inspection alone. Our study revealed a weak linkage between early-generation seed (EGS) potato producers, commercial, and QDS seed potato producers, and seed quality control laboratories. Seed potato quality assurance operations were carried out by only a few seed regulatory laboratories with several concerns raised over the effectiveness of quality standards since seed-borne diseases, such as bacterial wilt, have been found at high frequency in the country’s seed potato system. Hence, the current procedures and challenges call for the necessity of upgrading current quality assurance in seed potato certification. Our study underlines the need for policymakers, development partners, and researchers to collaborate and pool efforts to consider transforming the quality declared system to appropriate seed certification. We recommended that institutionalizing novel plant disease diagnostics into seed regulatory frameworks is needed for sustainable potato production and food security in Ethiopia. Full article

Adults with a history of living in residential youth care (RYC) face elevated risks across various life domains. In this cohort profile paper, we outline the design of a comprehensive follow-up study—the VINGO study—targeting young adults (22–30 years) with a history of living in RYC (T2). We describe the recruitment strategy and present sample characteristics. Data were collected in the baseline study (T1) from 2011 to 2014. At T1, the 400 adolescent participants showed a high prevalence of mental disorders, maltreatment experiences, substance use, and self-reported suicide attempts. Data collection at T2 10 years later (2021–2023) included self-reported sociodemographic information, physical health, childhood maltreatment, dissociation, quality of life, social support, and self-esteem using standardized and validated instruments. A diagnostic psychiatric assessment and subjective evaluation of service utilization were conducted by telephone interviews. Additionally, a qualitative sub-study involved in-depth interviews of fourteen participants. We reached a 52% response rate at T2. Comparing participants (n = 157, 107 females) to non-participants (n = 243, 123 females) based on T1 data revealed that T2 participants had a higher prevalence of depression, anxiety, and conduct disorder and a lower prevalence of ADHD at T1. Furthermore, T2 participants reported more suicide attempts, experiences of maltreatment, and problematic substance use at T1. Our results show that we reached a burdened population, positioning the VINGO study as a unique opportunity to examine a vulnerable population of emerging adults. Full article

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder, and although the diagnosis is primarily based on clinical criteria, ENMG, as the “gold standard”, does not always show detectable changes. Therefore, our study suggests that alterations in echogenicity and heterogeneity of the phrenic nerve (PN) may serve as potential additional diagnostic tools for ALS. Methods: Our study included 32 patients in the ALS group and 64 individuals in the control group. Each participant underwent an interview and completed questionnaires to collect clinical and demographic data, including age, gender, height, body mass index (BMI), hip and waist circumference, duration of illness, ALS-FRS-R score, comorbidities, and medication use. Ultrasound examinations of the PN were performed by two authors using a high-resolution “Philips EPIQ 7” ultrasound machine equipped with a linear 4–18 MHz transducer. The ALS group participants underwent PN sonography and conduction examinations, arterial blood gas (ABG) analysis, respiratory function tests (RFT), and electroneuromyography (ENMG). Results: The study demonstrated that the phrenic nerve is significantly smaller on both sides in patients with ALS compared to the control group (p < 0.01). Changes in the homogeneity and echogenicity of the PN were also observed on both sides. On the right side, 43.8% of the nerves showed heterogeneity, 40.6% were isoechoic, and 21.9% were hyperechoic. On the left side, 59.4% of the nerves exhibited heterogeneity, 34.4% were isoechoic, and 28.1% were hyperechoic. Moreover, sonography on both sides showed significant correlation with ALS-FRS-R, COMPASS-31, and ENMG results. Conclusions: Our study highlights the importance of phrenic nerve ultrasound as a promising supplementary diagnostic tool for ALS. The significant differences in phrenic nerve size, echogenicity, and homogeneity between patients with ALS and the control group demonstrate that ultrasound imaging can detect morphological changes in the phrenic nerve. Incorporating phrenic nerve ultrasound into routine diagnostic protocols could improve early detection, enhance disease monitoring, and offer a more comprehensive understanding of the neurodegenerative processes in ALS. Full article