Jacobs Institute of Women's Health
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If I tell you my problems, how will you perceive me? : A qualitative study of mental health knowledge, barriers, and opportunities for care among Kenyan adolescents during COVID-19
No full textINTRODUCTION: The majority of the world\u27s adolescents live in low-and middle-income countries (LMICs). However, there is a dearth of knowledge about adolescents\u27 perspectives on mental health and sources of distress there. Therefore, a qualitative study of adolescents\u27 and caregivers\u27 beliefs and experiences related to mental illness was conducted in Nairobi, Kenya. MATERIALS AND METHODS: Six focus group discussions were conducted with 46 participants at two peri-urban settlements in Nairobi from November to December 2020. Using a two-step analytic process, we generated core themes, and the study team reviewed the transcripts and triangulated the themes. RESULTS: Themes include knowledge about mental health and illness, triggers of psychological disturbances, attitudes towards mental illness, practices adopted to strengthen mental health, barriers to strengthening mental health among young people, emerging needs around caregiver mental health and parenting, and community recommendations on interventions. Adolescents had limited knowledge of specific mental illnesses but articulated triggers, stresses, and challenges they face in daily life in an in-depth manner. Caregivers demonstrated a breadth of knowledge and understanding of adolescent mental health. CONCLUSION: Adolescents and their caregivers face tremendous stresses in the Nairobi settlements. Mental health literacy is limited, but adolescents and caregivers are ready to embrace mental health services. Reducing stigma and access to youth-friendly services are crucial to expanding service engagement
Healing Hands: Art Therapy Meets Medical Education
No full textArt therapy has the potential to enrich physician assistant/associate education by integrating knowledge of social-emotional needs into existing curricula. Using the window of tolerance as a framework, a workshop series was presented in which art therapists explored stressors and coping strategies for medical professionals to reduce burnout and enhance social emotional awareness in patient care. The hypotheses studied focused on more in-depth education and practiced awareness of provider social-emotional needs through art therapy, with anticipated outcomes including identification of healthy coping mechanisms, decreased stress, and increased awareness of patient mental health needs. While quantitative results were affected by external variables, qualitative data showcased positive impacts on social-emotional awareness and coping, emphasizing the need for continued integration of experiential opportunities provided by trained mental health professionals for provider self-care to foster resilience and patient attunement in medical education
Sex-chromosome complement and Activin-A shape the therapeutic potential of TNFR2 activation in a model of MS and CNP
No full textTumor necrosis factor receptor 2 (TNFR2) activation is a promising-therapeutic strategy for autoimmune disorders such as multiple sclerosis (MS) and chronic neuropathic pain (CNP). This study aimed to identify mechanisms governing the sex-specific efficacy of TNFR2 activation on abrogating pain and motor disease severity in mice experiencing experimental autoimmune encephalomyelitis (EAE), a rodent model of MS. We find that the XX sex-chromosome complement is indispensable for TNFR2-mediated attenuation of EAE-associated motor disease. Mice with XY chromosomes experienced exacerbated motor disease severity, associated with an elevated magnitude of neurodegeneration and demyelination. Contrasting this, we show that TNFR2-mediated alleviation of EAE induced CNP is both sex and sex-chromosome independent. However, the alleviation of CNP following TNFR2 activation across two different neuropathic pain models (EAE and chronic constriction injury) was dependent on the gonadal hormone Activin-A. This suggests a shared mechanism through which gonadal-derived factors impact TNFR2-mediated pain relief, independent of sex hormones. These findings highlight the importance of considering sex chromosomes and sex-independent gonadal hormones in evaluating potential sex-specific differences in drug efficacy during therapeutic development
A Comparison of Preoperative Frailty Indices Correlation with Perioperative Risk for Patients Undergoing Sacrocolpopexy
No full textOBJECTIVE: To assess whether frailty as defined by the NSQIP mFI-5 or the RAI-rev indices is correlated with 30-day postoperative outcomes for patients undergoing SCP, and whether one index is more closely correlated than the other. METHODS: SCPs performed between 2006-2020 were identified in the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. Frailty was calculated using two indices: the NSQIP modified frailty index (mFI-5), and the revised surgical Risk Analysis Index (RAI-rev). mFI-5 scores and RAI-rev scores were analyzed as continuous variables. Binary logistic regression and t-test analyses were performed to apply mFI-5 and RAI-rev as predictors of surgical complications, 30-day readmissions, 30-day mortality, and hospital length of stay (LOS). RESULTS: We identified 9,082 SCPs between 2006-2020. Minor complications were experienced by 5.2% of patients, and 3.9% of patients experienced major complications. The 30-day readmission and mortality rates were 2.8% and 0.02%, respectively. The mFI-5 was significantly associated with increased odds of major complications overall, failure to wean ventilator, myocardial infarction, septic shock, and 30-day readmission. The RAI-rev, on the other hand, was associated with increased odds of individual complications such as pneumonia, failure to wean ventilator, renal failure, CVA, cardiac arrest, myocardial infarction, and septic shock. CONCLUSIONS: Frailty may be a useful predictor of complications after SCP, depending on which frailty index is used. The mFI-5 is significantly associated with increased odds of major complications and 30-day readmission, and may help in the decision making and risk counseling for patients with POP considering SCP
Ten Years of Pediatric Velopharyngeal Insufficiency Surgery: National Operative Trends, 30-day Complication Rates, and Implications
No full textBackgroundVelopharyngeal insufficiency (VPI) can be effectively treated surgically with palatal lengthening or pharyngeal procedures. There is limited data on long-term national trends in their use and associated outcomes. This study evaluates 10 years of trends and outcomes in VPI-correcting procedures.MethodsWe conducted a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program Pediatric database, identifying cases with CPT codes corresponding to VPI-correction procedures. Patients 6 to 18 years old were included. Outcomes included operative characteristics and postoperative complications.ResultsOf 5957 cases, 45% were palatal lengthening, and 55% were pharyngeal procedures (63% pharyngeal flap and 37% sphincter pharyngoplasties). Palatal procedures had longer operative (P \u3c 0.001) and anesthesia (P \u3c 0.001) durations compared to pharyngeal procedures. Pharyngeal flaps had longer operative (P \u3c 0.001) and anesthesia (P \u3c 0.001) durations compared to sphincter pharyngoplasties. Palatal-lengthening surgeries had higher rates of wound dehiscence (P = 0.001) but no significant difference in major complications compared to pharyngoplasties. No differences in complication rates between pharyngeal flaps and sphincter pharyngoplasties were observed.DiscussionLow complication rates across palatal lengthening and pharyngeal procedures suggest that VPI surgical planning should prioritize factors such as patient anatomy, existing comorbidities, and the potential risks associated with prolonged operative and anesthesia times
Renin Angiotensin Inhibition and Lower Risk of Kidney Failure in Patients with Heart Failure: Subtitle: RAS inhibition and kidney failure in heart failure
No full textBACKGROUND: Renin-angiotensin system (RAS) inhibitors reduce risk of kidney failure in patients with chronic kidney disease, but worsen kidney function in heart failure patients, especially in those with chronic kidney disease. Less is known about risk of kidney failure in heart failure patients receiving RAS inhibitors. METHODS: We used propensity score matching for outcome-blinded assembly of 168,860 Veterans with heart failure phenotyped by artificial intelligence who were balanced on 77 baseline characteristics and initiated on RAS inhibitors. Hazard ratio (95% CI) for 5-year kidney failure in high-dose (versus low-dose) RAS inhibitor group was estimated, accounting for competing risk of death. Kidney failure was defined as kidney replacement therapy or estimated glomerular filtration rate (eGFR) \u3c15 mL/min/1.73m. RESULTS: New-onset kidney failure occurred in 4.1% (3455/84,430) and 3.5% (2966/84,430) of patients in low-dose and high-dose RAS inhibitor groups, respectively (HR, 0.85; 95%CI, 0.81-0.89). Respective HRs (95%CIs) in eGFR subgroups ≥60, 45-59 and 15-44 mL/min/1.73m were 1.21 (1.08-1.36), 0.93 (0.82-1.05) and 0.82 (0.77-0.87). The association was similar across ejection fraction subgroups. There was a lower risk of death in the subgroup with ejection fraction ≤40%. CONCLUSIONS: Patients with heart failure receiving high-dose (versus low-dose) RAS inhibitors had a lower associated risk of kidney failure, which was driven by the subgroup with chronic kidney disease. This new information may help to inform future guideline recommendations and clinical practice regarding RAS inhibitor use in these patients. Future studies need to examine this association in those with normal kidney function
Predictors of atypical language lateralization in focal epilepsy: A mega-analysis of fMRI evidence
No full textOBJECTIVE: To identify predictors of language lateralization derived from functional magnetic resonance imaging (fMRI) in children and adults with left- and right-sided focal epilepsy. METHODS: We conducted a mega-analysis of data from 914 individuals from 24 samples. We used multilevel models to identify predictors of language lateralization in left and right hemisphere epilepsy groups. We assigned each participant a clinical predictor score to explore whether there was a cumulative influence of predictors on increasing atypical language lateralization. RESULTS: Left hemisphere epilepsy was a predictor of greater atypical language lateralization in the combined sample. Additional predictors of atypical language lateralization included left/ambidextrous handedness in both the left and right hemisphere groups, and longer duration of epilepsy, frontal lobe involvement, and history of a stroke or other precipitating injury in the left hemisphere group only. There was a cumulative effect of predictors in the left hemisphere groups. Eighty percent of individuals with four or more predictors had atypical language lateralization, compared to 19% of individuals with no predictors, other than left hemisphere epilepsy. SIGNIFICANCE: Consistent with theories of language plasticity, we demonstrated a robust effect of early acquired left hemisphere injury on language lateralization. There was also a subtle effect of duration of epilepsy, perhaps reflecting increasing bilaterality with age in adulthood. The association between left/ambidextrous handedness and atypical language lateralization in the left and right hemisphere groups likely reflects both genetic and epilepsy-associated effects. The total number of predictors identified for an individual could serve as an indication for presurgical language fMRI, when surgical management is considered
Modified frailty index is a useful predictor for complications following total elbow arthroplasty in all populations
No full textBACKGROUND: This retrospective review aimed to specify whether the 5-item modified frailty index (mFI-5) is a valid measure for surgeons when assessing the likelihood of complications in patients undergoing total elbow arthroplasty (TEA). METHODS: TEA patients 50 years or older were identified from the NSQIP database from 2006 to 2019. Patients were stratified based on age to create a 50+, a 65+, and an 80-89-year-old cohort. Thirty-day outcomes assessed in this study included mortality, unplanned readmission, return to the operating room, urinary tract infection, bleeding requiring transfusion, prolonged hospital stay, and discharge to a location other than home. The mFI-5 was calculated based on the sum of the presence of five comorbidities. Bivariate and multivariate analyses compared the complication rates among mFI-5 scores. RESULTS: The study included a total of 614 TEA patients aged 50 years or older. Following adjustment, patients older than 50 with mFI-5 = 1 had an increased risk of being discharged to a non-home location compared to patients with mFI-5 = 0 (odds ratio (OR) 3.27). Compared to patients with mFI-5 = 0, those with mFI-5 = 2 or greater had an increased risk of bleeding requiring transfusion (OR 5.13), prolonged hospital stay (\u3e 5 days) (OR 5.83), and discharge to a non-home destination (OR 9.88). Relative to patients with mFI-5 = 1, those with mFI-5 = 2 or greater were more likely to have prolonged hospital stay (OR 3.07) and discharge to a non-home location (OR 3.05). Patients older than 65 and patients in the 80-89-year-old cohort with mFI-5 = 2 were also more likely to have a non-home discharge (OR 10.40 and 21.84, respectively). CONCLUSION: Higher mFI-5 scores in patients aged 50 and older were associated with worse postoperative outcomes including non-home discharge, transfusion likelihood, and prolonged hospitalization. Similar trends were observed in both the 65 + and 80-89-year-old cohorts regarding the risk of non-home discharge, however, higher mFI-5 scores in these older groups did not have an increased likelihood of postoperative transfusion or prolonged hospital stay
Breaking the silence: understanding the unique burden on informal Black male dementia caregivers
No full textAs the rates of Alzheimer\u27s disease (AD) and AD and related dementias (ADRD) in the United States steadily rise, so too does the demand for informal caregiving. Research on AD/ADRD caregiving highlights the associated risk of adverse health outcomes and lower quality of life; however, there is a lack of discussion about Black male dementia caregivers, who already face unique health challenges. Through an intersectionality lens, this perspective will raise awareness of the multifaceted burden of Black male informal AD/ADRD caregiving, along with strategies to better support this underserved community. HIGHLIGHTS: The non-Hispanic Black population in the United States is disproportionately affected by Alzheimer\u27s disease (AD) and AD and related dementias (ADRD), which will increase the demand for caregiving. Most dementia informal caregiving research focuses on non-Hispanic White females, with little emphasis on Black men, who represent an at-risk population. By adopting an intersectional approach, clinicians, researchers, and policymakers can better understand and improve the health of informal Black male AD/ADRD caregivers. The increasing prevalence of AD and ADRD in the US Black community can create an added strain on Black male informal caregivers. Examining the unique AD/ADRD caregiving needs of Black men can inform future research to improve the health of similar at-risk communities