Jacobs Institute of Women's Health
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Factors affecting antenatal corticosteroid use in low- and middle-income countries: Facility characteristics, structural readiness, and past performance of CEmONC signal functions
No full textAntenatal corticosteroids (ACS) utilization is disproportionately limited in low- and middle-income countries where most global preterm newborns who could benefit from this intervention are born. Understanding the factors affecting ACS use is crucial for improving its uptake. This study aimed to investigate facility-level factors associated with ACS use in low-resource countries. We used data from ten Service Provision Assessment surveys across nine countries. We restricted the sample to facilities that provided delivery services. Our primary outcome was recent ACS use, defined as having administered ACS within the past three months before the survey. We conducted mixed-effect log binomial regressions, with country as a fixed effect and sub-national regions as random intercepts, to explore the association between recent ACS use and facility characteristics, injectable corticosteroids and ultrasound availability, facility structural readiness, and past performance of nine Comprehensive Emergency Obstetric and Newborn Care (CEmONC) signal functions. A sensitivity analysis excluding the Afghanistan data was performed since the country adopted a different sampling strategy that mainly sampled urban facilities. This study included 6183 facilities from nine countries. Across eight countries with nationally representative data, only 22.7% (median, range 4.0% to 27.4%) of facilities that provided delivery services had used ACS recently, compared to 59.4% in the Afghanistan survey. Urban facilities had a 21% higher likelihood of recent ACS use (95% CI 6%-38%) than rural facilities. Corticosteroid availability was associated with a 14% higher likelihood of recent ACS use (95% CI 1%-29%). Facilities in the highest readiness tertile were more likely to have recent ACS use than those in the lowest (RR 1.91, 95% CI 1.58-2.30). Each CEmONC signal function, except assisted vaginal deliveries, was significantly associated with recent ACS use, with neonatal resuscitation having the largest effect (RR 2.62, 95% CI 1.93-3.55). In conclusion, facilities that had performed CEmONC services were more likely to administer ACS, highlighting the importance of provider knowledge, skills, and competence in managing obstetric and newborn emergencies for effective ACS provision
Chest Wall Injury Society guidelines for surgical stabilization of rib fractures: Indications, contraindications, and timing
No full textMapping Social Support Networks for African American Women During Childbirth in the USA: A Systematic Scoping Review
No full textBACKGROUND: African American women face disproportionately high maternal mortality and morbidity rates in the USA, driven by structural racism, healthcare inequities, and limited access to culturally responsive care. Social support networks are known to improve maternal health outcomes, yet a comprehensive understanding of how these supports operate for African American mothers remains underdeveloped. OBJECTIVE: To systematically identify and characterize social support networks available to African American women during childbirth in the USA. METHODS: We conducted a systematic scoping review following PRISMA-ScR guidelines. Literature searches were performed across PubMed, CINAHL Complete, and PsycINFO for studies published between January 2019 and October 2024. Studies were included if they addressed social support for African American women during pregnancy, labor, or postpartum. Data extraction and quality assessment using the Johns Hopkins Evidence-Based Practice Rating Scale were conducted by five reviewers. RESULTS: Fourteen studies (4 qualitative, 8 quantitative, 2 mixed methods) involving 8243 participants were included. Four core dimensions of social support emerged: emotional support (from partners, family, and doulas) significantly reduced psychological distress; instrumental support (financial aid, childcare) improved birth satisfaction and reduced postpartum worry; informational support enhanced decision-making, with network density rather than size predicting effectiveness; and appraisal support (advocacy and validation) mitigated experiences of obstetric racism. Structural barriers, including systemic racism and economic constraints, limited access to comprehensive support across all dimensions. CONCLUSIONS: Social support networks significantly influence maternal experiences for African American women. However, effectiveness is constrained by persistent structural inequities. IMPACT: Healthcare professionals must expand access to culturally congruent doula services, address provider bias, and strengthen community-based support systems to improve African American maternal health outcomes
Developing, Analyzing, and Interpreting Outcome Assessments to Improve Endpoints in Infectious Diseases Clinical Research
No full textEvidence from clinical research studies, in addition to patient values and clinical experience, helps practitioners best apply medical interventions to clinical practice. Part of evaluating the evidence is understanding the outcomes used as endpoints in research studies. The most direct evidence of patient benefit comes from endpoints that evaluate the effects of interventions on patient survival, symptoms, and function, and the impact of symptoms and function on health-related quality of life. In this article, we discuss how to develop endpoints for clinical research studies focusing on patient-reported outcome measures, including those measuring patient symptoms, function, and health-related quality of life. We discuss the process for determining (1) which concepts to measure, including which concepts are most relevant to patients (content validity); (2) who performs the measurement and which measurement properties to use (construct validity); and (3) how to analyze and interpret the results obtained using the chosen measurements
Pediatric Theory of Unpleasant Symptoms: A Multi-level Symptom Theory for Pediatric Cancer
No full textBACKGROUND: Children with cancer often experience significant symptom burden and toxicities associated with cancer treatment. Advancing pediatric symptom science through theory-guided research is essential to inform targeted interventions that ameliorate suffering and enhance quality of life. However, current symptom theories do not reflect the complex relationships between the child, family, and clinician. This highlights the need for a new framework encompassing the child\u27s experience, while also integrating family and clinician perspectives. OBJECTIVES: This narrative review introduces a novel pediatric theory of symptoms developed through a comprehensive synthesis of published literature and existing theory. METHODS: The Theory of Unpleasant Symptoms was critically evaluated for empirical gaps and areas for enhancement. Through an iterative process of literature review and theoretical refinement, we developed an adapted theory, called The Pediatric Theory of Unpleasant Symptoms (Pedi-TOUS). RESULTS: The Pedi-TOUS captures the multidimensional symptom experiences of children with cancer. It integrates diverse perspectives on symptom perception and delineates multi-level, influencing factors and performance outcomes associated with symptom experiences. Notably a novel influencing factor regarding relationships is introduced, emphasizing the collaborative role of caregivers and clinicians in shaping the symptom experience. CONCLUSIONS: The Pedi-TOUS is a responsive adaptation of existing theory, reflecting emerging trends in pediatric oncology symptom science. It provides a robust conceptual basis for future research aimed at elucidating the comprehensive symptom experiences of children with cancer. IMPLICATIONS FOR NURSING PRACTICE: Pedi-TOUS can inform clinical practice by guiding the development of tailored, evidence-based interventions to improve symptom management and patient care in pediatric oncology
Improvement in Patient-Reported Symptoms of Generalised Myasthenia Gravis With Rozanolixizumab in the Randomised Phase 3 MycarinG Study Using the MG Symptoms PRO
No full textBACKGROUND: In the Phase 3 MycarinG study (NCT03971422), rozanolixizumab improved myasthenia gravis (MG)-specific outcomes versus placebo in patients with generalised MG, including those measured by the five independent MG Symptoms patient-reported outcome (PRO) scales: Muscle Weakness Fatigability (MWF), Physical Fatigue (PF) and Bulbar Muscle Weakness (BMW) as secondary endpoints and Ocular Muscle Weakness and Respiratory Muscle Weakness (exploratory endpoints). This research aimed to provide further insights into these improvements. METHODS: Post hoc analyses evaluated correlation (Pearson coefficient) between MG Symptoms PRO and subdomain scores of MG Activities of Daily Living (MG-ADL) and Quantitative MG (QMG) at baseline. Proportions of responders reaching clinically meaningful thresholds and analyses at the item level (observed mean change and Rasch modelling of predicted change from baseline) are reported for MWF, PF, and BMW with rozanolixizumab versus placebo at Day 43. RESULTS: Correlation coefficients between MG Symptoms PRO and MG-ADL were strong (≥ 0.7) for ocular and bulbar scores and moderate (0.5 to \u3c 0.7) for other scores. Correlations with clinician-assessed QMG scores were generally weak (\u3c 0.5). For MWF, PF, and BMW, greater proportions of responders were observed with rozanolixizumab 7 mg/kg (46.9%, 31.3% and 26.6%, respectively) or 10 mg/kg (56.5%, 48.4% and 32.3%) versus placebo (28.1%, 26.6% and 10.9%). Item-level analyses demonstrated rozanolixizumab benefit at a symptom-specific level. DISCUSSION: MG Symptoms PRO scales correlate well with concepts in MG-ADL while assessing additional concepts, such as PF and MWF. Results from the MG Symptoms PRO in MycarinG reflected improvements from baseline in patient-relevant symptoms, including fatigue, with rozanolixizumab
Identifying resilience promoting factors and sex differences in youth with ADHD across the transition to middle school
No full textBACKGROUND: Despite extensive research on risk factors contributing to functional impairment in youth with attention-deficit/hyperactivity disorder (ADHD), there is considerable heterogeneity in outcomes. Some youth experience significant wide-ranging impairments, others experience impairment in specific domains (e.g., academics, social relationships), and still others avoid long-term negative effects. Most existing studies focus on deficits, overlooking strength-based factors that may contribute to positive outcomes for youth with ADHD. A risk-resilience framework offers a valuable approach to identifying promotive and protective mechanisms for youth with ADHD, particularly during the critical developmental transition from elementary school to middle school. Yet research remains limited by cross-sectional methods, small samples, and a failure to consider sex differences in factors supporting well-being. METHODS: This study protocol describes the background and method for a prospective observational study - Resilience in Student Education (RISE) - examining individual and social-contextual resilience promoting mechanisms among youth with ADHD from fifth grade through seventh grade, with an added focus on the potentially moderating role of sex in understanding associations between resilience promotive and protective factors for functional outcomes among youth with ADHD. DISCUSSION: This study also includes formation and engagement of a Youth Advisory Board of adolescents with ADHD (8th-12th grades) to ensure lived experience is incorporated in study measurement, participant engagement/retention, and dissemination of findings with an eye towards how identified promotive and protective factors can be incorporated into interventions to support the well-being of youth with ADHD
Outcomes of infant laryngotracheal reconstruction in tracheostomy decannulation and avoidance
No full textOBJECTIVE: Management of laryngotracheal stenosis in the infant is challenging for patients, families, and providers. This study was designed to evaluate the impact of patient characteristics and surgical techniques on rates of tracheostomy decannulation and avoidance in infants managed with laryngotracheal reconstruction (LTR). METHODS: Charts were retrospectively reviewed for all pediatric patients with laryngotracheal stenosis managed with open airway surgery at a tertiary children\u27s hospital between 2008 and 2021. The primary outcome evaluated was tracheostomy decannulation and avoidance. RESULTS: Forty infants were included in the study with a median age of 7.5 months and weight of 6.7 kg. More than half (62.5 %) of the infants were Black or African American. Seventy percent of patients included had grade 3 Myer-Cotton subglottic stenosis. Infants, compared with children (n = 153), were far less likely to have a tracheostomy prior to LTR (22.5 % vs 73.2 %, p \u3c 0.001), undergo double stage surgery (17.5 % vs 51 %, p = 0.001), or use stenting post operatively (7.5 % vs 34.6 %, p = 0.001). Rates of tracheostomy decannulation and avoidance in infants were similar to those in children treated with LTR (82.5 % vs 75.2 %, p = 0.404). In infants, the rate of tracheostomy decannulation and avoidance was far lower in those treated with double stage surgery (OR 0.075, CI 0.01-0.47, p = 0.008), with glottic stenosis (OR 0.103, CI 0.015-0.62, p = 0.015), or multilevel stenosis (OR 0.075, CI 0.01-0.47, p = 0.008). CONCLUSION: We present a large cohort of infants undergoing LTR for tracheostomy decannulation and avoidance demonstrating efficacy with a reduced chance of success with glottic or multilevel stenosis
Movement Disorders in Children: A Primer for Physical Medicine and Rehabilitation Specialists
No full textMovement disorders are a group of neurologic diseases characterized by abnormalities in motor function that are not attributable to weakness or spasticity. They are divided into hyperkinetic (involuntary movements) or hypokinetic (paucity of movement). In this article, we will present common clinical scenarios where physical medicine and rehabilitation specialists are likely to encounter movement disorders. Then, we will discuss pharmacologic interventions, focusing on medications specific to phenomenologies that may be encountered in physical medicine and rehabilitation clinics. Finally, we will provide an overview of deep brain stimulation for refractory movement disorders
Evaluating diagnostic uncertainty and the role of surgical management in cherubism: a review of nine cases
No full textOBJECTIVE: Cherubism is a rare genetic disorder characterized by bilateral proliferative lesions of the mandible and maxilla. Diagnosis is complex and conservative management is favored; however, aggressive cases often require surgical intervention. This study aims to enhance understanding of diagnostic challenges and surgical strategies to address functional and aesthetic concerns. STUDY DESIGN: Nine patients diagnosed with cherubism from 2010 to 2024 were included. Patients were graded from I to VI. Clinical presentation, radiographic and histopathologic data, and treatment courses were documented. Outcomes included symptom resolution, functional and aesthetic results. RESULTS: Mean age at consultation was 8.1 ± 3.4 years. All patients had mandibular involvement; six had maxillary involvement. Genetic testing identified a SH3BP2 mutation in one patient. Two Grade VI cases presented with respiratory and ophthalmic symptoms. Seven patients underwent surgical debulking. Patients with Grade VI cherubism underwent multiple debulking procedures and one received adjuvant denosumab therapy. Surgical outcomes were favorable, with improved facial symmetry in all patients and significant improvement in proptosis and respiratory symptoms in severe cases. CONCLUSIONS: Cherubism is a rare disease that requires an individualized management approach. Surgical management is effective in aggressive cases involving rapidly expanding lesions, impending pathologic fracture, and severe psychosocial distress. Denosumab is a promising adjuvant therapy for enhancing surgical outcomes