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Effects of a gender-responsive maternal, newborn and child health program on health and economic outcomes during COVID-19 in Kenya: a mixed-methods study
No full textBackground: The COVID-19 pandemic worsened health and economic disparities for women in resource-limited settings. Chamas for Change (Chamas, Swahili for 'groups with a purpose') is a gender-responsive maternal, newborn and child health program that combines health education with social support and microfinance activities to address systematic disparities in maternal and infant health outcomes. This study evaluated the program's effectiveness in mitigating pandemic-related health and economic inequities in Trans-Nzoia County, Kenya, a region with significant pre-existing vulnerabilities.
Methods: We conducted a mixed-methods study using an explanatory sequential design from March to December 2023. We collected quantitative data from 609 women in 3 cohorts: continuous Chamas participants (n = 128), discontinued (drop-out) participants (n = 240), and women without Chamas exposure (n = 241). We measured maternal health indicators and the Poverty Probability Index (PPI) score as primary outcomes. Quantitative analysis included linear mixed-effects models (unadjusted and adjusted). Qualitative data from focus group discussions and key informant interviews (n = 57) were analyzed using the Gender and COVID-19 Matrix.
Results: Continuous Chamas participants achieved significantly higher rates of postpartum visits (OR = 19.54; 95% CI:3.76-101.57) and exclusive breastfeeding (OR = 8.04; 95% CI:1.52-42.43), demonstrating reduced disparities in essential maternal health services. They showed lower health insurance uptake (OR = 0.43; 95% CI:0.22-0.83) and minimal improvements in PPI scores. Qualitative findings revealed that while the pandemic disrupted health services, Chamas membership provided continuity of care through adapted CHW services. However, pandemic-related restrictions limited the program's economic benefits, potentially due to the program's shifted focus toward health service delivery during the crisis, intensifying existing economic inequities.
Conclusion: The Chamas program effectively sustained maternal and child health practices during the COVID-19 pandemic through adapted CHW support but showed limited ability to protect members from economic hardship. This demonstrates both the resilience and limitations of community-based interventions during widespread crises. Our results highlight the need for robust governmental support and social protection measures to address underlying economic vulnerabilities for women. Future pandemic preparedness should integrate CHWs into formal health systems and focus on strengthening linkages with formal financial systems while supporting CHWs' role in reducing inequities in maternal and newborn health service delivery during crises
The role of postoperative sucralfate in adults following tonsillectomy and sleep surgery: a systematic review
No full textPurpose: To investigate the efficacy of topical sucralfate on postoperative recovery following oropharyngeal surgery in adults using pain scales, analgesic use, and various self-reported measures.
Methods: CINAHL, Cochrane Library, PubMed, and SCOPUS databases were searched from inception through July 3, 2024. Randomized controlled trials related to topical sucralfate following oropharyngeal surgery in patients at least 18 years old were included. Study protocols for clinical trials, abstracts, and non-English language articles were excluded. Two authors extracted data, and disagreements were resolved with a third party if needed. Risk of bias was assessed according to Risk of Bias 2 (RoB 2) tool. Results of included studies and a narrative summary of our findings are presented through descriptive statistics (frequency (%) for categorical variables and mean (range) for continuous variables).
Results: Four studies (n = 185) pertaining to topical sucralfate and post-operative outcomes in an adult population were included. The sucralfate group had a mean age of 40.08 vs. 37.50 for the control group. The sucralfate group had a significantly higher reduction in pain scores than the control group. The sucralfate group also had statistically significant improvements in otalgia, strength, diet tolerance, and reduction in analgesic use compared to the control group in two of the four studies.
Conclusions: Oropharyngeal surgery is commonly performed in adults despite having a morbid recovery process. The literature shows promising results with the use of sucralfate in the reduction of post-operative pain in adults; however, further investigation is warranted given the limited scope of the literature
How much furosemide should be administered to prevent transfusion‐associated circulatory overload? Results of a dose‐finding study
No full textBackground and objectives: Transfusion-associated circulatory overload (TACO) is a common and life-threatening transfusion complication. Because of uncertainty regarding dosing, pre-transfusion furosemide prophylaxis is not widely endorsed. The aim of this study was to generate a furosemide dose-response curve in TACO-susceptible patients using the multiple comparisons procedure and modelling (MCP-Mod) methodology.
Materials and methods: Inpatients aged ≥50 years receiving intravenous (IV) furosemide were screened for eligibility at two academic hospitals. Exclusion criteria were active bleeding, haemodynamic instability, glomerular filtration rate (GFR) < 30 mL/min/1.73 m2 and diuretic therapy administered within 24 h or albumin administered within 8 h. The primary outcome measure was 6-h urine output post furosemide administration. After incorporation of age, sex, chronic diuretic use, mean arterial pressure, GFR and serum albumin as covariates of diuretic response, MCP-Mod was applied after every 50th enrolment until a weight-adjusted dose-response curve was identified with 100 mL precision.
Results: One-hundred forty-nine patients were enrolled. Urine output varied widely at each furosemide dose. Because of the presence of outliers and a paucity of patients receiving higher doses, only those receiving doses up to 0.6 mg/kg (n = 132) were included. After incorporating covariates, linear-log was identified as the best fitting model. Application of this formula revealed that, depending upon patient characteristics, 10-40 mg of furosemide IV would be required to achieve a diuresis volume of 400 mL, which is sufficient to offset 1 red blood cell unit.
Conclusion: We report a novel furosemide dose-response model for TACO-susceptible patients. Once validated, this model will guide furosemide dosing for a planned controlled trial evaluating furosemide for TACO prevention
462 Parental involvement is related to parental resilience and offspring neural reward prediction error signaling
No full textObjectives/Goals: Our goal was to investigate the associations between parental resilience and parenting behaviors, and their relationship to their offspring’s reward neurocircuitry function; in particular, the reward prediction error (RPE) circuit, a transdiagnostic marker of psychopathology. Methods/Study Population: N = 26 parent–child dyads (children ages 10–14) were recruited. Parents reported on parenting behaviors using the Alabama Parenting Questionnaire (APQ), and resilience using the Connor-Davidson Resilience Scale (CD-RISC). Children performed the Novelty task, a reward learning task, during fMRI scanning. Trial-by-trial RPEs were calculated based on a reinforcement learning model. Brain regions of interest (ROIs) including the nucleus accumbens, anterior putamen, and ventromedial prefrontal cortex were created (regions implicated in RPE representation). Results/Anticipated Results: The APQ parental involvement subscale was associated with increased negative affect tolerance (r = 0.40, p Discussion/Significance of Impact: Findings suggest that parental factors may impact neurocircuitries underlying psychopathology in offspring, and consequently, risk for offspring psychopathology. Interventions designed to increase parental resiliency may reduce risk for psychopathology in offspring, perhaps by increasing parental involvement and neural RPE sensitivity
Renal Proximal Tubule Cell-specific Megalin Deletion Does Not Affect Atherosclerosis But Induces Tubulointerstitial Nephritis in Mice Fed Western Diet
No full textBackground: Pharmacological inhibition of megalin (also known as LRP2 [low-density lipoprotein receptor-related protein-2]) attenuates atherosclerosis in hypercholesterolemic mice. Since megalin is abundant in renal proximal tubule cells (PTCs), the purpose of this study was to determine whether PTC-specific deletion of megalin reduces hypercholesterolemia-induced atherosclerosis in mice.
Methods: Female Lrp2 f/f mice were bred with male Ndrg1-Cre ERT2 +/0 mice to develop PTC-LRP2 +/+ and PTC-LRP2 -/- littermates. To study atherosclerosis, all mice were bred to an LDL (low-density lipoprotein) receptor -/- background and fed a Western diet to induce atherosclerosis.
Results: PTC-specific megalin deletion did not attenuate atherosclerosis in LDL receptor -/- mice in either sex. Serendipitously, we discovered that PTC-specific megalin deletion led to interstitial infiltration of CD68+ cells and tubular atrophy. The pathology was only evident in male PTC-LRP2 -/- mice fed a Western diet but not in mice fed a normal laboratory diet. Renal pathologies were also observed in male PTC-LRP2 -/- mice in an LDL receptor +/+ background fed the same Western diet, demonstrating that the renal pathologies were dependent on diet and not on hypercholesterolemia. In contrast, female PTC-LRP2 -/- mice had no apparent renal pathologies. In vivo multiphoton microscopy demonstrated that PTC-specific megalin deletion dramatically diminished ALB (albumin) accumulation in PTCs within 10 days of Western diet feeding. RNA-sequencing analyses demonstrated the upregulation of inflammation-related pathways in the kidney.
Conclusions: PTC-specific megalin deletion does not affect atherosclerosis but leads to tubulointerstitial nephritis in mice fed a Western diet, with severe pathologies in male mice
A Regional Analysis of Air Quality and Respiratory Health Outcomes in the Northwest Indiana and Chicagoland Area
No full textBackground: Northwest Indiana (NWI) houses three of seven coal-based steel factories in the US and other major industries that contribute to air pollution in NWI and Chicagoland. Pollutants such as ozone, PM2.5, and PM10 are associated with respiratory disease onset and exacerbation. The American Lung Association has assigned failing air pollution grades to most NWI and Chicagoland counties. While respiratory diseases are prevalent locally, there is limited research on air pollution’s role. This study investigated air pollution exposures and associations with respiratory outcomes in NWI and Chicagoland.
Methods: This retrospective study analyzed data from the Chicago Multiethnic Prevention and Surveillance Study (COMPASS), with social determinants of health, demographic, and environmental data for adults from 2013-2023. Additional air quality data were obtained from the Environmental Protection Agency and Washington University in St. Louis. Descriptive, bivariate (Chi-Square; Mann Whitney U, Kruskal Wallis, Spearman Rank), and multivariate (Binary Logistic Regression; Linear Regression, p<0.05) analyses were conducted using SPSS 31.0 (p<0.05). This study was IRB-exempt (Indiana University IRB #27779).
Results: This study included 2,971 participants with respiratory conditions including asthma (94.4%), COPD (6.5%), chronic bronchitis (7.4%), and lung cancer (1.0%), with 8.5% residing near a pollution source. Among participants with respiratory conditions, exposure to one pollution source was associated with fewer hospitalizations (B=-.823), while clinic visits predicted more hospitalizations (B=.749). For asthma, less than high school education (OR=2.4), some college education (OR=3.3), exposure to one (OR=2.1) and multiple pollution sources (OR=2.7) increased the odds of ED visits. Contrastingly, exposure to one pollution source (B=-.830, p=.003) was associated with fewer hospitalizations. Former smoking was associated with older age (B=7.620) of asthma diagnosis.
Conclusion: Air pollution and SDOH were associated with increased ED utilization for asthma, reflecting their combined impact. NWI is heavily industrialized but underrepresented in environmental research, warranting further environmental justice research and interventions
Who decides? Exploring decisional dynamics for periviable resuscitation among diverse family structures
No full textObjective: To investigate conflict resolution and decisional authority among diverse family structures in periviable resuscitation decision-making.
Methods: We recruited 60 parent dyads, including 30 with prior periviable delivery experience and 30 first-time expecting dyads between 22 and 26 weeks gestation. Our diverse sample included heterosexual and same-sex partnerships, married and unmarried partners. Virtual interviews explored decision-making, engagement, and conflict resolution.
Results: Four themes emerged: "Mom is the priority," highlighting maternal decisional authority; "partner involvement is crucial," emphasizing engagement; "parents prioritize who will be caring for the child," indicating caregiver considerations; and "parents want empathy and support," underscoring emotional needs.
Conclusions: Findings reveal maternal priority in decision-making, the importance of partner involvement, and a challenges with lacking inclusive legal and ethical guidance for non-heteronormative families. The study highlights the need for shared decision-making that considers family structures, legal aspects, and emotional complexities to enhance inclusive, informed decision-making processes for parents facing periviable delivery
Radiation-Induced Immune Responses from the Tumor Microenvironment to Systemic Immunity
No full textRadiotherapy remains a central component of cancer therapy that induces DNA damage and cancer cell death. Beyond its cytotoxic effects, radiotherapy acts as a potent immunomodulator by releasing immunogenic molecules, inflammatory mediators, and neoantigens that shape anti-tumor immunity. Radiation-induced immune responses can have opposing effects, including immune activation or immunosuppression that dictate local tumor responses. Increasing evidence suggests these immunologic effects are not confined to the site of irradiation, as radiation exposure to surrounding normal tissue can trigger systemic immune signaling that affects local tumor progression as well as metastatic spread. This review examines radiotherapy-induced immune responses across three interconnected contexts: (i) tumor-intrinsic signaling during radiation; (ii) tumor microenvironmental changes where innate and adaptive immune responses alter local outcomes; and (iii) systemic and off-target effects contributing to broader immune remodeling. A comprehensive understanding of radiotherapy-induced immune responses will guide therapeutic strategies to enhance its immunological potential while minimizing unintended immune and off-target effects
Emergency Physician Perspectives on the Use of Patient Experience Surveys
No full textIntroduction:
Although emergency medicine specialty societies have published policy statements on the use of patient experience data, we know little about how these data are currently used within physician groups. We also have little information about individual emergency physicians’ perspectives on the use of these data.
Methods:
A total of 1049 questionnaires were distributed via email to residency program alumni of a large Midwestern residency program in June-July 2024. Participants were asked questions regarding their time in practice since residency, practice setting, and their current group or employer’s use of emergency department (ED) patient experience feedback. Descriptive statistics were calculated for all variables, and a logistic regression was performed to determine associations between respondent sex and years in practice with the odds of perceiving the use of experience ratings as fair. Finally, open-ended responses were reviewed thematically to identify common patterns.
Results:
From a distribution to 1049 individuals, there were 99 (9.4%) responses. A total of 33 (33.3%) respondents made free-response comments. The most common uses of data were the publication of group performance and individual emails to physicians regarding patient feedback. Financial incentives were more common at the group level than at the individual level. Female physicians had lower odds of perceiving use of the ratings as fair. In addition, physicians raised concerns in free response comments about gender and racial bias, sample size and distribution of surveys, and the relevance of factors outside of physician control.
Conclusion:
Emergency physicians held relatively neutral positions on whether the current use of experience data was reasonable. However, they had numerous concerns regarding the data quality
Inhibitor development in nonsevere hemophilia: data from the European Haemophilia Safety Surveillance (EUHASS) registry
No full textBackground: Information on inhibitor development in nonsevere hemophilia and its association with clotting factor concentrate type is limited.
Objectives: To assess inhibitor development in patients with nonsevere hemophilia A (HA) and hemophilia B (HB) in the European Haemophilia Safety Surveillance system.
Methods: Inhibitors and total treated patients are reported annually. Any exposure to concentrate per year was considered a treatment year. Incidence rates per 1000 treatment years and 95% CIs were calculated according to type of concentrate and compared using incidence rate ratios (IRRs).
Results: During 2008 to 2023, 90 centers reported on 36,074 (HA) and 9238 (HB) treatment years. The inhibitor rate for nonsevere HA receiving factor (F)VIII was 4.2 per 1000 treatment years (95% CI, 3.5-4.9). Inhibitors developed at median 47.5 years (P25-P75 [IQR], 17.0-69.0), after median 40 exposure days (EDs; IQR, 17-80), with 58% occurring <50 EDs and 88% <100 EDs. Overall, 4 of 149 (2.7%) patients in the inhibitor group were female. Only one inhibitor was reported in nonsevere HB, in a female patient (FIX 7%, after 6 EDs), resulting in an inhibitor rate of 0.1 per 1000 treatment years (95% CI, 0.0-0.6). Compared with standard half-life recombinant FVIII, inhibitor rates on both plasma-derived FVIII (IRR, 0.27; 95% CI, 0.11-0.58; P < .001) and extended half-life FVIII (IRR, 0.18; 95% CI, 0.02-0.68; P = .002) were significantly reduced.
Conclusion: Inhibitors in nonsevere hemophilia occurred at a rate of 4.2 per 1000 treatment years in HA and 0.1 per 1000 treatment years in HB. Compared with standard half-life FVIII, inhibitor development on plasma-derived and extended half-life FVIII were reduced. These data show that inhibitor monitoring is relevant with nonsevere HA in both sexes and should be continued lifelong