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“It’s just what’s around these days”: social and contextual pragmatism in substance transitions
Get PDFBackground The overdose epidemic is presently driven by polydrug use, sparking renewed interest in why people initiate use of certain drugs or drug combinations. Current research privileges the physiological ends of consumption, often ignoring the social and environmental context of use. Framed by social cognitive theory, the purpose of this study was to characterize factors precipitating substance initiation, transition, and combination beyond the immediate effects of the substance(s). Methods We conducted 30 semi-structured interviews with people who use drugs across North Carolina, exploring substance use history and risk and protective factors of polydrug use. Participants also completed a visual timeline activity. We used a staged analytic approach, beginning with deductive Structural Coding and ending with inductive Reflexive Thematic Analysis at both the transcript and excerpt levels. Results We conceptualized substance transitions as pragmatic responses to environments of constraints and opportunities. Socially, transitions facilitated interpersonal closeness, aligned use with network norms, and responded to ubiquitous drug availability. Transitions also reflected navigation of material constraints, including which substances were locally available, logistically accessible, and financially sustainable. Conclusions Beyond the desire for new or enhanced physiological effects, substance transitions serve social and practical functions, like facilitating emotional closeness and responding to market conditions. Interventions to reduce the risks of use should expand viable options by addressing structural barriers and promoting safe, affordable, and accessible supply
Laying the groundwork for a culturally sensitive pediatric primary care eating disorders intervention for the Latino community: insights from focus groups
Get PDFBackground Adolescents and caregivers from the Latino community face significant barriers to accessing treatment for eating disorders (ED) and disordered eating (DE) including cultural stigma, language barriers, and limited availability of culturally congruent care. Most existing ED/DE interventions were developed for non-Hispanic White populations, often limiting their application to families from the Latino community. To address this disparity, we are developing First Approach Skills Training- Trastornos de la Conducta Alimentaria (FAST-TCA), a culturally adapted version of FAST-DE, a brief workbook-based intervention for ED/DE designed for implementation in pediatric primary care. Methods This study used a community-engaged iterative process to inform the first steps of the cultural adaptation of FAST-DE into FAST-TCA. Two rounds of semi-structured focus groups were conducted with each of two stakeholder groups: Latino caregivers of adolescents with ED/DE histories and Latino adolescents with lived experience of ED/DE. Focus groups were recorded, transcribed, and analyzed using a codebook thematic analysis informed by a phenomenological perspective. Results Seven themes emerged from caregiver focus groups: psychological and social influences on ED/DE development, treatment experiences, family context, barriers to care, treatment priorities, caregiver empowerment, and workbook design and accessibility. Four themes were extracted from adolescent focus groups: navigating cultural identity and ED/DE, family dynamics and support, the need for sensitive and thoughtful content delivery, and ED/DE recovery experience reflections. Across both groups, participants emphasized the importance of accessible, culturally congruent, family-centered care and offered specific feedback that informed the revisions to the FAST-TCA workbook, including the incorporation of culturally relevant foods and expanded caregiver psychoeducation. Conclusions Focus group insights guided the development of the first draft of FAST-TCA, an initial cultural adaptation of FAST-DE. This study demonstrates the utility of community-engaged methods in enhancing the cultural relevance of ED/DE interventions. The next phase of the cultural adaptation will occur following the pilot implementation of FAST-TCA, where additional feedback from adolescents and caregivers will inform further refinement of the intervention
Aging, Mental Health and Ethnic Disparities: Understanding Geriatric Mental Health in Western Nepal.
Get PDFObjective: This study examined the prevalence of anxiety, low mental well-being, loneliness, depression, and insomnia among older adults in a district of western Nepal and identified factors associated with each of these conditions. Methods: A community-based cross-sectional study was conducted in Dang, Nepal from August 2023 to January 2024 among adults aged 60 years or older using purposive sampling technique (n = 814). Validated tools were used to assess each mental health conditions. Multivariate logistic regressions were conducted to identify factors associated with each condition. Results: Five percent of older adults had low mental well-being, 7.25% experienced loneliness, 14.13% showed signs of general anxiety disorder (GAD), 6.58% had depression, and 1.97% had insomnia. Older adults of Dalit ethnicity, those with chronic illnesses, and those with a family history of mental illness had a disproportionately higher odds of developing one or more mental health conditions compared with their counterparts. Conclusion: Mental health conditions such as anxiety, depression, sleep difficulties and loneliness, and low mental well-being were less prevalent in Dang compared to previous studies in Nepal, and were associated with caste, chronic illnesses, and family history of mental illnesses. These findings highlight the need for targeted mental health screening and culturally sensitive interventions-such as community-based programs that acknowledge caste-based stigma, strengthen family and social support systems, and integrate local language counseling- to address mental health needs of vulnerable older adults. Future nationally representative studies are needed to provide a broader understanding of mental health among older adults in Nepal
From NICU to home: meeting the mental health needs of families after discharge
Get PDFFamilies of infants hospitalized in the neonatal intensive care unit (NICU) are at an increased risk for depression, anxiety, and trauma symptoms that often persist well beyond transition from the NICU. While NICU professionals provide vital medical care for high-risk infants, they also offer interdisciplinary support for families, including collaboration with psychosocial and psychiatric services in select settings. Despite psychosocial support systems often being present during NICU hospitalization, significant gaps remain in post-NICU mental health support for parents. Comprehensive discharge preparation and outpatient follow-up planning for infants, as well as their families, are essential to optimize both long-term outcomes and the well-being of the entire family unit. In this paper, we review current evidence regarding mental health risks for families during transitions of care and highlight practice recommendations and advocacy opportunities for enhanced family-centered, interdisciplinary follow-up care after transition from the NICU
Grant Writing in Public Health Academia: Navigating Federal, Foundation, and Nonprofit Landscapes
Get PDFAs the demand for competitive and impactful research intensifies, public health scholars must navigate a grant landscape marked by increasing complexity, cross-sectoral expectations, and heightened accountability.
In response, this literature review synthesizes evidence from academic and open-access sources to identify best practices in grant writing within academic institutions, with particular attention to faculty development, narrative design, university-level infrastructure, evaluation planning, and sustainability. While grounded in public health, the review draws on cross-sectoral insights to elevate strategies that support contextually relevant, interdisciplinary, and high-impact proposal development.
Findings emphasize that successful proposals are not solely the product of individual skill but emerge from organizational ecosystems that support strategic communication, relational collaboration, and administrative capacity. The review highlights promising models, such as mentorship-driven faculty development, participatory evaluation frameworks, and research development infrastructure, that position grant writing as both a technical and strategic endeavor. It also identifies structural challenges, including disparities in university-level support, ambiguity in funder expectations, and under-investment in post-award capacity.
Emerging trends, such as the use of AI in proposal development, curricular integration of grant writing, and facilitative pre-award support, reflect a broader reimagining of grant writing as a collaborative process embedded in organizational practice.
The review concludes with implications for practice and policy, urging institutions to move beyond isolated interventions and invest in coordinated systems that make grant development more accessible, sustainable, and impactful. In doing so, they establish public health research as a cornerstone of population health, capable of informing policy, catalyzing innovation, and strengthening the systems that support community well-being
Longitudinal Trajectories of Premorbid Social and Academic Adjustment in Youth at Clinical High Risk for Psychosis: Implications for Conversion
Get PDFBACKGROUND AND HYPOTHESIS: Social and academic adjustment deteriorate in the years preceding a psychotic disorder diagnosis. Analyses of premorbid adjustment have recently been extended into the clinical high risk for psychosis (CHR) syndrome to identify risk factors and developmental pathways toward psychotic disorders. Work so far has been at the between-person level, which has constrained analyses of premorbid adjustment, clinical covariates, and conversion to psychosis. STUDY DESIGN: Growth-curve models examined longitudinal trajectories in retrospective reports of premorbid social and academic adjustment from youth at CHR (n = 498). Interaction models tested whether known covariates of premorbid adjustment problems (attenuated negative symptoms, cognition, and childhood trauma) were associated with different premorbid adjustment trajectories in converters vs non-converters (ie, participants who did/did not develop psychotic disorders within 2-year follow-up). STUDY RESULTS: Converters reported poorer social adjustment throughout the premorbid period. Converters who developed psychosis with an affective component reported poorer academic adjustment throughout the premorbid period than those who developed non-affective psychosis. Tentatively, baseline attenuated negative symptoms may have been associated with worsening social adjustment in the premorbid period for non-converters only. Childhood trauma impact was associated with fewer academic functioning problems among converters. Cognition effects did not differ based on conversion status. CONCLUSIONS: Premorbid social function is an important factor in risk for conversion to psychosis. Negative symptoms and childhood trauma had different relationships to premorbid functioning in converters vs non-converters. Mechanisms linking symptoms and trauma to functional impairment may be different in converters vs non-converters, suggesting possible new avenues for risk assessment
Female Patients With Mucopolysaccharidosis II (MPS II): Insights From the Hunter Outcome Survey
Get PDFMucopolysaccharidosis II is a rare, X-linked disease, with very few reports of affected female patients. Natural history data describe a predominantly male population, and appropriate disease characterization in female patients is lacking. This analysis explores the somatic disease burden and clinical progression of female patients with MPS II enrolled in the Hunter Outcome Survey (HOS; NCT03292887), a global disease registry. In total, 15 female patients were identified, representing 1.1% of the total patients in HOS. The median ages at first symptom onset and diagnosis were 1.8 and 3.1 years, respectively. A total of 8/14 (57.1%) of patients had cognitive impairment at the latest visit. X-chromosome abnormalities were reported in two patients. Most patients (11/15, 73.3%) had received at least one dose of idursulfase, which was generally well tolerated; no serious adverse events during follow-up were considered treatment-related. Musculoskeletal and ear symptoms were present in all 14 patients with data recorded. Almost all females also experienced neurological, abdominal/gastrointestinal, and pulmonary disease, similar to the symptomatology reported in males. Most patients underwent surgery (41 procedures in 12 patients). Two participants had a male sibling with MPS II who was also enrolled in HOS. Both sibling sets had missense variants and demonstrated several differences in signs/symptoms between the male and female siblings. Notably, only the female siblings displayed cognitive impairment. This report illustrates the disease burden in female patients with MPS II, helping to inform clinicians about the likely prognosis for this extremely rare subgroup of patients
Mapping integrated implementation of Adapted Resource and Implementation Application (ARIA) and REDCap version hospital-based pediatric cancer registry (HBCR) in Ethiopia: An implementation Study
Get PDFThis study presents the perceived implementability of the digital Hospital-Based Cancer Registry (HBCR) and the Adapted-Resource Implementation Application (ARIA) to enhance data systems and treatment standards at Pediatric Oncology unit (POU). A 2-year (2023–2025) implementation study on the integrated application of ARIA and HBCRs is being conducted at Jimma University Medical Center (JUMC) and St. Paul Hospital Millennium Medical College (SPHMMC). This article reports the formative assessment results, guided by the Consolidated Framework for Implementation Research (CFIR), involved eight focus group discussions, four in-depth interviews, and two co-design workshops with diverse healthcare providers and hospital management/leadership personnel. The integrated implementation of HBCR-ARIA was viewed as innovative and adaptable. Digital HBCR was perceived as more effective than manual methods for managing pediatric oncology data. Similarly, ARIA was perceived as effective and feasible for providing patient-specific standardized care. Workflows and responsibilities were co-defined separately for the respective POUs. The co-designed implementation strategy includes residents filling demographic and diagnostic information of patients’ on HBCR interim document and then cross-checked by the pediatric Hematology and Oncology (PHO) fellows. The Medical Monitor (PHO senior) approves the validity of the document before entry into REDCap by the data clerk. ARIA is filled by PHO fellows and approved by second PHO fellow or PHO seniors based on the availability. Facilitators in both the inner (hospital) and outer (external) settings outweighed the barriers. Facilities and motivated human resources are in place to implement the digital HBCR and ARIA strategies at the respective POU. However, challenges such as inconsistent electric power, unreliable internet services, and logistic-supply issues. The implementation strategies for digitized HBCR and ARIA, co-designed to fit the specific contexts of two POU, appear promising but require further evaluation
Distribution of methane-cycling archaea in buried ridge flank sediment: community zonation, activity, and potential environmental drivers
Get PDFSubseafloor sediments harbor Earth’s biggest reservoir of methane, with most of this methane being produced biologically by methanogenic archaea (methanogens). Yet, little is known about the controls on in situ abundances, community structure, and biochemical pathways of methanogens, and closely related anaerobic methane oxidizing archaea (ANMEs), in these environments. Here we examine the vertical distribution of methane-cycling archaea at Integrated Ocean Drilling Program Site U1301, an offshore drilling site on the eastern flank of the Juan de Fuca Ridge, that was previously characterized with respect to its in situ temperature profile, sediment provenance, geochemical gradients, and general microbial community structure. We integrate (1) functional gene analyses (mcrA) to analyze methane-cycling archaeal abundances and community structure with (2) sediment porewater concentration profiles of sulfate, methane, Mn2+, and Fe2+ to shed light on the distributions of dominant microorganisms and processes involved in subseafloor methane cycling. These analyses indicate that sediments from the cold seafloor (2 °C) to the hot basement (64 °C), across zones of sulfate reduction (SR), anaerobic oxidation of methane (AOM), and methanogenesis (MG), were dominated by two phylogenetic clusters. These belonged to the family Methanoperedenaceae, which couples the oxidation of methane to the reduction of nitrate or metals, and the candidate order Methanophagales (group ANME-1a-b). The latter has mainly been linked to sulfate-dependent AOM, although a facultative methanogenic metabolism has also been proposed. Other groups of methane-cycling archaea (ANME-2c, -3, Methanothrix, Methanocellales, Candidatus Nezhaarchaeales) were only detected in single samples from the upper and lower AOM zones and the MG zone. No stimulation of methanogenic activity was evident at the deep sediment-basement interface; however, the dominant Methanoperedenaceae and Methanophagales phylotypes throughout the sediment column cluster phylogenetically with those previously detected in underlying basalt, suggesting dispersal and similar selective forces on methane-cycling archaea across this major lithological boundary. Based on the observed dominance of Methanoperedenaceae and porewater geochemical profiles which indicate decoupling between measured sulfate and methane concentrations in sediments with methane oxidation, we propose that a significant portion of AOM in the iron- and manganese-rich sediments of the Juan de Fuca Ridge Flank proceeds through the reduction of iron (III) and manganese (IV)
Promoting ENT‐erest: Evaluating the Effect of Early, Focused Exposure to Otolaryngology
Get PDFExposure to otolaryngology throughout medical school is variable, with the majority of students receiving their first exposure in clerkships. This shortens the match timeline for students who pursue otolaryngology and decreases learning opportunities for all students. The aim of the current study is to assess the impact of an otolaryngology curriculum for preclinical medical students. Pre‐post. This study was conducted among preclinical students at the UNC SOM in fall 2022 and fall 2024. Students participated in an otolaryngology education curriculum including a surgical simulation session, anatomy demonstrations, and career exploration lectures. Surveys before and after the simulation were used to assess understanding of concepts, procedures, and interest in otolaryngology, consisting of multiple‐choice and Likert scale questions. Pre‐survey and post‐survey results were compared. A total of 39 students completed the pre‐survey, and 37 completed the post‐survey. Roughly half of these students (58%) had prior exposure to otolaryngology, most commonly research (34.6%) and shadowing (30.8%). Of those that completed both surveys, there was a statistically significant improvement in understanding of otolaryngology concepts and procedures (P < .05). Students reported that these sessions increased their interest in (4.25/5) and understanding of (4.38/5) otolaryngology, anatomy (3.88/5), and ear, nose, and throat (ENT) conditions (4.16/5). Early, intentional exposure to otolaryngology not only fosters student interest in the specialty but also improves their understanding of otolaryngologic care. Medical educators should aim to provide focused, early exposure to medical students regardless of their specialty interest to enhance both specialty knowledge and general medical competence. 4