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L-carnitine is essential for myocardial metabolism, and its depletion may compromise heart function. We conducted a prospective observational study to assess serum carnitine profiles in 26 children under 36 months of age undergoing elective open-heart surgery with cardiopulmonary bypass. Measurements included free carnitine, acylcarnitine, and the acylcarnitine-to-free carnitine ratio, recorded preoperatively and at multiple postoperative time points up to 24 hours. We observed a significant postoperative decline in free carnitine and an increase in the acylcarnitine-to-free carnitine ratio, both of which correlated with cardiopulmonary bypass duration. These results highlight a perioperative disturbance in carnitine metabolism, suggesting potential relevance for postoperative cardiac recovery.
While early-life adverse experiences have been linked to late-life cognitive decline, few studies have explored war exposure. Paradoxically, one study even indicated a late-life cognitive advantage of early-childhood war exposure. In the present study, we explored these associations.
Methods:
We examined older adults exposed to World War II (1940–1944; n = 1179) and the subsequent Civil war (1946–1949; n = 962) in Greece during early and middle childhood with a comprehensive neuropsychological assessment and for ApoE-ε allele status, including demographic information and medical history.
Results:
Higher cognitive performance in language tasks predicted middle childhood, relative to early childhood, WWII-exposure group membership (B = .316, p = .038, OR:1.372, 95%CI:1.018–1.849), primarily for men, while higher attention/speed (B = .818, p = .002, OR:2.265, 95%CI:1.337–3.838) and total cognitive score (B = .536, p = .040, OR:1.709, 95%CI:1.026–2.849) were predictors of belonging to the middle-childhood group, only in men. Individuals who did not meet criteria for Mild Cognitive Impairment (MCI)/dementia were more likely to belong to the middle-childhood war-exposure group. Similarly, for the Civil war, higher cognitive scores and reduced likelihood to meet criteria for MCI/dementia were predictors of middle, relative to early childhood war exposure group membership (visuospatial score: B = .544, p = .001, OR:1.723, 95%CI:1.246–2.381, MMSE: B = .134, p = .020, OR:1.143, 95%CI:1.021–1.297), primarily for women. Results remained consistent when adjusting for multimorbidity, sex, education, current age, depression, and anxiety.
Conclusion:
The present findings suggest that better cognitive performance and lower likelihood of MCI or dementia were associated with being exposed to significant hardships, such as war, during middle childhood, regardless of potentially confounding factors. Further studies are needed to shed light on this relationship.
To assess the prevalence and identify sociodemographic predictors of regular fast-food consumption (R-FFC) among United Arab Emirates (UAE) adults to inform public health nutrition responses to growing diet-related ill health in the region.
Design:
This is a descriptive cross-sectional study using purposive, convenience sampling. Data were collected using an online survey adapted from two validated surveys and distributed via social media platforms. R-FFC was defined as visiting a fast-food restaurant to eat ≥ 2 times/week. Pearson’s χ2 tests and multiple binary logistic regression models were used to investigate prevalence and predictors of R-FFC. All statistical significance was considered at P-value < 0·05.
Setting:
Community, adults living in the UAE.
Participants:
UAE residents, ≥ 18 years, who consumed fast food ≥ once during the previous month.
Results:
Totally, 320 respondents met the inclusion criteria (age = mean 23·7 (sd 7·7) years). The prevalence of R-FFC was 46·6 %. Based on results from the regression model, predictors of R-FFC were being female (AOR 2·47; 95 % CI 1·06, 5·79), married (AOR 3·11; 95 % CI 1·25, 7·77), BMI ≥ 25·0 (AOR 2·09; 95 % CI 1·10, 4·00) and residing outside Abu Dhabi (AOR 32·79; 95 % CI 12·06, 89·16). None of the remaining variables reached statistical significance. Taste was the most common reason for FFC (56·9 %), followed by convenience (21·6 %). Regular fast-food consumers were more likely to ‘super-size’ meals (P = 0·011), eat alone (P = 0·009) and not have regular meal patterns (P = 0·004).
Conclusions:
The study revealed a high prevalence of R-FFC among UAE adults, and novel cultural predictors and characteristics of FFC in this context, highlighting the importance of socially and culturally informed research and public health strategies in this region.
Optic neuritis (ON) represents the most common optic neuropathy in young adults; however, longitudinal data on visual recovery, particularly in autoimmune ON subtypes, remain limited. This study aimed to assess long-term visual outcomes in patients with severe ON without multiple sclerosis stratified by autoantibody status: aquaporin-4 (AQP4)-IgG positive, myelin oligodendrocyte glycoprotein (MOG)-IgG positive and double seronegative (DN).
Methods:
A retrospective cohort analysis was conducted at a tertiary neurology center in southern India, including severe ON patients (best-corrected visual acuity [BCVA] ≤1.0 logMAR) between January 2016 and April 2024. Serological testing for AQP4 and MOG antibodies was performed via cell-based assays. Visual outcomes were categorized as “good recovery” (≥66.77% improvement in BCVA) and “complete recovery” (return to baseline BCVA).
Results:
Among 42 patients, 17 were AQP4-IgG positive, 10 MOG-IgG positive and 15 DN. The median BCVA at nadir was 1.7 logMAR. Compared with that in the MOG-IgG group, the likelihood of complete visual recovery was lower in both the AQP4-IgG (hazard ratio [HR]: 0.18; p = 0.16) and DN (HR: 0.56; p = 0.34) groups. For good recovery, the AQP4-IgG (HR: 0.16; p = 0.001) and DN (HR: 0.24; p = 0.001) groups had significantly lower HR. All MOG-IgG–positive patients achieved good recovery, compared with fewer than half in the other groups.
Conclusion:
Antibody status predicted long-term visual outcomes in patients with isolated ON, with MOG-IgG conferring the best recovery, AQP4-IgG the worst and DN intermediate, underscoring the importance of early, antibody-guided management.
Disparities in clinical outcomes exist among children with CHD, and social determinants of health are a significant contributor. Follow-up care plays an important role in long-term health and may be impacted by social determinants of health. We aimed to describe the population with lapses in care to outpatient, general paediatric cardiology from a social determinants of health standpoint and compare them to our primary service area.
Methods:
A retrospective chart review was completed for children who had lapses in care within outpatient, general cardiology. Data were compared to the Cincinnati Children’s Hospital Medical Center’s primary service area population.
Results:
A higher proportion of patients who had lapses in care were noted to identify as Hispanic/Latino, utilised some form of public insurance, and lived in communities with more social deprivation.
Conclusion:
Patients who identify as a minority race/ethnicity, utilise public insurance, or live in an area with a higher social deprivation may be at a higher risk for lapses in outpatient cardiology care, including both follow-up care and initial evaluations.
Cardiovascular disease (CVD) is the leading cause of death worldwide. Research suggests people with Mental Health Disorders (MHDs) have increased CVD risk. However, knowledge gaps exist regarding CVD risk management for general practice patients with MHD, and interventions that might improve CVD prevention. This study examined the perspectives of general practice professionals in Ireland on cardiovascular risk assessment for patients already diagnosed with MHD and to describe current approaches to identifying this population using the Mental Health Finder (MHF) tool.
Methods:
An embedded mixed-methods design was adopted, guided by constructivist grounded theory and the Social Ecological Model. Aggregated anonymised data, including availability and use of the MHF tool, were collected from five practices and analysed in SPSS. In-depth semi-structured interviews were conducted with 12 general practitioners and three practice nurses. Qualitative data were analysed using Braun and Clarke’s Reflexive Thematic Analysis.
Results:
Of the five practices, two had access to the MHF tool. These reported combined prevalence of 18.7% for MHD compared with 0.5–11.5% in practices without the tool, highlighting the importance of systematic identification. Qualitative analysis generated four themes: (1) prevalence of MHD in general practice, (2) association between MHD and CVD risk, (3) CVD risk management in patients with MHD, and (4) holistic care.
Conclusion:
CVD risk assessment for patients with MHD in general practice is largely opportunistic and unstructured. Participants highlighted the need for structured frameworks, protocols, and enhanced supports to enable systematic cardiovascular assessment and management in this population.
We report a nearly complete mitochondrial genome (mitogenome) of Echinostoma caproni (Egyptian isolate), which was reassembled and thoroughly annotated from whole-genome sequencing data available from Sequence Read Archive (accession No. ERS055227). Although a mitogenome of E. caproni has previously been deposited in GenBank (accession No. AP017706), it represents a partial sequence lacking the transfer RNA (tRNA)-Ser2 and possessing only a short non-coding region. In contrast, the newly reconstructed mitogenome in this study is 14,549 bp in length and comprises 12 protein-coding genes, 22 tRNA genes, 2 ribosomal RNA genes, and a 1,256 bp non-coding region containing 4 repeat units. The annotated sequence has been deposited in the Third Party Annotation database in GenBank (accession No. BK071757). Phylogenetic inference based on mitogenomic data indicates that E. caproni is closely related to E. miyagawai strains. This improved mitogenome provides a reliable genomic resource for comparative mitogenomic analyses and phylogenetic studies within the family Echinostomatidae.
High uncertainty in recent global health, geopolitical, and climate crises has been proposed as one important driver of the rise in youth mental health problems. This makes intolerance of uncertainty – a transdiagnostic risk factor for mental health problems – a promising target for intervention.
Methods
This study presents a novel single-session online training that took a synergistic mindset approach to promote uncertainty-as-adaptive and growth mindsets. The novel Uncertainty-Mindset Training was compared with Psychoeducation and No-Training control groups in 259 older adolescents/emerging adults (18-to-24-year-olds).
Results
The Uncertainty-Mindset Training reduced intolerance of uncertainty, anxiety symptoms, and depression symptoms 1 month later. Importantly, the clinical gains were mediated by reductions in intolerance of uncertainty.
Conclusions
Given that this ultra-brief training can be delivered at scale globally and at no cost to the users, it shows promise for significant public health impacts.
People with severe mental illness (SMI) (schizophrenia-spectrum and bipolar disorders) experience a 15–20-year reduction in life expectancy. The role of social determinants, including that of social exclusion, in contributing to excess mortality in SMI remains underexplored.
Methods
Retrospective cohort study, comprising 8098 people with clinician-diagnosed SMI, matched to 581,209 population controls, followed for 5.7 years using person-level linked health/ census records. A social exclusion index was derived from census indicators: marital status, social isolation, economic inactivity, education, tenure, housing stability, and material assets.
Results
Social exclusion was more common in SMI than in controls and strongly associated with higher mortality. Relative to the least socially excluded controls, adjusted hazard ratios (aHR) for mortality in SMI were: 16–44 years: aHR 7.58 (95% CI: 2.75–20.86) in the least socially excluded, increasing to 12.34 (7.92–19.24) in the most excluded; 45–64 years: 3.34 (1.98–5.64) [least excluded] increasing to 6.58 (5.32–8.14) [most excluded]; 65+ years: 2.71 (1.90–3.86) [least excluded], increasing to 3.07 (2.48–3.80)[most excluded]. Excess mortality among those with SMI was pronounced at younger ages if never married; by mid-life if living alone or economically inactive; and at 65+ years in those with SMI living alone, renting, or with no car ownership. Economic inactivity and lack of qualifications accounted for 16–35% of SMI mortality.
Conclusions
Social exclusion is an under-recognized contributor to premature mortality in SMI. Targeting social determinants through novel socially-focused interventions could improve survival in people with SMI.
Thai researchers developed a new self-report measure of executive functions for adolescents based on Diamond’s framework (the Behavioral Inventory Measure of Executive Functions [BIMEFs]). How it was developed, its psychometric properties, and norms by sex and age are reported here.
Method:
An independent panel of experts evaluated the content validity of BIMEFs. Reliability was checked using Cronbach’s alpha with a sample of 45 secondary students. 1,865 students, ages 12 – 18 years (65% female) from across Thailand participated in the normative study.
Results:
The BIMEFs consists of 42 items that assess inhibitory control (IC), working memory (WM), and cognitive flexibility (CF), including eight subcomponents. For all items, the index of item-objective congruence was >0.5 and Cronbach’s alpha was >0.7. Confirmatory factor analysis (CFA) showed the adjusted goodness of fit index to be 0.9. The strongest sex difference was for IC. Students of 13 years scored lower on EFs overall, IC, WM, CF, and all subcomponents than older students. Self-control, verbal working memory, and being able to change perspectives showed the most pronounced differences by age.
Conclusion:
The BIMEFs, which is designed to be culturally-appropriate for Thailand and cross-culturally generally, is the first EF questionnaire based on Diamond’s framework. It shows good psychometric properties and sensitivity to age and sex differences. It indicates that IC development, at least in Thailand, plateaus earlier than WM and CF and that CF shows a more protracted development during adolescence than IC or WM.
The COVID-19 pandemic intensified food insecurity (FI) and stress for many pregnant individuals, which may have contributed to adverse fetal developmental programming. This study aimed to identify key social determinants of health associated with pandemic-related FI and stress, and their association with gestational weight gain (GWG) and newborn birth weight in a Canadian pregnant cohort. Data were collected retrospectively from 273 pregnant individuals who delivered infants in Canada during the pandemic (March 2020–March 2023). Validated questionnaires were used to assess FI and pandemic-related stress, and GWG and infant birth weight were self-reported. FI was experienced by 55.7% of the participants, while 33.7% and 19.7% reported heightened stress related to COVID-19 infection and pregnancy preparedness, respectively. Participants from food-secure and food-insecure households differed significantly in parental structure, age, sexual orientation, housing status, household income, number of children in the household and pregnancy planning (all p values < 0.01). Heightened stress for both pregnancy preparedness and COVID-19 infection was also significantly associated with these same factors (all p values < 0.05) but not for age and housing status. FI and heightened stress were not associated with GWG outside the recommended range. However, significantly higher likelihood of birth weight extremes was observed with heightened COVID-19 infection-related stress (OR, 95% CI 1.50, 1.05–2.12, p = 0.02) and pregnancy preparedness-related stress (1.60, 1.10–2.31, p = 0.01), but not with FI. These findings underscore the influence of psychosocial factors on FI and stress during pregnancy, which may negatively impact infant health outcomes during the pandemic.
Maternal diabetes during pregnancy, including pre-gestational and gestational diabetes mellitus (DM), can significantly affect fetal development, particularly in the kidneys. This study aimed to investigate the effects of maternal diabetes on fetal kidney size, parenchymal thickness, and renal artery hemodynamics using ultrasonography. A total of 128 pregnant women were enrolled and classified into pre-gestational DM (n = 28), gestational DM (n = 36), and control (n = 64) groups. Fetal kidney measurements, including anteroposterior, mediolateral, and longitudinal diameters as well as renal parenchymal thickness (RPT) and renal artery pulsatility index (PI), were assessed between 28 and 38 weeks of gestation. Fetal kidney volumes and their ratios to estimated fetal weight (EFW) and abdominal circumference (AC) were significantly lower in both the pre-gestational and gestational DM groups than in the controls (p < 0.05). However, no significant differences were observed in the RPT/AC ratios or renal artery PI among the groups. Furthermore, no significant correlations were found between maternal hemoglobin A1c (HbA1c) levels and fetal kidney or blood flow parameters. These findings suggest that maternal diabetes alters fetal kidney growth patterns relative to the overall fetal size, potentially reflecting developmental programming that may affect nephron endowment and long-term renal health. The lack of significant differences in RPT/AC ratios and renal artery PI may be attributed to effective diabetes management or limitations in detecting subtle changes using the current ultrasound methodologies. Further longitudinal studies with larger cohorts and postnatal follow-up are warranted to clarify long-term renal outcomes and explore the precise mechanisms underlying these developmental changes.
The pervasive integration of digital media into daily life is reshaping how individuals encounter and internalize harmful contents. Unrestricted access exposes students to emotionally disruptive materials, including depictions of violence, substance use, and harassment, raising concerns about its impact on well-being. This study examines a serial mediation model linking antisocial media exposure to subjective well-being (SWB) through school-based victimization as sequential pathways. Using data from 326 high school students in Nigeria, we applied partial least squares structural equation modeling to test hypothesized relationships. Results indicate that antisocial media exposure was not directly associated with SWB but significantly predicted experiences of teacher and peer victimization. Peer victimization mediated the relationship between antisocial media exposure and SWB (β = −0.023, 95% CI: [−0.054, −0.004], p < 0.05). Furthermore, antisocial media exposure increased the likelihood of teacher victimization, which facilitated peer victimization, ultimately compromising SWB (β = −0.030, 95% CI: [−0.058, −0.011], p < 0.05). Effects varied by gender and academic level, underscoring intersectional risks linked to media exposure. Findings highlight the need for targeted interventions addressing both teacher and peer victimization in resource-constrained educational contexts.
Cardiac tamponade is a rare but life-threatening condition in children, typically requiring urgent percutaneous pericardiocentesis. Despite its clinical importance, comprehensive data on paediatric cardiac tamponade are limited.
Methods:
We retrospectively reviewed 251 paediatric patients (0–18 years) with cardiac tamponade who underwent emergency percutaneous pericardiocentesis to evaluate the aetiological spectrum, age distribution, and associated clinical factors between November 2003 and May 2025. Diagnosis was based on echocardiographic criteria indicating haemodynamic compromise. Patients were categorised by age group, underlying aetiology, and recent history of cardiac intervention.
Results:
Structural heart diseases were the leading cause of cardiac tamponade (51.6%), particularly in neonates and infants. Pericardiocentesis was most frequently performed in children aged 6–12 years (28.2%). Cardiomyopathies were more prevalent in older age groups. Infectious causes were the second most common aetiology (11.5%). Cardiac Tamponade occurred more frequently following cardiac surgery (12.3%) than after catheter-based interventions. Iatrogenic tamponade was identified in six patients, most commonly during high-risk transcatheter procedures. Genetic syndromes were present in 30 patients, with Down syndrome being the most common.
Conclusions:
To the best of our knowledge, this study represents the largest single-centre cohort of paediatric cardiac tamponade requiring pericardiocentesis. Cardiac causes, particularly structural heart diseases, represent the most common aetiology across all age groups; therefore, these patients should be promptly evaluated for cardiac tamponade when presenting with relevant symptoms.
To explore the spirituality issues among cancer patients undergoing cancer treatment at Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania.
Methods
This was a qualitative study involving purposively selected cancer patients receiving treatment at ORCI, Dar es Salaam, Tanzania. Data were collected through one-to-one audiotaped interviews using a pilot-tested semi-structured interview guide. Data saturation was reached at the 24th interview. Thematic data analysis was used.
Results
Twenty-four cancer patients attending ORCI, consisting of 12 males and 12 females, aged 18–65, participated in the study. The majority of participants, 71% (n = 17), had low education, 71% (n = 17) were of low socioeconomic status, and 83% (n = 20) were either Christians or Muslims. Six broad themes emerged: aspects of life contributing to meaning and purpose of life, beliefs surrounding cancer, effects of cancer on spirituality, spirituality in relation to seeking health care, spirituality and coping with cancer, and spirituality needs of cancer patients.
Significance of results
Cancer patients at ORCI face significant spirituality issues and hold misconceptions about the causes and treatment of cancer. Palliative care practitioners must routinely identify and address spiritual issues of cancer patients in order to improve the quality of life of cancer patients.
The recovery model of mental health care is distinct from the biomedical model of mental health care. To promote one runs the risk of marginalising the other. Both approaches have merit. Values of hope and optimism, social inclusion, collaborative decision-making, retaining a personal identity beyond an identity simply defined by a diagnosis of mental illness, are all central to the recovery model. A reorientation of mental health services is required, a change in culture which embodies the principles of a recovery model within which, the perspectives of patients and families are heard together with the perspectives of mental health professionals who have knowledge and expertise to offer. In Meath Community Mental Health Services we have implemented such a recovery model, the model of open dialogue where principles of dialogue, social inclusion, immediate help and collaborative decision-making are paramount. We began this service in 2019 and carried out an audit of the first 6 months of our implementation. The audit illustrated overwhelming satisfaction from service users and their families with the new approach. On foot of our successful pilot project we have extended the model of open dialogue to other teams in Meath and Louth, including the in-patient unit in Drogheda. Our open dialogue project illustrates how a recovery model of mental health care can be successfully implemented in a public mental health system.
Small-for-gestational age (SGA) is an important global public health issue because of its increasing prevalence and long-term effects. Maternal smoking is a known risk factor for SGA; however, the effect of grandmaternal smoking on the risk of SGA in grandchildren SGA remains unclear. In this study, we examined whether grandmaternal smoking during pregnancy was associated with small birth weight, length, and head circumference for gestational age. Data were obtained from 23,730 pregnant women and their offspring from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Studies. A total of 1,130 grandmaternal-maternal-child triads were identified. Grandmaternal smoking during pregnancy was defined by the Maternal and Child Health Handbook owned by the mothers at birth mothers when they were born. Birth outcomes of grandchildren were obtained from medical records and converted to SGA using the 10th percentile for weight, length, and head circumference. A multivariate logistic regression and propensity scores were used for the analysis. Prevalence of <10th percentile for birth weight, length, and head circumference in grandmaternal smokers were 10.2%, 2.0%, and 10.2%, respectively. Grandmaternal smoking during pregnancy was associated with the lower grandchild’s birth weight (odds ratio (OR) [95% (CI)]: 2.86 [1.05–7.82]) and remained consistent when adjusted by propensity score (OR [95% CI]: 2.87 [1.04–7.92]). Grandmaternal smoking should not be ignored when assessing the SGA risk. Future work should consider the complex mediating relationship between smoking and growth restriction across generations.