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Despite evidence of associations between glucocorticoid treatment and adverse psychiatric and suicidal behaviour outcomes, large-scale observational evidence for serious outcomes is lacking.
Aims
To assess the risk of psychiatric and suicidal behaviour outcomes during glucocorticoid treatment.
Method
Using Swedish population registers, we identified 1 105 964 individuals aged 15–54 years who collected a glucocorticoid prescription in oral form between 2006 and 2020. We investigated associations with a range of psychiatric outcomes: unplanned specialist healthcare contacts due to depressive, bipolar, anxiety or schizophrenia-spectrum disorders; and deaths by suicide or unplanned specialist healthcare contacts due to self-harm (‘suicidal behaviour’). We estimated hazard ratios from Cox proportional hazards models in a medication-only cohort by comparing outcome rates during and outside treated periods within individuals. We further identified individuals with an autoimmune or gastrointestinal autoimmune disorder diagnosis and compared hazards of the outcomes between those who did and did not initiate a glucocorticoid using a target trial emulation approach.
Results
We found increased risks for psychiatric outcomes, with within-individual hazard ratios ranging from 1.08 (95% CI, 1.00–1.16) for depressive disorders to 1.23 (95% CI, 1.12–1.36) for bipolar disorder and 1.25 (95% CI, 1.20–1.31) for anxiety disorders. We found no clear association with suicidal behaviour (hazard ratio: 1.06; 95% CI, 0.96–1.17). These findings were similar when stratified by age and gender. Within-individual associations were attenuated in those diagnosed with an autoimmune disorder. The risk of anxiety and bipolar disorder outcomes appeared particularly elevated in the first weeks of treatment. Absolute rates were modestly elevated during treatment, and higher in those with a history of psychiatric disorders.
Conclusions
Glucocorticoid treatment is associated with elevated risks of serious psychiatric outcomes, including the onset and relapse of common psychiatric disorders. Individuals with psychiatric histories may require additional monitoring during glucocorticoid treatment.
The Pediatric Acute Care Cardiology Collaborative (PAC3) previously showed decreased postoperative chest tube duration and length of stay in children undergoing 9 Society of Thoracic Surgeons benchmark operations. Here we report how these gains were sustained over time and spread to 8 additional centers within the PAC3 network.
Methods:
Patient data were prospectively collected across baseline and intervention phases at the original 9 centres (Pioneer) and 8 new centres (Spread). The Pioneer baseline phase was 6/2017–6/2018 and Spread was 5/2019–9/2019. The Pioneer intervention phase was 7/2018–7/2021 and Spread 10/2019–7/2021. The primary outcome measure was postoperative chest tube duration in hours, with the aim of 20% overall reduction. Balancing measures included chest tube reinsertion and readmission for pleural effusion. Statistical process control methods and traditional statistics were used to analyse outcomes over time.
Results:
Among 5,042 patients at 17 centres, demographics were comparable. The Pioneer cohort (n = 3,383) sustained a 22.6% reduction in mean chest tube duration (from 91.9 hours to 70.5 hours), while the Spread cohort (n = 1,659) showed a 9.7% reduction (from 73.1 hours to 66.0 hours) in the first 13 months following intervention. Across both cohorts, rates of reinsertion (2.0% versus 2.1%, p = 0.869) and readmission for effusion did not change (0.3% versus 0.5%, p = 0.285).
Conclusions:
This multicenter prospective quality improvement study demonstrated sustained reduction in chest tube duration at 9 centres while successfully spreading improvement to 8 additional centres. This project serves as a model for post-operative multicentre quality improvement across a large cohort of congenital cardiac surgery patients.
This article explores the dynamics of urban peripheries in Mandate Palestine, focusing on the Jewish neighbourhoods of Bat Galim in Haifa and HaTikvah near Tel Aviv and Jaffa. It argues that the social and geographical isolation of these peripheries created a dual dynamic: strengthening bonds within the neighbourhood communities while also giving rise to significant conflicts, both within the Jewish society and in Jewish–Arab relations. Drawing on archival sources, letters and interviews, the research examines resident agency, social tensions and inter-communal interactions, demonstrating how these peripheries shaped urban society and culture under British colonial rule through processes of separation and connection.
Citizen trust in public institutions has become a major concern for policy makers, but how institutional design affects institutional trust is not entirely clear. Existing research has mainly focused on the macro-level of welfare regimes or on the micro-level of citizens’ or frontline workers’ attributes. Our knowledge about interrelations between organisational aspects of welfare delivery and (dis)trust-formation at the meso-level of institutional design remains scarce. In the article, we investigate how users experience institutional fragmentation and how this impacts their trust in the welfare system. Based on forty-three interviews with social assistance users in Germany and Poland, we demonstrate that fragmentation is indeed relevant as an experiential context for (dis)trust-formation. However, we found that low institutional fragmentation is not, per se, trust-promoting and that higher fragmentation can be a driver for developing trust in individual caseworkers. Citizens’ perceptions of procedural justice and experienced administrative burdens are discussed as possible mediators.
As youth transition into adolescence, their desire for autonomy leads to changes in the family dynamic, resulting in increased family conflict and possible disruptions to children’s psychological health. Previous literature, however, has largely neglected to consider whether the association between family conflict and child behavioral difficulties is uni- or bi-directional. The current study used latent curve growth models with structured residuals (LCMs-SR) to investigate this question in the Adolescent Brain & Cognitive Development (ABCD) study. At four annual waves (baseline through 3-year follow-up), youth (N = 11,868; Mage at Time 1 = 9.48 years; 48% female; 50% White) reported on family conflict while parents reported on youths’ internalizing and externalizing behaviors. Youth reported family conflict levels as increasing over four years. Furthermore, family conflict was bidirectionally associated with externalizing behavior, in that families with greater than expected conflict had children with more externalizing behaviors, and youth with more externalizing behaviors reported greater than expected conflict at home. Internalizing behavior, however, did not predict later family conflict, though family conflict predicted deviations in later internalizing behavior. These findings add to the literature by demonstrating bidirectional influences between children’s behavior and family functioning across emerging adolescence.
Noonan syndrome is associated with lymphatic system structural abnormalities and may present with potentially fatal refractory chylothorax. We report a 2-year-old boy with Noonan syndrome with non-traumatic chylothorax who was refractory to dietary therapy with medium-chain triglyceride milk, octreotide, prednisolone, lymphatic embolisation, and lymphatico-venous anastomosis but improved with etilefrine administration. Etilefrine may be a treatment option for paediatric chylothorax, regardless of the aetiology.
This article presents an overview of findings from an ERC-funded DigiScore project that investigates how digital technologies are reshaping music creation, performance and accessibility. Digital scores, defined as interactive interfaces for musical ideas, enable innovative compositional approaches, immersive performance experiences and inclusive practices. Drawing on nearly 50 case studies across five continents, the research highlights four key impacts: (1) enhanced interactivity and multimedia integration; (2) non-linear and real-time compositional methods; (3) novel performance opportunities in physical and virtual spaces; (4) broader accessibility for diverse musicians and audiences. An overview of case studies by the project’s partners and principal investigator illustrates how digital scores impact the creative practices of composers and performers, while also influencing audience engagement and fostering collaboration and participation. Despite challenges in balancing technological complexity with usability, the findings demonstrate how digital scores democratise music-making, offering new creative possibilities and redefining contemporary musical practices.
In praising Sallust, Tacitus chose the epithet florentissimus in delightful allusion to the former’s apparently innovative (and influential) use of the adverb carptim in his presentation of his novel approach to writing res gestae populi Romani: the adverb and the superlative adjective share an easily discernible etymological connection.
Heavy rain and flood frequently occur in recent years and hospitals’ preparedness for flood is important. To secure patient safety, hospital evacuation planning and drills due to flooding by heavy rain is inevitable. In the study the relation of factors with hospitals’ preparedness for flood by heavy rain was analyzed.
Methods
Subjects of the study were disaster base hospitals in Japan (n = 765). Internet survey conducted in 2022. Bayesian network was used to analyze the interrelation of factors.
Results
430 hospitals (56.2%) were used for analysis. 42.1% of the hospital were located in designated flooded area and 33.7% of the hospitals have planning of hospital evacuation due to flooding. Display of area where flooding is expected in case of heavy rain and landslide warning area leads to a hospital evacuation planning and evacuation drills.
Conclusion
Display of flooded area by heavy rain or landslide warning zone by governments is effective in advancing hospital preparedness for flood. Hospitals’ recent experience of flood or landslide did not lead to evacuation planning or evacuation drills due to flood. These findings are useful in advancing hospitals’ preparedness for flood and heavy rain.
Much recent political theory aims to move beyond the dominant approach to theorizing justice by foregrounding cases of injustice. Judith Shklar’s The Faces of Injustice is regularly invoked in this context, yet the full force of her challenge to the “normal model of justice” and its implications for understanding injustice have not been fully appreciated. This article reconstructs and defends Shklar’s approach to theorizing injustice. It evaluates the differences between John Rawls’s account of the sense of justice and Shklar’s notion of the sense of injustice, showing why the latter should be theorized in relation to plural, competing, and ever-changing expectations, rather than in relation to ideal principles of justice. It illustrates how we can evaluate political responses to injustice without recourse to such principles and maintains that doing so is a strength of any democratic theory that is committed to giving injustice its due.
We trace the formation of the Kadehine, a Mauritanian cultural and political movement of the late 1960s and early 1970s, with a focus on aspects of the “political underground” central to the movement’s strategies and organizing principles. As an anthropological history of the Kadehine, we focus on the organizing perspective afforded by its sources (largely interviews and movement literature). These sources emphasize the importance of clandestinity, as well as the influence of New Left ideas. We then develop a concept, “political underground,” describing the importance of clandestinity and its relationship to the radical politics of its time.