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The presence of right-to-left shunt has been proposed as a prominent mechanism of paradoxical embolism in patients with active cancer. We conducted a retrospective observational study including patients presenting to the Ottawa Hospital between January 2020 and December 2022 with ischemic stroke with and without active cancer. Among 491 patients (36.9% female, median age 53), 43 (8.8%) had active cancer, with 12 (27.9%, 95% CI 15–44) having a shunt. Of 448 patients without cancer, 133 (29.7%, 95% CI 25–34) had a shunt. Overall, our finding does not support the hypothesis that cancer-associated stroke is related to right-to-left shunting.
Individuals with subthreshold depression (StD), a potentially preclinical stage of major depression, may habitually employ maladaptive expression suppression strategies in emotion regulation. However, the effect of emotional suppression (EES) and underlying neural mechanisms remain unclear.
Methods
Data came from two samples (Sample 1: 55 StD, 60 healthy controls (HC); Sample 2: 23 StD, 20 HC). Both samples completed expression suppression tasks. Using drift diffusion modeling, we decomposed performance on the emotional assessment process into separate processing components, particularly the speed of information update (drift rate), to examine how depression and emotional suppression affect decision-making. To further reveal the potential mechanism, we conducted fMRI scanning in Sample 2 and characterized latent neurocircuit driving emotion suppression and drift rate using dynamic causal modeling (DCM).
Results
The EES negatively correlated with drift rate. StD showed reduced efficacy of EES and faster drift rates of negative preference. Greater activation was observed in the dorsolateral prefrontal cortex (dlPFC) and amygdala in StD during suppression. DCM analysis revealed that inefficient EES might be explained by the stronger connection from the right dlPFC to the right amygdala, while the faster drift rate might be attributed to a stronger connection from the left amygdala to the right dlPFC.
Conclusions
Our study uncovered novel latent behavioral and neurocircuit mechanisms of early risk for depression. Ineffective emotional suppression in StD is associated with faster accumulation of negative evidence. The underlying neural mechanism may involve aberrant regulation between the dlPFC and amygdala in negative contexts.
Renal replacement therapy is sometimes utilised after paediatric heart transplant, although current data on this are extremely limited. We sought to identify incidence of renal replacement therapy and patient characteristics, comorbidities, and outcomes when renal replacement therapy was needed around paediatric heart transplant.
Materials and methods:
The Pediatric Health Information System database was queried for paediatric intensive care patients who underwent a heart transplant from 2018 to 2021. Demographic and clinical data were analysed. Only patients admitted for heart transplant with heart transplant occurring on day 0 of admission were included to ensure that renal replacement therapy was postoperative.
Results:
A total of 235 patients who underwent heart transplant were included. Of these, 22 (9.3%) required renal replacement therapy. Mortality during admission was 3.8% in those without renal replacement therapy and 40.9% of patients requiring renal replacement therapy. Renal replacement therapy was associated with cardiomyopathy, infection, rejection, acute kidney injury, acute hepatic failure, and fluid overload.
Conclusions:
Renal replacement therapy was utilised in 9.3% of paediatric heart transplant admissions and is associated with increased mortality. Postoperative need for renal replacement therapy is associated with increased mortality and adverse transplant outcomes.
Smartphones have become essential, making our daily lives more manageable; however, excessive use may cause problems. University students are particularly vulnerable to smartphone addiction. This study examines the relationship between smartphone addiction and health-promoting lifestyles among university students.
Methods:
A cross-sectional study was conducted with 911 students at Dokuz Eylul University, Izmir, Turkey. Data were collected via Smartphone Addiction Scale-Short Version (SAS-SV) and Health Promotion Lifestyle Profile II (HPLP II). The printed forms were used, and the researcher administered the survey in person and recorded the responses.
Results:
Prevalence of smartphone addiction was 34.1%. Several factors were significantly associated, including female gender (p = 0.049), being single (p = 0.042), self-perceived smartphone addiction (p < 0.001), daytime sleepiness (p < 0.001), and poor sleep quality (p < 0.001). Students with smartphone addiction had significantly lower HPLP II scores (p = 0.001).
Logistic regression analysis showed that gender was no longer a significant factor. Those without a partner (OR: 1.47, 95% CI: 1.07–2.03), those who considered themselves smartphone addicts (OR: 6.86, 95% CI: 4.99–9.42), and those with daytime sleepiness (OR: 1.52, 95% CI: 1.08–2.14) had higher odds of smartphone addiction. Higher HPLP II scores were protective against smartphone addiction (OR: 0.99, 95% CI: 0.98–0.99).
Conclusions:
This study highlights that students with smartphone addiction engage in less health-promoting behaviours and experience poor sleep quality and daytime sleepiness. Self-perceived smartphone addiction was strongly associated with actual addiction, while a healthier lifestyle appeared to have a protective effect. There is a need for strategies to promote healthy habits and reduce smartphone addiction among university students.
This study investigated functional connectivity in the default mode, central executive, dorsal attention, and salience networks (SN) and its relation to executive function in youth with traumatic brain injury.
Methods:
Twenty-three youth with traumatic brain injury (11 with moderate-to-severe injury (6 male, mage = 11.78 ± 2.68 years, mtimesinceinjury = 3.71 ± 2.43 years) and 12 with complicated-mild injury (9 male, mage = 12.59 ± 1.99 years, mtimesinceinjury = 4.55 ± 1.59 years) and 17 youth with orthopedic injury (11 male, mage = 11.75 ± 2.12 years, mtimesinceinjury = 3.95 ± 1.79 years)) completed resting-state functional magnetic resonance imaging and a parent rated their child’s executive function.
Results:
We found group differences in the strength of connectivity among four regions in the default mode network (DMN) and two regions of the SN, ps < .05, Eta2 = .151–.229. The orthopedic injury group demonstrated significant negative between-network connectivity, while brain injury groups had negligible negative or, in some cases, positive between-network associations. Groups did not differ on parent ratings of executive function, as all groups fell above the normative mean, reflecting poorer than expected everyday executive behavior. Attenuation of typical negative between-network association between the posterior cingulate in the DMN and two regions of the salience network was associated with worse parent-rated executive behavior (rs = .291–.317, ps < .05).
Conclusions:
Findings illustrate the implications of disrupted downregulation of the default mode network by the SN following pediatric brain injury. They also demonstrate how disruption in functional connectivity may underlie poor executive function after childhood traumatic brain injury.
Generalized anxiety disorder (GAD) is characterized by persistent worry and physical symptoms, with prevalence estimates ranging from 0.8% to 8%. Researchers utilize various tools, such as standardized diagnostic interviews and self-report questionnaires, to estimate GAD prevalence in population-level studies. However, the diagnostic accuracy of these tools varies greatly. This scoping review aimed to identify the tools used for GAD prevalence estimation and assess the extent to which diagnostic tool accuracy is reported.
Methods
A systematic search was conducted in MEDLINE, Embase and PsycINFO using MeSH terms and keywords related to GAD prevalence. No date restrictions were applied. Studies were eligible if they used nationally or regionally representative samples and defined GAD based on DSM-5, ICD-11 or older case definitions. Studies focusing solely on specific sub-groups were excluded. Data extraction included study characteristics, diagnostic tools and reporting of test accuracy.
Results
A total of 537 studies were initially identified, with 48 meeting inclusion criteria, published between 1994 and 2024. Most studies were conducted in Europe (43.75%) and employed cross-sectional designs (92%). Structured diagnostic interviews were the most commonly used tool (77.08%), although self-report questionnaires gained popularity after 2005. Among the included studies, 62.5% reported test accuracy, often addressing validity and reliability.
Conclusions
Despite the widespread use of diagnostic tools in prevalence studies, test accuracy is not consistently reported, which may impact the reliability of prevalence estimates. The variability in agreement between self-report questionnaires and structured diagnostic interviews highlights the need for transparent reporting of test characteristics to improve the validity of GAD prevalence assessments across populations.
Carbapenem-resistant Enterobacterales were isolated from the outlet of a wastewater treatment plant in Kristianstad in southern Sweden, during spring and summer of the year 2024. MALDI-ToF MS identification and subsequent whole-genome sequencing identified eight Klebsiella pneumoniae strains belonging to ST437 and ST873 and 10 Escherichia coli strains belonging to ST167, ST648, ST1284, and ST8346. All strains, except K. pneumoniae ST873, were NDM-5 positive. K. pneumaniae ST437 and E. coli ST8346 carried two carbapenemase genes, blaNDM-5 and blaOXA-181, as well as the extended-spectrum-β-lactamases (ESBL) gene blaCTX-M-15. These two multi-drug-resistant ST variants that are widespread globally, that have previously not been detected in clinical settings in Sweden, are now detected in treated wastewater in a Swedish middle-sized town.
Palliative care development in primary care is crucial worldwide. This study reports on the secondary outcomes of a study that evaluated whether a complex intervention in primary care for patients with palliative care needs impacted their healthcare utilization.
Methods:
A before-after study was conducted with family physicians and patients with palliative care needs. Physicians received palliative care training and implemented a new primary palliative care consultation model. Healthcare utilization in the 12 weeks before, during, and after the intervention was compared.
Results:
We analysed healthcare utilization for 33 patients with advanced disease. Pre-intervention, there were high rates of no medical consultations, emergency visits, hospital admissions, and outpatient referrals (84.8%, 75.8%, 81.8%, and 84.8%, respectively). Despite slight reductions during and after the intervention, the differences were not statistically significant.
Conclusions:
The reduction in healthcare utilization was not statistically significant, but the data inform sample size calculations for future economic analyses.
Trial registration:
ClinicalTrials.gov ID – NCT05244590. Registration: 14th February 2022.
Telemedicine is increasingly playing a vital role in European health systems, offering great potential for improving healthcare access and outcomes. Funded between September 2022 and December 2024, the Joint Action ‘Strengthening eHealth including telemedicine and remote monitoring for health care systems for CANcer prevention and care’ (eCAN JA) provided evidence-base for person-centred implementation of telemedicine services among cancer patients in the European Union (EU). Through a mixed-method approach, this foresight study gathered insights from key decision-makers in 14 EU Member States and eight cancer patient associations via two surveys and a joint workshop, conducted within the Sustainability Work Package (WP4) of the eCAN JA. Our results show that EU Member States and cancer patients view telemedicine as a useful and complementary tool, however, not as a replacement for in-person services for cancer care. The policy recommendations from our study can be summarised as follows: (i) develop legal frameworks to complement in-person care with telemedicine; (ii) improve digital literacy and information technology infrastructure while ensuring privacy and health equity; and (iii) engage patients in the co-design of telemedicine services. Implementing these recommendations will enhance the integration of telemedicine into cancer care in Europe.
This study sought to explore how food company representatives perceive the food industry’s role in responding to and driving consumer demand for healthy and unhealthy foods.
Design:
Semi-structured interviews were conducted in 2022 by 2–3 researchers to explore food company representatives’ perspectives related to consumer demand for healthy and unhealthy food. Detailed field notes, including verbatim quotes, were recorded, and the data were analysed thematically.
Setting:
This study was part of a government-funded 12-month intervention programme to assess the impact of tailored support for food companies on company nutrition-related policies and practices.
Participants:
Thirty-two food company representatives from thirteen large food and beverage manufacturers in Australia.
Results:
Six themes were identified. Company representatives acknowledged that manufacturers actively shaped demand for both healthy and unhealthy foods. Healthy reformulation and aspects of nutrition labelling were constrained by anticipated consumer resistance, while demand for ‘less healthy’ products was driven by non-health attributes such as taste, comfort and affordability. Internal company marketing teams held significant influence regarding product development, promotion and labelling. Supermarkets were perceived as shaping demand via their marketing strategies. The competitive landscape, driven by the pursuit of market share, was seen to fuel an ongoing cycle of promotion of ‘less healthy’ products.
Conclusions:
Food companies acknowledge playing an active role in influencing consumer demand for healthy and unhealthy food and beverages. A whole-of-system response, including changes in government regulation and practice change by the food industry, is needed to drive stronger action and accountability from food companies to support healthier diets.
Emotional-approach coping (EAC), including emotional expression (EE) and emotional processing (EP), may impact stress and quality of life (QOL) in cancer populations, with some evidence that EAC effects vary by sex.
Methods
Men (n = 85) and women (n = 63) with renal cell carcinoma (RCC) completed the EAC Scale, Perceived Stress Scale (PSS), and 36-item Medical Outcomes Study Short Form Survey (SF-36) physical component scale (PCS) and mental component scale (MCS) at study entry and 10 months later. The PROCESS macro (model 7) was used to examine the indirect effect of baseline EAC (EE, EP) on 10-month QOL (PCS, MCS) via baseline PSS, with sex as a moderator of the association between EAC and PSS (i.e., four models of moderated mediation).
Results
Bootstrap estimates of indirect effects revealed significant moderated mediation, such that, for female participants, greater EE at study entry was associated with lower PSS, which in turn was associated with higher PCS and MCS 10 months later; whereas for males, EE was not associated with PSS and was not indirectly associated with physical and mental health-related QOL via PSS. Models examining the indirect effects of EP on QOL via PSS were nonsignificant for male and female participants.
Significance of results
EE is an important correlate of perceived stress for females but not males with RCC. Perceived stress early in treatment has a robust association with subsequent health-related QOL. Interventions aimed at supporting EE for females with RCC may have long-term QOL benefits.
Depression among women living with HIV affects their psychological well-being, HIV disease management, and prevention of mother-to-child transmission. A subset of 25 women selected from the intervention arm of the Maternal Depression Treatment in HIV (M-DEPTH) cluster randomized trial were interviewed; they had received either antidepressant therapy (ADT) or problem-solving therapy (PST). Their experiences as new mothers with the effects of depression and treatment on HIV disease and pregnancy management were assessed in a brief qualitative interview conducted in 2022. Seven were treated with ADT, 15 with PST, and three received both treatment modalities; all but two (n=23) responded to depression treatment. Participants reported improved adherence to HIV antiretroviral therapy and described the treatment as being effective in alleviating depressive symptoms. Additionally, the process of treatment helped them to learn a lot about depression, mental health, and its connection to physical and emotional well-being. Participants also reported improvements in parenting and pregnancy management. The results highlight the need for greater prioritization of mental health care for women living with HIV to prevent poor mental health outcomes and enhance overall functioning, including management of HIV disease, pregnancy, and parenting.