Tetralogy of Fallot patients face an elevated risk of developing chylothorax and pleural effusions post-surgery. This patient group exhibits risk factors known to compromise the lymphatic system, such as elevated central venous pressure, pulmonary flow changes, and hypoxia. This study investigates the morphology and function of the lymphatic system in tetralogy of Fallot patients through lymphatic magnetic resonance imaging and near-infrared fluorescence imaging, respectively.

Post-repair tetralogy of Fallot patients aged 6–18 years were recruited, along with age and gender-matched controls. Magnetic resonance imaging was used to assess the morphology of the thoracic lymphatic vessels and the thoracic, while near-infrared fluorescence imaging was used to assess lymphatic activity utilising lymph rate, velocity, and pressure.

Nine patients and 10 controls were included. Echocardiography revealed that 2/3 of the patients had moderate-severe pulmonary regurgitation, while none displayed signs of elevated central venous pressure. Magnetic resonance imaging identified three patients with type 3 (out of 4 types) lymphatic abnormalities, while controls had none. The thoracic ducts showed severe (one patient) and moderate (one patient) tortuosity. Mean thoracic duct diameters were 3.3 mm ±1.1 in patients and 3.0 mm ± 0.8 in controls (p-value = 0.53). Near-infrared fluorescence imaging revealed no anomalous patterns.

Despite no presence of clinical lymphatic disease, 3/9 of the repaired tetralogy of Fallot patients exhibited lymphatic morphological abnormalities. The significance of these anomalies remains uncertain currently. Further research is needed to determine whether these lymphatic alterations in this patient cohort are a result of congenital malformations, haemodynamic shifts, or prenatal and early-life saturation levels.

Abusive head trauma (AHT) is a form of inflicted brain injury that is associated with significant neurological impairment. Given that injuries occur during infancy, cognitive deficits may not become fully apparent for years. It is useful to understand injury factors related to outcomes. A recent study by Eismann et al. (2020) used length of PICU stay as a measure of injury severity and found that it is predictive of short-term and long-term outcomes in AHT. The current study aimed to examine injury severity factors related to acute outcomes (<3 months since injury) within a population of infants admitted to an inpatient rehabilitation unit (IRU).

The sample consisted of 45 infants (32 male, 13 female) hospitalized with suspected AHT. Age at injury was 0-21 months (MED= 4.89 months, SD = 5.48). The majority of patients (93%) had moderate to severe injury based on length of PICU stay (4+ days) [3]. Patients were administered the Mullen Scales of Early Learning (MSEL) during IRU admission, within 3 months of injury (range: 13-68 days; MED: 31 days). Pearson bivariate correlations were used to examine the relationship between MSEL subscales (ELC: Early Learning Composite; VR: Visual Reception; RL: Receptive Language; EL: Expressive Language; FM: Fine Motor; GM: Gross Motor) and the following factors: days since injury and hospitalization time (days in PICU, PICU/General Pediatrics, IRU, total hospitalization). P-values less than .05 were considered significant.

Scores on the MSEL Early Learning Composite ranged from exceptionally low to high average (Standard Score Range: <49-111; MED: 82; SD = 18.79). Unlike prior studies, time in PICU and time in PICU/General Pediatrics were not associated with any MSEL subscales. MSEL was moderately correlated with days in IRU (ELC: r = -.44; VR: r = -.37; RL: r = -.32; EL: r = -.36; GM: r = -.29) and total hospitalization time (ELC: r = -.46; VR: r = -.42; RL: r = -.36; EL: r = -.37; GM: r = -.31), such that longer hospitalization was associated with lower scores. Greater days since injury was also associated with lower MSEL scores (ELC: r = -.45; VR: r = -.42; RL: r = -.40; EL: r = -.36; FM: r = -.33; GM: r = -.35).

These results suggest that within an inpatient rehabilitation setting, longer total hospitalization time (including time on IRU) is moderately associated with worse acute neurobehavioral outcomes. While length of PICU stay has been associated with short-term outcomes in the outpatient setting (Eismann et al., 2020), this was not found in the current inpatient sample which had more severe injuries (longer PICU stay, inpatient rehabilitation admission). Interestingly, children assessed further out from injury had worse scores on the MSEL, which has previously been noted. Though this seems counterintuitive, it may reflect that participants with more severe injuries had a longer delay before they were capable of engaging in a neurodevelopmental assessment. These findings have implications for prognosticating early outcomes of AHT in an inpatient rehabilitation setting.

Chronic musculoskeletal pain is associated with neurobiological, physiological, and cellular measures. Importantly, we have previously demonstrated that a biobehavioral and psychosocial resilience index appears to have a protective relationship on the same biomarkers. Less is known regarding the relationships between chronic musculoskeletal pain, protective factors, and brain aging. This study investigates the relationships between clinical pain, a resilience index, and brain age. We hypothesized that higher reported chronic pain would correlate with older appearing brains, and the resilience index will attenuate the strength of the relationship between chronic pain and brain age.

Participants were drawn from an ongoing observational multisite study and included adults with chronic pain who also reported knee pain (N = 135; age = 58.3 ± 8.1; 64% female; 49% non-Hispanic Black, 51% non-Hispanic White; education Mdn = some college; income level Mdn = $30,000 - $40,000; MoCA M = 24.27 ± 3.49). Measures included the Graded Chronic Pain Scale (GCPS), characteristic pain intensity (CPI) and disability, total pain body sites; and a cognitive screening (MoCA). The resilience index consisted of validated biobehavioral (e.g., smoking, waist/hip ratio, and active coping) and psychosocial measures (e.g., optimism, positive affect, negative affect, perceived stress, and social support). T1-weighted MRI data were obtained. Surface area metrics were calculated in FreeSurfer using the Human Connectome Project's multi-modal cortical parcellation scheme. We calculated brain age in R using previously validated and trained machine learning models. Chronological age was subtracted from predicted brain age to generate a brain age gap (BAG). With higher scores of BAG indicating predicated age is older than chronological age. Three parallel hierarchical regression models (each containing one of three pain measures) with three blocks were performed to assess the relationships between chronic pain and the resilience index in relation to BAG, adjusting for covariates. For each model, Block 1 entered the covariates, Block 2 entered a pain score, and Block 3 entered the resilience index.

GCPS CPI (R2 change = .033, p = .027) and GCPS disability (R2 change = 0.038, p = 0.017) significantly predicted BAG beyond the effects of the covariates, but total pain sites (p = 0.865) did not. The resilience index was negatively correlated and a significant predictor of BAG in all three models (p < .05). With the resilience index added in Block 3, both GCPS CPI (p = .067) and GCPS disability (p = .066) measures were no longer significant in their respective models. Additionally, higher education/income (p = 0.016) and study site (p = 0.031) were also significant predictors of BAG.

In this sample, higher reported chronic pain correlated with older appearing brains, and higher resilience attenuated this relationship. The biobehavioral and psychosocial resilience index was associated with younger appearing brains. While our data is cross-sectional, findings are encouraging that interventions targeting both chronic pain and biobehavioral and psychosocial factors (e.g., coping strategies, positive and negative affect, smoking, and social support) might buffer brain aging. Future directions include assessing if chronic pain and resilience factors can predict brain aging over time.

Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent, inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature.

We aimed to investigate the risk of suicide among refugees in Sweden and Norway according to their sex, age, region/country of birth and duration of residence.

Each suicide case between the age of 18-64 years during 1998 and 2018 (17,572 and 9,443 cases in Sweden and Norway, respectively) was matched with up to 20 population-based controls, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide.

The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI: 0.5-0.6) and 0.3 (95% CI: 0.3-0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI: 0.7-1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age.

The findings of almost similar suicide mortality advantages among refugees in two host countries may suggest that resiliency and culture/religion-bound attitudes could be more influential for suicide risk among refugees than other post-migration environmental and structural factors in the host country.

No significant relationships.

The North American AED Pregnancy Registry (NAAPR) provides crucial data for understanding the risks of antiepileptic drug (AED) exposure in pregnancy. This study aims to quantify the Canadian contribution to NAAPR and compare AED usage in pregnancy in Canada and the USA.

Enrollment rate ratios (ERR) to NAAPR, adjusted for the populations of women of childbearing age, were calculated for the USA, Canada, and for the different Canadian provinces. Methods of enrollment to NAAPR and AED usage were compared between the two countries using chi-squared tests.

Between 1997 and 2019, 10,215 pregnant women enrolled into NAAPR: 4.1% were Canadian (n = 432, ERR = 0.39, CI95% = 0.35–0.43). Within Canada, no patients were enrolled from the three northern territories or from Prince Edward Island. While fewer patients than expected enrolled from Quebec (ERR = 0.35, CI95% = 0.19–0.58), Nova Scotia had the highest enrollment rate (ERR = 1.55; CI95% = 0.66–3.11). Compared with their American peers, Canadians were less likely to have been enrolled by their healthcare provider and more likely to have been enrolled via social media (p < 0.01). Canadian women were more likely to be taking carbamazepine (24% vs. 15%; p < 0.01) or valproic acid (8% vs. 4%; p < 0.01).

The proportion of Canadian enrollees into NAAPR was less than expected based on the relative population size of Canadian women of reproductive age. Greater Canadian enrollment to NAAPR would contribute to ongoing worldwide efforts in assessing the risks of AEDs use in pregnant women and help quantify rates of AED usage, major congenital malformations, and access to subspecialized epilepsy care within Canada.

Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature. We aimed to investigate (1) the risk of suicide in refugees resident in Sweden and Norway, in general, and according to their sex, age, region/country of birth and duration of residence, compared with the risk of suicide in the respective majority host population; (2) if factors related to socio-demographics, labour market marginalisation (LMM) and healthcare use might explain the risk of suicide in refugees differently in host countries.

Using a nested case-control design, each case who died by suicide between the age of 18 and 64 years during 1998 and 2018 (17 572 and 9443 cases in Sweden and Norway, respectively) was matched with up to 20 controls from the general population, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide. Separate models were controlled for factors related to socio-demographics, previous LMM and healthcare use. Analyses were also stratified by sex and age groups, by refugees' region/country of birth and duration of residence in the host country.

The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI 0.5–0.6) and 0.3 (95% CI 0.3–0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI 0.7–1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age except for younger refugees aged 18–24 who did not have a statistically significant relative difference in suicide risk than their respective host country peers. Factors related to socio-demographics, LMM and healthcare use had only a marginal influence on the studied associations in both countries.

Refugees in Sweden and Norway had almost similar suicide mortality advantages compared with the Swedish-born and Norwegian-born population, respectively. These findings may suggest that resiliency and culture/religion-bound attitudes towards suicidal behaviour in refugees could be more influential for their suicide risk after resettlement than other post-migration environmental and structural factors in the host country.

Stress and mental health problems is common among medical students, but we lack studies of intervention programmes during medical school.

The students participated in one of two group session programmes during their third year at medical school. One option was a self-development programme delivered by trained group therapists. Alternatively the students chose a programme focusing on themes of special relevance to doctors. The format was one and a half hours' group sessions, once weekly, altogether 12 times. The baseline data were gathered before the intervention (T1).We studied the effect 3 months post intervention (T2), in this first follow-up paper. One class (N= 128) of medical students were given the group intervention programmes. The next year class (comparison group) received no intervention (N= 152). The main outcome of this study was Perceived Medical School Stress (PMSS), which has been linked to anxiety and depression, as well as need for treatment. We used multilevel linear model (repeated measures) to test for differences over time.

Both the intervention and the comparison groups showed a decline in PMSS from T1 to T2. There was an interaction between time and the intervention, and this indicates a significant effect (P=0.01) of the intervention. We found this effect due to the participation in the self-development groups (P=0.009). All effects were controlled for age and gender.

The self-development groups have a beneficial effect on stress among the students in a three months follow-up.

Effective preventive strategies could reduce disability and the long term social and health complications associated with depression, but options are limited. Cognitive bias modification (CBM) is a novel, simple, and safe intervention that corrects the attentional and interpretive biases associated with depression.

To determine if CBM decreases the one-year onset of major depression in adults at risk.

This randomised controlled trial will recruit adults with subsyndromal depression living in Australia (parallel design, 1:1 allocation ratio). The intervention will be delivered via the internet over 52 weeks. The primary outcome of interest is the onset of a major depression according to DSM-IV-TR criteria. Secondary outcomes of interest include change in the severity of depressive (Patient Health Questionnaire, PHQ-9) and changes in attention and interpretive biases. Outcomes will be collected 3, 6, 9 and 12 months after randomisation.

Preliminary data on a subsample of 20 participants showed that the mean±SE PHQ-9 score of controls was 7.5±0.9 at study entry and 7.1±1.5 at week 6 (paired t-test=0.29, p=0.779), whereas the mean±SE score of active CBM participants was 7.4±1.0 and 4.4±1.1, respectively (paired t=6.00, p<0.001). The mean PHQ-9 difference between control and active CBM participants over 6 weeks was 2.6±1.5 points (t=1.79, p=0.090). One of 11 controls (9.1%) and 0/9 active CBM participants showed evidence of clinically significant depressive symptoms at week 6 (i.e., PHQ-9≥15).

By March 2015, 6-months preliminary data will be available on 165 participants.

To identify predominant dietary patterns in four African populations and examine their association with obesity.

Cross-sectional study.

We used data from the Africa/Harvard School of Public Health Partnership for Cohort Research and Training (PaCT) pilot study established to investigate the feasibility of a multi-country longitudinal study of non-communicable chronic disease in sub-Saharan Africa. We applied principal component analysis to dietary intake data collected from an FFQ developed for PaCT to ascertain dietary patterns in Tanzania, South Africa, and peri-urban and rural Uganda. The sample consisted of 444 women and 294 men.

We identified two dietary patterns: the Mixed Diet pattern characterized by high intakes of unprocessed foods such as vegetables and fresh fish, but also cold cuts and refined grains; and the Processed Diet pattern characterized by high intakes of salad dressing, cold cuts and sweets. Women in the highest tertile of the Processed Diet pattern score were 3·00 times more likely to be overweight (95 % CI 1·66, 5·45; prevalence=74 %) and 4·24 times more likely to be obese (95 % CI 2·23, 8·05; prevalence=44 %) than women in this pattern’s lowest tertile (both P<0·0001; prevalence=47 and 14 %, respectively). We found similarly strong associations in men. There was no association between the Mixed Diet pattern and overweight or obesity.

We identified two major dietary patterns in several African populations, a Mixed Diet pattern and a Processed Diet pattern. The Processed Diet pattern was associated with obesity.