Transition readiness of youth with co-occurring chronic health and mental health conditions: A mixed methods study.

BACKGROUND: A large proportion of youth with chronic conditions have mental health comorbidities. However, the effect of these comorbidities on paediatric-adult transition readiness, and the relevance of widely used tools for measuring transition readiness, are unknown. OBJECTIVE: The objectives of this study were to describe and explore the transition readiness of youth with co-occurring chronic health and mental health conditions using a combination of quantitative data obtained from participants completing the Transition Readiness Assessment Questionnaire (TRAQ) and qualitative data. DESIGN AND PARTICIPANTS: A three-phase sequential explanatory mixed methods design was employed, with the qualitative strand taking priority. First, the TRAQ scores (range 1-5) of youth with co-occurring conditions (n = 61) enroled in a multisite randomized controlled trial were measured, followed by qualitative interviews with a sample of youth (n = 9) to explain the quantitative results. Results from both strands were then integrated, yielding comprehensive insights. RESULTS: Median TRAQ scores ranged from 2.86 on the appointment keeping subscale to 5.00 on the talking with providers subscale. The qualitative results uncovered the complexities faced by this group concerning the impact of a mental health comorbidity on transition readiness and self-management skills across TRAQ domains. The integrated findings identified a diverse and highly individualized set of strengths and challenges amongst this group that did not align with overarching patterns as measured by the TRAQ. CONCLUSIONS: This mixed methods study generated novel understandings about how youth with co-occurring conditions develop competencies related to self-care, self-advocacy and self-management in preparation for paediatric-adult service transitions. Results demonstrated the assessment of transition readiness using a generic scale does not address the nuanced and complex needs of youth with co-occurring chronic health and mental health conditions. Our findings suggest tailoring transition readiness practices for this group based on youths' own goals, symptoms, coping mechanisms and resources. PATIENT OR PUBLIC INVOLVEMENT: This study was conducted in collaboration with five young adult research partners (YARP) with lived experience transitioning from paediatric to adult health/mental health services. The YARP's contributions across study phases ensured the perspectives of young people were centred throughout data collection, analysis, interpretation and presentation of findings. All five YARP co-authored this manuscript.

"They go hand in hand": a patient-oriented, qualitative descriptive study on the interconnectedness between chronic health and mental health conditions in transition-age youth.

BACKGROUND: Transition-age youth (TAY) with chronic health conditions frequently experience co-occurring mental health conditions. However, little is known about the perspectives of TAY with co-occurring diagnoses preparing to exit pediatric health and mental health services. Research is needed to understand the impact of a mental health condition on transition readiness and self-management in TAY with chronic health conditions. METHODS: TAY (aged 16-20 years) with co-occurring chronic health and mental health conditions were recruited in Alberta, Canada. Nine semi-structured individual interviews were completed by phone or videoconference, and transcribed verbatim. Guided by qualitative description, we analyzed the data using thematic analysis in partnership with five young adults with lived experience in the health/mental health systems. RESULTS: Participants shared their experiences living with simultaneous physical and mental health concerns and preparing for transition to adult care. Our analysis revealed three overarching themes: 1) "they're intertwined": connections between chronic health and mental health conditions in TAY, 2) impact of mental health on transition readiness and self-management, and 3) recommendations for service provision from the perspectives of TAY. CONCLUSIONS: Our findings highlighted the myriad ways in which physical and mental health are connected as TAY prepare for service transitions using specific examples and powerful metaphors. TAY endorsed the importance of providers discussing these connections in routine clinical care. Future research should involve co-designing and evaluating educational material addressing this topic with diverse TAY, caregivers, and service providers.

Gap junction intercellular communications regulate NK cell activation and modulate NK cytotoxic capacity.

Gap junctions (GJs) mediate intercellular communication between adjacent cells. Previously, we showed that connexin 43 (Cx43), the main GJ protein in the immune system, mediates Ag transfer between human dendritic cells (DCs) and is recruited to the immunological synapse during T cell priming. This crosstalk contributed to T cell activation, intracellular Ca(2+) responses, and cytokine release. However, the role of GJs in NK cell activation by DCs and NK cell-mediated cytotoxicity against tumor cells remains unknown. In this study, we found polarization of Cx43 at the NK/DC and NK/tumor cell-contact sites, accompanied by the formation of functional GJs between NK/DCs and NK/tumor cells, respectively. Cx43-GJ-mediated intercellular communication (GJIC) between human NK and DCs was bidirectional. Blockage of Cx43-GJIC inhibited NK cell activation, though it affected neither the phenotype nor the function of DCs. Cx43 knockdown or inhibition using mimetic peptides greatly reduced CD69 and CD25 expression and IFN-γ release by DC-stimulated NK cells. Moreover, blocking Cx43 strongly inhibited the NK cell-mediated tumor cell lysis associated with inhibition of granzyme B activity and Ca(2+) influx. Our data identify a novel and active role for Cx43-GJIC in human NK cell activation and antitumor effector functions that may be important for the design of new immune therapeutic strategies.

Social networks and risk of eating disorders in Chilean young adults.

Introduction: Introduction: in Western societies, social networks are prominent sources of information and entertainment, widely accessed due to internet availability. While social networks offer health benefits, their impact varies across generations and populations. Concerns arise about their influence on mental health, with potential hindrance to social relationships. Social networks are recognized as contributors to eating disorders, influencing nutritional behaviors and impacting self-perception negatively. For this, the objective of present study was determining the association between the risk of eating disorders (ED) and the use of social networks in young adults in the Araucanía Region of Chile. Methods: a descriptive cross-sectional study was conducted on the young adult population. The subjects were recruited online through crucial social networks between November and December 2021. A self-reported online form was administered, asking for sociodemographic variables, social network use, and risk of eating disorders. The EAT-26 was applied for the latter variable. To determine the association between variables, each condition was dichotomized against the presence or absence of ED risk. Results: a total of 370 responses were collected, representing females (62.7 %) primarily from the 20-28 age group (79.5 %) and from the university student group (54.9 %); 12.9 % of the sample were at risk of ED. The variables associated with a higher risk of an eating disorder were being female (p = 0.001), preference for Twitter (p = 0.017), interest in food influencers (p = 0.008), and perceived frequency of advertising (p = 0.007). Conclusion: in this sample, there is an association between the use of social networks and the risk of ED, but this depends mainly on the social network used and exposure/preference of food-related content.

Introducción: Introduction: en las sociedades occidentales, las redes sociales son fuentes destacadas de información y entretenimiento, ampliamente accesibles gracias a la disponibilidad de internet. Aunque ofrecen beneficios para la salud, su impacto varía entre generaciones y poblaciones. Surgen preocupaciones sobre su influencia en la salud mental, con un posible obstáculo para las relaciones sociales. Se reconoce que las redes sociales contribuyen a los trastornos alimentarios, influyendo en los comportamientos nutricionales y afectando negativamente la autopercepción. Por ello, el objetivo de este estudio fue determinar la asociación entre el riesgo de trastornos alimentarios (ED) y el uso de redes sociales en adultos jóvenes en la Región de la Araucanía, Chile. Methods: se llevó a cabo un estudio descriptivo transversal en la población de adultos jóvenes. Los sujetos fueron reclutados en línea a través de redes sociales clave entre noviembre y diciembre de 2021. Se administró un formulario en línea autoinformado, solicitando variables sociodemográficas, uso de redes sociales y riesgo de trastornos alimentarios. Se aplicó el EAT-26 para esta última variable. Para determinar la asociación entre variables, se dicotomizó cada condición frente a la presencia o ausencia de riesgo de ED. Results: se recopilaron un total de 370 respuestas, principalmente de mujeres (62,7 %) en el grupo de edad de 20-28 años (79,5 %) y de estudiantes universitarios (54,9 %). El 12,9 % de la muestra estaba en riesgo de ED. Las variables asociadas con un mayor riesgo de trastorno alimentario fueron el género femenino (p = 0,001), preferencia por Twitter (p = 0,017), interés en influencers de alimentos (p = 0,008) y percepción de la frecuencia de la publicidad (p = 0,007). Conclusion: en esta muestra, existe una asociación entre el uso de redes sociales y el riesgo de ED, pero esto depende principalmente de la red social utilizada y la exposición/preferencia de contenido relacionado con la alimentación.

Development of the Strengths, Skills, and Goals Matrix: a tool for facilitating strengths-based adolescent and young adult engagement in research.

BACKGROUND: The involvement of adolescents and young adults (AYAs) with lived experience of health and mental health conditions as partners in research is increasing given the prominence of participatory approaches to research, including patient-oriented research (POR). Much of the relevant research is conducted by graduate students. While guiding AYA engagement frameworks and models exist, the processes of partnering with AYAs in patient-oriented graduate-level research projects have not been well established. Co-developed tools and practices are required to support strengths-based, developmentally appropriate AYA-graduate student partnerships. OBJECTIVES: The objectives of this commentary are: (1) to share the processes of partnership between a graduate student and five Young Adult Research Partners (YARP), (2) to describe the co-design and implementation of the Strengths, Skills, and Goals Matrix (SSGM), a tool for facilitating strengths-based AYA engagement in research, and (3) to outline considerations for applying this tool across a variety of research contexts with patient partners. MAIN BODY: Within the YARP-graduate student partnership, the SSGM offered extensive benefits, including tangible skill development, peer mentorship, and rapport building among all members. This tool offers strategies for strengths-based engagement practices which emphasize AYAs' preferences and goals throughout POR projects. Practical recommendations and considerations for applying the SSGM within graduate-level research and beyond are described, including the importance of connecting AYAs' current (and desired) skills to specific tasks within the research project and resulting outputs. CONCLUSIONS: The SSGM has possible relevance in a variety of settings given its broadly applicable structure. Future research could explore the adaptation, application, and evaluation of the SSGM across research contexts to determine its feasibility and ease of implementation. PATIENT OR PUBLIC CONTRIBUTION: This article was conceived of and co-authored by five young adult research partners. The YARP co-designed the SSGM presented in this article, the figures, and substantially contributed to the preparation of the article.

The involvement of adolescents and young adults (AYAs) with lived experience of health and mental health conditions as partners in research is becoming more common in student research projects. Though guidelines for engaging AYAs as partners in research exist, the steps for developing meaningful AYA-student partnerships are not clearly defined. These partnerships require tools and practices that are co-developed by AYAs and students to be successful. In this commentary, we share the details of a partnership between a graduate student and five AYA research partners. Next, we describe how we developed the Strengths, Skills, and Goals Matrix (SSGM), a tool for supporting AYA engagement in research which emphasizes the capabilities and goals of each AYA partner. Finally, we outline suggestions for patient partners and research teams interested in using this tool in different settings. Within our research partnership, the SSGM helped all members build relationships, develop skills, and share their skills with one another. The SSGM focuses on the strengths of each person and allows patient partners to determine their own goals for engaging in research. Future research should explore how the SSGM works for different types of research teams or projects.

Percepciones del enfermero en el cuidado del paciente con aislamiento de contacto infectado por Klebsiella Pneumoniae carbapenemasa / Perceptions of the nurse in the care of the patient with isolation of contact infected by Klebsiella Pneumoniae carbapenemase

La percepción como concepto es el proceso mediante el cual la conciencia integra los estímulos sensoriales sobre objetos, hechos o situaciones y los transforma en experiencia útil. El presente trabajo fue una investigación cualitativa de tipo fenomenológico, cuyo objetivo principal es analizar cuáles son las percepciones del enfermero en el cuidado del paciente con aislamiento de contacto infectado por Klebsiella Pneumoniae Carbapenemasa. Los participantes fueron los enfermeros del internado general y de la unidad de terapia intensiva. El análisis de datos se realizó a través de la transcripción de las entrevistas resaltando puntos fuertes y relacionándolos entre ellos para poder obtener dimensiones y características comunes. Los participantes firmaron un consentimiento informado en donde se les solicito permiso para la grabación. Los hallazgos se organizaron en 3 dimensiones: percepción emocional del enfermero que se expresa en el miedo, la incertidumbre y la necesidad de conocimiento, el apoyo entre colegas como medio para afrontar las emociones y la igualdad y comprensión a la hora de brindar cuidado al paciente aislado por Klebsiella Pneumoniae carbapenemasa. Percepción empática que se evidencia en la empatía del personal de enfermería frente al paciente con aislamiento de contacto por Klebsiella Pneumoniae carbapenemasa. Comportamiento en la relación enfermero-paciente expresa la importancia del conocimiento y evidencia como el actuar de enfermería mejora a través de la adquisición del mismo logrando mejora en la calidad de atención brindando seguridad y confianza, no solo al paciente, sino a su propio equipo. Conclusión: Los servicios de enfermería necesitan brindar un acompañamiento con orientación desde un primer momento al enfermero que brinda cuidado al paciente con aislamiento por Klebsiella Pneumoniae carbapenemasa[AU]

Summary: perception as a concept is the process by which consciousness integrates sensory stimuli on objects, events or situations and transforms them into useful experience. The present work was a qualitative phenomenological investigation, the main objective of which is to analyze the perceptions of the nurse in the care of the patient with contact isolation infected by Klebsiella Pneumoniae Carbapenemasa. The participants were the nurses from the general boarding school and the intensive care unit. The data analysis was carried out through the transcription of the interviews, highlighting strong points nd relating them to each other in order to obtain common dimensions and characteristics. The participants signed an informed consent requesting permission for the recording. The findings were organized in 3 dimensions: emotional perception of the nurse that is expressed in fear, uncertainty and the need for knowledge, support among colleagues as a means to face emotions, and equality and understanding when providing care to the patient. isolated by Klebsiella Pneumoniae carbapenemasa. Empathic perception that is evidenced in the empathy of the nursing staff towards the patient with contact isolation due to Klebsiella Pneumoniae carbapenemase. Behavior in the nurse-patient relationship expresses the importance of knowledge and evidence of how nursing actions improve through the acquisition of it, achieving an improvement in the quality of care, providing security and confidence, not only to the patient, but to their own team. Conclusion: Nursing services need to provide guidance with guidance from the first moment to the nurse who provides care to the patient with Klebsiella Pneumoniae carbapenemasa isolation[AU]

A percepção como conceito é o processo pelo qual a consciência integra estímulos sensoriais em objetos, eventos ou situações e os transforma em experiências úteis. O presente trabalho foi uma investigação qualitativa fenomenológica, cujo objetivo principal é analisar as percepções do enfermeiro no cuidado ao paciente com isolamento de contato infectado por Klebsiella Pneumoniae Carbapenemasa. Os participantes foram os enfermeiros do internato geral e da unidade de terapia intensiva. A análise dos dados foi realizada por meio da transcrição das entrevistas, destacando os pontos fortes e relacionando-os entre si a fim de obter dimensões e características comuns. Os participantes assinaram um termo de consentimento livre e esclarecido solicitando permissão para a gravação. Os achados foram organizados em 3 dimensões: percepção emocional do enfermeiro que se expressa no medo, incerteza e necessidade de conhecimento, apoio entre os colegas como forma de enfrentar as emoções e igualdade e compreensão no cuidado ao paciente. Isolado por Klebsiella Pneumoniae carbapenemasa. Percepção empática que se evidencia na empatia da equipe de enfermagem para com o paciente com isolamento de contato por Klebsiella Pneumoniae carbapenemase. O comportamento na relação enfermeiro-paciente expressa a importância do conhecimento e da evidência de como a ação de enfermagem se aprimora por meio de sua aquisição, alcançando uma melhoria na qualidade da assistência, proporcionando segurança e confiança, não só ao paciente, mas à própria equipe. Conclusão: Os serviços de enfermagem precisam fornecer orientações com orientações desde o primeiro momento ao enfermeiro que presta cuidados ao paciente com isolamento de Klebsiella Pneumoniae carbapenemasa[AU]

Ameloblastin and amelogenin expression in posnatal developing mouse molars.

Ameloblastin and amelogenin are structural proteins present in the enamel matrix of developing teeth. Here we report the results of in situ hybridization analyses with DNA probes of ameloblastin and amelogenin expression in the mandibular first molars of ICR/Jcl mice from postnatal day 1 to day 15. Ameloblastin mRNA expression was observed in ameloblasts at day 2 while amelogenin mRNA was detected in secretory ameloblasts at day 3. Significant expression of both molecules was observed at days 4, 5 and 6, after which the levels decreased. Amelogenin expression ended on day 10, while ameloblastin mRNA was only weakly detected on day 12. Neither amelogenin nor ameloblastin expression was observed in day 15 mouse molars. Amelogenin and ameloblastin mRNAs were restricted to ameloblasts. We conclude that amelogenin and ameloblastin expression is enamel-specific, and suggest that these genes might be involved in the mineralization of enamel. It is possible that ameloblastin could participate in the attachment of ameloblasts to the enamel surface. In this case, the downregulation of expression may indicate the beginning of the maturation stage in which the ameloblasts tend to detach from the enamel layer.

Radiological findings of uterine arteriovenous malformation: a case report of an unusual and life-threatening cause of abnormal vaginal bleeding.

Uterine arteriovenous malformations may cause life-threatening abnormal genital bleeding in women at childbearing age. Transvaginal Doppler ultrasonography is a widely available, noninvasive and excellent diagnostic method. The authors report the case of a patient with history of gestational trophoblastic disease and multiple curettage procedures who developed uterine arteriovenous malformations, with remission of the lesions after treatment with methotrexate.

Malformações arteriovenosas uterinas podem causar sangramento genital anormal, representando risco de morte nas mulheres em idade reprodutiva. O ultrassom transvaginal com Doppler é um método não invasivo amplamente disponível e excelente ferramenta diagnóstica. Apresentamos o caso de paciente com história de doença trofoblástica gestacional e múltiplas curetagens que evoluiu com malformações arteriovenosas uterinas, apresentando remissão das lesões após tratamento com metotrexate.

A utilização do lúdico no cenário da hospitalização pediátrica / The use of play in the pediatric hospitalization scenario

Objetivo: descrever a percepção da equipe multiprofissional sobre a utilização do lúdico e dos fatores que interferem na sua prática no contexto do cuidado à criança hospitalizada. Método: trata-se de estudo qualitativo, descritvo, exploratório realizado na Clínica Pediátrica de um hospital universitário, com 18 profissionais, por meio de entrevista semiestruturada e emprego da técnica de Análise de Conteúdo. Resultados: revela-se que os profissionais percebem como o lúdico ajuda a modificar o ambiente hospitalar, os sentimentos e o processo de comunicação com a criança, influencia na adesão às terapêuticas, à socialização, à promoção de vínculos e à colaboração com a equipe, ainda que nem todos se sintam preparados para incorporá-lo à sua rotina de trabalho. Conclusão: depara-se a equipe com dificuldades relacionadas aos recursos humanos e materiais, embora haja benefícios; contudo, investe para que a atenção integral à criança seja mediada de forma humanizada, na capacitação da equipe e modificação da prática de cuidados no hospital.(AU)

Objective: to describe the perception of the multiprofessional team about the use of play and the factors that interfere in their practice in the context of the care of hospitalized children. Method: this is a qualitative, descriptive, exploratory study carried out in the Pediatric Clinic of a university hospital, with 18 professionals, through a semistructured interview and using the Content Analysis technique. Results: it is revealed that the professionals perceive how play help to modify the hospital environment, the feelings and the process of communication with the child, influences adherence to therapies, socialization, the promotion of bonds and collaboration with the team, even though not everyone feels prepared to incorporate it into their work routine. Conclusion: the team faces difficulties related to human and material resources, although there are benefits; however, it invests so that the child's integral care is mediated in a humanized way, in the qualification of the team and modification of the practice of care in the hospital.(AU)

Objetivo: describir la percepción del equipo multiprofesional sobre la utilización del lúdico y de los factores que interfieren en su práctica en el contexto del cuidado al niño hospitalizado. Método: se trata de un estudio cualitativo, descriptivo, exploratorio realizado en la Clínica Pediátrica de un hospital universitario, con 18 profesionales, por medio de entrevista semiestructurada y empleo de la técnica de Análisis de Contenido. Resultados: se revela que los profesionales perciben cómo el lúdico ayuda a modificar el ambiente hospitalario, los sentimientos y el proceso de comunicación con el niño, influye en la adhesión a las terapias, a la socialización, a la promoción de vínculos y a la colaboración con el equipo, aunque no todos se sienten preparados para incorporarlo a su rutina de trabajo. Conclusión: se encuentra el equipo con dificultades relacionadas con los recursos humanos y materiales, aunque hay beneficios; sin embargo, invierte para que la atención integral al niño sea mediada de forma humanizada, en la capacitación del equipo y modificación de la práctica de cuidados en el hospital.(AU)

Radiological findings of uterine arteriovenous malformation: a case report of an unusual and life-threatening cause of abnormal vaginal bleeding / Aspectos radiológicos da malformação arteriovenosa uterina: relato de caso de uma causa incomum e perigosa de sangramento vaginal anormal

Uterine arteriovenous malformations may cause life-threatening abnormal genital bleeding in women at childbearing age. Transvaginal Doppler ultrasonography is a widely available, noninvasive and excellent diagnostic method. The authors report the case of a patient with history of gestational trophoblastic disease and multiple curettage procedures who developed uterine arteriovenous malformations, with remission of the lesions after treatment with methotrexate.

Malformações arteriovenosas uterinas podem causar sangramento genital anormal, representando risco de morte nas mulheres em idade reprodutiva. O ultrassom transvaginal com Doppler é um método não invasivo amplamente disponível e excelente ferramenta diagnóstica. Apresentamos o caso de paciente com história de doença trofoblástica gestacional e múltiplas curetagens que evoluiu com malformações arteriovenosas uterinas, apresentando remissão das lesões após tratamento com metotrexate.