Sleep measures as a predictor of suicidal ideation among high-risk adolescents.

Suicide is the second leading cause of death among youth aged 15-24 years. Identifying modifiable risk factors relevant to adolescents is crucial for suicide prevention. Sleep patterns have been linked to suicidality in adults, but lack sufficient study in youth. This ecological momentary assessment (EMA) study aimed to explore the relationship between objectively and subjectively measured sleep characteristics and next-day suicidal ideation in high-risk youth. We included 29 adolescents (12-18 years old) admitted to the inpatient psychiatric ward post-suicide attempt or due to suicidal intent within the previous month. We conducted objective (actigraphy) and subjective (sleep diary) sleep pattern assessments over ten consecutive days. Daily suicidal ideation was evaluated using a questionnaire based on the validated C-SSRS interview. A significant positive association was observed between sleep onset latency (SOL) and expressing a "death wish" the following day (OR = 1.06, 95% CI [1-1.11], p = .04), with each minute of longer SOL increased the risk for a death wish the following day by 6%. In addition, a marginally significant negative association was observed between total sleep time (TST) and expressing a "death wish" the following day (OR = 0.57, 95% CI [0.3-1.11], p = 0.1), with each one-hour decrease in objectively measured TST increasing the odds of a death wish by 43%. Our study highlights the interplay between sleep patterns and suicidal ideation, with SOL and TST playing a significant role that may function as proximal risk factors for suicidality and as a target for intervention while treating suicidal youth.

Persona-PhysioSync AV: Personalized Interaction through Personality and Physiology Monitoring in Autonomous Vehicles.

The emergence of autonomous vehicles (AVs) marks a transformative leap in transportation technology. Central to the success of AVs is ensuring user safety, but this endeavor is accompanied by the challenge of establishing trust and acceptance of this novel technology. The traditional "one size fits all" approach to AVs may limit their broader societal, economic, and cultural impact. Here, we introduce the Persona-PhysioSync AV (PPS-AV). It adopts a comprehensive approach by combining personality traits with physiological and emotional indicators to personalize the AV experience to enhance trust and comfort. A significant aspect of the PPS-AV framework is its real-time monitoring of passenger engagement and comfort levels within AVs. It considers a passenger's personality traits and their interaction with physiological and emotional responses. The framework can alert passengers when their engagement drops to critical levels or when they exhibit low situational awareness, ensuring they regain attentiveness promptly, especially during Take-Over Request (TOR) events. This approach fosters a heightened sense of Human-Vehicle Interaction (HVI), thereby building trust in AV technology. While the PPS-AV framework currently provides a foundational level of state diagnosis, future developments are expected to include interaction protocols that utilize interfaces like haptic alerts, visual cues, and auditory signals. In summary, the PPS-AV framework is a pivotal tool for the future of autonomous transportation. By prioritizing safety, comfort, and trust, it aims to make AVs not just a mode of transport but a personalized and trusted experience for passengers, accelerating the adoption and societal integration of autonomous vehicles.

Effectiveness of the BNT162b2 mRNA COVID-19 vaccine among adolescents with juvenile-onset inflammatory rheumatic diseases.

OBJECTIVES: The effectiveness of the BNT162b2 mRNA COVID-19 vaccine for adolescents with juvenile-onset inflammatory or immune rheumatic diseases (IRDs) is unknown. Several studies have suggested attenuated immunogenicity in patients with IRD. This study evaluated the effectiveness of the BNT162b2 mRNA COVID-19 vaccine in preventing COVID-19 infection in adolescents with juvenile-onset IRD compared with controls without immune rheumatic disease. METHODS: We used data from Clalit Health Services, the largest health-care organization in Israel, to conduct an observational cohort study from February to December 2021, involving 12-18 year-old adolescents diagnosed with IRD. Study outcomes included documented COVID-19 infection in relation to vaccination status and immunomodulatory therapy. We estimated vaccine effectiveness as one minus the risk ratio. Adolescents aged 12-18 years without immune rheumatic disease served as controls. RESULTS: A total of 1639 adolescents with IRD (juvenile idiopathic arthritis, SLE, or familial Mediterranean fever) were included and compared with 524 471 adolescents in the same age range without IRD. There was no difference in COVID-19 infection rates after the second dose of vaccine between those with IRD and controls (2.1% vs 2.1% respectively, P = 0.99). The estimated vaccine effectiveness for adolescents with IRD was 76.3% after the first dose, 94.8% after the second and 99.2% after the third dose. CONCLUSION: We found that the BNT162b2 mRNA vaccine was similarly effective against COVID-19 infection in adolescents with and without IRD. Immunomodulatory therapy did not affect its effectiveness. These results can encourage adolescents with IRD to get vaccinated against COVID-19.

Automated detection of atrial fibrillation based on vocal features analysis.

INTRODUCTION: Early detection of atrial fibrillation (AF) is desirable but challenging due to the often-asymptomatic nature of AF. Known screening methods are limited and most of them depend of electrocardiography or other techniques with direct contact with the skin. Analysis of voice signals from natural speech has been reported for several applications in medicine. The study goal was to evaluate the usefulness of vocal features analysis for the detection of AF. METHODS: This prospective study was performed in two medical centers. Patients with persistent AF admitted for cardioversion were enrolled. The patients pronounced the vowels "Ahh" and "Ohh" were recorded synchronously with an ECG tracing. An algorithm was developed to provide an "AF indicator" for detection of AF from the speech signal. RESULTS: A total of 158 patients were recruited. The final analysis of "Ahh" and "Ohh" syllables was performed on 143 and 142 patients, respectively. The mean age was 71.4 ± 9.3 and 43% of patients were females. The developed AF indicator was reliable. Its numerical value decreased significantly in sinus rhythm (SR) after the cardioversion ("Ahh": from 13.98 ± 3.10 to 7.49 ± 1.58; "Ohh": from 11.39 ± 2.99 to 2.99 ± 1.61). The values at SR were significantly more homogenous compared to AF as indicated by a lower standard deviation. The area under the receiver operating characteristic curve was >0.98 and >0.89 ("Ahh" and "Ohh," respectively, p < .001). The AF indicator sensitivity is 95% with 82% specificity. CONCLUSION: This study is the first report to demonstrate feasibility and reliability of the identification of AF episodes using voice analysis with acceptable accuracy, within the identified limitations of our study methods. The developed AF indicator has higher accuracy using the "Ahh" syllable versus "Ohh."

Humoral Response to Pfizer BNT162b2 Vaccine Booster in Maintenance Hemodialysis Patients.

INTRODUCTION: Coronavirus disease is associated with increased morbidity and mortality in maintenance hemodialysis (MHD) patients. Recent breakthrough infection in vaccinated people has led some authorities to recommend a booster dose for patients fully vaccinated 5-8 months ago. We aimed to assess the humoral response of MHD patients following a booster dose with the BNT162b2 vaccine. METHODS: The study included 102 MHD patients vaccinated with 2 doses of the BNT162b2 (Pfizer-BioNTech) vaccine. A third dose (booster) was recommended to all MHD patients in our center and was given to those who opted to receive it, resulting in a booster group and a control group that did not receive the booster. Previous exposure was excluded by testing for the presence of the anti-nucleocapsid antibody (SARS-CoV-2) or positive PCR. We assessed the humoral response before and after the booster dose. RESULTS: Of 66 patients in the booster group, 65 patients (98.5%) developed a positive antibody response, from 472.7 ± 749.5 to 16,336.8 ± 15,397.3, as compared to a sustained decrease in the control group (695.7 ± 642.7 to 383.6 ± 298.6), p < 0.0001. No significant adverse effects were reported. Prior antibody titers were positively correlated to IgG levels following the booster dose. There was a significant association between malnutrition-inflammation markers and the humoral response. CONCLUSIONS: Almost all MHD patients developed a substantial humoral response following the booster dose, which was significantly higher than levels reported for MHD patients following administration of 2 doses alone. Further studies and observations are needed to determine the exact timing and dosing schedule.

Alopecia Areata as a Proximal Risk Factor for the Development of Comorbid Depression: A Population-based Study.

Alopecia areata and depression tend to co-occur; however, their temporal association has not been comprehensively investigated. The aim of this study was to examine the temporal association between alopecia areata and depression. The study included only cases with a comorbid presentation of alopecia areata and depression (n = 1,936), extracted from the databases of the Clalit Health Services, Israel. Survival analyses were used to assess the cumulative probability of receiving alopecia areata as comorbid diagnosis in the years following depression, and vice versa, compared with the opposite trajectory. The results indicate that patients with alopecia areata had greater odds of subsequent depression within 2 years from alopecia areata diagnosis, and showed a steeper increase in cumulative probability of depression as time progressed (log-rank =336.38, p < 0.001), compared with the opposite trajectory. All patients with alopecia areata had comorbid depression within 10 years of alopecia areata, compared with 70% of depression patients receiving diagnoses of comorbid alopecia areata within the same time-frame.

Gen Z during the COVID-19 crisis: a comparative analysis of the differences between Gen Z and Gen X in resilience, values and attitudes.

In the current study we seek to examine the difference between Generation Z and Generation X in terms of coping with a global crisis (COVID-19), specifically regarding resilience in times of crisis, personal values ​​and attitudes during that time. Based on the theory of generations, we aimed to explore whether different generations have different levels of resilience, values and attitudes during the global crisis. Data were gathered in a cross-sectional study; 958 participants participated, divided into two age-groups: 508 participants of Generation Z (ages ranged between 18-24; 53.9% males [Age: M = 21.05, SD = 1.96]; 46.1% females [Age: M = 21.14, SD = 1.83]), and 205 participants of Generation X (ages ranged between 40-50; 54.2% males [Age: M = 45.16, SD = 3.15]; 45.8% females [Age: M = 45.23, SD = 3.01]). It was found that members of Generation Z (Gen Z) were less resilient. Also, Gen Z members had higher levels of openness to change, and self-enhancement as compared to Generation X (Gen X). In addition, Gen Z were found to be more positive in their attitudes toward flexible learning but no differences between the generations were found as for flexible work. Both generation members had the similar attitudes towards online consumption. Despite the magnitude and significance of the crisis, the main values of each generation remained unchanged in many respects, but attitudes of both generations are positive towards hybrid work and consumption.

Immature platelets in patients hospitalized with Covid-19.

Coronavirus disease 2019 (Covid-19) is associated with high incidence of venous and arterial thromboembolic events. Currently, there are no markers to guide antithrombotic therapy in Covid-19. Immature platelets represent a population of hyper-reactive platelets associated with arterial events. This prospective study compared consecutive Covid-19 patients (n = 47, median age = 56 years) to patients with acute myocardial infarction (AMI, n = 100, median age = 59 years) and a group of stable patients with cardiovascular risk factors (n = 64, median age = 68 years). Immature platelet fraction (IPF) and immature platelet count (IPC) were determined by the Sysmex XN-3000 auto-analyzer on admission and at subsequent time-points. IPF% on admission was higher in Covid-19 than the stable group and similar to the AMI group (4.8% [IQR 3.4-6.9], 3.5% [2.7-5.1], 4.55% [3.0-6.75], respectively, p = 0.0053). IPC on admission was also higher in Covid-19 than the stable group and similar to the AMI group (10.8 × 109/L [8.3-18.1], 7.35 × 109/L [5.3-10.5], 10.7 × 109/L [7.7-16.8], respectively, P < 0.0001). The maximal IPF% among the Covid-19 group was higher than the stable group and similar to the AMI group. The maximal IPC in Covid-19 was higher than the maximal IPC in both the stable and AMI groups (COVID-19: 14.4 × 109/L [9.4-20.9], AMI: 10.9 × 109/L [7.6-15.2], P = 0.0035, Stable: 7.55 × 109/L [5.55-10.5], P < 0.0001). Patients with Covid-19 have increased immature platelets indices compared to stable patients with cardiovascular risk factors, and as the disease progresses also compared to AMI patients. The enhanced platelet turnover and reactivity may have a role in the development of thrombotic events in Covid-19 patients.

Towards a Personalized Multi-Domain Digital Neurophenotyping Model for the Detection and Treatment of Mood Trajectories.

The commercial availability of many real-life smart sensors, wearables, and mobile apps provides a valuable source of information about a wide range of human behavioral, physiological, and social markers that can be used to infer the user's mental state and mood. However, there are currently no commercial digital products that integrate these psychosocial metrics with the real-time measurement of neural activity. In particular, electroencephalography (EEG) is a well-validated and highly sensitive neuroimaging method that yields robust markers of mood and affective processing, and has been widely used in mental health research for decades. The integration of wearable neuro-sensors into existing multimodal sensor arrays could hold great promise for deep digital neurophenotyping in the detection and personalized treatment of mood disorders. In this paper, we propose a multi-domain digital neurophenotyping model based on the socioecological model of health. The proposed model presents a holistic approach to digital mental health, leveraging recent neuroscientific advances, and could deliver highly personalized diagnoses and treatments. The technological and ethical challenges of this model are discussed.

The diagnostic clinical value of thumb metacarpal grind, pressure-shear, flexion, and extension tests for carpometacarpal osteoarthritis.

STUDY DESIGN: Clinical measurement. INTRODUCTION: Common provocative maneuvers to differentiate thumb carpometacarpal (CMC) osteoarthritis from other sources of pain are the grind, metacarpal (MC) flexion, and MC extension tests. A maneuver known as the pressure-shear test is described here. PURPOSE OF THE STUDY: To compare the diagnostic value of the grind, metacarpal flexion, metacarpal extension, and pressure-shear tests for CMC osteoarthritis of the thumb. METHODS: The diagnostic accuracy of each test was compared in 127 thumbs from 104 patients. Sensitivity, specificity, and predictive values of each test were calculated. In a secondary analysis, polychoric correlation coefficients were used to assess the correlation of each test with severity defined by Eaton-Littler stage. RESULTS: The overall diagnostic accuracy of the thumb MC grind, pressure-shear, flexion, and extension tests were 70%, 98%, 47%, and 55%, respectively. The sensitivities were 64%, 99%, 36%, and 46%, respectively, and specificities were 100%, 95%, 100%, and 100%, respectively. For the diagnosis of Thumb CMC arthritis, the MC pressure-shear test was superior overall in terms of overall diagnostic accuracy and sensitivity, while having comparable specificity to the other maneuvers. CONCLUSION: The pressure-shear test was found to be superior to the commonly used grind maneuver and the provocative maneuvers of MC flexion and extension tests to confirm diagnosis of CMC osteoarthritis.

Rotator cuff tears: correlation between geometric tear patterns on MRI and arthroscopy and pre- and postoperative clinical findings.

BACKGROUND: Magnetic resonance imaging (MRI) is considered to be the best non-invasive procedure for the evaluation of rotator cuff (RC) tendon tears. Burkhart's classification is a geometric classification of full-thickness RC tears on MRI. PURPOSE: To correlate MRI and arthroscopic geometric full-thickness RC tears according to the Burkhart's classification with pre- and postoperative clinical findings. MATERIAL AND METHODS: Patients who underwent arthroscopic RC repair between 2006 and 2010 were retrospectively evaluated. Preoperative MRI and arthroscopic surgical reports were reviewed for tear geometry (Burkhart's) by three (1 radiologist, 2 surgeons) and two (surgeons) readers. MRIs were also evaluated for tear size and change of tear size in successive sagittal sections and for muscle mass and fatty infiltration. Clinical examinations were performed preoperatively and at least 12 months afterwards. Postoperative function questionnaires were filled in by the patients. RESULTS: Forty-six patients (35 men, 11 women; mean age, 57 years; range, 41-72 years) were evaluated. Tears depicted on MRIs were classified as crescent in 11 patients (24%), longitudinal in three (6.5%), massive contracted in 29 (63%), and cuff arthropathy in three (6.5%). Muscle changes were noted almost exclusively in patients with massive tears and cuff arthropathy (16/32 patients, P = 0.013). MRIs and arthroscopic geometric classifications were in close agreement. Tear type did not correlate with pre- and postoperative physical examination or with postoperative clinical questionnaires scores. CONCLUSION: Geometric RC tear characterizations on preoperative MRIs were closely associated with arthroscopic findings. Postoperative results were not affected by the geometric pattern of the tears.

RV size may predict death in unstable patients with PE.

BACKGROUND: Pulmonary emboli (PE) is a life threatening condition that discovered in many patients only "post mortem". Sub massive and massive PE that led to hemodynamic collapse characterized by right ventricular (RV) dysfunction, leading to a higher risk of death. OBJECTIVES: To assess the ability to predict in hospital death of patients with acute PE, using a non-gated computed tomography pulmonary angiography (CTPA), based on the dimensions of the right ventricle. METHODS: A retrospective study that analyzed CTPA images of patients admitted with acute PE during the years 2012-2017. The cohort study included 300 patients with documented acute PE, among them 255 hospitalized in medical (non-intensive care unit) wards, 45 were hospitalized in an intensive care unit (ICU). RESULTS: Among the 45 patients admitted to the ICU 8% died. Larger RV diameters predicted mortality (OR = 10.14, 95% CI [1.09-93.86]) as well as lower systolic and diastolic blood pressure measurements (p = 0.001 and 0.01). Among the 255 patients admitted to the Internal Medicine Ward 7% died. Older age (p = 0.028), sepsis and cancer (both p < 0.001), high WBCs count (p < 0.001), and renal failure (p < 0.001) predicted death. Lower blood pressure (systolic and diastolic) (p < 0.001, 0.008), older age (p < 0.007), sepsis (p < 0.001), cancer (p = 0.006), higher WBCs count (p < 0.001), and impaired renal function (p < 0.001) predicted death in patients admitted with acute PE. CONCLUSIONS: Clinical parameters and hematological parameters could predict death of patients admitted with acute PE. RV diameter, measured by the non-ECG gated CTPA, had an additive predictive value for patients who admitted to the ICU.

Childbirth as a traumatic event for attendant fathers.

Background: Negative reactions such as post-traumatic stress disorder (PTSD) following childbirth have been increasingly reported in mothers, particularly following objectively and subjectively difficult childbirth experiences. A small body of research has examined fathers' reactions to childbirth, with mixed results.Objective: The study aimed to further these studies, investigating whether objective and subjective aspects of fathers' participation in childbirth were related to levels of PTSD and fear of childbirth symptoms, in the first year following childbirth.Method: In total, 224 fathers whose partners had given birth within the previous 12 months answered online questionnaires that examined participation in childbirth, subjective appraisals, levels of fear of childbirth, and PTSD symptoms. Data were analysed using structural equation modelling, examining both direct and indirect effects.Results: Approximately 6% of fathers reported symptoms consistent with probable PTSD. Negative cognitions mediated the path between an emergency caesarean and PTSD. Fear of childbirth was related to emergency caesareans and lack of information from the medical team.Conclusions: Future studies should examine the level of fathers' participation, their subjective appraisal of childbirth, and fear of childbirth, when assessing fathers' reactions to childbirth.

Fathers may report fear of childbirth, not just PTSD, following a traumatic childbirth.Negative appraisal mediates the relationship between an emergency caesarean and PTSD.Fear of childbirth is related to lower levels of information sharing by staff.

Waiting for the Boss's Blue Checkmark to Appear: Supervisor's Attentiveness, Negative Emotions, and Work Engagement During Instant Messaging at Work.

In organizations, employees actively manage the immediacy with which they respond to instant messages to cope with mobile connectivity overload caused by continuous interactions. This research conducted a naturalistic observational design to examine real-life mobile connectivity behaviors in organizations and measure their occupational well-being consequences. Specifically, we focused on the use of a feature (WhatsApp's blue checkmark) that enables senders to know precisely when recipients choose to read their messages. In the study, 192 participants sent important messages to their supervisors through WhatsApp. The study used Confirmatory Factor Analysis and moderation analyses to explore the relationship between supervisors' attentiveness (indicated by WhatsApp's blue checkmark), negative emotions, work engagement, and the quality of leader-member exchange (LMX). Drawing on the perspective of 'digital well-being,' we investigated the role of relationship quality between supervisors and employees (LMX) as a moderator. We hypothesized that relationship quality would buffer against negative feelings and decreased work engagement when employees await a response after sending important messages to their supervisors. Indeed, supervisor's inattentiveness was positively correlated with negative affect and negatively correlated with employee engagement. Surprisingly, we found that employees with strong relationship quality (high LMX) with their supervisors experienced lower work engagement while waiting for an indication that their message had been read. These results suggest that timely indications of message read by supervisors play an important role in mitigating negative emotions and fostering higher work engagement among employees.

Childbirth, trauma and family relationships.

Background: Childbirth is a major life event with expected positive outcomes, yet for some women postnatal psychopathological symptoms may harm women's interpersonal relationships. We hypothesized that higher levels of postnatal depression, post-traumatic stress (PTSD) symptoms, and fear of childbirth would be associated with mother-baby bond disorders and relationship dissatisfaction in couples.Method: A cross-sectional self-report online questionnaire was used to survey partnered women who had delivered in the year prior to the study. We used a convenience sample of 228 women recruited through purposive and snowball sampling. Childbirth experience, PTSD symptoms, attachment style, depression, mother-baby bond disorders, and couple relationship dissatisfaction were measured.Results: Women with higher PTSD and postnatal depression scores reported higher levels of mother-baby bond disorders-a relationship fully mediated by postnatal depression symptoms. Women who perceived childbirth as fearful or anxiety provoking had higher levels of PTSD and postnatal depression symptoms. Fearful and anxious birth perception was positively associated with mother-baby bond disorders-an association partly mediated by PTSD symptoms. Insecure attachment style was not found to be significantly associated with fearful or anxious perceptions of childbirth.Limitations: Women who have postnatal PTSD/depression are less inclined to participate in a study of this nature. Also, online surveys prevented the use of clinical diagnoses of PTSD and depression.Discussion and conclusions: Our results suggest that PTSD and postnatal depression affect women's mental health and family bonding. Women should be assessed for negative traumatic birth experiences, PTSD, and depression, to allow targeted observation for psychopathologies and therapeutic interventions.

Depression, not posttraumatic stress disorder (PTSD), is related to increased couple dissatisfaction.Both PTSD and depression are related to increased mother-baby bond disorders.Fear of childbirth increases as symptoms of PTSD and depression increase.

Virtual reality in the management of stress and anxiety disorders: A retrospective analysis of 61 people treated in the metaverse.

Mental health is the second largest group of health disorders associated with prolonged disability. Treating conditions such as stress and anxiety are a global health challenge due to inadequate funding and resources. Therefore, providing virtual treatment in the metaverse may provide a novel method of treatment for these conditions. We conducted a retrospective analysis of health records of people experiencing stress and anxiety who were treated principally in the metaverse using virtual reality. The main objective was to determine if virtual mental health treatment was achievable and safe, with measurable outcomes repeated at multiple time points. Here, 61 participants health records were evaluated (50% were female, 19% male, 31% identified as other). The cohort was 45.7 ± 15.7 years of age and reported no adverse effects with outcomes measured. Specifically, anxiety (via Generalized Anxiety Disorder Scale) decreased by 34% (p = 0.002) and stress (via Perceived Stress Scale) decreased by 32% (p < 0.001) after virtual intervention. The data suggests that this method of treatment was feasible, safe, and outcomes were obtainable over a range of time points. This early data suggest that management in the metaverse for these conditions may be beneficial, however, further prospective studies are necessary to better understand these clinical findings.

Virtual reality in the management of patients with low back and neck pain: a retrospective analysis of 82 people treated solely in the metaverse.

BACKGROUND: Clinically, neck pain disorders (NPD) and non-specific low back pain (NS-LBP) are respectively the fourth and first most common conditions associated with the greatest number of years lived with disability. Remote delivery of care may benefit healthcare sustainability, reduce environmental pollution, and free up space for those requiring care non-virtual care. METHODS: A retrospective analysis was performed on 82 participants with NS-LBP and/or NPD who received exercise therapy delivered solely in the metaverse using virtually reality. The study was to determine if this was achievable, safe, had appropriate outcome measures that could be collected, and if there was any early evidence of beneficial effects. RESULTS: The study demonstrated that virtual reality treatment delivered via the metaverse appears to be safe (no adverse events or side effects). Data for more than 40 outcome measures were collected. Disability from NS-LBP was significantly reduced (Modified Oswestry Low Back Pain Disability Index) by 17.8% (p < 0.001) and from NPD (Neck Disability Index) by 23.2% (p = 0.02). CONCLUSIONS: The data suggest that this method of providing exercise therapy was feasible, and safe (no adverse events reported), that complete reports were obtained from a large selection of patients, and that software acquired outcomes were obtainable over a range of time points. Further prospective research is necessary to better understand our clinical findings.

A Cross Sectional Study to Identify Traumatic Stress, Medical Phobia and Non-Adherence to Medical Care among Very Young Pediatric Patients.

After a traumatic medical event, such as surgery or hospitalization, a child may develop a phobia of medical care, sometimes preventing future medical adherence and impairing recovery. This study examined the correlation of Pediatric Medical Traumatic Stress (PMTS) on the development of Medical Phobia (MP) and subsequent treatment adherence. We enrolled 152 parents of children aged 1-6 hospitalized in a surgical ward. During hospitalization, parents completed questionnaires that identified post-traumatic stress symptoms. Four months post hospitalization, parents completed questionnaires on post-traumatic stress, medical phobia, psychosocial variables and medical adherence. We found a positive correlation between PMTS and MP and low adherence to medical treatment. In addition, MP mediated the relationship between PMTS severity and adherence, indicating that PMTS severity is associated with stronger medical phobia, and lower pediatric adherence to medical treatment. Our findings suggest that medical phobia serves as an essential component of PMTS. It is important to add medical phobia to medical stress syndrome definition. In addition, as MP and PMTS are involved in the rehabilitation and recovery process and subsequent success, it is an important aspect of treatment adherence.

Is serum-derived exosomal hTERT transcript a marker of oncogenic activity in primary brain tumors? An exploratory study.

BACKGROUND: In order to proliferate indefinitely, all tumors require a telomere maintenance mechanism. The expression of human telomerase reverse transcriptase (hTERT) enables telomere maintenance and provides cancer cells with limitless replicative potential. As such, it may serve as an attractive biomarker for oncogenic activity. This study explored whether a liquid biopsy that analyses blood derived exosomal hTERT transcript (e-hTERT-trans) may serve as such a biomarker in gliomas and meningiomas when compared to healthy controls. METHODS: Exosomes were isolated from the pre-operative sera of patients' samples stored in the biobank of both Rabin and Sheba Medical Centers. The levels of e-hTERT-trans were measured in 81 healthy controls, 117 meningiomas, 17 low-grade gliomas, and 61 glioblastomas. Clinical parameters of the patients were collected retrospectively and compared to the levels of the e-hTERT-trans. RESULTS: The upper normal limit of controls e-hTERT-trans was 1.85 relative quantitation (RQ). The rate of detection increased with rising tumor grade and correlated with tumor recurrence in meningiomas: mean RQ without recurrence (2.17 ± 11.7) versus with recurrence (3.59 ± 4.42; p = 0.002). In glioblastomas, preoperative measurements correlated with tumor volume and with the disease course on serial sampling. CONCLUSIONS: We demonstrated for the first time that the expression of e-hTERT-trans transcript can be measured in the serum of primary brain tumors. This exosomal marker carries the potential to serve as a biomarker once used in conjunction with other clinical and radiological parameters. Future studies are required to investigate whether the sensitivity could be augmented and whether it can be implemented into routine patients care.

Coping strategies of families and their relationships with family quality of life during Covid-19 pandemic.

The COVID-19 pandemic has brought new challenges to almost every aspect of parents' and their children's lives, posing an acute threat to the families' quality of life (FQOL). This study had two aims: (1) to identify changes in family coping-strategy profiles among parents pre- and during the first COVID-19 lockdown and (2) to analyze interactions between the clusters of coping strategies pre-COVID with FQOL during the first lockdown. A sample of 253 parents (58.5% mothers) of children (3 to 18 yr old) completed the Family Pandemic Oriented Personal Evaluation Scales and the FQOL Scale about their family life pre- and during the COVID-19 lockdown. Four family coping-strategy clusters were found. Differences were found between those clusters pre- and during the first COVID-19 lockdown, with a high percentage of families using the positive appraisal strategy more often. Significant interactions were found between the family coping-strategy clusters pre-COVID-19 and the FQOL factors before and during the pandemic. Most families maintained their FQOL levels during the first lockdown. Close and frequent interactions between family members had relationships with positive emotions and significant effects on well-being. Results showed that positive cognitive appraisal was a protective factor against a significant decrease in FQOL during the first COVID-19 lockdown.