Maternal stressors and maternal bonding among immigrant and Refugee Arab Americans resettled in the United States.

Maternal bonding with the infant and child is essential for the growth and development of the child, and for establishing the relationship between them. The effect of maternal acculturative stress, trauma, and depressive symptoms on maternal bonding has been established in nonimmigrant populations, but not in immigrant and refugee populations. In this study, we aimed to (1) examine the relationships among maternal psychosocial stress (acculturative stress, posttraumatic stress), depressive symptoms, and maternal bonding, and (2) examine whether maternal depression is a mediator of the relationship between maternal psychosocial stress and maternal bonding among a sample of Arab American immigrant and refugee mothers. Using a cross-sectional design, we recruited 78 immigrant and refugee Arab American mothers. Acculturative stress was correlated with posttraumatic stress (ρ = 0.56, p < 0.001), depressive symptoms (ρ = 0.48, p < 0.001), and bonding impairment (ρ = 0.39, p < 0.001). Posttraumatic stress and depressive symptoms were also correlated with maternal bonding impairment (ρ = 0.39, and 0.52, respectively, p < 0.001 for both). The effect of maternal psychosocial stress on maternal bonding was mediated by depressive symptoms. We concluded that higher levels of acculturative stress and posttraumatic stress were associated with higher levels of depressive symptoms and impairment of maternal bonding. Additionally, maternal depressive symptoms mediated the relationship between maternal stress and bonding. Assessing the stressors and depressive symptoms of immigrant and refugee mothers is key to avoiding negative effects on child outcomes.

Antibiotic prescription in bone augmentation and dental implant procedures: a multi-center study.

BACKGROUND: Adherence to antibiotic recommendations and safety aspects of restrictive use are important components when combating antibiotic resistance. The primary aim of this study was to assess the impact of national guidelines on antibiotic prescriptions for bone augmentation procedures among dentists working at three specialized clinics. The secondary aim was to assess the occurrence of postoperative infections. METHODS: Medical charts of 400 patients treated with bone augmentation were reviewed: 200 in the years 2010-2011 and 200 in 2014-2015. The Swedish national recommendations for antibiotic prophylaxis were published in 2012. RESULTS: There was a wide variation in antibiotic regiments prescribed throughout the study. The number of patients treated with antibiotic prophylaxis in a single dose of 2 g amoxicillin, and treated as advocated in the national recommendations, was low and decreasing between the two time periods from 25% (n = 50/200) in 2010-2011 to 18.5% (n = 37/200) in 2014-2015. The number of patients not given any antibiotics either as a prophylactic single dose or during the postoperative phase increased (P < 0.001). The administration of a 3-7-days antibiotic prescription increased significantly from 25.5% in 2010-2011 to 35% in 2014-2015. The postoperative infection rates (4.5% and 6.5%) were without difference between the studied periods. Smoking and omitted antibiotic prophylaxis significantly increased the risk of postoperative infection. Logistic regression analyses showed that patient male gender and suffering from a disease were predictive factors for the clinician to adhere to the guidelines. CONCLUSIONS: After introduction of national recommendations for antibiotic prophylaxis before bone augmentation procedures, the patient group receiving a single preoperative dose decreased while the group not given antibiotic prophylaxis increased. There was no difference in occurrence of postoperative infections between the two time periods. The results indicate a need for educational efforts and strategies for implementation of antibiotic prudence and awareness among surgeons performing bone augmentation procedures.

Association of maternal and paternal psychosocial stress and infant hair cortisol among Arab American immigrants: A pilot study.

Acculturative stress is unique among immigrants and refers to the stress associated with maintaining cultural values and traditions in the host country. Immigrant parents confront psychosocial variables such as acculturative stress, anxiety, and depression that might result in intergenerational negative consequences on their infants. Measurement of hair cortisol concentration (HCC), an outcome of neuroendocrine dysregulation, is one relatively noninvasive approach to gauge stress in infants. No published studies have evaluated associations among parents' psychosocial variables and infants' HCC among immigrant families. Therefore, the purpose of this study was to: (1) examine the relationship between maternal and paternal psychosocial stress variables; and (2) examine the association between psychosocial variables of both parents (acculturative stress, anxiety, and depression) and infants' HCC among immigrant Arab American families. A sample of 31 immigrant Arab American triads (mother-father-infant) was recruited. During one home visit, each parent completed the study questionnaires separately when the baby was 6-24 months old and a hair sample was collected from the infant for HCC. Parents reported significant symptoms of anxiety (33% mothers; 45% fathers) and depression (33% mothers; 35.5% fathers). Paternal acculturative stress, anxiety, and depressive symptoms were significantly correlated to infants' HCC. Acculturative stress, anxiety, and depressive symptoms were significantly correlated between mother-father dyads. Future research should continue to focus on immigrant families and include both parents to better understand and improve infant health.

Antibiotic utilization in emergency dental care in Stockholm 2016: a cross sectional study.

OBJECTIVES: To investigate systemic antibiotics utilization in emergency dental care and to determine the most common treatment measures performed during emergency visits in public versus private emergency care in Sweden. MATERIAL AND METHODS: Two questionnaires were answered by dentists at one large public and one large private emergency dental clinic in Stockholm, Sweden. The first questionnaire pertained to the emergency care provided to patients (n = 1023) and the second concerned the dentists' (n = 13) own knowledge and attitudes towards antibiotic treatment and oral infections. The results of the questionnaires were tested using a Chi-square test. RESULTS: Sixteen percent of all patients seeking emergency dental treatment received antibiotics. The most common overall reason for visiting an emergency clinic was pain (52%, n = 519). The most common diagnoses made by the participating dentists in the public clinic were tooth/filling fracture (17%, n = 91) and gingivitis (14%, n = 76), while in the private clinic they were tooth fracture (29%, n = 146) and symptomatic apical periodontitis (15%, n = 72). Although the number of patients with infection was higher in the public care clinic, there was no significant difference in total number of antibiotic prescriptions between the two clinics. The rate of patients receiving antibiotic prescription as sole treatment was 41% (n = 34) in private care and 31% (n = 18) in public care. Thirty-one percent (n = 4) of dentists prescribed antibiotics for patients with diagnoses normally not requiring antibiotics, citing reasons such as time limitation, patient request, patient travel, patient safety, and follow-up not possible. CONCLUSION: Although antibiotic prescription frequency among the Swedish emergency care dentists participating in this study was low, areas for improvement could include providing education to improve dentists' knowledge on both antibiotic prescription in emergency dental care and treatment of acute oral infections.

Long-term follow-up of children with neuroblastoma receiving radiotherapy to metastatic lesions within the German Neuroblastoma Trials NB97 and NB 2004.

PURPOSE: Neuroblastoma (NB) is the most common extracranial solid malignancy during childhood. Despite a multimodal treatment approach, the prognosis of patients with metastatic NB is not satisfactory. Although radiotherapy (RT) has become an integral part of treatment of the primary tumor, the role of RT in osteomedullary lesions is not well defined. A retrospective analysis was conducted to evaluate the impact of RT for metastatic sites in children with high-risk NB. METHODS: All patients with stage 4 NB from the prospective, multicenter NB trials NB97 and NB2004 who received RT to metastatic sites during frontline treatment were included in this retrospective analysis. RESULTS: A total of 18 children were irradiated with a median dose of 36 Gray (Gy; range 20-45 Gy) to one or more (range 1-3) osteomedullary metastases with or without concomitant RT to the primary tumor site. The median follow-up time was 149 months (range 55-220) in survivors. At 5 years, local relapse-free survival (LRFS) at irradiated metastatic sites and metastases-free survival (MFS) at distant, non-irradiated site rates were 51.4 and 39.9%, respectively. The estimated overall survival (OS) rate at 5 years was 49.4%. No high-grade acute or late toxicity and no secondary malignancy was reported. CONCLUSION: RT to metastases is feasible for patients with stage 4 NB. However, an impact of RT to residual metastatic sites on outcome was not found. Studies with larger cohorts or prospective trials would be desirable in order to elucidate the role of RT for metastases.

Prophylactic antibiotics for staged bone augmentation in implant dentistry.

Background: The objective of the study was to assess the effect of prophylactic antibiotics on the outcome of bone augmentation and subsequent dental implant placement by combining the recommended quality assessment methods for systematic reviews and primary studies.Materials and methods: This is a complex systematic review in which systematic reviews as well as primary studies are scrutinised. A search of Medline (OVID), The Cochrane Library (Wiley) and EMBASE, PubMed and Health technology assessment (HTA) organisations as-well as a complementary hand-search was carried out. Selected primary studies were assessed using GRADE. Each study was reviewed by three authors independently.Results: Abstract screening yielded six potential systematic reviews allocated for full-text inspection. A total of ten primary studies were read in full-text. No relevant systematic reviews regarding the topic of this article were found. The quality assessment resulted in two primary studies with a moderate risk of bias. Of the two studies with a moderate risk of bias, one compared a single dose of clindamycin 600 mg preoperatively with the same preoperative dose followed by four doses of 300 mg every 6 h. The second study compared a single dose prophylaxis of two different types of antibiotic compounds.Conclusion: In conclusion, the scientific evidence regarding the use of antibiotic prophylaxis for reducing the risk of infection in conjunction with bone augmentation procedures during dental implant placement is very limited. The infection rate as compared to nonusage of prophylactic antibiotics, selection of the most suitable compound, and the optimal duration of prophylactic treatment is still unknown.

Acculturative stress and lack of social support predict postpartum depression among U.S. immigrant women of Arabic descent.

PURPOSE: To examine the relationships among acculturative stress, social support, and postpartum depression (PPD) symptoms among U.S. immigrant women of Arabic descent; and to examine if social support moderates the associations between acculturative stress and PPD symptoms. METHODS: Using a cross-sectional design, a sample of 115 U.S. immigrant women of Arabic descent, all between 1 and 12 months postpartum, were enrolled from clinics in Dearborn, MI. Data were analyzed using correlational and multiple linear regression. RESULTS: Women had a mean age of 29 ±â€¯5 years and were 5 ±â€¯4 months postpartum. Women had been in the U.S. for 7 ±â€¯6 years and had a mean education of 12 ±â€¯4 years. The majority had an annual household income of <$40,000 (88%), were unemployed (80%), and preferred Arabic language for interview (68%). Higher levels of acculturative stress, higher levels of education, antenatal anxiety, and lower levels of social support predicted PPD symptoms (all significant at p < .05). The moderating effect of social support on the association between acculturative stress and PPD symptoms was not supported. CONCLUSIONS: Acculturative stress, lack of social support, higher level of education, and antenatal anxiety predicted PPD symptoms. Future research is needed to examine acculturative stress among immigrant women in different U.S. SETTINGS: Longitudinal studies and utilizing diagnostic assessments of PPD is highly recommended. Nurses need to screen immigrant women of Arabic descent for anxiety and depression during antenatal visits and develop evidence-based interventions targeted to improve mental health during pregnancy and postpartum.

FLT3-ligand treatment of humanized mice results in the generation of large numbers of CD141+ and CD1c+ dendritic cells in vivo.

We established a humanized mouse model incorporating FLT3-ligand (FLT3-L) administration after hematopoietic cell reconstitution to investigate expansion, phenotype, and function of human dendritic cells (DC). FLT3-L increased numbers of human CD141(+) DC, CD1c(+) DC, and, to a lesser extent, plasmacytoid DC (pDC) in the blood, spleen, and bone marrow of humanized mice. CD1c(+) DC and CD141(+) DC subsets were expanded to a similar degree in blood and spleen, with a bias toward expansion of the CD1c(+) DC subset in the bone marrow. Importantly, the human DC subsets generated after FLT3-L treatment of humanized mice are phenotypically and functionally similar to their human blood counterparts. CD141(+) DC in humanized mice express C-type lectin-like receptor 9A, XCR1, CADM1, and TLR3 but lack TLR4 and TLR9. They are major producers of IFN-λ in response to polyinosinic-polycytidylic acid but are similar to CD1c(+) DC in their capacity to produce IL-12p70. Although all DC subsets in humanized mice are efficient at presenting peptide to CD8(+) T cells, CD141(+) DC are superior in their capacity to cross-present protein Ag to CD8(+) T cells following activation with polyinosinic-polycytidylic acid. CD141(+) DC can be targeted in vivo following injection of Abs against human DEC-205 or C-type lectin-like receptor 9A. This model provides a feasible and practical approach to dissect the function of human CD141(+) and CD1c(+) DC and evaluate adjuvants and DC-targeting strategies in vivo.

Antibiotic prescription patterns among Swedish dentists working with dental implant surgery: adherence to recommendations.

OBJECTIVES: To investigate antibiotic prophylaxis prescription behaviors among Swedish dentists working with dental implant surgery and the influence of scientific reviews. MATERIAL AND METHODS: An observational questionnaire study was conducted in 2008 and 2012. Dental clinic addresses were found through online search services of Swedish telephone directories. The questionnaires were posted to eligible dentists (120 in 2008, 161 in 2012) in the Stockholm region, Sweden. Absolute frequencies were used to describe the data. Chi-square tests were applied to assess statistically significant differences. RESULTS: The response rate was 75% in 2008 and 88% in 2012. In 2008, 88% of the dentists routinely prescribed antibiotic prophylaxis when performing implant surgery and 74% in 2012 (P = 0.01). There was a significant reduction in the dentists prescription patterns as 65% prescribed a single dose in 2012, compared to 49% in 2008 (P = 0.04). Amoxicillin was the drug of choice for 47% of the respondents in 2012, and 21% in 2008 (P = 0.01). Dentists without postgraduate clinical training were significantly more prone to extend antibiotic administration after surgery (P < 0.009). CONCLUSIONS: There is a wide variation in the choice of compound and prescription patterns of prophylactic antibiotic prior to implant insertion. A reduction in antibiotic prescription to a single dose was observed comparing 2008 and 2012, probably influenced by scientific reviews. Dentists with postgraduate education are more likely to limit antibiotic usage.

A phase 1b study of placenta-derived mesenchymal stromal cells in patients with idiopathic pulmonary fibrosis.

BACKGROUND AND OBJECTIVE: Idiopathic pulmonary fibrosis (IPF) is a degenerative disease characterized by fibrosis following failed epithelial repair. Mesenchymal stromal cells (MSC), a key component of the stem cell niche in bone marrow and possibly other organs including lung, have been shown to enhance epithelial repair and are effective in preclinical models of inflammation-induced pulmonary fibrosis, but may be profibrotic in some circumstances. METHODS: In this single centre, non-randomized, dose escalation phase 1b trial, patients with moderately severe IPF (diffusing capacity for carbon monoxide (DLCO ) ≥ 25% and forced vital capacity (FVC) ≥ 50%) received either 1 × 10(6) (n = 4) or 2 × 10(6) (n = 4) unrelated-donor, placenta-derived MSC/kg via a peripheral vein and were followed for 6 months with lung function (FVC and DLCO ), 6-min walk distance (6MWD) and computed tomography (CT) chest. RESULTS: Eight patients (4 female, aged 63.5 (57-75) years) with median (interquartile range) FVC 60 (52.5-74.5)% and DLCO 34.5 (29.5-40)% predicted were treated. Both dose schedules were well tolerated with only minor and transient acute adverse effects. MSC infusion was associated with a transient (1% (0-2%)) fall in SaO2 after 15 min, but no changes in haemodynamics. At 6 months FVC, DLCO , 6MWD and CT fibrosis score were unchanged compared with baseline. There was no evidence of worsening fibrosis. CONCLUSIONS: Intravenous MSC administration is feasible and has a good short-term safety profile in patients with moderately severe IPF.

Uncertainties in ocular proton planning and their impact on required margins.

PURPOSE: To review required margins in ocular proton therapy (OPT) based on an uncertainty estimation and to compare them with widely used values. Further, uncertainties when using registered funduscopy images in the 3D model is investigated. METHODS: An uncertainty budget in planning and delivery was defined to determine required aperture and range margins. Setup uncertainties were considered for a cohort of treated patients and tested in a worst-case estimation. Other uncertainties were based on a best-guess and knowledge of institutional specifics, e.g. range reproducibility. Margins for funduscopy registration were defined resulting from scaling, rotation and translation of the image. Image formation for a wide-field fundus camera was reviewed and compared to the projection employed in treatment planning systems. RESULTS: Values for aperture and range with margins of 2.5 mm as reported in literature could be determined. Aperture margins appear appropriate for setup uncertainties below 0.5 mm, but depend on lateral penumbra. Range margins depend on depth and associated density uncertainty in tissue. Registration of funduscopy images may require margins of >2 mm, increasing towards the equator. Difference in the projection may lead to discrepancies of several mm. CONCLUSIONS: The commonly used 2.5 mm aperture margin was validated as an appropriate choice, while range margins could be reduced for lower ranges. Margins may however not include uncertainties in contouring and possible microscopic spread. If a target base is contoured on registered funduscopy images care must be taken as they are subject to larger uncertainties. Multimodal imaging approach in OPT remains advisable.

Outcome After Modern Proton Beam Therapy in Childhood Craniopharyngioma: Results of the Prospective Registry Study KiProReg.

PURPOSE: Craniopharyngiomas (CPs) are rare tumors of the sellar region often leading to significant comorbidities due to their close proximity to critical structures. The aim of this study was to analyze survival outcome and late toxicities after surgery and proton beam therapy (PBT) in childhood CPs. METHODS AND MATERIALS: Within the prospective registry study "KiProReg" (DRKS0000536), data of 74 childhood patients with CP, receiving PBT between August 2013 to June 2022 were eligible. Late toxicities were analyzed according to the grading system of the Common Terminology Criteria for Adverse Events, version 4.0. RESULTS: Median follow-up since first diagnosis was 4.3 years (range, 0.8-14.7). In addition, 75.7% of patients received PBT at time of disease progression or recurrence, whereas 24.3% as part of their primary therapy (definitive or adjuvant). Predominantly (85.1%), pencil beam scanning technique was used. The median total dose and initial tumor volume were 5400 cGy relative biologic effectiveness (RBE) and 17.64 cm³ (range, 3.07-300.59), respectively. The estimated (±SE) 3-year overall survival, progression-free, and cystic failure-free survival rate after PBT were 98.2% (±1.7), 94.7% (±3.0), and 76.8% (±5.4), respectively. All local failures (n = 3) were in-field relapses necessitating intervention and occurred exclusively in patients receiving PBT at progression or recurrence. Early cystic enlargements after PBT were typically asymptomatic and self-limiting. Fatigue, headaches, vision disorders, obesity, and endocrinopathies were the predominant late toxicities. No high-grade (≥3) new-onset visual impairment or cognitive deterioration occurred compared with baseline. The presence of cognitive impairments at the end of follow-up correlated with size of the planning target volume (P = .034), Dmean dose to the temporal lobes (P = .032, P = .045) and the number of surgical interventions before PBT (P = .029). CONCLUSIONS: Our findings demonstrate favorable local control rates using modern PBT with acceptable late toxicities. Cyst growth within 12 months after radiation therapy is typically not associated with tumor progression. Longer follow-up must be awaited to confirm results.

Myeloma-induced alloreactive T cells arising in myeloma-infiltrated bones include double-positive CD8+CD4+ T cells: evidence from myeloma-bearing mouse model.

The graft-versus-myeloma (GVM) effect represents a powerful form of immune attack exerted by alloreactive T cells against multiple myeloma cells, which leads to clinical responses in multiple myeloma transplant recipients. Whether myeloma cells are themselves able to induce alloreactive T cells capable of the GVM effect is not defined. Using adoptive transfer of T naive cells into myeloma-bearing mice (established by transplantation of human RPMI8226-TGL myeloma cells into CD122(+) cell-depleted NOD/SCID hosts), we found that myeloma cells induced alloreactive T cells that suppressed myeloma growth and prolonged survival of T cell recipients. Myeloma-induced alloreactive T cells arising in the myeloma-infiltrated bones exerted cytotoxic activity against resident myeloma cells, but limited activity against control myeloma cells obtained from myeloma-bearing mice that did not receive T naive cells. These myeloma-induced alloreactive T cells were derived through multiple CD8(+) T cell divisions and enriched in double-positive (DP) T cells coexpressing the CD8αα and CD4 coreceptors. MHC class I expression on myeloma cells and contact with T cells were required for CD8(+) T cell divisions and DP-T cell development. DP-T cells present in myeloma-infiltrated bones contained a higher proportion of cells expressing cytotoxic mediators IFN-γ and/or perforin compared with single-positive CD8(+) T cells, acquired the capacity to degranulate as measured by CD107 expression, and contributed to an elevated perforin level seen in the myeloma-infiltrated bones. These observations suggest that myeloma-induced alloreactive T cells arising in myeloma-infiltrated bones are enriched with DP-T cells equipped with cytotoxic effector functions that are likely to be involved in the GVM effect.

Practical approaches to conducting biopsychosocial research with refugee and internally displaced communities.

Refugees and internally displaced people comprise one percent of the world population. Forced migration involves a multitude of ongoing stressful and traumatic experiences, often resulting in lasting psychological symptoms for people resettling as refugees. Despite these risks, the underrepresentation of refugee populations in research-particularly in biological sciences-has impeded the allocation of effective resources and the development of novel interventions for these groups. This paper identifies and addresses key methodological challenges to successfully and appropriately conducting research with refugee and internally displaced communities, many of which have served as barriers to improving research representation for these populations. Methodological challenges discussed include language and literacy barriers; political fears; differing cultural dynamics between participants and researchers; and others. We provide practical recommendations for overcoming each challenge, often sourced from our experience conducting multi-year studies and interventions in refugee mental health. Several key strategies include the recruitment of researchers and research assistants from similar cultural and linguistic backgrounds as participants; providing detailed, ongoing communication about informed consent; avoiding assumptions regarding participants' understanding of concepts that may vary based on culture or experience (e.g., "voluntary" research; confidentiality); and adopting flexible data collection procedures compatible with participants' needs and restrictions. Finally, we discuss the role of the researcher in regard to cultural competencies and partnering with the refugee community. Given the increasing global population of refugees, the strategies discussed in this paper are suggested in order to encourage future research in this underrepresented population and empower investigators to logistically carry out studies with refugees.

Perceived adversity and psychological distress in refugee married couples resettling in the United States.

BACKGROUND: Syrian and Iraqi refugees are a growing segment of the U.S. population, and although exposure to war and violence has been linked to psychological distress in individual refugees, few studies have examined the distress in married couples. METHODS: Using a cross-sectional design, a convenience sample of 101 Syrian and Iraqi refugee couples was recruited from a community agency. The purpose of this study was to (1) examine the relationships between perceived adversity and psychological distress (PTSD, anxiety, and depressive symptoms) among individual study participants; and (2) determine whether these relationships were correlated to their spouses' perceived adversity and psychological distress. RESULTS: The bivariate correlation analysis showed strong positive correlations between PTSD and depression/anxiety for wives (r = .79; p < .001) and for husbands (r = .74; p < .001). There were also low- to mid-range positive cross-associations between husbands' and wives' PTSD (r = .34; p = .001) and depression/anxiety (r = .43; p < .001). Finally, we found a significant positive association between husbands' and wives' perception of adversity (r = .44; p < .001). Interestingly, the husbands' perception of adversity was positively associated with their PTSD (r = .30; p = .02) and depression/ anxiety scores (r = .26; p = .04) as well as with their wives' depression/ anxiety scores (r = .23; p = .08). In contrast, the wives' perception of adversity was not associated with either their own or their spouses' psychological distress. CONCLUSION: Our findings suggest that war, trauma, and stress of migration impact the couple as a unit, possibly due to shared experiences, and the impact of one partner's stress on the other. Addressing these perceptions and personal interpretations of the adverse experiences via cognitive therapy approaches could help reduce not only stress in the individual but also that of their partner.

Metabolic profile in first episode drug naïve patients with psychosis and its relation to cognitive functions and social cognition: a case control study.

1st episode drug naïve patients with psychosis might be at higher risk for cardiometabolic disturbances which could affect the different cognitive, and executive functions and domains of social cognition. This study aimed to study the metabolic parameters in 1st episode drug naïve patients with psychosis, to evaluate the relation of these cardiometabolic domains to the cognitive, executive functions, and social cognition. Socio-demographic characteristics of 150 first episode drug naïve patients with psychosis and 120 matched healthy control groups were collected. The current study also assessed the cardiometabolic profile and cognitive functions in both groups. Social cognition was examined by Edinburgh Social Cognition Test. The study revealed a statistically significant difference in parameters of metabolic profile among the studied groups (p < 0.001*), the scores of cognitive and executive tests were statistically significantly different (p < 0.001*). In addition, the patient's group has lowered scores of domains of social cognition (p < 0.001*). Also, the mean affective theory of mind was negatively correlated with the conflict cost of the Flanker test (r = -.185* p value = .023). The total cholesterol level (r = - 0.241**, p value = .003) and level of triglycerides (r = - 0.241**, p value = 0.003) were negatively correlated with the interpersonal domain of social cognition, the total cholesterol level is positively correlated to the total score of social cognition (r = 0.202*, p value = 0.013). Patients with 1st episode drug naïve psychosis showed disturbed cardiometabolic parameters which have deleterious effects on cognitive functions and social cognition.

Applicator-guided proton therapy versus multichannel brachytherapy for vaginal vault irradiation.

To dosimetrically compare applicator-guided intensity-modulated proton therapy (IMPT) and multichannel brachytherapy (MC-BRT) for vaginal vault irradiation (VVI) with special focus on dose to organs at risk (OARs) and normal tissues. Ten patients with uterine confined endometrial cancer who received adjuvant vaginal cuff brachytherapy were included in this study. For each patient an additional IMPT treatment plan was created using the same computed tomography dataset and contours segmented for MC-BRT plans. Clinical target volume (CTV) was defined as the proximal 3.5 cm of the vagina including the entire thickness of vaginal wall. Planning target volume for IMPT plans was generated from the CTV with an addition isotropic 3 mm margin. OARs included rectum, bladder, sigmoid, small bowel and femoral heads. The prescribed dose was 21 Gy in 3 fractions. For simplicity, all doses were expressed in Gy and a constant relative biological effectiveness of 1.1 was used for IMPT plans. Plan comparison was performed using dose-volume histogram and treatment planning parameters. A significant improvement of the D98% coverage for CTV was reached by the applicator-guided IMPT plans (p < 0.01). IMPT also provided a dose reduction in all OARs except for femoral heads due to the lateral beam direction, especially significant reduction of V5Gy, D2cc, D0.1 cc, Dmean, V95% values for the rectum and Dmean, D0.1 cc to bladder, sigmoid, small bowel. Additionally, IMPT plans showed a significant reduction of integral dose to normal tissue with respect to MC-BRT (221.5 cGy.L vs. 653.6 cGy.L, p < 0.01). Applicator-guided IMPT has the potential for improving plan quality in VVI while maintaining the high conformity afforded by the state-of-the-art intracavitary brachytherapy.

Psychosocial Factors and Telomere Length Among Parents and Infants of Immigrant Arab American Families.

Background: Immigrant Arab American families face multiple stressors related to migration and resettlement. Telomere length (TL) is an established biomarker of aging and psychosocial stress. No published studies have concurrently examined the association between maternal and paternal psychosocial factors and infants' TL. The purpose of this study was to: (1) compare mother, father, and infant TLs; (2) explore the association of maternal and paternal psychosocial factors (acculturative stress and depressive symptoms) with maternal and paternal TL; and (3) explore the association of maternal and paternal psychosocial factors with infants' TL among Arab American immigrants. Method: Using a cross-sectional exploratory design, a sample of 52 immigrant Arab American mother-father-infant triads were recruited from community centers. Data were collected in a single home visit when the infant was 6-24 months old. Each parent completed the study questionnaires addressing their psychosocial factors (acculturative stress, and depressive symptoms), then parents and infants provided buccal cell for TL measurement. Results: Maternal TL was positively correlated to infants' TL (r = .31, p = .04) and significantly shorter (p < .001). Paternal TL was not correlated with infant TL but was significantly shorter than infant's TL (p < .001). Maternal depression was significantly correlated with mothers' TL (r = .4, p = .007). Higher levels of maternal depressive symptoms were significantly associated with shorter infant TL when controlling for background characteristics. Conclusions: Our pilot study is the first study to examine maternal and paternal psychosocial factors related to migration and infants' TL. More research is needed to advance our understanding of the effects of immigration on the intergenerational transfer of stress and trauma.

Is an Endorectal Balloon Beneficial for Rectal Sparing after Spacer Implantation in Prostate Cancer Patients Treated with Hypofractionated Intensity-Modulated Proton Beam Therapy? A Dosimetric and Radiobiological Comparison Study.

BACKGROUND: The aim of this study is to examine the dosimetric influence of endorectal balloons (ERB) on rectal sparing in prostate cancer patients with implanted hydrogel rectum spacers treated with dose-escalated or hypofractionated intensity-modulated proton beam therapy (IMPT). METHODS: Ten patients with localized prostate cancer included in the ProRegPros study and treated at our center were investigated. All patients underwent placement of hydrogel rectum spacers before planning. Two planning CTs (with and without 120 cm3 fluid-filled ERB) were applied for each patient. Dose prescription was set according to the h strategy, with 72 Gray (Gy)/2.4 Gy/5× weekly to prostate + 1 cm of the seminal vesicle, and 60 Gy/2 Gy/5× weekly to prostate + 2 cm of the seminal vesicle. Planning with two laterally opposed IMPT beams was performed in both CTs. Rectal dosimetry values including dose-volume statistics and normal tissue complication probability (NTCP) were compared for both plans (non-ERB plans vs. ERB plans). RESULTS: For ERB plans compared with non-ERB, the reductions were 8.51 ± 5.25 Gy (RBE) (p = 0.000) and 15.76 ± 11.11 Gy (p = 0.001) for the mean and the median rectal doses, respectively. No significant reductions in rectal volumes were found after high dose levels. The use of ERB resulted in significant reduction in rectal volume after receiving 50 Gy (RBE), 40 Gy (RBE), 30 Gy (RBE), 20 Gy (RBE), and 10 Gy (RBE) with p values of 0.034, 0.008, 0.003, 0.001, and 0.001, respectively. No differences between ERB and non-ERB plans for the anterior rectum were observed. ERB reduced posterior rectal volumes in patients who received 30 Gy (RBE), 20 Gy (RBE), or 10 Gy (RBE), with p values of 0.019, 0.003, and 0.001, respectively. According to the NTCP models, no significant reductions were observed in mean or median rectal toxicity (late rectal bleeding ≥ 2, necrosis or stenosis, and late rectal toxicity ≥ 3) when using the ERB. CONCLUSION: ERB reduced rectal volumes exposed to intermediate or low dose levels. However, no significant reduction in rectal volume was observed in patients receiving high or intermediate doses. There was no benefit and also no disadvantage associated with the use of ERB for late rectal toxicity, according to available NTCP models.

Acculturative Stress and Postpartum Depressive Symptoms among Immigrant Arab American Couples.

PURPOSE: The purpose of this study was to examine the relationships between acculturative stress, perceived stress, social support, and postpartum depression (PPD) symptoms among immigrant Arab American couples. METHODS: Using a cross-sectional design, 30 Arab American immigrant couples were enrolled. During home visits, couples completed the demographic information, the Multi-Dimensional Acculturative Stress Inventory, Perceived Stress, the Multidimensional Scale of Perceived Social Support among Arab Women, and the Edinburgh Postnatal Depression Scale. Data were analyzed using bivariate linear regression and Pearson correlation. RESULTS: In bivariate regressions, paternal and maternal acculturative stress was moderately associated with maternal PPD symptoms (r = .39, and .46, respectively; p < .05). Maternal perceived stress (r = .70, P < .01) was strongly associated with PPD and maternal perceived social support was moderately associated with PPD (r = -.42, p < .05). Maternal and paternal acculturative stress was strongly correlated (r = .61, p < .001). CONCLUSION: Couple's acculturative stress and mother's perceived stress were positively associated with mother's PPD symptoms. Our findings suggest the need to develop a culturally appropriate procedure to assess couple's stress that may affect immigrant women at high risk for PPD.