Second malignancies in patients treated for Ewing sarcoma: A systematic review.

The therapies used to treat Ewing sarcoma are associated with a risk of second malignant neoplasm (SMN). We conducted a systematic review to pool available evidence on the risks, types, and outcomes after SMN. We obtained 52 articles that met inclusion criteria. Cumulative incidence rates of SMN ranged from 0.9 to 8.4% and 10.1 to 20.5% at 5 and 30 years after initial diagnosis. Of the 327 reported SMNs, 63.6% were solid tumors, although acute myeloid leukemia /myelodysplastic syndrome was the single most commonly diagnosed SMN, with generally poor outcomes. Patients treated for Ewing sarcoma are at substantial risk of SMN, with a broad range of reported secondary cancers.

School Violence Exposure as an Adverse Childhood Experience: Protocol for a Nationwide Study of Secondary Public Schools.

BACKGROUND: Poor mental health and adverse childhood experiences (ACEs) predict extensive adverse outcomes in youth, including increases in long-term risk for chronic disease and injury, impaired emotional development, and poor academic outcomes. Exposure to school violence, specifically intentional gun violence, is an increasingly prevalent ACE. The anticipation of school shootings has led to the implementation of school safety and security interventions that may increase anxiety, depression, and other indicators of poor mental well-being among students and staff alike. Despite this, the association between exposure to existing school safety interventions and early adolescent student mental health outcomes, while accounting for one's history of ACEs, has not been previously investigated. OBJECTIVE: The study protocol described here aims to determine whether there is a significant difference in the prevalence of mental health outcomes, perceived school safety, and academic engagement between adolescent students (grades 6-12) at schools who have experienced a school shooting and those who have not; whether existing interventions to promote school safety and security are associated with poor mental health outcomes among students and school staff; and what the strength of the association between school safety interventions and mental health outcomes among students and teachers is in schools that have experienced a school shooting versus schools that have never experienced a school shooting. METHODS: This observational study will collect cross-sectional survey data from a nationwide sample of students, teachers, and principals at 12 secondary public schools across the United States. The participants come from 6 randomly selected exposure schools that have either experienced a recent (<2 years ago) intentional school shooting or have experienced an intentional school shooting less recently (>2 years ago). Data from these schools are being directly compared with 6 secondary schools that have never experienced a school shooting. RESULTS: Institutional review board approval for this research project was obtained and the study subsequently began its recruitment and data collection phase in January 2024. Data collection is currently ongoing and the expected completion date is January 2025. The analytic plan is designed to determine if the strength of the association between school safety interventions and mental health outcomes differs among students and school staff in schools with varying levels of school violence exposure. Analyses will be used to evaluate the role of ACEs on the relationships among exposure to an intentional school shooting, exposure to school safety strategies, and student outcomes (ie, mental health and well-being, perceptions of school safety, and educational outcomes). CONCLUSIONS: The results from this study promise to generate meaningful and novel findings on the extent to which having a prior history of ACEs moderates the relationships among exposure to intentional school gun violence, school safety strategies, and student outcomes (ie, mental health and well-being, and perceptions of school safety). TRIAL REGISTRATION: ClinicalTrials.gov NCT06153316; https://clinicaltrials.gov/study/NCT06153316. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56249.

Uncovering gaps in management of vasomotor symptoms: findings from a national need assessment.

CONTEXT: This national needs assessment study explores the knowledge, attitude, beliefs, and practices (KABP) gaps related to vasomotor symptoms (VMS) associated with menopause among primary care and OB/GYN clinicians. VMS significantly impacts healthcare costs, workplace productivity, and patient psychosocial health, but a notable disconnect exists between healthcare providers and patients, with provider reticence and knowledge gaps playing a contributing role. OBJECTIVES: This study aims to identify and propose optimal educational strategies to address these barriers, with attention to health disparities affecting women of color. METHODS: Methods employed include a multimodal approach of literature review, expert opinion, qualitative interviews, surveys, focus groups, and case studies, ensuring diverse clinician input. Data collection involved in-depth clinician interviews, a nationally disseminated clinician survey, and focus groups. RESULTS: Results indicate a critical deficiency in healthcare providers' understanding and management of VMS, especially among OB/GYN residents, with 75 % showing limited knowledge. The study also highlights the disproportionate impact of knowledge gaps on women of color, emphasizing the need for a culturally informed approach in medical training and practice. There's a notable discrepancy between clinicians' current and desired abilities in managing VMS, indicating a need for ongoing professional development. Significant variability in approaches to diagnosing and treating VMS, as well as substantial knowledge gaps about treatment options, underscore the need for evidence-based protocols. CONCLUSIONS: Although VMS are a normal aspect of aging, they can significantly disrupt quality of life for many women, necessitating intervention. Beyond the immediate discomfort, VMS can impact quality of life and trigger insomnia and mood disturbances. This study exposes both new and previously recognized gaps in healthcare providers' knowledge and management skills concerning VMS treatment options, particularly regarding hormonal and nonhormonal therapies. Furthermore, our findings highlight the need for a deeper understanding of how VMS uniquely impacts women of diverse backgrounds. Research, including the Study of Women's Health Across the Nation (SWAN), suggests that the experience and severity of VMS may be influenced by socioeconomic status, race/ethnicity, body mass index (BMI), and smoking status. However, the complex interplay of these factors and their relative contributions remain unclear. Further investigation is crucial to facilitate equitable access to effective treatment for all women. To bridge these gaps, improved education starting as early as residency is essential. This education should address common misconceptions about VMS and its management. Healthcare providers must enhance their competence in discussing the broad spectrum of VMS impacts and employ effective communication strategies to ensure that patients are well-informed about their symptoms and available treatment options.