Grand Prince of Vladimir Vsevolod the Big Nest and his wife Maria Vsevolozha (Shvarnovna) had twelve children, eight of whom were sons; Grand Prince Alexander Yaroslavich Nevsky was their grandson. Two competing hypotheses exist regarding the origin of Maria Vsevolozha, attributing it to either Ossetian or Czech nobility. Maria Shvarnovna was buried in the Knyaginin Monastery in Vladimir, Russia. Although her remains were reinterred several times, they were never moved from the original burial location. During the 2015 restoration works, skeletal remains, presumably belonging to Maria Shvarnovna, were sampled for paleogenetic analysis in order to determine their origin. More than 144,000 single nucleotide polymorphisms (SNPs) were identified. Their analysis demonstrated that the remains belong to a female carrying mitochondrial haplogroup U4b1a4 and unambiguously confirmed a third-degree biological relationship (great-grandmother-great-grandson) with Prince Dmitry Alexandrovich, the son of Grand Prince Alexander Yaroslavich Nevsky. This result fully corresponds to the genealogical relationships described in medieval chronicles. A multivariate statistical analysis of the genome revealed the two most probable proximal genetic sources of her origin: an Alan component, understood here in a broad cultural-historical sense encompassing populations of the Early and High Middle Ages, and an East Eurasian component. Among medieval populations, the genome of Maria Shvarnovna shows the closest genetic affinity to individuals associated with the SaltovoMayaki archaeological culture, characteristic of the Don forest-steppe region and resulting from the migration of Alan tribes, as well as to individuals from the Kara-Zhygach necropolis (14th century), whose genomes also consist of a dominant Alan and a minor East Eurasian component. Not only do the findings support the Alan hypothesis and reject the Czech origin of Maria Shvarnovna, but they also allow one to confidently assert the reliable genetic identification of early representatives of the Rurikid princely dynasty due to the confirmed biological relationship with her great-grandson Dmitry Alexandrovich.
Japanese spotted fever (JSF) is an increasingly reported tick-borne disease in Japan. Although person-to-person transmission has not been documented, familial clusters have rarely been reported. We report two cases of JSF in a married couple in their 70s who developed symptoms one week apart after shared weeding activities. The wife presented with the classic triad of fever, rash, and eschar, whereas the husband presented with fever and rash but no identifiable eschar, creating a diagnostic challenge. Following confirmation of JSF in the wife, a skin biopsy specimen and blood samples were obtained from the husband, and the diagnosis was confirmed by polymerase chain reaction. We reviewed all previously reported familial JSF clusters in Japan and identified 11 patients from five families. Including the present two patients, a total of 13 familial cases were analyzed. Fever was observed in all 13 patients (100%), rash in 12 (92.3%), and eschar in seven (53.8%). The median interval between symptom onset among family members was five days (range = 0-10 days). Among five index cases, four experienced treatment initiation ≥6 days after symptom onset or received no effective JSF-directed therapy, whereas five of six subsequent cases received treatment within five days. Both fatal cases occurred among index patients. In familial JSF clusters, symptom onset may be staggered despite shared environmental exposure, and eschars may be absent in nearly half of patients. Recognition of an index case may facilitate earlier diagnosis and treatment of subsequently affected family members. Clinicians should consider JSF in patients presenting with unexplained fever and rash, even in the absence of an eschar, and obtain a detailed history regarding family illness, outdoor activities, and potential tick exposure.
To investigate the clinical phenotype and molecular pathogenesis of a hereditary hemochromatosis family with double-site mutations in SLC40A1 . High-throughput exome sequencing was performed to screen for gene mutations, and Sanger sequencing was used to validate the suspected mutations in SLC40A1 . The pathogenicity of the variants was predicted using bioinformatics tools including PROVEAN, FATHMM, and MutPred2. The amino acid conservation was analyzed using Mega software, and the mutated protein models were simulated with PyMol software. The proband and his two twin daughters had significantly elevated serum ferritin levels, while his wife was normal. Genetic testing revealed that the proband and his two twin daughters had heterozygous missense mutations c.94C>T (p.His32Tyr) in exon 2 and c.431A>C (p.Asn144Thr) in exon 5 of SLC40A1 . The wife did not carry any mutations in the SLC40A1 gene. Bioinformatics analysis suggested that p.His32Tyr and p.Asn144Thr were pathogenic mutations, and the related amino acid sites were highly conserved across seven species. Protein modeling showed that the His32Tyr substitution caused the loss of the hydrogen bond between His32 and Asp181 and the formation of an additional hydrogen bond with Gln155, significantly affecting the protein's spatial conformation. The p.Asn144Thr mutation did not cause significant structural abnormalities in the protein. The missense mutations c.94C>T (p.His32Tyr) and c.431A>C (p.Asn144Thr) in SLC40A1 are likely responsible for the iron overload in the proband and may represent the genetic cause of primary hemochromatosis. 一个遗传性SLC40A1 双位点突变血色病家系的临床表型及分子致病机制研究. 探讨一个遗传性SLC40A1 双位点突变血色病家系的临床表型及分子致病机制。. 应用高通量外显子测序筛查全基因变异，Sanger测序验证SLC40A1 可疑变异；利用PROVEAN、FATHMM和MutPred2生物信息学软件预测变异致病性，Mega软件分析氨基酸保守性，PyMol软件模拟变异蛋白模型。. 先证者及其两个双胞胎女儿血清铁蛋白显著升高，而其妻子正常。基因检测显示先证者及其两个双胞胎女儿SLC40A1 第2号外显子存在c.94C>T（p.His32Tyr）杂合错义突变，第5号外显子存在c.431A>C（p.Asn144Thr）杂合错义突变，而其妻子无SLC40A1 基因 突变。生物信息学分析结果提示，p.His32Tyr和p.Asn144Thr为致病变异，相关的氨基酸位点在7个物种中高度保守。蛋白模拟显示，His32变异为Tyr32后导致与Asp181之间的氢键消失，并与Gln155之间形成额外氢键，严重影响蛋白质空间构象。p.Asn144Thr变异后并未对蛋白质空间结构造成明显改变。. SLC40A1 c.94C>T（p.His32Tyr）和c.431A>C（p.Asn144Thr）错义突变异可能导致了先证者铁过载，也是引起原发血色病的遗传学病因。.
The focus of the present study is to highlight and understand the effect of hysterectomy on physical, psychological, social and marital status among women aged under 40 years of age, in the cultural context of Pakistan DESIGN: The study used a qualitative phenomenological approach to explore the lived experiences of the women. The present study was conducted at Sheikh Zayed Hospital, a tertiary care public sector hospital located in Lahore, Pakistan. The participants of the study were women under 40 years of age who have undergone hysterectomy in the last 2 years. The data of such women were recruited from the hospital and were selected using pre-defined inclusion and exclusion criteria through purposive sampling. In-depth interviews were conducted with seven women, and data were analysed thematically. Four major themes and 12 sub-themes evolved during data analysis that included 1) physical and psychological effects (physical changes and recovery period, the tragedy of invisible loss of an organ and emotional distress and mood swings); 2) family and communal dynamics (reaction of in-laws, reaction of parents and siblings and reaction of friends and colleagues); 3) role fulfilment (wife and child bearer, sick role, professional role and domestic role) and 4) effects on marital life (relationship with husband and insecurity of the possibility of husband taking a second wife). The present study found that women who have undergone hysterectomy before the age of 40 years have adverse physical, psychological, social and marital effects in their lives due to lack of societal support and acceptance related to the anatomical procedure. These findings highlight the profound influence of socio-cultural expectations and familial dynamics on women's post-hysterectomy experiences, underscoring the need for greater awareness and sensitivity toward their physical and psychosocial well-being.
Reproductive and Child Health (RCH) is a crucial indicator of a country's development. Involvement of males in RCH services is often limited in India. Therefore, it is crucial to explore the role and involvement of men in maternal healthcare during pregnancy and childbirth. Hence present study was planned to assess the awareness and participation in RCH among married males in an urban area of Western Maharashtra and to find out socio-demographic factors associated with male participation in reproductive child health care. This cross-sectional study was conducted from September 2019 to October 2021 in an urban area of Western Maharashtra. Census data of all participants was available through family folders. Out of these, names of married men (<40 years) of age were selected, and numbers were allotted to each individual. A total of 393 married men were selected through systematic random sampling from a complete list of eligible participants. A pre-tested structured questionnaire assessed socio-demographic characteristics, knowledge, and participation in RCH care (antenatal, natal, postnatal care, immunization, and contraception). Data analysis was conducted using SPSS version 20. The mean age of respondents was 31 years, with a 98.4% literacy rate. 97% knew about contraception; 52.7% were currently using it. 85.5% showed moderate to high participation in RCH care. 84.7% of couples made joint decisions regarding family planning. Significant associations were found between male participation and education, wife's education, and number of children. Male involvement is essential for improving RCH outcomes. Education and joint decision-making emerge as critical factors influencing male participation. The study highlights the need for integrating men into reproductive health programs to improve health outcomes. Encouraging joint decision-making in reproductive and family health is a promising strategy for achieving maternal health goals.
In ethnic minority communities like in Vietnam, reproductive decision-making is shaped not only by access to services but by deeply rooted cultural and gender norms. A stark 'reproductive paradox' emerges, where high fertility is idealised yet unsafe abortion remains prevalent. This study explores how women, men and healthcare workers in Son La province perceive family planning and gender-based violence (GBV), with attention to the structural and symbolic forces that shape the reproductive autonomy of the women in the region. A qualitative study was conducted in March 2022 in Son La province, using semistructured interviews and three group discussions with 18 participants, including mothers, fathers, pregnant women and healthcare workers from both Kinh and Mong ethnic groups. Data were analysed using Krippendorff's content analysis, framed by Social Constructionism and Symbolic Interactionism, to understand how cultural narratives shape Kinh and Mong women's reproductive autonomy. Participants described how women's reproductive autonomy is constrained by structural and symbolic violence. Contraceptive choices were often controlled by husbands and mothers-in-law. Some women rejected intrauterine devices to avoid affecting male sexual comfort. 'Wife snatching' and early marriage were normalised as tradition. While both ethnic groups preferred large families, Kinh participants cited lineage expectations, whereas Mong participants emphasised ancestral blessings and land. Unsafe abortion, through herbal or informal methods, was common when women's choices conflicted with stigma or family control. Findings underscore how gendered and ethnic hierarchies restrict reproductive autonomy of Kinh and Mong women in the region. Interventions should integrate family planning and GBV services, promote cultural humility and engage local actors in codesigning solutions that respect both biomedical and indigenous reproductive logics.
Carlton George Smith, M.Sc., M.D., Ph.D., R.C.N.V.R. (1905-2003) was a Canadian anatomist and professor at the University of Toronto. He was highly regarded as an outstanding teacher, cutting-edge neuroscience researcher, and accomplished author. Dr. Smith became a member of the AAA in 1938 and joined the prestigious Cajal Club in 1950. In 1942, he joined the Naval Medical Research Unit in Halifax, eventually becoming its Commanding Officer, where he assisted with landmark research related to naval and military operational barriers during World War II. This research further bolstered his interests in the neuroanatomical bases of the special senses. Dr. Smith pioneered 3-dimensional (3D) teaching of neuroanatomy long before the era of technological advancement, using geometrical forms to describe the anatomical relationships between pathways and structures of the central nervous system. His innovative and evidence-based approaches, based on meticulous dissections, providing the foundation for both simple line drawings and detailed illustrations that were incorporated into several neuroanatomy books. He later developed a series of plaster models with his wife, Marguerite "Rita" Harland Smith, that highlight the complex 3D relationships of the human brain, head, and neck. Dr. Smith and Rita's legacy lives on through the models he donated to medical schools across Canada and at the University of Toronto through the endowment of scholarships and lectures. This article will include notable milestones in Dr. Smith's life with an emphasis on his scholarly and educational contributions to the field of neuroanatomy.
Domestic violence constitutes a pervasive global issue, posing significant threats to the physical and psychological well-being of family members, with women being disproportionately affected. This study aimed to evaluate the efficacy of a safety plan intervention in mitigating the experiences of domestic violence among female victims residing in Tehran, Iran. A quasi-experimental design was employed, utilizing a pre-test, post-test (at 30 and 60-day intervals) with a control group. Fifty-six female victims of domestic violence aged between 20 and 61 years were randomly assigned to either an experimental group (n = 28) or a control group (n = 28). The experimental group received training on the "safety plan" intervention. Data collection was conducted using the Wife Abuse Experience Questionnaire, and statistical analysis was performed using Repeated measures ANOVA. Analysis revealed that the total domestic violence score in the experimental group significantly declined from the pre-test mean of 38.5 to the first post-test mean of 28.86, and subsequently to the follow-up mean of 29.14. Conversely, the control group exhibited an initial reduction in the first post-test (from 33.36 to 28.43), followed by a slight increase at the follow-up stage (mean of 30.54). Repeated measures ANOVA demonstrated that this divergence in trends was statistically significant, confirming the intervention's efficacy regarding the total domestic violence score. Furthermore, the intervention successfully mitigated emotional violence, verbal violence, and sexual violence. However, no statistically significant impact was noted concerning mild physical violence or severe physical violence. The safety plan intervention emerged as a concise and efficacious approach for mitigating domestic violence experiences among female victims. Notably, the intervention demonstrated effectiveness in reducing non-physical forms of violence, including emotional, verbal, and sexual abuse. Consequently, this intervention holds promise as a practical tool for social workers and specialists within support centers dedicated to addressing domestic violence.
Although Erik H. Erikson himself and some scholars have acknowledged the significant contributions of his wife, Joan M. Erikson, to psychological theory, her specific role in shaping this framework has remained insufficiently examined. Drawing on an analysis of Joan's educational background, her shared life with Erik, and the affective and intellectual interdependence between them, this study suggests that Joan was not merely a supporter but a collaborator who was deeply involved in conceptual construction, structural refinement, textual revision, and the publication process of the theory. In particular, her involvement in discussions surrounding the concept of basic trust, the establishment of the "generativity" stage, and her systematic articulation of the ninth stage in later life represent important moments in the historical development of life cycle theory. This study further suggests that Joan's scholarly labor was not entirely invisible but rather was rendered partially visible and simultaneously marginalized within dominant academic narratives. Revisiting Joan's role in the construction and development of the theory helps restore the actual collaborative conditions of theoretical production rather than diminish Erik's scholarly achievements. This case highlights the value of attending to collaboration, intimacy, and the division of intellectual labor in accounts of knowledge production within psychoanalysis, developmental psychology, and the history of science. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Cotard's syndrome is a rare psychopathological phenomenon characterized by nihilistic delusions concerning one's body, existence, or death. We report the case of an 88-year-old man with no previous psychiatric treatment who was admitted following a medication-overdose suicide attempt in the context of a severe depressive crisis. After intensive and internal medical treatment, he developed a fluctuating confusional state characterized by disturbances of orientation, impaired attention, paranoid ideation, and nihilistic beliefs. During this period, he repeatedly stated that he was dead, had been cremated, and that his wife had also died. Notably, these nihilistic beliefs persisted during relatively lucid intervals, even as the severity of the disturbance of consciousness fluctuated. Severe depressive symptoms, somatic decompensation, metabolic abnormalities, sensory impairment, frontotemporal atrophy, and mild neurocognitive impairment were present. The clinical picture was interpreted as Cotard-type nihilistic delusions emerging during a fluctuating delirious state in the context of severe depression, suicidal behavior, and underlying neurocognitive vulnerability. Treatment with risperidone, mirtazapine, somatic stabilization, and supportive psychotherapy was followed by gradual resolution of both the confusional state and the nihilistic delusions. This case highlights the complex interplay between delirium, severe depression, suicidal behavior, and neurocognitive impairment in the development of Cotard-type phenomena and underscores the importance of a careful differential diagnostic approach when nihilistic delusions arise in medically and cognitively vulnerable older adults.
Intimate partner violence is a major public health and human rights issue, affecting one in four women globally. It is particularly prevalent in low‑ and middle‑income countries, where reproductive‑age women face heightened risks due to cultural norms, poverty, and weak legal protections. It is linked to severe mental, physical, and reproductive health consequences, as well as intergenerational and societal impacts. Using recent demographic and health survey data, this study provides updated cross‑regional insights into intimate partner violence among women in Africa and Asia to inform culturally tailored interventions and strengthen policy frameworks. A cross-sectional study was conducted using recent demographic and health survey data (2022-2024) from twelve countries in sub-Saharan Africa and Asia, including 88,414 women aged 15-49 years. Intimate partner violence was measured using 13 self‑reported items adapted from the Conflict Tactics Scale and coded as a binary outcome. Explanatory variables were selected based on the WHO ecological model, covering individual, relationship, community, and societal factors. Weighted data were analyzed in STATA 17 using multilevel logistic regression to account for clustering, with associations reported as adjusted odds ratios and 95% confidence intervals. The overall prevalence of intimate partner violence among reproductive‑age women in sub-Saharan Africa and Asia was 29.51% (95% CI: 29.21-29.81), with emotional (21.03%) being most common. Prevalence ranged from 51.74% in the Democratic Republic of Congo to 13.53% in the Philippines. Multilevel analysis identified significant predictors, including age, education, marital and employment status, early cohabitation, number of children, maternal abuse exposure, attitudes toward wife‑beating, partner jealousy, fear of partner, smoking, partner alcohol use, and region. Notably, partner alcohol consumption (AOR = 3.10), fear of partner (AOR = 2.98), and partner jealousy (AOR = 2.96) showed the strongest associations with intimate partner violence. Nearly one in three reproductive‑age women experienced intimate partner violence, highlighting its magnitude and public health importance. Intimate partner violence was strongly associated with socio‑demographic, behavioral, and attitudinal factors and regional differences. These findings call for multi‑level interventions that promote women's empowerment, challenge harmful gender norms, strengthen legal frameworks, and expand community‑based support, while future longitudinal and qualitative research should deepen understanding and guide evidence‑based policy.
Young and middle-aged patients with first-episode acute myocardial infarction (AMI) and their spousal face significant psychological challenges, yet existing research often overlooks their dyadic interdependence in the process of benefit finding. To investigate the levels of benefit finding in young and middle-aged patients with first-episode acute myocardial infarction and their spouses, to identify the influencing factors, and to analyze the pathways among these factors. A cross-sectional study was conducted among 212 dyads of young and middle-aged patients with first-episode acute myocardial infarction and their spouses. Data were collected using a set of validated scales to measure benefit finding, psychological resilience, coping styles, and family function. Data analyses encompassed descriptive statistics, Pearson correlation, multiple linear regression, and path analysis via the Actor-Partner Interdependence Model (APIM) to examine the actor and partner effects within the dyads. Benefit finding scores were (64.77 ± 13.05) for patients and (65.65 ± 12.87) for spouses. Multiple regression revealed that patients' benefit finding was significantly associated with their own education, comorbidities, number of stents, resilience, positive coping, and their spouse's resilience. For spouses, their benefit finding was associated with their own education, age, resilience, family function, as well as the patient's age and comorbidities (all p < 0.05). The Actor-Partner Interdependence Model (APIM) further showed significant actor effects: both patients' and spouses' resilience and positive coping positively predicted their own benefit finding. Moreover, spouse's family function exhibited a significant actor effect on their own benefit finding. Regarding partner effects, both patients' and spouses' resilience positively predicted each other's benefit finding. Benefit finding in both patients and spouses is moderate-low and influenced by multiple individual and dyadic factors. Interventions should target resilience, coping strategies, and family function from a dyadic perspective to enhance benefit finding.
Military personnel are at an elevated risk of depression after combat exposure, which can create significant stress for both the civilian spouses/partners and their children. However, the complex associations between parental mental health, family dynamics, and child characteristics have rarely been examined in post-deployment populations. This study examined the associations between parental depressive symptoms, parental locus of control, and child negative emotionality using a random-intercept cross-lagged panel model in US military families. The findings indicated that for mothers, increases in parental locus of control were associated with decreases in later parental depressive symptoms, while increases in child negative emotionality were associated with an increase in later parental depressive symptoms. For fathers, increases in parental locus of control were surprisingly associated with an increase in later child negative emotionality. These findings suggest that parenting interventions for military families should strengthen mothers' parental locus of control to buffer against depressive symptoms, while equipping fathers with noncoercive, emotionally supportive parenting strategies during reintegration.
Breast cancer is the most dreaded malignancy affecting women worldwide. The menace is even worse in developing countries due to poor access to early detection and appropriate treatment. Late presentation to healthcare facilities accounts for over 70% of the patients diagnosed with advanced breast cancer in Nigeria. The lack of awareness, ignoble attitude, and negative perceptions are all responsible for patients not coming to the hospital at the onset of the disease, thus making mastectomy an essential modality of treatment. The survey interrogated the level of awareness, attitude, and perception about mastectomy among patients diagnosed with breast cancer at the Breast and Endocrine Surgery Clinics of University of Abuja Teaching Hospital, Gwagwalada, Abuja, Federal Capital Territory, Nigeria. One hundred and seventy seven (88.9%) of the participants were aware of breast cancer, and the source of their information was predominantly from health personnel. Twenty two (11.1%) of the participants are unaware of breast cancer, representing a population in dare need of health education. 145 (72.9%) of the participants had a positive perception toward mastectomy. Fifty four (27.1%) of them had a negative perception towards mastectomy for the following reasons: loss of femininity 16 (8.0%), loss of body image 15 (7.5%), stigmatization 10 (5.0%), sexuality 7 (3.5%), and loss of beauty 4 (2.0%). Health insurance coverage of the cost of mastectomy and availability of breast prosthesis and reconstruction will enable 149 (74.9%), and 120 (60.3%), respectively, of the patients to embrace mastectomy. 103 (51.8%) of the participants agreed that proper preoperative counseling may enhance their acceptance of mastectomy. Efforts must be geared towards educating the public and, in particular, patients with breast cancer that early mastectomy for advanced or metastatic disease has survival benefits. Incorporating spouses, family members, and caregivers in breast cancer education will improve the perception of mastectomy. Résumé Introduction:Le cancer du sein reste la tumeur la plus redoutée chez les femmes partout dans le monde. Dans les pays en développement, le problème devient encore plus grave parce que le dépistage précoce et les soins adaptés sont rares. Au Nigéria, plus de 70 % des patientes arrivent tard aux centres de santé et on découvre la maladie à un stade avancé. Le manque de sensibilisation, les attitudes défavorables et les perceptions négatives font que les patientes consultent tard. La mastectomie devient alors une modalité thérapeutique essentielle. La mastectomie reste une option indispensable pour le traitement.Matériels et Méthodes:Nous avons évalué le niveau de connaissance, les attitudes et les perceptions des patientes sur la mastectomie. Les patientes atteintes d’un cancer du sein étaient suivies dans les services de chirurgie mammaire et d’endocrinologie de l’Hôpital Universitaire d’Abuja, situé à Gwagwalada, Abuja, Territoire de la Capitale Fédérale, Nigéria.Résultats:Cent soixante sept participantes, soit 88,9 %, connaissaient le cancer du sein, et le personnel de santé constituait la principale source d’information des participantes. Vingt deux participantes, soit 11,1 %, ne connaissaient pas le cancer du sein ; les participantes ont donc besoin d’une éducation sanitaire immédiate. Par ailleurs, 145 participantes (72,9 %) avaient une perception favorable de la mastectomie. Cinquante-quatre participantes (27,1 %) en avaient une perception défavorable pour les raisons suivantes : perte de féminité chez 16 participantes (8,0 %), altération de l’image corporelle chez 15 participantes (7,5 %), stigmatisation pour 10 participantes (5,0 %), des inquiétudes concernant la sexualité chez 7 participantes (3,5 %) et une crainte de perdre sa beauté physique pour 4 participantes (2,0 %). Une couverture financière de la mastectomie par l’assurance maladie et l’accès à des implants mammaires ou à une reconstruction mammaire seraient de nature à faciliter l’acceptabilité de cette intervention pour 149 participantes (74,9 %) et 120 participantes (60,3 %) respectivement. De plus, 103 participantes (51,8 %) ont jugé qu’une préparation préopératoire appropriée pourrait contribuer à renforcer leur adhésion à la chirurgie.Conclusion:Il importe de mener des actions soutenues pour informer la population générale et surtout les femmes diagnostiquées d’un cancer du sein que recourir à une mastectomie précoce dans le contexte d’une maladie avancée ou avec métastases apporte des avantages significatifs en matière de durée de vie. Faire participer les partenaires, la famille et les proches aidants aux démarches d’information sur le cancer du sein contribuerait aussi à transformer la façon dont on perçoit cette intervention.
Spousal caregivers provide critical support for cancer patients but are at high risk for adverse psychological outcomes. We aimed to investigate the associations between resilience and factors related to resilience in partner caregivers with caregiver anxiety, depression, and perceived stress. This cross-sectional study used baseline data from the "Resilient Caregivers" randomized trial testing a resilience-based group intervention in distressed spousal cancer caregivers. Participants were spouses of cancer patients undergoing treatment (regardless of stage and type) and scored ≥ 4 on the Distress Thermometer. All participants completed questionnaires assessing resilience, social support, valued living, rumination, attention to threat, coping behaviors, metacognitive beliefs, anxiety, depression, and perceived stress. Seventy-nine spouses of cancer patients undergoing treatment were included, with the majority being female (75%), over 50 years old (80%), and with at least an undergraduate education (86%). Obstruction to valued living, rumination, and attention to threat were significantly negatively correlated with resilience (p ≤ 0.05). Low resilience, obstruction to valued living, rumination, and attention to threat were significantly associated with anxiety, depression, and perceived stress (p ≤ 0.01), while maladaptive coping was significantly associated with depression and perceived stress (p ≤ 0.05) and maladaptive metacognitive beliefs were significantly associated with anxiety (p = 0.03). We found that obstruction to valued living, rumination, and attention to threat were associated with lower resilience and higher levels of anxiety, depression, and stress. These factors may be potential targets in future interventions to strengthen caregiver resilience and improve psychological outcomes among spousal caregivers.
This study assesses the effects of World War II military service on outcomes for immigrant veterans. Linked, full-count U.S. Census data are used in a triple-differences design. Immigrant veterans are more likely to become citizens and marry U.S.-born spouses. There is little evidence of differences in labor market or educational outcomes relative to U.S.-born veterans.
The COVID-19 pandemic placed significant strain on physicians. Gender inequities in medicine preceded the pandemic. This study aimed to assess the association of COVID-19 lockdown on physicians' careers, work-life balance, resilience, and burnout from a gender perspective, in Lebanon. A web-based survey was sent to all Lebanese Syndicate of Physicians members. Data was collected between August and September 2022. The survey was designed comprising five domains to assess personal characteristics, career impact, work-family intersection, resilience, and burnout. A total of 165 physicians were included in the analysis. A greater percentage of women were married with children and in a non-surgical specialty. During COVID-19 lockdown, more women occupied part-time positions compared to pre-COVID-19 (29.2%vs.18.0%, p = 0.04), whereas there was no significant difference among men. While both men and women shifted to more remote work during COVID-19, there was no statistically significant difference by gender. Moreover, more women than men reported increased time spent on household tasks (64.0%vs.36.8%, p < 0.001). While the majority of both men and women reported increased parenting activities, a higher percentage of women reported solely bearing childcare responsibilities during school disruptions. Furthermore, a higher percentage of women reported relying on their extended family during childcare disruptions (30.9%vs.9.5%, p < 0.001), compared to men who reported relying more on their spouses (52.6%vs.9.1%, p < 0.001). Multivariate regression of Work-to-Family conflict and resilience scales did not show any statistically significant difference by gender, nor was there a gendered difference in burnout scores. Being married and married with children were both associated with higher resilience in physicians. Our study highlights the disproportionate association between COVID-19 lockdown and experiences of women physicians. Policies and initiatives to retain women physicians during crises are of paramount importance as are interventions targeting resilience in single physicians and overall burnout.
Uncontrolled gout (UG) refers to persistently elevated serum urate (SU) levels >6 mg/dL and ongoing gout symptoms despite use of urate-lowering therapy (ULT). The objective of this study was to evaluate the burden associated with informal caregiving for individuals with UG. To inform survey development, concept elicitation (CE) interviews were conducted with informal caregivers of patients with UG between April and May 2024. A separate cohort of informal caregivers meeting the same eligibility criteria was recruited via physician panels to complete a web-based, cross-sectional survey between January and February 2025. Survey outcomes included caregiver health-related quality of life (HRQOL), productivity, and 12-month patient health care resource use. Four caregivers participated in CE interviews, which informed survey development. Separately, 40 caregivers completed the survey. Survey respondents were predominantly female (73%) and had a mean age of 55.1 (SD 10.6) years, and most (73%) were spouses/partners of patients with UG. UG affected caregivers' HRQOL, with more than 30% feeling at least "quite a bit" stressed, overwhelmed, or physically exhausted/drained. Between 36% and 50% of caregivers reported at least "moderate" burden associated with assisting patients with UG treatment, depending on the ULT used. Caregivers reported a 41% reduction in their ability to perform daily activities overall, and among those employed, they reported a 36% reduction in their ability to work. On average, employed caregivers missed 2.7 hours of work in the prior seven days due to caregiving responsibilities. Caring for a patient with UG substantially negatively impacted caregivers' HRQOL and interfered with caregivers' ability to work and perform daily activities.
NTRK fusion-positive non-small cell lung cancer (NSCLC) represents a rare molecular subtype in which effective clinician-patient communication and an understanding of the lived experience are essential to supporting personalized care. This podcast presents a video interview exploring experiences associated with NTRK fusion-positive NSCLC, examining key stages of the diagnostic and treatment pathway, including biomarker testing, the emotional impact of diagnosis, initiation of targeted therapy, and managing treatment-related adverse events. It also considers the psychological impact of NTRK fusion-positive NSCLC, including the emotional burden of diagnosis, challenges of independently seeking information about rare alterations, treatment delays, and the transition from chemotherapy to a targeted therapeutic approach. Emphasis is placed on the importance of timely biomarker testing and transparent communication around biomarker testing and treatment timelines, as well as greater clinical recognition of the uncertainty often experienced by individuals with rare genomic alterations. By amplifying the patient voice, this piece seeks to foster greater awareness and empathy among healthcare professionals and contribute to improved outcomes in precision oncology.
Although adding immune checkpoint inhibitors to neoadjuvant chemotherapy improves outcomes in high-risk early-stage breast cancer, opportunities remain to further enhance response. Dual checkpoint blockade offers a potential strategy to further enhance efficacy. To evaluate the combination of anti-programmed cell death 1 protein (PD-1) cemiplimab and anti-lymphocyte activation gene 3 (LAG-3) added to neoadjuvant therapy in ERBB2-negative early-stage, high-risk breast cancer. The I-SPY2 (Investigation of Serial Studies to Predict Your Therapeutic Response With Imaging and Molecular Analysis 2) is an ongoing randomized clinical platform trial being conducted at multiple US clinical sites including patients with early-stage (II or III) ERBB2-negative, high-risk breast cancer. Participants, continuously enrolled since 2010, were adaptively randomized from February 2, 2020, to December 9, 2021, to one of several experimental neoadjuvant therapies or control groups based on receptor subtypes defined by hormone receptor (HR), ERBB2 status, and MammaPrint (Agendia Inc) molecular risk, categorized as high (MP1) or ultrahigh (MP2). Data were analyzed from January 1, 2022, to August 5, 2025. Both groups received weekly paclitaxel for 12 weeks, then doxorubicin and cyclophosphamide followed by surgery; concomitant with paclitaxel, the intervention group also received 4 doses of cemiplimab and fianlimab (PCF) every 3 weeks. Pathologic complete response (pCR). Treatments graduated when they achieved 85% bayesian probability of success in a subtype-specific phase 3 trial. Pathway-specific biomarkers were assessed for response prediction. A total of 78 participants (mean [SD] age, 47 [39-54] years) were randomized to the intervention group, with 350 participants (mean [SD] age, 48 [39-57] years) randomized to the historical control population. PCF graduated in all clinical signatures, with pCR rates vs control of 44% (95% CI, 34%-53%) vs 21% (95% CI, 17%-25%) in all ERBB2, 53% (95% CI, 39%-67%) vs 29% (95% CI, 22%-36%) in triple-negative, and 36% (95% CI, 23%-49%) vs 14% (95% CI, 9%-19%) in HR-positive and ERBB2-negative disease. Among the total participants, 16 (21%) experienced adrenal insufficiency, including hypophysitis (11% grade 3 or 4), mostly occurring after immunotherapy completion. PCF was found to be highly effective in the subset of patients with immune signature positive status (ImPrint positive). In this randomized clinical trial, the combination of PD-1 and anti-LAG-3 inhibition with standard NAC was effective in early-stage ERBB2-negative breast cancer, particularly in patients displaying a positive ImPrint immune signature. These results warrant further definitive trials. ClinicalTrials.gov Identifier: NCT01042379.