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Identification of children at risk for developmental delays associated with neurodevelopmental disorders depends on consistent early developmental surveillance defined as flexible, longitudinal, continuous, and cumulative assessment of child development conducted at every pediatric visit. Our objective is to describe primary care providers' experiences and responses regarding the implementation of the Survey of Well-being of Young Children (SWYC) as the primary developmental screener in a large health system. A descriptive qualitative survey using convenience sampling of pediatric health care providers at U.S. military facilities was conducted between April and May 2024. This study was determined exempt by the Institutional Review Board at the Uniformed Services University of the Health Sciences. Out of 95 respondents at 55 facilities, nearly all respondents (96%) reported using the SWYC, and 48% also used an additional screener, most commonly The Modified Checklist for Autism in Toddlers, Revised (85%). Over half (57%) reported screening at every well-child visit, exceeding the mandated schedule. Qualitative analysis revealed positive themes of the SWYC's comprehensive focus on social determinants of health and its ease of use. Negative themes included concerns about the reliability (sensitivity and specificity) of results, provider preference for alternative tools, and administrative and emotional burdens on providers and families. Military providers generally valued the SWYC's all-in-one, comprehensive approach, but had concerns about accuracy and insufficient referral resources. Continued evaluation and support for providers are warranted to ensure high fidelity to screening guidelines and effective implementation.
Neurofibromatosis (NF) comprises genetic tumor predisposition syndromes with multisystem involvement, yet pediatric mortality data remain scarce in middle-income settings. Malignant peripheral nerve sheath tumors (MPNST) represent the leading cause of premature death in this population. This study analyzed 16-year temporal trends and regional disparities in pediatric NF/MPNST mortality and hospitalizations in Brazil. We conducted a nationwide ecological study of individuals aged 0-19 years from 2008 to 2023. Mortality data were obtained from the Mortality Information System (SIM) and hospital admissions from the Hospital Information System (SIH/SUS), with temporal trends assessed using Prais-Winsten regression. We calculated Age-Specific Mortality Rates (ASMRs) and assessed excess mortality risk using Standardized Mortality Ratios (SMR) to identify regional disparities. A total of 177 pediatric deaths were identified, with MPNST accounting for 64.9% (N = 115) and NF for 35.1% (N = 62). SMR analysis revealed significant geographic inequalities. Children aged 0-9 in the South region faced a mortality risk double that of the reference population (SMR = 2.02; 95% CI 1.08-3.46; p = 0.010), whereas adolescents in the North region exhibited significantly lower-than-expected mortality. Despite global therapeutic advances, mortality rates in Brazil remained statistically stagnant across all age groups and conditions (p values were non-significant). Conversely, NF-related hospitalizations demonstrated an increasing trend (+ 2.98% annually for ages 0-9; + 1.94% for ages 10-19), while MPNST admissions remained stable. Pediatric mortality from NF and MPNST in Brazil has remained unchanged for 16 years, contrasting with the rising trend in NF-related hospitalizations. This discrepancy, coupled with marked regional disparities, suggests persistent structural challenges in early diagnosis and equitable access to specialized oncology care. These findings highlight a critical need for national notification systems and improved therapeutic strategies for affected children and adolescents.
Protein-energy malnutrition (PEM) is common in gastrointestinal (GI) cancers and may worsen inpatient outcomes. Contemporary national data describing the impact of PEM among young adults with GI malignancies are limited. We conducted a retrospective cohort study using HCUP NIS data from 2018 to 2021. We identified hospitalizations of adults aged 18 to 39 years with GI cancers using ICD 10 CM codes C15 to C26. We defined PEM using ICD-10-CM diagnosis codes recorded during the index hospitalization; therefore, PEM reflects clinically documented/coded malnutrition rather than the full burden of nutritional risk or clinically undiagnosed malnutrition. Primary outcomes were in hospital mortality and discharge disposition. Secondary outcomes were LOS and total hospital charges. We used survey weighted multivariable logistic and linear regression to estimate adjusted associations, accounting for age, sex, race or ethnicity, payer, income quartile, admission type, calendar year, and age adjusted CCI. Among 58,910 weighted hospitalizations of young adults with gastrointestinal cancers, 11,915 (20.2%) had protein-energy malnutrition (PEM). Compared with those without PEM, hospitalizations with PEM had a higher burden of advanced disease and acute illness, including a greater prevalence of metastatic disease (71.8% vs. 53.1%), and experienced worse unadjusted outcomes, including higher in-hospital mortality (8.4% vs. 3.2%), longer length of stay (10.43 vs. 5.63 days), and higher total hospital charges ($133,790 vs. $83,702). In adjusted analyses, PEM was independently associated with increased odds of in-hospital mortality (aOR 2.13, 95% CI 1.72-2.56; p < 0.001) and higher odds of non-home discharge (aOR 1.67, 95% CI 1.47-1.89; p < 0.001). PEM was also associated with substantially greater resource utilization, including an adjusted increase of 4.49 hospital days (β + 4.492; SE 0.248; p < 0.001) and $53,513 higher total hospital charges (β +$53,512.6; SE $5,527.6; p < 0.001). PEM affected one in five hospitalizations among young adults with GI cancers and was independently associated with increased mortality, non-home discharge, LOS, and hospital charges. These findings support routine inpatient nutritional assessment and early intervention in this high risk population.
This cross-sectional study evaluates state-level limitations and exemptions regarding cellphone use among public school students.
The objective of this study was to explore if vaginal angle is associated with pelvic organ prolapse (POP) stage and predominant compartment utilizing a simple physical examination measurement as a possible screening tool for POP. We conducted an exploratory cross-sectional analysis of women from our urogynecology clinics who underwent POP Quantification (POP-Q) examination and vaginal-angle measurements. Angle at rest and with Valsalva were measured using a POP-Q stick placed in the vaginal apex and a goniometer with attached line level (0° reference = horizontal). Angle change was calculated (resting - Valsalva). Reproducibility of angle measurements between examiners was assessed (r = 0.92-0.95, p < 0.0001). Associations for vaginal angle with POP stage and predominant compartment were estimated using linear regression, adjusting for age, parity, body mass index, hysterectomy status, and prior POP surgery. Data from 477 women were included, 78 with POP-Q stage 0 support, 156 with stage 1, 111 with stage 2, and 132 with stages 3-4. A total of 241 patients had anterior-predominant, 35 apical-predominant, 83 posterior-predominant, and 40 equal anterior/posterior POP. Resting angle was higher for POP-Q stage 1 than 0 (adjusted β = 3.6, 95% confidence interval [CI]: 0.8 to 6.5), and Valsalva change angles were higher for POP-Q stages 1/2 than for 0 (adjusted βs: 6.8 to 8.0, p < 0.05). Valsalva and change angles were greatest with posterior-predominant POP (adjusted βs compared with anterior-predominant 3.3 to 4.2, p < 0.05). Using a simple clinical measurement, we found that vaginal angles were associated with POP stage, particularly transition from "normal support" (0) to stage 2, and with predominant compartment, particularly posterior-predominant POP. Larger studies are warranted to investigate the reproducibility of these findings and clinical implications.
A standardized, multimodal Enhanced Recovery After Surgery (ERAS) protocol was implemented to improve postoperative outcomes in patients undergoing metabolic bariatric surgery (MBS). This quality improvement initiative evaluated the impact of a standardized, multimodal ERAS protocol on postoperative outcomes in MBS patients. Implemented at a community hospital where perioperative practices were inconsistent, this evidence-based pathway introduced a structured approach to perioperative care to enhance recovery and promote safer, more efficient outcomes. A pre- and post-quality improvement study was conducted among adults undergoing MBS at a Midwestern community hospital following implementation of a structured ERAS protocol. Patients younger than 18 years and those with long-term opioid use were excluded. The Model for Evidence-Based Practice Change guided protocol development and implementation. Pre-implementation and post-implementation cohorts were compared across primary endpoints, including PONV incidence, opioid consumption, and length of stay (LOS). Mann-Whitney U tests, and chi-square or Fisher's exact tests were used (p < .05). ERAS implementation resulted in a significant reduction in postoperative opioid use (Mdn = 22.5 vs. 80.0 MME; U = 143.50, p < .001). No significant differences were observed in PONV or LOS between groups. Protocol adherence was high (89.4%). A structured, multimodal ERAS protocol was an effective quality improvement strategy for patients undergoing MBS at a community hospital. Standardizing perioperative care was associated with a significant reduction in opioid requirements without increasing PONV or LOS, supporting broader adoption of ERAS pathways in bariatric surgery programs.
Stemless shoulder arthroplasty utilizes epiphysometaphyseal fixation, eliminating the need for humeral canal reaming. Extending stemless technology to reverse total shoulder arthroplasty (rTSA) introduced distinct biomechanical challenges. In the absence of diaphyseal support, concerns regarding humeral component subsidence, varus tilting, and aseptic loosening arise. In the United States, stemless rTSA remains investigational, with the Fx Easytech Reversed system currently under evaluation through an Investigational Device Exemption clinical trial. Explanted components were submitted to an independent orthopaedic laboratory for systematic, non-destructive analysis comprising high-magnification microscopy. Bony ongrowth was assessed using a non-standardized, semi-quantitative grading scale applied across four fixation surface quadrants (Q1-Q4), estimating tissue coverage from 0 (none) to 4 (75-100%). Bony ongrowth was observed on all three titanium-hydroxyapatite (Ti/HA)-coated humeral anchor bases across implantation durations ranging from 39 days to 3 years and 8 months, with semi-quantitative scores of Q1: 2-4, Q2: 4, Q3: 3-4, Q4: 3. No case was revised for fixation failure. Ti/HA-coated stemless humeral components demonstrated osseointegration under the compressive-dominant loading environment of rTSA. Bony ongrowth was evident as early as 39 days postoperatively. Larger retrieval series and long-term follow-up are necessary to confirm the durability of stemless humeral implants. Level IV, Case Report.
Accurate glenoid baseplate inclination is an important technical goal in reverse shoulder arthroplasty (RSA), but reliably achieving the planned target remains challenging. We compared deviation from planned baseplate inclination between conventional and robotic-assisted RSA using the Mako robotic system (Stryker, Kalamazoo, MI). We retrospectively reviewed consecutive primary RSAs performed by a single fellowship-trained shoulder surgeon over one year. All cases were planned using Blueprint software (Stryker). Achieved inclination was measured on standardized postoperative radiographs using the RSA angle by two blinded reviewers and averaged for analysis. The primary outcome was absolute deviation from planned inclination. Secondary outcomes included variability in inclination error, the proportion of cases within 5° and 10° of plan, and outliers greater than 10°. A total of 103 RSAs were included (42 conventional, 61 robotic-assisted). Baseline characteristics were comparable except for body mass index (BMI). Mean absolute deviation was lower with robotic assistance but did not reach significance (2.7° ± 2.1° vs 3.9° ± 3.7°; P = .07). Robotic assistance significantly reduced variability in inclination error (SD 2.1° vs 3.7°; Levene P = .02, F test P < .001). No robotic case deviated more than 10° from plan, compared with 4 of 42 conventional cases (0% vs 10%; P = .03). In a single-surgeon series, conventional and robotic-assisted RSA achieved similar mean radiographic baseplate inclination accuracy, but robotic assistance reduced error variability and eliminated large outliers. These findings suggest that the value of robotic assistance may lie not in marginal improvements in average accuracy, but in narrowing the error distribution and improving the reproducibility of component placement.
With the continuous optimization of systemic treatment regimens and the advancement of imaging assessment technologies, the overall survival rate of early-stage breast cancer has been steadily improving, providing an evidence-based basis for exploring de-escalation of local surgical treatment. This article systematically reviews five pathways for de-escalation of local surgical treatment in breast cancer and their key clinical evidence: selective exemption from breast surgery after neoadjuvant therapy by verifying pathologic complete response through imaging combined with vacuum-assisted biopsy (NRG-BR005, MICRA, MD Anderson Exceptional Responders trials, etc.); active surveillance replacing immediate surgery for low-risk ductal carcinoma in situ (COMET, LORIS, LORD, etc.); percutaneous ablation replacing partial breast-conserving surgery (ICE3, PO-RAFAELO, etc.); exemption from sentinel lymph node biopsy for patients with clinically negative lymph nodes and negative axillary ultrasound (INSEMA, SOUND, etc.); and reducing the false-negative rate (FNR) by using sentinel combined with targeted axillary dissection to avoid axillary lymph node dissection in initially node-positive patients who convert to clinically node-negative after neoadjuvant therapy (ACOSOG Z1071, SENTINA, SN FNAC, etc.). The clinical translation of the above strategies requires precise risk stratification, standardized pathological assessment, closed-loop long-term follow-up, and fully informed decision-making. Its core lies in establishing a comprehensive management plan based on rigorous screening and evidence-driven approaches, grounded in verifiable complete remission or low risk. 随着系统治疗方案的不断优化和影像评估技术的进步，早期乳腺癌的总生存率持续提高，这为局部手术治疗的降阶梯探索提供了循证基础。该文综述了乳腺癌局部手术降阶梯的5条路径及其关键临床证据：新辅助治疗后通过影像联合真空辅助活检验证病理完全缓解后选择性豁免乳腺手术（NRG-BR005、MICRA、MD Anderson Exceptional Responders试验等）；低风险导管原位癌以主动监测替代即刻手术（COMET、LORIS、LORD试验等）；经皮消融替代部分保乳手术（ICE3、PO-RAFAELO试验等）；临床淋巴结阴性且腋窝超声阴性患者豁免前哨淋巴结活检（INSEMA、SOUND试验等）；新辅助治疗后腋窝转阴者以前哨联合靶向腋窝清扫降低假阴性率从而避免腋窝清扫（ACOSOG Z1071、SENTINA、SN FNAC试验等）。上述策略的临床转化需以精准风险分层、规范化病理评估、闭环式长期随访和充分知情决策为前提，其核心在于以可验证的完全缓解或低风险为基础，建立严格筛选与证据驱动的综合管理方案。.
Ovarian cancer remains the most lethal gynecological malignancy and represents a major cause of cancer-related mortality among women worldwide. Despite advances in therapeutic strategies, treatment efficacy is frequently limited by systemic toxicity, chemoresistance, and disease recurrence, highlighting the urgent need for novel, mechanism-based targeted therapies with improved safety profiles. In the present study, we investigated the anti-cancer activity of atranorin (ATR), a naturally derived small-molecule compound, with a particular focus on its ability to induce ferroptosis by modulation of the LUCAT1/STAT3 signaling axis. Human ovarian cancer cell lines (OVCAR-3 and SKOV-3) and normal ovarian surface epithelial (OSE) cells were employed to evaluate cytotoxic selectivity and mechanistic effects. ATR selectively inhibited proliferation of ovarian cancer cells while exerting minimal cytotoxicity toward normal OSE cells. Mechanistic analyses demonstrated that ATR significantly suppressed LUCAT1 and STAT3 expression at both mRNA and protein levels, as confirmed by qRT-PCR and Western blotting. Concomitantly, ATR upregulated ferroptosis-related genes and proteins. Biochemical assessments revealed increased intracellular reactive oxygen species (ROS), elevated malondialdehyde (MDA) and iron accumulation, and depletion of glutathione (GSH), collectively indicating activation of ferroptotic cell death. Furthermore, ATR significantly impaired migratory and invasive capacities of ovarian cancer cells. Collectively, our findings identify ATR as a compound capable of inducing biochemical features consistent with ferroptosis in ovarian cancer through suppression of the LUCAT1/STAT3 axis. These results uncover a previously uncharacterized mechanistic pathway underlying ATR-mediated anti-tumor effect and support its potential development as a targeted therapeutic candidate for ovarian cancer management.
To assess the association between myelodysplastic syndrome and de novo bone metastasis of urothelial carcinoma. A cohort of 145,719 patients with MDS and/or UTCA included from the surveillance, epidemiology, and end results (SEER) database was conducted to assess the risk of de novo bone metastasis of UTCA (DNBM-UTCA) in patients with previously diagnosed myelodysplastic syndrome (PD-MDS). The odds ratio for developing DNBM-UTCA between MDS and non-MDS patients was estimated. Weibull accelerated failure time model was applied to evaluate the survival outcomes of patients with UTCA. Our findings suggest that PD-MDS is a powerful risk factor for DNBM-UTCA (adjusted odds ratio, 6.428; 95% CI, 1.866-16.497; p < 0.001) and a poor prognostic factor on survival (adjusted survival time ratio, 0.485; CI, 0.338-0.695; p < 0.001). Our findings suggest that PD-MDS was associated with higher odds of DNBM-UTCA and poorer survival outcomes, which may warrant additional clinical attention during treatment decision-making. However, these findings should be considered hypothesis-generating rather than causal. Further prospective studies and mechanistic investigations are needed to better clarify the biological basis underlying the observed association between PD-MDS and bone metastasis in UTCA.
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare autoimmune disease in which renal involvement is a major determinant of morbidity and mortality. Epidemiologic data suggest lower reported prevalence of AAV among Black populations, but whether differences exist in disease presentation and renal severity at diagnosis remains poorly characterized. We conducted a retrospective cohort study using a large, multi-institutional electronic health record network. Adults diagnosed with AAV between 2015 and 2025 were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. Demographic characteristics, renal manifestations at presentation, dialysis dependence, and ANCA serologic testing were extracted. Primary analyses compared Black and White patients using descriptive statistics, Welch t-tests, Fisher's exact tests, and odds ratios (ORs) with 95% confidence intervals (CIs). Among 789 adults with AAV, 84.8% were White and 8.2% were Black. Black patients were diagnosed at a younger mean age than White patients (55 ± 15 vs 64 ± 16 years; p<0.001). Dialysis dependence was more frequent among Black patients (21.5% vs 13.3%; OR: 1.79, CI: 0.88-3.45), as was hematuria (38.5% vs 28.1%; OR: 1.59, CI: 0.9-2.78). Proteinuria occurred at similar rates across groups. ANCA serologic testing was incompletely captured. In this multi-institutional cohort, Black patients with AAV presented at a younger age and tended to be more likely to require dialysis and have hematuria. These findings suggest that underrepresentation in rare disease cohorts may coexist with substantial disease burden at presentation, underscoring the importance of examining severity alongside prevalence in population-level studies.
Objective Depression and anxiety are common across hematopoietic stem cell transplantation (HSCT) and predict poorer adherence and worse outcomes, yet their burden at the initial psychiatric evaluation has not been documented in Mexican patients. Brief validated screeners such as the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) could detect these symptoms at this early, accessible window, before conditioning begins. We aimed to describe the frequency and severity of depressive and anxiety symptoms, assessed by the PHQ-9 and GAD-7, in patients entering an HSCT protocol at a Mexican tertiary center during their initial psychiatric evaluation. Methods A retrospective, cross-sectional, observational study was conducted at the Centro Medico Nacional "20 de Noviembre" (ISSSTE), Mexico City. We reviewed records of 104 adult patients evaluated by the Psychiatry Department as part of the HSCT protocol between January 2024 and November 2025; 103 met the inclusion criteria. PHQ-9 and GAD-7 scores, demographic data, hematological diagnosis, and transplantation type were extracted. Clinically significant depression was defined as PHQ-9 ≥10 and clinically significant anxiety as GAD-7 ≥10. Data were analyzed with descriptive statistics, non-parametric tests, and Fisher's exact tests (alpha=0.05). Results The median age was 51 years (interquartile range [IQR] 38.5-60.5); 55.3% were men. The most common diagnosis was multiple myeloma (48.5%); 66% were scheduled for autologous transplantation. Median PHQ-9 was 0 (IQR 0-2); clinically significant depression was detected in eight patients (7.8%; 95% confidence interval [CI] 4.0-14.6). Median GAD-7 was 0 (IQR 0-1.5); clinically significant anxiety was present in two patients (1.9%; 95% CI 0.5-6.8). Co-occurrence of both was also 1.9%. Patients aged 18-35 years had a fourfold higher prevalence of mild anxiety compared with those aged 36-55 years (prevalence ratio [PR]=4.2; 95% CI 1.17-15.10; p=0.026). PHQ-9 and GAD-7 scores correlated positively (p<0.0001). Conclusions At the initial psychiatric encounter, most HSCT patients reported minimal affective symptoms; the timing of assessment, before conditioning begins, and the prior selection of medically and psychosocially stable candidates likely explain these low rates. The 7.8% rate of clinically significant depression and the concentration of mild anxiety in younger patients support systematic screening with validated tools at this early stage. The age-anxiety association is confounded with diagnosis and transplantation type and requires replication in larger samples. Longitudinal studies are needed to characterize symptom trajectories throughout the transplantation process.
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can resemble central nervous system infection in children because fever, headache, vomiting, cerebrospinal fluid pleocytosis, and multifocal brain lesions may coexist. We report a previously healthy 13-year-old boy who developed headache, fever, vomiting, and binocular horizontal diplopia. Examination showed transient exotropia with apparent adduction limitation but no encephalopathy, seizures, limb weakness, pupillary abnormality, optic neuritis, or spinal cord lesion. Cerebrospinal fluid showed mononuclear-predominant pleocytosis with mildly elevated protein. Brain magnetic resonance imaging showed evolving patchy fluid-attenuated inversion recovery hyperintensities in the right temporal lobe, basal ganglia, periventricular region adjacent to the fourth ventricle, and later the right frontal lobe. Extensive microbiological testing was unrevealing. Serum myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) was repeatedly positive by live cell-based assay, whereas aquaporin-4 immunoglobulin G (AQP4-IgG) and autoimmune encephalitis antibodies were negative. Clinical improvement occurred during overlapping treatment with intravenous immunoglobulin and corticosteroids. On illness day 97, during prednisone tapering following an individualized off-label decision to use rituximab, the patient remained clinically stable. This case highlights that pediatric MOGAD should be considered when an infection-like central nervous system presentation is accompanied by evolving multifocal magnetic resonance imaging abnormalities and negative pathogen studies. Diplopia can be an important focal clue; however, because the ocular motor examination was incomplete, internuclear ophthalmoplegia could not be confirmed.
Evaluate our comprehensive vasectomy care pathway, find ways to improve patient experience, and optimize efficiency. We performed a retrospective cohort study of men presenting for vasectomy consultation at a single academic center. Demographics, pre-consult research behavior, and reasons for vasectomy consideration including influence of the 2022 Supreme Court decision were collected via standardized survey. Clinical outcomes included progression to vasectomy, unplanned post-operative contact (UPC), post-vasectomy semen analysis (PVSA) completion, and PVSA positivity. Logistic regression was used to assess predictors of follow-through from consultation to procedure. PVSA positivity rates were evaluated across time cutoffs from 85 to 115 days. Of 364 men presenting for consultation, 263 (72%) proceeded with vasectomy. Patients reporting any pre-consult independent research were more likely to follow through compared to those reporting no preparation (86% vs 58%; OR 4.36, p = 0.002). Only 6% of patients reported the Supreme Court decision as influencing their decision. UPCs occurred in 13.3% of patients and were unaffected by nursing follow-up calls. 83% of patients completed PVSA, with positivity declining sharply when testing was performed after 100 days, from 8% to less than 3% (OR 4.57, p = 0.012). Pre-consult patient preparation is a strong predictor of vasectomy care pathway completion. Although observational, nursing follow-up phone calls did not appear to minimize UPC frequency in our cohort. Scheduling PVSA at or beyond 100 days post-procedure was associated with reduced positive semen analyses. Finally, the recent Supreme Court Dobbs decision had minimal influence on men. These findings support the development of targeted educational interventions to optimize pathway completion and minimize UPC.
To describe the humanistic and economic burden among informal caregivers of individuals with transfusion-dependent β-thalassemia (TDT) across the US and Europe. A mixed-methods study was conducted with qualitative interviews in the US and UK and an online survey in the US, UK, France, Italy, and the Netherlands. The survey included CarerQoL-7D, ZBI-12, and WPAI: CG and captured time spent providing informal care and out-of-pocket (OOP) expenses. Interviews were analyzed using the Framework Method, and survey data with descriptive analyses. Monetary values were standardized to US dollars (2025 USD). Interviews with 10 caregivers revealed five key themes: (1) Need for a strong support network; (2) Burden of disease management and constant care; (3) Barriers and facilitators to optimal care; (4) Impact on caregivers' daily life, work, and aspirations; and (5) Emotional distress and impacts on well-being. Seventy caregivers completed the survey. The CarerQoL-7D indicated adverse impacts on quality of life (QoL), with > 60% reporting mental health, daily activity, and physical health problems. On average, US and European caregivers spent 34.7 and 40.5 h per week performing caregiving activities, respectively. WPAI: CG results indicated overall work impairment of 33 and 43% among US and European caregivers, respectively. Average annual OOP expenses were $6000 in the US and $3348 in Europe. Caregivers of people with TDT experience negative impacts on QoL and work productivity. There is a need for healthcare policies to address caregiver's distinct challenges. Improving access to emerging therapies may ease caregiver and patient burden.
Nonmedical vaccine exemptions are increasingly common in the United States and threaten population immunity levels in children. While vaccine hesitancy and pediatric vaccination coverage in the United States have been extensively researched, work focused on vaccine exemptions remains relatively limited. The objectives of this study are to examine associations between parental religious, partisan, and vaccine-hesitant social identities and vaccine exemptions. A national, cross-sectional survey was conducted from August 20 through September 9, 2025. Parents and legal guardians of children five years of age or younger were recruited from an online panel and asked if their child had ever missed a vaccination due to a medical or nonmedical vaccine exemption. A total of 1,042 respondents were included in the data analysis, 72 of whom reported that their child did not receive a vaccine due to a nonmedical exemption. The prevalence of nonmedical vaccine exemptions differed significantly according to respondent race, partisanship, religiosity, and vaccine-hesitant identity. Multiple logistic regression modeling produced significant associations between nonmedical exemptions and race, education, religiosity, and vaccine-hesitant identity. These findings reinforce previously identified predictors of vaccine hesitancy in the United States but also extend the evidence base by explicitly examining predictors of vaccine exemptions.
Understanding of real-world clinical practice for patients with atopic dermatitis (AD) in the Middle East is limited. We aimed to describe clinical characteristics, treatment patterns and disease burden for adult patients. Data were drawn from the Adelphi Real World AD Disease Specific Programme™, a cross-sectional survey of qualified dermatologists and their patients in the United Arab Emirates, Kingdom of Saudi Arabia, Kuwait, Qatar and Turkey between September 2022 and March 2023. Dermatologists reported patient demographics, clinical characteristics and treatment history. Patients reported the Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), EQ-5D-5L, and Work Productivity and Activity Impairment questionnaire. Overall, 209 dermatologists reported data on 736 patients, of whom 437 self-reported data. Dermatologists subjectively determined that 200 patients had 'mild', 283 had 'moderate' and 253 had 'severe' AD at survey. Mean (SD) patient age was 28.8 (8.1) years; 50% were male and 50% female. Overall mean (SD) POEM scores were 9.7 (5.5), DLQI were 9.7 (5.5), EQ-5D-5L were 0.72 (0.29) and overall work impairment was 46.0% (22.3%). Majority were prescribed topical treatments (89%), 18% received systemic immunosuppressants and 13% received biologics. Our findings highlight the disease burden and need to use more efficacious treatment in the Middle East, to improve clinical outcomes.
Advances in neonatal intensive care in Kazakhstan have improved the survival of preterm infants, including those with very low birth weight (VLBW) and extremely low birth weight (ELBW). However, after hospital discharge, these medically vulnerable children may remain insufficiently protected against vaccine-preventable infections because of prolonged temporary medical exemptions, clinical caution, parental concerns, and fragmented coordination between specialized follow-up services and primary health care. This study aimed to assess vaccination coverage in a 10-year cohort of high-risk preterm infants and to identify clinical, parental, and organizational factors associated with delayed immunization. We conducted a retrospective cohort study of 331 high-risk preterm infants followed at a specialized pediatric center in Astana, Kazakhstan, between 2015 and 2024. Vaccination status at hospital discharge and at 24 months of chronological age, documented temporary medical exemptions, reasons for delayed or missed vaccination, and confirmed cases of pertussis and measles were analyzed. A supplementary cross-sectional survey of parents, physicians, and health care managers was conducted to further explore barriers to catch-up immunization. At hospital discharge, 259 infants (78.2%) had not received the BCG or hepatitis B vaccine. By 24 months of age, 34.1% (n = 113) were fully vaccinated according to age, whereas 49.8% (n = 165) remained completely unvaccinated. During the observation period, 30 cases of measles and 17 cases of pertussis were recorded within the cohort, primarily during nationwide outbreaks. Among the 10 children with a history of measles before 12 months of age, 2 developed subacute sclerosing panencephalitis (SSPE), 1 developed profound hearing loss, and 1 required prolonged oxygen therapy following pneumonia. In addition, 2 children with periventricular leukomalacia (PVL) experienced clinical deterioration, while 1 infant with pertussis required hospitalization during the acute phase of illness. High-risk preterm infants in this cohort experienced substantial and persistent gaps in immunization after hospital discharge. These findings underscore the importance of regular reassessment of temporary medical exemptions, improved coordination between specialized follow-up services and primary health care, and strengthened catch-up immunization strategies for medically vulnerable children.