Child sexual abuse is the most frequently reported form of violence against children in Indonesia, with reported cases increasing over the past 5 years. This study aimed to identify risk and protective factors associated with sexual abuse among adolescents aged 13-17 years in Indonesia. The analysis used data from the 2024 National Survey of Children's and Adolescents' Life Experiences (SNPHAR), including 6,811 respondents. Bivariate analyses were conducted using chi-square tests to identify variables associated with sexual abuse. Variables with p-values less than 0.25 in binary logistic regression were included in multivariable logistic regression. Odds ratios, adjusted odds ratios (AORs), and 95% confidence intervals (CIs) were calculated to identify risk and protective factors associated with the experience of sexual abuse. Overall, 8.74% of respondents reported experiencing sexual abuse. Protective factors included never having worked (AOR, 0.774; 95% CI, 0.606 to 0.989; p<0.05), never having witnessed violence (AOR, 0.200; 95% CI, 0.166 to 0.243; p<0.001), and no history of sexual intercourse (AOR, 0.083; 95% CI, 0.042 to 0.155; p<0.001). Conversely, positive gender attitudes (AOR, 1.556; 95% CI, 1.295 to 1.869; p<0.001) and knowledge of child protection services (AOR, 3.854; 95% CI, 3.147 to 4.720; p<0.001) were unexpectedly associated with elevated risk. Violence-free environments and limited exposure to early sexual experiences appear to represent critical protective factors. Counterintuitive associations suggest potential influences of cultural norms, patriarchy, and limited access to services.
The gendered nature of UK gyms presents barriers to women's use of these spaces, where they often feel intimidated and self-conscious. Personal trainers (PTs) could be instrumental in creating less objectifying exercise environments for women. Exploring the actual interactions in personal training sessions and the dyadic experiences of these interactions could further understanding on how fitness professionals can improve women's experiences of exercise. The present study aimed to explore PTs' and their women clients' perspectives on their body-related interactions in their sessions. Six PT-client dyads from the UK took part in an observation-interview study. We used a novel method involving triangulating data from the personal training session itself, an interview with the PT and an interview with the client. Interactions from each dyad's recorded session were selected according to Objectification Theory and previous research in the personal training context. PTs and clients were then interviewed about their experiences of the selected interactions. Data from sessions and interviews were analysed using a critical realist reflexive thematic analysis. Four themes were generated and presented as composite vignettes: 1) A Body Alliance: How Relational History Creates a Safe Space, 2) Fluidity of Expertise Over the Client's Body, 3) When Body Talk is Lost in Translation, and 4) Strength in Reassurance. Findings suggest ways in which PTs can communicate in order to promote positive body image amongst their clients. This understanding provides insight into how to fitness professionals may reduce barriers to exercise for women, such that more women engage in exercise long-term.
Use of anti-B-cell maturation antigen (BCMA) chimeric antigen receptor T-cell (CAR-T) therapy to treat relapsed/refractory multiple myeloma is increasing. Studies suggest that effective bridging therapy (BT) prior to anti-BCMA CAR-T therapy can enhance efficacy and safety outcomes. Through qualitative interviews and a consensus workshop, 10 European experts shared their clinical experience regarding optimal BT selection, efficacy, safety and outcomes post-CAR-T, focussing on heavily pretreated patients and emerging BT options, such as bispecific T-cell engagers. Experts agreed that BT should aim to reduce tumour burden and maintain or improve patient performance status, while avoiding treatment-related toxicity that could delay or prevent CAR-T infusion. The balance between treatment duration and achieving an adequate response is important, and patient characteristics are key for BT selection, especially in difficult-to-treat populations. Here, we discuss the unique therapy talquetamab, a GPRC5DxCD3 bispecific antibody, which demonstrates robust efficacy and rapid response rates in clinical trials, and is being considered as a BT option before anti-BCMA CAR-T therapy based on expert experience and real-world data. This consensus, based on clinical experience, aims to provide guidance on BT for healthcare professionals (HCPs) involved in anti-BCMA CAR-T therapy and aid standardisation of care in this rapidly advancing field.
To examine provider and patient usage, engagement, and experiences with the Seamless Care Optimizing the Patient Experience Mental Health (SCOPE-MH) program, as well as explore how the program has been adapted across hubs. This research used a multimethod study design conducted across 8 SCOPE-MH hubs between January 2021 and June 2023. Ontario. SCOPE-MH staff, providers, and patients were included. Overall, 36 physicians and 44 patients completed surveys, and 29 interdisciplinary hub representatives participated in interviews. Data collection were guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and included a cross-sectional survey with providers and patients, along with qualitative interviews with SCOPE-MH staff. The evaluation focused on patient satisfaction, provider engagement, program effectiveness, and hub adaptations. Survey data were analyzed descriptively, while qualitative data, including pathway depictions, were analyzed using content analysis. Survey responses from providers and patients at the inaugural SCOPE-MH hub demonstrated the program's positive impact on care and service delivery. Findings show that SCOPE-MH effectively linked unaffiliated providers to mental health resources and services. Analysis of interview data identified variations in staffing, services, and target populations compared to the pilot pathway, demonstrating potential for adaptation to meet diverse needs. The SCOPE-MH program improved primary care for mental health by facilitating access to resources and improving provider and patient experiences at the inaugural hub. Its adaptable model offers valuable insights for health care organizations designing or evaluating similar interventions. While findings from the pilot hub highlight the potential of such care models to enhance service delivery, evaluation in additional hubs is ongoing, and results from these subsequent implementations remain preliminary.
Traumatic events can disrupt neurodevelopment, increasing the risk for neuropsychiatric disorders. However, the relationships between specific types of traumas and the emergence of particular neuropsychiatric traits remain elusive. Here, we examine the long-term consequences of different life-threatening events experienced during four distinct developmental periods in mice. Our findings at the behavioral and molecular/cellular levels in adulthood suggest a crucial role for timing (rather than type) of stress during development in shaping long-term outcomes. Our parallel analysis of individuals exposed to trauma at diverse life stages reveals similar results. Finally, our proteomic data suggest the brain-derived neurotrophic factor (BDNF)-pathway as a promising therapeutic target for ameliorating psychopathology related to trauma experienced specifically in early adulthood in mice and potentially in individuals. Our results point to the existence of critical periods for trauma exposure that uniquely influence adult behavioral outcomes and induce time-specific molecular/cellular patterns in the brain, which may have therapeutic implications.
With longer survivals in advanced cancer, the need for supportive care is increasing. However, in Korea, these services remain limited, and many patients rely on long-term care hospitals. We investigated the supportive care experiences of patients with advanced cancer and their caregivers, and preferred place of care (pPOC) by performance status (PS). A cross-sectional survey was conducted at a tertiary hospital in Seoul, Korea, targeting patients hospitalized only for supportive care and their caregivers. PS was assessed using the Eastern Cooperative Oncology Group scale [good (0-1) or poor (2-4)]. Hospital and home care experiences and pPOC were compared by PS. Logistic regression analysis was used to identify factors associated with pPOC. This study included 200 participants (117 patients, 83 caregivers). Among patients, 72% had good PS and 28% had poor PS. Main reasons for hospitalization were symptom control (51.2%), assistance with daily living (36.5%), and device or wound management (22.5%). Overall, 60.5% of participants reported discomfort during hospitalization, mostly related to hospital life, and 34.5% noted that care was insufficient at home, particularly those in the poor PS group (27.1% vs. 53.6%). Concern about emergencies was the most common home-care difficulty. Despite these challenges, 60% of participants chose home as their future pPOC, with no significant differences by PS or other demographic/clinical factors. Although most patients with advanced cancer and their caregivers preferred home for supportive care, many relied on hospitals. Structured home-based medical care programs are urgently required in South Korea.
To evaluate the content and structure of OCD-specific training within United States osteopathic (D.O.) and allopathic (M.D.) medical schools. Although many physicians encounter patients with obsessive-compulsive disorder (OCD) in clinical practice, limited familiarity with the full range of OCD presentations, including typical and atypical forms, may contribute to misdiagnosis and delays in accurate diagnosis and treatment. Respondents from 35 of the 154 (22.73%) medical schools within the United States (28 (80%) allopathic, 7 (20%) osteopathic schools) completed a survey assessing demographics, school information, and OCD-focused training within medical school curriculums. Descriptives were gathered to characterize the level of training experience and type of training, and information provided throughout pre-clinical and clinical training. Length of OCD-specific training varied among schools, with an average of 1.79 h total (standard deviation = 1.18 h). Few schools had faculty members or elective coursework and rotations specific to OCD training and education. Content covered was variable; for example, contamination was the most frequently taught (91.4%) while responsibility for harm was the least frequently taught (48.6%). The concept of ego-dystonia in OCD was taught in most medical schools (75.8%). While many medical schools contain basic education and training on OCD, there are significant gaps in training that may contribute to delays in diagnosis or even cases of misdiagnosis. Addressing these gaps in training could improve the diagnosis and treatment of OCD within clinical practice.
Growing evidence identifies linkages between drought and flooding and poorer sexual health outcomes, yet adolescents and youth are understudied in this research. We aimed to explore the lived experiences of adolescents and youth regarding the associations between drought/flooding, resource insecurity, and sexual health in Mathare and Kisumu, Kenya. We conducted a multi-method qualitative study in Mathare, an urban informal settlement in Nairobi, and Kisumu and adjacent fishing communities, with a purposive sample of youth aged 16-24 years. We conducted SenseMaker individual interviews with the web-based tool, followed by group-based digital storytelling workshops. We conducted framework thematic analysis guided by the resource insecurity framework. SenseMaker participants included n = 20 youth (Kisumu: n = 10 women; Mathare: n = 5 women and n = 5 men), followed by four group-based digital storytelling workshops with 33 youth (Kisumu: n = 9 women; Mathare: n = 8 mothers, n = 8 men; n = 8 women). There were 42 unique participants. Participant narratives reflected the following themes: (1) drought and flooding exacerbate multiple resource insecurities (food, water, sanitation, menstruation); (2) increased resource insecurity-related transactional sex; (3) drought, flooding, and resource insecurities increase risks of sexual and gender-based violence; and (4) youth recommend structural- and community-level strategies for promoting sexual health. Findings from a sample of youth in two climate-affected Kenyan settings identify complex pathways from drought and flooding to sexual health, particularly through resource insecurity, transactional sex, and sexual and gender-based violence. Findings can guide the integration of extreme weather and sexual health programming with youth to integrate economic empowerment and sexual and gender-based violence reduction to advance equity and rights.
In this early career review article, we aimed to portray a sense of the important skills and knowledge obtained but more importantly the incredible ethos of collaboration and mentorship we experienced. These are attributes we have brought forward to our current roles, ensuring the patient stays at the center of service development, focusing on excellence in care and advocating for patients at a local and national level.
Constrictive pericarditis represents the end stage of chronic pericardial inflammation and is characterized by impaired diastolic filling due to pericardial fibrosis and/or calcification, leading to progressive right-sided heart failure. Pericardiectomy remains the definitive treatment, yet perioperative risk remains substantial in patients with advanced disease. We performed a retrospective single-center cohort study of 47 consecutive patients undergoing surgical pericardiectomy for constrictive pericarditis between January 2010 and December 2021. Perioperative characteristics, operative strategy, and early outcomes, including 30-day mortality, postoperative morbidity, and length of stay, were assessed. Mean age was 58 ± 14 years, and 64% of patients were male (n = 30). In the study 65% of patients presented with NYHA functional class III to IV, and operative risk was elevated, with a mean EuroSCORE II of 8.5 ± 2.3 and a mean STS score of 9.4 ± 2.3. Median sternotomy was used in 94% of patients (n = 44), radical pericardiectomy in 64% (n = 30), and a beating-heart strategy without cardiopulmonary bypass in 79% (n = 37), whereas cardiopulmonary bypass was required in 21% (n = 10). We found 30-day all-cause mortality was 6% (n = 3). Major postoperative complications included sepsis in 13% (n = 6) and renal failure requiring dialysis in 8.5% (n = 4). Mean ICU stay was 3.7 ± 4.5 days, and mean total hospital stay was 11 ± 6.7 days. Pericardiectomy for constrictive pericarditis can be performed with acceptable early mortality and morbidity even in a high-risk population. In experienced centers, an individualized surgical strategy prioritizing extensive pericardial resection with selective use of cardiopulmonary bypass appears feasible for the management of advanced disease.
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This study aimed to investigate the clinical efficacy and safety of dabrafenib plus trametinib for BRAFV600E-mutated advanced thyroid carcinoma in a Japanese real-world setting. We analyzed 37 BRAFV600E-mutated advanced thyroid carcinoma patients treated with dabrafenib plus trametinib between November 2023 and July 2025. Thirty-one patients (84%) had papillary thyroid carcinoma (PTC) histology, one (3%) had poorly differentiated thyroid carcinoma (PDTC) histology, and 5 (13%) had anaplastic thyroid carcinoma (ATC) histology. Among 31 PTC patients, dabrafenib plus trametinib was initiated as first-line treatment in 16 patients. The most common previous systemic therapy was lenvatinib (n = 16, 43%). The most common sites of target lesion were the lung (n = 23, 62%) and lymph node (n = 23, 62%). The median sum of the diameters of the target lesion was 40 mm (range, 8-166 mm). The objective response and disease control rates were 29% and 74% in patients with PTC, and 50% and 83% in patients with non-PTC (PDTC and ATC), respectively. The 12-month progression-free survival rates in patients with PTC and non-PTC (PDTC and ATC) were 73.2% (95% confidence interval [CI], 48.7-87.4%) and 60.0% (95% CI, 12.6-88.2%) (hazard ratio, 2.769; 95% CI, 0.691-11.1; p = 0.134), respectively. Dabrafenib plus trametinib treatment showed a response rate similar to that observed in clinical trials for BRAFV600E-mutated advanced thyroid carcinoma in this real-world study. However, long-term follow-up is required to determine the efficacy of dabrafenib plus trametinib treatment.
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In end-stage biventricular heart failure, heart transplantation remains the gold standard, but graft shortage and temporary contraindications may preclude access. Among patients who are ineligible for a total artificial heart (TAH), biventricular implantation of continuous-flow left ventricular assist devices (LVADs) has been reported as an off-label salvage strategy in highly selected patients. From 2023 to 2025, we included consecutive patients who underwent - as a bridge to transplantation - simultaneous biventricular HeartMate 3 implantation at Rennes University Hospital. All had refractory biventricular heart failure and met strict eligibility criteria. We used a previously published surgical approach, with right-sided implantation through an atrial inflow. This retrospective single-centre analysis included 10 patients who underwent simultaneous biventricular HeartMate 3 implantation. The procedure proved technically feasible. Early mortality occurred in 30% of patients, while the remaining patients achieved initial haemodynamic stabilization under biventricular support. A successful bridge to transplantation was achieved in 30%, after a median (interquartile range) support duration of 223 (153-256) days. Major complications included reoperation for bleeding in 20%, significant infection in 30% but no ischaemic strokes. At discharge, end-organ function was preserved, with median creatinine of 61μmol/L and median bilirubin of 10μmol/L. The so-called HeartMate 6 procedure may represent a feasible salvage bride-to-transplant option in highly selected patients when TAH is unavailable or anatomically unsuitable. Careful selection of patients and a highly trained surgical team is mandatory.
Very preterm (VP) infants undergo rapid brain development while hospitalized in the neonatal intensive care unit (NICU). Meaningful auditory experiences enhance brain development, yet understanding VP infants' auditory environment remains a challenge. We examined the trajectories of auditory exposures of VP infants before term-equivalent age. This was a prospective, observational study of 25 VP infants born ≤32 weeks and 6 days gestation in a hybrid-design NICU. We collected 128 auditory recordings using language environment analysis (LENA) devices, with up to six consecutive weekly recordings per infant. We performed repeated-measure correlations between auditory measurements and postmenstrual age (PMA) and assessed relationships with room type and parental presence using stratification. Between 31 and 39 weeks PMA, VP infants experienced primarily silence (63.2% of recorded time) and electronic sounds (14.5%), with overall limited meaningful language exposure (3.9%). With advancing PMA and transitioning from single-family rooms to semi-private bays, meaningful language increased (r = 0.54, p < 0.001) and noise exposure decreased (r = -0.59, p < 0.001). Higher parental presence appeared to positively correlate with language exposure. VP infants experience reduced meaningful auditory exposures during NICU hospitalization. Further work should examine how modifiable NICU environment factors could be leveraged to optimize auditory experiences during a sensitive period. NICU auditory environments remain suboptimal for preterm infants, with a predominance of silence and limited meaningful experiences. In this hybrid-design NICU, meaningful language exposures monitored longitudinally increased with advancing postmenstrual age and as infants transitioned from single-family rooms to semi-private bays. Modifiable factors, including NICU designs, models of care, and parental presence, may play a role in optimizing auditory exposures of preterm infants. A better understanding of factors influencing the auditory experience can facilitate the design of effective interventions in the NICU.
Although women who experience perinatal loss can donate breastmilk to milk banks, psychological and psychosocial effects on them remain understudied. Understanding these impacts is crucial for delivering comprehensive, person-centered care throughout the donation process. This qualitative systematic review aims to fill this knowledge gap by synthesizing experiences from relevant qualitative studies. We conducted comprehensive searches of multiple databases, including PubMed, Web of Science, the Cochrane Library, EMBASE, CINAHL, CNKI, Wanfang Data, VIP, and SinoMed. The review covers qualitative empirical studies published from database inception through March 2024. A meta-synthetic methodology was employed to synthesize the included studies. Five synthesized findings were derived: (a) diverse motivations for donating breastmilk; (b) positive experiences in the process of donating breastmilk; (c) negative experiences in the process of donating breastmilk; (d) facilitators and barriers to breastmilk donation; (e) reconstructing meaning after perinatal loss. The results of this study emphasize that sustained attention should be paid to the experiences of breastmilk donation among women experiencing perinatal loss to guide healthcare professionals in providing more individualized bereavement support and breastmilk donation programs. Trial Registration: CRD42024508866.
Single-incision laparoscopic totally extraperitoneal inguinal hernia repair (SILS-TEP) provides excellent cosmetic outcomes but is technically more demanding than conventional multi-port TEP. Most studies on learning curves focus on single-surgeon experiences. This study aimed to evaluate the collective learning curves of SILS-TEP among multiple experienced gastrointestinal surgeons using cumulative sum (CUSUM) analysis. We retrospectively reviewed 1500 consecutive unilateral SILS-TEP procedures performed by six surgeons (250 cases per surgeon) between May 2021 and December 2025. All surgeons were proficient in general laparoscopic surgery (10-33 years of experience) but were novices in SILS-TEP. Learning curves were analyzed based on operative time using CUSUM analysis. The proficiency threshold was identified, and perioperative outcomes were compared between the learning phase (Phase 1) and the experienced phase (Phase 2). CUSUM analysis identified a mean proficiency threshold of 95 cases (range: 63-147 cases) across all surgeons. The median operative time significantly decreased from 81 min in Phase 1 to 66 min in Phase 2 (p < 0.0001). While recurrence (0.067%) and overall complication (1.67%) rates remained stable, the incidence of peritoneal injury was significantly lower in Phase 2 compared to Phase 1 (p = 0.0004). The learning curve for SILS-TEP stabilized at an institutional mean of 95 cases under a structured mentoring program. However, individual proficiency thresholds varied notably, ranging from 63 to 147 cases. These findings suggest that while 95 cases serve as a useful institutional benchmark, training programs should remain flexible to accommodate individual surgical learning paces to ensure maximum safety.
The capacity of hippocampal circuits to transform inputs into downstream outputs is fundamental to navigation and memory, yet the circuit-level mechanisms that enable this flexibility in adapting to experience remain unclear. Here we approach this problem by performing large-scale (up to 1,024 channel) recordings across the hippocampal-retrosplenial cortex (RSC) circuit in behaving mice, enabling simultaneous access to spiking activity in dentate gyrus (DG), CA3, CA2, CA1 and RSC. On the basis of a linear dimensionality-reduction technique known as partial canonical correlation analysis, we identify low-dimensional communication subspaces1 between two regions while accounting for influences from a third area. These subspaces captured distinct input-output transformations in the CA1 region, linking upstream hippocampal activity (DG, CA3 and CA2) to downstream cortical targets (RSC). Intrinsic firing properties and anatomical location constrained subspace memberships-members were mapped to deep sublayers of the CA3-CA1-RSC axis during both spatial and non-spatial tasks. These subspaces could recombine overlapping neuronal pools to support distinct interareal interactions across changing experiences and brain states. Reactivation patterns of CA1-CA3 subspaces, but not those of CA1-RSC, during post-experience sleep correlated with replay, reflecting a plasticity-stability balance in the input-output transformation along the hippocampal-retrosplenial axis. Our findings suggest a model in which hippocampal-neocortical communication reconfigures predetermined circuit motifs to flexibly encode experiences.
The integration of artificial intelligence (AI) into clinical decision support (CDS) holds promise for proactive, personalized, and precision care. However, current understanding of how to establish trustworthy human-AI partnerships is in its infancy, despite its critical importance for implementing AI in healthcare. We present the Asthma-Guidance and Prediction System (A-GPS) as a case study of a practice-integrated AI platform that demonstrates how trustworthy, generalizable and sustainable AI can be developed, evaluated, and implemented in real-world asthma care. We describe major challenges and solutions based on our real-world experience during the process and offer the practical framework, approaches, tools and workflow for implementing trustworthy, generalizable and sustainable AI in frontline practices. While A-GPS is an asthma-specific AI tool, it was built on top of a disease-agnostic electronic health record (EHR)-integrated clinical decision support (CDS) platform based on an Application Programming Interface (API)‑first backbone of reusable services. It was designed to reduce chart-review/processing burden and enable proactive, guideline-concordant asthma management by synthesizing fragmented longitudinal multimodal data into a clinical decision-relevant summary at the point of care. A-GPS platform integrates multiple natural language processing (NLP) algorithms to leverage free texts info in EHRs, machine learning model to offer risk stratification, and remote patient monitoring (RPM) approaches to capture real-time data from patients, enabling remote asthma (chronic disease) care. The platform has been deployed via Substitutable Medical Applications and Reusable Technologies-on-Fast Healthcare Interoperability Resources (SMART-on-FHIR) to ensure in-workflow delivery and maintainable governance making it flexible and interoperable across different EHRs systems and different chronic diseases. The translational maturity of A-GPS as an AI-powered CDS tool for pediatric asthma was demonstrated and sustained through engagement and co-design with diverse community and care team partners, including adult and pediatric Community Advisory Board, pediatric patients and their parents, clinicians (primary care providers and specialists), nurses, schedulers, as well as bioethicists and regulatory experts. Moreover, the tool was evaluated in two randomized clinical trial (RCT)s. The first trial showed a 67% reduction in clinicians' EHR review time, high clinician satisfaction, potential healthcare cost savings, fairness in model performance, and no adverse events. Trustworthiness was further assessed and supported through fairness evaluation by participant socioeconomic status (SES) using the HOUsing-based SocioEconomic Status (HOUSES) index, human-centered user interface/user experience (UI/UX) analysis, clinician workflow optimization, transparent governance practices, and best practices for regulatory science. The A-GPS experience operationalizes a reproducible, lifecycle-governed framework for generating decision-grade evidence on safety, effectiveness, usability, fairness, and workflow integration, directly addressing the translational gap between AI model development and trustworthy, sustainable deployment in real-world clinical environments. These efforts led to national recognitions, including invitation to the inaugural American Medical Informatics Association (AMIA) AI Showcase, and AI evaluation use case for a national health AI coalition. The second RCT evaluated the feasibility of integrating a remote patient monitoring (RPM) device (home spirometry) into the A-GPS platform, with a published RCT protocol that serves as a framework for RCT for evaluating AI models under the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines for RCTs that evaluate AI tools, offering the practical framework, approaches, tools, and workflow for trustworthy, generalizable and sustainable AI tools in asthma care. This work illustrates how team science, community engagement, implementation science, and learning health system principles can be operationalized to establish a human-AI partnership model to advance translational science and clinical care, with the goal of improving health for all.