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Context: The need for socially innovative care models is crucial in addressing the challenges posed by ageing populations. Social innovations developed in other settings often require adaptation to ensure they are the best fit for a new setting. Perspective: We propose that participatory Theory of Change workshops can strengthen the development and adaptation of best-fit social innovations in long-term care by engaging multiple stakeholders to develop a program theory which describes how a complex programme or policy is hypothesised to work in a given context. We use an example from InCARE, a European Union funded project from 2020 to 2023, which aimed to develop and use participatory processes to design and implement social innovations for long-term care in Spain, Austria and North Macedonia. Implications: Theory of Change can work to develop a common vision with stakeholders, identify and adapt innovative ideas, engage early and meaningfully with stakeholders and partner with stakeholders who can support sustainability as well as outline the challenges and limitations inherent in the Theory of Change approach.

ABSTRACT Case report of a case of acute pancreatitis (AP) at a patient previously known with essential thrombocytosis (ET). The most redoubtable complications of AP in this case were: pancreatic necrosis and splahnic vein thrombosis (SVT). Patient was followed‐up for 3 months with complete resolution of SVT under anticoagulation. As far as we know this is the first case ever published suffering simultaneously from AP and ET, both conditions known for their increased risk of developing thrombi.

Successful participation in Proficiency Testing/Interlaboratory Comparison (PT/ILC) schemes is a method to ensure validity of results for any laboratory. It is also a component of a complex of means for demonstrating technical competence of a laboratory as an organization. The new accreditation standard ISO 17043 for PT providers together with the newly updated ILAC Policy of PT participation introduce a different perspective on the activity of PT provider in regard to quality assurance.

Abstract Background Genomic surveillance is crucial for monitoring malaria transmission and understanding parasite adaptation to interventions. Zambia lacks prior nationwide efforts in malaria genomic surveillance among African countries. Methods We conducted genomic surveillance of Plasmodium falciparum parasites from the 2018 Malaria Indicator Survey in Zambia, a nationally representative household survey of children under five years of age. We whole-genome sequenced and analyzed 241 P. falciparum genomes from regions with varying levels of malaria transmission across Zambia and estimated genetic metrics that are informative about transmission intensity, genetic relatedness between parasites, and selection. Results We provide genomic evidence of widespread within-host polygenomic infections, regardless of epidemiological characteristics, underscoring the extensive and ongoing endemic malaria transmission in Zambia. Our analysis reveals country-level clustering of parasites from Zambia and neighboring regions, with distinct separation in West Africa. Within Zambia, identity by descent (IBD) relatedness analysis uncovers local spatial clustering and rare cases of long-distance sharing of closely related parasite pairs. Genomic regions with large shared IBD segments and strong positive selection signatures implicate genes involved in sulfadoxine-pyrimethamine and artemisinin combination therapies drug resistance, but no signature related to chloroquine resistance. Furthermore, differences in selection signatures, including drug resistance loci, are observed between eastern and western Zambian parasite populations, suggesting variable transmission intensity and ongoing drug pressure. Conclusions Our findings enhance our understanding of nationwide P. falciparum transmission in Zambia, establishing a baseline for analyzing parasite genetic metrics as they vary over time and space. These insights highlight the urgency of strengthening malaria control programs and surveillance of antimalarial drug resistance.

Proficiency Testing/Interlaboratory Comparisons play an important role that is widely accepted in demonstrating the validity of results of any laboratory and inspection body. To ensure a coherent approach in the field within an economy, accreditation bodies develop specific policies for laboratories and inspection bodies’ participation in proficiency testing/interlaboratory comparisons.

Background. The purpose of this research was to evaluate the degree of mineralization as well of the chemical composition at the interface of failed dental implants with surrounding bone. Material and methods. The analysis was performed on human histological samples by the aid of a scanning electron microscope and an energy-dispersive x-ray spectroscopy (ESEM-EDX). Results. The middle and the apical region of the implant surfaces had higher quantity of bone tissue deposition. A higher degree of mineralization was observed in these two regions as well. Conclusion. From the analysis performed by the aid of scanning electron microscopy, it appears that the bone tissue deposition is better represented in the middle and apical region of the implants.

Summary: Background: A highly effective vaccine for malaria remains an elusive target, at least in part due to the under-appreciated natural parasite variation. This study aimed to investigate genetic and structural variation, and immune selection of leading malaria vaccine candidates across the Plasmodium falciparum's life cycle. Methods: We analysed 325 P. falciparum whole genome sequences from Zambia, in addition to 791 genomes from five other African countries available in the MalariaGEN Pf3k Database. Ten vaccine antigens spanning three life-history stages were examined for genetic and structural variations, using population genetics measures, haplotype network analysis, and 3D structure selection analysis. Findings: Among the ten antigens analysed, only three in the transmission-blocking vaccine category display P. falciparum 3D7 as the dominant haplotype. The antigens AMA1, CSP, MSP119 and CelTOS, are much more diverse than the other antigens, and their epitope regions are under moderate to strong balancing selection. In contrast, Rh5, a blood stage antigen, displays low diversity yet slightly stronger immune selection in the merozoite-blocking epitope region. Except for CelTOS, the transmission-blocking antigens Pfs25, Pfs48/45, Pfs230, Pfs47, and Pfs28 exhibit minimal diversity and no immune selection in epitopes that induce strain-transcending antibodies, suggesting potential effectiveness of 3D7-based vaccines in blocking transmission. Interpretation: These findings offer valuable insights into the selection of optimal vaccine candidates against P. falciparum. Based on our results, we recommend prioritising conserved merozoite antigens and transmission-blocking antigens. Combining these antigens in multi-stage approaches may be particularly promising for malaria vaccine development initiatives. Funding: Purdue Department of Biological Sciences; Puskas Memorial Fellowship; National Institute of Allergy and Infectious Diseases (U19AI089680).

Background. Sinus floor elevation is considered a safe procedure to properly augment the height of the edentulous crest. Often, complications may arise due to multiple causes and can lead to a poor outcome of the graft and implant’s osseointegration. A careful surgical approach, a good knowledge of possible obstacles, and careful treatment planning can reduce the risks of complications, as well as their impact on the surgical outcome. This study aims to make a literature review of 40 articles, analyzing the incidence and type of complications related to maxillary sinus graft surgeries and graft materials. Material and methods. A total of 40 articles published between 2015 and 2021 were selected for a systematic literature review on maxillary sinus floor complications. The studies were selected from 2 different internet databases: PubMed and Science Direct. The sinus lift complications were counted and their incidence was organized upon the surgical technique and the timing of occurrence (intraoperative, postoperative). It was also analyzed if the graft material influences the complication rate. Results. In a group of 1757 sinus augmentation surgeries performed on 1605 patients, 363 complications were found. Sinus membrane perforation occurred in 242 cases, 29 procedures resulted in partial or total graft loss, there were 26 postoperative cases of sinusitis, 24 sinus infections, 16 wound dehiscence, 6 bleeding complications, 5 lost implants, and 2 oro-antral fistulas. Conclusion. Sinus lift complications are sometimes inherent circumstances of the procedures, but they can also be prevented through an accurate technique and preoperative plan. The type of bone graft does not influence the incidence of surgical complications.

Preeclampsia and systemic lupus erythematosus are medical conditions with established elevated risks of pregnancy complications and fetal compromise. Active lupus during pregnancy can trigger the appearance of preeclampsia. Research has demonstrated an increase in lupus disease flares during pregnancy, secondary to hormonal shifts required in order to maintain pregnancy. Hemolytic anemia, leucopenia, thrombocytopenia, sudden onset of hypertension after 20 weeks of gestation and decreasing complement components such as C3, C4 and CH50 are hallmarks of lupus flares during pregnancy. Timely and accurate prediction of preeclampsia is now feasible through estimation of novel placental and endothelial biomarkers, chiefly sFlt-1 and PIGF. A sFlt-1 to PIGF ratio under 38, in patients under 34 weeks of gestation suspected of disease, boasts the highest negative predictive value for preeclampsia and can successfully rule out preeclampsia development in the following 4 weeks in patients with normal values. Moreover, the sFlt-1 to PIGF ratio has proven its utility in the differential diagnosis of preeclampsia and active lupus nephritis, with normal ratio values noted in cases of lupus flares during pregnancy. Further research is required in order to identify other novel potential biomarkers.

Abstract Research integrity, an essential precept of scientific inquiry and discovery, comprises norms such as Rigor, Reproducibility, and Responsibility (the 3R’s). Over the past decades, numerous issues have arisen that challenge the reliability of scientific studies, including irreproducibility crises, lack of good scientific principles, and erroneous communications, which have impacted the public’s trust in science and its findings. Here, we highlight one important component of research integrity that is often overlooked in the discussion of proposals for improving research quality and promoting robust research; one that spans from the lab bench to the dissemination of scientific work: responsible science communication. We briefly outline the role of education and institutions of higher education in teaching the tenets of good scientific practice and within that, the importance of adequate communications training. In that context, we present our framework of responsible science communication that we live by and teach to our students in courses and workshops that are part of the Johns Hopkins Bloomberg School of Public Health R3 Center for Innovation in Science Education.

Abstract A major challenge in understanding the neurobiological basis of psychiatric disorders is rigorously quantifying subjective metrics that lie at the core of mental illness, such as low self-esteem. Self-esteem can be conceptualized as a ‘gauge of social approval’ that increases in response to approval and decreases in response to disapproval. Computational studies have shown that learning signals that represent the difference between received and expected social approval drive changes in self-esteem. However, it is unclear whether self-esteem based on social approval should be understood as a value updated through associative learning, or as a belief about approval, updated by new evidence depending on how strongly it is held. Our results show that belief-based models explain self-esteem dynamics in response to social evaluation better than associative learning models. Importantly, they suggest that in the short term, self-esteem signals the direction and rate of change of one’s beliefs about approval within a group, rather than one’s social position.

Introduction. COVID-19 is a viral infection with a variable clinical spectrum, ranging from asymptomatic carrier state to severe pneumonia. It is associated with a variety ofcomplications, including musculo-skeletal abnormalities. Whereas myalgia is a common clinical finding at these patients, only a few cases of COVID-19-associated rhabdomyolysis have been described in the literature. Case presentation. We describe the case of a 42-year old male confirmed with SARS-CoV-2 infection who presented to the emergency department with an 11-day evolution of dyspnea, cough, fatigue, myalgia and hyperchromic urine. The psysical examniation revealed dyspnea and an oxigen saturation of 87% while breathing ambient air, being otherwise normal. Blood tests showed neutrophilia, increased inflammatory markers, COVID-19 associated coagulopathy and elevation of muscular enxymes creatine-kinase and myoglobin. The chest computer tomography was consistent with mixed pneumonia, distributed in all pulmonary segments and the case was interpreted as a severe form of SARS-CoV-2 infection, associated with acute respiratory failure and rhabdomyolysis. Upon treatment (Enoxaparin, Aspirin, Dexamethasone, Favipiravir, oxygen administered by face mask, fluid resuscitation), his condition considerably improved, along with the laboratory findings, and he was discharged, without developing acute kidney injury or other complications related to rhabdomyolysis during his admission. Conclusion. COVID-19 patients can develop rhabdomyolysis, which can result in life-threating complications.

BackgroundAlthough care use should parallel needs, enabling and predisposing circumstances including the socio-demographic inequities of socioeconomic status (SES), gender, or isolation often intervene to diminish care. We examine whether availability of state-funded medical and support services at home can rebalance these individual and social inequities, and do this by identifying if and how intersecting social identities predict homecare use among older Canadian adults.MethodsUsing the Canadian Longitudinal Study on Aging (CLSA) of 30,097 community-dwelling adults aged 45 to 85, we performed recursive partitioning regression tree analysis using Chi-Squared automatic interaction detection (CHAID). Combinations of individual and social characteristics including sociodemographic, family-related, physical and psychological measures and contextual indicators of material and social deprivation were explored as possible predictors of formal and informal care use.ResultsDiminished function i.e. increased need, indicated by Activities of Daily Living, was most strongly aligned with formal care use while age, living arrangement, having no partner, depression, self-rated health and chronic medical conditions playing a lesser role in the pathway to use. Notably, sex/gender, were not determinants. Characteristics aligned with informal care were first-need, then country of birth and years since immigration. Both 'trees' showed high validity with low risk of misclassification (4.6% and 10.8% for formal and informal care, respectively).ConclusionsAlthough often considered marginalised, women, immigrants, or those of lower SES utilised formal care equitably. Formal care was also differentially available to those without the financial or human resources to receive informal care. Need, primarily medical but also arising from living arrangement, rather than SES or gender predicted formal care, indicating that universal government-funded services may rebalance social and individual inequities in formal care use.

Worldwide, cervical cancer ranks 4th in frequency in the female population, with about half of the cases being fatal. In Romania, it is the second type of cancer found in women, after breast cancer and the main cause of cancer mortality in patients aged between 15 and 44 years. The main cause of this type of cancer is human papilloma virus (HPV) infection. Although HPV is very widespread (> 85%), progression to cervical cancer is relatively rare. In countries that have implemented cervical screening programs, the incidence and mortality caused by this pathology have decreased by 50-75%. Also, the emergence of vaccines against the most common strains of oncogenic HPV and the implementation of vaccination programs will bring additional benefits in preventing cervical cancer. This paper presents the results of a retrospective study, performed on a number of 92 patients, which aimed to know the distribution of different HPV genotypes, their impact on the cervical epithelium, the degree of access to the national screening program, and openness to anti HPV vaccination.

Introduction. Peri-implantitis is a condition of the tissues adjacent to dental implants, which can occur in patients with implant-prosthetic restorations, following inadequate prophylactic measures. However, these peri-implants, untreated or improperly treated, can lead over time to quite severe complications, which can quickly turn into emergencies of low, medium or increased intensity in the usual dental care. Purpose. Peri-implantitis is not a major dental emergency, but ignoring and/or treating it incorrectly can lead to complications that are considered major in dentistry. That is why we tried through this study to verify the knowledge related to peri-implantitis as well as the complications that may arise from the nontreatment of these diseases, among the practitioners involved in this field. Material and method. The study was conducted with the help of 37 specialists involved in implantprosthetic treatments, aged between 37 and 53 years, using a 7-point questionnaire. Results and discussions. The results show the concern of specialists in the field of oral implantology regarding peri-implantitis, as well as the complications arising from them. Conclusions. Knowing the causes but also the complications arising from peri-implantitis are very important for the creating preventive programs, which with a reduced effort bring the long-term success of implant supported restorations.

Introduction. Peri-implantitis is a non-specific inflammation, induced or maintained in the host tissues. Peri-implantitis usually presents a succession of specific symptoms, such as: bleeding on palpation, mobility of the dental implant, pain, increased depth of the pockets located around dental implants. Purpose. Thus, in this material we wanted to carry out a review of the main notions, both theoretical and practical, which characterize the diseases of surrounding tissues of dental implant called peri-implantitis. Material and method. For this study, we used 31 practitioners from Bucharest who frequently perform implant-prosthetic rehabilitation treatments, based on a questionnaire consisting of 6 questions. Results and discussions. The doctors included in the study showed that they have a thorough training in the field of implant-prosthetic restorations and of course in the diagnosis and treatment of peri-implantitis. Conclusions. In-depth knowledge of the notions related to peri-implantitis leads to an early diagnosis, favoring the rapid application of a treatment that prevents the occurrence of subsequent complications.

Introduction. Sialolithiasis is one of the most common pathologies of the salivary glands. When calculi are present in the distal excretory duct, in the hilum or in the parenchyma, complete removal of the submandibular gland is recommended. Case report. We present the case of a 43-year-old male patient, suffering from left chronic submandibular sialadenitis. The patient accused recurring colic and intermittent swelling of the left submandibular gland experienced for about 10 years, with a progressive evolution. CT scan revealed a lower volume of the left submandibular gland compared to the right submandibular gland, the presence of a microcalcification in the parenchyma and an oval calcification corresponding to the projection area of the left submandibular gland’s duct. A left sub mandibulectomy was performed. Conclusion. Complete removal of the submandibular gland is the most effective therapy for sialolithiasis, being associated with better long-term outcomes and low operative morbidity.

Health care workers (HCWs) are at higher risk for SARS-CoV-2 infection and may play a role in transmitting the infection to vulnerable patients and members of the community. This is particularly worrisome in the context of asymptomatic infection. We performed a cross-sectional study looking at asymptomatic SARS-CoV-2 infection in HCWs. We screened asymptomatic HCWs for SARS-CoV-2 via PCR. Complementary viral genome sequencing was performed on positive swab specimens. A seroprevalence analysis was also performed using multiple assays. Asymptomatic health care worker cohorts had a combined swab positivity rate of 29/5776 (0.50%, 95%CI 0.32-0.75) relative to a comparative cohort of symptomatic HCWs, where 54/1597 (3.4%) tested positive for SARS-CoV-2 (ratio of symptomatic to asymptomatic 6.8:1). SARS-CoV-2 seroprevalence among 996 asymptomatic HCWs with no prior known exposure to SARS-CoV-2 was 1.4-3.4%, depending on assay. A novel in-house Coronavirus protein microarray showed differing SARS-CoV-2 protein reactivities and helped define likely true positives vs. suspected false positives. Our study demonstrates the utility of routine screening of asymptomatic HCWs, which may help to identify a significant proportion of infections.

Introduction Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the intensive care unit (ICU). Probiotics are defined as live microorganisms that may confer health benefits when ingested. Prior randomised trials suggest that probiotics may prevent infections such as VAP and Clostridioides difficile–associated diarrhoea (CDAD). PROSPECT (Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial) is a multicentre, double-blinded, randomised controlled trial comparing the efficacy of the probiotic Lactobacillus rhamnosus GG with usual care versus usual care without probiotics in preventing VAP and other clinically important outcomes in critically ill patients admitted to the ICU.Methods and analysis The objective of E-PROSPECT is to determine the incremental cost-effectiveness of L. rhamnosus GG plus usual care versus usual care without probiotics in critically ill patients. E-PROSPECT will be performed from the public healthcare payer’s perspective over a time horizon from ICU admission to hospital discharge.We will determine probabilities of in-ICU and in-hospital events from all patients alongside PROSPECT. We will retrieve unit costs for each resource use item using jurisdiction-specific public databases, supplemented by individual site unit costs if such databases are unavailable. Direct costs will include medications, personnel costs, radiology/laboratory testing, operative/non-operative procedures and per-day hospital ‘hoteling’ costs not otherwise encompassed. The primary outcome is the incremental cost per VAP prevented between the two treatment groups. Other clinical events such as CDAD, antibiotic-associated diarrhoea and in-hospital mortality will be included as secondary outcomes. We will perform pre-specified subgroup analyses (medical/surgical/trauma; age; frailty status; antibiotic use; prevalent vs no prevalent pneumonia) and probabilistic sensitivity analyses for VAP, then generate confidence intervals using the non-parametric bootstrapping approach.Ethics and dissemination Study approval for E-PROSPECT was granted by the Hamilton Integrated Research Ethics Board of McMaster University on 29 July 2019. Informed consent was obtained from the patient or substitute decision-maker in PROSPECT. The findings of this study will be published in peer-reviewed journals.Trial registration number NCT01782755; Pre-results.

Molecular pathology of benign prostatic hyperplasia is multifactorial and involves endocrine, biochemical, immunological interactions. The mechanisms involved in the onset and progression of benign prostatic hyperplasia are: infections, 50 years of age, hormones and neurotransmitters imbalances, inflammation, oxidative stress. The potential role of glycosylation in the pathogenesis of prostate disease has been neglected. In this study we documented the profile of gangliosides in normal and pathological prostatic tissues together with the pathologic changes seen in the level of extracellular gangliosides in patients with prostate pathology. Analysis of the data in the literature suggests that gangliosides may represent immunologic markers useful in the differential diagnosis between prostate cancer and benign prostatic hyperplasia.

Molecular pathology of benign prostatic hyperplasia is multifactorial and involves endocrine, biochemical, immunological interactions. The mechanisms involved in the onset and progression of benign prostatic hyperplasia are: infections, older than 50 years, imbalances in hormones and neurotransmitters, inflammation, oxidative stress. It is estimated that an infectious etiology can be a cause of wrong immune response directed at the prostate. Inflammatory neuropathies often occur after infections with various microorganisms. It is also known, that the presence of microorganisms is heterogeneous in patients with benign prostatic hyperplasia. In this paper we documented the antibody profile of anti-GM1, -GM2, -GM3, -GD1a, -GD1b, -GT1b, -GQ1b IgG and IgM type in 30 patients with benign prostatic hyperplasia and in 30 controls. The results showed an increasing anti-GD1a and anti-GQ1b titer in patients with benign prostatic hyperplasia compared to control. The authors suggest that a careful monitoring of the patients developing an endogenous anti-gangliosidic immune response is required in order to assess these antibodies as potential risk factors for neuropathy in patients with benign prostatic hyperplasia.

ObjectiveProstate lesions detected with multiparametric magnetic resonance imaging (mpMRI) are classified for their malignant potential according to the Prostate Imaging-Reporting And Data System (PI-RADS™2). In this study, we evaluate the diagnostic accuracy of the mpMRI with and without gadolinium, with emphasis on the added diagnostic value of the dynamic contrast enhancement (DCE).Materials and methodsThe study was retrospective for 286 prostate lesions / 213 eligible patients, n = 116/170, and 49/59% malignant for the peripheral (Pz) and transitional zone (Tz), respectively. A stereotactic MRI-guided prostate biopsy served as the histological ground truth. All patients received a mpMRI with DCE. The influence of DCE in the prediction of malignancy was analyzed by blinded assessment of the imaging protocol without DCE and the DCE separately.ResultsSignificant (CSPca) and insignificant (IPca) prostate cancers were evaluated separately to enhance the potential effects of the DCE in the detection of CSPca. The Receiver Operating Characteristics Area Under Curve (ROC-AUC), sensitivity (Se) and specificity (Spe) of PIRADS-without-DCE in the Pz was 0.70/0.47/0.86 for all cancers (IPca and CSPca merged) and 0.73/0.54/0.82 for CSPca. PIRADS-with-DCE for the same patients showed ROC-AUC/Se/Spe of 0.70/0.49/0.86 for all Pz cancers and 0.69/0.54/0.81 for CSPca in the Pz, respectively, p>0.05 chi-squared test. Similar results for the Tz, AUC/Se/Spe for PIRADS-without-DCE was 0.75/0.61/0.79 all cancers and 0.67/0.54/0.71 for CSPca, not influenced by DCE (0.66/0.47/0.81 for all Tz cancers and 0.61/0.39/0.75 for CSPca in Tz). The added Se and Spe of DCE for the detection of CSPca was 88/34% and 78/33% in the Pz and Tz, respectively.ConclusionDCE showed no significant added diagnostic value and lower specificity for the prediction of CSPca compared to the non-enhanced sequences. Our results support that gadolinium might be omitted without mitigating the diagnostic accuracy of the mpMRI for prostate cancer.

BACKGROUND:Phylogenetics has been used to investigate HIV transmission among men who have sex with men. This study compares several methodologies to elucidate the role of transmission chains in the dynamics of HIV spread in Quebec, Canada. METHODS:The Quebec Human Immunodeficiency Virus (HIV) genotyping program database now includes viral sequences from close to 4,000 HIV-positive individuals classified as Men who have Sex with Men (MSMs), collected between 1996 and early 2016. Assessment of chain expansion may depend on the partitioning scheme used, and so, we produce estimates from several methods: the conventional Bayesian and maximum likelihood-bootstrap methods, in combination with a variety of schemes for applying a maximum distance criterion, and two other algorithms, DM-PhyClus, a Bayesian algorithm that produces a measure of uncertainty for proposed partitions, and the Gap Procedure, a fast non-phylogenetic approach. Sequences obtained from individuals in the Primary HIV Infection (PHI) stage serve to identify incident cases. We focus on the period ranging from January 1st 2012 to February 1st 2016. RESULTS AND CONCLUSION:The analyses reveal considerable overlap between chain estimates obtained from conventional methods, thus leading to similar estimates of recent temporal expansion. The Gap Procedure and DM-PhyClus suggest however moderately different chains. Nevertheless, all estimates stress that longer older chains are responsible for a sizeable proportion of the sampled incident cases among MSMs. Curbing the HIV epidemic will require strategies aimed specifically at preventing such growth.

In both adults and pediatric population, depression is a major disability cause; suicide is the third death cause among children and adolescents. Whereas depression and depression with associated anxiety are among the most common psychiatric pathologies in children and adolescents (with strong impact on their global functionality and with a significant influence on their development process), they are far from studied thoroughly. This study aims to highlight certain demographic and clinical patterns associated to depression of anxiety in children and adolescents, which may represent premises for broader future research and for the consolidation of primary, secondary, and tertiary prevention methods.

Atât la adulţi cât şi în cazul populaţiei pediatrice, depresia constituie o cauză majoră de dizabilitate, suicidul fiind a treia cauză de deces în rândul copiilor şi adolescenţilor. Cu toate că depresia şi depresia asociată cu anxietate sunt unele dintre cele mai frecvente patologii psihiatrice în rândul copiilor şi adolescenţilor, având un impact puternic asupra funcţionalităţii globale a acestora şi punând o amprentă remarcabilă asupra procesului lor de dezvoltare, rămân un domeniu insuficient explorat. Studiul de faţă îşi propune evidenţierea unor pattern-uri demografice şi clinice asociate depresiei şi anxietăţii la copii şi adolescenţi, care pot constitui premise pentru cercetări viitoare mai ample, dar şi pentru consolidarea unor metode de prevenţie primară, secundară şi terţiară.

Objective. The authors interest was focused on interferon impact on dopamine status and on the relation between negative emotional state and dopamine in melanoma patients. Methods. 60 patients diagnosed with malignant melanoma in 1st or 2nd clinical stage were included in the first 56 days after surgical removal of the tumor in an observational prospective study. The patients were divided in 2 groups: group A that included 30 cases treated with 10MU interferon alpha2b/mp three times a week for one year and group B that included 30 cases with no adjuvant treatment. Urinary dopamine (ELISA) was evaluated before treatment with interferon alpha2b, after 1, 6, 12 months of treatment and after 6 months from the end of the treatment. Neuropsychiatric disorders were grouped according to their frequency in melanoma patients. Results. Neuropsychiatric disorders associated with the treatment with interferon were: irritability, asthenia and fatigability, sleep disorders, anxiety, cognitive disorders, somatic symptoms. The treatment with interferon altered dopamine metabolism. Dopamine returned to the pretherapeutical values at six months after interferon was stopped. Patients with low levels of urinary dopamine had a high, statistically significant risk of developing depression during interferon treatment (OR=2.647, IC=2.186-3.014, p=0.0216). Conclusions. Low dopamine might have a major role in the development of depression secondary to interferon treatment.

Schizofrenia cu debut precoce şi foarte precoce, mai specifi c, manifestă înainte de 18, respectiv 13 ani, constituie o entitate nosologică încă insufi cient explorată, ce aduce cu sine o veritabilă provocare diagnostică dată de specifi cităţile vârstei timpurii la care apare. Totodată, schizofrenia cu debut în copilărie şi adolescenţă se întrepătrunde cu o serie de tulburări ale dezvoltării neurocognitive, având şi o importantă susceptibilitate genetică. Întregul context de apariţie a acesteia, difi cultatea detectării simptomelor psihoproductive în copilăria mică, severitatea simptomelor şi cronicizarea, impun o conduită diagnostică riguroasă şi o abordare multidisciplinară în vederea realizării terapiei optime de lungă durată şi integrării socio-familiale a pacienţilor. Lucrarea de faţă îsi propune sintetizarea datelor din litaratura de specialitate în vederea realizării unui precursor pentru cercetări viitoare ample, care să conducă la crearea unor ghiduri de abordare specifi că a schizofreniei la copil şi adolescent.

Very early onset and early onset schizophrenia – which manifest themselves before the age of 13 (the fi rst) and 18 (the latter) – represent a little explored nosological entity, which entails a genuine diagnostic challenge, considering the specifi cities of young age. At the same time, childhood and adolescence onset schizophrenia intertwines with a series of neurocognitive development disorders, comprising an important genetic susceptibility. The entire context of its emergence, the diffi culty of detecting psychoproductive symptoms during early childhood, the severity of symptoms and the chronicization impose a rigorous diagnostic behaviour and a multidisciplinary approach for optimal long-term therapy and for the socio-professional integration of patients. This paper aims at synthesizing the literature review, which may represent a starting point for ample future research; the purpose is to create specifi c guides on childhood and adolescence schizophrenia.

Recent years have witnessed greater involvement of European Union (EU) organisations in health communication campaigns that address chronic diseases and that are designed for implementation in multiple countries. This development raises challenges inherent in adapting the design of public health communication campaigns to multi-national settings. This article provides a first exploratory investigation of these challenges and how to address them based on data gathered from four expert focus groups, each concentrated on a common risk factor for chronic disease: smoking, alcohol consumption, unhealthy diet and sedentary lifestyle. Despite the exploratory nature of the data, it was possible to identify several common key challenges: variation in behaviours, social and cultural norms, and issues related to language and communication channels, the divide between EU stakeholders and local actors, and differences in national legislation and available resources. Two risk factor-specific challenges were also identified: effective messaging for complex issues (unhealthy diet) and the involvement of industry representatives (smoking, sedentary lifestyle). We propose conceiving of cross-national communication campaigns as providing a common blueprint and structure that can inform and support the development of differentiated yet harmonised local campaigns.

The integration of cellular and molecular structural data is key to understanding the function of macromolecular assemblies and complexes in their in vivo context. Here we report on the outcomes of a workshop that discussed how to integrate structural data from a range of public archives. The workshop identified two main priorities: the development of tools and file formats to support segmentation (that is, the decomposition of a three-dimensional volume into regions that can be associated with defined objects), and the development of tools to support the annotation of biological structures.

Obesity and depression represent two fundamental problems of public health at a global level; paediatric obesity is alarming both per se and through the risk of maintaining the obese status in adulthood and of continuing to be exposed to comorbidity, implicitly. On the other hand, depressionin childrenis a genuine diagnostic problem (considering its masked clinical symptomatology) and a diagnostic necessity (considering its severe consequences and mostly the pathological alterations of food-related behaviour). This paper seeks to elaborate a synthesis of the current scientifi c literature regarding the causes of obesity – depression comorbidities in children,with a focus on the interrelation and common etiopathogenic origin.

Obezitatea şi depresia reprezintă două probleme fundamentale de sănătate publică la nivel mondial, obezitatea pediatrică fi ind alarmantă atât per se, cât şi prin riscul menţinerii statutului de obez la vârsta adultă şi implicit a continuării expunerii la comorbidităţi. Pe de altă parte, depresia la copil este o veritabilă provocare diagnostică, dată fiind simptomatologia clinică mascată a acesteia, şi o necesitate date fi ind consecinţele severe ale acesteia şi, în particular, modifi cările patologice asupra comportamentului alimentar. Lucrarea de faţă îşi propune realizarea unei sinteze a literaturii de specialitate actuale cu privire la resorturile comorbidităţii obezitate – de presie la copil vizând interrelaţia şi originea etiopatogenică comună.

Both functional abdominal pain and irritable bowel syndrome are common causes of chronic abdominal pain in children and adolescents. Addressing these nosological entities is done according to the biopsychosocial model of functional gastrointestinal disorders, given their effect on quality of life and psychosocial status thereof. The cognitive-behavioral therapy, family psychotherapy, relaxation techniques or hypnotherapy have proved effective in achieving better coping mechanisms in alleviating psychological and somatic symptoms. However, antidepressant medication including selective serotonin reuptake inhibitors and tricyclic antidepressants, improve psychiatric symptomatology, especially depressive mood due to gastrointestinal illness, but also digestive symptoms due to mechanisms of action that depend on complex neurotransmitters.

Atât durerea abdominală funcţională, cât şi sindromul de intestin iritabil, sunt cauze frecvente ale durerii cronice abdominale la copil şi adolescent. Abordarea acestor entităţi nosologice se face conform modelului biopsihosocial al tulburărilor gastrointestinale funcţionale, dat fi ind efectul acestora asupra calităţii vieţii pacienţilor şi asupra statusului psihosocial al acestora. Astfel, terapia cognitiv-comportamentală, psihoterapia de familie, tehnicile de relaxare sau hipnoterapia şi-au demonstrat efi cienţa în obţinerea unor mai bune mecanisme de coping şi în atenuarea simptomatologiei psihice, cât şi somatice. Totodată, medicaţia antidepresivă incluzând inhibitorii recaptării serotoninei şi antidepresivele triciclice, aduce ameliorări notabile ale simptomatologiei psihice de aspect hipertimic negativ datorată afecţiunii gastrointestinale, dar şi a celei somatice digestive prin mecanisme dependente de acţiunea complexă a neuromediatorilor.

The bipolar disorder becomes more and more frequent in the pediatric field, raising numerous questions regarding the diagnosis. In most cases, the standard criteria of the disease are not fully met in the case of a child, requiring their particularization and a more accurate classifi cation. Also, a central issue is the differentiation and/ or detection of comorbidity with ADHD and conduct disorders in children.

The frequency of suicidal behavior in children and adolescents has increased signifi cantly in recent years, representing a plurifactorial phenomenon, with determining factors in both psychiatric disorders, especially depression and conduct disorders, and also environmental factors including dysfunctional families, academic failure, faulty relationships, including an issue of increasing interest which lies on the border between illness and social factor, represented by the abuse of psychoactive substances. Approaches remain unorganized and inadequate, thus maintaining a real interest in the folowing subject, child and adolescent suicide, and furthermore raising the issue of improving the means of effective intervention for this situation of global importance