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Children with chronic illnesses present unique health, psychosocial, and learning challenges. Due to the complexities surrounding their needs, these children and their families often encounter multilayered barriers when accessing educational services and health care management. Medical-family-school interprofessional interagency collaborations (IIC) are needed to facilitate information sharing across institutions, treatment alignment among care partners, and equitable and high-quality school-based service delivery. This article presents a novel hospital-based school consultative liaison service, the Educational Achievement Partnership Program (EAPP), which conducts IIC with the families, schools, hospitals, and community care partners of children with chronic illnesses. We explore disproportionalities in IIC services among low-income and racially/ethnically minoritized children and examine ways to increase IIC service access and utilization. Results demonstrate that systematic changes targeting in-person communication with families significantly increased minoritized and low-income children's EAPP participation. Despite this increase, differences occurred between minoritized and White children's utilization through all stages of EAPP service delivery. These results underscore the importance of ongoing IIC service evaluation to examine the effectiveness of implementation components. We discuss implications and highlight opportunities for similar medical-family-school IIC under a school psychologist-led medical liaison consultative approach. We conclude that IIC is best fostered through innovations in communication models, graduate training, practice, and research.

Through the years, the range of services involving animals benefiting people, often described as “animal-assisted interventions” (AAIs), has been plagued with confusing and inconsistent taxonomy, terminology, and definitions. This has caused difficulties for the delineation of roles of service providers, for the recipients of services, as well as for the preparation, training, and expectations of the animals that work in different roles. It can be argued that these difficulties have compromised the development of the field in terms of establishing agreed standards of practice, qualifications, and competencies and adopting good animal welfare practices. It has also likely limited the base of evidence, as search terms used to access studies are not consistent, and study protocols are difficult to compare, lacking uniformity in terminology. Additionally, the current terminology cannot accommodate the expansion and diversification of programs in recent years, which is likely to continue as the field evolves. Establishing internationally agreed upon uniform taxonomy, terminology, and definitions is crucial to more accurately reflect the key features of different approaches, to define the scope and competencies for different service providers and their animals, to provide transparency about services for recipients, and to ensure the appropriate preparation, training, and support of the animals that work with them., The recommendations in this article are the result of an international work group that convened over the course of two years. The umbrella term animal-assisted services (AAS) is proposed, defined as services that are facilitated, guided or mediated by a health or human service provider or educator, who works with and maintains the welfare of a specially alongside a specially qualifying animal to provide therapeutic, educational, supportive and/or ameliorative processes aimed at enhancing the well-being of humans. AAS are further categorized into three main areas: treatment, education, and support programs. A recommendation for provider-specific terminology is also suggested. The aim of these proposals is to set clear expectations and boundaries for each specialty of practice, without compromising the richness and diversity of each approach. The adoption of this new umbrella term and its categories is intended to improve clarity for all involved in the receipt and delivery of services, as well as for those who study their effects.

Abstract Osteosarcoma is the most common primary malignant bone tumor with a strong tendency to metastasize, limiting the prognosis of affected patients. Genomic, epigenomic and transcriptomic analyses have demonstrated the exquisite molecular complexity of this tumor, but have not sufficiently defined the underlying mechanisms or identified promising therapeutic targets. To systematically explore RNA-protein interactions relevant to OS, we define the RNA interactomes together with the full proteome and the transcriptome of cells from five malignant bone tumors (four osteosarcomata and one malignant giant cell tumor of the bone) and from normal mesenchymal stem cells and osteoblasts. These analyses uncover both systematic changes of the RNA-binding activities of defined RNA-binding proteins common to all osteosarcomata and individual alterations that are observed in only a subset of tumors. Functional analyses reveal a particular vulnerability of these tumors to translation inhibition and a positive feedback loop involving the RBP IGF2BP3 and the transcription factor Myc which affects cellular translation and OS cell viability. Our results thus provide insight into potentially clinically relevant RNA-binding protein-dependent mechanisms of osteosarcoma.

The paper begins with the prerequisite assumption that social deprivation is a fragile and porous category. Thus, our hypothesis is, that how people are affected by the restrictions against the spreading of the coronavirus is often discussed in far too general and simplistic terms. It is often taken as a given, that the virus and the restriction measures not only have caused severe difficulties for us all (due to social distancing, fear, affected health, etc.), but that the measures have exacerbated already previously existing forms of social deprivation. Therefore, it is assumed that marginalized groups are particularly affected by these effects of the pandemic. Two major German studies show the alleged effects of the relevant measures on adolescents and emerging adults (COPSY and FIBS) against the backdrop of social and economic deprivation; their results confirmed that social deprivation entails a higher degree of being affected by the pandemic. However, this picture becomes thwarted by considering the results of 10 narrative interviews, that were conducted by us with emerging adults in a German vocational training institute between April and August 2021 and showed variegated forms of experiencing issues related to the pandemic. In our analysis, we used the method of objective hermeneutics. In this paper, we present our considerations by outlining two contrastive experiences with the COVID-19 pandemic, in order to highlight the divergent ways in which the pandemic has been experienced even among individuals who previously had been affected by social deprivation -- at least at first glance -- in similar ways. The conceptual lens through which we interpret these two examples is, firstly, the one of precariousness and precarity (Butler 2009). And secondly, the concept of recognition derived from Honneth's pertinent theory and Butler's account of recognizability will play a pivotal role. While Honneth's approach allows us to emphasize the normative and existential role of the fulfilment of our basic desire for recognition and the detrimental implications of disregard, Butler provides us with the means to thoroughly analyse the socio-historical conditions of misrecognition and social invisibility. Moreover, Butler focuses specifically on the recognizability of precariousness (Honneth's triad of love, being respected as a rights bearer and solidarity shows a different focus). Combining qualitative research on precarious live circumstances with a theoretical perspective on recognition can also be found in a stunning research on couples in atypical working relations (Wimbauer and Motakef 2019). Proceeding from these theories and 'applying' them to our empirical material, we seek to call into question a too generalizing and hegemonic picture of how people were affected by pertinent restrictions. Qualitative interviews are able to point us to significant differences in the experience of the restrictions. In terms of an outlook, we suggest that a sensitization for previously excluded kinds of experiences forms a crucial basis for a less normalizing, that is, more inclusive account of interpreting the affectedness and needs of variegated social groups; the pandemic has influenced and altered structures of the recognition of vulnerability and, by the same token, made them more explicit. It thus is an occasion for a critical engagement with the recognizability of needs, deprivation, discrimination, and related phenomena.

Abstract Background Although avoidant/restrictive food intake disorder (ARFID) presents the replacement and extension of feeding disorders of infancy and childhood, previous research into ARFID concentrated mainly on older patients. While birth-related characteristics play an etiologic role in feeding disorders, virtually nothing is known so far in ARFID. Therefore, the first aim of the study was to identify differences in birth-related characteristics in younger vs. older children with ARFID. Second, differences in physical and mental comorbidities, and third, diagnostic features between age groups were analysed. Methods Among N = 51 in- and outpatient treatment-seeking patients, n = 23 patients aged 0–5 years (30% girls) and n = 28 patients aged 6–17 years (57% girls), with an interview-based diagnosis of ARFID were included. Data on the pre- and perinatal period and mental and physical comorbidities were derived from patients’ medical records, while diagnostic criteria, main ARFID presentation, and sociodemographic variables were collected through diagnostic interview. Results Significantly, younger patients with ARFID were born more often preterm and had more pre- and perinatal complications and a higher incidence of postnatal invasive procedures. Patients with ARFID aged 0–5 years presented significantly more physical comorbidities and conditions, especially congenital anomalies, while mental comorbidities, especially mood disorders, were significantly more common in patients with ARFID aged 6–17 years. No age differences were found for the distribution of diagnostic criteria and main ARFID presentation. Conclusion This is the first study which aimed to identify age-specific characteristics in patients with ARFID with potential relevance for diagnosis and treatment. Especially birth-related complications, including invasive procedures postnatally, may be associated with developing ARFID, highlighting the importance of a closer view on these potential risk factors of the disorder. Future research with longitudinal design and larger samples may allow more detailed information on further age-specific associations, symptom trajectories, and age-specific risk factors for ARFID.

Victor Hugo Urrutia-Baca,1,* Karen Ivonne Gonzalez Brosig,2 Alina Abigail Salazar-Garza,3,* Ricardo Gomez-Flores,4 Patricia Tamez-Guerra,4 Myriam Angelica De La Garza-Ramos3,* 1Institute for Obesity Research, Tecnologico de Monterrey, Monterrey, Nuevo León, México; 2School of Health Sciences, Universidad del Valle de Mexico, Monterrey, Nuevo León, México; 3School of Dentistry, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, México; 4School of Biological Sciences, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, México*These authors contributed equally to this workCorrespondence: Myriam Angelica De La Garza-Ramos, School of Dentistry, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico, Tel +52 811 3404 370 ext. 1781, Email myriam.garzarm@uanl.edu.mxPurpose: Epidemiological studies have been conducted to improve the health and economic quality of life of indigenous communities in Mexico. These studies have found that infections cause frequent health problems. Helicobacter pylori are responsible for conditions ranging from gastritis to stomach cancer. This study determined the prevalence of H. pylori in families from Siltepec, Chiapas, Mexico.Patient and Methods: Ninety-nine dental plaque samples from 36 families were studied. Real-time PCR was performed to detect H. pylori using previously reported primers. The Mann–Whitney U-test was used for the statistical analysis. According to the family role of H. pylori-positive individuals, the VacA s1/m1 genotype and CagA gene correlated.Results: The mother had the highest expression of VacA s1/m1-/cagA- with 19% (8/42), followed by the first child with 14.3% (6/42). The major roles for the vacA s1/m1+/cagA- were the mother and first child with 9.5% (4/42), followed by the remaining children with 4.8% (2/42). The vacA s1/m1-/cagA+ genotype was 7.1% (3/42) for the mother and 4.8% (2/42) for the father. Finally, the vacA s1/m1+/cagA+ genotype only appeared in the mother, son I, and son III with 2.4% (1/42).Conclusion: The vacA s1/m1/cagA genotypes predominated in the mother, suggesting potential transmission between the mother and child during the first years of life.Plain language summary: Helicobacter pylori is a bacterium that causes duodenal and gastric ulcers and is a risk factor for gastric cancer. It has been found in the dental plaque of children and adults. This study was conducted to identify if the mother can transmit the infection to her children.Keywords: Helicobacter pylori, infection, gastrointestinal diseases, infection transmission, nutrition

Abstract Background The therapeutic advances and progress in the care for preterm infants have enabled the regular survival of very immature infants. However, the high burden of lifelong sequelae following premature delivery constitutes an ongoing challenge. Regardless of premature delivery, parental mental health and a healthy parent–child relationship were identified as essential prerogatives for normal infant development. Family centered care (FCC) supports preterm infants and their families by respecting the particular developmental, social and emotional needs in the Neonatal Intensive Care Unit. Due to the large variations in concepts and goals of different FCC initiatives, scientific data on the benefits of FCC for the infant and family outcome are sparse and its effects on the clinical team need to be elaborated. Methods This prospective single centre longitudinal cohort study enrols preterm infants ≤ 32 + 0 weeks of gestation and/or birthweight ≤ 1500 g and their parents at the neonatal department of the Giessen University Hospital, Giessen, Germany. Following a baseline period, the rollout of additional FCC elements is executed following a stepwise 6-months approach that covers the NICU environment, staff training, parental education and psychosocial support for parents. Recruitment is scheduled over a 5.5. year period from October 2020 to March 2026. The primary outcome is corrected gestational age at discharge. Secondary infant outcomes include neonatal morbidities, growth, and psychomotor development up to 24 months. Parental outcome measures are directed towards parental skills and satisfaction, parent-infant-interaction and mental health. Staff issues are elaborated with particular focus on the item workplace satisfaction. Quality improvement steps are monitored using the Plan- Do- Study- Act cycle method and outcome measures cover the infant, the parents and the medical team. The parallel data collection enables to study the interrelation between these three important areas of research. Sample size calculation was based on the primary outcome. Discussion It is scientifically impossible to allocate improvements in outcome measures to individual enhancement steps of FCC that constitutes a continuous change in NICU culture and attitudes covering diverse areas of change. Therefore, our trial is designed to allocate childhood, parental and staff outcome measures during the stepwise changes introduced by a FCC intervention program. Trial registration Clinicaltrials.gov, trial registration number NCT05286983, date of registration 03/18/2022, retrospectively registered, http://clinicaltrials.gov .

Emerging adulthood without vocational training concerns young people from difficult social backgrounds who are often not adequately reached by therapeutic help. Difficult and traumatic experiences with therapeutic institutions are common to many of these young people in addition to a long lasting, unsatisfying patient-career. Without professional support from the therapeutic field, vocational qualification measures often cannot meet the needs of young people with inner conflicts. A counseling center for people with mental health problems was set up in 2010 as a link between professional support and a therapeutic setting. This article critically examines the importance of counseling for improving the personal situation of participants in vocational qualification measures on a descriptive level. We take a perspective on identity development and defense mechanisms in the thought of Vaillant and Erikson. Both theories focus on the social embeddedness of psychological processes. This theoretical background helps to understand young peoples’ situations and difficulties. The unique setting of the counseling center that aims to match the particular needs of these young people is presented. Thus a low-threshold, destigmatising and flexible setting should provide better access to psychosocial support for participants in vocational qualification measures. Opportunities and limits of the concept are discussed.

The international response to armed conflict in Africa often takes the form of a regime complex characterized by institutional proliferation, overlap, unclear hierarchies, and multiple interconnections. At the same time, the course of conflict is hardly predictable. In such an environment, how can component units (institutional fora) of a regime complex effectively govern through complexity? We explore this question by focusing on the EU as an important actor within regime complexes. Building on the regime complexity literature and complexity theory, we identify four conditions. We argue that actors who operate as resource hubs, create complementarity, support system self-organization, and practice adaptive forms of peacebuilding are best placed to manage regime complexity. Empirically we probe these assumptions in the context of the Sahelian security regime complex and the role the EU is playing in it.

Abstract SARS-CoV-2 continues to circulate in the human population necessitating regular booster immunization for its long-term control. Ideally, vaccines should ideally not only protect against symptomatic disease, but also prevent transmission via asymptomatic shedding and cover existing and future variants of the virus. This may ultimately only be possible through induction of potent and long-lasting immune responses in the nasopharyngeal tract, the initial entry site of SARS-CoV-2. To this end, we have designed a vaccine based on recombinantly expressed receptor binding domain (RBD) of SARS-CoV-2, fused to the C-terminus of C. perfringens enterotoxin, which is known to target Claudin-4, a matrix molecule highly expressed on mucosal microfold (M) cells of the nasal and bronchial-associated lymphoid tissues. To further enhance immune responses, the vaccine was adjuvanted with a novel toll-like receptor 3/RIG-I agonist (Riboxxim™), consisting of synthetic short double stranded RNA. Intranasal prime-boost immunization of mice induced robust mucosal and systemic anti-SARS-CoV-2 neutralizing antibody responses against SARS-CoV-2 strains Wuhan-Hu-1, and several variants (B.1.351/beta, B.1.1.7/alpha, B.1.617.2/delta), as well as systemic T-cell responses. A combination vaccine with M-cell targeted recombinant HA1 from an H1N1 G4 influenza strain also induced mucosal and systemic antibodies against influenza. Taken together, the data show that development of an intranasal SARS-CoV-2 vaccine based on recombinant RBD adjuvanted with a TLR3 agonist is feasible, also as a combination vaccine against influenza.

This article presents data on Coronavirus disease (COVID-19)-related learning, health, and mental health concerns of 134 families of children with heart disease (HD), the most common birth defect, who are followed by a unique hospital-based Educational Achievement Partnership Program (EAPP) designed to serve as a liaison across the family, the child's medical team, and school. At-school, remote, and hybrid learning alternatives prompted by the COVID-19 pandemic presented families with an especially complex decision to make for children with HD due to competing complications in this population: Increased susceptibility to illness, greater risk of neuropsychological problems, and higher level of individualized education services that are not readily transferable to a home learning platform. Parents of school-aged children with HD completed a survey about COVID-19-related school support needs as part of a quality improvement project. Survey results revealed 51% of children would learn from home during the 2020-2021 school year due to concerns about the child's underlying health condition, indicating a marked change in schooling modality compared to prior years (4% in 2019). Nearly 75% of families requested medical guidance for COVID-19-related school health and education plan addendums. Seventy-three percent of families had mental health concerns about their child; severity of HD was related to families' reports about mental health concerns. Findings suggest follow-up is needed by school psychologists and medical consultative collaborative partners to support the transition back to in-person schooling after the COVID-19 pandemic concludes and to identify long-term educational consequences of disrupted learning during this period.

Introduction: The spectrum of ultrasonographic findings of benign, atypical, and malignant papillary lesions is broad. This study describes the ultrasonographic findings, clinical manifestations, and histopathological correlation of papillary breast lesions in Mexican patients. Material and Methods: We reviewed the pathology database of ultrasound (US)-guided core needle biopsies (CNB) to identify all papillary breast lesions diagnosed between January 2012 and December 2016. US findings were described using the BI-RADS lexicon. Clinical data and histopathologic diagnosis were recorded. Results: Thirty-four papillary breast lesions from 34 women were included. There were 22 (64.7%) benign, 10 (29.4%) atypical, and 2 (5.9%) malignant papillary lesions. The most common clinical presentation was a palpable mass (n = 24, 70.6%); two (5.9%) patients had nipple discharge, while 8 (23.5%) were asymptomatic. The most common ultrasonographic features were an oval shape (n = 18, 53.0%), a not-circumscribed margin (n = 20, 58.8%), parallel orientation (n = 33, 97.0%), a hypoechoic pattern (n = 27, 79.4%), and no posterior features (n = 31, 91.2%). Vascularity (n = 24, 70.6%) and ductal ectasia (n = 4, 11.8%) were associated findings. Calcifications were not observed. The pathological diagnoses of the benign papillary lesions were intraductal papilloma (n = 21, 61.8%) and intraductal papillomatosis (n = 1, 2.9%). Ten (29.5%) atypical papilloma cases were intraductal papilloma with atypical hyperplasia. Intracystic papillary carcinoma (n = 1, 2.9%) and invasive micropapillary carcinoma (n = 1, 2.9%) were the malignant lesions. Conclusion: This study is the first in Mexico that presents the ultrasonographic findings, clinical characteristics, and histopathological correlations of benign, atypical, and malignant papillary breast lesions.

BackgroundStudies measuring hair cortisol concentration (HCC) have been increasingly conducted to document stress-related, endocrine changes aggregated over time. Previous studies have shown that HCC reflects abnormalities in the hypothalamic–pituitary-adrenocortical axis (HPA axis) in the context of somatic diseases, such as Cushing’s syndrome. HCC variations also reveal a corresponding alteration in HPA-axis-function in mental disorders, highlighting its potential role as a biomarker for interventions targeting mental health problems.AimsThe aim of this study was to investigate the role of HCC in various psychological and neuropsychiatric interventions and to explore the extent to which HCC can serve as a predictive or outcome parameter in such interventions by conducting a PRISMA-compliant review of the literature.MethodsFrom May to July 2022, the databases Web of Science, Google Scholar, PsychINFO, and ResearchGate were systematically searched using different combinations of relevant keywords. Studies of different types that examined HCC in the context of a wide range of psychological and neuropsychiatric interventions were included. Studies in languages other than English or German and animal studies were excluded. The MMAT tool was used, to assesses the Risk of bias.ResultsThe initial search identified 334 studies. After applying the inclusion and exclusion criteria, 14 publications with a total number of 1,916 participants were identified. An association between HCC and PTSD, depressive disorders, and ongoing social and family stress can be documented. The effect of relaxation techniques, mental training, CBT, or PTSD therapy on HCC has been studied with equivocal results. Some studies found decreased HCC after treatment, while others did not show a clear effect. Baseline HCC appears to be of particular importance. In some studies, higher baseline HCC was associated with increased treatment response, providing a predictive value for HCC.DiscussionHCC is increasingly being used as a biomarker for the mapping of psychological and neuropsychiatric interventions. However, due to the wide range of study populations and interventions, results are still heterogeneous. Nevertheless, HCC seems to be an encouraging biological parameter to describe the trajectory of different interventions aimed at improving mental health.

IntroductionMultidimensional pediatric-psychosomatic inpatient treatment should be considered a highly relevant concept in the German healthcare system. This treatment concept has been successfully integrated to support youth with mental disorders and patients with chronic somatic conditions. Studies on treatment impact and empirical evidence of pediatric-psychosomatic inpatient therapies are rare, despite their clinical significance. Therefore, the study aims to provide initial indications of what constitutes to enhanced treatment effectiveness by comparing two different pediatric-psychosomatic inpatient treatment concepts. The clinics are comparable regarding the treated disorders, which include: dissociative, mood, and somatoform disorders, and psychological factors associated with chronic somatic conditions. Multidimensional treatment in both clinics include components of individual and family therapy, along with group-, art-, music-, creative-, and physio-therapy. Both clinics differed regarding their treatment philosophy in which; Clinic A practiced psychodynamic behavioral elements more strongly, while Clinic B rooted itself more strongly with psychoanalysis and family-dynamic practices.MethodEach clinic recruited 25 patients for the study. They completed two questionnaires both at admission and discharge, which measured general behavioral and emotional problems (YSR); and, respectively, difficulties in emotion perception and processing (TAS-26). The effectiveness of the treatment was examined by conducting one-sample t-test and effect sizes for each clinic. To obtain information on differentiating treatment effects, mixed ANOVAs were calculated. For estimating its influence, the treatment duration was taken into account as a covariate calculating an ANCOVA.ResultsIn both settings, treatment effects can be observed regarding internalizing problems. For alexithymia, no effects were seen in Clinic B, while in Clinic A, there was a significant reduction. When comparing both clinics, the ANOVAs showed significant interaction effects displaying advantages for Clinic A in the reduction of internalizing, total behavioral problems and alexithymia. Taking into account the treatment duration as a covariate, those effects level out. Significant differences between the clinics were no longer statistically detectable.DiscussionThe present study provides substantial preliminary indications on the effectiveness of multidimensional pediatric-psychosomatic inpatient therapy, which seems suitable for alleviating the general symptom burden and problems by identifying and processing emotions. Furthermore, the results indicate that an extended treatment duration may contribute to more pronounced effects.