Chronic Illness Research Articles

Gulf war illness: a tale of two genomes

IntroductionGulf War illness (GWI) is an environmentally-triggered chronic multisymptom illness typified by protean symptoms, in which mitochondrial impairment is evident. It has been likened to accelerated aging. Nuclear genetics of detoxification have been linked to GWI.ObjectiveTo see whether mitochondrial (mt) haplogroup U – a heritable profile of mitochondrial DNA that has been tied to aging-related conditions – significantly predicts greater GWI severity; and to assess whether GWI severity is influenced by mitochondrial as well as nuclear genetics. 54 consenting Gulf War veterans gave information on GWI severity, of whom 52 had nuclear DNA assessment; and 45 had both nuclear and mitochondrial DNA assessments. Regression with robust standard errors assessed prediction of GWI severity as a function of nuclear genetics (butyrylcholinesterase variants), mitochondrial genetics (haplogroup U, previously tied to aging-related conditions); or both.ResultsBChE “adverse” variants significantly predicted GWI severity (β(SE) = 23.4(11.4), p = 0.046), as did mt haplogroup U (β(SE) = 36.4(13.6), p = 0.010). In a model including both, BChE was no longer significant, but mt haplogroup U retained significance (β(SE) = 36.7(13.0), p = 0.007). This is the first study to show that mitochondrial genetics are tied to GWI severity in Gulf-deployed veterans. Other data affirm a tie to nuclear genetics, making GWI indeed a “tale of two genomes.”

Bacterial bioremediation as a sustainable strategy for the mitigation of Bisphenol-A.

In the era dominated by plastic, the widespread use of plastic in our daily lives has led to a growing accumulation of its degraded byproducts, such as microplastics and plastic additives like Bisphenol A (BPA). BPA is recognized as one of the earliest man-made substances that exhibit endocrine-disrupting properties. It is frequently employed in the manufacturing of epoxy resins, polycarbonates, dental fillings, food storage containers, infant bottles, and water containers. BPA is linked to a range of health issues including obesity, diabetes, chronic respiratory illnesses, cardiovascular diseases, and reproductive abnormalities. This study examines the bacterial bioremediation of the BPA, which is found in many sources and is known for its hazardous effects on the environment. The metabolic pathways for the breakdown of BPA in important bacterial strains were hypothesized based on the observed altered intermediate metabolites during the degradation of BPA. This review discusses the enzymes and genes involved in the bacterial degradation of BPA. The utilization of naturally occurring microorganisms is the most efficient and cost-effective method due to their selectivity of strains, ensuring sustainability.

Closing the Gap: Foster Parents' Lived Experiences and Recommendations for Interdisciplinary Health-Care Providers.

Purpose: This study explored barriers and facilitators to utilizing health-care services for foster youth, from the perspective of foster parents. Background: There are nearly 437,283 youths in the United States foster care system. Youths living in locations that are different from their familial home situations have a significantly higher occurrence of physical and mental health illnesses than children who remain in their familial homes, increasing risk for homelessness, substance use and abuse, chronic long-term illnesses, and incarceration, thus placing additional burden on the health-care system. Design and Methods: This study utilized a qualitative descriptive design with purposive sampling, with video focus groups to explore 15 foster parents' experiences in accessing health-care services for foster youth. Results: Barriers and facilitators to accessing health care and care coordination were identified, including logistics, transportation, electronic health record access, location of health care, and the impact of the social worker. Practice Implications: Nurses are well-positioned to aid in closing gaps in care for foster youth. Conclusions: These experiences provide important insights and implications for health-care providers and for future research and policy development.

Exploring Symptom Management Experiences Among College Students With Type 1 Diabetes Mellitus Using a Theoretical Framework: A Qualitative Study.

The purpose of this study was to explore symptom management experiences among college students with type 1 diabetes mellitus (T1DM). Limited qualitative data using a theoretical framework exist that explore the self-care behavior processes for symptom management. A qualitative approach was used for this study. The middle-range theory of self care of chronic illness served as a framework for data collection and analysis procedures. Data collection included distributing a survey to collect participants' demographic and sociodemographic data and utilizing a semi-structured interview guide to conduct one-on-one interviews with 31 participants. Interviews occurred via Zoom (n = 28) and in person (n = 3). Interview transcripts were uploaded in NVivo for data management. The research team created a codebook using theoretical constructs to assist with thematic analysis. Data are representative of a sample whose characteristics include undergraduate students ages 18 to 23 living with T1DM for 2 years or more who attended large, public, 4-year universities located in the southeastern United States. Three main themes were created using theoretical constructs: symptom detection experiences, symptom interpretation experiences, and symptom response experiences. Two subthemes were identified for each theme. Participants engaged in symptom management for blood glucose regulation through detecting changes in their blood glucose physiologically and via technology. Additionally, symptom interpretation involved analyzing blood glucose trends and determining common causes of blood glucose changes. Symptom response included immediately addressing hypoglycemia but delayed responses addressing hyperglycemia. Challenges were present responding to hypoglycemia; therefore, additional research is warranted to improve symptom response skills.

Effect of Chronic Illness on Psychological Resilience in Adults in Indonesia

Purpose: The aim of the study was to analyze the effect of chronic illness on psychological resilience in adults in Indonesia. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Recent research on the effect of chronic illness on psychological resilience in adults in Indonesia indicates that chronic illnesses significantly impact psychological well-being and resilience. Studies reveal that individuals with chronic conditions often experience decreased resilience due to increased stress and reduced coping abilities. However, factors such as strong social support, effective coping strategies, and access to mental health resources can mitigate these negative effects. For instance, patients with robust social networks and adaptive coping mechanisms show higher levels of psychological resilience despite their chronic conditions. Unique Contribution to Theory, Practice and Policy: Stress and coping theory, conservation of resources (COR) theory & self-determination theory (SDT) may be used to anchor future studies on the effect of chronic illness on psychological resilience in adults in Indonesia. Healthcare providers should implement resilience training programs that equip individuals with chronic illnesses with practical skills to enhance their psychological resilience. Policymakers should integrate psychological resilience into chronic illness management policies by mandating the inclusion of mental health support as a core component of chronic disease care.

Subjective Cognitive Dysfunction in Chronic Illness: A Systematic Review and Meta-Synthesis.

Qualitative studies have examined the experiences of subjective cognitive dysfunction in specific populations or specific disease stages, but there has not yet been a systematic synthesis and evaluation of findings related to perceptions of subjective cognitive dysfunction in nondementia-related chronic illnesses. The aim of this study was 2-fold: (1) to undertake a systematic review of experiences of subjective cognitive dysfunction in people with nondementia-related chronic disease and (2) to develop an explanatory framework to describe the experiences of living with subjective cognitive dysfunction. Four databases were systematically searched for studies on subjective cognitive dysfunction up to June 2023. Qualitative synthesis was conducted on the final sample (N = 25) using Sandelowski's adaptation of Nobilt and Hare's reciprocal transactional analysis method. Critical appraisal was completed using the Critical Appraisal Skills Programme checklist. Through constant comparison of key concepts, findings were organized within 4 interrelated themes that informed a conceptual explanatory model of adapting to living with subjective cognitive dysfunction: (1) symptoms, (2) health care, (3) perceptions of self, and (4) relationships. Participants highlighted how subjective cognitive dysfunction affected interactions in health care settings and involved other symptoms that in turn complicated meaning, self-enhancement, and mastery. Our model of the process of adapting provides a new way to conceptualize cognitive dysfunction in chronic illness and suggests opportunities for health care professionals to support patients and their families. The results highlight the need for more research to better understand the role of subjective cognitive dysfunction in nondementia-related chronic illnesses.The review protocol was registered in PROSPERO (CRD42021231410).

Factors associated with stunting among children 0-23 months in Aceh: A cross-sectional study using SSGI 2021

Stunting is a chronic health problem that affects children and has long-term implications for cognitive development. The multifactorial causes of stunting require the identification of the most dominant factors to facilitate effective interventions. This study aimed to analyze the factors associated with stunting in children under two years old in Aceh. This was a cross-sectional study involving 2,395 subjects aged 0-23 months. Data were obtained from the 2021 SSGI national survey, consisting of stunting prevalence, child and family characteristics, household sanitation, universal health insurance ownership, breastfeeding and complementary feeding practices, immunization status, parenting and pregnancy classes, supplementary feeding, and food security. Logistic regression analysis was performed with 95% confidence intervals. The results showed a significant association between stunting and child sex, sanitation conditions, parental education, exclusive breastfeeding, complementary feeding practices, immunization status, micronutrient supplementation, and breastfeeding duration (p<0.05). In conclusion, the factors associated with stunting in children aged 0-23 months in Aceh are sanitation, parental education, exclusive breastfeeding, complementary feeding practices, immunization, micronutrient supplementation, and duration of breastfeeding. This study highlights the importance of improved nutrition education, family support, increased immunization coverage, and improved environmental sanitation to reduce the prevalence of stunting among young children in Aceh.

Prostate cancer: unmet supportive and palliative care needs: national survey of patients and family carers

ObjectivesMen living with prostate cancer have supportive and palliative needs. However, few studies detail unmet needs (vs quality of life measurement) or include data from those with advanced disease. We...

Challenges in teleworking management related to accommodations, inclusion, and the health of workers: A qualitative study through the lens of social exchanges.

Telework is increasingly prevalent and holds the potential to serve as an accommodation, facilitating inclusion and promoting healthy participation among various segments of the workforce, such as aging employees, individuals with chronic illnesses or those living alone with one or more dependents. Nevertheless, this promising avenue presents management challenges that remain underexplored in the literature. This study aimed to identify the challenges in telework management related to accommodations, inclusion and the health of workers with life situations entailing specific needs. We conducted a descriptive interpretative study grounded in Social Exchange Theory, by collecting data through interviews with 9 managers and conducting focus groups involving 16 workers. We used a thematic-analysis approach to analyze the data. We identified seven overarching themes encapsulating management challenges that relate to accommodation (e.g., maintaining a balance between the benefits for the worker and the impacts on the organization) inclusion (e.g., maintaining team cohesion) and health (e.g., managing teleworkers' emotions). The findings underscore the significance of fostering robust social exchanges across hierarchical levels, and they highlight the necessity of equipping managers with the requisite tools to navigate the ethical quandaries arising from accommodation requests.

A Virtual Functional Medicine-Based Interdisciplinary and Integrative Intervention for Gulf War Illness.

The War-Related Illness and Injury Study Center at the VA New Jersey Health Care System (WRIISC-VANJ) serves as one of the three tertiary referral centers for combat deployed Veterans of all eras with medically unexplained or difficult-to-diagnose conditions that may be related to deployment-related exposures. Many of the Veterans seen at the WRIISC experience chronic multisymptom illness (CMI), also known as Gulf War Illness (GWI). Given the complexity and interconnectedness of symptoms, Veterans with GWI are often unlikely to produce meaningful results when addressing single symptoms. Further, Veterans with GWI often have co-morbid cognitive and behavioral health conditions (e.g., TBI, PTSD, Depression), which further compromise their self-efficacy in following treatment recommendations. Thus, the WRIISC-NJ, in collaboration with Wellness Solutions Group, developed a virtual Functional Medicine-based Interdisciplinary and Integrative Intervention to improve the health of Veterans by assisting them in implementing lifestyle changes. The 6-month telehealth program included functional medicine assessments, nutrition and adaptive exercise coaching, mindfulness meditation and yoga, guest health lectures, character strength coaching, and targeted nutritional supplements. Aspects of the program were tailored to the unique clinical needs of each Veteran. Participants completed baseline and 6 month follow-up assessments of physical and emotional symptoms and overall functioning. Follow-up scores were compared with baseline data. The program was well received by Veterans with attendance across all offered sessions ranging from 70 to 100%. Further, at the end of the clinical pilot program, improvements were demonstrated in physical and mental health symptoms, intentional weight loss/gain, functional movement, and sleep quality. These preliminary results demonstrate the possibility of creating positive health outcomes across multiple health indicators in medically complex combat-deployed Veterans. Our early success and participant enthusiasm for this clinical pilot program also illustrate an opportunity to provide individualized, innovative solutions for the evaluation and treatment of Veterans with GWI.

Infrastructures of support: Australian young people’s perspectives on caring during the pandemic and future disability and care policy reform

ABSTRACT Today’s young people are critical stakeholders in the future of social care policy and services, but their voices and perspectives are often overlooked in public debate and deliberation on disability services, aged care, and support for family carers. This article reports on a pilot project involving focus groups with young people in the Australian Capital Territory, Australia. Participants included young people with caring roles for family members with disability and chronic illness and young people without lived experience of disability or care. The article explores how young people’s understandings of care were profoundly shaped by their experiences during the COVID-19 pandemic. Lockdowns, health concerns and media coverage heightened their awareness of the diverse ways in which people support each other in families and communities and the systemic issues afflicting the formal care sector. The article draws on the concept of care as critical social and economic infrastructure to frame participants’ proposals for future reform of policy and services. The findings indicate that young people both with and without current care roles want to see significantly more investment in the care and support sectors, and these groups view meaningful engagement with service users as key to improving access to needed supports.

An Epidemiological Study of Physical-Mental Multimorbidity in Youth: Une étude épidémiologique de la morbidité physique-mentale chez les jeunes.

This epidemiological study estimated the lifetime prevalence of chronic physical illness (i.e., an illness that lasted or was expected to last ≥6 months) and 6-month prevalence of mental disorder and multimorbidity (i.e., ≥1 physical illness and ≥1 mental disorder) in youth. Associations between physical illness and mental disorder were quantified, including the number of illnesses. Secondary objectives examined factors associated with mental disorder, after controlling for physical illness. Data come from 10,303 youth aged 4-17 years in the 2014 Ontario Child Health Study (OCHS). Physical illness was measured using a list of chronic conditions developed by Statistics Canada. Mental disorders were measured using the OCHS Emotional Behavioural Scales. The Health Utility Index Mark III assessed overall functional health. Weighted prevalence estimates showed 550,090 (27.8%) youth had physical illness, 291,986 (14.8%) had mental disorder, and 108,435 (5.4%) had multimorbidity. Physical illness was not associated with mental disorder. However, youth with 2 physical illnesses, as compared to no physical illnesses, had increased odds of having any mental (OR = 1.75 [1.08, 2.85]), mood (OR = 2.50 [1.39, 4.48]) and anxiety disorders (OR = 2.40 [1.33, 4.31]). Mean functional health scores demonstrated a dose-response association across health status categories, with the highest scores among healthy youth and the lowest scores among multimorbid youth (all p < .05). Chronic physical illness and mental disorders are prevalent in youth. Youths with 2 physical illnesses have a higher likelihood of mental disorders. Higher functional health scores protected against all mental disorders. Mental health interventions for youth should promote strong overall functional health. Physical-Mental Multimorbidity in Ontario Youth.

Prevalence and factors associated with anemia among HIV-infected women in sub-saharan Africa: a multilevel analysis of 18 countries

BackgroundDespite the intended 50% reduction in anemia in women of reproductive age, this tendency has only worsened. Even though iron deficiency is the most prevalent cause of anemia, anemia and chronic illnesses like HIV are closely associated; in fact, 48.6% of people living with HIV who were 15 years of age or older had anemia. However, the burden of anemia among HIV-positive women in sub-Saharan African (SSA) countries is not well documented. Therefore, the goal of our research was to investigate anemia and the factors that are linked to it in SSA women who had HIV infections.MethodsA cross-sectional study was conducted using demographic and health survey datasets from 18 SSA countries. A total of 7823 weighted samples were included. STATA version 16 software was used for analysis. A multilevel logistic regression model was fitted. An adjusted odds ratio with a 95% CI and a p-value < 0.05 was used to declare significantly associated factors.ResultThe overall prevalence of anemia was found to be 45.1% [95% CI: 43.97–46.18%]. Of those 5.05%, 37.97%, and 56.97% were severely, moderately, and mildly anemic, respectively. Education level of primary [AOR = 0.74, 95% CI: 0.62, 0.89], secondary [AOR = 0.81, 95% CI: 0.68, 0.98], and higher [AOR = 0.74, 95% CI: 0.55, 0.99], as well as current contraceptive use [AOR = 0.74, 95% CI: 0.63, 0.87] were negatively associated with anemia. While pregnancy [AOR = 1.51, 95% CI: 1.17, 1.94], breast feeding [AOR = 1.38, 95% CI: 1.17, 1.64], health insurance [AOR = 1.50, 95% CI: 1.25, 1.80], and menstruation within six weeks prior to data collection [AOR = 1.36, 95% CI: 1.20, 1.54] had a significant positive relation with anemia among HIV-infected women in SSA countries.ConclusionAnemia is a serious public health problem among HIV-infected women in SSA countries. Pregnancy, breast feeding, health insurance, and menstruation within six weeks prior to data collection were significant risk factors. On the other education and current contraceptive use were significant protective factors for anemia among HIV-infected women in SSA countries. Therefore, strategies aimed at early identification of anemia may lead to an improvement in the health of HIV-infected women.

Effects of early age of menarche on the health of Indian middle-aged women: A survey study

The age of menarche, which is a sign that a female has reached reproductive maturity, has a significant impact on the health of women. Numerous components, including nutritional status, socioeconomic status, diet, environment, sibling relationship, hereditary and genetic factors, religious group, ethnicity, psychological stress, migration, and chronic illness, have been postulated to influence the age of menarche. Opinions on these theories have varied, both for and against the theory. In a survey it was reported that women complaints joint pains /stiff shoulder and LBA. Risk of musculoskeletal problems and the perception of pain could increase with obesity.To find the prevalence of physiological and psychological health problems in middle-aged females due to early menarche.Women matching the study criteria and willing to participate in the survey were approached and informed consent was taken. An interview was conducted on either a physical or virtual mode by a trained therapist as per the check list designed for this study.The content of the checklist was validated with the help of experts in this study domain and subjected to statistical tests which yielded a Cronbach’s score of 0.967. The participants response on this checklist was analyzed and a strong association of physical and psychological health issue was documented particularly among working women, multiparous women, and with type of delivery women had undergone during 1 pregnancy.The present study documented significant findings with the early age of menarche and its association with physical and psychological health of the women.

Reducing asthma attacks in disadvantaged school children with asthma: study protocol for a type 2 hybrid implementation-effectiveness trial (Better Asthma Control for Kids, BACK)

BackgroundAsthma is a leading cause of children’s hospitalizations, emergency department visits, and missed school days. Our school-based asthma intervention has reduced asthma exacerbations for children experiencing health disparities in the Denver Metropolitan Area, due partly to addressing care coordination for asthma and social determinants of health (SDOH), such as access to healthcare and medications. Limited dissemination of school-based asthma programs has occurred in other metropolitan and rural areas of Colorado. We formed and engaged community advisory boards in socioeconomically diverse regions of Colorado to develop two implementation strategy packages for delivering our school-based asthma intervention — now termed “Better Asthma Control for Kids (BACK)" — with tailoring to regional priorities, needs and resources.MethodsIn this proposed type 2 hybrid implementation-effectiveness trial, where the primary goal is equitable reach to families to reduce asthma disparities, we will compare two different packages of implementation strategies to deliver BACK across four Colorado regions. The two implementation packages to be compared are: 1) standard set of implementation strategies including Tailor and Adapt to context, Facilitation and Training termed, BACK-Standard (BACK-S); 2) BACK-S plus an enhanced implementation strategy, that incorporates network weaving with community partners and consumer engagement with school families, termed BACK-Enhanced (BACK-E). Our evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, including its Pragmatic Robust Implementation Sustainability Model (PRISM) determinants of implementation outcomes. Our central hypothesis is that our BACK-E implementation strategy will have significantly greater reach to eligible children/families than BACK-S (primary outcome) and that both BACK-E and BACK-S groups will have significantly reduced asthma exacerbation rates (“attacks”) and improved asthma control as compared to usual care.DiscussionWe expect both the BACK-S and BACK-E strategy packages will accelerate dissemination of our BACK program across the state – the comparative impact of BACK-S vs. BACK-E on reach and other RE-AIM outcomes may inform strategy selection for scaling BACK and other effective school-based programs to address chronic illness disparities.Trial registrationClinicaltrials.gov identifier: NCT06003569, registered on August 22, 2023, https://classic.clinicaltrials.gov/ct2/show/NCT06003569.

The Autoimmune Library: An Arts-Based Approach to Women of Color’s (Counter)Narratives of Chronic Illness

ABSTRACT Guided by critical race theorizing (CRT) and arts-based methodologies (i.e., metaphor and pictorial narrative mapping [PNM]), the present study analyzed the healthcare (counter)narratives of 150 United States (U.S.) women of color (i.e., Black/African American, Hispanic/Latina, Native American/Alaska Native, and Multiracial) who have autoimmune disease. Sensitized by the metaphor of a library book, participants were asked to story their healthcare journey through identification of a title, chapters, genre, and book cover description (i.e., [Illness] Storybook Survey). Using critical thematic analysis, we first identified dominant and counter-narratives present in participant storybooks, categorized by literary supra-themes of characters (i.e., dominant narrative of me versus my body, counter-narratives of me versus the system and illness as lineal), plot (i.e., dominant narrative of a hero’s journey, counter-narrative of chaos), and tone (i.e., dominant narrative of inspiration, counter-narratives of tangible self-help and humor). Next, guided by PNM, a data visualization technique, each author illustrated one counter-narrative within each literary supra-theme. Our analysis interrogates how participants’ stories both reify and resist ideological and structural power at the intersections of their racial, gender, and illness identities. Collectively, this study offers unique contributions to critical, intersectional, and arts-based approaches to communication research, and forwards new methods for studying health narratives historically located in the margins.

Chronic illness as cultural disruption: The impact of chronic illness on religious and cultural practice.

The relationship between religion and health tends to be framed positively. Religion has been found to act as a coping mechanism and source of support in times of ill health. In this paper, we focus on the disruptive effect of chronic illness on religious practice and cultural engagement. Drawing on interviews with ethnic minority adults with end-stage kidney disease, who also identify as religious, we introduce the concept 'cultural disruption'. While religious practice and belief was found to provide strength and comfort we also found that chronic illness had a disruptive impact on religious and cultural practice that participants attempted to manage. To highlight the potential disruptive effect of chronic illness on religious faith and cultural engagement we identify three elements of cultural disruption-disruption to religious practice, disruption to sense of self and identity and disruption to wellbeing. We conclude by suggesting that understanding and accounting for the potential of cultural disruption when diagnosing, treating and supporting people with chronic illness offers an alternative entry point to the life-worlds of patients who identify as religious and the things that are important to them.

The experience of hope in dyads living with advanced chronic illness in Portugal: a longitudinal mixed-methods study

BackgroundHope is an important resource that helps patients and families thrive during difficult times. Although several studies have highlighted the importance of hope in different contexts, its specific manifestations in the realm of advanced chronic illness need further exploration. In this study, we sought to elucidate the intricate interplay between the construct of hope and the lived experience of advanced chronic illness within patient-caregiver dyads. Our objectives were (a) to explore the dyadic experience of hope as a changing dynamic over time for patients living with advanced chronic illness and their informal caregivers and (b) to evaluate variations of hope and symptom burden across time.MethodsWe conducted a longitudinal mixed-methods study with a convergent design between December 2020 and April 2021. Patients living with advanced chronic illness and informal caregivers participated as a dyad (n = 8). The Herth Hope Index scale was used to measure dyads' level of hope and the Edmonton Symptom Assessment System was used to measure patients’ symptom burden. Descriptive statistics were undertaken. A thematic analysis as described by Braun and Clarke was conducted to analyze dyadic interview data. Dyads' experience of hope was described by using the six dimensions of hope in the Model of Hope of Dufault and Martocchio.ResultsDyadic scores of hope and patients' symptom burden were stable over time. The constructs of hope in dyads included “Living one day at the time,” “Having inner force/strength,” and “Maintaining good health.” Changes in patterns of hope were captured for each dyad in their transition over time. Data converged for all dyads except one.ConclusionsThe findings of our study show a constant presence of hope even in the face of adversity. Healthcare professionals must find ways to promote hope in dyads of patients living with advanced chronic diseases. Nurses play a pivotal role; dyadic interviews should be promoted to create a safe space for both patients and informal caregivers in order to share experiences. More research is needed to address patients' and informal caregivers' hope in chronic illness because current hope-based interventions primarily target cancer diagnoses.

Multidisciplinary Perspectives on Medical Decision-Making for Ostomy Surgery in Pediatric IBD: Themes from Focus Groups.

Pediatric Inflammatory Bowel Disease (IBD) is a chronic illness where patients may undergo ostomy surgery. Medical decision-making (MDM) for ostomy surgery is complex for patients/families and multidisciplinary healthcare professionals (HCPs) alike, with current uncertainty about how multidisciplinary HCPs think about ostomy care to inform future interventions to facilitate equitable multidisciplinary care for patients. This study sought to understand pediatric IBD multidisciplinary HCPs' perceptions regarding ostomy-related MDM and education. Multidisciplinary HCPs (e.g., gastroenterology medical providers, social workers, surgeons, and ostomy nurses) participated in semi-structured focus groups. Focus group data underwent qualitative analysis to identify themes. Three multidisciplinary focus groups were conducted, with n = 12 participants across all groups. Qualitative analysis identified three main themes, including (1) HCP perceptions of ostomies, (2) Patient/family-related factors, and (3) Professional roles and collaboration challenges. Ostomy surgery in pediatric IBD requires complex multidisciplinary MDM and education. Perspectives of multidisciplinary HCPs identified patient, HCP, and systems factors that may impact MDM for ostomy surgery. This work highlights nuances in MDM and education in IBD, and the critical role of ongoing research and improved standardized processes to coordinate multidisciplinary ostomy-related MDM and education in this population.

Recent Advances in Understanding and Treating Multiple Sclerosis

MS, often known as multiple sclerosis, is a chronic autoimmune illness that is characterised by inflammation, demyelination, and neurodegeneration in the central nervous system (CNS). This review provides a comprehensive summary of current achievements in multiple sclerosis (MS) research, focusing on substantial advancements in understanding the biology of the disease, improving diagnostic tools, and developing a variety of treatment strategies. Multiple Sclerosis (MS) is characterised by an attack by the immune system on myelin, which is the protective sheath that surrounds nerve fibres. This attack results in a wide variety of neurological symptoms. Genetic factors, such as polymorphisms in the HLA-DRB1 gene, as well as environmental variables, such as a lack of vitamin D and viral infections, have been identified as contributors to disease susceptibility. However, the exact cause of multiple sclerosis (MS) is still unknown. Among the advancements in diagnostics are the utilisation of more sophisticated magnetic resonance imaging (MRI) techniques and the investigation of novel biomarkers in cerebrospinal fluid (CSF) and clinical blood. Beyond the standard disease-modifying treatments (DMTs), there are now additional treatment alternatives available, which include more recent medications that have mechanisms of action that are more specifically targeted. Treatments that are only coming into existence, such as monoclonal antibodies and cell-based therapies, provide the possibility of progress in the management of diseases. The purpose of this review is to provide a summary of the most important discoveries, identify trends in research, and explore the significance of current developments for MS care as well as future research directions.