Cumulative Assessment Research Articles

Update of a database of toxicological effects of pesticides in view of performing cumulative risk assessments. Part 1: Catalogue of toxicity endpoints and data model for the collection of toxicity endpoints.

Abstract A catalogue of toxicity endpoints was developed for a consistent collection of toxicological information. The toxicity endpoints of relevance for cumulative risk assessment were organised in a table for each target organ/tissue/system (cumulative assessment group (CAG) at level 1) including information on specific toxicological effect(s) (CAG at level 2), indicators that reflect the relevance for the CAG at level 2, and descriptions/interpretations that allow an understanding of the CAG at level 2. A data model for the collection of toxicity endpoints was developed to ensure the possibility of integration of the collected data to the EFSA OpenFoodTox database, in order to extend it to non‐critical endpoints. The collection of toxicity endpoints and grouping of active substances were performed for a total of 328 active substances and 165 of their metabolites. The data model was filled in for all the OpenFoodTox columns as far as possible and essential information which could not be entered in the OpenFoodTox columns were noted in the ‘Remark column’. In total, 29 CAGs at level 1 have been evaluated for inclusion of specific toxicological effects (CAGs at level 2), whereas four CAG1 targets (gastrointestinal tract, immune system, lungs and skin) were not evaluated as the effects observed in these CAG1 targets were not considered relevant for CAGs at level 2. A number of toxicological effects considered adverse and of relevance for human risk assessment, but generally not relevant for CAGs at level 2, include mortality, clinical signs of toxicity, changes in bodyweight and body weight gain, changes in food consumption and water consumption, changes in clinical biochemistry and urinalysis parameters and changes in organ weights without histopathological changes. © National Food Institute, Technical University of Denmark, 2024

Flavouring group evaluation 420 (FGE.420): Hesperetin dihydrochalcone.

The EFSA Panel on Food Additives and Flavourings (FAF) was requested to evaluate the safety of hesperetin dihydrochalcone [FL-no: 16.137] as a new flavouring substance, in accordance with Regulation (EC) No 1331/2008. The substance is structurally related to the group of flavonoids evaluated in FGE.32 and is the aglycone of neohesperidine dihydrochalcone. Based on the data provided for [FL-no: 16.137], the Panel considered that a read-across between hesperetin dihydrochalcone and the substances in FGE.32 is not needed. Nevertheless, the flavonoids evaluated in FGE.32 were considered in a cumulative exposure assessment. The information provided on the manufacturing process, the composition and the stability of [FL-no: 16.137] was considered sufficient. The Panel concluded that there is no concern with respect to genotoxicity. No absorption, distribution, metabolism and excretion (ADME) studies on [FL-no: 16.137] were provided, but studies investigating the ADME of neohesperidine dihydrochalcone were submitted. The Panel noted that [FL-no: 16.137] has the same fate in the organism, as that of neohesperidine dihydrochalcone and considered that [FL-no: 16.137] can be anticipated to be metabolised to innocuous products only. In a prenatal developmental toxicity study, no maternal or foetal toxicity was observed. In a 90-day toxicity study, indications were obtained that the substance affects thyroid hormone levels at all doses tested (100-1000 mg/kg bw per day). Since these changes were not accompanied by apical findings indicative of hypothyroidism, the Panel considered these hormonal effects as not adverse. Using 1000 mg/kg bodyweight (bw) per day as reference point, adequate margins of exposure were calculated for adults and children, when considering the chronic added portions exposure technique (APET) dietary exposure estimates. Cumulative chronic exposure estimates to [FL-no: 16.137] and the four structurally related substances evaluated in FGE.32 do not raise a safety concern. The use of [FL-no: 16.137] as food flavouring, under the proposed conditions of use, does not raise a safety concern.

Critical appraisal of the Expert Knowledge Elicitation (EKE) methodology to identify uncertainties in building cumulative assessment groups for craniofacial alterations

The European Food Safety Authority (EFSA) conducted a retrospective cumulative dietary risk assessment (CRA) on active substances (AS) and metabolites included in the plant protection products registered in Europe which could provoke craniofacial alterations. Two Cumulative Assessment groups (CAGs) were established: one for alterations due to abnormal skeletal development (CAG-DAC) and one for head soft tissue alterations and brain neural tube defects (CAG-DAH).The probability that each substance is correctly assigned to the specific CAGs (CAG-membership probability) was assessed using weight of evidence and expert knowledge elicitation (EKE) techniques conducted for the six substances identified as risk drivers in each CAG. Four out of the six substances allocated to the CAG-DAC or to the CAG-DAH presented a large interval of uncertainty, with probability of belonging to the attributed CAG between 10 to 70% or 33 to 90%, which makes it difficult to determine if the substances truly belong to the CAG.In the present work the probability ranges of each risk driver were reassigned according to the approximate probability scale recommended in the EFSA guidance on uncertainty analysis. It is proposed that AS with a high probability are to be included in the CAG and those with a low probability removed from the CAG. For compounds with very large probability ranges, uncertainty assessments would have to be redone to reach narrower probability ranges. Finally, whenever recent decisions on reproduction toxicity classifications made by the European Chemical Agency (ECHA) are available, these should be used to conclude on CAG memberships.

Incorporating stressor interactions into spatially explicit cumulative impact assessments.

Human-induced stressors are impacting the oceans and reducing the biodiversity of marine ecosystems. The many stressors affecting marine environments do not act in isolation. However, their cumulative impact is difficult to predict. Most of the available methods for quantifying cumulative impacts on marine ecosystems sum the impact of individual stressors to estimate cumulative impact. We demonstrate how experimental evidence from interacting stressors can be accounted for in cumulative impact assessments. We adapted a widely used additive model to incorporate nonadditive stressor interactions into a marine spatially explicit cumulative impact assessment for seagrasses. We combined experimental data on the impact of multiple stressors with spatial data on stressor intensity to test whether stressor interactions impact seagrasses in a case study region in South Australia. We also assessed how uncertainty about cumulative impacts changes when uncertainty in stressor interactions is included in the impact mapping. The results from an additive spatial cumulative impact assessment model were compared with results from the model incorporating interactions. Cumulative effects from the interaction model were more variable than those produced by the additive model. Five of the 15 stressor interactions that we tested produced impacts that significantly deviated from those predicted by an additive model. Areas of our study region that showed the largest discrepancies between the additive and interactive outputs were also associated with higher uncertainty. Our study demonstrates that the inclusion of stressor interactions changes the pattern and intensity of modeled spatial cumulative impact. Additive models have the potential to misrepresent cumulative impact intensity and do not provide the opportunity for targeted mitigation measures when managing the interactive effects of stressors. Appropriate inclusion of interacting stressor data may have implications for the identification of key stressors and the subsequent spatial planning and management of marine ecosystems and biodiversity.

Assessment of Sustainability in the Supply Chain of Sweet Red Pepper Paste Production With Exergy and Life Cycle Analyses

ABSTRACTThis study examines cumulative energy (CEnC), exergy (CExC), CO₂ emissions (CCO₂C), and life cycle assessment of sweet red pepper (SRP) paste production. A whole system approach in five improvement scenarios including different packaging materials and precision farming encompasses the supply chain from farm to fork and cradle to gate. The largest impact on SRP farming is caused by the use of diesel oil, the excessive use of chemical fertilizers, and the use of electricity. In SRP farming step, the CEnC is mainly caused by 86.5% fertilizer and 11% diesel usage. Hotspot impact categories were determined as abiotic (fossil) depletion potential, global warming potential, and human toxicity potential. The base case scenario has the greatest values for CEnC, CExC, and CCO₂C and impact assessment results. A CEnC value reduction of 48.6%, 50%, and 30% in the factory processing, packaging‐transportation step and whole process, respectively, is observed when the biodiesel scenario is performed. With a 40% reduction in global warming potential value, the combination of polyethylene terephthalate packaging, biodiesel, and precision farming scenario yielded the best results for each impact category analyzed in this study.

Brain Removal With an Occipital Hinge Preserving Overlying Anatomy.

Brain removal during a gross anatomy course in medical school serves multiple purposes. It allows for the teaching of cranial vault anatomy, as well as the external brain, cranial nerves, and cerebral vasculature. Techniques to remove the brain while preserving these delicate structures generally damage the overlying anatomy of the dura and suboccipital triangle. Even though brain removal usually comes later in most gross anatomy courses, with the suboccipital triangle being taught at the beginning, it is still beneficial to preserve previously dissected structures, not only for use in cumulative practical assessments but also for additional teaching opportunities. Shrinking the availability of time and money has prompted anatomy departments to identify and develop potential areas for shared resources to teach medical students in clerkships, residents, and allied health professionals. The ideal brain removal technique would safely remove the brain, preserving its structure, cranial nerves, and vasculature, while also preserving an intact dura and suboccipital triangle. We present an occipital hinge technique of brain removal that preserves the cranial nerves and vasculature, as well as an intact, in situ dura, without damaging previously dissected suboccipital triangles.

Improving struggling medical and nursing students’ subjective vitality, school engagement and academic performance through a peer mentorship intervention programme: an intervention protocol

BackgroundThe undergraduate medical training programme is demanding and rigorous. This underlines the importance of a peer mentorship strategy to improve the well-being, self-determination, school connectedness, and performance of struggling medical and nursing students. This study is aimed at identifying struggling medical and nursing students using two cumulative continuous assessment test (CAT) scores, assess their subjective vitality and school engagement and evaluate the impact of the peer mentorship intervention on them.MethodsThe study will adopt a mixed-methods approach and will be conducted in the medical colleges of Nnamdi Azikiwe University, Awka, Nigeria, and the University of Rwanda. Three instruments will be used: The subjective Vitality Scale (SVS), the University Student Engagement Inventory (USEI), and the academic records of the students before and after the commencement of the intervention programme. The consenting least-performing medical and nursing students identified by their low CAT scores (below 45%) in basic medical sciences will be selected for study in each institution. The outcome measures will include students’ CAT scores, subjective vitality, and school engagement scores. The data will be analysed both quantitatively and qualitatively. Thematic content analysis will be adopted in the analysis of the responses generated from the focus group discussion. The mean ± standard deviation or median and interquartile range statistic will be adopted for the quantitative data.DiscussionGiven the paucity of data on struggling medical and nursing students in Nigeria and Rwanda, this research was designed to help in exploring evidence-based interventions to improve and prevent poor subjective well-being of struggling students. The study is expected to fill these knowledge gaps. Trial registration: Pan African Clinical Trial registry, PACTR202405546896613, registration date: 27th May, 2024. This proposal has been supported by grant 1R25TW011217 from the US National Institutes of Health (NIH)/Fogarty International Center (FIC) which also includes co-funds from the U.S. Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC) and the President’s Emergency Plan for AIDS Relief (PEPFAR) to the African Forum for Research and Education in Health (AFREhealth). The Grant Principal Investigators are Profs. Nelson K.Sewankambo (contact PI), Prisca Adejumo, Jean Bisimwa Nachega, Fatima Suleman.

The roles and unexplored potential of policy experimentation in climate adaptation governance: A systematic literature review

AbstractPolicy experimentation has emerged globally as a novel governance approach to address complex socio‐environmental problems. In the climate adaptation literature, policy experiments that test technical and governance innovations on a small scale in real‐world conditions are increasingly utilized to explore new pathways for climate adaptation. However, there is a lack of empirical evidence on how policy experiments lead to transformative change in climate adaptation governance, particularly regarding their role as a change strategy. This systematic literature review aims to thoroughly investigate the topic by mapping the empirical characteristics of policy experiments, their role and their outcomes. An existing analytical framework was adapted to fulfill this objective by qualitatively and quantitatively analyzing 27 empirical papers. The findings reveal that policy experiments in climate adaptation often address multiple climate hazards, sectors and actors, yet they are spatially and temporally limited, being predominantly located in Europe. Moreover, the study highlights the transformative potential of policy experiments in climate adaptation governance, emphasizing their effectiveness in testing technical and governing innovations, as well as implementing adaptation policies. Policy experiments predominantly contribute to social learning rather than direct policy changes, requiring specific strategies to upscale the knowledge generated. We conclude the paper with a research agenda that stresses the need for more cumulative and comparative (post)assessments of climate adaptation experiments. This is important given the potential of policy experiments as governing approaches in the advancement of climate adaptation.

Real-time hazard assessment of maize based on the chilling injury process —— Using a standard curve to establish a daily cumulative assessment method

Cold damage caused by low temperatures is known as chilling injury (CI), and it has consistently been one of the primary meteorological disasters affecting maize. With ongoing global climate change, the issue of chilling injury is becoming more prominent, exhibiting new characteristics and presenting new challenges. Consequently, understanding the disaster process and conducting a more refined real-time chilling injury identification have become significant challenges. In this study, we divided maize planting areas into seven maturity types based on the accumulated temperature, constructed a standard curve of the daily accumulated temperature from 1991 to 2020, proposed real-time identification indicators based on the CI process, and developed a real-time CI hazard assessment model. The results indicated that the model can capture independent CI events and rapidly determine the location, intensity, duration and scope of CIs, thereby providing a basis for accurately understanding the impact of chilling injury and taking timely countermeasures. The combination of accumulated temperature standard curves for seven maturity types of maize and the CI curve was used to construct the CI daily scale identification indicator, ΔEAT. Judgment thresholds for the CI identification indicators at various maturity levels were obtained by correlating them with historical disaster data. The frequency and intensity of maize CI gradually increased from the extremely late-maturing zone to the extremely early-maturing zone, with the seeding and emergence periods being the peak periods for CI. The spatiotemporal evolution characteristics of the three different degrees of CI events in 1992, 2004, and 2017 were consistent with the historical disaster records. Northeastern Inner Mongolia and most of Heilongjiang were found to be high-hazard areas for maize CIs. The constructed daily CI identification indicators can accurately and rapidly identify maize CIs, providing practical and targeted guidance for combating these injuries.

Strengthening vaccination assessment at a southern oncology center: A quality improvement endeavor.

322 Background: The 2013 revision of the Standards for Adult Immunization Practice by the National Vaccine Advisory Committee (NVAC) mandated healthcare professionals to evaluate and ensure adult patients' immunization. Additionally, the 2024 recommendations from the American Society of Clinical Oncology (ASCO) stressed the importance of determining vaccination status of adults newly diagnosed with cancer, to safeguard against vaccine-preventable diseases. Our 2022-2023 cumulative assessment rate for flu vaccination was 64%, and COVID-19 vaccination status was not being assessed in the electronic medical record (EMR). This prevented us from identifying patients who would benefit from vaccination. Methods: A quality improvement initiative was initiated at Norton Cancer Institute – Downtown Office, focusing on enhancing vaccination assessment. Launching in October 2024, the initiative targeted flu and COVID-19 vaccination assessment, with updates to flu assessment questions and the implementation of a COVID-19 assessment flowsheet in the EMR. Best practice advisories (BPAs) were employed to prompt nurse clinicians and providers to order vaccines based on patient responses. Staff compliance was reinforced through tailored training sessions for medical assistants responsible for initial patient assessments, with an emphasis on reconciling external records to improve assessment accuracy. A de-identified data set was created to analyze workflow compliance, the data was abstracted from the relational databases of our institution's EMR system. Abstraction queries were written in SQL using the Microsoft SQL Server Management Studio platform. Results: Following the implementation of the initiative, there was an increase in vaccination assessment completion rates for both Flu and Covid-19. Flu assessment rates improved from 64% at the end of the 2022-2023 flu season to 76% during the 2023-2024 flu season. The implementation of Covid-19 Vaccination assessment workflow also resulted in increased assessment rates each month of the initiative, starting in October with initial rate of 36% and ending in March with 67% cumulative assessment rate. Conclusions: The targeted intervention increased vaccination assessment practices within the oncology setting; by improving clinical workflow to better align with NVAC guidelines and ASCO recommendations for assessment of vaccination status. By Improving vaccination assessment processes our hope is to improve rates of vaccination for oncology patients.

Cumulative Assessment of Tone and Reactivity of the Microvascular Bed Based on in vivo Optical Flowmetry Data. Justification of the Approach

Cumulative Assessment of Tone and Reactivity of the Microvascular Bed Based on in vivo Optical Flowmetry Data. Justification of the Approach

Assessing the potential of multi-use to reduce cumulative impacts in the marine environment

The intentional combination of two or more marine activities with the purpose of sharing space, infrastructure, resources and/or operations, referred to as multi-use, is gaining attention as a means to reduce the spatial footprint of human activities but possibly also its ecological footprint. In this study, the Spatial Cumulative Assessment of Impact Risk for Management (SCAIRM) method was adapted and applied to assess whether multi-use can reduce the ecological footprint in terms of the cumulative impacts on the marine ecosystem, by integrating multiple offshore activities in different configurations as compared to these activities separated in space, referred to as single-use. These configurations combine renewable energy, aquaculture, nature restoration and tourism activities, in different combinations. For the sake of this multi-use assessment these activities were subdivided into actions, their allocation in space and time represented in scenarios (e.g. single-use versus multi-use) which were then evaluated in terms of their ecological footprint (i.e. Impact Risk). The main finding is that the calculated Impact Risk in multi-use is often lower than that in single-use and in any case never higher. This study also shows that there is still much to be gained in terms of further reduction in Impact Risk through an optimization of the multi-use design by comparing the scenario based on actual pilots deemed more realistic (i.e. co-existence with limited synergies) with a hypothetical optimal scenario (i.e. multi-functional).

Cumulative collision risk and population-level consequences of industrial wind-power plant development for two vulture species: A quantitative warning

Prioritizing renewable energy generation over the conservation of natural habitats and species on a large spatial scale, leads to the paradox of impacting biodiversity to mitigate climate change. In this study, we aim at quantifying the long-term demographic impact of the excess mortality caused by collisions with wind turbines on the populations of two vulture species of conservation concern. Using long-term monitoring data and Integrated Population Models (IPMs), we quantified demographic parameters and projected population trends under various wind power development scenarios. Our findings indicate that even under our most optimistic scenarios, annual collision mortality could reach up to 30 % of the current Cinereous vulture population and 7 % of the Griffon vulture population. Without further wind power expansion, both vulture populations are predicted to remain stable or increase over the next 20 years. However, the addition of 85 wind turbines is likely to drive the Cinereous vulture to local extinction within 18 years and significantly slow the growth of the Griffon vulture population. Scenarios involving larger numbers of turbines could result in the extinction of both species within two to five years for Cinereous vultures and up to 20 years for Griffon vultures, depending on space use intensity. Our results underscore the vulnerability of long-lived species to excess mortality and highlight the need for comprehensive Environmental Impact Assessments (EIAs) that incorporate population dynamics analyses. Effective conservation strategies must include rigorous pre- and post-construction monitoring, the availability of monitoring data, and cumulative impact assessments that consider the entire foraging range of these species. Additionally, strategic planning to avoid critical vulture habitats and implementing mitigation measures in buffer zones are essential. This study emphasizes the necessity of integrating biodiversity considerations into renewable energy planning to balance the goals of energy production and wildlife conservation.

Методические аспекты использования анализа аллостатической нагрузки в оценке здоровья работающего населения в условиях воздействия производственных факторов (аналитический обзор)

Preventive medicine of pathogenetically based technologies for prenosological diagnostics of health risks at the stage of reversible physiological dysregulation is being introduced into practice as a relevant strategy for preserving population. It provides suitable conditions for timely prevention of chronic diseases and reducing risks of premature mortality among working age population. Using resources of the scientific information systems CyberLeninka, eLibrary, PubMed and Google scholar, the authors analyzed and summarized scientific literature data on methodological aspects and problems related to practical appli-cation of the concept of allostasis and allostatic load (AL) in assessing and predicting health risks for working population. The review focuses on the main causes of physiological dysregulation leading to AL formation under environmental exposures, including occupational ones; presents the most popular biomarkers of the functional state of the neuroendocrine, immune-inflammatory, cardiovascular and metabolic systems included in the sets of variables for determining the AL index. The review also provides the description of the most common algorithms for calculating the AL index used in preventive examinations of workers and highlights methodological approaches to the correction of AL values with regular intake of medicines. The sex-specific age dynamics of AL is presented; attention is drawn to the aggravating effect produced on AL by negative behavioral factors. The review shows that it is still difficult to introduce this methodology into routine practices of preventive medical examinations of working population despite the proven diagnostic and prognostic significance of the prenosological diagnosis of health disorders based on AL. This is mostly due to lack of consensus on standardized approaches to creating sets of biomarker scales and a method for calculating the AL index, as well as considering the sex factor and contribution of therapeutic effects to cumulative assessment of risks of developing physiological dysfunctions.

P19-58 Use of transcriptomic signatures of pesticide active substances in human kidney cells to support definition of cumulative assessment groups (CAGs) for risk assessment

P19-58 Use of transcriptomic signatures of pesticide active substances in human kidney cells to support definition of cumulative assessment groups (CAGs) for risk assessment

Methodological aspects of using allostatic load analysis in assessing health of working population exposed to adverse occupational factors (Analytical review)

Preventive medicine of pathogenetically based technologies for prenosological diagnostics of health risks at the stage of reversible physiological dysregulation is being introduced into practice as a relevant strategy for preserving population. It provides suitable conditions for timely prevention of chronic diseases and reducing risks of premature mortality among working age population. Using resources of the scientific information systems CyberLeninka, eLibrary, PubMed and Google scholar, the authors analyzed and summarized scientific literature data on methodological aspects and problems related to practical appli-cation of the concept of allostasis and allostatic load (AL) in assessing and predicting health risks for working population. The review focuses on the main causes of physiological dysregulation leading to AL formation under environmental exposures, including occupational ones; presents the most popular biomarkers of the functional state of the neuroendocrine, immune-inflammatory, cardiovascular and metabolic systems included in the sets of variables for determining the AL index. The review also provides the description of the most common algorithms for calculating the AL index used in preventive examinations of workers and highlights methodological approaches to the correction of AL values with regular intake of medicines. The sex-specific age dynamics of AL is presented; attention is drawn to the aggravating effect produced on AL by negative behavioral factors. The review shows that it is still difficult to introduce this methodology into routine practices of preventive medical examinations of working population despite the proven diagnostic and prognostic significance of the prenosological diagnosis of health disorders based on AL. This is mostly due to lack of consensus on standardized approaches to creating sets of biomarker scales and a method for calculating the AL index, as well as considering the sex factor and contribution of therapeutic effects to cumulative assessment of risks of developing physiological dysfunctions.

Data collection, hazard characterisation and establishment of cumulative assessment groups of pesticides for specific effects on the thyroid: 2024 update

Data collection, hazard characterisation and establishment of cumulative assessment groups of pesticides for specific effects on the thyroid: 2024 update

Using cumulative human impact assessment to support adaptive management of the threatened species’ habitats in the Yangtze River Estuary

The conflict between multiple functions of human use and habitat conservation represents an intractable challenge for environmental management. While numerous studies on marine conservation prioritize cumulative impact assessments (CIA) to tackle this issue, estuaries — despite their immense conservation significance amidst intense human activities — remain overlooked. Taking the Yangtze River Estuary (YRE) as the case study area, it is one of the most intensely human-utilized estuaries globally, yet it serves as a critical habitat and migratory corridor for the endangered Chinese sturgeon (Acipenser sinensis).We employed ecological indicators and quantitative modeling to assess habitat suitability and cumulative anthropogenic impacts on this endangered species in the YRE. The results demonstrated that suitable habitat distribution and human impact varied for juvenile Chinese sturgeon in the YRE. The suitable habitat distribution for juvenile Chinese sturgeon was concentrated in Chongming Dongtan and the North Channel. Ship density, submarine optical cables, and smooth cord grass invasion were the main anthropogenic factors impacting the Chinese sturgeon's migrating habitat in the YRE. Moreover, existing Chinese sturgeon habitats remain at risk, with 36.24 % of potential habitats and 56.60 % of high human impact areas requiring enhanced protection. Adaptive management strategies were proposed, tailored to the spatial and environmental protection needs across the dynamic habitat demands of aquatic species. Our spatially explicit and indicator-based findings provide key scientific support for enlarging protected areas and implementing adaptive management of human activities to balance conservation and sustainable use in this highly utilized ecosystem.

Sexual Abuse, Commercial Sexual Exploitation, and Cumulative Adversity Among Sexually Diverse and Non-Sexually Diverse Girls in the Juvenile Justice System

ABSTRACT Despite awareness about high rates of sexual abuse among girls in the juvenile justice system, little is known about the additional risk conferred upon sexually diverse (SD) youths, as well as the combined vulnerability of sexual abuse and commercial sexual exploitation of children (CSEC) – frequently a survival behavior amplifying disproportionate juvenile justice contact among SD and non-SD juvenile justice-involved (JJI) girls. In a sample of JJI-girls, we compared SD (n = 52) with non-SD (n = 46) JJI-girls on sexual victimization (e.g. sexual abuse occurring within different relationship-types, CSEC), and broader developmental adversity burden disadvantage (cumulative trauma/loss exposure-types) and distress (posttraumatic stress disorder [PTSD]; cumulative stressor-reactivity, grief-specific, and adversity-related symptoms), health distress/impairment, and sexual and physical health-risk indicators. While comparable on childhood sexual abuse frequency, SD JJI-girls reported greater cumulative sexual abuse severity across relationship-types, higher sexual abuse within non-familial contexts, and more CSEC involvement. They also reported more social determinants of health (e.g. trauma/loss exposure-types) and showed elevations on all health-risk indicators, and most cumulative adversity burden indicators, despite comparable PTSD severity. Our findings emphasize the need to consider multiple sexual victimization facets, including the combined vulnerability of sexual abuse and CSEC, and utilize cumulative developmental assessment approaches among youths vulnerable to maltreatment and exploitation.

Laser technologies in the treatment of patients with a combination of rosacea subtypes: comparative data

Phototechnologies occupy a leading position in the treatment of patients with rosacea. The most effective technologies are laser: pulsed dye laser (585nm, 595nm) and neodymium laser (1064nm), however, issues of comparative analysis, including in patients with a combination of rosacea subtypes, require further study.Material and methods. We observed 64 patients with diagnosed rosacea with a combination of subtypes: erythematotelangiectatic and papulopustular. Among them, 48 (75%) were female and 16 (25%) were male. The age of the patients varied widely: from 31 to 57 years, the average age was 39.2±4.6 years. The average duration of the disease was 5.1±2.3 years. Depending on the therapy, patients were divided into 2 groups: group 1 received treatment with a neodymium laser, group 2 – treatment with a pulsed dye laser.Research results. A cumulative assessment taking into account clinical research methods with a sufficient degree of reliability revealed the advantages of a neodymium laser over a pulsed dye laser, regardless of the clinical picture of rosacea, which was confirmed by the dynamics of the IGA/PGA indices: reduction in group 1 was 79.5%/66.7%, in group 2–63.2%/51.3%, respectively. These data were confirmed by the dynamics of the DIQI index – 81.7% and 61.6%, respectively.