Early Start Research Articles

Sibling-Mediated Early Start Denver Model Support for Young Autistic Children

Young autistic children and their siblings often need support to play and engage with each other. The inclusion of older siblings in the provision of support may improve outcomes for autistic children and strengthen the sibling relationship. This study evaluated the inclusion of older siblings in the delivery of Early Start Denver Model (ESDM) support to autistic children aged between 3 and 4 years. It used a non-concurrent multiple baseline across participants design to evaluate the effects of sibling-mediated ESDM for four young autistic children and their older, non-autistic siblings. For most dyads, there were improvements in autistic child engagement and in sibling initiations during the sibling-mediated ESDM, which were generally maintained at follow-up. There was some improvement in sibling responses and minimal improvement in autistic child imitation and functional utterances. Sibling initiations and responses were generally positively correlated with autistic child engagement, functional utterances, and imitation. The parents of children in all four dyads found the sibling-mediated ESDM to be acceptable. These preliminary results suggest that sibling-mediated ESDM may be beneficial for improving the interaction between autistic children and their non-autistic siblings while benefits for teaching additional child skills might be more limited.

The experience of transfeminine adolescents and their parents regarding fertility preservation via testicular sperm extraction (TESE): a qualitative study.

How do transfeminine adolescents and their parents experience fertility preservation via testicular sperm extraction (TESE)? Participants experienced the TESE process positively when provided with appropriate guidance to navigate the decisional dilemma between preserving future biological parenthood and the pressure to start puberty suppression early. Sperm banking through ejaculation is not feasible for all transfeminine adolescents due to genital dysphoria and early puberty; for this group, TESE is the only alternative. However, during early puberty, they must postpone or pause puberty suppression until spermatogenesis is fully developed. All consecutive TESE patients in our centre and their parents were invited to participate. Between December 2022 and May 2023, we included 6 adolescents and 10 parents. We used a qualitative approach based on semi-structured interviews to study the experience of the transfeminine adolescents and their parents. Transfeminine adolescents diagnosed with gender dysphoria in early puberty (Tanner stage ≥2) who underwent TESE before the start of puberty suppression or gender-affirming hormones participated in this study. The interviews were recorded, manually transcribed and analysed using reflective thematic analysis focusing on understanding the participants' experiences of puberty and fertility preservation and the various factors and social processes influencing their decision to undergo TESE. Transfeminine adolescents decide to undergo invasive fertility preservation because of a possible, future desire for parenthood. Parents stressed the importance of preventing future decisional regret. They both saw masturbation to obtain a semen sample as unreachable. Even though TESE is a surgical procedure with possible complications and pain afterwards, this alternative seemed less dysphoric to them.Adolescents had to postpone the start of puberty suppression, waiting for spermatogenesis to complete. Given the unpredictable development of puberty, they felt a lot of stress and anxiety during this period and were primarily concerned about the lowering of their voice. Because of this puberty-related stress, they were constantly balancing their motivations for fertility preservation against the early start of puberty suppression to prevent unwanted irreversible pubertal body changes. To support this decisional dilemma, adolescents and their parents need adequate communication with each other and their healthcare providers to reflect on their stress for pubertal change. Furthermore, close, continuous surveillance of their current mental state by their parents, together with their psychologist and pubertal development by their physicians, is needed. Despite the challenging decision and postponement of puberty suppression, they retrospectively experienced it positively without any regret. All adolescents successfully underwent TESE, with viable spermatozoa obtained and without complications. This may result in a more positive reflective experience regarding fertility preservation. Furthermore, the perspectives of adolescents with the intention of TESE but who already started with puberty suppression before the preservation were not included. This study helps healthcare providers improve their counselling and guidance of transfeminine adolescents who consider postponing puberty suppression for fertility preservation via TESE. The adolescents and their parents know more clearly what to expect during fertility preservation. Specific peer-support programs may facilitate the decision process for upcoming adolescents. No external funding was used for this study. None of the authors have any conflicts of interest. Not applicable.

Impact of the timing of invasive mechanical ventilation in patients with sepsis: a multicenter cohort study

BackgroundThe potential adverse effects associated with invasive mechanical ventilation (MV) can lead to delayed decisions on starting MV. We aimed to explore the association between the timing of MV and the clinical outcomes in patients with sepsis ventilated in intensive care unit (ICU).MethodsWe analyzed data of adult patients with sepsis between September 2019 and December 2021. Data was collected through the Korean Sepsis Alliance from 20 hospitals in Korea. Patients who were admitted to ICU and received MV were included in the study. Patients were divided into ‘early MV’ and ‘delayed MV’ groups based on whether they were on MV on the first day of ICU admission or later. Propensity score matching was applied, and patients in the two groups were compared on a 1:1 ratio to overcome bias between the groups. Outcomes including ICU mortality, hospital mortality, length of hospital and ICU stay, and organ failure at ICU discharge were compared.ResultsOut of 2440 patients on MV during ICU stay, 2119 ‘early MV’ and 321 ‘delayed MV’ cases were analyzed. The propensity score matching identified 295 patients in each group with similar baseline characteristics. ICU mortality was lower in ‘early MV’ group than ‘delayed MV’ group (36.3% vs. 46.4%; odds ratio, 0.66; 95% confidence interval, 0.47–0.93; p = 0.015). ‘Early MV’ group had lower in-hospital mortality, shorter ICU stay, and required tracheostomy less frequently than ‘delayed MV’ group. Multivariable logistic regression model identified ‘early MV’ as associated with lower ICU mortality (odds ratio, 0.38; 95% confidence interval, 0.29–0.50; p < 0.001).ConclusionIn patients with sepsis ventilated in ICU, earlier start (first day of ICU admission) of MV may be associated with lower mortality.

Programming the onset of ovarian stimulation: from early follicular phase start to oral contraceptive pill, to luteal phase E2, Duostim, and random start oral contraceptive protocols

Ovarian stimulation has been the single most efficient measure ever taken in assisted reproductive technology for improving outcomes by harvesting multiple oocytes and ultimately, embryos. Today, ovarian stimulation protocols consist of administrating exogenous gonadotropins to override the natural mechanisms that control the ovulatory quota to one in humans. For practicality issues, there have been numerous attempts to control, or "program," when ovarian stimulation is initiated to improve functionality and in turn efficacy for assisted reproductive technology programs. The different options for controlling the onset of ovarian stimulation currently available are discussed here, as well as the novel possibility of using progestins for blocking premature ovulation.

Оценка болевого синдрома в реабилитационных мероприятиях после операции по поводу разрыва ахиллова сухожилия

INTRODUCTION. Patients who have been injured need an early start of rehabilitation measures. This is due to the fact that prolonged restriction of motor activity, lack of exercise, vascular and other changes lead to muscle atrophy, limited mobility in joints, impaired metabolic processes in the extremities, loss of functional conditions. AIM. To optimize the complex of measures for early rehabilitation after surgery for Achilles tendon rupture, taking into account the assessment of pain syndrome. MATERIAL AND METHODS. The research work was carried out at the Department of Medical Rehabilitation and Sports Medicine. To implement the tasks set, the following stages were introduced: a critical analysis of domestic and foreign sources, the development of an individual rehabilitation plan with an assessment of pain syndrome. RESULTS AND DISCUSSION. For effective rehabilitation in the postoperative period, it is important to objectively control the patient's pain sensations, gradually increasing the load on the damaged tendon. The pain monitoring and weight load dosing scale based on the visual analog scale has found wide application. Visual analog scale consists of a horizontal line on which the extreme points correspond to 0 points (no pain) and 10 points (maximum unbearable pain). The patient marks a point on this line corresponding to his current pain level. The pain syndrome was assessed on the day of surgery, and then on the 7th, 14th, 21st, 35th, 42nd and 49th days of follow-up after surgery. If by the end of the second week after surgery, the pain syndrome is 0-2 points, this indicates a favorable healing process and the possibility to begin early mobilization of the tendon. During this period, you can gradually increase the weight load on the limb, starting with partial support on the foot. If the pain syndrome persists, it is more than 2 points according to visual analog scale by the end of the second week, which may indicate the development of complications that prevent normal healing: inflammation, failure of sutures, suppuration of the surgical wound. CONCLUSION. The proposed technique using a visual analog scale is a tool for assessing pain and functional status in the preparation of a set of measures for early rehabilitation after surgery for rupture of the Achilles tendon. The assessment of pain symptoms is a determining factor in the introduction of early tendon mobilization. KEYWORDS: Achilles tendon rupture, pain syndrome, early rehabilitation

Individual placement and support in mental health services: evaluation of routine clinical data using aretrospective chart review

People with severe mental illnesses are often excluded from working life and would like support to (re)enter the general labor market as part of the psychiatric treatment. Individual placement and support (IPS) is an effective method of finding and retaining work in the general labor market. The aim of the study was to determine the integration rates of IPS into the general labor market in acute and postacute psychiatric settings, identifying patient, setting and program characteristics associated with (re)entering work. A retrospective chart review (RCR) of routine clinical data between 2016 and 2021 was carried out. The IPS program adherence was rated using the IPS fidelity scale. A total of 375 patients participated in the IPS with at least 4 appointments. The (re)integration rate into the general labor market was 51.7%. A shorter time period to the last working day, diagnosis of F1, F2, F3 (vs. F4), change of treatment setting and IPS in the psychiatric institute outpatient department (PIA), IPS fidelity and the number of IPS coaching sessions were positively correlated with (re)integration into work. The implementation of IPS in clinical mental healthcare is possible and leads to high integration rates in the open labor market. An early start of IPS during the clinical treatment can promote social inclusion.

Potential drivers of differences in breeding phenology as a component of life history strategies among coexisting species

Abstract Breeding phenology can have strong demographic consequences. Yet, the reasons why coexisting animal species differ in breeding phenology have received little attention. We tested selection pressures that underlie life history variation, such as age‐specific mortality, diet, and body size to explain breeding phenology of 16 coexisting songbird species in arid shrubland in South Africa. The average start and end dates for the earliest and latest species differed by 1.5 months, with a gradient among remaining species. Nest predation risk generally increased through the season, although species differed in seasonal patterns. Species with lower annual adult mortality, greater seasonal increases in nest predation, and greater nest predation rates had earlier start and stop dates, thereby reducing demographic risks. Species with higher adult mortality had larger brood sizes that require more food and they bred later when food was more abundant. Evolved timing of breeding thereby reflected risk management and food availability related to longevity and brood size. These factors may place unrecognized constraints on within‐species responses to climate change. Given the importance of phenology for fitness, phenology should be integrated as a core life history trait in future theory, and evolutionary constraints need to be considered in responses to climate change. Read the free Plain Language Summary for this article on the Journal blog.

Variations in volume; Breast size in trans women in relation to timing of testosterone suppression.

Breast development is an important outcome for trans women receiving gender affirming hormone therapy (GAHT). Limited breast development has been reported, possibly because of testosterone exposure during puberty. The impact of puberty suppression (PS) on breast development is unclear. To investigate the impact of PS and timing of PS prior to GAHT on breast volume and satisfaction. Cross-sectional study. Tertiary gender identity clinic. 60 trans women (aged 17-57 years) after 4.5±1.7 years of GAHT were included of whom 23 initiated PS early in puberty (Tanner stage G2-3), 17 late in puberty (Tanner stage G4-5), and 20 started GAHT in adulthood without prior PS. Breast volume measured with a 3D scanner and breast satisfaction measured with a questionnaire. Comparisons of breast volumes were adjusted for fat percentage. Median breast volume was 115ml (IQR 68; 203), i.e. bra cup-size <A. Breast volume was 47ml (95%CI -9; 104) larger in the late PS group compared to early PS but this difference was only 4ml (95%CI -67; 75) after correction for fat percentage. Breast volume in the adult group was comparable to the early and late PS groups (adult vs. early PS 27 ml (95% CI -28; 83) and adult vs. late PS -20 ml (95% CI -80; 40)). In total, 68% of subjects were satisfied with breast size (57% of early PS, 76% of late PS and 70% of adult group). Early start of PS was not associated with larger breast volume, suggesting that pubertal testosterone exposure does not affect breast volume after subsequent GAHT. Despite limited breast size, most trans women were satisfied with their breast development.

Little Talks: Building Home Visiting’s Capacity to Promote Communication and Language Skills for Children under Three Years of Age

Poverty continues be most prevalent among young children under three years of age, when development, particularly in communication and language skills, is rapid and vulnerable to socioeconomic impacts. Home visiting was intentionally formulated to support parents in promoting children’s development and health, offsetting poverty’s threats. Little Talks, a parent-mediated intervention to promote children’s communication and language growth, was designed for implementation in home visiting programs. Developed through community-partnership research methods, Little Talks is a modular intervention that is tailored to parents’ styles and preferences for interacting with their children. A randomized control trial of Little Talks’ effectiveness in attaining outcomes aligned with the two-generational processes inherent in home visiting was undertaken. Situated in an Early Head Start program, home visitors and the families they served were randomly assigned to receive EHS with Little Talks and typical EHS services. Assessed across four time points during a 10-month period, Little Talks was demonstrated to significantly enhance the quality of home visits and parents’ involvement in their children’s early learning experiences. In addition, parents’ depressive symptoms did not increase as noted for the comparison condition. Communication and language growth improved for EHS Little Talks children, although statistical significance was not attained. Moreover, parenting outcomes were greatest for families who were less acculturated to US either by immigration status and/or language preferences. Implications advancing Little Talks as a feasible and effective addition to home visiting programs are offered.

PENERAPAN CRITICAL PATH METHOD (CPM) DALAM MENGANALISIS MANAJEMEN WAKTU PADA PERENCANAAN IKLAN GMS DIGITAL MARKETING

Planning helps monitor activities. to achieve the expected efficiency and effectiveness. In advertising planning at GMS Digital Marketing, there are often losses. The purpose of this study is to find out how to manage good time in advertising planning in GMS Digital Marketing and find out what efforts can be made so that advertising planning has efficient time. A mathematical approach called Critical Path Analysis (CPM) is used to organize the grouping of project operations. The project activities described using the CPM Method are a two-round procedure consisting of a forward and backward approach to setting a schedule when conducting a critical path analysis. ES and EF are set up during the forwarding process. During the transfer, LS and LF are determined. Early Start (ES) is the fastest way to start an activity. CPM is a cost-cutting approach for projects. We can know when costs and schedules need to be negotiated to meet project deadlines while keeping costs as low as possible. When a dimension is used, then CPM is used. (More accurate time estimates). Therefore, from the results of this study, a critical path is obtained that requires additional labor and time in completing the work

STANDARD AND BIOPSYCHOSOCIAL OSTEOPATHIC MANAGEMENT FOR PATIENTS WITH NON-SPECIFIC LOW BACK PAIN (THE OSCAR STUDY): A SINGLE-CASE EXPERIMENTAL DESIGN

Purpose and BackgroundGuidelines recommend biopsychosocial care for chronic, complex musculoskeletal conditions, including non-specific low back pain. The aims were: 1/ to assess how patients with low back pain respond to osteopathic treatment, both before and after an osteopath has completed a Biopsychosocial Pain Management (BPM) course; and 2/ to assess if it is feasible and acceptable for osteopath participants to receive weekly SCED data and use it to guide patient management.Methods and ResultsA multiple baseline single case experimental design trial (clinicaltrials.gov, on 18/10/2021, ID number NCT05120921) with 11 UK osteopaths was conducted. Patients were randomised to early, middle or late treatment start dates. Statistical analysis assessed the change between baseline, intervention and follow-up periods. Primary outcomes were the Numeric Pain Rating (NPR) and Patient Specific Function Scales (PSFS), measured during the baseline, the 6-week intervention, and during a 12-week follow-up period.At baseline, the osteopaths reported stronger biopsychosocial attitudes to pain, compared to biomedical beliefs (PABS: 34 behavioural scale; 29 biomedical scale). Overall, patient participants showed daily increases in symptoms during the pre-treatment phase (+0.24/day, p&lt;0.001), and daily decreases during treatment (−2.94 over the treatment phase, p&lt;0.001), which continued post-treatment (−3.36 over 12 weeks, p=0.04). Similar improvements were observed for function.ConclusionOsteopathic care was shown to help patients with persistent low back pain. Patient recruitment was challenging because of the randomisation. With further development, the method shows feasibility as a means of enhancing research activity among practising clinicians.Previous presentations or publications of the workThe protocol was published (https://doi.org/10.1016/j.ijosm.2023.100660) and presented at SBPR in 2022. The results were presented to an osteopathic conference in October 2023.Ethics approval was received from the University College of Osteopathy Research Ethics Committee.Conflicts of interestsJerry Draper-Rodi receives fees from the sales of the e-learning course on the biopsychosocial management on the UCO CPD platform.Sources of fundingThe research was funded by the Osteopathic Foundation.

Turn off that night light! Light-at-night as a stressor for adolescents.

Light-at-night is known to produce a wide variety of behavioral outcomes including promoting anxiety, depression, hyperactivity, abnormal sociability, and learning and memory deficits. Unfortunately, we all live in a 24-h society where people are exposed to light-at-night or light pollution through night-shift work - the need for all-hours emergency services - as well as building and street-lights, making light-at-night exposure practically unavoidable. Additionally, the increase in screentime (tvs and smart devices) during the night also contributes to poorer sleep and behavioral impairments. Compounding these factors is the fact that adolescents tend to be "night owls" and prefer an evening chronotype compared to younger children and adults, so these teenagers will have a higher likelihood of being exposed to light-at-night. Making matters worse is the prevalence of high-school start times of 8 am or earlier - a combination of too early school start times, light exposure during the night, and preference for evening chronotypes is a recipe for reduced and poorer sleep, which can contribute to increased susceptibility for behavioral issues for this population. As such, this mini-review will show, using both human and rodent model studies, how light-at-night affects behavioral outcomes and stress responses, connecting photic signaling and the circadian timing system to the hypothalamic-pituitary adrenal axis. Additionally, this review will also demonstrate that adolescents are more likely to exhibit abnormal behavior in response to light-at-night due to changes in development and hormone regulation during this time period, as well as discuss potential interventions that can help mitigate these negative effects.

The good, the bad and the ugly of luteal phase stimulations

An early follicular phase start of ovarian stimulation in assisted reproductive technology (ART) is only required if a fresh embryo transfer is planned. A shift from fresh to frozen embryo transfers has recently characterized ART treatments and, combined with the trend towards treatment individualization and simplification, facilitated random-start stimulation. Luteal phase stimulation, started between ovulation and the next menses, has gained momentum and the good, the bad and the ugly sides have become obvious with the increasing number performed. Unprotected intercourse during the follicular phase or around ovulation can result in an unknown and undetectable conception at the time of starting stimulation. Aside from the theoretical implications for embryo development from exposure to stimulation medication, embryo-derived human chorionic gonadotrophin may cause ovarian hyperstimulation syndrome. The duration of stimulation and consumption of gonadotrophin appear to be longer and higher than in the early follicular phase start approach, although the number of retrieved/mature oocytes is comparable or, in some instances, higher. On the other hand, elevated progesterone concentrations during the luteal phase may prevent premature ovulation and, in theory, might replace pituitary suppression using gonadotrophin-releasing hormone antagonists or exogeneous progestins. Furthermore, the flexibility in stimulation timing will meet the needs of patients with time constraints.

Understanding Business Models in the Brazilian Context of Electric Mobility: A Proposed Framework

In the transition to electric mobility (EM), business model innovation plays a crucial role in expanding the use of electric vehicles and increasing acceptance of this technology. The transition pathways differ between countries in the largest economies and those in Latin America. Brazil presents a unique scenario, benefiting from an early start with biofuels, the production of flex-fuel vehicles, predominantly renewable electric energy generation (&gt;80%), and the absence of a structured national policy aligned with local governments. This study introduces a framework that surveys and categorizes businesses in EM, relating them to sustainable development aspects and regulatory maturity. It builds a solid conceptual foundation, incorporating data from technical and commercial events, as well as interviews with Brazilian specialists for validation. The proposed framework aids in understanding the Brazilian context, identifying regulatory gaps, and developing a common language to advance studies on business model innovation, contributing to electromobility studies in Latin America. Additionally, it can guide the construction of regional and local public policies and help identify more sustainable projects.

Early identification of rheumatoid arthritis: does it induce treatment-related cost savings?

ObjectiveEarly diagnosis and treatment-start is key for rheumatoid arthritis (RA), but the economic effect of an early versus a later diagnosis has never been investigated. We aimed to investigate whether...

Undetected, natural conception pregnancies in luteal phase stimulations-case series and review of literature.

What is the risk of an undetected natural conception pregnancy during luteal phase ovarian stimulation, and how does it impact the pregnancy's course? The risk for an undetected, natural conception pregnancy in luteal phase ovarian stimulation is low and it appears that ovarian stimulation is unlikely to harm the pregnancy. Random start ovarian stimulation appears to be similarly effective as early follicular stimulation start; and it allows ovarian stimulation to be started independent of the cycle day and throughout the cycle, in accordance with the patients' and clinics' schedule as long as there is no intention of a fresh embryo transfer in the same cycle. Starting ovarian stimulation in the luteal phase bears the possibility of an-at the timepoint of stimulation start-undetected, natural conception pregnancy that has already occurred. There is scarce data on the incidence of this event as well as on the possible implications of ovarian stimulation on the course of an existing pregnancy. This retrospective observational study, performed between June 2017 and January 2024, analyzed luteal phase stimulations, in which a natural conception pregnancy was detected during the ovarian stimulation treatment for IVF/ICSI. Luteal phase stimulation was defined as ovarian stimulation started after ovulation and before the next expected menstrual bleeding, with a serum progesterone (P4) level of >1.5 ng/ml on the day of stimulation start or 1 day before. Women who underwent a luteal phase ovarian stimulation in a tertiary referral ART center. A total of 488 luteal phase stimulation cycles were included in the analysis. Luteal phase stimulation was only started after a negative serum hCG measurement on the day or 1 day before commencement of ovarian stimulation. Ten patients (2.1%) had an undetected natural conception pregnancy at the time of luteal phase stimulation start. Eight of these patients underwent an ovarian stimulation in a GnRH-antagonist protocol and two in a progestin-primed stimulation protocol (PPOS). Recombinant FSH was used as stimulation medication for all patients, the patients with a PPOS protocol received additional recombinant LH. One pregnancy (0.2%) was detected after the oocyte retrieval, the other nine pregnancies were detected either due to persistent high serum progesterone levels or due to an increasing progesterone level after an initial decrease before oocyte retrieval. In the cycles with an undetected natural conception pregnancy, the median number of stimulation days was 8 days (range: 6-11 days) and median serum hCG at detection of pregnancy was 59 IU hCG (range: 14.91-183.1). From 10 patients with a pregnancy, three patients delivered a healthy baby, two patients had ongoing pregnancies at the time of summarizing the data, three patients had biochemical pregnancies (patient age: 30, 39, and 42 years), one patient had an ectopic pregnancy which required a salpingectomy, and one patient (age: 34 years) had an early pregnancy loss. The retrospective study design and the small sample size can limit the accuracy of the estimates. Overall, there is a small risk of undetected natural conception pregnancies when luteal phase stimulation is undertaken. It appears that there are no adverse effects through either direct effect on the embryo or indirectly through a detrimental effect on the corpus luteum function on the pregnancy in our cohort. This study did not receive funding. The authors declare that there is no conflict of interest. N/A.

Reproductive Behavior of Adolescent Girls: Analysis of Risk Factors, Prospects of Prevention and Education

INTRODUCTION: Caring of reproductive health of children and adolescents in the society, especially of adolescent girls as a group most vulnerable to risks in the reproductive sphere, continues to be of high importance. The studies confirm that education and awareness about reproductive health can reduce the probability of problems occurring. The existing legal regulations emphasize the importance of providing accurate and timely information of reproductive health. AIM: Scientific justification of the strategy of forming safe reproductive behavior of adolescent girls on the basis of the peculiarities of their current reproductive behavior taking into account the opinion of specialists in the fields of education and healthcare. MATERIALS AND METHODS: To assess the peculiarities of reproductive behavior of adolescent girls, an anonymous questionnaire survey of 400 adolescent girls was conducted. To determine the expectations of the participants of the sex education process, as well as the main directions of preventive work and education, a survey of 400 parents of adolescent girls, 86 pediatricians, 34 obstetricians-gynecologists and 420 teachers was conducted. For all groups of participants, author’s questionnaires were developed. RESULTS: The reproductive behavior of adolescent girls living in the territory of the Novosibirsk region, is characterized by early start of sex life (15.90 ± 0.14 years), promiscuity (1.70 ± 1.10 partners), refusal to use effective means of contraception. Parents of adolescent girls emphasize the leading role of the family in sex education, suggesting participation of doctors and teachers in the process, but remain dissatisfied with the intensity of preventive measures. A similar problem is emphasized by specialists in the healthcare and education systems who indicate the possibility of conducting preventive work with adolescent girls remotely. In the opinion of pediatricians and obstetricians-gynecologists, providing preventive information on the reproductive health and behavior, will not only create safe reproductive behavior for modern adolescents, but is also an effective strategy of improving the system of reproductive health protection. CONCLUSION: The study identified features of the reproductive behavior of adolescent girls that characterize it as risky. The results emphasize the need for an integrated approach to assessing and maintaining the health of adolescent girls, and also focus attention on the importance of educational work in this age group. The study serves as a basis for further preventive strategies in the field of reproductive health and education.

Adolescents’ sleep quality is associated with day of the week, school timing and chronotype

Late chronotypes and early school start times are associated with unhealthy sleep habits during adolescence. Here we examine the impact of the relationship between school timing and chronotype on sleep quality in 349 Argentinian high-school students (age: 17-18 y.o., 49% females) randomly assigned to attend school in the morning, afternoon or evening. Students completed the Munich Chronotype Questionnaire and ranked their sleep quality using a Likert-like scale. We found higher sleep quality on free days than on weekdays. Importantly, morning-attending students showed lower sleep quality on weekdays. Finally, the interaction between school timing and chronotype was associated with sleep quality on weekdays: later chronotypes were associated with poorer sleep quality in morning- and afternoon-attending students, but not in the evening. Altogether, our results suggest that attending school in the morning is associated with shorter sleep duration and higher social jetlag, but also with lower sleep quality during adolescence.

Predictors of symptomatic intracerebral hemorrhage after endovascular treatment for acute ischemic stroke due to tandem lesion in anterior circulation

BackgroundEndovascular treatment (EVT) of tandem lesion (TL) in the anterior circulation acute ischemic stroke (IS) usually requires periprocedural antithrombotic treatment and early initiation of dual antiplatelet therapy (DAPT) after carotid stenting. However, it may contribute to an occurrence of symptomatic intracerebral hemorrhage (SICH) in some cases. We investigated factors influencing the SICH occurrence and assessed the possible predictors of SICH after EVT. MethodsIS patients with TL in the anterior circulation treated with EVT were enrolled in the multicenter retrospective ASCENT study. A good three-month clinical outcome was scored as 0–2 points in modified Rankin Scale (mRS) and recanalization using the TICI scale. SICH was assessed using the SITS-MOST criteria. Logistic regression analysis was used for the assessment of possible predictors of SICH with adjustment for potential confounders. ResultsIn total, 300 (68.7 % males, mean age 67.3 ± 10.2 years) patients with median of admission NIHSS 17 were analyzed. Recanalization (TICI 2b-3) was achieved in 290 (96.7 %) patients and 176 (58.7 %) had mRS 0–2. SICH occurred in 25 (8.3 %) patients. Patients with SICH did not differ from those without SICH in the rate of periprocedural antithrombotic treatment (64 vs. 57.5 %, p = 0.526) and in the rate of DAPT started within the first 12 h after EVT (20 vs. 42.2 %, p = 0.087). After adjustment, admission NIHSS and admission glycemia were found as the only predictors of SICH after EVT. ConclusionAdmission NIHSS and glycemia were found as the only predictors of SICH after EVT for TL. No associations between periprocedural antithrombotic treatment, early start of DAPT after EVT and SICH occurrence were found.

Persistent effectiveness of CGRP antibody therapy in migraine and comorbid medication overuse or medication overuse headache - a retrospective real-world analysis

BackgroundManagement of patients with migraine who have concomitant medication overuse (MO) or medication overuse headache (MOH) is a major problem in clinical practice. Detoxification of acute analgesics before or during initiation of prophylactic therapy has long been recommended although this concept has recently been questioned. Additionally, relapse after detoxification is a common problem. This real-world study analyses the initial and sustained effectiveness of prophylactic migraine therapy with CGRP (receptor) antibodies without prior detoxification in patients with comorbid MO or MOH for up to one year.MethodsA retrospective real-world analysis was performed on 291 patients (episodic migraine (EM) with MO (EM-MO; n = 35), EM without MO (EM-noMO; n = 77), chronic migraine (CM) with MOH (CM-MOH; n = 109), CM without MOH (CM-noMOH; n = 70). All patients began treatment with either erenumab (n = 173), fremanezumab (n = 70) or galcanezumab (n = 48) without prior detoxification. Data were available for up to 12 months of treatment. Responder rates for monthly headache days (MHD), monthly migraine days (MMD) and monthly acute medication intake (AMD) were analysed.ResultsAll groups showed a significant reduction in MHD, MMD and AMD at the last observed time point compared to baseline. In patients with CM and MOH, 60.6% (66/109) no longer fulfilled the definition of MO or MOH and a further 13.8% (15/109) had only EM-MO. In the EM cohort, 89% (31/35) of MO patients lost their MO during therapy. MHD and AMD 30% responder rates were comparable for CM-MOH and CM-noMOH (MHD: CM-MOH: 56.0% vs. CM-noMOH: 41.4%, p = 0.058, AMD: CM-MOH: 66.1% vs. CM-noMOH: 52.9%, p = 0.077). MMD responder rate did not differ significantly (after Bonferroni adjustment) (CM-MOH: 62.4% vs. CM-noMOH: 47.1%, p = 0.045, α = 0.017). After successful initiation of therapy, 15.4% of the initial CM-MOH patients relapsed and met the criterion for CM-MOH at the end of follow-up. There were no antibody specific differences in response to therapy.ConclusionsOur data confirms the effectiveness of CGRP antibody treatment in migraine patients with additional MOH or MO in a real-world setting. Low relapse rates after initial successful therapy support an early start of CGRP antibody treatment in patients with MOH or MO.Trial registrationNo registration, retrospective analysis.Graphical