Five-year Course Research Articles

Diagnosis and Treatment of Newborns Referred to the Metabolism Department From the National Newborn Screening Program in Türkiye: A 5-Year Single-Center Experience

Objective: The aims of this study were to investigate biochemical and genetic tests and treatment plans of newborns referred to our center with inherited metabolic disorders screened in Türkiye National Newborn Screening Program (NNSP). Material and Methods: The medical records of babies referred by the NNSP between January 2019 and November 2023 were scanned retrospectively. Plasma biotinidase activity and the biotinidase gene (BTD) analysis results for suspected biotinidase deficiency (BD), the plasma phenylalanine and phenylalanine hydroxylase gene (PAH) analysis for a suspicion of phenylketonuria (PKU) were documented with treatment information. Results: A total of 143 babies, 78 (54.5%) with suspected BD and 65 (45.5%) with suspected PKU were included. A PAH gene analysis was performed on 23 (35.4%) of those had high plasma phenylalanine levels, among which 86.9% were identified with the biallelic variant. Five patients were started on sapropterin-diet combined therapy, three on diet therapy and one on sapropterin therapy. In the first serum biotinidase activity measurement of babies referred with suspected BD, a heterozygous deficiency was detected in 48.7%, partial deficiency in 39.7% and profound deficiency in 10.3%. A BTD gene analysis was performed on 79.5% of those with suspected BD, and biallelic variants were detected in 50%. Forty-six patients (59.0%) underwent biotin treatment. Conclusion: In our study, approximately one-third of the babies referred from NNSP over the five-year course of the study had biallelic variants of the relevant disease. Our research is one of the few studies on NNSP in our country and presents the diagnosis and treatment process of PKU and BD.

Preparing students for primary dental care in the Republic of Ireland

There are two dental schools in the Republic of Ireland, graduating approximately 90 new dentists annually following successful completion of a five-year undergraduate course. Currently, once these graduates have been awarded their degree, they have no legal requirement to complete post-graduation training, foundation training or continuing professional development. While the vast majority will do this voluntarily, it sets a high bar for dental educators to prepare these students to practice independently in primary dental care. As in other jurisdictions, there can often be a disconnect between the ethos taught to students for delivering primary dental care in dental schools and remuneration systems once graduates enter the workforce. Changing demographics will need to be reflected in our undergraduate curricula with explicit teaching in the area of gerodontology.

Online teaching, procrastination and student achievement

Despite growing consensus in the public debate that self-discipline is key to succeeding in an online learning environment, the evidence available is very limited. We investigate the role of procrastination as a moderator of the impact of online teaching on student performance. We take advantage of the forced transition from traditional class-based to online teaching induced by the COVID-19 pandemic and adopt a difference-in-differences strategy using administrative data of four cohorts of students enrolled in an Italian University. We find that online teaching has reduced student performance by about 1.4 credits per semester on average (0.11 Standard Deviations). However, this aggregate effect masks great heterogeneity as the negative influence on performance varies significantly according to student tendency to procrastinate with online teaching being particularly detrimental for students affected by present-bias problems. The total negative effect for procrastinators amounts to more than 18% of the workload for a semester, so implying a potential delay of approximately two semesters in the expected date of graduation for students following an online as opposed to a face-to-face five-year Degree course.

Learning Evaluation in Engineering Studies: Cognitive Assessment, Informational Scaling and Systemic Modeling of the Knowledge Acquisition Process

The research work presented is in line with previous work on the complexity of the learning process. This complexity is approached through the study of perception, regarded as a non-deterministic system of interactions that evolves over time. The activity of these interactions is achieved through the various senses mobilized by learners.We have conducted a study intended to define a reliable procedure to measure learners’ perceptions of the skills expected through the engineering training curriculum, as well as their impact on the way these learners mobilize, under the influence of these perceptions, environmental and personal resources with the goal of achieving success. These learners thus generate their own environment for the purpose of their professionalization, as well as their personal and cognitive development. The processing of the descriptive, inferential and confirmatory results of the study led us to observe the evolution and variation of skills perception in engineering students over their five-year course. Temporal variability can be observed in perceptions, depending on the nature of the skills and on the phases of the course study marked by the temporal evolution of learning processes. These markers processes shed light on the dialogical relation found between educational science and sciences of perception.

The Effects of CNI and Mtori-Based Regimens on Bone Mineral Density After Renal Transplantation.

Background: Since glucocorticoids are used in low maintenance doses today, the relationship between calcineurin inhibitors (CNI) and osteoporosis has become clinically significant in osteoporosis after solid organ transplantation. However, there is evidence that the mammalian target of rapamycin inhibitors (mTORi) may be beneficial via osteoclast inhibition. Objective: The bone mineral density (BMD) changes are investigated in renal transplant patients under CNI or mTORi-based maintenance regimens during the first five-year post-transplant course. Methods: This study consists of thirty-three renal allograft recipients with less than one year of dialysis history. The exclusion criteria were: being older than 50 years old, history of bisphosphonate use, parathyroidectomy, CNI-mTORi switch after the post-transplant third month, diuretic use, and history of malignancy. First and fifth-year BMD scores and simultaneous laboratory parameters were evaluated. Results: CNI (n=21) and mTORi group (n=12) had similar demographics, dialysis vintages, first and fifth-year serum parathormone, calcium, phosphate, magnesium, alkaline phosphatase, and 25-OH-vitamin D levels. The femur neck scores of the CNI group decreased from -0.82 (±0.96) to -1.52 (±0.92) (p=0.020). We observed a significant decrease in the CNI group compared to the mTORi group [-0.70 (±0.68) and 0.30 (±0.36), respectively; p<0.01] when the BMD score changes were evaluated among years. The mean femur neck score of the mTORi group increased insignificantly from -1.13 (±0.65) to -0.82 (±0.56) at the fifth-year DXA scan (p=0.230). Similar trends were also observed in L1-4 scores. Conclusion: Our study suggests that CNI-based treatment is associated with decreased femur neck BMD scores, and mTORi-based treatment tends to be beneficial in the post-transplant five-year follow-up.

An Interview on a Hot Summer Day with Polish Book Creators Ewa Kozyra-Pawlak and Paweł Pawlak

An Interview on a Hot Summer Day with Polish Book Creators Ewa Kozyra-Pawlak and Paweł Pawlak Anita Wincencjusz-Patyna (bio), Ewa Kozyra-Pawlak, and Paweł Pawlak Ewa and Paweł Pawlak both graduated from the State Higher School of Fine Arts (at present the Eugeniusz Geppert Academy of Art and Design) in Wroclaw, Poland. They gained their MFA diplomas in 1985 in graphic design and printmaking. Ewa focuses on children’s book illustration, specializing in textile collage. She has worked on about thirty books and has provided illustrations for children’s magazines and school handbooks. She also writes poems, performs calligraphy, and translates from French and English. Paweł focuses on book illustration and graphic design, mostly for young readers. He has worked on over 100 books and is highly acclaimed in Poland and abroad. Click for larger view View full resolution AWP: You both graduated from a university of arts. How did you benefit from the five-year course of studies in graphic arts? PP: For me mental gymnastics was absolutely the most valuable of all the things we learnt, not so much technical aspects of the given tasks. Some sort of intellectual base, which was strongly related to our faculty in general, and in particular to our specialization, namely graphic design. Our professors paid special attention to everything that preceded the actual image. The processes of thinking and understanding was crucial. AWP: It means contents first, then form. PP: Precisely. All the thinking before creating a picture may be really diverse. Very analytic, nonstandard, paradoxical. It doesn’t matter. What counts is the thinking itself which precedes working on any project. Deciding the way of approach. But the very decision is essential. EKP: I would add that our department focused on posters at that time. For half of a year we would consider two words, cause and result for instance, and this was the core of the whole process. Combining words, i.e. a slogan, with images. First the slogan, then a long time of thinking, and eventually the work. Hence our huge appetite for picturebooks— for “handmade” picturebooks, I should stress—as we love to play with [End Page 92] words and pictures as with equally important means of expression. This is an ideal structure for us. And this is what we creatively strive for. PP: I agree. Like posters, a picturebook is a combination of words and pictures. AWP: Comparing both, it is worth noticing that a poster appears as an extreme synthesis, whereas a book has a complex narration… PP: …space and time. It is just a larger area for our work. AWP: You have both experienced different periods in the history of Polish book illustration: the difficult decades of the 1980s and 1990s, an interesting transformation at the turn of the millennium, and the last fifteen years, when children’s books from Poland have celebrated international successes and Polish illustrators have provided highly artistic realizations. Which of these periods has been the most favorable for you? PP: Certainly not the first one, although my books had huge circulation numbers at the time. Still, I think that my own experiences and personal development are far more important than the external circumstances. For me, it was definitely my first participation in a French book (Romain Drac’s Sauvons les sapins) in Bologna 2001, where Becky Bloom, an English publisher, found me and invited me to a collaboration. Then a Polish publisher, Muchomor, published the titles that came out of this collaboration in Polish as well (Emily Horn’s Excuse Me… Are You a Witch? and Bloom’s The Hare and the Tortoise). The collaboration with Muchomor resulted in other titles (e.g., A Cat That Wagged Its Tail), which gave me great energy, and proved that I can create various books that I can be proud of. Among them I would like to distinguish: Baj Is A-Walking on the Wall (with poems by Kazimiera Iłłakowiczówna), Angel’s Two Hearts (by Wojciech Widłak), and my own original works Magiships and Steamicians and Oscar Seeks a Friend. When you add the illustrations to Leszek Kołakowski’s Tales from the Kingdom of Lailonia and...

«Трудное дыхание»: к вопросу о преодолении натурального в культурном

The problem of transforming everyday concepts of a child into scientific concepts and their interaction posed by L.S. Vygotskii is still relevant. This article analyzes the transformation of the everyday concept of breathing and respiration to the scientific concept, starting with the ideas of a preschooler and up to the end of school age. The material of the experimental teaching within the framework of a five-year biology course for middle school is presented in comparison with the traditional introduction of the scientific concept. Teaching-learning processes are investigated as a series of mediation acts. Analysis of the students learning activity and their learning difficulties demonstrates the dynamics of conceptual changes. It is possible to see the relationship between the initial (‘everyday’) and the emerging scientific concept. Observations are analyzed from the point of view of Lev Vygotskii and his scientific school and other investigators also. The conditions for overcoming the ‘encapsulation’ of scientific concepts in human consciousness are discussed. The way of development and final appropriation of a scientific concept is shown. The nature of the transformation of an everyday concept in interaction with the scientific concept are discussed.

Specific Autoantibodies in Neovascular Age-Related Macular Degeneration: Evaluation of Morphological and Functional Progression over Five Years

(1) Background: Altered levels of autoantibodies (aab) and their networks have been identified as biomarkers for various diseases. Neovascular age-related macular degeneration (nAMD) is a leading cause for central vision loss worldwide with highly variable inter- and intraindividual disease courses. Certain aab networks could help in daily routine to identify patients with a high disease activity who need to be visited and treated more regularly. (2) Methods: We analyzed levels of aab against Angiotensin II receptor type 1 (AT1-receptor), Protease-activated receptors (PAR1), vascular endothelial growth factor (VEGF) -A, VEGF-B, and VEGF-receptor 2 in sera of 164 nAMD patients. In a follow-up period of five years, we evaluated changes in functional and morphological characteristics. Using correlation analyses, multiple regression models, and receiver operator characteristics, we assessed whether the five aab have a clinical significance as biomarkers that correspond to the clinical properties. (3) Results: Neither the analyzed aab individually nor taken together as a network showed statistically significant results that would allow us to draw conclusions on the clinical five-year course in nAMD patients. (4) Conclusions: The five aab that we analyzed do not correspond to the clinical five-year course of nAMD patients. However, larger, prospective studies should reevaluate different and more aab to gain deeper insights.

Professional Doctorate in Midwifery: What is it and Why Would I Do One?

According to national midwifery-specific and healthcare profession strategy, embedding research into the professions, including creating researcher leaders, is a priority. Evidence shows that this provides benefit for the people we care for, the employing organisation and the individual employee. However, developing the knowledge to undertake or lead research can seem overwhelming. The Professional Doctorate is one pathway available to support people in the development of research knowledge and skills. This five-year part-time course is completed alongside clinical work. Initial taught content develops knowledge and skills, before leading on to completion of independent research, with appropriate supervision throughout.

A Comparison of Outcomes in Early-Stage Breast Cancer After External Beam Radiotherapy, Endocrine Therapy, Both, or Neither: A Retrospective Cohort Study Across a Large Health System

Several trials have compared endocrine therapy (ET) alone vs. ET and radiotherapy (RT) in low-risk early-stage ER+ breast cancer and have shown that the addition of RT to ET modestly reduces the rate of loco-regional recurrence (LRR) without altering survival. ET alone has thus become a standard strategy in managing these patients. Data evaluating the efficacy of RT alone is scarce. However, the toxicity of ET is not trivial, so as RT courses become ever shorter and safer, a re-evaluation of the strategy of RT alone is warranted. This analysis reports on outcomes of early-stage node-negative breast cancer treated with RT, ET, both, or neither at a multi-hospital health system. We hypothesized that RT alone yields comparable LRR to ET alone in ER+ positive early-stage breast cancer.The shared electronic health record of multiple facilities within a university health system was queried to identify women with pathologic T1-2 N0 breast cancer treated with breast-conserving surgery between 2007 and 2016. Data collection included demographic features, tumor characteristics, treatment type, and evidence of LRR. Analysis was restricted to those patients with ER+ disease. Five-year LRR were compared across groups using the Kaplan-Meier method. A multivariate analysis was performed to identify factors associated with LRR.1340 patients met inclusion criteria. Of these, 84 were treated with RT alone, 155 with ET alone, 1042 with both RT and ET, and 59 received breast conserving surgery only. Demographic and tumor variables are listed below. The 5-year rates of LRR for RT, ET, both, and neither, respectively, were 4.2% (95% CI 1.4-12.7), 5.6% (95% CI 2.6-11.7), 0.6% (95% CI 0.2-1.4), and 31.9% (95% CI 19.8-48.6). While not receiving any adjuvant therapy was associated with significantly higher rate of LRR (P < 0.001), the difference between RT and ET alone was not significant (P = .395). On multivariate analysis, age < 50 (HR 3.3; 95% CI 1.5-7.1), high grade (HR 2.5; 95% CI 1.1-5.8), and observation (HR 9.8; 95% CI 3.2-29.6) were associated with higher LRR, whereas receipt of both RT and ET was associated with lower LRR (HR 0.2; 95% CI 0.1-0.5).RT yielded LRR equivalent to ET in this population, while the combination was superior to either treatment alone. For patients with early-stage ER+ breast cancer, a prospective randomized trial comparing RT to ET and evaluating quality of life (QoL) is needed. In light of new trial data, a five-day course of RT can be considered; this treatment may yield equivalent LRR and better QoL than a five-year course of ET.

Assessing Predictors of Tamoxifen Nonadherence in Patients with Early Breast Cancer.

Adjuvant endocrine therapy (AET) is generally proposed to all patients with hormone receptor-positive breast cancer to reduce the risk of recurrence and death. Adherence to therapy is crucial. However, non-adherence to AET is common, with estimates of up to 50% of patients not successfully completing a five-year course of treatment, and it is significantly associated with lower survival rates and a higher risk of recurrence. Currently, no gold standard is available to assess adherence. Several studies, most of them retrospective in nature, have used both direct and indirect methods to monitor the adherence to therapy in breast cancer. The indirect method is more widely used, and it is based on pharmacy prescription refills and patient administered questionnaires. On the other hand, direct methods such as a measurement of the level of the drug or its metabolites in blood or urine are much more precise, but more expensive and not routinely implemented. In this review, we analyzed the results of the major studies focused on the adherence to tamoxifen in breast cancer patients. We identified several factors associated with poor adherence, such as the side effects of therapy, the lack of shared decision-making between the physician and patient, the context in which the discussion takes place, and whether the patients are enrolled in a clinical trial. Moreover, we discussed possible methods to improve adherence to adjuvant therapy in breast cancer.

MO573CNI AND MTORI-BASED REGIMENS ON FIVE-YEAR COURSE OF BONE MINERAL DENSITY SCORES AFTER RENAL TRANSPLANTATION

Abstract Background and Aims Since glucocorticoids are used in low maintenance doses today, the relationship between calcineurin inhibitors (CNI) and osteoporosis after solid organ transplantation has gained clinical significance. In contrast, (mammalian target of rapamycin inhibitors) mTORi agents are shown to have an antiresorptive effect on bone by reducing osteoclastic activity in vitro and in vivo. We investigated the bone mineral density (BMD) changes on an extremely selective group of incident renal transplant recipients under CNI or mTORi-based maintenance treatment regimens during the first five-year posttransplant course. Method This study consists of renal allograft recipients with a dialysis history of less than one year. Patients older than 50 years old, using CNI - mTORi combinations, patients with a history of a prior renal transplant, acute rejection, CNI – mTORi switch after posttransplantation first three months, bisphosphonate treatment, parathyroidectomy, diuretic use, and malignancy excluded to eliminate all confounding factors for bone mineral loss. First and fifth-year BMD scores and simultaneous laboratory parameters were evaluated. Results CNI (n=21) and mTORi (n=17) groups had similar demographics, dialysis vintages, cumulative steroid doses, first and fifth-year parathormone, calcium, phosphate, magnesium, alkaline phosphatase, and 25-OH-vitamin D levels. The femur neck scores of the CNI group decreased from -0.82(±0.96) to -1.52(±0.92) (p=0.020). We observed a significant decrease in the CNI group compared to the mTORi group [-0.70(±0.68) and 0.30(±0.36), respectively; p&amp;lt;0.01] when BMD score changes evaluated among years. The mean femur neck score of the mTORi group insignificantly increased from -1.13(±0.65) to -0.82(±0.56) at the fifth-year DXA scan (p=0.230). Although statistically insignificant, similar trends were also observed in L1-4 scores. Conclusion Our study suggests that CNI-based treatment is associated with decreased femur neck and L1-4 BMD scores, and mTORi-based treatment tends to be beneficial presumably due to their antiresorptive effects in the posttransplant five-year follow-up. Our findings may shed light on long-term maintenance therapy management in renal transplant patients with bone disease if supported by future studies.

Cost sharing for breast cancer hormone therapy: How do dual eligible patients' copayment impact adherence.

ObjectiveTo examine the different levels of copayment assistance and treatment adherence among Medicare and Medicaid dual eligible beneficiaries with breast cancer in the U.S.Research designPropensity Score methodology was adopted to minimize potential selection bias from the nonrandom allocation of the treatment group (i.e., full Medicaid beneficiaries) and control group (i.e., Medicare Savings Programs [MSPs] beneficiaries). Longitudinal hierarchical model and Cox proportional-hazard model were adopted to examine patients’ adherence over their full five-year course of adjuvant hormone therapy.ResultsOur study cohort consisted of 1,133 dual eligible beneficiaries diagnosed with hormone receptor-positive early stage breast cancer in years 2007 –mid 2009. About 80.5% of them received MSPs benefits, while the rest received full Medicaid benefits. On average for a standardized 30-day hormone therapy medication, full Medicaid beneficiaries spent $0.5-$2.0 and MSP beneficiaries spent $1.4-$4.8 in copayment. After adjusting for other factors, this copayment reduction wasn’t associated with a significantly better adherence. However, when the catastrophic coverage threshold was reached (copayments reduced to zero), significant improvement in adherence was found in both groups.ConclusionsOur study found that small amount of cost-sharing reduction did not affect Medicare and Medicaid dual eligible patients’ medication treatment adherence, however, the elimination of cost-sharing (even a minimal amount) was associated with improved adherence. Future legislative and advocacy efforts should be paid on eliminating cost sharing for dual eligibles, and possibly even a broader group of financially vulnerable patients.

A look at university student service quality and satisfaction

Purpose The purpose of this study is to investigate university students’ perception of service quality and satisfaction in a developing country to guide quality improvement. Design/methodology/approach The study uses a quantitative survey design. A new instrument has been developed to measure student perceived service quality. Data was collected from 182 undergraduate students enrolled in a five-year BEd course at the one University of Education in Myanmar. Findings A significant gender difference was found only in one of the service quality dimensions, hostel facilities. There was a significant difference in student satisfaction in the year of study. Apart from cafeteria and hostel facilities, students’ perceived-level of service quality was significantly different. All service quality dimensions were significantly correlated with student satisfaction. Significant relationships were found among intention to leave the university, trust in management and overall satisfaction with the university. Research limitations/implications This study uses data collected from undergraduate students studying at the one University of Education in Myanmar. Practical implications The study adds on to the service quality literature on higher education in developing countries, specifically in Myanmar. The students’ perceived service quality dimensions resulting from this study can be applied by universities to evaluate their performance. Originality/value The research findings presented in this paper fill the gap in the existing literature by providing empirical knowledge on service quality measurement and student satisfaction in the higher education context. The study is among the first studies of students’ perception of service quality and satisfaction in Myanmar.

The experiences, attitudes and understanding of research amongst medical students at an Australian medical school

BackgroundResearch engagement plays an integral role in developing clinicians that practice effective, evidence-based medicine. Research participation by clinicians, however, is declining. Given the link between research during medical school and future research output, promotion of medical student research is one avenue by which this shortage can be addressed. Student research attitudes and participation in Australia are not well-documented in the literature. This study therefore aims to investigate research practices, motivators, and barriers amongst Australian medical students in order to determine whether there is a need for further integration of research within Australian medical school curriculums.MethodsA cross-sectional study design was used to explore research experience and attitudes, as well as the enablers and barriers to research amongst students enrolled in all years of the five-year medical course at Monash University. A questionnaire was created by combining questions from several surveys on medical student research and comprised Likert scales, multiple choice options and free-text responses assessing research experience, attitudes, motivators, and barriers.ResultsSeven hundred and four respondents (69.4% female; survey response rate 36.7%) reported variable research experience and interest. Less than half of the cohort (n = 296; 44.9%) had contributed to a research project. Increasing employability for specialty training programs was the primary motivating factor (n = 345; 51.9%) for pursuing research, with only 20.5% (n = 136) citing an interest in academia as a motivator. Time constraints (n = 460; 65.3%) and uncertainty surrounding how to find research opportunities (n = 449; 63.8%) were the most common barriers to research.ConclusionsMedical students at Monash University are interested in but have limited experience with research. Students are, however, primarily motivated by the prospect of increasing employability for specialist training; medical schools should therefore focus on encouraging intrinsic motivation for pursuing research. Greater integration of research education and opportunities within medical school curricula may also be required to provide students with the skills necessary to both pursue research and practice evidence-based medicine.

PCN213 THE IMPACT OF THE INTRODUCTION OF GENERIC AROMATASE INHIBITORS ON HORMONE THERAPY ADHERENCE OVER THE FULL COURSE OF FIVE-YEAR TREATMENT FOR BREAST CANCER

To explore the impact of the introduction of generic aromatase inhibitors (GAIs) on adjuvant hormone therapy (AHT) adherence among Medicare beneficiaries over the full recommended five-year course of breast cancer treatment.

A Five Year Longitudinal Study of the Educational Environment in a Newly Integrated Medical Curriculum

ObjectivesThe College of Medicine at Gulf Medical University (GMU), Ajman, United Arab Emirates, was subjected to a curricular reform, which shifted the institution from a traditional curriculum to a hybrid, student-centred, integrated curriculum. There are no previous studies analysing the consequences of such a curricular modification on the educational environment (EE). Therefore, this study aimed to analyse the EE of a pioneer cohort of the innovative curriculum over their five-year course of study.MethodsThis prospective longitudinal study was conducted between September 2009 and September 2013 at the College of Medicine. The Dundee Ready Education Environment Measure questionnaire was completed by a pioneer cohort of students at the start of each academic session for five consecutive years. The mean overall, subscale and individual statement scores were evaluated using the Kruskal-Wallis and Wilcoxon-rank sum tests.ResultsA total of 178 responses were collected (response rate: 90.4%). The mean overall score throughout the five years of study was 130/200. A significant difference in the scores (P <0.05) was observed as the students proceeded through the course. The overall and subscale scores were significantly higher in the first and final years of study. Analysis of the statements recognised the medical knowledge of the teachers’ and students’ awareness of empathy and social interactions as persistent strengths of the college over the entire course of study. A curricular overload, a want for support systems for stressed students, students’ waning interest levels and assessment strategies emerged as areas that warranted further attention.ConclusionThe pioneer cohort of the new curriculum rated their EE as positive throughout their five years of study at GMU. An examination of individual statements revealed the programme’s strengths and areas for improvement for the institution.

Course and naturalistic treatment seeking among persons with first episode mania in India: A retrospective chart review with up to five years follow-up

BackgroundAn understanding of the early course of Bipolar Disorder (BD) can contribute towards developing timely interventions. First episode mania (FEM) determines a diagnosis of bipolarity, and therefore, onset of BD-I. We investigated the course of BD-I over a five-year period after FEM by retrospective chart review. MethodsCharts of patients diagnosed with FEM in 2008 (n = 108) were reviewed. Data was extracted about FEM and subsequent course up to 5 years, for those who came for follow-up during this period. The factors influencing course were evaluated with statistical analyses including logistic regression and survival analysis. ResultsThe mean age at onset of BD was 26 ± 9.2 years and mean age at FEM was 27.1 ± 9 years. 41 (38%) patients had previous depression. Patients who returned for at least one follow-up were 60/108 (55.6%), with 54 (90%) of them experiencing another mood episode following FEM. Most recurrences occurred between 6 months to 1 year after FEM, with manic episodes occurring two-three times as frequently as depressive episodes. Good adherence to treatment was a predictor of fewer hospitalizations [B = −0.61; t = −3.1; p = 0.004]. LimitationsThe study was limited by its retrospective design and high number of dropouts. ConclusionThe five-year course after FEM showed twice the number of manic compared to depressive recurrences, irrespective of when the recurrence occurred. Consistent with earlier reports from India, BD-I appears to be mania-predominant, even early in the course. This has significant implications in planning maintenance treatments.

Macular Edema in Childhood Uveitis.

Pediatric uveitis is associated with a high incidence of severe and frequently permanent visual loss. This article summarizes the current understanding of the disease and the therapeutic options that are available to improve treatment outcomes. A Medline search spanning the last 10 years was undertaken using the key terms "pediatric uveitis" or "childhood uveitis" and "macular edema". Articles which appertained to case reports or small case series were excluded from consideration, whereas those in which the opinions of experts were expressed, as well as reviews, were not. The information contained in these latter two forms of publication was particularly valuable, owing to the scarcity of prospective clinical data appertaining to the treatment of pediatric uveitis-associated macular edema. Ten years ago, 34% of children who presented with uveitis manifested secondary complications at the time of diagnosis. During the ensuing 3 years of treatment, this rose to 86%. Heightening awareness of the disease with earlier referrals to expert centers, as well as the advent of therapeutic strategies involving anti-TNF agents and intravitreal corticosteroids, have led to a decrease in the incidence of legal blindness in the affected eyes from 18 - 69% to below 8% during a five-year course of treatment. Early diagnosis and strict control of inflammatory activity have led to a dramatic reduction in the incidence of vision-threatening secondary complications. In the majority of cases, it has also been possible to resolve cystoid macular edema, which, if insufficiently controlled by systemic therapy, usually responds well to intravitreal dexamethasone implants.

Is very low infant birth weight a predictor for a five-year course of depression in parents? A latent growth curve model

BackgroundA very low birth weight (VLBW) is considered as a significant risk factor for early-onset developmental problems in infants, but is also discussed as a potential risk factor for the development of depressive symptoms in affected parents. MethodsIn this study, the 5-year courses of maternal and paternal depression with VLBW and term born infants (n = 250 families) are modeled and predicted by factors existing at the time of birth. ResultsThe dyadic trajectories of depression could be best described by five classes (I no depression, II minor maternal depression, III increasing dyadic depression, IV significant maternal depression, V highly depressed mothers). VLBW was a significant predictor for the course of parental depression – even under control of preexisting psychiatric disorders and other confounders. Interaction effects and a dose-response relationship were not existent. LimitationsClass IV and V had to be merged for the prediction analysis, a missing bias could not be ruled out, and families with a low birth weight (between 2500 and 1500g) were not included. ConclusionsThe results are well in line with what is known from studies so far, suggesting that maternal and paternal trajectories of depression show distinctable patterns which are associated with a VLBW. An early screening of mothers and fathers of a VLBW infant seems reasonable to prevent the development of a depression in parents and further difficulties for the child.