Opinion Statements Research Articles

Use of Prenatal Exome Sequencing: Opinion Statement of the French Federation of Human Genetics Working Group.

Prenatal whole exome sequencing (pES) is increasingly prescribed for fetuses with ultrasound anomalies. Starting from the local French prenatal medicine practice, healthcare system and legal landscape, we aimed to address the broad medical and ethical issues raised by the use of pES for women and couples as well as for prenatal care providers. The French Federation of Human Genetics established a working group composed of clinicians and biologists from all over France to discuss pES challenges. A literature review was also performed. We emphasize the importance of non-directive information that helps couples make a decision that is consistent with their personal values and ideas. We address the difficulty of obtaining informed consent that respects the couple's autonomy, despite the complexity of the information and regardless of their level of education and cultural background. We address whether variants of uncertain significance and unsolicited results should be reported. We emphasize the need for national harmonization of access to pES and the need for multidisciplinary meetings in complex situations. We point out that the specific French context of healthcare financing and the French law have a major influence on medical care organization and support for couples. The outcome of the working group is the development of 12 proposals. This opinion statement, dedicated to prenatal care providers worldwide although linked to the French context, will provide food for thought and assist them in understanding the complexity and implications of pES.

Analyses of mwoch: Acholi nicknames

Rationale of Study – Mwoch is an Acholi term for various poetic pronouncements. Depending on the frequency of use and popular reaction, such pronouncements can define individual identity or become community nicknames that work like national anthems. In general, mwoch are folkloric, metaphoric or panegyric statements of opinion on life; in this article, we translate mwoch as nicknames whose main cultural landscape is the Acholi of Northern Uganda. Methodology – Discourse analysis, participant observation, and interviews dating back to the 1940s were among the parameters we used. Yet, we fear that overindulgence in mainstream research methods will ‘get us stuck in a tar baby’ (Disney Walt, 1946). Findings – Though ‘getting stuck in a tar baby’ is culturally North American, it is similar to the Acholi folktale entitled ododo pa apwoyo, oculli ki won poto ngor (tale of the hare, wildcat and the owner of a field of cowpeas). The Hare and Wildcat used to steal the cowpeas; the owner noted goings-on but could not catch the culprits. The theft continued until the owner conceived and crafted a beautiful girl (tar baby) from the latex of a rubber tree and placed it in his field of cowpeas. When the two came to steal the crop, they saw the tar baby, engaged with it and got stuck. Implications – Although Acholi and American folktales strike similar notes, Acholi folktales are often different since they are largely verbal rather than visual and metaphoric rather than overt. Unless analysed and discussed, meanings in such expressions may remain hidden and rather useless to stakeholders, including scholars. Originality – This is an original article whose main goal is to unravel the meanings, if not the knowledge, of a few selected Acholi nicknames.

Sleep disorders and a review of the uses of valerian, chamomile, lavender and passionflower: Pharmacy students’ knowledge and views

Insomnia is a common sleep disorder that affects the quality and length of sleep. Individuals who suffer from insomnia may encounter daytime fatigue, mood problems, impaired concentration, and increased risk of chronic diseases. This disorder can be acute or chronic. Acute insomnia is short-term and usually triggered by stress or life events, while chronic insomnia is long-term and often associated with other medical or psychological conditions. Insomnia can be treated with medications, lifestyle changes or herbal remedies. Four different herbs are thought of as potential treatment for insomnia: Valerian, Chamomile, Lavender, and Passionflower. This paper analyzes the potential effects of these remedies and their effectiveness in treating insomnia. It also collected data on what pharmacy students know about sleep disorders and their opinions about aspects that affect sleep. A total of 40 students completed the demographic survey questions with a 100% response rate. Of these, 36 answered the five knowledge-based questions (89.5% response rate) and about 35 (88%) completed the opinion questions. The five opinion statements had an average agreement rate of 81.2% among the survey respondents.

Cross-disciplinary working between gynaecologists and mental healthcare professionals: a mixed-methods systematic review protocol

IntroductionReproductive hormone transitions (menstrual cycle, post partum and menopause) can trigger mental disorders in a subset of women. Gynaecological diseases, such as endometriosis and polycystic ovary syndrome, can also elevate...

Familial occurrence of colorectal cancer: prevention, aftercare and genetic counseling

Colorectal cancer (CRC) is the third most common type of cancer in Switzerland in terms of annual new cases and cancer deaths. Since most cantons have an organized screening program, more people are recorded with a positive family history of CRC. In the majority, the familial form of CRC is present, a hereditary form is much less common. Relatives of patients with CRC are a heterogeneous group whose CRC risk varies. A good assessment of disease risk can optimize the benefit-risk ratio for more intensive prevention. These recommendations («expert opinion statement») are intended to serve as a basis in clinical practice for planning preventative care, monitoring and human genetic counseling in the presence of a family history positive for CRC.

A Practical Guide to Using Oral JAK Inhibitors for Atopic Dermatitis from the International Eczema Council.

Janus kinase inhibitors (JAKinibs) have the potential to dramatically alter the landscape of atopic dermatitis (AD) management due to their promising efficacy results from phase 3 trials and rapid onset of action. However, JAKinibs are not without risk, and their use is not appropriate for all AD patients, making this a medication class that dermatologists should understand and consider when treating patients with moderate-to-severe AD. This consensus expert opinion statement from the International Eczema Council (IEC) provides a pragmatic approach to prescribing JAKinibs, including choosing appropriate patients, dosing, clinical and lab monitoring, as well as long-term use. An international cohort of authors from the IEC with expertise in JAKinibs selected topics of interest and were formed into authorship groups covering 10 subsections. The groups performed topic-specific literature reviews, consulted up-to-date adverse event (AE) data, referred to product labels and provided analysis and expert opinion. The manuscript guidance and recommendations were reviewed by all authors as well as the IEC Research Committee. We recommend JAKinibs be considered for patients with moderate to severe AD seeking the benefits of rapid reduction in disease burden and itch, oral administration, and the potential for flexible dosing. Baseline risk factors should be assessed prior to prescribing JAKinibs, including increasing age, venous thromboembolisms, malignancy, cardiovascular health, kidney/liver function, pregnancy and lactation, and immunocompetence. Patients being considered for JAKinib therapy should be current on vaccinations and we provide a generalized framework for laboratory monitoring, though clinicians should consult individual product labels for recommendations as there are variations among the JAKinib class. Patients who achieve disease control should be maintained on the lowest possible dose, as many of the observed AEs occurred in a dose-dependent manner. Future studies are needed in AD patients to assess the durability and safety of continuous long-term use of JAKinibs, combination medication regimens, and the effects of flexible, episodic treatment over time. The decision to initiate a JAKinib should be shared among patient and provider, accounting for AD severity and personal risk/benefit assessment, including consideration of baseline health risk factors, monitoring requirements and treatment costs.

Los Angeles County dentists’ opinions on discussing human papilloma virus-related oral health issues and recommending vaccine to patients

ABSTRACT Dentists are well-positioned to discuss oral health issues related to Human Papillomavirus (HPV) and recommend the HPV vaccine to their patients, mainly because the HPV virus causes oropharyngeal cancers.. We assessed Los Angeles (LA) County dentists’ opinions on discussing HPV-related oral health issues and recommending the HPV vaccine to their patients. We tested if opinions differed between dentists whose primary patient population was only adults versus children and adults. We mailed a 19-item survey to 2000 randomly sampled LA County dentists for this cross-sectional study. The primary outcome variable was a summary opinion score of 7 opinion statements. We ran descriptive, bivariate comparisons and adjusted linear regression models. Overall, 261 dentists completed the survey. A majority (58.5%) worried they would lose patients if they recommended the vaccine; 49% thought dentists were not appropriate to educate, counsel, or advise on HPV-related issues; 42% were concerned about the safety of the vaccine; and 40% did not feel comfortable recommending the vaccine. The mean summary opinion score was 21.4 ± 5.4 for the total sample. Regression analysis showed no differences in opinions between dentists whose primary patient population was only adults versus children and adults (Coefficient = 0.146, p = 0.83). Overall, the responding dentists were not very favorable about discussing oral health-related HPV issues and recommending the HPV vaccine to their patients. Additionally, the overall opinions were similar between dentists whose primary patient population was only adults versus children and adults.

Recurrence of autoimmune liver diseases after liver transplantation: Review and expert opinion statement.

Autoimmune liver diseases (AILDs) constitute the fourth most common indication for liver transplantation (LT) across the world. In general, the outcomes after LT are acceptable; however, disease recurrence after LT is common for all AILD, which can negatively affect graft and overall survival. Several questions persist, including the risk factors associated with recurrent disease, optimal antirejection medications, strategies to reduce the risk of recurrence, and how to best incorporate these strategies into clinical practice. For that reason, we assembled an international group of experts to review evidence to address these outstanding questions regarding LT for AILD. Survival rates after LT are ~90% and 70% at 1 and 5 years, and recurrent disease occurs in 10%-50% of patients with AILD. In patients with disease recurrence, graft survival decreased by 18% and 28% and overall survival by 8% and 12% at 5 and 10 years after LT, respectively. Recurrent autoimmune hepatitis is associated with high aminotransferases and immunoglobulin G (IgG) before LT, lymphoplasmacytic infiltrates in the explants, and may be associated with the absence of steroids after LT. However, the efficiency and safety of triple immunosuppressive maintenance therapy is still debatable. Younger age at diagnosis with primary biliary cholangitis or LT is associated with primary biliary cholangitis recurrence. Preventive use of ursodeoxycholic acid reduces the risk of recurrence and has a benefit in graft and patient survival. Episodes of systemic inflammation, including T-cell-mediated rejection, active ulcerative colitis, and episodes of cholangitis, are associated with recurrent PSC. Recurrent disease for AILD is associated with worse graft and patient survival. Patients with autoimmune hepatitis could be considered for long-term low-dose predniso(lo)ne, whereas patients with primary biliary cholangitis should be placed on preventive ursodeoxycholic acid after LT. There are no specific treatments for PSC recurrence; however, adequate control of inflammatory bowel disease and optimal immunosuppression to avoid T-cell-mediated rejection should be encouraged.

Alleged State Aid in Relation to a Deduction/Non-Inclusion Structure in Luxembourg – Opinion Statement ECJ-TF 1/2024 on the Decision of the CJEU of 5 December 2023 in Engie (Joined Cases C-451/21P and C-454/21P)

In this CFE Opinion Statement, submitted to the EU Institutions in February 2024, the CFE ECJ Task Force comments on the CJEU’s decision of 5 December 2023 in Engie (Joined Cases C-451/21P and C-454/21P), which addressed alleged State aid in relation to a deduction/non-inclusion structure in Luxembourg.

Screening for Lung Cancer in India: Expert Opinion Statement.

Lung cancer (LC) has the highest rate of disability-adjusted life years (DALY) of all cancers in India. A large majority of patients with LC present with advanced disease, resulting in poor survival rates. Early diagnosis can improve survival outcomes as the patients can be treated with curative intent. The National Lung Screening Trial (NLST), in 53,454 persons at high risk for LC in the US, showed a 20% (95% confidence interval of 6.8-26.7; p = 0.004) relative reduction in LC-specific mortality in the patients screened with low-dose computed tomography (LDCT) compared with chest X-ray. To date, India does not have a formal LC screening (LCS) program. As a panel of experts, we reviewed a synthesis of a targeted literature search on the burden of LC, the current status of diagnosis of LC, barriers to early diagnosis, current referral pathways, LC risk patterns, use of artificial intelligence (AI) and risk calculators for risk assessment, and a multidisciplinary team (MDT) approach to diagnosis LC. We used the existing international LCS guidelines, data from published literature, and clinical experience to depict the characteristics of the population at risk of LC in India-young age (<40 years), smoking, especially the predominance of bidi smoking (an indigenous form of tobacco smoking), exposure to biomass fuel smoke, especially in rural women, and air pollution being the prominent features. LC in India is characterized by a higher rate of driver mutations and adenocarcinomatous histology. Here, we present the expert opinion on risk-based LCS in India and discuss the challenges, facilitators, and research priorities for the effective rollout of LCS in India.

Addressing the psychosocial aspects of transition to adult care in patients with cystinosis.

Cystinosis is a rare autosomal-recessive lysosomal storage disease that progressively affects multiple organs beginning with the kidneys. Patients require lifelong multidisciplinary care for the management of kidney disease and progressive extra-renal manifestations, and thus, they are especially fragile and vulnerable during transition from pediatric to adult care. Previous documents have provided guidance to help the medical transition of these highly burdened patients. Patients and their families often experience great psychological distress and face significant social challenges; for these reasons, they often need help from psychologists, social workers, and other psychosocial professionals. Due to the rarity of the disease, most psychosocial professionals have no expertise in this disorder and require advice. To this end, a steering committee (SC) composed of six experts, including pediatric nephrologists, psychologists, and social workers with experience in the care for patients with cystinosis, have identified and addressed seven key questions related to psychosocial challenges of the disease and the burden of treatment. Ten additional international experts (the extended faculty, EF) were invited to answer these questions. Since robust evidence is lacking, as in many rare diseases, conclusions were based on collective agreement between members of the SC and the EF, and the consolidated answers were summarized into expert opinion statements. The present document contains information on the concerns and psychosocial burden of patients with cystinosis and of their caregivers, and provides practical advice for timely and appropriate support to facilitate the transition to adult care.

Social Determinants of Health and the Link to Colorectal Cancer Outcomes.

OPINION STATEMENT: Colorectal cancer (CRC) remains the second most deadly cancer in the United States, behind only lung cancer. Despite improvements in incidence due to screening and mortality in part due to better treatments, there are some groups that have not seen these promising changes. American Indian/Alaska Native and non-Hispanic Black individuals, certain geographic regions, and lower socioeconomic groups have all been shown to have worse CRC outcomes. A significant body of evidence has linked these disparities in outcomes to social determinants of health (SDH). SDH are defined by the WHO as "the non-medical factors that influence health outcomes." These factors include but are not limited to income, education, social support, neighborhood of residence, and access to healthcare. Individuals who are negatively impacted by SDH have been shown to have a higher incidence of CRC. These individuals are also less likely to receive adequate CRC screening, are less likely to receive appropriate treatment, and have increased CRC mortality. Interventions that target different SDH domains have been shown to lead to increased rates of CRC screening and receipt of appropriate treatment while simultaneously improving CRC mortality. The aim of this review is to highlight the connection between SDH and CRC outcomes while also exploring interventions that target SDH and thereby improve CRC outcomes.

Fact-opinion differentiation

Statements of fact can be proved or disproved with objective evidence, whereas statements of opinion depend on personal values and preferences. Distinguishing between these types of statements contributes to information competence. Conversely, failure at fact-opinion differentiation potentially brings resistance to corrections of misinformation and susceptibility to manipulation. Our analyses show that on fact-opinion differentiation tasks, unsystematic mistakes and mistakes emanating from partisan bias occur at higher rates than accurate responses. Accuracy increases with political sophistication. Affective partisan polarization promotes systematic partisan error: As views grow more polarized, partisans increasingly see their side as holding facts and the opposing side as holding opinions.

Compatibility with Fundamental Freedoms of a Municipal Surcharge Distinguishing between Residents and Non-Residents for the Purposes of the Applicable Rate – Opinion Statement ECJ-TF 4/2023 on the Decision of the EFTA Court of 4 July 2023 in RS (Case E-11/22)

In this CFE Opinion Statement, submitted to the EU Institutions in December 2023, the CFE ECJ Task Force comments on the CJEU’s decision of 4 July 2023 in RS (Case E-11/22), which addressed whether or not municipal surcharges are compatible with the fundamental freedoms.

“That’s just, like, your opinion” – European citizens’ ability to distinguish factual information from opinion

Abstract In the current media landscape, it is becoming increasingly difficult for citizens to rely on trustworthy information, not least because reliable facts are mixed with dubious claims, unsubstantiated opinions, or outright lies. The ability to distinguish factual from other types of mediated information is becoming increasingly crucial, but we know little about how well-equipped citizens are to make these distinctions. In an original survey study conducted in ten European countries, we asked respondents whether they considered six different statements relating to the European Union to be factual or opinion statements. Our results show that citizens have considerable difficulties in correctly identifying both factual information and opinions. Next to pre-existing judgements, we identify media-related, political, and sociodemographic factors that influence categorisation accuracy. We discuss our findings in relation to citizens’ perceptions of journalistic credibility and their information literacy as well as ongoing debates about the effectiveness of fact-checkers on social media.

International consensus on post-transplantation diabetes mellitus.

Post-transplantation diabetes mellitus (PTDM) remains a leading complication after solid organ transplantation. Previous international PTDM consensus meetings in 2003 and 2013 provided standardized frameworks to reduce heterogeneity in diagnosis, risk stratification and management. However, the last decade has seen significant advancements in our PTDM knowledge complemented by rapidly changing treatment algorithms for management of diabetes in the general population. In view of these developments, and to ensure reduced variation in clinical practice, a 3rd international PTDM Consensus Meeting was planned and held from 6-8 May 2022 in Vienna, Austria involving global delegates with PTDM expertise to update the previous reports. This update includes opinion statements concerning optimal diagnostic tools, recognition of prediabetes (impaired fasting glucose and/or impaired glucose tolerance), new mechanistic insights, immunosuppression modification, evidence-based strategies to prevent PTDM, treatment hierarchy for incorporating novel glucose-lowering agents and suggestions for the future direction of PTDM research to address unmet needs. Due to the paucity of good quality evidence, consensus meeting participants agreed that making GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) recommendations would be flawed. Although kidney-allograft centric, we suggest that these opinion statements can be appraised by the transplantation community for implementation across different solid organ transplant cohorts. Acknowledging the paucity of published literature, this report reflects consensus expert opinion. Attaining evidence is desirable to ensure establishment of optimized care for any solid organ transplant recipient at risk of, or who develops, PTDM as we strive to improve long-term outcomes.

Developing a coding scheme for annotating opinion statements in L2 interactive spoken English with application for language teaching and assessment

Evaluative meanings are known to be difficult to identify and quantify in corpus data (Hunston 2004). The research in this area has largely drawn on the annotating schemes offered by the frameworks of Appraisal (Read and Carroll 2012; Fuoli 2018) or stance (Simaki et al. 2019). However, these annotation schemes have been applied predominantly to written production and to first language use. This study, therefore, proposes an annotation scheme for identifying and classifying linguistic expressions of opinion with particular application for second language (L2) language teaching and language assessment contexts. In addition, the coding scheme also specifically deals with spoken interactive communication, with particular attention paid to aspects such as the co-construction of opinion statements (Hovarth and Eggins 1995). The paper outlines the components of the coding scheme along with their theoretical underpinning, addresses some of the challenges in applying the codes and annotating real-life data, and discusses future possibilities and considerations related to the application of the coding scheme.

Deep learning-based radiomics allows for a more accurate assessment of sarcopenia as a prognostic factor in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common malignancies and is a major cause of cancer-related mortalities worldwide (Forner et al., 2018; He et al., 2023). Sarcopenia is a syndrome characterized by an accelerated loss of skeletal muscle (SM) mass that may be age-related or the result of malnutrition in cancer patients (Cruz-Jentoft and Sayer, 2019). Preoperative sarcopenia in HCC patients treated with hepatectomy or liver transplantation is an independent risk factor for poor survival (Voron et al., 2015; van Vugt et al., 2016). Previous studies have used various criteria to define sarcopenia, including muscle area and density. However, the lack of standardized diagnostic methods for sarcopenia limits their clinical use. In 2018, the European Working Group on Sarcopenia in Older People (EWGSOP) renewed a consensus on the definition of sarcopenia: low muscle strength, loss of muscle quantity, and poor physical performance (Cruz-Jentoft et al., 2019). Radiological imaging-based measurement of muscle quantity or mass is most commonly used to evaluate the degree of sarcopenia. The gold standard is to measure the SM and/or psoas muscle (PM) area using abdominal computed tomography (CT) at the third lumbar vertebra (L3), as it is linearly correlated to whole-body SM mass (van Vugt et al., 2016). According to a "North American Expert Opinion Statement on Sarcopenia," SM index (SMI) is the preferred measure of sarcopenia (Carey et al., 2019). The variability between morphometric muscle indexes revealed that they have different clinical relevance and are generally not applicable to broader populations (Esser et al., 2019).

The VASCERN PPL working group patient pathway for primary and paediatric lymphoedema

Lymphoedema is caused by an imbalance between fluid production and transport by the lymphatic system. This imbalance can be either caused by reduced transport capacity of the lymphatic system or too much fluid production and leads to swelling associated with tissue changes (skin thickening, fat deposition). Its main common complication is the increased risk of developing cellulitis/erysipelas in the affected area, which can worsen the lymphatic function and can be the cause of raised morbidity of the patient if not treated correctly/urgently. The term primary lymphoedema covers a group of rare conditions caused by abnormal functioning and/or development of the lymphatic system. It covers a highly heterogeneous group of conditions. An accurate diagnosis of primary lymphoedema is crucial for the implementation of an optimal treatment plan and management, as well as to reduce the risk of worsening. Patient care is diverse across Europe, and national specialised centres and networks are not available everywhere. The European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN) gathers the best expertise in Europe and provide accessible cross-border healthcare to patients with rare vascular diseases. There are six different working groups in VASCERN, which focus on arterial diseases, hereditary haemorrhagic telangiectasia, neurovascular diseases, lymphoedema and vascular anomalies. The working group Paediatric and Primary Lymphedema (PPL WG) gathers and shares knowledge and expertise in the diagnosis and management of adults and children with primary and paediatric lymphoedema. The members of PPL WG have worked together to produce this opinion statement reflecting strategies on how to approach patients with primary and paediatric lymphoedema. The objective of this patient pathway is to improve patient care by reducing the time to diagnosis, define the best management and follow-up strategies and avoid overuse of resources. Therefore, the patient pathway describes the clinical evaluation and investigations that lead to a clinical diagnosis, the genetic testing, differential diagnosis, the management and treatment options and the patient follow up at expert and local centres. Also, the importance of the patient group participation in the PPL WG is discussed.

Right To Be Paid Interest on Overpayment of Taxes in Breach of EU Law – Opinion Statement ECJ-TF 3/2023 on the CJEU Decision of 8 June 2023 in E. v. Dyrektor Izby Administracji Skarbowej we Wrocławiu (Case C-322/22)

In this CFE Opinion Statement, submitted to the EU Institutions on 4 October 2023, the CFE ECJ Task Force comments on the CJEU’s decision of 8 June 2023 in E. v Dyrektor Izby Administracji Skarbowej we Wrocławiu (Case C-322/22), which addressed a Polish domestic rule limiting the right to the interest on overpayments of corporate income tax in breach of EU law, to the period running from the 30th day following the publication, in the Official Journal of the European Union, of a ruling of the Court of Justice finding that the collection of the tax was incompatible with EU law.