Risk Of Crisis Research Articles

Obesity as a Risk Factor for Hyperglycemia, Electrolyte Disturbances, and Acute Kidney Injury in the Emergency Department

Background/Objectives: Obesity is a global health challenge linked to a higher risk of metabolic and cardiovascular complications. This study investigates the role of cardiovascular markers in predicting metabolic crises in obese patients, focusing on the prevalence and clinical implications of these markers. Methods: This retrospective cohort study included 433 patients presenting with metabolic crises at the Emergency Department of Timișoara Municipal Emergency Hospital between 2019 and 2024. Patients were classified into obese (n = 161) and non-obese (n = 272) groups, with obesity further stratified into four grades based on body mass index (BMI). Cardiovascular markers, including NT-proBNP, troponin I, CRP, CK-MB, and D-dimer, alongside metabolic parameters, were analyzed. Results: Metabolic crises were significantly more prevalent in obese patients in all metabolic emergencies: hyperglycemia (27.9% vs. 11.0%, p < 0.001), electrolyte imbalance (23.6% vs. 9.2%, p < 0.001), and acute kidney injury (AKI) (12.4% vs. 5.5%, p = 0.01). NT-proBNP levels independently predicted AKI in obese patients (adjusted OR: 1.14 per 1000 pg/mL, 95% CI: 1.10–1.19, p < 0.001), with excellent discriminatory power (AUC: 0.88). Troponin I and D-dimer were higher in hyperglycemia and electrolyte imbalance, respectively, emphasizing the role of cardiac stress and pro-thrombotic states. Inflammatory markers such as CRP were significantly associated with metabolic disturbances, supporting the contribution of systemic inflammation. Comorbidities, particularly heart failure and atrial fibrillation, further increased the risk of metabolic crises. Conclusions: Cardiovascular markers suggest potential utility for early risk stratification of metabolic crises in obese patients. However, further studies are needed to validate their clinical applicability and to establish standardized approaches for integrating these biomarkers into routine practice, especially in patients with advanced obesity grades.

2793 Virtual wards for people with frailty—evidence to think anew?

Abstract Introduction Increasing prevalence of people living with frailty is a key challenge to healthcare providers. One solution may be virtual wards (VWs). Our research sought to: examine different frailty VW models; and determine how, why and under what circumstances VWs may work effectively. During our early research, NHS England (NHSE) started roll-out of short-term VWs intended to treat acute patients with frailty crises at home instead of hospital. We expected our work to inform NHSE policy, especially how to ‘do’ VWs better. Methods We conducted a rapid realist review of frailty VWs, searching published and grey literature for evidence on multidisciplinary VWs based in the UK, using a literature-based definition of VWs. Information on how and why VWs might ‘work’ was extracted and synthesised iteratively into context-mechanism-outcome configurations (CMOCs). Throughout we engaged closely with clinicians and patient/public contributors. The iterative nature of the realist review led to emerging understanding. Results From 28 documents, we identified two VW models: longer-term, proactive care wards admitting patients at high risk of a frailty crisis; and short-term reactive care wards for people experiencing a frailty crisis. Using evidence from both models, we generated 12 CMOCs, under three themes. First, building blocks for effective VW operation (e.g. common standards agreements, information sharing, a multidisciplinary team planning patient care remotely). Second, how the VW delivers the frailty pathway (e.g. patient selection, assessment, proactive care). Third, Patient/Caregiver empowerment. Mechanisms included motivating professionals (e.g. a ‘team-of-teams’); buy-in; building relationships: professionals, patients and caregivers. VWs should be set within frailty management guidance, and a whole-system approach to care is needed. For sustainability of VWs, proactive care for people at high risk of a frailty crisis should be provided. Conclusions This review has implications for optimal implementation and sustainability of frailty VWs, through proactive care and a whole system approach.

Barriers to the Management of Classic Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency.

Classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is a rare genetic condition that requires lifelong management from birth. Individuals with CAH and their families often face structural barriers to obtaining comprehensive care and treatment, including limited access to appropriate newborn screening, comprehensive care centers, and medications. Social and cultural barriers to care may include stigmatization, discrimination, and adverse medical experiences. At the individual and family level, comprehensive care may be affected by education, finances, health-care coverage, geographic location, and lack of social supports. These barriers are often further magnified for individuals living in underresourced countries. Inadequate access to comprehensive care and medications increases the risk of life-threatening adrenal crisis and disease-related comorbidities. This review article examines the current structural, sociocultural, and individual barriers that individuals with CAH and their families may face when managing their condition throughout their lifetime.

Prediction of scleroderma renal crisis in patients of systemic sclerosis: insight from the CRDC cohort study.

Early personalized identification of systemic sclerosis (SSc) patients at risk for scleroderma renal crisis (SRC) can help provide better treatment and improve outcomes. This study aimed to create and validate a new multi-predictor nomogram to predict SRC risk and compare it to an existing model. A retrospective multicentre observational study was conducted using clinical data from SSc patients with SRC registered in the Chinese Rheumatism Data Center (CRDC) database. Each SSc patient with SRC was matched with four SSc patients without SRC, registered consecutively afterward, as controls. Differences between the two groups were analyzed using Student's t test, Mann-Whitney U test, χ2 test, or Fisher's exact test. Key risk factors were identified using univariate and multivariate logistic regression, as well as LASSO regression. The Nomogram's performance was assessed with ROC curves, calibration plots, decision curve analysis, and Bootstrap resampling for internal and external validation. NRI and IDI were used to compare models. The nomogram incorporated predictive factors such as myocardial involvement, SSc subtype, anaemia, platelet count, and disease duration. The AUC showed strong discrimination in both the training and validation datasets. Calibration curves and the Hosmer-Lemeshow test indicated good agreement between predicted and actual outcomes. Decision curve analysis demonstrated greater clinical net benefit. The NRI and IDI results showed significant improvement over the previous model. A Nomogram with improved predictive performance compared with the previous one was developed in a larger sample size in China.

Cardiovascular Safety of Anti-CGRP Monoclonal Antibodies in Older Adults or Adults With Disability With Migraine

Monoclonal antibodies (mAbs) targeting calcitonin gene-related peptide (CGRP) or its receptor (anti-CGRP mAbs) offer effective migraine-specific preventive treatment. However, concerns exist about their potential cardiovascular risks due to CGRP blockade. To compare the incidence of cardiovascular disease (CVD) between Medicare beneficiaries with migraine who initiated anti-CGRP-mAbs vs onabotulinumtoxinA in the US. This retrospective, sequential cohort study was conducted among a nationally representative population-based sample of Medicare claims from May 2018 through December 2020. Data analysis was performed from August to December 2023. This study included fee-for-service Medicare beneficiaries aged 18 years or older with migraine who initiated either anti-CGRP mAbs or onabotulinumtoxinA. Beneficiaries who had a history of myocardial infarction (MI), stroke, cluster headache, malignant cancer, or hospice service within a 1-year baseline period prior to treatment initiation were excluded. To minimize channeling bias from new drug introductions and time-related bias due to the COVID-19 pandemic, 5 cohorts were established, representing sequential 6-month calendar intervals based on the initial prescription or date of index anti-CGRP mAbs or onabotulinumtoxinA use. Anti-CGRP mAbs vs onabotulinumtoxinA. The primary outcome was time to first MI or stroke. Secondary outcomes included hypertensive crisis, peripheral revascularization, and Raynaud phenomenon. The inverse probability of treatment-weighted Cox proportional hazards models were used to compare outcomes between the 2 treatment groups. Among 266 848 eligible patients with migraine, 5153 patients initiated anti-CGRP mAbs (mean [SD] age, 57.8 [14.0] years; 4308 female patients [83.6%]) and 4000 patients initiated onabotulinumtoxinA (mean [SD] age, 61.9 [13.7] years; 3353 female patients [83.8%]). Use of anti-CGRP mAbs was not associated with an increased risk of composite CVD events (adjusted hazard ratio [aHR], 0.88; 95% CI, 0.44-1.77), hypertensive crisis (aHR, 0.46; 95% CI, 0.14-1.55), peripheral revascularization (aHR, 1.50; 95% CI, 0.48-4.73), or Raynaud phenomenon (aHR, 0.75; 95% CI, 0.45-1.24) compared with onabotulinumtoxinA. Subgroup analyses by age group and presence of established non-MI or stroke CVD showed similar findings. In this cohort study, despite initial concerns regarding the cardiovascular effects of CGRP blockade, anti-CGRP mAbs were not associated with an increased risk of CVD compared with onabotulinumtoxinA among adult Medicare beneficiaries with migraine, who were predominantly older adults or individuals with disability. Future studies with longer follow-up periods and in other populations are needed to confirm these findings.

Assessment of acute suicide risk in life crises.

Assessment of acute suicide risk in life crises.

Perceptions of Frail Older Adults on Contributing Factors Causing the Onset of Crises Leading to Hospital Admissions: A Qualitative Study.

To explore frail older people's perceptions of factors contributing to a health crisis, describe similarities and depict these in a chronological, aggregated patient journey map. An exploratory-descriptive qualitative study. Frail older patients visiting the emergency department of a metropolitan academic hospital in the Netherlands during the first 6 months of 2021 were recruited by purposive sampling. Semi-structured interviews were conducted and analysed thematically. Patient journey mapping was used to identify, combine and depict chronological similarities in perceptions. Fifteen interviews contained five themes: continuity of healthcare, self-perception on frailty, self-management, impact of support system within an urban environment and acute event before the emergency department visit. The patient journey map identified uncoordinated care by healthcare providers, deterioration from at least 6 months before the emergency department visit and a time demarcation at 4 weeks before the emergency department visit with an unexpected event leading to an acute health problem. While patients were aware of the health event leading to the acute hospitalisation, they were less aware of the impact of contributing cascading events in the months before. The journey map suggests that strategies can be applied to inform older adults, be more patient-oriented and provide an anticipated plan towards advance care, healthy ageing and admission avoidance. Findings showed contributing factors to a health crisis were not interpreted accordingly, creating a cascade of problems, difficult to counter when someone is already frail. By generating knowledge, standardising frequent assessments of daily life and intervening at an earlier stage by making use of the patient journey map, the risk of a potential crisis and hospitalisation could be reduced or even avoided. COREQ (COnsolidated criteria for REporting Qualitative research). No patient or public contribution.

End-of-life care for people with sickle cell disease: barriers to and facilitators of high-quality care.

End-of-life (EOL) care is a critical part of sickle cell disease (SCD) management. However, barriers to high-quality EOL care remain, including (1) disease-related barriers (prior opioid exposure, risk of vaso-occlusive crises, chronic conditions with conflicting needs, and limitations of receiving disease-directed therapy on hospice); (2) communication-related barriers (challenges of identifying and responding to religious and spiritual concerns, limited health literacy, and previous health care system experience); (3) systemic issues (social determinants of health, structural racism, and mistrust of the medical system). However, palliative care and interdisciplinary collaboration can overcome many of these barriers. In addition, we can improve EOL care by accounting for opioid exposures, multimodal symptom management, and exploring (1) who people want involved in decision-making, (2) the role of religion and spirituality in decision-making, and (3) previous experiences with EOL. Systemic barriers can be addressed through the social determinants of health screening, minimizing financial burdens of care, and building longitudinal relationships with people with SCD. This requires the continued education of SCD providers about primary palliative care and palliative care providers about SCD. With such strategies, high-quality EOL care is possible for this vulnerable population.

Traumatic stress, social support, resilience, and posttraumatic growth: Comparison of LBGT+ and heterosexual individuals in a developing country.

Posttraumatic growth (PTG) is a concept that may emerge after a traumatic experience and describes an experience that includes reaching a higher level of development in various areas of life compared to pretrauma. Although everyone is at risk for traumatic experiences, some populations such as minorities may be at more risk for stress, crisis, and trauma. However, there are limited studies that examine the difference between minority and majority groups in terms of variables related to trauma and PTG. The present study aims to investigate these variables between lesbian, gay, bisexual, and transgender (LGBT+), which is considered a minority group, and heterosexual individuals in a developing country like Turkey. Participants were 40 LGBT+ and 73 heterosexual individuals aged between 18 and 60 (26.88 ± 8.21). PTG, posttraumatic stress disorder symptoms, psychological resilience, social connectedness, perceived available support, and psychological inflexibility were measured using self-report questionnaires. All questionnaires were internally consistent (αs from .87 to .96). PTG showed a significant correlation only with the perceived available support both for all participants and for LGBT+ and heterosexual groups separately. All variables except PTG differed significantly between LGBT+ and heterosexual individuals. The results have implications regarding an LGBT+ community in a developing country, as they appear to have clinically significant traumatic symptoms. In addition, LGBT+ individuals also appear to have less social and individual resources, which should be considered for delivering treatments and providing support for this group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Extra-Adrenal Paraganglioma on Fine-Needle Aspiration Cytology: A Case Series.

Paragangliomas (PGs) are rare tumors that most commonly occur in the head and neck region and along the sympathetic chain. Fine-needle aspiration cytology is not commonly used for the diagnosis of PG due to the potential risk of hemorrhage and hypertensive crisis. As a result, limited studies describe the cytological features of PGs. In this case series, we will discuss the fine-needle aspiration features of three cases of extra-adrenal PGs. The cellular arrangement in smears was either singly scattered or loosely cohesive clusters. The cells were polygonal with pleomorphic nuclei, abundant granular cytoplasm, and bland chromatin. Cellblock showed two types of cells with focal acinar formation. Immunohistochemistry also confirmed the diagnosis. These results were also in keeping with radiological findings. Fine-needle aspiration cytology, along with clinicoradiological findings, can help in making an accurate preoperative diagnosis of PG.

Oral Glucocorticoids for Skin Fibrosis in Early Diffuse Systemic Sclerosis: A Target Trial Emulation Study From the European Scleroderma Trials and Research Group Database.

The objective of this study is to evaluate whether adding oral glucocorticoids to immunosuppressive therapy improves skin scores and ensures safety in patients with early diffuse cutaneous systemic sclerosis (dcSSc). We performed an emulated randomized trial comparing the changes from baseline to 12 ± 3 months of the modified Rodnan skin score (mRSS: primary outcome) in patients with early dcSSc receiving either oral glucocorticoids (≤20 mg/day prednisone equivalent) combined with immunosuppression (treated) or immunosuppression alone (controls), using data from the European Scleroderma Trials and Research Group. Secondary end points were the difference occurrence of progressive skin or lung fibrosis and scleroderma renal crisis. Matching propensity score was used to adjust for baseline imbalance between groups. We matched 208 patients (mean age 49 years; 33% male; 59% anti-Scl70), 104 in each treatment group, obtaining comparable characteristics at baseline. In the treated group, patients received a median prednisone dose of 5 mg/day. Mean mRSS change at 12 ± 3 months was similar in the two groups (decrease of 2.7 [95% confidence interval {95% CI} 1.4-4.0] in treated vs 3.1 [95% CI 1.9-4.4] in control, P = 0.64). Similar results were observed in patients with shorter disease duration (≤ 24 months) or with mRSS ≤22. There was no between-group difference for all prespecified secondary outcomes. A case of scleroderma renal crisis occurred in both groups. We did not find any significant benefit of adding low-dose oral glucocorticoids to immunosuppression for skin fibrosis, and at this dosage, glucocorticoid did not increase the risk of scleroderma renal crisis.

The Correlation Between Effort-Reward Imbalance at Work and the Risk of Burnout Among Nursing Staff Working in an Emergency Department-A Pilot Study.

Background: Nurses in emergency rooms face high levels of psychological stress during their work, which is why they have an increased risk of burnout. The aim of this pilot study was to determine the extent to which effort-reward imbalance (ERI) at work is connected to the risk of burnout among emergency nurses. Methodology: Thirty-five nurses from the central emergency department of a maximum care provider, aged 35.1 ± 0.6 years, voluntarily participated in this pilot study. ERI was recorded using the Effort-Reward Imbalance questionnaire. The nurses were then divided into two groups: the nonrisk group (ERI ratio < 1, n = 19) and the risk group (ERI ratio ≥ 1, n = 16). The burnout dimensions were determined via the Maslach Burnout Inventory (MBI) and the burnout risk was then determined. Results: Nurses in the nonrisk group were significantly less emotionally exhausted (1.6 ± 1.1 points) and had a lower overall risk of burnout (MBI total score 1.2 ± 0.67 points) than the nurses of the risk group. (3.3 ± 1.5 and 2.2 ± 1.2 points, respectively). Eighteen nurses from the total sample had a medium or high risk of burnout. There is a correlation between the risk of burnout and the ERI ratio (r = 0.392, p < 0.05) and the ERI scale "job promotion" (r = -0.462, p < 0.05). Conclusions: The pilot study provides indications of a relationship between effort-reward imbalance at work and burnout risk in emergency nurses. These findings may improve rewards for nurses in the form of increased salary and/or recognition to reduce the risk of burnout among employees and avoid turnover. Further research is needed to investigate the influence of preventive measures on the risk of burnout and gratification crises, particularly with regard to the influence of status and recognition on the risk of burnout.

Liquidity Management Practices and Financial Performance of Microfinance Banks in Nairobi City County, Kenya

Microfinance banks are financial institutions that provide loans, insurance, saving platforms and other financial products to various individuals. Thus, these institutions require sufficient liquid assets to enable them to meet their routine financial obligations. However, in Kenya, microfinance banks have been recording a declining trend regarding their financial performance over time, leading to grave concerns. Thus, this study aimed to assess cash management practices and their effect on Nairobi City County’s MFB's financial performance. The analysis and elucidation of the literature was facilitated by the examination of the Keynesian Liquidity theory. A descriptive research design with a regression analysis model was embraced in determining the predictor variable’s impact on the explained variable. Data review guide was then utilized to gather secondary data, which was obtained from the CBK and covered the years 2017 to 2022. According to the study, operational cash flow management and cash management significantly and favorably impacted the financial performance of Kenyan microfinance institutions. Nonetheless, the financial performance of Kenya's microfinance institutions was significantly impacted negatively by operational efficiency management. As per the study's findings, microfinance banks in Kenya carry out cash budget preparation, bank reconciliation, cash inflow and outflow recording, cash expense payment, and cash surplus investment. As a result, they manage their funds carefully. Furthermore, the stability and functioning of the financial system depend heavily on efficient cash flow management. It entails keeping an eye on money coming in from investments, sales, and outside funding sources as well as tracking money going out to pay for bills, obligations, and loan repayments. Microfinance banks are able to balance inflows and outflows, lower the risk of liquidity crises, and take advantage of growth possibilities by managing cash flow well. This allows microfinance institutions to make well-informed choices regarding debt management, expansion strategies, and investments—all of which are essential for overall financial success. To maximize the beneficial effects on financial performance, the study recommends adhering to the statutory minimum liquidity ratio. Since excessive liquidity and illiquidity reduce the institutions' profitability, microfinance banks should implement effective cash management procedures.

Life shocks and self-perceived risk of housing loss among low-income individuals

Purpose This study aims to describe the self-perceived risk of housing loss among low-income individuals in the context of four potential life shocks and examines whether individuals’ social and economic resources are protective against self-perceived risk of housing loss in the context of these life shocks. Design/methodology/approach The authors conducted a national online survey of low-income households in the USA. The authors asked respondents to assess whether they would be at risk of housing loss if they experienced any of four potential life shocks: job loss, moderate and major medical catastrophes and damage to home from natural disaster. Logistic regression models estimated the association between self-perceived risk of housing loss in the context of these life shocks and respondents’ economic and social resources, adjusting for sociodemographic covariates. Findings A minority of respondents reported that they would be able to maintain their housing if they were to experience a life shock (i.e. 34%–43% depending on the specific life shock). Receipt of more generous forms of income support as well as having family or friends to live with in the event of housing loss were the most consistent economic and social resource predictors of respondents’ self-perceived ability to maintain their housing in the context of a life shock. Originality/value The findings suggest that comprehensive assessments of risk of housing crises should take into account how individuals view their vulnerability to housing loss if they were to experience a life shock.

Determination of the Level of von Willebrand Factor, ADAMTS13, and Ratio of ADAMTS13:von Willebrand Factor in Sickle Cell Disease Patients.

Sickle cell anemia (SCA) is a hypercoagulable state characterized by a significant alteration in hemostatic parameters which may predispose an increased risk of vaso-occlusive crisis (VOC). Sickle cell disease (SCD) is the most common genetic disorder in sub-Saharan Africa. Nigeria bears a high disease burden with an estimated prevalence of 1%-3% of its population being affected by the disease. The study seeks to determine the role of von Willebrand factor (VWF), ADAMTS13, and the ratio of ADAMTS13:VWF antigen in the pathogenesis of VOC. The objective of this study is to evaluate the level of VWF, ADAMTS13, and their ratio in SCD subjects in Calabar and to determine their role in the pathogenesis of VOC. This is a comparative study carried out at the University of Calabar Teaching Hospital (UCTH), Calabar. Sixty SCA patients were evaluated in VOC and steady states as well as five parented healthy controls. VWF: Ag and ADAMTS13:Ag were evaluated using Assaypro enzyme-linked immunosorbent assay kits with Lot nos. 01751728 and 04222167R, respectively. Data were analyzed by IBM SPSS Chicago software version 21. The study was approved by the UCTH Institution Ethical Review Board. The mean ages of the SCA subjects and controls were 23.5 ± 7.2 years and 26.5 ± 5.6 years, respectively (P = 0.706). There were 23 (38.3%) males in the SCA group and 21 (42.0%) females in the controls. There was no significant difference in their sex distribution (P = 0.063). The mean (standard deviation [SD]) of VWF in VOC, steady state, and controls were 2.52 ± 0.34, 1.34 ± 0.23, and 1.41 ± 0.23 IU/mL, respectively. The differences in mean were significantly higher in VOC state (P = 0.003). The mean ± SD of ADAMTS13 in VOC, steady state, and controls were 0.61 ± 0.10, 0.44 ± 0.06, and 0.62 ± 0.10 μg/L, respectively. ADAMTS13 levels did not differ significantly across the groups (P = 0.270). Similarly, there was no significant difference between ADAMTS13:VWF ratios across the groups (P = 0.318). VWF level is elevated in VOC state and thus may be implicated in the pathogenesis of VOC. ADAMTS13 and the ratio of ADAMTS13:VWF are not significantly affected in VOC.

Cardiac Surgery and Transcatheter Intervention for Valvular Heart Disease in Carcinoid Syndrome: Risk Factors, Outcomes, and Evolving Therapeutic Strategies.

Carcinoid heart disease (CHD) affects right-sided valves and causes significant mortality and morbidity. Even though the pathophysiology of the disease is not entirely understood, it is known that chronic exposure to high levels of circulating serotonin is the main factor responsible for developing valvular heart disease. Cardiac imaging plays a critical role in the management of CHD, so the final diagnosis can be performed through multimodal imaging techniques and the measurement of biomarkers. Moreover, in observational studies, surgical treatment of carcinoid-induced valve disease has been found to improve outcomes. Despite advancements in pre-operative preparation in recent years, mortality rates remain high in elderly patients and those with multiple comorbidities due to the risk of intra-operative carcinoid crisis and high post-operative bleeding. In this comprehensive review, we will analyze the causes of carcinoid syndrome and how it can result in severe right heart failure. The role of different imaging modalities in detecting heart valve disease will be discussed together with the therapeutic options at our disposal, such as medical treatment, surgery, and the novel role of transcatheter intervention.

MODERN TRANSFORMATIONS OF NATIONAL ECONOMIES IN RESPONSE TO THE GLOBALIZATION OF FINANCE AND CREDIT

The study's relevance is determined by the fact that the global economy is a chaotic system composed of millions of interconnected elements (economies of individual countries). In this context, it is emphasized that each national economy experiences periods of growth and decline. These cycles have an irregular nature and can be triggered by intermittenсies in the finance and credit sectors in globalized economies, specifically phenomena of sudden, unpredictable surges in activity or volatility that cause their transformation, while in periods of relative stability, they ensure their sustainability. Thus, the article's aim is a comprehensive analysis of typical transformations of national economies as a response to the globalization of the finance and credit. The study emphasizes that the globalization of the finance and credit creates a highly dynamic and complex environment where the economies of various countries are closely interconnected. As a result of globalization, financial crises, technological innovations, and geopolitical events can rapidly spread across the globe, triggering significant changes in the economies of different nations. These processes are quite chaotic, but they exhibit certain recurring patterns. The transformations of national economies, driven by core intermittent events, manifest in the liberalization of financial markets, the development of financial innovations, the strengthening of central banks, and the reinforcement of international cooperation. Most countries have liberalized their financial markets by lowering barriers for foreign investors and expanding access to financial services. National economies are actively developing financial innovations such as fintech, blockchain, and cryptocurrencies to adapt to the new conditions of global competition. Central banks are playing an increasingly important role in stabilizing financial systems and mitigating the effects of financial crises. Countries are collaborating internationally to develop common rules and standards in the financial and credit sectors, aiming to minimize the risks of global financial crises. The transformations of national economies affect developed and developing countries, bringing about positive and negative consequences.

The horror of today and the terror of tomorrow: The role of future existential risks and present-day political risks in climate activism.

In response to the urgent global climate crisis, climate activism has risen as a potent force. Decision-making regarding climate collective action includes individuals' perceptions of the anticipated future existential risks of the climate crisis (risk of inaction) and present-day political risks of climate activism (risk of action). Our research, spanning four studies (two correlational surveys and two pre-registered experiments), focused on climate activism in Germany (N = 1027). We consistently showed that heightened politicized activist identification was associated with both confrontational and non-confrontational climate collective action across four studies. Furthermore, the anticipated existential climate risk was associated with non-confrontational climate action and present-day political risk with confrontational action. Politicized climate identity remained a robust predictor across different action tactics, while the content and temporality of risk (future existential vs. present-day political) in one's environment determined the transition between engagement in confrontational and non-confrontational climate action dynamically. Nevertheless, we did not find causal links between risk perceptions and collective action. We discuss our findings in line with ESIM (Elaborated Social Identity Model), and potential explanations for the lack of causal relationship and future directions for alternative methodologies and comprehensive conceptualization of risk perceptions are suggested.

Interconnectedness of financial markets in crises in the case of the enlarged BRICS

The article presents a study of the connectivity and integration of sovereign bond and stock markets in 10 BRICS+ countries in the context of crisis instabilities in 2019−2024. Financial markets are becoming more integrated, and an increasing share of public investments are carried out across borders, which increases not only the opportunities for participants, but also the risks of a new crisis. The work used data on central bank rates of the considered countries, yield indices of 10-year government bonds, gold and Brent oil prices. The methods include the analysis of exchange rate dynamics, connectivity estimates based on the multivariate concordance coefficient and two-factor Friedman rank variance analysis, VAR models, Granger predictability and cointegration. The objective of this study is to analyze the interrelationship and cointegration between the sovereign bond and equity markets of selected BRICS+ countries during crisis periods. Our findings indicate that market interrelationship intensifies during crises, which in turn amplifies volatility. Additionally, we observed that none of the economies within the BRICS+ group can be classified as fully integrated or entirely isolated markets. The disruption of the interrelationship in the sovereign bond markets of the group is primarily reflected in the inconsistency of dynamic changes between Russia, China, and India. During the global shock of 2019–2020, the crisis spread from China, followed by Indonesia, and later to the other countries of the group. The financial and debt markets of the sampled countries were able to quickly cope with the severe shocks of the COVID-2019 period. The 2022–2024 crisis, which lasted significantly longer, began in Russia before spreading to countries across Asia and Africa. By 2024, Russia’s sovereign bond yields showed a marked decline. The increased market volatility following 2022 disrupted the integration and interrelationship of the stock and debt markets within the BRICS+ countries.

Severe Hyperandrogenism in 46,XX Congenital Adrenal Hyperplasia: Molecular Physiopathology, Late Diagnoses, and Personalized Management.

Congenital Adrenal Hyperplasia (CAH) is a group of autosomal recessive endocrine disorders characterized by alteration in adrenal hormonal secretions. The most common form is caused by CYP21A2 mutations that result in 21-hydroxylase deficiency. Clinical features can vary, from salt-wasting forms, characterized by a lack of mineralocorticoid activity with a risk of perinatal-onset adrenal crises, to "simple-virilizing" forms with sufficient aldosterone secretion, up to milder "non-classical" forms, with a variable grade of hyperandrogenism but no severe hormonal deficiencies. During pregnancy, CAH 46,XX fetuses are exposed to elevated androgen levels, leading to a variable grade of virilization and potential central nervous system effects if untreated. These patients are usually (but not always) assigned female at birth, but some cases may be misdiagnosed and assigned male, potentially inducing fertility, gender identity, and sexual behavior issues in adulthood. In these patients, the benefits and risks of a late gender transition should be carefully evaluated. In this paper, we reviewed the literature concerning the most interesting peculiarities of these conditions.