Developmentally Appropriate and Youth-Friendly Rheumatology Services

Paediatric and adult healthcare services approach adolescents and young adults (AYA) differently; but whether located in adult or paediatric services, AYA healthcare should remain consistent with the key principles underpinning the practice of adolescent medicine and responsive to the changing needs of AYA. All rheumatology services should recognise AYA as a distinct patient group with unique healthcare and psychosocial needs. AYAs require treatment within their wider psychosocial context, taking into account the life changes and transitions that shape this stage of development. Flexible, person-centred developmentally appropriate healthcare, peer support and knowledge and skills training are important for this group of individuals for whom feeling “normal” is of major importance. This chapter highlights the importance of ensuring that AYA rheumatology services are both developmentally appropriate and youth-friendly; outlines the key characteristics of such services, including some examples on how to translate them into practice; and discusses some implementation and training considerations

Does mutual fund ownership increase corporate environmental spending?

This paper examines how mutual fund ownership influences corporate environmental spending, and the channels through which this impact operates. Using a unique hand collected dataset of Chinese listed companies between 2011 and 2018, we report mutual fund investment is associated with significantly increased corporate environmental spending. This influence is moderated by institutional factors including state-owned enterprises and stronger legal environments. We also assess the environmental awareness associated with environmental spending through examining the number of ‘green’ questions raised by investors and the ‘green’ credentials of board members. Moreover, we find that mutual funds with green investment objectives have significantly increased corporate environmental spending levels. We conclude mutual find ownership has a positive influence on environmental spending and should be encouraged within China

Comprehensive genome-wide analysis of retinal vessel caliber reveals microvascular-blood pressure pathways:advancing predictive, preventive, and personalized medicine

Background: Retinal vessel caliber is strongly associated with systemic blood pressure (BP); however, the causal relationship between retinal vascular caliber and BP remains unclear. Understanding this relationship is essential for advancing predictive, preventive, and personalized medicine (PPPM) approaches to effectively manage hypertension and its related complications. Working hypothesis: Microvessel morphology is causally related to blood pressure. By integrating genome-wide association studies, Mendelian randomization analysis, transcriptomic data, and multivariate genomic approaches, this study aims to identify predictive biomarkers, uncover preventive strategies, and develop personalized intervention targets, thereby advancing the principles of 3P medicine for improved cardiovascular health management. Methods and results: We conducted a comprehensive investigation into the genetic factors underlying retinal vessel calibers and their complex relationship with BP traits. Our genome-wide association study (GWAS) assess retinal vessel calibers—central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and the arteriole-to-venule ratio (AVR)—in a subset of 36,223 individuals of European descent from the UK Biobank. The analysis identified 9, 5, and 4 SNPs located in TNS, Y_RNA, PBLD, C10orf32-ASMT:AS3MT, GNB3:CDCA3, NTN4, COL4 A2, CTD-2378E21.1, WNT7B, VTA1, FCF1, NPLOC4, FUT1 and CSK region, which are significantly associated with CRAE, CRVE, and AVR, respectively. Genetic correlation analysis revealed shared heritability between BP traits and both CRAE and AVR, but not CRVE. Mendelian randomization analysis confirmed bidirectional causal relationships between CRAE and BP traits, whereas CRVE was neither influenced by nor influenced BP traits. To explore the potential regulatory mechanisms, we leveraged transcriptomic data and identified the following causal pathways in vessel tissue: The expression of MRPL23-AS1 and ULK3 was correlated with the elevation of blood pressure SBP and narrowing of the CRAE. Finally, we constructed a multivariable genetic model including CRAE, AVR, SBP, and DBP, suggesting a common driving factor which underlies these traits. Conclusions: Our study elucidates the complex relationship between BP and retinal vessel caliber, highlighting potential intervention targets for lowering BP and vascular narrowing–related diseases. These findings contribute to the development of tailored prevention and treatment strategies aligned with PPPM principles.</p

Love in the Face of Loss:Associations Between Self-Compassion, Compassionate Love, and Sexual and Relationship Satisfaction in Couples Experiencing a Recent Pregnancy Loss

The demands of pregnancy loss may lead to an adjustment period, which can strain couples’ sexual and relationship satisfaction. Compassion is a mental health promotion tool that may buffer the effect of negative life events, such as pregnancy loss, on well-being. Nevertheless, it is not well-understood how self-compassion or compassion felt for a partner (i.e., compassionate love) are associated with sexual and relationship satisfaction in couples coping with a recent pregnancy loss. We aimed to examine how self-compassion and compassionate love are associated with sexual and relationship satisfaction in couples after pregnancy loss in a pre-registered, cross-sectional study of couples (N = 138) who experienced a loss in the last 4 months. Using structural equation modeling and controlling for age and relationship and loss characteristics, we found no associations between either couple member’s self-compassion and their own or their partners’ sexual and relationship satisfaction. However, for individuals who were pregnant when the loss occurred, higher compassionate love was associated with their own and their partner’s greater sexual and relationship satisfaction. For individuals who were not pregnant, greater compassionate love was associated with their own higher relationship satisfaction (but not that of their partner). Fostering compassion for one’s partner may be a target for intervention post-loss to strengthen couples’ relational well-being after a pregnancy loss.</p

“What I’m Trying to Say Is That Some Nurses Are Good While Some Are Not Good”:Diverse Attitudes of Health Workers Providing Sexual and Reproductive Health Services to Young People in Nigeria

IntroductionAttitudes of healthcare providers towards young people seeking sexual and reproductive health services (SRHS) are poorly described in research. Yet, this has implications for the promotion and operations of Youth Friendly Sexual and Reproductive Health Services (YFSRHS). This study seeks to identify and describe the overall treatments received by young people seeking SRHS.MethodA total of 31 qualitative sessions were conducted, comprising 20 in-depth interviews (IDIs) with healthcare providers and 11 focus group discussions (FGDs) with young people aged 15–24 years in Ebonyi state. The data were collected from December 2022 to March 2023. The analyses followed a coding reliability approach.ResultsFindings indicate that healthcare providers express both negative and positive attitudes when providing SRHS to young people. The attitude expressed is determined by the SRH sought and an intersection of social characteristics like age, gender, marital status and economic status. Thus, young unmarried persons may be reprimanded for seeking safe motherhood and newborn care, whereas young married persons are better received and treated positively. Young boys and girls experience negative treatment when seeking contraceptives but young girls are easily attended to when seeking information and counselling on SRH.ConclusionHealthcare providers’ attitude when dealing with young people seeking SRHS is influenced by multiple social dimensions, which reinforce discrimination and marginalisation

Inspired by pathogenic mechanisms:A novel gradual multi-modal fusion framework for mild cognitive impairment diagnosis

Mild cognitive impairment (MCI) is a precursor to Alzheimer's disease (AD), and its progression involves complex pathogenic mechanisms. Specifically, disturbed by gene variants, the regulation of gene expression ultimately changes brain structure, resulting in the progression of brain diseases. However, the existing works rarely take these mechanisms into account when designing their diagnosis methods. Therefore, we propose a novel gradual multi-modal fusion framework to fuse representative data from each stage of disease progression in hybrid feature space, including single nucleotide polymorphism (SNP), gene expression (GE), and magnetic resonance imaging (MRI). Specifically, to integrate genetic sequence and expression data, we design a SNP-GE fusion module, which performs multi-modal fusion to obtain genetic embedding by considering the relation between SNP and GE. Compared with SNP-GE fusion, representation of genetic embedding and MRI have more obvious heterogeneity, especially correlation with disease. Therefore, we propose to align the manifold of genetic and imaging representations, which can explore the high-order relationship between imaging and genetic data in the presence of modal heterogeneity. Our proposed framework was validated using the Alzheimer's Disease Neuroimaging Initiative dataset, and achieved diagnosis accuracy of 76.88%, 72.84%, 87.72%, and 95.00% for distinguishing MCI from control normal, lately MCI from early MCI, MCI from AD, and AD from control normal, respectively. Additionally, our proposed framework helps to identify some multi-modal biomarkers related to MCI progression. In summary, our proposed framework is effective not only for MCI diagnosis but also for guiding the further development of genetic and imaging-based brain studies. Our code is published at https://github.com/tianxu8822/workflow_MCI/tree/main/.</p