Pathways to child and adolescent psychiatric clinics: a multilevel study of the significance of ethnicity and neighbourhood social characteristics on source of referral

<p>Abstract</p> <p>Background</p> <p>In the Swedish society, as in many other societies, many children and adolescents with mental health problems do not receive the help they need. As the Swedish society becomes increasingly multicultural, and as ethnic and economic residential segregation become more pronounced, this study utilises ethnicity and neighbourhood context to examine referral pathways to child and adolescent psychiatric (CAP) clinics.</p> <p>Methods</p> <p>The analysis examines four different sources of referrals: family referrals, social/legal agency referrals, school referrals and health/mental health referrals. The referrals of 2054 children aged 11-19 from the Stockholm Child-Psychiatric Database were studied using multilevel logistic regression analyses.</p> <p>Results</p> <p>Results indicate that ethnicity played an important role in how children and adolescents were referred to CAP-clinics. Family referrals were more common among children and adolescents with a Swedish background than among those with an immigrant background. Referrals by social/legal agencies were more common among children and adolescents with African and Asian backgrounds. Children with Asian or South American backgrounds were more likely to have been referred by schools or by the health/mental health care sector. A significant neighbourhood effect was found in relation to family referrals. Children and adolescents from neighbourhoods with low levels of socioeconomic deprivation were more likely to be referred to CAP-clinics by their families in comparison to children from other neighbourhoods. Such differences were not found in relation in relation to the other sources of referral.</p> <p>Conclusions</p> <p>This article reports findings that can be an important first step toward increasing knowledge on reasons behind differential referral rates and uptake of psychiatric care in an ethnically diverse Swedish sample. These findings have implications for the design and evaluation of community mental health outreach programs and should be considered when developing measures and strategies intended to reach and help children with mental health problems. This might involve providing information about the availability and accessibility of health care for children and adolescents with mental health problems to families in certain neighbourhoods and with different ethnic backgrounds.</p

Liquid biopsies for liquid tumors:Emerging potential of circulating free nucleic acid evaluation for the management of hematologic malignancies

Circulating free nucleic acids; cell free DNA and circulating micro-RNA, are found in the plasma of patients with hematologic and solid malignancies at levels higher than that of healthy individuals. In patients with hematologic malignancy cell free DNA reflects the underlying tumor mutational profile, whilst micro-RNAs reflect genetic interference mechanisms within a tumor and potentially the surrounding microenvironment and immune effector cells. These circulating nucleic acids offer a potentially simple, non-invasive, repeatable analysis that can aid in diagnosis, prognosis and therapeutic decisions in cancer treatment

A Novel RUNX1 Genetic Variant Identified in a Young Male with Severe Osteoporosis

ABSTRACT This case describes a young man with an unusual cause of severe osteoporosis and markedly deranged bone microarchitecture resulting in multiple fractures. A potentially pathogenic germline variant in the runt‐related transcription factor 1 (RUNX1) gene was discovered by a focused 51‐gene myeloid malignancy panel during investigation for his unexplained normochromic normocytic anemia. Further bone‐specific genetic testing and a pedigree analysis were declined by the patient. Recent experimental evidence demonstrates that RUNX1 plays a key role in the regulation of osteogenesis and bone homeostasis during skeletal development, mediated by the bone morphogenic protein and Wnt signaling pathways. Therefore, rarer causes of osteoporosis, including those affecting bone formation, should be considered in young patients with multiple unexpected minimal trauma fractures. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research

Pomalidomide Alone or in Combination With Low Dose Dexamethasone As Maintenance Following Induction With Pomalidomide And Low Dose Dexamethasone In Relapsed And Refractory Myeloma (Allg Mm14

Background: Whilst the addition of dexamethasone to upfront therapy with Immunomodulatory (IMiD®) agents is important to mediate rapid reduction in disease burden, preliminary findings suggest that the NK stimulatory effects of IMiD® compounds are best harnessed without the co-administration of dexamethasone, and may be especially effective in the setting of minimal disease burden (in the maintenance setting for example) when some inherent immune recovery has occurred. However this has yet to be confirmed in a prospective clinical trial. Aims: To evaluate the effect of maintenance with POM alone (Arm 1) versus POM-LoDEX (Arm 2) on progression free survival (PFS), overall survival (OS), and kinetics of response (overall response rate (ORR)) in relapsed myeloma (MM) patients refractory to lenalidomide (R-LEN) demonstrating stable disease (SD) or better following salvage treatment with pomalidomide (POM) and low dose dexamethasone (LoDEX) induction. Methods: Multicentre, open-label, randomized phase 2 study of relapsed RLEN patients who had received>2 prior lines of therapy. POM 4mg days 1-21 (28 day cycle) was administered alone or in combination with LoDEX (40mg weekly) as maintenance following an induction with 4 cycles of POM and LoDEX. Treatment continued until toxicity or progression. Peripheral blood samples for immune studies were collected pre-induction and prior to cycles 1, 3, 6 and 10 of maintenance. Results: 154 patients from 11 sites were enrolled on to the study (M:F 80:74), with a median age of 67 years (range 35-88). Median number of prior lines of therapy was 4.5 (2-14). All patients had failed LEN (100%), 127 (82.5%) were also refractory to bortezomib (double refractory) and 94 (61%) had received a prior autologous stem cell transplant. 72 (47%) patients achieved SD or better with POM-LoDEX induction and were randomised, 35 to POM (Arm 1) and to 37 to POM-LoDEX (Arm 2). After a median follow-up of 19 months, median PFS for all patients from study entry was 4.2m (IQR 2.1 – 8.6m). PFS for randomised patients (from time of randomisation) was 2.7m for POM (arm 1) versus 5.6 for POM-LoDEX (arm 2) (p=0.39). The PFS hazard rate for Arm 2 was relatively constant compared to Arm 1 which started with a hazard rate double that of Arm 2 but dropped to less than half of the rate in Arm 2 by 15 months, suggesting that with longer follow-up, there may be an emergent advantage to maintenance with POM versus POM-LoDEX (Figure 1.). Median OS for all patients from study entry was 13.2m (IQR 6.3-26.8m). For randomised patients, median OS (from time of randomisation) was 19m for POM (Arm 1) versus 13.7m for POM-LoDEX (Arm 2) (p=0.41). ORR (≥PR) for all patients was 45.5% [CR=5 (3.3%), VGPR=13 (8.4%), PR=52 (33.8%)]. Clinical benefit rate (CBR) (≥MR) was 55.2% [MR=15 (9.7%)]. Summary/Conclusions: In patients with relapsed myeloma, after initial disease control/debulking is achieved with POM - LoDEX, induction, maintenance with single agent POM may be more effective for sustaining disease control than continuation of POM-LoDEX. Correlative studies are currently underway to further investigate the immunological mechanisms behind this observation