The role of functional health literacy in long-term treatment outcomes in psychosocial care for adolescents

Although among adolescents with psychosocial problems low health literacy may increase the risk of poor treatment outcomes, the contributing mechanisms within treatment remain unclear. A better understanding of these mechanisms could contribute to improved treatment processes and outcomes. This study aims to examine the relationship between functional health literacy, treatment processes (treatment adherence, learning processes), and treatment outcome (level of psychosocial problems) in adolescents in psychosocial care. We used data from a prospective cohort study among adolescents aged 12-18 (N = 390), collected in four successive measurements: at entry into care, and 3, 12, and 24 months thereafter. We used a mixed effect model to investigate the association between level of functional health literacy (adequate vs. inadequate) and treatment processes (treatment adherence, learning processes) and treatment outcome (level of psychosocial problems). Between adolescents with adequate and inadequate functional health literacy, we found no differences or change over time in adherence or learning processes. The level of psychosocial problems significantly declined over time (β = - 1.70, 95% CI [- 2.72, - 0.69], p = .001) to a similar degree in both groups, though, in all measurements, the level was consistently higher for adolescents with inadequate health literacy. We conclude that health literacy levels did not affect change in treatment processes nor in outcomes of psychosocial treatment. However, the consistently higher level of psychosocial problems among adolescents with inadequate health literacy suggests an unaddressed need in psychosocial care

Supporting Adolescents with Mental Health Problems in Secondary Education:Feasibility of a Supported Education Intervention

Mental health problems in adolescence can have a profound influence on school functioning, educational attainment and thus future societal participation. Supported education (SEd) is a potentially useful method for educational professionals to help adolescents with mental health problems in secondary school improve their functioning by stimulating collaboration, ownership, and participation. In this study, we examined the feasibility of SEd in secondary education by examining its acceptability, implementation, and preliminary effectiveness. We performed a mixed-methods study using quantitative data (questionnaires) and qualitative data (interviews) from educational professionals (EP) and adolescents, aged 13-17, about their experiences with a SEd intervention. Regarding the acceptability of the intervention, three main themes emerged: (a) structure, (b) autonomy, and (c) applicability of the intervention. Themes regarding the implementation were: (a) lack of time, (b) personal attitude, (c) mastery, and (d) complexity of the school environment. The findings show that, for those that followed the intervention, SEd is a promising approach to support adolescents with mental health problems to improve their functioning and participation in school. Further research is needed on the effectiveness of the intervention

Inter-fraction motion robustness and organ sparing potential of proton therapy for cervical cancer

Purpose: Large-field photon radiotherapy is current standard in the treatment of cervical cancer patients. However, with the increasing availability of Pencil Beam Scanning Proton Therapy (PBS-PT) and robust treatment planning techniques, protons may have significant advantages for cervical cancer patients in the reduction of toxicity. In this study, PBS-PT and photon Volumetric Modulated Arc Therapy (VMAT) were compared, examining target coverage and organ at risk (OAR) dose, taking inter- and intra-fraction motion into account. Materials and methods: Twelve cervical cancer patients were included in this in-silico planning study. In all cases, a planning CT scan, five weekly repeat CT scans (reCTs) and an additional reCT 10 min after the first reCT were available. Two-arc VMAT and robustly optimised two- and four-field (2F and 4F) PBS-PT plans were robustly evaluated on planCTs and reCTs using set-up and range uncertainty. Nominal OAR doses and voxel-wise minimum target coverage robustness were compared. Results: Average voxel-wise minimum accumulated doses for pelvic target structures over all patients were adequate for both photon and proton treatment techniques (D98 > 95%, [91.7–99.3%]). Average accumulated dose of the para-aortic region was lower than the required 95%, D98 > 94.4% [91.1–98.2%]. With PBS-PT 4F, dose to all OARs was significantly lower than with VMAT. Major differences were observed for mean bowel bag V15Gy: 60% [39–70%] for VMAT vs 30% [10–52%] and 32% [9–54%] for PBS-PT 2F and 4F and for mean bone marrow V10Gy: 88% [82–97%] for VMAT vs 66% [60–73%] and 67% [60–75%] for PBS-PT 2F and 4F. Conclusion: Robustly optimised PBS-PT for cervical cancer patients shows equivalent target robustness against inter- and intra-fraction variability compared to VMAT, and offers significantly better OAR sparing

Intradermal Administration of Influenza Vaccine with Trehalose and Pullulan-Based Dissolving Microneedle Arrays

Most influenza vaccines are administered via intramuscular injection which has several disadvantages that might jeopardize the compliance of vaccinees. Intradermal administration of dissolving-microneedle-arrays (dMNAs) could serve as minimal invasive alternative to needle injections. However, during the production process of dMNAs antigens are subjected to several stresses, which may reduce their potency. Moreover, the needles need to have sufficient mechanical strength to penetrate the skin and subsequently dissolve effectively to release the incorporated antigen. Here, we investigated whether blends of trehalose and pullulan are suitable for the production of stable dMNA fulfilling these criteria. Our results demonstrate that production of trehalose/pullulan-based dMNAs rendered microneedles that were sharp and stiff enough to pierce into ex vivo human skin and subsequently dissolve within 15 min. The mechanical properties of the dMNAs were maintained well even after four weeks of storage at temperatures up to 37°C. In addition, immunization of mice with influenza antigens via both freshly prepared dMNAs and dMNAs after storage (four weeks at 4°C or 37°C) resulted in antibody titers of similar magnitude as found in intramuscularly injected mice and partially protected mice from influenza virus infection. Altogether, our results demonstrate the potential of trehalose/pullulan-based dMNAs as alternative dosage form for influenza vaccination.Drug Delivery Technolog

Response to comment on 'Amphibian fungal panzootic causes catastrophic and ongoing loss of biodiversity'

Lambert et al. question our retrospective and holistic epidemiological assessment of the role of chytridiomycosis in amphibian declines. Their alternative assessment is narrow and provides an incomplete evaluation of evidence. Adopting this approach limits understanding of infectious disease impacts and hampers conservation efforts. We reaffirm that our study provides unambiguous evidence that chytridiomycosis has affected at least 501 amphibian species

Building trust in agribusiness supply chains: A conceptual model of buyer-seller relationships in the seed potato industry in Asia

In the absence of a certified seed system, potato farmers in Asia must purchase replacement seed tubers from an informal seed system. With no third party assurance that the seed tubers purchased are of good quality, the farmer's decision to purchase seeds may be influenced by the long-standing relationships that have been established between buyers and sellers. Trust is the critical determinant of a good buyer-seller relationship. Through maintaining communication and the making of various relationship specific investments, a conceptual model is proposed which suggests that seed suppliers may engage in trust building behavior which should result in the preferred seed supplier enjoying a greater share of the farmer's patronage