Higher and Lower Endorsement of Eating Disorder Symptoms Among Adolescents and Their Caregivers

ABSTRACT Objective Low symptom endorsement among adolescents with eating disorders (EDs) may pose challenges for the accurate assessment of symptoms. To better understand low symptom endorsement, the current study examined demographic and clinical characteristics associated with lower symptom endorsement among adolescents with EDs, and compared patterns of endorsement between adolescents and their caregivers. Method Treatment‐seeking adolescents ( N  = 629) completed measures of ED psychopathology (Eating Disorder Examination‐Questionnaire; EDE‐Q), depression, and anxiety at admission, and caregivers completed the Parent EDE‐Q. Patients were categorised as ‘higher endorsers’ or ‘lower endorsers’ based on their EDE‐Q Global score. Results Patients with anorexia nervosa–restricting subtype (AN‐R) were more likely to be low symptom endorsers than those with AN–binge/purge subtype (AN‐BP). Lower endorsers had a shorter length of stay, lower anxiety and depression symptoms at admission, and lower percent of expected body weight at admission and discharge than higher endorsers. Adolescents with AN‐R exhibited more discrepancy between their report of ED symptoms and their caregivers' report than adolescents with AN‐BP. Conclusion The current study supports the importance of including multiple informants when assessing adolescents with EDs.

Walking the land with property owners

Analysis of Causal Factors to Acute Malnutrition Among Children Under the Age of Five in West Nile, Uganda

ABSTRACT Addressing child malnutrition requires a comprehensive understanding of its determinants. However, empirical evidence examining the relationships between these determinants and child malnutrition outcomes remains limited in Uganda. This study examined the underlying causes of acute malnutrition among children under 5 years of age in refugee settlements and surrounding host communities in West Nile, Uganda. Quantitative data were collected through a cross‐sectional survey using a two‐stage cluster sampling method including 767 mothers and 1167 children under the age of 5 years. The data collected included household food security, dietary intake, access to health and nutritional services, and anthropometric measurements. Confirmatory factor analysis was used to assess the fit of the hypothetical model, and structural equation modeling (SEM) examined the relationships between latent variables and weight‐for‐height Z ‐scores. The prevalence of Global Acute Malnutrition was estimated to be 8.8%, and a low proportion of children (7.2%) and their mothers (15.0%) met the minimum dietary diversity requirements. SEM revealed that household food security ( p  = 0.006) and maternal body mass index ( p  < 0.001) had significant positive effects on children's nutritional status, whereas the direct effects of the other factors were not statistically significant. The analysis also revealed that access to health and nutrition services had significant positive effects on dietary intake ( p  = 0.002) and disease incidence ( p  < 0.001). Additionally, dietary intake had a significant protective effect against disease ( p  < 0.001), and, in turn, household food security positively and significantly influenced dietary intake ( p  = 0.042). These findings suggest that future interventions aimed at reducing undernutrition in children, particularly in the context of protracted emergencies, should integrate food security, maternal health, and food delivery services.

Why Feminist Participatory Methods Matter for Global Health Research in Sub‐Saharan Africa

ABSTRACT Research in global health is often framed as centering health equity. However, research and programmatic partnerships are often relationships between institutions and researchers in high‐income countries (HICs), and researchers and actors in low‐ and middle‐income countries (LMICs), including many countries in Sub‐Saharan Africa (SSA). Such relationships are rife with power dynamics that require thoughtful attention and solutions. Feminist research methods, including perspectives from intersectional and African feminist thinkers, as well as participatory approaches, may offer a means of engaging with power inequities and disrupting often taken‐for‐granted assumptions in the SSA context. Such epistemological perspectives and methods not only disrupt “traditional” research relationships and challenge unexamined assumptions about knowledge but are also driven by the lived experiences of health disparities in specific, formerly colonized contexts and can therefore lead to context‐specific or localized solutions to complex health inequities. This paper explores how these specific feminist research perspectives and methods can challenge power dynamics that are often embedded in global health research and interventions in SSA.

The Impact of Aquaporin‐4 Deletion on K + ‐Induced Astrocytic Swelling Depends on K + Concentration

ABSTRACT Astrocytes swell in response to elevations in extracellular K + concentration. This K + ‐induced swelling is widely believed to be due to astrocytic K + uptake, even if the underlying mechanisms are not fully understood. Conflicting results pertaining to the role of the brain water channel AQP4 in K + ‐induced swelling have been presented. This calls for revisiting the effect of AQP4 on K + ‐induced astrocytic swelling dynamics. In this study, we performed two‐photon microscopy of acute hippocampal slices from wildtype (WT) and Aqp4 −/− mice to assess astrocytic swelling in response to medium high 10 mM and pathologically high 50 mM [K + ] solutions. We demonstrate that K + ‐induced swelling is attenuated in Aqp4 −/− astrocytes exposed to 10 mM [K + ] o compared to WT. In slices exposed to 50 mM [K + ] o , peak swelling was similar between the two genotypes, whereas the cell volume recovery was more complete in Aqp4 −/− astrocytes. We demonstrate that the two [K + ] concentrations elicit fundamentally different astrocytic Ca 2+ signaling responses, and that the Ca 2+ signaling response differs between the genotypes in the 10 mM [K + ] o  scenario. Our findings suggest that K + ‐induced astrocytic swelling has different mechanistic underpinnings, depending on the K + concentration to which the astrocytes are exposed, and that altered astrocytic Ca 2+ signaling is a putative mechanism involved.

Neuronal Activity Promotes Node‐Like Cluster Assembly Prior to Myelination and Remyelination in the Central Nervous System

ABSTRACT In recent years, myelination has been recognized as a key process in neural plasticity and network refinement, in addition to its role in axonal conduction and neuronal metabolic support. The fast saltatory conduction along myelinated fibers relies on the nodes of Ranvier. Node‐like clusters can form prior to myelin deposition in development and repair and can regulate axonal conduction, myelin deposition initiation, as well as contribute to the formation of mature nodes of Ranvier. In this study, we show that node‐like cluster assembly is modulated by neuronal activity and could thus be an intermediate step in activity‐induced (re)myelination. We further identify the regulation of Nav1.1 expression, which we show to be required for node‐like cluster formation, as part of the molecular mechanism implicated in the activity‐dependent regulation of node‐like cluster assembly. This process may serve in shaping neuronal networks and myelin patterns during development, plasticity and repair.

Predictors and Correlates of Loneliness and Social Isolation in People With Dementia: Longitudinal Findings From the IDEAL Programme

ABSTRACT Objective To identify predictors of loneliness and social isolation experienced by people with dementia at baseline and over time. Methods Using data from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study (2014–2018), we examined the prevalence and predictors of loneliness and social isolation in 1547 people with mild‐to‐moderate dementia over 24 months. Loneliness was measured using the six‐item De Jong Gierveld Scale at baseline and 24 months and social isolation by the six‐item Lubben Social Network Scale at baseline, 12 and 24 months. Generalised linear mixed effects models examined possible predictors of loneliness and social isolation including individual characteristics, depression, cognition, cultural participation, and neighbourhood characteristics. Results At baseline 35.4% of people with dementia were categorised as being lonely and 28.8% as socially isolated, increasing to 39.3% and 32.0% 2 years later. Over the 24‐month follow‐up none of these predictors were associated with changes in social isolation scores. Only perceived neighbourhood trust was associated with change in loneliness longitudinally. At baseline, depressive symptoms, living alone, smaller social networks and lower neighbourhood trust were associated with greater loneliness. Cross‐sectionally, loneliness and lower cognitive ability were associated with greater social isolation, and greater cultural participation, more green and blue spaces nearby and higher neighbourhood trust were associated with lower social isolation scores. Conclusions The findings highlight the importance of the local environment and cultural participation for people with dementia. Enhancing interactions with the local neighbourhood through initiatives such as dementia friendly communities may help to reduce loneliness and social isolation.

Finding Solutions to Addressing Inequalities in Dementia Diagnosis and Care: Recommendations From a Country‐Wide Consultation

ABSTRACT Background Accessing a diagnosis and receiving adequate care and support for dementia can often be subject to various inequalities. Personal‐, community‐, and infrastructure‐level factors can contribute to and often intersect in causing unequal health and care outcomes. With a paucity of evidence to inform solutions for dementia inequalities, the aim of this public consultation exercise was to explore potential solutions to inequalities in dementia diagnosis and care with different dementia stakeholders. Methods Utilising a future workshop approach, we conducted 11 in‐person and remote consultation workshops to discuss experienced barriers of accessing diagnosis and care; discuss an ideal‐world scenario where no barriers exist; and solutions to reach more equitable dementia diagnosis and care with people with dementia, unpaid carers, health and social care professionals, and third sector representatives. Discussions were synthesised by the research team and one public consultation group and mapped against the Dementia Inequalities model. Results A total of 131 different stakeholders in dementia attended 11 workshops across England. Solutions were identified across three layers of inequalities, with the majority of solutions proposed on a community and infrastructure level. Examples included link workers, a social care career pathway, Community Champions, adequate home equipment, and digital training. Some solutions require Governmental input, such as creating career pathways in the social care workforce, similar to the NHS, to train and maintain good paid carers, as well as a cross‐UK national dementia strategy raising the priority of dementia and required changes. Conclusions Dementia inequalities could be addressed via diverse and holistic approaches. With limited evidence to date on the impact of some of the proposed solutions, future research needs to build on these recommendations and design and test suitable interventions.

Feasibility and Validity of Ultra‐Low‐Field MRI for Measurement of Regional Infant Brain Volumes in Structures Associated With Antenatal Maternal Anemia

ABSTRACT The availability of ultra‐low‐field (ULF) magnetic resonance imaging (MRI) has the potential to improve neuroimaging accessibility in low‐resource settings. However, the utility of ULF MRI in detecting child brain changes associated with anemia is unknown. The aim of this study was to assess the comparability of 3T high‐field (HF) and 64mT ULF volumes in infants for brain regions associated with antenatal maternal anemia. This neuroimaging substudy is nested within Khula South Africa, a population‐based birth cohort. Pregnant women were enrolled antenatally and postnatally, and mother–child dyads ( n  = 394) were followed prospectively at approximately 3, 6, 12, and 18 months. A subgroup of infants was scanned on 3T and 64mT MRI systems across study visits and images were segmented using MiniMORPH. Correlations and concordance coefficients were used to cross‐validate HF and ULF infant brain volumes for the caudate nucleus, putamen, and corpus callosum. Seventy‐eight children (53.85% male) had paired HF (mean [SD] age = 9.64 [5.26] months) and ULF (mean [SD] age = 9.47 [5.32] months) datasets. Results indicated strong agreement between systems for intracranial volume (ICV; r  = 0.96, ρ ccc  = 0.95) and brain regions of interest in anemia including the caudate nucleus ( r  = 0.89, ρ ccc  = 0.86), putamen ( r  = 0.97, ρ ccc  = 0.96) and corpus callosum ( r  = 0.87, ρ ccc  = 0.79). This cross‐validation study demonstrates excellent correspondence between 3T and 64mT volumes for infant brain regions implicated in antenatal maternal anemia. Findings validate the use of ULF MRI for pediatric neuroimaging on anemia in Africa.

Vocal Fold Immobility After Radiofrequency Ablation of Thyroid Nodules: A Survey of Laryngologists and an Algorithm for Periprocedural Voice Assessment

ABSTRACT Background Rates of vocal fold motion impairment (VFMI) during and after thermal ablative treatments for thyroid nodules have not been well documented. This study surveys a large group of laryngologists to assess the rate of VFMI and dysphonia referral patterns after thermal ablation. A peri‐procedural voice assessment algorithm for proceduralists performing thermal ablation for thyroid nodules is presented. Methods Thirteen‐question‐survey related to VFMI postablation. Results Sixty‐one respondents completed the survey. One‐third of total respondents affirmed a VFMI after thermal ablation, with 81% documenting evidence on laryngeal examination. Immediate dysphonia was the most common presenting symptom. Referral patterns varied, but a large portion of patients were referred more than one week postprocedure despite the proceduralist having knowledge of potential VFMI. Conclusion VFMI is a risk during thermal ablation of thyroid nodules. Greater attention to voice during ablation and use of a procedural voice assessment algorithm may mitigate the risk of injury and potentially improve outcomes.