INTRODUCTION: Immune checkpoint inhibitors are a new form of immunotherapy that has transformed the treatment landscape for an ever-increasing number of malignancies. While these medications utilize and enhance the immune system to treat malignancies, they can also have significant side effects, termed immune related adverse events, that in many ways resemble autoimmune disease states. One such example is inflammatory arthritis, which has been found to resemble a number of different presentations, including rheumatoid arthritis and seronegative spondyloarthropathies. In addition to these traditional inflammatory arthritis phenotypes, worsening of pre-existing arthritis is another subgroup of inflammatory arthritis that has previously not been considered in this population. Furthermore, while the effects of these autoimmune arthropathies on functionality is well-documented, it is not known whether there is a significant effect on functionality in patients that experience immune checkpoint inhibitor-induced arthritis. Given that patient reported outcomes are a validated and routinely utilized measure of functionality and quality of life, the Health Assessment Questionnaire, pain visual analogue scale and Patient Global Assessment were used to measure these outcomes following diagnosis. Our aim here is to explore the subtypes of inflammatory arthritis that result from this type of treatment and its overall effect on functionality and quality of life. METHODS: This study was a retrospective review of patients at one academic center who experienced an inflammatory arthritis resulting from immune checkpoint inhibition and required a referral to a rheumatologist for further work-up. Patients were evaluated in clinic at which time they also completed a Health Assessment Questionnaire as part of standard of care. Once patients were evaluated, their inflammatory arthritis was classified based on which clinical arthritis that it matched most closely, including polymyalgia rheumatica, rheumatoid arthritis, seronegative spondyloarthritis, or an exacerbation or osteoarthritis. Other demographic information such as gender, age, and race were also collected. Patient questionnaires were scored and compared to the type of inflammatory arthritis to assess for any correlations. RESULTS: We found 30 patients that had an inflammatory arthritis resulting from immune checkpoint inhibition, with 12 having a polyarthritis similar to rheumatoid arthritis, 11 patients having osteoarthritis exacerbation, 4 patients with a polymyalgia rheumatica arthritis phenotype and 3 patients with a spondyloarthopathy. In terms of the patient reported outcomes, the overall score was 0.57 ± 0.47, indicating that there was little effect of these arthropathies on overall functionality. The pain visual analogue scale had an average score of 41.8 ± 31.4 mm and the Patient Global Assessment had an overall score of 25.6 ± 26.7 mm. DISCUSSION: The overall results suggest that the inflammatory arthritis phenotypes do not significantly impact the functionality or quality of life of most patients who experience this side effect. Given that the use of immune checkpoint inhibitors will continue to grow, the overall need to better understand the resulting arthritis presentations is key. This is perhaps most true for those with pre-existing osteoarthritis, given the widespread nature of the disease in the general population and the prominence of the exacerbation as seen in our cohort.

Introduction Paediatric Intensive Care has developed rapidly in recent years with a dramatic increase in survival rates. However, there are increasing concerns regarding the impact that admission to a Paediatric Intensive Care Unit (PICU) has on both the child and their family. Following discharge from PICU, children may be living with complex medical problems as well as dealing with the psychosocial impact that their illness has had on them and their family. Objectives To describe the long-term health outcomes of children admitted to a paediatric intensive care unit (PICU). Methods A full literature search was conducted including the databases; MEDLINE via PubMed, Cochrane Central Register of Controlled Trials, (CENTRAL), Scopus, Web of Science, CINAHL, ERIC, Health Source Nursing/Academic, APA PsycInfo. All studies including children under 18 admitted to a PICU were included. Primary outcome was short- and longerterm mortality. Secondary outcomes were neurodevelopment/cognition/school performance; physical function, psychological function/behaviour impact, quality of life outcomes and social/family implications. Studies focused on Neonatal Intensive Care Admission and articles with no English translation were excluded. Results One hundred and five articles were included in the analysis. Mortality in PICU ranged from 1.3% to 50%. Mortality in high income countries reduced over time but the data did not show the same trend for low- and middle-income countries. Higher income countries were found to have lower Standardised Mortality Rates (SMRs) than low- and middle-income countries. Children had an ongoing risk of death for up to 10 years following PICU admission. Children admitted to PICU also have more ongoing morbidity than their healthy counterparts with more cognitive/developmental problems, more functional health issues, poorer quality of life as well as increased psychological problems. Their parents also have an increased risk of Post Traumatic Stress Disorder (PTSD). Discussion Most of the studies identified are from high income countries and only include short-term follow up. More data is needed from low- and middle-income countries and over longer terms. The studies were markedly heterogenous and were all observational. Agreement is needed regarding which outcomes are most important to measure as well as standardised methods of assessing them. Further research is needed to identify the risk factors which cause children to have poorer outcomes as well as to identify predictive and modifiable factors which could be targeted in practice improvement initiatives.

This study used a twin and triplet sample to investigate the influence of preschoolers’ physical activity levels and internalizing problems on subsequent health outcomes (body-mass index, internalizing behavior problems, household health behaviors) in middle childhood. The potential influence of stressors salient in childhood (household chaos, socioeconomic status, stressful life events) on the hypothesized relationship between physical activity and internalizing on health was also explored. A specific focus was placed on examining the underlying genetic and environmental influences of children’s physical activity levels, as assessed by both temperamental (parent-reported) activity levels and observed (in-lab) motor behavior, using a behavioral genetic approach. By measuring physical activity in these two ways, this project also investigated the validity of the observational coding scheme developed for the current study to assess preschoolers’ overt motor behavior during laboratory testing. Data from 65 families (n = 134 children) included in the Southern Illinois Twins/Triplets and Siblings Study (SITSS) were examined from age 5 (physical activity levels, internalizing problems, and household chaos) to follow-up (body-mass index, internalizing problems, household health behavior, socioeconomic status, and stressful life events) when children were age 7-13 years old. Findings indicated that observed motor behavior and temperamental activity were not significantly correlated, suggesting that these measures assess different aspects of preschoolers’ physical activity levels. Additionally, results supported the reliability and validity of the newly developed observational coding scheme, which underscores the utility of this measure; employing this methodological tool in future studies focused on investigating motor behavior in childhood may be particularly fruitful. Genetic analyses demonstrated that approximately 66% and 34% of the variance in observed motor behavior was accounted for by additive genetic and non-shared environmental influences, respectively, whereas the variance in temperamental activity was attributable to dominant genetic effects (72%) and non-shared environmental influences (28%). These results suggest that differences in age 5 physical activity levels are largely due to genetic differences. Finally, longitudinal analyses showed that health outcomes at follow-up were significantly influenced by 5-year-old temperamental activity and internalizing problems, as well as follow-up socioeconomic status and stressful life events: 1) children who were older, were boys, and lived in a low socioeconomic status household had a higher body-mass index at follow-up; 2) children with higher age 5 internalizing problems and concurrent stressful life events had greater internalizing problems at follow-up; 3) boys and children with higher age 5 temperamental activity had lower scores for household health behaviors. The present project provides greater insight into childhood health (body-mass index, internalizing, household health behaviors) by examining factors relevant to health (physical activity levels, internalizing problems, stress) across development (i.e., from age 5 to ages 7-13 years).

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Forskning tyder på att 200 000 personer i Sverige drabbas av en ätstörning någon gång under livet. Studiens syfte var att utforska behandlingen mot ätstörningar och de erfarenheter som patienter och deras anhöriga upplevt genom bemötande och delaktighet i vården och den inverkan de fått på deras tillfrisknad. Semistrukturerade intervjuer genomfördes med fem tidigare ätstörningspatienter och två anhöriga. Data analyserades med hjälp av tematisk analys. Av resultatet framkom ett övergripande tema: Se hela mig - kropp och själ hör ihop samt sex underteman: styrande stereotypa föreställningar, den stereotypa bildens följder, tillit och misstro, kompetens påverkan relationella band, medbestämmande och samverkan, maktobalans. Deltagarna saknade behandling för de tankar och känslor som upprätthåller ätstörningen. Auktoritära tillvägagångsätt främjade inte arbetsallians eller delaktighet. Deltagarna upplevde att utebliven psykologisk behandling orsakat att de fortsatt levt med negativa tankar och beteenden som mer eller mindre vidmakthållit ätstörda beteenden. Utifrån deltagarnas önskemål och beskrivningar av brister förefaller det behövas kompetenshöjande insatser kring bemötande i behandlingen av ätstörningar.

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Magister Pharmaceuticae - MPharm / Gestational diabetes mellitus (GDM) is a condition that affects pregnant women and is one of the most common complications related to pregnancy. According to the World health organisation (WHO), the usual window for diagnosing GDM is between 24 and 28 weeks of gestation and the primary aim of diagnosing gestational diabetes is to identify women and infants at risk of short- or longer-term adverse outcomes. Recent results from the hyperglycaemia and adverse pregnancy outcome (HAPO) study have suggested that even mild levels of hyperglycaemia can have adverse effects on foetal outcomes but there are uncertainties about the prevalence of these outcomes in GDM diagnosed according to the latest WHO 2013 guideline and/or IADPSG 2010 criteria in diverse populations. GDM prevalence has been studied by different researchers, but the prevalence of adverse foetal outcomes in GDM diagnosed based on the latest WHO 2013 guideline and/or IADPSG 2010 criteria have not yet been explored except for the data published by the HAPO study. Due to the lack of sufficient knowledge on foetal outcomes in GDM, this study was conducted to review the evidence on the prevalence of adverse foetal outcomes in GDM diagnosed according to WHO 2013 guideline and/or the IADPSG 2010 criteria. Different databases including PubMed, Science Direct, Google Scholar and CINAHL as well as bibliographic citations were searched using a well-formulated search strategy to find the relevant observational studies (prospective/retrospective cohort and case-control) using explicit inclusion and exclusion criteria. The following search terms were used, “gestational diabetes”, “pregnancy”, “adverse fetal outcomes” and “adverse foetal outcomes”. The findings of this study were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the obtained data analysed using MetaXL ® version 5.3. This review was registered online on PROSPERO, the International prospective register of systematic reviews (registration number: CRD42020155061). Fifteen studies with 88,831 pregnant women (range: 83-25,543 participants) from 12 countries around the world were identified, with a wide variation in the prevalence of foetal outcomes in GDM using the stipulated criteria. These studies were unevenly distributed geographically as six of them were conducted in Asia, four in Europe, four in North America, one in Australia and none in Africa, Antarctica and South America. A meta-analysis found that the overall prevalence of foetal outcomes ranged from 1% (perinatal mortality) to 11% ( large for gestational age). The finding is limited due to the paucity of data on the prevalence of foetal outcomes in GDM. However, more studies using these criteria in low- and middle- income countries (LMICs) are needed by health care providers, to inform practice and allocate resources for control of GDM and its adverse foetal outcomes in diverse settings and ethnic groups, especially in LMICs.

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Abstract available in the JACC Cardiovascular Interventions.