Recruitment of Adolescent Young Carers to a Psychosocial Support Intervention Study in Six European Countries: Lessons Learned from the ME-WE Project

Young carers provide a substantial amount of care to family members and support to friends, yet their situation has not been actively addressed in research and policy in many European countries or indeed globally. Awareness of their situation by professionals and among children and young carers themselves remains low overall. Thus, young carers remain a largely hidden group within society. This study reports and analyses the recruitment process in a multi-centre intervention study offering psychosocial support to adolescent young carers (AYCs) aged 15-17 years. A cluster-randomised controlled trial was designed, with recruitment taking place in Italy, the Netherlands, Slovenia, Sweden, Switzerland and the United Kingdom exploiting various channels, including partnerships with schools, health and social services and carers organisations. In total, 478 AYCs were recruited and, after screening failures, withdrawals and initial dropouts, 217 were enrolled and started the intervention. Challenges encountered in reaching, recruiting and retaining AYCs included low levels of awareness among AYCs, a low willingness to participate in study activities, uncertainty about the prevalence of AYCs, a limited school capacity to support the recruitment; COVID-19 spreading in 2020-2021 and related restrictions. Based on this experience, recommendations are put forward for how to better engage AYCs in research.

Visibility as a Key Dimension to Better Health-Related Quality of Life and Mental Health: Results of the European Union Funded "ME-WE" Online Survey Study on Adolescent Young Carers in Switzerland

This paper examines the health-related quality of life (HRQL) and mental health of adolescent young carers (AYCs) aged 15-17 in Switzerland, based on data collected within the Horizon 2020 project 'Psychosocial support for promoting mental health and well-being among AYCs in Europe' (ME-WE). It addresses the following questions: (1) Which characteristics of AYCs are associated with lower HRQL and with higher level of mental health problems? (2) Do AYCs who are less visible and less supported report a lower HRQL and more mental health issues than other AYCs? A total of 2343 young people in Switzerland, amongst them 240 AYCs, completed an online survey. The results show that female AYCs and AYCs with Swiss nationality more often reported having mental health issues than their male and non-Swiss counterparts. Furthermore, the findings show a significant association between receiving support for themselves and visibility from their school or employer and the HRQL. Moreover, AYCs who reported that their school or employer knew about the situation also reported fewer mental health issues. These findings can inform recommendations for policy and practice to develop measures aimed at raising the visibility of AYCs, which is the first step for planning AYC tailored support.

A novel direct inducible nongenetic murine model of diabetes-aggravated atherosclerosis

Background and aims

Atherosclerosis, the main pathology underlying cardiovascular diseases is accelerated in diabetic patients (1,2). Genetic mouse models require breeding efforts which are time-consuming and costly. Our aim was to establish a new nongenetic model of inducible metabolic risk factors that mimics hyperlipidemia, hyperglycemia, or both and allows the detection of phenotypic differences dependent on the metabolic stressor(s) on any genetic background.

Methods and results

Wild type mice were injected with gain-of-function PCSK9D377Y (proprotein convertase subtilisin/kexin type 9) mutant adeno-associated viral particles (AAV) and streptozotocin (STZ) and fed either a high-fat diet (HFD) or high-cholesterol/high fat-diet (Paigen diet, PD) for 12 and 20 weeks. LDLR KO mice were used as reference control. Combined hyperlipidemic and hyperglycemic mice (HGHCi), but not hyperlipidemia (HCi) alone, displayed characteristic features of aggravated atherosclerosis characterized by larger and less stable plaques (necrotic core area in HGHCi HFD: 24% vs HCi HFD: 13% vs LDLR KO HFD: 18% area, at 20 weeks p<0.05; fibrous cap thickness in HGHCi: 13 μm vs HCi HFD: 23 μm vs LDLR KO HFD: 17 μm, at 20 weeks, p<0.05) which contained more macrophages (MOMA-2 in HGHCi HFD: 27% vs HCi HFD: 19% vs LDLR KO HFD: 46% area/plaque, at 20 weeks, p<0.05) and less smooth muscle cells (α-SMA in HGHCi HFD: 12% vs HCi HFD: 25% vs LDLR KO HFD: 18% area/plaque, at 20 weeks, p<0.05), on both HFD or PD diet. Diabetic atherosclerotic mice (HGHCi) fed a HFD showed 37% plaque area (of total lumen) compared to 16% plaque area in non-diabetic mice (HCi HFD) and 17% in LDLR KO HFD after 12 weeks; and 43% (HGHCi HFD) vs. 29% (HCi HFD) vs 39% plaque area (LDLR KO HFD) after 20 weeks (Figure 1A, B). Differences between the diabetic HGHCi and non-diabetic HCi HFD mice were confirmed using RNA-seq analysis of aortic tissue, revealing that significantly more genes were dysregulated in mice with combined hyperlipidemia and hyperglycemia than in the hyperlipidemia-only group. The HGHCi-associated genes were related to pathways regulating inflammation (increased Cd68, iNos, and Tnfa expression) and extracellular matrix degradation (Adamts4 and Mmp14) (Figure 1C). When comparing HFD with PD, the PD aggravated atherosclerosis to a greater extent in mice and showed plaque formation after 8 weeks (HGHCi PD: 48% plaque area vs. HCi PD: 30% plaque area), therefore, representing a direct inducible hyperglycemic atherosclerosis model compared with HFD-fed mice, in which atherosclerosis is severe by 8 weeks.

Conclusion

We established a nongenetic direct inducible mouse model of diabetes-aggravated atherosclerosis allowing comparative analyses of atherosclerosis in diabetic and non-diabetic conditions and its modification by diet, allowing analyses of multiple metabolic hits in mice.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft (DFG)

Discovering new perspectives - strengthening autonomy. Students from different healthcare professions interact with patients and provide care in a self-determined and interprofessional manner

The Careum Summer School (CSS) is a learning setting that enables self-regulated learning in an environment in which trainees and students from the various medical, nursing and therapeutic healthcare professions taught in the Swiss education system (upper secondary and tertiary levels A and B) develop project ideas together with patients and their caregivers. The aim of this learning setting is to promote a positive attitude among trainees and students towards interprofessional collaboration that includes patients as cooperation partners. Objective: The evaluation examines the extent to which trainees' and students' attitudes towards interprofessional collaboration changed. Information was also obtained on the experiences patients and their caregivers had during their participation in the CSS programme. Methodology: A total of 69 trainees and students were given access to an online survey in the form of the German version of the University of the West of England Interprofessional Questionnaire (UWE-IP) one week before the CSS programme began and six weeks after it concluded. Problem-focused interviews were also conducted with 11 patients and their caregivers. Results: The attitudes of the trainees and students in the UWE-IP Interprofessional Learning Scale improved significantly after the CSS programme was conducted (median t1=22.0/t2=16.0). The effect size was r=0.839 (Wilcoxon test for dependent samples). No significant results could be identified for the other three UWE-IP scales. Patients and their caregivers reported that they were able to actively participate in the CSS programme and felt valued and appreciated. Conclusion: The CSS offered a learning environment in which all participants were able to exchange knowledge and information in an interprofessional manner and work collaboratively on the development of a project idea - for example an interprofessional competency passport with a spider diagram.

Long-term Survival with 18-Fluorodeoxyglucose Positron Emission Tomography-directed Therapy in Non-small Cell Lung Cancer with Synchronous Solitary Brain Metastasis

AIMS

At diagnosis, <1% of patients with non-small cell lung cancer (NSCLC) have synchronous solitary brain metastasis (SSBM). In prior cohorts without 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) staging, definitive treatment to intracranial and intrathoracic disease showed a 5-year overall survival (OS) of 11-21%. We investigated the long-term survival outcomes for patients with SSBM NSCLC, diagnosed in the FDG-PET/CT era and treated definitively with local therapies to both intracranial and intrathoracic sites of disease.

MATERIALS AND METHODS

This retrospective study assessed patients staged with FDG-PET/CT who received definitive lung and SSBM treatment from February 1999 to December 2017. A lung-molecular graded prognostic assessment (lung-molGPA) score was assigned for each patient using age, performance status score, and, where carried out, molecular status. Overall survival and progression-free survival (PFS) were calculated using Kaplan-Meier methods. Cox proportional hazard models determined OS and PFS prognostic factors.

RESULTS

Forty-nine patients newly diagnosed with NSCLC and SSBM had a median age of 63 years (range 34-76). The median follow-up of all patients was 3.9 years. Thirty-three patients (67%) had ≥T2 disease, 23 (47%) had ≥N2. At 2 years, 45% of first failures were intracranial only (95% confidence interval 30-59). At 3 and 5 years, OS was 45% (95% confidence interval 32-63) and 30% (95% confidence interval 18-51), respectively. In ≥N1 disease, 5-year OS was 34% (95% confidence interval 18-63). The 3- and 5-year PFS was 8% (95% confidence interval 3-22) and 0%, respectively. Higher lung-molGPA was associated with longer OS (hazard ratio 0.26, 95% confidence interval 0.11-0.61, P = 0.002). Higher lung-molGPA (hazard ratio 0.33, 95% confidence interval 0.15-0.71, P = 0.005) and lower N-stage (hazard ratio 1.56, 95% confidence interval 1.13-2.15, P = 0.007) were associated with longer PFS.

CONCLUSIONS

Definitive treatment of patients with NSCLC and SSBM staged with FDG-PET/CT can result in 5-year survivors, including those with ≥N1 disease.

Early-stage mantle cell lymphoma: a retrospective analysis from the International Lymphoma Radiation Oncology Group (ILROG)

Background

Mantle cell lymphoma (MCL) rarely presents as early-stage disease, but clinical observations suggest that patients who present with early-stage disease may have better outcomes than those with advanced-stage disease.

Patients and methods

In this 13-institution study, we examined outcomes among 179 patients with early-stage (stage I or II) MCL in an attempt to identify prognostic factors that influence treatment selection and outcome. Variables examined included clinical characteristics, treatment modality, response to therapy, sites of failure, and survival.

Results

Patients were predominantly male (78%) with head and neck being the most common presenting sites (75%). Most failures occurred outside the original disease site (79%). Although the administration of radiation therapy, either alone or with chemotherapy, reduced the risk of local failure, it did not translate into an improved freedom from progression or overall survival (OS). The treatment outcomes were independent of treatment modality. The 10-year OS for patients treated with chemotherapy alone, chemo-radiation therapy and radiation therapy alone were 69%, 62%, and 74% (P = 0.79), and the 10-year freedom from progression were 46%, 43%, and 31% (P = 0.64), respectively.

Conclusion

Given the excellent OS rates regardless of initial therapy in patients with early-stage MCL, de-intensified therapy to limit treatment-related toxicity is a reasonable approach.

Palmitoylation of cdc42 Promotes Spine Stabilization and Rescues Spine Density Deficit in a Mouse Model of 22q11.2 Deletion Syndrome

22q11.2 deletion syndrome (22q11DS) is associated with learning and cognitive dysfunctions and a high risk of developing schizophrenia. It has become increasingly clear that dendritic spine plasticity is tightly linked to cognition. Thus, understanding how genes involved in cognitive disorders affect synaptic networks is a major challenge of modern biology. Several studies have pointed to a spine density deficit in 22q11DS transgenic mice models. Using the LgDel mouse model, we first quantified spine deficit at different stages using electron microscopy. Next we performed repetitive confocal imaging over several days on hippocampal organotypic cultures of LgDel mice. We show no imbalanced ratio between daily spine formation and spine elimination, but a decreased spine life expectancy. We corrected this impaired spine stabilization process by overexpressing ZDHHC8 palmitoyltransferase, whose gene belongs to the LgDel microdeletion. Overexpression of one of its substrates, the cdc42 brain-specific variant, under a constitutively active form (cdc42-palm-CA) led to the same result. Finally, we could rescue spine density in vivo, in adult LgDel mice, by injecting pups with a vector expressing cdc42-palm-CA. This study reveals a new role of ZDHHC8-cdc42-palm molecular pathway in postsynaptic structural plasticity and provides new evidence in favor of the dysconnectivity hypothesis for schizophrenia.