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ObjectivesThe safeguarding process involves a number of different components and multidisciplinary professionals working in both community and hospital settings. This workshop provides an integrated simulation teaching package, to demystify the Strategy Meeting and offer insight into the role of the of the Multi-Agency Safeguarding Hub (MASH).Video Simulation – highlight challenges to parental and multi-professional communication, consider key points in a safeguarding history and examination, and referral processes.Multidisciplinary Teamworking – provide an awareness of challenges of multi-agency working, understand roles and responsibilities of professionals at a strategy meeting and its purpose.Level 3. Safeguarding – contributing towards the acquisition of knowledge, skills and competencies required for the specific professional roles, supplementary to core Level 3.MethodsThe workshop followed the journey of an originally filmed mock paediatric case (non-accidental injury in a non-ambulant child), from presentation in the GP surgery, to assessment in the Emergency Department and hospital discharge. It included:Multidisciplinary group discussion – ‘hopes and fears’ for the day and interactive discussion.Video simulations – filmed ‘mock Strategy Meeting’ of the case with real life members of the interprofessional team, from Health & Social Care, Safeguarding, GP leads, Emergency Medicine, Paediatrics, Police and Radiology.Presentations – MASH and referral processes, with expert speakers.A multidisciplinary faculty included the Trust’s named doctor for safeguarding, MASH leads, representatives from General Practice, Paediatrics and the Simulation team. Participants included staff from Paediatrics, the Emergency Department, Primary Care, wards and the community.ResultsCourse feedback was extremely positive, with participants unanimously stating their knowledge and confidence regarding safeguarding cases increased, with 100% of participants interested in future similar training opportunities. Participants highlighted that the interactive nature of the training was a very valuable adjunct to their core Level 3 Safeguarding training. Opportunity to discuss and share knowledge across multidisciplinary background and specialties, as well as insight into each stage of the patient journey (primary and secondary care), offered a unique insight into the safeguarding process.ConclusionUse of video simulation to follow the patient journey, alongside interactive multidisciplinary discussions, provides valuable insight into challenges of safeguarding cases. In combination with an expert multidisciplinary faculty, the workshop was highly informative, generated insightful reflections and was enjoyed by participants. There is scope for expansion of this innovative package to other Trusts and interdisciplinary teams, to increase confidence around challenging cases and provide a multidisciplinary approach to learning.

ObjectivesGlucagon-like peptide 1 receptor agonists (GLP1-RA) are indicated for the treatment of type 2 diabetes and more recently for weight loss. The aim of this study was to assess the risks associated with GLP1-RA exposure during early pregnancy.DesignThis multicentre, observational prospective cohort study compared pregnancy outcomes in women exposed to GLP1-RA in early pregnancy either for diabetes or obesity treatment with those in two reference groups: (1) women with diabetes exposed to at least one non-GLP1-RA antidiabetic drug during the first trimester and (2) a reference group of overweight/obese women without diabetes, between 2009 and 2022.SettingData were collected from the databases of six Teratology Information Services.ParticipantsThis study included 168 pregnancies of women exposed to GLP1-RA during the first trimester, alongside a reference group of 156 pregnancies of women with diabetes and 163 pregnancies of overweight/obese women.ResultsExposure to GLP1-RA in the first trimester was not associated with a risk of major birth defects when compared with diabetes (2.6% vs 2.3%; adjusted OR, 0.98 (95% CI, 0.16 to 5.82)) or to overweight/obese (2.6% vs 3.9%; adjusted OR 0.54 (0.11 to 2.75)). For the GLP1-RA group, cumulative incidence for live births, pregnancy losses and pregnancy terminations was 59%, 23% and 18%, respectively. In the diabetes reference group, corresponding estimates were 69%, 26% and 6%, while in the overweight/obese reference group, they were 63%, 29% and 8%, respectively. Cox proportional cause-specific hazard models indicated no increased risk of pregnancy losses in the GLP1-RA versus the diabetes and the overweight/obese reference groups, in both crude and adjusted analyses.ConclusionsThis study offers reassurance in cases of inadvertent exposure to GLP1-RA during the first trimester of pregnancy. Due to the limited sample size, larger studies are required to validate these findings.

This study was realized in the frame of an IAEA Coordinated Research Project for the evaluation of sediment dynamics, applying in-situ radiometric methods accompanied with a theoretical model. The in-situ methods were validated using lab-based high-resolution gamma-ray spectrometry. Sediment dynamics assessments were performed based on the measured and mapped activity concentrations of specific 238U progenies (214Bi or 214Pb), 232Th progenies (208Tl and 228Ac), and 40K along the shoreline of the beach. The maps of the activity concentrations of natural radionuclides were produced rapidly using software tools (R language v4.5). The sediment dynamics of the studied area were also investigated through numerical simulations, applying an open source model considering land–sea interactions and meteorological conditions and the corresponding sediment processes. The assessments, which were conducted utilizing the detailed data from the natural radioactivity maps, were validated by the simulation results, since both were found to be in agreement. Generally, it was confirmed that the distribution of radionuclides reflects the selective transport processes of sediments, which are related to the corresponding processes that occur in the study area. Legrena Beach in Attica, Greece, served as a pilot area for the comparative analysis of methods and demonstration of their relevance and applicability for studying coastal processes.

HypothesisThe main hypothesis is that a digital, biodata-driven, and personalized program would exhibit high user retention and engagement, followed by more effective management of their depressive and anxiety symptoms.ObjectiveThis pilot study explores the feasibility, acceptability, engagement, and potential impact on depressive and anxiety and quality of life outcomes of the 16-week Feel Program. Additionally, it examines potential correlations between engagement and impact on mental health outcomes.MethodsThis single-arm study included 48 adult participants with mild or moderate depressive or anxiety symptoms who joined the 16-week Feel Program, a remote biodata-driven mental health support program created by Feel Therapeutics. The program uses a combination of evidence-based approaches and psychophysiological data. Candidates completed an online demographics and eligibility survey before enrolment. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder Scale, respectively. The Satisfaction with Life Scale and the Life Satisfaction Questionnaire were used to assess quality of life. User feedback surveys were employed to evaluate user experience and acceptability.ResultsIn total, 31 participants completed the program with an overall retention rate of 65%. Completed participants spent 60 min in the app, completed 13 Mental Health Actions, including 5 Mental Health Exercises and 4.9 emotion logs on a weekly basis. On average, 96% of the completed participants were active and 76.8% of them were engaged with the sensor during the week. Sixty five percent of participants reported very or extremely high satisfaction, while 4 out of 5 were very likely to recommend the program to someone. Additionally, 93.5% of participants presented a decrease in at least one of the depressive or anxiety symptoms, with 51.6 and 45% of participants showing clinically significant improvement, respectively. Finally, our findings suggest increased symptom improvement for participants with higher engagement throughout the program.ConclusionsThe findings suggest that the Feel Program may be feasible, acceptable, and valuable for adults with mild or moderate depressive and/or anxiety symptoms. However, controlled trials with bigger sample size, inclusion of a control group, and more diverse participant profiles are required in order to provide further evidence of clinical efficacy.

Recent spatial and vertical distributions of 137Cs activity concentration in the Aegean Sea are presented almost 30 years after the Chernobyl accident. The study aims to provide the current radioactivity levels of 137Cs in the Aegean Sea and to combine the 137Cs activity concentration with typical oceanographic parameters (T, S) in order to utilize them as tracers to identify/validate the different water masses that are present in the Aegean Sea. This work was performed in the frame of the “KRIPIS” project in 2017 for continuous investigations of the deep basins from all over the Aegean Sea and includes samplings from the water column layers of seven stations. The 137Cs activity concentrations were determined via lab-based gamma ray spectroscopy after appropriate chemical pre-concentration of 137Cs, while the salinity and temperature of the water column were obtained by in-situ measurements. The activity concentration values of 137Cs varied from 1.6 to 5.5 Bq m−3. Clear distinction of the Black Sea and Levantine Waters was obtained based on the combination of temperature and salinity values with 137Cs activity concentration. Furthermore, including 137Cs as a supplementary tracer, the Transitional Subsurface Aegean Waters were identified at the Myrtoan and Antikythera Straits, combining the salinity, temperature and 137Cs activity concentration.

Introduction: Data from the literature show that prolonged-release injectable antipsychotics (LAIs) ensure constant blood drug levels better patient compliance and offer a simpler treatment regimen for both patients and caregivers. This observational–descriptive study aims to detect the possible complications found in newborns of women with bipolar or psychotic disorders and LAI therapy during pregnancy. Methods: This study involved women with psychotic disorders during pregnancy who contacted the Teratology Information Center of Bergamo, Italy between 2016 and 2021 to receive counseling on the possible risks of exposure to LAI therapy. The follow-up procedure was carried out by telephone interview or direct contact with the patient and/or her physician. Results: In this study, LAI treatment in pregnancy was not associated with an increased risk of malformations. All but one of the children in the sample were born healthy and the mothers maintained psychopathological compensation during pregnancy. Conclusions: This study showed that, despite the small size of the sample under examination, the administration of LAIs do not compromise the normal intrauterine development of the unborn child and there were no evident major malformations.

Clozapine, an atypical antipsychotic, can cause potentially life-threating side effects such as agranulocytosis. Our case presents a picture of severe anemia without any depression of the white cells or platelet lines. A 36-year-old man with treatment-resistant schizophrenia was admitted to the Psychiatric Unit for therapy assessment. After admission, he was gradually switched to clozapine treatment, 400 mg/d. General laboratory test results were normal, with a hemoglobin (Hb) level of 15.2 g/dL. The Hb level gradually decreased to 7.1 g/dL 10 weeks after switching to clozapine, when the patient underwent blood transfusion and clozapine therapy was stopped. No evidence of bleeding was noted. The reticulocyte count was less than 60.000/µL. Other anemia causes were excluded. Bone marrow aspiration performed at 10 weeks revealed red cell hypocellularity, while myelopoietic and megakaryocytic cell lines were normal. All these findings confirmed the diagnosis of pure red cell aplasia. The Hb level gradually increased to 13.3 g/dL 4 weeks after clozapine discontinuation, and the patient was discharged with olanzapine 5 mg/d. Clozapine has been reported to cause hematological abnormalities. In our patient, the diagnosis of pure red cell aplasia was made on the basis of severe and selective anemia, reticulocytopenia, and erythroid aplasia. The pathogenesis of hematologic abnormalities due to clozapine treatment is not known. Suggested mechanisms include a direct toxic effect of clozapine, or its metabolite, on the erythroid precursor cells, or formation of a drug-antibody complex. These aspects call for further and deeper research and reports of clinical observations.

Prenatal depression carries substantial risks for maternal and fetal health and increases susceptibility to postpartum depression. Untreated depression in pregnancy is correlated with adverse outcomes such as an increased risk of suicidal ideation, miscarriage and neonatal growth problems. Notwithstanding concerns about the use of antidepressants, the available treatment options emphasize the importance of specialized medical supervision during gestation. The purpose of this paper is to conduct a brief literature review on the main antidepressant drugs and their effects on pregnancy, assessing their risks and benefits. The analysis of the literature shows that it is essential that pregnancy be followed by specialized doctors and multidisciplinary teams (obstetricians, psychiatrists and psychologists) who attend to the woman’s needs. Depression can now be treated safely during pregnancy by choosing drugs that have no teratogenic effects and fewer side effects for both mother and child. Comprehensive strategies involving increased awareness, early diagnosis, clear guidelines and effective treatment are essential to mitigate the impact of perinatal depression.

Many clinical conditions require radiological diagnostic exams based on the emission of different kinds of energy and the use of contrast agents, such as computerized tomography (CT), positron emission tomography (PET), magnetic resonance (MR), ultrasound (US), and X-ray imaging. Pregnant patients who should be submitted for diagnostic examinations with contrast agents represent a group of patients with whom it is necessary to consider both maternal and fetal effects. Radiological examinations use different types of contrast media, the most used and studied are represented by iodinate contrast agents, gadolinium, fluorodeoxyglucose, gastrographin, bariumsulfate, and nanobubbles used in contrast-enhanced ultrasound (CEUS). The present paper reports the available data about each contrast agent and its effect related to the mother and fetus. This review aims to clarify the clinical practices to follow in cases where a radiodiagnostic examination with a contrast medium is indicated to be performed on a pregnant patient.

Introduction: Our consensus statement aims to clarify the use of antidepressants and anxiolytics during breastfeeding amidst clinical uncertainty. Despite recent studies, potential harm to breastfed newborns from these medications remains a concern, leading to abrupt discontinuation of necessary treatments or exclusive formula feeding, depriving newborns of benefits from mother’s milk. Methods: A panel of 16 experts, representing eight scientific societies with a keen interest in postpartum depression, was convened. Utilizing the Nominal Group Technique and following a comprehensive literature review, a consensus statement on the pharmacological treatment of breastfeeding women with depressive disorders was achieved. Results: Four key research areas were delineated: (1) The imperative to address depressive and anxiety disorders during lactation, pinpointing the risks linked to untreated maternal depression during this period. (2) The evaluation of the cumulative risk of unfavorable infant outcomes associated with exposure to antidepressants or anxiolytics. (3) The long-term impact on infants’ cognitive development or behavior due to exposure to these medications during breastfeeding. (4) The assessment of pharmacological interventions for opioid abuse in lactating women diagnosed with depressive disorders. Conclusions: The ensuing recommendations were as follows: Recommendation 1: Depressive and anxiety disorders, as well as their pharmacological treatment, are not contraindications for breastfeeding. Recommendation 2: The Panel advocates for the continuation of medication that has demonstrated efficacy during pregnancy. If initiating an antidepressant during breastfeeding is necessary, drugs with a superior safety profile and substantial epidemiological data, such as SSRIs, should be favored and prescribed at the lowest effective dose. Recommendation 3: For the short-term alleviation of anxiety symptoms and sleep disturbances, the Panel determined that benzodiazepines can be administered during breastfeeding. Recommendation 4: The Panel advises against discontinuing opioid abuse treatment during breastfeeding. Recommendation 5: The Panel endorses collaboration among specialists (e.g., psychiatrists, pediatricians, toxicologists), promoting multidisciplinary care whenever feasible. Coordination with the general practitioner is also recommended.