This study aimed to evaluate the feasibility of incorporating an integrative screening procedure comprised of the Psychosocial Assessment Tool (PAT), Strengths and Difficulties Questionnaire (SDQ), and The Child PTSD Symptom Scale (CPSS-5) (part A) into the initial referral process at a public outpatient child and adolescent psychiatry clinic. We aimed to (1) evaluate the feasibility of the screening procedure; (2) identify distinct psychosocial profiles through latent profile analysis (LPA); and (3) determine whether these unique profiles correlate with varying symptom severity levels to enhance treatment precision. Data from 901 families referred to a child and adolescent psychiatry clinic between January 2024 and January 2025 were analyzed. Parents completed the PAT, SDQ and CPSS-A online prior to intake. LPA was used to identify psychosocial profiles. A pre-post comparison assessed whether implementation of screening increased rates of comprehensive care (psychiatric and para-medical treatment). Screening completion was high (95.7
Working with culturally diverse populations in pediatric cardiology settings requires cultural competence and cultural humility. However, little is known about how physicians integrate these approaches. In this study we examined how pediatric cardiology providers describe the incorporation of cultural competence and humility into healthcare services provided to families of children with congenital heart disease (CHD) in pediatric settings in Israel, a country characterized by significant cultural, ethnic, and religious diversity. Semi-structured interviews were conducted with 17 pediatric cardiologists (12 men, five women; age 45–71 years) from various regions in Israel. Participants had between eight and 33 years of experience in the field. Interviews explored physicians’ perspectives on cultural competence and humility in their daily work with children and families affected by CHD. Data were analyzed using thematic content analysis with an interpretive phenomenological approach. Three main themes were identified: (1) Cultural awareness, or physicians’ examination of their own cultural and professional values, particularly evident among those from minority backgrounds; (2) Cultural knowledge, or the understanding of families’ health-related beliefs and cultural values, acquired primarily through direct clinical experience rather than formal training; and (3) Cultural skills, including the use of culture-specific expressions, integration of spiritual leaders, and navigation of language barriers. The findings revealed an interplay between cultural competence and cultural humility, with physicians demonstrating varying levels of self-awareness and adaptation to diverse cultural needs. Whereas participants demonstrated substantial cultural knowledge and skills, they faced challenges related to self-awareness and a lack of systematic approaches to cultural practices. The study highlights the need for structured support and training in cultural competence and humility within pediatric cardiology settings, particularly in culturally diverse contexts. Future interventions should focus on developing and implementing effective healthcare delivery models specifically designed to address the needs of vulnerable populations in pediatric settings.
ABSTRACT:We evaluated long-term outcomes of 288 children with refractory-Langerhans cell histiocytosis (R-LCH) from 26 countries, who were prescribed off-label MAPK inhibitors (MAPKis) according to clinical indications. MAPKi indications included 148 R-risk-organ-positive (R-RO+), 67 R-risk-organ-negative (R-RO-), 13 lung destruction (lung), 9 sclerosing cholangitis (SC), 49 neurodegeneration (ND), and 2 diabetes insipidus (DI) cases. Median ages at diagnosis and MAPKi onset were 1.3 and 2.3 years, respectively, with median follow-up of 3.7 years (1166 person-years). Agents mostly prescribed as monotherapies were 184 prescriptions of vemurafenib, 115 of dabrafenib, 3 of encorafenib, 42 of cobimetinib, 45 of trametinib, and/or 1 prescription of binimetinib; followed 51 times by various chemotherapies or hematopoietic stem-cell transplantation, or 28 times by combined anti-BRAF-anti-MEK. Short-term responses (<8 weeks) ranged from 98% (R-RO+ and R-RO-), to 30% (lung) to none (ND, DI, and SC); although long-term lung and ND responses could be observed. Skin rash was the most frequent adverse event (∼55%), and 7 others included 1 case of cardiomyopathy and 6 of retinitis. Five developed MAPKi-unrelated tumors and 9 patients died. Five-year survival was 98%. After 113 patients with R-LCH discontinued MAPKi, 69 experienced disease reactivation. None of the various empirical maintenance therapies were able to prevent secondary reactivation. Among the 143 assessable patients without ND-LCH at MAPKi onset, 60 developed ND (45%, 5-year risk). MAPKis appeared to be safe and effective in children with R-RO+/RO-LCH, whereas other indications' responses were less frequent or occurred later. Further studies are needed to find effective maintenance-therapy approaches, particularly to prevent frequently observed secondary ND.
Background: This study describes the rapid development and implementation of a community-based mental health intervention for civilians evacuated during the October 7, 2023, terrorist attack in Israel. Methods: Applied at the Yearim Hotel, the services were led by volunteer professionals and based on an integration of existing guidelines with ongoing needed adaptations. Services encompassed a mental health clinic, therapeutic art studio, and a coordinated model of care emphasizing interdisciplinary collaboration. Evaluation of the services drew on its utilization data and qualitative interviews with volunteer clinicians, members of the managerial team and evacuees. Results: Findings demonstrate high feasibility and acceptability of the applied model, as evidenced by sustained delivery, evacuee engagement, and smooth transition to government-backed services. Conclusions: Structured, volunteer-led, community-integrated services can be rapidly deployed in crisis settings. The presented model of mental health services offers practical insights for future emergency preparedness.
Background: Focal segmental glomerulosclerosis (FSGS) is a leading cause of renal disease presenting with steroid-resistant nephrotic syndrome (SNRS) and variable stages of chronic kidney disease (CKD). Monogenic etiologies for FSGS are increasingly recognized, particularly in pediatric and familial cases. Missense variants in the MAF BZIP Transcription Factor B (MAFB) gene cause a dominantly inherited condition with variable phenotype, ranging from isolated ocular or renal manifestations to syndromic FSGS. Methods: Detailed clinical and genetic investigations were conducted in an extended family presenting with a spectrum of renal and extra-renal manifestations. Results: Using Exome Sequencing (ES), a heterozygous variant, c.797T>C; p.(Leu266Pro) in the MAFB gene was identified in multiple affected family members. Variant segregation confirmed its presence in additional family members. The proband exhibited CKD accompanied by congenital auricular anomalies, hearing loss, and neurodevelopmental delay. An affected sibling presented with nephrotic-range proteinuria, Duane retraction syndrome (DRS) and neurodevelopmental involvement, while another family member had an isolated renal phenotype. Several of these features have not been previously associated with MAFB. Tools for structural modeling and stability predictions supported the functional impact of this variant. Conclusions: Our findings expand the phenotypic spectrum of MAFB-associated disease and further emphasize its variability.
