Patient needs in women of childbearing age with psoriasis: retrospective analysis from the German PsoBest registry.

Background: Women of childbearing age (WoCBA) with psoriasis face additional burden related to contraindications of systemic treatments during pregnancy/lactation and to the physical and psychosocial impact of psoriasis on their intimate/sexual relationships. Objective: Within a people-centered health care model, this study aimed to identify specific patient needs and their correlates in WoCBA (18-45 years), in comparison to same-age men and women above 45 years. Methods: Baseline data from the German PsoBest registry, including patients with moderate/severe plaque-type psoriasis with the indication for systemic therapy, were retrospectively analyzed. Psoriasis severity was assessed with the Psoriasis Area and Severity Index and patient-reported outcomes included EuroQoL Visual Analogue Scale, Dermatology Life Quality Index (DLQI), and Patient Needs Questionnaire. Results: The participants were 2308 WoCBA, 3634 men between 18 and 45 years of age, and 3401 women older than 45 years. In comparison to both control groups, WoCBA reported more DLQI impairments and higher needs to reduce social impairments (eg, "to be able to lead a normal working life"; "to be less burdened in your partnership"; "to be able to have a normal sex life"). These patient needs were associated with having psoriasis arthritis, previous systemic therapy, worse general health, and more DLQI impairments. Limitations: Retrospective analysis of an established dataset limited the examination of specific developmental, sexual, and reproductive variables. Conclusion: The specific needs of WoCBA with psoriasis were particularly related to the work context/financial stability and intimate relationships, which are crucial aspects in family planning. These results claim for a sex/age-sensitive approach in the psoriasis health care, by considering these needs as qualifiers in the clinical decision for systemic treatment.

Mental models for inclusive, socially-just disaster planning: a multi-community study in Saint Martin after Hurricane Irma.

Local perspectives provide different insights into disaster planning and response as compared to those of experts. Eliciting them, however, can be challenging, particularly for marginalised groups whose viewpoints have historically been excluded from planning processes. Fuzzy cognitive mapping (FCM) provides a semi-quantitative approach to representing the collective understanding or 'mental models' of diverse individuals and communities. This study involved 23 FCM interviews across three neighbourhoods of Saint Martin to comprehend: (i) how individuals' mental models of Hurricane Irma (2017) differ based on their context; (ii) how aligned mental models are with policy and planning documents; and (iii) the implications for the inclusiveness and representativeness of disaster response policies. It found that the residents of different neighbourhoods provided unique insights into the factors driving the social-ecological system, and that official policies aligned closely with priorities. The paper argues that the inclusion of the perspectives of different groups in disaster recovery is essential for an equitable process.

The role of disasters in shaping narratives of resilience and transformation in Puerto Rico.

Extreme weather events can act as "focusing events" that open windows of opportunity in the policy process for increasing resilience and transforming existing systems to be more sustainable and just. However, due to the multiple and contested meanings of resilience, it is uncertain to what extent a focusing event will foster transformational policy change as opposed to re-entrenching existing systems and structures. We conducted quantitative content and qualitative narrative analyses of Puerto Rican climate and energy policy before and after Hurricane Maria to assess the effect of a climate-induced disaster on the framings of resilience and transformation. We find that these terms are used predominantly in service of changes needed to promote the stability of the existing energy system. This suggests that after Hurricane Maria, achieving stability has been the dominant goal for resilience and transformation. As long as those responsible for the Puerto Rican energy system emphasize stability without actively working to enable longer-term transformational change, Puerto Ricans are unlikely to experience a rapid transition toward a sustainable, inclusive energy system.

Characterization of patients with psoriatic arthritis in dermatologic and rheumatologic care: analysis of two registries.

BACKGROUND AND OBJECTIVE: Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease affecting the musculoskeletal system, skin and nails. The aim is to characterize sociodemographic and clinical patient profiles documented in dermatologic and rheumatologic care. PATIENTS AND METHODS: Data of 704 patients with PsA from the dermatological Psoriasis Registry PsoBest (PB) and 1066 patients from the rheumatological disease registry RABBIT-SpA (RS) were analyzed. Comparable anamnestic and clinical variables were identified and descriptively analyzed. RESULTS: The mean age was 51.7 years in PB and 51.9 in RS. Disease duration of psoriasis was longer, mean cutaneous severity was higher in PB. However, more patients in RS vs. PB had tender joints and swollen joints. Mean Dermatology Life Quality Index was higher in PB and mean Health Assessment Questionnaire in RS. Patient reported global disease activity and pain were lower in PB. IL-23 inhibitors were used more frequently in PB, and TNF inhibitors in RS. CONCLUSIONS: Clinical specialization was associated with different clinical and treatment patterns of PsA. This may indicate a selection by dominant manifestation of psoriatic disease and potentially by effects of health care access. Psoriatic arthritis should be treated in a multidisciplinary approach considering all facets of this complex disease.

Human Lung Organoids-A Novel Experimental and Precision Medicine Approach.

The global burden of respiratory diseases is very high and still on the rise, prompting the need for accurate models for basic and translational research. Several model systems are currently available ranging from simple airway cell cultures to complex tissue-engineered lungs. In recent years, human lung organoids have been established as highly transferrable three-dimensional in vitro model systems for lung research. For acute infectious and chronic inflammatory diseases as well as lung cancer, human lung organoids have opened possibilities for precise in vitro research and a deeper understanding of mechanisms underlying lung injury and regeneration. Human lung organoids from induced pluripotent stem cells or from adult stem cells of patients' samples introduce tools for understanding developmental processes and personalized medicine approaches. When further state-of-the-art technologies and protocols come into use, the full potential of human lung organoids can be harnessed. High-throughput assays in drug development, gene therapy, and organoid transplantation are current applications of organoids in translational research. In this review, we emphasize novel approaches in translational and personalized medicine in lung research focusing on the use of human lung organoids.

Locally led adaptation: Promise, pitfalls, and possibilities.

Locally led adaptation (LLA) has recently gained importance against top-down planning practices that often exclude the lived realities and priorities of local communities and create injustices at the local level. The promise of LLA is that adaptation would be defined, prioritised, designed, monitored, and evaluated by local communities themselves, enabling a shift in power to local stakeholders, resulting in more effective adaptation interventions. Critical reflections on the intersections of power and justice in LLA are, however, lacking. This article offers a nuanced understanding of the power and justice considerations required to make LLA useful for local communities and institutions, and to resolve the tensions between LLA and other development priorities. It also contributes to a further refinement of LLA methodologies and practices to better realise its promises. Ultimately, we argue that the utility of the LLA framing in promoting climate justice and empowering local actors needs to be tested empirically.

Opportunities for Nature-based Solutions to contribute to Climate-Resilient Development Pathways.

There is potential for Nature-based Solutions (NbS) to contribute to Climate Resilient Development (CRD) due to their integrated approach to mitigation, adaptation, and sustainable development. However, despite alignment between NbS and CRD's objectives, realization of this potential is not guaranteed. A CRD Pathways (CRDP) approach helps to analyze the complexities of the relationship between CRD and NbS, and a climate justice lens enables the identification of the multiple ways that NbS can support or undermine CRD by foregrounding the politics inherent in deciding between NbS trade-offs. We use stylized vignettes of potential NbS to examine how the dimensions of climate justice reveal the potential of NbS to contribute to CRDP. We consider tensions in NbS projects between local and global climate objectives, and the potential for NbS framing to reinforce inequalities or unsustainable practices. Ultimately, we present a framework that combines climate justice and CRDP in an analytical tool for understanding the potential for a NbS to support CRD in specific places.

Interprofessional education about patient decision support in specialty care.

Specialty care involves services provided by health professionals who focus on treating diseases affecting one body system. In contrast to primary care - aimed at providing continuous, comprehensive care - specialty care often involves intermittent episodes of care focused around specific medical conditions. In addition, it typically includes multiple providers who have unique areas of expertise that are important in supporting patients' care. Interprofessional care involves multiple professionals from different disciplines collaborating to provide an integrated approach to patient care. For patients to experience continuity of care across interprofessional providers, providers need to communicate and maintain a shared sense of responsibility to their patients. In this article, we describe challenges inherent in providing interprofessional patient decision support in specialty care. We propose ways for providers to engage in interprofessional decision support and discuss promising approaches to teaching an interprofessional decision support to specialty care providers. Additional evaluation and empirical research are required before further recommendations can be made about education for interprofessional decision support in specialty care.