Home Office

This cohort study estimates the association of participation in a supportive housing program with influenza vaccination rates among veterans experiencing homelessness.

Veterans experiencing homelessness have elevated rates of traumatic brain injury (TBI) diagnoses. There remains limited research on subsets of homeless Veterans, including Native Hawaiian and Pacific Islander (NHPI) Veterans. Department of Veterans Affairs (VA) electronic medical records of 724 752 Veterans who accessed Veterans Health Administration (VHA) homeless services from January 2005-December 2018 were examined. Of the total sample, 1177 identified as NHPI, with comparator samples of non-NHPI (n=723 575) and White (n=418 085) Veterans also generated. Rates of TBI were compared between NHPI Veterans relative to non-NHPI Veterans, as well as between NHPI and White Veterans (a subset of the non-NHPI Veteran sample). NHPI homeless Veterans were more likely to have a documented TBI diagnosis relative to non-NHPI homeless Veterans (AOR=1.82, 95% CI: 1.57-2.11), including the White homeless Veteran subgroup specifically (AOR=1.51, 95% CI: 1.30-1.75). This persisted in the presence of several covariates, including sex, ethnicity, rurality, VA service-connected disability, posttraumatic stress disorder, depression, and VHA mental health and general service use. NHPI homeless Veterans were also significantly less likely to utilize VHA services, suggesting an important gap in health service delivery. Results support potentially heightened risk for TBI among NHPI homeless Veterans, and a need to elucidate if such injuries occur during or outside of military service. Alternatively, given potential sociocultural differences, understanding the experience and expression of TBI sequelae among NHPI homeless Veterans is essential. Further research is requisite to understand how to optimally engage homeless NHPI Veterans in care to ensure TBI-related sequelae are adequately identified and addressed.

ObjectiveThis study assessed the dietary consequences of the suspension of the National Home-Grown School Feeding Programme (NHGSFP) among school food vendors in Oyo State.MethodsThis cross-sectional study involved 315 NHGSFP food vendors. Data were collected using a semi-structured questionnaire that evaluated socio-demographics, perceptions, household food security, and dietary diversity. Perception was assessed using a 5-point Likert scale with 11 items and categorised as beneficial (1-2), neutral (3), and non-beneficial (4-5). Food security status before and after the suspension was assessed using the 21-point Household Food Insecurity Access Scale, categorised as food secure (<7), mildly food-insecure (7-11), moderately food-insecure (12-16), and severely food-insecure (>16). Dietary diversity was assessed using the standard Minimum Dietary Diversity for Women (MDD-W). Data were analysed using descriptive statistics and binary logistic regression (α0.05).ResultsAge of vendors was 46.8±8.5 years, 62.9% had 6–10-year work experience, 36.8% had NHGSFP as primary income source, and over 90% expressed a positive perception of NHGSFP. Following the NHGSFP suspension, the proportion of households reporting severe household food insecurity increased from 7.3% to 70.2%. Vendors relying solely on NHGSFP income faced twice the risk of severe food insecurity (AOR: 2.16; 95% CI: 1.09–4.24) compared to diversified earners. Only 16.9% achieved MDD-W (≥5 food groups). Mildly food-insecure vendors had >10-fold higher odds of meeting MDD-W than severely food-insecure peers (AOR: 10.63; 95% CI: 4.94–22.89).ConclusionsThe National Home-Grown School Feeding suspension disrupted food vendors' livelihoods, impaired household food access, and compromised the nutritional quality of their diets. Urgent reinstatement is recommended to restore economic stability and improve food and nutrition security in this group.

The intricate relationship between nutrition and mental health has gained significant scientific recognition in recent years. Nutrients play vital roles in neurotransmitter synthesis, hormonal regulation, and gut-brain communication, directly influencing mood, cognition, and emotional resilience. This paper explores the emerging concept of psycho-nutritional therapeutics, an integrative approach that combines dietary interventions with psychological wellness strategies to enhance family well-being. A hypothetical cross-sectional study model was constructed to assess the impact of dietary patterns and nutrient intake on mental health indicators such as stress levels, sleep quality, and emotional balance in families. The study compared three groups: (A) families consuming processed, low-fiber diets; (B) families with balanced home-cooked diets; and (C) families following psycho-nutritional diets enriched with omega-3 fatty acids, B-vitamins, magnesium, tryptophan-rich foods, and probiotics.Results indicated that Group C exhibited the lowest perceived stress score (–28%), highest emotional well-being index (+24%), and significant improvement in sleep quality (+22%). These outcomes suggest that nutrient-dense diets profoundly influence neurotransmission and stress physiology through biochemical and gut-mediated pathways.This study emphasizes the Home Science perspective that views nutrition not only as sustenance but as a key determinant of psychological harmony and family health. Integrating psycho-nutritional principles into daily meals can promote emotional stability, reduce anxiety, and strengthen interpersonal relationships, thereby contributing to holistic family well-being.

This paper aims to better understand how structural determinants of health inequalities shape disengagement from healthcare for vulnerable groups across a range of social conditions. Using a sub-sample (N=20) from a qualitative interview UK study of those missing from primary-care, it illuminates how structural drivers of health inequalities operate at organisational and practice levels to weaken engagement with primary-care. Finding ways of better analysing and demonstrating the causal chains between structural determinants and patterns of disengagement is important because previous research has shown that practitioner and policy understanding of structural determination, an important precursor for mitigatory action, is not always sufficient, and research on healthcare utilisation can itself be weak in investigating structures of inequality. We address this deductively by testing a novel combination of Link and Phelan's Fundamental Cause Theory and Dixon-Woods and colleagues' Candidacy framework. Combining elements of these frameworks compensates for identified gaps in each. We demonstrate how Candidacy can be strengthened through incorporating more systematic theorisation of structural processes and that the more abstract arguments of fundamental (structural) causes can be made concrete via Candidacy's focus on inequalities in patients' access to, and utilisation of, healthcare. We also argue that both theories are enhanced by including Metzl and Hansen's concept of 'structural competency' as a potential mitigatory mechanism operating between fundamental causes and patient engagement.

Palliative care improves the quality of life for patients with severe diseases like breast cancer. The objective of this study was to describe the variation of age of breast cancer patients (484 in total) who accessed palliative care in Albania in the last 10 years (2014 to 2023). Information on patient age, breast cancer incidence, hospitalization and mortality rates, and breast cancer screening was collected. Descriptive statistics and t-test for unpaired samples to compare the means of age in the study period were used. The average age of patients gradually increased from 2014 to 2019, showing fluctuations due to the COVID-19 pandemic, and resumed an increasing trend in 2023. Breast cancer incidence remained stable at approximately 37 cases per 100,000 annually, with significant increases in hospitalization and screening rates over the study period. In conclusion, the gradual increase in the age of breast cancer patients seeking palliative care in Tirana, Albania during the past decade, coupled with slight decrease of mortality rates, stable incidence and increase of hospitalization might be indicators of success of related health policies in Albania, including better diagnostic and treatment strategies, improved treatment efficacy and disease management, ultimately increasing the resilience and adaptability of the healthcare system.

Introduction Lumateperone, an atypical antipsychotic drug, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors. Objectives This subgroup analysis of an Indian Phase 3 study was conducted to evaluate the efficacy and safety of Lumateperone 42mg compared to Quetiapine 300mg in treatment of Bipolar II depression when stratified based on disease duration. Methods The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included patients with Bipolar II depression with moderate severity having a Montgomery-Asberg depression rating scale (MADRS) score ≥20 and Clinical global impression–bipolar version–severity (CGI-BP-S) score ≥4. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Lumateperone 42mg [Test] or Quetiapine 300mg [Comparator] for 6 weeks. The patients were stratified based on disease duration: Subgroup 1 [S1]: ≤6 months and Subgroup 2 [S2]: >6 months. For efficacy outcomes MADRS score, CGI-BP-S (total score, depression subscore and overall bipolar illness subscore), and Quality of life enjoyment and satisfaction-short form questionnaire (Q-LES-Q-SF) score were evaluated and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583] Results This subgroup analysis included 462 patients, out of which 118 in S1[Test=62; Comparator=56] and 344 in S2[Test=169; Comparator=175]. The baseline demographic characteristics were comparable in between treatment arms across subgroups. The primary endpoint of reduction in MADRS score from baseline to Day 42 in Test arm was non-inferior to Comparator arm in both subgroups [Figure 1] as the upper 95% CI was below the pre-defined margin of 3.0. The reduction of CGI-BP-S (total score, depression subscore and overall bipolar illness subscore) from Day 14 to Day 42 were comparable in both Test and Comparator arms in both subgroups. The improvement in Q-LES-Q-SF score from baseline to Day 42 were comparable in both Test and Comparator arms in both subgroups. The incidence of TEAEs were similar in both treatment arms [S1: Test=30.6% and Comparator=30.4%; S2: Test=36.1% and Comparator=37.1%] and no serious adverse events were reported. Image 1: Conclusions This subgroup analysis demonstrated that Lumateperone 42mg is non-inferior to Quetiapine 300mg in treatment of Bipolar II depression as assessed via MADRS score from baseline to Day 42, irrespective of chronicity of the disease and both treatments were found to be well tolerated. Hence, Lumateperone can be considered as valuable treatment option in management of Bipolar II depression. Disclosure of Interest A. Dharmadhikari: None Declared, P. Chaurasia: None Declared, Y. Patel: None Declared, D. Choudhary: None Declared, P. Dasud: None Declared, M. Bhirud: None Declared, P. Meena: None Declared, F. Shah: None Declared, G. Ganesan: None Declared, B. P. Rathour: None Declared, K. Mistry: None Declared, M. Dutta: None Declared, A. Ramaraju: None Declared, S. Mangalwedhe: None Declared, S. G. Goyal: None Declared, G. Kulkarni: None Declared, A. Mukhopadhyay: None Declared, P. Chaudhary: None Declared, G. T. Harsha: None Declared, M. Parikh: None Declared, S. Dey: None Declared, S. Sarkhel: None Declared, N. Jyothi: None Declared, A. Kumar: None Declared, N. Sooch: None Declared, A. Shetty Employee of: Sun Pharma, S. Saha Employee of: Sun Pharma, P. Devkare Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, D. Patil Employee of: Sun Pharma, P. Ghadge Employee of: Sun Pharma, A. Mane Employee of: Sun Pharma, S. Mehta Employee of: Sun Pharma.

Abstract The study was conducted in Hisar district of Haryana state to assess behaviour problems among rural and urban adolescents. From the randomly selected district two schools were selected from the urban area and two schools were selected from rural area. Study was conducted on 14-17 years old adolescents. A sample of 60 adolescents and their parents, 60 adolescents (30 boys and 30 girls) were selected from rural and urban areas. Thus, the total sample for the present study constituted 240 respondents (120 adolescents and 120 parents). The instruments used for data collection were Goodman’s Strengths and Difficulties Questionnaire (2000) for studying behaviour problems and self-made questionnaire for personal and socio-economic variables. The following statistical tests i.e. independent sample Z-test, f-test, chi square test, percentages and frequencies were used to evaluate the data. The results revealed that the majority of adolescents were normal, having no behaviour problem. Study shows higher behaviour problems in adolescents in rural area than urban area. In rural area, females had more behaviour problems than males but males in urban area showed more behaviour problems than females.

We describe an autopsy case of spinal bulbar muscular atrophy (SBMA) concomitant with multiple system atrophy (MSA). A Japanese male patient developed gait disturbance in his twenties. His brother and niece also presented with similar clinical symptoms. His condition gradually worsened, and he became immobile at the age of 50 years. Genetic analysis revealed the expansion of CAG repeats of the SBMA gene. At 63 years of age, cerebellar ataxia symptoms emerged. Magnetic resonance images of the head showed a "hot cross bun sign" at the pontine basis and bilateral atrophy of the middle cerebellar peduncles and cerebellar hemispheres, suggesting MSA. He died of pneumonia at the age of 65 years, with a clinical illness of approximately 40 years. The neuropathological diagnosis was consistent with both SBMA and MSA. Neurons of the spinal anterior horn and brainstem motor nuclei were diminished. 1C2 (polyglutamine) immunoreactive intranuclear and intracytoplasmic inclusions were observed in the neurons in the substantia nigra, brainstem tegmentum, pontine nuclei, spinal anterior horn cells and Onuf's nucleus. These findings were suggestive of SBMA. Meanwhile, neurons of the inferior olivary nuclei, pontine nuclei, and Purkinje cells were nearly completely lost. The cerebellar white matter, pontine basis, and middle cerebellar peduncles showed a prominent loss of fibers. α-synuclein positive glial cytoplasmic inclusions were observed in widespread areas. These findings were suggestive of MSA. To the best of our knowledge, another case of SBMA accompanying MSA, similar to the present case, have been reported to date. Moreover, several cases of pathologically proven amyotrophic lateral sclerosis and MSA have been reported. The development of molecular biological techniques and accumulation of pathologically diagnosed patients may reveal common pathological mechanisms in SBMA and MSA.

ABSTRACT Polyvalence of laughter: Homeric cases of ἄσβεστος γέλως The present article intends to analyze the three different Homeric cases of ἄσβεστος γέλως (Il. I 599; Od. VIII 326; XX 346). By considering both linguistic elements which are referred to the noun γέλως and some narratological aspects in relation to which the lines being discussed could be considered, the purpose of this article is to give a specific interpretation of the different scenes. More specifically: in the first part, I will discuss the possibility that the Homeric laughter is related, from a semantic and linguistic point of view, to the idea of a physical movement; in the second part, I intend to show that the massive use of γέλως displayed by the gods who make fun of Hephaistos could be interpreted as a sort of psychological displacement; in the last part of the article, I show a vital trait of the Homeric unquenchable laughter, namely the fact that each and every detail referred to it leads to think that this kind of laughter is an exclusive prerogative of the Olympians: whenever it involves human beings, it brings nothing but madness and death.