| 1. |
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| 2. |
- Glasbey, JC, et al.
(författare)
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- 2021
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swepub:Mat__t
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| 3. |
- Tabiri, S, et al.
(författare)
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- 2021
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swepub:Mat__t
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| 4. |
- Bravo, L, et al.
(författare)
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- 2021
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swepub:Mat__t
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| 5. |
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| 6. |
- Ikuta, K. S., et al.
(författare)
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Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019
- 2022
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Ingår i: Lancet. - : Elsevier BV. - 0140-6736. ; 400:10369, s. 2221-2248
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Tidskriftsartikel (refereegranskat)abstract
- Background Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2.5th and 97.5th percentiles across 1000 posterior draws for each quantity of interest. Findings From an estimated 13.7 million (95% UI 10.9-17.1) infection-related deaths in 2019, there were 7.7 million deaths (5.7-10.2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13.6% (10.2-18.1) of all global deaths and 56.2% (52.1-60.1) of all sepsis-related deaths in 2019. Five leading pathogens-Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa-were responsible for 54.9% (52.9-56.9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185-285) per 100 000 population, and lowest in the high-income super-region, with 52.2 deaths (37.4-71.5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
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| 10. |
- Weismuller, T. J., et al.
(författare)
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Patient Age, Sex, and Inflammatory Bowel Disease Phenotype Associate With Course of Primary Sclerosing Cholangitis
- 2017
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Ingår i: Gastroenterology. - : Elsevier BV. - 0016-5085 .- 1528-0012. ; 152:8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Primary sclerosing cholangitis (PSC) is an orphan hepatobiliary disorder associated with inflammatory bowel disease (IBD). We aimed to estimate the risk of disease progression based on distinct clinical phenotypes in a large international cohort of patients with PSC. METHODS: We performed a retrospective outcome analysis of patients diagnosed with PSC from 1980 through 2010 at 37 centers in Europe, North America, and Australia. For each patient, we collected data on sex, clinician-reported age at and date of PSC and IBD diagnoses, phenotypes of IBD and PSC, and date and indication of IBD-related surgeries. The primary and secondary endpoints were liver transplantation or death (LTD) and hepatopancreatobiliary malignancy, respectively. Cox proportional hazards models were applied to determine the effects of individual covariates on rates of clinical events, with time-to-event analysis ascertained through Kaplan-Meier estimates. RESULTS: Of the 7121 patients in the cohort, 2616 met the primary endpoint (median time to event of 14.5 years) and 721 developed hepatopancreatobiliary malignancy. The most common malignancy was cholangiocarcinoma (n = 594); patients of advanced age at diagnosis had an increased incidence compared with younger patients (incidence rate: 1.2 per 100 patient-years for patients younger than 20 years old, 6.0 per 100 patient-years for patients 21-30 years old, 9.0 per 100 patient-years for patients 31-40 years old, 14.0 per 100 patient-years for patients 4150 years old, 15.2 per 100 patient-years for patients 51-60 years old, and 21.0 per 100 patient-years for patients older than 60 years). Of all patients with PSC studied, 65.5% were men, 89.8% had classical or large-duct disease, and 70.0% developed IBD at some point. Assessing the development of IBD as a time-dependent covariate, Crohn's disease and no IBD (both vs ulcerative colitis) were associated with a lower risk of LTD (unadjusted hazard ratio [HR], 0.62; P <.001 and HR, 0.90; P =.03, respectively) and malignancy (HR, 0.68; P =.008 and HR, 0.77; P =.004, respectively). Small-duct PSC was associated with a lower risk of LTD or malignancy compared with classic PSC (HR, 0.30 and HR, 0.15, respectively; both P <.001). Female sex was also associated with a lower risk of LTD or malignancy (HR, 0.88; P =.002 and HR, 0.68; P <.001, respectively). In multivariable analyses assessing the primary endpoint, small-duct PSC characterized a low-risk phenotype in both sexes (adjusted HR for men, 0.23; P <.001 and adjusted HR for women, 0.48; P =.003). Conversely, patients with ulcerative colitis had an increased risk of liver disease progression compared with patients with Crohn's disease (HR, 1.56; P <.001) or no IBD (HR, 1.15; P =.002). CONCLUSIONS: In an analysis of data from individual patients with PSC worldwide, we found significant variation in clinical course associated with age at diagnosis, sex, and ductal and IBD subtypes. The survival estimates provided might be used to estimate risk levels for patients with PSC and select patients for clinical trials.
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| 11. |
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| 12. |
- Ahmed, K. Matin, et al.
(författare)
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Arsenic enrichment in groundwater of the alluvial aquifers in Bangladesh : an overview
- 2004
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Ingår i: Applied Geochemistry. - : Elsevier BV. - 0883-2927 .- 1872-9134. ; 19:2, s. 181-200
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Tidskriftsartikel (refereegranskat)abstract
- Arsenic in the groundwater of Bangladesh is a serious natural calamity and a public health hazard. Most groundwater from the shallow alluvial aquifers (<150 m), particularly in the Holocene plain lands, are vulnerable to As-enrichment. Delta plains and flood plains of the Ganges-Brahmaputra river system are moderately to severely enriched and more than 60% of the tube wells are affected. Shallow aquifers in the Meghna river basin and coastal plains are extremely enriched with more than 80% of the tube wells affected. Aquifers in the Pleistocene uplands and Tertiary hills are low in As. The vertical lithofacies sequence of the sediments from highly enriched areas of the country show two distinct lithofacies associations-a dominantly sandy channel-fill association and a fine-grained over bank association. The sediments can be grouped into 4 distinct lithofacies, viz. clay, silty clay, silty sand and sand. Thin section petrography of the As-enriched aquifer sands shows that the sands are of quartzolithic type and derived from the collision suture and fold thrust belt of the recycled orogen provenance. Groundwater is characterized by circum-neutral pH with a moderate to strong reducing nature. The waters are generally of Ca-Mg-HCO3 or Ca-Na-HCO3 type, with HCO3- as the principal anion. Low SO42- and NO3-, and high dissolved organic C (DOC) and NH4+ concentrations are typical chemical characteristics of groundwater. The presence of dissolved sulfides in these groundwaters indicates reduction Of SO4. Total As concentration in the analyzed wells vary between 2.5 and 846 mug l(-1) with a dominance of As(III) species (67-99%). Arsenic(III) concentrations were fairly consistent with the DOC and NH4+ contents. The HNO3 extractable concentrations of As (As-NO3) in the sediments (0.5-17.7 mg kg(-1)), indicate a significant positive correlation with Fe-NO3, Mn-NO3, Al-NO3 and P-NO3. The concentrations Of S-NO3 (816-1306 mg kg(-1)) peaked in the clay sediments with high organic matter (up to 4.5 wt.%). Amounts of oxalate extractable As (As..) and Fe (Fe x) ranged between 0.1-8.6 mg kg(-1) and 0.4-5.9 g kg(-1), respectively. Arsenic(ox) was positively correlated with Fe-ox, Mn-ox, and Al-ox in these sediments. Insignificant amounts of opaque minerals (including pyrite/arsenopyrite) and the presence of high As contents in finer sediments suggests that some As is incorporated in the authigenically precipitated sulfides in the reducing sediments. Moreover, the chemical extractions suggest the presence of siderite and vivianite as solid phases, which may control the aqueous chemistry of Fe and PO43-. Reductive dissolution of Fe oxyhydroxide present as coatings on sand grains as well as altered mica (biotite) is envisaged as the main mechanism for the release of As into groundwater in the sandy aquifer sediments.
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| 13. |
- Das, P., et al.
(författare)
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Exotic decay of 115Cs
- 2023
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Ingår i: Physical Review C. - 2469-9985. ; 108:6
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Tidskriftsartikel (refereegranskat)abstract
- The detailed study of the β+/EC decay of the very neutron-deficient and alpha-unbound nucleus 115Cs is presented. The measurement was performed at the ISOLDE, CERN where delayed charged particles and γ rays were detected. The observed delayed γ rays are in agreement with the previously reported characteristics γ rays of 115Xe. Based on the experimental observations, the tentative ground-state spin of 115Cs is suggested to be 7/2+ or 9/2+. Furthermore, the measured decay branching ratio of delayed protons exceeds the previously reported value. Additionally, new delayed α-branching ratio and several reconstructed proton and α-unbound excited states of 115Xe are being reported for the first time. The properties of proton-unbound states at excitation energies from 3.9–7.9 MeV have been obtained by fitting the delayed proton spectrum via the Bayesian method. The measured lifetimes of these proton-unbound states are in the order of zeptoseconds.
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| 14. |
- Kirstein, Oliver, et al.
(författare)
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Neutron position sensitive detectors for the ESS
- 2014
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Ingår i: Proceedings of Science. - : Proceedings of Science (PoS). ; Vertex2014, s. 029-029
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Konferensbidrag (refereegranskat)abstract
- The European Spallation Source (ESS) in Lund, Sweden will become the world's leading neutron source for the study of materials. It will be a long pulse source, with an average beam power of 5 MW delivered to the target station. The ESS is in the construction phase, which started in 2013 with the completion of the Technical Design Report (TDR). The instruments are being selected from conceptual proposals submitted by groups from around Europe. These instruments present numerous challenges for detector technology in the absence of the availability of Helium-3, which is the default choice for detectors for instruments built until today and due to the extreme rates expected across the ESS instrument suite. Additionally a new generation of source requires a new generation of detector technologies to fully exploit the opportunities that this source provides. To meet this challenge at a green-field site, the detectors will be sourced from partners across Europe through numerous in-kind arrangements; a process that is somewhat novel for the neutron scattering community. This contribution presents briefly the current status of detectors for the ESS, and outlines the timeline to completion. For a conjectured instrument suite based upon instruments recommended for construction, a recently updated snapshot of the current expected detector requirements is presented. A strategy outline as to how these requirements might be tackled by novel detector developments is shown. In terms of future developments for the neutron community, synergies should be sought with other disciples, as recognized by various recent initiatives in Europe, in the context of the fundamentally multi-disciplinary nature of detectors. This strategy has at its basis the in-kind and collaborative partnerships necessary to be able to produce optimally performant detectors that allow the ESS instruments to be world-leading. This foresees and encourages a high level of collaboration and interdependence at its core, and rather than each group being all-rounders in every technology, the further development of centres of excellence across Europe for particular technologies and niches.
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| 17. |
- Arman, M. M., et al.
(författare)
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Synchrotron radiation X-ray absorption fine structure and magnetization improvement of A-site Ce3+ doped LaFeO3
- 2020
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Ingår i: Journal of Magnetism and Magnetic Materials. - : Elsevier BV. - 0304-8853. ; 513
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Tidskriftsartikel (refereegranskat)abstract
- Synchrotron radiation (SR) is an interesting tool for probing the properties of the matter in various domains such as nanotechnology, energy materials, catalysis and the cultural heritage. Herein, we synthesized nanomultiferroic samples La1−xCexFeO3 (0.00 ≤ x ≤ 0.15) using auto combustion method and glycine as a fuel. The magnetic behavior was studied and interrelated with the results of synchrotron radiation X-ray absorption fine structure (XAFS) spectroscopy for better understanding the compositional-dependent fine local structures of A-site (Ce3+) doped LaFeO3 nanomultiferroic. The crystallinity and phase formation of the samples of perovskite structure were confirmed by XRD technique. Field emission scanning electron microscopy (FESEM) revealed the formation of homogenous porous morphology in the prepared nanomultiferroic. The collected XAFS signals at Fe K- edge (7112 eV) and La L3- edge (5483 eV) are analyzed, fitted, and refined in both the XANES and EXAFS regions. All obtained results are correlated in order to help in the interpretation of the magnetic character of nanocrystallite La1−xCexFeO3 (0.00 ≤ x ≤ 0.15). It was observed that there is a magnetization improvement in Ce3+ doped LaFeO3 samples where the molar magnetic susceptibility (χM) increased upon Ce3+ doping. The characteristics of the improved magnetic nanomultiferroic hand in hand with its distinguished morphology recommend it in multifunctional applications such as catalysts and/or γ-radiation dosimetry purposes.
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| 19. |
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| 20. |
- Eldeeb, Tarek M., et al.
(författare)
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Novel three-dimensional chitosan-carbon nanotube–PVA nanocomposite hydrogel for removal of Cr6+ from wastewater
- 2020
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Ingår i: Desalination and Water Treatment. - : Desalination Publications. - 1944-3994. ; 184, s. 163-177
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Tidskriftsartikel (refereegranskat)abstract
- A novel hybrid nanocomposite adsorbent was prepared by encapsulation of multi-walled carbon nano-tubes within polyvinyl alcohol/chitosan hydrogel (Cs/MWCNT/PVA) and cross-linked with glu-taraldehyde. The chemical reactions between the components affected the position and intensities of the infrared bands. This nanocomposite has excellent Cr6+ ions adsorption efficiency. The optimal conditions of the process as a function of the solution pH, contact time, ionic strength, and sorbent weight were investigated. The batch equilibrium experiments revealed that the most suitable pH for chromium adsorption was at 1.5. The maximum adsorption capacity for the hydrogel was 217.4 mg g–1 as estimated by the Langmuir model. Other isotherm models, such as Freundlich and Temkin, were used to analyze the experimental data and the models’ parameters were evaluated. The pseudo-first and second-order, Elovich, intraparticle diffusion, and film diffusion kinetic models were also inves-tigated. The obtained results enabled to estimate the possibility to use the Cs/MWCNT/PVA hydrogel in the removal of Cr6+ ions from wastewater by adsorption.
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| 21. |
- Enuameh, Yeetey Akpe Kwesi, et al.
(författare)
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Termination of pregnancy data completeness and feasibility in population-based surveys : EN-INDEPTH study
- 2021
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Ingår i: Population Health Metrics. - : BioMed Central (BMC). - 1478-7954. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background: Termination of pregnancy (TOP) is a common cause of maternal morbidity and mortality in low- and middle-income countries. Population-based surveys are the major data source for TOP data in LMICs but are known to have shortcomings that require improving. The EN-INDEPTH multi-country survey employed a full pregnancy history approach with roster and new questions on TOP and Menstrual Restoration. This mixed methods paper assesses the completeness of responses to questions eliciting TOP information from respondents and reports on practices, barriers, and facilitators to TOP reporting.Methods: The EN-INDEPTH study was a population-based cross-sectional study. The Full Pregnancy History arm of the study surveyed 34,371 women of reproductive age between 2017 and 2018 in five Health and Demographic Surveillance System (HDSS) sites of the INDEPTH network: Bandim, Guinea-Bissau; Dabat, Ethiopia; IgangaMayuge, Uganda; Kintampo, Ghana; and Matlab, Bangladesh. Completeness and time spent in answering TOP questions were evaluated using simple tabulations and summary statistics. Exact binomial 95% confidence intervals were computed for TOP rates and ratios. Twenty-eight (28) focus group discussions were undertaken and analysed thematically.Results: Completeness of responses regarding TOP was between 90.3 and 100.0% for all question types. The new questions elicited between 2.0% (1.0-3.4), 15.5% (13.9-17.3), and 11.5% (8.8-14.7) lifetime TOP cases over the roster questions from Dabat, Ethiopia; Matlab, Bangladesh; and Kintampo, Ghana, respectively. The median response time on the roster TOP questions was below 1.3 minutes in all sites. Qualitative results revealed that TOP was frequently stigmatised and perceived as immoral, inhumane, and shameful. Hence, it was kept secret rendering it difficult and uncomfortable to report. Miscarriages were perceived to be natural, being easier to report than TOP. Interviewer techniques, which were perceived to facilitate TOP disclosure, included cultural competence, knowledge of contextually appropriate terms for TOP, adaptation to interviewee's individual circumstances, being non-judgmental, speaking a common language, and providing detailed informed consent.Conclusions: Survey roster questions may under-represent true TOP rates, since the new questions elicited responses from women who had not disclosed TOP in the roster questions. Further research is recommended particularly into standardised training and approaches to improving interview context and techniques to facilitate TOP reporting in surveys.
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| 22. |
- Ercan, Ayse Bahar, et al.
(författare)
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Clinical and biological landscape of constitutional mismatch-repair deficiency syndrome: an International Replication Repair Deficiency Consortium cohort study.
- 2024
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Ingår i: The Lancet. Oncology. - 1474-5488. ; 25:5, s. 668-682
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Tidskriftsartikel (refereegranskat)abstract
- Constitutional mismatch repair deficiency (CMMRD) syndrome is a rare and aggressive cancer predisposition syndrome. Because a scarcity of data on this condition contributes to management challenges and poor outcomes, we aimed to describe the clinical spectrum, cancer biology, and impact of genetics on patient survival in CMMRD.In this cohort study, we collected cross-sectional and longitudinal data on all patients with CMMRD, with no age limits, registered with the International Replication Repair Deficiency Consortium (IRRDC) across more than 50 countries. Clinical data were extracted from the IRRDC database, medical records, and physician-completed case record forms. The primary objective was to describe the clinical features, cancer spectrum, and biology of the condition. Secondary objectives included estimations of cancer incidence and of the impact of the specific mismatch-repair gene and genotype on cancer onset and survival, including after cancer surveillance and immunotherapy interventions.We analysed data from 201 patients (103 males, 98 females) enrolled between June 5, 2007 and Sept 9, 2022. Median age at diagnosis of CMMRD or a related cancer was 8·9 years (IQR 5·9-12·6), and median follow-up from diagnosis was 7·2 years (3·6-14·8). Endogamy among minorities and closed communities contributed to high homozygosity within countries with low consanguinity. Frequent dermatological manifestations (117 [93%] of 126 patients with complete data) led to a clinical overlap with neurofibromatosis type 1 (35 [28%] of 126). 339 cancers were reported in 194 (97%) of 201 patients. The cumulative cancer incidence by age 18 years was 90% (95% CI 80-99). Median time between cancer diagnoses for patients with more than one cancer was 1·9 years (IQR 0·8-3·9). Neoplasms developed in 15 organs and included early-onset adult cancers. CNS tumours were the most frequent (173 [51%] cancers), followed by gastrointestinal (75 [22%]), haematological (61 [18%]), and other cancer types (30 [9%]). Patients with CNS tumours had the poorest overall survival rates (39% [95% CI 30-52] at 10 years from diagnosis; log-rank p<0·0001 across four cancer types), followed by those with haematological cancers (67% [55-82]), gastrointestinal cancers (89% [81-97]), and other solid tumours (96% [88-100]). All cancers showed high mutation and microsatellite indel burdens, and pathognomonic mutational signatures. MLH1 or MSH2 variants caused earlier cancer onset than PMS2 or MSH6 variants, and inferior survival (overall survival at age 15 years 63% [95% CI 55-73] for PMS2, 49% [35-68] for MSH6, 19% [6-66] for MLH1, and 0% for MSH2; p<0·0001). Frameshift or truncating variants within the same gene caused earlier cancers and inferior outcomes compared with missense variants (p<0·0001). The greater deleterious effects of MLH1 and MSH2 variants as compared with PMS2 and MSH6 variants persisted despite overall improvements in survival after surveillance or immune checkpoint inhibitor interventions.The very high cancer burden and unique genomic landscape of CMMRD highlight the benefit of comprehensive assays in timely diagnosis and precision approaches toward surveillance and immunotherapy. These data will guide the clinical management of children and patients who survive into adulthood with CMMRD.The Canadian Institutes for Health Research, Stand Up to Cancer, Children's Oncology Group National Cancer Institute Community Oncology Research Program, Canadian Cancer Society, Brain Canada, The V Foundation for Cancer Research, BioCanRx, Harry and Agnieszka Hall, Meagan's Walk, BRAINchild Canada, The LivWise Foundation, St Baldrick Foundation, Hold'em for Life, and Garron Family Cancer Center.
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| 24. |
- Nahal, M. S. H., et al.
(författare)
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Assessment of health status in adolescents with spina bifida in the West Bank, Palestine: sense of coherence and self-perceived health
- 2022
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 44:19, s. 5479-5486
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To assess self-perceived health and sense of coherence (SOC) in adolescents with spina bifida (SB) in the West Bank, Palestine, compared to a healthy reference group. Further, to assess the association between impairment levels in the adolescents with SB and their self-perceived health and SOC. Methods Fifty adolescents with SB and 150 healthy adolescents completed measures of self-perceived health - the Pediatric Quality of Life Inventory (PedsQL(TM) 4.0) - and SOC. The rehabilitation center nurses identified the physical impairments of the adolescents with SB from their medical records, and classified them by impairment severity. Results Adolescents with SB reported lower self-perceived health (PedsQL median 55, IQR 42-67), than the reference group (median 85, IQR 74-90), p < 0.001, and lower SOC (median 47, IQR 44-50) than the reference group (median 55, IQR 44-61), p < 0.001. Impairment level was inversely associated with both self-perceived health and SOC. Conclusions The low self-perceived health and SOC among adolescents with SB in Palestine indicate the need for collaboration between policy makers and providers to improve these adolescents' physical and social environment and to promote the rehabilitation services provided for them.
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| 25. |
- Nahal, M. S., et al.
(författare)
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Palestinian children's narratives about living with spina bifida: Stigma, vulnerability, and social exclusion
- 2019
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Ingår i: Child Care Health and Development. - : Wiley. - 0305-1862 .- 1365-2214. ; 45:1, s. 54-62
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Tidskriftsartikel (refereegranskat)abstract
- Background Living with spina bifida in Palestine is a critical issue that might influence various aspects of the individual's life. It is a challenge for children, their families, and health care providers because it requires lifelong treatment and follow-up of care provision. However, little focus has been placed on these children's perceptions about their daily life experiences with spina bifida. Purpose To illuminate the lived experience of children with spina bifida in the West Bank, Palestine. Methods A qualitative study was conducted using the phenomenological hermeneutical method to interpret the meaning of being a child with spina bifida in Palestine. Ten children with spina bifida, aged 7-18 years, were interviewed. The two local authors independently analyzed the Arabic transcriptions, whereas the two Swedish authors analyzed the transcriptions after translation to English. Finally, the four authors discussed their analysis and reached agreement about the themes. Results Studying the children's experience with spina bifida helped us highlight their feelings, needs, and challenges. The findings were formulated into one main theme, Vulnerability and suffering due to social exclusion and stigma, which was grounded in three themes: Experiencing negative self-concept, Experiencing vulnerability, and Obtaining a sense of security. These three themes were in turn derived from subthemes. Conclusion The Palestinian children in this study faced physical, emotional, and psychosocial challenges, which negatively influenced their health and development. They were vulnerable and stigmatized, and they lived with a negative self-concept. The findings could help health professionals, families, and caregivers to achieve a deeper understanding of what being a child with disabilities entails, and the findings may also serve as a platform for interventions that seek to promote these children's development and to enable them to experience childhood as a meaningful and positive process.
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