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European Journal of Pediatrics Jun 2024Anterior and posterior drooling are prevalent comorbidities in children with neurodevelopmental disabilities. Considering the heterogeneity of the patient population and...
UNLABELLED
Anterior and posterior drooling are prevalent comorbidities in children with neurodevelopmental disabilities. Considering the heterogeneity of the patient population and the multifactorial aetiology of drooling, an interdisciplinary and individualised treatment approach is indispensable. However, no tool for stepwise decision-making in the treatment of paediatric drooling has been developed previously. Within the Radboudumc Amalia Children's Hospital, care for children with anterior and/or posterior drooling secondary to neurodevelopmental disabilities is coordinated by a saliva control team with healthcare professionals from six disciplines. In alignment with international literature, published guidelines, and evidence gained from two decades of experience and research by our team, this paper proposes an algorithm reflecting the assessment and treatment approach applied in our clinic. First, directions are provided to decide on the necessity of saliva control treatment, taking type of drooling, the child's age, and the severity and impact of drooling into account. Second, the algorithm offers guidance on the choice between available treatment options, highlighting the importance of accounting for child characteristics and child and caregiver preferences in clinical (shared) decision-making.
CONCLUSIONS
With this algorithm, we aim to emphasise the importance of repeated stepwise decision-making in the assessment and treatment of drooling in children during their childhood, encouraging healthcare professionals to apply a holistic approach.
WHAT IS KNOWN
• Children with anterior or posterior drooling secondary to neurodevelopmental disabilities comprise a heterogeneous group, necessitating an individualised treatment approach. • No stepwise decision-making tool is available for the treatment of paediatric drooling.
WHAT IS NEW
• Deciding on the necessity of saliva control treatment should be a conscious process, based on type of drooling, age, and drooling severity and impact. • Type of drooling, age, cognition, oral motor skills, self-awareness, posture, diagnosis, and child/caregiver preferences need to be considered to decide on the optimal treatment.
PubMed: 38943011
DOI: 10.1007/s00431-024-05658-5 -
International Journal of Behavioral... Jun 2024Adolescents account for 15% of new HIV cases in Kenya. HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are highly effective prevention tools, but...
BACKGROUND
Adolescents account for 15% of new HIV cases in Kenya. HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are highly effective prevention tools, but uptake is low among adolescents, particularly in resource-limited settings. We assessed awareness and acceptability of PrEP and PEP among Kenyan adolescents.
METHOD
Focus group discussions were conducted with 120 adolescent boys and girls ages 15 to 19 in Kisumu. Data were analyzed using the Framework Approach.
RESULTS
Adolescent participants often had not heard of or could not differentiate between PrEP and PEP. They also confused these HIV prevention tools with emergency contraceptives. Taking a daily pill to prevent HIV was perceived as analogous to taking a pill to treat HIV. Boys were aware of and willing to consider using PrEP and PEP due to their dislike for using condoms. Adolescents identified insufficient information, cost, and uncomfortableness speaking with healthcare workers about their HIV prevention needs due to sexuality stigma as barriers to using PrEP and PEP.
CONCLUSION
Low awareness and poor understanding of PrEP and PEP among adolescents reveal the need for increased education and sensitization about these HIV prevention options. Expanding access to sexual and reproductive health services that are tailored to the needs of adolescents and staffed with non-judgmental providers could help reduce sexuality stigma as a barrier to accessing care. New HIV prevention approaches such as long-acting injectables or implants, on-demand regimens, and multipurpose prevention technologies may encourage increased uptake of PrEP and PEP by adolescents.
PubMed: 38942977
DOI: 10.1007/s12529-024-10290-6 -
Surgical and Radiologic Anatomy : SRA Jun 2024The present case report aims to describe the rare coexistence of three variants of the cerebral arterial system diagnosed by computed tomography angiography (CTA).
PURPOSE
The present case report aims to describe the rare coexistence of three variants of the cerebral arterial system diagnosed by computed tomography angiography (CTA).
METHODS
A retrospective study on head and neck CTAs was performed on a Greek adult population from the Department of Radiology, University Hospital of Larissa. An interesting case of an 80-year-old male was further investigated.
RESULTS
The cerebral arterial circle presented with a combination of three variations. The left anterior cerebral artery (ACA) was fenestrated 1.4 mm proximally to the anterior communicating artery formation. The left posterior cerebral artery (PCA) was also fenestrated, 5.5 mm distally to its origin from the basilar artery. Lastly, the right PCA originated from the ICA supraclinoid segment.
CONCLUSIONS
This case report highlights an unusual coexistence of A1 and P1 segments fenestration with a fetal PCA, resulting in a unique cerebral circle. A1 segment fenestration has been previously reported as rare, while the PCA fenestration as extremely rare variant. Awareness of these rare variations could aid interventionists in their preoperative assessments.
PubMed: 38942933
DOI: 10.1007/s00276-024-03428-4 -
Journal of Hand Therapy : Official... Jun 2024Musician's focal dystonia (mFD) is a rare, neurological, task-specific disorder that mainly affects the upper extremity (especially the hands) and generally appears as a...
BACKGROUND
Musician's focal dystonia (mFD) is a rare, neurological, task-specific disorder that mainly affects the upper extremity (especially the hands) and generally appears as a painless muscular incoordination that can mark the end of a musician's professional career. The present literature review intends to highlight the current understanding of musician's focal dystonia, its underlying neural mechanisms and the role of prevention and treatment in physiotherapy, psychotherapy and other fields as occupational therapy.
PURPOSE
The aim of the present literature review was to gain an overview of mFD in the medical, psychological and physical therapy literature and investigate what strategies for diagnosis and rehabilitation are available today.
STUDY DESIGN
The present article is a literature review, based on the search for full-text publications with the goal of comparing the main strategies for mFD rehabilitation and prevention presented in the literature.
METHODS
This literature review compared many relevant papers and studies available in literature today for mFD epidemiology, neural mechanisms, treatment and prevention, to discuss what we know today and highlight the aspects that can still be enhanced in the future.
RESULTS
According to our results, current literature gives a good understanding of mFD epidemiology, but further studies are needed to fully comprehend the neurological aspects and develop more rehabilitation strategies, especially in the psychological field. Our research also highlighted the need for a multidisciplinary approach that considers both physical and psychological aspects.
CONCLUSIONS
Physical rehabilitation strategies are helpful but, considering the amount of psychological aspects involved in mFD, a holistic approach should be considered and developed in the future. Finally, prevention must have a primary role in mFD treatment, raising awareness around it and, possibly, avoiding its development.
PubMed: 38942654
DOI: 10.1016/j.jht.2024.02.011 -
Journal of the American Board of Family... Jun 2024Social risk data collection is expanding in community health centers (CHCs). We explored clinicians' practices of adjusting medical care based on their awareness of...
BACKGROUND
Social risk data collection is expanding in community health centers (CHCs). We explored clinicians' practices of adjusting medical care based on their awareness of patients' social risk factors-that is, changes they make to care plans to mitigate the potential impacts of social risk factors on their patients' care and health outcomes-in a set of Texas CHCs.
METHODS
Convergent mixed methods. Surveys/interviews explored clinician perspectives on adjusting medical care based on patient social risk factors. Survey data were analyzed with descriptive statistics; interviews were analyzed using thematic analysis and inductive coding.
RESULTS
Across 4 CHCs, we conducted 15 clinician interviews and collected 97 surveys. Interviews and surveys overall indicated support for adjustment activities. Two main themes emerged: 1) clinicians reported making frequent adjustments to patient care plans based on their awareness of patients' social contexts, while simultaneously expressing concerns about adjustment; and 2) awareness of patients' social risk factors, and clinician time, training, and experience all influenced clinician adjustments.
CONCLUSIONS
Clinicians at participating CHCs described routinely adjusting patient care plans based on their patients' social contexts. These adjustments were being made without specific guidelines or training. Standardization of adjustments may facilitate the contextualization of patient care through shared decision making to improve outcomes.
PubMed: 38942447
DOI: 10.3122/jabfm.2023.230289R1 -
Annals of Allergy, Asthma & Immunology... Jun 2024Asthma is a prevalent health concern among Illinois children and management is significantly influenced by social determinants. Seventeen states have adopted stock...
BACKGROUND
Asthma is a prevalent health concern among Illinois children and management is significantly influenced by social determinants. Seventeen states have adopted stock inhaler laws, but implementation varies widely.
OBJECTIVE
To assess critical barriers to implementation and address sustainability of stock inhaler programming in school-based asthma care in IL.
METHODS
Semi-structured interviews were conducted with high asthma burden school districts in IL to assess barriers in implementing stock inhaler policies and resultant programming. Thematic analysis was performed, using Atlas.ti to identify and code "threats" to future sustainability. Data was synthesized and presented to stakeholders for barrier mitigation. A schematic flow chart outlining steps to support sustainability was created.
RESULTS
Eighteen interviews were conducted with key community partners across eight Illinois school districts, representing rural, urban, and suburban areas. Analysis revealed 25 barriers, with several identified as "threats" to future sustainability, including liability concerns, follow-up care assurance, funding/resources, pharmacy dispensing practices, district-level readiness to change, and nurse staffing. Stakeholders formed a statewide coalition to address these barriers, increase awareness, plan evaluations, and advise on state funding allocation. A national stock inhaler toolkit tailored to school administrative needs was developed to support sustainability efforts.
CONCLUSION
Strategic stakeholder and community engagement are vital for establishing and sustaining stock inhaler programs that adhere to policy mandates. Many districts face challenges initiating and maintaining such programs without critical barrier mitigation and support. Collaborative solutions are necessary to ensure effective school-based asthma management and mitigate persistent pediatric asthma health disparities.
PubMed: 38942380
DOI: 10.1016/j.anai.2024.06.023 -
Clinics in Dermatology Jun 2024Frontal fibrosing alopecia (FFA) is characterized by a receding hairline in the frontotemporal region due to the gradual loss of hair follicles and then follicular stem...
Frontal fibrosing alopecia (FFA) is characterized by a receding hairline in the frontotemporal region due to the gradual loss of hair follicles and then follicular stem cells and follicular fibrosis. Follicular stem cells are crucial in skin healing after chemical peeling and other resurfacing procedures. Although there is a possible association of FFA with a history of facial and scalp surgical procedures, there is no information on the safety of cosmetic procedures in patients with FFA. We report five patients with FFA who experienced unusual and complicated outcomes after undergoing a deep chemical peel (phenol and croton oil). As the prevalence of FFA continues to increase globally, it is essential to raise awareness about the potential incompatibility of this dermatologic disorder with specific cosmetic procedures, such as deeper peels and other resurfacing modalities.
PubMed: 38942154
DOI: 10.1016/j.clindermatol.2024.06.024 -
Physics in Medicine and Biology Jun 2024Reducing the radiation dose leads to the X-ray computed tomography (CT) images suffering from heavy noise and artifacts, which inevitably interferes with the subsequent...
Reducing the radiation dose leads to the X-ray computed tomography (CT) images suffering from heavy noise and artifacts, which inevitably interferes with the subsequent clinic diagnostic and analysis. Leading works have explored diffusion models for low-dose CT imaging to avoid the structure degeneration and blurring effects of previous deep denoising models. However, most of them always begin their generative processes with Gaussian noise, which has little or no structure priors of the clean data distribution, thereby leading to long-time inference and unpleasant reconstruction quality. To alleviate these problems, this paper presents a Structure-Aware Diffusion model (SAD), an end-to-end self-guided learning framework for high-fidelity CT image reconstruction. First, SAD builds a nonlinear diffusion bridge between clean and degraded data distributions, which could directly learn the implicit physical degradation prior from observed measurements. Second, SAD integrates the prompt learning mechanism and implicit neural representation into the diffusion process, where rich and diverse structure representations extracted by degraded inputs are exploited as prompts, which provides global and local structure priors, to guide CT image reconstruction. Finally, we devise an efficient self-guided diffusion architecture using an iterative updated strategy, which further refines structural prompts during each generative step to drive finer image reconstruction. Extensive experiments on AAPM-Mayo and LoDoPaB-CT datasets demonstrate that our SAD could achieve superior performance in terms of noise removal, structure preservation, and blind-dose generalization, with few generative steps, even one step only.
PubMed: 38942004
DOI: 10.1088/1361-6560/ad5d47 -
British Journal of Hospital Medicine... Jun 2024Systemic lupus erythematosus (SLE) is a complex autoimmune disease where the body loses tolerance to its own antigens, particularly nuclear antigens. Abnormal responses...
Systemic lupus erythematosus (SLE) is a complex autoimmune disease where the body loses tolerance to its own antigens, particularly nuclear antigens. Abnormal responses from T and B cells lead to the production of autoantibodies and the formation of immune complexes in tissues, triggering complement activation, inflammation, and irreversible organ damage. SLE can affect any part of the body, resulting in diverse clinical symptoms. One rare manifestation of SLE is lupus mesenteric vasculitis (LMV), which presents with vague symptoms, abnormal laboratory findings, and specific imaging features. LMV, although uncommon, can progress to severe complications such as bowel perforation, haemorrhage, and even mortality. Here, we report a case of LMV with the involvement of multiple organ systems (including mucocutaneous, musculoskeletal, serosal cavities, and haematological systems), presenting initially with life-threatening intractable gastrointestinal bleeding, and complicated by severe pulmonary infection. By sharing this case, we aim to enhance clinicians' confidence in managing critical SLE cases and raise awareness about disease surveillance.
Topics: Humans; Gastrointestinal Hemorrhage; Lupus Erythematosus, Systemic; Vasculitis; Female; Mesentery; Tomography, X-Ray Computed; Adult
PubMed: 38941968
DOI: 10.12968/hmed.2024.0108 -
Acta Psychologica Jun 2024Cancel culture is a prevalent boycotting practice used to exert pressure, express disapproval, and enforce consequences online. While multiple studies have been done on...
Cancel culture is a prevalent boycotting practice used to exert pressure, express disapproval, and enforce consequences online. While multiple studies have been done on cancel culture's history, evolution, and effects, none of them were focused on Cancel Culture for Gen Z, the most socially aware and digitally inclined generation. The study aimed to uncover the factors that influence Gen Z's intention to participate and actual participation in cancel culture by utilizing a newly established integrated framework of Belief in a Just World (BJW) and the Theory of Planned Behavior (TPB). A total of 677 valid survey responses from Gen Z respondents were collected to thoroughly evaluate the belief and behavioral dimensions of cancel culture through the utilization of Structural Equation Modeling (SEM). The study's results showed that attitude towards cancel culture, the subjective norm of cancel culture, and perceived behavioral control, are strong facilitating conditions that drive Gen Z's intent and actual participation in canceling behavior. It was seen that BJW has no effect on actual canceling behavior and a reverse effect on the intention to participate in canceling behavior. For the canceling methods, 97 % will unsubscribe or unfollow accounts and 94.68 % will block or mute accounts. It was also discovered that Facebook, Instagram, and YouTube are the top social media platforms used by Gen Zs in the Philippines with at least a 94 % usage rate. The findings of this study may be utilized by businesses and policymakers on how to reduce the incidence and impact of cancel culture.
PubMed: 38941914
DOI: 10.1016/j.actpsy.2024.104378