The Many Faces of Pediatric Acne: How to Tailor Nonprescription Acne Treatment and Skincare Using Cleansers and Moisturizers.

BACKGROUND: Acne vulgaris (acne) is a common, complex, multifactorial disorder. Various expressions of acne in childhood can be categorized by age, severity, and pubertal status. OBJECTIVE: To improve pediatric acne patients’ outcomes, various expressions of pediatric acne to educate and tailor nonprescription acne treatment and skincare using cleansers and moisturizers were defined and discussed. METHODS: An expert panel of pediatric dermatologists and dermatologists reviewed and discussed nonprescription acne treatment and skincare literature. The results from the literature searches were used together with the panel’s expert opinion and experience to adopt various expressions of pediatric acne and prevention, treatment, and maintenance of the condition using nonprescription acne treatment and skincare. RESULTS: The panel agreed on sixteen acne patient profiles addressing various age categories of pediatric acne: neonatal acne: birth to ≤ 8 weeks; infantile acne: 8 weeks to ≤1 year; mid-childhood acne: 1 year to <7 years; preadolescent acne: ≥7 to 12 years; adolescent acne: ≥12 to 19 years or after menarche for girls. Nonprescription acne treatment and skincare products containing lipids such as ceramides play an important role in monotherapy, adjunctive, and maintenance treatment; however, their role in pediatric acne is not well defined and requires more studies. CONCLUSION: Pediatric acne deserves more attention from healthcare providers treating children regarding differential diagnosis, treatment, and maintenance using nonprescription acne treatment and skincare. J Drugs Dermatol. 2022;21(6):602-612. doi:10.36849/JDD.6872.

Do Antimicrobial Resistance Patterns Matter? An Algorithm for the Treatment of Patients With Impetigo.

BACKGROUND: Impetigo, a highly contagious bacterial skin infection commonly occurring in young children, but adults may also be affected. The superficial skin infection is mainly caused by Staphylococcus aureus (S. aureus) and less frequently by Streptococcus pyogenes (S. pyogenes). Antimicrobial resistance has become a worldwide concern and needs to be addressed when selecting treatment for impetigo patients. An evidence-based impetigo treatment algorithm was developed to address the treatment of impetigo for pediatric and adult populations. METHODS: An international panel of pediatric dermatologists, dermatologists, pediatricians, and pediatric infectious disease specialists employed a modified Delphi technique to develop the impetigo treatment algorithm. Treatment recommendations were evidence-based, taking into account antimicrobial stewardship and the increasing resistance to oral and topical antibiotics. RESULTS: The algorithm includes education and prevention of impetigo, diagnosis and classification, treatment measures, and follow-up and distinguishes between localized and widespread or epidemic outbreaks of impetigo. The panel adopted the definition of localized impetigo of fewer than ten lesions and smaller than 36 cm2 area affected in patients of two months and up with no compromised immune status. Resistance to oral and topical antibiotics prescribed for the treatment of impetigo such as mupirocin, retapamulin, fusidic acid, have been widely reported. CONCLUSIONS: When prescribing antibiotics, it is essential to know the local trends in antibiotic resistance. Ozenoxacin cream 1% is highly effective against S. pyogenes and S. aureus, including methycyllin-susceptible and resistant strains (MRSA), and may be a suitable option for localized impetigo.J Drugs Dermatol. 2021;20(2):134-142. doi:10.36849/JDD.5475 THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

The surface climatology of the Ross Ice Shelf Antarctica.

The University of Wisconsin-Madison Antarctic Automatic Weather Station (AWS) project has been making meteorological surface observations on the Ross Ice Shelf (RIS) for approximately 30 years. This network offers the most continuous set of routine measurements of surface meteorological variables in this region. The Ross Island area is excluded from this study. The surface climate of the RIS is described using the AWS measurements. Temperature, pressure, and wind data are analysed on daily, monthly, seasonal, and annual time periods for 13 AWS across the RIS. The AWS are separated into three representative regions - central, coastal, and the area along the Transantarctic Mountains - in order to describe specific characteristics of sections of the RIS. The climatology describes general characteristics of the region and significant changes over time. The central AWS experiences the coldest mean temperature, and the lowest resultant wind speed. These AWSs also experience the coldest potential temperatures with a minimum of 209.3 K at Gill AWS. The AWS along the Transantarctic Mountains experiences the warmest mean temperature, the highest mean sea-level pressure, and the highest mean resultant wind speed. Finally, the coastal AWS experiences the lowest mean pressure. Climate indices (MEI, SAM, and SAO) are compared to temperature and pressure data of four of the AWS with the longest observation periods, and significant correlation is found for most AWS in sea-level pressure and temperature. This climatology study highlights characteristics that influence the climate of the RIS, and the challenges of maintaining a long-term Antarctic AWS network. Results from this effort are essential for the broader Antarctic meteorology community for future research.

Public Health Nursing Activities: Visible or Invisible?

OBJECTIVE: To promote visibility of public health nurses (PHNs), this study identified public health nursing activities and explored PHN perceptions of the impact of their activities on the health of the communities they serve. DESIGN AND SAMPLE: Two surveys with questions focusing on PHN activities were made available electronically. Following the initial survey, the second survey had more detailed questions about PHN activities, including time spent and frequency of activities as well as open-ended questions. Sixty staff level PHNs, representing 29 states, completed the first survey; 49 completed the second survey. MEASURES: Demographic variables and PHN activities were analyzed by population, setting, program, intervention, essential services, and prevention level using descriptive statistics. Themes or categories were determined through a content analysis of responses to three open-ended questions. RESULTS: PHNs reported a wide variety of activities that included: (1) individual/family, community, and systems intervention levels, (2) primary, secondary, and tertiary prevention, and (3) all 10 Public Health Essential Services. PHNs perceived they perform work that is essential for community health. CONCLUSION: PHNs do work that is both visible and invisible. PHNs need to be proactive in promoting all their work to increase the visibility of their contributions to population health.

Cornerstones of public health nursing.

The "Cornerstones of Public Health Nursing" describe the values and beliefs that underlie the practice of Public Health Nursing, which is a synthesis of public health and nursing. The impetus for the development of the Cornerstone framework originated from the need to advocate for public health nursing programs, positions, and funding. Grounded in practice, their development engaged stakeholders from the public health nursing community at every phase. The Cornerstone framework has been used over the past decade by educators to teach public health nursing and by administrators in state and local health departments for orientation and continuing education. The Cornerstones have been nationally and internationally disseminated. This paper describes the development and dissemination of the Cornerstones framework by public health nurses in Minnesota and features exemplars from practice.

Finding common ground in public health nursing education and practice.

Preparation of the public health nursing (PHN) workforce requires public health nurses from academia and practice to collaborate. However, a shortage of PHN clinical sites may lead to competition between schools of nursing for student placements. The Henry Street Consortium, a group of 5 baccalaureate schools of nursing and 13 local health departments in the state of Minnesota, developed a model for collaboration between PHN education and practice. This paper describes the development process--the forming, storming, norming, and performing stages--experienced by the Henry Street Consortium members. The consortium developed a set of entry-level core PHN competencies that are utilized by both education and practice. It developed menus of learning opportunities that were used to design population-based PHN clinical experiences. In addition, the consortium created a model for training and sustaining a preceptor network. The members of the Henry Street Consortium collaborated rather than competed, used consensus for decision making, and respected and accepted different points of view. This collaboration significantly impacted how schools of nursing and local health departments work together. The consortium's ability to retain its relevance, energy, and momentum for both academic and agency partners sustains the collaboration.

The Henry street consortium population-based competencies for educating public health nursing students.

The Henry Street Consortium, a collaboration of nurse educators from universities and colleges and public health nurses (PHNs) from government, school, and community agencies, developed 11 population-based competencies for educating nursing students and the novice PHN. Although many organizations have developed competency lists for experts, the Consortium developed a set of competencies that clearly define expectations for the beginning PHN. The competencies are utilized by both education and practice. They guide nurse educators and PHNs in the creation of learning experiences that develop population-based knowledge and skills for baccalaureate nursing students. Public health nursing leaders use the competencies to frame their expectations and orientations for nurses who are new to public health nursing. This paper explains the meaning of each of the 11 population-based competencies and provides examples of student projects that demonstrate competency development. Strategies are suggested for nurse educators and PHNs to promote effective population-based student projects in public health agencies.

VE-PTP controls blood vessel development by balancing Tie-2 activity.

Vascular endothelial protein tyrosine phosphatase (VE-PTP) is an endothelial-specific receptor-type tyrosine phosphatase that associates with Tie-2 and VE-cadherin. VE-PTP gene disruption leads to embryonic lethality, vascular remodeling defects, and enlargement of vascular structures in extraembryonic tissues. We show here that antibodies against the extracellular part of VE-PTP mimic the effects of VE-PTP gene disruption exemplified by vessel enlargement in allantois explants. These effects require the presence of the angiopoietin receptor Tie-2. Analyzing the mechanism we found that anti-VE-PTP antibodies trigger endocytosis and selectively affect Tie-2-associated, but not VE-cadherin-associated VE-PTP. Dissociation of VE-PTP triggers the activation of Tie-2, leading to enhanced endothelial cell proliferation and enlargement of vascular structures through activation of Erk1/2. Importantly, the antibody effect on vessel enlargement is also observed in newborn mice. We conclude that VE-PTP is required to balance Tie-2 activity and endothelial cell proliferation, thereby controlling blood vessel development and vessel size.

Consumer health informatics: from genomics to population health.

Innovations in health information technology have ushered in a new era of health care. The use of emerging information and communication technology to improve or enable health and health care is the central focus of consumer health informatics (CHI). Traditionally, CHI interventions to promote health and well-being have targeted the individual or family. Advances in genomic health and the emergence of public health informatics call for broadening the scope of CHI. The authors discuss CHI from the point-of-view of the consumer (e.g., from individuals to policy makers) and the level of health data from the subcellular (e.g., genetic or protein structures) to population (e.g., geographically-referenced information).

Development of the public health nursing competency instrument.

This paper describes the development and initial testing of an instrument to measure population-based public health nursing competencies. Although multiple lists of public health competencies exist, literature review did not elicit a valid instrument that could measure changes in public health nursing competency over time. The public health nursing competency instrument, consisting of 195 measurable activities organized in the framework of the nursing process, was developed. Competency scores of practicing public health nurses significantly increased after a continuing education series, and the instrument was confirmed by experts to be a valid reflection of public health nursing practice. The time required for instrument development exceeded expectations because of the multiple stages of delineating competencies and validating data with national experts.

Vascular endothelial cell-specific phosphotyrosine phosphatase (VE-PTP) activity is required for blood vessel development.

VE-PTP, a receptor-type phosphotyrosine phosphatase, associates with the tyrosine kinase receptor Tie-2 and VE-cadherin and enhances the adhesive function of the latter. Here, VE-PTP was found to be restricted to endothelial cells, with a preference for arterial endothelium. Mutant mice expressing a truncated, secreted form of VE-PTP lacking the cytoplasmic and transmembrane domains and the most membrane-proximal extracellular fibronectin type III repeat, showed severe vascular malformations causing lethality at 10 days of gestation. Although blood vessels were initially formed, the intraembryonic vascular system soon deteriorated. Blood vessels in the yolk sac developed into dramatically enlarged cavities. In explant cultures of mutant allantoides, endothelial cells were found next to vessel structures growing as cell layers. No signs for enhanced endothelial apoptosis or proliferation were observed. Thus, the activity of VE-PTP is not required for the initial formation of blood vessels, yet it is essential for their maintenance and remodeling.

Population-based public health interventions: practice-based and evidence-supported. Part I.

The Intervention Wheel is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. The Intervention Wheel, previously known as the Public Health Intervention Model, was originally introduced in 1998 by the Minnesota Department of Health, Section of Public Health Nursing. The model has been widely disseminated and used throughout the United States since that time. The evidence supporting the Intervention Wheel was recently subjected to a rigorous critique by regional and national experts. This critical process, which involved hundreds of public health nurses, resulted in a more robust Intervention Wheel and established the validity of the model. The critique also produced basic steps and best practices for each of the 17 interventions. Part I describes the Intervention Wheel, defines population-based practice, and details the recommended modifications and validation process. Part II provides examples of the innovative ways that the Intervention Wheel is being used in public health/public health nursing practice, education, and administration. The two articles provide a foundation and vision for population-based public health nursing practice and direction for improving population health.

Population-based public health interventions: innovations in practice, teaching, and management. Part II.

The Intervention Wheel is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. The Intervention Wheel, previously known as the Public Health Intervention Model, was originally introduced in 1998 by the Minnesota Department of Health, Section of Public Health Nursing (PHN). The model has been widely disseminated and used throughout the United States since that time. The evidence supporting the Intervention Wheel was recently subjected to a rigorous critique by regional and national experts. This critical process, which involved hundreds of public health nurses, resulted in a more robust Intervention Wheel and established the validity of the model. The critique also produced basic steps and best practices for each of the 17 interventions. Part I describes the Intervention Wheel, defines population-based practice, and details the recommended modifications and validation process. Part II provides examples of the innovative ways that the Intervention Wheel is being used in public health/PHN practice, education, and administration. The two articles provide a foundation and vision for population-based PHN practice and direction for improving population health.

Search for Lawsonia intracellularis and Bilophila wadsworthia in malabsorption-diseased chickens.

Proliferative enteropathy is an important enteric disease caused by Lawsonia intracellularis. A wide range of host species can be infected by the same bacterium, yet the clinico-pathologic features among these hosts remains almost identical. The disease has been recognized regularly among ratites, but not in other avian families, such as galliforms, even though these suffer uncharacterized enteric conditions. Fresh ileum-colon contents were obtained from 228, 3- to 8-week-old chickens with enteric disease, kept at 14 large commercial farms in the southern USA. DNA was extracted from each sample and subjected to polymerase chain reactions (PCR) with primers specific to eubacterial DNA, L. intracellularis, and Bilophila wadsworthia. All chicken samples were positive for eubacterial DNA, 29 chickens (13%) were positive for B. wadsworthia DNA, and none were positive for L. intracellularis DNA. Given the ubiquitous nature of L. intracellularis, we consider it likely that some avian families do not carry the necessary mechanism for L. intracellularis viability. Bilophila wadsworthia appears to be a consistent member of the colonic flora of some host animals. Neither bacterium appears to be associated with malabsorption syndromes in chickens.

A population-based approach to pediculosis management.

Pediculosis is a population-based problem that is a priority concern for many communities. Public health nurses in a county health department collaborated with epidemiologists, nursing students, and faculty to design and implement an effective population-based pediculosis management project. The focus of the project was the development of pediculosis treatment and prevention guidelines based on recognized best practices that were acceptable to both epidemiologists and practicing public health nurses. Public health nurses disseminated these guidelines to community providers and reinforced their use through consultation and educational sessions. Two critical changes occurred as a result of the project. First, community providers significantly changed their recommendations for the treatment of pediculosis after nursing intervention. Second, public health nurses increased their population-based practice skills, continued to use those skills to address pediculosis, and extended those skills to additional population-based initiatives.

Assessment, program planning, and evaluation in population-based public health practice.

Public health practitioners in Minnesota developed and implemented a population-based public health practice model for community assessment, program planning, and evaluation. The ultimate goal of this process is improvement in population health. Major challenges to the implementation of a population-based model are addressed through the use of a theory of action; interventions at community, systems, and individual levels; and intermediate evaluation indicators. Examples of resulting changes in public health practice are described.