Topical steroid withdrawal syndrome in a mother and son: A case report.

Topical corticosteroids are first-line treatment for many dermatoses, and are generally considered safe and effective. However, topical steroid withdrawal syndrome can result from use of topical corticosteroids, and this condition is not well-known among physicians. This article reports a mother and son whose presentations of topical steroid withdrawal syndrome following the discontinuation of prolonged, high-potency topical corticosteroid use were nearly identical. This report adds to the growing body of evidence that topical steroid withdrawal syndrome is its own entity, rather than an exacerbation of the underlying dermatosis, and adds to the few pediatric reports of topical steroid withdrawal syndrome. Management for both patients involved topical corticosteroid discontinuation; however, it took approximately 2 years before the majority of their topical steroid withdrawal syndrome manifestations resolved. Increased awareness surrounding this condition is essential to facilitate topical steroid withdrawal syndrome prevention and diagnosis and to decrease topical corticosteroid phobia and increase patient-physician trust.

Occupational photoallergic contact dermatitis to thiourea in a firefighter.

Thioureas are a relatively uncommon cause of allergic contact dermatitis and a rare cause of photoallergic contact dermatitis. They are primarily used as vulcanization accelerators in the production of neoprene, and common sources of exposure include gloves, shoe insoles, wet suits, and orthopedic braces. We report a multifactorial case of severe episodic photoallergic contact dermatitis to thiourea in a 29-year-old firefighter. Multiple sources of neoprene exposure were identified, including a firefighting mask, continuous positive airway pressure strap, and hockey helmet.

Evaluating Birth Outcomes From a Community-Based Pregnancy Support Program for Refugee Women in Georgia.

Refugee women face numerous and unique barriers to sexual and reproductive healthcare and can experience worse pregnancy-related outcomes compared with U.S.-born and other immigrant women. Community-based, culturally tailored programs like Embrace Refugee Birth Support may improve refugee access to healthcare and health outcomes, but empirical study is needed to evaluate programmatic benefits. This community-engaged research study is led by the Georgia Doula Access Working Group, including a partnership between academic researchers, Emory Decatur Hospital nurses, and Embrace. We analyzed hospital clinical records (N = 9,136) from 2016 to 2018 to assess pregnancy-related outcomes of Embrace participants (n = 113) and a comparison group of women from the same community and racial/ethnic backgrounds (n = 9,023). We controlled for race, language, maternal age, parity, insurance status, preeclampsia, and diabetes. Embrace participation was significantly associated with 48% lower odds of labor induction (OR = 0.52, p = 0.025) and 65% higher odds of exclusive breastfeeding intentions (OR = 1.65, p = 0.028). Embrace showed positive but non-significant trends for reduced cesarean delivery (OR = 0.83, p = 0.411), higher full-term gestational age (OR = 1.49, p = 0.329), and reduced low birthweight (OR = 0.77, p = 0.55). We conclude that community-based, culturally tailored pregnancy support programs like Embrace can meet the complex needs of refugee women. Additionally, community-engaged, cross-sector research approaches could ensure the inclusion of both community and clinical perspectives in research design, implementation, and dissemination.

Pharmacologic Treatment of Idiopathic Chilblains (Pernio): A Systematic Review.

Idiopathic chilblains is a cold-induced inflammatory condition that causes significant morbidity. When preventative measures alone are inadequate, oral nifedipine is generally recommended as first-line pharmacologic therapy. Given the natural course of this spontaneously remitting/relapsing condition, controls are needed to critically appraise studies and determine the value of treatments. We report a systematic review of placebo-controlled or comparative therapeutic trials for the treatment of idiopathic chilblains. Our search of PubMed, Embase, and Cochrane databases, identified 11 studies that met our inclusion criteria for a combined study population n = 576. Therapies included nifedipine, pentoxifylline, tadalafil, topical glyceryl trinitrate (GTN), topical minoxidil, diltiazem, corticosteroids, and vitamin D. There was moderate evidence to support the use of nifedipine and pentoxifylline in the treatment of severe or refractory cases of idiopathic chilblains, while other therapies had inadequate evidence or nonsignificant results compared to placebo.

Using Visual Aids to Enhance Physician-Patient Discussions and Increase Health Literacy.

Health literacy refers to the comprehension required to make well-informed decisions regarding one's health. It is a critical component in helping patients to understand how to take their medications appropriately. However, many patients do not possess the comprehension necessary for medication adherence. The result of poor literacy is a higher incidence of misunderstanding medication instructions. Visual aids have the ability to transcend language and numeracy barriers and can therefore improve the effectiveness of communication and broaden target audiences. To enhance communication that is language independent, a template was created to provide instructions for proper use and explanation of risks for adverse events. This template is designed to fit on a single double-sided page. This template can be adapted for use in explaining any medication using universal pictograms available from online resources. This would enable any practitioner to design information sheets for their unique use.

Examining the cognitive profile of children with Developmental Coordination Disorder.

BACKGROUND: While primarily a motor disorder, research considering the cognitive abilities in children with Developmental Coordination Disorder (DCD) is limited; even though these children often struggle academically. AIMS: The present study aimed to characterise the IQ profile of children with and without DCD, and to identify whether children with DCD exhibit specific cognitive weaknesses. METHODS AND PROCEDURES: 104 children participated in the study. Fifty-two children (mean age, 9 years) with a diagnosis of DCD were matched to 52 typically-developing children by age and gender. Cognitive ability was assessed using the Wechsler Intelligence Scale for Children (WISC-IV). OUTCOMES AND RESULTS: Children with DCD performed poorer than their peers on processing speed and working memory measures. Individual analyses revealed varied performance in the DCD group across all cognitive indices, despite displaying Full-Scale IQs in the typical range. Discriminant function analyses show processing speed and working memory performance predicted only 23% of between-group variability. CONCLUSIONS: Children with DCD present with a heterogeneous cognitive profile, lending support to individual case analyses in research and when designing educational assistance plans. The motorically-demanding nature of the WISC-IV processing speed tasks raises specific concerns about using this index of the IQ assessment in this population. Research and practical implications are raised.

Arsenic Keratosis in a Patient from Newfoundland and Labrador, Canada: Case Report and Review.

BACKGROUND AND OBJECTIVE: Millions of people worldwide suffer from chronic arsenic poisoning due to contaminated drinking water. The devastating effects of chronic arsenic ingestion are multisystem, but depending on the dose and frequency of exposure, may take many years to become clinically apparent. The earliest and most common manifestations are dermatological, and therefore, recognition of hallmark lesions is key. In this report, we describe a suspected case of palmoplantar arsenical keratosis in a patient from Newfoundland, Canada. METHODS: Case report and review of relevant literature via PubMed search. RESULTS: A 64-year-old fisherman from rural Newfoundland presented with a 12-year history of hyperkeratotic palmoplantar papules/plaques. The lesions first appeared on the sole of his left foot but gradually extended to involve the sole of his right foot and palms. Numerous violaceous keratotic papules with erosions were observed. Both the patient and his wife were found to have elevated blood arsenic levels, and the arsenic concentration in their artesian well was 14.2 ug/L (maximum acceptable concentration: 10 ug/L). Interestingly, biopsy showed a lichen-sclerosis-like inflammatory pattern that seems to deviate from the classic histologic description. The patient is being treated with oral acitretin, and minor improvement has been noted. CONCLUSION: It is important to consider arsenic exposure whenever a patient presents with acral hyperkeratosis. Further research is needed to develop more effective treatments for chronic arsenicism and to determine the effects of very low-dose exposure and what truly constitutes a safe level.

Magnesium amino-bis(phenolato) complexes for the ring-opening polymerization of rac-lactide.

Magnesium compounds of tetradentate amino-bis(phenolato) ligands, Mg[L1] (1) and Mg[L2] (2) (where [L1] = 2-pyridyl-N,N-bis(2-methylene-4-methoxy-6-tert-butylphenolato), and [L2] = dimethylaminoethylamino-N,N-bis(2-methylene-4-methyl-6-tert-butylphenolato)) were prepared. The proligands, H2[L1] and H2[L2] were reacted with di(n-butyl)magnesium in toluene to give the desired compounds in high yields. Compounds 1 and 2 exhibit dimeric structures in solutions of non-coordinating solvents as observed by NMR spectroscopy and in the solid state as shown by the single crystal X-ray structure of 2. These compounds exhibit good activity for rac-lactide polymerization in solution and in molten lactide.

The effect of motor load on planning and inhibition in developmental coordination disorder.

Previous research has reported mixed findings regarding executive function (EF) abilities in developmental coordination disorder (DCD), which is diagnosed on the basis of significant impairments in motor skills. The current study aimed to assess whether these differences in study outcomes could result from the relative motor loads of the tasks used to assess EF in DCD. Children with DCD had significant difficulties on measures of inhibition and planning compared to a control group, although there were no significant correlations between motor skills and EF task performance in either group. The complexity of the response, as well as the component skills required in EF tasks, should be considered in future research to ensure easier comparison across studies and a better understanding of EF in DCD over development.

Bodily illusions in young children: developmental change in visual and proprioceptive contributions to perceived hand position.

We examined the visual capture of perceived hand position in forty-five 5- to 7-year-olds and in fifteen young adults, using a mirror illusion task. In this task, participants see their left hand on both the left and right (by virtue of a mirror placed at the midline facing the left arm, and obscuring the right). The accuracy of participants' reaching was measured when proprioceptive and visual cues to the location of the right arm were put into conflict (by placing the arms at different distances from the mirror), and also when only proprioceptive information was available (i.e., when the mirror was covered). Children in all age-groups (and adults) made reaching errors in the mirror condition in accordance with the visually-specified illusory starting position of their hand indicating a visual capture of perceived hand position. Data analysis indicated that visual capture increased substantially up until 6 years of age. These findings are interpreted with respect to the development of the visual guidance of action in early childhood.

At-home environment, out-of-home environment, snacks and sweetened beverages intake in preadolescence, early and mid-adolescence: the interplay between environment and self-regulation.

Obesity-related behaviors, such as intake of snacks and sweetened beverages (SSB), are assumed to result from the interplay between environmental factors and adolescents' ability to self-regulate their eating behaviors. The empirical evidence supporting this assumption is missing. This study investigated the relationships between perceptions of at-home and out-of-home food environment (including SSB accessibility, parental, and peers' social pressure to reduce intake of SSB), nutrition self-regulatory strategies (controlling temptations and suppression), and SSB intake. In particular, we hypothesized that these associations would differ across the stages of preadolescence, early and mid-adolescence. Self-reported data were collected from 2,764 adolescents (10-17 years old; 49 % girls) from 24 schools in the Netherlands, Poland, Portugal, and the United Kingdom. Path analysis indicated that direct associations between peers' social influence and SSB intake increased with age. Direct negative associations between at-home and out-of-home accessibility and SSB intake as well as direct positive associations between parental pressure and intake become significantly weaker with age. Accessibility was related negatively to self-regulation, whereas higher social pressure was associated with higher self-regulation. The effects of the environmental factors were mediated by self-regulation. Quantitative and qualitative differences in self-regulation were observed across the stages of adolescence. The associations between the use of self-regulatory strategies and lower SSB intake become significantly stronger with age. In preadolescence, SSB intake was regulated by means of strategies that aimed at direct actions toward tempting food. In contrast, early and mid-adolescents controlled their SSB intake by means of a combination of self-regulatory strategies focusing on direct actions toward tempting food and strategies focusing on changing the psychological meaning of tempting food.

Access to excess: how do adolescents deal with unhealthy foods in their environment?

PURPOSE: Easy access to unhealthy foods is believed to contribute to the current overweight epidemic. It remains unclear, however, how access to unhealthy foods is related to self-regulation of food intake. This study tests the hypothesis that using self-regulation strategies buffers the negative influences of easy access to unhealthy foods. METHODS: Cross-sectional survey data from 2764 adolescents aged 10-17 years from four European countries (The Netherlands, UK, Poland and Portugal) about use of self-regulation strategies, access to unhealthy foods and intake of unhealthy foods (sweet and salty snacks and sugar-sweetened beverages) were used. RESULTS: Both access to unhealthy foods and use of self-regulation strategies were independently, but in opposing directions, related to intake of unhealthy foods. Easy access to unhealthy food products was associated with higher consumption, but this effect could be attenuated by use of self-regulation strategies to facilitate healthy eating even when the food environment tempts one to do otherwise. CONCLUSIONS: Health promotion policy and programs should not only address the food environment but could also teach young people better strategies to deal with it.

Anxiety profiles in children with and without developmental coordination disorder.

Previous work has highlighted that children diagnosed with DCD may be at risk of greater problems related to emotional wellbeing. However, to date much work has relied on population based samples, and anxiety has not been examined within a group of children given a clinical diagnosis of DCD. Additionally, the profile of individual differences has generally not been considered within this group. Therefore, a group of parents (n=27) completed the parent version of the Spence Children's Anxiety Scale (SCAS-P; Spence, 1998) in relation to their children with a diagnosis of DCD. Their responses on this measure were compared to those of parents with typically developing (TD) children (n=35; both groups 6-15 years of age). Children diagnosed with DCD were reported to experience significantly greater levels of anxiety overall, as well as having significantly greater difficulty than the TD group in the domains of panic/agoraphobic anxiety, social phobia, and obsessive compulsive anxiety. In addition, the individual profiles of types of anxiety reportedly experienced varied widely across the DCD group. These findings suggest that anxiety is a major problem for a proportion of children diagnosed with DCD, and raises questions regarding intervention, long term outcomes, and the nature of the disorder itself.