Isolated eyelid neonatal Langerhans cell histiocytosis.

Langerhans cell histiocytosis (LCH) is a condition characterized by clonal proliferation of the phagocytic cells derived from the bone marrow. In this article, we present an exceedingly rare case of congenital/neonatal LCH in a 3-week-old girl who initially presented with an isolated swelling of the eyelid, initially misdiagnosed as a chalazion. Subsequently, a biopsy was performed, and histopathological evaluation confirmed the diagnosis of LCH. A staging work-up revealed no evidence of multisystem involvement, and thus, local steroid injection was performed as the initial treatment for the residual lesion. Cases of localized LCH that manifest as eyelid masses are rare, and most reported cases involve children over the age of one year. To the best of our knowledge, this case represents the first reported instance of neonatal LCH presenting as an eyelid mass. Although neonatal LCH is rare, ophthalmologists must be aware of this presentation and include it in the differential diagnosis for eyelid lesions in infants during the first month of life.

Health-Related Social Control and Perceived Stress Among High-Risk Latina Mothers with Type 2 Diabetes and Their At-Risk Adult Daughters.

BACKGROUND: Diabetes-related multi-morbidity and cultural factors place Latinas with diabetes at increased risk for stress, which can threaten illness management. Families provide an ideal focus for interventions that seek to strengthen interpersonal resources for illness management and, in the process, to reduce stress. The current study sought to examine whether participating in a dyadic intervention was associated with reduced perceived stress and, furthermore, whether this association was mediated by persuasion and pressure, two forms of health-related social control. METHOD: Latina mothers with diabetes and their at-risk adult daughters participated in either (1) a dyadic intervention that encouraged constructive collaboration to improve health behaviors and reduce stress, or (2) a usual-care minimal control condition. Actor-partner interdependence model analysis was used to estimate the effect of the intervention on dyads' perceived stress, and mother-daughter ratings of health-related social control as potential mediators. RESULTS: Results revealed that participating in the intervention was associated with significantly reduced perceived stress for daughters, but not for mothers (ß = - 3.00, p = 0.02; ß = - 0.57, p = 0.67, respectively). Analyses also indicated that the association between the intervention and perceived stress was mediated by persuasion, such that mothers' who experienced more health-related persuasion exhibited significantly less post-intervention perceived stress (indirect effect = - 1.52, 95% CI = [- 3.12, - 0.39]). Pressure exerted by others, however, did not evidence a mediating mechanism for either mothers or daughters. CONCLUSION: These findings buttress existing research suggesting that persuasion, or others' attempts to increase participants' healthy behaviors in an uncritical way, may be a driving force in reducing perceived stress levels.

The prevalence of asthma risk and contributing factors in underserved Vietnamese children in Orange County, CA.

OBJECTIVES: Vietnamese constitutes one of the fastest growing minority groups in America, with the largest concentration in Orange County (OC), CA. Yet, there are limited data on the prevalence of asthma in Vietnamese children. Our study evaluated the risk of asthma and key contributing factors among these children living in OC, CA. METHOD: Five elementary schools in OC that were predominantly Vietnamese with low socioeconomic status were selected for participation. Validated surveys were sent to parents of all students ages 3-12 in these schools with materials available in English, Vietnamese and Spanish. Surveys included questions to identify the risk of asthma and related key factors. Surveys were completed by parents and returned to schools. RESULTS: There were 1530 participants eligible for analysis. Asthma risk was 30.4%, and of these, 22.6% had no prior diagnosis. Contributing factors to identification of those at risk were male gender (p < 0.001), preferred use of the Vietnamese language (p = 0.004), longer duration in the United States (p = 0.019), and smoker in the household (p = 0.015). CONCLUSIONS: The prevalence of asthma risk in our community of low socioeconomic status Vietnamese children was found to be higher than commonly appreciated. Furthermore, a considerable number of these children had not been previously diagnosed. Given the limited information in this population, our current findings of asthma risk and key contributing factors could affect health care policies that allow appropriate funding for programs dedicated to asthma care in this and other growing population.

Multimodal imaging of an RPGR carrier female.

Background: Retinitis pigmentosa GTPase regulator (RPGR) gene mutations are a common cause of X-linked retinitis pigmentosa and X-linked cone-rod dystrophy. There have been no previous reports of association with crystalline retinopathy or pseudo-crystalline retinopathy.Materials and Methods: We describe the history, clinical findings, retinal imaging, and electrodiagnostic studies of a patient with a tapetal-like reflex (TLR) and pseudo-crystalline retinopathy secondary to RPGR mutation.Case Description: Asymptomatic TLR secondary to RPGR mutation was diagnosed in a 14-year-old African American female with a family history of retinal dystrophy and no other past ophthalmic or medical history. Pseudo-crystalline retinopathy was observed on the Optos scanning laser ophthalmoscopy (SLO) imaging system but not on color fundus photography (CFP). Evidence of a TLR secondary to RPGR mutation was confirmed by CFP, autofluorescence, and genetic testing.Conclusion: We present a case of pseudo-crystalline retinopathy seen on Optos imaging in a patient with a TLR secondary to RPGR mutation.

Inflammatory choroiditis and papillitis from Crohn's disease in a child.

A 5-year-old boy had subacute painless visual loss in his left eye with disk edema, macular edema, and choroidal thickening. He was subsequently diagnosed with inflammatory papillitis and choroiditis from Crohn's disease. The disk and macular edema responded minimally to antivascular endothelial growth factor injections but significantly to intravitreal corticosteroids.

Professional development in integrative health through an interprofessional online course in clinical settings.

BACKGROUND: Although there is mounting clinical and cost-effectiveness evidence supporting integrative healthcare (IH), a significant knowledge gap hinders widespread adoption by health professionals. INTERVENTION: Foundations in Integrative Health (FIH), a 32-h online competency-based interprofessional course to address this knowledge gap. METHODS: The course was pilot-tested by an interprofessional sample of providers in various clinical settings as professional and staff development. OUTCOME MEASURES: Prior to and following the course, participants completed an IH knowledge test, an IH self-efficacy self-assessment, and validated measures of burnout, wellness behaviors, and attitudes toward IH, interprofessional teams, and patient involvement. Evaluation surveys were administered following each unit and the course. RESULTS: Thirty-one percent of the participants (n = 214/690) completed the course. Pre/post course improvements were found in IH knowledge, IH self-efficacy, attitudes towards IH and interprofessional teams, and several wellness behaviors. The course was positively evaluated with 81% of the participants indicating interest in applying IH principles in their practice and 92% reported that the course enhanced their clinical experience. CONCLUSION: This study demonstrates the outcomes of a multi-site, online IH curriculum offered to a diverse group of health professionals in various clinical settings. This course may allow clinical settings to offer an interprofessional, IH curriculum even with limited on-site faculty expertise.

Novel and Unusual Retinal Findings in Two Patients with Neurofibromatosis Type 1.

Neurofibromatosis type 1 (NF1) is a phacomatosis known to be associated with several developmental abnormalities in multiple organ systems including the eyes. NF1 can present with varying ophthalmic manifestations, including Lisch nodules, retinal astrocytic hamartomas, capillary hemangiomas, plexiform neurofibromas, and choroidal nodules. We present 2 cases of NF1 with presentations that may represent underreported retinal abnormalities occurring in NF1. Case 1 presents a patient who developed spontaneous peripheral retinal dialysis with subsequent retinal detachment; case 2 discusses a patient with multiple pigmented choroidal lesions bilaterally.

Characteristics and Fate of Abstracts Presented at American Academy of Ophthalmology Meetings.

PURPOSE: The purpose of this study is to evaluate the characteristics and publication outcomes of abstracts presented in American Academy of Ophthalmology (AAO) meetings. SUBJECT AND METHODS: Abstracts from AAO meetings for the years 2012 and 2013 were evaluated from the meeting archives. The study characteristics were recorded for each abstract. Each abstract was assessed for publication in a peer-reviewed scientific journal using three search engines (PubMed, Medline, and Google Scholar). Time to publication was also calculated. RESULTS: A total of 929 abstracts presented to 2 AAO meetings were analyzed. Among subspecialty areas, retina represented the largest percentage of accepted meeting abstracts (33.3%) followed by cornea (21.9%), cataract (14.9%), and glaucoma (14.4%). A total of 304 abstracts (32.7%) were published in peer-reviewed journals as full-length articles. The median time to publication was 40 months, and the median impact factor of the journal for the published manuscript was 1.9. In multivariable models, topics related to glaucoma were most likely to be published followed by retina. The odds for publication were higher if the first author was affiliated with a residency program, and if the first author originated from South Korea and the United States. CONCLUSIONS: Our study presents the landscape of publication outcomes for abstracts presented in national AAO meetings with ~1/3 of presented abstracts culminated in publication in a peer-reviewed journal.

A Case of Non-Resolving MEK Inhibitor-Associated Retinopathy.

The mitogen-activated kinase pathway plays an important role in cell survival, and its dysregulation is associated with cancers such as melanoma. Drugs designed to target this pathway have been associated with serous retinal detachments in a new entity termed MEK inhibitor-associated retinopathy (MEKAR). MEKAR has classically been described as self-limiting, with serous fluid often resolving without discontinuation of the drug. We present a case in which a patient undergoing treatment for metastatic melanoma with lacnotuzumab, a macrophage colony-stimulating factor inhibitor that blocks an upstream component of the mitogen-activated protein kinase pathway, developed serous retinopathy that did not resolve despite drug discontinuation.

Rationale and study protocol for Unidas por la Vida (United for Life): A dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters.

BACKGROUND: Half of Mexican-American women are under-active and nearly 78% are overweight/obese. The high lifetime risk of developing type 2 diabetes necessitates a culturally appropriate lifestyle intervention. PURPOSE: Unidas por la Vida is a novel dyadic intervention that capitalizes on the centrality of family in Latino culture to mobilize an existing family dyad as a resource for health behavior change. The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes. METHODS: Participants (N = 460 mother-adult daughter dyads) will be randomized into one of three conditions: 1) dyadic participation (mothers-daughters) in a lifestyle intervention; 2) individual participation (mothers alone; unrelated daughters alone) in a lifestyle intervention; and 3) mother-daughter dyads in a minimal intervention control group. RESULTS: The primary outcome is weight loss. Secondary outcomes include physical activity, dietary intake, physiological measures (e.g. HbA1c), and body composition. Both the dyadic and individual interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group, with women assigned to the dyadic intervention expected to lose more weight and to maintain the weight loss longer than women assigned to the individual intervention. CONCLUSION: Because health risks are often shared by multiple members of at-risk families, culturally appropriate, dyadic interventions have the potential to increase the success of behavior change efforts and to extend their reach to multiple family members. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02741037.

Prevalence of Complementary and Alternative Medicine Usage in Vietnamese American Asthmatic Children.

This study examined the frequency and type of complementary and alternative medicine (CAM) therapy, as well as characteristics associated with CAM usage. A survey about parental preferences and beliefs regarding CAM usage was distributed to 5 schools with predominantly low socioeconomic Vietnamese children. For the 360 Vietnamese children previously diagnosed with asthma whose families responded, most preferred conventional therapy as prescribed by the physician. The prevalence of CAM usage was 38.1%. Common CAM therapies were steam inhalation, creams/topical oils, foods, prayer, oil inhalation, massage, herbal medication, coining, and cupping. Significant predictors of CAM usage were older age (11-12 years) (P = .038), English language of survey response (P = .001), environmental tobacco smoke exposure (P = .001), fear of long-term medication usage, and perception of asthma as a condition related to genetics (P = .023). These findings suggest that assessing CAM therapy will provide a more holistic approach to asthma therapy.

Longitudinal survey on integrative medicine education at an underserved health centre.

Complementary and alternative medicine (CAM) is widely used by adults in the USA. However, most physicians do not inquire about CAM use leading to missed opportunities to dialogue about wellness and detect harmful practices. In 2012, an integrative medicine (IM) consultation clinic alongside an optional IM Residency Track for family medicine residents was established at the University of California, Irvine Family Health Center in Santa Ana, CA. This study evaluated the impact of these programmes on physicians' CAM/IM knowledge and receptiveness. Online surveys assessing self-reported attitudes, knowledge and practices were distributed in 2012 (baseline) and 2014 (follow-up) to family physicians with response rates of 83% (35/42) and 62% (23/37), respectively. At baseline, 91.5% of physicians believed that patient satisfaction would moderately/strongly increase if offered CAM/IM consultations and therapies. At follow- up, physician understanding of clinical applications of massage, acupuncture, meditation/relaxation, yoga and Tai Chi increased. Percentage of physician referrals to a CAM/IM consultation clinic increased (5.7- 69.6%; p < 0.01) as well as physician-initiated CAM/IM discussion (20.0-60.9%; p < 0.01). This study demonstrates the immediate effect of IM education in a primary care training site and the receptiveness of its community-based physicians towards these changes.

Use of and interests in complementary and alternative medicine by Hispanic patients of a community health center.

INTRODUCTION: We evaluated complementary and alternative medicine (CAM) use among a medically underserved, predominately Hispanic community at the University of California Irvine Family Health Center, a federally qualified health center. METHODS: A cross-sectional, anonymous survey assessed patient use of, interest in, and communication preferences concerning CAM. RESULTS: The 150 respondents primarily self-identified as Hispanic (74%), were born outside the United States (55%), were medically insured (56%), and had a high school education or less (55%). Of these respondents, 63% used at least 1 type of CAM; the most commonly used were: vitamins/supplements (32%), herbal medicine (29%), dietary/nutritional therapy (26%), massage (24%), meditation/relaxation (15%) and chiropractic (11%). Therapies that patients most desired to see provided at the clinic included massage, healthier cooking, guidance on herbs/supplements, and diet/nutrition. Among respondents, 61% were comfortable disclosing CAM use to physicians, 58% agreed physicians should have basic knowledge of CAM, and 47% desired that physicians ask about CAM use. CONCLUSIONS: Results demonstrate that CAM use is common among patients, and a large proportion of patients have interest in accessing CAM through their primary care clinic. Patients recognize the importance of communicating CAM use with their providers and seem receptive to discussing such topics.

Using community-based participatory research to assess the asthma needs of Vietnamese American children.

BACKGROUND: Very little is known about the burden of asthma in Vietnamese American children. Prior data have suggested that the burden of childhood asthma is significant for this population, although they seem to underutilize Western healthcare for unclear reasons. OBJECTIVES: To gain insight into the perceptions of the burden, health needs, and traditional health beliefs regarding childhood asthma in the Vietnamese American community in Orange County, CA. Additionally, to foster and build sustainable relationships with the community and to ensure that our research process is mutually rewarding for all stakeholders. METHODS: Using a community-based participatory research (CBPR) approach, we initiated the formation of the Vietnamese Children's Asthma Project (VCAP) and used focus groups of various community stakeholders as a platform to gather information, give basic asthma education, and build relationships. RESULTS: A total of 66 people participated in the focus groups: 26 parents, 20 Vietnamese American physicians, 12 school nurses, and 8 school-community liaisons (SCLs). Overall, all participants believe that asthma is a significant problem and that language is a barrier to healthcare access for the Vietnamese community. We learned that academic achievement is a high priority for Vietnamese parents and associating better asthma control with improved academic performance may be a way to improve asthma education and adherence with therapy. We also found that although healthcare providers believe that parental traditional beliefs contribute to non-adherence to Western therapies, Vietnamese American parents report that they prefer to use Western medications to treat their children's asthma. CONCLUSIONS: Through the use of CBPR and the development of VCAP, we successfully conducted focus groups to assess the Vietnamese American perception of the burden of childhood asthma in their community and to gauge their receptivity to participate in further studies about childhood asthma and receptivity to subsequent interventions.

Dyadic collaboration in shared health behavior change: the effects of a randomized trial to test a lifestyle intervention for high-risk Latinas.

OBJECTIVE: This study sought to evaluate the feasibility of a pilot, dyad-based lifestyle intervention, the Unidas por la Vida program, for improving weight loss and dietary intake among high-risk Mexican American mothers who have Type 2 diabetes and their overweight/obese adult daughters. METHOD: Mother-daughter dyads (N = 89) were recruited from two federally qualified health centers and randomly assigned to either the Unidas intervention or to the control condition. The 16-week Unidas intervention consisted of the following: (a) four group meetings, (b) eight home visits, and (c) booster telephone calls by a lifestyle community coach. The control condition consisted of educational materials mailed to participants' homes. Participants completed surveys at T1 (baseline) and T2 (16 weeks) that assessed various demographic, social network involvement, and dietary variables. RESULTS: Unidas participants lost significantly more weight at T2 (p < .003) compared with the control participants. Furthermore, intervention participants also were more likely to be eating foods with lower glycemic load (p < .001) and less saturated fat (p = .004) at T2. Unidas participants also reported a significant increase in health-related social support and social control (persuasion control only) and a decrease in undermining. CONCLUSIONS: The Unidas program promoted weight loss and improved dietary intake, as well as changes in diet-related involvement of participants' social networks. The results from this study demonstrate that interventions that draw upon multiple people who share a health-risk have the potential to foster significant changes in lifestyle behaviors and in social network members' health-related involvement. Future research that builds on these findings is needed to elucidate the specific dyadic and social network processes that may drive health behavior change.

Unidas por la Vida (United for Life): implementing a culturally-tailored, community-based, family-oriented lifestyle intervention.

Unidas por la Vida, a behavioral weight-loss program, was developed for use among low-income, Mexican-American women with diabetes and their overweight/obese adult daughters. The program leverages community resources in a partnership between primary care and community-based organizations. This paper describes the program's implementation, lessons learned, and implications for sustainability.

Common respiratory diseases.

The self-medication phenomenon in upper respiratory tract infections, rhinosinusitis, asthma, and chronic obstructive pulmonary disease are significant and will continue to increase. Current level of evidence is poor because of the small number of good quality studies, small sample size, short duration, and variation in the composition of the herbal interventions or therapies. The current review points to several potential therapies that could be effective either alone, or as adjuncts to conventional therapies.