Neonatal skin health and associated dermatological conditions.

PURPOSE OF REVIEW: This review describes recent developments in neonatal skincare management and situates these findings within the preexisting literature on neonatal dermatology. RECENT FINDINGS: The studies included in this review expand research methods evaluating skincare management to different contexts across the world. Several studies explore the roles of emollient therapy, disinfection, and skin-to-skin contact on improving neonates' long-term health outcomes. Recent findings also assess the impact of neonatal interventions on atopic dermatitis risk later in life as well as epidemiological and microbiome variables that may predict this risk. Additionally, updates on various dermatological conditions unique to neonates are discussed in further detail. SUMMARY: Neonatal skincare management differs in notable ways from that of other age groups. The presentation of dermatologic diseases as well as the rare conditions that affect neonates make their clinical management unique. The recent literature on neonatal dermatology can help inform clinicians regarding important considerations in treating their neonatal population.

Inequities in Technology Access and Digital Health Literacy Among Patients With Dermatologic Conditions: Cross-Sectional Analysis of the National Health Interview Survey.

Certain sociodemographic factors are associated with low technology access and digital healthy literacy.

Supportive Oncodermatology in Pediatric Patients.

Cutaneous reactions to targeted therapies are varied and common. Pediatric dermatology literature is emerging on the specific types and prevalence of cutaneous reactions to targeted therapies that hone in on membrane-bound receptors, intracellular signaling targets, and antiangiogenesis agents, as well as targeted immunotherapies. Data regarding the timing, severity, and treatment algorithms are most plentiful for BRAF, MEK, and EGFR inhibitors.

Financial Worry and Psychological Distress Among Immigrants in the United States, 2013-2018.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted links among economic stability, health outcomes, and migration. The facets of financial worry and their associated psychological burden have been understudied among the immigrant population. The goal of this study was to determine the specific facets of financial worry and associated psychological burden in immigrants. This cross-sectional study, which used data from the 2013 to 2018 National Health Interview Survey (NHIS), examined patient-reported measures of worry regarding financial strain. The NHIS is a household survey of noninstitutionalized, nonmilitary adults in the United States. Multivariable ordinal logistic regressions were used to define adjusted odds ratios (AORs) for financial worry and psychological distress, adjusting for various sociodemographic variables. Among 131,669 US-born and 26,155 non-US-born participants who responded to all 6 questions on the 6-item Kessler Psychological Distress Scale (K6), the overall prevalence of participants reporting any serious psychological distress (K6 score ≥13) was 3.0% and 2.25%, respectively. Despite these overall prevalence data, there were specific areas of financial worries that were higher in non-US-born participants than in US-born participants. Compared with US-born participants, non-US-born participants had higher rates of financial worries regarding retirement [75.78% vs. 69.08%, AOR=1.37, 95% confidence interval (CI) 1.29-1.45, P<0.001], medical costs due to illness (worry about not being able to pay medical costs of a serious illness or accident) (74.94% vs. 65.27%, AOR=1.37, 95% CI: 1.29-1.45, P<0.001), standard of living (74.25% vs. 65.29%, AOR=1.42, 95% CI: 1.34-1.51, P<0.001), and medical cost of health care (worry about not having enough to pay medical costs for normal health care) (66.52% vs. 52.67%, AOR=1.51, 95% CI: 1.43-1.60, P<0.001), among other costs. Notably, serious psychological distress in non-US-born individuals was associated with increased financial worry relative to US-born individuals with a similar level of psychological distress. Further research is needed to evaluate the role physicians can play in mitigating psychological distress in patients with increased financial worry.

Expanding the palette of pediatric playthings: A call to action for pediatric dermatologists.

Children recognize race and skin color from a young age. Given the important role of play in the development of children's understanding of social norms and cultural values, it is essential to incorporate toys and other educational materials with diverse skin tones to teach children about race and skin color. Analyses of children's books and toys have shown a lack of diversity in representation of races and skin types. Pediatric dermatologists are uniquely positioned to foster conversations about skin tone and advocating for more diverse materials in classrooms and clinics. In this manuscript, we discuss best practices and resources for facilitating discussions on skin tone with children in the dermatology clinic.

Continuing patient care to underserved communities and medical education during the COVID-19 pandemic through a teledermatology student-run clinic.

A virtual pediatric dermatology student-run clinic was initiated during the COVID-19 pandemic, when in-person educational opportunities were limited. The clinic's aim is to provide high-quality dermatologic care to a diverse, underserved pediatric patient population while teaching trainees how to diagnose and manage common skin conditions. In our initial eight sessions, we served 37 patients, predominantly those with skin of color, and had a low no-show rate of 9.8%. This report describes the general structure of the clinic, goals, and the patient population to provide an overview of our educational model for those interested in similar efforts.

Pediatric primary cutaneous anaplastic large cell lymphoma treated with brachytherapy.

Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is a CD30+ lymphoproliferative disorder that rarely occurs in children. Although there are currently no consensus guidelines for the treatment of cutaneous lymphoma in the pediatric population, the isolated form of PC-ALCL is typically managed by surgical excision or external beam radiation therapy. We report the case of a 6-year-old girl with primary cutaneous anaplastic large cell lymphoma that was treated with brachytherapy with no recurrence after 21 months of follow-up, suggesting that brachytherapy may be considered as a treatment for pediatric cutaneous large cell anaplastic lymphoma.

Changes to the Psychiatric Chatbot Landscape: A Systematic Review of Conversational Agents in Serious Mental Illness: Changements du paysage psychiatrique des chatbots: une revue systématique des agents conversationnels dans la maladie mentale sérieuse.

OBJECTIVE: The need for digital tools in mental health is clear, with insufficient access to mental health services. Conversational agents, also known as chatbots or voice assistants, are digital tools capable of holding natural language conversations. Since our last review in 2018, many new conversational agents and research have emerged, and we aimed to reassess the conversational agent landscape in this updated systematic review. METHODS: A systematic literature search was conducted in January 2020 using the PubMed, Embase, PsychINFO, and Cochrane databases. Studies included were those that involved a conversational agent assessing serious mental illness: major depressive disorder, schizophrenia spectrum disorders, bipolar disorder, or anxiety disorder. RESULTS: Of the 247 references identified from selected databases, 7 studies met inclusion criteria. Overall, there were generally positive experiences with conversational agents in regard to diagnostic quality, therapeutic efficacy, or acceptability. There continues to be, however, a lack of standard measures that allow ease of comparison of studies in this space. There were several populations that lacked representation such as the pediatric population and those with schizophrenia or bipolar disorder. While comparing 2018 to 2020 research offers useful insight into changes and growth, the high degree of heterogeneity between all studies in this space makes direct comparison challenging. CONCLUSIONS: This review revealed few but generally positive outcomes regarding conversational agents' diagnostic quality, therapeutic efficacy, and acceptability, which may augment mental health care. Despite this increase in research activity, there continues to be a lack of standard measures for evaluating conversational agents as well as several neglected populations. We recommend that the standardization of conversational agent studies should include patient adherence and engagement, therapeutic efficacy, and clinician perspectives.

Arginine vasopressin infusion is sufficient to model clinical features of preeclampsia in mice.

Copeptin, a marker of arginine vasopressin (AVP) secretion, is elevated throughout human pregnancies complicated by preeclampsia (PE), and AVP infusion throughout gestation is sufficient to induce the major phenotypes of PE in mice. Thus, we hypothesized a role for AVP in the pathogenesis of PE. AVP infusion into pregnant C57BL/6J mice resulted in hypertension, renal glomerular endotheliosis, intrauterine growth restriction, decreased placental growth factor (PGF), altered placental morphology, placental oxidative stress, and placental gene expression consistent with human PE. Interestingly, these changes occurred despite a lack of placental hypoxia or elevations in placental fms-like tyrosine kinase-1 (FLT1). Coinfusion of AVP receptor antagonists and time-restricted infusion of AVP uncovered a mid-gestational role for the AVPR1A receptor in the observed renal pathologies, versus mid- and late-gestational roles for the AVPR2 receptor in the blood pressure and fetal phenotypes. These findings demonstrate that AVP is sufficient to initiate phenotypes of PE in the absence of placental hypoxia, and indicate that AVP may mechanistically (independently, and possibly synergistically with hypoxia) contribute to the development of clinical signs of PE in specific subtypes of human PE. Additionally, they identify divergent and gestational time-specific signaling mechanisms that mediate the development of PE phenotypes in response to AVP.

Angiotensin AT1A receptors expressed in vasopressin-producing cells of the supraoptic nucleus contribute to osmotic control of vasopressin.

Angiotensin II (ANG) stimulates the release of arginine vasopressin (AVP) from the neurohypophysis through activation of the AT1 receptor within the brain, although it remains unclear whether AT1 receptors expressed on AVP-expressing neurons directly mediate this control. We explored the hypothesis that ANG acts through AT1A receptors expressed directly on AVP-producing cells to regulate AVP secretion. In situ hybridization and transgenic mice demonstrated localization of AVP and AT1A mRNA in the supraoptic nucleus (SON) and the paraventricular nucleus (PVN), but coexpression of both AVP and AT1A mRNA was only observed in the SON. Mice harboring a conditional allele for the gene encoding the AT1A receptor (AT1Aflox) were then crossed with AVP-Cre mice to generate mice that lack AT1A in all cells that express the AVP gene (AT1AAVP-KO). AT1AAVP-KO mice exhibited spontaneously increased plasma and serum osmolality but no changes in fluid or salt-intake behaviors, hematocrit, or total body water. AT1AAVP-KO mice exhibited reduced AVP secretion (estimated by measurement of copeptin) in response to osmotic stimuli such as acute hypertonic saline loading and in response to chronic intracerebroventricular ANG infusion. However, the effects of these receptors on AVP release were masked by complex stimuli such as overnight dehydration and DOCA-salt treatment, which simultaneously induce osmotic, volemic, and pressor stresses. Collectively, these data support the expression of AT1A in AVP-producing cells of the SON but not the PVN, and a role for AT1A receptors in these cells in the osmotic regulation of AVP secretion.