The impact of vaccine hesitancy on psychological impairment among healthcare workers in a Total Worker Health© approach.

Introduction: Vaccination practice is a well-known individual protective measure for biological risk in healthcare. During the COVID-19 pandemic vaccine hesitancy has grown among healthcare workers (HCWs). The study aims to investigate how vaccine hesitancy influences the psychological burden experienced by healthcare workers. Methods: This study aimed to explore attitudes of HCWs in acceptance or refusal of vaccinations related to the risk of psychological impairment (PI) and describe the associated occupational factors, during the seasonal flu/COVID-19 vaccination campaign of 2022-2023. 302 HCWs were enrolled in the study. A questionnaire was self-administered, including two scales on the risk of psychological impairment (Psychological Injury Risk Indicator, PIRI) and vaccine hesitancy (Adult Vaccine Hesitancy Scale, AVHS). Results: PIRI scores revealed that 29.8% of participants were at risk of PI. Differences in sex, age, occupational seniority, professional category, and night shifts were found between HCWs at risk of PI and those not at risk. Females registered a four-fold higher risk than males (85.6% vs. 14.4%, χ2 = 4.450, p < 0.05). Nurses were the highest risk category, followed by physicians and technicians (54.4% vs. 30.0% vs. 12.2%, χ2 = 14.463, p < 0.001). 41.7% of participants received the flu vaccination, and 98.9% received the COVID-19 vaccine. HCWs were prone to being vaccinated to protect patients and family members. Conversely, vaccine refusal was attributed to the perception of flu vaccines as not beneficial and COVID-19 contagion at low risk. The latter was more frequently reported for HCWs at risk of PI (16.7% vs. 4.7%, χ2 = 11.882, p = 0.001). Finally, hesitant HCWs were at higher risk of psychological impairment than others. Discussion: HCWs expressed vaccine acceptance considering their social role in the community as protectors. However, the underestimation of the risk of severity of COVID-19 was more relevant among HCWs at risk of PI than others. Psychological aspects need to be considered by healthcare providers when fighting vaccine hesitancy.

Partnering with the woman who declines recommended maternity care: Development of a statewide guideline in Queensland, Australia.

BACKGROUND: Choice, a fundamental pillar of woman-centred maternity care, depends in part on the right to decline recommended care. While professional guidance for midwives and obstetricians emphasises informed consent and respect for women's autonomy, there is little guidance available to clinicians or women about how to navigate maternity care in the context of refusal. AIM: To describe the process and outcomes of co-designing resources to support partnership between the woman who declines recommended maternity care and the clinicians and health services who provide her care. MATERIALS AND METHODS: Following a participatory co-design process involving consumer representatives, obstetricians, midwives, maternal fetal medicine specialists, neonatologists, health service executives, and legal and ethics experts, implementation of the resources was trialled in seven Queensland Health services using Improvement Science's Plan-Do-Study-Act cycles. RESULTS: Resources for Partnering with the woman who declines recommended maternity care have now been implemented statewide, in Queensland, including a guideline, two consumer information brochures (available in 11 languages), clinical form, flowcharts, consumer video, clinician education, and culturally capable First Nations resources. Central to these resources is an innovative shared clinical form, that is accessible online, may be initiated and carried by the woman, and where she can document her perspective as part of the clinical notes. CONCLUSION: Queensland is the first Australian jurisdiction, and perhaps internationally, to formally establish this kind of guidance in clinical practice. Such guidance is identified as an enabler of choice in the national Australian strategy Woman-centred care: Strategic directions for Australian maternity services.

Discitis Mimicking Septic Arthritis in a 17-Month-Old Boy.

Discitis in children is uncommon, typically occurring between the ages of two and eight years. The etiology is not established, but it is generally considered a bacterial infection. Symptoms vary with age but commonly include irritability, refusal to walk, and back pain. These various clinical presentations cause delays in diagnosis. We present this case to draw attention and familiarise clinicians with its presentations. A 17-month-old boy presented with a one-week history of refusal to walk. Examination showed an unusual finding of the child keeping his right leg in a flexed position with hip tenderness. Inflammatory markers were raised. Initially, the patient was managed for suspected septic arthritis of the hip joint. Initial tests were inconclusive, and magnetic resonance imaging (MRI) on day 23 revealed discitis at L4-L5. After a course of antibiotics and monitoring of inflammatory markers, his clinical condition improved. The mainstay of treatment is antibiotics, with surgery reserved for complicated cases. Discitis has a good prognosis in children.

Potential donor family behaviours, experiences and decisions following implementation of the Organ Donation (Deemed Consent) Act 2019 in England: A qualitative study.

BACKGROUND: In May 2020, England implemented "deemed consent" legislation, to make it easier for individuals to donate their organs and convey their decision when alive. Families are supposed to support the decision but can still override it if they disagree. We aimed to learn more about this changed role when families were approached about organ donation. METHODS: A qualitative study using semi-structured interviews with families, feedback from nurses, comparisons with audit data, and public involvement. We used framework analysis with a health systems perspective and utilitarian theory to explore if the law worked. FINDINGS: 103 participants were interviewed representing 83 potential donation cases. In 31/83 (37%) cases donation was fully supported, in 41/83 (49%) cases families supported retrieval of some organs, tissues and procedures, and in 11/83 (13%) cases families declined completely. Themes explaining why the law was not (yet) working included: Understanding and agreeing the family's role, confusion about deemed consent, not supporting the deceased expressed decisions, organ donation as too much of a harm, the different experiences of donation pathways, transition from end-of-life to organ donation discussions, experiences of 'consent', paperwork and processes. Families frequently questioned if their relative wanted to have a surgery rather than supporting the person who died to save lives. CONCLUSION: Families use the unique experience of their relative dying in intensive care to create alternate narratives whereby the outcome satisfies their own utility and not necessarily those of the potential donor. New public ongoing media campaigns crafted to be more supportive of organ donation as a benefit to transplant recipients could help families overcome the many difficulties they encounter at the bedside. IMPLICATIONS FOR CLINICAL PRACTICE: The soft opt-out policy has not empowered nurses to help families at their most vulnerable to increase their support for and consent to deceased organ donation.

Conscientious Objection to Gender-Affirming Surgery: A Cross-Sectional Analysis of Plastic Surgery and Urology Residency Programs.

OBJECTIVE: Medical conscientious objection is a federally protected right of physicians to refuse participation in medically indicated services or research activities that are incompatible with their ethical, moral, or religious beliefs. Individual provider objections to gender-affirming surgery have been documented, however the prevalence of such objections is unknown. Our study aimed to characterize physician objections to gender-affirming surgery in plastic surgery and urology residencies and to assess related institutional policies. DESIGN, SETTING, PARTICIPANTS: A cross-sectional electronic survey was administered to program leadership of 239 accredited US plastic surgery and urology residencies from February to October 2023. Trainee exposure to gender-affirming surgery, programmatic experience with objections, and presence and content of institutional objection policies were collected. Bivariate analyses were performed to determine associations with objectors. RESULTS: One-hundred and twenty-four plastic surgery (n = 59) and urology (n = 65) residencies completed the survey, representing a 52% response rate. Most programs included didactic training (n = 107, 86%) and direct clinical exposure (n = 98, 79%) to gender-affirming surgery. Few (n = 24, 19%) endorsed existent objection policies. Sixteen programs (13%) experienced objections to gender-affirming surgery by trainees (n = 15), faculty (n = 6), and staff (n = 1). Neither geographic region, exposure to gender-affirming surgery, nor presence of objection policies significantly contributed to programmatic objections. Programs with formal objection policies reported increased confidence in addressing future objection events (p = 0.017). CONCLUSIONS: Objection to gender-affirming surgery is a rare, but plausible occurrence amongst plastic surgery and urology trainees. Residency programs should consider anticipatory policies to protect patients and, when feasible, provide reasonable accommodations for objecting trainees.

On the efficacy and efficiency of treating pediatric feeding disorder.

Inappropriate mealtime behavior (IMB) is a type of feeding challenge within the broader class of food refusal. The purpose of this study was to critically analyze the efficacy of interventions for the treatment of IMB through a meta-analysis of research using single-case experimental designs. We examined the extent to which different interventions resulted in decreases in IMB while also producing increases in food acceptance. This meta-analysis was also used to examine the efficiency of different interventions in achieving clinical significance. We identified 38 studies involving 266 cases in which IMB was treated with a behavioral intervention. The results indicated interventions that combined escape extinction and non-escape extinction had greater effect sizes for both reducing IMB and increasing food acceptance than either escape extinction alone or non-escape extinction alone. However, interventions that included escape extinction were slightly less efficient at decreasing IMB than were interventions that did not include escape extinction. We discuss the implications of these findings and provide recommendations for future research.

Decision Style Inventory Application in Parent/Guardian Vaccination Decision-Making: A Pilot Study.

INTRODUCTION: Cases of preventable diseases continue to occur globally. Much literature is present about barriers and factors that influence vaccination, but little is known about psychologically ingrained decision-making styles and their relationship with vaccination decisions. DESIGN/METHODS: This quantitative descriptive cross-sectional pilot study aimed to explore using an established tool, the Decision Style Inventory (Rowe & Mason, 1987), in parents/guardians of children 2 months to 20 years old. RESULTS: Nineteen parents/guardians participated in this study and provided positive feedback on the Decision Style Inventory (Rowe & Mason, 1987). Descriptive statistics revealed vaccination decisions occurred more frequently with certain decision styles. CONCLUSIONS: Further research examining associations between decision styles and vaccination decisions is warranted. The findings of such research could lead to new tool development that integrates external factors and parental decision-making style. This new tool could allow healthcare providers to select targeted interventions that holistically address parental vaccination decisions.

COVID-19 Vaccination Acceptance and Hesitancy in Healthcare Workers and the General Population: A Systematic Review and Policy Recommendations.

INTRODUCTION: The COVID-19 pandemic challenged the scientific community to find and develop a vaccine to fight the disease. However, problems with achieving high vaccine coverage have emerged, even among high-risk groups such as healthcare workers (HCWs). OBJECTIVE: The objective of this study is to examine factors that influence HCW's and the general population's adherence to COVID-19 vaccination and national policies to vaccinate HCWs and other target groups. METHODS: This study implemented a systematic review. The eligibility criterion for inclusion was being a HCW, target population for COVID-19 vaccination, or general population. Vaccination was the target intervention, and the COVID-19 pandemic was the context. We selected publications published between 1 January 2020 and 31 March 2022. Qualitative synthesis used a meta-aggregation approach. RESULTS: Nineteen articles were included in the review, with study samples varying from 48 to 5708 participants. Most of the evidence came from cross-sectional and qualitative studies. The main findings were related to vaccine hesitancy rather than acceptance. Factors associated with HCW vaccine hesitancy included subjective feelings such as safety concerns, rapid vaccine development, and insufficient testing. Countries have adopted few public policies to address this problem, and the main concern is whether to enforce vaccination and the extent to which measures are legal. CONCLUSION: The quality of the evidence base remains weak. Skepticism, mistrust, and hesitancy toward vaccination are global issues that can jeopardize vaccination coverage.

Psychiatric assessment for patients who decline cancer treatment: perspectives from medical residents.

PURPOSE: Among patients with cancer, a comorbid mental disorder is associated with higher mortality. This could be partially attributed to reduced access to oncological care, sometimes due to treatment refusal. Recommendations were issued in 2018 by the French and Francophone Society of Psycho-Oncology concerning the management of oncological treatment refusal. This study aimed to examine oncology residents' view on psychiatric assessment in this context. METHODS: In February 2021, we conducted a descriptive, observational, cross-sectional pilot study among French residents involved in oncology regarding their management of cancer treatment refusal and the importance they assign to psychiatric assessment, using an online questionnaire with 12 multiple-choice questions. RESULTS: Among 87 respondents, only 35.6% systematically explore the history of mental disorders when facing cancer treatment refusal. Even in cases with a known history of mental disorders, only 42.5% systematically refer the patient to a psychiatrist. 96.5% of them were unaware of the 2018 recommendations. CONCLUSION: The importance given to psychiatric assessment in cases of oncological treatment refusal remains insufficient. Qualitative studies are needed to understand the underlying reasons for this refusal. The development of psychiatric consultation-liaison interventions in oncology centers is necessary to improve the management of these cases and provide appropriate training.

Severity of inattention symptoms, experiences of being bullied, and school anxiety as mediators in the association between excessive short-form video viewing and school refusal behaviors in adolescents.

Background: Recent years have seen an increase in school refusal behavior among adolescents, potentially due to factors like excessive short-form video viewing, bullying, and school anxiety. Limited research has investigated how these factors contribute to school refusal behavior. This study used random forest regression, path analysis, and network analysis to identify key variables and pathways leading to school refusal behavior. Methods: In this cross-sectional questionnaire-based study, 2,056 (996 male, 1,060 female, mean age: 14.79 ± 1.24 years) middle and senior high school students were asked to complete the School Refusal Behavior Assessment questionnaire to assess school refusal behavior features, the Excessive Short-Form Video Viewing Scale as well as self-reported viewing times during leisure days to assess excessive short-form video viewing, the SNAP-IV Rating Scale to assess the severity of inattention symptoms, and the self-administered questionnaires to assess experiences of being bullied and school anxiety. Results: The prevalence of school refusal behavior in the surveyed adolescents was found to be 31.9% [95% confidence interval (CI): 29.8-33.9%]. In terms of significance, the severity of inattention symptoms exhibited the greatest predictive power, while excessive short-form video viewing accounted for the most variance. Path analysis revealed that excessive short-form video viewing not only directly affects school refusal behavior features but also does so indirectly through severity of inattention symptoms and school anxiety. Key bridge factors in this pathway include intense fear and anxiety associated with school attendance, manifesting as somatic symptoms and avoidance behaviors. Conclusion: The findings indicate that not only does excessive short-form video viewing directly influence school refusal behavior features in adolescents, but it also indirectly impacts these features through mechanisms involving severity of inattention symptoms and school anxiety. The bridge factors highlight potential targets for interventions among the SRB features and predictors.

Just a number? Donor age and (lack of) associated reasons for heart offer refusal.

The use of 50+ year-old donors for heart transplant (HT) is rare in the United States. We assessed reasons for this-and whether it reflects concern about age itself or associated risk factors-using a survey of US HT centers. The Donor Heart Study enrolled US adult potential heart donors from 2015 to 2020. A total of 6,814 surveys across 2,197 donors cited, on average, 2.4 reasons (per donor) for offer refusal. Age was cited often (by ≥50% of centers surveyed) for 715 donors (33%). In this subgroup, accompanying donor-related reasons for refusal were infrequent, with no cardiac abnormality cited in most cases. Donor age showed associations with (1) age as a reason for refusal and (2) discard. Both abruptly increased at age 50: 55% of 50 to 51-year-old donors were refused often due to age (vs 38% of 48-49-year-olds), and 72% were discarded (vs 55% of 48-49-year-olds), despite no evidence of a threshold effect of age on outcomes.

School Refusal Behaviors: The Roles of Adolescent and Parental Factors.

School refusal behaviors in adolescents have deleterious immediate and long-term consequences and are associated with mental ill-health such as anxiety and depression. Understanding factors that place youth at higher risk of school refusal behavior may assist in developing effective management approaches. We investigated parental and adolescent factors that may be associated with school refusal behaviors by specifically focusing on the role of parental and adolescent emotion dysregulation, their anxiety and depression, and parental rearing style. First, we hypothesized that adolescents with school refusal behaviors, as well as their parents, will report higher levels of emotion dysregulation, anxiety, and depression compared to their counterparts without school refusal behaviors. Furthermore, we hypothesized that multivariate models testing the role of parental and child factors concurrently will show that parental (emotion dysregulation, anxiety and depression, and rearing styles) and adolescent (emotion dysregulation, anxiety, and depression) factors are associated with school refusal behaviors. One hundred and six adolescents aged 12 to 18 years and their parents completed an online questionnaire measuring both parental and adolescent emotion dysregulation, anxiety, depression, parental rearing styles, and adolescents' school refusal behaviors. Adolescents with school refusal behaviors reported greater anxiety and depression, with their parents showing greater emotion dysregulation. Multivariate analyses showed that parental emotion dysregulation and adolescent age were associated with school refusal behaviors independently. Future management for school refusal behaviors should consider age-tailored approaches by incorporating training for parental emotion regulation skills.

Patient Autonomy Versus Intervention: Geriatric Care Dilemmas.

Background: The ethical challenges faced by physicians when patients or their families refuse medical interventions are particularly complex in geriatric care. This manuscript explores the delicate balance between professional recommendations and patient autonomy, focusing on the nuanced decisions surrounding enteral nutrition in older patients. Methods: Two case studies are presented: a 99-year-old woman with a history of hypertension, diabetes, and coronary heart disease, and an 82-year-old man with Alzheimer's disease. Both cases involve the recommendation of a nasogastric tube for enteral nutrition, and the subsequent patient and family responses to this intervention. Results: In the first case, the patient and her family initially refused the tube due to personal beliefs and financial concerns, leading to a focus on psychological support and symptom management. The patient eventually agreed to the tube, but tragically passed away shortly after. In contrast, the second case resulted in the patient's family agreeing to the tube after a thorough discussion, leading to a successful recovery and the patient's ability to eat orally 6 months later. Conclusions: The cases underscore the importance of patient-centered care, clear communication, and empathy in geriatric medicine. They highlight the need for healthcare providers to respect patient autonomy, be aware of their own biases, and engage in open dialogue with patients and families. The manuscript advocates for a nuanced approach to medical ethics, where the patient's journey is guided with respect and care, honoring their wishes while striving for the best possible outcomes.

Factores asociados al rechazo de contracepción posparto en un Hospital Público / Factors associated with postpartum contraceptive refusal in a public hospital, 2021

Objetivo: Determinar los factores asociados al rechazo de la contracepción posparto en un Hospital Público, 2021. Métodos: Estudio observacional, analítico, transversal; incluyó 251 puérperas inmediatas atendidas en un Hospital Público entre mayo y junio del 2021. La variable principal fue rechazo de la contracepción posparto y factores asociados: sociodemográficos, obstétricos, personal-cultural, institucional. Se usó un cuestionario válido y confiable. Además, la prueba Chi cuadrado de Pearson y Regresión de Poisson para el análisis estadístico y se tuvo aprobación de Comité de Ética. Resultados: El 16,7 % rechazó los contraceptivos modernos. El nivel educativo bajo (p < 0,011; RPa: 4,51; IC: 1,42-14,35), la percepción de una mala situación económica (p = 0,001; RPa: 3,65; IC: 1,72-7,76), las complicaciones durante el trabajo de parto y dos horas posparto (p = 0,041; RPa: 8,16; IC: 1,09-61,19), el embarazo planificado (p = 0,002; RPa: 2,51; IC: 1,38-4,55), la experiencia negativa de contracepción (p = 0,000; RPa: 11,26; IC: 5,85-21,66), la actitud negativa de la pareja (p = 0,006; RPa: 4,90; IC: 1,57-15,31) y la percepción de conocimiento insuficiente sobre contracepción (p = 0,049; RPa: 0,53; IC: 0,28-0,996); se asociaron al rechazo de contracepción en el posparto. Conclusión: El nivel educativo bajo, la percepción de una mala situación económica, las complicaciones durante el trabajo de parto y dos horas posparto, el embarazo planificado, la experiencia negativa de contracepción, la actitud negativa de la pareja, se asocian al rechazo de contracepción posparto; la percepción de conocimiento insuficiente sobre contracepción se asoció a la disminución de rechazo(AU)

Objective: To determine the factors associated with the refusal of postpartum contraception in a Public Hospital, 2021. Methods: Observational, analytical, cross-sectional study; included 251 immediate postpartum women treated in a Public Hospital between May and June 2021. The main variable was rejection of postpartum contraception and associated factors: sociodemographic, obstetric, personal-cultural, and institutional. A valid and reliable questionnaire was used. In addition, Pearson's Chi-square test and Poisson's regression were used for statistical analysis and the Ethics Committee was approved. Results: 16.7% rejected modern contraceptives. Low educational level (p < 0.011; PRa: 4.51; CI: 1.42-14.35), the perception of a bad economic situation (p = 0.001; RPa: 3.65; CI: 1.72-7.76), complications during labor and two hours postpartum (p = 0.041; PRa: 8.16; CI: 1.09-61.19), planned pregnancy (p = 0.002; PRa: 2.51; CI: 1.38-4.55), negative experience of contraception (p = 0.000; PRa: 11.26; CI: 5.85-21.66), the negative attitude of the partner (p = 0.006; RPa: 4.90; CI: 1.57-15.31) and the perception of insufficient knowledge about contraception (p = 0.049; RPa: 0.53; CI: 0.28-0.996); were associated with contraceptive rejection in the postpartum period. Conclusion: Low educational level, perception of a poor economic situation, complications during labor and two hours postpartum, planned pregnancy, negative contraceptive experience, negative partner attitude, are associated with postpartum contraceptive rejection; The perception of insufficient knowledge about contraception was associated with a decrease in rejection(AU)

Unmasking vaccine hesitancy and refusal: a deep dive into Anti-vaxxer perspectives on COVID-19 in Spain.

BACKGROUND: At the time of the emergence of COVID-19, denialist and anti-vaccine groups have also emerged and are shaking public confidence in vaccination. METHODS: A qualitative study was conducted using online focus groups. Participants had not received any doses of vaccination against the disease. A total of five focus group sessions were conducted with 28 participants. They were recruited by snowball sampling and by convenience sampling. RESULTS: The two major topics mentioned by the participants were adverse effects and information. The adverse effects described were severe and included sudden death. In the case of information, participants reported: (1) consultation of websites on which scientists posted anti-vaccination content; and (2) distrust. CONCLUSIONS: At a time when anti-vaccine groups pose a major challenge to public health in general, and to COVID-19 vaccination campaigns in particular, this study is a first step towards gaining deeper insight into the factors that lead to COVID-19 vaccine refusal.

Strategies to prevent blood loss and reduce transfusion in emergency general surgery, WSES-AAST consensus paper.

Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient's values and target the best outcome possible given the patient's desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes.

Exploring the relationship between vaccine hesitancy and mothers' perspectives on COVID-19 vaccines for children ages 5-11 years during the omicron predominant period 2021-2022: a qualitative study.

Background: The United States Food and Drug Administration authorized COVID-19 vaccines for children ages 5-11 years in October 2021 during the Omicron predominant period. Parental vaccine hesitancy was prevalent during this time, resulting in low childhood COVID-19 vaccine uptake. Most studies exploring factors influencing parental vaccine hesitancy have focused on racial and ethnic minorities and lower socioeconomic populations; however, there is little knowledge of the drive drivers of vaccine hesitancy among White parents with higher education and socioeconomic statuses. Methods: We conducted semi-structured interviews with a sample of 15 White mothers of children ages 5-11 years in Atlanta, GA, between October-December 2021. Thematic analysis was performed using NVivo 12. Results: Mothers were college-educated, homeowners, and fully vaccinated against COVID-19. Key findings included decreased pediatrician's recommendations for COVID-19 vaccines, reliance on information from specialized doctors and scientists, distrust in public health authorities, high risk-perception of COVID-19 vaccines, and low risk-perception of COVID-19 disease. Factors related to vaccine acceptance were altruism and practicality. Conclusion: This study adds to the sparse literature on reasons for vaccine hesitancy among White mothers of children ages 5-11 years with higher educational and socioeconomic status. Improving vaccine uptake among this group is critical for protecting the health of their children and other vulnerable populations. Tailored vaccine messaging and intervention are warranted to address their unique attitudes, beliefs, and behaviors. An enhanced understanding of the factors influencing subpopulations of parents can help vaccine policymakers and healthcare providers improve efforts to reduce vaccine hesitancy, particularly for new vaccines.

Examining the association between untreated caries in children and parent fluoride treatment refusal.

BACKGROUND: In this case-control study, the authors examined the relationship between untreated caries in children and parent fluoride treatment refusal. The authors hypothesized that parents of children with a history of untreated caries would be less likely to refuse topical fluoride for their children than parents of children with no history of untreated caries. METHODS: The study included children (≤ 18 years old) who were patients at a university dental clinic from January 2016 through June 2020. Children whose parents refused fluoride treatment were age-matched with children whose parents did not refuse fluoride treatment (n = 356). The outcome variable was parent topical fluoride refusal for their children (no, yes). The predictor variable was a history of untreated caries (no, yes). Confounding variable-adjusted modified Poisson regression models were used to estimate the prevalence ratio of parent fluoride refusal by means of children's untreated caries status. RESULTS: Approximately 46.3% of children had a history of untreated caries. The prevalence of parent fluoride refusal for children with a history of untreated caries was significantly lower than that for children with no history of untreated caries (adjusted prevalence ratio, 0.79; 95% CI, 0.64 to 0.98; P = .03). CONCLUSIONS: Parents of children with a history of caries are less likely to refuse topical fluoride treatment, which suggests that untreated caries may motivate parents to accept preventive dental treatments like fluoride. PRACTICAL IMPLICATIONS: Dental care professionals should assess caries risk and communicate a child's caries risk before making a recommendation regarding topical fluoride treatment.

Synergistic Treatment of Infected Burn Wound Utilizing Maggot Debridement and Acellular Fish Skin Grafting-A Case Report.

Here, we report about a patient with a full-thickness burn injury of the left lower extremity with approximately 8% of total BSA affected. Initial therapy consisted of necrosectomy and wound coverage with split-thickness graft. The patient developed a wound infection with Pseudomonas aeruginosa, resulting in the failure of the skin graft to achieve complete healing. The case was further complicated by the patient's concurrent presentation of anemia, characterized by a hematocrit level of 19.8% on 11th day after admission. Additionally, the patient refused acceptance of any blood transfusion, adding a significant layer of complexity to the management strategy. In summary, the patient's critical state required an immediate intervention. Due to the contraindication for a further surgical debridement and autograft, we changed the treatment strategy to a conservative approach. First, the wound was debrided employing maggot therapy 17 days after admission. Subsequently, free soft tissue coverage was accomplished using decellularized fish skin dressings on 45th day. This approach yielded satisfactory wound closure. Following an approximately 2-month hospitalization period (52nd day after admission), the patient was discharged with a stable wound condition, nearing complete healing.

Assessing Feeding Difficulties in Children Presenting with Non-IgE-Mediated Gastrointestinal Food Allergies-A Commonly Reported Problem.

Many guidelines have been published to help diagnose food allergies, which have included feeding difficulties as a presenting symptom (particularly for non-IgE-mediated gastrointestinal allergies). This study aimed to investigate the prevalence of feeding difficulties in children with non-IgE-mediated gastrointestinal allergies and the association of such difficulties with symptoms and food elimination. An observational study was performed at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. Children aged 4 weeks to 16 years without non-allergic co-morbidities who improved on an elimination diet using a previously published Likert scale symptom score were included. This study recruited 131 children, and 114 (87%) parents completed the questionnaire on feeding difficulties. Feeding difficulties were present in 61 (53.5%) of the 114 children. The most common feeding difficulties were regular meal refusals (26.9%), extended mealtimes (26.7%), and problems with gagging on textured foods (26.5%). Most children (40/61) had ≥2 reported feeding difficulties, and eight had ≥4. Children with feeding difficulties had higher rates of constipation and vomiting: 60.7% (37/61) vs. 35.8% (19/53), p = 0.008 and 63.9% (39/61) vs. 41.5% (22/53), p = 0.017, respectively. Logistic regression analysis demonstrated an association between having feeding difficulties, the age of the child, and the initial symptom score. Gender and the number of foods excluded in the elimination diet were not significantly associated with feeding difficulties. This study found that feeding difficulties are common in children with non-IgE-mediated gastrointestinal allergies, but there is a paucity of food allergy specific tools for establishing feeding difficulties, which requires further research in the long-term and consensus in the short term amongst healthcare professions as to which tool is the best for food allergic children.