Synchronous disease onset and flares in siblings with PFAPA.

BACKGROUND: Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) is a clinical syndrome of unclear etiology. PFAPA has generally been considered a non-hereditary fever syndrome; however, this has been called into question with recent reports of family clustering. Few reports have been published describing siblings with PFAPA. To our knowledge, this is the first report of siblings with near simultaneous onset of disease followed by synchronous disease flares. CASE PRESENTATION: We describe the case of near simultaneous onset of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis in siblings followed by synchronous disease flares of clear frequency and nearly identical character. Flares were characterized predominantly by fever, aphthous ulceration, cervical lymphadenitis, and the absence of infection. The fever episodes demonstrated a robust response to glucocorticoids and recurred in the same staggered manner every four weeks, with complete absence of symptoms and normal growth and development between episodes. Nine months after onset, the older sibling, a 5-year-old female, underwent tonsillectomy resulting in dramatic resolution of episodes. At the same time, her 2-year-old sister experienced resolution of her fever episodes, though she did not undergo tonsillectomy herself. CONCLUSION: This is an unusual case of simultaneous onset PFAPA followed by synchronous disease flares. PFAPA is an uncommon clinical syndrome, and it is rarely diagnosed in siblings. The etiology of PFAPA remains unclear. Though the disease is classically considered sporadic, there is a growing body of evidence to suggest that PFAPA may be heritable.

Oral health and health care in female sex workers: concomitant quantitative and qualitative approaches.

Sex workers, including female ones, have a higher risk of developing cancer and oral diseases due to the overlapping of risk factors. To characterize oral health status and healthcare practices and behaviors in female sex workers. Both quantitative and qualitative concomitant approaches were used. A closed-ended questionnaire, clinical examination, and semi-structured interview were administered, from July 2017 to August 2018, to 21 intentionally selected participants, in the city of Itajaí, southern Brazil. Although the participants reported having good oral health and healthcare habits, some oral diseases and harmful habits were observed. Poor oral hygiene and habits such as smoking, alcohol, and illicit drug use were found. Most of the participants had undergone gynecological follow-up in the last 12 months. Qualitative analysis gave rise to six categories: Social aspects of working as a sex worker, Work routine, Sexual practices and behaviors and protection from sexually transmitted infections, Practices and behaviors (including unprotected sun exposure, smoking, and alcohol use at work), Use of illicit drugs at work, and General and oral health care and perceptions about their oral health. Oral health status of the participants was variable, and most of them smoked cigarettes, drank alcohol, and consumed illicit drugs at work. Preventive condom use was reported. Most of them underwent recent serological tests for sexual diseases and gynecological follow-up, incentivized by the community health workers that facilitate access to public services.

Biologics for the Treatment of Food Allergies.

Food allergy is increasingly prevalent and poses a life-threatening risk to those afflicted. The health care costs associated with food allergies are also increasing. Current and emerging treatments for food allergies aim at protecting against reactions caused by accidental ingestion and increasing the food allergen reaction threshold, although this protection is often temporary. In the future, ideal biologic therapies would target key mediators of the type II immune pathway, essential in development of the atopic march to prevent development of food allergies. Biologics offering long-term protection against allergic reactions to food are needed, and several agents are already in development.

The readability, suitability, and content features of eczema action plans in the United States.

BACKGROUND/OBJECTIVES: Little is known about the reading grade level (readability), appropriateness of design (suitability), and content variability of written eczema action plans (EAPs), which can impact the effectiveness of these patient education tools. Here, we assess the readability, suitability, and content of EAPs currently used by pediatric dermatologists in the United States. METHODS: This was a cross-sectional study of EAPs submitted by members of the Society for Pediatric Dermatology (n = 26). Readability, suitability, and content of sampled plans were systematically assessed. RESULTS: Mean (SD) reading grade level was 9.0 (2.1); one in five was written at the recommended level of 6th grade or lower. While the majority of EAPs were found to be adequately suitable, one in five was unsuitable and only two superior. Documents scored most poorly in layout/design and learning stimulation. Plans scored best in the categories of content and literacy demand. EAPs focused on similar content themes, though specific recommendations and descriptors of atopic dermatitis (AD) disease states varied considerably. CONCLUSIONS: The health literacy burden of EAPs in the United States could be lowered by improving their readability, incorporating graphics, stimulating reader engagement, and developing standards for how AD flares are defined.

The New York City Mental Health Needs Assessment Study (MHNAS): Objectives, design, and methods.

OBJECTIVES: This paper describes the objectives, design, and methods of the Mental Health Needs Assessment Study (MHNAS). The objective of the MHNAS was to assess the needs of individuals transitioning to the community following psychiatric hospitalization and again 3-5 months later to inform community service planning. Needs were defined broadly to include domains like housing, employment, treatment, and social support. METHODS: The MHNAS used a 2-stage clustered sampling approach where the primary sampling units were hospitals and secondary sampling units were patients. The study included an in-person patient interview, an assessment of need from a key hospital worker, and a follow-up telephone interview 3-5 months after discharge. RESULTS: One thousand one hundred twenty-nine patients from 8 randomly selected hospitals participated. The overall response rate was 54.3% with a cooperation rate of 71.8%. The sample was similar to the overall population of psychiatric patients with respect to several key demographics. CONCLUSION: The MHNAS demonstrates the feasibility of conducting a needs assessment with a random sample of psychiatric inpatients in a large urban setting. Results from this study may improve community service planning to better meet individuals' needs, with the ultimate goal of reducing rehospitalization and promoting recovery.

Community-Acquired MRSA Pericarditis and Mediastinitis in a Previously Healthy Infant.

Invasive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections disproportionately affect children, but there are few pediatric reports of pericarditis and mediastinitis caused by CA-MRSA in previously healthy children. Here we report a severe case of CA-MRSA pericarditis with extension to the mediastinum and carotid sheath in a previously healthy 8-month-old infant who was successfully treated with surgical interventions and with a combination of daptomycin and vancomycin. The relatively indolent clinical course in this patient was notable given the significant extent of infection. This case highlights the potential virulence of CA-MRSA in previously healthy children and the importance of early diagnosis, prompt drainage, and appropriate antibiotic coverage.

Psicólogo intensivista: reflexões sobre a inserção profissional no âmbito hospitalar, formação e prática profissional / El psicólogo intensivista: reflexiones acerca de la inserción en el ámbito hospitalario, formación y práctica profesional / Intensive care psychologist: reflections about professional insertion, professional qualification and practice at the hospital

Esta pesquisa buscou analisar o perfil do psicólogo hospitalar atuante em Unidades de Terapia Intensiva em hospitais públicos e privados de Porto Alegre, conhecer sua formação, as principais intervenções psicológicas utilizadas no atendimento ao paciente e seus familiares, as possibilidades de intervenção com a equipe assistencial atuante em terapia intensiva e identificar possíveis carências na formação do psicólogo que sejam consideradas essenciais pelas participantes para atuação neste campo. Os dados foram coletados através de um questionário sociodemográfico e uma entrevista semi dirigida. Foram entrevistadas sete psicólogas intensivistas de dois hospitais de Porto Alegre-RS, atuantes em unidades de atenção a pacientes adultos, pediátrica e neonatal. As informações obtidas nas entrevistas foram submetidas à análise de conteúdo, e dela emergiram categorias temáticas para posterior interpretação dos resultados. Foi percebida uma carência nos cursos de Psicologia de conteúdos que capacitem os alunos para as especificidades da atuação em saúde e sua inserção em equipes multiprofissionais. A pesquisa também evidenciou a necessidade de adaptação das técnicas já utilizadas na clínica, tanto no que diz respeito à avaliação psicológica quanto nos atendimentos a pacientes, familiares e intervenções em grupo. Evidencia-se a carência de estudos sobre Psicologia Intensivista, destacando a necessidade de mais pesquisas nesta área.

Resumen La investigación buscó cono cer las especificidades de la práctica del psicólogo intensivista, analizando aspectos de su rutina profesional, dificultades y potencialidades, principales intervenciones con familiares y equipos de salud, además de investigar sobre su formación profesional y como esta repercute sus acciones en la actualidad. Los datos fueron recogidos a través de cuestionario sociodemográfico y entrevista semidirigida. Fueron entrevistadas siete psicólogas intensivistas, de dos hospitales de la ciudad de Porto Alegre-RS, actuantes en unidades de atención a pacientes adultos, pediátrica y neonatal. Las informaciones obtenidas en las entrevistas fueron sometidas a un análisis de contenido y emergieron categorías temáticas para la posterior interpretación de los resultados. Fue percibida una carencia en los cursos de Psicología de contenidos que capaciten los alumnos para las especificidades de la actuación en salud y su inserción en equipos multiprofesionales en el actual contexto brasilero. Además de esto, la investigación evidenció la necesidad de adaptación de las técnicas ya utilizadas en la clínica, tanto en lo que se refiere a la evaluación psicológica como en la atención a pacientes, familiares e intervenciones en grupo. Evidenciase la carencia de estudios sobre Psicología Intensivista, destacando la necesidad de un mayor número de investigaciones en el área.

Abstract This research aimed to investigate the specifities of the work of intensive care psychologists, analyzing aspects of their professional routines, difficulties and potential, major interventions with patients, families and healthcare teams, and also investigate their training and how it affects the professional actions that have been explored nowadays. The data was collected through a sociodemographic questionnaire and a semistructured interview. Seven intensive care psychologists were interviewed, active in two hospitals in Porto Alegre-RS, both in care units to adult patients, and in areas such as pediatric and neonatal. Information obtained from the interviews was subjected to content analysis from which emerged some topics for the subsequent interpretation of the results. From this analysis, a shortage in Psychology courses that enables students to the specifics of performance in healthcare and its role in multi-professional teams in the current Brazilian context was perceived. In addition, the survey also highlighted the need to adapt the techniques that these pofessionals already used in clinical care, both in terms of psychological assessment as in the care to patients and family and group interventions. The lack of studies on Intensive Psychology was overt, highlighting the need for more research in this area.

Psicólogo intensivista: reflexões sobre a inserção profissional no âmbito hospitalar, formação e prática profissional / El psicólogo intensivista: reflexiones acerca de la inserción en el ámbito hospitalario, formación y práctica profesional

Esta pesquis a buscou analisar o perfil do psicólogo hospitalar atuante em Unidades de Terapia Intensiva em hospitais públicos e privados de Porto Alegre, conhecer sua formação, as principais intervenções psicológicas utilizadas no atendimento ao paciente e seus familiares, as possiblidades de intervenção com a equipe assistencial atuante em terapia intensiva e identificar possíveis carências na formação do psicólogo que sejam consideradas essenciais pelas participantes para atuação neste campo. Os dados foram coletados através de um questionário sociodemográfico e uma entrevista semidirigida. Foram entrevistadas sete psicólogas intensivistas de dois hospitais de Porto Alegre-RS, atuantes em unidades de atenção a pacientes adultos, pediátrica e neonatal. As informações obtidas nas entrevistas foram submetidas à análise de conteúdo, e dela emergiram categorias temáticas para posterior interpretação dos resultados. Foi percebida uma carência nos cursos de Psicologia de conteúdos que capacitem os alunos para as especificidades da atuação em saúde e sua inserção em equipes multiprofissionais. A pesquisa também evidenciou a necessidade de adaptação das técnicas já utilizadas na clínica, tanto no que diz respeito à avaliação psicológica quanto nos atendimentos a pacientes, familiares e intervenções em grupo. Evidencia-se a carência de estudos sobre Psicologia Intensivista, destacando a necessidade de mais pesquisas nesta área.(AU)

La investigación buscó cono cer las especificidades de la práctica del psicólogo intensivista, analizando aspectos de su rutina profesional, dificultades y potencialidades, principales intervenciones con familiares y equipos de salud, además de investigar sobre su formación profesional y como esta repercute sus acciones en la actualidad. Los datos fueron recogidos a través de cuestionario sociodemográfico y entrevista semidirigida. Fueron entrevistadas siete psicólogas intensivistas, de dos hospitales de la ciudad de Porto Alegre-RS, actuantes en unidades de atención a pacientes adultos, pediátrica y neonatal. Las informaciones obtenidas en las entrevistas fueron sometidas a un análisis de contenido y emergieron categorías temáticas para la posterior interpretación de los resultados. Fue percibida una carencia en los cursos de Psicología de contenidos que capaciten los alumnos para las especificidades de la actuación en salud y su inserción en equipos multiprofesionales en el actual contexto brasilero. Además de esto, la investigación evidenció la necesidad de adaptación de las técnicas ya utilizadas en la clínica, tanto en lo que se refiere a la evaluación psicológica como en la atención a pacientes, familiares e intervenciones en grupo. Evidenciase la carencia de estudios sobre Psicología Intensivista, destacando la necesidad de un mayor número de investigaciones en el área.(AU)

Predictors of senior center use among older adults in New York City public housing.

Despite agreement among stakeholders that senior centers can promote physical and mental health, research on senior center use in urban populations is limited. Our objective was to describe demographic and health factors associated with senior center use among urban, low-income older adults in order to inform programming and outreach efforts. We used data from a 2009 telephone survey of 1036 adults randomly selected from rosters of New York City public housing residents aged 65 and older. We analyzed senior center use by race/ethnicity, age, gender, health, housing type, and income, and used a forward selection approach to build best-fit models predicting senior center use. Older adults of all ages and of both genders reported substantial use of senior centers, with nearly one third (31.3%) reporting use. Older adults living alone, at risk of depression, or living in specialized senior housing had the greatest use of centers. Senior center use varied by race/ethnicity, and English-speaking Hispanics had a higher prevalence of use than Spanish-speaking Hispanics (adjusted prevalence ratio [PR]=1.69, 95% CI: 1.11-2.59). Spanish-speaking communities and older adults living in non-senior congregate housing are appropriate targets for increased senior center outreach efforts.

Assessing the susceptibility of transgenic mice overexpressing deer prion protein to bovine spongiform encephalopathy.

Several transgenic mouse models have been developed which facilitate the transmission of chronic wasting disease (CWD) of cervids and allow prion strain discrimination. The present study was designed to assess the susceptibility of the prototypic mouse line, Tg(CerPrP)1536(+/-), to bovine spongiform encephalopathy (BSE) prions, which have the ability to overcome species barriers. Tg(CerPrP)1536(+/-) mice challenged with red deer-adapted BSE resulted in 90% to 100% attack rates, and BSE from cattle failed to transmit, indicating agent adaptation in the deer.

Astrocytes in the rat medial amygdala are responsive to adult androgens.

The posterodorsal medial amygdala (MePD) exhibits numerous sex differences including differences in volume and in the number and morphology of neurons and astroctyes. In adulthood, gonadal hormones, including both androgens and estrogens, have been shown to play a role in maintaining the masculine character of many of these sex differences, but whether adult gonadal hormones maintain the increased number and complexity of astrocytes in the male MePD was unknown. To answer this question we examined astrocytes in the MePD of male and female Long Evans rats that were gonadectomized as adults and treated for 30 days with either testosterone or a control treatment. At the end of treatment brains were collected and immunostained for glial fibrillary acidic protein. Stereological analysis revealed that adult androgen levels influenced the number and complexity of astrocytes in the MePD of both sexes, but the specific effects of androgens were different in males and females. However, sex differences in the number and complexity of adult astrocytes persisted even in the absence of gonadal hormones in adulthood, suggesting that androgens also act earlier in life to determine these adult sex differences. Using immunofluorescence and confocal microscopy, we found robust androgen receptor immunostaining in a subpopulation of MePD astrocytes, suggesting that testosterone may act directly on MePD astrocytes to influence their structure and function.

Contrast-enhanced MRI of right ventricular abnormalities in Cx43 mutant mouse embryos.

Imaging of the mammalian cardiac right ventricle (RV) is particularly challenging, especially when a two-dimensional method such as conventional histology is used to evaluate the morphology of this asymmetric, crescent-shaped chamber. MRI may improve the characterization of mutants with RV phenotypes by allowing analysis of the samples in any plane and by facilitating three-dimensional image reconstruction. MRI was used to examine the conditional knockout Cx43-PCKO mouse line known to have RV malformations. To help delineate the cardiovascular system and facilitate identification of the right ventricular outflow tract (RVOT), embryonic day (E) 17.5 embryos were perfusion fixed through the umbilical vein followed by a gadolinium-based contrast agent mixed in 7% gelatin. Micro-MRI experiments were performed at 7 T and followed by paraffin embedding of specimens, histological sectioning and hematoxylin and eosin (H&E) staining. Imaging of up to four embryos simultaneously allowed for higher throughput than traditional individual imaging techniques, while intravascular contrast afforded excellent signal-to-noise characteristics. All control embryos (n = 4) and heterozygous Cx43 knockout embryos (n = 4) had normal-appearing right ventricular outflow tract contours by MRI. Obvious abnormalities in the RVOT, including abnormal bulging and infiltration of contrast into the wall of the RV, were seen in three out of four Cx43-PCKO mutants with MRI. Furthermore, three-dimensional reconstruction of MR images with orthogonal projections as well as maximum-intensity projection allowed for visualization of the relationship of infundibular bulging segments to the pulmonary trunk in Cx43-PCKO mutant hearts. The addition of MRI to standard histology in the characterization of RV malformations in mutant mouse embryos aids in the assessment and understanding of morphologic abnormalities. Flexibility in the viewing of MR images, which can be retrospectively sectioned in any desired orientation, is particularly useful in the investigation of the RV, an asymmetric chamber that is difficult to analyze with two-dimensional techniques.

Distinct cardiac malformations caused by absence of connexin 43 in the neural crest and in the non-crest neural tube.

Connexin 43 (Cx43) is expressed in the embryonic heart, cardiac neural crest (CNC) and neural tube, and germline knockout (KO) of Cx43 results in aberrant cardiac outflow tract (OFT) formation and abnormal coronary deployment. Prior studies suggest a vital role for CNC expression of Cx43 in heart development. Surprisingly, we found that conditional knockout (CKO) of Cx43 in the dorsal neural tube and CNC mediated by Wnt1-Cre failed to recapitulate the Cx43-null OFT phenotype, although coronary vasculature was abnormal in this mutant line. A broader CKO mediated by P3pro (Pax3)-Cre, involving both ventral and dorsal aspects of the thoracic neural tube and CNC, resulted in infundibular bulging and coronary anomalies similar to those seen in germline Cx43-null hearts. P3pro-Cre-mediated loss of Cx43 in the neural tube was characterized by a late phase of cellular delamination from the dorsal and lateral neural tube, a markedly increased abundance of neuroepithelium-derived cells outside of the neural tube and an excess of such cells infiltrating the heart and infundibulum. Thus, expression of Cx43 in the CNC is crucial for normal coronary deployment, but Cx43 is not required in the CNC for normal OFT morphogenesis. Rather, this study suggests a novel function for Cx43 in which Cx43 acts through non-crest neuroepithelial cells to suppress cellular delamination from the neural tube and thereby preserve normal OFT development.