The learning needs and clinical requirements of post graduate critical care nursing students in rural and regional contexts: A scoping review.

OBJECTIVES: The objective of this review was to establish the learning needs and clinical requirements of postgraduate critical care nursing students preparing for clinical practice in rural and regional contexts. REVIEW METHOD USED: Scoping review. DATA SOURCES: Published and unpublished empirical studies. REVIEW METHODS: A scoping review based on database searches (CINAHL and Medline) using Aromataris and Munn's four-step search strategy, plus subsequent forward reference search strategy was undertaken, applying predetermined selection criteria. The review aligned to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Review. Studies were uploaded into Endnote 20© for storage and into Covidence 2.0© for data extraction. Screening was undertaken by a primary reviewer, with a secondary reviewer evaluating the studies identified as relevant by the first reviewer. Qualitative codes were derived, and reflexive thematic analysis synthesised the results of the review, using Braun and Clarke's six-phase process. RESULTS: Nine foundational learning needs for critical care nursing students were extracted from the literature. The nine established foundational learning needs were: behavioural attributes/personal base; critical thinking and analysis; ethical practice; identification of risk; leadership, collaboration, and management; professional practice; provision and coordination of clinical care; research knowledge, standards of care, and policy development; and the health consumer experience. Discerning learning needs specific to rural and regional critical care nursing students was difficult. Only one study that met the inclusion criteria was identified. This study identified some instances of interest in relation to rural and regional learning needs. These instances were related to preparation of rural students for low-volume, high-stake situations; transfer of critically ill patients; stabilisation and preparation of critically ill patients; and care of specific patient groups such as, critically ill, bariatric, paediatric, obstetric, trauma, and patients with behavioural issues. CONCLUSIONS: Limited literature exists within the rural and regional critical care nursing educational context, making it difficult to determine the unique learning needs of students within this group. This scoping review lays the groundwork for further research into the needs of critical care nursing students situated within the rural and regional context.

Safety and efficacy of a novel diffractive lens array using a picosecond 755 nm alexandrite laser for treatment of wrinkles.

INTRODUCTION: Picosecond lasers have been reported to be effective for removal of tattoo pigment. This prospective study evaluated the efficacy and safety of the treatment of peri-oral and -ocular wrinkles using a novel diffractive lens array coupled with a picosecond 755 nm alexandrite laser. METHODS: Forty female subjects presenting with wrinkles from photodamage were enrolled in an IRB approved study. Subjects received four picosecond diffractive lens array treatments to the full face at 1 month intervals. Six subjects were biopsied (two subjects at 1 month, two subjects at 3 months, and two subjects at 6 months). Digital photographic images were taken at 1, 3, and 6 months post-final treatment visits. Images were graded by blinded physicians for fine lines/wrinkles, erythema, dyschromia, and global improvement. Data on discomfort level, satisfaction, and side effects were recorded. RESULTS: Overall blinded physician rated global improvement ranged from improved to much improved at 1-, 3-, and 6-month time points. At baseline the average Fitzpatrick wrinkle score was 5.48. At the 6-month follow-up the average score was 3.47. The overall average change in score from pre-treatment to post-treatment was 1.97. Subject self-assessment at 6 months indicated that 90% of subjects were extremely or satisfied with their results. Unanticipated adverse events were absent with anticipated post-treatment erythema lasting for just several hours. CONCLUSIONS: A novel diffractive lens array used with a picosecond 755 nm alexandrite laser for treatment of wrinkles is highly effective and safe for wrinkles and other signs of photoaging. Lasers Surg. Med. 49:40-44, 2017. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Leg Rejuvenation: A Combination Approach: A Review and Our Experience.

BACKGROUND: Patients increasingly seek to enhance the appearance of their legs. Elimination of unwanted leg veins, reduction of epidermal photo-aging changes such as solar lentigines and keratoses, tightening of skin laxity and reduction of adipose tissue are among the most commonly requested goals. Many patients require a combination approach to address their concerns. It is important for dermatologists to be aware of the multitude of procedures that can be performed, often in combination, to rejuvenate the leg. OBJECTIVE: The purpose of this review article was to discuss procedures for improving the appearance of the leg and to share the authors experience, especially in the combination approach to leg rejuvenation. METHODS: A literature search was performed to investigate cosmetic procedures being performed on the leg, with an emphasis on controlled or randomized studies. In addition, the authors contributed their personal experience. RESULTS: Our discussion of the literature review highlights the treatments for leg veins, unwanted fat, cellulite, and photodamage of the legs that are most supported in peer-reviewed publications. CONCLUSION: A synergistic, combination approach to leg rejuvenation works best. This includes the use of injectable agents, energy-based devices, and more invasive surgical procedures.

Psychometric performance of the English language six-item Caring Behaviours Inventory in an acute care context.

AIMS AND OBJECTIVES: This study aimed to evaluate the psychometric performance of the six-item Caring Behaviours Inventory in a sample of Australian acute hospital inpatients. BACKGROUND: Caring is significant for nursing, and exploring the prevalence of staff-caring behaviours is imperative for high-quality acute care. There is a need for psychometrically sound scales that measures caring in acute care, without imposing extensive respondent burden. DESIGN: A cross-sectional survey design was used to distribute the six-item Caring Behaviours Inventory to an Australian sample of hospital inpatients (n = 210) in December 2012. METHOD: Psychometric evaluation included item performance, construct validity and internal consistency reliability. RESULTS: The six-item Caring Behaviours Inventory had satisfactory psychometric performance as evidenced by normally distributed scores, a uni-dimensional structure explaining 65% of variance in data, a total Cronbach's α of 0·89 and corrected item-total correlations between 0·51-0·82. CONCLUSION: The six-item Caring Behaviours Inventory had satisfactory estimates of validity and reliability when tested in an Australian sample of acute hospital inpatients. The tool contributes to the literature by being a brief and nonburdensome alternative with seemingly strong psychometric properties to be used in future measures of caring in nursing. RELEVANCE TO CLINICAL PRACTICE: The six-item Caring Behaviours Inventory provides a psychometrically tested fundament for reflective clinical discussions on how nurse behaviours facilitate or impede patient experiences of caring. This can benefit quality development in clinical practice as being in tune with patient experiences and expectations is fundamental to high quality services and patient satisfaction.

A heutagogical approach to building the residential aged care workforce capability and capacity.

OBJECTIVE: This paper reports on the design and implementation of an interactive online education package for the diverse Australian residential aged care workforce, in response to the findings of the Royal Commission into Aged Care Quality and Safety. A decade of reports has consistently highlighted the need for an educated workforce to care for the increasingly frail older people with complex care needs living in residential aged care. Cost, availability and timing of education have been identified as barriers to uptake of education for this workforce. METHODS: A heutagogical approach was used to design an evidence-based, modular, online education package for nurses, care workers and allied health practitioners working in the residential aged care sector. The subject matter was developed by experts and the education divided into modules. A key challenge was to design a package that was inclusive of the diversity of educational needs in this workforce. The package does not provide assessments on completion of the modules, relying solely on the motivation of the individual learner. RESULTS: This online education package provides choice and self-determination for users in their learning journey. Collaborating with experts to develop an online education program that is learner-driven, challenges the conventions of education. Users can navigate the package at their pace; choose the modules they have identified as knowledge gaps or are of interest; and complete the education in their own time. CONCLUSION: As expected, most users are care workers and nurses and the five modules of the Dementia program are the most popular.

Impact of Animal-Assisted Interaction on Anxiety in Children With Advanced Cancer and Their Caregivers.

Background: Pediatric patients with advanced cancer and their caregivers have unique psychosocial needs. Anxiety often worsens throughout treatment for both patients and parents, and, if undertreated, can cause suffering. Animal-assisted interaction (AAI) incorporates animals into patient care in a structured manner for the purpose of therapeutic benefit. Objective: To evaluate feasibility of incorporating AAI into patient care and to assess AAI effectiveness in decreasing patient and caregiver anxiety in pediatric patients with advanced cancer, defined by relapsed or refractory disease. Design: Randomized controlled study. Setting/Subjects: Participants were children (n = 19) and parents (n = 21) who were randomized to AAI group or usual care (UC) group. Measures: Participants completed weekly measures to assess anxiety, including the 20-question State-Trait Anxiety Inventory (STAI). Results: Our results demonstrated feasibility of the use of AAI in children with advanced cancer. While they did not reveal a significant difference in anxiety scores over the four sessions in either group, parents randomized to the AAI group had lower STAI State subscores at initial visit in comparison to the UC group. The difference in initial STAI State anxiety scores for caregivers may indicate a positive effect of AAI in reducing anxiety surrounding appointments through anticipation of seeing a therapy dog. Conclusion: Further research is needed to determine the effectiveness of AAI in pediatric patients with advanced cancer and their caregivers, but results are promising that participation in AAI may lessen caregiver anxiety. Clinical Trial Registration Number is: NCT03765099.

Altitude exposures during commercial flight: a reappraisal.

BACKGROUND: Hypobaric hypoxia during commercial air travel has the potential to cause or worsen hypoxemia in individuals with pre-existing cardiopulmonary compromise. Knowledge of cabin altitude pressures aboard contemporary flights is essential to counseling patients accurately about flying safety. The objective of the study was to measure peak cabin altitudes during U.S. domestic commercial flights on a variety of aircraft. METHODS: A handheld mountaineering altimeter was carried by the investigators in the plane cabin during commercial air travel and peak cabin altitude measured. The values were then compared between aircraft models, aircraft classes, and distances flown. RESULTS: The average peak cabin altitude on 207 flights aboard 17 different aircraft was 6341 +/- 1813 ft (1933 m +/- 553 m), significantly higher than when measured in a similar fashion in 1988. Peak cabin altitude was significantly higher for flights longer than 750 mi (7085 +/- 801 ft) compared to shorter flights (5160 +/- 2290 ft/1573 +/- 698 m). Cabin altitude increased linearly with flight distance for flights up to 750 mi in length, but was independent of flight distance for flights exceeding 750 mi. Peak cabin altitude was less than 5000 ft (1524 m) in 70% of flights shorter than 500 mi. Peak cabin altitudes greater than 8000 ft (2438 m) were measured on approximately 10% of the total flights. CONCLUSIONS: Peak cabin altitude on commercial aircraft flights has risen over time. Cabin altitude is lower with flights of shorter distance. Physicians should take these factors into account when determining an individual's need for supplemental oxygen during commercial air travel.

A rare cause of posterior reversible encephalopathy syndrome: Acute lymphoblastic leukemia.

Key Clinical Message: The presentation of posterior reversible encephalopathy syndrome (PRES) as the initial presenting sign of acute lymphoblastic leukemia is unusual, as PRES is more often a complication of therapy. This case highlights the importance of maintaining a broad differential diagnosis for pediatric hypertension and its complications. Abstract: A 6-year-old male presented with a seizure-like episode. Evaluation revealed hypertension and brain imaging showed findings consistent with posterior reversible encephalopathy syndrome. Complete blood count showed lymphoblasts, and the cause of his hypertension was determined to be renal infiltration of leukemia cells due to B-cell acute lymphoblastic leukemia.

Using Teamwork to Bridge the Adolescent and Young Adult Gap.

PURPOSE: Individuals diagnosed with cancer age between 15 and 39 years (adolescents and young adults [AYAs]) have not seen improvement in survival compared with children or older adults; clinical trial accrual correlates with survival. Unique unmet needs among AYAs related to psychosocial support and fertility preservation (FP) are associated with health-related quality of life. METHODS: We enhanced existing structures and leveraged faculty/staff across pediatric/adult oncology to create novel teams focused on AYA (age 15-39 years) care at a single center, with minimal dedicated staff and no change to revenue streams. We aimed to influence domains shown to drive survival and health-related quality of life: clinical trial enrollment, physician/staff collaboration, psychosocial support, and FP. We captured metrics 3 months after patients presented to the institution and compared them before/after Program implementation using descriptive statistics. RESULTS: Among 139 AYAs (age 15-39 years) from the pre-Program era (January 2016-February 2019: adult, n = 79; pediatric, n = 60), and 279 from the post-Program era (February 2019-March 2022: adult, n = 215; pediatric, n = 64), there was no change in clinical trial enrollment(P ≥ .3), whereas there was an increase in the proportion of AYAs referred for supportive care and psychology (pediatric: P ≤ .02; adult: P ≤ .001); whose oncologists discussed FP (pediatric: 15% v 52%, P < .0001; adult: 37% v 50%, P = .0004); and undergoing FP consults (pediatric: 8% v39%, P < .0001; adult 23% v 38%, P = .02). CONCLUSION: This team-based framework has effected change in most targeted domains. To affect all domains and design optimal interventions, it is crucial to understand patient-level and facility-level barriers/facilitators to FP and clinical trial enrollment.

Atypical granular cell tumor-apropos of a case with indeterminate malignant potential.

Malignant granular cell tumor is relatively uncommon, constituting 1%-2% of all granular cell tumors.We describe a case of a 53-year-old woman who presented with a 4.5 X 5.5-cm nodule on her left lower abdomen. An initial punch biopsy revealed a pandermal infiltrate of epithelioid cells with finely granular cytoplasm and vesicular nuclei-histologic features consistent with a granular cell tumor. Given the large size of the neoplasm, an excisional biopsy was recommended that revealed in addition to the above, focal ulceration, epithelioid cells with vesicular nuclei and prominent nucleoli, increased mitotic activity, pleomorphism, and epidermotropism with pagetoid spread-features that were histologically concerning for malignant transformation. We present this case to increase awareness of an uncommon entity and to emphasize the pitfalls associated with incomplete removal and an inadequate biopsy.

Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy.

BACKGROUND: Hospitals are advised to measure antibiotic use and monitor its relationship to resistance. The World Health Organization's recommended metric is the defined daily dose (DDD). An alternative measure is the number of days of therapy (DOT). The purpose of this study was to contrast these measures. METHODS: We measured the use of 50 antibacterial drugs that were administered to adults who were discharged from 130 US hospitals during 1 August 2002-31 July 2003. RESULTS: Of 1,795,504 patients, 1,074,174 received at least 1 dose of an antibacterial drug (59.8%). The mean (+/- standard deviation) of total antibacterial drug use measured by the number of DDDs per 1000 patient-days and the number of DOTs per 1000 patient-days were not significantly different (792+/-147 and 776+/-120, respectively; P=.137), although the correlation was poor (r=0.603). For some individual drugs, such as levofloxacin and linezolid, there was no significant difference between DDDs per 1000 patient-days and DOTs per 1000 patient-days, because the administered daily dosage was nearly equivalent to the DDD. When the administered dosage exceeded the DDD, such as for ampicillin-sulbactam and cefepime, estimates of use based on DDDs per 1000 patient-days significantly exceeded those based on DOTs per 1000 patient-days (P<.001). When the administered dosage was less than the DDD, such as for piperacillin-tazobactam and ceftriaxone, estimates of use based on DDDs per 1000 patient-days were significantly lower than those based on DOTs per 1000 patient-days (P<.001). CONCLUSION: The measurement of aggregate hospital antibiotic use by DDDs per 1000 patient-days and DOTs per 1000 patient-days is discordant for many frequently used antibacterial drugs, because the administered dose is dissimilar from the DDD recommended by the World Health Organization. DDD methods are useful for benchmarking purposes but cannot be used to make inferences about the number of DOTs or relative use for many antibacterial drugs.

Noninvasive measurement of carboxyhemoglobin levels for adjustment of diffusion capacity measured during pulmonary function testing.

BACKGROUND: The diffusing capacity of the lungs for carbon monoxide (D(LCO)) is commonly measured during pulmonary function testing (PFT). Although adjustment of the measured D(LCO) for an elevated baseline carboxyhemoglobin level is recommended, carboxyhemoglobin is not routinely measured, which may reduce the accuracy of D(LCO) measurements. We sought to assess the utility of routine carboxyhemoglobin measurement and subsequent D(LCO) correction in patients referred for PFT. METHODS: We retrospectively reviewed 100 consecutive PFT results, including D(LCO) assessment. We used a pulse CO-oximeter (recently approved by the Food and Drug Administration) to noninvasively measure baseline carboxyhemoglobin (S(pCO)). We used simple descriptive statistics to compare the S(pCO) values. In subjects with elevated S(pCO) (> 2%) we adjusted the percent-of-predicted D(LCO). Interpretation of D(LCO) was categorized according to the American Thoracic Society classification scheme for respiratory impairment. RESULTS: The self-reported smokers had higher average S(pCO) than did self-reported nonsmokers (1.6% vs 3.5%, p < 0.001), although 14% of nonsmokers had an elevated S(pCO) and 26% of smokers had normal S(pCO). When the D(LCO) was corrected for elevated S(pCO), 2 patients moved from a category of moderate impairment to mild impairment. Both were smokers. CONCLUSIONS: The noninvasive measurement of carboxyhemoglobin is easy to perform during PFT. When precise measurement of D(LCO) is important, noninvasive measurement of carboxyhemoglobin may be of value. If routine S(pCO) measurement is considered, the highest yield is among current smokers.

Treatment of lateral canthal rhytides with a medium depth chemical peel with or without pretreatment with onabotulinum toxin type A: a randomized control trial.

BACKGROUND: Combination therapies used to treat the photoaged skin have become more popular as studies demonstrate greater efficacy and improved clinical outcomes compared to single treatment modalities. OBJECTIVES: To evaluate the safety and effectiveness of treating the lateral canthal rhytide complex with a Jessner's and 35% TCA peel with and without pretreatment with BTX-A. METHODS: Twenty-six subjects with Fitzpatrick skin types I -III were randomized to receive treatment of their lateral canthal rhytide complex with a Jessner's and 35% TCA peel with or without pretreatment with BTX-A. A single blinded dermatologist assigned a lateral canthal wrinkle score of subjects' at baseline and week 8-10. RESULTS: Comparison between the two treatment groups demonstrated that the group receiving combination treatment had significantly greater improvement in wrinkle reduction as compared to the group only receiving the chemical peel (P =0.002). In addition, there was no significant association between skin type and treatment groups (P = 0.11). CONCLUSIONS: These findings suggest that treating the lateral canthal rhytide complex with a combination of BTX-A followed by Jessner's and 35% TCA peel is more effective than chemical peel alone. These results are independent of skin type and demonstrate an additional treatment strategy for lateral canthal rhytides.

Moving beyond gender: processes that create relationship equality.

Equality is related to relationship success, yet few couples achieve it. In this qualitative study, we examine how couples with children in two time cohorts (1982 and 2001) moved toward equality. The analysis identifies three types of couples: Postgender, gender legacy, and traditional. Movement toward equality is facilitated by: (a) Stimulus for change, including awareness of gender, commitment to family and work, and situational pressures; and (b) patterns that promote change, including active negotiation, challenges to gender entitlement, development of new competencies, and mutual attention to relationship and family tasks. Implications for practice are discussed.

Treatment of Acne Vulgaris With Salicylic Acid Chemical Peel and Pulsed Dye Laser: A Split Face, Rater-Blinded, Randomized Controlled Trial.

INTRODUCTION: Pulsed dye laser (PDL) has been used to treat acne lesions and scar erythema by interrupting superficial vasculature. Salicylic acid chemical peels are employed chiefly due to their lipophilic, comedolytic, and anti-inflammatory properties. Although studies have looked at peels and laser therapy independently in acne management, we examined these treatments in combination. Our primary objective was to evaluate the safety and efficacy of concurrent use of salicylic acid peels with PDL versus salicylic acid peels alone in the treatment of moderate to severe acne vulgaris. METHODS: Adult patients with moderate to severe acne were included. Subjects received a total of 3 treatments at 3-week intervals. Per randomized split-face treatment, at week 0, one half of the subject's face was treated with PDL (595 nm) followed by whole face application of a 30% salicylic acid peel. At weeks 3 and 6, the treatments were repeated. At 0 and 9 weeks, patients were assessed with the Global Evaluation Acne (GEA) scale and Dermatology Life Quality Index (DLQI) questionnaire. RESULTS: Nineteen subjects were enrolled, and 18 completed the study. Significant improvement in acne was seen in both the combined (laser and peel) and chemical peel alone treatment arms (P < .0005 and P = .001). Using the GEA scale score, compared to week 0, the mean difference in acne improvement at week 9 was -1.61 in the combination therapy group versus -1.11 in the peel only group. Based on the GEA scale scoring, a statistically significant greater difference in acne improvement was seen, from week 0 to week 9, in the combination treatment group compared with the peel only group (P = .003). CONCLUSION: While acne subjects had significant benefit from the salicylic acid peel alone, they experienced greater significant benefit from PDL treatment used in conjunction with salicylic acid peels. The adjunctive utilization of PDL to salicylic acid peel therapy can lead to better outcomes in acne management.

Oral care of hospitalised older patients in the acute medical setting.

Oral health care is an essential aspect of nursing care. There are many variances in the quality and frequency of the oral care that is delivered to patients by nursing staff, such as oral care being given a low priority when compared to other nursing care elements, oral care being neglected, and oral care delivery being dependent on the nurse's knowledge of oral hygiene. Additionally, there are some particular patient groups known to be at risk of oral health problems or who have existing oral diseases and conditions. As people age their susceptibility increases to chronic and life-threatening diseases, and they can be at increased risk of acute infections increases compromised by ageing immune systems. The aim of this literature review was to ignite the discussion related to the oral care practices of nurses for older acute medical hospitalised patients. The review revealed that nursing staff know that good nursing includes oral health care, but this knowledge does not always mean that oral health care is administered. Oral health care seems to be separated from other nursing activities and is not discussed when nursing care plans are written, only when oral problems are obvious.

Treatment of forehead/glabellar rhytide complex with combination botulinum toxin a and hyaluronic acid versus botulinum toxin A injection alone: a split-face, rater-blinded, randomized control trial.

BACKGROUND: Forehead and glabella rhytides are treated mostly with neurotoxins, although some practitioners prefer the concurrent use of fillers. It has been suggested that combination treatments can result in a better overall improvement. AIMS: To compare the safety and effectiveness of treatment of forehead and glabellar lines with botulinum toxin A alone versus botulinum toxin A and filler. METHODS: Split-face, randomized control trial. Twenty subjects with forehead/glabellar rhytide complex (static and dynamic creases) enrolled. Subjects were randomized and injected with botulinum toxin alone on one side of the forehead/glabella and hyaluronic acid filler followed by botulinum toxin on the other side. Blinded ratings were obtained to assess the effectiveness of treatment for static and dynamic rhytides, respectively, at 2-week, 6-week, 3-month, and 6-month follow-up visits. Subjects performed a self-evaluation at the end of the study. Adverse events were recorded. RESULTS: Ratings of both treatments showed comparable efficacy, with 100% of subjects experiencing improvement from baseline regardless of treatment type at weeks 2, 6, and 12. Combination treatment produced longer-lasting results in dynamic forehead wrinkles, and greater static and dynamic wrinkle reduction in the glabella at week 24. Subject self-evaluations showed that both treatments were effective, with a nominal preference for combination treatment. CONCLUSIONS: Glabella and forehead lines can be effectively and safely reduced with neurotoxin alone as well as neurotoxin in combination with fillers. Combination treatment may provide a slightly better cumulative benefit and also increase the persistence of effect.

Association of pediatric psoriasis severity with excess and central adiposity: an international cross-sectional study.

OBJECTIVE: To investigate the relationship of excess and central adiposity with pediatric psoriasis severity. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, cross-sectional study of 409 psoriatic children. Psoriasis was classified as mild (worst Physician's Global Assessment score ≤3 with body surface area ≤10%) or severe (worst Physician's Global Assessment score ≥3 with body surface area >10%). Children were enrolled from 9 countries between June 19, 2009, and December 2, 2011. MAIN OUTCOME MEASURES: Excess adiposity (body mass index percentile) and central adiposity (waist circumference percentile and waist to height ratio). RESULTS: Excess adiposity (body mass index ≥85th percentile) occurred in 37.9% of psoriatic children (n=155) vs 20.5% of controls (n=42) but did not differ significantly by severity. The odds ratio (95% CI) of obesity (body mass index ≥95th percentile) overall in psoriatic children vs controls was 4.29 (1.96-9.39) and was higher with severe (4.92; 2.20-10.99) than with mild (3.60; 1.56-8.30) psoriasis, particularly in the United States (7.60; 2.47-23.34, and 4.72; 1.43-15.56, respectively). Waist circumference above the 90th percentile occurred in 9.3% of the control (n=19), 14.0% of the mild psoriasis (n=27), and 21.2% of the of severe psoriasis (n=43) participants internationally; this incidence was highest in the United States (12.0% [n=13], 20.8% [16], and 31.1% [32], respectively). Waist to height ratio was significantly higher in psoriatic (0.48) vs control (0.46) children but was unaffected by psoriasis severity. Children with severe psoriasis at its worst, but mild at enrollment, showed no significant difference in excess or central adiposity from children whose psoriasis remained severe. CONCLUSIONS: Globally, children with psoriasis have excess adiposity and increased central adiposity regardless of psoriasis severity. The increased metabolic risks associated with excess and central adiposity warrant early monitoring and lifestyle modification. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00879944

Gendered power in cultural contexts: Part III. Couple relationships in Iran.

Sometimes therapists assume that gender equality is not relevant when working with couples from traditional cultures. This study of couples in Iran suggests more complexity. The authors identify a variety of views and practices regarding equality between men and women in relationships. Some aspired to traditional roles; others attempted to create mutually supportive relationships. Yet others were somewhere in-between. This study helps identify important dimensions that may be overlooked when we define couple equality only by American standards or understand it only through a Western lens. The study provides insight into the dilemmas couples face when ideals of equality intersect with societal structures that maintain gendered power and offers suggestions for addressing gender when working with couples with traditional cultural backgrounds.