Eosinophilic Esophagitis Lehman, Heather K; Lam, Weyman
The Pediatric clinics of North America,
10/2019, Letnik:
66, Številka:
5
Journal Article
Recenzirano
Eosinophilic esophagitis is a recently defined condition that has dramatically increased in prevalence in the last several decades. It may occur at any age, but the clinical presentation in young ...children is often more vague than the classic solid food dysphagia and food impacting that are the major presenting symptoms of eosinophilic esophagitis in adults and adolescents. Successful therapies exist, including medications and dietary modifications, but disease typically recurs when the intervention is discontinued.
This paper reports on two comparative ranking tasks performed by a sample of the British citizens (N = 304). The first was designed to compare levels of relative trust vested in a sample of UK risk ...regulatory bodies and associated stakeholder groups. The second sought to elicit a ranking of a range of previously identified facets of social trust referenced to their desirability as attributes of a government funded risk regulatory body. The ranking tasks were embedded within a broader programme of research focused on "Evaluating public understandings of and trust in the Health and Safety Executive" (Pidgeon et al., 2003). It is argued that deriving rankings of multi-faceted phenomena using the method of paired comparisons offers a more robust approach to rating social trust entities than the direct ranking techniques used in previous studies in this area. Results are discussed with reference to qualitative findings from the broader programme of work on public trust in HSE (Pidgeon et al., 2003) and the wider literature on public trust in risk regulation.
The question of whether bilingualism can improve aspects of cognitive function is a hotly debated topic, with evidence on both sides. A few recent studies have reported that bilingualism may provide ...a limited buffer against some aging-related cognitive decline. This study aimed to test that hypothesis by analyzing the combinatorial effects of age and language upon executive function (i.e., general cognitive control mechanisms that regulate cognition and behavior). Amazon Mechanical Turk was used to reach an international sample of younger (YA) and older adults (OA) from 24 countries. 81 participants were monolingual (ML: N(YA)=37, N(OA)=44), and 82 participants were bilingual/multilingual (BL: N(YA)=43, N(OA)=39). Executive function components of inhibition, updating, and switching were measured using stop signal, letter memory, and color shape tasks, respectively. ANOVAs were used to analyze the dataset. The stop signal task indicated that YA had shorter reaction times than OA, F(1,151)=14.51, p<.001. The letter memory task showed a main effect of age in which YA recalled more letters than OA, F(1,158)=7.65, p<.01. Finally, the color shape task revealed that a shorter cued stimulus interval led to a greater switch cost, F(1,151)=83.87, p<.01. Notably, no effects of language (i.e., bilingualism) were significant. YA and OA performed as expected regarding normal cognitive aging; however, no interactions were found between ML and BL participants within each age group. Therefore, this study provides data that challenges the claim that extensive experience with multiple languages can be a reliably protective factor against some normative aging declines in executive function.
This study examined whether a history of diabetic ketoacidosis (DKA) is associated with changes in longitudinal cognitive and brain development in young children with type 1 diabetes.
Cognitive and ...brain imaging data were analyzed from 144 children with type 1 diabetes, ages 4 to <10 years, who participated in an observational study of the Diabetes Research in Children Network (DirecNet). Participants were grouped according to history of DKA severity (none/mild or moderate/severe). Each participant had unsedated MRI scans and cognitive testing at baseline and 18 months.
In 48 of 51 subjects, the DKA event occurred at the time of onset, at an average of 2.9 years before study entry. The moderate/severe DKA group gained more total and regional white and gray matter volume over the observed 18 months compared with the none/mild group. When matched by age at time of enrollment and average HbA
during the 18-month interval, participants who had a history of moderate/severe DKA compared with none/mild DKA were observed to have significantly lower Full Scale Intelligence Quotient scores and cognitive performance on the Detectability and Commission subtests of the Conners' Continuous Performance Test II and the Dot Locations subtest of the Children's Memory Scale.
A single episode of moderate/severe DKA in young children at diagnosis is associated with lower cognitive scores and altered brain growth. Further studies are needed to assess whether earlier diagnosis of type 1 diabetes and prevention of DKA may reduce the long-term effect of ketoacidosis on the developing brain.
One-way pendulum? Weyman, Andrew K; Roy, Deborah; Nolan, Peter
International journal of workplace health management,
01/2020, Letnik:
13, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Purpose
Staff shortage in the UK National Health Service has a long history, but is widely predicted to become acute over the next decade. Falling enrolment rates in health professional training and ...restrictions to migrant labour recruitment have brought the, traditionally neglected, issue of staff retention into sharp relief. The purpose of this paper is to represent the first large scale systematic appraisal of the relative salience of recognised headline drivers of employee exodus from the NHS.
Design/methodology/approach
The data were collected from an opportunity sample of 1,594 health professionals, managers and administrators employed by the NHS. Participants completed a paired ranking task (Case V method of paired comparisons, Thurston, 1927) to determine the relative importance of eight widely cited reasons for exit. The item set was derived from focus groups conducted as a component of the wider study.
Findings
Findings revealed almost universal consensus regarding the primacy of shortage of resources, job demands and time pressure. Pay was ranked lower than predicted. Flexible working arrangements do not presented as a key solution, and there is no support for claims of generational differences.
Research limitations/implications
Survivor population effects could constitute a source of sample bias, i.e. all participants were current NHS employees. It is possible that those who remain may be more resilient or hold different dispositions to leavers. Thus, comparisons by age and grade may not be comparing like with like. Tapping respondent beliefs about the actions of peers can embody some degree of inaccuracy and attribution bias. However, effects can be considered to operate as a source of common, rather than systematic, error across the demographics compared. The medical and dental sample was too small to give confidence in detected differences.
Practical implications
Findings challenge the claim that wider availability of flexible working hours will significantly reduce exit rates. Pay, being a source of dissatisfaction, does not constitute a key push variable in itself, rather its salience reflects the effort reward-imbalance produced by rises in job demands.
Social implications
Staff shortages in the NHS represent a threat to: public well-being – waiting lists and demand for care; the well-being of who continue to work in the NHS – job demands and resources; the employment prospects of staff who leave involuntarily, e.g. on grounds of incapacity and threats to health and well-being – extending to impacts on their dependents.
Originality/value
Issues of staff retention within the NHS are topical and under researched. The findings provide an up to date picture of the relative influence of headline drivers of early exit from the NHS. The study draws upon a more diverse and comprehensive sample of NHS employees that any other known previous studies of early exit. Findings are of potential international relevance to other State health systems. The authors believe this to be the largest (sample) known application of the method of paired comparisons.
Idiopathic primary ovarian insufficiency (POI) is a reproductive endocrine disorder defined as the loss of ovarian function before age 40. The condition is characterized by infertility, estrogen ...deficiency, and premature menopause. POI has significant long-term physical and psychosocial sequelae. Because POI is underrecognized and challenging to diagnose, patients often experience a “diagnostic odyssey” that contributes to impaired health-related quality of life. This review provides a state-of-the-science overview of POI, approach to diagnosis and management, and interprofessional aspects of care. We highlight unanswered questions and future directions and underscore the nurse practitioner’s role in providing holistic care for women with POI.
•Individuals with primary ovarian insufficiency commonly present with menstrual irregularity ranging from oligomenorrhea to amenorrhea.•Long-term sequelae include increased mortality risk, infertility, depression, and psychosexual and sexual dysfunction•Patients with primary ovarian insufficiency often experience a “diagnostic odyssey” that contributes to impaired health-related quality of life.•The constellation of physical and psychosocial sequelae of primary ovarian insufficiency necessitates an interdisciplinary and patient-centered approach to management.
OBJECTIVE: Continuous glucose monitoring (CGM) has been demonstrated to improve glycemic control in adults with type 1 diabetes but less so in children. We designed a study to assess CGM benefit in ...young children aged 4 to 9 years with type 1 diabetes. RESEARCH DESIGN AND METHODS: After a run-in phase, 146 children with type 1 diabetes (mean age 7.5 ± 1.7 years, 64% on pumps, median diabetes duration 3.5 years) were randomly assigned to CGM or to usual care. The primary outcome was reduction in HbA1c at 26 weeks by ≥0.5% without the occurrence of severe hypoglycemia. RESULTS: The primary outcome was achieved by 19% in the CGM group and 28% in the control group (P = 0.17). Mean change in HbA1c was –0.1% in each group (P = 0.79). Severe hypoglycemia rates were similarly low in both groups. CGM wear decreased over time, with only 41% averaging at least 6 days/week at 26 weeks. There was no correlation between CGM use and change in HbA1c (rs = –0.09, P = 0.44). CGM wear was well tolerated, and parental satisfaction with CGM was high. However, parental fear of hypoglycemia was not reduced. CONCLUSIONS: CGM in 4- to 9-year-olds did not improve glycemic control despite a high degree of parental satisfaction with CGM. We postulate that this finding may be related in part to limited use of the CGM glucose data in day-to-day management and to an unremitting fear of hypoglycemia. Overcoming the barriers that prevent integration of these critical glucose data into day-to-day management remains a challenge.
Abstract
Disclosure: I.R. McDonald: None. E.S. Blocker: None. E.A. Weyman: None. C.K. Welt: None. A.A. Dwyer: None.
Evidence suggests people with POI have unmet health and information needs that ...contribute to impaired health-related quality of life (HR-QoL). Co-creation can produce high-quality patient-facing educational materials that respond to patient-identified needs and overcome healthcare disparities. Our goal was to co-create patient-facing materials that respond to unmet health and informational needs, mitigate health disparities, and improve HR-QoL for people with POI. The project had three sequential steps. First, we synthesized the state of the science on HR-QoL, care, and management of POI. Next, we conducted a systematic scoping review to identify “best practices” for co-creating patient-facing materials. Last, we employed co-creation best practices, patient engagement, and an iterative “design thinking” process to co-create and evaluate patient-facing POI materials. The HR-QoL scoping review identified three inter-related themes related to impaired HR-QoL in POI (diagnostic odyssey, isolation & stigma, and ego integrity) along with sub-themes of decreased sexual function, altered body image, psychological vulnerability and catastrophizing. The co-creation scoping review identified 6 best practices for co-creation: (1) begin with a review of the literature, (2) utilize a framework to inform the process, (3) involve clinical and patient experts from the beginning, (4) engage diverse perspectives, (5) ensure patients have the final decision, and (6) employ validated evaluation tools. Informed by the synthesis of care and management of POI, we partnered with patients to create concise patient-facing materials responding to unmet health and informational needs of people with POI. Patients engaged in co-creation using the “design thinking” process: empathize, define the question, ideate/brainstorm, iterate prototypes (n=4), and testing using the “gold standard” Patient Education Materials Assessment Tool (PEMAT). The final 2-page patient-facing materials were evaluated using 7 readability algorithms revealing a consensus reading level of 7th grade (i.e., fairly easy to read for an 11-13 year-old). The patient partners rated the materials as highly acceptable and actionable. The online PEMAT evaluation is underway in collaboration with POI patient organizations. We envision such co-creation will produce understandable and actionable materials (i.e., all PEMAT domain scores >80%). This project may serve as a roadmap for healthcare organizations and patients to collaborate and surmount health disparities and improve care for other health conditions.
Presentation: Friday, June 16, 2023
Early-onset type 1 diabetes may affect the developing brain during a critical window of rapid brain maturation. Structural MRI was performed on 141 children with diabetes (4-10 years of age at study ...entry) and 69 age-matched control subjects at two time points spaced 18 months apart. For the children with diabetes, the mean (±SD) HbA1c level was 7.9 ± 0.9% (63 ± 9.8 mmol/mol) at both time points. Relative to control subjects, children with diabetes had significantly less growth of cortical gray matter volume and cortical surface area and significantly less growth of white matter volume throughout the cortex and cerebellum. For the population with diabetes, the change in the blood glucose level at the time of scan across longitudinal time points was negatively correlated with the change in gray and white matter volumes, suggesting that fluctuating glucose levels in children with diabetes may be associated with corresponding fluctuations in brain volume. In addition, measures of hyperglycemia and glycemic variation were significantly negatively correlated with the development of surface curvature. These results demonstrate that early-onset type 1 diabetes has widespread effects on the growth of gray and white matter in children whose blood glucose levels are well within the current treatment guidelines for the management of diabetes.
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