Attachment Styles and Traumatic Responses: Exploring the Impact of Parental Interaction on Child Development and Coping Mechanisms

This article explores the intricate relationship between attachment styles formed during early childhood and the subsequent responses to traumatic events, particularly the death of a parent. Drawing on the theoretical framework of attachment theory and incorporating contemporary research, the paper discusses how parental interactions shape the neural circuitry of infants and children, influencing their ability to form secure or insecure attachments. These attachment styles, in turn, play a critical role in determining the child’s coping mechanisms when faced with trauma. This paper focuses on trying to understand how attachment theory is connected to the reaction to trauma with a highlight on the four major styles of attachments which are secure, anxious, avoidant, and disorganized to mention but a few, and how they influence stress and adversity in children. Attachment theory holds that human beings’ ability to form affectional bonds in infancy determines their patterns of relatedness across the life cycle. The type of attachment that is secure usually supports healthy adaptation and good coping mechanisms regardless of the trauma in the childhood of the child. While secure attachment mostly facilitates favorable trauma-related outcomes, anxious or avoidant attachment can exacerbate or alter the responses. The caregiving system that is avoidant attachment has implications of autonomous self-functioning which has features of suppression of the emotional response and poor search for emotional support during stress. From the principles of developmental psychology and trauma theory, the paper also focuses on the major significance of the child’s early caregivers’ interactions that define the resilience and vulnerability factor. This knowledge is therefore critical in designing specific interventions based on the improvement of coping behaviors and emotional regulatory systems of children who have been exposed to trauma. Finally, we have the synthesis of new knowledge about the role of secure attachment relationships as its fundamental element in shaping adaptive traumatization and psychological development. The article also delves into the physiological processes involved in emotional regulation and the role of cortisol in disrupting attachment. Finally, the implications of these findings for therapeutic interventions and the challenges of addressing prolonged grief and traumatic responses in clinical settings are considered.

Evaluation of Hemoglobin and Serum Erythropoietin Levels in Patients with Polycythemia Vera and Secondary Polycythemia

Objective: This study compares hemoglobin and erythropoietin levels in patients with polycythemia vera and secondary polycythemia. Study Design: A retrospective cross-sectional study evaluating the serum erythropoietin and hemoglobin levels in patients with polycythemia vera and secondary polycythemia. This study was performed simultaneously in Texas state of the U.S. and Fars Province in Iran. Methods: Hemoglobin, hematocrit and erythropoietin test results were collected from patients aged 19 to 75 years who were diagnosed with polycythemia vera and secondary polycythemia. Patients records with history of thrombocythemia, congestive heart failure, dyspnea, anemia and pregnant woman were excluded from study. Patients in each decade of life were examined in separate groups, so that changes in hemoglobin related to aging did not affect the research results. Results: 75% of the patients were men, and 25% were women. A total of 1580 patients were analyzed in this study. 57.3% of patients in UTMB and 38.8 patients in Iran have hemoglobin level above 17 mg/dl. 74% of patients in UTMB and 88% of patients in Iran have erythropoietin below 10 IU/mL. Polycythemia in UTMB was more common in people over 50 and in Iran in patients under 50 years old. The serum hemoglobin and erythropoietin levels in patients with polycythemia vera were not significantly different in compare to secondary polycythemia patients. Data showed that there were 84 polycythemia patients per 100,000 people. The results of this study in UTMB and Iran showed that 4.5% and 7%, respectively, of patients with polycythemia had a positive JAK2 test. Conclusion: Low erythropoietin levels may not be helpful in differentiating polycythemia vera from secondary polycythemia. .

Factors associated with concussion-symptom knowledge and attitudes toward concussion care seeking in a national survey of parents of middle-school children in the US

Background:Developing appropriate concussion prevention and management paradigms in middle school(MS)settings requires understanding parents’general levels of concussion-related knowledge and attitudes.This study examined factors associated with concussion-symptom knowledge and care-seeking attitudes among parents of MS children(aged 10-15 years).Methods:A panel of 1224 randomly selected U.S.residents,aged ≥18 years and identifying as parents of MS children,completed an online questionnaire capturing parental and child characteristics.The parents’concussion-symptom knowledge was measured using 25 questions,with possible answers being“yes”,“maybe”,and“no”.Correct answers earned 2 points,“maybe”answers earned 1 point,and incorrect answers earned 0 point(range:0-50;higher scores=better knowledge).Concussion care-seeking attitudes were also collected using five 7-point scale items(range:5-35;higher scores=more positive attitudes).Multivariable ordinal logistic regression models identified predictors of higher scores.Models met proportional odds assumptions.Adjusted odds ratios(aORs)with 95%confidence intervals(95%CIs)(excluding 1.00)were deemed statistically significant.Results:Median scores were 39(interquartile range:32-44)for symptom knowledge and 32(interquartile range:28-35)for care-seeking attitude.In multivariable models,odds of better symptom knowledge were higher in women vs.men(aOR=2.28;95%CI:1.71-3.05),white/non-Hispanics vs.other racial or ethnic groups(aOR=1.88;95%CI:1.42-2.49),higher parental age(10-year-increase aOR=1.47;95%CI:1.26-1.71),and greater competitiveness(10%-scale-increase aOR=1.24;95%CI:1.13-1.36).Odds of more positive care-seeking attitudes were higher in white/non-Hispanics vs.other racial or ethnic groups(aOR=1.45;95%CI:1.06-1.99)and in older parental age(10-year-increase aOR=1.24;95%CI:1.05-1.47).Conclusion:Characteristics of middle school children’s parents(e.g.,sex,race or ethnicity,age)are associated with their concussion-symptom knowledge and care-seeking attitudes.Parents’variations in concussion knowledge and attitudes warrant tailored concussion education and prevention.

Use of sport-related concussion information sources among parents of United States middle school children

Objective:Parents may use various information sources to obtain information about sport-related concussions(SRC).This study examined SRCrelated information sources used by parents of United States middle school children(age:10-15 years).Methods:A panel of 1083 randomly selected U.S.residents,aged≥18 years and identifying as parents of middle school children,completed an online questionnaire capturing parental and child characteristics,and utilization and perceived trustworthiness of various sources of SRC-related information.Multivariable logistic regression models identified factors associated with utilizing each source.Adjusted odds ratios(OR)with 95%confidence intervals(95%CIs)excluding 1.00 were deemed significant.Results:Doctors/healthcare providers(49.9%)and other healthcare-related resources(e.g.,Centers for Disease Control and Prevention,WebMD)(37.8%)were common SRC-related information sources;64.0%of parents utilized≥1 of these sources.Both sources were considered“very”or“extremely”trustworthy for SRC-related information among parents using these sources(doctors/healthcare providers:89.8%;other healthcare-related resources:70.9%).A 10-year increase in parental age was associated with higher odds of utilizing doctors/healthcare providers(adjusted odd ratio(OR_(adjusted))=1.09,95%CI:1.02-1.16)and other healthcare-related resources(OR_(adjusted)=1.11,95%CI:1.03-1.19).The odds of utilizing doctors/healthcare providers(OR_(adjusted)=0.58,95%CI:0.40-0.84)and other healthcare-related resources(OR_(adjusted)=0.64,95%CI:0.44-0.93)were lower among parents whose middle school children had concussion histories versus the parents of children who did not have concussion histories.Conclusion:One-third of parents did not report using doctors/healthcare providers or other healthcare-related resources for SRC-related information.Factors associated with underutilization of these sources may be targets for future intervention.Continuing education for healthcare providers and educational opportunities for parents should highlight accurate and up-to-date SRC-related information.

Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans

Background:Large numbers of post-deployment U.S.veterans are diagnosed with post-traumatic stress disorder(PTSD)and/or traumatic brain injury(TBI),leading to an urgent need for effective interventions to reduce symptoms and increase veterans’coping.PTSD includes anxiety,flashbacks,and emotional numbing.The symptoms increase health care costs for stress-related illnesses and can make veterans’civilian life difficult.Methods:We used a randomized wait-list controlled design with repeated measures of U.S.military veterans to address our specific aim to test the efficacy of a 6-week therapeutic horseback riding(THR)program for decreasing PTSD symptoms and increasing coping self-efficacy,emotion regulation,social and emotional loneliness.Fiftyseven participants were recruited and 29 enrolled in the randomized trial.They were randomly assigned to either the horse riding group(n=15)or a wait-list control group(n=14).The wait-list control group experienced a 6-week waiting period,while the horse riding group began THR.The wait-list control group began riding after 6 weeks of participating in the control group.Demographic and health history information was obtained from all the participants.PTSD symptoms were measured using the standardized PTSD Checklist-Military Version(PCL-M).The PCL-M as well as other instruments including,The Coping Self Efficacy Scale(CSES),The Difficulties in Emotion Regulation Scale(DERS)and The Social and Emotional Loneliness Scale for Adults-short version(SELSA)were used to access different aspects of individual well-being and the PTSD symptoms.Results:Participants had a statistically significant decrease in PTSD scores after 3 weeks of THR(P≤0.01)as well as a statistically and clinically significant decrease after 6 weeks of THR(P≤0.01).Logistic regression showed that participants had a 66.7%likelihood of having lower PTSD scores at 3 weeks and 87.5%likelihood at 6 weeks.Under the generalized linear model(GLM),our ANOVA findings for the coping self-efficacy,emotion regulation,and social and emotional loneliness did not reach statistical significance.The results for coping self-efficacy and emotion regulation trended in the predicted direction.Results for emotional loneliness were opposite the predicted direction.Logistic regression provided validation that outcome effects were caused by riding longer.Conclusion:The findings suggest that THR may be a clinically effective intervention for alleviating PTSD symptoms in military veterans.

Risk of overweight and obesity among migrants in Switzerland

We assessed the risk of overweight and obesity for six large migrant groups in Switzerland. We used population-based survey data form the Swiss Migrant Health Survey 2010 and the Swiss Health Survey 2007. The sample comprised permanent residents aged 17 - 64 years (n = 14,637). Multivariate logistic regressions have been used to estimate odds ratios (OR). Compared with Swiss nationals, the odds of being obese were 1.97 times higher for Turkish nationals (CI-95 1.26, 3.07), 1.73 times higher for Kosovan nationals (CI-95 1.09, 2.74) and 3.42 times higher for Serbs (CI-95 2.28, 5.12). The chance of being obese was not statistically different between Swiss nationals and those from Portugal, Italy, and Germany. The chance of being overweight or obese (BMI ≥ 25) was higher for migrants than for Swiss nationals. The respective odds were 1.54 times higher for nationals from Portugal (CI-95 1.13, 2.11), 2.05 times higher for those from Turkey (CI-95 1.50, 2.78), 2.67 times higher for those from Serbia (CI-95 1.93, 3.68), 2.68 times higher for those from Kosovo (CI-95 2.01, 3.56), and 2.16 times higher for nationals from Italy (CI-95 1.54, 3.02). We suggest that preventive initiatives should take into account the specific needs of migrants as well as the needs of persons with low education from all nationalities.

Slacklining:An explanatory multi-dimensional model considering classical mechanics,biopsychosocial health and time

This paper aims to overcome slacklining’s limited formulated explanatory models.Slacklining is an activity with increasing recreational use,but also has progressive adoption into prehabilitation and rehabilitation.Slacklining is achieved through self-learned strategies that optimize energy expenditure without conceding dynamic stability,during the neuromechanical action of balance retention on a tightened band.Evolved from rope-walking or‘Funambulus’,slacklining has an extensive history,yet limited and only recent published research,particularly for clinical interventions and in-depth hypothesized multi-dimensional models describing the neuromechanical control strategies.These‘knowledge-gaps’can be overcome by providing an,explanatory model,that evolves and progresses existing standards,and explains the broader circumstances of slacklining’s use.This model details the individual’s capacity to employ control strategies that achieve stability,functional movement and progressive technical ability.The model considers contributing entities derived from:Self-learned control of movement patterns;subjected to classical mechanical forces governed by Newton’s physical laws;influenced by biopsychosocial health factors;and within time’s multi-faceted perspectives,including as a quantified unit and as a spatial and cortical experience.Consequently,specific patient and situational uses may be initiated within the framework of evidence based medicine that ensures a multi-tiered context of slacklining applications in movement,balance and stability.Further research is required to investigate and mathematically define this proposed model and potentially enable an improved understanding of human functional movement.This will include its application in other diverse constructed and mechanical applications in varied environments,automation levels,robotics,mechatronics and artificial-intelligence factors,including machine learning related to movement phenotypes and applications.

Slacklining as therapy to address non-specific low back pain in the presence of multifidus arthrogenic muscle inhibition

Low back pain(LBP)represents the most prevalent,problematic and painful of musculoskeletal conditions that affects both the individual and society with health and economic concerns.LBP is a heterogeneous condition with multiple diagnoses and causes.In the absence of consensus definitions,partly because of terminology inconsistency,it is further referred to as non-specific LBP(NSLBP).In NSLBP patients,the lumbar multifidus(MF),a key stabilizing muscle,has a depleted role due to recognized myocellular lipid infiltration and wasting,with the potential primary cause hypothesized as arthrogenic muscle inhibition(AMI).This link between AMI and NSLBP continues to gain increasing recognition.To date there is no‘gold standard’or consensus treatment to alleviate symptoms and disability due to NSLBP,though the advocated interventions are numerous,with marked variations in costs and levels of supportive evidence.However,there is consensus that NSLBP management be cost-effective,self-administered,educational,exercise-based,and use multi-modal and multi-disciplinary approaches.An adjuvant therapy fulfilling these consensus criteria is‘slacklining’,within an overall rehabilitation program.Slacklining,the neuromechanical action of balance retention on a tightened band,induces strategic indirect-involuntary therapeutic muscle activation exercise incorporating spinal motor control.Though several models have been proposed,understanding slacklining’s neuro-motor mechanism of action remains incomplete.Slacklining has demonstrated clinical effects to overcome AMI in peripheral joints,particularly the knee,and is reported in clinical case-studies as showing promising results in reducing NSLBP related to MF deficiency induced through AMI(MF-AMI).Therefore,this paper aims to:rationalize why and how adjuvant,slacklining therapeutic exercise may positively affect patients with NSLBP,due to MF-AMI induced depletion of spinal stabilization;considers current understandings and interventions for NSLBP,including the contributing role of MF-AMI;and details the reasons why slacklining could be considered as a potential adjuvant intervention for NSLBP through its indirect-involuntary action.This action is hypothesized to occur through an over-ride or inhibition of central down-regulatory induced muscle insufficiency,present due to AMI.This subsequently allows neuroplasticity,normal neuro-motor sequencing and muscle re-activation,which facilitates innate advantageous spinal stabilization.This in-turn addresses and reduces NSLBP,its concurrent symptoms and functional disability.This process is hypothesized to occur through four neuro-physiological processing pathways:finite neural delay;movement-control phenotypes;inhibition of action and the innate primordial imperative;and accentuated corticospinal drive.Further research is recommended to investigate these hypotheses and the effect of slacklining as an adjuvant therapy in cohort and control studies of NSLBP populations.

The beginning of the journey to study patient safety and care quality in hospital settings using inpatient falls as an example

病人安全是WHO2006年启动的一项全球性工作。我国卫生部与国家中医药管理局在2005-2007年开展的医院管理年活动中,都将提高医疗质量和保证医疗安全作为重中之重。本刊特邀曾惠明（Huey-Ming Tzeng）博士,美国密歇根大学护理学院副主任、教授、美国中西部护理研究协会会员,撰写了《病人安全与护理照护的研究旅程：以住院病人跌倒为例》。

Inter-and intra-rater reliability of diffusion tensor imaging parameters in the normal pediatric spinal cord

AIM: To assess inter- and intra-rater reliability(agreement) between two region of interest(ROI) methods in pediatric spinal cord diffusion tensor imaging(DTI). METHODS: Inner-Field-of-View DTI data previously acquired from ten pediatric healthy subjects(mean age = 12.10 years) was used to assess for reliability. ROIs were drawn by two neuroradiologists on each subject data twice within a 3-mo interval. ROIs were placed on axial B0 maps along the cervical spine using free-hand and fixed-size ROIs. Agreement analyses for fractional anisotropy(FA), axial diffusivity, radial diffusivity and mean diffusivity were performed using intra-class-correlation(ICC) and Cronbach's alpha statistical methods.RESULTS: Inter- and intra-rater agreement between the two ROI methods showed moderate(ICC = 0.5) to strong(ICC = 0.84). There were significant differences between raters in the number of pixels selected using free-hand ROIs(P < 0.05). However, no significant differences were observed in DTI parameter values. FA showed highest variability in ICC values(0.10-0.87). Cronbach's alpha showed moderate-high values for raters and ROI methods. CONCLUSION: The study showed that high reproducibility in spinal cord DTI can be achieved, and demonstrated the importance of setting detailed methodology for post-processing DTI data, specifically the placement of ROIs.

Health Status Inequality among Immigrants in Switzerland

Objective: To assess self-rated health and impairments for six large immigrant groups (Germany, Italy, Kosovo, Portugal, Serbia, Turkey) in Switzerland. Methods: We used population-based survey data from the Swiss Migrant Health Survey 2010 and the Swiss Health Survey 2007. The sample comprised permanent residents aged 17 - 64 years (n = 14,637). Multivariate logistic regressions have been used to estimate odds ratios (OR). Results: Ill health and activities of daily living (ADL) impairments were associated with older age in all groups. However, nationals from Turkey and nationals from Kosovo were substantially more likely than Swiss to report ill health (OR = 1.05;CI = 1.02 - 1.09;P = 0.001 and OR = 1.05;CI = 1.01 - 1.10;P = 0.016) and ADL impairments (OR = 1.06;CI = 1.03 - 1.09;P = 0.000 and OR = 1.04;CI = 1.01 - 1.07;P = 0.004) with increasing age. Furthermore, Portuguese women were more likely (OR = 2.65;CI = 1.40 - 5.03;P = 0.003) to report ill health than Swiss women. Conclusions: Immigrant-specific preventive and health promotion initiatives should target vulnerable immigrants from Turkey, Portugal, and Kosovo. Furthermore, groups with few economic and psychosocial resources in the general population of Switzerland should be more involved in interventions to reduce health risk.

The impact of the coronavirus disease 2019 pandemic on physical activity in U.S. children

Background:Daily moderate-to-vigorous physical activity(MVPA)is vital to the physical,mental,and social well-being of children.Early restrictions during the coronavirus disease 2019(COVID-19)pandemic included the closure of schools and physical activity(PA)amenities across the US.This study aimed to examine the impact of the pandemic on the PA and play behavior of U.S.children and to provide evidencebased recommendations to improve their PA.Methods:A cross-sectional,online,parent-reported survey was conducted of children aged 318 years between April and June 2020 to assess light PA and MVPA using a modified Godin Leisure-Time Exercise Questionnaire.Additional items included family/child socioeconomic demographics,child adaptability to the pandemic,and community access.The survey was shared through social media and snowball sampling distribution.Results:Analysis of 1310 surveys indicated child PA scores declined significantly during the pandemic(from 56.6 to 44.6,max 119,p<0.001).Specifically,MVPA score decreased(from 46.7 to 34.7,max 98,p<0.001)while light PA remained the same.Age-based changes were seen in the quantity,variety,and intensity of PA,with the lowest pandemic-related impact seen in preschoolers and the highest in high schoolers(4.7 vs.17.2,p<0.001).Community-based peer PA decreased across all age groups.Conclusion:This study shows decreased PA levels in U.S.children,according to parent reporting,during the COVID-19 pandemic.Recommendations for community leaders,educators,and parents to improve PA in children are provided.With continued spread of COVID-19,these results and recommendations may be imperative to the physical well-being of U.S.children.

Relationships among Health and Spiritual Beliefs, Religious Practices, and Congregational Support in Individuals with Cancer

To assess relationships among physical health, mental health, spiritual experiences, religious practices, and perceived congregational support for individuals with cancer. Design: A cross-sectional analysis of 56 individuals from outpatient settings (25 with cancer, 31 healthy controls). Measures: Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS;[1]);Medical Outcomes Scale-Short Form 36 (SF-36) General Health Perception (GHP) and General Mental Health (GMH) scales. Results: Participants with cancer reported significantly higher levels of Daily Spiritual Experiences and Religious Support on the BMMRS than the Healthy Controls. No BMMRS subscales were significantly correlated with the SF-36, although the BMMRS subscales had larger correlations with the SF-36 GMH scale (mean = 0.23;range = 0.14 - 0.37) than the GHP scale (mean = 0.16;range = 0.01 - 0.33). Conclusions: Individuals with cancer rely on spiritual beliefs and congregations support more than healthy controls. Statistical trends indicate that individuals with cancer use spiritual, religious, and congregational support factors primarily to assist them in emotion-ally coping with their disease, rather than to improve physical health.

Prevalence and predictors of smoking in a mining town in Kitwe, Zambia: A 2011 population-based survey

Smoking is one of the major preventable causes of death and non-communicable diseases which include hypertension, cardiovascular diseases and cancers. The aim of the study is to establish prevalence and predictors of smoking so that interventions specific to these communities can be executed to prevent smoking. A cross sectional study was conducted using a modified World Health Organizations Global Non Communicable Diseases (NCD) Surveillance Initiative NCD-STEPs 1 and 2. Multivariate logistic regression was used to examine the determinants of tobacco smoking. A total of 1627 individuals participated in the survey, of which 42.3% were males. About half of the participants were of age 25-34 years (56.0%), and 41.7% had attained secondary level of education. Overall, 8.7% of the participants (18.1% among males and 1.8% among females) currently smoked any tobacco product. Female respondents were 71% (AOR = 0.29, 95%CI [0.21, 0.39]) less likely to smoke cigarettes compared to male respondents. Compared to respondents who had no formal education, respondents who had attained primary level of education were 45% (AOR = 1.45, 95%CI [1.02, 2.08]) more likely to smoke, and those who attained college or university level of education were 57% (AOR = 0.43, 95%CI [0.28, 0.65]) less likely to smoke. Respondents who did not consume alcohol were 50% (AOR = 0.50, 95%CI [0.41, 0.61]) less likely to smoke compared to those who consumed alcohol. The study showed that sex, education, and alcohol consumption were independently associated with Smoking. These are the key determinants which should be considered when designing a health education and awareness campaign to the residents.

Translation in Data Mining to Advance Personalized Medicine for Health Equity

Personalized medicine is the development of “tailored” therapies that reflect traditional medical approaches with the incorporation of the patient’s unique genetic profile and the environmental basis of the disease. These individualized strategies encompass disease prevention and diagnosis, as well as treatment strategies. Today’s healthcare workforce is faced with the availability of massive amounts of patient- and disease-related data. When mined effectively, these data will help produce more efficient and effective diagnoses and treatment, leading to better prognoses for patients at both the individual and population level. Designing preventive and therapeutic interventions for those patients who will benefit most while minimizing side effects and controlling healthcare costs requires bringing diverse data sources together in an analytic paradigm. A resource to clinicians in the development and application of personalized medicine is largely facilitated, perhaps even driven, by the analysis of “big data”. For example, the availability of clinical data warehouses is a significant resource for clinicians in practicing personalized medicine. These “big data” repositories can be queried by clinicians, using specific questions, with data used to gain an understanding of challenges in patient care and treatment. Health informaticians are critical partners to data analytics including the use of technological infrastructures and predictive data mining strategies to access data from multiple sources, assisting clinicians’ interpretation of data and development of personalized, targeted therapy recommendations. In this paper, we look at the concept of personalized medicine, offering perspectives in four important, influencing topics: 1) the availability of “big data” and the role of biomedical informatics in personalized medicine, 2) the need for interdisciplinary teams in the development and evaluation of personalized therapeutic approaches, and 3) the impact of electronic medical record systems and clinical data warehouses on the field of personalized medicine. In closing, we present our fourth perspective, an overview to some of the ethical concerns related to personalized medicine and health equity.

糖尿病相关的足溃疡预防指南(2023年更新版)——《国际糖尿病足工作组:糖尿病相关的足病预防与管理指南(2023)》的一部分

本章是2023年国际糖尿病足工作组(IWGDF)关于糖尿病相关的足溃疡预防的指南,是在2019年版指南基础上的更新。本指南面向临床医生和其他医务人员。我们遵循推荐、评估、发展和评价分级(GRADE)方法,采用患者-干预-比较-结局(PICO)的方法来设计临床问题和关键结局,并进行了包括必要的Meta分析在内的医学科学文献的系统综述,同时撰写了推荐及其理由。这些推荐基于系统综述中证据质量、在没有足够证据的情况下的专家意见、同时考虑干预措施的有益和不良效果,以及患者的偏好、成本、公平性、可行性和适用性的权衡。我们推荐对足溃疡风险较低的糖尿病患者每年进行一次保护性感觉丧失和周围动脉病变的筛查,并对高危患者进行更高频率的筛查以及其他危险因素的筛查。为了预防足溃疡,要对有危险因素的患者进行健康教育,教育其对足部进行适当地自我护理,在没有适当的足部保护的情况下不要行走,并对溃疡前兆进行有效治疗。指导足溃疡中高危风险的糖尿病患者穿着合适、宽松的治疗性鞋类,并考虑指导他们监测足部皮肤温度。开具处方使用治疗性鞋类,这些鞋类在行走时具有缓解足底压力的效果,能够防止足底溃疡复发。推荐足溃疡中低风险人群最好制定一个有监督的足踝运动计划,以减少溃疡风险;就溃疡的风险而言,每天总共增加1000步的负重活动可能是安全的。对于有溃疡前兆的非僵直锤状趾患者,可考虑屈肌腱切断术。我们建议不要用神经松解减压术来预防足溃疡。要对足溃疡中高危的糖尿病患者给予综合足部护理,以预防溃疡复发。贯彻这些推荐有助于医疗专业人员对有足溃疡风险的糖尿病患者提供更好的护理,增加无溃疡的天数,减少患者糖尿病相关的足病的医疗负担。

ADHD in Children and Adolescents: Barriers to Ethical and Successful Treatment

This review provides a comprehensive analysis of attention deficit hyperactivity disorder (ADHD), a neurodevelopmental disorder characterized by inattention, hyperactivity, or impulsivity. The global prevalence of the disorder ranges from 2% to 7%, with an average of around 5%. ADHD affects individuals of all ages, with symptoms typically becoming visible as early as 3 years. The symptoms range from mild to severe and may persist into adulthood. The disorder affects a variety of demographic groups, including differences in age, gender, race, and ethnicity, with varying effects, prevalence, and treatment options among these groups. Treatment options for ADHD range from behavioral interventions to prescription medication, with a number of medications available on the market for treating ADHD. The review also highlights the issues of relapse and safety concerns associated with the use of medication, as well as the challenges associated with diversity and socioeconomic barriers in the diagnosis and treatment of the disorder.

Factors and expectations influencing concussion disclosure within NCAA DivisionⅠathletes:A mixed methodological approach

Background:Participation in sports is associated with many benefits to all aspects of health;however,it also comes with the risk of injury,particularly concussions.Self-disclosure and care seeking following a concussion are especially important because of the lack of outwardly visible signs and/or symptoms.Although recent research has explored factors affecting concussion disclosure,use of isolated methodologies limits the ability to contextualize how disclosure or nondisclosure occurs.Therefore,the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association(NCAA)athletes that may influence concussion disclosure.Methods:This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports,all of whom completed a concussion-education session with pre-/post-test surveys and a semistructured interview.Eligible athletes were at least 18 years old and on an NCAA roster.The surveys focused on previous concussion-related disclosure behaviors,knowledge,attitudes,beliefs,norms,and intentions about disclosing concussion.Interviews focused on the athletes’experiences related to concussion disclosure.Survey data were analyzed using descriptive statistics and Mann-Whitney U tests.Interviews were analyzed using a Consensual Qualitative Research tradition.Results:Participants had good concussion knowledge(median=46.0),positive attitudes(median=38.0),strong beliefs(median=13.0),and strong intentions to disclose concussion symptoms(median=7.0).None of the constructs differed by participants’gender.Although quantitative findings were mostly positive,interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult.Educational efforts,sport culture,and medical professional presence were the primary facilitators discussed by participants.Stigma,pressure,and a lack of team support were perceived as disclosure barriers.Conclusion:The context in which concussion disclosure occurs or does not occur is vital to the success of educational interventions.Interventions must prioritize stakeholder-and team-based perspectives on concussion to establish a network supportive to disclosure.

Is Dosage Adjustment for Olanzapine Really Necessary?

Schizophrenia is a prevalent and disabling disorder, commonly treated with medications such as clozapine and olanzapine. However, long-term side effects and limitations of these drugs, coupled with treatment resistance in a significant proportion of patients, necessitate alternative strategies. Furthermore, individuals with schizophrenia are at an increased risk of developing kidney and liver diseases, which may be influenced by cardiovascular comorbidities and shared genetic markers. Considering the use of olanzapine in patients with severe liver or kidney diseases requires careful evaluation. Although these organs play crucial roles in olanzapine excretion and metabolism, current pharmacological research suggests that dosage adjustment may not be necessary even in the presence of severe organ disease. Olanzapine acts on D2 and 5HT2A receptors, alleviating both positive and negative symptoms of schizophrenia. However, the metabolism and clearance of olanzapine exhibit substantial inter-individual variability influenced by factors such as gender, age, ethnicity, smoking habits, and co-medication. Additionally, olanzapine may induce unwanted side effects, including prolactin release, metabolic dysregulation, and liver-related complications. The present study aims to investigate whether dosage adjustment of olanzapine is necessary for individuals with comorbid moderate liver and severe kidney disease. While the study remains ongoing, preliminary findings using a pharmacokinetic model predict that dosage adjustment may not be required in these patients. The expected olanzapine plasma concentration in individuals with both conditions is estimated to be 18.14ng/ml, which is considerably below the identified toxic dosage threshold of 100ng/ml. However, further investigations are warranted to validate the findings and establish definitive guidelines and personalize treatment strategies for individuals with both liver and kidney disease.

Utilizing Instilling Negative Pressure Wound Therapy with Vashe Wound Solution for an Infected Sternal Dehiscence: A Case Report

Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.