Dry eye signs and symptoms in aromatase inhibitor treatment and the relationship with pain

PurposeAromatase inhibitors (AIs) limit the synthesis of oestrogen in peripheral tissues thus lowering levels of oestrogen. The primary aim was to evaluate whether women treated with AIs have altered dry eye symptoms and signs. A sub-aim was to investigate whether symptoms of dry eye in postmenopausal women were associated with symptoms of non-eye pain, ocular pain and self-rated pain perception.MethodsThis cross-sectional, observational, single visit study recruited 56 postmenopausal women (mean age 64.1 + 7.9 years) and 52 undergoing AI treatment (mean age 66.6 + 9.0). Ocular symptoms (OSDI, MGD14) and pain questionnaires (PSQ, OPAS) were administered and signs of dry eye and meibomian gland dysfunction were evaluated.ResultsAlmost half of each group reported dry eye symptoms, defined as OSDI>12 (48% control, 46% AI). The PSQ score was significantly higher in the AI group (p = 0.04). Neither frequency or severity of dry eye (or MGD) symptoms scores were significantly different between groups. In the AI group, meibomian gland expressibility score was worse (p = 0.003); there were no differences in any other signs. Higher OSDI scores were associated with higher OPAS eye-pain scores (r = 0.49, p < 0.001), but not OPAS non-eye pain (r = 0.09, p = 0.35). Pain perception (PSQ) showed a moderate positive association with OPAS eye-pain (r = 0.30, p = 0.003).ConclusionsIn this study elevated ocular symptoms were observed in both the AI treated and the untreated groups, with no difference between the groups. Women undergoing AI treatment for early stage breast cancer had worse meibum expressibility score and increased pain perception compared to an untreated group of women.     

Survey on current practices for neurological prognostication after cardiac arrest

PurposeTo investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients.MethodsAn anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories: background data, clinical data, decision-making and consequences.ResultsA total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32–34 °C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3–5 (58%) or CPC 4–5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain.ConclusionNational recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach: EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial.     

儿科诊断性X线扫描家属知情与接受现状调查

目的:了解建德市基层医院儿科门诊进行X线扫描治疗中,家属对X射线检查的知情同意与接受现状。方法:随机抽取建德市属3家公立综合性医院共60位接受X线扫描的儿童患者家属为调查对象,发放自制调查问卷并统计分析。结果:55位(91.67%)患者表示治疗前主治医生只告知了X射线是诊断性检查,没有具体告知X射线的危害性;18位(30%)的患者家属不清楚辐射会对人体有损害,42位(70%)不清楚或不注意辐射警示标志,更不会主动要求防护措施,学历水平较高者及有从事医务工作背景者接受X射线检查的为12人(20%),明显低于学历水平低者或没有从事医务工作背景者的46人(76.67%),不知可否接受的有2人(3.33%)(P<0.001)。结论:基层医院儿科诊断性X射线扫描前的知情同意告知仍需加强,儿科放射检查偏多,应避免并加强宣传和教育。     

An evaluation of wayfinding abilities in adolescent and young adult males with autism spectrum disorder

BackgroundWayfinding refers to traveling from place to place in the environment. Despite some research headway, it remains unclear whether individuals with Autism Spectrum Disorder (ASD) show strengths, weaknesses, or similarities in wayfinding compared with ability-matched typically developing (TD) controls.MethodThe current study tested 24 individuals with ASD, 24 mental-ability (MA) matched TD (MA-TD) controls, and 24 chronological-age (CA) matched TD (CA-TD) controls. Participants completed a route learning task and a survey learning task, both programmed in virtual environments, and a perspective taking task. Their parents completed questionnaires assessing their children’s everyday wayfinding activities and competence.ResultsOverall, CA-TD controls performed better than both the ASD group and the MA-TD group in both wayfinding tasks and the perspective taking task. Individuals with ASD performed similarly to the MA- TD controls on wayfinding performance except for backtracking routes. Perspective taking presented an area of deficit for people with ASD and it predicted individual differences in route learning and survey learning. Parents’ reports did not predict their children’s wayfinding performance. Two mini meta-analyses, including previous studies and the current study, showed a significant deficit in route learning, but not in survey learning for the ASD group relative to MA-TD controls.ConclusionsAlthough participants with ASD showed impairments in wayfinding relative to CA-TD controls, the impairment is not specific to their ASD, but rather due to their mental age. Nevertheless, route reversal in route learning may present unique difficulty for people with ASD beyond the effects of mental age.     

Vaccine timeliness and prevalence of undervaccination patterns in children ages 0–19 months,U.S., National Immunization Survey-Child 2017

ObjectivesTypically, early childhood vaccination coverage in the U.S. is measured as the proportion of children by age 24 months who completed recommended vaccine series. However, these measures do not reflect whether vaccine doses were received at the ages recommended by the U.S. Advisory Committee on Immunization Practices, or whether children received vaccines concomitantly, per the ACIP recommended schedule. This study’s objective was to quantify vaccine timeliness and prevalence of specific patterns of undervaccination in U.S. children ages 0–19 months.MethodsUsing 2017 National Immunization Survey-Child data, we calculated days undervaccinated for the combined 7-vaccine series and distinguished undervaccination patterns indicative of parental vaccine hesitancy, such as spreading out vaccines across visits (“shot-limiting”) or starting some but not all recommended vaccine series (“selective vaccination”), from other non-hesitancy patterns, such as missing final vaccine doses or receiving all doses, with some or all late. We measured associations between demographic, socioeconomic and other characteristics with undervaccination patterns using multivariable log-linked binomial regression. Analyses accounted for the complex survey design.ResultsAmong n = 15,333 U.S. children, only 41.2% received all recommended vaccine doses on-time by age 19 months. Approximately 20.9% of children had an undervaccination pattern suggestive of parental vaccine hesitancy, and 36.2% had other undervaccination non-hesitancy patterns. Uninsured children and those with lower levels of maternal education were more likely to exhibit undervaccination patterns suggestive of parental hesitancy. Lower levels of maternal education were also associated with other non-hesitancy undervaccination patterns.ConclusionsMore than half of children in the U.S. are undervaccinated at some point by 19 months of age. Ongoing assessment of vaccine timeliness and immunization schedule adherence could facilitate timely and targeted public health interventions in populations with high levels of undervaccination.     

Impact of state weights on national vaccination coverage estimates from household surveys in Nigeria

National vaccination coverage estimates from household surveys are widely used in monitoring and planning of immunization programs. In Nigeria, survey-reported national coverage estimates have shown large fluctuations in the past few years. In this paper, we examine the impact of state-level survey weighting on Nigeria’s national vaccination coverage estimation. In particular, we focus three vaccination-related outcomes among children aged 12–23 months: the coverage of the third dose of diphtheria, pertussis, and tetanus vaccine (DPT3); the coverage of the first dose of measles-containing vaccine (MCV1); and the availability rate of home-based vaccination record (HBR). We compare the sample selection and weight assignment of three major survey programs in Nigeria, and show that considerable portions of the changes in survey-reported national coverage estimates can be explained by shifts in state-level weights. Our analysis demonstrates the importance of state weighting method in estimating aggregated national coverage figures and provides important context for interpreting changes in coverage estimates between surveys in the future.