Confidentiality Discussions and Private Time With a Health-Care Provider for Youth,United States, 2016

Purpose

The objective of the study was to define factors associated with adolescent and young adult (AYA) experiences with private time and having discussed confidentiality and the impact of these experiences on improving delivery of clinical preventive services.

Screen exposure exacerbates ADHD symptoms indirectly through increased sleep disturbance

ObjectivesThe aim of this study was twofold. First, to confirm the deleterious aspect of evening screen exposure in school-aged children, in particular the effect of screens in the bedroom. Second, to explore the three-way association between degree of screen exposure, sleep disturbance, and ADHD symptoms. Solid evidence exists on the link between sleep disturbance and ADHD symptoms, and screen exposure and sleep disturbance. However, no studies have formally assessed the impact of screen exposure on ADHD symptoms in children, as a function of sleep disturbance.MethodsParents of 374 French children (201 girls, 173 boys, mean age of 10.8 ± 2.8 years old) completed the Sleep Disturbance Scale for Children (SDSC), the Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale, and a questionnaire about their children's screen habits (total hours in the morning, afternoon, and evening per day). Correlational analyses between evening screen exposure, sleep quality and behavioral problems were conducted. Then, formal mediation analyses were run in order to quantify the relationship between variables.ResultsSchool-aged children with screens in their bedrooms demonstrated more sleep and behavioral problems. Evening TV exposure was associated with higher SDSC and ADHD scores. Furthermore, the Structural Equation Modelling approach confirmed that evening screen exposure is directly associated with more disrupted sleep, which in turn is directly associated with behavioral problems.ConclusionsThese findings encourage families to avoid putting screens in their children's bedrooms, and limit evening screen exposure. They furthermore demonstrate the importance of taking into account screen exposure time (morning, afternoon, evening) and location (bedroom or elsewhere) in future studies.     

不同内固定治疗锁骨远端粉碎性骨折的疗效

目的针对锁骨远端粉碎性骨折患者采用不同的内固定治疗方案进行临床治疗,分析其临床治疗效果。方法选取本院2016年8月—2018年7月收治的锁骨远端粉碎性骨折患者40例作为研究对象,按照随机数字表法分成两组,试验组20例,对照组20例。试验组患者采用锁骨远端锁定钢板内固定治疗方案,对照组患者采用锁骨钩钢板内固定治疗方案,对比两组患者的手术时间、术中出血量、愈合时间、并发症发生情况。结果研究结果表明,试验组患者的手术时间和术中出血量对比对照组差异没有统计学意义(P>0.05);试验组患者的愈合时间短于对照组,并发症发生率低于对照组,对比差异不具有统计学意义(P>0.05)。结论对于锁骨远端粉碎性骨折患者的治疗,采用锁骨远端锁定钢板内固定治疗方案能够有效缩短愈合时间,降低并发症发生率,促进患者快速恢复。     

Effect of sinapic acid on aripiprazole pharmacokinetics in rats: Possible food drug interaction

Dietary supplements and foods can interact with various drugs, leading to possible clinical concerns. This study aimed to investigate the effect of orally administered sinapic acid (SA) on the pharmacokinetics of aripiprazole (APZ) in rats and its possible modulatory effects on hepatic cytochrome P450 (CYP3A2 and CYP2D6) expression in the liver tissues. Single dose and multiple dose parallel groups of wistar rats were categorized into six groups (n = 6 each) which abstained from food for 12 h prior to the experiment, while water was allowed ad libitum. The investigation was carried out for single dose: Group I was treated with normal saline orally for 15 days (normal control). Group II was administered normal saline orally for 15 days and received APZ (3 mg/kg p.o.) on day 15. Group III received SA (20 mg/kg p.o.) for 15 days and received APZ (3 mg/kg p.o.) on day 15. Group IV was treated with SA (20 mg/kg p.o.) for 15 days. For the multiple dose study, Group I was treated with normal saline orally for 15 days (normal control); Group II received APZ (3 mg/kg p.o.) daily for 15 days; Group III was administered with SA (20 mg/kg p.o.) and APZ (3 mg/kg p.o.) for 15 days and Group IV received SA (20 mg/kg p.o.) for 15 days. The group I and IV were kept common in single and multiple dose groups. After last APZ dose, plasma samples were collected and APZ concentrations were determined using an UPLC-MS/MS technique. The pharmacokinetic parameters were calculated using a non-compartmental analysis. The concomitant administration of APZ with SA (as single or multiple dose) resulted in an increase in APZ absorption and a decrease on its systemic clearance. This was associated with a reduction in CYP3A2 and CYP2D6 protein expressions by 33–43% and -71–68% after the single and multiple co-administration, which are two enzymes responsible of the metabolism of APZ. Therefore, a reduction in the metabolic clearance appears to be the mechanism underlying the drug interaction of dietary supplement containing SA with APZ. Therefore, the concomitant administration of SA and APZ should be carefully viewed. Further investigations are required to assess the clinical significance of such observations in humans.     

Tracheal intubation

Tracheal intubation is the act of placing a tube into the trachea. The tube enables oxygen delivery and removal of carbon dioxide, while also allowing for the administration of pharmacological agents. Intubation is the most reliable method of maintaining an airway under anaesthesia, and for protection against aspiration of stomach contents. Traditionally, intubation is achieved by direct visualization of the glottis, but now indirect laryngoscopy (via a videolaryngoscope) is a common alternative. Prior to embarking upon intubation, a thorough patient history and examination must be undertaken by the laryngoscopist; equipment must be prepared and checked; a trained assistant present; and an experienced anaesthetist available in case assistance is required. Once the endotracheal tube has been placed, correct positioning must be confirmed via both clinical examination and monitoring, including capnography. Tracheal intubation is a procedure that should only be undertaken by trained operators and is not without risk. It is important to note that it is failure to oxygenate patients rather than failure to intubate that ultimately leads to serious morbidity and mortality. The Difficult Airway Society has produced guidelines on how to manage unanticipated difficulty in tracheal intubation; it is essential that every practitioner trained to intubate patients is familiar with these algorithms and the key principles of safe airway management.