Tag: 24/5/22

Categories : Skin ConditionsTags :

No One Type of Emollient is Best for Children with AD

On By ModernMedia
Atopic dermatitis
Source: Wikimedia CC0

A trial has directly comparing emollients found that no one type of emollient is better than another when it comes to atopic dermatitis (AD) in children.  The results from the study are published in The Lancet Child & Adolescent Health and British Journal of General Practice.

Emollients are recommended for the one in five children with AD.  Lack of research in this area means guidelines vary widely in what is recommended, which leads to confusion and waste.

In the study, 550 children with AD aged under 12 years were randomised to use one of four types of emollient (lotion, cream, gel or ointment) as their main emollient for 16 weeks. Parents completed diaries about their child’s AD for a year, and some were interviewed to gain an in-depth understanding of how they used the emollients and what they thought of them.  All children also had an independent examination of their skin.

Used alongside other AD treatments, there was no difference in effectiveness of the four types of emollient used in the study.  Skin reactions such as itching or redness were common with all emollienttypes.  Awareness of the different types of emollient was low, and users had different preferences based on how the emollients look and feel.  For example, some people liked how lotions quickly soaked in whereas others preferred the “barrier” provided by ointments.

Professor Matthew Ridd, a GP and study lead from Centre for Academic Primary Care at the University of Bristol, said: “A study of this type has been long overdue.  It has not been in the interest of the manufacturers to directly compare types of moisturiser in the way we have done in this trial.  Our findings challenge conventions about how often moisturisers need to be applied, which types are less likely to cause problems and which patients should be recommended certain types. For example, ointments are often suggested for more severe eczema, yet they were found to be no better.”

Professor Hywel Williams, consultant dermatologist and co-researcher at the University of Nottingham, explained: “Along with anti-inflammatory treatments such as topical corticosteroids, emollients are a really key part of treatment for childhood eczema, preventing flares and helping to soothe the skin and improving the quality of life for children and their carers.

“Our study shows that one size does not fit all, and points to the need for doctors to make parents aware of the different emollient types and to help them choose which one is mostly likely to work for them.  At last we have evidence that supports the saying, ‘The best moisturisers are the ones the patient will use.’”

Further work is needed to determine if these findings apply to adolescents and adults with AD, and people with other dry skin conditions.

Source: EurekAlert!

Categories : PaediatricsTags :

New Ambulatory BP Monitoring Guidance for Children and Adolescents

On By ModernMedia
Boys running
Photo by Margaret Weir on Unsplash

An American Heart Association scientific statement reviewing new evidence and guidance on ambulatory blood pressure monitoring (ABPM) of children and adolescents published in the journal Hypertension.

The statement provides simplified classifications for ABPM in children and adolescents. ABPM is designed to evaluate a person’s blood pressure during daily living activities, including times of physical activity, sleep and stress.

Key points of the statement:

  • The statement provides simplified classifications for ambulatory blood pressure monitoring (ABPM) in children and adolescents. ABPM is designed to evaluate a person’s blood pressure during daily living activities, including times of physical activity, sleep and stress.
  • The new classifications come with guidance on when ABPM is appropriate and how to interpret monitoring results.
  • Children who have medical diagnoses, such as kidney disease, may have normal office blood pressure but significant abnormalities noted on ABPM. Without taking ABPM into account, this can lead to a more benign prognosis.
  • Elevated childhood blood pressure is linked to heart and kidney damage during youth and adulthood, as well as brain changes associated with worse cognitive function.
  • ABPM helps ease concern of spikes in blood pressure caused by measurement anxiety, known as white coat hypertension, and helps assess daily blood pressure patterns.
  • ABPM is used to confirm whether a child or adolescent with high blood pressure during a clinic measurement truly has hypertension.

Source: American Heart Association

Categories : Medical IndustryTags :

The World is Short of 43 Million Health Workers

On By ModernMedia
Healthcare worker pulling on gloves
Image by Gustavo Fring on Pexels

In order to attain universal healthcare coverage, the world needs an additional 43 million health workers, according to research from the Institute for Health Metrics and Evaluation (IHME) published in The Lancet. Sub-Saharan Africa, South Asia, and North Africa and the Middle East were found to have the largest shortfalls in health worker coverage.

“These are the most comprehensive estimates to date of the global health care workforce,” said senior author Dr Rafael Lozano, Director of Health Systems at IHME. “Health care workers are essential to the functioning of health systems, and it’s very important to have these data available so that countries can make informed decisions and plan for the future.”

Four categories of health worker were studied: physicians, nurses and midwives, dental personnel, and pharmaceutical personnel. In 2019, they estimated that more than 130 countries had shortages of physicians and more than 150 had shortages of nurse and midwives. When comparing current levels of health care workers to the minimum levels needed to meet a target score of 80 on the universal health coverage (UHC) effective service coverage index, researchers estimated a shortage of more than 43 million health care workers, including 30.6 million nurses and midwives and 6.4 million physicians.

“We found that the density of health care workers is strongly related to a nation’s level of social and economic development,” said lead author Dr. Annie Haakenstad, Assistant Professor at IHME. “There are different strategies and policy approaches that may help with addressing worker shortages, and these should be tailored to the individual situation in each country. We hope that these estimates can be used to help prioritize policy interventions and inform future planning.”

The study revealed more than a 10-fold difference in the density of health care workers across and within regions in 2019. Densities ranged from 2.9 physicians for every 10 000 people in sub-Saharan Africa to 38.3 per 10 000 in Central Europe, Eastern Europe, and Central Asia. Cuba also stood out, with a density of 84.4 per 10 000 compared to 2.1 in Haiti.

Similar disparities were observed in measuring numbers of nurses and midwives, with a density of 152.3 per 10 000 in Australasia compared to 37.4 per 10 000 in Southern Latin America. Despite steady increases in the health care workforce between 1990 and 2019, substantial gaps persisted.

The researchers cited existing literature that highlights factors that contribute to worker shortages, including out-migration of health workers, war and political unrest, violence against health care workers, and insufficient incentives for training and retention. They noted that high-income locations should follow WHO guidelines on responsible recruitment of health personnel to avoid contributing to workforce gaps in lower-income regions.

The study findings demonstrated just how poorly prepared the world was when the COVID pandemic struck, further straining health systems that already were short of crucial frontline workers. These estimates will help policymakers, hospitals, and medical clinics prepare for future pandemics by focusing on training and recruitment. The authors also note that there is still much to learn about the impact of the pandemic on the health workforce. This includes gender dynamics in human resources for health (HRH) and how the departure of women from formal employment for care-taking duties at home may have depleted the health workforce, among other stressors on HRH during the pandemic.     

The full dataset from the study is available at the Global Health Data Exchange.

Source: Institute for Health Metrics and Evaluation

Categories : COVIDTags :

No Difference in BA.1 and BA.2 Omicron Severity

On By ModernMedia
Image from Pixabay

In a study published in Nature, a research team has shown that the BA.2 subvariant of omicron is similar to BA.1 in both the severity of illness it causes and in its ability to cause infection.

BA.2 is the dominant subvariant of Omicron in nearly seven dozen countries. The study’s findings stand in contrast to an earlier study that relied on recombinant virus bearing spike proteins from BA.1 and BA.2.

“That study indicated BA.2 may be more pathogenic than BA.1,” said Prof Yoshihiro Kawaoka, who led the present study. “But when we used authentic virus, we found that BA.2 is not more pathogenic.”

Prof Kawaoka and research associate professor and co-author Peter Halfmann, said that their findings suggest that other parts of the omicron virus may attenuate the pathogenicity of its spike proteins alone.

Relying on rodent models for the disease, researchers and their collaborators tested viruses isolated from human samples. Both subvariants of omicron caused less severe illness compared to earlier strains, including delta and the original wild strain of the virus.

The study team also found that existing therapeutic monoclonal antibodies and antiviral drugs remain effective against BA.2.

However, plasma from vaccinated people and from people who recovered from earlier infections was less effective at neutralising both subvariants of omicron compared to earlier virus strains, and plasma from people infected with BA.1 was less effective at neutralising BA.2.

But the researchers also found that plasma from people who were vaccinated and then infected with BA.1 or earlier variants exhibited a smaller decrease in effectiveness against BA.2.

“If you’re vaccinated and then infected, you’re protected against many different variants,” said Prof Kawaoka, especially compared to prior infection alone or vaccination alone.

The researchers are now testing the newest sub-variants of omicron, including BA.2.12.1, which has begun to rapidly spread in New York state.

Source: University of Wisconsin