Atopic dermatitis (AD) is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in the management and care of AD, providing updated and expanded recommendations based on the available evidence. In this first of 4 sections, methods for the diagnosis and monitoring of disease, outcomes measures for assessment, and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed.

http://blackbook.com.br/wp-content/uploads/2014/02/OK-aad-2012-atopic-dermatitis-guideline-part-1-article-in-press.pdf

Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis.

Placebo

This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus-based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This second part of the guideline covers antimicrobial therapy, systemic treatment, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions, whereas the first part covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy. Management of AE must consider the individual clinical variability of the disease. Systemic immunosuppressive treatment with cyclosporine, methotrexate, azathioprine and mycophenolic acid is established option for severe refractory cases, and widely available. Biologicals targeting the T helper 2 pathway such as dupilumab may be a safe and effective, disease-modifying alternative when available. Oral drugs such as JAK inhibitors and histamine 4 receptor antagonists are in development. Microbial colonization and superinfection may cause disease exacerbation and can require additional antimicrobial treatment. Allergen-specific immunotherapy with aeroallergens may be considered in selected cases. Psychosomatic counselling is recommended especially in stress-induced exacerbations. Therapeutic patient education ('Eczema school') is recommended for children and adult patients. General measures, basic emollient treatment, bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy have been addressed in the first part of the guideline.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.14891

Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I.

The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune-suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies.

https://www.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1468-3083.2012.04635.x

Guidelines for treatment of atopic eczema (atopic dermatitis) part I.

* Abbreviations:
 RCT — : randomized controlled trial
 SSRI — : selective serotonin reuptake inhibitor

It has long been an axiom in clinical pediatrics that “children are not just little adults.” It has also been recognized that there are many changes from birth through childhood and the adolescent years. However, the full implications of pediatric age groupings for health care and research are still not adequately understood. There is still much to be discovered about children’s biological and psychological development and how these processes affect the effectiveness and efficacy of interventions. Trial design that accounts for age differences and promotes consistency in reporting of age-related data is essential to ensure the validity and clinical usefulness of pediatric trial data.

A recent study highlighted variable treatment efficacy in children versus adults. In this study, 128 meta-analyses from Cochrane reviews, containing data on at least 1 adult and 1 pediatric randomized controlled trial (RCT) with a binary primary efficacy outcome, were reviewed.1 The authors found that in all except 1 case, the 95% confidence intervals could not exclude a relative difference in treatment efficacy between adults and children of >20%; in two-thirds of these cases, the relative difference in observed point estimates was >50%. The study also highlighted the paucity of RCTs in pediatrics; the median number of children per meta-analysis was 2.5 times smaller than the number of adults.

Children and adults seem to have distinctive responses to treatments. For example, administration of phenobarbitones is useful for adults with cerebral malaria and is associated with decreased convulsions. However, in children, this drug is associated with increased 6-month mortality. Similarly, corticosteroids may offer survival benefit for adults with bacterial meningitis but not for children with the same condition. In acute traumatic brain injury, corticosteroids did not decrease mortality in adults, but there was a trend for increased mortality in children.1 In asthma, long-acting β2-agonists decreased … 

Address correspondence to Martin Offringa, MD, PhD, Senior Scientist and Program Head, Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. E-mail: martin.offringa{at}sickkids.ca

Standard 6: Age Groups for Pediatric Trials

Atopic eczema is an itchy inflammatory skin condition which affects the quality of life of children with eczema and their parents; it can affect up to 15% of school children in the UK. Psychological and educational approaches to treating eczema have been used to complement medication in managing eczema by, for example, promoting relaxation and educating parents and children to understand the condition and their role in its successful management. However, the effectiveness of these approaches has not been systematically reviewed.

The main finding of the review is that there is currently only limited research evidence about the effectiveness of educational and psychological approaches when used with medicines for the treatment of childhood eczema. We were only able to include one study on the effectiveness of psychological approaches in the review. We included four educational studies, of which three identified that education decreased the severity of the eczema, and one study found that education improved quality of life for parents of children with eczema. Relaxation methods reduced the severity of the eczema, compared to discussion only, in the psychological study. Two different approaches have been used to deliver education; one led by a nurse and the other by a team of health professionals.

Due to weaknesses in the quality of most of the research studies and the fact that different measures were used to evaluate effectiveness of the approaches, we cannot draw strong conclusions about whether psychological and educational approaches work or which is the best approach to use. More details are needed about the psychological and educational approaches used, to allow a greater understanding of the key factors that might help reduce eczema. Better description of the research methods used are also needed. Research priority should also be given to comparing the relative cost effectiveness of health professionals educating parents either in teams or by nurses alone.

No adverse effects have been reported.

Limitations of the review: We were able to find only five studies eligible for inclusion in the review and we were not able to combine findings from these studies due to the different ways in which effectiveness of the approaches were measured.

/pdf/psychological-and-educational-interventions-for-atopic-4vwz71372o.pdf

Psychological and educational interventions for atopic eczema in children

This feature considers the challenges that academic librarians are increasingly being faced with in the delivery of information skills training to large student numbers with limited time and staff resources. A case study is presented of how an academic liaison librarian used a blended learning approach and innovative teaching practice to successfully deliver information skills training to large student numbers within the Faculty of Health and Social Care at Hull University.



HS

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1471-1842.2011.00942.x

The development of a blended learning approach to delivering information skills training to large health related student audiences with limited staff resource.

Introduction This research explored Instagram ‘Fitness Influencers’, to develop an understanding of the content they post online, the level of objectification and gender differences in the extent of this objectification. The media previously has presented gendered representations of women and men, with women subjected to greater objectification than males, with similar findings in social media research. Fitness Influencers are online micro-celebrities influential on young people, thus knowledge of the images being consumed is beneficial due to the associated detrimental effects of unconsciously internalising objectified media and that promoting unattainable beauty standards. Methods A content analysis of 90 influencer images was conducted to provide an understanding of the type of images shared, followed by a Chi square (χ2) to determine gender differences; the qualitative content analysis phase identified four main themes, lifestyle, brand endorsements, engaged in activity and objectification. Results There were no significant gender differences found (p>0.05) however, objectification sub-themes found significant differences in muscularity between males and females and in sultry poses (p<0.001), in line with gender stereotypes and norms in society. Conclusion The identification of greater objectification of males highlights the need for greater consideration for male’s body image, and greater consideration for the content being shared online more generally, due to the associated detrimental effects of consuming certain types of imagery.

/pdf/imagery-matters-the-role-of-fitness-influencers-in-the-5ky0fz0v.pdf

Imagery Matters: The Role of Fitness Influencers in the Reproduction of Socio-Cultural Gender Norms

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Psychological and educational interventions for atopic eczema in children

The development of a blended learning approach to delivering information skills training to large health related student audiences with limited staff resource.

Imagery Matters: The Role of Fitness Influencers in the Reproduction of Socio-Cultural Gender Norms