Testing ADHD, executive functioning, and stimulant medication as predictors of psychotic symptoms in children

Executive dysfunction has been associated with psychotic experiences. One of the syndromes most associated with executive dysfunction difficulties in childhood is ADHD. However, stimulant ADHD medications are known to increase psychotic-like symptoms in some circumstances. These interrelated factors make it difficult to tease apart which of these most predict psychotic experiences. Using cross sectional data analysis, this thesis looks into the extent of how executive dysfunction, ADHD, and stimulant medication each independently predict psychotic symptoms in 9-10-year-old children. Part 1 is a conceptual paper based on a review of related literature. The primary aim was to understand the natures of ADHD, executive dysfunction, and stimulant medications. It further investigates their associations and potential mechanisms for psychotic experiences. Part 2 is an empirical paper, which reports a study on predictors of psychotic experiences in children. The study aimed to examine to what extent a diagnosis of ADHD, stimulant medication, and executive dysfunction each independently predict psychotic symptoms in children after controlling for potential confounders. Findings indicate that ADHD was not associated with psychotic experiences. On the other hand, both stimulant medication and executive dysfunction showed a significant relationship with psychotic experiences, even after controlling for confounders. Stimulant medication did not moderate the relationship between executive dysfunction and psychotic experiences. Clinical implications and future recommendations are further discussed. Part 3 is a critical appraisal of the study of the literature review and the empirical study. It includes personal reflections on the research processes from a clinical and research perspective

The Management of Chronic Myofascial Thoracolumbar Pain with Dry Needling, Spinal Manipulation, Cognitive Behavioral Therapy and Exercise: A Case Report

Background & Purpose: Chronic pain suffers have been shown to be comorbid with psychosocial impairments such as anxiety, depression and pain catastrophizing. Cognitive Behavioral Therapy (CBT) is a popular non-pharmacological treatment that has shown efficacious outcomes in reducing pain and disability levels in chronic pain suffers. Myofascial pain syndrome is a pain condition within the soft tissue that is perpetrated by myofascial trigger points (MTrP). MTrPs are associated with greater disability, poorer sleep quality and altered muscle activation patterns. MTrPs are also correlated with the development of central sensitization and chronic pain syndromes. Dry needling (DN) and Spinal Manipulative Therapy (SMT) have shown to reduce pain and disability in MTrP. The purpose of this case report is to provide a treatment rationale and documentation of the efficacy of combining CBT, DN, SMT and exercise in the management of an individual with chronic myofascial pain syndrome. Case Description: A 33-year-old male veteran was referred to therapy with a chief complaint of a constant, dull burning mid-scapular ache extending down to his lower back and up to his trapezius on the right side. He described this pain as 6/10 at current and constant, 5/10 at best with rest and pain medication and 10/10 at worst that occurs intermittently with prolonged sitting, walking and particularly forward-bending. Physical impairments included decreased and painful active range of motion, thoracic spine and rib hypomobility, and lumbar spine hypermobility with a positive prone instability test. MTrPs were identified along the T6-8 paraspinals, rhomboids at the medial border of the right scapula and lumbar segments L1-2 and L4-5. The patient was treated for nine 30-minute treatment sessions following a one-hour initial evaluation. DN was performed in 4/10 sessions; CBT, SMT and exercise were performed in every session. Outcomes: Pain intensity and catastrophizing were measured by the Numeric Pain Rating Scale (NPRS) and Pain Catastrophizing Scale (PCS). Disability was measured by the Oswestry Disability Index (ODI) and the Patient Specific Functional Scale (PSFS). Active functional movement was measured using the Selective Functional Movement Assessment (SFMA). Following ten treatments, NPRS improved from 7/10 to 3/10, PCS improved from 31/52 to 16/52, and ODI improved from 72% to 8%. PSFS to return to golfing improved from a perceived ability of as a 7/10 ability and return to CrossFit activities as 8/10. SFMA multi-segmental flexion and rotation and overhead squat improved to functional painful while single leg stance improved to functional non-painful. Thoracic spine and rib mobility improved to a grade 3 without pain. Discussion: Pain intensity, catastrophizing, disability and functional movement were all improved following nine treatment sessions. The outcomes of this case report suggest a multimodal treatment approach of DN, SMT, CBT and exercise may be beneficial for individuals with chronic myofascial pain

Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction

BACKGROUND: A dacryocystorhinostomy (DCR) procedure aims to restore drainage of tears by bypassing a blockage in the nasolacrimal duct, through the creation of a bony ostium that allows communication between the lacrimal sac and the nasal cavity. It can be performed using endonasal or external approaches. The comparative success rates of these two approaches have not yet been established and this review aims to evaluate the relevant up-to-date research.OBJECTIVES: The primary aim of this review is to compare the success rates of endonasal DCR with that of external DCR. The secondary aim is to compare the complication rates between the two procedures.SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2016, Issue 8), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to 22 August 2016), Embase (January 1980 to 22 August 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to 22 August 2016), Web of Science Conference Proceedings Citation Index- Science (CPCI-S) (January 1990 to 22 August 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 22 August 2016. We requested or examined relevant conference proceedings for appropriate trials.SELECTION CRITERIA: We included all randomised controlled trials (RCTs) comparing endonasal and external DCRs.DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility and extracted data on reported outcomes. We attempted to contact investigators to clarify the methodological quality of the studies. We graded the certainty of the evidence using GRADE.MAIN RESULTS: We included two trials in this review. One trial from Finland compared laser-assisted endonasal DCR with external DCR, and one trial from India compared mechanical endonasal DCR (using punch forceps) with external DCR. The trials were poorly reported and it was difficult to judge the extent to which bias had been avoided.Anatomic success was defined as the demonstration of a patent lacrimal passage on syringing, or endoscopic visualisation of fluorescein dye at the nasal opening of the anastomoses after a period of at least six months following surgery. Subjective success was defined as the resolution of symptoms of watering following surgery after a period of at least six months. Both included trials used anatomic patency demonstrated by irrigation as a measure of anatomic success. Different effects were seen in these two trials (I(2) = 76%). People receiving laser-assisted endonasal DCR were less likely to have a successful operation compared with external DCR (63% versus 91%; risk ratio (RR) 0.69, 95% confidence intervals (CI) 0.52 to 0.92; 64 participants). There was little or no difference in success comparing mechanical endonasal DCR and external DCR (90% in both groups; RR 1.00, CI 0.81 to 1.23; 40 participants). We judged this evidence on success to be very low-certainty, downgrading for risk of bias, imprecision and inconsistency. The trial from Finland also assessed subjective improvement in symptoms following surgery. Resolution of symptoms of watering in outdoor conditions was reported by 84% of the participants in the external DCR group and 59% of those in the laser-assisted endonasal DCR group (RR 0.70, CI 0.51 to 0.97; 64 participants, low-certainty evidence).There were no cases of intraoperative bleeding in any participant in the trial that compared laser-assisted endonasal DCR to external DCR. This was in contrast to the trial comparing mechanical endonasal DCR to external DCR in which 45% of participants in both groups experienced intraoperative bleeding (RR 1.00, 95% CI 0.50 to 1.98; 40 participants). We judged this evidence on intraoperative bleeding to be very low-certainty, downgrading for risk of bias, imprecision and inconsistency.There were only two cases of postoperative bleeding, both in the external DCR group (RR 0.33, 95% CI 0.04 to 3.10; participants = 104; studies = 2). There were only two cases of wound infection/gaping, again both in the external DCR group (RR 0.20, CI 0.01 to 3.92; participants = 40; studies = 1). We judged this evidence on complications to be very low-certainty, downgrading one level for risk of bias and two levels for imprecision due to the very low number of cases.AUTHORS' CONCLUSIONS: There is uncertainty as to the relative effects of endonasal and external DCR. Differences in effect seen in the two trials included in this review may be due to variations in the endonasal technique, but may also be due to other differences between the trials. Future larger RCTs are required to further assess the success and complication rates of endonasal and external DCR. Different techniques of endonasal DCR should also be assessed, as the choice of endonasal technique can influence the outcome. Strict outcome criteria should be adopted to assess functional and anatomical outcomes with a minimal follow-up of six months.</p

Global education for gender equality and sustainable human development. Making the connections

The paper examines and explores why gender equality must be seen as a final goal in and of itself and as a prerequisite for attaining sustainable human development goals and building global citizenship. Discriminatory practices in all areas including education, as well as traditional and harmful gender norms like violence against women limit, inhibit and eventually impede the full development and empowerment of women which is critical to the realization of these two goals. Globalization brought about an increasingly commercialized orientation to education which mainly caters to market needs and priorities. In this context, there is an urgent need for a meaningful reorientation of educational programs that aims at strengthening and broadening students’ critical thinking and understanding of education as a means to promote sustainable human development and global citizenship. For illustration, the specifi c example of Miriam College in the Philippines, is used to discuss both the possibilities, and challenges of gendered global learning strategies. (DIPF/Orig.)Der Beitrag untersucht, warum die Gleichstellung der Geschlechter als Endziel an und für sich und als Voraussetzung für die Verwirklichung einer nachhaltigen menschlichen Entwicklung und den Aufbau globaler Bürgerschaft gesehen werden muss. Geschlechtsdiskriminierende Praktiken in allen Bereichen, einschließlich im Bildungssystem, sowie traditionelle und Gender Normen und Gewalt gegen Frauen verhindern die volle Entfaltung und Stärkung von Frauen, die entscheidend für die Verwirklichung dieser beiden Ziele ist. Die Globalisierung bewirkte eine zunehmend kommerzialisierte Ausrichtung von Bildungsprozessen, die sich primär den marktwirtschaftlichen Zwängen unterwirft. In diesem Zusammenhang gibt es einen dringenden Bedarf für eine sinnvolle Neuausrichtung von Bildung, die darauf abzielt, das kritische Denken und Verständnis zu fördern und Bildung als Mittel zu einer nachhaltigen menschlichen Entwicklung und einer globalen Bürgerschaft begreift. (DIPF/Orig.

Optimizing Clinical Outcomes for Endoscopic Lacrimal Duct Recanalization in Patients with Complete PANDO

Abstract Purpose The study aims to describe modifications and refinements in the technique and technology of Transcanalicular Endoscopic Lacrimal Duct Recanalization (TELDR) based on anatomical foundations to optimize its clinical outcomes in patients with complete Primary Acquired Nasolacrimal Duct Obstruction (PANDO). Methods The medical records of 115 patients who underwent Transcanalicular Endoscopic Lacrimal Duct Recanalization procedures from January 2018 to July 2020 were reviewed retrospectively. Of the 115 patients, only those 35 patients with complete PANDO characterized by longstanding epiphora of 5–7 years duration, dense, diffuse fibrous tissue obstruction involving the sac, sac duct junction and the entire length of the nasolacrimal duct were included in the study. Parameters for success were analyzed based on patency on irrigation, functional endoscopic dye test, and improvement of epiphora. Results Forty-five cases from 35 patients with complete PANDO were included in the study. The mean length of time from the date of operation to silicone stent removal was 8.1 weeks while the mean length of follow-up starting from the removal of silicone stent to last follow-up was 61.0 weeks. There were 95.6% anatomic patency on canalicular irrigation with saline and 95.6% functional patency based on functional endoscopic dye test. There was significant improvement of epiphora (p-value of &lt; 0.0001) post-operatively. Conclusion The results of modified TELDR improved clinical outcomes and could be a definitive treatment in patients with complete PANDO with longstanding, dense, diffuse, fibrous tissue obstruction. Patients who experience reobstruction, may undergo a repeat of the recanalization approach.</jats:p