Practical Management of Patients with Atopic Dermatitis on Dupilumab.

INTRODUCTION: Dupilumab is approved to treat moderate-to-severe atopic dermatitis (AD) in several countries in patients as young as 6 years of age. Since its approval, practical issues related to the use of dupilumab for AD have arisen, with particular interest in transitioning from current therapies and managing medication overlap, considerations for special populations of patients with AD, and management of potential adverse events. METHODS: This article aims to review the literature addressing several practical management issues related to dupilumab use for AD and to provide a framework for clinical decision-making in these circumstances and sub-populations. Each statement was reviewed, revised and voted on by authors to provide their level of agreement and degree of uncertainty for each statement. RESULTS: An agreement level > 80% was achieved for all of the statements. CONCLUSION: The expert panel provides statements considering the practical management of patients with AD taking dupilumab to inform clinical decision-making in specific but frequently encountered clinical situations.

Facing the "new normal": How adjusting to the easing of COVID-19 lockdown restrictions exposes mental health inequalities.

BACKGROUND: Re-establishing societal norms in the wake of the COVID-19 pandemic will be important for restoring public mental health and psychosocial wellbeing as well as economic recovery. We investigated the impact on post-pandemic adjustment of a history of mental disorder, with particular reference to obsessive-compulsive (OC) symptoms or traits. METHODS: The study was pre-registered (Open Science Framework; https://osf.io/gs8j2/). Adult members of the public (n = 514) were surveyed between July and November 2020, to identify the extent to which they reported difficulties re-adjusting as lockdown conditions eased. All were assessed using validated scales to determine which demographic and mental health-related factors impacted adjustment. An exploratory analysis of a subgroup on an objective online test of cognitive inflexibility was also performed. RESULTS: Adjustment was related to a history of mental disorder and the presence of OC symptoms and traits, all acting indirectly and statistically-mediated via depression, anxiety and stress; and in the case of OC symptoms, also via COVID-related anxiety (all p < 0.001). One hundred and twenty-eight (25%) participants reported significant adjustment difficulties and were compared with those self-identifying as "good adjusters" (n = 231). This comparison revealed over-representation of those with a history or family history of mental disorder in the poor adjustment category (all p < 0.05). 'Poor-adjusters' additionally reported higher COVID-related anxiety, depression, anxiety and stress and OC symptoms and traits (all p < 0.05). Furthermore, history of mental disorder directly statistically mediated adjustment status (p < 0.01), whereas OC symptoms (not OC traits) acted indirectly via COVID-related anxiety (p < 0.001). Poor-adjusters also showed evidence of greater cognitive inflexibility on the intra-extra-dimensional set-shift task. CONCLUSION: Individuals with a history of mental disorder, OC symptoms and OC traits experienced greater difficulties adjusting after lockdown-release, largely statistically mediated by increased depression, anxiety, including COVID-related anxiety, and stress. The implications for clinical and public health policies and interventions are discussed.

The hunt is on

What if we could track down the virus that will cause the next pandemic before it leaps from other animals to humans, asks David Adam

Career and technical education high school principals: Perceptions after a sudden federal policy shift

Federal legislative acts have steadily aimed at closing the divide between Career and Technical Education (CTE) and academic programs since publication of A Nation At Risk in 1983. This trend culminated in the Every Student Succeeds Act (ESSA) goal that there should be alignment between CTE and academic standards if States and local educational agencies (LEA) were to receive funding under ESSA. However, that policy trend was punctuated before that goal was to take effect. This qualitative study focused on the lived experiences of ten New York City Department of Education CTE school principals as they made sense of their roles and of the state of CTE in light of this federal policy shift. Six key findings revealed their experiences with the policy shift itself, integration of CTE and academics at their schools, and their hopes and fears for the future of CTE in light of recent federal policy shifts. Implications for policy focus on the contradiction within ESSA caused by the recent federal policy shift. Recommendations for practice range from improved communication by state, district, and school-level leadership, and the introduction of structures that would focus on the needs of CTE schools and their teachers and leaders. Additionally, as a postscript to this study, the researcher acknowledges the global Covid-19 pandemic, which hit the United States after the conclusion of this study as a timely example of punctuated equilibrium, and offers it as a construct for examining and understanding the impact of the current COVID-19 pandemic, a phenomenon, on education. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Concerns over UK advice.

Key scientific data and advice to the UK government won't be published until the coronavirus pandemic ends, reports David Adam.