How has the COVID-19 pandemic affected eczema self-management and help seeking? A qualitative interview study with young people and parents/carers of children with eczema.

Background: Eczema can have a considerable impact on quality of life. Treatments can improve this, but management is complex. Barriers to eczema self-management may be impacted upon by environmental context, such as the COVID-19 pandemic. Objectives: To explore experiences of eczema, self-management, and accessing healthcare and advice during the COVID-19 pandemic among young people with eczema and parents/carers of children with eczema. Methods: Qualitative semi-structured interviews were carried out with 36 participants recruited from general practices as part of randomised controlled trials of online eczema resources. Results: Changes to everyday life-Periods of staying at home due to the pandemic alter the burden of eczema, with reports of an improved routine and application of topical treatments for many, but difficulties with handwashing for others. Parents/carers reported improved eczema control due to closures of educational settings. Young people reported higher stress that may have triggered eczema flare-ups. Changes to access to advice and treatment-There was a reluctance to seek medical appointments in a non-emergency situation. Participants reported a lack of trust in the outcome of telephone consultations because health professionals were unable to see or feel the skin. Delays or difficulties when obtaining appointments and treatments caused frustration. Access to an online eczema resource was reported to have extra value in the context of the pandemic. Conclusion: Changes to lifestyle and access to healthcare during the pandemic have affected eczema and self-management. Healthcare settings may want to consider providing extra reassurance around remote consultations.

Views and experiences of managing eczema: systematic review and thematic synthesis of qualitative studies.

BACKGROUND: The number of qualitative studies on eczema has increased rapidly in recent years. Systematically reviewing these can provide greater understandings of people's perceptions of eczema and eczema treatments. OBJECTIVES: We sought to systematically review and thematically synthesize qualitative studies exploring views and experiences of people with eczema and parents/carers of children with eczema. METHODS: We searched MEDLINE, EMBASE, PsycINFO and CINAHL from the earliest date available to February 2019. We selected papers focusing on views and experiences of eczema and eczema treatments, and barriers/facilitators to eczema self-management. We excluded papers focusing on health service provision models or health professionals' views. RESULTS: We synthesized 39 papers (reporting 32 studies) from 13 countries. We developed four analytical themes: (1) Eczema not viewed as a long-term condition; (2) Significant psychosocial impact not acknowledged by others; (3) Hesitancy (patient/carer uncertainty) about eczema treatments; and (4) Insufficient information and advice. Our findings suggest that people with eczema and their carers experience frustration at having to manage a condition that is often seen by others as mundane but has significant psychosocial impact and is difficult to manage due to concerns about, and burden of, treatment. This frustration can be exacerbated by experiences of conflicting and/or insufficient information and advice from health professionals, family and others. CONCLUSIONS: Effective self-management of eczema could be supported by addressing beliefs and concerns about treatments; seeking positive ways to promote a 'control not cure' message; acknowledging psychosocial impacts of eczema and treatment burden; and providing clear consistent advice or signposting towards reliable information.

'It's like the bad guy in a movie who just doesn't die': a qualitative exploration of young people's adaptation to eczema and implications for self-care.

BACKGROUND: Eczema is a common childhood inflammatory skin condition, affecting more than one in five children. A popular perception is that children 'outgrow eczema', although epidemiological studies have shown that, for many, eczema follows a lifelong episodic course. OBJECTIVES: To explore the perceptions of young people about the nature of their eczema and how these perceptions relate to their self-care and adapting to living with eczema. METHODS: This is a secondary inductive thematic analysis of interviews conducted for Healthtalk.org. In total 23 interviews with young people with eczema were included. Of the 23 participants, 17 were female and six male, ranging from 17 to 25 years old. RESULTS: Participants generally experienced eczema as an episodic long-term condition and reported a mismatch between information received about eczema and their experiences. The experience of eczema as long term and episodic had implications for self-care, challenging the process of identifying triggers of eczema flare-ups and evaluating the success of treatment regimens. Participants' experiences of eczema over time also had implications for adaptation and finding a balance between accepting eczema as long term and hoping it would go away. This linked to a gradual shift in treatment expectations from 'cure' to 'control' of eczema. CONCLUSIONS: For young people who continue to experience eczema beyond childhood, a greater focus on self-care for a long-term condition may be helpful. Greater awareness of the impact of early messages around 'growing out of' eczema and provision of high-quality information may help patients to manage expectations and support adaptation to treatment regimens. What's already known about this topic? There is a common perception that people 'grow out of' eczema, but for many people eczema follows a lifelong episodic course. Qualitative work has shown that parents can find that being told their child will grow out of eczema is dismissive, and that they have difficulty with messages about 'control not cure' of eczema. It is unclear how young people perceive their eczema and the implications of this perception for their adaptation and self-care. What does this study add? The message that many people 'grow out of' eczema has a potentially detrimental effect for young people where the condition persists. This has implications for young people's perceptions of their eczema, their learning to self-care and how they adapt to living with eczema and eczema treatments. What are the clinical implications of this work? Clinicians need to promote awareness among young people that eczema is a long-term episodic condition in order to engage them with effective self-care. Young people transitioning to self-care need evidence-based information that is specific and relatable to them.

Contraceptive method mix menu: providing healthy choices for women.

This article addresses expansion of the contraceptive method mix, in the specific context of underserved women in developing countries who, like all women, expect to maintain their health status while successfully regulating their fertility. It is a critical review of the health implications of the contraceptive methods most commonly included on a menu of options and includes fertility awareness methods as essential non-supply method options where barriers currently exist for supply methods.

PIP: In developing countries, many couples have little or no choice of contraception. Thus, underserved couples include those who wish to control their fertility but use no method as well as those who have only a limited number of choices available and would switch to a more acceptable method if they could. The barriers to use of contraceptives requiring supplies or medical services include fear of health risks, lack of good quality services and products, and religious or cultural taboos. Contraceptive method mixes must include a variety of "safe" contraceptives (those that protect against pregnancy and minimize health risks and side effects), because individual women must have the opportunity to judge how a contraceptive may affect the short- and long-term quality of their lives. The standard menu of contraceptives offered includes female sterilization, the IUD, oral contraceptives, condoms, and nonsupply methods such as fertility awareness methods and traditional methods. Each of these methods has comparative benefits and disadvantages. As the number of contraceptive users worldwide increases from 381 million couples in 1990 to 567 million in 2000, the challenge to provide safe, effective, acceptable, and affordable contraceptive options will also increase. A variety of such options will be necessary because no single method is appropriate for all couples. Because barriers to use of methods requiring supplies or medical services will continue to exist, fertility awareness methods must be considered an essential option. The effectiveness of fertility awareness methods must be improved, however, to achieve wider acceptability. Each couple must receive information about the benefits and disadvantages of each method offered so they can make a fully informed choice.

Detection of malignant melanoma with iodine-123 iodoamphetamine.

Iodoamphetamine (IMP) was shown by in vitro assay to have a high uptake by human melanotic melanoma cells, as compared to amelanotic melanoma cells. Eleven patients with proven malignant melanoma (MM) and 3 normal subjects were imaged at 2-4 hr and 16-24 hr after the i.v. injection 5 mCi (185 MBq) of [123I]IMP. One patient had a recurrent tumor that was subsequently shown to be squamous cell carcinoma. The index lesion was not visualized in the three patients with amelanotic melanomas. The index lesion/lesions were visualized in six of the seven other patients, except for 4/16 nodules in one patient. The seventh patient had a large, necrotic melanotic tumor that was not visualized, but an unsuspected lesion in the iliac nodes was detected. Multiple unsuspected lesions were detected in a second patient. While many lesions were seen at 2-4 hr, all lesions (other than a patient with small bowel disease) were seen best at 16-24 hr. No eye uptake was observed in any patient or control subject. Testicular uptake was seen in all males at 16-24 hr. Iodine-123 IMP appears to be a useful agent for the detection and follow-up of patients with melanotic MM.

Personnel exposure from flood phantoms and point sources during quality assurance procedures.

Nuclear medicine technologists routinely use flood phantoms containing 5 to 10 mCi (185-370 MBq) of Tc-99m to perform quality assurance tests on scintillation cameras. This paper presents the results of a study that measured the radiation exposure received by three individuals from a Tc-99m flood phantom during the daily performance of flood-field uniformity tests on three scintillation cameras. The extrapolated annual personnel exposure to the anterior trunk and the back of the hand were 172 mR and 220 mR, respectively. Additional measurements indicate that personnel performing these tests with a 10-mCi Co-57 flood disk source or a 200-muCi point source would receive approximately 25% and 1%, respectively, of the exposure from a 10-mCi Tc-99m flood phantom. These exposure levels should be considered when evaluating personnel radiation exposure in a nuclear medicine clinic.