Addressing Health Equity in Food Allergy.

Social determinants of health can lead to poor health outcomes for food-allergic patients, including limited access to allergen-free foods and specialty care. Housing and transportation limitations can worsen social factors including food insecurity, poor early food introduction, increased reactivity to foods, lower tertiary/allergy care utilization, and increased emergency department utilization. A key component of addressing health equity involves valuing all people with sustained, focused efforts to address social determinants of health. In this clinical commentary, we discuss the current state of heath equity for food-allergic patients, highlighting the disparities in emergency care, food allergy prevention, and food insecurity. Solutions to improve health equity through clinical practice are proposed. Currently available funding opportunities through the National Institutes of Health for health equity initiatives are outlined. Gaps in health equity for food-allergic patients include the lack of documented successful implementation of effective solutions to food insecurity, poor early food introduction uptake, poor access to specialist care, and unequal distribution of educational resources. The availability of research funding and legislative policies supporting access to food and education bolster the impetus to move toward health equity for 20 million people in the United States with food allergy.

Receiver operating characteristic curve analysis of the Weiss Functional Impairment Rating Scale-Parent Report for screening children with ADHD: Looking beyond symptoms in ADHD diagnosis.

AIM: The current study aimed at examining the ability of the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) to discriminate between children with ADHD and controls in functional impairment and identifying optimal cutoff scores for the WFIRS-P subscales and total scale. METHODS: Parents of 51 children with ADHD (90.2% male; grades 1-6) and 51 gender/grade matched controls (90.2% male; grades 1-6) completed the WFIRS-P. Receiver operating characteristic (ROC) curve analysis was used to examine the ability of the WFIRS-P to differentiate children with ADHD from controls and to determine optimal cutoff scores of the WFIRS-P. RESULTS: Area under the curve (AUC) was 0.98 for the WFIRS-P total scale, indicating excellent ability to differentiate children with ADHD from controls. The score of 0.45 with 0.88 for sensitivity and 0.96 for specificity was determined as the optimal cutoff score for the total scale of the WFIRS-P. AUC was 0.73 to 0.97 for the WFIRS-P subscales, suggesting good to excellent ability for discriminating between children with ADHD and controls. Among the subscales, the family subscale score of 0.42 with 0.92 for sensitivity and 0.96 for specificity showed the highest discriminating power. The self-concept and life skills subscales had low sensitivity, suggesting Iranian mothers do not identify problems with self-concept or difficulty with life skills as particularly problematic in ADHD. CONCLUSIONS: The WFIRS-P is a sensitive and specific measure of the functional impairment associated with ADHD in Iranian children. Our sample was predominantly male, limiting the generalizability of results to females.

The current state of lesbian, gay, bisexual, and transgender cultural competency among U.S. dermatology residents.

Lesbian, gay, bisexual, and transgender (LGBT) people interface with dermatology providers for many reasons. Implementing culturally competent LGBT dermatologic care necessitates evaluating provider competency to identify where gaps remain. Objectives: To assess the LGBT cultural competency among U.S. dermatology residents. Methods: A self-reporting, cross-sectional survey was emailed to U.S. dermatology program coordinators (N = 143). LGBT patient exposure, LGBT educational hours, and LGBT cultural competency via the LGBT-Development of Clinical Skills Scale (with the subscales Clinical Preparedness, Attitudinal Awareness, and Basic Knowledge) were measured. Results: Dermatology residents (N = 119) across the United States completed the survey. They reported caring for less than 20 LGBT patients per year and receiving less than 75 minutes of LGBT education per year. They reported significantly higher Attitudinal Awareness than both Clinical Preparedness and Basic Knowledge; they reported significantly higher Basic Knowledge than Clinical Preparedness. They reported significantly less adequate clinical training and supervision, experience, and competence to assess transgender patients compared to lesbian, gay, and bisexual patients. In general, dermatology residents who reported more LGBT patients and LGBT education also reported higher LGBT cultural competency. Limitations: A larger national sample of U.S. dermatology residents is necessary for generalizability. Conclusions: Currently, there is a lack of LGBT education in U.S. dermatology residency curricula, which may delay addressing the health disparities that exist in this patient population. Due to such dearth of standardized LGBT education, dermatology residents likely do not feel adequately knowledgeable or prepared to address LGBT needs. Both LGBT education and LGBT patient experiences may help alleviate these shortcomings and help LGBT patients feel affirmed in their dermatologic care.

Minocycline as add-on treatment decreases the negative symptoms of schizophrenia; a randomized placebo-controlled clinical trial.

There are contradictory reports about the efficacy of minocycline for treating schizophrenia. This is a randomized, placebo-controlled clinical trial investigating the effectiveness of minocycline for treating schizophrenia. Forty three patients with schizophrenia diagnosed according to DSM-IV were randomly allocated into minocycline (200mg/d) + risperidone group (n = 21) or placebo + risperidone group (n = 22). Scale for Assessment of Negative Symptoms (SANS), Positive and Negative Syndrome Scale for schizophrenia (PANSS), Beck's Depression inventory, and Abnormal Involuntary Movement Scale (AIMS) were used. Assessments occurred at baseline, week 4 and week 8. Thirty five patients completed the trial. The changes of SANS total score from baseline to week 4 were not statistically different between the two groups. However, at week 8, there was a statistically significant difference between the two groups. SANS score decreased in the minocycline group more than that of the placebo group (12.2(7.9) versus 6.8(8.6), respectively). The decline of PANSS Negative score from baseline to week 8 in the minocycline group was more than placebo group (4.3(4.2) versus 3.2(3.3). However, the difference was not statistically significant. No one dropped out due to adverse effects. This trial supports the effectiveness of minocycline as an adjuvant treatment with risperidone for treating negative symptoms of patients with schizophrenia. Some patents on the use of tetracycline for the treatment of schizophrenia are also outlined.

Lovastatin for the adjunctive treatment of schizophrenia: a preliminary randomized double-blind placebo-controlled trial.

While statins target many of the pathways to neuroprogression in schizophrenia, the safety and efficacy of statins for treating schizophrenia has never been examined. This is an 8-week randomized double blind controlled clinical trial examining the efficacy and safety of adjunctive lovastatin (20 mg/day) treatment or placebo for people with schizophrenia. The baseline characteristics of the two groups were not different. Endpoint changes in Positive and Negative Syndrome Scale (PANSS) total and subscale scores did not differ between the two groups. However there was a significant difference between the doses of risperidone used in the two groups. The mean dose in the lovastatin and placebo groups were 4.8(1.8) and 3.4(1.4) mg/day, respectively (P<.03). No serious adverse events were reported. Slowness of movements, muscle rigidity, increased appetite, and decreased energy were the most common adverse effects, and these rates did not differ between the two groups. This study failed to demonstrate a benefit of lovastatin on symptoms of schizophrenia. This combination was well tolerated. However, a higher dosage of risperidone was used for treating the disorder in those taking concomitant lovastatin compared to placebo.