Peer-assisted learning (PAL): skills lab tutors' experiences and motivation

BACKGROUND

Peer-assisted learning (PAL) is a common teaching and learning method in medical education worldwide. In the setting of skills laboratories (skills labs), student tutors are often employed as an equivalent alternative to faculty teachers. However, to the best of our knowledge, there is a lack of qualitative studies which explore the reasons for the personal commitment of student tutors. The aim of our study was to examine how undergraduate students experienced and evaluated their roles as skills lab student tutors, what their motivation was, and whether social and cognitive congruence played a role in their teaching experiences.

METHODS

We conducted in-depth, semi-structured interviews with student tutors who were currently teaching in a skills lab. After the interviews had been transcribed verbatim, two independent investigators performed a qualitative content analysis according to Mayring.

RESULTS

In total, we conducted nine interviews with student tutors. Our results revealed that all student tutors showed great enthusiasm and motivation for their jobs as peer teachers. One of the main motivating factors for student tutors to teach in a skills lab was the possibility to simultaneously share and improve their knowledge and expertise. In general, the participants of our study had high aspirations for their teaching. They found it particularly important to be empathetic with the student learners. At the same time, they thought they would personally benefit from their teaching activities and develop a certain expertise as student tutors.

CONCLUSIONS

With the present study we are able to gain some insight into what motivates student tutors to teach in a skills lab and what kind of experiences they have. Our results provide an important input for the future training of highly qualified student tutors.

High similarity of IgG antibody profiles in blood and saliva opens opportunities for saliva based serology

Saliva based diagnostics is a rapidly evolving field due to the large diagnostic potential and simple sample collection. Currently only few individual molecules were investigated for their diagnostic capabilities in saliva. A systematic comparison of IgG antibody profiles in saliva and plasma is still missing in scientific literature. Our hypothesis is that IgG profiles in plasma and saliva are highly similar for each individual. As a consequence, one could implement practically any plasma based IgG assay (classical serology) as saliva based assay. In other words, the IgG antibodies found in blood are also accessible from saliva. We confirm our hypothesis by comparing IgG reactivities towards protein and peptide antigens. We isolated saliva IgG with high purity and demonstrate that plasma IgG reactivities (classical serology) can be inferred from saliva. As a showcase we perform Hepatitis B virus antibody (plasma-)titer determination from saliva. Additionally we show that plasma and saliva IgG profiles of 20 individuals are highly similar for 256 peptide antigens and match (unsupervised) with high probabilities. Finally, we argue for generalisation to the complete IgG antibody profile. The presented findings could contribute greatly to the development of saliva based diagnostic methods of numerous antibody based tests.

Social Media Research Strategy to Understand Clinician and Public Perception of Health Care Messages

Introduction:

Despite the potential of social media to influence public health and generate insights, the process of monitoring and analyzing the dissemination of health care messages on social media has been described as difficult and in need of improvement.

Objectives:

The objective of this study was to describe and demonstrate a reproducible methodology for cataloging and analyzing health care–related social media comments and provide insight into how clinicians and members of the general public respond to health care messaging on social media.

Methods:

We collected social media comments related to the American Dental Association’s 2016 “Evidence-Based Clinical Practice Guideline for the Use of Pit-and-Fissure Sealants” between April 10, 2017, and October 31, 2017, from Facebook, Twitter, LinkedIn, Reddit, and online message boards for the New York Times, FiveThirtyEight, and Dentaltown. Using data provided in the comments, we conducted engagement analysis as well as content, network, and sentiment analysis across 8 categories.

Results:

We collected 671 comments. Among our findings, Facebook (472 of 671) was the most popular platform among commentators; almost half of all comments (335 of 671) aligned with the recommendations of the 2016 American Dental Association sealants guideline; clinicians were more likely than the general public to like a comment that suggested an improvement to the guideline; and >75% of comments (521 of 671) were supported by anecdotal evidence.

Conclusion:

As the prevalence of anecdotes on social media suggests, the likelihood of falsehoods spreading on social media is high. Insights gleaned from the methodology described in this research could help combat the spread of such misinformation by providing disseminators of health care messaging with insight into their target audiences. Armed with this knowledge, disseminators can craft health care messages that more effectively engage clinicians and the general public.

Knowledge Transfer Statement:

The methodology used in this research provides a reproducible strategy for tracking social media engagement with health care messages. Engagement results can assist future delivery of health care messages to key stakeholders and ensure better implementation and adoption of these communications.

Global glacier mass changes and their contributions to sea-level rise from 1961 to 2016

Glaciers distinct from the Greenland and Antarctic ice sheets cover an area of approximately 706,000 square kilometres globally¹, with an estimated total volume of 170,000 cubic kilometres, or 0.4 metres of potential sea-level-rise equivalent². Retreating and thinning glaciers are icons of climate change³ and affect regional runoff⁴ as well as global sea level^5,6. In past reports from the Intergovernmental Panel on Climate Change, estimates of changes in glacier mass were based on the multiplication of averaged or interpolated results from available observations of a few hundred glaciers by defined regional glacier areas^7-10. For data-scarce regions, these results had to be complemented with estimates based on satellite altimetry and gravimetry¹¹. These past approaches were challenged by the small number and heterogeneous spatiotemporal distribution of in situ measurement series and their often unknown ability to represent their respective mountain ranges, as well as by the spatial limitations of satellite altimetry (for which only point data are available) and gravimetry (with its coarse resolution). Here we use an extrapolation of glaciological and geodetic observations to show that glaciers contributed 27 ± 22 millimetres to global mean sea-level rise from 1961 to 2016. Regional specific-mass-change rates for 2006-2016 range from -0.1 metres to -1.2 metres of water equivalent per year, resulting in a global sea-level contribution of 335 ± 144 gigatonnes, or 0.92 ± 0.39 millimetres, per year. Although statistical uncertainty ranges overlap, our conclusions suggest that glacier mass loss may be larger than previously reported¹¹. The present glacier mass loss is equivalent to the sea-level contribution of the Greenland Ice Sheet¹², clearly exceeds the loss from the Antarctic Ice Sheet¹³, and accounts for 25 to 30 per cent of the total observed sea-level rise¹⁴. Present mass-loss rates indicate that glaciers could almost disappear in some mountain ranges in this century, while heavily glacierized regions will continue to contribute to sea-level rise beyond 2100.

Transverse technique: complementary approach to measurement of first-trimester uterine artery Doppler

OBJECTIVES

To define a protocol for the first-trimester assessment of uterine artery pulsatility index (UtA-PI) using the new transverse technique, to evaluate UtA-PI measured using the transverse approach vs that obtained using the conventional sagittal approach and to determine if accelerated onsite training (in both methods) of inexperienced sonographers can achieve reproducible UtA-PI measurements comparable with those obtained by an experienced sonographer.

METHODS

This was a prospective observational study of women with a singleton pregnancy attending for routine combined first-trimester screening at 11 to 13 + 6 weeks' gestation. The study consisted of two parts, each conducted at a different center (Part 1 in Calgary, Canada and Part 2 in Hong Kong). In Part 1, UtA-PI measurements were performed using the transverse and sagittal techniques by four sonographers trained in both methods, in 10 cases each, and measurement indices (PI), time required and subjective difficulty in obtaining satisfactory measurements were compared. The one sample t-test and Wilcoxon signed rank test were used when appropriate. Bland-Altman plots were used to assess measurement agreement, and intraclass correlation coefficient (ICC) was used to evaluate measurement reliability. A target plot was used to assess measures of central tendency and dispersion. In Part 2, one experienced and three inexperienced sonographers prospectively measured UtA-PI using both approaches in 42 and 35 women, respectively. Inexperienced sonographers underwent accelerated onsite training by the experienced sonographer. Measurement approach and sonographer order were on a random basis. ICC, Bland-Altman and Passing-Bablok analyses were performed to assess measurement agreement and reliability and effect of accelerated training.

RESULTS

In Part 1, no difference was observed between the two techniques in mean time to acquire the measurements (118 s for sagittal vs 106 s for transverse; P = 0.38). The four sonographers reported that the transverse technique was subjectively easier to perform (P = 0.04). Bias and ICC for mean UtA-PI between sagittal and transverse measurements were -0.05 (95% limits of agreement, -0.48 to 0.37) and 0.94, respectively. Measurements obtained using the transverse technique after correcting for gestational age were significantly closer to the expected distribution than those obtained using the sagittal technique. In Part 2, there were no significant differences in median UtA-PI measured using the different approaches for both experienced and inexperienced sonographers (P > 0.05 for all sonographers). Mean UtA-PI measurement reliability between approaches was high for the experienced (ICC = 0.92) and inexperienced (ICC > 0.80) sonographers. UtA-PI measurement approaches did not deviate from linearity, while bias ranged from -0.10 to 0.07. The median time required was similar between the techniques (56.1 s for sagittal vs 49.3 s for transverse; P = 0.054).

CONCLUSIONS

This novel transverse approach for the measurement of UtA-PI in the first trimester appears to be comparable with the sagittal approach in terms of reliability, reproducibility and time required, and may be easier to perform. Providing accelerated onsite training can be helpful for improving the reliability of UtA-PI measurements and could potentially facilitate the broad implementation of first-trimester pre-eclampsia screening. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Multicenter Evaluation of a Chromogenic Substrate Method for Photometric Determination of Prothrombin Time

A multicenter study of a chromogenic substrate method for photometric determination of prothrombin time was conducted in order to evaluate its clinical application. Seven laboratories pailicipaled in the study using a total of 742 plasma samples from 417 patients on oral anticoagulant therapy, 261 healthy subjects and 64 patients with different diseases especially of the liver as well as 30 patients with hereditary deficiency of coagulation factors II, V, VII, X. The chromogenic PT method was compared to a standardized coagulometric PT assay which uses the same sensitive human placenta thromboplastin calibrated against international reference preparations. A high correlation of the prothrombin ratio values of the chromogenic and the coagulometric assay was obtained in 402 plasma samples (r = 0.940; y = 1.02x − 0.1). The study showed that the chromogenic PT reagent is sensitive to deficiency of the coagulation factors of the extrinsic pathway but not affected by heparin up to 1 IU/ml because of the heparin antagonist added. The precision (coefficient of variation) of the photometric method ranged between 0.6 and 3% (intraassay CV) and between 1.4 and 5.8 (interassay CV). The International Sensitivity Index (ISI) obtained for the used lot was 1.09. The therapeutical range in percentage activity for patients in a stable phase of an anticoagulant therapy was found to be from 15 to 27 percent of normal. The results of the clinical evaluation proved the good comparability of the new chromogenic PT test with coagulometric methods, its high factor sensitivity, good reproducibility and easy performance.

Neurophysiological Assessment of the Electrostimulation Procedures Used in Stroke Patients during Rehabilitation

The aim of this study was to evaluate the effectiveness of the associated electrotherapeutical and kinesiotherapeutical treatment in patients after ischemic stroke (N=24), mainly by means of neurophysiological tests. All patients underwent the same 20 days of neurorehabilitation procedures. Particular attention was paid to three-stage modified electrotherapy procedures such as: oververtebral functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS) and the alternate neuromuscular functional electrical stimulation (NMFES) of antagonistic muscles of the wrist and the ankle (N=16). Electrotherapy was supplemented with kinesiotherapeutic (mainly PNF) procedures acting as an amplifier. Clinical assessment included muscle tension (Ashworth's scale), muscle force (Lovett's scale) and reflex scoring at wrist and ankle. However, the effectiveness of the procedures was measured by the assessment of results in complex and repetitive, bilaterally performed global electromyography (EMG) and electroneurography (ENG; M-wave studies). The statistical analysis obtained from results in clinical and neurophysiological examinations suggested that the dorsiflexion of wrist and ankle was improved in the majority of patients who took part in this study. EMG and ENG examinations showed that 20 days of therapy improved both activity in muscle motor units on the more paralyzed side (mainly within upper extremities) and to a lesser degree in the transmission of efferent impulses within motor fibers of nerves. The results obtained suggest that patients after ischemic strokes never show an isolated unilateral disability in motor functions.

No definite similarities between the results of clinical and neurophysiological studies were found, which may suggest greater accuracy of the neurophysiological evaluation.

Intramammary infusion of Escherichia coli lipopolysaccharide negatively affects feed intake, chewing, and clinical variables, but some effects are stronger in cows experiencing subacute rumen acidosis

Feeding high-grain diets increases the risk of subacute rumen acidosis (SARA) and adversely affects rumen health. This condition might impair the responsiveness of cows when they are exposed to external infectious stimuli such as lipopolysaccharide (LPS). The main objective of this study was to evaluate various responses to intramammary LPS infusion in healthy dairy cows and those experimentally subjected to SARA. Eighteen early-lactating Simmental cows were subjected to SARA (n = 12) or control (CON; n = 6) feeding conditions. Cows of the control group received a diet containing 40% concentrates (DM basis) throughout the experiment. The intermittent SARA feeding regimen consisted in feeding the cows a ration with 60% concentrate (DM basis) for 32 d, consisting of a first SARA induction for 8 d, switched to the CON diet for 7 d, and re-induction during the last 17 d. On d 30 of the experiment, 6 SARA (SARA-LPS) and 6 CON (CON-LPS) cows were intramammary challenged once with a single dose of 50 μg of LPS from Escherichia coli (O26:B6), whereas the other 6 SARA cows (SARA-PLA) received 10 mL of sterile saline solution as placebo. To confirm the induction of SARA, the reticular pH was continuously monitored via wireless pH probes. The DMI remained unchanged between SARA and CON cows during the feeding experiment, but was reduced in both treatment groups receiving the LPS infusion compared with SARA-PLA, whereby a significant decline was observed for cows of the SARA-LPS treatment (-38%) compared with CON-LPS (-19%). The LPS infusion did not affect the reticuloruminal pH dynamics, but significantly enhanced ruminal temperature and negatively affected chewing behavior. The ruminal temperature increased after the LPS infusion and peaked about 1 h earlier in SARA-LPS cows compared with the cows of the CON-LPS treatment. Moreover, a significant decline in milk yield was found in SARA-LPS compared with CON-LPS following the LPS infusion. Cows receiving LPS had elevated somatic cell counts, protein, and fat contents in milk as well as decreased lactose contents and pH following the LPS infusion, whereby the changes in milk constituents were more pronounced in SARA-LPS than CON-LPS cows. Rectal temperature and pulse rate were highest 6 h after LPS infusion, but rumen contractions were not affected by the LPS infusion. The data suggest that a single intramammary LPS infusion induced fever and negatively affected feed intake, chewing activity, rectal temperature, and milk yield and composition, whereby these effects were more pronounced in SARA cows.

Routine Treatment of Cervical Cytological Cell Changes: Diagnostic Standard, Prevention and Routine Treatment of Cervical Cytological Cell Changes - An Assessment of Primary and Secondary Prevention and Routine Treatment Data in the Context of an Anonymous Data Collection from Practicing Gynaecologists; an Academic, Non-Interventional Study

Introduction: Diagnosis and treatment of vaginal and cervical cytological cell changes are described in European and national guidelines. The aim of this data collection was to evaluate the remission rates of PAP III and PAP III D cytological findings in patients over a period of 3-4 months. Method: The current state of affairs in managing suspicious and cytological findings (PAP III, and III D) in gynecological practice was assessed in the context of a data collection survey. An evaluation over a period of 24 months was conducted on preventative measures, the occurrence and changes to normal/suspect/pathological findings and therapy management (for suspicious or pathological findings). Results: 307 female patients were included in the analysis. At the time of the survey 186 patients (60.6 %) had PAP III and 119 (38.8 %) had PAP III D findings. The spontaneous remission rate of untreated PAP III patients was 6 % and that of untreated PAP III D patients was 11 %. The remission rates of patients treated with a vaginal gel were 77 % for PAP III and 71 % for PAP III D. Conclusion: A new treatment option was used in gynecological practice on patients with PAP III and PAP III D findings between confirmation and the next follow-up with excellent success.

Pretransplant NPM1 MRD levels predict outcome after allogeneic hematopoietic stem cell transplantation in patients with acute myeloid leukemia

The objective was to evaluate the prognostic impact of pre-transplant minimal residual disease (MRD) as determined by real-time quantitative polymerase chain reaction in 67 adult NPM1-mutated acute myeloid leukemia patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). Twenty-eight of the 67 patients had a FLT3-ITD (42%). Median age at transplantation was 54.7 years, median follow-up for survival from time of allografting was 4.9 years. At transplantation, 31 patients were in first, 20 in second complete remission (CR) and 16 had refractory disease (RD). Pre-transplant NPM1 MRD levels were measured in 39 CR patients. Overall survival (OS) for patients transplanted in CR was significantly longer as compared to patients with RD (P=0.004), irrespective of whether the patients were transplanted in first or second CR (P=0.74). There was a highly significant difference in OS after allogeneic HSCT between pre-transplant MRD-positive and MRD-negative patients (estimated 5-year OS rates of 40 vs 89% P=0.007). Multivariable analyses on time to relapse and OS revealed pre-transplant NPM1 MRD levels >1% as an independent prognostic factor for poor survival after allogeneic HSCT, whereas FLT3-ITD had no impact. Notably, outcome of patients with pre-transplant NPM1 MRD positivity >1% was as poor as that of patients transplanted with RD.

Perception of Slope and Distance in Photographs and in the Real World

We report a series of experiments in which spatial judgments of the real world were compared with equivalent judgments of photographs of the real-world scenes. In experiment 1, subjects judged the angle from the horizontal of natural slopes. Judgments of slope correlated with true slope (r=0.88) but judgments were in general overestimates. Equivalent judgments of slope in photographs again correlated with true slope (r=0.91) but judgments tended to be overestimates for small angles (6°) and underestimates for larger angles (up to 25°). In experiment 2 slope judgments were made under laboratory conditions rather than in the natural world. The slopes, which were viewed monocularly, varied from 5° – 45°, and were either plain, or textured, or included perspective information (a rectangle drawn on the surface) or had both texture and perspective. Judgments were overestimates, but the correlation with true slope was high (r=0.97). Slopes with either texture or perspective were judged more accurately than plain slopes, but combining texture and perspective information conferred no further benefit. Judgment of the angle of the same slopes in photographs produced similar results, but the degree of overestimation (closer to the vertical) was greater than for the real slopes. In experiment 3, subjects either judged the distance of landmarks ranging from 200 m to 5000 m from the observation point, or judged distance to the landmarks in photographs. In both cases subjects' judgments were well described by a power function with exponents close to one. Although there are large individual differences, subjects' judgments of slope and distance are accurate to a scale factor, and photographs yield similar judgments to real scenes.

The Generalizability of the Paediatric Developmental Passport: A Multi-Site Randomized Controlled Trial

BACKGROUND: The Pediatric Developmental Passport (passport) is an innovative tracking tool for families of children with autism spectrum disorder (ASD). It provides a mechanism for clearly communicating appropriate regional developmental services, an opportunity track progress in accessing these developmental services and a valuable summary of the developmental care received by that child for pediatrician. A qualitative study with parents and health professionals (developmental pediatricians, developmental nurses, pediatricians) lead to the design and iterative review of the passport.

OBJECTIVES: The objective of this study was to determine the general-izability and effectiveness of the passport compared to placebo in a multi-site pragmatic randomized control trial.

DESIGN/METHODS: A pragmatic multi-site randomized controlled trial was conducted with families of children between 0-6 years of age diagnosed with ASD. Families from two different models of developmental care were enrolled into the study. One site was a sub-urban developmental consultation clinic and the second site was a shared-care model between developmental pediatricians and general pediatricians in an urban resource restricted area. All families included in the study were randomized to receive the passport or placebo (blank card). Agencies providing Autism specific behaviour therapy (ABA) within each site were contacted directly to obtain accurate contact and access status of recommended developmental services. To determine passport effectivenes a pearson’s chi square test was conducted using a significant p value of <0.05.

RESULTS: Forty children with ASD were included and followed in this study. The passport proved to be significantly more effective in aiding families to contact developmental services than the placebo (blank card). A significantly larger portion of families (90.5%) with the passport contacted agencies for ABA (applied behaviour analysis) therapy compared to families with the placebo (61.9%, (p value significant at <0.05). More families with the passport tended to contact ABA in less than 2 months (48%) than the placebo group (35%), but this was not statistically significant.

CONCLUSION: The pediatric developmental passport enables families of children newly diagnosed with Autism to contact necessary behavioural services more often than those who did not receive the passport after diagnosis.

A Retrospective Review of Service Documentation by Physicians Following Families of Children Diagnosed with Autism Spectrum Disorder: Identifying Gaps in Communication

BACKGROUND: Currently very little is reported on the best way for family physicians and pediatricians to manage children diagnosed with autism spectrum disorder (ASD). There is no standard way to monitor whether families manage to access services, how long they wait for services, and what they do if services are deferred/denied. Consequently, families are often left with limited guidance and support when accessing developmental services.

OBJECTIVES: To evaluate the documentation patterns in medical charts of children diagnosed with ASD between 0-6-years old, whose care is shared between general and developmental pediatricians working in an inner-city setting. In particular, to study how physicians document the timeline and access to medical investigations and community services recommended by physicians.

DESIGN/METHODS: A retrospective chart review of a random sample of approximately 40 patients diagnosed between 0-6-years old with ASD followed by general and developmental pediatricians is currently being conducted at St. Michael’s Hospital. A systematic review of referral pathway to diagnosis, medical investigations, procurement of financial support and access to community services will be performed. Details obtained for review include date of recommendation, parent contact date, date on wait list, start date, and end date.

RESULTS: Preliminary data from 30 patient medical records revealed inconsistencies in how services were documented by physicians. 80% of charts noted that Intensive Behavior Intervention (IBI), Applied Behaviour Analysis (ABA) and speech and language therapy (SLP) were recommended and/or accessed by families. However, the recorded timeline of access varied extensively, with start and end dates recorded in ≤ 20% of charts for ABA, ≤ 50% of charts for SLP and ≤ 70-80% of charts for IBI. ABA therapy appeared to be the most difficult to access, with uptake occurring in only 50% of recommendations. Medical investigation results were often present, however the dates for hearing and vision tests were inconsistently recorded by the pediatrician in the medical charts. Parent education and attendance to drop-in centres were not recommended or accessed in 50% and 25% of patient charts respectively.

CONCLUSION: Preliminary results demonstrate inconsistent patterns of documentation by pediatricians following children with ASD when monitoring medical and community services, especially when recording timelines. Advocating for timely involvement in appropriate services requires an awareness of patients’ past and current involvement in services. Thus, further research may be warranted to determine why certain services are less frequently documented, and how these gaps in communication can be improved to ensure optimal management.

Inner-City Fathers of Children Affected by Chronic Illness: A Systematic Scoping Review of Their Experiences

BACKGROUND: Childhood chronic illness often impacts not just the child but the whole family, particularly the parents. Parents from inner-city backgrounds (defined as low income/socioeconomic status, unemployed, immigrant, refugee, or ethnic minority, and living in an urban area) face additional challenges. Research has traditionally centred on the mother’s role in caring for a child with a chronic illness, but with the increasing role of fathers caring for these children, research has shifted its focus on paternal experience. However, the experiences of inner-city fathers remain largely unknown.

OBJECTIVES: This systematic scoping review aims to explore the experiences of fathers of children with disabilities or chronic health conditions from inner city families, using the Double ABCX model as a conceptual framework.

DESIGN/METHODS: A systematic scoping review was conducted between November 2014 and January 2015 using the Arksey and O'Malley framework. Seven databases were searched (Medline, PsycInfo, Embase, Web of Science, CINAHL, Scopus, and Social Work Abstracts). Titles and abstracts meeting inclusion and exclusion criteria were included in the full text review for further assessment. Qualifying articles were critically appraised and relevant data were extracted. The Double ABCX model was used to qualitatively evaluate the articles in terms of stressors, resources, perception, coping, and adaptation.

RESULTS: 5114 articles were initially identified and 14 articles met the inclusion criteria. Most of the included studies were conducted in the USA. Most articles discussed fathers from low income/SES backgrounds, while others discussed ethnic minority, immigrant/refugee, and unemployed fathers. Fathers' stressors included financial strain and barriers to accessing healthcare. Fathers' resources, or sources of support, ranged from immediate to extended family members, depending on ethnicity. In terms of perceptions, fathers had different approaches to reconciling the care-giver role with cultural gender norms. Inner-city fathers had more desire for information about their children’s health, but some were uncomfortable with asking physicians. Inner-city fathers were more at risk for coping difficulties and used different coping strategies compared to higher income fathers. Inner-city fathers were at higher risk for maladaptation, including depression, PTSD and less acceptance of the child.

CONCLUSION: Fathers from inner-city backgrounds caring for their children affected by chronic illnesses and disabilities have unique experiences requiring a comprehensive approach to providing and communicating care to these children and caregivers. Findings from this review can be used to guide pediatricians in advocating for resources to reduce stressors, enhance coping, and promote positive adaptation for inner-city fathers.

Consensus: soy isoflavones as a first-line approach to the treatment of menopausal vasomotor complaints

The association between an increased uptake of isoflavones and a reduced frequency of menopausal hot flushes was first described in 1992, based on a lower incidence of hot flushes in countries with a high consumption of soy. Since then, numerous clinical trials with various sources of isoflavones including soy and red clover have been presented, with practically all of the studies with adequate design delivering an outcome in favour of isoflavone supplementation. An in-depth risk assessment (EFSA 2015) concludes that the amply available human data does not indicate any suspected harmful effects from a potential interaction of isoflavones with hormone-sensitive tissues in the mammary gland, the uterus and the thyroid gland. Safety was ascertained with long-term intake of up to 150 mg isoflavones per day ingested for the duration of at least 3 years. Moreover, high isoflavone intake was found to have preventive effects with respect to breast cancer. Clinical findings indicate potential benefits of isoflavone exposure even during breast cancer treatment with tamoxifen or anastrozole.