BACKGROUND Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder affecting 3-7% of children globally. Alternative treatments are needed to address the limitations of traditional pharmacotherapy and non-pharmacotherapy, such as drug side effects and substantial time and financial costs. In this light, digital therapeutics (DTx) for childhood ADHD are emerging as an effective alternative, with the benefits of potentially being free from serious side effects typical of software-based treatments and facilitating easy home use without constraints on time or space. OBJECTIVE This feasibility study aims to evaluate whether a 4-week digital treatment program can improve symptoms, problem behaviors, and neurocognitive functions in children with ADHD, independent of medication status, while also gauging their satisfaction with the program. METHODS We recruited 22 Korean children between the ages of 6-12 years with a diagnosis of ADHD. During the pre-intervention visit, we collected data on ADHD symptoms, relevant behavior scales, and neurocognitive assessments. Participants then used the program 5 times per day, 5 days a week, for 4 weeks at home. At the post-intervention visit, we collected the same data as during the pre-visit and gathered additional feedback on their experience over the 4-week period. RESULTS A total of 19 participants were included in the statistical analysis, showing significant decreases in scores across various categories. These include the Korean ADHD rating scale (K-ADHD-RS) total (P=.004), Inattentive (P=.004), Hyperactive/Impulsive (P=.011), Korean Conners parent rating scale (K-CPRS) total (P<.001), Impulsive-Hyperactive (P=.001), and Conduct ProblemⅠ (P=0.043). Significant improvements were also noted in the Stroop word (P=.004), color (P<.001), and color-word (P<.001) scores. Caregiver and child satisfaction surveys yielded mean ratings of 4.3 and 4.1 out of 5, respectively. CONCLUSIONS A four-week gamified intervention significantly improved attention and hyperactivity/impulsivity in children with ADHD, irrespective of medication status, demonstrating its effectiveness and acceptability as a treatment option.
Objectives The purpose of this research is to analyze the trend of instructional consulting research and propose the direction of future research in the field. Methods In order to achieve the research purpose and derive the research results, research trend analysis was conducted based on the analysis criteria of four types (quantitative change, research subject, research purpose, and research method). Excel, power query, and textom are research tools for creating descriptive statistics and generating visualization data. Results First, instructional consulting research showed an increase until 2012. However, it has been steadily decreasing since 2013. In particular, instructional consulting research is concentrated between early and mid-term. Insturctional consulting research within the last three years is insufficient. Second, the research subjects set in the instructional consulting research were mainly ‘instructor’, and the ratio was in the order of elementary school, university secondary school, and infant level. Among the research subjects, ‘learner’ were insignificant, but the university level accounted for a high proportion. Third, in the instructional consulting research, the research purpose was in the order of fact-finding, discovery of practice cases, search for development directions, model development, characteristic analysis, and effectiveness. Fourth, the research methods used in instructional consulting research were in the order of case research, literature research, investigation research, experimental research, and others. Conclusions First, instructional consulting research decreased as it was reduced due to the flow of educational policy, but it is necessary to increase the interest of instructional consulting academic researchers and systematic research support. Second, it is necessary to expand and conduct research to check whether learners' learning improvement, which is the purpose of instructional consulting, has been achieved. In addition, it should be supported to search for ways for teachers to voluntarily participate in instructional consulting and to prepare institutional devices. Third, rather than focusing on instructional consulting practice, the research purpose trend should continue to secure basic data, analyze cases, and explore the direction of instructional consulting development from a system perspective. Fourth, it is necessary to make efforts by researchers in the field of instructional consulting to maintain the tendency that research methods are not biased to one side.
Please cite this paper as: Topical calcineurin inhibitors compromise stratum corneum integrity, epidermal permeability and antimicrobial barrier function. Experimental Dermatology 2010; 19: 501–510.
Abstract
Background: Topical calcineurin inhibitors (TCIs) such as pimecrolimus and tacrolimus have recently been used for dermatologic diseases including atopic dermatitis instead of topical glucocorticoids, because they display comparable efficacy, but less-frequent side effects. Although even short-term topical glucocorticoid compromise epidermal permeability barrier homeostasis, the effects of TCI on barrier function have not yet been reported. However, viral infections such as eczema herpeticum and molluscum contagiosum, which could indicate an impaired skin barrier, continue to occur with TCI use in atopic dermatitis.
Objectives: We determined here whether TCIs disrupt epidermal permeability barrier and antimicrobial function, and whether these effects can be prevented.
Methods and results: In normal humans, topical pimecrolimus and tacrolimus applied twice-daily for 5 days, delay barrier recovery without an increase in basal transepidermal water loss was observed. Co-application of physiologic lipid mixture (PLM) containing an equimolar ratio of ceramides, cholesterol and free fatty acids normalized barrier homeostasis in the face of topical TCIs. In hairless mice, 4 days of TCI treatment also disrupted barrier function significantly. TCIs-treated epidermis showed the decrease of epidermal lipid content, lamellar body number and secretion, and lipid synthesis-related enzymes such as 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase, serine-palmitoyl transferase and fatty acid synthase, implying decreased lipid synthesis. TCIs also suppressed expression of IL-1α and antimicrobial peptides, CRAMP and mouse β-defensin 3. However, these TCI-induced abnormalities can be overridden by topical replacement with PLM.
Conclusions: Our results demonstrate that TCIs induce negative effects on the skin barrier including permeability and antimicrobial functions, which are mediated by decreasing epidermal lipid synthesis, lamellar body secretion and antimicrobial peptides expression through suppression of cytokine such as IL-1α, therefore co-treatment with PLM would be helpful to overcome these negative effects.
Predicting food allergy resolution is essential to minimize the number of restricted foods in children. However, there have been no studies on the natural history of peanut allergy (PA) in Korea.This study aimed to evaluate the natural course and prognostic factors of immediate-type PA in children till the age of 10 years.We retrospectively collected data of 122 children who developed PA before 60 months of age from 3 tertiary hospitals in Korea. Diagnosis and resolution of PA was defined as an oral food challenge test or a convincing history of symptoms within 2 h after peanut ingestion. The prognostic factors for resolution of PA were identified using the Cox proportional hazard model.The median (interquartile range) age at diagnosis was 2.0 (1.3-3.0) years. Among the 122 children, PA resolved in 18 (14.8%) children. The level of peanut-specific IgE (sIgE) at diagnosis in the persistence group was significantly higher than that in the resolution group (p = 0.026). The probabilities of resolution of PA were 10.3% and 32.8% at the ages of 6 and 10 years, respectively. A peanut-sIgE level ≥1 kU/L at diagnosis was significantly associated with persistent PA (hazard ratio, 5.99; 95% confidence interval, 1.89-18.87).Only 10.3% of our patients had a probability of developing spontaneous resolution of PA by 6 years of age. Peanut-sIgE levels ≥1 kU/L at diagnosis were associated with the persistence of PA.
in a Single Pediatric Intensive Care Unit in KoreaTo compare mortality rate, the adjustment of case-mix variables is needed.The Pediatric Index of Mortality (PIM) 3 score is a widely used case-mix adjustment system of a pediatric intensive care unit (ICU), but there has been no validation study of it in Korea.We aim to validate the PIM3 in a Korean pediatric ICU, and extend the validation of the score from those aged 0-16 to 0-18 years, as patients aged 16-18 years are admitted to pediatric ICU in Korea.A retrospective cohort study of 1,710 patients was conducted in a tertiary pediatric ICU.To validate the score, the discriminatory power was assessed by calculating the area under the receiver-operating characteristic (ROC) curve, and calibration was evaluated by the Hosmer-Lemeshow goodness-of-fit (GOF) test.The observed mortality rate was 8.47%, and the predicted mortality rate was 6.57%.For patients aged < 18 years, the discrimination was acceptable (c-index = 0.76) and the calibration was good, with a χ 2 of 9.4 in the GOF test (P = 0.313).The observed mortality rate in the hematooncological subgroup was high (18.73%),as compared to the predicted mortality rate (7.13%), and the discrimination was unacceptable (c-index = 0.66).In conclusion, the PIM3 performed well in a Korean pediatric ICU.However, the application of the PIM3 to a hemato-oncological subgroup needs to be cautioned.Further studies on the performance of PIM3 in pediatric patients in adult ICUs and pediatric ICUs of primary and secondary hospitals are needed.
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