Search

There is a paucity of research concerning the diagnosis and treatment of paediatric vitiligo. This reality parallels published patient reports of profound dissatisfaction with the state of knowledge and available treatments. This study was meant to assess the attitudes of paediatric dermatologists towards the therapeutics of paediatric vitiligo. A survey was designed and approved by the survey committee of the Pediatric Dermatology Research Alliance to be distributed to the members. The study was exempted by the IRB of the Mount Sinai Hospital and posted to an online survey system. A total of 56 dermatologists completed the survey, a majority of whom practiced in the US (n = 44, 78·6%), followed by Mexico (n = 6, 10·7%). Most were board-certified (n = 48, 85·7%). Practitioners reported seeing an average of eight paediatric and adolescent vitiligo patients per month. Providers surveyed reported feeling most comfortable treating older patients 13–17 (n = 48, 85·7%), 9–12 (n = 47, 84%), 5–8 (n = 40, 71·4%), 2–4 years (n = 18, 32·1%), 13–23 months (n = 12, 21·4%), 7–12 months (n = 4, 7·1%), and 0–6 months (n = 1, 1·7%). Among the 8 (14·3%) respondents who used an oral JAK inhibitor, the age of the patients ranged from 4 months to 16 years. Most providers surveyed (n = 50, 89·3%) used an interview with the patient and parents to assess for quality-of-life impairments in children and adolescents. Bloodwork was performed always or usually (n = 25, 44·6%), sometimes (n = 11, 19·6%), and rarely (n = 9, 16·1%). Full thyroid panels (n = 38, 67·8%) and 25-OH vitamin D levels (n = 27, 48·2%) led tests ordered. For children under 8 years with 25% vitiligo +/− eyelid involvement TCI (n = 48, 85·7%; n = 45, 80·3%), TCS (n = 21, 37·5%; n = 30, 53·6%), excimer laser (n = 8, 85·7%; n = 11, 19·6%), NB-UVB (n = 6, 10·7%; n = 7, 12·5%), and cover-up makeup (n = 7, 11·9%; n = 8, 14·3%) were used. For 8+ with body depigmentation

Environmental remediation of polluted sites in developing communities often faces difficulties due to the misalignment of project objectives with the needs and interests of local communities, establishment of unrealistic expectations for the outcome of the project, and failure to account for the available resources in the community itself. Remediation decisions favor technical data and technical solutions as the main means of determining remediation options, requiring significant investment and local capacity that are often not found in developing communities. Often these systems fail to account for the social aspects in environmental management and remediation. In contrast, new approaches in local knowledge-based solutions focus on pre-existing environmental management initiatives to establish objectives that are meaningful to the community itself. “Positive deviance” – or the idea that there are solutions already in communities that are successful at addressing challenges despite the barriers that a community faces – are often overlooked during project design and implementation. Identifying examples of positive deviance and working with community members who are well versed in local challenges, available resources, and local capacity presents opportunities for community members to establish project objectives and provides the foundation for future environmental management projects in the area. We present a case study of artisanal and small-scale gold mining (ASGM) in the Andes municipality, Antioquia, Colombia and local initiatives to overcome community-identified environmental pollutants. Through a series of semi-structured interviews, surveys, and site visits, we identified community perception of environmental pollutants, management techniques for mining waste, and grassroots initiatives that were locally developed to address them. Through key communication and interaction between innovators with identified positive deviance projects, technical experts, and other miners facing similar challenges, innovative projects that account for the social, political, and economic realities of a developing community can become widespread, leading to improved environmental and social conditions.

Changing demographics, the shift to community prevention and health promotion, complexity of medical care advances, and chronicity requires nursing professionals who are attuned to the diverse healthcare needs of communities. Nursing schools are beginning to build on holistic admission procedures that are being used by other healthcare disciplines to be more inclusive in the evaluation of applicants. This article outlines the background of holistic admissions and a State University implementation for prospective prelicensure nursing student admissions that reflect institutional mission and goals to create a more inclusive learning environment. The School of Nursing has five years of experience in holistic admissions of a second baccalaureate entry program and now is applying those procedures to high school entry nursing applicants. This article shares the complex vetting required in obtaining statewide academic and local stakeholder approval to change freshmen admission procedures across a University system. New applicant holistic admission appraisal included aptitude, characteristics, and experiences along with academic metrics. Recruitment, selection, and admission procedures are multifaceted and require change at the University and State levels to achieve the goal of a more diverse student population. Implementing creative holistic admissions processes will better align the future-nursing workforce with communities they serve.