Non-medical Treatment Research Articles

EXPLORING POSSIBLE CAUSES FOR DELAYS SEEKING MEDICAL TREATMENT AMONG INDONESIAN WOMEN WITH BREAST CANCER

Objective: This study aimed to explore the underlying causes for the delays seeking medical treatment experienced by Indonesian women with breast cancer and what kinds of non-medical treatment were pursued instead.Methods: This study used qualitative methods with in-depth interviews among 20 participants to reveal the causes of delaying medical treatment by patients with breast cancer. Subjects were chosen from women diagnosed with breast cancer who had delayed their medical treatment for various reasons and were currently undergoing medical treatment at a hospital.Results: The underlying causes for the delay of medical treatment were varied, including psychological reasons (fear of surgery, being worried about adverse effects of the medicine, making troubles to the other people, afraid of losing breast, or losing husband); lack of knowledge about cancer (unfamiliar with the symptoms of cancer, possible cancer cure by nutritious food, more trust in alternative medicine, myth, participant’s husband did not approve her surgery, only rely on prayer, forgot if she was sick); factors deriving from health service system (limited facilities, a false diagnosis, queue rooms/radiotherapy/for hospitalization, the radiotherapy equipment was out of service, patient unable to walk, high out-of-pocket cost, and doctors were not communicative). During time delay, some patients have also sought non-medical treatment with herbal medicines, non-herbal medicines, and non-conventional treatment (laser, reiki, acupuncture, and vest treatments).Conclusion: Many factors affect the delay of medical care among patients with breast cancer. Often, these delays influence the patients to seek alternative treatments.

Feasibility of a social media/online community support group intervention among chronic pain patients on opioid therapy

Aims: Assess whether the Harnessing Online Peer Education (HOPE) social media-based support group can engage patients on opioids at risk for misuse/overdose to discuss risk reduction strategies.Methods: Fifty-one patients on chronic opioid therapy and risk factors for aberrant medication-taking behaviors were randomized to a HOPE intervention or control (Facebook) group.Results: Compared to control group participants, intervention participants had almost 10 times higher posting engagement (n = 411 posts versus 45; 73% versus 52% of participants). Participants discussed coping, pain, medication and non-medication treatments, and other opioid and addiction-related topics.Discussion: Results suggest that a HOPE online community might serve as an effective behavioral intervention tool among chronic pain patients on opioid therapy.

Cardiac rehabilitation and non-medical treatment of chronic heart failure (without devices)

Cardiac rehabilitation and non-medical treatment of chronic heart failure (without devices) Abstract. In the last decades, treatment of chronic heart failure has experienced important improvements, not only regarding medical and device therapy, but also concerning non-medical management. A multidisciplinary approach addressing self-management of medical therapy, improvement of cardiovascular risk factors, and optimization of lifestyle has gained a lot of attention. Its implementation is recognised as a class I, evidence A indication in the most recent European guidelines. Unfortunately, due to different reasons, referral of patients to structured cardiac rehabilitation programmes is still insufficient, although exercise training has been shown to improve exercise capacity and quality of life, to reduce rehospitalisation rates and potentially to improve prognosis. Further efforts to promote the non-medical treatment of heart failure patients are therefore needed.

Battlefield Acupuncture (BFA) For Pain Management in a VA Community Living and Rehabilitation Center

Chronic pain affects at least 116 Million U.S. adults at an estimated cost of $650 billion annually in direct medical treatment and lost productivity. Approximately 25%-50% of community-dwelling older adults and 45%-80% of nursing home residents have substantial pain. Pain management is commonly medication-based and opioids are still widely used to treat pain. Although opioids may have some benefit for acute pain management, habitual use of these drugs for chronic pain carries many risks. In 2010, a Joint Task Force evaluated pain management in the military and veteran’s health care and found that there is a paucity of non-medication treatments for pain. Acupuncture was identified as a safe, effective and well-accepted modality for pain management. Unfortunately, there are not enough licensed acupuncturist in the Department of Defense(DOD) and the Veterans Administration(VA) to provide this service. Battlefield Acupuncture (BFA), developed by Dr. Richard Niemtzow, is a highly effective, easily-learned pain management technique. It uses just the ear and can be taught in 4 hours. Providers can credential in the VA and integrate BFA into their practice to successfully manage pain and reduce dependence on medications. Joint Incentive funding through the DOD and VA has allowed us to teach providers BFA.

Experiences of an internet-based support and coaching model for adolescents and young adults with ADHD and autism spectrum disorder \u2013a qualitative study

BackgroundThere is a great demand for non-medical treatment and support targeting the needs of adolescents and young adults with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). There is also a lack of qualitative studies providing in-depth insight into these individuals’ own experiences within this area. The current study aimed to explore how adolescents and young adults with ADHD, ASD or both experienced taking part in an internet-based support and coaching intervention.MethodsSixteen participants with ASD, ADHD or both who had participated in an 8-week internet-based support and coaching model, were interviewed using semi-structured interviews. Data was analyzed using qualitative content analysis.ResultsAnalysis yielded three themes; Deciding to participate, Taking part in the coaching process and The significance of format. Various motives for joining were expressed by participants, such as viewing the technology as familiar and appealing and expecting it to be better suited to their situation. There was also a previously unfulfilled need for support among participants. In deciding to take part in the intervention the coaches’ competence and knowledge were considered essential, often in the light of previously negative experiences. Taking part in the coaching process meant feeling reassured by having someone to turn to in view of shared obstacles to seeking and receiving help. The support was used for talking through and receiving advice on matters related to their diagnosis. Findings further revealed appreciation for aspects relating to the format such as communicating through the written word, being in one’s own home and an experience of immediacy. Some disadvantages were voiced including incomplete personal interaction and failing technology. There were also suggestions for greater flexibility.ConclusionsThe in-depth qualitative data obtained from this study suggest that the current model of support and the internet-based format have specific qualities that could play an important role in the support of adolescents and young adults with ADHD and ASD. Although not a replacement for face-to-face interaction, it could be a promising complement or alternative to other support and treatment options.Trial registration“Internet-based Support for Young People with ADHD and Autism - a Controlled Study” retrospectively registered in www.clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT02300597) at 2014–11-10.

Holistic approach to COPD patients

The holistic approach, known also as the bio-psycho-social approach should be the main approach to COPD patients. COPD is a progressive and debilitating disease, associated with several co-morbidities and with significant impact on the quality of life not only of the patients, but on their family and relatives. Behavioral factors such as smoking and inappropriate life style are contributing factors to the progression of the disease and decreased quality of life (QoL). These patients could also need palliative care in the end stages of the disease. The general practitioner (GP) is a key person in providing high quality health care for COPD patients, because they are mainly observed, treated and managed in a general practice setting. GPs must be aware of the new guidelines, skilled enough and prepared to deal with them, applying the holistic approach. We are focusing on some important issues such as early recognition/ detection of COPD in general practice, close follow-up, proper medical and non-medical treatment, inducing life style changes, supportive care, quality of life (including approved tests) and palliative care. Applying a holistic approach means also organizing teams according to the needs of the patient with medical and nonmedical specialists. Applying a holistic approach is the best tactical and strategic option for better care and life for COPD patients. I thank the event for giving me an opportunity to speak in front of delegates and many other people from pulmonologists all over the world. I thank everyone for giving good reviews and testimonials for my talk. It was really a great experience for me to attend this two day conference and I enjoyed all the talks at the conference venue and gained lot of knowledge. I am also interested in attending more and more conference of conference series in future. I also suggest young students to attend the conferences organized by conference series to gain knowledge from the talks that speaker’s present. I met colleagues with varying levels of experience in the field of pulmonology. Lyubima Despotova-Toleva MD, PhD is a Medical Doctor with acknowledged specialties in Paedicatics, Family Medicine, Health Care Management and specialization in Paediatric Cardiology. She is a University Professor of Plovdiv Practice/Family Medicine, Scientific Advisor of PhD students, Chairperson of the Bulgarian Long-term and Palliative Care Society. Also, she is the Editor-in-Chief of Folia Palliatrica journal, Board Member of EMA, EGPRN and Lifetime Member of WONCA, IAHPC and WHPCA. She is the Author of more then 150 scientific publications, over 30 monographs, textbooks and manuals. She is the Leader, Coordinator and Senior Researcher in more then 20 international and national research and educational projects and programs (Fulbright, JSPS, mEducator, SmokeFreeBrain etc).

Effect of Peripheral Heart Action on Body Composition and Blood Pressure in Women with High Blood Pressure

Objectives: Exercise is non-medical treatment and low-risk strategy for people with hypertension. Therefore, the aim of this study was to evaluate the effect of peripheral heart action (PHA) on body composition and blood pressure in women with high blood pressure. Methods: Twenty women (age = 38 - 46 years, BMI = 21 - 31 kg/m2) who had high blood pressure (135/88 mm Hg) volunteered to participate. Ten were randomly selected and submitted to 32 PHA exercise sessions. The remaining 10 participants served as a non-exercise control group. Systolic (SBP) and diastolic blood pressure (DBP), skinfold, and 1RM tests of maximum strength were determined before and after 36 exercise sessions. Results: SBP and DBP were decreased significantly (P < 0.05) in the PHA group but not in the non-exercise control group. Furthermore, the training group made significant improvements in test of one-repetition maximum and body composition compared to the control group (P < 0.05). Conclusions: Resistance exercises using the PHA approach can be considered as a low-risk treatment for people with high blood pressure in order to improve blood pressure, increase muscular strength, and enhance overall fitness.

Prevalence, Burden, and Treatment of Lower Urinary Tract Symptoms in Men Aged 50 and Older: A Systematic Review of the Literature.

We conducted a systematic review of literature from the years 2000 through 2017 on the prevalence and burden of lower urinary tract symptoms (LUTS) in men aged 50 and older, and medical treatments of and alternative nonmedical approaches to LUTS. EBSCOhost (Medline with Full Text) was searched for observational, experimental, and review studies in peer-reviewed journals in the English language. Our review found that LUTS were highly prevalent in the world and estimated to affect 2.3 billion people in 2018, with 44.7% being men. Men with LUTS suffer from not only burdensome symptoms such as nocturia and urgency but also adverse psychological consequences (e.g., anxiety and depression) and financial burden. Current medical treatments are clinically effective, but their efficacy is compromised by side effects and low compliance rates. Alternative nonmedical treatments for LUTS were also sought worldwide. There is evidence that lifestyle modifications such as pelvic muscle exercises and bladder training, physical activity, dietary modification, and nutritional supplements can alleviate LUTS and improve patient quality of life; however, evidence based on rigorous methodology remains minimal and cannot be generalized across populations. Evidence of effectiveness of weight loss programs to reduce LUTS is inconclusive. We conclude that although behavioral treatment is a promising approach to alleviating LUTS, especially when combined with medical treatments, well-designed randomized controlled and longitudinal clinical trials on behavioral treatments of LUTS are still needed. Minimally invasive procedures and neuromodulation therapy also show positive results of alleviating LUTS but require further research as well.

Management of Type 2 Diabetes and Chronic Kidney Disease in Fiji in 2018: Knowledge, Attitude, and Practice of Patients

The Review of Diabetic Studies,2019,15,1,26-34.DOI:10.1900/RDS.2019.15.26Published:February 2019Type:Original ArticleAuthors:Mohammed Alvis Zibran, and Masoud Mohammadnezhad Author(s) affiliations:Mohammed Alvis Zibran and Masoud Mohammadnezhad School of Public Health and Primary Care, Fiji National University. Abstract:Objective: The aim was to identify the level of knowledge, attitude, and practice (KAP) in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) at Sigatoka Subdivisional Hospital (SSH) in 2018 since no studies have been done on this issue so far in Fiji. Methods: A quantitative, cross-sectional study including 225 patients was carried out July 1, 2018, through August 31, 2018, using a validated self-structured questionnaire. Fijians, aged 30 years or above, with confirmed T2D and CKD who were attending the Special Outpatient Department (SOPD) at SSH, were included in the study using a purposive sampling method to identify eligible participants. Data was gathered by a questionnaire that covered questions related to each aspect of KAP. Results: The relation of native Fijians (i- Taukei) to Fijians of Indian descent (FID) was approximately 1:1. The majority of participants had high levels of knowledge, attitude, and practice (61.8%, 63.6%, and 88.4%, respectively). However, a few areas of low knowledge were evident, such as the relation between high blood pressure and renal status in people with diabetes and the need for renal transplant in end-stage kidney disease (ESKD) abroad. Low attitude was apparent for the impact and management of diabetic kidney disease (DKD). Low practice was evident regarding clinic attendance, self-monitoring, and opting for non-medical treatment. Conclusion: The majority of T2D patients with CKD had a high level of knowledge, but weaknesses were observed in the self-management of CKD and clinic attendance. This information should be considered by clinicians and policy-makers to improve management and treatment of CKD in T2D. Keywords:Attitude, Awareness., Chronic kidney disease, Fiji islands, KAP Questionnaire, Knowledge, Practice, Type 2 diabetesView:PDF (399.31 KB)

Non-motor disorders in patients with muscular dystonia

Non-motor disturbances represented by sensory, affective, obsessive-compulsive disorders, cognitive dysfunction, sleep disturbances are often found in patients with dystonia and have a negative impact on their quality of life. The prevalence of sensory and affective disorders and sleep disturbances is above 50% in patients with cervical dystonia and is 25% in patients with blepharospasm, writing spasm; cognitive dysfunction is found in more than 25% of patients with focal dystonia. The relationship of non-motor, in particular psychiatric disorders, with the impairment of social and everyday life and worsening of quality of life in whole was shown. Common pathophysiological mechanisms of non-motor disorders as well as approaches to treatment of these disorders are discussed. The authors present the results on the positive effect of botulinum toxin therapy that reduces cognitive dysfunction, sensory disorders and depressive syndrome. Non-medication treatment of non-motor disorders in patients with dystonia is considered.

Utilization of physical therapy services in Germany.

Physical therapy plays an important role in health care and is listed as a therapy in many clinical guidelines. Claims data gathered by statutory health insurers demonstrate that in Germany physical therapy accounts for more than 70% of the reimbursable costs of all non-medical treatments comprising physical therapy, logopaedics, occupational therapy and podiatry. In monetary terms, this equates to about EUR 4.4 billion annually. According to self-reports of the respondents of GEDA 2014/2015-EHIS on their utilization of physical therapy services 25.5% of women and 17.7% of men used physical therapy services within the 12 months that preceded the interview. This rate increases significantly with age, reaching its peak among the 50-to-59 year age group, at 30.7% among women and 20.1% among men. People with a high level of education and those with private health insurance use physical therapy services more frequently. Moreover, people living in the eastern part of Germany use physical therapy services more often than those living in the western federal states.

Associations between methadone maintenance treatment and crime: a 17‐year longitudinal cohort study of Canadian provincial offenders

To estimate and test the difference in rates of violent and non-violent crime during medicated and non-medicated methadone treatment episodes. The study involved linkage of population level administrative data (health and justice) for all individuals (n=14 530) in British Columbia, Canada with a history of conviction and who filled a methadone prescription between 1 January 1998 and 31 March 2015. Methadone maintenance treatment was the primary independent variable and was treated as a time-varying exposure. Each participant's follow-up (mean: 8years) was divided into medicated (methadone was dispensed) and non-medicated (methadone was not dispensed) periods with mean durations of 3.3 and 4.6years, respectively. Socio-demographics of participants were examined along with the main outcomes of violent and non-violent offences. During the first 2 years of treatment (≤2.0years), periods in which methadone was dispensed were associated with a 33% lower rate of violent crime [0.67 adjusted hazard ratio (AHR), 95% confidence intervals (CI)=0.59, 0.76] and a 35% lower rate of non-violent crime (0.65 AHR, 95% CI=0.62, 0.69) compared with non-medicated periods. This equates to a risk difference of 3.6 (95% CI=2.6, 4.4) and 37.2 (95% CI=33.0, 40.4) fewer violent and non-violent offences per 100 person-years, respectively. Significant but smaller protective effects of dispensed methadone were observed across longer treatment intervals (2.0 to ≤5.0years, 5.0 to ≤10.0years). Among a cohort of Canadian offenders, rates of violent and non-violent offending were lower during periods when individuals were dispensed methadone compared with periods in which they were not dispensed methadone.

A network meta-analysis in comparing prophylactic treatments of radiotherapy-induced oral mucositis for patients with head and neck cancers receiving radiotherapy

ObjectivesThe objective of this network meta-analysis is to optimize the prophylactic treatment for radiotherapy-induced oral mucositis in patients with head and neck cancer (HNSCC) receiving postoperative or definitive radiotherapy with or without chemotherapy. Materials and methodsWe searched electronic databases to identify all eligible randomized clinical trials on oral mucositis. The endpoint was grade 0–2 oral mucositis. Odds ratios (OR) and the corresponding 95% confidence intervals (CI) were extracted. Network meta-analysis was performed using the frequentist approach to conduct multiple treatment comparisons. ResultsIn total, 57 trials with 5261 patients were eligible for this study. Both direct and network meta-analysis revealed that low-level laser additional to standard oral care (SOC) was better than most of the other treatments and achieved the highest effect on grade 0–2 oral mucositis, with a surface under the cumulative ranking curve (SUCRA) of 95.8%; however, SOC with or without placebo had worse effect than most of the other treatments and was ranked worst (SUCRA = 0.4%). Moreover, sensitivity analysis performed after we had combined the SOC and placebo groups (non-medication treatment, NMT) yielded similar results, with SUCRA of 91.3% and 3.5% for low-level laser and NMT, respectively. ConclusionsLow-level laser additional to SOC may be a more effective prophylactic treatment for reducing severe radiotherapy-induced oral mucositis; SOC alone is insufficient for patients with HNSCC receiving postoperative or definitive radiotherapy with or without chemotherapy.

Pain is an underestimated symptom in cystic fibrosis.

Life expectancy is increasing in cystic fibrosis and new aspects of the disease have to be taken into account in cystic fibrosis care. Pain is encountered among 70% of adult and pediatric patients with cystic fibrosis. This symptom is underestimated by the multidisciplinary team. It has been reported as impacting quality of life and adherence to treatments. The location of pain is inconstant among the different studies but the major symptoms are headaches, gastrointestinal, and chest pain. Pain is different for each patient and requires careful evaluation using questionnaires some of which specifically developed for patients with cystic fibrosis. Medical and nonmedical treatment such as ostheopathy or sophrology may relieve pain symptoms but have to be adjusted in the frame of a global personalized care. Pain maybe an underestimated symptom among patients with cystic fibrosis and impacts negatively on quality of life. VIDEO ABSTRACT.

Critical issues and current challenges in osteoporosis and fracture prevention. An overview of unmet needs.

Osteoporosis is a silent disease with increasing prevalence due to the global ageing population. Decreased bone strength and bone quality is the hallmark of osteoporosis which leads to an increased risk of fragility fractures in elderly. It has been estimated that approximately ~50% of women will suffer during their lifetime from an osteoporotic fracture. This must be considered as a major health concern, as it has previously been established that fragility fracture has been associated with decreased quality of life due to increased disability, more frequent hospital admission and most importantly, osteoporotic fractures have been related to an augmented mortality risk. Anti-osteoporotic drugs are available for improving bone quality. Although there is access to these therapeutic options, there remain multiple unmet needs in the field of osteoporosis and fracture care, for example, the primary prevention of osteoporosis in young individuals (to reach a high peak bone mass), the optimization of the use of imaging techniques [dual-energy X-ray absorptiometry (DXA), vertebral fracture assessment (VFA) and new techniques measuring bone quality], the use of nonmedical treatment options and surgical techniques of fracture healing. In this review, we will discuss topics that play a role in the occurrence and prevention of fractures, and we give an overview of and insight into the critical issues and challenges around osteoporosis and fracture prevention.

Medicaid Prior Authorization Policies for Medication Treatment of Attention-Deficit/Hyperactivity Disorder in Young Children, United States, 2015.

In 2011, the American Academy of Pediatrics updated its guidelines for the diagnosis and treatment of children with attention-deficit/hyperactivity disorder (ADHD) to recommend that clinicians refer parents of preschoolers (aged 4-5) for training in behavior therapy and subsequently treat with medication if behavior therapy fails to sufficiently improve functioning. Data available from just before the release of the guidelines suggest that fewer than half of preschoolers with ADHD received behavior therapy and about half received medication. About half of those who received medication also received behavior therapy. Prior authorization policies for ADHD medication may guide physicians toward recommended behavior therapy. Characterizing existing prior authorization policies is an important step toward evaluating the impact of these policies on treatment patterns. We inventoried existing prior authorization policies and characterized policy components to inform future evaluation efforts. A 50-state legal assessment characterized ADHD prior authorization policies in state Medicaid programs. We designed a database to capture data on policy characteristics and authorization criteria, including data on age restrictions and fail-first behavior therapy requirements. In 2015, 27 states had Medicaid policies that prevented approval of pediatric ADHD medication payment without additional provider involvement. Seven states required that prescribers indicate whether nonmedication treatments were considered before Medicaid payment for ADHD medication could be approved. Medicaid policies on ADHD medication treatment are diverse; some policies are tied to the diagnosis and treatment guidelines of the American Academy of Pediatrics. Evaluations are needed to determine if certain policy interventions guide families toward the use of behavior therapy as the first-line ADHD treatment for young children.

Comparative assessment of metabolic, hormonal and psychological characteristics of young obese men

Aim. To study metabolic-hormonal status and psychological characteristics of young obese men. Material and methods. The study included 87 young obese men (BMI ≥30 kg/m2) aged 16-25 yr given medication or non-medication treatment for 12 weeks. Blood glucagon-like peptide-1 (GLP-1), insulin, and glucose levels were measured after orlistat intake. Final screening included biochemical and hormonal studies. 48 patients underwent psychological testing. Results. Orlistat therapy resulted in clinically significant reduction of body mass (by more than 5% in 50% of the patients). Cortisol level also decreased while testosterone level increased. Meal test revealed elevated baseline GLP-1 level in 77,7% of the patients. There was correlation between baseline GLP-1 and insulin levels (r=0,61; р=0,001). Orlistat therapy decreased anxiety and depression (p<0,05) as well as manifestations of external eating behaviour but increased those of restrictive eating behaviour.

Non-medication Treatment of Atrial Fibrillation

Atrial fibrillation accounts for 20–30% of all causes of ischemic cerebral infarction. Patients with chronic atrial fibrillation tend to be overlooked because their symptoms diminish as the baseline heart rate decreases. However, some recent reports that warn against the risk of ischemic stroke and heart failure due to atrial fibrillation have been published, and various medical treatments and safe and effective procedures have been introduced. Key words: Atrial Fibrillation; Catheter Ablation

Hubungan Pola Asuh Orangtua Terhadap Pertumbuhan dan Perkembangan Anak dengan Autism

Hubungan Pola Asuh Orangtua Terhadap Pertumbuhan dan Perkembangan Anak dengan Autism
 Abstrak
 Latar belakang: Autism adalah kelainan perkembangan sistem saraf pada seseorang yang kebanyakan diakibatkan oleh faktor hereditas dan kadang-kadang telah dapat dideteksi sejak bayi berusia 6 bulan. Pola asuh orangtua juga sangat dibutuhkan dalam tahap pertumbuhan dan perkembangan, karena waktu terbanyak interaksi anak autis ada dalam keluarga. Orangtua berperan sebagai stimulator pertumbuhan dan perkembangan anak autis.
 Metode: Desain penelitian cross sectional, dengan uji bivariat dengan Spearman rho. jumlah sampel 84 anak autism dan orangtua mereka di Kota Palangka Raya, pengambilan sampel dengan tehnik sampling purposive, pengambilan data menggunakan lembar observasi, kuesioner dan software Anthro WHO Plus 2011.
 Hasil: Pola asuh orangtua yang tertinggi, pola asuh demokratis (84,5%), pola asuh permisif (8,3%), pola asuh ototriter (7,1 %). Status gizi pada anak autism persentase tertinggi adalah status gizi normal (53,6%), status gizi gemuk (21,4%), status gizi obesitas (17,9%), status gizi kurus dan sangat kurus masing-masing sama (3,6%). Tingkat Kognitif anak autism, persentase tertinggi tingkat kognitifnya meningkat (73,8%), dan tingkat kognitif tetap (26,2%). Ada hubungan signifikan anatara pola asuh orangtua dengan status gizi anak autism, dimana nilai ρ 0,008 > α 0,01. Ada hubungan signifakan antara pola asuh ibu dengan tingkat kognitif anak autism ρ 0,001 > α 0,01.
 Kesimpulan: Perlu diteliti lagi faktor lainnya yang menyebabkan status gizi anak autis dapat menjadi obesitas bahkan ada yang sangat kurus, sehingga walaupun anak autism harus diet glutein dan casein, sebagai syarat awal terapi anak autis, mereka tetap dapat memiliki status gizi normal, serta tidak mengalami obesitas akibat komposisi makanan yang tidak diperhatikan. Orangtua perlu menentukan pola asuh yang tepat sebagai media interaksi yang dengan anak autis, karena anak autism yang mengalami hambatan berkomunikasi akan sulit untuk menerima informasi dari lingungan, yang artinya akan sulit untuk meningkat kognitifnya dalam proses belajar dan akan sulit pula menerima pengaturan diet sebagai non medikamentosa terapi anak autis.
 Kata kunci: Pola asuh orangtua, kognitif, status gizi, anak autism

Advances in the management of thyroid eye diseases: An overview.

Thyroid eye disease (TED) remains a notorious ailment for both patients and the treating ophthalmologists. Recent years have witnessed considerable research in the immunopathogenic mechanism of TED that has resulted in an expansion and modification of the available management options. Purpose of this review is to summarise the advances in the management of thyroid ophthalmopathy. A thorough literature search and of the past 10 years web search with words Thyroid ophthalmopathy, recent, advances. Recent VISA classification and new serum markers seem to have potential to give diagnostic as well as therapeutic guidance, gauge treatment response and even identify risk of disease progression. Majority of TED patients can be managed conservatively due to its self-limiting nature but if indicated, still steroids are the preferable medical therapy; however, there is an increasing consensus towards the use of parenteral form as compared to the oral one on account of greater efficacy with lesser side effects. Steroid sparing medications, for example, rituximab, infliximab, etanercept, adalimumab, teprotumumab, tocilizumab, tanshinone, are showing encouraging results and form an area of active research. Radiation therapy remains as an adjunctive modality in active diseases as a nonmedical treatment for TED with some promising data. Surgical intervention may be required in vision threatening conditions or to counteract the sequel of inflammatory phase. Advances in surgical techniques like stereotactic image-guided balanced orbital decompression with endoscopic approach ensure meticulous dissection with minimal trauma.