OBJECTIVE: Pediatric obstructive sleep apnea (OSA) caused by adenoids or an enlarged palatine tonsil has a negative impact on physical and mental growth. Surgical removal of the tissue is effective but entails a life-threatening risk of postoperative bleeding, which is up to 30 times higher in chronic pediatric disease cases. However, endoscopes and resection devices provide safe, reliable surgical methods. Here, we report the efficacy and safety of endoscopic powered intracapsular tonsillectomy and adenoidectomy (PITA) for pediatric OSA in patients with high-risk comorbidities.
METHODS: This retrospective case series included pediatric patients with OSA who underwent PITA at a single tertiary medical center between April 2017 and May 2023. Ten patients (three males and seven females; mean age 6.4 years, range 2-12 years) were included; all met the Japanese criteria for complex chronic pediatric conditions.
RESULTS: The average operative time was 61 min; a microdebrider was used in eight cases and a coblator in two cases. Although there was no postoperative bleeding, one case experienced regrowth.
CONCLUSIONS: Our data show that an endoscopic PITA approach could reduce the risk of severe bleeding and relieve the sleeping conditions of pediatric patients with complex chronic OSA.

This review tested the use of psychological theories for predicting seasonal influenza vaccination behaviour among adults with a health condition (for which the vaccine is clinically indicated).
Ovid (1946-August 2018), Embase (1974-August 2018), CINAHL (1958-August 2018) and PSYCInfo (1986-August 2018) databases were searched. Studies drawing upon a psychosocial or psychological theory to explain seasonal influenza vaccination behaviour among adults with a high-risk health condition were eligible for inclusion. Papers were systematically extracted by title, abstract and full text. Quantitative and qualitative studies were included, and all papers were quality assessed.
A total of 4840 papers were identified after removal of duplicates. Twelve papers were retained in the narrative synthesis. Studies were conducted across a range of high-risk condition populations and most (83.3%) were cross-sectional. The Health Belief Model (HBM), the model of Psychological Flexibility, The Health Action Process Approach and House\'s Framework of Social Support were applied. Ten out of 12 papers (83.3%) drew on the HBM.
There was evidence of an association between HBM perceived benefits, perceived barriers and vaccination behaviour, although there were inconsistencies across studies. This review highlighted the need for further research, particularly prospective studies of high methodological quality.