Knowledge, Attitudes, and Perceptions of Skin Cancer Clinical Trials in the Hispanic Population.

OBJECTIVE: To determine the factors that might limit Hispanic patients from participating in dermatological clinical trials. METHODS: From January 2022 to July 2022, we administered a 31-item, in-person questionnaire to patients recruited in the waiting area of the Caridad Center, one of the largest free clinics in the United States with a predominately Hispanic population, and a nearby private primary care clinic. RESULTS: Overall, Hispanic patients agreed significantly more with statements in the domain of attitude and behavioral beliefs compared to non-Hispanic survey respondents. The Hispanic ethnicity was associated with increased odds of agreeing with the following statements: "My community would really benefit from skin cancer clinical trials" (OR=0.52; 95% CI 0.30, 0.92), "My participation in a skin cancer study would be very good" (OR=0.59; 95% CI 0.35, 0.99), and "I like to do good for others" (OR=0.41; 95% CI 0.22, 0.77). CONCLUSION: While the United States population is composed of 18.5% Hispanics, they only account for 1% of patients enrolled in clinical trials. This study helps identify potential motivational factors for Hispanic patients to participate in skin cancer clinical trials.

Effectiveness of atopic dermatitis patient education programs - a systematic review and meta-analysis.

Patient education in atopic dermatitis (AD) has worked in parallel to the gold standard of pharmacological treatment as a foundational component of therapeutic regimens. In addition to improving patient education, past investigations of educational interventions have demonstrated profound reductions in disease severity for patients living with AD. However, prior meta-analytical work has focused mostly on comparing in-person interventions, and thus the need to determine the effectiveness of virtual methodologies in the current post-COVID era remains. In this study, we conducted a systematic review of the literature to determine the effectiveness of online programming in AD education compared to in-person interventions. A comprehensive search was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions 2019. Studies were retrieved based on articles published up to 04 April 2023. Adherence to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement guided the reportage process for this systematic review and meta-analysis. The primary outcome of our meta-analysis was the effect of various educational modalities on atopic dermatitis severity as measured by multiple scales across the studies, the most common including SCORAD, Dermatology Life Quality Index (DLQI), Patient Oriented Eczema Measure (POEM), and Eczema Area and Severity Index (EASI). Most studies were randomized controlled trials, primarily from North America and Western Europe and focused on patient and/or caregiver education about disease management, self-care techniques, avoidance of triggers, and comprehensive understanding of the disease process. Our pooled analyses showed that targeted educational programs in understudied adult populations can be as impactful as those in pediatric groups. Moreover, virtual interventions can be employed as constructive tools for reducing barriers of access to patient education. Future research on educational interventions should utilize various methodologies to encourage individual learning preferences with a focus on adult cohorts.

Treatment of post-burn pruritus - A systematic review and meta-analysis.

BACKGROUND: Post-burn pruritus is one of the most common complaints reported by patients with limited evidence for a gold-standard treatment. OBJECTIVE: To review the literature and assess the efficacy of various interventions in treating post-burn pruritus. METHODS: PubMed, MEDLINE, CINAHL, Web of Sciences, Ovid Databases, and ClinicalTrials.Gov were searched. The articles were scored by two assessors for inclusion with a third independent assessor resolving conflicting scores. RESULTS: The present systematic review and meta-analysis synthesised findings from a total of nine studies, representing a pool of 323 patients. The standardized mean effect size for the various categories of interventions was: naltrexone at 1.47 (95 % CI of 0.75-2.20, p < 0.0000), coverings at 0.94 (95 % CI of 0.40-1.48, p = 0.006), topical ozonated oil at 2.64 (95 % CI of 1.94-3.34, p < 0.00001), lasers at 2.34 (95 % CI of 1.60-3.09, p < 0.00001), current stimulation at 1.03 (95 % CI of -0.04 to 2.10, p = 0.06), and lemon balm tea at 0.54 (95% CI of 0.12-0.96, p = 0.01). CONCLUSIONS: Current evidence suggests that current modalities have a statistically significant, but not clinically significant, reduction in pruritus. This review highlights the limited quality of evidence in the literature and the poor quality of reporting among excluded studies.

A Cost-Based Analysis of Anti-aging Products Across Four Major United States Retailers.

Background In the field of aesthetic dermatology, there is currently very little data on affordability and cost analysis regarding cosmeceuticals as more demand from patients showing interest in cosmeceutical products to reduce and prevent aging continues to grow. Photoaging, a form of extrinsic aging from sun exposure, can be ameliorated by applying sunscreen and retinol products. Topical ascorbic acid and niacinamide have been shown to target the oxidative stress process that contributes to photoaging. These four products have been identified as the cosmeceutical ingredients with the most evidence-based data on photoaging prevention and treatment. Objective Given the demand for effective skin care, the paucity of data on cost differentiation, and the availability of cosmeceutical products, we analyzed the unit cost of four anti-aging products from major online and physical retailers in the United States. Such a cost comparison may facilitate more economically appropriate recommendations on skin care to consumers. Methods and materials We analyzed sunscreen, topical vitamin C (ascorbic acid), topical vitamin B3 (niacinamide), and topical vitamin A (retinol) products sold by four major United States retailers: Walmart, Ulta, Walgreens, and Amazon. The average cost in dollars per ounce (dollar/oz) was calculated for each product category at each retailer. Statistical analyses were done to determine statistical significance for each product category between retailers as well as between each category of product. Results Between the four retailers, Walmart offered the lowest cost per ounce for every product. In contrast, Amazon offered the highest cost per ounce for every product except for sunscreen. We also found that sunscreen products are less expensive per ounce as compared to retinol, ascorbic acid, and niacinamide products. Conclusion Dermatologists should be knowledgeable of product costs when providing patients with anti-aging product recommendations. Our study provides data on the financial cost by retail location of evidence-based anti-aging cosmeceuticals to better guide physicians in patient consulting and economical resource sharing.

Monodactylous Longitudinal Melanonychia in Pediatric Skin of Color: A Case Series and Review.

Introduction: Longitudinal melanonychia, a pigmented longitudinal streak on the nail, is a common clinical finding that may be associated with subungual melanoma with varying presentation depending on race and skin tone. It has been long reported that darker skinned ethnicities have a higher prevalence of longitudinal melanonychia in the US population (e.g., African Americans with 77% prevalence) [Indian J Dermatol. 2021;66(4):445], but unfortunately, there are limited studies exclusively looking at longitudinal melanonychia in pediatric patients of color. Case Presentation: In this case series, we review the current literature and report the findings of 8 cases of longitudinal melanonychia in children with skin types IV or greater. Out of the 8 cases identified, only 4 returned to the clinic for monitoring (n = 4), and there was an average of 20.8 months between the initial and final visits. Of the patients that returned for follow-up, 2 showed no relevant changes in the nail pigmentation, 1 showed fading of the band, and 1 patient showed enlargement of the band to involve the whole nail. Conclusion: Although many sources recommend a conservative approach to treatment that involves monitoring and follow-up, our findings indicate that a wait-and-see method cannot be applied to all cases in the pediatric population due to disruptions in continuity of care. An individualized approach considering such factors should be employed for each patient, and certain high-risk features of the ABCDEF nail melanoma model may be relevant in pediatric cases.

Trends in Health Care Utilization Among United States Children With Eczema by Age, Sex, Race, and Hispanic Ethnicity: National Health Interview Survey 2006-2018.

Background: Higher health care utilization has been proven among US children with eczema than those without, but disparities may exist among sociodemographic subgroups. Objective: To determine health care utilization trends among children with eczema across sociodemographic factors. Methods: We included children (0-17 years old) from the US National Health Interview Survey 2006-2018. We calculated the survey-weighted health care utilization by determining proportion of children attending a well-child checkup, seen by a medical specialist, and seen by a mental health professional in the previous 12 months for children with and without eczema, by race (white, black, American Indian/Alaska Native, Asian, and multiracial), Hispanic ethnicity (yes/no), age (0-5, 6-10, 11-17), and gender (male/female) subgroups using SPSS complex samples. Joinpoint regression was used to estimate piecewise log-linear trends in the survey-weighted prevalence, annual percentage change, and disparities between subgroups. Results: We included 149,379 children-there was higher health care utilization in children with eczema than those without. However, when comparing the average annual percentage change (AAPC), white children had a significantly higher AAPC of "attending a well-child checkup" than black children. In addition, only white children showed a significantly increasing trend in being "seen by a medical specialist," whereas all other minority race subgroups had stagnant trends. For those "seen by a mental health professional," there were increasing trends only in the male and non-Hispanic subgroups out of all the sociodemographic subgroups. Conclusion: Improving awareness among primary care physicians to refer children with moderate-to-severe eczema to medical specialists (eg, allergists, dermatologists, and mental health/attention-deficit/hyperactivity disorder professionals) when necessary could improve quality of life and reduce emergency department visits-especially among minority race, Hispanic, and female children.

A clínica cem anos depois: novas figuras de gozo

O autor se interroga sobre novas formas de sintomas surgidas na sociedade dita pós-moderna, em comparação com o tempo da descoberta freudiana. Cem anos após a descoberta do inconsciente, novos invólucros surgiram para os sintomas, mercê do discurso da ciência e de seu efeito, o discurso capitalista. São novas figuras de gozo que já não se enquadram na concepção clássica das deformações do inconsciente e de seu tratamento, e desafiam a psicanálise. A toxicomania é uma delas. A segunda clínica de lacan - a do gozo -, articula em função do objeto e, em última análise, apoiada na teoria dos nós, nos permite compreender sua economia e orientar nossa práxis (AU)

A Psicossomática: Uma Forma de Forclusão

Depois de uma rápida apresentação da teoria de Freud sobre as neuroses atuais, comparando-as com as neuroses de transferência, o autor se propõe buscar uma compreensão dos fenômenos psicossomáticos à luz da teoria lacaniana. Para isto, expõe as diferentes passagens da obra de Lacan onde ele se refere à psicossomática, ordenando-as segundo as categorias do imaginário e do simbólico. Finalmente, apoiando-se nos próprios textos de Lacan, o autor propõe o mecanismo da forclusão como hipótese explicativa para o fenômeno psicossomático

Do gozo ao desejo. A clínica da perversão

Partindo de uma análise do dispositivo analítico e do processo analítico enquanto experiência originária referida ao neurótico, que aí procura um saber relacionado à sua condição de sujeito de fala, e portanto de desejo, o AUTOR se pergunta como fica esta situação ante a demandado perverso, que aí se coloca, de saída, não como sujeito, mas como objeto a serviço do gozo do Outro, negando a falta e professando um saber sem “furo”. A análise de um outro caso de perversão mostra como, apesar dos limites de significação, o acesso ao simbólico possibilita ao perverso mudanças subjetivas, graças à posição do analista e à repetição própria ao dispositivo analítico