The prevalence of anxiety disorders in dermatology outpatients: A systematic review and meta-analysis.

Anxiety is common in those with medical conditions and has significant impacts on mental well-being as well as physical health outcomes. While several systematic reviews have examined the prevalence of anxiety in specific dermatological conditions, no reviews have examined the prevalence across the entire dermatology outpatient setting. This systematic review aims to provide an overview to dermatologists of the prevalence of, and trends in, anxiety in their outpatient clinics. As such, prevalence of anxiety in dermatology outpatient clinics was examined, and variations across type of anxiety and dermatological conditions were assessed. A search of PubMed, Embase, Cochrane and PsycINFO was conducted for studies that assessed anxiety prevalence in dermatology outpatients, with the last search conducted on 7 September 2022. Results underwent title/abstract and full-text screening, followed by data extraction. Studies of patients 16 years and older and representative of dermatology clinics were included. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis was conducted using CMA software, and subgroup analysis was conducted on relevant variables. 5423 studies were identified, and 32 included, with a total n = 12,812 participants. Under the random effects model, prevalence was estimated at 26.7% (95%CI 22.4-31.4; 95%PI 9.7-55.4). Subgroup analysis revealed a higher prevalence among studies of psoriasis patients than general dermatology studies. Estimates of prevalence were higher when assessed via self-report screening than diagnostic interview. Anxiety occurred frequently among dermatology outpatients, especially psoriasis outpatients, at a higher rate than common estimates of prevalence in the general population. Given the effect of anxiety on patient outcomes and well-being, dermatologists are encouraged to consider how anxiety may impact patients in their clinic, and how they can best identify patients with anxiety and subsequently support them.

Fasting plasma glucose, diagnosis of gestational diabetes and the risk of large for gestational age: a regression discontinuity analysis of routine data.

OBJECTIVE: To estimate the causal effects of fasting plasma glucose (FPG) and diagnosis of gestational diabetes (GDM) on birthweight and the risks of large for gestational age (LGA). DESIGN: Regression discontinuity analysis of routine data. SETTING: Two district general hospitals in West Yorkshire, UK. POPULATION: A cohort of 7062 women with singleton pregnancies who were screened for GDM and gave birth to a baby at ≥24 weeks of gestation in 2017-2019, inclusive. METHODS: The causal effects of FPG and GDM diagnosis were estimated using the two-stage least-squares approach, around the diagnostic threshold of FPG ≥ 5.6 mmol/l recommended by the UK's National Institute for Health and Care Excellent (NICE), controlling for ethnicity, maternal age, parity, height and weight. MAIN OUTCOME MEASURES: Birthweight (standardised for sex and gestational age) and large for gestational age (standardised as birthweight above the 90th centile). RESULTS: For each 1 mmol/l increase in FPG the observed birthweight increased by Z-score = 0.48 standard deviations (95% CI 0.39 to 0.57) and the odds of LGA increased by OR = 2.61 (95% CI 1.86 to 3.66). Conversely, GDM diagnosis reduced the observed birthweight by Z = -0.61 (95% CI -0.94 to -0.29) and lowered the odds of LGA by OR = 0.33 (95% CI 0.15 to 0.74). Similar, but less certain, patterns were observed for caesarean section, shoulder dystocia and perinatal death. CONCLUSIONS: The relationship between FPG and LGA is potent but is dramatically reduced by GDM diagnosis (and all the consequences thereof). Women with mild hyperglycaemia (with an FPG of 5.1-5.5 mmol/l) who fall below the current NICE threshold for GDM diagnosis have the highest risks of adverse outcomes, suggesting a need to reconsider their current care. TWEETABLE ABSTRACT: Regression discontinuity analysis shows that untreated mild hyperglycaemia increases the odds of large for gestational age, but that a diagnosis of gestational #diabetes lowers the odds by three times.

HIV infection and universal precautions: why are health workers so fearful given the facts?

Identifying people who are infected with HIV has drawn significant media attention over the past decade. This is an ethical issue that must be dealt with by health care workers, urgently. Services to people with HIV are being compromised by the attitudes and practices of some health care workers. Infection control nurses should provide leadership to health care workers who share the challenge of delivering effective and efficient services to people with HIV/AIDS.

Electrophoretic variation in a population of the lichen Peltigera rufescens (Weis.) Mudd.

Isoelectric focusing was used to investigate the distribution of enzymes exhibiting phosphoglucose isomerase, phosphoglucose mutase, malate dehydrogenase, esterase, hexokinase, glucose-6-phosphate dehydrogenase, peroxidase and fructose-1,6-bisphosphatase activities in a central Ontario population of the lichen Peltigera rufescens (Weis) Mudd. Samples of thalli were collected in order to estimate enzymatic variation in thalli collected within a site (separated by distances of 1-10 m) and between sites (separated by 5-15 km). A total of 85 different enzyme bands were identified in the 27 samples analysed. The results indicated that, at some locations, within site variation was as large as between site variation. The importance of this variation in the design of physiological studies of lichens is discussed.

Isolation and Characterization of Two Enzymes Capable of Hydrolyzing Fructose-1,6-Bisphosphatase from the Lichen Peltigera rufescens.

Two enzymes capable of hydrolyzing fructose-1,6-bisphosphate (FBP) have been isolated from the foliose lichen Peltigera rufescens (Weis) Mudd. These enzymes can be separated using Sephadex G-100 and DEAE Sephacel chromatography. One enzyme has a pH optimum of 6.5, and a substrate affinity of 228 micromolar FBP. This enzyme does not require MgCl(2) for activity, and is inhibited by AMP. The second enzyme has a pH optimum of 9.0, with no activity below pH 7.5. This enzyme responds sigmoidally to Mg(2+), with half-saturation concentration of 2.0 millimolar MgCl(2), and demonstrates hyperbolic kinetics for FBP (K(m) = 39 micromolar). This enzyme is activated by 20 millimolar dithiothreitol, is inhibited by AMP, but is not affected by fructose-2-6-bisphosphate. It is hypothesized that the latter enzyme is involved in the photosynthetic process, while the former enzyme is a nonspecific acid phosphatase.

Seasonal Changes in the Kinetic Parameters of a Photosynthetic Fructose-1,6-Bisphosphatase Isolated from Peltigera rufescens.

The kinetic parameters of the photosynthetic fructose-1,6-bisphosphatase isolated from Peltigera rufescens (Weis) Mudd. were measured on a seasonal basis and during a laboratory-induced temperature acclimation. Both the substrate affinity and Ea changed on a seasonal basis. During the summer, the Ea decreased from 91.8 to 62.3 kilojoules per mole. The K(m) fructose-1,6-bisphosphate measured at temperatures above 25 degrees C was also found to decrease by 50%. This seasonal change in K(m) can be induced by growing the lichen under appropriate conditions for 2 weeks, and is correlated to a change in the net photosynthetic rates. It is hypothesized that this change in fructose-1,6-bisphosphatase is related to the seasonal temperature acclimation process that has been previously reported in this species.

Thermal sensitivity in lichens.

Lichens are believed to be extremely resistant to high-temperature stress when desiccated. Results from a reexamination of this concept indicate that some air-dry lichen thalli can be extremely sensitive to even moderate levels of heat stress whereas others exhibit a considerable degree of heat resistance. These differential levels of thermal resistance correlate exactly with the ecology of these populations.