Unraveling the Tapestry of Pain: A Comprehensive Review of Ethnic Variations, Cultural Influences, and Physiological Mechanisms in Pain Management and Perception.

The medical management of pain is a nuanced challenge influenced by sociocultural, demographic, and ethical factors. This review explores the intricate interplay of these dimensions in shaping pain perception and treatment outcomes. Sociocultural elements, encompassing cultural beliefs, language, societal norms, and healing practices, significantly impact individuals' pain experiences across societies. Gender expectations further shape these experiences, influencing reporting and responses. Patient implications highlight age-related and socioeconomic disparities in pain experiences, particularly among the elderly, with challenges in managing chronic pain and socioeconomic factors affecting access to care. Healthcare provider attitudes and biases contribute to disparities in pain management across racial and ethnic groups. Ethical considerations, especially in opioid use, raise concerns about subjective judgments and potential misuse. The evolving landscape of placebo trials adds complexity, emphasizing the importance of understanding psychological and cultural factors. In conclusion, evidence-based guidelines, multidisciplinary approaches, and tailored interventions are crucial for effective pain management. By acknowledging diverse influences on pain experiences, clinicians can provide personalized care, dismantle systemic barriers, and contribute to closing knowledge gaps, impacting individual and public health, well-being, and overall quality of life.

Association of Patient-Surgeon and Patient-Physical Therapist Relationships With Return to Sports After ACL Reconstruction: The Untested Dimension in Outcome Assessments.

Background: The Quality of Patient-Surgeon Relationship (QPASREL) is an 11-item questionnaire developed and validated to assess the relationship between practitioners and patients on recovery and return to work after surgery. Purpose: To evaluate the association of patient-surgeon relationship (PSR) and patient-physical therapist relationship (PPR), as measured by QPASREL, with a patient's return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). Study Design: Case-control study; Level of evidence, 3. Methods: This study targeted patients who underwent primary ACLR at a specialized sports surgery referral center between January and May 2021. Patients who had revision surgery, multiligamentous knee injury, and sedentary status were excluded from the study. Patients were grouped based on ability to RTS at the preinjury level 1 year postoperatively (RTS group and no-RTS group). The primary outcome was rate of RTS at 1 year postoperatively, and the primary dependent variables were the quality of PSR and PPR as measured by QPASREL scores at 6-month intervals. Secondary outcomes were the correlation and discriminative capacity of the QPASREL compared with the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scores (collected at 6-month intervals). Results: The study included 243 patients. Patients in the RTS group exhibited a higher mean PPR QPASREL score (36.6 ± 5.1) compared with no-RTS patients (34.8 ± 5.2; P = .01) as well as a higher mean PSR score (35.7 ± 5.1) compared with no-RTS patients (33.8 ± 5.9; P = .01). Multivariate analysis showed that every 5-point increase in the QPASREL scores for PPR and PSR resulted in a 39% (odds ratio [OR] = 1.39; P = 0.014) and 35% (OR = 1.35, P = 0.021) increased odds of RTS, respectively. A weak yet positive correlation was found between QPASREL and ACL-RSI. The predictive capacity of the QPASREL (area under the curve [AUC] = 0.60 for PPR and 0.61 for PSR), although significant, was less powerful compared with that of the ACL-RSI (AUC = 0.73). Conclusion: The quality of the PPR and PSR, as measured by QPASREL scores, demonstrated a significant association with RTS rates at 1 year after ACLR. A weak yet positive correlation was found between QPASREL and ACL-RSI.

Postoperative Negative Pain Thoughts and Their Correlation With Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair: An Observational Cohort Study.

BACKGROUND: Pain and pain perception are influenced by patients' thoughts. The short form Negative Pain Thoughts Questionnaire (NPTQ-SF) can be used to quantify unhelpful negative cognitive biases about pain, but the relationship between NPTQ-SF scores and orthopaedic surgery outcomes is not known. PURPOSE/HYPOTHESIS: The purpose was to assess the relationship between negative pain thoughts, as measured by the NPTQ-SF, and patient-reported outcomes in patients undergoing arthroscopic rotator cuff repair, as well as to compare NPTQ-SF scores and outcomes between patients with and without a history of chronic pain and psychiatric history. It was hypothesized that patients with worse negative pain thoughts would have worse patient-reported outcomes. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: In total, 109 patients undergoing arthroscopic rotator cuff repair were administered the 4-item NPTQ-SF, 12-item Short Form Health Survey (SF-12), American Shoulder and Elbow Surgeons (ASES) Shoulder Evaluation Form, and visual analog scale pain survey preoperatively between July 2021 and August 2022. The same surveys were completed ≥6 months postoperatively by 74 patients confirmed to have undergone arthroscopic rotator cuff repair. RESULTS: Preoperative NPTQ-SF scores did not show any correlation with the postoperative patient-reported outcomes measured in this study. Postoperative NPTQ-SF scores were statistically significantly negatively correlated with postoperative SF-12 Physical Health Score, SF-12 Mental Health Score, ASES, and satisfaction scores (P < .05). Postoperative NPTQ-SF scores were statistically significantly positively correlated with postoperative visual analog scale scores (P < .001). Moreover, postoperative NPTQ-SF scores were statistically significantly negatively correlated with achieving a Patient Acceptable Symptom State and the minimal clinically important difference on the postoperative ASES form (P < .001 and P = .009, respectively). CONCLUSION: Postoperative patient thought patterns and their perception of pain are correlated with postoperative outcomes after rotator cuff repair. This correlation suggests a role for counseling and expectation management in the postoperative setting. Conversely, preoperative thought patterns regarding pain, as measured by the NPTQ-SF, do not correlate with postoperative patient-reported outcome measures. Therefore, the NPTQ-SF should not be used as a preoperative tool to aid the prediction of outcomes after rotator cuff repair.

A life lost to anorexia nervosa: A case report of rapid progressive disease and its psychological aspects.

The prevalence of anorexia nervosa has been on the rise. Exploring key factors in treating this condition as well as psychological factors influencing the onset and maintenance of the disorder can increase the chance of treatment success.

Gluten-Free Diet and Other Celiac Disease Therapies: Current Understanding and Emerging Strategies.

A lifelong gluten-free diet (GFD) is the only treatment for celiac disease and other gluten-related disorders. Nevertheless, strict adherence to the GFD is often challenging due to concerns about social isolation, risk of gluten contaminations, high cost, poor quality and the taste of gluten-free products. Moreover, although the GFD is effective in achieving mucosal healing, it may lead to dietary imbalances due to nutrient deficiencies over a long period of time. To overcome these issues, several gluten-free wheat flours have been developed to create products that closely resemble their gluten-containing counterparts. Furthermore, given the critical importance of adhering to the GFD, it becomes essential to promote adherence and monitor possible voluntary or involuntary transgressions. Various methods, including clinical assessment, questionnaires, serology for celiac disease, duodenal biopsies and the detection of Gluten Immunogenic Peptides (GIPs) are employed for this purpose, but none are considered entirely satisfactory. Since adherence to the GFD poses challenges, alternative therapies should be implemented in the coming years to improve treatment efficacy and the quality of life of patients with celiac disease. The aim of this narrative review is to explore current knowledge of the GFD and investigate its future perspectives, focusing on technology advancements, follow-up strategies and insights into a rapidly changing future.

Adaptation of Morningness-Eveningness Questionnaire (MEQ) in Bengali Language.

BACKGROUND: Morningness-Eveningness Questionnaire (MEQ) has been used to assess working efficiency of an individual. The self-reporting MEQ is available in English language, and its applicability to Indian scenario is limited to educated/ English proficient individuals only. Since, majority in India still depend on the regional languages for communication, it is difficult to make live translation of the questionnaire while administration and results may also vary due to tester's language proficiency. The present study focused on adapting MEQ in Bengali language. METHOD: The English version of Morningness-Eveningness Questionnaire (MEQ) was a self-assessment questionnaire consisting of 19 questions to measure whether a person's peak alertness was in the morning, evening or in between. The translation of the questionnaire was done using forward-backward-translation method by six experts in Bengali language, and was content validated by thirty native Bengali speakers. The speakers were asked to rate the questions on a 5-point rating scale with 1 being very familiar and 5 being not at all familiar. All the questions rated as 1 or 2 were considered for the Bengali version of MEQ, while those rated as 3 or above were reframed and revalidated. RESULT: The Bengali version of the MEQ has good reliability (Cronbach's alpha 0.74). Item analysis revealed it as a good consistent scale for estimating the circadian type of the participants. Participants were classified into 5 Circadian types based on the cut-off scores. Majority of participants are intermediate type, followed by Morningness. CONCLUSION: The application of MEQ will help in management of tinnitus.

Top Ten Tips Palliative Care Clinicians Should Know About the Psychological Aspects of Palliative Care Encounters.

Palliative care clinicians enhance the illness experiences of patients and their families through building therapeutic relationships. Many psychological concepts underlie a clinician's approach to a specific patient. Through high-yield tips, this article highlights ten selected psychological elements that palliative care clinicians often use to support patients. As we all (both clinicians and patients) bring our own histories and unique biographies to the work of palliative care, a more explicit focus on the psychological aspects of this work can enhance our own experience and efficacy as providers. With a thoughtful focus on the psychological aspects of how we engage with patients, palliative care clinicians can offer a more meaningful therapeutic encounter.

The quest for wellness: How to optimise self-care strategies for diabetic foot management?

Diabetic foot ulceration (DFU) is common and highly recurrent, negatively impacting the individuals' quality of life. The 2023 guidelines of the International Working Group on the Diabetic Foot emphasise that adherence to foot self-care recommendations is one of the most important factors in DFU prevention. These guidelines also briefly mention that depression and other psychosocial problems can hamper treatment and ulcer healing. Moreover, a new clinical question was added on psychological interventions for ulcer prevention, although the evidence regarding the role of psychological and social factors is still limited. To help the field progress, this narrative overview discusses how a stronger focus on psychological factors by both researchers and clinicians could improve the care for people at high DFU risk. The review starts with a testimony of a person living with DFU, explaining that for him, the absence of shared decision-making has been a key barrier to successful foot self-care implementation. Intervention studies that address patient-reported barriers are still scarce, and are therefore urgently needed. Furthermore, the key elements of psychological interventions found to be successful in managing diabetes are yet to be implemented in DFU risk management. Importantly, research evidence indicates that commonly advocated foot self-care recommendations may be insufficient in preventing DFU recurrence, whereas digital technology appears to effectively reduce recurrent DFU. More research is therefore needed to identify determinants of patient acceptance of digital technology.

Medical and Psychological Aspects of Pregnancy in Women with Obesity and after Bariatric Surgery.

Chronic diseases are potential risk factors for pregnancy duration and neonatal outcomes. This narrative review aimed to summarize the research results on the specifics of pregnancy in women with obesity and after bariatric surgery. PubMed and Google Scholar databases were searched. Systematic reviews, meta-analyses, clinical trials, and references to identified articles from the last ten years (2013-2023) were included. Ultimately, 107 literature items were qualified. It has been shown that women with obesity planning pregnancy should reduce their body weight because obesity is a risk factor for adverse obstetric and neonatal outcomes. Bariatric surgery effectively reduces excessive body weight and the health risks in women with obesity during pregnancy and their offspring. However, at least a year interval between surgery and conception is recommended. An interdisciplinary medical team should provide patient care during pregnancy with knowledge and skills related to people after bariatric surgery. Due to the increased risk of mental disorders, especially depression, it is necessary to constantly monitor the mental state of women and provide psychological support and education on a healthy lifestyle during pregnancy and the postpartum period.

Unveiling Skin Manifestations: Exploring Cutaneous Signs of Malnutrition in Eating Disorders.

The intricate interplay between eating disorders, malnutrition, and their cutaneous manifestations is the focal point of this comprehensive review. The review delves into the clinical significance of recognising and understanding these visible signs in the context of eating disorders. It highlights the vital role of nutrition in maintaining healthy skin and addresses the challenges associated with relying solely on cutaneous signs for diagnosis. Emphasising a multidisciplinary approach involving dermatologists, psychiatrists, and nutritionists, the review underscores the holistic nature of the treatment. Addressing psychological aspects alongside nutritional rehabilitation is underscored with a forward-looking perspective on future research avenues. This review is valuable for healthcare professionals by synthesising existing knowledge and identifying research gaps. It aims to improve the diagnosis, treatment, and preventative strategies for individuals dealing with the complex challenges of eating disorders and malnutrition.

Assessing Household's Municipal Waste Segregation Intentions in Metropolitan Cities of Pakistan: A Structural Equation Modeling Approach.

There is a growing concern about inappropriate waste disposal and its negative impact on human health and the environment. The objective of this study is to understand household waste segregation intention considering psychological, institutional, and situational factors simultaneously. Insights into the motivations of household waste segregation drivers may assist in a better knowledge of how to pursue the most efficient and effective initiatives. For this purpose, data from a representative sample comprising 849 households is obtained from the twin cities of Islamabad and Rawalpindi (Pakistan). The empirical analysis employs a Structural Equation Modeling (SEM) approach, showing that policy instruments have significant direct and indirect impacts on households' segregation intentions. The results highlight that government policy instruments strengthen personal and perceived norms for waste segregation intentions, resulting in an external intervention that would encourage intrinsic motivation. Therefore, policy actions become the main entry point for initiating waste segregation behavior. Public policy must continue to emphasize waste segregation since it may help resource recovery. This is imperative because the environment is a shared resource, and its conservation increases social welfare.

Clinical-Psychological Aspects Involved in Gynecological Surgery: Description of Peri-Operative Psychopathological Symptoms and Illness Behavior.

Background: Within the current literature concerning the gynecological surgery, there are only a few studies that focus on the psychological aspects that characterize the peri-operative period. In this research, the psychopathological symptoms and the illness behavior were assessed in order to confirm previous results about clinical variables such as the type and method of intervention, as well as psychological aspects regarding the positive anamnesis for mental disorders. Moreover, other factors including the desire for maternity and previous surgical interventions and pregnancies were also investigated. Methods: In this observational research, 58 women (age = 41.5±8.8), that undergone gynecological surgery (conservative and non-conservative) for benign pathologies, were consecutively recruited. Information on psychopathological symptoms was collected 15 days (T0) and one day before surgery (T1), and at the time of discharge (T2) through the Symptom Questionnaire (SQ). At T2, the Illness Behavior Questionnaire (IBQ) was also administered. Results: The descriptive analyzes conducted on the total sample demonstrated that while anxious activation and irritable mood decrease from T0 to T1, somatizations and depression mood increase between T1 and T2. Moreover, the comparisons between groups, dividing the sample according to the clinical-medical and psychological variables, highlighted that the type and modality of the intervention, as well as a positive history for the presence of psychological disorders, the desire for maternity, and previous surgical interventions and pregnancies, can influence the course of psychopathological symptoms. Conclusion: This study highlights the need to include a clinical-psychological evaluation and to pay attention to specific clinical variables regarding women that are undergoing a conservative or non-conservative gynecological surgery. Considering the psychological impact of these type of interventions, the clinical history of these women, as well as their fears and desires, could facilitate a better management of the patients in terms of well-being, adherence to treatment, and recovery.

Fundamento: Dentro de la literatura actual referente a la cirugía ginecológica, existen pocos estudios que se centren en los aspectos psicológicos que caracterizan el perioperatorio. En esta investigación se evaluaron los síntomas psicopatológicos y la conducta de enfermedad con el fin de confirmar resultados previos sobre variables clínicas como el tipo y método de intervención así como aspectos psicológicos en cuanto a la anamnesis positiva para trastornos mentales. Además, también se investigaron otros factores, como el deseo de maternidad y las intervenciones quirúrgicas y embarazos previos. Métodos: En esta investigación observacional, se reclutaron consecutivamente 58 mujeres (edad=41.5±8.8), sometidas a cirugía ginecológica (conservadora y no conservadora) por patologías benignas. La información relativa a los síntomas psicopatológicos se ha recogido durante 15 días (T0) y un día antes de la cirugía (T1), y en el momento del alta (T2) a través del Cuestionario de Síntomas (SQ). En T2 también se administró el Cuestionario de Conducta de Enfermedad (IBQ). Resultados: Los análisis descriptivos realizados sobre la muestra total demostraron que mientras la activación ansiosa y el estado de ánimo irritable disminuyen de T0 a T1, las somatizaciones y el estado de ánimo depresivo aumentan entre T1 y T2. Además, las comparaciones entre grupos, dividiendo la muestra de acuerdo con las variables clínico-médicas y psicológicas, destacaron que el tipologia y modalidad de la intervención, así como una historia positiva para la presencia de trastornos psicológicos, deseo de maternidad y antecedentes quirúrgicos, las intervenciones y los embarazos pueden influir en el curso de los síntomas psicopatológicos. Conclusión: Este estudio pone de relieve la necesidad de incluir una evaluación clínico-psicológica y prestar atención a variables clínicas específicas en mujeres que se someten a una cirugía ginecológica conservadora o no conservadora. Considerando el impacto psicológico de este tipo de intervenciones, la historia clínica de estas mujeres, sus miedos y deseos podría facilitar un mejor manejo de las pacientes en términos de bienestar, adherencia al tratamiento y recuperación.

Association of Grit With Postoperative Knee Outcomes and Physical Function After ACL Reconstruction in Adolescent Athletes.

BACKGROUND: Grit is the disposition to strive for long-term goals despite setbacks and challenges. Given the lengthy, arduous process of rehabilitation after anterior cruciate ligament reconstruction (ACLR), an athlete's grit may predict postoperative outcomes across time. PURPOSE/HYPOTHESIS: The primary aim of the study was to evaluate the relationships between baseline (preoperative) grit and postoperative knee outcomes across the year after ACLR among adolescents. We hypothesized that athletes with more grit would achieve better postoperative outcomes over time than less gritty athletes. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: All participants completed the Short Grit Scale, the Pediatric International Knee Documentation Committee (Pedi-IKDC) Scale, the Lysholm Knee Scoring Scale, the Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric scale for pain interference and mobility, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), and the Quality of Life in Neurological Disorders (NeuroQoL) Lower Extremity Function Short Form at a preoperative appointment and then again at approximately 3, 6, and 12 months after ACLR. We constructed linear mixed models to assess the relationships between baseline grit, time, age, sex, and postoperative outcome measures (statistical significance of α = .05). RESULTS: We included 137 participants (mean age 15.8 ± 2.74 years, 70% female) from a prospective registry of athletes undergoing ACLR by 1 surgeon at a single institution. There were no statistically significant changes in grit over time or differences in grit between age and sex. Higher baseline grit was significantly associated with greater postoperative HSS Pedi-FABS scores (ß = 3.72 ± 1.46; P = .01; 95% CI, 0.85-6.59) and NeuroQoL scores across time (ß = 3.37 ± 0.93; P < .001; 95% CI, 1.55-5.20). There were no significant associations between baseline grit and Pedi-IKDC, Lysholm, and PROMIS pain interference or mobility scores. CONCLUSION: Athletes with higher baseline grit reported superior postoperative physical function and activity level over the course of 1 year after ACLR compared with less gritty athletes. Grit may be a useful measure in predicting success in regaining physical function across time after ACLR in adolescent athletes.

Consequences of Psychological Aspects: From Jordanian Heart Failure Patients' Beliefs.

Introduction: Psychological aspects are common in patients with heart failure (HF). Psychological aspects have negative consequences in patients with HF. Objective: This study was conducted to gain a deeper understanding of the consequences of psychological aspects in Jordanian patients with HF. Methods: This study is a qualitative study conducted with the participation of 24 patients with HF. Data were collected using semi-structured interviews. Results: The main theme of the findings can be expressed as "Consequences of psychological aspects of HF." The following four sub-themes emerged from the data: social isolation, disturbance of feelings, being non-compliant, and growing burden on the health care system. Conclusion: The findings revealed the need for informing healthcare providers about the negative consequences of psychological aspects and develop clinical guidelines to evaluate psychological aspects to support these patients.

Significant reduction in diabetes distress and improvements in psychosocial outcomes: A pilot test of an intervention to reduce diabetes distress in adults with type 1 diabetes and moderate-to-severe diabetes distress (REDUCE).

AIM: To pilot-test an intervention, co-designed with people with type 1 diabetes (T1DM) and diabetes specialist nurses, to reduce diabetes distress (DD) in adults with T1DM and moderate-to-severe DD. METHODS: A group-based programme to reduce DD in people with T1DM and moderate-to-severe DD (REDUCE) was pilot-tested in four groups with five bi-weekly two and a half-hour meetings facilitated by two trained diabetes specialist nurses. Data collection included baseline and post-intervention questionnaires measuring DD and psychosocial outcomes and semi-structured interviews with participants post-intervention (n = 18). Data were analysed using descriptive statistics and systematic text condensation. RESULTS: Twenty-five adults with T1DM participated in the study. The median age and diabetes duration of participants were 50 (IQR: 32;57.5) years and 26 (IQR: 18;45) years, respectively. Seventeen (68%) were women. The pilot study showed a significant reduction in DD (measured by Type 1 Diabetes Distress Scale) between baseline and post-intervention from 2.6 ± 0.7 to 1.9 ± 0.6 (mean ± SD) (p < 0.001). The largest reductions were seen on the subscales: powerlessness 1.2 ± 1.1, eating distress 0.9 ± 1.2 and fear of hypoglycaemia 0.8 ± 1.0 (mean ± SD). Significant improvements were also seen for quality of life, diabetes empowerment and emotion regulation. Qualitative data showed that REDUCE supported participants in verbalizing emotions and seeing worries in a more constructive perspective. Acknowledgement of negative diabetes experiences eased negative self-judgments. Sharing experiences among peers increased relatedness and reduced loneliness. CONCLUSION: Participation in REDUCE was associated with significant reduction in DD and significant increase in quality of life. Larger scale studies are planned to determine sustained effectiveness of REDUCE.

Systematic review of technology-mediated peer support interventions in paediatric type 1 diabetes care.

AIMS: There is increasing interest in the role of peer support in diabetes care. However, technology-mediated peer support in paediatric type 1 diabetes remains understudied.We aimed todescribe technology-mediated peer support interventions for children living with type 1 diabetes, their caregivers and healthcare providers. METHODS: CINAHL, Embase and MEDLINE (Ovid) were searched from Jan 2007 to June 2022. We included randomised and non-randomised trials with peer support interventions for children living with diabetes, their caregivers and/or healthcare providers. Studies examining clinical, behavioural or psychosocial outcomes were included. Quality was assessed with the Cochrane risk of bias tool. RESULTS: Twelve of 308 retrieved studies were included, with a study duration range of 3 weeks to 24 months and most were randomised trials (n = 8, 66.67%). Four technology-based interventions were identified: phone-based text messages, video, web portal and social media, or a hybrid peer support model. Most (58.6%, n = 7) studies exclusively targeted children with diabetes. No significant improvement was observed in psychosocial outcomes (quality of life, n = 4; stress and coping, n = 4; social support, n = 2). Mixed findings were observed in HbA1c (n = 7) and 28.5% studies (n = 2/7) reported reduced incidence of hypoglycaemia. CONCLUSIONS: Technology-mediated peer support interventions may have the potential to improve diabetes care and outcomes. However, further well-designed studies are necessary that address the needs of diverse populations and settings, and the sustainability of intervention effects.

'Be the Match'. Predictors of Decisions Concerning Registration as a Potential Bone Marrow Donor-A Psycho-Socio-Demographic Study.

(1) Background: The study was aimed at a better understanding of the factors determining making a decision to become a potential bone marrow donor, in a Polish research sample; (2) Methods: The data was collected using a self-report questionnaire among persons who voluntarily participated in the study concerning donation, conducted on a sample of the Polish population via Internet. The study included 533 respondents (345 females and 188 males), aged 18-49. Relationships between the decision about registration as potential bone marrow donor and psycho-socio-demographic factors were estimated using the machine learning methods (binary logistic regression and classification & regression tree); (3) Results. The applied methods coherently emphasized the crucial role of personal experiences in making the decision about willingness for potential donation, f.e. familiarity with the potential donor. They also indicated religious issues and negative health state assessment as main decision-making destimulators; (4) Conclusions. The results of the study may contribute to an increase in the effectiveness of recruitment actions by more precise personalization of popularizing-recruitment actions addressed to the potential donors. It was found that selected machine learning methods are interesting set of analyses, increasing the prognostic accuracy and quality of the proposed model.

Atopic Dermatitis: Disease Features, Therapeutic Options, and a Multidisciplinary Approach.

The latest findings regarding AD pathogenesis point to an impaired function of the epidermal barrier, changed immune response, colonization of the skin by microorganisms, and certain psychological factors among other causes/triggers. The inflammatory response of AD patients is mainly associated with the activation of T cells (Th2 cells predominate), dendritic cells, macrophages, keratinocytes, mast cells, and eosinophils. Therapy usually involves medical evaluations and adequate management including treatment of concomitant diseases (e.g., allergies and infections), patient education and nursing care, psychological support, and nutritional consultations, which are organized through specific programs and structured educational groups. Systemic AD therapy includes conventional systemic treatment (cyclosporine, methotrexate, azathioprine) and new, specific drugs, interleukin inhibitors (e.g., dupilumab) and JAK inhibitors (baricitinib, abrocitinib, upadacitinib, etc.). Since many AD patients are affected by various psychological factors and comorbidities, they should be assessed and managed through a multidisciplinary approach, involving different professions (psychologists, ear-nose-throat specialists, pulmonologists, allergologists, immunologists, nutritionists, pediatricians, gastroenterologists, psychiatrists (when necessary), and others). A multidisciplinary approach provides better coping strategies and improves control over the disease, patient adherence to therapy, and quality of life. It also has a positive influence on family quality of life while at the same time making more efficient use of dermatology healthcare resources, reducing the economic burden on both patients and society.

Factors That Affect Return to Sports After an Achilles Tendon Rupture: A Qualitative Content Analysis.

Background: Achilles tendon rupture is common among physically active individuals, yet a high percentage fail to return to their former activity after the injury. Quantifiable factors such as type of treatment, hours of rehabilitation, and age have not been associated with return-to-play rates. A factor that influences recovery is the participant's experience before and throughout the rehabilitation process, which can be explored using a qualitative content analysis. Purpose: To explore and describe what influences the participant to return to physical activity after an Achilles tendon rupture. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty participants (14 men; mean age, 46 years) were interviewed as part of this study. All participants had ruptured their Achilles tendon 4 to 6 years before the interviews. From the interviews, codes were extracted that evolved into 19 subcategories, 6 categories, and 1 theme. Results: The overarching theme that emerged was "Help me and then I can fix this." The 6 categories were (1) one's own drive to succeed, (2) having a supportive social network, (3) trusting the support from the health and social systems, (4) receiving and adapting information from others drives persistence in returning to activity, (5) impact of the injury on psychological factors; and (6) influence of physiological aspects. Conclusion: To be able to recover properly from an Achilles tendon rupture and return to activity, the study participants described the importance of obtaining the support needed to be able to gain optimal rehabilitation. In the participants' opinion, for a greater chance of successful treatment and rehabilitation, it was vital to be provided with good support.

Training Conditions and Psychological Health: Eating Behavior Disorders in Spanish High-Performance Women's Olympic Wrestling Athletes-A Qualitative Study.

(1) Background: the aim of this study was to determine the factors that affect the occurrence of behaviors related to possible eating disorders in Spanish high-performance Olympic wrestling athletes. (2) Methods: The sample consisted of 22 elite female wrestlers selected through purposive sampling with inclusion criteria of (i) having been a national champion, (ii) having been part of the Spanish team, and (iii) suffering or having suffered from an eating disorder. The semistructured interviews were conducted online and lasted between 20 and 40 min. A statistical analysis was performed with NVivo10 software. (3) Results: the athletes showed a series of issues grouped into three main themes, which were divided into the following categories-firstly, the reasons why wrestlers lose weight; secondly, the inadequate procedures they use; and, finally, the reference persons involved in the process. (4) Conclusions: The training conditions in high-performance sports have psychological and behavioral effects on wrestlers. Wrestlers have to move down to lower categories; however, they do not take into account how this practice influences their health when using inadequate procedures. Rapid and significant weight loss produces negative effects, especially in the female population, generating an incidence of eating disorders. The information obtained provided elements of interest for reflection on possible solutions to prevent existing eating disorders.