Disparities and barriers to the access of biologics in moderate-to-severe adult psoriasis.

Psoriasis is a chronic, relapsing inflammatory skin disorder that is associated with substantial physical and psychosocial comorbidity. Although biologic agents have offered transformative therapeutic advantages to those unresponsive to traditional treatments, data from recent literature indicate significant undertreatment of certain populations, highlighting potential barriers to access. This review aims to comprehensively elucidate barriers to biological therapy, addressing a recognized gap in the current literature. A search was conducted using MEDLINE, Embase, and Web of Science to investigate the obstacles and disparities that prevent access to biologic treatments in biologic-naïve psoriatic patients. Emergent themes were then systematically categorized into five primary domains: patient-level, prescriber-level, medicine-level, organizational-, and external environment-level factors. Our results demonstrate pronounced barriers and disparities encompassing increased age, race, socioeconomic status, rural location, cost and insurance, and insufficient knowledge that may hinder access to biologic treatments among psoriatic patients. Further research on how these barriers can be effectively addressed is needed to optimize treatment outcomes.

The Acne Education Project: An educational initiative to improve acne health literacy and promote help-seeking behavior in young adolescents.

BACKGROUND: Acne vulgaris is an inflammatory skin condition that is associated with poor acne health literacy. Diminished acne health literacy leads to delays in the access of health care, resulting in mismanagement, disfigurement, and psychosocial morbidity. This study evaluates the potential role of early acne education in young adolescent populations to improve acne health literacy and facilitate help-seeking behavior. METHODS: The Acne Education Project is a Canadian medical student-led initiative founded to create evidence-based resources to increase acne health literacy. A 45-min interactive Zoom presentation on acne was created and delivered to 2292 students ages 9-13 in British Columbia, Canada. A quality improvement survey was administered pre-intervention, immediate post-intervention, and 1-month post-intervention to evaluate baseline acne knowledge and knowledge retention to guide presentation and resource development. RESULTS: Responses from 676 unique individuals were collected. Analysis using linear mixed-effects models demonstrated that respondents were significantly more confident in their general knowledge of acne, strategies to prevent acne, identification of psychosocial sequelae of acne, and more willing to seek help immediately post-intervention (p < .001). Differences in scores were not fully preserved in magnitude at the 1-month post-intervention assessment. However, students still scored significantly higher in all categories compared to the pre-intervention baseline (p < .001). CONCLUSION: Our findings suggest that early acne education can improve acne health literacy and promote help-seeking behavior. Given the potential long-term implications, further research is needed to explore the long-term impact of early acne education and the benefit of integrating acne education into the public education curriculum in Canada.

Perspectives and knowledge of acne vulgaris among young adolescents.

Acne occurs in up to 90% of young adolescents, but prior research has found that this population exhibits a limited understanding of acne and is vulnerable to myths and misinformation accumulated from family members, friends, and social media. We created a virtual presentation on skin hygiene, acne prevention, and acne-associated stigma for adolescent youth (aged 9-13) to improve acne health literacy, which was reviewed by three board-certified dermatologists. A descriptive cross-sectional study using data collected for quality improvement (n = 209, total) revealed that approximately half (n = 102/202, 50.5%) of all students believed that acne could not be treated with medications, only 34.0% (n = 67/197) believed acne could impact their mental health, and most students incorrectly believed that dirt buildup (n = 124/209, 59.3%) and poor hygiene (n = 125/209, 59.8%) were pathogenic for acne. Our results stress the necessity of early evidence-based educational interventions as a cornerstone to breaking self-perpetuating myths and misinformation that may lead to acne mismanagement, delayed access to healthcare, and permanent scarring later in life.

Association between COVID-19 vaccination and bullous pemphigoid - a case series and literature review.

Bullous pemphigoid is an acquired autoimmune blistering dermatosis that is commonly associated with high morbidity and mortality. New-onset bullous pemphigoid following vaccinations has rarely been reported in the literature. We report two cases of new-onset bullous pemphigoid after COVID-19 vaccination followed by a brief literature review. Twenty-six cases were included in our analysis. Our cases support that new-onset bullous pemphigoid may develop following COVID-19 vaccinations. Entering a period of clinical remission before subsequent COVID-19 vaccinations in addition to close follow-up should be considered to lessen the risk of recurrences or exacerbations.

Unsupervised speech segmentation: an analysis of the hypothesized phone boundaries.

Despite using different algorithms, most unsupervised automatic phone segmentation methods achieve similar performance in terms of percentage correct boundary detection. Nevertheless, unsupervised segmentation algorithms are not able to perfectly reproduce manually obtained reference transcriptions. This paper investigates fundamental problems for unsupervised segmentation algorithms by comparing a phone segmentation obtained using only the acoustic information present in the signal with a reference segmentation created by human transcribers. The analyses of the output of an unsupervised speech segmentation method that uses acoustic change to hypothesize boundaries showed that acoustic change is a fairly good indicator of segment boundaries: over two-thirds of the hypothesized boundaries coincide with segment boundaries. Statistical analyses showed that the errors are related to segment duration, sequences of similar segments, and inherently dynamic phones. In order to improve unsupervised automatic speech segmentation, current one-stage bottom-up segmentation methods should be expanded into two-stage segmentation methods that are able to use a mix of bottom-up information extracted from the speech signal and automatically derived top-down information. In this way, unsupervised methods can be improved while remaining flexible and language-independent.

Visual-tactile examination compared with conventional radiography, digital radiography, and Diagnodent in the diagnosis of occlusal occult caries in extracted premolars.

PURPOSE: This laboratory study compared visual-tactile examination with conventional radiographs, digital radiographs, and laser fluorescence in the detection of occlusal occult caries on extracted premolar teeth. METHODS: Extracted premolars without obvious caries or restorations were collected from school dental clinics. Occlusal surfaces of 320 extracted premolars were examined visually with an explorer, then examined using the KaVo Diagnodent unit and scored using specific criteria. The teeth were exposed using conventional and digital radiography, respectively. The radiographs were assessed for dentin radiolucencies beneath the occlusal surface. RESULTS: Of the 320 teeth used in this study, 302 were scored as sound by visual-tactile examination. Of these, 57 (19%) demonstrated dentin radiolucency on conventional bite-wings, and 245 (81%) were scored as radiographically sound. Thus, the sensitivity and specificity values of the visual-tactile examination compared with conventional radiography were 81% and 44%, respectively. In contrast, Diagnodent produced results of 82% sensitivity and 36% specificity when compared with conventional radiography. When compared to digital radiography, the sensitivity and specificity values of the visual-tactile examination were 90% and 44%, respectively. In contrast, when compared to digital radiography, Diagnodent showed a very low specificity of only 32%, although sensitivity was still high at 91%. Differences in specificity among the techniques were statistically significant (P < .03), whereas differences in sensitivity were not (P > .01). CONCLUSIONS: Although the diagnosis of occult dentinal caries may be further enhanced by the Diagnodent, a combination of visual-tactile examination and either conventional or digital radiography should identify over 80% of lesions.

Effects of oral health education and tooth-brushing on mutans streptococci infection in young children.

PURPOSE: The purpose of this study was to examine the effects of maternal dental health education and tooth-brushing instruction on the levels of mutans streptococci in pre-school children. METHODS: One hundred and seven children (44 boys and 63 girls) with a mean age of 20.5 months, randomly selected from a community child health clinic within a 2-week period, participated in this study. Medical, dental, and dietary information was obtained through a questionnaire. The children's mouths were examined, and plaque samples were obtained by swabbing the teeth and mucosa. A commercial microbiological kit was used to determine the presence of mutans streptococci. The mothers were instructed in tooth-brushing using a soft-scrub method. The children were recalled to the same clinic after a period of 4 weeks to obtain a second evaluation of the mutans streptococci levels. RESULTS: At the first visit, 69 of the 107 children (64%) showed positive infection with mutans streptococci. Ninety (84%) children returned for the recall examination. In the second examination, only 44 (49%) of the 90 children showed positive results for mutans streptococci. The difference in number of children who tested positive is statistically significant (P < .01). At the first visit, children who did not show infection with mutans streptococci were those who reported greater frequency of tooth-brushing (P < .05) and less snacking (P < .05). There were 26 children (29%) who converted from positive to negative results for mutans streptococci infection between the first and second visits (P < .01). This conversion from positive to negative infection was attributed mainly to increased tooth-brushing, as other dental health habits remained the same. CONCLUSIONS: Infection with mutans streptococci in young children is associated with increased snacking frequency and inadequate tooth-brushing. A single dental health education session and tooth-brushing instruction to mothers results in approximately a 25% reduction in mutans streptococci infection in young children from a relatively high socioeconomic status.