To analyze the relationship between contact dermatitis and delayed wound healing, discuss the diagnosis and treatment of lower leg contact dermatitis, and provide an algorithm for the patient with a ...red leg and delayed wound healing.
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
After participating in this educational activity, the participant will:1. Describe the nature of contact dermatitis.2. Distinguish between allergic and irritant contact dermatitis and the other major differential diagnoses of delayed wound healing in this clinical scenario.3. Outline the steps in the diagnosis of allergic contact dermatitis and irritant contact dermatitis and identify common haptens responsible for allergic contact dermatitis in patients with venous leg ulcers.4. Apply the algorithm for delayed wound healing on a background of lower leg dermatitis.
The literature on climate migration is increasingly concerned with linking the natural-environmental and socio-cultural dimensions of risk response. However, the epistemological disjuncture between ...‘objective’ and subjective accounts of the environment is an impediment. In particular, despite clear evidence of mutual relevance, work on the emotional landscape of climate change has remained separate from more systematic analyses. Aiming to resolve this, this paper uses the case of a Cambodian beggar to show how recent developments across three fields have laid the groundwork for the structural and emotional dimensions of climate change response to be engaged with under a coherent theoretical rubric.
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DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
IMPORTANCE: Alopecia areata (AA) is an autoimmune disease characterized by hair loss that can impose a substantial psychological burden on patients, including major depressive disorder (MDD), yet ...many patients report mental health symptoms prior to the onset of AA. As such, there may be an association between MDD and AA that acts in both directions. OBJECTIVE: To assess the bidirectional association between MDD and AA. DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study included patients 10 to 90 years of age registered with The Health Improvement Network in general practices in the United Kingdom between January 1, 1986, and May 16, 2012. Statistical analysis was conducted from August 17, 2017, to April 23, 2018. To assess the risk of AA, the following 2 cohorts were defined: patients with an incident diagnosis of MDD (exposure) and a reference general population cohort. To assess the risk of MDD, the following 2 cohorts were defined: patients with an incident diagnosis of AA (exposure) and a reference general population cohort. Person-time was partitioned into unexposed and exposed time in the exposure cohorts. MAIN OUTCOMES AND MEASURES: In the analysis of the risk of AA, development of incident AA during follow-up was considered the main outcome measure. In the analysis of the risk of MDD, development of incident MDD during follow-up was considered the primary outcome measure. RESULTS: In the analysis of the risk of AA, 405 339 patients who developed MDD (263 916 women and 141 423 men; median age, 36.7 years interquartile range, 26.6-50.5 years) and 5 738 596 patients who did not develop MDD (2 912 201 women and 2 826 395 men; median age, 35.8 years interquartile range, 25.3-52.6 years) were followed up for 26 years. After adjustment for covariates, MDD was found to increase the risk of subsequently developing AA by 90% (hazard ratio, 1.90; 95% CI, 1.67-2.15; P < .001). Antidepressants demonstrated a protective effect on the risk of AA (hazard ratio, 0.57; 95% CI, 0.53-0.62; P < .001). In the analysis of the risk of MDD, 6861 patients who developed AA (3846 women and 3015 men; median age, 31.5 years interquartile range, 18.2 years) and 6 137 342 patients who did not develop AA (3 172 371 women and 2 964 971 men; median age, 35.9 years interquartile range, 27.0 years) were followed up for 26 years. After adjustment for covariates, AA was found to increase the risk of subsequently developing MDD by 34% (hazard ratio, 1.34; 95% CI, 1.23-1.46; P < .001). CONCLUSIONS AND RELEVANCE: These temporal analyses suggest that, while patients with AA are at risk for subsequently developing MDD, having MDD also appears to be a significant risk factor for development of AA, with antidepressant use confounding this risk.
Vitiligo patients often report their mental health has an effect on their skin. However, it is unknown as to whether a common mental disorder, such as major depressive disorder (MDD), can also ...precipitate the onset of vitiligo.
Evaluate a bidirectional relationship between MDD and vitiligo using The Health Improvement Network database.
Incident MDD and referent cohorts were followed until the development of vitiligo. Also, incident vitiligo and referent cohorts were followed until the development of MDD. Cox proportional hazards models were used, and numerous covariates were adjusted for.
In adjusted models, MDD patients (n = 405,397) were at a 64% increased risk for vitiligo (hazard ratio 1.64, 95% confidence interval CI 1.43-1.87, P < .0001) compared with the referent cohort (n = 5,739,048). This risk was decreased in patients using antidepressants. Compared with the referent cohort (n = 6,137,696), patients with vitiligo (n = 7104) that were <30 years of age at diagnosis had a higher risk of developing MDD than patients ≥30 years of age (hazard ratio 1.31, 95% CI 1.14-1.50, P < .0001 vs 1.22, 95% CI 1.08-1.37, P = .001, respectively).
This study did not evaluate the severity of MDD or vitiligo on outcome development.
These results highlight the burden of depression in patients with vitiligo and support the possible existence of pathophysiological connections between these 2 conditions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The factors that contribute to the development of psoriatic arthritis (PsA) among patients with psoriasis are not well known; however, systemic inflammation is believed to be important. On the basis ...of recent laboratory work demonstrating that major depressive disorder (MDD) is associated with increased systemic inflammation, we hypothesized that patients with psoriasis who develop MDD are at increased risk of subsequently developing PsA. We utilized The Health Improvement Network, a primary care medical records database, to identify 73,447 individuals with psoriasis. Patients were followed up to 25 years until the development of the primary outcome of PsA or the censor date. The exposure of interest was the development of MDD. Cox proportional-hazards models showed that patients with psoriasis who developed MDD were at significantly increased risk of subsequently developing PsA compared with patients who did not develop MDD, even after accounting for numerous covariates (hazard ratio 1.37, 95% confidence interval 1.05–1.80, P = 0.021). This result was maintained through numerous sensitivity analyses. These data support the hypothesis that MDD increases the risk of developing PsA among patients with psoriasis, suggesting a need for heightened prevention and management of MDD in patients with psoriasis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Approaches to communicating climate science beyond academia are necessary for enhancing salience, understanding, and engagement and accelerating action. This Primer discusses the heterogeneous manner ...in which climate change messaging is received by different audiences, how social scientific approaches could help to better tailor climate change messaging to this varied landscape, and how attempts to close this gap must consider the emotional and affective dimensions of climate messaging. We explore how the use of narratives can enhance effective climate science communication and emphasize the importance of evidence-based advocacy in the current era of global challenges, uncertainty, and post-truth.
Approaches to communicating climate science beyond academia are necessary for enhancing salience, understanding, and engagement and accelerating action. This Primer discusses the heterogeneous manner in which climate-change messaging is received by different audiences, how social scientific approaches could help to better tailor climate-change messaging to this varied landscape, and how attempts to close this gap must consider the emotional and affective dimensions of climate messaging. We explore how the use of narratives can enhance effective climate science communication and emphasize the importance of evidence-based advocacy in the current era of global challenges, uncertainty, and post-truth.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
This article contends that many critics of social capital have failed to note a gradual but significant evolution taking place at the fringes of the theory. Influenced by work conducted by both ...critics and proponents, but unburdened by the theoretical flaws associated with "capital" status, various authors working in network theory and related disciplines have begun, independently, to solve the practical problems of the field. Sufficient progressive work now exists to form the basis of a new formulation, with locality, function and socio-physical linkages as its core tenets. Arguing that the future of social capital lies as an "umbrella concept", this paper delineates the theoretical adjustments necessary to construct a practical, interdisciplinary reformulation.
In shaping environmental policy, knowledge is power. Yet the opposite is also true. Control over the absence of knowledge facilitates certain policy outcomes being deflected, obscured, or magnified ...in a way that furthers political, personal, or institutional ends. Applying previous work on ignorance studies and agnotology to the development of Cambodian drought policy, the paper demonstrates how data gaps, restrictions on data sharing, and obstacles to data dissemination serve institutional interests and shape policy development. It proceeds in three parts, each reflecting one aspect of drought sensing in Cambodia and more broadly: hydrological, meteorological, and agricultural. First, how data on the Mekong River is shaped by regional geopolitics. Second, how national rainfall and flood data reflect the political geography of sub-national government administration. Third, how this multi-scalar landscape of political and institutional interests links data generation, data dissemination and adaptation policy, closing certain adaptation pathways, whilst opening others.
•This paper examines data gaps, restrictions on data sharing, and restrictions on data dissemination.•This paper presents an agnotological perspective on the politics of data gaps and environmental policy generation.•It shows that drought policy development in Cambodia is influenced by control over environmental generation and circulation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Intraoral allergic contact dermatitis (ACD) is an uncommonly reported entity. The most commonly implicated allergens are metals that are incorporated into dental appliances. Intraoral ACD to nonmetal ...allergens is even less frequently described. Cinnamic aldehyde is widely used as a flavoring agent in foods and dentifrices. However, intraoral ACD to cinnamon flavoring agents has only been sporadically reported. In these cases, a variety of sources have been implicated, including candy, chewing gum, mouthwash, lip sunscreen, cinnamon toast, volatile oils, and toothpaste. The clinical presentation of intraoral ACD reactions varies greatly, and as a result, clinicians often do not recognize the diagnosis. Furthermore, because patients are typically unable to provide a list of putative allergens, a high degree of clinical suspicion is required to make the correct diagnosis. We describe several patients with intraoral ACD caused by cinnamon and review the literature associated with this condition.
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