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Skin is the largest peripheral endocrine organ and functions as a hormone target and endocrine gland. A cutaneous hypothalamus-pituitary-adrenal (HPA)-like axis enables the skin to respond to stress and regulates its steroidogenic activity. The pilosebaceous unit is a site for production and metabolism of a number of steroid hormones, including stress and sex hormones. This is an overview of the important role that the cutaneous HPA-like-axis plays in the pathogenesis and treatment of inflammatory pilosebaceous disorders, including acne, rosacea, seborrheic dermatitis, and hidradenitis suppurativa.

The following errors were discovered in this article: The third row of Figure 1 was mislabelled; the result for the row for Ali et al., 2013 in Table 1 was mislabelled; in Table 3, the rows for Contreras and Maitra, for Avitabile 2012 and for German et al had errors; two studies were omitted from Figure 3B; the values for % cholera vaccine coverage for Emch et al., 2009 in Supplement 7, Figure 2 were incorrect; and "quality of evidence" values for Ali et al., 2013 and for Cooper and Fitch 1983 were incorrect.

Ultraviolet (UV) radiation is associated with negative health effects, including sun damage and skin cancer. The purpose of this study is to compare the protective effects of the shade provided by a sun umbrella versus that provided by a tree. Sun sensors that register the level and dose of UV radiation were placed in the shade and in direct sunlight. Measurements were recorded every half hour between the hours of 12:30 p.m. and 3:00 p.m. in Sacramento, California. The results suggest that the level of UV radiation in the shade is not zero. The sensors located in tree shade indicated that over 5% of UV radiation was detected in the shade. The sensors located in sun-umbrella shade showed that greater than 17% of UV radiation reached the shade. The sun sensors used in our study collected UV radiation data relevant to UV index; however, they did not differentiate between UVA, UVB, visible, and infrared light. The amount of UV radiation detected in the shade is not zero, thus regular sunscreen use and other sun protective practices should be followed to reduce the risk of sun damage and skin cancer.

The role of exogenous progestin in the development of acne is unclear. Progestins are known for their androgenic potential, but newer generations of progestins have low or anti-androgenic activity. This review will evaluate the association between progestins found in hormonal long-acting reversible contraceptives (intrauterine devices and subdermal implants) and acne, as well as the role of oral contraceptives in acne management. Our review demonstrates that the cause and effect relationship between progestins and acne is difficult to establish and future studies that seek to understand how progestins modulate acne are necessary.

Vasculitis can be a primary disorder or a cutaneous manifestation of a viral infection. The present case describes an atypical localized cutaneous varicella-zoster virus infection inducing a small vessel vasculitis in a patient with multisystem sarcoidosis. Additionally, we discuss the differential diagnoses and treatment options. Varicella-Zoster infection occurs more frequently in immunosuppressed populations and can present with uncharacteristic clinical manifestations complicating the diagnosis as in the present case.

The current study examined the impact of high school counselors' support of Latina/o students' career development outcomes. We used a quantitative, predictive design to explore Latina/o students' vocational self-efficacy and outcome expectations. Perceptions of investment, accessibility, positive regard, appraisal, and expectations from school counselors did not impact Latina/o students' vocational self-efficacy or outcome expectations. In addition to a discussion regarding the importance of these findings, implications for school counselors and researchers are offered.

BackgroundMany interventions delivered to improve health may benefit not only direct recipients but also people in close physical or social proximity. Our objective was to review all published literature about the spillover effects of interventions on health outcomes in low-middle income countries and to identify methods used in estimating these effects.MethodsWe searched 19 electronic databases for articles published before 2014 and hand-searched titles from 2010 to 2013 in five relevant journals. We adapted the Cochrane Collaboration's quality grading tool for spillover estimation and rated the quality of evidence.ResultsA total of 54 studies met inclusion criteria. We found a wide range of terminology used to describe spillovers, a lack of standardization among spillover methods and poor reporting of spillovers in many studies. We identified three primary mechanisms of spillovers: reduced disease transmission, social proximity and substitution of resources within households. We found the strongest evidence for spillovers through reduced disease transmission, particularly vaccines and mass drug administration. In general, the proportion of a population receiving an intervention was associated with improved health. Most studies were of moderate or low quality. We found evidence of publication bias for certain spillover estimates but not for total or direct effects. To facilitate improved reporting and standardization in future studies, we developed a reporting checklist adapted from the CONSORT framework specific to reporting spillover effects.ConclusionsWe found the strongest evidence for spillovers from vaccines and mass drug administration to control infectious disease. There was little high quality evidence of spillovers for other interventions.

Acne vulgaris affects most people at some point in their lives. Due to unclear etiology, likely with multiple factors, targeted and low-risk treatments have yet to be developed. In this review, we explore the multiple causes of acne and how plant-based foods and supplements can control these. The proposed causative factors include insulin resistance, sex hormone imbalances, inflammation and microbial dysbiosis. There is an emerging body of work on the human gut microbiome and how it mediates feedback between the foods we eat and our bodies. The gut microbiome is also an important mediator of inflammation in the gut and systemically. A low-glycemic load diet, one rich in plant fibers and low in processed foods, has been linked to an improvement in acne, possibly through gut changes or attenuation of insulin levels. Though there is much interest in the human microbiome, there is much more unknown, especially along the gut-skin axis. Collectively, the evidence suggests that approaches such as plant-based foods and supplements may be a viable alternative to the current first line standard of care for moderate acne, which typically includes antibiotics. Though patient compliance with major dietary changes is likely much lower than with medications, it is a treatment avenue that warrants further study and development.

We present a rare case of acute febrile neutrophilicdermatosis, also known as Sweet syndrome,associated with recurrence of metastatic cervicalcancer. This report highlights similar reports andserves as an important reminder of the relationshipbetween Sweet syndrome and cervical cancer.Increasing awareness of Sweet syndrome assistsclinicians in recognizing characteristic findings andencourages evaluation of patients for new-onsetor recurrent neoplastic disease. Additionally, wediscuss the typical presentation of the syndrome, theproper workup and treatment, and a common pitfallencountered in the diagnosis of Sweet syndrome.

We present a 17-year-old boy who developed a generalized urticarial eruption, malar rash, fever, and arthralgia within one week of initiating minocycline therapy for acne. His workup showed positive antinuclearand anti-histone antibodies. His symptoms quickly resolved after discontinuing minocycline and starting oral prednisone. We believe the constellation of his symptoms, laboratory findings, and temporalassociation of minocycline initiation was suggestive of minocycline-induced lupus. Unique to this case is that his urticarial presentation was so striking that it could have been initially regarded as drug induced urticaria without considering drug-induced lupus. Since minocycline is so widely prescribed for acne among the dermatology community, we believe that it is important for dermatologists to be aware of this alternative clinical presentation of minocyclineinduced lupus.

Hidradenitis suppurativa is a recurrent inflammatory skin condition characterized by abscesses and boils, predominantly in the groin, armpit, and buttocks areas. HS is not a life-threatening condition, but severely impairs quality of life in those affected. Finding a successful treatment approach for HS has been challenging, in part because of the lack of a gold-standard treatment method, limited research-based information, and the nature of clinical variation in the disease. Treatment commonly consists of antibiotics, anti-inflammatory therapy, hormonal therapy, and more invasive clinical procedures. Treatment is chosen by the degree of severity by which the condition presents and is modified accordingly. This review describes the roles of hormones in the pathogenesis of hidradenitis suppurativa and describes the use of hormonal therapy such as, finasteride, dutasteride, spironolactone, and oral contraceptives. The outcomes of the use of these modalities in various clinical studies are summarized.

The most recent version of the Individuals with Disabilities Education Improvement Act (IDEIA) emphasizes research-based intervention in the school setting. Administrators expect school psychologists to lead initiatives introducing interventions and techniques derived from scientific approaches, such as applied behavior analysis (ABA). However, in the field of school psychology, the use and possible barriers of ABA are largely unknown. The study's purpose was to gather data to evaluate whether self-efficacy and autonomy support mediate the relationship between school psychologists' training and reported use of ABA. Participants included 405 practicing school psychologists who provided information about their training and completed measures of self-efficacy, autonomy support, and reported practice. Structural equation modeling revealed that training predicted reported ABA practice, and these direct relationships were mediated by self-efficacy. Autonomy support was related to both training and reported practice but did not mediate the association between them. Although ABA training for school psychologists is increasing, results provide preliminary support for the mediating relationship between a school psychologists' perception of self-efficacy for ABA and the use of ABA in practice. In addition to traditional training and coursework, findings suggest that practicing school psychologists need opportunities in the field to enhance their self-efficacy related to the practice of ABA.

This article reviews recent research on perception of tangible pictures in sighted and blind people. Haptic picture naming accuracy is dependent upon familiarity and access to semantic memory, just as in visual recognition. Performance is high when haptic picture recognition tasks do not depend upon semantic memory. Viewpoint matters for the ease or difficulty of interpreting haptic pictures of solid objects. Top views were easiest for sighted and blind persons when geometrical solids had constant cross-sections in the vertical axis. The presence or absence of viewpoint effects depends upon the nature of the solids that are represented. Congenitally blind people do not spontaneously produce perspective drawings, but recent data suggests that depictions including linear perspective can be understood after minimal experience. The results suggest that two-dimensional configurations are not necessarily problematic for touch. (Contains 5 figures.)

Introduction:The COVID-19 pandemic has challenged outpatient mental health clinics. This article compares care delivery and patient characteristics before and during the COVID-19 pandemic in outpatient mental health clinics within an academic health system. Methods:A retrospective cohort study was conducted in patients who received outpatient psychiatric services at two clinics (A and B). The investigators compared care delivery with patients with mental health conditions prepandemic (January 1–December 31, 2019) and midpandemic (January 1–December 31, 2020) periods. Care delivery was defined as the number and type of new and return visits (telehealth and face-to-face visits), patients with recorded measurement-based care (MBC) outcomes, and communication capability between patients and providers. Results:During the prepandemic period, 6,984 patients were seen in Clinics A and B, resulting in 57,629 visits. In the midpandemic period, 7,110 patients were served, resulting in 61,766 total visits. Medication management visits increased from 2019 to 2020; number of visits with documented outcome measures increased by 90% in Clinic A and 15% in Clinic B. The number of MyChart messages per patient increased more than twofold during the midpandemic period. The number of new visits with primary diagnosis of anxiety disorders increased in CY2020 and the number of visits with primary diagnosis of major depressive/mood disorders decreased in CY2020. Payor mix did not vary between the two periods although there was variability between payor mix at the two primary clinic locations. Discussion:The study suggests that there was no detrimental impact on access to care between the prepandemic and midpandemic periods within the health system. Mental health visits while pivoting to telehealth increased during the midpandemic period. Transition to telepsychiatry improved the ability to administer and document MBC. [ABSTRACT FROM AUTHOR]