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Sebum production is thought to play a major role in acne vulgaris in adolescents. Psychological stress may exacerbate acne; however, it is not known whether the perceived association between stress and acne exacerbation is due to increased sebum production. The aims of this study were to determine: (i) if psychological stress in adolescents is associated with increased sebum production; and (ii) if stress is associated with increased acne severity independent of, or in conjunction with, increased sebum production. Ninety-four secondary school students in Singapore (mean age 14.9 years) were enrolled in this prospective cohort study. During a high stress condition (prior to mid-year examinations) and a low stress condition (during the summer holidays), the following were evaluated: (i) self-reported stress level using the Perceived Stress Scale; (ii) sebum level at baseline and at 1 h; and (iii) acne severity. The prevalence of self-reported acne in this study population was high (95% in males and 92% in females). Most subjects had mild to moderate acne. Sebum measurements did not differ significantly between the high stress and low stress conditions. For the study population as a whole, we observed a statistically significant positive correlation (r=0.23,p=0.029) between stress levels and severity of acne papulopustulosa. In adolescents, psychological stress does not appear to affect the quantity of sebum production. The study suggests a significant association between stress and severity of acne papulopustulosa, especially in males. Increased acne severity associated with stress may result from factors other than sebum quantity. [ABSTRACT FROM AUTHOR]

Over the past several decades, emphasis on patient-centered care, the dramatic growth of refractive surgery in the United States, and increasing competition in the eye care marketplace have made patient expectations increasingly important in the field of ophthalmology. Patient-centered care recognizes the obligation to understand and meet patient''s expectations. Despite increasing patient expectations for refractive surgery and eye care in general, however, there has been limited research on patient expectations within the field of ophthalmology. The vast majority of existing research on patients'' expectations has focused on expectations of primary care physicians. Because ophthalmologists are involved in both surgical and medical care, it is important to expand the consideration of patient expectations beyond the traditional primary care setting. Using elements of the taxonomy developed by Kravitz (Kravitz RL: Patients'' expectations for medical care: an expanded formulation based on review of the literature. Med Care Res Rev 53:3–27, 1996), this article reviews the existing literature on patient expectations and draws attention to the limited research in specialty and surgical fields. This article has the following objectives: 1) provide a context for understanding what patient expectations are, 2) review the different ways that patient expectations are measured, 3) illustrate the content of patient expectations from empirical research, 4) outline potential determinants of patient expectations, and 5) discuss the role of patient expectations in ophthalmology. [Copyright &y& Elsevier]

Shiitake mushroom-induced toxicoderma, or shiitake dermatitis, is a widely recognized phenomenon in Japan, China, and Korea but only recently has been reported outside of Asia. Affected individuals develop a characteristic pattern of whiplike, linear, erythematous wheals within 1 to 2 days after consumption of raw or cooked shiitake mushrooms. Lentinan, a polysaccharide component of shiitake mushrooms with antitumor properties, is thought to instigate a toxic reaction, resulting in the appearance of a rash. Shiitake dermatitis is self-limited and typically resolves within days to weeks of its appearance.

Patient satisfaction has become a significant component of health care outcomes and an increasingly important component of quality assessment. Selecting the appropriate methods to measure patient satisfaction is a critical challenge for health care managers, yet, there is limited knowledge of the methods used to develop patient satisfaction instruments. In this brief report, we provide insights into the development of a patient satisfaction instrument for outpatient care at the Duke Private Diagnostic Clinic (PDC). We surveyed the 12 medical directors and asked them to rate 15 concept areas for inclusion in an outpatient satisfaction survey. We then constructed a patient satisfaction survey by drawing selected subscales from the publicly available PSQ-18 (Patient Satisfaction Questionnaire) and CAHPS (Consumer Assessment of Health Plans) surveys to address the seven highest rated concept areas: 1) general/overall satisfaction; 2) courteousness of office staff; 3) courteousness of physicians; 4) doctor/patient communication; 5) professionalism; 6) ease and time to get appointment; and 7) technical quality of care.