Search

Background: Understanding the decision factors that drive harmful alcohol use among young adults is of practical and theoretical importance. We apply fuzzy-trace theory (FTT) to investigate a potential danger that may arise from the arguably correct notion that a single drink carries no meaningful risk. Decisions that are mentally represented as one drink at a time could contribute to excessive drinking., Methods: College students (N = 351) made a series of decisions to take or decline eight hypothetical drinks presented one at a time. Outcome measures included each decision, recent alcohol consumption (weekly drinks, peak blood alcohol content, and binges), and alcohol-related harms (scores on the Brief Young Adult Alcohol Consequences Questionnaire and Alcohol Use Disorders Identification Test). Linear regression models predicted each outcome from sex, perceived risk of a single drink, perceived risk of heavy drinking, perceived consequences of drinking, and general health-related risk sensitivity., Results: Consistent with FTT, decisions to have a first drink and up to four additional drinks in short succession were each associated with lower perceived risk of one drink-a "just-one drink" effect-independent of perceived risks of heavy drinking, perceived consequences of drinking, and general risk sensitivity. Similarly, all measures of recent alcohol consumption and consequent harms were associated with perceived risk of one drink. Participants reporting "zero risk" of a single drink had worse outcomes on all measures than those reporting at least "low risk.", Conclusions: Results are consistent with the theoretically informed premise that consumption decisions are typically made one drink at a time rather than by deciding the total number of drinks to be consumed in a sitting. When decisions about alcohol use proceed one drink at a time, a perception of zero risk in a single drink may contribute to heavy drinking., (© 2024 Research Society on Alcohol.)

Background: Receiving specialty substance treatment or general mental health treatment during remission from substance use disorders (SUD) may reduce odds of SUD recurrence, but little is known about prevalence of treatment or perceptions of treatment need among remitted people in the United States., Sample: Participants in the National Survey on Drug Use and Health, years 2018-2020, were considered remitted if they ever had an SUD (i.e., self-reported history of "problems with alcohol or drugs", or lifetime history of treatment for SUD) but did not meet DSM-IV criteria for substance abuse or dependence during the prior year (n = 9,295)., Analyses: Annual prevalence was estimated for any SUD treatment (e.g., mutual-help groups), any mental health (MH) treatment (e.g., private therapy), self-reported perceived need for SUD treatment, and self-reported unmet need for MH treatment. Generalized linear models examined effects of socio-demographics, mental illness, past-year substance use, and self-identified recovery status on outcomes., Findings: MH treatment was more common than SUD treatment (27.2% [25.6%, 28.8%] v. 7.8% [7.0%, 8.6%], respectively). Unmet need for mental health treatment was reported by 9.8% [8.8%, 10.9%], but only 0.9% [0.6%, 1.2%] perceived need for substance treatment. Age, sex, marital status, education, health insurance, mental illness, and prior year alcohol use were among the factors associated with variation in outcomes., Conclusion: Most people who maintained clinical remission from substance use disorders in the U.S. during the prior year did so without treatment. Remitted people report substantial unmet need for mental health treatment, but not specialized substance use treatment., Competing Interests: Declaration of Competing Interest No conflict declared., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Cutaneous metastases from internal malignancies in women overwhelmingly emanate from the breast and typically exhibit features of an adenocarcinoma, although other histopathologic patterns may also be seen. Neuroendocrine breast carcinoma represents an uncommon variant of mammary carcinoma with fewer than 40 cases of the small cell subcategory reported. As with other small cell carcinomas, they may exhibit Merkel cell-like features and appropriate diagnosis of these tumor deposits often turns on clinical history and an appropriate immunohistochemical profile. Herein, we report the first known patient with cutaneous metastases from a small cell neuroendocrine breast carcinoma., (Copyright © 2012 John Wiley & Sons A/S.)

Brown recluse spider bites (BRSB) cause a myriad of reactions ranging from local necrosis to potentially lethal systemic involvement. Envenomation may induce a generalized exanthem known clinically but not described histologically. We report a 49-year-old female who developed a generalized exanthem 24 hours after BRSB. The histopathology demonstrated a necrotizing vasculitis similar to that seen at an envenomation site but without epidermal necrosis. Loxoscelism should be considered in patients residing in endemic areas who present with a vasculitic exanthem.

Objective: To determine physician preparation for performing the skin cancer examination (SCE)., Design: We evaluated medical students' observation, training, and practice of the SCE; hours spent in a dermatology clinic; and self-reported skill level for the SCE by a self-administered survey., Participants: Graduating students at 7 US medical schools during the 2002-2003 academic year., Main Outcome Measures: Percentages of students reporting SCE skill observation, training, and practice., Results: Of 934 students, 659 (70.6%) completed surveys. Twenty-three percent of students had never observed an SCE, 26.7% had never been trained to perform an SCE, and 43.4% had never examined a patient for skin cancer. Only 28.2% rated themselves as somewhat or very skilled in the SCE. This rate dropped to 19.7% among 553 students who had not completed a dermatology elective. Compared with students without training, students who had been trained at least once in the SCE were 7 times more likely to rate themselves as being somewhat or very skilled in the SCE. Sixty-nine percent of students agreed that insufficient emphasis in their medical training was placed on learning about the SCE., Conclusions: This survey documents the need for more consistent training of medical students in SCE. Even brief curricular additions would augment students' perceived skill levels and improve practice patterns and competencies of future physicians. More frequent and improved SCEs might result in earlier detection of melanoma and nonmelanoma skin cancers by nondermatologists, with significant public health benefits.

In the last several years, amantadine has been increasingly prescribed for akinesia in Parkinson's disease and to combat fatigue associated with multiple sclerosis. Amantadine is a well-known medication involved in drug-induced livedo reticularis (LR), yet remains under-reported in the English literature. We describe 2 patients with amantadine livedo reticularis: one patient with multiple sclerosis had, previous to this eruption, tolerated 4 years of amantadine therapy without adverse reactions and another patient with Parkinson's disease who developed LR 1 month after starting amantadine.

Background: Human immunodeficiency virus-associated eosinophilic folliculitis (HIV-EF) among homosexual men is a commonly reported dermatologic finding, while only 4 cases in HIV-positive women have been documented in the literature to date. This article describes 2 additional cases of HIV-EF in immunocompromised women and reviews the data on this condition., Observations: The diagnoses were made on the basis of clinical appearance and microscopic analysis of skin biopsies. The women were not receiving highly active antiretroviral therapy (HAART) and their CD4 cell counts were below 100/ micro L., Conclusions: As HIV prevalence continues to increase in the female population, more cases of HIV-EF will be seen among women. Because the etiology of HIV-EF remains elusive, no single treatment stands above the rest although several successful therapies have been demonstrated. However, HAART restores the proper T-cell milieu, which seems to improve the course of this disease.

Latex allergy is recognized worldwide as a serious health risk. To date, exposure assessment and intervention strategies have focused primarily on respiratory protection; this work evaluates the potential role of dermal protein penetration in the development of latex allergy. In vitro penetration models using flow-through diffusion cells and both human surgical specimens and hairless guinea pig skin (CrL: IAF/HA) demonstrated iodinated latex proteins (ammoniated and non-ammoniated) penetrating into and through both intact and abraded skin. Although less than 1% penetration was observed with intact skin, up to 23% of latex proteins applied to abraded skin were recovered from receptor fluid within 24 h of exposure. Phosphoimaging of the concentrated effluent revealed proteins ranging in size from 3 to 26 kDa. Using a (3)H(2)O penetration assay to evaluate barrier integrity, the amount of latex protein penetration was found to positively correlate with the degree of dermabrasion. Immunohistochemistry of the skin localized latex proteins in the Langerhans cell-rich epidermis and in the dermis. Both in vitro penetration studies and immunohistochemistry supported the use of hairless guinea pig skin as a surrogate for human skin in evaluating latex protein penetration. In studies performed in vivo, 35% of hairless guinea pigs topically exposed to latex proteins (100 microg) 5 days per week for 3 months demonstrated elevations in latex-specific IgG1. The implication for these data is that the skin is not only a plausible route for latex sensitization but can be a major exposure route when the integument has been compromised.

Given the increasing prevalence of occupational sensitization to acrylate compounds, n-butyl acrylate (BAC), ethyl acrylate (EAC), and trimethylol propane triacrylate (TMT) were recommended by the National Toxicology Program for hypersensitivity testing in female B6C3F1 mice. The objectives of these studies were to determine the irritating and sensitizing potential of these three compounds using an irritation assay, the murine Local Lymph Node Assay (LLNA), and the Mouse Ear Swelling Test (MEST). The minimal irritating concentration for TMT was determined to be 1.0%, whereas BAC and EAC demonstrated no irritation up to 30%, the highest concentration tested. TMT tested positive in the LLNA at concentrations as low as 0.1% whereas an induction concentration of 0.3% was required to elicit a positive response in the MEST. Furthermore, BAC tested negative in the MEST at induction concentrations as high as 30%, but yielded positive results in the LLNA at concentrations as low as 20%. EAC, at all concentrations tested, was negative in both the MEST and the LLNA. Cross reactivity was only seen when mice were sensitized with TMT and challenged with BAC. In these studies, the LLNA was a more sensitive indicator of the allergic potential of these three acrylates when compared to the MEST.

Dicyclohexylcarbodiimide (DCC) and diisopropylcarbodiimide (DIC) are two commonly used coupling reagents in protein synthesis resulting in exposure of individuals in chemical and pharmaceutical industries as well as research laboratories involved in protein synthesis and recombinant DNA techniques. The objectives of these studies were to determine the irritation and sensitizing potential of these two compounds when applied topically to B6C3F1 mice. Sensitization potential was assessed by the Mouse Ear Swelling Test (MEST) and the murine Local Lymph Node Assay (LLNA). Concentrations used in the contact hypersensitivity assays were determined by primary irritancy studies. DCC and DIC were identified as both irritants and contact sensitizers with the MEST being a more sensitive indicator of sensitization potential. The MEST identified DCC as a sensitizer at concentrations as low as 0.006% (w/v) 24 hr and 48 hr post challenge and DIC at 0.3% (w/v) and 1.5% (w/v) 24 and 48 hr post challenge, respectively. In the LLNA, the lowest concentrations yielding a significant response were 0.06% (w/v) for DCC and 10% (w/v) for DIC.