Association between fish oil supplements use and serum per- and polyfluoroalkyl substances (PFAS): Results from the National Health and Nutrition Examination Survey.

BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) are widespread pollutants and classified as potentially carcinogenic to humans. Although consumption of fish, seafood, and their byproducts is a known source of dietary PFAS exposure, little is known about the association between use of fish oil supplements and PFAS. Here, we examine associations between fish oil supplement use and serum PFAS concentrations. METHODS: This analysis includes adults, ages 25 years of age and older, surveyed as part of the National Health and Nutrition Examinations Survey (NHANES). Outcomes include five serum PFAS compounds: perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorohexane sulphonic acid (PFHxS) and perfluorodecanoic acid (PFDA). To determine the association between fish oil use and log-transformed PFAS concentrations, survey-weighted linear regression was used to estimate multivariate-adjusted ratios between supplement-users' and non-users' geometric mean serum PFAS concentrations. RESULTS: No association was observed between fish oil use and PFAS. While results did not vary substantially by age, gender, study cycle, there was some indication of a potential inverse association in subgroups of interest. Specifically, an inverse association was observed between fish oil supplement use and PFOS levels in older adults, females, and in early calendar years; an inverse association was also observed between fish oil and PFNA in females and early calendar years. CONCLUSIONS: While fish oil users did not experience increased serum PFAS, there was an unexpected inverse association in some population subgroups. Further research will be needed to better understand whether this pattern reflects true differences, chance, or bias.

Common reasons why acne patients call the office.

BACKGROUND: Communication between physicians and patients is essential to providing proper medical care. At times, patients leave visits with insufficiently addressed questions. These questions prompt patients to call the clinic for additional information, which disrupts the flow of care, delays proper treatment, and reduces patient satisfaction. PURPOSE: We aim to examine acne patients' post-visit questions to develop interventions to improve patient education and reduce call backs. METHODS: A retrospective electronic medical record chart review was performed involving Wake Forest Baptist Health Dermatology clinic visits between October 1, 2012 and October 31, 2012. We identified acne patients using clinic visit notes and recorded their telephone calls to the clinic between October 1, 2012 and March 29, 2013. RESULTS: Of 315 acne patients, 31 (9.8%) called the clinic. Isotretinoin was the subject of 66.7% of the calls, half of which involved questions about potential side effects. Other calls addressed topical medications, acne symptoms, and pharmacy requests. LIMITATIONS: The study involved one center and email and fax correspondence was not captured. CONCLUSIONS: We found gaps in communication sufficient to require patients to call in for support, specifically regarding oral isotretinoin treatment. Interventions to address these questions have the potential to improve quality of care.

Quality of life measures for acne patients.

Acne vulgaris affects most adolescents and two-thirds of adults and is associated with substantial psychosocial burden. Health-related quality of life (HRQOL) for patients with acne is an important factor of patient care, and several dermatologic and acne-specific measures have been created to assist in acne research, management, and care. This review describes several skin disease and acne-specific HRQOL measures and their applications in clinical care or research. The ideal HRQOL measure for the management of patients with acne is a concise questionnaire that places minimal burden on respondents and allows physicians to track improvement in HRQOL with successful treatment.