Psychological parameters of psoriasis.

Psoriasis is a chronic, inflammatory scaling dermatosis. The marked visible appearance of the lesions have a negative impact on body image that leads to decreased self-esteem, hence seriously compromising the patient's quality of life. The clinical picture critically affects the social well-being of the patient since the disease is commonly misunderstood and feared by the social environment as being contagious. The patient feels stigmatized and this further intensifies their lack of self-confidence and self-esteem. Feelings of shame and guilt increase the tendency toward suicidal ideation. The poor quality of life of psoriatic patients has been associated with excessive alcohol consumption, increased smoking and greater use of tranquilizers, sedatives and antidepressants. As far as mental impairment is concerned, a correlation has been found between psychological stress and the clinical severity of symptoms: the more mentally affected the patient, the more severe the dermatologic lesions. Similarly, stressful life events constitute a major risk for the occurrence and recurrence, exacerbating the severity and duration of the symptoms. Depression and anxiety can worsen the disease or cause resistance to treatment or patient's indifference, which in turn can lead to expensive and prolonged treatment. Not least, the disease itself contributes to anxiety, depression and psychological stress, thus creating a "vicious circle" that is difficult to manage. Given that women seem to invest more in their personal appearance than men, it is hardly surprising that female psoriatic patients report higher levels of depression. Similarly, the risk of mental disorders is also higher in younger patients for whom body image plays an equally significant role. The severity of the disease, side effects of therapy and mental disorders are among the causes that have been attributed to sexual dysfunction reported by some psoriatic patients. At the social level, stigma, social rejection, feelings of shame, embarrassment and lack of confidence provoked by the disease often lead to the discontinuation of daily activities and social withdrawal. This review attempts to describe the prevalence of psychological stress and its negative social impact on patients with psoriasis. The recognition and treatment of these psychosocial problems may contribute to improving the quality of life for patients and reduce treatment costs. The collaboration between the psychiatrist and the dermatologist is a fundamental prerequisite toward addressing these issues.

Characteristics that enhance adherence to high-carbohydrate/high-fiber diets by persons with diabetes.

This study sought to characterize 40 clients with diabetes, 19 of whom adhered to a high-carbohydrate/fiber diet and 21 of whom did not, in accordance with the adherence pattern. There would seem to be distinct differences in the characteristics of adherers and non-adherers. Dietary adherence was found to be independent for sex, age, occupation, marital status, ethnicity, and education. However, comparison of the groups' health and dietary perceptions showed that non-adherers, as opposed to adherers, were not concerned about reaching their ideal body weight; needed to be motivated to exercise by family or friends; did not perceive diabetes as a threat to their health; were not satisfied with their knowledge about diabetes; were not content with their nutrient status but believed they were consuming adequate amounts of carbohydrate; and believed that they did not need to change their intake of fruit, vegetables, and bread--liking/disliking of these foods being the most important barrier to dietary change. Such patients, identified in screening for potential dietary non-adherence, may benefit from the use of educational strategies different from those used with patients who are more oriented toward health.

Fractures of the dens and risk of pseudarthrosis.

This study deals with 49 fractures of the dens treated at the Orthopedic Department of Athens University during the past 17 years. These fractures represent 14.2% of all cervical fractures treated during the same period at our department. Forty-one cases have been reviewed and analyzed, the average follow-up time being 10 years (1-16). Pseudarthrosis was found to be present in seven cases (17%), and its relationship to different factors was examined. The type of fracture and particularly the direction of the fracture line were found to be major factors leading to pseudarthrosis. Many other factors, such as displacement, traction, the stability obtained, the presence of associated injuries, and the time elapsed till treatment was started, as well as the age of the patients, seem to play--alone or in combination--important roles in the development of pseudarthrosis. These factors have been classified according to their importance and graded. With a total of 10 points or more a dens fracture is characterized as a fracture "at risk of pseudarthrosis", i.e., a fracture with a higher possibility of developing a pseudarthrosis. This knowledge may contribute to proper and earlier management of such an injury.