Utility of high-resolution ultrasound in measuring subcutaneous fat thickness.

OBJECTIVE: Previous studies conclude that high-resolution ultrasound (HRUS) enables noninvasive and accurate measurements of subcutaneous fat thickness. The primary objective of this cross-sectional study was to better characterize subcutaneous fat thickness measurements in a diverse patient population using HRUS. Secondarily, we sought to correlate these measurements with patients' body image. METHODS: A cross-sectional study to measure subcutaneous fat measurements at seven distinct anatomic sites, including upper and lower extremities, submental, and torso regions, in 40 men and women of different ages and races using HRUS. Independent t-tests and analysis of variance were performed to analyze findings. RESULTS: In our patient population, on average, women had thicker subcutaneous fat than men at all anatomic sites. Asian patients had significantly reduced fat thickness at peripheral anatomic sites, such as arms when compared to patients who identified as Black and Other (p = 0.05 and p = 0.008, respectively). Lastly, women reported decreased total body satisfaction at all anatomic sites when compared to men. CONCLUSION: The information obtained and methods developed in this study may be utilized clinically during patient selection for fat reduction procedures, including for estimating the degree of likely benefit; for managing pathologies involving subcutaneous fat thickness alteration; and to monitor the progression of lipodystrophy secondary to disease or drugs.

Rates of Vascular Occlusion Associated With Using Needles vs Cannulas for Filler Injection.

Importance: Soft-tissue augmentation with skin fillers can be delivered with needles or microcannulas, but unwanted vascular occlusions are possible. Objective: To determine whether filler-associated vascular occlusion events of the face occur more often with injections performed with needles than with microcannulas. Design, Setting, and Participants: This retrospective cohort study included a random sample of board-certified dermatologists deemed eligible based on membership in relevant professional societies and attendance at relevant national professional meetings. Participants completed detailed forms in which they could enter deidentified data and volume statistics pertaining to patients undergoing filler procedures in their practices. Data were collected from August 2018 to August 2019. Exposures: Injectable fillers approved by the US Food and Drug Administration delivered via needles or microcannulas. Main Outcomes and Measures: The primary outcome measure was intravascular occlusion. Occlusion events were graded by severity (no sequelae, scar, and ocular injury or blindness). Results: A total of 370 dermatologists (mean [SD] years in practice, 22.3 [11.1] years) participated and reported 1.7 million syringes injected. The risk of occlusion with any particular filler type using needle or cannula never exceeded 1 per 5000 syringes injected. Overall, 1 occlusion per 6410 per 1-mL syringe injections was observed with needles and 1 per 40 882 with cannulas (P < .001). Of the 370 participants, 106 (28.6%) reported at least 1 occlusion. Multivariate analysis found that injections with cannula had 77.1% lower odds of occlusion compared with needle injections. Participants injecting fillers for more than 5 years had 70.7% lower odds of occlusion than those who were less experienced. For each additional injection per week, the odds of occlusion decreased by 1%, and 85% of occlusions had no long-term sequelae. Nasolabial folds and lips were most likely to be occluded, with mean severity level of occlusions highest at the glabella. Conclusions and Relevance: In this cohort study, filler injections with either needles or cannulas were associated with a very low risk of intravascular occlusion events. Moreover, the vast majority of such events were minor and resolved without scar or other injury. Injections with microcannulas were less often associated with occlusion events than injections with needles. Occlusion risk per syringe appeared decreased after the first few years of clinical practice and was also lower among those who more frequently inject fillers. Whether a needle or cannula is most appropriate for injection may depend on patient factors, anatomic site, and the type of defect being treated.

The Self-Stigma of Suicide Attempt Survivors.

Although suicide attempt survivors report feelings of shame and stigmatization, no published scale measures self-stigma experienced by attempt survivors. This article describes the creation and validation the Self-Stigma of Suicide Attempt Scale (SSSAS). In this study, the SSSAS was validated in an online sample (n = 292) of suicide attempt survivors. Results supported the progressive model of self-stigma, wherein a substantial proportion of suicide attempt survivors were aware of stigma, but fewer applied that stigma to themselves or felt harmed by it. Reliabilities of SSSAS subscales were high. Harm subscale scores were correlated with depression, self-esteem, recovery, empowerment, and stigma stress in the expected directions. Future research can seek to further validate the scale and explore relationship between self-stigma and other constructs.

Benefits and risks of suicide disclosure.

RATIONALE: Individuals who attempt suicide are often subject to stigma and may feel ashamed to talk openly about their experiences with suicide. However, failure to disclose could interfere with care-seeking, increase distress, and limit social support. While research on other concealable stigmatized conditions (e.g. mental illness and HIV) has identified the complexities of disclosure decisions, little is known about disclosure for suicide attempt survivors. OBJECTIVE: Given the lack of research in this area, this study aimed to explore suicide attempt survivor perspectives on risks and benefits of suicide disclosure. METHODS: Academic researchers partnered with a community-based participatory research team to develop and conduct the research. The team conducted group and individual interviews with U.S. suicide attempt survivors (n = 40), using thematic analysis to code responses into themes for benefits (n = 12) and risks/barriers (n = 10) of disclosing. RESULTS: Participants collectively identified how disclosure could benefit them (n = 9) through enhanced social support, strengthening of personal relationships, access to treatment, and opportunities for self-reflection. Participants described how disclosure could benefit others (n = 3) by reducing stigma, allowing attempt survivors to help peers who are currently struggling with suicidal ideation, and by providing psychoeducation on suicidality. Participants also described ways that disclosure could put them at risk (n = 8), in terms of stigma, unsupportive reactions, unwanted treatment, or loss of privacy. Participants were concerned that disclosure could put confidants at risk (n = 2) of being overburdened or triggered. CONCLUSION: While the study methodology did not allow for an exploration of which benefits or risks may be most salient for suicide attempt survivors, this study lays groundwork for future research on disclosure of suicidal thoughts and behaviors. Furthermore, these results can be used by service providers to support suicide attempt survivors in strategic disclosure decisions that maximize benefits and reduce risks.