The effect of smoking and age on the response to first-line therapy of hidradenitis suppurativa: An institutional retrospective cohort study.

BACKGROUND: Treatment for hidradenitis suppurativa is often empiric and inadequate, and determining which patients will respond is difficult. OBJECTIVE: We sought to determine which patient factors are associated with a positive response to first-line medical therapy. METHODS: A single-center retrospective cohort study of all patients with hidradenitis suppurativa seen between January 1, 1992, and October 1, 2014, was conducted. Response to first-line medical therapy (oral/topical antibiotics, intralesional corticosteroids, and topical washes) was examined at follow-up within 6 months of initiating therapy. A multivariate binary logistic regression model was built examining response to treatment and the interplay of patient factors and treatment initiated. RESULTS: In all, 198 patients were included in the final model. Nonsmokers (odds ratio 2.634, 95% confidence interval 1.301-5.332, P = .007) and older individuals (odds ratio 1.046 for each additional year, 95% confidence interval 1.020-1.072, P < .001) were more likely to have improvement at follow-up. In addition, current smokers differed significantly from nonsmokers in several regards. LIMITATIONS: The retrospective nature of this study is a limitation, as is relying on classification of disease severity from physical examination findings in some patients. CONCLUSIONS: The results of this study suggest that clinicians may be able to more accurately predict which patients with hidradenitis suppurativa will respond to first-line medical therapy, and which patients may require therapy escalation.

Hiding the word: examining the relationship between a new measure of religiosity and sexual behavior.

The relationship between religiosity and sexual behavior has been previously investigated, but researchers have not examined the relationship between the intellectual dimension of religiosity and sexual behavior. In this study, we developed an intellectual measure of religiosity, Hiding the Word (HTW), and examined whether it accounted for variation in the sexual behavior of college students, beyond that for which age and a generic measure of religiosity could account. Results showed, after accounting for age and generic religiosity, HTW made a significant contribution to distinguishing between students who had, and those who had not, engaged in various sexual behaviors. For females, this was the case in three of the five behaviors examined (all except receiving oral sex and participating in unprotected penile-vaginal intercourse at most recent sexual encounter), and for males, two of the four behaviors (sexual intercourse and anal intercourse). HTW was less of a factor in accounting for variation in the frequency of participation. For males, HTW was significant for the frequency of participation in penile-vaginal intercourse, receiving oral sex, and the number of sexual partners in the last month. For females, HTW was significant only for the number of sexual partners in the last month. Thus, religiosity, and specifically HTW, seems to play more of a role in determining whether or not a person has participated in behavior, rather than in the frequency of participation.

Vulvovaginal Involvement in Pediatric Stevens-Johnson Syndrome: A Case Series.

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening spectra of mucocutaneous delayed hypersensitivity reactions. Prodromal viral-like symptoms are followed by a characteristic diffuse rash caused by keratinocyte apoptosis and epidermal detachment. CASES: Three adolescents were admitted with SJS/TEN and vulvovaginal involvement following initiation of lamictal, bactrim, and phenobarbital. The patients received intravenous immunoglobulin and intravenous steroids. One patient received etanercept. Topical emollients and strict perineal hygiene were initiated. No permanent sequelae were noted following vaginoscopy. SUMMARY AND CONCLUSIONS: Vulvovaginal involvement in SJS/TEN can occur and may result in permanent architectural changes. Basic management includes withdrawal of causative medication, intravenous steroids, intravenous immunoglobulin (IVIG), and supportive care. Early initiation of perineal hygiene, vaginal barrier creams, and menstrual suppression should be employed. Vaginoscopy may be used to document full recovery.

Epicutaneous Staphylococcus aureus induces IL-36 to enhance IgE production and ensuing allergic disease.

IgE induced by type 2 immune responses in atopic dermatitis is implicated in the progression of atopic dermatitis to other allergic diseases, including food allergies, allergic rhinitis, and asthma. However, the keratinocyte-derived signals that promote IgE and ensuing allergic diseases remain unclear. Herein, in a mouse model of atopic dermatitis-like skin inflammation induced by epicutaneous Staphylococcus aureus exposure, keratinocyte release of IL­36α along with IL-4 triggered B cell IgE class-switching, plasma cell differentiation, and increased serum IgE levels-all of which were abrogated in IL-36R-deficient mice or anti-IL­36R-blocking antibody-treated mice. Moreover, skin allergen sensitization during S. aureus epicutaneous exposure-induced IL-36 responses was required for the development of allergen-specific lung inflammation. In translating these findings, elevated IL­36 cytokines in human atopic dermatitis skin and in IL­36 receptor antagonist-deficiency patients coincided with increased serum IgE levels. Collectively, keratinocyte-initiated IL­36 responses represent a key mechanism and potential therapeutic target against allergic diseases.

An evaluation of an abstinence-only sex education curriculum: an 18-month follow-up.

The article examines the results from an 18-month follow-up evaluation of an abstinence education curriculum series. Participants were students from 15 school districts recruited to participate in the project. The intervention was the Sex Can Wait curriculum series, consisting of upper elementary, middle school, and high school components. The 5-week curriculum was implemented by teachers who had participated in a special teacher training workshop. Both intervention and comparison students were surveyed before and after the curriculum intervention and at 18-month follow-up. Results indicated short-term effects as follows. Upper elementary intervention students indicated higher level of knowledge, more hopefulness for the future, and greater self-efficacy than did the comparison group. Middle school intervention students did not differ from comparison students. High school intervention students reported lower participation rates than the comparison group students in sexual intercourse (ever and last month), a more positive attitude toward abstinence and a greater intent to remain abstinent. Long-term (18 month) benefits were noted as follows: upper elementary intervention students had greater knowledge and were less likely than comparison students to report participation in sexual intercourse in the last month. Middle school intervention students were less likely than comparison students to report participation in sexual intercourse ever and sexual intercourse in the last month. High school intervention students evidenced greater knowledge and greater intent to remain abstinent than did comparison students. Results indicate that the program did have some positive benefits that should be considered by those interested in abstinence education programming.

Blockade of ENaCs by amiloride induces c-Fos activation of the area postrema.

Epithelial sodium channels (ENaCs) are strongly expressed in the circumventricular organs (CVOs), and these structures may play an important role in sensing plasma sodium levels. Here, the potent ENaC blocker amiloride was injected intraperitoneally in rats and 2h later, the c-Fos activation pattern in the CVOs was studied. Amiloride elicited dose-related activation in the area postrema (AP) but only ~10% of the rats showed c-Fos activity in the organum vasculosum of the lamina terminalis (OVLT) and subfornical organ (SFO). Tyrosine hydroxylase-immunoreactive (catecholamine) AP neurons were activated, but tryptophan hydroxylase-immunoreactive (serotonin) neurons were unaffected. The AP projects to FoxP2-expressing neurons in the dorsolateral pons which include the pre-locus coeruleus nucleus and external lateral part of the parabrachial nucleus; both cell groups were c-Fos activated following systemic injections of amiloride. In contrast, another AP projection target--the aldosterone-sensitive neurons of the nucleus tractus solitarius which express the enzyme 11-ß-hydroxysteriod dehydrogenase type 2 (HSD2) were not activated. As shown here, plasma concentrations of amiloride used in these experiments were near or below the IC50 level for ENaCs. Amiloride did not induce changes in blood pressure, heart rate, or regional vascular resistance, so sensory feedback from the cardiovascular system was probably not a causal factor for the c-Fos activity seen in the CVOs. In summary, amiloride may have a dual effect on sodium homeostasis causing a loss of sodium via the kidney and inhibiting sodium appetite by activating the central satiety pathway arising from the AP.

Participant satisfaction in an adult telehealth education program using interactive compressed video delivery methods in rural Arkansas.

CONTEXT: Rural Americans have less access than their urban counterparts to health promotion information. PURPOSE: To assess differences in program satisfaction associated with age, gender, ethnicity, community size, and education among participants in an Arkansas adult telehealth education program that utilized interactive video technology. METHODS: A program evaluation instrument was administered to a convenience sample of 2567 people who participated in the program from 1996 through 1999. FINDINGS: The evaluation instrument demonstrated adequate internal consistency reliability (Cronbach's alpha = 0.85) and construct validity. Older adults, blacks, American Indians, and participants from smaller rural communities and with a high school degree or less had significantly greater satisfaction (P < .001 to P = .03). CONCLUSIONS: The findings suggest that socioeconomic and demographic factors can affect satisfaction with telehealth education programs.

Examining external and internal poverty as antecedents of teen pregnancy.

OBJECTIVES: To identify antecedents of teen pregnancy. METHODS: Data from the National Education Longitudinal Study were analyzed. This data set allowed us to identify eighth-grade antecedents of teen pregnancy/childbearing. RESULTS: The variables that were found to be most predictive of later pregnancy were reflective of internal poverty (locus of control, subject's educational expectations, and confidence in graduating from high school) and external poverty (parents' highest education). CONCLUSIONS: Prevention programs must begin before the eighth grade, instill an internal locus of control, promote academic achievement by enriching children's perception of personal life options for which an education is needed, empower children and their familial models, and prevent internal poverty.

An evaluation of an abstinence education curriculum series: sex can wait.

OBJECTIVE: To examine the effects of an abstinence education curriculum series on student outcomes. METHODS: The series was taught at upper elementary, junior high, and high school levels. A questionnaire was administered to all intervention and comparison students before and after implementation of the curriculum. RESULTS: At the upper elementary level, the curriculum group had better outcomes on knowledge, self-efficacy, and a more hopeful outlook; at the middle school level no differences; at the high school level, findings favored the curriculum group on attitude, behavioral intent, and sexual behavior variables. CONCLUSION: Results are encouraging and should be considered by those interested in helping young people postpone sexual involvement.

Participant satisfaction with a school telehealth education program using interactive compressed video delivery methods in rural Arkansas.

Socioeconomic and demographic factors can affect the impact of telehealth education programs that use interactive compressed video technology. This study assessed program satisfaction among participants in the University of Arkansas for Medical Sciences' School Telehealth Education Program delivered by interactive compressed video. Variables in the one-group posttest study were age, gender, ethnicity, education, community size, and program topics for years 1997-1999. The convenience sample included 3,319 participants in junior high and high schools. The School Telehealth Education Program provided information about health risks, disease prevention, health promotion, personal growth, and health sciences. Adolescents reported medium to high levels of satisfaction regarding program interest and quality. Significantly higher satisfaction was expressed for programs on muscular dystrophy, anatomy of the heart, and tobacco addiction (p < 0.001 to p = 0.003). Females, African Americans, and junior high school students reported significantly greater satisfaction (p < 0.001 to p = 0.005). High school students reported significantly greater satisfaction than junior high school students regarding the interactive video equipment (p = 0.011). White females (p = 0.025) and African American males (p = 0.004) in smaller, rural communities reported higher satisfaction than White males. The School Telehealth Education Program, delivered by interactive compressed video, promoted program satisfaction among rural and minority populations and among junior high and high school students. Effective program methods included an emphasis on participants' learning needs, increasing access in rural areas among ethnic groups, speaker communication, and clarity of the program presentation.

Bone mineral density levels of college-aged women in northwest Arkansas.

Osteoporosis has affected more than 20 million American, women, completely altering their way of life. Osteoporosis is highly preventable if steps are taken to build healthy bone; however, many college students do not have lifestyle habits that have a positive effect on their bones. For this study, a questionnaire was used to investigate childhood dairy consumption, high school sport participation, dieting behaviors, eating behaviors and bone mineral density levels of college women at the University of Arkansas in Fayetteville. Eighty percent of the participants were Caucasian or of Asian descent, while 20% were of other races; 34% of the participants consumed three or more servings of milk a day as children, while current calcium consumption was at an average of 16 servings a week. Many of the participants were active in high school, as 67% participated in high school sports. Fifty-two percent of the college women in the sample had dieted in the past year, and 44% perceived they were not at a desirable weight. Forty-five percent skip more than three meals a week. Of the participants, two had osteoporosis and 23 had osteopenia. Clearly, development of osteoporosis is not limited to older adults, and college women are in need of education related to bone health.

Lessons from the trenches: meeting evaluation challenges in school health education.

BACKGROUND: Those involved in school health education programs generally believe that health-education programs can play an important role in helping young people make positive health decisions. Thus, it is to document the effects of such programs through rigorous evaluations published in peer-reviewed journals. METHODS: This paper helps the reader understand the context of school health program evaluation, examines several problems and challenges, shows how problems can often be fixed, or prevented, and demonstrates ways in which challenges can be met. A number of topics are addressed, including distinguishing between curricula evaluation and evaluation of outcomes, types of evaluation, identifying stakeholders in school health evaluation, selection of a program evaluator, recruiting participants, design issues, staff training, parental consent, instrumentation, program implementation and treatment fidelity, participant retention, data collection, data analysis and interpretation, presentation of results, and manuscript preparation and submission. RESULTS: Although there is a lack of health-education program evaluation, rigorous evaluations that have been conducted have, at least in some cases, led to wider dissemination of effective programs. CONCLUSIONS: These suggestions will help those interested in school health education understand the importance of evaluation and will provide important guidelines for those conducting evaluations of school health-education programs.

A survey of patients with inflatable penile prostheses for satisfaction.

PURPOSE: We assessed patient satisfaction with 3 types of penile prostheses, namely the AMS 700 Series(R), Mentor Alpha 1(R) and Mentor Alpha NB(R). MATERIALS AND METHODS: The subjects consisted of 330 patients selected by stratified, systematic random sampling from among 1,298 subjects undergoing virgin 3-piece inflatable penile implant surgeries performed by the same surgical team at 1 hospital between January 1992 and December 1998. Data were collected by computer assisted telephone interviewing with a survey developed by the authors. The survey consisted of 37 questions in 7 sections, including 1 demographic section and 6 patient satisfaction sections. RESULTS: Of the 330 patients selected 248 (75%) could be contacted. Of these, 199 (80%) responded to the full survey and the remaining 49 (20%) agreed to respond only to the question, "How satisfied are you with the prosthesis?" Of the 199 full responders 12 (6%) had AMS implants and 187 (94%) had Mentor implants. Of the 49 single question responders 5 (10%) had AMS implants and 44 (90%) had Mentor implants. Of the 248 patients the overall satisfaction rate was 69%. Although there was no significant difference at the 5% level in patient satisfaction by implant type, responses tended to favor the Alpha IPPs in terms of overall sexual satisfaction (p =0.058), natural feeling of the prosthesis (p =0.061), flaccid appearance of the penis when deflated (p =0.054), and education with demonstration of inflation and deflation (p =0.075). CONCLUSIONS: There was a high degree of overall patient satisfaction across implant types.

The impact of telemedicine on patients' cost savings: some preliminary findings.

This study evaluated patients' cost savings in a telehealth project at the University of Arkansas for Medical Sciences' (UAMS) during 1998-2002. Differences in patients' cost savings from telemedicine were assessed by gender, age, ethnicity, education, occupation, annual household income, health insurance status, and household and community size. Variables examined for patients' cost savings included travel distance for medical care, missed days at work, and family expenses. The study population consisted of self-selected telemedicine patients in rural Arkansas (N = 410 consults). Results suggest that without telemedicine, 94% of patients would travel greater than 70 miles for medical care; 84% would miss one day of work; and 74% would spend $75-$150 for additional family expenses. With telemedicine, 92% of patients saved $32 in fuel costs; 84% saved $100 in wages; and 74% saved $75-$150 in family expenses. Patients living alone (p < 0.001) and in smaller rural communities (p = 0.002) were significantly more likely to miss one day of work without telemedicine than patients with larger households and those residing in larger rural communities. Females (p = 0.040) and patients with a annual household income over $25,000 (p = 0.005) were significantly more likely to have family expenses over $150 without telemedicine than males and patients with a household income of $25,000 or less.