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Conclusion The non-toxicity and non-immunogenicity of PEG guarantee the lack of allergic and immunological reactions. The PEG-crosslinking technology guarantees a high duration time of the implanted hydrogel because of more resistant physiological degradation. This article is protected by copyright. All rights reserved.Purpose We evaluated whether the rate of incident chronic opioid use is higher in obese patients with rheumatoid arthritis (RA). Methods Participants with RA in Forward were asked about use of weak and strong opioid medications on semi-annual surveys. Incident chronic opioid use was defined as new reported use extending over two contiguous surveys (~7 to 12 months). Cox proportional hazards models evaluated associations between body mass index (BMI) at enrollment and incident chronic opioid use (overall use and strong opioid use). Models adjusted for demographics, smoking, disease duration, RA treatments, household income, and educational level. The predicted 5-year cumulative incidence was calculated from Cox models. Results Among 19,794 participants, 2,802 experienced an incident episode of chronic opioid use over 93,254 person-years of follow-up. Higher BMI was associated with higher risk of chronic opioid use. Severe obesity (BMI >35 kg/m2 ) was associated with a higher risk of overall use [HR 1.74 (1.72,2.04) p less then 0.0001] and strong opioid use [HR 2.11 (1.64,2.71) p less then 0.001] compared to normal BMI. This association was partially explained by greater comorbidity, pain, and disability in obese groups. The attributable risk for obesity was 15% of overall opioid use and 24% of strong opioid use. Conclusions Obesity is associated with a substantially higher risk of incident chronic opioid use. Approximately 1 in 4 cases of incident use of strong opioids may be attributable to obesity, suggesting a major public health impact. Interventions to prevent or reduce obesity could have an important impact on the use of opioids.Working with suicidal clients is frequently referred to as one of the most demanding and anxiety-provoking aspects of therapeutic work. The aim of this study was to obtain an in-depth understanding of therapists' experience in treating suicidal individuals and to develop a theoretical model of it. Eleven psychotherapists (four men and seven women) participated in individual semistructured interviews. learn more The interviews were audiotaped, transcribed and analysed by the principles of grounded theory. We developed a model of dynamic balance in therapists' experiences and views on working with suicidal clients. The model includes six core themes, which represent aspects of therapists' experience and views where a dynamic balance is needed between two different poles. The core themes are as follows (i) understanding of suicidality the general versus specific; (ii) the role of alliance protective factor versus no guarantees; (iii) attitudes acceptant versus life-oriented; (iv) emotional response worry versus trust; (v) responsibility therapist's professionality versus client's autonomy; and (vi) focus suicidality versus individual as a person. The model takes into account other variables that are relevant to the process and outcomes of the therapy factors, related to the therapist and the client, as well as system regulations and therapeutic setting. The presented model may be helpful for mental health professionals in reflecting on their experiences of working with suicidal clients, describing the relevant topics and the way they relate to each other.Time to improvement is a crucial characteristic for effective treatments of chronic inflammatory conditions, such as psoriasis. Apremilast is a recently approved drug, belonging to the small molecule phosphodiesterase 4 inhibitors, whose optimal safety and efficacy profile is somewhat affected by slow activity rate in clinical trials. Real world case series are suggesting a more consistent improvement, and with this additional personal investigation on 48 patients, we signal that 58% of patients achieved Psoriasis Area and Severity Index (PASI) 50, and 19% PASI 75 improvement in the first 8 weeks of treatment. Results at 16-week are remarkable, with overall 55% of patients achieving PASI 75, 21% PASI 90 and 14% PASI 100. Only 8 patients (18, 6%) had slightly improved, although satisfied with the regimen, and determined to continue. Noteworthy, our population was rather problematic in terms of comorbidities (86%), and resistance to other treatments, with only 28% naïve to systemics, including biologics. Moreover, the observation period includes the Italian outbreak of COVID-19 epidemic, and further information on apremilast safety are provided, no one of the patients having stopped treatment. In such a critical period, the apremilast satisfactory speed of therapeutic response in a real-world setting has further strengthens patient's compliance to remain safely at home, which is the best strategy to limit contagion.Coronavirus Disease 2019 (COVID-19) has been declared a pandemic. We conducted a systematic review to reveal the contribution of dermatologists in COVID-19 research. 298 articles were included and classified into cutaneous manifestations of COVID-19, operating experience against COVID-19, mechanisms and treatment of COVID-19, disinfection and personal protective equipment(PPE)-related skin diseases and other topics. The value of these articles and their impact on clinical impact were discussed and we hope that dermatologists can have a better understanding of these areas from this study. This article is protected by copyright. All rights reserved.Recently there is a surge in cosmetic and aesthetic surgery procedures. Several patient seeking various cosmetics procedures present to aesthetic surgery clinics and demanding procedures which are out of proportion. Several of these patients have under-recognized or untreated psychiatric disorders. Proper screening and evaluation of these patients could save money and resources. This brief review focuses on current trends, clinical and psychological assessment and expectations on the part of patients and recommendations regarding management of these patients.
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