Ramseybryan3243

Skin cancer prevention is at the forefront of public health as morbidity increases. Limited data exists on effective interventions to reduce sunburn frequency and modifiable risk factors. This research aims to determine an association between 1) demographic characteristics and outdoor sunburn frequency, and 2) sunburn frequency and sun-related risk and protective factors in a nationally representative, cross-sectional household survey. Of 23,430 surveys sent, 4,883 respondents reported sunburn-related data. Association between sunburns and demographic, risk, and protective factors were examined. When assessing demographic factors, potential confounding was addressed using multivariable analysis. In multivariable models, younger, non-Hispanic White respondents were more likely to report sunburn. Those with higher income were more likely to report any sunburn, but less likely to sunburn frequently. Females were less likely to report frequent sunburns. Engagement in sporting events, outdoor events, and day-to-day activities during the most recent sunburn was more commonly reported by those with frequent sunburns as compared with those with infrequent sunburns. Sun-protection interventions targeting higher-risk demographics during time spent outdoors, at sporting events, and during other day-to-day activities may be beneficial. Further insight into risk and protective behaviors for those who did not burn could be useful to guide public health interventions.

The SARS-CoV-2/COVID-19 pandemic dramatically impacted the delivery of healthcare, including dermatological services. In the initial stages of the pandemic, reduced patient flow produced a dramatic drop in the volume of skin cancer screening. Consistent with COVID-19 precautions, our practice conducted visual skin examinations (VSE) utilizing semi-automated total body photography (TBP).

A cross-sectional study of patient characteristics and self-reported melanoma risk factors associated with TBP usage was conducted on all patients from May to November 2020 in a single practitioner private dermatology setting. The process and histopathology-confirmed outcomes were compared to those in the same 6-month period in 2019.

For the May-November 2020 timeframe, those who opted for the home TBP (35%) compared to clinic TBP were younger, had higher self-reported skin cancer risk, and were more likely to have had previous TBP sessions. Overall, the number of TBP sessions increased, while dermoscopy usage and biopsy number decreased. There was no change in the number and distribution of skin cancer diagnoses compared to the same period in 2019. The Melanoma-In-SituInvasive Melanoma (MISINV) ratio was above the U.S. Colcemid ratio reported for 2020 of 0.951 (95,710 MIS100,350 INV).

Semi-automated TBP was successfully implemented during the pandemic without affecting skin cancer detection.

Semi-automated TBP was successfully implemented during the pandemic without affecting skin cancer detection.Non-celiac gluten sensitivity is often clinically indistinguishable from celiac disease, and patients show improvement or resolution of their symptoms with a gluten-free diet. In contrast to celiac disease, the effects of gluten on the skin and hair in the context of non-celiac gluten sensitivity are not as clear. This review aims to describe the impact of gluten on the skin and hair in patients with non-celiac gluten sensitivity and those without a definitive celiac disease diagnosis. A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guidelines for systematic reviews. Forty-two publications met inclusion criteria with five studies describing the skin manifestations of non-celiac gluten sensitivity. Trials identifying the impact of a gluten-free diet on skin disease, as well as dermatologic conditions and their associations with antigliadin antibodies were also identified. Dermatologic manifestations in patients with non-celiac gluten sensitivity vary and may be non-specific. It may be appropriate for some of these patients with skin manifestations to trial a gluten-free diet. Dermatologic conditions that may respond positively to a gluten-free diet include psoriasis, atopic dermatitis, vitiligo, and palmoplantar pustulosis, while linear IgA disease does not appear to improve with this dietary change.

Hospital performance comparisons for transparency initiatives may be inadequate if peer comparison groups are poorly defined.

The objective of this study was to evaluate a new approach identifying hospital peers for comparison.

We used Mahalanobis distance as a new method of developing peer-specific groupings for hospitals to incorporate both external and internal complexity. We compared the overlap in groups with an existing method used by the Veterans' Health Administration's Office for Productivity, Efficiency, and Staffing (OPES).

One hundred twenty-two acute-care Veterans' Health Administration's Medical Facilities as defined in the OPES fiscal year 2014 report.

Using 15 variables in 9 categories developed from expert input, including both hospital internal measures and community-based external measures, we used principal components analysis and calculated Mahalanobis distance between each hospital pair. This method accounts for correlation between variables and allows for variables having different variances. We identified the 50 closest hospitals, then eliminated any potential peer whose score on the first component was >1 SD from the reference hospital. We compared overlap with OPES measures.

Of 15 variables, 12 have SDs exceeding 25% of their means. The first 2 components of our analysis explain 24.8% and 18.5% of variation among hospitals. Eight of 9 variables scaling positively on the first component measure internal complexity, aligning with OPES groups. Four of 5 variables scaling positively on the second component but not the first are factors from the policy environment; this component reflects a dimension not considered in OPES groups.

Individualized peers that incorporate external complexity generate more nuanced comparators to evaluate quality.

Individualized peers that incorporate external complexity generate more nuanced comparators to evaluate quality.