Profiling and predicting help-seeking behaviour among trauma-exposed UK firefighters

Background: Firefighters often do not avail of psychological support services within fire services. Hence, investigating help-seeking behaviour is crucial to determine viable support options. Objective: This study attempted to characterize help-seeking behaviour among UK firefighters by profiling and identifying patterns of help-seeking. Methods: An online survey was administered to 1282 UK firefighters who were asked which help-seeking options they availed of within and outside professional settings. The analysis was conducted in two linked phases. First, latent class analysis was used to identify the fewest profiles that most accurately described help-seeking behaviour. Second, multinomial logistic regression analysis was employed to describe class composition using demographic and years in service variables, while ANOVA was employed to identify variation in alcohol consumption and openness to discussing emotions across help-seeking classes. Results: Five distinct help-seeking classes were identified. Class 1 (9.2%) represented firefighters who availed of all forms of support. Class 2, the smallest class (6.9%) represented firefighters who independently sought External Professional Psychological Support. Class 3 (12.2%) represented those who mainly sought Friends Support. Class 4, the largest class (48.7%) represented those who mainly sought Spousal Support. Class 5 (23%) represented firefighters who sought all avenues of Social Support. Regression analyses indicated that the External Psychological Support class was more likely to be single with fewer years in service. Firefighters longest in service were less likely to seek Social Support, and those who relied on Spousal support had the lowest alcohol consumption. Conclusion: Variations in help-seeking behaviour among UK firefighters were found. Firefighters who sought spousal support had the lowest alcohol consumption rates, indicating a protected profile. Firefighters who only sought friends and informal colleagues' support had the highest alcohol consumption rates and the most difficulty in discussing feelings, indicating a potential at-risk profile. Recognizing these differences in help-seeking patterns is important for targeting interventions.

Spontaneous regression of subungual keratoacanthoma with reossification of underlying distal lytic phalynx

A 45-year-old man presented with a rapidly enlarging keratotic lesion of the distal subungual right middle finger. An X-ray of the digit revealed a well-defined cup-shaped lytic lesion of the phalynx underlying the subungual nodule. The lesion resolved spontaneously with reossification of the underlying bony defect. The clinical history and X-ray is consistent with a diagnosis of spontaneously resolving subungual keratoacanthoma.

Treatment of subungual exostoses by elective day case surgery

Twenty-one patients (11 female, 10 male: mean age 21.3 years) with subungual exostoses were treated with elective surgery under local anaesthetic in a dermatology day case theatre over a period of 8 years. Fifteen (71%) tumours affected the great toe, four (19%) affected other toes and two (10%) affected fingers. All received local excision with great care to remove all tumour residue from the terminal phalanx. Wounds were allowed to heal by secondary intention. Attention was paid to preoperative antiseptic procedure and postoperative analgesia. During follow-up of between 6 and 36 months (mean 17 months), there were two relapses (10%) in the first 12 months, seen in two of the younger subjects aged 9 and 13 years. One required further surgery. One further case suffered long-term dystrophy due to perioperative damage to nail matrix. Conservative and thorough treatment of this pathology can be achieved using the appropriate tools in a dermatology day case theatre.

Lower eyelid reconstruction using pedicled skin flap and palatal mucoperiosteum

BACKGROUND

Full-thickness lower eyelid reconstruction requires functional as well as aesthetic considerations to be successful in the long term. The three elements necessary for a stable result are skin, mucosa, and a semirigid "skeleton" to provide the support that prevents the development of ectropion. A number of techniques combining these elements are described in the literature, with reconstruction in one or more stages.

OBJECTIVE

We report a simple method of reconstruction of a full-thickness lower eyelid defect, in which palatal mucoperiosteum provided both the mucosal and the "skeletal" components following tumor excision.

METHODS

Literature review and report of illustrated case.

RESULTS

A cosmetically acceptable result with no functional deficit or donor site morbidity.

CONCLUSION

Palatal mucoperiosteum provides an abundant supply of tissue that may be used successfully in the reconstruction of the lower eyelid. It functions both as a mucosal lining in addition to a semirigid supporting framework.

Epidermal Langerhans cells, HIV-1 infection and psoriasis

Langerhans cells (LCs) subserve an important antigen-presenting function in the skin immune system. They bear CD4 receptors, which make them potential targets for infection with the human immunodeficiency virus (HIV-1). The observation of reduced numbers of LCs in the skin of patients with the acquired immunodeficiency syndrome (AIDS), and the association of severe psoriasis with HIV-1 infection, raise interesting questions regarding the role of LCs in the skin of HIV-1-positive psoriatic patients. In this study, LCs were quantified in the lesional and non-lesional skin of seven HIV-1-positive psoriatic patients, and the results were compared with age-, sex- and site-matched HIV-1-negative psoriatic patients. The number of LCs was determined by staining skin sections with S-100 polyclonal antibody, using the three-step avidin-biotin immunoperoxidase method. The S-100-positive cells above the basal layer were quantified in two ways: cells/mm2 of epidermal area, and cells/mm of length of basement membrane. HIV-1-positive psoriatic patients showed a reduction in the number of epidermal LCs compared with HIV-1-negative psoriatic patients using both methods of quantification, in both lesional and non-lesional skin (P < 0.05, Mann-Whitney test). In addition, a reduction in the number of LCs in lesional compared with non-lesional skin was observed in both HIV-1-positive and -negative patients when LCs were quantified per mm2 of epidermal area (P < 0.05, Wilcoxon test).(ABSTRACT TRUNCATED AT 250 WORDS)

The role of factor XIIIa-positive dermal dendrocytes in HIV-1-positive psoriatics

Factor XIIIa-positive dermal dendrocytes (FXIIIa+ dd) may have an important role in the pathogenesis of psoriasis, in that their numbers are increased in lesional skin compared with non-lesional skin. Moreover, in AIDS-associated Kaposi's sarcoma the number of these cells is also increased, in comparison with the classical type of Kaposi's sarcoma. In addition, patients suffering from HIV-1 infection may develop severe psoriasis. The aim of this study was to examine the distribution of FXIIIa+ dd in lesional and non-lesional skin from seven psoriatic patients with positive HIV-1 serology, and compare the results with age-, sex-, and site-matched HIV-1-negative psoriatic patients. In both patient groups there was an increase of FXIIIa+ dd in the papillary dermis in lesional skin, compared with non-lesional skin (HIV+ [P = 0.007]; HIV- [P = 0.0006]). Positive cells were also observed within the epidermis in lesional skin in both groups. However, there was no significant difference between HIV-1+ and HIV-1- groups in the number of FXIIIa+ dd in the epidermis and dermis (P > 0.05). These findings suggest that, if FXIIIa+ dd do have a role in psoriasis, deterioration of this condition in HIV-1+ patients is not due to proliferation of dermal dendrocytes.

Ammoniated mercury ointment as a cause of peripheral neuropathy

A 72-year-old Caucasian man with widespread psoriasis presented with a sensory-motor peripheral neuropathy following 40 years' use of an ammoniated mercury ointment. No clinical involvement of his central nervous system was noted and no other possible causative factors for his peripheral nerve disease were found. D-Penicillamine treatment induced mercuriuresis and blood levels of mercury fell to normal. His peripheral neuropathy improved slowly after normalisation of the serum mercury. It is believed that his condition was caused by percutaneous absorption of mercury. Ammoniated mercury ointments should have no role in the current management of skin disorders.

Phototoxic potential of thiazide diuretics in normal subjects

Monochromator phototesting has been carried out in 22 subjects before and 2 weeks after therapy with either bendroflumethiazide (bendrofluazide) or hydrochlorothiazide. An increase in erythemal sensitivity was observed in several subjects in those wave bands that are maximally absorbed by the respective drugs in vitro. Both drugs showed similar phototoxic capabilities, yet in clinical practice, reports of photosensitivity caused by hydrochlorothiazide are much more common than those caused by bendroflumethiazide. One possible reason is suggested.