RESUMO
Notalgia paresthetica (NP) is a sensory neuropathy characterized by chronic pruritus, skin pain, and other pathologic sensations affecting the mid-to-upper back. NP may be under-recognized and under-diagnosed, with limited data available on its symptom presentation and treatment patterns. NP-DERM was an internet-based survey of dermatologists (n = 650) from 8 different countries on their perspectives on NP symptoms and current treatment practices. Dermatologists typically treated a median of 12 patients with NP per month. Dermatologists reported that itch (pruritus) was the most common symptom for their patients with NP, followed by hyperpigmentation and sensitive skin. The most burdensome NP symptom was pruritus, followed by burning or hot sensation, and painful or raw skin. The most prescribed treatments included non-medicated skin care, topical corticosteroids, oral antihistamines, medicated topicals, and gabapentin or pregabalin. Physicians reported low satisfaction with available treatments. The most common reason for physicians to discontinue patients' therapy was lack of response.
Assuntos
Dermatologistas , Pesquisas sobre Atenção à Saúde , Padrões de Prática Médica , Prurido , Humanos , Prurido/tratamento farmacológico , Prurido/diagnóstico , Prurido/terapia , Prurido/etiologia , Padrões de Prática Médica/estatística & dados numéricos , Parestesia/diagnóstico , Feminino , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Carga de SintomasRESUMO
Background: Notalgia paresthetica (NP) is a form of neuropathic itch characterized by recurrent itch in the mid back. Much about NP remains unclear, especially the patient experience.Objectives: The Neuropathic Itch Patient Survey (NIRVE) was a global, online survey conducted to better characterize the symptom burden of neuropathic itch from the patient perspective.Patients and methods: This report focuses on the symptom burden of the subpopulation of NIRVE participants with a self-reported diagnosis of NP (N = 91). Respondents reported visiting a median of 2 healthcare providers (HCPs) for their symptoms before receiving an accurate diagnosis of NP.Results: The most common cutaneous symptoms ever experienced were itch/pruritus, sensitive skin, painful or raw skin, numbness, and tingling. The symptoms reported by the most respondents as currently being experienced included itch/pruritus, numbness, painful or raw skin, tingling, and burning or hot sensation. Of patients currently experiencing symptoms, numbness and itch/pruritus were ranked as the most intense, followed by tingling, burning or hot sensation, and then painful or raw skin. Most patients consult multiple healthcare providers (HCPs) before receiving a diagnosis for their condition.Conclusion: Itch is overwhelmingly the most prevalent symptom of the condition, although half of patients also report experiencing sensitive skin, painful or raw skin, numbness, or tingling.
Assuntos
Prurido , Humanos , Prurido/diagnóstico , Prurido/etiologia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Parestesia/diagnóstico , Parestesia/etiologia , Idoso , Inquéritos e Questionários , Adulto Jovem , Hipestesia/diagnóstico , Hipestesia/etiologia , Autorrelato , PrevalênciaRESUMO
Background: Atopic dermatitis (AD) affects 2%-10% of adults worldwide. Occurrence and severity of symptoms and treatment success vary among patients. Objective: To determine disease severity, burden, and treatment use and satisfaction in adults with AD. Methods: An international internet-based survey was conducted (October 5-November 1, 2021) in participants with AD from Canada, France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States. Results: Of 2005 AD patients surveyed, 92% had body surface area (BSA) involvement <10%. Itch was the most bothersome symptom; 48.5% of participants reported severe itch in the past week (Itch Numerical Rating Scale [NRS] 7-10; 45.9% for BSA <10%, 75.0% for BSA ≥10%). Most participants reported moderate or severe sleep disturbance in the past week (Sleep NRS 4-10; 67.1% for BSA <10%, 92.3% for BSA ≥10%). Itch was the top reason for participants' most recent health care provider visit; reducing itching was their top treatment goal. Topical therapies, which were most commonly used, resulted in low treatment satisfaction. Conclusions: Itch was the most bothersome AD symptom. Although clinical development has focused on improving skin lesions, improving itch is patients' top treatment goal. This survey highlights the need for systemic antipruritic therapies that could reduce itch in nonlesional and lesional skin.
Assuntos
Dermatite Atópica , Adulto , Humanos , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/epidemiologia , Índice de Gravidade de Doença , Prurido/etiologia , Prurido/terapia , Prurido/diagnóstico , Inquéritos e Questionários , Efeitos Psicossociais da Doença , Qualidade de VidaRESUMO
Serosorting (i.e., engaging in unprotected sex with partners known to be of the same serostatus) can be a difficult process for men who have sex with men (MSM) who frequently make assumptions about their partners' serostatus. This process can be further complicated by a partner's dishonesty as well as other individual and contextual factors. The present study specifically examined how assumptions of serostatus made about unknown serostatus partners impact on the sexual behavior of 110 alcohol-abusing HIV-positive MSM. Although previous research has shown that HIV-positive MSM are more likely to serosort with other known HIV-positive men than with known HIV-negative men, our data suggest that unprotected sex behavior may not be specifically driven by whether or not they made assumptions of seroconcordance or serodiscordance. The types of assumptions these HIV-positive MSM made about their unknown status sexual partners and the basis for such assumptions were also examined. Owing to the ambiguities involved in assumptions of a partner's serostatus in sexual encounters, the 'unknown status' partner category is analytically distinct from 'known status' categories, and needs to be more fully explored because of its impact on perceived serosorting, rather than actual serosorting, among HIV-positive men.
Assuntos
Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Adulto , Alcoolismo/epidemiologia , Comorbidade , Infecções por HIV/epidemiologia , Soronegatividade para HIV , Soropositividade para HIV/psicologia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Assunção de Riscos , Sexo Seguro/psicologia , Percepção Social , Estados Unidos/epidemiologiaRESUMO
An ethnically diverse sample (79.0% men of color) of HIV seropositive (HIV+) men who have sex with men (MSM) with alcohol use disorders from the New York City metropolitan area was recruited from a variety of settings frequented by such men. Data were collected using quantitative assessments and calendar based techniques at the baseline assessment of a longitudinal study assessing the relationship between alcohol and substance use and sexual risk behaviors as well as alcohol use and HIV disease progression. Data were selected on a sample of 253 HIV+ MSM (mean age = 38.55, SD = 6.73). Of these, the majority of participants (80.2%, n=203) reported engaging in sexual behaviors with casual partners. In terms of sexual behaviors that put partners at greatest risk for HIV transmission, unprotected anal insertive intercourse was most likely to occur with unknown status casual partners (46.8%, n=95) than with either HIV negative casual partners (19.2%, n=39) or with HIV+ casual partners (40.8%, n=83). Further, bivariate analyses indicated significant relationships between the use of several substances and sexual behaviors that put partners at greatest risk for HIV transmission, as well as a significant positive relationship between drinks per drinking day and viral load.
Assuntos
Alcoolismo/epidemiologia , Infecções por HIV/epidemiologia , HIV-1 , Homossexualidade Masculina , Assunção de Riscos , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Alcoolismo/complicações , Infecções por HIV/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/complicaçõesRESUMO
Directly addressing HIV medication adherence and substance use together is ideal in light of the research on the complex connections between these two behaviors. This paper describes the development of a pilot program in which a combined motivational interviewing and cognitive behavioral therapy intervention was used to increase adherence to highly active antiretroviral therapy (HAART) and reduce substance use in HIV-infected adults. The main goals of the pilot study were (1) to confirm the ability to recruit HIV-positive substance users taking HAART; (2) to demonstrate the ability to retain participants over the course of an eight-session intervention; and (3) to examine changes in substance use and HAART adherence from pretreatment to posttreatment. Twelve HIV-positive adults with a substance use disorder participated in an 8-week intervention, which consisted of weekly individual sessions with a trained therapist. Results showed that despite the small sample size, there was a significant reduction in substance use from pretreatment to posttreatment. No statistically significant differences were found for changes in HIV medication adherence, but the trends suggest the potential for positive results with a larger sample. Retention for all eight sessions of the treatment was 73.3%. Eighty percent completed the 3-month follow-up assessment. Participants reported high therapeutic alliance reflecting comfort with their therapists and in the treatment. Overall, the pilot demonstrated feasibility and acceptability of the treatment. Furthermore, results suggest that this may, in fact, be an effective intervention to reduce substance use and improve HIV medication adherence.
Assuntos
Terapia Antirretroviral de Alta Atividade/métodos , Terapia Cognitivo-Comportamental/métodos , Infecções por HIV/tratamento farmacológico , Educação de Pacientes como Assunto/métodos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adulto , Fatores Etários , Atitude Frente a Saúde , Feminino , Seguimentos , Infecções por HIV/diagnóstico , Infecções por HIV/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Projetos Piloto , Medição de Risco , Fatores Sexuais , Análise de Sobrevida , Resultado do TratamentoRESUMO
The literature on alcohol use has failed to form a consensus on the association between alcohol use and unsafe sex among samples of men who have sex with men (MSM). Although drinking behavior may not be causally related to unsafe sex, it is possible that alcohol use plays a role in sexual scripts. In this paper, we assessed the role that alcohol use plays in the sexual experiences of HIV-seropositive MSM in terms of sexual script theory. An ethnically diverse sample (81% men of color) of HIV-positive MSM with alcohol use disorders from the New York City metropolitan area was recruited from a variety of settings frequented by such men. A critical incident measure was used to qualitatively assess contextual issues regarding participants' most recent incident of unsafe sex while under the influence of alcohol. Qualitative analysis revealed three basic sexual scripts involving alcohol: routine, spontaneous, and taboo. Each script had its own sources of risk for unsafe sex. Interventions targeting alcohol use and unsafe sex should be sensitive to the role that alcohol plays in the sexual scripts of HIV-positive MSM.
Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Soropositividade para HIV/psicologia , Homossexualidade Masculina/psicologia , Assunção de Riscos , Parceiros Sexuais/psicologia , Adulto , Anedotas como Assunto , Soropositividade para HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
HIV seropositive (HIV+) gay and bisexual men continue to report unprotected sexual practices. Although numerous research studies have examined the relationship between alcohol use and unsafe sex, few have examined this from a qualitative perspective. In this paper, we examined the impact of alcohol use on stigmatized sexual practices among HIV+ gay and bisexual men with alcohol-use disorders. An ethnically diverse sample (81% men of color) from the New York City metropolitan area was recruited from a variety of settings frequented by gay and bisexual men. Using a qualitative interview, contextual issues regarding sexual activities under the influence of alcohol were examined. Qualitative analysis revealed that alcohol use facilitates engagement in sexual practices that are perceived as stigmatic while sober. Interventions targeting alcohol use and unsafe sex should be sensitive to the role which alcohol plays in the sexual practices among HIV+ gay and bisexual men.