Sicosis de la barba. Preferred Name. Folliculitis keloidalis. Dermatitis papillaris capillitii.
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Carly A. Elston; Dr. Dirk M. El tratamiento de las cicatrices queloides es complejo y son frecuentes las recidivas. Cancers Basel. El tratamiento principal consiste en el manejo de la enfermedad subyacente. Eritema multiforme C. Eritema migratorio D. El eritema migratorio es un signo temprano de la enfermedad de Lyme.
Condilomas acuminados. Las lesiones afectan los brazos, la cara y el cuero cabelludo. Granulomas no caseificantes con pocos linfocitos circundantes C. Pueden estar elevadas las concentraciones de acetilcolinesterasa, calcio y fosfatasa alcalina. Fitofotodermatitis B. Desarrollo normal C. Dermatitis flagelada por setas Shiitake D. Incontinencia pigmentaria. No se trata de una fitofotodermatitis.
Tampoco es una dermatitis por setas Shiitake o dermatitis flagelada. Anemia perniciosa B. Enfermedades autoinmunes C. Todas las anteriores. El tratamiento puede ser un reto y debe ser individualizado. Microsporum canis B. Microsporum audouinii C. Trichophyton violaceum D. Trichophyton tonsurans. Celulitis disecante B. Forunculosis C. El tratamiento de la celulitis disecante es un reto.
More than 3 decades since its emergence in the United States, HIV continues to spread and disproportionately affect socially marginalized groups. Preexposure prophylaxis PrEP , a highly effective prevention strategy federally approved since , could fundamentally alter the course of the epidemic. This nonstandardized approach has constrained PrEP access. PrEP access has not only been inadequate but also inequitable, with several groups in high need showing lower rates of uptake than do their socially privileged counterparts.
Recognizing these early warning signs that current approaches to PrEP implementation could exacerbate existing HIV disparities, we call on health professionals to integrate PrEP into routine preventive health care for adult patients—particularly in primary care, reproductive health, and behavioral health settings. Drawing on the empirical literature, we present 4 arguments for why doing so would improve access and access equity, and we conclude that the benefits clearly outweigh the challenges.
The year was a landmark year in the history of HIV prevention. This daily oral antiretroviral medication is effective in protecting HIV-negative adults from acquiring HIV [ 1 ] and is indicated for those at risk because of sexual behavior, injection practices, or both.
Preexposure prophylaxis PrEP is an important addition to the menu of prevention options offered to patients in health care settings because traditional prevention methods, such as condoms, have only partially addressed the HIV epidemic. HIV continues to spread, with transmission accelerated among certain groups in particular e. Despite the immense promise of PrEP and the unique advantages it affords, many health care providers, including those aware of this recent prevention innovation, have not discussed PrEP with their patients or prescribed it.
We argue that PrEP should be discussed with all adult patients as part of routine preventive health care—particularly in primary care, reproductive health, and behavioral health settings—and made available to those who elect to use it unless medically contraindicated.
All Americans deserve scientifically accurate, easy-to-access information about HIV transmission and prevention. This entails providing clear, specific, consistent, and scientifically up-to-date messages about risk and prevention strategies. However, health care providers can play a particularly pivotal role in disseminating this information because of their medical training and capacity to immediately link individuals to prevention resources and perform associated medical monitoring.
Routine PrEP education and provision would diminish the selection biases and missed opportunities inherent in the present nonstandardized approach. In the health care system, routinization involves the institutionalization of clinical activities to follow an established pattern with the goal of improving medical decision-making and overall community health. People at risk for HIV have reported diverse preferences for sources of PrEP information and care, including primary care physicians, infectious disease specialists, gynecologists, and psychiatrists, [ 14 , 15 ] and it is incumbent on all health care providers to offer or support access to PrEP resources.
Providers, particularly those practicing in primary care, reproductive health, and behavioral health settings, should be prepared to routinely perform nonjudgmental sexual health and substance use assessments and to discuss PrEP as 1 of multiple HIV prevention options available. To maximize the quality and range of services that providers are able to offer, PrEP should be embedded in a broader, ongoing discussion of sexual and behavioral health that also incorporates sexual history and goals, other sexually transmitted infections, pregnancy, and substance use.
Multiple resources are available to support providers in discussing and providing PrEP e. Routinization has been an effective strategy to help normalize and promote uptake of other sexual health prevention services. For example, contraception, which was heavily stigmatized in its early days, is now more commonly discussed and offered to female patients of reproductive age regardless of their stated sexual activity and pregnancy risk.
Instituting a routine approach to PrEP education and provision comes with challenges, and various strategies for motivating and regulating such change will need to be explored. Health care providers and administrators will have to be educated about PrEP and perceive value in adopting a routinized approach in their clinical practices.
Securing approval and formal endorsement from medical authorities and revising clinical guidance to reflect this recommendation may help promote buy-in.
Enhancing the visibility of health care settings that have successfully adopted a routinized model of PrEP education and provision could demonstrate feasibility and help cultivate new norms that encourage similar institutions to follow suit.
Structural initiatives could also be considered as a means of ensuring routine PrEP education; for example, existing state laws that mandate offering HIV testing to patients could be amended to also require PrEP counseling for those who test negative.
Although there are certain to be obstacles to routinizing PrEP in preventive care, the potential public health benefits of a more equitable and effective approach to implementing PrEP are substantial, realistic, and worthy of additional investment.
We draw on the empirical literature to present 4 arguments for integrating PrEP into routine preventive health care, highlighting the mechanisms by which a routinized approach to PrEP discussion and provision would improve access and avoid exacerbating existing HIV disparities Table 1 provides a summary. Of note, we have anticipated criticisms of this approach involving concerns about cost-effectiveness, provider time constraints, side effects and safety, and impact on other sexually transmitted infections.
Individuals at risk for HIV are not easily identifiable. HIV risk is unlike many other medical conditions or health concerns that providers routinely diagnose on the basis of direct observation of symptoms. Although a minority of patients at risk for HIV have clinical signs of recent condomless sex or injection drug use e. Patients may not accurately disclose the extent to which they are consistently using condoms, clean needles, and other methods of protection and whether they consider these methods to be acceptable for multiple reasons, including discomfort with sharing sensitive information and fear of provider judgment.
MSM—and Black MSM in particular [ 18 ] —may be uncomfortable disclosing their same-sex sexual behavior to providers because of anticipated or internalized heterosexism i. Additionally, if patients are unaware that a provider is conditioning PrEP education and access on their disclosure of relevant risk behavior, they may lack incentive to disclose such behavior.
Even if patients were fully forthcoming about their sexual histories and goals, providers broaching PrEP only with patients they judge to be at substantial risk for HIV is problematic because risk prediction is an imperfect process. The US Public Health Service [ 2 ] and other health authorities have published clinical guidelines containing eligibility criteria to help determine HIV risk and PrEP candidacy, but these criteria are not sensitive to all patients who stand to benefit from PrEP.
Therefore, if providers use these criteria to identify patients with whom to discuss PrEP, some PrEP candidates will be missed. Racial disparities in PrEP eligibility according to preestablished criteria may reflect the failure of such criteria to sufficiently capture the social and structural risk factors driving the HIV epidemic in the Black community and driving HIV disparities; [ 19 , 20 ] for example, because people tend to choose sexual partners of the same race and the HIV prevalence among Black MSM is disproportionately high, [ 3 ] each condomless sex act with a partner from this partner pool carries higher risk on average.
This network-level risk factor is not accounted for in standard PrEP eligibility criteria. The US Public Health Service guidelines [ 2 ] do encourage clinicians to consider epidemiological context, but this recommendation is not consistently captured in the listed indications for PrEP use commonly referenced as eligibility criteria.
Thus, providers should not rely on preestablished eligibility criteria to determine who should be educated about PrEP, as this could inappropriately disqualify Black MSM and others, amplifying existing HIV disparities. Rather, preestablished criteria should be regarded as useful but not exclusive cues that PrEP might be appropriate. Finally, it is worth noting that providers neglecting to raise the topic of PrEP with at-risk patients is of particular concern because many such individuals are still unaware of PrEP [ 22 ] and are hence dependent on their providers to introduce the topic.
In some communities, awareness may be especially limited among racial and ethnic minority groups in which HIV incidence is disproportionately high. They are also reinforced by other mechanisms e.
That these alternative sources of education and reinforcement are largely lacking for PrEP makes it all the more important that this prevention tool be routinely discussed in health care settings to ensure that potential PrEP candidates are not missed. Broadening PrEP recommendations beyond narrowly defined groups such as MSM and serodiscordant couples allows more equitable access, [and] is likely to be less stigmatizing than targeting specific risk groups.
Routinization of PrEP education and provision in preventive care would facilitate PrEP access by helping normalize its use, fostering greater acceptance among potential candidates, providers, and the broader public. Presently, PrEP is perceived by many as a medication specific to gay men and an indicator of promiscuity. Integrating PrEP into routine preventive care by discussing it with all patients and providing it to those who elect to use it would help reframe it as medication appropriate for sexually active individuals irrespective of sexual orientation or partner sex, consistent with its indication.
PrEP stigma affects demand by potential candidates and supply by health care providers. With the current nonroutinized approach, providers who are familiar with stereotypes of PrEP users as gay, exceptionally risky, or both may fail to recognize PrEP candidates who do not fit these preconceptions on the basis of their gender or self-presentation. At the same time, providers may be reluctant to broach the topic of PrEP with patients belonging to stereotyped groups for fear of offending them by insinuating stereotypical assumptions.
This may influence public support for policies and programs that make PrEP affordable for many patients and improve access for racial and sexual minorities in particular.
A patient-centered model of care aligns with the values put forward by the Institute of Medicine, [ 32 ] the American Medical Association, [ 33 ] and other professional organizations dictating medical codes of conduct. Providers should present PrEP as a preventive option and support patients in making an informed decision about whether it fits with their sexual experiences and goals. Routinely discussing PrEP with patients could help alleviate the pressure or discomfort providers experience when deciding PrEP eligibility by making it a shared endeavor with their patients.
Some providers have anticipated difficulty identifying PrEP candidates to be a potential barrier to PrEP provision, in part because they perceive many providers to lack the skills needed to effectively communicate about sexual health with patients. Patients possess significantly greater insight into their sexual histories and intentions than do their providers, even when they are fully forthcoming in sexual health discussions.
Failing to broach the topic with a patient constitutes one-sided decision-making on the basis of incomplete data. If educating patients about PrEP was routinized, providers may be motivated to seek skills-based training on discussing sex with patients and could build competence and confidence in this area by way of experience.
This could allow providers to make more informed recommendations about PrEP to patients, help them better address other dimensions of sexual health such as relationship safety and sexual satisfaction, and serve as a gateway to patients accessing other health services.
There is minimal harm in broaching the topic of PrEP with all patients, including those not currently at substantial risk for HIV. Patients are unlikely to initiate PrEP if they perceive no benefit in doing so. A patient who expresses a desire for PrEP is likely to be motivated by perceived HIV risk, irrespective of whether associated behavior has been disclosed. Women at high risk for HIV have expressed anger over not being informed about PrEP sooner [ 14 , 29 ] and concern about their health care providers being uninformed about PrEP.
Cie 10 Total
Not to be redistributed or modified in any way without permission. Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The author and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the stan- dards accepted at the time of publication.
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Carly A. Elston; Dr. Dirk M. El tratamiento de las cicatrices queloides es complejo y son frecuentes las recidivas. Cancers Basel. El tratamiento principal consiste en el manejo de la enfermedad subyacente.
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From professional translators, enterprises, web pages and freely available translation repositories. Last Update: Usage Frequency: 1 Quality:. Rigidez de la Nuca. Raideur de la nuque.
Home Login Register Search. Report this link. Seleccione una: a. La respuesta correcta es: A. Pregunta 7 Sin contestar Puntaje de 1. FASE V c.