Bibliothek

Notizen: Questionnaire-tools for surveying occupational skin diseases and exposure are needed for comparable epidemiological research, workplace assessments, and evaluation of workplace interventions. The Nordic Occupational Skin Questionnaire Group supported by the Nordic Council of Ministers has developed a standardized questionnaire-tool for surveys on work-related skin diseases and skin exposures to environmental factors.Nordic Occupational Skin Questionnaire (NOSQ-2002) includes two questionnaires designed for separate purposes. NOSQ-2002/short is a 4-page questionnaire for screening skin problems at workplaces. NOSQ-2002/long is an in-depth survey tool for research purposes. The questionnaire covers occupational history, atopic symptoms, self-reported hand or forearm eczema, exacerbating factors, consequences and life impact of dermatoses, self-reported contact urticaria on hands or forearms, skin symptoms, skin tests, exposures, and protective glove use. For the time being, NOSQ-2002 is available in English, Danish, Swedish, Finnish and Icelandic. Further translations are welcomed.The NOSQ-2002 report includes a review of pertinent literature on questionnaire methods for skin disease studies. Questions on work and exposure can be tailored to specific populations or occupational groups, according to the instructions and recommendations given in NOSQ-2002/INFO version of the questionnaire.The NOSQ-2002 questionnaire files can be downloaded from /NOSQ. The Nordic Council of Ministers has the copyright to the NOSQ-2002 questionnaires. Use of the questionnaires is free of charge. The NOSQ-2002 questionnaires and their present and possible future translations cannot be used commercially.

Notizen: Background: This study aimed to evaluate the cumulative incidence, point prevalence, and severity of atopic dermatitis (AD) in a pediatric population. We also aimed to identify differential diagnoses relevant to AD in this population. Methods: Children scheduled for a health visit at 5.5 years of age were selected consecutively during the period October 1997–March 1998 from two cities in southern Sweden (Göteborg and Kristianstad). Schultz Larsen's questionnaire was used to evaluate the cumulative incidence of AD. Clinical examination was performed by dermatologists (A.B. and Å.S.) for those children with active eczema. The UK working party's criteria were used for the clinical diagnosis of AD. The SCORAD index was used to evaluate the severity of eczema. This index includes evaluation of extent, intensity, and subjective symptoms to a maximum score of 103 points. Results: In Göteborg 1219 and in Kristianstad 742 questionnaires were answered regarding 1961 children, 1004 boys and 957 girls. The response rate was 89%. According to the answers to Schultz Larsen's questionnaire, the cumulative incidence of AD in the whole material was 20.7% (406/1961) (CI 95% 18.9–22.5). In Göteborg, 104 of the examined children fulfilled the UK working party's criteria, equivalent to a point prevalence of 8.5% (CI 95% 7.0–10.1). In Kristianstad, the corresponding point prevalence was 11.5% (CI 95% 9.2–13.8). The severity of AD was evaluated in all children with visible eczema. SCORAD evaluation was performed in 155 of the 157 children with visible eczema. The majority of children had mild or moderate eczema; mean value 20.5 (CI 95% 18.7–22.3), median 19.6. Of the 96 children who did not fulfil the criteria of AD, other skin disorders were diagnosed in 51 at the clinical examination. Dry skin was by far the most common differential diagnosis. Conclusions: We have used validated protocols to evaluate the cumulative incidence, point prevalence, and severity of AD in a population-based study in southern Sweden The present study, involving a rural and urban pediatric population, shows that AD is common, usually classified as mild or moderate, and seems to increase over time.

Notizen: Background  Several studies among dermatological patients have shown a link between various chronic dermatological diseases and mental morbidity.Objectives  To explore the association between self-reported skin morbidity and psychosocial factors in the general population.Methods  This population-based cross-sectional study is part of the Oslo Health Study conducted during 2000–2001. All individuals in Oslo County, Norway, born in 1924/25, 1940/41, 1955, 1960 and 1970 received a postal questionnaire, which 18 770 men and women answered. The questionnaire provided information on sociodemographic factors and self-reported health and psychosocial factors. Dichotomous variables for 10 self-reported skin complaints were used. These were previously validated and refer to the most common chronic skin diseases. Mental distress was measured with a validated 10-item instrument, the Hopkins Symptom Check List-10; social support with the number of confidants; and negative life events with a 12-item validated instrument.Results  The odds ratio (OR) for mental distress was 1·70 [95% confidence interval (CI) 1·21–2·38] for having itch, 1·64 (95% CI 1·15–2·34) for pimples and 1·72 (95% CI 1·06–2·80) for face rash in an adjusted model. In an adjusted model the OR for skin disease was 1·60 (95% CI 1·39–1·84) when the individual had experienced more than two negative life events; and 2·52 (95% CI 2·12–3·00) for mental distress. Skin morbidity increased for both genders, with poor social support network. There was a significant interaction between social support network and negative life events in the logistic regression model for skin disease when adjusted for sociodemographic factors.Conclusions  The study quantifies the association between dermatological problems and psychosocial factors at a population level. It underlines the need to focus on these issues in research and needs assessment in dermatology.

Notizen: Background  Estimation of skin diseases in the community is challenging because we do not easily have access to the nonhealthcare-seeking population. A potential tool is a questionnaire asking for self-reported skin complaints. Such an instrument has not yet been developed.Objectives  To validate a simple instrument assessing skin morbidity in the general adult population, to predict clinical skin morbidity from self-reported skin complaints.Methods  A questionnaire was drawn up in Norwegian and validated against clinical signs in two samples of an urban population, 100 healthcare-seeking adults in a dermatological clinic, and 100 nonhealthcare-seeking adults. A total self-reported score was calculated and validated against severity of clinical signs (no sign, trivial, moderate or severe). The inter-rater agreement was assessed in a small study including 16 patients from a dermatological clinic.Results  The participation rate was 98%. The sensitivity was 61%, the specificity 69% and the positive predictive value 82% when the caseness criterion was any clinical sign of skin disease. The agreement was good between the two observers for clinical skin morbidity, with κ = 0·67.Conclusions  This questionnaire is a simple tool to evaluate skin morbidity in an adult population. The use of self-reported complaints to predict clinical morbidity may be of value in quantifying and exploring skin diseases at the population level. Further studies are needed to improve the instrument. It is our intention to demonstrate the potential usefulness of this questionnaire in a forthcoming population survey in Norway.

Notizen: Background  Previous studies on prevalence of skin diseases in the population have been based on clinical examination of a sample of the population. A questionnaire on self-reported skin complaints has recently been developed and validated for use in population surveys, but has not been used until now.Objectives  To quantify the skin morbidity in an adult urban population assessed by a newly developed self-measurement instrument, and to explore the associations between skin morbidity and sociodemographic factors in the community.Methods  The study was a population-based cross-sectional study carried out in the city of Oslo. Adult participants (n = 18 770) aged 30–76 years answered a questionnaire giving information on self-reported skin complaints, and which included demographic, psychosocial and general health variables.Results  Itch was the dominating skin complaint in all age groups. Adjusted odds ratios for itch, self-reported hand eczema and self-reported acne showed significant associations with female gender and reporting households of middle income. There was no association with employment categories.Conclusions  This study shows that skin complaints referring to the most common chronic skin diseases varied with age, gender and marital status, and worsened with middle-income household. It provides evidence that household income is associated with skin morbidity, bringing dermatological aspects to studies on health inequalities.

Notizen: Background  Hand eczema is a major cause of morbidity and lost earnings. Many interventions ranging from topical steroids to oral ciclosporin are used, but their evidence base and the best methods to assess their efficacy are uncertain.Objectives  As part of a long-term project to improve standards of design and reporting in hand eczema trials, we sought to describe the prevalent study designs and comment on the quality of reporting of such studies.Methods and data sources  Electronic databases (Cochrane, Medline, Embase, Pascal, Jicst-Eplus, Amed) were searched from January 1977 to April 2003 using all possible variants of the terms hand and eczema/dermatitis. In addition, four general medical and 17 specialist dermatology journals were hand-searched by pairs of researchers for all possible therapeutic studies.Study selection  Studies were eligible for inclusion if they dealt with hand eczema as diagnosed by a physician irrespective of the aetiology, and if they described the results of a study of a therapeutic intervention in humans. Single case reports and reviews were excluded, but case series and nonrandomized studies were considered alongside randomized studies.Data selection  For each study, two researchers independently assessed the type of study, outcome measures, enrolment criteria, randomization, masking of interventions and how losses to follow-up were dealt with.Main outcome measures  Proportion of studies according to type of intervention and study type. Proportion of randomized controlled trials (RCTs) that adequately reported eligibility criteria, randomization generation and concealment, masking and intention-to-treat analysis.Results  A total of 90 studies reported in 87 papers dealt with 11 different classes of interventions. Around 80% of the studies dealt with just four interventions: ultraviolet light, topical steroids, radiation and systemic immunosuppressives. Of the 90 studies, 44 were case series, 15 were nonrandomized controlled trials, and the remaining 31 were RCTs. Of the 31 RCTs, 16 were parallel (one with cross-over design) and 15 self-controlled. Only 11 of the RCTs adequately reported eligibility criteria. The randomization method was described in 10, and there was adequate concealment of allocation in eight. Masking the treatment allocation from both the study assessors and patients was done in 11 RCTs, and intention-to-treat analysis was reported in four. Only 13 RCTs were 4 months or longer in duration. No study reported a rationale for the sample size, and in only one study had the outcome variable been validated.Conclusions  Most ‘trials’ in hand eczema are not RCTs. Internally controlled (left/right) studies were common. Based on the poor overall quality of reporting, most RCTs of hand eczema trials are not adequate to guide clinical practice. Future trials of hand eczema should be randomized, using a parallel group or self-controlled design. Research is needed to develop validated and clinically relevant outcome measures. Most of the remaining issues relating to poor quality of existing evidence can be relatively easily dealt with by following the CONSORT guidelines.

Notizen: Summary Background Hand eczema is a common skin disease that affects about 10% of the general population of working age in Sweden. The resulting long sick-leave periods and need for changes of work and re-training put an economic burden on society, and there is an interest indeveloping cost-effective epidemiological surveillance instruments such as a screening questionnaire. Objectives In a search for a simple screening questionnaire for hand eczema we compared the validity of a question about the presence of hand eczema with hand eczema diagnosis based on self-reported signs. Methods Consecutive patients (n = 95) referred for hand eczema and people in an ongoing epidemiological survey (n = 113) participated in the study. Before seeing an experienced dermatologist they had to: (1) answer a short questionnaire about current signs and symptoms from the hands; and (2) state whether they had hand eczema on the day of examination. The minimum criteria for hand eczema diagnosed by the dermatologist (‘gold standard’) were erythema and papules or vesicles, or erythema and scaling and fissures/lichenification. Results Of the 208 persons examined 93 fulfilled the criteria for hand eczema according to the ‘gold standard’. Hand eczema diagnosis based on clinical signs reported in the questionnaire by the participants gave a sensitivity of 0·62 and a specificity of 0·87 in comparison with the dermatologists' diagnoses. Regarding the question about current hand eczema, agreement was good between the participants' and the dermatologists' judgements, giving a sensitivity of 0·87 and a specificity of 0·79. Comparing clinical signs reported by the participants and the findings by the dermatologists, the best agreement was for fissures, with a κ-value of 0·65 (95% CI 0·55–0·75), and the poorest was for papules with 0·47 (95% CI 0·32–0·62). Conclusions It was difficult for the individual to identify skin signs compatible with the clinical diagnosis of hand eczema. Asking ‘Do you have hand eczema?’ had high sensitivity and specificity compared to the suggested gold standard for hand eczema. However, the validity of a screening questionnaire depends on the type of population investigated.