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ABSTRACT: PURPOSE: Late HIV presentation is still a health concern, even in industrialised countries. Data concerning this problem in Eastern Germany are scarce. We investigated associated factors in a cohort of HIV-infected patients in Dresden, Germany, including syphilis serology as a proxy for sexual risk behaviour. METHODS: A retrospective cohort study on 348 patients presenting for the first time in our treatment centre from 1986 to 2010 was undertaken. Risk factors of late (CD4 cells <350/μl) and very late (CD4 cells <200/μl) presentation either to care or to diagnosis were identified by means of logistic regression analyses. RESULTS: Of 348 classifiable patients, 54 % were late and 33.9 % were very late presenters to care. In a subgroup of 260 patients with recent HIV diagnosis, 50.4 % were late and 31.2 % were very late presenters to diagnosis. Age >24 years was a significant independent factor associated with late or very late presentation, but not male gender, originating from high-prevalence countries (HPC) or years of presentation. Being MSM alone was not associated with early or late HIV presentation, but MSM with positive TPHA or TPPA showed a lower risk of late presentation, predominantly in those presenting late to diagnosis [odds ratio (OR) 0.42, p = 0.048]. CONCLUSIONS: A positive syphilis screening test seems to be a determinant for lower risk of late presentation to HIV care and diagnosis in MSM. The presence and awareness of sexually transmitted infections (STIs) such as syphilis may lead to earlier utilisation of HIV health care and, thus, promote earlier HIV diagnosis. HIV prevention strategies should focus more on STIs and not only on HIV.
Infection 06/2013; · 2.66 Impact Factor
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ABSTRACT: Background: Atopic dermatitis (AD) and attention-deficit/hyperactivity disorder (ADHD) are frequent paediatric conditions with high medical relevance. A possible relationship between atopic diseases (i.e., AD, asthma, and allergic rhinitis) has long been discussed, but convincing evidence is still missing. Methods: We investigated the relationship between AD and ADHD in two cross-sectional studies and in two birth cohort studies considering lifestyle factors, environmental factors, and atopic comorbidities as potential confounders. To quantify the strength of association between AD and ADHD, data from the four epidemiologic studies were summarized by means of a meta-analysis. Odds ratios (OR) were pooled for the association between prevalent or previous AD and prevalent ADHD from the four studies adjusted for age, sex, and atopic comorbidity (allergic rhinitis, asthma). Results: The epidemiologic studies conducted consistently indicate an association between AD and ADHD which is independent of environmental exposures and other comorbidities. Particularly infant AD appears to be associated with later development of ADHD symptoms. Sleeping problems due to AD are suggested as playing an important role for the observed association between AD and ADHD. The pooled OR (95 % confidence interval (95 %CI)) for the association between AD and ADHD was 1.43 (1.25-1.64). Discussion: Four new epidemiologic studies consistently indicate a positive association between AD and ADHD. Compared to children without AD, children with previous or prevalent AD have an approximately 43 % increased risk to be diagnosed with ADHD or to display clinical ADHD symptoms. Following our findings, the biological mechanisms underlying the observed comorbidity between AD and ADHD require further investigation in order to subsequently develop targeted therapeutic and preventive strategies.
Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 01/2013; 41(1):35-44. · 0.99 Impact Factor
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ABSTRACT: ZUSAMMENFASSUNG Hintergrund: Die kumulativ einwirkende solare ultraviolette (UV) Strahlung ist für die weltweite Zunahme der nichtmelanozytären Hautkarzinome verantwort-lich. Dazu zählen Plattenepithelkarzinome und deren Frühformen – die aktini-schen Keratosen – sowie Basalzellkarzinome. Nichtmelanozytäre Hautkarzino-me stellen die häufigste Krebserkrankung in Regionen mit hellhäutiger Bevöl-kerung dar. An vielen Außenarbeitsplätzen ist eine erhöhte beruflich bedingte Exposition gegenüber UV-Strahlung gegeben. Neuere Untersuchungen weisen auf einen Zusammenhang zwischen Außenarbeitsplätzen und der Entstehung von nichtmelanozytärem Hautkrebs hin. Methoden: Basierend auf einer selektiven Literaturrecherche werden die Er-kenntnisse zur beruflich und außerberuflich bedingten Exposition gegenüber UV-Strahlung sowie die Ergebnisse von Metaanalysen zum Zusammenhang zwischen Außentätigkeiten und dem vermehrten Auftreten von nichtmelanozy-tärem Hautkrebs dargestellt. Zudem wird eine Übersicht über Empfehlungen zur Prävention und Begutachtung gegeben.
Deutsches Ärzteblatt 10/2012; Deutsches Ärzteblatt(109-43):715-720.
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ABSTRACT: Background: The cumulative effect of solar ultraviolet (UV) radiation is respon-sible for the worldwide increase in non-melanoma skin cancer, a category that includes squamous cell carcinoma and its precursors (the actinic keratoses) as well as basal-cell carcinoma. Non-melanoma skin cancer is the most common type of cancer in areas of the world with a light-skinned population. The occu-pational exposure to UV radiation is high in many outdoor occupations; recent studies suggest that persons working in such occupations are more likely to develop non-melanoma skin cancer. Methods: On the basis of a selective review of the literature, we present the current state of knowledge about occupational and non-occupational UV expo-sure and the findings of meta-analyses on the association of outdoor activity with non-melanoma skin cancer. We also give an overview of the current rec-ommendations for prevention and for medicolegal assessment.
Deutsches Ärzteblatt International. 10/2012; Dtsch Arztebl Int(109-43):715-20.
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ABSTRACT: The cumulative effect of solar ultraviolet (UV) radiation is responsible for the worldwide increase in non-melanoma skin cancer, a category that includes squamous cell carcinoma and its precursors (the actinic keratoses) as well as basal-cell carcinoma. Non-melanoma skin cancer is the most common type of cancer in areas of the world with a light-skinned population. The occupational exposure to UV radiation is high in many outdoor occupations; recent studies suggest that persons working in such occupations are more likely to develop non-melanoma skin cancer.
On the basis of a selective review of the literature, we present the current state of knowledge about occupational and non-occupational UV exposure and the findings of meta-analyses on the association of outdoor activity with non-melanoma skin cancer. We also give an overview of the current recommendations for prevention and for medicolegal assessment.
Recent meta-analyses have consistently documented a significantly higher risk of squamous cell carcinoma of the skin among persons who work outdoors (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.40-2.22, p<0.001). There is also evidence for an elevated risk of basal-cell carcinoma (OR 1.43, 95% CI 1.23-1.66, p = 0.0001), but the effect is of lesser magnitude and the study findings are not as uniform.
The association of occupational exposure to solar UV radiation with squamous cell carcinoma, including actinic keratosis, has been conclusively demonstrated. It follows that, in Germany, suspected non-melanoma skin cancer in persons with high occupational exposure to UV radiation should be reported as an occupational disease under § 9, paragraph 2 of the Seventh Book of the German Social Code (Sozialgesetzbuch, SGB VII). Preventive measures are urgently needed for persons with high occupational exposure to UV radiation.
10/2012; 109(43):715-20. · 2.92 Impact Factor
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Archives of pediatrics & adolescent medicine 09/2012; · 3.73 Impact Factor
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Jochen Schmitt,
Phyllis Spuls,
Maarten Boers,
Kim Thomas,
Joanne Chalmers,
Evelien Roekevisch,
Mandy Schram,
Richard Allsopp,
Valeria Aoki,
Christian Apfelbacher, [......],
Yael Rosenbluth,
Hidehisa Saeki,
Marie-Louise Schuttelaar,
Jean-Francois Stalder,
Ake Svensson,
Roberto Takaoka,
Carl-Fredrik Wahlgren,
Stephan Weidinger,
Andreas Wollenberg,
Hywel Williams
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ABSTRACT: The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research.
Allergy 07/2012; 67(9):1111-7. · 6.27 Impact Factor
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ABSTRACT: Background: Systemic sclerosis (SSc) is a rare connective tissue disease. Few data are available on treatment satisfaction, determinants of quality of life, and the health status of dermatology patients with SSc. Patients and methods: Cross-sectional study based on 72 consecutive dermatological patients with SSc. Objective clinical data were collected with a physician's questionnaire and subjective data were collected with a patients' questionnaire on disease characteristics, treatment satisfaction, quality of life, depressive symptoms, and Antonovsky's sense of coherence (SOC). We also tested the significance of possible determinants of treatment satisfaction. Results: Treatment satisfaction was 72.0 (± 22.2; VAS 1-100). The assessment of professional competence of the treating physician was the most important determinant of treatment satisfaction and was independent of the patient's age and sex. The assessment of physician empathy, information about the disease, and the patient's own evaluation of the severity of disease were also associated with treatment satisfaction. The mean health-related quality of life (QoL; EQ-5D) was 0.74 (± 0.28) and the mean SOC was 72.6 (± 10.6). 58 % of patients reported moderate to severe pain and 13 % were treated for pain symptoms. In 69 % there was evidence of probable depression (CES-D $ 22); 8 % were on antidepressants. Conclusions: Treatment satisfaction was average and correlated especially with the sense of professional competence of the treating physician. In SSc patients, a diminished health-related quality of life as well as pain and evidence of depression are common and seem to be inadequately treated. However, the SOC indicates a lower general vulnerability. In the future, screening for pain and symptoms of depression should part of routine practice in SSc patients and, if necessary, interdisciplinary care should be initiated.
Journal der Deutschen Dermatologischen Gesellschaft 07/2012; · 1.47 Impact Factor
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MMW Fortschritte der Medizin 05/2012; 154(8):52-3.
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ABSTRACT: AimTo systematically describe and summarize the specific occupational health impact of tobacco farm working.
Subjects and methodsQualitative systematic review applying a standardized electronic literature search strategy (MEDLINE, TOXNET, EMBASE, AGRICOLA,
Science Citation Index; until January 2007) and hand search within eligible articles. Double assessment of eligibility and
study results. Inclusion of all studies on specific work-related health risks of tobacco farm workers, e.g. risk factors for
and frequency of green tobacco sickness (GTS) and other specific health risks, as well as intervention studies.
ResultsWe identified 31 relevant publications. Concerning GTS substantial heterogeneity was observed in terms of the case definition
and frequency of disease occurrence. Seasonal prevalence ranged between 8 and 89%. Incidence was reported to be 1.9 cases
per 100 person days. In the two studies included on primary prevention of GTS hand washing and the use of protective clothes
were effective. Studies conducted on cancer as well as on urticaria and contact eczema in tobacco harvesters are scarce.
ConclusionHealth problems due to transdermal nicotine absorption are frequent among tobacco harvesters. GTS as well as chronic health
effects in this population need to be further investigated. The toxicity to the cardiovascular system and carcinogenicity
of chronic dermal nicotine exposure are likely to exist as non-smoking tobacco harvesters show similar cotinine and nicotine
levels compared to active smokers in the general population. Effective intervention strategies addressing the specific needs
of the tobacco harvesters in different regions around the world must be developed, evaluated and further improved. It is important
to educate tobacco farm workers, farmers and health care providers on GTS and other health risks.
Journal of Public Health 04/2012; 15(4):255-264. · 2.06 Impact Factor
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ABSTRACT: Hintergrund und Ziel:
Die Entwicklung verschiedener biologischer Therapien (sog. Biologics) ist ein großer Fortschritt für die Behandlung der Psoriasis
vulgaris. Diese Metaanalyse fasst die Evidenz aus randomisierten kontrollierten Studien (RCTs) der in Deutschland zur Behandlung
der mittelschweren bis schweren Psoriasis vulgaris zugelassenen Biologics zusammen.
Material und Methodik:
Systematisches Review und Metaanalyse aller RCTs, in denen im Januar 2008 in Deutschland zur Behandlung der mittelschweren
bis schweren Psoriasis vulgaris zugelassene Biologics geprüft wurden. Identifikation relevanter Studien durch systematische
elektronische Literaturrecherche in MEDLINE, EMBASE, Cochrane Library und Scopus. Primärer Endpunkt: Anteil an Patienten mit
mindestens 75%iger Reduktion im Psoriasis Area and Severity Index (PASI) Score (PASI75-Responder), sekundäre Endpunkte: klinisch
relevante Besserung der Lebensqualität, monatliche Inzidenz an Studienabbrüchen und unerwünschten Ereignissen. Die Prozentsätze
der PASI75-Responder wurden als Risikodifferenz (RD) dargestellt und statistisch zusammengefasst.
Ergebnisse:
25 Artikel zu 16 RCTs mit insgesamt 8 057 Patienten mit mittelschwerer bis schwerer Psoriasis vulgaris wurden qualitativ analysiert.
15 doppelblinde, plazebokontrollierte Studien wurden in die Metaanalyse eingeschlossen. Infliximab war wirksamer als alle
anderen biologischen Optionen als Kurztherapie für die mittelschwere bis schwere Psoriasis vulgaris (RD [95%-Konfidenzintervall,
CI] 76% [72–80%]). Adalimumab (RD [95%-CI] 59% [45–73%]) war wirksamer als Efalizumab (RD [95%-CI] 24% [19–30%]) und Etanercept.
Bei Etanercept bestand ein deutlicher Dosis-Wirkungs-Effekt (2 × 50 mg wöchentlich: RD [95%-CI] 44% [40–48%]; 2 × 25 mg wöchentlich:
RD [95%-CI] 30% [25–35%]). Die Behandlung mit allen untersuchten Biologics verbesserte die Lebensqualität der Psoriasispatienten.
Die monatliche Rate an Studienabbrüchen aufgrund unerwünschter Ereignisse betrug bei Infliximab 1,2%, bei Etanercept 0,5%,
bei Efalizumab 1,0% und bei Adalimumab 0,5%.
Schlussfolgerung:
Der klinische Nutzen der einzelnen derzeit zur Behandlung der mittelschweren bis schweren Psoriasis vulgaris zugelassenen
Biologics unterscheidet sich beträchtlich. Infliximab ist die wirksamste Therapieoption, gefolgt von Adalimumab. Große kontrollierte
Studien deuten auf eine hohe Sicherheit aller Präparate in der Kurzzeittherapie hin. Kürzlich etablierte Register werden weitere
wichtige Daten zur Sicherheit unter Alltagsbedingungen liefern.
Background and Purpose:
The development of different biological therapies (so-called biologics) is a great progress for the treatment of the psoriasis
vulgaris. The evidence from randomized controlled trials (RCTs) of biologics, which have been licensed in Germany for the
treatment of moderate-to-severe psoriasis vulgaris, were pooled in this meta-analysis.
Material and Methods:
Systematic review and meta-analysis of all RCTs, in which biologics licensed in Germany as of January 2008 for the treatment
of moderate-to-severe psoriasis vulgaris were examined. Relevant trials were identified by systematic electronic literature
search in MEDLINE, EMBASE, Cochrane Library, and Scopus. Primary endpoint: proportion of patients achieving a 75% reduction
in the Psoriasis Area and Severity Index (PASI) Score (PASI75 responder), secondary endpoints: clinically relevant improvement
in the quality of life, monthly incidences of study withdrawals and adverse events. PASI75 response rates were statistically
pooled and represented as risk differences (RD).
Results:
25 articles on 16 RCTs totaling 8,057 patients with moderate-to-severe psoriasis vulgaris were qualitatively analyzed. 15
double-blind and placebo- controlled trials were compared by meta-analysis. Infliximab had the highest efficacy in the short-term
therapy of moderate-to-severe psoriasis vulgaris (RD [95% confidence interval, CI] 76% [72–80%]). Adalimumab (RD [95% CI]
59% [45–73%]) was more effective than efalizumab (RD [95% CI] 24% (19–30%]) and etanercept. Treatment with etanercept showed
a clear dose-response effect (50 mg twice weekly: RD [95% CI] 44% (40–48%]; 25 mg twice weekly: RD [95% CI] 30% (25–35%]).
All biologics improved the quality of life of psoriasis patients. Monthly incidence rates of withdrawals due to adverse events
were 1.2% for infliximab, 0.5% for etanercept, 1.0% for efalizumab, and 0.5% for adalimumab.
Conclusion:
A patient’s chance to reach considerable clinical benefit differs significantly between the different biological therapies
currently approved for moderate-to-severe psoriasis vulgaris. Infliximab is most effective, followed by adalimumab. Large
controlled studies indicate a high safety of all biologics in the short-term treatment. Recently established registers will
provide additional important safety data under real-life conditions.
04/2012; 104(2):125-136.
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Journal der Deutschen Dermatologischen Gesellschaft 04/2012; 10(4):258-64. · 1.47 Impact Factor
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ABSTRACT: Dapsone is widely used in the treatment of leprosy and several chronic inflammatory dermatological conditions. Hypersensitivity reactions to dapsone are potentially fatal adverse drug reactions with unknown prevalence and risk factors. We performed a systematic review covering all reported cases of hypersensitivity reactions, in order to systematically summarize the published evidence on prevalence, clinical course and fatality rate. Articles were identified through standardized search strategies. Included studies were reviewed for hypersensitivity characteristics and odds ratios were calculated in univariate and multivariate regression models to assess the risk factors for fatal outcome. A total of 114 articles (17 epidemiological studies, 97 case reports) totalling 336 patients with hypersensitivity reactions were included for analysis. From the epidemiological studies a total hypersensitivity reaction prevalence rate of 1.4% (95% confidence interval 1.2–1.7%) was determined. Mucosal involvement, hepatitis, higher age and disease occurrence in non-affluent countries were associated with higher risk of fatal outcome. Overall, the fatality rate was 9.9%.
Acta Dermato-Venereologica 03/2012; 92(2):194-9.
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Journal of Investigative Dermatology 09/2011; · 6.31 Impact Factor
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ABSTRACT: Semipermanent henna tattoos containing para-phenylenediamine (PPD) are a well-known cause of severe contact dermatitis, mainly in children. Another relevant exposure source to PPD are hair dyes, which are increasingly used by children and have also been reported to cause intense facial and scalp dermatitis. German patch test guidelines for children recommend that PPD should only be tested in patients who have had a henna tattoo, and then at a reduced concentration of PPD 0.5 % for 24 hours.
We report on patch test results in four patients, three children and one adolescent, with a history of contact dermatitis to henna tattoos or hair dye. We used the recommended or even lower patch test concentrations of PPD with 24-hours exposure in all patients.
All patients showed very strong patch test reactions to PPD and cross-reactions to related compounds even after dilution of PPD to as low as 0.05 %. Therefore, we suggest that in children with a history of allergic reactions to this compound, a titration test should be performed beginning at a concentration of maximal 0.05 %. This procedure has also been proposed previously based on a larger cases series in adults.
Journal der Deutschen Dermatologischen Gesellschaft 08/2011; 10(4):258-64. · 1.47 Impact Factor
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ABSTRACT: Topical corticosteroids are widely used to treat atopic dermatitis (AD), but their anti-inflammatory mode of action can be accompanied by several unwanted side effects including skin atrophy and telangiectasia. In this 8-week, investigator-blinded, intraindividual right-left comparison study with patients with mild-to-moderate AD, hydrocortisone 1% cream (HCT) was applied twice daily for 4 weeks on one side of forehead skin without clinical signs of AD and pimecrolimus 1% cream (PIM) on the other. Epidermal and dermal thickness were assessed by optical coherence tomography (OCT) and high-frequency ultrasound, respectively. Skin atrophy and telangiectasia were assessed by contact dermatoscopic photography (Dermaphot(®)). Treatment with HCT leads to a significant decrease in epidermal thickness after only 2 weeks of treatment, while the decrease in PIM-treated sites was less pronounced and was not statistically significant. By 4 weeks after the end of treatment, epidermal thickness returned to baseline values. No dermal thinning or development of telangiectasia could be observed by means of ultrasound or Dermaphot(®), respectively. In summary, this study indicates that a 2-week single course of topical treatment with a mildly potent steroid can cause transient epidermal thinning, an effect not seen in the PIM group. The slight decrease with PIM - although not significant - could be due to normalization of the increased skin thickness caused by a subclinical inflammation in AD. This study suggests that PIM may be safer for treatment of AD in sensitive skin areas like the face, especially when repeated application is required.
Experimental Dermatology 06/2011; 20(10):832-6. · 3.54 Impact Factor
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Christian Joachim Apfelbacher,
Wilhelm Akst,
Sonja Molin, Jochen Schmitt,
Andrea Bauer,
Elke Weisshaar,
Vera Mahler,
Sabine Treichel,
Thomas Ruzicka,
Thomas Luger,
Peter Elsner,
Thomas Ludwig Diepgen
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ABSTRACT: The aim of the CARPE (German acronym: Chronisches Handekzem-Register zum Patienten-Langzeitmanagement; meaning: chronic hand eczema registry on long-term patient management) registry is to investigate characteristics and treatment modalities in patients affected by chronic hand eczema in Germany.
The registry was built up under the auspices of the German Dermatological Society (Deutsche Dermatologische Gesellschaft, DDG). Patients with chronic hand eczema are prospectively assessed by dermatological examination and patient questionnaire. Socio-economic data and data on diagnostics, skin status, severity and treatment of chronic hand eczema and atopy criteria are repeatedly assessed. Here, we present baseline characteristics of the first 515 patients.
53.8 % of the patients were female, mean age was 47.3 years. The average duration of CHE was 7.7 years. 30.4 % had already received inpatient care, 31.2 % had been on sick leave in the past 12 months. 94.5 % had received topical corticosteroids prior to inclusion in the registry, 31.9 % topical calcineurin inhibitors, 38.3 % UV therapy, 28.6 % systemic antihistamines, 36.5 % systemic treatments, 14.9 % systemic corticosteroids, 25.8 % systemic retinoids.
The CARPE project demonstrates the high medical burden and therapeutic challenge of chronic hand eczema and presents first data for health care research. Furthermore, the designed follow-up study will present important data about the natural history and prognosis of this chronic skin disease.
Journal der Deutschen Dermatologischen Gesellschaft 05/2011; 9(9):682-8. · 1.47 Impact Factor
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ABSTRACT: Approximately 15 % of all cases of melanoma are diagnosed before age 35 years. In Germany, individuals ≥ 35 years are eligible for the national skin cancer screening program. The effectiveness of a population-based skin cancer screening in general and in particular for young adults is unclear.
Assessment of the effectiveness of a skin cancer screening program and of risk factors for detection of a melanoma/atypical nevus in the setting of a screening for the age group 14 to 34 years.
A total of 12,187 individuals age 14 to 34 years were screened in Saxony for skin cancer by a dermatologist in the program "Haut-Check 14-34 Jahre" of the AOK PLUS, a large German health insurance, between January and July 2009. Demographic, clinical and histopathological data and UV-exposure data were collected from each participant. Multivariate logistic regression models were used to assess risk factors for the detection of a (histopathologically confirmed) melanoma or atypical nevus.
2.8 % of the eligible individuals participated in the skin cancer screening program with women being more likely to do so. In 1 072 individuals (8.8 %) screening included at least one excision of a skin lesion leading to the diagnosis of melanoma in two participants, melanoma in situ in four persons, and atypical nevus in 641 persons. Use of tanning beds, higher age, number of nevi, and previous cutaneous excision were independent risk factors for the detection of a melanoma or atypical nevus.
In 5.5 % of all cases skin cancer screening resulted in the excision of a malignant or atypical melanocytic lesion. It remains unclear what proportion of these cases would have been detected in routine care. The rate of excisions per newly diagnosed melanoma was 179 : 1. Further investigations are necessary to explore the reasons for this low diagnostic specificity. This study highlights the possibilities and limitations of routine data to evaluate screening programs and indicates the need to collect additional information on healthcare utilization behaviour.
Journal der Deutschen Dermatologischen Gesellschaft 04/2011; 9(8):608-16. · 1.47 Impact Factor
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ABSTRACT: Several studies have looked at the relationship between childhood atopic disease and health-related quality of life (HRQoL), but existing research is limited by selected populations, small samples or lack to consider each of the three atopic conditions simultaneously.
Impact of 4-week and 12-month occurrences of the three conditions on HRQoL were analysed by the use of complex sample general linear models alone and adjusted for the other atopic conditions, sociodemographics and mental health in a population-based sample (n = 6,518) of children and adolescents aged 11-17.
In univariate analyses, total HRQoL was significantly impacted by eczema and hay fever but not asthma with stronger effects for 4-week occurrence. In multivariate analyses, 12-month occurrence of hay fever and 4-week occurrence of eczema and hay fever significantly impacted on total HRQoL. Although most of the variance in HRQoL was explained by mental health, independent effects of the atopic conditions remained.
Atopic conditions impact HRQoL over and above mental health. When analysing the relationship between atopic conditions and HRQoL, it is important to consider more immediate versus less immediate effects of the conditions. Extent of impairment and the domains affected appear to vary when different time intervals are used.
Quality of Life Research 02/2011; 20(8):1295-305. · 2.30 Impact Factor
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ABSTRACT: Eczema, as defined by the World Allergy Organization (WAO) revised nomenclature in 2003, affects 15% to 20% of school children and 2% to 5% of adults worldwide. About 50% of people with eczema demonstrate atopy, with specific immunoglobulin E responses to allergens. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of topical medical treatments, and dietary interventions in adults and children with established eczema? What are the effects of breastfeeding, reducing allergens, or dietary interventions for primary prevention of eczema in predisposed infants? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 54 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: breastfeeding, controlling house dust mites, corticosteroids, dietary exclusion of eggs or cow's milk, elementary diets, emollients, essential fatty oils, few-foods diet, multivitamins, pimecrolimus, probiotics, pyridoxine, reducing maternal dietary allergens, tacrolimus, vitamin E, and zinc supplements.
Clinical evidence 01/2011; 2011.
