Acceptability and perceived benefits of validated pruritus assessment instruments in the dermatological office and clinic: The perspectives of patients and physicians.

BACKGROUND: Several patient-reported outcome measures (PROMs) have been developed for research to assess the multiple dimensions of chronic pruritus (CP). The acceptability and perceived benefits of their use in clinical practice remain unknown. OBJECTIVES: To assess the acceptability and perceived benefits of validated PROMs from the perspective of patients and physicians in dermatological offices and clinics. METHODS: Patients with CP due to atopic dermatitis, psoriasis, chronic prurigo or chronic urticaria were recruited at 10 dermatological offices and two dermatological clinics in Germany. Patients completed a set of validated PROMs on pruritus intensity (numerical rating scale, NRS), symptom control (itch-controlled days, ItchCD), quality of life (Dermatology Life Quality Index, DLQI; 5-pruritus life quality, 5PLQ) and general health status (EuroQol, EQ-VAS). Acceptability (relevance, difficulty of completion, length) and benefits (usefulness, feasibility) of these tools were assessed on a NRS (0-10) by patients and physicians, respectively. Data were analysed descriptively. Linear regression was used to study potential associations between age, sex, occupation, office versus clinic, change of therapy and physician-reported benefits. RESULTS: N = 523 patients (46% male, average age: 53.5 years) participated. Acceptability of PROMs by patients was high, indicated by low difficulty (Md = 0, IQR = 0-1 for all PROMs) and high relevance (Md = 8, IQR = 4-10 for all PROMs). Also, most patients (89-95%) rated length of the questionnaires as 'exactly right'. Physicians rated the NRS as the most beneficial instrument (feasibility: Md = 8, IQR = 6-10; usefulness: Md = 9, IQR = 7-10). Hierarchical linear regression revealed that only recruitment site (dermatological office vs. clinic) was significantly associated with usefulness and feasibility (higher ratings for clinical context; ßs = 0.149-0.258, ps <0.05; except feasibility for EQ5d, ß = ns). CONCLUSION: PROMs are welcomed by patients, while physicians consider instruments measuring pruritus intensity and impairment of quality of life as beneficial for the clinical routine. Widespread implementation of PROMs in daily clinical work is needed to improve care.

EADV Task Force Pruritus White Paper on chronic pruritus and chronic prurigo: Current challenges and future solutions.

Chronic pruritus (CP) is frequent in general medicine and the most common complaint in general dermatology. The prevalence of CP is expected to rise in the future due to the ageing population. The clinical presentation, underlying aetiology and treatment strategy of CP are heterogeneous. Also, individual treatment aims and physical, psychic and economic burdens of patients might vary. Chronic prurigo (CPG) is the most severe disease in the chronic pruritus spectrum, being associated with long-standing scratch-induced skin lesions and a therapy refractory itch-scratch-cycle. It is thus important to raise disease awareness for CP and CPG in the general public and among decision-makers in the health system. Further, there is a need to support a rational clinical framework to optimize both diagnostics and therapeutics. Currently, there is still a shortcoming regarding approved therapies and understanding CP/CPG as severe medical conditions. Therefore, the EADV Task Force Pruritus decided to publish this white paper based on several consensus meetings. The group consented on the following goals: (a) ensure that CP is recognized as a serious condition, (b) increase public awareness and understanding of CP and CPG as chronic and burdensome diseases that can greatly affect a person's quality of life, (c) clarify that in most cases CP and CPG are non-communicable and not caused by a psychiatric disease, (d) improve the support and treatment given to patients with CP to help them manage their disease and (e) publicize existing therapies including current guidelines. We aim to point to necessary improvements in access and quality of care directed to decision-makers in health policy, among payers and administrations as well as in practical care.

Cadmium tolerance of Typha domingensis Pers. (Typhaceae) as related to growth and leaf morphophysiology / A tolerância ao cádmio por Typha domingensis Pers. (Typhaceae) correlacionada com o crescimento e a morfofisiologia foliar

Abstract Typha domingensis (cattail) is a native macrophyte known by its capacity to tolerate several heavy metals effects and the potential use for phytoremediation. However, in despite that cadmium (Cd) is one of the most toxic pollutants; its effects in T. domingensis biology remain uninvestigated. Thus, the objective of this study was to study the tolerance of T. domingensis to cadmium contamination by evaluating its growth, Cd uptake, leaf anatomy and gas exchange. The experiment was designed using three cadmium concentrations (0, 10 and 50 µM) and ten replicates for 90 days. The cadmium uptake, growth, gas exchange, chlorophyll content and leaf anatomy were evaluated. Data was submitted to ANOVA and Scott-Knott test for P<0.05. Typha domingensis accumulates Cd proportionally to its concentration on the solution and the content of this metal was higher in roots as compared to shoots. Plants showed no significant modifications on growth parameters such as the biomass production, number of leaves, number of clones and the biomass allocation to organs. The photosynthesis, transpiration and chlorophyll content were not modified by Cd. Most anatomical traits evaluated were not modified by the metal but the stomatal density and the proportion of vascular tissues were reduced under 50 µM of Cd. In despite, the leaf anatomy showed no toxicity evidences for any Cd level. The absence of growth reduction and the stability of anatomical and physiological traits give insight about the Cd tolerance of this species. Therefore, T. domingensis is able to overcome Cd toxicity and shows potential for phytoremediation.

Resumo A espécie Typha domingensis (taboa) é uma macrófita nativa conhecida por sua tolerância a vários metais pesados e potencial uso na fitorremediação. Contudo, apesar de que o Cd é um dos poluentes mais tóxicos; Seus efeitos em T. domingensis ainda não foram investigados. Assim, o objetivo desse estudo foi avaliar a tolerância de T. domingensis ao cádmio, avaliando o crescimento, absorção de Cd, anatomia foliar e trocas gasosas. O experimento foi conduzido utilizando três concentrações de Cd (0, 10 e 50 µM) e dez repetições por 90 dias.. O crescimento, trocas gasosas e o teor de clorofila e anatomia foliar foram avaliados. Os dados foram submetidos à ANOVA e ao teste de Scott-Knott para P<0,05. A absorção de cádmio, crescimento, trocas gasosas, teor de clorofila e anatomia foliar foram analisados. As plantas de T. domingensis podem acumular Cd proporcionalmente à sua concentração na solução e o teor deste metal foi maior nas raízes em comparação com a parte aérea. As plantas não apresentam modificações significativas nos parâmetros de crescimento como produção de biomassa, número de folhas, número de clones produzidos e alocação de biomassa nos órgãos. A fotossíntese, transpiração e conteúdo de clorofila não foram afetados de forma significativa pelo Cd. A maioria das características anatômicas avaliadas não apresentou diferenças, mas houve redução na densidade estomática e na proporção de tecidos vasculares na concentração de 50 µM de Cd. A anatomia foliar não mostrou evidências de toxicidade em nenhum dos níveis de Cd. A ausência de redução de crescimento e estabilidade das características anatômicas e fisiológicas caracteriza alta tolerância da espécie ao Cd. Portanto, T. domingensis é capaz de superar a toxicidade do Cd e demostra potencial para fitorremediação.

Anatomical traits related to stress in high density populations of Typha angustifolia L. (Typhaceae) / Características anatômicas relacionadas ao estresse em altas densidades populacionais de Typha angustifolia L. (Typhaceae)

Abstract Some macrophytes species show a high growth potential, colonizing large areas on aquatic environments. Cattail (Typha angustifolia L.) uncontrolled growth causes several problems to human activities and local biodiversity, but this also may lead to competition and further problems for this species itself. Thus, the objective of this study was to investigate anatomical modifications on T. angustifolia plants from different population densities, once it can help to understand its biology. Roots and leaves were collected from natural populations growing under high and low densities. These plant materials were fixed and submitted to usual plant microtechnique procedures. Slides were observed and photographed under light microscopy and images were analyzed in the UTHSCSA-Imagetool software. The experimental design was completely randomized with two treatments and ten replicates, data were submitted to one-way ANOVA and Scott-Knott test at p<0.05. Leaves from low density populations showed higher stomatal density and index. These modifications on stomatal characteristics were more evident on the leaf abaxial surface. Plants from low density populations showed thicker mesophyll and higher proportion of aerenchymal area. Roots from low density populations showed a higher proportion of the vascular cylinder. Whereas, plants from higher density populations showed greater thickness of the endodermis, exodermis, phloem and root cortex. Higher density populations showed a higher proportion of aerenchymal gaps in the root cortex. Therefore, cattail plants from populations growing under high density population show anatomical traits typical of plants under stress, which promotes the development of less functional anatomical modifications to aquatic environments.

Resumo Algumas espécies de macrófitas podem apresentar um elevado potencial de crescimento, colonizando extensas áreas de ambientes aquáticos. O crescimento descontrolado da taboa (Typha angustifolia L.) causa problemas para a biodiversidade local e para atividades antrópicas, isso também pode levar à competição e problemas para a própria espécie. Dessa forma, o objetivo desse trabalho foi verificar se ocorrem modificações anatômicas em plantas de Typha angustifolia L. de diferentes densidades populacionais, uma vez que essas podem auxiliar na compreensão da biologia dessa espécie. Raízes e folhas de T. angustifolia foram coletadas de populações naturais com alto e baixo adensamento populacional. Esse material vegetal foi fixado e submetido a procedimentos usuais de microtécnica vegetal. As lâminas foram observadas e fotografadas em microscopia de luz e as imagens analisadas no software UTHSCSA-Imagetool. O delineamento experimental foi inteiramente casualizado com dois tratamentos e dez repetições, os dados foram submetidos à análise de variância e ao teste de Scott-Knott para p<0,05. As folhas das populações com baixa densidade demonstraram maior densidade e índice estomáticos. Essas características foram mais evidentes na superfície abaxial em comparação com a superfície adaxial. As plantas de populações com baixo adensamento demonstraram maior espessura do mesofilo e área de aerênquima foliar. As raízes das populações com baixo adensamento demonstraram maior proporção do cilindro vascular. Por outro lado, as plantas de populações com alto adensamento demonstraram maior espessura da endoderme, exoderme, floema e do córtex nas raízes. Populações de alto adensamento demonstraram maior proporção de aerênquima no córtex radicular. Portanto, plantas de taboa sob alto adensamento populacional estão sob estresse o qual promove o desenvolvimento de modificações anatômicas menos funcionais para os ambientes aquáticos.