Fiabilidad y validez de constructo de la versión colombiana del instrumento de calidad de vida Skindex-29© en Medellín, Colombia / Reliability and construct validity of the colombianversion of the quality of life instrumentSkindex-29© in Medellin, Colombia / Fiabilidade e validade de constructo da versão colombianado instrumento de qualidade de vidaskindex-29© em Medellín, Colômbia

Introducción: La adaptación cultural de los instrumentos de calidad de vida y su evaluación psicométrica se deben hacer de forma rigurosa y estandarizada. Objetivo: evaluar la fiabilidad y la validez de constructo de la versión colombiana del instrumento Skindex-29©. Métodos: se incluyeron pacientes con enfermedades cutáneas inflamatorias o generalizadas; con enfermedades no inflamatorias o localizadas, e individuos sanos y se determinó la fiabilidad intraobservador e interobservador. Resultados: se encuestaron 265 individuos. El coeficiente alfa de Cronbach fue de 0,957 para el instrumento total. Los coeficientes de correlación intraclase de la consistencia intraobservador e interobservador fueron superiores al 0,9. Los pacientes con enfermedades dermatológicas generalizadas y con dermatosis inflamatorias tuvieron puntuaciones más altas que las de aquellos con lesiones cutáneas no inflamatorias o aisladas. Conclusiones: los resultados corroboran la validez de constructo del instrumento estudiado. En el futuro es necesario evaluar otras propiedades psicométricas del mismo tales como su validez de contenido y de criterio y su sensibilidad al cambio.

Background: The cultural adaptation of quality of life instruments and their psychometric evaluation should be done rigorously and according to the standards. Objective: This study assessed the reliability and construct validity of the Colombian version of the Skindex-29 instrument. Methods: Patients with inflammatory or generalized skin diseases and with non-inflammatory or localized diseases, and healthy individuals were included. We determined the intra- and inter-observer reliability. Results: We surveyed 265 individuals. Cronbach’s alpha was 0.957 for the total instrument. The intraclass correlation coefficients for intra-observer and inter-observer consistency were higher than 0.9. Patients with generalized or inflammatory diseases had higher scores than those with non-inflammatory or isolated lesions. Conclusions: The results support the construct validity of the studied instrument. In the future, it is necessary to evaluate other psychometric properties such as its content and criteria validity, and its sensitivity to change.

Introdução: A adaptação cultural dos instrumentos de qualidade de vida e sua avaliação psicométrica, deve se fazer de forma rigorosa e padronizada. Objetivo: Avaliar a fiabilidade e a validade de constructo da versão Colombiana do instrumento Skindex-29©. Métodos: Se incluíram pacientes com doenças cutâneas inflamatórias ou generalizadas; com doenças não inflamatórias ou localizadas e indivíduos saudáveis e se determinou a fiabilidade intra e inter-observador. Resultados: Se entrevistaram um total de 265 indivíduos. O coeficiente alfa de Cronbach foi de 0.957 para o instrumento total. Os coeficientes de correlação intra-aula da consistência intra-observador e inter-observador foram superiores a 0.9. Os pacientes com doenças dermatológicas e com dermatose inflamatórias apresentaram pontuações mais altas do que os pacientes com lesões cutâneas não inflamatórias ou isoladas. Conclusões: Mediante este estudo se corroboro a validade de constructo do instrumento. No futuro é necessário avaliar outras propriedades psicométricas do instrumento tais como sua validade de conteúdo, de critério e sua sensibilidade à mudança.

Preprueba para la adaptación cultural de la versión española del instrumento de calidad de vida dermatológico Skindex-29, en Colombia / Pre-test for the cross cultural adaptation of the Spanish version of the quality of life instrument Skindex-29 in Colombia

Antecedentes. La investigación clínica, y en especial los ensayos clínicos, debe involucrar la evaluación de la calidad de vida relacionada con la salud como una de las maneras de medir los desenlaces subjetivos de las intervenciones sobre las personas. Objetivo. Evaluar la comprensión e interpretación de la versión española del Skindex-29 entre colombianos. Pacientes y métodos. El cuestionario fue administrado a adultos colombianos que consultaron por cualquier enfermedad dermatológica a la consulta externa de la Institución Prestadora de Salud (IPS) Universitaria de la Universidad de Antioquia o a un consultorio dermatológico particular, y a individuos sanos que no presentaban ningún trastorno cutáneo. Cada uno de los sujetos manifestaba la comprensión o no de cada pregunta y sugería la posibilidad de cambiar su redacción. Resultados. Se encuestaron 21 individuos: 9 sanos y 12 con algún problema dermatológico. La edad promedio fue de 41,7 años y 66,7% eran mujeres. De los 29 ítems, cuatro requirieron traducción y “retrotraducción”. Entre estos, en el ítem 25 se continuaron presentando dificultades en la comprensión, por lo que se requirió utilizar otra versión traducida y “retrotraducida” del ítem, con lo cual se logró su comprensión completa en una nueva prueba en 20 individuos. Conclusión. Se obtuvo una versión colombiana preliminar del Skindex-29. Se requirió la traducción y “retrotraducción” de cuatro ítems antes de aplicar dicho cuestionario a una población colombiana. En un paso siguiente, se evaluarán las propiedades sicométricas del cuestionario final y la determinación de su validez de constructo, su fiabilidad y su sensibilidad al cambio.

Self-reported adherence to treatment and quality of life in mild to moderate acne.

BACKGROUND: Adherence to treatment is a mayor issue in dermatology, and its relationship to quality of life has barely been studied. OBJECTIVE: To evaluate the relationship between scores on the Skindex-29 skin disease assessment scale and adherence to treatment in patients with acne. METHODS: An observational, prospective study of 1,628 patients carried out by 252 clinicians in Spain. RESULTS: Adherence was related to better objective and subjective severity index scores and better Skindex-29 scale scores at the end of the study. Young, male and unemployed patients had the worst adherence scores. Baseline and final Skindex-29 scale scores were significantly worse in non-adherent females, while non-adherent males scored better. Reasons for non-adherence were side effects for older patients and forgetfulness for younger ones. CONCLUSION: Dermatologists should explain that adherence to treatment is linked to better outcomes and better quality of life. Young females with high Skindex-29 scale scores and males with low Skindex scores are especially prone to non-adherence.

Use of biological agents in patients with moderate to severe psoriasis: a cohort-based perspective.

OBJECTIVE: To compare characteristics of patients enrolled in a long-term multicenter cohort trial who had used biological therapies for treatment of psoriasis with those who had not used these agents. DESIGN: Retrospective analysis of users vs nonusers of biological therapies. SETTING: Database from the PUVA Follow-up Study, a multicenter, 30-year study of patients originally treated with psoralen UV-A (PUVA) for moderate to severe psoriasis. Patients A total of 521 patients who completed the last cycle of follow-up of the PUVA Follow-up Study. MAIN OUTCOME MEASURES: Demographic data, severity data (physician global assessment), type of biological therapy used, patients' opinions about their therapy, and their best treatment. RESULTS: Seventy-four of 521 patients (14%) used biological therapies: 65% etanercept (n = 48), 22% infliximab (n = 16), 11% efalizumab (n = 8), and 8% alefacept (n = 6). Users of biological therapies were younger, had more formal education, and were more likely to have had a greater extent of psoriasis at entry than the other cohort members. In 1998, those who used biological treatments were more likely than other cohort members to have been assessed as having severe psoriasis. In 2004, no significant difference was noted. Users of etanercept considered this agent to be as effective as methotrexate and more effective in clearing their skin and having fewer adverse effects than PUVA or UV-B. The proportion of patients originally enrolled in the 16 centers who had used biological agents varied greatly (0%-33%). CONCLUSION: After short durations of therapy, patients' opinions about biological agents tended to be positive.

[Consensus document on phototherapy: PUVA therapy and narrow-band UVB therapy]. / Documento de consenso sobre fototerapia: terapias PUVA y UVB de banda estrecha.

It is essential to develop a consensus document on phototherapy in order to adapt this procedure to the specific characteristics, needs and reality of our milieu. Using a review of existing literature on the subject and the experience of its own members as a reference, the Spanish Photobiology Group (GEF) of the Spanish Academy of Dermatology and Venereology (AEDV) has developed some therapeutic guidelines for the most widely used modes of phototherapy: PUVA therapy and narrow-band UVB (NBUVB) therapy. These guidelines deal with generalities about the equipment, calibration and regulation in phototherapy booths, and the concept and indications for these forms of treatment are reviewed. Recommendations are also proposed regarding patient selection, therapeutic procedures, associated pharmacological agents of interest and the prevention and management of adverse effects. The consensus document is designed as a flexible and practical instrument intended for use in daily clinical practice, aimed at optimizing the possibilities of phototherapy while reducing risks for patients and therapists.

Sclerodermatous graft-vs-host disease: clinical and pathological study of 17 patients.

OBJECTIVE: To collect and review all cases of sclerodermatous chronic graft-vs-host disease from January 1, 1982, through December 31, 2000. SETTING: University hospital in Madrid, Spain. PATIENTS: During the study period, 493 allogenic bone marrow transplantations were performed. Sclerotic lesions developed in 17 patients. RESULTS: Sclerotic lesions appeared after a mean of 529 days. Previously, 10 (59%) of 17 patients showed a leopard-skin eruption. Sclerosis was generalized in 12 patients and localized in 5. Nine patients presented with rippling of the skin and 8 with lichen sclerosus lesions. We found no anti-Scl-70 or anti-centromere antibodies. Results of histological analysis showed pandermal or deep-dermal sclerosis, slight vacuolar degeneration of the basal cell layer, and follicular damage with follicular plugs. In 6 (50%) of the 12 patients with evaluable biopsy specimens, septal panniculitis was found. Squamous syringometaplasia and mucin deposits were also detected. Treatment with high doses of prednisone and azathioprine helped in 8 of 9 patients. In 12 patients, sclerosis disappeared after 487 days. CONCLUSIONS: Leopard-skin eruption, follicular involvement, ripply skin, and lichen sclerosus lesions have been described poorly or not at all in sclerodermatous graft-vs-host disease. The presence of lichen sclerosus, morphea, septal fibrosis, and fasciitis suggests that the sclerosis can start at and affect any level of the skin. Treatment with prednisone and azathioprine seems to halt the process. Most patients have a good prognosis with treatment. Although most lesions disappear, small areas of fibrosis may remain that do not produce any physical or functional impairment.

[The Spanish version of Skindex-29. An instrument for measuring quality of life in patients with cutaneous diseases]. / La versión española de Skindex-29. Un instrumento de medida de la calidad de vida en pacientes con enfermedades cutáneas.

BACKGROUND: Quality-of-life studies aim to measure objectively how patient life is affected by disease. Generation of a novel instrument is more expensive and time-consuming than adapting a test already existing in another language. Skindex-29 is a widely validated American instrument to measure quality of life in patients with cutaneous disease. A study of the psychometric properties of the Spanish version of Skindex-29 is presented. PATIENTS AND METHOD: The test was administered to adults in an outpatient dermatological clinic. Age, sex and disease were registered for each patient. Three groups were studied: healthy people, patients with inflammatory skin disease and patients with isolated or tumoral lesions. Construct validity, internal consistency, reproducibility at 72 hours, responsiveness and feasibility were evaluated. RESULTS: Responses of 318 patients were analyzed; 65% were women, with a mean age of 36 years. Validity construction was demonstrated, with significant differences between healthy people and patients as well as between both groups of patients. Reliability was also demonstrated, with Cronbach's coefficient alpha values above 0.84 and intraclass correlation values above 0.7. The test showed responsiveness to clinical change. The percentage of non-response was low, and floor and ceiling effects were adequate. CONCLUSION: The Spanish version of Skindex-29 constitutes an instrument with validity, reliability, and sensitivity to change to measure the effects of cutaneous conditions on quality of life of Spanish patients.