Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria are Underused in Clinical Practice.

BACKGROUND: Patient-reported outcome measures (PROMs) are validated and standardized tools that complement physician evaluations and guide treatment decisions. PROMs are crucial for monitoring atopic dermatitis (AD) and chronic urticaria (CU) in clinical practice, but there are unmet needs and knowledge gaps regarding their use in clinical practice. OBJECTIVE: We investigated the global real-world use of AD and CU PROMs in allergology and dermatology clinics as well as their associated local and regional networks. METHODS: Across 72 specialized allergy and dermatology centers and their local and regional networks, 2,534 physicians in 73 countries completed a 53-item questionnaire on the use of PROMs for AD and CU. RESULTS: Of 2,534 physicians, 1,308 were aware of PROMs. Of these, 14% and 15% used PROMs for AD and CU, respectively. Half of physicians who use PROMs do so only "rarely" or "sometimes". AD and CU PROM usage is associated with being female, younger, and a dermatologist. POSCORAD and UAS were the most utilized PROMs for AD and CU, respectively. Monitoring disease control and activity are the main drivers of the use of PROMs. Time constraints were the primary obstacle to using PROMs, followed by the impression that patients dislike PROMs. AD and CU PROM users would like training in selecting the proper PROM. CONCLUSION: Even though PROMs offer several benefits, their use in routine practice is suboptimal, and physicians perceive barriers to their use. It is essential to attain higher levels of PROM implementation in accordance with national and international standards.

Areas of professional life and job satisfaction of nurses.

Introduction: Job satisfaction among nurses is closely related to work environment as well as organizational and professional commitment. Satisfaction is a concept derived from Latin, where "satis" means "enough," as much as is needed to fully satisfy expectations, needs, aspirations, in such a way that there is no room for complaint. Job satisfaction, on the other hand, is formulated as a positive attitude of employees toward the duties of the job, the work environment and other employees. The aim of this paper was to demonstrate how the different areas of nurses' professional life, i.e., workload, control, rewards, community, sense of justice and values, correlate with their perceived job satisfaction. Materials and methods: A cross-sectional study was conducted in a group of 509 nurses working in a public hospital in Poland. Data were collected using a survey questionnaire, which consisted of a section containing sociodemographic data and standardized instruments: The Minnesota Satisfaction Questionnaire (MSQ) and The Areas of Worklife Survey (AWS) developed by Maslach and Leiter. Correlations were made using Spearman's rho coefficient. The calculations also used stepwise linear regression analysis after checking certain assumptions, including checking the assumption of normality of residuals and the Durbin-Watson Test. Results: The mean score for the 20 items of the MSQ questionnaire ranged from 3.05 to 3.43 on a 5-point Likert scale. Support from the interdisciplinary team, which concerned assessing the quality of the social environment in the workplace, cooperation and showing positive feelings received the highest rating among respondents (3.51 ± 0.76). The sense of fair treatment at work averaged 3.26 ± 0.58. The area of value conflict within the organization itself or between the employee's values and those of the organization, respondents rated an average of 3.26 ± 0.65. The mean score for all areas of professional work in the surveyed group was 3.09 ± 0.45. Conclusion: As satisfaction in particular areas of work life increases, so does the level of satisfaction in such aspects of work as achievement and a sense of fairness. The higher the level of satisfaction in the area of control, the more the sense of satisfaction with independence increases. The higher the satisfaction of respondents in the areas of values, workload and control, the higher the level of satisfaction with working conditions occurs.

Subjective assessment of occupational stress and mental health of nurses during the Covid-19 pandemic period.

Introduction: Health status, sickness absence, and nurses' attrition have a direct impact on the quality of care provided and patients' health outcomes. The Covid-19 pandemic exacerbated issues that existed within the Polish healthcare system prior to the pandemic, including staff shortages, low wages, and system inadequacies. The aim of this study was to investigate how nurses during the Covid-19 pandemic period rated the burdensomeness of job characteristics and their mental health status, as well as the correlations between factors directly caused by the Covid-19 pandemic and nurses' subjective assessments of job characteristics and mental health. Method: The cross-sectional study was conducted in January 2022, in Poland and involved 796 registered nurses working in hospitals. Results: Despite the pandemic's sweeping societal effects, this research finds limited alteration in nurses' perceptions of job stress and self-assessed mental health. Factors such as contact with infected patients, quarantine, and isolation do not appear to substantially modify mental health perceptions among nurses. Intriguingly, nurses subjected to COVID-19 testing report heightened stress and compromised mental health. Conclusion: The interplay of diverse factors influencing the well-being of nurses is intricately complex. It is advisable to prudently execute interventions and strategies to address the pandemic, aiming to alleviate its potential adverse effects on the mental health of nurses.

Neuro-Immuno-Psychological Aspects of Chronic Urticaria.

Urticaria is a condition characterized by the development of itchy wheals (hives), angioedema, or both. The pathophysiology of chronic spontaneous urticaria (CSU) is still poorly understood. It is suggested that there is no dominant and independent mechanism of CSU; however, there are different immunological and non-immunological abnormalities that act simultaneously or/and follow each other resulting in clinical symptoms. The latest hypothesis points out that mast cells (MCs) to be activated via autoantibodies in autoallergic or autoimmune mechanism mediators released from degranulated MCs are responsible for the vasoactive and neurospecific effect in CSU. According to many clinical observations, it is suggested that psychological stress can be both a triggering factor in the onset of CSU and a modulating one in the course of the disease and therapy effectiveness. Of importance, the mechanistic background of the psychological stress response in the skin has not yet been fully elucidated. However, of note, a variety of inflammatory mediators, neuropeptides, and neurotransmitters facilitate this phenomenon. This review presents recent findings on the neuro-immuno-psychological aspects of CSU, highlighting an emerging role of neuro-immune interactions. It also points out the usefulness of psychological tools employment for the baseline diagnosis of perceived stress level and the presence of its symptoms. Furthermore, it proposes the implementation of non-invasive interventions to reduce psychological stress and anxiety. A bio-psycho-social approach including psychological support and patient education seems to be as important as traditional pharmacotherapy for CSU. It facilitates the effective control of active disease and a prolonged remission time in this disease.

Chronic Urticaria Treatment with Omalizumab-Verification of NLR, PLR, SIRI and SII as Biomarkers and Predictors of Treatment Efficacy.

Biomarkers that are able to predict the response to omalizumab (OMA) in chronic spontaneous urticaria (CSU) are highly valued. The aim of our study was to evaluate the UAS7 (urticaria activity score assessed for 7 days), DLQI (dermatology life quality index), SII (systemic immune-inflammation index), SIRI (systemic inflammation response index), PLR (platelet/lymphocyte ratio) and NLR (neutrophil/lymphocyte ratio) in a group of 46 CSU a patients treated for 24 weeks with OMA (300 mg every 4 weeks). There were no statistically significant differences observed at the start nor at the end of the treatment between the two groups (responders vs. non-responders) and SII, SIRI, PLR and NLR. However, a statistically significant correlation was observed between severity of urticaria expressed in UAS7 scores and the quality of life (evaluated by DLQI). Furthermore, at week 24, both groups demonstrated significant improvement in quality of life. Our single center study did not confirm the usefulness of SII, SIRI, NLR or PLR as predictors of the response to OMA in CSU. However, it is of importance that even patients who did not respond to the treatment presented a significant improvement in quality of life. Additionally, we also observed that the efficacy of treatment was unchanged amongst patients who underwent a second series of treatment in cases of relapse.

Psychosocial Burden and Quality of Life of Surveyed Nurses during the SARS-CoV-2 Pandemic.

This study analyzes the impact of occupational burnout on the quality of life (QOL) of nurses surveyed during the SARS-CoV-2 pandemic. A total of 668 active nurses employed in public hospitals in Podkarpackie voivodeship (Poland) were surveyed. Throughout the pandemic, all wards where responders worked had a division into so-called "clean" and "dirty" zones, as well as balanced working hours. The research used the authors' survey questionnaire Maslach Burnout Inventory (MBI) and the Polish version of the World Health Organization Quality of Life Instrument Short Form (WHOQOL-BREF). Descriptive statistics were used in the analysis of the collected material, while correlations between ordinal or quantitative variables were made using Spearman's-rho coefficient. According to 94.0% of respondents, stress is an integral part of the nursing profession. The mean of the respondents' MBI burnout was 50.83 +/- 9.05 pts. The respondents' overall quality of life also averaged 65.74 +/- 13.12 pts. There were negative statistically significant correlations between the MBI and BREF domains, most of which were characterized by clear strengths of association. Higher exhaustion in various occupational aspects is associated with poorer quality of life in individual domains.

Stress and Occupational Burnout of Nurses Working with COVID-19 Patients.

COVID-19 pandemic brings many challenges to the daily work of nurses. While carrying out professional tasks for patients infected with the SARS-CoV-2 virus, nurses experience tremendous psychological pressure due to their workload in a high-risk environment. This causes severe stress and leads to occupational burnout. The purpose of this study was to assess the level of stress and occupational burnout among surveyed nurses working with patients with COVID-19. A total of 118 nurses working with patients infected with SARS-CoV-2 virus participated in the study. Among the respondents, there were 94.9% women and 5.1% men. The average age of the respondents was 38.1 +/- 2.1. The survey was conducted between April and May 2022. The research tool was a survey questionnaire, consisting of three parts: sociodemographic data and self-administered survey questionnaire containing questions about the specifics of working with COVID-19 patients. The third part was a standardized tool: the MBI Burnout Questionnaire by Christina Maslach. Participation in the study was anonymous and voluntary. Statistical analysis for independence of variables used the Chi-square test. On the other hand, coefficients based on the Phi test and Kramer's V test, as well as non-parametric Mann-Whitney U-test (for 2 samples) and Kruskal-Wallis test (for more than 2 samples) were used to determine the strength of the relationship. During these analyses, in addition to standard statistical significance, the corresponding "p" values were calculated using the Monte Carlo method. The results obtained allow us to conclude that surveyed nurses working with COVID-19 patients are exposed to various stressors leading to occupational burnout. The vast majority of respondents, i.e., 90.7%, believe that stress is an integral part of the nursing profession and the average of MBI burnout among respondents was 55.67 +/- 9.77 pts., emotional exhaustion 24.74 +/- 6.11, depersonalization 12.42 +/- 2.99 and a sense of personal achievement 18.52 +/- 4.50 which means that only slightly more than half of the nurses surveyed noticed symptoms of occupational burnout themselves. The research has revealed that working with a patient who is positive for COVID-19 is a cause of stress and is related to experiencing symptoms of burnout in the group of surveyed nurses.

Increased serum levels of interleukin-17 in patients with alopecia areata and non-segmental vitiligo.

Introduction: Alopecia areata (AA) and vitiligo are both skin diseases of autoimmune origin. AA is characterized by patchy hair loss primarily on the scalp but may involve other areas as well, while vitiligo is caused by the destruction of melanocytes and results in the appearance of white patches on any part of the body. Many facts indicate similar pathogenesis of these diseases. Both dermatoses are associated with frequent coexistence of other autoimmune diseases and share common genetic risk factors. Recent data support the theory of the involvement of IL-17 in the pathogenesis of both AA and vitiligo. Aim: To evaluate and compare the serum levels of interleukin (IL)-17 in patients with AA and non-segmental vitiligo (NSV). To assess whether the pattern of serum cytokine concentration can be associated with clinical details and activity of the disease. Material and methods: A cross-sectional study was conducted on 33 patients with AA, 30 patients with NSV, and 30 healthy controls. Serum levels of IL-17 were determined quantitatively by ELISA method. Results: Our analysis identified a systemic inflammatory signature associated with AA and NSV, characterized by elevated levels of IL-17. The levels of IL-17 did not differ significantly between AA patients and NSV patients. Conclusions: Our results show that AA and vitiligo may share common etiopathogenetic pathways, which suggests the potential of developing targeted therapies for both AA and vitiligo treatment. Imbalance of T cell subpopulations and complex systemic cytokine profiles may contribute to the pathogenesis of AA and vitiligo.

Impact of SARS-CoV-2 Pandemic on Psychosocial Burden and Job Satisfaction of Long-Term Care Nurses in Poland.

Psychosocial consequences of the coronavirus pandemic are severe for health care workers due to their higher levels of exposure. Nurses often experience tremendous psychological pressure as a result of their workload in a high-risk environment. The purpose of this study was to determine the impact of the SARS-CoV-2 pandemic on the psychosocial burden and job satisfaction of nurses employed in long-term care. One hundred thirty-eight nurses employed in long-term care participated in the study. The respondents were 96.4% female and 3.6% male. The mean age of the respondents was 53.99 (standard deviation-4.01). The study was conducted between February and June 2021. The research tool was a standardized psychosocial risk scale questionnaire, which is a scientifically validated diagnostic tool with high reliability and accuracy coefficients. The primary tests used during the statistical analyses were non-parametric Mann-Whitney U (for two samples) and Kruskal-Wallis (for more than two samples) tests for assessing differences. During these analyses, in addition to standard statistical significance, appropriate p-values were calculated using the Monte Carlo method. Correlations between ordinal or quantitative variables were made using Spearman's rho coefficient. The results obtained allow us to conclude that the respondents rated the characteristics present in the workplace that constitute psychosocial risks at an average level. Emotional commitment and continuance-type commitment to the respondents' job position were also at a medium level. Respondents' self-rated ability to work for nurses employed in long-term care during the SARS-CoV-2 pandemic and commitment to patient care was high at 4.0 and 4.18, with a maximum of 5 points.

Rationing of Nursing Care on Example of Selected Health Care Facility.

Contemporary health determinants require nurses to develop new competencies and skills while performing complex tasks in all forms of health care. The problem of rationing of care is present all over the world and usually occurs when available resources are too low to provide adequate care to all patients. The most common reasons for loss of care are shortages of nurses, use of modern treatment methods, increased demand for care by a large number of patients, and greater knowledge of patients about their rights. A questionnaire survey was conducted among 295 nurses employed in hospital wards. The survey was conducted from September to December 2020 using the standardized BERNCA (The Basel Extent of Rationing of Nursing Care) questionnaire to measure the level of rationing of nursing care. The research was hampered by the sanitation regime associated with the SARS CoV-2 pandemic. Nursing care rationing is dependent on seniority and place of work. The mean total BERNCA score of the degree of rationing of nursing care was 2.58 ± 0.96 on a scale of 0 to 4 (where 0 means "no need for it" and 4 means "often". The median score was 2.69. The higher frequency of rationing nursing care was characteristic of those working on surgical wards. The mean score obtained by them was 2.72 ± 0.86, with the median equal to 2.88. In the case of nurses employed in non-surgical wards, the scores were 2.08 ± 1.07 and 2.28, respectively. Rationing of nursing care is dependent on seniority and work location, with a higher degree of rationing of care occurring in surgical units.

Increased Serum Levels of IFN-γ, IL-1ß, and IL-6 in Patients with Alopecia Areata and Nonsegmental Vitiligo.

Alopecia areata (AA) and vitiligo are both common skin diseases of autoimmune origin. Both alopecia areata and vitiligo have shown to be affected by oxidative stress. The present work is aimed at evaluating and comparing the serum proinflammatory cytokine levels in AA and nonsegmental vitiligo (NSV). A cross-sectional study was conducted of 33 patients with AA, 30 patients with NSV, and 30 healthy controls. Serum levels of interferon γ (IFN-γ), interleukin- (IL-) 1ß, and IL-6 were determined quantitatively by ELISA method. Our analysis identified a signature of oxidative stress associated with AA and NSV, characterized by elevated levels of IFN-γ (AA: p = 0.007283; NSV: p = 0.038467), IL-1ß (AA; NSV: p ≤ 0.001), and IL-6 (AA; NSV: p ≤ 0.001). IL-6 was also significantly increased in NSV patients in comparison with AA patients (p = 0.004485). Our results supported the hypothesis that oxidative stress may play a significant role in promoting and amplifying the inflammatory process both in AA and vitiligo. The complex understanding of both disease etiopathogenesis involves interrelationships between oxidative stress and autoimmunity. The clinical study registration number is RNN/266/16/KE.