Themes and Topics on Diversity, Equity, and Inclusion in JMIR Dermatology Publications.

Publications dealing with topics considered to be pertinent to diversity, equity, and inclusion are increasing. Due to the increasing trend, dermatology journals have started to implement ways to evaluate and understand these publications. Here, we discuss a keyword approach to identify and then categorize these publications. Keywords identified 43 manuscripts. Two reviewers screened the articles' titles and abstracts, and recommended a full manuscript review for 24 publications. Through the scope of definitions from the National Institutes of Health, an editorial board member performed a full-text review and assigned a primary theme to the publications. Themes included equity (n=20) and diversity/inclusion (n=4). Topics were racial/ethnic differences in care delivery or society (n=17), incomplete understanding of gender and sex (n=3), gender identity (n=2), socioeconomic class and its impact on health (n=1), care for rural underserved communities (n=1), and religion (n=1). The results of this review demonstrate a predominance of equity-related publications, particularly emphasizing racial/ethnic differences in health care delivery, in the publications identified in JMIR Dermatology. Future research can focus on creating a review aid to assist editorial board members when providing feedback to manuscripts, refining the keywords, and using thematic analysis methodology to evaluate large sets of publications.

Prioritising Cochrane reviews to be updated with health equity focus.

BACKGROUND: The prioritisation of updating published systematic reviews of interventions is vital to prevent research waste and ensure relevance to stakeholders. The consideration of health equity in reviews is also important to ensure interventions will not exacerbate the existing inequities of the disadvantaged if universally implemented. This study aimed to pilot a priority setting exercise based on systematic reviews of interventions published in the Cochrane Library, to identify and prioritise reviews to be updated with a focus on health equity. METHODS: We conducted a priority setting exercise with a group of 13 international stakeholders. We identified Cochrane reviews of interventions that showed a reduction in mortality, had at least one Summary of Findings table and that focused on one of 42 conditions with a high global burden of disease from the 2019 WHO Global Burden of Disease report. This included 21 conditions used as indicators of success of the United Nations Universal Health Coverage in attaining the Sustainable Development Goals. Stakeholders prioritised reviews that were relevant to disadvantaged populations, or to characteristics of potential disadvantage within the general population. RESULTS: After searching for Cochrane reviews of interventions within 42 conditions, we identified 359 reviews that assessed mortality and included at least one Summary of Findings table. These pertained to 29 of the 42 conditions; 13 priority conditions had no reviews with the outcome mortality. Reducing the list to only reviews showing a clinically important reduction in mortality left 33 reviews. Stakeholders ranked these reviews in order of priority to be updated with a focus on health equity. CONCLUSIONS: This project developed and implemented a methodology to set priorities for updating systematic reviews spanning multiple health topics with a health equity focus. It prioritised reviews that reduce overall mortality, are relevant to disadvantaged populations, and focus on conditions with a high global burden of disease. This approach to the prioritisation of systematic reviews of interventions that reduce mortality provides a template that can be extended to reducing morbidity, and the combination of mortality and morbidity as represented in Disability-Adjusted Life Years and Quality-Adjusted Life Years.

Assessment of the validity of international classification of disease tenth revision codes for atopic dermatitis.

Little is known about the validity of ICD-10-CM codes for atopic dermatitis (AD) in healthcare claims databases. We assessed the validity of ICD-10-CM codes for identifying adult patients with AD. The healthcare claims database from a large metropolitan tertiary care medical center was queried for diagnostic codes of L20.x and L30.9. Medical records were reviewed for demographics, comorbidities, Hanifin & Rajka (H-R), and United Kingdom Working Party (UKWP) criteria. Sensitivity, specificity, and positive predictive values (PPVs) were calculated. Overall, 833 patients were identified with ≥ 1 occurrence of the aforementioned ICD-10 codes for AD. Using H-R and UKWP criteria as the gold-standard definitions of AD, the PPV of any aforementioned L20.x ICD-10 codes was 39.1% and 51.4%, with sensitivity of 98.1% and 97.4%, respectively. The PPV was 25% and 50% for L20.82; 66.7% and 100% for L20.84; 37.5% and 62.5% for L20.89; 60.1% and 51.4% for L20.9, respectively. PPV generally increased when case definitions combined ICD-10 codes with coexistent ICD-10 codes for asthma or hay fever, food allergy, and allergic rhinitis, and to a lesser extent coding of the ICD-10 code for AD by a dermatologist. Among patients with all these criteria, PPV increased to 100% and 80% based on H-R and UKWP criteria, but sensitivity decreased to 83.3% and 80.0%, respectively. In conclusion, ICD-10-CM codes for AD alone had poor PPV for identifying AD in a healthcare claims database. Combined ICD-10 codes for AD and comorbid atopic disease improved PPV and specificity of classification at the expense of sensitivity.

Dermatologic Research Potential of the Observational Health Data Sciences and Informatics (OHDSI) Network.

BACKGROUND: The Observational Health Data Sciences and Informatics (OHDSI) network enables access to billions of deidentified, standardized health records and built-in analytics software for observational health research, with numerous potential applications to dermatology. While the use of the OHDSI has increased steadily over the past several years, review of the literature reveals few studies utilizing OHDSI in dermatology. To our knowledge, the University of Colorado School of Medicine is unique in its use of OHDSI for dermatology big data research. SUMMARY: A PubMed search was conducted in August 2020, followed by a literature review, with 24 of the 72 screened articles selected for inclusion. In this review, we discuss the ways OHDSI has been used to compile and analyze data, improve prediction and estimation capabilities, and inform treatment guidelines across specialties. We also discuss the potential for OHDSI in dermatology - specifically, ways that it could reveal adherence to available guidelines, establish standardized protocols, and ensure health equity. Key Messages: OHDSI has demonstrated broad utility in medicine. Adoption of OHDSI by the field of dermatology would facilitate big data research, allow for examination of current prescribing and treatment patterns without clear best practice guidelines, improve the dermatologic knowledge base and, by extension, improve patient outcomes.

Skin of Color Representation on Wikipedia: Cross-sectional Analysis.

BACKGROUND: Wikipedia is one of the most popular websites and may be a go-to source of health and dermatology education for the general population. Prior research indicates poor skin of color (SOC) photo representation in printed dermatology textbooks and online medical websites, but there has been no such assessment performed to determine whether this discrepancy also exists for Wikipedia. OBJECTIVE: The aim of this study was to investigate the number and quality of SOC photos included in Wikipedia's skin disease pages and to explore the possible ramifications of these findings. METHODS: Photos of skin diseases from Wikipedia's "List of Skin Conditions" were assigned by three independent raters as SOC or non-SOC according to the Fitzpatrick system, and were given a quality rating (1-3) based on sharpness, size/resolution, and lighting/exposure. RESULTS: We identified 421 skin disease Wikipedia pages and 949 images that met our inclusion criteria. Within these pages, 20.7% of images of skin diseases (196 of 949 images) were SOC and 79.3% (753 of 949 images) were non-SOC (P<.001). There was no difference in the average quality for SOC (2.05) and non-SOC (2.03) images (P=.81). However, the photo quality criteria utilized (sharpness, size/resolution, and lighting/exposure) did not capture all aspects of photo quality. Another limitation of this analysis is that the Fitzpatrick skin typing system is prone to subjectivity and was not originally intended to be utilized as a non-self SOC metric. CONCLUSIONS: There is SOC underrepresentation in the gross number of SOC images for dermatologic conditions on Wikipedia. Wikipedia pages should be updated to include more SOC photos to mend this divide to ameliorate access to accurate dermatology information for the general public and improve health equity within dermatology.

The Contact Dermatitis Quality of Life Index (CDQL): Survey Development and Content Validity Assessment.

BACKGROUND: There is limited measurement and reporting of quality of life (QoL) outcomes for patients with contact dermatitis (CD). OBJECTIVE: The purpose of this study is to develop a standardized Contact Dermatitis Quality of Life index (CDQL) for adult patients. METHODS: A list of 81 topics was compiled from a review of QoL measures used previously in CD research. A total of 2 rounds of web-based Delphi surveys were sent to physicians who registered to attend the 2018 American Contact Dermatitis Society meeting, asking that they rank the relevance of topics for measuring QoL in CD using a 4-point scale. Items met consensus for inclusion if at least 78% of respondents ranked them as relevant or very relevant, and their median score was ≥3.25. RESULTS: Of the 210 physicians contacted, 34 physicians completed the initial survey and 17 completed the follow-up survey. A total of 22 topics met consensus for inclusion in the CDQL, addressing symptoms, emotions, functions of daily living, social and physical functions, work/school functions, and treatment. CONCLUSIONS: This study was limited by the following factors: few open-ended questions in the initial survey, a lack of direct patient feedback, and long survey length, which likely contributed to lower survey participation. The CDQL is a comprehensive, CD-specific QoL measure developed on the basis of expert consensus via a modified Delphi process to be used by physicians and other health care professionals who care for adult patients with contact dermatitis.

The Burden of Skin and Subcutaneous Diseases in the United States From 1990 to 2017.

Importance: Skin and subcutaneous diseases affect the health of millions of individuals in the US. Data are needed that highlight the geographic trends and variations of skin disease burden across the country to guide health care decision-making. Objective: To characterize trends and variations in the burden of skin and subcutaneous tissue diseases across the US from 1990 to 2017. Design, Setting, and Participants: For this cohort study, data were obtained from the Global Burden of Disease (GBD), a study with an online database that incorporates current and previous epidemiological studies of disease burden, and from GBD 2017, which includes more than 90 000 data sources such as systematic reviews, surveys, population-based disease registries, hospital inpatient and outpatient data, cohort studies, and autopsy data. The GBD separated skin conditions into 15 subcategories according to incidence, prevalence, adequacy of data, and standardized disease definitions. GBD 2017 also estimated the burden from melanoma of the skin and keratinocyte carcinoma. Data analysis for the present study was conducted from September 9, 2019, to March 31, 2020. Main Outcomes and Measures: Primary study outcomes included age-standardized disability-adjusted life-years (DALYs), incidence, and prevalence. The data were stratified by US states with the highest and lowest age-standardized DALY rate per 100 000 people, incidence, and prevalence of each skin condition. The percentage change in DALY rates in each state was calculated from 1990 to 2017. Results: Overall, age-standardized DALY rates for skin and subcutaneous diseases increased from 1990 (821.6; 95% uncertainty interval [UI], 570.3-1124.9) to 2017 (884.2; 95% UI, 614.0-1207.9) in all 50 states and the District of Columbia. The degree of increase varied according to geographic location, with the largest percentage change of 0.12% (95% UI, 0.09%-0.15%) in New York and the smallest percentage change of 0.04% (95% UI, 0.02%-0.07%) in Colorado, 0.04% (95% UI, 0.01%-0.06%) in Nevada, 0.04% (95% UI, 0.02%-0.07%) in New Mexico, and 0.04% (95% UI, 0.02%-0.07%) in Utah. The age-standardized DALY rate, incidence, and prevalence of specific skin conditions differed among the states. New York had the highest age-standardized DALY rate for skin and subcutaneous disease in 2017 (1097.0 [95% UI, 764.9-1496.1]), whereas Wyoming had the lowest age-standardized DALY rate (672.9 [95% UI, 465.6-922.3]). In all 50 states and the District of Columbia, women had higher age-standardized DALY rates for overall skin and subcutaneous diseases than men (women: 971.20 [95% UI, 676.76-1334.59] vs men: 799.23 [95% UI, 559.62-1091.50]). However, men had higher DALY rates than women for malignant melanoma (men: 80.82 [95% UI, 51.68-123.18] vs women: 42.74 [95% UI, 34.05-70.66]) and keratinocyte carcinomas (men: 37.56 [95% UI, 29.35-49.52] vs women: 14.42 [95% UI, 10.01-20.66]). Conclusions and Relevance: Data from the GBD suggest that the burden of skin and subcutaneous disease was large and that DALY rate trends varied across the US; the age-standardized DALY rate for keratinocyte carcinoma appeared greater in men. These findings can be used by states to target interventions and meet the needs of their population.

Leprosy: Treatment and management of complications.

In the second article in this continuing medical education series, we review the treatment of leprosy, its immunologic reactions, and important concepts, including disease relapse and drug resistance. A fundamental understanding of the treatment options and management of neuropathic sequelae are essential to reduce disease burden and improve patients' quality of life.

Canadian Burden of Skin Disease From 1990 to 2017: Results From the Global Burden of Disease 2017 Study [Formula: see text].

BACKGROUND: Skin diseases can have high morbidity that can be costly to society and individuals. To date, there has been no comprehensive assessment of the burden of skin disease in Canada. OBJECTIVES: To evaluate the burden of 18 skin and subcutaneous diseases from 1990 to 2017 in Canada using the Global Burden of Disease (GBD) data. METHODS: The 2017 GBD study measures health loss from 359 diseases and injuries in 195 countries; we evaluated trends in population health in Canada from 1990 to 2017 using incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Data are presented as rates (per 100 000), counts, or percent change with the uncertainty interval in brackets. RESULTS: From 1990 to 2017 for all skin diseases, DALY rates increased by 8% to 971 per 100 000 (674-1319), YLD rates increased by 8% to 897 per 100 000 (616-1235), YLL rates increased by 4% to 74 per 100 000 (53-89), and death rates increased by 18% to 5 per 100 000 (3-6). DALY rates for melanoma increased by 2% to 54 per 100 000 (39-68), for keratinocyte carcinoma by 14% to 17 per 100 000 (16-19), and for skin and subcutaneous disease by 8% to 900 per 100 000 (619-1233). The observed over expected ratios were higher for skin and subcutaneous disease (1.37) and keratinocyte carcinoma (1.17) and were lower for melanoma (0.73). CONCLUSIONS: The burden of skin disease has increased in Canada since 1990. These results can be used to guide health policy regarding skin disease in Canada.

Healthcare and dermatology on WeChat.

WeChat is a closed social networking platform that allows users to connect privately, providing instant text, photo sharing, voice, and video calls. It is now the most popular mobile chat app in China. The widespread use and ease of establishing technology made WeChat an ideal platform for healthcare, in which it has many uses that include scheduling, follow up, and post-procedure monitoring. In addition, one may make payments and handle prescriptions via e-pharmacy. Dermatologists are often looking for a secure and easy way to use mobile applications to share clinical images and to obtain photographs from patients. We aim to provide an overview of WeChat and its current applications for healthcare and dermatology.

An assessment of social media usage by dermatology residency programs.

Despite the increasing popularity of social media, the activity of dermatology residency programs on top social media platforms has never been investigated to our knowledge. We investigated a total of 126 dermatology residency programs to assess their presence and popularity on social media. Searches were conducted to identify dermatology residency departments' accounts on Facebook, Twitter, and Instagram. The number of Facebook likes, Twitter followers, and Instagram followers were recorded. Of the 126 dermatology residency programs, 29 (23%) were active on Facebook, 14 (11%) on Twitter, and 9 (7%) on Instagram. There was a wide range in the number of Facebook likes, Twitter followers, and Instagram followers. The top ten dermatology residency programs with the highest Facebook likes, Twitter followers, and Instagram followers were charted. Our results demonstrate the sparse usage of social media by dermatology residency programs. Although social media continues to increase in prevalence, dermatology residency programs are underutilizing these valuable resources.

Industry payments to dermatologists: updates from the 2016 open payment data.

Payments made to dermatologists by pharmaceutical and medical device manufacturing companies have become better understood following the advent of the Open Payments program. The purpose of this study was to analyze payments made to dermatologists in 2016 and evaluate trends in the payments from the previously published 2014 data.

An updated assessment of social media usage by dermatology journals and organizations.

Despite the increasing prevalence of social media usage, the activity of dermatology journals and professional and patient-centered organizations on top social media platforms has not been investigated since 2012. We investigated a total of 124 dermatology journals, 242 professional organizations, and 78 patient-centered organizations to assess their presence and popularity on social media. Searches were conducted to identify journals and organizations on Facebook and Twitter. Similar searches were done for organizations on LinkedIn. The number of Facebook likes, Twitter followers, and LinkedIn followers of the dermatological entities were quantified. There were 22 (17.7%) dermatology journals active on Facebook and 21 (16.9%) on Twitter. Amongst the professional organizations, 114 (47.1%) were on Facebook, 69 (28.5%) on Twitter, and 50 (20.7%) on LinkedIn. In comparison, 68 (87.2%) patient-centered organizations were on Facebook, 56 (71.8%) on Twitter, and 56 (71.8%) on LinkedIn. Our results demonstrate that the popularity of dermatology journals and professional and patient-centered organizations on top social networking sites has grown markedly since 2012. Although the number of dermatology journals on social media has increased since 2012, their presence continues to trail behind professional and patient-centered dermatological organizations, suggesting underutilization of a valuable resource.

Corrigendum: Editorial boards of dermatology journals and their potential financial conflict of interest.

The original article was published on August 15, 2018 and corrected on September 15, 2018. The revised version of the article removes a co-author, unintentionally retained during the editorial proofing process. This change appears in the revised online PDF copy of this article.