Chronic Nodular Prurigo: A European Cross-sectional Study of Patient Perspectives on Therapeutic Goals and Satisfaction.

Chronic nodular prurigo is characterized by recalcitrant itch. Patient perspectives on therapeutic goals, satisfaction with therapy and efficacy of therapeutic regimens for this condition are unknown. This questionnaire study examined these issues in 406 patients with chronic nodular prurigo from 15 European dermatological centres. Improvements in itch, skin lesions and sleep were the most important goals. Emollients, topical corticosteroids and antihistamines were the most frequently used treatments, while a minority of patients were prescribed potent medications, such as systemic immunosuppressants and gabapentinoids. Most patients were not satisfied with their previous therapy (56.8%), while 9.8% did not receive any therapy despite having active disease. A substantial number of respondents (28.7%) considered none of the therapeutic options effective. Although chronic nodular prurigo is a severe disease, most patients were not treated with potent systemic drugs, which may contribute to the high levels of dissatisfaction and disbelief in available therapies. Specific guidelines for chronic nodular prurigo and the development of novel therapies are necessary to improve care.

Assessment of Intra- and Inter-Rater Reliability of Three Methods for Measuring Atopic Dermatitis Severity: EASI, Objective SCORAD, and IGA.

BACKGROUND: Numerous different scoring systems have been proposed for assessing the severity of atopic dermatitis (AD). Many of these methods did not undergo proper validation and reliability testing. OBJECTIVE: The aim of our study was to compare the reliability and reproducibility of the Eczema Area and Severity Index (EASI), objective Scoring Atopic Dermatitis (oSCORAD), and Investigator Global Assessment (IGA). METHODS: On the scoring day, 10 trained dermatologists evaluated 10 adult patients with AD using the EASI, oSCORAD, and IGA. All subjects were assessed twice by each physician. Correlations between measures were analysed using the Pearson correlation coefficient. The intra-class correlation coefficient (ICC) was calculated to assess intra-rater reliability; the coefficient of variation (CV) was used to assess inter-rater variability. RESULTS: Significant positive correlations were observed between each scale in both assessments. The ICCs for the EASI and oSCORAD were 0.71 and 0.66, respectively, indicating good reliability, while the ICC for the IGA (0.54) indicated only fair reliability. The CVs for the oSCORAD and IGA were 28.1 and 33.0, respectively, indicating moderate variability. The CV for the EASI was 66.5, indicating high variability. CONCLUSION: Among the 3 compared scales, the oSCORAD had the highest inter-rater reliability, whereas the EASI had the highest intra-rater reliability. None of the 3 scoring methods showed a significant advantage over the other. Thus, a reliable assessment of AD severity requires the use of at least 2 independent measurements simultaneously.

The Role of Oxidative Stress in Atopic Dermatitis and Chronic Urticaria.

Atopic dermatitis (AD) and chronic urticaria (CU) are common skin diseases with an increasing prevalence and pathogenesis that are not fully understood. Emerging evidence suggests that oxidative stress plays a role in AD and CU. The aim of the single-center cross-sectional study was to compare markers of oxidative stress in 21 patients with AD, and 19 CU patients. The products of protein oxidation, total antioxidant capacity (TAC), and markers of lipid peroxidation were estimated in the serum. AD patients had a higher level of advanced protein oxidation products and a lower level of thiol groups than healthy participants. However, CU patients had statistically higher levels of AOPP and 3-nitrotyrosine than healthy subjects. The level of thiol groups and serum TAC decreased significantly in patients with CU. There was no difference in serum concentration of lipid peroxidation products, Amadori products, ratio of reduced to oxidized glutathione, and ability of albumin to binding cobalt between AD or CU patients compared to healthy subjects. We found a moderate positive significant correlation between AOPP and age in patients with AD. In patients with CU, TAC was negatively correlated with age. These results may shed light on the etiopathogenesis of AD or CU, and confirm an oxidative burden in these patients. Furthermore, our study could be useful in developing new therapeutic methods that include using antioxidants in dermatological diseases.

The measurement of state engagement in actions beyond basic professional duties.

BACKGROUND: The goal of this paper is to present the phenomenon of engagement in actions that go beyond basic professional duties, and the factor structure and other psychometric properties of the daily measurements of this construct, which corresponds with the growing interest of researchers in the phenomenon of employee engagement, extra-role behaviors and the factors that affect them on a daily basis. MATERIAL AND METHODS: The research was carried out among 62 full-time or part-time working students of the humanities and social sciences (79% of whom were female), using a 5-day on-line daily survey. The main measure was a modified Polish version of the 9-item questionnaire consistent with the Utrecht Work Engagement Scale (UWES), which was prepared on the basis of the adaptation of the State Work Engagement (SWE) questionnaire proposed by Breevaart et al. (2012) to measure daily work engagement. RESULTS: The obtained results have shown that the adapted version of the SWE questionnaire is a reliable and valid measure which can be used to measure daily fluctuations in beyond-duties engagement. The 3-factor multilevel model has a satisfactory fit. CONCLUSIONS: The study contributes to the current body of literature by examining state engagement in actions that go beyond basic professional duties and the validity of its measurement. It also shows that giving employees more autonomy and feedback may positively influence their beyond-duties engagement. Med Pr. 2020;71(2):127-36.

The Relationship Between Spirituality, Health-Related Behavior, and Psychological Well-Being.

Studies suggest a positive association of spirituality and health behaviors with well-being (especially subjective well-being), but still the precise character of such relationships between all these constructs remains unknown. The present study aims to explore the relations between spirituality, health-related behaviors, and psychological well-being in the context of acquired education. A questionnaire survey was conducted among 595 students from six different universities, whose study programs either focused on the human body or the human mind and spirit. Path analysis and linear regression were used to model the relationship between the examined constructs. The results show that both spirituality and health-related behaviors are positively related to psychological well-being, and that the relationship with spirituality is also mediated by health-related behaviors. Only spirituality is associated with the type of acquired education, especially in the group of students whose studies focus on the human mind and spirit. Moreover, spirituality in this group seems to display a stronger relationship with psychological well-being. These findings may contribute to the better understanding of some significant determinants of psychological well-being. They carry important implications for the faculty members responsible for curriculum preparation to account for teaching contents related to the conduct of a healthy lifestyle and to spiritual development.

Physical Activity, Sedentary Behavior, and Quality of Life among University Students.

The aim of our study was to explore the relation between physical activity, sedentary behavior, and the subjective and objective indicators of quality of life as well as life satisfaction among university students, whose education is related to different dimensions on health. Participants (N = 595) were invited to fill in a set of suitable questionnaires. The path analysis and linear regression were used to establish a relationship between the examined constructs. Only some types of physical activity have shown a positive relation with the quality of life; the study also revealed some age and gender regularities. Physical activity in the household was most positively correlated to the quality of life. The amount of leisure and transport physical activity decreased with age, and there were also gender differences regarding the intensity and type of physical activity. Sedentary behavior during the week related positively with the subjective quality of life and its intimacy dimension, but sedentary behavior at the weekends was negatively related to objective and subjective quality of life as well as dimensions including intimacy, safety, and communicative aspect of the quality of life. Neither physical activity nor sedentary behavior demonstrated a significant relation with the level of life satisfaction. The type of physical activity undertaken and its matching to the needs of the young person affected their objective and subjective quality of life. Those findings may have important implications for institutions responsible for promoting active lifestyle.

The reliability of three psoriasis assessment tools: Psoriasis area and severity index, body surface area and physician global assessment.

BACKGROUND: A wide variety of psoriasis assessment tools have been proposed to evaluate the severity of psoriasis in clinical trials and daily practice. The most frequently used clinical instrument is the psoriasis area and severity index (PASI); however, none of the currently published severity scores used for psoriasis meets all the validation criteria required for an ideal score. OBJECTIVES: The aim of this study was to compare and assess the reliability of 3 commonly used assessment instruments for psoriasis severity: the psoriasis area and severity index (PASI), body surface area (BSA) and physician global assessment (PGA). MATERIAL AND METHODS: On the scoring day, 10 trained dermatologists evaluated 9 adult patients with plaque-type psoriasis using the PASI, BSA and PGA. All the subjects were assessed twice by each physician. Correlations between the assessments were analyzed using the Pearson correlation coefficient. Intra-class correlation coefficient (ICC) was calculated to analyze intra-rater reliability, and the coefficient of variation (CV) was used to assess inter-rater variability. RESULTS: Significant correlations were observed among the 3 scales in both assessments. In all 3 scales the ICCs were > 0.75, indicating high intra-rater reliability. The highest ICC was for the BSA (0.96) and the lowest one for the PGA (0.87). The CV for the PGA and PASI were 29.3 and 36.9, respectively, indicating moderate inter-rater variability. The CV for the BSA was 57.1, indicating high inter-rater variability. CONCLUSIONS: Comparing the PASI, PGA and BSA, it was shown that the PGA had the highest inter-rater reliability, whereas the BSA had the highest intra-rater reliability. The PASI showed intermediate values in terms of interand intra-rater reliability. None of the 3 assessment instruments showed a significant advantage over the other. A reliable assessment of psoriasis severity requires the use of several independent evaluations simultaneously.

12-Item Pruritus Severity Scale: Development and Validation of New Itch Severity Questionnaire.

INTRODUCTION: A validated assessment of pruritus intensity is an important but still difficult clinical problem due to a subjective nature of this sensation. OBJECTIVE: The aim of this study was the creation and validation of new itch severity questionnaire assessing pruritus intensity. MATERIAL AND METHODS: A total of 148 patients with pruritic dermatoses were asked to assess pruritus intensity using 12-Item Pruritus Severity Score (12-PSS) and Visual Analogue Scale (VAS). Patients were also asked to complete the Dermatology Life Quality Index (DLQI) and Hospitality Anxiety and Depression Scale (HADS). Test-retest comparison of 12-PSS was conducted in 102 subjects who completed the itch questionnaire twice with the 3- to 5-day interval. RESULTS: We have created the 12-PSS assessing pruritus intensity (two questions), pruritus extent (one question) and duration (one question), influence of pruritus on concentration and patient psyche (four questions), and scratching as a response to pruritus stimuli (four questions). A maximum scoring was 22 points. The results showed strong consistency (Cronbach α coefficient 0.81). A significant correlation was observed with VAS (r = 0.58, p < 0.001) and quality of life level according to DLQI (r = 0.53, p < 0.001). Test-retest comparison in 102 subjects revealed a satisfactory reproducibility of achieved results (ICC = 0,72). CONCLUSIONS: The newly developed pruritus severity questionnaire may be used in daily clinical practice in the future.