Comparison of patients' and providers' severity evaluation of oral mucosal conditions.

BACKGROUND: In dental diseases, significant discrepancies were observed in the oral health-related quality of life evaluation between patients and providers. Few studies have been performed specifically on the impact of oral mucosal diseases on patients' health. OBJECTIVE: We sought to compare the evaluation of the severity of oral mucosal conditions in providers and patients. METHODS: Patients with an oral mucosal condition were recruited at the oral health care unit of a dermatologic hospital. Severity was evaluated both by the physician and by the patient, using a global severity assessment score on a 5-point scale. The 14-item Oral Health Impact Profile was used to evaluate oral health-related quality of life, the 12-item General Health Questionnaire for psychologic problems, and the 20-item Toronto Alexithymia Scale for alexithymia (ie, the difficulty in identifying and expressing feelings). RESULTS: Data were complete for 206 patients. The agreement between patients' and providers' evaluation was very low (Cohen κ = 0.18). Severity was particularly underestimated by the physician in patients with alexithymia (43% compared with 25% of patients with no alexithymia) and with psychologic problems (44% vs 25%). LIMITATIONS: Because of the high number of different conditions, and thus the small figures in each group, it was not possible to analyze the concordance between patient and provider in each single condition. CONCLUSION: Even in the severity assessment of his or her own disease, it is plausible that a patient does not provide a simple clinical evaluation, but includes subjective aspects. It is important for the physician to take into account the severity the patient perceives in making treatment decisions, and in evaluating clinical improvement.

Identifying individuals at high risk of melanoma: a simple tool.

Simple and reliable tools for identifying patients at high risk for melanoma with preventive measures have important public health implications. An individual risk score for cutaneous melanoma was constructed and externally validated. With the summary coefficients of the risk factors for cutaneous melanoma, derived from a meta-analysis, a melanoma risk score was tested in an Italian population and externally validated in a Brazilian population. Common nevi, skin and hair color, freckles, and sunburns in childhood were the variables included in the final predictive model. The discriminatory ability of the models was assessed by the receiver operating characteristic (ROC) curve. The performance of the model was also evaluated by conducting an external validation. The area under the curve (AUC) of the candidate model was 0.79 (95% confidence interval: 0.75-0.82). The same model, when applied in the Brazilian population, presented an AUC of 0.79 (95% confidence interval: 0.70-0.86). At the cut-off level of 3 and more, 89 and 80% of the melanoma cases were correctly classified as 'at risk for melanoma' in the Italian and in the Brazilian populations, respectively. The risk model is a simple tool that identifies patients for preventive measures and may be used with reasonable confidence in different populations. The risk model may help family doctors in referring patients to dermatological clinics and thus improve early diagnosis.

Health-related quality of life and nail disorders.

Health-related quality of life (HRQoL) measurements in clinical practice ensure that treatment and evaluations focus on the patient rather than the disease. To verify whether these measurements are also relevant in a minor dermatological disease and whether a generic routine assessment is sufficient to capture different aspects of quality of life, we studied patients affected by nail disorders. The Skindex-29, the 12-item General Health Questionnaire and the 36-item Short Form of the Medical Outcomes Study questionnaires were used. A total of 114 patients were enrolled: 31% men aged 48 +/- 15 years and 69% women aged 49 +/- 14 years (mean +/- SD). The mean values of SF-36 scales in nail disorders were higher than those reported for minor skin diseases, and Skindex-29 values were lower. A duration of disease > or =1 year was associated with higher Skindex-29 scores on the symptom and emotions scales. Patients with onychomycosis have higher values on the Skindex-29 social functioning scale compared with other nail disorders. The use of HRQoL measurements in routine clinical activities allows us to depict how nail disorders affect patients and show how relevant some neglected aspects, such as pain or emotional trauma, are and offers us the opportunity to address these issues in a patient-centred approach to treatment.