A protocol for recording the sign of flexural dermatitis in children.

The presence of visible flexural dermatitis is a key feature in diagnosing atopic dermatitis. We describe a protocol for recording this sign in population-based studies, which could be used by suitably trained non-dermatologists. The protocol was developed using a standard set of photographs and accompanying instructions, which define the terms 'dermatitis' and 'flexural'. When assessed during a survey of skin disease in primary schoolchildren, there was excellent agreement between a trained nurse and a dermatologist with regard to the presence or absence of this sign in 73 consecutive children, with perfect agreement in 71 children (97%), and a chance corrected agreement index (kappa statistic) of 0.90 (95% confidence interval [CI] 0.77-0.99). Agreement between two nurses on 114 consecutive schoolchildren was not quite as good, with perfect agreement in 102 children (90%), and a kappa value of 0.51 (95% CI 0.26-0.77). The protocol is easy to perform, does not require children to undress, takes < 1 min to carry out, and is highly acceptable to children and staff. This protocol may be useful in standardizing the assessment of atopic dermatitis in population studies of children.

London-born black Caribbean children are at increased risk of atopic dermatitis.

BACKGROUND: Previous reports suggest that atopic dermatitis is more common in black Caribbean children born in the United Kingdom than in white children. It is unclear whether these differences are caused by selection bias or variations in the use of the word "eczema" in the groups studied. OBJECTIVE: Our objective was to explore ethnic group differences in the prevalence of atopic dermatitis in London schoolchildren. METHODS: A cross-sectional prevalence survey of 693 junior school children in three schools was performed. Atopic dermatitis was defined in three ways: (1) by a dermatologist, (2) by visible flexural dermatitis as recorded by an independent observer, and (3) by a history of flexural dermatitis according to the child's parents. RESULTS: The prevalence of atopic dermatitis according to examination by a dermatologist was 16.3% in black Caribbean children and 8.7% in white children. This increased risk was present for different methods of defining of a atopic dermatitis and persisted after adjustment for potential confounders. CONCLUSION: London-born black Caribbean children appear to be at an increased risk of having atopic dermatitis.

London-born black Caribbean children are at increased risk of atopic dermatitis

BACKGROUND: Previous reports suggest that atopic dermatitis is more common in black Caribbean children born in the United Kingdom than in white children. It is unclear whether these differences are caused by selection bias or variations in the use of the word "eczema" in the groups studied. OBJECTIVE: Our objective was to explore ethnic group differences in the prevalence of atopic dermatitis in London schoolchildren. METHOD: A cross-sectional prevalence survey of 693 junior school children in three schools was performed. Atopic dermatitis was defined in three ways: (1) by a dermatologist, (2) by visible flexural dermatitis as recorded by an independent observer, and (3) by a history of flexural dermatitis according to the child's parents. RESULTS: The prevalence of atopic dermatitis according to examination by a dermatologist was 16.3 percent in black Caribbean children and 8.7 percent in white children. This increased risk was present for different methods of defining of atopic dermatitis and persisted after adjustment for potential confounders. CONCLUSION: London-born black Caribbean children appear to be at an increased risk of having atopic dermatitis. (AU)

Validation of a role-play measure of children's social skills.

A videotape-administered role-play test of children's social skills was developed and its psychometric properties tested. Performance criteria for the test were derived from popular children's ratings of the effectiveness of different role-play responses. The test was administered to 157 fourth- and fifth-grade boys and girls who had been classified as popular, average, neglected, or rejected, on the basis of sociometric testing. The test evidenced good interrater, test-retest, and internal consistency reliabilities. Children's role-play performance correlated significantly with teacher ratings of social competence and with peer-liking ratings. Neglected children performed more poorly on the role-play test than popular children. When differences in intelligence among social status groups were statistically controlled, social status groups did not differ on the role-play test. Results of the discriminant analyses support the conclusion that teacher ratings are better than role-play tests for identifying rejected children, whereas role-play tests and measures of intelligence appear more accurate than teacher ratings for identifying neglected children.

Assessing pediatric clerkship evaluations using generalizability theory.

Evaluation of pediatric clerkship ratings using generalizability theory is demonstrated. Ratings collected during an academic year are analyzed in a generalizability study, with emphasis placed upon the nature of the designs used to collect ratings. Since decisions regarding students' performances are made with these data, decision-study type analyses were carried out using the generalizability study results. Recommendations are made as to the type of designs that could be used in order to obtain generalizable results.

Obtaining generalizability coefficients for clinical evaluations.

This article discusses the determination of reliability coefficients for clinical evaluation forms by use of generalizability theory. This method is contrasted to some of the commonly used measures of interobserver agreement, interobserver reliability, and classical reliability. The value of this method in terms of making recommendations, such as the number of judges and the number of items on a form, in order to improve reliability is illustrated by two examples. Also, the difference between norm-referenced decisions and criterion-referenced decisions in determining reliability with this method is presented.