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1.
Rev Chilena Infectol ; 36(3): 283-291, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859746

RESUMO

INTRODUCTION: Condylomas or genital warts (GW) are the most frequently diagnosed sexually transmitted infection (STI) in STI centers in Chile, but there are no population statistics available. OBJECTIVES: To describe the prevalence of GW in patients from 18-60 years of age who attend outpatient dermatology, gynecology and urology practice; the demographic characteristics of the patients and the diagnostic and treatment tools. METHODS: A sample of Chilean specialists stratified by region, population and gender of patients was provided with a logbook and answered a questionnaire. RESULTS: The GW prevalence was 2.44% for the whole group; 3.76% for the 18-34 age group and 1.29% for the 35-60 years group (p = 0.0000). The average age of patients with GW was 29.4 years in women and 32.7 years in men (p = 0.019). The distribution by age was different according to gender and health system. Visual inspection was the most frequent diagnostic method used and imiquimod cream the most common treatment, however, there were differences in the use of diagnostic and therapeutic tools according to the patient's gender, specialty of the doctor and health system. CONCLUSIONS: The high prevalence of GW confirmed the need and importance of public health interventions to address this problem.


Assuntos
Condiloma Acuminado/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Adolescente , Adulto , Antineoplásicos/uso terapêutico , Chile/epidemiologia , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/tratamento farmacológico , Demografia/estatística & dados numéricos , Dermatologistas/estatística & dados numéricos , Feminino , Ginecologia/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Imiquimode/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Adulto Jovem
2.
J Drugs Dermatol ; 18(10): 980-984, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584775

RESUMO

Background: The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing likely due to improved detection and a growing elderly population. Although the prognosis of cSCC is excellent with complete surgical excision, many patients who go on to develop metastasis are initially classified as low-risk. The most commonly used staging systems, American Joint Committee on Cancer (AJCC) and Brigham Women's Hospital (BWH), have low sensitivity and low positive predictive value for predicting metastasis. A gene expression profile test (cSCC-GEP) is in development to identify patients with cSCC at high risk for metastasis and death. Objective: To determine the impact of cSCC-GEP test results on management decisions made by dermatologists for cSCC patients. Design, Setting, and Participants: 402 dermatologists attending a national dermatology conference completed an online survey designed to determine the impact of cSCC-GEP test results on management decisions in a variety of clinical situations. Participants answered a series of questions related to three cSCC patient vignettes, each featuring different patient and lesion characteristics. Main Outcomes and Measures: Proportion of dermatologists who would recommend radiation, chemotherapy/immunotherapy, or sentinel lymph node biopsy (SLNBx) for each patient vignette (without cSCC-GEP results, with a lower risk result, or with a higher risk result). The effect of the test results on the follow-up intervals recommended by dermatologists was also examined. Results: In the majority of vignettes, a lower risk cSCC-GEP test result led to a statistically significant decrease in the proportion of dermatologists who would recommend radiation, chemotherapy/immunotherapy, SLNBx, or quarterly follow-up. Conversely, a higher risk cSCC-GEP result significantly altered management toward increased intensity (more recommendations for radiation, chemotherapy/immunotherapy, SLNBx, or quarterly follow-up) in all vignettes. Conclusions and Relevance: The results of a cSCC-GEP test appear to significantly impact decisions made by dermatologists regarding subsequent management, SLNBx, and follow-up intervals for patients with cSCC. J Drugs Dermatol. 2019;18(10):980-984.


Assuntos
Carcinoma de Células Escamosas/terapia , Tomada de Decisão Clínica/métodos , Dermatologia/métodos , Perfilação da Expressão Gênica , Neoplasias Cutâneas/terapia , Adulto , Assistência ao Convalescente/métodos , Idoso , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Dermatologistas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Medição de Risco/métodos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Inquéritos e Questionários/estatística & dados numéricos
3.
J Drugs Dermatol ; 18(10): 987-990, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584776

RESUMO

Introduction: Introduction: Although future atopic dermatitis (AD) clinical research is intended to improve standard-of-care treatment, how patients are currently treated is not well characterized. The purpose of this study was to determine the most frequent medications prescribed in all ages of AD. Methods: The National Ambulatory Medical Care Survey (NAMCS) is a nationally representative survey of United States office-based ambulatory visits and records demographics, diagnoses, and treatments. This is a cross-sectional study using the NAMCS of all AD outpatient office visits from 2006 to 2015. Patient visits with an ICD-9-CM code for AD (691.8) were collected and analyzed. Frequency tables were created for age, race, providers managing AD, and treatment. Results: Patient demographics of AD visits included 51% male (95% Confidence Interval [CI]: 44-58%), 71% white (65-77%), 19% African American (14-25%), and 10% Asian (6-14%). About 31% (24-37%) of visits were to pediatricians and 27% (22-33%) to dermatologists whereas per physician, dermatologists managed more AD visits than pediatricians. Topical corticosteroids (59%; 52-66%) were the most common class of medications prescribed followed by antibiotics (11%; 6-16%) and second generation antihistamines (6%; 3-10%). The most common topical corticosteroid prescribed in AD was triamcinolone (25% of office visits; 18-31%). Hydrocortisone was the most common topical corticosteroid prescribed to children <1 year of age and children aged 8 to 18, whereas triamcinolone was more common in children 2 to 7 years and adults >18 years. Discussion: Topical corticosteroids were the most frequent prescriptions provided at office-based ambulatory visits whereas antibiotics and second-generation antihistamines were the second and third most common prescribed medications, respectively. Although pediatricians manage more AD visits than dermatologists in total visits, dermatologists manage more AD visits than pediatricians per physician. Characterizing how AD patients are currently treated may build a reference for future clinical research investigating novel standard-of-care treatment in AD. J Drugs Dermatol. 2019;18(10):987-990.


Assuntos
Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Padrão de Cuidado/estatística & dados numéricos , Administração Cutânea , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Dermatologistas/estatística & dados numéricos , Feminino , Glucocorticoides/uso terapêutico , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Lactente , Recém-Nascido , Masculino , Visita a Consultório Médico/estatística & dados numéricos , Estados Unidos , Adulto Jovem
4.
J Drugs Dermatol ; 18(8): 798-802, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424710

RESUMO

Cutaneous fungal infections account for millions of office visits per year, yet their varied presentations often lead to misdiagnosis. If dermatology clinics are Clinical Laboratory Improvement Amendment (CLIA) certified, direct microscopy with potassium hydroxide or other stains can be used to inexpensively and rapidly diagnose fungal infections. In this survey, we examined dermatologists' perceptions of fungal preparations and CLIA certification to identify barriers that prevent the use of these bedside diagnostics. The response rate was 13% (n=308, based on the number of emails opened). When a cutaneous fungal infection is suspected, 20.94% rarely/never and 19.86% sometimes perform fungal preparations, often because they think clinical diagnosis is adequate or that preparations take too long. 21.32% reported not having CLIA certification, most frequently because the process requires too much work, or they do not know how to apply. Of providers with CLIA certification, over 25% thought it was difficult to obtain. Our results demonstrate that numerous barriers prevent the common use of fungal preparations, including the perception that clinical diagnosis is sufficient and the lack of required CLIA certification. These barriers emphasize the need for additional education about cutaneous fungal infections and use of bedside diagnostics. Additionally, policy-based interventions are necessary to ease the process of CLIA certification.


Assuntos
Dermatomicoses/diagnóstico , Fungos/isolamento & purificação , Indicadores e Reagentes/química , Adulto , Idoso , Dermatologistas/estatística & dados numéricos , Dermatologia/métodos , Dermatologia/estatística & dados numéricos , Dermatomicoses/microbiologia , Dermatomicoses/patologia , Diagnóstico Diferencial , Feminino , Humanos , Hidróxidos/química , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/estatística & dados numéricos , Microscopia , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Compostos de Potássio/química , Padrões de Prática Médica/estatística & dados numéricos , Pele/microbiologia , Pele/patologia , Inquéritos e Questionários/estatística & dados numéricos
8.
Pediatr Dermatol ; 36(4): 564-566, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30968450

RESUMO

The October 2018 report from the United Nations Intergovernmental Panel on Climate Change predicts significant threats to human health secondary to anthropogenic global warming; children have been and will continue to be disproportionately affected by these weather-related changes. Multiple physician groups have acknowledged climate change as a public health issue, calling upon providers to educate their communities about this looming health crisis while also reducing their individual carbon footprints. A significant body of literature has also documented the adverse dermatologic consequences of a warmer planet, highlighting the importance of pediatric dermatologists in addressing climate change. Here, we summarize the rationale for the pediatric dermatologist as public health advocate, providing specific actionable items through which our specialty can positively address the climate change crisis and in turn protect the health of our patients now and in the future.


Assuntos
Defesa da Criança e do Adolescente , Bem-Estar da Criança , Mudança Climática , Dermatologistas/estatística & dados numéricos , Dermatologia/tendências , Pediatria/tendências , Criança , Humanos , Papel do Médico , Saúde Pública , Sociedades Médicas , Estados Unidos
9.
JAMA Dermatol ; 155(4): 465-470, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30825412

RESUMO

Importance: Although overall antibiotic use among dermatologists is decreasing, there has been an increase in use associated with dermatologic procedures during the past decade. This higher antibiotic use may increase antibiotic-associated adverse events and promote the development of antibiotic resistance. Objective: To characterize antibiotic use associated with dermatologic procedures, including geographic variation. Design, Setting, and Participants: Using Optum Clinformatics DataMart deidentified commercial claims data, we performed a repeated cross-sectional analysis of antibiotic prescribing by dermatologists from 2008 to 2016. Dermatology clinicians were identified by their National Uniform Claim Committee taxonomy codes, encounters for surgical procedures were identified by Common Procedure Terminology codes, and courses of oral antibiotics prescribed by these clinicians were identified by their National Drug Codes. Exposures: Claims for oral antibiotic prescriptions associated with encounters with dermatologists associated with dermatologic procedures. Main Outcomes and Measures: Frequency of antibiotic prescribing and associated procedures. Poisson regression models were used to assess for changes in the frequency of antibiotic prescribing over time. Results: Between 2008 and 2016, among 1 934 633 encounters (1 128 244 unique patients, 854 072 [44.1%] were women and the median [interquartile range] age was 66 [52-76] years) for dermatologic procedures, oral antibiotic prescribing associated with benign excisions increased from 2.9% to 4.4% of visits (52.5% relative change; incidence rate ratio [IRR], 1.04; 95% CI, 1.03-1.04), antibiotic prescribing associated with malignant excisions increased from 4.2% to 6.3% of visits (49.5% relative change; IRR, 1.06; 95% CI, 1.05-1.06), and antibiotic prescribing associated with Mohs surgery increased from 9.9% to 13.8% of visits (39.7% relative change; IRR, 1.04; 95% CI, 1.03-1.04). There was greater than 2-fold variation in antibiotic prescribing rates across geographic census divisions. If higher prescribing divisions were to develop antibiotic prescribing rates similar to lower prescribing divisions, antibiotic use could be decreased by over 50%. Conclusions and Relevance: Oral antibiotic prescribing by dermatologists associated with benign excisions, malignant excisions, and Mohs surgery is increasing over the past decade and there is substantial geographic variation. These findings highlight that there may be opportunities to optimize antibiotic use associated with dermatologic procedures.


Assuntos
Antibacterianos/administração & dosagem , Procedimentos Cirúrgicos Dermatológicos/métodos , Resistência Microbiana a Medicamentos , Uso de Medicamentos/estatística & dados numéricos , Adulto , Idoso , Antibacterianos/efeitos adversos , Estudos Transversais , Bases de Dados Factuais , Procedimentos Cirúrgicos Dermatológicos/estatística & dados numéricos , Dermatologistas/estatística & dados numéricos , Dermatologia/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/métodos , Cirurgia de Mohs/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco
11.
JAMA Dermatol ; 155(3): 290-297, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30649187

RESUMO

Importance: Dermatologists prescribe more oral antibiotic courses per clinician than any other specialty, and this use puts patients at risk of antibiotic-resistant infections and antibiotic-associated adverse events. Objective: To characterize the temporal trends in the diagnoses most commonly associated with oral antibiotic prescription by dermatologists, as well as the duration of this use. Design, Setting, and Participants: Repeated cross-sectional analysis of antibiotic prescribing by dermatologists from January 1, 2008, to December 31, 2016. The setting was Optum Clinformatics Data Mart (Eden Prairie, Minnesota) deidentified commercial claims data. Participants were dermatology clinicians identified by their National Uniform Claim Committee taxonomy codes, and courses of oral antibiotics prescribed by these clinicians were identified by their National Drug Codes. Exposures: Claims for oral antibiotic prescriptions were consolidated into courses of therapy and associated with the primary diagnosis from the most recent visit. Courses were stratified into those of extended duration (>28 days) and those of short duration (≤28 days). Main Outcomes and Measures: Frequency of antibiotic prescribing and associated diagnoses. Poisson regression models were used to assess for changes in the frequency of antibiotic prescribing over time. Results: Between 2008 and 2016 among 985 866 courses of oral antibiotics prescribed by 11 986 unique dermatologists, overall antibiotic prescribing among dermatologists decreased 36.6% (1.23 courses per 100 visits) from 3.36 (95% CI, 3.34-3.38) to 2.13 (95% CI, 2.12-2.14) courses per 100 visits with a dermatologist (prevalence rate ratio for annual change, 0.931; 95% CI, 0.930-0.932), with much of this decrease occurring among extended courses for acne and rosacea. Oral antibiotic use associated with surgical visits increased 69.6% (2.73 courses per 100 visits) from 3.92 (95% CI, 3.83-4.01) to 6.65 (95% CI, 6.57-6.74) courses per 100 visits associated with a surgical visit (prevalence rate ratio, 1.061; 95% CI, 1.059-1.063). Conclusions and Relevance: Continuing to develop alternatives to oral antibiotics for noninfectious conditions, such as acne, can improve antibiotic stewardship and decrease complications from antibiotic use. In addition, the rising use of postoperative antibiotics after surgical visits is concerning and may put patients at unnecessary risk of adverse events. Future studies are needed to identify the value of this practice and the risk of adverse events.


Assuntos
Antibacterianos/administração & dosagem , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/tendências , Administração Oral , Estudos Transversais , Dermatologistas/estatística & dados numéricos , Dermatologia/métodos , Feminino , Humanos , Masculino , Minnesota , Prevalência , Estudos Retrospectivos , Fatores de Tempo
13.
Br J Dermatol ; 180(2): 373-381, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29953582

RESUMO

BACKGROUND: Application of deep-learning technology to skin cancer classification can potentially improve the sensitivity and specificity of skin cancer screening, but the number of training images required for such a system is thought to be extremely large. OBJECTIVES: To determine whether deep-learning technology could be used to develop an efficient skin cancer classification system with a relatively small dataset of clinical images. METHODS: A deep convolutional neural network (DCNN) was trained using a dataset of 4867 clinical images obtained from 1842 patients diagnosed with skin tumours at the University of Tsukuba Hospital from 2003 to 2016. The images consisted of 14 diagnoses, including both malignant and benign conditions. Its performance was tested against 13 board-certified dermatologists and nine dermatology trainees. RESULTS: The overall classification accuracy of the trained DCNN was 76·5%. The DCNN achieved 96·3% sensitivity (correctly classified malignant as malignant) and 89·5% specificity (correctly classified benign as benign). Although the accuracy of malignant or benign classification by the board-certified dermatologists was statistically higher than that of the dermatology trainees (85·3% ± 3·7% and 74·4% ± 6·8%, P < 0·01), the DCNN achieved even greater accuracy, as high as 92·4% ± 2·1% (P < 0·001). CONCLUSIONS: We have developed an efficient skin tumour classifier using a DCNN trained on a relatively small dataset. The DCNN classified images of skin tumours more accurately than board-certified dermatologists. Collectively, the current system may have capabilities for screening purposes in general medical practice, particularly because it requires only a single clinical image for classification.


Assuntos
Aprendizado Profundo , Interpretação de Imagem Assistida por Computador/métodos , Neoplasias Cutâneas/diagnóstico , Pele/diagnóstico por imagem , Conjuntos de Dados como Assunto , Dermatologistas/estatística & dados numéricos , Dermoscopia , Humanos , Interpretação de Imagem Assistida por Computador/instrumentação , Interpretação de Imagem Assistida por Computador/estatística & dados numéricos , Aplicativos Móveis , Sensibilidade e Especificidade , Smartphone
14.
J Dermatolog Treat ; 30(3): 237-239, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30078341

RESUMO

PURPOSE: Injectable biologics (IB) are important in dermatology and we sought to examine the distribution of US IB-prescribing dermatologists. MATERIALS AND METHODS: We used Centers for Medicare and Medicaid Services Medicare Provider Utilization and Payment Data: Part D for 2013-2015. The density of dermatologists who prescribe IB (etanercept, adalimumab, ustekinumab, secukinumab) in each US county, represented as number of dermatologists per 100,000 Medicare Part D beneficiaries, was calculated. RESULTS: 2,992 dermatologists (26.3% of dermatologists) prescribed IB in this study. The national density of IB-prescribing dermatologists was 7.22. Only 778 counties (24.8%) have at least one IB-prescribing dermatologist. The densities of IB-prescribing dermatologists in metropolitan counties were 8.07-8.12. The densities of IB-prescribing dermatologists were 4.55 and 6.51 for urban populations of greater than 20,000 people adjacent and non-adjacent to metropolitan areas, respectively. Urban counties with populations between 2,500-19,999 and adjacent to a metropolitan area had a density of 2.03 and urban counties with the same population and not adjacent to a metropolitan area had a density of 2.84. Completely rural or urban counties with populations under 2,500 people had densities between 2.31-2.35. CONCLUSIONS: There are disparities in the availability of IB-prescribing dermatologists across urban-rural geographic settings in the US.


Assuntos
Produtos Biológicos/uso terapêutico , Dermatologistas/estatística & dados numéricos , Dermatologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adalimumab/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Etanercepte/uso terapêutico , Humanos , Medicare , População Rural , Estados Unidos , População Urbana , Ustekinumab/uso terapêutico
15.
Br J Dermatol ; 180(2): 390-396, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30218575

RESUMO

BACKGROUND: The Psoriasis Area and Severity Index (PASI) represents the gold standard for psoriasis severity assessments but is limited by its subjectivity and low intra- and inter-rater consistency. OBJECTIVES: To investigate the precision and reproducibility of automated, computer-guided PASI measurements (ACPMs) in comparison with three trained physicians. METHODS: This was a comparative observational study assessing ACPMs attained by automated total-body imaging and computerized digital image analysis in a cohort of 120 patients affected by plaque psoriasis of various severities. The level of agreement between ACPMs and physicians' PASI measurements was calculated by the intraclass correlation coefficient (ICC). The reproducibility of ACPMs in comparison with physicians' PASI measurements was investigated by performing two successive 'repeat PASI calculations' in the same patients. RESULTS: The agreement between ACPMs and physicians' PASI calculations in 120 fully evaluable patients was high (ICC 0·86, 95% confidence interval 0·80-0·90, mean absolute difference 2·5 PASI points). Repeat ACPMs to measure the reproducibility showed an excellent ICC of 0·99 (95% confidence interval 0·98-0·99) with a mean absolute difference of 0·5 PASI points. The ACPMs thus outperformed the three physicians for intrarater reliability (mean ICC 0·86). CONCLUSIONS: The results of this first clinical study investigating ACPMs in 120 patients with psoriasis indicate a similar precision and higher reproducibility in comparison with trained physicians. Limitations arise from poorly observable body sites and from patients unable to attain predefined postures during automated image acquisition.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Psoríase/diagnóstico , Índice de Gravidade de Doença , Adulto , Dermatologistas/estatística & dados numéricos , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/instrumentação , Interpretação de Imagem Assistida por Computador/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Fotografação , Reprodutibilidade dos Testes , Pele/diagnóstico por imagem
16.
Dermatol Ther ; 32(2): e12796, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30520195

RESUMO

Recently, advances in understanding the etiology of urticaria and updates of diagnostic and therapeutic management guidelines have drawn attention to chronic urticaria (CU) morbidity. The present study aimed to evaluate Iranian dermatologists' practice and real life management of CU patients. A total of 35 dermatologists and 443 patients were included in the study. Number of female patients was 321 (72.5%). Mean (standard deviation) age of the study patients was 38 (13) years and the median (inter quartile range) of disease duration was 12 (6-48) months. Severity of patients' symptoms was mild for 32.1%, moderate for 38.7%, severe for 18.8%, and 10.4% of them had no evident signs or symptoms. The most common diagnostic methods were physical examination (96.6%), differential blood count (83.5%), erythrocyte sedimentation rate (77.4%), and C-reactive protein (62.8%). The number of dermatologists prescribed nonsedating antihistamines (nsAH) in regular dose and high dose mono therapy were 26 (74%) and 6 (17%), respectively. About 66% of dermatologists were familiar with British Association of Dermatologists (BAD) guideline. The most common first-line treatment for CU by Iranian dermatologists was nonsedating antihistamines in regular or high doses. The real-life management of patients with CU in Iran was in accordance with the available practice guidelines.


Assuntos
Dermatologistas/estatística & dados numéricos , Antagonistas dos Receptores Histamínicos H1 não Sedativos/administração & dosagem , Padrões de Prática Médica/estatística & dados numéricos , Urticária/tratamento farmacológico , Adulto , Doença Crônica , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Índice de Gravidade de Doença , Urticária/diagnóstico , Adulto Jovem
17.
J Dermatol ; 46(3): 206-212, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30592077

RESUMO

This study aimed to determine the prevalence of vitamin D insufficiency among Thai dermatologists compared with the general working-age population in Bangkok. A cross-sectional study was conducted in healthy Thai physicians who had at least 1 years' experience in dermatology practise and a subsample of the general Thai population from the Fourth National Health Survey. Serum 25-hydroxyvitamin D (25[OH]D), a combination of 25(OH)D2 and 25(OH)D3, levels in both groups were measured using liquid chromatography coupled with mass spectrometry. The majority of dermatologists were of Fitzpatrick skin type III (n = 61, 61.3%) or IV (n = 32, 33.3%). The mean serum 25(OH)D and 25(OH)D3 levels were 18.9 and 18.2 ng/mL, respectively, whereas the corresponding levels in the general population were 26.5 and 25.8 ng/mL. None of the dermatologist had serum 25(OH)D sufficiency (>30 ng/mL), 38 (38.78%) had vitamin D insufficiency (20-30 ng/mL) and 60 (61.22%) had vitamin D deficiency (<20 ng/mL). The frequency of vitamin D deficiency in dermatologists was significantly higher than in the general population (61.2% vs 19.2%, P < 0.001). Ninety percent of dermatologists used sunscreen daily and spent time mostly indoors. Dermatologists used physical sun-protection more than half of the time when outdoors, for example, a book or paper as a sunshade (70.3%), an umbrella (48.4%), a long-sleeved shirt (20.4%) or a hat (9.7%). In conclusion, dermatologists showed a remarkably high prevalence of vitamin D deficiency which may be due to inadequate exposure to sunlight, regular use of sunscreen and practicing various sun-protection activities.


Assuntos
Dermatologistas/estatística & dados numéricos , Deficiência de Vitamina D/epidemiologia , Vitamina D/sangue , Adulto , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Luz Solar , Protetores Solares/administração & dosagem , Tailândia/epidemiologia , Deficiência de Vitamina D/sangue
18.
Clin Dermatol ; 37(1): 21-28, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30554618

RESUMO

The Ibero Latin American College of Dermatology, CILAD, the largest dermatologic organization in the region, was established in 1948 during the course of the V International Congress of Leprosy held in Havana, Cuba. Constituted in its beginning with fewer than 100 dermatologists from nine countries, its growth has been exponential, reaching now around 4000 members spread throughout Latin America, the Iberian Peninsula, and other regions of the world. In recent years, academic activity has been intense, such as the development of several institutional programs, like its community health care program, designed for geographic areas lacking dermatologic care in the Latin American region. This contribution presents a review of its history, noting the dermatologists and personalities who ennoble the institution. The multiple areas of interest of this growing dermatologic organization are described, and the projections toward the future are discussed.


Assuntos
Dermatologistas/estatística & dados numéricos , Dermatologia/organização & administração , Sociedades Médicas , Mão de Obra em Saúde/estatística & dados numéricos , Mão de Obra em Saúde/tendências , Humanos , América Latina/epidemiologia , Pesquisa/estatística & dados numéricos , Sociedades Médicas/tendências
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