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Schultheis M, Grabbe S, Staubach P, Hennig K, Mauch M, Burckhardt M, Langer G, Heise M, Zamsheva M, Schollenberger L, Strobel A. Drivers of disease severity and burden of hidradenitis suppurativa: a cross-sectional analysis on 553 German patients. Int J Dermatol 2024; 63:188-195. [PMID: 37919257 DOI: 10.1111/ijd.16889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory disease of the inverse skin regions with an age peak at around 40 years and an estimated prevalence of 1%. Nodules and abscesses can develop into fistules and scarring, which cause severe pain. HS is a progressive, life-defining disease that leads to physical limitations, inability to work, and social isolation. There is still little data on the drivers of disease severity and burden. METHOD The cross-sectional study is based on the baseline data of 553 participants of the health care research project "EsmAiL," which was carried out as a multicenter randomized controlled trial. It included adult HS-patients presenting with at least three inflammatory lesions and at least a moderate impact on quality of life. RESULTS Disease activity increases with age. Men are more severely affected than women but feel less burdened. Obesity negatively influences disease activity and disease burden. Affected individuals have a higher level of education than the age adjusted population, but the unemployment rate is significantly higher. Disease activity significantly reduces quality of life and promotes depression and anxiety. CONCLUSIONS HS is a severe and debilitating dermatosis. As a result of the well-established factors involved, HS requires a multi-causal approach to management, in addition to medical and surgical treatment. This must take into account all available therapeutic options, as well as patient education to reduce risk factors and pain, and psychological support. HS requires interdisciplinary and multi-professional care. To prevent disease progression, a structured treatment plan is needed.
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Affiliation(s)
- Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Melanie Mauch
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
| | - Marion Burckhardt
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
| | - Gero Langer
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Marcus Heise
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of General Practice and Family Medicine, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Marina Zamsheva
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lukas Schollenberger
- Interdisciplinary Center for Clinical Trials, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Alexandra Strobel
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
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Szepietowska M, Dabrowska A, Dziasek S, Lisicki B, Skinderowicz K, Wilczyński B, Krajewski PK, Szepietowski JC. Hand Eczema in High School Students in Poland: A Cross-sectional Study. Acta Derm Venereol 2024; 104:adv1367. [PMID: 38197698 PMCID: PMC10795688 DOI: 10.2340/actadv.v104.18367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Marta Szepietowska
- DDepartment of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Alicja Dabrowska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Szymon Dziasek
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Lisicki
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Skinderowicz
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Wilczyński
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland.
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Krajewski PK, Strobel A, Schultheis M, Staubach P, Grabbe S, Hennig K, Matusiak L, von Stebut E, Garcovich S, Bayer H, Heise M, Kirschner U, Nikolakis G, Szepietowski JC. Hidradenitis Suppurativa Is Associated with Severe Sexual Impairment. Dermatology 2024; 240:205-215. [PMID: 38190809 DOI: 10.1159/000536128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/25/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the pilosebaceous unit, often affecting and deforming intimate regions. HS is associated with severe pain, pruritus, and constant, purulent, malodorous discharge expected to impair sexual health of patients. METHODS We performed a cross-sectional, multicentric study involving 199 German patients from the health services research project "Epidemiology and Care in Acne inversa (EpiCAi)." The sexual health, HS severity, and quality of life of the studied group were evaluated using a specially designed questionnaire. RESULTS Regardless of gender, HS has an enormous impact on patients' sexual health. The patients scored, on average, 28.8 ± 5.3 points on the Relation and Sexuality Scale (RSS). Multiple linear regression revealed that females and patients with Hurley III stage had higher sexual dysfunction (p = 0.012). Sexual dysfunction is associated with pain (β = 0.25), the number of active lesions, the affected areas (β = 0.14), and psychosocial aspects, including low quality of life (β = 0.404), stigmatization (β = 0.411), depression (β = 0.413), and anxiety (β = 0.300). Patients already see a substantial decrease in sexual frequency in the early stages of HS, while functional impairment and fear increase with the severity of the disease. CONCLUSION Sexual health and management of its dysfunctions should be part of a holistic approach to HS patients.
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Affiliation(s)
- Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
- Profile Centre of Health Sciences Halle, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
| | - Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - Hans Bayer
- Dermatology Outpatient Office Hautmedizin Bad Soden, Bad Soden, Germany
| | - Marcus Heise
- Profile Centre of Health Sciences Halle, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
- Institute for Health- and Nursing Science, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
- Institute of General Practice and Family Medicine, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Zalewski A, Krajewski PK, Szepietowski JC. Psychosocial Consequences of Hand Eczema-A Prospective Cross-Sectional Study. J Clin Med 2023; 12:5741. [PMID: 37685808 PMCID: PMC10488619 DOI: 10.3390/jcm12175741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Hand eczema (HE) is a chronic inflammatory disease with a high prevalence, negatively influencing patients' quality of life (QoL). It may also affect patients' psychological status. The aim of this study was to assess and characterize the psychological burden of HE, its influence on patients' QoL, and the presence and severity of anxiety and depressive disorders in HE patients. METHODS The study group consisted of 100 adult HE individuals. To assess the severity of the disease, two instruments were used: the Investigator Global Assessment for Chronic Hand Eczema (IGA-CHE) scale and the Hand Eczema Severity Index (HECSI). Assessment of patients' quality of life (QoL) was obtained with the use of the DLQI tool. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires were employed to assess depression and anxiety, respectively, as well as a modified version of the Hospital Anxiety and Depression Scale (HADS-M). RESULTS The mean DLQI value for the whole group reached 11.62 ± 6.35 points (13.27 ± 6.67 points in females and 9.15 ± 4.95 points in males; p = 0.023). A decrease in QoL correlated positively with the severity of the disease and the severity of itch and pain. In 17 patients (17%), a possible diagnosis of depressive disorder was found. Patients scoring higher results on the PHQ-9 and HADS-M depression (D) questionnaires reported greater intensity of the itch (r = 0.363, p < 0.001, and r = 0.237, p = 0.017, respectively) and the pain (r = 0.445, p < 0.001, and r = 0.287, p = 0.004, respectively). The anxiety disorder might possibly be diagnosed in 25% of patients (n = 25). This study revealed a positive correlation between the severity of the anxiety symptoms, measured with the use of both GAD-7 and HADS-M anxiety (A) tools, and the intensity of the pain (r = 0.248, p = 0.013, and r = 0.342, p = 0.001, respectively). The severity of depressive and anxiety symptoms correlated positively with the severity of the disease. CONCLUSIONS The psychosocial burden of HE is an undeniable phenomenon. The disorder influences patients' QoL and may cause mental disturbances such as depression and anxiety disorders.
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Affiliation(s)
| | | | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
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Zalewski A, Krajewski PK, Szepietowski JC. Prevalence and Characteristics of Itch and Pain in Patients Suffering from Chronic Hand Eczema. J Clin Med 2023; 12:4198. [PMID: 37445233 DOI: 10.3390/jcm12134198] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Hand eczema (HE) is a frequent chronic inflammatory dermatosis. Itch and pain are considered two of the most common and burdensome symptoms of the disease. Yet, the data related to these symptoms are still limited. The aim of this study was to evaluate characteristics of itch and pain in adults suffering from HE. METHODS The study group comprised 100 adult HE patients. An original questionnaire designed by the authors was used to survey the patients. It included questions regarding demographic characteristics such as the duration of the disease, exacerbation count, past diagnostics and treatment, as well as atopic predispositions. Additionally, the itch and pain intensity (numerical rating scale-NRS) during '3 days prior to the study' and the 'entire disease' period was implemented. The clinical assessment of the disease severity was performed according to two specific measurement instruments: Investigator Global Assessment for Chronic Hand Eczema (IGA-CHE) scale and Hand Eczema Severity Index (HECSI). To assess patient quality of life (QoL), the DLQI tool was used and to determine the level of stigmatization and for its impact on patients' life the 6-Item Stigmatization Scale (6-ISS) was employed. RESULTS Within the period of 3 days prior to the examination, itch was reported by 81.0% of patients (n = 81), whereas 53.0% (n = 53) of them experienced pain. Both symptoms were reported more frequently in females (itch: p = 0.022; pain: p = 0.033). When sexes were compared, females reached higher scores in both IGA-CHE and HECSI. Itch and pain intensity correlated positively with disease severity. The intensity of itch and pain significantly influences HE patients' QoL. A positive correlation between the 6-ISS score and the intensity of itch in the 'last 3 days' period was revealed (r = 0.221; p = 0.027). CONCLUSIONS Itch and pain are common symptoms in HE patients, significantly contributing to the feeling of stigmatization. Providing characteristics of itch and pain may improve HE management. Symptom-decreasing treatment would definitely have a positive influence on patients' well-being.
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Affiliation(s)
- Adam Zalewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
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Thumb Carpometacarpal Arthritis Surgery: The Patient Experience. Plast Reconstr Surg 2021; 148:809-815. [PMID: 34398864 DOI: 10.1097/prs.0000000000008313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with symptomatic recalcitrant thumb carpometacarpal arthritis often undergo surgery. Although most surgical patients do well, the authors anticipated that a substantial portion of their thumb carpometacarpal surgery patients would have unsatisfactory experiences and express unmet expectations, dissatisfaction, and regret, regardless of surgical procedure performed. The authors hypothesized those experiences would correlate with patient-reported outcomes scores. METHODS The authors identified patients who had undergone trapeziectomy alone or with ligament reconstruction 1 to 4 years previously for primary thumb carpometacarpal arthritis. One hundred twelve patients completed Quick Disabilities of the Arm, Shoulder and Hand and visual analogue scale pain, expectations, satisfaction, and regret questionnaires. RESULTS More than 40 percent of patients expected to "return to normal" after surgery for pain, strength, and/or function. Including all patients, 7, 19, and 11 percent had unmet expectations for improvement in pain, strength, and function, respectively. Twelve percent expressed dissatisfaction with their outcome. Although just 4 percent regretted undergoing surgery, 13 percent would likely not recommend the procedure to someone they care about. There were no statistically significant differences for any patient-reported outcomes between trapeziectomy-alone (n = 20) and trapeziectomy with ligament reconstruction (n = 92). Visual analogue scale and Quick Disabilities of the Arm, Shoulder and Hand questionnaire scores were both moderately correlated with expectations being met for pain, strength, and function and for satisfaction with surgical outcome. CONCLUSIONS Patients' thumb carpometacarpal surgical experiences vary considerably. Many express dissatisfaction or a lack of expectations met with the two most common procedures. A thorough understanding and review of expectations preoperatively may be uniquely pertinent for these patients. Further research should determine predictors and potentially modifiable factors for unsatisfactory outcomes.
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The Burden of Hidradenitis Suppurativa Signs and Symptoms in Quality of Life: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136709. [PMID: 34206415 PMCID: PMC8293810 DOI: 10.3390/ijerph18136709] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 12/19/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent and debilitating inflammatory skin disease of the hair follicle that usually presents as painful, deep-seated inflamed lesions in the apocrine gland-bearing areas of the body. HS patients suffer from uncomfortable signs and symptoms, such as pain, pruritus, malodour and suppuration, which may impair patients’ quality of life (QoL). Although HS patients frequently experience these signs and symptoms, they are only occasionally assessed by clinicians and, unexpectedly, the scientific evidence available is limited and heterogeneous. The aim of this study is to summarize the evidence regarding the impact of HS signs and symptoms on QoL to serve as a basis for future research and help clinicians to consider them in the daily care of HS patients. A systematic review and meta-analysis were conducted following PRISMA Guidelines. The following search algorithm was used: (hidradenitis or “acne inversa”) and (pain or itch or odour or malodour or suppuration or oozing or drainage) and (“quality of life”). The literature search identified 836 references, 17 of them met the eligible criteria and were included for analysis, representing 4929 HS patients. Mean age of the participants was 36.28 years and there was a predominance of female sex among study participants. The BMI of the population was in the range of over-weight and about two out five patients were active smokers. Studies included patients with mild to moderate HS, with a mean disease duration of 13.69 years. The HS signs and symptoms assessed were pain, pruritus, malodour and suppuration. Overall, the higher intensity of a sign or symptom correlated with poorer general QoL or specific QoL dimensions including sexual distress, anxiety, depression and sleep. The most frequently employed tool to assess QoL was the Dermatology Life Quality Index (DLQI). DLQI was used in 52.9% of the studies (9/17) with a mean value of 10.70 (2.16 SD). The scores employed to assess signs and symptoms severity were subjective and varied between studies, being the numerical rating scale (NRS) for each of the most used symptoms. The mean NRS value for pain was 3.99 and the mean NRS for pruritus was 4.99. In conclusion, we have summarized, categorized and analyzed the scientific evidence regarding signs and symptoms in HS patients and their impairment in QoL. Their assessment should be thorough and included during routine evaluation of HS patients to motivate therapeutic modifications and increase patients’ health.
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Krajewski PK, Matusiak Ł, von Stebut E, Schultheis M, Kirschner U, Nikolakis G, Szepietowski JC. Quality-of-Life Impairment among Patients with Hidradenitis Suppurativa: A Cross-Sectional Study of 1795 Patients. Life (Basel) 2021; 11:34. [PMID: 33429896 PMCID: PMC7828046 DOI: 10.3390/life11010034] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/22/2022] Open
Abstract
The chronic, inflammatory skin disorder hidradenitis suppurativa (HS) is associated well documented negative influences on patients' quality of life (QoL). The aim of this study was to present more robust data on patients' QoL impairment by demographic data and its correlation with well-known HS risk factors on a cohort of 1795 German patients. The instrument used for measuring QoL in this study was the Dermatology Life Quality Index (DLQI). Overall, patients reported a very large effect of HS on their QoL (mean DLQI: 13.2 ± 8.1 points), and 22% of the analyzed population even reported to consider the effect as extremely large. Women tended to experience significantly higher impairment than men (p < 0.001). QoL impairment correlated positively with pain (r = 0.581, p < 0.001), HS severity (measured by the International Hidradenitis Suppurativa Severity Score System (IHS4)) as well as Hurley. Neck involvement tended to decrease QoL significantly more than any other location (14.7 ± 8.3 points). This study confirms the enormous influence of HS on patients' QoL in a large cohort. Knowledge of QoL impairment in such patients is crucial for proper understanding and holistic management of this disease.
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Affiliation(s)
- Piotr K. Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (Ł.M.)
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (Ł.M.)
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, 50923 Cologne, Germany;
| | - Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, 55122 Mainz, Germany;
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, 55116 Mainz, Germany;
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, 06847 Dessau, Germany;
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (Ł.M.)
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Chien CW, Lin CY. Community Participation of School-Age Children: Who is at Risk of Restricted Participation? Phys Occup Ther Pediatr 2021; 41:447-463. [PMID: 33761819 DOI: 10.1080/01942638.2021.1900489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS This study aimed to identify children with restricted community participation and examine the extent to which the child, family, and environmental factors were associated with restricted participation. METHODS A school-based sample of 92 children with disabilities and 391 children without disabilities aged 5-12 years was recruited in Hong Kong. Parents completed the Participation and Environment Measure for Children and Youth and a demographic questionnaire. Moreover, children completed the Children's Depression Inventory. Rasch analysis was used to determine the criteria that differentiated between children with and without participation restriction, based on frequency of activities. Logistic regression was used to identify the factors associated with participation restriction. RESULTS One hundred seventy-three children (35.8% of the sample), including 42 with disabilities, were identified as having restricted participation. Participation restriction was associated with higher depressive symptoms in children (odds ratio (OR) = 1.05, 95% confidence interval (CI) [1.01, 1.08]), lower environmental resources (OR = 0.97, 95% CI [0.96, 0.99]), and coming from families with three or more children (OR = 2.80, 95% CI [1.44, 5.46]). CONCLUSIONS The results suggest that a sizable number of children are at risk for restricted participation in the community. Healthcare services and strategies that address the associated factors are needed to promote children's community participation.
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Affiliation(s)
- Chi-Wen Chien
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Interpreting Patient-reported Outcome Scores for Clinical Research and Practice. Med Care 2019; 57 Suppl 5 Suppl 1:S8-S12. [DOI: 10.1097/mlr.0000000000001062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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van Aken M, Oosterman J, van Rijn T, Woudsma K, Ferdek M, Ruigt G, Kozicz T, Braat D, Peeters A, Nap A. Experimental pain tolerance is decreased and independent of clinical pain intensity in patients with endometriosis. Fertil Steril 2018; 110:1118-1128. [DOI: 10.1016/j.fertnstert.2018.06.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023]
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Matusiak Ł. Profound consequences of hidradenitis suppurativa: a review. Br J Dermatol 2018; 183:e171-e177. [PMID: 29744872 DOI: 10.1111/bjd.16603] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 01/03/2023]
Abstract
Hidradenitis suppurativa (HS) influences patients' lives in many ways. The most troublesome symptom of HS is chronic pain, of mild-to-moderate intensity, which is reported by almost all patients. With reference to psychosocial evaluation, HS appears to be a highly debilitating disease. The major factors influencing patients' well-being are disease severity, the number of flares or affected skin areas, and the lesion location. The mean Dermatology Life Quality Index scores of 8·3-12·7 points obtained among patients with HS are typical for severe dermatoses, which have a large impact on patients' quality of life (QoL). HS not only affects skin-related QoL issues, but also has a profound impact on general QoL measures - it causes substantial deterioration of both physical and mental health. Considering the impaired QoL due to HS and HS-associated, nonpsychiatric comorbidities, it is not surprising that patients with HS experience psychological disturbances. In both observational and registry studies, depression and anxiety were significantly related to HS. The prevalences were estimated as 1·6-42·9% and 0·8-3·9%, respectively. HS was also linked to feelings of loneliness and stigmatization. Moreover, these patients have a significantly increased suicide risk (hazard ratio 2·42). HS, with its frequent involvement of the genital area, causes a pronounced impairment of sex life (66·7% of patients with HS reported sexual difficulties). Finally, HS causes significant financial burden, not only through the costs of healthcare, but also due to a substantial impact on patients' professional careers. This is a reason for absenteeism from work for approximately half of patients, and a relatively high unemployment rate.
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Affiliation(s)
- Ł Matusiak
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Chałubińskiego 1,, 50-368, Wrocław, Poland
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Walton DM, Marsh J. The Multidimensional Symptom Index: A new patient-reported outcome for pain phenotyping, prognosis and treatment decisions. Eur J Pain 2018; 22:1351-1361. [PMID: 29635812 DOI: 10.1002/ejp.1224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND There are few patient-reported outcomes routinely used that capture frequency and interference of different pain-related symptoms on a single scale. The purpose of this study was to describe the development and initial validation of the new Multidimensional Symptom Index (MSI). METHODS Items were generated from patient interviews of the experience of chronic pain. Health valuations were created from rankings of 82 healthy subjects for each of 120 symptom (×10) × frequency (×3) × interference (×4) combinations using preference-based health valuations (0-100). Ranks for each symptom combination were then used in scale scoring. A sample of 300 patients with acute or chronic pain subsequently completed the MSI and a battery of other tools. Exploratory (EFA) and Confirmatory (CFA) factor analyses were triangulated with theory to arrive at the factor structure. Convergent validity was tested against established measures. RESULTS Health rankings resulted in scores of 0-12 for each of the 10 symptom types. Factor analyses revealed two factors: MSI Somatic Symptoms and MSI Non-Somatic Symptoms. The MSI also quantified number of symptoms experienced (/10), mean frequency (/3) and mean interference (/4). The indices showed appropriate associations with the established PROs. CONCLUSIONS The MSI is a new symptom-focused PRO that allows patient phenotyping and may have value for screening, prognosis and evaluating change. SIGNIFICANCE This article presents the development and psychometric properties of a new measure of pain and related symptom frequency and interference. This measure could aid clinicians in establishing clinically relevant pain phenotypes for screening, prognosis and treatment decisions.
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Affiliation(s)
- D M Walton
- School of Physical Therapy, Western University, London, ON, Canada.,Bone and Joint Institute, Western University, London, ON, Canada
| | - J Marsh
- School of Physical Therapy, Western University, London, ON, Canada.,Bone and Joint Institute, Western University, London, ON, Canada
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van Aken M, Oosterman J, van Rijn T, Ferdek M, Ruigt G, Kozicz T, Braat D, Peeters A, Nap A. Hair cortisol and the relationship with chronic pain and quality of life in endometriosis patients. Psychoneuroendocrinology 2018; 89:216-222. [PMID: 29414035 DOI: 10.1016/j.psyneuen.2018.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 12/15/2017] [Accepted: 01/02/2018] [Indexed: 12/30/2022]
Abstract
Endometriosis is a chronic estrogen-dependent disease in which pelvic pain is the dominant symptom. The negative effects of endometriosis on the life of women with this disease can be a cause of stress. Stress levels can be measured in different ways, mostly reflecting acute stress responses. Hair cortisol measurements are a reflection of long-term systematic cortisol levels. In this study a first attempt is made to measure cortisol levels in hair of endometriosis patients in comparison with healthy controls. Moreover, it is explored whether chronic pain symptoms as well as different aspects of Health Related Quality of Life (HRQoL) are associated with hair cortisol levels in women with endometriosis. Results show that the mean hair cortisol level is significantly higher in women with endometriosis compared to healthy controls (p = 0.018). There is a positive correlation between hair cortisol level and HRQoL in patients but not in controls (Rho 0.426). The level of hair cortisol does not correlate with the reported pain intensity in patients (Rho -0.082). These results are indicative of an altered HPA-axis function in endometriosis patients, possibly caused by higher chronic stress level in these patients. Moreover, a potential explanation for the positive correlation of cortisol with the HRQoL in these patients is that patients with a high HRQoL have an adequate stress response by increasing their cortisol levels as a response to physical and emotional stress induced by the endometriosis.
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Affiliation(s)
- Mieke van Aken
- Department of Anatomy, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Gynaecology and Obstetrics, Rijnstate, Arnhem, The Netherlands.
| | - Joukje Oosterman
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Tineke van Rijn
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Magdalena Ferdek
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Psychology Laboratory, Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Gé Ruigt
- Clinical Consultancy for Neuroscience Drug Development BV, Oss, The Netherlands
| | - Tamas Kozicz
- Department of Anatomy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Didi Braat
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, The Netherlands
| | - Ard Peeters
- Department of Anatomy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Annemiek Nap
- Department of Gynaecology and Obstetrics, Rijnstate, Arnhem, The Netherlands
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15
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Pain cognition versus pain intensity in patients with endometriosis: toward personalized treatment. Fertil Steril 2017; 108:679-686. [DOI: 10.1016/j.fertnstert.2017.07.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/15/2017] [Accepted: 07/17/2017] [Indexed: 11/19/2022]
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