Utilization of Preventive Health Care in Adults and Children With Eczema

Exploring the causal relationship between gut microbiota and atopic dermatitis: A Mendelian randomization study

Accumulating evidence indicates a correlation between gut microbiota (GM) and atopic dermatitis (AD). Nevertheless, the causal relationship between specific pathogenic bacterial taxa and AD remains uncertain. This investigation utilized a two-sample Mendelian randomization (MR) analysis to assess the causal association between GM and AD, identifying the most influential GM taxa. An MR study was conducted utilizing summary statistics derived from genome-wide association studies encompassing 207 GM taxa and their association with AD risk. The genome-wide association studies summary statistics for 207 GM taxa (from phylum to species level) were generated by the Dutch Microbiome Project. The genetic variants (P < 1 × 10-5) correlated with GM (n = 7738) were identified from this investigation. Additionally, 4 supplementary MR approaches, simple mode, MR-Egger, weighted mode, and weighted median, supported the inverse-variance weighted approach. Furthermore, sensitivity analyses were executed using leave-one-out analysis, Cochran Q test, MR-Egger intercept test, MR pleiotropy residual sum and outlier global test, and MR Steiger test. The MR analysis identified 17 distinct bacterial taxa involving 2 orders, 4 families, 5 genera, and 6 species. The inverse-variance weighted method demonstrated that 6 bacterial taxa were positively associated with AD. These taxa included the order Pasteurellales, family Burkholderiales noname, family Pasteurellaceae, genus Burkholderiales noname, species Burkholderiales bacterium_1_1_47, and species Desulfovibrio piger. Eleven bacterial taxa were negatively associated with AD, comprising the order Actinomycetales, family Micrococcaceae, family Oscillospiraceae, genus Rothia, genus Collinsella, genus Oscillibacter, genus Pseudoflavonifractor, species Oscillibacter_unclassified, species Roseburia hominis, species R mucilaginosa, and species Parabacteroides merdae. Moreover, the MR-Egger intercept test and MR pleiotropy residual sum and outlier global test validated that the MR analysis remained unaffected by horizontal pleiotropy (P > .05). Furthermore, the leave-one-out analysis contributed to validating the robustness of the outcomes. Finally, an MR Steiger directionality test confirmed the assessment of potential causal direction (P < .001). This investigation identified specific intestinal flora causally associated with AD risk, offering novel insights for future investigations and innovative avenues for AD diagnosis, therapeutic intervention, and prognostic assessment.

Relevant Dermatoses Among U.S. Military Service Members: An Operational Review of Management Strategies and Telemedicine Utilization

Despite skin being the largest and most exposed organ of the human body, skin issues can be challenging to diagnose in deployed military service members. Common reasons deployed soldiers seek dermatological evaluation include infections, inflammatory skin conditions, and skin growth. Due to limited access to specialized care in deployed settings, dermatological conditions are undertreated and underdiagnosed. As a result, dermatological conditions are a leading contributor to decreased combat effectiveness among deployed medical forces. To lessen the burden of dermatological diseases, military providers should promptly identify operational skin diseases and alleviate modifiable barriers faced by service members. In a post-pandemic era with novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and monkeypox infections, the duty to effectively treat operational skin lesions is ever important. The need for military dermatologists continues to rise as the global landscape continues to evolve with unprecedented infections and increased bioterrorism threats. Teledermatology offers many solutions to mitigate the high demand for dermatologists during pandemics. Dermatological consultations account for the highest number of telemedicine visits in the US Military Health System (MHS). As such, increased utilization of teledermatology will reduce infection-related dermatological sequelae and prevent the medical evacuation of service members from military operations. This review collates and categorizes relevant dermatological conditions encountered among deployed personnel. This report outlines the standard of care and modified treatments recommended according to potential barriers faced in operational settings.

Mental health impairment among children with atopic dermatitis: A United States population-based cross-sectional study of the 2013-2017 National Health Interview Survey

BACKGROUND

Atopic dermatitis (AD) is associated with mental health disorders, but its impact on global mental health symptoms is less clear.

OBJECTIVE

To determine the association between pediatric AD and mental health impairment.

METHODS

In a cross-sectional study using 2013-2017 United States National Health Interview Survey data, children with and without AD were assessed for mental disorder with impairment (MDI) using a validated behavioral screening questionnaire. Mental health services utilization was also reported.

RESULTS

The prevalence of any MDI was 26.7% (95% confidence interval [CI], 25.1-28.3) among children with AD and 17.7% (95% CI, 17.2-18.2) among those without AD, with severe MDI being present in 10.9% (95% CI 9.9-12.1) and 6.2% (95% CI 5.9-6.5), respectively. Adjusted for sociodemographic factors, AD was associated with higher odds of MDI (odds ratio, 1.52; 95% CI, 1.39-1.67), including impairments in conduct, emotions, peer relationships, and attention. Among children with AD, 19.9% (95% CI, 16.6-23.8) and 53.5% (95% CI, 48.5-58.5) of those with mild or severe MDI, respectively, had seen a mental health professional in the last year.

LIMITATIONS

Misclassification bias may arise from self-reported data.

CONCLUSION

AD is associated with clinically significant mental health symptoms, but many affected children may not seek or receive care for their symptoms.

Associations of self-reported allergic diseases and musculoskeletal problems in children: A US population-based study

BACKGROUND

Previous studies have found increased rates of musculoskeletal problems in adults with allergic disease, but whether this association holds true for children is unknown.

OBJECTIVE

To investigate the association of bone, joint, and muscle problems in children with a history of allergic disease.

METHODS

Data were obtained from the 2007 Child and Adolescent Health Measurement Initiative. Univariable and multivariable logistic regression models accounting for the sampling design were used to evaluate associations of bone, joint, and muscle problems with allergic diseases, such as asthma, hay fever, food allergies, and eczema. Associations were summarized with odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

The survey included 91,642 individuals aged 0 to 17 years. Multivariable modeling found statistically significant associations between the number of allergic diseases and bone, joint, and muscle problems (1 allergic disease: adjusted OR, 1.28; 95% CI, 1.04-1.56; P = .02; 2 allergic diseases: adjusted OR, 2.55; 95% CI, 1.92-3.39; P < .001; 3 allergic diseases: adjusted OR, 2.70; 95% CI, 1.88-3.86; P < .001; and 4 allergic diseases: adjusted OR, 4.35; 95% CI, 2.46-7.69; P < .001). Severe eczema (but not mild eczema) was associated with bone, joint, and muscle problems (adjusted OR, 2.81; 95% CI, 1.64-4.81; P < .001) and with bone problems (adjusted OR, 6.08; 95% CI, 1.94-19.12; P = .002).

CONCLUSION

Self-reported allergic diseases in children were associated with bone, joint, and muscle problems, and associations strengthened with allergic disease severity and number of allergic diseases. Severe eczema may be associated with bone problems in children. Bone, joint, and muscle problems must be considered in children with severe allergic disease, and prospective studies are necessary to define this association.

The Crohn's and Colitis Foundation of America Survey of Inflammatory Bowel Disease Patient Health Care Access

BACKGROUND

Despite anecdotal information about unaffordable care for patients with inflammatory bowel disease (IBD), there are no data regarding access to health care resources and expert care for patients with IBD. Our study was designed to assess IBD patients' ability to access and use care, as well as the timeliness, affordability, and financial stressors related to care.

METHODS

We modified the Centers for Disease Control National Health Interview Survey for IBD. The resultant 59-question survey was electronically mailed to the entire Crohn's and Colitis Foundation of America (CCFA) mailing list. Three thousand six hundred eight adult U.S. respondents completed the survey. Statistical analysis was performed.

RESULTS

Respondents who had insurance coverage were 96.1%, but 66.3% reported health care-related financial worry. Of the 452 patients who tried to obtain new insurance coverage in the year prior, 60.1% (n = 270) reported difficulty finding sufficient coverage. We found that 25.4% (n = 897) of patients reported delays in medical care, and 48.0% (n = 431) of those respondents reported that the delay was due to cost concerns. Respondents who were denied coverage by an insurance company were 55.3%. Risk factors for emergency department utilization included Crohn's disease, younger age, female sex, lower income, non-White race, and steroid therapy.

CONCLUSIONS

Our assessment of patient health care access suggests that many patients have health care-related financial worry and have forgone a variety of medical services because of cost, lack of prompt access to care, denial by insurance carriers, and worry over medical coverage. We also identify risk factors for emergency department utilization. These data inform additional studies and interventions to improve access for patients with IBD.

Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults

BACKGROUND

Atopic dermatitis (AD) is associated with chronic itch, allergic disease and sleep disturbance, all of which might increase the risk of attention deficit (hyperactivity) disorder (ADD/ADHD). Previous analyses have found a consistent association between AD and ADD/ADHD, although the underlying factors contributing to such an association remain underexplored. Additionally, the relationship has been underexplored in adults.

OBJECTIVES

To determine if childhood and adult AD and AD severity are associated with ADD/ADHD and to delineate the factors contributing to such an association.

METHODS

We analysed data on 354 416 children aged 2-17 years and 34 613 adults age 18+ years from 19 U.S. population-based surveys, including the National Health Interview Survey 1997-2013 and the National Survey of Children's Health 2003/4 and 2007/8.

RESULTS

In multivariate models adjusting for age, sex, sociodemographics, allergic disease and healthcare utilization, AD was associated with ADD/ADHD in both children [adjusted odds ratio (95% confidence interval), 1·14 (1·03-1·26)] and adults [1·61 (1·25-2·06)]. Children with both severe AD and only 0-3 nights of adequate sleep per week had much higher odds of ADD/ADHD [16·83 (7·02-40·33)] than those with 0-3 nights of adequate sleep per week [1·83 (1·47-2·26)] or mild-moderate AD alone [1·56 (1·22-1·99)]. AD was most strongly associated with severe ADHD. AD unaccompanied by other allergic disease was also associated with increased risk of ADD/ADHD in children. Among children with AD, history of anaemia, headaches and obesity were associated with even higher odds of ADD/ADHD. Asthma, insomnia and headaches increased the odds of ADHD in adults with AD, although underweight body mass index was protective.

CONCLUSIONS

Atopic dermatitis is associated with increased odds of ADD/ADHD in adults and children. Several factors increase the risk of ADHD in adults and children with AD.

Associations of Physical Activity and Sedentary Behavior with Atopic Disease in United States Children

OBJECTIVES

To determine if eczema, asthma, and hay fever are associated with vigorous physical activity, television/video game usage, and sports participation and if sleep disturbance modifies such associations.

STUDY DESIGN

Data were analyzed from 2 cross-sectional studies including 133 107 children age 6-17 years enrolled in the 2003-2004 and 2007-2008 National Survey of Children's Health. Bivariate and multivariate survey logistic regression models were created to calculate the odds of atopic disease and atopic disease severity on vigorous physical activity, television/video game use, and sports participation.

RESULTS

In multivariate logistic regression models controlling for sociodemographic factors, lifetime history of asthma was associated with decreased odds of ≥1 days of vigorous physical activity (aOR, 0.87; 95% CI, 0.77-0.99) and decreased odds of sports participation (0.91; 95% CI, 0.84-0.99). Atopic disease accompanied by sleep disturbance had significantly higher odds of screen time and lower odds of sports participation compared with children with either atopic disease or sleep disturbance alone. Severe eczema (aOR, 0.39; 95% CI, 0.19-0.78), asthma (aOR, 0.29; 95% CI, 0.14-0.61), and hay fever (aOR, 0.48; 95% CI, 0.24-0.97) were all associated with decreased odds of ≥1 days of vigorous physical activity. Moderate (aOR, 0.76; 95% CI, 0.57-0.99) and severe eczema (aOR, 0.45; 95% CI, 0.28-0.73), severe asthma (aOR, 0.47; 95% CI, 0.25-0.89), and hay fever (aOR, 0.53; 95% CI, 0.36-0.61) were associated with decreased odds of sports participation in the past year.

CONCLUSIONS

Children with severe atopic disease, accompanied by sleep disturbance, have higher risk of sedentary behaviors.

Eczema Is Associated with Childhood Speech Disorder: A Retrospective Analysis from the National Survey of Children's Health and the National Health Interview Survey

OBJECTIVE

To determine if eczema is associated with an increased risk of a speech disorder.

STUDY DESIGN

We analyzed data on 354,416 children and adolescents from 19 US population-based cohorts: the 2003-2004 and 2007-2008 National Survey of Children's Health and 1997-2013 National Health Interview Survey, each prospective, questionnaire-based cohorts.

RESULTS

In multivariate survey logistic regression models adjusting for sociodemographics and comorbid allergic disease, eczema was significantly associated with higher odds of speech disorder in 12 of 19 cohorts (P < .05). The pooled prevalence of speech disorder in children with eczema was 4.7% (95% CI 4.5%-5.0%) compared with 2.2% (95% CI 2.2%-2.3%) in children without eczema. In pooled multivariate analysis, eczema was associated with increased odds of speech disorder (aOR [95% CI] 1.81 [1.57-2.05], P < .001). In a single study assessing eczema severity, mild (1.36 [1.02-1.81], P = .03) and severe eczema (3.56 [1.70-7.48], P < .001) were associated with higher odds of speech disorder. History of eczema was associated with moderate (2.35 [1.34-4.10], P = .003) and severe (2.28 [1.11-4.72], P = .03) speech disorder. Finally, significant interactions were found, such that children with both eczema and attention deficit disorder with or without hyperactivity or sleep disturbance had vastly increased risk of speech disorders than either by itself.

CONCLUSIONS

Pediatric eczema may be associated with increased risk of speech disorder. Further, prospective studies are needed to characterize the exact nature of this association.

Eczema Is Associated with Childhood Speech Disorder: A Retrospective Analysis from the National Survey of Children's Health and the National Health Interview Survey

OBJECTIVE

To determine if eczema is associated with an increased risk of a speech disorder.

STUDY DESIGN

We analyzed data on 354,416 children and adolescents from 19 US population-based cohorts: the 2003-2004 and 2007-2008 National Survey of Children's Health and 1997-2013 National Health Interview Survey, each prospective, questionnaire-based cohorts.

RESULTS

In multivariate survey logistic regression models adjusting for sociodemographics and comorbid allergic disease, eczema was significantly associated with higher odds of speech disorder in 12 of 19 cohorts (P < .05). The pooled prevalence of speech disorder in children with eczema was 4.7% (95% CI 4.5%-5.0%) compared with 2.2% (95% CI 2.2%-2.3%) in children without eczema. In pooled multivariate analysis, eczema was associated with increased odds of speech disorder (aOR [95% CI] 1.81 [1.57-2.05], P < .001). In a single study assessing eczema severity, mild (1.36 [1.02-1.81], P = .03) and severe eczema (3.56 [1.70-7.48], P < .001) were associated with higher odds of speech disorder. History of eczema was associated with moderate (2.35 [1.34-4.10], P = .003) and severe (2.28 [1.11-4.72], P = .03) speech disorder. Finally, significant interactions were found, such that children with both eczema and attention deficit disorder with or without hyperactivity or sleep disturbance had vastly increased risk of speech disorders than either by itself.

CONCLUSIONS

Pediatric eczema may be associated with increased risk of speech disorder. Further, prospective studies are needed to characterize the exact nature of this association.