The Patient-Oriented Scoring of Atopic Dermatitis and SCORAD in young children: New data on interpretability and clinical usefulness

BACKGROUND

There is limited data about the clinical meaningfulness of the Scoring of Atopic Dermatitis (SCORAD) and Patient-Oriented SCORAD (PO-SCORAD), particularly in children with mild-to-moderate AD. Regular use of patient-reported outcomes, may deliver more accurate information about the overall health status of AD patients than routine but sparse physician assessments.

OBJECTIVE

To confirm the correlation between SCORAD, PO-SCORAD, Patient-Oriented Eczema Measure (POEM) and Investigator's Global Assessment (IGA). To evaluate the interpretability and clinical usefulness of the SCORAD and PO-SCORAD scores in children.

METHODS

Data were drawn from a 12-week randomized controlled trial in 335 children, aged 2-6 years, with mainly mild-to-moderate AD. Investigators captured SCORAD and IGA at each study visit. Parents used PO-SCORAD twice-weekly, and POEM once-weekly.

RESULTS

There were strong correlations between PO-SCORAD and SCORAD (r = 0.874), PO-SCORAD and POEM (0.734) and PO-SCORAD and IGA (0.613). The best fit ('k' statistic: 0.68) between SCORAD and IGA classes was noted for the following SCORAD categories: <12 (clear/almost clear); 12-25 (mild); and ≥25 (moderate/severe). PO-SCORAD area under the curve over 8 weeks was significantly greater than that of SCORAD (p = 0.0002), giving a better estimate of disease severity between visits. Patients with a flare within the next 7 days had significantly higher PO-SCORAD scores 7 days before the flare (p < 0.0001). Moderate erythema was the most significant flare predictor (p < 0.0001).

CONCLUSION

PO-SCORAD is robust and reliable and appears to warrant far greater utility in routine clinical practice than other scores. PO-SCORAD, used twice-weekly, may improve the management of patients with AD.

Suttee Sainthood through selflessness: pain of repression or power of devotion?

The immolation of Hindu widows has generated much horror while remaining tenaciously mixed with clandestine admiration. Reported in many eyewitness accounts and literary works, the topic has given rise to highly contested sociocultural, legal and ideological debates, strongly linked to women’s rights. But the root question has not gone away: is suttee/sati just painful female victimisation or can it also reflect powerful female agency and the power of devotion? This article examines two literary works, Maud Diver’s Lilamani, in which an Englishwoman unreservedly idolises a suttee, and Krupabai Satthianadhan’s Kamala, where an Indian woman expresses deep pride in sutteehood. Engaging in a search for deeper meanings, this article asks what makes these two women writers revere a suttee so totally. Can one really be a suttee-saint through selflessness, or are there some deeper meanings yet to be uncovered? A wider political interpretation is suggested to re/present the root meaning of suttee.