Abstract Lichen sclerosus (LS) is a chronic inflammatory dermatosis predominantly affecting the anogenital region, which can have significant impact on quality of life. Burden of treatment (BOT) is defined as the workload of healthcare experienced by patients and consequences on well‐being. In this prospective study, 35 women with vulval LS completed a detailed Treatment Burden Questionnaire to assess their BOT. Nineteen (54.3%) achieved a score of 35 or less, signifying low BOT; ten (28.6%) between 36 and 65, signifying moderate BOT; and six (17.1%) above 65, signifying high BOT. Seven (20%) patients reported BOT scores of greater than 59, which has been designated as a cut‐off for increased risk of treatment‐related burnout. Higher BOT scores were moderately correlated with higher DLQI scores (r = 0.47, p < 0.01). BOT in LS is low for most patients, although a minority are at risk of treatment‐related burnout. BOT should be considered when forming treatment guidelines for LS.
In early 2020, mask usage was mandated for healthcare workers (HCWs) to limit the transmission of COVID-19.1, 2 Since then, dermatoses related to personal protective equipment (PPE) have become well-recognized and widely reported, predominantly related to pressure-related damage and irritant contact dermatitis (ICD).3 A previous Irish study showed that 82% of staff developed ICD, with 26% reporting PPE-related facial dermatoses.4 We sought to evaluate the prevalence and contributory factors in 'maskne' development amongst Irish HCWs during the COVID-19 pandemic. In April-May 2021, 700 self-administered questionnaires were distributed to staff in three university hospitals in Cork, Ireland. The questionnaire enquired about history of acne, PPE exposure, maskne development, contributing/alleviating factors and whether advice/treatment was sought. In total, 337 completed the questionnaire (48% response rate). Most (84.6%, n = 285) were female. Forty-nine per cent were aged between 20 and 30 years, 27.6% between 31 and 40 years and 23.3% were over 40 years. Nursing staff comprised 64.1% of participants, doctors 22%, healthcare assistants (HCAs) 4.7% and allied health professionals 3.9%. Most respondents (72.5%) worked on general wards, 10% on COVID-19 wards, 4.5% in intensive care units and 3.2% in emergency departments. A quarter (26%, n = 87) had a previous history of acne, and a quarter (25.5%, n = 84) had a family history of acne (first degree relative). The majority were White (82.7%; n = 278) followed by South Asian (7.7%; n = 26), East Asian (3.3%; n = 11) and Black (2.2%; 7). As per the Fitzpatrick scale, most (52.7%) participants reported type I (19.2%, n = 64) or type II (33.5%, n = 112) skin. More darkly pigmented skin types were reported in 47.8% [type III 22.5% (n = 75); type IV 13.8% (n = 46); type V 9.9% (n = 33) and 1.2% (n = 4) type VI]. Over half (53.4%, n = 180) of respondents reported developing maskne since the onset of the COVID-19 pandemic. The majority were (85.5%, n = 154) self-reported papulopustular eruptions, 46% (n = 83) comedonal breakouts and 22.5% (n = 44) nodulocystic lesions. Only 12.8% of HCW with maskne sought medical advice (Fig. 1). Factors associated with increased rates of maskne included female gender (OR 4.26; 95% CI 2.11–8.20; P < 0.001), younger age [64.1% of 20–30 year olds compared with 48.8% and 46.7% of the 31–40 and >40 year categories respectively (P = 0.037)], history of acne (OR 2.16 95% CI 1.28–3.64; P = 0.004), family history of acne (OR 1.7 95% CI 1.02–2.89; P = 0.04), working in a 'hot and sweaty' environment (OR 1.89; 95% CI 1.14–3.15; P = 0.014), use of emollients under the masks (OR 1.89; CI 1.21–2.95; P = 0.005) and use of face shields and goggles (OR 1.59; 95% CI 0.97–2.60; P = 0.031; Table 1). There was no correlation with duration of mask use (P = 0.097), number of shifts worked per week (P = 0.52), job description (P = 0.793), use of hormonal contraception amongst female staff members (P = 0.474), Fitzpatrick skin type (P = 0.844) or ethnicity (P = 0.22). Over half of our HCWs developed maskne since the onset of the COVID-19. Our findings suggest that female HCW, younger HCW and those with a personal or family history of acne are at increased risk. The reduction in duration of usage may not prevent maskne, but application of emollients under masks should not be recommended.5 Limitations of our study include self-reporting of maskne. Our study was vulnerable to responder bias. However, with 55% of the 48% respondents reporting maskne, even if all non-respondents did not develop maskne, the overall prevalence would still have been at least 26%. We did not account for confounding variables such as the use of other comedogenic products, such as make-up. This study highlights the pervasiveness of maskne in the COVID-19 era. Most HCW with maskne do not seek medical attention, so the impact of this occupational dermatosis may be under-estimated. None declared by LK, COC, GOB, COB, JG and JB. The data are available on request.
Chlamydia is the most commonly notified infection in Australia; most diagnoses are in young people, and re-infections are common. Re-infection leads to onward transmission and increases the risk of reproductive morbidity and HIV transmission. Guidelines recommend re-testing 3 months following treatment to detect re-infections. We assessed trends in re-testing after a chlamydia diagnosis in Sexual Health Clinics (SHCs) in New South Wales (NSW) over a 5-year period and factors associated with re-testing.
Methods
Routine patient data from 2009 to 2013 were extracted from 33 SHCs. A Chi-2 test was used to assess time trends in the proportion re-tested in 2–4 months following a chlamydia diagnosis and also 2–12 months, in a range of risk groups. Multivariate logistic regression was used to determine demographic, risk behaviour and clinic factors associated with re-testing at 2–4 months, adjusting for clinic clustering.
Results
Overall 8,646, chlamydia diagnoses were analysed and 1,281 (15%) were re-tested in 2–4 months (23% of GBM, 25% of sex workers, 12% of young heterosexuals aged <30 years), with a significant increase over time (13% in 2009 to 18% in 2012, p < 0.01). In a broader time frame of 2–12 months, re-testing was higher at 26% (42% of GBM, 41% of sex workers, 20% of young heterosexuals) with a modest increase over time (25% to 30%, p < 0.01). Factors associated with re-testing in 2–4 months were: being GBM (adjusted odds ratio (aOR) = 1.65, 95% CI: 1.44 -1.90, p < 0.01), current sex work (aOR = 2.04,95% CI: 1.65–2.52, p < 0.01), attending the clinic >5 times (aOR: 3.11,95% CI: 2.62–3.70, p < 0.01) and people attending clinics with SMS reminders (aOR = 2.25,95% CI: 1.16–4.37, p = 0.01).
Conclusions
Re-testing at 2–4 months after a chlamydia diagnosis increased over time, but remains low. GBM and sex workers were more likely to be re-tested, perhaps because they were attending anyway. Attending clinics with SMS reminders increased the likelihood of re-testing. Additional strategies, such as home-collection, may be needed to increase re-testing in young heterosexuals.
Disclosure of interest statement
The ACCESS Sexual Health Services Network is funded by the NSW Ministry of Health, Victorian Department of Health, Australian Capital Territory Department of Health, and the Northern Territory Department of Health.
The Athens International Airport Eleftherios Venizelos began operation in March 2001. The Airport Company's Environmental Department, which has been certified according to ISO 14001, ensures compliance with environmental regulations and seeks to continuously improve the airport's environmental performance. The objective of this paper is to illustrate in detail the airport's comprehensive approach to air quality management. Exposure of the surrounding population is monitored with a multi-station Air Quality Monitoring Network (AQMN). Concentrations of ozone, particulate matter, oxides of nitrogen, carbon monoxide, sulphur dioxide and hydrocarbons are monitored along with basic meteorological parameters. A structured database was created for the AQMN, including the necessary programming to automate the quality control of the raw data based on scientific criteria and processing in accordance with accepted guidelines. Furthermore, the Airport Company is in the process of installing additional monitoring equipment, including a sound radar (wind profiler) and a Differential Optical Absorption Spectroscopy (DOAS) system. Finally, various company-wide measures are taken to reduce pollutant emissions as well as energy consumption.
Abstract Introduction The architecture and function of sleep during infancy and early childhood has not been fully described in the scientific literature. The impact of early sleep disruption on cognitive and physical development is also under-studied. The aim of this review was to investigate early childhood sleep development over the first two years and its association with neurodevelopment. Methods This review was conducted according to the 2009 PRISMA guidelines. Four databases (OVID Medline, Pubmed, CINAHL, and Web of Science) were searched according to predefined search terms. Results Ninety-three studies with approximately 90,000 subjects from demographically diverse backgrounds were included in this review. Sleep is the predominant state at birth. There is an increase in NREM and a decrease in REM sleep during the first two years. Changes in sleep architecture occur in tandem with development. There are more studies exploring sleep and early infancy compared to mid and late infancy and early childhood. Discussion Sleep is critical for memory, learning, and socio-emotional development. Future longitudinal studies in infants and young children should focus on sleep architecture at each month of life to establish the emergence of key characteristics, especially from 7–24 months of age, during periods of rapid neurodevelopmental progress.
Abstract Background The hazard ratio (HR) is the most common measure used to quantify treatment effects in heart failure (HF) clinical trials. However, the HR is only valid when the proportional hazards assumption is plausible, and the HR may be difficult to interpret for clinicians and laypeople. Restricted mean survival time (RMST), defined as the average time-to-event before a specific timepoint, is an intuitive summary of group-wise survival. The difference between two RMSTs measures treatment effects without model assumptions and may communicate more clinically interpretable results. Purpose To evaluate statistical and clinical properties of RMST-based statistics applied to clinical trial data for treatments of HF with reduced ejection fraction. Methods Patient time-to-event data was reconstructed from the published primary and secondary outcome Kaplan-Meier curves from landmark HF clinical trials. We estimated the RMST-differences between treatment groups as a measure of treatment effect with published data, and compared statistical testing results and effect size values to HR analysis results. Results We analyzed 7 HF clinical trials, including data from a total of 27,845 patients (Table 1). RMST should be interpreted as the average number of months that the outcome is avoided over the study period. As examples: On average, treatment with enalapril for 12 months extended each patient's life by 2.2 months compared to placebo, and treatment with spironolactone for 34 months extended each patient's life by 2.2 months compared to placebo. Conclusions RMST-difference test statistic has identical statistical conclusions as HRs but provided an intuitive estimate of each treatment effect. RMST-based data can potentially be used to better communicate treatment effects to patients, to assist in patient-preference discussions and shared decision-making Funding Acknowledgement Type of funding source: None
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