Table 1 - available via license: Creative Commons Attribution 4.0 International
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Source publication
Purpose
A comprehensive and representative nationwide general practice database was explored to study associations between atopic disorders and prescribed medication in children.
Method
All children aged 0–18 years listed in the NIVEL Primary Care Database in 2014 were selected. Atopic children with atopic eczema, asthma and allergic rhinitis (AR)...
Context in source publication
Context 1
... 2014, 409,312 children were identified for this study, including 45,964 atopic children with at least one atopic disorder (selection of cases with higher probability of a clinically relevant disorder) and 3-year follow-up; these children were from 316 different general practices partic- ipating in NIVEL-PCD, for which 45,964 non-atopic children were matched ( Table 1). The mean age was 10.0 (SD 4.9) years. ...
Citations
... The results of our study do not contradict this notion, although they reveal no noticeable differences in inflammation markers and their reduction post-treatment, except for erythema. It is conceivable that children with atopy undergo more comprehensive and prolonged treatment overall (18), potentially leading to a long-term reduction in erythema. Furthermore, our analysis showed no notable differences in itchiness between MC patients with and without a history of atopy. ...
The association between molluscum contagiosum and concomitant atopic dermatitis and its impact on clinical features and treatment outcomes remains unclear. This retrospective study, conducted in the paediatric dermatology clinic of a tertiary medical centre, aimed to compare molluscum patients with and without atopic dermatitis. A total of 615 children with molluscum were included, 13.17% of whom had atopic dermatitis. While the latter group exhibited higher lesion count and itchiness (p=0.026 and p=0.044, respectively), no significant differences were observed in average lesion diameter, ulceration, purulence, and erythema (p=0.239, p=0.730, p=0.682, and p=0.296, respectively). Both groups showed comparable responses to molluscum-specific and supportive treatments, with no distinct difference in outcomes or recurrence of visits. It was concluded that atopic dermatitis does not exacerbate molluscum morbidity, inflammation markers, treatment outcomes or recurrence rates.
... g. 4 or more therapies: odds radio 2.82, 95 % confidence interval of 2.19-3.63). With the background that children suffering from atopic disease currently receive about 1.9 times as frequently antibiotic than children without atopy [72], the prescribing behavior of ENT specialists should be questioned critically. ...
Zusammenfassung
Unter Mikrobiom versteht man die Gesamtheit der bakteriellen, parasitären, viralen oder anderen zellulären Mikroorganismen, die den menschlichen Körper oder ein anderes Lebewesen besiedeln. Das Mikrobiom zeigt in den anatomischen Bereichen der Hals-Nasen-Ohrenheilkunde eine deutliche regionale Varianz. Für die Bereiche von Ohr, Nase, Rachen, Larynx und Haut sind jeweils verschiedene Interaktionen des Mikrobiomes mit allgemeinen Faktoren wie Alter, Diät und Lebensstilfaktoren (z. B. Rauchen) in den letzten Jahren bekannt geworden. Zudem liegen eine Reihe von Erkenntnissen vor, dass das Mikrobiom an der Pathogenese verschiedener Erkrankungen auch im HNO-Bereich beteiligt ist. Der vorgestellte Übersichtsartikel fasst die wesentlichen Erkenntnisse dieses sich aktuell äußerst rasch entwickelnden Forschungsgebietes überblickartig zusammen.
... In our study, the non-ACOS cohort without the OSs/ICSs as reference, the risk of the depression in the patients receiving ICSs/OSs without significant differences between the ACOS cohort and the non-ACOS cohort (Table 3) support this speculation. In recent Spain study [14], the defined the ACOS cohort based on the patients who had received a physician confirmed diagnosis of both asthma ([ICD-9] code: 493) and COPD (ICD-9 codes:491, 492, and/or 496), and combined with medication (ATC [Anatomical Therapeutic Chemical] code: R03, Antiasthmatics [33]). In their study, the frequency of the depression between the ACOS cohort (n = 5,093) and COPD cohort (n = 22,778) was without significant difference. ...
... This observation is likely to reflect the complex effects of ICSs/OSs [12,35] on the central nervous system and the probable interplay among individual susceptibility [39], disease factors (e.g., comorbidities), and external environmental stressors (e.g., alcohol) [33]. Therefore, in different study cohorts, steroid use at different doses or for different durations has different impacts on the risk of depression. ...
Purpose
To clarify the relationship between asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS) and depression.
Methods
We identified 10,911 patients who received an ACOS diagnosis and concurrent treatment between January 2000 and December 2009. Subjects without ACOS were included in the non-ACOS cohort (n = 10,911). Cox proportional hazard regression analysis was performed to compare the risk of depression between the ACOS and non-ACOS cohorts.
Results
The risk of depression was higher in the ACOS cohort than in the non-ACOS cohort (adjusted hazard ratios (aHRs) = 1.67, 95% confidence interval [CI] = 1.48–1.88). In the ACOS cohort, the aHRs for depression were [2.44 (95% CI = 1.45–4.11); 2.36 (95% CI = 1.58–3.52)] in patients [aged 20–39 years; without comorbidity]. In the ACOS cohort, the aHRs for depression were 1.70 (95% CI = 1.51–1.93) and 1.84 (95% CI = 1.55–2.19) in patients without inhaled corticosteroids (ICSs) and oral steroids (OSs) use, respectively. Moreover, the aHRs for the risk of depression were 1.16 (95% CI = 0.95–1.41) and 1.12 (95% CI = 0.96–1.29) in patients with ICSs and OSs use, respectively.
Conclusion
The risk of depression is higher in ACOS patients, even in those without comorbidities or in young adults. The events of the depression were not significant difference in patients receiving the ICSs/OSs between the ACOS and the non-ACOS cohorts.
Background
The Rotterdam Eczema Study was an observational cohort study with an embedded pragmatic randomised controlled open-label trial. It was conducted in children with atopic dermatitis (AD) in the Dutch primary care system. The objective of the trial was to determine whether a potent topical corticosteroid (TCS) is more effective than a low-potency TCS.
Objective
We are aiming to communicate transparently about the poor recruitment for the trial part and to explore the reasons why recruitment was weak.
Design
We used a survey to find out what patients in the cohort did when they experienced a flare-up.
Methods
Descriptive statistics were used to present the baseline characteristics of participants in the trial and the results of the survey.
Results
In total, 367 patients were included in the cohort. Of these, 32 were randomly assigned to a trial treatment; they had a median age of 4.0 years (IQR 2.0–9.8). A total of 69 of the 86 children (80.2%) who could participate in the survey responded. 39 (56.5%) suffered a flare-up during the follow-up (making them potentially eligible for inclusion in the trial). 26 out of 39 (66.7%) increased their use of an emollient and/or TCS themselves. Only 12 of the 39 (30.7%) contacted their general practitioner (GP) as instructed in the study protocol, but 8 out of these 12 did not meet the inclusion criteria for the trial.
Conclusion
The main reason why cohort participants did not take part in the trial was that they did not contact their GPs when they experienced an AD flare-up. Furthermore, the majority of patients who contacted their GPs did not match the inclusion criteria of the trial. We expect that the lessons learnt from this study will be useful when developing future studies of children with AD in primary care.
Background:
General practitioners (GPs) have an important role in managing patients with atopic dermatitis (AD). Although pivotal, adherence to dermatological guidelines in general practice has not been assessed.
Objectives:
To assess GPs' perceived adherence and barriers to the Dutch AD guideline.
Methods:
A survey was conducted among 391 GPs in the Netherlands between December 2021 and May 2022. GPs rated their perceived adherence and perceived barriers concerning five key recommendations of the AD guideline, following an existing framework. The correlation between perceived adherence and barriers was investigated using Spearman's rank correlation.
Results:
A total of 213 GPs (54%) participated. Perceived adherence rates varied across recommendations (43.7% to 98.1%). Lowest adherence was reported for recommendations concerning topical corticosteroids (TCS). Across all recommendations, patient factors (65.6%; SD 11.6) and lack of applicability to specific patient groups (29.5%; SD 10.5) were reported most frequently as barriers. The overall correlation between adherence and barriers was strongest for knowledge (ρ .55; SD .10) and attitude-related factors (range: ρ .40--.62).
Conclusion:
GPs' perceived adherence and barriers vary substantially across recommendations of the AD guideline. In particular, GPs reported lower adherence to recommendations concerning TCS. Next to patient-related factors, strong correlations between adherence perceived by GPs and knowledge and attitude-related barriers suggest the importance of addressing these factors as well to improve adherence.
Introduction
For the analysis of clinical effects, multiple imputation (MI) of missing data were shown to be unnecessary when using longitudinal linear mixed-models (LLM). It remains unclear whether this also applies to trial-based economic evaluations. Therefore, this study aimed to assess whether MI is required prior to LLM when analyzing longitudinal cost and effect data.
Methods
Two-thousand complete datasets were simulated containing five time points. Incomplete datasets were generated with 10, 25, and 50% missing data in follow-up costs and effects, assuming a Missing At Random (MAR) mechanism. Six different strategies were compared using empirical bias (EB), root-mean-squared error (RMSE), and coverage rate (CR). These strategies were: LLM alone (LLM) and MI with LLM (MI-LLM), and, as reference strategies, mean imputation with LLM (M-LLM), seemingly unrelated regression alone (SUR-CCA), MI with SUR (MI-SUR), and mean imputation with SUR (M-SUR).
Results
For costs and effects, LLM, MI-LLM, and MI-SUR performed better than M-LLM, SUR-CCA, and M-SUR, with smaller EBs and RMSEs as well as CRs closers to nominal levels. However, even though LLM, MI-LLM and MI-SUR performed equally well for effects, MI-LLM and MI-SUR were found to perform better than LLM for costs at 10 and 25% missing data. At 50% missing data, all strategies resulted in relatively high EBs and RMSEs for costs.
Conclusion
LLM should be combined with MI when analyzing trial-based economic evaluation data. MI-SUR is more efficient and can also be used, but then an average intervention effect over time cannot be estimated.
Background:
Primary care providers (PCPs), including pediatricians and general practitioners, are often the first to see children with eczema/atopic dermatitis (AD). Little is known about management of pediatric AD by PCPs and adherence to national guidelines.
Objective:
To review existing literature examining management components of pediatric AD (topical corticosteroids [TCS], topical calcineurin inhibitors [TCIs], antihistamines, bathing, emollients, and diet) by PCPs.
Data sources:
PubMed/Medline and Embase.
Study eligibility criteria:
English-language articles dated 2015-2020 reporting outcomes addressing management of pediatric AD by PCPs.
Study appraisal and synthesis methods:
Two authors independently screened titles/abstracts, reviewed full-text articles, extracted relevant data, and evaluated study quality. Disagreements were resolved by a third author.
Results:
20 articles were included. Surveys and national database analyses were the most common methodologies (n=7 each). PCPs commonly prescribed TCS but had a preference for low-potency agents, overprescribed non-sedating antihistamines, and avoided TCIs. PCPs commonly recommended emollients, although this was not universal. Data characterizing non-medication management were limited.
Limitations:
Most studies did not examine individual patient encounters, but rather relied on providers reporting their general behaviors. Provider behavior may vary based on country of practice.
Conclusions and implications of key findings:
Knowledge and management gaps exist among PCPs in treating pediatric AD in key areas including knowledge of TCS safety profiles and prescribing of TCIs. The current literature is largely limited to small studies that evaluate prescribing behaviors with limited data characterizing non-medication management, highlighting the need for future research in this area.
Rationale
Antibiotics are among the most common medications dispensed to children and youth. The objective of this study was to characterize and compare antibiotic use patterns between children and youth with and without asthma.
Methods
We conducted a population-based nested case-control study using health administrative data from Ontario, Canada in 2018. All Ontario residents aged 5 to 24 years with asthma were included as cases. Cases were matched to controls with a 1:1 ratio based on age (within 0.5 year), sex, and location of residence. Multivariable conditional logistic regression was used to obtain an odds ratio (OR) and 95% confidence interval (95% CI) for having filled at least 1 antibiotic prescription, adjusted for socioeconomic status, rurality, and presence of common infections, allergic conditions, and complex chronic conditions.
Results
The study population included 1 174 424 Ontario children and youth aged 5 to 24 years. 31% of individuals with asthma and 23% of individuals without asthma filled at least 1 antibiotic prescription. The odds of having filled at least 1 antibiotic prescription were 34% higher among individuals with asthma compared to those without asthma (OR: 1.34, 95% CI: 1.32–1.35). In the stratified analysis, the odds ratios were highest in the youngest group of children studied, aged 5 to 9 years (OR: 1.45, 95% CI: 1.41–1.48), and in females (OR: 1.36, 95% CI: 1.34–1.38).
Conclusion
Asthma is significantly associated with increased antibiotic use in children and youth. This association is the strongest in younger children and in females.
Background
Atopic eczema, asthma, and allergic rhinitis (AR) create a serious burden on general practice resources.
Aim
To investigate the use of general practice resources (that is, consultation visits, telephone contacts, and home visits) in children with physician-diagnosed atopic disorders (ADs).
Design & setting
In a nested index-control study design, all children (here defined as individuals aged 2–18 years) listed in a representative general practice database were selected in 2014.
Method
Children diagnosed with ADs were matched on age and sex with non-atopic controls within the same practice. For all the different groups, the number and frequency of children contacting the GP were calculated.
Results
Of the children with atopic eczema (n = 15 202), 80% consulted the GP in 2014 (controls = 67%). Of the children with asthma (n = 7754), 80% consulted the GP (controls = 65%), and for children with AR (n = 6710), this was 82% (controls = 66%). Of the children with all three ADs, 91% consulted the GP (controls = 68%). On average, a child with atopic eczema contacted the GP 2.8 times/year (controls = 1.9); for children with asthma, the contact frequency was 3.0 (controls = 1.9); and for AR, 3.2 (controls = 1.9). For children with all three ADs, the contact frequency was 4.3 (controls = 2.0). Consultations related to the ADs investigated only explain a smaller part of the increased healthcare utilisation in atopic children.
Conclusion
Atopic children use more general practice resources compared to non-atopic children, yet frequently for morbidity or other health-related questions not related to one of the ADs.
