Atopic dermatitis in the pediatric population: A cross-sectional, international epidemiologic study.

BACKGROUND: Little is known on the current global prevalence of atopic dermatitis (AD) in the pediatric population. OBJECTIVE: To estimate the real-world global prevalence of AD in the pediatric population and by disease severity. METHODS: This international, cross-sectional, web-based survey of children and adolescents (6 months to <18 years old) was conducted in the following 18 countries: North America (Canada, United States), Latin America (Argentina, Brazil, Columbia, Mexico), Europe (France, Germany, Italy, Spain, United Kingdom), Middle East and Eurasia (Israel, Saudi Arabia, Turkey, United Arab Emirates, Russia), and East Asia (Japan, Taiwan). Prevalence was determined using the following 2 definitions: (1) diagnosed as having AD according to the International Study of Asthma and Allergies in Childhood (ISAAC) criteria and self- or parent-report of ever being told by a physician that they or their child child had AD (eczema); and (2) reported AD based on the ISAAC criteria only. Severity was assessed using the Patient Global Assessment (PtGA) and Patient-Oriented Eczema Measure (POEM). RESULTS: Among 65,661 responders, the 12-month diagnosed AD prevalence (ISAAC plus self-reported diagnosis) ranged from 2.7% to 20.1% across countries; reported AD (ISAAC only) was 13.5% to 41.9%. Severe AD evaluated with both PtGA and POEM was generally less than 15%; more subjects rated AD as mild on PtGA than suggested by POEM. No trends in prevalence were observed based on age or sex; prevalence was generally lower in rural residential settings than urban or suburban. CONCLUSION: This global survey in 18 countries revealed that AD affects a substantial proportion of the pediatric population. Although prevalence and severity varied across age groups and countries, less than 15% had severe AD.

Diabetes injectable therapy: type 2 diabetes management in Danish practice.

Most diabetes care is done by GPs in Denmark. This study aimed to identify the barriers for GPs in initiating injectable therapies and reasons for referral to specialists. The web interview conducted included 85 GPs and 30 specialists experienced in type 2 diabetes (T2D). GPs felt more comfortable with initiating the first injectable therapy (defined as a glucagon-like peptide-1 receptor agonist (GLP-1 RA) or basal insulin) than the second (defined as adding a basal insulin in patients treated with a GLP-1 RA (± oral anti-diabetic treatments [OADs]), or adding either a GLP-1 RA or a bolus insulin in patients treated with basal insulin (± OADs). The main barriers to initiating injectables were related to the complexity of available injectable therapies and the lack of comfort with complex patient profiles, namely patients with difficult glycemia control or significant comorbidities, whom GPs would rather refer to specialists. Main attributes that would increase the GPs' comfort level with initiation of injectables are low risk of hypoglycemia, glycemic control improvement and ease of use of the treatment. An injectable therapy with such attributes could help to overcome barriers to initiating injectable in primary care.

Perceptions of general practitioners on initiation and intensification of type 2 diabetes injectable therapies. A quantitative study in the United Kingdom.

Most diabetes care is done by general practitioners (GPs) in the UK. This study aimed to determine GPs' comfort level in initiating and intensifying injectable therapies, identifying any associated barriers, and assessing reasons for referral to specialists. This web-interview included 128 general practitioners (GPs) experienced in type 2 diabetes (T2D) management, as well as 57 specialists and 30 nurses who were studied for secondary objectives. GPs felt more comfortable initiating the 1st injectable therapy - typically the glucagon-like peptide-1 receptor agonists (GLP-1 RA) - than the 2nd. The main barriers to initiating injectables were related to the complexity of injectable therapies and the lack of comfort with complex patient profiles, namely patients with difficultly achieving glycaemic control or those with significant comorbidities who GPs would rather refer to specialists. The main attributes that would increase their comfort level with initiation of injectables are improved glycaemic control, weight control and low risk of hypoglycaemia. An injectable therapy with these attributes could help to overcome barriers to initiating injectable therapies among GPs other healthcare professionals in primary care.

An exploration of the barriers to the confident diagnosis of irritable bowel syndrome: A survey among general practitioners, gastroenterologists and experts in five European countries.

BACKGROUND: The diagnostic processes for chronic abdominal conditions are challenging. Despite their tendency for diagnostic tests in patients with irritable bowel syndrome (IBS) symptoms, clinicians are encouraged to make a positive diagnosis based on symptom criteria without alarm signs. We explored how European physicians diagnose and manage patients suffering from IBS. METHODS: We conducted a vignette-based survey to evaluate the diagnostic approaches in four standardized patients with IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), inflammatory bowel disease (IBD) and chronic constipation (CC). General practitioners (GP, n = 104), gastroenterologists (GE, n = 100) and IBS experts (n = 25) from five European countries participated. RESULTS: Experts showed the highest rates of correct diagnoses (88%-92%) for all cases except CC (only 60%) and were more prone to a positive diagnosis (64%/68% in IBS-C/CC), whereas GEs and GPs tended toward a diagnosis by exclusion (63%/63% and 62%/60% in IBS-C/CC). In the CC vignette, conducting tests was more frequent than prescribing treatment among 44% experts, 63% GEs and 36% GPs. The diagnosis of IBD presented little difficulty for any of the participants. CONCLUSIONS: This study highlights the difficulties in confidently diagnosing chronic functional bowel conditions, especially for non-experts, whereas IBD caused little difficulty. Differentiating between IBS-C and CC seemed particularly challenging, even for experts.

Application of the disease-specific Quality of Life Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA) questionnaire in a general population: results from a French panel study.

OBJECTIVES: To assess the psychometric properties of the disease-specific Quality of Life Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA) questionnaire in a general population, and collect French normative data. METHODS: A postal survey was conducted on 2900 adult panelists representative of the French population. The participants were asked to complete a questionnaire including the QoL-AGHDA and an evaluation of their overall health status (OHS). The QoL-AGHDA score ranges from 0 to 25, a lower score indicating better QoL. Psychometric properties of the QoL-AGHDA were assessed. The mean QoL-AGHDA scores were described by sex and age groups. RESULTS: The return rate was 75%. The quality of completion and internal consistency reliability were good: 95% of the respondents completed all 25 QoL-AGHDA items and Cronbach's alpha was 0.86. The QoL-AGHDA score was able to discriminate between the respondents according to their OHS (from 1.5 for excellent to 12.3 for poor OHS, P < 0.001). The mean QoL-AGHDA score was 4.6 for the overall population, 5.1 for females and 4.2 for males, and ranged from 4.8 for the youngest to 6.1 for the oldest respondents. CONCLUSIONS: The QoL-AGHDA questionnaire showed good psychometric properties when administered in the French population. French reference values were collected, completing the QoL-AGHDA normative database already available in several European countries.