Chronic hand eczema in Europe: Patient experiences and perspectives (CHEPEP) in qualitative interviews.

BACKGROUND: Chronic hand eczema (CHE) is a very common skin disease among the European population. It causes itch and pain and, in more severe cases, seriously impairs hand functioning at work and in private life. OBJECTIVES: To explore perspectives of people with lived experience on CHE-related problems, wishes and goals. METHODS: Following a qualitative approach, we conducted topic-guided interviews in five European countries and applied template analysis to identify recurrent themes among patients with CHE. RESULTS: We interviewed 60 patients in seven outpatient dermatological and occupational medicine clinics in Croatia, Denmark, Germany, the Netherlands and Spain. Five main themes were identified: (1) knowledge about the disease and its course, (2) preventive behaviour, (3) hand eczema therapy, (4) impact on everyday life and (5) attitudes towards CHE and healthcare. Participants did not feel well informed about CHE, especially about causes, triggers and treatment options. Preventive measures were experienced as more or less effective but also cumbersome. Experiences with therapy were diverse. Treatment satisfaction depended on the results and on the perceived support from the treatment teams. Participants found it important to be taken seriously, to receive practical advice, to try out additional treatments or examinations, find new hope and have occupational perspectives. They wished that others could better understand the physical and emotional burden of CHE. Patient support groups were not mentioned. Participants found it important to learn to take care of themselves and accept life with CHE. CONCLUSIONS: Due to its annoying symptoms, high visibility and impaired functioning at work and in private life, CHE has a high emotional and social impact. Some people may require support to learn coping with CHE and its prevention. Patients wish for information about causes and triggers. They value physicians who listen to them and keep looking for solutions.

Protocol for the development of a core domain set for hand eczema trials.

BACKGROUND: Clinical hand eczema trials measure a variety of outcome domains to determine the success of interventions. This considerably limits the comparability and overall confidence in the study results, and thereby the strength of recommendations for clinical practice. OBJECTIVES: The Hand Eczema Core Outcome Set (HECOS) initiative aims to develop a core outcome set (COS) for the standardized evaluation of interventions in future hand eczema trials and reviews. This COS will define the minimum that should be measured and reported in controlled and randomized-controlled trials of therapeutic hand eczema interventions. The objective of this protocol is to specify the methods to develop a core domain set. METHODS: In Phase 1, a list of candidate domains will be derived from a systematic literature review concerning previously measured outcomes in hand eczema trials, from qualitative patient interviews and from expert interviews. In Phase 2, a consensus study about core domains will be conducted by an online 3-round Delphi survey and a face-to-face meeting, applying predefined consensus criteria. HECOS involves hand eczema and methods experts as well as patients and further stakeholders with an interest in the initiative. OUTLOOK: When a set of core domains has been defined, HECOS is going to identify appropriate outcome measurement instruments in a development process that will be detailed in another protocol. The COS will considerably enhance the methodological quality, comparability and usefulness of hand eczema trials for clinical decision-making and the development of new therapeutic options for hand eczema, and also reduce the effort of planning, conducting, and reporting individual hand eczema studies, reviews and meta-analyses.

[Core outcome measurements in hand eczema trials : The HECOS initiative]. / Erfassung von Core-Outcomes in Handekzemstudien : Die HECOS(Hand Eczema Core Outcome Set)-Initiative.

BACKGROUND: To enhance the informative value and comparability of hand eczema trials, the consensus of a set of core outcomes is necessary. OBJECTIVES: How is success of therapeutic and preventive interventions currently determined in hand eczema trials? Which standard should apply in the future? MATERIALS AND METHODS: As a first step, a systematic literature review was conducted to describe the status in controlled and randomized-controlled hand eczema trials from 2000-2017 and to identify the applied outcomes. The Hand Eczema Core Outcome Set (HECOS) initiative follows the guidelines of the Cochrane Skin Group Core Outcomes Set Initiative (CS-COUSIN) so that its further process is going to ensure the validity of the proposed measurement instruments and the appropriate inclusion of patients', physicians', and researchers' perspectives. RESULTS: Previous trials predominantly assessed erythema, scaling, fissures, vesicles, or pruritus as clinical signs and symptoms of hand eczema. These variables were often not reported separately but as part of a variety of scores. Only few hand eczema scores were applied in more than one trial-most commonly the Hand Eczema Severity Index (HECSI, in 10% of the trials). Overall skin condition, without mentioning specific signs or symptoms, was assessed in 51% of the trials. CONCLUSIONS: Although certain clinical signs and symptoms were assessed by a majority of hand eczema trials, comparability of results was not ensured because various measurement instruments were applied. HECOS is going to agree on a set of relevant and valid core outcome measurement instruments.

Knowledge of outdoor workers on the effects of natural UV radiation and methods of protection against exposure.

The most important but influenceable risk factor in the development of skin cancer is the unprotected exposure to solar ultraviolet (UV) radiation. In order to assure adequate and effective protection against UV exposure, a level of knowledge about solar radiation and its effects is required. The objective of this study was to assess the knowledge of workers in outdoor professions on the effects of natural UV radiation and methods of protection against exposure. Forty outdoor workers were given a standardized questionnaire designed to ascertain their level of knowledge. The majority of participants knew exposure to solar radiation can be detrimental depending on exposure time. Eighty-three percentage recognized that people working regularly in an outdoor environment may be at risk due to high exposure. Long-sleeved clothing plus headgear and sunscreen containing sun-protecting substances were deemed adequate methods of protection by 83% and 85% respectively. Seventy percentage of the outdoor workers were familiar with the definition of the sun protection factor (SPF), yet only 25% correctly identified the amount of sunscreen needed to achieve the SPF as indicated on the product. A mere 8% of participants knew that symptoms of a sunburn first became apparent 3 h after sun exposure and only 18% were able to accurately gauge the amount of time they could spend in the sun before developing one. Although 30% had heard of the ultraviolet index (UVI), only 13% understood that protecting your skin using additional measures is recommended as of UVI 3. Overall, 30% of the outdoor workers thought themselves sufficiently protected against the harmful effects of the sun. While the participants of this study had a basic fundamental understanding of the effects of solar radiation and methods of protection against exposure, there remains an urgent need for further clarification across all demographic groups.

Osmosensor and osmoregulator properties of the betaine carrier BetP from Corynebacterium glutamicum in proteoliposomes.

The secondary glycine betaine uptake system BetP of Corynebacterium glutamicum was purified from Escherichia coli membranes in strep-tagged form after heterologous expression of the betP gene and was reconstituted in E. coli lipids. BetP retained its kinetic properties (V(max) and K(m) for betaine and Na(+)) as compared with intact cells. The influence of driving forces (Na(+) gradient and/or electrical potential) on betaine uptake was quantified in proteoliposomes. BetP was effectively regulated by the external osmolality and was stimulated by the local anesthetic tetracaine. A shift of the optimum of osmotic stimulation to higher osmolalities was linearly correlated with an increasing share of phosphatidyl glycerol, the major lipid of the C. glutamicum plasma membrane in the E. coli lipid proteoliposomes. This finding correlates with results demonstrating an identical shift when betP was expressed in E. coli instead of C. glutamicum. These data indicate that (i) BetP comprises all elements of osmosensing and osmoregulatory mechanisms of betaine uptake, (ii) osmoregulation of BetP is directly related to protein/membrane interactions, (iii) the turgor pressure presumably plays no major role in osmoregulation of BetP, and (iv) the regulatory properties of BetP may be related to the physical state of the surrounding membrane.

Influence of (22S,23S)-homobrassinolide on rooting capacity and survival of adult Norway spruce cuttings.

To determine whether brassinosteroids promote clonal propagation of mature coniferous trees, cuttings of adult Norway spruce (Picea abies (L.) Karst.) trees were harvested in late March, treated with (22S,23S)-28-homobrassinolide (SSHB), and stored at 2 degrees C in darkness until they were planted in May. Treatment of the cuttings with SSHB significantly enhanced the formation of adventitious roots by increasing percent rooting from 50% in the control cuttings to 92% in the 60 ppm SSHB treatment. N(6)-Benzyladenine (BA) stimulated rooting slightly although not significantly, but it counteracted the stimulative effect of SSHB when cuttings were treated with both compounds together. In a second study, the above-ground parts of medium-sized mature clonal Norway spruce trees were pretreated from the end of June till August with SSHB or BA or both. Needle retention of cuttings taken from the pretreated trees the following spring was prolonged until September and the cuttings flushed, but did not root, whereas cuttings from untreated stock plants died before September. No interaction between BA and SSHB was observed. When these pretreatments were repeated the following year on the same mature clonal trees rooting of cuttings was significantly improved in the 5 ppm SSHB treatment.

Endogenous plant hormones of the broad bean, Vicia faba L. (-)-jasmonic acid, a plant growth inhibitor in pericarp.

(-)-Jasmonic acid was identified as a plant growth inhibitor of the pericarp of Vicia faba by means of gas-liquid chromatography, high resolution mass spectrometry, (1)H-nuclear magnetic resonance ((1)H-NMR), and (13)C-NMR. Additionally, the pericarp contains very small amounts of abscisic acid (ABA) and 4'-dihydrophaseic acid. The highest level of jasmonic acid was reached prior to full pericarp length. This amount (3 µg g(-1) fresh weight) is similar to the maximal ABA content in the developing seed. Jasmonic acid is a plant growth inhibitor possessing a relative activity in the wheat seedling bioassay of 1-2.5%, compared to ABA. Contrary to ABA, jasmonic acid does not cause retardation of leaf emergence. The possible physiological role of jasmonic acid in the pericarp is discussed and compared with the assumed function of ABA in developing seeds.