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179 Association of childhood atopic dermatitis with decreased physical activity and increased sedentary behavior
ABSTRACTS | Clinical Research I: Epidemiology and Patient Outcomes Research 178
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Serious infections are on the rise in US patients with psoriasis D Hsu and JI Silverberg Northwestern University Feinberg School of Medicine, Chicago, IL Psoriasis is a chronic inflammatory skin disorder with immune dysregulation and use of systemic immunosuppressive treatments that may predispose toward serious infections. We sought to determine the rates of serious infections in children and adults with psoriasis. We analyzed data from the 2002-2012 Nationwide Inpatient Sample, containing a 20% sample of all US hospitalizations. Psoriasis was determined by a validated algorithm and 15 serious infections were assessed using ICD-9-CM codes. Psoriasis was associated with significantly higher odds of pneumonia (logistic regression, odds ratio [95% confidence interval]: 1.13 [1.11-1.15]), septicemia (1.23 [1.21-1.26]), cellulitis (3.90 [3.82-3.98]), necrotizing fasciitis (1.64 [1.20-2.25]), diverticulitis (1.41 [1.34-1.48]), enterocolitis (1.15 [1.11-1.20]), osteomyelitis (1.63 [1.48-1.80]), infectious arthritis (2.32 [2.07-2.60]), encephalitis (1.30 [1.111.51]), any viral (1.21 [1.16-1.26]) or herpes simplex viral (1.55 [1.21-1.99]) infection and fungal infection (2.39 [2.34-2.45]), not associated with meningitis (1.05 [0.94-1.16]) and associated with lower odds of pyelonephritis (0.86 [0.79-0.94]) and appendicitis (0.50 [0.470.54]). Infection rates significantly increased in psoriasis patients from 2002 to 2012 for septicemia, pneumonia, diverticulitis, enterocolitis, encephalitis, any viral or fungal infection (analysis of variance with Tukey correction, P<0.05 for all). Serious infections increased at a faster rate (delta) in psoriasis compared with non-psoriasis patients for septicemia, pneumonia, necrotizing fasciitis, diverticulitis, pyelonephritis, enterocolitis, osteomyelitis, infectious arthritis, meningitis, encephalitis, fungal and herpes simplex virus infection in at least one time interval from 2002-2012. Multiple risk factors for these infections were identified, including age, race, sex, income, insurance status, hospital location, season of admission and number of chronic conditions (P<0.0001 for all). Future research is needed to determine how to reduce the risk of serious infections in patients with psoriasis.
Association of childhood atopic dermatitis with decreased physical activity and increased sedentary behavior MA Strom1 and JI Silverberg1,2 1 Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL and 2 Multidisciplinary Eczema Center, Northwestern Medicine, Chicago, IL Atopic dermatitis (AD) is a pruritic, relapsing, inflammatory skin disorder that can adversely impact many aspects of pediatric health. The hallmark of AD is intense pruritus, which is very commonly exacerbated by heat and sweat. We hypothesized that children with AD avoid physical activity in order to avoid itch. We analyzed data from 131,783 children in 2 US population-based studies (2003-2004 and 2007-2008 National Survey of Children’s health [NSCH]) to determine levels of physical activity and sedentary behaviors in pediatric AD. In multivariate logistic regression models adjusting for socio-demographics, AD was associated with decreased odds of 3 days of physical activity per week (adjusted odds ratio [95% confidence interval]: 0.88 [0.80e0.98], P¼0.02). In NSCH 2007-2008, severe AD was associated with significantly increased odds of 5 hours of daily television or video games (2.62 [1.19e5.79], P¼0.02), decreased odds of 1 days of physical activity per week (0.39 [0.19e0.79], P¼0.007) and decreased odds of participation in sports (0.45 [0.28e0.73], P¼0.001). Compared to children with either AD or sleep disturbance, children with both AD and sleep disturbance had even lower odds of sports participation (0.66 [0.50e0.86], P¼0.002) and higher odds of 5 hours of daily television or video games usage (3.13 [1.98e4.95], P<0.001). The results of this study suggest that children with AD engage in less physical activity and more sedentary behaviors.
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An effort to create a mobile app to assess the burden of disease of atopic dermatitis L Gracey Maniar1, K Jethwani2 and J Kvedar2 1 Harvard Combined Dermatology Residency Training Program, Boston, MA and 2 Partners Center for Connected Health, Boston, MA Atopic dermatitis is chronic condition that requires a significant effort for treatment. Decreased quality of life results from severe itch, poor sleep, increased skin infections, and substantial stress in patients and caregivers. It requires an investment of time and money to follow diligent sensitive skin care and apply topical medications and moisturizers multiple times a day. Flares can occur when treatments are missed and sometimes result in emergency room visits, leading to increased health care costs. There is great opportunity to improve upon how eczema care is continued outside of the clinic and to gather more research data for atopic dermatitis. In partnership with the National Eczema Association, a mobile app will be developed to assess the burden of disease of atopic dermatitis by collecting data on symptoms and flares, as well as promoting better adherence by providing reminders with incentives to complete treatments. This data will be used for clinical studies and be displayable for clinicians to use at clinic visits. We are at the forefront of change in how healthcare is provided. While the relationship of the patient with the physician is of utmost importance, there is great potential to both improve the continuity of care outside of the clinic and to easily collect new data through the use of mobile apps for use in future clinical studies.
Clinical predictors of prolonged hospital stay and readmission for lower limb cellulitis J Lavian1, G Lin1, M Oppenheim2, C Sison3 and A Garg1 1 Dermatology, Northwell Health, Lake Success, NY, 2 Infectious Disease, Northwell Health, Manhasset, NY and 3 Biostatistics, Northwell Health, Manhasset, NY The purpose of the study was to describe demographics, co-morbidities, admission vitals, and laboratory markers of infection among lower limb cellulitis (LLC) patients with prolonged hospital stay >5 days as well as those readmitted for LLC. A retrospective case control study was performed in the Northwell Health System in order to estimate the likelihood of independent variables being associated with LOS >5 days and readmission. Patients 18 years old with a primary admitting diagnosis of LLC between 2009 and 2014 were included in the study. Comparison groups were used consisting of patients with LOS 5 days and those not readmitted for LLC, respectively. There were 4209 admissions for LLC with 1662 having a LOS >5 days (39.5%). The median age for LOS >5 days was 70.1 vs. 63 for LOS <5 days. Age >50 years old [OR:2.21, CI:1.87-2.60], hypertension [OR:1.19, CI:1.04-1.35], diabetes mellitus [OR:1.34, CI:1.15-1.56], tachycardia [OR:1.57, CI:1.28-1.92], hypotension [OR:1.69, CI:1.25-2.27], WBC >10.5 [OR:1.60, CI:1.41-1.82], neutrophil percentage >77 [OR:1.97, CI:1.72-2.26], bicarbonate <22 [OR:1.73, CI:1.42-2.12], creatinine >1.3 [OR:2.15, CI:1.87-2.47] were associated with a prolonged hospital stay. Readmission rate for LLC was 11.2% (471/4224) with a median age of 68.6 years. Patients readmitted for LLC were more likely to have age 50 [82.4%; OR 1.10, CI 1.03-1.19, per 10 units]. There was no statistical difference in smoking (28.3%), obesity (42.5%), hypertension (35.2%), diabetes mellitus (22.5%), renal insufficiency (29.9%), fever (3.0%), tachycardia (10.9%), hypotension (5.5%), leukocytosis (34.4%) and neutrophilia (28.2%) among those readmitted and not readmitted for LLC. Further prospective studies are needed to validate these clinical characteristics and determine risk-stratification rules for LLC to identify patients at risk for prolonged hospitalization and readmission.
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Association of socioeconomic and geographic factors with Google search trends for skin protective and risk behaviors D Seth1, H Gittleman2, Q Olstrom2, J Barnholtz-Sloan2 and JS Bordeaux3 1 Case Western Reserve University School of Medicine, Cleveland, OH, 2 Case Comprehensive Cancer Center, Cleveland, OH and 3 Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH Internet search trends are a unique representation of health information seeking behaviors. Recently, they have been used to track non-communicable conditions. Google Trends search value index (SVI) data SVI provides search frequency data relative to total search volume and was analyzed to study searches for skin protective behaviors (“sunscreen”) and skin risk factors (“tanning salon” and “tanning bed”) from 2010 to 2015. There were statistically significant differences in search frequency (SVI) for both skin protective behaviors and skin risk factors across seasons (p<0.001), indicating seasonal variation for these search terms. Geographically, Hawaii had the highest SVI for skin protective behaviors (i.e., sunscreen), while Alaska had the lowest. West Virginia had the highest SVI for skin risk factors (i.e., tanning bed and tanning salon), while Hawaii had the lowest. Skin protective behavior SVI by state correlated significantly with the state’s average income, latitude and percent white in an univariate model, while in a multivariate model, it was correlated significantly with the state’s level of educational attainment, average income, and latitude (p<0.05). There was a weak negative association between skin risk SVI by state and educational attainment (r¼ -0.33, p<0.05) and average income (r¼ -.34, p< 0.05). In the multivariate model for skin risk behaviors by state, skin risk behavior SVI was correlated with educational attainment, average income, and latitude (p<0.05). This data suggests that there not only seasonal differences in Internet search trends for skin protective and skin risk behaviors but also that these search trends are impacted by state-wide socioeconomic and geographic factors. These findings corroborate existing epidemiological studies on sunscreen and tanning bed use, supporting the application of Internet search trends in skin-related public health.
S32 Journal of Investigative Dermatology (2016), Volume 136
Cutaneous lymphoma international consortium (CLIC): Uniting worldwide experts to develop and validate a prognostic index model K Rogers1, M Vermeer2, P Quaglino3, R Hoppe1, P Porcu4, J Guitart5, J Kim1, A Gru10, G Wood9, M Duvic8, S Whittaker6, J Scarisbrick7 and Y Kim1 1 Stanford U., Stanford, CA, 2 Leiden U., Leiden, Netherlands, 3 U. of Turin, Turin, Italy, 4 OSU, Columbus, OH, 5 Northwestern U., Chicago, IL, 6 St. Thomas Hospital, London, United Kingdom, 7 UHB, Birmingham, United Kingdom, 8 MDACC, Houston, TX, 9 U. of Wisc., Madison, WI and 10 UVA, Charlottesville, VA The international community of cutaneous lymphoma (CL) experts has assembled in an unprecedented collaborative alliance (CLIC), to generate large-scale data for the improvement of management and outcomes in CL. CLIC investigators demonstrated the feasibility of such international collaboration by publishing a retrospective study of prognostic factors that included 29 international sites, which also underscored the intrinsic flaws of a retrospective analysis, thus supporting the need for a prospective approach. With > 50 centers working in concert, the CLIC’s initial prospective project (PROCLIPI) will identify prognostic factors in advanced-stage mycosis fungoides (MF) and Se´zary syndrome (SS) and validate an index model to augment the prognostic power of our staging system and improve risk stratification for clinical management. Minimum and exploratory data dictionaries have been created and an international data flow and repository has been established to capture well-defined, prospective data. Furthermore, a federated biobank where patient samples are linked with clinical annotation will be maintained for translational research. CLIC investigators in Europe (led by J Scarisbrick) have successfully launched this study in 2015. Given the significant heterogeneity of the histopathology in MF/SS, CLIC partners have established criteria for histologic data and the process to optimize quality, which includes a central pathology review. The success of PROCLIPI will strengthen global connectivity of the CLIC alliance, provide widely utilizable resources for translational research and showcase the unparalleled scale of scientific collaboration among experts sharing a common vision.
179
Serious infections are on the rise in US patients with psoriasis D Hsu and JI Silverberg Northwestern University Feinberg School of Medicine, Chicago, IL Psoriasis is a chronic inflammatory skin disorder with immune dysregulation and use of systemic immunosuppressive treatments that may predispose toward serious infections. We sought to determine the rates of serious infections in children and adults with psoriasis. We analyzed data from the 2002-2012 Nationwide Inpatient Sample, containing a 20% sample of all US hospitalizations. Psoriasis was determined by a validated algorithm and 15 serious infections were assessed using ICD-9-CM codes. Psoriasis was associated with significantly higher odds of pneumonia (logistic regression, odds ratio [95% confidence interval]: 1.13 [1.11-1.15]), septicemia (1.23 [1.21-1.26]), cellulitis (3.90 [3.82-3.98]), necrotizing fasciitis (1.64 [1.20-2.25]), diverticulitis (1.41 [1.34-1.48]), enterocolitis (1.15 [1.11-1.20]), osteomyelitis (1.63 [1.48-1.80]), infectious arthritis (2.32 [2.07-2.60]), encephalitis (1.30 [1.111.51]), any viral (1.21 [1.16-1.26]) or herpes simplex viral (1.55 [1.21-1.99]) infection and fungal infection (2.39 [2.34-2.45]), not associated with meningitis (1.05 [0.94-1.16]) and associated with lower odds of pyelonephritis (0.86 [0.79-0.94]) and appendicitis (0.50 [0.470.54]). Infection rates significantly increased in psoriasis patients from 2002 to 2012 for septicemia, pneumonia, diverticulitis, enterocolitis, encephalitis, any viral or fungal infection (analysis of variance with Tukey correction, P<0.05 for all). Serious infections increased at a faster rate (delta) in psoriasis compared with non-psoriasis patients for septicemia, pneumonia, necrotizing fasciitis, diverticulitis, pyelonephritis, enterocolitis, osteomyelitis, infectious arthritis, meningitis, encephalitis, fungal and herpes simplex virus infection in at least one time interval from 2002-2012. Multiple risk factors for these infections were identified, including age, race, sex, income, insurance status, hospital location, season of admission and number of chronic conditions (P<0.0001 for all). Future research is needed to determine how to reduce the risk of serious infections in patients with psoriasis.
Association of childhood atopic dermatitis with decreased physical activity and increased sedentary behavior MA Strom1 and JI Silverberg1,2 1 Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL and 2 Multidisciplinary Eczema Center, Northwestern Medicine, Chicago, IL Atopic dermatitis (AD) is a pruritic, relapsing, inflammatory skin disorder that can adversely impact many aspects of pediatric health. The hallmark of AD is intense pruritus, which is very commonly exacerbated by heat and sweat. We hypothesized that children with AD avoid physical activity in order to avoid itch. We analyzed data from 131,783 children in 2 US population-based studies (2003-2004 and 2007-2008 National Survey of Children’s health [NSCH]) to determine levels of physical activity and sedentary behaviors in pediatric AD. In multivariate logistic regression models adjusting for socio-demographics, AD was associated with decreased odds of 3 days of physical activity per week (adjusted odds ratio [95% confidence interval]: 0.88 [0.80e0.98], P¼0.02). In NSCH 2007-2008, severe AD was associated with significantly increased odds of 5 hours of daily television or video games (2.62 [1.19e5.79], P¼0.02), decreased odds of 1 days of physical activity per week (0.39 [0.19e0.79], P¼0.007) and decreased odds of participation in sports (0.45 [0.28e0.73], P¼0.001). Compared to children with either AD or sleep disturbance, children with both AD and sleep disturbance had even lower odds of sports participation (0.66 [0.50e0.86], P¼0.002) and higher odds of 5 hours of daily television or video games usage (3.13 [1.98e4.95], P<0.001). The results of this study suggest that children with AD engage in less physical activity and more sedentary behaviors.
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An effort to create a mobile app to assess the burden of disease of atopic dermatitis L Gracey Maniar1, K Jethwani2 and J Kvedar2 1 Harvard Combined Dermatology Residency Training Program, Boston, MA and 2 Partners Center for Connected Health, Boston, MA Atopic dermatitis is chronic condition that requires a significant effort for treatment. Decreased quality of life results from severe itch, poor sleep, increased skin infections, and substantial stress in patients and caregivers. It requires an investment of time and money to follow diligent sensitive skin care and apply topical medications and moisturizers multiple times a day. Flares can occur when treatments are missed and sometimes result in emergency room visits, leading to increased health care costs. There is great opportunity to improve upon how eczema care is continued outside of the clinic and to gather more research data for atopic dermatitis. In partnership with the National Eczema Association, a mobile app will be developed to assess the burden of disease of atopic dermatitis by collecting data on symptoms and flares, as well as promoting better adherence by providing reminders with incentives to complete treatments. This data will be used for clinical studies and be displayable for clinicians to use at clinic visits. We are at the forefront of change in how healthcare is provided. While the relationship of the patient with the physician is of utmost importance, there is great potential to both improve the continuity of care outside of the clinic and to easily collect new data through the use of mobile apps for use in future clinical studies.
Clinical predictors of prolonged hospital stay and readmission for lower limb cellulitis J Lavian1, G Lin1, M Oppenheim2, C Sison3 and A Garg1 1 Dermatology, Northwell Health, Lake Success, NY, 2 Infectious Disease, Northwell Health, Manhasset, NY and 3 Biostatistics, Northwell Health, Manhasset, NY The purpose of the study was to describe demographics, co-morbidities, admission vitals, and laboratory markers of infection among lower limb cellulitis (LLC) patients with prolonged hospital stay >5 days as well as those readmitted for LLC. A retrospective case control study was performed in the Northwell Health System in order to estimate the likelihood of independent variables being associated with LOS >5 days and readmission. Patients 18 years old with a primary admitting diagnosis of LLC between 2009 and 2014 were included in the study. Comparison groups were used consisting of patients with LOS 5 days and those not readmitted for LLC, respectively. There were 4209 admissions for LLC with 1662 having a LOS >5 days (39.5%). The median age for LOS >5 days was 70.1 vs. 63 for LOS <5 days. Age >50 years old [OR:2.21, CI:1.87-2.60], hypertension [OR:1.19, CI:1.04-1.35], diabetes mellitus [OR:1.34, CI:1.15-1.56], tachycardia [OR:1.57, CI:1.28-1.92], hypotension [OR:1.69, CI:1.25-2.27], WBC >10.5 [OR:1.60, CI:1.41-1.82], neutrophil percentage >77 [OR:1.97, CI:1.72-2.26], bicarbonate <22 [OR:1.73, CI:1.42-2.12], creatinine >1.3 [OR:2.15, CI:1.87-2.47] were associated with a prolonged hospital stay. Readmission rate for LLC was 11.2% (471/4224) with a median age of 68.6 years. Patients readmitted for LLC were more likely to have age 50 [82.4%; OR 1.10, CI 1.03-1.19, per 10 units]. There was no statistical difference in smoking (28.3%), obesity (42.5%), hypertension (35.2%), diabetes mellitus (22.5%), renal insufficiency (29.9%), fever (3.0%), tachycardia (10.9%), hypotension (5.5%), leukocytosis (34.4%) and neutrophilia (28.2%) among those readmitted and not readmitted for LLC. Further prospective studies are needed to validate these clinical characteristics and determine risk-stratification rules for LLC to identify patients at risk for prolonged hospitalization and readmission.
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Association of socioeconomic and geographic factors with Google search trends for skin protective and risk behaviors D Seth1, H Gittleman2, Q Olstrom2, J Barnholtz-Sloan2 and JS Bordeaux3 1 Case Western Reserve University School of Medicine, Cleveland, OH, 2 Case Comprehensive Cancer Center, Cleveland, OH and 3 Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH Internet search trends are a unique representation of health information seeking behaviors. Recently, they have been used to track non-communicable conditions. Google Trends search value index (SVI) data SVI provides search frequency data relative to total search volume and was analyzed to study searches for skin protective behaviors (“sunscreen”) and skin risk factors (“tanning salon” and “tanning bed”) from 2010 to 2015. There were statistically significant differences in search frequency (SVI) for both skin protective behaviors and skin risk factors across seasons (p<0.001), indicating seasonal variation for these search terms. Geographically, Hawaii had the highest SVI for skin protective behaviors (i.e., sunscreen), while Alaska had the lowest. West Virginia had the highest SVI for skin risk factors (i.e., tanning bed and tanning salon), while Hawaii had the lowest. Skin protective behavior SVI by state correlated significantly with the state’s average income, latitude and percent white in an univariate model, while in a multivariate model, it was correlated significantly with the state’s level of educational attainment, average income, and latitude (p<0.05). There was a weak negative association between skin risk SVI by state and educational attainment (r¼ -0.33, p<0.05) and average income (r¼ -.34, p< 0.05). In the multivariate model for skin risk behaviors by state, skin risk behavior SVI was correlated with educational attainment, average income, and latitude (p<0.05). This data suggests that there not only seasonal differences in Internet search trends for skin protective and skin risk behaviors but also that these search trends are impacted by state-wide socioeconomic and geographic factors. These findings corroborate existing epidemiological studies on sunscreen and tanning bed use, supporting the application of Internet search trends in skin-related public health.
S32 Journal of Investigative Dermatology (2016), Volume 136
Cutaneous lymphoma international consortium (CLIC): Uniting worldwide experts to develop and validate a prognostic index model K Rogers1, M Vermeer2, P Quaglino3, R Hoppe1, P Porcu4, J Guitart5, J Kim1, A Gru10, G Wood9, M Duvic8, S Whittaker6, J Scarisbrick7 and Y Kim1 1 Stanford U., Stanford, CA, 2 Leiden U., Leiden, Netherlands, 3 U. of Turin, Turin, Italy, 4 OSU, Columbus, OH, 5 Northwestern U., Chicago, IL, 6 St. Thomas Hospital, London, United Kingdom, 7 UHB, Birmingham, United Kingdom, 8 MDACC, Houston, TX, 9 U. of Wisc., Madison, WI and 10 UVA, Charlottesville, VA The international community of cutaneous lymphoma (CL) experts has assembled in an unprecedented collaborative alliance (CLIC), to generate large-scale data for the improvement of management and outcomes in CL. CLIC investigators demonstrated the feasibility of such international collaboration by publishing a retrospective study of prognostic factors that included 29 international sites, which also underscored the intrinsic flaws of a retrospective analysis, thus supporting the need for a prospective approach. With > 50 centers working in concert, the CLIC’s initial prospective project (PROCLIPI) will identify prognostic factors in advanced-stage mycosis fungoides (MF) and Se´zary syndrome (SS) and validate an index model to augment the prognostic power of our staging system and improve risk stratification for clinical management. Minimum and exploratory data dictionaries have been created and an international data flow and repository has been established to capture well-defined, prospective data. Furthermore, a federated biobank where patient samples are linked with clinical annotation will be maintained for translational research. CLIC investigators in Europe (led by J Scarisbrick) have successfully launched this study in 2015. Given the significant heterogeneity of the histopathology in MF/SS, CLIC partners have established criteria for histologic data and the process to optimize quality, which includes a central pathology review. The success of PROCLIPI will strengthen global connectivity of the CLIC alliance, provide widely utilizable resources for translational research and showcase the unparalleled scale of scientific collaboration among experts sharing a common vision.