- Email: [email protected]
Occupational skin disorders: A health services analysis of workers' compensation cases, 2004-2008
P1901
P1903
Melanoma cancer registry reporting practices of US dermatologists Seema Kini, Emory University, Atlanta, GA, United States; Suephy Chen, MD, MS, Emory University, Atlanta, GA, United States; Todd Cartee, MD, Emory University, Atlanta, GA, United States Melanoma (MM) is one of the most lethal cutaneous malignancies and the eighth most common cancer in the United States. Underreporting and reporting delay are believed to be a significant source of inaccuracy in current estimates of MM incidence. Despite a legal mandate and established reporting procedures for new cases of MM to state cancer registries in all 50 states, many physicians remain unaware of this obligation. Dermatologists attending the Cutaneous Oncology Symposium at the 2010 American Academy of Dermatology conference were surveyed regarding characteristics of their clinical and MM-reporting practices. Chisquare analysis was used to compare categorical variables and multivariate logistic regression was used to develop a predictive model at the 0.10 significance level. Of the 424 dermatologists surveyed, 111 (26%) completed the survey. Seven subjects were excluded as they practiced outside of the United States. The 104 subjects included in the final dataset represented 30 US states, were mostly (64%) male, and half (51%) had practiced [20 years. Half (50%) did not believe/know they were obligated to report new diagnoses of MM to their state cancer registry and 58 (56%) did not report/know of someone in their practice who reports MM to their state cancer registry. Dermatologists who diagnose fewer than than 10 new MMs over the past year were more likely to be unaware of the reporting requirement (OR, 2.17; 90% CI, 0.79-6.00) than those who diagnose more than than 20 cases of MM per year. Similarly, dermatologists who do not evaluate their own histology (OR, 4.11; 90% CI, 0.95-17.85) or do not send specimens to an out of state pathology lab (OR, 2.40; 90% CI, 0.95-6.08) had an increased odds of not reporting MM to a cancer registry. This study highlights a lack of awareness (‘‘knowledge gap’’) of the obligation to report MM diagnoses to a central cancer registry and a paucity of actual reporting (‘‘practice gap’’) among diagnosing clinicians. Educational efforts may need to be targeted towards specific dermatology populations such as those who diagnose fewer than 10 MMs per year. Further studies incorporating a broader survey of a greater number of dermatologists are clearly warranted to investigate MM reporting practices among dermatologists in the United States.
Translation into Brazilian-Portuguese language, cross-cultural adaptation, and validation of a disease-specific quality of life questionnaire: Acnespecific quality of life questionnaire (Acne-QoL) Cristhine Kamamoto, MD, Federal University of S~ao Paulo, S~ao Paulo, Brazil; Edileia Bagatin, MD, Federal University of S~ao Paulo, S~ao Paulo, Brazil; Jane Tomimori, Federal University of S~ao Paulo, S~ao Paulo, Brazil; Karime Hassun, MD, Federal University of S~ao Paulo, S~ao Paulo, Brazil Purposes: (1) To translate into Brazilian-Portuguese language and provide a crosscultural adaptation of a disease-specific quality of life questionnaire, Acne-specific quality of life questionnaire (Acne-QoL) in patients with facial acne; (2) to correlate the quality of life scores according Acne-QoL to demographic factors in patients with facial acne; (3) to verify the validity of the Acne-QoL Brazilian-Portuguese (BP) version among patients with facial acne; and (4) to analyze the reliability of AcneQoL BP version through the assessment of internal consistency and test-retest reproducibility. Methods: Measurement properties were assessed through the following methods: (1) validity: by correlations between clinical factors and Acne-QoL scores, as well as the correlation between Acne-QoL BP version domain scores and SF-36 domain scores (one-way analysis of variance, Pearson and Spearman correlation coefficients, and linear regression analysis); (2) internal consistency (Cronbach a cofficient); and (3) test-retest reproducibility (intraclass correlation coefficient and Wilcoxon test).
Commercial support: None identified.
Results: A sample of 80 participants were classified in mild (33.8%), moderate (36.2%), and severe facial acne (30%) according to classification proposed by the AAD. The Acne-QoL mean score was 46.86 6 22.21 and mean domains score were 12.43 6 7.19 (self-perception), 12.28 6 6.93 (role-social), 11 6 6.6 (role-emotional), and 11.16 6 5.11 (acne symptoms). The SF-36 domains varied from 66.47 and 93.72. Patients with young age, male gender, and shorter acne duration presented significant higher Acne-QoL scores. The Acne-QoL BP version domain scores were similar among acne severity groups except for ‘‘role social’’ domain. The independent variables entered into linear regression model were: age and severity (selfperception domain and total score); age, gender and severity (role social domain), and age and duration (role emotional and sympton domains). Acne-QoL domains demonstrated correlations with themselves, overall score and ‘‘role social’’ and ‘‘health mental’’ domains SF-36. Internal consistency (0.925-0.952) and test-retest reproducibility were considered statistically acceptable (0.768-0.836). Conclusion: The Brazilian-Portuguese version of Acne-QoL is a reliable and valid outcome measure to be used in facial acne studies. It can also be proposed as a useful instrument to assess quality of life and treatment outcomes of patients with facial acne. Commercial support: None identified.
P1904
P1902 A survey of skin conditions and concerns in South Asian Americans: Results of a community-based survey Sejal Shah, MD, St. Luke’s Roosevelt Hospital Center, New York, NY, United States; Aanand Geria, MD, Howard University Hospital, Washington, District of Columbia, United States; Andrew Alexis, MD, MPH, St. Luke’s Roosevelt Hospital Center, New York, NY, United States; Dhaval Bhanusali, MD, Stony Brook Medical Center, Coram, NY, United States; Rajiv Nijhawan, MD, St. Luke’s Roosevelt Hospital Center, New York, NY, United States South Asians (SAs) represent a rapidly growing part of the US population, increasing 188% from 1990 to 2000 (from 0.27% to 0.78%). Studies investigating the epidemiology of skin disorders in SA Americans are lacking. We conducted a communitybased survey study to determine common skin conditions and concerns among this population. Secondary endpoints were to assess skin cancer awareness, sun protective behaviors, and bleaching cream use in this population. Surveys were distributed to SA adults in the New York City area. One hundred ninety surveys were completed. More than half (54%) of responders were female and 46% were male. The five most common dermatologic diagnoses included: acne (37%), eczema (22%), fungal infection (11%), warts (8%), and moles (8%). The five most common skin concerns included: dry skin (25%), hair loss (22%), uneven tone (21%), dark spots (18%), and acne (17%). Fifty-five percent of those surveyed were not sure or did not believe that skin cancer occurs in people with darker skin. Although 64% of responders believed that skin cancer was related to sun exposure, 12% did not think the two are related and 24% were unsure. Seventy-five percent of those surveyed ‘‘sometimes,’’ ‘‘rarely,’’ or ‘‘never’’ practiced sun protective behaviors. The most common protective technique used was sunscreen (43%) followed by seeking shade (28%). Furthermore, awareness about the relationship between skin cancer and sun exposure and skin cancer in darker skin was likelier in those living in the US for more than 20 years (P ¼ .001 and .014, respectively). Most (91%) felt that ‘‘fair’’ or ‘‘medium’’ skin was most attractive; only 4% found ‘‘dark’’ or ‘‘very dark’’ skin attractive. Twenty-one percent of respondents had used or were currently using bleaching creams. Our results suggest that skin conditions and concerns in this population are similar to those seen in other skin of color populations. In addition, beauty appears to be defined by fair skin, which may explain some of the common skin concerns and the relatively high rate of bleaching cream use. Although the majority of those surveyed thought that skin cancer was related to sun exposure, less than 50% believed that skin cancer could occur in darker skin and only one quarter regularly practiced sun protection. These findings highlight the need for more education on sun protection and skin cancer in this population. Commercial support: None identified.
FEBRUARY 2011
Occupational skin disorders: A health services analysis of workers’ compensation cases, 2004-2008 Nita Kohli, MD, MPH, University of California Los Angeles, Division of Occupational and Environmental Medicine, Los Angeles, CA, United States; Paul Papanek, MD, MPH, Kaiser Permanente Los Angeles Medical Center, Department of Occupational Health, Los Angeles, CA, United States; Philip Harber, MD, MPH, University of California Los Angeles, Division of Occupational and Environmental Medicine, Los Angeles, CA, United States Background: Skin disorders represent approximately 10% to 15% of total workplace injuries and are the most commonly reported category of occupational illnesses not resulting from acute or repetitive trauma (NIOSH). Contact dermatitis is reported to account for more than 90% of workers’ compensation claims for occupational skin disorders. Purpose: This study characterizes occupational skin disorders, their relative frequency, patterns by occupation, treatment length, and disability in a large occupational medicine multisite practice setting. Methods: Data were abstracted from workers’ compensation cases treated at Kaiser Permanente occupational health clinics throughout southern California. Inclusion criteria: Dermatologic ICD-9 codes with dates of injury from January 1, 2004 through December 31, 2008. The data were analyzed descriptively, summarizing the nature of visits; and the relationship between predictor variables, such as personal characteristics and job, with the dermatologic diagnoses was ascertained using chi-square and general linear model analysis. Results: Occupational skin disorders accounted for 1% of all workers’ compensation cases seen in Kaiser’s southern California occupational health clinics. Among these, burns accounted for 65% of cases, followed by dermatitis (20%). Except in personal care jobs, burns comprised the highest category of claims across all occupations, including office jobs (61%). More lost work days per case occurred for skin infections than for other skin disorders (4 days; P ¼ .035). There was a significant difference between job types with regards to number of visits (P ¼.017), length of disability (P ¼.001), and interval to first visit (P ¼.001). Workers in construction and production had the most visits (average 4) and disability days per case (average 9 and 4 days, respectively). Interval to first visit was longer for personal care workers than for other occupations (56.2 days; P ¼.001), and for males versus females (27.1 days vs 19.1 days; P ¼ .001). Conclusion: Occupational skin disorders do not appear to occur as frequently as previous literature reports have indicated. Contrary to the literature, the majority of occupational skin disorders reported in this large series were burns rather than dermatitis. Occupation matters, and plays a significant role in healthcare utilization, lost work time, and disability management. Dermatologists should consider these as important health outcomes. Commercial support: None identified.
J AM ACAD DERMATOL
AB81
P1903
Melanoma cancer registry reporting practices of US dermatologists Seema Kini, Emory University, Atlanta, GA, United States; Suephy Chen, MD, MS, Emory University, Atlanta, GA, United States; Todd Cartee, MD, Emory University, Atlanta, GA, United States Melanoma (MM) is one of the most lethal cutaneous malignancies and the eighth most common cancer in the United States. Underreporting and reporting delay are believed to be a significant source of inaccuracy in current estimates of MM incidence. Despite a legal mandate and established reporting procedures for new cases of MM to state cancer registries in all 50 states, many physicians remain unaware of this obligation. Dermatologists attending the Cutaneous Oncology Symposium at the 2010 American Academy of Dermatology conference were surveyed regarding characteristics of their clinical and MM-reporting practices. Chisquare analysis was used to compare categorical variables and multivariate logistic regression was used to develop a predictive model at the 0.10 significance level. Of the 424 dermatologists surveyed, 111 (26%) completed the survey. Seven subjects were excluded as they practiced outside of the United States. The 104 subjects included in the final dataset represented 30 US states, were mostly (64%) male, and half (51%) had practiced [20 years. Half (50%) did not believe/know they were obligated to report new diagnoses of MM to their state cancer registry and 58 (56%) did not report/know of someone in their practice who reports MM to their state cancer registry. Dermatologists who diagnose fewer than than 10 new MMs over the past year were more likely to be unaware of the reporting requirement (OR, 2.17; 90% CI, 0.79-6.00) than those who diagnose more than than 20 cases of MM per year. Similarly, dermatologists who do not evaluate their own histology (OR, 4.11; 90% CI, 0.95-17.85) or do not send specimens to an out of state pathology lab (OR, 2.40; 90% CI, 0.95-6.08) had an increased odds of not reporting MM to a cancer registry. This study highlights a lack of awareness (‘‘knowledge gap’’) of the obligation to report MM diagnoses to a central cancer registry and a paucity of actual reporting (‘‘practice gap’’) among diagnosing clinicians. Educational efforts may need to be targeted towards specific dermatology populations such as those who diagnose fewer than 10 MMs per year. Further studies incorporating a broader survey of a greater number of dermatologists are clearly warranted to investigate MM reporting practices among dermatologists in the United States.
Translation into Brazilian-Portuguese language, cross-cultural adaptation, and validation of a disease-specific quality of life questionnaire: Acnespecific quality of life questionnaire (Acne-QoL) Cristhine Kamamoto, MD, Federal University of S~ao Paulo, S~ao Paulo, Brazil; Edileia Bagatin, MD, Federal University of S~ao Paulo, S~ao Paulo, Brazil; Jane Tomimori, Federal University of S~ao Paulo, S~ao Paulo, Brazil; Karime Hassun, MD, Federal University of S~ao Paulo, S~ao Paulo, Brazil Purposes: (1) To translate into Brazilian-Portuguese language and provide a crosscultural adaptation of a disease-specific quality of life questionnaire, Acne-specific quality of life questionnaire (Acne-QoL) in patients with facial acne; (2) to correlate the quality of life scores according Acne-QoL to demographic factors in patients with facial acne; (3) to verify the validity of the Acne-QoL Brazilian-Portuguese (BP) version among patients with facial acne; and (4) to analyze the reliability of AcneQoL BP version through the assessment of internal consistency and test-retest reproducibility. Methods: Measurement properties were assessed through the following methods: (1) validity: by correlations between clinical factors and Acne-QoL scores, as well as the correlation between Acne-QoL BP version domain scores and SF-36 domain scores (one-way analysis of variance, Pearson and Spearman correlation coefficients, and linear regression analysis); (2) internal consistency (Cronbach a cofficient); and (3) test-retest reproducibility (intraclass correlation coefficient and Wilcoxon test).
Commercial support: None identified.
Results: A sample of 80 participants were classified in mild (33.8%), moderate (36.2%), and severe facial acne (30%) according to classification proposed by the AAD. The Acne-QoL mean score was 46.86 6 22.21 and mean domains score were 12.43 6 7.19 (self-perception), 12.28 6 6.93 (role-social), 11 6 6.6 (role-emotional), and 11.16 6 5.11 (acne symptoms). The SF-36 domains varied from 66.47 and 93.72. Patients with young age, male gender, and shorter acne duration presented significant higher Acne-QoL scores. The Acne-QoL BP version domain scores were similar among acne severity groups except for ‘‘role social’’ domain. The independent variables entered into linear regression model were: age and severity (selfperception domain and total score); age, gender and severity (role social domain), and age and duration (role emotional and sympton domains). Acne-QoL domains demonstrated correlations with themselves, overall score and ‘‘role social’’ and ‘‘health mental’’ domains SF-36. Internal consistency (0.925-0.952) and test-retest reproducibility were considered statistically acceptable (0.768-0.836). Conclusion: The Brazilian-Portuguese version of Acne-QoL is a reliable and valid outcome measure to be used in facial acne studies. It can also be proposed as a useful instrument to assess quality of life and treatment outcomes of patients with facial acne. Commercial support: None identified.
P1904
P1902 A survey of skin conditions and concerns in South Asian Americans: Results of a community-based survey Sejal Shah, MD, St. Luke’s Roosevelt Hospital Center, New York, NY, United States; Aanand Geria, MD, Howard University Hospital, Washington, District of Columbia, United States; Andrew Alexis, MD, MPH, St. Luke’s Roosevelt Hospital Center, New York, NY, United States; Dhaval Bhanusali, MD, Stony Brook Medical Center, Coram, NY, United States; Rajiv Nijhawan, MD, St. Luke’s Roosevelt Hospital Center, New York, NY, United States South Asians (SAs) represent a rapidly growing part of the US population, increasing 188% from 1990 to 2000 (from 0.27% to 0.78%). Studies investigating the epidemiology of skin disorders in SA Americans are lacking. We conducted a communitybased survey study to determine common skin conditions and concerns among this population. Secondary endpoints were to assess skin cancer awareness, sun protective behaviors, and bleaching cream use in this population. Surveys were distributed to SA adults in the New York City area. One hundred ninety surveys were completed. More than half (54%) of responders were female and 46% were male. The five most common dermatologic diagnoses included: acne (37%), eczema (22%), fungal infection (11%), warts (8%), and moles (8%). The five most common skin concerns included: dry skin (25%), hair loss (22%), uneven tone (21%), dark spots (18%), and acne (17%). Fifty-five percent of those surveyed were not sure or did not believe that skin cancer occurs in people with darker skin. Although 64% of responders believed that skin cancer was related to sun exposure, 12% did not think the two are related and 24% were unsure. Seventy-five percent of those surveyed ‘‘sometimes,’’ ‘‘rarely,’’ or ‘‘never’’ practiced sun protective behaviors. The most common protective technique used was sunscreen (43%) followed by seeking shade (28%). Furthermore, awareness about the relationship between skin cancer and sun exposure and skin cancer in darker skin was likelier in those living in the US for more than 20 years (P ¼ .001 and .014, respectively). Most (91%) felt that ‘‘fair’’ or ‘‘medium’’ skin was most attractive; only 4% found ‘‘dark’’ or ‘‘very dark’’ skin attractive. Twenty-one percent of respondents had used or were currently using bleaching creams. Our results suggest that skin conditions and concerns in this population are similar to those seen in other skin of color populations. In addition, beauty appears to be defined by fair skin, which may explain some of the common skin concerns and the relatively high rate of bleaching cream use. Although the majority of those surveyed thought that skin cancer was related to sun exposure, less than 50% believed that skin cancer could occur in darker skin and only one quarter regularly practiced sun protection. These findings highlight the need for more education on sun protection and skin cancer in this population. Commercial support: None identified.
FEBRUARY 2011
Occupational skin disorders: A health services analysis of workers’ compensation cases, 2004-2008 Nita Kohli, MD, MPH, University of California Los Angeles, Division of Occupational and Environmental Medicine, Los Angeles, CA, United States; Paul Papanek, MD, MPH, Kaiser Permanente Los Angeles Medical Center, Department of Occupational Health, Los Angeles, CA, United States; Philip Harber, MD, MPH, University of California Los Angeles, Division of Occupational and Environmental Medicine, Los Angeles, CA, United States Background: Skin disorders represent approximately 10% to 15% of total workplace injuries and are the most commonly reported category of occupational illnesses not resulting from acute or repetitive trauma (NIOSH). Contact dermatitis is reported to account for more than 90% of workers’ compensation claims for occupational skin disorders. Purpose: This study characterizes occupational skin disorders, their relative frequency, patterns by occupation, treatment length, and disability in a large occupational medicine multisite practice setting. Methods: Data were abstracted from workers’ compensation cases treated at Kaiser Permanente occupational health clinics throughout southern California. Inclusion criteria: Dermatologic ICD-9 codes with dates of injury from January 1, 2004 through December 31, 2008. The data were analyzed descriptively, summarizing the nature of visits; and the relationship between predictor variables, such as personal characteristics and job, with the dermatologic diagnoses was ascertained using chi-square and general linear model analysis. Results: Occupational skin disorders accounted for 1% of all workers’ compensation cases seen in Kaiser’s southern California occupational health clinics. Among these, burns accounted for 65% of cases, followed by dermatitis (20%). Except in personal care jobs, burns comprised the highest category of claims across all occupations, including office jobs (61%). More lost work days per case occurred for skin infections than for other skin disorders (4 days; P ¼ .035). There was a significant difference between job types with regards to number of visits (P ¼.017), length of disability (P ¼.001), and interval to first visit (P ¼.001). Workers in construction and production had the most visits (average 4) and disability days per case (average 9 and 4 days, respectively). Interval to first visit was longer for personal care workers than for other occupations (56.2 days; P ¼.001), and for males versus females (27.1 days vs 19.1 days; P ¼ .001). Conclusion: Occupational skin disorders do not appear to occur as frequently as previous literature reports have indicated. Contrary to the literature, the majority of occupational skin disorders reported in this large series were burns rather than dermatitis. Occupation matters, and plays a significant role in healthcare utilization, lost work time, and disability management. Dermatologists should consider these as important health outcomes. Commercial support: None identified.
J AM ACAD DERMATOL
AB81