Monique Kilkenny

The prevalence of common skin conditions in australian school students : 3. Acne vulgaris

The prevalence, severity and disability related to facial acne (comprising acne on the head and neck) was assessed in a randomized sample of 2491 students (aged 4–18 years) from schools throughout the State of Victoria in Australia. Students were diagnosed clinically by a dermatologist or dermatology registrar. The overall prevalence (including 4–7 year olds) was 36.1% (95% confidence intervals, CI 24.7–47.5), ranging from 27.7% (95% CI 20.6–34.8) in 10–12 year olds to 93.3% (95% CI 89.6–96.9) in 16–18 year olds. It was less prevalent among boys aged 10–12 years than girls of the same age; however, between the ages of 16 and 18 years, boys were more likely than girls to have acne. Moderate to severe acne was present in 17% of students (24% boys, 11% girls). Comedones, papules and pustules were the most common manifestations of acne, with one in four students aged 16–18 years having acne scars. Twelve per cent of students reported a high Acne Disability Index score. This tended to correlate with clinical severity, although there was some individual variation in perception of disability. Seventy per cent of those found to have acne on examination had indicated in the questionnaire that they had acne. Of those, 65% had sought treatment, a substantial proportion of which (varying with who gave the advice) was classified as being likely to have no beneficial effect. This is the first population‐based prevalence study on clinically confirmed acne published from Australia. The results show that acne is a common problem. They suggest the need for education programmes in schools to ensure that adolescents understand their disease, and know what treatments are available and from whom they should seek advice.

Descriptive epidemiology of acne vulgaris in the community

Acne is a common skin condition. No universally accepted standardized classification system for acne vulgaris exists, although there is a strong need for it Thus, the clinical definition of acne has been unclear in many studies. The reported prevalence of acne varies from 35 to over 90% of adolescents at some stage. In some studies the prevalence of comedones approaches 100% in both sexes during adolescence. The prevalence of acne varies between sexes and age groups, appearing earlier in females than in males, possibly reflecting the earlier onset of puberty. There is a greater severity of acne in males than in females in the late teens, which is compatible with androgens being a potent stimulus to sebum secretion. The prevalence of acne at a given age has been shown to be highly dependent on the degree of sexual maturity. Acne commonly shows a premenstrual increase in women. Some studies have detected seasonal variability in acne vulgaris, with the colder months associated with exacerbation and the warmer months showing improvement. Other studies have not confirmed these findings. Several studies that have investigated the psychosocial impact of acne have had conflicting results. The prevalence of severe acne has decreased over the past 20 years due to improved treatment. The general prevalence figure for acne may be confounded by treatment and this factor needs to be accounted for when collecting data.

A Phase II Multicentered, Single-Blind, Randomized, Controlled Trial of the Stroke Self-Management Program

Background and Purpose— The benefits of chronic disease self-management programs for stroke survivors are uncertain because individuals with severe impairments have been excluded from previous research. We undertook a phase II randomized controlled trial to determine whether a self-management program designed for survivors (SSMP; 8 weeks) was safe and feasible compared to standard care (control) or a generic self-management program (generic; 6 weeks). Methods— Stroke survivors were recruited from 7 South Australian hospitals via a letter or indirectly (eg, newspapers). Eligible participants were randomized at a 1:1:1 ratio of 50 per group. Primary outcomes were recruitment, participation, and participant safety. Secondary outcomes were positive and active engagement in life using the Health Education Impact Questionnaire and characteristics of quality of life and mood at 6 months from program completion. Results— Of 315 people screened, 149 were eligible and 143 were randomized (48 SSMP, 47 generic, 48 control); mean age was 69 years (SD, 11) and 59% were female. Demographic features were similar between groups and 41% had severe cognitive impairment; 57% accessed the interventions, with 52% SSMP and 38% generic completing >50% of sessions (P=0.18). Thirty-two participants reported adverse events (7 control, 12 generic, 13 SSMP; P=0.3; 34% severe); however, none was attributable to the interventions. Potential benefits for improved mood were found. Conclusions— SSMP was safe and feasible. Benefits of the stroke-specific program over the generic program included greater participation and completion rates. An efficacy trial is warranted given the forecast growth in the stroke population and improved survival trends.

The prevalence of common skin conditions in Australian school students: 2. Atopic dermatitis

The prevalence of atopic dermatitis (AD) was recorded following examination by dermatologists and dermatology registrars of a random sample of 2491 school students throughout the State of Victoria, Australia. The overall prevalence, based on clinical examination, was 16.3% (95% confidence interval, CI 14.1–18.5), being higher in girls (17.7%; 95% CI 15.0–20.4) than boys (14.8%; 95% CI 11.8–17.8). Using the U.K. Working Party Diagnostic Criteria for AD reduced the prevalence to 10.8% (95% CI 9.3–12.3) with the prevalence in girls 12.3% (95% CI 10.1–14.4) and in boys 9.2% (95% CI 7.1–11.4). The prevalence was highest in 4–6 year olds (18.7% on clinical examination, 11.5% using the U.K. Working Party Criteria), decreasing with increasing age to 11.6% on clinical examination (8.6% on U.K. Working Party Criteria) among 16–18 year olds. Most of those with AD were classified as having mild disease (54.1%), with 32.1% classified as having minimal and 13.8% as having moderate to severe disease. Over 80% of those who reported on the questionnaire that they had dermatitis that was then confirmed on examination had been using one or more products to treat it. Nearly 90% of these products were classified as efficacious, with medical practitioners being the major source of advice for their use (77%). Pharmacists (8%), family/friends (6%) and others (9%), including beauticians and naturopaths, made up the remainder of the persons from whom those affected had sought advice about their treatment. These data, the first community‐based prevalence data on AD published from Australia, confirm that the condition is common among those of school age. There is a need for AD to be included among those conditions that are discussed in health education lessons in schools.

Adherence to clinical guidelines improves patient outcomes in Australian audit of stroke rehabilitation practice

OBJECTIVE To study the correlation between adherence to recommended management and good recovery outcomes in an Australian cohort of inpatients receiving rehabilitation. DESIGN Processes of care were audited and included those recommended in the Australian Clinical Guidelines for Stroke Rehabilitation and Recovery. SETTING National audit data from 68 rehabilitation units were used, with each hospital contributing up to 40 consecutive cases. PARTICIPANTS Not applicable. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Discharged home or an increase of greater than or equal to 22 in FIM scores between admission and discharge. Multivariable logistic regression models controlling for patient clustering were used to assess the associations between adherence to recommended management and recovery outcomes (dependent variables). RESULTS Hospitals contributed 2119 patients (median age 75y, 53% men). We found that rehabilitation units providing evidence-based management (eg, treatment for sensorimotor impairment 38%, hypertonicity 56%, mobility 94%, and home assessments 71%) were more likely to provide better recovery outcomes for people with stroke. A discharge FIM score of 100 was clinically relevant and was strongly correlated with whether or not a patient was discharged home. We found very good correlation between admission and discharge FIM scores in stroke rehabilitation. CONCLUSIONS This is one of the first study comparing adherence to recommended management in Australian rehabilitation units and stroke recovery outcomes based on national audit data. Novel findings include the significance of an FIM score between 80 and 100 and the clinical significance of various management processes.

The descriptive epidemiology of warts in the community

Warts are common skin infections caused by human papillomavirus (HPV) and affect most people sometime in their life. A number of epidemiological studies on the prevalence of warts have been completed in schools, various occupational groups, general practices and hospitals. All studies have relied on a subjective measure for the diagnosis of warts. Cross‐sectional studies completed in schools have shown the prevalence in children to vary from 2 to 20%. Occupational handlers of meat, poultry and fish have a higher prevalence than other workers. Children and young adults are the groups most affected. Future studies are needed to investigate the true frequency of warts in the community and the likelihood of an individual developing these lesions during his/her lifetime.

The prevalence of common skin conditions in Australian school students: 4 Tinea pedis

Tinea pedis is a condition that is common, often undiagnosed and frequently inadequately treated. It is reported as being rare in young children, but there are relatively few population‐based reports of prevalence. A randomized sample of 2491 students from schools throughout the State of Victoria, Australia, were examined by dermatologists and dermatology registrars, who recorded clinical signs suggestive of tinea pedis, which were then confirmed by fungal culture. The age‐ and sex‐adjusted prevalence of culture‐proven tinea pedis was 5.2% [95% confidence interval (CI) 3.58–6.82] increasing with age from 2.1% (95% CI 0.95–3.28) in 4–6 year olds to 9.7% (95% CI 5.21–14.26) in 16–18 year olds. A higher proportion of males (6.0%) had tinea pedis than females (4.3%). Trichophyton mentagrophytes and T. rubrum were the most common dermatophytes isolated on culture. Less than 40% of those with a positive diagnosis had reported on the questionnaire that they had tinea. Of those who reported correctly that they had tinea, 75% had used one or more products to treat their condition, of which more than 40% were classified as unlikely to have any therapeutic effect on tinea pedis. These data confirm that tinea pedis, a potentially transmissible disease, is common in Australian schoolchildren, including those in primary school. There is a need for education programmes in schools on the nature of tinea pedis, the treatment available, and the public health approach to infection control within the school and home environment.

Understanding long-term unmet needs in Australian survivors of stroke.

Background Limited data exist on the long-term needs of community-dwelling stroke survivors. We aimed to describe factors associated with the extent to which needs were met in Australian survivors of stroke. Method Multifaceted strategies were used to obtain a national sample. Adults 12+ months poststroke and living in the community participated. Needs were assessed over the domains of health, everyday living, work, leisure, social support, and finances. Multivariable negative-binomial and logistic regression were used. Results Seven hundred sixty-five survivors completed surveys. Most (84%) reported having needs that were not being fully met (median 4 of 20, Q1, Q3: 1, 9). Variations occurred based on age, residential location, time since stroke, and disability level. Multivariable results showed that having fatigue, cognition or emotional problems, decreasing age, and increased disability were associated with increasing numbers of needs not being fully met (P < 0·001). Factors associated with needs not being fully met were as follows: (1) greater disability (adjusted odds ratio: 3·4, 95% confidence interval: 1·9, 6·0) and fatigue problems (adjusted odds ratio: 2·0, 95% confidence interval: 1·1, 3·4) (health domain); (2) greater disability (adjusted odds ratio: 7·0, 95% confidence interval: 3·0, 17·0) and being one to two-years poststroke (adjusted odds ratio: 3·4, 95% confidence interval: 1·5, 7·8) (work domain); and (3) increased disability (adjusted odds ratio: 3·8, 95% confidence interval: 2·2, 6·5) and memory problems (adjusted odds ratio: 2·1, 95% confidence interval: 1·0, 4·2) (leisure domain). Conclusion The extent to which long-term needs were met was influenced by a variety of factors, particularly age, disability levels, and residential location. Changes need to be made to the way and extent to which survivors are supported following stroke.

The descriptive epidemiology of tinea pedis in the community

Tinea pedis is a common inflammatory skin condition due to infection by dermatophyte fungi. A number of epidemiological studies have been completed on the frequency of tinea pedis in the community, particularly sporting and occupational groups and schools. Most studies have focused on small, high‐risk populations. These include occupational groups involving manual labour, sporting groups such as swimmers, and those working or living in confined conditions with shared washing facilities, which favour the opportunity for crossinfection.

Maryborough skin health survey: Prevalence and sources of advice for skin conditions

A computer‐assisted telephone interview survey was carried out in the City of Maryborough to determine the prevalence and sources of advice for self‐reported skin conditions. Of the 443 adults contacted, 416 (94%) agreed to participate in the study. One hundred and fourteen people (27%) reported having one or more skin conditions over the past 2 weeks, which included eczema/dermatitis 25.5% (range, 18.1‐32.8%; 95% CI), warts 16.1% (9.8‐22.4%), acne 16.2% (9.6‐22.7%), cold sores 15.1% (7.3‐18.9%) and tinea 11.2% (5.9‐16.5%). Medical practitioners were the most common source of advice for 49% of skin conditions, followed by family and friends or self‐prescribed (25%). Advice from a pharmacist was sought for 19% of skin conditions. Logistic regression analysis showed that those people who reported a moderate to severe inflammatory skin condition, such as dermatitis, urticaria or psoriasis, were most likely to seek advice from their medical practitioner. The type and severity of skin condition were factors which determined where a person sought advice on diagnosis and management.