Motolani E. Ogunsanya

A systematic review of patient-reported outcomes in patients with cutaneous lupus erythematosus

Cutaneous lupus erythematosus (CLE) is a chronic dermatological autoimmune disease marked by photosensitive lesions that can lead to hyperpigmentation changes, scarring and hair loss. Health‐related quality of life (HRQoL) in patients with CLE is severely impaired. Given the heterogeneous nature of CLE, health perceptions of patients can differ significantly from those of clinicians. It is important to use subjective measures, such as patient‐reported outcomes (PROs), to capture HRQoL data in patients with CLE. We conducted a systematic review of published PRO instruments used in measuring HRQoL in patients with CLE. Also, we examined the disease burden on HRQoL in patients with CLE. To identify studies, PubMed/MEDLINE, Web of Science and CINAHL were searched using ‘CLE/cutaneous lupus erythematosus’ in combination with PRO‐related keywords such as ‘quality of life’, ‘self‐report’ and ‘instrument’. English‐language articles published between 2003 and 2014 were identified. A total of 482 citations were identified in the initial search. Eleven studies met our inclusion criteria, and five PRO instruments were found to be used: Skindex (versions 16 and 29), Dermatology Life Quality Index, 36‐Item Short‐Form Health Survey, and visual analogue scales for pain and pruritus. Patients with CLE reported having poor quality of life and experienced symptoms ranging from pain, pruritus and fatigue to photosensitivity. There is a limited number of studies examining PRO in patients with CLE. While our findings suggest that quality of life in patients with CLE is poor, further studies are needed to understand better the impact of CLE from patients’ perspectives.

Beliefs Regarding Prostate Cancer Screening Among Black Males Aged 18 to 40 Years.

This study was conducted to identify the salient behavioral beliefs of young Black men toward prostate cancer screening, and to identify the issues surrounding their comfortability with prostate examinations. A total of 20 Black men, aged between 18 and 40 years, participated in three focus group sessions between June 2013 and July 2013 in Austin, Texas. Participants were asked open-ended questions about: (a) the advantages and disadvantages of screening to identify salient behavioral beliefs about screening and (b) issues that would make prostate examinations comfortable or uncomfortable to identify comfortability factors. Focus group discussions were tape-recorded, transcribed, and content analyzed to identify emerging themes of salient beliefs and comfortability. Also, nine salient behavioral beliefs toward prostate cancer screening were identified, and eight factors were linked to comfortability with prostate examinations. Given the increase of prostate cancer disparity as a public health issue, understanding the beliefs of Black men of prescreening age (18-40 years) may be crucial to the effectiveness of future interventions to improve screening when recommended at later ages.

Knowledge of Prostate Cancer and Screening Among Young Multiethnic Black Men

The purpose of this study was to assess the knowledge of prostate cancer and screening and its associated factors in young Black men aged 18 to 40 years. This was a cross-sectional study conducted in a convenience sample of 267 young Black men in Austin, Texas. Knowledge about prostate cancer and screening was operationalized through 14 items, including 12 items from the Knowledge about Prostate Cancer Screening Questionnaire (PC knowledge), and two items assessing dietary knowledge and prostate cancer screening controversy. PC knowledge scores were regressed on age, cues to action, health screening experience, and demographic/personal factors. Most participants were African American men of American origin (65.3%) and were college freshmen (18.9%). PC knowledge scores were low, with mean correct responses of 28.5%, mean knowledge score of 5.25 ± 3.81 (possible score range of 0 to 14, with higher scores indicating higher PC knowledge) and a median score of 5.00. On average, 47% of the respondents replied “Don’t Know” to the questions. Overall, PC knowledge scores were low among these young Black men, especially in domains related to risk factors, screening age guidelines, limitations, and diet. It is thus important that these men be educated more on these important domains of prostate cancer and screening so that the decision to screen or not will be an informed one. Health screening experience, residence area, major field of study, and academic classification were significant predictors of knowledge.

Predictors of prostate cancer screening using Andersen’s Behavioral Model of Health Services Use

PURPOSE The purposes of the study were to examine the prevalence of prostate cancer screening (PCS) in the United States and to identify predictors of PCS guided by Andersens Behavioral Model of Health Services Use (ABM). METHODS PCS rates were analyzed in men (aged ≥40y) using 2014 data from the Behavioral Risk Factor Surveillance System. Descriptive analysis was conducted using sampling weights to determine the prevalence of PCS (i.e., had a prostate-specific antigen test). Multiple logistic regression within the framework of ABM was used to identify predictors of PCS. The ABM variables of predisposing (e.g., age), enabling (e.g., health insurance), and need (e.g., comorbidities) comprised the independent variables. RESULTS Among the 131,415 men, 62.4% (N = 82,014) reported that they had a prostate-specific antigen test in the last 2 years. Among predisposing factors, age, education, income, and employment status were significantly associated with undergoing PCS. Informed decision-making process, health care coverage, regular health care provider, and length of time since last routine checkup were significant enabling factors. Health care provider recommendation and previous cancer diagnosis were significant need factors. CONCLUSIONS Most older men in the United States had previously engaged in PCS. Several ABM variables were predictive of PCS and should be considered when developing future strategies to encourage PCS in at-risk men with the recommended life expectancies. Such strategies should also ensure that the decision to undergo PCS is an informed process between patients and their health care providers.

Predictors of low quality of life in patients with discoid lupus

DEAR EDITOR, Discoid lupus erythematosus (DLE) is unique from other cutaneous lupus erythematosus (CLE) subtypes because of dyspigmentation and scarring, which are associated with quality of life (QoL) impairment in other skin disorders. While previous QoL studies have included heterogeneous cohorts of patients with CLE, we focused on patients with DLE to identify clinical and demographic features that correlate with QoL impairment. We hypothesized that greater skin disease activity, skin disease damage, dark skin type, female sex, low socioeconomic status (defined by annual income) and current smoking status would be associated with poorer QoL in patients with DLE. A cross-sectional pilot study was performed of 117 patients with DLE consecutively enrolled between April 2010 and April 2014 in outpatient dermatology clinics in the University of Texas Southwestern Medical Center and Parkland Health and Hospital System. Patients with a diagnosis of DLE based on clinical and/or histological evidence and over 18 years of age were included. This study was approved by the University of Texas Southwestern Institutional Review Board. We collected demographic information, medications, disease history and disease severity assessments (e.g. Cutaneous Lupus Activity and Severity Index – CLASI). Patients completed the QoL questionnaire SKINDEX-29+3, which contained three additional lupus-specific questions about concerns of sun exposure, hair loss and limitation of outdoor activities. These scores were primary outcomes, and high scores represented poor QoL. Patient characteristics were summarized as frequencies and percentages for categorical variables, and as medians and interquartile ranges for continuous variables. Relationships between SKINDEX-29+3 domain scores and predictor variables were evaluated by univariable and multivariable regression analyses. In addition to independent variables with P-values < 0 05 in the univariable analyses, we selected six variables (sex, smoking, annual income, CLASI activity, CLASI damage and skin type) based on prior literature and clinical experience to be included a priori in the multivariable analyses for each SKINDEX-29+3 domain. Statistical analysis was performed with SAS 9.4 (SAS Institute Inc., Cary, NC, U.S.A.). The multivariable analyses (Table S1; see Supporting Information) revealed that female sex and current smoking status were significantly associated with poorer QoL in the SKINDEX-29+3 emotions domain. In the SKINDEX-29+3 functioning domain, we identified significant predictor variables including current smoking status and lower annual income. Higher CLASI activity scores, female sex and current smoking status significantly correlated with higher SKINDEX-29+3 symptoms scores. Female sex was significantly associated with higher SKINDEX-29+3 lupus-specific scores. High SKINDEX29+3 scores in all four domains did not correlate with dark skin types or high CLASI damage scores. Figure 1 provides box and whisker plots of significant predictor variables and their SKINDEX-29+3 scores. Female sex was associated with poorer QoL in DLE for the SKINDEX29+3 emotions, symptoms and lupus-specific domains (Fig. 1a–d). Reporting annual income <

Erratum to: Determinants of Prostate Cancer Screening Intentions of Young Black Men Aged 18 to 40 Years

10 000 was associated with poorer QoL in the SKINDEX-29+3 functioning and symptoms domains vs. income >

Knowledge about Prostate Cancer Screening Questionnaire--Revised

50 000, and in the SKINDEX-29+3 lupus-specific domain vs. those between

Determinants of Prostate Cancer Screening Intentions of Young Black Men Aged 18 to 40 Years

10 000 and

Pharmacists’ perceptions regarding the impact of hydrocodone rescheduling on prescription volume, workflow management, and patient outcomes

50 000 (Fig. 1e–h). Current smokers had higher SKINDEX-29+3 scores than noncurrent smokers in the emotions, functioning and symptoms domains (Fig. 1i–l). Social factors may play a role in the greater QoL impairment seen in female patients with DLE. Women are more negatively affected by their hair loss and dyspigmentation in other skin diseases that present with these features, such as cicatricial alopecias and vitiligo. The negative effect of smoking on QoL in patients with DLE may reflect poor responsiveness to therapy such as antimalarials, and a heightened inflammatory response. Patients with DLE with low socioeconomic status are at risk for poor QoL, likely due to limited access to medical care, difficulty with transportation, lack of insurance or inability to afford medications. The lack of significant correlation between CLASI damage scores and SKINDEX-29 scores may be due to patients’ adjustment to their disease over time, as patients with DLE may be impacted by disease activity more than by the permanent sequelae of their disease. The nonsignificant association of dark skin type and high SKINDEX-29 scores may reflect limitations in the SKINDEX-29+3 questionnaire, which does not contain numerous questions specific to dyspigmentation. In focus-group sessions with patients with DLE, in which several had dark skin types, many noted the negative impact of their dyspigmentation and scarring through negative social perceptions and daily lifestyle adjustments to mask them (M. E. Ogunsanya & B. F. Chong, unpublished observations). Thus, we are devising a disease-specific questionnaire for CLE that probes more into these concerns and would help track disease improvement in future clinical trials.