Dermatological patients with itch report more stress, stigmatization experience, anxiety and depression compared to patients without itch: Results from a European multi-centre study

BACKGROUND

Itch as the most common symptom in dermatology has been shown to be related to psychological factors such as stress, anxiety and depression. Moreover, associations were found between perceived stigmatization and itch. However, studies investigating the differences between patients with dermatoses with and without itch regarding perceived stress, stigmatization, anxiety and depression are missing. Therefore, one of the aims of the second study of the European Society for Dermatology and Psychiatry (ESDaP study II) was to investigate these relationships in a large cohort of patients with different itchy dermatoses.

RESULTS

3399 patients with 14 different itchy dermatoses were recruited at 22 centres in 17 European countries. They filled in questionnaires to assess perceived stigmatization, stress, signs of clinically relevant anxiety or depression, itch-related quality of life, the overall health status, itch duration, frequency and intensity. The most significant association between the severity of itching and the perception of stress was observed among individuals with rosacea (correlation coefficient r = 0.314). Similarly, the strongest links between itch intensity and experiences of stigmatization, anxiety, and depression were found in patients with seborrheic dermatitis (correlation coefficients r = 0.317, r = 0.356, and r = 0.400, respectively). Utilizing a stepwise linear regression analysis, it was determined that within the entire patient cohort, 9.3% of the variation in itch intensity could be accounted for by factors including gender, levels of anxiety, depression, and perceived stigmatization. Females and individuals with elevated anxiety, depression, and perceived stigmatization scores reported more pronounced itch intensities compared to those with contrary attributes.

CONCLUSION

This study underscores the connection between experiencing itch and its intensity and the psychological strain it places on individuals. Consequently, psychological interventions should encompass both addressing the itch itself and the interconnected psychological factors. In specific cases, it becomes imperative for dermatologists to direct individuals towards suitable healthcare resources to undergo further psychological assessment.

Association between worries about climate change and mental health in Norwegian adolescents

Background

Climate change has a great impact on the future of children and young people. Since the global climate strike movement, many adolescents expressed worries about climate change. But do these worries lead to declined mental health and future optimism? Thus, we aim to explore associations between prevalence of worries about climate change, leisure activities and mental health problems in a representative sample of Norwegian adolescents.

Methods

In 2021, the youth survey Ungdata collected data from 139,841 Norwegian adolescents, which corresponds to a response rate of 75%. Descriptive analysis was used to calculate the prevalence of worries about climate change cannabis use and bi- and multivariate logistic regression analysis to examine the association between worries about climate change and mental health, leisure activities and alcohol and cannabis use, controlled for sociodemographics.

Results

Around 37% of Norwegian adolescents are worried about climate change. Worries increased with age and are more prevalent among girls. There is a relationship between mental health problems and worries about climate change (OR = 1.80 (CI:1.75-1.86)) still after adjusting for sociodemographic variables, leisure activities and alcohol and cannabis use (OR = 1.71 (1.10-1.42)).

Conclusions

The results indicate a real connection between mental health problems and worries about climate change, but the causal relationship needs further study. This knowledge makes it important for all profession, working with adolescents, paying special attention to possible negative effects of worries about climate change on the mental health of young people.

Key messages

• Worries about climate change has an impact on mental health of young people.

• Adolescent’s worries about climate change should be taken seriously.

Assessment of mental health and psychosocial support in Ukrainian refugee minors resettled in Norway

Background

The recent invasion of Ukraine has forced millions of civilians, especially women and children, to leave their country. Although the European Union offers guidance on individual health assessment of refugees fleeing the war in Ukraine, assessment practice varies across host countries and even on national basis. Thus, the aim of this project was to identify and prioritize procedures for mental health assessment of Ukrainian refugee minors in Norway.

Methods

This project applied a modified three-round-Delphi method. In a first step, the leading public health nurse and community physician in 40 municipalities across Norway were contacted via e-mail and asked to state who is in charge of health assessment, what is current assessing practice and what are the problems and needs. Answers were analysed and condensed and will be presented for rating in a second and third round.

Results

Preliminary results from the first round suggest that most municipalities are currently in a planning phase with uncertainties surrounding who and how future assessments will be done. Public health nurses or general practitioners are often in charge of health assessments, but it is unclear if this includes age-adjusted mental health assessments.

Conclusions

Preliminary results show that current practice in assessing mental health and psychosocial support for Ukranian refugee minors in Norway is very diverse. There is a need to evaluate and prioritize current procedures to assure an equal and age-adjusted procedures for all refugee minors, regardless of where they have resettled.

Key messages

The impact of COVID-19 on persons with concurrent mental health and substance use disorders

Background

The COVID-19 pandemic with its restrictions touched the daily life of most people. While everyday social life becomes difficult for citizens with economic and cultural capital, it becomes even worse for persons with mental health (MHD) and substance use disorders (SUD), who are particularly vulnerable to social exclusion. In this project, we aim to explore the impact of the pandemic on persons MHD/SUD, nearer, how the lockdown effected their daily life and further, the utilization of health care services under the consecutive waves of the pandemic.

Methods

The project has two parts: First we conducted 17 individual interviews and one focus group with persons with MHD/SUD, using thematic analysis. Second, we merged the Norwegian Patient Register, the Register for Infectious Diseases and data from Statistics Norway. We matched data of 41500 individuals with MHD/SUD after gender, age and health region with a sample from the general population as a control group and study the health care service utilization under the consecutive waves of the pandemic in Norway in 2020-2021.

Results

Within the qualitative study, we identified four interrelated main themes: (1) The COVID-19 outbreak as a perceived challenge, (2) A decline in mental health and well-being, (3) Increased substance use challenges, and (4) Diverse experiences with health and social services. The results show further that people with MHD/SUD have challenges with digital tools and/or do not have the appropriate equipment. Persons with MHD/SUD face greater barriers in accessing the health care system compared to the general population as a control group. Results of the register study are still preliminary.

Conclusions

Persons with MHD/SUD face major challenges during the COVID-19 pandemic There is reason to believe that new pandemics will emerge in the future. In this context, it is essential to gain knowledge of how to care for vulnerable groups in society and how to reach them in emergencies.

Key messages

• Continuous maintenance of low-threshold services for persons with MHD/SUD during a pandemic is essential.

• Improvement of digital skills of service users or alternatives to digital consultations should be considered.

'The psychosocial burden of alopecia areata and androgenetica': a cross-sectional multicentre study among dermatological out-patients in 13 European countries

BACKGROUND

Hair diseases play an important burden on patients' lives, causing significant emotional and psychosocial distress. However, the impairment due to different hair conditions, such as alopecia areata (AA) and androgenetic alopecia (AGA), has rarely been compared.

OBJECTIVE

The aim of this study was to assess the psychological burden of subgroups of patients with different hair diseases and to compare them to a healthy population.

METHODS

In this study, we analysed a subgroup of patients with hair diseases from patients of a large multicentre study including 3635 dermatological patients and 1359 controls from 13 European countries. In the subgroup of patients with hair diseases, we analysed the socio-demographic characteristics, the stress level, and the impact of hair diseases on quality of life (QoL), anxiety, and depression and we compared them among patients with AA, AGA and healthy controls.

RESULTS

The study population included 115 patients (77% women, 23% men) with hair diseases, 37 of whom with AA and 20 with AGA. Patients with hair diseases had a lower education level than healthy controls (medium educational level: 43% vs. 28%). Overall, 41% of the patients reported stressful life events during the last 6 months compared with 31% of the controls. Patients with the same age, sex, depression level and comorbidities had a worse QoL when suffering from AA than from AGA (Mean Dermatology Life Quality Index score: 5.8 vs. 2.5).

CONCLUSION

Patients with hair diseases are more anxious, depressed and have a lower QoL than controls.

The self-assessed psychological comorbidities of prurigo in European patients: a multicentre study in 13 countries

BACKGROUND

Prurigo is defined by the presence of chronic pruritus and multiple localized or generalized pruriginous lesions.

OBJECTIVE

The aim of this study was to assess the psychological burden of prurigo in patients of European countries.

METHODS

In this multicentre European study, 3635 general dermatology outpatients and 1359 controls were included. Socio-demographic data and answers to questionnaires (regarding quality of life, general health, anxiety and depression and suicidal ideation) were collected.

RESULTS

There were 27 patients with prurigo; of these, 63% were men, and the mean age was 58.6 years. Among patients with prurigo, 10 of 27 (37%) suffered from anxiety and 8 of 27 (29%) from depression. Suicidal ideation was reported in 5 of 27 (19%) patients, and for four of these five patients, suicidal ideation was related to their skin disease. These frequencies were higher in the 10 commonest dermatological diseases (including psoriasis, atopic dermatitis and leg ulcers). The impact on quality of life was severe, with a mean Dermatologic Life Quality Index (DLQI) of 12.4, with an extreme impact on quality of life for 23% of patients and a very large impact for 27% of patients.

CONCLUSION

The psychological comorbidities of prurigo are common, greater than those of other skin diseases, and their impact on quality of life is significant. Thus, it is important to study this condition and to find new treatments.

Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations

BACKGROUND

It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrists underdiagnose depression. This has not been explored among dermatologists.

OBJECTIVES

To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale (HADS).

METHODS

The study was an observational cross-sectional multicentre study of prevalent cases of skin diseases in 13 countries in Europe. Consecutive patients were recruited in outpatient clinics and filled in questionnaires prior to clinical examination by a dermatologist who reported any diagnosis of skin disease and signs of mood disorders.

RESULTS

Analysis of the 3635 consultations showed that the agreement between dermatologist and HADS was poor to fair (lower than 0·4) for all diagnosis categories. The true-positive rate (represented by the percentage of dermatologists recognizing signs of depression or anxiety in patients with depression or anxiety as defined by a HADS value ≥ 11) was 44·0% for depression and 35·6% for anxiety. The true negative rate (represented by the percentage of dermatologists not detecting signs of depression or anxiety in non-depressed or non-anxious patients defined by HADS-value < 11) was 88.8% for depression and 85.7% for anxiety.

CONCLUSIONS

Dermatologists in Europe tend to underestimate mood disorders. The results suggest that further training for dermatologists to improve their skills in diagnosing depression and anxiety might be appropriate. When present, the psychological suffering of patients with dermatological conditions needs to be addressed.

Experiences of Professional Helping Relations by Persons with Co-occurring Mental Health and Substance Use Disorders

Recovery in co-occurring mental health and substance use disorders often involves relationships with professional helpers, yet little is known about how these are experienced by service users. The aim of this study was to explore and describe behaviour and attributes of professional helpers that support recovery, as experienced by persons with co-occurring disorders. Within a collaborative approach, in-depth individual interviews with eight persons with lived experience of co-occurring disorders were analysed using systematic text condensation. The analysis yielded four categories of recovery-supporting behaviour and attributes of professional helpers and the ability to build trust cuts across all of them: Building trust through (a) hopefulness and loving concern, (b) commitment, (c) direct honesty and expectation and (d) action and courage. Services should allow for flexibility and continuity, and training should recognise the importance of establishing trust in order to reach out to this group.

The burden of common skin diseases assessed with the EQ5D™: a European multicentre study in 13 countries

BACKGROUND

Generic instruments measuring health-related quality of life (HRQoL), like EQ5D™, enable comparison of skin diseases with healthy populations and nondermatological medical conditions, as well as calculation of utility data.

OBJECTIVES

To measure HRQoL in patients with common skin diseases and healthy controls across Europe using the EQ5D.

METHODS

This multicentre observational cross-sectional study was conducted in 13 European countries. Each dermatology clinic recruited at least 250 consecutive adult outpatients to complete questionnaires, including the EQ5D.

RESULTS

There were 5369 participants (4010 patients and 1359 controls). Mean ± SD self-rated health state reported by patients was 69·9 ± 19·7; for controls it was 82·2 ± 15·5. When adjusted for confounding factors, including comorbidity, mean patient EQ visual analogue scores were 10·5 points lower than for controls (standardized β = -0·23). Odds ratio with 95% confidence interval for impairment in all five dimensions of EQ5D adjusted for confounders was doubled for patients compared with controls. Patients with hidradenitis suppurativa (HS), blistering conditions, leg ulcers, psoriasis and eczemas had the highest risk for reduction in HRQoL in most dimensions (2-10-fold). Data on differences of impairment by dimensions offer new insights.

CONCLUSIONS

This study confirms the large impact skin conditions have on patients' well-being, differentiating between aspects of HRQoL. Patients with HS, blistering diseases, leg ulcers, infections and most chronic skin diseases reported reduced HRQoL compared with patients with chronic obstructive lung disease, diabetes mellitus, cardiovascular disease and cancers. These findings are important in the prioritization of resource allocation between medical fields and within dermatological subspecialities.

Experimental Study on the Injection Compression Molding of Parts with Precision Contours

The thermomechanical history of the melt under injection compression molding follows a quadrilateral-shaped path, rather than conventional triangular-shaped path, over the P-v-T diagram. The control capacity and flexibility over post-filling is significantly enhanced. It thus can produce parts with better dimensional control with less frozen-in orientation than those from conventional injection molding. This paper is devoted to study its technological application on the precision molding of parts with precision contours. A modified injection molding machine incorporating compression mechanism, and a mold with movable wall and shut-off mechanism, are used. The quality of injection-compression-molded polysytrene convex lenses is defined and compared with those injection molded. With the same cooling time, injection compression can produce lenses with better quality than those without compression

Adolescents’ adverse experiences and mental health in a prospective perspective

Aims: The aim of this study is to examine the possible changes in depressive symptoms related to various adverse experiences, based on a three-year follow-up among adolescents. Methods: All 10th graders invited to enter the youth section of the Oslo Health Study 2001 (n = 3,811) constituted a baseline of a longitudinal study. A high level of mental distress (Hscl-10 score ≥1.85) according to the different life experiences was compared, at baseline (15 years) and follow-up (18 years). Results: All adverse experiences were associated with a high Hscl-10 score except parents not living together and death of a close person at 15 and 18 years for boys, and death of a close person at 18 years of age for girls. A development from high Hscl-10 score at baseline to low score at follow up was defined as recovery from mental distress. The proportion of the youth that had a high Hscl-10 score related to reporting adverse life experiences at age 15, followed by a low Hscl-10 score three years later proved to be between 44% and 89% among boys and between 16% and 31% among girls. Conclusions: From a three year longitudinal perspective the recovery from mental distress is substantial and higher among boys than among girls. However, mental distress seems to persist in a considerable proportion of the adolescents. Consequently, it is insufficient to brush aside traumas and hurt and rely on a time healing process only.

Itch in the community: associations with psychosocial factors among adults

BACKGROUND

Itch is a major symptom in dermatology but is little explored epidemiologically. Objective To describe the prevalence and the severity of itch, and to explore its relation to psychosocial factors.

METHODS

The design was cross-sectional and population-based. A total of 40 880 adults in Oslo were invited to answer a questionnaire.

RESULTS

Twenty-seven per cent report itch. Individuals reporting itch were younger, the majority were female, were non-Norwegian, had lower income, were more distressed, had experienced more negative life events and had poorer social support. Individuals with poor support who had experienced more negative life events reported more itch than individuals with good support (15. 6% compared to 10. 9%). The strong association with psychosocial factors was confirmed in a logistic regression.

CONCLUSION

There is a strong association between itch and psychosocial factors in the general population.

Water-Binding and Oxygen Permeability in Poly(vinyl alcohol) Films

The measurement and interpretation of isotherms for sorption of water onto, and oxygen permeability of, polymer substrates are important for designing polymers in applications such as agricultural seed coatings. In a preliminary study of water sorption in the commonly used copolymer poly(vinyl alcohol–co-vinyl acetate), moisture sorption isotherms were measured for a series of substrates of different comonomer composition at 25°C. The data were fitted to the D'Arcy–Watt model, which gave physically reasonable values for parameters related to the strength of monolayer adsorption to high affinity sites on the substrate and the number of sites for secondary water adsorption per unit mass. The oxygen permeability of poly(vinyl alcohol) films was found to be a function only of the water content of the films, with no other obvious contributing factors. Marked differences were seen in the populations of 'bound' and 'unbound' water characterized by 1H nuclear magnetic resonance (NMR) spectroscopy and moisture sorption isotherm fitting. There was no correlation of oxygen permeability with 'bound' or 'unbound' water measured by any means, a fact suggesting that there is a continuum of water environments within the materials.

Selective trapping of organochlorine compounds in mountain lakes of temperate areas

The study of fish concentrations and sediment inventories in 19 European high mountain lakes (40-67 degrees N) shows that a fraction of organochlorine compounds (OCs), the less volatile compounds (LVC; subcooled liquid vapor pressure < or = 10(-2.5) Pa), are trapped in the higher locations. This general trend is not significantly influenced by possible local sources. Compound distribution is related to average air temperatures. The phase-change pseudoenthalpies calculated from the sediment inventories closely match the summed theoretical volatilization and dissolution enthalpies. This fractionation effect is responsible for the accumulation of high concentrations of the LVC, the more persistent and toxic according to literature data, in organisms inhabiting sites far from the locations of synthesis or use.

Intrinsic rectification of ion flux in alamethicin channels: studies with an alamethicin dimer

Covalent dimers of alamethicin form conducting structures with gating properties that permit measurement of current-voltage (I-V) relationships during the lifetime of a single channel. These I-V curves demonstrate that the alamethicin channel is a rectifier that passes current preferentially, with voltages of the same sign as that of the voltage that induced opening of the channel. The degree of rectification depends on the salt concentration; single-channel I-V relationships become almost linear in 3 M potassium chloride. These properties may be qualitatively understood by using Poisson-Nernst-Planck theory and a modeled structure of the alamethicin pore.

[Cardiovascular risk factors in persons aged 40-42 years in the county of Hedmark 1988-94]

We present the results from three surveys conducted in 1988, 1991 and 1994 in Hedmark comparing risk factors for cardiovascular disease among men and women age 40-42 years. The data are compared with the results for persons in the same age group from the counties Vestfold, Rogaland and Nordland, and examined in the same periods. In 1991 the average levels of total cholesterol and infarction risk score were the same in Hedmark and the three other counties, but in 1994 Hedmark compared less favourably. While the mean levels of total cholesterol showed minimal difference between rural and urban municipalities in Hedmark, triglycerides and systolic blood pressure were higher in the rural areas. Adjustment of the results in Hedmark for lower attendance rate among unmarried, divorced and widowed persons in 1991 and 1994 than in 1988 does not affect other risk factors than smoking. We discuss possible explanations of the less favourable results and the implications for primary prevention of cardiovascular diseases.

[Occupational injuries and prolonged sick listings during the period 1989-93]

Norway lacks reliable data on the magnitude and development of occupational injuries. Each year about 25,000 occupational injuries and 2,000 occupational diseases are reported to the Labour Inspection. These constitute only one-third of all expected injuries and accidents related to the work environment. The aim of this study was to estimate the magnitude of occupational injuries in Norway causing long-term certification of illness. There was a 35% reduction in the incidence of occupational injuries in Norway from 1990 to 1993. The reduction applies to men and women combined, all age groups and most counties. The distribution of characteristics by age, sex, diagnosis and place of residence corresponds well with previous, limited studies. Injuries, especially fractures, account for approximately 70 per cent of the occupational injuries. Possible explanations for the decrease in incidence could be preventive efforts, a tighter labour market, a change from primary and secondary to tertiary industry, and the overall reduction in long-term certification of illness in Norway from 1990 to 1993.

Engineering stabilized ion channels: covalent dimers of alamethicin

The peptide alamethicin forms channels with a variety of conductance states. Selective stabilization of a particular state should simplify the task of understanding conductance in terms of channel structure. We synthesized two different covalent dimers of alamethicin in which peptides were linked at their C-terminal ends by flexible tethers. Both dimeric peptides formed channels with conductances that matched those of alamethicin channels. Particular conductance states were selectively stabilized, however, with lifetimes up to 170-fold longer than the same states observed with monomers. In addition, tethering appeared to limit the size of the structures formed so that, even at higher peptide concentrations, a single predominant conductance state was obtained. We suggest this state corresponds to a channel made from six alamethicin molecules (three dimers).

Refinement of the spinal muscular atrophy locus by genetic and physical mapping

We report the mapping and characterization of 12 microsatellite markers including 11 novel markers. All markers were generated from overlapping YAC clones that span the spinal muscular atrophy (SMA) locus. PCR amplification of 32 overlapping YAC clones shows that 9 of the new markers (those set in italics) map to the interval between the two previous closest flanking markers (D5S629 and D5S557): cen-D5S6-D5S125-D5S435-D5S1407- D5S629-D5S1410-D5S1411/D5S1412-D5S1413- D5S1414-D5Z8-D5Z9-CATT1-D5Z10/D5Z6- D5S557-D5S1408-D5S1409-D5S637-D5S351-MA P1B-tel. Four of these new markers detect multiple loci in and out of the SMA gene region. Genetic analysis of recombinant SMA families indicates that D5S1413 is a new proximal flanking locus for the SMA gene. Interestingly, among the 40 physically mapped loci, the 14 multilocus markers map contiguously to a genomic region that overlaps, and perhaps helps define, the minimum genetic region encompassing the SMA gene(s).

[WHO strategies to reduce childhood mortality in developing countries]

In 1990, world political leaders decided to make an effort to reduce childhood mortality in developing countries. One of several formulated goals was to reduce childhood mortality by one third compared with the figures for 1990. The child health programmes, which include vaccination, diarrhoeal and respiratory infection programmes, have already managed to reduce the mortality from common childhood diseases significantly. WHO is primarily an organization with technical cooperative aspirations, but still needs all possible available professional and economic support, in order to reduce childhood mortality even further.

[Physicians' initiative, cooperation and attitude when working with disability pension cases]

Ten district physicians in the county of Finnmark were interviewed in order to focus on physicians' attitudes in cases ending up with a disability pension. The interviews were based on a study of the physicians' five most recent disability pension cases. The study and the interviews disclosed that physicians in Finnmark play an active part in the process leading to a disability pension. They actively encourage their patients to apply for such a pension. The physicians have a marked influence on the assessment of alternatives to a disability pension. Non-medical considerations led to many physicians feeling frustrated when preparing the expert declaration.

[Cholesterol level among school children. Cholesterol measurements in adolescents in a municipality in Finnmark and a municipality in Sogn and Fjordane]

This article reports a survey conducted to measured serum cholesterol in pupils aged 13-16 years in a municipality in the county of Finnmark and in a municipality in the county of Sogn og Fjordane. Cholesterol levels were analysed and information was collected by questionnaire on eating habits, smoking habits and occurrence of cardiovascular disease in the family. We did not find any differences between the two communities in respect of cholesterol level, nor any relationship between eating habits and cholesterol level. Pupils with parents and/or grandparents with cardiovascular disease had a significantly higher cholesterol level than pupils with no such disease in their family.