Atopic dermatitis (AD) is one of the most common chronic dermatological diseases. It has affected up to a fifth of schoolchildren and their caregivers. It will alter not only children’s physical health, but also worsen the quality of life among children and their family. This global public health problem also increased the financial and social burden to healthcare system in the past decades. Educational intervention has been proved to be an adjunct to current treatment to restore the altered quality of life and skin condition effectively. It could be simply carried out by trained nurses in the routine practice to educate patients about proper AD management. However, such intervention is seldom mentioned in the local setting. Therefore, it is essential to establish an effective evidence-based guideline of nursing consultation in order to enhance patients’ clinical outcomes. The objectives of this study are to search and synthesize current literatures systematically in educational interventions for AD children for reducing disease severity and improving quality of life, to assess the implementation potential of identified educational interventions, to develop an evidence-based guideline of nursing consultation for providing better skin care to the AD children and to develop the implementation and evaluation plan the proposed intervention. Nursing consultation session for AD children is proposed in this study. The target population and setting are AD children aged from 4-16 years attending to one of the local public dermatological outpatient clinics. Evidence and relevant data are yielded from eight high-quality studies. The potential of implementing the proposed intervention is assessed based on the transferability of the findings, feasibility and the cost-benefit ratio. An evidence-based guideline is eventually developed with the best evidence-based findings. At last, an implementation plan and evaluation plan for the proposed guideline are well designed. This evidence-based guideline is designed to improve the quality of life and reduce the severity of skin condition of AD children. It is recommended to establish to all dermatological outpatient clinics locally. / published_or_final_version / Nursing Studies / Master / Master of Nursing

In general, AD is diagnosed based on Hanifin and Rajka's diagnostic criteria or the UK working diagnostic criteria. The atopic status of study participants was evaluated clinically by (1) the presence of atopic symptoms including allergie rhinitis, asthma or hyperactive airway disease in patients, parents, and/or siblings, (2) measuring the concentrations of total and allergen-specific IgE in their peripheral blood, and/or (3) positive skin prick tests to common aeroallergens or food allergens. The severity of AD was assessed either clinically by validated disease scores, objective serum parameters such as serum chemokine levels, or physiological parameters such as nocturnal wrist movements. Quality of life (QoL) is assessed with the Cantonese version of the Children's Dermatology Life Quality Index (CDLQI). Although not a gold standard, ail assessment tools were compared against SCORAD. / Research Hypotheses or aims: (1) To investigate if AD severity as determined by a 12-month-severity score correlates with a validated acute severity score. The research aims to establish a chronic severity scores for local use in AD research. (2) To explore if correlations exist between objective and subjective symptoms. (3) To evaluate if quality of life (QoL) correlates with disease severity. (4) To assess if age and gender may affect quality of life. (5) To explore if serum markers (CTACK, IL-18, BDNF, and substance P.) correlate with disease severity or quality of life score. (6) To evaluate if urine LTE4 as a non-serum marker correlates with disease severity. (7) To evaluate if nocturnal wrist movements correlate with various clinical and laboratory markers. (8) To evaluate if skin hydration (SH) and transepidermal water loss (TEWL) correlate with severity and QoL. (9) In a final chapter, we give a number of clinical studies to illustrate the application of these methods in clinical research. / The objectives of the MD thesis are to explore various clinical scores, quality of life evaluation, laboratory tests, and mechano-physiological parameters as assessment tools for the evaluation of AD. The research hypotheses are that many aspects of the disease can be objectively measured by these new scores and markers. The application of some of these assessment tools in clinical trials will be described. In all of the studies reported, I am the principal investigator and the first author of the publications in indexed medical journals. / Kam Lun Ellis Hon. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3419. / Thesis (M.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 192-213). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

No description available.

No description available.

No description available.

Faculty of Health Sciences, WITS University, as partial fulfillment for the requirements of the degree of Master of Medicine in Dermatology Johannesburg 2017 / Introduction: Atopic Dermatitis (AD) is a chronic relapsing inflammatory skin condition affecting 5-20% of children under 11 years of age, characterised by intense pruritus, redness and discomfort. Research suggests that AD has been shown in quality of life assessments to be rated among the worst in term of its effect on sleep. There is no research on the effects of sleep loss on the natural history and time course of skin disorders either, especially in South Africa. Aims: The objectives of this study were: 1. to describe the various sleep disturbances associated with AD in children up to and including 12 years of age and 2. to compare the characteristics of children with sleep problems to those without sleep problems in AD Patients and Methods: This was a prospective observational / descriptive hospital based study conducted at the paediatric dermatology outpatient department at Chris Hani Baragwanath Academic Hospital (CHBAH). Questionnaire technique was used consisting of the children’s sleep habits questionnaire (CSHQ), a useful parent-reported instrument validated to identify both behaviourally based and medically based sleep problems in 4-12 years old school age children. Results: The prevalence of sleep problems in paediatric patients with AD was found to be 61.3%. There was no significant difference between males and females. Snoring as well as apnoea and snorting were significantly different in the rhinitis versus non-rhinitis group. The overall sleep disturbance rate was significantly different in those with rhinitis versus those without. Conclusions: While Atopic Dermatitis is often regarded by health professionals as a minor problem, in this study, 61.3% of children with AD have disturbed sleep. / MT2017

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Introduction. The atopic diseases of asthma, eczema and hayfever are immunologically mediated diseases initiated and perpetuated by T-helper (Th) cells of the Th2 phenotype, in affluent countries the prevalence of atopic diseases has increased dramatically in the last 40 years. This increase has been attributed to declining dietary intake of naturally occurring antioxidants. Epidemiological data and in vitro studies demonstrating that antioxidant deficiency is associated with Th2 differentiation support this 'antioxidant' hypothesis. The 'hygiene' hypothesis attributes the recent increase in atopic disease to declining childhood infections. This proposal originated from the observation of an inverse association between atopic disease and birth order. There is increasing interest that in utero influences play a critical role in determining the development of childhood atopic disease. There are reports that Th-cells from genetically susceptible neonates and neonates who subsequently develop atopic disease exhibit altered in vitro proliferative and cytokine responses. A proposed in utero influence is the sensitisation of fetal Th- cells by allergens and this concept is supported by indirect evidence. This thesis describes a prospective study designed to test the hypothesis that maternal allergen exposure and dietary antioxidant intake during pregnancy influence fetal Th-cell differentiation and the subsequent development of childhood atopic disease. Methods. Advantage was taken of a prospective cohort study of 2,000 pregnant women. Cord blood samples were obtained from a random sample of the neonates at birth. Cord blood mononuclear cells (CBMC) were stimulated with mitogen, control antigens and allergens. CBMC proliferative responses were quantified and CBMC interleukin-4 (IL-4) and interferon-y (IFN-y) secretion was measured by the celELISA method. These responses were related to antenatal data collected prospectively relating to the pregnancy. In a small number of samples the CD45 isoform of the responding CBMC was determined to investigate whether in utero allergen sensitisation of fetal Th-cells occurs. CBMC responses were also related to respiratory symptoms and atopic disease during the first year of infant life. Results. CBMC responses from 223 cord blood samples were characterised. CBMC culture conditions were optimised and the celELISA successfully detected secreted IFN-y and IL-4. CBMC proliferative responses were detected in 27-91% of cord blood samples, IL-4 responses in 18-31% and IFN-y responses in 19-88%. CD45 isoform analysis indicated that in utero sensitisation of timothy grass specific Th-cells occurs in 38% of pregnancies. CBMC proliferative responses were positively associated with a family history of atopic disease and maternal smoking. CBMC proliferative responses were negatively associated with birth order and maternal dietary vitamin E intake during pregnancy. CBMC IFN-gamma and IL-4 cytokine responses were positively associated with each other and a family history of atopic disease. CBMC IFN-gamma responses were negatively associated with birth order. Wheezing illness in the first year tended to be associated with increased CBMC proliferative responses at birth. Conclusions. Previously identified risk factors for atopic disease, which have been considered to be manifestations of post-natal influences, exert significant antenatal influences. The accepted adverse effects of maternal smoking on children's respiratory health may be a consequence of in utero influences. This study demonstrates a major in utero component to the association between birth order and atopy, contradicting the widely held assumption that it is a consequence of the protective effect of childhood infections. The maternal influence of dietary vitamin E intake raises the possibility of preventing childhood allergy by modifying the maternal diet during pregnancy. This study also provides the most direct evidence to date of the in utero sensitisation of Th-cells by allergens.

The purpose of the study was to test the hypothesis that dogs sensitized to soy antigen would produce significantly greater amounts of antigen specific IgE antibody compared to a control population before and after challenges with soy, hydrolyzed soy, and non-soy diets. Further, we sought to evaluate important allergenic components of soy using Western blot analysis. Lastly, absorption and mucosal function testing using inert sugars were evaluated for our sensitized and non-sensitized controls. Eight dogs (6 female, 2 male) were sensitized to whole soy using an established protocol. Seven dogs (3 female, 4 male) roughly age matched were used as controls. The dogs were randomly split into three groups. All dogs were fed an elimination diet of egg and Brewer's rice for six weeks. Samples were collected and each group was fed a diet of soy and rice flour, hydrolyzed soy and rice flour, or corn and rice flour for three weeks. Samples were collected and each group was fed the elimination diet followed by challenge with each of the diets. Serum was collected and stored for allergen specific IgE semi-quantitation and Western blot analysis using whole soy fractionated into globulin and whey components. A solution of monosaccharide and disaccharide sugars was administered in a volume determined by weight. Six hours after administration the dogs were catheterized and the entire urine volume was collected for measurement of sugar recovery by high pressure chromatography, followed by pulsed amphometric detection. There was a statistically significant difference in serum IgE between sensitized and control dogs after the elimination diet, and also for each of the challenged diets. There were differences detected by Western blot analysis for allergens within the soy globulin and whey fractions for sensitized dogs compared to control dogs. There were no significant differences between sensitized and control dogs for sugar recovery for any of the diets. We conclude that although there were significant differences in measurable IgE between sensitized and control dogs, we were unable to differentiate these groups using gastrointestinal mucosal permeability and function testing.