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Journal of the American Academy of Dermatology
Volume 61, n° 5
pages 806-812 (novembre 2009)
Doi : 10.1016/j.jaad.2009.03.035
accepted : 25 Mars 2009
Original Articles

Prevalence of adult atopic dermatitis among nursing staff in a Taiwanese medical center: A pilot study on validation of diagnostic questionnaires
 

Cheng-Che E. Lan, MD, PhD a, c, e, Chien-Hung Lee, PhD h, Yi-Wei Lu, MS f, Chi-Ling Lin, MD a, c, e, Hsiu-Hui Chiu, MD a, c, e, j, Tsai-Ching Chou, MD a, c, e, Stephen Chu-Shung Hu, MD a, c, e, Ching-Ying Wu, MD a, c, e, Yi-Ying Kim, MD a, c, e, Hui-Ju Yang, MD a, c, e, Yin-Chun Chen, MD a, c, e, Ching-Shuang Wu, PhD g, Hui-Yu Hsu, MS b, Sheng-Lan Shieh, BS b, Hsin-Su Yu, MD, PhD a, c, e, Ying-Chin Ko, MD, PhD d, i, Gwo-Shing Chen, MD, PhD a, c, e,
a Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 
b Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 
c Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 
d Department of Public Health, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 
e Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 
f Graduate Institute of Healthcare Administration, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan 
g Department of Medical Laboratory Science and Biotechnology, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan 
h Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan 
i Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Zhunan, Taiwan 
j Department of Dermatology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan 

Reprint requests: Gwo-Shing Chen, MD, PhD, Department of Dermatology, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd, Kaohsiung, Taiwan.
Abstract
Background

Atopic dermatitis (AD) is a chronic, relapsing dermatosis. Previous studies have focused mostly on pediatric patients, and investigations emphasizing adult AD have been limited.

Objective

We set out to determine the 1-year prevalence and evaluate the validity of the International Study of Asthma and Allergies in Childhood (ISAAC) and United Kingdom Working Party (UKWP) AD questionnaires of adult AD in Taiwan.

Methods

We conducted a cross-sectional study among nursing staff at a university hospital. The 1-year prevalence of AD was assessed by ISAAC and UKWP questionnaires. Subsequently, the dermatologists’ diagnosis based on Hanifin and Rajka criteria was used as a reference for validation.

Results

The overall response rate was 92.9%, equivalent to 1131 complete questionnaires. Ninety adult patients with AD (8%) were identified by dermatologists’ diagnosis whereas ISAAC identified 107 (9.5%); sensitivity and specificity were 36.7% and 92.9%, respectively. UKWP identified 42 (3.7%) patients with AD; sensitivity and specificity were 42.2% and 99.6%, respectively. Using the receiver operating characteristic curve analysis, the UKWP criteria performed significantly better than its ISAAC counterpart. Further analysis indicated that modification of these criteria resulted in significant improvement in their diagnostic efficacy. More specifically, modified ISAAC showed 90.0% and 55.2% sensitivity and specificity, respectively, whereas modified UKWP demonstrated 82.2% and 94.2% sensitivity and specificity, respectively.

Limitation

Most of the study subjects were female with a high educational background.

Conclusion

Currently available questionnaire instruments do not perform well in the identification of adult patients with AD. Modification of the original questionnaires may allow for future large-scale epidemiologic studies.

The full text of this article is available in PDF format.

Key words : adult atopic dermatitis, diagnostic criteria, prevalence

Abbreviations used : AD, AUC, ISAAC, NPV, PPV, ROC, RV, UKWP



 Drs. Lan and Lee contributed equally to this work
 Supported by National Health Research Institute, Taiwan, NHRI-CN-PD9611P.
 Conflicts of interest: None declared.



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