S. Esmann - Academia.edu (original) (raw)

Papers by S. Esmann

Dermatology, 2014

Health-related quality of life (HRQoL) instruments are used increasingly. In order to assign clin... more Health-related quality of life (HRQoL) instruments are used increasingly. In order to assign clinical meaning to HRQoL scores, the interpretation of instruments is essential but lagging in dermatology. To establish a clinical interpretation of the Skin Cancer Quality of Life questionnaire (SCQoL), a newly validated HRQoL instrument for patients with non-melanoma skin cancer (NMSC), using an anchor-based method, and to test the responsiveness. Receiver-operating characteristic analysis was used to propose clinically meaningful cut-off scores for SCQoL including 101 patients with NMSC. The following bands were established: score 0-3 corresponds to no impairment, 4-6 corresponds to mild impairment, 7-10 to moderate impairment and 11-27 to severe impairment of HRQoL. Testing the responsiveness shows a moderate effect size and significantly lower scores only for the domain emotion and the global item. Using proposed clinical cut-off scores for SCQoL may help clinicians in their decision-making, help monitoring clinical improvement and classify patients just as e.g. the Dermatology Life Quality Index can.

The Journal of Dermatology, 2012

Journal of the European Academy of Dermatology and Venereology, 2006

The primary objective was to examine the influence of parents' gender on the assessment o... more The primary objective was to examine the influence of parents' gender on the assessment of quality of life among infants with atopic dermatitis. The secondary objective was to examine the psychological factors affecting the assessment. Questionnaires were completed by 28 couples, as a basis for gender comparison. Data were gathered on disease severity, confidence of treatment, Major Depression Index (MDI), Spielberger Trait Anxiety Inventory (STAI) and the Infants' Dermatitis Quality of Life Index (IDQOL). The mothers' scores were higher than those of fathers for all assessments, although differences were not statistically significant. Significant correlations were found between MDI and severity assessment for mothers only and between MDI and STAI for both genders. Multiple linear regression analysis suggested gender differences in the proposed model, where only depression was appearing statistically significant (P = 0.029). Our data presented suggest that no significant gender-dependent differences occur in parents' overall severity assessment of the eczema in their children, but the influence of the different factors studied is not equal in the two sexes. Future instruments aimed at surrogate assessment of disease severity in children by their parents should take this into account and provide explicit testing of possible gender differences.

Journal of the European Academy of Dermatology and Venereology, 2010

Dermatologic Surgery, 2013

Disease-specific quality of life (QoL) questionnaires are increasingly used to provide patient-re... more Disease-specific quality of life (QoL) questionnaires are increasingly used to provide patient-reported out-come measures in both malignant and non-malignant disease. To create, validate and test the psychometrics of the Skin Cancer Quality of Life (SCQoL), which was designed to measure health-related QoL in patients with non-melanoma skin cancer affecting any area and undergoing any therapy. The SCQoL was developed in a stepwise approach. Three pilot studies (testing content and face validity) and psychometric testing (scale structure, reliability, domains and known-groups validity, concurrent and convergent validity) were conducted. Rasch analyses were performed on the final questionnaire. The initial 10-item questionnaire was reduced to 9 items following interviews and inter-item correlations. The nine item scale was confirmed by Item Response Theory (IRT) and internal consistency. Differential Item Functioning (DIF) was found for a single item, but the effect was small. The final 9-item SCQoL is unidimensional and consists of 3 domains covering function, emotions and control. Furthermore there is one single global item. The total score range from 0 to 27. Higher score denote a greater impairment of the QoL.

British Journal of Dermatology, 2010

Acta Dermato Venereologica, 2011

Hidradenitis suppurativa influences patients' lives in many ways. It is therefore necessa... more Hidradenitis suppurativa influences patients' lives in many ways. It is therefore necessary to focus on the effects of the disease on daily life in order better to define patient-related outcomes in hidradenitis suppurativa studies. Interviews were conducted with 12 patients with hidradenitis suppurativa. Initial single interviews were followed by semi-structured and structured qualitative focus group interviews in order to improve the richness of the data and obtain in-depth understanding of the impact of the topics. Important topics were found to relate to aspects of interpersonal contact, especially in relation to smell and appearance, various emotional reactions, and feelings of lack of control. It was found that hidradenitis suppurativa has a great emotional impact on patients and promotes isolation due to fear of stigmatization. Shame and irritation are frequent and relate to smell, scars, itching and pain. Quality of life is adversely affected and professional support is needed.

British Journal of Dermatology, 2013

Limited knowledge is available regarding quality of life in patients with actinic keratosis (AK).... more Limited knowledge is available regarding quality of life in patients with actinic keratosis (AK). To develop and validate a disease-specific questionnaire - the Actinic Keratosis Quality of Life questionnaire (AKQoL) - to assess the quality of life of patients with AK. Based on an extensive literature search and patient interviews, the AKQoL was developed in a stepwise approach. An initial mega-questionnaire was composed and subsequently shortened based on statistical differences between patients and controls. A test-retest was done to establish the reliability and to refine the items further. Rasch analyses were performed on the final questionnaire. Initially, 175 items were tested in a mega-questionnaire. The questionnaires were sent out twice and statistical analyses were made, reducing the number of questions to 18 and 10, respectively. Subsequent inter-item correlations showed that one item had only a weak correlation to the rest of the scale. This was confirmed by the Rasch model and by internal consistency as evaluated by Cronbach's coefficient alpha. Only one item was found to provide a small sex difference. A Bland-Altman plot showed excellent reliability. Items are scored on a standard 4-point Likert scale and summarized in a total score of maximum 27 points. A higher score indicates greater quality of life impairment. A nine-item questionnaire for patients with AK was developed. The AKQoL has three domains covering emotions, function and control and one single global item. The questionnaire's scale structure, the content and face validity, and the reliability have been established.

Dermatology, 2014

Health-related quality of life (HRQoL) instruments are used increasingly. In order to assign clin... more Health-related quality of life (HRQoL) instruments are used increasingly. In order to assign clinical meaning to HRQoL scores, the interpretation of instruments is essential but lagging in dermatology. To establish a clinical interpretation of the Skin Cancer Quality of Life questionnaire (SCQoL), a newly validated HRQoL instrument for patients with non-melanoma skin cancer (NMSC), using an anchor-based method, and to test the responsiveness. Receiver-operating characteristic analysis was used to propose clinically meaningful cut-off scores for SCQoL including 101 patients with NMSC. The following bands were established: score 0-3 corresponds to no impairment, 4-6 corresponds to mild impairment, 7-10 to moderate impairment and 11-27 to severe impairment of HRQoL. Testing the responsiveness shows a moderate effect size and significantly lower scores only for the domain emotion and the global item. Using proposed clinical cut-off scores for SCQoL may help clinicians in their decision-making, help monitoring clinical improvement and classify patients just as e.g. the Dermatology Life Quality Index can.

The Journal of Dermatology, 2012

Journal of the European Academy of Dermatology and Venereology, 2006

The primary objective was to examine the influence of parents' gender on the assessment o... more The primary objective was to examine the influence of parents' gender on the assessment of quality of life among infants with atopic dermatitis. The secondary objective was to examine the psychological factors affecting the assessment. Questionnaires were completed by 28 couples, as a basis for gender comparison. Data were gathered on disease severity, confidence of treatment, Major Depression Index (MDI), Spielberger Trait Anxiety Inventory (STAI) and the Infants' Dermatitis Quality of Life Index (IDQOL). The mothers' scores were higher than those of fathers for all assessments, although differences were not statistically significant. Significant correlations were found between MDI and severity assessment for mothers only and between MDI and STAI for both genders. Multiple linear regression analysis suggested gender differences in the proposed model, where only depression was appearing statistically significant (P = 0.029). Our data presented suggest that no significant gender-dependent differences occur in parents' overall severity assessment of the eczema in their children, but the influence of the different factors studied is not equal in the two sexes. Future instruments aimed at surrogate assessment of disease severity in children by their parents should take this into account and provide explicit testing of possible gender differences.

Journal of the European Academy of Dermatology and Venereology, 2010

Dermatologic Surgery, 2013

Disease-specific quality of life (QoL) questionnaires are increasingly used to provide patient-re... more Disease-specific quality of life (QoL) questionnaires are increasingly used to provide patient-reported out-come measures in both malignant and non-malignant disease. To create, validate and test the psychometrics of the Skin Cancer Quality of Life (SCQoL), which was designed to measure health-related QoL in patients with non-melanoma skin cancer affecting any area and undergoing any therapy. The SCQoL was developed in a stepwise approach. Three pilot studies (testing content and face validity) and psychometric testing (scale structure, reliability, domains and known-groups validity, concurrent and convergent validity) were conducted. Rasch analyses were performed on the final questionnaire. The initial 10-item questionnaire was reduced to 9 items following interviews and inter-item correlations. The nine item scale was confirmed by Item Response Theory (IRT) and internal consistency. Differential Item Functioning (DIF) was found for a single item, but the effect was small. The final 9-item SCQoL is unidimensional and consists of 3 domains covering function, emotions and control. Furthermore there is one single global item. The total score range from 0 to 27. Higher score denote a greater impairment of the QoL.

British Journal of Dermatology, 2010

Acta Dermato Venereologica, 2011

Hidradenitis suppurativa influences patients' lives in many ways. It is therefore necessa... more Hidradenitis suppurativa influences patients' lives in many ways. It is therefore necessary to focus on the effects of the disease on daily life in order better to define patient-related outcomes in hidradenitis suppurativa studies. Interviews were conducted with 12 patients with hidradenitis suppurativa. Initial single interviews were followed by semi-structured and structured qualitative focus group interviews in order to improve the richness of the data and obtain in-depth understanding of the impact of the topics. Important topics were found to relate to aspects of interpersonal contact, especially in relation to smell and appearance, various emotional reactions, and feelings of lack of control. It was found that hidradenitis suppurativa has a great emotional impact on patients and promotes isolation due to fear of stigmatization. Shame and irritation are frequent and relate to smell, scars, itching and pain. Quality of life is adversely affected and professional support is needed.

British Journal of Dermatology, 2013

Limited knowledge is available regarding quality of life in patients with actinic keratosis (AK).... more Limited knowledge is available regarding quality of life in patients with actinic keratosis (AK). To develop and validate a disease-specific questionnaire - the Actinic Keratosis Quality of Life questionnaire (AKQoL) - to assess the quality of life of patients with AK. Based on an extensive literature search and patient interviews, the AKQoL was developed in a stepwise approach. An initial mega-questionnaire was composed and subsequently shortened based on statistical differences between patients and controls. A test-retest was done to establish the reliability and to refine the items further. Rasch analyses were performed on the final questionnaire. Initially, 175 items were tested in a mega-questionnaire. The questionnaires were sent out twice and statistical analyses were made, reducing the number of questions to 18 and 10, respectively. Subsequent inter-item correlations showed that one item had only a weak correlation to the rest of the scale. This was confirmed by the Rasch model and by internal consistency as evaluated by Cronbach's coefficient alpha. Only one item was found to provide a small sex difference. A Bland-Altman plot showed excellent reliability. Items are scored on a standard 4-point Likert scale and summarized in a total score of maximum 27 points. A higher score indicates greater quality of life impairment. A nine-item questionnaire for patients with AK was developed. The AKQoL has three domains covering emotions, function and control and one single global item. The questionnaire's scale structure, the content and face validity, and the reliability have been established.