TO THE EDITOR Prurigo nodularis (PN) is a chronic dermatosis characterized by intensely pruritic, symmetrically distributed hyperkeratotic nodules. Although the cause of the disease is unknown, PN often develops in the context of systemic, dermatologic, and neuropsychiatric conditions (Boozalis et al., 2018;Iking et al., 2013;Winhoven and Gawkrodger, 2007). Despite this, limited data are available on the epidemiology of PN and burden of associated diseases (Boozalis et al., 2018;Iking et al., 2013). Here we estimate the prevalence of PN and the burden of associated conditions in a real-world, US population using a national claims database.Institutional review board approval was granted by the Johns Hopkins University School of Medicine. Data from the IBM MarketScan Commercial Claims and Encounters Database (IBM Watson Health) between October 2015 and December 2016 were analyzed, using standard codes based on the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). Adults with PN were defined as patients aged 18 to 64 years with 2 medical claims for PN (ICD-10-CM: L28.1) and continuous enrollment for 3 months before and after the index diagnosis (Supplementary Material). Three cohorts without PN were respectively identified for comparison: age-and sex-matched controls from the general population, patients with atopic dermatitis (AD), and patients with psoriasis. Patient demographics were recorded on the index date, with comorbidities selected based on associations with PN in previous literature and clinical experience
Objectives:The supermarket industry now services many customers through online food shopping over the Internet. The Internet shopping process offers a novel opportunity for the modification of dietary patterns. The aim of this study was to evaluate the effects on consumers' purchases of saturated fat of a fully automated computerised system that provided real-time advice tailored to the consumers' specific purchases recommending foods lower in saturated fat.Design:This study was a blinded, randomised controlled trial.Setting:The study was conducted in Sydney, New South Wales, Australia.Participants:The participants were consumers using a commercial online Internet shopping site between February and June 2004.Interventions:Individuals assigned to intervention received fully automated advice that recommended specific switches from selected products higher in saturated fat to alternate similar products lower in saturated fat. Participants assigned to control received general non-specific advice about how to eat a diet lower in saturated fat.Outcome Measures:The outcome measure was the difference in saturated fat (grams per 100 g of food) in shopping baskets between the intervention and control groups.Results:There were 497 randomised participants, mean age 40 y, each shopping for an average of about three people. The amount of saturated fat in the foods purchased by the intervention group was 0.66% lower (95% confidence interval 0.48–0.84, p < 0.001) than in the control group. The effects of the intervention were sustained over consecutive shopping episodes, and there was no difference in the average cost of the food bought by each group.Conclusions:Fully automated, purchase-specific dietary advice offered to customers during Internet shopping can bring about changes in food purchasing habits that are likely to have significant public health implications. Because implementation is simple to initiate and maintain, this strategy would likely be highly cost-effective.
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