BACKGROUND

Therapeutic inertia (TI) is the inability of physicians to initiate a more aggressive treatment in patients who need them. It is more common among patients with chronic disease and may be secondary to physician-related factors, patient-related factors, or healthcare system-related factors.

OBJECTIVES

This study aims to explore the evidence behind TI in the management of moderate to severe psoriasis and to determine the factors that contribute to it.

METHODS

An extensive literature search was conducted systematically in Cochrane Library, Medline, Epistemonikos, Google Scholar, and HERDIN from their inception up to June 2023. Cross-sectional studies that looked into TI in moderate to severe psoriasis and discussed the factors that lead to it were included. The review was limited to peer-reviewed journals written in English. Outcomes were presented as counts and percentages, and notable findings from each study were highlighted.

RESULTS

3256 records were identified but only 4 studies met the inclusion criteria and were included in the analysis. Based on the available evidence, the prevalence of TI in psoriasis varies from 25.4-35.6%. The occurrence of TI in psoriasis is largely caused by physician-related factors (reluctance to escalate treatment due to lack of knowledge and experience) and patient-related factors (satisfaction with current treatment or refusal to change treatment due to psychological barriers). Healthcare system-related factors were not directly explored.

CONCLUSION

The limited data on TI in the management of moderate to severe psoriasis presents opportunities to further explore its prevalence, the factors contributing to it, and its effect on treatment outcomes.

Human ; Psoriasis

Background. Prolonged sun exposure without adequate sun protection places outdoor workers such as traffic enforcers at risk for skin cancer. Data on knowledge, attitude, and practices amongst traffic enforcers are currently unavailable, hence the need for research on this matter.

Objectives. 1) To evaluate the knowledge, attitude, and practices of traffic enforcers on sun exposure and sun protection, 2) To identify any association with sociodemographic characteristics, and 3) To determine whether knowledge and attitude are correlated with sun-protective practices.

Method. An analytical cross-sectional study was conducted from January to February 2019 among traffic enforcers in Pasig City, Philippines thru a self-administered questionnaire. Descriptive statistics were used to summarize the sociodemographic profile of the respondents while the Fisher's exact/Chi-square test was used to determine the association between sociodemographic variables and adequacy of knowledge, attitude, and practices. Pearson's rho was used to determine the degree of association between knowledge, attitude, and practices.

Results. A total of 178 traffic enforcers with a 100% response rate participated in the study. 94.4% had adequate knowledge and 93.8% had a desirable attitude as opposed to 46.1% who had adequate sun-protective practices. Adequate knowledge was found to be significant when obtained from television (51.19% at p=0.018), with the respondents being least knowledgeable about proper sunscreen use. Only a few had the desired positive attitude that sunscreen is not an added expense at 39.89%. The most common methods of sun protection were the wearing of sunglasses (82.02%), long-sleeved clothing (68.54%), and the wearing of a wide-brimmed hat (65.17%). Reapplication of sunscreen was the least common at 32.02%. Those with an adequate sun-protective practice obtained their knowledge from social media (48.78% at p=0.003). Adequacy of knowledge when compared to actual practice noted that there were more respondents with poor knowledge translating to poor practice (9.38% at p=0.019). There was insufficient evidence to state associations between the sociodemographic profile and knowledge, attitude, or practice. Correlations between knowledge, attitude, and practices on sun exposure and sun-protective practices were found to be weak.

Conclusion. Most of the traffic enforcers who partici pated in this study had adequate knowledge and a desirable attitude on sun exposure and sun protection but had inadequate sun-protective practices, emphasizing the need to investigate other factors that hinder translation of adequate knowledge and attitude to adequate practice. Occupational health policies need to be implemented to reduce the harmful effects of UV radiation in high-risk populations such as traffic enforcers.

Health Knowledge, Attitudes, Practice ; Cross-Sectional Studies ; Sunlight