Investigation of Disease cognition and Skin Care Practices Among Caregivers of Children with Moderate-to-Severe Atopic Dermatitis: A Cross-sectional Study

Investigation of Disease cognition and Skin Care Practices Among Caregivers of Children with Moderate-to-Severe Atopic Dermatitis: A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigation of Disease cognition and Skin Care Practices Among Caregivers of Children with Moderate-to-Severe Atopic Dermatitis: A Cross-sectional Study Xihuan Xu, Lin Zhang, Chenchen Yang, Xia Li, Ping Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8114672/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Atopic dermatitis (AD) is a chronic inflammatory skin disorder requiring continuous management and caregiver participation. This study aimed to assess disease cognition and skin care practices among caregivers of children with moderate-to-severe AD. Methods A cross-sectional questionnaire survey was administered to caregivers of 215 children with moderate-to-severe AD treated at the Department of Dermatology, Xuzhou Children’s Hospital. Univariate and multivariate logistic regression analyses were performed to identify factors associated with cognition levels. Results The overall cognition rate among caregivers was 57.7%. Educational attainment, occupation, residence, disease duration, and severity were significantly associated with cognition (P < 0.05). Multivariate analysis identified caregivers’ education level, occupation, disease duration, and severity as independent determinants (P < 0.05). Dermatologists (81.9%) and online media (54.4%) were the main knowledge sources. Individualized education was preferred (76.3%), whereas group lectures were least favored (32.1%). Regarding skin care habits, 41.9% of children bathed ≤ 1 time per week, 60.9% bathed for > 10 minutes, and 79.5% used topical emollients, though 69.8% applied them < 2 times daily. Only 23.7% of caregivers understood the efficacy of functional emollients. Conclusions Caregivers exhibited inadequate disease cognition and suboptimal skin care practices. Targeted health education should be strengthened to improve long-term AD management outcomes. Atopic dermatitis Children Disease cognition Influencing factors Health education Figures Figure 1 Figure 2 Figure 3 Introduction Atopic dermatitis (AD) is a chronic, recurrent inflammatory skin disorder associated with impaired epidermal barrier function. It predominantly affects children and adolescents, with approximately 60% of affected children presenting symptoms within the first year of life[ 1 ]. The prevalence of AD among Chinese children aged 1–7 years is approximately 12.94%, with about one-quarter of cases classified as moderate to severe[ 2 ]. Clinical manifestations of atopic dermatitis are diverse, being characterized primarily by dry skin and pruritic eczematous lesions, which often significantly impair children's quality of life and their physical and mental health[ 3 ]. The prolonged and complex treatment process also imposes substantial psychological stress and a heavy economic burden on families[ 4 ]. Although biologics and JAK inhibitors have demonstrated significant efficacy in treating moderate-to-severe AD, recurrent flare-ups persist in some children, underscoring the necessity of comprehensive interventions beyond pharmacotherapy. As primary implementers of disease management, caregivers' enhanced disease cognition and nursing competencies are pivotal for achieving long-term effective management of AD, stabilizing conditions, and improving outcomes[ 5 ]. Therefore, this study aimed to investigate the disease cognition and skin care behaviors of caregivers of children with moderate-to-severe atopic dermatitis, thereby providing a reference for optimizing health education strategies and enhancing disease management. Subjects and Methods Study participants A total of 215 caregivers of children with moderate-to-severe atopic dermatitis were enrolled from the Department of Dermatology, Xuzhou Children’s Hospital, between March and August 2025. The study was approved by the Ethics Committee of Xuzhou Children’s Hospital. All caregivers signed informed consent forms prior to participation. Inclusion and exclusion criteria Inclusion criteria:(1) Children aged 0–7 years diagnosed with AD according to the Hanifin and Rajka diagnostic criteria;(2) Moderate-to-severe disease severity based on the SCORAD score, with 25–50 points indicating moderate severity and 51–103 points indicating severe severity;(3) Caregivers capable of independently completing a paper-based questionnaire. Exclusion criteria (1) Caregivers with cognitive impairment or psychiatric disorders; (2) Caregivers with communication barriers or those who discontinued the questionnaire for any reason. Survey method This study developed a disease cognition questionnaire based on relevant guidelines and previous literature[ 6 , 7 , 8 ].The questionnaire was revised according to pre-survey feedback to finalize the instrument. It was administered and collected on site by trained researchers. The questionnaire comprised four sections:(1) general information: including the child’s gender, age, disease duration, and residence, as well as the caregiver’s gender, age, educational level, occupation, and annual household income. (2) skin care practices: bathing frequency and duration, and the frequency and type of moisturizer use. (3) disease knowledge: 30 questions covering the definition, etiology, triggers, diet, treatment, and daily care of atopic dermatitis. We focused on ten core assessment items, selected based on clinical experience, to evaluate key nursing and treatment factors influencing disease control. These items assessed caregivers' mastery of essential knowledge in the following domains: disease concept, etiology, triggers, feeding, bathing, moisturizing, clothing, laundry practices, topical corticosteroids, and novel therapies. (4) health education needs: including knowledge sources and preferred educational formats. Cognitive Assessment Criteria This study assessed cognition at both the group and individual levels:(1) Overall disease cognition (group level): This reflected the collective mastery of questionnaire content among all respondents. The overall cognition rate was calculated as: (Sum of correct answers per respondent) / (Total number of respondents × Total number of questions) × 100% . A single-question correct rate ≥ 60% was defined as adequate cognition, and < 60% as inadequate cognition. (2) Key cognition (individual level): This reflected caregivers’ mastery of 10 critical topics. Each correct answer was assigned 1 point, and incorrect or ‘unsure’ responses were scored 0, yielding a maximum total of 10 points. Based on the pre-survey score distribution and commonly used cutoff values for knowledge questionnaires, a total score ≥ 6 was defined as ‘adequate cognition’, while < 6 was considered ‘inadequate cognition’. Knowledge acquisition pathways and preferred health education formats Analyze the distribution of knowledge acquisition pathways across different cognitive levels among caregivers and their health education needs. Statistical Analysis Data processing and statistical analyses were conducted using SPSS Statistics version 27.0. Normally distributed quantitative data were expressed as the mean ± standard deviation( \(\:\stackrel{\text{-}}{\text{x}}\text{±}\text{s}\) ), whereas categorical variables were presented as frequencies and percentages [n (%)]. Differences in categorical variables were examined using the \(\:\text{}{\text{x}}^{\text{2}}\) test. Variables showing significant associations in the univariate analysis were subsequently entered into a multivariate logistic regression model to identify factors independently related to caregivers’ cognition levels. Statistical significance was established at a p value < 0.05. Results General Information A total of 220 questionnaires were distributed, and 215 valid responses were collected, yielding a response rate of 97.73%. Among the pediatric patients, 116 were males and 99 were females, with a mean age of 3.22 ± 2.42 years. The duration of illness was ≤ 1 year in 96 cases and > 1 year in 119 cases. SCORAD scores indicated moderate disease in 177 cases and severe disease in 38 cases. Sixty-two cases resided in rural areas and 153 in urban areas. Among caregivers, 67 were males and 148 were females, with an average age of 33.18 ± 4.96 years. Regarding educational attainment, 40 had a junior high school education or below, 69 had completed high school or vocational school, and 106 held a bachelor’s degree or higher. The occupational distribution included professionals (n = 52), clerical workers (n = 31), self-employed individuals (n = 35), farmers or laborers (n = 29), unemployed caregivers (n = 28), and others (n = 40). Annual household income ranged mainly between 50,000 and 100,000 yuan (n = 84, 39.1%). Only 27 caregivers (12.6%) had received health education prior to the survey. Overall cognition level of atopic dermatitis among caregivers Among the 30 atopic dermatitis–related questions, caregivers correctly answered 3,724 items, yielding an overall cognition rate of 57.74%, suggesting generally limited understanding. Specifically, cognition regarding the concept of AD, triggers or aggravating factors, oral antihistamines, and systemic corticosteroids was relatively adequate (correct rates > 60%). However, understanding of etiology, dietary management, topical corticosteroids, calcineurin inhibitors, and novel therapies such as biologics was limited (correct rates < 60% for each). In terms of nursing practices, the majority of caregivers focused on clothing management and moisturization but demonstrated significant gaps in their understanding of appropriate bathing frequency, functional emollient use, and proper laundry practices. Univariate analysis of factors influencing key cognition levels among caregivers Results for the ten key cognition items showed that caregivers exhibited relatively good understanding of AD concepts, triggers and aggravating factors, and clothing care, whereas the lowest cognition was observed in feeding practices (Table 1 ). Univariate analysis revealed that educational attainment, occupation, place of residence, duration of the child’s illness, and disease severity were the main factors influencing cognition levels (P < 0.05). Caregivers with higher education levels, professional or technical occupations, urban residence, longer disease duration, and more severe disease had significantly higher cognition levels (Table 2 ). Table 1 Ten key cognitive aspects assessed among caregivers Category Number of Correct Responses Cognition Rate (%) Concept 183 85.12 Etiology 33 15.35 Triggers/Aggravating Factors 132 61.40 Feeding 8 3.72 Bathing 94 43.72 Moisturizing 55 25.58 Clothing 197 91.63 Clothing washing 68 31.63 Topical corticosteroids 115 53.49 Biological agents and other novel therapies 55 25.58 Table 2 Univariate analysis of caregivers’ key cognition scores Clinical characteristics Number(%) Score \(\:{\text{x}}^{\text{2}}\) P Sex 1.862 0.172 Male 16(23.88) 3.99 ± 1.73 Female 49(33.11) 4.55 ± 1.76 Age 2.066 0.356 40years 7(35.00) 3.95 ± 1.91 Residence 4.887 0.027 Rural 12(19.35) 3.69 ± 1.73 Urban 53(34.64) 4.65 ± 1.71 Education level 15.828 < 0.001 Junior high school or below 5(12.50) 3.42 ± 1.57 High school/vocational school 15(21.74) 4.19 ± 1.62 Bachelor's degree and above 45(42.45) 4.85 ± 1.77 Occupation 13.030 0.023 Farmer/Worker 2(6.90) 3.48 ± 1.53 Professionals 21(40.38) 4.98 ± 1.60 Clerical Staff 12(38.71) 4.71 ± 1.72 Self-employed 9(25.71) 4.17 ± 1.86 Unemployed 11(39.29) 4.43 ± 1.69 Other 10(25.00) 4.10 ± 1.89 Annual household income(in RMB) 3.997 0.406 200,000 7(43.75) 4.75 ± 1.98 Duration of illness 4.039 0.044 ≤ 1year 22(23.16) 4.05 ± 1.67 > 1year 43(35.83) 4.63 ± 1.80 Disease severity 4.604 0.032 Moderate 48(27.12) 4.33 ± 1.72 Severe 17(44.74) 4.55 ± 1.97 Received health education 1.616 0.204 Yes 11(40.74) 5.44 ± 1.50 No 54(28.72) 4.22 ± 1.75 Multivariate logistic regression analysis of caregivers’ key cognition levels Variables that were statistically significant in the univariate analysis were subsequently included in a multivariate logistic regression model. The results showed that a bachelor’s degree or higher (OR = 4.23, 95% CI: 1.16–15.49, P = 0.029), being unemployed (OR = 5.97, 95% CI: 1.02–34.98, P = 0.048), disease duration > 1 year (OR = 2.15, 95% CI: 1.11–4.17, P = 0.024), and severe disease (OR = 3.03, 95% CI: 1.34–6.84, P = 0.008) were identified as independent factors associated with caregivers’ cognition levels (Fig. 1 ). Analysis of skin care practices among children with moderate-to-severe atopic dermatitis Among the surveyed children, 41.9% bathed once or less per week, 42.8% bathed two to three times per week, and 15.3% bathed four or more times per week. Bathing duration was ≤ 10 minutes in 84 cases (39.1%), 11–20 minutes in 86 cases (40.0%), and > 20 minutes in 45 cases (20.9%). The frequency of topical moisturizer application was less than twice daily in 69.8% of cases (Fig. 2 ). Regarding moisturizer types, 141 participants used ordinary moisturizers, while 51 used therapeutic (medical-grade) moisturizers. Immediate post-bathing application was reported by 180 participants (83.7%). Physician recommendation following an eczema or atopic dermatitis diagnosis was the primary source of moisturizer-use habits (79.5%) (Fig. 3 ). Caregivers’ disease cognition pathways and health education needs The primary sources of AD-related knowledge among caregivers were dermatologists (81.9%) and online media platforms (54.4%). There was no statistically significant difference in channels of knowledge acquisition among caregivers with different cognition levels (P > 0.05). Caregivers showed the greatest preference for one-on-one educational guidance from physicians (76.3%), whereas the lowest preference was for lectures or patient support group meetings (32.1%) (Fig. S1 ). Discussion Understanding the disease cognition and its influencing factors among caregivers of children with atopic dermatitis (AD) is essential for developing targeted health-education strategies. Numerous studies conducted both domestically and internationally have demonstrated that educational interventions can enhance caregivers’ disease-management capabilities, improve clinical outcomes in pediatric patients, and enhance their quality of life[ 9 , 10 ]. In this study, caregivers of children with moderate-to-severe AD demonstrated an overall disease-cognition rate of 57.7%, reflecting generally limited knowledge. Marked deficiencies were identified in understanding the etiology, feeding practices, skin care, topical corticosteroids, and novel therapies, indicating that clinical education should prioritize these domains. Scientific feeding practices form the foundation of effective disease control in pediatric AD. Previous studies have reported that the prevalence of food allergy among Chinese children aged < 2 years with moderate-to-severe atopic dermatitis was 49.7%[ 11 ]. Insufficient disease cognition among caregivers often results in unnecessary dietary restrictions, thereby increasing the risk of malnutrition. Consequently, dietary guidance should be reinforced in routine management, and food-allergen screening performed when necessary to facilitate individualized nutritional intervention. Topical corticosteroids remain the first-line therapy for pediatric AD; however, this survey revealed inadequate caregiver knowledge regarding application methods and widespread “steroid phobia.” Studies have shown that such fear of corticosteroids directly compromises treatment adherence and efficacy[ 12 ]. Educational programs should therefore emphasize the necessity, safety, and correct use of topical corticosteroids—including dosage, frequency, and duration—while promoting the concept of “proactive maintenance therapy” to alleviate anxiety and optimize disease control[ 13 ]. For moderate-to-severe cases, topical therapy alone is often insufficient. The advent of targeted biologic agents offers safer and more effective options[ 14 ]; nevertheless, only 25.6% of caregivers in this study correctly recognized novel therapies, highlighting delays in public knowledge dissemination. Clinical education should thus incorporate communication on biologic treatments, including indications, treatment duration, and expected outcomes, to strengthen caregivers’ confidence in disease management. The “Key 10 Items” represent core components of treatment principles for moderate-to-severe AD[ 15 , 16 ]. Multivariate analysis identified caregivers’ educational attainment, occupational type, disease duration, and disease severity as significant determinants of cognition level. Caregivers holding a bachelor’s degree or higher, those unemployed, those caring for children with disease duration ≥ 1 year, and those managing severe cases demonstrated significantly higher cognition levels. This finding suggests that higher educational background and greater caregiving experience enhance disease understanding and decision-making capacity. These characteristics appear to act as protective factors for caregivers’ cognitive levels. Future health-education initiatives should therefore focus on parents with lower educational attainment and those newly caring for affected children, aiming to strengthen disease cognition and adherence, thereby improving long-term management outcomes. This survey also revealed that dermatologists were the predominant source of AD-related information, and most caregivers preferred individualized instruction to group education. Clinicians should optimize educational delivery by integrating personalized counseling during outpatient visits and through online follow-ups. In China, dermatology outpatient services play an important role in patient education for atopic dermatitis. Physicians typically provide guidance through face-to-face counseling, health seminars, which have shown positive effects on treatment adherence and disease control[ 17 ]. However, the absence of a unified educational framework has led to notable disparities in educational quality among regions and institutions. Existing programs are mostly short-term and fail to address patients’ long-term and individualized management needs. Moreover, in China, patient education and long-term management of atopic dermatitis remain at an early stage. Therefore, it is essential to establish a more standardized health education system[ 18 ]. Regarding skincare practices, although 83.7% of caregivers reported using moisturizers as advised, gaps remained between knowledge and behavior. Survey results indicated that 56.3% of caregivers lacked adequate knowledge of standardized bathing practices. Nie et al. [ 19 ]reported similar findings among adult patients with atopic dermatitis and caregivers of pediatric patients, where limited bathing and skincare knowledge was associated with inappropriate caregiving behaviors. Therefore, insufficient understanding of proper bathing practices may directly contribute to improper skincare behaviors. Consequently, health-care providers require enhanced training in patient-education skills. Instruction should include detailed guidance on emollient selection (favoring functional skincare products), application frequency (≥ twice daily), and appropriate bathing practices (5–10 minutes, daily or every other day) to improve adherence[ 20 , 21 ]. In summary, caregivers of children with moderate-to-severe AD exhibited generally low levels of disease cognition, influenced by multiple demographic and clinical factors. Clinicians should implement stratified health-education programs tailored to population characteristics. Educational content and delivery should balance scientific rigor with accessibility, transitioning outpatient education from single-session interventions to continuous programs. Furthermore, establishing national standards and training frameworks for AD-related health education is essential to improve educational quality, strengthen treatment adherence, and promote long-term disease control. This single-center study, with a limited sample size, has restricted representativeness. The absence of a standardized AD-knowledge assessment tool and reliance on a self-designed questionnaire may introduce subjectivity and measurement bias. Future multicenter studies should aim to refine and validate standardized scales to establish a scientific and unified framework for evaluating caregiver knowledge of atopic dermatitis. Declarations Acknowledgements We acknowledge with appreciation the hard work and dedication of all staff members involved in the implementation and data collection of this study. Author contributions Conception and design of the research: Xihuan Xu, Ping Chen. Collection of data: Xihuan Xu, Chenchen Yang, Xia Li. Analysis and interpretation of the data: Xihuan Xu, Lin Zhang. Writing of the manuscript: Xihuan Xu, Lin Zhang. Project administration and writing review: Ping Chen. All authors read and approved the final draft. All authors have reviewed and approved the final version of the manuscript for publication. Funding None. Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethical Review and Informed Consent This study was approved by the Ethics Committee of Xuzhou Children's Hospital affiliated with Xuzhou Medical University (Approval No. 2025-05-01-H01) and was conducted in accordance with the principles of the Declaration of Helsinki. Before participation, all subjects were fully informed of the study’s purpose and procedures and provided written informed consent. Consent to publish Not applicable. Competing interests The authors declare no competing interests. References Eichenfield LF, Stripling S, Fung S et al (2022) Recent Developments and Advances in Atopic Dermatitis: A Focus on Epidemiology, Pathophysiology, and Treatment in the Pediatric Setting. Paediatr Drugs 24:293–305. https://doi.org/10.1007/s40272-022-00499-x Guo Y, Li P, Tang J et al (2016) Prevalence of atopic dermatitis in chinese children aged 1–7 ys. Sci Rep 6:29751. https://doi.org/10.1038/srep29751 Kruse LL, Mancini AJ (2024) Atopic Dermatitis in Children. Pediatr Ann 53. https://doi.org/10.3928/19382359-20240205-02 Eyerich K, Gooderham MJ, Silvestre JF et al (2024) Real-world clinical, psychosocial and economic burden of atopic dermatitis: results from a multicountry study. J Eur Acad Dermatol Venereol 38:340–353. https://doi.org/10.1111/jdv.19500 Muzzolon M, Imoto RR, Canato M et al (2021) Educational intervention and atopic dermatitis: impact on quality of life and treatment. Asia Pac Allergy 11:e21. https://doi.org/10.5415/apallergy.2021.11.e21 Reljić V, Gazibara T, Nikolić M et al (2017) Parental knowledge, attitude, and behavior toward children with atopic dermatitis. Int J Dermatol 56:314–323. https://doi.org/10.1111/ijd.13529 Immunology Group, Chinese Society of Dermatology (2023) Consensus on the whole-process management of atopic dermatitis. Chin J Dermatol 56:5–15. https://doi.org/10.35541/cjd.20220618 Immunology Group, Chinese Society of Dermatology, Atopic Dermatitis Working Group (2020) Guideline for diagnosis and treatment of atopic dermatitis in China (2020). Chin J Dermatol 53:81–88. https://doi.org/10.35541/cjd.20191000 Singleton H, Hodder A, Almilaji O et al (2024) Educational and psychological interventions for managing atopic dermatitis (eczema). Cochrane Database Syst Rev 2024:CD014932. https://doi.org/10.1002/14651858.CD014932.pub2 Andrade LF, Abdi P, Mashoudy KD et al (2024) Effectiveness of atopic dermatitis patient education programs – a systematic review and meta-analysis. Arch Dermatol Res 316:135. https://doi.org/10.1007/s00403-024-02871-y Wang H (2024) Food allergies associated with atopic dermatitis in children: scientific cognition and standardized management. 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Asian Pac J Allergy Immunol 39:145–155. https://doi.org/10.12932/AP-010221-1050 Chinese Society of Dermatology, China Dermatologist Association, Song Z et al (2023) Clinical pathway for the diagnosis and treatment of moderate to severe atopic dermatitis in China (2023): an expert consensus. Chin J Dermatol 56:1000–1007. https://doi.org/10.35541/cjd.20230247 Wilken B, Zaman M, Asai Y (2023) Patient education in atopic dermatitis: a scoping review. Allergy Asthma Clin Immunol Off J Can Soc Allergy Clin Immunol 19:89. https://doi.org/10.1186/s13223-023-00844-w Gu C, Yao X, Li W (2023) Burden of Disease; the Current Status of the Diagnosis and Management of Atopic Dermatitis in China. J Clin Med 12:5370. https://doi.org/10.3390/jcm12165370 Nie Z, Fan P, Zhou Y, Han S (2024) Knowledge, attitudes, and practices in adult patients and parents of pediatric atopic dermatitis patients: a cross-sectional study. Front Public Health 12:1460044. https://doi.org/10.3389/fpubh.2024.1460044 Wollenberg A, Barbarot S, Bieber T et al (2018) Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol 32:657–682. https://doi.org/10.1111/jdv.14891 van Halewijn KF, Lahnstein T, Bohnen AM et al (2022) Recommendations for emollients, bathing and topical corticosteroids for the treatment of atopic dermatitis: a systematic review of guidelines. Eur J Dermatol 32:113–123. https://doi.org/10.1684/ejd.2022.4197 Additional Declarations No competing interests reported. Supplementary Files FigS1.tif Fig. S1 Caregivers’ preferences for different forms of health education. Caregivers showed the greatest preference for one-on-one educational guidance from physicians (76.3%), followed by educational brochures (52.1%) and online interactions (45.6%). The lowest preference was observed for lectures or patient support group meetings (32.1%). Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 20 Jan, 2026 Editor assigned by journal 15 Nov, 2025 Submission checks completed at journal 15 Nov, 2025 First submitted to journal 14 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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10:27:32","extension":"tif","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4299860,"visible":true,"origin":"","legend":"","description":"","filename":"Fig1.tif","url":"https://assets-eu.researchsquare.com/files/rs-8114672/v1/f5a6cbfb2555caf28e9a52cd.tif"},{"id":100877037,"identity":"894df381-27d8-4afd-a440-3ceac295ca81","added_by":"auto","created_at":"2026-01-22 10:27:31","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":51978,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig2.png","url":"https://assets-eu.researchsquare.com/files/rs-8114672/v1/a608b8d3b3741785469a7cca.png"},{"id":100877043,"identity":"c56b236d-c9b7-4ef3-983d-613bc4cb15d8","added_by":"auto","created_at":"2026-01-22 10:27:31","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":87564,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig3.png","url":"https://assets-eu.researchsquare.com/files/rs-8114672/v1/fd45e9be6d7ca730e6a162cd.png"},{"id":100877047,"identity":"a828d985-cb2c-4c5a-b63f-49ac1f65e7b9","added_by":"auto","created_at":"2026-01-22 10:27:32","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":643018,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig1.png","url":"https://assets-eu.researchsquare.com/files/rs-8114672/v1/5f8c415e843b28a77613f3d9.png"},{"id":100877046,"identity":"4092e528-4ce9-4105-8cc4-5c76a737c763","added_by":"auto","created_at":"2026-01-22 10:27:32","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79040,"visible":true,"origin":"","legend":"","description":"","filename":"6c8216f35302453c8514218a55cafc541structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8114672/v1/ca10b010f9ee15c540cb5eb9.xml"},{"id":100877044,"identity":"1cae0287-4550-4efc-b7e8-32d9fdb72427","added_by":"auto","created_at":"2026-01-22 10:27:31","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":88519,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8114672/v1/b0555bd90d56a744ad3cd761.html"},{"id":100877033,"identity":"5d0eb4a7-0c1c-4644-938e-665ddbd3444e","added_by":"auto","created_at":"2026-01-22 10:27:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32849,"visible":true,"origin":"","legend":"\u003cp\u003eMultivariate logistic regression analysis of factors associated with caregivers’ cognition levels. Multivariate logistic regression was performed to identify factors associated with caregivers’ disease cognition. Higher education level (bachelor’s degree or above; OR = 4.23, 95% CI = 1.16–15.49, \u003cem\u003eP\u003c/em\u003e = 0.029), unemployment (OR = 5.97, 95% CI = 1.02–34.98, \u003cem\u003eP\u003c/em\u003e = 0.048), longer duration of illness (OR = 2.15, 95% CI = 1.11–4.17, \u003cem\u003eP\u003c/em\u003e = 0.024), and greater disease severity (OR = 3.03, 95% CI = 1.34–6.84, \u003cem\u003eP\u003c/em\u003e = 0.008) were significantly associated with better disease cognition among caregivers.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-8114672/v1/45d212ba635d3b607bbd0455.png"},{"id":100877031,"identity":"293e2ab0-dffd-40da-8dfc-8dca3b6b7a95","added_by":"auto","created_at":"2026-01-22 10:27:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":94497,"visible":true,"origin":"","legend":"\u003cp\u003eMoisturizer Application Frequency. Among the surveyed children, 11.2% had never used moisturizers, 20.0% used them once or twice per week, 11.2% three to four times per week, 24.7% once daily, 30.2% twice or more daily, and 2.8% used them occasionally.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-8114672/v1/5e77757dc413ad05ccfe19ef.png"},{"id":100877034,"identity":"965adbfe-ca21-48c4-af98-cc8b79e5a6ae","added_by":"auto","created_at":"2026-01-22 10:27:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":221775,"visible":true,"origin":"","legend":"\u003cp\u003eSources of moisturizer usage habits. Most caregivers (79.5%) obtained information from physicians after diagnosis, followed by recommendations from other caregivers (11.6%), online health education resources (16.8%), childcare specialists (5.8%), pediatric health guidance clinics (4.7%), and other sources (8.4%).\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-8114672/v1/1a68c0c6e6c6455f1fbb2123.png"},{"id":101298985,"identity":"f1c6bebe-a7be-4f6b-9aa2-ad78a3036650","added_by":"auto","created_at":"2026-01-28 09:38:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1165455,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8114672/v1/365bbdba-c6a9-4d57-b3f9-4f9bb62dfba6.pdf"},{"id":100877038,"identity":"7e4c811a-9343-4085-bd44-0b8099f9ca98","added_by":"auto","created_at":"2026-01-22 10:27:31","extension":"tif","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":268380,"visible":true,"origin":"","legend":"\u003cp\u003eFig. S1 Caregivers’ preferences for different forms of health education. Caregivers showed the greatest preference for one-on-one educational guidance from physicians (76.3%), followed by educational brochures (52.1%) and online interactions (45.6%). The lowest preference was observed for lectures or patient support group meetings (32.1%).\u003c/p\u003e","description":"","filename":"FigS1.tif","url":"https://assets-eu.researchsquare.com/files/rs-8114672/v1/b336fb1f7879a1b7a64ddb97.tif"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigation of Disease cognition and Skin Care Practices Among Caregivers of Children with Moderate-to-Severe Atopic Dermatitis: A Cross-sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAtopic dermatitis (AD) is a chronic, recurrent inflammatory skin disorder associated with impaired epidermal barrier function. It predominantly affects children and adolescents, with approximately 60% of affected children presenting symptoms within the first year of life[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The prevalence of AD among Chinese children aged 1\u0026ndash;7 years is approximately 12.94%, with about one-quarter of cases classified as moderate to severe[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Clinical manifestations of atopic dermatitis are diverse, being characterized primarily by dry skin and pruritic eczematous lesions, which often significantly impair children's quality of life and their physical and mental health[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The prolonged and complex treatment process also imposes substantial psychological stress and a heavy economic burden on families[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Although biologics and JAK inhibitors have demonstrated significant efficacy in treating moderate-to-severe AD, recurrent flare-ups persist in some children, underscoring the necessity of comprehensive interventions beyond pharmacotherapy. As primary implementers of disease management, caregivers' enhanced disease cognition and nursing competencies are pivotal for achieving long-term effective management of AD, stabilizing conditions, and improving outcomes[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, this study aimed to investigate the disease cognition and skin care behaviors of caregivers of children with moderate-to-severe atopic dermatitis, thereby providing a reference for optimizing health education strategies and enhancing disease management.\u003c/p\u003e"},{"header":"Subjects and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy participants\u003c/h2\u003e \u003cp\u003eA total of 215 caregivers of children with moderate-to-severe atopic dermatitis were enrolled from the Department of Dermatology, Xuzhou Children\u0026rsquo;s Hospital, between March and August 2025. The study was approved by the Ethics Committee of Xuzhou Children\u0026rsquo;s Hospital. All caregivers signed informed consent forms prior to participation.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eInclusion criteria:(1) Children aged 0\u0026ndash;7 years diagnosed with AD according to the Hanifin and Rajka diagnostic criteria;(2) Moderate-to-severe disease severity based on the SCORAD score, with 25\u0026ndash;50 points indicating moderate severity and 51\u0026ndash;103 points indicating severe severity;(3) Caregivers capable of independently completing a paper-based questionnaire.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion criteria\u003c/strong\u003e \u003cp\u003e(1) Caregivers with cognitive impairment or psychiatric disorders;\u003c/p\u003e \u003c/p\u003e \u003cp\u003e(2) Caregivers with communication barriers or those who discontinued the questionnaire for any reason.\u003c/p\u003e\n\u003ch3\u003eSurvey method\u003c/h3\u003e\n\u003cp\u003eThis study developed a disease cognition questionnaire based on relevant guidelines and previous literature[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].The questionnaire was revised according to pre-survey feedback to finalize the instrument. It was administered and collected on site by trained researchers. The questionnaire comprised four sections:(1) general information: including the child\u0026rsquo;s gender, age, disease duration, and residence, as well as the caregiver\u0026rsquo;s gender, age, educational level, occupation, and annual household income. (2) skin care practices: bathing frequency and duration, and the frequency and type of moisturizer use. (3) disease knowledge: 30 questions covering the definition, etiology, triggers, diet, treatment, and daily care of atopic dermatitis. We focused on ten core assessment items, selected based on clinical experience, to evaluate key nursing and treatment factors influencing disease control. These items assessed caregivers' mastery of essential knowledge in the following domains: disease concept, etiology, triggers, feeding, bathing, moisturizing, clothing, laundry practices, topical corticosteroids, and novel therapies. (4) health education needs: including knowledge sources and preferred educational formats.\u003c/p\u003e\n\u003ch3\u003eCognitive Assessment Criteria\u003c/h3\u003e\n\u003cp\u003eThis study assessed cognition at both the group and individual levels:(1) Overall disease cognition (group level): This reflected the collective mastery of questionnaire content among all respondents. The overall cognition rate was calculated as:\u003c/p\u003e \u003cp\u003e \u003cem\u003e(Sum of correct answers per respondent) / (Total number of respondents \u0026times; Total number of questions) \u0026times; 100%\u003c/em\u003e. A single-question correct rate\u0026thinsp;\u0026ge;\u0026thinsp;60% was defined as adequate cognition, and \u0026lt;\u0026thinsp;60% as inadequate cognition. (2) Key cognition (individual level): This reflected caregivers\u0026rsquo; mastery of 10 critical topics. Each correct answer was assigned 1 point, and incorrect or \u0026lsquo;unsure\u0026rsquo; responses were scored 0, yielding a maximum total of 10 points. Based on the pre-survey score distribution and commonly used cutoff values for knowledge questionnaires, a total score\u0026thinsp;\u0026ge;\u0026thinsp;6 was defined as \u0026lsquo;adequate cognition\u0026rsquo;, while\u0026thinsp;\u0026lt;\u0026thinsp;6 was considered \u0026lsquo;inadequate cognition\u0026rsquo;.\u003c/p\u003e\n\u003ch3\u003eKnowledge acquisition pathways and preferred health education formats\u003c/h3\u003e\n\u003cp\u003eAnalyze the distribution of knowledge acquisition pathways across different cognitive levels among caregivers and their health education needs.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData processing and statistical analyses were conducted using SPSS Statistics version 27.0. Normally distributed quantitative data were expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{\\text{-}}{\\text{x}}\\text{\u0026plusmn;}\\text{s}\\)\u003c/span\u003e\u003c/span\u003e), whereas categorical variables were presented as frequencies and percentages [n (%)]. Differences in categorical variables were examined using the \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{}{\\text{x}}^{\\text{2}}\\)\u003c/span\u003e\u003c/span\u003etest. Variables showing significant associations in the univariate analysis were subsequently entered into a multivariate logistic regression model to identify factors independently related to caregivers\u0026rsquo; cognition levels. Statistical significance was established at a p value \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Information\u003c/h2\u003e \u003cp\u003eA total of 220 questionnaires were distributed, and 215 valid responses were collected, yielding a response rate of 97.73%. Among the pediatric patients, 116 were males and 99 were females, with a mean age of 3.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42 years. The duration of illness was \u0026le;\u0026thinsp;1 year in 96 cases and \u0026gt;\u0026thinsp;1 year in 119 cases. SCORAD scores indicated moderate disease in 177 cases and severe disease in 38 cases. Sixty-two cases resided in rural areas and 153 in urban areas. Among caregivers, 67 were males and 148 were females, with an average age of 33.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96 years. Regarding educational attainment, 40 had a junior high school education or below, 69 had completed high school or vocational school, and 106 held a bachelor\u0026rsquo;s degree or higher. The occupational distribution included professionals (n\u0026thinsp;=\u0026thinsp;52), clerical workers (n\u0026thinsp;=\u0026thinsp;31), self-employed individuals (n\u0026thinsp;=\u0026thinsp;35), farmers or laborers (n\u0026thinsp;=\u0026thinsp;29), unemployed caregivers (n\u0026thinsp;=\u0026thinsp;28), and others (n\u0026thinsp;=\u0026thinsp;40). Annual household income ranged mainly between 50,000 and 100,000 yuan (n\u0026thinsp;=\u0026thinsp;84, 39.1%). Only 27 caregivers (12.6%) had received health education prior to the survey.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOverall cognition level of atopic dermatitis among caregivers\u003c/h2\u003e \u003cp\u003eAmong the 30 atopic dermatitis\u0026ndash;related questions, caregivers correctly answered 3,724 items, yielding an overall cognition rate of 57.74%, suggesting generally limited understanding. Specifically, cognition regarding the concept of AD, triggers or aggravating factors, oral antihistamines, and systemic corticosteroids was relatively adequate (correct rates\u0026thinsp;\u0026gt;\u0026thinsp;60%). However, understanding of etiology, dietary management, topical corticosteroids, calcineurin inhibitors, and novel therapies such as biologics was limited (correct rates\u0026thinsp;\u0026lt;\u0026thinsp;60% for each). In terms of nursing practices, the majority of caregivers focused on clothing management and moisturization but demonstrated significant gaps in their understanding of appropriate bathing frequency, functional emollient use, and proper laundry practices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eUnivariate analysis of factors influencing key cognition levels among caregivers\u003c/h2\u003e \u003cp\u003eResults for the ten key cognition items showed that caregivers exhibited relatively good understanding of AD concepts, triggers and aggravating factors, and clothing care, whereas the lowest cognition was observed in feeding practices (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Univariate analysis revealed that educational attainment, occupation, place of residence, duration of the child\u0026rsquo;s illness, and disease severity were the main factors influencing cognition levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Caregivers with higher education levels, professional or technical occupations, urban residence, longer disease duration, and more severe disease had significantly higher cognition levels (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTen key cognitive aspects assessed among caregivers\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Correct Responses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCognition Rate (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriggers/Aggravating Factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoisturizing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClothing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClothing washing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTopical corticosteroids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiological agents and other novel therapies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis of caregivers\u0026rsquo; key cognition scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{x}}^{\\text{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16(23.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49(33.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10(21.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30-40years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48(32.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;40years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(35.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(19.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53(34.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior high school or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(12.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school/vocational school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15(21.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor's degree and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45(42.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer/Worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(6.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(40.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClerical Staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(38.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(25.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11(39.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10(25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnnual household income(in RMB)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(21.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50,000-100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26(30.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e100,000-150,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(26.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e150,000-200,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;200,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(43.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;1year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22(23.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43(35.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease severity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.604\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48(27.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17(44.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceived health education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11(40.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54(28.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate logistic regression analysis of caregivers\u0026rsquo; key cognition levels\u003c/h2\u003e \u003cp\u003eVariables that were statistically significant in the univariate analysis were subsequently included in a multivariate logistic regression model. The results showed that a bachelor\u0026rsquo;s degree or higher (OR\u0026thinsp;=\u0026thinsp;4.23, 95% CI: 1.16\u0026ndash;15.49, P\u0026thinsp;=\u0026thinsp;0.029), being unemployed (OR\u0026thinsp;=\u0026thinsp;5.97, 95% CI: 1.02\u0026ndash;34.98, P\u0026thinsp;=\u0026thinsp;0.048), disease duration\u0026thinsp;\u0026gt;\u0026thinsp;1 year (OR\u0026thinsp;=\u0026thinsp;2.15, 95% CI: 1.11\u0026ndash;4.17, P\u0026thinsp;=\u0026thinsp;0.024), and severe disease (OR\u0026thinsp;=\u0026thinsp;3.03, 95% CI: 1.34\u0026ndash;6.84, P\u0026thinsp;=\u0026thinsp;0.008) were identified as independent factors associated with caregivers\u0026rsquo; cognition levels (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis of skin care practices among children with moderate-to-severe atopic dermatitis\u003c/h2\u003e \u003cp\u003eAmong the surveyed children, 41.9% bathed once or less per week, 42.8% bathed two to three times per week, and 15.3% bathed four or more times per week. Bathing duration was \u0026le;\u0026thinsp;10 minutes in 84 cases (39.1%), 11\u0026ndash;20 minutes in 86 cases (40.0%), and \u0026gt;\u0026thinsp;20 minutes in 45 cases (20.9%). The frequency of topical moisturizer application was less than twice daily in 69.8% of cases (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Regarding moisturizer types, 141 participants used ordinary moisturizers, while 51 used therapeutic (medical-grade) moisturizers. Immediate post-bathing application was reported by 180 participants (83.7%). Physician recommendation following an eczema or atopic dermatitis diagnosis was the primary source of moisturizer-use habits (79.5%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eCaregivers\u0026rsquo; disease cognition pathways and health education needs\u003c/h2\u003e \u003cp\u003eThe primary sources of AD-related knowledge among caregivers were dermatologists (81.9%) and online media platforms (54.4%). There was no statistically significant difference in channels of knowledge acquisition among caregivers with different cognition levels (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Caregivers showed the greatest preference for one-on-one educational guidance from physicians (76.3%), whereas the lowest preference was for lectures or patient support group meetings (32.1%) (Fig.\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003eS1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eUnderstanding the disease cognition and its influencing factors among caregivers of children with atopic dermatitis (AD) is essential for developing targeted health-education strategies. Numerous studies conducted both domestically and internationally have demonstrated that educational interventions can enhance caregivers\u0026rsquo; disease-management capabilities, improve clinical outcomes in pediatric patients, and enhance their quality of life[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, caregivers of children with moderate-to-severe AD demonstrated an overall disease-cognition rate of 57.7%, reflecting generally limited knowledge. Marked deficiencies were identified in understanding the etiology, feeding practices, skin care, topical corticosteroids, and novel therapies, indicating that clinical education should prioritize these domains. Scientific feeding practices form the foundation of effective disease control in pediatric AD. Previous studies have reported that the prevalence of food allergy among Chinese children aged\u0026thinsp;\u0026lt;\u0026thinsp;2 years with moderate-to-severe atopic dermatitis was 49.7%[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Insufficient disease cognition among caregivers often results in unnecessary dietary restrictions, thereby increasing the risk of malnutrition. Consequently, dietary guidance should be reinforced in routine management, and food-allergen screening performed when necessary to facilitate individualized nutritional intervention.\u003c/p\u003e \u003cp\u003eTopical corticosteroids remain the first-line therapy for pediatric AD; however, this survey revealed inadequate caregiver knowledge regarding application methods and widespread \u0026ldquo;steroid phobia.\u0026rdquo; Studies have shown that such fear of corticosteroids directly compromises treatment adherence and efficacy[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Educational programs should therefore emphasize the necessity, safety, and correct use of topical corticosteroids\u0026mdash;including dosage, frequency, and duration\u0026mdash;while promoting the concept of \u0026ldquo;proactive maintenance therapy\u0026rdquo; to alleviate anxiety and optimize disease control[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For moderate-to-severe cases, topical therapy alone is often insufficient. The advent of targeted biologic agents offers safer and more effective options[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]; nevertheless, only 25.6% of caregivers in this study correctly recognized novel therapies, highlighting delays in public knowledge dissemination. Clinical education should thus incorporate communication on biologic treatments, including indications, treatment duration, and expected outcomes, to strengthen caregivers\u0026rsquo; confidence in disease management.\u003c/p\u003e \u003cp\u003eThe \u0026ldquo;Key 10 Items\u0026rdquo; represent core components of treatment principles for moderate-to-severe AD[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Multivariate analysis identified caregivers\u0026rsquo; educational attainment, occupational type, disease duration, and disease severity as significant determinants of cognition level. Caregivers holding a bachelor\u0026rsquo;s degree or higher, those unemployed, those caring for children with disease duration\u0026thinsp;\u0026ge;\u0026thinsp;1 year, and those managing severe cases demonstrated significantly higher cognition levels. This finding suggests that higher educational background and greater caregiving experience enhance disease understanding and decision-making capacity. These characteristics appear to act as protective factors for caregivers\u0026rsquo; cognitive levels. Future health-education initiatives should therefore focus on parents with lower educational attainment and those newly caring for affected children, aiming to strengthen disease cognition and adherence, thereby improving long-term management outcomes.\u003c/p\u003e \u003cp\u003eThis survey also revealed that dermatologists were the predominant source of AD-related information, and most caregivers preferred individualized instruction to group education. Clinicians should optimize educational delivery by integrating personalized counseling during outpatient visits and through online follow-ups. In China, dermatology outpatient services play an important role in patient education for atopic dermatitis. Physicians typically provide guidance through face-to-face counseling, health seminars, which have shown positive effects on treatment adherence and disease control[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, the absence of a unified educational framework has led to notable disparities in educational quality among regions and institutions. Existing programs are mostly short-term and fail to address patients\u0026rsquo; long-term and individualized management needs. Moreover, in China, patient education and long-term management of atopic dermatitis remain at an early stage. Therefore, it is essential to establish a more standardized health education system[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding skincare practices, although 83.7% of caregivers reported using moisturizers as advised, gaps remained between knowledge and behavior. Survey results indicated that 56.3% of caregivers lacked adequate knowledge of standardized bathing practices. Nie et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]reported similar findings among adult patients with atopic dermatitis and caregivers of pediatric patients, where limited bathing and skincare knowledge was associated with inappropriate caregiving behaviors. Therefore, insufficient understanding of proper bathing practices may directly contribute to improper skincare behaviors. Consequently, health-care providers require enhanced training in patient-education skills. Instruction should include detailed guidance on emollient selection (favoring functional skincare products), application frequency (\u0026ge;\u0026thinsp;twice daily), and appropriate bathing practices (5\u0026ndash;10 minutes, daily or every other day) to improve adherence[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn summary, caregivers of children with moderate-to-severe AD exhibited generally low levels of disease cognition, influenced by multiple demographic and clinical factors. Clinicians should implement stratified health-education programs tailored to population characteristics. Educational content and delivery should balance scientific rigor with accessibility, transitioning outpatient education from single-session interventions to continuous programs. Furthermore, establishing national standards and training frameworks for AD-related health education is essential to improve educational quality, strengthen treatment adherence, and promote long-term disease control. This single-center study, with a limited sample size, has restricted representativeness. The absence of a standardized AD-knowledge assessment tool and reliance on a self-designed questionnaire may introduce subjectivity and measurement bias. Future multicenter studies should aim to refine and validate standardized scales to establish a scientific and unified framework for evaluating caregiver knowledge of atopic dermatitis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe acknowledge with appreciation the hard work and dedication of all staff members involved in the implementation and data collection of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design of the research: Xihuan Xu, Ping Chen.\u0026nbsp;Collection\u0026nbsp;of data: Xihuan Xu, Chenchen Yang, Xia Li. Analysis and interpretation of the data: Xihuan Xu, Lin Zhang. Writing of the manuscript: Xihuan Xu, Lin Zhang.\u0026nbsp;Project administration and writing review: Ping Chen.\u0026nbsp;All authors read and approved the final draft.\u0026nbsp;All authors have reviewed and approved the final version of the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Review and Informed Consent \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Xuzhou Children\u0026apos;s Hospital affiliated with Xuzhou Medical University (Approval No. 2025-05-01-H01) and was conducted in accordance with the principles of the Declaration of Helsinki. Before participation, all subjects were fully informed of the study\u0026rsquo;s purpose and procedures and provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u0026nbsp;\u003c/strong\u003e Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp; The authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEichenfield LF, Stripling S, Fung S et al (2022) Recent Developments and Advances in Atopic Dermatitis: A Focus on Epidemiology, Pathophysiology, and Treatment in the Pediatric Setting. 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Eur J Dermatol 32:113\u0026ndash;123. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1684/ejd.2022.4197\u003c/span\u003e\u003cspan address=\"10.1684/ejd.2022.4197\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Atopic dermatitis, Children, Disease cognition, Influencing factors, Health education","lastPublishedDoi":"10.21203/rs.3.rs-8114672/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8114672/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAtopic dermatitis (AD) is a chronic inflammatory skin disorder requiring continuous management and caregiver participation. This study aimed to assess disease cognition and skin care practices among caregivers of children with moderate-to-severe AD.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional questionnaire survey was administered to caregivers of 215 children with moderate-to-severe AD treated at the Department of Dermatology, Xuzhou Children\u0026rsquo;s Hospital. Univariate and multivariate logistic regression analyses were performed to identify factors associated with cognition levels.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall cognition rate among caregivers was 57.7%. Educational attainment, occupation, residence, disease duration, and severity were significantly associated with cognition (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Multivariate analysis identified caregivers\u0026rsquo; education level, occupation, disease duration, and severity as independent determinants (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Dermatologists (81.9%) and online media (54.4%) were the main knowledge sources. Individualized education was preferred (76.3%), whereas group lectures were least favored (32.1%). Regarding skin care habits, 41.9% of children bathed\u0026thinsp;\u0026le;\u0026thinsp;1 time per week, 60.9% bathed for \u0026gt;\u0026thinsp;10 minutes, and 79.5% used topical emollients, though 69.8% applied them\u0026thinsp;\u0026lt;\u0026thinsp;2 times daily. Only 23.7% of caregivers understood the efficacy of functional emollients.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCaregivers exhibited inadequate disease cognition and suboptimal skin care practices. Targeted health education should be strengthened to improve long-term AD management outcomes.\u003c/p\u003e","manuscriptTitle":"Investigation of Disease cognition and Skin Care Practices Among Caregivers of Children with Moderate-to-Severe Atopic Dermatitis: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-22 10:27:26","doi":"10.21203/rs.3.rs-8114672/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-01-20T21:52:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-15T18:58:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-15T18:58:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Dermatological Research","date":"2025-11-14T12:47:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"2bc4606c-2c37-42dc-bb7f-7d7fa78d81ce","owner":[],"postedDate":"January 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-22T10:27:26+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-22 10:27:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8114672","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8114672","identity":"rs-8114672","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}