Cost-of-illness of rheumatoid arthritis and ankylosing spondylitis

OBJECTIVES:\ud To assess, quantify and summarise the cost of illness of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) from the societal perspective.\ud \ud METHODS:\ud Original studies reporting costs of RA or AS were searched systematically. Both cost-of-illness studies and economic evaluations of therapies were included. Studies were appraised for patient and study characteristics, type of costs and actual costs. Reported costs were aggregated by cost categories and overall mean costs were summarised by cost domain (healthcare, patient and family, and productivity costs).\ud \ud RESULTS:\ud Overall mean costs of RA (€14,906 per year) were above that of AS (€9,374 per year), while the relative distribution of costs over cost domains was approximately similar. For both diseases, productivity costs based on the human cost approach were 3 to 10 times higher than the friction costs and accounted for more than half the total costs of both diseases.\ud \ud CONCLUSIONS:\ud Productivity costs constitute the largest part of the total cost-off-illness of RA and AS reflecting the high burden of the disease on work participation. Although total and direct costs of illness in RA were higher than in AS, the average age of AS patients was 10 years lower and therefore, lifetime costs associated with AS may actually be equal or higher

How much control is enough? Optimizing fun with unreliable input

Brain-computer interfaces (BCI) provide a valuable new input modality within human- computer interaction systems, but like other body-based inputs, the system recognition of input commands is far from perfect. This raises important questions, such as: What level of control should such an interface be able to provide? What is the relationship between actual and perceived control? And in the case of applications for entertainment in which fun is an important part of user experience, should we even aim for perfect control, or is the optimum elsewhere? In this experiment the user plays a simple game in which a hamster has to be guided to the exit of a maze, in which the amount of control the user has over the hamster is varied. The variation of control through confusion matrices makes it possible to simulate the experience of using a BCI, while using the traditional keyboard for input. After each session the user �lled out a short questionnaire on fun and perceived control. Analysis of the data showed that the perceived control of the user could largely be explained by the amount of control in the respective session. As expected, user frustration decreases with increasing control. Moreover, the results indicate that the relation between fun and control is not linear. Although in the beginning fun does increase with improved control, the level of fun drops again just before perfect control is reached. This poses new insights for developers of games wanting to incorporate some form of BCI in their game: for creating a fun game, unreliable input can be used to create a challenge for the user

Self-esteem in patients with rheumatic diseases:The role of body-self unity

Background: Maintaining positive self-esteem is one of the challenges for patients with chronic diseases. Limitations in physical functioning, often associated with having a rheumatic disease, can influence the perception of the body as belonging to the person (or as detached from the self) and might thereby finally affect the self-esteem of patients. The concept of body-self unity has been investigated in a phenomenological research tradition that works with qualitative methodology and small samples. Objectives: To develop a questionnaire to measure body-self unity quantitatively and to investigate the predictive value of body-self unity for self-esteem in patients with rheumatic diseases. Methods: The Body Experience Questionnaire was developed for the measurement of body-self unity. Besides this questionnaire, illness cognitions, pain intensity, functional limitations and self-esteem were measured via computers with touchscreen. 168 patients (mean age = 54,2 years, 62% female) with a rheumatic disease participated in this study consecutive visiting the rheumatology clinic. To analyse predictors of self-esteem, hierarchical regression analyses were employed (first step demographic characteristics, second step disease related variables (disease duration, functional limitations, pain), final step psychological constructs (body-self unity, illness cognitions)). Results: The Body Experience Questionnaire revealed a two factor structure with good reliability (subscale harmony, Cronbachs alpha=.76; subscale alienation, Cronbachs alpha = 0.84). The final model of the hierarchical regression analyses showed that self-esteem can be predicted by helplessness, acceptance, harmony of body and self and most strongly by the alienation of body and self. R2 of the final model was 0.50 (delta R for psychological variables in the final step was 0.28). The relation between functional limitations and self-esteem was fully mediated by the psychological constructs body self unity and illness cognitions. Conclusion: This study showed the importance of psychological characteristics and particularly the experience of the body for self-esteem in patients with a rheumatic disease. Further research should explore therapies to increase the body-self unity

Essais d'épandage au sol de la deltaméthrine poudre mouillable à différentes doses contre Glossina palpalis (s.l.) dans une zone préforestière de Côte d'Ivoire

Des essais d'épandage au sol de deltaméthrine poudre mouillable 2,5% (NRDC 161) ont été effectués en janvier et novembre 1981 dans le foyer à Trypanosomiase humaine de Bouaflé, Côte d'Ivoire. Ces essais visaient à évaluer l'effet de différentes doses de ce pyréthrinoïde de synthèse sur la densité apparente par piègeage de G. palpalis (s.l.), vecteur de la maladie du sommeil dans la zone concernée. Trois doses ont été testées: 60 g de matière active (g.m.a.) par hectare à la concentration de 0,08% en janvier; 20 et 12 g.m.a./ha en novembre, aux concentrations de 0,027 et 0,016% respectivement. Pour chaque dose donnée, les traitements ont été exécutés une suele fois et à l'aide d'atomiseurs portatifs, Solo Port 423 de 5 m de portée. Les effets immédiats, à court et à moyen terme de l'insecticide sont très satisfaisants qu'il s'agisse des doses de 60 et 20 g.m.a./ha ou de la plus faible dose de 12 g.m.a./ha: taux de réduction de la densité apparente (D.A.P.) du vecteur compris dans l'ensemble entre 90 et 98% durant les deux premiers mois après traitement, quelle que soit la dose. A long terme, des taux de réduction dépassant 95% ont été obtenus jusqu'à 4 mois après épandage même avec la plus faible dose de 12 g.m.a./ha. La plus forte dose de 60 g.m.a./ha ne semble apporter aucun gain appréciable ni dans les taux de mortalité du vecteur, ni dans la rémanence de l'insecticide dans la zone d'étude. Afin de diminuer le cout en insecticide d'une éventuelle campagne de lutte chimique antiglossine et de sauvegarder au mieux les ressources de l'environnement, il est donc recommandé que la deltaméthrine p.m. en épandage au sol et en traitement rémanent, soit utilisée à la dose de 12 g.m.a./h

Health-related quality of life in sarcoidosis

Purpose of review: The review presents an overview of the scientific publications in the field of health-related quality of life (HRQL) in sarcoidosis. Recent findings: Literature on HRQL in sarcoidosis is limited. HRQL was mainly used as a primary or secondary endpoint in intervention studies. Moreover, most studies have measured HRQL in sarcoidosis by means of the generic questionnaire 36-Item Short-Form Health Survey. Sarcoidosis-specific questionnaires and computer-adapted testing are innovative approaches to the field. Summary: HRQL as a primary or secondary outcome in sarcoidosis studies is still scarce. In addition to the proper definition of the concept, the mode of measurement of HRQL remains a matter of debate. Because health-economical evaluations require data on gained quality of life, future studies on sarcoidosis should include HRQL as the study endpoin

Patient education and disease activity: A study among rheumatoid arthritis patients

Objective: To determine whether patients experiencing high disease activity derive more benefit from patient education than those experiencing low disease activity. - \ud Methods: Data from a randomized study on the effects of a program of patient education were analyzed retrospectively. Four subgroups were studied: the high disease activity subgroup of patients who had participated in the educational program, the complementary low disease activity subgroup, the high disease activity subgroup of controls, and its low disease activity complement. Patients with erythrocyte sedimentation rate >28 mm/first hour were classified as having high disease activity. Effects on frequency of physical exercises, endurance exercises, and relaxation exercises and effects on health status (Modified Health Assessment Questionnaire, Dutch Arthritis Impact Measurement Scales [AIMS]) were measured. - \ud Results: There were no significant differences between the adherence parameters of the various pairs of groups. Four months after the educational program began, anxiety and depression scores on the Dutch-AIMS had increased among participating patients who were experiencing high disease activity and decreased among those who were experiencing low disease activity. - \ud Conclusions: Patients experiencing high disease activity did not derive more benefit from patient education than those experiencing low disease activity. On the contrary, an increase of anxiety and depression is found in these patients. Further study is needed to confirm our findings

A social contract model of ‘disintegrity’ within the dual-process paradigm of moral psychology: Reducing the scope of the ‘belief-behavior incongruity’

Explaining why students cheat when it violates their moral beliefs, also called the ‘belief-behavior incongruity’ (BBI), is a difficult challenge most often overcome by referring to neutralization techniques, first described by Sykes and Matza (1957), whereby individuals deceive themselves with specious justifications for ignoring the moral imperative to follow rules. An underlying assumption of the neutralization view, that individuals’ abstract moral beliefs apply automatically to all contexts, is critiqued in the present work. The account of academic dishonesty developed herein is centered on the hypothesis that adolescent students’ felt moral obligation is informed by an intuitive sense of reciprocity between themselves and their learning contexts, which resembles a social contract, or ‘psychological teaching- learning contract’ (PTLC). Students who regard a class context or teacher more negatively are thus expected to feel less moral obligation to follow rules, and to cheat more as a result. The hypothesized PTLC model, which included key variables related to (A) self-concept, (B) achievement goal structure, (C) learning strategies, (D) moral obligation, and (E) social comparison theory, was tested with data from a diverse sample of secondary students in fifteen international schools across Asia, Europe, and Africa. A pilot study (N = 96) of the construct validity of psychometric measures was conducted prior to the Main Study, which included a Time 1 sample of N = 493, a Time 2 sample of N = 297 (spaced by approximately one year), and a longitudinal matched sample of N = 225. Structural equation modeling techniques were used to test the validity and invariance of the measurement model, as well as the structural relations hypothesized between variables. A small degree of gender non-invariance prompted separate analyses of gender-specific models. Results supported the PTLC hypothesis. Moral obligation overwhelmingly mediated the effects of perceived class quality on academic integrity, indicating that students felt morally obliged to be honest in a given class, as a function of their regard for its quality

Diagnostic accuracy of the ID-Migraine: a systematic review.

Objective: The purpose of this systematic review with meta-analysis is to determine the diagnostic accuracy of the ID Migraine as a decision rule for identifying patients with migraine. Background: The ID Migraine screening tool is designed to identify patients with migraine in primary care settings. Several studies have validated the ID Migraine across various clinical settings, including primary care,neurology departments, headache clinics, dental clinics, ENT and primary care settings. Several studies have validated the ID Migraine across various clinical settings, including primary care, neurology departments, headache clinics, dental clinics, ENT and ophthalmology. Method: A systematic literature search was conducted to identify all studies validating the ID Migraine, with the International Headache Criteria as the reference standard. The methodological quality of selected studies was assessed using the Quality of Diagnostic Accuracy Studies tool. All selected studies were combined using a bivariate random effects model. A sensitivity analysis was also conducted, pooling only those studies using representative patient groups (primary care;neurology departments; and headache clinics) to determine the potential influence of spectrum bias on the results. Results: Thirteen studies incorporating 5,866 patients are included. The weighted prior probability of migraine across the thirteen studies is 59%. The ID Migraine is shown to be useful for ruling out rather than ruling in migraine, with a greater pooled sensitivity estimate (0.84, 95% CI 0.75 – 0.90) than specificity (0.76, 95% CI 0.69 – 0.83). A negative ID Migraine score reduces the probability of migraine from 59% to 23%. The sensitivity analysis reveals similar results. Conclusions: This systematic review quantifes the diagnostic accuracy of the ID Migraine as a brief, practical and easy to use diagnostic tool for Migraine. Application of the ID Migraine as a diagnostic tool is likely to improve appropriate diagnosis and management of Migraine sufferers

A goal management intervention for polyarthritis patients: rationale and design of a randomized controlled trial

Background A health promotion intervention was developed for inflammatory arthritis patients, based on goal management. Elevated levels of depression and anxiety symptoms, which indicate maladjustment, are found in such patients. Other indicators of adaptation to chronic disease are positive affect, purpose in life and social participation. The new intervention focuses on to improving adaptation by increasing psychological and social well-being and decreasing symptoms of affective disorders. Content includes how patients can cope with activities and life goals that are threatened or have become impossible to attain due to arthritis. The four goal management strategies used are: goal maintenance, goal adjustment, goal disengagement and reengagement. Ability to use various goal management strategies, coping versatility and self-efficacy are hypothesized to mediate the intervention’s effect on primary and secondary outcomes. The primary outcome is depressive symptoms. Secondary outcomes are anxiety symptoms, positive affect, purpose in life, social participation, pain, fatigue and physical functioning. A cost-effectiveness analysis and stakeholders’ analysis are planned. Methods/design The protocol-based psycho-educational program consists of six group-based meetings and homework assignments, led by a trained nurse. Participants are introduced to goal management strategies and learn to use these strategies to cope with threatened personal goals. Four general hospitals participate in a randomized controlled trial with one intervention group and a waiting list control condition. Discussion The purpose of this study is to evaluate the effectiveness of a goal management intervention. The study has a holistic focus as both the absence of psychological distress and presence of well-being are assessed. In the intervention, applicable goal management competencies are learned that assist people in their choice of behaviors to sustain and enhance their quality of lif