Probabilistic markov model estimating cost effectiveness of methylphenidate osmotic-release oral system versus immediate-release methylphenidate in children and adolescents: Which information is needed?

Background: Incidence of attention deficit hyperactivity disorder (ADHD) in children and adolescents has been increasing. The disorder results in high societal costs. Policymakers increasingly use health economic evaluations to inform decisions on competing treatments of ADHD. Yet, health economic evaluations of first-choice medication of ADHD in children and adolescents are scarce and generally do not include broader societal effects. Objectives: This study presents a probabilistic model and analysis of methylphenidate osmotic-release oral system (OROS) versus methylphenidate immediate-release (IR). We investigate and include relevant societal aspects in the analysis so as to provide cost-effectiveness estimates based on a broad societal perspective. Methods: We enhanced an existing Markov model and determined the cost effectiveness of OROS versus IR for children and adolescents responding suboptimally to treatment with IR. Enhancements included screening of a broad literature base, updated utilit

Measuring perceived benefit and disease-related burden in young cancer survivors: validation of the Benefit and Burden Scale for Children (BBSC) in the Netherlands

Item does not contain fulltextPURPOSE: Perceiving favourable changes from one's illness may go hand in hand with experiencing harmful psychosocial effects. Each of these constructs should be considered when examining children's levels of psychological adjustment following stressful life events. A paediatric instrument that accounts for both positive and negative impact of stressful events has not been investigated in The Netherlands before. The aim of the study was to investigate psychometric properties of the Dutch version of the Benefit and Burden Scale for Children (BBSC), a 20-item questionnaire that intends to measure potential benefit and burden of illness in children. METHODS: Dutch paediatric survivors of childhood cancer aged 8-18 (N = 77) completed the BBSC and other psychological questionnaires: Pediatric Quality of Life Inventory (health-related quality of life), State-Trait Anxiety Inventory for Children (anxiety), Children's Revised Impact of Event Scale (posttraumatic stress) and Strengths and Difficulties Questionnaire (behavioural functioning). Reliability and validity were evaluated. RESULTS: Internal consistency (Cronbach's alpha, benefit 0.84, burden 0.72), test-retest reliability (benefit r = 0.74, burden r = 0.78) and homogeneity (mean inter-item correlation, benefit r = 0.34, burden r = 0.22) were satisfactory. Burden was associated with HRQoL (-), anxiety (+), posttraumatic stress symptoms (+) and behavioural problems. Benefit did not correlate with the psychological outcomes. CONCLUSIONS: The Dutch version of the BBSC shows promising psychometric properties. Perceived benefit and disease-related burden are distinct constructs; both should be considered when examining children's psychological adjustment to potentially traumatic experiences. The BBSC may be useful as monitoring and screening instrument

Assessment of explanatory models of mental illness: effects of patient and interviewer characteristics

Background: Explanatory models (EMs) refer to patients’ causal attributions of illness and have been shown to affect treatment preference and outcome. Reliable and valid assessment of EMs may be hindered by interviewer and respondent disparities on certain demographic characteristics, such as ethnicity. The present study examined (a) whether ethnic minority patients reported different EMs to ethnically similar interviewers in comparison with those with a different ethnicity, and (b) whether this effect was related to respondents’ social desirability, the perceived rapport with the interviewer and level of uncertainty toward their EMs. Methods: A total of 55 patients of Turkish and Moroccan origins with mood and anxiety disorders were randomly assigned to ethnically similar or dissimilar interviewers. EMs were assessed, using a semi-structured interview, across 11 different categories of causes. Results: Participants who were interviewed by an ethnically similar interviewer perceived interpersonal, victimization and religious/mystical causes as more important, whereas interviews by ethnically dissimilar interviewers generated higher scores on medical causes. These effects were not mediated by the perceived rapport with the interviewer, and social desirability had a modest impact on the results. Higher uncertainty among participants toward medical and religious/mystical causes seemed to be associated with greater adjustment in the report of these EMs. Conclusion: The findings have significant implications for interviewer selection in epidemiological research and clinical practice

A case-only study to identify genetic modifiers of breast cancer risk for BRCA1/BRCA2 mutation carriers

Breast cancer (BC) risk for BRCA1 and BRCA2 mutation carriers varies by genetic and familial factors. About 50 common variants have been shown to modify BC risk for mutation carriers. All but three, were identified in general population studies. Other mutation carrier-specific susceptibility variants may exist but studies of mutation carriers have so far been underpowered. We conduct a novel case-only genome-wide association study comparing genotype frequencies between 60,212 general population BC cases and 13,007 cases with BRCA1 or BRCA2 mutations. We identify robust novel associations for 2 variants with BC for BRCA1 and 3 for BRCA2 mutation carriers, P < 10−8, at 5 loci, which are not associated with risk in the general population. They include rs60882887 at 11p11.2 where MADD, SP11 and EIF1, genes previously implicated in BC biology, are predicted as potential targets. These findings will contribute towards customising BC polygenic risk scores for BRCA1 and BRCA2 mutation carriers

Sex differences in physical symptoms: The contribution of symptom perception theory

Health surveys, studies on physical symptom reporting, and medical registration of physical complaints find consistent sex differences in symptom reporting, with women having the higher rates. By and large, this female excess of physical symptoms is independent from the symptom measure, response format and time frame used, and the population under study. As most studies concern healthy individuals, the sex difference can not simply be attributed to a greater physical morbidity in women. In this paper we propose a number of explanations for this phenomenon, based on a biopsychosocial perspective on symptom perception. We discuss a symptom perception model that brings together factors and processes from the extant literature which are thought to affect symptom reporting, such as somatic information, selection of information through attention and distraction, attribution of somatic sensations, and the personality factors somatisation and negative affectivity. Finally, we discuss the explanations for sex differences in physical symptoms that arise from the model.physical symptoms health women sex differences

Gender differences in physical symptoms and illness behavior: A health diary study

Recent studies on symptom perception have highlighted the role of psychological factors, such as mood states and external involvement, in physical symptom reporting. To date, the consistently found higher physical symptom reports in women have not been studied from this perspective. The present study aimed to investigate the psychological determinants of gender differences in physical symptoms and illness behavior on a daily basis. During four adjacent weeks, a healthy primary care sample of 92 women and 61 men kept health diaries, containing scales for physical symptoms, illness behavior, external information and positive and negative mood. The daily health records showed the typical gender difference in physical symptoms, but not in illness behavior. Negative mood was found to be the strongest predictor of physical symptoms. Physical symptoms in turn were the strongest predictor of illness behavior. The modest gender difference in physical symptoms disappeared after controlling for positive and negative mood. Thus, mood states seem to mediate gender differences in symptom reporting.Physical symptoms Illness behavior Gender differences Health diaries

Gender perspectives and quality of care: Towards appropriate and adequate health care for women

Gender inequalities in health are a consequence of the basic inequality between men and women in many societies. Despite the importance of socio-economic factors, women's health is also greatly affected by the extent and quality of health services available to them. Both non-governmental women's organizations and feminist health researchers have in recent years identified major gender inequalities in access to services and in the way men and women are treated by the health care system. Firstly, although women are major health care users as well as providers, they are under-represented in decision-making in health care. Secondly, no justice is done in general to existing differences in position and needs of women and men in defining quality of health care, i.e. gender aspects. Among women's organizations, there is general agreement that "gender sensitive health care should be available, accessible, affordable, appropriate and acceptable". In addition, health care for women should be adequate and not depart from a male model of health and illness. In this paper, we pay attention to inappropriate health care for women on the one hand, as illustrated by the increasing medicalization of women's reproductive life [menstruation, menopause, pregnancy and childbirth and (in)fertility]. On the other hand, we discuss gender bias in the management of serious, life-threatening diseases such as cardiovascular disease, lung cancer, and kidney failure, as a form of inadequate care. These examples are followed by a global vision on quality of care from a gender perspective, as formulated by the women's health care movement in the Netherlands and at the Fourth International Conference on Women in Beijing. If anything, the recommendations agreed upon in Beijing will have to ensure the consolidation and enhancement of good quality health care for women around the world. The final discussion, attempts to give some general recommendations for achieving more adequate (gender sensitive) and appropriate (non-medicalizing) health care for women. These recommendations pertain to health and health care research, policy, education, and organization from a women's perspective.gender perspectives health care for women