Future expectations and worst-case future scenarios of patients with rheumatoid arthritis: a focus group study

Objective:\ud Over the past 15 years, developments in the treatment of rheumatoid arthritis (RA) have resulted in better clinical outcomes. The aim of the present study was to explore how patients think their RA will influence their lives in the future, and which of these future expectations would be the worst for them to experience.\ud \ud Methods:\ud A focus group study was performed in 16 RA patients. Three groups were heterogeneously composed, based on age group (18–40, 40–65, 65–80), gender and having a paid job or not. Patients were asked about the expected future impact of RA and worst-case future scenarios. Transcripts were coded by three researchers under the main components of the International Classification of Functioning, Disability and Health. The codes were discussed until agreement was reached about all codes.\ud \ud Results:\ud Dependency on others, increasing dependency on medication, inability to walk, activity limitations and worsening fatigue were mentioned as worst-case future scenarios. Further concerns were raised about the acceptance of RA and possible disappearance of physicians' expertise. Nevertheless, hope and positive feelings were expressed toward continuous medication improvements.\ud \ud Conclusion:\ud The present study provided insight into RA patients' future expectations and worst-case future scenarios. The results may be of help in the development of support interventions to put concerns and worst-case future scenarios into a realistic perspective. Furthermore, insight into patients' worst-case future scenarios could be used to improve the validity and responsiveness of the Time Trade-Off, an instrument to measure preference-based health-related quality of life

Moving beyond a limited follow-up in cost-effectiveness analyses of behavioral interventions

Background Cost-effectiveness analyses of behavioral interventions typically use a dichotomous outcome criterion. However, achieving behavioral change is a complex process involving several steps towards a change in behavior. Delayed effects may occur after an intervention period ends, which can lead to underestimation of these interventions. To account for such delayed effects, intermediate outcomes of behavioral change may be used in cost-effectiveness analyses. The aim of this study is to model cognitive parameters of behavioral change into a cost-effectiveness model of a behavioral intervention. Methods The cost-effectiveness analysis (CEA) of an existing dataset from an RCT in which an high-intensity smoking cessation intervention was compared with a medium-intensity intervention, was re-analyzed by modeling the stages of change of the Transtheoretical Model of behavioral change. Probabilities were obtained from the dataset and literature and a sensitivity analysis was performed. Results In the original CEA over the first 12 months, the high-intensity intervention dominated in approximately 58% of the cases. After modeling the cognitive parameters to a future 2nd year of follow-up, this was the case in approximately 79%. Conclusion This study showed that modeling of future behavioral change in CEA of a behavioral intervention further strengthened the results of the standard CEA. Ultimately, modeling future behavioral change could have important consequences for health policy development in general and the adoption of behavioral interventions in particular

Set obres sobre retòrica i persuasió

El comentari crític de set obres sobre retòrica i persuasió, publicades recentment, ofereix una visió de diverses perspectives teòriques i també de les aplicacions a situacions comunicatives específiques. Les obres són El arte de hablar , de José Antonio Hernández Guerrero i María del Carmen García Tejera; Retórica , de Giambattista Vico, editada per primera vegada en castellà; 40 jocs per parlar català , de Jacqueline Jacquet, Sílvia Casulleras, Núria Mirabet; Acròbates de l'emoció , d'Amadeu Viana; Tres finestres obertes al món de la comunicació , de Ricard Morant i Miquel Peñarroya; El lenguaje de la negociación , de Joan Mulholland; i Tècniques de negociació i resolució de conflictes , de Carles Mendieta i Suñé