Long-Term Quality of Life Improvement in Subjects with Healed Erosive Esophagitis: Treatment with Lansoprazole

Gastroesophageal reflux disease (GERD) is a chronic symptomatic condition and may be associated with erosive esophagitis (EE). Considerable data on the long-term maintenance of healing of EE are available, but data on long-term GERD symptom prevention and patient quality of life (QOL) are limited. To investigate QOL in subjects with healed EE who received 12 months of double-blind maintenance treatment with lansoprazole or ranitidine, followed by long-term open-label lansoprazole therapy to prevent recurrence of EE. Subjects with healed EE received 12 months of double-blind maintenance treatment with lansoprazole 15 mg once daily or ranitidine 150 mg twice daily, followed by dose-titrated, open-label lansoprazole therapy for up to 82 months. During double-blind treatment (n = 206), lansoprazole-treated patients showed significantly (P ≤ 0.05) greater improvements than ranitidine-treated patients in the frequency, severity, and ‘bothersomeness’ of heartburn, the symptom index, problems of activity limitation, eating and drinking problems, symptom problems, health distress, and social functioning. During dose-titrated, open-label treatment (n = 195), all disease-specific QOL scales except sleep improved significantly (P < 0.001) from open-label baseline at each time-point. Maintenance treatment with lansoprazole for 12 months in healed EE subjects produced significantly greater improvements in QOL indicators than ranitidine. These improvements were sustained during dose-titrated, open-label lansoprazole treatment

Modeling complex ecological economic systems: toward an evolutionary, dynamic understanding of people and nature

Recent understanding about system dynamics and predictability that has emerged from the study of complex systems is creating new tools for modeling interactions between anthropogenic and natural systems. A range of techniques has become available through advances in computer speed and accessibility and by implementing a broad, interdisciplinary systems view

Validation of the SF-36 in patients with endometriosis.

OBJECTIVES: Endometriosis presents with significant pain as the most common symptom. Generic health measures can allow comparisons across diseases or populations. However, the Medical Outcomes Study Short Form 36 (SF-36) has not been validated for this disease. The goal of this study was to validate the SF-36 (version 2) for endometriosis. METHODS: Using data from two clinical trials (N = 252 and 198) of treatment for endometriosis, a full complement of psychometric analyses was performed. Additional instruments included a pain visual analog scale (VAS); a physician-completed questionnaire based on patient interview (modified Biberoglu and Behrman--B&B); clinical global impression of change (CGI-C); and patient satisfaction with treatment. RESULTS: Bodily pain (BP) and the Physical Component Summary Score (PCS) were correlated with the pain VAS at baseline and over time and the B&B at baseline and end of study. In addition, those who had the greatest change in BP and PCS also reported the greatest change on CGI-C and patient satisfaction with treatment. Other subscales showed smaller, but significant, correlations with change in the pain VAS, CGI-C, and patient satisfaction with treatment. CONCLUSIONS: The SF-36--particularly BP and the PCS--appears to be a valid and responsive measure for endometriosis and its treatment

Tree species diversity and utilities in a contracting lowland hillside rainforest fragment in Central Vietnam

Abstract Background Within the highly bio-diverse ‘Northern Vietnam Lowland Rain Forests Ecoregion’ only small, and mostly highly modified forestlands persist within vast exotic-species plantations. The aim of this study was to elucidate vegetation patterns of a secondary hillside rainforest remnant (elevation 120–330 m, 76 ha) as an outcome of natural processes, and anthropogenic processes linked to changing forest values. Methods In the rainforest remnant tree species and various bio-physical parameters (relating to soils and terrain) were surveyed on forty 20 m × 20 m sized plots. The forest's vegetation patterns and tree diversity were analysed using dendrograms, canonical correspondence analysis, and other statistical tools. Results Forest tree species richness was high (172 in the survey, 94 per hectare), including many endemic species (>16%; some recently described). Vegetation patterns and diversity were largely explained by topography, with colline/sub-montane species present mainly along hillside ridges, and lowland/humid-tropical species predominant on lower slopes. Scarcity of high-value timber species reflected past logging, whereas abundance of light-demanding species, and species valued for fruits, provided evidence of human-aided forest restoration and ‘enrichment’ in terms of useful trees. Exhaustion of sought-after forest products, and decreasing appreciation of non-wood products concurred with further encroachment of exotic plantations in between 2010 and 2015. Regeneration of rare tree species was reduced probably due to forest isolation. Conclusions Despite long-term anthropogenic influences, remnant forests in the lowlands of Vietnam can harbor high plant biodiversity, including many endangered species. Various successive future changes (vanishing species, generalist dominance, and associated forest structural-qualitative changes) are, however, expected to occur in small forest fragments. Lowland forest biodiversity can only be maintained if forest fragments maintain a certain size and/or are connected via corridors to larger forest networks. Preservation of the forests may be fostered using new economic incentive schemes

The Diabetes Intention, Attitude, and Behavior Questionnaire: evaluation of a brief questionnaire to measure physical activity, dietary control, maintenance of a healthy weight, and psychological antecedents

Shana B Traina,1 Susan D Mathias,2 Hilary H Colwell,2 Ross D Crosby,2–4 Charles Abraham5 1Patient-Reported Outcomes, Janssen Global Services, LLC, Raritan, NJ, USA; 2Health Outcomes Solutions, Winter Park, FL, USA; 3Biomedical Statistics & Methodology, Neuropsychiatric Research Institute, Fargo, ND, USA; 4Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA; 5Psychology Applied to Health, University of Exeter Medical School, Exeter, UK Background: This study assessed measurement properties of the 17-item Diabetes Intention, Attitude, and Behavior Questionnaire (DIAB-Q), which measures intention to engage in self-care behaviors, including following a diabetes diet and engaging in appropriate physical activity. Methods: The DIAB-Q includes questions based on the Theory of Planned Behavior. Items were developed using published literature, input from health care professionals, and qualitative research findings in patients with and without type 2 diabetes mellitus (T2DM). In Stage I of the study, 23 adults with T2DM were interviewed to evaluate the content and clarity of the DIAB-Q. In Stage II 1,015 individuals with T2DM completed the DIAB-Q and supplemental questionnaires, including the Short Form-36 acute (SF-36), section III of the Multidimensional Diabetes Questionnaire, the Summary of Diabetes Self-Care Activities questionnaire, and self-administered items relevant to the treatment and management of T2DM (eg, blood pressure and glycated hemoglobin [HbA1c]) at baseline and 3–7 days later. Once the DIAB-Q scale structure was determined, its test–retest reliability, construct validity, and known-groups validity were evaluated, and minimal clinically important change was estimated. Results: In Stage I, the 23 respondents surveyed generally reported that the DIAB-Q was clear and comprehensive and endorsed questions as relevant to their intentions to engage in diabetes-related self-care activities. Most subjects in Stage II were male, Caucasian, and married. Mean age was 63 years. Factor analysis revealed six psychological constructs (Behavior, Planning, Intention, Perceived Behavioral Control, Attitude, and Subjective Norm). Test–retest reliability was acceptable (≥0.70) for all scales, except Perceived Behavioral Control. Construct validity was demonstrated based on correlations with diabetes-specific items/scales and the SF-36. Known-groups validity was confirmed for Behavior, Planning, and Intention when respondents were categorized into groups that differed based on body mass index, disease severity, and HbA1c. Item scores were transformed to a 100-point scale, and minimal clinically important change estimates ranged from 6–11 points, representing the change that would be considered important to a respondent. Conclusion: The DIAB-Q is a brief, psychometrically sound, patient-reported outcome that can be used among individuals with T2DM to evaluate intention to engage in self-care behaviors. Keywords: diabetes, Theory of Planned Behavior, DIAB-Q, attitude, intention, behavior, patient-reported outcome, questionnair