Limited results of group self-management education for rheumatoid arthritis patients and their partners: explanations from the patient perspective

This study aimed to identify the reasons for limited results of group self-management for RA patients and their partners from the patient perspective. Semi-structured interviews with ten male and ten female patients who had participated in group self-management with or without their partner were content analyzed with respect to motivation to participate and the effects of the program on them. The limited effects of the self-management program appear to be linked with low motivation to participate and to change health behavior. The data show that a decline in health and also stressful life events might be associated with the disappointing effects of the program. Three strategies were proposed for improving the program’s effects: (a) provide information about the program in advance to ensure that patients have appropriate expectations. (b) Enhance intrinsic motivation to change health behavior by counseling techniques. (c) Tailoring with respect to motivation and current concerns could help to form more homogeneous groups or could be the basis for a tailored online intervention

Neue Regeln guter Unternehmensführung

Die gute Führung von Unternehmen und die Höhe der Managergehälter stehen nach diversen Finanzskandalen von Unternehmen und den Kursmanipulationen am Neuen Markt im Mittelpunkt des öffentlichen Interesses. Im Mai dieses Jahres hat die EU Kommission einen Aktionsplan über „Modernisierung des Gesellschaftsrechts und Verbesserung der Corporate Governance in der Europäischen Union“ vorgelegt. Und in der Bundesrepublik beschäftigt sich derzeit die „Cromme-Kommission“ mit der Weiterentwicklung ihres Anfang 2002 veröffentlichten „Deutschen Corporate Governance Kodex“. Was beinhalten die Reformvorschläge? Wie sind sie zu beurteilen? --

Modeling Interactions Between Latent Variables in Research on Type D Personality: A Monte Carlo Simulation and Clinical Study of Depression and Anxiety

Item does not contain fulltextSeveral approaches exist to model interactions between latent variables. However, it is unclear how these perform when item scores are skewed and ordinal. Research on Type D personality serves as a good case study for that matter. In Study 1, we fitted a multivariate interaction model to predict depression and anxiety with Type D personality, operationalized as an interaction between its two subcomponents negative affectivity (NA) and social inhibition (SI). We constructed this interaction according to four approaches: (1) sum score product; (2) single product indicator; (3) matched product indicators; and (4) latent moderated structural equations (LMS). In Study 2, we compared these interaction models in a simulation study by assessing for each method the bias and precision of the estimated interaction effect under varying conditions. In Study 1, all methods showed a significant Type D effect on both depression and anxiety, although this effect diminished after including the NA and SI quadratic effects. Study 2 showed that the LMS approach performed best with respect to minimizing bias and maximizing power, even when item scores were ordinal and skewed. However, when latent traits were skewed LMS resulted in more false-positive conclusions, while the Matched PI approach adequately controlled the false-positive rate

A more active lifestyle in persons with a recent spinal cord injury benefits physical fitness and health

Study design:A prospective cohort study. Objectives:To study the longitudinal relationship between objectively measured everyday physical activity level, and physical fitness and lipid profile in persons with a recent spinal cord injury (SCI).Setting:A rehabilitation centre in the Netherlands and the participant's home environment. Methods:Data of 30 persons with a recent SCI were collected at the start of active rehabilitation, 3 months later, at discharge from inpatient rehabilitation, and 1 year after discharge. Physical activity level (duration of dynamic activities as % of 24 h) was measured with an accelerometry-based activity monitor. Regarding physical fitness, peak oxygen uptake (VO2peak) and peak power output (POpeak) were determined with a maximal wheelchair exercise test, and upper extremity muscle strength was measured with a handheld dynamometer. Fasting blood samples were taken to determine the lipid profile. Results:An increase in physical activity level was significantly related to an increase in VO2peak and POpeak, and an increase in physical activity level favourably affected the lipid profile. A nonsignificant relation was found with muscle strength. Conclusion:Everyday physical activity seems to have an important role in the fitness and health of persons with a recent SCI. An increase in physical activity level was associated with an increase in physical fitness and with a lower risk of cardiovascular disease.Spinal Cord advance online publication, 6 December 2011; doi:10.1038/sc.2011.152

Fish Allergy:Fishing for Novel Diagnostic and Therapeutic Options

Fish allergy is one of the most common food allergies. The currently recommended treatment commonly consists of avoiding all fish species. Recent literature suggests that these recommendations are overprotective for the majority of fish-allergic patients. This review summarizes recent findings and provides practical information regarding management of fish allergy in the individual patient. After precise history taking supported by additional specific IgE measurements and/or skin prick tests, fish-allergic patients can generally be categorized into the following clinical clusters: (A) poly-sensitized patients reacting to all fish species due to their sensitization to the panallergen β-parvalbumin, (B) mono-sensitized patients with selective reactions to individual fish species only, and (C) oligo-sensitized patients reacting to several specific fish. A number of allergens including parvalbumin, enolase, and aldolase can be involved. Depending on the specific cluster the patient belongs to, oral food challenges for one or more fish species can be performed with the aim to provide safe alternatives for consumption. This way, several alternative fish species can be identified for mono- and oligo-sensitized patients that can safely be consumed. Notably, even poly-sensitized patients generally tolerate fish species low in β-parvalbumin such as tuna and mackerel, particularly when processed. Taken together, allergological evaluation of patients with a documented fish allergy should be strongly considered, as it will allow the majority of patients to safely reintroduce one or more fish species

Incentive Compatible Reimbursement Schemes for Physicians

We consider physicians with fixed capacity levels. If a physician’s capacity exceeds demand, she may have an incentive to overtreat, i.e., she may provide unnecessary treatments to use up idle capacity. By contrast, with excess demand she may undertreat, i.e., she may not provide necessary treatments since other activities are financially more attractive. We first show that simple fee-for-service reimbursement schemes do not provide proper incentives. If insurers use, however, fee-for-service schemes with quantity restrictions, they solve the fraudulent physician problem

Inactive and sedentary lifestyles amongst ambulatory adolescents and young adults with cerebral palsy

textabstractBackground: To assess physical behaviour, including physical activity and sedentary behaviour, of ambulatory adolescents and young adults with cerebral palsy (CP). We compared participant physical behaviour to that of able-bodied persons and assessed differences related to Gross Motor Functioning Classification System (GMFCS) level and CP distribution (unilateral/bilateral). Methods. In 48 ambulatory persons aged 16 to 24 years with spastic CP and in 32 able-bodied controls, physical behaviour was objectively determined with an accelerometer-based activity monitor. Total duration, intensity and type of physical activity were assessed and sedentary time was determined (lying and sitting). Furthermore, distribution of walking bouts and sitting bouts was specified. Results: Adolescents and young adults with CP spent 8.6% of 24 hours physically active and 79.5% sedentary, corresponding with respectively 123 minutes and 1147 minutes per 24 hours. Compared to able-bodie

Energy expenditure in chronic stroke patients playing Wii Sports: a pilot study

Background: Stroke is one of the leading causes of long-term disability in modern western countries. Stroke survivors often have functional limitations which might lead to a vicious circle of reduced physical activity, deconditioning and further physical deterioration. Current evidence suggests that routine moderate- or vigorous-intensity physical activity is essential for maintenance and improvement of health among stroke survivors. Nevertheless, long-term participation in physical activities is low among people with disabilities. Active video games, such as Nintendo Wii Sports, might maintain interest and improve long-term participation in physical activities; however, the intensity of physical activity among chronic stroke patients while playing Wii Sports is unknown. We investigated the energy expenditure of chronic stroke patients while playing Wii Sports tennis and boxing. Methods: Ten chronic ([greater than or equal to] 6 months) stroke patients comprising a convenience sample, who were able to walk independently on level ground, were recruited from a rehabilitation centre. They were instructed to play Wii Sports tennis and boxing in random order for 15 minutes each, with a 10-minute break between games. A portable gas analyzer was used to measure oxygen uptake (VO2) during sitting and during Wii Sports game play. Energy expenditure was expressed in metabolic equivalents (METs), calculated as VO2 during Wii Sports divided by VO2 during sitting. We classified physical activity as moderate (3-6 METs) or vigorous (>6 METs) according to the American College of Sports Medicine and the American Heart Association Guidelines. Results: Among the 10 chronic stroke patients, 3 were unable to play tennis because they had problems with timing of hitting the ball, and 2 were excluded from the boxing group because of a technical problem with the portable gas analyzer. The mean ([plus/minus]SD) energy expenditure during Wii Sports game play was 3.7 ([plus/minus]0.6) METs for tennis and 4.1 ([plus/minus]0.7) METs for boxing. All 8 participants who played boxing and 6 of the 7 who played tennis attained energy expenditures >3 METs. Conclusions: With the exception of one patient in the tennis group, chronic stroke patients played Wii Sports tennis and boxing at moderate-intensity, sufficient for maintaining and improving health in this population

Inactive and sedentary lifestyles amongst ambulatory adolescents and young adults with cerebral palsy

Background: To assess physical behaviour, including physical activity and sedentary behaviour, of ambulatory adolescents and young adults with cerebral palsy (CP). We compared participant physical behaviour to that of able-bodied persons and assessed differences related to Gross Motor Functioning Classification System (GMFCS) level and CP distribution (unilateral/bilateral). Methods. In 48 ambulatory persons aged 16 to 24 years with spastic CP and in 32 able-bodied controls, physical behaviour was objectively determined with an accelerometer-based activity monitor. Total duration, intensity and type of physical activity were assessed and sedentary time was determined (lying and sitting). Furthermore, distribution of walking bouts and sitting bouts was specified. Results: Adolescents and young adults with CP spent 8.6% of 24 hours physically active and 79.5% sedentary, corresponding with respectively 123 minutes and 1147 minutes per 24 hours. Compared to able-bodie