Health-related quality of life impairment and indirect cost of Crohn’s disease : a self-report study in Poland

Evidence on indirect cost of Crohn's disease (CD) is available but typically provides information on the loss of productivity at paid work of patients. In the present study, the quality of life and indirect costs of CD patients were assessed (overall and by disease severity).A self-report questionnaire-based study among adult Polish patients with CD was performed. We collected data on patients' characteristics, quality of life, loss of productivity, consumption of medical resources, and out-of-pocket expenses. The disease severity was determined using the patient's version of the Harvey-Bradshaw index. Productivity costs were assessed from the social perspective, using a human capital approach. The cost of absenteeism, presenteeism and permanent work disability was valuated using the gross domestic product per worker. The patients' productivity loss at unpaid work was measured by time inputs of others to assist patients. The productivity loss among informal caregivers and patients' productivity loss at unpaid work were valuated with the average wage in Poland. The results were adjusted for confounders.The responses from 200 patients (47% in remission) were analysed. The mean utility index was 0.839 (SD 0.171). The total indirect cost was estimated at €462.47 per patient per month (24.0%, absenteeism; 35.0%, work disability; 30.4%, presenteeism; 0.4%, productivity loss at unpaid work; and 10.4%, informal care). A significant correlation of the quality of life and productivity losses with disease severity was observed. Compared with active disease, the remission subgroup had a higher utility index by 16% (p<0.001) and lower indirect costs by 71% (p = 0.003) for absenteeism, 41% (p = 0.030) for presenteeism, 76% (p<0.001) for productivity loss at unpaid work, and 75% (p<0.001) for informal care.Our study revealed the social burden of CD and high dependency of indirect costs and quality of life on the severity of CD in Poland

Effectiveness of fixed-dose combination therapy in hypertension : systematic review and meta-analysis

Introduction: Clinical studies have revealed that fixed-dose combinations (FDCs) of drugs can have a better effect on blood pressure than free-equivalent combinations (FECs). Our objectives were to perform an up-to-date assessment of the effectiveness of FDCs and FECs in antihypertensive therapy, to provide more accurate results by using a stratified meta-analysis. Material and methods: A systematic review was performed in PubMed, Web of Science, and Cochrane databases according to PRISMA guidelines. The outcomes were adherence (compliance), persistence to medication, reduction of blood pressure and the safety profile. We used the Newcastle Ottawa scale or the Delphi list for the assessment of the quality of cohort studies or clinical trials, respectively. Heterogeneity was assessed using the Cochrane Q test and I2 statistic. Results: Of 301 abstracts screened, 26 primary studies and 2 other metaanalyses were identified, of which 12 studies were included in the metaanalyses and 3 studies were included in the narrative review. The FDC treatment is associated with a significant improvement in adherence and persistence in comparison with FEC treatment, e.g., the average medicine possession ratio increased with FDC by 13.1% (p < 0.001). For endpoints correlated with higher adherence (e.g., a reduction in blood pressure), a nonsignificant benefit was observed for FDCs. Moreover, it was demonstrated that higher adherence can lead to a lower risk of cardiovascular events. Conclusions: In comparison with FECs, the FDC treatment is associated with a significant improvement in the cooperation between a doctor and a patient and with increased patients’ adherence to the treatment schedule

Disease activity, quality of life, and indirect costs of ulcerative colitis in Poland

Introduction: Ulcerative colitis (UC) require expensive, lifelong treatment, which generates huge direct costs and has a significant impact on the quality of life, especially in the active state of the disease. Aim: To assess the indirect costs, health-related quality of life, and clinical characteristics of patients with UC in Poland. Additionally, we investigated the association between activity of UC and productivity loss of patients in a Polish setting. Material and methods: A questionnaire survey was conducted using the Patient Simple Clinical Colitis Activity Index (P-SCCAI) to assess disease activity, as well as the modified Work Productivity and Activity Impairment Questionnaire to assess productivity loss. The quality of life was presented as utility calculated with the EQ-5D-3L questionnaire. Indirect costs were assessed with the Human Capital Approach and were expressed in Polish zlotys (PLN) as well as in euros (€). Correlations were presented using the Spearman coefficient. Results: We performed our analysis based on 202 full questionnaires collected. Mean patient age and age at disease onset were 33.14 years (standard deviation (SD): 9.90) and 26.35 years (SD: 8.89), respectively. The mean P-SCCAI score in the analysed group of patients was 8.26, and the mean utility was 0.8651. Average and median annual indirect costs per working person were €2043 and €1389 (8543 PLN and 5808 PLN), respectively, calculated using the gross domestic product, as well as €4791 and €3257 (20,026 PLN and 13,615 PLN), respectively, calculated using the gross value added. Total productivity loss was significantly correlated with the disease activity. Conclusions: Ulcerative colitis causes a decrease in the quality of life as well as patients’ productivity loss associated with both absenteeism and with presenteeism

Removal of nickel(II) and lead(II) ions from aqueous solution using peat as a low-cost adsorbent: A kinetic and equilibrium study

AbstractAnalysis was carried out to determine the physicochemical characteristics – morphological and structural, electrokinetic properties, elemental composition and functional groups – of peat, with a view to its use as a potential adsorbent of heavy metal ions from aqueous solutions. A significant part of the study comprised tests of adsorption of nickel(II) and lead(II) ions from model solutions. It was determined how the parameters of the adsorption process (time, pH, quantity of sorbent) influence the effectiveness of removal of nickel(II) and lead(II) ions. The adsorption kinetics are also described, using a pseudo-first-order model and pseudo-second-order models of types 1–4. The results show strong correspondence to a pseudo-second-order kinetics model of type 1 (r2=0.999 for all initial concentrations). Another key part of the analysis was the use of the Langmuir and Freundlich models to determine the adsorption isotherms. The experimental data were in strong correspondence with Langmuir’s isotherm model. The sorption capacities of peat with respect to nickel(II) and lead(II) ions were 61.27mg(Ni2+)/g and 82.31mg(Pb2+)/g. Desorption tests confirmed the possibility of reusing peat as an effective sorbent of environmentally harmful metals. A mechanism is also proposed for the adsorption of Ni2+ and Pb2+ ions on adsorbent

Serum pentraxin 3 concentration in patients with type 2 diabetes and nonalcoholic fatty liver disease

INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) is common in patients with type 2 diabetes (T2D). Pentraxin 3 (PTX3), a marker of inflammation, is a cardiovascular risk factor. OBJECTIVES We examined clinical and biochemical factors associated with serum PTX3 concentrations in patients with T2D with and without NAFLD. PATIENTS AND METHODS Serum material was obtained from 116 patients with T2D (mean age, 59.1 years), including 79 patients with NAFLD. RESULTS Median (interquartile range) PTX3 level was 4.264 (2.293) ng/ml in patients with and 3.773 (3.223) ng/ml in patients without NAFLD (P = 0.93). In the whole group, PTX3 level was associated with total cholesterol, low‑density lipoprotein cholesterol (LDL‑C), apolipoprotein (apo) B100, apo C3, triglyceride (TG) concentrations, and waist circumference after adjustment for age and gender. As indicated by partial regression coefficient b, increase of independent variable LDL‑C by 1 mmol/l was associated with the rise of PTX3 by 1.2017 ng/ml, increase of apo B100 by 1 mg/dl with the rise of PTX3 by 1.0051 ng/ml, and increase of apo C3 by 1 μg/dl with the rise of PTX3 by 1.0012 ng/ml. In patients with T2D with NAFLD, total cholesterol, LDL‑C, TG, apo C3, and apo B100 were associated with PTX3. Associations of PTX3 with apolipoproteins were observed only in the NAFLD group. CONCLUSIONS Reported associations of PTX3 level add new insight into possible mechanisms of its atherogenic actions

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