Psychological Treatment for Headache : A Pilot Study on the Efficacy of Joint Psychoeducational Group and Relaxation Training

Headache is a severe and disabling chronic condition. Literature shows that psycho-educational interventions may be useful for several chronic pain disorders. We tested an integrated psycho-educational and relaxation intervention addressed to patients suffering from headache. The outcome indicators are a direct measure of headache (headache days per month) and two indirect measures (disability due to headache and medications used). At the end of the intervention patients also filled in a satisfaction questionnaire. Forty-seven subjects participated to the study. The treatment significantly reduced frequency of headache attacks (Wilcoxon p<0.01) and disability caused by headache (Wilcoxon p<0.001). There was also a sensible reduction in medication use. Almost all patients judged the intervention positively. An integrated approach may be very useful to ameliorate the burden of headache, to discontinue medication and to improve quality of lif

Poprawa jakości życia i aktywności chorych na migrenę po leczeniu profilaktycznym. Wieloośrodkowe, długotrwałe badanie prospektywne

Głównym celem w leczeniu migreny jest poprawa jakości życia warunkowanej stanem zdrowia (HRQOL, health-related quality of life) i zmniejszenie ograniczeń aktywności. Brakuje jednak danych dotyczących wpływu leczenia profilaktycznego na wymienione parametry. U 141 kolejno zgłaszających się pacjentów z migreną bez aury, u których stosowano leczenie profilaktyczne, autorzy monitorowali zmiany HRQOL przy użyciu kwestionariusza Short Form 36 (SF-36) i ograniczenie aktywności związane z bólami głowy za pomocą kwestionariusza Migraine Disability Assessment Score (MIDAS). Trwające 3 miesiące badanie ukończyło łącznie 102 pacjentów. Średnia (SD, standard deviation) liczba dni z bólami głowy w ciągu miesiąca zmniejszyła się z 8,0 (3,7) do 5,0 (2,3) (p < 0,001). Średnie miesięczne stosowanie leków doraźnych zmalało z 7,4 (3,5) do 4,4 (3,1) (p < 0,001). Całkowity wynik w skali MIDAS zmniejszył się znacząco (poprawa). Wszystkie wyniki uzyskane z użyciem skal SF-36 wzrosły (poprawa), przy czym większość z nich w sposób znaczący. Jest to pierwsze badanie, w którym prospektywnie oceniono wpływ leczenia profilaktycznego na HRQOL i aktywność codzienną w dużej serii grupie chorych. Wskazuje ono, że leczenie profilaktyczne może zmniejszyć indywidualne i społeczne obciążenia związane z migreną

A cost-effectiveness analysis of shortened direct-acting antiviral treatment in genotype 1 noncirrhotic treatment-naive patients with chronic hepatitis C virus

BACKGROUND:Direct-acting antivirals are successful in curing hepatitis C virus infection in more than 95% of patients treated for 12 weeks, but they are expensive. Shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs. OBJECTIVES:To evaluate the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 noncirrhotic treatment-naive patients. METHODS:Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare 3 unstratified shortened treatment durations (8, 6, and 4 weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were re-treated with a 12-week treatment regimen. Parameter inputs were taken from published studies. RESULTS:The 8-week treatment duration had an expected incremental net monetary benefit of £7737 (95% confidence interval £3242-£11 819) versus the standard 12-week treatment, per 1000 patients. The 6-week treatment had a positive incremental net monetary benefit, although some uncertainty was observed. The probability that the 8- and 6-week treatments were the most cost-effective was 56% and 25%, respectively, whereas that for the 4-week treatment was 17%. Results were generally robust to sensitivity analyses, including a threshold analysis that showed that the 8-week treatment was the most cost-effective at all drug prices lower than £40 000 per 12-week course. CONCLUSIONS:Shortening treatments licensed for 12 weeks to 8 weeks is cost-effective in genotype 1 noncirrhotic treatment-naive patients. There was considerable uncertainty in the estimates for 6- and 4-week treatments, with some indication that the 6-week treatment may be cost-effective

Plasma long-chain polyunsaturated fatty acids and neurodevelopment through the first 12 months of life in phenylketonuria

The aims of the study were to examine the relationship between long-chain polyunsaturated fatty acid (LCPUFA) status at diagnosis of phenylketonuria (PKU) and neurodevelopment through the first 12 months of life, and to and bottlefed in the first days of life on the basis of LCPUFA status. Twenty infants with PKU were prospectively examined through the first year of life. Plasma fatty acids were measured in infants at diagnosis. Plasma phenylalanine levels were determined monthly. Main outcome measures were the Bayley Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) at 5 and 12 months of age, and the visual function at 12 months, evaluated by P100 wave latencies with visual evoked potentials. A higher PDI score was associated with higher plasma arachidonic acid at diagnosis (adjusted correlation coefficient of PDI at 5 months, r=0.38, p=0.05). P100 wave latency at 15 minutes of arc (15\u2032) was associated with the early plasma arachidonic acid (adjusted r=-0.56, p=0.02) and phenylalanine levels at 12 months (adjusted r=0.22, p=0.05). No association was found between MDI score and any essential fatty acids. Breastfed infants exhibited higher plasma arachidonic acid (mean difference, \u394=3.4%; 95% confidence interval [CI]=1.2-5.6%) and shorter P100 wave latency at 15' (\u394=-21ms, 95%CI=-30 to -12) than bottlefed infants. Within the population of this study, a weak positive association has been found between plasma LCPUFAs at diagnosis (higher in breastfed infants) and neurodevelopmental indices through the first year of life

Polychlorinated biphenyls in colostral milk and visual functionat 12 montsh of life

Background and aims: Environmental contaminants such as persistent organic chlorines and heavy metals, which are supplied to the foetus by transplacental transfer and to breastfed infants by the milk, may impair cognitive functions. Long-chain polyunsaturated fatty acids, which are known to enhance development during foetal life and early infancy, may counteract the toxic effect of environmental contaminants. In this study, we have investigated whether polychlorinated biphenyls (PCBs) impair early development of vision, and whether such impairment can be modulated by essential long-chain polyunsaturated fatty acids. Material: Healthy term infants born in Milan and its surroundings, and who were exclusively breastfed for at least 4 mo, were prospectively examined up to the age of 12 mo. Methods: Samples from colostrums, the first 2 d after delivery, and of mature breast-milk after 1 and 3 mo were collected. The samples were analyzed for PCB 105, 118, 138, 153, 156 and 180 and for DDT and DDE. In all infants, the plasma levels of the long-chain polyunsaturated fatty acids (LC-PUFAs), C18:2 n-6, C18:3 n-3, C20:4 n-6, C20:5 n-3 and C22:6 n-3 were analysed within the first three postnatal days. The PCB levels in colostral milk, as well as of LC-PUFAs in plasma, were considered to mirror perinatal supply. Visual function was evaluated by P100 with latency evoked potentials (VEPs) at 12 mo of age. Statistical analysis was based on simple and partial correlation coefficients (p < 0.05). Results: On bivariate analysis, wave latency VEP at 15 min was significantly related to the colostral levels of DDT, DDE and all examined PCBs except PCB 105 (with correlation coefficient r = 0.401 to 0.618), whereas P100 wave latency VEP at 60 min was related to DDT (r = 0.513) and PCB 180 (r = 0.504). Infant plasma levels of C22:6 n-3 were inversely associated with P100 wave latency at 60 min (r = -0.418) and at 1 Hz-2 J (r = -0.466). After controlling for C22:6 n-3, the partial correlation coefficient of P100 wave latency VEP at 15 min to the colostral level of PCB 180 was 0.403 (p = 0.07). Conclusion: Within the population of this study, a weak relation was found between impaired visual function at 12 mo of age of healthy infants and the levels of PCBs, DDT and DDE in colostral milk. The effect of impairment was no longer evident after controlling for the plasma level of LC-PUFAs as found in the infant a few days after birth