Performance of the EQ-5D in Patients with Irritable Bowel Syndrome

ABSTRACTObjectiveThe EQ-5D is a standardized, nondisease-specific instrument for evaluating patients' preference-based valuations of health-related quality of life (HRQoL). This study's purpose was to determine the psychometric properties of EQ-5D in patients with irritable bowel syndrome (IBS).MethodsData from four European IBS studies were assessed: UK (n = 161 and n = 297), Spain (n = 503), and Germany (n = 100). The EQ-5D is a five-item health state descriptive system used to develop health states (EQ-5DINDEX) and a visual analog scale (VAS) (0–100 from worst to best imaginable health state, EQ-5DVAS). Measures used with the EQ-5D included the SF-36, Irritable Bowel Syndrome—Quality of Life (IBS-QOL), and both subjective and clinical global assessments of IBS. Convergent validity was assessed using SF-36 and IBS-QOL data, discriminant validity using global ratings of IBS severity, and responsiveness by subjective and physician assessment of condition.ResultsModerate-to-high associations (r ≥ 0.33) were seen between the EQ-5DVAS and the SF-36 and IBS-QOL subscales. Mean response scores to EQ-5DINDEX dimensions and the EQ-5DVAS score were significantly better for control patients than for patients with IBS (all P < 0.01). The EQ-5DVAS was able to discriminate between levels of pain severity (quartiles, P < 0.001; mild/moderate/severe, P < 0.05) and general health severity (mild/moderate/severe, P < 0.001). The EQ-5DVAS and the EQ-5DINDEX were responsive in patients using both a self-perceived (Subject's Global Assessment) and physician-rated (Clinic Global Assessment) improvement.ConclusionsThe EQ-5D performs well in comparison to general and disease-specific outcomes. It is a valid and responsive measure that can be used to generate preference-based valuations of HRQoL in patients with IBS and useful for comparisons in clinical and cost-effectiveness studies

Further Validation of an Individualized Migraine Treatment Satisfaction Measure

AbstractObjectiveTo assess individualized satisfaction with migraine treatment, patient expectations, importance rankings, treatment outcomes, and overall satisfaction were combined using a four-part conceptual model. This article describes the measurement properties of the Migraine Treatment Satisfaction Measure (MTSM) using participants from a randomized controlled trial evaluating a Headache Management Program (HMP).MethodsParticipants completed the first two parts of the MTSM upon enrollment and the final two parts at 6 months. Internal consistency reliability was computed within each of the four modules. Discriminant validity was ascertained using Migraine Disability Assessment Survey (MIDAS), Patient Health Questionnaire-9, and MSFB scores. Convergent validity was established by hypothesized positive correlations between MTSM scores, Medical Outcomes Study Short-Form (SF-36), MIDAS, and Migraine Symptom Frequency Bother (MSFB).ResultsIn total, 124 participants (mean age 45.4 years, 75% women, 59.7% Caucasian) enrolled. Internal consistency for expectations, importance rankings, outcomes, and satisfaction measures was 0.83, 0.95, 0.86, and 0.95, respectively. As the severity of depression increased, MTSM scores decreased significantly. ANOVA between MTSM scores and symptom bothersomeness and symptom frequency tertiles showed a significant decrease in satisfaction in the moderate-to-severe groups. MTSM scores showed expected associations with MSFB scores (−0.301; P < 0.01), MIDAS (−0.267; P < 0.01), general health (0.253; P < 0.05), mental health (0.217; P < 0.05), and vitality subscales of SF-36 (0.214; P < 0.05). Patients in the HMP reported significantly higher MTSM scores (43.2 vs. 31.4; P < 0.001). Patients on triptans reported a significantly higher satisfaction compared to patients on analgesics (39.5 vs. 32.9; P < 0.05).ConclusionThe MTSM is a valid and reliable patient-reported outcome that can be used to evaluate differences in treatment satisfaction associated with migraine therapies

Validation of Electronic Data Capture of the Irritable Bowel Syndrome—Quality of Life Measure, the Work Productivity and Activity Impairment Questionnaire for Irritable Bowel Syndrome and the EuroQol

ABSTRACTObjectivesTo assess the comparability, reliability, and subject acceptability of electronic data capture (EDC) versions of Irritable Bowel Syndrome—Quality of Life (IBS-QOL), EuroQoL (EQ-5D) and Work Productivity and Activity Impairment (WPAI:IBS) instruments.MethodsComparability of EDC and paper questionnaires was evaluated in 72 subjects with IBS who completed a baseline EDC or paper questionnaire, a crossover questionnaire 24 hours later, and a retest of the crossover version at 1 week. The EDC version was presented on a hand-held device. Comparability was assessed using paired t-test statistics, intraclass correlation coefficients (ICC) and tests for internal consistency (Cronbach's alpha).ResultsNo significant differences were found between scores obtained by paper questionnaire and EDC at the baseline and crossover assessments. ICCs between baseline and crossover assessments ranged from 0.83 to 0.96 for the IBS-QOL scores, 0.82 to 0.96 for the WPAI:IBS scores, and 0.77 to 0.82 for the EQ-5D. Internal consistency was comparable for the two data collection methods for the IBS-QOL overall score (0.96) and subscales and the EQ-5D Index (0.70 vs. 0.74). Retest statistics (ICC) were generally comparable between the EDC and paper versions for all scores. Ease of use was comparable for the two modes of administration, but more patients preferred EDC (47.2%) than the paper questionnaire (23.6%).ConclusionsEDC versions of the IBS-QOL, EQ-5D, and WPAI:IBS are comparable to paper questionnaires in internal consistency and test–retest reliability, and have greater patient acceptability

Incubation parameters, offspring growth, and behavioral adaptations to heat stress of Black Skimmers (Rynchops niger) in a Neotropical inland colony (Aves, Charadriiformes, Laridae)

This study focuses on incubation parameters, egg morphometrics, and body mass development, hatching, and behavioral adaptations to heat stress within a colony of freshwater-breeding Black Skimmers (Rynchops niger) located in the private nature reserve of Serviço Social do Comércio (SESC) in the northern Pantanal, Mato Grosso, Brazil. Temperatures of nest, eggs, and surface substratum, as well as the development of embryos, were surveyed using thermal imaging, a method allowing digital recording from a distance and in a fraction of the time of traditional measuring techniques. The mean egg dimensions (n = 71) were 4.48 (± 0.13) × 3.27 (± 0.07) cm; the mean mass at hatching was 24.3 (± 1.9) g, with a significant decrease over incubation time. The mean surface temperature of eggs varied from 30.9℃ to 39.7℃, while the sand surface temperature was 20℃ at 06:00 h, rising to 47.7℃ at 11:00 h. There was a significant increase (7%) in egg surface temperature throughout incubation. Incubation-bout durations (n = 2108) were correlated with the microclimatic conditions of the substratum, becoming shorter with increasing sand-surface temperature around midday. Egg hatching lasted one day, and siblings hatched no more than 24 h apart. The mean body mass on Day 1 after hatching was 16.8 (± 1.6) g (n = 6). Three days after hatching, chicks moved to new sand depressions provided by parents near the original nest, where they remained motionless or tried to hide under riparian vegetation. The single chick that fledged had a growth rate of K = 0.117 and a t₁₀₋₉₀ value of 37.3 days. On Day 7, dorsal pintail feathers and primaries appeared, which were open on Day 15. After 14 days, the chick was able to regulate its body temperature, and no more feeding by parental birds during the daytime was observed. On Day 21, the immature plumage was fully developed. Fledging was completed on Day 27. Our study demonstrates that thermal imaging is a useful method of surveying egg and embryo development in the Black Skimmer, reducing nest disturbance and observation efforts

Behavioral and Other Phenotypes in a Cytoplasmic Dynein Light Intermediate Chain 1 Mutant Mouse

The cytoplasmic dynein complex is fundamentally important to all eukaryotic cells for transporting a variety of essential cargoes along microtubules within the cell. This complex also plays more specialized roles in neurons. The complex consists of 11 types of protein that interact with each other and with external adaptors, regulators and cargoes. Despite the importance of the cytoplasmic dynein complex, we know comparatively little of the roles of each component protein, and in mammals few mutants exist that allow us to explore the effects of defects in dynein-controlled processes in the context of the whole organism. Here we have taken a genotype-driven approach in mouse (Mus musculus) to analyze the role of one subunit, the dynein light intermediate chain 1 (Dync1li1). We find that, surprisingly, an N235Y point mutation in this protein results in altered neuronal development, as shown from in vivo studies in the developing cortex, and analyses of electrophysiological function. Moreover, mutant mice display increased anxiety, thus linking dynein functions to a behavioral phenotype in mammals for the first time. These results demonstrate the important role that dynein-controlled processes play in the correct development and function of the mammalian nervous system

Adaptation of a microbial detection array as a monitoring tool revealed the presence 2 of mosquito-borne viruses and insect-specific viruses in field-collected mosquitoes

Several mosquito-borne diseases affecting humans are emerging or re-emerging in the United States. The early detection of pathogens in mosquito populations is essential to prevent and control the spread of these diseases. In this study, we tested the potential applicability of the Lawrence Livermore Microbial Detection Array (LLMDA) to enhance bio-surveillance by detecting microbes present in Aedes aegypti, Aedes albopictus and Culex mosquitoes that are major vector species globally, including in Texas. The sensitivity and reproducibility of the LLMDA was tested in mosquito samples spiked with different concentrations of dengue virus (DENV) revealing a detection limit of \u3e100 but \u3c1000 pfu/mL. Additionally, field-collected mosquitoes from Chicago, Illinois and College Station, Texas of known infection status (West Nile virus (WNV) and Culex flavivirus (CxFLAV) positive) were tested on the LLMDA to confirm its efficiency. Mosquito field samples of unknown infection status, collected in San Antonio, TX and the Lower Rio Grande Valley (LRGV), TX were run on the LLMDA and further confirmed by PCR or qPCR. The analysis of the field samples with the LLMDA revealed the presence of cell fusing agent virus (CFAV) in Ae. aegypti populations. Wolbachia was also detected in several of the field samples (Ae. albopictus and Culex spp.) by the LLMDA. Our findings demonstrated that the LLMDA can be used to detect multiple arboviruses of public health importance including viruses that belong to the Flavivirus, Alphavirus and Orthobunyavirus genera. Additionally, insect-specific viruses and bacteria were also detected from field-collected mosquitoes. Another strength of this array is its ability to detect multiple viruses in the same mosquito pool allowing for the detection of co-circulating pathogens in an area, and the identification of potential ecological associations between different viruses. This array can aid in the bio-surveillance of mosquito borne viruses circulating in specific geographical areas

Do people favour policies that protect future generations? Evidence from a British survey of adults

Long-range temporal choices are built into contemporary policy-making, with policy decisions having consequences that play out across generations. Decisions are made on behalf of the public who are assumed to give much greater weight to their welfare than to the welfare of future generations. The paper investigates this assumption. It briefly discusses evidence from sociological and economic studies before reporting the findings of a British survey of people's intergenerational time preferences based on a representative sample of nearly 10,000 respondents. Questions focused on two sets of policies: (i) health policies to save lives and (ii) environmental policies to protect against floods that would severely damage homes, businesses and other infrastructure. For both sets of policies, participants were offered a choice of three policy options, each bringing greater or lesser benefits to their, their children's and their grandchildren's generations. For both saving lives and protecting against floods, only a minority selected the policy that most benefited their generation; the majority selected policies bringing equal or greater benefits to future generations. Our study raises questions about a core assumption of standard economic evaluation, pointing instead to concern for future generations as a value that many people hold in common

Multimodal MRI as a diagnostic biomarker for amyotrophic lateral sclerosis

Objective Reliable biomarkers for amyotrophic lateral sclerosis ( ALS ) are needed, given the clinical heterogeneity of the disease. Here, we provide proof‐of‐concept for using multimodal magnetic resonance imaging ( MRI ) as a diagnostic biomarker for ALS . Specifically, we evaluated the added diagnostic utility of proton magnetic resonance spectroscopy ( MRS ) to diffusion tensor imaging ( DTI ). Methods Twenty‐nine patients with ALS and 30 age‐ and gender‐matched healthy controls underwent brain MRI which used proton MRS including spectral editing techniques to measure γ‐aminobutyric acid ( GABA ) and DTI to measure fractional anisotropy of the corticospinal tract. Data were analyzed using logistic regression, t ‐tests, and generalized linear models with leave‐one‐out analysis to generate and compare the resulting receiver operating characteristic ( ROC ) curves. Results The diagnostic accuracy is significantly improved when the MRS data were combined with the DTI data as compared to the DTI data only (area under the ROC curves ( AUC ) = 0.93 vs. AUC  = 0.81; P  = 0.05). The combined MRS and DTI data resulted in sensitivity of 0.93, specificity of 0.85, positive likelihood ratio of 6.20, and negative likelihood ratio of 0.08 whereas the DTI data only resulted in sensitivity of 0.86, specificity of 0.70, positive likelihood ratio of 2.87, and negative likelihood ratio of 0.20. Interpretation Combining multiple advanced neuroimaging modalities significantly improves disease discrimination between ALS patients and healthy controls. These results provide an important step toward advancing a multimodal MRI approach along the diagnostic test development pathway for ALS.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106065/1/acn330.pd

Post-diagnosis serum insulin-like growth factors in relation to dietary and lifestyle changes in the Prostate testing for cancer and Treatment (ProtecT) trial.

PURPOSE: The insulin-like growth factor (IGF) system is modifiable by diet and lifestyle, and has been linked to prostate cancer development and progression. METHODS: We conducted a prospective cohort study of 621 men diagnosed with localized prostate cancer to investigate the associations of dietary and lifestyle changes with post-diagnosis circulating levels of IGF-I and IGFBP-3. We used analysis of covariance to estimate the associations, controlling for baseline IGF-I or IGFBP-3, respectively. RESULTS: Mean IGF-I levels were 6.5% (95% CI -12.8, -0.3%, p = 0.04) lower in men who decreased their protein intake after diagnosis compared to men who did not change. Men who changed their fruit and vegetable intake had lower IGF-I levels compared to non-changers [Decreased intake: -10.1%, 95% CI -18.4, -1.8%, p = 0.02; Increased intake: -12.0%, 95% CI -18.4, -1.8%, p = 0.002]. IGFBP-3 was 14.6% (95% CI -24.5, -4.8%, p = 0.004) lower in men who achieved a healthy body mass index after diagnosis. Men who became inactive had 9.5% higher average IGF-I levels (95% CI 0.1, 18.9%, p = 0.05). CONCLUSIONS: Decreased protein intake and body mass index, and increased physical activity and fruit and vegetable intake, following a prostate cancer diagnosis were associated with reduced post-diagnosis serum IGF-I and IGFBP-3. Counterintuitively, reduced fruit and vegetable intake was also associated with reduced IGF-I, but with weak statistical support, possibly implicating chance. If confirmed in other studies, our findings may inform potential lifestyle interventions in prostate cancer. ProtecT was registered at International Standard Randomised Controlled Trial Registry, http://isrctn.org as ISRCTN20141297