The Effects of Telephone Intervention on Arthritis Self-Efficacy, Depression, Pain and Fatigue in Older Adults with Arthritis

The current study was conducted to examine the effects of telephone intervention on arthritis self-efficacy, depression, pain and fatigue in older adult patients in different clinical settings. Eighty-five subjects from two clinics were randomly assigned to either the control (n = 45) or intervention (n = 40) groups. The study was a mixed quantitative/qualitative design. Each subject completed several pre-tests including the Arthritis Self-Efficacy (ASE) scale, the Geriatric Depression scale (GDS), and numeric rating scales for both pain and fatigue. All subjects received an informational packet on self-management of arthritis and developed an action plan and personal goals for self-management of their arthritis over the next six weeks. Subjects in the intervention groups also received a brief educational session on the packet and were called once weekly for the next five weeks. The calls followed a script, addressing different sections of the informational packet. The calls were designed to be both instructional and motivational. Subjects in the control groups were not contacted until the sixth week. At that time all subjects were called and the assessment tools were re-administered. Quantitative data analysis (repeated measures ANOVA) showed a significant increase in ASE scores over time for both intervention and control groups. Qualitative data analysis revealed the emergence of several major themes that were supported by the subjects\u27 responses. The telephone interventions helped many of the participants initiate exercise programs for the first time in their lives. Participants also indicated that they were determined to adhere to these programs, that they would make other lifestyle changes that would assist their arthritis self-management, and that the telephone interventions were helpful in facilitating medical care for arthritis exacerbations and other medical problems. Telephone intervention was helpful in promoting adherence to exercise programs and other lifestyle changes that may assist older patients in the self-management of their arthritis, and was helpful in facilitating medical care. Arthritis education classes have been developed which have been shown to enhance the self-management of arthritis in older patients. Telephone intervention may be an alternative means of enhancing self-management for these individuals

33354 Efficacy of apremilast in patients with mild to moderate psoriasis assessed by the physician global assessment and body surface area composite tool: Post hoc analysis from ADVANCE

Background: In ADVANCE (NCT03721172), apremilast 30 mg BID (APR) demonstrated significantly greater sPGA response vs. PBO at Week 16 (22% vs. 4%; P \u3c.0001) in patients with mild-to-moderate psoriasis. The Physician Global Assessment and Body Surface Area Composite Tool (PGA × BSA) is a simple, sensitive measure of psoriasis severity for patients with BSA\u3c10%. We performed a post hoc analysis of the efficacy results from ADVANCE using the PGA×BSA. Methods: This current post hoc analysis included all randomized patients. Missing data were imputed by multiple imputation. PGAxBSA-50/75/90 was 50%, 75% and 90% improvement in PGAxBSA from baseline. Results: Of 595 randomized patients (APR: 297; PBO: 298), baseline characteristics were similar for mean BSA (APR: 6.4; PBO: 6.3), sPGA score 2 (APR 31%; PBO: 31%), sPGA score 3 (APR: 69%; PBO: 70%), and mean PGA×BSA (APR: 17.6; PBO: 17.5). At Week 16, significantly more patients achieved PGAxBSA-50/75/90 response with APR vs. PBO: PGA×BSA-50, 67% vs. 26% (P \u3c.0001), difference 41%, 95%CI (32.7,48.5) PGA×BSA-75, 46% vs. 13% (P \u3c.0001), difference 33%, 95%CI (25.8,40.2) PGA×BSA-90, 27% vs. 3% (P \u3c.0001), difference 24%, 95%CI (18.3,29.6) A significant improvement from baseline at Week 16 in PGA×BSA was observed with APR vs PBO: Mean % change (SE) in PGA×BSA, -51.8 (4.2) vs. 1.97 (4.3); difference (95%CI): -53.8 (-65.4, -42.2), P \u3c.0001. Conclusions: The PGA×BSA Composite Tool appeared to be a sensitive and a relevant measure for mild-to-moderate psoriasis that showed significantly greater treatment differences at 50%, 75%, and 90% response thresholds at Week 16 with APR compared with PBO in ADVANCE

26085 Key efficacy and safety of apremilast in patients with mild to moderate plaque psoriasis in the phase 3 ADVANCE trial

Background: In ADVANCE, apremilast 30 mg BID (APR) demonstrated efficacy in mild-to-moderate psoriasis vs placebo (PBO). We report subgroup analyses by baseline psoriasis-involved BSA (≤5%, \u3e5%). Methods: Biologic-naive adults with mild-to-moderate psoriasis (sPGA 2-3, BSA 2%-15%, PASI 2-15) inadequately controlled with or intolerant to ≥1 topical were randomized to APR or PBO for 16 weeks. At Week 16, endpoints were compared between treatment groups and by baseline BSA. Results: At baseline, 284 patients had BSA ≤5% (APR: 143; PBO: 141); 311 had BSA \u3e5% (APR: 154; PBO: 157). Overall, a greater proportion of APR patients achieved the primary endpoint, sPGA response (score 0/1 [clear/almost clear] with ≥2-point reduction at Week 16) vs PBO (21.6% vs 4.1%, P 5%: 54.6% vs 14.9%, P 5%: 45.4% vs 17.6%, P 5%: 50.6% vs 19.2%, P 5%: 11.0 vs 10.0 DLQI 5-point improvement (baseline DLQI \u3e5): - BSA≤5%: 56.6% vs 31.2%, P =.0002 - BSA\u3e5%: 64.4% vs 36.4%, P ˂.0001. Conclusions: Greater proportions of patients achieved efficacy outcomes and greater improvements in QOL with APR vs PBO. Comparable improvements were observed between mild and moderate subgroups

28043 Roflumilast cream significantly improves chronic plaque psoriasis in patients with steroid-sensitive area involvement

Roflumilast cream is a nonsteroidal, selective phosphodiesterase-4 inhibitor in development for plaque psoriasis (PsO). A double-blind, phase 2b trial randomized adults with PsO to once daily roflumilast 0.3%, 0.15%, or vehicle for 12 weeks (NCT03638258).(1) Efficacy was assessed using Investigator Global Assessment (IGA), Worst Itch Numeric Rating Scale (WI–NRS), and Psoriasis Symptom Diary (PSD). This posthoc analysis reports efficacy and safety in patients with steroid-sensitive area involvement (plaques on the face, neck, or in intertriginous areas). Of 331 patients, 160 had steroid-sensitive area involvement. The primary endpoint in the study, IGA status clear/almost clear at Week 6 was met by 27.2% patients with steroid sensitive areas (P =.007 vs vehicle), 22.3% (P =.026), and 6.3% on roflumilast 0.3%, roflumilast 0.15%, and vehicle, respectively; relative to 30.1% (P =.026), 24.1% (P =.098), and 12.0% patients without steroid-sensitive areas. Among patients with baseline WI–NRS score ≥4, 73.5%, 55.6%, and 32.6% of those with steroid-sensitive areas and 45.9%, 72.7%, and 23.7% of those without steroid-sensitive areas achieved a 4-point reduction with roflumilast 0.3%, 0.15%, or vehicle at Week 12. PSD improvement from baseline at Week 12 for patients with steroid-sensitive areas was -48.3 (P ˂.001), -43.1 (P =.012), and -24.9, and for patients without steroid-sensitive areas -35.7 (P =.003), -44.6 (P ˂.001), and -17.1. Most treatment emergent adverse events were mild to moderate and there was no evidence of local irritation. Once-daily roflumilast cream was well tolerated with significant improvements in investigator and patient assessed PsO outcomes in patients with steroid-sensitive area involvement on the face, neck, or intertriginous areas

The Social Power of Algorithms

This article explores the questions associated with what might be thought of as the social power of algorithms. The article, which introduces a special issue on the same topic, begins by reflecting on how we might approach algorithms from a social scientific perspective. The article is then split into two sections. The first deals with the issues that might be associated with an analysis of the power of the algorithms themselves. This section outlines a series of issues associated with the functionality of the algorithms and how these functions are powerfully deployed within social world. The second section then focuses upon the notion of the algorithm. In this section, the article argues that we need to look beyond the algorithms themselves, as a technical and material presence, to explore how the notion or concept of the algorithm is also an important feature of their potential power. In this section, it is suggested that we look at the way that notions of the algorithm are evoked as a part of broader rationalities and ways of seeing the world. Exploring the notion of the algorithm may enable us to see how algorithms also play a part in social ordering processes, both in terms of how the algorithm is used to promote certain visions of calculative objectivity and also in relation to the wider governmentalities that this concept might be used to open up

Personalization Paradox in Behavior Change Apps:Lessons from a Social Comparison-Based Personalized App for Physical Activity

Social comparison-based features are widely used in social computing apps. However, most existing apps are not grounded in social comparison theories and do not consider individual differences in social comparison preferences and reactions. This paper is among the first to automatically personalize social comparison targets. In the context of an m-health app for physical activity, we use artificial intelligence (AI) techniques of multi-armed bandits. Results from our user study (n=53) indicate that there is some evidence that motivation can be increased using the AI-based personalization of social comparison. The detected effects achieved small-to-moderate effect sizes, illustrating the real-world implications of the intervention for enhancing motivation and physical activity. In addition to design implications for social comparison features in social apps, this paper identified the personalization paradox, the conflict between user modeling and adaptation, as a key design challenge of personalized applications for behavior change. Additionally, we propose research directions to mitigate this Personalization Paradox