Patients’ experiences of coping with Idiopathic Pulmonary Fibrosis and their recommendations for its clinical management

BackgroundIdiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive and life-limiting condition. From a healthcare perspective it is vital to establish effective methods of improving the quality of remaining life in these patients. This requires a detailed understanding of the multiple impacts of an IPF diagnosis on the individual.MethodsWe sought to understand how patients coped with their initial diagnosis, how they live with the disease day-to-day, and their experiences and opinions of the professional support they receive. A patient-centred approach was used to explore the social, psychological and physical impacts of IPF. Semi-structured interviews were conducted by an experienced academic. Interview questions were written by the researchers but guided by informal conversations with patients and clinicians. An inductive thematic approach was used to analyse the data, allowing us to identify common themes in the patients’ experiences.ResultsOf fifty invited participants, ten took part in the study (aged 53–81 years; 9 male). Inductive analysis of interviews identified seven second-order themes and eleven first-order themes, represented by two General Dimensions: ‘Patient experience with the condition’ and ‘Patient-led recommendations for practice’. The key message on ‘coping’ in these patients was that acceptance of their condition led to a sense of optimism. Participants reported using appraisal-focused coping strategies to change their perspectives (thinking positively) and emotion-focused strategies to overcome depression (the main opportunity for emotional expression being an IPF support group). The support group also facilitated problem-focused coping: individuals exchanged knowledge and experience and gave one another tips on how to live with their condition.ConclusionsHealth professionals should provide patients with information that focuses on living with IPF, encouraging them to make lifestyle changes and adaptations to improve quality of life. Family members should receive education about IPF so that they can support such changes. Patients should be encouraged to join a support group and to participate in physical activity (again preferably group-based). This study offers novel findings that will help inform much-needed changes in the practice of supporting IPF patients to cope with their diagnosis and disease progression

Cost-effectiveness analysis of paediatric mental health interventions: a systematic review of model-based economic evaluations

Mental health disorders among children and youth are causing significant burden on health care systems. Hence, identifying cost-effective interventions is important for effective mental health care allocation. Although model-based economic evaluations are an essential component of assessing cost-effectiveness, evidence are limited in the context of child and youth mental health care. The objective was to systematically review the model-based economic evaluations of mental health interventions for children and youth. Methods: Four databases (MEDLINE, EMBASE, PsycINFO and Web of Science) were searched using appropriate search terms to retrieve model-based economic evaluations of mental health interventions for children and youth. The reporting quality of the included studies were appraised using the Consolidated health economic evaluation reporting standards (CHEERS) checklist. Results: The database search yielded 1921 records. Of the 12 selected for review, 66% were published after year 2015. Most of the studies were related to anxiety and post-traumatic stress disorder. There were eight cost-utility studies, three cost-effectiveness studies, and one study using both forms of analysis. Six studies used Markov models, three used decision trees, and three studies used both types of models. However, the model structure, health states, time horizon, and economic perspective showed wide variation. The reporting quality of the included studies varied from 91% to 96%. Conclusion: Model based mental health economic evaluations among children and youth are increasingly being reported in recent research. The included studies used Markov models and decision trees, either alone or in combination, and the majority of the articles were of good reporting quality

Prevalence and risk factors for impaired kidney function in the district of Anuradhapura, Sri Lanka: a cross-sectional population-representative survey in those at risk of chronic kidney disease of unknown aetiology.

BACKGROUND: Over the last 20 years there have been reports of a form of chronic kidney disease of unknown cause (CKDu) affecting rural communities in the North Central Province of Sri Lanka. Valid prevalence estimates, using a standardised methodology, are needed to assess the burden of disease, assess secular trends, and perform international comparisons. METHODS: We conducted a cross-sectional representative population survey in five study areas with different expected prevalences of CKDu. We used a proxy definition of CKDu involving a single measure of impaired kidney function (eGFR< 60 mL/min/1.7m2, using the CKD-Epi formula) in the absence of hypertension, diabetes or heavy proteinuria. RESULTS: A total of 4803 participants (88.7%) took part in the study and 202 (6.0%; 95% CI 5.2-6.8) had a low eGFR in the absence of hypertension, diabetes and heavy proteinuria and hence met the criteria for proxy CKDu. The proportion of males (11.2%; 95% CI 9.2-13.1) were triple than the females (3.7%; 95% CI 2.9-4.5). Advancing age and history of CKD among parents or siblings were risk factors for low GFR among both males and females while smoking was found to be a risk factor among males. CONCLUSIONS: These data, collected using a standardised methodology demonstrate a high prevalence of impaired kidney function, not due to known causes of kidney disease, in the selected study areas of the Anuradhapura district of Sri Lanka. The aetiology of CKDu in Sri Lanka remains unclear and there is a need for longitudinal studies to describe the natural history and to better characterise risk factors for the decline in kidney function

Prediction of graft survival and cost effectiveness of kidney transplantation according to donor quality levels in Australia

This thesis sought to better understand how quality of donor kidneys and allocating kidneys based on the presumed longevity can increase value for money in donor kidney use. It showed that remaining on dialysis in the hope of receiving a superior-quality kidney is not a cost-effective strategy for any age group. If the Australian kidney allocation system can enable low-quality kidneys for older recipients, this will reduce discard rates, and promote the best value for all donated kidneys. The new index developed to predict graft failure demonstrated adequate potential to make pre-transplantation predictions about the longevity of a donated kidney

Prevalence of selected health issues among workers in small scale industries in Sri Lanka

Background: Current study was done to assess the prevalence of selected health issues among workers, in small scale industries in a district in Sri Lanka.Methods: A cross sectional study was conducted among workers in four selected small scale industry categories namely food and beverages, apparel, non metallic mineral products and fabricated metal products in a district of Sri Lanka. Data was collected using an interviewer administered questionnaire.Results: Analysis was based on 727 workers. The prevalence of headache (2.2%, 95% CI 1.5 – 3.1) and eye problems (2.1%, 95% CI 1.4 – 2.9) were the commonest general health issues detected. Back pain was the most prevalent work related musculoskeletal pain reported by the participants (6.1%, 95% CI 4.8 – 7.8). Most of the work-related musculoskeletal pain was either of short duration (lasting 1- 6 days) or long lasting (more than 2 weeks).Conclusion: Musculoskeletal diseases are prevalent among the study population. This needs to be investigated in-depth to identify the correlates to plan interventions.</p

Hypertension in a rural community in Sri Lanka: Prevalence, associated factors and its effect on the renal profile

Introduction: Chronic kidney disease (CKD) in which the disease cannot be attributed to any known cause is named CKD of uncertain aetiology (CKDu). The main aims of this analysis were to estimate the prevalence of hypertension and to identify the associated factors in a rural community vulnerable to CKDu and to identify the effect of hypertension on the renal profile among this community. Methods: We conducted a cross-sectional representative population survey in five study areas in Anuradhapura district, a rural district in Sri Lanka. Blood pressure, blood glucose, bioimpedance measurements and renal profile were measured using standard instruments and protocols. Results: A total of 4803 participants (88.7%) took part in the study. The overall prevalence of hypertension in the study population was 26.3% (95% confidence interval 25.0-27.5). Among those who were previously diagnosed, only 17.3% had normal blood pressure. Increasing age, family history of hypertension, presence of diabetes mellitus, estimated glomerular filtration rate (EGFR) less than 60 ml/min per 1.7m2 and increasing BMI were independently associated with having hypertension. High prevalence of hypertension was observed among those who had EGFR less than 60 ml/min per 1.7m2. Hypertension was significantly associated with having EGFR less than 60 ml/min per 1.7m2 (adjusted odds ratio 2.931). Conclusion: One in four individuals in the rural district of Anuradhapura is a hypertensive. Hypertension poses a significant burden to CKD even in populations affected by CKDu. Hence, public health initiatives should be implemented parallelly to control both CKDu and hypertension in these rural communities.</p

Influence of Weight Bearing Dorsiflexion (WBDF) on Ankle Injury History Among Semi-professional Recreational Basketball Players

Ankle injuries are one of the most common occurrences in the field of sports. Weight bearing dorsiflexion range can be an effecting factor in ankle injuries. Weight bearing lunge test is used to assess weight bearing dorsiflexion. By using this test as a standard testing protocol, it is possible to minimize development of further sport related ankle injuries.  But this test for basketball players with ankle injuries has not been studied yet. The current study will aim to examine the weight bearing dorsiflexion of basketball players related to their gender, ankle injury history and leg dominance. A quasi-experimental design study was conducted. Thirty-four (34) participants were recruited and initially and two (2) were excluded. 18 participants were male and 14 were female basketball players in Colombo Blues and Kotelawala Defence University basketball teams. The average of age of the sample was 21.8 years. Demographic data, information about training time, injury history of the participants was obtained using an interview administered assessment form. The Weight Bearing Dorsiflexion was measured using digital inclinometer. Findings indicated that the weight bearing dorsiflexion range is smaller than that of males (p&gt;0.05). There was a significant difference in weight bearing dorsiflexion and ankle injury history (p&lt;0.01) among players. Significant differences were seen in influence in leg dominance to weight bearing dorsiflexion (p&lt;0.05). This is the first study that is investigated weight bearing dorsiflexion among basketball players in Sri Lanka. No significant difference was found between gender and weight bearing dorsiflexion. A significant difference was determined between ankle injury history and weight bearing dorsiflexion. Furthermore, a significant difference was found in leg dominance and weight bearing dorsiflexion

Influence of Weight Bearing Dorsiflexion (WBDF) on Ankle Injury History Among Semi-professional Recreational Basketball Players

Ankle injuries are one of the most common occurrences in the field of sports. Weight bearing dorsiflexion range can be an effecting factor in ankle injuries. Weight bearing lunge test is used to assess weight bearing dorsiflexion. By using this test as a standard testing protocol, it is possible to minimize development of further sport related ankle injuries.  But this test for basketball players with ankle injuries has not been studied yet. The current study will aim to examine the weight bearing dorsiflexion of basketball players related to their gender, ankle injury history and leg dominance. A quasi-experimental design study was conducted. Thirty-four (34) participants were recruited and initially and two (2) were excluded. 18 participants were male and 14 were female basketball players in Colombo Blues and Kotelawala Defence University basketball teams. The average of age of the sample was 21.8 years. Demographic data, information about training time, injury history of the participants was obtained using an interview administered assessment form. The Weight Bearing Dorsiflexion was measured using digital inclinometer. Findings indicated that the weight bearing dorsiflexion range is smaller than that of males (p&gt;0.05). There was a significant difference in weight bearing dorsiflexion and ankle injury history (p&lt;0.01) among players. Significant differences were seen in influence in leg dominance to weight bearing dorsiflexion (p&lt;0.05). This is the first study that is investigated weight bearing dorsiflexion among basketball players in Sri Lanka. No significant difference was found between gender and weight bearing dorsiflexion. A significant difference was determined between ankle injury history and weight bearing dorsiflexion. Furthermore, a significant difference was found in leg dominance and weight bearing dorsiflexion

Mapping the Minnesota living with heart failure questionnaire (MLHFQ) to EQ-5D-5L in patients with heart failure

Background: Mapping algorithms can be used to convert scores from a non-preference based instrument to health state utilities. The objective of this study was to develop mapping algorithms which will enable the Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores to be converted into EQ-5D-5L utility scores that can be used in heart failure related cost utility studies. Method: Patients diagnosed with heart failure were recruited from Australia. Mapping algorithms were developed using both direct and indirect response mapping approach. Three model specifications were considered to predict the EQ-5D-5 L utility score using MLHFQ total score (Model 1), MLHFQ domain scores (Model 2), or MLHFQ item scores (Model 3). Six regression techniques, each of which has the capability to cope with either skewness, heteroscedasticity, ceiling effects and/or the potential presence of outliers in the data set were used to identify the optimal mapping functions for each of the three models. Goodness-of-fit of the models were assessed using six indicators. In the absence of an external validation dataset, predictive performance of was assessed using three-fold cross validation method. In the indirect response mapping, EQ. 5D 5 L responses were predicted separately using the MLHFQ item scores using ordered logit model. Results: A total of 141 patients participated in the study. The lowest mean absolute error (MAE) was recorded from the multivariable fractional polynomials (MFP) model in all three-model specifications. Regarding the indirect response mapping, results showed that the performance was comparable with the direct mapping approach based on root mean squared error (RMSE) but was worse based on MAE. Conclusion: The MLHFQ can be mapped onto EQ-5D-5 L utilities with good predictive accuracy using both direct and indirect response mapping techniques. The reported mapping algorithms would facilitate calculation of health utility for economic evaluations related to heart failure.</p