Personal and Societal Health Quality Lost to Tuberculosis

BACKGROUND: In developed countries, tuberculosis is considered a disease with little loss of Quality-Adjusted Life Years (QALYs). Tuberculosis treatment is predominantly ambulatory and death from tuberculosis is rare. Research has shown that there are chronic pulmonary sequelae in a majority of patients who have completed treatment for pulmonary tuberculosis (PTB). This and other health effects of tuberculosis have not been considered in QALY calculations. Consequently both the burden of tuberculosis on the individual and the value of tuberculosis prevention to society are underestimated. We estimated QALYs lost to pulmonary TB patients from all known sources, and estimated health loss to prevalent TB disease. METHODOLOGY/PRINCIPAL FINDINGS: We calculated values for health during illness and treatment, pulmonary impairment after tuberculosis (PIAT), death rates, years-of-life-lost to death, and normal population health. We then compared the lifetime expected QALYs for a cohort of tuberculosis patients with that expected for comparison populations with latent tuberculosis infection and without tuberculosis infection. Persons with culture-confirmed tuberculosis accrued fewer lifetime QALYs than those without tuberculosis. Acute tuberculosis morbidity cost 0.046 QALYs (4% of total) per individual. Chronic morbidity accounted for an average of 0.96 QALYs (78% of total). Mortality accounted for 0.22 QALYs lost (18% of total). The net benefit to society of averting one case of PTB was about 1.4 QALYs. CONCLUSIONS/SIGNIFICANCE: Tuberculosis, a preventable disease, results in QALYs lost owing to illness, impairment, and death. The majority of QALYs lost from tuberculosis resulted from impairment after microbiologic cure. Successful TB prevention efforts yield more health quality than previously thought and should be given high priority by health policy makers. (Refer to Abstracto S1 for Spanish language abstract)

Development and validation of a new multidimensional measure of inspiration:associations with risk for bipolar disorder

Background: Individuals at risk for, and diagnosed with, bipolar disorder (BD) appear to have heightened levels of creativity. Although inspiration is creativity, the ways in which individuals appraise and respond emotionally to inspiration in BD remain unexplored. Method: The present study reports on a new measure of inspiration (External and Internal Sources of Inspiration Scale - EISI). The reliability and validity of EISI were explored along with associations between EISI and BD risk. Results: Among a cross-national student sample (N = 708) 5 inspiration factors were derived from EISI (self, other, achievement, prosocial and external inspiration). Reliability, concurrent validity and convergent/divergent validity were good. Total EISI and all subscales were associated with increased positive rumination, and total EISI and the achievement EISI subscale were associated with impulsivity. Total EISI, self and prosocial EISI subscales were independently associated with BD risk and current mania symptoms. Conclusion: This new measure of inspiration is multidimensional, reliable and valid. Findings suggest that self and prosocial focused inspiration are particularly associated with risk for BD after controlling for current manic symptoms. Future studies in clinical populations may illuminate the relationships between inspiration and creativity in BD