858 research outputs found

    PAM14: TREATMENT WITH LEFLUNOMIDE IMPROVES THE UTILITY OF PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS: AN APPLICATION OF THE SF-6D

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    Consistency between three different ways of administering the Short Form 6 Dimension version 2

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    Background The Short Form 6 Dimension (SF-6D) is a multi-attribute utility instrument derived from the Short-Form 36 Health Survey Version 2 (SF-36v2) quality of life questionnaire and is used to calculate quality-adjusted life years (QALYs) on a scale 0 to 1. The SF-6Dv2 is a new version of the SF-6D. Objective The aim of this study was to assess the consistency of respondents’ answers to 3 different methods to administer this new version. Methods SF-6Dv2 utility values were generated from the SF-36v2 using the following: (1) full questionnaire with 36 items (SF-6Dv2SF-36); (2) subset questionnaire with 10 items (SF-6Dv2ind-10); (3) SF-6Dv2 administered as an independent instrument (rephrased questionnaire with only 6 items [SF-6Dv2ind-6]). The order of the 3 instruments was randomly allocated between respondents. Results A total of 782 respondents from Quebec, Canada, were interviewed, out of whom 697 fully completed the survey. Very few deviations in respondents’ answers were observed between the 3 instruments, with mean weighted kappa of 0.79 (range 0.61-0.91) and mean global consistency index of 70% (range 54-83). Maximal difference in utility values generated was found between SF-6Dv2ind-10 and SF-6Dv2ind-6 (mean difference 0.016, P < .01), whereas minimal difference was found between SF-6Dv2SF-36 and SF-6Dv2ind-10 (0.002, P = .38). No ceiling effect was observed. Conclusions The SF-6Dv2 was designed to derive utilities from the SF-36v2, and our results indicate that it is still preferable to use the full questionnaire, although the difference with other variants of the questionnaire is very small. To use the SF-6Dv2 as an independent instrument will thus introduce minimal bias in utility values generated

    ASCA observations of the young rotation-powered pulsars PSR B1046-58 and PSR B1610-50

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    We present X-ray observations of two young energetic radio pulsars, PSRs B1046-58 and B1610-50, and their surroundings, using archival data from the Advanced Satellite for Cosmology and Astrophysics (ASCA). The energetic pulsar PSR B1046-58 is detected in X-rays with a significance of 4.5 sigma. The unabsorbed flux, estimated assuming a power-law spectrum and a neutral hydrogen column density N_H of 5E21 cm^-2 is (2.5 +/- 0.3) x 10E-13 ergs/cm^2/s in the 2-10 keV band. Pulsed emission is not detected; the pulsed fraction is less than 31% at the 90% confidence level for a 50% duty cycle. We argue that the emission is best explained as originating from a pulsar-powered synchrotron nebula. The X-ray counterpart of the pulsar is the only hard source within the 95% error region of the previously unidentified gamma-ray source 3EG J1048-5840. This evidence supports the results of Kaspi et al. (1999), who in a companion paper, suggest that PSR B1046-58 is the counterpart to 3EG J1048-5840. X-ray emission from PSR B1610-50 is not detected. Using similar assumptions as above, the derived 3 sigma upper limit for the unabsorbed 2-10 keV X-ray flux is 1.5E-13 ergs/cm^2/s. We use the flux limit to estimate the pulsar's velocity to be less than ~170 km/s, casting doubt on a previously reported association between PSR B1610-50 and supernova remnant Kes 32. Kes 32 is detected, as is evident from the correlation between X-ray and radio emission. The ASCA images of PSR B1610-50 are dominated by mirror-scattered emission from the X-ray-bright supernova remnant RCW 103, located 33' away. We find no evidence for extended emission around either pulsar, in contrast to previous reports of large nebulae surrounding both pulsars.Comment: Accepted for publication in the ApJ (v.528, pp.436-444) Correcting typo in abstract of .tex fil

    EQ-5D in skin conditions: an assessment of validity and responsiveness

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    Aims and objectives This systematic literature review aims to assess the reliability, validity and responsiveness of three widely used generic preference-based measures of health-related quality of life (HRQL), i.e., EQ-5D, Health Utility Index 3 (HUI3) and SF-6D in patients with skin conditions. Methods A systematic search was conducted to identify studies reporting health state utility values obtained using EQ-5D, SF-6D, or HUI3 alongside other HRQL measures or clinical indices for patients with skin conditions. Data on test-retest analysis for reliability, known group differences or correlation and regression analyses for validity, and change over time or responsiveness indices analysis were extracted and reviewed. Results A total of 16 papers reporting EQ-5D utilities in people with skin conditions were included in the final review. No papers for SF-6D and HUI3 were found. Evidence of reliability was not found for any of these measures. The majority of studies included in the review (12 out of 16) examined patients with plaque psoriasis or psoriatic arthritis and the remaining four studies examined patients with either acne, hidradenitis suppurativa, hand eczema, or venous leg ulcers. The findings were generally positive in terms of performance of EQ-5D. Six studies showed that EQ-5D was able to reflect differences between severity groups and only one reported differences that were not statistically significant. Four studies found that EQ-5D detected differences between patients and the general population, and differences were statistically different for three of them. Further, moderate-to-strong correlation coefficients were found between EQ-5D and other skin-specific HRQL measures in four studies. Eight studies showed that EQ-5D was able to detect change in HRQL appropriately over time and the changes were statistically significant in seven studies. Conclusions Overall, the validity and responsiveness of the EQ-5D was found to be good in people with skin diseases, especially plaque psoriasis or psoriatic arthritis. No evidence on SF-6D and HUI3 was available to enable any judgments to be made on their performance

    A review of the status and range expansion of common carp (Cyprinus carpio L.) in Ireland

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    Although common carp are known to have been present in Ireland since the early 17th century, historically the species’ distribution was extremely localised. Owing to the popularity of carp as a sport fish in more recent times, it was suspected that the species range had expanded. Distribution maps were constructed from records in the published literature and consultations with both angling and governmental bodies, facilitating a review of the temporal changes in the range and distribution of carp from 1950 to the present day. There has been a significant increase in the range of distribution of carp, by order of 302% in the national 10 km grid-square network. The characteristic pattern of extinction and colonisation of carp in Irish water bodies clearly indicates that the species has not spread by natural dispersal but rather by human-mediated transfers, which are the mechanism for the species’ range expansion. While carp has been able to establish self-sustaining populations in Ireland, these remain restricted to smaller, often land-locked, water bodies. Future climatic warming and the increasing popularity of carp as an angling quarry may facilitate further range expansion, both naturally and human mediated

    Improving the measurement of QALYs in dementia: Developing patient- and carer-reported health state classification systems using Rasch analysis

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    Objectives: Cost-utility analysis is increasingly used to inform resource allocation. This requires a means of valuing health states before and after intervention. Although generic measures are typically used to generate values, these do not perform well with people with dementia. We report the development of a health state classification system amenable to valuation for use in studies of dementia, derived from the DEMQOL system, a measure of health-related quality of life in dementia by patient self-report (DEMQOL) and carer proxy-report (DEMQOL-Proxy). Methods: Factor analysis was used to determine the dimensional structure of DEMQOL and DEMQOL-Proxy. Rasch analysis was subsequently used to investigate item performance across factors in terms of item-level ordering, functioning across subgroups, model fit and severity-range coverage. This enabled the selection of one item from each factor for the classification system. A sample of people with a diagnosis of mild/moderate dementia (n=644) and a sample of carers of those with mild/moderate dementia (n=683) were used. Results: Factor analysis found different 5-factor solutions for DEMQOL and DEMQOL-Proxy. Following item reduction and selection using Rasch analysis, a 5-dimension classification for DEMQOL and a 4-dimension classification for DEMQOL-Proxy were developed. Each item contained 4 health state levels. Conclusion: Combining Rasch and classical psychometric analysis is a valid method of selecting items for dementia health state classifications from both the patient and carer perspectives. The next stage is to obtain preference weights so that the measure can be used in the economic evaluation of treatment, care and support arrangements for dementia

    Improving the measurement of QALYs in dementia: developing patient- and carer-reported health state classification systems using Rasch analysis

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    Objectives: Cost-utility analysis is increasingly used to inform resource allocation. This requires a means of valuing health states before and after intervention. Although generic measures are typically used to generate values, these do not perform well with people with dementia. We report the development of a health state classification system amenable to valuation for use in studies of dementia, derived from the DEMQOL system, a measure of health-related quality of life in dementia by patient self-report (DEMQOL) and carer proxy-report (DEMQOL-Proxy). Methods: Factor analysis was used to determine the dimensional structure of DEMQOL and DEMQOL-Proxy. Rasch analysis was subsequently used to investigate item performance across factors in terms of item-level ordering, functioning across subgroups, model fit and severity-range coverage. This enabled the selection of one item from each factor for the classification system. A sample of people with a diagnosis of mild/moderate dementia (n=644) and a sample of carers of those with mild/moderate dementia (n=683) were used. Results: Factor analysis found different 5-factor solutions for DEMQOL and DEMQOL-Proxy. Following item reduction and selection using Rasch analysis, a 5-dimension classification for DEMQOL and a 4-dimension classification for DEMQOL-Proxy were developed. Each item contained 4 health state levels. Conclusion: Combining Rasch and classical psychometric analysis is a valid method of selecting items for dementia health state classifications from both the patient and carer perspectives. The next stage is to obtain preference weights so that the measure can be used in the economic evaluation of treatment, care and support arrangements for dementia.quality adjusted life years; health related quality of life; Rasch analysis; preference-based measures of health; health states; dementia

    Nutritional and Non-nutritional Strategies in Bodybuilding: Impact on Kidney Function

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    © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)Bodybuilders routinely engage in many dietary and other practices purported to be harmful to kidney health. The development of acute kidney injury, focal segmental glomerular sclerosis (FSGS) and nephrocalcinosis may be particular risks. There is little evidence that high-protein diets and moderate creatine supplementation pose risks to individuals with normal kidney function though long-term high protein intake in those with underlying impairment of kidney function is inadvisable. The links between anabolic androgenic steroid use and FSGS are stronger, and there are undoubted dangers of nephrocalcinosis in those taking high doses of vitamins A, D and E. Dehydrating practices, including diuretic misuse, and NSAID use also carry potential risks. It is difficult to predict the effects of multiple practices carried out in concert. Investigations into subclinical kidney damage associated with these practices have rarely been undertaken. Future research is warranted to identify the clinical and subclinical harm associated with individual practices and combinations to enable appropriate and timely advicePeer reviewedFinal Published versio

    Evaluating the Relationship Between Visual Acuity and Utilities in Patients With Diabetic Macular Edema Enrolled in Intravitreal Aflibercept Studies

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    PURPOSE. The purpose of this study was to explore the relationship between visual acuity and utility (health-related quality of life) in diabetic macular edema (DME) using intravitreal aflibercept data. METHODS. The relationship between visual acuity in the best-seeing eye (BSE) and worseseeing eye (WSE) and utility was explored using ordinary least squares (OLS) and randomeffects models adjusted for different covariates (age, age2 , sex, body mass index, smoking status, glycated hemoglobin, diabetes severity, comorbidities, and geographic region). Utility was measured using the EuroQoL-five dimensions questionnaire (EQ-5D) and Visual Functioning Questionnaire-Utility Index (VFQ-UI). For each model, coefficients (R2 ) were reported, and WSE/BSE was expressed as the ratio of coefficients (OLS models). Models were independent of treatment effects, and outcomes from all time points (up to week 100) were included where available. RESULTS. Data from 1320 patients with DME were analyzed. In all models, the association between visual acuity (BSE > WSE) was stronger with VFQ-UI– than EQ-5D–derived utilities. The estimated relationship between VFQ-UI and visual acuity in the BSE and WSE was robust, even with an increasing number of covariates. WSE/BSE coefficient ratios were similar across VFQ-UI OLS models (32%) compared with EQ-5D models (41%–48%). Actual (unadjusted) versus predicted data plots also showed a better fit with VFQ-UI– than EQ-5D–derived utilities. CONCLUSIONS. These analyses show that VFQ-UI was more sensitive than EQ-5D–derived utilities for measuring the impact of visual acuity in the BSE and WSE. Visual acuity in the BSE was a major contributor to utility, but WSE is also important though to a lesser degree as shown by the coefficient ratios. These new data will be useful for health technology assessments in DME, where utilities data are lacking. Keywords: diabetic macular edema, intravitreal aflibercept, utilit
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