Correlates of health-related quality of life in young-old and old–old community-dwelling older adults

Purpose

This study aimed (1) to examine the role of potential correlates of HRQoL in a large representative sample of older adults, and (2) to investigate whether the relationships between HRQoL and potential factors differ as a function of HRQoL component (physical vs. mental) and/or age cohort (young-old vs. old–old).

Methods

This cross-sectional study included 802 older adults aged 60–79 years old. HRQoL was assessed using the SF-36 questionnaire. Functional fitness was assessed using the Senior Fitness Test. Physical activity was measured via the Baecke questionnaire. Demographic information, mental and health features were obtained through questionnaires.

Results

A multiple regression analysis showed that BMI (β = ?0.15, p?=?0.001), body strength (β =?0.21, p?<?0.001), aerobic endurance (β =?0.29, p?<?0.001), physical activity (β =?0.11, p?=?0.007), depressive symptoms (β = ?0.19, p?<?0.001), falls (β = ?0.19, p?<?0.001), and living alone (β = ?0.16, p?<?0.001) were all significantly related to HRQoL-SF-36 total score. The positive relation with aerobic endurance was significantly higher for the physical component of HRQoL, while the negative relation with living alone was significantly higher for the mental component. The positive relation of HRQoL with physical activity was significantly higher in old–old compared to young-old adults.

Conclusion

This data suggest that body composition, functional fitness, psycho-social factors, and falls are important correlates of HRQoL in old age. There are HRQoL-component and age-cohort differences regarding these correlates, underlying the need for specific strategies at the community level to promote HRQoL in older adults.

     

Predictors of vitamin D supplementation amongst infants in Ireland throughout the first year of life

Aim

To investigate predictors of compliance with the recommendation that all infants in Ireland are supplemented daily from birth to 12 months of age with 5 μg of vitamin D.

Subjects and methods

A prospective observational study was conducted. Self-complete questionnaires recorded socio-demographic characteristics, health behaviours and supplementation practices for 158 mother-infant dyads at 4, 9 and 12 months post-partum. A 2-day food diary was also obtained on 12-month-old infants to examine the contribution of diet to vitamin D intakes.

Results

At 4, 9 and 12 months of age, 57.6% (n = 91), 34.2% (n = 54) and 23.4% (n = 37) of infants, respectively, were supplemented as recommended. In multivariate analyses, receiving supplementation advice from health professionals in the early post-partum period was the most significant predictor of correctly supplementing 4-month-old [p?<?0.01; odds ratio, OR: 61.94 (95% confidence interval, CI: 11.53–332.83)], 9-month-old [p?<?0.01, OR: 10.30 (95% CI: 2.29–46.27)] and 12-month-old [p?=?0.04, OR: 3.85 (95% CI: 1.05–14.08)] infants. Amongst 12 month olds, mean intakes from diet and supplementation combined (7.6?±?4.7 μg/day) were suboptimal.

Conclusion

Suboptimal vitamin D supplementation practices were evident throughout infancy. Dietary intakes of vitamin D did not compensate for suboptimal supplementation practices. Supplementation practices may improve if health professionals advocate safe supplementation during routine infant health checks.

     

The association between social network factors and mental health at different life stages

Objectives

Psychosocial factors are important determinants of an individual’s health. This study examines the association between health scores and social network factors on mental health across different life stages.

Methods

Data were drawn from the Household Income and Labour Dynamics in Australia survey for adolescents (n = 1739), adults (n = 10,309) and seniors (n = 2287). Hierarchical regression modelling was applied to examine effects within and across age groups. All the variables were derived from the self-completion questionnaire.

Results

The social network factors were statistically significant predictors of mental health outcomes for all three life stages. For adolescents, the three social network factors were statistically significant with social isolation having the largest impact (β = ?.284, p < .001), followed by social connection (β = .084, p < .001) and social trust having a similar effect (β = .073, p < .001). For adults social isolation had the highest impact (β = ?.203, p < .001), followed by social connection (β = .110, p < .001) and social trust (β = .087, p < .001).The results for seniors were social isolation (β = ?.188, p < .001), social connection (β = .147, p < .001) and social trust (β = .032, p < .05).

Conclusions

After adding the social network factors, the models improved significantly with social isolation playing the most significant role across all life stages, whereas the other social network factors played a differentiated role depending upon the life stage. These findings have practical implications in the design of mental health interventions across different life stages.

     

In-person and online social participation and emotional health in individuals with multiple sclerosis

Purpose

Individuals with multiple sclerosis (MS) sometimes have barriers to social participation. The advent of the internet has created online support systems for social participation such as websites for individuals with MS. However, minimal research has been conducted about determinants of individuals’ in-person and online social participation or how types of social participation contribute to emotional well-being. The present study aims are: (1) to assess the role of access to resources and other determinants as enabling in-person and online social participation, and (2) to analyze the association between social participation and emotional health of individuals with MS.

Methods

The sample consisted of 508 individuals diagnosed with relapsing/remitting or secondary/progressive MS. Data from NARCOMS registry and data from original questionnaire on determinants of social participation and emotional health were merged. Logistic and linear regression analyses were performed.

Results

Individuals with access to the internet were more likely to participate online with friends (OR 5.47, p < .001) and the community (OR 47.7, p < .001). Individuals who regularly participate in in-person social participation with friends reported being happier (B = .38, p < .001), less depressed (B = ?2.01, p < .001), and less anxious (B = ?1.21, p < .001) than those who did not. However, there was no evidence of a relationship between emotional health and online social participation.

Conclusion

Increasing access to in-person social participation with friends will likely have the most positive impact on emotional health. Future research should examine the aspects of online participation that are helpful or harmful.

     

The impact of post-procedural complications on reimbursement,length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany

Background

The impact of various post-procedural complications after transcatheter aortic valve implantation (TAVI) on resource use and their consequences in the German reimbursement system has still not been properly quantified.

Methods

In a retrospective observational study, we use data from the German DRG statistic on patient characteristics and in-hospital outcomes of all isolated TAVI procedures in 2013 (N = 9147). The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation was analyzed using both unadjusted and risk-adjusted linear and logistic regression analyses.

Results

A total of 235 (2.57%) strokes, 583 (6.37%) bleeding events, 474 (5.18%) cases of acute kidney injury and 1428 (15.61%) pacemaker implantations were documented. The predicted reimbursement of an uncomplicated TAVI procedure was €33,272, and bleeding events were associated with highest additional reimbursement (€12,839, p < 0.001), extra length of stay (14.58 days, p < 0.001), and increased likelihood of mechanical ventilation for more than 48 h (OR 17.91, p < 0.001). A more moderate complication-related impact on resource use and reimbursement was found for acute kidney injury (additional reimbursement: €5963, p < 0.001; extra length of stay: 7.92 days, p < 0.001; ventilation >48 h: OR 6.93, p < 0.001) as well as for stroke (additional reimbursement: €4125, p < 0.001; extra length of stay: 4.68 days, p < 0.001; ventilation >48 h: OR 5.73, p < 0.001). Pacemaker implantations, in contrast, were associated with comparably small increases in reimbursement (€662, p = 0.006) and length of stay (3.54 days, p = 0.006) and no impaired likelihood of mechanical ventilation more than 48 h (OR 1.22, p = 0.156). Interestingly, these complication-related consequences remain mostly unchanged after baseline risk-adjustment.

Conclusions

Post procedural complications such as bleeding events, acute kidney injuries and strokes are associated with increased resource use and substantial amounts of additional reimbursement in Germany, which has important implications for decision making outside of the usual clinical sphere.

     

The association between maternal nutrition and lifestyle during pregnancy and 2-year-old offspring adiposity: analysis from the ROLO study

Aim

To examine the association between maternal nutrition and lifestyle factors and offspring adiposity, using baseline and 2-year postpartum follow-up data from a randomised control trial of low glycaemic index diet.

Subject and methods

Food diaries and lifestyle questionnaires were completed during pregnancy and infant feeding and maternal lifestyle questionnaires 2 years postpartum for 281 mother and infant pairs from the ROLO study. Maternal anthropometry was measured throughout pregnancy and infant and maternal anthropometry was measured 2 years postpartum.

Results

Maternal 2 year postpartum body mass index (BMI) was positively associated with offspring BMI-for-age z-score (B?=?0.105, p?=?0.015). Trimester 2 saturated fat intake was positively associated with offspring subscapular:triceps skinfold ratio (B?=?0.018, p?=?0.001). Trimester 1 glycaemic index was also positively associated with offspring sum of subscapular and triceps skinfolds (B?=?0.009, p?=?0.029).

Conclusions

Maternal BMI 2 years postpartum was positively associated with offspring BMI. Pregnancy saturated fat intake was positively and polyunsaturated fat negatively associated with offspring adiposity. While further research is necessary, pregnancy and the postpartum period may be early opportunities to combat childhood obesity.

     

Quality of life in adults with asthma treated in allergy and pneumology subspecialties: relationship with sociodemographic,clinical and psychological variables

Purpose

Prior studies suggest that specialist care associates with improved health-related quality of life (HRQL) in asthmatic patients. However, there are limited studies focused on differences in HRQL among subspecialties. The aim of this study was to assess the differences in HRQL between adult asthmatic patients treated in pneumology or allergy practices, and to estimate to what extent the differences in HRQL can be explained by sociodemographic, clinical or psychological characteristics of patients from each specialty.

Methods

We recruited adult asthmatic outpatients from allergy and pneumology practices. Information on sociodemographic, clinical and psychological characteristics was collected, and HRQL was assessed with generic and disease-specific questionnaires. HRQL was compared between groups adjusting for sociodemographic, clinical and psychological characteristics.

Results

A total of 287 asthmatic patients participated in the study (105 from pneumology and 182 from allergy). Patients treated by pneumologists reported significantly poorer HRQL in physical dimensions of generic questionnaire and all dimensions of disease-specific questionnaire. Pneumology patients were older (p < .001) and had a lower education level (p < .001); a higher number of patients were in a non-active employment situation (p = .003) and had worse pulmonary function (p < .001), longer duration of disease (p = .020), higher prevalence of obesity (p < .001) and uncontrolled asthma (p < .001), and a higher rate of previous absenteeism (p = .001). Depression and the use of cognitive avoidance coping were also higher among pneumology patients (p = .050 and p = .022, respectively). There were not significant differences in HRQL between pneumology and allergy patients after adjustment for these sociodemographic, clinical and psychological characteristics.

Conclusions

Asthmatic patients treated by pneumologists reported poorer HRQL than patients treated by allergists, but this outcome is attributed to differences in several sociodemographic, clinical and psychological characteristics between the two groups of patients.

     

Reduced hospitalization rates are not associated with increased mortality or readmission rates in an emergency department in Israel

Background and Aim

In 2011 the Israeli Ministry of Health (MOH) instructed hospitals to limit occupancy in the internal medicine wards to 120%, which was followed by a nationwide reduction in hospitalization rates. We examined how readmission and mortality rates changed in the five years following the changes in occupancy rates and hospitalization rates.

Methods

All visits to the Tel Aviv Medical Center internal Emergency Medicine Department (ED) in 2010, 2014 and 2016 were captured, with exclusion of visits by patients below 16 of age and patients with incomplete or faulty data. The main outcomes were one-week readmission rates and one-month death rates. The secondary outcomes were admission rate, ED visit length & admission-delay time (minutes), and rates of admission-delayed patients.

Results

After exclusion, a total of 168,891 internal medicine ED patients were included in the analysis. Mean age was 58.0 and 49% were males. During the relevant period (2010–2016), total medical ED visits increased by 11% - 53,327, 56,588 and 59,066 in 2010, 2014 and 2016 respectively. Hospitalization rates decreased from 46% in 2010 to 35% in 2015 (p <?0.001), with the most prominent reduction in the elderly population. One-week readmission rates were 6.5, 6.4 and 6.7% in 2010, 2014 and 2016 respectively (p =?0.347 and p =?0.21). One-month mortality was similar in 2010 and 2014 (4.4 and 4.5%, p =?0.388) and lower in 2016 (4.1%, p =?0.048 compared with 2010). Average ED visit length increased from 184?min in 2010 to 238 and 262?min in 2014 & 2016 (p <?0.001 for both) and average delay time to ward admission increased from 97?min in 2010 to 179 and 240 in 2014 & 2016 (p <?0.001 for both). In 2010 24% of the admitted patients were delayed in the ED more than 2?h, numbers that increased to 53% in 2014 and 66% in 2016 (p?<?0.001 for both).

Conclusion

Following the 2011 MOH’s decision to establish a 120% occupancy limit for internal medicine wards along with natural growth in population volume, significant changes were noted in the work of a large, presumably representative emergency department in Israel. Although a steady increase in total ED visits along with a steady reduction in hospitalization rates were observed, the readmission and mortality rates remained low. The increase in the average length of ED visits and in the delay from ED admission to a ward reflects higher burden on the ED.The study was not able to establish a causal connection between the MOH directive and the subsequent changes in ED activity. Nonetheless, the study has significant potential implications for policy makers, including the presence of senior ED physicians during afterhours, creation of short-stay diagnostic units and proper adjustments in ED size and personnel.

     

The impact of non-financial and financial encouragements on participation in non school-based human papillomavirus vaccination: a retrospective cohort study

Objective

Adolescent vaccination coverage under a system of non school-based vaccination is likely to be suboptimal, but might be increased by targeted encouragement campaigns. We analysed the effect on human papillomavirus (HPV) vaccination initiation by girls aged 12–18 of two campaigns set up in Flanders (Belgium) in 2007 and 2009: a personal information campaign and a combined personal information and financial incentive campaign.

Methods

We analysed (objective) data on HPV vaccination behaviour from the National Alliance of Christian Mutualities (NACM), Flanders’ largest sickness fund. We used z-scores to compare the monthly proportion of girls initiating HPV vaccination over time between carefully selected intervention and control groups. Separate analyses were done for older and younger girls. Total sample sizes of the intervention (control) groups were 221 (243) for the personal information campaign and 629 (5,322) for the combined personal information and financial incentive campaign.

Results

The personal information campaign significantly increased vaccination initiation, with older girls reacting faster. One year after the campaign the percentages of vaccination initiation for the oldest girls were 64.6 and 42.8 % in the intervention and control group, respectively (z = 3.35, p = 0.0008); for the youngest girls the percentages were 78.4 and 68.1 % (z = 1.71, p = 0.09). The combined personal information and financial incentive campaign increased vaccination initiation among certain age groups. One year after the campaign the difference in percentage points for HPV vaccination initiation between intervention and control groups varied between 18.5 % (z = 3.65, p = 0.0002) and 5.1 % (z = 1.12, p = 0.26).

Conclusion

Under a non school-based vaccination system, personal information and removing out-of-pocket costs had a significant positive effect on HPV vaccination initiation, although the effect substantially varied in magnitude. Overall, the obtained vaccination rates remained far below those realised under school-based HPV vaccination.

     

Mindful creativity matters: trajectories of reported functioning after severe traumatic brain injury as a function of mindful creativity in patients’ relatives: a multilevel analysis

Objective

The objective of the present investigation was to examine the association of mindful creativity with the trajectory of recovery (emotional, interpersonal, cognitive, and total functioning) of patients with severe TBI.

Methods

This was drawn from a subsample of an adult prospective cohort study on severe TBI in Switzerland; patients and their relatives were assessed at 3, 6, and 12 months (patients N = 176, relatives N = 176). Predictor measures were assessed using Mindful Creativity Scale—short form and time (trajectory of functioning of the patient over time). Outcome measures were assessed using Patient Competency Rating Scale for Neuro-rehabilitation (PCRS-NR; measuring emotional, interpersonal, cognitive, and total functioning post-injury). All measures were assessed at each time point. Mixed linear models were run separately for ages >50 and ≤50 (i.e., bimodal distribution).

Results

Patients’ mindful creativity showed no significant association with patients’ functioning across time in any of the models. In all age groups, interpersonal functioning decreased across time (slope_>50 = ?4.66, p = .037; slope_≤50 = ?7.19, p = .007). Interestingly, in age group ≤50, interpersonal functioning increased when looking at relative mindful creativity by time (slope = 1.69, p = .005). Additionally, relatives mindful creativity was significantly associated with patients’ functioning in age group ≤50: (a) patients’ total functioning (slope = 0.18, p = .03) and (b) cognitive functioning (slope = 0.72, p = .020).

Conclusions

Relatives’ mindful creativity was significantly associated with patients’ functioning after severe TBI. Implications for treatment and future research are discussed.

     

Digestion-resistant maltodextrin effects on colonic transit time and stool weight: a randomized controlled clinical study

Purpose

Increased awareness of the importance of dietary fibre has led to increased interest in “functional” fibre components like digestion-resistant maltodextrin (RMD). This randomized, placebo-controlled, double-blind study assessed the effects of RMD in the colonic transit time (CTT) and defecation characteristics (frequency, stool volume and consistency).

Methods

Sixty-six healthy adult volunteers (32 men) who did not have a daily defecation habit had a 7-day run-in period before the 21-day intervention period with RMD or placebo. CTT and segmental CTT (SCTT) were assessed by a single abdominal X-ray film taken at the end of both periods after radiopaque marker ingestion. Defecation characteristics and intestinal functions were also assessed, which were self-reported by patients. Intragroup comparisons were evaluated by Student’s paired t test, Bonferroni test and Chi-square test, while time comparisons by analysis of variance (ANOVA) and time-by-treatment interaction by repeated-measures ANOVA.

Results

Fifty-seven subjects were assessed for CTT (placebo, n = 28; RMD, n = 29). In the RMD group, the total CTT, left SCTT and rectosigmoidal SCTT decreased significantly compared to baseline (p < 0.01 each; ?13.3, ?4.7, ?8.7 h, respectively). Significant differences between groups were observed in total CTT and left SCTT. Significant time-by-treatment interaction was observed in the RMD group for stool volume (p = 0.014), increasing 56 % compared to baseline (p < 0.01), while remained unchanged in the placebo group. Stool consistency was improved only in the RMD group (p < 0.01). No adverse effects related to study products were observed.

Conclusions

The results show that RMD improved CTT, stool volume, stool consistency and some intestinal functions in a healthy population.

     

Health,risk behaviour and consumption of addictive substances among physicians - results of an online survey

Background

Previous studies were able to show that hazardous alcohol and substance abuse among physicians is not rare. Currently no recent data to detect risk groups are available either on the prevalence of hazardous drinking disorders and risky health behaviour among physicians or on influencing factors (age, gender, role, institution, specialization, working hours).

Methods

A 42-item online questionnaire was distributed to 38 university hospitals, 296 teaching hospitals and 1290 physicians in private practice. The questionnaire addressed health behaviour and alcohol/substance consumption as well as demographic and work-related properties.

Results

Out of 1338 a total of 920 questionnaires could be evaluated. 90% of physicians estimate their health status as satisfying. 23% of doctors consume hazard quantities of ethanol, 5% are nicotine addicted, and 8% suffer from obesity. Childlessness (p =?0,004; OR?= 1,67; KI?= 1,17-2,37) for both genders and the role of a resident for females (p =?0,046, OR?=?3,10, KI?= 1,02-9,40) poses a risk factor for hazardous alcohol consumption. Weekly working hours of more than 50 h (p =?0,009; OR?= 1,56; KI?= 1,12-2,18) and a surgical profession (p <?0,001; OR?= 2,03; KI?= 1,47-2,81) may also be a risk factor towards hazardous and risky health behaviour.

Conclusion

A more structured and frequently repeated education on help offerings and specific institutions for addicted and risk groups seems essential.

     

Efficacy and safety of a natural mineral water rich in magnesium and sulphate for bowel function: a double-blind,randomized, placebo-controlled study

Purpose

The present placebo-controlled, double-blind, randomized trial aimed to investigate whether a natural mineral water rich in magnesium sulphate and sodium sulphate (Donat Mg) may help to improve bowel function.

Methods

A total of 106 otherwise healthy subjects with functional constipation were randomly assigned to consume 300 or 500 mL of a natural mineral water as compared to placebo water, over a course of 6 weeks. The 300-mL arms were terminated due to the results of a planned interim analysis. Subjects documented the complete spontaneous bowel movements, spontaneous and overall bowel movements/week, stool consistency, gastrointestinal symptoms and general well-being in a diary. Change in the number of complete spontaneous bowel movements was defined as the primary outcome.

Results

For the 75 subjects in the 500-mL arms, the change in the number of complete spontaneous bowel movements per week tended to be higher in the active group when compared to placebo after 6 weeks (T2 = 1.8; p _value = 0.036; one-sided). The mean number of spontaneous bowel movements significantly increased over the course of the study, with significant differences between study arms considering the whole study time (F test = 4.743; p _{time × group} = 0.010, 2-sided). Stool consistency of spontaneous bowel movements (p < 0.001) and the subjectively perceived symptoms concerning constipation (p = 0.005) improved significantly with the natural mineral water as compared to placebo.

Conclusions

The daily consumption of a natural mineral water rich in magnesium sulphate and sodium sulphate improved bowel movement frequency and stool consistency in subjects with functional constipation. Moreover, the subjects’ health-related quality of life improved.

Clinical Trial Registration

EudraCT No 2012-005130-11.

     

Sedentary time among primary school children in south-west Germany: amounts and correlates

Background

Sedentary behaviour in children is related to different health consequences such as overweight and cardio-metabolic diseases that can track into adulthood. Previous studies have shown that children spend hours being sedentary, but no data of sedentary time (ST) among German children has been available, yet. Therefore, this study investigated objectively measured amounts and correlates of ST in a sample of German primary school children.

Methods

Children’s physical activity (PA) was objectively assessed for 6 days using a multi-sensor device (Actiheart®; CamNtech, Cambridge, UK). Activity levels were categorized on the basis of energy expenditure (MET) into sedentary, light PA (LPA), and moderate to vigorous PA (MVPA). ST excluding sleeping hours was assessed for 231 children (7.1 ± 0.6 years, male: 45.9%) and analysed for independent groups. Examined factors (parental education, household income, and migration background) were assessed by parental questionnaire. Children’s weight, height and gender were collected in schools. Weight status was calculated on the basis of BMI percentiles.

Results

On average, children spent 3.5 ± 1.5 h daily being sedentary, excluding sleeping hours. Significantly higher ST was found in girls (t = ?4.6; p < 0.01), in children with migration background (t = ?6.9; p < 0.01), at the weekend (t = ?2.8; p < 0.01), and among inactive children (t = 6.8; p < 0.01). Additionally, significant correlations with ST in this sample were identified for MVPA (B = ?0.99; [?1.09;-0.88], p < 0.01), LPA (B = ?0.89; [?0.97;-0.82], p < 0.01), migration background (B = ?17.64; [5.24;30.04], p < 0.01), gender (B = ?13.48; [?25.94;-1.01], p < 0.05) and household income (B = ?4.80; [?9.07; ?0.53], p < 0.05).

Conclusion

Girls, children with migration background, and inactive children were identified as potential risk groups. A higher income was associated with less ST. In general, ST was higher at the weekend. Furthermore, as PA was found to be negatively correlated to ST, these activities may replace each other. Therefore, these findings should be considered in future health interventions.

Trial registration

German Clinical Trials Register (DRKS), DRKS-ID: DRKS00000494 DATE: 25/08/2010.

     

Depression risk in patients with late-onset rheumatoid arthritis in Germany

Goal

The goal of this study was to determine the prevalence of depression and its risk factors in patients with late-onset rheumatoid arthritis (RA) treated in German primary care practices.

Methods

Longitudinal data from general practices (n=1072) throughout Germany were analyzed. Individuals initially diagnosed with RA (2009–2013) were identified, and 7301 patients were included and matched (1:1) to 7301 controls. The primary outcome measure was the initial diagnosis of depression within 5 years after the index date in patients with and without RA. Cox proportional hazards models were used to adjust for confounders.

Results

The mean age was 72.2 years (SD: 7.6 years). A total of 34.9 % of patients were men. Depression diagnoses were present in 22.0 % of the RA group and 14.3 % of the control group after a 5-year follow-up period (p < 0.001). In the multivariate regression model, RA was a strong risk factor for the development of depression (HR: 1.55, p < 0.001). There was significant interaction of RA and diagnosed inflammatory polyarthropathies (IP) (RA*IP interaction: p < 0.001). Furthermore, dementia, cancer, osteoporosis, hypertension, and diabetes were associated with a higher risk of developing depression (p values <0.001).

Conclusion

The risk of depression is significantly higher in patients with late-onset RA than in patients without RA for subjects treated in primary care practices in Germany. RA patients should be screened routinely for depression in order to ensure improved treatment and management.

     

Impact on healthcare resource utilization of multiple sclerosis in Spain

Background

Multiple sclerosis (MS) is a chronic disease with a high socioeconomic impact. The aim of this study was to assess healthcare resources utilization and costs in a sample of patients with MS.

Methods

A retrospective, cohort study was conducted using electronic medical records from 19 primary care centres in Asturias and Catalonia, Spain. Adult patients diagnosed with MS were distributed into two groups according to the Expanded Disability Status Scale (EDSS) score: 0–3.5 (no-moderate disability) and 4–9.5 (severe disability). Healthcare (direct cost) and non-healthcare costs (work productivity losses) were analysed. An analysis of covariance (ANCOVA) was used for correction, p <?0.05. A multiple regression model was performed to obtain the variables associated with costs.

Results

A total of 222 patients were analyzed; mean (SD) age: 45.5 (12.5) years, 64.4% female, and 62.2% presented a diagnosis of relapsing-remitting MS. Median EDSS score was 2.5, with 68.5% of the patients with no to moderate disability. The mean annual cost per MS patient was €25,103. For no-moderate and severe disability, the ANCOVA-adjusted mean annual cost was €23,157 and €29,242, respectively (p =?0.013). Direct costs and MS disease-modifying therapy accounted for 39.4% and 31.7% of the total costs, respectively. The total costs were associated with number of relapses (β?=?0.135, p =?0.001), time since diagnosis (β?=?0.281, p =?0.023), and age (β?=?0.198, p =?0.037).

Conclusions

Multiple sclerosis imposes a substantial economic burden on the Spanish National Health System, patients and society as a whole. Costs significantly correlated with disease progression.

     

Exploring the relationship between EQ-5D,DLQI and PASI,and mapping EQ-5D utilities: a cross-sectional study in psoriasis from Hungary

Background

There is a growing interest in policy making for using utility measures and identifying algorithms to convert disease-specific measures into utilities.

Objectives

To analyse the relationship between EQ-5D, Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI) in psoriasis. To transform DLQI scores, and key clinical, demographic and health service utilisation variables into utilities.

Methods

A cross-sectional questionnaire survey of 200 consecutive adult patients with moderate to severe psoriasis was carried out in two Hungarian university clinics. The relationship between the outcome measures were analysed with correlations and with the known-groups method. Bivariate and multivariate regression algorithms on EQ-5D scores were formulated.

Results

The mean age of respondents was 51 years (SD = 12.9), 68.5 % were male, and 51.5 % received biological therapy. Median EQ-5D, DLQI, and PASI scores were 0.73, 3.0, and 3.45, respectively. EQ-5D showed a moderate correlation with the DLQI and with the PASI (r _s = ?0.48 and ?0.43, p < 0.05). Strong correlation was found between DLQI and PASI (r _s = 0.81, p < 0.05). DLQI and PASI discriminated better among groups categorised by the localisation of the lesions than EQ-5D. Presence of psoriasis on the neck and/or décolletage was associated with the greatest health related quality of life (HRQOL) impairment. Ten variables were incorporated in a multivariate algorithm that accounted for 48.8 % of EQ-5D variance (ANOVA p < 0.001).

Conclusions

This study provided the first evidence that patients with visible psoriatic lesions have significantly worse HRQOL compared to those with non-visible lesions, measured not only with DLQI but also with EQ-5D. In addition to demographic and clinical variables, our model included health service utilisation variables related to psoriasis, and explained higher proportion of EQ-5D variance than any previous findings in the literature.

     

Consumption of <Emphasis Type="Italic">Bifidobacterium animalis</Emphasis> subsp. <Emphasis Type="Italic">lactis</Emphasis> BB-12 in yogurt reduced expression of TLR-2 on peripheral blood-derived monocytes and pro-inflammatory cytokine secretion in young adults

Purpose

Probiotic bacteria modulate immune parameters and inflammatory outcomes. Emerging evidence demonstrates that the matrix used to deliver probiotics may influence the efficacy of probiotic interventions in vivo. The aims of the current study were to evaluate (1) the effect of one species, Bifidobacterium animalis subsp. lactis BB-12 at a dose of log10 ± 0.5 CFUs/day on immune responses in a randomized, partially blinded, 4-period crossover, free-living study, and (2) whether the immune response to BB-12 differed depending on the delivery matrix.

Methods

Healthy adults (n = 30) aged 18–40 years were recruited and received four treatments in a random order: (A) yogurt smoothie alone; smoothie with BB-12 added (B) before or (C) after yogurt fermentation, or (D) BB-12 given in capsule form. At baseline and after each 4-week treatment, peripheral blood mononuclear cells (PBMCs) were isolated, and functional and phenotypic marker expression was assessed.

Results

BB-12 interacted with peripheral myeloid cells via Toll-like receptor 2 (TLR-2). The percentage of CD14⁺HLA-DR⁺ cells in peripheral blood was increased in male participants by all yogurt-containing treatments compared to baseline (p = 0.0356). Participants who consumed yogurt smoothie with BB-12 added post-fermentation had significantly lower expression of TLR-2 on CD14⁺HLA-DR⁺ cells (p = 0.0186) and reduction in TNF-α secretion from BB-12- (p = 0.0490) or LPS-stimulated (p = 0.0387) PBMCs compared to baseline.

Conclusions

These findings not only demonstrate a potential anti-inflammatory effect of BB-12 in healthy adults, but also indicate that the delivery matrix influences the immunomodulatory properties of BB-12.

     

Wealth index,empowerment and modern contraceptive use among married women in Nigeria: are they interrelated?

Background

Nigeria, a patriarchal society, is one of the more impoverished countries of the world and while its fertility and population growth rates are high, its modern contraceptive (MC) prevalence rate is low. The wealth status and decision-making power of a woman have implications on their use of MC. Studies that examined the relationship between women’s empowerment, wealth index and MC use in Nigeria are scarce.

Methods

A national representative cross-sectional data on women of reproductive age (n? =?5,098) was used. Data were analysed using Chi-square and interactive logistic regression models (α?=?0.05).

Results

Mean age of the women was 32.9(σ?=?8.0) and 23.8 % were currently using MC. Current use of MC was found to be higher among the following: Yoruba (48.5 %) than Igbo (27.3 %) and Hausa women (2.9 %); highly (36.9 %) than poorly empowered women (12.1 %); upper class (35.0 %) than lower class (5.9 %); and Christians (35.5 %) than Muslims (12.6 %; p?<?0.001). Injectables and condoms were the most reported MC method currently used. In the interactive model, being in lower class and poorly empowered inhibits current use of MC. The predictors of current use of MC when wealth index and women empowerment were used either jointly or interactively in the controlled regression equation were wealth index, region, education, religion, ethnicity, family planning information access on media, receiving family planning information at health facility and living children sex composition.

Conclusion

Modern contraceptive prevalence rate among Nigerian women was low particularly among the lower class and poorly empowered. Strategies to improve the use of MC should target women in the lower class in Nigeria.