Profile and quality of life of the adult population in good health according to the level of vitality: European NHWS cross sectional analysis

BACKGROUND

The World Health Organization's definition of health highlights the importance of mental and physical wellbeing and not only disease state. However, lack of awareness on the burden of impaired vitality and its impact on the quality of life of the general healthy population prevents healthcare providers from delivering appropriate solutions and advice. This study aims to better characterize this population in Europe and identify the profile and the health reported outcomes associated with impaired vitality.

METHODS

This retrospective observational study included National Health and Wellness Survey (NHWS) data collected in healthy participants aged 18-65 years from five European Union countries in 2018. Socio-demographic and lifestyle characteristics, comorbidities, attitudes towards healthcare systems, Patient Activation Measure, health-related quality of life outcomes (EQ-5D), and work productivity and activity impairment were analysed according to SF-12 vitality score subgroups (≥ 60, 50- < 60, 40- < 50, < 40).

RESULTS

A total of 24,295 participants were enrolled in the main analysis. Being a female, younger, having a lower income and being obese or having sleep and mental disorders was associated with an increased risk of impaired vitality. This was associated with a higher consumption of healthcare resources along with having a weak patient-physician relationship. Participants who were disengaged in the self-management of their health were 2.6 times more likely to have a low level of vitality. For participants in the lowest vitality group, odds of mobility problems increased by 3.4, impairment of usual activity by 5.8, increased of pain and discomfort by 5.6 and depression and anxiety by 10.3, compared with participants in the highest vitality group. Also, odds of presenteeism increased by 3.7, overall work impairment by 3.4 and daily activity losses by 7.1.

CONCLUSION

Evidence-based trends facilitate the identification of a healthy population with impaired vitality in real-world practice. This study highlights the actual burden of low vitality on daily life activities, particularly on mental health and reduced work productivity. Additionally, our results underline the importance of self-engagement in the management of vitality impairment and highlights the need to implement strategies to address this public health concern in the affected population (HCP-patient communication, supplements, meditation).

The economic and humanistic burden of bipolar disorder in adults in the United States

BACKGROUND

Bipolar disorder is associated with functional impairment and diminished health-related quality of life (HRQoL). The purpose of this study was to estimate the annual per patient direct healthcare costs, indirect costs, and HRQoL of patients with bipolar disorder by depressive symptom severity and overall compared to the general population in the US.

METHODS

This cross-sectional study used self-reported data from the 2020 US National Health and Wellness Survey. Adult respondents who reported bipolar disorder symptoms in the past 12 months and/or a diagnosis of bipolar disorder were identified (bipolar disorder cohort) and were further classified by depressive symptom severity based on Patient Health Questionnaire (PHQ-9) scores (none/mild = 0-9, moderate = 10-14, severe = 15-27). Annualized direct healthcare costs and indirect costs were calculated from 6-month healthcare resource utilization and work productivity, respectively. A general population cohort was constructed using 2:1 propensity score matching. Multivariate regression models of all-cause hospitalizations in the past 6 months, annualized direct healthcare costs, annualized indirect costs, and HRQoL (eg, EuroQol 5-Dimension Health Questionnaire (EQ-5D)) controlled for confounders (demographic and clinical characteristics).

RESULTS

Of 3583 adults meeting pre-specified criteria for bipolar disorder, 1401 (39.1%) reported none/mild, 889 (24.8%) moderate, and 1293 (36.1%) severe depressive symptom severity. Additionally, 3285 (91.7%) were matched to 6570 adults in the general population. Compared to the general population, adjusted mean hospitalizations (0.53 vs. 0.30), annualized per patient direct healthcare costs ($20,846 vs. $11,391), and indirect costs ($14,795 vs. $9274) were significantly greater for the bipolar disorder cohort (all p < 0.001); adjusted HRQoL (EQ-5D: 0.69 vs. 0.79) was significantly worse (p < 0.001). By depressive symptom severity, adjusted mean hospitalizations (none/mild = 0.30, moderate = 0.50, severe = 0.46), direct healthcare costs ($14,389, $22,302, $21,341), and indirect costs ($10,799, $17,109, $18,470) were significantly greater for moderate and severe compared to none/mild depressive symptom severity (all p < 0.01); adjusted HRQoL (EQ-5D: 0.77, 0.67, 0.59) was significantly worse (p < 0.001).

CONCLUSIONS

Among respondents with bipolar disorder, those with moderate to severe depression had greater direct healthcare costs and indirect costs as well as worse HRQoL than those with mild or no depressive symptoms. Treatment targeting reduction in depressive symptoms may reduce the economic and humanistic burden of bipolar disorder.

Burden, Control, and Treatment of Moderate to Severe Atopic Dermatitis in 2021: A United States Patient Survey Study

BACKGROUND

Recent data on unmet needs in the treatment of moderate to severe atopic dermatitis (AD) in the US are not available.

OBJECTIVE

To describe disease control, quality of life (QoL), and treatment satisfaction in a United States population with moderate-to-severe AD.

METHODS

Cross-sectional 2021 survey conducted among US patients recruited to an online survey from Kantar e-profiles, their panel partners, and Global Perspectives. Adults with self-reported, physician-diagnosed AD completed the primary survey. Of those reporting moderate to severe AD, a subset, including patients who &ldquo;strongly disagreed,&rdquo; &ldquo;somewhat disagreed,&rdquo; or were &ldquo;neutral&rdquo; on the statement &ldquo;my eczema is adequately controlled&rdquo; (&ldquo;inadequately controlled&rdquo;) with varying experience with approved biologic treatment (dupilumab), completed a second, enriched survey. Outcome measures evaluated included self-reported disease control and severity and validated measures including Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD), Dermatology Life Quality Index (DLQI), Recap of Atopic Eczema (RECAP), and Treatment Satisfaction Questionnaire for Medication (TSQM-9).

RESULTS

Of 3,285 patients who participated in the primary survey, 1,935 self-reported moderate-to-severe AD, 979 (51%) of whom reported inadequate control. A total of 371 completed the enriched survey, leading to an analytic sample with 87 controlled patients and 284 inadequately controlled patients (178/284 inadequately controlled patients never received dupilumab, 23 previously received it, and 83 were currently receiving it). Mean RECAP, PO-SCORAD, and DLQI scores were significantly worse (P&lt;0.01) for inadequately controlled vs controlled patients: 7.26 vs 13.9; 38.3 vs 26.9; and 9.9 vs 7.0, respectively. Mean TSQM-9 scores for inadequately controlled vs controlled patients were significantly worse across all domains&mdash;effectiveness, convenience, and global satisfaction (P&lt;0.01): 45.5 vs 69.5, 62.3 vs 72.5, 48.3 vs 69.3, respectively.

CONCLUSIONS AND RELEVANCE

This study found about half of the patients had inadequate control of their disease. This may partially be due to underuse of systemic biologics in eligible patients. There remains an unmet need for additional education on current and new systemic biologics that could allow patients to achieve better AD control, improved QoL, and greater overall treatment satisfaction. J Drugs Dermatol. 2023;22(2):119-131. doi:10.36849/JDD.7071.

Abstract P2-12-15: Understanding the complex non face-to-face interventions delivered by the clinical nurse specialists in metastatic breast cancer

Introduction: Despite improving survival rates in breast cancer, globally one third of patients diagnosed with primary breast cancer will go onto develop metastatic breast cancer. In recent years treatment for metastatic breast cancer in the United Kingdom has moved to the ambulatory setting using treatments such as, oral chemotherapies, oral biological and bisphosphonate therapies meaning telephone consultation and clinical management, pivotal to confluent care.

Research Objectives: To determine the number and complexity of incoming telephone calls, the stage of the metastatic breast cancer disease pathway for example at diagnosis, treatment, follow-up, and palliative care, the nursing interventions, outcomes and the reason for contact from patients and carers.

Rationale: Previous studies demonstrate much of the clinical work of the clinical nurse specialist is delivered via the telephone. The rationale of this study was to examine the complexity of non face-to-face patient interaction with the metastatic breast cancer clinical nurse specialist.

Method: A prospective study conducted over a 1 – month period at a United Kingdom National Health Service Foundation Hospital Trust. Data was collected by two clinical nurse specialists on incoming calls using Excel and a bespoke interrelational structured query database. These data were then mined using standard data mining techniques and pattern recognition techniques.

Results: The study collected 28 days of data. 229 patient and carer telephone contacts were recorded. Most calls were from patients (62.5%). Incoming calls resulted in the delivery of 1282 interventions, a mean of six interventions per call (range1-8) and clustered into four areas: meeting information needs (29%), symptom management (26%), psychological/social issues (33%) and other issues (12%). The incoming telephone work accounted for 63 h which represented 30% of the total working time of the clinical nurse specialist. Calls primarily originated from patients who were in the follow-up phase (43% of calls), a group usually thought to prefer self management.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-12-15.

Fulvestrant in advanced breast cancer following following failure of tamoxifen and a third generation aromatase inhibitor

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Background: Endocrine therapy is a key modality in the management of estrogen receptor positive metastatic breast cancer. Fulvestrant (ICI 182,780) is an estrogen receptor downregulator. It has previously been shown to be as effective as anastrozole in patients who had previously progressed on tamoxifen. Methods: A retrospective study was carried out of metastatic breast cancer patients treated at Charing Cross Hospital between 2002–2005 who had received fulvestrant following treatment failure with tamoxifen and a third generation aromatase inhibitor. All patients were postmenopausal and received fulvestrant 250mg IM every 28 days. Measurable disease was assessed by response evaluation criteria in solid tumors (RECIST). Results: A total of 45 patients were identified with a median age of 60 (range 36 to 90). The ER status was known in 95% (n=43) of patients and was positive in all cases, it was unknown in 2% (n=2). At the time of commencing fulvestrant, 96% (n=43) had metastatic disease and 4% (n=2) locally advanced disease. All patients had received at least 2 lines of prior endocrine therapy (including adjuvant therapy), at time of starting fulvestrant the median number of prior regimens was 3 (range 3–5). Fulvestrant was administered for a median of 4 months (range 1 to 20 months), with 4 patients currently still receiving therapy as of 1 November 2006. Of the 45 patients, 2.2% (n=1) achieved a partial response, while 31% (n=14) achieved stable disease for at least 6 months. Thus, 33.3% (n=15) obtained clinical benefit (defined as PR or SD for at least 6 months). The response rates based on line of therapy will be presented. Of the 45 patients, 41 were evaluable for survival data. The median survival of the remaining patients from the start of fulvestrant therapy was 9 months (range 1 to 48 months). Of the 44 patients, 14% (n=6) remain alive. The treatment was well tolerated and toxicity data will be presented. Conclusions: Fulvestrant is well tolerated and is efficacious as treatment for advanced breast cancer that has failed tamoxifen and a third generation aromatase inhibitors.

No significant financial relationships to disclose.

The temporary use of allograft for complicated wounds in plastic surgery

A retrospective analysis was performed on the use of glycerol-preserved allografts (GPA) in the preparation of complicated wounds for secondary wound closure. All files from the plastic surgery department in the period 1992-1998 were screened. Thirty-three patients within a total 85 GPA treatments were selected and screened for indication of use of GPA, frequency of GPA changes, duration of treatment and whether or not subsequent autografting was possible. GPA was used as a biological cover for the following indications: problematic wound healing, 13 cases; non-healing burns, 12 cases; carcinoma, 4 cases; unstable scar, 2 cases; shortage of skin, 2 cases. The average frequency of GPA application was 2.6 times, with a mean duration of 5 days per application. In 84 cases (32 patients) the wound was successfully covered with autograft. In conclusion, GPA was used with good results as a temporary cover for complicated wounds. We postulate that angiogenic effects of this biological dressing may have contributed to the improved healing conditions and successful secondary wound closure.

Electromagnetic optimization of multilevel diffractive elements by use of the wavelet transform

We present an optimization algorithm for the design of multilevel diffractive optical elements in the electromagnetic domain. The method uses the wavelet transform to parameterize the diffractive optical elements according to a set of coefficients that corresponds to a multiresolution basis. Both local and global optimizations can be performed within a single algorithm. A design example consisting of the optimization of a two-dimensional millimeter-wave diffractive lens over a 10% bandwidth is presented.

Biochemical characterization of salmon pancreas disease virus

Salmon pancreas disease virus (SPDV) has been shown to cause severe economic losses in farmed Atlantic salmon (Salmo salar) and has been reported to occur in Europe, Scandinavia and the United States. This paper describes the biochemical characterization of SPDV in terms of its RNA and protein composition. SPDV was purified by precipitation from infected Chinook salmon embryo (CHSE-214) cell-culture supernatant and sucrose density-gradient centrifugation. Fractions containing virus were identified by an immunodot blot assay using an SPDV-specific MAb. Two major proteins with molecular masses of approximately 55 and 50 kDa, putatively identified as the E1 and E2 alphavirus glycoproteins respectively, were detected when purified virus preparations were analysed by PAGE. Radiolabelling experiments indicated that SPDV infection of CHSE-214 cells did not shut-off host-cell protein synthesis, making attempts to identify virus-specific proteins unsuccessful. However, radioimmunoprecipitation assay (RIPA) experiments showed that two SPDV-specific MAbs reacted with a protein in the 50-55 kDa range. Northern blot hybridization with cloned cDNA probes indicated that infected cells contained RNA species of approximately 11.4 and 4 kb, which correspond to the genomic and subgenomic RNAs specified by SPDV. The results described are consistent with SPDV being characterized as an alphavirus.

Use of a monoclonal antibody against an Escherichia coli O26 surface protein for detection of enteropathogenic and enterohemorrhagic strains

A monoclonal antibody (MAb) was obtained from a mouse immunized with solubilized outer membrane proteins extracted from a bovine enterohemorrhagic strain of Escherichia coli (EHEC), O26. The MAb produced a strong immunoblot reaction at approximately 21 kDa for an O26 strain containing the intimin gene (eae) and verocytotoxin (VT), but not with an O26 eae- and VT-negative strain, or O157 eae- and VT-positive strains. The MAb was used in a sandwich enzyme-linked immunosorbent assay (ELISA) format to screen strains from animal and human sources, and all reactive strains were characterized for the presence of eae and the gene encoding VT factors by PCR. The antigen was detected in a group of strains containing a high proportion of O26, the majority of which were eae positive with or without VT; these were isolated mostly from animal enteritis cases but included a small number of human enteric isolates. Nonreactors included eae-positive (with or without VT) O157 strains and one O26 strain. In a survey of mixed cultures from both animal and human enteric disease, ELISA-positive reactions were obtained from 7.1 to 11.2% of samples from bovine, porcine, ovine, and human sources. The two human O8 and ten animal O26 ELISA-reactive pure strains obtained from these samples contained six eae- and/or VT-positive strains; the other six strains lost their ELISA positivity following storage at -70 degrees C, after which none were found to contain either eae or VT factors. The association of the antigen detected by the MAb with significant enteropathogenic E. coli and EHEC virulence factors in isolates from both animal and human enteric infections indicates a diagnostic potential for the assay developed.

Demonstration of bovine virus diarrhoea virus antigen in formalin fixed, paraffin embedded tissue using a streptavidin/biotin technique

The detection of bovine virus diarrhoea virus (BVDV) antigen in sections from formalin fixed, paraffin embedded tissue is described. Pre-digestion of the sections with 0.02 per cent protease XIV for 18 hours at 4 degrees C is necessary to unmask formalin fixed antigen. A hyperimmune antiserum prepared in a pig, using a combination of BVDV and hog cholera virus inoculations, linked to a biotinylated anti-pig/streptavidin peroxidase detection system demonstrated antigen in a wide range of tissues from cases of mucosal disease and persistently viraemic animals. The inclusion of a monoclonal anti-pig immunoglobulin linked to a biotinylated anti-mouse/streptavidin peroxidase detection system greatly reduced non-specific staining.

Attitude prototypes as determinants of attitude-behavior consistency

This article addresses the questions of when we can predict from an individual's attitude toward a social group to the individual's behavior toward a specific member of that group. One possibility is that individuals determine their attitudes toward a social group by assessing their reactions to an imagined group representative who embodies the defining or central group characteristics--the prototypical group member. When they encounter a specific group member whose characteristics match well those of the "attitude prototype", individuals display attitude-behavior consistency; when the match is poor, they display attitude-behavior inconsistency. This proposition was tested in two experiments, and in each the attitude-behavior relationship was greater in relation to prototypical than to unprototypical group members. In addition, knowledge of an unprototypical group member had little or no effect on attitude prototypes. Rather, the unprototypical group member was dismissed as atypical, leaving the prototype intact to influence future social behavior. The implications for attitude change, and possible applications to more abstract attitudes, are discussed.

Attitude prototypes as determinants of attitude-behavior consistency

This article addresses the questions of when we can predict from an individual's attitude toward a social group to the individual's behavior toward a specific member of that group. One possibility is that individuals determine their attitudes toward a social group by assessing their reactions to an imagined group representative who embodies the defining or central group characteristics--the prototypical group member. When they encounter a specific group member whose characteristics match well those of the "attitude prototype", individuals display attitude-behavior consistency; when the match is poor, they display attitude-behavior inconsistency. This proposition was tested in two experiments, and in each the attitude-behavior relationship was greater in relation to prototypical than to unprototypical group members. In addition, knowledge of an unprototypical group member had little or no effect on attitude prototypes. Rather, the unprototypical group member was dismissed as atypical, leaving the prototype intact to influence future social behavior. The implications for attitude change, and possible applications to more abstract attitudes, are discussed.

2-bromo-alpha-ergocryptine (CB-154) and tamoxifen (ICI 46,474) induced suppression of the genesis of mammary carcinomas in female rats treated with 7,12-dimethylbenzanthracene (DMBA): a comparison

Daily treatment of female Sprague-Dawley rats with CB-154 (prolactin suppressor) or Tamoxifen (estrogen antagonist) for 33 days before and after 7,12-dimethylbenzanthracene (DMBA) administration reduced (p less than 0.005) the incidence of mammary carcinomas by 58 and 49%, respectively. A combination of CB-154 and Tamoxifen further reduced (p less than 0.005) mammary carcinoma incidence by an additional 50-59%. Treatment with Tamoxifen for 66 days beginning 33 days after carcinogen treatment reduced (p less than 0.05) the incidence of mammary carcinomas by 65%; CB-154 treatment, during the same time period, did not significantly effect the final yield of mammary carcinomas. The combination of Tamoxifen and CB-154 was comparable to Tamoxifen alone in suppressing the incidence of mammary carcinomas in the latter study. These results demonstrate a substantial suppressive and synergistic effect of Tamoxifen and CB-154 in the initiating phases of mammary carcinogenesis while in the early promoting phases of this oncogenic process, short-term treatment with Tamoxifen was superior to CB-154 treatment; no synergism between these clinically important compounds was observed.