Use of the SF-36v2 Health Survey as a Screen for Risk of Major Depressive Disorder in a US Population-based Sample and Subgroup With Chronic Pain.

STUDY OBJECTIVES: To assess the feasibility of using the SF-36v2 mental health (MH) and mental component summary (MCS) scores for classification of risk for major depressive disorder (MDD), and to determine cut-off scores based on the sensitivity and specificity in a general US representative sample, and a chronic pain subpopulation. METHODS: Data were analyzed from the 2013 US National Health and Wellness Survey (adults 18 y old and above; N=75,000), and among a chronic pain subpopulation (n=6679). Risk of MDD was a score ≥10 on the Patient Health Questionnaire (PHQ-9). Logistic regression modeling was used to predict at risk for MDD and receiver operating characteristic curves were produced. RESULTS: The total sample had MH scores of 48.8 and MCS scores of 48.9, similar to the normative US population mean. Percent of respondents with a PHQ-9≥10 were 15.0% and 29.1% for the total sample and chronic pain subpopulation, respectively. Cut-off scores (PHQ-9≥10) in the total sample for the MH and MCS were 43.0 and 46.0, respectively. Specificities for the MH and MCS were 77.8% and 76.1%; sensitivities were 84.9% and 88.1%, respectively. Among the subpopulation with chronic pain, cut-off scores for the MH and MCS were 40.4 and 43.1, respectively. Corresponding specificities for the MH and MCS were 77.9% and 73.9%; sensitivities were 78.3% and 83.4%, respectively. CONCLUSIONS: The SF-36v2 was found to have sufficient specificity and sensitivity to categorize participants at risk for MDD. If no depression questionnaire is available, it is feasible to use the SF-36v2 to characterize the MH of populations.

Impact of binge eating disorder on functional impairment and work productivity in an adult community sample in the United States.

AIM: This study compared functioning and productivity in individuals meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for binge eating disorder (BED) to those without BED. METHODS: A sample of US adults from the National Health and Wellness Survey completed an Internet survey in October 2013. In addition to BED diagnostic criteria, the survey assessed functional impairment and productivity, respectively, using the Sheehan Disability Scale (SDS) and Work Productivity and Activity Impairment (WPAI) questionnaire. Differences between BED and non-BED respondents were assessed using multivariate models controlling for factors, including age, sex and comorbidities. RESULTS: Of 22 397 respondents, 344 were categorised as BED respondents and 20 437 as non-BED respondents. Compared with non-BED respondents, BED respondents exhibited significantly (all P<.001) greater functional impairment on the SDS, as measured by mean±SD total (14.04±9.46 vs 3.41±6.36), work/school (3.86±3.62 vs 1.01±2.21), social life/leisure activities (5.29±3.49 vs 1.22±2.33) and family life/home responsibilities (4.89±3.44 vs 1.18±2.26) scores. Adjusted odds ratios (95% CIs) indicated that BED respondents were more impaired than non-BED respondents on the work/school (4.24 [3.33-5.40]), social life/leisure activities (6.37 [4.97-8.15]) and family life/home responsibilities (5.76 [4.51-7.34]) domains of the SDS. On the WPAI, BED respondents reported significantly (all P<.001) higher percentages (mean±SD) of absenteeism (9.59%±19.97% vs 2.90%±12.95%), presenteeism (30.00%±31.64% vs 10.86%±20.07%), work productivity loss (33.19%±33.85% vs 12.60%±23.22%) and activity impairment (43.52%±34.36% vs 19.94%±27.22%) than non-BED respondents. CONCLUSIONS: The findings suggest individuals with BED experience considerable impairment in functioning and work productivity compared with individuals without BED.

The healthy personality from a basic trait perspective.

What basic personality traits characterize the psychologically healthy individual? The purpose of this article was to address this question by generating an expert-consensus model of the healthy person in the context of the 30 facets (and 5 domains) of the Revised NEO Personality Inventory (Costa & McCrae, 1992) system of traits. In a first set of studies, we found that the healthy personality can be described, with a high level of agreement, in terms of the 30 facets of the NEO-PI-R. High levels of openness to feelings, positive emotions, and straightforwardness, together with low levels on facets of neuroticism, were particularly indicative of healthy personality functioning. The expert-generated healthy personality profile was negatively correlated with profiles of pathological personality functioning and positively correlated with normative personality functioning. In a second set of studies, we matched the NEO-PI-R profiles of over 3,000 individuals from 7 different samples with the expert-generated healthy prototype to yield a healthy personality index. This index was characterized by good retest reliability and cross-rater agreement, high rank-order stability, and substantial heritability. Individuals with high scores on the healthy personality index were psychologically well-adjusted, had high self-esteem, good self-regulatory skills, an optimistic outlook on the world, and a clear and stable self-view. These individuals were low in aggression and meanness, unlikely to exploit others, and were relatively immune to stress and self-sufficient. We discuss the results in the light of their implications for both research and theory on healthy personality functioning. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Assessment of Fearless Dominance and Impulsive Antisociality via normal personality measures: convergent validity, criterion validity, and developmental change.

This report provides evidence for the reliability, validity, and developmental course of the psychopathic personality traits (factors) of Fearless Dominance (FD) and Impulsive Antisociality (IA) as assessed by items from the Multidimensional Personality Questionnaire (MPQ; Patrick, Curtin, & Tellegen, 2002). In Study 1, MPQ-based measures of FD and IA were strongly correlated with their corresponding composite scores from the Psychopathic Personality Inventory-Revised (Lilienfeld & Widows, 2005). In Study 2, FD and IA had relatively distinct associations with measures of normal and maladaptive personality traits. In Study 3, FD and IA had substantial retest coefficients during the transition to adulthood, and both traits showed average declines with an especially substantial drop in IA. In Study 4, FD and IA were correlated with measures of internalizing and externalizing problems in ways consistent with previous research and theory. Collectively, these results provide important information about the assessment of FD and IA.

Factors associated with physicians' decision to discontinue or down-titrate sulfonylureas for type 2 diabetes patients.

BACKGROUND: Sulfonylureas (SUs) can help manage type 2 diabetes mellitus, but often have side effects. The objective of this study was to identify factors impacting physicians' decisions to discontinue (DC) or down-titrate (DT) SU therapy. METHODS: 1,026 physicians from the All Global panel were asked to rate level of concern regarding potential reasons for DC or DT on a 7-point Likert scale (1 = not concerned, 7 = extremely concerned). Physicians also provided information regarding treatment decisions from one DC patient, one DT patient, and two current SU users. RESULTS: When asked to report what factors might lead them to DC or DT an SU, physicians reported that hypoglycemic events requiring medical assistance (DC = 6.0, DT = 5.9), hypoglycemic events requiring nonmedical assistance (DC = 5.9, DT = 5.9), other hypoglycemic events not requiring assistance (DT = 5.7), and treatment goals not being met (DC = 5.6) were most concerning. DC and DT patients were more likely to have experienced ≥ 1 hypoglycemic events in the previous year vs. current users (DC = 41.0%, DT = 43.1%, current = 8.8%; p < .05). CONCLUSIONS: Results highlight the strong influence  of hypoglycemia on physicians' decisions to DC or DT SU therapy.

Patient and Oncology Nurse Preferences for the Treatment Options in Advanced Melanoma: A Discrete Choice Experiment.

BACKGROUND: Understanding the perceptions of patients and oncology nurses about the relative importance of benefits and risks associated with newer treatments of advanced melanoma can help to inform clinical decision-making. OBJECTIVES: The aims of this study were to quantify and compare the views of patients and oncology nurses regarding the importance of attributes of treatments of advanced melanoma. METHODS: A discrete choice experiment (DCE) was conducted in US-based oncology nurses and patients diagnosed with advanced melanoma. Patients and nurses were enlisted through online panels. In a series of scenarios, respondents had to choose between 2 hypothetical treatments, each with 7 attributes: mode of administration (MoA), dosing schedule (DS), median duration of therapy (DoT), objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and grade 3 or 4 adverse events (AEs). Hierarchical Bayesian logistic regression models were used to estimate preference weights. RESULTS: A total of 200 patients with advanced melanoma and 150 oncology nurses participated. The relative importance estimates of attributes by patients and nurses, respectively, were as follows: OS, 33% and 28%; AEs, 29% and 26%; ORR, 25% and 27%; PFS, 12% and 15%; DS, 2% and 3%; DoT, 0% and 0%; and MoA, 0% and 0%. CONCLUSION: Both patients and oncology nurses valued OS, ORR, and AEs as the most important treatment attributes for advanced melanoma, followed by PFS, whereas DS, DoT, and MoA were given less value in their treatment decisions. IMPLICATIONS FOR PRACTICE: Oncology nurses and patients have similar views on important treatment considerations for advanced melanoma, which can help build trust in shared decision-making.

Severity of hypoglycaemia and health-related quality of life, work productivity and healthcare costs in patients with type 2 diabetes in Europe.

AIMS: Hypoglycaemia in patients with type 2 diabetes mellitus (T2DM) is associated with poor health outcomes, such as reduced health-related quality of life (HRQoL). This study aimed to assess the impact of hypoglycaemic events by severity on HRQoL, work productivity and healthcare costs in patients with T2DM. MATERIALS AND METHODS: European patients with T2DM selected from the National Health and Wellness Survey who were currently receiving pharmacologic therapy were stratified into 3 groups based on the reported history and severity of hypoglycaemic events (no event, nonsevere, severe) experienced in the previous 3 months. Patients' work productivity, HRQoL, healthcare resource use (HCRU) and associated costs were assessed as self-reported outcomes. RESULTS: Of 1269 patients included in the study, 652 (51.4%) patients had not experienced an event, while 533 (42.0%) and 84 (6.6%) patients had experienced nonsevere and severe hypoglycaemic events, respectively, in the previous 3 months. An increase in hypoglycaemia severity was associated with a decrease in HRQoL, and an increase in HCRU and healthcare costs. CONCLUSIONS: The impact of hypoglycaemia varies by severity and has a negative impact on HRQoL and overall HCRU and costs.

Sleep Tracking and Exercise in Patients With Type 2 Diabetes Mellitus (Step-D): Pilot Study to Determine Correlations Between Fitbit Data and Patient-Reported Outcomes.

BACKGROUND: Few studies assessing the correlation between patient-reported outcomes and patient-generated health data from wearable devices exist. OBJECTIVE: The aim of this study was to determine the direction and magnitude of associations between patient-generated health data (from the Fitbit Charge HR) and patient-reported outcomes for sleep patterns and physical activity in patients with type 2 diabetes mellitus (T2DM). METHODS: This was a pilot study conducted with adults diagnosed with T2DM (n=86). All participants wore a Fitbit Charge HR for 14 consecutive days and completed internet-based surveys at 3 time points: day 1, day 7, and day 14. Patient-generated health data included minutes asleep and number of steps taken. Questionnaires assessed the number of days of exercise and nights of sleep problems per week. Means and SDs were calculated for all data, and Pearson correlations were used to examine associations between patient-reported outcomes and patient-generated health data. All respondents provided informed consent before participating. RESULTS: The participants were predominantly middle-aged (mean 54.3, SD 13.3 years), white (80/86, 93%), and female (50/86, 58%). Use of oral T2DM medication correlated with the number of mean steps taken (r=.35, P=.001), whereas being unaware of the glycated hemoglobin level correlated with the number of minutes asleep (r=-.24, P=.04). On the basis of the Fitbit data, participants walked an average of 4955 steps and slept 6.7 hours per day. They self-reported an average of 2.0 days of exercise and 2.3 nights of sleep problems per week. The association between the number of days exercised and steps walked was strong (r=.60, P<.001), whereas the association between the number of troubled sleep nights and minutes asleep was weaker (r=.28, P=.02). CONCLUSIONS: Fitbit and patient-reported data were positively associated for physical activity as well as sleep, with the former more strongly correlated than the latter. As extensive patient monitoring can guide clinical decisions regarding T2DM therapy, passive, objective data collection through wearables could potentially enhance patient care, resulting in better patient-reported outcomes.

Impact of the severity of hypoglycemia on health - Related quality of life, productivity, resource use, and costs among US patients with type 2 diabetes.

AIMS: To explore the association between hypoglycemia severity and health-related quality of life (HRQoL), productivity, health care resource utilization (HCRU), and costs among patients with type 2 diabetes mellitus (T2DM). METHODS: Data were from the 2013 US National Health and Wellness Survey. This analysis included adults with treated T2DM. Participants were categorized based upon their self-reported experience in the previous 3 months: no hypoglycemia, non-severe hypoglycemia, or severe hypoglycemia. Validated instruments were used to measure HRQoL and productivity; HCRU was based on participant-reported health care provider (HCP) and emergency department (ED) visits and hospitalizations. Multivariable models tested for trends across the severity groups. RESULTS: The analysis included 3630 participants-1729 (47.6%) with non-severe hypoglycemia and 172 (4.7%) with severe hypoglycemia. Mental and physical component scores and utility scores were significantly associated with hypoglycemia severity (P < 0.001 for each). Similar trends were observed for absenteeism (P < 0.001), presenteeism (P = 0.005), HCP and ED visits (P ≤ 0.002), and hospitalizations (P < 0.001). Annual HCRU costs associated with increasingly severe hypoglycemia were $6908, $7132, and $15,410, respectively (P < 0.001), and productivity costs were $7248, $7493, and $12,167, respectively (P = 0.008). CONCLUSION: Hypoglycemia severity appears to be related to reduced HRQoL and productivity, which are mirrored by increased direct and indirect costs.

Evaluating the structure of psychopathic personality traits: A meta-analysis of the Psychopathic Personality Inventory.

Which core traits exemplify psychopathic personality disorder is a hotly debated question within psychology, particularly regarding the role of ostensibly adaptive traits such as stress immunity, social potency, and fearlessness. Much of the research on the interrelationships among putatively adaptive and more maladaptive traits of psychopathy has focused on the factor structure of the Psychopathic Personality Inventory (PPI) and its revision, the Psychopathic Personality Inventory-Revised (PPI-R). These instruments include content scales that have coalesced to form 2 higher order factors in some (but not all) prior studies: Fearless Dominance and Self-Centered Impulsivity. Given the inconsistencies in prior research, we performed a meta-analytic factor analysis of the 8 content scales from these instruments (total N > 18,000) and found general support for these 2 dimensions in community samples. The structure among offender samples (e.g., prisoners, forensic patients) supported a 3-factor model in which the Fearlessness content scale loaded onto Self-Centered Impulsivity (rather than Fearless Dominance). There were also indications that the Stress Immunity content scale had different relations to the other PPI scales in offender versus community samples. We discuss the theoretical and diagnostic implications of these differing factor structures for the field of psychopathy research. (PsycINFO Database Record

Hypoglycemia in type 2 diabetes: understanding patients' and physicians' knowledge and experience.

PURPOSE: The aim of the current study is to assess the patient and physician experience and knowledge of hypoglycemia in the management of type 2 diabetes (T2DM). METHODS: T2DM patients (N = 1002) completed questionnaires on hypoglycemia experience, familiarity, and fear. Their responses were compared across various antihyperglycemic treatment regimens; specifically, (1) insulin only or insulin combined with sulfonylurea [SU] and/or metformin, (2) SU only with/without metformin, and (3) neither insulin nor SU. Physicians (N = 1003) completed questionnaires on hypoglycemia knowledge and decision-making, and their responses were compared by specialty [75% primary care providers (PCPs) and 25% endocrinologists]. RESULTS: T2DM patients treated with, (1) insulin only, or (2) insulin plus SU or metformin, reported the most experience and familiarity with-but also fear of-hypoglycemic events. Insulin-treated patients (insulin alone or insulin plus SU/metformin) also reported experiencing more hypoglycemia (all p-values <0.012). For physicians, endocrinology specialty was significantly associated with higher hypoglycemia knowledge scores (all p-values <.001). Irrespective of specialty, physician hypoglycemia knowledge, in turn, was associated with correct treatment decision-making (all p-values <0.001). CONCLUSIONS: Insulin-based antihyperglycemic regimens were associated with high prevalence, severity, familiarity, and fear of hypoglycemia. An effective strategy to mitigate the burden of hypoglycemia may be to optimize pharmacological therapy to prevent these events. Since physician hypoglycemia knowledge was highly correlated to correct therapeutic decision-making, continued physician education regarding this acute complication of diabetes treatment should be prioritized for those managing patients with T2DM.

Examining the reliability and validity of an abbreviated Psychopathic Personality Inventory-Revised (PPI-R) in four samples.

A recently developed 40-item short-form of the Psychopathic Personality Inventory-Revised (PPI-R; Lilienfeld & Widows, 2005) has shown considerable promise as an alternative to the long-form of the instrument (Eisenbarth, Lilienfeld, & Yarkoni, 2015). Beyond the initial construction of the short-form, however, Eisenbarth et al. only evaluated a small number of external correlates in a German college student sample. In this study, we evaluate the internal consistency of the short-form scales in 4 samples previously administered the full PPI-R (3 U.S. college student samples and 1 U.S. forensic psychiatric inpatient sample) and examine a wide range of external correlates to compare the nomological nets of the short- and long-forms. Across all 4 samples, correlations between each short-form scale and its corresponding long-form scale were uniformly high (all rs > .75). In terms of external correlates, the pattern of associations was exceedingly similar, for the short-form and long-form composites with a largely trivial reduction in effect size. Collectively, our findings offer considerable support for the utility of this new short-form as a substitute for the full PPI-R. (PsycINFO Database Record

Experts' Views Regarding the Conceptualization of Narcissism.

There is debate over the definition of narcissism across social/personality and clinical psychology. The current article aims to quantify the level of disagreement by measuring experts' opinions concerning the attributes most central to narcissism. Accordingly, we developed a comprehensive list of attributes associated with narcissism and had 49 self-identified experts (among them 17 women, 23 psychologists from clinical psychology and 22 from social/personality psychology) rate these characteristics and provide their opinions on several issues related to the conceptualization of narcissism. Experts generally believe that the grandiose features of narcissism are more central than the vulnerable features. However, differences between clinical and social/personality psychologists were evident, especially regarding the relevance of self-esteem. Given the results, we suggest that researchers specify the kind of narcissism being assessed in a given study and consider using assessments of the full range of narcissistic features in future research to provide a more comprehensive perspective on the construct.

Patient and oncologist preferences for attributes of treatments in advanced melanoma: a discrete choice experiment.

PURPOSE: To examine and compare patient and oncologist preferences for advanced melanoma treatment attributes and to document their trade-offs for benefits with risks. MATERIALS AND METHODS: A discrete choice experiment (DCE) was conducted among advanced melanoma patients and oncologists. Qualitative pilot testing was used to inform the DCE design. A series of scenarios asked stakeholders to choose between two hypothetical medications, each with seven attributes: mode of administration (MoA), dosing schedule (DS), median duration of therapy (MDT), objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and grade 3-4 adverse events (AEs). Hierarchical Bayesian logistic regression models were used to determine patients' and oncologists' choice-based preferences, analysis of variance models were used to estimate the relative importance of attributes, and independent t-tests were used to compare relative importance estimates between stakeholders. RESULTS: In total, 200 patients and 226 oncologists completed the study. OS was most important to patients (33%), followed by AEs (29%) and ORR (25%). For oncologists, AEs were most important (49%), followed by OS (34%) and ORR (12%). An improvement from 55% to 75% in 1-year OS was valued similar in magnitude to a 23% decrease (from 55% to 32%) in likelihood of AEs for oncologists. CONCLUSION: Patients valued OS, AEs, and ORR sequentially as the most important attributes in making a treatment decision, whereas oncologists valued AEs most, followed by OS and ORR. In comparison, patients differed significantly from oncologists on the importance of ORR, AEs, and PFS, but were consistent in OS and the rest of attributes.

A Pilot RCT of a Values-Based Mindfulness Group Intervention with Jail Inmates: Evidence for Reduction in Post-Release Risk Behavior.

This study pilot-tested a values and mindfulness-based intervention (Re-Entry Values and Mindfulness Program: REVAMP) in a sample of male jail inmates. REVAMP aimed to reduce post-release risky behavior by targeting dimensions of mindfulness (e.g., willingness/acceptance) and associated proximal outcomes/mechanisms of action (emotion regulation, self-control, shame/guilt). Inmates were randomly assigned to REVAMP (n=21) or treatment as usual (TAU, n=19). Attendance and feedback supported REVAMP's feasibility and acceptability. At post-treatment, ANCOVAs showed that the REVAMP group increased more on willingness/acceptance, self-judgment and shame relative to TAU. Relative increases in willingness/acceptance persisted at 3-month post-release. Criminal activity was assessed by self-report at three months post-release and official criminal records at three years post-release. At both time-points, there was a marginally statistically significant trend of medium effect size for lower criminal recidivism in the REVAMP group compared to TAU. There were no statistically significant differences in self-reported post-release substance misuse. This pilot RCT indicated mindfulness-based interventions may hold promise for reducing inmates' post-release risky behavior and encourages future research in this area.

Associations Between COPD Severity and Work Productivity, Health-Related Quality of Life, and Health Care Resource Use: A Cross-Sectional Analysis of National Survey Data.

OBJECTIVE: The aim of this study was to investigate the associations between presence of chronic obstructive pulmonary disease (COPD) and increasing COPD severity with work productivity and activity impairment (WPAI), health-related quality of life (HRQoL), and health care resource use (HCRU) in employed adults. METHODS: Employed adults aged at least 40 years from the 2010 to 2012 US National Health and Wellness Survey were selected for this study. Associations of interest were assessed using multivariate regression models. RESULTS: The study sample consisted of 60,389 respondents with 4.1% reporting a physician diagnosis of COPD. Of these, 55.4%, 37.6%, and 7.0% reported their COPD severity was mild, moderate, and severe, respectively. The presence of COPD and increasing COPD severity was associated with higher WPAI, lower HRQoL, and higher HCRU (all P < 0.001). CONCLUSION: In an employed population, presence of COPD and increasing COPD severity negatively impacts health outcomes, particularly work productivity.

Examining the association between pain severity and quality-of-life, work-productivity loss, and healthcare resource use among European adults diagnosed with pain.

OBJECTIVE: The goal of this research was to quantify the association between pain severity and several health outcomes in a large sample of patients diagnosed with some form of pain. METHODS: Responses from patients who had been diagnosed with some form of pain (n = 14,459) were drawn from the 2013 EU National Health and Wellness Survey (NHWS; n = 62,000). Respondents reported their subjective pain severity in the past week on a numerical rating scale (0-10) as well as the Medical Outcomes Study Short Form (SF-36), Work Productivity and Activity Impairment Questionnaire (WPAI), and healthcare resource utilization in the past 6 months (healthcare professional (HCP) visits, emergency room (ER) visits, and hospitalizations). Associations between pain severity and health outcomes were examined via a series of regression models controlling for a set of demographic and health-related covariates. RESULTS: After controlling for demographics and comorbidities, pain severity in the past week was shown to be significantly negatively associated with Health Utilities (b = -0.022, p < 0.001) and positively associated with overall WPAI scores (b = 0.18, p < 0.001) and healthcare resource use (Hospitalizations: b = 0.13, p < 0.001; ER Visits: b = 0.14, p < 0.001; HCP Visits: b = 0.08, p < 0.001). The nature of these relationships (linear, curvilinear, etc.) is also explored. LIMITATIONS: This study was a self-report cross-sectional study which may have biased the results and does not allow for causal inferences to be made. Finally, the regression models run were limited to available covariates and, hence, some potentially important covariates may not have been included in these models. CONCLUSIONS: The findings suggest that reducing pain severity could result in an increase in patients' quality-of-life and work productivity, and a decrease in healthcare resource use. The equations, linking pain and outcomes, were presented in an accessible format so they could be readily applied in healthcare decision-making.

Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed.

BACKGROUND: Atrial fibrillation (AF) is associated with an increased risk of stroke. Anticoagulant (AC) therapies are effective at treating AF, but carry with them an increased risk of bleed. Research suggests that a large proportion of AF patients who have high risk of stroke and low risk of bleeding are not currently receiving AC treatment. The goal of this study was to understand the reasons why these patients do not engage in this potentially life-saving treatment. METHOD: Through a self-report online survey, using validated instruments, 1,184 US adults who self-reported a diagnosis of AF were screened for the risk of stroke and bleed. Of these patients, 230 (19.4%) were at high risk of stroke, low risk of bleed, and not currently using an AC treatment, and were asked follow-up questions to assess their reasons for nontreatment, attitudes toward treatment, and attitudes toward dosing regimens. RESULTS: The most common reasons patients stopped AC treatment were concerns regarding bleeding (27.8%) and other medical concerns (26.6%), whereas the most common reason cited for not being prescribed an AC in the first place was the use of antiplatelet therapy as an alternative (57.1%). In both cases, potentially erroneous decisions regarding perceived stoke and/or bleeding risk were also a factor. Finally, the largest factors regarding attitudes toward treatment and dosing regimen were instructions from an authority figure (eg, physician, pharmacist) and ease of use, respectively. CONCLUSION: Results suggest that many AF patients who are at high risk of stroke but at low risk of bleed may not be receiving AC due to potentially inaccurate beliefs about risk. This study also found that AF patients place trust in physicians above other factors such as cost when making treatment decisions. Increased education of patients by physicians on the risks and benefits may be a simple strategy to improve outcomes.

The Humanistic Burden of Type 1 Diabetes Mellitus in Europe: Examining Health Outcomes and the Role of Complications.

AIMS: Diagnoses of Type 1 Diabetes Mellitus (T1DM) in Europe appear to be on the rise. Therefore it is imperative that researchers understand the potential impact that increases in prevalence could have on the affected individuals as well as on society as a whole. Accordingly this study examined the humanistic and economic burden of T1DM in patients relative to those without the condition across a number of health outcomes including health status, work productivity loss, activity impairment, and healthcare resource use. METHODS: Survey data from a large, representative sample of EU adults (The EU National Health and Wellness Survey) were examined. RESULTS: Results suggest that overall burden is higher for those diagnosed with T1DM than respondents without diabetes and that burden increases as complications associated with T1DM increase. CONCLUSIONS: Taken together, these results suggest that treatment strategies for T1DM should balance clinical, humanistic, and economic burden and patients should be educated on the role of complications in disease outcomes.

The Humanistic and Economic Burden of Narcolepsy.

STUDY OBJECTIVES: To evaluate the burden of narcolepsy--with respect to psychiatric comorbidities, Health-Related Quality of Life (HRQoL), direct costs for healthcare resource utilization, and indirect costs for reported work loss-through comparison of patients to matched controls. METHODS: This analysis was conducted on data from the 2011, 2012, and 2013 US National Health and Wellness Survey (NHWS; 2011 NHWS n = 75,000, 2012 NHWS n = 71,157, and 2013 NHWS n = 75,000). Patients who reported a narcolepsy diagnosis (n = 437) were matched 1:2 with controls (n = 874) on age, sex, race/ethnicity, marital status, education, household income, body mass index, smoking status, alcohol use, exercise, and physical comorbidity. Chi-square tests and one-way analyses of variance were used to assess whether the narcolepsy and control groups differed on psychiatric comorbidities, HRQoL, labor force participation, work productivity, and healthcare resource utilization. RESULTS: Patients with narcolepsy, in comparison to matched controls, reported substantially (two to four times) greater psychiatric comorbidity, HRQoL impairment, prevalence of long-term disability, absenteeism, and presenteeism, and greater resource use in the past 6 mo as indicated by higher mean number of hospitalizations, emergency department visits, traditional healthcare professional visits, neurologist visits, and psychiatrist visits (each p < 0.05). CONCLUSIONS: These population-based data suggest that a narcolepsy diagnosis is associated with substantial adverse impact on mental health, HRQoL, and key economic burdens that include work impairment, resource use, and both direct and indirect costs. Although this study is cross-sectional, the results highlight the magnitude of the potential opportunity to improve mental health, lower costs, and augment work-related productivity through effective assessment and treatment of narcolepsy.