Healthcare resource utilization and costs associated with long-term corticosteroid exposure in patients with systemic lupus erythematosus.

Objective To evaluate the association between exposure to oral corticosteroids and future healthcare resource utilization and costs for patients with systemic lupus erythematosus. Methods Adults diagnosed with systemic lupus erythematosus (index date) between 1 January 2008 and 30 June 2013 and naive to oral corticosteroids with continuous health plan enrollment for ≥6 months pre- and ≥5 years post-index were identified from a large health plan claims database. Per-patient monthly average daily dose of oral corticosteroids (prednisone or its equivalent) was calculated for the first 2 years post-index to categorize patients into four steroid exposure cohorts: low (≤5 mg/day), medium (6-20 mg/day), high (>20 mg/day) and no steroids. Differences in healthcare resource utilization and total healthcare costs during the third year post-index across corticosteroid exposure cohorts were modeled with adjustment for baseline characteristics. Results The study included 18,618 systemic lupus erythematosus patients (163 high dose, 1127 medium dose, 6717 low dose and 10,611 no steroids). Compared to low-dose corticosteroid users, high-dose corticosteroid users were more likely to have emergency room visits (39.3% vs. 29.7%; p = 0.0085) and to be hospitalized (21.5% vs. 12.3%; p = 0.0005). After adjustment for baseline characteristics, they also had significantly greater average annual total healthcare costs (US$60,366 vs. US$18,777; p < 0.0001). A 1 mg increase in corticosteroid average daily dose was associated with 1.07 times the average annual costs after adjusting for baseline characteristics ( p < 0.0001). Conclusion Long-term high-dose oral corticosteroid use was associated with significantly greater future healthcare resource utilization and costs. Judicious reduction in daily steroid dose may decrease the imminent economic burden associated with high-dose steroid use in systemic lupus erythematosus.

A systematic review and meta-analysis of outpatient treatment for acute diverticulitis.

BACKGROUND: The shift from routine antibiotics towards omitting antibiotics for uncomplicated acute diverticulitis opens up the possibility for outpatient instead of inpatient treatment, potentially reducing the burden of one of the most common gastrointestinal diseases in the Western world. PURPOSE: Assessing the safety and cost savings of outpatient treatment in acute colonic diverticulitis. METHODS: PubMed and EMBASE were searched for studies on outpatient treatment of colonic diverticulitis, confirmed with computed tomography or ultrasound. Outcomes were readmission rate, need for emergency surgery or percutaneous abscess drainage, and healthcare costs. RESULTS: A total of 19 studies with 2303 outpatient treated patients were included. These studies predominantly excluded patients with comorbidity or immunosuppression, inability to tolerate oral intake, or lack of an adequate social network. The pooled incidence rate of readmission for outpatient treatment was 7% (95%CI 6-9%, I2 48%). Only 0.2% (2/1288) of patients underwent emergency surgery, and 0.2% (2/1082) of patients underwent percutaneous abscess drainage. Only two studies compared readmission rates outpatients that had similar characteristics as a control group of inpatients; 4.5% (3/66) and 6.3% (2/32) readmissions in outpatient groups versus 6.1% (4/66) and 0.0% (0/44) readmissions in inpatient groups (p = 0.619 and p = 0.174, respectively). Average healthcare cost savings for outpatient compared with inpatient treatment ranged between 42 and 82%. CONCLUSION: Outpatient treatment of uncomplicated diverticulitis resulted in low readmission rates and very low rates of complications. Furthermore, healthcare cost savings were substantial. Therefore, outpatient treatment of uncomplicated diverticulitis seems to be a safe option for most patients.

[The module "Motorik" in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Motor fitness and physical activity of children and young people]. / Motorik-Modul (MoMo) im Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS). Motorische Leistungsfähigkeit und körperlich-sportliche Aktivität von Kindern und Jugendlichen in Deutschland.

Motor fitness and physical activity are important aspects of a healthy development in childhood and adolescence. However, the assessment of motor fitness and physical activity is not subject to standardized criteria; furthermore, the samples investigated do not provide a representative image of the whole population. Therefore, the existing data only allow very limited statements on the state and development of motor fitness and physical activity. The "Motorik" module, as part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), offers nationwide representative data on the motor fitness and physical activity of children and adolescents for the first time. Besides the baseline-analysis, another aim is to analyse the complex relationship between motor fitness, physical activity and health. Motor fitness, based on the systematisation of motor abilities, was assessed using a test profile. The test profile consists of 11 items measuring cardiorespiratory fitness, strength, coordination and mobility. Physical activity was assessed using a questionnaire containing 51 items on the duration, intensity and frequency of physical activity in everyday life, during leisure time, at school and in sports clubs. The above-mentioned questionnaire subtopics were supplemented by questions on the weekly prevalence of at least 60 minutes of daily physical activity, on material and local conditions, as well as on cognition and motivation for physical activity. In the years 2004 to 2006, the motor fitness and physical activity of 4,529 children and young people between the ages of 4 and 17 years was investigated on 168 sample points in the context of the "Motorik" module. Half of the children and adolescents investigated belong to the middle class, approximately 15% have a background of migration. The majority of the subjects come from small towns, about a quarter live in the city, less than 20% are settled in rural areas.

[Examination of motor fitness within the scope of The Child and Adolescent Health Survey]. / Untersuchungen zur Motorik im Rahmen des Kinder- und Jugendgesundheitssurveys.

Several studies indicate that physical performance of children and young people is declining. However, actually available data on physical performance and physical activity of children and young people are not representative and hence no countrywide predictions can be made. The examination of motor fitness in association with development and health of children and young people is indispensable for the implementation of appropriate measures of intervention. The module 'Motoric' in the National Health Survey for Children and Adolescents shall remedy the deficiency of information. For the module, 6,000 children and adolescents, age 4-17 years, will be representatively drawn from the total survey sample. Their physical performance and physical activity will be comprehensively assessed. For this purpose, appropriate tests have been developed. In pilot studies, all methods were tested for practicability, objectivity, reliability, and validity. The application of methods was coordinated between the Robert Koch-Institute and the Institute of Sport and Science of Sports, University of Karlsruhe.

Referent cognitions theory: the role of closeness of reference points in the psychology of voice.

The most generally accepted and best documented manipulation in procedural justice experiments is varying whether or not participants are allowed an opportunity to voice their opinion about a decision. To better understand the psychology of voice, the authors focus on Referent Cognitions Theory (RCT). It is argued that thus far RCT has not been used to explain the psychology of voice and that previous RCT research suffers from methodological problems and has been more outcome oriented than necessary. Two experiments resolve these problems and show that people react more strongly to procedures (especially no-voice procedures) when reference points are close as opposed to distant. These findings suggest that closeness of reference points plays an important role in the psychology of voice. The findings expand RCT in significant ways and indicate that insight into the role of reference points is essential for understanding the psychology of justice.

Uncertainty management: the influence of uncertainty salience on reactions to perceived procedural fairness.

On the basis of fairness heuristic theory, it is argued in this article that people especially need fairness when they are reminded about aspects of their lives that make them uncertain. It is therefore proposed that thinking about uncertainty should make fairness a more important issue to people. The findings of 3 experiments support this line of reasoning: Asking (vs. not asking) participants 2 questions that solicited their thoughts and feelings of being uncertain led to stronger effects of perceived procedural fairness on participants' affective reactions toward the way they were treated. It is argued that these findings suggest that fairness matters to people especially when they are trying to deal with things that make them uncertain. An implication of the current findings therefore may be that fairness is important to people because it gives them an opportunity to manage uncertain aspects of their lives.

Fine motor assessment in chronic wrist pain: the role of adapted motor control.

OBJECTIVE: To show whether a difference in fine motor control exists between patients with chronic, undiagnosed wrist pain (CUWP) and healthy controls. Furthermore, a method to assess fine motor function of the wrist is evaluated. DESIGN: A case-control study. SETTING: The Academic Medical Center in Amsterdam, the Netherlands. SUBJECTS: Twenty-seven CUWP patients were compared with 50 healthy control subjects. INTERVENTIONS: Subjects performed horizontal stroke patterns on a digital writing tablet connected to a computer. The control subjects were tested twice to obtain test-retest reliability. A visual analogue scale was used to assess subjective pain. MAIN OUTCOME MEASURES: Fluency of movement and average velocity were measured. Intraclass correlation, ANOVA repeated measures statistics and Pearson correlation were calculated. RESULTS: There is a significant difference in fluency of motion between patients and controls, possibly due to a disturbed motor control, since there is no relationship between pain and test score, nor do CUWP patients have any abnormality in the wrist that can explain the disturbance in motor function. The test method is reliable (ICC = 0.78) and valid. CONCLUSIONS: The disturbed fine motor control in CUWP patients is suggested to maintain chronic wrist pain through 'strain injury, causing' pain evasive adaptation of the motor control system. This might lead to new perspectives regarding treatment of CUWP patients.

Toward understanding why fairness matters: the influence of mortality salience on reactions to procedural fairness.

This article focuses on the question of why fairness matters to people. On the basis of fairness heuristic theory, the authors argue that people especially need fairness when they are uncertain about things that are important to them. Following terror management theory, the authors focus on a basic kind of human uncertainty: fear of death. Integrating these two theoretical frameworks, it is proposed that thinking about their mortality should make fairness a more important issue to people. The findings of three experiments support the authors' line of reasoning: Asking participants to think about their mortality led to stronger fair process effects (positive effects of perceived procedural fairness on subsequent reactions) than not asking them to think about mortality. It is argued that these findings suggest that fairness especially matters to people when they are uncertain about fundamental aspects of human life such as human mortality.

How do I judge my outcome when I do not know the outcome of others? The psychology of the fair process effect.

On the basis of fairness heuristic theory, the authors provide an explanation of the frequently replicated fair process effect (the finding that perceived procedural fairness positively affects how people react to outcomes). The authors argue that, in many situations, people may find it difficult to assess whether their outcome is fair or unfair and satisfying or unsatisfying because they only have information about their own outcome and they do not know the outcomes of others and that, in these situations, people use the fairness of the procedure as a heuristic substitute to assess how to judge their outcome. The results of 2 experiments corroborate the authors' line of reasoning. Findings are discussed in terms of recent developments toward an integration of the procedural and distributive justice domains.