Solitary bees reduce investment in communication compared with their social relatives.

Social animals must communicate to define group membership and coordinate social organization. For social insects, communication is predominantly mediated through chemical signals, and as social complexity increases, so does the requirement for a greater diversity of signals. This relationship is particularly true for advanced eusocial insects, including ants, bees, and wasps, whose chemical communication systems have been well-characterized. However, we know surprisingly little about how these communication systems evolve during the transition between solitary and group living. Here, we demonstrate that the sensory systems associated with signal perception are evolutionarily labile. In particular, we show that differences in signal production and perception are tightly associated with changes in social behavior in halictid bees. Our results suggest that social species require a greater investment in communication than their solitary counterparts and that species that have reverted from eusociality to solitary living have repeatedly reduced investment in these potentially costly sensory perception systems.

Involvement, satisfaction and unmet health care needs in patients with psoriatic arthritis.

OBJECTIVE: To examine the involvement in care, participation in medical decision, satisfaction of health care and unmet needs in patients with PsA. To explore factors related to involvement and satisfaction with care. METHODS: One hundred and five patients with PsA attending four regional hospital rheumatology outpatient clinics were invited and consented to self-administer questionnaires, including socio-demographic data, quality of life with SF-12, involvement in medical decision, satisfaction with care and unmet health care needs. RESULTS: The overall perceived knowledge of disease was moderate. Good disease knowledge and good physical functioning were positively associated with involvement in care. Age, sex and pain scores were not associated with involvement in multivariate analysis. A low score in at least one question on involvement was the single independent negative predictor for satisfaction with health care. Only a minority (9%) was actively participating in medical decision-making. Among non-participants, 61.5% expressed the wish to participate. In aspects of education of disease, advice for exercise, psychological support and social support, respectively, 68.3, 73.3, 29.3 and 41.6% of the patients expressed unmet needs. CONCLUSION: Low involvement is negatively associated with satisfaction with health care in PsA. Good knowledge of disease and good physical functioning is positively associated with involvement. The current study supports patient education as an important factor associated with involvement of and satisfaction with care in PsA patients. Such patients have a high desire for information and numerous unmet health care needs. There is a need for improvement in the delivery of care to patients with PsA.

Impact of illness and variables associated with functional impairment in Chinese patients with psoriatic arthritis.

OBJECTIVES: To assess the impact of disease and functional outcomes in Chinese patients with psoriatic arthritis (PsA) and to identify variables associated with poor functional outcomes. METHODS: A cross sectional study performed in 80 consecutive patients with PsA from a single center. Functional outcomes were assessed by the Health Assessment Questionnaire (HAQ) and the Bath Ankylosing Spondylitis Functional Index (BASFI). Clinical variables included social-demographic characteristics and clinical features. Linear regression analyses were performed to identify variables associated with functional impairment. RESULTS: Thirty-six men and 44 women with mean (+/-SD) age and duration of arthritis of 48.6 (+/-13.0) and 10.2 (+/-6.9) years were studied. One-third reported PsA related unemployment and change in job nature. Another third experienced a reduction of income due to PsA. The median (IQR) HAQ and BASFI were 0.44 (1.09) and 2.1 (4.38). These functional scores correlated highly with each other and with the patient's perception of health, but correlated only moderately or poorly with other disease activity variables. Multivariate analysis identified higher damaged joint count, poorer patients' perception of health, poor socioeconomic factor and higher CRP as factors associated with higher HAQ. Higher back pain score; higher CRP, higher damaged joint count and poor socioeconomic factor were associated with BASFI. CONCLUSION: PsA in Chinese subjects has had significant social-economic impact. Joint damage was found to be associated with functional impairment.

Costs and quality of life of patients with ankylosing spondylitis in Hong Kong.

OBJECTIVES: To assess the annual direct, indirect and total societal costs, quality of life (QoL) of AS in a Chinese population in Hong Kong and determine the cost determinants. METHODS: A retrospective, non-randomized, cross-sectional study was performed in a cohort of 145 patients with AS in Hong Kong. Participants completed questionnaires on sociodemographics, work status and out-of-pocket expenses. Health resources consumption was recorded by chart review. Functional impairment and disease activity were measured using the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), respectively. Patients' QoL was assessed using the Short Form-36 (SF-36). RESULTS: The mean age of the patients was 40 yrs with mean disease duration of 10 yrs. The mean BASDAI score was 4.7 and BASFI score was 3.3. Annual total costs averaged USD 9120. Direct costs accounted for 38% of the total costs while indirect costs accounted for 62%. Costs of technical examinations represented the largest proportion of total cost. Patients with AS reported significantly impaired QoL. Functional impairment became the major cost driver of direct costs and total costs. CONCLUSION: There is a substantial societal cost related to the treatment of AS in Hong Kong. Functional impairment is the most important cost driver. Treatments that reduce functional impairment may be effective to decrease the costs of AS and improve the patient's QoL, and ease the pressure on the healthcare system.

Cranial computed tomography in the assessment of neurological complications in critically ill patients with systemic lupus erythematosus.

The cranial computed tomography findings in 22 critically ill patients with systemic lupus erythematosus in the intensive care unit were reviewed to document the spectrum of pathology encountered and to assess the contribution of cranial computed tomography to the diagnosis and management of such patients, many of whom had severe multisystem disease. Thirty-one scans were performed in 22 patients, all of which were abnormal. Premature cerebral atrophy was identified in fifteen patients (68%), cerebral infarction in five (23%), intracranial haemorrhage and cerebral oedema in four each (18%), and hydrocephalus in three (14%). Six patients had multiple pathologies. The cranial computed tomography findings confirmed the clinical diagnosis in 13 of 22 cases (59%) and altered it in nine (41%). The contribution to diagnosis and management justifies transportation and computed tomography scanning. The contribution to patient outcome, however, is uncertain as mortality was 91%.