Isocyanates and human health: multistakeholder information needs and research priorities.

OBJECTIVES: To outline the knowledge gaps and research priorities identified by a broad base of stakeholders involved in the planning and participation of an international conference and research agenda workshop on isocyanates and human health held in Potomac, Maryland, in April 2013. METHODS: A multimodal iterative approach was used for data collection including preconference surveys, review of a 2001 consensus conference on isocyanates, oral and poster presentations, focused break-out sessions, panel discussions, and postconference research agenda workshop. RESULTS: Participants included representatives of consumer and worker health, health professionals, regulatory agencies, academic and industry scientists, labor, and trade associations. CONCLUSIONS: Recommendations were summarized regarding knowledge gaps and research priorities in the following areas: worker and consumer exposures; toxicology, animal models, and biomarkers; human cancer risk; environmental exposure and monitoring; and respiratory epidemiology and disease, and occupational health surveillance.

Treatment of very early rheumatoid arthritis with symptomatic therapy, disease-modifying antirheumatic drugs, or biologic agents: a cost-effectiveness analysis.

BACKGROUND: Long-term control or remission of rheumatoid arthritis (RA) may be possible with very early treatment. However, no optimal first therapeutic strategy has been determined. OBJECTIVE: To assess the potential cost-effectiveness of major therapeutic strategies for very early RA. DESIGN: Decision analytic model with probabilistic sensitivity analyses. DATA SOURCES: Published data, the National Data Bank for Rheumatic Diseases, and actual 2007 hospital costs. TARGET POPULATION: U.S. adults with very early RA (symptom duration

Using nominal group technique to assess chronic pain, patients' perceived challenges and needs in a community health region.

PURPOSE: The purpose of this study was to better understand the experiences of people suffering from chronic pain in order to plan client-centred educational interventions. METHODS: People in the community with chronic pain were invited via newspapers, newsletters and e-mail discussion lists to participate in a needs assessment process and to attend an educational session at a local community college. Using the nominal group technique, which is a qualitative method of data gathering, 53 participants reported their perceived challenges and needs in dealing with chronic pain. Participants were randomly assigned to one of 10 groups ranging from three to seven people. Responses were pooled to develop an overall list of their major concerns and needs. RESULTS: Issues were classified into six priority areas: medical and treatments, problems with daily living, emotional distress, social issues, sleep disturbances and financial issues. Participants indicated they had difficulty finding accessible, effective and acceptable care. Many participants perceived their family physician or other health-care providers were not adequately meeting their health-care needs. Specifically, sleep disorders; feeling of depression, irritability, worry and anxiety were perceived as medical and treatment areas requiring improvement. In addition, participants sought greater validation of their lived experience of chronic pain. CONCLUSION: Participants perceived that their needs were not being met adequately. There is a need for further study on physician-patient communication and its impact on patient health status and disability.