Subjective health status and health-related quality of life among women with Recurrent Vulvovaginal Candidosis (RVVC) in Europe and the USA.

BACKGROUND: Recurrent vulvovaginal candidosis (RVVC) is a chronic condition causing discomfort and pain. Health status and health-related quality of life (HRQoL) in RVVC were never previously described using validated questionnaires. The objective of this study is to describe subjective health status and HRQoL and estimate health state utilities among women with RVVC. METHODS: A cross-sectional online survey was conducted among women who reported having suffered four or more yeast infections over the past 12 months, in five European countries (France, Germany, Italy, Spain and the UK) and the USA. Index scores were derived from the EQ-5D, a questionnaire providing a single index value for health status. The SF-36 questionnaire was used for HRQoL assessment. Information on disease severity, treatment patterns and productivity was also collected. RESULTS: 12,834 members of online research panels were contacted. Among them, 620 women with RVVC (5%) were selected to complete the full questionnaire. The mean EQ-5D index score was 0.70 (95% confidence interval: [0.67, 0.72]) and the difference between women with a yeast infection at the time of questionnaire completion and other respondents was 0.05 (p = 0.47). The EQ-5D index score increased significantly with the time since last infection (p < 0.001). 68% of women reported depression/anxiety problems during acute episode, and 54% outside episodes, compared to less than 20% in general population (p < 0.001). All SF-36 domain scores were significantly below general population norms. Mental health domains were the most affected. The impact on productivity was estimated at 33 lost work hours per year on average, corresponding to estimated costs between €266/year and €1,130/year depending on the country. CONCLUSIONS: Subjective health status and HRQoL during and in between acute inflammatory episodes in women with RVVC are significantly worse than in the general population, despite the use of antifungal therapy. The average index score in women with RVVC is comparable to other diseases such as asthma or COPD and worse than diseases such as headache/migraine according to US and UK catalogs of index scores. The survey also revealed a significant loss of productivity associated with RVVC.

Prevalence of recurrent vulvovaginal candidiasis in 5 European countries and the United States: results from an internet panel survey.

OBJECTIVE: This study aimed to estimate prevalence of vulvovaginal candidiasis (VVC) and recurring VVC (RVVC). MATERIALS AND METHODS: An online omnibus survey was administered to 6,010 women aged 16 and older in 6 countries. RESULTS: We analyzed surveys from 6,000 women. Depending on the country, between 29% and 49% of participating women reported having a health care provider-diagnosed vaginal yeast infection during their lifetime. More than one fifth of women reporting one vaginal yeast infection also reported a 12-month period with 4 or more infections (RVVC) (overall 9%). The cumulative probability of RVVC after an initial vaginal yeast infection was very high. By age 25 years, the probability was 10% for women having had 1 initial yeast infection. By age 50 years, it was 25%. CONCLUSIONS: The overall rates of VVC and RVVC were high and consistent with previous findings. Results were consistent across countries with the exception of France, which had a lower rate of VVC. This may reflect differences in risk behavior, response to infection, or sampling biases. Recurring VVC is a significant health problem in western countries, and the probability that VVC will progress to RVVC is high.

Developing a scale of communicative participation: a cognitive interviewing study.

PURPOSE: To revise and improve the instructions, candidate items and response format for a tool to measure communicative participation. METHOD: Cognitive interviewing techniques, designed to study the process that respondents use to answer survey questions, were used to test a bank of candidate items for a measure of communicative participation. Twelve participants with spasmodic dysphonia (SD), a neurologic condition characterized by voice and speech changes, were asked to complete a sample questionnaire and then were interviewed regarding the clarity of instructions, candidate items and response format. Analysis of the interviews was conducted using qualitative techniques and resulted in a series of modifications to the measurement tool. RESULTS: Problems identified related to candidate items included inadequate context, double-barreled or ambiguous items, redundancy, unclear or generally confusing items, infrequent situations, and cultural sensitivity. Participants preferred response options that asked them to rate interference rather than other dimensions such as satisfaction. CONCLUSIONS; Subtle differences in items and response options make key differences in how participants interpret and make decisions about their responses. Rich contextual information is needed in order to respond to items that sample communicative participation. Participants preferred response options that capture the barriers that they experience when participating in everyday communication situations.

Immediate effect of Ayres's sensory integration-based occupational therapy intervention on children with autism spectrum disorders.

OBJECTIVE: This study examined the effects of Ayres' sensory integration intervention on the behavior and task engagement of young children with autism spectrum disorders (ASD). Clinical observations and caregiver reports of behavior and engagement also were explored to help guide future investigations. METHOD: This single-subject study used an ABAB design to compare the immediate effect of Ayres's sensory integration and a play scenario on the undesired behavior and task engagement of 4 children with ASD. RESULTS: No clear patterns of change in undesired behavior or task management emerged through objective measurement. Subjective data suggested that each child exhibited positive changes during and after intervention. CONCLUSION: When effects are measured immediately after intervention, short-term Ayres's sensory integration does not have a substantially different effect than a play scenario on undesired behavior or engagement of young children with ASD. However, subjective data suggest that Ayres's sensory integration may produce an effect that is evident during treatment sessions and in home environments.