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1.
Diabetes Ther ; 2020 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-32468515

RESUMO

INTRODUCTION: Type 2 diabetes (T2D) is a complex chronic disease with an increasing prevalence worldwide. It is commonly associated with complications, such as cardiovascular disease (CVD). Patients with both T2D and established CVD are exposed to increased risk of further cardiovascular events, which means increased healthcare costs and impairments to quality of life and survival. To determine the added burden of CVD for T2D patients, we have analyzed the consumption and costs of healthcare and mortality in two T2D patient cohorts, with and without established CVD, respectively, during a 5-year follow-up in a Swedish region. METHODS: Patients with T2D on 1 January 2012 were identified using the administrative database of Region Östergötland and the Swedish National Diabetes Register. Established CVD was defined as the presence of a CVD-related healthcare visit in the period 2002-2011. Identified T2D patients were then followed retrospectively for 5 years (2012-2016) and data collected on utilization of healthcare resources, healthcare costs, and survival. Data pertinent to the study were retrieved from regional databases and national registries. RESULTS: On the index date (1 January 2012) there were 19,731 patients with T2D (prevalence 4.5%) in Region Östergötland, of whom 5490 had established CVD. Those patients with established CVD were older, more often men, and had longer diabetes duration and worse kidney function than those without. Compared to T2D patients without CVD, those with CVD had a significantly higher healthcare consumption, experienced higher costs, and had lower survival during the follow-up. CONCLUSION: This study confirms that established CVD is common among patients with T2D (approximately 30%). Established CVD has negative effects on the utilization of healthcare resources, healthcare costs, and mortality. It is therefore very important to improve the treatment strategy of this patient group.

2.
J Dermatolog Treat ; : 1-15, 2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-32202445

RESUMO

Purpose: To compare PASI outcomes of approved biologics and apremilast after 1 year of treatment.Methods: A systematic review identified RCTs and long-term extensions reporting PASI 75, 90, and 100 responses in adults with moderate-to-severe psoriasis. Data for analysis were modeled using a Bayesian multinomial likelihood model with probit link.Results: Twenty-eight studies reporting PASI responses were included in the network meta-analysis. Differences in study design led to a stepwise approach to synthesis, consisting of two analyses. The primary analysis included nine RCTs investigating comparative efficacy at 1 year. Results indicated risankizumab, brodalumab, and guselkumab were the most effective therapies, followed by ixekizumab and secukinumab; all demonstrated superiority to ustekinumab and etanercept. The secondary analysis extended the primary analysis with 19 further studies comparing active interventions to placebo outcomes extrapolated from induction. The interventions generating the highest PASI response were the same as the primary analysis. These therapies were more effective than apremilast, ustekinumab, adalimumab, certolizumab, etanercept, and infliximab.Conclusions: This NMA demonstrated that evaluated IL-17 and IL-23 inhibitors outperformed other biological therapies after 1 year. Risankizumab had a higher probability of achieving PASI outcomes than all other biologics, except brodalumab and guselkumab, where no significant difference could be concluded.

3.
Food Nutr Res ; 632019.
Artigo em Inglês | MEDLINE | ID: mdl-31548838

RESUMO

Background: Breakfast is often described as the most important meal of the day. Several studies have focused on examining if breakfast habits have any short-term effects on school attendance, academic achievement, and general health in children and adolescents. Informed decisions of whether to promote eating breakfast or not require a more long-term perspective. Objective: The aim of this study was to conduct a systematic review of scientific publications studying the effects identified as potentially relevant for the economic evaluation of eating breakfast in children and adolescents. Design: A systematic literature review was conducted. Studies were identified by searching the electronic databases PubMed, CINAHL, Web of Science, and PsycINFO between January 2000 and October 2017. The inclusion criteria applied were published articles from peer-reviewed journals with full text in English, quantitative studies collecting primary data with school-aged children, and adolescents aged from 6 to 18 years as participants, performed entirely or partly in countries with advanced economies, except Japan and Taiwan. Results: Twenty-six studies fulfilled the inclusion criteria, and studies that were judged to be of at least moderate quality were included in the analysis. The results of the review of eating breakfast studies showed positive and conclusive effects on cognitive performance, academic achievement, quality of life, well-being and on morbidity risk factors. Conclusions: The overall assessment of the studies indicated positive effects of eating breakfast. How the identified effects influence societal costs and an individual's quality-adjusted life years require further research.

4.
PLoS One ; 14(9): e0219911, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31513601

RESUMO

INTRODUCTION: Individuals with functional impairments or chronic diseases are often in need of assistance in their daily lives. For these individuals it is essential to find novel, cost-effective solutions to meet their needs. Service dogs are dogs that are specially trained to assist individuals with functional impairments and may be able to improve these individuals' quality of life at a reasonable cost, i.e. be cost effective. Cost-effectiveness analyses are used to illustrate the cost of an intervention in relation to its effects and provide important input to decision-makers when setting priorities. AIM: The aim of this study is to assess the cost effectiveness of a certified physical service dog and a diabetes alert dog compared to a regular companion dog. METHOD: Costs, life years and quality-adjusted life years were estimated over a 10-year time horizon using a decision-analytic model built upon evidence from the"service and hearing dog project". The primary outcome was the incremental cost-effectiveness ratio expressed as cost per gained quality-adjusted life year. The analysis was conducted from a societal perspective. Costs and effects were discounted with 3% per annum and reported in USD. RESULTS: Compared to a regular companion dog, a physical service dog is cost saving [-6,000 USD] and gives the dog owner more quality-adjusted life years [0.28]. The diabetes alert dog is also cost effective in comparison with a regular companion dog [-4,500 USD, 0.06 QALYs]. CONCLUSION: This study indicates that a certified service dog is cost saving in comparison with a regular companion dog for individuals with functional impairments or chronic diseases. The uncertainty of the analysis implies that further studies are needed in order to confirm these results. Nevertheless, physical service dogs and diabetes alert dogs show potential to be a valuable support and decision analytic models are useful tools to provide this information.


Assuntos
Análise Custo-Benefício , Reabilitação , Animais , Doença Crônica , Tomada de Decisões , Diabetes Mellitus , Cães , Cadeias de Markov , Reabilitação/economia , Reabilitação/métodos
5.
BMJ Open ; 9(5): e027847, 2019 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-31122995

RESUMO

INTRODUCTION: The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction. METHODS AND ANALYSIS: In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire. ETHICS AND DISSEMINATION: Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019-2022 and are planned to be used for the development of future care models. TRIAL REGISTRATION NUMBER: NCT03180606.

6.
Acta Derm Venereol ; 99(4): 393-399, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30628631

RESUMO

Psoriasis is a chronic inflammatory disorder that imposes a substantial economic burden. We conducted a cost-utility analysis from a Swedish healthcare payers perspective using a decision-tree model with a 12-week time horizon. Patients with psoriasis vulgaris could have two 4-week cycles of topical treatment with calcipotriol 50 µg/g and betamethasone 0.5 mg/g as dipropionate (Cal/BD) foam or Cal/BD ointment before progressing to phototherapy/methotrexate. In the base-case analysis, Cal/BD foam dominated over Cal/BD ointment. The increased efficacy of Cal/BD foam resulted in fewer consultations and a decreased risk of progressing to phototherapy/methotrexate. Although Cal/BD foam costs more than Cal/BD ointment, this was offset by lower costs for phototherapy/methotrexate or consultation visits. Sensitivity analyses revealed that the base-case net monetary benefit was robust to plausible variations in key parameters. In conclusion, Cal/BD foam was predicted to be more cost-effective than Cal/BD ointment in the treatment of psoriasis vulgaris.


Assuntos
Betametasona/análogos & derivados , Calcitriol/análogos & derivados , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/economia , Custos de Medicamentos , Glucocorticoides/administração & dosagem , Glucocorticoides/economia , Psoríase/tratamento farmacológico , Psoríase/economia , Administração Cutânea , Aerossóis , Betametasona/administração & dosagem , Betametasona/efeitos adversos , Betametasona/economia , Calcitriol/administração & dosagem , Calcitriol/efeitos adversos , Calcitriol/economia , Tomada de Decisão Clínica , Ensaios Clínicos Fase II como Assunto , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Árvores de Decisões , Fármacos Dermatológicos/efeitos adversos , Progressão da Doença , Composição de Medicamentos , Glucocorticoides/efeitos adversos , Humanos , Modelos Econômicos , Visita a Consultório Médico/economia , Pomadas , Fototerapia/economia , Psoríase/diagnóstico , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Suécia , Fatores de Tempo , Resultado do Tratamento
7.
BMC Geriatr ; 18(1): 270, 2018 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-30409125

RESUMO

BACKGROUND: Obesity and chronic pain are common comorbidities and adversely influence each other. Advanced age is associated with more comorbidities and multi-morbidities. In this study, we investigated the burden of overweight/obesity and its comorbidities and their associations with chronic pain in a random population sample of Swedish older adults. METHODS: The cross-sectional analysis involved a random sample of a population ≥ 65 years in south-eastern Sweden (N = 6243). Data were collected from a postal questionnaire that addressed pain aspects, body mass index (BMI), and health experiences. Chronic pain was defined as pain during the previous three months. According to the 0-10 Numeric Rating Scale, pain scored ≥7 corresponds to severe pain. Binary logistic regression was used to determine the variables associated to pain aspects. RESULTS: A total of 2633 (42%) reported chronic pain. More obese older adults (BMI ≥30 kg/m2) experienced chronic pain (58%) than those who were low-normal weight (BMI < 25 kg/m2, 39%) or overweight (25 ≤ BMI < 30 kg/m2, 41%). Obese elderly more frequently had pain in extremities and lower back than their peers. In the multivariate model, obesity (Odds Ratio (OR) 1.59, 95% Confidence Interval (CI) 1.33-1.91) but not overweight (OR 1.08, 95% CI 0.95-1.22) was associated with chronic pain. Obesity (OR 1.53, 95% CI 1.16-2.01) was also significantly related to severe pain. We also found other comorbidities - i.e., traumatic history (OR 2.52, 95% CI 1.99-3.19), rheumatic diseases (OR 5.21, 95% CI 4.54-5.97), age ≥ 85 years (OR 1.66, 95% CI 1.22-2.25), and depression or anxiety diagnosis (OR 1.83, 95% CI 1.32-2.53) - showed stronger associations with pain aspects than weight status. CONCLUSION: In older adults, excess weight (BMI 30 or above) is a potentially modifiable factor but not the only risk factor that is associated with chronic pain and severe pain. Future studies should investigate the effectiveness of interventions that treat comorbid pain and obesity in older adults.


Assuntos
Dor Crônica/epidemiologia , Comorbidade/tendências , Sobrepeso/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Dor Crônica/etiologia , Dor Crônica/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Razão de Chances , Sobrepeso/complicações , Sobrepeso/psicologia , Fatores de Risco , Inquéritos e Questionários , Suécia/epidemiologia
8.
BMC Health Serv Res ; 18(1): 497, 2018 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-29945630

RESUMO

BACKGROUND: Individuals with severe disability often require personal assistance and help from informal caregivers, in addition to conventional health care. The utilization of assistance dogs may decrease the need for health and social care and increase the independence of these individuals. Service and hearing dogs are trained to assist specific individuals and can be specialized to meet individual needs. The aim of this study was to describe and explore potential consequences for health-related quality of life, well-being and activity level, of having a certified service or hearing dog. METHODS: A longitudinal interventional study with a pre-post design was conducted. At inclusion, all participants in the study had a regular (untrained) companion dog. Data were collected before training of the dog started and three months after certification of the dog. Health-related quality of life was assessed with EQ-5D-3L, EQ-VAS and RAND-36. Well-being was measured with WHO-5 and self-esteem with the Rosenberg Self-Esteem Scale. In addition, questions were asked about physical activity and time spent away from home and on social activities. Subgroups were analyzed for physical service and diabetes alert dogs. RESULTS: Fifty-five owner-and-dog pairs completed the study (30 physical service dogs, 20 diabetes alert dogs, 2 epilepsy alert dogs, and 3 hearing dogs). Initially, study participants reported low health-related quality of life compared with the general population. At follow-up, health-related quality of life measured with the EQ-VAS, well-being and level of physical activity had improved significantly. In the subgroup analysis, physical service dog owners had lower health-related quality of life than diabetes alert dog owners. The improvement from baseline to follow-up measured with EQ-5D statistically differed between the subgroups. CONCLUSIONS: The target population for service and hearing dogs has an overall low health-related quality of life. Our study indicates that having a certified service or hearing dog may have positive impact on health-related quality of life, well-being and activity level. Service and hearing dogs are a potentially important "wagging tail aid" for this vulnerable population, able to alleviate strain, increase independence, and decrease the risk of social isolation. TRIAL REGISTRATION: The trial was retrospectively registered in http://clinicaltrial.gov , NCT03270592. September, 2017.


Assuntos
Pessoas com Deficiência , Cães , Exercício Físico , Adolescente , Adulto , Idoso , Animais , Diabetes Mellitus/reabilitação , Pessoas com Deficiência/reabilitação , Epilepsia/reabilitação , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Autoimagem , Comportamento Social , Suécia , Adulto Jovem
9.
J Mark Access Health Policy ; 6(1): 1478539, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29915664

RESUMO

Background: The launch of hepatitis C (HCV) drugs such as sofosbuvir or ledipasvir has fostered the question of affordability of novel high budget impact therapies even in countries with high domestic product. European countries have developed a variety of mechanisms to improve affordability of such therapies, including 'affordability thresholds', price volume agreements or caps on individual product sales, and special budgets for innovative drugs. While some of these mechanisms may help limit budget impact, there are still significant progresses to be made in the definition and implementation of approaches to ensure affordability, especially in health systems where the growth potential in drug spending and/or in the patient contribution to health insurance are limited. Objectives: In this article, we will review how seven countries in western Europe are approaching the question of affordability of novel therapies and are developing approaches to continue to reward new sciences while limiting budget impact. We will also discuss the question of affordability of cost-effective but hugely expensive therapies and the implications for payers and for the pharmaceutical industry. Results: There is clearly not one solution that is used consistently across countries but rather a number of 'tools' that are combined differently in each country. This illustrates the difficulty of managing affordability within different legal frameworks and within different health care system architectures.

10.
Qual Life Res ; 27(7): 1827-1833, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29616427

RESUMO

PURPOSE: Quality-adjusted life years (QALYs) measure health by combining length and quality of life. QALYs constitute the effect side of incremental cost-effectiveness ratios, describing the results of health economic evaluations. The objectives of this study were to (1) investigate the prevalence of states worse than dead (SWD) when using the EuroQol-5D UK value set, and (2) to study to what extent SWDs are reasonable with a starting point in experience-based valuations of health states. METHODS: Data from a Swedish cross-sectional population survey were used. The survey was directed to 10,000 persons 65 years and older and its primary aim was to investigate the prevalence and consequences of chronic pain. The survey included questions reflecting life situation and well-being. Some of these were used in order to characterise people in SWD. RESULTS: SWD were found in 1.8% of the 6611 respondents. The prevalence of SWD increased with advancing age and was more common among women than men. The control questions used indicated that most of the persons being in SWD according to the EQ-5D UK value set most probably would not judge themselves to be in a SWD. CONCLUSIONS: Though negative QALY-weights are not very common, they constitute a non-negligible part of health states in a Swedish population 65 years and older. Prevalence of SWD is higher among women than men and increases with age. From responses to other questions on well-being and life situation, there is reason to doubt the reasonableness of experience-based negative QALY-weights in many cases.


Assuntos
Mortalidade/tendências , Qualidade de Vida/psicologia , Anos de Vida Ajustados por Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Inquéritos e Questionários
11.
Curr Med Res Opin ; 34(10): 1839-1847, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29598152

RESUMO

OBJECTIVE: There is limited evidence on patients' adherence and the impact of the prescribed dosing regimen in non-vitamin-K oral anticoagulants (NOACs). We aimed to assess secondary adherence to NOACs and to determine the impact of the dosing regimen in patients with atrial fibrillation. METHODS: Patients using a NOAC between 2009 and 2013 were identified from the nation-wide Swedish Prescribed Drug Register and the Dutch regional IADB.nl database. Patients using a consistent dosage for at least 180 consecutive days were included. Adherence was calculated using the medication possession ratio (MPR) and adjusted for overlapping dates. Adherence was defined as a MPR ≥0.8. Sensitivity analyses were performed using a MPR ≥0.9. Logistic regression was performed to compare secondary adherence and to explore the influence of the dosing regimen. RESULTS: A total of 5254 Swedish and 430 Dutch NOAC users were included. The mean MPR was 96.0% (SD 7.8%) in Sweden and 95.1% (SD 10.1%) in the Netherlands. Multivariable logistic regression analysis showed that a twice daily regimen had a lower likelihood of being secondary adherent compared to a once daily regimen in Sweden (odds ratio [OR] 0.21 [95% CI 0.12-0.35]). LIMITATIONS: The influence of selection bias introduced by the inclusion criterion of ≥2 dispensations covering at least 180 days could not be excluded. CONCLUSIONS: This study demonstrated that secondary adherence was high in this specific setting among patients with at least two initial dispensations of a NOAC covering a minimum of 180 days. The use of NOACs in a once daily regimen showed higher adherence compared to a twice daily regimen.


Assuntos
Fibrilação Atrial , Adesão à Medicação/estatística & dados numéricos , Administração Oral , Idoso , Antitrombinas/administração & dosagem , Antitrombinas/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Dabigatrana/administração & dosagem , Dabigatrana/efeitos adversos , Relação Dose-Resposta a Droga , Revisão de Uso de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Piridonas/administração & dosagem , Piridonas/efeitos adversos , Rivaroxabana/administração & dosagem , Rivaroxabana/efeitos adversos , Suécia/epidemiologia , Tromboembolia/prevenção & controle
12.
Europace ; 19(9): 1556-1578, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28934408
13.
J Pain Res ; 10: 2009-2019, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28883740

RESUMO

BACKGROUND: Several studies have illustrated that multisite pain is more frequent than single pain site, and it is associated with an array of negative consequences. However, there is limited knowledge available about the potential factors associated with multisite pain in the elderly general population. OBJECTIVE: This cross-sectional study examines whether the number of anatomical pain sites (APSs) is related to sociodemographic and health-related factors in older adults including oldest-old ages using a new method (APSs) to assess the location of pain on the body. MATERIALS AND METHODS: The sample came from the PainS65+ cohort, which included 6,611 older individuals (mean age = 76.0 years; standard deviation [SD] = 7.4) residing in southeastern Sweden. All the participants completed and returned a postal survey that measured sociodemographic data, total annual income, pain intensity and frequency, general well-being, and quality of life. The number of pain sites (NPS) was marked on a body manikin of 45 sections, and a total of 23 APSs were then calculated. Univariable and multivariable models of regression analysis were performed. RESULTS: Approximately 39% of the respondents had at least two painful sites. The results of the regression analysis showed an independent association between the APSs and the age group of 75-79 years, women, married, high pain intensity and frequency, and low well-being and quality of life, after adjustments for consumption of analgesics and comorbidities. The strongest association was observed for the higher frequency of pain. CONCLUSION: Our results suggest that APSs are highly prevalent with strong relationships with various sociodemographic and health-related factors and concur well with the notion that multisite pain is a potential indicator of increased pain severity and impaired quality of life in the elderly. Our comprehensive method of calculating the number of sites could be an essential part of the clinical presentation, assessment, and treatment of multisite pain.

14.
BMC Geriatr ; 17(1): 200, 2017 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-28865445

RESUMO

BACKGROUND: Improved knowledge based on clinical features of chronic pain in older adults would be valuable in terms of patient-orientated approaches and would provide support for health care systems in optimizing health care resources. This study identifies subgroups based on pain and psychological symptoms among Swedish older adults in the general population and compares derived subgroups with respect to socio-demographics, health aspects, and health care costs. METHODS: This cross-sectional study uses data collected from four registers and one survey. The total sample comprised 2415 individuals ≥65 years old. A two-step cluster analysis was performed. Data on pain intensity, number of pain sites, anxiety, depression, and pain catastrophizing were used as classification variables. Differences in socio-demographics, quality of life, general health, insomnia, and health care costs among the clusters were investigated. Association of the clusters with the above parameters was further evaluated using multinomial logistic regression. RESULTS: Four major clusters were identified: Subgroup 1 (n = 325; 15%) - moderate pain and high psychological symptoms; Subgroup 2 (n = 516; 22%) - high pain and moderate psychological symptoms; Subgroup 3 (n = 686; 30%) - low pain and moderate psychological symptoms; and Subgroup 4 (n = 767; 33%) - low pain and low psychological symptoms. Significant differences were found between the four clusters with regard to age, sex, educational level, family status, quality of life, general health, insomnia, and health care costs. The multinomial logistic regression analysis revealed that Subgroups 1 and 2, compared to Subgroup 4, were significantly associated with decreased quality of life, decreased general health, and increased insomnia. Subgroup 3, compared to Subgroup 4, was associated with decreased general health and increased insomnia. In addition, compared to Subgroup 4, Subgroups 1 and 2 were significantly associated with higher health care costs. CONCLUSIONS: Two high risk clusters of older adults suffering from chronic pain; one mainly based on psychological symptoms and one mainly on pain intensity and pain spread, associated with decreased quality of life and health and increased health care costs were identified. Our findings indicate that subgroup-specific treatment will improve pain management and reduce health care costs.


Assuntos
Catastrofização/psicologia , Dor Crônica/psicologia , Idoso , Idoso de 80 Anos ou mais , Catastrofização/epidemiologia , Catastrofização/fisiopatologia , Dor Crônica/epidemiologia , Dor Crônica/fisiopatologia , Análise por Conglomerados , Estudos Transversais , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Medição da Dor/métodos , Vigilância da População , Qualidade de Vida , Inquéritos e Questionários , Suécia
15.
Qual Life Res ; 26(11): 3059-3068, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28664459

RESUMO

PURPOSE: The aim of this study was to investigate whether the dependency of midlife stroke survivors had any long-term impact on their spouses' QALY-weights. METHOD: Data on stroke survivors, controls, and spouses were collected from the 7-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke. Health-related quality of life was assessed by the SF-36, and the preference-based health state values were assessed with the SF-6D. Spouses of dependent and independent stroke survivors were categorized according to their scores on the modified Rankin Scale. An ordinary least squares regression analysis was used to evaluate whether the dependency of the stroke survivors had any impact on the spouses' QALY-weights. RESULT: Cohabitant dyads of 247 stroke survivors aged <70 at stroke onset and 245 dyads of controls were included in the study. Spouses of dependent stroke survivors (n = 50) reported a significant lower mean QALY-weight of 0.69 in comparison to spouses of independent stroke survivors (n = 197) and spouses of controls, (n = 245) who both reported a mean QALY-weight of 0.77. The results from the regression analysis showed that higher age of the spouse and dependency of the stroke survivor had a negative association with the spouses' QALY-weights. CONCLUSION: The QALY-weights for spouses of dependent midlife stroke survivors were significantly reduced compared to spouses of independent midlife stroke survivors. This indicates that the inclusion of spouses' QALYs in evaluations of early treatment and rehabilitation efforts to reduce stroke patients' dependency would capture more of the total effect in dyads of stroke survivors.


Assuntos
Anos de Vida Ajustados por Qualidade de Vida , Cônjuges/psicologia , Acidente Vascular Cerebral/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/mortalidade , Sobreviventes
16.
BMC Complement Altern Med ; 17(1): 358, 2017 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-28693538

RESUMO

BACKGROUND: Dogs are the most common companion animal, and therefore not surprisingly a popular choice for animal-assisted interventions. Dog-assisted interventions are increasingly used in healthcare. The aim of the review was to conduct a systematic literature review of quantitative studies on dog-assisted interventions in healthcare, with the intention of assessing the effects and cost-effectiveness of the interventions for different categories of patients. METHODS: A systematic review of the scientific literature reporting results of studies in healthcare, nursing home or home care settings, was conducted. The inclusion criteria applied for this review were: quantitative studies, inclusion of at least 20 study subjects, existence of a control and performed in healthcare settings including nursing homes and home care. The electronic databases PubMed, AMED, CINAHL and Scopus were searched from their inception date through January 2017, for published articles from peer-reviewed journals with full text in English. RESULTS: Eighteen studies that fulfilled the inclusion criteria, and were judged to be of at least moderate quality, were included in the analysis. Three of them showed no effect. Fifteen showed at least one significant positive effect but in most studied outcome measures there was no significant treatment effect. Dog-assisted therapy had the greatest potential in treatment of psychiatric disorders among both young and adult patients. Dog-assisted activities had some positive effects on health, wellbeing, depression and quality of life for patients with severe cognitive disorders. Dog-assisted support had positive effects on stress and mood. CONCLUSIONS: The overall assessment of the included studies indicates minor to moderate effects of dog-assisted therapy in psychiatric conditions, as well as for dog-assisted activities in cognitive disorders and for dog-assisted support in different types of medical interventions. However, the majority of studied outcome measures showed no significant effect.


Assuntos
Terapia Assistida com Animais , Cães , Transtornos Mentais/terapia , Afeto , Animais , Humanos , Animais de Estimação , Estresse Psicológico
17.
Health Qual Life Outcomes ; 15(1): 150, 2017 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-28743277

RESUMO

BACKGROUND: Healthcare interventions that have positive effects on the stroke survivors' health-related quality of life (HRQoL) and quality-adjusted life-years (QALYs) might also have positive effects for their spouses in terms of improved HRQoL and/or reduced spousal informal support. However, knowledge about stroke survivors' HRQoL and QALY and the consequences for their spouses' HRQoL and QALY is limited. Therefore, the aim of this study was to describe the HRQoL and QALY-weights in dyads of stroke survivors in comparison with dyads of healthy controls, and to study the relationship between the stroke survivors' QALY-weights and consequences for spouses in terms of QALY-weight and annual cost of informal support, using a long-term perspective. METHODS: Data on stroke survivors, controls, and spouses were collected from the seven-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). HRQoL was assessed by the SF-36, and the preference-based health state values were assessed with the SF-6D. The magnitude of the support was assessed with a study specific time-diary. An ordinary least squares (OLS) regression was used to estimate the association between stroke survivors' and spouses' QALY-weights. A two-part econometric model was used to estimate the association between stroke survivors' QALY-weights and the time spent and cost of spouses' informal support. RESULTS: Cohabitant dyads of 248 stroke survivors' aged <70 at stroke onset and 245 controls were included in the study. Stroke survivors had lower HRQoL in the SF-36 domains physical functioning, physical role, general health, vitality (P < 0.001), and social functioning (P = 0.005) in comparison with their cohabitant spouses. There was no significant difference in HRQoL for the dyads of controls. The results from the regression analyses showed that lower QALY-weights of the stroke survivors were associated with lower QALY-weights of their spouses and increased annual cost of spousal informal support. CONCLUSION: Our results show that the QALY-weights for stroke survivors had consequences for their spouses in terms of annual cost of spousal informal support and QALY-weights. Hence, economic evaluation of interventions that improve the HRQoL of the stroke survivors but ignore the consequences for their spouses may underestimate the value of the intervention.


Assuntos
Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Cônjuges/psicologia , Acidente Vascular Cerebral/psicologia , Sobreviventes/psicologia , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
18.
Brain Behav ; 7(6): e00716, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28638721

RESUMO

OBJECTIVES: Stroke is a major global disease that requires extensive care and support from society and relatives. The aim of this study was to identify and quantify the long-term informal support and to estimate the annual cost of informal support provided by spouses to their stroke surviving partner. METHOD: Data were based on the 7-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke. One-third of the spouses stated that they provided support to their stroke surviving partner. The magnitude of the support was assessed with a study-specific time-diary and was estimated for independent and dependent stroke survivors based on the scores of the modified Rankin Scale. To deal with skewed data, a two-part econometric model was used to estimate the annual cost of informal support. RESULT: Cohabitant dyads of 221 stroke survivors aged <70 at stroke onset were included in the study. Spouses of independent stroke survivors (n = 188) provided on average 0.15 hr/day of practical support and 0.48 hr/day of being available. Corresponding figures for spouses of dependent stroke survivors (n = 33) were 5.00 regarding practical support and 9.51 regarding being available. The mean annual cost of informal support provided for independent stroke survivors was estimated at €991 and €25,127 for dependent stroke survivor. CONCLUSION: The opportunity cost of informal support provided to dependent midlife stroke survivors is of a major magnitude many years after stroke onset and should be considered in economic evaluations of health care.


Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Idade de Início , Idoso , Cuidadores/economia , Custos e Análise de Custo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Apoio Social , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/epidemiologia , Reabilitação do Acidente Vascular Cerebral/economia , Reabilitação do Acidente Vascular Cerebral/métodos , Sobreviventes/estatística & dados numéricos , Suécia/epidemiologia , Tempo
19.
Circulation ; 135(19): 1851-1867, 2017 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-28483832

RESUMO

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Internacionalidade , Programas de Rastreamento/métodos , Humanos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle
20.
Europace ; 19(10): 1650-1656, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28340009

RESUMO

Aims: The primary objective of this study was to use computer simulations to suggest an optimal age for initiation of screening for unknown atrial fibrillation and to evaluate if repeated screening will add value. Methods and results: In the absence of relevant clinical studies, this analysis was based on a simulation model. More than two billion different designs of screening programs for unknown atrial fibrillation were simulated and analysed. Data from the published scientific literature and registries were used to construct the model and estimate lifelong effects and costs. Costs and effects generated by 2 147 483 648 different screening designs were calculated and compared. Program designs that implied worse clinical outcome and were less cost-effective compared to other programs were excluded from the analysis. Seven program designs were identified, and considered to be cost effective depending on what the health-care decision makers are ready to pay for gaining a quality-adjusted life-year (QALY). Screening at the age of 75 implied the lowest cost per gained QALY (€4 800/QALY). Conclusion: In conclusion, examining the results of more than two billion simulated screening program designs for unknown atrial fibrillation, seven designs were deemed cost-effective depending on how much we are prepared to pay for gaining QALYs. Our results showed that repeated screening for atrial fibrillation implied additional health benefits to a reasonable cost compared to one-off screening.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/economia , Técnicas de Apoio para a Decisão , Eletrocardiografia/economia , Custos de Cuidados de Saúde , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Tomada de Decisão Clínica , Simulação por Computador , Análise Custo-Benefício , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Valor Preditivo dos Testes , Prevalência , Prognóstico , Avaliação de Programas e Projetos de Saúde , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Tempo
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