Ascertainment and Prevalence of Post-Traumatic Stress Disorder (PTSD) in People with Intellectual Disabilities

ABSTRACT

Introduction: Post-traumatic stress disorder (PTSD) may be under-recognized in people with intellectual disabilities (PWID) and reviews on appropriate screening tools and prevalence are lacking. This review aims to identify PTSD screening tools for PWID and estimate the prevalence of PTSD within this population. Method: Medline, PubMed, Embase, PsycINFO, Cochrane, Global Health, and Web of Science databases were searched (inception to October 2017) to identify eligible literature. Papers were also found via manual searches of the references of eligible studies. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, subjected to exclusion criteria and quality appraised using STROBE criteria for observational studies and an adapted form of the Newcastle-Ottawa scale for cross-sectional studies. Seven studies were identified. Meta-analysis was carried out on the prevalence studies and heterogeneity quantified using I². Results: Three tools for screening PTSD in PWID were found: two for use in adults (the Lancaster and Northgate Trauma Scale and the Impact of Event Scale – Intellectual Disabilities) and the Adapted Anxiety Disorders Interview Schedule for Children with PTSD. Five studies reported PTSD prevalence in PWID. The weighted pooled prevalence of PTSD in PWID was found to be 10%, 95% CI [0.4%, 19.5%], toward the upper limit of estimated PTSD prevalence in the general population (5–10%). Conclusion: PTSD can be diagnosed in PWID but may go unrecognized by health-care professionals. The identified tools should be further compared and assessed for acceptability and efficacy to improve the identification of PTSD in PWID.     

中药特殊煎法的探讨与思考(三):包煎

"包煎"是中药汤剂特殊煎法的一大特色,而一些人对需包煎的中药、包煎的原因以及如何包煎缺乏基本的认识或存在一定的误解,从而出现因中药煎煮不当导致的临床疗效不佳或副作用等一系列问题。结合古今文献,尝试剖析中药包煎的原因及注意事项,并对如何包煎提出探索性的思考,为中药包煎提供科学依据以促进临床合理用药。     

Cost-effectiveness of breast cancer screening programme for women in rural China

In low and middle-income countries mammographic breast cancer screening is prohibitively expensive and a cheaper alternative option is to use ultrasound as the primary screening test. In 2009, China launched a breast cancer screening programme for rural women aged 35–64 years with clinical breast examination coupled with ultrasound as the primary tool. Our study aimed to analyse the cost-effectiveness of breast screening compared to no screening among Chinese rural women. We developed a Markov model to estimate the lifetime costs and effects for rural women aged 35 years from a societal perspective. Asymptomatic women in the intervention arm were screened every 3 years before age 64 years. Breast cancer in the non-screening arm can only be diagnosed on presentation of symptoms. Parameter uncertainty was explored using one-way and probabilistic sensitivity analyses. Compared to no screening, breast cancer screening cost $186.7 more and led to a loss of 0.20 quality-adjusted life years (QALYs). Breast screening was more expensive and did harm to health among rural women with an incremental cost-effectiveness ratio (ICER) of $-916/QALY. The sensitivity analysis identified utility loss from false positives as the factor that most influenced the results, but this did not affect the conclusions. In a rural setting with such low breast cancer incidence, screening for asymptomatic disease is not cost-effective with current screening tools. Priority should be given to ensure that symptomatic women have proper access to diagnosis and treatment at an early stage as this will lead to mortality reductions without the usual screening harms.     

Evaluating Benefit-risk Decision-making in Spinal Muscular Atrophy: A First-ever Study to Assess Risk Tolerance in the SMA Patient Community

PurposePatients’ perceptions of benefit–risk are essential to informing the regulatory process and the context in which potential therapies are evaluated. To bring this critical information to regulators, Cure SMA launched a first-ever Benefit-Risk Survey for spinal muscular atrophy (SMA) to characterize decision-making and benefit–risk trade-offs in SMA associated with a potential therapy. We hypothesized that risk tolerance would be correlated with SMA type/severity and disease progression. This article presents the results of a benefit–risk survey to enhance understanding of how patients with SMA and caregivers evaluate specific benefits and risks associated with potential therapies.MethodsAffected adults, representing all SMA types (I–IV) within the Cure SMA database, and caregivers of affected individuals of all ages/types were invited via e-mail to participate. Best–worst scaling (BWS) was used to assess participants’ priorities on benefit–risk trade-offs, as it provides higher discrimination and importance scaling among tested attributes. Twelve potentially clinically meaningful treatment benefits and 11 potential risks (ranging in severity and immediacy) were tested. Multiple factors were correlated with individual responses, including: SMA type/disease severity, stage of disease, respondent type, sex, and quality of life/level of independence (current and expected). Survey respondents were also evaluated for "risk-taking attitudes."FindingsA total of 298 responses were evaluated (28% affected adults and 72% caregivers, mostly parents). Most respondents were diagnosed >5 years ago (67.3%), with 22.1% SMA type I, 45.6% SMA type II, and 27.9% SMA type III. No strong correlation was found between risk tolerance and SMA type, stage of disease progression, respondent type, sex, quality of life assessment, or rated levels of independence. Irrespective of SMA type, respondents consistently rated the following risks, associated with a potential treatment, as "least tolerable": life-threatening allergic reactions; 1 in 1000 risk of life-threatening side effects leading to possible organ failure; or worsening quality of life. Furthermore, all SMA type respondents rated these risks as "most tolerable": invasive mode of treatment administration (including need for general anesthesia); side effect of dizziness; and other common side effects such as nausea, vomiting, loss of appetite, headaches, back pain, or fatigue.ImplicationsWith the approval of the first SMA treatment, these findings offer a unique opportunity to assess and characterize baseline risk-tolerance in SMA against which to evaluate future SMA treatment options. Although differences had been expected in risk tolerance among respondents based on disease baseline and certain patient attributes, this was not observed. Survey results should inform future SMA drug development and benefit–risk assessments.     

Sustainability and switching of biologics for psoriasis and psoriatic arthritis at Fukuoka University Psoriasis Registry

Biologics are efficacious for treating psoriasis vulgaris (PsV) and psoriatic arthritis (PsA), but sometimes must be terminated or changed for various reasons including ineffectiveness or adverse events. To find the optimal choice of biologics for treating psoriasis, we analyzed the real‐world data on drug survival and the reason for terminating or switching biologics. Medical records from patients with PsV or PsA, who visited the Department of Dermatology, Fukuoka University Hospital from 2010 to 2017, were analyzed. Two hundred and eleven patients received biologics, and 147 patients (69.7%) were treated with only one biologic, while 64 patients (30.3%) were switched to different products. Frequently used biologics in PsV were ustekinumab (UST), infliximab and adalimumab when calculated by patient‐year. Tumor necrosis factor inhibitor (TNFi) use decreased while UST and interleukin (IL)‐17 inhibitors increased in newly introduced patients. UST showed the highest survival rate as a first‐line drug, but the advantage was lost in the second reagent's group. The major reasons for terminating/switching biologics were as follows: primary ineffectiveness (26.4%), secondary loss of efficacy (36.5%), patient's preference, including referral to nearby hospital, or stopped visiting (22.6%), side‐effects (7.7%), comorbidities (3.4%) and economic burden (2.4%). In PsA patients, TNFi are more frequently employed than in PsV patients, although switching to UST or IL‐17 inhibitors showed an increasing trend. Biologic reagents were changed mostly because of primary or secondary loss of efficacy, which affected drug survival. Further research is needed to find the optimal choice of biologics with larger samples at multiple facilities.     

Baseline Mammography: What Is It and Why Is It Important? A Cross-Sectional Survey of Women Undergoing Screening Mammography

Objectives

Studies have shown that having a baseline mammogram, the first screening mammogram, available for comparison at the time of interpreting a subsequent mammogram significantly decreases the potential of a false-positive examination. Our aim was to evaluate knowledge of and perception about the significance of baseline mammograms in those women undergoing screening mammography.