Estimating the costs of epilepsy: an international comparison of epilepsy cost studies

PURPOSE: To compare systematically the national and per capita estimates of the cost of epilepsy in different countries. METHODS: Studies for this literature review were selected by conducting a Medline literature search from January 1966 to March 2000. Key methodologic, country-related, and monetary issues of the selected epilepsy cost studies were evaluated to compare their direct cost estimates and to explore their distribution. The results of the selected studies were made comparable by converting them with different types of conversion factors and expressing them as a proportion of the national expenditure on health care. RESULTS: Ten epilepsy cost studies were reviewed. The proportion of national health care expenditure on epilepsy shows a range of 0.12-1.12% or 0.12-1.05% depending on the type of conversion factor. The list of cost components included in the estimation of the direct costs of epilepsy differs from study to study. A comprehensive list is associated with a decrease in the contribution of drug and hospital costs to the total direct costs of epilepsy. CONCLUSIONS: This study highlights the importance of studying the economic consequences of epilepsy and of interpreting the results on the international level. The results of epilepsy cost studies can provide insight into the distribution of the costs of epilepsy and the impact of epilepsy on the national expenditure on health care.     

Coronary artery bypass grafting: long-term psychological and social outcomes

Long-term psychosocial outcomes were examined in 132 patients 7 to 22 years (M = 9.4 years) after coronary artery bypass grafting. The control group comprised 145 medically treated patients with coronary heart disease of 7 to 22 year duration (M = 9.2). Significantly more medically than surgically treated patients were scored in the clinically significant range for anxiety, and for depression on the hospital anxiety and depression scale. Significantly more medically than surgically treated patients reported a definite, considerable, or very severe impairment of family relationships, social activities, leisure activities, home management, and work on the social functioning scale. Work status did not significantly differ between surgical and medical patients. This study shows previously unreported long-term favorable psychosocial outcomes in patients who underwent coronary artery bypass grafting.     

Contingent self-worth moderates the relationship between school stressors and psychological stress responses

This study examined the moderating role of contingent self-worth on the relationships between school stressors and psychological stress responses among Japanese adolescents. A total of 371 Japanese junior high school students (184 boys and 187 girls, M_age = 12.79 years, SD = 0.71) completed the Japanese version of the Self-Worth Contingency Questionnaire and a mental health checklist at two points separated by a two-month interval. Hierarchical multiple regression analyses were then used to determine whether contingent self-worth moderated the relationship between school stressors and psychological stress responses. The results indicated that, when psychological stress responses were controlled for at Time 1, contingent self-worth did not predict the psychological stress responses at Time 2. However, a two-way interaction between contingent self-worth and stressors was found to significantly influence psychological stress responses, thus indicating that stressors had a stronger impact on psychological stress responses among those with high contingent self-worth compared to those with low contingent self-worth.     

社会、心理因素对儿童癫痫患者复发的影响

目的 探讨社会、心理因素对儿童癫痫患者复发的影响.方法 选择2019年1月～2020年1月于我院治疗的88例癫痫患儿为研究对象,病情控制后随访至少1年,记录复发情况,设为复发组与未复发组.用儿童抑郁自评量表(DSRSC)、儿童焦虑性情绪障碍筛查表(SCARED)、中小学生羞耻感量表、儿童睡眠习惯问卷(CSHQ)对患者进...     

Context-based interpersonal relationship modulates social comparison between outcomes: an event-related potential study

Social comparison is a common behavior that largely determines people’s experience of decision outcome. Previous research has showed that interpersonal relationship plays a pivotal role in social comparison. In the current study, we investigated whether the manipulation of context-based relationship would affect participants’ comparison of self-outcome and other-outcome. Participants first finished a trust game with likeable (dislikeable) partner and then they were involved in a gambling task and observed the outcomes for themselves and for partners. According to self-reports, participants were more satisfied with likeable partner’s gains than losses only when they received gains, but they were always more satisfied with dislikeable player’s losses compared to gains. Event-related potentials including the feedback-related negativity (FRN), P3 and late positive component (LPC) were sensitive to context-based relationship. Specifically, the prediction error signal (indexed by the FRN) was largest when participants received losses but dislikeable player received gains. Meanwhile, the P3 indicates that participants had stronger motivation to outperform dislikeable player. Finally, the LPC was larger when participants received the same outcomes with dislikeable players. In general, our results support the key point of the self-evaluation maintenance model that personal closeness modulates subjective sensitivity when drawing a comparison of one’s outcomes with other’s outcomes.     

Fearfulness moderates the link between childhood social withdrawal and adolescent reward response

Withdrawal from peers during childhood may reflect disruptions in reward functioning that heighten vulnerability to affective disorders during adolescence. The association between socially withdrawn behavior and reward functioning may depend on traits that influence this withdrawal, such as fearfulness or unsociability. In a study of 129 boys, we evaluated how boys’ fearfulness and sociability at age 5 and social withdrawal at school at ages 6 to 10 and during a summer camp at age 9/10 were associated with their neural response to reward at age 20. Greater social withdrawal during childhood was associated with heightened striatal and mPFC activation when anticipating rewards at age 20. Fearfulness moderated this effect to indicate that social withdrawal was associated with heightened reward-related response in the striatum for boys high on fearfulness. Altered striatal response associated with social withdrawal and fearfulness predicted greater likelihood to have a lifetime history of depression and social phobia at age 20. These findings add greater specificity to previous findings that children high in traits related to fear of novelty show altered reward responses, by identifying fearfulness (but not low levels of sociability) as a potential underlying mechanism that contributes to reward alterations in withdrawn children.     

Perceived social support moderates the link between threat-related amygdala reactivity and trait anxiety

Several lines of research have illustrated that negative environments can precipitate psychopathology, particularly in the context of relatively increased biological risk, while social resources can buffer the effects of these environments. However, little research has examined how social resources might buffer proximal biological risk for psychopathology or the neurobiological pathways through which such buffering may be mediated. Here we report that the expression of trait anxiety as a function of threat-related amygdala reactivity is moderated by perceived social support, a resource for coping with adversity. A significant positive correlation between amygdala reactivity and trait anxiety was evident in individuals reporting below average levels of support but not in those reporting average or above average levels. These results were consistent across multiple measures of trait anxiety and were specific to anxiety in that they did not extend to measures of broad negative or positive affect. Our findings illuminate a biological pathway, namely moderation of amygdala-related anxiety, through which social support may confer resilience to psychopathology. Moreover, our results indicate that links between neural reactivity and behavior are not static but rather may be contingent on social resources.     

Current management and surgical outcomes of medically intractable epilepsy

Epilepsy is one of the most common neurologic disorders in the world. While anti-epileptic drugs (AEDs) are the mainstay of treatment in most cases, as many as one-third of patients will have a refractory form of disease indicating the need for a neurosurgical evaluation. Ever since the first half of the twentieth century, surgery has been a major treatment option for epilepsy, but the last 10–15 years in particular has seen several major advances. As shown in relatively recent studies, resection is more effective for medically intractable epilepsy (MIE) than AED treatment alone, which is why most clinicians now endorse a neurosurgical consultation after approximately two failed regimens of AEDs, ultimately leading to decreased healthcare costs and increased quality of life.     

Personality traits and social behaviors predict the psychological adjustment of Chinese people with epilepsy

Very little is known about the psychosocial correlates of psychological morbidity among Chinese people with epilepsy (PWE). No studies have investigated the association between social relationships and psychological morbidity, while most studies examined only the negative impact of maladaptive personalities on psychological adjustment in PWE. This study examined the association of psychological morbidity with a broad array of personality traits and social skills in a sample of 54 Chinese PWE. Respondents completed the Temperament and Character Inventory (TCI), the Social Performance Survey Schedule (SPSS), and the Hospital Anxiety and Depression Scale (HADS) via semi-structured interview. Regression analyses revealed that, independent of demographic and medical variables and perceived impact, Harm Avoidance was positively associated with anxiety and depression whereas Self-Directedness was negatively associated with anxiety and depression; that Cooperativeness was inversely associated with anxiety. Social skills were inversely associated with depression whereas negative social skills were inversely associated with anxiety. Clinical implications of adaptive personality traits and social skills functioning are discussed.     

The association between health literacy and outcomes of care among epilepsy patients

PurposeTo determine the association between health literacy and outcomes of care (seizure control and quality of life) in individuals with epilepsy followed at a level four epilepsy center.MethodsWe conducted a face-to-face interview of patients seen at the Comprehensive Epilepsy Program of the University of Florida HSC/Jacksonville. We obtained demographic and clinical data, administered the Quality of Life in Epilepsy-10 inventory, and performed the Liverpool Seizure Severity Scale. We asked three screening questions taken from the Short Test of Functional Literacy in Adults. Using each health literacy question as the target variable we determined the predictor variables that were associated with responses to these questions and performed multiple linear regression to determine those that retained their significance.ResultsOne hundred and forty adult patients with epilepsy comprised the study population. On univariate analysis, patients who did poorly on questions for health literacy that included “difficulty reading hospital materials” and “difficulty filling out medical forms” had lower scores on the QOLIE-10 and lower annual household incomes. This significance was maintained on multivariate analysis. Those who had problems learning about their medical condition due to difficulties understanding written information had poorer scores on the QOLIE-10, increased seizure frequency, and lower educational levels on univariate analysis. However, on multivariate analysis, only poorer scores on quality of life were independently significant.ConclusionPatients with epilepsy who have limited health literacy do not necessarily have poorer seizure control but have lower quality of life scores.     

Mediating influences of social support: personal, family, and child outcomes

The mediating influences of social support were examined in a study of 137 parents of mentally retarded, physically impaired, and developmentally at-risk children. Social system theory was used as a conceptual framework for assessing the effects of social support on personal well-being, parental attitudes toward their child, family integrity, parental perceptions of child functioning, parent-child play opportunities, and child behavior and development. A series of hierarchical multiple regression analyses by sets, controlling for family SES and income, child sex and age, and child developmental quotient and diagnosis showed that both satisfaction with support and number of sources of support had main and/or interactive effects in all sets of outcome measures. More supportive social networks were associated with better personal well-being, more positive attitudes, and more positive influences on parent-child play opportunities and child behavior and development. Findings were discussed in terms of both methodological and conceptual contributions to understanding the broad-based influences of social support.     

The worldwide costs of dementia 2015 and comparisons with 2010

Introduction

In 2010, Alzheimer's Disease International presented estimates of the global cost of illness (COI) of dementia. Since then, new studies have been conducted, and the number of people with dementia has increased. Here, we present an update of the global cost estimates.

Economic grand rounds: psychological distress and depression associated with job loss and gain: the social costs of job instability

The authors used Medical Expenditure Panel Survey data for 81,097 respondents in 2004-2007, a period of economic expansion, to examine psychological distress among depressed and nondepressed persons in four categories: employed (73%), unemployed (23%), recent job loss (4%), and recent job gain (<1%). Depressed persons who experienced job loss or unemployment were significantly more distressed than depressed persons who were employed. Among depressed persons, on all measures of distress except one (worthlessness), unadjusted distress levels for those who gained a job were higher than for those who had lost a job. Measurements of the social costs of job instability need to account for costs related to unemployment and underemployment.