Patients' Satisfaction with Psychiatric Treatment: Comparison Between an Open and a Closed Ward

The study compared patients' satisfaction with psychiatric inpatient treatment between an open and a closed ward. During a six-month period, all voluntarily participating patients on two wards of a psychiatric University hospital were investigated anonymously at admission and/or before discharge. A self-rating questionnaire (SATQ-98) was used to assess satisfaction with several domains of psychiatric inpatient treatment. In total, 135 questionnaires were received (retrieval rate 49%). The general level of satisfaction with treatment was high. General satisfaction, satisfaction with medication, ward equipment, visiting opportunities, and regulations for going out were significantly lower at discharge on the closed ward. Dissatisfaction with medication was related to low actual mood, and to low satisfaction with the frequency of psychotherapeutic interventions, visiting opportunities, and with the treating doctor. The results thus far strongly support the need for patients' satisfaction with treatment to be taken into account in order to improve psychiatric inpatient services, particularly on closed wards.     

Serum nerve growth factor concentration and its role in the preclinical stage of dementia

OBJECTIVE: Nerve growth factor is important for the development and function of the cholinergic basal forebrain. The authors examined the hypothesis that the concentration of nerve growth factor is lower than normal in the preclinical phase of neurodegenerative dementia, especially Alzheimer's disease. METHOD: The serum nerve growth factor concentration of subjects from the Berlin Aging Study and the Berlin Memory Clinic who later developed Alzheimer's disease were compared with those of subjects who were free of dementia and subjects who were already suffering from Alzheimer's disease. RESULTS: There were 17 subjects in each group, matched for age and sex. The three groups differed in log-10-transformed mean nerve growth factor concentrations: 1.62 (SD=0.59) for the healthy comparison subjects, 0.92 (SD=0.30) for the subjects with preclinical dementia, and 1.44 (SD=0.61) for the subjects with Alzheimer's disease. CONCLUSIONS: These results support the hypothesis of disturbed nerve growth factor regulation in the serum of patients with preclinical Alzheimer's disease. Mechanisms by which these disturbances appear are unclear, but they may reflect the situation in the preclinical Alzheimer's disease brain.     

Costs and quality of life for patients with multiple sclerosis in Belgium

This cost-of-illness analysis for Belgium is part of a Europe-wide study on the costs of multiple sclerosis (MS). The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity. Patients from four specialized MS centres participated in the survey by answering a mail questionnaire. In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all medical and non-medical resource consumption, sick leave, early retirement, informal care as well as QOL (in the form of utility weights). A total of 799 respondents were included in the analysis (response rate 38%). The mean age of the cohort was 48 years, and 12% of patients were 65 years or older. Forty-six percent of patients had mild disease (Expanded Disability Status Scale [EDSS] score 0–3), 20% severe disease (EDSS score ≥7), and the mean EDSS score in the sample was 4.2 (median 4.0), with a utility of 0.51. Costs and utility are highly correlated with disease severity. Workforce participation decreases from approximately 75 to 80% in early disease to approximately 6% in the very late stages. Hospitalization and ambulatory visits increase by a factor of 10 between early and late disease; investments and services increase from basically no cost to € 6.000 to € 7.000 per year; productivity losses increase ninefold; and informal care increases from € 300 per year at an EDSS score of 0–1 to € 15.000 to € 16.000 per year at an EDSS score ≥7. Hence, total mean costs per patient are driven essentially by the distribution of the severity levels in the sample, increasing from approximately € 12.000 per year at an EDSS score of 0–1 to € 51.500 per year at an EDSS score of 8-9. The same is true for utility, which decreases from 0.85 to 0.06 as the disease becomes severe. However, the utility loss compared to the general population is high at all levels of the disease (0.25 at an EDSS score of 2 to 0.44 at an EDSS score 5–6 leading to an estimated loss of 0.3 quality-adjusted life-year (QALY) per patient. Relapses for patients with an EDSS score <5 are associated with a cost of approximately € 3.360 and a utility loss of 0.1 during the quarter in which they occur. Public payers (health-care costs, community care, sick payments and invalidity pensions) cover an estimated 55% of all costs.     

Costs and quality of life of multiple sclerosis in the United Kingdom

This cost-of-illness analysis for the United Kingdom is part of a Europe-wide study on the costs of multiple sclerosis (MS). The objective was to analyze the costs and quality of life (utility) related to the level of disease severity. People with MS from a database administered by a UK charity (the MS Trust) were asked to participate in the survey by answering a postal questionnaire. In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all resource consumption, medical, non-medical, work absence and informal care as well as utility. The response rate was 19%, and a total of 2048 people were included. The mean age of the cohort was 51 years, and 23% of people were ≥60 years of age. Disease severity was concentrated in people with moderately severe MS (Expanded Disability Status Scale [EDSS] score of 4 to 6.5), with 21, 60 and 19% of people reporting mild, moderate and severe disease, respectively. Costs and utility are highly correlated with disease severity. Mean annual costs for all people in the study increase from approximately £ 12.000 at an EDSS score <4 to almost £ 60.000 at an EDSS score ≥7. In particular, employment rates are reduced from 82% in early disease to 2% at an EDSS score of 8, while the costs of inpatient care, investments, informal care and productivity losses increase by more than tenfold between an EDSS score of 0-1 and a score ≥7. Utility decreases from 0.92 at an EDSS score of 0 to a state worse than death in the most severe state (–0.18 at an EDSS score of 9). Compared to the results in an earlier cost study in the United Kingdom using a comparable methodology, costs have substantially increased, by roughly 40%. Part of the increase is due to a higher use of disease-modifying drugs and, possibly linked with this, a higher use of ambulatory care and services. Another part of the increase is most likely due to an increased age in the current sample, with more patients on early retirement due to MS and more intense use of informal care. However, another reason may lie in the methodology, e.g. different unit costs or differences in the sample distribution, despite a similar mean EDSS score of 5.1.     

Costs and quality of life of multiple sclerosis in Germany

This cost-of-illness analysis based on information from 2973 patients with multiple sclerosis (MS) in Germany is part of a Europe-wide study on the costs of MS. The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity. Patients from six centres (office- and hospital-based physicians) and patients enrolled in a database were asked to participate in the survey; 38% answered a mail questionnaire. In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all resource consumption, medical, non-medical, work absence, informal care, as well as QOL (measured as utility). The mean age of the cohort was 45 years, and 18% of patients were 65 years of age or older. Forty-seven percent of patients had mild disease (Expanded Disability Status Scale [EDSS] score 0–3), 36% had moderate disease (EDSS score 4–6.5) and 12% had severe disease (EDSS score ≥7). The mean EDSS score in the sample was 3.8 (median 4.0), with a mean utility of 0.62. Costs and utility are highly correlated with disease severity. Workforce participation decreases from 73% in very early disease to less than 10% in the very late stages, leading to a tenfold rise in productivity losses in the late stages of disease. Hospitalisation and ambulatory visits rise by a factor of 5–6 between early and late disease; investments and services increase from basically no cost to € 2700; and informal care increases by a factor of 27 for patients with an EDSS score of 7 and by a factor of 50 for patients at the very severe end of the EDSS scale (8–9). Hence, total mean costs per patient are determined essentially by the distribution of the severity levels in the sample, increasing from approximately € 18 500 at an EDSS score of 0–1 to € 70 500 at an EDSS score of 8–9. The same is true for utility, which decreases from 0.86 to 0.10 as the disease becomes severe. However, the utility loss compared to the general population is high at all levels of the disease, leading to an estimated loss of 0.2 quality-adjusted life-years per patient. Relapses are associated with a cost of approximately € 3 000 and a utility loss of 0.1 during the quarter in which they occur. Compared with a similar study performed in 1999, resource consumption, with the exception of drugs, is somewhat lower. This is most likely due to a difference in the severity distribution of the two samples and to changes in health-care consumption overall in the country, such as the introduction of diagnosis-related groups (DRGs, Fallpauschalen).     

Benign familial infantile convulsions: a clinical study of seven Dutch families.

Benign familial infantile convulsions (BFIC) is a recently identified partial epilepsy syndrome with onset between 3 and 12 months of age. We describe the clinical characteristics and outcome of 43 patients with BFIC from six Dutch families and one Dutch-Canadian family and the encountered difficulties in classifying the syndrome. Four families had a pure BFIC phenotype; in two families BFIC was accompanied by paroxysmal kinesigenic dyskinesias; in one family BFIC was associated with later onset focal epilepsy in older generations. Onset of seizures was between 6 weeks and 10 months, and seizures remitted before the age of 3 years in all patients with BFIC. In all, 29 (67%) of the 43 patients had been treated with anti-epileptic drugs for a certain period of time. BFIC is often not recognized as (hereditary) epilepsy by the treating physician. Seizures often remit shortly after the start of anti-epileptic drugs but, because of the benign course of the syndrome and the spontaneous remission of seizures, patients with low seizure frequency do not necessarily have to be treated. If prescribed, anti-epileptic drugs can probably be withdrawn after 1 or 2 years of seizure freedom.     

The Burden of Ankylosing Spondylitis in Spain

Objective:  To investigate the burden of ankylosing spondylitis (AS) in Spain, as baseline for economic evaluation of the use of biological agents.
Methods:  A cross-sectional retrospective observational study was performed in 601 patients with AS in Spain, using a methodology developed in studies in the United Kingdom and Canada. Patients were mailed a questionnaire asking about their health-care consumption, out-of-pocket expenses, work capacity, need for informal care during the past 3 months, as well as quality of life. Patient's current functional status and disease activity level was assessed using the Bath functional and disease activity indexes (BASFI and BASDAI).
Results:  The mean age (median) was 47.8 (12.4) years, and the mean disease duration was 18.8 years. Eighty percent of patients were male, and slightly more than half of patients below 65 years of age were working. The mean (median) BASDAI and BASFI scores were 4.3 (2.5) and 3.8 (2.9),respectively, and all levels of disease severity were represented. The mean (median) total annual cost per patient is estimated at €20,328 (€7920). Direct health care represented 22.8%, investments (adaptations of house and devices) and informal care 43.5%, and productivity losses 33.7%. Costs increased significantly with worsening disease, in particular diminishing physical function, covering a range between €5000 and €75,000 per patient and year. The mean (median) utility was 0.59 (0.30). Utility showed a significant inverse relation with BASFI and BASDAI, covering a range from 0.80 for patients with BASFI/BASDAI below 3 to 0.25 for patients with BASFI/BASDAI greater than 7.
Conclusions:  As in studies in other countries, all types of costs accelerate steeply with worsening disease while utility decreases significantly, indicating the need to prevent disease progression.     

Detection of human cytomegalovirus in urine samples by cell culture,early antigen assay and polymerase chain reaction

Summary With the advent of effective therapy rapid, sensitive and reliable assays for diagnosis of human cytomegalovirus (HCMV) infections are required. In a total of 1,928 urine samples, detection of HCMV-immediate early antigen in a spin amplified microplate culture by a monoclonal antibody and immunoperoxidase staining (EA-assay) was compared with virus isolation in cell culture. Sensitivity of the EA assay was 85.5% and specificity was 99.5% compared with virus isolation. Overall agreement of both assays was 97.8%. In addition, in 235/1,928 urine samples amplification of HCMV-DNA was performed by means of polymerase chain reaction (PCR) using primers from the immediate early (IE1) gene region and 141/1,928 using primers from the late region (LA). The sensitivity of PCR compared with virus isolation was 67.8% for IE1 primers and 94.1% for LA primers (statistical significance: p<0.01, Chi-square-test). Overall agreement between virus isolation and PCR was 88.5% for IE1-PCR and 84.4% for LA-PCR. Discordant results were more often found in adults with acute infection and immunocompromised patients than in infants.

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Nachweis von humanem Zytomegalievirus in Urinproben mittels Zellkultur, Early-Antigen-Test und Polymerasekettenreaktion

Zusammenfassung Schnelle und verläßliche Teste für die Diagnostik von Zytomegalie- (CMV) Infektionen sind besonders seit dem Aufkommen einer effektiven antiviralen Therapie gefordert. Bei insgesamt 1928 Urinproben wurde der Nachweis von CMV-Frühantigen in Zentrifugationskultur (Mikrotiterplatte) mit einem monoklonalen Antikörper und Immunperoxidase-Färbung (Early-Antigen-Test) mit der herkömmlichen Virusisolierung in Zellkultur verglichen. Die Sensitivität des Early-Antigen-Tests betrug 85,5%, die Spezifität 99,5% im Vergleich zur Virusisolierung. Die Übereinstimmung beider Tests war 97,8%. Zusätzlich erfolgte in 235 der 1928 Urinproben der Nachweis von CMV-DNS mittels Polymerase-Kettenreaktion (PCR) mit Primern aus dem Bereich des viralen Immediate-Early-Gens (IE1) und in 141 der 1928 Proben mit Primern aus dem Bereich des Late-Gens (LA). Im Vergleich zur Virusisolierung erreichte die PCR eine Sensitivität von 67,8% mit IE1-Primern und von 94,1% mit LA-Primern (statistische Signifikanz: p<0.01, Chi-square-Test). Die Übereinstimmung von Virusisolierung und PCR betrug 88,5% (IE1) und 84,4% (LA). Bei Erwachsenen mit akuter Infektion und Immunsupprimierten Patienten waren die Ergebnisse weniger übereinstimmend als bei Kindern.