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991.
992.
Ian J Douglas Krishnan Bhaskaran Rachel L Batterham Liam Smeeth 《British journal of clinical pharmacology》2015,79(6):1020-1027
Aims
Drug treatments for obesity have proven efficacy from randomized trials, but their effectiveness in routine clinical practice is unknown. We assessed the effects on weight and body mass index (BMI) of orlistat and sibutramine when delivered in routine primary care.Methods
We used United Kingdom data from the Clinical Practice Research Datalink to estimate the effects of orlistat or sibutramine on weight and BMI over 3 years following treatment initiation. For comparison, we matched each patient with up to five obese patients receiving neither drug. Mixed effects linear regression with splines was used to model change in weight and BMI. Mean change with 95% confidence intervals (CI) was estimated.Results
We identified 100 701 patients receiving orlistat, 15 355 receiving sibutramine and 508 140 non-intervention patients, with body mass index of 37.2, 36.6 and 33.2 kg m−2, respectively. Patients receiving orlistat lost, on average, 0.94 kg month−1 (0.93 to 0.95) over the first 4 months. Weight gain then occurred, although weight remained slightly below baseline at 3 years. Patients receiving sibutramine lost, 1.28 kg month−1 (1.26 to 1.30) over the first 4 months, but by 3 years had exceeded baseline weight. Non-intervention patients had slight increases in weight throughout the 3 year period, with gains ranging between 0.01 and 0.06 kg month−1.Conclusions
Orlistat and sibutramine had early effects on weight loss, not sustained over 3 years. As new treatments for obesity are approved, their effectiveness should be measured in routine clinical practice, as effectiveness may be considerably less than seen in randomized trials. 相似文献993.
According to the justification hypothesis, non‐employed individuals may over‐report their level of work limitation, leading to biased census/survey estimates of the prevalence of severe disabilities and the associated labor force participation rate. For researchers studying policies which impact the disabled or elderly (e.g., Supplemental Security Income, Disability Insurance, and Early Retirement), this could lead to significant bias in key parameters of interest. Using the American Community Survey, we examine the potential for both inflated and deflated reported disability status and generate a general index of disability, which can be used to reduce the bias of these self‐reports in other studies. We find that at least 4.8 million individuals have left the labor force because of a work‐limiting disability, at least four times greater than the impact implied by our replication of previous models. Copyright © 2013 John Wiley & Sons, Ltd. 相似文献
994.
995.
Development of a fragile X syndrome (FXS) knowledge scale: towards a modified multidimensional measure of informed choice for FXS population carrier screening
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Alice G. Ames BSc Alice Jaques PhD Obioha C. Ukoumunne PhD Alison D. Archibald PhD Rony E. Duncan PhD Jon Emery MA MBBCh DPhil Sylvia A. Metcalfe PhD 《Health expectations》2015,18(1):69-80
Background
Genetic carrier screening is increasingly possible for many conditions, but it is important to ensure decisions are informed. The multidimensional measure of informed choice (MMIC) is a quantitative instrument developed to evaluate informed choice in prenatal screening for Down syndrome, measuring knowledge, attitudes and uptake. To apply the MMIC in other screening settings, the knowledge scale must be modified.Objective
To develop and validate a modified MMIC knowledge scale for use with women undergoing carrier screening for fragile X syndrome (FXS).Setting and participants
Responses to MMIC items were collected through questionnaires as part of a FXS carrier screening pilot study in a preconception setting in Melbourne, Australia.Design
Ten knowledge scale items were developed using a modified Delphi technique. Cronbach''s alpha and factor analysis were used to validate the new FXS knowledge scale. We summarized the knowledge, attitudes and informed choice status based on the modified MMIC.Results
Two hundred and eighty‐five women were recruited, 241 eligible questionnaires were complete for analysis. The FXS knowledge scale items measured one salient construct and were internally consistent (alpha = 0.70). 71% (172/241) of participants were classified as having good knowledge, 70% (169/241) had positive attitudes and 27% (65/241) made an informed choice to accept or decline screening.Discussion and conclusions
We present the development of a knowledge scale as part of a MMIC to evaluate informed choice in population carrier screening for FXS. This can be used as a template by other researchers to develop knowledge scales for other conditions for use in the MMIC. 相似文献996.
997.
The development and initial validation of a questionnaire to measure help‐seeking behaviour in patients with new onset rheumatoid arthritis
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Rebecca J. Stack BSc MBPsS MSc PhD Christian D. Mallen BMBS FRCGP PhD Chris Deighton BMedSci MD FRCP Patrick Kiely BSc MBBS PhD FRCP Karen L. Shaw BSc MBPsS PgCert PhD Alison Booth RN MSc Kanta Kumar RN MSc Susan Thomas BA MA Ian Rowan Rob Horne BSc MSc PhD MRPharm Peter Nightingale BSc PhD Sandy Herron‐Marx RGN DPSN BA PGcap PhD Clare Jinks BA MPhil PhD Karim Raza FRCP PhD 《Health expectations》2015,18(6):2340-2355
998.
Problems and hopes perceived by mothers,fathers and physicians of children receiving palliative care
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Douglas L. Hill PhD Victoria A. Miller PhD Kari R. Hexem MPH Karen W. Carroll BS Jennifer A. Faerber PhD Tammy Kang MD Chris Feudtner MD PhD MPH 《Health expectations》2015,18(5):1052-1065
Background
The quality of shared decision making for children with serious illness may depend on whether parents and physicians share similar perceptions of problems and hopes for the child.Objective
(i) Describe the problems and hopes reported by mothers, fathers and physicians of children receiving palliative care; (ii) examine the observed concordance between participants; (iii) examine parental perceived agreement; and (iv) examine whether parents who identified specific problems also specified corresponding hopes, or whether the problems were left ‘hopeless’.Method
Seventy‐one parents and 43 physicians were asked to report problems and hopes and perceived agreement for 50 children receiving palliative care. Problems and hopes were classified into eight domains. Observed concordance was calculated between parents and between each parent and the physicians.Results
The most common problem domains were physical body (88%), quality of life (74%) and medical knowledge (48%). The most common hope domains were quality of life (88%), suffering (76%) and physical body (39%). Overall parental dyads demonstrated a high percentage of concordance (82%) regarding reported problem domains and a lower percentage of concordance on hopes (65%). Concordance between parents and physicians regarding specific children was lower on problem (65–66%) and hope domains (59–63%). Respondents who identified problems regarding a child's quality of life or suffering were likely to also report corresponding hopes in these domains (93 and 82%, respectively).Conclusion
Asking parents and physicians to talk about problems and hopes may provide a straightforward means to improve the quality of shared decision making for critically ill children. 相似文献999.
1000.