Population norms for the EQ-5D-3L: a cross-country analysis of population surveys for 20 countries.

This study provides EQ-5D population norms for 20 countries (N = 163,838), which can be used to compare profiles for patients with specific conditions with data for the average person in the general population in a similar age and/or gender group. Descriptive EQ-5D data are provided for the total population, by gender and by seven age groups. Provided index values are based on European VAS for all countries, based on TTO for 11 countries and based on VAS for 10 countries. Important differences exist in EQ-5D reported health status across countries after standardizing for population structure. Self-reported health according to all five dimensions and EQ VAS generally decreased with increasing age and was lower for females. Mean self-rated EQ VAS scores varied from 70.4 to 83.3 in the total population by country. The prior living standards (GDP per capita) in the countries studied are correlated most with the EQ VAS scores (0.58), while unemployment appeared to be significantly correlated in people over the age of 45 only. A country's expenditure on health care correlated moderately with higher ratings on the EQ VAS (0.55). EQ-5D norms can be used as reference data to assess the burden of disease of patients with specific conditions. Such information, in turn, can inform policy-making and assist in setting priorities in health care.

Eficacia del topiramato en niños y adolescentes con problemas en el control de los impulsos: resultados preliminares / Efficacy of topiramate in children and adolescent with problems in impulse control: preliminary results

Introducción. Si bien el topiramato en el terreno farmacológico ha mostrado probada eficacia en los trastornos del control de impulsos (TCI), este hecho no ha sido constatado con la misma evidencia en niños y adolescentes. Nuestro objetivo consiste en valorar la mejoría sintomática de diversos TCI en dichas edades tras la introducción del topiramato.Caso clínico. Once casos con TCI (criterios DSM-IV) fueron evaluados mediante la escala de impulsividad de Barrat (EIB) de forma basal y al mes y los 3 meses del inicio de tratamiento con topiramato.Resultados. Encontramos diferencias significativas en la subescala de impulsividad cognitiva (p = 0,040) y en la puntuación global de la EIB (p=0,043) entre la puntuación basal y al mes de tratamiento; a los 3 meses también la subescala de impulsividad motora mostró diferencias significativas con respecto a la basal (p=0,015).Conclusiones. Las reducciones significativas en la puntuación de la EIB en pacientes valorados en consulta de psiquiatría infantojuvenil por TCI bajo criterios consensuados hacen considerar el topiramato un fármaco eficaz en el control de la impulsividad asociada a diversos trastornos psiquiátricos también en niños y adolescentes. Son necesarios más estudios que incluyan un número mayor de casos y con grupo control para confirmar estos resultados

Introduction. Although in the pharmacological field topiramate has shown proved efficacy in impulsive behavioral disorders (IBD), this fact has not been demonstrated with the same evidence in children and adolescents. The aim of this study is to evaluate improvement of symptoms in different IBD in those ages after treatment with topiramate. ;;Clinical case. Eleven cases of IBD (DSM-IV criteria) were evaluated with the Barrat Impulsivity Scale (BIS), obtaining scores at zero, one and three months after starting treatment with topiramate. Results. We found significant differences in the cognitive impulsivity subscale (p=0.040) and total score of the BIS (p=0.043) when BIS scale was measured after one month of treatment; after three months of treatment, the motor impulsivity subscale also showed significant differences (p=0.015). Conclusions. The significant reductions at BIS scores in child and adolescents outpatients who have IBD make us consider topiramate as an effective pharmacological option for treatment of impulsivity in several psychiatric disorders, also in childhood and adolescence. More studies are needed to confirm these results, with bigger samples and control groups

[Efficacy of topiramate in children and adolescent with problems in impulse control: preliminary results]. / Eficacia del topiramato en niños y adolescentes con problemas en el control de los impulsos: resultados preliminares.

INTRODUCTION: Although in the pharmacological field topiramate has shown proved efficacy in impulsive behavioral disorders (IBD), this fact has not been demonstrated with the same evidence in children and adolescents. The aim of this study is to evaluate improvement of symptoms in different IBD in those ages after treatment with topiramate. CLINICAL CASE: Eleven cases of IBD (DSM-IV criteria) were evaluated with the Barrat Impulsivity Scale (BIS), obtaining scores at zero, one and three months after starting treatment with topiramate. RESULTS: We found significant differences in the cognitive impulsivity subscale (p=0.040) and total score of the BIS (p=0.043) when BIS scale was measured after one month of treatment; after three months of treatment, the motor impulsivity subscale also showed significant differences (p=0.015). CONCLUSIONS: The significant reductions at BIS scores in child and adolescents outpatients who have IBD make us consider topiramate as an effective pharmacological option for treatment of impulsivity in several psychiatric disorders, also in childhood and adolescence. More studies are needed to confirm these results, with bigger samples and control groups.

Aspectos psicosociales y éticos del cáncer infantil / Psychosocial and ethical aspects of childhood cancer

Se estudian los diversos aspectos relacionados con la atención psicosocial a los niños con procesos neoplásicos: el diagnóstico, el estrés psicosocial y la adaptación desde la normalidad a la patología. Se subraya la importancia de la comunicación con el paciente y su familia y el abordaje psicosocial de las secuelas físicas y psíquicas. Se desarrolla la problemática relacionada con los aspectos éticos, con especial atención a la investigación clínica en los pacientes. Se tratan, asimismo, la confidencialidad y las cuestiones psicosociales relacionadas con el equipo asistencial (AU)

Different aspects related with psychosocial care to children with neoplastic conditions are studied: diagnosis, psychosocial stress and adaptation from normality to the disease. The importance of communication with the patient and his/her family and psychosocial approach of the physical and psychic sequels is stressed. The problematic aspect related with ethical aspects, giving special attention to clinical research in the patients, is developed. Furhermore, confidentiality and psychosocial questions related with the health care team are discussed (AU)

Cost-effectiveness analysis of therapeutic strategies for patients with chronic hepatitis C previously not responding to interferon.

BACKGROUND: The efficacy of combination therapy in patients with chronic hepatitis C previously not responding to interferon monotherapy is lower than that in naive patients, and there has been no economic evaluation in this population. AIM: To develop a cost-effectiveness analysis of therapeutic regimens with interferon-alpha and ribavirin in previous interferon non-responders. METHODS: A Markov simulation model was used to project the clinical and economic outcomes of five different therapeutic strategies, including a 'no treatment' alternative, using the health care system perspective. The efficacy data for the different doses and durations were obtained from a previously performed meta-analysis. A sensitivity analysis was performed to test the robustness of the model, analysing changes in different variables. RESULTS: Applying a 3% discount rate, the standard patient on combination therapy for 12 months showed increases of 0.80 years and 1.55 quality-adjusted life years, when compared with the 'no treatment' strategy. This option led to an incremental cost-effectiveness ratio of 11,767 euros per year of life gained and 6073 euros per quality-adjusted life year. CONCLUSIONS: Combination therapy with interferon plus ribavirin is cost-effective in previous interferon non-responders and is within the range of some well-accepted medical interventions in our health care system.

[Paroxetine treatment for children and adolescents with anxiety disorders]. / Paroxetina en los trastornos de ansiedad en niños y adolescentes.

BACKGROUND: Paroxetine has become an effectiveness treatment in anxiety disorders in adults. Despite the fact that this is an especially prevalent psychiatrist disorder in children and adolescents, there are very few studies in this population. This study examines the effectiveness of paroxetine in children and adolescents with anxiety disorders. METHODOLOGY: Fifteen children and adolescents with ICD-criteria for anxiety disorder were selected. Anxiety measurement was taken with STAI scale and was filled out before treatment and 6 months later (mean). We have used descriptive parameters and t Student test for the analysis of dependent samples. Statistic work was done with SPSS 8.0. RESULTS: On first testing, the mean score for State Factor was 41.8 (ds: 5.9) and on second after treatment- it was 24.66 (ds: 9.8). Trait Factor was 43.53 (ds: 8.27) on first testing and 25 (ds: 8.91) on second. These differences in mean scores for both State and Trait factors were significant (alpha=0.05, p= 0.000). CONCLUSIONS: Our results support the hypothesis of clinical improvement at Anxiety Disorders in children and adolescent using Paroxetine. It seems logical to continue the study increasing sample size and evaluation time.

Paroxetina en los trastornos de ansiedad en niños y adolescentes / Paroxetine treatment for children and adolescents with anxiety disorders

Introducción. Aun cuando en sujetos adultos se ha confirmado la efectividad de la paroxetina en los trastornos de ansiedad, existen pocos estudios al respecto en niños y adolescentes, a pesar de ser un grupo de patologías psiquiátricas especialmente prevalentes en dicha población. Este estudio examina la efectividad de la paroxetina en la población infantojuvenil. Metodología. Estudio prospectivo de 15 niños y adolescentes con criterios CIE-10 del espectro de los trastornos de ansiedad. La medición de la ansiedad se realizó mediante la escala STAI (Estado y Rasgo), siendo administrada una primera vez previa prescripción de la paroxetina y un segundo retest a los 6 meses (media). Se emplean para su presentación parámetros descriptivos y para su análisis estadístico la prueba de la 't' de Student para medias de muestras dependientes. La explotación estadística se realizó con el programa SPSS 8.0.Resultados. La media de puntuaciones obtenida en el factor Estado de la escala STAI en la primera administración fue de 41,8 (DE 5,9), frente a una media en la segunda medición de 24,66 (DE 9,8).Asimismo, en la valoración del factor Rasgo se observan diferencias entre la primera administración del test (media: 43,53, DE 8,27) y el retest (media: 25, DE 8,91). Dichas diferencias de medias, tanto en factor Rasgo como en Estado, fueron significativas (alfa = 0,05, p= 0,000).Conclusiones. Los resultados apoyan la hipótesis de la mejoría clínica de los trastornos ansiosos con paroxetina también en población infantojuvenil. Parece, por tanto, adecuado continuar los estudios ampliando la muestra elegida y su evaluación en el tiempo (AU)

Meta-analysis: combination therapy with interferon-alpha 2a/2b and ribavirin for patients with chronic hepatitis C previously non-responsive to interferon.

BACKGROUND: The efficacy of interferon-alpha plus ribavirin treatment for patients not responding to interferon monotherapy is not well established. AIM: To assess the efficacy and safety of combination therapy with interferon-alpha 2a/2b plus ribavirin by performing a meta-analysis of randomized clinical trials. METHODS: A systematic search of electronic databases for randomized clinical trials of interferon-alpha 2a/2b plus ribavirin was conducted independently by two investigators. Data abstraction was performed. The primary end-point was a sustained virological response. Estimates of the common odds ratio were calculated using a random effects model. RESULTS: Of the 127 identified studies, 46 were considered for evaluation and 10 were included (1728 patients). The pooled sustained virological response was 12.6% (95% CI, 9.5-16.3%) for combination therapy vs. 2% (95% CI, 0.9-4.0%) for interferon monotherapy, with a common odds ratio of 5.49. Higher doses of interferon, a longer duration of therapy (48 weeks) and genotypes other than 1 and 4 were associated with an improvement in response. More side-effects and discontinuations were observed with combination therapy than with interferon monotherapy. CONCLUSIONS: Non-responders to interferon may benefit from re-treatment with combination therapy, especially from a 48-week regimen.

[Development, validity and reliability of a general addiction scale. A preliminary study]. / Desarrollo, validez y seguridad de una escala de adicción general. Un estudio preliminar.

INTRODUCTION: The authors develop a General Scale to measure the intensity of the addiction to substances (not alcohol, not opiates) and addictive behaviors. METHODS: The General Scale is a self-scale compound by eleven ítems that was delivered to fifty and five students of the courses 5 masculine and 6 masculine of the Medicine of the University of Alcalá (Madrid, Spain), and was them requested that applied said scale from different supposed addictive: tobacco; tea, coffee or cola drinks; chocolate; others sweet; alcohol; sex; use of the personal computer and/or Internet and/or videoplay; and to practice sports. Of that manner, each subject provided a total of 440 complimented scales.Finally, it was requested the subjects that indicated in a scale apart, their degree of addiction from the different exposed concepts. Those data served of external criterion. RESULTS AND DISCUSSION: The Scale is monodimensional, and shows a high construct validity (account 63% of the total variance obtained by a Factorial Analysis), a high alpha reliability (alpha: 0.94) and a good internal consistency (split-half method with the Spearman-Brown correction; R: 0.92). All items share with the general addiction concept that represents the total score of the Scale, an common variance proportion equal or over the 52%. CONCLUSION: The Scale seems be a valid and reliable instrument to compare groups of the calls new addictions of a measurable manner.

Desarrollo, validez y seguridad de una escala de adicción general. Un estudio preliminar / Development, validity and reliability of a general adiction scale. A preliminary study

Introducción: Los autores desarrollan una Escala de Adicción General para medir la intensidad de la adicción a sustancias (no alcohol no opioides) y comportamientos adictivos. Métodos: La EAG es una escala autoaplicada compuesta por once ítems que se entregó a cincuenta y cinco estudiantes de los cursos 5º y 6º de la licenciatura de Medicina de la Universidad de Alcalá, y se les solicitó que aplicaran dicha escala a diferentes supuestos adictivos: a) el tabaco; b) té, café o bebidas de cola; c) el chocolate; d) otros dulces; e) el alcohol; f) el sexo; g) uso del ordenador y/o Internet y/o videojuego; y h) practicar deportes. De ese modo, cada sujeto proporcionó un total de ocho escalas cumplimentadas, lo que en conjunto supuso manejar 440 Escalas de Adicción General cubiertas. Al final se solicitó a los sujetos que señalaran en una escala aparte su grado de adicción a los diferentes conceptos expuestos. Esos datos sirvieron de criterio externo. Resultados y discusión: La Escala es monodimensional y muestra una elevada validez de constructo (explica el 63 por ciento de la varianza total obtenida por un análisis factorial), una alta fiabilidad alfa ( : 0,94) y una buena consistencia interna por el método de las dos mitades con la corrección de Spearman-Brown (R: 0,92). Todos los ítems comparten con el concepto de adicción general que representa la puntuación total de la Escala, una proporción de varianza igual o superior al 52 por ciento. Conclusión: La Escala parece ser un instrumento válido y fiable para comparar grupos de las llamadas 'nuevas adicciones' de un modo mensurable (AU)

Evaluación económica de la vacunación rutinaria a niños de 15 meses de edad frente al virus de la varicela-zoster / Economic evaluation of routine vaccination of 15 month old children against chicken-pox-zoster

Fundamento. Se realiza una evaluación económica, coste-efectividad, comparando un programa hipotético de vacunación rutinaria y masiva frente al virus de la varicela-zoster en niños de 15 meses de edad de la Comunidad Foral de Navarra, frente a la actual estrategia de vacunación reducida a población de alto riesgo. Material y métodos. Se utilizan árboles de decisiones para calcular los costes de los cuidados sanitarios de los casos de infección y de los efectos del programa de vacunación apoyado en los modelos de Markov. La eficacia de la vacuna es del 90-95 por ciento y el escenario para la vacunación produce una inmunogenecidad de al menos diez años, con coberturas del 90 por ciento. Se han tenido en cuenta, tanto los costes directos de los cuidados sanitarios como los costes indirectos en pesetas constantes de 1995, debidos a la pérdida productiva a cargo de algún familiar y el punto de vista adoptado para la valoración del estudio ha sido el social. Resultados. El índice coste-efectividad refleja el coste o ahorro adicional por caso evitado de infección que supone vacunar rutinariamente a los niños respecto a vacular sólo a aquellas personas pertenecientes a las poblaciones de alto riesgo. El coste por caso evitado se sitúa entre las 3500 y las 4000 ptas. Por cada peseta invertida en el programa de vacunación se producirá un reembolso de 0'45 ptas. Conclusiones. El programa de vacunación rutinaria provoca un coste incremental. Sólo en el supuesto de reducir el precio de la vacuna en más de un 50 por ciento, podría el índice coste-efectividad ofrecer un beneficio social neto. (AU)

Análisis y costes de utilización de servicios de la esquizofrenia en Navarra durante los tres primeros años de la enfermedad / Analysis and costs of utilisation of the schizophrenia services in Navarra during the first three years of the disease

La esquizofrenia ocasiona un impacto económico considerable sobre el paciente, su familia y la sociedad en general, por la importante cantidad de costes que genera en términos de recursos sanitarios necesarios para el tratamiento y cuidado, pérdidas de productividad, sufrimiento y dolor. Este trabajo desarrolla una metodología de estimación de los costes sociales directos e indirectos de la esquizofrenia en Navarra, de acuerdo a una aproximación de "abajo a arriba" según un modelo de incidencia. Se seleccionaron pacientes procedentes de una área adscrita al centro de Salud Mental de Burlada con una edad entre 15 y 45 años, con diagnóstico de esquizofrenia confirmado en el momento de la evaluación (DSM-IV). El coste anual por paciente ascendió a 1.230.392 ptas en el primer año tras el diagnóstico, reduciéndose al 75,2 por ciento en el segundo año y al 54,1 por ciento en el tercer año. Los costes directos representaron el 46,7 por ciento en el primer año y el 34,7 y 42,9 por ciento en los años segundo y tercero, respectivamente. Destaca la importancia relativa de los cuidados informales en el conjunto de los costes, que alcanzaron el 36, 40 y 42 por ciento respectivamente de los costes totales. Se ha realizado también un intento de aproximación de los costes anuales de la esquizofrenia en Navarra para el primer y tercer año desde el diagnóstico, obteniendo un coste total entre 63 y 140 millones de pesetas para el primer año y entre 34 y 76 millones de pesetas en el tercer año (AU)

[Economic evaluation of routine vaccination of 15 month old children against chicken-pox-zoster]. / Evaluación económica de la vacunación rutinaria a niños de 15 meses de edad frente al virus de la varicela-zoster.

BACKGROUND: An economic, cost-effectiveness evaluation was carried out that compared a hypothetical program of routine mass vaccination against the chicken-pox-zoster virus in children aged 15 months in the Foral Community of Navarra against the present strategy of vaccination that is restricted to the high risk population. MATERIAL AND METHODS: Decision trees based on Markov models were used to calculate the costs of the health care of cases of infection and the costs of the effects of the vaccination program. The efficacy of the vaccination is 90-95%, and the scenario produces an immunogenicity of at least ten years, with a coverage of 90%. Account was taken of both the direct costs of health care and the indirect costs, with 1995 Pesetas taken as a constant, due to the loss in productivity of a family member, and a social view point was adopted for evaluating the study RESULTS: The index of cost-effectiveness reflects the additional cost or saving for each case of avoided infection brought about by vaccinating the children in comparison with vaccinating only those persons belonging to the high risk population sectors. The cost per avoided case is situated between 3,500 Ptas and 4,000 Ptas. For each Peseta invested in the vaccination program there would be a reimbursement of 0.45 Pesetas. CONCLUSIONS: The routine vaccination program produces an incremental cost. Only in the case of a reduction in the price of the vaccine by more than 50% would the cost-effectiveness index offer a net social profit.

Service utilization and costs of first-onset schizophrenia in two widely differing health service areas in North-East Spain. PSICOST Group.

OBJECTIVE: The aim of the study was to analyse the cost-incidence of schizophrenia in two areas with widely differing health service systems. METHOD: The costs of patients with schizophrenia in the 3 years after the first service contact were evaluated (i) in an area (A) with fully developed mental health community programmes and (ii) in another area (B) without such programmes. The assessment included a standard description of services, as well as clinical, social and disability aspects. RESULTS: Sociodemographic and clinical characteristics were comparable. The mean direct costs for both areas in the 3-year period were, respectively, 4287 dollars and 6540 dollars in year 1, 2416 dollars and 2888 dollars in year 2, and 2120 dollars and 1862 dollars in year 3. Direct costs in area A were 35% lower than those in area B during the first year, 16.4% lower during the second year, and 12.2% higher during the third year. CONCLUSION: Direct costs were higher in the area that lacked intermediate mental health services, mainly due to hospitalization. Non-provision of intermediate mental health care may lead to inefficiencies in the healthcare system.

Utilisation of mental health services and costs of patients with schizophrenia in three areas of Spain.

BACKGROUND: The analysis of the costs of schizophrenia and its treatment under different mental health care structures will facilitate the improved allocation of the limited resources available for the treatment of schizophrenia. The research we present compares health service use and total health care costs of three cohorts of subjects with schizophrenia which are representative of three areas of Spain (Burlada in Navarra, Cantabria and the Eixample of Barcelona). METHOD: We selected first-time contacts with any psychiatric service who received a diagnosis of schizophrenia. Subjects were evaluated in the third year after onset. RESULTS: The mean number of out-patient visits per patient per year was 10.7 and the mean in-patient days were 9.5. The mean direct cost per patient in the third year of treatment was US$2243. Costs were higher for single subjects and for people who had a relapse. Costs of subjects with better functioning were lower than costs of subjects with a worse state. CONCLUSIONS: Direct costs of care in Spain were lower than the reported figures from other western European countries. Costs were greater in the two centres with greater community mental health service development. Some of the findings may be explained by service availability.