Cost-effectiveness of guided self-help treatment for recurrent binge eating.

Objective: Adoption of effective treatments for recurrent binge-eating disorders depends on the balance of costs and benefits. Using data from a recent randomized controlled trial, we conducted an incremental cost-effectiveness analysis (CEA) of a cognitive–behavioral therapy guided self-help intervention (CBT–GSH) to treat recurrent binge eating compared to treatment as usual (TAU). Method: Participants were 123 adult members of an HMO (mean age = 37.2 years, 91.9% female, 96.7% non-Hispanic White) who met criteria for eating disorders involving binge eating as measured by the Eating Disorder Examination (C. G. Fairburn & Z. Cooper, 1993). Participants were randomized either to treatment as usual (TAU) or to TAU plus CBT–GSH. The clinical outcomes were binge-free days and quality-adjusted life years (QALYs); total societal cost was estimated using costs to patients and the health plan and related costs. Results: Compared to those receiving TAU only, those who received TAU plus CBT–GSH experienced 25.2 more binge-free days and had lower total societal costs of $427 over 12 months following the intervention (incremental CEA ratio of ?$20.23 per binge-free day or ?$26,847 per QALY). Lower costs in the TAU plus CBT–GSH group were due to reduced use of TAU services in that group, resulting in lower net costs for the TAU plus CBT group despite the additional cost of CBT–GSH. Conclusions: Findings support CBT–GSH dissemination for recurrent binge-eating treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost-effectiveness analysis of short-term course and regular course of antithyroid drug therapy for Graves' disease]

One hundred and- eighteen newly diagnosed patients with Graves' disease were treated by tapazole for 6 months (short-term course) and followed up for another 12 months. Forty three percent remission rate was found in this group. A regular course of antithyroid drug therapy for 1.5-2 years with 50% remission rate was taken as control. Cost-effectiveness analysis was made to compare the cost in the two different kinds of therapy. The results showed that the total costs of the treatment per 100 cases were 17,746 yuan for the short-term therapy and 30,708 yuan for the regular therapy, with an average of 412.7 yuan and 614.2 yuan per case respectively. In comparison with the short-term therapy, the regular course could remit 7 more cases at a cost of 12,962.40 yuan, with an average of 1851.80 yuan per case. Therefore, the cost was high by prolonged course of therapy to increase slightly remission rate, although it could remit a few more cases. This study suggests that six-month treatment is preferable for those who live in the rural or remote area where the economy was less developed. A longer course of therapy may be unnecessary for those who have been treated by antithyroid drugs for 6 months or longer and are predicted to obtain a possible prolonged remission.     

Time course of apoptosis in collagen-induced arthritis

A heterodox model of healing incorporating the basic dualism of Western philosophy--the world of concrete material substance versus that of thought, ideals, and spirit--is proposed. Such dualism is reflected in Western constructions of healing. An explanatory paradigm model with a horizontal axis representing paradigms of healing from positivism to metaphysics and a vertical axis representing activities of healing from the material to the spiritual was derived from ethnographic work with healers. A health practice model following the same philosophical patterns illustrates reflected American cultural values in the relative positioning of healing modalities from the orthodox biomedical to the most metaphysical or alternative. Examples of specific modalities of healing, many of which are resurfacing with increasing public interest in alternative therapies, are illustrated. This model places biomedicine in the same context as other philosophical approaches to healing as a standard for comparison. Implications for practice and research are discussed.     

Beyond the self-help polemics.

Asserts that G. M. Rosen's (see record 1987-16844-001) contentions regarding self-help (SH) treatment books are provocative and bear on important issues in the translation of research findings into practical implications. Evidence is provided to challenge Rosen's implications that all SH authors are mercenary charlatans and that the majority of SH books are somehow bad for the consumer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanisms explaining the onset, course and spontaneous resolution of gouty arthritis

Cytogenetic analysis of short-term cultures from three untreated and one recurrent ependymoma revealed clonal aberrations in three of the four tumors. A posterior fossa ependymoma from a 3-year-old male patient showed trisomy 11 as the sole clonal chromosome aberration. A recurrent spinal ependymoma from a 35-year-old male showed hypertriploid clones with abnormalities involving chromosomes 1p11,7q21, and 10p13. A 62-year-old male patient with a cerebellar ependymoma showed a hypodiploid stem-cell line with clonal structural aberrations of both the long and short arms of chromosome 1, an interstitial deletion of 2q, trisomy 7, and monosomy for chromosomes 11, 13, and 16. A 3-year-old female patient with posterior fossa ependymoma showed a normal 46,XX karyotype. Chromosome 1 aberrations appear to be the most consistent finding in this small series of tumors, with the net loss or rearrangement of chromosome 1 pter-->p22 material from two of the four tumors. These findings, in addition to a previously published case [1], suggest a possible role for genes on the short arm of chromosome 1 in the cytogenetic evaluation of ependymomas.     

Clinical and immunologic criteria of the activity of different variants of the course of rheumatoid arthritis

Clinical and immunological studies were carried out in 24 IgM-RF seropositive and 10 seronegative patients with rheumatoid arthritis (RA). Manifest disorders of microcirculation were noted in the examinees, which was confirmed by changes in platelet hemostasis, detection of antibodies to cardiolipins and of Von Willebrandt's factor antigen, and a high level of circulating immune complexes. Analysis of laboratory and immunological findings showed an association of extraarticular symptoms of RA and detection of anticardiolipin antibodies and Von Willebrandt's factor antigen. The activity of the pathological process correlated with the time course of these parameters.     

Using the media to foster self-help groups.

Describes a project that consisted of putting ongoing self-help groups on the radio for 1 hr a week. The 1st half hour each week involved an actual session of a self-help group; during the 2nd half hour, calls from the audience were taken and answered by members of the group. The groups were directed at helping women cope wth motherhood, at men who abused their wives or children, and at parents of children with behavior problems. Increases in referral calls to each group were found after the self-help groups went on the air. Process recordings of the shows were useful in documenting the communication patterns employed during the shows. A panel of 12 mental health professionals judged that the programs did not provide unethical, harmful, or inaccurate information. The present project provided a demonstration of how researchers can work collaboratively with media and self-help groups in monitoring change in community-level types of interventions. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnosis and course of early-onset arthritis: results of a special early arthritis clinic compared to routine patient care

OBJECTIVE: Early arthritis patients referred to an Early Arthritis Clinic (EAC) (n = 233) were compared to 241 patients from the routine out-patient clinic with respect to lag time between the onset of symptoms and the visit to the rheumatologist, clinical presentation and the consistency of the diagnosis after 1 yr. RESULTS: The reduction in median lag time for the EAC patients was at least 3 months. An insidious onset of symptoms was found more often in the rheumatoid arthritis (RA) patients in the routine clinic. In 70% of all cases, a diagnosis could be made after 2 weeks and, if the clinical diagnosis was definite RA, this hardly changed during the following year. Early erosions were seen in 25% of RA patients and were associated with a positive rheumatoid factor (OR 2.08, 95% CI 0.95 4.59). CONCLUSION: An early diagnosis of RA at the EAC is possible and reliable; the high frequency of erosions illustrates the need for early treatment.     

Cost-effectiveness analysis

When different health care interventions are not expected to produce the same outcomes both the costs and the consequences of the options need to be assessed. This can be done by cost-effectiveness analysis, whereby the costs are compared with outcomes measured in natural units--for example, per life saved, per life year gained, and per pain or symptom free day. Many cost-effective analyses rely on existing published studies for effectiveness data as it is often too costly or time consuming to collect data on cost and effectiveness during a clinical trial. Where there is uncertainty about the costs and effectiveness of procedures sensitivity analysis can be used, which examines the sensitivity of the results to alternative assumptions about key variables. In this article Ray Robinson describes these methods of analysis and discusses possibilities for how the benefits of alternative interventions should be valued.     

Cost-effectiveness of evaluating the new technologies

The problem of evaluating cost-effectiveness claims is complex and not readily solved. However, such evaluation represents an important direction for technology assessment as resources become more scarce. Neumann et al.'s analysis (1996) represents one solution to the relatively simple problem of pharmacoeconomic studies. In addition, Fryback and Thornbury included a useful method for approaching the cost-effectiveness of all medical technologies. I note that the cost-effectiveness cutoff of $50,000 per quality-adjusted life year is an incremental one, meaning that new technology must be substantially more cost-effective than older technology. This is currently not the case where incremental improvements over previous technology are often quite small. Interested readers are referred to standard tests in the field, including Drummond, Stoddart, and Torrance (1987), Eisenberg (1986), and Sox, Blatt, Higgins, and Marton (1988).     

Use of self-help books in psychotherapy.

A survey concerning the recommendation of self-help books to clients was completed by 209 psychologists (66.5% male, 94.3% White, mean age?=?45 yrs). Most of the respondents indicated that they did prescribe self-help books infrequently. The likelihood of prescribing books was significantly related to the psychologist's gender, with women recommending books more often than did men, and to employment setting, with private practitioners recommending books more often than did academicians. Psychologists had little familiarity with popular self-help books but thought favorably of the ones of which they knew. Respondents' evaluations of 29 best-selling self-help books are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Here comes the self-help revolution in mental heath.

A massive, systemic, and yet largely silent revolution is occurring in mental health today and is gathering steam for tomorrow: self-help efforts without professional intervention. The self-help revolution traverses multiple disciplines and entails diverse activities. In this article, the author briefly traces the reasons for this self-help revolution and, more urgently, argues for organized psychology's vital involvement in it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

DNA vaccines, cyberspace and self-help programs

Occasionally, a major change in vaccine methodology comes along. Such would appear to be the case with the advent of DNA-mediated immunization, colloquially known as DNA vaccines. This represents a radical new way to deliver antigens; it involves the direct introduction of a plasmid DNA encoding an antigenic protein which is then expressed within cells of the organism. This leads to surprisingly strong immune responses, involving both the humoral and cellular arms of the immune system. DNA-mediated immunization to a single antigen can provide protection against infection by a pathogen. Here, a guide is provided comprising twelve steps to help design and carry out DNA-mediated immunization. This approach to immunization will greatly facilitate studies of immunophysiological responses to antigens of pathogenic organisms. An Internet site (URL: http:@www.genweb.com/Dnavax/dnav ax.html) has been created to help promote this potentially revolutionary approach to vaccination in the service of public health.     

Making self-help more helpful: A randomized controlled trial of the impact of augmenting self-help materials with implementation intentions on promoting the effective self-management of anxiety symptoms.

Objective: The effectiveness of self-help materials may be constrained by failures to undertake recommended exercises or to deploy the techniques that one has learned at the critical moment. The present randomized controlled trial investigated whether augmenting self-help materials with if–then plans (or implementation intentions) could overcome these problems and enhance the self-management of anxiety symptoms. Method: At baseline, participants who reported anxiety symptoms completed the Hospital Anxiety and Depression Scale (HADS) and the state version of the State–Trait Anxiety Inventory (STAI). Participants were then randomized via a computer program to standard self-help (n = 86), augmented self-help (n = 90), or no-intervention (n = 86) conditions. Eight weeks later, 95% (n = 249) of the participants completed the HADS and STAI again. Results: Findings showed a significant reduction in anxiety in the augmented self-help condition compared with both the standard self-help and no-intervention conditions (caseness rates on the HADS at follow-up were 21%, 49%, and 44%, respectively). Mediation analyses indicated that the benefits of augmented self-help materials were explained by improved detection of anxiety-related triggers and greater experienced benefits of the self-help techniques. Conclusions: These findings suggest that implementation intentions offer a valuable supplement to self-help materials that can enhance their impact on outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)