Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat (Fig. 1), with an increased risk for developing chronic disease. Of these overweight children, a quarter are obese, with a significant likelihood of some having multiple risk factors for type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood. The prevalence of overweight is dramatically higher in economically developed regions, but is rising significantly in most parts of the world. In many countries the problem of childhood obesity is worsening at a dramatic rate. Surveys during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becoming overweight each year. The burden upon the health services cannot yet be estimated. Although childhood obesity brings a number of additional problems in its train – hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression – the greatest health problems will be seen in the next generation of adults as the present childhood obesity epidemic passes through to adulthood. Greatly increased rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesityrelated conditions will be found in young adult populations, and their need for medical treatment may last for their remaining life-times. The costs to the health services, the losses to society and the burdens carried by the individuals involved will be great. The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late. Specifically, the report:

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-789X.2004.00133.x

Obesity in children and young people: a crisis in public health.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/j.2051-5545.2011.tb00014.x

Physical illness in patients with severe mental disorders.I. Prevalence, impact of medications and disparities in health care

There are a number of ways in which a clinical diagnosis of dementia of the Alzheimer type can be made – the application of clinical criteria is the commonest but ancillary techniques such as neuroima

Clinical Diagnosis of Alzheimer's Disease

https://tud.qucosa.de/api/qucosa%3A26871/attachment/ATT-0/

Cost of disorders of the brain in Europe 2010

A number of different diseases or injuries can damage the central or peripheral nervous system and produce neuropathic pain (NP), which seems to be more difficult to treat than many other types of chronic pain. As a group, patients with NP have greater medical co-morbidity burden than age- and sex-adjusted controls, which makes determining the humanistic and economic burden attributable to NP challenging. Health-related quality of life (HR-QOL) is substantially impaired among patients with NP. Patients describe pain-related interference in multiple HR-QOL and functional domains, as well as reduced ability to work and reduced mobility due to their pain. In addition, the spouses of NP patients have been shown to experience adverse social consequences related to NP. In randomized controlled trials, several medications have been shown to improve various measures of HR-QOL. Changes in HR-QOL appear to be tightly linked to pain relief, but not to the development of adverse effects. However, in cross-sectional studies, many patients continue to have moderate or severe pain and markedly impaired HR-QOL, despite taking medications prescribed for NP. The quality of NP treatment appears to be poor, with few patients receiving recommended medications in efficacious dosages. The substantial costs to society of NP derive from direct medical costs, loss of the ability to work, loss of caregivers' ability to work and possibly greater need for institutionalization or other living assistance. No single study has measured all of these costs to society for chronic NP. The cost effectiveness of various interventions for the treatment or prevention of different types of NP has been assessed in several different studies. The most-studied diseases are post-herpetic neuralgia and painful diabetic neuropathy, for which tricyclic antidepressants (both amitriptyline and desipramine) have been found to be either cost effective or dominant relative to other strategies. Increasing the use of cost-effective therapies such as tricyclic antidepressants for post-herpetic neuralgia and painful diabetic neuropathy may improve the HR-QOL of patients and decrease societal costs. Head-to-head clinical trials comparing NP therapies are needed to help assess the relative clinical efficacy of treatments, ideally using HR-QOL and utility outcomes. The full costs to society of NP, including productivity loss costs, have not been determined for chronic NP. Improved relative efficacy, utility and cost estimates would facilitate future cost-effectiveness research in NP.

Neuropathic pain: quality-of-life impact, costs and cost effectiveness of therapy.

UNLABELLED FOUNDATION AND OBJECTIVE: To make a comparative study of the degree of impact of different diseases in the health related quality of life (HRQoL) of workers. MATERIAL AND METHODS A questionnaire including the measure of HRQoL SF-36, was sent by mail and fulfilled by employees of the Pfizer company in Spain. Differences in the impact in HRQoL between subjects with and without several characteristics, with less or more degree of work productivity and with and without antecedents of several diseases and current treatment, were assessed by means of statistical tests of U Mann-Whitney and Kruskal-Wallis. RESULTS In a sample of 399 valuable subjects, 35.8+/-6.5 years (mean+/-standard deviation), with a 63.7% of men, worst HRQoL scores in the Physical Summary Component of SF-36 were observed among subjects with history of some disease (52.6+/-5.9 days versus 55.9+/-2.6), migraine (46.2+/-5.9 versus 54.7+/-4.1), musculoskeletal (49.7+/-7.2 versus 53.9+/-5.1) and digestive diseases (51.5+/-6.6 versus 54.1+/-4.9), and/or taking some current treatment (50.2+/-6.4 versus 55.0+/-4.4); p <0.05 for all comparisons. In the Physical Summary Component of SF-36 worst HRQoL scores were observed among subjects with history of some disease (51.4+/-7.1 versus 53.4+/-5.9), digestive (49.9+/-8.3 versus 52.5+/-6.3) and mental disorders (46.0+/-8.8 versus 52.4+/-6.4); p <0.05 for all comparisons. CONCLUSIONS The impact of the disease in the HRQoL was associated to the type of pathological antecedents, being migraine that hit more negatively in the Physical Health, and mental disorders in the Mental Health.

https://scielo.isciii.es/pdf/ami/v24n1/original1.pdf

Impacto de distintas enfermedades en la calidad de vida relacionada con la salud (CVRS) en una población laboral

Conclusiones: Celecoxib es una opción costeefectiva en el tratamiento de la artrosis, ya que va a reducir de forma importante la aparición de complicaciones gastrointestinales graves con un coste extra razonable y moderado cuando se compara con los AINE. Su uso va siendo progresivamente más eficiente a medida que se utiliza en poblaciones con mayor riesgo de desarrollar complicaciones gastrointestinales.

Análisis farmacoeconómico del uso de celecoxib en el tratamiento de la artrosis

Objetivo: Comparar los costes sanitarios relativos, desde la perspectiva del Sistema Nacional de Salud (SNS), de iniciar tratamiento con pregabalina o ISRS/ISRN como terapias anadidas, en pacientes con trastorno de ansiedad generalizada (TAG), resistentes a la terapia basada en benzodiazepinas (RB).

Metodo: Se seleccionaron para este analisis economico post-hoc pacientes ambulatorios con TAG (DSM-IV) y RB que habian sido incluidos en un estudio de cohortes de 6 meses, prospectivo, multicentrico y observacional. La resistencia a las benzodiazepinas se definio como respuesta insuficiente, con persistencia de sintomas de ansiedad (escala de ansiedad HAM-A.16), despues de 6 meses de tratamiento con benzodiazepinas. Los pacientes no habian sido expuestos previamente a pregabalina ni a ISRS/ISRN. Los datos relativos al uso de recursos sanitarios (farmacos, visitas medicas, hospitalizaciones, etc.) asociadas con el TAG se recogieron en la consulta de inicio y en la final del ensayo. Los costes relacionados se estimaron en cada consulta yse compararon los cambios ajustados utilizando ANCOVA.

Resultados: Se trato un total de 128 pacientes con TAG refractario con pregabalina y a 126 con ISRS/ISRN. Al compararla con los ISRS/ISRN, la pregabalina estuvo asociada significativamente con un menor porcentaje de usuarios de benzodiazepinas; 57,0% vs 87,3%, p<0,001, y una reduccion mayor de las consultas medicas; -15,1 vs -13,0, p=0,029. La media total de los costes sanitarios decrecio significativamente solo en la cohorte de pregabalina; -289. (p=0,003), aunque a los seis meses los costes no fueron significativamente diferentes entre los grupos; 977 � vs 822 �, respectivamente.

Conclusion: Iniciar tratamiento con pregabalina esta asociado con una reduccion significativa de las consultas medicas y de los costes totales del TAG en los recursos de salud al compararlos con los ISRS/IRSN, en pacientes resistentes a benzodiazepinas en el sistema espanol de salud. En comparacion con los ISRS/ISRN, la terapia con pregabalina mostro un porcentaje significativamente menor de pacientes en tratamiento concomitante con benzodiazepinas.

A comparative cost-analysis of initiating pregabalin or SSRI/SNRI therapy in benzodiazepine-resistant patients with generalized anxiety disorder in Spain

Background and objective: The ARthritis Treatment Satisfaction (ARTS) questionnaire specifically assesses patients’ satisfaction with osteoarthritis treatment. However, its usefulness is limited since its criterion validity is unknown. The goal of this research was to analyse the criterion validity of the questionnaire in order to identify a cut-off value able to differentiate patients who are satisfied and those who are unsatisfied with osteoarthritis treatment and to establish the possible need for switching therapy.

Criterion validity of the ARthritis Treatment Satisfaction (ARTS) questionnaire: patient satisfaction with treatment and need for switching therapy.

Background and Objective: Hip and knee osteoarthritis is highly prevalent in the elderly, and the incidence is estimated to increase in the coming decades. Prior to surgery, symptomatic treatment, starting with non-pharmacological therapies, should be prescribed. Paracetamol (acetaminophen) is the recommended first pharmacological treatment for osteoarthritis. If paracetamol is ineffective, non-steroidal anti-inflammatory drug (NSAID) treatment is indicated. The superiority of NSAIDs over paracetamol has been demonstrated in several studies. Furthermore, the assessment of patient satisfaction could be an adequate indicator of the quality of care given and is likely related to the evolution of the condition and the therapeutic regimen. The objective of this study was to assess the satisfaction of patients diagnosed with hip and/or knee osteoarthritis who had been previously treated with paracetamol and switched to NSAID treatment due to a lack of effectiveness by paracetamol. Methods: An observational, prospective, multicentre and comparative study was conducted in 2009 among patients diagnosed with hip and knee OA who visited outpatient orthopaedic clinics. The evaluation of treatment effectiveness was carried out using a patient-based visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The satisfaction regarding change of treatment due to a lack of effectiveness and/or the presence of adverse effects was evaluated using the osteoARthritis Treatment Satisfaction (ARTS) questionnaire. Results: A total of 2437 patients were evaluated (knee OA: 1438 [59%]; hip OA: 621 [25.5%]; knee and hip OA: 124 [5.1%]; and without OA location registered: 254 [10.4%]). The study findings showed an increase in patient satisfaction after abandoning the use of paracetamol to treat OA. Statistically significant increases in both overall satisfaction mean (from 57.7 [SD 13.5] to 71.3 [SD 12.0]) and in each of the four domains of the ARTS questionnaire were observed (p < 0.0001 in all cases). According to the WOMAC and a VAS, treatment effectiveness increased significantly after 3 months (p < 0.0001) and significant correlations with satisfaction were observed (r = −0.32 and r = −0.29, respectively; p < 0.0001). The mean (SD) change in global satisfaction in patients treated with NSAIDs was 14.9 (15.5) versus 7.2 (14.4) for patients treated with non-NSAIDs (p < 0.0001). Patients taking NSAID treatment showed substantially more improvement over those taking non-NSAID treatment. Conclusion: NSAIDs relieve pain due to O A in paracetamol-resistant patients and improve treatment effectiveness and patient satisfaction with treatment. Furthermore, paracetamol-refractory subjects under conventional medical treatment with NSAIDs experienced the drug as more effective and also tended to be more satisfied with treatment than those treated with non-NSAIDs.

Treatment satisfaction after switching to another therapy in Spanish orthopaedic clinic outpatients with knee or hip osteoarthritis previously refractory to paracetamol.

Javier Rejas

Papers

Impacto de distintas enfermedades en la calidad de vida relacionada con la salud (CVRS) en una población laboral

Análisis farmacoeconómico del uso de celecoxib en el tratamiento de la artrosis

A comparative cost-analysis of initiating pregabalin or SSRI/SNRI therapy in benzodiazepine-resistant patients with generalized anxiety disorder in Spain

Criterion validity of the ARthritis Treatment Satisfaction (ARTS) questionnaire: patient satisfaction with treatment and need for switching therapy.

Treatment satisfaction after switching to another therapy in Spanish orthopaedic clinic outpatients with knee or hip osteoarthritis previously refractory to paracetamol.