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Introduction: The media is an important source of health-related information for patients, general public, policymakers and health professionals and has a large influence on their knowledge and opinions. No studies so far have explored the content, nature and quality of health journalism in Bangladesh. Objectives: To i) explore the nature and quality of media coverage of health stories in Bangladeshi newspapers, ii) understand the perceptions of reporters about medical- and health journalism, including the perceived barriers and facilitators, and iii) identify factors influencing health reporting. Methods: In a mixed-method pilot study, during a five-month period, all medical and healthcare related news articles published in three leading Bangladeshi daily newspapers (N=461), were content analyzed, and journalists were asked in a questionnaire about their knowledge and medical skills. Results: Only 44% of the articles reported in a positive tone on health services aspects, while 27.1% were related to malpractice or treatment errors. Many articles contained questionable medical information (49.9%), mostly regarding unregistered clinicians (67.5%), often referred to as ‘doctor’. Treatment errors by unregistered clinicians were reported seven times more often than those by registered physicians (p

Introduction Although parental support is an important component in programs designed to prevent overweight in children, current programs pay remarkably little attention to the role of parenting. We therefore developed a web-based parenting program entitled “Making a healthy deal with your child”. This e-learning program can be incorporated into existing overweight prevention programs. The aim of this study was to determine the effectiveness of this e-learning program. Materials and methods The effectiveness was examined in a two-armed cluster randomized controlled trial. The participants were 475 parent-child dyads of children 9–13 years of age in the Netherlands who participated in an existing schoolclass-based overweight prevention program. At the school grade level, parents were randomly assigned to either the intervention or the control condition. Measurements were taken from both parents and children at baseline, and 5 and 12 months after baseline. Primary outcomes included the child’s dietary and sedentary behavior, and level of physical activity. Secondary outcomes included general parenting style, specific parenting practices, and parental self-efficacy. Linear mixed effects models and generalized linear mixed effects models were conducted in R. Results Intention-to-treat analyses and completers only revealed no significant effects between the intervention and control condition on energy balance-related behaviors of the child and parenting skills after correction for multiple testing. The parents’ mean satisfaction with the e-learning program (on a 10-point scale) was 7.0±1.1. Conclusions Although parents were generally satisfied with the parenting program, following this program had no significant beneficial effects regarding the children’s energy balance-related behaviors or the parenting skills compared to the control condition. This program may be more beneficial if used by high-risk groups (e.g. parents of children with unhealthy energy balance-related behaviors and/or with overweight) compared to the general population, warranting further study.

The United Kingdom and the Netherlands exhibit similar levels of heavy episodic drinking but different drinking patterns among youths. This study aimed to assess the impact of country of residence on heavy episodic drinking among 293 British and Dutch youths, accounting for other behavioral determinants. Participants completed online questionnaires measuring impulsivity, sensation-seeking, alcohol consumption, and constructs from the Theory of Planned Behavior [TPB]. Mediation analysis established that British youths engaged in more frequent heavy drinking episodes than Dutch youths, as they had weaker intentions to refrain from heavy drinking, and lower perceived behavioral control. Country of residence also was a direct predictor of frequency of heavy drinking episodes, not mediated by personality traits. Thus, country of residence seems an important factor in heavy episodic drinking, partly mediated through TPB constructs. Interventions may benefit from targeting country-specific drinking behavior and related socio-psychological mechanisms.

OBJECTIVE: To retrospectively compare the long-term clinical, functional, and cost outcomes for early RA patients (symptoms

Objective Inflammation-related symptoms such as pain, swelling and tenderness of the affected joint are frequently assessed using 5-point diary rating scales in gout clinical trials. Combining these into a single gout attack symptom intensity score may be a useful summary measure for these data, which is potentially more responsive to change compared with the individual components. The objective of this study was to develop a patient-reported gout flare intensity score, the Gout Attack Intensity Score (GAIS), for use in clinical studies, that includes components for gout-related pain, swelling and tenderness. Methods Data from a randomized controlled trial comparing anakinra to standard of care for the treatment of acute gout attacks were used for this study. A 7-day flare diary was completed by patients, including questions relating to intensity of pain, swelling and tenderness (5-point rating scales). Scalability of these items was assessed using Mokken Scale Analysis, and reliability using greatest lower bound reliability coefficients. Known-groups validity was evaluated, as well as the responsiveness to change and the presence of floor and ceiling effects. Results Scalability of the single items was supported, and GAIS scores were reliable (greatest lower bound >0.80). GAIS scores demonstrated responsiveness to change with high effect sizes (>0.8), and discriminated better between responders and non-responders compared with its single-item components. No floor and ceiling effects were found. Conclusion The GAIS seems to be a reliable and responsive instrument for assessing patient-reported gout attack intensity that may be used in gout clinical studies.

Background Health-related quality of life (HRQOL) as a patient reported outcome plays important roles in the life of patients with RA (rheumatoid arthritis) and SLE (Systemic lupus erythematosus) as well as their families. Evaluating the impact of sustained remission on HRQOL is important and could be of potential help in daily practice. Thus, we aimed to assess and compare prospectively the impact of sustained remission on HRQOL in Saudi RA and SLE female cohorts. Results Sixty-two female patients with active RA and 34 female patients with active SLE fulfilled the inclusion-, entry- and follow-up criteria. At baseline, the SLE patients had significantly better SF-36 scores than the RA patients. In both groups, significant correlations were found between disease activity and physical (PCS) and mental (MCS) components summary of the SF-36 (all p’s ≤ 0.001). In sustained remission, both SLE and RA patients showed significant improvements of the SF-36 scores (p < 0.001) compared to baseline. RA patients in sustained remission had a significantly better general health, bodily pain and physical functioning, and total PCS scores (p < 0.001) than those with SLE. Conclusions Both SLE and RA patients in sustained remission showed strongly improved HRQOL. In sustained remission, RA patients had comparable or better HRQOL than SLE patients.

Background: Personal recovery is increasingly recognized as important outcome for people with bipolar disorder (BD), but research addressing associated factors of personal recovery in this group remains scarce. This study aimed to explore the association of sociodemographic variables, social participation, psychopathology, and positive emotion regulation with personal recovery in BD. Methods: Baseline data from a randomized controlled trial and survey data were combined (N = 209) and split into a training (n = 149) and test sample (n = 60). Block-wise regression analyses and model training were used to determine the most relevant predictors. The final parsimonious model was cross-validated in the test sample. Results: In the final parsimonious model, satisfaction with social roles (β =.442, p 2 =.561) and performed well in predicting personal recovery in the independent test sample (adjusted R2 =.491). Conclusions: Our findings suggest that especially social participation, anxiety and positive rumination might be relevant treatment targets when aiming to improve personal recovery. Practitioner points: Personal recovery is considered an increasingly important outcome for people with chronic mental health conditions, including bipolar disorder. We found that anxiety and manic symptoms as well as positive rumination and social participation were independently associated with personal recovery in bipolar disorder. Therefore, these outcomes might be relevant treatment targets when aiming to improve personal recovery in bipolar disorder. Possible interventions to improve these outcomes are discussed, including supported employment and vocational rehabilitation for social participation and exercising with savoring strategies to increase positive rumination.

BackgroundLimitations in physical functioning are a big concern especially for patients with chronic or musculoskeletal diseases. Therefore, physical functioning is often used as a core outcome of treatments. The generic patient-reported outcomes information system (PROMIS) physical function (PF) item bank has shown potential to measure PF with better precision, interpretability and lower respondent burden compared with traditional patient-reported outcome measures. This study provides an overview of the current evidence on the quality of the measurement properties of the translated Dutch–Flemish PROMIS-PF item bank and its subdomains, and their derived short forms and computer adaptive tests (CATs).MethodsPubMed was searched up to June 17th 2020 for validation studies of Dutch–Flemish PROMIS-PF in Dutch and Flemish adults. Quality assessment of the included studies was conducted using the COSMIN Risk of bias checklist. The COSMIN criteria for good measurement properties were used to judge the results of the studies, which were adjusted and added to where needed for this review, in the context of IRT instruments and item banks. The quality of evidence was summarized for each measurement property based on the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach.ResultsEleven studies were included, evaluating the PROMIS-PF item bank, the Upper Extremity (UE) subdomain, and/or their derived short forms and CATs in different clinical populations. There is evidence for sufficient structural validity, measurement precision, construct validity, and cross-cultural validity of the Dutch–Flemish PROMIS-PF item bank. The upper extremity subdomain item bank shows high quality evidence for structural validity and measurement precision. Content validity of these item banks has not been thoroughly demonstrated in a Dutch–Flemish population. Furthermore, the derived instruments have far less robust evidence: there are fewer validation studies available and none examined their performance as stand-alone administered instruments.ConclusionsThe first studies into the Dutch–Flemish PROMIS-PF item bank and the UE subdomain show promising results, with especially high quality evidence for sufficient structural validity and measurement precision. However, more studies, and with higher methodological quality, are needed to study the instruments derived from these item banks. These studies should also evaluate content validity, reliability and responsiveness.

Purpose Generalized pain hypersensitivity is frequently observed in chronic pain conditions. Currently, identification is based on expert clinical opinion, and in very few cases combined with quantitative sensory testing. The objectives of this study were to develop and evaluate a short self-report measure of generalized pain hypersensitivity: a generalized pain questionnaire (GPQ). Methods Items for the GPQ were developed based on a literature review, followed by an interview study with ten rheumatic patients with suspected pain hypersensitivity. We examined the psychometric properties of the preliminary items in a sample of 212 outpatients suffering from either fibromyalgia (FM; n=98) or rheumatoid arthritis (n=114). Additionally, self-reported data were gathered on sociodemographics, fibromyalgia-survey criteria, health status, and neuropathic-like pain features. Results Mokken-scale analyses demonstrated a unidimensional seven-item scale with strong homogeneity (H=0.65) and high reliability (r=0.90). Correlations between total GPQ scores and relevant external measures, such as the FM-survey criteria and neuropathic-like pain features, were consistent with a priori expectations, supporting its external construct validity. Furthermore, the GPQ had good accuracy in distinguishing between patients with FM (generally assumed to be the result of central nervous system hypersensitization) and patients with RA (assumed to result mostly in local nociceptive or inflammatory pain), with an area under the receiver-operating characteristic curve of 0.89. A cutoff value >10 had the highest combination of sensitivity (82.7%) and specificity (77.2%). Conclusion The GPQ is psychometrically sound and appears promising for measuring the presence and severity of generalized pain hypersensitivity in chronic pain patients.

Objective The growing evidence for the dual continua model of psychopathology and well‐being has important implications for measuring outcomes in mental health care. The aim of the current study is to validate a measure of well‐being as well as the dual continua model in adults with mood, anxiety, personality, and developmental disorders. Methods 472 adult psychiatric outpatients filled out the Mental Health Continuum‐Short Form (MHC‐SF) and the Outcome Questionnaire before start of treatment. Results Confirmatory factor analyses (CFA) confirmed the three‐factor structure of emotional, psychological, and social well‐being of the MHC‐SF. The dual continua model had the best fit in the complete sample and the different diagnostic groups. Conclusion The MHC‐SF is a reliable and valid instrument to measure well‐being in the psychiatric population. Although relatively high correlations between psychopathology and well‐being exist, the results underline the importance to measure well‐being in addition to psychopathology in mental health care.

Objective: To determine the impact of stopping tumor necrosis factor inhibitor (TNFi) treatment on patient-reported outcomes (PROs) of physical and mental health status, health utility, pain, disability and fatigue in patients with established rheumatoid arthritis (RA). Methods: In the pragmatic 12-month POET trial, 817 RA patients with ≥6 months of remission or stable low disease activity were randomized 2:1 to stopping or continuing TNFi. In case of flare, TNFi was restarted at the discretion of the rheumatologist. PROs were assessed every 3 months. Results: TNFi was restarted within 12 months in 252/531 patients (47.5%) in the stop group. At 3 months, mean PRO scores were significantly worse in the stop group and a larger proportion of patients experienced a minimal clinically important difference (MCID) on all PROs. Effect sizes (ES) were strongest for health utility (ES = -0.24) and pain (ES = -0.30). Mean scores improved again after this point but disability scores remained significantly different at 12 months. After 12 months, the relative risk of experiencing a MCID ranged from 1.16 for mental health status to 1.58 for fatigue. Mean PRO scores for patients restarting TNFi within 6 months were no longer significantly different from those that did not restart TNFi at 12 months. Conclusion: Stopping TNFi had a significant negative short-term impact on a broad range of PROs. Long-term negative consequences appeared to be limited and outcomes in patients needing to restart TNFi within the first 6 months tended to be restored at 12 months. This article is protected by copyright. All rights reserved.

Objective Traditional patient-reported physical function instruments often poorly differentiate patients with mild-to-moderate disability. We describe the development and psychometric evaluation of a generic item bank for measuring everyday activity limitations in outpatient populations. Study design and setting Seventy-two items generated from patient interviews and mapped to the International Classification of Functioning, Disability and Health (ICF) domestic life chapter were administered to 1128 adults representative of the Dutch population. The partial credit model was fitted to the item responses and evaluated with respect to its assumptions, model fit, and differential item functioning (DIF). Measurement performance of a computerized adaptive testing (CAT) algorithm was compared with the SF-36 physical functioning scale (PF-10). Results A final bank of 41 items was developed. All items demonstrated acceptable fit to the partial credit model and measurement invariance across age, sex, and educational level. Five- and ten-item CAT simulations were shown to have high measurement precision, which exceeded that of SF-36 physical functioning scale across the physical function continuum. Floor effects were absent for a 10-item empirical CAT simulation, and ceiling effects were low (13.5%) compared with SF-36 physical functioning (38.1%). CAT also discriminated better than SF-36 physical functioning between age groups, number of chronic conditions, and respondents with or without rheumatic conditions. Conclusion The Rasch assessment of everyday activity limitations (REAL) item bank will hopefully prove a useful instrument for assessing everyday activity limitations. T-scores obtained using derived measures can be used to benchmark physical function outcomes against the general Dutch adult population. Electronic supplementary material The online version of this article (doi:10.1007/s11136-017-1627-0) contains supplementary material, which is available to authorized users.

Background: The importance of both specific emotion regulation strategies and overall deficits in emotion regulation in the context of psychopathology is widely recognized. Besides alleviating psychological symptoms, improving mental well-being is increasingly considered important in treatment of people with mental disorders. However, no comprehensive meta-analysis on the relationship between emotion regulation and well-being in people with mental disorders has been conducted yet. Objective: The aim of the current study was to synthesize and meta-analyze evidence regarding the relationship between emotion regulation and well-being in clinical samples across studies. Method: A systematic literature search was conducted in PsycINFO, PubMed and Scopus and 94 cross-sectional effect sizes from 35 studies were meta-analyzed to explore this relationship. To be eligible for the meta-analysis, studies had to include a clinical sample, assess at least one specific emotion regulation strategy or overall deficits in emotion regulation and include well-being as outcome. Results: The findings showed significant small to moderate negative relationships with well-being for the strategies avoidance (r = −0.31) and rumination (r = −0.19) and positive relationships with reappraisal (r = 0.19) and acceptance (r = 0.42). Grouping together putative adaptive and maladaptive strategies revealed similar sized relationships with well-being in the expected direction. Overall deficits in emotion regulation showed a negative moderate correlation with well-being (r = −0.47). No substantial difference in relationships was found when clustering studies into hedonic and eudaimonic well-being. Conclusion: Our findings suggest that emotion regulation is not merely related with psychopathology, but also with well-being in general as well as hedonic and eudaimonic well-being. Therefore, it might also be important to improve emotion regulation when aiming to improve well-being in people with mental disorders.

Background To develop a Korsakoff-specific measure of quality of life (QoL), to be rated by professional caregivers, and to field-test its psychometric properties in a sample of patients with Korsakoff’s syndrome (KS) living in a specialized nursing home. Methods A research version of the QUALIKO was developed based on an existing instrument for dementia (the QUALIDEM), literature review and two rounds of surveys among expert professionals involved in the care for patients with KS. Next, QoL was independently rated using the preliminary QUALIKO for 77 patients with KS by two primary caregivers. Results The research QUALIKO consisted of 48 items describing observable behaviors across ten aspects of QoL relevant to patients with KS. Six items demonstrated poor scalability in the field test. The remaining 42 items all formed subscales with moderate to strong scalability according to Mokken scale analysis. Reliability was acceptable to good across both raters for all subscales (Mokken rho’s = 0.70–0.90), except for the two 2-item subscales of negative affect and positive self-image (Mokken rho’s = 0.47–0.71). Inter-observer agreement was excellent for five subscales (ICCs = 0.75–0.89) and fair to moderate for the other five subscales (ICCs = 0.59–0.72). The multidimensional internal structure was confirmed and all subscales were significantly correlated with primary caregivers’ global ratings of QoL except for positive self-image. Missing item values were low and floor and ceiling effects acceptable for most subscales. Conclusions The QUALIKO holds promise as a feasible, reliable, and valid measure of QoL in residential KS patients. Future research in larger samples is needed to confirm the psychometric dimensionality of the instrument, to gather normative data and to examine its test-retest reliability.

Contains fulltext : 221348.pdf (Publisher’s version ) (Open Access) Introduction: Personality traits may predict the use of substances in individuals with mild intellectual disabilities (MID) or borderline intellectual functioning (BIF). The Dutch version of the Substance Use Risk Profile Scale (SURPS), adapted for this population, was tested on its psychometric properties. Method: Individuals with MID or BIF (IQ 50–85; N = 91) were recruited via disability care facilities or addiction treatment centers in the Netherlands. Reliability and validity was assessed with confirmatory factor analyses, internal consistency, and correlational analyses. Results: The original four-factor structure of the SURPS was supported. Criterion validity was partially supported by associations between substance use and three subscales, and moderation analyses confirmed that these findings are independent of IQ status (MID vs. BIF). Conclusion: The Dutch version of the SURPS adapted for individuals with MID-BIF has adequate psychometric properties, and seems suitable for research both within samples of individuals with MID and individuals with BIF. 17 p.

Objectives To test the psychometric properties of the United Kingdom’s Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure (CQRA-PREM) in patients with spondyloarthritis (SpA) and rheumatoid arthritis (RA) and to implement this questionnaire in daily practice in the Netherlands. Methods After a forward-backward translation procedure into Dutch, the CQRA-PREM was tested into two quality registries in daily practice. Face validity was assessed with focus group interviews. Feasibility was evaluated through completion times and interpretability of domain scores through floor and ceiling effects. Internal consistency (Cronbach’s α coefficients) and homogeneity (corrected item-total correlations) were determined. Divergent validity was assessed by Spearman’s rank correlation coefficients (rs) between the average scores of domains and outcome measures. The CQRA-PREM was implemented in daily practice, and the results were used in quality improvement cycles. Results Face validity of the CQRA-PREM was good. The CQRA-PREM was completed by 282 patients with SpA and 376 with RA. Median time to complete the CQRA-PREM was 4.7 min. Ceiling effects were found in three out of seven domains. Internal consistency of nearly all domains was considered good (0.65 ≤ α ≤ 0.95). Thresholds for homogeneity were exceeded within three domains (rp > 0.7), suggesting item redundancy. Divergent validity showed that nearly all domains of the CQRA-PREM were at most weakly correlated with outcomes measures (− 0.3 ≤ rs ≤ 0.3). The CQRA-PREM could identify areas of improvement for providing patient-centered care. Conclusion The CQRA-PREM has acceptable psychometric properties and has shown to be a useful tool in evaluating quality of care from the patients’ perspective in the Netherlands. Trial registration SpA-Net is registered in the Netherlands Trial Registry (NTR6740). Key Points • The Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure (CQRA-PREM) is a valid measure for assessing patient-centeredness of rheumatology care. • The Dutch version of the CQRA-PREM shows acceptable psychometric properties. • The CQRA-PREM shows to be a useful tool in Plan-Do-Check-Act quality improvement cycles in the Netherlands. • The CQRA-PREM can be used for benchmarking and quality improvement of rheumatology services.

Background The aim of this retrospective study was to examine the longitudinal association between disease activity and radiographic damage in a cohort of patients with early RA (symptom onset Methods Baseline to 3-year follow-up data were used from patients included in the DREAM remission induction cohort. Patients received protocolized T2T treatment, aimed at 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR) remission. Disease activity (DAS28-ESR and C-reactive protein, CRP) were assessed at least every 3 months; X-rays of the hand and feet at inclusion, 6 months, and 1, 2, and 3 years were scored using modified Sharp/van der Heijde scoring (SHS). Between and within-person associations between time-integrated disease activity and radiographic progression over time were examined. Results A subset of 229 out of 534 included patients were available for analysis. At the between-patient level, time-integrated DAS28-ESR scores were not significantly correlated with progression at the 6 month and 2-year follow-up and only weakly at the 1-year (Pearson’s correlation coefficient r = 0.17, P r = 0.21, P r between 0.39 and 0.59; P values Conclusions In early RA patients treated according to T2T, radiographic progression appears to be an individually determined disease process, driven by factors other than consistent high disease activity. For individual patients, the intra-patient relation between disease activity and cumulative radiographic damage during the first 6 months is a good indicator for this relation in later years. Trial registration Netherlands Trial Register NTR578, 12 January 2006.

Background The Ankylosing Spondylitis Disease Activity Score (ASDAS) is a widely used composite measure of disease activity in axial spondyloarthritis (axSpA). Such a tool is lacking for peripheral SpA (pSpA). However, the ASDAS also assesses peripheral joint symptoms. Previously, trial data have shown that the ASDAS has high sensitivity to change and high discriminatory ability between disease states in pSpA (1). We hypothesized that the ASDAS can be used to measure disease activity in all patients with pSpA in clinical practice. Objectives To investigate the construct validity of the ASDAS in pSpA in comparison with axSpA in clinical practice. Methods Data from a registry for SpA in the Netherlands (SpA-Net) were used. Construct validity of the ASDAS was assessed by testing hypotheses about Spearman correlations with other outcomes measures including individual components of disease activity, physical functioning and health-related quality of life (HRQoL). Construct validity was also assessed by stratifying patients according to ASDAS cut-offs to compare means of different health outcomes across ASDAS states by one-way ANOVA analyses. All analyses were repeated after stratification for the presence/absence of psoriasis in pSpA. Results were compared to the performance of the ASDAS in axSpA. Results In total, 194 patients with pSpA and 222 patients with axSpA were included. Poor to high correlation was found between ASDAS and measures of disease activity (rs0.20 to 0.78), a moderate correlation was found between ASDAS and measures of physical functioning (rs0.61 to 0.64) and a poor to moderate correlation was found between ASDAS and measures of HRQoL in pSpA (rs-0.27 to -0.66) (table 1). With increasing ASDAS states, significantly worse scores were found on (other) measures of disease activity, physical functioning and HRQoL in pSpA (table 2). Stratification for the presence/absence of psoriasis showed similar results (data not shown). All results for pSpA were comparable to axSpA (see for example Table 1). Conclusion The ASDAS demonstrated similar construct validity in all patients with pSpA and axSpA in clinical practice. Therefore, the ASDAS can also be used to measure disease activity in pSpA in daily practice. Reference [1] Turina MC, et al. A psychometric analysis of outcome measures in peripheral spondyloarthritis. ARD 2016;75:1302-7. Disclosure of Interests None declared

AIMS: To test effectiveness of the Healthy School and Drugs (HSD) program on tobacco and alcohol use in Dutch secondary special education (SE) schools, and whether this depends on subtypes of SE-schools and the level of implementation. DESIGN: In a quasi-experimental design with baseline and post-treatment follow-up 35 classes (N = 363) were allocated arbitrarily or depending on teacher motivation to either intervention condition (N = 205) or usual curriculum (N = 158). SETTING: Thirteen secondary SE-schools spread throughout the Netherlands. PARTICIPANTS: Recruited during the Fall of 2013 from 3 school subtypes: SE for adolescents with intellectual/physical disabilities (SEI; N = 13), behavioral/emotional difficulties (SEB; N = 136), and learning disabilities/developmental disorders (SEL; N = 214). MEASUREMENTS: Self-reported lifetime smoking prevalence and lifetime drinking frequency as outcomes, and school subtype (SEL/SEB) and implementation fidelity (high/low) as moderators. FINDINGS: No significant differences were found at follow-up in lifetime smoking (OR = 1.52; 95% CI = 0.74-3.12) and drinking frequency (d = 0.01; 95% CI = -0.16-0.18). Interaction analyses revealed adverse effects in SEB students for alcohol use (d = 0.43; 95% CI = 0.16-0.69). Effect on tobacco refusal self-efficacy was positively moderated by implementation fidelity (d = 0.35; 95% CI = 0.07-0.63). CONCLUSION: The Healthy School and Drugs program adapted for secondary special education in the Netherlands lacked clear evidence for effects on all outcomes. This pilot study further suggests that within special education substance use interventions may need to be targeted at school subtypes, as these may have harmful effects among students with behavioral difficulties. Finally, limited evidence was found that program effectiveness may depend on implementation fidelity.This article is protected by copyright. All rights reserved. Language: en

Objective To further simplify the simple erosion narrowing score (SENS) by removing scored areas that contribute the least to its measurement precision according to analysis based on item response theory (IRT) and to compare the measurement performance of the simplified version to the original. Methods Baseline and 18-month data of the Combinatietherapie Bij Reumatoide Artritis (COBRA) trial were modeled using longitudinal IRT methodology. Measurement precision was evaluated across different levels of structural damage. SENS was further simplified by omitting the least reliably scored areas. Discriminant validity of SENS and its simplification were studied by comparing their ability to differentiate between the COBRA and sulfasalazine arms. Responsiveness was studied by comparing standardized change scores between versions. Results SENS data showed good fit to the IRT model. Carpal and feet joints contributed the least statistical information to both erosion and joint space narrowing scores. Omitting the joints of the foot reduced measurement precision for the erosion score in cases with below-average levels of structural damage (relative efficiency compared with the original version ranged 35–59%). Omitting the carpal joints had minimal effect on precision (relative efficiency range 77–88%). Responsiveness of a simplified SENS without carpal joints closely approximated the original version (i.e., all Δ standardized change scores were ≤0.06). Discriminant validity was also similar between versions for both the erosion score (relative efficiency = 97%) and the SENS total score (relative efficiency = 84%). Conclusion Our results show that the carpal joints may be omitted from the SENS without notable repercussion for its measurement performance.

Background The aim of this study was to identify predictors of prolonged disease control after discontinuation of tumor necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis (RA). Methods Post-hoc analysis of 439 RA patients (67.3% rheumatoid factor positive) with longstanding RA in remission or with stable low disease activity, randomized to stopping TNFi treatment in the multicenter POET trial. Prolonged acceptable disease control was defined as not restarting TNFi treatment within 12 months after stopping. Baseline demographic and disease-related variables were included in univariate and multivariate logistic regression analysis for identifying predictors of relapse. Results One year after baseline, 220 patients (50.1%) had not restarted TNFi treatment. Use of an anti-TNF monoclonal antibody (versus a receptor antagonist, OR = 2.41; 95% CI: 1.58–3.67), ≤10 yrs. disease duration (OR = 2.15; 95% CI: 1.42–3.26) and low or moderate multi-biomarker disease activity (MBDA) scores (OR = 2.00; 95% CI: 1.10–3.64) at baseline were independently predictive of successful TNFi discontinuation (area under the receiver operating characteristic curve = 0.66; 95% CI: 0.61–0.71). Results were similar when using no physician-reported flare as the criterion. TNFi-free survival was significantly different for patient groups based on the number of predictors present, ranging from 21.4% of patients with no predictor present to 66.7% of patients with all three predictors present. Conclusion Patients using an anti-TNF monoclonal antibody, with shorter disease duration and low or moderate baseline MBDA score are most likely to achieve prolonged disease control after TNFi discontinuation. Trial registration Netherlands Trial Register NTR3112, 21 October 2011. Electronic supplementary material The online version of this article (10.1186/s41927-019-0071-x) contains supplementary material, which is available to authorized users.

BackgroundDepression is a highly prevalent disorder, causing a large burden of disease and substantial economic costs. Web-based self-help interventions seem promising in promoting mental health.AimsTo compare the efficacy of a guided web-based intervention based on acceptance and commitment therapy (ACT) with an active control (expressive writing) and a waiting-list control condition (Netherlands Trial Register NTR1296).MethodAdults with depressive symptoms from the general population were randomised to ACT (n = 82), expressive writing (n = 67) or waiting-list control (n = 87). The main outcome was reduction in depressive symptoms assessed with the Center for Epidemiological Studies – Depression scale.ResultsSignificant reductions in depressive symptoms were found following the ACT intervention, compared with the control group (Cohen's d = 0.56) and the expressive writing intervention (d = 0.36). The effects were sustained at 6-month and 12-month follow-up.ConclusionsAcceptance and commitment therapy as a web-based public mental health intervention for adults with depressive symptoms can be effective and applicable.

HighlightsWe investigate online activities among a representative sample (NL) from 2010 to 2013.Capital enhancing activities were relatively popular among men and younger people.These activities were also popular among those with higher education and income.Changes in the distribution of demographics between 2010 and 2013 were observed.There is increasing capital for those with higher education and income. We investigate types of Internet activities among a representative sample of the Dutch population from 2010 to 2013. We examined usage patterns of seven types of Internet activities (i.e., information, news, personal development, commercial transaction, social interaction, leisure, and gaming) and related these patterns with gender, age, education, and income. Activities related to news, personal development, commercial transaction, and social interaction increased in popularity. For most capital enhancing activities, men, younger people, higher educated people, and people with higher than average incomes were prominent. These observations, however, are subject to change. The Internet seems to provide increasingly more capital-enhancing opportunities for those with higher education and income, which would accordingly reinforce their already strong positions in society.

Background Gout is a common, monosodium urate crystal-driven inflammatory arthritis. Besides its clinical manifestations, patients often also suffer from pain, physical impairment, emotional distress and work productivity loss, as a result of the disease. Patient-reported outcome measures (PROMs) are commonly used to assess these consequences of the disease. However, current instrument endorsements for measuring such outcomes in acute and chronic gout clinical settings are based on limited psychometric evidence. The objective of this systematic literature review was to identify currently available PROMs for gout, and to critically evaluate their content and psychometric properties, in order to evaluate the current status regarding PROMs for use in gout patients. Methods Systematic literature searches were performed in the PubMed and EMBASE databases. The methodological quality of included papers was appraised using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, and evaluation of measurement properties (reliability, responsiveness, construct validity, floor and ceiling effects) was done in accordance with published quality criteria. Item content was appraised by linking health concepts to the International Classification of Functioning Disability and Health (ICF) framework. Results In total, 13 PROMs were identified, of which three were targeted specifically at gout patients. The majority of the PROMs were rated positively for content validity. For most instruments, limited evidence was available for construct validity and reliability. Instruments to assess pain scored well on responsiveness and floor and ceiling effects, but not much is known about their reliability in gout. Conclusions The physical functioning subscale of the SF-36v2 (Short Form-36 item version 2) is the only PROM that had sufficient supporting evidence for all its psychometric properties. Many of the commonly used PROMs in gout are currently not yet well supported and more studies on their measurement properties are needed among both acute and chronic gout populations. Electronic supplementary material The online version of this article (10.1186/s12955-019-1125-x) contains supplementary material, which is available to authorized users.

Item does not contain fulltext OBJECTIVE: To evaluate, from a societal perspective, the incremental cost-effectiveness of withdrawing tumor necrosis factor inhibitor (TNFi) treatment compared to continuation of these drugs within a 1-year, randomized trial among rheumatoid arthritis patients with longstanding, stable disease activity or remission. METHODS: Data were collected from a pragmatic, open-label trial. Cost-utility analysis was performed using the nonparametric bootstrapping method, and a cost-effectiveness acceptability curve was constructed using the net-monetary benefit framework, where a willingness-to-accept threshold (WTA) was defined as the minimal cost saved that a patient accepted for each quality-adjusted life year (QALY) lost. RESULTS: A total of 531 patients were randomized to the stop group and 286 patients to the continuation group. Withdrawal of TNFi treatment resulted in a >60% reduction of the total drug cost, but led to an increase of approximately 30% in other health care expenditures. Compared to continuation, stopping TNFi resulted in a mean yearly cost saving of euro7,133 (95% confidence interval [95% CI] euro6,071, euro8,234]) and was associated with a mean loss of QALYs of 0.02 (95% CI 0.002, 0.040). Mean saved cost per QALY lost and per extra flare incurred in the stop group compared to the continuation group was euro368,269 (95% CI euro155,132, euro1,675,909) and euro17,670 (95% CI euro13,650, euro22,721), respectively. At a WTA of euro98,438 per QALY lost, the probability that stopping TNFi treatment is cost-effective was 100%. CONCLUSION: Although an official WTA is not defined, the mean saved cost of euro368,269 per QALY lost seems acceptable in The Netherlands, given existing data on willingness to pay.

Objective To evaluate the reliability of a crosswalk, developed in The Netherlands, between the Health Assessment Questionnaire (HAQ) disability index (DI) and the Short Form 36 physical functioning scale (PF-10) in a sample of patients with various rheumatic diseases in the US. Methods Baseline data from patients with rheumatoid arthritis (RA; n = 29,020), fibromyalgia (FM; n = 3,776), and systemic lupus erythematosus (SLE; n = 1,609) participating in the National Data Bank for Rheumatic Diseases were analyzed. Reliability of the crosswalk was evaluated by calculating intraclass correlation coefficients (ICCs), and agreement between observed and predicted scores was evaluated using the Bland-Altman approach. Results The crosswalk produced reliable conversions for both the HAQ DI (ICC range 0.70–0.77) and PF-10 (ICC range 0.73–0.78) in all 3 disease groups. The mean difference between observed and expected scores was close to zero in US patients with RA. For all 3 disease groups, the limits of agreement were fairly wide and conversion at the level of individual patients is not recommended. Conclusion The crosswalk produced reliable conversions at the group level in a crosscultural setting and can be used to convert HAQ DI to PF-10 scores and vice versa in US patients with RA, FM, or SLE

OBJECTIVE: To evaluate and compare the measurement precision and sensitivity to change of the Health Assessment Questionnaire disability index (HAQ DI), the Short Form 36 physical functioning scale (PF-10), and simulated Patient-Reported Outcomes Measurement Information System (PROMIS) physical function computer adaptive tests (CATs) with 5, 10, and 15 items, using item response theory-based simulation studies. METHODS: The measurement precision of the various physical function instruments was evaluated by calculating root mean square errors (RMSEs) between true physical function levels (latent physical function score) and estimated physical function levels. Measurement precision was evaluated at 9 levels of physical function, with 5,000 simulated response patterns per level. Sensitivity to change was evaluated by the ability of a simple statistical test to detect simulated change scores of small to moderate magnitude (standardized effect sizes 0.20, 0.35, and 0.50). RESULTS: RMSEs were smaller for the PROMIS physical function 15-item CAT (CAT-15) and CAT-10 than for the HAQ DI and PF-10 across all levels of the latent physical function scale. Only marginal improvement in performance was observed for the CAT-15 compared with the CAT-10, and the CAT-5 performed quite similarly to the HAQ DI and PF-10 across most levels of the latent physical function scale. Substantially improved sensitivity to change was observed for the CAT-10 compared with the HAQ DI and PF-10, particularly in detecting moderate effect sizes. CONCLUSION: Clearly higher measurement precision was observed for the PROMIS CAT compared with the HAQ DI and PF-10. Higher reliability also translated into lower sample size requirements for detecting changes in clinical status.

Objective Although treat-to-target (T2T) strategies are effective in early rheumatoid arthritis (RA) patients, important individual variations exist in the course toward remission. Growth mixture modeling provides more insight into this heterogeneity by identifying subgroups of patients with similar response patterns. This study aimed to identify distinct trajectories of disease activity in early RA patients following a T2T strategy during their first year. Methods Data on various clinical and patient-reported measures were collected from the Dutch Rheumatoid Arthritis Monitoring remission induction cohort. Growth mixture modeling was applied to examine the impact of T2T on subgroups characterized by different types of growth trajectories, as measured with the Disease Activity Score in 28 joints. Results Three distinct trajectories of disease activity were found. The normative trajectory contained most patients (82.6%), showing a quickly decreasing disease activity that stabilized at remission after 9 months. This group performed best on clinical and patient-reported measures over time and were more likely to be men. A smaller group (14.1%) also approached remission, but demonstrated a slower response to treatment. Finally, a minority (3.3%) showed no improvement after 1 year, despite an initial quick decrease in disease activity during the first months of treatment. Conclusion Disease activity in early RA patients during the first year of a T2T strategy does not follow a linear pattern, nor is a single developmental trajectory applicable to all patients. Future studies should attempt to identify more specific risk factors for poor outcome to enable early identification of patients in need of alternative therapeutic approaches.

Item does not contain fulltext This paper aims to examine the interchangeability of the disease activity score in 28 joints (DAS28)-erythrocyte sedimentation rate (ESR) and DAS28-CRP scores in a diverse sample of rheumatoid arthritis (RA) patients and to evaluate generalizability over gender, age, and disease duration. A sample of 682 patients was drawn from the DREAM registry. Agreement between the two DAS28 scores was analyzed using the intraclass correlation coefficient (ICC), Bland Altman plots, and a matrix of classification agreement over DAS28 disease activity categories. Despite a strong linear correlation between the DAS28 scores and a high ICC value of 0.931, a considerable lack of individual agreement could be observed, with Bland-Altman 95 % limits of agreement ranging between -0.85 and +1.25 points. On average, DAS28-CRP scores were 0.20 points lower than DAS28-ESR scores, and data stratification on age and gender showed that this systematic bias was most severe in older women (0.39 points). The overall classification agreement across DAS28 categories was 76.69 %, with the agreement being lowest (35.37 %) in the low disease activity group. Patients were more easily classified as being in remission when using the DAS28-CRP measure. DAS28-ESR and DAS28-CRP scores are not interchangeable within individuals. The DAS28-CRP tends to yield lower values of disease activity than the DAS28-ESR, resulting in substantial classification differences.

This study aims to determine whether patients with rheumatoid arthritis (RA) experience more general feelings of guilt and shame than their peers without RA and to examine possible correlates of guilt and shame in RA. In a cross-sectional survey study, 85 out-patients with RA (77 % female; median disease duration, 11 years) and 59 peer controls completed the Experience of Shame Scale (ESS) and the Test of Self-Conscious Affect (TOSCA). Patients additionally completed measures of health status, self-efficacy, cognitive emotion regulation, and numerical rating scales for life satisfaction and happiness. Patients and peer controls were well matched for sociodemographic characteristics. No significant differences between patients and controls were found for guilt or different types of shame as measured with the TOSCA or ESS. In multivariate analyses, female patients reported more feelings of bodily shame and higher guilt proneness, while younger patients reported more character and bodily shame. Worse social functioning and more self-blaming coping strategies were the strongest independent correlates of shame. Shame proneness was only independently associated with more self-blame, whereas guilt proneness was only associated with female sex. None of the physical aspects of the disease, including pain and physical functioning, correlated with feelings of guilt and shame. Patients with longstanding RA do not experience more general feelings of shame or guilt than their peers without RA. Shame and guilt in RA is primarily associated with demographic and psychosocial characteristics and not with physical severity of the disease.

This article describes the development and evaluation of the Engaged Living Scale (ELS) as a new self-report, process-specific measure to assess an engaged response style as conceptualized in acceptance and commitment therapy (ACT). The psychometric properties of the ELS test scores were evaluated in both a nonclinical sample (N = 439) and a clinical sample consisting of chronic pain patients who participated in a study on the effects of an online ACT intervention (N = 238). Item analysis and exploratory factor analysis in the nonclinical sample suggested a 16-item version of the ELS with 2 subscales, Valued Living (10 items) and Life Fulfillment (6 items). A bifactor model with 2 specific factors and 1 general underlying factor showed the best fit in confirmatory factor analyses in the chronic pain sample. In both samples, the scores on the ELS and its subscales showed good internal consistency and construct validity by consistent patterns of relationships with theoretically related process and outcome variables, such as psychological well-being, anxiety/depression, acceptance, mindfulness, and pain interference in daily life. Furthermore, in the chronic pain sample, the ELS showed incremental validity in explaining anxiety and depression, positive mental health, and pain interference beyond both acceptance and mindfulness. This study suggests the ELS shows promise as a useful tool for the measurement of an engaged response style, enabling more comprehensive evaluation of working mechanisms of ACT.

OBJECTIVE: To evaluate the cross-cultural measurement equivalence of the US and Dutch Health Assessment Questionnaire II (HAQ-II) in rheumatoid arthritis (RA). METHODS: Item response theory (IRT) analyses were performed on US (n=18747) and Dutch (n=1022) HAQ-II data to evaluate the equivalence of cross-cultural item performance. Observed inconsistencies were modeled by assigning country-specific item parameters to biased items. The impact of cross-cultural item bias on the comparability of the Dutch and US total scores was analyzed by evaluating the agreement between physical function levels estimated from an IRT model with country specific-item parameters for biased items and the physical function levels estimated from the original model that does not account for cultural bias. RESULTS: Two items showed significant cross-cultural bias. However, the agreement in physical function estimates between the respecified and original model was very high with ICC >0.99 and the Bland–Altman limits of agreement ranging from -0.08 to 0.07 on a latent scale with a mean of 0 and standard deviation 1. CONCLUSIONS: This study suggests that the Dutch and US HAQ-II produce total scores that can be interpreted interchangeably across countries in RA studies, despite some minor bias at the item level.

Objective: Existential anxiety (EA) is a construct that refers to fears that are provoked by core threats of human existence, such as death, meaninglessness, and fundamental loneliness. The objective of this study was to develop an EA measure that can be used in research and clinical practice. Method: The Existential Concerns Questionnaire (ECQ) was completed by a nonclinical sample of 389 adults, together with questionnaires measuring death anxiety, intolerance of uncertainty, neuroticism, distress, meaning, and life events. Adaptations were made based on item analysis and factor analysis. A total of 99 adults who had an anxiety and/or depressive disorder completed the final version. Results: The ECQ was demonstrated to be essentially unidimensional and showed good reliability and stability. Correlations with other measures were within the expected range of strength, except for a weak association with life events. Conclusion: Initial results regarding the psychometric properties of the ECQ are promising.

The Acceptance and Action Questionnaire-II (AAQ-II) is a self-report measure designed to assess experiential avoidance as conceptualized in acceptance and commitment therapy (ACT). The current study is the first to evaluate the psychometric properties of the AAQ-II in a large sample of adults (N = 376) with mild to moderate levels of depression and anxiety who participated in a study on the effects of an ACT intervention. The internal construct validity and local measurement precision were investigated by fitting the data to a unidimensional item response theory (IRT) model, and the incremental validity of the AAQ-II beyond mindfulness, as measured by the Five Facet Mindfulness Questionnaire, was assessed. Results of the IRT analyses suggest that the AAQ-II is a unidimensional measure of experiential avoidance and has satisfactory reliability for group comparisons in mild to moderately depressed and anxious populations. Item functioning was found to be independent of gender and slightly dependent on age in this sample. Furthermore, the AAQ-II showed incremental validity beyond 5 mindfulness facets in explaining depression, anxiety, and positive mental health. This study suggests the AAQ-II shows promise as a useful tool for the measurement of experiential avoidance in mild to moderately depressed and anxious populations.

Disability, or activity limitation, is a common problem in patients with gout. This study explores recent studies examining the nature and extent of disability in gout and addresses the merits and limitations of current self-reported measures of disability.Gout has a significant impact on patients' ability to perform normal self-care activities, recreational and social activities, and work. Comparative studies indicate that gout patients' physical functioning is strongly reduced and comparable to those with other severe rheumatic conditions. Moreover, gout has been shown to result in substantial work absence and reduced productivity. However, few studies have thoroughly examined the concept of disability in gout. Additionally, assessment of disability due to gout still seems particularly challenging and it is unclear whether current measurement instruments are sufficiently valid and accurate.Gout-related disability is an underestimated and understudied problem. More qualitative and quantitative studies are needed that examine the concept of disability in gout and its impact on patients' lives, both during and between disease flares. Moreover, future studies should try to identify gout-specific disability issues and examine the relevance and comprehensiveness of existing measures to further improve the assessment of disability in gout.

Aim: A prospective open-label study comparing the efficacy and safety of methotrexate (MTX) and chloroquine (CQ) in articular and cutaneous manifestations of systemic lupus erythematosus (SLE). Methods: Consecutive SLE patients were randomly assigned to either 10 mg MTX weekly or 150 mg CQ daily during 24 weeks. Outcome measures were: numbers of swollen and tender joints, duration of morning stiffness, visual analog scale (VAS) for articular pain, physician global assessment index, patient global assessment index, SLE Disease Activity Index (SLEDAI), disappearance of skin rash and erythrocyte sedimentation rate (ESR). Results: Forty-one patients consented to participate, 15 were allocated in the MTX group and 26 in the CQ group. Two patients on MTX dropped out due to side-effects and two in the CQ group, one due to side-effects and one due to inefficacy. Baseline demographic, clinical and laboratory parameters of the two groups were nearly identical. In both groups the clinical and laboratory parameters improved significantly over 24 weeks, except the ESR in the MTX group. The results of the outcome measures at the end of the trial did not differ significantly between the two groups, except morning stiffness (P < 0.05 in favor of the MTX group) and ESR (P < 0.01 in favor of the CQ group). Rise of serum alanine aminotransferase was observed in two cases in the MTX group and in none in the CQ group. Conclusion: Low-dose MTX appears to be as effective as CQ in patients with articular and cutaneous manifestations of SLE, having an acceptable toxicity profile. Results of this prospective study need to be confirmed in a larger study.

Objective.To examine the construct validity of the 28-tender joint count (TJC-28) using item response theory (IRT)-based methods.Methods.A total of 457 patients with early stage rheumatoid arthritis (RA) were included. Internal construct validity of the TJC-28 was evaluated by determining whether the TJC-28 fit a 2-measure logistic IRT model. As well, we tested whether the discrimination and difficulty parameters of the joints properly reflected the known left-right symmetry of joint involvement. External validity was evaluated by correlations with other established measures of disease activity, including pain, disability, general health, erythrocyte sedimentation rate (ESR), and the 28-swollen joint count.Results.The TJC-28 showed a good fit with the 2-parameter logistic model, with no relevant differential item functioning across sex, age, and time and with excellent reliability. The 28 joints covered a reasonable range of disease activity, even though they were mainly targeted at patients with moderate or high disease activity levels. The joint parameters reflected the left-right symmetry of joint involvement for all pairs of joints except one. All disease activity measures, except ESR, were significantly correlated with the TJC-28. Most correlations were of the expected magnitude.Conclusion.The TJC-28 showed good internal and acceptable external construct validity for patients with early-stage RA. The IRT analyses did point to some potential limitations of the instrument, a major problem being its limited measurement range. Future research should examine whether instrument modifications might lead to a more robust assessment of disease activity in patients with RA.

There is a growing consensus that mental health is not merely the absence of mental illness, but it also includes the presence of positive feelings (emotional well-being) and positive functioning in individual life (psychological well-being) and community life (social well-being). We examined the structure, reliability, convergent validity, and discriminant validity of the Mental Health Continuum-Short Form (MHC-SF), a new self-report questionnaire for positive mental health assessment. We expected that the MHC-SF is reliable and valid, and that mental health and mental illness are 2 related but distinct continua. This article draws on data of the LISS panel of CentERdata, a representative panel for Longitudinal Internet Studies for the Social Sciences (N = 1,662). Results revealed high internal and moderate test-retest reliability. Confirmatory factor analysis (CFA) confirmed the 3-factor structure in emotional, psychological, and social well-being. These subscales correlated well with corresponding aspects of well-being and functioning, showing convergent validity. CFA supported the hypothesis of 2 separate yet related factors for mental health and mental illness, showing discriminant validity. Although related to mental illness, positive mental health is a distinct indicator of mental well-being that is reliably assessed with the MHC-SF.

Objective. To compare the measurement properties of the HAQ disability index (HAQ-DI), HAQ-II and short form 36 physical functioning scale (PF-10) in patients with gout. Methods. A cross-sectional sample of 97 patients with gout completed all three measures. Reliability was assessed by examining the internal consistency of the scales. Validity was assessed by testing for expected intercorrelations and associations with other aspects of health status and the ability to discriminate between patients with different levels of general health. Additionally, distributional properties were examined. Results. All three measures demonstrated high reliability (Cronbach’s α ≥0.93), strong intercorrelations (r ≥ 0.75), and the expected pattern of external correlations. The HAQ-DI and HAQ-II performed somewhat better in discriminating between patients. However, both demonstrated ceiling effects of 34.0 and 25.8%, respectively, compared with only 7.2% of the patients scoring no disability on the PF-10. Conclusions. The HAQ-DI, HAQ-II and PF-10 demonstrated similar and adequate reliability and validity for measuring functional disability in patients with gout. The large ceiling effects of both HAQ versions, however, may point to limited content validity and responsiveness to change. Further research should examine whether current instruments cover all aspects of physical functioning relevant to patients with gout

Despite the attention for corporate, brand and product images, only few studies focus on methodological comparisons of image research methods. This article presents a comparison of two current instruments: the Q-sort method and a Likert attitude questionnaire. The study applies both methods to measure the image of beef, using the same assertions in similar samples of consumers. The two methods produce consistent results, but differ in the possibilities of data analysis and interpretation. An advantage of the Q-sort method is that it offers straightforward insights in the underlying structure of image within audience segments. On the other hand, the Q-sort method does not give overall indications of an image, and limits occur for analyzing the relationships between image and other variables.

Contains fulltext : 71296_p85.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To examine the factorial validity of the short form Arthritis Impact Measurement Scales 2 (AIMS2-SF) in patients with rheumatoid arthritis (RA). METHODS: Data were from a sample of 279 patients with active RA who completed the long form AIMS2 before starting treatment with tumor necrosis factor alpha-blocking agents. Confirmatory factor analyses were conducted to test and compare the fit of the currently used theoretical measurement model of the AIMS2-SF, originally suggested for the long form AIMS2, and 2 alternative models based on previous exploratory research. RESULTS: A model with the physical dimension divided into upper and lower body limitations was superior to the current model, and both models provided a clearly better fit than a model without a separate symptom dimension. Under the restrictive assumption of uncorrelated error terms, none of the models achieved a consistent and acceptable fit as judged by several goodness-of-fit indices. Allowing error covariances between 6 pairs of items within the same dimension resulted in an improved and acceptable fit of both the current model and the model with a separate upper and lower body component. CONCLUSION: This study generally supports the factorial validity of the AIMS2-SF and suggests the use of separate scores for upper and lower body limitations. Further research is needed to resolve the issue of high error correlations associated with particular items.

Tumor necrosis factor inhibitor (TNFi) biologic agents are an effective treatment for rheumatoid arthritis (RA). It is unclear whether patients whose disease is in remission or who have stable low disease activity need to continue use of TNFi or can stop this treatment. This study was undertaken to assess whether patients with established RA who are in remission or have stable low disease activity can effectively and safely stop their TNFi therapy.The study was designed as a pragmatic multicenter, open-label randomized controlled trial. Inclusion criteria were a diagnosis of RA according to the American College of Rheumatology 1987 classification criteria, as well as use of a TNFi for at least 1 year along with a stable dose of disease-modifying antirheumatic drugs and a Disease Activity Score in 28 joints (DAS28) of3.2 over the 6 months preceding trial inclusion. Patients were randomized in a 2:1 ratio to either stop or continue treatment with their current TNFi. Flare was defined as a DAS28 of ≥3.2 during the 12-month follow-up period and an increase in score of ≥0.6 compared to the baseline DAS28.In total, 531 patients were allocated to the stop group and 286 to the TNFi continuation group. At 12 months, more patients had experienced a flare in the stop group (272 [51.2%] of 531) than in the continuation group (52 [18.2%] of 286; P 0.001). The hazard ratio for occurrence of a flare after stopping TNFi was 3.50 (95% confidence interval [95% CI] 2.60-4.72). The mean DAS28 in the stop group was significantly higher during the follow-up period compared to that in the continuation group (P 0.001). Of the 195 patients who restarted TNFi treatment after experiencing a flare and within 26 weeks after stopping, 165 (84.6%) had regained a DAS28 of3.2 by 6 months later, and the median time to a regained DAS28 of3.2 was 12 weeks (95% Cl 10.7-13.3). There were more hospitalizations in the stop group than in the continuation group (6.4% versus 2.4%).Stopping TNFi treatment results in substantially more flares than does continuation of TNFi in patients with established RA in remission or with stable low disease activity.

To test the effectiveness of the Healthy School and Drugs (HSD) programme on tobacco and alcohol use in Dutch secondary special education (SE) schools, and whether this depends upon subtypes of SE schools and the level of implementation.In a quasi-experimental design with baseline and post-treatment follow-up, 363 students were allocated arbitrarily or depending on teacher motivation to either intervention condition (n = 205) or usual curriculum (n = 158).Thirteen secondary SE schools spread throughout the Netherlands.Participants were recruited during the autumn of 2013 from three school subtypes: SE for adolescents with intellectual/physical disabilities (SEI; n = 13), behavioural/emotional difficulties (SEB; n = 136) and learning disabilities/developmental disorders (SEL; n = 214).Self-reported life-time smoking prevalence and life-time drinking frequency as outcomes, and school subtype (SEL/SEB) and implementation fidelity (high/low) as moderators.No significant differences were found at follow-up in life-time smoking [odds ratio (OR) = 1.52; 95% confidence interval (CI) = 0.74-3.12] and drinking frequency (d = 0.01; 95% CI = -0.16 to 0.18). Interaction analyses revealed adverse effects in SEB students for alcohol use (d = 0.43; 95% CI = 0.16-0.69). Effect on tobacco refusal self-efficacy was moderated positively by implementation fidelity (d = 0.35; 95% CI = 0.07-0.63).The Healthy School and Drugs programme adapted for secondary special education in the Netherlands lacked clear evidence for effects on all outcomes. This pilot study suggests further that, within special education, substance use interventions may need to be targeted at school subtypes, as these may have harmful effects among students with behavioural difficulties. Finally, limited evidence was found that programme effectiveness may depend upon implementation fidelity.

To further simplify the simple erosion narrowing score (SENS) by removing scored areas that contribute the least to its measurement precision according to analysis based on item response theory (IRT) and to compare the measurement performance of the simplified version to the original.Baseline and 18-month data of the Combinatietherapie Bij Reumatoide Artritis (COBRA) trial were modeled using longitudinal IRT methodology. Measurement precision was evaluated across different levels of structural damage. SENS was further simplified by omitting the least reliably scored areas. Discriminant validity of SENS and its simplification were studied by comparing their ability to differentiate between the COBRA and sulfasalazine arms. Responsiveness was studied by comparing standardized change scores between versions.SENS data showed good fit to the IRT model. Carpal and feet joints contributed the least statistical information to both erosion and joint space narrowing scores. Omitting the joints of the foot reduced measurement precision for the erosion score in cases with below-average levels of structural damage (relative efficiency compared with the original version ranged 35-59%). Omitting the carpal joints had minimal effect on precision (relative efficiency range 77-88%). Responsiveness of a simplified SENS without carpal joints closely approximated the original version (i.e., all Δ standardized change scores were ≤0.06). Discriminant validity was also similar between versions for both the erosion score (relative efficiency = 97%) and the SENS total score (relative efficiency = 84%).Our results show that the carpal joints may be omitted from the SENS without notable repercussion for its measurement performance.

The assessment of clinically meaningful changes in patient-reported pain has become increasingly important when interpreting results of clinical studies. However, proposed response criteria, such as the minimal clinically important difference, do not correspond with the growing need for information on truly meaningful, individual improvements. The aim of the present study was to investigate satisfactory improvements in pain from the patient’s perspective. Data were collected in a 2-week prospective study of 181 arthritis patients treated with a local corticosteroid injection. Baseline and follow-up pain were assessed on 100 mm visual analogue scales for pain intensity (VAS-PI). At baseline, patients also marked a hypothetical level on a VAS-PI representing a satisfactory improvement in pain. Patient-perceived satisfactory improvement (PPSI) was constructed using a 5-point categorical rating of change scale at follow-up as the anchor. PPSI was associated with a minimal reduction of 30 mm or 55% on the VAS-PI. Since absolute change in pain associated with satisfactory improvement proved highly dependent on baseline pain, percent change scores performed better in classifying improved patients. The 55% threshold for satisfactory improvement was consistent over the course of treatment and reasonably consistent across groups of patients. Our data suggest that PPSI is a clinically relevant and stable concept for interpreting truly meaningful improvements in pain from the individual perspective.

Objective.To compare the psychometric functioning of multidimensional disease-specific, multiitem generic, and single-item measures of fatigue in patients with rheumatoid arthritis (RA).Methods.Confirmatory factor analysis (CFA) and longitudinal item response theory (IRT) modeling were used to evaluate the measurement structure and local reliability of the Bristol RA Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ), the Medical Outcomes Study Short Form-36 (SF-36) vitality scale, and the BRAF Numerical Rating Scales (BRAF-NRS) in a sample of 588 patients with RA.Results.A 1-factor CFA model yielded a similar fit to a 5-factor model with subscale-specific dimensions, and the items from the different instruments adequately fit the IRT model, suggesting essential unidimensionality in measurement. The SF-36 vitality scale outperformed the BRAF-MDQ at lower levels of fatigue, but was less precise at moderate to higher levels of fatigue. At these levels of fatigue, the living, cognition, and emotion subscales of the BRAF-MDQ provide additional precision. The BRAF-NRS showed a limited measurement range with its highest precision centered on average levels of fatigue.Conclusion.The different instruments appear to access a common underlying domain of fatigue severity, but differ considerably in their measurement precision along the continuum. The SF-36 vitality scale can be used to measure fatigue severity in samples with relatively mild fatigue. For samples expected to have higher levels of fatigue, the multidimensional BRAF-MDQ appears to be a better choice. The BRAF-NRS are not recommended if precise assessment is required, for instance in longitudinal settings.

Contains fulltext : 152917.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To evaluate the content validity and measurement properties of the Patient-Reported Outcome Measurement Information System (PROMIS) physical function item bank and a 20-item short form in patients with RA in comparison with the HAQ disability index (HAQ-DI) and 36-item Short Form Health Survey (SF-36) physical functioning scale (PF-10). METHODS: The content validity of the instruments was evaluated by linking their items to the International Classification of Functioning, Disability and Health (ICF) core set for RA. The measures were administered to 690 RA patients enrolled in the Dutch Rheumatoid Arthritis Monitoring registry. Measurement precision was evaluated using item response theory methods and construct validity was evaluated by correlating physical function scores with other clinical and patient-reported outcome measures. RESULTS: All 207 health concepts identified in the physical function measures referred to activities that are featured in the ICF. Twenty-three of 26 ICF RA core set domains are featured in the full PROMIS physical function item bank compared with 13 and 8 for the HAQ-DI and PF-10, respectively. As hypothesized, all three physical function instruments were highly intercorrelated (r 0.74-0.84), moderately correlated with disease activity measures (r 0.44-0.63) and weakly correlated with age (rs 0.07-0.14). Item response theory-based analysis revealed that a 20-item PROMIS physical function short form covered a wider range of physical function levels than the HAQ-DI or PF-10. CONCLUSION: The PROMIS physical function item bank demonstrated excellent measurement properties in RA. A content-driven 20-item short form may be a useful tool for assessing physical function in RA.

Item does not contain fulltext OBJECTIVE: The aim of this study was to identify baseline predictors of achieving patient-perceived satisfactory improvement (PPSI) in pain after 6 months of treat to target in patients with early RA. METHODS: Baseline and 6 month data were used from patients included in the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Simple and multivariable logistic regression analyses were used to identify significant predictors of achieving an absolute improvement of 30 mm or a relative improvement of 50% on a visual analogue scale for pain. RESULTS: At 6 months, 125 of 209 patients (59.8%) achieved an absolute PPSI and 130 patients (62.2%) achieved a relative PPSI in pain. Controlling for baseline pain, having symmetrical arthritis was the strongest independent predictor of achieving an absolute [odds ratio (OR) 3.17, P = 0.03] or relative (OR 3.44, P = 0.01) PPSI. Additionally, anti-CCP positivity (OR 2.04, P = 0.04) and having

To evaluate and compare the measurement precision and sensitivity to change of the Health Assessment Questionnaire disability index (HAQ DI), the Short Form 36 physical functioning scale (PF-10), and simulated Patient-Reported Outcomes Measurement Information System (PROMIS) physical function computer adaptive tests (CATs) with 5, 10, and 15 items, using item response theory-based simulation studies.The measurement precision of the various physical function instruments was evaluated by calculating root mean square errors (RMSEs) between true physical function levels (latent physical function score) and estimated physical function levels. Measurement precision was evaluated at 9 levels of physical function, with 5,000 simulated response patterns per level. Sensitivity to change was evaluated by the ability of a simple statistical test to detect simulated change scores of small to moderate magnitude (standardized effect sizes 0.20, 0.35, and 0.50).RMSEs were smaller for the PROMIS physical function 15-item CAT (CAT-15) and CAT-10 than for the HAQ DI and PF-10 across all levels of the latent physical function scale. Only marginal improvement in performance was observed for the CAT-15 compared with the CAT-10, and the CAT-5 performed quite similarly to the HAQ DI and PF-10 across most levels of the latent physical function scale. Substantially improved sensitivity to change was observed for the CAT-10 compared with the HAQ DI and PF-10, particularly in detecting moderate effect sizes.Clearly higher measurement precision was observed for the PROMIS CAT compared with the HAQ DI and PF-10. Higher reliability also translated into lower sample size requirements for detecting changes in clinical status.

To evaluate the reliability of a crosswalk, developed in The Netherlands, between the Health Assessment Questionnaire (HAQ) disability index (DI) and the Short Form 36 physical functioning scale (PF-10) in a sample of patients with various rheumatic diseases in the US.Baseline data from patients with rheumatoid arthritis (RA; n = 29,020), fibromyalgia (FM; n = 3,776), and systemic lupus erythematosus (SLE; n = 1,609) participating in the National Data Bank for Rheumatic Diseases were analyzed. Reliability of the crosswalk was evaluated by calculating intraclass correlation coefficients (ICCs), and agreement between observed and predicted scores was evaluated using the Bland-Altman approach. RESULTS. The crosswalk produced reliable conversions for both the HAQ DI (ICC range 0.70-0.77) and PF-10 (ICC range 0.73-0.78) in all 3 disease groups. The mean difference between observed and expected scores was close to zero in US patients with RA. For all 3 disease groups, the limits of agreement were fairly wide and conversion at the level of individual patients is not recommended.The crosswalk produced reliable conversions at the group level in a crosscultural setting and can be used to convert HAQ DI to PF-10 scores and vice versa in US patients with RA, FM, or SLE.