Professional and Personal Experiences and Perceived Facilitator Effectiveness

The very fact that multiple sclerosis (MS) is incurable and necessitates life-long care makes it one of the most burdensome illnesses. The aim of this study was to compare the cost-effectiveness of orally administered medications (e.g., fingolimod, dimethyl fumarate, and teriflunomide), interferon (IFN)-based therapy, and monoclonal antibodies (MABs) (e.g., natalizumab and rituximab) in the management of relapsing-remitting multiple sclerosis (RRMS) in Saudi Arabia using real-world data. This was a retrospective cohort study in which patients with RRMS aged ≥18 years without any other chronic health conditions with non-missing data for at least 12 months were recruited from the electronic health records of a university-affiliated tertiary care center. Multiple logistic regressions controlling for age, sex, and duration of therapy were conducted to examine the odds of disability progression, clinical relapse, MRI lesions, and composite outcome (e.g., relapse, lesion development on MRI, disability progression). The number of patients who met the inclusion criteria and were included in the analysis was 146. Most of the patients were female (70.51%) and young (e.g., ≤35 years of age). There were 40 patients on the orally administered agents (e.g., dimethyl fumarate, teriflunomide, fingolimod), 66 patients were on IFN-based therapy (e.g., Rebif®), and 40 patients were on monoclonal antibodies (e.g., rituximab and natalizumab). Patients on MABs had lower odds of the composite outcome (OR = 0.17 (95% CI: 0.068–0.428)). The use of orally administered agents was dominant (e.g., more effective and less costly), with average annual cost savings of USD −4336.65 (95% CI: −5207.89–−3903.32) and 8.11% higher rate of effectiveness (95% CI: −14.81–18.07) when compared with Rebif®. With regard to the use of MABs in comparison to Rebif®, MABs were associated with higher cost but a better rate of effectiveness, with an average additional annual cost of USD 1381.54 (95% CI: 421.31–3621.06) and 43.11% higher rate of effectiveness (95% CI: 30.38–61.15) when compared with Rebif®. In addition, the use of MABs was associated with higher cost but a better rate of effectiveness, with an average additional annual cost of USD 5717.88 (95% CI: 4970.75–8272.66) and 35% higher rate of effectiveness (95% CI: 10.0–42.50) when compared with orally administered agents. The use of MABs in the management of RRMS among the young patient population has shown to be the most effective therapy in comparison to both IFN-based therapy (e.g., Rebif®) and orally administered agents, but with higher cost. Orally administered agents resulted in better outcomes and lower costs in comparison to IFN-based therapy. Future studies should further examine the cost-effectiveness of different disease-modifying therapies for the management of RRMS using more robust study designs.

An effort is made to provide a more satisfactory test of the usefulness of effective tariff rates in determining resource movements by comparing effective rates of protection calculated for South Africa for two points of time with resource shifts over the same time. Also tested are whether the ''high'' and ''low'' effective rates and percentage changes in effective rates predict resource shifts better tha the complete scale of rates. The authors then test the conclusion that resources have been attracted to only those sectors that have very high effective rates or large percentage changes in effective rate and examine the association between nominal tariff rates and resource allocation. Cohen in 1969 and Guisenger and Schydlowsky in 1970 showed that there is a high correlation between nominal and effective rates, which raises the question of whether it is worth calculating effective tariff rates if nominal rates are close substitutes. 14 references.

This study examined the financial management practices of 62 participants in Smart Steps stepfamily education courses 1 year following their course completion. Qualitative interviews revealed 29 participants changed their financial practices as a result of the course, 29 did not change, and 4 provided unclear responses. Common reasons for no change included having functional practices that predated the relationship education course or financial difficulties remaining, despite course participation. Common reasons for change included working together as a couple and implementing budget or saving practices. Latino participants were more likely to report change than were European Americans. Findings and implications highlight both the opportunities and challenges associated with teaching financial education as part of a relationship education program.

This study highlights the experience of 356 adults who attended a 12-hour stepfamily relationship education course. Referred to as “stepcouples,” these adult participants were either remarried, cohabitating, or seriously dating someone who had children from a previous relationship. Self-report measures of relationship quality were gathered before the course began, at the end of the 6-week course, and 1 month later. Results from repeated measures analysis of variance suggest that stepcouples, regardless of their race or marital status, report that they benefit from stepfamily relationship education. For both white and Latino participants, reports of commitment increased and agreement on finances, ex-partners, and parenting all improved over time. Responses from semistructured interviews are included to illustrate participants’ perspectives. The similarity in outcomes, as well as the qualitative responses, point to research and practice implications regarding whether stepfamily education should be, or needs to be, different for married and unmarried stepcouples.

What constitutes effective wayfinding directions: The interactive role of descriptive cues and memory demands

This paper models a capital-exporting country that encounters difficulties in taxing foreign-source income, due to tax evasion problems. The paper compares the country's optimal effective tax rates on the income from capital invested at home and abroad (including penalties levied on detected tax evaders). It finds that tax evasion abroad does not provide a justification for a relatively low effective rate on foreign-source income. Under a variety of circumstances, foreign-source income should actually be taxed at a relatively high effective rate, regardless of the severity of tax evasion problems abroad. However, tax evasion abroad does tend to reduce the optimal taxation of capital income both at home and abroad.

Though myasthenia gravis (MG) is a typical autoimmune disorder, there was some controversy on the treatment of the childhood-onset MG. By observing the efficacy of different therapies, the authors analyzed the affecting factors of prognosis in childhood-onset MG. The retrospective data of 155 patients with childhood-onset MG (age of MG onset was less than 15 years) were collected from Department of Neurology, Beijing Tongren Hospital (January 2000 - February 2010). The patients were non-randomly divided according to their treatment into 3 groups (glucocorticoid, thymectomy and glucocorticoid combined with thymectomy groups). Postintervention status meeting the criteria of Myasthenia Gravis Foundation of America (MGFA) "complete stable remission, CSR", "pharmacologic remission, PR", "minimal manifestations, MM", or "Improved, I" was regarded as desirable response, which was used as primary indicator of observation. The authors assessed the efficacy of three therapies and analyzed the influencing factors of prognosis by using Chi-square test and Logistic regression. At 3 months of treatment, glucocorticoid group showed the highest effective rate. At the end of 1 year or 2 years of treatment, glucocorticoid combined with thymectomy group showed the highest effective rate respectively. The generalization rate of MG at 2 years, 10 years and 20 years in childhood-onset ocular MG patients were 4.3%, 10.7%, and 41.5%, respectively. Of patients with generalization of MG, 48.1% occurred within 2 years, 92.6% within 20 years. Univariate analysis showed that in childhood-onset ocular MG patients, variables such as age at onset (> 10 years), LG-MG and with chronic fatigue were significantly associated with general MG conversion. Whereas multivariate analysis showed that patients with age at onset (> 10 years) and chronic muscle fatigue were apt to convert to generalized MG. Glucocorticoid appeared to have an effect that leads to early remission of symptoms in childhood-onset MG patients and glucocorticoid combined with thymectomy appeared to have better long-term effect. For those childhood-onset ocular MG patients with longer course of disease, older age of onset, chronic fatigue, or LG-MG, physicians should try to prevent the generalization of MG by immunosuppressive therapies.

To analyze the efficacy and safety of dexamethasone in the treatment of non-puerperal mastitis (NPM), providing a new idea for the treatment of NPM. From August 1, 2017 to August 30, 2024, case data were collected from 552 patients with NPM. After grouping according to different treatment options, the SPSS statistical software was used for retrospective analysis of the collected data. The number of days of drug treatment before operation in group B was less than other groups (p < 0.001). The group B had the most significant relief of pain symptoms and shorter time to complete relief of pain than other groups (p < 0.001). There were statistically significant differences between the 5 groups in the time required for pain to disappear and the time required for the volume to be reduced by half after treatment (p < 0.05).The overall efficacy evaluation had the highest effective rate in Group B (100%) and the lowest in Group D (2.10%), and the difference was statistically significant (p < 0.001).No side effects such as abnormalities in liver and kidney functions, water-electrolyte disorders, or peptic ulcers were observed in the five groups during drug treatment. There was no statistically significant difference in the occurrence of side effects such as rash, diarrhoea and hyperglycaemia among patients in the five groups (p > 0.05).The side effects of nausea (vomiting) and skin pigmentation in group E were higher than other groups(p < 0.001). In terms of weight gain (full moon face), nervous excitability (insomnia) and menstrual disorders, group B was lower than other groups (except group D without hormone therapy)(p < 0.001). In terms of postoperative recurrence after ipsilateral breast surgery, the recurrence rates of patients in group B were lower than those of the other four groups, and group D had the highest recurrence rate (8.30%), with a statistically significant difference (p < 0.001). Satisfaction survey found that group B had the highest satisfaction rate other groups (p < 0.05). The number of days required for the volume to be reduced by half after treatment was the most influential factor in the satisfaction survey. At the same time, we found that the obvious effect and recovery rate of GLM group was higher than that of PCM group, and the difference was statistically significant (p < 0.05). Dexamethasone combined with levofloxacin/Metronidazole in the treatment of NPM has many advantages: first of all, it can significantly relieve the pain symptoms caused by the disease and effectively reduce the size of the lesion. Meanwhile, for the patients who plan to undergo surgery, the number of days of preoperative drug treatment can be reduced, and the overall effective rate is the highest. Secondly, the short-term application of drugs to treat side effects less, high safety; in the meantime, the risk of recurrence of the ipsilateral breast was less and the satisfaction of the patients was higher. The overall significant efficiency and recovery rate of GLM patients were higher than those of PCM patients.

Objective: To examine the association between the clinical efficacy of fecal microbiota transplantation (FMT) in recipients and the choice of donor, and to observe the characteristics of intestinal flora and metabolites among different donors. Methods: A retrospective case-control study was conducted. Donor whose feces was administrated for more than 30 recipients was enrolled. Data of 20 FMT donors and corresponding recipients at Intestinal Microecology Diagnosis and Treatment Center of the Tenth People's Hospital from October 2018 to December 2019 were collected retrospectively. During follow-up, the efficacy of each recipient 8-week after FMT treatment was recorded and analyzed. Based on the efficacy of each donor, the donors were divided into three groups: high efficacy group (effective rate >60%, 10 donors), moderate efficacy group (effective rate 30%-60%, 6 donors) and low efficacy group (effective rate <30%, 4 donors). The structure of the bacterial flora and the content of fecal short-chain fatty acids in each group of donors were detected and compared among groups. Association of the efficacy of each donor group with the morbidity of complications, and association of efficacy of recipients with donors were analyzed. The evaluation indicators of FMT efficacy included objective clinical effectiveness and/or subjective effectiveness. Objective effectiveness indicated clinical cure plus clinical improvement, and subjective effectiveness indicated marked effectiveness plus medium effectiveness through questionnaire during follow-up. Results: A total of 1387 recipients were treated by 20 donors, including 749 cases of chronic constipation, 141 cases of chronic diarrhea, 107 cases of inflammatory bowel disease (IBD), 121 cases of irritable bowel syndrome (IBS), 83 cases of autism, and 186 cases of other diseases, such as radiation bowel injury, intestinal pseudo-obstruction, paralytic intestinal obstruction, functional bloating and allergic diseases. There were 829 cases, 403 cases, and 155 cases in high efficacy group, moderate efficacy group and low efficacy group respectively. Baseline data among 3 groups were not significantly different (all P> 0.05). In comparison of bacterial abundance (operational taxonomic unit, OTU) among different effective donor groups, the high efficacy group was the highest (330.68±57.28), the moderate efficacy group was the second (237.79±41.89), and the low efficacy group was the lowest (160.60±49.61), whose difference was statistically significant (F=16.910, P<0.001). In comparison of bacterial diversity (Shannon index), the high efficacy group and the moderate efficacy group were higher (2.96±0.36 and 2.67±0.54, respectively), and the low efficacy group was lower (2.09±0.55), whose difference was statistically significant (F=5.255, P=0.017). In comparison of butyric acid content among three groups, the high efficacy group had the highest [(59.20±9.00) μmol/g], followed by middle efficacy group [(46.92±9.48) μmol/g], and the low efficacy group had the lowest [(37.23±5.03) μmol/g], whose difference was statistically significant (F=10.383, P=0.001). The differences of acetic acid and propionic acid among three groups were not statistically significant (all P>0.05). A total of 418 cases developed complications (30.1%). Morbidity of complication in low efficacy group, moderate efficacy group and high efficacy group was 40.6% (63/155), 30.0% (121/403) and 28.2% (243/829) respectively, and the difference was statistically significant (χ(2)=9.568, P=0.008). The incidence of diarrhea in low efficacy group, moderate efficacy group and high efficacy group was 7.1% (11/155), 4.0% (16/403) and 2.8% (23/829) respectively, and the difference was statistically significant (χ(2)=7.239, P=0.027). Comparing the incidences of other types of complications, no statistically significant differences were found (all P>0.05). Follow up began 8 weeks after the FMT treatment. The total follow-up rate was 83.6% (1160/1387). The overall effective rate 58.3% (676/1160). Effective rates of various diseases were as follows: chronic constipation 54.3% (328/604), chronic diarrhea 88.5% (115/130), IBD 56.1% (55/98), IBS 55.1% (59/107), autism 61.6% (45/73), and other diseases 50.0% (74/148). Comparing the effective rate of three groups of donors for different diseases, there was no statistically significant difference in chronic diarrhea (P>0.05); there was a positive correlation trend in IBD, IBS and autism, but the differences were not statistically significant (all P>0.05). For chronic constipation and other diseases, high efficacy group had the highest effective rate [65.0% (243/374) and 63.2% (55/87)], followed by moderate efficacy group [49.4% (86/174) and 38.1% (16/42)], and low efficacy group had the lowest [16.1% (9/56) and 15.8% (3/19)], whose differences were significant (all P<0.05). Conclusions: Different donors have different efficacy in different diseases. Chronic constipation, radiation bowel injury, etc. need to choose donors with high efficacy. IBD, IBS and autism may also be related to the effectiveness of donors, while chronic diarrhea is not associated to the donor. The efficiency of the donor is negatively correlated to the morbidity of complications. The abundance and diversity of intestinal flora and the content of butyric acid may affect the efficacy of the donor.

To explore the effectiveness related indicators which might help identify the indications of Tongxinluo Capsule () and Kangxin Capsule () targeting on qi deficiency and blood stasis pattern in Chinese medicine (CM) in the treatment of angina pectoris. The data from a multicenter, randomized and double-blinded study conducted at 5 centers in China were obtained for the analysis. A total of 239 patients with angina pectoris and CM syndrome of qi deficiency and blood stasis were randomly assigned in a 1:1 ratio to Tongxinluo Capsule group (119 cases) and Kangxin Capsule group (120 cases). Angina effectiveness and electrocardiogram (ECG) improvement were selected as the therapeutic outcomes. After a 4-week treatment, the effective rates of Tongxinluo Capsule and Kangxin Capsule were 43.70% and 25.00%, respectively (P <0.05). Serum low-density lipoprotein (LDL) level was found to influence the effectiveness of Tongxinluo Capsule which had higher effective rate in the patients with lower level of LDL. Heart rate was found to influence the effectiveness in the patients treated with Kangxin Capsule which had higher effective rate in the patients with heart rate [Symbol: see text]80 beats/min. LDL level and heart rate were the indicators which help indentify the indications of Tongxinluo Capsule and Kangxin Capsule, respectively, in the treatment of angina pectoris with CM syndrome of qi deficiency and blood stasis.

Pharmacists' Role in Depression Care: A Survey of Attitudes, Current Practices, and Barriers

Pharmacists may be well placed to take up a role in depression care, complementing the role of general practitioners. However, depression care is a relatively new role for pharmacists, and little is known of their attitudes, current practices, and barriers toward it. A random sample of 200 community pharmacists in Belgium was surveyed about the care of patients with depression in comparison with patients with other, physical conditions. The 69 pharmacists who responded to the survey generally endorsed a very positive attitude toward their potential role in depression care. This willingness was, however, not reflected in current practice, and fulfilling this role appeared to be more difficult with patients with depression in comparison with patients with other, physical conditions. A lack of training in mental health issues was the most important barrier reported. Cooperation with general practitioners in depression care was desired, but the current level of cooperation was rather low. For pharmacists to effectively take up depression care, perceived barriers need to be addressed through specific training programs and increased cooperation with general practitioners.

Current literature yields mixed results about the effectiveness of relationship education (RE) with low-income participants and those who experience a high level of individual or relational distress. Scholars have called for research that examines whether initial levels of distress act as a moderator of RE outcomes. To test whether initial levels of relationship and/or individual distress moderate the effectiveness of RE, this study used two samples, one of couples who received couple-oriented relationship education with their partner (n=192 couples) and one of individuals in a relationship who received individual-oriented RE by themselves (n=60 individuals). We delivered RE in a community-based setting serving primarily low-income participants. For those attending with a partner, there was a significant interaction between gender, initial distress, and time. Findings indicate that women who were relationally distressed before RE reported the largest pre-postgains. Those who attended an individual-oriented RE program reported significant decreases in individual distress from pre to post, but no significant relationship gains. Findings also suggest that initial levels of distress did not moderate the effectiveness of individual-oriented RE.

Objective To investigate the clinical efficacy and adverse reactions of glycyrrhizin combined with methylprednisolone for Henoch-Schonlein purpura in pediatric patients.Methods 62 pediatric patients with Henoch-Schonlein purpura hospitalized into our hospital from March to December,2012 were randomly divided into a treatment group and a control group,31 for each group.The treatment group were treated methylprednisolone with 10 mg/ (kg · d) and glycyrrhizin 1-2 mg/ (kg · d),while the control group with only methylprednisolone 10 mg/(kg · d).The curative effects,the incidence of adverse reactions,and the recurrence rate were recorded in both groups.Statistical analysis was performed using t test and x2 test; and P ＜ 0.05 was considered statistically significant.Results In the treatment group,the total effective rate was 93.55％,the markedly effective rate was 80.65％,the incidence of adverse reactions was 6.45％,and the three-month recurrence rate was 12.90％; while in the control group,the total effective rate was 90.32％,the markedly effective rate was 58.06％,the incidence of adverse reactions was 15.63％,and the three-month recurrence rate was 16.13％.Compared with the control group,the treatment group has a significantly higher markedly effective rate(P ＜ 0.05) and significantly lower incidence of adverse reactions(P ＜ 0.05),but had no significant difference in the three-month recurrence rate(P ＞ 0.05).Conclusions Glycyrrhizin combined with methylprednisolone for pediatric patients with Henoch-Schonlein purpura have a high effective rate and low incidence of adverse reactons; however,it has no significant effect in reducing the patients' three-month recurrence rate. Key words: Henoch-Schonlein purpura; Methylprednisolone; Glycyrrhizin

Effective marginal tax rates are of interest to policymakers due to the concern that high rates lead to disincentives to work, particularly for secondary earners in couple families and single parents who pay personal income tax and lose government welfare payments as their private income increases. Hypothetical models of the tax and welfare system demonstrate the possibility of high effective marginal tax rates particularly for secondary earners in lower income families where personal income tax intersects with the loss of means‐tested welfare payment. This paper estimates effective marginal tax rates across the whole working‐age population, rather than for hypothetical families, using a microsimulation model based on a nationally representative sample of Australians. These distributional estimates suggest that high and very high effective marginal tax rates are relatively rare and that most persons of a working‐age face rates that are relatively modest. The paper extends previous work on distributional effective marginal tax rates to include the impact of formal childcare and the higher education loan program.