Side Benefits Research Articles

A Qualitative Research Study to Understand Post-Transfusion Well-Being in Patients with Myelodysplastic Syndromes

INTRODUCTION Patients with myelodysplastic syndrome (MDS) frequently receive red blood cell (RBC) transfusions to alleviate symptoms of fatigue and improve well-being, yet their experiences of transfusion have not been previously characterized. The aim of this qualitative study was to explore the changes in well-being that patients with MDS experience with RBC transfusion and hence, to inform the selection of Quality of Life (QoL) tools for future studies in this transfused patient population.METHODS: An applied qualitative approach was used for the study. Adult patients with MDS receiving chronic RBC transfusions at two hematology/oncology outpatient clinics between August 1, 2013 and March 31, 2014 were invited to participate in a 10-20 minute semi-structured interview. Patients were excluded if they could not provide informed consent. Interviews elicited information pertaining to: side effects and benefits of transfusion therapy; the patient's experience of anemia and fatigue prior to, during, and after transfusion; and the impact of transfusion on their QoL. Interviews were recorded, transcribed, and analyzed using QSR's NVivo 10 software. Standard techniques of qualitative content analysis were used. Two researchers independently reviewed all transcripts to identify and develop codes to categorize information from the interviews. The coding scheme was applied to the interview information, compared for agreement with discrepancies resolved and refined using consensus. The final version of the coding scheme was applied to all transcripts by one researcher. Informational content of the data within each code were reviewed and interpreted to form summative statements. Statements were grouped, organized and summarized under 3 major themes: participant experience of fatigue, impact of RBC transfusion, and side effects of transfusion. The study was approved by the local research ethics board and informed consent was obtained from all participants.RESULTS: 12/16 (75%) of patients approached consented to participant in the study (median age: 77; IQR, 72, 80 years; 2 female). Participant experience of fatigue: All participants reported experiencing fatigue, which significantly impacted their activities of daily living. Severity of fatigue prior to transfusion varied between participants, and for two participants' levels of fatigue also varied between transfusions. Impact of RBC transfusion: Time to recovery from fatigue varied between participants, ranging an improvement noted during the transfusion to 24 hours post-transfusion. Although transfusion did not alleviate symptoms of fatigue completely, participants reported improved appetite and decreased lethargy. One participant reported having a better frame of mind post-transfusion. Effect of transfusion on symptom relief varied between participants, ranging from several days to three weeks. Side effects of transfusion: Four participants reported side effects accompanying some transfusions, which included: confusion described as "heaviness in the head", headache, rise in temperature, itchiness/rash, epistaxis, and/or lightheadedness. Side effects were short-lived and not severe. In addition to the patient derived findings reported above, we identified 4 challenges to performing this qualitative study in the MDS population: MDS affects an aging population with several comorbidities, which may further compromise well-being; patients live sedentary lifestyles, which may impede their ability to assess subtle changes in well-being; caregiver presence during the interview can impact the patient perspective; and, the timing of interviews can affect the quality of data depending on the participant's level of fatigue.CONCLUSION: Results of this study reveal that the experiences of patients who receive RBC transfusion are diverse and are not consistent between consecutive transfusion episodes. Considering the findings, an appropriate QoL tool for use in this population should be short and quick to complete, disease specific, have an emphasis on fatigue and should have a short recall period to capture transient changes in well-being. DisclosuresLeber:Celgene Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees.

Rooting Out Corruption or Rooting for Corruption? The Heterogeneous Electoral Consequences of Scandals

Corruption scandals have been found to have significant but mild electoral effects in the comparative literature (Golden 2006). However, most studies have assumed that voters punish all kinds of illegal practices. This article challenges this assumption by distinguishing between two types of corruption, according to the type of welfare consequences they have for the constituency. This hypothesis is tested using data from the 2011 Spanish local elections. We exploit the abundance of corruption allegations associated with the Spanish housing boom, which generated income gains for a wide segment of the electorate in the short term. We find that voters ignore corruption when there are side benefits to it, and that punishment is only administered in those cases in which they do not receive compensation.

In Praise of Faction: How Special Interests Benefit Constitutional Order

Political factions are rarely treated as normatively desirable entities in constitutional or international law. On the contrary, they are either are regarded as forces that thwart the general welfare or as sources of chronic political instability. In response, the conventional wisdom often focuses on how to deploy institutional or legal structures that minimize the influence of faction. By contrast, this Essay argues that the institutions of constitutional and international law that are forged by self-interested factions can create significant side benefits for the rest of the society. At bottom, such institutions are likely to be more durable and energetic than those created by disinterested or high-minded social designers. Thus, rather than focus on trying to curtail the influence of faction in shaping political institutions, it may make more sense to broaden the scope of such influence to be as inclusive as possible.

Resident Evaluation of a Required Telepsychiatry Clinical Experience.

The authors explored resident experiences of telepsychiatry clinical training. This paper describes an analysis of evaluation forms completed by psychiatry residents following a required training experience in telepsychiatry. Retrospective numeric and narrative data were collected from 2005 to 2012. Using a five-point Likert-type scale (1 = strongly disagree and 5 = strongly agree), residents ranked the session based on the following characteristics: the overall experience, interest in participating in telepsychiatry in the future, understanding service provision to underserved areas, telepsychiatry as mode of service delivery, and the unique aspects of telepsychiatry work. The authors also conducted a content analysis of narrative comments in response to open-ended questions about the positive and negative aspects of the training experience. In all, 88% of residents completed (n = 335) an anonymous evaluation following their participation in telepsychiatry consultation sessions. Numeric results were mostly positive and indicated that the experience was interesting and enjoyable, enhanced interest in participating in telepsychiatry in the future, and increased understanding of providing psychiatric services to underserved communities. Narrative data demonstrated that the most valuable aspects of training included the knowledge acquired in terms of establishing rapport and engaging with patients, using the technology, working collaboratively, identifying different approaches used, and awareness of the complexity of cases. Resident desire for more training of this nature was prevalent, specifically a wish for more detail, additional time for discussion and debriefing, and further explanation of the unique aspects of telepsychiatry as mode of delivery. More evaluation of telepsychiatry training, elective or required, is needed. The context of this training offered potential side benefits of learning about interprofessional and collaborative care for the underserved.

Analisis Keberterimaan Pengguna terhadap Aplikasi Sistem Manajemen Operasi Irigasi menggunakan Technology Acceptance Model (Studi Kasus Daerah Irigasi Boro, Purworejo)

Aplikasi Sistem Manajemen Operasi Irigasi (SMOI) merupakan sebuah aplikasi sistem operasi irigasi yang dikembangkan oleh Balai Irigasi. SMOI dikembangkan sebagai aplikasi berbasis website yang mengedepankan konsep paperless atau menggantikan peran kertas dalam operasi irigasi. SMOI didesain untuk mampu melakukan proses pengiriman data operasi irigasi secara otomatis dengan memanfaatkan jaringan komunikasi layanan internet. Metodologi yang digunakan untuk megetahui tingkat kebeterimaan pengguna atas aplikasi ini menggunakan metode Technology Acceptance Model (TAM) dengan melakukan pengambilan data tentang tingkat keberterimaan penggunaan aplikasi pada suatu populasi di Daerah Irigasi Boro, Purworejo melalui pengisian kuesioner. Selanjutnya data dianalisis secara statistik untuk mendapatkan tingkat keberterimaan pengelola irigasi setempat. Sebanyak 78,6% responden menjawab setuju terhadap Variabel Kemudahan dengan tingkat signifikansi sebesar 0,79. Hal ini menunjukkan bahwa Variabel kemudahan memiliki pengaruh terhadap sikap pengguna SMOI. Sedangkan sebanyak 82,2% responden menjawab setuju terhadap Variabel Manfaat dengan tingkat signifikansi 0,044. Hal ini menunjukkan bahwa dari sisi manfaat, SMOI lebih mempengaruhi pengelola irigasi untuk mengunakannya dibandingkan dari sisi kemudahan.

Diagnosis, pathophysiology and management of premenstrual syndrome

Key content An overview of current information available on premenstrual syndrome (PMS), which is in accordance with the new RCOG Green‐top Guideline. Definition of PMS and explanation about the different types of premenstrual disorders. How to accurately diagnose PMS. Discussion about various treatment options available in accordance with the current literature. Learning objectives Develop an understanding of the pathophysiology behind PMS. How to diagnose PMS accurately and understand the different classifications of PMS. How to treat PMS, including the different treatment options available and discussion about side effects and benefits. Ethical issues Discussion about the long‐term risks of GnRH analogue use, and the impact of long‐term estrogen deficiency following a bilateral salpingoophorectomy. Misdiagnosed PMS in patients with underlying psychiatric and medical conditions.

Diet Modification for Overactive Bladder: an Evidence-Based Review

Overactive bladder (OAB) is a clinical diagnosis defined by the presence of urinary urgency with or without urgency urinary incontinence (UUI) and is often associated with frequency and nocturia. First-line treatment for OAB is behavioral and dietary modifications because they have minimal side effects and high potential benefits. There is evidence that diet can have a significant effect on the symptoms of OAB. This has led to increasing interest in characterizing the effect of specific dietary changes on OAB prevalence and severity. The aim of this paper is to review the specific nutritional factors that have been found to be associated with OAB and describe the relationship between OAB and diet-related medical conditions such as obesity and insulin resistance.

Pedunculopontine Nucleus Stimulation: Where are We Now and What Needs to be Done to Move the Field Forward?

Falls and gait impairment in Parkinson’s Disease (PD) is a leading cause of morbidity and mortality, significantly impacting quality of life and contributing heavily to disability. Thus far axial symptoms, such as postural instability and gait freezing, have been refractory to current treatment approaches and remain a critical unmet need. There has been increased excitement surrounding the surgical targeting of the pedunculopontine nucleus (PPN) for addressing axial symptoms in PD. The PPN and cuneate nucleus comprise the mesencephalic locomotor region, and electrophysiologic studies in animal models and human imaging studies have revealed a key role for the PPN in gait and postural control, underscoring a potential role for DBS surgery. Previous limited studies of PPN deep brain stimulation (DBS) in treating gait symptoms have had mixed clinical outcomes, likely reflect targeting variability and the inherent challenges of targeting a small brainstem structure that is both anatomically and neurochemically heterogeneous. Diffusion tractography shows promise for more accurate targeting and standardization of results. Due to the limited experience with PPN DBS, several unresolved questions remain about targeting and programing. At present, it is unclear if there is incremental benefit with bilateral versus unilateral targeting of PPN or whether PPN targeting should be performed as an adjunct to one of the more traditional targets. The PPN also modulates non-motor functions including REM sleep, cognition, mood, attention, arousal, and these observations will require long-term monitoring to fully characterize potential side effects and benefits. Surgical targeting of the PPN is feasible and shows promise for addressing axial symptoms in PD but may require further refinements in targeting, improved imaging, and better lead design to fully realize benefits. This review summarizes the current knowledge of PPN as a DBS target and areas that need to be addressed to advance the field.

Complementary medicine and primary dysmenorrhea

Primary Dysmenorrhea and Complementary Medicine Ataollahi , M¹; Amir AliAkbari, S*² - Alumnus, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran . (-Lecturer, Dept. of Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Abstract Background and objective: Dysmenorrhea is one of the most common gynecological complaints of women which interfers with daily activities and causes missing work and school. Complementary therapy is a safe , and reliable treatment for primary dysmenorrhea that its effectiveness has been showen in many studies. Considering the prevalence of primary dysmenorrhea and harmful side effects of some synthetic drugs, the present study aims to summarize the effect of complementary medicine on primary dysmenorrhea. Materials and Methods: A search for English and Persian literature published from (000 to (01 was conducted using key words : dysmenorrhea-primary dysmenorrhea ,complementary therpy and nonpharmachologic tetherapy from databases Pubmed, SID, Scirus and Elsevier .A total number of 30 publications were included in the review. Results: Complementary medicine includes the use of dietary supplements, vitamins, aroma therapy, herbal therapy, homeopathy, acupressure, sport and massage and is safe, affordable, and accessible. It has less side effects, acceptability and high tolerability and can replace highly morbid chemical agents. Conclusions: based on the findings of the present research and the high prevalence of dysmenorrhea, further studies on the side effects and benefits of complementary medicine and comparing the influence of complementary medicine with chemical drugs is mandatory. Keywords: primary dysmenorrhea, complementary medicine, herbs, pain reduction. *Corresponding Author: Sedigheh, Amir AliAkbari. Lecturer, Dept. of Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: asa_akbari@yahoo.com

Neural estimation of strong ground motion duration

This paper presents and discusses the use of neural networks to determine strong ground motion duration. Accelerometric data recorded in the Mexican cities of Puebla and Oaxaca are used to develop a neural model that predicts this duration in terms of the magnitude, epicenter distance, focal depth, soil characterization and azimuth. According to the above the neural model considers the effect of the seismogenic zone and the contribution of soil type to the duration of strong ground motion. The final scheme permits a direct estimation of the duration since it requires easy-to-obtain variables and does not have restrictive hypothesis. The results presented in this paper indicate that the soft computing alternative, via the neural model, is a reliable recording-based approach to explore and to quantify the effect of seismic and site conditions on duration estimation. An essential and significant aspect of this new model is that, while being extremely simple, it also provides estimates of strong ground motions duration with remarkable accuracy. Additional but important side benefits arising from the model’s simplicity are the natural separation of source, path, and site effects and the accompanying computational efficiency.

Characteristics, perceived side effects and benefits of electronic cigarette use: a worldwide survey of more than 19,000 consumers.

Background: Electronic cigarette (EC) use has grown exponentially over the past few years. The purpose of this survey was to assess the characteristics and experiences of a large sample of EC users and examine the differences between those who partially and completely substituted smoking with EC use. Methods: A questionnaire was prepared, translated into 10 different languages and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers. Results: In total, 19,414 participants were included in the analysis, with 88 of them (0.5%) reported not being smokers at the time of EC use initiation. Complete substitution of smoking was reported by 81.0% of participants (former smokers) while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. They were using ECs for a median of 10 months. They initiated EC use with a median of 18 mg/mL nicotine-concentration liquids; 21.5% used higher than 20 mg/mL. Only 3.5% of participants were using 0-nicotine liquids at the time of the survey. Former smokers were highly dependent (Fagerström Test for Cigarette Dependence = 7) and were heavier smokers (21 cigarettes per day when smoking) compared to current smokers. The most important reasons for initiating EC use for both subgroups was to reduce the harm associated with smoking and to reduce exposure of family members to second-hand smoking. Most considered ECs as less harmful than tobacco cigarettes, while 11.0% considered them absolutely harmless. Side effects were reported by more than half of the participants (59.8%), with the most common being sore/dry mouth and throat; side effects were mild and in most cases were subsequently resolved (partially or completely). Participants experienced significant benefits in physical status and improvements in pre-existing disease conditions (including respiratory disease such as asthma and chronic obstructive lung disease). Being former smoker was independently associated with positive effects in health and improvements in disease conditions. Conclusions: The results of this worldwide survey of dedicated users indicate that ECs are mostly used to avoid the harm associated with smoking. They can be effective even in highly-dependent smokers and are used as long-term substitutes for smoking. High levels of nicotine are used at initiation; subsequently, users try to reduce nicotine consumption, with only a small minority using non-nicotine liquids. Side effects are minor and health benefits are substantial, especially for those who completely substitute smoking with EC use. Further population and interventional studies are warranted.

Competency-Based Education: Milestones or Millstones1?

In the past decade, there has been increasing interest in competency-based education (CBE), the notion that an expert physician is defined by a broad set of identified competencies. The idea has been advanced, nearly simultaneously, in several countries—Canada (CanMEDS roles),1 the United States (Accreditation Council for Graduate Medical Education [ACGME] competencies),2 the United Kingdom (Tomorrow's Doctor),3 and Scotland (the Scottish Doctor)4—and adopted by others. CanMEDS competencies have been adopted and adapted by 16 countries, including the Netherlands, Denmark, and Mexico.5 Moreover, the Carnegie Foundation's influential Flexner centenary strongly recommended adopting CBE and made the claim that “Adoption of OBE [outcome-based or competency-based education] would better equip medical graduates to respond effectively in complex situations and efficiently continue to expand the depth and breadth of the requisite competencies.”,6,7 Similar promises emerge from many of these foundational documents. Harden8(p666) ascribes a number of advantages to OBE/CBE: OBE is a sophisticated strategy for curriculum planning that offers a number of advantages. It is an intuitive approach that engages the range of stakeholders . . . it encourages a student-centred approach and at the same time supports the trend for greater accountability and quality assurance . . . [it] highlights areas in the curriculum which may be neglected . . . such as ethics and attitudes . . .. Regrettably, these declarations appear to be more a matter of faith than of evidence. The primary intent of CBE is, we believe, transparency, so that the profession and the public can be confident that a training program is producing competent physicians who are equipped with the knowledge and skills for practice. It is hard to challenge that premise; the issue is whether the proposed mechanisms can deliver on the promise. A corollary common to both CBE and its predecessor—behavioral objectives—is the notion that different learners will achieve different competencies at different rates, so that residents may be certified competent in starting an intravenous line early in their career but may take longer to achieve competency in intubation. The individual need not take additional time practicing skills for which he or she is competent and can, therefore, learn more efficiently by focusing on those skills for which competence has not yet been achieved. An extrapolation of that notion is that some residents may well achieve all the competencies available on a particular rotation earlier or later than others, and so, can progress through graduate medical education (GME) at a different pace. Whether the approach can be operationalized satisfactorily at the level of precision required to implement CBE, the fact remains that it may have positive side benefits, such as increased observations of residents, greater attention to the GME curriculum, and so forth. To ensure that those goals are met and the implementation of CBE is not sidelined by a ponderous administrative superstructure, this editorial is intended to elaborate potential problems at 3 levels: conceptual, psychometric, and logistic.

Creating a compelling business case for employers; psychosocial benefit for mature workers

Twenty years ago, those of us in the allied health field were trained to believe that mature people didn't lodge workers’ compensation claims and mature workers didn't have injuries because they ‘knew their work environment so well’. Only 7 years ago, insurers believed that their book of claims in Workers’ Compensation had no age related correlation to claims costs. We now know that all of these assumptions do not stand up in relation to the current workforce in Australia and we are building a wealth of knowledge about the mature cohort in today's workforce.This presentation will guide the audience through the process of developing a compelling business case to assist employers understand the cost benefit of proactively engaging with their mature employees and the benefits for both the workers over fifty five years of age and businesses in Australia.In developing a business case, the first stage of a strategy is being formulated for the care and well-being of mature workers, this leads to preparedness for effective return to work measures in the event of injury and health maintenance strategies for mature workers. The side benefits to a business are vast; from reduced turnover and associated costs, the retention of knowledge to reduced insurance costs and productivity benefits.Five years of analytical data will be presented to demonstrate the trending, the influences and precautionary tales for those committed to the psychological well-being of the mature workforce in Australia.

Greenhouses and their humanizing synergies

Greenhouses in space will require advanced technical systems of automatic watering, soil-less cultivation, artificial lighting, and computerized observation of plants. Functions discussed for plants in space habitats include physical/health requirements and human psychology, social cohesion, as well as the complex sensorial benefits of plants for humans. The authors consider the role of plants in long-term space missions historically since 1971 (Salyut 1) and propose a set of priorities to be considered within the design requirements for greenhouses and constructed environments given a range of benefits associated with plant–human relationships. They cite recent research into the use of greenhouses in extreme environments to reveal the relative importance of greenhouses for people living in isolated locations. Additionally, they put forward hypotheses about where greenhouses might factor into several strata of human health. In a recent design-in-use study of astronauts' experiences in space habitats discussed in Architecture for Astronauts (Springer Press 2011) it was found that besides the basic advantages for life support there are clearly additional “side benefits” for habitability and physical wellbeing, and thus long-term mission success. The authors have composed several key theses regarding the need to promote plant–human relationships in space, including areas where synergy and symbiosis occur. They cite new comprehensive research into the early US Space Program to reveal where programmatic requirements could be added to space architecture to increase the less quantifiable benefits to astronauts of art, recreation, and poetic engagement with their existential condition of estrangement from the planet. Specifically in terms of the technological requirements, the authors propose the integration of a new greenhouse subsystem component into space greenhouses—the Mobile Plant Cultivation Subsystem—a portable, personal greenhouse that can be integrated functionally into future greenhouse constructions in space.

Determinants of contraceptive choice among Japanese women: ten years after the pill approval

The Japanese government approved the use of oral contraception (OC) in 1999, but OC users remain a small minority in Japan. Using the results of an online survey conducted in 2010, I examine the factors determining Japanese women’s choice of contraceptive method by estimating multinomial choice models. The estimation results indicate that OC use is positively associated with age, willingness to pay for contraceptive effectiveness, frequency of intercourse and experience with abortion or emergency contraception. These findings suggest that OC use increases as women learn from experience and that the low and declining frequency of intercourse in Japan offers one explanation for the slow diffusion of OC. Additionally, the findings indicate that OC use is more prevalent among women with a higher risk of unintended pregnancies. Subjective probabilities regarding each contraceptive method’s contraceptive effectiveness, disruption of romantic moods, partner disapproval, side benefits and minor, non-life-threatening side effects are important determinants of contraceptive choice. The perceived risk levels of OC side effects are significantly higher than the population-based probabilities, implying that increased medical knowledge might increase OC use.

Stress-testing macro stress testing: Does it live up to expectations?

We critically review the state of the art in macro stress testing, assessing its strengths and weaknesses. We argue that, given current technology, macro stress tests are ill-suited as early warning devices, i.e. as tools for identifying vulnerabilities during seemingly tranquil times and for triggering remedial action. By contrast, as long as properly designed, stress tests can be quite effective as crisis management and resolution tools. We also see additional side benefits, stemming largely from the way such tests can discipline thinking about financial stability. We suggest possible ways to improve their performance.

Patient perceptions about potential side effects and benefits from chemotherapy agents.

6595 Background: Little is known about how breast cancer patients (pts) perceive the relative side effects and benefits of different chemotherapy (CT) agents. The objective of this study was to better understand these preferences in pts receiving CT at a Canadian cancer center. Methods: Pts completed a Web survey. Grade I/II (mild to moderate) and III/IV (moderate to severe) descriptions of 9 common CT side effects were assigned preferences by: conjoint and standard gamble (SG). Conjoint involved making trade-offs among different risks of side effects, yielding preferences (utilities) for each side effect. SG involved choosing to stay in a selected side effect state or taking a gamble between full health (probability p) or being dead (1-p). For each side effect, p was varied until the patient was indifferent of the side effect. Pts were also asked to rate how much of detriment in quality of life they would endure for benefits in survival. Results: 102 women participated, mean age 54 + 11, stage 1 (21%), 2 (24%), 3 (38%) and 4 (18%). Among the grade I/II side effects, a 5% reduction in risk of sensory neuropathy, nausea, and motor neuropathy had the highest impact on preferences. Among grade III/IV side effects, motor neuropathy, nausea/vomiting, and mucositis made the most difference. SG preferences for side effects were lowest (i.e. least preferred) for grade III/IV nausea (0.624) followed by diarrhea (0.633), hand-foot syndrome (0.681), and highest for grade I/II sensory neuropathy (0.757), mucositis (0.756), and myalgia (0.750). Agree/disagree items revealed patients are willing to endure quality of life detriments for improvement in survival; this willingness increased as disease stage increased (p=0.01). Conclusions: Relatively small changes in the risks of some CT side effects may have substantial impacts on pt treatment preferences. Nevertheless, pts will endure significant toxicity for a potential gain in survival. The standard gamble utilities from this population may also be used to quality-adjust life expectancy in cost-effectiveness evaluations of breast cancer chemotherapies.

Predictors of statin adherence, switching, and discontinuation in the USAGE survey: Understanding the use of statins in America and gaps in patient education

Although statins have been shown to reduce cardiovascular disease mortality, less than half of U.S. adults achieve their low-density lipoprotein cholesterol goal. In many patients initiated on a statin, adherence rates decrease over time. To characterize current and former statin users, identify reasons for the discontinuation or switching of statins, and identify factors associated with adherence. The USAGE survey is a cross-sectional, self-administered Internet-based survey of 10,138 U.S. adults fielded September to October 2011. The following statin users were identified and compared: adherent nonswitchers, adherent switchers, non-adherent switchers, and discontinuers. Univariate and multivariate models using a priori covariates for adherence and discontinuation were examined. Most participants were current statin users who adhered with their prescribed statin (82.5%, n = 8371). Former statin users or discontinuers (12%, n = 1220) cited muscle pain, a side effect, as the primary reason for discontinuation (60%), followed by cost (16%), and then perceived lack of efficacy (13%). Discontinuers were less satisfied with their physicians' explanation of cholesterol treatment, more likely to use the Internet to research statins, and less likely to undergo frequent cholesterol monitoring. Among adherent statin users, the primary reasons for switching were muscle side effects (33%) and cost (32%). Individuals at risk for non-adherence included those with low household income, those who experienced muscle pain as a side effect while on statin therapy, and those taking medication for cardiovascular disease. Statin-related muscle side effects are common and contribute significantly to rates of discontinuation, switching, and non-adherence. Improved physician patient communication about side effects and benefits of statins are necessary to improve both adherence and outcomes.

Piracy in a two-sided software market

This paper studies the impact of software piracy in a two-sided-market setting. Software platforms attract developers and users to maximize their profits. The equilibrium price structure is affected by piracy: license fees to developers are higher with more software protection but the impact on user prices is ambiguous. A conflict between platforms and software developers over software protection may arise: whereas one side benefits from better protection, the other party loses out. Under platform compatibility, this conflict is no longer present.

Prescription of Testosterone-Lowering Medications for Sex Offender Treatment in German Forensic-Psychiatric Institutions

Different clinical guidelines suggest using testosterone-lowering medications (TLM) in sex offender treatment in addition to psychotherapy. Within Germany, there are two officially approved agents. So far, no current data exist about the routine use of TLM in a clinical context. The present observational study evaluates the frequency of the prescription of TLM and other medications in sex offender treatment in German forensic-psychiatric institutions. Experts are asked about the observed effects and side effects of TLM. The heads of all 69 German forensic-psychiatric hospitals and outpatient clinics were asked to fill out a questionnaire assessing offender characteristics and treatment methods in use. Main outcome measures were the number of patients being treated with TLM and other pharmacological agents for reducing sexual drive. Further effects and side effects of the agents were evaluated. Thirty-two participating institutions reported on 3,963 patients, 611 of them being sex offenders (15.4%). Most sex offenders had been convicted for child sexual abuse (39.8%) or a sexual assault/rape (37.6%). Almost all sex offenders were treated psychotherapeutically and 37% were receiving an additional pharmacological treatment. Of all the sex offenders, 15.7% were treated with TLM; 10.6% were treated with a gonadotropin-releasing hormone agonist; and 5.1% were treated with cyproterone acetate. Of these, 26.0-75.4% showed improvements in such outcomes as reduction of frequency and/or intensity of sexual thoughts. The remaining 21.3% of sex offenders who received a pharmacological agent were treated with selective serotonin reuptake inhibitors (11.5%) or antipsychotic medications (9.8%). TLM are a frequently used addition to psychotherapy in sex offenders. In light of the lack of controlled clinical trials and the many side effects, benefits and risks should always be thoroughly assessed.