Ágnes Mészáros

Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis

BACKGROUND In spite of the growing literature about adult attention-deficit hyperactivity disorder (ADHD), relatively little is known about the prevalence and correlates of this disorder. AIMS To estimate the prevalence of adult ADHD and to identify its demographic correlates using meta-regression analysis. METHOD We used the MEDLINE, PsycLit and EMBASE databases as well as hand-searching to find relevant publications. RESULTS The pooled prevalence of adult ADHD was 2.5% (95% CI 2.1-3.1). Gender and mean age, interacting with each other, were significantly related to prevalence of ADHD. Meta-regression analysis indicated that the proportion of participants with ADHD decreased with age when men and women were equally represented in the sample. CONCLUSIONS Prevalence of ADHD in adults declines with age in the general population. We think, however, that the unclear validity of DSM-IV diagnostic criteria for this condition can lead to reduced prevalence rates by underestimation of the prevalence of adult ADHD.

Attention deficit hyperactivity disorder (ADHD): gender- and age-related differences in neurocognition

BACKGROUND Despite the growing recognition that the clinical symptom characteristics associated with attention deficit hyperactivity disorder (ADHD) persist into adulthood in a high proportion of subjects, little is known about the persistence of neurocognitive deficits in ADHD. The objective was twofold: (1) to conduct a meta-analysis of neuropsychological studies to characterize attentional performance in subjects with adult ADHD by examining differences in ADHD versus normal control subjects; and (2) to investigate whether these differences vary as a function of age and gender. METHOD Twenty-five neuropsychological studies comparing subjects with adult ADHD and healthy controls were evaluated. Statistical effect size was determined to characterize the difference between ADHD and control subjects. Meta-regression analysis was applied to investigate whether the difference between ADHD and control subjects varied as a function of age and gender across studies. RESULTS Tests measuring focused and sustained attention yielded an effect size with medium to large magnitude whereas tests of simple attention resulted in a small to medium effect size in terms of poorer attention functioning of ADHD subjects versus controls. On some of the measures (e.g. Stroop interference), a lower level of attention functioning in the ADHD group versus the controls was associated with male gender. CONCLUSIONS Adult ADHD subjects display significantly poorer functioning versus healthy controls on complex but not on simple tasks of attention, and the degree of impairment varies with gender, with males displaying a higher level of impairment.

Pharmacotherapy of adult attention deficit hyperactivity disorder (ADHD): a meta-analysis

Our objective was to conduct a meta-analysis of therapeutic efficacy of pharmacological treatment of adult ADHD based on data from controlled clinical trials. We used the search engines PubMed and Medline to identify relevant clinical trials. Short-term studies with double-blind parallel-group design were selected for the analysis. Altogether, we identified 11 trials that met the criteria, and investigated a total of 1991 subjects, 694 and 1297 of whom were treated with placebo or active medication, respectively. In order to pool efficacy data from studies with different characteristics, including different number of participants, different trial duration and measures of efficacy, the statistical effect sizes for each study had to be calculated. Our findings showed that the pooled effect size across all treatments was in the medium-to-high range (Cohens d=0.65, p<0.0001 vs. placebo), and the effect size for stimulants (Cohens d=0.67, p<0.0001 vs. placebo) was somewhat higher than for non-stimulant medications (Cohens d=0.59, p<0.0001 vs. placebo). The current database of controlled trials for adult ADHD is relatively small, and does not include data for many of the potentially important agents. In addition, effect-size estimates for different classes of medications (i.e. stimulant and non-stimulant medications) were based on separate studies; head-to-head comparisons of various agents are severely lacking. Nonetheless, results of this meta-analysis across all ADHD medications in adult subjects demonstrated statistically significant and clinically robust improvement in symptom severity compared to placebo treatment.

Factors Associated with Medication Adherence in Patients with Chronic Obstructive Pulmonary Disease

Background: Predictors of medication adherence are not well known in chronic obstructive pulmonary disease (COPD). It is therefore necessary to identify factors associated with adherence to improve the effectiveness of COPD management within real-world situations. Objectives: The goals of this study were to estimate adherence to respiratory medication and to identify factors related to adherence in COPD patients. Methods: This was an observational, cross-sectional study conducted on a sample of COPD outpatients. The following information was obtained: adherence to respiratory therapy (Morisky Medication Adherence Scale), age, gender, smoking status, COPD severity [Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage], lung function [post-bronchodilator forced expiratory volume in 1 s (FEV1)], treatment regimen for COPD, COPD medication costs per month paid by the patient and health-related quality of life (EuroQol 5-dimension questionnaire). A multivariate logistic regression analysis was performed to identify the independent predictors of adherence. Results: Of the 170 participants (mean age 63.8 years, 41.8% male), 58.2% reported optimal adherence. Adherence to respiratory therapy was associated with age, current smoking status, number of respiratory drugs, number of daily respiratory drug doses and quality of life (p < 0.005). Adherence to respiratory therapy was not related to gender, GOLD stage, FEV1 or COPD medication costs. Conclusions: Adherence to COPD medication regimens is poor. Less frequent dosing regimens could be an effective method to enhance adherence to respiratory therapy. Quality-of-life monitoring within clinical practice settings could facilitate improved medication adherence.

Trends in the non-steroidal anti-inflammatory drug market in six Central–Eastern European countries based on retail information†

The objective of this study was to evaluate the non‐steroidal anti‐inflammatory drug market of six Central and Eastern European countries. Trends and similarities were compared across the examined countries.

Evaluation of asthma knowledge and quality of life in Hungarian asthmatics

Background:  The objective was to develop an educational instrument, to assess its impact as an intervention instrument and to examine quality of life (QoL).

Factorial design for the analysis of patient's quality of life in asthma.

Chronic diseases like asthma have a great impact on the everyday life of patients. Evaluation of a patient’s quality of life informs us about how the patient is feeling and whether or not he or she is able to function physically, socially and emotionally. The objectives of this study were to assess the quality of life of asthmatic patients and to study the influence of age and disease severity, as independent variables, on the patient’s quality of life. A 2-factor, 3-level face-centred central composite design was applied to construct a second-order polynomial model describing the effects of age and the severity on the quality of life. The second-order polynomial model was successfully applied to describe the effect of age and asthma severity with good correlation on the quality of life measured by either generic (Visual analogue scale) or disease specific (St George’s Respiratory Questionnaire) instruments in the examined subjects. Our findings suggest quality of life may be used as a non-invasive patient-centred monitoring system as a guide for disease management if measured regularly.

Economic evaluation of nonsteroidal anti-inflammatory drug strategies in rheumatoid arthritis

OBJECTIVES Although disease modifying antirheumatic drugs (DMARDs) are the first choice drugs in the treatment of rheumatoid arthritis, many patients still take nonsteroidal anti-inflammatory drugs (NSAIDs) as well. These drugs may cause serious gastric adverse events with continuous usage. Cyclooxygenase-2 (COX2) inhibitors were supposed to have a gastrointestinal (GI) friendly side effect profile. The aim of the study is to compare three therapeutic strategies: conventional NSAIDs, NSAID in combination with proton pump inhibitors (PPIs), and the selective COX2 inhibitor therapy (celecoxib). METHODS A decision tree model was developed, for 1 year, to simulate cohorts within the three arms (NSAIDs, NSAID + PPI, celecoxib). The efficacy of the different active agents of NSAIDs in therapeutically relevant doses was assumed to be the same, consequently differences can be seen in the side effect profile of the drugs. Medical costs, the costs of the side effects (GI, cardiovascular [CV] events), and quality-adjusted life-years (QALYs) were calculated to gain an incremental cost-effectiveness ratio (ICER). Evaluations were made from a third party payers perspective. We performed one-way deterministic sensitivity analyses; the results were displayed in tornado diagrams. RESULTS Our model indicates that NSAID + PPI offers extra health gain for extra costs compared with conventional NSAIDs (ICER:14,287 euro/QALY), while it dominates celecoxib because of celecoxibs higher costs and lower effectiveness. According to the sensitivity analyses, QALYs had the highest influence on ICER. CONCLUSIONS Although COX2 inhibitors have elevated GI efficacy compared with NSAIDs, celecoxib seems to be an adequate choice only for a limited group of patients with specific conditions because of the significantly higher price and CV risk profile.

Adherence to Therapy in Chronic Obstructive Pulmonary Disease

Non-adherence in COPD is common and poses a significant barrier to optimal disease management. According to the World Health Organization (WHO), adherence to long-term therapies averages only 50% (WHO, 2003). Patient adherence in chronic diseases can result in poor health outcomes and increased health-care expenditures (WHO, 2003). Discontinuation of COPD therapy contributes to increasing the frequency of exacerbations, the number of hospitalisations and the mortality rate (Bourbeau & Bartlett, 2008; Regueiro et al., 1998; Vestbo et al., 2011).

Cost of Tuberculosis in Childhood

Background: Cost of management of tuberculosis (TB) has high expenses from both patient and health insurance perspective. Methods: A systematic review on cost analysis of TB in children was executed in Ovid-MEDLINE for the period 1991-2011. Search terms were tuberculosis, cost and childhood. Review articles, commentaries, letters were excluded. Results: The first search resulted 156 articles, after linguistic and content screening 16 articles were considered for further analysis. The topics related to the cost-analysis were latent tuberculosis infection, BCG vaccination, cost-effectiveness of TB control program, TB screening, extrapulmonary TB, TB in resource rich and resource poor countries. Conclusion: After processing the results of the articles, it was identified that tuberculosis screening among schoolchildren and kindergarteners as well as BCG revaccination is not cost-effective in low-burden countries.