THE ADD-ADHD DILEMMA ADD? ADHD? A student in my "regular" junior English class, Joseph was tall, thin, quiet and very well- mannered, with a string of good's following his name—good attendance, motivation, attitude, cooperation, peer acceptance. But his spelling was atrocious and from his first writing sample I realized that Joseph was severely dyslexic. He did write in his jo
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Aszah12816_pwahlqvistResolution of Upper Gastrointestinal Symptoms
Associated With Chronic Non-Steroidal
Anti-Inflammatory Drug Therapy has a Positive Impact
on Patient-Reported Productivity
Peter Wahlqvist,1 Klas Bergenheim,1 Göran Långström,1 Jørgen Næsdal1
1Clinical Science, AstraZeneca, Mölndal, Sweden Table 1. Productivity results for all patients at baseline and for responders/non-responders at follow-up after 2 or 4 weeks
(4-week data used for non-responders at 2 weeks)
Results from this exploratory study
indicate that successful treatment of
upper gastrointestinal symptoms in
chronic NSAID users has a significantly
positive impact on their ability to work
and carry out daily activities.
#Hours lost due to reduced productivity while at work = number of hours actually worked multiplied by per cent of reduced It is estimated that 20–35% of patients using NSAIDs, including COX-2 selective NSAIDs, A recent international, placebo-controlled percentage by which productivity is reduced while performing regular daily activities other efficacy of 4 weeks’ esomeprazole treatment in upper abdominal pain, discomfort or burning) Quality of Life in Reflux and Dyspepsia
associated with continuous COX-2-selective QOLRAD is a disease-specific questionnaire and non-selective NSAID use in a non-ulcer statistically significant and relatively high upper GI symptoms on quality of life (QoL) (range: 0.4–0.6), supporting the validity of during the previous week, in which 25 items combine into 5 dimensions: Sleep disturbance, Furthermore, a relationship was established To explore the impact of upper GI symptoms, Food and drink problems, Emotional distress, between reduced productivity variables and in chronic NSAID users, on the ability to work Vitality, and Physical/social functioning.
GI symptoms (GSRS dimensions and upper GI Gastrointestinal Symptom Rating Scale
symptom diary data), the strongest being withthe GSRS dimension Abdominal pain.
GSRS is a scale for assessing GI symptomsduring the previous week, in which 15 items A productivity questionnaire was given to all Table 2. Change score correlations between baseline
the Swedish patients (n=77) participating in and 4 weeks (2-week data used when 4-week data
were missing); Pearson correlation coefficients
non-responders after 2 or 4 weeks’ treatment were identified by use of upper GI symptom productivity,
diaries (primary measure in clinical study).
Responders were defined as having a reduction Evaluable productivity data were obtained QOLRAD dimensions
from 61 patients (mean age 54 [range 20–78] mild symptoms, on a 7-grade Likert scale, years; 41 responders, 20 non-responders) of which 27 patients (44%; 14 responders, Results were calculated for responders and non-responders irrespective of treatment.
treatment (baseline), patients reported an Other patient-reported instruments in the study included the Quality of Life in Reflux GSRS dimensions
(per patient, per week); a reduction in work Productivity questionnaire
A Work Productivity and Activity Impairment (WPAI) questionnaire, previously used and Upper GI symptoms
validated in patients with gastroesophageal from work, 12 percentage units for reduced Abbreviations: GI = gastrointestinal; GSRS = Gastrointestinal reflux disease,4 was modified to assess the Symptom Rating Scale; QOLRAD = Quality of Life in Reflux work productivity and 16 percentage units impact of upper GI symptoms on productivity and Dyspepsia. *p<0.05; **p<0.01.
for reduced productivity in activities.
during the previous week. The questionnairecontains three questions relating to work time: On a weekly basis, therefore, results imply that treatment success is associated with an 5. REFERENCES
avoidable loss of work productivity of around 1. Langman MJ, et al. JAMA 1999; 282: 1929–33 other reasons; and hours actually worked.
2. Buttgereit F, et al. Am J Med 2001; 110 (Suppl 3A): 13S–9S There are two questions regarding reduced 0.7 hours are due to absence from work and 3. Yeomans N, et al. Gastroenterology 2003; 124(Suppl 1): A107 4. Wahlqvist P, et al. Value Health 2002; 5: 106–13 productivity: one relates to the percentage by 5. Wiklund I, et al. Eur J Surg 1998; 164(Suppl 583): 41–9 which productivity at work is reduced due to 6. Revicki DA, et al. Qual Life Res 1998; 7: 75–83 Supported by a grant from AstraZeneca R&D, MöIndal, Sweden
No Med, No Ed? BY PERRY A. ZIRKEL I N APRIL 1997, a first-grade teacher in ing more to offer Michael and that a differ- In March 2000, the psychiatric evalua- Millbrook, New York, a small town east ent placement was probably the best solu- tion report was issued, concluding that Pax-of Poughkeepsie, filled out an ADHD tion. However, the parents rejected the dis- il had induced the psycho