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Treatment thresholds and minimal clinically important effect sizes of antiosteoporotic medication
(2022)
Background
Patient decisions to take preventative treatments for osteoporosis depend on their perceptions of fracture risk, medication effect sizes (ES) of benefits and harms. However, physicians and lay persons may have differing perceptions of risks and medication efficacy. Both tend to overestimate medication benefits. This study surveyed at what risk physicians would prescribe and lay persons would be willing to take bisphosphonates, the minimum ES both groups do demand and the physicians estimates of the actual benefit of bisphosphonates.
Design
Cross-sectional online questionnaire survey.
Methods
Respondents were confronted with a case vignette with an osteoporotic patient (10-year femoral fracture risk: 32%). They were asked at what threshold of 10-year-risk of femoral neck fracture they would prescribe or take a drug. They were asked for the minimum ES (absolute risk reduction, ARR) they demand from bisphosphonates to prescribe or take them. Physicians were asked to provide their estimate of the actual ARR of bisphosphonates.
Results
114 physicians and 140 lay persons answered (convenience sample/snowball distribution). The 10-year-risk threshold of lay persons (Mdnlay = 60%) willing to take medication was twice as high as the physicians’ threshold (Mdnphy = 30%) to prescribe it (p < .001). The median minimum ARR physicians demanded for bisphosphonates prescription was 17%, whereas lay persons demanded 22% (p < .001). Physicians estimated the actual ARR of bisphosphonates to be 12%. This estimated effect size was below their own minimum threshold for prescription.
Conclusions
Lay persons tolerate a higher fracture risk and demand a larger benefit of antiosteoporotic medication for fracture prevention than physicians. Physicians demand higher minimum benefits than their own estimates which in turn are above the benefit evidence suggests. Physicians should be more familiar with ES of antiosteoporotic drugs concerning patient outcomes and actively advise lay persons before preventive treatment decisions are taken.
Following Michael Lipsky's well‐known argument that policy is made in the daily encounters between street‐level bureaucracy and citizens, a growing body of research emphasizes that actors and organizations delivering social and labor‐market policy play a crucial role in welfare‐state politics. Using qualitative data collected at three local employment agencies in Germany, this article explores worker‐client relations as a crucial mechanism through which activation policies are translated into practice. The analysis investigates how caseworkers define their role and their relationships with clients. The findings show that it is essential for caseworkers to achieve client compliance. In such a context, building relationships of trust is a strategic instrument in overcoming possible barriers to co‐operation in the caseworker‐client interaction. Caseworkers develop strategies to create the impression of trustworthiness and to motivate both unemployed clients and employers to become trust‐givers in the caseworker‐client relation. While research has often stressed the dichotomy between disciplining and enabling elements of activation policies, our explorative study shows that persuasion and trust‐building are a further important dimension of the frontline delivery of activation policies. These strategies reflect the importance of emotional aspects of frontline work.
Background
The ongoing Covid-19 pandemic not only threatens physical health, but also affects the mental health of people. Yet, health consequences of the pandemic do not affect all members of society equally. We therefore assessed the mental health burden of individuals who are at increased risk of severe illness from Covid-19 compared to individuals who are at low risk of severe illness during the first lockdown (March, 2020) in Germany. Furthermore, we investigated variables mediating the effect of being an individual at increased risk of serve illness on depression.
Methods
Adult German residents (n = 2.369) provided responses to a cross-sectional online survey about risk factors for of severe illness from Covid-19 and various aspects of mental health during the first lockdown in Germany. For data collection, standardized and validated self-report measures were used and for data analysis Mann-Whitney U-tests as well as regression and mediation analyses were performed.
Results
The results clearly show that the mental health burden is higher among individuals at increased risk of severe illness from Covid-19 compared to individuals at low risk of severe illness from Covid-19. Moreover, our findings indicate that the association between Covid-19 risk status and depressive symptoms is mediated by concerns about mental health, anxiety and loneliness in a causal effect chain.
Conclusions
Individuals at increased risk of severe illness from Covid-19 have an increased need for psychosocial support during times of lockdown. Future public health policies should pay special attention to these individuals and support them by targeted offers. More research, however, is needed on possible long-term consequences of social distancing on mental health.