Sa1409 Additive and Interaction Effects of Medical and Mental Comorbidities on Health Outcomes in a Sample of Severely Affected IBS Patients From Two Tertiary Care Clinics

2012 ◽  
Vol 142 (5) ◽  
pp. S-297 ◽  
Author(s):  
Jeffrey M. Lackner ◽  
Changxing Ma ◽  
Gregory D. Gudleski ◽  
Laurie Keefer ◽  
Emily T. Smith ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Tertiary Care ◽  
Interaction Effects ◽  
Mental Comorbidities

Issues in the Provision of Health Care in India: An Overview

2020 ◽  
pp. 097674792094518
Author(s):  
Vani Kant Borooah
Keyword(s):  
Health Outcomes ◽  
Rural Areas ◽  
Health Workers ◽  
Tertiary Care ◽  
Health Resources ◽  
Successful Implementation ◽  
Trade Offs ◽  
Vested Interests ◽  
Explicit Recognition ◽  
Optimal Mix

After reviewing health outcomes and policy in India, this paper concludes that there are at least six sets of issues to be addressed about improving the quantity and quality of health services, and ipso facto improving health outcomes, in India. First, the amount of resources earmarked for health needs to increase. Second, health resources need to be used in a fair and just manner and, in particular, complaints relating to egregious health outcomes need to be addressed. Predominant in this set of issues is oversight and regulation of private-sector health provision. The third set of issues relates to the allocation of health resources and, in particular, to the imbalance in the allocation of health resources between towns and villages. A fourth issue is the accessibility of rural areas since it is the most remote areas that have the lowest density of health workers. Another issue is the more efficient use of health workers in order to make them more productive. Finally, Indian health policy is stronger on rhetoric and aspiration than it is on action and implementation. The successful implementation of the policy requires the explicit recognition that objectives are often competing (primary versus tertiary care) and the acknowledgement that, with budgetary constraints, one cannot have more of one without having less of the other. The first role of policy is to then choose the optimal mix of objectives with respect to these trade-offs. Secondly, policies come up against vested interests which agitate (often with the support of opposition politicians) and litigate against proposed changes. Lastly, policies in India are made against a background of poor governance with the predatory presence of corruption looming over every policy initiative. In implementing, rather than simply articulating, a policy it is important to address these governance issues.

BIDIRECTIONAL SCREENING FOR TUBERCULOSIS AND DIABETES MELLITUS IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA

2021 ◽  
pp. 93-95
Author(s):  
Arun Babu.V ◽  
Deepak Kanna.K
Keyword(s):  
Diabetes Mellitus ◽  
Health Outcomes ◽  
South India ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Diabetic Patients ◽  
Hiv Screening ◽  
Care Hospital ◽  
Tuberculosis Patients ◽  
Bidirectional Relationship

Screening for Tuberculosis in people with Diabetes and screening for Diabetes in people with Tuberculosis will allow earlier detection of co-morbidities, leading to better health outcomes. This study carried out in a tertiary care hospital in South India consisted of 500 Diabetic patients and 250 patients of Tuberculosis. In 250 Tuberculosis patients screened for DM, the overall prevalence of DM in TB patients was 24.8%,out of which 17.2 % already had Diabetes and 7.6% was the additional yield during screening. About 500 Diabetes cases screened for tuberculosis, 7.6% had symptoms suggestive of tuberculosis. On further evaluation of these subjects none of them revealed evidence for tuberculosis. There exists a bidirectional relationship between TB and diabetes, and they both impact the presentation of each other. This study highlights the need of routine screening for dysglycemia for all TB patients, especially at the time of diagnosis, similar to HIV screening.

Cost-effectiveness of treating head and neck cancer using intensity-modulated radiation therapy: implications for cancer control program in India

2020 ◽  
Vol 36 (5) ◽  
pp. 492-499
Author(s):  
Akashdeep Singh Chauhan ◽  
Shankar Prinja ◽  
Sushmita Ghoshal ◽  
Roshan Verma
Keyword(s):  
Cost Effectiveness ◽  
Health Outcomes ◽  
Incremental Cost ◽  
Head And Neck ◽  
Tertiary Care ◽  
Primary Data ◽  
Costs And Benefits ◽  
Intensity Modulated ◽  
The Cost ◽  
3D Crt

BackgroundThe newer cancer treatment technologies hold the potential of providing improved health outcomes at an additional cost. So it becomes obligatory to assess the costs and benefits of a new technology, before defining its clinical value. We assessed the cost-effectiveness of intensity-modulated radiotherapy (IMRT) as compared to 2-dimensional radiotherapy (2-DRT) and 3-dimensional radiotherapy (3D-CRT) for treating head and neck cancers (HNC) in India. The cost-effectiveness of 3-DCRT as compared to 2-DRT was also estimated.MethodsA probabilistic Markov model was designed. Using a disaggregated societal perspective, lifetime study horizon and 3 percent discount rate, future costs and health outcomes were compared for a cohort of 1000 patients treated with any of the three radiation techniques. Data on health system cost, out of pocket expenditure, and quality of life was assessed through primary data collected from a large tertiary care public sector hospital in India. Data on xerostomia rates following each of the radiation techniques was extracted from the existing randomized controlled trials.ResultsIMRT incurs an incremental cost of $7,072 (2,932–13,258) and $5,164 (463–10,954) per quality-adjusted life year (QALY) gained compared to 2-DRT and 3D-CRT, respectively. Further, 3D-CRT as compared to 2-DRT requires an incremental cost of $8,946 (1,996–19,313) per QALY gained.ConclusionBoth IMRT and 3D-CRT are not cost-effective at 1 times GDP per capita for treating HNC in India. The costs and benefits of using IMRT for other potential indications (e.g. prostate, lung) require to be assessed before considering its introduction in India.

scholarly journals Health outcomes and unmet needs in patients with long-standing rheumatoid arthritis attending tertiary care in Greece: a cohort study

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Dimitrios T. Boumpas ◽  
Prodromos Sidiropoulos ◽  
Loukas Settas ◽  
Piotr Szczypa ◽  
Vassilis Tsekouras ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Health Outcomes ◽  
Unmet Needs ◽  
Tertiary Care

scholarly journals Hypothalamic-Pituitary Disorders in Childhood Cancer Survivors: Prevalence, Risk Factors and Long-Term Health Outcomes

2019 ◽  
Vol 104 (12) ◽  
pp. 6101-6115 ◽  
Author(s):  
Laura van Iersel ◽  
Zhenghong Li ◽  
Deo Kumar Srivastava ◽  
Tara M Brinkman ◽  
Kari L Bjornard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Outcomes ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Alkylating Agents ◽  
Tertiary Care ◽  
Childhood Cancer Survivors ◽  
Mineral Density ◽  
Adverse Health ◽  
Adverse Health Outcomes

Abstract Context Data on hypothalamic-pituitary (HP) disorders in systematically evaluated childhood cancer survivors are limited. Objective To describe prevalence, risk factors, and associated adverse health outcomes of deficiencies in GH deficiency (GHD), TSH deficiency (TSHD), LH/FSH deficiency (LH/FSHD), and ACTH deficiency (ACTHD), and central precocious puberty (CPP). Design Retrospective with cross-sectional health outcomes analysis. Setting Established cohort; tertiary care center. Patients Participants (N = 3141; median age, 31.7 years) were followed for a median 24.1 years. Main Outcome Measure Multivariable logistic regression was used to calculate ORs and 95% CIs for associations among HP disorders, tumor- and treatment-related risk factors, and health outcomes. Results The estimated prevalence was 40.2% for GHD, 11.1% for TSHD, 10.6% for LH/FSHD, 3.2% for ACTHD, and 0.9% for CPP among participants treated with HP radiotherapy (n = 1089), and 6.2% for GHD, and <1% for other HP disorders without HP radiotherapy. Clinical factors independently associated with HP disorders included HP radiotherapy (at any dose for GHD, TSHD, LH/FSHD, >30 Gy for ACTHD), alkylating agents (GHD, LH/FSHD), intrathecal chemotherapy (GHD), hydrocephalus with shunt placement (GHD, LH/FSHD), seizures (TSHD, ACTHD), and stroke (GHD, TSHD, LH/FSHD, ACTHD). Adverse health outcomes independently associated with HP disorders included short stature (GHD, TSHD), severe bone mineral density deficit (GHD, LH/FSHD), obesity (LH/FSHD), frailty (GHD), impaired physical health-related quality of life (TSHD), sexual dysfunction (LH/FSHD), impaired memory, and processing speed (GHD, TSHD). Conclusion HP radiotherapy, central nervous system injury, and, to a lesser extent, chemotherapy are associated with HP disorders, which are associated with adverse health outcomes.

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