Direct non-medical and indirect costs for families with children with congenital cardiac defects in Germany: a survey from a university centre

2010 ◽  
Vol 20 (2) ◽  
pp. 178-185 ◽  
Author(s):  
Andreas U. Gerber ◽  
Agnieszka Hompanera Torre ◽  
Guido Büscher ◽  
Stephanie A.K. Stock ◽  
Christine Graf ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Indirect Costs ◽  
Medical Services ◽  
Cardiac Defects ◽  
Congenital Cardiac Disease ◽  
Lost Productivity ◽  
Life Threatening ◽  
Clinically Significant ◽  
Financial Burdens ◽  
Families With Children

AbstractIntroductionParents of children with congenital cardiac disease suffer from psychological stress and financial burdens. These costs have not yet been quantified.Materials and methodsIn cooperation with paediatricians, social workers, and parents, a questionnaire was devised to calculate direct non-medical and indirect costs. Direct non-medical costs include all costs not directly related to medical services such as transportation. Indirect costs include lost productivity measured in lost income from wages. Parents were retrospectively queried on costs and refunds incurred during the child’s first and sixth year of life. The questionnaire was sent out to 198 families with children born between 1980 and 2000. Costs were adjusted for inflation to the year 2006. Children were stratified into five groups according to the severity of their current health status.ResultsFifty-four families responded and could be included into the analysis (27.7%). Depending on severity, total direct non-medical and indirect costs in the first year of life ranged between an average of €1654 in children with no or mild (remaining) cardiac defects and an average €2881 in children with clinically significant (residual/remaining) findings. Mean expenses in the sixth year of life were as low as €562 (no or mild (remaining) cardiac defects) and as high as €5213 (potentially life-threatening findings). At both points in time, the highest costs were lost income and transportation; and day care/ babysitting for siblings was third.DiscussionFamilies of children with congenital cardiac disease and major sequelae face direct non-medical and indirect costs adding up to €3000 per year on average. We should consider compensating families from low socioeconomic backgrounds to minimise under-use of non-medical services of assistance for their children.

Reducing the Toll of Injuries in Childhood Requires Support for a Focused Research Effort

PEDIATRICS ◽  
1983 ◽  
Vol 72 (5) ◽  
pp. 736-737
Author(s):  
◽  
Keyword(s):  
Research Effort ◽  
Adult Life ◽  
Medical Services ◽  
Unintentional Injuries ◽  
Permanent Disability ◽  
Childhood Injury ◽  
Different Types ◽  
Lost Productivity ◽  
Early Adult Life ◽  
Life Threatening

Injury is the leading cause of death and disability in childhood and early adult life. Trauma represents the largest loss of potential years of life1 and burdens the nation with enormous costs in terms of human suffering and disability, lost productivity, and medical services.2 In 1977, deaths from unintentional injuries ("accidents") accounted for nearly half of all deaths of children aged 1 to 14 years.3 Nonfatal, unintentional injuries, which are estimated to outnumber fatalities by 100 to 1,4 frequently result in permanent disability. Fatal inflicted injury (homicide) is a large and growing pediatric problem.5 Nonfatal child abuse and neglect affect more than 500,000 children per year,6 resulting in a progressive burden for its victims and society. If those who are young are to be protected from life-threatening injury, a quickened pace of progress in injury care and prevention is needed. Efforts to build Emergency Medical Services were begun in the 1970s, but these services are not yet widely developed.2 Advances in other aspects of critical care for the injured have also evolved slowly. In the area of injury prevention, considerable progress has been made in the development of ways to understand and control childhood injury; this is evident by the reductions in certain types of childhood injury. The most notable successes have been the reduction of poisoning and flame burns as causes of death and disability in childhood.7,8 Important theoretic advances have been (1) the elimination of the term "accident," which suggests chaotic and random effects, and its replacement with the notion of "injury," which suggests the transfer of physical or chemical energy to a victim; (2) recognition that the types of interventions most likely to succeed are ones that require infrequent participation by the potential victim and his family (or none at all); and (3) awareness that different types of measures are needed to prevent different types of injury.9

The role of flexible fibreoptic bronchoscopy in evaluation of pulmonary diseases in children with congenital cardiac disease

2007 ◽  
Vol 17 (2) ◽  
pp. 140-144 ◽  
Author(s):  
Ori Efrati ◽  
Udi Gonik ◽  
Dalit Modan-Moses ◽  
Bella Bielorai ◽  
Asher Barak ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Flexible Bronchoscopy ◽  
Fibreoptic Bronchoscopy ◽  
External Compression ◽  
Specific Diagnosis ◽  
Congenital Cardiac Disease ◽  
Large Airways ◽  
Life Threatening ◽  
Pulmonary Abnormalities

Background:Diseases of the lungs and airways can be life-threatening in patients with congenital cardiac disease. External compression, and tracheobronchomalacia, as well as pathology of the large airways, can cause respiratory symptoms such as wheezing, stridor, fever, and dyspnoea, along with producing difficulty to wean the patient from mechanical ventilation. A definite diagnosis may be achieved by fibreoptic flexible bronchoscopy.Aims:To characterize the patients who underwent bronchoscopy for respiratory diseases associated with congenital cardiac disease, and to evaluate the safety, total diagnostic rate, and diagnostic rate, which yielded alteration of treatment in this group of patients.Methods:We reviewed retrospectively the records of 39 patients with congenital cardiac disease associated with abnormalities of the airways who underwent 49 fibreoptic bronchoscopies between 1999 and 2004. The patients were evaluated with regard to rate of diagnosis, the rate of procedures that resulted in alteration of management, and the rate of complications.Results:Fibreoptic flexible bronchoscopy was safe, and contributed to a specific diagnosis in almost nine-tenths of the procedures. A specific diagnosis that resulted in treatment alteration was achieved in one-fifth of the procedures.Conclusions:Fibreoptic flexible bronchoscopy has an important role in the evaluation of pulmonary abnormalities in patients with congenital cardiac diseases, and should be considered as an initial diagnostic tool that may guide the clinician with regard to the proper therapy.

Protein-losing enteropathy: integrating a new disease paradigm into recommendations for prevention and treatment

2011 ◽  
Vol 21 (4) ◽  
pp. 363-377 ◽  
Author(s):  
Jeffery Meadows ◽  
Kathy Jenkins
Keyword(s):  
Cardiac Disease ◽  
Patient Population ◽  
Disease Process ◽  
Single Institution ◽  
Protein Losing Enteropathy ◽  
Congenital Cardiac Disease ◽  
Prevention And Treatment ◽  
Financial Burdens ◽  
Uncommon Complication

AbstractProtein-losing enteropathy is a relatively uncommon complication of Fontan procedures for palliation of complex congenital cardiac disease. However, the relative infrequency of protein-losing enteropathy belies the tremendous medical, psychosocial and financial burdens it places upon afflicted patients, their families and the healthcare system that supports them. Unfortunately, because of the complexity and rarity of this disease process, the pathogenesis and pathophysiology of protein-losing enteropathy remain poorly understood, and attempts at treatment seldom yield long-term success. The most comprehensive analyses of protein-losing enteropathy in this patient population are now over a decade old, and re-evaluation of the prevalence and progress in treatment of this disease is needed. This report describes a single institution experience with the evaluation, management, and treatment of protein-losing enteropathy in patients with congenital cardiac disease in the current era, follows with a comprehensive review of protein-losing enteropathy, focused upon what is known and not known about the pathophysiology of protein-losing enteropathy in this patient population, and concludes with suggestions for prevention and treatment.

Distribution of ABO phenotypes in patients with congenital cardiac defects

2008 ◽  
Vol 18 (3) ◽  
pp. 307-310 ◽  
Author(s):  
Kirsten C. Odegard ◽  
Peter C. Laussen ◽  
David Zurakowski ◽  
Stephan J. Hornykewycz ◽  
Jonathan C. Laussen ◽  
...  
Keyword(s):  
United States ◽  
General Population ◽  
Cardiac Disease ◽  
United States Of America ◽  
Statistical Significance ◽  
The United States ◽  
Cardiac Defects ◽  
Congenital Cardiac Defects ◽  
Congenital Cardiac Disease ◽  
Chi Square Analysis

AbstractBackgroundCardiac anomalies are among the most frequent congenital malformations, but the basic underlying causes for most cardiac defects remains undetermined. Some 40 years ago, a higher incidence of blood group B was reported in a small number of African-American children with congenital cardiac defects. In this study, we sought to re-evaluate this association using a larger population.Methods and ResultsWe collected data from 1985 patients undergoing cardiac surgery from July, 2000, through December, 2004. We divided the patients into 6 subgroups according to their diagnosis. We then compared the prevalence of ABO phenotypes between the patients and the general population of the United States of America by chi-square analysis. There were no significant differences in the distribution of the ABO phenotypes amongst the subgroups of those with congenital cardiac disease, or any for subgroup compared to the general population.ConclusionWhile statistical significance is influenced by the size of the population within the United States of America and the small numbers within each of our subgroups of patients with congenital cardiac disease, we have been unable to show any relationship between the distribution of ABO phenotypes and the existence of congenital cardiac disease.

A Serological Storm

1970 ◽  
Vol 9 (2) ◽  
Author(s):  
Bertha Wong MD ◽  
Maria Bagovich MD ◽  
Ivan Blasutig PhD ◽  
Simon Carette MD MPhil
Keyword(s):  
Differential Diagnosis ◽  
Hepatitis C Virus ◽  
Immune System ◽  
Hepatitis C ◽  
Hcv Infection ◽  
Clinical Context ◽  
Autoantibody Profile ◽  
Life Threatening ◽  
Clinically Significant ◽  
Sensory Polyneuropathy

This article describes a patient presenting with a sensory polyneuropathy and multiple autoantibodies, leading to the diagnosis of hepatitis C virus (HCV) infection. His widely positive autoantibody profile in the absence of clinically significant rheumatic disease illustrates the importance of interpreting autoimmune serology in the appropriate clinical context and the concept of HCV being a non-specific activator of the immune system. In addition, it highlights the importance of considering untreated HCV infection in the differential diagnosis of rheumatic complaints, particularly if the workup reveals multiple autoantibodies, as HCV is a potentially severe and life-threatening disease, which can be appropriately managed with effective antiviral therapy.

scholarly journals Trends in incidence rate, health care use, and costs due to rib fractures in the Netherlands

2021 ◽  
Author(s):  
Jonne T. H. Prins ◽  
Mathieu M. E. Wijffels ◽  
Sophie M. Wooldrik ◽  
Martien J. M. Panneman ◽  
Michael H. J. Verhofstad ◽  
...  
Keyword(s):  
Health Care ◽  
Incidence Rate ◽  
Health Care Costs ◽  
Indirect Costs ◽  
Rib Fractures ◽  
Work Absence ◽  
Lost Productivity ◽  
The Mean ◽  
Using Data ◽  
Care Costs

Abstract Purpose This study aimed to examine population-based trends in the incidence rate, health care consumption, and work absence with associated costs in patients with rib fractures. Methods A retrospective nationwide epidemiologic study was performed with data from patients with one or more rib fractures presented or admitted to a hospital in the Netherlands between January 1, 2015 and December 31, 2018 and have been registered in the Dutch Injury Surveillance System (DISS) or the Hospital Discharge Registry (HDR). Incidence rates were calculated using data from Statistics Netherlands. The associated direct health care costs, costs for lost productivity, and years lived with disability (YLD) were calculated using data from a questionnaire. Results In the 4-year study period, a total of 32,124 patients were registered of which 19,885 (61.9%) required hospitalization with a mean duration of 7.7 days. The incidence rate for the total cohort was 47.1 per 100,000 person years and increased with age. The mean associated direct health care costs were €6785 per patient and showed a sharp increase after the age of 75 years. The mean duration of work absence was 44.2 days with associated mean indirect costs for lost productivity of €22,886 per patient. The mean YLD was 0.35 years and decreased with age. Conclusion Rib fractures are common and associated with lengthy HLOS and work absenteeism as well as high direct and indirect costs which appear to be similar between patients with one or multiple rib fractures and mostly affected by admitted patients and age.

scholarly journals The bowel and beyond: extracolonic findings from CT colonography

2021 ◽  
Author(s):  
Gerard Lambe ◽  
Peter Hughes ◽  
Louise Rice ◽  
Caoimhe McDonnell ◽  
Mark Murphy ◽  
...  
Keyword(s):  
Ct Colonography ◽  
Surgical Intervention ◽  
Potential Significance ◽  
Age And Gender ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Extracolonic Findings ◽  
The Difference ◽  
Clinically Significant ◽  
And Gender

AbstractCT colonography has emerged as the investigation of choice for suspected colorectal cancer in patients when a colonoscopy in incomplete, is deemed high risk or is declined because of patient preference. Unlike a traditional colonoscopy, it frequently reveals extracolonic as well as colonic findings. Our study aimed to determine the prevalence, characteristics and potential significance of extracolonic findings on CT colonography within our own institution. A retrospective review was performed of 502 patients who underwent CT colonography in our institution between January 1, 2010 and January 4, 2015. Of 502 patients, 60.63% had at least one extracolonic finding. This was close to other similar-sized studies (Kumar et al. Radiology 236(2):519–526, 2005). However, our rate of E4 findings was significantly higher than that reported in larger studies at 5.3%(Pooler et al. AJR 206:313–318, 2016). The difference may be explained by our combination of symptomatic/screening patients or by the age and gender distribution of our population. Our study lends support to the hypothesis that CT colonography may be particularly useful in identifying clinically significant extracolonic findings in symptomatic patients. CT colonography may allow early identification of extracolonic malignancies and life-threatening conditions such as an abdominal aortic aneurysm at a preclinical stage when they are amenable to medical or surgical intervention. However, extracolonic findings may also result in unnecessary investigations for subsequently benign findings.

Endocrinal complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease

2008 ◽  
Vol 18 (S2) ◽  
pp. 256-264 ◽  
Author(s):  
Heather Dickerson ◽  
David S. Cooper ◽  
Paul A. Checchia ◽  
David P. Nelson
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Cardiac Disease ◽  
Congenital Heart ◽  
Healthcare Intervention ◽  
Time Interval ◽  
Quality Reporting ◽  
Cardiac Malformations ◽  
Comprehensive List ◽  
Congenital Cardiac Disease

AbstractA complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the endocrine system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.As surgical survival in children with congenital cardiac disease has improved in recent years, focus has necessarily shifted to reducing the morbidity of congenital cardiac malformations and their treatment. A comprehensive list of endocrinal complications is presented. This list is a component of a systems-based compendium of complications that will standardize terminology and thereby allow the study and quantification of morbidity in patients with congenital cardiac malformations. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, initiatives to improve quality, reporting of complications, and comparing strategies of treatment.

Impact on parents of feeding young children with congenital or acquired cardiac disease

2000 ◽  
Vol 10 (6) ◽  
pp. 574-581 ◽  
Author(s):  
Christine Imms
Keyword(s):  
Cardiac Disease ◽  
Negative Impact ◽  
Mood State ◽  
Negative Mood ◽  
Oral Feeding ◽  
Social Emotional ◽  
Negative Mood State ◽  
Congenital Cardiac Disease ◽  
Culturally Based ◽  
Emerging Themes

AbstractFeeding an infant is an interactive process that facilitates social, emotional and culturally based skills. Children with congenital or acquired cardiac disease frequently require supportive regimes with regard to feeding so as to maintain weight, resulting in altered experiences for both the child and family. This study evaluated the practical, emotional and social ramifications for parents, of having a child with cardiac disease who also experienced difficulties with oral feeding. The study sampled three groups of parents who had children less than 3 years of age: those with cardiac disease who had difficulty in feeding, those with cardiac disease and no such difficulty, and those with no medical diagnosis. Parents completed a questionnaire about feeding, a time diary of activities involved in feeding, and Tuckman's Mood Thermometers, which measure anger and ‘poorness-of-mood’ associated with feeding the identified child. Parents of children with cardiac disease and a feeding difficulty reported a significantly more negative mood-state, and significantly longer time associated with feeding, than parents of children in the other two groups. Emerging themes from qualitative analysis of the data suggested that having a child with congenital cardiac disease producing difficulty in feeding had a strong negative impact on the whole family.

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