Comorbidity and Healthcare Expenditure in Women with Osteoporosis Living in the Basque Country (Spain)

Objectives.This study aimed to establish the prevalence of multimorbidity in women diagnosed with osteoporosis and to report it by deprivation index. The characteristics of comorbidity in osteoporotic women are compared to the general female chronic population, and the impact on healthcare expenditure of this population group is estimated.Methods.A cross-sectional analysis that included all Basque Country women aged 45 years and over (N= 579,575) was performed. Sociodemographic, diagnostic, and healthcare cost data were extracted from electronic databases for a one-year period. Chronic conditions were identified from their diagnoses and prescriptions. The existence of two or more chronic diseases out of a list of 47 was defined as multimorbidity.Results.9.12% of women presented osteoporosis and 85.04% of them were multimorbid. Although multimorbidity in osteoporosis increased with age and deprivation level, prevalence was higher in the better-off groups. Women with osteoporosis had greater risk of having other musculoskeletal disorders but less risk of having diabetes (RR = 0.65) than chronic patients without osteoporosis. People with poorer socioeconomic status had higher healthcare cost.Conclusions.Most women with osteoporosis have multimorbidity. The variety of conditions emphasises the complexity of clinical management in this group and the importance of maintaining a generalist and multidisciplinary approach to their clinical care.

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Causal impact of social care, public health and healthcare expenditure on mortality in England: cross-sectional evidence for 2013/2014

BMJ Open ◽

10.1136/bmjopen-2020-046417 ◽

2021 ◽

Vol 11 (10) ◽

pp. e046417

Author(s):

Stephen Martin ◽

Francesco Longo ◽

James Lomas ◽

Karl Claxton

Keyword(s):

Public Health ◽

Social Care ◽

Healthcare Expenditure ◽

Least Squares Method ◽

Total Mortality ◽

Public Healthcare ◽

Cross Sectional ◽

Local Public Health ◽

Spending Growth ◽

The Impact

ObjectivesThe first objective is to estimate the joint impact of social care, public health and healthcare expenditure on mortality in England. The second objective is to use these results to estimate the impact of spending constraints in 2010/2011–2014/2015 on total mortality.MethodsThe impact of social care, healthcare and public health expenditure on mortality is analysed by applying the two-stage least squares method to local authority data for 2013/2014. Next, we compare the growth in healthcare and social care expenditure pre-2010 and post-2010. We use the difference between these growth rates and the responsiveness of mortality to changes in expenditure taken from the 2013/2014 cross-sectional analysis to estimate the additional mortality generated by post-2010 spending constraints.ResultsOur most conservative results suggest that (1) a 1% increase in healthcare expenditure reduces mortality by 0.532%; (2) a 1% increase in social care expenditure reduces mortality by 0.336%; and (3) a 1% increase in local public health spending reduces mortality by 0.019%. Using the first two of these elasticities and data on the change in spending growth between 2001/2002–2009/2010 and 2010/2011–2014/2015, we find that there were 57 550 (CI 3075 to 111 955) more deaths in the latter period than would have been observed had spending growth during this period matched that in 2001/2002–2009/2010.ConclusionsAll three forms of public healthcare-related expenditure save lives and there is evidence that additional social care expenditure is more than twice as productive as additional healthcare expenditure. Our results are consistent with the hypothesis that the slowdown in the rate of improvement in life expectancy in England and Wales since 2010 is attributable to spending constraints in the healthcare and social care sectors.

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Hubungan Faktor Demografi Dan Dukungan Sosial Dengan Depresi Pascasalin

Jurnal Profesi Medika Jurnal Kedokteran dan Kesehatan ◽

10.33533/jpm.v11i2.229 ◽

2018 ◽

Vol 11 (2) ◽

Author(s):

Nurfatimah Nurfatimah ◽

Cristina Entoh

Keyword(s):

Social Support ◽

Postnatal Depression ◽

Economic Status ◽

Depression Scale ◽

Dominant Factor ◽

Research Subjects ◽

Cross Sectional ◽

One Year ◽

The Impact ◽

The Relationship

Postnatal depression is a mental disorder after the birth of her child and can last up to one year. Maternal postnatal mood disorder not an easy matter. The impact can be devastating life of the mother and her child. Currently there are many women who experienced postnatal depression but has not been detected. The purpose of this study was to analyze the relationship between demographic factors and social support in postnatal depression in The Working Area Of Puskesmas Kayamanya.The design of this research is cross sectional. Research subjects were followed for 56 respondents ranging from childbirth to 7 days postnatal. The samples was chosen by using consequtive sampling. The instruments used in this research are the Edinburgh Postnatal Depression Scale (EPDS) and standard social support questionnaire. The results reveal that the age is not significantly associated with depression postnatal (p = 0.514) and education (p = 0.154); but it is significantly parity (p = 0.012); economic status (p = 0.030), social support include the family (p = 0.035); friends (p = 0.017); and midwives (p = 0.005). The multivariate analysis reveals that midwifes support (wald=4,236; p= 0,04) is the dominant factor causing postnatal depression.

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Impact of COVID-19 and Partial Lockdown on Access to Care, Self-Management and Psychological Well-being among People with Diabetes: A Cross-sectional Study

10.22541/au.160770440.01726562/v1 ◽

2020 ◽

Author(s):

Ester Yeoh ◽

Sooon Guan Tan ◽

Yingshan Lee ◽

Ying Yee Low ◽

Su Chi Lim ◽

...

Keyword(s):

Mental Health ◽

Psychological Distress ◽

Health Services ◽

Clinical Care ◽

Self Care ◽

Well Being ◽

Cross Sectional ◽

Disinhibited Eating ◽

Health Services Access ◽

The Impact

Background The impact of lockdown measures can be widespread, affecting both clinical and psychosocial aspects of health. This study aims to assess changes in health services access, diabetes self-care, behavioral and psychological impact of COVID-19 and partial lockdown in Singapore. Methods We conducted a cross-sectional online survey amongst people with diabetes with the Diabetes Health Profile-18 (DHP-18). Hierarchical regression analyses were performed for each DHP-18 subscale (Psychological Distress, Disinhibited Eating and Barriers to Activity) as dependent variables in separate models. Results Among 301 respondents, 45.2% were women, majority were ethnic Chinese (67.1%), aged 40 to 49 years (24.2%), have Type 2 diabetes (68.4%) and on oral medications (42.2%). During the lockdown, nearly all respondents were able to obtain their medications, supplies (94%) and contact their doctors (97%) when needed. Respondents reported less physical activity (38%), checking of blood pressure (29%) and blood glucose (22%). Previous diagnosis of mental health conditions (β=11.44, p= 0.017), diabetes-related comorbidities (β= 3.98, p= 0.001) and Indian ethnicity (β= 7.73, p= 0.018) were significantly associated with higher psychological distress. Comorbidities were associated with higher disinhibited eating (β= 2.71, p= 0.007) while mental health condition was associated with greater barriers to activities (β= 9.63, p= 0.033). Conclusion Health services access were minimally affected but COVID-19 and lockdown had mixed impact on self-care and management behaviors. Greater clinical care and attention should be provided to people with diabetes with greater number of comorbidities and previous mental health disorders during the pandemic and lockdown.

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Abstract P194: A Prospective Study of the Association of Flushing Bother, Impact, Treatment Satisfaction and Discontinuation of Niacin Therapy

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap194 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Josephine M Norquist ◽

Jane Liao ◽

Tiffany B Miller ◽

Lori D Bash ◽

Douglas J Watson ◽

...

Keyword(s):

Side Effects ◽

Real World ◽

Treatment Satisfaction ◽

Patient Adherence ◽

Alternative Methods ◽

Cross Sectional ◽

Niacin Therapy ◽

One Year ◽

A Prospective Study ◽

The Impact

Background: Niacin has proven lipid-modifying efficacy and cardiovascular benefit. Previous cross-sectional and retrospective studies have suggested that niacin-induced flushing (NIF) significantly limits patient adherence to therapy. We conducted a one-year ‘real-world’ prospective observational study to characterize the impact and severity of NIF symptoms in subjects newly prescribed extended-release (ER) niacin. Methods: Subjects were surveyed daily during week 1 of therapy and thereafter via telephone at weeks 5, 9, 13 and months 6, 9 and 13. Surveys included the Global Flushing Symptom Score (GFSS), Flushing Impact Questionnaire (FIQ), and Treatment Satisfaction Questionnaire for Medication (TSQM). Results: A total of 306 subjects were recruited of which 43.5% (n=133) discontinued ER niacin by the end the study. Among those who discontinued, the median duration of ER niacin use was 95 days (range 2-402 days). At discontinuation, 3 (2.3%) subjects were on 250mg, 71 (54%) on 500mg, 1 (0.8%) on 750mg, 27 (20.3%) on 1000mg, 6 (4.5%) on 1500mg, and 4 (3.1%) on 2000mg. Dose was not available for 21 subjects. Over half of the discontinuers experienced flushing symptoms; 82% reported moderate to extreme flushing (GFSS≥4) and 68% reported severe to extreme (GFSS≥7) prior to discontinuation. About 74% of the discontinuers reported that moderate was the greatest degree of flushing they could tolerate before discontinuation. Those who discontinued and reported experiencing flushing side effects reported high degrees of impact in the FIQ Irritation/Frustration domain: mean (SD) 3.0 (1.3) (0=not at all, 4=extremely) and high dissatisfaction due to side effects as measured by the TSQM Side Effect domain: mean (SD) 63.3 (33.8) (0=extremely dissatisfied, 100=extremely satisfied). In addition, subjects who reported moderate or greater flushing bother during week 1 were 3.3 times more likely to discontinue due to flushing than those who reported less bother (95% CI: 1.01-10, p<0.05). Conclusion: Results from this study suggest that in a “real-world” setting, flushing side effects are bothersome and have an impact on continuation of ER niacin therapy. Further research is needed into alternative methods for increasing ER niacin acceptability.

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Policies to Reduce Antibiotic Consumption: The Impact in the Basque Country

Antibiotics ◽

10.3390/antibiotics9070423 ◽

2020 ◽

Vol 9 (7) ◽

pp. 423

Author(s):

Paula Rojas ◽

Fernando Antoñanzas

Keyword(s):

Bacterial Resistance ◽

Moving Average ◽

Basque Country ◽

Arima Model ◽

Antibiotic Consumption ◽

Line Treatment ◽

Autoregressive Integrated Moving Average ◽

Drug Packaging ◽

One Year ◽

The Impact

In 2013, a change in copayment rate was introduced in the Basque Country (one year later than in the other regions in Spain), and improvements were made to drug packaging. In 2014, a National Program Against Bacterial Resistance (Spanish abbreviation: PRAN) was approved. The aim of this study is to analyze the impact of change to the copayment rate, the adjustment of drug packaging, and the approval of PRAN on the consumption of antibiotics. Raw monthly data on the consumption of antibiotics (costs, packages, and daily defined doses per thousand people (DID)) were collected from January 2009 to December 2018 in the Basque Country. Counterfactual and intervention analysis (Autoregressive integrated moving average (ARIMA) model) was performed for the total series, disaggregated by group of antibiotics (2019 WHO Access, Watch, and Reserve (AWaRe) Classification) and active substances with the highest cost per prescription (cefditoren and moxifloxacin), the lowest cost per prescription (doxycycline and cloxacillin), and the most prescribed active ingredients (amoxicillin, azithromycin, and levofloxacin). Introduction of copayment led to a ‘stockpiling effect’ one month before its implementation, equal to 8% in the three consumption series analyzed. Only the adjustment of drug packaging significantly reduced the number of packages dispensed (−12.19%). PRAN approval reduced consumption by 0.779 DID (−4.51%), representing a significant decrease for both ’access’ and ’watch’ group antibiotics. Despite the delay in implementing changes to copayment, there was a ‘stockpiling effect’. With the adjustment of packaging, fewer packs were prescribed but with a higher drug load and price. PRAN approval reduced both the consumption of ’access group antibiotics’ (first-line treatment) and ’watch group antibiotics’ (second-line treatment).

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How does the outcome of research training fellowships funded via the NHS compare with that from competitively funded fellowships from the MRC and other charities: a cross-sectional retrospective survey of trainees undertaking research training in the West Midlands

BMJ Open ◽

10.1136/bmjopen-2017-019630 ◽

2018 ◽

Vol 8 (1) ◽

pp. e019630

Author(s):

Charlotte Maybury ◽

Matthew David Morgan ◽

Russell Smith ◽

Lorraine Harper

Keyword(s):

Clinical Training ◽

Online Survey ◽

Research Training ◽

Clinical Care ◽

Clinical Work ◽

Research Experience ◽

The West ◽

Cross Sectional ◽

West Midlands ◽

The Impact

ObjectivesThis study aimed to investigate the impact of research training funded via the National Health Service (NHS) on medical trainees compared with traditional clinical research training fellowships (CRTFs).Design, setting and participantsOnline survey of 221 clinical trainees who had completed a period of research during their clinical training between 2009 and 2015 in the West Midlands.Main outcome measuresResearch outcomes.ResultsOverall response rate was 59%, of whom 72 participants were funded by CRTFs and 51 funded by the NHS. Although participants with CRTFs were more likely to be awarded a higher degree compared with those on NHS-administered funding (66/72 CRTFs and 37/51 NHS, P=0.005), similar proportions of NHS-funded and CRTF-funded participants entered clinical lecturer posts on completing initial research training (8/51 NHS and 16/72 CRTF, P=0.37). 77% of participants had three or more publications (CRTF 57 and NHS 39, P=0.72). 57 participants had completed clinical training; similar proportions of CRTF-funded and NHS-funded trainees had research included in their consultant contract (12/22 NHS and 14/26 CRTF, P=0.96) or were appointed to academic posts (3 of 25 NHS funded and 6 of 32 CRTF, P>0.05). 95% of participants would recommend to colleagues and 82% of participants felt the research experience improved their provision of clinical care with no difference between CRTF-funded and NHS-funded participants (P=0.49). Continuing to participate in clinical work during the research reduced reports of trainee difficulty on returning to clinical work (23/108 continued clinical work vs 12/22 no clinical work, P=0.001).ConclusionResearch training funded by the NHS provides a quality experience and contributes to the clinical academic capacity within the UK. More needs to be done to support NHS participants to successfully achieve a higher degree.

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The impact of out-of pocket payments of households for dental healthcare services on catastrophic healthcare expenditure in Iran

BMC Public Health ◽

10.1186/s12889-021-11209-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Abraha Woldemichael ◽

Satar Rezaei ◽

Ali Kazemi Karyani ◽

Mohammad Ebrahimi ◽

Shahin Soltani ◽

...

Keyword(s):

Dental Care ◽

Rural Areas ◽

Healthcare Expenditure ◽

Financial Burden ◽

Healthcare Services ◽

Dental Services ◽

Cross Sectional ◽

Care Services ◽

Out Of Pocket Payments ◽

The Impact

Abstract Background Dental healthcare is the costliest and single most source of the financial barrier to seeking and use of needed healthcare. Hence, this study aims to analyses impact of out-of-pocket (OOP) payments for dental services on prevalence catastrophic healthcare expenditure (CHE) among Iranian households during 2018. Methods We performed a cross-sectional analysis to determine the prevalence rate of CHE due to use of dental healthcare services among 38,858 Iranian households using the 2018 Household Income and Expenditure Survey (HIES) survey data of Iran. The WHO approach was used to determine the CHE due to use of dental care services at the 40% of household capacity to pay (CTP). Multiple logistic regression models were used to obtain the odds of facing with CHE among households that paid for any dental healthcare services over the last month while adjusting for covariates included in the model. These findings were reported for urban, rural areas and also for low, middle and high human development index HDI across provinces. Results The study indicated that the prevalence of CHE among households that used and did not used dental services over the last month was 16.5% (95% CI: 14.9 to 18.3) and 4.3% (95% CI: 4.1 to 4.6), respectively. The adjusted odds ratio (AOR) for the covariates revealed that the prevalence of CHE for the overall households that used dental healthcare service was 6.2 times (95% CI: 5.4 to 7.1) than those that did not use dental healthcare services. The urban households that used dental healthcare had 7.8 times (95%CI: 6.4–9.4) while the rural ones had 4.7 times (95% CI: 3.7–5.7) higher odds of facing CHE than the corresponding households that did not use dental healthcare services. Conclusions The study indicates that out-of-pocket costs for dental care services impose a substantial financial burden on household’s budgets at the national and subnational levels. Alternative health care financing strategies and policies targeted to the reduction in CHE in general and CHE due to dental services in particular are urgently required in low and middle income countries such as Iran.

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Medicolegal Significance of Torture Under Police Custody on Prisoners’ Health and Recommendations for Prevention of Violence Against Torture

Journal of Gandhara Medical and Dental Science ◽

10.37762/jgmds.5-2.82 ◽

2019 ◽

Vol 5 (2) ◽

pp. 16-20

Author(s):

Sayed Muhammad Yadain ◽

Aftab Alam Tanoli ◽

Riffat Masood ◽

Shagufta Shafi ◽

Rizwan Zafar Ansari ◽

...

Keyword(s):

The Body ◽

Physical Work ◽

Physical Assault ◽

Cross Sectional ◽

Police Custody ◽

Wide Range ◽

Hands On ◽

Istanbul Protocol ◽

One Year ◽

The Impact

OBJECTIVES:The aim of the study was to determine (a) most common sites of torture, nature of injuries and their complications and (b) psychological and physical effects of torture on the prisoner’s mental and physical health. METHODOLOGY: It was a cross-sectional descriptive study. The study was conducted on 193 prisoners admitted at District Police Hospital Peshawar over a period of one year. These prisoners were the victims of torture under police captivity. Majority of the victims were prisoners. The data was collected on a Performa mentioning age, duration of captivity; nature of injuries (simple, grievous), weapon used for physical torture (blunt, sharp) and prisoners were interviewed and examined by the medical officers and co-authors. SPSS 20 was used for data analysis. RESULTS: One hundred and eighty (93.2%) of the 193 subjects were male. Average age was 27.4 ±4 years. Hundred (51.8%) prisoners were physically tortured and 92 cases (47.6%) were due to physical assault among prisoners. Out of 92 cases 12 (13.04%) prisoners showed injuries due to strenuous physical work, mostly on palms and soles in the form of blisters. These injuries were carefully examined and correlated with history. Torture methods observed in this study were beating with hands on face (35.6%), whipping with rod (61.6%), kicking on buttock and abdomen (16.4%), forceful dragging (16.4%), burning with cigarettes (12.3%), hanging with hand cuffs (13.7%) and whipping on palms and sole (6.9%). Majority of the cases (74%) were tortured in custody, (12.3%) in prisons, (9.6%) on the street and (4.1%) at home. The impact of physical and psychological torture was variable depending upon the duration of captivity and nature of torture. Patients kept for a longer period 42 (42%) had developed post captivity psychosocial stress syndrome. Physical torture has taken 07 (3%) lives and 24 (12.4%) victims were permanently disabled in this year. CONCLUSION: A wide range of different types of injuries were observed on various parts of the body. Blunt trauma was most frequent. Violation of Istanbul Protocol for violence against torture under police custody was also clear.

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Changes in Pediatric Fracture Cases during the Coronavirus Disease 2019 Pandemic: Data from a National Referral Orthopedic Hospital in Indonesia

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6720 ◽

2021 ◽

Vol 9 (E) ◽

pp. 754-758

Author(s):

Pamudji Utomo ◽

Muhammad Yogatama Wirawan ◽

Hendra Cahya Kumara ◽

Mochamadsyah Beizar Yudistira

Keyword(s):

Standard Deviation ◽

Population Group ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Service Support ◽

Pediatric Fracture ◽

Orthopedic Hospital ◽

The Mean ◽

The Impact

AIM: This study aims to compare the impact of coronavirus disease 2019 (COVID-19) on pediatric fracture services in a national referral orthopedic hospital in Indonesia to understand the service provisions that may be required during the pandemic. METHODS: The study compared the population group during 1 year of the COVID-19 pandemic in Indonesia to the same period 1 year before. This cross-sectional study was performed in Prof. Dr. R Soeharso Orthopedic Hospital, Surakarta, Indonesia, from March 2019 to February 2021. The subjects were pediatric fracture patients aged 0–18 years. Patients recorded on other orthopedic service support installations such as radiology, laboratory, or physiotherapy and diagnosed with any other orthopedic sub-specialty were excluded. RESULTS: A total of 1787 patients were recorded in this study, with the mean of pediatric fracture patients during the pre-COVID-19 period was 90.75 (standard deviation [SD]: 28.5) and during the COVID-19 period was 58.16 (SD: 19.17) monthly. In the 1st year of the pandemic, there was a significant reduction in clinical visits compared to the same period in 2019 (p < 0.005). CONCLUSION: There were significant differences in pediatric fracture cases clinic visits and patients’ length of stay in the COVID-19 period than before the COVID-19 occurred.

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O27 THE IMPACT OF NERVE MANAGEMENT ON THE RISK FOR PERSISTING POSTOPERATIVE PAIN FOLLOWING OPEN ANTERIOR MESH REPAIR OF INGUINAL HERNIA

British Journal of Surgery ◽

10.1093/bjs/znab396.026 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Linn Westin ◽

Ulf Gunnarsson ◽

Gabriel Sandblom ◽

Ursula Dahlstrand

Keyword(s):

Postoperative Pain ◽

Mesh Repair ◽

Cross Sectional Study ◽

Cross Sectional ◽

Ordered Logistic Regression ◽

Post Operative Pain ◽

Intraoperative Management ◽

Mesh Hernia Repair ◽

One Year ◽

The Impact

Abstract Aim The impact of peripheral nerve management on post-operative pain is poorly known. The aim was to evaluate how management of the inguinal nerves during anterior mesh hernia repair affects the risk for long-term postoperative pain. Material and Methods Cross-sectional study based on the Swedish Hernia Register (SHR). Includes patients over 18 years of age with an open anterior repair during 2012-2018, who responded to a one-year follow-up questionnaire regarding pain. Ordered logistic regression analysis was applied to determine risk factors for pain. Results In total 35,720 patients who were operated with anterior mesh repair responded to the PROM questionnaire. Overall, 15.6% reported pain interfering with daily activities. The risk for persisting groin pain one year after surgery was not impacted by transecting the iilioingiounal nerve (0.49), the iliohypogastric nerve (0.17) or the genital branch of the genotiofemoral nerve (0.25) in a multivariable ordinal regression adjusting for anaesthesia, gender, age and emergency surgery. Conclusions Intraoperative management of the three main inguinal nerves was not associated with the risk for persisting pain in the operated groin one year after surgery.

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