Health Cost Burden Research Articles

The Characteristics of Chronic Rhinosinusitis at Wangaya Regional Hospital Denpasar Period January-December 2022

ABSTRACT Chronic rhinosinusitis is inflammation that affects the nose and paranasal sinuses accompanied by two or more symptoms, one of which is blockage or obstruction in the nose and nasal mucus that flows posteriorly or anteriorly which can be accompanied by additional symptoms in the form of pain or pressure on the face and reduced olfactory sensitivity or loss of smell when symptoms more than 12 weeks. Chronic rhinosinusitis has a greater impact on reducing quality of life and huge burden of health costs than acute rhinosinusitis. This research was retrospective descriptive uses secondary data from medical records January-December 2022 Otorhinolaryngology Department of Wangaya Regional Hospital Denpasar. The sampling technique used was total sampling. Data collected included gender, age, occupation, main complaint, comorbidities, number of sinus involvement, location of sinuses, therapy. The data obtained were analyzed univariately using SPSS software version 23.0 and presented in the form of tables and narratives. From the research, it was obtained that the gender was mostly female 51.2%, average age of 38.05 ± 14.26 years with the highest age group is 46-60 years old, mostly private employees 48.8%. The most common main complaint was a blocked nose 48.8%. The highest comorbid was septum deviation 14%. The majority of sinuses involved were single rhinosinusitis 67%. The highest location in the maxillary sinus 69.8%. The majority of therapy was medication 58.1%. Most cases were found in female gender, average age 38.05 ± 14.26 year age group is 46-60 years old, private employees, main complaint was blocked nose, comorbidities with deviated septum, single rhinosinusitis, the highest location in the maxillary sinus, medicamentosa therapy. Keywords: Characteristics, Patients, Chronic Rhinosinusitis

Analisis Peran Promosi Kesehatan Dalam Mendukung Keberhasilan Program Pencegahan Penyakit Tidak Menular Di Indonesia

Non-Communicable Diseases (NCD) are chronic and non-communicable diseases that cannot be transmitted from one person to another in any form. Currently PTM is a serious global health problem, which is marked by the emergence of new cases and deaths from Non-Communicable Diseases (NCD) every year. Prevention and management of PTM must be done as early as possible considering that PTM sufferers have a low quality of life, causing the burden of health costs to increase thereby increasing the mortality rate. One effective strategy to prevent an increase in the number of PTM sufferers is to carry out health promotion programs. Health promotion is carried out to empower individuals and communities to consciously involve themselves in adopting healthy living habits. This study uses the Systematic Literature Review (SLR) method. Data collection was carried out by analyzing various reading sources or literature relevant to the research topic. A literature search was carried out using the Google Scholar electronic site in the form of a search engine with the keywords health promotion, prevention programs and Non-Communicable Diseases (PTM). There are 6 articles related to the role of health promotion in supporting the success of non-communicable disease prevention programs. Based on the analysis conducted, it can be concluded that the role of health promotion is needed to support the success of non-communicable disease prevention programs in Indonesia. Because one of the effective strategies to prevent the increasing number of PTM sufferers is to carry out health promotion programs.

Bacteriological Evaluation Of Nigerian Currency Notes From Selected Handlers In Ilesha Metropolis Of Osun State, Nigeria

Background: Peoples from various background and from difffferent works of life with difffferent hygienic status always engaged in  physical transactions with a legal tender of varied denominations for exchange of goods and services, and one of the legal tender  offiffifficially recognized in Nigeria is called naira. This study evaluated bacterial contaminants onnaira notes in circulations from  selected handlers with specifific profession and determined the resistance of the isolates to conventional antibiotic in use.  Methods: A  total of 160 samples of currency notes 20 each of 8 existing denominations in Nigeria, collected from selected participants  of various professions soaked in ringer's solution were serially diluted, subculture to various bacteriological media, Gram  stained and biochemically characterized. Determination by antibiogram study was carried out,with a view to identifying resistance risk  factors that could be associated with these contaminatedcurrency notes.  Results: The microbial load was found to be higher in lower denominations irrespective of their polymer status. The total bacterial  count per milliliter varied between 2.28 ×104 and 4.20×107 CFU, while the percentage distributions of isolates; Staphylococcus aureus  (36.8%), Escherichia coli (31.5%), Bacillus spp (3.7%) and Pseudomonas aeruginosa (27.5%) and varied resistance to antibiotics used were  recorded.  Conclusion: Bacterial antibiotic resistance has been associated with treatment failure, high health cost  burden and loss of manpower  hours due to over hospitalization. The microbial contaminant loads capable of causing opportunistic infection were found to be  present in currency notes examined. The alarming resistance of bacteria to selected conventional antibiotics used in this study, serves  an indication of potential threat of contaminated currency notes to public health. &nbsp

Pressure sore of malar prominence on horseshoe headrest: Prevention of one complication becomes road for another?

Pressure sores over bony prominences of heel or sacrum due to positioning are commonly reported, however, the same occurring over malar prominences are rarely seen. We report a case of pressure sore over malar prominence in a patient undergoing surgery in the prone position on horseshoe headrest. These injuries pose a risk of infection, need for surgical intervention, increasing woes, and health cost burden of the patient. Patient care team should aim to prevent such complications by appropriate support device selection, adequate padding, and frequent position changes.

SYSTEMATIC REVIEW OF THE EFFICIENCY OF TELEMEDICINE DURING THE COVID-19 PANDEMIC

COVID-19 is a world health problem that has caused significant changes in the health care system. During the COVID-19 pandemic, some efforts are needed to reduce the spread of the. Telemedicine, as a remote technology, is one of the effective options for use in the healthcare system today. This study aims to explore the efficiency of using telemedicine as one of the facilities in the context of controlling COVID-19. This systematic review research uses 4 databases: PubMed, ScienceDirect, ProQuest, and Wiley. The keywords used are "telemedicine" or "telehealth," "e-Health," and "COVID-19". The inclusion criteria are the articles that contain telemedicine in the control of COVID-19, published in 2021 in Indonesian or English by accredited journals, and using observational, descriptive, or case research. About 1,877 article titles were identified, and 1,869 were excluded because they were irrelevant and did not match the inclusion factor. A total of 8 articles were included in the analysis of this study. One article found that the effectiveness of telemedicine for rural communities is difficult to access. Six articles found that telemedicine reduces the frequency of visits to doctors/hospitals, reduces transportation costs, reduces hospitalization time and costs, reduces the workload of health workers, and reduces the transmission of COVID-19. One article listed the effectiveness of telemedicine for COPD patients with COVID-19. Telemedicine as a health care system is a promising effort during the COVID-19 pandemic and has excellent potential to help reduce the burden of health costs.

Comparative Experimental Evaluation of L-carnitine and Cholecalciferol on Amikacin Induced Nephrotoxicity and Clinical Evaluation of Amikacin Induced Adverse Drug Reactions

Background: Reduction of health cost burden with existing low-cost drug and thereby improving patient compliance is utmost necessary. Keeping in mind the above, we started with low cost, broad spectrum, WHO enlisted essential drug amikacin. We tried to revaluate it with another two low-cost drugs, L-carnitine, and Cholecalciferol. Objectives: Measurement of amikacin induced nephrotoxicity by means of abnormal renal biochemical parameters on albino rats and comparison of improvement after administration of L-carnitine & Cholecalciferol along with renal histopathology examination (HPE) of amikacin treated rats and causality assessment of amikacin induced adverse drug reactions (ADR) in hospitalized patient. Materials and Methods: Healthy albino male rats (N=40) were taken from Institutional animal house of Burdwan medical College and Hospital (BMCH) and were randomly divided into 4 groups. CPCSEA acclimatization guideline followed. IEAC and CREC clearances taken. Renal biochemical parameters from blood samples were analysed. Sterile water for injection was given to all group. Group I is control (only vehicle), Amikacin added to Group II, III and IV. L carnitine & Cholecalciferol was added to Group III & Group IV respectively. Post test measurement of renal biochemical parameters and HPE were done. Clinical observation of amikacin treated hospitalised patients and collection of their ADR in BMCH were done to find out correlations with animal experiment. Results: Statistical analyses were done using Graph Pad Prism version.4 software. Minimisation of amikacin induced nephropathy were seen, more in Group IV than Group III. HPE found the same conclusion. WHO UMC causality assessment revealed, 94.35% ADR were “probable/likely” whereas 5.65% were “possible”. The Naranjo’s adverse reaction probability scale revealed almost the same. Conclusion: Interventional animal experiment, biochemical parameters, histopathology along with open label, non-interventional, prospective observational study clearly indicates cholecalciferol is significantly better than L carnitine to minimise the effects of amikacin induced nephropathy.

Bibliometric analysis of scientific publications on health care insurance in India from 2000 to 2021

ABSTRACT Background India's health care suffers from high out-of-pocket medical expenses that lead to a higher financial burden on poor people. To reduce the health cost burden, the government of India has initiated many governments funded insurance schemes since 2000. Private health insurance also flourished, but the coverage is limited to wealthier households. Many researchers have published many scientific publications on this research domain, but the bibliometric analysis of scientific publications is missing. Methods We have relied on the ‘SCOPUS' database for data collection based on the wider availability of literature. 761 documents extracted were journal articles, published between 2000 and 2021 followed by certain inclusion and exclusion criteria. Biblioshiny package of R-Studio has been used for data analysis. Results Our analysis reflect upon various aspects of Bibliographic analysis like number of articles published, cited, country wise scientific production etc. Our results also reflect on very few studies that relate to Poverty, income, young adults, aged, adolescents, and children, where there is further scope for research. Conclusion We found that the health insurance-related publication rate has increased over the period. But it requires more research especially the implementation of health insurance mechanisms from the health system perspective. The study will be a policy document to find the research gaps in the healthcare insurance domain.

COST OF ILLNESS DIABETES MELITUS TIPE 2: NARRATIVE REVIEW

Diabetes mellitus (DM) is chronic disease that requires routine lifelong treatment. Uncontrolled blood sugar levels in DM patients can cause complications. This has an impact on the burden of health costs. The aim of this study to conduct a narrative review of the cost of illness in type 2 DM patients in various countries. The English articles used in this study were obtained from Pubmed, ScienceDirect, and Wiley that published in the period 2011 to 2021. The cost reported in the articles were local currency that later converted into US dollars according to the time of the study. Based on the narrative review, there are 19 articles that meet the criteria. In the article, there are varied perspectives, methods, and cost categories. The total cost per year for type 2 DM ranged from US$246.1 to US$5894.1, direct, and indirect costs per patient per year ranged from US$ 104.6 to US$5246.4 and US$82.9 to US$2299.4. Type 2 diabetes mellitus increases the burden of health costs. The presence of complications in type 2 DM patients requires higher health costs compared to uncomplicated type 2 DM patients and non-DM patient

The 2018 annual cost burden for children under five years of age hospitalised with respiratory syncytial virus in Australia.

Respiratory syncytial virus (RSV) is one of the principal causes of acute bronchiolitis and respiratory tract infections in young children. Routine RSV surveillance in Australian children is limited; vaccines are in late stage development; prophylactic monoclonal antibody (mAb) treatment is available but expensive; and there has been uncertainty around the cost burden. The objective of this study was to determine the annual cost burden for children under five years of age hospitalised with RSV in a single health service in 2018, with national extrapolation based on published Australian prevalence data. The methods utilised individual patient-level cost data prospectively collected for hospitalised children under five years of age in a tertiary Melbourne paediatric hospital. Results were extrapolated to all Australian children under five years of age to determine the national annual health cost burden, from a healthcare sector perspective over a 12 month time horizon. The results included 363 children with a mean age of 9.2 months (standard deviation, SD: 8.5 months). The mean cost per child was $17,120 (SD: $37,562), with a combined health service cost of $6,214,439. The reported Australian hospitalisation rate for RSV in the target age group ranged from 2.2 to 4.5 per 1,000 children under five years of age, resulting in a 2018 extrapolated cost range of $59,218,844-$121,129,453 for the estimated 3,459-7,075 children affected (combined index and all-cause six-month readmissions). This study concluded that RSV represents a significant cost burden to Australia's health care system. These data are important for future health economic assessments of preventative therapies, such as new RSV mAb treatments and maternal/childhood RSV vaccines, and provides valuable insights to inform health care planning and health policy.

Potential impact of COVID-19 related unemployment on increased cardiovascular disease in a high-income country: Modeling health loss, cost and equity.

BackgroundCardiovascular disease (CVD) is a leading cause of health loss and health sector economic burdens in high-income countries. Unemployment is associated with increased risk of CVD, and so there is concern that the economic downturn associated with the COVID-19 pandemic will increase the CVD burden.AimsThis modeling study aimed to quantify potential health loss, health cost burden and health inequities among people with CVD due to additional unemployment caused by COVID-19 pandemic-related economic disruption in one high-income country: New Zealand (NZ).MethodsWe adapted an established and validated multi-state life-table model for CVD in the national NZ population. We modeled indirect effects (ie, higher CVD incidence due to high unemployment rates) for various scenarios of pandemic-related unemployment projections from the NZ Treasury.ResultsWe estimated the potential CVD-related heath loss in NZ to range from 23,300 to 36,900 health-adjusted life years (HALYs) for the different unemployment scenarios. Health inequities would be increased with the per capita health loss for Māori (Indigenous population) estimated to be 3.7 times greater than for non-Māori (49.9 vs 13.5 HALYs lost per 1000 people). The estimated additional health system costs ranged between (NZ$303 million [m] to 503m in 2019 values; or US$209m to 346m).Conclusions and policy implicationsUnemployment due to the COVID-19 pandemic could cause significant health loss, increase health inequities from CVD, and impose additional health system costs in this high-income country. Prevention measures should be considered by governments to reduce this risk, including additional job creation programs and measures directed towards the primary prevention of CVD.

Comparison of Diagnostic Value between Point of Care Testing (POCT) and Standardize HbA1c Testing in Primary Health Care

Diabetes Mellitus is one of the biggest health problems. HbA1c is used to diagnose, to monitor treatment and treatment adjustment. High Performance Liquid Chromatography (HPLC) and electron spray mass spectrometry are recommended to measure HbA1c. But both methods need expensive cost, facility, and potentially increase health cost burden. HbA1c measurement using Point of Care Testing (POCT) is developed in Indonesia. POCT is more comfortable, has lower cost and easily brought to primary health care. Aim: to assess the clinical efficacy of POCT compared with a standard examination by HPLC. Methods: It is a cross-sectional observational study conducted at a first-level health facility (FKTP) in Malang. The subject population was patients who went to an outpatient unit in FKTP with inclusion criteria aged 20-75 years, were participants in the chronic disease management program (PROLANIS), both diabetes and non-diabetes. Results: Three hundred and thirty eight subjects were participated in this study. Five subjects were excluded because the presence of anemia. We used Wilcoxon test to compare HbA1c level between two methods and Rank Spearman correlation test to find correlation between two methods. This study showed measurement HbA1c level using POCT method had good accuracy (>80%). Other than diagnosis value, increased utilization of POCT HbA1c might also be caused by its portability and patient’s comfort. Conclusions: This study showed a strong correlation (R=0.016) between POCT HbA1c and standardized measurement. POCT HbA1c also showed good accuracy in all HbA1c groups.

A Kabbalistic View of Healthcare Transformation

A Kabbalistic View of Healthcare Transformation

Factors associated with physical activity levels in people with venous leg ulcers: A multicentre, prospective, cohort study.

Increasing levels of physical activity among people with venous leg ulcers (VLUs) can potentially reduce the health cost burden, improve functional aspects of patients' lives and increase ulcer healing rates. The aim of this study was to investigate factors associated with physical activity levels in patients with VLUs. Data from 2016 to 2017 Aspirin for Venous Leg Ulcer cohort study were analysed for the present study. Ninety participants were recruited from 5 outpatient specialist wound clinics across Victoria, Australia between August 2016 and April 2017. There was a statistically significant association between diabetes and physical activity, with a higher proportion of people with type 2 diabetes in the sedentary category. Further, there was a statistically significant association between patient-reported VLU education and physical activity levels. An indirect advantage of relevant, easy-to-understand education about VLUs may increase physical activity levels, which may facilitate improved time to healing of VLUs.

Comparison of Three Criteria for Interpretation of Electrocardiogram in the Military.

Screening of competitive athletes and other individuals exposed to regular and intense physical exercise, such as military personnel, can lead to an early and preclinical identification of cardiac conditions associated with a higher risk for sudden cardiac death. The electrocardiogram (ECG) has been recommended for the precompetitive screening, but its interpretation remains controversial. The aim of this study was to compare three different standardized criteria for interpretation of athletes' ECG applied in military. Prospective study of 1,380 consecutive healthy military, 249 (18%) also involved in competitive sport, screened with clinical history, physical examination, and ECG. The ECG was interpreted according to the European Society of Cardiology (ESC) recommendations, the Seattle Criteria (SC), and the Refined Criteria (RC). Independently of the criteria used, the majority of the individuals included had ECG changes, mainly physiological: ESC 55.1%, SC 63.6%, and RC 64.4%. The rate of pathological ECGs was significantly higher with the ESC criteria when compared to SC and RC (ESC 14.8%, SC 5.0% and RC 4.5%; p < 0.001). A significant cardiac abnormality was diagnosed with additional investigations in 4 patients (Brugada syndrome Type 1, mitral valve prolapse, bicuspid aortic valve, and Wolff-Parkinson-White pattern). Electrical cardiac adaptations are frequent in military personnel, similar to competitive athletes. Some ECG changes, previously considered pathological, could in fact correspond to physiological adaptations. The refinement of the ECG interpretation in this athletic population seems to reduce the rate of false-positive cases. This may have a favorable socioeconomic impact, especially by reducing the health cost burden and number of disability days.

The Contribution of Ageing to Hospitalisation Days in Hong Kong: A Decomposition Analysis.

Background: Ageing has become a serious challenge in Hong Kong and globally. It has serious implications for health expenditure, which accounts for nearly 20% of overall government expenditure. Here we assess the contribution of ageing and related factors to hospitalisation days in Hong Kong. We used hospital discharge data from all publicly funded hospitals in Hong Kong between 2001 and 2012. Methods: A decomposition method was used to examine the factors that account for the change of total hospitalisation days during the two periods, 2001-2004 and 2004-2012. The five factors include two demographic factors – population size and age-gender composition – and three service components – hospital discharge rate, number of discharge episodes per patient, and average length of stay (LOS) – which are all measured at age-gender group level. In order to assess the health cost burden in the future, we also project the total hospitalisation days up to 2041, for a range of scenarios. Results: During the decreasing period of hospitalisation days (2001-2004), the reduction of LOS contributed to about 60% of the reduction. For the period of increase (2004-2012), ageing is associated with an increase in total hospitalisation days of 1.03 million, followed by an increase in hospital discharge rates (0.67 million), an increase in the number of discharge episodes per patient (0.62 million), and population growth (0.43 million). The reduction of LOS has greatly offset these increases (-2.19 million days), and has become one of the most significant factors in containing the increasing number of hospitalisation days. Projected increases in total hospitalisation days under different scenarios have highlighted that the contribution of ageing will become even more prominent after 2022. Conclusion: Hong Kong is facing increasing healthcare burden caused by the rapid increase in demand for inpatient services due to ageing. Better management of inpatient services with the aim of increasing efficiency and reducing LOS, avoidable hospitalisation and readmission, without compromising patient satisfaction and quality of service, are crucial for containing the rapid and enormous increases in total hospitalisation days for Hong Kong. The results would be relevant to many rapidly ageing societies in this region.

Novel therapies for T cell lymphoma

Peripheral T-cell lymphomas (PTCL) are a heterogeneous collection of lymphomas that are associated with a very poor prognosis. Conventional therapies, historically based on protocols for aggressive B-cell lymphomas, deliver less than adequate outcomes; the majority of patients experience early relapse after frontline treatment and current 5 year overall survival is only 10–30%. Clearly, new approaches are needed. In recent years there has been a plethora of novel agents showing activity in PTCL, often in patients with advanced relapsed or refractory disease. These agents include antifolate drugs (pralatrexate), histone deacetylase inhibitors (vorinostat, romidepsin, panobinostat, belinostat), nucleoside analogues (gemcitabine, forodesine, clofarabine), monoclonal antibodies (anti-CD52, anti-CD4, anti-CD2), immunotoxins (bentuximab vedotin; anti-CD30), fusion toxins (denileukin diftitox; CD25), immunomodulatory agents (IMiDs such as lenalidomide), and proteasome inhibitors (bortezomib). This is an exciting time in the treatment of PTCL, as our ever improving understanding of the distinguishing features, pathogenesis, molecular biology and progression of PTCL and the knowledge of the mechanism and efficacy of novel therapies, may see a real improvement in outcomes for patients. Biomarker co-development will be absolutely critical to advancing the field of PTCL therapy. Already, by dissecting out the biology of the disease, specific targeted approaches are being used (CD30, ALK, CCR4). Understanding the primary mechanism of action and key targets of the less specific agents such as the HDACi, lenalidome or aurora kinase inhibitors, will help us pre-select patients with the highest likelihood of benefit, reducing exposure to potential toxicities while reducing the overall health cost burden.

Von der Pathophysiologie zur Entwicklung von Leitlinien und neuen Behandlungskonzepten der Schizophrenie

Mental illnesses show an annual prevalence of up to 4% and are therefore comparatively frequent. Schizophrenia substantially adds with direct as well as indirect costs (sick leave) to the overall burden of health costs caused by mental illness. The unfavourable prognosis of schizophrenia is caused by its negative symptoms and cognitive deficits. The underlying pathophysiological mechanism can most likely be regarded as a disorder of regenerative capacities of the human brain. The implementation of guidelines, quality indicators and treatment pathways improves the treatment quality in schizophrenia patients, but should, however not be abused as a tool for cost-cutting measures. A stratification in the long-term course as well as the development of biomarkers in the fields of genomics and imaging may help to promptly improve the treatment options for schizophrenia.

Life or Debt: Underinsurance in America

Life or Debt: Underinsurance in America

Medicare in the USA: a review of 45 years of health provision

From a review of the experience and history of Medicare in the US over these 45 years, politics and economics played a large role in its introduction, in the direction it took in its initial years, and more recently in the introduction of "donut hole" drug coverage. However, health planning and policy processes in federal and state agencies have grown, and by using data collected over the years on the Medicare programme specifically, and the health system more broadly, trial programmes to control costs and introduce efficiencies into healthcare have been and will continue to be undertaken. Those identified as workable and effective are then introduced as policy. For at least two generations now, in the US, the burden of health costs in old age, the period of greatest vulnerability to disease and chronic conditions, has been lifted, as foreseen by President Johnson in 1966.

The Growing Financial Burden Of Health Care: National And State Trends, 2001–2006

The financial burden of health care--the ratio of total out-of-pocket spending for health care services and premiums to total family income--continues to increase nationally. As a result of this trend, more people have been exposed to high costs and lack essential services. This study examines trends nationally and among selected states between 2001 and 2006. The results show considerable state-to-state variation associated mainly with differences in family income and, to a lesser extent, out-of-pocket spending for insurance premiums. Nationally, middle- and higher-income people with private insurance experienced the largest increases in financial burden. Moreover, almost 30 percent of the U.S. population either had a high financial burden of health costs or were uninsured. These facts underscore that escalating health care costs affect all socioeconomic strata, not just the poor.