Rehabilitation Costs Research Articles

Анализ взаимосвязи между частотой возникновения падений пациентов и уровнем культуры безопасности в медицинской организации

The problem of patient falls in healthcare organizations is a pressing concern for modern healthcare. Falls can lead to serious consequences, including significant limitations in physical activity, the development of anxiety disorders, and depression. Additionally, fall-related injuries are associated with high costs for treatment and rehabilitation. Special comprehensive programs are implemented in healthcare organizations to prevent falls, but the success of their implementation largely depends on the level of safety culture among healthcare personnel. The aim of this study is to investigate the relationship between the level of safety culture among healthcare personnel and the frequency of patient falls. Methods. The study was conducted in the multidisciplinary clinic JSC «Medicina» in Moscow from 2014 to 2020. The safety culture was assessed using the SOPS Hospital Survey 1.0 (HSPSC). The frequency of falls was evaluated based on online forms filled out by staff. Results. The study assessed the dynamics of the fall frequency per 1,000 bed-days in the hospital. Falls were categorized according to the severity of associated injuries. A correlation was found between the fall frequency and safety culture composites, such as «teamwork» –0.826 (p=0.022), «learning from errors» –0.747 (p=0.049), «executive actions in support of patient safety» –0.760 (p=0.047), «overall impression on patient safety» –0.821 (p=0.024), «frequency of reported incidents» 0.782 (p=0.038), «openness of communication» –0.846 (p=0.017), «unit collaboration» –0.867 (p=0.012), «shift handoffs and patient transfers» –0.791 (p=0.034), «non-punitive response to errors» 0.838 (p=0.019), and «average level of safety culture across all composites» –0.809 (p=0.027) (table 1). Conclusion. The study confirms the importance of assessing safety culture as part of a comprehensive approach to prevent patient falls in hospitals. The level of safety culture among healthcare personnel is inversely correlated with the frequency of patient falls. An increase in the level of safety culture is associated with a decrease in fall frequency and a reduction in the number of associated injuries. Additionally, the level of safety culture may potentially serve as an integral indicator of the effectiveness of programs aimed at preventing adverse events related to medical care. The study’s findings are relevant for a wide range of readers interested in issues related to healthcare safety.

Association between physical activity and costs in very mild to moderately frail community-dwelling older adults: a cross-sectional study.

Physical activity (PA) plays a vital role in maintaining the functional ability that enables well-being in older age (healthy aging), potentially also saving costs for the healthcare system and society. The aim of this study was to examine the association between PA and healthcare and societal costs in a sample of very mild to moderately frail older adults. This cross-sectional study is a secondary analysis using baseline data from the PromeTheus randomized-controlled trial, which included 385 very mild to moderately frail community-dwelling older adults (70 + years) from Germany. Participants self-reported their health-related resource use in the previous 6 months (FIMA questionnaire), which was monetarily valued using standardized unit costs. PA was also self-reported using the German Physical Activity Questionnaire for middle-aged and older adults (German-PAQ-50+) and categorized as 'insufficient'/'sufficient' or 'insufficient'/'moderate'/'high' in accordance with the World Health Organization guidelines for PA. Mean and median healthcare costs (including outpatient, inpatient, rehabilitation, formal care, and medication costs) and societal costs (healthcare costs plus informal care costs) for different PA groups were estimated using generalized linear models and quantile regression, with sociodemographic variables and physical capacity (Short Physical Performance Battery) as covariates. Of the sample, 24% were classified as insufficiently, 23% as moderately, and 54% as highly active. Sufficient PA, especially high PA, was associated with lower costs in the 6 months prior to data collection compared to insufficient PA (-€6,237, 95% CI [-10,656; -1,817] and -€8,333, 95% CI [-12,183; -4,483], respectively). The cost difference between PA intensity groups was largely driven by differences in informal care costs and decreased substantially when physical capacity was accounted for in the analyses; e.g., the mean difference in societal costs between sufficient and insufficient PA decreased from -€7,615 (95% CI [-11,404; -3,825]) to -€4,532 (95% CI [-7,930; -1,133]). Promoting PA throughout the lifespan as a means of promoting healthy aging and reducing dependency in old age could potentially provide economic benefits and help to mitigate the economic consequences of an aging population with increasing health and long-term care needs. Future longitudinal studies should attempt to disentangle the mediating and confounding role of physical capacity and health status in the association between PA and costs.

Cost-benefit analysis of working with recovery in river management using Marxan

With the impact and cost of continued river degradation and climate change-induced extreme rainfall and floods, there is growing urgency to achieve and maintain good river health to meet global sustainable development goals. Up-scaling and working with nature-based solutions at regional, catchment and fluvial corridor scales is critical. One way to achieve this is to work within a recovery-enhanced approach to river rehabilitation, incorporating processes of geomorphic and vegetative recovery to build fluvial corridors in areas where they have become fragmented. Geomorphologically-informed cost-benefit analysis has not previously been applied in a riverine or riparian context, at the catchment or regional scale needed. We applied Marxan in a novel manner to undertake the first cost-benefit analysis for geomorphologically-informed rehabilitation of river systems. We estimated that to rehabilitate 75,500 km of streams in coastal catchments of NSW will cost $8.2 billion, comparing favourably to recent single flood event insurance losses, and projected future losses. We developed Marxan scenarios based on three broad approaches to river management: ad hoc and reactive, working with recovery and corridors, across current and future time periods. We found there are considerable current and flow-on future financial and non-financial benefits, and lower initial total and per-hectare rehabilitation costs, by fully adopting working with recovery or corridors approaches and moving away from the ad hoc and reactive approaches which dominate current practice. Implementing targeted rehabilitation based on a rolling sequence over time of corridors scenarios provides optimal holistic solutions to improve geomorphic condition and enhance recovery potential at landscape-scale. Our study demonstrates the use of Marxan as an accessible tool to address prioritisation complexity, and to run and cost landscape-scale rehabilitation scenarios over time. Our study also demonstrates the positive offsite feedbacks that occur through multiplier effects, as recovery occurs, and corridors are built. Geomorphologically-informed decision making becomes more robust, transparent, cost-effective, consistent across catchments, and adaptive to local situations and evolving river management priorities.

The influence of Multi-Layer Plastic Packaging (MPP) on the high-temperature performance of asphalt binders and mixtures using wet and dry mixing methods

ABSTRACT High temperatures, combined with heavy traffic loads, increase the risk of permanent deformation and reduce the useful lifespan of pavements, leading to a greater need for maintenance and rehabilitation activities throughout the pavement's service life. This study aims to evaluate the effectiveness of recycled thermoplastic additives, specifically Multi-Layer Plastic Packaging (MPP) materials, in enhancing the high-temperature performance of asphalt mixtures. MPP materials, including types such as Polyester, Polyethylene, Nylon, and Metalized Polyester, were used for binder modification in asphalt mixtures. The modification was conducted using both wet and dry methods. The physical and rheological properties of the modified binders were assessed at high temperatures to determine their impact on stiffness and resistance to permanent deformation. The results indicate that MPP materials significantly improve the high-temperature performance of asphalt mixtures by enhancing binder stiffness and resistance to permanent deformation, with the wet method proving more effective than the dry method. These findings highlight the need for developing practical guidelines for incorporating MPP materials in asphalt production in the future and underscore the importance of comprehensive studies on maintenance, rehabilitation, and overall pavement lifecycle costs.

Lung Lesions in Exposure to Pesticides and Herbicides (Literature Review and Case Report)

Pesticides (herbicides, insecticides, fungicides, zoocides) are mixtures of substances of chemical or biological origin used to destroy or inhibit the growth of microorganisms, fungi, harmful vegetation, and other living organisms. These organisms damage crop and livestock production, degrade the quality of agricultural products, materials, and goods. Pesticides are classified into organic, and inorganic based on their chemical composition. About 1,000 active ingredients are used in pesticides, of which 310 are considered particularly hazardous. Extensive use of pesticides leads to the destruction of biocenoses and the emergence of various pathological changes in the human body. Among the pesticide ingredients with acute and chronic toxicity, abamectin, aluminum phosphide, beta-cyfluthrin, bifenthrin, chlorpyrifos, deltamethrin, diazinon, fenamiphos, malathion, methomyl, oxamyl, primicarb, propargite, tebuconazole, chlorothalonil, bromoxynil, bromoxynil octanoate, brodifacoum, and others stand out. In conditions of pesticide load on soils, the frequency of allergic and respiratory diseases is steadily increasing. Chronic obstructive pulmonary disease (COPD), caused by smoking and pesticides, leads to loss of working capacity and social activity, as well as significant costs for treatment and rehabilitation. The article discusses the pathogenetic and clinical aspects of the formation of COPD under conditions of synergy (smoking + pesticides). Various clinical phenotypes of COPD are also considered. A clinical case of a patient with COPD caused by smoking and prolonged contact with pesticides (mosplan, zellek-super, goal 2E), which manifested with chronic respiratory failure, multifocal atherosclerosis, and heart failure, is described.

Virtual Assessment of Functional Mobility in Lower Extremity Prosthesis Clients: An Exploratory Study

ObjectiveTo investigate the relationship between patient perception of lower extremity function and a home-based virtual clinician assessment of mobility in lower limb prosthesis clients. DesignDescriptive observational study using a clinician-administered functional mobility survey and timed Up and Go test to assess lower extremity function under supervision. SettingHealth Insurance Portability and Accountability Act-compliant online virtual platform. ParticipantsTwelve lower limb loss clients currently using prostheses, aged ≥19 years, not pregnant, and with no stroke, seizure disorder, or cancer. InterventionsNot applicable. Main Outcome MeasuresMain outcomes were mobility survey scores and mean timed Up and Go duration. ResultsMost participants reported significant ease of completing basic indoor ambulation and toileting tasks (66%-75%) and significant difficulty in running or prolonged ambulation activities (83%) requiring use of lower limb prosthesis. Timed Up and Go test was faster (11.0±2.9 s) than the reference range for transtibial prosthesis users and negatively associated with self-reported lower extremity functional status (r=−.70, P=.02). ConclusionsSelf-reported movement with lower limb prostheses at home and evaluation of mobility via a virtual platform is a feasible assessment modality that may reduce the frequency of therapy visits, defray some rehabilitation costs, and minimize the travel burden to distant prosthetic clinics.

Cost-Effectiveness Analysis of Rehabilitation Methods for Stroke Survivors

Background: One of the challenges in stroke management is how to provide rehabilitation services to stroke patients in Iran. Objectives: This study aimed to evaluate and compare the cost-effectiveness of rehabilitation interventions for stroke patients in three settings: Hospitals, stroke units, and homes. Methods: This cross-sectional study was conducted from the perspective of the health system. A Markov model with a 20-year time horizon and 3-month cycles was used to analyze costs and outcomes. Cost data were collected from 210 patients undergoing rehabilitation in hospitals, homes, or stroke units. The cost-effectiveness analysis (CEA) was conducted by calculating the incremental cost-effectiveness ratio (ICER) using Tree Age software. Results: The average rehabilitation cost for the home strategy ($2306 ± 35.018) was less than that for the hospital ($2955 ± 48.18) and stroke unit ($3485 ± 51.63) strategies. Furthermore, the QALY of the home strategy (26.03) was 8 times higher than that of the hospital (17.99) and 19 times higher than that of the stroke unit (7.03). The average cost-effectiveness ratios for the hospital, stroke unit, and home groups were $11424, $33159, and $7233 per QALY, respectively. The ICERs for stroke unit and home rehabilitation relative to hospital rehabilitation were $2517 and $2145 per QALY, respectively. Conclusions: According to the results, the home-based rehabilitation strategy is more cost-effective than hospital and stroke unit rehabilitation strategies. Given the high rates of stroke and its associated costs in Iran, it is suggested that policymakers lay the groundwork for providing these services at home.

The relationship between intervertebral disc pathologies and the use of digital devices and lack of physical activity in adolescents

Background/Aim: Existing research on herniated discs in adolescents primarily focuses on surgical interventions and outcomes, with fewer studies investigating the effectiveness of non-surgical therapies. The correlation between obesity, facet tropism, lumbosacral transitional vertebrae, trauma, certain sports activities, and herniated discs in adolescents is well-documented. Comparable to adults, a sedentary lifestyle in adolescents potentially carries a significant risk of developing disc degeneration and herniation. Consequently, this study aims to examine the relationship between increased digital device usage, decreased physical activity, and the onset of disc pathologies in adolescents. Methods: The study group included 94 patients aged between 10 and 16 years diagnosed with cervical (CDH), thoracic (TDH), and lumbar (LDH) disc disease. For each participant, the individual daily usage time spent on desktop computers, tablets, laptops, and mobile phones and the total time spent on all digital devices were evaluated. Their level of physical activity was also assessed using the International Physical Activity Questionnaire – Short Form (IPAQ-SF). The study eliminated causes such as listhesis, facet tropism, lumbosacral transitional vertebra, trauma, and sports injuries that could prompt the development of these spinal pathologies. Additionally, other conditions that might cause spinal pain, such as scoliosis, rheumatological diseases with spinal involvement, tumors, and myofascial pain, were also ruled out. Results: The average age of all patients was 13.44 (2.07) years. A majority were women (n=55), comprising 58.50% of the sample. Of the patients, 60.64% had CDH, 12.77% had TDH, and 75.53% had LDH. The amount of physical activity and time spent on digital devices were similar across both genders (P=0.194 and P=0.770). A significant correlation was found between CDH and the time spent on tablets, laptops, and mobile phones (P<0.001). Again, a significant correlation was observed between LDH, usage of desktop computers, total time spent on all digital devices, and the IPAQ-SF score for low physical activity (P<0.001). Conclusion: The prevalence and duration of digital device use among adolescents are increasing, while physical activity is decreasing. Our study indicates that this situation may be linked to the development of disc degeneration and hernias. Understanding this association can help reduce treatment and rehabilitation costs and prevent the potential loss of workability and quality of life resulting from a herniated disc. Consequently, additional comparative research on this topic is crucial.

Intelligent ankle–foot prosthesis based on human structure and motion bionics

The ankle–foot prosthesis aims to compensate for the missing motor functions by fitting the motion characteristics of the human ankle, which contributes to enabling the lower-limb amputees to take care of themselves and improve mobility in daily life. To address the problems of poor bionic motion of the ankle–foot prosthesis and the lack of natural interaction among the patient, prosthesis, and the environment, we developed a complex reverse-rolling conjugate joint based on the human ankle–foot structure and motion characteristics, the rolling joint was used to simulate the rolling-sliding characteristics of the knee joint. Meanwhile, we established a segmental dynamics model of the prosthesis in the stance phase, and the prosthetic structure parameters were obtained with the optimal prosthetic structure dimensions and driving force. In addition, a carbon fiber energy-storage foot was designed based on the human foot profile, and the dynamic response of its elastic strain energy at different thicknesses was simulated and analyzed. Finally, we integrated a bionic ankle–foot prosthesis and experiments were conducted to verify the bionic nature of the prosthetic joint motion and the energy-storage characteristics of the carbon fiber prosthetic foot. The proposed ankle–foot prosthesis provides ambulation support to assist amputees in returning to social life normally and has the potential to help improve clinical viability to reduce medical rehabilitation costs.

The cost of total hip arthroplasty: compare the hospitalization costs of national centralized procurement and national volume-based procurement.

With the increasing demand for joint replacement surgery in China, the government has successively issued the policies of national centralized procurement (NCP) and national volume-based procurement (NVBP) of artificial joints. The purpose of this study is to evaluate the impact of NCP and NVBP policies on hospitalization cost, rehospitalization and reoperation rate of total hip arthroplasty (THA). In total, 347 patients who underwent THA from January 2019 to September 2022 were retrospectively analyzed. According to the implementation of NCP and NVBP, patients were divided into three groups: control group (n = 147), NCP group (n = 130), and NVBP group (n = 70). Patient-level data on the total hospitalization costs, rehospitalization rate, THA reoperation rate and inpatient component costs were collected before and after the implementation of the policies and Consumer Price Index was used to standardize the cost. After the implementation of NCP and NVBP, the total cost of hospitalization decreased by $817.41 and $3950.60 (p < 0.01), respectively. The implantation costs decreased from $5264.29 to $4185.53 and then rapidly to $1143.49 (p < 0.01), contributing to increased total cost savings. However, the cost of surgery and rehabilitation increased after NCP and NVBP implementation (p < 0.01). The proportion of implants decreased from 66.76 to 59.22% and then to 29.07%, whereas that of drugs increased from 7.98 to 10.11% and then to 12.06%. The proportion of operating expenses rose from 4.86 to 8.01% and then to 18.47%. Univariate linear regression analysis showed that hospital stay, NCP and NVBP were correlated with total hospitalization cost (p < 0.01). Multivariate analysis showed that hospital stay, NCP and NVBP were independent predictors of total hospitalization cost (p < 0.01). In this study, hospital stay, NCP, and NVBP were independent predictors of total inpatient costs. After the implementation of NVBP policy, the cost of implants and hospitalization has decreased significantly, and the technical labor value of medical staff has increased, but a multifaceted method is still needed to solve the problem of increasing costs of other consumables. Limitations of the study suggest the need for further and more comprehensive evaluation in the future.

Assessment of flooding impact on thin pavement structure in Texas coastal region

Over the recent years, transportation infrastructure in the United States have experienced numerous hurricanes or tropical storms usually accompanied with heavy rainfalls. This may lead to flooding on pavements and higher groundwater levels, causing soil erosion, slope instability, reduced pavement strength, and lowering pavement’s load-bearing capacity, subsequently shortening pavement service life or increasing rehabilitation and maintenance costs. This study focuses on the impact of flooding on thin pavement structure with surface-treated pavements in Texas coastal region, which contains 6,277 lane miles of roads. First, at a project level, a Mechanistic-Empirical pavement design tool is used to analyze pavement performance under flooding and non-flooding/normal conditions. Pavement life is estimated for different flooding timing cases. Second, simulations are run to evaluate the impact of flooding on the pavement life at a network level. Three flooding frequencies are highlighted: low, 100-year; medium, 50-year; and high, 20-year. By a comparison with non-flooding baseline, it is found that the pavement life for the entire weak pavement network in the coastal region can be reduced at varying degrees due to the flooding impact. The quantified pavement life reduction can serve to enhance pavement design practice and system management decision making in a proactive manner.

Implementation and validation of robot-enabled embedded sensors for structural health monitoring

In the past decades, structural health monitoring (SHM) has matured into a viable supplement to regular inspections, allowing to execute repair and maintenance work at early stages of structural damage, thus resulting in relatively low rehabilitation costs. With the advent of wireless technologies and advancements in information and communication technologies, civil infrastructure has been increasingly instrumented with wireless sensor nodes to record, analyze, and communicate structural data relevant to SHM. However, in harsh environments, wireless sensor nodes may be damaged and fail to operate. A promising alternative to wireless sensor nodes is to embed sensors directly into concrete. In this paper, a sensor system for embedment into concrete is proposed, able to self-assess the structural data recorded from the concrete. Moreover, the data and information provided by the sensors are collected by robotic systems via RFID data transfer in an attempt to reduce the amount of human interaction and to overcome the limitations with respect to communication range and power supply. In laboratory experiments, the sensor systems are embedded into a concrete structural element, validating the capabilities of the sensors to record and to analyze the structural data. Furthermore, as will be shown in the paper, power will be supplied on-demand by legged robots that are deployed to collect the data and information, which is provided by the sensors for persistent storage. In summary, this study corroborates that the embedded sensors represent a crucial step towards intelligent, self-assessing concrete.

SURGICAL METHODS OF PREVENTION OF POST-MASTECTOMY SYNDROME: A LITERATURE REVIEW

Relevance: Despite improvements in early diagnosis, breast cancer continues to be one of the most common types of malignant tumors in the Republic of Kazakhstan, affecting about 5,000 women annually. Surgery remains the main method of treatment for breast cancer. Rapid development and improvement of various methods and devices for reconstructive plastic surgery plays an important role in the medical, psychological, and social rehabilitation of patients with breast cancer, allowing to achieve better aesthetic and functional results. Postmastectomy syndrome (PMPS) is a complex complication of surgical tumor resection and affects almost half of women who have undergone this intervention. The study aimed to analyze surgical methods for the prevention of postmastectomy syndrome to improve the outcomes, the course of the postoperative period and the quality of life of patients. Methods: Data from MEDLINE, Embase, Scopus, PubMed, and Cochrane Central Register of Controlled Trials were analyzed to select and analyze relevant information over the past 10 years using the keywords: “postmastectomy syndrome,” “mastectomy,” “lymphedema,” “brachioplexitis.” Results: The literature analysis showed that treating PMS requires a comprehensive approach, since the manifestations of PMS may vary depending on individual characteristics, the extent of surgical intervention, and other individual factors. The effectiveness of the interventions varied, with some showing promising results in reducing pain intensity, while others demonstrated improvements in functional outcomes and quality of life. Thus, it was found that ultrasound dissection is superior to electrocoagulation in terms of intraoperative blood loss, amount of lymphorrhea, and average hospital stay. Lymphatic-venous anastomoses are difficult to reproduce, but have been reported to be 95% effective in preventing lymphedema. Autologous fat tissue transplantation solves several problems, including reducing chronic pain syndrome (&gt;6 months) by 3.1 points. Brachioplexitis and associated complications can be prevented during surgery. Conclusions: Given the variability of PMS complications, it is advisable to prevent the burden and financial costs of rehabilitation in the postoperative period. Surgical methods of prevention discussed in this literature review can be used intraoperatively to significantly reduce the risk of PMS.

A Comprehensive Review of Life Cycle Cost Assessment of Recycled Materials in Asphalt Pavements Rehabilitation

This paper provides a comprehensive review of the use of life cycle cost assessment (LCCA) and life cycle assessment (LCA) methods for evaluating the sustainability and costs of using recycled materials in asphalt pavement rehabilitation projects. The review begins with an introduction to pavement rehabilitation strategies and the importance of choosing techniques based on thorough engineering and economic analyses. It then explores the different types of recycled materials that can be utilized, including reclaimed asphalt pavement, recycled concrete aggregate, and recycled asphalt shingles, discussing the key characteristics and properties of these materials based on previous laboratory studies. The review also examines the various rehabilitation methods that employ recycled content, such as cold in-place recycling, hot in-place recycling, and full-depth reclamation, providing a detailed breakdown of the construction, maintenance, and rehabilitation costs considered in LCCA and analyzing the environmental benefits of recycled material usage through a review of LCA techniques and criteria like carbon footprint reduction, impacts on air and water quality, and considerations of technological factors. Software tools for conducting LCA are compared and challenges to advancing the adoption of recycled materials are reviewed along with directions for future research efforts. The unique contribution of this work is its holistic assessment of LCCA and LCA methodologies to inform the sustainable and cost-effective deployment of recycled materials in asphalt pavement rehabilitation, a topic of growing importance for transportation infrastructure management. In summary, this current work provides a valuable review of how LCCA and LCA methodologies can assess the sustainability and costs of employing recycled content in asphalt pavement rehabilitation projects.

Health economic evaluation of rehabilitative short-term care : Analysis of the costs of geriatric patients with and without rehabilitative short-term care after inpatient hospital stay

Geriatric patients requiring rehabilitation and admitted to short-term care after an acute inpatient hospital stay seldom receive rehabilitative services later. Rehabilitative short-term care (REKUP) supplements short-term care with rehabilitative measures, aiming to prevent functional restrictions and long-term care. To conduct acost and cost-effectiveness analyses of REKUP and provide data for anationwide rollout. Anon-randomized controlled prospective study was carried out. The intervention group (IG) was paired 1:2 with acontrol group (KG), resulting in the formation of three collectives with follow-up periods of either 30,90 or 180 days (each with IG and KG). Using administrative claims data from the AOK Baden-Württemberg, the mean total costs from the perspective of the health insurance were calculated. Apotential impact of the intervention on costs was analyzed using the difference in differences approach. The analysis comprised 129 patients (IG43; KG86). During the follow-up periods, the IG presented higher rates of rehabilitation and lower rates of long-term care and mortality. Regarding costs, no statistically significant differences were found between the IG and KG in any of the three collectives. For nursing care and medication costs, costs were significantly higher in the follow-up period for the KG, whereas costs for rehabilitation were significantly higher for the IG (p < 0.001). Patients receiving REKUP utilize rehabilitation services more often and have alower likelihood of requiring nursing care or dying with no statistically significant differences in costs. There are potential advantages of REKUP in the target population, which warrant further investigation due to methodological limitations.

Cost of out-of-hospital cardiac arrest survivors compared with matched control groups

IntroductionSocietal costs of out-of-hospital cardiac arrest (OHCA) survivors may be extensive due to high health care utilization and sick leave. Knowledge of the costs of OHCA survivors may guide decision-makers to prioritize health resources. AimThe aims of the study were to evaluate the costs of OHCA survivors from a societal perspective, and to compare these costs to the costs of individuals with non-cardiac arrest myocardial infarction (MI) and individuals with no cardiac disease (non-CD). MethodsFrom the Danish OHCA Registers, survivors, with a cardiac arrest between 2005–2018 were identified. Each case was assigned one MI control and one non-CD control, matched on gender and age. Based on register data, costs of healthcare utilization, sick leave, vocational rehabilitation, disability pension and other social benefits one year before event and five years after, were estimated. ResultsIn total 5,646 OHCA survivors were identified with associated control groups. The mean costs for OHCA survivors during the 6-year period were €119,106 (95%CI: 116,297–121,916), with €83,472 (95%CI: 81,392–85,552) being healthcare costs. Mean costs of OHCA survivors were €49,132 higher than the MI-control group and €100,583 higher than the non-CD control group. ConclusionsTotal costs of OHCA survivors were considerably higher than costs of MI- and non-CD controls. Hospital costs were highest during the first year after event, and work inability during the second to fifth year with sick leave and later disability pension as main burdens.

Prediction of bleeding in labor in women with uterine scar as a tool to prevent massive blood loss: an observational cohort study

Background. Postpartum hemorrhage is recognized as a leading cause of maternal mortality and morbidity in the world. Predicting postpartum hemorrhage in high-risk patients with uterine scar enables preventive measures to be scheduled and costs of treatment and rehabilitation to be reduced.Objective. To determine antenatal predictors of high postpartum hemorrhage risk in pregnant women with uterine scar in order to improve the prevention of massive blood loss.Methods. An observational cohort study involves the medical records of 4494 maternity women with uterine scar (pregnancy and delivery histories) of the Perinatal Center of Regional Clinical Hospital No. 2, Krasnodar Krai. The study sample included data of maternity women coded O34.2 according to International Classification of Diseases, 10th Edition, for the period from 2017 to 2020. The sample participants were distributed into two groups depending on the blood loss during delivery, determined in compliance with clinical recommendations: a group of patients without massive blood loss during delivery and a group of patients with massive blood loss in labor/early postpartum period. The study was mainly focused on parameters of the prediction performance of bleeding in labor and early postpartum period in pregnant women with uterine scar using a multiparametric, logistic regression models. The study considered demographic data, comorbidity, obstetric history, pregnancy course, ultrasound data, and volume of blood loss at delivery. The performance of prediction for postpartum hemorrhage was calculated using multivariate binary logistic regression. Descriptive statistical analysis was carried out by means of statistical software package SPSS Version 26 (IBM, USA). Two-sided p-value &lt; 0.05 was taken as a statistically significant difference. A prognostic significance of predictors was determined by binary logistic regression. The Wald statistic was used to determine an observed significance. In order to define the performance of the model, the study involved calculating sensitivity, specificity, positive and negative predictive value, Nagelkerke coefficient of determination, as well as performing ROC analysis. The DeLong test was used for paired comparisons of ROC curves.Results. In the retrospective follow-up group (2017–2020) (n = 502), postpartum hemorrhage with massive blood loss occurred in 41 cases (8.17%). For the model based on clinical-anamnestic predictors, the prediction performance for postpartum hemorrhage comprised: sensitivity = 12.2% (95% confidence interval (CI) 4.1–26.2); specificity = 99.3% (95% CI 98.1–99.9); positive predictive value = 62.5% (95% CI 24.5–91.5); negative predictive value = 92.6% (95% CI 89.9–94.8); area under the ROC curve = 0.864 (95% CI 0.807–0.920), p &lt; 0.001. The prediction performance for the model based on three ultrasound predictors (asymmetry coefficient of placental thickness, uterine wall bulging in the scar and myometrial thickness in the placentation zone) comprised: sensitivity = 85.4% (95% CI 70.8–94.4); specificity = 98.5% (95% CI 96.9–99.4); positive predictive value = 83.3% (95% CI 68.6–93.0); negative predictive value = 98.7% (95% CI 97.2–99.5); area under the ROC curve = 0.919 (95% CI 0.855–0.983), p &lt; 0.001. No significant difference was revealed for the performance of the models ( p = 0.170). For the model based on ultrasound predictors and placenta previa, the prediction performance comprised: sensitivity = 85.4% (95% CI 70.8–94.4); specificity = 98.5% (95% CI 96.9–99.4); positive predictive value = 83.3% (95% CI 68.6–93.0); negative predictive value = 98.7% (95% CI 97.2–99.5); area under the ROC curve = 0.955 (95% CI 0.912–0.999), p &lt; 0.001. The model based on clinical-anamnestic and ultrasound indicators predicted postpartum hemorrhage with sensitivity equal to 85.4% (95% CI 70.8–94.4); specificity — 98.9% (95% CI 97.4–99.6); positive predictive value — 87.5% (95% CI 73.2–95.8); negative predictive value — 98.7% (95% CI 97.1–99.5); area under the ROC curve — 0.984 (95% CI 0.966–1.0), р &lt; 0,001. Thus, this model outperformed the model based on clinical-anamnestic data (p &lt; 0.001), based on ultrasound predictors (p = 0.006) and revealed no difference with the model considering placenta previa and ultrasound predictors (p = 0.127). Using prenatal prediction of postpartum hemorrhage based on ultrasound features, the incidence of massive blood loss at delivery decreased from 6.88/1000 deliveries (2019–2020) to 4.18/1000 deliveries (2021–2022) (p &lt; 0.001).Conclusion. Ultrasound predictors in pregnant women with uterine scar increase the sensitivity of antenatal prediction of postpartum hemorrhage based on the assessment of clinical and anamnestic risk factors, thereby enabling preventive measures to be scheduled in the risk group and incidence of massive blood loss to be reduced.

Avian Haemosporidian Infection in Wildlife Rehabilitation Centres of Portugal: Causes, Consequences, and Genetic Diversity.

In the last decade, over 40% of bird species in Europe have experienced poor and bad conservation status, with more than 30% of bird species in mainland Portugal threatened with extinction. Along with anthropogenic factors, parasites and pathogens such as avian haemosporidians have been suggested to be responsible for these avian population declines. Wildlife rehabilitation centres play an essential role in species conservation and preservation. Moreover, animals admitted for rehabilitation can provide valuable information regarding transmission and pathogenicity of many diseases that affect wild birds that are rarely sampled in nature. However, reports of haemosporidians in captive birds are still limited. Here, we explored the prevalence and genetic diversity of avian haemosporidians in 89 birds from 29 species admitted to rehabilitation centres in Portugal, showing an overall infection prevalence of 30.3%. The prevalence of infection was higher in Strigiformes and in birds admitted to rehabilitation centres due to debilitating diseases. Remarkably, 30% of the infected bird species have not been found to harbour malaria parasites in preceding studies. We detected 15 different haemosporidian lineages infecting a third of bird species sampled. Notably, 2 out of these 15 detected haemosporidian lineages have not been obtained previously in other studies. Furthermore, we also identified nine new host-parasite interactions representing new host records for these haemosporidian parasites. Finally, our results revealed that birds infected with haemosporidians require longer rehabilitation treatments, which increase the economic costs for rehabilitation and may impair their survival prospects. These findings emphasise the importance of integrating haemosporidian infection considerations into rehabilitation protocols, highlighting the challenges posed by these infections in avian conservation and rehabilitation, including economic and logistical demands.

Modeling life expectancy and cost effectiveness for UHPC bridge retrofitting techniques

Bridge components are subject to both structural loads and environmental stressors, rendering them susceptible to accelerated deterioration and potential collapse in the absence of effective maintenance and rehabilitation strategies. Moreover, the phenomenon of wet-dry cycling, coupled with elevated chloride concentrations prevalent in coastal regions, further expedites the degradation process of bridges, thereby escalating maintenance frequency and repair costs. In response to this challenge, the integration of innovative materials such as Ultra High-Performance Concrete (UHPC) is being explored for the development and implementation of maintenance and rehabilitation strategies. This study presents a comparative analysis between conventional methods and UHPC applications for bridge repairs, utilizing Life Cycle Cost Analysis (LCCA) to encompass both agency and user costs, and applies Monte Carlo simulation to account for the variability of the modeling factors. A practical case study illustrates the applicability of the LCCA methodology, revealing that the utilization of UHPC contributes to a reduction in the total life cycle cost for bridge maintenance and rehabilitation. Life expectancy, Average Daily Traffic (ADT), and the duration of construction activities during rehabilitation emerge as the most influential factors affecting life cycle costs. The main contributions of the study are the development of the life-expectancy model and step-by-step Life-Cycle Cost Analysis (LCCA) methodology. Findings from this study aim to identify cost-effective retrofitting techniques for maintaining bridges in a “State of Good Repair.”

Reducing hip and non-vertebral fractures in institutionalised older adults by restoring inadequate intakes of protein and calcium is cost-saving

Older adults in aged care homes account for 30% of the population burden of hip fractures(1). Nutritional interventions to correct protein and calcium inadequacies reduce these and other debilitating fractures, perhaps partly by reducing falls and slowing deterioration in bone morphology. We aimed to determine whether a nutritional approach to fracture risk reduction in aged care homes is cost-effective. Costing was estimated based on results of a prospective two-year cluster-randomised controlled trial involving 3313 residents in 27 aged care homes (intervention using high dairy menus), 3911 residents in 29 aged care homes (controls consuming from normal menus) and cost of ambulance, hospital, rehabilitation, and residential care incurred after fracture. The incremental cost-effectiveness ratios per fracture averted within a 2-year time horizon were estimated from the Australian healthcare perspective applying a 5% discount rate on costs after the first year. Intervention resulted in a total of 3.5 servings of milk, yoghurt and/or cheese daily, achieving 1,142mg calcium and 69g protein versus usual daily intakes of 700mg calcium and 58g protein consumed by controls. This intervention reduced all fractures by 33% at a daily cost of AU$0.66 per resident. The base-case results showed that intervention was cost-saving per fracture averted, with robust results in a variety of sensitivity and scenario analyses. Scaling the benefits of intervention to the Australian community equated to a saving of AU$66,780,000 annually in Australia and remained cost saving up to a daily food expenditure of AU$1.07 per aged care resident. Averting hip and other non-vertebral fractures in older adults in aged care homes by restoring nutritional inadequacies of protein and calcium is cost saving and supports the wide-spread implementation of this type of nutritional intervention in similar settings.