Cost Of Care For People Research Articles

The Cost of Diabetes Care-An Elephant in the Room.

Everyone dealing with health care today knows there is an elephant in the room, impossible to miss but frequently ignored—the cost of diabetes care. Although clinicians and scientists may wish to neglect the financial side of diabetes care and focus on less contentious and more familiar matters, this option is no longer viable. For people with diabetes and their families, the elephant stands in the way every day, and for those who plan health services and payment, it is a major concern. Fortunately, the scientific methods used in epidemiologic, clinical, and health services research can be applied to the economics of diabetes care. Collecting observations, identifying patterns, forming hypotheses, and prospectively testing the hypotheses can be just as relevant when one of the variables examined is the cost of care. It is the mission of Diabetes Care to present the best scientific studies related to diabetes. This issue of Diabetes Care has a special section focused on the economic impact of diabetes, including studies designed to understand it and to assess potential solutions. The American Diabetes Association (ADA) has previously reported the costs of diabetes in the U.S. for the years 2002 (1), 2007 (2), and 2012 (3). This issue of Diabetes Care includes a 2017 update (4). Because the methods used in these analyses are similar, comparisons are possible. The most noteworthy findings from the current report are the continuing increase and the remarkable magnitude of the total direct costs of diabetes in the U.S.: $116 billion in 2007, $176 billion in 2012, and $237 billion in 2017. The cost of care for people with diabetes now accounts for ∼1 in 4 health care dollars spent in the U.S. Care for a person with diabetes now costs an average of $16,752 per year. As in prior reports, the 2017 …

Prescribing for patients at the end of life

Approximately 550 000 people in the UK die each year, and mortality rates are set to rise. It is anticipated that the annual number of deaths per year in the UK will have increased by 17% by the year 2030. This rise is attributed largely to an aging population. The three main causes of death within the UK are circulatory disease, respiratory disease, and cancer (Office for National Statistics, 2017). The NHS plays a large part in the care of people who are dying; this care includes enabling people to choose where they would like to be in their last days of life. Place of death is particularly important to many people who receive a diagnosis of a terminal condition and research suggests that most people want to die at home—around 63%. Just 28% of people wish to die in a hospice, 8% in hospitals and 1% in nursing or residential care (Help the Hospices et al, 2013). The cost of caring for people at the end of life is financially expensive to the NHS but is indisputably a vital part of the patient and family's journey and the human cost when this is not achieved may be immeasurable. The financial cost to the NHS in the last 90 days of life can vary dependant on the care setting; however, on average, £4500 is spent on hospital stays per person, hospice care is estimated at around £550 per day and the average cost of community nurse visits is estimated at £278 per day (NHS Confederation, 2017).

The opportunity costs of caring for people with dementia in Southern Spain

ObjectiveThe aim of this paper is to study the opportunity costs (OC) that are involved in being a caregiver and to compare them with the direct costs assumed by the State and the families. We evaluate direct cost (those that imply a payment-out-of-pocket) and indirect cost (those that imply a dedication in time). We hypothesized that costs increase with the severity of the dementia, with the educational level and active occupational situation of caregiver. They are greater if the caregiver is male, but if the patient and caregiver cohabit they are reduced. Method778 surveys were analyzed. Data was collected using a questionnaire specifically designed for the purpose, with the collaboration of Alzheimer's Diseases Associations in Andalusia (Spain). For the indirect cost, we used the reveal preferences method. For the comparison between groups an ANOVA and a MANOVA was done. ResultsThe hypotheses were confirmed. The OC exponentially increases with severity. More than 55% of costs are assumed by families. Occupied people have higher educational level and incomes and contract more external support. Costs are significantly higher for male caregivers. Cohabiting reduces all kinds of costs. ConclusionsThe relationship between educational level and employment situation lead to think that if these variables are greater more people will seek professional support. Cultural reasons still maintain women as main caregivers for all educational levels. The existence of these informal caregivers as the main care providers is a saving for the State, and a brake for the development of professional supply.

Prevention and management of dementia: a priority for public health

Today, nearly 50 million people worldwide have dementia, with this figure projected to increase to 75 million by 2030 and to 132 million by 2050, 1 Prince M Wimo A Guerchet M Ali GC Wu YT Prina M World Alzheimer report 2015—the global impact of dementia: an analysis of prevalence, incidence, cost and trends. Alzheimer's Disease International, London2015 Google Scholar largely driven by population ageing. Dementia causes not only disability and dependency for individuals affected by the disorder, but can also have a profoundly detrimental effect on family and other carers, who are at high risk of developing depression and anxiety disorders. 2 Mahoney R Regan C Katona C Livingston G Anxiety and depression in family caregivers of people with Alzheimer disease: the LASER-AD study. Am J Geriatr Psychiatry. 2005; 13: 795-801 Summary Full Text Full Text PDF PubMed Scopus (311) Google Scholar The cost of caring for people with dementia is more than US$800 billion per year globally, rising to $2 trillion by 2030. 1 Prince M Wimo A Guerchet M Ali GC Wu YT Prina M World Alzheimer report 2015—the global impact of dementia: an analysis of prevalence, incidence, cost and trends. Alzheimer's Disease International, London2015 Google Scholar With no disease-modifying treatments for dementia currently available, health-care systems are in danger of becoming overwhelmed by the future costs of caring for people with dementia. Progress on dementia—leaving no one behindThe Lancet Commission Dementia Prevention, Intervention, and Care1 makes a timely evidence-driven contribution to global efforts to improve the lives of people with dementia and their carers, and limit the future impact on societies. The Commission proposes ambitious prevention targets, treatment of cognitive symptoms in people with Alzheimer's disease or dementia with Lewy bodies, individualised dementia care, provision of care for carers, planning for the future for patients and families, risk protection balanced with respect for autonomy, management of neuropsychiatric symptoms, consideration of dementia in end of life care, and use of technological innovations to improve care but not replace social contact. Full-Text PDF Dementia prevention, intervention, and careActing now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and in doing so, will transform the future for society. Full-Text PDF

The cost of care homes for people with dementia in England: a modelling approach.

To examine the cost of care for people with dementia in institutional care settings, to understand the major cost drivers and to highlight opportunities for service development. Data on 277 residents with dementia in 16 UK residential or nursing homes were collected. We estimated care and support costs and fitted models to the data. Sensitivity analyses were also conducted. Care home residents cost £792 weekly: 95% of the costs accounted for by direct fees. Hospital contacts contributed the largest proportion of the additional costs. Having an established diagnosis of dementia (b = 0.070; p < 0.05) was associated with higher costs. No association was found between cost and needs (b = -0.002; p = 0.818). The absence of an association between cost and needs emphasizes the importance of a more needs-based costing system which could result in clinical and economic advantages. Copyright © 2016 John Wiley & Sons, Ltd.

Evaluating the costs and cost-effectiveness of interventions for people with learning disabilities and behaviour that challenges: the need to improve the evidence base

Purpose The purpose of this paper is to provide a commentary on the challenges associated with evaluating the costs and cost-effectiveness of interventions for people with learning disabilities and behaviour that challenges. Design/methodology/approach The paper is a commentary on a range of evidence relating to the findings of “Positive behavioural support for children and adolescents with learning disabilities: an initial exploration of service and costs”. Specific attention is paid to gaps in the literature and the evidence base for the cost of care for people with learning disabilities and behaviour that challenges. Findings Recommendations for person-centred support and increased use of behavioural and psychological interventions for people with learning disabilities and behaviour that challenges are based on limited evidence. The literature is particularly sparse in relation to the cost implications for service providers or informal carers of implementing such interventions and the question of whether they reduce costs through preventing residential placements and long-term inpatient admissions. Originality/value More high-quality research is required in the area of behavioural and psychological interventions for people with learning disabilities and behaviour that challenges. Trials in this area should include high-quality economic evaluations including budget impact analysis to provide information on the cost implications for different government agencies and cost-effectiveness analysis incorporating impact on quality of life.

Utilisation patterns and cost of hospital care for people living with HIV in Ireland in 2012: a single-centre study.

Data on the pattern and cost of health service use by HIV patients are required for evaluations of the cost-effectiveness of new drugs and technologies as well as being essential for service planning. The aim of this study was to identify the utilisation patterns and cost of hospital care for HIV patients in a single centre in Ireland in 2012. Data on the frequency and non-drug costs of all hospital resources used by HIV patients were extracted from a hospital activity-based costing system. Cost data were analysed using a generalised linear model. A total of 328 patients, 3672 patient months, were included in this study. Patients had a mean of 4.4 scheduled infectious disease outpatient appointments per patient year; 37% of patients also used another outpatient service, 15% in-patient services, 4% day-case service and 18% emergency department services in 2012. Patients with very advanced HIV disease continue to incur a disproportionate amount of the total cost of providing care. This study provides baseline utilisation and cost data for use of both infectious-disease and non-infectious disease hospital services and will be useful for service planning in light of the likely increases in resource demands.

What is the potential for improving care and lowering cost for persons with dementia?

The increasing prevalence of dementia with population aging has heightened interest in understanding patterns of utilization and health expenditures in persons with dementia (PWD) among policy officials, practicing physicians, and health system. While a substantial part of this interest is concerned with the high costs of care for people diagnosed with dementia (Kelley et al., 2015), less attention has been focused on the costs and consequences of missed or delayed diagnosis in those who screen positive for dementia. The article on "Healthcare resource utilization and cost in dementia: are there differences between patients screened positive for dementia with and those without a formal diagnosis of dementia in primary care in Germany?" by Michalowsky and colleagues (Michalowsky et al., 2015) in this issue makes a particularly important contribution in this regard.

Direct and indirect costs and resource use in dementia care: A cross-sectional study in patients living at home

BackgroundDue to the high prevalence of dementia, health care needs are increasing beyond existing formal resources. In Spain, it is the family that takes care of this disease. AimsTo analyze the direct (health and non-health) and indirect economic costs related to care of people with dementia living with their informal caregiver in the home care/community environment, from the perspective of illness severity, associated comorbidity and social impact. DesignMulticentric, descriptive study. SettingThree primary care public health centers associated with Hospital Clínic, Barcelona (Spain). ParticipantsPatients over 65 years old with a diagnosis of dementia, and included in a home care program. Inclusion criteriaPeople with a diagnosis of dementia made by a specialist neurologist; aged 65 years or older; a score ≤24 on the Mini-Mental State Examination, and identification of an informal caregiver. Exclusion criteriaPatients unable to identify an informal caregiver, and those with primary psychiatric pathology or Korsakoff's syndrome. MeasurementsUse of Resources in Dementia to assess costs; Mini-Mental State Examination to evaluate cognitive capacity; Katz-Index to measure functional capacity; Neuropsychiatric Index for neuropsychiatric symptoms, and the Charlson-Index for comorbidity. Data collection took place between November, 2010 and April, 2012. ResultsThe average estimated monthly care costs for people with dementia in the home setting are 1956.2€ (SD 1463.9). Informal care was the major contributor to this with a mean estimated cost of 1214.86 (SD 902.68)€/month. Greater illness severity, dependency in activities of daily living, comorbidity and behavioral disturbance are associated with higher costs. Behavioral disturbance appeared as the only factor independently associated with cost in dementia care. The group of people with dementia with severe behavioral disturbance requires the most care resources with an average cost of 2545.2 (SD 1753.2)€/month. ConclusionsThere is a direct association between dementia severity and increased costs. In addition, informal caregivers looking after people with dementia in Spain represent an important social cost. The independent factor associated with an increase in the total costs of patient care was neuropsychiatric symptoms.

Estimating the cost of caring for people with cancer at the end of life: A modelling study

Background: People with advanced cancer require a range of health, social and informal care during the final phases of life. The cost of providing care to this group as they approach the end of their lives is unknown, but represents a significant cost to health and social care systems, charities patients and their families. Aim: In this study, we estimate the direct and indirect costs for lung, breast, colorectal and prostate cancer patients at the end of life (from the start of strong opioids to death) in England and Wales. Methods: We use a modelling-based approach to estimate the costs of care. Data are estimated from the literature and publicly available data sets. Probabilistic sensitivity analysis is used to reflect uncertainty in model estimates. Results: Total estimated costs for treating people with these four cancers at the end of life are £641 million. Breast and prostate cancer patients have the highest expected cost per person at £12,663 (95% credible interval (CI): £1249–£38,712) and £14,859 (95% CI: £1391–£46,424), respectively. Lung cancer has the highest expected total cost (£226m). The value of informal care giving accounts for approximately one-third of all costs. Conclusion: The cost to society of providing care to people at the end of their lives is significant. Much of this cost is borne by informal care givers. The cost to formal care services of replacing this care with paid care giving would be significant and demand for care will increase as the demographic profile of the population ages.

Longitudinal costs of caring for people with Alzheimer's disease.

There has been an increasing interest in the relationship between severity of disease and costs in the care of people with dementia. Much of the current evidence is based on cross-sectional data, suggesting the need to examine trends over time for this important and growing cohort of the population. This paper estimates resource use and costs of care based on longitudinal data for 72 people with dementia in Ireland. Data were collected from the Enhancing Care in Alzheimer's Disease (ECAD) study at two time points: baseline and follow-up, two years later. Patients' dependence on others was measured using the Dependence Scale (DS), while patient function was measured using the Disability Assessment for Dementia (DAD) scale. Univariate and multivariate analysis were used to explore the effects of a range of variables on formal and informal care costs. Total costs of formal and informal care over six months rose from €9,266 (Standard Deviation (SD): 12,947) per patient at baseline to €21,266 (SD: 26,883) at follow-up, two years later. This constituted a statistically significant (p = 0.0014) increase in costs over time, driven primarily by an increase in estimated informal care costs. In the multivariate analysis, a one-point increase in the DS score, that is a one-unit increase in patient's dependence on others, was associated with a 19% increase in total costs (p = 0.0610). Higher levels of dependence in people with Alzheimer's disease are significantly associated with increased costs of informal care as the disease progresses. Formal care services did not respond to increased dependence in people with dementia, leaving it to families to fill the caring gap, mainly through increased supervision with the progress of disease.

Diabetic Kidney Disease: A Report From an ADA Consensus Conference

The incidence and prevalence of diabetes mellitus have grown significantly throughout the world, due primarily to the increase in type 2 diabetes. This overall increase in the number of people with diabetes has had a major impact on development of diabetic kidney disease (DKD), one of the most frequent complications of both types of diabetes. DKD is the leading cause of end-stage renal disease (ESRD), accounting for approximately 50% of cases in the developed world. Although incidence rates for ESRD attributable to DKD have recently stabilized, these rates continue to rise in high-risk groups such as middle-aged African Americans, Native Americans, and Hispanics. The costs of care for people with DKD are extraordinarily high. In the Medicare population alone, DKD-related expenditures among this mostly older group were nearly $25 billion in 2011. Due to the high human and societal costs, the Consensus Conference on Chronic Kidney Disease and Diabetes was convened by the American Diabetes Association in collaboration with the American Society of Nephrology and the National Kidney Foundation to appraise issues regarding patient management, highlighting current practices and new directions. Major topic areas in DKD included (1) identification and monitoring, (2) cardiovascular disease and management of dyslipidemia, (3) hypertension and use of renin-angiotensin-aldosterone system blockade and mineralocorticoid receptor blockade, (4) glycemia measurement, hypoglycemia, and drug therapies, (5) nutrition and general care in advanced-stage chronic kidney disease, (6) children and adolescents, and (7) multidisciplinary approaches and medical home models for health care delivery. This current state summary and research recommendations are designed to guide advances in care and the generation of new knowledge that will meaningfully improve life for people with DKD.

Service utilisation and family support of people with dementia: a cohort study in England.

This study aimed to compare costs of caring for people with dementia in domiciliary and residential settings, central England. A cohort of people with dementia was recruited during a hospital stay 2008-2010. Data were collected by interview at baseline, and 6- and 12-month follow-up, covering living situation (own home with or without co-resident carer, care home); cognition, health status and functioning of person with dementia; carer stress; utilisation of health and social services; and informal (unpaid) caring input. Costs of formal services and informal caring (replacement cost method) were calculated. Costs of residential and domiciliary care packages were compared. Data for 109 people with dementia were collected at baseline; 95 (87.2%) entered hospital from their own homes. By 12 months, 40 (36.7%) had died and 85% of the survivors were living in care homes. Over one-half of people with dementia reported social care packages at baseline; those living alone had larger packages than those living with others. Median caring time for co-resident carers was 400 min/day and 10 h/week for non co-resident carers. Residential care was more costly than domiciliary social care for most people. When the value of informal caring was included, the total cost of domiciliary care was higher than residential care, but not significantly so. Carer stress reduced significantly after the person with dementia entered a care home. Caring for people with dementia at home may be more expensive, and more stressful for carers, than care in residential settings.

Does Change in Cognitive Function Predict Change in Costs of Care for People With a Schizophrenia Diagnosis Following Cognitive Remediation Therapy?

Background and Aims: Schizophrenia leads to significant personal costs matched by high economic costs. Cognitive function is a strong predictor of disabilities in schizophrenia, which underpin these costs. This study of cognitive remediation therapy (CRT), which has been shown to improve cognition and reduce disability in schizophrenia, aims to investigate associations between improvements in cognition and cost changes. Methods: Eighty-five participants with schizophrenia were randomized to receive CRT or treatment as usual and were assessed at baseline, posttherapy, and 6 month follow-up. Four structural equation models investigated associations between changes in cognitive function and costs of care. Results: All 4 models provided a good fit. Improvement in 3 individual cognitive variables did not predict total cost changes (model 1). But improvement in a single latent cognition factor was associated with a reduction in depression, which in turn was associated with reduced subsequent total costs (model 2). No significant associations with constituent daycare and special accommodation cost changes were apparent with 3 individual cognitive change variables (model 3). But improvement in a single latent cognitive change variable was associated with subsequent reductions in both daycare and special accommodation costs (model 4). Conclusion: This study exemplifies a method of using cost changes to investigate the effects and mechanisms of CRT and suggests that executive function change may be an important target if we are to reduce disability and resultant health and social care costs.

Activating People to Address Their Health Care Needs: Learning from People with Lived Experience of Chronic Illnesses

One of the primary goals of health care reform is improving the quality and reducing the costs of care for people with co-morbid mental health and physical health conditions. One strategy is to integrate primary and behavioral health care through care coordination and patient activation. This qualitative study using community based participatory research methods informs the development of integrated care by presenting the perspectives of those with lived experience of chronic illnesses and homelessness. Themes presented include the internal and external barriers to addressing health needs and the key role of peer support in overcoming these barriers.

Health care costs in people with diabetes and their association with glycemic control and kidney function.

OBJECTIVETo determine the association between laboratory-derived measures of glycemic control (HbA1c) and the presence of renal complications (measured by proteinuria and estimated glomerular filtration rate [eGFR]) with the 5-year costs of caring for people with diabetes.RESEARCH DESIGN AND METHODSWe estimated the cumulative 5-year cost of caring for people with diabetes using a province-wide cohort of adults with diabetes as of 1 May 2004. Costs included physician visits, hospitalizations, ambulatory care (emergency room visits, day surgery, and day medicine), and drug costs for people >65 years of age. Using linked laboratory and administrative clinical and costing data, we determined the association between baseline glycemic control (HbA1c), proteinuria, and kidney function (eGFR) and 5-year costs, controlling for age, socioeconomic status, duration of diabetes, and comorbid illness.RESULTSWe identified 138,662 adults with diabetes. The mean 5-year cost of diabetes in the overall cohort was $26,978 per patient, excluding drug costs. The mean 5-year cost for the subset of people >65 years of age, including drug costs, was $44,511 (Canadian dollars). Cost increased with worsening kidney function, presence of proteinuria, and suboptimal glycemic control (HbA1c >7.9%). Increasing age, Aboriginal status, socioeconomic status, duration of diabetes, and comorbid illness were also associated with increasing cost.CONCLUSIONSThe cost of caring for people with diabetes is substantial and is associated with suboptimal glycemic control, abnormal kidney function, and proteinuria. Future studies should assess if improvements in the management of diabetes, assessed with laboratory-derived measurements, result in cost reductions.

Development of DEMQOL-U and DEMQOL-PROXY-U: generation of preference-based indices from DEMQOL and DEMQOL-PROXY for use in economic evaluation

Dementia is one of the most common and serious disorders in later life and the economic and personal cost of caring for people with dementia is immense. There is a need to be able to evaluate interventions in dementia using cost-effectiveness analyses, but the generic preference-based measures typically used to measure effectiveness do not work well in dementia. Existing dementia-specific measures can effectively measure health-related quality of life but in their current form cannot be used directly to inform cost-effectiveness analysis using quality-adjusted life-years as the measure of effectiveness. The aim was to develop two brief health-state classifications, one from DEMQOL and one from DEMQOL-Proxy, to generate health states amenable to valuation. These classification systems consisted of items taken from DEMQOL and DEMQOL-Proxy so they can be derived from any study that has used these instruments. In the first stage of the study we used a large, clinically representative sample aggregated from two sources: a sample of patients and carers attending a memory service in south London and a sample of patients and carers from other community services in south London. This included 644 people with a diagnosis of mild/moderate dementia and 689 carers of those with mild/moderate dementia. For the valuation study, the general population sample of 600 respondents was drawn to be representative of the UK general population. Households were sampled in urban and rural areas in northern England and balanced to the UK population according to geodemographic profiles. In the patient/carer valuation study we interviewed a sample of 71 people with mild dementia and 71 family carers drawn from a memory service in south London. Finally, the instruments derived were applied to data from the HTA-SADD (Study of Antidepressants for Depression in Dementia) trial. This was a complex multiphase study with four linked phases: phase 1 - derivation of the health-state classification system; phase 2 - general population valuation survey and modelling to produce values for every health state; phase 3 - patient/carer valuation survey; and phase 4 - application of measures to trial data. All four phases were successful and this report details this development process leading to the first condition-specific preference-based measures in dementia, an important new development in this field. The first limitation relates to the lack of an external data set to validate the DEMQOL-U and DEMQOL-Proxy-U classification systems. Throughout the development process we have made decisions about which methodology to use. There are other valid techniques that could be used and it is possible to criticise the choices that we have made. It is also possible that the use of a mild to moderate dementia sample has resulted in classification systems that do not fully reflect the challenges of severe dementia. The results presented are sufficiently encouraging to recommend that the DEMQOL instruments be used alongside a generic measure such as the European Quality of Life-5 Dimensions (EQ-5D) in future studies of interventions in dementia as there was evidence that they can be more sensitive for patients at the milder end of disease and some limited evidence that the person with dementia measure may be able to reflect deterioration. The National Institute for Health Research Health Technology Assessment programme.

Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial

BackgroundAssistive technology and telecare (ATT) are relatively new ways of delivering care and support to people with social care needs. It is claimed that ATT reduces the need for community care, prevents unnecessary hospital admission, and delays or prevents admission into residential or nursing care. The current economic situation in England has renewed interest in ATT instead of community care packages. However, at present, the evidence base to support claims about the impact and effectiveness of ATT is limited, despite its potential to mitigate the high financial cost of caring for people with dementia and the social and psychological cost to unpaid carers.Method/designATTILA (Assistive Technology and Telecare to maintain Independent Living At Home for People with Dementia) is a pragmatic, multi-centre, randomised controlled trial over 104 weeks that compares outcomes for people with dementia who receive ATT and those who receive equivalent community services but not ATT. The study hypothesis is that fewer people in the ATT group will go into institutional care over the 4-year period for which the study is funded. The study aims to recruit 500 participants, living in community settings, with dementia or significant cognitive impairment, who have recently been referred to social services.Primary outcome measures are time in days from randomisation to institutionalisation and cost effectiveness. Secondary outcomes are caregiver burden, health-related quality of life in carers, number and severity of serious adverse events, and data on acceptability, applicability and reliability of ATT intervention packages. Assessments will be undertaken in weeks 0 (baseline), 12, 24, 52 and 104 or until institutionalisation or withdrawal of the participant from the trial.DiscussionIn a time of financial austerity, CASSRs in England are increasingly turning to ATT in the belief that it will deliver good outcomes for less money. There is an absence of robust evidence for the cost-effectiveness and benefit of using assistive technology and telecare. The ATTILA trial meets a pressing need for robust, generalisable evidence to either justify continuing investment or reappraise the appropriate scale of ATT use.Trial registrationCurrent Controlled Trials ISRCTN86537017

Imaging techniques in oncology

Identifying and diagnosing cancerous diseases is currently one of the main tasks of today’s radiologist. Every year cancer is diagnosed worldwide in over 12 million people. Within a single year, 7 million people die from cancer worldwide. The most commonly diagnosed cancers are lung, breast, and colorectal cancers. The most common causes of cancer death are lung, stomach, and liver cancers. Besides identifying primary tumours, it is also very important that radiology identifies possible metastases in other organs such as the liver, bones, brain, etc. at an early stage. Today all this information is gained using imaging techniques. The radiologist thus plays an important part in the treatment of people suffering from cancer. A further important task of the radiologist using imaging techniques is judging whether oncological treatment of the tumour’s course has to be initiated. In this way, the radiologist is able to make a statement as to whether the targeted oncological therapy has achieved its goal or whether in the absence of a response it has to be further adjusted. The total medical care costs for people with cancer are approximately 20% higher than those for heart or vascular diseases, which are the second leading causes of global health costs. These high costs, however, arise as the result of many different factors such as costs of medication and the various therapy options, nursing care, and a lesser proportion also due to the application of radiological techniques. The radiologist has many different techniques at his disposal to identify neoplasias within the body. In principle, there are techniques using or not using X-rays.

Yoga for Chronic Low Back Pain: New Evidence in 2011

Copyright: © 2012 Groessl EJ. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Chronic low back pain is a highly prevalent [1], and is typically defined as back pain lasting greater than 4 weeks [2]. In addition to pain itself, chronic low back pain also results in increased psychological symptoms [3,4], increased disability, [5] and reduced health-related quality of life (HRQOL) [6,7]. Subsequently, the health care costs of people with chronic low back pain are 60% higher than those without back pain[8], and the total economic impact (socioeconomic costs and health care costs) was an estimated $100 billion annually as of 2008 [9].