Disability Costs Research Articles

Impact of headache frequency and preventive treatment failure on quality of life, disability, and direct and indirect costs among individuals with episodic migraine in the United States.

To evaluate unmet needs among individuals with episodic migraine (EM) in the United States (US). Data are limited on the impact of headache frequency (HF) and preventive treatment failure (TF) on the burden of migraine in the US. A retrospective, cross-sectional analysis of 2019 National Health and Wellness Survey (NHWS) data was conducted from an opt-in online survey that identified respondents (aged ≥18 years) in the US with self-reported physician-diagnosed migraine. Participants were stratified by HF (low: 0-3 days/month; moderate-to-high: 4-14 days/month) and prior preventive TF (preventive naive; 0-1 TF; ≥2 TFs). Comparisons were conducted between preventive TF groups using multivariable regression models controlling for patient demographic and health characteristics. Among individuals with moderate-to-high frequency EM, the NHWS identified 397 with ≥2 TFs, 334 with 0-1 TF, and 356 as preventive naive. The 36-item Short-Form Health Survey (version 2) Physical Component Summary scores were significantly lower among those with ≥2 TFs, at a mean (standard error [SE]) of 41.4 [0.8] versus the preventive-naive 46.8 [0.9] and 0-1 TF 44.5 [0.9] groups; p < 0.001 for both). Migraine Disability Assessment Scale scores were significantly higher in the ≥2 TFs, at a mean (SE) of 37.7 (3.9) versus preventive-naive 26.8 (2.9) (p < 0.001) and 0-1 TF 30.1 (3.3) (p = 0.011) groups. The percentages of time that respondents experienced absenteeism (mean [SE] 21.6% [5.5%] vs. 13.4% [3.6%]; p = 0.022), presenteeism (mean [SE] 55.0% [8.3%] vs. 40.8% [6.5%]; p = 0.015), overall work impairment (mean [SE] 59.4% [5.6%] vs. 45.0% [4.4%]; p < 0.001), and activity impairment (mean [SE] 56.8% [1.0%] vs. 44.4% [0.9%]; p < 0.001) were significantly higher in the ≥2 TFs versus preventive-naive group. Emergency department visits (preventive-naive, p = 0.006; 0-1 TF, p = 0.008) and hospitalizations (p < 0.001 both) in the past 6 months were significantly higher in the ≥2 TFs group. Direct and indirect costs were significantly higher in the ≥2 TFs (mean [SE] $24,026 [3460]; $22,074 [20]) versus 0-1 TF ($10,897 [1636]; $17,965 [17]) and preventive-naive ($11,497 [1715]; $17,167 [17]) groups (p < 0.001 for all). Results were similar in the low-frequency EM group. In this NHWS analysis, individuals with more prior preventive TFs experienced significantly higher humanistic and economic burden regardless of HF.

Osteoarthritis and social disadvantage interactions: retrospective overview and emergent findings and health implications

Osteoarthritis, a widespread arthritic disease commonly resulting in considerable pain and functional disability is often found to vary among those deemed affected. While age, gender, and genetics commonly explain this, what does the research show specifically in terms of extrinsic factors such as social disadvantage? This report aimed to update what is known about the social context and its role as a possible remediable osteoarthritis disability determinant if suboptimal. Using the PUBMED data base and others, osteoarthritis studies published between January 1, 2000 and March 20, 2024 concerning possible social disadvantage linkages were sought and carefully examined. As well, data drawn from the researcher’s repository were reviewed. The search results revealed a growing interest in this topic where osteoarthritis can be observed to be negatively influenced in the face of one or more forms of social deprivation. Yet, very few clinical trials prevail to either test the validity of this idea or apply these understandings to preventing suffering. In light of the increasing osteoarthritis burden, despite years of research, it appears that to maximize wellbeing for all, and to limit or obviate unwanted osteoarthritis associated health and disability costs, more resounding research along with a focus on advancing social equity and mitigating all forms of social deprivation is strongly indicated.

The Healthcare and Societal Costs of Familial Intellectual Disability.

Most of the studies on the cost of intellectual disability are limited to a healthcare perspective or cohorts composed of individuals where the etiology of the condition is a mixture of genetic and non-genetic factors. When used in policy development, these can impact the decisions made on the optimal allocation of resources. In our study, we have developed a static microsimulation model to estimate the healthcare, societal, and lifetime cost of individuals with familial intellectual disability, an inheritable form of the condition, to families and government. The results from our modeling show that the societal costs outweighed the health costs (approximately 89.2% and 10.8%, respectively). The lifetime cost of familial intellectual disability is approximately AUD 7 million per person and AUD 10.8 million per household. The lifetime costs to families are second to those of the Australian Commonwealth government (AUD 4.2 million and AUD 9.3 million per household, respectively). These findings suggest that familial intellectual disability is a very expensive condition, representing a significant cost to families and government. Understanding the drivers of familial intellectual disability, especially societal, can assist us in the development of policies aimed at improving health outcomes and greater access to social care for affected individuals and their families.

Global, regional, and national burden of neck pain, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

Neck pain is a highly prevalent condition that leads to considerable pain, disability, and economic cost. We present the most current estimates of neck pain prevalence and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) by age, sex, and location, with forecasted prevalence to 2050. Systematic reviews identified population-representative surveys used to estimate the prevalence of and YLDs from neck pain in 204 countries and territories, spanning from 1990 to 2020, with additional data from opportunistic review. Medical claims data from Taiwan (province of China) were also included. Input data were pooled using DisMod-MR 2.1, a Bayesian meta-regression tool. Prevalence was forecast to 2050 using a mixed-effects model using Socio-demographic Index as a predictor and multiplying by projected population estimates. We present 95% UIs for every metric based on the 2·5th and 97·5th percentiles of 100 draws of the posterior distribution. Globally, in 2020, neck pain affected 203 million (95% uncertainty interval [UI] 163-253) people. The global age-standardised prevalence rate of neck pain was estimated to be 2450 (1960-3040) per 100 000 population and global age-standardised YLD rate was estimated to be 244 (165-346) per 100 000. The age-standardised prevalence rate remained stable between 1990 and 2020 (percentage change 0·2% [-1·3 to 1·7]). Globally, females had a higher age-standardised prevalence rate (2890 [2330-3620] per 100 000) than males (2000 [1600-2480] per 100 000), with the prevalence peaking between 45 years and 74 years in male and female sexes. By 2050, the estimated global number of neck pain cases is projected to be 269 million (219-322), with an increase of 32·5% (23·9-42·3) from 2020 to 2050. Decomposition analysis of the projections showed population growth was the primary contributing factor, followed by population ageing. Although age-standardised rates of neck pain have remained stable over the past three decades, by 2050 the projected case numbers are expected to rise. With the highest prevalence in older adults (higher in females than males), a larger effect expected in low-income and middle-income countries, and a rapidly ageing global population, neck pain continues to pose a challenge in terms of disability burden worldwide. For future planning, it is essential we improve our mechanistic understanding of the different causes and risk factors for neck pain and prioritise the consistent collection of global neck pain data and increase the number of countries with data on neck pain. Bill & Melinda Gates Foundation and Global Alliance for Musculoskeletal Health.

Incorporating Wearable Technology for Enhanced Rehabilitation Monitoring after Hip and Knee Replacement.

Osteoarthritis (OA) poses a growing challenge for the aging population, especially in the hip and knee joints, contributing significantly to disability and societal costs. Exploring the integration of wearable technology, this study addresses the limitations of traditional rehabilitation assessments in capturing real-world experiences and dynamic variations. Specifically, it focuses on continuously monitoring physical activity in hip and knee OA patients using automated unsupervised evaluations within the rehabilitation process. We analyzed data from 1144 patients who used a mobile health application after surgery; the activity data were collected using the Garmin Vivofit 4. Several parameters, such as the total number of steps per day, the peak 6-minute consecutive cadence (P6MC) and peak 1-minute cadence (P1M), were computed and analyzed on a daily basis. The results indicated that cadence-based measurements can effectively, and earlier, differ among patients with hip and knee conditions, as well as in the recovery process. Comparisons based on recovery status and type of surgery reveal distinctive trajectories, emphasizing the effectiveness of P6MC and P1M in detecting variations earlier than total steps per day. Furthermore, cadence-based measurements showed a lower inter-day variability (40%) compared to the total number of steps per day (80%). Automated assessments, including P1M and P6MC, offer nuanced insights into the patients' dynamic activity profiles.

Goodbye to PIP, but hello to what? Disability, social security, devolution and policy change in Scotland

The Scottish Government has ambitions to build a new social security system in Scotland with new powers over social security. With the ability to now entirely replace the UK’s Personal Independence Payment, highly controversial for the way it has narrowed entitlement and made the process of applying stressful, the Scottish Government has the opportunity to transform both the experience of disabled people in applying for social security and ensure that what is paid more accurately reflects the costs of disability. However, while significant improvements to the process of applying appear to have been made and these are having a positive impact on access to payment, the Scottish Government’s gradualist approach has also put off by some years more fundamental improvements.

A new innovative method to measure the cost of war: future with fewer conflicts via harm reduction approaches

BackgroundThe destruction of World War I (WWI) and World War II (WWII) changed the world forever. In this analysis, the economic costs of WWI and WWII are considered via a harm reduction approach to highlight the cost of war via the mortality of military personnel. The harm reduction philosophy and homeostasis of a biological cell are utilized as a pragmatic approach and analogy to give a greater context to the findings, despite the omission of civilian casualties and military disabilities.MethodsTangible (e.g., loss of wages, productivity, and contributions) and intangible (e.g., quality of life) costs are estimated based on the value of each military personnel derived from secondary data and a mathematical model. This is the first study to estimate the cost of war based on soldier’s mortality during the first and second World War.ResultsBased on the tangible value, the WWI and WWII cost for the military personnel was US$43.204 billion ($13 billion ≤ α ≤ $97 billion) and US$540.112 billion ($44 billion ≤ α ≤ $1 trillion). When the intangible cost is considered, it is estimated that the WWI cost was beyond US$124 trillion ($43 trillion ≤ β ≤ $160 trillion), and the WWII cost was above US$328 trillion ($115 trillion ≤ β ≤ $424 trillion). The sensitivity analyses conducted for WWI and WWII demonstrate different ranges based on tangible and intangible values.ConclusionsIn the current climate of increasing hostilities, inequalities, global warming, and an ever-changing world, economic prosperities are directly linked to peace, stability, and security. Therefore, any future decisions for military conflicts need to increasingly consider harm reduction approaches by considering the cost of life and potential disabilities for each nations’ soldiers, sailors, and pilots.

Do urinary and double incontinence predict changes in living arrangements and mobility in older women after hip fracture? – a 1-year prospective cohort study

BackgroundContinence problems are known to be associated with disability in older adults. Costs of disability and resulting need for more supported living arrangements are high after a hip fracture. The aim was to examine pre-fracture urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) as predictors of changes in mobility and living arrangements in older female hip fracture patients in a 1-year follow-up.MethodsStudy population comprised 1,675 female patients aged ≥ 65 (mean age 82.7 ± 6.8) sustaining their first hip fracture between 2007–2019. Data on self-reported pre-fracture continence status was collected. The outcomes were declined vs. same or improved mobility level and need for more assisted vs same or less assisted living arrangements 1-year post-fracture. Separate cohorts of 1,226 and 1,055 women were generated for the mobility and living arrangements outcomes, respectively. Age- and multivariable-adjusted logistic regression models were used to determine the associations of UI, DI, and other baseline characteristics with the outcomes.ResultsOf the patients, 39% had declined mobility or more assisted living arrangements at 1-year follow-up. Adjusting for age, both pre-fracture UI and DI were associated with changes in mobility and living arrangements. In the multivariable analysis, UI (OR 1.88, 95% CI 1.41–2.51) and DI (1.99, 95% CI 1.21–3.27) were associated with decline in mobility level while only DI (OR 2.40, 95% CI 1.22–4.75) remained associated with the need for more assisted living arrangements.ConclusionsBoth pre-fracture UI and DI in older women are risk factors for declining mobility level, but only DI for more supported living arrangements 1-year post-hip fracture. UI likely develops earlier in life and might not necessarily be strongly associated with the onset or increasing disability in later years. DI may indicate more marked vulnerability and burden to patients as well as to formal and informal caregivers.

Physiotherapists’ barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice in patients at risk of recurrence of low back pain: a qualitative study

BackgroundRecurrences of low back pain (LBP) are frequent and associated with high levels of disability and medical costs. Regular exercise practice may be an effective strategy to prevent recurrences of LBP, however, the promotion of this behaviour by physiotherapists seems to be challenging. This study aims to explore physiotherapists’ perceived barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice by patients at risk of recurrence of low back pain.MethodsTwo focus groups with primary healthcare physiotherapists were conducted, based on a semi-structured interview schedule informed by the Behaviour Change Wheel, including the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). All focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis, using a coding matrix based on the COM-B and TDF, was performed by two independent researchers. A third researcher was approached to settle disagreements.ResultsIn total, 14 physiotherapists participated in the focus groups. The analysis revealed a total of 13 barriers (4 COM-B components and 7 TDF domains) and 23 facilitators (5 COM-B and 13 TDF) to physiotherapists’ implementation of a behaviour change-informed exercise intervention. The most common barriers were the lack of skills and confidence to implement the proposed intervention. These were explained by the fact that it differs from the usual practice of most participants and requires the learning of new skills applied to their contexts. However, for those who had already implemented other similar interventions or whose rationale is aligned with the new intervention, there seemed to exist more positive determinants, such as potential benefits for physiotherapists and the profession, improvement of quality of care and willingness to change clinical practice. For others who did not previously succeed in implementing these types of interventions, more context-related barriers were mentioned, such as lack of time to implement the intervention, schedule incompatibilities and lack of material and human resources.ConclusionsThis study identified modifiable barriers and facilitators to physiotherapists’ implementation of a behaviour change-informed exercise intervention for patients at risk of recurrence of LBP in primary healthcare. The findings of this study will allow the systematic and theory-based development of a behaviour change-informed training programme, aimed at physiotherapists and supporting the successful implementation of the exercise intervention.

Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing low back pain in Alberta, Canada.

Low back pain (LBP) is a common condition causing disability and high healthcare costs. Alberta faces challenges with unnecessary referrals to specialists and long wait times. A province-wide standardized clinical care pathway based on evidence-based best practices can improve efficiency, reduce wait times, and enhance patient outcomes. Implementing such pathways has shown success in other areas of healthcare in Alberta. This study developed a clinical decision-making pathway to standardize care and minimize uncertainty in assessment, diagnosis, and management. A systematic rapid review identified existing tools and evidence that could support a comprehensive LBP clinical decision-making tool. Forty-seven healthcare professionals participated in four rounds of a modified Delphi approach to reach consensus on the assessment, diagnosis, and management of patients presenting to primary care with LBP in Alberta, Canada. This project was a collaborative effort between Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJHSCN) and the Alberta Bone and Joint Health Institute (ABJHI). A province-wide expert panel consisting of professionals from different health disciplines and regions collaborated to develop an LBP clinical decision-making tool. This tool presents clinical care pathways for acute, subacute, and chronic LBP. It also provides guidance for history-taking, physical examination, patient education, and management. This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of LBP, and assist in clinical decision-making for primary care providers in both public and private sectors.

ECCO Fellowship Generation of an IBD single-cell multiome ATLAS for deeper understanding of IBD sub-phenotypes

Abstract Background and Aims Inflammatory Bowel Disease (IBD) is one of the most prevalent gastrointestinal diseases worldwide (1, 2, 3). Disabling symptoms affect the quality of life of IBD patients, and incurred disability and healthcare costs result in a high socio-economic burden (1, 4, 5). Despite new biologicals and small-molecule drugs, patients deal with high rates of non-response, requiring therapy switching without evidence-based guidance on optimal therapy choices for each specific disease condition. Methods In an effort to better understand the disease pathomechanisms underlying IBD, an essential role has been played by single-cell RNA sequencing (scRNAseq). Two scRNAseq studies, one in Crohn’s disease (CD) (Martin e.a., Cell 2019), and one in ulcerative colitis (UC) (Smillie e.a., Cell 2019), characterized the molecular and functional heterogeneity of phenotypically similar IBD cases, and gave us the first clues on the mechanism underlying non-response to anti-TNFa. However, the statistical power of these studies is limited due to their small cohort sizes (6, 7, 8). To acquire further insights into IBD, and to definitively establish the mechanism underlying anti-TNFa non-response without having to generate costly new single-cell experiments, we propose harmonizing smaller IBD scRNAseq studies and performing large-scale meta-analyses. Specifically, our goal is to start with meta-analyzing four IBD scRNAseq datasets (two CD, each ~100 ind, and two UC, each ~30 ind) and to perform a powerful meta-analysis. To easily add more datasets we will create a pipeline for integrating scRNAseq data. Anticipated Impact The large meta-analysis will allow us to get more insight into the mechanisms underlying disease subphenotypes, and to get insight into the effect of commonly used IBD therapies (anti-TNFa, thiopurines) on the gut mucosal composition and inflammatory pathways. The datasets and related results will be made publicly available through a single-cell IBD ATLAS web interface, fulfilling the need for an easily queryable large IBD scRNAseq dataset.

Economic evaluation of preventive cognitive therapy versus care as usual in cognitive behavioral therapy responders.

The highly recurrent nature of Major Depressive Disorder is a major contributor to disability and health care costs. Several studies indicate that recurrence may be prevented with Preventive Cognitive Therapy (PCT). This study is the first to perform an economic evaluation of PCT in comparison with care as usual for recurrently depressed patients who experienced two or more depressive episodes and remitted after receiving Cognitive Behavioural Therapy. An economic evaluation from the societal perspective was performed alongside a randomized trial (N = 214). Health-related quality of life (QALYs), depression-free days, health care utilization, and productivity losses were measured between randomization and 15 months follow-up. The costs were indexed to the reference year 2014. QALY gains did not differ significantly between the groups (p = 0.69). Depression-free days were higher after PCT (p = 0.02). Societal costs of PCT were 10,417 euro and for care as usual 9,545 euro per person. We found a 47% likelihood that PCT led to additional QALYs at higher costs, and there was a 26% likelihood that PCT led to fewer QALYs at higher costs. When depression-free days was used as an outcome, we found PCT had a 72% likelihood of leading to more depression-free days at higher costs than care as usual and a 27% likelihood of leading to more depression-free days at lower societal costs. The 15-month follow-up might be too short to draw long-term conclusions about the cost-effectiveness of the PCT. The data collected for this study is part of an RCT to examine the effectiveness of adding PCT to care as usual. Therefore, the study was powered primarily to detect an effect in time to relapse/recurrences. The economic evaluation is slightly in favour of the PCT condition when depression-free days is used as an outcome. PCT is not cost-effective given the high costs per additional QALYs from the societal perspective when QALYs are the effect measure. https://www.onderzoekmetmensen.nl/en, identifier NL2482.

Photobiomodulation Therapy Plus Usual Care Is Better than Usual Care Alone for Plantar Fasciitis: A Randomized Controlled Trial.

Plantar fasciitis (PF) results in pain-related disability and excessive healthcare costs. Photobiomodulation therapy (PBMT) has shown promise for decreasing both pain and disability related to PF. The purpose was to assess the clinical impact of PBMT on pain and function in people with PF. Prospective, randomized controlled clinical trial. A convenience sample of adults with PF were randomly assigned to one of three groups: (1) usual care, (2) usual care plus nine doses of PBMT with 25W output power over three weeks, or (3) usual care plus nine doses of PBMT with 10W output power over three weeks. Both 10W and 25W PBMT participants received the same total dose (10J/cm2) by utilizing a simple area equation. Pain (with Defense and Veterans Pain Rating Scale) and function (by Foot and Ankle Ability Measure) were measured at baseline, weeks 3, and 6 for all groups, and at 13 and 26 weeks for PBMT groups. PBMT groups experienced a reduction in pain over the first three weeks (from an average of 4.5 to 2.8) after which their pain levels remained mostly constant, while the UC group experienced a smaller reduction in pain (from an average of 4 to 3.8). The effects on pain were not different between PBMT groups. PBMT in both treatment groups also improved function more than the UC group, again with the improvement occurring within the first three weeks. Pain and function improved during the three weeks of PBMT plus UC and remained stable over the following three weeks. Improvements sustained through six months in the PBMT plus UC groups. Level II- RCT or Prospective Comparative Study.

A window into the mind-brain-body interplay: Development of diagnostic, prognostic biomarkers, and rehabilitation strategies in functional motor disorders.

Functional motor disorders (FMD) present a prevalent, yet misunderstood spectrum of neurological conditions characterized by abnormal movements (i.e., functional limb weakness, tremor, dystonia, gait impairments), leading to substantial disability and diminished quality of life. Despite their high prevalence, FMD often face delayed diagnosis and inadequate treatment, resulting in significant social and economic burdens. The old concept of psychological factors as the primary cause (conversion disorder) has been abandoned due to the need for more evidence about their causal role. According to a predictive coding account, the emerging idea is that symptoms and disability may depend on dysfunctions of a specific neural system integrating interoception, exteroception, and motor control. Consequently, symptoms are construed as perceptions of the body's state. Besides the main pathophysiological features (abnormal attentional focus, beliefs/expectations, and sense of agency), the lived experience of symptoms and their resulting disability may depend on an altered integration at the neural level of interoception, exteroception, and motor control. Our proposal aims to elucidate the pathophysiological mechanisms of FMD through a three-stage research approach. Initially, a large cohort study will collect behavioral, neurophysiological, and MRI biomarkers from patients with FMD and healthy controls, employing eXplainable Artificial Intelligence (XAI) to develop a diagnostic algorithm. Subsequently, validation will occur using patients with organic motor disorders. Finally, the algorithm's prognostic value will be explored post-rehabilitation in one subgroup of patients with FMD. Data collection for the present study started in May 2023, and by May 2025, data collection will conclude. Our approach seeks to enhance early diagnosis and prognostication, improve FMD management, and reduce associated disability and socio-economic costs by identifying disease-specific biomarkers. This trial was registered in clinicaltrials.gov (NCT06328790).

Association of Serum Beta-Carotene with Metabolic Risk Factors among a Work Cohort in Malaysia.

Metabolic syndrome (MetS) poses increased risks for non-communicable diseases, increasing all-cause mortality, disability, and healthcare costs. Beta-carotene as the major carotenoid is identified to play an important role in the pathophysiology of MetS. The present study aimed to investigate the association between serum beta-carotene levels with metabolic syndrome and metabolic risk factors among a cohort of teachers in Peninsular Malaysia. This cross-sectional study investigated a sub-sample of 645 serum samples which were randomly selected for beta-carotene determination. Socio-demographic, lifestyle and metabolic risk factors were measured following standard protocols. There were equal proportions of males and females, with majority Malays (69%) followed by the Chinese (24%) and Indians (6.5%). The prevalence of MetS was 24.8% with abnormal waist circumference and high blood pressure as the most commonly reported metabolic risk factors. The median serum beta-carotene was 5.15 (5.07) μmol/L. Serum beta-carotene in the lowest quartile (Q1) was found to be significantly associated with MetS (OR: 5.81; 95% CI: 2.96, 11.38) and metabolic risk factors, namely triglycerides (OR: 6.38; 95% CI: 3.04, 13.35), fasting blood sugar (OR: 3.32; 95% CI: 1.48, 7.43), HDL-cholesterol (OR: 2.88; 95% CI: 1.58, 5.26) and waist circumference (OR: 2.94; 95% CI: 1.73, 5.01), after adjusted for potential confounders. In summary, participants with lower serum beta-carotene had higher odds for MetS and the above-mentioned metabolic risk factors.

CHINESE AMERICAN FAMILY CAREGIVERS’ PERCEPTIONS OF HOME CARE AND FACILITY CARE FOR LOVED ONES WITH ADRD

Abstract Cognitive decline and impairment among older adults are significant public health concerns because they lead to increased disability, caregiver burden, and healthcare costs associated with the treatment of declining cognitive function. The Chinese American population, the largest Asian group in the US, is aging rapidly, and it is expected that older Chinese Americans and their caregivers will increasingly need ADRD care planning for home care and facility care. Therefore, the goal of this study is to examine the beliefs and attitudes of Chinese American family caregivers regarding home care and facility care for their loved ones with ADRD. In our study, N=17 Chinese American caregivers were recruited to participate in the study interview through a partnership with the Alzheimer’s Program at the Chinese American Service League. The mean age of the caregivers was 49.6 years, and the majority were female, married, had college degrees or higher, and reported being in good health. Results indicated that most ADRD patients needed medium or high levels of care and were cared for at home. Chinese American caregivers were reluctant to place their loved ones in facilities, such as nursing homes or memory care centers, due to high costs, poor quality of care, language barriers, and Chinese filial piety. Additionally, most Chinese caregivers lacked knowledge regarding the types of home care and facility care and the services provided. Therefore, future development of culturally and linguistically targeted interventions for ADRD care planning is necessary for Chinese American patients with ADRD and family caregivers.

Current Review of Regenerative Medicine Therapies for Spine-Related Pain.

Persistent spinal pain syndromes are pervasive and lead to functional impairment, increased healthcare utilization, potential disability, and high societal costs. Spinal (cervical, thoracic, lumbar, and sacroiliac joint) pain includes mechanical, degenerative, inflammatory, oncologic, and infectious etiologies. Regenerative medicine is a novel biotechnology targeting mechanical, degenerative, and inflammatory conditions believed to cause pain. Preparations including platelet-rich plasma, mesenchymal stem cells (adipose tissue and bone marrow aspirate concentrates), and growth factors are derived from an autologous donor. The goal of intervention through guided injection of the regenerative media is to reduce inflammation and reverse the degenerative cascade in hopes of restoring normal cellular composition (physiologic homeostasis) and anatomical function to improve pain and function. The authors review limited research supporting the use of platelet-rich plasma injections for facet joint arthropathy and sacroiliac joint pain compared to traditional steroid treatments, as well as the use of platelet rich plasma or mesenchymal stem cells for lumbar discogenic and radicular pain. Current evidence to support regenerative medicine for spine-related pain is limited. Although several studies demonstrated a reduction in pain, many of these studies had a small number of participants and were case series or prospective trials. Regenerative medicine treatments lack evidence for the treatment of spine-related pain. Large randomized controlled trials are needed with consistent study protocols to make further recommendations.

Assessing the Fiscal Burden of Obesity in Canada by Applying a Public Economic Framework.

Rising obesity prevalence is a health priority for many governments because of its impact on population health and economic consequences. We sought to estimate the broader consequences of obesity in Canada by applying a government perspective framework that captures lost tax revenues and increased government spending on social benefit programs. An age-specific prevalence-based model was built to quantify the fiscal burden of disease for government attributed to people living with obesity. The model was populated with age-specific wages, employment activity and government benefits received to estimate taxes and transfer costs. A targeted literature search was conducted to identify modifiers of employment status, wages and disability status attributed to people with obesity, and applied to employment and epidemiological projections which enabled us to estimate government costs and tax losses. Government tax revenue and costs attributed to obesity were projected over a 10-year period and discounted at 3%. The fiscal burden of obesity in Canada is estimated at CAD$22,974 million (2021). This figure consists of obesity-attributed revenue losses of CAD$9404 million from direct taxes due to decreased employment activity and CAD$2374 million from indirect tax revenue losses due to reduced consumption taxes. Healthcare costs are estimated at CAD$7881 million annually and disability costs of CAD$3686 million annually. This fiscal burden of disease distributed amongst taxpayers in 2021 is estimated to be CAD$752 per capita. We estimate for every 1% reduction in obesity prevalence, CAD$229.7 million net fiscal gains can be achieved annually. Obesity is associated with substantial clinical and economic burden not only to the healthcare system but also to wider government budgets as demonstrated using fiscal analysis. Reductions in obesity prevalence are likely to have positive fiscal gains for government from reduced spending on public benefits and increased tax revenue attributed to employment changes.

Societal Cost of Racial Pneumococcal Disease Disparities in US Adults Aged 50 Years or Older.

This study aimed to estimate the societal cost of racial disparities in pneumococcal disease among US adults aged ≥ 50 years. In a model-based analysis, societal costs of invasive pneumococcal disease (IPD) and hospitalized nonbacteremic pneumococcal pneumonia (NBP) were estimated using (1) direct medical costs plus indirect costs of acute illness; (2) indirect costs of pneumococcal mortality; and (3) direct and indirect costs of related disability. Disparities costs were calculated as differences in average per-person pneumococcal disease cost between Black and non-Black adults aged ≥ 50 years multiplied by the Black population aged ≥ 50 years. Costs were in 2019 US dollars (US$), with future costs discounted at 3% per year. Total direct and indirect costs per IPD case were US$186,791 in Black populations and US$182,689 in non-Black populations; total hospitalized NBP costs per case were US$100,632 (Black) and US$96,781 (non-Black). The difference in population per-person total pneumococcal disease costs between Black and non-Black adults was US$47.85. Combined societal costs of disparities for IPD and hospitalized NBP totaled US$673.2 million for Black adults aged ≥ 50 years. Disease and disability risks, life expectancy, and case-fatality rates were influential in one-way sensitivity analyses, but the lowest cost across all analyses was US$194 million. The 95% probability range of racial disparity costs were US$227.2-US$1156.9 million in a probabilistic sensitivity analysis. US societal cost of racial pneumococcal disease disparities in persons aged ≥ 50years is substantial. Successful pneumococcal vaccination policy and programmatic interventions to mitigate these disparities could decrease costs and improve health.

Comparison of ACGIH lifting threshold limit values to validated low back disorder lifting assessment methods outcomes.

Work-related low back pain (LBP) increases the workforce disability and healthcare costs. This study evaluated the LBD risk level associated with handling the ACGIH TLVs in lifting tasks corresponding to various horizontal and vertical zones. The aim of this study was to compare the low-risk ACGIH TLV to risk outcomes from various validated lifting assessment methods, including the OSU LBD Risk Model, NIOSH Lifting Equation, and LiFFT. Twenty-four subjects were recruited for this study to perform various lifting conditions. The various ergonomic assessment methods were then used to obtain the risk assessment outcomes. The selected assessment methods showed that the ACGIH-defined TLVs are associated with less than high-risk for LBD for all the assessed tasks. The findings showed a moderate agreement (Kendall's W = 0.477) among the various assessment methods risk outcomes. The highest correlation (ρ= 0.886) was observed between the NIOSH Lifting Equation and LiFFT methods risk assessment outcomes. The findings showed that ACGIH-defined TLVs possesses less than high-risk for LBD. The outcomes of the selected ergonomic assessment methods moderately agree to each other.