Estimates Of Need Research Articles

About Principles of Forming of Legal Mechanism of Citizens Digital Profiling

In the article the analysis of stages of development of citizens digital profiling in Russia is carried out. Based on the analysis the authors draw the conclusions on forming of legal mechanism according to principles in reliance on main functions of state. In particular, social function stipulates that categorization of citizens is allowed only for estimation of need in material assistance, supplementary guarantees and favours. Economical function includes execution of financial control and monitoring, stimulation of economical activity of citizens. Law enforcement function is focused on prevention and early recognition of legal wrongs including in digital sphere. Human rights function is realized in actions to stem violations of rights and legitimate interests including electoral. An idea of commercialization of digital profiling, its perception as a product aimed to risk minimization during rendering of financial and other services poses a danger of discrimination of citizens and criminalization of this sphere.

Predictive value of neutrophil-to-lymphocyte ratio in terms of need for intensive care unit and mortality in maintenance hemodialysis patients with COVID-19.

The transmission risk of Severe Acute Respiratory Syndrome Coronavirus-2 virus infection is increased in maintenance hemodialysis (MHD) patients, and also the disease causes much higher mortality than the normal population. The aim of this study is to define the predictive value of neutrophil-to-lymphocyte ratio (NLR) in terms of worse outcomes in MHD patients. A total of 123 MHD patients who had received inpatient care due to COVID-19 infection were included in this multicentered retrospective study. Receiver operating curve analysis were plotted to illustrate C reactive protein (C-rp), systemic inflammatory index (SII) and NLR best cut-off values for estimation of need for intensive care unit (ICU) and mortality. Multivariate regression analysis and Cox proportional hazard models were constructed to determine the association between C-rp, SII and NLR and mortality. Twenty-eight (23%) patients with MHD were dead due to COVID-19. Nonsurvivor patients was significantly older than the survivors (p < 0.001) and also had higher rates of diabetes mellitus (p=0.01) and coronary artery disease (p=0.02). Cox regression analysis revealed that NLR >5.17 significantly associated with mortality [HR: 6.508, p < 0.001]. Similarly, SII > 726 [HR: 3.124, p=0.006] and C-rp > 88 [HR: 4.590, p=0.002] were significantly associated with mortality due to COVID-19 in hospitalized MHD patients. Multivarite logistic regression analysis showed that age older than 60 years, higher ferritin, and NLR > 5.17 were independent factors associated with mortality. NLR had favorable predictive value than the C-rp and SII in terms of need for ICU and mortality in MHD patients. Determining the poor prognosis with simple and easily applicable markers may reduce mortality in these patients with early supportive treatments.

Estimating need and coverage for five priority assistive products: a systematic review of global population-based research

IntroductionTo improve access to assistive products (APs) globally, data must be available to inform evidence-based decision-making, policy development and evaluation, and market-shaping interventions.MethodsThis systematic review was undertaken to identify studies...

Estimation of Need for Palliative Care in Urban Field Practice Area of Bengaluru- A Cross Sectional Study

Background Palliative care is an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illnesses. Every year over 40 million people are in need of palliative care. According to a WHO survey funding for palliative care was available in 68 of countries and only 40 of countries reported that the services reached at least half of patients in need. As the coverage of palliative care services is inadequate data on number of people requiring palliative care services must be estimated prior to planning of services in a particular area.Objectives To estimate the need for palliative care in urban field practice area of a medical college in Bengaluru.Methodology A community based cross-sectional study was done in 741 households through stratified random sampling method in urban field practice area of BMCRI Bengaluru during the period of November and December 2021. Data was collected by conducting house to house survey and any available member of the household was interviewed. Descriptive and inferential statistics were done using SPSS 20.0 version.Results Out of 741 households 2557 individuals were surveyed. Twenty seven households had at least one family member who was in need of palliative care. The period prevalence of need of palliative care in this community was 10.51000 population. The most common disease condition in need of palliative care was cardiovascular disease 29.6. Most of them were females 1627.Conclusion Around 10.51000 population were identified to be in need of palliative care. The prevalence was highest among females lower socioeconomic class those with less education and those suffering from agerelated weakness.

SUBSTANTIATION OF DEVELOPMENT STAGES OF THE INFORMATION SYSTEM FOR SUPPORT OF TESTS OF ARMAMAENT AND MILITARY EQUIPMENT OF THE ARMED FORCES OF UKRAINE

One of the important areas of support and development of the state's defense capabilities is to equip the armed forces with modern armament and military equipment (AME). In recent years, due to the situation in eastern Ukraine, there has been a significant increase in the pace of development and adoption of the newest models of AME. The process of harmonizing national standards with NATO standards also contributes to this. Naturally, it causes an increase in the need for timely and high-quality testing of AME samples. Accordingly, the task of improving the efficiency of all processes that accompany the testing of defense products is urgent.&#x0D; The article considers the problem of practical development of information system for support of tests of AME, the purpose of which is to automate information processes in the preparation and conduct of tests, which should reduce time and labor costs at all stages of testing. Based on the previously substantiated spiral model of software product development and the concept of building an information system for test support, a step-by-step plan for the implementation of the information system is proposed.&#x0D; The system of requirements to the prototype of the information system with limited functionality is formulated, according to which the rating estimation of need and possibility of prioritized realization of the basic functional modules of the information system is carried out. Based on the requirement of functional connectivity of the modules, the information system composition on the next turn of the life cycle spiral model is substantiated. The step-by-step approach during creation and provisioning of databases and data registers with information are considered. As the information system develops, the transition to an incremental model of software product development is not excluded.&#x0D; It is expected that the automation of information processes related to the planning and conducting of tests, as well as the processing of test results and preparation of reporting documentation can positively impact the overall efficiency of the organization and conducting of tests, as well as ensure the proper quality of results.

Use of the sociodental approach in estimating orthodontic treatment needs in adolescent patients.

The sociodental model integrates clinical assessment, perceived impacts of malocclusion on quality of life, and behavioural propensity when prioritising orthodontic treatment. This study compares the effect of using different instruments to measure impact-related need on the assessment of orthodontic treatment need based on the sociodental framework. In this cross-sectional study, 206 Malaysian adolescents (age: 11-18 years) were screened in orthodontic clinics to identify those with normative need, oral impacts due to malocclusion, and having high and medium-to-high behavioural propensities. The Index of Orthodontic Treatment Need classified normative need. The Psychosocial Impact of Dental Aesthetics (PIDA) questionnaire and the Condition-Specific Child-Oral Impacts on Daily Performances (CS-OIDP) index measured oral impacts. Subjects' behavioural propensities for successful treatment outcome were based on the Basic Periodontal Examination and International Caries Detection and Assessment System. Data were analysed using the McNemar test. The response rate was 99.0%. Estimates of normative need (89.7%) were significantly reduced under the sociodental model by 65.7% (p < 0.0001) when impact-related need was measured using PIDA, and by 41.7% (p < 0.0001) when measured using CS-OIDP. The difference between the results of the two instruments in proportions of identified need for orthodontic treatment was 24.0% (p < 0.0001). For Malaysian adolescents, estimates of need for orthodontic treatment when assessed with the sociodental approach were substantially lower than normative clinical assessment and depended highly on the tools selected to assess the patient's impact-related need. Health policy makers should understand the implication of adopting one instrument or the other when estimating orthodontic treatment need.

Peer mentor training: Pathway to competency for facilitators of Healthy Mothers Healthy Families workshops.

Healthy Mothers Healthy Families (HMHF) is a women's health and empowerment programme designed to promote the health and well-being of mothers of children with a disability. An ongoing need to extend the reach of HMHF to more mothers, and increase scalability, resulted in development of a training programme based in principles of adult and transformative learning, to credential mothers as HMHF facilitators. The current study evaluated the process and outcomes of the competency training programme for new facilitators. A pretest and posttest design with midway data collection point was implemented to evaluate the facilitators' competence following the training programme. Surveys contained specifically designed demographic questions, open-ended questions, self-report of competency and estimation of need for education/training. Fifteen predetermined criteria enabled self-ratings. Training of facilitators occurred alongside delivery of 23-day HMHF workshops. Workshop participants provided anonymous objective evaluation of the facilitators' competencies. Triangulation enabled comparison of self-ratings, workshop participant ratings and author evaluation of new facilitators. Facilitators (N = 7) completed all theory and practical elements of the HMHF facilitator education package and were successfully credentialed in May 2020. Overall, facilitators' competency ratings were highest at Time 3, which followed successful co-facilitation of at least three HMHF workshops. As expected, facilitators rated their highest need for education/training at baseline. At Time 3, facilitators self-reported a lower need for education/training for all competency criteria. All facilitators received mean anonymous competency ratings from workshop participants (N = 294), above the predetermined benchmark that was required to become credentialled. The HMHF competency training programme, based on principles of adult and transformative learning, was effective in training seven HMHF facilitators who were mothers and had suitable professional backgrounds to deliver HMHF workshops. Training supports the fidelity of the HMHF intervention. Further research to evaluate maternal outcomes for participants attending the facilitator-lead workshops is warranted.

Who needs, receives and misses out on palliative and end-of-life care? A population-based study to identify needs and gaps in a regional health service.

Objective The aim of this study was to assess the unmet need for palliative and other end-of-life care, as well as the sociodemographic and diagnostic factors associated with suboptimal access, among residents in an Australian region. Methods A cross-sectional descriptive and analytical study was performed using non-identifiable linked data from four administrative and two clinical datasets. The study population comprised 3175 patients aged ≥15 years who died in hospital in 2016 and 2017. The main outcome measures were the proportion of decedents potentially benefitting from end-of-life care and receiving end-of-life care. Results An estimated 74.8% of decedents needed palliative or other end-of-life care in the year before death. Approximately 13.3% did not receive any end-of-life care despite its potential benefit. The highest proportions with 'unmet need' were decedents with chronic obstructive pulmonary disease (31.0%) and heart failure (26.3%). Adjusting for sociodemographic and diagnostic factors, access was lowest among those aged <65 years (adjusted odds ratio (aOR) 0.44; 95% confidence interval (CI) 0.31-0.64) and those with heart failure (aOR 0.58; 95% CI 0.47-0.72). Conclusions Estimates of need and access provide a sound basis for planning local palliative and end-of-life care services. These methods can be used on an ongoing basis to monitor service delivery. What is known about this topic? There is a small but expanding literature on estimating the need for palliative care at a population level. There is a lack of data regarding access to palliative and other end-of-life care across multiple settings (e.g. home, specialist palliative care unit, hospital) and patient groups (e.g. defined by sociodemographics and diagnostics). What does this paper add? The study builds on previously used methods for estimating the need for palliative care, with some refinements, including the addition of 'other clinical indications' and the use of weights to derive more realistic estimates. The estimates of need are consistent with recent estimates from Australia and overseas, whereas the estimates of access are similar to a recent Australian estimate, but higher than estimates from overseas. The gaps in access are highest among those with the major types of chronic organ failure, particularly heart and respiratory. What are the implications for practitioners? The study demonstrates how routinely collected data at a regional level can be used to estimate need and access to palliative and end-of-life care, in the hospital and in the community. These methods of estimating need and unmet need can be used to inform the planning and development of services, as well as to monitor progress with implementation of changes in service provision.

Investing in road construction infrastructure projects under public-private partnership in the form of concession

Purpose. To substantiate an approach to road development investment management in Ukraine in compliance with the principle of syncretism and the use of Quality Function Deployment methodology, to improve the methodological approach to calculating the concession fee for brown-field and green-field road concession projects. Methodology. The study used a set of general and special methods of cognition: the Quality Function Deployment (QFD) method, the environmental approach, multimodal analysis, Decoupling Index, Decoupling Factor, logical generalization, quantitative and qualitative comparison, scientific abstraction and systematization. Findings. According to the results of research on interrelation of cost of an investment project and volumes of works by their types, an economic-mathematical model of estimation of need for investments in projects for construction, reconstruction, repair and maintenance of public motor roads is offered. The proposed model, unlike the existing ones, is based on lateral understanding of the clarity of delineation of capital needs by type of road construction, which will provide taking management decisions on investment projects with model and information tools that will help obtain the most realistic assessment of need for capital needed to improve the transport operation condition of motor roads in Ukraine. Originality. The organizational-economic mechanism of management of investment activity of road economy and the estimation of efficiency of co-financing investment projects under programs on construction, reconstruction, repair and maintenance of motor roads is advanced. The diagnostics of efficiency of investment of construction of public motor roads under public-private partnership in the form of concession is improved. Practical value. The results of the study can be used in the activities of road industry of Ukraine for the development and implementation of investment projects under motor road development programs.

Does the International Narcotics Control Board (INCB) sufficiently prioritise enablement of access to therapeutic opioids? A systematic critical analysis of six INCB annual reports, 1968-2018

Background The International Narcotics Control Board (INCB) has overseen international drug control since 1968 with the dual remit of restricting illicit production and use of controlled substances, whilst enabling access for clinical purposes. Two opioid crises are present under its jurisdiction: i) abuse, dependence and premature mortality in high-income countries; and ii) inadequate supply of opioids for clinical purposes for most of the world represented almost exclusively by low- and middle-income countries. Methods Systematic critical analysis using corpus linguistics as a method of document analysis to investigate the regulatory climate promoted by the INCB, through language used regarding opioids in a representative sample of annual Reports, 1968-2018. Instances of key terms (narcotics, opiates, opioids, analgesia) were retrieved, with surrounding text for context. Two systematic coding phases were undertaken by two researchers, adjudicated by a third, to develop themes. We report frequencies per-1000 words of themes and key terms, aggregated and by decade. Results Five themes were developed within three domains: abuse and dependency, illegal trade (domain 1: illicit uses); policy, enforcement and context (domain 2: illicit and therapeutic uses), and access for therapeutic use, estimates of need (domain 3: therapeutic uses). For fifty years, the INCB has focussed predominantly upon domain 1: illicit uses, with little attention to domain 3: therapeutic Uses. Decreasing attention is provided to the estimates of annual requirements system, under which global opioid access to opioids is documented as inadequate. Conclusions The INCB must consider how improving availability of therapeutic opioids could reduce widespread suffering safely and effectively. Urgent international and national action is required to improve methods of accurately estimating population-level needs for opioids for all therapeutic requirements. Fears of illicit production or use should not limit the prospects of accessing appropriate therapeutic opioids where the majority of the world, today, have no realistic access.

591 Cost Savings in Operative Burn Care

Abstract Introduction “Over the past 30 years, techniques of early excision and grafting along with enhancement of critical care have significantly improved survival following severe burn. Despite these advancements, large volume blood loss associated with surgical intervention continues to be a challenging aspect of burn surgery.” (Sterling, 2011) “Estimates of blood loss in adults during burn surgery range from 196 to 269 ml for each percent of the body surface area excised and grafted.” (Cartotto, 2000) A gold standard to achieve hemostasis does not exist. Therefore, institutions rely on their habit, practices, and FDA guidelines to formulate a standard of care. (Groenewold et al, 2011) In multiple comparison studies, “telfa pads soaked in epinephrine solution are a mainstay of hemostasis.” (Sterling, 2010) In 2018, an epinephrine shortage led to an increase cost to the operating room (OR) during the surgical treatment of burn wounds. This prompted the pharmacy and OR to collaborate on a more cost-effective measure without compromising patient care. Methods In November 2018, the epinephrine dosages were modified. Dosages were changed from Epinephrine 1;1000, 1mg/ml, 60mg/L for adults and 30mg/L for pediatrics to Epinephrine 1:1000, 1mg/ml, 30mg/L for adults and 15mg/L for pediatric patient’s. Parameters were set as to the amount of product that would be preordered from the pharmacy for each patient based on the total body surface area to be excised and or grafted: Should additional quantities be needed, an arrangement was made that the pharmacy would prepare and deliver the solution to the OR within 15 minutes of order to avoid delays in treatment. The time periods examined were: June 1, 2018 though November 7, 2018 and November 8, 2018 through June 20, 2019. Total burn patients requiring surgical intervention admitted during this time frame were 180 and 184 patients. June 2018-November 2018 represents previous practice. November 2018-June 2019 represents the implementation of changes in epinephrine dosage and establishing parameters for ordering. Results The overall Cost Savings In Operative Burn Care in relation to decreasing the dosage of Epinephrine from November 2018 to June 2019 was $100,952.25. Setting parameters provided better estimation of need and resulted in a 26% decrease in ordered product. Better estimation of product led to a 9.3% decrease in waste. Decreasing waste led to a savings of $28,463.61. Monthly cost to the OR for Epinephrine solution decreased to $9708.30 per month indicating a savings of $26,291.70 per month. Conclusions Operative costs decreased therefore leading to departmental savings. Applicability of Research to Practice Burn wound hemostasis was accomplished using reduced doses of Epinephrine solution. Nurses have a clearer picture on the amount of Epinephrine solution to order for each patient. The amount of product waste was reduced.

122 Designing a Financially Sustainable Geriatric-Friendly Emergency Department

The American College of Emergency Physicians (ACEP) Geriatric Emergency Department (GED) Guidelines recommend the inclusion of geriatric-trained staff and geriatric equipment in the ED to provide optimal care to older patients. However, the Guidelines and the GED Accreditation process led by ACEP do not provide instructions on how to justify these increased costs to emergency departments. We modeled the costs of staff and equipment and propose a budget-neutral system for a GED. Average staff salaries including the cost of fringe benefits (30% rate) were obtained from a Midwestern hospital with an academic ED of 80,000 annual visits. Average payment for services provided was obtained from the hospital's billing department (geriatric consultations) as well as the 2019 Center for Medicare & Medicaid Services therapy reimbursement rates for moderate complexity therapy evaluations in a Midwest state (https://www.stratapt.com/medicare-fee-calculator). We assumed that all patients were insured by Medicare and/or Medicaid and that hospital personnel work 8-hour days with 4.5 weeks of vacation (237.5 working days/year). We used our ED triage numbers for January 2019 to determine the average number of patients per day who answer “yes” to the triage question, “Do you use a walker, cane or other device to help with mobility?” as an estimate of need for a mobility device while in the ED. For staffing estimates, a nurse practitioner billing at an 85% reimbursement rate for unsupervised geriatric consultations would be budget neutral at 7.1 consultations in the ED per workday. A pharmacist stationed in the ED billing medication management codes for outpatient medication reconciliation would be budget neutral for salary costs at 7.7 consultations per workday. Physical and occupational therapists can also be budget neutral; however, payment for these consultations are generally included in diagnosis-related group (DRG) reimbursements for admitted patients, so not all consultations in the ED would be independently billable. For mobility equipment estimates, electronic medical record data from January 2019 demonstrated that 19% of patients endorse using a mobility aid at ED triage, or about 41 patients per day, with an average length of stay in an ED bed of 8.3 hours. Assuming uniform distribution throughout the 24-hour day, 14 patients would require a mobility aid at the bedside at any given hour. The cost of walkers in our market is $145 each (or $2,030 for 14). Given prior studies estimating the added inpatient cost of one fall to be $7,000-$14,000, the investment in 14 walkers at a total cost of $2,030 would be justified by a cost savings of about $5,000 if a single fall were to be prevented. The cost profile further improves for canes, which cost $26 each in our market. The staff and equipment needed to comply with the Geriatric ED Guidelines is justifiable. Staff who can bill for consultations can be budget neutral practicing within the ED. Additional mobility aids are also a justifiable cost prevention item. This analysis does not factor in ED volume, and all consultations must be medically justifiable to be billable.

Estimating Service Needs for Alcohol and Other Drug Users According to a Tiered Framework: The Case of the São Paulo, Brazil, Metropolitan Area.

The purpose of this study was to estimate the need for population-level services for alcohol and other drug abuse in support of local planning. Data were drawn from a subsample of 2,942 interviewees from the São Paulo Megacity Study, which evaluated mental health in the general population (18 years and older) of residents in the São Paulo metropolitan area. This population was classified into five hierarchical categories of severity, making it possible to obtain estimates of need for services, combining evaluation criteria regarding drug and alcohol use and general and mental health comorbidities over the last 12 months. For the at-risk groups in this population, estimates from the Potential Demand for the Use of Services survey interviews over the last year were generated. Concerning the need for services, 86.5% of the population (Tier 1) had no problems related to drug and alcohol use, 8.9% (Tier 2) used heavily, 3.5% (Tiers 3, 4, and 5) met criteria for substance abuse disorders, among whom 1.3% (Tiers 4 and 5) require more specialized and intensive treatment and support. The following estimates for the Potential Demand for the Use of Services were found: 25.5% (Tier 3) and 51.1% (Tier 4), indicating that a significant number of individuals met criteria for substance abuse disorders but did not perceive any need for professional help or neglected the help available. In São Paulo there exists a large sector of the population that requires prevention strategies regarding the risks and harm resulting from alcohol and drug use, followed by a group requiring more specialized care. But a large number of substance users requiring specialized support did not use services and did not believe that they needed professional help.

Estimating the Needs of Substance Problem Use Services: An Exercise in Seven Finnish Municipalities Using Nationally Collected, Municipal-Level Survey and Register Data†.

The needs of substance problem use services (SPUSs) should ideally be assessed locally to support the provision of appropriate, cost-effective services for the population. In this article we present a model for estimating the adult population's potential needs for and actual use of SPUSs. We used Finnish survey and register data as material for a qualitative assessment. The purpose of our article is to contribute to a discussion on the dimensions of assessment of the need for SPUSs at a local level. Seven Finnish municipalities were chosen as examples. The need for SPUSs was assessed by freely available register and survey data of the use of services, substance use and problem use, side effects of use, and lack of social support. Babor et al.'s (2008) description of links between the use of services and need for treatment, in terms of substance use and general social conditions, and Ritter's (2014a) set of methods for assessing the need for treatment are used as theoretical background. The number of people using SPUSs varied from one municipality to the next. The local service system policy and the general well-being of the population have a remarkable role in the use of SPUSs. Estimations of need and demand with indicators can be useful for local treatment system policy but must be interpreted with thorough knowledge of the local treatment and social handling resources and general social situation. Comparisons between different local areas should be made with caution.

Key Considerations in Planning for Substance Use Treatment: Estimating Treatment Need and Demand.

Estimates of the extent of treatment need (defined by the presence of a diagnosis for which there is an effective treatment available) and treatment demand (defined as treatment seeking) are essential parts of effective treatment planning, service provision, and treatment funding. This article reviews the existing literature on approaches to estimating need and demand and the use of models to inform such estimation, and then considers the implications for health planners. A thematic review of the literature was undertaken, with a focus on covering the key concepts and research methods that have been used to date. Both need and demand are important estimates in planning for services but contain many difficulties in moving from the theory of measurement to the practicalities of establishing these figures. Furthermore, the simple quantum of need or demand is limited in its usefulness unless it is matched with consideration of different treatment types and their relative intensity, and/or explored as a function of geography and subpopulation. Modeling can assist with establishing more fine-tuned planning estimates, and is able to take into account both client severity and the various treatment types that might be available. Moving from relatively simplistic estimates of need and demand for treatment, this review has shown that although such estimation can inform national or subnational treatment planning, more sophisticated models are required for alcohol and other drug treatment planning. These can help health planners to determine the appropriate amount and mix of treatments for substance use disorders.

Estimation of Needs for Addiction Services: A Youth Model.

In the field of health care services, resource allocation is increasingly determined based on a population needs model. Although service needs models have been developed for adults with substance use problems, it would seem inappropriate to apply them indiscriminately to young people. The method used proposes six steps: (1) targeting the population, (2) estimating the proportion of the population affected by substance misuse and (3) the proportion of youths who should receive services, (4) identifying categories of services, (5) estimating the proportions of youths who should have access to each category of services, and (6) applying the model to real use of services by youths to recalibrate it. Youths ages 12-17 from the Province of Québec were classified within a tiered model comprising four levels of substance use severity. Youths in need of services varied from 38% (weak response) to 95% (high response) for the highest severity cases. Service categories retained are detoxification/intoxication, outpatient, and residential, with each one being subdivided into four categories. The proportion of youths from each tier who should access categories and subcategories of services varied widely. After a pre-experimentation, the model was adjusted. The model can be applied in different jurisdictions, with the caution of adjusting prevalence to local reality. Further improvement will be based on more accurate information concerning the path of clients through services, better strategies to reach youths in need of services, and increased knowledge of optimal service categories. Models adapted to low- or moderate-income countries, where the health care system has minimal services in the areas of mental health and addiction, should be developed.

Social and economic impact of a case management approach for people with rare and complex conditions in Salaj, Romania

Background: Over 36 million people in Europe (patients and families) are affected by a rare disease (RD). Often not sufficiently supported by mainstream social systems, they struggle to make the most of their potential throughout their life course. Additionally, caregivers assisting their family member may find providing care over the long term challenging. A recent survey by EURORDIS-Rare Disease Europe showed that many caregivers (30%) spend more than six hours daily helping the patients. For 52%, the RD had a severe or very severe impact on their daily lives, and the time dedicated to coordination of care was substantial both for the patients themselves and their caregivers. The INNOVCare project, co-funded by the European Union, suggests implementation of integrated and patient-centred care pathways. These pathways involve linking health services to social and support services that RD patients use on a daily basis. In a current pilot project in Salaj, Romania, four case managers provide individualised guidance to coordinate the services for the user, to delineate a personalised pathway for each patient and to create effective changes in patients’ autonomy and daily lives. Our study aims to analyse the social and economic impact of this project, including both resource consumption and potential improvements in patients’/families’ quality of life. Methods: 120 patients with RD were randomly assigned to case managers for nine months in two cohorts. The first cohort will receive case management support for nine months whereas the control group usual treatment. After nine months the groups will be rotated. Data collection started in March 2017 through questionnaires to patients and their families distributed before, after nine months, and after 18 months using the same measurement tools. The questionnaires cover socio-economic status; patients’ condition, level of disability, and estimation of need; use of health, social and local services, health-related quality of life; work situation; and caregiver burden. Preliminary results: Patients’ mean EQ VAS score was 53.3 at baseline. The majority reported any problems in all dimensions with pain/discomfort and mobility being the most prominent. After 9 months, the mean scores were 54.0 and 62.0 for the 1st and 2nd cohort, respectively. Patients reported most problems in mobility and pain/discomfort (1st cohort) compared to usual activities and anxiety/depression (2nd cohort). Caregivers reported a mean EQ VAS score of 74.2 at baseline. At follow-up, the mean scores were 83.9 and 80.8 with the highest prevalence of problems reported in the dimensions pain/discomfort and anxiety/depression. ZBI scores showed a reduction from baseline to first follow-up. Mean ZBI (Zarit Caregiver Burden Interview) was 13.2 at baseline compared to 12.0 (1st cohort) and 12.3 (2nd cohort) at follow-up. Data analysis is ongoing and more results will be presented at the conference. Conclusions: Preliminary results from the 9-months follow-up suggest a positive impact mainly on the caregivers. However, by achieving coordinated and more person-centred care, the social inclusion will improve both for the patients and for their caregivers, which will hopefully lead to a reduced caregiver burden and less anxiety, stress, and financial pressure.

Global programmatic use of bedaquiline and delamanid for the treatment of multidrug-resistant tuberculosis.

The World Health Organization recommended two new drugs, bedaquiline (BDQ) and delamanid (DLM), for the treatment of multidrug-resistant tuberculosis (MDR-TB) in 2013 and 2014, respectively. An estimated one third of patients with MDR-TB would benefit from the inclusion of these drugs in their treatment regimens. A convenience sample of 36 countries voluntarily reported monthly data on cumulative programmatic use of new drugs to the Drug-Resistant TB Scale-Up Treatment Action Team between 1 July 2015 and 31 June 2017. Programmatic use was defined as treatment for MDR-TB with newer drugs outside of clinical trials or compassionate use. A total of 10 164 persons were started on BDQ and 688 started on DLM during the reporting period. Only 15.7% of the 69 213 persons estimated to need newer drugs over the study period were reported to have received them. While there has been significant progress in some countries, uptake of the newer drugs has not kept pace with a conservative estimate of need; fewer than 20% of persons likely to benefit from either BDQ or DLM have received them. Concerted efforts are needed to ensure that the newer drugs are made available more widely for persons with MDR-TB in need of these therapeutic options.

Assessment of the production of cervical cancer care procedures in the Brazilian National Health System in 2015.

to assess the procedures production of screening, diagnostic investigation and precursor lesions treatment for cervical cancer in the Brazilian National Health System (SUS). normative evaluation with calculation of estimates of need based on national screening guidelines in two scenarios: organized (1) and opportunistic (2) screening; data were obtained from the SUS Ambulatory Care Information System and the Cervical Cancer Information System. considering the scenario 1, the production of cytopathologic exams (-46,9%) and biopsies (-44.9%) was below the necessary in Brazil, whereas colposcopy (61.3%) and precursor lesions treatments (37.4%) were above; in scenario 2, biopsies were below the necessary (-48.5%) whilst colposcopy (193.9%) and precursor lesions treatments (28.4%) were above. there were deficits in cytopathologic exams and biopsies and excess of colposcopies and treatment of precursor lesions in Brazil.

Estimating the variation in need for community-based social care by body mass index in England and associated cost: population-based cross-sectional study

BackgroundAdult obesity is linked to a greater need for social care because of its association with the development of long term conditions and because obese adults can have physical and social difficulties which inhibit daily living. Obesity thus has considerable social care cost implications but the magnitude of these costs is currently unknown. This paper outlines an approach to estimating obesity-related social care costs in adults aged over 65 in England.MethodsWe used univariable and multivariable logistic regression models to investigate the relation between the self-reported need for social care and potential determinants, including body mass index (BMI), using data from Health Survey for England. We combined these modelled estimates of need for social care with the mean hours of help received, conditional on receiving any help, to calculate the expected hours of social care received per adult by BMI.ResultsBMI is positively associated with self-reported need for social care. A one unit (ie 1 kg/m2) increase in BMI is on average associated with a 5% increase in the odds of need for help with social care (odds ratio 1.05, 95% CI 1.04 to 1.07) in an unadjusted model. Adjusting for long term illness and sociodemographic characteristics we estimate the annual cost of local authority funded care for those who receive it is £599 at a BMI of 23 but £1086 at a BMI of 40.ConclusionBMI is positively associated with self-reported need for social care after adjustment for sociodemographic factors and limiting long term illness. The increase in need for care with BMI gives rise to additional costs in social care provision which should be borne in mind when calculating the cost-effectiveness of interventions aimed at reducing obesity.