Family Economic Burden Research Articles

Potential Loss among Infant Feeding Options

Introduction: The conceptual relationship between economics and breastfeeding is still mathematically invaluable, while the family's economic burden increases along with babies born. Indicating potential loss when a family chooses other than breastmilk is a progressive way to manage campaign messages about exclusive breastmilk and prolonged breastfeeding. Descriptive studies are needed to magnify all of these indicators and transform them into measuring instruments generalized to assess family expenditures related to infant feeding.Methods: This study uses a quantitative descriptive design, questionnaire draft upon qualitative open questions containing all micro indicators impacted financially during the baby’s first year. Data collection was carried out in Makassar based on telephone surveys with 330 preliminary samples. After structural analysis and data reduction, the expenditure indicators were divided into medical and non-medical expenses.Results: The study show there is a difference in the average amount of family expenses of those who provide formula milk compared to breastmilk. This outcome is 21.1 times higher in non-medical components and 2.5 times higher in the medical component. One of the highest contributions in medical expenses is the cost of a recurrent visit to a pediatrician due to a history of illness such as allergies, respiratory infections, and diarrhea.Conclusion: This empirical fact stated the strong affirmation of how families should consider wisely to choose the best feeding pattern for babies aged 0-12 months.

EKONOMI KELUARGA MAHASISWA PROGRAM STUDI PENDIDIKAN ILMU PENGETAHUAN SOSIAL JURUSAN PENDIDIKAN ILMU ILMU SOSIAL FAKULTAS KEGURUAN DAN ILMU PENDIDIKAN

The purpose of this study was to determine the economic condition of the families of students of the Social Sciences Education Study Program, FKIP Untan. The form of research is a survey. The results of the research on family conditions mostly came from areas outside the city of Pontianak, with as many as 139 students (67.48%) and from the city of Pontianak as many as 67 people (32.52%). Parents are mostly farmers. With an average student family income in the range of Rp. 1,000,000 - Rp. 1,950,000 (income of father, mother, me, and siblings). The income earned is not sufficient for the family's needs, because the average monthly expenditure is over Rp. 2,000,000. In general, parents of students complained that the family's economic burden was quite heavy. In order to help the family economy, most students also work to help the family economy. Such as: guarding a grocery store, taking children to school, as a pinatu (ironing clothes) in a laundry business. The status of the house owned by students is a house that is privately owned. The lighting facility uses electricity with a power of 450 watts. Entertainment facilities for television, tape recorder, and radio. Electricity bill payments have been in arrears. There are 42 students who received Bidik Misi scholarships, 4 students received scholarships from the local government of Kayong Regency. 1 student gets a scholarship from the Sekadau Regency Government, 1 student gets a Partial Independent Untan scholarship. 10 students who received PPA scholarships and 8 students who received PBM scholarships. Payment of student tuition fees ranges from UKT 3, 4, and 5. In Pontianak living at someone's house as a household assistant, and not being paid tuition fees, they are only given the opportunity to live and eat. Meanwhile, tuition fees must be paid by themselves.

Trend of chickenpox incident cases through absent vaccination in Najaf Governorate-Iraq from January 2009 to May 2014

Background: Chickenpox infection is a common and highly contagious viral disease caused by the varicella zoster virus. It is highly endemic disease with increasing annual incidence in absence of varicella immunization program in Iraq. The predominance of uncomplicated cases in children tends to overshadow the morbidity associated with social and economic burden of families in addition to risk of complication in younger age groups. Chickenpox now has been considered one of the most common vaccine-preventable diseases in many countries including Iraq.Amis of the study: Describing the epidemiology of registered clinical cases of chickenpox in Najaf governorate of January 2009 to May 2014. More over verifying the increasing number of incident cases of chickenpox for future need of varicella vaccine in Iraq.Methodology: A descriptive cross sectional study was conducted of January 2009 to May 2014, and the data was collected of the public health department of the existing anonymous surveillance of chickenpox. Those monthly records were sent of corresponding surveillance units of six districts in Najaf governorate including north of Najaf, south of Najaf, Al-Kufa, Al-manathera, Al-abbassiya and Al-mishkhab districts. The variables included age groups, gender, and district distributions in this study were based on a classification used in the surveillance system in Iraq.Results: The frequency of chickenpox cases in Najaf Governorate revealed an obvious rise of (1076) in 2009 and (2563) in 2010 to (4692) in 2o13. The incidence rate of occurrence of clinical chickenpox cases also shows an obvious rise in 2011 was 408/100000 population. Most often cases occurred in age group 5-14 years (75 %) and only (3.05 %) in those over 45 years. According to gender distribution, there was sustained non-significant preponderance for the male over female. All registered cases had shown the same seasonal distribution with two peaks of infection per year; spring (March, April and May) and early winter (November, December and January) seasons. Median Endemic Index of chickenpox cases in Najaf in May of 2009-2013 was 633 and the number of cases during January through May 2014 was 558.Conclusion: chickenpox is still increasing in incident cases in Najaf governorate which necessitate thinking of varicella vaccine recommendation.

Impact of low-level fine particulate matter and ozone exposure on absences in K-12 students and economic consequences

High air pollution levels are associated with school absences. However, low level pollution impacts on individual school absences are under-studied. Understanding the variability of pollution at individual schools within an urban region could improve school recess decisions, better identify local pollution sources, and improve local economic impact assessments by providing granular information relevant to specific schools. We modelled PM2.5 and ozone concentrations at 36 schools from July 2015 to June 2018 using data from a dense, research grade regulatory sensor network. We determined exposures and daily absences at each school. We used a generalized estimating equations model to retrospectively estimate rate ratios for association between outdoor pollutant concentrations and school absences. We estimated lost school revenue, productivity, and family economic burden. PM2.5 and ozone concentrations and absence rates vary across the School District. Pollution exposure was associated with a rate ratio as high as 1.02 absences per μg m−3 and 1.01 per ppb increase for PM2.5 and ozone, respectively. Significantly, even PM2.5 and ozone exposure below the air quality index breakpoints for good air quality (<12.1 μg m−3 and <55 ppb, respectively) was associated with positive rate ratios of absences: 1.04 per μg m−3 and 1.01 per ppb increase, respectively. Granular local measurements enabled demonstration of air pollution impacts that varied between schools and were undetectable with averaged pollution levels. Reducing pollution by 50% would save $426 000 per year districtwide. Pollution reduction benefits would be greatest in schools located in socioeconomically disadvantaged areas. Heterogeneity in exposure, disproportionately affecting socioeconomically disadvantaged schools, points to the need for fine resolution exposure estimation. The economic cost of absences associated with air pollution is substantial even excluding indirect costs such as hospital visits and medication. These findings may help elucidate the differential burden on individual schools and inform local decisions about recess and regulatory considerations for localized pollution sources.

Family impact and economic burden among caregivers of children with chronic kidney disease in Assiut, Egypt

BackgroundChronic disease greatly increases children’s dependency on parents/caregivers (usually mothers) as they face new problems associated with caring for a child with chronic disease. Thus, chronic kidney disease (CKD) presents a burden for children and their families that last throughout life in different aspects. This study aimed to assess family impact and economic burden of chronic kidney disease (CKD) in children on their families.MethodsA cross-sectional study was carried out on 250 caregivers of children with CKD attending tertiary care hospital/health insurance clinics in Assiut, Egypt using PedsQL™ family impact module (FIM) for assessing family impact and economic burden between January and May 2018.ResultsSeventy six percent of caregivers shared paying for treatment with health insurance while 14% paid the total expenses out of their pockets. Although the majority (87.2%) of caregivers suffered different degrees of financial hardship, more than 60% of them had no coping strategy. The regression module showed that responding caregiver, degree of financial hardship, treatment modality, and socioeconomic class were significant predictors of total FIM (β = 0.38, P < 0.001; β = 0.28, P < 0.001; β = 0.22, P < 0.001; β = 0.13, P = 0.006 respectively).ConclusionMost caregivers were involved in paying for treatment of their children either totally or sharing with health insurance and suffered different degrees of financial hardship. Mothers, caregivers with great financial hardship, and caregivers of children on dialysis had the lowest scores of PedsQL™ FIM. There is a high need for expansion of health insurance umbrella to reduce financial hardship together with continued multidimensional support to families.

The outcome and burden of Chinese patients with neurodegenerative diseases: A 10-year clinical feature study.

As the Chinese population continues to age, the incidence of neurodegenerative diseases (NDDs) has increased dramatically, which results in heavy medical and economic burden for families and society. The objective of this study was to evaluate NDDs in a southern Chinese hospital over a 10-year period and examine trends in demographics, outcome, length of stay (LOS) and cost. Retrospective medical records of patients from January 2010 to December 2019 were collected, including 7231 patients with NDDs (as case group) and 9663 patients without any NDDs (as control group). The information of social demographic data, admission source, reasons for admission, outcomes, LOS, and cost were extracted and analysed. The average hospitalisation age of the patients with NDDs is over 65years (peak age 70-89years). Compared with the control group, the case group had a longer LOS and a higher cost and the numbers of patients with NDDs increased yearly from 2010 to 2019. The LOS shortened while the cost increased. Clinical features affected LOS and cost. Patients suffering from infection, abnormal blood pressure and the imbalance of water-electrolyte homoeostasis as main reasons for admission were decreased; however, heart disease, cerebrovascular accident and mental diseases were significantly increased, the overall change trend of fracture/trauma remained stable. The rate of discharge to home care and mortality declined; discharge to other medical or community facilities increased over 10years. The majority of NDDs patients tended to be older. During the last 10years from 2010 to 2019, the numbers of NDDs patients increased yearly, the trend of LOS became shortening and the cost gradually increasing. The main reasons of admission and outcomes of hospital showed different trends.

Application of integrated medical care model in continuous nursing of premature infants

Objective To study the application of integrated medical care model in continuous nursing of premature infants. Methods A total of 100 premature infants admitted to this hospital from January 2017 to January 2018 were randomly divided into control group and observation group, 50 cases of each group.The control group was given routine nursing, while the observation group was treated with integrated nursing mode.Two weeks after two group of premature infant nursing effect was compared, respectively from premature clinical indicators (serum total bilirubin, for the first time defecation time, average daily milk supply, the body quality), complication rate (hard swollen, apnea, feeding intolerance), economic indicators (mechanical ventilation, parenteral nutrition, examination cost, hospitalization cost), and their parents to nursing satisfaction. Results The clinical indicators and parents' satisfaction with nursing in the observation group were better than those in the control group, and the complications and economic indicators in the observation group were significantly lower than those in the control group, and the differences were statistically significant(P<0.05). Conclusions In the continuous care of preterm infants, the integrated nursing mode can reduce the incidence of postpartum complications of preterm infants, reduce the economic burden of families, improve the various clinical indicators of preterm infants, improve the safety, and enhance the satisfaction of parents with nursing work, with high clinical value. Key words: Integrated medical care model; Nursing intervention; Premature infants; Continuous care

Stem Cell Senescence: the Obstacle of the Treatment of Degenerative Disk Disease.

Intervertebral disc (IVD) has a pivotal role in the maintenance of flexible motion. IVD degeneration is one of the primary causes of low back pain and disability, which seriously influences patients' health, and increases the family and social economic burden. Recently, stem cell therapy has been proven to be more effective on IVD degeneration disease. However, stem cell senescence is the limiting factor in the IVD degeneration treatment. Senescent stem cells have a negative effect on the self-repair on IVD degeneration. In this review, we delineate that the factors such as telomerase shortening, DNA damage, oxidative stress, microenvironment and exosomes will induce stem cell aging. Recent studies tried to delay the aging of stem cells by regulating the expression of aging-related genes and proteins, changing the activity of telomerase, improving the survival microenvironment of stem cells and drug treatment. Understanding the mechanism of stem cell aging and exploring new approaches to delay or reverse stem cell aging asks for research on the repair of the degenerated disc.

Family Economic Burden of Elderly Chronic Diseases: Evidence from China.

Chronic diseases among the elderly and their huge economic burden on family have caught much attention from economists and sociologists over the past decade in China. This study measured the economic burden of elderly chronic disease (ECD) in families using the China Health and Retirement Longitudinal Study (CHARLS) data set from Peking University (China). We studied some aspects of this burden, including health-service utilization, out-of-pocket expenditure on inpatient and outpatient, total family expenditures on items, and labor force participation rates of family members, etc. Some interesting things were found, for example, the additional annual expenditure on inpatient care (per member) in ECD-families was 37 to 45 percent of the annual expenditure in the control group; the labor-force participation rate in ECD-families was 2.4 to 3.3 percent of points lower than in the control group.

Probiotic Lactobacillus casei: Effective for Managing Childhood Diarrhea by Altering Gut Microbiota and Attenuating Fecal Inflammatory Markers.

Background: Acute diarrhea is a major cause of childhood morbidity and an economic burden for families. The aim of this study is to explore the effect of probiotics on clinical symptoms, intestinal microbiota, and inflammatory markers during childhood diarrhea. Methods: Children (n = 81) aged six months to six years (mean age 2.31 years) hospitalized for acute diarrhea were randomized to receive probiotics (Lactobacillus casei variety rhamnosus; n = 42) or no probiotics (n = 39) orally twice daily for seven days. Feces samples were also collected to evaluate microbial content using a traditional agar plate and next-generation sequencing. Immunoglobulin A (IgA), lactoferrin, and calprotectin were determined by enzyme-linked immunosorbent assay (ELISA) and compared in different groups. Other clinical symptoms or signs, including fever, vomiting, diarrhea, abdominal pain, bloated abdomen, daily intake, appetite, and body weight were also assessed. Results: Data were collected from 81 individuals across three different time points. Total fecal IgA levels in fecal extracts of the probiotics group were higher than those in the control group, reaching statistical significance (p < 0.05). Concentrations of fecal lactoferrin and calprotectin were significantly downregulated in patients with probiotic Lactobacillus casei variety rhamnosus (Lc) consumption compared to those of the control (p < 0.05). Probiotic Lc administration may be beneficial for gut-microbiota modulation, as shown by the data collected at one week after enrollment. Counts of Bifidobacteria and Lactobacillus species were elevated in stool culture of the probiotic group. Appetite and oral intake, body-weight gain, abdominal pain, bloating, as well as bowel habits (diarrhea) were much better in children receiving probiotics compared with those in the control group. Conclusion: Fecal IgA increased during acute diarrhea under Lc treatment; in contrast, fecal lactoferrin and calprotectin were downregulated during acute diarrhea under Lc treatment. Probiotic Lc may be a useful supplement for application in children during acute diarrhea to reduce clinical severity and intestinal inflammatory reaction.

Socioeconomic status and deaths due to unintentional injury among children: A socio-spatial analysis in Taiwan

In Taiwan, unintentional injury is the leading cause of death among children <10 years old. Low socioeconomic status is a risk factor associated with a high prevalence of injuries and our study aimed to explore the geographic distribution of mortality due to unintentional injury in this age group assessing the association between this type of injury on the one hand and socioeconomic disadvantages and family structure on the other using cluster and spatial regression analyses. Using exploratory factor analysis, we assembled nine socioeconomic variables into four composite factors including area-level poverty, family burden, family fragility and unemployment. We found significant spatial clusters of childhood deaths due to unintentional injury and identified three major causes of death involved, i.e. traffic accidents, drowning and suffocation. Significant associations were found between death due to unintentional injury and area-level social disadvantages including poverty, family fragility, family economic burden and unemployment, while controlling for spatial autocorrelation. Our conclusion is that socioeconomic disadvantages need to be addressed to reduce the number of deaths due to childhood unintentional injury.

PERNIKAHAN DINI DI INDONESIA: FAKTOR DAN PERAN PEMERINTAH (PERSPEKTIF PENEGAKAN DAN PERLINDUNGAN HUKUM BAGI ANAK)

Children are the most valuable assets for the sustainability of a country. Quality should be preferred over quantity. Even though the quantity is very large, it must be balanced with good quality. This paper aims to explain early marriage in terms of legal perspective and its relation to the deprivation of children's rights. With a qualitative approach, there are five reasons that the community legalizes early marriage, namely: the age limit of marriage (Law No. 1 of 1974), akil baliqh, sustenance, in order to reduce the family's economic burden and who is ideal to marry first. Early marriage also results in social problems, namely: divorce, weak family stability, gender discrimination, and parenting for children becomes less good. Everyone is allowed to marry in the hope that marriage takes place between men and women who are mature in terms of their age, thoughts, and actions. However, the problem that is very crucial nowadays in Indonesia is justifying early marriage, arguing that it has met the requirements in Law No. 1 of 1974 concerning Marriage. However, this should not be a benchmark that age is allowed to marry, but there must be many considerations in terms of maturity, maturity in thinking and acting. In order to avoid divorce especially at a young age. In fact, what happens in Indonesia, if the child is less than 16 years old, the religious court gives a dispensation for marriage due to reasons of pregnancy, religious faktors, economic faktors, and educational faktors. Even worse, there is a village in Indonesia that responds positively to underage marriage. There is an assumption that early marriage is a tradition that must be guarded because it is a heritage. There are many reasons that at the age of 20 it has not been legalized for marriage, which is one of them from the aspect of reproductive health. Then, for women they are very difficult to continue their education to a higher level because they have the responsibility to take care of their husbands. Kata kunci: Pernikahan Dini, Aspek Sosial dan Hukum, Hak Asasi Manusia, Anak

Report on an international workshop on kangaroo mother care: lessons learned and a vision for the future

BackgroundGlobally, complications of prematurity are the leading cause of death in children under five. Preterm infants who survive their first month of life are at greater risk for various diseases and impairments in infancy, childhood and later life, representing a heavy social and economic burden for families, communities and health and social systems. Kangaroo mother care (KMC) is recommended as a beneficial and effective intervention for improving short- and long-term preterm birth outcomes in low- and high-income settings. Nevertheless, KMC is not as widely used as it should be. The International Network on KMC runs biennial workshops and congresses to help improve the coverage and quality of KMC worldwide. This paper reports the results of the two-day workshop held in November 2016, where 92 participants from 33 countries shared experiences in a series of round tables, group work sessions and plenaries.FindingsBarriers to and enablers of KMC are discussed with regard to parents, health workers and the health system. Key factors for effective implementation and uptake relate to appropriate training for health staff, adherence to protocols and the creation of a welcoming environment for families. Recommendations for planning for national programmes are made according to a six-stage change model. Resources and the cost of making progress are discussed in terms of investment, maintenance, and acceleration and scaling-up costs. KMC training requirements are presented according to three levels of care. To ensure quality KMC, key requisites are proposed for the different KMC components and for sensitive communication with caregivers. The group attending to the monitoring and evaluation of KMC at a national and subnational level highlight the lack of standard indicator definitions. Key priorities for investment include health services research, harmonisation of indicators, development of a costing tool, programming and scaling up, and the follow-up of preterm infants.ConclusionIt is hoped that this report will help to further scale-up and sustain KMC through a systematic approach that includes raising commitment, identifying key strategies to address the main barriers and using existing facilitators, ensuring training and quality, agreeing on indicators for monitoring and evaluation, and advancing implementation research.

Family Economic Burden Associated to Caring for Children with Cancer.

This work sought to determine the family economic burden associated with caring for the child with cancer. Descriptive study with quantitative approach. The sample comprised 50 families of children with cancer attending a foundation in Bogotá (Colombia), which accompanies integrally children with lupus and cancer from a vulnerable population (providing food, psychological and spiritual advice, lodging, transportation and education). An identification file was employed to characterize the subjects and the Survey "Financial cost of caring for Chronic illness" by Montoya et al. The analysis was performed through the methodology "Economic burden attributable to caring for a person with chronic illness in Colombia" (CARACOL, for the term in Spanish), which quantifies the level of burden in sexagesimal degrees and the financial cost of the burden; a higher number of sexagesimal degrees indicate a higher level of economic burden. Families of children with cancer have a high economic burden, in particular in transportation (28.5°), communications (26.3°), health (20.8°), housing (19.7°), and food (17.4°). The families have a high economic burden associated with caring for the child with cancer. It is necessary to implement social support strategies to these families to keep the economic burden from interfering with adherence to treatment and, hence, with the child's survival.

The Economic Burden of Families with Autism Spectrum Disorders (ASD) Children in Malaysia

The economic burden of families with Autism Spectrum Disorders (ASD) children that are far beyond the needs of typical children causes physical and mental stress for their parents. The study aims to examine the economic burden of parents with ASD children in Malaysia. Calculation is made using a cost-loss approach due to ASD that include direct, indirect and developmental costs. Using convenient sampling method, a total of 245 parents have filled out questionnaires through online or hard copies. Development costs represent the highest cost of RM20,989.33, followed by medical direct costs RM8,378.73, RM5,033.57 for non-medical direct costs and RM963.99 for indirect costs. The total cost of financing an ASD child is RM35,365.62 a year. This is a huge and burdensome amount for parents. The findings of this study may assist responsible parties in the planning of effective service provision to suit the need of parents with ASD children in Malaysia.

Opinions on the prevention and treatment of chronic critical illness

Chronic critical illness (CCI) is an inevitable result of overpopulation and aging, as well as the development of medicine. The number of CCI patients will constantly increase and become an unaffordable economic burden for families, societies and countries. CCI could be prevented by multiple measures. Firstly, doctors must know about the pathophysiology and etiology of the disease. When providing organ function support for CCI patient, we have to know and treat the cause of the disease as early as possible. Secondly, we need to precisely monitor the insults caused by the disease and/or improper host response to the disease, evaluate the organ reserve function, and predict the outcomes and life quality after discharging from hospital. In addition, it is necessary to strengthen the humanity training of health care workers, publicize the correct thanatopsis in the whole society that every life is "born to die", and define the core role of medicine as "to comfort always".

Epidemiology of depression at Traditional Chinese Medicine Hospital in Shanghai, China

BackgroundThough Chinese Traditional Medicine (TCM) is one of the most important parts of health care system in China, studies on the epidemiology of depression in TCM are scarce and mental health issues in TCM have been neglected for longtime. MethodsThis was an interview-based survey. The prevalence of depression and suicidal risk in outpatients at a TCM hospital was identified by a one-stage diagnosing process using the Mini International Neuropsychiatric Interview. Associated risk factors, role impairment, and service utility were also assessed. ResultsA total of 2000 outpatients aged from 18 to 65years completed the survey with a response rate of 87.0%. The estimated prevalence of major depressive disorder was 13.2% for lifetime and 4.9% for current. No significant gender differences were found. Depression was more common in patients who lacked social support, experienced family economic burden and health burden, and underwent negative life events, poor self-rated health, or with moderate/severe sleep problem than in their correspondents; all with statistical significance (OR: 1.83–6.82). Patients with depression reported a mean of 82.7days and 99.3days of sick leave due to their physical and mental condition, respectively, which was much longer than those without depression (24.8days and 25.8days, respectively). Only 30.0% of patients with depression sought professional help from psychiatrists/psychologists or used antidepressants. LimitationsThe recall bias could not be ruled out in this study and could have led to an underestimation of true prevalence and the unmet need for treatment. Since this study was cross-sectional, the causal relationships between sociodemographic factors and depression cannot be determined. ConclusionsDepression is common at TCM hospitals. The impairments due to depression are striking, and unmet needs for treatment are pervasive. Consequently, mental health services in TCM should not be neglected any longer.

Correlation analysis of family burden and support for maintenance hemodialysis patients

Objective To investigate the relationship between family burden and support for maintenance hemodialysis (MHD) patients. Methods Family APGAR index scale (APGAR scale) and disease family burden scale (FBS) were used to investigate among 126 MHD patients (selected by convenient sampling method) from July 2012 to December 2013 in one Beijing level three class A hospital. Results The score of family burden was (36.01±7.52) presented at 3 aspects of family economic burden, family daily life and family entertainment activities. The total score of family support was (7.71±3.01), in which the good family function was 92 cases (73.1%), family slightly obstacles 14 cases (11.1%), and family serious obstacles 20 cases (15.8%). The burden score of family having MHD patients had negative correlation with the score of family support (r=-0.426, P<0.05). Conclusions MHD patients′ family support has significant influence on family burden. Therefore, the nursing staffs should strengthen the concept of holistic nursing care, pay more attention to the patients′ family burden as well as nursing care, so as to perfect the family function, enhance the family support and comprehensively enhance the quality of care for patients. Key words: Maintenance hemodialysis; Family burden; Family support

Patient-Centered Medical Home and Family Burden in Attention-Deficit Hyperactivity Disorder.

Attention-deficit hyperactivity disorder (ADHD) can impair child health and functioning, but its effects on the family's economic burden are not well understood. The authors assessed this burden in US families of children with ADHD, and the degree to which access to a patient-centered medical home (PCMH) might reduce this burden. We conducted cross-sectional analyses of 2005-2006 and 2009-2010 National Surveys of Children with Special Health Care Needs, focusing on families of children with ADHD. They defined family economic burden as (1) family financial problems (annual expenses for the child's health care or illness-related financial problems for the family) and/or (2) family employment problems (job loss, work time loss, or failure to change jobs to avoid insurance loss). Relative risk models assessed associations between PCMH and family economic burden, adjusted for child age, sex, ethnicity, ADHD severity, poverty status, caregiver education, and insurance. In 2009, 26% of families reported financial problems because of the child's ADHD, 2.1% reported out-of-pocket expenses >5% of income, and 36% reported employment problems. Only 38% reported care that met all 5 criteria for a PCMH (similar to rates in 2005-2006). In multivariable analysis, care in a PCMH was associated with 48% lower relative risk (RR) of financial problems (RR = 0.52, p < .001) and 36% lower relative risk of employment problems (RR = 0.64, p < .001). Among PCMH components, family-centered care and care coordination were more strongly associated with lower burden. The economic burdens of families with ADHD are significant but may be alleviated by family-centered care and care coordination in a medical home.

A comparative study on medical expenditure for diabetes mellitus and non-diabetes mellitus in 9 provinces of China, between 2000 and 2009

To compare the medical expenditure and its trend for diabetes mellitus and non-diabetes mellitus and to assess the direct economic burden of diabetes for individuals and families. Using data from the China Health and Nutrition Survey(CHNS), propensity scores matching(PSM)was used to match diabetes mellitus and non-diabetes mellitus according to the related characteristic variables. Data from 679 pairs of objects was then compared. From 2000 to 2009, gaps of annual medical expenditure from diabetes mellitus and non-diabetes mellitus showed an increase, from 3361.93 to 6608.48 Yuan, with the ratios of medical expenditure about 4 times. The ratios of personal economic burden and family economic burden had an increase of about 4-5 times. Compared with non-diabetes mellitus, the annual medical expenses was significantly higher among patients with diabetes mellitus. The absolute cost appeared a dramatic increase, along with the personal and familiar economic burden.