High Financial Burden Research Articles

Prediabetes in Syria and Its Associated Factors: A Single-Center Cross-Sectional Study.

IntroductionPrediabetes is a major risk factor for diabetes and many chronic complications, particularly cardiovascular disease (CVD). Risk factors vary among races and demographics. This is the first study to assess prediabetes in Syria and its relevant risk factors.MethodsThis cross-sectional study was conducted in a primary health clinic in Al-Mouwasat University Hospital, the major Hospital in Damascus, Syria. Interviews, examinations, and blood investigations were carried out by qualified physicians in the clinic.ResultsThis study included 406 participants, of which 363 (89.4%) were females, 43(10.6%) were males, 91 (22.4%) had prediabetes, 108 (26.6%) were overweight, and 231 (56.9%) were obese. Older age, positive family history of diabetes, obesity, abdominal obesity in females, high cholesterol, being married, and CVD were statistically significantly associated with prediabetes (p < 0.05). However, prediabetes was not associated with gender, living in the city or country, cigarette smoking, hypertension, diet, triglycerides, or polycystic ovary syndrome (p > 0.05). However, in the multivariable analysis, only high cholesterol, familial diabetes, and waist diameter had significant association.ConclusionsPrevalence of prediabetes in our study in Syria was higher than what was estimated by previous studies. While many risk factors were similar to other countries in the regions, other risk factors differed. These results were highly reflective of high burden of prediabetes and diabetes, mainly in relatively young females. Further studies are required to tackle this rising issue as it imposes major complications in the long term, and the high financial burden on the health care system.

Synthesis and Antibacterial Evaluation of Rhodanine and Its Related Heterocyclic Compounds against S. aureus and A. baumannii.

Antimicrobial resistance is a serious challenge to modern medicine. Besides imposing high financial burden, multidrug resistant infections are directly responsible for high morbidity and mortality. Even though a number of antibiotics are currently available to treat infections caused by ESKAPE organisms, more and more bacterial strains are becoming resistant to these drugs. Prevailing circumstances pose an urgent unmet need for the development of newer antimicrobials to treat the infections caused by MDR organisms. Rhodanine and structurally related 5-membered heterocycles possess wide range of pharmacological activities. A number of these derivatives have shown good to potent inhibition against various microorganisms. They are reported to alter the function of DNA gyrase B, metallo-β-lactamases, penicillin binding protein (PBP), Mur ligases, RNA polymerase, Enoyl ACP reductases, 1-deoxy-d-xylulose-5-phosphate reductoisomerase. etc which are vital in bacterial growth, survival and replication. In this study, we have generated a library of Rhodanine and related 5 membered heterocyclic derivatives and screened them against a panel of pathogens. Among all the compounds, 2a-i, 3a-b, 3g, 4, 6b-c, 6e, 6g, 12a-b and 14b-c have demonstrated good to moderate inhibition against S. aureus (MIC 0.125-8 μg/mL). Further, compound 17b demonstrated moderate activity against A. baumannii (MIC 8 μg/mL). In addition, compounds 2a, 2e, 4, 6c, 6g and 14b have shown good to mild inhibition against MDR S. aureus including VRSA (MIC 0.5-16 μg/mL) with good selectivity index 20-1600. In addition, compound 2e inhibited the growth gradually after 6 h in time kill kinetic studies and not antagonized with the tested FDA approved drugs.

TECHNOLOGICAL PROCESSES OF COMBATING CORRUPTION OF OUR TIME

The article determines that system-wide technologies aimed at ensuring the proper quality of adopted regulatory legal acts and effective law enforcement practice rightly include: legal technology, legal monitoring, legal expertise, legal forecasting. Special technologies that contribute to the suppression and prevention of corruption include anti-corruption monitoring; anti-corruption examination of regulatory legal acts and their projects. Coordination technologies include: regulatory impact assessment, information and legal technologies for systematizing legislation and processing legal data, etc. The author has proven that the current technology of zinc regulatory impact, as well as the recently introduced assessment of the actual impact, carried out on the basis of the conclusions of the relevant government bodies, experts and representatives of the business community, as additional practical tools aimed at improving the quality, effectiveness and efficiency of legal regulation of the conditions for conducting business and investment activities, it is more correct to attribute not to coordination technologies, but to the type of funds associated with the direct cessation and prevention of corruption. The consolidation of excessive duties, prohibitions and restrictions in the field of entrepreneurial and other economic activities, the establishment of uncertain and difficult to implement requirements for citizens and organizations, the creation of conditions leading to unreasonably high financial burdens for individuals and legal entities are obvious corruption factors. It was concluded that anti-corruption technologies, both standard ones, requiring constant improvement in terms of compliance with objective realities, and new ones, make it possible not only to prevent the onset of harmful consequences from committing corruption offenses, but also to improve the quality of lawmaking, its effectiveness and optimize management processes.

Using Latent Class Analyses to Examine Health Disparities among Young Children in Socially Disadvantaged Families during the COVID-19 Pandemic.

Rising income inequality is strongly linked to health disparities, particularly in regions where uneven distribution of wealth and income has long been a concern. Despite emerging evidence of COVID-19-related health inequalities for adults, limited evidence is available for children and their parents. This study aimed to explore subtypes of families of preschoolers living in the disadvantaged neighborhoods of Hong Kong based on patterns of family hardship and to compare their patterns of parenting behavior, lifestyle practices, and wellbeing during the COVID-19 pandemic. Data were collected from 1338 preschoolers and their parents during March to June 2020. Latent class analysis was performed based on 11 socioeconomic and disease indicators. Multivariate logistic regressions were used to examine associations between identified classes and variables of interest during the COVID-19 pandemic. Four classes of family hardship were identified. Class 1 (45.7%) had the lowest disease and financial burden. Class 2 (14.0%) had the highest financial burden. Class 3 (5.9%) had the highest disease burden. Class 4 (34.5%) had low family income but did not receive government welfare assistance. Class 1 (low hardship) had lower risks of child maltreatment and adjustment problems than Class 2 (poverty) and Class 3 (poor health). However, children in Class 1 (low hardship) had higher odds of suffering psychological aggression and poorer physical wellbeing than those in Class 4 (low income), even after adjusting for child age and gender. The findings emphasize the need to adopt flexible intervention strategies in the time of large disease outbreak to address diverse problems and concerns among socially disadvantaged families.

EE261 Economic Burden of Hemophilia B Patients in the United States: A Systematic Literature Review

Hemophilia B (HB) is a rare X-linked congenital bleeding disorder characterized by a deficiency of coagulation factor IX (FIX). Diagnosed and undiagnosed prevalence rates per 100,000 males are 2.57 and 1.14 for HB in 2020, USA, respectively. Though HB affects only a small portion of population, it imposes high overall cost and financial burden on individuals, payers, and society in general. Current systematic literature review (SLR) aimed to summarize the economic burden reported in patients with HB.

EE166 Cost-Effectiveness of Treatment Strategies for Severe Hemophilia a Patients in the United States

Hemophilia A is a rare genetic bleeding disorder associated with high morbidity and significant financial burden. For bleed prevention, about 80% of patients use prophylaxis, 20% on-demand infusions of either standard half-life factor VIII products (SHL-FVIII) or the newer extended half-life products (EHL–FVIII). Adding heterogeneity to the treatment paradigm, gene therapy is a new promising treatment being evaluated for hemophilia and multiple other genetic pathologies. Our study examined the cost-effectiveness of eight treatment strategies: on-demand and prophylaxis using either SHL-FVIII or EHL-FVIII, with and without gene therapy.

Bibliometric analysis of scientific publications on health care insurance in India from 2000 to 2021

ABSTRACT Background India's health care suffers from high out-of-pocket medical expenses that lead to a higher financial burden on poor people. To reduce the health cost burden, the government of India has initiated many governments funded insurance schemes since 2000. Private health insurance also flourished, but the coverage is limited to wealthier households. Many researchers have published many scientific publications on this research domain, but the bibliometric analysis of scientific publications is missing. Methods We have relied on the ‘SCOPUS' database for data collection based on the wider availability of literature. 761 documents extracted were journal articles, published between 2000 and 2021 followed by certain inclusion and exclusion criteria. Biblioshiny package of R-Studio has been used for data analysis. Results Our analysis reflect upon various aspects of Bibliographic analysis like number of articles published, cited, country wise scientific production etc. Our results also reflect on very few studies that relate to Poverty, income, young adults, aged, adolescents, and children, where there is further scope for research. Conclusion We found that the health insurance-related publication rate has increased over the period. But it requires more research especially the implementation of health insurance mechanisms from the health system perspective. The study will be a policy document to find the research gaps in the healthcare insurance domain.

Association of modifiable factors with financial burden and health literacy among patients with cancer.

6573 Background: Cancer patients are at a higher risk of financial burden compared to those with other chronic illnesses and those without cancer. Additionally, cancer patients with low health literacy are at risk for poor health outcomes and poor self-management. Aside from factors such as education and insurance, there is limited information on the role of modifiable factors in predicting financial burden and health literacy. The aim of this study was to identify risk factors associated with financial burden and health literacy among cancer patients. Methods: Participants were 2,260 adult, English- or Spanish-speaking patients who were recruited from an NCI-designated cancer center in the Chicagoland area as part of a trial on symptom management. Participants completed measures on depressive symptoms and anxiety using the Patient-Reported Outcomes Measurement Information System (PROMIS). Financial burden was assessed using a Comprehensive Score for Financial Toxicity (COST FACIT) item (FT12) and health literacy was assessed by the Single Item Literacy Screener (SILS). Additional information on insurance and cancer diagnosis were extracted from medical records. The area deprivation index (ADI) was calculated using national percentile rankings for the patient’s block group. All patient-reported outcomes were assessed at study baseline. Cross-sectional logistic regression models were fit with the FT12 item [dichotomized as high (somewhat/quite a bit/very much) vs. low (not at all/a little bit) financial burden] and SILS [dichotomized as high (quite a bit/extremely) vs. low (not at all/a little bit/somewhat) health literacy] as separate outcomes. The primary covariates of interest were anxiety and depressive symptoms T-scores (dichotomized reflect normal limits vs. elevated distress). Analyses were adjusted for socio-demographic and clinical characteristics. Results: After adjusting for covariates, significant associations of greater financial burden were PROMIS depression [odds ratio (OR): 1.63 (95% CI: 1.22-2.19)] and PROMIS anxiety (OR: 1.60; 95% CI: 1.22-2.10). In addition, higher ADI score, lower education, unemployment, and low health literacy were significantly associated with greater financial burden. PROMIS depression (OR: 2.15; 95% CI: 1.38-3.40) was associated with low heath literacy, along with disability/leave of absence, Medicare/Medicaid/uninsured and lower education. Conclusions: Modifiable factors are associated with financial burden and health literacy. These results support the systematic screening for financial burden and health literacy in addition emotional well-being. Interventions targeting the modifiable factors elucidated in this study may further efforts to provide quality and equitable comprehensive cancer care. Future work should evaluate the potential causal pathways between depression, health literacy, and financial burden.

Using real-world data to assess variations in cost and healthcare utilization for patients diagnosed with bladder cancer.

e18815 Background: Disparities in diagnosis, treatment, and outcomes for bladder cancer in underserved patient populations persist in the United States. High out-of-pocket costs can prevent patients from seeking or continuing treatment, which can worsen existing disparities in care. The Association of Community Cancer Centers (ACCC) conducted a claims analysis of Medicare beneficiaries diagnosed with bladder cancer to assess differences in healthcare utilization and costs and to inform future provider education initiatives. Methods: ACCC convened an expert steering committee of multidisciplinary specialists and patient advocates to guide the development of the claims analysis methodology and code sets used to identify study cohorts and model variables. Using the CMS Medicare 100% Innovator Administrative Claims Data Set, incident patients were defined as those newly diagnosed in 2018 using a 24-month lookback to confirm no prior bladder cancer diagnosis. Claims for incident patients incurred in the time-period between 24 months prior to and 24 months following diagnosis date were analyzed to generate descriptive summaries of cohorts by severity of disease at diagnosis. Classification is defined by treatment observed within 6 months of diagnosis: No treatment, Early Stage-treated (intravesical chemotherapy), and Late-stage (one or more claims of non-intravesical systemic therapy, radiation therapy, or major bladder surgery). Results: 4,356 incident patients were identified: average age 77.7, 71% male, 56% no treatment, 15% early-stage treated, 28% late-stage. Patients diagnosed at late-stage incur 128% more allowed costs (total amount paid by Medicare and patients) on all-cause healthcare in the first year after diagnosis than early-stage patients who receive treatment ($76,483 vs $33,530) and 101% higher cumulative costs two years following diagnosis ($112,178 vs $55,814). Patients diagnosed at late-stage incur 90% more out-of-pocket costs (copays, coinsurance, deductibles) in the first year following diagnosis than early-stage treated patients ($9,970 vs $5,225) and 81% higher cumulative out-of-pocket costs two years following diagnosis ($15,145 vs $8,390). For both early- and late-stage patients, the month of diagnosis is the most expensive. 53% of all costs incurred in the month of diagnosis are for cystoscopy/TURBT procedures. Elevated costs persist at levels higher than pre-diagnosis levels for at least 20 months. Among late-stage patients, treatments (surgery, radiation therapy, and systemic therapy) sum to 34% of all costs incurred in 6 months following diagnosis. Conclusions: Patients diagnosed with late-stage bladder cancer experience higher financial burden and need more resource-intensive services than those diagnosed at an earlier stage. Earlier diagnosis of bladder cancer is needed to improve patient outcomes and reduce financial burden.

Pharmacotherapy of Generalized Myasthenia Gravis with Special Emphasis on Newer Biologicals.

Myasthenia gravis (MG) is a chronic, fluctuating, antibody-mediated autoimmune disorder directed against the post-synaptic neuromuscular junctions of skeletal muscles, resulting in a wide spectrum of manifestations ranging from mild to potentially fatal. Given its unique natural course, designing an ideal trial design for MG has been wrought with difficulties and evidence in favour of several of the conventional agents is weak as per current standards. Despite this, acetylcholinesterases and corticosteroids have remained the cornerstones of treatment for several decades with intravenous immunoglobulins (IVIG) and therapeutic plasma exchange (PLEX) offering rapid treatment response, especially in crises. However, the treatment of MG entails long-term immunosuppression and conventional agents are viable options but take longer to act and have a number of class-specific adverse effects. Advances in immunology, translational medicine and drug development have seen the emergence of several newer biological agents which offer selective, target-specific immunotherapy with fewer side effects and rapid onset of action. Eculizumab is one of the newer agents that belong to the class of complement inhibitors and has been approved for the treatment of refractory general MG. Zilucoplan and ravulizumab are other agents in this group in clinical trials. Neisseria meningitis is a concern with all complement inhibitors, mandating vaccination. Neonatal Fc receptor (FcRn) inhibitors prevent immunoglobulin recycling and cause rapid reduction in antibody levels. Efgartigimod is an FcRn inhibitor recently approved for MG treatment, and rozanolixizumab, nipocalimab and batoclimab are other agents in clinical trial development. Although lacking high quality evidence from randomized clinical trials, clinical experience with the use of anti-CD20 rituximab has led to its use in refractory MG. Among novel targets, interleukin 6 (IL6) inhibitors such as satralizumab are promising and currently undergoing evaluation. Cutting-edge therapies include genetically modifying T cells to recognise chimeric antigen receptors (CAR) and chimeric autoantibody receptors (CAAR). These may offer sustained and long-term remissions, but are still in very early stages of evaluation. Hematopoietic stem cell transplantation (HSCT) allows immune resetting and offers sustained remission, but the induction regimens often involve serious systemic toxicity. While MG treatment is moving beyond conventional agents towards target-specific biologicals, lack of knowledge as to the initiation, maintenance, switching, tapering and long-term safety profile necessitates further research. These concerns and the high financial burden of novel agents may hamper widespread clinical use in the near future.

Financial burden for families of children with type 1 diabetes: a cross-sectional survey from North India.

IntroductionType 1 diabetes (T1D) incurs substantial out-of-pocket expenses (OOPE) on insulin and diabetes-related supplies. The information on OOPE is scarce from low- and middle-income countries. We aimed to estimate annual OOPE for children with T1D attending our diabetes clinic located in North India.MethodsAn online survey was conducted among parents of 380 children with T1D (mean age: 10.3 ± 4.6 years). Modified BG Prasad scale was used to estimate the socioeconomic status (SES).ResultsThe mean duration of T1D was 3.6 ± 2.6 years; 54.9% of children were boys. The median HbA1c (IQR) was 7.9% (5–15%). 51.9% belonged to lower or lower-middle SES. Mean annual spending on glucose monitoring, insulin administration, and laboratory investigations were Indian Rupee (INR) 21,576, INR 28,965, and INR 5069, respectively (total INR 55,185, IQR: 26,575–105,027). The cost of a single visit to the doctor was approximately INR 2889. Thirty children required hospitalization during the last year, which costs INR 27,495 on average. 30.3% had more than 50% of their total family income spent on diabetes care, with a significant negative correlation with their SES (r = – 0.738, p = 0.00). Only 11.6% were receiving financial support from any agency. 36.6% of families had to borrow money; the OOPE exceeded income from all sources in 8.2% of families.ConclusionsThere is a high financial burden of T1D care for North Indian children, almost on the verge of losing sustainability. Further studies are warranted to furnish larger OOPE data to guide policy decisions aimed at reducing direct costs to patients.

Time trends in cancer and dementia related hospital admissions among Medicare fee-for-service population, 2013–2018

Cancer and dementia are two complicated morbidities that are commonly found in older adults and require substantial healthcare resources.[ [1] Caba Y. et al. The impact of dementia on cancer treatment decision-making, cancer treatment, and mortality: a mixed studies review. JNCI Cancer Spectr. 2021; 5: 1-18 Crossref Google Scholar , [2] McWilliams L. et al. A systematic review of the prevalence of comorbid cancer and dementia and its implications for cancer-related care. Aging Ment Health. 2017; : 1-18 Google Scholar ] Caring for patients with the co-presence of cancer and dementia, who suffer from impaired cognitive function with complex medical needs, is challenging for clinicians, caregivers, and healthcare systems. With the aging US population, the increasing number of older adults with these two comorbid conditions is likely to place a high demand on hospitals. Meanwhile, the shift of care delivery from inpatient to settings such as outpatient and homes, increasing reliance on family caregivers, and improved community care support may help reduce unnecessary hospitalizations.[ 3 2021 Alzheimer's disease facts and figures Alzheimers Dement. 2021; 17: 327-406 Crossref PubMed Scopus (739) Google Scholar , 4 Federman A.D. et al. Association of a bundled hospital-at-home and 30-day postacute transitional care program with clinical outcomes and patient experiences. JAMA Intern Med. 2018; 178: 1033-1040 Crossref PubMed Scopus (88) Google Scholar , 5 Handley N.R. Bekelman J.E. The oncology hospital at home. J Clin Oncol. 2019; 37: 448-452 Crossref PubMed Scopus (23) Google Scholar ] It is important to understand the pattern of hospitalization, which is one of the major drivers of healthcare costs and high financial and caregiving burden for patients and their families, among the growing population with cancer and dementia. While there has been extensive research on the incidence, prevalence, and healthcare utilization among older adults with either cancer or dementia, existing literature examining older adults with both conditions is scarce and limited in scope. [ [1] Caba Y. et al. The impact of dementia on cancer treatment decision-making, cancer treatment, and mortality: a mixed studies review. JNCI Cancer Spectr. 2021; 5: 1-18 Crossref Google Scholar , [2] McWilliams L. et al. A systematic review of the prevalence of comorbid cancer and dementia and its implications for cancer-related care. Aging Ment Health. 2017; : 1-18 Google Scholar , [6] Kedia S.K. et al. Health care utilization among elderly medicare beneficiaries with coexisting dementia and cancer. Gerontol Geriatr Med. 2017; 3 (p. 2333721416689042) Crossref PubMed Google Scholar , [7] Liu B. et al. Trends of hospitalizations among patients with both cancer and dementia diagnoses in New York 2007-2017. Healthc (Amst). 2021; 9100565 Google Scholar ] In particular, no national estimates exist regarding the hospitalization rates among older adults with comorbid cancer and dementia. To fill this gap, we examined the national and state-level trends in hospitalization rates among Medicare fee-for-service (FFS) beneficiaries with the co-presence of a major cancer (breast, prostate, lung, and colorectal) and dementia diagnoses. We hypothesized a growing trend of inpatient use among this population during the years 2013–2018. Due to the heterogeneity in cancer-specific prognosis and treatment, we also examined the trend of hospitalizations among this population by cancer types.

Protective Effects of Pegylated Choline Acetyltransferase in a Murine Model of DSS Colitis

Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, affects up to 3 million people in the United States alone, significantly worsens a patient’s quality of life, and is associated with a high financial burden. Current treatments for IBD are mainly biologicals that have significant side effects. No efficient pharmacological treatments are currently available for IBD. Previous studies established that activation of the vagus nerve‐based inflammatory reflex inhibits cytokine production and regulates immune responses through cholinergic signaling. Acetylcholine released by a T cell subset expressing choline acetyltransferase (ChAT), the enzyme that catalyzes the biosynthesis of acetylcholine, inhibits cytokine production via signaling through α7 nicotinic acetylcholine receptors (α7nAChR). However, the possibility of controlling inflammation by systemic administration of ChAT is unexplored. Here we examined the efficacy of ChAT in improving disease activity in a preclinical model of colitis. To prolong the half‐life of circulating ChAT, the protein was modified by covalently attaching repeating units of polyethylene glycol (PEG), resulting in enzymatically active PEG‐ChAT. We utilized a well‐established model of colitis ‐ dextran sulfate sodium induced colitis. Wild type C57/black 6 mice were exposed to 4% DSS (M.W 36 000‐50 000) in drinking water for 7 days prior to administration of PEG‐ChAT. Starting on day 8, animals received PEG‐ChAT or vehicle intraperitoneally twice per day for 7 days. PEG‐ ChAT treated mice showed a significantly lower disease activity index as compared with vehicle treated controls with the disease (d11 p=0.006 ChAT mice: 0.17DAI±0.05, n=9 versus vehicle mice: 0.66DAI±0.13, n=10). The decreased severity of colitis in PEG‐ChAT‐treated mice as compared with vehicle‐treated controls is further demonstrated by a significant improvement in body weight gain (d14 p=0.01 ChAT mice: ‐5.1%±1.1, n=10 versus vehicle mice: ‐15.5%±2.9, n=10) and colon length (p=0.006 ChAT mice: 7.15cm±0.2, n=10 versus vehicle mice: 6.2cm±0.2, n=10). In conclusion, PEG‐ChAT reduces disease activity in a preclinical model of colitis. Together these studies provide new insights into the role of PEG‐ChAT as an experimental anti‐inflammatory therapeutic modality for the treatment of IBD.

Phospholipids in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease, or NAFLD – is a pathology that usually has a metabolic cause and is not caused by excessive alcohol consumption. NAFLD is the most frequent chronic liver disease worldwide and is accompanied by a high financial burden for the patient and the healthcare system. NAFLD is generally considered a “benign disease” with low progression to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Nevertheless, due to the large number of affected patients, the prevalence of cirrhosis of the liver has gradually increased, and in fact it represents the third cause of liver transplantation in the world. Moreover, even if the frequency of HCC in patients with NAFLD is lower than in patients with HCV/HBV cirrhosis, the absolute number of HCC associated with NASH is higher due to the higher number of patients with NAFLD. It is likely that the importance of this disease will continue to grow in the future, when new treatments and prevention programs for hepatitis C and B reduce the size of viral liver infections. Many aspects of the disease have yet to be solved. It is very important to understand the mechanisms underlying the occurrence and development of NAFLD, the features of the clinic and diagnosis, as well as the tactics of management and treatment of patients with non-alcoholic fatty liver disease. It is important for patients to get a complete understanding of NAFLD so that they can play an active role in the treatment of their disease.

Imaging of the Temporomandibular Joint.

Temporomandibular disorder (TMD) is a common musculoskeletal condition that causes pain and disability for patients and imposes a high financial burden on the healthcare system. The most common cause of TMD is internal derangement, mainly secondary to articular disc displacement. Multiple other pathologies such as inflammatory arthritis, infection, and neoplasm can mimic internal derangement. MRI is the modality of choice for evaluation of the TMJ. Radiologists need to be familiar with the normal anatomy and function of the TMJ and MR imaging of the internal derangement and other less common pathologies of the TMJ.

Etiological Agents of Urinary Tract Infection (UTI)

Urinary tract infection is one of the most common infectious diseases and has a high financial burden on society. The occurrence of urinary tract infection acquired by the population is higher in young women, almost half of all women will have at least one UTI episode during their lifetime, and about 1 in 3 women will have at least one UTI episode at the age of 24 years. Urinary tract infection increases with age for both sexes. It is estimated that 10 percent of men and 20 percent of women over 65 years of age have bacterial symptoms. Worldwide, Community-associated UTI (CAUTI) prevalence is 0.7% and the main risk factors are age, sexual activity, history of urinary tract infection, and diabetes. UTI is caused by Gram-negative and Gram-positive bacteria, where more than 95 % of UTI cases are caused by bacteria. Gram-negative organisms, primarily from the Enterobacteriaceae family, are responsible for UTI. It includes Escherichia coli (74.20 %), Enterococcus spp (5.30 %), Staphylococcus saprophyticus (1.40 %) Pseudomonas spp. (3.20 %), Klebsiella pneumoniae (6.20 %), and Proteus mirabilis (2.00 %) are among the bacteria that cause UTIs, with other bacteria accounting for 8.70 % .The aim of this review is to provide a summary and critical evaluation of the published evidence about the etiological agents of urinary tract infection.

Epidemiology of extrapulmonary tuberculosis among pediatric inpatients in mainland China: a descriptive, multicenter study

ABSTRACT Pediatric tuberculosis (TB) is a serious infectious disease that affects many children worldwide and is more likely to be extrapulmonary than adult TB. However, the clinical and epidemiological profile, and cost burden of pediatric extrapulmonary TB (EPTB) in China remain unknown. Here, we conducted a descriptive, multicenter study of pediatric TB patients from 22 hospitals across all six regions in China from October 2015 to December 2018. Of 4,654 patients, 54.23% (2,524) had pulmonary TB (PTB), 17.76% (827) had EPTB, and 28.00% (1,303) had concurrent extrapulmonary and pulmonary TB (combined TB). Compared with PTB, EPTB and combined TB were associated with lower hospitalization frequency (2.43 and 2.21 vs. 3.16 times), longer length of stay (10.61 and 11.27 vs. 8.56 days), and higher rate of discharge against medical advice (8.46% and 9.44% vs. 5.67%). EPTB was associated with higher mortality (0.97% vs. 0.24% and 0.31%), higher rate of low birth weight (17.69% vs. 6.79% and 6.22%), worse diagnosis at the first visit (21.16% vs. 34.67% and 44.47%), and worse hospitalization plan situation (4.35% vs. 7.81% and 7.44%), compared with PTB and combined TB. EPTB and combined TB had higher financial burdens (17.67% and 16.94% vs. 13.30%) and higher rates of catastrophic expenditure (8.22% and 9.59% vs. 5.03%), compared with PTB. Meningitis TB (34.18%) was the most frequent form of total extrapulmonary infection and had the highest cost burden and rate of catastrophic expenditure. In conclusion, improved screening approaches for pediatric EPTB are needed to reduce diagnostic challenges and financial burden.

Effect of a single intra-articular administration of stanozolol in a naturally occurring canine osteoarthritis model: a randomised trial

Osteoarthritis (OA) is a disease with a high negative impact on patient’s quality of life and a high financial burden. It is a source of chronic pain and affects all mammals, including humans and dogs. As the dog is a common model for translation research of human OA, and exploring spontaneous dog OA can improve the health and well-being of both humans and dogs. To describe the effect of the intra-articular administration of stanozolol in a naturally occurring canine OA model, forty canine (N = 40) hip joints were randomly assigned to receive stanozolol or saline (control). On treatment day and at 8, 15, 30, 90, and 180 days post-treatment, several evaluations were conducted: weight distribution, joint range of motion, thigh girth, digital thermography, and radiographic signs. Also, synovial fluid C-reactive protein and interleukin-1 levels were evaluated. Results from four Clinical Metrology Instruments was also gathered. Results were compared with Repeated Measures ANOVA, with a Huynh–Feldt correction, paired-samples t-test, or Wilcoxon signed-rank test, with p < 0.05. OA was graded as mild (90%), moderate (5%), and severe (5%), including both sexes. They had a mean age of 6.5 ± 2.4 years and a bodyweight of 26.7 ± 5.2 kg. No differences were found between groups at treatment day in all considered evaluations. Weight distribution showed significant improvements with stanozolol from 15 days (p < 0.05) up to 180 days (p < 0.01). Lower values during thermographic evaluation in both views taken and improved joint extension at 90 (p = 0.02) and 180 days (p < 0.01) were observed. Pain and function scores improved up to 180 days. In the control group, radiographic signs progressed, in contrast with stanozolol. The use of stanozolol was safe and produced significant improvements in weight-bearing, pain score, and clinical evaluations in a naturally occurring canine OA model.

Quality of Life and its Determinants in Patients With Adrenal Insufficiency: A Survey Study at 3 Centers in the United States.

Current evidence on determinants of quality of life (QoL) in patients with adrenal insufficiency (AI) is limited. This work aimed to identify the determinants of QoL in different subtypes of AI. This multicenter cross-sectional survey study was conducted using a patient-centered questionnaire, the Short Form-36. Of 529 participants, 223 (42.2%) had primary AI, 190 (35.9%) had secondary AI, and 116 (21.9%) had glucocorticoid-induced AI. Median age was 58 years (interquartile range: 43-68 years) and 342 (64.8%) were women. In multivariable analyses, patients were more likely to report worse physical scores if they were women (odds ratio [OR]: 3.3; 95% CI, 1.8-6.0), had secondary AI or glucocorticoid-induced AI (OR: 2.5; 95% CI, 1.4-4.3), had shorter duration of AI (OR: 2.0; 95% CI, 1.1-3.6), were treated with more than 25 mg hydrocortisone equivalent daily (OR: 2.3; 95% CI, 1.2-4.6), had more comorbidities related to glucocorticoid excess (OR: 2.3; 95% CI, 1.3-4.0), reported a higher financial burden from AI (OR: 2.1; 95% CI, 1.3-3.6), and reported difficulties with AI management (OR: 2.5; 95% CI, 1.2-5.2). Women (OR: 2.1; 95% CI, 1.08-4.0), shorter duration of AI (OR: 2.4; 95% CI, 1.4-4.3), higher financial burden (OR: 2.3; 95% CI, 1.3-4.0), difficulties with AI management (OR: 2.6; 95% CI, 1.4-4.9), and lack of family support (OR: 9.1; 95% CI, 2.3-33.3) were associated with worse mental component scores. In patients with AI, QoL could be improved by addressing certain determinants, such as avoiding GC overreplacement, providing in-depth education on self-management, offering more comprehensive insurance coverage, and ensuring better family support.

Pharmaceutical regulation and policies in Austria

Austria is a middle-sized, high-income country in Central Europe with universal health coverage and a highly fragmented health care system. Medicines for outpatient use that are reimbursed by the social health insurance are price-regulated, whereas medicines for inpatient use are neither subject to price regulation nor to health technology assessment (HTA). These medicines are procured by hospitals, hospital groups and provinces which are the main owner of public hospitals. The major pricing policy for new medicines in the outpatient sector is external price referencing. Austria refers to all other 26 European Union (EU) Member States; the determined benchmark price must not exceed the EU average price. External price referencing is based on list prices, but the statutory manufacturer discounts applicable in some reference countries are considered. Regular price reviews with subsequent price adjustments are in place. For generic and biosimilar medicines to be included in the outpatient positive list, a price link policy is applied with different reduction rates for generics and biosimilars. In the supply chain, prices of all medicines are regulated through regressive mark-up schemes for wholesale and community pharmacies. The inclusion in the outpatient positive list is based on an HTA process which comprises pharmacological, medical-therapeutic and economic evaluations, followed by price negotiations about the reimbursement price. For medicines with high financial burden for the public payers, the Austrian Social Insurance (for the outpatient sector) and procurers for hospitals tend to conclude managed-entry agreements with confidential discounts. For outpatient medicines, patients are charged a fixed prescription fee per prescribed item; no further co-payments apply for outpatient or inpatient medicines. Studies have shown that the current pricing and reimbursement policies in Austria have contributed to keep prices of outpatient medicines stable (high-cost medicines tend to range above EU average), whereas the unregulated prices of medicines used in hospitals are frequently the highest in European comparison. Pharmacy mark-ups are also high in comparison to other European countries.