High Health Care Research Articles

Wrongful birth and wrongful life lawsuits in obstetrics and gynecology

Developments in preconception and prenatal technologies have led to undeniable advances in how healthcare providers screen and treat patients. Despite these advances, at any point errors can occur leading to misdiagnosis or a missed diagnosis. In some instances, the missed information can lead to the birth of a child with health issues where short of the error, the decision to avoid conception or terminate the pregnancy might have been made. When these lapses unfold, there exists the potential for a wrongful birth or wrongful life lawsuit to ensue. While these two actions are based on the same set of events, they are distinct legal claims with varying degrees of judicial permissibility. Global legal acceptability of wrongful birth and life lawsuits tends to resemble patterns in the United States. Analyzing prior wrongful birth and wrongful life claims can reveal common trends in events leading to these types of lawsuits, as well as an understanding of their potential outcomes. A familiarity with wrongful birth and wrongful life lawsuits demonstrates how these cases are a unique from other forms of prenatal or birth injury tort lawsuits and can provide insights to common shortcomings in clinical practice. Applying these lessons to clinical practice highlights key approaches towards limiting the risk of certain errors leading to wrongful birth and wrongful life lawsuits, with the goal of healthcare providers offering high quality healthcare.

A machine learning model for the early diagnosis of bloodstream infection in patients admitted to the pediatric intensive care unit.

Bloodstream infection (BSI) is associated with increased morbidity and mortality in the pediatric intensive care unit (PICU) and high healthcare costs. Early detection and appropriate treatment of BSI may improve patient's outcome. Data on machine-learning models to predict BSI in pediatric patients are limited and neither study included time series data. We aimed to develop a machine learning model to predict an early diagnosis of BSI in patients admitted to the PICU. This was a retrospective cohort study of patients who had at least one positive blood culture result during stay at a PICU of a tertiary-care university hospital, from January 1st to December 31st 2019. Patients with positive blood culture results with growth of contaminants and those with incomplete data were excluded. Models were developed using demographic, clinical and laboratory data collected from the electronic medical record. Laboratory data (complete blood cell counts with differential and C-reactive protein) and vital signs (heart rate, respiratory rate, blood pressure, temperature, oxygen saturation) were obtained 72 hours before and on the day of blood culture collection. A total of 8816 data from 76 patients were processed by the models. The machine committee was the best-performing model, showing accuracy of 99.33%, precision of 98.89%, sensitivity of 100% and specificity of 98.46%. Hence, we developed a model using demographic, clinical and laboratory data collected on a routine basis that was able to detect BSI with excellent accuracy and precision, and high sensitivity and specificity. The inclusion of vital signs and laboratory data variation over time allowed the model to identify temporal changes that could be suggestive of the diagnosis of BSI. Our model might help the medical team in clinical-decision making by creating an alert in the electronic medical record, which may allow early antimicrobial initiation and better outcomes.

Predictive Factors for 30-Day Readmission and Increased Healthcare Utilization in Sickle Cell Disease Patients: A Single-Center Comparative Retrospective Study.

SCD poses a significant healthcare burden. Understanding the factors contributing to high healthcare utilization and readmissions is crucial for improving the quality of care provided. This retrospective comparative observational study was conducted at King Saud University Medical City and included 160 SCD patients. A comparison was made between patients with no readmission and patients with at least one 30-day readmission. Another comparison was done between high healthcare-utilizing patients and low healthcare-utilizing patients. A regression model for 30-day readmission prediction was created. Readmission was significantly higher in patients using opioids, following up with pain clinics, and having a history of AVN (p= 0.002, p=0.028 and p=0.025 respectively). Higher healthcare utilization was associated with older age, smoking, use of opioids and GABA analogs, and psychiatric illnesses, including depression, substance use disorder, and anxiety. Predictors of 30-day readmission were hydroxyurea use (odds ratio, 2.819 [95% CI,1.082 to 7.34], p = 0.034), follow-up with pain management clinics (odds ratio, 2.248 [95% CI,1.547 to 3.266], p = 0.001), and SCD genotype (SS genotype) (odds ratio, 1.754 [95% CI,1.012 to 3.042], p = 0.045). Using the Paracetamol/Codeine combination significantly reduced the likelihood of readmission within 30 days of discharge. This study identified factors associated with 30-day readmission rate and high healthcare utilization among SCD patients. Strategies to reduce readmissions may include specialized SCD clinics, educational programs for patients, improved physician awareness of mental health screening, and further research on the impact of opioid use. Limitations include retrospective nature, single-center design, reliance on self-reported data, and exclusion of critically ill patients. However, despite the limitations, this study could lay a foundation for future projects aiming to optimize care and outcomes for patients living with SCD.

Association of accelerated aging with the incidence risk of Cardiometabolic diseases in people with severe mental illnesses: A prospective analysis in UK Biobank

Cardiometabolic diseases (CMDs) comorbidities among people with severe mental illnesses (SMI) are associated with a high healthcare burden and premature mortality. This study aims to evaluate whether biological aging has an interaction with SMI on incident CMDs, and to examine the association of four biological aging indicators with CMDs incidence in this population. Data were sourced from the UK Biobank, a large prospective cohort study. Four indicators were used to assess biological aging including frailty phenotype, frailty index, KDM-biological age acceleration and phenotypic age acceleration. Cox proportional hazards regression models were used to examine the associations. We observed higher prevalence of frailty and accelerated biological age with SMI than those without SMI. Further analysis found significant interaction effect of pre-frailty and SMI (PPre-frail*SMI=0.005) as well as biological age acceleration and SMI (PQ3 (>P75)*SMI=0.038). 14.7 % of the participants with SMI developed CMDs during the follow-up. Compared with non-frail participants, those with frailty (frailty phenotype: HR=1.68, 95 % CI: 1.50, 1.88, P < 0.001; frailty index: HR=2.44, 95 % CI: 2.11–2.81, P < 0.001) and biological age acceleration (KDM-biological age acceleration (Q3): HR=1.91, 95 % CI: 1.74, 2.11, P < 0.001; phenotypic age acceleration (Q3): HR=2.07, 95 % CI: 1.86, 2.30, P < 0.001) had a significantly higher risk of CMDs in the adjusted model. A series of sensitivity analyses were conducted to illustrate the robustness of the findings. These findings highlight the important implications for concerning about the high incidence of CMDs comorbidities and intervention of aging in people with SMI.

Social Acceptance of Mobile Health Technologies Among the Young Population in Nigeria

Mobile devices are widely used in modernizing healthcare delivery because of their unique features related to accessibility, virtual interaction, and connectivity. While developing countries, with limited resources, strive to achieve high healthcare standards, and mobile health (mHealth) solutions could transform healthcare delivery systems in these countries, their functionality is currently limited. This study investigates the potential systematic introduction of mHealth services and their social acceptability in developing countries, with a particular focus on Nigeria. This cross-sectional study was conducted with a sample of university students. Structural equation modeling was used to test the study hypotheses, and descriptive statistics were used to analyze the sociodemographic characteristics of the participants. Psychological and personal characteristics, environmental characteristics, and conditions of use associated with mHealth technology adoption were examined based on eight constructs (health consciousness, trust, social influence, perceived risk, performance expectancy, facilitating conditions, effort expectancy, and behavioral intention). The results indicate that trust and performance expectancy are significant predictors of mHealth acceptance in the surveyed population. The future acceptance of mHealth among young people in developing countries holds great significance for improving healthcare delivery, addressing the unique challenges faced by developing countries, and leveraging the preferences of young individuals, which could contribute to the advancement of mHealth solutions and enhance healthcare accessibility. The findings shed light on the acceptance of mHealth technologies among the young populations of developing countries, with implications for future efforts to improve healthcare delivery and address the healthcare challenges of these countries.

Second-line anti-retroviral treatment failure and its predictors among patients with HIV in Ethiopia: A systematic review and meta-analysis.

Antiretroviral therapy (ART) treatment failure remains a major public health concern, with multidimensional consequences, including an increased risk of drug resistance, compromised quality of life, and high healthcare costs. However, little is known about the outcomes of second-line ART in Ethiopia. Therefore, this systematic review and meta-analysis aimed to determine the incidence and determinants of second-line ART treatment failure. Articles published in PubMed, Google Scholar, Science Direct, and Scopus databases were systematically searched. All observational studies on the incidence and predictors of treatment failure among patients with HIV on second-line ART were included. A random-effects model was used to estimate the pooled incidence, and subgroup analysis was performed to identify the possible sources of heterogeneity. Publication bias was checked using forest plot, Begg's test, and Egger's test. The pooled odds ratio was also computed for associated factors. Seven studies with 3,962 study participants were included in this study. The pooled incidence of second-line antiretroviral treatment failure was 5.98 (95% CI: 4.32, 7.63) per 100 person-years of observation. Being in the advanced WHO clinical stage at switch (AHR = 2.98, 95% CI: 2.11, 4.25), having a CD4 count <100 cells/mm3 (AHR = 2.14, 95% CI: 1.57, 2.91), poor drug adherence (AHR = 1.78, 95% CI: 1.4, 2.25), and tuberculosis co-infection (AHR = 2.93, 95% CI: 1.93, 4.34) were risk factors for treatment failure. In conclusion, this study revealed that that out of 100 person-years of follow-up, an estimated six patients with HIV who were on second-line antiretroviral therapy experienced treatment failure. The risk of treatment failure was higher in patients who were in an advanced WHO clinical stage, CD4 count <100 cells/mm3, and presence tuberculosis co-infection. Therefore, addressing predictors reduces the risk of treatment failure and maximizes the duration of stay in second-line regimens.

An analysis of financial protection and financing incidence of out-of-pocket health expenditures in Kazakhstan from 2018 to 2021

Universal health coverage relies on providing essential medical services and shielding individuals from financial risks. Our study assesses the progressivity of out-of-pocket (OOP) payments, identifies factors contributing to healthcare expenditure inequality, and examines catastrophic health expenditures (CHE) prevalence in Kazakhstan from 2018 to 2021. Using retrospective analysis of National Statistics Bureau data, we employed STATA 13 version for calculations CHE incidence, progressivity, Lorenz and concentration curves. In 2020–2021, OOP expenditures in Kazakhstan decreased, reflecting a nearly twofold reduction in the CHE incidence to 1.32% and 1.24%, respectively. However, during these years, we observe a transition towards a positive trend in the Kakwani index to 0.003 and 0.005, respectively, which may be explained by household size and education level factors. Increased state financing and quarantine measures contributed to reduced OOP payments. Despite a low healthcare expenditure share in gross domestic product, Kazakhstan exhibits a relatively high private healthcare spending proportion. The low CHE incidence and proportional expenditure system suggest private payments do not significantly impact financial resilience, prompting considerations about the role of government funding and social health insurance in the financing structure.

Pre-diagnosis Predictors of High Health Care Cost Among Patients with Myasthenia Gravis Using a Combined Machine-learning and Regression Approach (P4-11.011)

Pre-diagnosis Predictors of High Health Care Cost Among Patients with Myasthenia Gravis Using a Combined Machine-learning and Regression Approach (P4-11.011)

Characterization of three novel stem rot pathogens and their antagonistic endophytic bacteria associated with Cistanche deserticola.

Cistanche deserticola is a precious Chinese medicinal material with extremely high health care and medicinal value. In recent years, the frequent occurrence of stem rot has led to reduced or even no harvests of C. deserticola. The unstandardized use of farm chemicals in the prevention and control processes has resulted in excessive chemical residues, threatening the fragile desert ecological environment. Therefore, it is urgent to explore safe and efficient prevention and control technologies. Biocontrol agents, with the advantages of safety and environment-friendliness, would be an important idea. The isolation, screening and identification of pathogens and antagonistic endophytic bacteria are always the primary basis. In this study, three novel pathogens causing C. deserticola stem rot were isolated, identified and pathogenicity tested, namely Fusarium solani CPF1, F. proliferatum CPF2, and F. oxysporum CPF3. For the first time, the endophytic bacteria in C. deserticola were isolated and identified, of which 37 strains were obtained. Through dual culture assay, evaluation experiment and tissue culture verification, a biocontrol candidate strain Bacillus atrophaeus CE6 with outstanding control effect on the stem rot was screened out. In the tissue culture system, CE6 showed excellent control effect against F. solani and F. oxysporum, with the control efficacies reaching 97.2% and 95.8%, respectively, indicating its great potential for application in the production. This study is of great significance for the biocontrol of plant stem rot and improvement of the yield and quality of C. deserticola.

Susceptibility to Treatment-Resistant Depression Within Families

Antidepressant responses and the phenotype of treatment-resistant depression (TRD) are believed to have a genetic basis. Genetic susceptibility between the TRD phenotype and other psychiatric disorders has also been established in previous genetic studies, but population-based cohort studies have not yet provided evidence to support these outcomes. To estimate the TRD susceptibility and the susceptibility between TRD and other psychiatric disorders within families in a nationwide insurance cohort with extremely high coverage and comprehensive health care data. This cohort study assessed data from the Taiwan national health insurance database across entire population (N = 26 554 001) between January 2003 and December 2017. Data analysis was performed from August 2021 to April 2023. TRD was defined as having experienced at least 3 distinct antidepressant treatments in the current episode, each with adequate dose and duration, based on the prescribing records. Then, we identified the first-degree relatives of individuals with TRD (n = 34 467). A 1:4 comparison group (n = 137 868) of first-degree relatives of individuals without TRD was arranged for the comparison group, matched by birth year, sex, and kinship. Modified Poisson regression analyses were performed and adjusted relative risks (aRRs) and 95% CIs were calculated for the risk of TRD, the risk of other major psychiatric disorders, and different causes of mortality. This study included 172 335 participants (88 330 male and 84 005 female; mean [SD] age at beginning of follow-up, 22.9 [18.1] years). First-degree relatives of individuals with TRD had lower incomes, more physical comorbidities, higher suicide mortality, and increased risk of developing TRD (aRR, 9.16; 95% CI, 7.21-11.63) and higher risk of other psychiatric disorders than matched control individuals, including schizophrenia (aRR, 2.36; 95% CI, 2.10-2.65), bipolar disorder (aRR, 3.74; 95% CI, 3.39-4.13), major depressive disorder (aRR, 3.65; 95% CI, 3.44-3.87), attention-deficit/hyperactivity disorders (aRR, 2.38; 95% CI, 2.20-2.58), autism spectrum disorder (aRR, 2.26; 95% CI, 1.86-2.74), anxiety disorder (aRR, 2.71; 95% CI, 2.59-2.84), and obsessive-compulsive disorder (aRR, 3.14; 95% CI, 2.70-3.66). Sensitivity and subgroup analyses validated the robustness of the findings. To our knowledge, this study is the largest and perhaps first nationwide cohort study to demonstrate TRD phenotype transmission across families and coaggregation with other major psychiatric disorders. Patients with a family history of TRD had an increased risk of suicide mortality and tendency toward antidepressant resistance; therefore, more intensive treatments for depressive symptoms might be considered earlier, rather than antidepressant monotherapy.

Implementing digital sexual and reproductive health care services in youth clinics: a qualitative study on perceived barriers and facilitators among midwives in Stockholm, Sweden

BackgroundDigital health care services have the potential to improve access to sexual and reproductive health care for youth but require substantial implementation efforts to translate into individual and public health gains. Health care providers are influential both regarding implementation and utilization of the services, and hence, their perceptions of digital health care services and the implementation process are essential to identify and address. The aim of this study was to explore midwives’ perception of digital sexual and reproductive health care services for youth, and to identify perceived barriers and facilitators of the implementation of digital health care provision in youth clinics.MethodsWe performed semi-structured interviews with midwives (n = 16) working at youth clinics providing both on-site and digital sexual and reproductive health care services to youth in Stockholm, Sweden. Interview data were analyzed using a content analysis approach guided by the Consolidated Framework for Implementation Research (CFIR).ResultsMidwives acknowledged that the implementation of digital health care improved the overall access and timeliness of the services at youth clinics. The ability to accommodate the needs of youth regarding their preferred meeting environment (digital or on-site) and easy access to follow-up consultations were identified as benefits of digital health care. Challenges to provide digital health care included communication barriers, privacy and confidentiality concerns, time constraints, inability to offer digital appointments for social counselling, and midwives’ preference for in person consultations. Experiencing organizational support during the implementation was appreciated but varied between the respondents.ConclusionDigital sexual and reproductive health care services could increase access and are valuable complements to on-site services in youth clinics. Sufficient training for midwives and organizational support are crucial to ensure high quality health care. Privacy and safety concerns for the youth might aggravate implementation of digital health care. Future research could focus on equitable access and youth’ perceptions of digital health care services for sexual and reproductive health.

Optimization of the fermentation process and antioxidant activity of mixed lactic acid bacteria for honeysuckle beverage.

The aim of the research was to obtain a high healthcare honeysuckle beverage with strong antioxidant activity. Honeysuckle (Lonicera japonica Thunb) was used as the raw material in this experiment. The effects of fermentation temperature, fermentation time, lactic acid bacteria inoculation amount, and sugar addition amount on the sensory quality of honeysuckle beverage were investigated by single factor test and orthogonal test, and the best process was obtained. The physicochemical indexes and antioxidant activity of honeysuckle beverages fermented with lactic acid bacteria were studied. The results showed that the fermentation temperature of the beverage was 37 °C, the fermentation time was 24 h, the inoculation amount of Lactiplantibacillus plantarum and Lactobacillus acidophilus mixed starter (1:1) was 3%, and 8% white granulated sugar was added. The highest sensory score was 87.30 ± 0.17, which was the optimal process. The honeysuckle liquid mixed inoculation with Lactiplantibacillus plantarum and Lactobacillus acidophilus was fermented for 24 h. The number of viable bacteria reached 9.84 ± 0.02 lg cfu/mL, the pH value was 3.10 ± 0.01, and the total polyphenol content was 7.53 ± 0.03 mg GAE/g. The number of lactic acid bacteria, pH, total polyphenol content, and free radical scavenging rate were significantly increased (p < 0.05) compared with the non-inoculated and single-inoculated lactic acid bacteria. To sum up, it was concluded that a better quality beverage could be obtained by fermenting a solution of honeysuckle with Lactiplantibacillus plantarum and Lactobacillus acidophilus mixed fermentation agent, providing a new approach and new ideas for the development of deep processing and fermented beverages using honeysuckle.

Effect of a national infection control programme in Sweden on prosthetic joint infection incidence following primary total hip arthroplasty: a cohort study

ObjectivesProsthetic joint infection (PJI) is a serious complication following total hip arthroplasty (THA) entailing increased mortality, decreased quality of life and high healthcare costs.The primary aim was to investigate whether...

Prison or treatment? Gender, racial, and ethnic inequities in mental health care utilization and criminal justice history among incarcerated persons with borderline and antisocial personality disorders.

Borderline and antisocial personality disorders are characterized by pervasive psychosocial impairment, disproportionate criminal justice involvement, and high mental health care utilization. Although some evidence suggests that systemic bias may contribute to demographic inequities in criminal justice and mental health care among persons experiencing these mental health conditions, no research to date has explicitly examined such differences. Women and White persons would be more likely to endorse internalizing symptoms and have a more extensive history of mental health service utilization, whereas men, persons from minoritized racial groups, and persons identifying as Hispanic/Latino would be more likely to endorse externalizing symptoms and have more extensive histories of involvement with the criminal justice system. This study examined gender, racial, and ethnic differences in symptom presentation, criminal justice history, and mental health care utilization in a sample of 314 adults with comorbid borderline and antisocial personality disorders enrolled in prison-based substance use treatment programs in the United States. Results suggested that men with these personality disorders were more likely to have early extensive criminal justice involvement, whereas women and White people had more extensive mental health treatment histories. Women were also more likely to endorse a range of internalizing symptoms, and White and non-Hispanic participants were more likely to endorse a history of reckless behavior. Notably, however, many associations-particularly, racial differences in symptom presentation and mental health utilization history and gender differences in symptom presentation-did not persist after we controlled for preincarceration employment and educational attainment. Results highlight a range of gender, racial, and ethnic inequities in criminal justice involvement and mental health utilization among this high-risk high-need population. Findings attest to the likely impact of societal, structural, and systemic factors on trajectories of persons affected by this comorbidity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Early prediction of end-stage kidney disease using electronic health record data: a machine learning approach with a 2-year horizon.

In the United States, end-stage kidney disease (ESKD) is responsible for high mortality and significant healthcare costs, with the number of cases sharply increasing in the past 2 decades. In this study, we aimed to reduce these impacts by developing an ESKD model for predicting its occurrence in a 2-year period. We developed a machine learning (ML) pipeline to test different models for the prediction of ESKD. The electronic health record was used to capture several kidney disease-related variables. Various imputation methods, feature selection, and sampling approaches were tested. We compared the performance of multiple ML models using area under the ROC curve (AUCROC), area under the Precision-Recall curve (PR-AUC), and Brier scores for discrimination, precision, and calibration, respectively. Explainability methods were applied to the final model. Our best model was a gradient-boosting machine with feature selection and imputation methods as additional components. The model exhibited an AUCROC of 0.97, a PR-AUC of 0.33, and a Brier score of 0.002 on a holdout test set. A chart review analysis by expert physicians indicated clinical utility. An ESKD prediction model can identify individuals at risk for ESKD and has been successfully deployed within our health system.

IJCM_236A: Out-of-pocket expenditure on healthcare among geriatric population in central Kerala

Background: India is facing dual challenges caused by a rapid increase in burden of non-communicable diseases, marking epidemiological transition and an unprecedented expansion of geriatric population. The elderly faces a higher burden of disease due to a decline in their physical and immune systems, resulting in greater need and utilization of healthcare. The expanding geriatric population is inadequately supported by appropriate healthcare services which is essential for healthy ageing. Out-of-pocket expenditure on health carries significant adverse impacts. In order to lessen the financial burden of out-of-pocket medical expenses, the healthcare needs of the elderly ought to be addressed. Objectives: To assess the healthcare utilization pattern and out-of-pocket expenditure on healthcare among geriatric population in central Kerala. Methodology: A community based cross-sectional study was conducted among 150 elderly individuals, systematically sampled from 5 randomly selected wards of Adat Gram Panchayat in Thrissur district, Kerala. Data on sociodemographic characteristics, healthcare utilization and healthcare expenditure were collected using a pretested, semi-structured questionnaire by one-to-one interview. Appropriate statistical tests were used for analysis. Results: Mean age of respondents was calculated to be 72.64 ± 7.42. Majority (63.3%) preferred to utilize private health facility. 88.7% followed modern system of medicine. 43.3% had availed health insurance. Most commonly reported morbidities among elderly were Diabetes, hypertension and dyslipidaemia. The median direct medical cost was ?3000 (?560, ?4200) while the median direct non-medical cost was ?300 (?200, ?500). The total median out-of-pocket expenditure on healthcare among elderly was ?3550. Conclusion: Increasing burden of chronic diseases in elderly, high private healthcare utilization and suboptimal health insurance coverage leads to an increase in out-of-pocket expenditure on healthcare. Measures should be adopted for strengthening of health services and expanding insurance coverage among elderly, which in turn will reduce burden of out-of-pocket health expenditure.

Pharmacists as clinical care partners: How a pharmacist-led intervention is associated with improved medication adherence in older adults with common chronic conditions.

Hypertension, hyperlipidemia, and type 2 diabetes (T2D) are 3 of the most common chronic conditions, but related medication adherence rates are far below 80%. Consequences of poor adherence include high health care utilization/costs and increased mortality. There is accumulating evidence in support of the benefits of affording pharmacists the opportunity to practice at the full scope of their licensure by engaging in patients' clinical care. To examine the impact of a large national pharmacy chain's pharmacist-led interventions to improve medication adherence among older adults with hypertension, hyperlipidemia, or T2D. A secondary objective was to estimate the potential cost savings associated with improved adherence. Participants were Medicare patients aged 18 years or older who had 2 or more prescription fills in at least 1 of the 3 therapeutic classes. The primary outcome, optimal adherence, was defined as proportion of days covered (PDC) of 80% or higher. A difference-in-differences (DID) design with a generalized linear model analytical approach was applied to examine differences between intervention participants and controls. The study period spanned from 2020 to 2022. Intervention participants (n = 317,613, age 70.1 years, female sex 57.0%) had lower baseline optimal adherence than controls (n = 943,389, age 73.3, female sex 56.1%) for diabetes (76.9% vs 79.8%), hypertension (79.0% vs 83.0%), and cholesterol (78.6% vs 82.1%). The DID results showed that between 2020 and 2022, optimal adherence had significant absolute increases for intervention participants (diabetes: +4.0%, hypertension: +6.3%, cholesterol: +6.1%) vs controls who declined in adherence (diabetes: -1.6%, hypertension: -0.4%, cholesterol: -1.4%). All DID models were significant at P < 0.0001. Total cost of care was projected based on improvements in adherence. Based on PDC improvements for the test population, we estimate that the pharmacist consultations were associated with annual total health care cost savings of $10,329,284 ($109 per capita), $31,640,660 ($122 per capita), and $21,589,875 ($75 per capita) for test population patients with diabetes, hypertension, and hyperlipidemia, respectively. The study found that the pharmacist-led interventions were significantly associated with increased optimal adherence over 2 years. These findings demonstrate the potential of pharmacist-led interventions to improve medication adherence among older adults with chronic conditions. Strategies to expand pharmacist-provided care must be further examined.

Pulmonary hypertension survival and hospitalisations in people living with HIV: a systematic review and meta-analysis

IntroductionPeople living with HIV (PLHIV) have a higher risk of developing pulmonary hypertension (PH) with subsequent poorer prognosis. This review aimed to determine the (1) survival outcomes and (2) proportion...

Carrying on with life as a lung cancer survivor: a qualitative study of Australian survivors' employment, finances, relationships, and healthcare experiences.

With novel therapies, more individuals are living longer with lung cancer (LC). This study aimed to understand the impacts of LC on life domains such as employment, finances, relationships, and healthcare needs. Individuals 18+, diagnosed with LC, 6-24 months post-treatment were recruited through an Australian LC cohort study (Embedding Research and Evidence in Cancer Healthcare-EnRICH). Demographic, clinical, quality-of-life and distress data were obtained through the EnRICH study database. Participants completed telephone interviews. Qualitative data were analysed via Framework methods. Twenty interviews (10 females) were conducted. Most participants were diagnosed with advanced LC (Stage III =8, Stage IV =6), and were on average 17 (range, 10-24) months post-diagnosis. Four themes related to "carrying on with life" as a LC survivor were identified: (I) the winding path back to work: those working pre-diagnosis discussed challenges of maintaining/returning to employment, and the meaning and satisfaction derived from work. (II) Vulnerability versus protection: managing the financial impacts of LC: wide variations in financial impacts, some described lost income and high healthcare expenses, others felt financially protected. (III) Connection and loneliness: navigating relationships as a survivor: some experienced lost friendships due to their diagnosis, others noted more meaningful connections. (IV) Still under the umbrella: healthcare during survivorship: participants noted the importance of ongoing oncology team connection and the vital role of cancer care coordinators. Many individuals living with LC want to "carry on" with life. Participants spoke of challenges and opportunities across life domains of relationships, work, and finances, and noted the importance of continued specialist healthcare throughout survivorship.

Monkey Pox and its Impact on the Human Health in the World

This editorial was conducted in year 2023 in which main aim was to investigate Monkeypox (MPX) impact on the human health worldwidely. Several studies were searched through different online available sources including google scholar, pubmed, and researchgate. All studies were critically reviewed and analyzed the findings. MPX was first appeared in Denmark in 1958 among Monkeys, which were kept for research, later it appeared in a nine (9) months old boy in Democratic Republic of the Congo in 1970. The monkey pox was caused by Monkey Pox virus (MPXV) which is double stranded DNA virus. It belongs to Orthopoxvirus genus in Poxviridae family which consist of Variola, Cowpox, Vaccina and other viruses. The two genetic clades of the virus were clades I and II. The natural reservoir of MPXV was unknown and various small mammals such as squirrels and monkeys were susceptible. The sign and symptoms includes, rashes, swollen lymph nodes, sore throat, headache, muscle aches, back pain and muscle fatigue. MPXV transmits through respiratory droplets which creates due to face to face talking, breathing, kissing and also transmit through body touching. It was observed that the virus entered through broken skin, mucosal surfaces or through respiratory tract. Moreover, sexual partners is also the source of spreading MPXV. MPXV virus spread from one region to another through exports which affect different countries of the world. The virus spread to Europe and America from African region and outbreak occurred in 2022-2023. Mostly tecovirimat and smallpox treatment were used for management of MPXV. Several individuals died and also many were severely ill. This mortality and morbidity also affects the world economy. Due to MPXV, many health problems were raised including anxiety, depression and social stigma. Based on studies analysis, it is recommended to implement the quarantine strategy throughout the world for prevention and spreading of MPXV. Focus should be on transportation, imports, and exports of goods region to region. High quality healthcare centers should be design to tackle such outbreaks. Preferred to wash hand properly with sanitizer and soap. Better research laboratories is also advised for better, early and timely diagnosis of MPXV. Stay at home is another strategy in such situation. Moreover, awareness and medical counseling center is also important to aware public about the transmission, diagnosis and treatment of MPXV. Counseling center are important to reduce and remove the social stigma among general public.