High Personal Costs Research Articles

Stem cell therapy for stroke

Cerebral stroke can cause permanent neurological damage, behavioral incapacity and is associated with a high personal and financial cost. Therapeutic options are severely limited. In the past 10 years there has been an explosion of research interest in how a variety of stem cell populations respond in animal models of stroke. Manipulation of endogenous and exogenously introduced stem cells has provided a preponderance of information on how stem cells may improve aspects of cellular and functional recovery following largely ischemic models of stroke. These in turn have led the way to the initiation of clinical trials.

Predictors of Place of Death for Those in Receipt of Home-Based Palliative Care Services in Ontario, Canada.

Many cancer patients die in institutional settings despite their preference to die at home. A longitudinal, prospective cohort study was conducted to comprehensively assess the determinants of home death for patients receiving home-based palliative care. Data collected from biweekly telephone interviews with caregivers (n = 302) and program databases were entered into a multivariate logistic model. Patients with high nursing costs (odds ratio [OR]: 4.3; confidence interval [CI]: 1.8-10.2) and patients with high personal support worker costs (OR: 2.3; CI: 1.1-4.5) were more likely to die at home than those with low costs. Patients who lived alone were less likely to die at home than those who cohabitated (OR: 0.4; CI: 0.2-0.8), and those with a high propensity for a home-death preference were more likely to die at home than those with a low propensity (OR: 5.8; CI: 1.1-31.3). An understanding of the predictors of place of death may contribute to the development of effective interventions that support home death.

Spanning a Decade of Physician Boundary Violations: Are We Improving?

Sexual boundary violations can negatively impact the culture of safety within a medical practice or healthcare institution and severely compromise the covenant of care and physician objectivity. Lack of education and training is one factor associated with physician misconduct that leads to high financial and personal cost. This paper presents a follow-up study of physicians referred to a professional development course in 2001 and presents demographic data from 2001 to present. The paper focuses on the education and remediation progress regarding sexual misconduct by physicians.

Exercise prescription to prevent injuries during recreational alpine skiing and snowboarding

Background: Skiing and snowboarding are popular recreational sports worldwide, promoting health through physical activity. Regrettably, participation in snow sports also involves injury risk. Each year, skiing and snowboarding activities contribute to the total number of sports-related injuries, and associated high socio-economic and personal costs. In several sports, targeted exercise programs are reported to be effective in reducing injury rates, and therefore have the potential to prevent skiing and snowboarding injuries. Purpose: The purpose of this work was to systematically review the literature to identify exercises and/or training strategies that are suggested to prevent alpine skiing and snowboarding injuries in recreational participants. Methods: Fourteen electronic databases were systematically searched using relevant MeSH terms and keywords. Articles were included when they addressed injury prevention, recreational alpine skiing or snowboarding, and musculoskeletal injuries. Two independent reviewers quality assessed all articles meeting inclusion using a validated checklist with higher percentage scores indicating higher quality. Data were subsequently extracted from articles using a standard form and categorized to facilitate data synthesis and interpretation. Results: Thirty articles met the defined inclusion criteria and scored 72± 17% (range: 23–100%) during quality assessment. From these articles, 80 recommendations for the prevention of musculoskeletal injuries in recreational alpine skiers and snowboarders were sourced, but none pertained to exercise prescription per se. The recommendations were instead grouped into 5 main categories: equipment (n= 24), education and knowledge (n= 11), awareness and behaviour (n= 15), experience (n= 10) and third-party involvement (n= 20). Most articles (73%) contained recommendations relevant to than one of these areas. Conclusion(s): The importance of targeting physical fitness in injury prevention is accepted in sports medicine and rehabilitation; yet, exercise programs for the prevention of injuries in snow sports are not readily available. As these sports involve high velocities and impact forces, it is not surprising that equipment related injury prevention recommendations were often reported. However, the nature of these sports also indicates a need for appropriate levels of strength, endurance, and conditioning to ensure an adequate control of alpinemanoeuvres and avoidance of injuries. Despite the lack of documented exercise programs, the value of using a multi-facetted approach to preventing injuries was evident. The lack of published data in this area is perhaps due to the challenges of performing an exercise-based injury prevention study in recreational skiers and snowboarders, which would need relatively large sample sizes, long-term follow-up, and extensive documentation and attention to confounding variables for valid, reliable and conclusive results. Implications: Until large-scale experimental research is performed, the prescription of exercises for the prevention of injuries in recreational alpine skiers and snowboarders has limited specificity and depends on empirical evidence from other sports.

Obesity and Diabetes in Pacific Islanders: the Current Burden and the Need for Urgent Action

Non-communicable diseases (NCDs) now account for more than 36 million deaths each year; many of which are premature. Pacific Islanders are some of the worst afflicted by obesity and diabetes with prevalence of both diseases rising disproportionately faster in the Pacific region over the past three decades than in the rest of the world. A high burden of disease is also found among enclaves of Pacifican migrants in the USA, Australia, and New Zealand. Urgent action is needed to alleviate the high economic and personal costs now associated with NCDs in Pacific Islanders. In this article, we describe contributors to the temporal trends in obesity and diabetes, discuss the current burden of disease in the Pacific Islands and among migrant communities, and suggest priorities for future research in this area. Finally, we discuss challenges unique to intervention among Pacific Islanders and highlight promising opportunities to reduce the NCD burden.

Cybersecurity Challenges and Compliance Issues within the U.S. Healthcare Sector

Increasingly there are security breaches in U.S. Healthcare organizations that result in billions of dollars of damage to the healthcare system and a high personal cost to individuals whose identifiable and private information is unprotected. The Privacy Act of 1974, Health Insurance Portability and Accountability Act (HIPAA), and Health Information Technology for Economic and Clinical Health Act (HITECH) are three prominent Acts by the federal government that regulate and protect the confidentiality of personal information in the Healthcare system against breaches. This is a case study examining three organizations in the Healthcare Sector using document analysis to ascertain the problems that resulted in information breaches and the consequences of such breaches. It indicates the failures that occur with the inadequate compliance to the above federal Acts and provides recommendations to control future breaches from occurring. The organizations examined are: The Veterans Administration which lacked basic security controls, the Utah Department of Technology Service that failed to control their personally identifiable information, and private healthcare organizations which revealed shortcomings in HIPAA compliance after data breach disclosures or random audits. Each case results from a lack of proper protection on systems and equipment containing sensitive data. The study recommendations include the need for organizations to lead by example as well as the establishment of tighter regulations and enforcement measures relating to civil fines, and audits to review organizational compliance with federal laws.

Predictors of institutionalization for people with multiple sclerosis

BackgroundMultiple Sclerosis (MS) is a chronic, progressive disease of the central nervous system with a high prevalence in Canada. While the disease course is highly variable, a significant portion of people with MS may spend more than 10 years living with severe disability, and many of those will eventually require full time institutional care. Despite the high personal and economic cost of this care, little is known about predictors of institutionalization. ObjectiveThe objective of this study was to identify predictors of institutionalization. MethodsLongitudinal data from a university MS clinic database were extracted to explore nursing home placement over time of an urban subgroup. Cox regression analysis was performed with age of MS onset and sex, as well as baseline information obtained at the first MS clinic assessment: MS course, Kurtzke Expanded Disability Status Scale score, and functional system scores. ResultsOlder age of onset (p = .019) and higher baseline scores in specific functional systems (cerebellar, bowel/bladder, brainstem, and cerebral/mental) were significant (p = .000, p = .000, p = .001, p = .000 respectively) predictors of nursing home placement. ConclusionsPatients with older age of MS onset and those with baseline impairment in specific functional systems (cerebellar, bowel/bladder, brainstem, and cerebral/mental) may be at higher risk for future institutionalization and should be assessed with particular care to determine potential avenues of support to minimize this.

Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) – focus on the UK

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) can be bothersome and negatively impact on a patient's quality of life (QoL). As the prevalence of LUTS/BPH increases with age, the burden on the healthcare system and society may increase due to the ageing population. This review unifies literature on the burden of LUTS/BPH on patients and society, particularly in the UK. LUTS/BPH is associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning, and through its negative impact on QoL for patients and partners. LUTS/BPH is often underdiagnosed and undertreated. Men should be encouraged to seek medical advice for this condition and should not accept it as part of ageing, while clinicians should be more active in the identification and treatment of LUTS/BPH. To assess the burden of illness and unmet need arising from lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH) from an individual patient and societal perspective with a focus on the UK. Embase, PubMed, the World Health Organization, the Cochrane Database of Systematic Reviews and the York Centre for Reviews and Dissemination were searched to identify studies on the epidemiological, humanistic or economic burden of LUTS/BPH published in English between October 2001 and January 2013. Data were extracted and the quality of the studies was assessed for inclusion. UK data were reported; in the absence of UK data, European and USA data were provided. In all, 374 abstracts were identified, 104 full papers were assessed and 33 papers met the inclusion criteria and were included in the review. An additional paper was included in the review upon a revision in 2014. The papers show that LUTS are common in the UK, affecting ≈3% of men aged 45-49 years, rising to >30% in men aged ≥85 years. European and USA studies have reported the major impact of LUTS on quality of life of the patient and their partner. LUTS are associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning. While treatment costs in the UK are relatively low compared with other countries, the burden on health services is still substantial. LUTS associated with BPH is a highly impactful condition that is often undertreated. LUTS/BPH have a major impact on men, their families, health services and society. Men with LUTS secondary to BPH should not simply accept their symptoms as part of ageing, but should be encouraged to consult their physicians if they have bothersome symptoms.

La denuncia de prevaricación como forma de desgastar a un gobierno: el caso Juan Macías del Real = Weakening a Goverment through reporting malfeasance: the case of Juan Macías del Real

The need of rebuild ‘the Escuadra’, destroyed in 1898, caused a political controversy that was used to abate the Sagasta, Silvela and Maura Cabinets. This last, despite the success achieved in 1907, was beset by the complaint of prevarication submitted by Macías del Real. A bitter parliamentary discussion took place with protest marches in La Carrera de San Jerónimo Street of Madrid. Luís Morote, despite suffering high personal and political costs, was asked to clarify the truth of the charges against the Maura Cabinet that emerged strengthened from the test.

Race, age and serious psychological distress in the USA

Racial minority status in the USA has been found as a risk factor of psychological distress. Serious psychological distress can lead to high personal and healthcare costs across different disease categories, life experiences and age cohort. This study aims to examine the interaction effect of race and age on psychological distress among non-Hispanic White, Asian, Black and Latino adults. This study uses data from a random sample of 43,672 adults aged 18 and older living in California, collected by the California Health Interview Survey in 2009. Younger Black respondents had the greatest prevalence of psychological distress, while the elderly White respondents had the lowest. Middle-aged Asian respondents reported a significantly smaller prevalence of psychological distress than middle-aged White respondents. Elderly Asian and Latino respondents were more likely to experience serious psychological distress than elderly White and Black respondents. There was no statistical difference in the prevalence of se...

Benefits of strength training for the prevention and treatment of sarcopenia

Sarcopenia is a syndrome characterized by a gradual loss and generalized skeletal muscle mass and strength at risk for adverse outcomes such as physical disability, poor quality of life and mortality. It has several contributing factors: the aging process throughout life, influences on development in the early stages of life, eating sub optimal, bed rest or sedentary lifestyle, chronic diseases and certain drug treatments. Sarcopenia represents a deterioration of health status with a high personal cost: mobility disorders, increased risk of falls and fractures, impaired ability to perform everyday activities, disability, loss of independence and increased risk of death. The strength training is currently one of the most effective methods for combating sarcopenia by stimulating hypertrophy and increase strength. The strength training programs in older people themselves are probably one of the most effective preventive measures to delay the onset of sarcopenia. In this literature review different factors related sarcopenia and strength training as a preventive method is analyzed.

The effect of Early Head Start on child welfare system involvement: A first look at longitudinal child maltreatment outcomes

The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving low-income families with children prenatally through age three years, is one of the largest federally funded programs for infants and toddlers in the United States. A national randomized trial found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. The current study used administrative data from state child welfare agencies to examine the impact of EHS on documented abuse and neglect among children from seven of the original seventeen programs in the national EHS randomized controlled trial. Results indicated that children in EHS had significantly fewer child welfare encounters between the ages of five and nine years than did children in the control group, and that EHS slowed the rate of subsequent encounters. Additionally, compared to children in the control group, children in EHS were less likely to have a substantiated report of physical or sexual abuse, but more likely to have a substantiated report of neglect. These findings suggest that EHS may be effective in reducing child maltreatment among low-income children, in particular, physical and sexual abuse.

Faecal incontinence in older people: evaluation, treatment and new surgical techniques

SummaryFaecal incontinence is a disabling condition, with a high personal, social and economic cost. Whilst it may occur at any age, prevalence and severity of symptoms is higher among older people. There are many therapeutic options, ranging from non-invasive treatments to complex surgical techniques, with results that can be considered satisfactory in about 70% of individuals. A comprehensive study of the type of incontinence and its presentation and severity, together with consideration of the general condition of the patient and their environment, are the keys that will decide the best treatment option.

Racial/ethnic disparities in the assessment and treatment of pain: Psychosocial perspectives.

Racial/ethnic disparities not only are prevalent throughout the U.S. health care system but also have proved refractory to change. Such disparities are evident and similarly persistent in the treatment of patients with chronic pain conditions, exacting high personal and societal costs. While psychosocial factors contribute significantly to this intractable problem, an integrated examination of the literature is lacking. This article provides an overview of psychosocial factors that contribute to disparities in the treatment of chronic pain patients and in their adjustment to pain. It focuses initially on aspects of pain assessment that can occasion disparate care. Because pain is a subjective phenomenon that often defies objective medical assessment, it is particularly susceptible to social psychological influences, such as stereotypes. We pay particular attention to negative racial/ethnic stereotypes as well as to the circumstances that are likely to trigger stereotype-driven judgments. Subsequent sections review psychosocial factors that can influence a patient's experience of pain, those that can influence the patient-provider interaction, and those that operate in the public health environment. After each section, we suggest actions that could address identified issues related to clinical care, research, and policy. Policy recommendations generally are linked to provisions of the Affordable Care Act. We conclude with a discussion of the role that psychology should play in future efforts to address the persistent problem of racial/ethnic disparities in pain care.

How Leaders' Prosocial Behaviors Lead to Higher Performance Ratings and Lower Salaries

A core assumption of the prosocial behavior literature is that prosocial workplace behaviors impose high personal costs on prosocial actors, despite some evidence that such behaviors enhance prosocial actors' job performance. We make sense of this apparent contradiction by arguing that prosocial behaviors are acts of self-interest because they enhance employees' influence over peers as well as job performance ratings but are acts of altruism because they undermine prosocial actors' salaries. Across a large sample of high-level organizational leaders, we found that leaders who performed prosocial behaviors as perceived by their peers received higher work performance ratings from their bosses, and this relationship was mediated by the ability to influence peers. However, we also found that highly prosocial leaders tend to earn lower salaries than their less prosocial counterparts. We discuss how our findings extend and enrich the prosocial behavior literature by showing that prosocial behaviors can be conceptualized simultaneously as acts of self-interest as well as altruism.

A fragile bond: adoptive parents' experiences of caring for children with a diagnosis of reactive attachment disorder

To understand how adoptive parents caring for children with a diagnosis of reactive attachment disorder (RAD) make sense of their life-worlds by establishing the meanings that underlie and structure their experiences of their everyday lives. Reactive attachment disorder is a serious psychosocial disorder of childhood that causes short- and long-term relationship, health and social consequences for children. It is more likely to be observed in children being cared for by foster carers, kinship carers or adoptive parents. Exploration of adoption from parents' perspectives is not well documented, and no previous work has been undertaken to understand the challenges of caring for children with a diagnosis of reactive attachment disorder. The study was guided by Husserl's phenomenology, which aims to uncover the underlying essential meanings intrinsic to a phenomenon. Three concepts are central to this approach: essences, intuiting and eidetic reduction. Semi-structured interviews were conducted with eight adoptive parents. Data were analysed using an adaptation of Colaizzi's method. Four essential elements fundamental to participants' lived experiences of caring for a child with a diagnosis of RAD were uncovered: being profoundly unprepared, being insecure, being assailed by unexpected emotions and being committed. The parent-child relationship is a fragile bond developed at an unexpectedly high personal cost; it is a committed relationship but vulnerable to continual destabilisation. The involvement in the preparation of adoptive parents of child and adolescent mental health (CAMH) staff with expertise in the impact of early neglect or separation on children should be considered. The development of systems to prepare, screen and identify potential challenges and problems prior to adoption might help adoptive parents. Access to a CAMH professional in the pre and postadoption phases might assist potential adoptive parents in making informed decisions around the choice of a child for adoption.

50 years of hurdles and hope in anxiolytic drug discovery

Anxiety disorders are the most prevalent group of psychiatric diseases, and have high personal and societal costs. The search for novel pharmacological treatments for these conditions is driven by the growing medical need to improve on the effectiveness and the side effect profile of existing drugs. A huge volume of data has been generated by anxiolytic drug discovery studies, which has led to the progression of numerous new molecules into clinical trials. However, the clinical outcome of these efforts has been disappointing, as promising results with novel agents in rodent studies have very rarely translated into effectiveness in humans. Here, we analyse the major trends from preclinical studies over the past 50 years conducted in the search for new drugs beyond those that target the prototypical anxiety-associated GABA (γ-aminobutyric acid)-benzodiazepine system, which have focused most intensively on the serotonin, neuropeptide, glutamate and endocannabinoid systems. We highlight various key issues that may have hampered progress in the field, and offer recommendations for how anxiolytic drug discovery can be more effective in the future.

Knowledge on Musculoskeletal Diseases by the Spanish Population

ObjectiveTo explore knowledge on musculoskeletal-diseases (MSDs) by the Spanish population. MethodsThis was a cross-sectional study of the general population (>18 years) using a telephone survey of 1009 subjects stratified by habitat size, age, sex, and geographic area. A structured questionnaire was used to collect information on the subjects, their general knowledge of MSDs (GK), their specific knowledge of particular MSDs (SK), and their knowledge of their social impact (KSI). Synthetic indicators of the level of knowledge were used to analyze, using univariate and multivariate models, variables associated to the level of knowledge. ResultsThe KSI level ranges from medium–high (mean: 0.62±0.16 out of 1), suggesting that most subjects recognize MSDs as disabling conditions which affect the ability to work and have a high personal and social cost. The GK level is intermediate (mean: 0.50±0.17); 60% of subjects know something about MSDs, but 54% state that their information is poor/very poor. The SK level is low (mean: 0.18±0.10), and there are some MSDs that are little known (lupus, spondylitis). Being male or retired or having a MSD is associated to a greater knowledge of MSDs. ConclusionThe Spanish population has a medium level of knowledge of the frequency and extent to which MSDs affect performance of activities by those who suffer them. They identify them adequately and have a GK of their symptoms, but have little information about them. The level of knowledge varies depending on social and demographic factors and on whether or not the subject has direct or indirect experience of what a MSD means.

Persistence of chronic major depression: A national prospective study

BackgroundChronic major depressive disorder (CMDD) is highly prevalent and associated with high personal and societal cost. Identifying risk factors for persistence and remission of CMDD may help in developing more effective treatment and prevention interventions. MethodsProspective cohort study of individuals participating in the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1; n=43,093) and its 3-year follow-up (Wave 2; n=34,653) who met a diagnosis of CMDD at the Wave 1 assessment. ResultsAmong the 504 respondents who met criteria for present CMDD at Wave 1, only 63 (11.52%) of them continued to meet criteria of CMDD. A history of childhood sexual abuse, earlier onset of MDD, presence of comorbidity and a history of treatment-seeking for depression predicted persistence of CMDD three years after the baseline evaluation. LimitationsOur sample is limited to adults, our follow-up period was only three-years and the diagnosis of CMDD at baseline was retrospective. ConclusionsCMDD shows high rates of remission within three years of baseline assessment, although some specific risk factors predict a persistent course. Given the high personal and societal cost associated with CMDD, there is a need to develop and disseminate effective interventions for CMDD.

Conocimiento de la población española de las enfermedades músculo-esqueléticas

ObjectiveTo explore knowledge on musculoskeletal-diseases (MSDs) by the Spanish population. MethodsThis was a cross-sectional study of the general population (> 18 years) using a telephone survey of 1,009 subjects stratified by habitat size, age, sex, and geographic area. A structured questionnaire was used to collect information on the subjects, their general knowledge of MSDs (GK), their specific knowledge of particular MSDs (SK), and their knowledge of their social impact (KSI). Synthetic indicators of the level of knowledge were used to analyze, using univariate and multivariate models, variables associated to the level of knowledge. ResultsThe KSI level ranges from medium-high (mean: 0.62±0.16 out of 1), suggesting that most subjects recognize MSDs as disabling conditions which affect the ability to work and have a high personal and social cost. The GK level is intermediate (mean: 0.50±0.17); 60% of subjects know something about MSDs, but 54% state that their information is poor/very poor. The SK level is low (mean: 0.18±0.10), and there are some MSDs that are little known (lupus, spondylitis). Being male or retired or having a MSD is associated to a greater knowledge of MSDs. ConclusionThe Spanish population has a medium level of knowledge of the frequency and extent to which MSDs affect performance of activities by those who suffer them. They identify them adequately and have a GK of their symptoms, but have little information about them. The level of knowledge varies depending on social and demographic factors and on whether or not the subject has direct or indirect experience of what a MSD means.