Higher Healthcare Costs Research Articles

Dendritic Cells Trained Immunity: A Revolutionary Therapy in Genitourinary Tract infections

Genitourinary Tract infections (GTI), including both vulvovaginal candidiasis (VVC) and urinary tract infections (UTIs), represent a significant burden on public health, affecting millions of women worldwide. These conditions not only impact the quality of life of patients but also incur high healthcare costs due to the need for recurrent treatment and management of complications. The mainstay of treatment for these conditions has traditionally been antibiotics and antifungals. However, overuse of these medications is linked to antibiotic resistance and adverse effects. Dendritic cell trained immunity is an innovative, state-of-the-art reprogramming therapy that offers a revolutionary approach, especially when conventional vaccines are unavailable or for individuals experiencing recurrent infections. Novel studies have demonstrated that these glycoconjugates induce long-lasting epigenetic changes in dendritic cells (DCs), initiating a trained immunity effect that extends protection against subsequent microbial exposures. The aim of this study is to present the latest evidence on the treatment of recurrent genitourinary tract infections, highlighting the potential of dendritic cell trained immunity as a significant breakthrough in gynecological care. This innovative approach not only represents a shift from traditional treatment methods but also offers hope for more effective and sustainable management of recurrent infections, ultimately improving patient outcomes and reducing the burden on healthcare systems.

Ten-year progression of obesity-related complications in a population with overweight and obesity in the UK: A retrospective open cohort study.

To assess the prevalence of individual obesity-related complications (ORCs) and multimorbidity (≥ 1, ≥ 2 and ≥ 3 ORCs), and multimorbidity-associated healthcare costs, over 10 years. This retrospective open cohort study used Discover, a UK database of linked primary and secondary electronic health records. Adults were stratified by body mass index (BMI; overweight: 25-< 30 kg/m2; obesity class I: 30-< 35 kg/m2; obesity class II: 35-< 40 kg/m2; obesity class III: ≥ 40 kg/m2). Outcomes by year since baseline were assessed for serial cross sections across the study period (1 January 2004 to 31 December 2019; the index date was the date of first eligible BMI measurement). Across 1 410 146 individuals (overweight: 1 008 101; obesity class I: 278 782; obesity class II: 80 621; obesity class III: 42 642), ORC prevalence was higher in successive BMI groups, and increases over time were generally greater for obesity relative to overweight. In those with ORC multimorbidity, both higher BMI and the presence of more ORCs were associated with higher annual per-person healthcare costs. Costs increased over time in those individuals with obesity and one or more ORC, as well as in those with obesity and two or more ORCs. Higher BMI was associated with higher baseline ORC prevalence and a greater increase in ORC prevalence over time, and with higher healthcare costs in those with multimorbidity. To reduce the burden of overweight and obesity on patients and healthcare systems, the presence, number and type of ORCs should be considered in developing effective, targeted prevention and management care pathways.

Revolutionizing patient education with GPT-4o: A new approach to preventing surgical site infections in total hip arthroplasty.

Total hip arthroplasty (THA) is a common surgical procedure known for its generally positive outcomes, but it also comes with the risk of surgical site infections (SSIs), which can result in significant complications and higher healthcare costs. Effective patient education plays a vital role in reducing these risks, as well-informed patients are more likely to take preventive measures and identify early signs of complications. The advent of advanced language models like GPT-4o has opened new avenues for patient education, potentially revolutionizing the way information is delivered and understood. This research letter explores the utility of GPT-4o in enhancing patient education specifically related to SSIs following THA. The capabilities of GPT-4o include offering tailored educational materials, providing 24/7 availability, facilitating humanized interactive learning, and supporting multilingual education. These features significantly improve patient understanding, engagement, and adherence to preventive measures, enhancing the overall quality of healthcare services. However, challenges such as equitable access, language and cultural barriers, and data privacy must be addressed. Utilizing GPT-4o's advanced AI capabilities can revolutionize patient education, thereby decreasing the incidence of SSIs and enhancing postoperative recovery for THA patients.

Graft-versus-host disease in patients with bone marrow transplants: A retrospective study analyzing outcomes and healthcare burden in US hospitals.

Graft-versus-host disease (GVHD) is a recognized complication among individuals undergoing bone marrow transplantation (BMT). There is a requirement for supplementary data regarding the in-patient outcomes of GVHD in individuals who have undergone BMT. Our analysis seeks to assess the healthcare burden and outcomes associated with GVHD in hospitalized patients who have undergone BMT. In this retrospective study, we used data from the National Inpatient Sample (NIS) database spanning from 2016 to 2019. Utilizing ICD-10 codes, we distinguished hospitalizations related to BMT and grouped them into two categories: those with GVHD and those without GVHD. Our areas of focus included in-hospital mortality, length of stay, charges, and associations related to GVHD. Unadjusted odds ratios/coefficients were computed through univariable analysis, followed by adjusted odds ratios (aORs)/coefficients from multivariable analysis that considered potential confounding factors. From 2016 to 2019, data were collected from 13,999 hospitalizations with bone marrow transplants. Among them, 836 had GVHD cases. Patient characteristics showed slight differences in mean age and demographics between the two groups, with GVHD patients having a mean age of 51.61 years and higher percentages of males and whites. Analyzing outcomes, patients with GVHD experienced significantly longer hospital stays (41.4 days vs. 21.3 days) and higher total hospital charges ($824,058 vs. $335,765). Adjusting for confounding factors, GVHD posed a substantial risk. The aOR for mortality in GVHD hospitalizations was 7.20 (95% CI: 5.54-9.36, p < .001). The coefficient for the length of stay was 19.36 days (95% CI: 17.29-21.42, p < .001), and the coefficient for total hospital charges was $453,733 (95% CI: $396,577 to $510,889, p < .001) in GVHD cases. Furthermore, GVHD in patients was associated with elevated risks of various medical conditions. The aORs for sepsis, pneumonia, acute respiratory failure, intubation and mechanical ventilation, Clostridium difficile infection, and acute kidney injury (AKI) in GVHD patients were 2.79 (95% CI: 2.28-3.41, p < .001), 3.30 (95% CI: 2.57-4.24, p < .001), 5.10 (95% CI: 4.01-6.49, p < .001), 4.88 (95% CI: 3.75-6.34, p < .001), 1.45 (95% CI: 1.13-1.86, p = .003), and 3.57 (95% CI: 2.97-4.29, p < .001). GVHD in individuals undergoing BMT is linked to elevated mortality rates, prolonged hospitalization, and higher healthcare costs. Moreover, they face a significantly increased risk of developing complications, such as sepsis, pneumonia, acute respiratory failure, C. difficile infection, and AKI. These results underscore the critical need for vigilant monitoring and effective GVHD management to improve patient outcomes and reduce the complications associated with BMT. Nevertheless, further prospective studies are essential to obtain a more profound understanding and a comprehensive assessment of outcomes in these hospitalized patients.

‘Beyond our pregnancies and bodies’: benefits and barriers to antenatal care clinic utilisation among pregnant women in Abeokuta, southwest Nigeria

ABSTRACT This study explored the benefits and barriers to antenatal care (ANC) utilization in Abeokuta, Southwest Nigeria, using case study and fieldwork research designs. Data collection involved qualitative methods from both primary and secondary sources. Through snowball and purposive sampling, 21 participants were recruited for key informant interviews (KIIs) and in-depth interviews (IDIs). Secondary data sources included books, journal articles, theses, and archival materials from the National Archives in Ibadan. Thematic analysis was used for data analysis, and descriptive narrative was employed for data interpretation. The study revealed that antenatal clinics have evolved beyond maternal and pregnancy care, becoming centers for social, economic, and political interactions. However, barriers such as high healthcare costs, distance, certain beliefs, and the COVID-19 outbreak hindered ANC utilization among many women in Abeokuta. To address these barriers, the study recommended a multifaceted approach involving collaboration with all stakeholders, including traditional birth attendants, strong government political will, and efforts to tackle poverty and illiteracy.

Alloimmunization in myelodysplastic syndrome is associated with higher healthcare costs, longer hospitalizations, and increased mortality.

Transfusion of red blood cells (RBC) is an important component of treatment for myelodysplastic syndromes (MDS). Patients receiving frequent transfusions are more likely to develop alloimmunization, an immune reaction to minor RBC antigens that increases the risk of complications including delayed hemolysis. Phenotypic matching is believed to reduce alloimmunization although rigorous evidence is lacking. This study examines the association of alloimmunization with clinical and economic outcomes and may give insight into the potential benefit of phenotypic matching in MDS. This study used data from 1054 hospitals included in the Premier hospital chargemaster dataset. Alloimmunized MDS patients (January 2015 to June 2019) were indirectly identified by ICD-10 codes (antiglobulin crossmatch and RBC antibody identification). The primary objective was assessment of the association between incremental cost per patient encounter and alloimmunization in MDS patients. Secondary objectives were assessment of the association of length of stay, intensive care unit (ICU) admission, and inpatient mortality for alloimmunized versus non-alloimmunized MDS patients. Worse clinical and economic outcomes were observed for the alloimmunized group. Higher costs (14%), more ICU admissions (38%), longer hospital (21%) and ICU stays (55%), and greater mortality (30%) were observed among alloimmunized MDS patients compared to non-alloimmunized (p < .0001 for all comparisons). Alloimmunization may be associated with higher costs and greater risk of ICU admission and death in patients with MDS. While further mechanistic research is needed, it seems that MDS patients may benefit substantially from practices that limit risk of alloimmunization, including providing prophylactic antigen matching.

Mapping the costs and socioeconomic characteristics involved in traumatic brain injuries: a scoping review.

To identify the articles in the existing literature that analyse healthcare costs according to the socioeconomic position (pre- or post-injury) for traumatic brain injury survivors. Secondary aims were to describe the types of costs and socioeconomic characteristics and to determine whether socioeconomic characteristics affect the risk of traumatic brain injury or whether the consequences of trauma alter living conditions post-injury. This scoping review followed the methods proposed by Arksey and O'Malley. The literature search was performed in 5 databases. Twenty-two articles were included, published between 1988 and 2023. Only 2 articles (9%) followed the guidelines for economic evaluation of healthcare programmes and 2 articles (9%) evaluated socioeconomic position "completely" with 3 main individual measures of socioeconomic characteristics (i.e., education, income, and occupation). The relationship between costs and socioeconomic characteristics could vary in 2 ways in traumatic brain injury: socioeconomic disadvantage was mostly associated with higher healthcare costs, and the cost of healthcare reduced the survivors' living conditions. This work highlights the need for a detailed and methodologically sound assessment of the relationship between socioeconomic characteristics and the costs associated with trauma. Modelling the care pathways of traumatic brain injury would make it possible to identify populations at risk of poor recovery or deterioration following a TBI, and to develop specific care pathways. The aim is to build more appropriate, effective, and equitable care programmes.

Percutaneous Repair of Chronic Aortic Pseudoaneurysm: A Single-Center Experience

BackgroundAortic pseudoaneurysm (AP) is a late complication of aortic repair that, without intervention, carries a high mortality rate. Surgical repair has significant in-hospital mortality and high health care costs. Endovascular stent grafting use is currently limited to branch-free aortic segments or the use of complex fenestrated devices. Our objective was to review the literature and share our institution’s experience with AP percutaneous closure by vascular plugs and occluder technology. MethodsWe retrospectively reviewed percutaneous AP closure cases published in the literature (2005-2016) and from our institution (2017-2019). The follow-up strategy in our institution group was up to the discretion of the performing physician. We measured the procedure’s safety, complications, and follow-up outcomes. ResultsWe found 40 cases in the literature and 10 at our institution. The procedural success rate was 90% in the literature and 100% in our group. Our group’s average length of stay was 1.9 days with no observed major procedural complications. The literature’s follow-up was generally limited to the hospitalization period. Our patients had a median follow-up time of 12 months (range 3-47 months). Late follow-up of AP demonstrated that sac size remained stable or reduced in 6 patients, but a size increase was observed in 4 patients requiring surgical intervention. Death from nonprocedure-related complications occurred in 40% of our patients. The cost per procedure was hypothetically less than for performing open surgical repair. ConclusionsOur experience shows a viable option for percutaneous AP repair, given its initial safety and cost-effectiveness. Our experience highlights the critical role of follow-up imaging in identifying AP expansion and the need for further intervention. The high nonaorta-related mortality seen in follow-up emphasizes the high-risk nature of the population due to comorbidities.

Estimating the economic impact of comorbidities in patients with MASH and defining high-cost burden in patients with noncirrhotic MASH.

Metabolic dysfunction-associated steatohepatitis (MASH) is associated with high health care costs. This US study investigated the economic burden of MASH, particularly in patients without cirrhosis, and the impact of comorbidities on health care costs. This retrospective, observational study used data from patients diagnosed with MASH aged ≥18 years from October 2015 to March 2022 (IQVIA Ambulatory electronic medical record-US). Patients were stratified by the absence or presence of cirrhosis. Primary outcomes included baseline characteristics and annualized total health care cost after MASH diagnosis during follow-up. In addition, this study defined high costs for the MASH population and identified patient characteristics associated with increased health care costs among those without cirrhosis. Overall, 16,919 patients (14,885 without cirrhosis and 2034 with cirrhosis) were included in the analysis. The prevalence of comorbidities was high in both groups; annual total health care costs were higher in patients with cirrhosis. Patients with a high-cost burden (threshold defined using the United States national estimated annual health care expenditure of $13,555) had a higher prevalence of comorbidities and were prescribed more cardiovascular medications. MASH diagnosis was associated with an increase in cost, largely driven by inpatient costs. In patients without cirrhosis, an increase in cost following MASH diagnosis was associated with the presence and burden of comorbidities and cardiovascular medication utilization. Comorbidities, such as cardiovascular disease and type 2 diabetes, are associated with a higher cost burden and may be aggravated by MASH. Prioritization and active management may benefit patients without cirrhosis with these comorbidities. Clinical care should focus on preventing progression to cirrhosis and managing high-burden comorbidities.

Neuroprotective and Nootropic Evaluation of some Important Medicinal Plants in Dementia: A Review

: Dementia is a devitalising decline in neurological acuity, which burdens both high- and lowincome countries due to poor diagnostic systems and high healthcare costs. A growing population and rises in deleterious environmental and genetic anomalies aggravate new and aggressive cases of dementia and neurodegenerative disorders. The unparalleled capability of medicinal plants is constantly explored in treating neurological disorders, and some of these phytocompounds are used for treating diseases. However, some of these metabolites are neurotoxic and disrupt DNA polymerase functions. They possess lifethreatening side effects and are unable to prevent disease progression. Therefore, it is important to focus on discovering novel compounds from new medicinal plants. Our review encompasses some medicinal plant metabolites recently explored in treating this disease. We also summarized the molecular mechanism of action as determined in in-vitro: the toxic dose, nootropic and neuroprotective effects on neurophysiology and neurotransmitter levels, and the antioxidant effects.

Digital Interventions to reduce hospitalization and hospital readmission for chronic obstructive pulmonary disease (COPD) patient: systematic review

BackgroundThe high readmission rate following chronic obstructive pulmonary disease (COPD) has created a significant global health challenge, with high healthcare costs and a growing burden of care. Digital interventions, including telemonitoring, Telehealth, web, or mobile-based, can address these challenges, but there has yet to be a systematic review of the impact of digital interventions on reducing hospital readmission for patients with COPD. The aim of this systematic review was to assess the effectiveness of digital interventions in lowering hospitalization and rehospitalization for patients with COPD.MethodsWe conducted a systematic literature search from PubMed and Scopus to identify randomized controlled trials (RCTs) published in English with outcomes related to hospital admission or readmission within 30 days of hospital discharge.ResultsThe search and selection process followed PRISMA guidelines and resulted in a final sample of 12 RCTs. We found mixed results. Of the 12 included studies, only four studies [mobile-based (n=1), Telehealth (n=1), Telemonitoring (n=2)] found positive effect of a digital intervention on hospital readmission. Seven studies [mobile-based (n=1), Telehealth (n=1), Telemonitoring (n=3), Web-based (n=2)] did not demonstrate clear evidence of a significant reduction in hospitalization rate. Based on these findings, the primary factors contributing to the outcome variation were differences in intervention components used and their operator, COPD severity, patient age, and sample size.ConclusionsSystematic review provides the first insight into the impact of digital intervention on hospital readmission among patients with COPD . While some studies showed positive results, the evidence is mixed, and further research is needed. COVID-19 has accelerated the use of digital intervention and created the opportunity for comprehensive research and investigation with more updated information and further impact on readmission.

The role of neuropsychology in the care of patients with functional neurological symptom disorder.

Functional neurological symptom disorder (FNSD) is a neuropsychiatric condition characterized by signs/symptoms associated with brain network dysfunction. FNSDs are common and are associated with high healthcare costs. FNSDs are relevant to neuropsychologists, as they frequently present with chronic neuropsychiatric symptoms, subjective cognitive concerns, and/or low neuropsychological test scores, with associated disability and reduced quality of life. However, neuropsychologists in some settings are not involved in care of patients with FNSDs. This review summarizes relevant FNSD literature with a focus on the role of neuropsychologists. A brief review of the literature is provided with respect to epidemiology, public health impact, symptomatology, pathophysiology, and treatment. Two primary areas of focus for this review are the following: (1) increasing neuropsychologists' training in FNSDs, and (2) increasing neuropsychologists' role in assessment and treatment of FNSD patients. Patients with FNSD would benefit from increased involvement of neuropsychologists in their care.

DOSAGE study: protocol for a phase III non-inferiority randomised trial investigating dose-reduced chemotherapy for advanced colorectal cancer in older patients

IntroductionTreating older adults with chemotherapy remains a challenge, given their under-representation in clinical trials and the lack of robust treatment guidelines for this population. Moreover, older patients, especially those with...

Exploring the Relationship between Food Insecurity, Chronic Health Conditions, and Serious Mental Illness in the United States: Implications for Social Work.

Food insecurity (FI) is a modifiable social determinant of health that impacts approximately 10 percent of the U.S. population. FI has been linked to poorer health outcomes and higher healthcare costs. Given the prevalence of chronic health conditions in the United States, including serious mental illness (SMI), the current study aims to better understand the relationship between FI and chronic conditions, including SMI, in a nationally representative sample. Authors analyzed data from the 2016 Medical Expenditure Panel Survey household component and food security supplement. Findings indicate the prevalence of FI among those with diabetes, lung disease, stroke, and SMI is higher than among the general population, with the prevalence for those with SMI being particularly high (43 percent of the sample). Logistic regression models indicate strong, statistically significant relationships between FI and chronic conditions, including SMI, as well as FI and two or more chronic illnesses, even when controlling for sociodemographic and health factors. There are likely bidirectional relationships between FI and chronic conditions. Findings have implications for social workers, in relation to prevention and treatment of SMI and FI through direct care, advocacy, and integrated services in health, mental health, and social services.

Determinants of Late HIV Diagnosis and Advanced HIV Disease Among People Living with HIV in Tanzania.

About half of people infected with Human Immunodeficiency Virus (HIV) often present late for care, resulting in higher healthcare costs, undesired treatment outcomes, and ongoing HIV transmission. This study aimed to assess the prevalence and determinants of late HIV diagnosis and advanced HIV disease (AHD) in Tanzania. Data were obtained from the 2016-17 Tanzania HIV impact survey. We included 677 newly diagnosed people living with HIV. Late HIV diagnosis and AHD were defined as having a CD4 cell count below 350 cells/µL or 200 cells/µL at diagnosis, respectively. Bivariate and multivariable logistic regression models were fitted to identify the determinants of late HIV diagnosis or AHD. The mean age of the participants was 37.8 years (SD, 12.4). About two-thirds were women (62.6%). The prevalence of late HIV diagnosis was 42.4%, whereas the prevalence of AHD was 17.7%. Factors associated with late HIV diagnosis included age 31-40 years (adjusted odds ratio [aOR] = 1.72, 95% confidence interval [CI]: 1.14-2.60), age ≥41 years (aOR = 1.79, 95% CI: 1.16-2.76), male sex (aOR = 1.88, 95% CI: 1.29-2.73), and active syphilis infection (aOR=2.63, 95% CI: 1.20-5.76). Factors associated with AHD were age 31-40 years (aOR = 2.12, 95% CI: 1.18-3.81), age ≥41 years (aOR = 2.42, 95% CI: 1.32-4.41), male sex (aOR = 1.77, 95% CI: 1.09-2.87), formal education (aOR = 0.49, 95% CI: 0.30-0.81) and active syphilis infection (aOR = 2.49, 95% CI: 1.07-5.77). Late HIV diagnosis and AHD are prevalent among newly diagnosed people living with HIV in Tanzania. Specific subgroups are more likely to present late for HIV care, including middle-aged and older adults, men, illiterate individuals, and those with active syphilis and HIV co-infection. Therefore, we recommend expanding HIV testing services and implementing targeted interventions to improve early access and enrollment in HIV care.

Italian healthcare resource consumptions and direct costs of adults with atopic dermatitis before and after dupilumab treatment.

Atopic dermatitis (AD) is a heterogeneous disease, associated with comorbidities, and high healthcare consumptions and costs. This study assessed the burden before and after treatment with dupilumab in adults with severe AD from 2018 to 2020, from the perspective of the Italian National Health Service (SSN). From Fondazione Ricerca e Salute's administrative healthcare database (~5 million inhabitants/year), adults treated with dupilumab from 09/01/2018 to 31/12/2020 (index date) and a five-year lookback were identified. Age, sex and comorbidities at baseline, concomitant drugs, overnight hospitalizations, outpatient specialist services and direct costs charged to the SSN one year before/after index date were assessed. Of 337 adults treated with dupilumab (5.8x100,000 adult inhabitants/2019; 8.0x100,000/2020; 55% males; mean age 43±19), 68% (228/337) had ≥12-month follow-up available. Asthma was a common comorbidity (23% patients). Rates of patients treated with nearly all concomitant AD-related therapies reduced from 12 months before to 12 months after dupilumab treatment: antibacterials (from 59% to 50%), systemic corticosteroids (55% to 29%), antihistamines (54% to 38%) and cyclosporine (52% to 7%). A similar trend was observed among patients with asthma as comorbidity. Within 12 months before/after dupilumab, patients hospitalized halved from 14% to 7%, and patients receiving outpatient specialist care reduced from 72% to 65%. Annual mean direct total costs per patient treated with dupilumab charged to the SSN, net of dupilumab cost, were €1384 and €773, before and after dupilumab dispensation, respectively. Before dupilumab, observed patients had higher healthcare resource consumptions and direct SSN costs than after dupilumab.

Dynamic three-dimensional coculture model: The future of tissue engineering applied to the peripheral nervous system

Traumatic injuries to the peripheral nervous system (PNI) can lead to severe consequences such as paralysis. Unfortunately, current treatments rarely allow for satisfactory functional recovery. The high healthcare costs associated with PNS injuries, worker disability, and low patient satisfaction press for alternative solutions that surpass current standards. For the treatment of injuries with a deficit of less than 30 mm to bridge, the use of synthetic nerve conduits (NGC) is favored. However, to develop such promising therapeutic strategies, in vitro models that more faithfully mimic nerve physiology are needed. The absence of a clinically scaled model with essential elements such as a three-dimension environment and dynamic coculture has hindered progress in this field. The presented research focuses on the development of an in vitro coculture model of the peripheral nervous system (PNS) involving the use of functional biomaterial which microstructure replicates nerve topography. Initially, the behavior of neuron-derived cell lines (N) and Schwann cells (SC) in contact with a short section of biomaterial (5 mm) was studied. Subsequent investigations, using fluorescent markers and survival assays, demonstrated the synergistic effects of coculture. These optimized parameters were then applied to longer biomaterials (30 mm), equivalent to clinically used NGC. The results obtained demonstrated the possibility of maintaining an extended coculture of SC and N over a 7-day period on a clinically scaled biomaterial, observing some functionality. In the long term, the knowledge gained from this work will contribute to a better understanding of the PNS regeneration process and promote the development of future therapeutic approaches while reducing reliance on animal experimentation. This model can be used for drug screening and adapted for personalized medicine trials. Ultimately, this work fills a critical gap in current research, providing a transformative approach to study and advance treatments for PNS injuries.

Factors and Reasons of Self-Medication: For Health Education on Self-Medication Risks and Healthy Safecare Practices

The public has turned to self-medication during the pandemic due to the rising social media influence, the availability of over-the-counter drugs, and the public’s fear of getting the virus. Self-medication is a widespread practice in both developed and developing nations. Self-medication has been noted to be on the rise worldwide. Health professionals are worried on the practice of self-medication by adamant sick persons, and prescription drugs over-the-counter are persisted for the treatment of diseases. This study critically examined the factors and reasons for the self-medication of the elderly in the City of San Jose Del Monte, Bulacan. The results of the study served as a baseline reference to develop health education on self-medication risks to promote healthy safety practices. Furthermore, the objectives of this research were to examine the prevailing opinions of the elderly about the factors of self-medication and to assess the main ideas of the elderly on the reasons for self-medication. The study employed a descriptive research design that determined the nature of the specific occurrences under investigation. [1] The adopted standardized Factors and Reasons of Self-Medication Survey Questionnaire was utilized. It was revealed that age and monthly income were two factors that had a significant impact on the decisions that older people made regarding their self-medication. In terms of reasons, these include: the similarity of symptoms with past illnesses, perceived illness as mild, need for quick relief/urgency, distance of health institutions, drug access to pharmacy, high healthcare cost, long lines or waiting time in the physician’s clinic and hospital, and self-medication is cheaper were the common reasons for self-medication. The findings of the study provided components of health teachings in framing health education on self-medication risks and healthy safety practices.

Demand and Supply Drivers of Medicare and Non-Medicare Health Spending: An Analysis of U.S. States, 1991-2019.

For the last four decades, policymakers have attempted to control the United States's high health care costs by reducing patients' demand for care (e.g., by imposing managed-care restrictions or high costs on patients at the time of use). Yet studies based mostly on data from the public Medicare program, which covers mostly elderly Americans, suggest that supply (e.g., number of physicians or hospital beds) rather than demand drives aggregate service use and, hence, costs. Using variation between U.S. states in per enrollee Medicare spending versus per capita spending of all other (non-Medicare) individuals, we find that greater supply boosts costs for the entire population. Furthermore, we find that factors that suppress demand in the non-Medicare population do reduce non-Medicare health care spending, but simultaneously increase Medicare spending. This suggests that for a given supply of medical resources, suppressing demand for one group of patients may produce a compensatory increase in provision of care to those whose demand has not been suppressed. Health planning to assure adequate medical resources where they are needed while preventing excess supply where it is duplicative and wasteful is likely a more effective cost control strategy than the imposition of managed-care restrictions or imposing higher costs onto patients seeking care.

Environmental economics of green recovery in mineral extraction: Balancing production and conservation

This study examines data from 1995 to 2021 using self-regressive distribution lag modeling to uncover how mineral wealth utilization influences sustainable development in select Central Asian countries. Our findings highlight a critical challenge: increased mineral asset mining significantly hampers the region's ecological growth, both immediately and over time, due to its detrimental environmental impacts. However, there is a beacon of hope: a 1% increase in hydropower output can elevate the sustainability score by 0.19% in the long term and 0.10% in the short term, showcasing the transformative potential of renewable energy. On the flip side, escalating carbon dioxide emissions pose a serious threat, stalling green financial development through ecological harm and higher healthcare costs. Furthermore, urbanization slightly diminishes the long-term sustainability score by 0.06%. This gives a clear confirmation of the necessity of Central Asian countries to embrace the renovation of the state's vectors for conformism towards the idea of ecological sustainability. The necessary legislative measures, the development of renewable power sources, making natural resources trading more effective and integrating eco-friendly finance to support green projects will help the region chart its course toward a sustainable and prosperous development.