High Health Costs Research Articles

Comparing Medicare plan selection among beneficiaries with and without a history of cancer.

Individuals aging into Medicare must choose among plans that vary in their scope of benefits, access to health care providers, and exposure to out-of-pocket expenses. When faced with complex coverage decisions, it is unclear whether older adults consider their experiences with prior serious illness or current medical conditions. We estimated the association between a self-reported history of cancer and initial plan selection among 3811 Health and Retirement Study participants aging into Medicare between 2008 and 2020. The proportion of individuals with and without a history of cancer who chose Medicare Advantage was similar; however, the probability of selecting traditional Medicare plus supplemental coverage was 8.03 percentage points (95% confidence interval, 2.99-13.07) higher for respondents with a history of cancer compared with those without a history of cancer. Individuals with a history of cancer may have accounted for their previous experiences with high-cost health care services and prioritized plans with robust benefits (eg, greater financial protections). Raising awareness of and enhancing educational resources could ensure that older adults select plans that meet their current and evolving health care needs.

Patterns of facility and patient related factors to the orthopedic and trauma admissions at the Kenyatta National Hospital: A qualitative assessment.

Inappropriate utilization of higher-level health facilities and ineffective management of the referral processes in resource-limited settings is increasingly becoming a concern in health care management in developing countries. This is characterized by self-referrals and frequent bypassing of nearest health facilities coupled with low formal referral mechanisms. This scenario lends itself to a situation where uncomplicated medical conditions are unnecessarily managed in a high-cost health facility. This situation compromises the ability and capacity of Kenyatta National Hospital (KNH) to function as a tertiary referral health facility as envisioned by Kenya Health Sector Referral Implementation Guidelines of 2014, Kenya 201 constitution and KNH legal statue of 1987. The study objective was to assess the patterns of facility and patient related factors to the orthopaedic and trauma admissions at the KNH. This was a descriptive qualitative study design. The study was conducted amongst the orthopaedic and trauma admission caseload for 2021. Data collection was done through a) data abstraction from 905 patients charts admitted during February to December 2021 and b) 10 (ten) semi-structured interviews with 10 major health facilities that refer to KNH to understand the reasons for referral to KNH. Quantitative data was analysed using Statistical Package for Social Science version 21.0 to calculate the frequency distribution. Qualitative data from the data abstraction and transcripts from the KIIs were analysed using NVivo version 12. The major facility and patient related factors to the orthopaedic and trauma admissions at KNH were inadequate human resource capacity and availability (42.7%), financial constraints (23.3%), inadequate Orthopaedic equipment's and implants availability (20.0%) and inadequate health facility infrastructure (6.3%) while the major patient related factor was patient's preference (23.4%). In conclusion, to decongest KNH requires that the lower-level health facilities need to be better equipped and resourced to handle essential orthopaedic and trauma care.

Intervenção no apego inseguro para o tratamento da dor crônica idiopática em Pediatria

INTRODUCTION: Chronic pain is a public health problem with a high prevalence in children and adolescents. It causes high health costs and severe burden to the quality of life of patients and their families. Since the 1950s, it has been found that primary caregiver-child attachment is paramount for the overall health of individuals and can interfere with the occurrence of several mental and physical disorders, including chronic pain. CASE REPORT: Two female teenagers with a history of mixed, idiopathic and disabling chronic pain for more than two years, culminating in hospitalization. They received an interdisciplinary approach in the first 24 hours of admission, especially from Psychology, which, since the first contact, identified significant stressors in childhood of both, including attachment insecurity, and engaged them into experiential techniques, relaxation techniques and limited reparenting, resulting in lower intensity of pain, lower need for analgesic drugs and lower disability in the first days of hospitalization and, consequently, resulting on hospital discharge. CONCLUSION: Chronic idiopathic pain in Pediatrics should be addressed by an interdisciplinary team, since the beginning. It should be recognized that the psychological component, especially the issue of insecure attachment, could be very important in etiopathogenesis, perpetuation and severity of chronic pain in many patients, so that addressing it is fundamental for therapeutic success. In addition to accelerate the recovery of the functionality and well-being of those affected, this strategy has the potential to reduce healthcare costs.

Prevalence, Incidence and Factors Associated with Diabetic Foot in People with Type 2 Diabetes: Systematic Review with Meta-Analysis.

Diabetic Foot is a severe chronic complication of diabetes and an important factor in the morbidity of diabetic people, resulting in high health costs and increased risk of death. To analyze the incidence, prevalence, and risk factors associated with diabetic foot in people with type 2 Diabetes Mellitus. Systematic literature review. Searches in MedLine via PubMed, LILACS, Web of Science, Scopus CINAHL, and Cochrane Library databases were performed. Inclusion of 52 studies. The R program, Metan packages, was used to calculate the meta-analysis. Given the heterogeneity of studies, the random effect was used to calculate the meta-analysis of risk factors. The meta-analysis showed that the prevalence of diabetic foot was 14% in a hospital setting and 5% in a community setting. The overall prevalence and incidence were 9% and 4%, respectively. Significant risk factors included time of DM (odds ratio [OR] =1.46, confidence interval [CI], 0.36-2.57, P = 0.009), smoking (OR = 1.46, CI, 1.16 -1.85, P< .001), glycated hemoglobin (OR = 0.96, CI, 0.50; 1.42, P< .001), peripheral arterial disease (OR = 3.38, CI, 2.07; 5.53, P < .001) and peripheral neuropathy (OR = 5.88, CI, 2.39-14.45, P<.001). Multidisciplinary monitoring, educational strategies, periodic foot examination for alterations, and early identification of risk factors are essential to prevent ulceration and reduce the disease burden.

Effect of enforcement of the national referral guidelines on patterns of orthopedic admissions to Kenyatta National Hospital, Kenya: Pre-post intervention study.

Inappropriate utilization of higher-level health facilities and ineffective management of referral processes in resource-limited settings are becoming increasingly a concern in health care management in developing countries. This is characterized by self-referral and frequent bypassing of the nearest health facilities coupled with low formal referral mechanisms. This scenario lends itself to a situation where uncomplicated medical conditions are unnecessarily managed in a high-cost health facility. On July 1, 2021, Kenyatta National Hospital (KNH) enforced the Kenya Health Sector Referral Implementation Guidelines, 2014, which required patients to receive approval from the KNH referral office and a formal referral letter to be admitted at KNH to reduce the number of walk-ins and allow KNH to function as a referral facility as envisioned by the Kenya 2010 Constitution and KNH legal statue of 1987. To determine the effect of enforcing the national referral guidelines on patterns of orthopaedic admissions to the KNH. This was a pre-post intervention study. Data abstraction was done for 459 and 446 charts before and after the enforcement of the national referral guidelines, respectively. Enforcement of the national referral guidelines reduced the proportion of walk-in admissions from 54.9% to 45.1%, while the proportion of facility referrals increased from 46.6% to 53.4% (p = 0.013). The percentage of non-trauma orthopaedic admissions doubled from 12.0% to 22.4% (p<0.001). There was also an increase in admissions through the Outpatient Clinic and Corporate Outpatient Clinic. The proportion of emergency admissions declined, while that of elective admissions increased. The increase in elective cases was mainly driven by the increase in female admissions with active insurance cover, tertiary education, non-trauma-related conditions and older age groups. However, the use of official formal written referral letters did not change despite the enforcement of the national referral guidelines. The enforcement of the national referral guidelines reduced the proportion of walk-ins' admissions to KNH. While the enforcement of the national referral guidelines had no effect on the use of official formal written referral letters, it did limit access and utilization of inpatient orthopedic services for young male patients with no active insurance cover and in need of emergency orthopedic care.

Modeling Long-Term Budgetary Impacts of Prevention: An Overview of Meta-analyses of Relationships Between Key Health Outcomes Across the Life-Course.

Budget analysis entities often cannot capture the full downstream impacts of investments in prevention services, programs, and interventions. This study describes and applies an approach to synthesizing existing literature to more fully account for these effects. This study reviewed meta-analyses in PubMed published between Jan 1, 2010 and Dec 31, 2019. The initial search included meta-analyses on the association between health risk factors, including maternal behavioral health, intimate partner violence, child maltreatment, depression, and obesity, with a later health condition. Through a snowball sampling-type approach, the endpoints of the meta-analyses identified became search terms for a subsequent search, until each health risk was connected to one of the ten costliest health conditions. These results were synthesized to create a path model connecting the health risks to the high-cost health conditions in a cascade. Thirty-seven meta-analyses were included. They connected early-life health risk factors with six high-cost health conditions: hypertension, diabetes, asthma and chronic obstructive pulmonary disorder, mental disorders, heart conditions, and trauma-related disorders. If confounders could be controlled for and causality inferred, the cascading associations could be used to more fully account for downstream impacts of preventive interventions. This would support budget analysis entities to better include potential savings from investments in chronic disease prevention and promote greater implementation at scale.

Implementing an integrated care pathway for Somatic Symptoms and Related Disorders (SSRDs) in paediatric population

Introduction: Somatic symptom and related disorders (SSRDs) are commonly encountered in pediatric hospital settings. These children and youth, who present with physical symptoms (e.g., headache, abdominal pain, dizziness) of emotional distress (e.g., anxiety, stress) are diagnostically and psychosocially complex, posing significant challenges for medical and behavioral health care providers. Children and adolescents with SSRDs have high health system utilization and costs and present in multiple clinical settings, have high school absenteeism, and are at elevated risk of iatrogenic harm and missed diagnoses. Patients and their caregivers present with variable readiness to engage in mental health assessment and treatment, with only 40% receiving physician-based mental health care within a year of diagnosis. There is a lack of standardization of care across and within institutions for youth with these disorders. As part of the hospital’s broader strategic direction to integrate physical and mental health care, a SSRD pathway, was developed to address care needs of one of the highest resource intensive populations at a tertiary care hospital. &#x0D; Methods: In 2021, a survey was conducted by our hospital’s implementation team to understand hospital stakeholder priorities when considering the many areas where new integrated care project could be launched. Stakeholders engaged in the survey included physician and operational leaders, clinical staff across the spectrum of disciplines, and a youth and family advisory panel. Focus groups (n = 57) were also conducted to solicit input and feedback. The results highlighted the need to develop a specialized care pathway for children and youth with SSRD focused on integrating physical and mental health care and support with system navigation. Using a logic model with iterative presentations to key stakeholders, the design phase included an interdisciplinary team approach with project management and operational resources to support project implementation and evaluation. Care pathways were developed based on a patient’s readiness to engage in mental health treatment and where they we along their diagnostic odyssey and care journey and intensity of resources required to support their care needs.&#x0D; Integrated Care Pathway: As part of the pilot pathway, a patient’s care journey will be planned in accordance with their level of readiness to accept both a somatization diagnosis and a need for mental health treatment. Patients who are partially or non-receptive to mental health supports will have access to a care manager with both physical and mental health expertise. The care manager will engage with families in shifting their focus and understanding about the mind-body connection and provide extended support with care navigation. Patients who are receptive to mental health treatments, will be referred to a group treatment program led by psychiatry and psychology with a focus on psychoeducation relating to the mind-body connection. Patients in this pathway will also have access to occupational therapy and physiotherapy resources to support with restoring function and improving school attendance, when needed. Pilot evaluation will include process and outcome measures such as number of children engaged in this pathway, time to return to functioning, completion of various mental health measures, and health resource utilization."

Fetal growth analysis from ultrasound videos based on different biometrics using optimal segmentation and hybrid classifier.

Birth defects and their associated deaths, high health and financial costs of maternal care and associated morbidity are major contributors to infant mortality. If permitted by law, prenatal diagnosis allows for intrauterine care, more complicated hospital deliveries, and termination of pregnancy. During pregnancy, a set of measurements is commonly used to monitor the fetal health, including fetal head circumference, crown-rump length, abdominal circumference, and femur length. Because of the intricate interactions between the biological tissues and the US waves mother and fetus, analyzing fetal US images from a specialized perspective is difficult. Artifacts include acoustic shadows, speckle noise, motion blur, and missing borders. The fetus moves quickly, body structures close, and the weeks of pregnancy vary greatly. In this work, we propose a fetal growth analysis through US image of head circumference biometry using optimal segmentation and hybrid classifier. First, we introduce a hybrid whale with oppositional fruit fly optimization (WOFF) algorithm for optimal segmentation of segment fetal head which improves the detection accuracy. Next, an improved U-Net design is utilized for the hidden feature (head circumference biometry) extraction which extracts features from the segmented extraction. Then, we design a modified Boosting arithmetic optimization (MBAO) algorithm for feature optimization to selects optimal best features among multiple features for the reduction of data dimensionality issues. Furthermore, a hybrid deep learning technique called bi-directional LSTM with convolutional neural network (B-LSTM-CNN) for fetal growth analysis to compute the fetus growth and health. Finally, we validate our proposed method through the open benchmark datasets are HC18 (Ultrasound image) and oxford university research archive (ORA-data) (Ultrasound video frames). We compared the simulation results of our proposed algorithm with the existing state-of-art techniques in terms of various metrics.

A Physics-Guided Deep Learning Approach for Functional Assessment of Cardiovascular Disease in IoT-Based Smart Health

The rapid development of the Internet of Things (IoT) widely supports the smart healthcare system. IoT-based smart health has significant importance for the diagnosis of cardiovascular disease in clinical practice. Combined with advanced artificial intelligence techniques, IoT-based smart health provides valuable and accurate diagnosis information remotely for cardiovascular disease. The functional assessment of cardiovascular disease is an essential task in clinical practice. It aims to determine the extent of myocardial ischemia through the measurement of the hemodynamic parameters of the coronary artery. However, the clinical adoption of the hemodynamic parameters is limited due to the potential risks and high health costs during measurements. Recent advances in artificial intelligence have enabled the computation of hemodynamic parameters based on the anatomical features of coronary arteries. However, the existing methods still lack explainability in the prediction. To address this issue, we present a physics-guided deep learning network for the functional assessment of cardiovascular disease in an IoT-based manner. We specifically design an attentive network to determine the effective features by considering the importance of coronary artery anatomy features and artery segments. To obtain the functional assessment with explainability, we incorporate physical knowledge related to the blood flow into the loss function. It can ensure that functional assessment follows the physical laws. Extensive experiments are performed on a synthetic dataset and a real-world clinical dataset. The results show that our approach can achieve accurate and physically consistent assessment. Moreover, our method promotes deeper adoption of IoT and deep learning in the field of smart health.

Peran Prolanis Memberikan Perlindungan Biaya Kesehatan Mencegah Pengeluaran Katastropik di Kota Jambi

The increasing incidence of catastrophic diseases such as hypertension and diabetes mellitus has an impact on catastrophic expenditure in Jambi City. Very high health costs risk causing household economic fragility. Prolanis is one of the programs organized by BPJS Health as part of the National Health Insurance to manage participants' chronic diseases by optimizing efficient health costs. This study aims to analyze costs due to illness and the role of Prolanis in providing health cost protection to participant households so as to prevent catastrophic expenditures. The research approach is quantitative and qualitative which describes the components of direct costs, indirect costs and total costs due to diabetes mellitus and hypertension and assesses the role of Prolanis in preventing catastrophic events in the household. Respondents totaling 180 people were selected using purposive sampling technique. The informants consisted of 20 Prolanis participants who regularly took part in Prolanis activities. The research was conducted in five work areas of community health centers in Jambi City. Quantitative data was analyzed using statistical software through descriptive statistical analysis stages. Qualitative data is summarized in an interview results matrix based on content. The results obtained were that the total costs borne by Prolanis participants due to hypertension and diabetes mellitus had decreased significantly while participating in Prolanis activities. The role of Prolanis for participants is to prevent complications from the disease they are suffering from, regulate the use of medication wisely, receive coordinated and routine disease treatment, and change to a healthier lifestyle. The role of Prolanis felt by participants has an impact on health expenses which can be reduced so that participants are free from catastrophic expenses. It is recommended that the Community Health Center as the technical implementing unit for Prolanis activities expand the scope of Prolanis participation in the work area and increase awareness of people suffering from chronic diseases to actively participate in Prolanis activities to prevent families from experiencing catastrophic spending.

Cardiology professionals' views of social robots in augmenting heart failure patient care.

Social robots are arriving to the modern healthcare system. Whether patients with heart failure, a prevalent chronic disease with high health and human costs would derive benefit from a social robot intervention has not been investigated empirically. Diverse healthcare provider's perspectives are needed to develop an acceptable and feasible social robot intervention to be adopted for the clinical benefit of patients with heart failure. Using a qualitative research design, this study investigated healthcare providers' perspectives of social robot use in heart failure patient care. Interdisciplinary healthcare providers from a tertiary care cardiac hospital completed a structured individual interview and a supplemental questionnaire. The framework method was used to analyse the qualitative data. Respondents (n = 22; saturation was reached with this sample; 77% female; 52% physicians) were open to using social robots to augment their practice, particularly with collecting pertinent data and providing patient and family education and self-management prompts, but with limited responsibility for direct patient care. Prior to implementation, providers required robust evidence of: value-added beyond current remote patient monitoring devices, patient and healthcare provider partnerships, streamlined integration into existing practice, and capability of supporting precision medicine goals. Respondents were concerned that social robots did not address and masked broader systemic issues of healthcare access and equity. The adoption of social robots is a viable option to assist in the care of patients with heart failure, albeit in a restricted capacity. The results inform the development of a social robotic intervention for patients with heart failure, including improving social robot efficiencies and increasing their uptake, while protecting patients' and providers' best interest.

8.E. Workshop: Digital Public Health and Climate change: The European Framework made easy

Abstract European Union has defined a strategy to tackle climate change - the European Green Deal (GD). However, this framework needs to put in place, engaging cities, public health professionals and new technologies vendors to incorporate the Green New Deal within the city dynamics to make it more healthy friendly. Climate change, although globally threating to the human population and biocenosis, yet has some positive sides if the unity achieved through the GD can be named so. This document strongly confirms the path to be navigated. What is the role of digital health and what is the possible contribution of digital public health? This European Commission document envisages Europe as the first climate-neutral continent while strengthening its economy, taking care of and improving its inhabitants’ health. The GD insists on the care for nature and a clear view that no one should be left out and left behind. This workshop point out that, even we have large regulatory framework on clean air, air pollution in the European Union continues to be the top environmental threat to health, leading to approx 400,000 early deaths annually and high health costs. Over 20 of the 27 EU countries fail to keep air quality standards, which for key pollutants are already less strict than what the World Health Organization (WHO) recommends. But climate change brings other threats. In this workshop we will firstly explore the richness of the GD and its contributions to public health framework in Europe. There were several possible scenarios, out of which two were considered: one based on collaboration and the other, on conflict. Several dimensions were examined to address both cooperation instruments and the consequences of non-cooperation: Energy production (e.g., conventional versus renewable) and use; water resources and food security; the environment (air quality) and the impact on health; Population and migration flow. Secondly, the potential of the Smart City will be explored as a tool to integrate dynamic public health interventions in the city leveraging the interactions of many citizens. An example from diabetes management will be considered within the Smart City concept. Finally, we will present tree examples of the dynamics of people and places will be addressed. It is important to note that health sector has an opportunity to not only prevent further damage from the air pollution and climate crises, but also to improve health outcomes by motivating people to contribute to decarbonizing, building climate resilience, and amplifying the message around the interdependency between climate change and human health. This workshop will present a framework, co-developed by WHO and Health Care Without Harm, for climate-resilient, sustainable health facilities. Key messages • Public health is part of the endeavour to tackle climate change, and the cities are an important playground for achieving the sustainability goals at local level aligned with the European Green Deal. • The smart cities can leverage digital public health interventions to better engage the citizens, integrate care and to improve the cities resilience to cope with climate urgency and urban health.

Prognostic Usefulness of Basic Analytical Data in Chronic Obstructive Pulmonary Disease Exacerbation

IntroductionCOPD causes high morbidity and mortality and high health costs. Thus, identifying and analyzing the distinctive and treatable traits seems useful to optimize the management of AEPOC patients. While various biomarkers have been researched, no solid data for systematic use have been made available. AimAssessing the short-term prognostic usefulness of clinical and analytical parameters available in routine clinical practice in COPD exacerbations. Material and methodsMulticenter prospective observational study conducted between 2016 and 2018. Patients admitted for COPD exacerbation who agreed to participate and signed an informed consent form were included. Prolonged stay, in-hospital mortality or early readmission was considered an unfavorable progression. 30-Day mortality was also analyzed. Results615 patients were included. Mean age was 73.9 years (SD 10.6); 86.2% were male. Progression of 357 patients (58%) was considered unfavorable. Mortality at 1 month from discharge was 6.7%. The multivariate analysis shows a relationship between the CRP/Albumin ratio and unfavorable progression (OR 1.008, 95% CI 1.00; 1.01), as well as increased risk of death at 1 month from discharge with elevated urea (OR 1.01, 95% CI 1.005; 1.02) and troponin T (OR 2.21, 95% CI 1.06; 4.62). ConclusionElevated CRP/Albumin, urea and TnT are prognostic indicators of poor short-term outcome in patients admitted for COPD exacerbation. Cardiovascular comorbidity and systemic inflammation could explain these findings.

Obesity is a disease: A Consensus Report by the Alliance to Fight Obesity in Greece

Obesity is defined as a chronic disease characterized by abnormal or excessive fat accumulation in the body. Obesity has taken on epidemic proportions, as the prevalence of overweight individuals globally is almost 30%. The causality of obesity is multifactorial; positive energy balance, genetic factors, endocrine diseases, medications, and food intake disorders are involved in the pathogenesis. Hippocrates wrote that “obesity is a disease itself and the harbinger of others”, recognizing that obesity is a disease that leads to many other diseases. Many scientific societies and the World Health Organization recognized obesity as a chronic disease. Obesity adversely affects many tissues and organs of the human body and is considered a multisystem disease. Obesity is closely related to increased mortality, development of type 2 diabetes mellitus, hypertension, atherosclerotic and thrombotic events, malignancies, respiratory, renal, neurological, musculoskeletal, and gastrointestinal disorders, and it affects immune system and fertility. Obesity is related to high health costs and affects quality of life. Primary prevention is of major importance and may lead to significant savings on resources. Upon establishment, it should be treated as a severe disease, the management of which reduce mortality and may prevent the development of severe and life-threatening complications. As a disease, it should stop being so underestimated and take the important part that it should be occupying in the public health and, once its importance has been recognised, it should be given the opportunity of being correctly treated in a scientifically way for the benefit of the people with obesity and the healthcare system.

Mapping the risk of respiratory infections using suburban district areas in a large city in Colombia

BackgroundAcute respiratory infections (ARI) in Cúcuta -Colombia, have a comparatively high burden of disease associated with high public health costs. However, little is known about the epidemiology of these diseases in the city and its distribution within suburban areas. This study addresses this gap by estimating and mapping the risk of ARI in Cúcuta and identifying the most relevant risk factors.MethodsA spatial epidemiological analysis was designed to investigate the association of sociodemographic and environmental risk factors with the rate of ambulatory consultations of ARI in urban sections of Cúcuta, 2018. The ARI rate was calculated using a method for spatial estimation of disease rates. A Bayesian spatial model was implemented using the Integrated Nested Laplace Approximation approach and the Besag-York-Mollié specification. The risk of ARI per urban section and the hotspots of higher risk were also estimated and mapped.ResultsA higher risk of IRA was found in central, south, north and west areas of Cúcuta after adjusting for sociodemographic and environmental factors, and taking into consideration the spatial distribution of the city’s urban sections. An increase of one unit in the percentage of population younger than 15 years; the Index of Multidimensional Poverty and the rate of ARI in the migrant population was associated with a 1.08 (1.06—1.1); 1.04 (1.01—1.08) and 1.25 (1.22—1.27) increase of the ARI rate, respectively. Twenty-four urban sections were identified as hotspots of risk in central, south, north and west areas in Cucuta.ConclusionSociodemographic factors and their spatial patterns are determinants of acute respiratory infections in Cúcuta. Bayesian spatial hierarchical models can be used to estimate and map the risk of these infections in suburban areas of large cities in Colombia. The methods of this study can be used globally to identify suburban areas and or specific communities at risk to support the implementation of prevention strategies and decision-making in the public and private health sectors.

Ginger: a representative material of herb-derived exosome-like nanoparticles.

Edible plant-derived exosome-like nanoparticles (PELNs) provide numerous benefits, including high yield, low cost, ethical compatibility, and multiple health benefits, which enable them to address technical constraints associated with mammalian nanoparticles. Herbs, known for their abundant bioactive components, are considered the primary source of natural medicines within the plant kingdom. Recently, a number of herbaceous sources have been investigated for the isolation and functionality of exosome-like nanoparticles (ELNs). However, they are commonly referred to as PELNs, and their distinct pharmacological properties are overlooked. In this review, these herb-derived ELNs are designated as HELNs, a novel herbal product that may also exhibit superior pharmacological activity compared to other types of PELNs. Among the documented HELNs, ginger-derived exosome-like nanoparticles (GELNs) are the most extensively studied. This review employs GELNs as an exemplar to delineate the process of extraction and purification, together with their physical and biochemical characteristics and therapeutic potential. The aim of this review is to promote the development and application of HELNs, and future research is encouraged to uncover their additional properties, extending beyond those of GELNs.

Impact of Medication-Based Treatment on Health Care Utilization Among Individuals With Opioid Use Disorder.

This study evaluated the association between medication for opioid use disorder (MOUD) and health care utilization over time among a sample of treatment-seeking individuals with opioid use disorder. In contrast to previous studies, this study used a novel measure of MOUD adherence, more comprehensive utilization data, and analyses that controlled for detailed individual and social determinants of health. This study was a secondary analysis of a comparative effectiveness trial (N=570) of extended-release naltrexone versus buprenorphine-naloxone. The outcome of interest was usage of nonstudy acute care, inpatient and outpatient addiction services, and other outpatient services across 36 weeks of assessment. Adherence (percentage of days taking MOUD) was defined as low (<20%), medium (≥20% but <80%), or high (≥80%). A two-part model evaluated the probability of utilizing a resource and the quantity (utilization days) of the resource consumed. A time-varying approach was used to examine the effect of adherence in a given month on utilization in the same month, with analyses controlling for a wide range of person-level characteristics. Participants with high adherence (vs. low) were significantly less likely to use inpatient addiction (p<0.001) and acute care (p<0.001) services and significantly more likely to engage in outpatient addiction (p=0.045) and other outpatient (p=0.042) services. These findings reinforce the understanding that greater MOUD adherence is associated with reduced usage of high-cost health services and increased usage of outpatient care. The results further suggest the need for enhanced access to MOUD and for interventions that improve adherence.

Addressing Healthcare Utilization and Costs for Older Adults with Limited Mobility Through a Multidisciplinary Home-Based Primary Care Program.

Home-based primary care (HBPC) has shown promise in the management of multiple chronic conditions for patients who are homebound or who have limited mobility. The objective of this study was to implement and evaluate an HBPC program that integrates the services of clinical pharmacists and community aging services providers in a community-based setting. Mountain Area Health Education Center's (MAHEC) HBPC program brought together an interdisciplinary team including medical providers, pharmacists, and community aging services providers to conduct home visits with older adults (age 50+). A single-arm, prepost analysis was conducted to determine differences from the year before program enrollment to the year postenrollment. We examined the frequency of health care visits, high-cost health care utilization (emergency department [ED] utilization and hospitalizations), and health care costs. Descriptive statistics characterized the study population and outcomes. Fisher's Exact Tests were used to determine if there was a significant difference between years. There were 130 home visits with 62 patients enrolled in the program. The Medicare Annual Wellness Visit (AWV) was completed for 32 (51.6%) patients. There were 13 (21.0%) and 12 (19.4%) individuals who had at least 1 ED visit and hospitalization, respectively, pre-enrollment as compared with 8 (12.9%) and 9 (14.5%) individuals postenrollment (p-value = 0.05, p-value = 0.06). During the postenrollment year, patient enrollees had an average per-member-per-month (PMPM) cost of $1567.96 as compared with $3053.21 in the year prior. Pharmacist and community agency services-integrated HBPC was implemented in the community setting. There was a decrease in high-cost health care utilization and total health care expenditures for patients as compared with the previous year.

Implementation of risk-sharing agreements in Saudi Arabia: Comparison and reflection on the NICE Model

In recent years, healthcare spending has increased, due to factors such as aging population, lifestylebased diseases, and high-cost health technologies. These factors have put enormous pressure on policymakers to curtail costs and shift towards value-based healthcare system. In this system, drug companies must demonstrate the value of their products in real-world settings. However, evidence may not be available at the time of product launch, leading to delays in reimbursement decisions and access of patients to products. To address this gap, risk-sharing agreements (RSA) have been introduced between manufacturers and payers. The most common type of RSA is the financial-based agreement which may take various forms such as annual sales caps, price-volume agreements, and comparator rebates. These agreements allow for rapid access to innovative medications. Another type of RSA is the outcome-based agreement which ties reimbursement to the real-world outcomes of products. These agreements are more complex, but they are expected to grow rapidly with the availability of real-world data. In the Middle East, the use of RSA is limited, although it is expected to increase with the ongoing shift towards a value-based healthcare system and introduction of health technology assessment. Saudi Arabia is leading these efforts in the region. This study was aimed at describing the current status of RSAs, trends in utilization of RSAs, and challenges of RSA implementation in Saudi Arabia (KSA). Real-world examples of RSAs in various healthcare sectors are also provided. Overall, the use of RSA facilitates access to innovative medications while ensuring value for money and efficient utilization of limited healthcare resources

Lycopene enhances bone neoformation in calvaria bone defects of ovariectomized rats.

Osteoporosis can affect a significant part of the population and fractures are the most common complications associated with this disease, leading to high public health costs. Thus, the prevention of fractures is relevant to individuals with signs and symptoms as well as to the health system. Postmenopausal osteoporosis has been associated with oxidative stress, emphasizing the importance of an efficient defense system to maintain bone health. Lycopene is a carotenoid with antioxidant properties that may stimulate osteoblastogenesis and inhibit osteoclastogenesis. The purpose of this investigation was to analyze the influence of lycopene in the bone neoformation of calvaria defects in ovariectomized rats utilizing the concentration of 45 mg/kg. Wistar Hannover female rats were divided into ovariectomized and sham groups. The ovariectomized animals received 45 mg/kg lycopene (OvxL) or water (Ovx) by daily gavage the day after ovariectomy/sham surgery for 16 weeks. Twelve weeks after ovariectomy, there were performed 5-mm calvaria defects followed by euthanasia after 4 weeks. Samples of bone tissue were collected to perform morphological and morphometrical analysis of the neoformed bone area, and percentage with Software Image J. Morphological evaluation showed mature bone with more osteocytes in the group OVxL when compared to the other groups. The morphometrical analysis demonstrated a significant increase of bone neoformation in the group OvxL (p<0.05). The data obtained suggest that lycopene benefits bone repair in the absence of estrogenic hormones.