Higher Medical Care Costs Research Articles

Nutritional status and nosocomial infections among adult elective surgery patients in a Mexican tertiary care hospital.

BackgroundControversy exists as to whether obesity constitutes a risk-factor or a protective-factor for the development of nosocomial Infection (NI). According to the obesity-paradox, there is evidence that moderate obesity is a protective-factor. In Mexico few studies have focused on the nutritional status (NS) distribution in the hospital setting.ObjectivesThe aim of this study was to estimate the distribution of NS and the prevalence of nosocomial infection NI among adult elective surgery (ES) patients and to compare the clinical and anthropometric characteristics and length of stays (LOS) between obese and non-obese patients and between patients with and without NI.MethodsWe conducted a cross-sectional study with a sample (n = 82) adult ES patients (21–59 years old) who were recruited from a tertiary-care hospital. The prevalences of each NS category and NI were estimated, the assessments were compared between groups (Mann-Whitney, Chi-squared or the Fisher's-exact-test), and the association between preoperative risk-factors and NI was evaluated using odds ratios.ResultsThe distribution of subjects by NS category was: underweight (3.66%), normal-weight (28.05%), overweight (35.36%), and obese (32.93%). The prevalence of NI was 14.63%. The LOS was longer (p<0.001) for the patients who developed NI. The percentages of NI were: 33.3% in underweight, 18.52% in obese, 17.39% in normal-weight, and 6.90% in overweight patients.ConclusionThe prevalence of overweight and obesity in adult ES patients is high. The highest prevalence of NI occurred in the underweight and obese patients. The presence of NI considerably increased the LOS, resulting in higher medical care costs.

Who Are the Big Medical Care Spenders?

The top 5 percent of medical care consumers account for 50 percent of medical care expenditures, which is 9 percent of annual U.S. GDP. We offer new theoretical and empirical evidence that not just poor health, but the path to poor health, can better predict big spenders. Modeling the full distribution of expenses using the Health and Retirement Survey, we find that a 10 percent decline in health increases the probability of participation in the top 5 percent by 22 percent. Focusing on health dynamics gives policy makers new avenues to address high medical care costs.

Stakeholders’ Values and Power Dynamics and Relations in Community Based Health Insurance: Evidence from Anambra State Nigeria.

Community based health insurance (CBHI) is a not-for-profit type of health insurance that has been used by poor people to protect themselves against the high costs of seeking medical care and treatment for illness. CBHI was piloted in Anambra State in Southeast Nigeria in 2003 as a way of increasing the provision and utilisation of health services. This study set out to identify the factors that influenced the development and implementation of the scheme. The study was conducted in 2006-2007 and compared the experiences of two communities two communities judged to have different levels of success in implementing CBHI, in terms of community involvement and support for the scheme and levels of enrolment. It involved document reviews, In depth interviews with state and local level policymakers, managers, health workers, and members of Community Health Committees. In addition, 8 Focus group discussions with members and non-members of CBHI were conducted. The result showed that the development and implementation of the CBHI followed a period of political transition with the introduction of a new State Governor who aspired to improve access to quality health care and who was personally responsible for driving the policy forward at rapid pace. Several factors affected the implementation of the scheme in the two case-study locations namely: relations between state and local government authorities; community support and participation; power dynamics between community actors; health workers attitudes towards the scheme and parallel drug acquisition and delivery systems. In implementing new health policies, effort should be made to secure widespread backing among groups (both within and outside the Ministry of Health) with the power to sustain implementation; include local actors who can either sustain or block implementation in the development of new policies in particular health workers; take into consideration power dynamics between local community actors when designing policies that will be implemented at the local-level and ensure that policy guidelines are clearly communicated to those responsible for implementing the policy and to community members.

Impact of Untreated High Blood Pressure on Renal Function Tests at Initial Diagnosis of Hypertension

Background: Pakistani population is at higher risk of developing hypertensive complications at a younger age, resulting from undiagnosed and untreated hypertension (HTN). High cost of medical care is a barrier to early detection and assessment of end organ damage as well as physicians are disinclined to adopt more aggressive therapeutic management to improve blood pressure control. A cross sectional study was planned to determine the effect of high blood pressure on renal function tests in a random population aged 25-50 year, at initial diagnosis of hypertension. Methods: The study was conducted on total 276 subjects; 201selected from five general practitioners clinics in Karachi and were classified into pre hypertensive, and hypertensive stages I and II on the basis of 7th JNC report. Two BP readings were taken half an hour apart. A blood sample was drawn for measurement of serum urea, creatinine and a dipstick test was done to check protein in urine. The results were compared with 75 control, normotensive subjects. The percentage, mean and Standard deviation were computed. ANOVA was performed to compare four study groups and LSD test was applied to compare pair-wise group. Pearson’s correlation was applied to find out association of renal function with stages of hypertension. Results: The mean urea and creatinine levels were on higher normal side in HTN stages-I and II (39.91±8.51 and 1.72±0.54 in stage-I and 44.51±9.93 and 1.91±0.88 in stage-II respectively). The frequency of proteinuria was also more in these groups, indicating declining renal function in these patients as compared to control and prehypertension groups. Conclusion: Subjects diagnosed with stage I and II HTN showed evidence of subclinical renal damage, along with the presence of proteinuria at the time of diagnosis.

The impact of hospice care on survival and cost saving among patients with liver cancer: a national longitudinal population-based study in Taiwan.

The aim of this study was to compare health-care expenditures and survival of these terminally ill patients receiving or not receiving hospice care in their last month of life. Using Taiwan's National Health Insurance Claims Database, we analyzed hospitalizations, OPD visits, associated costs, and survival. Logistic regression was used to identify predictors of high cost. We identified 3850 liver cancer patients who died during the 1997-2011 study period, 644 (16.6 %) of whom were hospice care patients. No significant difference was found in mean survival time between the hospice and non-hospice groups (1.77 ± 2.44 vs. 1.84 ± 2.37 years, p = 0.217). The mean health-care expenditures per person were US$2370 ± 3421 and US$2072 ± 1900 (p = 0.130). A total of 385 patients (10 %) received high-cost care (above US$5422) using 38.6 % of the total health-care expenditures spent on the entire population. The significant predictors of high costs were non-hospice care [odds ratio (OR) = 3.06, 95 % confidence interval (CI) 2.09-4.60], days of admission [risk increase per admission day being (OR = 1.19, 95 % CI 1.17-1.21)], admission into an intensive care unit (OR = 3.17, 95 % CI 1.94 to 5.15), use of ventilator (OR = 3.54, 95 % CI 1.91-6.52), cancer therapy (OR = 1.82, 95 % CI 1.33-2.48), hemodialysis (OR = 2.62, 95 % CI 1.07-6.02), and higher socioeconomic status (OR = 1.65, 95 % CI 1.10-2.45). Hospice care did not significantly affect survival, and hospice patients had lower per-patient expenditures and were less likely to require high-cost medical care than their non-hospice counterparts.

Costs of surviving meningococcal disease in Spain: Evaluation for two cases of severe meningitis and septicaemia

ObjectivesThe aim of this study was to count the lifelong rehabilitation costs associated with surviving meningococcal disease with major sequelae from the perspective of the Spanish National Healthcare System (NHS) and the national government. MethodsTwo severe scenarios describing meningococcal disease were developed, one case that represented meningococcal septicaemia and another case for meningococcal meningitis. The scenarios were developed based on a literature review on severe sequelae of meningococcal disease, and discussions with paediatricians who have been responsible for the treatment of children with this disease in Spain. Second, a detailed list of all health, educational and social care resources used by survivors during their acute illness and during the rest of their lives and by family members was obtained by interviewing survivors and their families. Professionals in health and social care were also interviewed to complete the list of resources and ensure the scenario's were accurate. The costs attributed to these resources were obtained from tariff lists, catalogues and published information by the national authorities. All costs were based on a life expectancy of a survivor of 70 years and expressed in EUR 2012. ResultsIn this study it was estimated that the lifelong discounted rehabilitation costs associated with the treatment of long-term sequelae due to meningococcal disease are approximately €1180,000–€1400,000. Medical care and social care were the main cost drivers for both septicaemia and meningitis. Annual costs showed to be the largest in the first year after diagnosis of the disease for both cases, due to high hospital admission and medical care costs during this period and decreased significantly over the years. ConclusionThis study shows that the lifelong rehabilitation costs associated with the survival of meningococcal disease with severe sequelae place an important burden on the NHS budget and governmental resources in Spain.

Perceptions of Spanish-speaking clientele of patient care services in a community pharmacy.

A paucity of studies exists that have assessed community pharmacy preferences of Spanish-speaking patients living in areas of the U.S. with rapidly growing Hispanic populations. The qualitative approach to this research affords a unique opportunity to further explore perceptions of the Spanish-speaking population. To identify perceptions of Spanish-speaking patients living in the U.S. with a focus on the care provided in community pharmacies, as well as to determine their satisfaction with community pharmacies. Participants were recruited after weekly Spanish-speaking church services for approximately one month. Qualitative, semi-structured individual interviews to identify perceived unmet patient care needs were conducted in Spanish and transcribed/translated verbatim. Qualitative thematic analysis was used to summarize findings. A written questionnaire was administered to collect patient satisfaction and demographic information, summarized using descriptive statistics. Twelve interviews were conducted by the principal investigator. Primary themes included lack of insurance coupled with high medical care costs serving as a barrier for acquisition of health care, difficulty accessing timely and convenient primary care, perceived negative attitudes from pharmacy personnel, lack of Spanish-speaking health care providers, and the provision of verbal and written medication information in English. The results of this study suggest a great need for health care providers, including pharmacists, to expand outreach services to the Spanish-speaking community. Some examples derived from the interview process include increasing marketing efforts of available services in the Spanish language, hiring Spanish-speaking personnel, and offering medical terminology education classes to Spanish-speaking patients.

Dashboard systems: implementing pharmacometrics from bench to bedside.

In recent years, there has been increasing interest in the development of medical decision-support tools, including dashboard systems. Dashboard systems are software packages that integrate information and calculations about therapeutics from multiple components into a single interface for use in the clinical environment. Given the high cost of medical care, and the increasing need to demonstrate positive clinical outcomes for reimbursement, dashboard systems may become an important tool for improving patient outcome, improving clinical efficiency and containing healthcare costs. Similarly the costs associated with drug development are also rising. The use of model-based drug development (MBDD) has been proposed as a tool to streamline this process, facilitating the selection of appropriate doses and making informed go/no-go decisions. However, complete implementation of MBDD has not always been successful owing to a variety of factors, including the resources required to provide timely modeling and simulation updates. The application of dashboard systems in drug development reduces the resource requirement and may expedite updating models as new data are collected, allowing modeling results to be available in a timely fashion. In this paper, we present some background information on dashboard systems and propose the use of these systems both in the clinic and during drug development.

Model Telediagnosis Serangan Jantung untuk Para Praktisi Kesehatan Menggunakan Mobile Phone

The lack of medical experts such as doctors at rural areas resulted in some problems such as the high cost of medical care and low service of doctors and medical resource provider. The conditions results in an idea to implement a communication system between rural medical practitioners and doctors in urban areas to perform remote diagnosis on patients (telediagnosis). The research involves several parties such as doctors, health centers, health practitioners (paramedics), patients, and hospitals and health institutions. The telediagnosis system development consists of the construction of a software application prototype as media input for patient data which will be sent to doctors at town, database systems design, integration of basic multimedia devices, medical diagnostic device integration, and application testing of telediagnosis performance using an android-based mobile application. Data integration patterns include patient data delivery patterns, checking a patient's diagnosis, saving and continuing to the physician or health care practitioner with real-timesystem. This study is conducted according to standard research stages: problem collection, problem analysis, research materials collection, research design, and research implementation. Telediagnosis system is used to facilitate remote diagnosis of patients at rural areas which is able to serve patients more quickly, and helps find out nearest location for patients to get medicines as well as recommendation of nearest hospital. This system helps decrease the workload of hospitals.

Importancia de la metodología enfermera en la mejora de la calidad de los cuidados en el paciente con traumatismo craneoencefálico grave. Revisión de la literatura

Los traumatismos craneoencefálicos (TCE) constituyen un importante problema de salud pública en los países occidentales, por el elevado índice de mortalidad, discapacidad y la prolongada hospitalización que conllevan. Son la primera causa de muerte e incapacidad en la población menor de 45 años y una causa importante de pérdida prematura de vida productiva, de altos costes de atención médica y de pérdidas socioeconómicas grandes para la sociedad. El objetivo del estudio es revisar la literatura actual relacionada con los cuidados de Enfermería aplicados a los pacientes con TCE grave, así como la influencia de los mismos en la mejora de la práctica asistencial y en la calidad de vida de los pacientes y sus familias. Para la realización del trabajo se lleva a cabo una revisión narrativa de la literatura relacionada sobre los aspectos más importantes que influyen en la atención y cuidados de los pacientes con TCE grave. Se revisan las bases de datos MEDLINE, CUIDEN, BDIE, INDEX, CINAHL, LILACS y revisiones sistemáticas de la COCHRANE. La aplicación de la metodología enfermera favorece el cuidado integral al paciente y familia, ayuda a prevenir complicaciones que puedan empeorar la recuperación del paciente disminuyendo las secuelas a largo plazo, y favorece la calidad de vida de estos pacientes además de contribuir en la mejora de la calidad asistencial.

Identifying and Prophylaxis of High-risk GI Bleeders in Cardiac Patients

Purpose: Identification of individuals at risk for gastrointestinal bleeding is extremely important because it is associated with increased mortality and morbidity. Risk factors associated with GI bleeding have been identified as age >64, hx of peptic ulcer disease, H. pylori infection, dyspepsia or GERD symptoms, chronic renal failure, diabetes mellitus, and concomitant use of other antiplatelet agents, anticoagulants, nonsteroidal anti-inflammatory drugs, and steroids. Recommendations made in 2010 ACC/ACG/AHA expert consensus recommend GI prophylaxis for all patients undergoing percutaneous coronary intervention (PCI) who are at high risk of adverse GI event consequent to therapy. Our purpose is to emphasize the importance of GI bleeding risk stratification and prophylaxis in patients prior to antithrombotic therapy in PCI. Methods: Retrospective study on 200 patients admitted to Plaza Medical Center in Fort Worth, TX, for percutaneous cardiac intervention requiring antithrombotic therapy from June 2010 to June 2011. We examined cardiology consults and identified risk factors for GI bleeding reported in past medical history, medications and review of systems. Next set of data was based on whether patients with three or more risk factors were appropriately placed on GI prophylaxis with a proton pump inhibitor. Results: Gastrointestinal risk factors were identified in PMH and medications. In ROS, no consults included pertinent positives or negatives regarding previous PUD, dyspepsia, reflux or bloatiness. Patients with or without risk factors were placed on pepcid. Patients with protonix on their medication lists were switched to pepcid. As a result, no one was appropriately placed on a proton pump inhibitor for prophylaxis. Conclusion: Gastrointestinal bleed is a common medical condition resulting in high medical care costs. There are many ways to improve the identification of patients at risk. Efforts should be aimed at increasing the awareness and promoting adequate history taking with emphasis on past medical history, medication list and review of systems. High-risk patients should be appropriately placed on GI prophylaxis with a proton pump inhibitor.

Combining Safety and Trainee Education in Surgical Oncology: We All Win

This timely article by Castleberry et al. brings focus to safety concerns in performing large and complex operations in cancer patients. The authors reviewed de-identified data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (PUFs) to study the overall 30-day postoperative mortality and morbidity rates and failure-torescue rate in patients undergoing oncologic operations for colorectal, hepatopancreaticobiliary, and gastroesophageal primary cancers. The primary purpose of the study was to assess the impact of surgical trainee involvement on riskadjusted 30-day morbidity and mortality in patients undergoing these procedures. The risk-adjusted results showed a 6.2 % (27.2 vs. 21 %) higher morbidity with trainee involvement but a 0.2 % (1.9 vs. 2.1 %) lower 30-day mortality rate and a 1.7 % (5.9 vs. 7.6 %) lower failure-to-rescue rate with trainee involvement. These absolute differences are small but were statistically significant due to the large study population of 77,862 patients. It is interesting that these differences were consistent across all types of oncologic procedures performed. There are many limitations of this data: only NSQIP participating hospitals were included, only 30-day mortality was recorded (there is not an insignificant number of patients undergoing hepatopancreaticobiliary and gastroesophageal procedures who may have delayed mortality between postoperative days 30–90). The reason for trainee involvement or no involvement was not recorded. The total number of trainees in a given operation was not recorded, and only the most senior PGY trainee who was present was recorded. Overall, this study suggests that trainee involvement does not worsen (and may even improve) perioperative mortality in patients undergoing complex oncologic procedures but may lead to a modest increase in postoperative morbidity. Another recent study on trainee involvement in open versus laparoscopic partial colectomy, also using ACS-NSQIP data, had similar results. These are encouraging studies as we go forward in our surgical teaching and training. We now place patient safety very appropriately as one of our top quality standards in patient care and the transparent involvement of trainees in the care of these patients in our teaching hospitals will be essential going forward. The ‘‘cost’’ of surgical resident and fellow training cannot be at the expense of poorer patient outcomes. It will be very interesting to see if future studies from these NSQIP hospitals (or other teaching hospitals) will be able to analyze longitudinal data and report any differences in cancer recurrence and cancer-specific survival with trainee involvement. The dynamics of how we teach in the operating room are rapidly expanding and changing. The high cost of medical care, the focus on reducing medical errors, and the ACGMEmandated resident work hour restrictions have brought out some of the best and most creative new approaches to teaching and learning from surgical educators. Surgical simulators allow all levels of residents to complete virtually and repetitively many of the essential steps in complex procedures before ever performing the actual surgeries. Instead of only one trainee performing and staying for an entire operation, many programs now encourage junior residents to observe and perform parts of operations (i.e., placing videoendoscopic ports or performing a laparotomy This article is an editorial about ‘‘Resident Education in the Era of Patient Safety: A nationwide analysis of outcomes and complications in resident-assisted oncologic surgery.’’ by Anthony Castleberry et al. available at doi: 10.1245/s10434-013-3079-2.

The effect of alpha-lipoic acid in ovariectomy and inflammation-mediated osteoporosis on the skeletal status of rat bone

Osteoporosis is a high mortality and morbidity ranged skeletal disease and results in high costs of medical care in the European Union. We evaluated the possible protective effect of alpha-lipoic acid (ALA) on rat bone metabolism in ovariectomy and inflammation-mediated osteoporosis models. Groups were designed as: (1) sham; (2) sham+inflammation; (3) ovariectomy (OVX); (4) ovariectomy+ALA—25mg/kg; (5) ovariectomy+ALA—50mg/kg; (6) ovariectomy+inflammation; (7) ovariectomy+inflammation+ALA—25mg/kg; and (8) ovariectomy+inflammation+ALA—50mg/kg groups. OVX groups were allowed to recover for two months. Then, inflammation was induced in inflammation groups by subcutaneous talc injection. ALA—25mg/kg and 50mg/kg were administered to drug groups chronically. The skeletal response was assessed by bone mineral density (BMD), osteopontin and osteocalcin measurements. Pro-inflammatory cytokine measurements (interleukin (IL)-1beta, interleukin-6, and tumor necrosis factor-alpha) were performed to observe inflammatory process. In OVX, INF and OVX+INF groups, BMD levels were lowest and osteocalcin, osteopontin, IL-1beta, IL-6, and TNF-alpha levels were highest when compared to sham group. ALA administration increased BMD levels and decreased osteocalcin, osteopontin, IL-1beta, IL-6, and TNF-alpha levels versus OVX and OVX+INF control groups. Both in senile and postmenopausal osteoporosis, the balance in coupling were destroyed on behalf of bone resorption. ALA had a protective effect on both senile and postmenopausal osteoporosis. The positive effect of this drug in these osteoporosis models might originate from its positive effects on bone turnover markers and cytokine levels. From this perspective, ALA may be a candidate for radical osteoporosis treatment both in senile and postmenopausal types clinically at the end of advanced studies.

SP0117 The Epidemiologic Burden of Osteoporotic Fractures

Fractures, the clinical manifestations of osteoporosis, are associated with pain, poor functional outcomes and increased mortality. Despite the increasing awareness of its consequences, osteoporosis has recently been recognized as a...

Medications for Improving Walking Performance in Peripheral Artery Disease

LOWER EXTREMITY PERIPHERAL ARTERY DISEASE (PAD) is a global health problem that will become increasingly prevalent as the world population lives longer with chronic disease. One report estimated that 1 in 16 Americans 40 years or older has PAD. Improving functional performance is a major treatment goal for patients with PAD. Men and women with PAD have greater functional impairment and more rapid functional decline than those without PAD. Among participants in the Walking and Leg Circulation Study (WALCS), a longitudinal observational study of 676 men and women (overall mean age, 71.0 years) with and without PAD, those with severe PAD, defined as an ankle brachial index less than 0.50, were 12 times more likely to become unable to walk continuously for 6 minutes at 2-year follow-up, compared with those with a normal ankle brachial index at baseline. At 5-year follow-up in the WALCS cohort, participants with severe PAD had a 4-fold increased risk of mobility loss, compared with participants without PAD at baseline. Participants with moderate and mild PAD, respectively, had a 3.82-fold and 3.22-fold increased risk of mobility loss at 5-year followup, compared with participants without PAD at baseline. The functional limitations experienced by patients with PAD are associated with poorer quality of life, increased hospitalization rates, higher mortality, and higher medical care costs. Given the increasing burden of PAD and its associated functional impairment, identifying interventions to improve functional performance in patients with PAD is an important public health challenge. In patients with PAD, supervised treadmill exercise improves maximal treadmill walking time by 50% to more than 200%. However, medical insurance typically does not pay for supervised treadmill exercise for patients with PAD, and most such patients do not participate in supervised treadmill exercise programs. Only 2 medications (pentoxifylline and cilostazol) are currently approved by the US Food and Drug Administration (FDA) for treating PAD-associated walking impairment. However, a recent systematic review concluded that pentoxifylline and cilostazol are associated with improvement in maximal treadmill walking distance of only 15% and 25%, respectively. New medical therapies are needed to improve functional performance in patients with PAD. In this issue of JAMA, Ahimastos and colleagues report results of a randomized, placebo-controlled clinical trial of rampiril vs placebo for improving walking performance in patients with PAD. In this trial, 212 patients with PAD and intermittent claudication were randomized to receive 10 mg of ramipril or matching placebo. At 24-week follow-up, participants with PAD randomized to receive ramipril achieved significantly greater increases in pain-free and maximum treadmill walking time, the 2 primary outcomes. Improvements in pain-free and maximum walking time were 75 seconds and 255 seconds greater, respectively, in the ramipril group relative to the placebo group. The magnitude of the increase in pain-free and maximum walking distance was substantial, corresponding to 77% and 123% increases, substantially greater than that observed with FDA-approved medications for claudication. Participants with PAD randomized to receive ramipril also achieved significantly greater gains in the Walking Impairment Questionnaire distance, walking speed, and stair climbing scores compared with the placebo group. Prior trials of ramipril therapy to improve walking performance in patients with intermittent claudication have yielded mixed results. A previous randomized controlled trial of ramipril vs placebo by Ahimastos et al involving 40 patients with symptomatic infrainguinal PAD and no history of diabetes or hypertension demonstrated gains in painfree and maximum walking distance of 227 and 451 seconds, respectively, compared with placebo. However, a recent meta-analysis by Shahin et al of 4 randomized trials involving 137 patients with PAD, including the 40 participants in the prior trial by Ahimastos et al, demonstrated no association between use of angiotensin-converting enzyme (ACE) inhibitors and improved walking performance. The trials included in this meta-analysis were heterogeneous and evaluated several different ACE inhibitors. Three of the trials were completed in the early 1990s, raising ques-

Overweight and Obesity, and Associated Factors among High School Students in Gondar Town, North West Ethiopia

Introduction: Overweight and obesity are defined as abnormal or excessive fat accumulation in the body that may affect health. The prevalence of overweight and obesity in children is increasing worldwide, and currently 1 child in 10 is overweight or obese. Overweight and obesity are now considered as very important risk factors for many chronic diseases which exploit high cost of medical care. Objective: To assess the prevalence of overweight and obesity, and associated factors among high school students in Gondar town. Methodology: Institution based cross-sectional study was conducted from April 12/2012 to April 30/2012 in Gondar town administration. A total of 800 students were included in the study. Multistage sampling strategy was applied to enroll students. Both bivariate and multivariate logistic regression analysis was done to identify associated factors. Result: The overall prevalence of overweight and obesity in this study was 5.4% and 0.5% respectively. The prevalence of overweight among the adolescents studying in private schools was 10.1% and was higher than those studying in government schools (4%). Overweight was 4.47 times higher among girls [Adjusted Odds Ratio (AOR) =4.47; 95% CI: 1.79, 11.13], and 2.53 times higher among Students of private school [AOR =2.53, 95% CI: 1.33, 4.64]. Consuming sweet food item was significantly associated with overweight. However, moderate or vigorous sport activity for at least 10 minutes continuously was only marginally significant. Conclusion and recommendation: This study revealed that Overweight and obesity are emerging in Gondar. School type, sex and consuming sweet food item were among the predictors that were significantly associated with overweight. Hence decreasing consumption of sweet food items and doing physical activity could reduce risk of overweight.

Hospices’ Enrollment Policies May Contribute To Underuse Of Hospice Care In The United States

Hospice use in the United States is growing, but little is known about barriers that terminally ill patients may face when trying to access hospice care. This article reports the results of the first national survey of the enrollment policies of 591 US hospices. The survey revealed that 78 percent of hospices had at least one enrollment policy that may restrict access to care for patients with potentially high-cost medical care needs, such as chemotherapy or total parenteral nutrition. Smaller hospices, for-profit hospices, and hospices in certain regions of the country consistently reported more limited enrollment policies. We observe that hospice providers' own enrollment decisions may be an important contributor to previously observed underuse of hospice by patients and families. Policy changes that should be considered include increasing the Medicare hospice per diem rate for patients with complex needs, which could enable more hospices to expand enrollment.

Multiple sclerosis – epidemiology, diagnosis, treatment and rehabilitation - a literature review

At present, multiple sclerosis is regarded as disease in which the immune system fights its own cells, in this case the nervous tissue. The World Health Organisation (WHO) estimates that 2.5 million people in the world suffer from multiple sclerosis, of which 40-60 come from Poland. The costs incurred in relation to the disease are high due to the duration of the disease, a quick loss of the ability to work by people suffering from it, and due to the high costs of immuno-suppressive treatment and broad medical care.

Evaluating medical resource utilization and costs associated with thrombocytopenia in chronic liver disease patients

Objective:Thrombocytopenia (TCP), defined as platelet counts <150,000/µL, is a common complication of severe chronic liver disease (CLD). This retrospective study estimated the prevalence of thrombocytopenia in a large population of CLD patients and compared medical resource utilization and medical care costs by TCP status.Methods:A retrospective analysis was conducted on a longitudinal administrative claims database from a large US commercial health plan. Patients assigned CLD diagnosis codes from January 1, 2000–December 31, 2003 were identified; annual ambulatory visits, ER visits, inpatient stays, and general and CLD-related medical care costs for patients with vs without TCP (identified using diagnosis codes and platelet count data if available) were compared.Results:Of 56,445 patients with an ICD-9-CM diagnosis for CLD, 1289 (2.3%) had a diagnosis for TCP. CLD patients with vs without a TCP diagnosis had >2.5-times the annual number of liver disease-related ambulatory visits (3.6 vs 1.4; odds ratio [OR] = 2.6, p < 0.01); were 13-times more likely to have a liver-related inpatient stay (OR = 13.0, p < 0.01); were nearly 4-times more likely to have a liver-related ER visit (OR = 3.9, p < 0.01); had 3.5-fold greater mean annual overall medical care costs ($43,560 vs $12,270, p < 0.01); and had 7-fold greater annual liver disease-related medical care costs ($9940 vs $1420, p < 0.01). Similar results were seen for patients with platelet count data indicating TCP.Limitations:CLD and TCP are not always diagnosed, nor is diagnosis uniform or standardized; administrative claims data are subject to coding errors, and individuals covered are not necessarily representative of the general US population. The number of CLD patients in this study with TCP (n = 1289) is small relative to that expected in the general US population.Conclusions:In this analysis, CLD patients with TCP used significantly more medical resources and incurred significantly higher medical care costs than those without TCP.

Value of Primordial and Primary Prevention for Cardiovascular Disease

The process of atherosclerosis may begin in youth and continue for decades, leading to both nonfatal and fatal cardiovascular events, including myocardial infarction, stroke, and sudden death. With primordial and primary prevention, cardiovascular disease is largely preventable. Clinical trial evidence has shown convincingly that pharmacological treatment of risk factors can prevent events. The data are less definitive but also highly suggestive that appropriate public policy and lifestyle interventions aimed at eliminating tobacco use, limiting salt consumption, encouraging physical exercise, and improving diet can prevent events. There has been concern about whether efforts aimed at primordial and primary prevention provide value (ie, whether such interventions are worth what we pay for them). Although questions about the value of therapeutics for acute disease may be addressed by cost-effectiveness analysis, the long time frames involved in evaluating preventive interventions make cost-effectiveness analysis difficult and necessarily flawed. Nonetheless, cost-effectiveness analyses reviewed in this policy statement largely suggest that public policy, community efforts, and pharmacological intervention are all likely to be cost-effective and often cost saving compared with common benchmarks. The high direct medical care and indirect costs of cardiovascular disease-approaching $450 billion a year in 2010 and projected to rise to over $1 trillion a year by 2030-make this a critical medical and societal issue. Prevention of cardiovascular disease will also provide great value in developing a healthier, more productive society.