Higher Medical Costs Research Articles

Directional Freeze-Casting Cryogel Loaded with Quaternized Chitosan Modified Gallium Metal-Organic Frameworks to Capture and Eradicate the Resistant Bacteria for Guided Regeneration in Infected Bone Defects.

Antimicrobial resistance and impaired bone regeneration are the great challenges in treating infected bone defects. Its recurrent and resistant nature, high incidence rate, long-term hospitalization, and high medical costs have driven the efforts of the scientific community to develop new therapies to improve the situation. Considering the complex microenvironment and persistent mechanisms mediated by resistant bacteria, it is crucial to develop an implant with enhanced osseointegration and sustained and effective infection clearance effects. Here, a positively charged quaternized chitosan (QCS) coated gallium-based metal-organic framework (GaMOF) is designed, to capture the antibiotic-resistant bacteria (Methicillin-resistant Staphylococcus aureus, MRSA) as a "captor", and rejuvenate Methicillin (Me) via disturbing the tricarboxylic acid (TCA) cycle. Then, a radially oriented porous cryogel loaded with the Me and QCSGaMOF is fabricated by the directional freeze-casting method. The oriented porous structure has an enhanced osseointegration effect by guiding the ingrowth of osteogenic cells. In vitro and in vivo experiments prove the advantages of as-prepared Me/QCSGa-MOF@Cryogel in combating resistant bacteria and guiding bone regeneration in infected bone defects.

Medication patterns and potentially inappropriate medication in patients with metastatic breast cancer: results of the BRE-BY-MED study

BackgroundThe treatment of metastatic breast cancer (mBC) focuses on prolonging patient survival, providing adequate symptom management, and maintaining quality of life (QoL). This includes supportive therapy to prevent or treat potential side effects and handle comorbidities. The combination of mBC therapy, supportive therapy, and treatment for comorbidities increases the risk for polypharmacy, potential drug-drug interactions (pDDI), potentially inappropriate medication (PIM), and potentially missing drugs (pMD). Therefore, the aim of this study was to assess medication patterns of mBC patients in routine care within a cohort study from South Germany.MethodsBetween July 2022 and February 2024 individuals with advanced or mBC, aged ≥ 18 years, living in Bavaria, and who gave written informed consent, were included in the BRE-BY-MED “Breast Cancer Care in Bavaria for Patients with Metastatic Disease” cohort study (DRKS00026601). BRE-BY-MED was carried out at the University Hospital Würzburg with the primary aim of estimating the prevalence of guideline-concordant treatment. For the present analysis cross-sectional data from the baseline assessment was used. Medication was extracted from routine medical records. PIM, pDDI and pMD were assessed using established criteria. Polypharmacy was defined as ≥ 5 concomitantly prescribed drugs.ResultsNinety-three patients with a median age of 57 years (IQR = 48–64 years), were consecutively enrolled in the BRE-BY-MED study. One patient was male. At baseline, a total of 668 drugs were documented for all patients, including 131 unique substances, of which 44% were mBC therapy, 18% supportive therapy and 38% treatment for comorbidities or supplements. Patients took a median of 6 (IQR = 5–9) concomitant drugs. Polypharmacy (i.e. ≥ 5 concomitant drugs) was observed in 80.6% (n = 75) of the patients. PIM were documented in 9.7% (n = 9), pDDI in 12.9% (n = 12) and pMD in 64.5% (n = 60) of the patients.ConclusionWe observed a high drug burden in mBC patients, largely due to treatment for comorbidities. These drugs might not only be associated with additional risk for side effects, pDDI, or PIM use, yet might also contribute to low medication adherence, higher medication costs and impaired QoL. Considering the burden of mBC and the predicted life expectancy, mBC patients might benefit from closer monitoring of their medication.

Formal guidelines from an expert panel: intensive care unit medical staffing, organisation and working hours to improve quality of life at work in France

BackgroundIntensive care units (ICU) are characterized by high medical assistance costs and great complexity. Recommendations to determine the needs of medical staff are scarce, generating appreciable variability. The French Intensive Care Society (FICS) and the French National Council of Intensive Care Medicine (CNP MIR, Conseil National Professionel de Médecine Intensive Réanimation) have established a technical committee of experts, the purposes of which were to draft recommendations regarding staffing needs in ICUs and to propose optimal organisation of work hours, a key objective being improved workplace quality of life.ResultsLiterature analysis was conducted according to the GRADE methodology (Grade of Recommendation Assessment, Development and Evaluation). The synthesis work of the experts according to the GRADE method led to the development of 22 recommendations in 6 field. The experts issued a strong recommendation associated with a high level of evidence which is that work organization be given priority during periods of permanent care, with a maximum 16 h of consecutive work permitted. For 21 other recommendations, the level of evidence did not allow GRADE classification, and led to the formulation of expert opinions. All recommendations and expert opinions were validated (strong agreement).ConclusionThe work in the intensive care unit and in the intermediate intensive care unit is multifaceted, both clinical and non-clinical, and must include at least the following continuity and quality for patient safety. This document provides a detailed framework to propose an optimal medical staff.

Relationship between oral hypofunction and medical expenditure in older adults in Japan

This study aimed to analyze the impact of poor oral function on medical expenditures among older adults. We diagnosed oral hypofunction based on dental data obtained from oral health examinations and examined its association with several annual medical expenditures. Compared to individuals without oral hypofunction, those with oral hypofunction incurred higher total, outpatient medical, inpatient medical, dental, dispensing medical, and lifestyle-related medical expenditures. Those with high medical expenditure costs were significantly more likely than those without to be 80 years old, male, with oral hypofunction, poor oral hygiene, xerostomia, poor lip closure, physical frailty, mental frailty, and subjective poor health. Logistic regression analysis indicated that oral hypofunction was significantly associated with total medical, inpatient medical, dental outpatient, dispensing medical, and lifestyle-related medical expenditures, compared to those without oral hypofunction (p < 0.05). Additionally, every increase in the number of items with declined oral function and total medical, dental, and dispensing medical expenditures increased significantly (p < 0.01). The results of this study suggest an association between oral hypofunction and several medical expenditures. The prevention and early detection of oral hypofunction would reduce not only dental but also medical expenditures by the maintenance of good health.

"Atlanta Is Like Wakanda… but With Real Big, Big Issues": A Focus Group Study of Community Strengths and Health Issues in Diverse Groups in Atlanta, Georgia.

This qualitative study explored perceived community strengths and health issues among 3 underserved and under-studied populations in the Atlanta, Georgia-older adults, Black or African American persons, and refugees/immigrants/migrants. Eight focus groups were conducted with 92 participants who were members of the 3 populations in Atlanta between November 2022 and March 2023. Although there were variations among groups, all groups emphasized diversity within their community as the foundation of community strength. Elements of the built environment such as parks, convenience stores, the Atlanta Beltline, and food outlets bolstered community strength. Furthermore, community members being able to voice concerns and the responsiveness of governmental institutions helped form strong relationships to build a strong community. Regarding health issues, common physical health concerns included hypertension and obesity, with varied mental health issues. Accessibility and affordability of healthy foods were significant social concerns, alongside challenges in healthcare access such as navigating complex systems and high medical costs. Tailored interventions recognizing community strengths and addressing specific health issues are crucial for improving outcomes in marginalized communities, necessitating a health-in-all policies approach considering social, cultural, and structural determinants of health.

High Medical Cost and Homelessness

High Medical Cost and Homelessness

The Global Burden of Multidrug-Resistant Tuberculosis: An In-Depth Review of Catastrophic Costs, Patient Burdens, and Strategies for Sustainable Healthcare Solutions

Background: Multidrug-resistant tuberculosis (MDR-TB) poses a significant global health challenge, with approximately 500,000 new cases reported in 2020, predominantly among vulnerable populations in low- and middle-income countries. The World Health Organization (WHO) aims to mitigate catastrophic costs associated with TB treatment, which often exceed 20% of a household's annual income, leading families into severe financial distress. This systematic review and meta-analysis aimed to assess the global burden of catastrophic expenditures related to MDR-TB, focusing on patient and family financial impacts. Methods: A comprehensive literature search was conducted across five databases (CINAHL, MEDLINE, Embase, Scopus, and Web of Science) and grey literature sources, utilizing relevant keywords related to MDR-TB and cost implications. Studies were selected based on their relevance to catastrophic costs incurred by MDR-TB patients. Results: The analysis revealed that the financial burden for MDR-TB patients is significantly higher than for drug-susceptible TB (DS-TB) cases, with treatment costs ranging from $2,423 in Peru to $14,657 in Tomsk, Russia. Factors influencing these costs include sociodemographic characteristics, diagnostic delays, and the duration of hospitalization. Notably, 43% of TB patients experienced catastrophic expenditures, with MDR-TB patients facing an even greater risk due to longer treatment durations and higher medication costs. Conclusions: In conclusion, the findings underscore the urgent need for effective interventions to reduce the financial burden of MDR-TB on patients and families. Enhanced drug susceptibility testing and improved healthcare access are critical for managing MDR-TB and preventing further economic devastation. Addressing these issues will be vital for achieving the WHO's end-TB strategy and ensuring sustainable healthcare solutions

Antibiotic Resistance Trends in Carbapenem-Resistant Gram-Negative Pathogens and Eight-Year Surveillance of XDR Bloodstream Infections in a Western Greece Tertiary Hospital.

Background: The increased prevalence of antibiotic resistance among Gram-negative bacteria presents a severe public health challenge, leading to increased mortality rates, prolonged hospital stays, and higher medical costs. In Greece, the issue of multidrug-resistant Gram-negative bacteria is particularly alarming, exacerbated by overuse of antibiotics and inadequate infection control measures. This study aimed to detect the prevalence of extensively drug-resistant (XDR) Gram-negative bacteria in a tertiary hospital in Western Greece over the last eight years from 2016 to 2023. Materials and Methods: In the present study, all Carbapenem-resistant (CR) Acinetobacter baumannii, K. pneumoniae and Pseudomonas aeruginosa. bloodstream isolates from patients hospitalized in the University General Hospital of Patras in Western Greece, from January 2016 to December 2023, were recorded. XDR strains were defined as non-susceptible to at least one agent in all but two or fewer antimicrobial categories (i.e., bacterial isolates remain susceptible to only one or two categories). The prevalence and distribution of these pathogens across different hospital wards and their susceptibility patterns to key antibiotics (aminoglycosides, trimethoprim-sulfamethoxazole, tigecycline, colistin, ampicillin-sulbactam, ceftolozane-tazobactam and ceftazidime-avibactam) were recorded. Results: A total of 1142 blood cultures growing carbapenem-resistant Klebsiella pneumoniae (CRKp), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPsA) were studied. In the present study, we found an increased resistance of both A. baumannii and K. pneumoniae in colistin. Acinetobacter baumannii had colistin resistance rates between 8.4% and 49.3%, showing a stable increase during the study period. K. pneumoniae showed an increased colistin-resistance rate in 2022 and 2023 (46.8% and 31.2%, respectively) Regarding P. aeruginosa, amikacin was almost inactive with a rate 68.4% and 87.5% in 2020 and 2023, respectively. Of all CR isolates, 69.3% were extensively drug-resistant (XDR). Acinetobacter baumannii had the highest percentage of XDR isolates (34.3%), followed by K. pneumoniae (26.8%) and P. aeruginosa (8.1%). Most XDR pathogens were isolated from the ICU (73.4%), followed by the internal medicine units (64%) and surgical units (22%). Conclusions: The rate of antimicrobial resistance and extensive drug resistance is alarmingly high, which calls for strict surveillance, control measures, and antibiotic stewardship to prevent the development of further resistance.

Integrating modern and herbal medicines in controlling malaria: experiences of orthodox healthcare providers in Ghana

BackgroundIn Ghana, the government has integrated herbal medicine into the formal healthcare system in response to widespread use of traditional remedies. However, empirical evidence supporting the contribution of integrated healthcare to malaria control remains limited. This study employed a phenomenological qualitative research design to explore the experiences of medical doctors and pharmacists from the coastal, forest and savannah regions of Ghana regarding the integration of modern and herbal medicine in the treatment and control of malaria. Donabedian’s framework for evaluating the quality of healthcare served as the foundational theoretical framework for this research.MethodsData were collected through individual in-depth interviews involving 26 participants and analysed using a framework analytical approach.ResultsThe findings revealed that inadequate political commitment to the practice of integration has led to several challenges, including the high cost of herbal anti-malaria medications, limited promotional activities surrounding integration, a shortage of qualified medical herbalists, inconsistent supply chains for herbal anti-malaria treatments, and a lack of standardisation in herbal medicine practices. Participants had divergent views regarding the impact of integration on malaria control; while medical doctors believed that the intervention has not significantly contributed to reducing malaria prevalence in Ghana, pharmacists viewed the presence of herbal clinics within government hospitals as an effective and sustainable alternative for treating malaria.ConclusionReflecting on these results, it is imperative for policymakers to explore strategies that could enhance the effectiveness of an integrated health system, thereby increasing the contribution of herbal medicine towards achieving a malaria free nation. Future research could benefit from including policymakers, heads of health directorates, and community members, regarding the role of public health interventions in addressing health inequities in Ghana.

Artificial Intelligence, Cybersight Detection of Diabetic Retinopathy in the Elderly in Vietnam

Diabetic retinopathy (DR) is a highly prevalent cause of vision loss worldwide. Detection of DR requires substantial human resources and high medical costs. Therefore, the use of diagnostic software has been recently explored. The study aimed to assess the results of DR diagnoses by Cybersight, an artificial intelligence software. A total of 1,012 patients with type 2 diabetes mellitus (1,943 eyes) with a mean age of 74.61 ± 6.73 years were included. Comprehensive demographic and clinical data were gathered, and all patients underwent color fundus photography following Cybersight's standardized protocols. The study compared Cybersight's accuracy with that of ophthalmologists in identifying key DR lesions, including retinal microvascular changes, exudates, hemorrhages, the diagnosis and staging of DR, using sensitivity, specificity, and weighted Kappa metrics. The prevalence of DR was 16.2%. A high level of agreement was found between Cybersight and ophthalmologists in DR diagnosis, with a sensitivity of 85.0%, specificity of 95.8%, and a weighted Kappa of 0.78. The presence of cataracts and the degree of pupil dilation notably impacted on the accuracy of DR diagnosis. The results have important implications for the potential application of Cybersight as a low-cost and effective tool for diabetic eye screening.

The Economic Burden of Myasthenia Gravis (MG): A Survey of Affected People and Their Families.

Claims-based analyses have demonstrated high medical costs associated with myasthenia gravis (MG). We examined the economic burden of MG from the perspective of affected people and their families. The Muscular Dystrophy Association developed and conducted an online survey of people with MG and their caregivers between October 26 and December 6, 2021. Major themes were: MG-associated financial decisions, quality of life, employment and direct/indirect costs of diagnosis, healthcare insurance, medical visits, medications/treatments, medical equipment/devices, and caregiving. Eight hundred people with MG and 238 caregivers responding on behalf of a person with MG completed the survey. Most respondents were white (85%) and about half (55%) had received a 4 year college degree or higher education. Respondents indicated that MG impacted their health, recreation, and finances. 70% reported making financial adjustments or seeking financial assistance. Annual out-of-pocket costs (mean, $15,798; median, $7750) were primarily driven by medications, cost to receive a diagnosis, and healthcare insurance premiums. People receiving infusions paid significantly more across all care domains. Demographic disparities were observed, with people of color, women, and those on disability paying significantly more to receive a diagnosis than their counterparts. The economic burden on people with MG and their families is substantial, primarily driven by direct costs. There is a need to engage more broadly with the MG community for generalizable information. Respondents were self-selected, which may impact results. The results will be used to educate the public and inform advocacy work, with the goal of improving the lives of people with MG.

Medical costs of treating myasthenia gravis in patients who need intravenous immunoglobulin (IVIg) – a register-based study

BackgroundSeveral innovative treatments are expected for myasthenia gravis (MG) in the coming years. Healthcare payers usually require cost-effectiveness analyses before reimbursement. We aimed to investigate resource utilization and direct medical costs for patients with MG treated with intravenous immunoglobulin (IVIg) to inform such analyses.MethodsWe identified patients with MG in the Norwegian Patient Registry based on at least two hospital encounters with an MG diagnosis (ICD-10 G70.0) from 1 Jan 2010 to 31 Dec 2021. IVIg treatment was identified by medical procedure and Anatomical Therapeutic Chemical (ATC) codes (RPGM05 and J06BA02). Using Diagnosis-Related Group (DRG) cost weights, we estimated direct medical costs for each year following the first MG diagnosis.ResultsOver the study period, 1083 patients were diagnosed with MG in Norway, of whom 155 (14.3%) were treated with IVIg. No significant differences in age or sex were observed between IVIg and non-IVIg patients. Compared with non-IVIg patients, IVIg-patients had 2.3 times higher direct medical costs during the first year after MG diagnosis (EUR 35,714 vs. EUR 15,457) and 3.1 times higher costs during the second year (EUR 19,119 vs. EUR 6256). In the fifth year after diagnosis, IVIg-patients still had higher costs and resource utilization than non-IVIg patients (EUR 9953 vs. EUR 5634).ConclusionIVIg treatment represents an important marker for high direct medical costs among patients with MG. The costs continue to be high during the first five years after MG diagnosis.

Evaluation of Drug Related Problems of Antihypertensive Drugs in Inpatient Hypertensive Patients at the Latemmamala Regional General Hospital, Soppeng Regency for the January-March 2023 Period

Hypertension is an increase in systolic blood pressure of more than 140 mmHg and diastolic blood pressure of more than 90 mmHg in two measurements taken five minutes apart at rest. Problems caused by drug abuse are called DRPs (Drug Related Problems). The occurrence of DRPs is known to have a detrimental effect on patient quality of life, increased mortality and high medical costs. This study aims to determine the incidence of DRPs and the types of DRPs that occur in hypertensive patients at Latemmamala Hospital, Soppeng Regency. This study is a type of non-experimental descriptive research conducted retrospectively using secondary data in medical records where samples were selected using purposive sampling technique. The results showed that of the 78 samples consisting of 42 women (53.85%) and 36 men (46.15%), all of which met the inclusion and exclusion criteria, showed that the age prevalence was more prone to hypertension at the age of 56-75 years as many as 47 patients (60.26%). There were 46 cases out of 43 patients who had the potential to experience DRPs. The most DRPs that occurred were in the case of C1.4 as many as 26 cases (56.52%), then C1.1 as many as 20 cases (43.48%).

Impact of porcine respiratory disease complex on carcass weight and meatiness: quantitative insights from a mixed-model analysis

BackgroundPorcine respiratory disease complex (PRDC) significantly impacts the swine industry worldwide, leading to economic losses due to poor growth performance, reduced feed efficiency, higher medication costs, and adversely affecting pig welfare by causing clinical symptoms such as fever, cough, loss of appetite, lethargy, and dyspnea. Cranio-ventral pulmonary consolidation (CVPC) and pleuritis are the most frequent macroscopic lung lesions observed in PRDC and are indicators of decreased animal welfare. This study aimed to quantify the effects of CVPC and pleurisy on carcass weight, meatiness, and average daily carcass weight gain (ADCWG) in fattening pigs, thereby assessing their impact on both production and welfare. A total of 679 slaughtered pigs from seven batches (farms) were evaluated for lung lesions at slaughter. We employed a mixed-model analysis to assess the correlation between lung lesions and production parameters across the farms.ResultsThe mean prevalence of lesions was 23.86% for CVPC and 15.46% for pleurisy, indicating a significant presence of respiratory disease affecting animal welfare. Pigs with severe lung lesions (≥ 15.1%) exhibited significantly lower ADCWG compared to pigs without lesions (0.951 kg/day vs. 0.997 kg/day, p = 0.024), reflecting reduced growth performance and welfare. The mixed-effects model revealed that lesions in the right apical lobe and dorso-caudal pleurisy were associated with significant reductions in carcass weight (− 2.77 kg and − 2.29 kg, respectively) and carcass meat (− 1.76 kg and − 1.43 kg, respectively). An economic analysis under average market price conditions demonstrated that severe lung lesions could lead to financial losses of up to 11.53 EUR per 100 kg of meat, emphasizing the economic impact of compromised welfare due to respiratory diseases.ConclusionsThis study provides quantitative evidence of the negative impact of CVPC and pleurisy on carcass weight and meatiness in fattening pigs. The findings underscore the importance of effective respiratory disease management in swine production, highlighting potential areas for targeted interventions to improve animal health and economic outcomes.

Financial challenges of being on long-term, high-cost medications.

The isocitrate dehydrogenase (IDH) inhibitor, vorasidenib, may offer a promising new treatment option for patients with IDH-mutant gliomas. However, the indefinite nature of this targeted therapy raises significant financial concerns. High costs of targeted cancer therapies, often exceeding $150 000 annually, contribute to financial toxicity, characterized by medical debt, income loss, and psychological stress, and place stress on health systems. This review analyzes the drug approval and pricing mechanisms in various countries and their impact on healthcare costs and patient access, focusing specifically on the impacts in neuro-oncology. The United States employs a market-driven approach resulting in higher drug prices, while most countries, such as the United Kingdom, Germany, France, Italy, Japan, South Africa, and Brazil, use negotiated pricing and health technology assessment to manage costs. The financial burden of expensive medications affects patient adherence and quality of life, with many cancer patients facing substantial out-of-pocket expenses and potential treatment abandonment, and many more unable to access these drugs altogether. Vorasidenib's introduction, while potentially improving patient outcomes, may exacerbate financial toxicity unless mitigated by patient access programs and cost-management strategies. As neuro-oncology treatment paradigms evolve, understanding the economic implications of new therapies is essential to ensure equitable access and optimize patient care.

Rural residents' willingness to utilize primary care and its influencing factors in the context of graded diagnosis and treatment: a study in Deqing, China.

Graded diagnosis and treatment is a key component in advancing healthcare system reforms and establishing a foundational healthcare framework. Primary care serves as the cornerstone of this system. Understanding the willingness to seek primary care and the factors influencing it can enhance primary care utilization and address the challenges of "difficult access to healthcare" and "high medical costs." This study, based on data from 415 rural residents in Deqing County, Zhejiang Province, analyzes their willingness to seek primary care and the factors influencing it using the Theory of Planned Behavior and structural equation modeling. The results of the study show the following: ① Attitude toward behavioral, subjective norm, and perceived behavior control significantly affect willingness to seek primary care, with attitude toward behavior having the greatest influence. ② Regarding attitude toward behavior, residents' evaluation of treatment costs in primary care, the medical environment, and trust in doctors significantly impact their willingness to seek primary care. ③ In terms of subjective norms, the level of support from others, as well as the recognition of graded diagnosis and treatment systems and family doctor contracting services, positively influence the willingness to use primary care. ④ For perceived behavioral control, residents' perception of personal and environmental factors affects their willingness to make a first visit to primary care facilities. The study recommends strengthening the awareness of the necessity of primary care among rural residents, improving the experience at the primary level, stimulating the desire for primary care, and increasing the frequency of primary care utilization.

Burden of Medical Costs Associated with Severe Maternal Morbidity in South Korea.

Adverse maternal health outcomes lead to health loss and unnecessary medical costs. However, few have explored how severe maternal morbidity (SMM) affects medical costs separately from blood transfusion. Therefore, the aim of this study was to evaluate the delivery-related costs of healthcare services in patients with and without SMM as well as blood transfusion. This retrospective cohort study used the National Health Insurance Service (NHIS) Delivery Cohort database in South Korea. We included all delivering mothers in South Korea from 2016 to 2021, except those with incomplete data, totaling 1,517,773 participants. The measured outcomes included delivery-related medical costs associated with SMM. A generalized estimating equation model with a log link, gamma distribution, and robust standard errors was used to estimate the mean delivery-related medical costs of SMM. SMM occurred in 2.2% of the cohort. The adjusted mean delivery-related medical costs were approximately 2.1- and 1.4-fold higher in cases with SMM without blood transfusion and only blood transfusion than in those without SMM, respectively ($2005, 95% CI: $1934-2078 and $1339, 95% CI: 1325-1354, respectively). The adjusted mean delivery-related medical costs were 1.5-fold higher in cases with SMM with blood transfusion than in those without SMM (SMM $1539, 95% CI: $1513-$1565). Medical costs associated with delivery-related SMM with or without blood transfusion were significantly higher than those of normal deliveries, with excess costs varying according to existing healthcare policies. Policymakers should consider supporting programs to prevent high medical costs by improving maternal health.

Effect of oral trehalose supplementation on inflammation and wound healing in patients with peri-trochanteric fractures: study protocol for a randomised clinical trial

IntroductionPeri-trochanteric fractures, common among the elderly with osteoporosis, pose significant morbidity and mortality risks. These fractures are increasing due to the ageing population, with Nordic countries seeing a high incidence....

Access to and Utilization of Endocrine Therapy Among Breast Cancer Survivors in Botswana.

Breast cancer (BC) is the most common female cancer worldwide, and the burden is increasing across sub-Saharan Africa. For women with hormone receptor-positive (HR+) cancers, endocrine therapy (ET) taken for 5-10 years can reduce the risk of recurrence by half. We explored experiences with ET and barriers to utilization among survivors in Botswana. We recruited women with nonmetastatic disease from a survivorship cohort who had undergone mastectomy within 1-5 years for semi-structured interviews to explore experiences with treatment. This thematic content analysis focused on ET, so the sample included women with HR+ cancer who should have received ET and HR- women who reported taking ET. We analyzed interviews with 19 women (mean age 54 years, 42% stage I/II, 58% stage III). Three key themes were identified: (1) limited provider counseling, (2) challenges refilling prescriptions at public pharmacies, and (3) high medication and transportation costs associated with private pharmacies. Subthemes included immunohistochemistry result communication, lack of knowledge, frequent public pharmacy stockouts, inconvenient prescription refill policies, and medication switching and discontinuation, especially among participants with low socioeconomic positions (SEPs). Women's persistence, SEP, and financial support facilitated refills. Although some experienced side effects, they were not a common reason for discontinuation. BC survivors in Botswana face multilevel barriers to accessing and adhering to ET. Provider and health system improvements are needed to effectively communicate ET importance and increase access to consistently available and affordable medication.

Efficacy of extracting and preventively intervening late-stage older adults who are at high risk for spending high medical costs by using the health check-up system in Japan: a pilot study.

In Japan, the seven diseases (femur fracture, cerebral infarction, chronic renal failure, heart failure, dementia, pneumonia, and chronic obstructive pulmonary disease) are the top causes of inpatient medical costs among the late-stage older adults aged 75 years and over. This pilot study was conducted with the following two objectives; (1) to examine the proportion of risks of onset and severity of seven diseases among the late-stage older adults, and (2) to examine the efficacy of interventions focusing on the prevention of unplanned hospitalization. Participants were 45,233 older adults aged 75 and over living in Kure City, Japan. In addition to the government-mandated health checkup items, the Intervention group underwent additional risk screening tests included questionnaires, physical examinations, blood tests, and educational guidance by nurses. The efficacy of the intervention was examined whether there were differences in the number of hospitalizations, the use of emergency and critical care, and the incidence of hemodialysis induction between the Intervention and control groups (Usual Health Checkup group and No Health Checkup group) for the 2 years. There were 485 participants in the Intervention group, 1,067 in the Usual Health Checkup group, and 43,712 in the No Health Checkup group. As the risks of seven diseases in the Intervention group, the largest proportion of deviations occurred for systolic blood pressure (63.3%), estimated salt intake (60.3%), and low-density lipoprotein cholesterol (51.5%). Estimated glomerular filtration rate deviated in 41.0%, N-terminal pro b-type natriuretic peptide in 37.9%. 7.5% scored <2 points on the Mini-Cog©, and 9.1% performed the Timed Up and Go test in >12 s. The incidence of hospitalization due to any of the seven diseases was significantly higher in the No Health Checkup group (p < 0.001). There were no differences among the three groups in the use of emergency and critical care or the introduction of hemodialysis. This study revealed that additional health checkup tests and intervention methods could be prevented hospitalization among the adults of 75 years and older. It is necessary to make health checkups and follow-ups more accessible those are already available within the existing health system in Japan.