Economic Impact of Self-Injected Biologics for Rheumatoid Arthritis in Japan: A Propensity Score-Matched Analysis From a Public Healthcare Payer Perspective.

Telemonitoring in complicated pregnancies involves cardiotocography (CTG), blood pressure, and symptom reporting. Understanding the use of in-hospital care during telemonitoring is essential for effective implementation of hybrid antenatal care models. To evaluate unplanned hospital visits and re-admissions during telemonitoring in complicated pregnancies using a real-world cohort. This single-center retrospective cohort study (2017-2023) included patients enrolled in telemonitoring for premature rupture of membranes (PPROM), preeclampsia (PE), fetal growth restriction (FGR), history of fetal demise, congenital anomalies, or recurrent reduced fetal movements. Patients conducted home-based CTG, blood pressure, and temperature monitoring, reviewed real time by obstetric professionals. Primary outcome was the use of in-hospital care categorized by number and reason for unplanned hospital visits and re-admissions. Secondary outcomes included perinatal and neonatal clinical outcomes. A total of 210 women were included in telemonitoring, due to PPROM (13.8%), PE (17.1%), FGR (28.1%), history of fetal demise (5.7%), recurrent reduced fetal movements (20.9%), congenital anomalies (6.7%), and other reasons (7.6%). Median gestational age at telemonitoring initiation was 33weeks (range 26-39), with a median duration of 11days (range 1-89). Unplanned hospital visits occurred in 76.2% (160/210), with 335 visits during 2789 monitoring days (12.0%), median of 1.6 visits per patient. Purpose of hospital visits included uninterpretable CTG (34.3%), symptoms of PE, PPROM, or hemorrhage (27.5%), non-reassuring CTG (13.4%), and reduced fetal movements (6.3%). Re-admissions occurred in 38.6% (81/210), most frequently in those with PPROM (51.7%) and PE (50.0%). Re-admission causes included non-reassuring CTG (21.3%), imminent labor (14.3%), severe hypertension (12.2%) antepartum hemorrhage (8.2%), reduced fetal movements (6.1%), maternal distress (5.1%), or other maternal symptoms (32.8%). Seven CTGs (0.25%) led to emergency cesarean sections within 24h. No maternal severe adverse events or intrauterine deaths occurred during telemonitoring. Five neonatal deaths (2.4%) occurred, none of them were attributable to telemonitoring care. Telemonitoring of complicated pregnancies resulted in 1-2 unplanned hospital visits per patient on average. These findings reflect expected clinical needs in complicated pregnancies. Re-admissions occurred in 38.6% of patients. No adverse events were attributable to telemonitoring. To further enable hospital at home care, these results provide valuable insights for policymakers and professionals regarding the implementation of telemonitoring in complicated pregnancies. Telemonitoring in complicated pregnancies led to an average of 1-2 unplanned visits per patient and 38.6% re-admissions, without related adverse events. These findings support provide valuable insight for policymakers and professionals regarding the implementation of telemonitoring in complicated pregnancies.

Millifluidic ion-selective optodes with integrated optical detection for colorimetric quantification of urinary calcium.

We explore the role of internal locus of control (LOC), migration status and gender, in healthcare utilization, using the Andersen Model. It addresses the knowledge gap in understanding how these factors influence healthcare access, especially in migrant populations. Utilization was assessed using the 2020 German Socioeconomic Panel with 26,028 adults (6,968 migrants). In this cross-sectional survey study, four outcomes were analyzed via regression models, including predisposing, enabling, and need factors. A migration background reduced the likelihood of doctor visits, while LOC increased it. Among migrants, LOC predicted even higher likelihood, especially in men, mitigating the negative impact of migration status. Migration background and LOC were not linked to hospital visits, and gender differences in doctor visits were found only in men. While individuals with a migration background had a lower chance of visiting doctors, internal control beliefs proved to be a significant resource for health behavior.

A computational phenotype for difficult-to-treat asthma with corticosteroid overuse using electronic health care records.

Early antiseizure medication tapering in 2-18-year-olds with single parenchymal neurocysticercosis based on risk assessment: A prospective intervention study.

Bereavement is a known risk factor for cardiovascular disease (CVD), but it remains unclear whether the COVID-19 pandemic-which disrupted health care and increased social isolation-altered this association. To compare the association between bereavement and incident CVD before and during the pandemic. This cohort study of Swedish national health registries included individuals aged 30 years or older in Sweden during the pre-COVID-19 (2018-2019) and COVID-19 (2020-2021) periods. Analyses were performed between September 2024 and August 2025. Bereavement exposure was defined as the loss of a partner, child, parent, or sibling. The first diagnosis of any CVD event, identified from an outpatient hospital visit or hospitalization via the Swedish Patient Register or death via the Swedish Cause of Death Register. Cox regression was used to estimate hazard ratios (HRs) of incident CVD after bereavement by study period, type of loss, and age. Analysis included a total of 5 365 829 study participants (51.4% female; median [IQR] age, 51.6 [40.4-64.6] years) during the pre-COVID-19 period and 5 522 898 study participants (51.4% female; median [IQR] age, 49.8 [38.2-62.8] years) during the COVID-19 period. Overall, 372 477 (6.94%) and 368 902 (6.68%) incident CVD cases were identified during the pre-COVID-19 and COVID-19 periods, respectively. Bereavement was associated with increased CVD risk regardless of period or type of loss. However, the risk increment was greater during the COVID-19 period compared with the pre-COVID-19 period for loss of a partner (HR, 1.46 [95% CI, 1.41-1.51] vs 1.30 [95% CI, 1.26-1.35]; P for difference < .001) and sibling (HR, 1.23 [95% CI, 1.20-1.27] vs 1.16 [95% CI, 1.13-1.19]; P for difference = .003). No period difference was noted for the loss of a child or parent. The risk increment after loss of a partner or parent increased with age, while the risk after loss of a child or sibling decreased with age. In this cohort study, bereavement was associated with increased CVD risk both before and during the COVID-19 pandemic; however, a stronger association for partner or sibling loss was noted during the pandemic. These findings suggest that bereavement may be a period of heightened cardiovascular vulnerability, underscoring the importance of targeted clinical monitoring and preventive care for bereaved individuals.

To improve dermatological care in underserved rural regions, the "Teledermatology in Styria" project launched on January 1st, 2020. General practitioners (GP) were digitally connected with dermatologists (DERM), supported by Styrian Health Fund, Styrian Medical Association, Austrian Health Insurance Fund Styria, Universities' Department of Dermatology, and e-derm-consult GesmbH. GPs submit clinical information and images (clinical, dermoscopic) of patient's skin conditions, via a "store-and-forward" service to DERM, who responded with diagnosis and treatment recommendations. The descriptive statistical analysis covered cases from five years without reference region and assessed patient and doctor acceptance through questionnaires. From 5,119 cases DERM changed GPs diagnosis in 51%, no diagnosis was provided by GPs in 23% and only in 25% DERM confirmed GPs diagnosis. While 19% of all cases required no therapy, most cases (61%) were managed by their GPs following teledermatological consultation. Referrals included 12% routine dermatological appointments, 3% urgent appointments, and 2% hospital visits. The case spectrum covered all dermato-venereological conditions, with only 34% neoplasms. Patient satisfaction exceeded 95%, based on 692 returned questionnaires. Only 17% of patients required additional dermatological examination after teledermatology. The months faster diagnosis and the high level of patient satisfaction highlight the benefits of teledermatological consultations.

Abstract Key summary points Aim For older patients at presumed high risk of short-term emergency department visits but without immediate hospital needs, we aim to describe a system that provides geriatrician telephone support to emergency medical dispatchers, offering a safe alternative to emergency department referral. Findings Providing geriatrician telephone support to emergency medical dispatchers could offer an alternative to referring certain older patients at presumed high risk of a short-term emergency department visit. Among older patients for whom an emergency department referral was not initially recommended, some experienced early unplanned hospital visits, highlighting the need to develop and strengthen reactive alternatives to emergency department referral. Message Collaboration between emergency medical dispatchers and on-phone geriatricians could provide a safe alternative to emergency department referrals for older patients at presumed high risk of short-term ED visits. Abstract Purpose To describe a system enabling Emergency Medical Dispatchers (EMD) to access direct geriatrician telephone support (SCAS: Senior Care Access System) with the purpose of providing alternatives to Emergency Department (ED) referral for older patients at presumed high risk of short-term ED visits. Methods This prospective study was conducted at the EMD of Toulouse University Hospital. EMD could contact the SCAS for patients aged 75 or older who were presumed to be at high risk of a short-term ED visit but did not require an immediate ED referral. The primary outcome was the alternative to ED referral decided by the SCAS, which included telephone advice, geriatric consultation, geriatric day hospital admission, admission to post-acute care and rehabilitation, or direct admission to an acute geriatric unit. Secondary outcomes were i) alternative follow-up destinations and ii) early unplanned hospital visits (ED visit or unplanned hospital admission within 7 days following the SCAS call). Results A total of 364 patients were included between September 1, 2023 and February 28, 2025. The mean age of the patients was 87.5 years (± 8.3), and 40.1% were male. The primary reason for the call was altered general health status (30.8%), followed by falls (17.9%). An alternative to ED referral was proposed for 287/364 patients (78.8%). Among the 117 patients for whom the SCAS decided no ED referral or admission to an acute geriatric unit, 32 (27.4%) patients experienced an early unplanned hospital visit within a median delay of 3 days. Conclusion Our study suggests that geriatrician telephone support for EMD could offer an alternative to ED referral for older patients with presumed high risk of short-term ED visit.

This study aimed to assess how paediatric cystic fibrosis (CF) patients attending an Australian tertiary paediatric hospital accepted and perceived the 'Captains on Call' (CoC) program, a positive distraction initiative by Starlight Children's Foundation Australia (Starlight). We invited caregivers of CF clinic attendees and CF patients aged eight and over to participate in an online survey, and healthcare professionals and Starlight team members involved in CoC to participate in an interview. Eighteen caregivers and ten children completed the survey, while three health professionals and four Starlight team members were interviewed. Findings indicate that CoC positively disrupts healthcare experiences for families, reduces anxiety and fear before and during hospital visits, averts negative rumination for caregivers and improves healthcare professionals' mood during visits. While participants shared their appreciation of CoC interactions being tailored to each child's interests, suggestions were made for better addressing adolescents' unique needs. Overall, CoC emerged as a highly valued program in the CF clinic at Women's and Children's Hospital, Adelaide, demonstrating potential to foster more positive healthcare experiences through play and positive distraction, mitigating the perceived negative impact of hospital visits for children with CF and their caregivers.

Introduction: Diabetes mellitus is the most common metabolic disease that has recently been proposed as a health priority worldwide. Objective: To assess the influence of food security, food choices, and nutritional status on glycemic control among adults living with Type 2 Diabetes. Methods: A cross-sectional study design was used to select adults from two health facilities during their scheduled hospital visit. Data collection was done from November 2022 to March 2023 using a questionnaire comprising sociodemographic characteristics, nutritional status, food security, and dietary diversity sections. Data was analyzed using SPSS version 27.0. Both bivariate and multivariate analyses were done to determine the factors associated with poor glycemic control. Results: The study included 299 respondents, and findings found that 77.9% of respondents had a poor fasting blood glucose level, while 22.1% had a good fasting blood glucose level. Respondents living in households with ≤4 family members were about two times more likely to have a poor fasting blood glucose compared to their counterparts living in households with more than 4 family members (aOR: 1.83, 95% CI: 1.02-3.28, p=0.042). However, food insecurity, poor dietary diversity, and high body mass index were found not to be significantly associated with poor fasting blood in the study area (p&gt;0.05). Conclusion: Most persons living with type II diabetes had poor glycemic control. Food security and dietary diversity were not found to influence the management of fasting blood glucose. However, small family size was the major determinant of the management of fasting blood glucose amongst adults.

Herpes zoster (HZ) represents a significant health and economic burden in Vietnam, driven by direct medical costs and influenced by patient's age, comorbidities, immunodeficiency, and HZ complications, including postherpetic neuralgia. This study was conducted to improve knowledge about the economic burden of HZ and associated costs in Vietnam. A retrospective cost-of-illness study was conducted using medical chart records of patients with HZ who sought medical care in July 2022-June 2023 at six specialized dermatologic hospitals in Vietnam. Total direct medical costs of HZ management were calculated per patient and per hospital visit, and analyzed according to age, health insurance or out-of-pocket payment, complications, comorbidities, and immune status. Costs were collected in Vietnamese dong in 2023 and converted to 2023 US dollars. Direct nonmedical and indirect costs were estimated based on published studies. The study included 1828 patients. The mean direct medical costs of HZ treatment were $114 per patient and $92 per hospital visit. Direct medical costs were influenced by older age, presence of complications and comorbidities, and immunodeficiency. Mean direct nonmedical costs were $18 per patient and $14 per visit, and indirect costs were estimated at $104 per patient and $84 per visit. Direct costs were generally higher for inpatients than outpatients. Indirect costs were largely similar for inpatients and outpatients. Out-of-pocket payments contributed more towards direct medical costs than health insurance payments. HZ and its complications impose a significant burden on patients and the private healthcare sector in Vietnam. Older age, comorbidities, immunodeficiency, and hospitalization were identified as key cost drivers in HZ management. The findings reflect the importance of introducing new management options to reduce the economic burden of HZ, and could support decision-making related to HZ prevention.

Abstract Rare Bone Disease Referral Centers (RBDCs) were established to improve the diagnosis and management of rare diseases. The objective of this retrospective observational study was to characterize real-life care pathways of patients with osteogenesis imperfecta (OI) in the Paris region. Patient data were extracted from the Assistance Publique-Hôpitaux de Paris (AP-HP) health data warehouse (Entrepôt de Données de Santé, EDS). Patients were identified using the ICD-10 code for OI (Q78.0) and keyword searches. Inclusion criteria were age ≥ 15 yr and at least one hospital visit between 01/01/2016 and 01/03/2021. After exclusion of unconfirmed diagnoses and patients younger than 15 yr, 472 patients with OI were included (mean age 39.5 ± 16.2 yr; 64.6% women). Of these patients, 78% (N = 368) were cared for in one of Paris RBDC, the majority in a single center (76% (N = 280)), while 104 patients (22%) were not seen within RBDCs in AP-HP data. The most frequent specialties involved were rheumatology (74.9%, N = 326), orthopedics (17.6%, N = 76), and otorhinolaryngology (12.9%, N = 56). The proportion of patients seen in rheumatology increased after the transition age of 25 yr (81.8% before vs 90% after, p = 0.04), whereas consultations in orthopedics and genetics decreased (29.5% vs 17.8%, p = 0.02%, and 22.7% vs 6.8%, p &amp;lt; 0.0001, respectively). Orthopedic surgery during follow-up was performed in 6.2% of patients followed in RBDCs and 8.6% of those not seen within RBDCs. Although 78% (N = 368) of patients with OI in the Paris region were followed within RBDCs, nearly one quarter were not (22%), suggesting persistent gaps in access to specialized care. These findings provide a real-life description of hospital-based care pathways for OI but do not allow assessment of the effectiveness of the referral center model.

Epilepsy is recognized to be a significant cause of premature mortality, socio-economic distress and poor quality of life in economically developed countries. Despite clear clinical guidelines, epilepsy care is marked by delayed diagnosis, fragmented management, high emergency admission rates, and pronounced health inequalities affecting rural populations, ethnic minority groups, and people with intellectual disabilities. Diagnostic pathways remain inefficient, with prolonged waits for electroencephalography (EEG), low sensitivity of routine investigations, and repeated inconclusive testing. Long-term management continues to depend on infrequent hospital visits and unreliable patient recall, contributing to suboptimal seizure control, avoidable morbidity, and preventable mortality. In the United Kingdom, epilepsy affects over 630 000 people, accounts for approximately £2 billion in annual healthcare costs and exemplifies these systemic failures. Current hospital-centric care models are failing to meet their complex, often lifelong, needs. In its recent 2025 "Fit for the Future" 10-year plan, the UK government mandates three fundamental shifts in healthcare: from hospital to community, analogue to digital, and sickness to prevention. Epilepsy diagnosis and care exemplify the potential for this comprehensive triumvirate transformation, with emerging technologies including point-of-care EEG systems, AI-powered diagnostics, wearable devices, and digital therapeutics offering unprecedented opportunities to deliver specialist-level care in community settings and reduce illness burden. However, successful implementation requires addressing digital exclusion risks for vulnerable populations. We propose that technology-enabled community epilepsy care can serve as a blueprint for the UK's National Health Service (NHS) transformation while delivering immediate benefits for patients, families, and healthcare systems. The convergence of clinical need, technological capability, and policy imperative creates a unique opportunity to move beyond incremental improvements to fundamental system redesign that ensures equitable access to high-quality epilepsy care across all communities. Such a model, if delivered, could be an exemplar for other chronic conditions both in the United Kingdom and globally. PLAIN LANGUAGE SUMMARY: Current epilepsy care in the United Kingdom often involves long waits and relies on infrequent hospital visits, which is not ideal for a lifelong condition. New technologies, such as wearable devices and AI-powered tools, offer a chance to change this. By moving care from hospitals into the community, we can provide faster diagnosis, continuous monitoring, and more personalised support. This will help improve the lives of the 630 000 people with epilepsy in the UK, ensuring they receive better, more accessible, and more equitable care.

Introduction: Sickle Cell Disease (SCD) remains a major health concern in Central India, particularly among tribal and underserved groups. Adolescents with SCD often experience a wide spectrum of physical, emotional, social, and academic challenges. Limited qualitative evidence captures adolescents lived narratives, which are essential for planning holistic interventions. Aim/Objective: To explore and describe the multifaceted lived experiences of adolescents (10-19 years) with SCD in central India. Methods: A descriptive phenomenological research design was utilized. Total eleven adolescents aged 10-19 years diagnosed with SCD were selected employing convenience sampling from a tertiary care hospital in Central India. In-depth semi-structured interviews were conducted ensuring privacy and confidentiality. Colaizzi's seven-step method was used for data analysis. Ethical approval and informed consent/assent were obtained prior to data collection. Results: Six major themes emerged including adolescents reported recurrent and unpredictable pain crisis leading to fatigue, reduced mobility, and frequent school absenteeism. These physical limitations disrupted daily functioning and restricted social participation. Emotionally, they experienced fear, frustration, and sadness, particularly during hospitalizations and academic loss, though many also expressed determination and hope for a better future. Social stigma, peer rejection, and concerns about future opportunities emerged as common struggles. However, strong familial support provided comfort. Health care experiences were mixed while participants valued compassionate care, they noted long waiting hours and limited adolescents-focused services. Medication routines and hospital visits were perceived as burdensome but necessary. Participants coped through rest, hydration, distraction, positive self-talk, and reliance on family and spiritual beliefs. Overall, adolescents demonstrated resilience despite interconnected physical, psychosocial, and healthcare challenges, emphasizing the need for age-appropriate psychosocial and educational support. Discussion/Conclusion: Adolescents with SCD endure substantial multidimensional burden that negatively affects their overall well-being and social identity. Findings highlight the need for adolescent-friendly pain management, mental health support, school-based awareness programs, and culturally tailored counseling interventions. Strengthening family support and community inclusiveness can improve resilience and quality of life in this underserved group.

Changing family structures, nuclearization and urbanization are reshaping the socialization and support networks of older adults. Smaller families and migration reduce direct care and engagement opportunities, impacting health and functional ability in the growing aging population. The study explored social networks and perceived social support for older adults in rural and urban Chengalpattu, Tamil Nadu, through 33 in-depth interviews (22 older adults and 11 caregivers). Using the Convoy Model of Social Relations, thematic analysis revealed that immediate close ties, such as spouses and children, provided essential emotional, physical and financial support to maintain functional ability, regardless of the individual's location. The middle circle of the extended family assisted with hospital visits, meals during emergencies and support when the immediate family was absent. The outer circle, comprising non family members and formal caregivers, offered physical, informational, logistical and occasional financial help. Parents of migrated children often receive financial aid and virtual emotional support, whereas extended family or neighbors provide physical assistance when caregivers are absent. In urban areas, work demands and technology use limit in-person family interaction, prompting elders to turn to WhatsApp, gaming apps and online health content to combat loneliness. They also perceived taking care of grandchildren as burdensome. In contrast, rural elders viewed time with children as "medicine" for emotional well-being. Caregivers reported feeling burdened by elder care, which increased the demand for caregiver support groups to reduce emotional strain.Strengthening intergenerational social relationships and promoting healthy, purposeful technology use are key strategies to support functional ability, emotional health and overall well-being in India's aging population.

Social vulnerability is associated with higher rate of emergency department visits and hospitalizations with vaccine preventable diseases among Colorado children.

This study aimed to determine the relationship between cyberchondria and digital literacy levels of parents of children aged 0-18 years and their attitudes toward traditional complementary medicine. This cross-sectional study was conducted. The dependent variable was the score on the Complementary, Alternative, and Conventional Medicine Attitude Scale (CACMAS). The independent variables were sociodemographic characteristics, Cyberchondria Severity Scale (CSS), and Digital Literacy Scale (DLS) scores. According to the linear regression analysis, CACMAS scores were significantly higher among those whose fathers were unemployed and whose mothers were primary school graduates (p < 0.05). Additionally, the CACMAS scores increased as the child's age decreased, DLS decreased, hospital visits occurred later in the day, and CSS increased (p < 0.05). Both a decrease in digital literacy and an increase in cyberchondria led to higher CAM attitudes.

Severe hypoglycemic events (SHEs) impose substantial clinical and economic burden on people with type 1 diabetes (pwT1D), yet real-world data describing this burden remain limited in the U.S. hospital setting. This study examined T1D-related complications and direct medical costs in pwT1D hospitalized or treated in the emergency department (ED) for hypoglycemia. IQVIA's PharMetrics Plus database was used to identify adults with T1D who experienced at least 1 hypoglycemic event requiring an inpatient hospitalization or ED visit from April 2016-April 2020. The SHE date was defined as the date of the first hospital-treated SHE: a claim with a hypoglycemia diagnosis and an inpatient hospitalization or ED visit. Patients were followed up until the end of continuous enrollment or end of the study period (April 30, 2022). Prevalence of T1D-related complications were descriptively summarized, and all-cause direct medical costs were calculated as per-patient-per-year (PPPY). The study was conducted during a period of early adoption of advanced diabetes technologies, such as hybrid closed-loop systems, and only included direct medical costs, potentially underestimating total costs. Among 4627 adults with T1D and hospital-treated SHEs, mean age was 41.4years, 57.3% were male, and 93.4% had commercial insurance. Common comorbidities included hypertension (24.6%), anxiety (9.5%), and depression (9.3%). Prevalence of retinopathy, neuropathy, chronic kidney disease (any stage), coronary artery disease, and peripheral vascular disease were 38.6%, 38.6%, 17.7%, 13.2%, and 11.4%, respectively. Total all-cause direct medical costs averaged $52,849 PPPY in 2022 USD ($59,719 in 2025 USD), driven primarily by inpatient hospitalization (mean-$22,981 in 2022 USD, $25,968 in 2025 USD). Among patients with a hospitalization, mean (SD) number of hospitalizations (PPPY) were 1.5 (3.6) and the average length of stay per patient (PPPY) was 5.0 (20.7) days. High T1D-related complication rates and elevated direct medical costs highlight the complexity of pwT1D who experienced hospital-treated SHEs.

Many Americans are in a coverage gap and unable to obtain affordable health insurance-particularly in non-Medicaid expanded states-which is associated with less preventative care, worse health outcomes, and a reliance on emergency care. To evaluate whether navigating uninsured patients to community-based primary care clinics that provide integrated care reduces preventable emergency visits and associated costs. This retrospective study evaluated the volume and costs of emergency department and inpatient hospitalization for patients accessing community-based integrated primary care (BCC) located near hospital centers as compared with those receiving usual care (non-BCC). The BCC group included 16,069 patients, and a propensity score-matched control group included 16,069 non-BCC patients. Patients less than 18 years old, with documented mental health issues, or whose EHR data were incomplete were excluded from the study. Emergency department (ED) and inpatient hospitalization (IP) visits and direct costs. Overall, the average per-person-year direct IP costs of BCC patients was 48% lower ( P <.001) and direct ED costs 43% lower ( P <.0001) than non-BCC patients. BCC patients had ∼44% fewer IP visits, and 29% fewer ED visits compared with non-BCC at 1-2 years of follow-up. BCC patients with diabetes related complications had 28% less IP costs and 27% less ED costs compared with non-BCC patients over 4 years ( P =.03, P =.01, respectively). This study supports the strategic navigation of uninsured patients from emergency departments and community settings to community-based primary care clinics offering integrated services, highlighting a promising population health approach.