Lost Work Days Research Articles

Occupational Injury Claims Related to Patient Lifting and Moving in a Safety-Oriented Emergency Medical Services Agency.

Background: Patient lifting injuries remain a significant hazard to Emergency Medical Services (EMS) providers despite preventative and mitigative strategies.Objective: To better characterize the nature of occupational injury involving patient and stretcher handling.Methods: A retrospective review of existing de-identified claims data was performed for the study period of January 1, 1999, through December 31, 2017. Independent reviewers analyzed each claim to determine if the claim was related to lifting or moving a patient. Any discrepancies between the two reviewers were analyzed by a third reviewer.Results: Eighty-two claims were identified as resulting from lifting or maneuvering patients. Fifty-two of these injuries (63.4%) resulted in at least one lost workday (LWD). Strains and sprains accounted for the majority of injuries with 63.4% (n=52) and 18.3% (n=15) respectively. Forty-two (51.2%) of these reports occurred when the provider was moving a patient, not involving a stretcher, while 37.8% (n=31) occurred due to lifting or maneuvering a stretcher with or without a patient. Conclusion: While the overall incidence of lifting injuries was less than reported in other occupational health data series, these injuries continue to occur, and cause significant operational and fiscal impact for EMS systems. This occurrence is despite advances in engineering controls and the organizational embracement of a culture of safety that focuses on risk identification and mitigation. Understanding the types of lifting/moving injuries, circumstances surrounding the injury, and contributing factors will help to maintain a heightened awareness of potential injuries associated with EMS work, and opportunities to reduce them.

Guideline No. 404: Initial Investigation and Management of Benign Ovarian Masses.

To provide recommendations for a systematic approach to the initial investigation and management of a benign ovarian mass and facilitate patient referral to a gynaecologic oncologist for management. Obstetricians, gynaecologists, family physicians, internists, nurse practitioners, radiologists, general surgeons, medical students, medical residents, fellows, and other health care providers. Women ≥18 years of age presenting for evaluation of an ovarian mass (including simple and unilocular cystic masses, endometriomas, dermoids, fibromas, and hemorrhagic cysts) who are not acutely symptomatic and without known genetic predisposition to ovarian cancer. This guideline aims to encourage conservative management and help reduce unnecessary surgery and long-term health complications, maintain fertility, and decrease operative costs and improve overall patient care and outcomes by providing criteria for referral of patients with ultrasound imaging findings suggestive of a malignant mass to a gynaecologic oncologist. Databases searched: Medline, Cochrane, and PubMed. Medical terms used: benign asymptomatic and symptomatic ovarian cysts, adnexal masses, oophorectomy, ultrasound diagnosis of cysts, simple ultrasound rules, surgical and medical therapies for cysts, screening for ovarian cancer, ovarian torsion, and menopause. Initial search was completed by 2017 and updated in 2018. Exclusion criteria were malignant ovarian cystic masses, endometriosis therapies, and other adnexal pathologies unrelated to the ovary. The content and recommendations were drafted and agreed upon by the authors. The Society of Obstetricians and Gynaecologists of Canada's Board of Directors approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation methodology framework. Implementation of the recommendations could reduce costs due to unnecessary surgeries and hospitalizations and reduce lost work days and the risk of loss of fertility, early menopause, and surgical complications. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

CONSENSO PIE DIABETICO ALAD - GLEPED

En Latinoamérica los estudios sobre prevalencia, incidencia, discapacidad, días laborales perdidos y costos por hospitalización a causa del pie diabético y sus complicaciones son escasos y diversos. En los estudios nacionales reportados por Argentina, Barbados, Brasil y Cuba, el rango de amputaciones del pie secundario a la Diabetes Mellitus (DM) oscila entre el 45 y el 75% de todas las causas de las amputaciones.Las úlceras y amputaciones constituyen un gran problema de salud que genera un alto costo para el paciente, sus familiares y los sistemas de salud pública que se ven obligados a destinar en subsidios y atención médica recursos importantes que pudieran emplearse para programas sociales, de investigación o desarrollo tecnológico.

Absenteeism and indirect costs during the year following the diagnosis of an operable breast cancer: A prospective multicentric cohort study

BackgroundDiseases consequence on individual work as much as consequences of being absent from work are matters of interest for decision makers. MethodsWe analyzed lengths of absenteeism and related indirect costs for patients with a paid activity in the year following the diagnosis of early stage breast cancer, in the prospective OPTISOINS01 cohort. Both human capital and friction costs approach were considered for the valuation of lost working days (LWD). For the analysis, the friction period was estimated from recent French data. The statistical analysis included simple and multiple linear regression to search for the determinants of absenteeism and indirect costs. Results93 % of the patients had at least one period of sick leave, with on average 2 period and 186 days of sick leave. 24 % of the patients had a part-time resumption after their sick leave periods, during 114 days on average (i.e. 41 LWD). Estimated indirect costs were 22,722.00 € and 7,724.00 € per patient, respectively for the human capital and the friction cost approach. In the multiple linear regression model, factors associated with absenteeism were: the invasive nature of the tumor (p = .043), a mastectomy (p = .038), a surgery revision (p = .002), a chemotherapy (p = .027), being a manager (p = .025) or a craftsman (p = .005). ConclusionBreast cancer lead to important lengths of absenteeism in the year following the diagnosis, but almost all patients were able to return to work. Using the friction cost or the human capital approach in the analysis led to an important gap in the results, highlighting the importance of considering both for such studies.

Productivity costs associated with metastatic breast cancer in younger, midlife, and older women.

The objective of the current study was to estimate productivity costs due to metastatic breast cancer (mBC) via productive time lost among survivors and potential life-years lost from premature mortality among 3 age groups: younger (aged 18-44 years), midlife (aged 45-64 years), and older (aged ≥65 years) women. The authors estimated the number of work and home productivity days missed due to mBC by age group using data from the 2000 to 2016 National Health Interview Survey. Years of potential life lost (YPLL) due to mBC were calculated for each age group using 2015 National Vital Statistics System data. The authors valued both sources of lost productivity time using the Current Population Survey and prior studies. The per-woman value of lost productive days (work and home) due to mBC ranged from $680 for older women to $5169 for younger women. In 2015, the value of lost work and home productivity days associated with mBC nationally was $67 million for younger women, $246 million for midlife women, and $66 million for older women. YPLL were highest among midlife women (403,786 life-years), followed by older women (248,522 life-years) and younger women (95,943 life-years). Midlife women were found to have the highest market value of YPLL ($4.1 billion), followed by younger women ($1.6 billion) and older women ($527 million). The results of the current study demonstrated that mBC generates a high economic burden through lost productivity, especially among midlife women.

Incidences and severity of wrist, hand, and finger injuries in the U.S. mining industry

BackgroundMining is known to be one of the most hazardous occupations of the modern workforce. Wrist, hand, and finger injuries are prevalent among miners. Several previous investigations have assessed factors and circumstances related to injuries in the mining industry. However, the literature lack a thorough analysis of wrist, hand, and finger injuries. PurposeThis study investigated the yearly trends of number and severity of wrist, hand, and finger injuries, and identified the factors that contribute to severe injuries. MethodsThe Mine Safety and Health Administration (MSHA) annual injury database from 2000 to 2017 was analyzed in this study. Wrist, hand, and finger injuries were examined with respect to accident type, nature of injury, lost workdays (LWD), activity, subunit, worker experience, source of injury, and injured fingers. Results18% of the total hand, wrist, and finger injuries were responsible for 84% of the total LWD. Median LWD for these injuries were greater than 30 days. While the total number of injuries declined by 56% over the assessed period, injury severity increased by 46%. Factors associated with the highest severity included caught in accidents, fracture and amputation injuries, maintenance, operating equipment, and roof bolter activities, underground subunits. Most of the severe injuries affected multiple fingers and index fingers. ConclusionsWhile the number of wrist, hand, and finger injuries in the mining industry declined from 2000 to 2017, injury severity increased. This trend in the injury data suggests that future investigations and solutions development efforts must focus on reducing injuries with high severity.

Average lost work productivity due to non-fatal injuries by type in the USA

ObjectiveTo estimate the average lost work productivity due to non-fatal injuries in the USA comprehensively by injury type.MethodsThe attributable average number and value of lost work days in the year...

PMH15 THE CHANGES OF DEPRESSION COSTS AFTER AN INTERNET-DELIVERED COGNITIVE BEHAVIOUR THERAPIES (IDCBT) PRELIMINARY DATA FROM RWD ECONOMIC MODEL

The aim was to assess the changes in costs and economic impact of depression-related absenteeism in private company after use of internet-delivered cognitive behavioural therapy (iCBT) and gather preliminary data from Real World Data (RWD) economic model. Depression cost review was conduct through local RWD ( Paraná State- LATAM ). Economic, observational studies of certificates managing delivered in the 12-month period (December 2017 to 2018), related to ICD 10 DEPRESSION were included for comparisons . They were divided into sectors A, B and C, by salary and certificates number. Mean costs before introduction of iCBT were directly compared with the mean costs after, if incorporate. The certificates were 2562 / 140.447. Sector A had prevalence of 80.8% (2072), with an average leave 3.6 days/ year. B Sector 113/2562 certificates, 4.4% , 6.16 days / year. C Sector, 93 certificates, 3.6%, 6.78 days leave /year / each employee. 1860 certificates, 72.5%, were 3 days or less. Long certificates , 10 days or more 14.5% of total, 368 certificates. Considering salary analyzed and absenteeism, the loss account 620.000,00 Brazilian reals (R$) in sector A, R$ 162.000,00 in sector B and 84.000,00 R$ in sector C. It means 866.000 R$ ( = 250.000 USD ) / YEAR of lost work days . From literature , comparisons from eight studies (N = 2402) demonstrated the effectiveness of IDCBT for depressive, medium effect (g = 0.54, 95% CI: 0.39-0.69). So applying these finding as model to our RWD , the results are in the worst scenario a saving of USD 97.500 and USD 172.500 in the best scenario. Following iCBT recommendation, our study showed that is clear the decrease depression-related costs comparing local RWD before and after implementation of new technology. Studies are need due to price threshold value and the value of patient health.

The association between janitor physical workload, mental workload, and stress: The SWEEP study.

Approximately 2.38 million janitors are employed in the U.S. While high physical workload may explain a lost-work days rate 2.7 times greater than other occupations, little is known about the association between janitors' physical workload, mental workload, and stress. The objective of this study was to assess the associations between physical (ergonomic) and mental workload exposures and stress outcomes among janitors. Questionnaire data, focused on ergonomic workload, mental workload and stress, were collected from Minnesota janitors for a one-year period. Physical workload was assessed with Borg Scales and Rapid Entire Body Assessments (REBA). Mental workload assessment utilized the NASA Task Load Index (TLX). Stress assessments utilized single-item ordinal stress scale (SISS) and Perceived Stress Scale-4 (PSS-4) measures. Descriptive and multivariable analyses, including bias adjustment, were conducted. Odds ratios (OR) and 95% confidence intervals (CI) for ergonomic workload (task frequency) effects on SISS were: REBA (1.18 OR, 1.02-1.37 CI); Borg (1.25 OR, 1.00-1.56 CI); combined REBA and Borg (1.10 OR, 1.01-1.20 CI). Mental workload was associated with higher PSS-4 levels (0.15 Mean Difference, 0.08-0.22 CI) and a 3% increased risk for each one-unit increase in the SISS scale (1.03 OR, 1.02-1.05 CI). This research demonstrated a moderate effect of physical and mental workloads on stress among janitors.

Physical therapy interventions for cervicogenic dizziness in a military-aged population: protocol for a systematic review

BackgroundTraumatic cervicogenic dizziness is dizziness that is temporally associated with neck pain and injury after other causes of dizziness have been excluded. It can lead to activity limitations and participation restrictions that may include lost duty or work days. The objective of this systematic review is to determine which interventions are most effective in decreasing dizziness or vertigo and neck pain in military-aged adults with traumatic cervicogenic dizziness.MethodsThe literature will be systematically searched using the following online databases: MEDLINE, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, CENTRAL, Cochrane Methodology Register), CINAHL, SCOPUS, Web of Science, and J-STAGE. The review will include randomized controlled trials (RCTs), including cluster RCTs and controlled (non-randomized) clinical trials or cluster trials, and observational studies (including prospective and retrospective comparative cohort and case–control or nested case–control studies) and determine the effectiveness of physical therapy interventions for the treatment of traumatic cervicogenic dizziness in military-aged adults. Assessment of methodological quality will be performed by two independent, blinded reviewers using the PEDro scale. The level of evidence will be determined using the GRADE scale. The primary outcome measures will be change in dizziness and neck pain and disability from baseline to the last available follow-up, measured using the Dizziness Handicap Inventory and Neck Disability Index. Other relevant outcome measures will include self-reported change in symptoms, time to return to duty or work, and quality of life.DiscussionThis systematic review will identify, evaluate, and integrate the evidence on the effectiveness of physical therapy interventions for cervicogenic dizziness in a military-aged population. We anticipate our findings may inform individual treatment and future research. Clinical recommendations generated from this systematic review may inform military physical therapy treatment of individuals with cervicogenic dizziness.Systematic review registrationIn accordance with the guidelines, our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 21 January 2020 (registration number CRD42020150853). In the event of protocol amendments, the date of each amendment will be accompanied by a description of the change and the rationale.

Work Loss in Relation to Pharmacological and Surgical Treatment for Crohn's Disease: A Population-Based Cohort Study.

PurposePatients with Crohn’s disease have increased work loss. We aimed to describe changes in work ability in relation to pharmacological and surgical treatments.Patients and MethodsWe linked data from the Swedish National Patient Register, The Swedish Quality Register for Inflammatory Bowel Disease SWIBREG, The Prescribed Drug Register, The Longitudinal Integrated Database for Health Insurance and Labour Market Studies, and the Social Insurance Database. We identified working-age (19–59 years) patients with incident Crohn’s disease 2006–2013 and population comparator subjects matched by sex, birth year, region, and education level. We assessed the number of lost workdays due to sick leave and disability pension before and after treatments.ResultsOf 3956 patients (median age 34 years, 51% women), 39% were treated with aminosalicylates, 52% with immunomodulators, 22% with TNF inhibitors, and 18% with intestinal surgery during a median follow-up of 5.3 years. Most patients had no work loss during the study period (median=0 days). For all treatments, the mean number of lost workdays increased during the months before treatment initiation, peaked during the first month of treatment and decreased thereafter, and was heavily influenced by sociodemographic factors and amount of work loss before first Crohn’s disease diagnosis. The mean increase in work loss days compared to pre-therapeutic level was ~3 days during the first month of treatment for all pharmacological therapies and 11 days for intestinal surgery. Three months after treatment initiation, 88% of patients treated surgically and 90–92% of patients treated pharmacologically had the same amount of work loss as before treatment start. Median time to return to work was 2 months for all treatments.ConclusionIn this regular clinical setting, patients treated surgically had more lost workdays than patients treated pharmacologically, but return to work was similar between all treatments.

The Economic Burden of Vertigo: Results From the Hospitalized and Outpatients.

Vertigo and dizziness are the common presenting concerns in emergency departments and outpatient clinics, accounts for approximately 15% to 20% of adults annually. We aimed to evaluate economic burden of vertigo on health-care system and work productivity in association between clinic characteristics of in- or outpatients. A total number of 2289 patients diagnosed with peripheric (noncentral) vertigo were evaluated retrospectively. The direct medical costs associated with vertigo classified as medication, consumable, imaging, and laboratory. In addition, the indirect costs were associated with lost working days. The overall economic impact of vertigo assessed via total expenditure for diagnosis and treatment. The mean duration of hospitalization was 5.6 ± 4.3 days and working day lost was 9.47 ± 3.90 days. The overall impact on work productivity of disease was 15.35 ± 6.11 days. The overall mean direct cost including all expenditure items associated with vertigo care was $250.25 ± $1479.62 per patient. The overall cost associated with vertigo was found to be statistically increased in the male, aged ≥65 years, widow or divorced, and hospitalized patients. Our findings clearly indicate that a vertigo-dizziness management program based on patients' risk factors may achieve to reduce hospitalizations and cost of hospital care as well.

Work-related injuries and illnesses and their association with hour of work: Analysis of the Oregon construction industry in the US using workers' compensation accepted disabling claims, 2007-2013.

ObjectivesThis study aimed to characterize injuries and illnesses among construction workers in the State of Oregon in the US and examine the association between injury frequency and severity with hour of work by using Workers’ Compensation (WC) accepted disabling claims data in the construction industry from 2007 to 2013.MethodsInjury frequency, rate, medical cost, and lost work days were analyzed by year, demographics, employment, injury nature, and temporal factors including hour of work. Multiple linear regression models were used to quantify adjusted associations between hour of work and medical cost and lost work days (indicating injury severity).ResultsThere were a total of 12 222 disabling claims in the Oregon construction industry. The average annual injury rate was 2.21 per 100 workers. Both the count and rate of disabling claims decreased during the study period. Male workers and young workers had higher injury rates, while medical cost and lost work days increased for older workers. Injuries occurring at night were more severe. The distribution of claims frequency by hour of work was bimodal, with peaks in the 4th and 8th hour. Compared with the first hour of work, the 5th and 13th hours corresponded to significantly more severe injuries and illnesses.ConclusionsThis study identified the burden and distribution of work‐related injuries and illnesses in the Oregon construction industry. Continued intervention efforts should target certain subpopulations (eg, young workers) and certain working time periods (eg, mid‐ and end‐shift) to protect construction workers’ safety and health.

Soldier-Centered Care: A Concept Analysis.

It is critical for the U.S. Army Medical Department to acknowledge the distinctive medical needs of soldiers and conceptualize soldier-centered care as a unique concept. In addition to the nationally recognized standards of patient-centered care, soldier-centered care includes provisions for the priorities of soldier health and wellness, injury prevention, illness and injury management, and the preservation of physical performance and medical readiness. The development of soldier-centered care as a distinctive concept may strengthen the evidence base for interventions that support improvements to soldier care and thus, enhance health outcomes specific to soldiers. The purpose of this article is to analyze the concept of soldier-centered care, clarify the meaning of soldier-centered care, and propose a theoretical definition. Rodgers' evolutionary concept analysis method was used to search and analyze the literature for related terms, attributes, antecedents, and consequences and to create a theoretical definition for soldier-centered care. The results of this concept analysis indicated that soldier-centered care is realized through the presence of nine attributes: operational alignment of care, provider and support staff therapeutic competence, management of transitions and care coordination, technology and accessibility, management of limited and lost work days, trust and expectation management, leadership support, continuity, and access to care. Soldier-centered care is focused on health and wellness promotion, disease and injury prevention, and early diagnosis and treatment of acute injuries in the primary care setting to facilitate timely injury recovery, reduce reinjury, and prevent long-term disabilities. The result of soldier-centered care is enhanced physical performance, medical readiness, and deployability for soldiers. Based on the literature analysis, the following theoretical definition of soldier-centered care is proposed: Soldier-centered care is individualized, comprehensive healthcare tailored to the soldier's unique medical needs delivered by a care team of competent primary care providers and support staff who prioritize trust and expectation management, operational alignment of care, leadership support, care coordination, and the management of limited and lost workdays through the use of evidence-based practice approaches that employ innovative information technology to balance access to care and continuity. The concept of soldier-centered care often emerges in discussions about optimal physical performance and medical readiness for soldiers. Although soldier-centered care and patient-centered care have similar conceptual underpinning, it is important to clarify the unique physical and medical requirements for soldiers that differentiate soldier-centered care from patient-centered care. Implementing the defining attributes of soldier-centered care in the U.S. Army primary care setting may improve the quality of care and health outcomes for soldiers. When defining performance metrics for primary care models of care, the U.S. Army Medical Department must consider assessing outcomes specific to the soldier population. Developing empirical indicators for the attributes of soldier-centered care will support meaningful testing of the concept.

Impacts of Manual Handling Training and Lifting Devices on Risks of Back Pain among Nurses: An Integrative Literature Review

Background: Musculoskeletal injuries, notably lower back injuries, are major occupational health problems among nurses. These injuries occur mainly due to incorrect use of body mechanics upon handling, lifting, and transfer of patients. It is the leading cause of occupational disability and is associated with increased healthcare costs. Reducing these injuries can lead to a significant reduction in healthcare costs.Purpose: This integrative literature review aims to examine the impacts of manual handling and lifting devices on the risk of back pain among hospital nurses.Methods: This study uses an integrative literature review design. Proquest, Science Direct, MEDLINE, and CINAHL were searched comprehensively. A Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow diagram was used to check the number of publications that were identified and screened for eligibility, and the number of publications excluded and reasons for exclusion. The Critical Appraisal Skills Programme (CASP) and the Centre for Evidence-Based Management critical appraisal checklist for a cross-sectional study (CEBM) were used to appraise the quality of selected articles.Results: Fifteen studies were found to highlight the importance of manual handling training programs and the consistent use of lifting devices in the prevention of low back pain. Ergonomics training, proper body mechanics and posture, use of body slings, workplace characteristics, availability of equipments and complexity of work, lost work days including nurses’ knowledge, experience, attitude and compliance are essential factors that impacts back pain.Conclusion: Manual handling training programs and the use of patient lifting equipment are effective in preventing lower back pain among nurses.

Modeling reservoir management for malaria control in Ethiopia

This study investigated how changes in reservoir water level affect mosquito abundance and malaria transmission in Ethiopia. Digital elevation models of three Ethiopian dams at lowland, midland and highland elevations were used to quantify water surface area and wetted shoreline at different reservoir water levels (70, 75, 80, 85, 90, 95 and 100% full capacity) to estimate surface area of potential mosquito breeding habitat. Reservoir water level drawdown rates of 10, 15 and 20 mm.day−1 were applied as scenarios to model larval abundance, entomological inoculation rate (EIR) and malaria prevalence at each dam. Malaria treatment cost and economic cost in terms of lost working days were calculated for each water level scenario and dam. At the lowland dam, increased larval abundances were associated with increasing reservoir water level and wetted shoreline area. In contrast, both larval abundances and area of wetted shoreline declined with increasing reservoir water level at the midland and highland dams. Estimated EIR, malaria prevalence, malaria treatment cost and economic cost generally decreased when the water level drawdown rate increased from 10 to 15 and 20 mm.day−1 irrespective of reservoir water level. Given the expansion of dam construction in sub-Saharan Africa, incorporating malaria control measures such as manipulating drawdown rates into reservoir management has the potential to reduce the malaria burden and health care costs in communities near reservoirs.

Implementation of Early Intervention Protocol in Australia for 'High Risk' Injured Workers is Associated with Fewer Lost Work Days Over 2Years Than Usual (Stepped) Care.

Purpose To evaluate whether a protocol for early intervention addressing the psychosocial risk factors for delayed return to work in workers with soft tissue injuries would achieve better long-term outcomes than usual (stepped) care. Methods The study used a controlled, non-randomised prospective design to compare two case management approaches. For the intervention condition, workers screened within 1-3weeks of injury as being at high risk of delayed returned to work by the Örebro Musculoskeletal Pain Screening Questionnaire-short version (ÖMPSQ-SF) were offered psychological assessment and a comprehensive protocol to address the identified obstacles for return to work. Similarly identified injured workers in the control condition were managed under usual (stepped) care arrangements. Results At 2-year follow-up, the mean lost work days for the Intervention group was less than half that of the usual care group, their claim costs were 30% lower, as was the growth trajectory of their costs after 11months. Conclusions The findings supported the hypothesis that brief psychological risk factor screening, combined with a protocol for active collaboration between key stakeholders to address identified psychological and workplace factors for delayed return to work, can achieve better return on investment than usual (stepped) care.

Socioeconomic burden of severe fever with thrombocytopenia syndrome in endemic areas of Anhui Province, eastern China

Understanding the socioeconomic burden of severe fever with thrombocytopenia syndrome (SFTS) is important for making decisions on health resources allocation. This study aimed to assess the economic burden of patients with this syndrome in endemic areas of the Anhui Province in 2018. A total of 114 patients were recruited, and the median age was 63.5years, 62 (54.4%) were female, 97 (85.1%) were farmers, 108 (94.7%) were survival patients, and 71 (62.3%) had a family monthly income less than $453.3. The median times of hospital visits and hospitalizations of patients were three times, and the median lost work days of these patients, caregivers and visitors were 14.5days, 14.5days and 7.5days, respectively. The median direct costs of the patient were $3,761.6, and the median indirect costs were $508.3. Taking direct and indirect costs into consideration, the median total economic costs of patients were $4,323.9, and the total annual cost of 2018 was $1,396,913.6. Although 113 (99.1%) patients had medical insurance, only 25.8% of costs were covered by reimbursement, and the total cost paid for by the patients and their families was $1,041,073.6 in 2018. Our findings revealed that the patients and their families had a significant economic burden, and preventive measures should be strengthened in endemic areas. The findings also provided baseline data for assessing the cost-effectiveness of the vaccines or anti-viral drugs in the near future in China.

Understanding the Brain in Chronic Pain

Chronic pain conditions cause among the highest levels of disability and lost work days of any class of disorders. The efficacy of current treatments has been disappointing

Optimal vaccine allocation during the mumps outbreak in two SIR centres

The aim of this work is to investigate the optimal vaccine sharing between two susceptible, infected, removed (SIR) centres in the presence of migration fluxes of susceptibles and infected individuals during the mumps outbreak. Optimality of the vaccine allocation means the minimization of the total number of lost working days during the whole period of epidemic outbreak $[0,t_f]$, which can be described by the functional $Q=\int _0^{t_f}I(t)\,{\textrm{d}}t$, where $I(t)$ stands for the number of infectives at time $t$. We explain the behaviour of the optimal allocation, which depends on the model parameters and the amount of vaccine available $V$.