Medical Consumption Research Articles

Socio-demographic characteristics and their relation to medical service consumption among elderly in Israel during the COVID-19 lockdown in 2020 as compared to the corresponding period in 2019.

The COVID-19 pandemic has led to the isolation of the population in Israel, including the elderly. The present study aimed to compare the consumption of medical services among adults over the age of 65 in Israel at the time of the first COVID-19 lockdown relative to the corresponding period the year before. We conducted a retrospective longitudinal observational quantitative research based on the Natali Healthcare Solutions Israel database of subscribers. Company subscribers over the age of 65 (N = 103,955) were included in the sample (64.5% women) in two time periods, before the COVID-19 outbreak-P1, in 2019, and during the first COVID-19 lockdown- P2 in 2020. Logistic regression was applied to examine service consumption for study variables. The average number of referrals to services was lower during the COVID-19 lockdown period (M = 0.3658, SD = 0.781) compared to the corresponding period in the previous year (M = 0.5402, SD = 0.935). The average number of ambulance orders, doctor home visits and service refusals were higher when compared to the same period in the previous year. During both time periods, women (P1- M = 0.5631, SD = 0.951; P2- M = 0.3846, SD = 0.800) required significantly more (p < .000) services than men (P1- M = 0.5114, SD = 0.910; P2- M = 0.3417, SD = 0.753). Older, widowed people, living in non-Jewish/mixed localities, or in average or below average socioeconomic status localities required relatively more services to those with opposite socio-demographic traits (p < .000). In a large sample of elderly in Israel, findings indicate a decrease in referrals to medical care during the first COVID-19 lockdown period, yet an increase in ambulance orders, doctor visits and service refusals. Socio-demographic characteristics showed a similar effect in both time periods. The period of the first COVID-19 lockdown was characterized by a higher incidence of medical service refusals as compared to the equivalent period in the previous year.

Expectation-based consumer purchase decisions: behavioral modeling and observations.

The online version contains supplementary material available at 10.1007/s11002-022-09650-7.

Disease burden in primary sclerosing cholangitis in the Netherlands: A long-term follow-up study.

Primary sclerosing cholangitis (PSC) is a progressive, cholestatic liver disease which greatly impacts the lives of individuals. Burden of disease due to shortened life expectancy and impaired quality of life is ill-described. The aim of this study was to assess long-term disease burden in a large population-based registry with regard to survival, clinical course, quality adjusted life years (QALYs), medical consumption and work productivity loss. All PSC patients living in a geographically defined area covering ~50% of the Netherlands were included, together with patients from the three liver transplant centres. Survival was estimated by competing risk analysis. Proportional shortfall of QALYs during disease course was measured relative to a matched reference cohort using validated questionnaires. Work productivity loss and medical consumption were evaluated over time. A total of 1208 patients were included with a median follow-up of 11.2year. Median liver transplant-free survival was 21.0 years. Proportional shortfall of QALYs increased to 48% >25 years after diagnosis. Patients had on average 12.4 hospital contact days among which 3.17 admission days per year, annual medical costs were €12 169 and mean work productivity loss was 25%. Our data quantify for the first time disease burden in terms of QALYs lost, clinical events, medical consumption, costs as well as work productivity loss, and show that all these are substantial and increase over time.

How sustainable are the biodegradable medical gowns via environmental and social life cycle assessment?

The growing disposable medical gown consumption due to the COVID-19 pandemic has driven tons of waste to landfills and posed plastic pollution. Investigating the pros and cons of biodegradable gowns over conventional counterparts can guide disposable medical gowns to be environmentally and socially sustainable. This work presents environmental and social life cycle assessments (E− and S-LCA) of biodegradable gowns to compare their environmental and social performances with conventional ones. The E-LCA evaluates the full-spectrum environmental impacts from gown production to end-of-life waste management processes, while the S-LCA assesses their associated influence on economic growth, employment, and worker welfare. The social impacts are evaluated based on the economic input-output analysis results of the economic sectors or gown life cycle stages involved in the gown value chain. Results show that biodegradable gown production poses 10.76% higher ecotoxicity than conventional alternatives contributed by pro-oxidant manufacturing. Integrating the landfill gas (LFG) capture and utilization processes into biodegradable gown waste treatment can reduce 48.81% of life cycle land use and over 5.67% of total greenhouse gas emissions. However, integrating this process in sanitary landfills to treat disinfected gown wastes can increase technical complexity, which enhances 70% of safety risks and 40% frequency of forced labor. Industrial composting biodegradable gowns can reduce over 20.5% of particulate matter formation versus sanitary landfills. Overall, fossil-based gowns possess full-spectrum environmental and social advantages over biodegradable counterparts treated by industrial composting and sanitary landfills. If improving the efficiencies of LFG capture by 85%, biogenic methane oxidation by 43%, and heat generation by 85%, biodegradable gowns can outperform conventional counterparts in reducing GHG emissions and fossil fuel use.

The landscape of medical care consumption in Israel: a nationwide population cross-sectional study

BackgroundThe Ecology of medical care was first published in 1961. The graphical square model showed that 75% of the population in the US and England experience a feeling of illness during a given month, 25% seek medical help and only one percent are hospitalized. In 2001, Green and colleagues found the same findings despite the many changes that occurred over the past decades. The frequency of illness, the desire for assistance and the frequency of seeking and getting medical assistance may differ in different populations due to cultural, economic, social, demographic background and local Health policy. This work describes the ecology of medical care consumption in Israel for the first time and examines the socio-demographic effects on consumption.MethodsThis is a Nationwide cross-sectional study. A telephone survey was conducted among a representative sample of the adult population (> 15 years) in Israel. Subjective morbidity rate in the preceding month, the rate of those considering medical assistance and those who got assistance were calculated. Correlation between socio-demographic variables and patterns of morbidity and medical care consumption was examined using a t-test and chi square for continuous quantitative and categorical variables. Logistic regression was used for multivariate analysis.ResultsA total of 1862 people participated; 49.5% reported having symptoms in the previous month, 45% considered seeking medical advice, 35.2% sought out medical assistance and only 1.5% were hospitalized. The vast majority chose to contact their family physician (58%) and the primary care setting provided their needs in 80% of the cases; Subjective morbidity and medical care consumption differed significantly between Israeli Jews and Arabs. Gaps in the availability of medical services were observed as residents of the periphery forewent medical services significantly more than others (OR = 1.42, p = 0.026).ConclusionsSubjective morbidity is less common in Israel than in other countries, but paradoxically consumption of medical services is higher. An Israeli who feels ill will usually consider receiving assistance and will indeed receive assistance in most cases. However, a greater tendency to forego medical services in the periphery indicates barriers and inequality in the provision of health services. Different cultural perceptions, lack of knowledge and low accessibility to medical services in the periphery probably contribute to the contrast shown between low consumption of medical services and high prevalence of chronic illness in Arab society. The prevailing preference for family medicine and its ability to deal with most requests for assistance suggest that strengthening family medicine in the periphery may reduce those barriers and inequalities.

Integrative Medicine and Holistic Care for the Post-pandemic Era

&lt;p&gt;臺灣在高齡化的情況下，多重疾病、衰弱與失能變得普遍，多重用藥與高醫療耗用的問題隨之浮現。照顧高齡衰弱病人，應重視健康促進與功能維持，將目標由治癒轉向照顧，因此需要跨領域團隊合作進行全人照護，並將照護場域由醫療機構延伸至社區居家。這樣的照護就是整合醫學的核心理念，根據本人意願，以價值為導向，提供全人、全程、全家、全團隊、全社區的五全照護模式。 在這背景下，各國的醫療體系開始面臨重整，包括減少治療疾病的急性病床、擴增以功能回復為目標的急性後期或是回復期病床、也提升在宅醫療的量能。疫情導致的就醫障礙，更使遠距與居家醫療的趨勢獲得普遍重視。後疫情時代的醫院整合醫學照護模式，應有專責病房來照顧多重疾病、高醫療耗用、身心失能的病人，並強化社區連結、建立在宅醫療團隊、提升遠距醫療能力，以提供病人從醫院到社區的全程健康照護服務。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;In Taiwan, the multimorbidity, frailty, and disability associated with population aging have aggravated the problem of polypharmacy and resulted in high medical resource consumption. The care for patients who are frail and in an advanced age must emphasize health promotion and function maintenance, focusing on the provision of care rather than the curing of a disease. This requires an interdisciplinary team capable of extending the holistic care provided in medical institutions to patients&amp;rsquo; homes. This is a type of care that embodies the core concepts of integrative medicine, namely a value-oriented health care that involves the patient, the medical treatment, the patient&amp;rsquo;s family, the medical team, and the community based on the patient&amp;rsquo;s own free will.To meet this requirement, medical systems worldwide are in the process of reorganization, and the measures taken include reducing the number of acute care beds, increasing the number of beds for post-acute and rehabilitative care, and enhancing the capacity for home health care. The barriers to medical access, which are induced by the COVID-19 pandemic, have also turned global attention to telemedicine and home health care. To provide patients with a holistic care that extends from hospital to community, post-pandemic medical institutions must apply integrative medicine; establish dedicated wards for patients with polypharmacy, high medical resource consumption, and physical and mental impairment; strength their ties with local communities; create medical teams proficient in home health care; and improve their abilities in telemedicine.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Seasonal influenza, its complications and related healthcare resource utilization among people 60 years and older: A descriptive retrospective study in Japan

Evidence suggests that older people aged ≥65 years and those aged 60–64 years with chronic medical conditions are at higher risk of developing severe complications due to influenza virus infection when compared with young, healthy adults. Although seasonal influenza is monitored through a nationwide passive surveillance in Japan, influenza related outcomes and medical resource consumption have not been fully documented. This retrospective database study aimed to describe the epidemiological and clinical characteristics of medically attended influenza cases aged ≥60 years and the associated medical resource consumption in Japan. We used clinically diagnosed influenza (CDI) based on the international classification of disease codes, and laboratory-confirmed influenza (LCI) based on influenza test results, to identify the patient population during a total of nine seasons (2010/2011 to 2018/2019). A total of 372,356 CDI and 31,122 LCI cases were identified from 77 medical institutions. The highest numbers of medically-attended influenza episodes were in patients aged 65–74 years and 75–84 years. On average, across seasons, 5.9% of all-cause hospitalizations were attributable to CDI and 0.4% were LCI. Influenza viruses type A and B co-circulated annually in varying degree of intensity and were associated with similar level of complications, including cardiovascular-related. Oxygen therapy increased with age; by contrast, mechanical ventilation, dialysis, blood transfusion, and intensive care unit admission were higher in the younger groups. In-hospital mortality for inpatients aged ≥ 85 years with CDI and LCI were 18.6% and 15.5%, respectively. Considering the burden associated with medically-attended influenza in this population, influenza prevention, laboratory confirmation and clinical management should be emphasized by general practicians and specialists like cardiologists to protect this aging population.

Development of a Reliable ic-ELISA with a Robust Antimatrix Interference Capability Based on QuEChERS Technology for the Rapid Detection of Zearalenone in Edible and Medical Coix Seeds and Subsequent Risk Assessments.

Indirect competitive enzyme-linked immunosorbent assay (ic-ELISA) is an ideal immunoassay method for large-scale screenings to detect mycotoxin contaminants. However, the matrix effect of complicated samples has always been challenging when performing immunoassays, as it leads to false-positive or negative results. In this study, convenient QuEChERS technology combined with optimizing the dilution solvent was ingeniously used to eliminate interference from the sample matrix to greatly improve the detection accuracy, and reliable ic-ELISAs for the two official tolerance levels of 60 and 500 μg/kg were developed to screen zearalenone (ZEN) in edible and medical coix seeds without any further correction. Then, the 122 batches of coix seeds were determined, and the positive rate was up to 97.54%. The contaminated distribution was further analyzed, and risk assessment was subsequently performed for its edible and medical purposes. The findings indicated that consumption of coix seeds with higher ZEN contamination levels may cause adverse health effects for both medical and edible consumption in the adult population; even under the condition of average contamination level, ZEN from coix seeds was the more prominent contributor to the total risk compared to other sources when used as food; thus, effective prevention and control should be an essential topic in the future.

Impact of triage by a rheumatologist on appropriateness of referrals from primary to secondary care: a cluster randomized trial

Objective The quality of referrals is often criticized, and the effectiveness of improvement efforts remains uncertain. We assessed the impact of a rheumatologist triaging patients in primary care on the appropriateness of referrals to secondary care, healthcare utilization, and patient experience and outcomes. Method A cluster randomized controlled trial was conducted with patients experiencing musculoskeletal complaints. Intervention practices deployed an experienced rheumatologist triaging patients through in-person review. Usual care was performed in control practices, where practitioners referred patients based on their own judgement. The primary outcome was the proportion of inflammatory rheumatic diseases (IRDs) diagnosed by rheumatologists in referred patients. Healthcare utilization (iMTA Medical Consumption Questionnaire), quality of life (EuroQol 5 Dimensions), and experience of care (Consumer Quality Index) were determined after 3 months of follow-up. Data were analysed according to the intention-to-treat principle. Results In total, 544 participants were included [mean age 51.4 (range 18–87) years; 24% were men]. Of all referred patients, 51% had an IRD in the intervention group versus 21% in the control group (p = 0.035). After 3 months of follow-up, patients from the triage intervention showed lower healthcare utilization (p = 0.006) and higher quality of life (p = 0.011), without a decline in experienced quality of care (p = 0.712), compared to controls. Conclusion Triage by a rheumatologist in primary care provides appropriate care and adequate experience of care, leading to a higher quality of life. Long-term evidence is needed to assess the value on cost-effectiveness before implementing this strategy nationwide.

Non-Biological and Biological Risk Indicators for Tooth Wear Outcomes in Adults

This study was undertaken to estimate the prevalence and severity of tooth wear (TW), as well as to assess non-biological and biological risk indicators for TW outcomes in adults. A cross-sectional study, adhering to the reporting STROBE guidelines, was conducted and had a convenience sample of adults ≥18 years of age who had at least one bilateral posterior molar contact. A total of 570 participants, seeking consultation at the University Hospital in Brussels, Belgium, were allocated to three age groups: 18–34 years (n = 232), 35–54 years (n = 256), and ≥55 years old (n = 79). Participants answered a self-applied questionnaire regarding sociodemographics, oral hygiene, and lifestyle behavior. The questionnaire was tested-retested (intraclass correlation coefficient = 0.71). Inter-examiner reliability for clinical examinations was k = 0.76–0.80. The prevalence of TW was 75% (95% CI: 71.7–78.9). Out of these patients, 42% (95% CI: 38.0–46.3) had as the primary etiological factor the process of dental erosion, while 22% (95% CI: 18.9–25.9) and 11% (95% CI: 8.6–13.9) had the processes of dental attrition and dental abrasion, respectively. The severity of TW according to BEWE highest score was mild in 31%, moderate in 28%, and severe in 17% of participants. The hierarchical logistic regression model for the association between risk indicators and TW irrespective of the etiology was significant for age (>35–54 years: OR = 2.35 and ≥55 years: OR = 3.89; p < 0.001), gender (>male: OR = 2.03; p < 0.001), toothpaste (>sensitive teeth: OR = 2.34; p = 0.005), occlusal splint (>yes: OR = 1.62; p = 0.03), and acidic beverages (≥once per day: OR = 1.62; p = 0.044). Consumption of acidic beverages was not associated with TW having as the primary etiological factor the process of dental attrition or dental abrasion, while it was significantly associated with the process of dental erosion (>once per week: OR = 1.69; p = 0.043 and ≥once per day: OR = 1.73; p = 0.016). Medical conditions were equally associated with the latter (OR = 3.11; p < 0.001). These findings could contribute to improving the effectiveness and sustainability of awareness in contemporary adult populations. In conclusion, the prevalence and severity of TW in adults were substantial. Medical conditions and consumption of acidic beverages were risk indicators for TW having as the primary etiological factor the process of dental erosion, although associations were moderate and weak, respectively.

A personalised intervention programme aimed at improving adherence to oral antidiabetic and/or antihypertensive medication in people with type 2 diabetes mellitus, the INTENSE study: study protocol for a randomised controlled trial

BackgroundMedication non-adherence is a prevalent health problem in people with type 2 diabetes mellitus (T2DM). Interventions have previously been developed to improve medication adherence, but inconsistent outcomes have been reported. A potential explanation for this inconsistency is a ‘one size fits all’ approach, with interventions not tailored to the needs and preferences of individuals. Therefore, the aim of this study is to evaluate the effectiveness of a personalised intervention programme aimed at improving adherence to oral antidiabetic and/or antihypertensive medication in people with T2DM.MethodsA parallel-group randomised controlled trial will be conducted in 40–50 community pharmacies in the Netherlands and the United Kingdom (UK). A total of 300 participants will be included and followed up for a period of 6 months. Participants will be people with T2DM identified as non-adherent to oral antidiabetic and/or antihypertensive medication, aged 35–75 years and mobile phone users. The intervention group will receive a personalised intervention programme that is based on one or more of the participants’ pre-defined non-adherence profile(s), namely (I) Knowledge and perceptions, (II) Practical problems, (III) Side effects and (IV) Negative mood and beliefs. The intervention comprises of one or more supporting modules, namely (I) Brief messaging, (II) Clinical medication review, (III) Medication schedule, (IV) Reminding messaging, (V) Medication dispensing systems, (VI) Smart messaging, (VII) Referral to general practitioner and (VIII) Unguided web-based Self Help Application for low mood. The control group will receive usual care including access to a publicly available informative diabetes website. The primary study outcome is medication adherence measured with a telephone pill count. Secondary outcomes are systolic blood pressure, HbA1c level, self-reported medication adherence, attitude and beliefs toward medication, satisfaction with diabetes treatment, health status and medical consumption and productivity cost. In addition, a process evaluation will be undertaken to establish the fidelity, reach and the extent to which intervention delivery is normalised in the daily practice of community pharmacy teams.DiscussionThe study can lead to a personalised intervention programme that improves medication adherence in people with T2DM that are non-adherent to oral antidiabetic and/or antihypertensive medication.Trial registrationDutch Trial Register, Trial NL8747, registered 02 July, 2020; ISRCTN Registry, ISRCTN36009809, registered 05 February, 2020.

Effects of Video-Based Patient Education and Consultation on Unplanned Health Care Utilization and Early Recovery After Coronary Artery Bypass Surgery (IMPROV-ED): Randomized Controlled Trial.

BackgroundHealth care utilization after coronary artery bypass graft (CABG) surgery is high and is partly of an unplanned nature. eHealth applications have been proposed to reduce care consumption, which involve and assist patients in their recovery. In this way, health care expenses could be reduced and quality of care could be improved.ObjectiveThe aim of this study was to evaluate if an eHealth program can reduce unplanned health care utilization and improve mental and physical health in the first 6 weeks after CABG surgery.MethodsA single-blind randomized controlled trial was performed, in which patients scheduled for nonacute CABG surgery were included from a single center in the Netherlands between February 2020 and October 2021. Participants in the intervention group had, alongside standard care, access to an eHealth program consisting of online education videos and video consultations developed in conjunction with the Dutch Heart Foundation. The control group received standard care. The primary outcome was the volume and costs of a composite of unplanned health care utilization, including emergency department visits, outpatient clinic visits, rehospitalization, patient-initiated telephone consultations, and visits to a general practitioner, measured using the Medical Technology Assessment Medical Consumption Questionnaire. Patient-reported anxiety and recovery were also assessed. Intention-to-treat and “users-only” analyses were used.ResultsDuring the study period, 280 patients were enrolled and randomly allocated at a 1:1 ratio to the intervention or control group. The intention-to-treat analysis consisted of 136 and 135 patients in the intervention and control group, respectively. At 6 weeks, the primary endpoint had occurred in 43 of 136 (31.6%) patients in the intervention group and in 61 of 135 (45.2%) patients in the control group (hazard ratio 0.56, 95% CI 0.34-0.92). Recovery was faster in the intervention group, whereas anxiety was similar between study groups. “Users-only” analysis yielded similar results.ConclusionsAn eHealth strategy comprising educational videos and video consultations can reduce unplanned health care utilization and can aid in faster patient-reported recovery in patients following CABG surgery.Trial RegistrationNetherlands Trial Registry NL8510; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8510International Registered Report Identifier (IRRID)RR2-10.1007/s12471-020-01508-9

Future medical and non-medical costs and their impact on the cost-effectiveness of life-prolonging interventions: a comparison of five European countries

When healthcare interventions prolong life, people consume medical and non-medical goods during the years of life they gain. It has been argued that the costs for medical consumption should be included in cost-effectiveness analyses from both a healthcare and societal perspective, and the costs for non-medical consumption should additionally be included when a societal perspective is applied. Standardized estimates of these so-called future costs are available in only a few countries and the impact of inclusion of these costs is likely to differ between countries. In this paper we present and compare future costs for five European countries and estimate the impact of including these costs on the cost-effectiveness of life-prolonging interventions. As countries differ in the availability of data, we illustrate how both individual- and aggregate-level data sources can be used to construct standardized estimates of future costs. Results show a large variation in costs between countries. The medical costs for the Netherlands, Germany, and the United Kingdom are large compared to Spain and Greece. Non-medical costs are higher in Germany, Spain, and the United Kingdom than in Greece. The impact of including future costs on the ICER similarly varied between countries, ranging from €1000 to €35,000 per QALY gained. The variation between countries in impact on the ICER is largest when considering medical costs and indicate differences in both structure and level of healthcare financing in these countries. Case study analyses were performed in which we highlight the large impact of including future costs on ICER relative to willingness-to-pay thresholds.

The Effects of Social Network and Institutional Embeddedness on Household Consumption: Evidence from China Household Finance Survey

Consumer behavior is embedded in a certain social structure and social networks, and the scale and density of household social networks will be likely to affect consumption expenditure. To explore the impact of social networks and institutional embeddedness on household consumption, this study constructs a model of consumption influencing factors, and devises an empirical study using the data of China Household Finance Survey (CHFS). The results show some innovation. (1) The impact of household social networks on total household consumption is significant. A 1% increase in social networks spending boosts household consumption spending by 0.364%. (2) The institutional embeddedness will affect household consumption. Every 1% increase of social security account balance (the proxy variable of institutional embeddedness) can boost household consumption by 0.196%. This proves that the social insurance institution can enhance consumer confidence and promote current consumption growth. (3) The results of the robustness test confirmed that even after replacing the dependent variable with “the proportion of developmental consumption in total household consumption,” the influence of social networks and institutional embeddedness on consumption is still significant. Using the variable “communication expenses” instead of “gift income and expenditure” as the proxy variable of social networks, the estimation result is still robust. (4) Social networks have a significant influence on all types of household consumption except medical care consumption, but the degree of influence is different. Further discussion revealed that the estimation results are different for different regions in China, but the coefficients of core independent variables are not significantly different. This conclusion is different from people’s intuition, which holds that people in regions with low economic development rely more on social communication and spend more on social communication to maintain a certain social status. The conclusion of this paper is of great significance for formulating policies and institutions affecting residents’ consumption.

Cannabis consumption in young adults with cancer: descriptive study

ObjectiveIn the USA, the increase in state-sanctioned medical and recreational cannabis consumption means more young adults (YA) with cancer are using cannabis. Data and information are needed to characterise this...

Socioeconomic Disparities in Health Care Consumption: Using the 2018-China Family Panel Studies.

The existing research on residents’ health care consumption mostly covers medical care consumption and seldom regards residents’ health care consumption as an independent research object. This article takes residents’ healthcare consumption as the research object and aims to explore the impact of socioeconomic status on healthcare consumption and its mechanisms. The data of this study came from the 2018-China Family Panel Studies (CFPS). The binary probit regression model and the Tobit model explored the impact mechanism of residents’ income, education, occupation, and physical activity on health care consumption decision-making and health care expenditure, respectively. The research results showed that, from the perspective of the direct influence mechanism, residents’ work income (0.029, p < 0.01) and education level (811.149, p < 0.01) had a significant positive impact on health care consumption. Residents whose occupations (−99.697, p < 0.01) tend to be more skilled and also have higher health care consumption. From the perspective of the mediating mechanism, residents’ physical exercise duration had a significant positive impact on their participation in healthcare consumption (0.005, p < 0.01) but had a weaker impact on healthcare consumption expenditure (21.678, p < 0.1). In general, socioeconomic status represented by income, education, and occupation had a significant positive impact on residents’ health care consumption. The duration of physical exercise also played an important mediating role.

A natural history study of medical cannabis consumption in pediatric autism in the United States

BackgroundAutism spectrum disorder is specifically approved for medical cannabis consumption in 20 U.S. states, the District of Columbia, and the Territory of Puerto Rico. Despite increased access, there is limited knowledge about who consumes medical cannabis, what they consume, and perceived effectiveness. We addressed these gaps by conducting a natural history study of medical cannabis consumption. MethodChildren and their families engaged with a large pediatric care system were recruited to complete a telephonic study regarding their medical cannabis consumption. All children had to be consuming approved medical cannabis products issued from a state that had legalized medical cannabis for the treatment of ASD or related behaviors (irritability, hyperactivity, anxiety) (N = 89). ResultsThe sample’s ‘level of support’ and gender-ratio reflected the general autism population (~33 % requiring ‘Very Substantial Support’ and ~80 % male). The most common treatment targets were ASD behaviors (repetitive behaviors) and irritability. More children consumed compounds with high cannabidiol (CBD) and low or no tetrahydrocannabinol (THC). While dose did not affect overall perceived effectiveness, compounds with high-levels of CBD and low-levels of THC (CBD-dominant) were perceived as more effective than CBD-only. ConclusionsThis “real world” study revealed that medical cannabis is being used to treat a wide range of behaviors. Our study also suggests that children consume CBD-rich products, and the effectiveness of CBD-dosing may be tied to the inclusion of THC in the compound. Future research should evaluate optimal dosing with a particular focus on the CBD-to-THC ratio.

Analysis of Medical Resource Consumption in Multiple Myeloma Patients Who Received Autologous Hematopoietic Stem Cell Transplantation

&lt;p&gt;目的:探討多發性骨髓瘤病人施行造血幹細胞移植之醫療資源耗用分析。&lt;/p&gt; &lt;p&gt;方法:本研究為回溯性之研究,研究樣本取自單一醫學中心,2010 年至 2017 年為 新診斷多發性骨髓瘤且有進行造血幹細胞移植的病人。結果:結果顯示接受造血幹細胞移植的病人年齡為 57.77 &amp;plusmn; 8.24 歲,平均門診次數為 97.77 &amp;plusmn; 64.72 次,住院次數為 5 &amp;plusmn; 3.09 次,急診次數為 3.04 &amp;plusmn; 5.02 次, 門診總花費為 1,318,724.23 &amp;plusmn; 1,009,450.62 元,住院總花費為 1,020,685.5 &amp;plusmn;478,821.88 元。&lt;/p&gt; &lt;p&gt;結論:接受治療的病人在第一年的門診及住院費用為最高,第二年之後會開始遞 減,而不接受治療的人則有相反的表現,第一年門診及住院費用最低,之後開始逐年上升,所花的醫療費用比接受治療的人更高。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Objectives: We conducted a medical resource consumption analysis in multiple myeloma patients who received hematopoietic stem cell transplantation at a single center.&lt;br /&gt;Methods: This was a retrospective study, and the subjects were newly diagnosed multiple myeloma patients who received hematopoietic stem cell transplantation from January 2010 to 31 December 2017 at a single medical center.&lt;/p&gt; &lt;p&gt;Results: The mean age of patients who received hematopoietic stem cell transplantation was 57.77 &amp;plusmn; 8.24 years. The mean number of outpatient visits was 97.77 &amp;plusmn; 64.72, mean number of hospitalizations was 5 &amp;plusmn; 3.09, mean number of emergency department visits was 3.04 &amp;plusmn; 5.02, total outpatient cost was 1,318,724.23 &amp;plusmn; 1,009,450.62 NTD, and total hospitalization cost was 1,020,685.5 &amp;plusmn; 478,821.88 NTD.&lt;/p&gt; &lt;p&gt;Conclusions: This study showed that the cost was the highest during the period of active treatment, and if the patient&amp;rsquo;s condition improved, the cost would decrease accordingly. This result was similar to that of our study, in which the outpa-tient and hospitalization expenses of the treated patients were the highest in the first year and began to decrease after the second year. The opposite was true for untreated patients whose outpatient and hospitalization expenses were the lowest in the first year and then increased annually. The medical expenses of untreated patients were higher than those of treated patients.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Cost-effectiveness of an app-based treatment for urinary incontinence in comparison with care-as-usual in Dutch general practice: a pragmatic randomised controlled trial over 12 months.

ObjectiveTo assess the cost‐effectiveness of app‐based treatment for female stress, urgency or mixed urinary incontinence (UI) compared with care‐as‐usual in Dutch primary care.DesignA pragmatic, randomised controlled, superiority trial.SettingPrimary care in the Netherlands from 2015 to 2018, follow‐up at 12 months.PopulationWomen with ≥2 UI‐episodes per week, access to mobile apps, wanting treatment.MethodsThe standalone app included conservative management for UI with motivation aids (e.g. reminders). Care‐as‐usual delivered according to the Dutch GP guideline for UI.Main outcome measuresCosts and cost‐effectiveness and ‐utility were assessed from a societal perspective, based on incontinence impact adjusted life years (IIALYs), quality adjusted life years (QALYs) and medical, non‐medical and productivity costs. Information on costs was obtained with the iMCQ and iPCQ questionnaires (medical consumption and productivity cost questionnaires).ResultsIn all, 262 women were andomised equally to app or care‐as‐usual; 89 (68%) and 83 (63%) attended follow‐up, respectively. Costs were lower for app‐based treatment with € −161 (95% confidence interval [CI −180 to −151) per year. Cost‐effectiveness showed small mean differences in effect for IIALY (0.04) and QALY (−0.03) and thus larger incremental cost‐effectiveness ratios (ICER: −€3696) and incremental cost‐utility ratios (ICUR: €6379).ConclusionApp‐based treatment is a cost‐effective alternative to care‐as‐usual for women with UI in Dutch primary care.Tweetable abstractApp‐treatment for female urinary incontinence cost‐effective compared to care‐as‐usual in general practice after 12 months.

Changes of Tumor Markers in Patients with Breast Cancer during Postoperative Adjuvant Chemotherapy.

Objective Serum tumor marker (STM) elevation can detect metastasis earlier than imaging diagnosis and, although not recommended by guidelines, is still widely used in clinical practice for postoperative follow-up of breast cancer patients. The purpose of this study was to investigate the change rules of CEA and CA153 in patients with HER2-negative breast cancer during postoperative adjuvant chemotherapy and their influencing factors. Materials and Methods The medical records of patients with HER2-negative early breast cancer who visited Xuanwu Hospital from September 2018 to June 2021 were retrospectively analyzed. Demographic characteristics and baseline data of CEA and CA153 at initial diagnosis were collected. Data of CEA, CA153, biochemistry (including ALT, AST, rGT, triglycerides, cholesterol, and blood glucose) and blood routine (including white blood cells, neutrophils, monocytes, lymphocytes, and platelets) were also collected before chemotherapy, at the end of chemotherapy and more than 3 months after the end of chemotherapy. LY/MONO, NEUT/LY, PLT/LY, and systemic immune inflammation index (SII) were calculated and statistically analyzed using SPSSAU software. Results A total of 90 patients were enrolled, all of whom were female, with a mean age of 55.11 ± 10.60 y. The value of CEA at initial diagnosis was 2.10 ± 1.11 ng/mL, and high expression was mostly correlated with past history of chronic diseases and tumor lymph node metastasis; the value of CA153 was 11.80 ± 6.60 U/mL, and high expression was correlated with high SII at initial diagnosis. Surgery did not affect the values of serum CEA and CA153. At the end of chemotherapy, CEA and CA153 were 2.68 ± 1.34 ng/mL and 18.51 ± 8.50 U/mL, respectively, which were significantly increased compared with those before chemotherapy, and were linearly correlated with the values before chemotherapy. They decreased (CEA 2.45 ± 1.19 ng/mL, CA153 10.87 ± 5.96 U/mL) again three months after the end of chemotherapy, manifested as “spiking” phenomenon, which was associated with lymph node metastasis at diagnosis, body metabolic disorders, and chronic inflammatory status. Conclusion CEA and CA153 were increased presenting as “spiking” phenomena in patients with early HER2-negative breast cancer during postoperative adjuvant chemotherapy, and the peak of increase was linearly correlated with the indicators before chemotherapy. Clinical attention should be paid to this change to avoid excessive diagnosis and treatment leading to medical resource consumption.