Use Of Medical Services Research Articles

Predisposing, Enabling, and Need Factors Associated with Psychotropic Medication and Mental Health Service Use among Children in Out-of-Home Care in the United States: A Scoping Review.

This scoping review aimed to identify predisposing, enabling, and need factors associated with the use of mental health services, including psychotropic medications, among children in out-of-home care in the United States. We searched the PsycInfo, SocINDEX, Medline, and Scopus databases, and 22 studies met inclusion criteria and were systematically analyzed. Among the included studies, 7 studies examined predictors associated with taking psychotropic medications, and 16 examined factors associated with using other mental health services. Significant predisposing, enabling, and need factors associated with greater use of mental health services, including psychotropic medications, were identified. The most frequently identified predisposing factors were child race/ethnicity, age, gender, and maltreatment. Important enabling factors were out-of-home placement type and length of care, and need factors included children's mental/behavioral problems. The results provide insight into maximizing factors facilitating children's use of mental health services to address mental health problems of children in out-of-home care. Further, the results imply the importance of the appropriate use of psychotropic medication (e.g., the type and dosage of medications) among children in out-of-home care. The identified factors can inform child welfare agencies and stakeholders on ways to improve access to mental health services and the appropriate use of psychotropic medications among children in out-of-home care in the United States.

Migrate to be equal.

Equitable access to healthcare is crucial to ensure the fundamental human right to health for all. However, the possibility to use in appropriate manner medical services (e.g., to access hospital) differs substantially across Italian regions. It is a situation, source of inequality, that has been known for some time and has not found a solution to date. In 2020, the pandemic year, 7.6% of hospital admissions occurred for patients residing in regions other than that of hospitalization. The starting regions with the highest mobility rate were Molise, Basilicata, Calabria and Abruzzo with a flight index of 28.1 (Molise)-16.1 (Abruzzo) for a total of 86,787 hospitalizations (16.8% of total national hospitalizations outside the region of residence). 58.7% of hospitalizations are for patients traveling from one of the regions bordering their residence, while 13.9% are for those who have crossed 2 regions and 27.4% at least 3 regions. The main cause of hospitalization is attributable to surgery for the replacement of major joints or reimplantation of the lower limbs with 124,860 discharges for hospitalized residents in their own region (16.1%), 16,996 hospitalized in a neighbouring region (20.4 %) and 8,019 hospitalized in a region far from their own (17.7%). The phenomenon of medical migration undermines the principles of universality, equality and fairness and it is therefore necessary to intervene to guarantee an unfulfilled right in its entirety.

Service intensity of community mental health outreach among people with untreated mental health problems in Japan: A retrospective cohort study.

This study aimed to clarify the association between treatment status (untreated or treated) at the start of community mental health outreach services and service intensity. This retrospective cohort study was conducted using the Tokorozawa City mental health outreach service users' data. Treatment status at the start of service (exposure variable) and the service intensity (outcome variables) were taken from clinical records. Poisson regression and linear regression analyses were conducted. The frequency of medical or social service use 12 months after service initiation was also calculated. This study was approved by the Research Ethics Committee at the National Center of Neurology and Psychiatry (No. A2020-081). Of 89 people, 37 (42%) were untreated. Family members in the untreated group were more likely to be targets or recipients of services than in the treated group (b = 0.707, p < 0.001, Bonferroni-adjusted p < 0.001). Compared to the treated group, the untreated group received fewer services themselves (b = -0.290, p = 0.005), and also fewer services by telephone (b = -0.252, p = 0.012); by contrast, they received more services at the health center (b = 0.478, p = 0.031) and for family support (b = 0.720, p = 0.024), but these significant differences disappeared after Bonferroni adjustment. At least 11% of people in the untreated group were hospitalized and 35% were outpatients 12 months after service initiation. Family involvement may be a key service component for untreated people. The service intensity with and without treatment may vary by service location.

Analysis of Factors Affecting the Awareness of the Health Care System

Objectives: This study was to analyze whether the factors affecting the awareness of the health care system appear differently. Methods: This study used the 2020 Medical Service Experience Survey, and 12,133 people were selected as the study subjects. Demographic characteristics, chronic disease treatment experience, and type of medical institution were designed as independent variables that affect health care system awareness, and education level, age, perceived health status, income quintile, chronic disease type, and medical service use experience were composed as sub-factors. Results: As a result of analyzing the multiple regression model, it was found that education level, income quintile, age, occupation, perceived health status, and private health insurance subscription were important factors influencing the awareness of the health care system. This showed a positive effect in the higher the education, the higher the income quintile, the higher the age from under 60, the better the perceived health status, the occupation is ‘paid work’, and the private health insurance subscription. Conclusions: It is meaningful that it was found that the awareness of the health care system was low in the low-educational and low-income groups, and that it empirically analyzed and proposed the need for a policy to improve awareness.

Rethinking non-urgent EMS conveyance to ED during night-time - a pilot study in Southwest Finland

BackgroundThe amount of emergency medical service missions has increased internationally in recent years, and emergency departments are overcrowded globally. Previous evidence has shown that patients arriving at the emergency department during nighttime (20 − 08) have to wait longer, are more likely to leave without being seen, and often have non-urgent conditions compared to patients arriving during the day. The objective of this pilot study was to examine what kind of patient groups are conveyed as non-urgent to the hospital by emergency medical service during nighttime and what kind of diagnostic tests and medical interventions those patients receive before morning to identify patient groups that could be non-conveyed or directed to alternative points of care.MethodsThis was a retrospective register study where the information of patients conveyed to university hospital during nighttime (20 − 08) were analyzed. Frequencies of the dispatch codes presenting complaints, medical treatments, and diagnostic tests were calculated. Age significance (under/over 70 years) was also tested.Results73.5% of the patients received neither medical treatment nor had diagnostic tests taken before morning. Most of these were patients with mental disorder(s), hip pain/complaint, or laceration/cut. Almost half of the patients with abdominal pain or fever had laboratory tests taken. Patients over 70 years old received more medications and had more diagnostic tests taken than younger patients.ConclusionsSome of the low-acuity patients could be non-conveyed or referred to alternative pathways of care to avoid impolitic use of emergency medical service and to reduce the workload of emergency departments. Further research is needed to ensure patient safety for patients who are not conveyed at night.

64 Effect of perioperative app on use of emergency medical services for patients recovering from laparotomy

64 Effect of perioperative app on use of emergency medical services for patients recovering from laparotomy

Adherence to Key Domains by Indian Physiotherapists in Low Back Pain Clinical Guidelines: A Narrative Review

Low back pain (LBP) is one of the most common musculoskeletal problems in rest of the world which causes disability, work absenteeism, and use of medical services. The therapeutic management of acute as well as chronic LBP seems to vary substantially among medical specialists and physical therapists, but there is also considerable variation in the management of LBP between countries. This narrative review investigates an adherence to clinical practice guideline (CPG) for LBP among Indian physiotherapists regarding key domains. We identified studies by using the PubMed database in August 2022 using keywords “low back pain” and “Clinical Practice Guidelines.” Twenty-five articles were found and articles available on full text and study years between 2012 and 2022 were selected as inclusion criteria. Overall, physiotherapists are aware of CPGs and find it challenging to implement. Many studies showed an overall low adherence to the CPG, but adherence was best when LBP is associated with red flags. In public sector, physiotherapists were more likely to be strictly in line with the CPGs for assessing the psychosocial risk factors. Consideration of psychosocial parameters in treatment might have contributed to an increased awareness of strengths and weaknesses and a motivation to change routine practice in the management of patients with LBP.

A protocol for the Heart Matters stepped wedge cluster randomised trial: The effectiveness of heart attack education in regions at highest-risk

AimTo describe the Heart Matters (HM) trial which aims to evaluate the effectiveness of a community heart attack education intervention in high-risk areas in Victoria, Australia. These local government areas (LGAs) have high rates of acute coronary syndrome (ACS), out-of-hospital cardiac arrest (OHCA), cardiovascular risk factors, and low rates of emergency medical service (EMS) use for ACS. MethodsThe trial follows a stepped-wedge cluster randomised design, with eight clusters (high-risk LGAs) randomly assigned to transition from control to intervention every four months. Two pairs of LGAs will transition simultaneously due to their proximity. The intervention consists of a heart attack education program delivered by trained HM Coordinators, with additional support from opportunistic media and a geo-targeted social media campaign. The primary outcome measure is the proportion of residents from the eight LGAs who present to emergency departments by EMS during an ACS event. Secondary outcomes include prehospital delay time, rates of OHCA and heart attack awareness. The primary and secondary outcomes will be analysed at the patient/participant level using mixed-effects logistic regression models. A detailed program evaluation is also being conducted. The trial was registered on August 9, 2021 (NCT04995900). ResultsThe intervention was implemented between February 2022 and March 2023, and outcome data will be collected from administrative databases, registries, and surveys. Primary trial data is expected to be locked for analysis by October 31st 2023, with a follow-up planned until March 31st 2024. ConclusionThe results from this trial will provide high-level evidence the effectiveness of a community education intervention targeting regions at highest-risk of ACS and low EMS use.

Effectiveness of Bundled Hyperpolypharmacy Deprescribing Compared With Usual Care Among Older Adults

Older patients using many prescription drugs (hyperpolypharmacy) may be at increased risk of adverse drug effects. To test the effectiveness and safety of a quality intervention intended to reduce hyperpolypharmacy. This randomized clinical trial allocated patients 76 years or older who used 10 or more prescription medications to a deprescribing intervention or to usual care (1:1 ratio) at an integrated health system with multiple preexisting deprescribing workflows. Data were collected from October 15, 2020, to July 29, 2022. Physician-pharmacist collaborative drug therapy management, standard-of-care practice recommendations, shared decision-making, and deprescribing protocols administered by telephone over multiple cycles for a maximum of 180 days after allocation. Primary end points were change in the number of medications and in the prevalence of geriatric syndrome (falls, cognition, urinary incontinence, and pain) from 181 to 365 days after allocation compared with before randomization. Secondary outcomes were use of medical services and adverse drug withdrawal effects. Of a random sample of 2860 patients selected for potential enrollment, 2470 (86.4%) remained eligible after physician authorization, with 1237 randomized to the intervention and 1233 to usual care. A total of 1062 intervention patients (85.9%) were reached and agreed to enroll. Demographic variables were balanced. The median age of the 2470 patients was 80 (range, 76-104) years, and 1273 (51.5%) were women. In terms of race and ethnicity, 185 patients (7.5%) were African American, 234 (9.5%) were Asian or Pacific Islander, 220 (8.9%) were Hispanic, 1574 (63.7%) were White (63.7%), and 257 (10.4%) were of other (including American Indian or Alaska Native, Native Hawaiian, or >1 race or ethnicity) or unknown race or ethnicity. During follow-up, both the intervention and usual care groups had slight reductions in the number of medications dispensed (mean changes, -0.4 [95% CI, -0.6 to -0.2] and -0.4 [95% CI, -0.6 to -0.3], respectively), with no difference between the groups (P = .71). There were no significant changes in the prevalence of a geriatric condition in the usual care and intervention groups at the end of follow-up and no difference between the groups (baseline prevalence: 47.7% [95% CI, 44.9%-50.5%] vs 42.9% [95% CI, 40.1%-45.7%], respectively; difference-in-differences, 1.0 [95% CI, -3.5 to 5.6]; P = .65). No differences in use of medical services or adverse drug withdrawal effects were observed. In this randomized clinical trial from an integrated care setting with various preexisting deprescribing workflows, a bundled hyperpolypharmacy deprescribing intervention was not associated with reduction in medication dispensing, prevalence of geriatric syndrome, utilization of medical services, or adverse drug withdrawal effects. Additional research is needed in less integrated settings and in more targeted populations. ClinicalTrials.gov Identifier: NCT05616689.

Treatment in obsessive–compulsive disorder

ABSTRACT Background: Obsessive-compulsive disorder (OCD) is characterised by affective and cognitive symptoms that impair overall functioning and cause psychological discomfort. Due to the use of medical services, these entail high societal costs. Objective: Our goal was to provide a thorough overview of this topic while evaluating the effectiveness of pharmacological therapies in OCD and clinical recommendations. Methods: We looked for papers on the use of drugs to treat OCD in the pubmed database, with an emphasis on clinical guidelines, the use of antidepressants, antipsychotics, mood stabilisers, off-label drugs, and pharmacogenomics. Results: Selective serotonin reuptake inhibitors (SSRIs) work best when taken for a lengthy period of time. A SSRI combination with cognitive behavioural therapy (CBT) or the similarly orientated exposure and response prevention (ERP) can produce better outcomes. Treatment options for refractory OCD include switching to a different SSRI or clomipramine or supplementing with an atypical antipsychotic. Further research is necessary because there is conflicting information about the use of antidepressants intravenously or in addition to antipsychotics. Treatment customization and pharmacogenomics may lessen treatment resistance. Conclusions: When compared to each treatment separately or to other treatments, SSRI/clomipramine combined with CBT/ERP produces the best results. For refractory OCD, new approaches are required. In the upcoming years, pharmacogenomics may play a more significant role.

Rural and Urban patients’ Requirements and Experiences of Out-of-hours medical care after cancer (RUREO): a questionnaire study

ObjectiveTo investigate how individuals diagnosed with cancer use out-of-hours (OOH) medical services, describe the behavioural determinants of OOH service use and explore whether there are differences between urban and rural...

Telemedical support for prehospital emergency medical service in severe emergencies: an open-label randomised non-inferiority clinical trial

BackgroundA tele-emergency medical service with a remote emergency physician for severe prehospital emergencies may overcome the increasing number of emergency calls and shortage of emergency medical service providers. We analysed whether routine use of a tele-emergency medical service is non-inferior to a conventional physician-based one in the occurrence of intervention-related adverse events.MethodsThis open-label, randomised, controlled, parallel-group, non-inferiority trial included all routine severe emergency patients aged ≥ 18 years within the ground-based ambulance service of Aachen, Germany. Patients were randomised in a 1:1 allocation ratio to receive either tele-emergency medical service (n = 1764) or conventional physician-based emergency medical service (n = 1767). The primary outcome was the occurrence of intervention-related adverse events with suspected causality to the group assignment. The trial was registered with ClinicalTrials.gov (NCT02617875) on 30 November 2015 and is reported in accordance with the CONSORT statement for non-inferiority trials.ResultsAmong 3531 randomised patients, 3220 were included in the primary analysis (mean age, 61.3 years; 53.8% female); 1676 were randomised to the conventional physician-based emergency medical service (control) group and 1544 to the tele-emergency medical service group. A physician was not deemed necessary in 108 of 1676 cases (6.4%) and 893 of 1544 cases (57.8%) in the control and tele-emergency medical service groups, respectively. The primary endpoint occurred only once in the tele-emergency medical service group. The Newcombe hybrid score method confirmed the non-inferiority of the tele-emergency medical service, as the non-inferiority margin of − 0.015 was not covered by the 97.5% confidence interval of − 0.0046 to 0.0025.ConclusionsAmong severe emergency cases, tele-emergency medical service was non-inferior to conventional physician-based emergency medical service in terms of the occurrence of adverse events.

School absenteeism in children with special health care needs. Results from the prospective cohort study ikidS.

Children with special health care needs (SHCN) due to a chronic health condition perform more poorly at school compared to their classmates. There is still little knowledge on the causal pathways and which factors could be targeted by interventions. We, therefore, investigated school absenteeism in children with SHCN compared to their peers. This study was based on data from the German population-based prospective cohort study ikidS (German for: I will start school). Children with SHCN were identified by the Children with Special Health Care Needs screener that captures five consequences of physical or mental chronic health conditions: (1) use or need of prescription medication, (2) above average use or need of medical, mental health, or educational services, (3) functional limitations compared with others of the same age, (4) use or need of specialized therapies, and (5) treatment or counseling for emotional, behavioral, or developmental problems. School absenteeism was defined as days absent from school due to illness during first grade and was reported by classroom teachers. Associations between SHCN consequences and school absenteeism were investigated by negative binomial regression models. Effect estimates were adjusted for confounding variables identified by a causal framework and directed acyclic graphs. 1,921 children (mean age at follow-up 7.3 years, standard deviation 0.3; 49% females) were included; of these, 14% had SHCN. Compared to their classmates, children with SHCN had more days absent (adjusted rate ratio: 1.37; 95% confidence interval 1.16, 1.62). The effect was strongest among children with i) functional limitations, ii) treatment or counseling for emotional, behavioral, or developmental problems, and iii) those who experienced two or more SHCN consequences. Children with SHCN have higher school absenteeism, which could-at least partly-explain their poorer school performance and lower educational attainment. SHCN-specific targeted interventions may reduce the adverse effects of SHCN on educational outcomes in children.

Household catastrophic health expenditure related to pain in Korea.

The data related to pain and catastrophic health expenditure (CHE) needed to be further explored. This study aims to understand the relationship between pain and CHE. Using cross-sectional analysis of 4-year data (2015-2018) from the Korea Health Panel, the prevalence of CHE and adjusted odds ratio (AOR) by pain type were confirmed. Among participants (n = 46,597), the prevalence of pain and severe pain were 24.2% and 1.1%, respectively. The use of medical services in emergency rooms, hospitalizations, and outpatients increased in the order of pain-free, pain, and severe pain (P < 0.001). Prevalence of household CHE was 3.3% vs. 11.1% vs. 25.9%, (P < 0.001). The AOR of CHE was 1.5 (95% confidence interval [CI], 1.4-1.7) for pain and 3.1 (95% CI, 2.5-3.9) for severe pain. Household capacity to pay per year was lower and lower in the order of pain-free, pain, and severe pain ($25,094 vs. $17,965 vs. $14,056, P < 0.001). Also, the household out-of-pocket expenditure per year was higher and higher in the order of pain-free, pain, and severe pain ($1,649, $1,870, $2,331, P < 0.001). It can be inferred that pain is one of the mechanisms of poverty. Positivist healthcare policies for the prevention and management of pain should be sought.

A Study on Role of Health Care Management Streams

Health care is the maintenance or improvement of health care via the prevention, diagnosis, treatment, amelioration, or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health care professionals and allied health care fields. Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, athletic training, and other health professions are all part of health care. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public healthcare. Access to health care may vary across countries, communities, and individuals, influenced by social and economic conditions as well as health care policies. Providing health care services means “the timely use of personal health care services to achieve the best possible health care outcomes. A limitation to health care services affects negatively the use of medical services, the efficacy of treatments, and overall outcome (well-being, mortality rates). An efficient health care system can contribute to a significant part of a country’s economy, development, and industrialization. Health care is conventionally regarded as an important determinant in promoting the general physical and mental health care and well-being of people around the world, An example of this was the worldwide eradication of smallpox in 1980, declared by the WHO as the first disease in human history to be eliminated by deliberate health care interventions.

Quality of pain management in patients with cancer in the outpatient setting.

12106 Background: Pain represents a common health issue among patients with cancer. Uncontrolled pain significantly impairs the quality of life, resulting in increased healthcare utilization and costs. We examined the patterns of pain medication prescriptions among patients with cancer pain in the outpatient setting. Methods: We used the National Ambulatory Medical Care Survey (NAMCS), an annually administered survey designed to collect data regarding the use of ambulatory medical services from office-based physicians in the United States. We analyzed NAMCS data from 2005 to 2019 for all types of cancers visits. The primary outcome was prescription of pain medications among patients with cancer pain. We performed multivariate logistic regression to identify factors associated with opioid and non-opioid prescription among patients with cancer pain. Results: We captured a total of 520.8 million outpatient visits from 2005-2019. Breast cancer (18.7%) followed by cancer of the male genital tract (11.0%) represented the highest proportion of patient visits. 4.8% of cancer patients reported pain. Majority (60%) complaining of pain did not receive any pain medications. 14.9% received opioids and 25.1% received nonsteroidal anti-inflammatory drugs, acetaminophen, or adjuvant pain medications. The odds of receiving opioids were 3.4 times higher among 45-65 years vs patients over 75 years. African-Americans had 84% higher odds of receiving opioid prescription compared to white patients. The odds of receiving opioids were 61% lower for privately insured vs patients on Medicare. Patients visiting oncologic care had 2.1 times higher odds of receiving opioids compared to primary care (Table). Conclusions: This is one of the largest drug utilization studies among patients with cancer in outpatient setting, covering half a billion patient visits. A significant proportion of outpatients with cancer who reported pain did not receive a prescription for analgesics suggesting a possibility of undertreatment of pain. Within the limitation of this dataset, undertreatment of pain in outpatients with cancer remains a major unmet patient need. [Table: see text]

EE213 Long COVID-19 Associated with 5-Fold Increase in Total Medical Costs and Greater Use of Inpatient and Outpatient Services Compared to Non-Long COVID-19: An Analysis of Real-World Data

Assess real-world evidence data on the prevalence and impact of long COVID (LC) to establish a baseline for the value of potential therapeutic interventions. This study was a retrospective, longitudinal analysis of administrative claims from multiple payer channels spanning 4/1/2020-6/30/2022. Inclusion criteria: 1) ICD-10-CM diagnosis code of COVID-19 (U07.1) on or after 4/1/2020 (COVID-19 diagnosis date=index date), 2) 18+ years of age on index, and 3) at least -365/+30 days of continuous plan enrollment surrounding index. Employing a conservative LC definition, patients were classified as LC if they presented at least 1 claim ≥ 28 days following the index date which included both a COVID-19 diagnosis and ≥1 of 8 LC-related symptoms. LC and non-LC patients were compared on demographics, COVID-19 symptoms, healthcare utilization, and medical costs. Descriptive statistics were presented for outcomes, and bivariate tests of significance were used to assess differences between cohorts. Of 4,938,801 medically attended COVID-19 patients meeting inclusion criteria, 386,153 (7.8%) qualified as LC. The LC patients were older (Mean(SD) = 67.0(19.0) vs. 51.0(20.7)), were more likely to be female (65.1% vs. 60.4%), were in poorer health (Deyo-Charlson Comorbidity Index=3.51(3.24) vs. 1.47(2.45)), and presented greater baseline total medical expenditures ($39,769($60,401) vs. $15,275($35,640); p < 0.0001). On index, LC patients had a higher rate of LC-related symptoms, and in the 180-day post-index period, LC patients incurred increased total medical costs ($38,874($54,098) vs. $7,319($18,439); p < 0.001) and greater use of inpatient and outpatient medical services. Patients with LC presented elevated rates of symptoms and incurred 5-fold greater medical costs post-index compared to non-LC patients. This study is one of the first to longitudinally quantify the cost and symptom burden of LC in a real-world setting and helps to establish a baseline for the value of potential therapeutic interventions.

Forecasting Tourism Demand for Medical Services

ABSTRACT: Medical tourism is considered nowadays as a multi-billion industry which can promote a country's economic growth. Therefore, forecasting the scheduled tourism demand for medical services is of great importance for policy makers. Doing so, however, is not an easy task due to the following reasons: Data on medical tourism are (i) not easily accessible; (ii) not typically distinguished from tourists' non-scheduled (unintentional) use of a country's medical services; and (iii) usually not publicly available for long time periods. In this paper, we present a novel way to forecast tourism demand (intentional and unintentional) foro medical services —a rough but informative proxy of medical tourism— using limited data. To perform the analysis, we use data on the percentage of hospital discharges of non-residents for 17 European countries over the period 2008-2019 retrieved from Eurostat. Our methodological approach is based on a forecasting technique recently developed by Kyriazi, Thomakos and Guerard ; the adaptive learning forecasting. According to this method, MSE (Mean Squared Error)-performance enhancements can be achieved using any forecast as input —as long as that input is not a 'perfect' forecast— by learning from past forecast errors. Within this context, even the most basic forecast, the no-change or naïve forecast, can be used as input to the adaptive learning procedure. Kyriazi, Thomakos and Guerard approach is very well suited to our research question because (i) the no-change forecast is a natural candidate in a short time series where models cannot be estimated with sufficient accuracy, (ii) the no-change forecast is obviously far from being the 'perfect' forecast, and (iii) the adaptive learning process can be initialized by the no-change forecast and then learn by its own past forecast errors. Our results show that adaptive learning forecasting leads to performance enhancements that range from the 5% to more than 20% relative to the no-change benchmark. This finding indicates the efficiency of the adaptive learning method in forecasting medical tourism demand; an important subcategory of tourism demand for which data are not easily accessible and freely available historical data are existing for short time periods.

Kindergarten conduct problems are associated with monetized outcomes in adolescence and adulthood.

Across several sites in the United States, we examined whether kindergarten conduct problems among mostly population-representative samples of children were associated with increased criminal and related (criminal + lost offender productivity + victim; described as criminal + victim hereafter) costs across adolescence and adulthood, as well as government and medical services costs in adulthood. Participants (N = 1,339) were from two multisite longitudinal studies: Fast Track (n = 754) and the Child Development Project (n = 585). Parents and teachers reported on kindergarten conduct problems, administrative and national database records yielded indexes of criminal offending, and participants self-reported their government and medical service use. Outcomes were assigned costs, and significant associations were adjusted for inflation to determine USD 2020 costs. A 1SD increase in kindergarten conduct problems was associated with a $21,934 increase in adolescent criminal + victim costs, a $63,998 increase in adult criminal + victim costs, a $12,753 increase in medical services costs, and a $146,279 increase in total costs. In the male sample, a 1SD increase in kindergarten conduct problems was associated with a $28,530 increase in adolescent criminal + victim costs, a $58,872 increase in adult criminal + victim costs, and a $144,140 increase in total costs. In the female sample, a 1SD increase in kindergarten conduct problems was associated with a $15,481 increase in adolescent criminal + victim costs, a $62,916 increase in adult criminal + victim costs, a $24,105 increase in medical services costs, and a $144,823 increase in total costs. This investigation provides evidence of the long-term costs associated with early-starting conduct problems, which is important information that can be used by policymakers to support research and programs investing in a strong start for children.

Analysis of the information about the incidence of heart failure, associated mortality and burden on the healthcare system, based on the encoding data in 15 subjects of the Russian Federation

Aim. This study aims to assess the incidence of heart failure (HF) and associated mortality, and also the burden on the healthcare system in the subjects of Russian Federation, based on the HF encoding data.Material and methods. We made a structured request for the number of patients with HF and the number of cases of providing medical care in 2019. HF was understood to mean the presence of at least one of the codes I09.9, I11.0, I13.0, I13.2, I25.5, I42.0, I42.5, I42.6, I42.7, I42.8, I42.9, I43.0, I43.1, I43.2, I43.8, I50.X (expanded encoding) according to International Classification of Diseases 10th Revision. The code I50.X was considered separately (the standard HF enconding).Results. The information about the incidence of HF, associated mortality and burden on the healthcare system was obtained from 15 subjects (53,6% from those that gave the data according to the request; the adult population is 18,9% from total adult population of Russian Federation). We noted significant heterogeneity between the regions. The median of the incidence of HF and associated mortality was 2,6 and 3,2% in accordance with the data of the expanded encoding, and 0,21 and 11,3% — according to the standard HF encoding. The presence of the code I50.x was observed in average in 9,4% of all cases of HF and defined the patients who frequently used emergency medical services and were frequently hospitalized (60 (18, 96) and 48 (20, 137) cases per 100 patients versus 9 (5, 24) and 17 (10, 70) cases in the expanded encoding).Conclusion. According to the encoding, the indicators of the incidence of HF and associated mortality vary greatly between the regions, the median values are 2,6 and 3,2% in expanded and 0,21 and 11,3% in standard approaches. In the standard encoding, there were more frequent use of emergency medical services and less number of outpatient visits. The development and introduction of a unified approach to encoding and recording the cases of HF will provide obtaining objective statistical data and using them for management decisions.