Number Of Unhealthy Days Research Articles

The Cost of Unhealthy Days: A New Value Assessment.

For-profit companies addressing disparities in social determinants of health (SDOH), also known as SDOH Industry companies, often lack member-level claims data to evaluate their organizational interventions. Health-related quality of life (HRQOL) measures, such as the Centers for Disease Control and Prevention's Healthy Days Measure, offer a unique proxy metric to evaluate impact. This retrospective study sought to explore the association between self-reported physically and mentally unhealthy days with health care costs among a Medicare Advantage (MA) population. A cross-sectional study of MA members receptive to a companion care program, and thus likely to have unmet social needs, was conducted. The analysis included members with recorded baseline unhealthy days and complete claims data (n = 2,354). Least squares regression analyses were performed to determine the relationship between baseline medical costs, physically unhealthy days, and mentally unhealthy days. A review of Major Diagnostic Categories (MDCs) was also included to elucidate the strength of the Healthy Days Measure as an indicator of the burden of health conditions. Each additional unhealthy day reported was associated with an increase in 30-day medical costs of $60 and $34 for physically and mentally unhealthy days, respectively. Unhealthy days and costs increased with an increasing number of MDCs. Compared with previous studies linking unhealthy days and health care expenditure, these data reveal the potential for even higher savings by reducing the number of unhealthy days in a high-risk population. This evidence supports using unhealthy days as a HRQOL measure and as an important tool for cost estimations.

Telehealth in Informal Caregivers of Stroke Survivors: A Systematic Review.

Background: There has been an increase in people with disabilities who require continuous care, which often falls to informal carers (ICs). Stroke is one of the conditions where ICs are most needed. Therefore, it is necessary for ICs to improve their caregiving skills and self-care capacity. Telehealth (TH) can facilitate them. The aim of this systematic review is to summarize the evidence of the effects of interventions on ICs of stroke patients. Methods: The search was conducted in Pubmed, Scopus, Web of Science, CINALH, Psychology and Behavioral Sciences Collection, and APA PsycInfo. Key search terms included "stroke", "informal caregiver" and "telemedicine". Only randomised clinical trials were included. Results: A total of 2031 articles were found in the databases, 476 were screened and 19 clinical trials met the eligibility criteria. Different TH programmes have evaluated many outcomes related to physical and emotional health. The TH tools included phone, videophone, web-based interventions, and social media. The most investigated outcome was depression; although contradictory results were found, the TH may have helped to prevent an increase in depressive symptoms. There were inconsistent results on the caregiving burden and the preparedness of the IC. However, TH has positive effects on the health of the ICs, reducing the number of unhealthy days, anxiety, task difficulty perception, and improving psychological health. Conclusions: TH may be a useful tool to improve the abilities and health of ICs of SS. No adverse effects have been reported. More quality studies evaluating the effects of telemedicine on the ICs of stroke survivors, as well as the most appropriate doses, are needed.

An integrated analysis of air pollution and meteorological conditions in Jakarta

Air pollution and climate change are general problems for society. This paper proposes an integrated analysis of the Air Quality Index (AQI) and meteorological conditions in Jakarta. The column-based data integration model is applied to create integrated data of the Air Quality Index and meteorological conditions. The integrated data is then used to generate a causal graph using the PC algorithm. The causal graph reveals that there exist causal relationships between pollutants and meteorological conditions, e.g, humidity, rainfall, wind speed, and duration of sunshine affect particulate matter 10 (PM_{10}); wind speed affects sulfur dioxide (SO_2); temperature affects ozone (O_3). The historical data records that the average wind speed is decreased and the number of unhealthy days has risen. Ozone and particulate matter are two pollutants that mainly influence poor air quality in Jakarta. The integrated data is also used to train Long Short-Term Memory (LSTM) and Gated Recurrent Unit (GRU) for forecasting. Experimental results show that LSTM using integrated data produces smaller errors for forecasting AQI and meteorological conditions.

Assessing short term air quality trend in Malaysia based on air pollution index (APi)

Air Pollution Index (API) is used in Malaysia to determine the daily air quality status, which is calculated based on the daily concentrations of particulate matter (PM10), ground-level ozone (O3), carbon monoxide (CO), sulphur dioxide (SO2) and nitrogen dioxide (NO2). This study presents short-term air quality trends based on API from the 52 air quality monitoring stations nationwide between 2010 and 2016. The air quality data and meteorological conditions were obtained from the Department of Environment and used for the API calculation. The API value is classified into six categories, namely: Good (0-50), Moderate (51-100), Unhealthy (101-200), Very Unhealthy (201-300), Hazardous (301-500), and Emergency (above 500). The coefficient of variation (CV) and Mann-Kendall trend test (MK) were used to assess the API variation and trend in each air quality monitoring station. Between the study periods, the API values were largely varied. Observation at 32 air quality monitoring stations have shown significant but small increasing trends, while 12 stations showed significant decreasing trends, and the remaining 8 stations showed no significant trends. The frequency of exceedance (API>50) was used to assess the percentages of unhealthy days. The analysis has found that air quality in Klang Valley was experiencing the highest number of unhealthy days, while the two Malaysian states in Borneo (Sabah and Sarawak) to be relatively less polluted.

Temporal profiles of ambient air pollutants and associated health outcomes in two polluted cities of the Middle East.

Dust storms and particulate matters had been increased due to climate change in the Middle East. On the other hand, urbanization and industrialization raised levels of gaseous air pollutants in all big cities. In the current study, air pollution information collected from Environmental Protection Agency of Khuzestan and Tehran containing hourly O3, NO2, CO, SO2, PM10 and PM2.5 concentrations between 2014 and 2015. This study evaluated the air quality of these two cities by Air Quality Index (AQI). As a result, mean concentrations of O3, NO2, PM10 and PM2.5 were higher in Ahvaz than Tehran while Tehran was more pollutant in terms of CO and SO2. Diurnal variations of O3 in weekend were the only trend located above weekday variations along the daytimes. Hourly variations of all pollutants changed with a wider range of concentrations in Ahvaz. Diurnal peaks of all pollutants showed their highest level on Monday as the busiest day in mega city, Tehran with the exception of SO2. PM2.5 was the worst and limiting pollutant for both cities. Accordingly, winter was the most polluted season by 77 and 33μgm-3 in Ahvaz and Tehran, respectively. Number of clean days was significantly lower in Ahvaz (no-day) than mega city, Tehran (<17days). The number of unhealthy days was also presented significantly higher in Ahvaz (>186days). Although, annual PM2.5 concentrations were more in Ahvaz, the higher at-risk population in Tehran caused more health endpoints in the capital of Iran. Consequently, both cities should have their own especial pattern to control air pollution and attributed health damages.

Treatment of Refractory Chronic Migraine with Worm Eggs: A Therapy Rooted in Evolution

Introduction: This was a small open label study designed to determine efficacy of helminth egg therapy in refractory chronic migraine (RCM) patients. It is probable that the immune system is involved in migraine. 1 Helminth worms have populated the GI tract of primates for millions of years. They downregulate the immune response. When the helminths (and other parasites) are removed, the result may be an increase in autoimmune illness. The immune system and inflammation are involved in migraine pathophysiology. Study design: Eleven RCM patients were enrolled. After the run-in period, patients ingested the helminth eggs every 2 weeks for 5 months. These eggs were from the pig whipworm, T. suris. The primary endpoint involved the number of moderate or severe headache days per month. The first (run-in) month was compared to the last 2 months of active therapy. Secondary endpoints included disability, depression, anxiety, and quality of life. Results: 5 of 11 patients met the primary endpoint (a reduction in moderate or severe headache days by at least 3 per month). The number of moderate or severe headache days decreased by 14, 10, 8, 7, and 3 in these patients. The patients who met the primary endpoint all began with essentially no clinical depression at baseline. Disability declined in all 5 patients, as did anxiety. Quality of life (number of unhealthy days per month) improved in 2 of the 5 patients who met the primary endpoint. 4 of 11 patients who completed the study did not meet the primary endpoint. 1 other patient did not supply data, and another discontinued treatment due to diarrhea. Analysis of their secondary endpoints did not result in any definitive conclusions as to why they did not improve. Conclusion: This study indicates that there may possibly be a role for helminth therapy in treating refractory chronic migraineurs. 5 of 11 patients did well. This treatment is rooted in evolution. The presence of helminths results in a downregulation of certain aspects of our immune system. By re-introducing helminths into the GI system, we may dampen our immune response. This may possibly help in the treatment of conditions that involve the immune system, such as migraine. Keywords: Migraine, Refractory Migraine, Headache, Helminth, Evolution, Chronic Migraine

Association between Vision Impairment and Physical Quality of Life Assessed Using National Surveillance Data.

Physically unhealthy days assessments in national health surveillance datasets represent a useful metric for quantifying quality-of-life differences in those with and without vision impairment. Disproportionately poorer physical health in the visually impaired population provides further rationale for the inclusion of vision care in multidisciplinary approaches to chronic disease management. This study aimed to assess the association between vision impairment and health-related quality of life using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. Data from each of the 50 states were extracted from the 2017 Behavioral Risk Factor Surveillance System data set. Self-report of difficulty seeing was used to categorize visually impaired versus nonvisually impaired populations. Self-report number of physically unhealthy days in the previous 30 days was used to quantify quality of life. The number of unhealthy days was calculated for the visually impaired and nonvisually impaired cohorts for each state. The ratio of the number of physically unhealthy days in the visually impaired versus nonvisually impaired population was calculated for each state and for different age cohorts. Mean numbers of physically unhealthy days among persons with and without severe vision impairment across all states were 10.63 and 3.68 days, respectively, and demonstrated considerable geographic variability. Mean ratios of physically unhealthy healthy days in the visually impaired versus the nonvisually impaired population were 2.91 in the 18- to 39-year-old cohort, 2.87 in the 40- to 64-year-old cohort, and 2.16 in the ≥65-year-old cohort. National surveillance data demonstrate a greater number of physically unhealthy days in the visually impaired population, indicating a need to improve our understanding of causes that lead to reduced physical health among those with vision impairment. Additional research is needed to better understand how individuals perceive vision as part of their overall health.

Racial/Ethnic Variations in Social Determinants of Mental Health Among Medicare Advantage Beneficiaries.

We examine associations between social determinants and mental health and assess how the associations vary by race/ethnicity using a large, diverse sample of older adults. A retrospective study of 444,057 older adults responding to the Medicare Health Outcomes Survey in 2015-2017 was conducted. Using a multilevel linear regression, we examined the associations between the self-reported number of unhealthy days due to mental health and social determinants, stratified by race/ethnicity. Health factors were most strongly associated with unhealthy days across all racial/ethnic groups. Strength of other factors varied by race/ethnicity. Social/economic factors had stronger associations among Whites, Asians, and multiracial individuals, while such factors were not significant for American Indians/Alaska Natives and Native Hawaiians/Other Pacific Islanders. We found varying degrees of associations between social determinants and poor mental health by racial/ethnic groups. These results suggest that homogeneous interventions may not meet the mental health needs of all.

The effect of air pollutant and built environment criteria on unhealthy days in Mashhad, Iran: Using OLS regression

Air pollution is one of the most important shared challenges among metropolises across the world, especially in developing countries such as Iran.The purpose of this study is to evaluate the effect of air pollutants and built environment on the number of unhealthy days in Mashhad metropolis in 2018. To achieve this goal, seven variables were used as independent variables (including population density, land use diversity, CO, NO2, SO2, PM10, PM2.5) and the number of unhealthy days was used as a dependent variable. The relationship between variables was analyzed using the Ordinary Least Squares (OLS) regression model in GIS in 40 municipal districts. The results show that the average of unhealthy days in Mashhad is 76 days. But its amount varies from 12 to 155 days in the districts. Furthermore, the correlation coefficient between the dependent and independent variables is ADJ.R2 = 0.80 which represents the effect of 80% of the independent variables on the dependent variable. Among the variables, “PM2.5” and “NO2” have a positive relationship and “CO” had a negative relationship with the number of unhealthy days. The relationship between other independent variables and the dependent variable was not confirmed. In addition, the residual standard deviation is not normally distributed. In general, it can be argued that the establishment of industrial and workshop activities and traffic of motor vehicles on highways have a significant role in CO, NO2 and PM2.5 emissions in the northern, northwestern, eastern and southeastern districts of the city. Therefore, it is suggested that these districts especially those that have more than 100 unhealthy days are given priority in the planning of urban manager actions.

Improved work productivity and health-related quality of life in patients with irritable bowel syndrome with diarrhea receiving eluxadoline following inadequate response to loperamide

BACKGROUND: Irritable bowel syndrome with diarrhea (IBS-D) is a chronic disorder of gut-brain interaction that negatively affects work productivity and health-related quality of life (HRQOL). IBS-D therapeutic options are limited and include loperamide, an over-the-counter μ-opioid receptor agonist commonly used as an antidiarrheal agent, and eluxadoline, a mixed μ- and κ-opioid receptor agonist and δ-opioid receptor antagonist approved in the United States for the treatment of IBS-D in adults. OBJECTIVE: To characterize the effect of eluxadoline on work productivity and HRQOL in patients with IBS-D with previous inadequate response to loperamide. METHODS: The Work Productivity and Activity Impairment Questionnaire for IBS-D (WPAI:IBS-D), Centers for Disease Control and Prevention Healthy Days Core Module (CDC HRQOL-4), and EuroQoL-5 Dimension (EQ-5D) instruments were administered at baseline and week 12 of a phase 4 clinical trial (RELIEF), assessing the efficacy and safety of eluxadoline treatment in adults with IBS-D reporting previous inadequate response to loperamide. Changes from baseline to week 12 for each assessment were evaluated using an analysis of covariance model. Indirect costs were calculated by converting overall work productivity losses into monetary values. RESULTS: A total of 346 patients were randomized to either eluxadoline (n = 172) or placebo (n = 174). From baseline to week 12, compared with placebo, twice-daily treatment with eluxadoline resulted in significantly greater reductions in absenteeism (2.6%; P = 0.046). Numerically greater decreases in presenteeism, overall work productivity loss, and daily activity impairment were also observed in patients receiving eluxadoline compared with those receiving placebo (P = not significant for each). Numerical reductions in overall work productivity loss from baseline to week 12 translate to approximately 2.4 hours per patient per week (123 hours annually) and correspond to an avoided overall work loss of $4,503 annually for an employee with IBS-D treated with eluxadoline. In addition, from baseline to week 12, treatment with eluxadoline led to a significantly greater reduction in the number of unhealthy days experienced (-1.7 days; P = 0.042), as well as numerical improvements in EQ-5D measures in comparison with placebo (P = not significant for each). CONCLUSIONS: In patients with IBS-D reporting inadequate response to loperamide, eluxadoline treatment was associated with significant reductions in absenteeism and the number of unhealthy days experienced. Eluxadoline treatment of IBS-D may lead to significant cost savings via mitigation of losses in work productivity. DISCLOSURES: This study was sponsored by Allergan plc (before acquisition by AbbVie, Inc.). Allergan plc and/or AbbVie, Inc., was involved in the study design, collection, analysis, interpretation of the data, writing of the report, and the decision to submit the report for publication. Abel and Burslem are employees of AbbVie, Inc., and own stock/stock options. Brenner has served as a consultant, speaker, and/or advisor for Allergan plc (before acquisition by AbbVie, Inc.), Alnylam, Alpha Sigma, Arena, Bayer, Ironwood Pharmaceuticals, Salix Pharmaceuticals, Shire, Synergy, and Takeda Pharmaceuticals. He is also supported in research by an unrestricted gift from the Irene D. Pritzker Foundation. Sayuk has served as a consultant and speaker for Allergan plc (before acquisition by AbbVie, Inc.), Gi Health Foundation, Ironwood Pharmaceuticals, Salix Pharmaceuticals, and Synergy. Portions of the current work were presented at AMCP Nexus; October 22-25, 2018; Orlando, FL.

Is Recycling Effective? Evidence from California between 2004 and 2017

Using county data from California between 2004 and 2017, this article exploits changes in households’ exposure to hazardous waste recycling to identify the effects on potential environmental and economic outcomes. While a 10% rise in recycling per household is associated with a 0.28% and 0.94% improvement in air quality and a decline in the number of unhealthy days in a year, recycling is associated with a rise in net energy generation and fuel consumption and not associated with economic activity. There is some evidence that households in zip codes with higher housing values and population density value reductions in hazardous waste.

Racism, Psycho-Social Stress, and Health-related Quality of Life.

There is a paucity of information on the intermediate behavioral pathways linking exposure to racial discrimination with negative health outcomes among racial and ethnic minority populations in low income settings. This study examined the association between experiences of discrimination and the number of unhealthy days due to physical or mental illness and whether alcohol use influenced the association. A community needs assessment was conducted from 2013-2014 within a low-income community in Florida. Structural equation modeling was performed using maximum likelihood estimation with robust standard errors. In a total of 201 observations, path analyses uncovered significant positive indirect associations (p<0.05) between perceived discrimination and unhealthy days through perceived stress, sleep disturbances, and chronic illness. Although a maladaptive mechanism, alcohol use was a strong buffer on the effects of racism on stress.

Pain, unhealthy days and poor perceived health among Japanese workers.

ObjectivesThe current research aimed to study the relationship between health‐related quality of life (poor perceived health/unhealthy days) and workers' pain.MethodsThis cross‐sectional study was conducted among 1360 Japanese workers of a Japanese company in Kyushu. Health‐related quality of life was measured by HRQOL‐4 tool developed by Centers for Disease Control and Prevention of the USA. Pain was assessed by numeric rating scale with 0‐10 points. Regression analysis was conducted to identify the relationship between health‐related quality of life and pain.ResultsParticipants who reported pain had significantly greater odds of having poor health compared to those with no pain (AOR = 3.99, 95% CI = 3.82‐4.18, P < .0001). In general, participants who had a higher frequency and intensity of pain had significantly greater odds of having poor health compared to those with no pain. Compared to those with no pain, participants with pain had an average of 2.85 (95% CI = 2.07‐3.63, P < .0001), 2.25 (95% CI = 1.52‐2.99, P < .0001), 4.41 (95% CI = 3.39‐5, P < .0001), and 1.9 (95% CI = 1.30‐2.50, P < .0001) more physically unhealthy days, mentally unhealthy days, total unhealthy days, and days with activity limitation, respectively. Headache causes many more unhealthy days and more poor health than any other pain, including back pain, shoulder/neck pain, and joint pain.ConclusionPoor health status and the number of unhealthy days among Japanese workers are strongly associated with the presence of pain and increases with the intensity and frequency of pain.

PEMODELAN DATA TERSENSOR KANAN MENGGUNAKAN ZERO INFLATED NEGATIVE BINOMIAL DAN HURDLE NEGATIVE BINOMIAL

Health is a very important thing for humanity. One way to look at a person's health condition is through the number of unhealthy days which can also shows the productivity of the community in a region. Modeling the number of unhealthy days which are examples of count data can be done using Poisson regression. Problems that are often faced in data counts are overdispersion and excess zero. Poisson regression cannot be applied to data that experiences both of these. Zero Inflated Negative Binomial and Hurdle Negative Binomial modeling was performed on data with 2 conditions, uncensored and censored. The explanatory variables used are gender, age, marital status, education level, home ownership status and rural-urban status. According to the results of the AIC and RMSE calculation, Zero Inflated Negative Binomial on censored data showed the best performance for estimating the number of unhealthy days.

Using the Healthy Days Measure to Assess Factors Associated with Poor Health-Related Quality of Life for Patients with Metastatic Breast, Lung, or Colorectal Cancer Enrolled in a Medicare Advantage Health Plan.

This study investigated factors associated with patient-reported health-related quality of life (HRQoL) using the Centers for Disease Control and Prevention's Healthy Days tool for patients with Medicare Advantage undergoing treatment for metastatic breast, lung, and colorectal cancer. In 2015, a total of 6390 patients were mailed surveys regarding factors that may influence their HRQoL, including cancer-related symptoms. HRQoL was measured as the number of physically and mentally unhealthy days experienced in the past 30 days and summed for the total number of unhealthy days. Frequent unhealthy days was defined as ≥14 total unhealthy days in the prior month. Of 1567 respondents, the mean number of total unhealthy days (standard deviation) was 14.0 (11.9) with 46.2% experiencing frequent unhealthy days. On average, patients reported 10.5 (10.5) physically and 6.7 (9.4) mentally unhealthy days. Cancer-related symptoms, particularly pain and fatigue, were significantly associated with increased unhealthy days. In adjusted models, patients with pain had 83% more unhealthy days than patients without pain; patients with fatigue had 104% more unhealthy days than patients without fatigue. Diarrhea/constipation and shortness of breath also were associated with more unhealthy days. Cancer-related symptoms, most notably pain and fatigue, were associated with worse HRQoL for patients with metastatic cancer. Interventions aimed at ameliorating symptoms may improve quality of life for patients undergoing cancer treatment.

Single Parents in Germany: The Interrelation Between Social Support and Mental Health

The lives of single mothers and fathers are associated with specific demands, which may result in higher psychosocial and physical strain compared to parents sharing their household with a partner. In this context, social support is known to function as a protective resource. The present article examines how different levels of social support interrelate with levels of mental health in single mothers and fathers in Germany. The data is drawn from the surveys 2009, 2010 and 2012 of the study "German Health Update" (GEDA) by the Robert Koch Institute. The sample includes 2062 single mothers and 242 single fathers. Logistic and negative binomial regressions estimate the interrelation between social support and psychosocial strain (self-reported number of unhealthy days due to psychological strain in the last 4 weeks) and depression (12-month prevalence) for single parents (adjusted for family and socio-economic factors). Single mothers with low social support have a 2-fold statistical odds (OR=2.0, 95% CI: 1.35-2.87) for at least one unhealthy day due to psychosocial strain compared to single mothers with strong social support. The odds for single fathers with low social support are 3.3-fold (95%-CI: 1.09-10.23). Furthermore, the number of unhealthy days increased by a factor of 1.4 (95%-CI: 1.20-1.66) for single mothers with low social support (IRR). The IRR for single fathers of the same group was 1.7-fold (95%-KI: 0.97-3.01). The odds of reported depression in the past twelve months is 1.8-fold (95%-CI: 1.18-2.67) for single mothers and 2.1 (95%-CI: 0.51-8.83) for single fathers with low social support compared to single parents with high social support. The results show that social support is an important resource for the mental health of single parents, regardless of other social circumstances. The results identify key populations to target for future health interventions. However, the correlations between social support and socio-economic status have to be explored further.

The diagnosis of asymptomatic disease is associated with fewer healthy days: A cross sectional analysis from the national health and nutrition examination survey.

To examine the effect of the diagnosis of asymptomatic disease on health-related quality of life (HRQoL). Secondary analysis of a national data set. We analysed adult participants in the 2011-2012 National Health and Nutrition Examination Survey (NHANES) of the civilian non-institutionalized US general population. Across three asymptomatic diseases (glucose intolerance, hyperlipidaemia, and hypertension), we examined four groups (without disease; with disease but no diagnosis; with disease and diagnosis but no treatment; and with disease, diagnosis, and treatment). For each asymptomatic disease, we examined group differences in self-rated health (ordinal logistic regression) and Healthy Days outcomes (number of the last 30 days that physical health was not good, mental health was not good, or inactive; regression). Models were adjusted for age, sex, smoking status, insurance status, income, education, race, body mass index, and comorbid conditions. Analyses included 6012 respondents (glucose intolerance), 2772 respondents (hyperlipidaemia), and 5524 respondents (hypertension). In adjusted models, those who did not know about their disease had the same self-rated health scores as those without the disease, those with the disease without treatment, and those with disease and treatment. In adjusted analyses of the Healthy Days questions, those with unknown disease reported the same number of unhealthy days as those without disease with the exception of glucose intolerance. Conversely, in four of the nine possible comparisons, those with known disease without treatment reported more unhealthy days than those with who did not know about their disease. In adjusted analyses, individuals knowing about their asymptomatic disease are more likely to experience decrements in healthy days compared to those without knowledge of their asymptomatic disease. Statement of contribution What is already known on this subject? There has been sparse evidence that diagnosis of asymptomatic diseases is related to reduced health-related quality of life in population studies. Previous studies have included patients receiving treatment, which impedes the ability to isolate the effects of diagnosis from the effects of treatment. What does this study add? This report examines three asymptomatic health conditions: glucose intolerance, hyperlipidaemia, and hypertension. Those who did not know about their health condition generally had the same health-related quality of life scores as those without health conditions. Conversely, those diagnosed with disease but not receiving treatment reported worse health-related quality of life.

Is Recycling Good for the Economy and Environment or Just Hot Air? Evidence from California between 1993-2013

Recycling has been touted as a cost-effective mechanism for improving environmental quality and raising employment. Using county-level data from California between 2004 and 2017, this paper exploits plausibly exogenous changes in the exposure of households' to hazardous waste recycling to identify the effects on potential environmental and economic outcomes. While a 10% rise in recycling per household is associated with a 0.28% and 0.94% improvement in air quality and decline in the number of unhealthy days in a year, recycling is associated with a rise in net energy generation and fuel consumption and no association with economic activity. Even though the potential environmental effects may be small, there is some evidence that households in zipcodes with higher housing values and population density value reductions in hazardous waste.

The relationship between comorbidity medication adherence and health related quality of life among patients with cancer

BackgroundStudies have demonstrated that comorbidities compound the adverse influence of cancer on health-related quality of life (HRQoL). Comorbidities adversely impact adherence to cancer treatment. Additionally, adherence to medications for comorbidities is positively associated with HRQoL for various diseases. This study used the Center for Disease Control and Prevention’s Healthy Days measure of HRQoL to explore the association between HRQoL and adherence to comorbidity medication for elderly patients with cancer and at least one comorbid condition.MethodsWe conducted a cross-sectional survey combined with retrospective claims data. Patients with metastatic breast, lung or colorectal cancer were surveyed regarding their HRQoL, comorbidity medication adherence and cancer-related symptoms. Patients reported the number of physical, mental and total unhealthy days in the prior month. The Morisky Medication Adherence 8-point scale was differentiated into moderate/high (> 6) and low (≤ 6) comorbidity medication adherence.ResultsOf the 1847 respondents, the mean age was 69.2 years, most were female (66.8%) and the majority of the sample had Medicare coverage (88.2%). Low comorbidity medication adherence was associated with significantly more total, mental and physical unhealthy days. Low comorbidity medication adherence was associated with the presence of patient-reported cancer-related symptoms. Patients reporting low, as compared to moderate/high, comorbidity medication adherence had 23.4% more unhealthy days in adjusted analysis, P = 0.007.ConclusionThe positive association between low comorbidity medication adherence and the number of unhealthy days suggests that addressing barriers to comorbidity medication adherence during cancer treatment may be an avenue for improving or maintaining HRQoL for older patients with cancer and comorbid conditions.

Investigating air quality status and air pollutant trends over the Metropolitan Area of Tehran, Iran over the past decade between 2005 and 2014.

Studies on the trend of air pollution in Tehran, Iran, as one of the most polluted metropolis in the world are scant, and today Tehran is known for its high levels of air pollutants. In this study, the trend of air pollution concentration was evaluated over the past 10 years (2004-2015). The data were collected from 22 stations of the Air Quality Control Company. Daily concentrations of CO, NO2, SO2, O3, PM10 were analyzed using SPSS 16 based on the statistical method, repeated measures, and intra-group test to determine the pattern of each pollutant changes. As a result of the 22 air pollution monitoring stations, NO2 and SO2 concentrations have been increasing over the period of 10 years. The highest anomaly is related to SO2. The CO concentrations represent a descending pattern over the period, although there was a slight increase in 2013 and 2014. The O3 concentrations declined in the following years. The average concentration of PM10 has been rising during the period. Also we evaluated changes of each pollutant in different months and calculated the number of clean, healthy, unhealthy days for sensitive, unhealthy, very unhealthy, and dangerous groups. The study findings illustrated the necessity for larger investment in air pollution abatement. Overall, trends have been progressed to worsening, the number of healthy days has been declined and the number of unhealthy days has been increased in recent years.