Health Care Priorities Research Articles

Outpatient healthcare costs associated with overweight and obesity in Italy

BackgroundTo evaluate outpatient healthcare expenditure associated with different levels of BMI and glucose metabolism alterations.MethodsThe study is based on a representative national sample of adults, with data obtained from electronic clinical records of 900 Italian general practitioners. Data relative to the year 2018 were analyzed. The study population was classified according to BMI (normal weight, overweight, and obesity classes 1, 2, and 3) and glucose metabolism status (normoglycemia – NGT; impaired fasting glucose – IFG; diabetes mellitus – DM). Outpatient health expenditures include diagnostic tests, specialist visits, and drugs.ResultsData relative to 991,917 adults were analyzed. Annual per capita expenditure rose from 252.2 Euro among individuals with normal weight to 752.9 Euro among those with class 3 obesity. The presence of obesity determined an excess cost, particularly among younger individuals. Within each BMI class, the presence of IFG or DM2 identified subgroups of individuals with substantially higher healthcare expenditures.ConclusionsOutpatient healthcare costs markedly increased with increasing BMI in all age categories, particularly among individuals below 65. Addressing the double burden of excess weight and hyperglycemia represents a significant challenge and a healthcare priority.

Аспекты качества жизни лиц трудоспособного возраста с хроническими неинфекционными заболеваниями органов дыхания

Chronic noncommunicable diseases (NCD) are widespread and affect people of different age groups in all countries. The fight against this group of diseases is one of the priorities of the modern health care. Non-infectious diseases of the respiratory system as well as other diseases, affect social, physical and mental components of well-being. The qualitative assessment of their influence helps to assess the study of the quality of life. P u r p o s e : to assess the quality of life of the working-age population of the Nizhny Novgorod region and to develop measures to reduce the risk factors for chronic non-infectious diseases of the respiratory system in these cohorts. M a t e r i a l s a n d m e t h o d s . A one-stage comparative study was carried out using the method of standardized interviewing using the SF‑36 questionnaire. The quality of life of people of various age-gender groups with chronic non-infectious diseases of the respiratory system was assessed. All respondents were stratified into groups by pathology and age. R e s u l t s . The scientific article reflects the results of the study of assessing the quality of life of working-age patients with the chronic respiratory system pathology. The analysis of the data revealed statistically significant differences in age, gender and groups of pathologies among the respondents. Differences in indicators reflecting emotional states were revealed among men and women of the working age. Age-related changes in indicators of physical and psychological components of health and on all scales of the quality of life were presented. The obtained values of patient indicators show the need to develop specific measures to reduce behavioral risk factors for chronic non-infectious respiratory diseases of the population of the Nizhny Novgorod region. Findings. The comparative analysis of the results of the scales of the quality of life and health components reflects the age-related changes in indicators. The people of the older age group of the working age demonstrate significantly low results. The indicators of physical functioning are statistically significantly different in different pathologies of the respiratory system. Chronic obstructive pulmonary disease (COPD) restricts the physical activity of patients more strongly than other pathologies. Low values of the quality of life reflect the need to develop the measures to reduce the risk factors for chronic non-infectious diseases for the population of the Nizhny Novgorod region.

Prevalence and Complications of Diabetes Mellitus in India: A Systematic Review

Abstract: Background and Aim: Diabetes is progressively becoming a vital chronic disease burden worldwide, mainly in developing countries such as India, necessitating a shift in healthcare priorities and advanced data on the epidemiology and impact of diabetes to help plan and prioritize health programs. We systematically reviewed the literature on diabetes prevalence and its complications in India. Methodology: This systematic review focuses on diabetes prevalence and complications in India from January 2000 to September 2021. Literature searches were conducted using electronic databases. Results: Diabetes prevalence ranged from 2.02% in rural Madhya Pradesh to 40.3% in Tamil Nadu. Diabetes prevalence was significantly higher in urban areas than in rural areas. The prevalence of prediabetes varied across Indian states ranging from 2.4% in Meghalaya to 47.6% in Delhi. The prevalence of chronic diabetes complications ranged from 4.8% to 21.7% for retinopathy, 0.9% to 62.3% for nephropathy, and 10.5% to 44.9% for neuropathy. Conclusion: Diabetes is a significant and widespread health problem in India. Dissimilarity in the prevalence of diabetes between individual states is observed. Most diabetes patients experience chronic complications of diabetes. Consequently, it is essential to map the urgent preventive approach to reduce the further increase in areas with high prevalence. Keywords: Type 2 diabetes, Diabetes complications, India, Urban, Rural.

The role of eradication of Helicobacter pylori infection in the prevention of gastric cancer (based on the Maastricht-VI consensus report)

The article discusses the statements of the section of the consensus meeting “Maastricht-VI” (2021), dedicated to the role of H.pylori infection eradication in prevention of the development of gastric cancer. Experts have confi rmed that this infection is currently the main etiological factor of gastric cancer. Its eradication leads to regression of atrophic changes in the gastric mucosa and reduces the risk of development of gastric cancer. This makes it necessary to implement the population program “test and treat” for the purpose of cancer prevention and to include it among the priorities of healthcare.

Association of postnatal age with neonatal hospital-onset bacteremia in a multicenter, retrospective cohort

Background: Prevention of hospital-onset bacteremia (HOB) in all settings is a healthcare priority. The CDC is developing a neonatal-specific HOB quality metric, but the epidemiology of neonatal HOB is poorly understood. Our objective was to validate a prior single-center finding that HOB risk varies by birthweight and postnatal age in a multicenter cohort. Methods: We performed a multicenter, retrospective cohort study of neonates admitted to 4 neonatal intensive care units (NICUs) for ≥4 days between July 1, 2016, and July 1, 2021. HOB was defined as a positive blood culture for bacteria or fungi on day ≥4 of admission. The first HOB event in the hospitalization was counted per neonate. Repeat HOB events during a neonate’s admission were excluded. Poisson regression models with robust variance estimates were used to estimate the incidence rate (IR) of HOB, expressed as HOB events per 1,000 patient days and IR ratios (IRRs), within strata defined by CDC birthweight categories and 4-week postnatal age intervals, adjusting for central venous catheter (CVC) presence at time of HOB and study site. Results: The analysis included 9,267 neonates, contributing 191,295 patient days and 470 HOB events, with an unadjusted IR of 2.46 per 1,000 patient days (Table 1). Of 477 infants born ≤750 g, 153 (30.1%) had a HOB with an IR of 13.3 (95% CI, 10.5–16.0) events per 1,000 patient days in the first 4 weeks after birth (Fig. 1). After adjusting for CVC presence and study site, infants ≤750 g had a higher HOB rate in the first 4 weeks of life (IRR, 7.45; 95% CI, 3.81–14.56) compared to infants ≥2,500 g. After 8 weeks of life, there was no difference in HOB rate in the 2 groups (IRR, 0.8, 95% CI, 0.3–2.7). Conclusions: Neonates born ≤750 g were at highest risk for HOB within the first 4 weeks after birth; however, risk for HOB was not consistent over time. Postnatal age should be considered in a neonatal HOB quality metric.Disclosures: None

HPR29 Health Equity Frameworks – Healthcare System Actions and Priorities

Health equity has been defined as attainment of the highest level of health for all people, regardless of race, ethnicity, disability, and/or other factors affecting access to care and health outcomes in healthcare delivery. Health equity is becoming a priority for payers and hospitals looking to improve patient outcomes. The objective of this research was to evaluate health equity frameworks currently used by payer and hospital organizations.

Cost and Cost-Effectiveness of Treating Childhood Cancer at Jimma Medical Center.

More than 70% of childhood cancer patients die in Sub-Saharan African countries due to a lack of access. Additionally establishing a childhood cancer treatment service is perceived as expensive by the decision-makers of LMICs. However, there is a paucity of evidence on the actual cost and cost-effectiveness of this service in LMICs including Ethiopia. This study provides context-relevant evidence to consider childhood cancer treatment in the healthcare priority settings in Ethiopia and other LMICs. Newly admitted case files of children for the year 2020/21 were reviewed. The cost was analyzed from the provider's perspective. The effectiveness was calculated using DALY averted based on the 5 years of survival rates, which is estimated from the 1-year survival rate of Kaplan-Meier output. The do-nothing was our comparator, and we assumed no cost (zero cost) will be incurred for the comparator. To account for sensitivity analyses, we varied the discount rate, 5-year survival rate, and life expectancy. During the study period, 101 children were treated in the unit. The total annual and unit cost to give treatment to childhood cancer patients was estimated at $279,648 and $2769, respectively. The highest per-patient annual unit cost of treatment was Hodgkin's lymphoma ($6252), while Retinoblastoma ($1520) was the least. The cost per DALY averted was $193, which is significantly less than Ethiopia's GDP per capita ($936.3). The results remained very cost-effective in sensitivity analyses. Childhood cancer treatment is very cost-effective in Ethiopia as per WHO-CHOICE thresholds even in a conservative adjustment of assumptions. Therefore, to enhance and improve children's health, childhood cancer should get a better concern in health priority.

Vasculogenic Mesodermal Cells Derived From Induced Pluripotent Stem Cells Improve Limb Perfusion and Decrease Necrosis in Murine Models of Hindlimb Ischemia

Critical limb-threatening ischemia (CLTI) is a national health care priority as there has been a 50% increase in amputations from 2010 to 2018. Unlike other cell products that simply secrete proangiogenic growth factors, induced pluripotent stem cell (iPSC)-derived mesodermal cells have the capacity to differentiate into endothelial cells and smooth muscle cells and form functioning blood vessels in vivo. Here we discuss the effects of intramuscular injection of human iPSC mesodermal cells (VSC100) on limb perfusion and limb necrosis. iPSCs were produced using methods including Yamanaka factors (Broxmeyer et al [21393480]). The iPSC cells were differentiated using sequential Activin A, BMP4, vascular endothelial growth factor, and fibroblast growth factor 2 to promote mesodermal and endothelial cell differentiation. Murine CLTI models were created via excision of the common femoral artery in male BALB-C Nude mice, aged 6 to 8 weeks. After creation of the CLTI model mice were randomized to 1 × 106 VSC100 cells labeled with td-tomato (red fluorescence) or vehicle control injected into the gastrocnemius and gracilis muscles (n = 10/group) at 7 to 14 days postinduction of ischemia. Limb perfusion was measured with laser speckle contrast imaging up to day 64, qualitative analysis of VSC100 differentiation into capillaries was assessed with immunohistochemical staining for isolectin B4 and human CD31 and confocal microscopy to detect td-tomato. Degree of tissue loss of the index limb was quantified with established necrosis scores. VSC100-treated BALB-C nude mice showed a significant increase in limb perfusion as compared to vehicle controls with average percent blood flow/contralateral limb ratios of 45% in treated groups compared to 25% in control (P < .001) at day 64 (Fig 1). Limb necrosis scores showed similar results, in that necrosis was statistically significantly reduced in iPSC-treated vs vehicle control treated groups (Fig 2). Immunohistochemical analysis showed qualitative significant deposition of cells of interest in our CLTI models. iPSC-derived VSC100 is a novel approach to treating CTLI as the cells are capable of forming functioning blood vessels in ischemia skeletal muscle, improve tissue perfusion, and mitigate tissue necrosis. These early results and data support further translational work to support development of an investigational new drug for future clinical trial studies.Fig 2Clinical scoring ratio of chronic limb-threatening ischemia (CLTI) in control vs treated groups. Mouse population same as in Fig 1 (n = 10/group).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

An Assessment of the Availability of Essential Medicines in Gadag Taluk, Karnataka: A Study of Primary Health Centers.

Background Essential medicines are those that meet the priority healthcare needs of most of the population and are included in the 2030 Agenda for Sustainable Development. The national list of essential medicines should be tailored to the specific needs of each nation and should always be accessible at reasonable prices and with guaranteed quality. Methods A cross-sectional study was done to assess the availability of essential medicines in primary health centers (PHCs) in Gadag Taluk. The data for the assessment of availability was collected using a checklist, which was prepared after reviewing the Karnataka list of essential medicines, surgical items, and miscellaneous items from 2021 to 2022 for PHCs. The sampling design was a universal sample of all 15 PHCs, as per health management information system data, to assess the availability of essential medicine in PHCs. Results Results indicate that theavailability of essential medicines in 15 PHCs in Gadag Taluk is 74.20%. The availability of anti-allergic drugs and drugs used in anaphylaxis was around 88%, whereas the availability of antidiabetic drugs and non-steroidal anti-inflammatory drugs was 86.88% and 86.66%, respectively. All other categories of drugs are available above 50%, except ophthalmic and ear, nose, and throat drugs. Conclusion The public sector should be strengthened by making sure that patients have access to free essential medicines and that essential medications are always available. This would help patients spend less money out of their own pockets and move India closer to achieving universal healthcare.

Keterkaitan Pengaruh Iklim Terhadap Angka Kejadian Tuberkulosis Berbasis Web Gis

Management of pulmonary tuberculosis (TB) in Bogor City is still a priority in health care. The high number of TB cases in the Lawang Gintung Health Center area in the 2017-2019 period reached 126 new cases. Where the most new cases were in the Muarasari Village with a total of 52 new cases of TB. This research method uses the spatial interpolation method to determine the distribution of climate and its association with the incidence of new cases of pulmonary TB. Through the development of spatial interpolation GIS, it is known that the pattern of distribution of cases per month in the area of ??the Public Health Center in terms of the relationship between climate and the development of new cases of TB in the area of ??the Lawang Gintung public Health center. Incidence Rate in the region public Health center Lawang Gintung per month during 2017-2019 was highest in February with an IR value of 8.7 per 10,000 people/population. The increase in the IR value in each month is accompanied by an increase in the average value of rainfall (mm²), air temperature (°C), and humidity (%). Where in January the IR value was 2.2, increasing in February to 8.7 with an average rainfall value per month of January 15.4 mm² and in February it increased to 25.3 mm². Followed by increasing the value of air temperature and humidity. Correlation of climate to the incidence of new cases of pulmonary TB in the region public Health center Lawang Gintung is known that rainfall is positive with an R² value of 0.50. Air temperature is negative where R² is 0.01 and humidity is positive with R² value is 0.17.

Patient safety in prisons: a multi-method analysis of reported incidents in England.

Prisoners use healthcare services three times more frequently than the general population with poorer health outcomes. Their distinct healthcare needs often pose challenges to safe healthcare provision. This study aimed to characterise patient safety incidents reported in prisons to guide practice improvement and identify health policy priorities.Design: We carried out an exploratory multi-method analysis of anonymised safety incidents from prisons. Safety incidents had been reported to the National Reporting and Learning System by prisons in England between April 2018 and March 2019. Reports were reviewed to identify any unintended or unexpected incident(s) which could have, or did, lead to harm for prisoners receiving healthcare. Free-text descriptions were examined to identify the type and nature of safety incidents, their outcomes and harm severity. Analysis was contextualised with subject experts through structured workshops to explain relationships between the most common incidents and contributory factors. Of 4112 reports, the most frequently observed incidents were medication-related (n = 1167, 33%), specifically whilst administering medications (n = 626, 54%). Next, were access-related (n = 559,15%), inclusive of delays in patients accessing healthcare professionals (n = 236, 42%) and managing medical appointments (n = 171, 31%). The workshops contextualised incidents involving contributing factors (n = 1529, 28%) into three key themes, namely healthcare access, continuity of care and the balance between prison and healthcare priorities. This study highlights the importance of improving medication safety and access to healthcare services for prisoners. We recommend staffing level reviews to ensure healthcare appointments are attended, and to review procedures for handling missed appointments, communication during patient transfers and medication prescribing.

Prediction of in-hospital mortality rate in COVID-19 patients with diabetes mellitus using machine learning methods.

Since its emergence in December 2019, until June 2022, coronavirus 2019 (COVID-19) has impacted populations all around the globe with it having been contracted by ~ 535M people and leaving ~ 6.31M dead. This makes identifying and predicating COVID-19 an important healthcare priority. The dataset used in this study was obtained from Shahid Beheshti University of Medical Sciences in Tehran, and includes the information of 29,817 COVID-19 patients who were hospitalized between October 8, 2019 and March 8, 2021. As diabetes has been shown to be a significant factor for poor outcome, we have focused on COVID-19 patients with diabetes, leaving us with 2824 records. The data has been analyzed using a decision tree algorithm and several association rules were mined. Said decision tree was also used in order to predict the release status of patients. We have used accuracy (87.07%), sensitivity (88%), and specificity (80%) as assessment metrics for our model. Initially, this study provided information about the percentages of admitted Covid-19 patients with various underlying disease. It was observed that diabetic patients were the largest population at risk. As such, based on the rules derived from our dataset, we found that age category (51-80), CPR and ICU residency play a pivotal role in the discharge status of diabetic inpatients.

Political Priorities, Voting, and Political Action Committee Engagement of Emergency Medicine Trainees: A National Survey.

Medicine is increasingly influenced by politics, but physicians have historically had lower voter turnout than the general public. Turnout is even lower for younger voters. Little is known about the political interests, voting activity, or political action committee (PAC) involvement of emergency physicians in training. We evaluated EM trainees' political priorities, use of and barriers to voting, and engagement with an emergency medicine (EM) PAC. Resident/medical student Emergency Medicine Residents' Association members were emailed a survey between October-November 2018. Questions involved political priorities, perspective on single-payer healthcare, voting knowledge/behavior, and EM PACs participation. We analyzed data using descriptive statistics. Survey participants included 1,241 fully responding medical students and residents, with a calculated response rate of 20%. The top three healthcare priorities were as follows: 1) high cost of healthcare/price transparency; 2) decreasing the number of uninsured; and 3) quality of health insurance. The top EM-specific issue was ED crowding and boarding. Most trainees (70%) were supportive of single-payer healthcare: "somewhat favor" (36%) and "strongly favor" (34%). Trainees had high rates of voting in presidential elections (89%) but less frequent use of other voting options: 54% absentee ballots; 56% voting in state primary races; and 38% early voting. Over half (66%) missed voting in prior elections, with work cited as the most frequent (70%) barrier. While overall, half of respondents (62%) reported awareness of EM PACs, only 4% of respondents had contributed. The high cost of healthcare was the top concern among EM trainees. Survey respondents had a high level of knowledge of absentee and early voting but less frequently used these options. Encouragement of early and absentee voting can improve voter turnout of EM trainees. Concerning EM PACs, there is significant room for membership growth. With improved knowledge of the political priorities of EM trainees, physician organizations and PACs can better engage future physicians.

Abstract 547: Vasculogenic Mesodermal Cells Derived From Induced Pluripotent Stem Cells Improve Limb Perfusion And Decrease Necrosis in Murine Models of Hindlimb Ischemia

Objectives: Critical Limb Threatening Ischemia (CLTI) is a health care priority with a 50% increase in amputations from 2010 to 2018. Unlike other cell products that simply secrete pro-angiogenic growth factors Induced pluripotent stem cells (iPSC) derived mesodermal cells can differentiate into endothelial and smooth muscle cells and form functioning blood vessels in vivo . We discuss the effects of intramuscular injection of human iPSC mesodermal cells (VSC100) on limb perfusion and limb necrosis. Methods: IPSCs were produced using methods including Yamanaka factors (Broxmeyer H. et al [21393480}). iPSC cells were differentiated using sequential Activin A, BMP4, VEGF, and FGF2 to promote mesodermal and endothelial cell (EC) differentiation. Murine CLTI models were created via excision of the common femoral artery in male BALB-C Nude mice, aged 6-8 weeks. After creation of the CLTI model mice were randomized to 1x10 6 VSC100 cells labeled with td-tomato (red fluorescence) or vehicle control injected into the gastrocnemius and gracilis muscles (N=10/group) at 7-14 days postinduction of ischemia. Limb perfusion was measured with Laser Speckle Contrast Imaging (LSCI) up to Day 64, qualitative analysis of VSC100 differentiation into capillaries was assessed with immunohistochemical staining for Isolectin B4 and human CD31 and confocal microscopy to detect td-tomato. Degree of tissue loss of the index limb was quantified with established necrosis scores. Results: VSC100 treated mice showed a significant increase in limb perfusion compared to controls, average percent blood flow/contralateral limb ratios of 45% in treated groups compared to 25% in control (p &lt; 0.001) at day 64 (Figure 1). Limb necrosis scores showed necrosis was statistically significantly reduced in iPSC treated versus vehicle control treated groups (Figure 2). Immunohistochemical analysis showed qualitative significant deposition of cells of interest in our CLTI models. Conclusions: iPSC derived VSC100 is a novel approach to treating CTLI as the cells can form functioning blood vessels in ischemic skeletal muscle, improve tissue perfusion, and mitigate tissue necrosis. These early results are being used for FDA applications for clinical trials utilizing iPSCs in CLTI patients.

Female reproductive health impacts of Long COVID and associated illnesses including ME/CFS, POTS, and connective tissue disorders: a literature review.

Long COVID disproportionately affects premenopausal women, but relatively few studies have examined Long COVID's impact on female reproductive health. We conduct a review of the literature documenting the female reproductive health impacts of Long COVID which may include disruptions to the menstrual cycle, gonadal function, ovarian sufficiency, menopause, and fertility, as well as symptom exacerbation around menstruation. Given limited research, we also review the reproductive health impacts of overlapping and associated illnesses including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS), connective tissue disorders like Ehlers-Danlos syndrome (EDS), and endometriosis, as these illnesses may help to elucidate reproductive health conditions in Long COVID. These associated illnesses, whose patients are 70%-80% women, have increased rates of dysmenorrhea, amenorrhea, oligomenorrhea, dyspareunia, endometriosis, infertility, vulvodynia, intermenstrual bleeding, ovarian cysts, uterine fibroids and bleeding, pelvic congestion syndrome, gynecological surgeries, and adverse pregnancy complications such as preeclampsia, maternal mortality, and premature birth. Additionally, in Long COVID and associated illnesses, symptoms can be impacted by the menstrual cycle, pregnancy, and menopause. We propose priorities for future research and reproductive healthcare in Long COVID based on a review of the literature. These include screening Long COVID patients for comorbid and associated conditions; studying the impacts of the menstrual cycle, pregnancy, and menopause on symptoms and illness progression; uncovering the role of sex differences and sex hormones in Long COVID and associated illnesses; and addressing historical research and healthcare inequities that have contributed to detrimental knowledge gaps for this patient population.

“This Is Where We Have Scored”: Exploring the Interface between Project and Institutional Sustainability Facilitated by a Faith-Based Development Organisation in Sierra Leone

This paper explores the issue of project sustainability through an analysis of the experiences of a Faith-Based Development Organisation (FBDO) in Bo, Sierra Leone. The FBDO in question was approached by members of their local Catholic Women Association (CWA) to help them with the planning and management of a farm that had been donated to them by a chief. They agreed to this, and a series of workshops were held in June 2014, along with follow-up discussions with local experts and businesses as to what could be done to help support the women in their endeavour. Amongst other priorities, the women identified the need for the farm to produce food, income and help with their development. However, an outbreak of the Ebola virus that occurred between 2014 and 2016, following as it did on the back of an 11-year (1991–2002) civil war in Sierra Leone, led to a re-evaluation of the farm project in the eyes of the FBDO as they decided to shift to earlier priorities in education and health care. Given the constraints regarding resources and personnel, community projects, such as the CWA farm project, became of much lesser importance even though it resonated strongly with the goals of the FBDO and government, and had garnered much support amongst international donors. The paper sets out that story, beginning with the workshops and discussions held in 2014, and the ramifications of these responses to various ‘shocks’, such as those presented by the civil war and disease outbreaks (Ebola and COVID-19); it also provides recommendations that might be of use regarding the interface between project and institutional sustainability within FBDOs and, indeed, the wider community of development organisations.

Availability of essential medicines, progress and regional distribution in China: a systematic review and meta-analysis.

Essential medicines are the backbone of healthcare and meet the priority healthcare needs of the population. However, approximately one-third of the global population does not have access to essential medicines. Although China formulated essential medicine policies in 2009, the progress of availability of essential medicines and regional variations remains unknown. Therefore, this study was conducted to evaluate the availability of essential medicines, their progress, and regional distribution in China in the last decade. We searched eight databases from their inception to February 2022, relevant websites, and reference lists of included studies. Two reviewers selected studies, extracted data, and evaluated the risk of bias independently. Meta-analyses were performed to quantify the availability of essential medicines, their progress, and regional distribution. Overall 36 cross-sectional studies conducted from 2009 to 2019 were included, with regional data for 14 provinces. The availability of essential medicines in 2015-2019 [28.1%, 95% confidence interval (CI): 26.4-29.9%] was similar to that in 2009-2014 (29.4%, 95% CI: 27.5-31.3%); lower in the Western region (19.8%, 95% CI: 18.1-21.5%) than Eastern (33.8%, 95% CI: 31.6-36.1%) and Central region (34.5%, 95% CI: 30.6-38.5%); very low for 8 Anatomical Therapeutic Chemical (ATC) categories (57.1%), and low for 5 categories (35.7%) among all ATC groups. The availability of essential medicines in China is low compared with the World Health Organization goal, has not changed much in the last decade, is unequal across regions, and lacks data for half of provinces. For policy-making, the monitoring system of the availability of essential medicines is to be strengthened to enable long-term surveillance, especially in provinces where the data has been missing. Meanwhile, Joint efforts from all stakeholders are warranted to improve the availability of essential medicines in China toward the universal health coverage target. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=315267, identifier: PROSPERO CRD42022315267.

Trends in economic burden of type 2 diabetes in China: Based on longitudinal claim data.

Diabetes is a major health issue in China that has a significant economic burden on society. Understanding the economic impact of diabetes can help policymakers make informed decisions about healthcare spending and priorities. This study aims to estimate the economic burden of patients with diabetes in an urban setting in China and to identify the impact of hospitalization and complications on health care costs for people with diabetes. The study was conducted in a sample city located in eastern China. All patients diagnosed with diabetes before January 2015 were identified from the official health management information system, and their social demographics and records of their health care uses and costs were extracted from the claim database from 2014 to 2019. Six groups of complications were identified according to ICD-10 codes. The diabetes-related direct medical cost (DM cost) was described for patients in stratified groups. A multiple linear regression model was applied to identify the effect of hospitalization and complications on the DM cost of diabetic patients. Our research included 44,994 patients with diabetes, the average annual DM costs for diabetic patients increased from 1,292.72 USD in 2014 to 2,092.87 USD in 2019. The costs of diabetes are closely related to hospitalizations and the type and number of complications. The average annual DM cost of patients who were hospitalized was 2.23 times that of those without hospitalization, and it rose as the number of complications increased. Cardiovascular complications and nephropathic complications were the complications that had the greatest impact on patients' DM costs, increasing by an average of 65 and 54%, respectively. The economic burden of diabetes in urban China has increased significantly. Hospitalization and the type and number of complications have significant impacts on the economic burden of patients with diabetes. Efforts should be made to prevent the development of long-term complications in the population with diabetes.

National and regional prevalence rates of hypertension in Saudi Arabia: A descriptive analysis using the national survey data.

Limited studies have examined the prevalence of hypertension (HTN) at the national and regional levels in Saudi Arabia. Therefore, this study aimed to examine the national and regional prevalence of HTN in the Saudi population. This study used the data from household health survey carried out by the General Authority for Statistics in 2017. It included 24,012 households representing the Saudi population across all 13 administrative regions. The diagnosis of HTN was confirmed by a self-reported history of a physician diagnosed HTN. The prevalence of HTN was 9.2% among Saudi population aged 15 years and older. It was relatively higher in women (10.0%) than in men (8.5%). The prevalence of HTN increased with advancing age (aged 65 years and older), accounting for 55.3% in women and 48.0% in men; its prevalence was relatively low among the younger age group, accounting for 0.1% in those aged 15-19 years. A large difference was found in the prevalence of HTN between regions, ranging from 6.0% in Najran region to 10.0% in Makkah region. This study reported the national and regional prevalence of HTN among Saudi adults using a representative sample with large variations in the prevalence rates according to age, sex, and regions. Older age, men, and Makkah region had higher prevalence of HTN. Our findings will help determine the etiological factors, identify the priorities for healthcare, and generate initiatives for policymakers, and develop preventive and therapeutic strategies for HTN.

Medicine and the Law.

Medico-legal claims in the South African health sector have markedly increased since approximately 2007. This is noteworthy as money spent on these claims from the public health budget, is money which should have been spent on the healthcare priorities identified in the National Department of Health Strategic Plan. As such, it becomes important to understand why these claims have shown drastic increases. This piece therefore discusses the causes of increased claims which include clinical errors, maladministration and mismanagement; the legal profession's contribution to the problem; legal developments and patient awareness as well as some other additional causes. Possible solutions are also offered such as those related to the NDOH and National Core Standards and Ideal Clinic initiative quality of care standards; improving the healthcare system and quality of care; better distinguishing between valid and invalid or fraudulent claims, the possible role of fit-for-purpose legislation and a reconsideration of compensation methods.