Loss Of Workforce Research Articles

Applications of Corneal Foreign Body Patients and Safety Eyewear Usage Rates

Purpose: To investigate the practices numbers and the utilize of individual safety goggles of corneal foreign body patients in four year.Materials and Methods: We examined all corneal foreign body patients who practiced for safety goggles use in Adıyaman University Education and Research Hospital Ophthalmol Department between January 1st 2013 and January 1st 2016. The patients were analyzed in database of our hospital for their number of appeals in the last four year. Results: In the last four years, determined that 102 (19.62%) of the 520 patients, who were admitted to our hospital due to corneal foreign body, the first application group, 172 (33.07%) patients 2-5 applications group, 72 (13.85%) patients 5-10 application group and 174 (33.46%) patients more than 10 applicants group. In addition; identified 325 (62.5%) of the patients did not use safety glasses, while 195 (37.5%) patients used safety glasses. Conclusions: We determined that most of the patients who applied to our clinic with corneal foreign body did not use safety glasses and that the applications were repetitive. Corneal foreign bodies are accepted preventable causes of loss of vision or decrease in visual acuity. It has also caused workforce loss and increased treatment costs.

The Code of Practice and its enduring relevance in Europe and Eastern and Southern Africa.

BackgroundThe relevance and effectiveness of the WHO Global Code of Practice on the International Recruitment of Personnel will be reviewed by the World Health Assembly in 2015. The origins of the Code of Practice and the global health diplomacy process before and after its adoption are analyzed herein.Methods and ResultsCase studies from the European and eastern and southern African regions describe in detail successes and failures of the policy implementation of the Code. In Europe, the Code is effective and even more relevant than before, but might require some tweaking. In Eastern and Southern Africa, the code is relevant but far from efficient in mitigating the negative effects of health workforce migration.ConclusionsSolutions to strengthen the Code include clarification of some of its definitions and articles, inclusion of a governance structure and asustainable and binding financing system to reimburse countries for health workforce losses due to migration, and featuring of health worker migration on global policy agendas across a range of institutional policy domains.

Psychiatry trainees in Turkey considers leaving the country

IntroductionThe brain drain of mental health professionals is an important issue especially for developing countries with inadequate recruitment rates. The European Federation of Psychiatric Trainees (EFPT) investigated the extent of migration among trainees across Europe by Brain Drain research project. Results from a non-EU country, with the lowest number of mental health professionals per 100 000 population across OECD countries might provide important clues.ObjectiveTo identify attitudes towards and behaviors towards international migration among psychiatry trainees from Turkey.MethodAn online survey was conducted among psychiatry trainees from Turkey in 2013, as part of the EFPT Brain Drain Research Project.ResultsOf 107 trainees surveyed, 74% considered living abroad. However, the rate of having even short mobility experience was just 13%, and these were mainly educational visits. More than half of those who visited a foreign country reported to have a satisfactory experience, which might explain the positive influence of these visits on attitudes towards migration. Responders perceived academic conditions as the most important aspect of training that needs to be improved, in line with the fact that inadequate training programs were important reasons for migrating.ConclusionOverall, psychiatry trainees in Turkey tend to remain in their country of origin, which may protect healthcare system against the detriment of workforce loss. The relatively low rate of migration may also reflect the legislative barriers (e.g. being o non-EU country) impeding migrating. Our findings also suggest that the unmet educational needs of trainees require immediate attention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Is the Routine Use of Impedance Analysis for the Diagnosis of Gastro-Esophageal Reflux Disease More Expensive than Conventional pH Monitoring? Cost Analysis of Two Procedures.

Conventional 24-h pH monitoring is the gold standard for the diagnosis of non-erosive, non-acidic gastro-esophageal reflux disease. Multichannel Intraluminal Impedance (MII) analysis markedly improves diagnostic accuracy of non-erosive, non-acidic gastro-esophageal reflux disease. However, MII catheters are more expensive than standard catheters. This study aimed to determine the rates of acid or non-acid reflux and by making a retrospective projection, to predict the costs of two algorithms. We retrospectively reviewed the medical data of 102 patients who presented to our hospital with suspected non-erosive GERD and underwent 24h impedance/pH-monitoring. Demographic characteristics, Demeester scores, number of reflux episodes, and results of impedance analysis were recorded. According to these data, cost was calculated either for the scenario in which impedance measurement was performed solely or following a negative conventional pH monitoring. Thirty-seven of all 102 patients (36.3%) had a Demeester score greater than 14.7. These patients were assigned as group 1 (acid reflux). The impedance analysis of the remaining 65 patients detected 34 patients (33.3%) to have more than 50 reflux episodes over a period of 24h and assigned as Group 2, and 31 patients (30.4%) had no reflux (group 3). The cost of the single- step algorithm using MII catheter was calculated as $15,300, while the total cost of two-step scenario would have been predicted as $16,890. Our study showed that an initial conventional pH monitoring can make the diagnosis of GERD in only one third of the patients with suspected non-erosive GERD. In nearly two-thirds of patients, however, repeated procedures and use of impedance catheters are needed. It is clear that this algorithm has certain drawbacks with regard to cost, patient comfort, and workforce loss.

The rural medical generalist workforce: The Royal New Zealand College of General Practitioners' 2014 workforce survey results.

INTRODUCTION Previous surveys have revealed a New Zealand rural medical generalist workforce that is mainly male, older and dependent on international medical graduates (IMGs). AIMS To provide a snapshot of the New Zealand rural medical generalist workforce in 2014 and to make comparisons with the urban medical generalist workforce. To assess future workforce losses and find ways to address them. METHODS In March/April 2014, a survey of members of The Royal New Zealand College of General Practitioners used the SurveyMonkey tool. A comparative analysis was undertaken ofself-identified rural and urban respondents. RESULTS The response rate was 55.9% (2525/4514). Of the 2203 working respondents, 17.1% self-identified as rural, working in rural general practice or rural hospital medicine. Compared with urban respondents, more rural generalists were male (57.5% rural vs 45.5% urban; P < 0.01), aged ≥ 55 years (38.2% rural vs 32.6% urban; P = 0.04) and involved in teaching (53.0% rural vs 30.0% urban; P < 0.01). IMGs were an integral part of the rural generalist workforce (52.8% rural vs 38.7% urban; P < 0.01). More rural generalists worked ≥ 36 h per week (66.8% rural vs 50.4% urban; P < 0.01) and they were more likely to retire within the next 10 years (40.4% rural vs 34.7% urban; P = 0.0417). DISCUSSION The rural medical generalist workforce continues to be mainly male, older and consist of a high proportion of IMGs. Findings confirm the fragility of this workforce and highlight the need for renewed efforts to improve recruitment and retention.

Dementia, Care and Time in Postwar Japan: The Twilight Years, Memories of Tomorrow and Pecoross’ Mother and Her Days

As the number of people affected by dementia increases rapidly, dementia has been transformed into an epidemic which endangers global health and wealth, and many populations are now living in what Jain terms a time of prognosis, in fear of the disease. Through its strong association with ageing and memory loss, dementia is conceived of as a linear decline into loss of self and death, and those with dementia as other. More significantly, imagined as a threat that signifies both a loss of able-bodied workforce and a large population dependent on care and support, dementia inevitably feeds into the ‘crisis-of-care’ narrative that is prominent in many ageing societies. With one of the fastest ageing populations in the world, and an extremely low birth rate, the dementia prognosis is particularly acute in Japan and dementia is strongly linked to the idea of a ‘care crisis’. This situation has produced an increasing number of cultural representations of dementia and care and this paper considers three of these cultural texts, all rooted in the historical and cultural contexts in which they were produced: the novel The Twilight Years; the film Memories of Tomorrow; and the comic book Pecoross’ Mother and Her Days. The analysis concentrates upon their representations of care, seeing this as a space where the ethical relationship between self and other can be negotiated and where time with dementia can be imagined and re-imagined. The analysis of these texts from a feminist ethics perspective demonstrates the potential of popular and creative representations to interrogate and potentially expand the meanings of dementia, ageing and living in prognosis.

Retirement due to disabilities in patients with type 1 diabetes a nationwide multicenter survey in Brazil.

BackgroundThere is scarcity of data concerning retirement and workforce loss exclusively in patients with type 1 diabetes. The aim of this study was to evaluate the prevalence, causes, and predictors of retirement in patients with type 1 diabetes in Brazil.MethodsThis was a multicenter cross-sectional study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,180 patients aged 22 ± 11.7 years; 56.3% of the participants were female, and 57.4% were Caucasians. The mean time since diabetes diagnosis was 10.3 ± 8.1 years. Patients’ information (clinical factors and retirement data) was obtained through a questionnaire and a chart review. Patients were retired by diabetes according to the Brazilian Institute of Social Security’s criteria that takes in account the presence of diabetes-related chronic complications certified by a doctor, excluding any personal reason or another health condition besides diabetes. Both quantitative and qualitative tests were employed, and a multivariate logistic regression model was performed to identify the factors associated with retirement due to disabilities in patients with type 1 diabetes.ResultsThe overall frequency of retirement was 4.2%, with no difference between genders. The mean age of retirement was 35.5 ± 9.3 years, resulting in 17.5 ± 9.1 years of workforce losses. These patients had a significantly higher prevalence of severe hypoglycemia, proliferative and non-proliferative retinopathy, foot disorders, chronic or end-stage renal disease requiring dialysis or transplantation, cataracts, glaucoma, psychological disorders, hypertension, and overweight/obesity than did the employed patients. Multivariate logistic regression analysis with retirement as the dependent variable showed adjusted odds ratios (ORs) of 4.87 (2.66-8.78) for the presence of microvascular complications and 3.7 (2.04-6.70) for macrovascular complications.ConclusionsRetirement due to disabilities occurred in 4.2% of Brazilian patients with type 1 diabetes at an early age and is strongly associated with diabetes-related chronic complications. Health care workers should thus reevaluate the quality of care given to these patients.

The Use of the Cognitive Behavioral Therapy for the Treatment of Migraine and Tension Type Headaches

Headache, which affects a large part of the community and causes loss of workforce, is gaining importance in terms of the burden which it brings on the society, by its function of restricting individuals social activities as well as increasing the health expenditure likewise drug consumption. Migraine and tension headaches are primary headaches which any organic causes can not be determined for them. For the treatment of headaches of this type besides the use of medicine, exercises with bio-feedbacks and acupuncture; in recent years cognitive behavioral treatments (CBT) appears to be effective. It’s shown that the negative mode of thinking onindividuals which have recurrent headaches, stimulates the headache, increase its severity and complicates the management of it. CBT provides for the person a self-help opportunity even the therapy is terminated, besides behavioral methods such as relaxation exercises, by developing strategies of self-monitoring, education, abilities of pain management and coping with the maladaptive beliefs and houghts. The purpose of this text is, providing information about the use of the cognitive behavioral therapies on primary headaches and basic principles of treatment.

Treatment of ankylosing spondylitis.

Ankylosing spondylitis is a chronic, inflammatory, rheumatic disease that can reduce the quality of life and increase the risk of disability and mortality. It also causes direct and indirect economic losses due to health expenses and as a result of workforce loss. Management of this disease consists of pharmacological and nonpharmacological modalities. Until recently, pharmacological treatment options have been very limited. However, development of novel biological drugs revolutionized the management of this disease. The aim of this review article is to present an updated overview of the pharmacologic treatment of ankylosing spondylitis. Nonpharmacological treatment modalities including physiotherapy and exercise are only briefly mentioned and surgical treatment is not discussed.

Like Parent, Like Child? Considerations on Intergenerational Transmission of Alcoholism

Alcoholism is an important socio-economical problem in contemporary society given that it could result in loss of human lives, increased medical care costs, loss of workforce and increased criminality. In this study the authors analyzed the factors which may determine or facilitate the intergenerational transmission of alcoholism. To this aim the authors performed a literature search on this topic in the electronic database PUBMED using adequate keywords. The results demonstrated the intergenerational transmission of the alcohol consumption and the consumption patterns. The transmission mechanisms are complex and have a multi-factorial determination in which both genetic and family factors are involved. The authors underline the importance of the psycho-social intervention at the family level for the interruption of the vicious cycle of intergenerational transmission of alcoholism, without neglecting the social context in which the family is situated.

Inappropriate use of serological tests for hepatitis B virus in Evliya Celebi Education and Research Hospital of Dumlupinar University, Kütahya

Since hepatitis B virus (HBV) infections may cause serious clinical symptoms and become chronic, the appropriate use and interpretation of laboratory tests in diagnosis is crucial. Implementation of serological tests for all HBV markers leads to high cost, labour force and time loss, so diagnostic algorithms are used for this purpose. The aims of this retrospective study were to detect the number of unnecessary test requests in HBV infection serology and financial burden as its consequence and to find out the reasons and ways of solutions. Three-years records of microbiology laboratory of Dumlupinar University Evliya Celebi Training and Research Hospital, Kutahya, Turkey, between 2011-2013 were analysed for the detection of unnecessary test requests and a total of 179.640 HBV serological test results were evaluated. Serological tests requested more than one on the same day and HBeAg, anti-HBe and anti-HBc IgM tests required from the patients with natural immunity or vaccinated ones were considered as unnecessary test requests. The main reasons of unnecessary test requests were detected as follows; unable to check the previous HBV test results in HIMS (Hospital Information Management System) owing to restricted of time, not being friendly user of HIMS, not trusting the test results, not knowing diagnostics algorithms, requiring of the tests by secretaries or other staff like nurses, not questioning HBV vaccination and requiring screening tests because of the defensive medicine. Survey questions prepared to search these reasons and awareness level of diagnostic algorithms were handed and asked to fill out 146 physicians working at clinics which made over 100 unnecessary requests in 3 years. Total numbers of unnecessary requested serological HBV tests were 5415 (3.01%) and total financial burden for our hospital in three years was 42.256 TL (18.373 USD) according to the notifications of Turkish Social Security Institution. It was determined that the most unnecessary test requests were HBeAg (44.86%), anti-HBe (37.75%) and anti-HBc IgM (37.41%). The most unnecessary test requests were made by internal medicine, obstetrics and gynaecology, general surgery and cardiology clinics, respectively. According to questionnaires filled by the 100 clinicians, the most common causes of unnecessary tests were hepatitis test requests from hospitalized patients for screening (96%), the tests required by secretary or nurse (62%), pre-surgical screening tests (53%) and lack of knowledge about diagnostic algorithms (42%). In conclusion, it is suggested that test requests should be restricted by using screening algorithms and in-service training should be provided, tests required by secretary or nurse should be stopped and previous test results should be conveyed to the clinicians actively through HIMS in order to prevent unnecessary test requests causing economic and workforce loss in HBV infection serology. These measures can provide early and true diagnosis for the patients and also will reduce the economic loss.

On the road to a stronger public health workforce: visual tools to address complex challenges.

The public health workforce is vital to protecting the health and safety of the public, yet for years, state and local governmental public health agencies have reported substantial workforce losses and other challenges to the workforce that threaten the public's health. These challenges are complex, often involve multiple influencing or related causal factors, and demand comprehensive solutions. However, proposed solutions often focus on selected factors and might be fragmented rather than comprehensive. This paper describes approaches to characterizing the situation more comprehensively and includes two visual tools: (1) a fishbone, or Ishikawa, diagram that depicts multiple factors affecting the public health workforce; and (2) a roadmap that displays key elements-goals and strategies-to strengthen the public health workforce, thus moving from the problems depicted in the fishbone toward solutions. The visual tools aid thinking about ways to strengthen the public health workforce through collective solutions and to help leverage resources and build on each other's work. The strategic roadmap is intended to serve as a dynamic tool for partnership, prioritization, and gap assessment. These tools reflect and support CDC's commitment to working with partners on the highest priorities for strengthening the workforce to improve the public's health.

Traditional and Novel Biochemical Markers in Diagnosis and Monitoring of Diabetes

Diabetes with an increasing rate in all over the world, cause high rates of mortality and morbidity, besides high costs for medical treatment of the patients and workforce loss. Because the disease has individual and social effects, it should be diagnosed earlier as far as possible and establishment of necessary lifestyle changes is extremely important. For this purpose, fast, easy and inexpensive diagnostic approaches are obligatory. Scientists are seeking novel parameters for diagnosis of diabetes. Oral glucose tolerance test (OGTT) has been used in diagnosis of diabetes for many years, and cut-off values for glucose in this test are updated by WHO and ADA frequently. Probably, novel parameters suggested as alternative to OGTT will be used routinely by clinicians in the near future.

Characterization of the Federal Workforce at the Centers for Disease Control and Prevention

Studies characterizing the public health workforce are needed for providing the evidence on which to base planning and policy decision making both for workforce staffing and for addressing uncertainties regarding organizing, financing, and delivering effective public health strategies. The Centers for Disease Control and Prevention (CDC) is leading the enumeration of the US public health workforce with an initial focus on CDC as the leading federal public health agency. To characterize CDC's workforce, assess retirement eligibility and potential staff losses, and contribute these data as the federal component of national enumeration efforts. Two sources containing data related to CDC employees were analyzed. CDC's workforce was characterized by using data elements recommended for public health workforce enumeration and categorized the occupations of CDC staff into 15 standard occupational classifications by using position titles. Retirement eligibility and potential staffing losses were analyzed by using 1-, 3-, and 5-year increments and compared these data across occupational classifications to determine the future impact of potential loss of workforce. As of the first quarter of calendar year 2012, a total 11 223 persons were working at CDC; 10 316 were civil servants, and 907 were Commissioned Corps officers. Women accounted for 61%. Public health managers, laboratory workers, and administrative-clerical staff comprised the top 3 most common occupational classifications among CDC staff. Sixteen percent of the workforce was eligible to retire by December 2012, and more than 30% will be eligible to retire by December 2017. This study represents the first characterization of CDC's workforce and provides an evidence base upon which to develop policies for ensuring an ongoing ability to fulfill the CDC mission of maintaining and strengthening the public's health. Establishing a system for continually monitoring the public health workforce will support future efforts in understanding workforce shortages, capacity, and effectiveness; projecting trends; and initiating policies.

Effects of Lumbosacral Angles on Development of Low Back Pain

Objective: Low back pain [LBP] is an important health issue due the diagnosis and treatment expenses and loss of workforce it leads to. Biomechanical changes in the vertebral column caused by changes in the lumbosacral angles [LSAs] may lead to LBP. The purpose of this study was to assess body mass index [BMI] and LSAs in patients with LBP and investigate the association between LBP, LSAs and BMI.Methods: Lumbar lordotic angle [LLA], LSA, sacro-horizontal angle [SHA] and sacral inclination angle [SIA] were measured in 117 patients with chronic LBP and 85 healthy normal controls [HNCs] by means of lumbosacral radiography. In addition, association between LSAs, BMI and LBP was investigated.Results: There were no significant differences between patients and HNCs regarding LSAs and BMI. LLA was lower in male patients with LBP compared to male HNCs without LBP [p = 0.013]. In addition, SIA [p = 0.002] and BMI [p = 0.006] were higher in female patients with LBP compared to male patients with LBP. It was found that an increase in LLA increased the risk of having LPB by approximately 1.04-folds [ranging from 1.01 to 1.08; p = 0.045]. On the other hand, no association was found between LSAs and BMI.Conclusion: Changes in LSAs may cause LBP. An increase in LLA may be influential in increasing the risk of LBP. Therefore, measurement of LSAs may guide the physician who is to make clinical decisions in examination of patients with LBP.

Cost-benefit analysis of hyperphenylalaninemia due to 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency: for consideration of expanded newborn screening in Hong Kong.

To evaluate the cost-benefit of implementing an expanded newborn screening programme for hyperphenylalaninemias due to 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency in Hong Kong. Regional public hospitals in Hong Kong providing care for cases of inborn errors of metabolism. Implementational and operational costs of a new expanded mass spectrometry-based newborn screening programme were estimated. Data on various medical expenditures for the mild and severe phenotypic subtypes were gathered from a case cohort diagnosed with PTPS deficiency from 2001 to 2009. Local incidence from a previously published study was used. Implementation and operational costs of an expanded newborn screening programme in Hong Kong were estimated at HKD 10,473,848 (USD 1,342,801) annually. Assuming a birthrate of 50,000 per year and an incidence of 1 in 29,542 live births, the medical costs and adjusted loss of workforce per year would be HKD 20,773,207 (USD 2,663,232). Overall the annual savings from implementing the programme would be HKD 9,632,750 (USD 1,234,968). Our estimates show that implementation of an expanded newborn screening programme in Hong Kong is cost-effective, with a significant annual saving for public expenditure.

CHRONIC PELVIC PAIN: FOCUS ON ETIOLOGY AND MODULATION

Chronic Pelvic Pain (CPP) is defined as pelvic pain in the same location for at least 6 months, affects up to 25% of women at some time in their lives and can result in dysmenorrhea, dyspareunia, menstrual irregularities, back pain, gastrointestinal and genitourinary symptoms and reduced fecundity. Some of the most common causes of CPP are endometriosis, vulvodynia and abdominal wall and pelvic floor myalgia and neuropathy. Most women with complaints of pelvic pain will undergo laparoscopy to both diagnose and treat these diseases, but laparoscopy is often is unsuccessful due to lack of intraperitoneal pathology or altered pain processing. Pain out of proportion to identifiable pathology is the most immediate and dramatic consequence of disorders associated with CPP and is responsible for a highly negative impact on quality of life and substantial workforce loss. Due to the alarming situation and unmet need, many countries have launched a call for more focused research on improving the treatment of CPP syndrome.

Abstract P3-08-03: Establishing Japanese model “working ring” - Informational, emotional and problem-solving group intervention for working breast cancer survivors

Abstract Background: Due to advancement of cancer treatment, the number of cancer survivors is increasing and our society also needs to consider cancer survivorship. Especially the prevalence of breast cancer by age is much younger in Japan than in western countries. About half of them were diagnosed in 30-50’s, and they are considered strong working force in society. Cancer and its treatment largely affect their working status, therefore support system for workers with cancer is urgently required. Methods: We established support systems by 3 phases. We assessed the effect of breast cancer and informational needs in Japanese young breast cancer survivors for working with cancer (Phase 1). We also estimated economic impact due to such work force loss from cancer (Phase 2). Furthermore, we designed intervention model “Working Ring” by health care providers for cancer survivors to facilitate returning to work or keeping their job, and evaluated its effect (Phase3). Results: Among 42 young (less than 35 years old) breast cancer survivors who worked at the time of diagnosis, 33% of them had to changed their role at work after diagnosis of breast cancer. Focused interview revealed they needed informational and emotional support system. According to the Japanese Health Ministry of Health, Labor and Welfare database, we estimated total economic loss due to cancer treatment, $1569 million for women and $2959 million for men. Breast cancer is estimated as a number one cause of economic loss among cancer survivors in Japan. Finally, we introduced group intervention for working survivors provided by health care professionals (psycho-oncologist, nurse, and medical social worker) and labor and social security attorney. In this “Working Ring”, patients were given information about working status, practical issues provided by their companies and our society in order to maintain their work. We enrolled total 22 working breast cancer survivors divided in 3 groups; each group was given by 3 sessions of one-hour group intervention. All attendees of the group intervention showed increase in knowledge and problem solving technique concerning working, and QOL improvement by using POMS. Discussion: We noted that there are many unmet needs for working breast cancer survivors and loss of their job causes enormous impact for social economy. Surprisingly, breast cancer is estimated number one cause of economic loss from cancer diagnosis in Japan. It is urgently required to establish support systems for working cancer survivors. Our group interventional model “Working Ring” was very successful to improve their anxiety and informational needs. We are currently extending this model through entire Japan. Conclusions: Most of cancer survivors are considered to be potential working force. To establish a support system for them to maintain working ability and environment is necessary for societal reintegration. (This work is supported by a Grant-in-Aid for Cancer research from the Japanese Health Ministry of Health, Labor and Welfare, H24-Ganrinsho-ippan-011). Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-03.

Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion.

In some patients of Fournier gangrene originated from perianal region, it is important to prevent fecal contamination in order to provide healing without wound infection. For this purposes, diverting colostomy or bowel management catheter methods were performed. In this study, it is aimed to carry out a comparison of prognosis and cost efficiency between diverting colostomy and bowel management catheter methods applied for preventing fecal contamination in Fournier's gangrene patients. Fourty-eight patients with diagnosis of Fournier's gangrene, serious perianal infections, and preserved sphincters and without rectum injury after debridement were included in the study. The cases were divided into two groups as patients who were subjected to colostomy for fecal diversion and who were subjected to bowel management catheter without colostomy. Then, the groups were compared in terms of age, predisposing factors, duration of hospital stay, mortality, additional surgery requirements, and cost. Fourty-eight patients were included the study. Sixteen patients were treated without colostomy. Decreased duration of total hospital stay, additional surgery requirements, and hospital expense in bowel management catheter group has determined. It is thought that preferring bowel management catheter method instead of colostomy in patients without rectum injury, who require diverting colostomy and have undamaged anal sphincters, can relieve patients, patients' relatives, healthcare organizations, and the national economy of a serious burden. In addition, although patients' satisfaction and workforce loss factors are not taken into consideration in this study, the bowel management catheter method is thought to have positive effects also on these parameters.

Controlling the Spread of Disease in Schools

Pandemic and seasonal infectious diseases such as influenza may have serious negative health and economic consequences. Certain non-pharmaceutical intervention strategies – including school closures – can be implemented rapidly as a first line of defense against spread. Such interventions attempt to reduce the effective number of contacts between individuals within a community; yet the efficacy of closing schools to reduce disease transmission is unclear, and closures certainly result in significant economic impacts for caregivers who must stay at home to care for their children. Using individual-based computer simulation models to trace contacts among schoolchildren within a stereotypical school setting, we show how alternative school-based disease interventions have great potential to be as effective as traditional school closures without the corresponding loss of workforce and economic impacts.