Societal cost of childhood intellectual disability in Australia

BACKGROUND

There is limited research quantifying the direct and indirect economic costs associated with intellectual disability (ID) in Australia. Costs incurred by families, governments and broader society include time spent providing care, absenteeism and increased healthcare utilisation. The purpose of this research is to quantify the costs associated with ID in childhood using a range of methods to collect cost data.

METHODS

Costs included healthcare service utilisation, pharmaceutical use, caregiver productivity losses and time spent providing care because of the child's disability. The sample comprised caregivers with a child with ID aged between 2 and 10 years old recruited in Australia. Healthcare service utilisation and pharmaceutical use were obtained from routinely collected administrative claims data. Healthcare utilisation not captured in the routinely collected administrative data and absenteeism data were obtained from a retrospective recall-based questionnaire. Time spent providing care because of the child's disability was obtained using a time-use diary.

RESULTS

The total cost of ID in Australia was estimated to be AUD 72 027 per year per child, and the total cost of ID in childhood was estimated to be AUD 12.5 billion per year. The cost to governments of ID in childhood was estimated to be AUD 6385 per child per year, resulting in a total cost to government of AUD 1.1 billion per year.

CONCLUSIONS

This is the first study to estimate the direct and indirect costs associated with ID in childhood. The results of this research demonstrate the considerable economic impact of ID in childhood on families, governments and broader society in terms of both direct and indirect costs. An understanding of the cost implications of any intervention are critical in assisting policymakers in planning and prioritising of health services.

Computer-aided diagnosis systems for osteoporosis detection: a comprehensive survey

Computer-aided diagnosis (CAD) has revolutionized the field of medical diagnosis. They assist in improving the treatment potentials and intensify the survival frequency by early diagnosing the diseases in an efficient, timely, and cost-effective way. The automatic segmentation has led the radiologist to successfully segment the region of interest to improve the diagnosis of diseases from medical images which is not so efficiently possible by manual segmentation. The aim of this paper is to survey the vision-based CAD systems especially focusing on the segmentation techniques for the pathological bone disease known as osteoporosis. Osteoporosis is the state of the bones where the mineral density of bones decreases and they become porous, making the bones easily susceptible to fractures by small injury or a fall. The article covers the image acquisition techniques for acquiring the medical images for osteoporosis diagnosis. The article also discusses the advanced machine learning paradigms employed in segmentation for osteoporosis disease. Other image processing steps in osteoporosis like feature extraction and classification are also briefly described. Finally, the paper gives the future directions to improve the osteoporosis diagnosis and presents the proposed architecture. Graphical abstract.

Health-related quality of life amongst primary caregivers of children with intellectual disability

BACKGROUND

Children with intellectual disability (ID) frequently have significant educational, social and health care needs, resulting in caregivers often experiencing a wide range of negative effects. This paper aims to determine the impact of childhood ID on caregivers' health-related quality of life (HRQoL) across co-morbid diagnostic groups. The second aim of this study is to determine the risk factors associated with lower HRQoL in this population.

METHODS

Caregivers of a child with ID aged between 2 and 12 years old completed an online survey to determine their HRQoL using the EQ-5D-5L measure. They were also asked demographic questions and about their dependent child's level of behavioural and emotional difficulties.

RESULTS

Of the total sample of 634 caregivers, 604 caregivers completed all five questions of the EQ-5D-5L. The mean age of caregivers was 39.1 years and 91% were women. Caregivers spent on average 66.6 h per week caring for their child related to their child's disability. The mean EQ-5D-5L score of caregivers was 0.80 (95% confidence interval: 0.79, 0.82), which is below the estimated Australian population norms (mean utility score of 0.92) for the age-equivalent population. Caregivers of children with autism spectrum disorders reported the lowest HRQoL (0.77, 95% confidence interval: 0.74, 0.79) of the five included co-morbid diagnostic groups. Caregivers with a lower income, a perceived low level of social support and children with higher degree of behavioural and emotional problems were likely to have a statistically lower HRQoL.

CONCLUSIONS

This is the first study to produce utility values for caregivers of children with ID. The utility values can be used to compare health states and can be used to inform comparative cost-effectiveness analyses. Demonstrating that caregivers of children with ID have reduced HRQoL and that this is associated with the degree of behavioural and emotional problems has important policy implications, highlighting the potential for policy interventions that target behavioural and emotional problems to improve outcomes for caregivers.

P4599Strict versus no fasting prior to cardiac catheterization: a prospective evaluation of safety and clinical outcomes

Background/Methods

No studies have examined safety of a no fasting (NF) strategy as compared to current nil per os (NPO) practice in patients undergoing non emergent cardiac catheterization (CC). We compared these two strategies in this single center, prospective, randomized study. Fasting group was NPO for solids after midnight but could have clear liquids up to 2 hours prior to procedure. NF group had no restriction or oral intake.

Results

A total of 520 patients enrolled till December 2018 were included in this interim analysis. Both groups had similar baseline characteristics (figure 1). As compared to the fasting group (n=274), NF group (n=246) had similar rates of primary outcomes: CIN (0.02% in both groups), peri-procedural hypotension (0.02% vs 0.03%), aspiration pneumonitis (none vs 0.009%), nausea/vomiting (0.05 vs 0.07%), hypoglycemia (0.007% vs 0.008%) respectively [p=not significant for all].Secondary outcomes including patient's satisfaction and 30-day mortality were also similar in both groups. Cost of index hospitalization was significantly lower in NF group (table 1).

Outcome table Outcomes Fasting group (n=274) Non- Fasting group (n=246) p value Length of Stay (days)† 2.13±0.2 1.96±0.19 0.524 SBP post catheterization† 133.31±1.44 133.15±1.39 0.936 Hypotension peri procedurally 6 (2%) 7 (3%) 0.617 Fluid resuscitation required for hypotension 2 (0.7%) 3 (1%) 0.669 Pressor required for hypotension 1 (0.4%) 2 (0.8%) 0.603 Acute Kidney Injury 10 (4%) 9 (4%) 0.981 Contrast induced nephropathy 5 (2%) 6 (2%) 0.612 Hypoglycemia 2 (0.7%) 2 (0.8%) 1 Hyperglycemia 12 (4%) 4 (2%) 0.080 Symptomatic hypotension 1 (0.4%) 2 (0.8%) 0.603 Nausea/vomiting 12 (5%) 15 (7%) 0.344 Aspiration pneumonitis 0 (0%) 2 (0.9%) 0.219 Patient satisfaction score† 4.39±0.06 4.45±0.06 0.438 Alive on discharge 271 (98.9%) 240 (98%) 0.622 30-day mortality 4 (1.5%) 6 (2.4%) 0.417 30-day Cardiac readmission 32 (13%) 26 (11%) 0.557 Total Cost (US Dollars)† 10148.97±985.71 7710.914±648.33 0.040 Results are shown as number (%). †Expressed as mean ± standard error.

Conclusion

NF strategy is safe and cost effective as compared to traditional NPO practice in patients undergoing CC.

Acknowledgement/Funding

A financial grant of USD15,000 from Guthrie Research Foundation

P2271Contemporary trends and outcomes of percutaneous vs. surgical aortic valve replacement in cancer patients

Importance

Cancer patients with severe AS are often ineligible for surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) is an emerging non-invasive treatment option for severe AS. Cancer patients likely stand to benefit from TAVR given its non-invasive nature; however, there is a paucity of data regarding the comparative effectiveness of TAVR vs. SAVR in cancer. We sought to assess the relative utilization, outcomes, and dispositions associated with TAVR vs. SAVR in cancer and non-cancer patients.

Methods

The US-based National Inpatient Sample was queried between 2012 and 2015 using ICD-9 codes for adults>18 years with comorbid AS and cancer without metastatic disease. Multiple in-hospital and disposition outcomes were evaluated. Comparison of TAVR vs SAVR required propensity score estimation using demographic, socio-economic, comorbidity, and hospital specific variables. A standardized morbidity ratio (SMR) weight was calculated by assigning TAVR a weight of 1, and those undergoing SAVR weight of PS/(1-PS). SMR-weighted generalized logistic regression was conducted to estimate the average effect of TAVR compared with SAVR. Finally, the Cochran–Mantel–Haenszel (CMH) test for propensity-matched data was utilized to compare the effect modification of cancer on these outcomes.

Results

A total of 979,912 out of 5,611,173 patients with AS were found to have non-metastatic cancer (17.5%). Average Elixhauser's mortality score of patients undergoing TAVR and SAVR was 8.9 vs. 8.1 and 8.5 vs. 7.1 for cancer vs. non-cancer respectively (p<0.0001). Over time, patients undergoing AVR increased in both groups, primarily driven by significantly increased rates of TAVR utilization in the cancer group. Over the study time period, an increase in the proportion of patients undergoing TAVR among all patients undergoing AVR was noted (figure) with 21.8% and 19.6% patient with prostate and breast cancer in 2015. TAVR in cancer patients was associated with lower odds of acute kidney injury [AKI; odds ratio (OR): 0.6, 95% confidence interval (CI): 0.5- 0.8], cardiogenic shock [OR: 0.6 (0.4–0.8)] and major bleeding [OR: 0.4 (0.3–0.5)] with no difference in in-hospital mortality and stroke compared to SAVR. Additionally, TAVR was associated with higher odds of home-discharge [OR: 1.9 (1.7–2.2)], and lower need for nursing facility transfer [OR: 0.7 (0.6–0.8) compared to SAVR among cancer patients. Similar outcomes are noted in the non-cancer cohort upon comparing TAVR to SAVR. However, favorable effect-modification of cancer was noted in regard to AKI (p=0.003), home discharge (p<0.0001), and less nursing facility transfer (p=0.0003), suggesting safety.

Conclusions

Compared to patients without cancer, the utilization of AVR in cancer patients has steadily increased. The benefits of TAVR over SAVR appear to extend to patients, regardless of cancer status. TAVR might be a more suitable procedure for cancer patients with AS.

Effectiveness of a counselling intervention implemented in antenatal setting for pregnant women facing domestic violence: a pre-experimental study

OBJECTIVE

To assess the effectiveness of a counselling intervention in antenatal care settings for pregnant women who report domestic violence.

DESIGN

Pre-experimental study with pretest-posttest design.

SETTINGS

Two public hospitals in Mumbai, India.

SAMPLE

In all, 2778 pregnant women accessing antenatal care (ANC) in the hospitals from February to November 2016 were approached for study participation; 2515 women consented. These women were screened by trained counsellors for domestic violence during pregnancy (domestic violence during pregnancy). Domestic violence during pregnancy was reported by 16.2% (408) of women. Of these, 155 women sought counselling services. Post-intervention analyses were carried out with 142 women at 6 weeks post-delivery; 13 women were not contactable.

METHODS

The 442 women who reported domestic violence during pregnancy were provided a minimum of two counselling sessions by trained counsellors during their ANC visits. A counselling intake form was used to collect pre- and post-intervention data.

MAIN OUTCOME MEASURES

Prevalence of domestic violence during pregnancy, change in women's ability to cope, safety, and health.

RESULTS

Prevalence of domestic violence during pregnancy (16.1%) was comparable to those of common obstetric complications routinely screened for during ANC. In all, 60-65% women reported cognitive changes such as recognising impact of violence and need to speak out against it. In all, 50.7% women took action at the individual level to address domestic violence during pregnancy. This change was not statistically significant (P-value 0.193). Of the women studied, 35.9% adopted at least one safety measure, and 84% of the women reported better health status post-intervention.

CONCLUSIONS

Routine enquiry and counselling for domestic violence during pregnancy are effective in improving women's ability to cope, safety, and health.

FUNDING

This study was funded by The John D. and Catherine T. MacArthur Foundation.

TWEETABLE ABSTRACT

Improving coping strategies, safety and health of pregnant women who reported domestic violence by providing counselling in antenatal care setting.

Interspersed 5'cis-regulatory elements ascertain the spatio-temporal transcription of cytoskeletal profilin gene family in Arabidopsis

Spatio-temporal expression patterns of cytoskeleton-associated profilin (PRF) family proteins in response to varied environmental stimuli are tightly regulated. Functional analyses of PRFs have revealed their crucial roles in varied developmental and stress related traits, but very little is implicit pertaining to cis-acting regulatory elements that regulate such intricate expression patterns. Here, we identified cis-elements with their varying distribution frequencies by scanning 1.5kbp upstream sequences of 5'regulatory regions of PRFs of dicot and monocot plant species. Predicted cis-elements in the regulatory sub-regions of Arabidopsis PRFs (AtPRFs) were predominantly associated with development-responsive motifs (DREs), light responsive elements (LREs), hormonal responsive elements (HREs), core motifs and stress-responsive elements (SREs). Interestingly, DREs, LREs and core promoter motifs, were extensively distributed up to the distal end of 5'regulatory regions on contrary to HREs present closer to the translational start site in Arabidopsis. The evolutionary footprints of predicted orthologous cis-elements were conserved, and preferably located in the proximal regions of 5'regulatory regions of evolutionarily diverged plant species. We also explored comprehensive tissue-specific global gene expression levels of PRFs under diverse hormonal and abiotic stress regimes. In response, the PRFs exhibited large transcriptional biases in a time- and organ-dependent manner. Further, the methodical elucidation of spatial expression analysis of predicted cis-elements binding transcription factors and relevant PRFs showed notable correlation. Results indicate that binding transcription factors' expression data is largely informative for envisaging their precise roles in the spatial regulation of target PRFs. These results highlight the importance of PRFs during plant development; and establish a relationship between their spatial expression patterns and presence of respective regulatory motifs in their promoter sequences. This information could be employed in future studies and field-utilization of cell wall structural genes.