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Saarinen SL, Borregaard B, Ekholm O, Christensen AV, Thorup CB, Thomsen T, Thrysoee L, Mols RE, Juel K, Berg SK, Rasmussen TB. Self-reported mental and physical health is associated with not returning to work in patients with ischemic heart disease. Int J Cardiol 2024; 409:132180. [PMID: 38759797 DOI: 10.1016/j.ijcard.2024.132180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Ischemic Heart Disease (IHD) can lead to prolonged sick leave and loss of ability to work. This study aimed to describe non-return to work (non-RTW) across three IHD subgroups at 3 and at 12 months post discharge, and explore whether baseline characteristics, and patient-reported mental and physical health were associated with work detachment. METHODS Data from the national cohort study DenHeart were used, including the patient-reported outcomes (PROs) Short-Form 12, Hospital Anxiety and Depression Scale, Edmonton Symptom Assessment Scale and HeartQoL measured at discharge and register-based follow-up at 3 and at 12 months. A total of 3873 patients with IHD ≤ 63 years old and part of the workforce prior to hospitalisation, were included in the analyses and divided into three groups: chronic IHD/stable angina, non-STEMI (non-ST-Elevation Myocardial Infarction)/unstable angina and STEMI (ST-Elevation Myocardial Infarction). A composite outcome of 'prolonged sick leave' and/or 'left the workforce' was defined as non-return to work (non-RTW). Adjusted logistic regression models were performed. RESULTS Overall, the frequency of non-RTW was 37.7% and 38.0% at 3 and 12 months, respectively, thus not improving with time. The largest proportion of non-RTW was found in STEMI patients, followed by non-STEMI/unstable angina and IHD/stable angina patients. Several clinical and socio-demographic factors, as well as patient-reported mental and physical health were associated with non-RTW among the subgroups. CONCLUSION The findings demonstrate a need for identifying IHD patients at risk of non-RTW after discharge based on their mental and physical health and a need for initiatives to minimize unwanted non-RTW.
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Affiliation(s)
- Stine Lise Saarinen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Thordis Thomsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Acute, Critical and Emergency Care Science Unit, Department of Anaesthesiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
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Dos Reis MF, Chaoubah A. The economic impact of stroke in Brazil, 2010-2019: Increase in public expenses of Unified Health System. J Stroke Cerebrovasc Dis 2023; 32:107382. [PMID: 37922682 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES To economically analyze the impact that outpatient and inpatient spending of the Unified Health System and social security expenses of the General Regime of Social Security generated to the Brazilian public system, between 2010 and 2019. MATERIALS AND METHODS Observational research, in which public data from the SUS Department of Informatics and the Social Security Historical Database were used, according to 10ª International Classification of Diseases code, I-64 (Stroke, not specified if hemorrhagic or ischemic). The Kruskal-Wallis test, complemented by Dunn's post-hoc test, and Spearman's bivariate correlation test were used to check for differences and correlations between variables. The expenditures were adjusted for inflation for the year 2019 and presented in american dollar s(U$). RESULTS Stroke public spending impacted an average of 120 million dollars per year and increased 15% during the historical series. Eighty-nine percent of these expenditures originated from hospital spending (p<0.05). On average, stroke accounted for 7.3% of spending on cardiovascular diseases and 0.72% of spending on the other codes of 10ª International Classification of Diseases. Total spending showed a positive correlation with the historical series (r=.702; p<0.05), with the increase in the elderly population (over 60 years of age) (r=.676; p<0.05) and with Gross Domestic Product per capita (r=.784; p<0,05). CONCLUSIONS The impact that stroke generated on public spending increased over the historical series, mainly due to hospital spending and by the prospect of increasing elderly population in Brazil, public spending tends to rise.
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Affiliation(s)
- Marcio Fernandes Dos Reis
- Centro Universitário Presidente Antônio Carlos/ UNIPAC/JF, Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora, Avenida Juiz de Fora, n. 1100; Bairro Granjas Bethânia; CEP: 36047-362, Juiz de Fora, Minas Gerais, Brazil.
| | - Alfredo Chaoubah
- Universidade Federal de Juiz de Fora, Programa de Pós-Graduação em Saúde Coletiva, Juiz de Fora, Minas Gerais, Brazil
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Ostwald DA, Schmitt M, Peristeris P, Gerritzen T, Durand A. The Societal Impact of Inclisiran in England: Evidence From a Population Health Approach. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1353-1362. [PMID: 37187238 DOI: 10.1016/j.jval.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/17/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES As first-in-class cholesterol-lowering small interfering ribonucleic acid, inclisiran provides effective reductions in low-density lipoprotein-cholesterol to achieve better cardiovascular (CV) health. We estimate the health and socioeconomic effects of introducing inclisiran according to a population health agreement in England. METHODS Building on the inclisiran cost-effectiveness model, a Markov model simulates health gains in terms of avoided CV events and CV deaths because of add-on inclisiran treatment for patients aged 50 years and older with pre-existing atherosclerotic CV disease. These are translated into socioeconomic effects, defined as societal impact. To that end, we quantify avoided productivity losses in terms of paid and unpaid work productivity and monetize them according to gross value added. Furthermore, we calculate value chain effects for paid work activities, drawing on value-added multipliers based on input-output tables. The derived value-invest ratio compares avoided productivity losses against the increased healthcare costs. RESULTS Our results show that 138 647 CV events could be avoided over a period of 10 years. The resulting societal impact amounts to £8.17 billion, whereas additional healthcare costs are estimated at £7.94 billion. This translates into a value-invest ratio of 1.03. CONCLUSIONS Our estimates demonstrate the potential health and socioeconomic value of inclisiran. Thereby, we highlight the importance to treat CVD and illustrate the impact that a large-scale intervention can have on population health and the economy.
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Affiliation(s)
- Dennis A Ostwald
- Health Economics Department, WifOR Institute, Darmstadt, Germany
| | - Maike Schmitt
- Health Economics Department, WifOR Institute, Darmstadt, Germany.
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Lopez-Santi R, Piskorz D, Garcia-Zamora S, Martinez D, Demaria DM, Renna N, Forte E, Ibarrola M, Igolnikof D, Lorenzatti A, Alexander B, Baranchuk A, Sosa-Liprandi A, Martinez F, Kaski JC. The attitudes of physicians toward guideline recommendations for the management of dyslipidemia in clinical practice - The VIPFARMA ISCP Project. Curr Probl Cardiol 2022; 48:101434. [PMID: 36198357 DOI: 10.1016/j.cpcardiol.2022.101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Daniel Piskorz
- Cardiovascular Institute of the Rosario British Sanatorium, Santa Fe, Argentina
| | | | - Diego Martinez
- Instituto Médico DAMIC-Fundación Rusculleda, Córdoba, Argentina
| | | | - Nicolas Renna
- Departamento de Cardiología, Hospital Español de Mendoza, Argentina
| | - Ezequiel Forte
- CENDIC, Centro Diagnóstico Cardiovascular, Entre Ríos, Argentina
| | | | - Darío Igolnikof
- Sanatorio de la Trinidad de Ramos Mejia, Buenos Aires, Argentina
| | | | - Bryce Alexander
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Felipe Martinez
- Instituto Médico DAMIC-Fundación Rusculleda, Córdoba, Argentina
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, United Kingdom
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5
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Sevic A, Hashemi NS, Thørrisen MM, Strømstad K, Skarpaas LS, Storm M, Brønnick KK. Effectiveness of eHealth Interventions Targeting Employee Health Behaviors: Systematic Review (Preprint). J Med Internet Res 2022; 25:e38307. [PMID: 37079369 PMCID: PMC10160931 DOI: 10.2196/38307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/12/2022] [Accepted: 02/27/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The number of people with noncommunicable diseases is increasing. Noncommunicable diseases are the major cause of disability and premature mortality worldwide, associated with negative workplace outcomes such as sickness absence and reduced work productivity. There is a need to identify scalable interventions and their active components to relieve disease and treatment burden and facilitate work participation. eHealth interventions have shown potential in clinical and general populations to increase well-being and physical activity and could be well suited for workplace settings. OBJECTIVE We aimed to provide an overview of the effectiveness of eHealth interventions at the workplace targeting employee health behaviors and map behavior change techniques (BCTs) used in these interventions. METHODS A systematic literature search was performed in PubMed, Embase, PsycINFO, Cochrane CENTRAL, and CINAHL in September 2020 and updated in September 2021. Extracted data included participant characteristics, setting, eHealth intervention type, mode of delivery, reported outcomes, effect sizes, and attrition rates. Quality and risk of bias of the included studies were assessed using the Cochrane Collaboration risk-of-bias 2 tool. BCTs were mapped in accordance with the BCT Taxonomy v1. The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. RESULTS In total, 17 randomized controlled trials met the inclusion criteria. The measured outcomes, treatment and follow-up periods, content of eHealth interventions, and workplace contexts had high heterogeneity. Of the 17 studies, 4 (24%) reported unequivocally significant findings for all primary outcomes, with effect sizes ranging from small to large. Furthermore, 53% (9/17) of the studies reported mixed results, and 24% (4/17) reported nonsignificant results. The most frequently targeted behavior was physical activity (15/17, 88% of the studies); the least frequently targeted behavior was smoking (2/17, 12% of the studies). Attrition varied greatly across the studies (0%-37%). Risk of bias was high in 65% (11/17) of the studies, with some concerns in the remaining 35% (6/17). Interventions used various BCTs, and the most frequently used were feedback and monitoring (14/17, 82%), goals and planning (10/17, 59%), antecedents (10/17, 59%), and social support (7/17, 41%). CONCLUSIONS This review suggests that, although eHealth interventions may have potential, there are still unanswered questions regarding their effectiveness and what drives the mechanism behind these effects. Low methodological quality, high heterogeneity and complexity, the characteristics of the included samples, and often high attrition rates challenge the investigation of the effectiveness and the making of sound inferences about the effect sizes and significance of the results. To address this, new studies and methods are needed. A megastudy design in which different interventions are evaluated in the same population over the same period on the same outcomes may solve some of the challenges. TRIAL REGISTRATION PROSPERO CRD42020202777; https://www-crd-york-ac-uk/prospero/display_record.php?RecordID=202777.
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Affiliation(s)
- Aleksandra Sevic
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Neda S Hashemi
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Mikkel Magnus Thørrisen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Kine Strømstad
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Lisebet Skeie Skarpaas
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Kolbjørn Kallesten Brønnick
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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6
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Landmesser U, Lindgren P, Hagström E, van Hout B, Villa G, Pemberton-Ross P, Arellano J, Svensson ME, Sibartie M, Fonarow GC. Cost-effectiveness of proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab in patients with a history of myocardial infarction in Sweden. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:31-38. [PMID: 33063111 PMCID: PMC8728027 DOI: 10.1093/ehjqcco/qcaa072] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/27/2020] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
Abstract
Aims To assess the cost-effectiveness of proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab added to standard-of-care lipid-lowering treatment [maximum tolerated dose (MTD) of statin and ezetimibe] in Swedish patients with a history of myocardial infarction (MI). Methods and results Cost-effectiveness was evaluated using a Markov model based on Swedish observational data on cardiovascular event rates and efficacy from the FOURIER trial. Three risk profiles were considered: recent MI in the previous year; history of MI with a risk factor; and history of MI with a second event within 2 years. For each population, three minimum baseline low-density lipoprotein cholesterol (LDL-C) levels were considered: 2.5 mmol/L (≈100 mg/dL), based on the current reimbursement recommendation in Sweden; 1.8 mmol/L (≈70 mg/dL), based on 2016 ESC/EAS guidelines; and 1.4 mmol/L (≈55 mg/dL), or 1.0 mmol/L (≈40 mg/dL) for MI with a second event, based on 2019 ESC/EAS guidelines. Proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab was associated with increased quality-adjusted life-years and costs vs. standard-of-care therapy. Incremental cost-effectiveness ratios (ICERs) were below SEK700 000 (∼€66 500), the generally accepted willingness-to-pay threshold in Sweden, for minimum LDL-C levels of 2.3 (recent MI), 1.7 (MI with a risk factor), and 1.7 mmol/L (MI with a second event). Sensitivity analyses demonstrated that base-case results were robust to changes in model parameters. Conclusion Proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab added to MTD of statin and ezetimibe may be considered cost-effective at its list price for minimum LDL-C levels of 1.7–2.3 mmol/L, depending on risk profile, with ICERs below the accepted willingness-to-pay threshold in Sweden.
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Affiliation(s)
- Ulf Landmesser
- Department of Cardiology, Medical Director Charité Cardiovascular Center (CC11), Campus Benjamin Franklin Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Managing Director, The Swedish Institute for Health Economics, Box 2127, 220 02, Lund, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, 751 85, Uppsala, Sweden
| | - Ben van Hout
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA
| | - Guillermo Villa
- Global Health Economics, Amgen (Europe) GmbH, Suurstoffi 22, 6343, Rotkreuz, Switzerland
| | - Peter Pemberton-Ross
- Global Health Economics, Amgen (Europe) GmbH, Suurstoffi 22, 6343, Rotkreuz, Switzerland
| | - Jorge Arellano
- Global Health Economics, Amgen Inc, 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Maria Eriksson Svensson
- Medical Affairs, Amgen AB, Gustav III: s Boulevard 54, 169 74, Solna, Sweden.,Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Mahendra Sibartie
- Medical Affairs, Amgen (Europe) GmbH, Suurstoffi 22, 6343, Rotkreuz, Switzerland
| | - Gregg C Fonarow
- Division of Cardiology, University of California Los Angeles, 10833 LeConte Avenue, Los Angeles, CA, 90095, USA
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7
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The Role of Exercise in Reducing Hyperlipidemia-Induced Neuronal Damage in Apolipoprotein E-Deficient Mice. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5512518. [PMID: 34409103 PMCID: PMC8367587 DOI: 10.1155/2021/5512518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/13/2021] [Accepted: 07/16/2021] [Indexed: 12/14/2022]
Abstract
Hyperlipidemia causes nervous system-related diseases. Exercise training has developed into an established evidence-based treatment strategy that is beneficial for neuronal injury. This study investigated the effect of exercise on hyperlipidemia-induced neuronal injury in apolipoprotein E-deficient (ApoE-/-) mice. Male ApoE-/- mice (age: 8 weeks) were randomly divided into four groups as follows: mice fed a normal diet (ND), normal diet+swimming training (ND+S), high-fat diet (HD), and high-fat diet+swimming (HD+S). Exercise training consisted of swimming for 40 min/day, 5 days/week for 12 weeks. After 12 weeks, we measured serum levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-c). We also evaluated glial fibrillary acidic protein (GFAP) expression levels using immunohistochemistry, real-time PCR, and immunoblotting. In addition, NLR family pyrin domain-containing 3 (NLRP3), interleukin- (IL-) 18, caspase-1, Bax, Bcl-2, and phosphorylated extracellular signal-regulated kinase (p-ERK) expression levels were measured using immunoblotting. Serum levels of TG, TC, and LDL-c were lower in ApoE-/- HD+S mice than in ApoE-/- HD mice. Immunohistochemistry, real-time PCR, and immunoblotting showed increased levels of GFAP in the ApoE-/- HD group. Immunoblotting revealed increased levels of NLRP3, IL-18, caspase-1, Bax, Bcl-2, and p-ERK in the ApoE-/- HD group; however, they were significantly suppressed in the ApoE-/- HD+S group. Therefore, exercise has protective effects against neuronal injury caused by hyperlipidemia.
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8
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Return to work following adverse cardiovascular events in adults with congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Economic Burden of Stroke Disease: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147552. [PMID: 34299999 PMCID: PMC8307880 DOI: 10.3390/ijerph18147552] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 01/01/2023]
Abstract
Globally, one of the main causes of non-communicable disease as a cause of death every year is stroke. The objective of this study was to analyze the burden in consequence of stroke. This research used a systematic review method. Furthermore, a search for articles was carried out in June–July 2020. Four databases were used to search articles from 2015 to 2020. Eligible studies were identified, analyzed, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The inclusion criteria were prospective cost studies, retrospective cost studies, database analysis, mathematical models, surveys, and COI studies that assess burden of stroke in primary and referral healthcare (hospital-based). The results showed that from four databases, 9270 articles were obtained, and 13 articles were qualified. A total of 9270 articles had the identified search keywords, but only 13 articles met the set criteria for inclusion. The criteria for inclusion were stroke patients, the economic burden of stroke disease based on cost of illness method, which is approximately equal to USD 1809.51–325,108.84 (direct costs 86.2%, and indirect costs 13.8%). Those that used the health expenditure method did not present the total cost; instead, only either direct or indirect cost of health expenditure were reported. For most hospital admissions due to stroke, LOS (length of stay) was the dominant cost. The high economic burden to manage stroke justifies the promotion and preventive efforts by the policymakers and motivates the practice of healthy lifestyles by the people.
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Barral M, Rabier H, Termoz A, Serrier H, Colin C, Haesebaert J, Derex L, Nighoghossian N, Schott AM, Viprey M. Patients' productivity losses and informal care costs related to ischemic stroke: a French population-based study. Eur J Neurol 2020; 28:548-557. [PMID: 33047452 DOI: 10.1111/ene.14585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Large societal costs of stroke should not be ignored. We aimed to estimate patients' productivity losses and informal care costs during the first year after ischemic stroke. METHODS A cross-sectional survey was performed within the STROKE69 regional population-based cohort study. At 1 year post-stroke, each patient and the corresponding main informal caregiver received questionnaires followed by a telephone interview if necessary. Time losses were valued using the human capital approach and proxy good method for patients with and without a professional activity, respectively. RESULTS Among the 222 patients with ischemic stroke (58% men; mean age 68 years; and 86% with a modified Rankin Scale (mRS) score of <3 at 3 months), 54%, 32%, and 25% received informal, formal, and both cares, respectively. Among the 108 main informal caregivers, 63% were women, 74% lived with the patient, and 57% were retired or unemployed. The mean cost of productivity losses was estimated at €7589 ± €12 305 per patient in the first post-stroke year with 5.4%, 71.2%, and 23.4% of these being attributed to presenteeism, absenteeism, and leisure time, respectively. Informal care was given at an average of 25 h/week. The annual mean estimated total cost of informal care was €10 635 per caregiver. CONCLUSIONS Informal care and productivity losses of patients with ischemic stroke during the first post-stroke year represent a significant economic burden for society comparable to direct costs. These costs should be included in economic evaluations with the adoption of a societal perspective to avoid underestimating the societal stroke economic burden.
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Affiliation(s)
- M Barral
- Hospices Civils de Lyon, Public Health Department, Lyon, France
| | - H Rabier
- Hospices Civils de Lyon, Public Health Department, Lyon, France.,Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France
| | - A Termoz
- Hospices Civils de Lyon, Public Health Department, Lyon, France.,Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France
| | - H Serrier
- Hospices Civils de Lyon, Public Health Department, Lyon, France.,Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France
| | - C Colin
- Hospices Civils de Lyon, Public Health Department, Lyon, France.,Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France
| | - J Haesebaert
- Hospices Civils de Lyon, Public Health Department, Lyon, France.,Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France
| | - L Derex
- Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France.,Comprehensive Stroke Center, Department of Neurology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, F-69500, Bron, France
| | - N Nighoghossian
- Comprehensive Stroke Center, Department of Neurology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, F-69500, Bron, France
| | - A-M Schott
- Hospices Civils de Lyon, Public Health Department, Lyon, France.,Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France
| | - M Viprey
- Hospices Civils de Lyon, Public Health Department, Lyon, France.,Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France
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11
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Godea Lupei S, Ciubotariu D, Danciu M, Lupușoru RV, Ghiciuc CM, Cernescu I, Gheţu N, Lupei M, Lupușoru CE. Improvement in serum lipids and liver morphology after supplementation of the diet with fish oil is more evident under regular feeding conditions than under high-fat or mixed diets in rats. Lipids Health Dis 2020; 19:162. [PMID: 32631338 PMCID: PMC7339424 DOI: 10.1186/s12944-020-01339-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 06/26/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Dietary n- 3 polyunsaturated fatty acids (PUFAs) have a role in preventing cardiovascular and hepatic diseases. However, their effects might differ significantly depending on individual dietary patterns. The aim of the present study was to evaluate the effects of dietary supplementation with ω-3 fatty acids (FA), administered in different schedules, on hepatic and aortic histological structure, lipid profile, and body weight (BW) in male Wistar rats under standard (SD), high-fat diet (HFD) and mixed feeding conditions. METHODS PUFA treatment consisted of the administration of 50 mg/kg fish oil (FO) daily by oral gavage. HFD was obtained by adding a suspension of 4% cholesterol, thiouracil and cholic acid to the animals' drinking water. The rats were maintained on the diets for 6 weeks, and different schedules of PUFA administration were used. At 14, 28, and 42 days, the morphology of liver and aortic samples and the levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), and triglycerides (TG) were assessed. RESULTS The HFD groups exhibited significant hyperlipidemia and aortic inflammation, with progression to atherogenesis after 6 weeks. Administration of PUFAs slightly attenuated the aortic changes in these groups and reduced the liver's tendency to steatosis. FO-induced metabolic improvement was more evident in SD than in HFD rats. For instance, after the first 2 weeks, SD animals that received PUFAs had significantly increased HDL levels vs. controls (62.375 ± 4.10 vs. 52.625 ± 8.38 mg/dL, P < 0.05), but HFD rats did not, and decreased TG levels were observed exclusively in the SD rats (57.6 ± 4.09 vs. 66 ± 4.69 mg/dL, P < 0.05). After 6 weeks of n- 3 PUFA administration, LDL was significantly lower in the SD rats than in controls (13.67 ± 4.13 vs. 30.83 ± 2.86 mg/dL, P < 0.001), but the decrease in the HFD rats, although significant (49.17 ± 5.85 mg/dL vs. 57.17 ± 4.96 g/dL, P < 0.05), was not as marked. In the mixed-diet groups, administration of 50 mg/kg/day FO for 14 days under SD conditions following 4 weeks of HFD slightly decreased TG (86.625 ± 11.67 vs. 73 ± 4.52 mg/dL, P < 0.05) and increased HDL (45.875 ± 5.28 vs. 56 ± 3.16 mg/dL). However, in these animals, n-3 PUFA administration had no effect on LDL or TC. Administration of half of the above dose failed to improve any biochemical parameters. FO protected against excessive weight gain mainly under SD conditions. CONCLUSIONS The results show that FO confers more protection against cardiovascular risk factors (increased LDL and TG, decreased HDL) and liver lipid accumulation when given to rats consuming regular diets than when given to rats consuming a high-fat diet. This argues that priority should be given to consumption of a healthy diet rather than to the use of supplements. The effectiveness of n-3 PUFAs might be reduced in the case of hyperlipidic intake or after consumption of a high-fat diet.
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Affiliation(s)
- Silvia Godea Lupei
- Department of Pharmacology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Diana Ciubotariu
- Department of Pharmacology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania.
| | - Mihai Danciu
- Department of Pathology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania.
| | - Raoul Vasile Lupușoru
- Department of Pathophysiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Cristina Mihaela Ghiciuc
- Department of Pharmacology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Irina Cernescu
- Department of Pharmacology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Nicolae Gheţu
- Department of Plastic Surgery, Regional Oncology Institute, Iaşi, Romania
| | - Mihai Lupei
- Department of Natural and Synthetic Polymers, Faculty of Chemical Engineering and Environment Protection, Gheorghe Asachi Technical University, Iaşi, Romania
| | - Cătălina Elena Lupușoru
- Department of Pharmacology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
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Timóteo AT, Gouveia M, Soares C, Cruz Ferreira R. Indirect costs of myocardial infarction in Portugal. Rev Port Cardiol 2020; 39:245-251. [DOI: 10.1016/j.repc.2019.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 10/24/2022] Open
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Indirect costs of myocardial infarction in Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Urriza Rodriguez D, Howard DP. Saving lives, saving limbs: tackling the global pandemic of peripheral arterial disease. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.23736/s1824-4777.19.01418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Kotseva K, Gerlier L, Sidelnikov E, Kutikova L, Lamotte M, Amarenco P, Annemans L. Patient and caregiver productivity loss and indirect costs associated with cardiovascular events in Europe. Eur J Prev Cardiol 2019; 26:1150-1157. [DOI: 10.1177/2047487319834770] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, UK
| | | | | | | | | | - Pierre Amarenco
- Department of Neurology and Stroke Centre, Bichat Hospital, Paris, France
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Sun Y, Tsai PJ, Chu CL, Huang WC, Bee YS. Epidemiology of benign essential blepharospasm: A nationwide population-based retrospective study in Taiwan. PLoS One 2018; 13:e0209558. [PMID: 30586395 PMCID: PMC6306223 DOI: 10.1371/journal.pone.0209558] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 12/09/2018] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE This study provides a nationwide, population-based data on the incidence of benign essential blepharospasm in Asian adults. BACKGROUND To describe the incidence, patient demographics, and risk factors associated with benign essential blepharospasm. DESIGN Population-based retrospective study. PARTICIPANTS AND SAMPLES A total of 1325 patients with benign essential blepharospasm were identified. METHODS Patients with diagnosis of blepharopsasm between January 2000 and December 2013 were sampled using the Longitudinal Health Insurance Database 2000. Secondary blepharospasm that may be related to neurological, trauma, and ocular surface disease were excluded. MAIN OUTCOME MEASURED Multivariate conditional logistic regression was used to estimate the odds ratios for potential risk factors of benign essential blepharospasm. RESULTS The mean annual incidence was 0.10‰ (0.07‰ for males, and 0.12‰ for females). The peak incidence was in the 50 to 59-year-old age group (0.19‰). People living in urban regions have more risk of developing blepharospasm comparing to people living in less urban regions (p <0.01). White-collar workers also have higher chance of having blepharospasm (p<0.001). Significant difference between control group and case group in hyperlipidemia (p <0.001), sleep disorders (p <0.001), mental disorders (depression, anxiety, obsessive compulsive disorder) (p <0.001), dry eye-related diseases (dry eye, Sjögren's syndrome) (p <0.001), Parkinson's disease (p <0.004), and rosacea (p <0.021) were also identified. CONCLUSIONS AND RELEVANCE Higher level of urbanization, white-collar work, sleep disorders, mental health diseases, dry eye-related diseases, Parkinsonism, and rosacea are possible risk factors for benign essential blepharospasm.
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Affiliation(s)
- Yng Sun
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Kaohsiung Medical University of Hospital, Kaohsiung, Taiwan
| | - Pei-Jhen Tsai
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | - Wei-Chun Huang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Youn-Shen Bee
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan
- National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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Ervasti J, Virtanen M, Lallukka T, Friberg E, Mittendorfer-Rutz E, Lundström E, Alexanderson K. Trends in diagnosis-specific work disability before and after ischaemic heart disease: a nationwide population-based cohort study in Sweden. BMJ Open 2018; 8:e019749. [PMID: 29674367 PMCID: PMC5914777 DOI: 10.1136/bmjopen-2017-019749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES We examined trends of diagnosis-specific work disability before and after ischaemic heart disease (IHD). DESIGN Participants were followed 4 years before and 4 years after an IHD event for diagnosis-specific work disability (sickness absence and disability pension). SETTING AND PARTICIPANTS A Swedish population-based cohort study using register data on all individuals aged 25-60 years, living in Sweden, and who suffered their first IHD event in 2006-2008 (n=23 971) was conducted. RESULTS Before the event, the most common diagnoses of work disability were musculoskeletal disorders (21 annual days for men and 44 for women) and mental disorders (19 men and 31 for women). After multivariable adjustments, we observed a fivefold increase (from 12 to 60 days) in work disability due to diseases of the circulatory system in the first postevent year compared with the last pre-event year among men. Among women, the corresponding increase was fourfold (from 14 to 62 days). By the second postevent year, the number of work disability days decreased significantly compared with the first postevent year among both sexes (to 19 days among men and 23 days among women). Among women, mean days of work disability due to diseases of the circulatory system remained at a higher level than among men during the postevent years. Work disability risk after versus before an IHD event was slightly higher among men (rate ratio (RR) 2.49; 95% CI 2.36 to 2.62) than among women (RR 2.29, 95% CI 2.12 to 2.49). When pre-event long-term work disability was excluded, diseases of the circulatory system were the most prevalent diagnosis for work disability after an IHD event among both men and women. CONCLUSIONS An IHD event was strongly associated with an increase in work disability due to diseases of the circulatory system, especially among men and particularly in the first postevent year.
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Affiliation(s)
- Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Marianna Virtanen
- Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden
| | - Tea Lallukka
- Finnish Institute of Occupational Health, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Lundström
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Luengo-Fernandez R, Howard DPJ, Nichol KG, Dobell E, Rothwell PM. Hospital and Institutionalisation Care Costs after Limb and Visceral Ischaemia Benchmarked Against Stroke: Long-Term Results of a Population Based Cohort Study. Eur J Vasc Endovasc Surg 2018; 56:271-281. [PMID: 29653901 PMCID: PMC6105571 DOI: 10.1016/j.ejvs.2018.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/07/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE/BACKGROUND There are few published data on the acute care or long-term costs after acute/critical limb or visceral ischaemia (ACLVI) events. Using data from patients with acute events in a population based incidence study (Oxford Vascular Study), the present study aimed to determine the long-term costs after an ACLVI event. METHODS All patients with first ever incident ACLVI from 2002 to 2012 were included. Analysis was based on follow up until January 2017, with all patients having full 5 year follow up. Multivariate regressions were used to assess baseline and subsequent predictors of total 5 year hospital care costs. Overall costs after an ACLVI event were benchmarked against those after stroke in the same population, during the same period. RESULTS Among 351 patients with an ACLVI event, mean 5 year total care costs were €35,211 (SD 50,500), of which €6443 (18%) were due to long-term institutionalisation. Costs differed by type of event (acute visceral ischaemia €16,476; acute limb ischaemia €24,437; critical limb ischaemia €46,281; p < 0.001). Results of the multivariate analyses showed that patients with diabetes and those undergoing above knee amputations incurred additional costs of €11,804 (p = 0.014) and €25,692 (p < 0.001), respectively. Five year hospital care costs after an ACLVI event were significantly higher than after stroke (€28,768 vs. €22,623; p = 0.004), but similar after including long-term costs of institutionalisation (€35,211 vs. €35,391; p = 0.957). CONCLUSION Long-term care costs after an ACLVI event are considerable, especially after critical limb ischaemia. Hospital care costs were significantly higher than for stroke over the long term, and were similar after inclusion of costs of institutionalisation.
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Affiliation(s)
- Ramon Luengo-Fernandez
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Dominic P J Howard
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Department of Vascular Surgery, Oxford University Hospitals NHS Foundation Trust, UK
| | - Kathleen G Nichol
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Oxford University Hospitals NHS Foundation Trust, UK
| | - Emily Dobell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Oxford School of Public Health, Nuffield Department of Population Health, University of Oxford, UK
| | - Peter M Rothwell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
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Sigurdardottir V, Drivelegka P, Svärd A, Jacobsson LTH, Dehlin M. Work disability in gout: a population-based case–control study. Ann Rheum Dis 2017; 77:399-404. [DOI: 10.1136/annrheumdis-2017-212063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/12/2017] [Accepted: 11/06/2017] [Indexed: 01/23/2023]
Abstract
ObjectivesTo examine the extent and cost of work disability among patients with gout compared with matched population controls and to analyse predictors of work disability.MethodsA regional cohort study using data from Swedish national and regional registries from January 2000 through December 2012, including 4571 patients with gout of working age, with a first recorded diagnosis of gout in the years 2003–2009 and 22 482 population controls, matched by age, sex and place of residence. Differences in baseline characteristics (educational level, income, previous employment and comorbidities) and the number of work-loss days (absenteeism) due to sick leave and disability pension for 3 years after identification were calculated. Predictors for new-onset work absenteeism (>90 days/year) in a subset were determined by conditional logistic regression.ResultsPatients with gout (median age 53 years) had significantly more comorbidities, lower income and lower level of education than matched controls. The average work absentee rate during the 3-year follow-up period was higher among patients with gout than controls, 22% and 14%, respectively (P<0.0001). New-onset absenteeism was in multivariate analyses significantly predicted by gout (OR 1.47; 95% CI 1.23 to 1.75). Other variables independently related to new-onset absenteeism were education ≤12 years, previous unemployment and history of sick leave, in addition to several comorbidities (renal disease, cardiovascular disease, alcohol abuse and obesity).ConclusionsGout is associated with substantially higher work absenteeism and costs for society due to productivity loss, after adjusting for associated comorbidities and socioeconomic differences. Whether more intensive treatment of gout is cost-effective needs to be addressed in future studies.
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Virtanen M, Ervasti J, Mittendorfer-Rutz E, Lallukka T, Kjeldgård L, Friberg E, Kivimäki M, Lundström E, Alexanderson K. Work disability before and after a major cardiovascular event: a ten-year study using nationwide medical and insurance registers. Sci Rep 2017; 7:1142. [PMID: 28442715 PMCID: PMC5430721 DOI: 10.1038/s41598-017-01216-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/24/2017] [Indexed: 02/07/2023] Open
Abstract
We examined the trajectories of work disability before and after IHD and stroke events. New IHD (n = 13521) and stroke (n = 7162) cases in 2006–2008 were retrieved from nationwide Swedish hospital records and their annual work disability days five years before and after the date of diagnosis were retrieved from a nationwide disability register. There was no pre-event differences in disability days between the IHD and stroke cases and five years prior to the event, they were close to those observed in the general population. In the first post-event year, the adjusted mean days increased to 83.9 (95% CI 80.6–86.5) in IHD; to 179.5 (95% CI 172.4–186.8) in stroke, a six-fold increase in IHD and 14-fold in stroke. Work disability leveled off among the IHD cases but not among those who had stroke. The highest disability levels for the fifth post-event year after a stroke event was associated with pre-existing diabetes (146.9), mental disorder (141.2), non-employment (137.0), and immigrant status (117.9). In a working-age population, the increase in work disability after a cardiovascular event decreases close to the pre-event level in IHD but remains particularly high after stroke; among patients with comorbid depression or diabetes, immigrants, and those not in employment.
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Affiliation(s)
- Marianna Virtanen
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00251, Helsinki, Finland.
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00251, Helsinki, Finland
| | - Ellenor Mittendorfer-Rutz
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, SE-171 77, Stockholm, Sweden
| | - Tea Lallukka
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00251, Helsinki, Finland.,Department of Public Health, University of Helsinki, Clinicum, P.O. Box 63, FI-00014, Helsinki, Finland
| | - Linnea Kjeldgård
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, SE-171 77, Stockholm, Sweden
| | - Emilie Friberg
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, SE-171 77, Stockholm, Sweden
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00251, Helsinki, Finland.,Department of Public Health, University of Helsinki, Clinicum, P.O. Box 63, FI-00014, Helsinki, Finland.,Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Erik Lundström
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Neurology, SE-171 77, Stockholm, Sweden
| | - Kristina Alexanderson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, SE-171 77, Stockholm, Sweden
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Effects of the duration of hyperlipidemia on cerebral lipids, vessels and neurons in rats. Lipids Health Dis 2017; 16:26. [PMID: 28143622 PMCID: PMC5282812 DOI: 10.1186/s12944-016-0401-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/27/2016] [Indexed: 01/09/2023] Open
Abstract
Background The present study was designed to investigate the effects of hyperlipidemia on the cerebral lipids, vessels and neurons of rats, and to provide experimental evidence for subsequent intervention. Method One hundred adult SD rats, half of which were male and half of which were female, were randomly divided into five groups on the basis of serum total cholesterol (TC) levels. Four groups were fed a hypercholesterolemic diet (rat chow supplemented with 4% cholesterol, 1% cholic acid and 0.5% thiouracil – this is also called a CCT diet) for periods of 1 week, 2 weeks, 3 weeks and 4 weeks, respectively. A control group was included. The levels of serum lipids, cerebral lipids, free fatty acids (FFA), interleukin-6 (IL-6), interleukin-1 (IL-1), tumor necrosis factor alpha (TNF-α), vascular endothelial growth factor (VEGF), oxidized low density lipoprotein (ox-LDL), A-beta precursor proteins (APP), amyloid beta (Aβ), glial fibrillary acidic protein (GFAP) and tight junction protein Claudin-5 were measured after the experiment. The pathologic changes and apoptosis of the rat brains were evaluated. Results Compared with the control group, after 1 week of a CCT diet, the levels of serum total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and brain triglycerides had increased by 2.40, 1.29 and 1.75 and 0.3 times, respectively. The serum high density lipoprotein cholesterol (HDL-C) had decreased by 0.74 times (P < 0.05) and the expression of IL-1, TNF-α and GFAP in the brains had increased (P < 0.05). In the second week, the expression of FFA and APP in the brains, and the amount of apoptotic neurons, had increased (P < 0.05). In the third week, the levels of VEGF, Ox-LDL and Aβ had increased, and the expression of Claudin-5 had decreased in the brains (P < 0.05). In the fourth week, the levels of TC, LDL-C and the amount of apoptotic neurons had increased (P < 0.05). The correlation analysis showed a positive correlation among FFA, TNF-α, VEGF, ox-LDL, Aβ, GFAP and neuronal apoptosis in the rat brains, and they all were negatively correlated with Claudin-5 (P < 0.05). Conclusion Hyperlipidemia may activate astrocytes by means of high levels of TG that will have direct toxic effects on the cerebral vessels and neurons by causing the secretion of TNF-α and IL-1 in the brains of rats. In the metabolic procession, brain tissue was shown to generate FFA that aggravated the biosynthesis of ox-LDL. With the extension of the duration of hyperlipidemia, high levels of cerebral TC and LDL-C were shown to aggravate the deposition of Aβ, induce the secretion of VEGF, reduce the expression of tight junction protein Claudin-5 and change the permeability of blood–brain barriers to factors that could damage cerebral vessels and neurons.
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