Healthcare resource utilisation for chronic kidney disease and other major non-communicable chronic diseases in China: a cross-sectional study

Estimated indirect costs of haemodialysis versus peritoneal dialysis from a patients' perspective at an Academic Hospital in Pretoria, South Africa

In South Africa (SA), patients with kidney failure can be on either haemodialysis (HD), which is performed by a healthcare professional in a hospital thrice weekly; or peritoneal dialysis (PD), which can performed daily at home. There needs to be more studies within the South African healthcare sector on the cost of kidney failure and especially the indirect costs associated with patients being on dialysis to provide future guidance. This study aimed to determine and compare the indirect costs associated with HD and PD from the patients' perspective at an Academic Hospital in Pretoria. The study used a cross-sectional prospective quantitative study design. The researcher used face-to-face interviews to collect data and the human capital approach to calculate productivity losses. The study population included all patients over 18 receiving HD or PD for over three months; 54 patients participated (28 on HD and 26 on PD). The study lasted seven months, from September 2020 to March 2021. Haemodialysis patients incurred greater productivity losses per annum ($8127.55) compared to PD (R$3365.34); the difference was statistically significant with a P-value of p < 0.001. More HD (96.4%) patients were unemployed than (76.9%) PD patients.

Comparison of attitudes toward the medical student-led community health education service to support chronic disease self-management among students, faculty and patients

BACKGROUND

Shortage of health professionals is one of the most important barriers for community health centers to provide quality primary care for chronic disease patients especially after the outbreak of COVID-19. Under such condition, medical students have been well-accepted as a force multiplier for community-based health service. Community service learning (CSL) based on medical student-led community health education service to support chronic disease self-management might be a valuable interactive learning tool in medical education. This study compared the attitudes toward medical student-led community health education service to support chronic disease self-management among three stakeholder roles in CSL, including medical students, faculty and patients.

METHODS

This cross-sectional comparative survey was conducted using a self-developed questionnaire among the convenience samples of undergraduate students and faculty members from the Medical College, Wuhan University of Science and Technology, as well as patient volunteers with chronic diseases recruited from a free on-site clinic offered by a community health center. Attitudes toward medical student-led community health education service to support chronic disease self-management were compared among students, faculty and patients.

RESULTS

A total of 515 valid questionnaires were obtained (342 were collected from medical students, 54 from faculty respondents, and 119 from patients). Overall positive attitudes toward medical student-led community health education service to support chronic disease self-management were positive. Among the three stakeholder roles, faculty and patients were more supportive of the current inadequate level of primary care provision within the community. However, patient respondents showed more negative attitudes towards using resources in higher medical education system to provide support for primary care practice, and participating in the medical student-led community health education service to support chronic disease self-management, and were most skeptical about the medical students' competency in supporting chronic disease self-management with their professional knowledge and skills. The educational value of CSL for medical undergraduates and the role of faculty instructors were most appreciated by faculty respondents. Additionally, > 62 years old and > 2 kinds of chronic diseases per patient exhibited significant correlations with positive patients' attitudes.

CONCLUSIONS

Medical students, faculty and patients had overall positive attitudes towards CSL based on medical student-led community health education service to support chronic disease self-management. However, more should be done to create higher expectations and enthusiasm of patients about CSL.

Effects of ambient temperature on hospital admissions for obstructive nephropathy in Wuhan, China: A time-series analysis

Under the background of global warming, it has been confirmed that heat exposure has a huge impact on human health. The current study aimed to evaluate the effects of daily mean ambient temperature on hospital admissions for obstructive nephropathy (ON) at the population level. A total of 19,494 hospitalization cases for ON in Wuhan, China from January 1, 2015 to December 31, 2018 were extracted from a nationwide inpatient database in tertiary hospitals according to the International Classification of Diseases (ICD)- 10 codes. Daily ambient meteorological and pollution data during the same period were also collected. A quasi-Poisson Generalized Linear Model (GLM) combined with a distributed lag non-linear model (DLNM) was applied to analyze the lag-exposure-response relationship between daily mean temperature and daily hospital admissions for ON. Results showed that there were significantly positive associations between the daily mean temperature and ON hospital admissions. Relative to the minimum-risk temperature (-3.4 ℃), the risk of hospital admissions for ON at moderate hot temperature (25 ℃, 75th percentile) occurred from lag day 4 and stayed to lag day 12 (cumulative relative risk [RR] was 1.846, 95 % confidence interval [CI]: 1.135-3.005, over lag 0-12 days). Moreover, the risk of extreme hot temperature (32 ℃, 99th percentile) appeared immediately and lasted for 8 days (RR = 2.019, 95 % CI: 1.308-3.118, over lag 0-8 days). Subgroup analyses indicated that the middle-aged and elderly (≥45 years) patients might be more susceptible to the negative effects of high temperature, especially at moderate hot conditions. Our findings suggest that temperature may have a significant impact on the acute progression and onset of ON. Higher temperature is associated with increased risks of hospital admissions for ON, which indicates that early interventions should be taken in geographical settings with relatively high temperatures, particularly for the middle-aged and elderly.