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Choi M, Sempungu JK, Lee EH, Lee YH. Living longer but in poor health: healthcare system responses to ageing populations in industrialised countries based on the Findings from the Global Burden of Disease Study 2019. BMC Public Health 2024; 24:576. [PMID: 38388412 PMCID: PMC10885395 DOI: 10.1186/s12889-024-18049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES This study aimed to examine changes in life expectancy (LE), health-adjusted life expectancy (HALE), unhealthy years of life, and disease burden of older people in industrialised countries and associations with health systems. METHODS We used estimates of LE and HALE, unhealthy years of life, years of life loss (YLL), years lived with disability (YLD) for individuals aged 70 years and over in 33 industrialised countries from 1990 to 2019 from the Global Burden of Disease Study 2019. A linear regression analysis was conducted to examine the association of health outcomes with the Healthcare Access and Quality (HAQ) index. RESULTS LE and HALE increased with improved HAQ index from 1990 to 2019. However, the number of unhealthy years of life increased. An increased HAQ index was associated with decreases in YLL. However, changes in YLD were relatively small and were not correlated with HAQ index. CONCLUSIONS The healthcare system needs to more address the increased morbidity burden among older people. It should be designed to handle to healthcare needs of the ageing population.
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Affiliation(s)
- Minjae Choi
- Institute for Future Public Health, Graduate School of Public Health, Korea University, Seoul, Republic of Korea
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Joshua Kirabo Sempungu
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
- Program in Public Health, Graduate School, Korea University, Seoul, Republic of Korea
| | - Eun Hae Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
- Program in Public Health, Graduate School, Korea University, Seoul, Republic of Korea
| | - Yo Han Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea.
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Zhao S, Zhang J, Wan H, Tao C, Hu M, Liang W, Xu Z, Xu B, Zhang J, Wang G, Li P, Lyu G, Gong Y. Role of Chinese Acupuncture in the Treatment for Chemotherapy-Induced Cognitive Impairment in Older Patients With Cancer: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e53853. [PMID: 38329790 PMCID: PMC10884956 DOI: 10.2196/53853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/06/2024] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Older patients with cancer experience cognitive impairment and a series of neurocognitive symptoms known as chemobrain due to chemotherapy. Moreover, older populations are disproportionately affected by chemobrain and heightened negative mental health outcomes after cytotoxic chemical drug therapy. Chinese acupuncture is an emerging therapeutic option for chemotherapy-induced cognitive impairment in older patients with cancer, despite limited supporting evidence. OBJECTIVE Our study aims to directly contribute to the existing knowledge of this novel Chinese medicine mode in older patients with cancer enrolled at the Department of Oncology/Chinese Medicine, Nanjing First Hospital, China, thereby establishing the basis for further research. METHODS This study involves a 2-arm, prospective, randomized, assessor-blinded clinical trial in older patients with cancer experiencing chemobrain-related stress and treated with Chinese acupuncture from September 30, 2023, to December 31, 2025. We will enroll 168 older patients with cancer with clinically confirmed chemobrain. These participants will be recruited through screening by oncologists for Chinese acupuncture therapy and evaluation. Electroacupuncture will be performed by a registered practitioner of Chinese medicine. The electroacupuncture intervention will take about 30 minutes every session (2 sessions per week over 8 weeks). For the experimental group, the acupuncture points are mainly on the head, limbs, and abdomen, with a total of 6 pairs of electrically charged needles on the head, while for the control group, the acupuncture points are mainly on the head and limbs, with only 1 pair of electrically charged needles on the head. RESULTS Eligible participants will be randomized to the control group or the experimental group in 1:1 ratio. The primary outcome of this intervention will be the scores of the Montreal Cognitive Assessment. The secondary outcomes, that is, attentional function and working memory will be determined by the Digit Span Test scores. The quality of life of the patients and multiple functional assessments will also be evaluated. These outcomes will be measured at 2, 4, 6, and 8 weeks after the randomization. CONCLUSIONS This efficacy trial will explore whether Chinese electroacupuncture can prevent chemobrain, alleviate the related symptoms, and improve the quality of life of older patients with cancer who are undergoing or are just going to begin chemotherapy. The safety of this electroacupuncture intervention for such patients will also be evaluated. Data from this study will be used to promote electroacupuncture application in patients undergoing chemotherapy and support the design of further real-world studies. TRIAL REGISTRATION ClinicalTrials.gov NCT05876988; https://clinicaltrials.gov/ct2/show/NCT05876988. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53853.
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Affiliation(s)
- Sunyan Zhao
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Zhang
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Haijun Wan
- Department of Gastroenterology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Chenjie Tao
- Department of Oncology, Eastern Hepatobiliary Hospital, Naval Medical University, Shanghai, China
| | - Meng Hu
- Department of Medical Oncology, Liyang People's Hospital, Liyang, China
| | - Wei Liang
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhi Xu
- Medical Affairs, ICON Public Limited Company (ICON Plc), Beijing, China
| | - Bingguo Xu
- Division of Chinese Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jiaying Zhang
- Division of Chinese Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guoxin Wang
- Division of Chinese Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ping Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Guangmei Lyu
- Information Centre, Jiangsu Health Vocational College, Nanjing, China
| | - Yongling Gong
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Chen J, Zhao M, Zhou R, Ou W, Yao P. How heavy is the medical expense burden among the older adults and what are the contributing factors? A literature review and problem-based analysis. Front Public Health 2023; 11:1165381. [PMID: 37397714 PMCID: PMC10313336 DOI: 10.3389/fpubh.2023.1165381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/12/2023] [Indexed: 07/04/2023] Open
Abstract
In recent years, the aging population and increasing medical expenses among the older adults have emerged as significant public health concerns. National governments must conduct medical expense accounting and implement measures to reduce the burden of medical costs on the older population. However, limited studies have focused on total medical expenditure from a macro perspective, with many researches exploring individual medical expenses from different perspectives. This review introduces the trend of population aging and its impact on health cost change, reviews research on the medical expense burden of the older population and contributing factors, and points out underlying problems and limitations of current studies. Based on the present studies, the review emphasizes the necessity of medical expense accounting and analyzes the medical expense burden of the older population. Future studies should explore the impacts of medical insurance funds and health service system reforms on reducing medical expenses and developing a supporting medical insurance reform plan.
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Affiliation(s)
- Jie Chen
- Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Meizhen Zhao
- Nursing Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Renyi Zhou
- Department of Orthopaedics, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenjing Ou
- College of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Pin Yao
- Department of Health Management, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Liu L, Xu Y, Jiang Y, Zhao L, Yin X, Shen C, Yang Y, Bai Q, Man X, Cheng W. Impact of Beijing healthcare reform on the curative care expenditure of outpatients with noncommunicable diseases based on SHA2011 and interrupted time series analysis. BMC Health Serv Res 2021; 21:1045. [PMID: 34600531 PMCID: PMC8487539 DOI: 10.1186/s12913-021-07059-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 09/20/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To analyse the changes in curative care expenditure (CCE) associated with noncommunicable diseases (NCDs) before and after the Beijing healthcare reform, thus providing a reference for the healthcare system. METHODS A total of 60 medical institutions were selected using multistage stratified cluster random sampling in Beijing, China. The records of approximately 100 million outpatients with NCDs in 2016-2018 were extracted. System of Health Accounts 2011 (SHA2011) was used to estimate the CCE. The segmented regression model was established to observe both the instant change and the slope change of intervention in interrupted time series analysis (ITSA). The study was conducted from December 2019 to May 2020 in Beijing, China. RESULTS From SHA2011, we found that the CCE for outpatients with NCDs in Beijing were 58.59, 61.46 and 71.96 billion RMB in 2016, 2017 and 2018, respectively. The CCE continued to rise at all hospital levels, namely, tertiary, secondary, and community-level hospitals. However, the proportion of CCE in tertiary hospitals decreased. From ITSA, we can also conclude that the CCE showed a significant increasing trend change at the three hospital levels after the intervention. The drug proportion showed a significant decreasing trend change in secondary and tertiary hospitals. CONCLUSIONS Beijing healthcare reform does have an impact on the CCE of NCDs.
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Affiliation(s)
- Liming Liu
- Beijing University of Chinese Medicine, Beijing, China
| | - Yue Xu
- Beijing University of Chinese Medicine, Beijing, China
| | - Yan Jiang
- Beijing University of Chinese Medicine, Beijing, China
| | - Liying Zhao
- Beijing University of Chinese Medicine, Beijing, China
| | - Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Beijing, China
| | - Chen Shen
- Beijing University of Chinese Medicine, Beijing, China
| | - Yong Yang
- Beijing University of Chinese Medicine, Beijing, China
| | - Qian Bai
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
| | - Xiaowei Man
- Beijing University of Chinese Medicine, Beijing, China.
- National Institute of Chinese Medicine Development and Strategy, Beijing, China.
- , Beijing, China.
| | - Wei Cheng
- Beijing University of Chinese Medicine, Beijing, China.
- National Institute of Chinese Medicine Development and Strategy, Beijing, China.
- , Beijing, China.
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Feng H, Pan K, Li X, Zhang L, Mao L, Rui D. Case study of the beneficiary group distribution of curative care expenditure based on SHA 2011 in Xinjiang autonomous region, China. BMJ Open 2021; 11:e043155. [PMID: 34183335 PMCID: PMC8240570 DOI: 10.1136/bmjopen-2020-043155] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/04/2022] Open
Abstract
BACKGROUND The System of Health Accounts 2011 (SHA 2011) assists in health policy analysis and health expenditure comparison at the international level. Based on SHA 2011, this study analysed the distribution of beneficiary groups of curative care expenditure (CCE) in Xinjiang, to present suggestions for developing health policies. METHODS A total of 160 health institutions were selected using the multistage stratified random sampling method. An analysis of the agewise CCE distribution, institutional flow, and disease distribution was then performed based on the SHA 2011 accounting framework. RESULTS In 2016, the CCE in Xinjiang was ¥50.05 billion, accounting for 70.18% of current health expenditure and 6.66% of the gross domestic product. The per capita CCE was ¥2366.56. The CCE was distributed differently across age groups, with the highest spending on people over the age of 65 years. The CCE was highest for diseases of the circulatory, respiratory and digestive systems. Most of the expenditure was incurred in hospitals and, to a lesser extent, in primary healthcare institutions. Family health expenditure, especially on children aged 14 years and below, accounted for a relatively high proportion of the CCE. CONCLUSION SHA 2011 was used to capture data, which was then analysed according to the newly added beneficiary dimension. The findings revealed that the use of medical resources is low, the scale of primary medical institutions needs to be significantly expanded and there is a need to optimise the CCE financing scheme. Therefore, the health policymaking department should optimise the relevant policies and improve the efficiency of health services.
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Affiliation(s)
- Honghong Feng
- Department of Public Health, Shihezi University School of Medicine, Shihezi, China
| | - Kai Pan
- Xinjiang Uighur Autonomous Region Center for Disease Control and Prevention, Wulumuqi, China
| | - Xiaoju Li
- Department of Public Health, Shihezi University School of Medicine, Shihezi, China
| | - Liwen Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, China
| | - Lu Mao
- Department of Public Health, Shihezi University School of Medicine, Shihezi, China
| | - Dongsheng Rui
- Department of Public Health, Shihezi University School of Medicine, Shihezi, China
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Zang S, OuYang J, Zhao M, Zhu Y, Liu J, Wang X. Factors associated with child delivery expenditure during the transition to the national implementation of the two-child policy in China. Health Qual Life Outcomes 2021; 19:30. [PMID: 33482815 PMCID: PMC7821516 DOI: 10.1186/s12955-021-01678-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to analyze the status of birthrates and the characteristics of child delivery expenditure under the Chinese two-child policy's transition period. We evaluated the socioeconomic factors associated with child delivery and provide evidence for decisions relating to health support for childbirth. METHODS Child delivery expense data were obtained from 2015 to 2017 in Dalian, China. A total of 13,535 obstetric records were enrolled using stratified random sampling and the proportional probability to size method. First, we calculated the current curative expenditure of child delivery and health financing in childbirth costs based on the System of Health Accounts 2011 (SHA 2011). Second, univariate analysis of variance and generalized linear modeling were performed to examine factors associated with child delivery expenditure. Third, we classified the included hospitals into the county, district, and municipal hospitals and compared maternal characteristics between these categories. RESULTS Overall, out-of-pocket payments accounted for more than 35% of the total expenditure on child delivery. Median (interquartile range) delivery expenditure at the county and district level hospitals [county-level: 5128.50 (3311.75-5769.00) CNY; district-level: 4064.00 (2824.00-6599.00) CNY] was higher than that at the municipal level hospitals: 3824.50 (2096.50-5908.00) CNY. The increase of child delivery expenditure was associated with an increased ratio of reimbursement, admissions to county and district level hospitals, cesarean sections, and length of stay, as well as a decline in average maternal age (p < 0.05). CONCLUSIONS Health financing for childbirth expenditure was not rational during the transition period of the family planning policy in China. Higher delivery expenditure at county and district level hospitals may indicate variations in medical professionalism. Poorly managed hospitalization expenditure and/or nonstandard medical charges for childbirth, all of which may require the development of appropriate public health policies to regulate such emerging phenomena.
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Affiliation(s)
- Shuang Zang
- School of Nursing, China Medical University, Shenyang, China
| | - Jing OuYang
- Humanity and Management College, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Meizhen Zhao
- Nursing Department, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yalan Zhu
- College of the Humanities and Social Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Jia Liu
- College of the Humanities and Social Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Xin Wang
- College of the Humanities and Social Sciences, China Medical University, Shenyang, 110122, Liaoning, China.
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Sun S, Yang L, Hu X, Zhu Y, Liu B, Yang Y, Wang X. The burden of the current curative expenditure of injury in Dalian, China-a study based on the "system of health accounts 2011". BMC Public Health 2021; 21:157. [PMID: 33468078 PMCID: PMC7814588 DOI: 10.1186/s12889-021-10164-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injury is one of the major public health problems and causes more than 5 million deaths in the world annually. Cases of specific types of injury are life-threatening and heavily-burdened to individuals and society. This study was aimed to assess the financial burden of injury on patients. METHODS A total of 565 medical institutions were selected with multistage stratified cluster random sampling, containing 152,553 valid samples. Subsequently, the distribution of injury current curative expenditure (CCE) in different dimensions (including age and site of injury) was analyzed under the framework of System of Health Accounts 2011 (SHA 2011) using the established database. RESULTS In China, both urban and rural injury mortality rates showed an upward trend of more than 5 percentage points from 2006 to 2016. In Dalian, the CCE of injury reached 1572.73 million RMB, accounting for 7.45% of the total CCE. Those aged 15-24 reported larger proportion of CCE than the other age groups. As for the injuries in body parts, injuries occurred to the spine, lower limb, head and foreign body cost most. CONCLUSIONS Dalian has a relatively serious burden of injury costs. The essential and primary goal is to reduce the cost. Young people should pay attention to protect their head and limbs from injury, and related government sectors should implement preventive and educative measures.
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Affiliation(s)
- Shu Sun
- The First Affiliated Hospital of China Medical University, No.155 Nanjing Beijie, Heping District, Shenyang, Liaoning Province, P.R. China, 110001
| | - Liuna Yang
- School of public health, Songshan Lake National High-tech Industrial Development, Guangdong Medical University, No.1 Xincheng Blvd, Zone, Dongguan, Guangdong Province, P.R. China, 523808
| | - Xinzhu Hu
- College of the Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, P.R. China, 110122
| | - Yalan Zhu
- College of the Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, P.R. China, 110122
| | - Boxi Liu
- College of the Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, P.R. China, 110122
| | - Yunbin Yang
- Southern Medical University, 1023-1063 Shatai south road, Guangzhou, Guangdong Province, P.R. China, 510515
| | - Xin Wang
- College of the Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, P.R. China, 110122.
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Hashemi-Demne J, Izadi-Avanji F, Kafaei-Atrian M. Development and psychometric properties of the online health information-seeking skill scale. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2021. [DOI: 10.4103/iahs.iahs_148_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chen J, Yang L, Qian Z, Sun M, Yu H, Ma X, Wan C, Yang Y. Cluster analysis of differences in medical economic burden among residents of different economic levels in Guangdong Province, China. BMC Health Serv Res 2020; 20:988. [PMID: 33115445 PMCID: PMC7594465 DOI: 10.1186/s12913-020-05817-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background This study compares and analyzes the differences of residents’ medical economic burden in different economic levels, explores the factors for improving the equity of health services in Guangdong, China. Methods Cluster analysis was carried out in 20 cities of Guangdong Province by taking 7 key factors on the equity of health services as indicators. Seven key factors were collected from Guangdong Statistical Yearbook 2017 and the Sixth National Population Census. R-type clustering was used to reduce the dimensionality of 7 candidate variables through similarity index. Q-type clustering was used to classify 20 cities in Guangdong Province. Results The cluster analysis divided Guangdong Province into three regions with different medical economic burden. The greater the proportion of the elderly over 65 years old, the greater the proportion of health care expenditure to per capita consumer expenditure of residents, and the heavier the medical economic burden. On average, 10.75% of the general budget expenditure of each city in Guangdong Province is spent on health care. Conclusions The lower per capita GDP, the higher proportion of the elderly over 65 years old and the lack of medical technicians are risk factors for the heavier medical burden of the residents and the fairness of health services. While increasing the health expenditure, the government needs to further complete the reform of the medical and health system, improve the efficiency of the medical system and curb the rapid rise of absolute health expenditures of individuals, which can reduce the economic burden of residents’ medical care.
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Affiliation(s)
- Jialong Chen
- School of Public Health, Guangdong Medical University, Dongguan, 523808, China
| | - Liuna Yang
- School of Public Health, Guangdong Medical University, Dongguan, 523808, China
| | - Zhenzhu Qian
- Guangdong Medical University, No.1 Xincheng Blvd, Songshan Lake National Hightech Industrial Development Zone, Dongguan, 523808, Guangdong, China
| | - Mingwei Sun
- School of Public Health, Guangdong Medical University, Dongguan, 523808, China
| | - Honglin Yu
- School of Public Health, Guangdong Medical University, Dongguan, 523808, China
| | - Xiaolei Ma
- Guangdong Medical University, No.1 Xincheng Blvd, Songshan Lake National Hightech Industrial Development Zone, Dongguan, 523808, Guangdong, China
| | - Chonghua Wan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, 523808, China
| | - Yunbin Yang
- Guangdong Medical University, No.1 Xincheng Blvd, Songshan Lake National Hightech Industrial Development Zone, Dongguan, 523808, Guangdong, China.
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Li F, Zhu B, Sang P, Jin C. How the resource allocation and inpatient behavior affect the expenditures of terminal malignant tumor patients? J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Li J, Xu X, Sun J, Cai W, Qin T, Wu M, Liu H. Activities of daily living, life orientation, and health-related quality of life among older people in nursing homes: a national cross-sectional study in China. Qual Life Res 2020; 29:2949-2960. [PMID: 32632641 DOI: 10.1007/s11136-020-02571-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to explore the current status of activities of daily living (ADLs), life orientation, and health-related quality of life (HRQoL) among older people in nursing homes and to further examine the mediating role of life orientation in the impact of ADLs on HRQoL. METHODS A national cross-sectional study was conducted among older people aged 60 and above in nursing homes by the randomly stratified cluster sampling method. The status of ADLs, life orientation and HRQoL were measured using an ADL scale, a life orientation scale and the SF-12v2 scale, respectively. Multiple linear regression models were used to identify explanatory factors associated with ADLs, life orientation, and HRQoL. The potential mediating role of life orientation in the relationship between ADL and HRQoL was explored by mediation analysis. RESULTS The overall prevalence of ADL disability was 52.67%, and 84.37% of older people in nursing homes had a negative life orientation. The mean scores of physical health and mental health among older people in nursing homes were 45.44 ± 6.46 and 42.67 ± 8.48, respectively. Some sociodemographic characteristics were associated with poor physical health and mental health. After adjustments were made for covariates, the life orientation score mediated 13.81% of the total effect of the ADL score on physical component score of HRQoL and mediated 45.33% of the mental component score of HRQoL. CONCLUSION A sizeable proportion of older people had ADL disability and negative life orientation, and HRQoL was poor among older Chinese people in nursing homes. Life orientation partially mediates the relationship between ADLs and HRQoL.
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Affiliation(s)
- Junling Li
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Xueying Xu
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Jinbin Sun
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Weijie Cai
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Tiantian Qin
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Mingcheng Wu
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Hongbo Liu
- School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, Shenyang, Liaoning Province, 110122, People's Republic of China.
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Khamis R, Sabbah H, Sabbah S, Peters L, Droubi N, Sabbah I. Evaluating the psychometric properties of the Arabic version of the Groningen Frailty Indicator among Lebanese elderly people. J Egypt Public Health Assoc 2019; 94:28. [PMID: 32813111 PMCID: PMC7364700 DOI: 10.1186/s42506-019-0028-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/03/2019] [Indexed: 12/03/2022]
Abstract
Background The levels of frailty are anticipated to increase as a result of population aging. A valid instrument is required to detect individuals at high risk of frailty. The present research aimed to assess feasibility, reliability, and construct validity of the Arabic version of Groningen Frailty Indicator (GFI) in urban and rural populations in South Lebanon. Methods During 2015, a cross-sectional study, which enrolled 390 community-dwelling individuals aged 65 years and above, was conducted in urban and rural areas in Nabatieh in South Lebanon. The survey included questions on sociodemographic and health-related characteristics, GFI, and Vulnerable Elders Survey-13 (VES-13). The translation and cultural adaptation of the GFI followed a standardized protocol. After that, the psychometric properties of the scale (i.e., feasibility, reliability, and validity) were evaluated. Results A total of 390 elderly filled out the questionnaire, of whom 51% were women and 70% lived in rural areas. 81.3% of elderly were identified as frail. The internal consistency of the GFI scale was high for all subscales (Cronbach’s alpha > 0.70), except the social scale (0.56). The GFI yielded statistically significant scores for subgroup analysis (known-groups validity) as higher levels of frailty were seen in older people, women, those with morbidities, and those reported poor financial status. The construct validity of the scale was supported by the significant correlation with the VES-13 (r = 0.73; p = 0.001), quality of life (r = − 0.22; p = 0.001), and self-reported health status (r = − 0.66; p = 0.001). Conclusion This study supports the feasibility, reliability, and validity of the GFI Arabic version as a screening tool for frailty among community-dwelling elderly in South Lebanon.
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Affiliation(s)
- Rania Khamis
- Institute of Social Science, Lebanese University, Saida, Lebanon
| | - Hala Sabbah
- Faculty of Economic Sciences and Business Administration, Lebanese University, Nabatieh, Lebanon
| | - Sanaa Sabbah
- Institute of Social Science, Lebanese University, Saida, Lebanon.,Doctoral School of Literature, Humanities & Social Sciences, Lebanese University, Beirut, Lebanon
| | - Lilian Peters
- VU University Medical Center Amsterdam, Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Nabil Droubi
- Faculty of Public Health, Lebanese University, Saida, Lebanon
| | - Ibtissam Sabbah
- Faculty of Public Health, Lebanese University, Saida, Lebanon.
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13
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He J, Yin Z, Duan W, Wang Y, Wang X. Factors of hospitalization expenditure of the genitourinary system diseases in the aged based on "System of Health Account 2011" and neural network model. J Glob Health 2018; 8:020504. [PMID: 30356462 PMCID: PMC6184416 DOI: 10.7189/jogh.08.020504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Hospitalization expenditure of genitourinary system diseases among the aged is often overlooked. The aim of our research is to analyze the basic situation and influencing factors of hospitalization expenditure of the genitourinary system diseases and provide better data for the health system. Methods A total of 1 377 681 patients aged 65 years and over were collected with multistage stratified cluster random sampling in 252 medical institutions in Liaoning China, and “System of Health Account 2011” (SHA2011) was conducted to analyze the expenditure of the diseases. The corresponding samples were extracted, the neural network model was utilized to fit the regression model of the diseases among the aged, and sensitivity analysis was used to rank the influencing factors. Results Total hospitalization expenditure in Liaoning was 51.286 billion yuan, and curative care expenditure of diseases of the genitourinary system was 3.350 billion yuan, accounting for 6.53%. In the neural network model, the training set of R2 was 0.71. The test set of R2 was 0.74. In the sensitivity analysis, top-three influencing factors were the length of stay, type of institutions and type of insurances; the weight was 0.28, 0.19 and 0.14, respectively. Conclusions This research used SHA2011 to grab a large amount of data and analyzed them depending upon the corresponding dimensions. The neural network can analyze the influencing factors of hospitalization expenditure of genitourinary diseases in elderly patients accurately and directly, and can clearly describe the extent of its impact by combining sensitivity analysis.
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Affiliation(s)
- Junlin He
- School of Public Health, China Medical University, Wuxi No. 2 People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Zhuo Yin
- College of Metropolitan Transportation, Beijing University of Technology, Beijing, China
| | - Wenjuan Duan
- College of the Humanities and Social Sciences, China Medical University, Shenyang, China
| | | | - Xin Wang
- College of the Humanities and Social Sciences, China Medical University, School of Public Health, Xinjiang Medical University, Urumqi, China
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14
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Cai Y, Zhu M, Sun W, Cao X, Wu H. Study on the cost attributable to central venous catheter-related bloodstream infection and its influencing factors in a tertiary hospital in China. Health Qual Life Outcomes 2018; 16:198. [PMID: 30305105 PMCID: PMC6180575 DOI: 10.1186/s12955-018-1027-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/26/2018] [Indexed: 11/14/2022] Open
Abstract
Background Central venous catheters (CVC) have been widely used for patients with severe conditions. However, they increase the risk of catheter-related bloodstream infection (CRBSI), which is associated with high economic burden. Until now, no study has focused on the cost attributable to CRBSI in China, and data on its economic burden are unavailable. The aim of this study was to assess the cost attributable to CRBSI and its influencing factors. Methods A retrospective matched case-control study and multivariate analysis were conducted in a tertiary hospital, with 94 patients (age ≥ 18 years old) from January 2011 to November 2015. Patients with CRBSI were matched to those without CRBSI by age, principal diagnosis, and history of surgery. The difference in cost between the case group and control group during the hospitalization was calculated as the cost attributable to CRBSI, which included the total cost and five specific cost categories: drug, diagnostic imaging, laboratory testing, health care technical services, and medical material. The relation between the total cost attributable to CRBSI and its influencing factors such as demographic characteristics, diagnosis and treatment, and pathogenic microorganism, was analysed with a general linear model (GLM). Results The total cost attributable to CRBSI was $3528.6, and the costs of specific categories including drugs, diagnostic imaging, laboratory testing, health care technical services, and medical material, were $2556.4, $112.1, $321.7, $268.7, $276.5, respectively. GLM analysis indicated that the total cost was associated with the intensive care unit (ICU), pathogenic microorganism, age, and catheter number, according to the sequence of standardized estimate (β). ICU contributed the most to the model R-square. Conclusion Central venous catheter–related bloodstream infection represents a great economic burden for patients. More attentions should be paid to further prevent and control this infection in China.
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Affiliation(s)
- Yuanyi Cai
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Min Zhu
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Wei Sun
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Xiaohong Cao
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Huazhang Wu
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China.
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15
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Guan X, Yang M, Man C, Tian Y, Shi L. The effect of the implementation of low price medicine policy on medicine price in China: A retrospective study. Int J Health Plann Manage 2018; 33. [PMID: 29709071 DOI: 10.1002/hpm.2537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/27/2018] [Accepted: 04/04/2018] [Indexed: 11/07/2022] Open
Abstract
In an effort to relieve the pressure of drug shortages, the Chinese government implemented Low-price Medicines (LPM) policy to raise the price cap in July 2014. The purpose of this study is to examine the effect of the implementation of this policy on drug price in China. Price data of 491 LPM, including 218 low-price chemical medicines (LPCM) and 273 low-price traditional Chinese medicines (LPTCM), were collected from 699 hospitals. We used interrupted time series design to identify the variation of monthly Laspeyres Indexes (LI) and Paasche Indexes (PI) for LPM, LPCM, and LPTCM. The result demonstrated that although LPM expenditures increased, the proportion of LPM expenditures accounting for all medicine expenditures fell from 3.6% to 3.2%. After the implementation of LPM policy, there was a significant increasing trend in LPM-PI, LPCM-PI, and LPTCM-PI. The trend in LPM-LI and LPCM-LI was found from descending to rising. However, for LPTCM, the trend in the LI remained to decrease after the policy implementation. Despite the LPM policy had an increasing impact on the LPM drug price, the proportion of LPM expenditures accounting for all medicine expenditures did not increase. More efforts are needed in the future to promote the rational drug use in China.
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Affiliation(s)
- Xiaodong Guan
- School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Mingchun Yang
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Chunxia Man
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Ye Tian
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Luwen Shi
- School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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16
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Awortwe C, Makiwane M, Reuter H, Muller C, Louw J, Rosenkranz B. Critical evaluation of causality assessment of herb-drug interactions in patients. Br J Clin Pharmacol 2018; 84:679-693. [PMID: 29363155 DOI: 10.1111/bcp.13490] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 12/13/2022] Open
Abstract
The aim of this review was to assess the severity of adverse drug reactions (ADRs) due to herb-drug interactions (HDI) in patients taking herbs and prescribed medications based on published evidence. Electronic databases of PubMed, the Cochrane Library, Medline and Scopus were searched for randomized or nonrandomized clinical studies, case-control and case reports of HDI. The data were extracted and the causal relationship of ADRs as consequences of HDI assessed using Horn's drug interaction probability scale or Roussel Uclaf Causality Assessment Method scoring systems. The mechanism of interaction was ascertained using Stockley's herbal medicine interaction companion. Forty-nine case reports and two observational studies with 15 cases of ADRs were recorded. The majority of the patients were diagnosed with cardiovascular diseases (30.60%), cancer (22.45%) and renal transplants (16.32%) receiving mostly warfarin, alkylating agents and cyclosporine, respectively. HDI occurred in patients resulting in clinical ADRs with different severity. Patients may poorly respond to therapeutic agents or develop toxicity due to severe HDI, which in either scenario may increase the cost of treatment and/or lead to or prolong patient hospitalization. It is warranted to increase patient awareness of the potential interaction between herbs and prescribed medicines and their consequences to curb HDI as a potential health problem.
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Affiliation(s)
- Charles Awortwe
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, 7505, South Africa.,Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, 7505, South Africa
| | - Memela Makiwane
- Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, 7505, South Africa
| | - Helmuth Reuter
- Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, 7505, South Africa
| | - Christo Muller
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, 7505, South Africa
| | - Johan Louw
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, 7505, South Africa
| | - Bernd Rosenkranz
- Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, 7505, South Africa
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