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Borchers-Arriagada N, Schulz-Antipa P, Conte-Grand M. Future fire-smoke PM 2.5 health burden under climate change in Paraguay. Sci Total Environ 2024; 924:171356. [PMID: 38447729 DOI: 10.1016/j.scitotenv.2024.171356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/07/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
Recent years have seen a rise in wildfire and extreme weather activity across the globe, which is projected to keep increasing with climate-induced conditions. Air pollution, especially fine particulate matter (PM2.5) concentration, is heavily affected by PM2.5 emissions from wildfire activity. Paraguay has been historically suffering from fires, with an average of 2.3 million hectares burnt per year during the 2003-2021 period. Annual PM2.5 concentration in Paraguay is 13.2 μg/m3, more than double the recommended by the WHO. We estimate that, historically, almost 40 % of fine air particulates can be attributed to fires. Using a random forest algorithm, we estimate future fire activity and fire related PM2.5 under different climate change scenarios. With global warming, we calculate that fire activity could increase by up to 120 % by 2100. Annual fire smoke PM2.5 from fires is expected to increase by 7.7 μg/m3 by 2100. Under these conditions, Paraguay is expected to suffer an increase in 3500 deaths per year attributable to fire smoke PM2.5 by 2100. We estimate the economic cost of fire smoke-related mortality by 2100 at US $ 5600 million, equivalent to 2.6 % of Paraguay's GDP, excluding other health- and productivity-related impacts on society.
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Affiliation(s)
| | - Paulina Schulz-Antipa
- Equity and Financial Institutions, Macro Trade and Investment, The World Bank Group, USA
| | - Mariana Conte-Grand
- Office of the Regional Director Sustainable Development Latin America and the Caribbean, The World Bank Group, USA; Universidad del CEMA, Buenos Aires, Argentina.
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Obeid N, Coelho JS, Booij L, Dimitropoulos G, Silva-Roy P, Bartram M, Clement F, de Oliveira C, Katzman DK. Estimating additional health and social costs in eating disorder care for young people during the COVID-19 pandemic: implications for surveillance and system transformation. J Eat Disord 2024; 12:52. [PMID: 38671494 PMCID: PMC11047001 DOI: 10.1186/s40337-024-01003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The impact of the COVID-19 pandemic on young people with eating disorders (EDs) and their families was profound, with surging rates of hospitalizations and referrals reported internationally. This paper provides an account of the additional health and social costs of ED care for young people living in Canada incurred during the COVID-19 pandemic, drawing attention to the available data to inform these estimates while noting gaps in data capacities to account for a full view of the ED system of care. METHODS Three methodologies were used to capture costs: (1) provincial administrative data holdings available at the Canadian Institute of Health Information (CIHI) were used by Deloitte Access Economics to conduct analyses on costs related to hospitalizations, emergency room visits, outpatient visits with physicians and loss of well-being from being on a waitlist. These were examined across three fiscal years (April 1 to March 31, 2019-2022) to compare costs from one year before to two years after the onset of the pandemic, (2) data collected on support-based community ED organizations and, (3) costs identified by young people, caregivers and health care professionals. RESULTS Estimates of additional health care costs and social costs arising from ED care waitlists were estimated to have increased by 21% across the two years after the onset of the pandemic and is likely to represent an underestimate of costs. Costs related to some standard ED care services (e.g. day treatment programs) and support-based community ED organizations that saw a 118% increase in services during this time, are some examples of costs not captured in the current cost estimate. CONCLUSIONS This paper provides a first account of the additional health and social ED care costs associated with the pandemic, which indicate at minimum, a 21% increase. The results invite discussion for more investments in ED services for young people in Canada, as it is unclear if needs are expected to remain elevated. We suggest a call for a national surveillance strategy to improve data holdings to aid in managing services and informing policy. A robust strategy could open the door for much-needed, data-informed, system transformation efforts that can improve ED care for youth, families and clinicians.
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Affiliation(s)
- Nicole Obeid
- Eating Disorders Research Lab, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, K1H 8L1, Ottawa, ON, Canada.
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
| | - Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Linda Booij
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Gina Dimitropoulos
- Calgary Eating Disorder Program, Alberta Health Services, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Patricia Silva-Roy
- Eating Disorders Research Lab, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, K1H 8L1, Ottawa, ON, Canada
| | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, ON, Canada
- School of Public Policy Administration, Carleton University, Ottawa, ON, Canada
| | - Fiona Clement
- Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Chen-Xu J, Jakobsen LS, Pires SM, Viegas S. Burden of lung cancer and predicted costs of occupational exposure to hexavalent chromium in the EU - The impact of different occupational exposure limits. Environ Res 2023; 228:115797. [PMID: 37001847 DOI: 10.1016/j.envres.2023.115797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Exposure to hexavalent chromium [Cr(VI)] occurs widely in occupational settings across the EU and is associated with lung cancer. In 2025, the occupational exposure limit is set to change to 5 μg/m3. Current exposure limits are higher, with 10 μg/m3 as a general limit and 25 μg/m3 for the welding industry. We aimed to assess the current burden of lung cancer caused by occupational exposure to Cr(VI) and to evaluate the impact of the recently established EU regulation by analysing different occupational exposure limits. METHODS Data were extracted from the literature, the Global Burden of Disease 2019) study, and Eurostat. We estimated the cases of cancer attributable to workplace exposure to Cr(VI) by combining exposure-effect relationships with exposure data, and calculated related DALYs and health costs in scenarios with different occupational exposure limits. RESULTS With current EU regulations, 253 cases (95%UI 250.96-255.71) of lung cancer were estimated to be caused by Cr(VI) in 2019, resulting in 4684 DALYs (95%UI 4683.57-4704.08). In case the welding industry adopted 10 μg/m3, a decrease of 43 cases and 797 DALYs from current values is expected. The predicted application of a 5 μg/m3 limit would cause a decrease of 148 cases and 2746 DALYs. Current costs are estimated to amount to 12.47 million euros/year (95%UI 10.19-453.82), corresponding to 39.97 million euros (95%UI 22.75-70.10) when considering costs per DALY. The limits implemented in 2025 would lead to a decrease of 23.35 million euros when considering DALYs, with benefits of introducing a limit value occurring after many decades. Adopting a 1 μg/m3 limit would lower costs to 1.04 million euros (95%UI 0.85-37.67) and to 3.33 million euros for DALYs (95%UI 1.89-5.84). DISCUSSION Assessing different scenarios with different Cr(VI) occupational exposure limits allowed to understand the impact of EU regulatory actions. These findings make a strong case for adapting even stricter exposure limits to protect workers' health and avoid associated costs.
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Affiliation(s)
- José Chen-Xu
- NOVA National School of Public Health, Public Health Research Centre, NOVA University Lisbon, Lisbon, Portugal; Public Health Unit, Primary Healthcare Cluster Baixo Mondego, Coimbra, Portugal.
| | | | | | - Susana Viegas
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
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Leite-Costa T, Rodrigues D, Sá F, Cruz Correia R. Time optimization in primary care - chronic prescription cost. BMC Health Serv Res 2023; 23:454. [PMID: 37158887 PMCID: PMC10166022 DOI: 10.1186/s12913-023-09355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Time optimization is a common goal to most health information institutions. In several countries, chronic electronic renewal prescriptions were one of the main focuses when implementing information systems. In Portugal, Electronic Medical Prescription (PEM®) software is used for most electronic prescriptions. This study aims to quantify the time spent in chronic prescription renewal appointments (CPRA) in primary care and its impact in the Portuguese National Health System (SNS). METHODS Eight general practitioners (GP) were included in the study during February 2022. The average duration of 100 CPRA was obtained. To determine the number of CPRA performed every year, a primary care BI-CSP® platform was used. Using Standard Cost Model and average medical doctor hourly rate in Portugal we estimated CPRA global costs. RESULTS Each doctor spent on average 1:55 ± 01:07 min per CPRA. There were 8295 GP working in 2022. A total 635 561 CPRA were performed in 2020 and 774 346 in 2021. In 2020, CPRA costs ranged 303 088 ± 179 419€, and in 2021 that number increased to 369 272 ± 218 599€. CONCLUSION This is the first study to quantify CPRA's real cost in Portugal. A PEM® software update would allow daily savings, ranging from 830€ (± 491€) in 2020 and 1011€ (± 598€) in 2021. That change could allow hiring 8 ± 5 GP in 2020 and 12 ± 7 in 2021.
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Affiliation(s)
- Tiffany Leite-Costa
- Mestrado em Informática Médica, Universidade do Porto, Porto, Portugal.
- USF Covelo, ACeS Porto Oriental, Porto, Portugal.
| | - Daniel Rodrigues
- Mestrado em Informática Médica, Universidade do Porto, Porto, Portugal
| | - Fernando Sá
- Mestrado em Informática Médica, Universidade do Porto, Porto, Portugal
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Kwan SC, Zakaria SB, Ibrahim MF, Wan Mahiyuddin WR, Md Sofwan N, A Wahab MI, Ahmad RDR, Abbas AR, Woon WK, Sahani M. Health impacts from TRAPs and carbon emissions in the projected electric vehicle growth and energy generation mix scenarios in Malaysia. Environ Res 2023; 216:114524. [PMID: 36228692 DOI: 10.1016/j.envres.2022.114524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Road transport contributes over 70% of air pollution in urban areas and is the second largest contributor to the total carbon dioxide emissions in Malaysia at 21% in 2016. Transport-related air pollutants (TRAPs) such as NOx, SO2, CO and particulate matter (PM) pose significant threats to the urban population's health. Malaysia has targeted to deploy 885,000 EV cars on the road by 2030 in the Low Carbon Mobility Blueprint (LCMB). This study aims to quantify the health co-benefits of electric vehicle adoption from their impacts on air quality in Malaysia. Two EV uptake projections, i.e. LCMB and Revised EV Adoption (REVA) projections, and five electricity generation mix scenarios were modelled up to 2040. We used comparative health risk assessment to estimate the potential changes in mortality and burden of diseases (BoD) from the emissions in each scenario. Intake fractions and exposure-risk functions were used to calculate the burden from respiratory diseases (PM2.5, NOx, SO2, CO), cardiovascular diseases and lung cancer (PM2.5). Results showed that along with a net reduction of carbon emissions across all scenarios, there could be reduced respiratory mortality from NOx by 10,200 mortality (176,200 DALYs) and SO2 by 2600 mortality (45,400 DALYs) per year in 2040. However, there could also be additional 719 mortality (9900 DALYs) per year from PM2.5 and 329 mortality (5600 DALYs) from CO per year. The scale of reduction in mortality and BoD from NOx and SO2 are significantly larger than the scale of increase from PM2.5 and CO, indicating potential net positive health impacts from the EV adoption in the scenarios. The health cost savings from the reduced BoD of respiratory mortality could reach up to RM 7.5 billion per year in 2040. In conclusion, EV is a way forward in promoting a healthy and sustainable future transport in Malaysia.
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Affiliation(s)
- Soo Chen Kwan
- Center for Toxicology and Health Risk Studies (CORE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sazalina Binti Zakaria
- Built Environment and Climate Change Unit, Generation & Environment Department, TNB Research, Malaysia
| | - Mohd Faiz Ibrahim
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Nurzawani Md Sofwan
- Environmental Health Program, Faculty of Health Sciences, Universiti Teknologi MARA Sarawak Branch, Kota Samarahan, Sarawak, Malaysia
| | - Muhammad Ikram A Wahab
- Center for Toxicology and Health Risk Studies (CORE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Radin Diana R Ahmad
- Built Environment and Climate Change Unit, Generation & Environment Department, TNB Research, Malaysia
| | - Ahmad Rosly Abbas
- Built Environment and Climate Change Unit, Generation & Environment Department, TNB Research, Malaysia
| | - Wei Kian Woon
- Corporate Strategy & Sustainability, Strategy and Ventures Division, Tenaga Nasional Berhad, Malaysia
| | - Mazrura Sahani
- Center for Toxicology and Health Risk Studies (CORE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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Sicras-Mainar A, Sicras-Navarro A, Palacios B, Sequera M, Blanco J, Hormigo A, Manito N, Alcázar-Arroyo R, Botana-Lopez MA. Epidemiology and resource use in Spanish type 2 diabetes patients without previous cardiorenal disease: CaReMe Spain study summary. ENDOCRINOL DIAB NUTR 2022; 69:509-519. [PMID: 36084988 DOI: 10.1016/j.endien.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/10/2021] [Indexed: 06/15/2023]
Abstract
AIMS To determine the first manifestation of cardiovascular or kidney disease (CVKD) and associated resource use in type 2 diabetes mellitus (T2DM) patients during seven years of follow-up. METHODS Observational-retrospective secondary data study using medical records of patients aged ≥18 years with T2DM and without prior CVKD between 2013 and 2019. The index date was 01/01/2013 (fixed date). The manifestation of CVKD was defined by the first diagnosis of heart-failure (HF), chronic-kidney disease (CKD), myocardial-infarction (MI), stroke or peripheral-artery disease (PAD). The main variables were baseline characteristics, manifestation of CVKD, mortality, resource use and costs. Descriptive analyses and Cox model were applied to the data. RESULTS 26,542 patients were selected (mean age: 66.6 years, women: 47.8%, mean duration of T2DM: 17.1 years). 18.7% (N=4974) developed a first CVKD manifestation during the seven years [distribution: HF (22.4%), CKD (36.6%), MI (14.5%), stroke (15.3%) and PAD (11.3%)]. Overall mortality was 8.3% (N=2214). The mortality risk of the group that developed HF or CKD as the first manifestation compared to the CVKD-free cohort was higher [HR: 2.5 (95% CI: 1.8-3.4) and 1.8 (95% CI: 1.4-2.3)], respectively. The cumulative costs per patient of HF (€50,942.80) and CKD (€48,979.20) were higher than MI (€47,343.20) and stroke (€47,070.30) and similar to PAD (€51,240.00) vs. €13,098.90 in patients who did not develop CVKD, p<0.001. CONCLUSIONS In T2DM patients, HF and CKD were the first most common manifestations and had higher mortality and re-hospitalisation rates. HF and CKD were associated with the highest resource use and costs for the Spanish National-Health-System.
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Affiliation(s)
| | | | | | | | | | - Antonio Hormigo
- Dirección Médica, Centro de Salud de San Andrés-Torca, Málaga, Spain
| | - Nicolas Manito
- Bellvitge Hospital, Hospitalet de Llobregat, Barcelona, Spain
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Aoun M, Helou E, Sleilaty G, Zeenny RM, Chelala D. Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives. BMC Health Serv Res 2022; 22:586. [PMID: 35501814 PMCID: PMC9063193 DOI: 10.1186/s12913-022-07936-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/11/2022] [Indexed: 01/10/2023] Open
Abstract
Background Chronic kidney disease (CKD) is the 12th leading cause of death worldwide. Cost-of-illness studies of CKD are scarce in developing countries. This study aims to estimate the cost of illness of all stages of CKD in Lebanon, from early stages until dialysis and kidney transplantation. The secondary objective is to identify factors related to the highest financial burden. Methods This is a cross-sectional study of CKD patients who presented to two nephrology clinics during November 2020. Their medical and administrative records were reviewed for collection of demographics, CKD characteristics, direct medical costs (medications, diagnostic tests, hospitalizations, inpatient care, outpatient care), direct non-medical costs (transportation) and indirect costs (productivity losses) for one year. Kruskal Wallis test was used to compare the costs between different CKD stages and categories. Logistic regression analysis was used to evaluate risk factors associated with costs. Results The sample included 102 non-dialysis CKD patients, 40 hemodialysis, 8 peritoneal dialysis and 10 transplant patients. Their mean age was 66.74 ± 15.36 years, 57.5% were males and 42.5% diabetics. The total median cost per year of CKD across all categories was assessed to be 7,217,500 Lebanese Pounds (3,750,000–35,535,250; 1 $USD = 1515 LBP in 2019) from the societal perspective and 5,685,500 LBP (2,281,750- 32,386,500) from the third-party payer perspective. Statistical analysis showed a higher total cost in hemodialysis (p < 0.001), higher cost of medications in transplant (p < 0.001) and higher cost in technique modality in peritoneal dialysis (p < 0.001). In a sub-analysis of hemodialysis patients, dialysis vintage negatively correlated with total societal cost (r = -0.391, p = 0.013); the regression analysis found diabetes as a risk factor for higher cost (OR = 2.3; 95%CI: 0.638,8.538; p = 0.201). In the subcategory of CKD-ND patients, age correlated with total societal cost (r = 0.323, p = 0.001); diabetes and coronary artery disease were significantly associated with higher total cost (OR = 2.4; 95%CI: 1.083,5.396; p = 0.031; OR = 3.7; 95%CI: 1.535,8.938; p = 0.004). Conclusions This cost of illness study showed a high burden of hemodialysis and peritoneal dialysis cost compared to transplant and non-dialysis CKD patients. It revealed a significantly higher cost of medications in transplant patients. Health policies should target interventions that prevent end-stage kidney disease and encourage kidney transplantation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07936-0.
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Affiliation(s)
- Mabel Aoun
- Department of Nephrology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon. .,Department of Nephrology, Saint-George Hospital, Ajaltoun, Lebanon.
| | - Elie Helou
- Department of Urology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Ghassan Sleilaty
- Unit of biostatistics, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Rony M Zeenny
- Pharmacy Director, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dania Chelala
- Department of Nephrology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.,Department of Nephrology at Hotel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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Veber T, Tamm T, Ründva M, Kriit HK, Pyko A, Orru H. Health impact assessment of transportation noise in two Estonian cities. Environ Res 2022; 204:112319. [PMID: 34740439 DOI: 10.1016/j.envres.2021.112319] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
Transportation noise is a growing public health concern worldwide, especially in urban areas, causing annoyance, sleep disturbance, cardiovascular diseases and other health effects. Recently, European Commission (EC) has developed a mutual methodology for assessing health impacts of transportation noise in European Union using strategic noise mapping. Applying this methodology, our aim was to quantify the health effects of road, rail and aircraft noise in two Estonian cities, Tallinn and Tartu. We also aimed to assess sensitivity of this methodology, while implementing lower threshold values and employing additional health outcomes. The proportion of highly annoyed residents due to road traffic noise was 11.6% in Tallinn, and 9.2% in Tartu; around 2.5% residents in both cities could have high sleeping disturbances. As exposure to railway and aircraft noise was relatively low in both cities, people with high annoyance and high sleep disturbance caused by railway and aircraft noise was below 1%. Ischemic heart disease (IHD) cases attributable to road traffic noise was estimated to be 122.6 in Tallinn and 21.5 in Tartu. Altogether transportation noise was estimated to cause 1807 disability adjusted life years (DALYs) in Tallinn and 370 DALYs in Tartu. The health costs were calculated as €126.5 and €25.9 million annually, respectively in the two cities. When we included higher number of health outcomes (stroke incidence, IHD deaths) and lowered exposure threshold by 5 dB, the annual burden of disease was doubled. As the latest epidemiological studies showed transportation noise having larger number of effects on lower noise levels, the results with the currently applied European Commission health impact assessment (HIA) methodology were rather conservative. Despite of uncertainties associated to applied methodology, transportation noise, especially road traffic noise, is an important environmental risk factor, that leads to considerable loss of healthy life years and causes large health costs in urban areas.
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Affiliation(s)
- Triin Veber
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
| | - Tanel Tamm
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Hedi Katre Kriit
- Sustainable Health, Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Anderi Pyko
- Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans Orru
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Sustainable Health, Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
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Bartscher AK, Seitz S, Siegloch S, Slotwinski M, Wehrhöfer N. Social capital and the spread of covid-19: Insights from european countries. J Health Econ 2021; 80:102531. [PMID: 34607120 PMCID: PMC8520571 DOI: 10.1016/j.jhealeco.2021.102531] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 05/03/2023]
Abstract
We investigate the effect of social capital on health outcomes during the Covid-19 pandemic in independent analyses for Austria, Germany, Great Britain, Italy, the Netherlands, Sweden and Switzerland. Exploiting detailed geographical variation within countries, we show that a one-standard-deviation increase in social capital leads to between 14% and 34% fewer Covid-19 cases per capita accumulated from mid-March until end of June 2020, as well as between 6% and 35% fewer excess deaths per capita. Our results highlight the positive health returns of strengthening social capital.
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Affiliation(s)
| | - Sebastian Seitz
- ZEW and University of Mannheim, L7 3-5, Mannheim 68131, Germany.
| | | | | | - Nils Wehrhöfer
- Deutsche Bundesbank and ZEW, Wilhelm-Epstein-Strae 14, Frankfurt 60431, Germany.
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Nunes RAO, Alvim-Ferraz MCM, Martins FG, Peñuelas AL, Durán-Grados V, Moreno-Gutiérrez J, Jalkanen JP, Hannuniemi H, Sousa SIV. Estimating the health and economic burden of shipping related air pollution in the Iberian Peninsula. Environ Int 2021; 156:106763. [PMID: 34280611 DOI: 10.1016/j.envint.2021.106763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/22/2021] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
Air pollution is the leading cause of the global burden of disease from the environment, entailing substantial economic consequences. International shipping is a significant source of NOx, SO2, CO and PM, which can cause known negative health impacts. Thus, this study aimed to estimate the health impacts and the associated external costs of ship-related air pollution in the Iberian Peninsula for 2015. Moreover, the impact of CAP2020 regulations on 2015 emissions was studied. Log-linear functions based on WHO-HRAPIE relative risks for PM2.5 and NO2 all-cause mortality and morbidity health end-points, and integrated exposure-response functions for PM2.5 cause-specific mortality, were used to calculate the excess burden of disease. The number of deaths and years of life lost (YLL) due to NO2 ship-related emissions was similar to those of PM2.5 ship-related emissions. Estimated all-cause premature deaths attributable to PM2.5 ship-related emissions represented an average increase of 7.7% for the Iberian Peninsula when compared to the scenario without shipping contribution. Costs of around 9 100 million € yr-1 (for value of statistical life approach - VSL) and 1 825 million € yr-1 (for value of life year approach - VOLY) were estimated for PM and NO2 all-cause burden of disease. For PM2.5 cause-specific mortality, a cost of around 3 475 million € yr-1 (for VSL approach) and 851 million € yr-1 (for VOLY approach) were estimated. Costs due to PM and NO2 all-cause burden represented around 0.72% and 0.15% of the Iberian Peninsula gross domestic product in 2015, respectively for VSL and VOLY approaches. For PM2.5 cause-specific mortality, costs represented around 0.28% and 0.06%, respectively, for VSL and VOLY approaches. If CAP2020 regulations had been applied in 2015, around 50% and 30% respectively of PM2.5 and NO2 ship-related mortality would been avoided. These results show that air pollution from ships has a considerable impact on health and associated costs affecting the Iberian Peninsula.
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Affiliation(s)
- Rafael A O Nunes
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Maria C M Alvim-Ferraz
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Fernando G Martins
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | | | - Vanessa Durán-Grados
- Departamento de Máquinas y Motores Térmicos, Escuela de Ingenierías Marina, Náutica y Radioelectrónica, Campus de Excelencia Internacional del Mar (CEIMAR), Universidad de Cádiz, Spain
| | - Juan Moreno-Gutiérrez
- Departamento de Máquinas y Motores Térmicos, Escuela de Ingenierías Marina, Náutica y Radioelectrónica, Campus de Excelencia Internacional del Mar (CEIMAR), Universidad de Cádiz, Spain
| | | | - Hanna Hannuniemi
- Departamento de Máquinas y Motores Térmicos, Escuela de Ingenierías Marina, Náutica y Radioelectrónica, Campus de Excelencia Internacional del Mar (CEIMAR), Universidad de Cádiz, Spain
| | - Sofia I V Sousa
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal.
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Vieta E, Alonso J, Pérez-Sola V, Roca M, Hernando T, Sicras-Mainar A, Sicras-Navarro A, Herrera B, Gabilondo A. Epidemiology and costs of depressive disorder in Spain: the EPICO study. Eur Neuropsychopharmacol 2021; 50:93-103. [PMID: 34058711 DOI: 10.1016/j.euroneuro.2021.04.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 12/26/2022]
Abstract
Depressive Disorders are the most common psychiatric diagnoses in the general population. To estimate the frequency, costs associated with Depressive Disorders in usual clinical practice, and in the whole Spanish population, a longitudinal, retrospective, observational study was carried out using data from the BIG-PAC database®. Study population: all patients aged ≥ 18 years with a diagnosis of a Depressive Disorder in 2015-2017. Prevalence was computed as the proportion of Depressive Disorder cases in the adult general population, and the incidence rate, as the number of new Depressive Disorder cases diagnosed per 1,000 person-years in the population using health services, during 2015-2017. We collected demographic variables, comorbidity, direct health costs, and indirect costs (temporary and permanent disability). Health costs related to Depressive Disorders were estimated according to the annual resource use rate (resource/patient/year). Indirect costs were calculated according to the human capital method. Using the study data and information from the Spanish National Institute of Statistics, we estimated the cost of Depressive Disorders corresponding to the Spanish adult population, including premature mortality. 69,217 Depressive Disorder patients aged ≥ 18 years who met the inclusion/exclusion criteria were studied (mean age: 56.8 years; female: 71.4%). Prevalence of Depressive Disorders in the general population was 4.73% (95% CI: 4.70-4.76%). Annual incidence rates (2015-2017) were 7.12, 7.35 and 8.02 per 1,000 person-years, respectively. Total costs observed in our Depressive Disorder patients were € 223.9 million (corresponding to a mean of € 3,235.3; mean/patient/year), of which, 18.4% were direct health care costs and 81.6%, non-health indirect costs (18% temporary occupational disability, 63.6% permanent disability). Considering also the cost of premature death, the mean cost per patient/year was € 3,402 and the estimated societal costs of Depressive Disorders in Spain were € 6,145 million. The prevalence and incidence of Depressive Disorders are consistent with other series reviewed. Resource use and total costs (especially non-health costs) were high.
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Affiliation(s)
- Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Jordi Alonso
- Health Services Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), CIBERESP, Pompeu Fabra University, Barcelona, Spain
| | - Víctor Pérez-Sola
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona IMIM (Hospital del Mar Medical Research Institute), Barcelona, CIBERSAM, Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Roca
- Institut Universitari d' Investigació en Ciències de la Salut, Idisba, Rediapp, University of Balearic Islands, Palma, Spain
| | | | | | | | | | - Andrea Gabilondo
- Mental Health and Psychiatric Care Research Group, Biodonostia Health Research Institute Osakidetza, San Sebastian, Spain
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12
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Wang Y, Liu Y, Ye D, Li N, Bi P, Tong S, Wang Y, Cheng Y, Li Y, Yao X. Temperatures and health costs of emergency department visits: A multisite time series study in China. Environ Res 2021; 197:111023. [PMID: 33745933 DOI: 10.1016/j.envres.2021.111023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Evidence is limited regarding the association between temperatures and health costs. OBJECTIVES We tried to investigate the association between temperatures and emergency department visits (EDVs) costs in China. METHODS Daily data on EDVs costs, weather, air pollution were collected from 17 sites in China during 2014-2018. A quasi-Poisson generalized additive regression with distributed lag nonlinear model was applied to assess the temperature-EDVs cost association. Random-effect meta-analysis was used to pool the estimates from each site. Attributable fractions and national attributable EDVs costs due to heat and cold were calculated. RESULTS Relative risk (RR) due to extreme heat over 0-7 lag days was 1.14 [95% confidence intervals (CI): 1.08-1.19] and 1.11 (95% CI: 1.07-1.16) for EDVs examination (including treatment) and medicine cost, respectively. People aged 18-44 and those with genitourinary diseases were at higher risk from heat. 0.72% of examination cost and 0.57% of medicine cost were attributed to extreme heat, costing 274 million Chinese Yuan annually. Moderate heat had lower RR but higher attributable fraction of EDVs costs. Exposure to extreme cold over 0-21 lag days increased the risk of medicine cost for people aged 18-44 [RR: 1.30 (95% CI: 1.10-1.55)] and those with respiratory diseases [RR: 1.56 (95% CI: 1.14-2.14)], but had non-statistically significant attributable fraction of the total EDVs cost. CONCLUSIONS Exposure to heat and cold resulted in remarkable health costs. More resources and preparedness are needed to tackle such a challenge as our climate is rapidly changing.
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Affiliation(s)
- Yu Wang
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yue Liu
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dianxiu Ye
- National Climate Center, China Meteorological Administration, Beijing, China
| | - Na Li
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shilu Tong
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China; Center for Global Health, Nanjing Medical University, Nanjing, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Yan Wang
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yibin Cheng
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yonghong Li
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Xiaoyuan Yao
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
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Fellahi JL, Futier E, Vaisse C, Collange O, Huet O, Loriau J, Gayat E, Tavernier B, Biais M, Asehnoune K, Cholley B, Longrois D. Perioperative hemodynamic optimization: from guidelines to implementation-an experts' opinion paper. Ann Intensive Care 2021; 11:58. [PMID: 33852124 PMCID: PMC8046882 DOI: 10.1186/s13613-021-00845-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/29/2021] [Indexed: 12/19/2022] Open
Abstract
Despite a large body of evidence, the implementation of guidelines on hemodynamic optimization and goal-directed therapy remains limited in daily routine practice. To facilitate/accelerate this implementation, a panel of experts in the field proposes an approach based on six relevant questions/answers that are frequently mentioned by clinicians, using a critical appraisal of the literature and a modified Delphi process. The mean arterial pressure is a major determinant of organ perfusion, so that the authors unanimously recommend not to tolerate absolute values below 65 mmHg during surgery to reduce the risk of postoperative organ dysfunction. Despite well-identified limitations, the authors unanimously propose the use of dynamic indices to rationalize fluid therapy in a large number of patients undergoing non-cardiac surgery, pending the implementation of a “validity criteria checklist” before applying volume expansion. The authors recommend with a good agreement mini- or non-invasive stroke volume/cardiac output monitoring in moderate to high-risk surgical patients to optimize fluid therapy on an individual basis and avoid volume overload. The authors propose to use fluids and vasoconstrictors in combination to achieve optimal blood flow and maintain perfusion pressure above the thresholds considered at risk. Although purchase of disposable sensors and stand-alone monitors will result in additional costs, the authors unanimously acknowledge that there are data strongly suggesting this may be counterbalanced by a sustained reduction in postoperative morbidity and hospital lengths of stay. Beside existing guidelines, knowledge and explicit clinical reasoning tools followed by decision algorithms are mandatory to implement individualized hemodynamic optimization strategies and reduce postoperative morbidity and duration of hospital stay in high-risk surgical patients.
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Affiliation(s)
- Jean-Luc Fellahi
- Service D'Anesthésie-Réanimation, Hôpital Louis Pradel, 59 boulevard Pinel, 69500, Hospices Civils de Lyon, Lyon, France. .,Laboratoire CarMeN, Université Claude Bernard Lyon 1, Inserm U1060, Lyon, France.
| | - Emmanuel Futier
- Département de Médecine Périopératoire, Anesthésie-Réanimation, CHU de Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS; Inserm U1103, 63000, Clermont-Ferrand, France
| | - Camille Vaisse
- Service D'Anesthésie-Réanimation, Hôpital Timone, AP-HM, Marseille, France
| | - Olivier Collange
- Service D'Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Université de Strasbourg, Strasbourg, France
| | - Olivier Huet
- Département D'Anesthésie-Réanimation, CHRU de La Cavale Blanche, Brest, France.,Université de Bretagne Occidentale, Brest, France
| | - Jerôme Loriau
- Service de Chirurgie Digestive, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Etienne Gayat
- Département d'Anesthésie-Réanimation, Hôpital Lariboisière, DMU PARABOL, AP-HP Nord et Université de Paris, Paris, France.,UMR-S 942, Inserm, Paris, France
| | - Benoit Tavernier
- Pôle d'Anesthésie-Réanimation, CHU Lille, Univ. Lille, ULR 2694-METRICS, Lille, France
| | - Matthieu Biais
- Pôle d'Anesthésie-Réanimation, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.,Université de Bordeaux, France, Inserm 1034, Pessac, France
| | - Karim Asehnoune
- Service d'Anesthésie-Réanimation Chirurgicale, Pôle Anesthésie Réanimations, Hôtel-Dieu, CHU de Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - Bernard Cholley
- Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,Université de Paris, Paris, France.,Inserm UMR S1140, Paris, France
| | - Dan Longrois
- Département d'Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP Nord, Paris, France.,Université de Paris, Paris, France
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Miranda AC, Santana JCC, Yamamura CLK, Rosa JM, Tambourgi EB, Ho LL, Berssaneti FT. Application of neural network to simulate the behavior of hospitalizations and their costs under the effects of various polluting gases in the city of São Paulo. Air Qual Atmos Health 2021; 14:2091-2099. [PMID: 34745381 PMCID: PMC8556003 DOI: 10.1007/s11869-021-01077-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/11/2021] [Indexed: 05/13/2023]
Abstract
This work aims to obtain an artificial neural network to simulate hospitalizations for respiratory diseases influenced by pollutant gaseous such as CO, PM10, PM2.5, NO2, O3, and SO2 emitted from 2011 to 2017, in the city of São Paulo. The hospitalization costs were also be calculated. MLP and RBF neural networks have been tested by varying the number of neurons in the hidden layer and the type of equation of the output function. The following pollutants and its concentration range were collected considering the supervision of Alto Tiete station set, in several neighborhoods in the city of São Paulo, from in the period 2011 to 2017: 28-63 µg/m3 of PM2.5, 52-110 µg/m3 of PM10, 49-135 µg/m3 of O3, 0.8-2.6 ppm CO, 41-98 µg/m3 of NO2, and 3-16 µg/m3 of SO2. Results showed that a RBF neural network with 6 input neurons, 13 hidden layer neurons, and 1 output neuron, using BFGS algorithm and a Gaussian function to neuronal activation, was the best fitted to the experimental datasets. So, knowing the monthly concentration of gaseous pollutions was possible to predict the hospitalization of 1464 to 3483 ± 510 patients, with costs between 570,447 and 1,357,151 ± 198,171 USD per month. This way, it is possible to use this neural network to predict the costs of hospitalizing patients for respiratory diseases and to contribute to the decision-making of how much the government should spend on health care.
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Affiliation(s)
- Amanda Carvalho Miranda
- Department of Pharmaceutical Sciences, Nine July University, São Paulo, Brazil
- Department of Production Engineering, Polytechnic School, University of São Paulo, Av. Prof. Luciano Gualberto, 1380, Butantã, São Paulo, SP 05508-010 Brazil
| | - José Carlos Curvelo Santana
- Department of Production Engineering, Polytechnic School, University of São Paulo, Av. Prof. Luciano Gualberto, 1380, Butantã, São Paulo, SP 05508-010 Brazil
- Department of Management Engineering, Federal University of ABC, University Mall, São Bernardo do Campo, 09606-045 Brazil
| | - Charles Lincoln Kenji Yamamura
- Department of Production Engineering, Polytechnic School, University of São Paulo, Av. Prof. Luciano Gualberto, 1380, Butantã, São Paulo, SP 05508-010 Brazil
| | - Jorge Marcos Rosa
- School of Textile Technology of SENAI, Rua Correia de Andrade, 232 Brás, São Paulo, SP 03008-020 Brazil
- School of Chemical Engineering, State University of Campinas, Barão Geraldo, Campinas, SP 13083-970 Brazil
| | - Elias Basile Tambourgi
- School of Chemical Engineering, State University of Campinas, Barão Geraldo, Campinas, SP 13083-970 Brazil
| | - Linda Lee Ho
- Department of Production Engineering, Polytechnic School, University of São Paulo, Av. Prof. Luciano Gualberto, 1380, Butantã, São Paulo, SP 05508-010 Brazil
| | - Fernando Tobal Berssaneti
- Department of Production Engineering, Polytechnic School, University of São Paulo, Av. Prof. Luciano Gualberto, 1380, Butantã, São Paulo, SP 05508-010 Brazil
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Blinkenberg M, Kjellberg J, Ibsen R, Magyari M. Increased socioeconomic burden in patients with primary progressive multiple sclerosis: A Danish nationwide population-based study. Mult Scler Relat Disord 2020; 46:102567. [PMID: 33296969 DOI: 10.1016/j.msard.2020.102567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Primary progressive multiple sclerosis (PPMS) is characterized by development of more chronic neurological manifestations from disease onset compared with relapsing remitting MS (RRMS) and secondary progressive MS (SPMS) but the following socioeconomic consequences have never been described in a nation-wide patient population. OBJECTIVE To determine if socioeconomic burden of PPMS is increased compared with RRMS and SPMS. METHODS We included patients from The Danish Multiple Sclerosis Registry diagnosed between 1998 and 2015. Yearly average health costs, public transfers and earned income was calculated from the index diagnosis date, and each year in a five-year period before and after index diagnosis date, for the three patient groups. A regression model estimating the odds ratio (OR) with PPMS as the comparator, was used to analyze the differences between PPMS vs. RRMS and PPMS vs. SPMS controlling for age and sex. RESULTS In total, 9563 MS patients were identified (1998-2015), with a characteristic distribution between different disease courses: 7012 patients with RRMS (73%), 1099 patients with PPMS (11%) and 1452 patients with SPMS (15%). Total health costs were lower in RRMS vs. PPMS (OR 0.76; 95% CI 0.74-0.78; p<0.0001) but not in SPMS vs. PPMS (OR 1.06; 95% CI 1.03-1.09; p<0.0001). Especially homecare costs were lower in RRMS vs. PPMS (OR 0.17; 95% CI 0.17-0.18; p<0.0001), less pronounced in SPMS vs. PPMS (OR 0.93; 95% CI 0.90-0.97; p = 0.0001). OR for health costs before and after diagnosis was significantly lower in RRMS vs. PPMS regarding most variables, less pronounced in SPMS vs. PPMS. CONCLUSION This nation-wide population-based study show that socioeconomic burden is significantly higher in PPMS relative to RRMS, but less pronounced compared with SPMS.
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Marazzi F, Barone R, Masiello V, Magri V, Mulè A, Santoro A, Cacciatori F, Boldrini L, Franceschini G, Moschella F, Naso G, Tomao S, Gambacorta MA, Mantini G, Masetti R, Smaniotto D, Valentini V. Oncotype DX Predictive Nomogram for Recurrence Score Output: The Novel System ADAPTED01 Based on Quantitative Immunochemistry Analysis. Clin Breast Cancer 2020; 20:e600-e611. [PMID: 32565110 DOI: 10.1016/j.clbc.2020.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Oncotype DX (ODX) predicts breast cancer recurrence risk, guiding the choice of adjuvant treatment. In many countries, access to the test is not always available. We used correlation between phenotypical tumor characteristics, quantitative classical immunohistochemistry (IHC), and recurrence score (RS) assessed by ODX to develop a decision supporting system for clinical use. PATIENTS AND METHODS Breast cancer patients who underwent ODX testing between 2014 and 2018 were retrospectively included in the study. The data selected for analysis were age, menopausal status, and pathologic and IHC features. IHC was performed with standardized quantitative methods. The data set was split into two subsets: 70% for the training set and 30% for the internal validation set. Statistically significant features were included in logistic models to predict RS ≤ 25 or ≤ 20. Another set was used for external validation to test reproducibility of prediction models. RESULTS The internal set included 407 patients. Mean (range) age was 53.7 (31-80) years, and 222 patients (54.55%) were > 50 years old. ODX results showed 67 patients (16.6%) had RS between 0 and 10, 272 patients between 11 and 25 (66.8%), and 68 patients > 26 (16.6%). Logistic regression analysis showed that RS score (for threshold ≤ 25) was significantly associated with estrogen receptor (P = .004), progesterone receptor (P < .0001), and Ki-67 (P < .0001). Generalized linear regression resulted in a model that had an area under the receiver operating characteristic curve (AUC) of 92.2 (sensitivity 84.2%, specificity 80.1%) and that was well calibrated. The external validation set (183 patients) analysis confirmed the model performance, with an AUC of 82.3 and a positive predictive value of 91%. A nomogram was generated for further prospective evaluation to predict RS ≤ 25. CONCLUSION RS was related to quantitative IHC in patients with RS ≤ 25, with a good performance of the statistical model in both internal and external validation. A nomogram for enhancing clinical approach in a cost-effective manner was developed. Prospective studies must test this application in clinical practice.
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Affiliation(s)
- Fabio Marazzi
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | | | - Valeria Masiello
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Valentina Magri
- Breast Unit, Division of Medical Oncology, Department of Radiological Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Antonino Mulè
- UOC di Anatomia Patologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Angela Santoro
- UOC di Anatomia Patologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Federica Cacciatori
- UOC di Anatomia Patologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Luca Boldrini
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Gianluca Franceschini
- UOC di Chirurgia Senologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Francesca Moschella
- UOC di Chirurgia Senologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giuseppe Naso
- Breast Unit, Division of Medical Oncology, Department of Radiological Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Silverio Tomao
- Breast Unit, Division of Medical Oncology, Department of Radiological Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Giovanna Mantini
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Riccardo Masetti
- UOC di Chirurgia Senologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Daniela Smaniotto
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
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Wrotek A, Czajkowska M, Jackowska T. Nosocomial Infections in Patients Hospitalized with Respiratory Syncytial Virus: A Practice Review. Adv Exp Med Biol 2020; 1271:1-10. [PMID: 32078148 DOI: 10.1007/5584_2020_483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Viral testing is not always recommended in children with bronchiolitis due to doubts concerning its prognostic use. In this retrospective study, we investigated how the RSV testing would influence the frequency of nosocomial infections (NI). The files of 305 children, hospitalized due to the respiratory syncytial virus (RSV) infection in the period 2010-2014, were reviewed in the study. We found ten cases of NI. The RSV preventive measures did not vary in the consecutive years investigated, but the number of viral tests substantially varied. In 2010, 2012, and 2014, when ca. 2 tests per RSV(+) patient were performed, the risk of NI per patient was 1.3%, while in 2011 and 2013, when the RSV testing was less frequent, the accumulated risk per patient was 5.2%. There was a strong adverse relationship between the number of tests performed and the number of NI (rho = -0.975). The children with NI, when compared to those without NI, required a longer hospital stay, generating higher hospital costs regarding treatment, productivity loss, and indirect costs. The expenditure for RSV testing in the years of a low NI risk was higher than that in the high-risk years. Conversely, the expenditure related to NI management was lower in the years of a low NI risk. Each euro spent on RSV testing saved over 26 € from the NI management expenditure. We conclude that RSV testing is needed in the hospital setting to isolate the infected children and to prevent nosocomial RSV spread. This strategy is health advantageous and requires less resources than NI treatment.
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Gade Sikjær M, Hilberg O, Ibsen R, Bock K, Løkke A. Direct and indirect economic and health consequences related to sarcoidosis in Denmark: A national register-based study. Respir Med 2019; 152:7-13. [PMID: 31128613 DOI: 10.1016/j.rmed.2019.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sarcoidosis is a systemic disease that primarily affects the younger population. Longitudinal studies of the economic burden of sarcoidosis are scarce. This study evaluates overall the economic burden of sarcoidosis in Denmark before and after initial diagnosis. METHODS We identified patients with sarcoidosis in the Danish National Patient Registry (1998-2010). All controls were randomly selected and matched concerning age, gender and residence. Data on direct and indirect costs, including frequency of primary and secondary sector contacts and procedures, medication, unemployment benefits and social transfer payments were extracted from national databases for patients and controls. RESULTS We identified 9119 patients with sarcoidosis and 36,432 matching controls. Patients with sarcoidosis had significantly higher rates of health-related contacts, higher usage of medication and more received unemployment and social payments compared with controls. The total health expenses were significantly higher in the sarcoidosis group 11 years before and 11 years after diagnosis than among controls. Income from public transfer payments was significantly higher in the sarcoidosis group five years prior of diagnosis until nine years post diagnosis. Especially women between 40 and 59 years have a lower income than their controls. CONCLUSION Sarcoidosis has a socioeconomic impact on adults especially during their prime working and providing years and this is evident several years prior to and post diagnosis. The authors advocate that further research should focus on identifying the proportion of patients with sarcoidosis that imposes the largest economic burden. Increased focus on early diagnosis and disease management may reduce the socioeconomic burden of sarcoidosis.
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Affiliation(s)
- Melina Gade Sikjær
- Department of Respiratory Medicine and Allergology, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark(1).
| | - Ole Hilberg
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark(2).
| | - Rikke Ibsen
- Cand.Scient, i2minds, Møllegade 32, 8000, Aarhus C, Denmark.
| | - Kathrine Bock
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark(2).
| | - Anders Løkke
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark(2).
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Herold R, Hoffmann W, van den Berg N. Telemedical monitoring of patients with chronic heart failure has a positive effect on total health costs. BMC Health Serv Res 2018; 18:271. [PMID: 29636040 PMCID: PMC5894132 DOI: 10.1186/s12913-018-3070-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 03/28/2018] [Indexed: 02/03/2023] Open
Abstract
Background Telemedical programs for patients with chronic heart failure have shown inconsistent effects on survival and hospitalization. Few studies analyzed effects of telemedical interventions on health costs, although this outcome may determine whether or not a successful program will be adopted by health insurance providers. We evaluated a large sized telemedicine program provided by a German statutory health insurance, consisting of regular telephone contacts and, for a subgroup of the participants, provision of an electronic scale in a routine care setting. We examined the effects of the program on the total healthcare costs after one year compared to a matched control group. Methods The evaluation was based on reimbursement data of the statutory health insurance. Participants of the program were matched to appropriate controls using a combination of exact (e.g. 5-year age group, gender, NYHA class) and propensity score (e.g. medication, psychiatric comorbidity) matching. The total health costs after one year were calculated on the basis of regression analyses in an intention-to-treat-approach. In a sensitivity analysis, the subgroup of patients with a documented beginning of the intervention was examined. Results Two thousand six hundred twenty two patients with chronic heart failure (55% male, mean age: 73.7 years) were included in the intervention program. 1943 participants (74%) could be matched with appropriate control patients. The telemedicine monitoring program for patients with chronic heart failure reduced total health costs after 12 months of the intervention: − 276€ per quarter year in rural regions and − 18€ in urban regions compared to the control group. Conclusions The telemedicine program could reduce total health costs, especially in rural regions in Germany.
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Affiliation(s)
- Robert Herold
- University Medicine Greifswald, Institute for Community Medicine, Ellernholzstr. 1-2, 17487, Greifswald, Germany
| | - Wolfgang Hoffmann
- University Medicine Greifswald, Institute for Community Medicine, German Center for Cardiovascular Disease (DZHK), Ellernholzstr. 1-2, 17487, Greifswald, Germany
| | - Neeltje van den Berg
- University Medicine Greifswald, Institute for Community Medicine, German Center for Cardiovascular Disease (DZHK), Ellernholzstr. 1-2, 17487, Greifswald, Germany.
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Sicras-Mainar A, Traseira-Lugilde S, Fernández-Sánchez T, Navarro-Artieda R. [Persistence to treatment and resources use with inhaled fixed-dose combinations of corticosteroids and long-acting β-adrenergic agonists for the treatment of asthma: A population-based retrospective study]. Semergen 2018; 44:472-484. [PMID: 29545018 DOI: 10.1016/j.semerg.2018.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/21/2018] [Accepted: 01/29/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine the persistence, exacerbations, and use of resources in patients who use inhaler treatment with fluticasone propionate/formoterol (PF/Form) in relation with other combinations of inhaled corticosteroid/long-acting β-adrenergic (ICS/LABA) at fixed doses, for the treatment of asthma in real-life practice. MATERIAL AND METHODS Observational study conducted by reviewing medical records. The study included subjects ≥18 years of age who started treatment with ICS/LABA and who met certain inclusion/exclusion criteria. The follow-up was carried out for one year. Study groups: a) PF/Form and b) Other-combinations (Other-ICS/LABA). MAIN MEASUREMENTS Persistence, medication possession ratio (MPR), exacerbations, and costs (direct/indirect). The statistical analysis was performed using regression models, with a P<.05. RESULTS A total of 3,203 patients were included in the study. By groups: a) FP/Form: 7.0% and b) Other-ICS/LABA: 93.0%. The mean age was 52.2 years, and 60.8% were women. A total of 44.9% of patients had persistent-moderate asthma. Patients under treatment with FP/Form were associated with greater persistence (67.6 vs. 61.2%, P=.043), a higher RPM (80.6 vs. 74.3%, P=.002), and less exacerbations (16.0 vs. 21.9%, P=.021), particularly severe-exacerbations (4.0 vs. 7.7%, P=.043). The mean/unit of the total cost (ANCOVA) was lower in patients under treatment with PF/Form (2,033 vs. € 2,486, P=.012), respectively. The total cost was associated with: Exacerbations (β=0.618), asthma-severity (β=0.214), age (β=0.073), and lack-adherence (RPM: β=-0.031), P<.01. CONCLUSIONS Patients undergoing treatment with PF/Form were associated with greater adherence to treatment (persistence, RPM), a circumstance that leads to less severe exacerbations and total costs for the national health system. These differences could be due to the pharmacological properties of the drug or other factors not measured.
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Affiliation(s)
- A Sicras-Mainar
- Dirección Científica, ClinicResearch, Tiana, Barcelona, España.
| | | | | | - R Navarro-Artieda
- Documentación Médica, Hospital Germans Trias i Pujol, Badalona (Barcelona), España
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Abstract
BACKGROUND The B‑type natriuretic peptide (BNP) level on discharge of patients hospitalized with decompensated heart failure (HF) is widely considered as the "baseline" value, and treatment should be targeted to maintain this level. The prognostic value of an increase in BNP level from discharge to the 1‑month follow-up in predicting rehospitalization has not been previously explored. METHODS The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial data were utilized to determine whether an increase in BNP level from discharge to the 1‑month follow-up is associated with a higher risk of rehospitalization. The study endpoints were all-cause rehospitalization up to 6 months following randomization. RESULTS Among 44 patients (mean age, 56 years, 71% men) who had their BNP levels checked on discharge and at the 1‑month follow-up, the average BNP level on discharge of the whole cohort was 467 pg/ml, which increased to 919 pg/ml at 1 month (p = 0.001). The median and interquartile range of the magnitude of rise in BNP level from discharge to 1‑month follow-up was higher in rehospitalized compared with non-rehospitalized patients (329 [11, 956] vs. 44 [-90, 316] pg/ml, p = 0.039, in both groups, respectively). Receiver operator characteristic curves showed that the magnitude of the rise in BNP from discharge to the 1‑month follow-up had an area under the curve of 0.686 (p = 0.0255) in predicting all-cause rehospitalization. Rehospitalized and non-rehospitalized patients had similar degree of clinical congestion and comparable BNP level on hospital discharge. CONCLUSION The magnitude of the rise in BNP level from discharge to the 1‑month follow-up is a useful prognostic factor that predicts rehospitalization in patients with HF.
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Affiliation(s)
- H R Omar
- Internal Medicine Department, Mercy Medical Center, Clinton, IA, USA.
| | - M Guglin
- Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, KY, USA
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Jones BA, Berrens RP. Application of an Original Wildfire Smoke Health Cost Benefits Transfer Protocol to the Western US, 2005-2015. Environ Manage 2017; 60:809-822. [PMID: 28905098 DOI: 10.1007/s00267-017-0930-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/10/2017] [Indexed: 06/07/2023]
Abstract
Recent growth in the frequency and severity of US wildfires has led to more wildfire smoke and increased public exposure to harmful air pollutants. Populations exposed to wildfire smoke experience a variety of negative health impacts, imposing economic costs on society. However, few estimates of smoke health costs exist and none for the entire Western US, in particular, which experiences some of the largest and most intense wildfires in the US. The lack of cost estimates is troublesome because smoke health impacts are an important consideration of the overall costs of wildfire. To address this gap, this study provides the first time series estimates of PM2.5 smoke costs across mortality and several morbidity measures for the Western US over 2005-2015. This time period includes smoke from several megafires and includes years of record-breaking acres burned. Smoke costs are estimated using a benefits transfer protocol developed for contexts when original health data are not available. The novelty of our protocol is that it synthesizes the literature on choices faced by researchers when conducting a smoke cost benefit transfer. On average, wildfire smoke in the Western US creates $165 million in annual morbidity and mortality health costs.
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Prichystalova R, Fini JB, Trasande L, Bellanger M, Demeneix B, Maxim L. Comparison of methods for calculating the health costs of endocrine disrupters: a case study on triclosan. Environ Health 2017; 16:55. [PMID: 28599657 PMCID: PMC5466740 DOI: 10.1186/s12940-017-0265-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 05/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Socioeconomic analysis is currently used in the Europe Union as part of the regulatory process in Regulation Registration, Evaluation and Authorisation of Chemicals (REACH), with the aim of assessing and managing risks from dangerous chemicals. The political impact of the socio-economic analysis is potentially high in the authorisation and restriction procedures, however, current socio-economic analysis dossiers submitted under REACH are very heterogeneous in terms of methodology used and quality. Furthermore, the economic literature is not very helpful for regulatory purposes, as most published calculations of health costs associated with chemical exposures use epidemiological studies as input data, but such studies are rarely available for most substances. The quasi-totality of the data used in the REACH dossiers comes from toxicological studies. METHODS This paper assesses the use of the integrated probabilistic risk assessment, based on toxicological data, for the calculation of health costs associated with endocrine disrupting effects of triclosan. The results are compared with those obtained using the population attributable fraction, based on epidemiological data. RESULTS The results based on the integrated probabilistic risk assessment indicated that 4894 men could have reproductive deficits based on the decreased vas deferens weights observed in rats, 0 cases of changed T3 levels, and 0 cases of girls with early pubertal development. The results obtained with the Population Attributable Fraction method showed 7,199,228 cases of obesity per year, 281,923 girls per year with early pubertal development and 88,957 to 303,759 cases per year with increased total T3 hormone levels. The economic costs associated with increased BMI due to TCS exposure could be calculated. Direct health costs were estimated at €5.8 billion per year. CONCLUSIONS The two methods give very different results for the same effects. The choice of a toxicological-based or an epidemiological-based method in the socio-economic analysis will therefore significantly impact the estimated health costs and consequently the political risk management decision. Additional work should be done for understanding the reasons of these significant differences.
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Affiliation(s)
- Radka Prichystalova
- Institut des Sciences de la Communication (UMS 3665), CNRS (Centre National de la Recherche Scientifique)/Université Paris Sorbonne/UPMC (Université Pierre et Marie Curie), 20 rue Berbier du Mets, 75013 Paris, France
| | - Jean-Baptiste Fini
- Sorbonne Universités, CNRS UMR 7221, RDDM, Muséum d’Histoire Naturelle, F-75005 Paris, France
| | - Leonardo Trasande
- Department of Pediatrics, NYU School of Medicine, 403 E 34th St, New York, NY 10016 USA
| | - Martine Bellanger
- School of Public Health, University Sorbonne Paris Cité, EA7348 MOS, Paris, France
| | - Barbara Demeneix
- Sorbonne Universités, CNRS UMR 7221, RDDM, Muséum d’Histoire Naturelle, F-75005 Paris, France
| | - Laura Maxim
- Institut des Sciences de la Communication (UMS 3665), CNRS (Centre National de la Recherche Scientifique)/Université Paris Sorbonne/UPMC (Université Pierre et Marie Curie), 20 rue Berbier du Mets, 75013 Paris, France
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Morin E, Gatti C, Bambridge T, Chinain M. Ciguatera fish poisoning: Incidence, health costs and risk perception on Moorea Island (Society archipelago, French Polynesia). Harmful Algae 2016; 60:1-10. [PMID: 28073552 DOI: 10.1016/j.hal.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 06/06/2023]
Abstract
Ciguatera Fish Poisoning (CFP) is a non-bacterial seafood poisoning well characterized in the remote archipelagos of French Polynesia, yet poorly documented in the Society archipelago, most notably on Moorea, the second most populated island in French Polynesia, which counts a high proportion of fishermen fishing on a regular basis. To address this knowledge gap, a holistic study of the ciguatera issue was conducted on Moorea. First, ciguatera risk was analysed in terms of incidence rate, fish species most commonly involved and risk stratification in Moorea lagoon based on 2007-2013 epidemiological data. A mean incidence rate of 8 cases per 10,000 inhabitants for the study period and an average under-reporting rate of 54% were found. Taking into account hospitalization and medication fees, and loss of productive days, the health-related costs due to CFP were estimated to be USD $1613 and $749 for each reported and unreported case, respectively, with an overall cost of USD $241,847 for the study period. Comparison of the present status of CFP on Moorea with a risk map established in the late 1970's showed that the spatial distribution of the risk has stayed relatively stable in time, with the north shore of the island remaining the most prone to ciguatera. Evaluation of the current knowledge on CFP among different populations groups, i.e. fishermen, residents and visitors, was also conducted through direct and indirect interviews. About half of the fishermen interviewed were actually able to identify risky fishing areas. While, overall, the CFP risk perception in the fishing community of Moorea seemed accurate, although not scientifically complete, it was sufficient for the safe practice of their fishing activities. This may be due in part to adaptive responses adopted by 36% of the fishermen interviewed, such as the avoidance of either high-risk fishing sites or toxic species. At the residents and visitors' level, the study points out a striking lack of awareness of the CFP issue among visitors, as compared to local residents. Indeed, less than 25% of Moorea visitors vs. an average of 98% in residents were aware of CFP or of its presence on the island. Interestingly, evaluation of the fish consumption preferences showed that 70% of visitors do not consume lagoon fish during their stay, not for fear of CFP, but mainly due to the lack of availability of these species in recreational facilities or because they have nutritional preference for pelagic fish. This lack of awareness, along with the report by several CFP patients of the consumption of fish species yet banned for sale, stress the need for improved communication efforts on this critical issue among both residents and visitors on Moorea. The implementation of a public outreach strategy is proposed, based on both existing information networks and low-cost communication actions through information displays at various strategic locations, e.g. Tahiti-Faa'a international airport, the ferry boat station, recreational facilities, as well as the major trading points on Moorea Island.
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Affiliation(s)
- Ewen Morin
- Ecole Pratique des hautes études (EPHE),USR 3278 EPHE CNRS UPVD CRIOBE Laboratoire d'excellence "Corail" BP 1013, 98729 Papetoai, Moorea, French Polynesia.
| | - Clémence Gatti
- Institut Louis Malardé (ILM), UMR 241-EIO, Laboratoire de recherche sur les Microalgues Toxiques BP 30, 98713 Papeete, Tahiti, French Polynesia.
| | - Tamatoa Bambridge
- Centre National de la Recherche Scientifique (CNRS), USR 3278 EPHE CNRS UPVD CRIOBE, Laboratoire d'excellence "Corail", BP 1013, 98729 Papetoai, Moorea, French Polynesia.
| | - Mireille Chinain
- Institut Louis Malardé (ILM), UMR 241-EIO, Laboratoire de recherche sur les Microalgues Toxiques BP 30, 98713 Papeete, Tahiti, French Polynesia.
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Andrade LF, Rapp T, Sevilla-Dedieu C. Exploring the determinants of endocrinologist visits by patients with diabetes. Eur J Health Econ 2016; 17:1173-1184. [PMID: 27038624 DOI: 10.1007/s10198-016-0794-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Diabetes is today a major public health concern in terms of its financial and social burden. Previous studies have revealed that specialist care for patients with diabetes leads to more positive outcomes than care by general practitioners (GPs) alone. The aim of this study was to estimate the determinants of endocrinologist consultation by patients with diabetes. METHODS We used a two-part model to explore both the decision to consult and the frequency of consultations. We used claim data collected for 65,633 affiliates of a French social security provider. Patients were aged over 18 and treated for diabetes (types I and II). We controlled for patients' socioeconomic characteristics, type of diabetes treatment, medical care, and health status. We also controlled for variables, such as the cost of a visit, the distance to the nearest endocrinologist's office, the density of medical practitioners and the prevalence of diabetes in the area. RESULTS The results show that the parameters associated with the decision to consult an endocrinologist were considerably different from factors associated with the frequency of consultations. A marked positive effect of income on the decision to consult was found, whereas travel time to the office had a negative impact on both the decision to consult and the frequency of consultations. Increasing treatment complexity is associated with a higher probability of consulting an endocrinologist. We found evidence of a significant substitution effect between GPs and endocrinologists. Finally, consultation price is a barrier to seeing an endocrinologist. CONCLUSION Given that financial barriers were identified in the relatively wealthy population analysed here, it is likely that this may be even more of an obstacle in the general population.
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Affiliation(s)
- Luiz Flavio Andrade
- MGEN Foundation for Public Health, 3 square Max Hymans, 75748, Paris Cedex 15, France
- LIRAES (EA 4470), University of Paris Descartes, 12 rue de l'École de médecine, 75270, Paris Cedex 06, France
| | - Thomas Rapp
- LIRAES (EA 4470), University of Paris Descartes, 12 rue de l'École de médecine, 75270, Paris Cedex 06, France
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Gómez-Restrepo C, Naranjo-Lujan S, Rondón M, Acosta A, Maldonado P, Arango Villegas C, Hurtado J, Hernández JC, Angarita MDP, Peña M, Saavedra MÁ, Quitian H. Latin American Clinical Epidemiology Network Series - Paper 6: The influence of alcohol in traffic accidents and health care costs of it in Bogotá-Colombia. J Clin Epidemiol 2017; 86:106-10. [PMID: 27771356 DOI: 10.1016/j.jclinepi.2016.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 11/22/2015] [Accepted: 10/10/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES In Colombia, some studies have estimated medical costs associated to traffic accidents. It is required to assess results by city or region and determine the influence of variables such as alcohol consumption. The main objective of this study was to identify health care costs associated to traffic accidents in Bogota and determine whether alcohol consumption can increase them. STUDY DESIGN AND SETTING Cross-sectional costs study conducted in patients over 18 years treated in the emergency rooms of six different hospitals in Bogota, Colombia. RESULTS The average total cost of medical care per patient was 628 USD, in Bogota-Colombia. The average cost per accident was estimated at 1,349 USD. On average, the total cost for health care for patients with positive blood alcohol level was 1.8 times higher than those who did not consume alcohol. The indirect costs were on average 115.3 USD per injured person. Numbers are expressed in 2011 U.S. dollars. CONCLUSION Alcohol consumption increases the risk of traffic accidents and direct medical health costs.
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Sicras A, Ferrer V, Collar JM, Navarro R, Sáez M. [Persistence to treatment by type of inhaler device in patients with asthma and chronic obstructive pulmonary disease]. Semergen 2017; 43:375-86. [PMID: 27425817 DOI: 10.1016/j.semerg.2016.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/16/2016] [Accepted: 05/20/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the initial treatment persistence with inhaled corticosteroids and long-acting beta-2 adrenergic bronchodilators (ICS/LABA) depending on the inhaler device used (pMDI or DPI), for the treatment of asthma and COPD. MATERIAL AND METHODS An multicenter observational study. Subjects in initial treatment with ICS/LABA during 2007-2011 were included, and a follow-up period of 3 years. 2 groups of study (asthma, COPD) and 2 subgroups were prepared according to the device type inhaler (pMDI or DPI). The main measurements were: sociodemographic, comorbidity, adherence (rate possession medication -RPM-), persistence, drugs, exacerbation rates, resources use, and their costs (direct and indirect costs). Multivariate methods were used for the variables correction, with significance level of P<.05. RESULTS The study included 2,082 asthma patients (pMDI: N = 566, 27.2%; DPI = 1,516, 72.8%). Patients with MDI devices showed a higher degree of persistence (32.5 vs. 27.8%; P=.037), treatment adherence (RPM: 83.1 vs. 80.5%; P<.001), fewer exacerbations (17.7 vs. 24.9%; P=.001) and lower health care costs (2,583 vs. 2,938 EUR; P = 0.042). 1,418 patients with COPD also were analyzed (pMDI: N = 524, 41.9%; DPI: N = 824, 58.1%) were analyzed. Patients with MDI devices also showed a higher degree of persistence (31.5 vs. 24.8%; P=.005), treatment adherence (RPM: 83.3 vs. 80.1%; P= .001), less exacerbations (40.1 vs. 48.2%; P=.002) and lower health care costs (3,922 vs. 4,588 EUR; P=.021). CONCLUSIONS pMDI devices (as ICS/LABA initial treatment) are associated with higher treatment persistence either in asthma or COPD, with lower exacerbation rates, and use of health resources and cost.
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Evler A, Scheller M, Wagels L, Bergs R, Clemens B, Kohn N, Pütz A, Voss B, Schneider F, Habel U. [Gender-inclusive care of victims of violence : The model project "Gender Gewaltkonzept" at the University Hospital Aachen]. Nervenarzt 2016; 87:746-752. [PMID: 26628043 DOI: 10.1007/s00115-015-0024-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Violence is a topic of great social relevance, frequently causing tremendous health consequences for those affected and high consequential costs for health care and the national economy. The established consulting and assistance services are usually restricted to offers for ambulant supply, mainly from private agencies or societies. As a result, there is no identification and care for patients who have experienced violence and who are treated in hospital. Another deficiency is the identification and care of male victims of violence. Despite wide-ranging offers of assistance, only very few gender-specific consulting and support services have been available to date.Therefore, the model project "Gender Gewaltkonzept" was initiated at Aachen University Hospital to assess the prevalence of violence and the potential consequences of the violence experienced on the patients' health. In addition, we investigated whether males and females are in need of different supply requirements.Based on the results of the project "Gender Gewaltkonzept" so far, and on prevalence estimates proving that there is a high rate of violent experiences in both males and females, this overview is aimed at presenting the aid and protection concepts available for victims of violence, in addition to the existing deficiencies of the care system. We present approaches to resolving these deficiencies to be able to establish all-encompassing gender-appropriate support for victims of violence.
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Affiliation(s)
- A Evler
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - M Scheller
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - L Wagels
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - R Bergs
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - B Clemens
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - N Kohn
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, Niederlande
- Department for Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, 6500 HB, Nijmegen, Niederlande
| | - A Pütz
- Frauen helfen Frauen e.V., Aachen, Deutschland
| | - B Voss
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - F Schneider
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
- JARA - Translational Brain Medicine, Aachen, Deutschland
| | - U Habel
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
- JARA - Translational Brain Medicine, Aachen, Deutschland
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Breit S, Hasler G. [Advantages and controversies of depot antipsychotics in the treatment of patients with schizophrenia]. Nervenarzt 2016; 87:719-23. [PMID: 26597275 DOI: 10.1007/s00115-015-0021-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this article is to give an overview of the advantages and disadvantages of the use of depot antipsychotics in the treatment of schizophrenia. The focus is on efficacy, tolerability, relapse prevention, patient compliance and satisfaction compared to oral administration forms. MATERIAL AND METHODS A literature search was conducted in medical databases. The results of meta-analyses, randomized controlled trials and systematic reviews from the years 1999-2014 were included. RESULTS AND DISCUSSION Depot antipsychotics ensure maintenance of constant blood levels and a continuous medication delivery. The efficacy and tolerability of depot antipsychotics are comparable to oral administration forms. Due to an improved medication compliance a reduction of relapse and hospitalization rates can be achieved. This is a key focus for improving outcomes and reducing costs in the treatment of schizophrenia.
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