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1.
Background
Ongoing armed conflict in Syria has caused large scale displacement. Approximately half of the population of Syria have been displaced including the millions living as refugees in neighboring countries. We sought to assess the health and nutrition of Syrian refugees affected by the conflict.Methods
Representative cross-sectional surveys of Syrian refugees were conducted between October 2 and November 30, 2013 in Lebanon, April 12 and May 1, 2014 in Jordan, and May 20 and 31, 2013 in Iraq. Surveys in Lebanon were organized in four geographical regions (North, South, Beirut/Mount Lebanon and Bekaa). In Jordan, independent surveys assessed refugees residing in Za’atri refugee camp and refugees residing among host community nationwide. In Iraq, refugees residing in Domiz refugee camp in the Kurdistan region were assessed. Data collected on children aged 6 to 59 months included anthropometric indicators, morbidity and feeding practices. In Jordan and Lebanon, data collection also included hemoglobin concentration for children and non-pregnant women aged 15 to 49 years, anthropometric indicators for both pregnant and non-pregnant women, and household level indicators such as access to safe water and sanitation.Results
The prevalence of global acute malnutrition among children 6 to 59 months of age was less than 5 % in all samples (range 0.3–4.4 %). Prevalence of acute malnutrition among women 15 to 49 years of age, defined as mid-upper arm circumference less than 23.0 cm, was also relatively low in all surveys (range 3.5–6.5 %). For both children and non-pregnant women, anemia prevalence was highest in Za’atri camp in Jordan (48.4 % and 44.8 %, respectively). Most anemia was mild or moderate; prevalence of severe anemia was less than or equal to 1.1 % in all samples of children and women.Conclusions
Despite the ongoing conflict, results from all surveys indicate that global acute malnutrition is relatively low in the assessed Syrian refugee populations. However, prevalence of anemia suggests a serious public health problem among women and children, especially in Za’atri camp. Based on these findings, nutrition partners in the region have reprioritized response interventions, focusing on activities to address micronutrient deficiencies such as food fortification.2.
Jocelyn DeJong Farah Sbeity Jennifer Schlecht Manale Harfouche Rouham Yamout Fouad M. Fouad Seema Manohar Courtland Robinson 《Conflict and health》2017,11(1):23
Background
The conflict in Syria that began in 2011 has resulted in the exodus of over 5 million Syrian refugees to neighbouring countries, with more than one million refugees currently registered by UNHCR in Lebanon. While some are living in tented settlements, the majority are living in strained conditions in rented accommodation or collective shelters in the Bekaa Valley next to Syria. Adolescents are particularly vulnerable in any crisis. In 2013–4, the American University in Beirut in collaboration with the Women’s Refugee Commission, Johns Hopkins and Save the Children, sought to understand the specific experiences of very young adolescents, those 10–14 years of age, in this protracted crisis context.Methods
The study was conducted in 2014 in Barelias and Qabelias – two urban areas located close to each other in the Beka’a valley that has a large concentration of Syrian refugees. Focus group discussions (FGDs), including community mapping and photo elicitation, were conducted with 10–12 and 13–14 year old Syrian refugee adolescents, in order to obtain information about their experiences and perspectives. FGDs were also implemented with 15–16 year old Syrian refugees and separately also with adult refugees, to consider their perspectives on the needs and risks of these adolescents.Results
A total of 16 FGD (8 for each sex, with 6–9 participants in each) were conducted in Arabic across the two sites, with 59 female participants and 59 male participants. The experiences and risks faced by these adolescents were significantly impacted by economic strain and loss of educational opportunities during displacement, and only a minority of adolescents in the study reported attending school. Additionally, on-going protection risks for girls were felt to be higher due to the crisis and displacement. In Lebanon this has resulted in increased risks of child marriage and limitations in mobility for adolescent girls. Adolescents, themselves expressed tensions with their Lebanese counterparts and feared verbal attacks and beatings from school-aged Lebanese male youth.Conclusions
Families and adolescents have been dramatically affected by the conflict in Syria, and the resulting forced displacement. The loss of educational opportunities is perhaps the most significant effect, with long-term devastating outcomes. Additionally, the futures of Syrian girls are deeply affected by new protection concerns, particularly as they are exposed to an unfamiliar and more liberal society in Lebanon. Child marriage and limitations in their mobility – particularly for girls - are presented by families as coping strategies to these risks. Programming is needed to ensure sustained education access for all adolescents, and to educate very young adolescents and their parents on managing their own health and well-being, given the multiple strains. More effort is needed to encourage positive interaction between adolescent Lebanese and adolescent Syrian refugees.3.
Sahadat Hossain Md. Shakhaoat Hossain Afifa Anjum Fahad Ahmed Md. Forhad Hossain Md. Elias Uddin 《Zeitschrift fur Gesundheitswissenschaften》2018,26(5):531-543
Aim
The objective of this study was to determine risk factors for non-communicable diseases (NCDs) on the basis of socio-demographic characteristics, lifestyle-related determinants, environmental and psychological characteristics, and individual and family disease history among university students in Bangladesh.Study design
Cross-sectional survey.Methods
Using the WHO STEPwise approach for NCDs, a cross-sectional study was conducted among 1,140 students. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS) software, version 22.Results
In all, 29.2% of the respondents (BMI?≥?23.00 kg/m2) were overweight and/or obese, and almost two-thirds (65%) of them did not take part in any physical activity (PA). A third (33.3%, p?=?0.002) of male smokers reported health problems and it was found that environmental tobacco smoke (ETS) was significantly responsible for developing asthma (OR?=?0.55; CI?=?0.33–0.93). Individual and family history of NCDs was statistically significant for obesity and asthma and considerably increased the odds ratio for heart disease.Conclusion
This study shows that the number of students suffering from different types of NCDs is not negligible. Their lifestyle and family history of NCDs are responsible for this to a significant extent. Urgent initiatives should be taken to rein in the spread of NCDs among the youth of Bangladesh.4.
Jennifer Schlecht Catherine Lee Brad Kerner Meghan Greeley Courtland Robinson 《Conflict and health》2017,11(1):31
Background
Between 2013 and 2014, a series of qualitative and quantitative research efforts were undertaken in three conflict affected communities (Syrian refugees in the Bekaa Valley, Lebanon, Somali refugees in Kobe Refugee camp Ethiopia, and migrant communities from Myanmar settled in Tak Province, Thailand) that sought to understand the lived experiences of very young adolescents during emergencies. A research consortium that included the Women’s Refugee Commission, Johns Hopkins University, American University in Beirut, International Medical Corps in Ethiopia, Save the Children in Lebanon and the Adolescent Reproductive Health Network in Thailand convened around these activities.Methods
The core research initiative, “Sexual and Reproductive Health Needs and Risks of Very Young Adolescents in Humanitarian Contexts” involved three phases of research: 1) A program needs assessment completed with key informants working on adolescent sexual and reproductive health in each context 2) qualitative research, that incorporated participatory approaches, with adolescents 10–16 years of age, and adults in the community in all three settings, and 3) A household survey with 10–14 year-olds in Ethiopia and Thailand. An additional phase of research was added in Lebanon and Ethiopia, to further explore the issue of child marriage which was a prominent experience identified within the core research initiative on very young adolescents.Results
This research supplement, exploring the experiences during early adolescence, highlighted the crucial role of education, prominent experiences of insecurity, existing knowledge on body change and fertility, peer and family relationships among this age group, as well as concerns around child marriage (Lebanon and Ethiopia), child labor (Thailand), and gender roles.Conclusion
Given the findings presented within this supplement, there are broad implications for work with very young adolescents by humanitarian actors in the settings where research was undertaken, and potentially, more broadly. Programs that promote health and well-being during early adolescence are critically needed in settings of conflict and displacement, and coordination among the diverse range of actors involved in such programming will be essential. Additionally, SRH programs for adolescents (10–14 years of age) in emergencies should include, at minimum, sensitive care for survivors of sexual violence, menstrual hygiene management, life skills, and fertility education. Humanitarian programs can better engage with parents, teachers, and community leaders as partners in the development and implementation of programs. Finally, fundamental rights to protection and education for all adolescents must be upheld.5.
Manuela Rehr Muhammad Shoaib Sara Ellithy Suhib Okour Cono Ariti Idriss Ait-Bouziad Paul van den Bosch Anais Deprade Mohammad Altarawneh Abdel Shafei Sadeq Gabashneh Annick Lenglet 《Conflict and health》2018,12(1):33
Background
Tackling the high non-communicable disease (NCD) burden among Syrian refugees poses a challenge to humanitarian actors and host countries. Current response priorities are the identification and integration of key interventions for NCD care into humanitarian programs as well as sustainable financing. To provide evidence for effective NCD intervention planning, we conducted a cross-sectional survey among non-camp Syrian refugees in northern Jordan to investigate the burden and determinants for high NCDs prevalence and NCD multi-morbidities and assess the access to NCD care.Methods
We used a two-stage cluster design with 329 randomly selected clusters and eight households identified through snowball sampling. Consenting households were interviewed about self-reported NCDs, NCD service utilization, and barriers to care.We estimated the adult prevalence of hypertension, diabetes type I/II, cardiovascular- and chronic respiratory conditions, thyroid disease and cancer and analysed the pattern of NCD multi-morbidities. We used the Cox proportional hazard model to calculate the prevalence ratios (PR) to analyse determinants for NCD prevalence and logistic regression to determine risk factors for NCD multi-morbidities by calculating odds ratios (ORs).Results
Among 8041 adults, 21.8%, (95% CI: 20.9–22.8) suffered from at least one NCD; hypertension (14.0, 95% CI: 13.2–14.8) and diabetes (9.2, 95% CI: 8.5–9.9) were the most prevalent NCDs. NCD multi-morbidities were reported by 44.7% (95% CI: 42.4–47.0) of patients. Higher age was associated with higher NCD prevalence and the risk for NCD-multi-morbidities; education was inversely associated.Of those patients who needed NCD care, 23.0% (95% CI: 20.5–25.6) did not seek it; 61.5% (95% CI: 54.7–67.9) cited provider cost as the main barrier. An NCD medication interruption was reported by 23.1% (95% CI: 20–4-26.1) of patients with regular medication needs; predominant reason was unaffordability (63.4, 95% CI: 56.7–69.6).Conclusion
The burden of NCDs and multi-morbidities is high among Syrian refugees in northern Jordan. Elderly and those with a lower education are key target groups for NCD prevention and care, which informs NCD service planning and developing patient-centred approaches.Important unmet needs for NCD care exist; removing the main barriers to care could include cost-reduction for medications through humanitarian pricing models. Nevertheless, it is still essential that international donors agencies and countries fulfill their commitment to support the Syrian-crisis response.6.
Background
Evidence is conflicting as to the whether tobacco smoking prevalence is higher in refugee than non-refugee populations. The aim of this study was to compare the prevalence and frequency of tobacco smoking in Palestine refugee and non-refugee adolescent populations in the Middle East.Methods
We conducted a cross-sectional analysis of the Global Youth Tobacco Survey (GYTS) conducted in Jordan, Lebanon, Syria, and the West Bank among adolescent Palestine refugees and non-refugees. Age- and sex-adjusted regression models assessed the association between refugee status and current (past-30 day) tobacco use prevalence and frequency.Results
Prevalence estimates for current tobacco smoking were similar between Palestine refugee and non-refugee groups in Jordan (26.7 % vs. 24.0 %), Lebanon (39.4 % vs. 38.5 %), and the West Bank (39.5 % vs. 38.4 %). In Syria, Palestine refugees had nearly twice the odds of current tobacco smoking compared to non-refugees (23.2 % vs. 36.6 %, AOR 1.96, 95 % CI 1.46–2.62). Palestine refugees consumed more cigarettes per month than non-refugees in Lebanon (β 0.57, 95 % CI 0.17–0.97) and Palestine refugees consumed more waterpipe tobacco per month than non-refugees in Syria (β 0.40, 95 % CI 0.19–0.61) and the West Bank (β 0.42, 95 % CI 0.21–0.64).Conclusions
Current tobacco smoking prevalence is in excess of 20 % in both adolescent Palestine refugee and non-refugee populations in Middle Eastern countries, however Palestine refugees may smoke tobacco more frequently than non-refugees. Comparison of simple prevalence estimates may therefore mask important differences in tobacco use patterns within population groups.7.
Mirjam Philippi Petra Melchert Dagmar Renaud 《Pr?vention und Gesundheitsf?rderung》2018,13(3):203-210
Background
The inclusion of refugees into the German health system is fraught with challenges. Besides need-based health services, refugees need information that enables them to appropriately use the German health care system and to increase their health literacy.Objectives
The aim of the study was to analyze the demands and needs for further health information for refugees from the views of medical experts and refugees.Materials and methods
In a mixed-methods design, 10 experts (medical staff) were interviewed. Based on the results of this qualitative research, a standardized questionnaire was developed. A total of 100 refugees (76.3% men; mean age 30.5 years; 84.7% came from Syria) answered the questionnaire.Results
The medical experts identified information needs for refugees about structures, access, and characteristics of the German health system. Concerning health knowledge, the experts miss appropriate information about prevention, health behavior, medication management as well as psyche and somatization. For the refugees, information about expenses, contact points in case of emergency and diagnostic screening seemed to be remarkably relevant.Conclusions
The results of this study illustrate health-related information needs of refugees. The results serve as a basis for target health information and health promotion. They can alert health care staff to the health information needs of refugees. Important topics for more understandable information seem to be the access to health system and additional costs for health services.8.
Waleed M. Sweileh 《Conflict and health》2018,12(1):43
Background
The Syrian conflict has created the worst humanitarian crisis of our time with approximately half of Syria’s pre-war population killed or forced to flee their homes. The current study aimed to analyze peer-reviewed literature published on Syrian refugees and displaced people.Methods
A bibliometric methodology was implemented using Scopus database after retrieving documents relevant to Syrian refugees and displaced people.Findings
In total, 323 documents were retrieved. Research articles constituted 71.2% (n?=?230) of the retrieved documents. The bulk (61.6%; n?=?199) of the retrieved documents were in health-related fields. Research domains of the retrieved health-related documents were mainly in the field of mental and psychosocial (17.3%; n?=?56), infectious diseases (15.2%; n?=?49), health policy and systems (16.4%; n?=?53), maternal and reproductive health (15.2%; n?=?49), and non-communicable diseases (NCD) (7.4%; n?=?24). Authors from research institutions in the United States produced the highest number of publications (24.5%; n?=?79), followed by Turkey (21.4%; n?=?69) and Lebanon (10.2%; n?=?33). The American University of Beirut was the most active (5.6%; n?=?18) research institution. Aside from Lebanon and Jordan, there was very little contribution from other Arab states. Conflict and Health was the most active journal (5.3%; n?=?17) in publishing on Syrian refugees and displaced people.Conclusion
The study highlighted some particular research gaps – most notably the limited research on NCDs. There was also modest international research collaboration and engagement from Arab countries aside from Lebanon and Jordan.9.
Background
Recent reports have suggested that child marriage among Syrians may be increasing as a result of displacement and conflict. This study sought to gather qualitative data about the factors that promote child marriage practices among Syrian refugees in Al Marj area in the Bekaa valley, Lebanon, where the majority of Syrian refugees have settled in Lebanon. The second aim of this study was to generate recommendations on how to mitigate the drivers and consequences of child marriage practices based on the findings.Methods
Eight focus group discussions were conducted separately with married and unmarried young women and mothers and fathers of married and unmarried women. Furthermore, researchers conducted 11 key informant interviews with service providers and stakeholders to understand how conflict and displacement influenced marriage practices of Syrian refugees in Al Marj community.Results
Although child marriage was a common practice in pre-conflict Syria, new factors seem to contribute to a higher risk of child marriage among Syrian refugees in Lebanon. Respondents cited conflict- and displacement-related safety issues and feeling of insecurity, the worsening of economic conditions, and disrupted education for adolescent women as driving factors. Service providers, young women, and parents also reported changes in some marriage practices, including a shorter engagement period, lower bride price, change in cousin marriage practices, and a reduced age at marriage.Conclusions
Recommendations for interventions to mitigate the drivers of child marriage and its negative consequences should be built on a clear understanding of the local refugee context and the drivers of child marriage in refugee settings. Interventions should involve multiple stakeholders, they should be adjusted to target each specific context, age group and marital status. For these interventions to be effective, they should be addressed concurrently, and they should be delivered in a culturally sensitive and practical manner.10.
Objectives
Health effects associated with air pollution at exposure levels below toxicity may not be directly related to level of exposure, but rather mediated by perception of the air pollution and by top-down processing (e.g., beliefs that the exposure is hazardous). The aim of the study was to test a model that describes interrelations between odorous air pollution at non-toxic exposure levels, perceived pollution, health risk perception, annoyance and health symptoms.Methods
A population-based questionnaire study was conducted in a Swedish community of residents living near a biofuel facility that emitted odorous substances. Individuals aged 18–75 years were selected at random for participation (n = 1,118); 722 (65 %) agreed to participate. Path analyses were performed to test the validity of the model.Results
The data support a model proposing that exposure level does not directly influence annoyance and symptoms, and that these relations instead are mediated by perceived pollution and health risk perception.Conclusions
Perceived pollution and health risk perception play important roles in understanding and predicting environmentally induced annoyance and health symptoms in odorous environments at non-toxic levels of exposure.11.
Background
Private health expenditure in systems of national health insurance has raised concern in many countries. The concern is mainly about the accessibility of care to the poor and the sick, and inequality in use and in health. The concern thus refers specifically to the care financed privately rather than to private health expenditure as defined in the national health accounts.Objectives
To estimate the share of private finance in total use of services covered by the national package of benefits. and to relate the private finance of use to the income and health of the users.Methods
The Central Bureau of Statistics linked the 2009 Health Survey and the 2010 Incomes Survey. Twenty-four thousand five hundred ninety-five individuals in 7175 households were included in the data. Lacking data on the share of private finance in total cost of care delivered, we calculated instead the share of uses having any private finance—beyond copayments—in total uses, in primary, secondary, paramedical and total care. The probability of any private finance in each type of care is then related, using random effect logistic regression, to income and health state.Results
Fifteen percent of all uses of care covered by the national package of benefits had any private finance. This rate ranges from 10 % in primary care, 16 % in secondary care and 31 % in paramedical care. Twelve percent of all uses of physicians’ services had any private finance, ranging from 10 % in family physicians to 20 % in pulmonologists, psychiatrists, neurologists and urologists. Controlling for health state, richer individuals are more likely to have any private finance in all types of care. Controlling for income, sick individuals (1+ chronic conditions) are 30 % in total care and 60 % in primary care more likely to have any private finance compared to healthy individuals (with no chronic conditions).Conclusions
The national accounts’ “private health spending” (39 % of total spending in 2010) is not of much use regarding equity of and accessibility to medical care by the population. The mean share of uses financed privately in 2010, a more relevant measure, is 15 % with large variation between types of care and physicians. While, as under national health insurance, richer persons contribute more into the finance of (private) medical care , and sicker persons are more likely to use it, the solidarity principle—cross subsidization from the rich to the sick, which is a fundamental principle of national health insurance systems, is clearly violated.12.
L. Claassens C. B. Terwee D. J. H. Deeg M. I. Broese van Groenou G. A. M. Widdershoven M. Huisman 《Quality of life research》2016,25(4):859-870
Purpose
In response to the increased emphasis placed on older people’s self-reliance in many welfare societies, we aimed to develop and validate a measurement instrument, assessing perceived control in health care among older adults with care needs. The target group consists of older people who live (semi-)independently and use professional health care, with or without informal care.Methods
Phase I (development) of the study consisted of the construction of the instrument based on the input from a variety of stakeholders. Phase II (validation) entailed a quantitative study in a sample of 247 respondents selected from the Longitudinal Aging Study Amsterdam, to assess the instrument’s construct validity (structural validity and hypotheses testing) and reliability (internal consistency).Results
The questionnaire consists of 29 items, related to organizing professional care, communication with care professionals, health management in the home situation, planning (more) complex care in the future, and perceived support from the social network. Based on a factor analysis, we identified three subscales: (I.) ‘perceived personal control in health care’; (II.) ‘anticipated personal control regarding future health care’; and (III.) ‘perceived support from the social network,’ with internal consistencies varying from Cronbach’s α = .71 to .90. Factor I was associated with mastery, self-efficacy, self-esteem (r = .31–.35) and factor III with social loneliness (r = ?.42). Factor II correlated less strongly with mastery, self-efficacy, and self-esteem (r < .30).Conclusion
Our questionnaire revealed sufficient construct validity and internal consistency. The instrument provides a basis for further quantitative research regarding control, especially in relation to health care-related outcomes.13.
Jazmin A. Reyes-Portillo Erica M. Chin Josefina Toso-Salman J. Blake Turner David Vawdrey Laura Mufson 《Child & youth care forum》2018,47(3):391-402
Background
No study to date has examined the effectiveness of integrating clinical decision support tools, like electronic health record (EHR) alerts, into the clinical care of youth at-risk for suicide.Objective
This study aimed to examine the feasibility and acceptability of using an EHR alert to increase clinicians’ use of safety planning with youth at-risk for suicide in an outpatient pediatric psychiatry clinic serving an urban low-income Latino community.Methods
An alert intervention was developed to remind clinicians to complete a safety plan whenever they documented that their patient endorsed suicidal ideation, plan, or attempt during a visit in EHR notes. The alert appeared as a separate window containing a reminder message to complete a safety plan once a clinician finished visit documentation.Results
There were 69 at-risk patients between the ages of 13–21 in the intervention period (M = 15.71; SD = 1.86; 66.7% female) and 64 (M = 15.38; SD = 1.93; 68.6% female) in the control period. Logistic regression analyses indicated that patients in the intervention period were significantly more likely than patients in the control period to receive a safety plan (p < .01). The pattern of results remained the same after adjusting for demographic variables (p = .01). Forty clinicians also completed a questionnaire assessing their satisfaction with the EHR alert, indicating moderate satisfaction (M = 3.01; SD = 0.63; range = 1.11–4.11).Conclusions
EHR alerts are associated with changes in clinicians’ behavior and improved compliance with best clinical practices for at-risk youth.14.
Kazumi Dokai Mochimasu Nobuyuki Miyatake Ayako Hase 《Environmental health and preventive medicine》2016,21(5):345-349
Objective
The purpose of the present pilot study was to investigate the link between diet and mental health in female university students enrolled in a training course for registered dietitians.Subjects and methods
A total of 62 female university students, with a mean age of 18.79 ± 0.45 years, participated in this cross-sectional study. Diet surveys were performed using the brief-type self-administered diet history questionnaire (BDHQ). Mental health was also evaluated using the general health questionnaire-12 (GHQ-12), which was the shortest form and clinically available. Lifestyles such as physical activity levels were also evaluated.Results
The mean energy intake was 1379 ± 575 kcal and the mean GHQ score was 3.11 ± 2.41. Among nutrients, vegetable fat and sucrose showed a weak positive correlation with the GHQ scores. Among food groups, potatoes, fats and oils, and confectioneries also showed a weak positive correlation with the GHQ scores. A multiple regression analysis showed that the confectioneries were the determining factor for the GHQ scores.Conclusion
Proper education concerning their diets and reducing confectioneries in their daily lives might be beneficial for the mental health of female university students.15.
Background
Nursing care insurance funds are supposed to deliver preventive services in nursing homes. The strengthening of cognitive resources is considered as one field of action.Aim
The preventive effectiveness of physical activity on cognitive performance in nursing home residents shall be evaluated.Methods
A systematic search was carried out in the databases MEDLINE, the Cochrane Library, EMBASE, CINAHL, PsycINFO and PEDro. Results were combined in random-effects meta-analyses.Results
Taking into account 13 primary studies, it was shown that those participating in physical activity showed statistically significant greater cognitive performance compared to controls (SMD = 0.43, 95% CI 0.20–0.66, p = 00002). Subgroup analyses suggest that nursing home residents with different cognitive impairments might benefit from long-lasting physical activity interventions. Due to the high risk of bias in included studies, the results must be interpreted with caution.Conclusion
Physical activity might be effective in the inpatient care setting. Further studies with longer intervention periods are required.16.
Tomáš Mlčoch Jiří Klimeš Libor Fila Věra Vávrová Veronika Skalická Marek Turnovec Veronika Krulišová Jitka Jirčíková Dana Zemková Klára Vilimovská Dědečková Alena Bílková Vladimíra Frühaufová Lukáš Homola Zuzana Friedmannová Radovan Drnek Pavel Dřevínek Tomáš Doležal Milan MacekJr. 《The European journal of health economics》2017,18(1):73-82
Background
Economic data pertaining to cystic fibrosis (CF), is limited in Europe generally, and completely lacking in Central and Eastern Europe. We performed an analysis of all direct costs associated with CF relative to key disease features and laboratory examinations.Methods
A retrospective prevalence-based cost-of-illness (COI) study was performed in a representative cohort of 242 CF patients in the Czech Republic, which represents about 65 % of all Czech CF patients. Medical records and invoices to health insurance companies for reference year 2010 were analyzed.Results
The mean total health care costs were €14,486 per patient, with the majority of the costs going towards medicinal products and devices (€10,321). Medical procedures (€2676) and inpatient care (€1829) represented a much smaller percentage of costs. A generalized linear model showed that the strongest cost drivers, for all cost categories, were associated with patient age and lung disease severity (assessed using the FEV1 spirometric parameter), when compounded by chronic Pseudomonas aeruginosa airway infections. Specifically, maximum total costs are around the age 16 years; a FEV1 increase of 1 % point represented a cost decrease of: 0.9 % (medicinal products), 1.7 % (total costs), 2.8 % (procedures) and 7.0 % (inpatient care).Conclusions
COI analysis and regression modeling using the most recent data available can provide a better understanding of the overall economic CF burden. A comparison of our results with other methodologically similar studies demonstrates that although overall costs may differ, FEV1 can nonetheless be utilized as a generally transferrable indicator of the relative economic impact of CF.17.
Dianne Currier Jane Pirkis John Carlin Louisa Degenhardt Shyamali C. Dharmage Billie Giles-Corti Ian Gordon Lyle Gurrin Jane Hocking Anne Kavanagh Louise A. Keogh Rachel Koelmeyer Anthony D. LaMontagne Marisa Schlichthorst George Patton Lena Sanci Matthew J. Spittal David M. Studdert Joanne Williams Dallas R. English 《BMC public health》2016,16(3):1030
Background
The Australian Longitudinal Study on Male Health (Ten to Men) was established in 2011 to build the evidence base on male health to inform policy and program development.Methods
Ten to Men is a national longitudinal study with a stratified multi-stage cluster random sample design and oversampling in rural and regional areas. Household recruitment was conducted from October 2013 to July 2014. Males who were aged 10 to 55 years residing in private dwellings were eligible to participate. Data were collected via self-completion paper questionnaires (participants aged 15 to 55) and by computer-assisted personal interview (boys aged 10 to 14). Household and proxy health data for boys were collected from a parent via a self-completion paper-based questionnaire. Questions covered socio-demographics, health status, mental health and wellbeing, health behaviours, social determinants, and health knowledge and service use.Results
A cohort of 15,988 males aged between 10 and 55 years was recruited representing a response fraction of 35 %.Conclusion
Ten to Men is a unique resource for investigating male health and wellbeing. Wave 1 data are available for approved research projects.18.
Ama de-Graft Aikins Mawuli Kushitor Kwadwo Koram Stella Gyamfi Gbenga Ogedegbe 《BMC public health》2014,14(Z2):S3
Background
The rising burden of chronic non-communicable diseases in low and middle income countries has major implications on the ability of these countries to achieve universal health coverage. In this paper we discuss the impact of cardiovascular diseases (CVD) on primary healthcare services in urban poor communities in Accra, Ghana.Methods
We review the evidence on the evolution of universal health coverage in Ghana and the central role of the community-based health planning services (CHPS) programme and the National Health Insurance Scheme in primary health care. We present preliminary findings from a study on community CVD knowledge, experiences, responses and access to services.Results
The rising burden of NCDs in Ghana will affect the achievement of universal health coverage, particularly in urban areas. There is a significant unmet need for CVD care in the study communities. The provision of primary healthcare services for CVD is not accessible, equitable or responsive to the needs of target communities.Conclusions
We consider these findings in the context of the primary healthcare system and discuss the challenges and opportunities for strengthening health systems in low and middle-income countries.19.
D. M. Mijnarends Y. C. Luiking R. J. G. Halfens S. M. A. A. Evers E. L. A. Lenaerts S. Verlaan M. Wallace Jos M. G. A. Schols J. M. M. Meijers 《The journal of nutrition, health & aging》2018,22(7):766-773
Objective
To assess the association between muscle parameters (mass, strength, physical performance) and activities of daily living (ADL), quality of life (QoL), and health care costs.Design
Cross-sectional Maastricht Sarcopenia Study (MaSS).Setting
Community-dwelling, assisted-living, residential living facility.Participants
227 adults aged 65 and older.Measurements
Muscle mass, hand grip strength and physical performance were assessed by bio-electrical impedance, JAMAR dynamometer and the Short Physical Performance Battery, respectively. Health outcomes were measured by the Groningen Activity Restriction Scale (disability in ADL) and the EQ-5D-5L (QoL). Health care costs were calculated based on health care use in the past three months.Results
Muscle strength and physical performance showed a strong correlation with ADL, QoL, and health care costs (P<.01); for muscle mass no significant correlations were observed. Regression analyses showed that higher gait speed (OR 0.06, 95%CI 0.01-0.55) was associated with a lower probability of ADL disability. Furthermore, slower chair stand (OR 1.23, 95%CI 1.08-1.42), and more comorbidities (OR 1.58, 95%CI 1.23-2.02) were explanatory factors for higher ADL disability. Explanatory factors for QoL and costs were: more disability in ADL (OR 1.26, 95%CI 1.12-1.41 for QoL; B = 0.09, P<.01 for costs) and more comorbidities (OR 1.44, 95%CI 1.14-1.82 for QoL; B = 0.35, P<.01 for costs).Conclusion
Lower gait speed and chair stand were potential drivers of disability in ADL. Disability in ADL and comorbidities were associated with QoL and health care costs in community-dwelling older adults. Improving physical performance may be a valuable target for future intervention and research to impact health burden and costs.20.
Rachel Burns Kolitha Wickramage Anwar Musah Chesmal Siriwardhana Francesco Checchi 《Conflict and health》2018,12(1):41