Atopic eczema: Its social and financial costs

Atopic dermatitis is a disorder with considerable social and financial costs. A recent Australian study indicates that the family stress related to the care of a child with moderate or severe atopic dermatitis is significantly greater than that of care of children with insulin-dependent diabetes mellitus. The factors contributing to family stress include: sleep deprivation; loss of employment; time taken for care of atopic dermatitis; and financial costs. An estimate of the yearly financial costs for a family and community (which includes medical, hospital, direct costs of treatments and indirect costs from loss of employment), range from $A1142 per child per year with mild atopic dermatitis, to $A6099 per year for a child with severe atopic dermatitis. As the current prevalence of atopic dermatitis in Australia is 10-15%, this indicates a considerable financial burden on the community. It is possible that appropriate interventions directed to reducing trigger factors, may produce worthwhile savings, in addition to benefits for the individuals and families. Atopic dermatitis should not be regarded as a minor skin disorder but as a condition which has the potential to be a major handicap involving considerable personal, social and financial consequences both for the family and for the community.     

Atopic eczema and preterm birth.

In a group of 443 children with atopic eczema there was a significant lack of subjects born before 37 weeks'' gestation. It is possible that preterm birth reduces the chances of the subsequent development of severe atopic disease.     

Atopic eczema,hyponatraemia, and hypoalbuminaemia.

We describe an infant with atopic eczema, treated with homoeopathic medicines, who presented with erythema and limb oedema. Concentrations of urinary and plasma sodium and plasma albumin were low. On conventional treatment he made a satisfactory recovery.     

Atopic dermatitis in Italian children: evaluation of its economic impact.

INTRODUCTION: The aim of our study was to evaluate the economic impact of atopic dermatitis (AD) on the family of young children affected by the disease in Italy. METHODS: Thirty-three families of young children affected by AD were asked to fill in a questionnaire about financial costs associated with providing health care during the past year for their child affected by AD. For each child AD severity was evaluated by using the SCORAD index. RESULTS: By analyzing the questionnaire, an annual average cost of 1254euro (about U.S. $1540) for each family was determined. Main expenses concern the use of moisturizing therapies, particular detergent, and private specialist consultations. Annual family average cost was lower for children with mild AD compared with those with moderate to severe AD. DISCUSSION: AD has a deep impact on the family budget, with an increasing cost in proportion to the increasing severity of the disease. These data support previous reports suggesting that the management of AD in children is complex and costly, altering the quality of life of children and their families.     

Childhood cancer: its impact and financial costs for Australian families

This study evaluated the impact and financial costs of childhood cancer for Australian families by means of a nonrandomized retrospective cross-sectional survey at the oncology department of a large metropolitan pediatric hospital. The Family Impact Scale (a standardized questionnaire) and the self-reported economic burden (a questionnaire on expenses and lifestyle changes) were utilized. Results of the family impact score were compared to a previously published cohort of children with insulin-dependent diabetes mellitus. The participants were 56 parents of children newly diagnosed with cancer in the year 2002. In addition to the expected high social and emotional impacts, the majority of families reported suffering from great or moderate economic hardship. Factors predictive for families at risk included single parenthood, lower household income, and greater distance from the hospital. The results show that the distribution of resources is not equitable and is currently failing to negate significant financial stresses for many Australian families.     

The impact of rotavirus gastroenteritis on the family

Background  

Rotavirus is the leading cause of severe diarrhea in young children and causes substantial morbidity and mortality. Although the clinical aspects have been well described, little information is available regarding the emotional, social, and economic impact of rotavirus gastroenteritis on the family of a sick child. The objectives of this study were to: 1) assess the family impact of rotavirus gastroenteritis through qualitative interviews with parents; 2) compare the clinical severity of rotavirus-positive and negative gastroenteritis; 3) test a questionnaire asking parents to rank the importance of various factors associated with a case of rotavirus gastroenteritis.     

Measuring the financial and productivity burden of paediatric hospitalisation on the wider family network

Aim

To estimate the non‐medical out‐of‐pocket costs for families with a child in hospital.

Methods

This study was a survey of 225 parents of paediatric inpatients on nine wards of an Australian public paediatric teaching hospital on two separate days. Our primary outcomes were the costs associated with: (i) time taken off work to care for the child in hospital; (ii) time off work or contributed by family and friends to care for other dependents; and (iii) travel, meals, accommodation and incidental expenses during the child's stay. Demographic data included postcode (to assess distance, socio‐economic status and remoteness), child's age, ward and whether this was their child's first admission.

Results

Mean patient age was 6.5 years (standard deviation 5.2). On an average per patient day basis, parents took 1.12 days off work and spent 0.61 (standard deviation 0.53) nights away from home, with 83.8% of nights away at the child's bedside. Parents spent Australian dollars (AUD)89 per day on travel and AUD36 on meals and accommodation. Total costs (including productivity costs) were AUD589 per patient day. Higher costs per patient day were correlated with living in a more remote area (0.48) and a greater travel distance to the hospital (0.41). A higher number of days off work was correlated (0.69) with number of school days missed.

Conclusion

These results demonstrate the considerable time and financial resources expended by families caring for a child in hospital and are important inputs in evaluating health‐care interventions that affect risk of hospitalisation and length of stay in paediatric care.     

The impact on family scale revisited: further psychometric data

This article presents additional psychometric data and a revised scoring procedure for the widely used Impact on Family Scale. The analyses were conducted with three datasets produced by validation studies conducted at the originating institution with populations drawn from the same inner-city communities as the original sample. The instrument has one robust factor representing overall family impact. In addition, there are two subsidiary sets of items (financial impact and sibling impact) of possible interest to future researchers. The correlation of the previously published and new Total Score is .97. Data indicate that the Impact on Family Scale is an easily administered, reliable, and valid measure of a family member's perception of the effect of a child's chronic condition that can be used across diagnostic groups. The Impact on Family Scale fills a gap in the measurement of the psychological and social consequences of chronic disorders in childhood that can be useful in clinical and health services research.     

The very low birth weight transport goes home: impact on the family

Very low birth weight (VLBW) infants are known to experience more health problems after discharge from the hospital, but the effects of such problems in terms of the demand for medical care and of the effect of this on the family are only just beginning to be described. A survey of the families of 132 children who were born weighing less than 1750 g at mostly suburban hospitals and transported to a Children's Hospital, who were 1-4 years old at the time of the survey, has revealed that these children continue to experience health problems to the extent that 35% are limited in one or more activities of daily living. They also incur greater use of health care services (17% hospitalized in the prior year; 54% with a doctor's visit in the prior month). The most important predictors of high perceived impact of these problems on the family is related to the number of activities limited by health, the age of the child, and the financial resources the family could bring to coping with the child's care. These findings provide further characterization of the families which may be most vulnerable to the ongoing health problems of the VLBW infant.     

Bioterrorism and its impact on the emergency department

With the recent anthrax attacks, bioterrorism has become a reality in the United States. These attacks have changed our understanding of anthrax and the use of bioweapons (BWs). Emergency department staff will be the first line of defense against probable future attacks. It is therefore critical that medical personnel are trained to recognize, respond to, and manage BW attacks. Recognizing a BW attack requires an understanding of the specific signals indicating a possible outbreak, as well as knowledge of the agents that constitute the most likely threat. Responding to an attack involves the proper notification of public health and law enforcement officials, surveillance tools to alert the medical community, and appropriate communication with the public to prevent panic. Managing an attack, in addition to direct treatment of victims, involves hospital defensive actions and effective utilization of resources and staff. Fundamental to the entire process is appropriate education and training of medical staff. Current data indicates a need for more BWs training to ensure preparedness.     

Gestational diabetes and its impact on the neonate

Gestational diabetes mellitus is a relatively common medical condition that was described as early as the nineteenth century. This article discusses the maternal and fetal pathophysiology and the impact of the maternal condition on the neonate. Fetal macrosomia and infant respiratory distress syndrome, cardiomyopathy, hypoglycemia, hypocalcemia, hypomagnesemia, polycythemia, and hyperviscosity all can occur as a result of maternal hyperglycemia and are discussed in detail. Therapeutic approaches and treatment options for the mother, manifestations and diagnosis of the infant, and current research related to this condition are also included.