吉林省食源性疾病患者就诊情况及疾病经济负担的评估

目的:了解吉林省食源性疾病患者就诊和疾病经济负担情况并分析疾病经济负担的影响因素,为食源性疾病的防治提供依据。方法:以2012-2013年在吉林省内连续居住6个月及以上的常住人口为调查对象,采用多阶段分层随机抽样方法,选取吉林省10个监测地区内7 353人(2012年3 065人,2013年4 288人)进行入户面对面调查。分析不同类型食源性疾病患者的就诊率和疾病经济负担情况;采用单因素和多重线性回归分析食源性疾病经济负担的影响因素。结果:吉林省食源性疾病患者就诊率为13.10%,不同年龄、文化程度、过去4周内发生急性胃肠炎次数和患病持续天数的患者就诊率比较差异有统计学意义(P<0.05),35~44岁年龄组患者就诊率高于其他年龄组(P<0.05),大学及以上文化程度的患者就诊率高于其他文化程度者(P<0.05),过去4周内发生急性胃肠炎2次以上的患者的就诊率高于其他患者(P<0.05),患病持续4 d及以上的患者就诊率高于其他患者(P<0.05)。157例食源性疾病患者的总经济负担为5 847.82元,人均疾病经济负担为37.25元。首次就诊机构级别和患病持续天数是食源性疾病经济负担的主要影响因素。结论:食源性疾病的就诊率不高,但给患者带来一定的经济负担,应提高基层医疗机构的利用率和诊疗能力,以降低食源性疾病患者的经济负担。     

Evaluating the clinical value of the hypoxia burden index in patients with obstructive sleep apnea

Purpose: We aimed to develop a novel index, the hypoxia burden index (HBI), that reflects the degree and duration of oxygen desaturation, and to determine whether this index is better than the apnea hypopnea-index (AHI) for evaluating obstructive sleep apnea (OSA) and cardiovascular diseases morbidities.

Methods: We retrospectively analyzed 459 adult subjects who underwent overnight polysomnography (PSG) in this study. The HBI was calculated by dividing the total desaturation area of SpO₂ below 90% by the TST measured in seconds. Correlations between the HBI and PSG parameters and the cardiovascular diseases (CVDs) of inpatients were explored.

Results: For the 459 participants, the HBI was highly correlated with the AHI (r = 0.690), lowest oxygen saturation (SpO₂min) (r = ?0.733), and proportion of cumulative sleep time with SpO₂ below 90% in total sleep time (TST) (CT90%) (r = 0.801). The HBI was mildly correlated with Epworth sleepiness scale score, morning systolic blood pressure, diastolic blood pressure, and mean arterial pressure. Among the significantly different parameters in the CVD and non-CVD groups in 202 inpatients (age, sex, the longest time of apnea, AHI, and HBI), only age, sex, and HBI [OR 1.006 (1.001–1.011), p = 0.021] were independently correlated with CVDs.

Conclusions: The HBI considers both hypoxia duration and severity during sleep. It may have potential value in predicting the clinical outcomes of OSA based on its correlation with ESS scores and morning blood pressure as well as its independent association with the prevalence of CVDs, whereas the AHI is not significantly associated with CVD prevalence.     

Expressed emotion and family burden in relatives of patients in first-episode psychosis

BACKGROUND

Evidence suggests that expressed emotion (EE) and family burden (FB) are phenomena that interact, but there is a lack of studies that analyze this association in patients in first-episode psychosis.

Psychometric properties of Persian version of the Caregiver Burden Scale in Iranian caregivers of patients with spinal cord injury

Purpose: To investigate the psychometric properties of the Persian version of Caregiver Burden Scale (CBS) in caregivers of patients with spinal cord injury.

Methods: This is a cross-sectional study. After a forward–backward translation, the CBS was administered to 110 caregivers of patients with spinal cord injury (men?=?60, women?=?50). Factor structure was evaluated by confirmatory factor analysis. The Internal consistency and test–retest reliability of the CBS were examined using Cronbach’s α and the intraclass correlation coefficient, respectively. Construct validity was assessed by examining the relationship among CBS and the World Health Organization Quality of Life, and the Beck Depression Inventory.

Results: The results of confirmatory factor analysis provided support for a five-factor model of CBS. All subscales of CBS revealed acceptable internal consistency (0.698–0.755), except for environment subscale (0.559). The CBS showed adequate test–retest reliability for its subscales (0.745–0.900). All subscales of CBS significantly correlated with both Beck Depression Inventory and World Health Organization Quality of Life, confirming construct validity.

Conclusions: The Persian version of the CBS is a valid and reliable measure for assessing burden of care in caregivers of patients with spinal cord injury.

• Implications for Rehabilitation

• Spinal cord injury leads to depression, high levels of stress and diminished quality of life due to the high physical, emotional, and social burdens in caregivers.

• Persian version of the Caregiver Burden Scale is a valid and reliable tool for assessing burden in Iranian caregivers of patients with spinal cord injury.

     

Economic Burden of Opioid-Induced Constipation Among Long-Term Opioid Users with Noncancer Pain

Background

Opioid-induced constipation (OIC) can be a debilitating side effect of opioid therapy and may result in increased medical costs. The published data on the economic burden of OIC among long-term opioid users are limited.

Objective

To assess the economic burden of OIC in patients with noncancer pain in a managed care population in the United States.

Methods

This retrospective study used 2007–2011 data from the Truven Health MarketScan Commercial and Medicare databases. The study included adults with ≥12 months of insurance enrollment before and after starting long-term (≥90 days) use of opioids. Patients were excluded if they had cancer or a diagnosis of drug abuse or drug dependence during the study period, or if they had constipation or bowel obstruction within 90 days before starting opioid therapy during the study period. OIC was identified by International Classification of Diseases, Ninth Edition codes for constipation (564.0) or bowel obstruction (560.x) within 12 months of the initiation of an opioid. Patients with OIC were identified in the nonelderly, elderly (age ≥65 years), and long-term care populations. Differences in costs and healthcare resource utilization were calculated using propensity scoring.

Results

A total of 13,808 nonelderly (age, 48.6 ± 10.4 years; female, 50%) and 2958 elderly patients (age, 78.7 ± 8.1 years; female, 70%) met the study inclusion criteria. Of 401 nonelderly and 194 elderly patients with OIC, 85 patients initiated opioid therapy in a long-term care facility (age, 80.7 ± 11.6 years; female, 77%). After matching by key covariates, patients with OIC had significantly more hospital admissions than patients without OIC (nonelderly, 33% vs 22%, respectively; P <.001; elderly, 51% vs 31%, respectively; P <.001) and longer inpatient stays (nonelderly, 3.0 ± 8.4 days vs 1.0 ± 3.0 days, respectively; P <.001; elderly, 5.2 ± 12.2 days vs 2.1 ± 4.0 days, respectively; P <.001). The group with OIC had significantly higher total healthcare costs than the group without OIC in all 3 study cohorts (nonelderly, $23,631 ± $67,209 vs $12,652 ± $19,717, respectively; elderly, $16,923 ± $38,191 vs $11,117 ± $19,525, respectively; long-term care, $16,000 ± $22,897 vs $14,437 ± $25,690, respectively; all P <.05).

Conclusion

To the best of our knowledge, this is the first study to analyze the economic impact of long-term use of opioids among patients with OIC, using real-world data. The findings underscore the significant economic burden associated with long-term opioid use for noncancer pain in a managed care population. Effective therapies for OIC may reduce the associated economic burden and improve quality of life for long-term opioid users.     

Chronic obstructive pulmonary disease hospitalisations and mortality in Victoria: analysis of variations by socioeconomic status

Objective: This paper analysed chronic obstructive pulmonary disease (COPD) hospitalisations, unplanned readmissions and deaths in Victoria to identify associations with socioeconomic status (SES). Methods: The data was taken from the Victorian Admitted Episodes Dataset, the Victorian Health Information Surveillance System, the Victorian Burden of Disease Study and the Australian Bureau of Statistics’ Index of Relative Socioeconomic Disadvantage. Results: COPD separations have a greater variation by SES than all separations. The average age‐standardised separation rate (10.43) for the top percentile Local Government Areas (LGA) was 5.8 times that of the bottom percentile LGAs (1.80). The top percentile group was the lowest SES group (effect size = 0.93). There were significant negative correlations between the age‐standardised COPD separation rates and SES across LGAs (r = ?0.60) and Regions (r = ?0.89). Analysis of readmissions (r = ?0.49), mortality data (r = ?0.51) and the burden of disease data (r = ?0.39) also showed significant inverse associations between COPD and SES. Conclusions and implications: Victorians living in the most disadvantaged areas have a greater burden from COPD, highlighting a need to prioritise public health services interventions to improve outcomes.     

Epidemiology of Cardiovascular Disease in China and Opportunities for Improvement: JACC International

The burden of cardiovascular (CV) disease is very high in China, due to highly prevalent and poorly controlled risk factors resulting from changing sociodemographic structure and lifestyles in its large population. Rapid economic development and urbanization have been accompanied by changing patterns, expression, and management of CV disease. However, the health care system in China lacks a hierarchical structure, with a focus on treating acute diseases in hospital while ignoring long-term management, and primary health care is too weak to effectively control CV risk factors. To address these challenges, the Chinese central government has ensured health is a national priority and has introduced reforms that include implementing policies for a healthy environment, strengthening primary care, and improving affordability and accessibility within the health system. Turning the inverted pyramid of the health care system is essential in the ongoing battle against CV disease.