A systematic review of the social and economic burden of influenza in low- and middle-income countries

ObjectivesThe economic burden of seasonal influenza outbreaks as well as influenza pandemics in lower- and middle-income countries (LMIC) has yet to be specifically systematically reviewed. The aim of this systematic review is to assess the evidence of influenza economic burden assessment methods in LMIC and to quantify the economic consequences of influenza disease in these countries, including broader opportunity costs in terms of impaired social progress and economic development.MethodsWe conducted an all language literature search across 5 key databases using an extensive list of key words for the time period 1950–2013. We included studies which explored direct costs (medical and non-medical), indirect costs (productivity losses), and broader economic impact in LMIC associated with different influenza outcomes such as confirmed seasonal influenza infection, influenza-like illnesses, and pandemic influenza.ResultsWe included 62 full-text studies in English, Spanish, Russian, Chinese languages, mostly from the countries of Latin American and the Caribbean and East Asia and Pacific with pertinent cost data found in 39 papers. Estimates for direct and indirect costs were the highest in Latin American and the Caribbean. Compared to high-income economies, direct costs in LMIC were lower and productivity losses higher. Evidence on broader impact of influenza included impact on the wider national economy, security dimension, medical insurance policy, legal frameworks, distributional impact, and investment flows.ConclusionThe economic burden of influenza in LMIC encompasses multiple dimensions such as direct costs to the health service and households, indirect costs due to productivity losses as well as broader detriments to the wider economy. Evidence from sub-Saharan Africa and in pregnant women remains very limited. Heterogeneity of methods used to estimate cost components makes data synthesis challenging. There is a strong need for standardizing research, data collection and evaluation methods for both direct and indirect cost components.     

Direct and indirect costs of heart failure in relation to diabetes status - A nationwide study

Background and aimHeart failure (HF) and diabetes mellitus (DM) are burdensome chronic diseases with high lifetime risks and numerous studies indicate associations between HF and DM. The objective of this study was to investigate the direct and indirect costs of HF patients with and without DM.Methods and resultsPatients with a first-time diagnosis of HF from 1998 to 2016 were identified through nationwide Danish registries and stratified according to DM status into HF with or without DM. The economic healthcare cost analysis was based on both direct costs, including hospitalization, procedures, medication and indirect costs including social welfare and lost productivity. The economic burden was investigated prior to, at, and following diagnosis of HF. Patients with concomitant HF and DM were younger (median age 74 vs. 77), had more comorbidities and fewer were female as compared to patients with HF but without DM. The socioeconomic burden of concomitant HF and DM compared to HF alone was substantially higher; 45% in direct costs (€16,237 vs. €11,184), 35% in home care costs (€3123 vs. €2320), 8% in social transfer income (€17,257 vs. €15,994) and they had 27% lower income (€10,136 vs. €13,845). The economic burden peaked at year of diagnosis, but the difference became increasingly pronounced in the years following the HF diagnosis.ConclusionPatients with concomitant HF and DM had a significantly higher economic burden compared to patients with HF but without DM.     

福州市内河蚊虫孳生情况的调查

目的了解福州市内河的蚊虫孳生情况,为城市科学灭蚊提供依据。方法采用目测和勺捕相结合的方法,调查福州市城区和城乡接合部内河蚊虫孳生的情况,以500 ml勺捕捞幼虫,计算孳生严重的内河的蚊幼密度(条/勺);选取孳生严重的内河进行蚊虫孳生的季节消长调查。结果调查城区河道300处,孳生2处,孳生频率为0.67%,调查城乡接合部河道200处,孳生24处,孳生率为12.0%。主要孳生蚊种为致倦库蚊,伴有少量褐尾库蚊孳生,幼虫密度最高可达到657条/勺。幼虫主要孳生在内河两岸和水生植物周围。福州市内河蚊虫孳生有比较明显的季节变化,5和11月为密度的2个高峰,2和8月为密度的2个低谷。结论福州城市内河在一定条件下会成为超大型蚊虫孳生地,是城市灭蚊中不可忽视的孳生场所。     

Costes médicos directos y sus predictores en la cohorte “Variabilidad en el manejo de la artritis reumatoide y las espondiloartritis en España”

Objective

To analyze the resource utilization in rheumatoid arthritis (RA) patients and predictive factors in and patients treated with biological drugs and biologic-naïve.

不同经济水平农村居民原发性高血压危险因素分析

目的 了解不同经济水平农村居民高血压危险因素有无不同.方法 采用自编问卷对河北省冀州市不同经济水平的≥35岁的农村居民中的469名新发高血压患者和2799名对照进行了原发性高血压危险因素调查,并进行了多因素Logistic回归分析.结果 经济水平较好组高血压危险因素(以OR值大小为序)依次为家族史、体质量指数、盐腌食品、每天吃鸡蛋、年龄,它们的OR分别为2.863、1.286、1.263、1.200、1.052;经济水平较差组高血压危险因素(以OR值大小为序)依次为家族史、吸烟、每天吃鸡蛋、饮酒、文化程度、性别、喜吃肥肉、体质量指数、年龄,它们的OR分别为3.990、1.767、 1.753、1.728、1.532、1.448、 1.276、 1.205、1.068,每天吃新鲜水果和家庭年人均收入高是高血压的保护因素,它们的OR为0.708和0.788.结论 经济水平不同高血压危险因素不完全相同.     

Electronic Medical Records and Electronic Health Records: Overview for Nurse Practitioners

Electronic medical records (EMRs) and electronic health records (EHRs) have become essential systems by which nurse practitioners (NPs) communicate vital patient information to other members of the health care team as well as to patients. In this article we examine the important distinctions between EMRs and EHRs; review the genesis of these types of records; summarize applicable provisions of the Health Insurance Portability and Accountability Act from a recent legal case centered around NP utilization of EMRs and EHRs; address open patient access to medical information; and examine threats to security. Suggestions are offered on ways in which NPs can safeguard confidential patient information.     

两种中心静脉输液技术的成本效果分析

目的 比较PICC和植入式静脉输液港（implantable venous access port,PORT）从置管到拔管全程的成本-效果,为中长期中心静脉输液技术的选择提供卫生经济学依据。 方法 采用回顾性队列研究,便利地选取上海市某三级甲等医院2016年1月—2019年10月采用PICC进行静脉输液的444例患者及2013年1月—2019年10月采用PORT的477例患者为研究对象,采用成本-效果分析,从医院角度比较两组总留置时间段、留置3~6个月、6~9个月、9~12个月时的总成本、综合效果指数、成本-效果比。 结果 在总留置时间段、留置3~6个月、6~9个月、9~12个月时,PICC组的日均总成本或总成本均低于PORT组,差异具有统计学意义（P<0.001）;PICC组综合效果指数均略低于PORT组;PICC组的成本-效果比均低于PORT组;增量成本-效果比分别为543.50、234 411.00、120 092.25和109 164.00。 结论 当导管留置时间≤12个月时,PICC成本-效果优于PORT,从卫生经济学角度,优先推荐PICC作为中长期静脉输液通路。此外,增量成本-效果比可辅助决策,若支付意愿值高于增量成本-效果比,则PICC和PORT均为成本-效果可接受的方案;反之,则PICC成本-效果更佳。     

Mauling of the “Celtic Tiger”: Clinical characteristics and outcome of first-episode depression secondary to the economic recession in Ireland

Background

There is a dearth of studies describing clinical characteristics and outcome of patients who present with mood disorders related to economic recession.

Aims

To describe a cohort of patients admitted with first-episode depression related to the Irish economic recession and compare this cohort with all other first-episode depressives admitted during the same time period (2009–2010).

Methods

A cohort of 137 patients admitted with first-episode depression to an independent university teaching hospital was prospectively identified and followed up from admission over 2 years (mean follow-up 430 days, s.d. 176 days). The cohort was divided into “Celtic Tiger” (patients with first-episode depression secondary to the economic recession) and non-Celtic Tiger control patients (other first-episode depressed patients). Both groups were compared in terms of clinical characteristics at baseline and outcome over follow-up.

Results

The number of admissions due to first depressive episodes were higher in recession years 2009/10 than in pre-recession years 2008/9. Celtic Tiger patients were predominantly male and more severely depressed with more marked suicidal ideation (χ², p<0.001) than control patients. They were more likely to recover (χ², p=0.013), less likely to recur (χ², p<0.001) and had faster time to recovery (log rank, p<0.001) and slower time to full recurrence (log rank, p=0.001). The Celtic Tiger patients spent more time asymptomatic and less time at full and subthreshold depression levels over follow-up.

Limitations

Study setting of centre specializing in affective disorders treatment, retrospective nature of follow-up after initial prospective interview and lack of patient follow-up interview.

Conclusion

The study describes a subgroup of patients with severe depression associated with economic recession with likely high suicide risk but very favourable outcome.     

住院精神病患者出走意念及其影响因素

目的探讨住院精神病患者出走意念及其影响因素,为进一步干预提供科学依据。方法对100例住院精神病患者出走意念进行回顾性调查,分析出走意念产生原因及其与患者一般资料的关系。结果本组患者出走意念发生率62.5%。无配偶、首发、首次住院患者出走意念发生率较高(χ2=6.838,20.907,17.145;P<0.001);出走意念发生率与年龄、病程、经济状况和社会支持呈反向关联(χ2=20.846、8.177、9.351,24.722;P<0.05);住院时间-出走意念发生率曲线呈倒"S"型(χ2=15.166,P=0.004);出走意念产生原因差异有统计学意义(χ2=174.362,73.516,26.710,31.469,46.712;P<0.01)。结论住院精神病患者出走意念发生率较高,住院初期以精神症状和不良反应影响较大,后期以正常心理需要为主。此外,年轻、无配偶、首发、首次住院、病程较短、经济状况和社会支持较差的患者更易产生出走意念。