Impact of diabetes on medical costs in the pre- and postoperative year of lower extremity amputations in Belgium.

AIMS: To compare the medical costs of individuals undergoing lower extremity amputation (LEA) in Belgium with those of amputation-free individuals. METHODS: Belgian citizens undergoing LEAs in 2014 were identified. The median costs per capita in euros for the 12 months preceding and following minor and major LEAs were compared with those of matched amputation-free individuals. RESULTS: A total of 3324 Belgian citizens underwent LEAs (2295 minor, 1029 major), 2130 of them had diabetes. The comparison group included 31,716 individuals. Amputation was associated with high medical costs (individuals with diabetes: major LEA €49,735, minor LEA €24,243, no LEA €2,877 in the year preceding amputation; €45,740, €21,445 and €2,284, respectively, in the post-amputation year). Significantly higher costs were observed in the individuals with (versus without) diabetes in all groups. This difference diminished with higher amputation levels. Individuals undergoing multiple LEAs generated higher costs (individuals with diabetes: €39,313-€89,563 when LEAs preceded index amputation; €46,629-€92,877 when LEAs followed index amputation). Individuals dying in the year after a major LEA generated remarkably lower costs. CONCLUSIONS: LEA-related medical costs were high. Diabetes significantly impacted costs, but differences in costs diminished with higher amputation levels. Individuals with multiple amputations generated the highest costs.

The missing link between poverty and child maltreatment: Parental burnout.

BACKGROUND: Child maltreatment remains a major social welfare and public health issue. The relationship between SES and child maltreatment has been intensively studied. And syntheses of meta-analyses have identified low SES as one of the five major antecedents of child maltreatment. OBJECTIVE: The underlying mechanism that explains the association between low SES and child maltreatment, has however not been clearly demonstrated. PARTICIPANTS AND SETTING: In a sample of 3429 parents (51.53 % low SES), we postulated a double mediation to explain this relationship, namely that low SES increased the imbalance between the parent's risk and resource factors, and that this imbalance in turn increased parental burnout, which itself increased parental neglect and violence. METHODS: We estimated three successive models encompassing the direct and indirect effects of low SES on the imbalance between risk and resource factors, parental burnout, parental neglect and parental violence. RESULTS: The results provide little support for the direct effect of poverty on parental burnout, parental neglect and parental violence. They rather confirm the mediating role of the imbalance between risk and resource factors and parental burnout. CONCLUSIONS: Parental burnout could be the missing link between poverty and child maltreatment. The results are discussed for research and clinical purposes.

Health literacy and the use of healthcare services in Belgium.

BACKGROUND: Most of the existing studies demonstrating the relationships between health literacy and health service use have been conducted outside Europe and cannot be generalised to European healthcare systems. Moreover, the majority of studies measure healthcare use via self-reports. This study investigated whether health literacy is related to the use of health services measured objectively via patient records in a European country. METHODS: 9617 members of a Belgian health insurance fund (59% females, ages 18-88 years, mean age 55.8 years) completed an online questionnaire including the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q) and agreed to have their responses linked to the insurance fund's health service use records. A two-part model approach was used to assess the association between health literacy and the use of healthcare services and the costs related, adjusting for personal and behavioural characteristics. RESULTS: Low health literacy is associated with more admissions to 1-day clinics, general practitioner (GP) home consultations, psychiatrist consultations and ambulance transports, and with longer stays in general hospitals. Associations with psychiatric hospitalisations and specialist consultations are also found but are not significant when correction for multiple comparisons is applied. In contrast, health literacy is not significantly related to the number of GP consultations, admissions to 1-day surgical clinics or emergency consultations. The relationship between health literacy and medication use is inconsistent. CONCLUSION: The results partly confirm that low health literacy is associated with greater use of healthcare services, and especially of more specialised services. Improving the health literacy of the population can be an effective strategy to promote a more (cost)-effective use of the healthcare services and thus contribute to population health.