RESUMO
BACKGROUND: Given that peripheral arterial disease (PAD) disproportionately affects people of lower socioeconomic status, out-of-pocket expenses for preventive medications are a major barrier to their use. We carried out a cost comparison of drug therapies for PAD to identify prescribing strategies that minimize out-of-pocket expenses for these medications. METHODS: Between March and June 2019, we contacted outpatient pharmacies in Hamilton, Ontario, Canada, to assess pricing of pharmacologic therapies at dosages included in the 2016 American College of Cardiology/American Heart Association guideline for management of lower extremity PAD. We also gathered pricing information for supplementary charges, including delivery, pill splitting and blister packaging. We calculated prescription prices with and without dispensing fees for 30-day brand-name and generic prescriptions, and 90-day generic prescriptions. RESULTS: Twenty-four pharmacies, including hospital-based, independent and chain, were included in our sample. In the most extreme scenario, total 90-day medication costs could differ by up to $1377.26. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee and delivery cost, if any. CONCLUSION: By opting for prescriptions for 90 days or as long as possible, selecting the lowest-cost generic drugs available in each drug class, and identifying dispensing locations with lower fees, prescribers can minimize out-of-pocket patient medication expenses. This may help improve adherence to guideline-recommended therapies for the secondary prevention of vascular events in patients with PAD.
Assuntos
Custos de Medicamentos , Medicamentos Genéricos , Gastos em Saúde , Doença Arterial Periférica , Humanos , Custos e Análise de Custo , Medicamentos Genéricos/economia , Ontário , Doença Arterial Periférica/tratamento farmacológico , Estados UnidosRESUMO
The clinical diagnostic evaluation of optic neuropathies relies on the analysis of the thickness of the retinal nerve fibre layer (RNFL) by optical coherence tomography (OCT). However, false positives and false negatives in the detection of RNFL abnormalities are common. Here we show that an algorithm integrating measurements of RNFL thickness and reflectance from standard wide-field OCT scans can be used to uncover the trajectories and optical texture of individual axonal fibre bundles in the retina and to discern distinctive patterns of loss of axonal fibre bundles in glaucoma, compressive optic neuropathy, optic neuritis and non-arteritic anterior ischaemic optic neuropathy. Such optical texture analysis can detect focal RNFL defects in early optic neuropathy, as well as residual axonal fibre bundles in end-stage optic neuropathy that were indiscernible by conventional OCT analysis and by red-free RNFL photography. In a diagnostic-performance study, optical texture analysis of the RNFL outperformed conventional OCT in the detection of glaucoma, as defined by visual-field testing or red-free photography. Our findings show that optical texture analysis of the RNFL for the detection of optic neuropathies is highly sensitive and specific.
Assuntos
Glaucoma , Doenças do Nervo Óptico , Glaucoma/diagnóstico por imagem , Humanos , Fibras Nervosas/patologia , Doenças do Nervo Óptico/diagnóstico por imagem , Retina/diagnóstico por imagem , Tomografia de Coerência ÓpticaRESUMO
Microcirculatory insufficiency has been hypothesized in glaucoma pathogenesis. There is a scarcity of data to comprehensively examine the changes in retinal microvasculature and its role in normal tension glaucoma (NTG). We conducted a cross-sectional case-control study and included 168 eyes from 100 NTG patients and 68 healthy subjects. Quantitative retinal arteriolar and venular metrics were measured from retinal photographs using a computer-assisted program. Radial peripapillary capillary network was imaged with OCT-A and quantitative capillary metrics (circumpapillary vessel density (cpVD) and circumpapillary fractal dimension (cpFD)) were measured with a customized MATLAB program. We found that NTG was associated with decreased arteriolar and venular tortuosity, arteriolar branching angle, cpVD and cpFD. Decreased venular caliber, arteriolar and venular branching angles, cpVD and cpFD were associated with thinner average RNFL thickness. Decreased arteriolar and venular branching angles, cpVD and cpFD were also associated with worse standard automated perimetry measurements (mean deviation and visual field index). Compared with retinal arteriolar and venular metrics, regression models based on OCT-A capillary metrics consistently showed stronger associations with NTG and structural and functional measurements in NTG. We concluded that NTG eyes showed generalized microvascular attenuations, in which OCT-A capillary metrics attenuations were more prominent and strongly associated with NTG.
Assuntos
Glaucoma de Baixa Tensão/diagnóstico por imagem , Retina/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem , Idoso , Estudos de Casos e Controles , Estudos Transversais , Técnicas de Diagnóstico Oftalmológico , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Glaucoma de Baixa Tensão/patologia , Masculino , Microcirculação , Pessoa de Meia-Idade , Retina/patologia , Vasos Retinianos/patologia , Tomografia de Coerência ÓpticaRESUMO
BACKGROUND: Researchers have found breastfeeding disparities between immigrant and native-born women in many countries. However, most studies on immigration and breastfeeding practices have been in Western countries. The aim of this study was to examine the effect of length of time since immigration on the breastfeeding practices of Mainland Chinese immigrants living in Hong Kong. METHODS: We recruited 2704 mother-infant pairs from the postnatal wards of four public hospitals in Hong Kong. We examined the effect of migration status on the duration of any and exclusive breastfeeding. RESULTS: Breastfeeding duration was progressively shorter as the time since immigration increased. When compared with mothers who had lived in Hong Kong for <5 years, Hong Kong-born participants had a 30% higher risk of stopping any breastfeeding (hazard ratio [HR] 1.34 [95% confidence interval {CI} 1.10-1.63]) and exclusive breastfeeding (HR 1.33 [95% CI 1.11-1.58]). In both Hong Kong-born and immigrant participants, breastfeeding cessation was associated with return to work postpartum and the husband's preference for infant formula or mixed feeding. Intention to exclusively breastfeed and to breastfeed for >6 months, and previous breastfeeding experience substantially reduced the risk of breastfeeding cessation for both Hong Kong-born and immigrant participants. CONCLUSIONS: Health care professionals should consider immigration history in their assessment of pregnant women and provide culturally adapted breastfeeding support and encouragement to this population.
Assuntos
Aculturação , Aleitamento Materno/etnologia , Aleitamento Materno/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Adulto , China , Emigrantes e Imigrantes/psicologia , Feminino , Hong Kong , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Gravidez , Modelos de Riscos Proporcionais , Retorno ao Trabalho/psicologia , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: The Baby-Friendly Hospital Initiative requires hospitals to pay market price for infant formula. No studies have specifically examined the effect of hospitals paying for infant formula on breastfeeding mothers' exposure to Baby-Friendly steps. OBJECTIVES: To investigate the effect of hospitals implementing a policy of paying for infant formula on new mothers' exposure to Baby-Friendly steps and examine the effect of exposure to Baby-Friendly steps on breastfeeding rates. METHODS: We used a repeated prospective cohort study design. We recruited 2 cohorts of breastfeeding mother-infant pairs (n = 2470) in the immediate postnatal period from 4 Hong Kong public hospitals and followed them by telephone up to 12 months postpartum. We assessed participants' exposure to 6 Baby-Friendly steps by extracting data from the medical record and by maternal self-report. RESULTS: After hospitals began paying for infant formula, new mothers were more likely to experience 4 out of 6 Baby-Friendly steps. Breastfeeding initiation within the first hour increased from 28.7% to 45%, and in-hospital exclusive breastfeeding rates increased from 17.9% to 41.4%. The proportion of mothers who experienced all 6 Baby-Friendly steps increased from 4.8% to 20.5%. The risk of weaning was progressively higher among participants experiencing fewer Baby-Friendly steps. Each additional step experienced by new mothers decreased the risk of breastfeeding cessation by 8% (hazard ratio = 0.92; 95% CI, 0.89-0.95). CONCLUSION: After implementing a policy of paying for infant formula, breastfeeding mothers were exposed to more Baby-Friendly steps, and exposure to more steps was significantly associated with a lower risk of breastfeeding cessation.
Assuntos
Aleitamento Materno/estatística & dados numéricos , Promoção da Saúde/métodos , Fórmulas Infantis/economia , Cuidado Pós-Natal/métodos , Adolescente , Adulto , Feminino , Seguimentos , Fidelidade a Diretrizes , Promoção da Saúde/economia , Promoção da Saúde/normas , Hong Kong , Humanos , Lactente , Recém-Nascido , Cuidado Pós-Natal/economia , Cuidado Pós-Natal/normas , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Desmame , Adulto JovemRESUMO
OBJECTIVE: To investigate the effect of public hospitals in Hong Kong not accepting free infant formula from manufacturers on in-hospital formula supplementation rates and breast-feeding duration. DESIGN: Prospective cohort study. SETTING: In-patient postnatal units of four public hospitals in Hong Kong. SUBJECTS: Two cohorts of breast-feeding mother-infant pairs (n 2560). Cohort 1 (n 1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n 1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding. RESULTS: The mean number of formula supplements given to infants in the first 24 h was 2·70 (sd 3·11) in cohort 1 and 1·17 (sd 1·94) in cohort 2 (P<0·001). The proportion of infants who were exclusively breast-fed during the hospital stay increased from 17·7 % in cohort 1 to 41·3 % in cohort 2 (P<0·001) and the risk of breast-feeding cessation was significantly lower in cohort 2 (hazard ratio=0·81; 95 % CI 0·73, 0·90). Participants who non-exclusively breast-fed during the hospital stay had a significantly higher risk of stopping any or exclusive breast-feeding. Higher levels of formula supplementation also increased the risk of breast-feeding cessation in a dose-response pattern. CONCLUSIONS: After implementation of a hospital policy to pay market price for infant formula, rates of in-hospital formula supplementation were reduced and the rates of in-hospital exclusive breast-feeding and breast-feeding duration increased.
Assuntos
Aleitamento Materno , Suplementos Nutricionais , Hospitais , Fórmulas Infantis , Políticas , Adolescente , Adulto , Custos e Análise de Custo , Feminino , Hong Kong , Humanos , Lactente , Fórmulas Infantis/economia , Estudos Prospectivos , Adulto JovemRESUMO
Body mass index (BMI) is commonly used for assessing body fat. Self-reported body weight and height derived BMI (SRDBMI) is a simple, low cost and non-invasive assessment tool and it may be a useful self-reported assessment tool to monitor the prevalence of overweight/obesity in community settings and for epidemiological research. We assessed the agreement of BW and BH between assessor measured and child self-reported values and evaluated the diagnostic ability of SRDBMI to identify children with overweight/obesity status and cardiometabolic risk factors (CMRFs) clustering. A cross-sectional study was conducted in school settings using a cluster sampling method. A total of 1,614 children aged 6-18 years were included in the analysis. Children were given a questionnaire to complete at home prior to the anthropometric measurements and blood taking at the schools. There was almost perfect agreement on BW, BH and BMI between self-reported and measured values [intraclass correlation coefficients ranged from 0.93 (95% CI: 0.93-0.94) to 0.99 (95% CI: 0.98-0.99)]. About half of the children reported their BW and BH absolute values within 1 kg and 2 cm of measured values, respectively. The SRDBMI demonstrated good diagnostic ability for identifying children with overweight/obesity status (sensitivity, specificity, positive and negative predictive values ranged from 0.83 to 0.98) and CMRFs clustering (AUC-ROCs values of BMI between measured and self-reported values were close ranging from 0.85 to 0.89). Self-reported BW and BH demonstrated almost perfect agreement with measured values and could substantially identify children with overweight/obesity status and CMRFs clustering.
Assuntos
Estatura , Peso Corporal , Doenças Cardiovasculares/epidemiologia , Doenças Metabólicas/epidemiologia , Sobrepeso/epidemiologia , Medição de Risco/métodos , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico , Criança , Análise por Conglomerados , Estudos Transversais , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Programas de Rastreamento , Doenças Metabólicas/diagnóstico , Sobrepeso/diagnóstico , Valor Preditivo dos Testes , Prevalência , Reprodutibilidade dos Testes , Fatores de Risco , AutorrelatoRESUMO
AIM: To validate a Tanner stages self-assessment questionnaire using gender-specific line drawings and brief explanatory text in Chinese. DESIGN: A cross sectional study design. SETTING: One primary and two secondary schools. PARTICIPANTS: 172 boys and 182 girls aged between 8 and 18 years. MAIN OUTCOME MEASURES: Students' self-assessments of pubertal maturation were compared with assessments made by a same gender rater using visual depiction physical examination. Raters' physical examinations were performed after the children had answered the self-assessment questionnaire individually and in private. Raters were blinded to the self-assessment results. Accuracy rates and weighted kappa statistic were used to evaluate the degree of agreement between children and raters. RESULTS: Substantial to almost perfect agreement was found between self- and rater's assessments of breast development and pubic hair growth in girls [weighted kappa 0.72 (P < 0.0001, 95% CI 0.66, 0.79) and 0.83 (P < 0.0001, 95% CI 0.78, 0.87) respectively]. Moderate to substantial agreement was found between self- and rater's assessments of male genital development and pubic hair growth [weighted kappa 0.58 (P < 0.0001, 95% CI 0.48, 0.68) and 0.80 (P < 0.0001, 95% CI 0.74, 0.86) respectively]. Most agreements between self- and rater's assessments differed by only one Tanner stage. Agreement was higher for girls than boys. Girls tended to overestimate their breast stages and boys tended to underestimate their genitalia development. CONCLUSION: This study confirms that a Tanner pubertal self-assessment questionnaire with line drawings and explanatory Chinese text can reliably estimate sexual maturation status in Hong Kong Chinese children.