RESUMEN
OBJECTIVE: Information on borderline personality disorder (BPD) and its comorbidities is often limited to concentrate on a few diagnoses. The aim of the study was to use national register data to investigate all diagnostic co-occurring mental health disorders and somatic diseases 3 years before and after initial BPD diagnosis compared with a matched control group. METHOD: The study was a register-based cohort of 2756 patients with incident BPD (ICD F60.3) and 11,024 matched controls, during 2002-2016. Comorbidity data were classified into main disease groups, in accordance with the World Health Organization ICD-10 criteria. RESULTS: Almost half the patients had been diagnosed with mental and behavioral disorders before the BPD diagnosis as compared to 3% in the control group. Further, the co-occurrence of diseases due to external causes of morbidity, including injury, self-harm, and poisoning were more represented in the BPD group before diagnosis as compared to the control group. In addition, co-occurring morbidity related to diseases in the circulatory, the respiratory, the digestive, the musculoskeletal, and the genitourinary system was more represented in the BPD group. After diagnosis, the proportion of patients with co-occurring morbidity increased further in all main disease groups in the BPD group. As many as 87% of patients had mental and behavioral co-occurring morbidity and 15% nervous diseases as compared with 3% and 4%, respectively, in the control group. Also, comorbidities related to external causes of morbidity, including for example, injury and self-harm were more represented in the BPD group. The BPD group had more somatic co-occurring morbidity, especially digestive, respiratory, circulatory, and endocrine diseases. Finally, the mortality over 12 years was statistically significantly higher in people with BPD than in the control group. CONCLUSION: Patients with BPD have higher odds for multiple physical health conditions and co-occurrence of mental health disorders.
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Trastorno de Personalidad Limítrofe , Humanos , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/psicología , Estudios Prospectivos , Salud Mental , ComorbilidadRESUMEN
OBJECTIVE: Heart failure (HF) imposes a major economic burden; however, the individual management for patients varies, potentially leading to large cost heterogeneity. The aim of this study was to investigate the spectrum of health cost by patients with HF and factors associated with high direct health cost. STUDY DESIGN: This was a nationwide, retrospective longitudinal study. METHODS: Using Danish nationwide registries from 2012 to 2015, we identified all patients aged >18 years with a first-time diagnosis of HF. Total health costs were investigated using two perspectives-at index and during 3 years of follow-up. Patients were investigated by decile cost groups. A multivariable logistic regression was used to identify variables associated with being in the highest cost decile compared with the rest (90%). RESULTS: A total of 11,170 patients with HF were included, and those in the highest cost decile (n = 1117, 10%) were younger (69 vs. 75 years), fewer were females (34% vs. 43%), and more were inpatients (83% vs. 70%) compared with the rest of the patients with HF (n = 10,053, 90%). Patients in the highest cost decile (10%) incurred a 30 times higher cost with a mean total health cost in index year of 86,607 compared with 2893 for patients in lowest cost decile (10%). The results were similar for 3 years aggregated (139,473 vs. 4086), corresponding to a 34 times higher cost. CONCLUSION: In patients with HF, a large total health cost heterogeneity exists with younger age, inpatient admittance, male sex, and comorbidities being associated with a higher likelihood of belonging to the highest cost group.
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Insuficiencia Cardíaca , Hospitalización , Femenino , Costos de la Atención en Salud , Insuficiencia Cardíaca/terapia , Humanos , Estudios Longitudinales , Masculino , Estudios RetrospectivosRESUMEN
OBJECTIVE: To assess the 24-month cost-effectiveness of supervised treatment compared to written advice in knee osteoarthritis (OA). DESIGN: 100 adults with moderate-severe OA not eligible for total knee replacement (TKR) randomized to a 12-week individualized, supervised treatment (exercise, education, diet, insoles and pain medication) or written advice. Effectiveness was measured as change in quality-adjusted life years (QALYs) from baseline to 24 months, including data from baseline, 3, 6, 12 and 24 months, while healthcare costs and transfer payments were derived from national registries after final follow-up. Incremental costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. A sensitivity analysis resampling existing data was conducted and the probability of cost-effectiveness was estimated using a 22,665 Euros/QALY threshold. In a sensitivity analysis, cost-effectiveness was calculated for different costs of the supervised treatment (actual cost in study; cost in private practice; and in-between cost). RESULTS: Average costs were similar between groups (6,758 Euros vs 6,880 Euros), while the supervised treatment were close to being more effective (incremental effect (95% CI) of 0.075 (-0.005 to 0.156). In the primary analysis excluding deaths, this led the supervised treatment to be cost-effective, compared to written advice. The sensitivity analysis demonstrated that the results were sensitive to changes in the cost of treatment, but in all scenarios the supervised treatment was cost-effective (ICERs of 6,229 to 20,688 Euros/QALY). CONCLUSIONS: From a 24-month perspective, a 12-week individualized, supervised treatment program is cost-effective compared to written advice in patients with moderate-severe knee OA not eligible for TKR. TRIAL REGISTRATION: ClinicalTrials.gov number: NCT01535001.
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Analgésicos no Narcóticos/uso terapéutico , Terapia por Ejercicio/métodos , Costos de la Atención en Salud , Osteoartritis de la Rodilla/rehabilitación , Educación del Paciente como Asunto/métodos , Años de Vida Ajustados por Calidad de Vida , Anciano , Analgésicos no Narcóticos/economía , Análisis Costo-Beneficio , Dinamarca , Dietoterapia/economía , Dietoterapia/métodos , Terapia por Ejercicio/economía , Femenino , Ortesis del Pié/economía , Humanos , Ibuprofeno/economía , Ibuprofeno/uso terapéutico , Masculino , Persona de Mediana Edad , Entrevista Motivacional , Osteoartritis de la Rodilla/economía , Sobrepeso/dietoterapia , Educación del Paciente como Asunto/economía , Modalidades de Fisioterapia/economía , Ausencia por Enfermedad/economía , Resultado del TratamientoRESUMEN
OBJECTIVE: Information on societal cost of patients with Borderline Personality Disorder (BPD) and spouses is limited. The aim was to investigate factual societal costs before and after initial BPD diagnosis. METHOD: A register-based cohort study of 2756 patients with incident BPD (ICD F60.3) with spouses and 11 024 matched controls, during 2002-2016. RESULTS: Total direct healthcare costs and lost productivity costs amounted 40 441 for patients with BPD, which was more than 16 times higher than the matched controls. Somatic and psychiatric health care costs and costs of lost productivity were increased during 5 years before initial diagnosis of BPD. Before and after initial diagnosis, health care costs and lost productivity were increased among spouses of patients with BPD. CONCLUSION: Patients with BPD differed substantially from the general population with respect to all included costs. The study documented a significant burden on their spouses. Besides the early onset of BPD, which implies that patients are affected before they finish school and enter labor market, the neurocognitive impairment and fundamental symptoms of BPD, e.g. unstable, intense relationships, impulsivity, and lack of stable sense of self together with psychiatric and somatic comorbidity are part of explanation of the excess costs of BPD.
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Trastorno de Personalidad Limítrofe/economía , Costo de Enfermedad , Costos de la Atención en Salud/estadística & datos numéricos , Sistema de Registros , Esposos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Dinamarca , Eficiencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: In the world today 10-20 million people are still living with late effects of poliomyelitis (PM), but the long-term consequences of the disease are not well known. The aim of this study was to describe lifelong morbidity and mortality among Danes who survived PM. METHODS: Data from official registers for a cohort of 3606 Danes hospitalized for PM in the period 1940-1954 were compared with 13 762 age- and gender-matched controls. RESULTS: Compared with controls, mortality was moderately increased for both paralytic as well as non-paralytic PM cases; Hazard Ratio, 1.31 (95% confidence interval, 1.18-1.44) and 1.09 (95% confidence interval, 1.00-1.19), respectively. Hospitalization rates were approximately 1.5 times higher among both paralytic and non-paralytic PM cases as compared with controls. Discharge diagnoses showed a broad spectrum of diseases. There were no major differences in morbidities between paralytic and non-paralytic PM cases. CONCLUSIONS: Poliomyelitis has significant long-term consequences on morbidity and mortality of both paralytic and non-paralytic cases.
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Poliomielitis/epidemiología , Poliomielitis/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Dinamarca/epidemiología , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Parálisis/complicaciones , Parálisis/epidemiologíaRESUMEN
We estimated the rate of compliance with oral bisphosphonates among Danish women and examined its association with health care resource use and cost. Approximately 30 % of Danish females aged >55 who take bisphosphonates are noncompliant, and noncompliance is significantly associated with increased health care resource use and cost. INTRODUCTION: Two objectives of this study were to estimate the rate of oral bisphosphonate compliance among Danish women and to examine the association of noncompliance with health care resource use and cost. METHODS: Women ≥55 with an index prescription claim for an oral bisphosphonate were identified from Danish national health registries between 2003 and 2008. Compliance was measured as the medication possession ratio (MPR) during the first 12 months post-index. Cost and health care resource use were collected for the following 12 months. RESULTS: Among the 38,234 women meeting the study inclusion criteria, 29.9 % were noncompliant (MPR <70 %). Younger age was associated with higher odds of compliance (OR [95 % CI] 1.22 [1.15-1.29] for ages 55-64 and 1.18 [1.12-1.24] for ages 65-74; reference age group ≥75 years). Rates of all-cause health care resource use were significantly higher in noncompliant subjects: 28.9 versus 23.0 % had inpatient admissions, 16.5 versus 13.0 % had emergency room visits, and 48.7 versus 43.3 % used outpatient services (P < 0.001 for all comparisons). The total mean (SD) all-cause cost per patient (excluding office visits) was 626 (2344) and 4178 (7854), respectively. The mean (SD) osteoporosis-related cost per patient (excluding office visits) was 572 (2085) and 754 (2857) for compliant and non-compliant subjects, respectively. The compliant subjects accrued significantly lower all-cause and OP-related cost than noncompliant subjects, regardless of whether the total cost or medical cost only was considered. CONCLUSIONS: Approximately 30 % of Danish females aged 55 or older who take bisphosphonates are noncompliant. Noncompliance is significantly associated with increased health care resource use and cost.
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Difosfonatos/uso terapéutico , Costos de la Atención en Salud , Recursos en Salud/estadística & datos numéricos , Osteoporosis/economía , Cooperación del Paciente , Anciano , Dinamarca , Femenino , Humanos , Persona de Mediana Edad , Osteoporosis/tratamiento farmacológico , Sistema de Registros , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: Dementia causes morbidity, disability and mortality, and as the population ages the societal burden will grow. The direct health costs and indirect costs of lost productivity and social welfare of dementia were estimated compared with matched controls in a national register based cohort study. METHODS: Using records from the Danish National Patient Registry (1997-2009) all patients with a diagnosis of Alzheimer's disease, vascular dementia or dementia not otherwise specified and their partners were identified and compared with randomly chosen controls matched for age, gender, geographical area and civil status. Direct health costs included primary and secondary sector contacts, medical procedures and medication. Indirect costs included the effect on labor supply. All cost data were extracted from national databases. The entire cohort was followed for the entire period - before and after diagnosis. RESULTS: In all, 78 715 patients were identified and compared with 312 813 matched controls. Patients' partners were also identified and matched with a control group. Patients had lower income and higher mortality and morbidity rates and greater use of medication. Social- and health-related vulnerability was identified years prior to diagnosis. The average annual additional cost of direct healthcare costs and lost productivity in the years before diagnosis was 2082 euros per patient over and above that of matched controls, and 4544 euros per patient after the time of diagnosis. CONCLUSIONS: Dementias cause significant morbidity and mortality, consequently generating significant socioeconomic costs.
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Demencia/economía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/economía , Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/psicología , Estudios de Cohortes , Costo de Enfermedad , Demencia/epidemiología , Demencia/psicología , Demencia Vascular/economía , Demencia Vascular/epidemiología , Demencia Vascular/psicología , Dinamarca/epidemiología , Empleo , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Factores Sexuales , Factores Socioeconómicos , Análisis de Supervivencia , Adulto JovenRESUMEN
BACKGROUND: Primary progressive multiple sclerosis (PPMS) is characterized by development of more chronic neurological manifestations from disease onset compared with relapsing remitting MS (RRMS) and secondary progressive MS (SPMS) but the following socioeconomic consequences have never been described in a nation-wide patient population. OBJECTIVE: To determine if socioeconomic burden of PPMS is increased compared with RRMS and SPMS. METHODS: We included patients from The Danish Multiple Sclerosis Registry diagnosed between 1998 and 2015. Yearly average health costs, public transfers and earned income was calculated from the index diagnosis date, and each year in a five-year period before and after index diagnosis date, for the three patient groups. A regression model estimating the odds ratio (OR) with PPMS as the comparator, was used to analyze the differences between PPMS vs. RRMS and PPMS vs. SPMS controlling for age and sex. RESULTS: In total, 9563 MS patients were identified (1998-2015), with a characteristic distribution between different disease courses: 7012 patients with RRMS (73%), 1099 patients with PPMS (11%) and 1452 patients with SPMS (15%). Total health costs were lower in RRMS vs. PPMS (OR 0.76; 95% CI 0.74-0.78; p<0.0001) but not in SPMS vs. PPMS (OR 1.06; 95% CI 1.03-1.09; p<0.0001). Especially homecare costs were lower in RRMS vs. PPMS (OR 0.17; 95% CI 0.17-0.18; p<0.0001), less pronounced in SPMS vs. PPMS (OR 0.93; 95% CI 0.90-0.97; p = 0.0001). OR for health costs before and after diagnosis was significantly lower in RRMS vs. PPMS regarding most variables, less pronounced in SPMS vs. PPMS. CONCLUSION: This nation-wide population-based study show that socioeconomic burden is significantly higher in PPMS relative to RRMS, but less pronounced compared with SPMS.
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Esclerosis Múltiple Crónica Progresiva , Esclerosis Múltiple Recurrente-Remitente , Esclerosis Múltiple , Dinamarca/epidemiología , Progresión de la Enfermedad , Humanos , Esclerosis Múltiple Crónica Progresiva/epidemiología , Factores SocioeconómicosRESUMEN
This manuscript highlights clinical applications of the Tenure dentin bonding agent. Research comparing diametral and bond strengths, and microleakage of Tenure and other dentin bonding agents is presented. The Light-cured Zionomer glass ionomer is shown to provide a superior dentin bond when compared to Vitrabond.
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Recubrimiento Dental Adhesivo/métodos , Cementos Dentales/normas , Resinas Compuestas , Filtración Dental , Restauración Dental Permanente/métodos , Femenino , Cementos de Ionómero Vítreo , Humanos , MasculinoRESUMEN
A histological study of the response in the pulps of human teeth to cervical restorations made with a composite resin following etching of the enamel for 2 minutes with 50 per cent phosphoric acid showed moderate inflammation after 14 days. Three specimens showed normal structure after 98 days. Teeth restored without etching showed only slight inflammation.
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Resinas Compuestas/toxicidad , Pulpa Dental/efectos de los fármacos , Restauración Dental Permanente , Erosión de los Dientes/terapia , Preparación de la Cavidad Dental , Pulpa Dental/patología , Humanos , Ácidos Fosfóricos/toxicidad , Pulpitis/inducido químicamente , Pulpitis/patología , Factores de TiempoRESUMEN
Both the Rembrandt Whitening System and Quik Start offer a conservative treatment of discolored teeth, with no adverse reactions to hard or soft tissues reported. As well, patient satisfaction has been high.
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Blanqueamiento de Dientes , Decoloración de Dientes/rehabilitación , Peróxido de Carbamida , Combinación de Medicamentos , Humanos , Peróxidos , Blanqueamiento de Dientes/instrumentación , Blanqueamiento de Dientes/métodos , Pastas de Dientes , Urea/análogos & derivadosRESUMEN
Although laminate veneers are usually placed individually in order to avoid bonding the anterior teeth together, an alternate technique is presented. The technique described is efficient and time-saving.
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Recubrimiento Dental Adhesivo/métodos , Coronas con Frente Estético , Porcelana Dental , HumanosRESUMEN
Strong dental materials and dental porcelains are providing dentists with restorative opportunities that are more conservative because they require less destruction of healthy tooth structure and yield a more esthetic result. In cases of severe wear due to attrition, abrasion, and erosion, this process can be stopped, restoring the esthetics and function by using proper techniques and materials. The case report described in this article demonstrates the conservative restoration of severe wear due to attrition and erosion. Teeth were lengthened, wear was restored, and further wear was ceased by using a combination of bonded porcelain, a heat, light, and self-cure resin system, and a new glass-ionomer restorative material. The result was a strong, durable restoration (that required no anesthesia) with high esthetics.