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1.
J Affect Disord ; 300: 289-295, 2022 Jan 01.
Article in English | MEDLINE | ID: mdl-34979179

ABSTRACT

BACKGROUND: The purpose of this study was to provide an operating mechanism for understanding the effects of COVID-19's on satisfaction with life, subject to students' general mental health METHODS: A sample of 1653 Greek speaking university students (72.4% females, 65.3% undergraduate, M age=26.1) completed an online survey including measures for perceived psychological, academic, and financial impact of the COVID-19 pandemic, general mental health and satisfaction with life. RESULTS: A mediation model was tested to illuminate these relationships by considering students' general mental health as a mediator. Findings demonstrated that there were significant direct effects of perceived COVID-19 impact on participants' financial status on satisfaction with life and indirect effects of perceived COVID-19 impact on participants' financial status and academic performance respectively on satisfaction with life through general mental health. LIMITATIONS: The study's cross-sectional design, self-report data and snowball sampling. CONCLUSIONS: The findings add to our understanding of the relationship between perceived COVID-19 impact and life satisfaction among university students, and they shed light on the critical role of general mental health in mediating the relationship. Targeting the factors that influence general mental health can help to mitigate potential problems while also finding ways to improve mental health and well-being.

2.
BMC Health Serv Res ; 22(1): 2, 2022 Jan 02.
Article in English | MEDLINE | ID: mdl-34974843

ABSTRACT

BACKGROUND: More than half of the TB patients in India seek care from the private sector. Two decades of attempts by the National TB Program to improve collaboration between the public and private sectors have not worked except in a few innovative pilots. The System for TB Elimination in Private Sector (STEPS) evolved in 2019 as a solution to ensure standards of TB care to every patient reaching the private sector. We formally evaluated the STEPS to judge the success of the model in achieving its outcomes and to inform decisions about scaling up of the model to other parts of the country. METHODS: An evaluation team was constituted involving all relevant stakeholders. A logic framework for the STEPS model was developed. The evaluation focused on (i) processes - whether the activities are taking place as intended and (ii) proximal outcomes - improvements in quality of care and strengthening of TB surveillance system. We (i) visited 30 randomly selected STEPS centres for assessing infrastructure and process using a checklist, (ii) validated the patient data with management information system of National TB Elimination Program (NTEP) by telephonic interview of 57 TB patients (iii) analysed the quality of patient care indicators over 3 years from the management information system (iv) conducted in-depth interviews (IDI) with 33 beneficiaries and stakeholders to understand their satisfaction and perceived benefits of STEPS and (v) performed cost analysis for the intervention from the perspective of NTEP, private hospital and patients. RESULTS: Evaluation revealed that STEPS is an acceptable model to all stakeholders. IDIs revealed that all patients were satisfied about the services received. Data in management information system of NTEP were consistent with the hospital records and with the information provided by the patient. Quality of TB care indicators for patients diagnosed in private hospitals showed improvements over years as proportion of TB patients notified from private sector with a microbiological confirmation of diagnosis improved from 25% in 2018 to 38% in 2020 and the documented treatment success rate increased from 33% (2018 cohort) to 88% (2019 cohort). Total additional programmatic cost (deducting cost for patient entitlements) per additional patient with successful treatment outcome was estimated to be 67 USD. Total additional expense/business loss for implementing STEPS for the hospital diagnosing 100 TB patients in a year was estimated to be 573 USD while additional minimum returns for the hospital was estimated to be 1145 USD. CONCLUSION: Evaluation confirmed that STEPS is a low cost and patient-centric strategy. STEPS successfully addressed the gaps in the quality of care for patients seeking care in the private sector and ensured that services are aligned with the standards of TB care. STEPS could be scaled up to similar settings.


Subject(s)
Private Sector , Tuberculosis , Hospitals, Private , Humans , India/epidemiology , Patient-Centered Care , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Tuberculosis/therapy
4.
Health Res Policy Syst ; 20(1): 3, 2022 Jan 03.
Article in English | MEDLINE | ID: mdl-34980159

ABSTRACT

BACKGROUND: In China, health technology assessment (HTA) has recently been adopted in pricing negotiation for medicine listing in the National Reimbursement Drug List. At present, how HTA is applied to inform the decision-making process remains underreported. In order to explore how the adoption of HTA was translated into listing and price negotiation results in light of the confidential nature of the negotiating process, this study aimed to compare the negotiated price and the clinical benefit of selected targeted anticancer medicines (TAMs) involved in the 2019 negotiation. MAIN TEXT: Among 16 TAMs successfully negotiated, only four TAMs representing four indication groups had appropriate reference medicines for comparison and were, therefore, included in the analysis. The price and clinical benefit of the four TAMs were compared against one or two reference medicines with the same initial indications. The sales prices for nine TAMs before and after the negotiation were extracted from the centralized medication procurement system. Clinical benefits were evaluated based on evidence from published articles and clinical guidelines. The results suggested that, despite the application of HTA, both rational and irrational decisions had been made about the reimbursement of TAMs in the 2019 negotiation, warranting further investigation. CONCLUSION: While the development and adoption of HTA has seen significant progress in China, actions are needed to ensure that the adoption of HTA is effectively applied in decisions on the reimbursement of medicines.


Subject(s)
Antineoplastic Agents , Technology Assessment, Biomedical , Costs and Cost Analysis , Drug Costs , Humans , Negotiating
5.
Physica A ; 592: 126810, 2022 Apr 15.
Article in English | MEDLINE | ID: mdl-34975211

ABSTRACT

In the aftermath of stock market crash due to COVID-19, not all sectors recovered in the same way. Recently, a stock price model is proposed by Mahata et al. (2021) that describes V- and L-shaped recovery of the stocks and indices, but fails to simulate the U- and Swoosh-shaped recovery that arises due to sharp fall, continuation at the low price and followed by quick recovery, slow recovery for longer period, respectively. We propose a modified model by introducing a new parameter θ = + 1 , 0 , - 1 to quantify investors' positive, neutral and negative sentiments, respectively. The model explains movement of sectoral indices with positive financial anti-fragility ( ϕ ) showing U- and Swoosh-shaped recovery. Simulation using synthetic fund-flow with different shock lengths, ϕ , negative sentiment period and portion of fund-flow during recovery period show U- and Swoosh-shaped recovery. It shows that recovery of indices with positive ϕ becomes very weak with extended shock and negative sentiment period. Stocks with higher ϕ and fund-flow show quick recovery. Simulation of Nifty Bank, Nifty Financial and Nifty Realty show U-shaped recovery and Nifty IT shows Swoosh-shaped recovery. Simulation results are consistent with stock price movement. The estimated time-scale of shock and recovery of these indices are also consistent with the time duration of change of negative sentiment from the onset of COVID-19. We conclude that investors need to evaluate sentiment along with ϕ before investing in stock markets because negative sentiment can dampen the recovery even in financially anti-fragile stocks.

6.
Isr J Health Policy Res ; 11(1): 1, 2022 Jan 03.
Article in English | MEDLINE | ID: mdl-34980264

ABSTRACT

BACKGROUND: In most countries, including those with national health insurance or comprehensive public insurance, some expenses for cancer treatment are borne by the ill and their families. OBJECTIVES: This study aims to identify the areas of out-of-pocket (OOP) spending in the last half-year of the lives of cancer patients and examine the extent of that spending; to examine the probability of OOP spending according to patients' characteristics; and to examine the financial burden on patients' families. METHODS: 491 first-degree relatives of cancer patients (average age: 70) who died 3-6 months before the study were interviewed by telephone. They were asked about their OOP payments during the last-half year of the patient's life, the nature of each payment, and whether it had imposed a financial burden on them. A logistic regression and ordered logit models were used to estimate the probability of OOP expenditure and the probability of financial burden, respectively. RESULTS: Some 84% of cancer patients and their relatives incurred OOP expenses during the last half-year of the patient's life. The average levels of expenditure were US$5800on medicines, $8000 on private caregivers, and $2800 on private nurses. The probability of paying OOP for medication was significantly higher among patients who were unable to remain alone at home and those who were less able to make ends meet. The probability of spending OOP on a private caregiver or private nurse was significantly higher among those who were incapacitated, unable to remain alone, had neither medical nor nursing-care insurance, and were older. The probability of a financial burden due to OOP was higher among those unable to remain alone, the incapacitated, and those without insurance, and lower among those with above-average income, those with better education, and patients who died at home. CONCLUSIONS: The study yields three main insights. First, it is crucial that oncology services provide cancer patients with detailed information about their entitlements and refer them to the National Insurance Institute so that they can exercise those rights. Second, oncologists should relate to the financial burden associated with OOP care at end of life. Finally, it is important to sustain the annual increase in budgeting for technologies and pharmaceuticals in Israel and to allocate a significant proportion of those funds to the addition new cancer treatments to the benefits package; this can alleviate the financial burden on patients who need such treatments and their families.

7.
J Biophotonics ; : e202100301, 2022 Jan 03.
Article in English | MEDLINE | ID: mdl-34978392

ABSTRACT

Nonlinear photoacoustic microscopy (PAM) is a novel approach to enhance contrast and resolution. In this study, a low-cost infrared (IR) lamp as a simple approach for nonlinear PAM is demonstrated. Numerical simulations are first performed to verify the nonlinear photoacoustic effect under steady heating for two cases: (a) Differentiation of absorbers with different Grüneisen coefficients; (b) enhancement of photoacoustic amplitude. Then, sets of experiments are conducted to experimentally demonstrate our proposed approach: (a) Longitudinal monitoring of photoacoustic A-line signals from two samples, porcine tissue ex vivo and hemoglobin and indocyanine green (ICG) solutions in tubes in vitro for demonstrating the above-mentioned two cases; (b) PAM imaging of hemoglobin and ICG solutions in tubes before and after IR lamp heating. Different signal change and amplitude enhancement are observed in different demonstrations, showing the efficacy of the proposed approach. By virtue of cost-effectiveness and decent performance, our work facilitates nonlinear PAM studies.

8.
J Contin Educ Nurs ; 53(1): 30-34, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34978479

ABSTRACT

One of the current worldwide public health problems is elderly financial abuse (EFA). Although EFA remains a hidden social phenomenon, it has been recognized as a serious concern in the United States, and currently, one in 18 cognitively intact older adults is affected by EFA. Detecting EFA is difficult because the perpetrators are often family members, trusted friends, or guardians. Thus, EFA is frequently unrecognized and grossly under-reported. In the coming decades, EFA will increase as the elderly population continues to grow rapidly worldwide. This article highlights the magnitude of the problem and the role of nurses and other health care providers in identifying, intervening in, and reporting EFA. [J Contin Educ Nurs. 2022;53(1):30-34.].


Subject(s)
Elder Abuse , Nurse's Role , Aged , Health Personnel , Humans , United States
9.
Gen Dent ; 70(1): 18-21, 2022.
Article in English | MEDLINE | ID: mdl-34978984

ABSTRACT

In-office printing of surgical guides is becoming increasingly common in the modern dental practice. This in vitro study sought to evaluate the accuracy of fit of surgical guides printed with 4 low-cost desktop 3-dimensional (3D) printers: SparkMaker Original, Photon, MP Mini SLA, and Epax X1. All of the printers in this study were released after 2017 and purchased for less than $500. All of the 3D printers were capable of printing biocompatible surgical guide resin. To evaluate the accuracy of the printers, a total of 20 surgical guides were produced with the 4 printers (n = 5) from the same stereolithography (STL) file using the same resin. The guides were then scanned with a laboratory scanner, and the intaglio surface was compared to the master STL file using metrology software. The null hypothesis was that, across printers, the intaglio surfaces of the printed surgical guides would achieve the standard of at least 80% of the surface fitting within a 100- µm tolerance level. Data were analyzed with the Tukey-Kramer test (P < 0.05). Three of the 4 printers (SparkMaker Original, Photon, and Epax X1) were able to consistently produce surgical guides within the accepted tolerance values. The Epax X1 surgical guide group had a significantly higher mean percentage of fit within the tolerance level (P < 0.05), indicating that this printer produced the greatest accuracy relative to the original STL file.


Subject(s)
Computer-Aided Design , Dental Implants , Humans , Printing, Three-Dimensional , Software , Stereolithography
10.
N C Med J ; 83(1): 11-16, 2022.
Article in English | MEDLINE | ID: mdl-34980645

ABSTRACT

A number of social and economic factors, such as the poverty rate, now guide North Carolina's efforts to improve health and well-being. Poverty is often measured using income. This is a useful measure of the ability to meet current expenses. However, new measures of poverty that use wealth as the variable provide a broader picture of financial well-being.


Subject(s)
Income , Poverty , Humans
11.
Article in English | MEDLINE | ID: mdl-34975286

ABSTRACT

Migrant remittances are potentially significant sources of funding for climate change adaptation and resilience building in developing countries. However, very little is understood about the linkages between climate actions and remittances at the household level. It is not clear how remittances can affect households' responses to climate change. This paper presents evidence from analyses of the associations between remittances to households, their climate hazard exposure, and adaptation actors. It uses concurrent data on international remittances receipts, three climate change related hazards (flooding, intense and irregular rainfall), and main adaptation actors (self/family, community, government, and NGOs) from over 600 households in South Eastern Nigeria. The results showed that household incidence of remittances is low (15%) while exposure to climate hazards is higher (flooding: 41.2%, intense rainfall: 47.1%, irregular rainfall: 29.9%). Nominal (contingency coefficient) associations between remittances and household climate hazard exposure and remittances and household adaptation actors were mostly moderate and insignificant. Therefore, households that received remittances and those that did not were not significantly different in terms of their exposure to climate hazard and main actors in climate adaptation. Self/families were the main actors in household climate actions. Governments and NGO actors were less prominent. The results suggest that unregulated remittances have limited impact on household climate hazard exposure and adaptive actions. However, there are indications that the contribution of remittances to financing climate adaptation may be enhanced by addressing issues with cost of remitting and remittee understanding of climate change to increase remittances volumes, incidence, and use.

12.
Data Brief ; 40: 107722, 2022 Feb.
Article in English | MEDLINE | ID: mdl-34977302

ABSTRACT

These data are coming from the derogation requests for the destruction of protected species in the context of construction or development work in France. These derogation requests include, among other things, the contents of an environmental impact assessment and the costs of the measures suggested to reduce the impact on the environment. In the article connected to this dataset, we studied the quality of the plant translocation protocols proposed in 95 derogation files (see Julien et al., 2022). We additionally collected during the reading of the files data that we make available here about the costs of (i) the total project, (ii) the mitigation hierarchy and (iii) the plant translocation operations and monitoring. These data complement our aforementioned paper by documenting how much translocations cost and in what proportion of the other costs reported in the projects we evaluated for quality. These data can be helpful for environmental stakeholders but also to further studies to determine the extent to which the environment is considered in land planning.

13.
JHEP Rep ; 4(1): 100390, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34977518

ABSTRACT

Background & Aims: Reinforced hepatocellular carcinoma (HCC) surveillance using magnetic resonance imaging (MRI) could increase early tumour detection but faces cost-effectiveness issues. In this study, we aimed to evaluate the cost-effectiveness of MRI for the detection of very early HCC (Barcelona Clinic Liver Cancer [BCLC] 0) in patients with an annual HCC risk >3%. Methods: French patients with compensated cirrhosis included in 4 multicentre prospective cohorts were considered. A scoring system was constructed to identify patients with an annual risk >3%. Using a Markov model, the economic evaluation estimated the costs and life years (LYs) gained with MRI vs. ultrasound (US) monitoring over a 20-year period. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the incremental costs by the incremental LYs. Results: Among 2,513 patients with non-viral causes of cirrhosis (n = 840) and/or cured HCV (n = 1,489)/controlled HBV infection (n = 184), 206 cases of HCC were detected after a 37-month follow-up. When applied to training (n = 1,658) and validation (n = 855) sets, the construction of a scoring system identified 33.4% and 37.5% of patients with an annual HCC risk >3% (3-year C-Indexes 75 and 76, respectively). In patients with a 3% annual risk, the incremental LY gained with MRI was 0.4 for an additional cost of €6,134, resulting in an ICER of €15,447 per LY. Compared to US monitoring, MRI detected 5x more BCLC 0 HCC. The deterministic sensitivity analysis confirmed the impact of HCC incidence. At a willingness to pay of €50,000/LY, MRI screening had a 100% probability of being cost-effective. Conclusions: In the era of HCV eradication/HBV control, patients with annual HCC risk >3% represent one-third of French patients with cirrhosis. MRI is cost-effective in this population and could favour early HCC detection. Lay summary: The early identification of hepatocellular carcinoma in patients with cirrhosis is important to improve patient outcomes. Magnetic resonance imaging could increase early tumour detection but is more expensive and less accessible than ultrasound (the standard modality for surveillance). Herein, using a simple score, we identified a subgroup of patients with cirrhosis (accounting for >one-third), who were at increased risk of hepatocellular carcinoma and for whom the increased expense of magnetic resonance imaging would be justified by the potential improvement in outcomes.

14.
J Asthma ; : 1-22, 2022 Jan 03.
Article in English | MEDLINE | ID: mdl-34978935

ABSTRACT

Objective: The purpose of this study was to examine the effect of Medicaid expansion on asthma-related health care services utilization and expenditures among low-income adult patients with asthma aged 26-64. Methods: Using a pooled dataset from 2007 to 2018 Medical Expenditures Panel Surveys (MEPS), we implemented a multivariate difference-in-differences analysis, which compared changes in utilization and expenditures for asthma-related health care services among adult patients with asthma with income below 133% Federal Poverty Level (FPL) vs. above 133%-400% FPL, before and after Medicaid expansion in 2014. We used negative binomial models to analyze utilization outcomes. Expenditures were estimated using two-part models with logit as the first part and generalized linear models as the second part. Estimates were weighted for the complex multi-stage sampling design of MEPS. Results: Medicaid expansion was associated with increases in both utilization and expenditures for asthma-related prescription drugs among low-income patients with asthma, by 1.8 prescription fills (p < 0.05) and $233 (p < 0.05) per year, respectively. No statistically significant association was detected for other asthma-related health care services. Conclusion: Medicaid expansion led to an increase in accessibility of prescription drugs among low-income asthma patients, but had no effect on other asthma-related health care services.

15.
Anal Chem ; 2022 Jan 03.
Article in English | MEDLINE | ID: mdl-34979088

ABSTRACT

The quantitative detection of different molecular targets is of utmost importance for a variety of human activities, ranging from healthcare to environmental studies. Bioanalytical methods have been developed to solve this and to achieve the quantification of multiple targets from small volume samples. Generally, they can be divided into two different classes: point of care (PoC) and laboratory-based approaches. The former is rapid, low-cost, and user-friendly; however, the majority of the tests are semiquantitative, lacking in specificity and sensitivity. On the contrary, laboratory-based approaches provide high sensitivity and specificity, but the bulkiness of experimental instruments and complicated protocols hamper their use in resource-limited settings. In response, here we propose a smartphone-based device able to support laboratory-based optical techniques directly at the point of care. Specifically, we designed and fabricated a portable microplate reader that supports colorimetric, fluorescence, luminescence, and turbidity analyses. To demonstrate the potential of the device, we characterized its analytical performance by detecting a variety of relevant molecular targets (ranging from antibodies, toxins, drugs, and classic fluorophore dyes) and we showed how the estimated results are comparable to those obtained from a commercial microplate reader. Thanks to its low cost (<$300), portability (27 cm [length] × 18 cm [width] × 7 cm [height]), commercially available components, and open-source-based system, we believe it represents a valid approach to bring high-precision laboratory-based analysis at the point of care.

16.
Article in English | MEDLINE | ID: mdl-34979571

ABSTRACT

AIMS: The Virtual Diabetes Outpatient Clinic for Children and Adolescents (VIDIKI) study was a 6-month quasi-randomized, multicentre study followed by an extension phase to evaluate the effects of monthly video consultations in addition to regular care. A health economic analysis was conducted to assess the direct costs. METHODS: The cost data of 240 study participants (1-16 years of age) with type 1 diabetes who were already using a continuous glucose monitoring system were collected in the first 6 months of the study. The intervention group (IG) received monthly video consultations plus regular care, and the waiting control group (WG) received only regular care. Cost data were collected for a comparable anonymized group of children from the participating health insurance companies during the 6-month period before the study started (aggregated data group [AG]). RESULTS: Cost data were analysed for the AG (N=840) 6 months before study initiation and those for the study participants (N=225/240). Hospital treatment was the highest cost category in the AG. There was a cost shift and cost increase in the IG and WG, whereby diabetes supplies were the highest cost category. The mean direct diabetes-associated 6-month costs were € 4,702 (IG) and € 4,936 (WG). CONCLUSION: The cost development within the cost collection period over two years possibly reflects the switch to higher-priced medical supplies. Video consultation as an add-on service resulted in a small but nonsignificant reduction in the overall costs.

17.
BMJ Open ; 12(1): e057468, 2022 Jan 03.
Article in English | MEDLINE | ID: mdl-34980632

ABSTRACT

OBJECTIVE: To assess the cost-effectiveness of an active 30-day surgical site infection (SSI) surveillance mechanism at a referral teaching hospital in Ghana using data from healthcare-associated infection Ghana (HAI-Ghana) study. DESIGN: Before and during intervention study using economic evaluation model to assess the cost-effectiveness of an active 30-day SSI surveillance at a teaching hospital. The intervention involves daily inspection of surgical wound area for 30-day postsurgery with quarterly feedback provided to surgeons. Discharged patients were followed up by phone call on postoperative days 3, 15 and 30 using a recommended surgical wound healing postdischarge questionnaire. SETTING: Korle-Bu Teaching Hospital (KBTH), Ghana. PARTICIPANTS: All prospective patients who underwent surgical procedures at the general surgical unit of the KBTH. MAIN OUTCOME MEASURES: The primary outcome measures were the avoidable SSI morbidity risk and the associated costs from patient and provider perspectives. We also reported three indicators of SSI severity, that is, length of hospital stay (LOS), number of outpatient visits and laboratory tests. The analysis was performed in STATA V.14 and Microsoft Excel. RESULTS: Before-intervention SSI risk was 13.9% (62/446) as opposed to during-intervention 8.4% (49/582), equivalent to a risk difference of 5.5% (95% CI 5.3 to 5.9). SSI mortality risk decreased by 33.3% during the intervention while SSI-attributable LOS decreased by 32.6%. Furthermore, the mean SSI-attributable patient direct and indirect medical cost declined by 12.1% during intervention while the hospital costs reduced by 19.1%. The intervention led to an estimated incremental cost-effectiveness ratio of US$4196 savings per SSI episode avoided. At a national scale, this could be equivalent to a US$60 162 248 cost advantage annually. CONCLUSION: The intervention is a simple, cost-effective, sustainable and adaptable strategy that may interest policymakers and health institutions interested in reducing SSI.

18.
Nat Biotechnol ; 2022 Jan 03.
Article in English | MEDLINE | ID: mdl-34980916
20.
J Natl Cancer Inst ; 2022 Jan 04.
Article in English | MEDLINE | ID: mdl-34981117

ABSTRACT

BACKGROUND: Financial toxicity is a growing problem in oncology, but no prior studies have prospectively measured the financial impact of cancer treatment in a diverse national cohort of newly diagnosed cancer patients. S1417CD was the first cooperative group-led multicenter prospective cohort study to evaluate financial hardship in metastatic colorectal cancer (mCRC) patients. METHODS: Patients aged 18 years or older within 120 days of mCRC diagnosis completed quarterly questionnaires for 12 months. We estimated the cumulative incidence of major financial hardship (MFH), defined as 1 or more of increased debt, new loans from family and/or friends, selling or refinancing home, or 20% or more income decline. We evaluated the association between patient characteristics and MFH using multivariate cox regression and the association between MFH and quality of life using linear regression. RESULTS: A total of 380 patients (median age = 59.9 years) were enrolled; 77.7% were White, 98.0% insured, and 56.5% had annual income of $50 000 or less. Cumulative incidence of MFH at 12 months was 71.3% (95% confidence interval = 65.7% to 76.1%). Age, race, marital status, and income (split at $50 000 per year) were not statistically significantly associated with MFH. However, income less than $100 000 and total assets less than $100 000 were both associated with greater MFH. MFH at 3 months was associated with decreased social functioning and quality of life at 6 months. CONCLUSIONS: Nearly 3 out of 4 mCRC patients experienced MFH despite access to health insurance. These findings underscore the need for clinic and policy solutions that protect cancer patients from financial harm.

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