Regional healthcare costs and burden of injury associated with electric scooters.

BACKGROUND: The introduction of shared electric scooters (e-scooters) to New Zealand has resulted in a large number of injuries. Within the past year, there have been studies addressing some of the impact of these e-scooter injuries, but none have included outpatient data or total regional costs. METHODS: This was a retrospective review of e-scooter associated injuries presenting to Auckland region healthcare providers in the seven months since their introduction using Accident Compensation Corporation (ACC) Claims data. The type of injuries and key metrics of their overall hospital burden were assessed between September 2018 and April 2019. The financial cost of these injuries was also estimated. RESULTS: A total of 770 patient presentations associated with e-scooters were identified during the study period. Of these, 524 (68.1%) were treated in the community by primary care physicians and 246 (31.9%) were treated in Auckland hospitals. The 246 hospital presentations used a total of 5,569 hospital bed-hours with 75 patients (30.5%) requiring admission and inpatient care. Of the hospital presentations, 49 patients (19.9%) required at least one operation, and 105 (42.7%) required specialist follow up care. 26.8% of injuries were thought to be associated with alcohol use. The estimated injury rate was 60 per 100,000 trips and hospital presentation rate was 20 per 100,000 trips. The combined cost attributable to these injuries was $608,843 (NZD) for Auckland City Hospital and $1,303,155 for the whole Auckland region. CONCLUSIONS: The overall burden of care due to the introduction of e-scooters to New Zealand has had significant impact both on the primary urban trauma center as well as community care facilities. E-scooter related injuries have had a large impact on regional healthcare costs.

The true cost of child abuse at a level 1 pediatric trauma center.

BACKGROUND: Child physical abuse (CPA) is a significant cause of morbidity and mortality. Children who sustain CPA consume significant healthcare resources. We hypothesized that the costs to care for children who sustain for children with CPA-type injuries are greater than the costs to care for children who sustain accidental injuries. METHODS: All confirmed CPA patients between the ages of 0 and 19 years old, who were admitted to a level 1 pediatric trauma center between January 2010 and September 2018, were retrospectively reviewed. We compared outcomes, including mortality, length of stay (LOS), diagnostic work-up, and overall cost using propensity matching between CPA and accidentally injured trauma patients. Patients were matched based on injury severity score (ISS). RESULTS: The CPA cohort (n = 595) was younger (1.31 +/- 1.96 years, p < 0.0001) than the accidental trauma patients (8.6 +/-5.54 years). The majority of the CPA patients had Medicaid coverage (75.1%), when compared to accidental trauma patients (37.5%; p < 0.0001). CPA patients had longer ICU LOS (2.43 days; p < 0.0001), increased ventilation days (2.57 days; p < 0.0001), and longer hospital LOS (6.56 days; p = 0.0004). The overall mortality rate for CPA patients was higher than accidental trauma patients (9.9% vs. 1.2%; p < 0.0001). The median hospital cost was significantly higher for those with CPA ($18,000) than accidental trauma ($10,100; p < 0.0001). CONCLUSION: The costs to care for children who sustain CPA-type injuries are significantly greater than the costs to care for children who sustain accidental trauma. Better screening tools, more provider education and broader community outreach efforts are needed to reduce the societal and economic costs associated with child physical abuse. STUDY TYPE: Treatment. LEVEL OF EVIDENCE: Level III.

Epidemiological and clinical profile of Korean travelers receiving international medical repatriation.

The aim of this study was to investigate the experiences of medical transportation of Korean travelers who suffered accidents abroad and then transferred home by our aeromedical team.We collected demographic and clinical data on patients injured while traveling abroad from January 2013 to July 2017. Descriptive analyses based on 4 different transportation methods and transport time since hospitalization were performed.A total of 33 patients were repatriated during the study period. Of these, 28 (84.8%) were trauma cases with pedestrian injuries being the most common (11 cases; 39.3%). Twenty patients were repatriated by flight-stretchers, 6 by flight-prestige, 2 by ship, and 5 by air ambulance. The air ambulance was the most expensive (average 61,124 US Dollars) mode of transportation (P = .001) and the ship took the longest time (14 hours) to transport patients back to Korea from regions with similar distance (P = .0023).We experienced medical repatriation of 33 seriously injured Korean travelers back to South Korea. Transfer time should be an important considering factor and directly contacting and communicating with the specialized staff of foreign hospitals could also be very important to reduce unnecessary overseas hospital stay and cost incidence.

Liability Determination of School Sports Injury Accidents: An Analysis Framework Based on Evolutionary Game.

In recent years, the outbreak of many school sports injury accidents aroused widespread public concern about liability determination of accident. Previous studies have examined the legal application of the liability principles from a law perspective, but few kinds of research attempted to analyze the progress of liability determination from the perspective of "law economics". To fill this research gap, we introduce the evolutionary game model, as an important theoretical tool of "law economics", to investigate how various factors influence the strategy selection of the parties, as well as examine what liability principle can effectively treat school sports injury accidents. The results indicate that the strategic selection of the subject of liability is significantly related to the accident compensation cost and the prevention cost of both parties. Moreover, we also find that both strict and proportional liability rules can play key roles in dealing with the issue of liability determination of school sports injury accidents, but the two liability rules have different effects on the strategic selection of parties. More specifically, compared to the strict liability principle, the proportional liability principle can motivate both the school and the students to adopt the active strategy of "appropriate caution" to prevent occurring sports injury accidents in schools.

The economic cost of inadequate sleep.

Study Objectives: To estimate the economic cost (financial and nonfinancial) of inadequate sleep in Australia for the 2016-2017 financial year and relate this to likely costs in similar economies. Methods: Analysis was undertaken using prevalence, financial, and nonfinancial cost data derived from national surveys and databases. Costs considered included the following: (1) financial costs associated with health care, informal care provided outside healthcare sector, productivity losses, nonmedical work and vehicle accident costs, deadweight loss through inefficiencies relating to lost taxation revenue and welfare payments; and (2) nonfinancial costs of loss of well-being. They were expressed in US dollars ($). Results: The estimated overall cost of inadequate sleep in Australia in 2016-2017 (population: 24.8 million) was $45.21 billion. The financial cost component was $17.88 billion, comprised of as follows: direct health costs of $160 million for sleep disorders and $1.08 billion for associated conditions; productivity losses of $12.19 billion ($5.22 billion reduced employment, $0.61 billion premature death, $1.73 billion absenteeism, and $4.63 billion presenteeism); nonmedical accident costs of $2.48 billion; informal care costs of $0.41 billion; and deadweight loss of $1.56 billion. The nonfinancial cost of reduced well-being was $27.33 billion. Conclusions: The financial and nonfinancial costs associated with inadequate sleep are substantial. The estimated total financial cost of $17.88 billion represents 1.55 per cent of Australian gross domestic product. The estimated nonfinancial cost of $27.33 billion represents 4.6 per cent of the total Australian burden of disease for the year. These costs warrant substantial investment in preventive health measures to address the issue through education and regulation.

A historical review of the U.S. Navy's busiest recompression chamber in the Pacific theater with a current perspective on caring for civilian divers within its area of responsibility: short communication.

On the island Nation of Guam, the United States Department of Defense has stationed military personnel from every service branch. Guam is utilized as a strategic waypoint for the U.S. military in the Pacific theater. As the largest service branch in the region, the Navy has placed a few Diving Medical Officers in Guam to collectively manage and treat patients with recompression therapy. Guam is also a popular tourist destination, with multiple recreational diving companies certifying individuals who are looking to take advantage of the beautiful warm water and exotic marine life. Unfortunately, with an increase in training and certifying inexperienced divers, came an increase in the operational tempo of the U.S. Navy's recompression chamber on Guam. The recompression chamber on Naval Base Guam (NBG) has been treating patients since 1971. With the only multiplace chamber in the Mariana Islands, Diving Medical Officers, with the accompanying chamber staff, treat military personnel, active-duty sponsored patients and civilian patients. Treating civilian patients by military providers through military treatment facilities presents multiple issues that must be addressed in an effort to provide efficient quality medical care. This article reviews the records, documents, and activity of the NBG chamber over the last four decades. Through the obtained data the information provides projected financial reimbursement from civilian patients. The article also sheds light on areas of needed improvement with regard to data collection, third-party financial collection efforts and the necessity of an inclusive electronic health record (EHR) for military and civilian patients.

Bridging the NCAA's Accident Insurance Coverage Gaps? A Deep Dive into the Uncertainties of Injury Coverage in College Contact Sports, and the Impact that has on Athletes' Future Physical and Financial Comfort.

This Note analyzes the flaws in the NCAA's current accidental injury health coverage policies for student-athletes and suggests ways to remedy the issues that plague student-athletes incurring serious injuries that may not be covered under current policies. Part I of this Note outlines the history of the NCAA and the policies relevant to the issues with accidental injury coverage currently in place. Part II looks at the significance of these coverage gaps in today's world of modern medicine and technology as well as the impact they have on the everyday life of college athletes. Part III suggests solutions to bridge the gaps in accidental injury coverage for the physical and financial futures of these student-athletes.

The costs of hazardous alcohol consumption in Germany.

Hazardous alcohol consumption in Germany is a main threat to health. By using insurance claim data from the German Statutory Health Insurance and a classification strategy based on ICD10 diagnoses-codes we analyzed a sample of 146,000 subjects with more than 19,000 hazardous alcohol consumers. Employing different regression models with a control function approach, we calculate life years lost due to alcohol consumption, annual direct and indirect health costs, and the burden of pain and suffering measured by the Charlson-Index and assessed pain diagnoses. Additionally, we simulate the net accumulated premium payments over expenses in the German Statutory Health Insurance and the Statutory Pension Fund for hazardous alcohol consumers from a lifecycle perspective. In total, €39.3 billion each year result from hazardous alcohol consumption with an average loss of 7 years in life expectancy. Hazardous alcohol consumers clearly do not "pay their way" in the two main German social security systems and also display a higher intangible burden according to our definitions of pain and suffering.

The determinants of defensive medicine in Italian hospitals: The impact of being a second victim.

BACKGROUND: Defensive medicine affects healthcare systems worldwide. The concerns and perception about medical liability could lead practitioners to practise defensive medicine. Second victim is a healthcare worker involved in an unanticipated adverse patient event. The role of being second victim and the other possible determinants for defensive medicine is mostly unclear. OBJECTIVE: To study the condition of being second victim as a possible determinants of defensive medicine among Italian hospital physicians. DESIGN, SETTING AND PARTICIPANTS: A secondary analysis of the database of the national survey study on the prevalence and the costs of defensive medicine in Italy that was carried out between April 2014 and June 2014 in 55 Italian hospitals was performed for this study. The demographic section of the questionnaire was selected including the physician's age, gender, specialty, activity volume, grade and the variable being a second victim after an adverse event. RESULTS: A total sample of 1313 physicians (87.5% response rate) was used in the data analyses. Characteristics of the participants included a mean age 49.2 of years and 19.4 average years of experience. The most prominent predictor for practising defensive medicine was the physicians' experience of being a second victim after an adverse event (OR=1.88; 95%CI, 1.38-2.57). Other determinants included age, years of experience, activity volume and risk of specialty. CONCLUSIONS: Malpractice reform, effective support to second victims in hospitals together with a systematic use of evidence-based clinical guidelines, emerged as possible recommendations for reducing defensive medicine.

Economic Estimation of the Losses Caused by Surface Water Pollution Accidents in China From the Perspective of Water Bodies' Functions.

The number of surface water pollution accidents (abbreviated as SWPAs) has increased substantially in China in recent years. Estimation of economic losses due to SWPAs has been one of the focuses in China and is mentioned many times in the Environmental Protection Law of China promulgated in 2014. From the perspective of water bodies' functions, pollution accident damages can be divided into eight types: damage to human health, water supply suspension, fishery, recreational functions, biological diversity, environmental property loss, the accident's origin and other indirect losses. In the valuation of damage to people's life, the procedure for compensation of traffic accidents in China was used. The functional replacement cost method was used in economic estimation of the losses due to water supply suspension and loss of water's recreational functions. Damage to biological diversity was estimated by recovery cost analysis and damage to environmental property losses were calculated using pollutant removal costs. As a case study, using the proposed calculation procedure the economic losses caused by the major Songhuajiang River pollution accident that happened in China in 2005 have been estimated at 2263 billion CNY. The estimated economic losses for real accidents can sometimes be influenced by social and political factors, such as data authenticity and accuracy. Besides, one or more aspects in the method might be overestimated, underrated or even ignored. The proposed procedure may be used by decision makers for the economic estimation of losses in SWPAs. Estimates of the economic losses of pollution accidents could help quantify potential costs associated with increased risk sources along lakes/rivers but more importantly, highlight the value of clean water to society as a whole.

[The Assessment of REC after Thermal Trauma as Part of the Appraisal Process for Statutory Accident Insurance in Germany (Part 1): Low Validity of the REC Form Developed by Donnersmarck and Hörbrand]. / Die Einstufung der MdE nach thermischen Trauma im Rahmen der Begutachtung der gesetzlichen Unfallversicherung (Teil I): Geringe Validität des MdE Bogens nach Donnersmarck und Hörbrand.

The total REC (reduction in earning capacity) after a thermal trauma is usually assessed using an appraisal form for burns victims, initially developed by Hoerbrandt and von Donnersmarck (1995). The criteria for functional impairment, local findings and vegetative-somatic complaints are somewhat imprecise given the broad scope of interpretation which the evaluator can employ in making an appraisal. This means that the overall appraisal of REC is subjective on the part of the evaluator. In addition, one can only calculate an overall REC of at most 40% from local findings and vegetative-somatic symptoms, even in patients with extensive large area burns. Considering these points we investigated the dependency of the results on the evaluator as well as the limited validity of the appraisal form originally developed by Hörbrand and Donnersmark.

[Cash value body, care of the accident and the injured body]. / Corps monnayable, prise en charge de l'accident et du corps accidenté

In our contemporary societies, physical injury resulting from a severe accident triggers a support process involving medical care and financial compensation, calculated according to the technical expertise of disability. Since 1958, the obligation for every individual to purchase an insurance has created the legal concept of pretium doloris ("prize of the pain") referring to a damage due to the physical and moral suffering of an individual. This concept also involves the idea that the injured person should be defined as a "victim" of a "prejudice" from which this person is entitled to expect compensation. The notion of compensation, whether financial or through medical care, contribute to give a social definition of the accident conceived as an existential phenomenon. In this paper, we undertake a philosophical analysis of these categories that allows to address the issue of care and that of evaluation - including financial - of the physical injury caused by the accident. We will see in particular that the problem of compensation refers both to the status of the body and the "recognition" of physical disability in financial terms. More broadly, the study of the repairing process of the physical injury will allow us to examine the contemporary issue of "cash value body" from a new perspective.

Sport-related concussions in New Zealand: a review of 10 years of Accident Compensation Corporation moderate to severe claims and costs.

OBJECTIVES: This paper provides an overview of the epidemiology of sport-related concussion and associated costs in New Zealand requiring medical treatment from 2001 to 2011 in seven sports codes. DESIGN: A retrospective review of injury entitlement claims by seven sports from 2001 to 2011. METHODS: Data were analyzed by sporting code, age, ethnicity, gender and year of competition for total and moderate-to-severe (MSC) Accident Compensation Corporation (ACC) claims and costs. RESULTS: A total of 20,902 claims costing $NZD 16,546,026 were recorded over the study period of which 1330 (6.4%) were MSC claims. The mean yearly number and costs of MSC claims were 133 ± 36 and $1,303,942 ± 378,949. Rugby union had the highest number of MSC claims per year (38; 95% CI 36-41 per 1000 MSC claims). New Zealand Maori recorded the highest total ($6,000,759) and mean cost ($21,120) per MSC claim. CONCLUSIONS: Although MSC injury claims were only 6.4% of total claims, they accounted for 79.1% of total costs indicating that although the majority of sport-related concussions may be minor in severity, the related economic costs associated with more serious sport-related concussion can be high. The finding that rugby union recorded the most MSC claims in the current study was not unexpected. Of concern is that rugby league recorded a low number of MSC claims but the highest mean cost per claim. Due to the high mean cost per concussion, and the high total and mean cost for New Zealand Maori, further investigation is warranted.

Public health implications of sleep loss: the community burden.

Poor sleep imparts a significant personal and societal burden. Therefore, it is important to have accurate estimates of its causes, prevalence and costs to inform health policy. A recent evaluation of the sleep habits of Australians demonstrates that frequent (daily or near daily) sleep difficulties (initiating and maintaining sleep, and experiencing inadequate sleep), daytime fatigue, sleepiness and irritability are highly prevalent (20%-35%). These difficulties are generally more prevalent among females, with the exception of snoring and related difficulties. While about half of these problems are likely to be attributable to specific sleep disorders, the balance appears attributable to poor sleep habits or choices to limit sleep opportunity. Study of the economic impact of sleep disorders demonstrates financial costs to Australia of $5.1 billion per year. This comprises $270 million for health care costs for the conditions themselves, $540 million for care of associated medical conditions attributable to sleep disorders, and about $4.3 billion largely attributable to associated productivity losses and non-medical costs resulting from sleep loss-related accidents. Loss of life quality added a substantial further non-financial cost. While large, these costs were for sleep disorders alone. Additional costs relating to inadequate sleep from poor sleep habits in people without sleep disorders were not considered. Based on the high prevalence of such problems and the known impacts of sleep loss in all its forms on health, productivity and safety, it is likely that these poor sleep habits would add substantially to the costs from sleep disorders alone.

Determining the effect of environmental accidents on responses to a Gulf of Mexico recreational for-hire fishing industry survey.

A survey designed to collect economic, attitudinal and policy data from the recreational for-hire (RFH) fishing industry in the U.S. Gulf of Mexico was conducted before and during the largest marine oil spill in U.S. history (the April 2010 Deepwater Horizon blowout). Respondents were grouped into two time periods based on when the survey was completed, where the break in groups was determined through the examination of the Pew Research Center's media coverage index and the per cent of fishing area closures due to the oil spill. A logistic regression was used to test variables that might predict the time period of a response. Results indicated that recall bias was not present in the financial variables examined, but that firm operating and demographic characteristics (i.e. vessel size, annual number of trips, number of vessels operating in the firm, tenure and household income) were significant in explaining the time period in which surveys were completed.

Mammography screening: how far is too far?

INTRODUCTION: This study answers the question: 'How far must a Canadian woman travel before the risk of a motor vehicle accident (MVA) outweighs the benefits of mammography screening?'. METHODS: Numbers needed to screen and false positive rates were extracted from information in the breast screening guidelines from the Canadian Task Force on screening for breast cancer. Motor vehicle accidents per billion vehicle kilometres were extracted from Transport Canada. The charts of women undergoing screening mammograms were reviewed to determine the average number of extra trips generated from a false positive mammogram. A formula was devised to determine when the distance travelled and risk of MVA outweighed the benefits of mammogram screening. RESULTS: How far a woman would need travel before the risk of that travel outweighed the benefits of screening mammography is determined by the province in which she lives (location) and her age. The distance of a round trip before the risk of travel outweighed the benefit of screening mammography varied from 65 km to 1151 km, according the patient's age and location. CONCLUSION: Travel risk is rarely discussed in recommending screening examinations. Nevertheless the benefits of screening can be outweighed by the risk of travel. Knowledge of travel risk is essential before recommending screening procedures.