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1.
BMJ Open ; 11(10): e049128, 2021 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-34670762

RESUMO

OBJECTIVES: To measure and explain financial toxicity (FT) of cancer in Italy, where a public healthcare system exists and patients with cancer are not expected (or only marginally) to pay out-of-pocket for healthcare. SETTING: Ten clinical oncological centres, distributed across Italian macroregions (North, Centre, South and Islands), including hospitals, university hospitals and national research institutes. PARTICIPANTS: From 8 October 2019 to 11 December 2019, 184 patients, aged 18 or more, who were receiving or had received within the previous 3 months active anticancer treatment were enrolled, 108 (59%) females and 76 (41%) males. INTERVENTION: A 30-item prefinal questionnaire, previously developed within the qualitative tasks of the project, was administered, either electronically (n=115) or by paper sheet (n=69). PRIMARY AND SECONDARY OUTCOME MEASURES: According to the protocol and the International Society for Pharmacoeconomics and Outcomes Research methodology, the final questionnaire was developed by mean of explanatory factor analysis and tested for reliability, internal consistency (Cronbach's α test and item-total correlation) and stability of measurements over time (test-retest reliability by intraclass correlation coefficient and weighted Cohen's kappa coefficient). RESULTS: After exploratory factor analysis, a score measuring FT (FT score) was identified, made by seven items dealing with outcomes of FT. The Cronbach's alpha coefficient for the FT score was 0.87 and the item-total correlation coefficients ranged from 0.53 to 0.74. Further, nine single items representing possible determinants of FT were also retained in the final instrument. Test-retest analysis revealed a good internal validity of the FT score and of the 16 items retained in the final questionnaire. CONCLUSIONS: The Patient-Reported Outcome for Fighting FInancial Toxicity (PROFFIT) instrument consists of 16 items and is the first reported instrument to assess FT of cancer developed in a country with a fully public healthcare system. TRIAL REGISTRATION NUMBER: NCT03473379.


Assuntos
Neoplasias , Medidas de Resultados Relatados pelo Paciente , Estudos Transversais , Atenção à Saúde , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
2.
Medicina (Kaunas) ; 57(4)2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33923830

RESUMO

This report addresses the extent to which there may be scope for preventive programmes for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and, if so, what economic benefits may accrue from the implementation of such programmes. We consider the economic case for prevention programmes, whether there is scope for preventive programmes for ME/CFS, and what are the health and economic benefits to be derived from the implementation of such programmes. We conclude that there is little scope for primary prevention programmes, given that ME/CFS is attributable to a combination of host and environmental risk factors, with host factors appearing to be most prominent, and that there are few identified modifiable risk factors that could be the focus of such programmes. The exception is in the use of agricultural chemicals, particularly organophosphates, where there is scope for intervention, and where Europe-wide programmes of health education to encourage safe use would be beneficial. There is a need for more research on risk factors for ME/CFS to establish a basis for the development of primary prevention programmes, particularly in respect of occupational risk factors. Secondary prevention offers the greatest scope for intervention, to minimise diagnostic delays associated with prolonged illness, increased severity, and increased costs.


Assuntos
Síndrome de Fadiga Crônica , Europa (Continente) , Humanos , Fatores Socioeconômicos
3.
Medicina (Kaunas) ; 57(3)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33652747

RESUMO

Background and Objectives: We have conducted a survey of academic and clinical experts who are participants in the European ME/CFS Research Network (EUROMENE) to elicit perceptions of general practitioner (GP) knowledge and understanding of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and suggestions as to how this could be improved. Materials and Methods: A questionnaire was sent to all national representatives and members of the EUROMENE Core Group and Management Committee. Survey responses were collated and then summarized based on the numbers and percentages of respondents selecting each response option, while weighted average responses were calculated for questions with numerical value response options. Free text responses were analysed using thematic analysis. Results: Overall there were 23 responses to the survey from participants across 19 different European countries, with a 95% country-level response rate. Serious concerns were expressed about GPs' knowledge and understanding of ME/CFS, and, it was felt, about 60% of patients with ME/CFS went undiagnosed as a result. The vast majority of GPs were perceived to lack confidence in either diagnosing or managing the condition. Disbelief, and misleading illness attributions, were perceived to be widespread, and the unavailability of specialist centres to which GPs could refer patients and seek advice and support was frequently commented upon. There was widespread support for more training on ME/CFS at both undergraduate and postgraduate levels. Conclusion: The results of this survey are consistent with the existing scientific literature. ME/CFS experts report that lack of knowledge and understanding of ME/CFS among GPs is a major cause of missed and delayed diagnoses, which renders problematic attempts to determine the incidence and prevalence of the disease, and to measure its economic impact. It also contributes to the burden of disease through mismanagement in its early stages.


Assuntos
Síndrome de Fadiga Crônica , Médicos de Atenção Primária , Europa (Continente) , Síndrome de Fadiga Crônica/epidemiologia , Humanos , Percepção , Inquéritos e Questionários
4.
Support Care Cancer ; 29(6): 3219-3233, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33094357

RESUMO

PURPOSE: This paper illustrates a conceptual model for a new patient-reported outcome measure (PROM) aimed at measuring financial toxicity (FT) in oncological setting in Italy, where citizens are provided universal healthcare coverage. METHODS: Focus groups with overall 34 patients/caregivers in three different Italian centers (from Northern, Centre, and Southern Italy) and an open-ended survey with 97 medical oncologists were undertaken. Transcripts from focus groups and the open-ended survey were analyzed to identify themes and links between themes. Themes from the qualitative research were supplemented with those reported in the literature; concepts identified formed the basis for item development that were then tested through the importance analysis (with 45 patients) and the cognitive debriefing (with other 45 patients) to test relevance and comprehension of the first draft PRO instrument. RESULTS: Ten domains were extracted by analyzing 156 concepts generated from focus groups and the open-ended survey. After controlling for redundancy, 55 items were generated and tested through the importance analysis. After controlling comprehension and feasibility through cognitive debriefing interviews, a first version of the questionnaire consisting of 30 items was devised. CONCLUSIONS: This qualitative study represents the first part of a study conducted to develop a new PROM to assess FT in Italy, by using a bottom-up approach that makes the most of patients' experiences and the health system analysis. TRIAL REGISTRATION: clinicaltrials.gov NCT03473379 first posted on March 22, 2018.


Assuntos
Neoplasias/economia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida/psicologia , Assistência de Saúde Universal , Feminino , Grupos Focais , Humanos , Masculino , Pesquisa Qualitativa , Inquéritos e Questionários
5.
Medicina (Kaunas) ; 57(1)2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33374291

RESUMO

Background and Objectives: The socioeconomic working group of the European myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) Research Network (EUROMENE) has conducted a review of the literature pertaining to GPs' knowledge and understanding of ME/CFS; Materials and Methods: A MEDLINE search was carried out. The papers identified were reviewed following the synthesis without meta-analysis (SWiM) methodology, and were classified according to the focus of the enquiry (patients, GPs, database and medical record studies, evaluation of a training programme, and overview papers), and whether they were quantitative or qualitative in nature; Results: Thirty-three papers were identified in the MEDLINE search. The quantitative surveys of GPs demonstrated that a third to a half of all GPs did not accept ME/CFS as a genuine clinical entity and, even when they did, they lacked confidence in diagnosing or managing it. It should be noted, though, that these papers were mostly from the United Kingdom. Patient surveys indicated that a similar proportion of patients was dissatisfied with the primary medical care they had received. These findings were consistent with the findings of the qualitative studies that were examined, and have changed little over several decades; Conclusions: Disbelief and lack of knowledge and understanding of ME/CFS among GPs is widespread, and the resultant diagnostic delays constitute a risk factor for severe and prolonged disease. Failure to diagnose ME/CFS renders problematic attempts to determine its prevalence, and hence its economic impact.


Assuntos
Síndrome de Fadiga Crônica , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/epidemiologia , Humanos , Atenção Primária à Saúde , Pesquisa Qualitativa , Fatores Socioeconômicos , Reino Unido
6.
Healthcare (Basel) ; 8(2)2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32272608

RESUMO

We have developed a Europe-wide approach to investigating the economic impact of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), facilitating acquisition of information on the economic burden of ME/CFS, and international comparisons of economic costs between countries. The economic burden of ME/CFS in Europe appears large, with productivity losses most significant, giving scope for substantial savings through effective prevention and treatment. However, economic studies of ME/CFS, including cost-of-illness analyses and economic evaluations of interventions, are problematic due to different, arbitrary case definitions, and unwillingness of doctors to diagnose it. We therefore lack accurate incidence and prevalence data, with no obvious way to estimate costs incurred by undiagnosed patients. Other problems include, as for other conditions, difficulties estimating direct and indirect costs incurred by healthcare systems, patients and families, and heterogeneous healthcare systems and patterns of economic development across countries. We have made recommendations, including use of the Fukuda (CDC-1994) case definition and Canadian Consensus Criteria (CCC), a pan-European common symptom checklist, and implementation of prevalence-based cost-of-illness studies in different countries using an agreed data list. We recommend using purchasing power parities (PPP) to facilitate international comparisons, and EuroQol-5D as a generic measure of health status and multi-attribute utility instrument to inform future economic evaluations in ME/CFS.

7.
J Med Screen ; 27(4): 186-193, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-31948342

RESUMO

OBJECTIVES: To estimate the cost-effectiveness of the public colorectal cancer screening program in the Abruzzo region, Italy. METHODS: Cost-effectiveness was analysed using a two-armed Markov model comparing: (1) Abruzzo screening program based on biennial faecal immunochemical occult blood testing, with colonoscopy as second level test for individuals with positive results, with (2) Treatment of symptomatic patients according to the stage of the neoplasm. Transition probabilities were adjusted for accuracy of tests and incidence of colorectal cancer. Diagnosis-related groups' charges and field collected data were used to estimate costs. Costs and benefits were discounted by 3.5%. Monte Carlo simulation confirmed the robustness of the model results. RESULTS: Assuming a compliance rate of 64.7%, the incremental cost-effectiveness ratio for the current colorectal screening program was €433.06/quality adjusted life year gained, considerably lower than conventional thresholds (around €30,000). CONCLUSION: Early detection and intervention programs help to avoid a large number of highly debilitating and expensive cancer treatments. These results show that the screening program currently implemented in Abruzzo should be considered as a good investment in health.


Assuntos
Colonoscopia/economia , Neoplasias Colorretais/economia , Detecção Precoce de Câncer/economia , Programas de Rastreamento/economia , Idoso , Algoritmos , Neoplasias Colorretais/diagnóstico , Análise Custo-Benefício , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Itália/epidemiologia , Masculino , Cadeias de Markov , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Método de Monte Carlo , Sangue Oculto , Probabilidade , Anos de Vida Ajustados por Qualidade de Vida , Reprodutibilidade dos Testes , Risco
8.
BMJ Open ; 9(9): e031485, 2019 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-31501130

RESUMO

INTRODUCTION: Financial toxicity (FT) is a well-recognised problem in oncology. US-based studies have shown that: (a) cancer patients have a 2.7 times risk of bankruptcy; (b) patients who declare bankruptcy have a 79% greater hazard of death; (c) financial burden significantly impairs quality of life (QoL) and (d) reduces compliance and adherence to treatment prescriptions. The aim of the project is to develop and validate a patient-reported-outcome (PRO) measure to assess FT of cancer patients in Italy, where, despite the universal health coverage provided by the National Health Service, FT is an emerging issue. METHODS AND ANALYSIS: Our hypothesis is that a specific FT measure, which considers the relevant sociocultural context and healthcare system, would allow us to understand the main determinants of cancer-related FT in Italy, in order to address and reduce these factors. According to the International Society for Pharmaco-economics and Outcomes Research guidelines on PROs, the project will include the following steps: (1) concept elicitation (from focus groups with patients and caregivers; literature; oncologists; nurses) and analysis, creating a coding library; (2) item generation (using a format that includes a question and a response on a 4-point Likert scale) and analysis through patients' cognitive interviews of item importance within different coding categories to produce the draft instrument; (3) factor analysis and internal validation (with Cronbach's alpha and test-retest for reliability) to produce the final instrument; (4) external validation with QoL anchors and depression scales. The use of the FT measure in prospective trials is also planned. ETHICS AND DISSEMINATION: The protocol is approved by the ethical committees of all the participating centres. The project will tentatively produce a validated tool by the spring 2021. The project might also represent a model and the basis for future cooperation with other European countries, with different healthcare systems and socioeconomic conditions. TRIAL REGISTRATION NUMBER: NCT03473379.


Assuntos
Tratamento Farmacológico/economia , Neoplasias/economia , Medidas de Resultados Relatados pelo Paciente , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Estudos Transversais , Análise Fatorial , Humanos , Itália , Neoplasias/tratamento farmacológico , Qualidade de Vida , Reprodutibilidade dos Testes , Projetos de Pesquisa , Inquéritos e Questionários
9.
Expert Opin Pharmacother ; 20(11): 1331-1340, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31090469

RESUMO

Introduction: Recently, the economic impact of multiple sclerosis (MS), which includes both direct and indirect costs, has been increasing. While direct costs comprise health-care costs, such as the cost of pharmaceuticals, additional treatments such as physiotherapy, and medical aids, indirect costs are triggered by the productivity loss of patients and caregivers. Although new drugs for MS have changed the therapeutic scenario, they have increased the direct costs of health-care services. Areas covered: This review describes the pharmacoeconomic aspects of synthetic therapies for MS. Additionally, it discusses the economic impact of the various classes of licensed disease-modifying treatments (DMTs) for relapsing forms of MS. Expert opinion: The emerging and more expensive DMTs for MS represent a considerable challenge for health-care systems and resource consumption. Future research should focus on the long-term efficacy of DMTs and the cost of treating MS in a real-life setting. Future biological and radiological biomarkers could help stratify patients at early stages of MS, helping physicians design a personalized therapeutic approach that could have a positive impact in economic terms.


Assuntos
Análise Custo-Benefício , Esclerose Múltipla/economia , Humanos , Imunossupressores/uso terapêutico , Cadeias de Markov , Esclerose Múltipla/tratamento farmacológico , Qualidade de Vida , Recidiva
10.
Value Health Reg Issues ; 19: 26-33, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30641294

RESUMO

BACKGROUND: The relevance of studies focusing on patient satisfaction becomes imperative for patients with cancer, who often face major changes in their lifestyles. Their perceived uncertainty in illness and their personal experiences with the services received are crucial factors for a qualitatively adequate assistance. OBJECTIVES: To assess the determinants of patient satisfaction, using a sample of 306 Bulgarian oncology outpatients. METHODS: The hypotheses tested concern the extent to which patient satisfaction depends on the uncertainty in illness; the patients' assessment of technical and interpersonal skills of nurses and medical staff; the information provision; and some organizational aspects. Patients were asked to answer a questionnaire composed of internationally validated scales assessing the determinants of patient satisfaction (measured through the European Organization for Research and Treatment of Cancer), uncertainty in illness (assessed through the Mishel Uncertainty in Illness Scale), and patients' health status (assessed through the EuroQol 5-dimensional questionnaire and the visual analogue scale). An ordered logit model was run, using the level of overall patient satisfaction as a dependent variable. RESULTS: This is one of the first studies carried out in Bulgaria for oncology patient satisfaction of subjective factors related to the frailty of the oncology patient status such as age, self-assessed health-related quality of life, and uncertainty in illness. Nevertheless, other determinants, reflecting the quality of the care provided, also have an impact on patient satisfaction, namely, the assessment of the nonmedical personnel, the perception of medical technical skills, and the access to a medical center. CONCLUSIONS: Results stress the relevance of reducing uncertainty in illness in patients with cancer by implementing a satisfactory patient-physician relationship in the management of the disease.


Assuntos
Nível de Saúde , Neoplasias/terapia , Satisfação do Paciente , Avaliação da Tecnologia Biomédica , Idoso , Bulgária , Feminino , Hospitalização , Humanos , Masculino , Pacientes Ambulatoriais/estatística & dados numéricos , Relações Médico-Paciente , Qualidade de Vida/psicologia , Inquéritos e Questionários
11.
BMJ Open ; 7(8): e017254, 2017 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-28838904

RESUMO

INTRODUCTION: 15 years after clinical onset, about 50% of patients with relapsing-remitting multiple sclerosis convert to secondary progressive multiple sclerosis (SPMS). Notwithstanding the importance of this transition, knowledge of the experiences and needs of patients and carers is fragmentary, and targeted interventions are not available. Managing the Transition to SPMS (ManTra) is a mixed methodology project to develop and test a user-led resource for newly diagnosed patients with SPMS. Here, we describe the developmental phase, consisting of a literature review and a new research study involving key stakeholders, in which we construct the resource. METHODS AND ANALYSIS: Round 1: The literature review and study will be conducted in parallel. The latter will identify patient needs using a qualitative approach consisting of: personal semistructured interviews with >15 recently diagnosed patients with SPMS; three focus group meetings (one with significant others of patients, one with neurologists and one with other health professionals caring for patients with SPMS). An online survey (>200 recently diagnosed Italian patients with SPMS) will follow to verify needs in a larger independent sample. An expert panel will outline a set of candidate resources/interventions that aim to satisfy the needs thus identified. Round 2: Consensus on the final resource will be obtained in a 1-day meeting of recently diagnosed patients with SPMS, significant others, health professionals and other stakeholders, using the nominal group technique. The expert panel will refine the resource, identify the outcome measures to assess its efficacy and ascertain the most suitable comparator (ManTra Phase 2, not part of this protocol). ETHICS AND DISSEMINATION: The study protocol was approved by the ethics committees of each of the involved centres: Foundation IRCCS Neurological Institute C Besta, Milan ; G D'Annunzio University of Chieti-Pescara and the Aldo Moro University of Bari. The results will be published in peer-reviewed journals, presented at conferences and a lay summary sent to participants.


Assuntos
Progressão da Doença , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Necessidades e Demandas de Serviços de Saúde , Esclerose Múltipla Crônica Progressiva , Consenso , Grupos Focais , Recursos em Saúde , Humanos , Itália , Modelos Lineares , Projetos de Pesquisa , Literatura de Revisão como Assunto , Inquéritos e Questionários
12.
Int J Health Policy Manag ; 6(8): 467-471, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28812846

RESUMO

The ageing of European population has been rapidly increasing during the last decades, and the problem of elderly care financing has become an issue for policy-makers. Long-term care (LTC) financing is considered a suitable proxy of the resources committed to elderly care by each government, but the preciseness of this approximation depends on the extent to which LTC is representative of elderly care within each country. Since there is a broad heterogeneity in LTC funding, organization and setting among European States, it is difficult to find a common parameter representing the public resources destined to the elderly care. We address these topics employing as a case study an Italian region, Lombardy, which in terms of population, dimension, healthcare organization and economic development could be compared to other European countries. The method we suggest, which consists basically in a careful estimate of all the public resources employed in the provision of services exclusively destined to the elderly, could be applied, with the due differences, to other European countries or regions.


Assuntos
Atividades Cotidianas , Financiamento Governamental , Serviços de Saúde para Idosos/economia , Assistência de Longa Duração/economia , Cuidados de Enfermagem , Idoso , Recursos em Saúde , Humanos , Itália
13.
Clin Drug Investig ; 37(4): 375-386, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28074337

RESUMO

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease with a substantial medical and economic burden. In Italy, it affects approximately 280,000 people, therefore representing the musculoskeletal disease with the highest economic impact in terms of costs for the National Health Service and the social security system. OBJECTIVE: The aim of this study was to estimate the annual economic burden of RA in Italy and determine the potential cost reduction considering the most effective biologic treatment for early rapidly progressing RA (ERPRA) patients. METHODS: The model developed considers both direct costs that are mainly due to the pharmacological treatments, and indirect costs, which also include the productivity lost because of the disease. A systematic literature review provided the epidemiological and economic data used to inform the model. A one-way probabilistic sensitivity analysis based on 5000 Monte Carlo simulations was performed. Furthermore, specific scenario analyses were developed for those patients presenting an ERPRA, with the aim of evaluating the effectiveness of different biologic treatments for this subgroup of patients and estimating potential cost reduction. RESULTS: The total economic burden associated with RA was estimated to be €2.0 billion per year (95% confidence interval [CI] €1.8-2.3 billion). Forty-five percent of the expenditure was due to indirect costs (95% CI €0.8-1.0 billion); 45% depended on direct medical costs (95% CI €0.7-1.1 billion), and the residual 10% was determined by direct non-medical costs (95% CI €0.16-0.25 billion). In particular, the costs estimated for ERPRA patients totalled €76,171,181, of which approximately €18 million was associated with patients with a high level of anti-citrullinated protein antibodies (ACPA). The results of the analysis outline how it is possible to obtain a cost reduction for ERPRA patients of between €1 and €3 million by varying the number of patients with a high level of immunoglobulin G treated with the most effective biologic drug. In fact, the latter may determine higher efficacy outcomes, especially for poor prognostic ERPRA patients, ensuing higher levels of productivity. CONCLUSIONS: This study presents a pioneering approach to estimate the direct and indirect costs of RA. The model developed is a useful tool for policy makers as it allows to understand the economic implications of RA treatment in Italy, identify the most effective allocation of resources, and select the most appropriate treatment for ERPRA patients.


Assuntos
Artrite Reumatoide/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Artrite Reumatoide/tratamento farmacológico , Recursos em Saúde , Humanos , Imunoglobulina G/imunologia , Itália , Método de Monte Carlo
14.
Qual Life Res ; 25(11): 2941-2956, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27245776

RESUMO

OBJECTIVES: Being hospitalized often causes psychological distress and compromises patients' psychological well-being, thereby augmenting the burden of illness. The aim of this paper is to investigate two possible determinants of anxiety and depression among hospitalized cardiac patients, namely uncertainty in illness, and coping strategies, controlling for the perceived health-related quality of life, and distinguishing between borderline and pathological levels of anxiety and depression. METHODS: Data on anxiety, depression, coping style, uncertainty in illness and self-assessed quality of life concerning 200 cardiac inpatients from a university hospital were collected through validated questionnaires. A biprobit analysis, whose dependent variables are hospital anxiety and depression, was carried out. RESULTS: Uncertainty in illness has a significant impact on the possibility of crossing the borderline level of both anxiety and depression. The coping strategy of Positive Reappraisal and Growth is inversely and significantly correlated to anxiety and depression, be it borderline or pathological; the Restraint Coping strategy is positively and significantly related to borderline anxiety. CONCLUSIONS: The reduction of uncertainty in illness and the development of adequate coping strategies should be promoted in order to decrease the patients' risk of crossing the borderline threshold of anxiety and depression.


Assuntos
Adaptação Psicológica/fisiologia , Ansiedade/psicologia , Depressão/psicologia , Cardiopatias/psicologia , Perfil de Impacto da Doença , Idoso , Feminino , Humanos , Itália , Masculino , Pacientes , Inquéritos e Questionários , Incerteza
15.
Int J Health Policy Manag ; 4(8): 523-30, 2015 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-26340392

RESUMO

BACKGROUND: Depression is a mental health state whose frequency has been increasing in modern societies. It imposes a great burden, because of the strong impact on people's quality of life and happiness. Depression can be reliably diagnosed and treated in primary care: if more people could get effective treatments earlier, the costs related to depression would be reversed. The aim of this study was to examine the influence of socio-economic factors and gender on depressed mood, focusing on Korea. In fact, in spite of the great amount of empirical studies carried out for other countries, few epidemiological studies have examined the socio-economic determinants of depression in Korea and they were either limited to samples of employed women or did not control for individual health status. Moreover, as the likely data endogeneity (i.e. the possibility of correlation between the dependent variable and the error term as a result of autocorrelation or simultaneity, such as, in this case, the depressed mood due to health factors that, in turn might be caused by depression), might bias the results, the present study proposes an empirical approach, based on instrumental variables, to deal with this problem. METHODS: Data for the year 2008 from the Korea National Health and Nutrition Examination Survey (KNHANES) were employed. About seven thousands of people (N= 6,751, of which 43% were males and 57% females), aged from 19 to 75 years old, were included in the sample considered in the analysis. In order to take into account the possible endogeneity of some explanatory variables, two Instrumental Variables Probit (IVP) regressions were estimated; the variables for which instrumental equations were estimated were related to the participation of women to the workforce and to good health, as reported by people in the sample. Explanatory variables were related to age, gender, family factors (such as the number of family members and marital status) and socio-economic factors (such as education, residence in metropolitan areas, and so on). As the results of the Wald test carried out after the estimations did not allow to reject the null hypothesis of endogeneity, a probit model was run too. RESULTS: Overall, women tend to develop depression more frequently than men. There is an inverse effect of education on depressed mood (probability of -24.6% to report a depressed mood due to high school education, as it emerges from the probit model marginal effects), while marital status and the number of family members may act as protective factors (probability to report a depressed mood of -1.0% for each family member). Depression is significantly associated with socio-economic conditions, such as work and income. Living in metropolitan areas is inversely correlated with depression (probability of -4.1% to report a depressed mood estimated through the probit model): this could be explained considering that, in rural areas, people rarely have immediate access to high-quality health services. CONCLUSION: This study outlines the factors that are more likely to impact on depression, and applies an IVP model to take into account the potential endogeneity of some of the predictors of depressive mood, such as female participation to workforce and health status. A probit model has been estimated too. Depression is associated with a wide range of socio-economic factors, although the strength and direction of the association can differ by gender. Prevention approaches to contrast depressive symptoms might take into consideration the evidence offered by the present study.


Assuntos
Transtorno Depressivo/epidemiologia , Modelos Estatísticos , Adulto , Idoso , Algoritmos , Pesquisa Empírica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
16.
J Eval Clin Pract ; 21(4): 649-55, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25913189

RESUMO

RATIONALE, AIMS AND OBJECTIVES: Uncertainty is a component of the illness experience and is likely to increase the burden of managing chronic illness, as cardiac pathologies and renal diseases. The impact of uncertainty should be taken into account and addressed with targeted intervention programmes. The purpose of this study is to contribute to the diffusion of the assessment of uncertainty in illness by validating the Mishel uncertainty in illness scale (MUIS) on chronic Italian patients. METHOD: The MUIS questionnaire was administered to 200 patients suffering from cardiac diseases and 50 patients with renal diseases. A confirmatory factor analysis was run for each of the MUIS dimensions (ambiguity, inconsistency, complexity and unpredictability). RESULTS: After some item reduction, three of the four MUIS scales, namely, ambiguity, inconsistency and complexity, exhibited satisfactory reliability coefficients (with Cronbach's alphas of, respectively, 0.796, 0.778 and 0.705), highly significant standardized regression weights and satisfactory/highly satisfactory fit indexes. Nevertheless, as the correlations among the scales mentioned earlier were high (all above 0.8) and statistically significant, the three subsets of ambiguity, complexity and inconsistency items were allowed to load onto a new single factor. A monodimensional uncertainty construct, grouping the majority of the items encompassed by these three MUIS scales, was successfully validated. CONCLUSIONS: This study provides researchers with an easy-to-administer instrument which is useful to investigate a crucial aspect related with patients' quality of life. Although a unique uncertainty construct is proposed, the in-depth analysis of the replies to each single item of the MUIS could help to monitor patients' emotional responses to the diagnosis and to the course of this disease and it might be useful to define appropriate strategies of coping and to focus on patients' quests for simplicity and clarity of treatment.


Assuntos
Cardiopatias/psicologia , Nefropatias/psicologia , Qualidade de Vida , Inquéritos e Questionários , Incerteza , Idoso , Doença Crônica , Feminino , Cardiopatias/epidemiologia , Humanos , Itália/epidemiologia , Nefropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
17.
J Headache Pain ; 16(Suppl 1): A3, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28132385
18.
Neurol Sci ; 35(9): 1447-52, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24737348

RESUMO

Multiple sclerosis is a chronic disease, likely to condition patients' daily living and quality of life: given the unpredictability of frequency and severity of the attacks, patients experience a high level of uncertainty. While there have been many analyses whose purpose was to monitor multiple sclerosis (MS) patients' quality of life, the role of uncertainty, that is peculiar to the disease, has not been adequately considered so far. The present study is aimed at filling this gap by validating for Italian MS patients the Mishel's Uncertainty Illness Scale (MUIS). The MUIS has been developed in the USA context in order to assess four aspects of uncertainty: ambiguity, complexity, inconsistency and unpredictability. It has been largely applied in the cancer, cardiac and chronic illness population. Data employed in this study have been collected at two neurological centres in Messina (IRCCS Centro Studi Neurolesi "Bonino Pulejo" and Policlinico di Messina) in the first semester of 2013 and refer to 120 MS patients. The confirmatory factor analysis described in this study validates two of the four dimensions of MUIS, namely ambiguity and inconsistency. The validation, though partial, of the MUIS, allows the use of this instrument in studies investigating quality of life for Italian patients.


Assuntos
Esclerose Múltipla Recidivante-Remitente/diagnóstico , Índice de Gravidade de Doença , Adulto , Idoso , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/psicologia , Qualidade de Vida , Reprodutibilidade dos Testes , Adulto Jovem
19.
Health Policy ; 111(3): 273-89, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23830561

RESUMO

There is an ongoing debate about the effect of different reimbursement systems on hospital performance and quality of care. The present paper aims at contributing to this literature by analysing the impact of different hospital payment schemes on patients' outcomes in Italy. The Italian National Health Service is, indeed, a particularly interesting case since it has been subject to a considerable decentralization process with wider responsibilities devolved to regional governments. Therefore, great variability exists in the way tariffs are used, as Regions have settled them in accordance with the characteristics of health care providers. An empirical analysis of the Italian hospital system is carried out using data from the National Program for Outcome Assessment on mortality and readmissions for Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), stroke and Chronic Obstructive Pulmonary Diseases (COPD) in the years 2009-2010. The results show that hospitals operating in Regions where prospective payments are used more extensively are generally associated with better quality of care.


Assuntos
Hospitalização , Sistema de Pagamento Prospectivo/organização & administração , Qualidade da Assistência à Saúde , Reembolso de Incentivo , Grupos Diagnósticos Relacionados , Pesquisa Empírica , Humanos , Itália , Programas Nacionais de Saúde , Análise de Regressão
20.
J Ment Health Policy Econ ; 15(1): 33-41, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22611091

RESUMO

BACKGROUND: Sleep related problems affect approximately 25-40% of children and adolescents. The acquisition of sleep patterns characterised by later bedtimes, insomnia and excessive daytime sleepiness is related to poorer school performance, daytime drowsiness, physical tiredness and a higher rate of psychiatric illnesses. Many studies have investigated the correlation between sleep and mood in children and adolescents and overall, show a positive association between sleep problems and psychiatric disorders. However, little is known about adolescents' personal perception of their psychological status as it is linked with the occurrence of mood changes and sleep-related problems. AIMS OF THE STUDY: The aim of the study is to explore the impact of variables such as age, gender, education and the perception of their own psychological status (evaluated through suitable questionnaires) on the simultaneous presence of sleep disturbances and affective symptoms in a sample of adolescents. A positive correlation between these two dependent variables signals the need to intervene with proper support programs. METHODS: A recursive bivariate probit model has been employed. This method allows us to take into account two dependent dummy variables and to consider the relationship between the two, presuming that one may also influence the other. The analysis has been carried out on a sample of 2,005 adolescents out of a total of 4,000 who declared their willingness to be telephonically interviewed using a questionnaire in two parts designed to obtain information about the participants sleep habits and affective symptoms. RESULTS: There is a positive correlation between sadness and daytime drowsiness. The estimated joint probability ranging from 5.5% to 9% in girls demonstrates a greater tendency for girls to experience both depression and altered sleep patterns. DISCUSSION AND LIMITATIONS OF THE STUDY: Just as sadness is a key symptom of affective disorders, daytime drowsiness indicates the presence of sleep disorders caused by sleep habits that are likely to evolve into affective symptoms. This assumption is confirmed by the results of this analysis. However, since the interviews were conducted during the years 2003 and 2004, a replication of the analysis would outline whether this evidence is still the same or whether changes in habits and behaviours have intervened to modify substantially this pattern in recent years. As the analysis considers a sample of adolescents living in two southern Italian regions, the study should be replicated in other geographical areas. IMPLICATIONS FOR HEALTH CARE PROVISIONS AND USE: The early detection of affective symptoms in adolescents may presumably lead to a diminished use of antidepressants and an improvement in learning abilities and school results along with strengthening of personal motivations. IMPLICATIONS FOR HEALTH POLICIES: Counselling and educational programs directed towards those adolescents demonstrating poor sleep habits should be planned and implemented to avoid further complications and impact on their mental health.


Assuntos
Afeto , Distúrbios do Sono por Sonolência Excessiva/economia , Distúrbios do Sono por Sonolência Excessiva/psicologia , Modelos Econométricos , Privação do Sono/economia , Privação do Sono/psicologia , Distúrbios do Início e da Manutenção do Sono/economia , Distúrbios do Início e da Manutenção do Sono/psicologia , Adolescente , Análise Custo-Benefício , Diagnóstico Precoce , Intervenção Médica Precoce/economia , Feminino , Humanos , Entrevistas como Assunto , Itália , Masculino , Transtornos do Humor/diagnóstico , Transtornos do Humor/economia , Estatística como Assunto
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