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1.
Clin Ter ; 174(1): 28-32, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36655641

RESUMO

Introduction: MTHFR being a key regulatory enzyme of 1-carbon metabolism pathway serves critical function of generation of SAM, replenishment of glutathione and nucleotide synthesis and finally methylation of the bio molecules. MTHFR gene mutation is a rare au-tosomal recessive inborn error of metabolism and presents with severe hyperhomocysteinemia. MTHFR polymorphisms on the other hand are commonly encountered of which two 677 C>T and 1298 A>C have been most widely studied and reported to increase the vulnerability to neural tube defects, congenital heart disease, various neuropsychiatric disorders like autism spectrum diseases and attention deficit hyperactiv-ity disease, cleft lip/ palate, acute leukaemia, cardiovascular diseases, occlusive vascular disease in children. Methods: We conducted this prospective clinical trial to examine whether yoga practice can up regulate MTHFR gene expression. Considering the prevalence of MTHFR polymorphism, varied spectrum of its implications in disease causation including male infertility, we conducted the trial involving 30 infertile men who underwent 3 weeks of supervised YBLI. Pre and post intervention assessment of the blood and semen sample was done to see the effects. Results: We have found more than fivefold up-regulation in the expression of MTHFR gene with significant reduction of seminal free radical levels after 3 weeks of yoga practice. Interestingly we noticed significantly higher MTHFR polymorphic variants in infertile male patients compared to healthy fertile controls. Conclusion: MTHFR polymorphisms are also independently associated with many paediatric diseases. Diagnosing MTHFR deficiency in children is a challenging job and requires high index of suspicion and continuous vigilance. Yoga based lifestyle may be adopted both by parents planning conception and also by adolescent children who are sufferers of this condition to halt the consequences of mild to moderate MTHFR deficiency.


Assuntos
Yoga , Adolescente , Criança , Humanos , Masculino , Efeitos Psicossociais da Doença , Genótipo , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Pais , Polimorfismo de Nucleotídeo Único
2.
Int J Palliat Nurs ; 29(1): 17-27, 2023 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-36692481

RESUMO

BACKGROUND: Caregiving burden is common among family caregivers (FCs). In Taiwan, no reports have compared caregiving burden according to disease stage, or explored the comprehensive factors of caregiving burden in the FCs of patients with hepatocellular carcinoma (HCC). AIM: The aim of the study was to investigate caregiving burden at different diagnosis stages and its potential predictors in the FCs of patients with hepatocellular carcinoma. METHODS: This descriptive, cross-sectional study included 192 FCs. Caregiving burden was measured using the Caregiver Reaction Assessment tool. The predictive factors of caregiving burden in the FCs of patients with HCC were identified using a linear regression model. RESULTS: The global caregiving burden had no significant differences between the four disease stages. The lack of family support and impact on schedule were significantly higher at the terminal stage than at the earlier stage. The risk factors of caregiving burden were high depression, high financial demand, heavy caregiving tasks, advanced age and frequent patient contact, which obtained a variance of 47.8% in the regression model. CONCLUSION: Healthcare providers need to proactively identify and assess FCs with risk factors of caregiving burden and provide appropriate interventions specific to individual needs at different disease stages.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Estudos Transversais , Efeitos Psicossociais da Doença , Cuidadores , Família
3.
Sci Rep ; 13(1): 86, 2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36596828

RESUMO

Excess mortalities are a more accurate indicator of true COVID-19 disease burden. This study aims to investigate levels of excess all-cause mortality and their geographic, age and sex distributions between January 2020-September 2021. National mortality data between January 2016 and September 2021 from the Department of Statistics Malaysia was utilised. Baseline mortality was estimated using the Farrington algorithm and data between 1 January 2016 and 31 December 2019. The occurrence of excess all-cause mortality by geographic-, age- and sex-stratum was examined from 1 January 2020 to 30 September 2021. A sub-analysis was also conducted for road-traffic accidents, ethnicity and nationality. Malaysia had a 5.5-23.7% reduction in all-cause mortality across 2020. A reversal is observed in 2021, with an excess of 13.0-24.0%. Excess mortality density is highest between July and September 2021. All states and sexes reported excess trends consistent with the national trends. There were reductions in all all-cause mortalities in individuals under the age of 15 (0.4-8.1%) and road traffic accident-related mortalities (36.6-80.5%). These reductions were higher during the first Movement Control Order in 2020. Overall, there appears to be a reduction in all-cause mortality for Malaysia in 2020. This trend is reversed in 2021, with excess mortalities being observed. Surveillance of excess mortalities can allow expedient detection of aberrant events allowing timely health system and public health responses.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , Malásia/epidemiologia , Pandemias , Efeitos Psicossociais da Doença , Etnicidade , Mortalidade
4.
BMC Gastroenterol ; 23(1): 21, 2023 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-36658489

RESUMO

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic inflammatory condition involving individuals across all age groups. Recent data suggests the increase in the prevalence of IBD and the surge in applying the biologic drugs in which both change the cost of IBD in recent years. Comprehensive assessment of direct and indirect cost profiles associated with IBD in our area is scarce. This study aimed to determine the economic burden of IBD in Iran from a societal perspective, using cost diaries. METHODS: Patients available on clinic registry and hospital information system (HIS), who were diagnosed with IBD, were invited to take part in this study. Demographic and clinical data, the healthcare resource utilization or cost items, absenteeism for the patients and their caregivers were obtained. The cost of the used resources were derived from national tariffs. The data regarding premature mortality in IBD patients was extracted from HIS. Productivity loss was estimated based on the human capital method. Then, cost date were calculated as mean annual costs per patient. RESULTS: The cost diaries were obtained from 240 subjects (Ulcerative colitis: n = 168, Crohn's disease, n = 72). The mean annual costs per patient were 1077 US$ (95% CI 900-1253), and 1608 (95% CI 1256, 1960) for the patients with ulcerative colitis and Crohn's disease, respectively. Of the total costs, 58% and 63% were in terms of the indirect costs for the patients with ulcerative colitis and Crohn's disease, respectively. The cost of illness for country was found to be 22,331,079 US$ and 15,183,678 US$ for patients with ulcerative colitis and Crohn's disease, respectively. Highest nationwide economic burden of IBD was found for patients older than 40 years were estimated to be 8,198,519 US$ and 7,120,891 US$, for ulcerative colitis and Crohn's disease, respectively. CONCLUSION: The medication was found to be the greatest contributor of direct medical costs. Productivity loss in terms of long-term disability and premature mortality were major components of IBD's economic burden in Iran.


Assuntos
Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Humanos , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/epidemiologia , Doença de Crohn/tratamento farmacológico , Doenças Inflamatórias Intestinais/epidemiologia , Custos de Cuidados de Saúde , Efeitos Psicossociais da Doença
6.
Br J Dermatol ; 188(1): 41-51, 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36689519

RESUMO

BACKGROUND: Pain is rated by patients with hidradenitis suppurativa (HS) as the disease's most impactful symptom. HS therapies are often insufficient to control inflammatory disease activity and pain. A better understanding of patient experiences with pain may improve patient-provider relationships and help identify strategies for addressing HS pain. OBJECTIVES: This qualitative study sought to characterize lived pain experiences of those with HS. METHODS: English-speaking patients ≥ 18 years old with a dermatologist-confirmed diagnosis of HS and an average numerical rating scale pain score of ≥ 1 over the preceding week were recruited from a single academic medical centre in Atlanta, Georgia, USA. Semistructured interviews were conducted from November 2019 to March 2020 to explore participants' HS pain experiences and the subsequent impact on their lives. Thematic saturation was reached after interviewing 21 participants. Interviews were audio recorded, transcribed, and analysed using thematic analysis. RESULTS: Among 21 study participants, the median 7-day average pain score was 6 (interquartile range 3-7; scale ranges from 0 to 10, with 10 being most pain). Participants' descriptions of pain were consistent with nociceptive pain, neuropathic pain and itch. Pain impacted multiple life domains, including physical limitations (decreased mobility and impaired sleep), decreased psychological wellbeing (irritability, depression, loss of control, and difficulty communicating pain experiences) and impaired social relationships (social isolation, intimacy problems and difficulty fulfilling social responsibilities). Although participants reported chronic discomfort, acutely painful and unpredictable HS disease flares caused more distress and quality-of-life (QoL) burden. Participants frequently treated their pain without input from the medical team, sometimes with unsafe medication doses or combinations. Factors contributing to self-management of pain included difficulty accessing timely outpatient care during disease flares and fear of stigma from healthcare providers. CONCLUSIONS: When present, HS-related pain may impact not only physical wellbeing but also mental health and relationships. In addition to therapies that target the inflammatory disease burden, treating the symptom of pain may improve patients' QoL and wellbeing. Because patients with HS have difficulty explaining their pain, proactively asking them about pain may identify unmet needs, facilitate better pain control and improve QoL. Further, the influence of HS-related pain on numerous aspects of QoL suggests the need for multidisciplinary, patient-centred approaches to HS pain management.


Assuntos
Hidradenite Supurativa , Neuralgia , Humanos , Adolescente , Hidradenite Supurativa/diagnóstico , Qualidade de Vida , Manejo da Dor , Efeitos Psicossociais da Doença
7.
BMJ Open ; 13(1): e065729, 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36690398

RESUMO

OBJECTIVES: The COVID-19 pandemic has posed unprecedented challenges to health systems and populations, particularly in India. Comprehensive, population-level studies of the burden of disease could inform planning, preparedness and policy, but are lacking in India. In West Bengal, India, we conducted a detailed analysis of the burden caused by COVID-19 from its onset to 7 January 2022. SETTING: Open-access, population-level and administrative data sets for West Bengal were used. PRIMARY AND SECONDARY OUTCOME MEASURES: Disability-adjusted life years (DALYs), years of potential productive life lost (YPPLL), cost of productivity lost (CPL: premature mortality and absenteeism), years of potential life lost (YPLL), premature years of potential life lost, working years of potential life lost (WYPLL) and value of statistical life (VSL) were estimated across scenarios (21 for DALY and 3 each for YPLL and VSL) to evaluate the effects of different factors. RESULTS: COVID-19 had a higher impact on the elderly population with 90.2% of deaths arising from people aged above 45. In males and females, respectively, DALYs were 190 568.1 and 117 310.0 years, YPPLL of the productive population was 28 714.7 and 16 355.4 years, CPL due to premature mortality was INR3 198 259 615.6 and INR583 397 335.1 and CPL due to morbidity was INR2 505 568 048.4 and INR763 720 886.1. For males and females, YPLL ranged from 189 103.2 to 272 787.5 years and 117 925.5 to 169 712.0 years for lower to higher age limits, and WYPLL was 54 333.9 and 30 942.2 years. VSL (INR million) for the lower, midpoint and upper life expectancies was 883 330.8; 882 936.4; and 880 631.3, respectively. Vaccination was associated with reduced mortality. CONCLUSIONS: The losses incurred due to COVID-19 in terms of the computed estimates in West Bengal revealed a disproportionately higher impact on the elderly and males. Analysis of various age-gender subgroups enhances localised and targeted policymaking to minimise the losses for future pandemics.


Assuntos
COVID-19 , Masculino , Feminino , Humanos , Idoso , COVID-19/epidemiologia , Anos de Vida Ajustados pela Incapacidade , Pandemias , Expectativa de Vida , Índia/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Efeitos Psicossociais da Doença
8.
Artigo em Inglês | MEDLINE | ID: mdl-36673849

RESUMO

OBJECTIVES: This study aims at evaluating the costs incurred by patients in Primary Healthcare facilities of Plateau State, Nigeria, due to uncomplicated malaria management. METHODS: Patients' information on resources used and absence from the labour market due to uncomplicated malaria illness were collected using the self-reported cost of illness instruments across 24 selected Primary Health Care (PHC) facilities in Plateau State. The collated data were used to estimate the direct medical and non-medical costs incurred by patients through the summation of the various costs paid out of pocket for the services; while the indirect cost was estimated using the human capital theory. All analyses were conducted through Microsoft Excel and IBM Statistical Package for Social Sciences (SPSS®) version 23 software. RESULTS: The average direct cost per episode of uncomplicated malaria was estimated at NGN 2808.37/USD 7.39, while the indirect average money equivalence of the time lost due to the ailment was estimated at NGN 2717/USD 7.55, giving an average cost of treating uncomplicated malaria borne by patients in Plateau State per episode to be NGN 5525.37/USD 14.94. The projected annual cost of the disease was NGN 9, 921,671,307.22 (USD 27, 560,198.08). CONCLUSIONS: The study showed substantial financial costs borne by patients due to uncomplicated malaria in Plateau State, comprising 50.83% of direct cost and 49.17% of the indirect cost of medications.


Assuntos
Estresse Financeiro , Malária , Humanos , Nigéria/epidemiologia , Malária/terapia , Custos e Análise de Custo , Atenção Primária à Saúde , Custos de Cuidados de Saúde , Efeitos Psicossociais da Doença
9.
Artigo em Inglês | MEDLINE | ID: mdl-36673882

RESUMO

The aim of this study was to investigate and quantify the association between oxygen concentration and life expectancy. The data from 34 provinces and 39 municipalities were included in all analyses. Bayesian regression modeling with spatial-specific random effects was used to quantify the impact of oxygen concentration (measured as partial pressure of oxygen) on life expectancy, adjusting for other potential confounding factors. We used hierarchical cluster analysis to group the provinces according to disease burden and analyzed the oxygen levels and the characteristics of causes of death between the clusters. The Bayesian regression analysis showed that the life expectancy at the provincial level increased by 0.15 (95% CI: 0.10-0.19) years, while at the municipal level, it increased by 0.17 (95% CI: 0.12-0.22) years, with each additional unit (mmHg) of oxygen concentration, after controlling for potential confounding factors. Three clusters were identified in the hierarchical cluster analysis, which were characterized by different oxygen concentrations, and the years of life lost from causes potentially related to hypoxia were statistically significantly different between the clusters. A positive correlation was found between oxygen concentration and life expectancy in China. The differences in causes of death and oxygen levels in the provincial clusters suggested that oxygen concentration may be an important factor in life expectancy when mediated by diseases that are potentially related to hypoxia.


Assuntos
Efeitos Psicossociais da Doença , Expectativa de Vida , Humanos , Teorema de Bayes , China/epidemiologia , Hipóxia
10.
Artigo em Inglês | MEDLINE | ID: mdl-36674311

RESUMO

OBJECTIVE: Pancreatic cancer poses a serious medical problem worldwide. Studies have reported the relationship between smoking and cancer. This study aimed to evaluate the burden of pancreatic cancer attributable to smoking and its global, regional and national trends, patterns and alterations from 1990 to 2019. METHODS: Data were extracted from the Global Health Data Exchange query tool, including deaths, disability-adjusted life-years (DALYs) and age-standardized rates (ASRs). Measures were stratified by sex, age, region, country/territory and sociodemographic index (SDI). We used Joinpoint regression to determine the secular trend of ASRs by calculating the average annual percentage change (AAPC). RESULTS: In 2019, smoking risk-related deaths and DALYs accounted for 21.3% and 21.1% of global pancreatic cancer, respectively. There were 113,384 (95% UI 98,830 to 128,466) deaths of smoking-attributable pancreatic cancer worldwide in 2019, of which 64.1% were in males. The disease burden was higher in males than in females. High-income regions or large population regions had the higher disease burden. East Asia carried the highest number of smoking-attributable pancreatic cancer deaths and DALYs. The Caribbean had the fastest increasing rate (AAPC = 3.849, 95% CI 3.310 to 4.391) of age-standardized death rate over the past 30 years. In 2019, China had the highest number of deaths, which was followed by the USA and Japan. There was a trend of increasing ASDR along with increases in SDI. CONCLUSION: Variations existed in the smoking risk-related pancreatic cancer burden among different sexes, age groups, regions and countries/territories. The burden of smoking-attributable pancreatic cancer should be considered an important health issue. Future strategies should include comprehensive policies to control tobacco use.


Assuntos
Carga Global da Doença , Neoplasias Pancreáticas , Masculino , Feminino , Humanos , Adulto , Anos de Vida Ajustados por Qualidade de Vida , Fumar/efeitos adversos , Fumar/epidemiologia , Efeitos Psicossociais da Doença , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/etiologia , Saúde Global , Fatores de Risco
11.
Int J Technol Assess Health Care ; 39(1): e2, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36606465

RESUMO

OBJECTIVES: The management of non-metastatic castration-resistant prostate cancer (nmCRPC) is rapidly evolving; however, little is known about the direct healthcare costs of nmCRPC. We aimed to estimate the cost-of-illness (COI) of nmCRPC from the Italian National Health Service perspective. METHODS: Structured, individual qualitative interviews were carried out with clinical experts to identify what healthcare resources are consumed in clinical practice. To collect quantitative estimates of healthcare resource consumption, a structured expert elicitation was performed with clinical experts using a modified version of a previously validated interactive Excel-based tool, EXPLICIT (EXPert eLICItation Tool). For each parameter, experts were asked to provide the lowest, highest, and most likely value. Deterministic and probabilistic sensitivity analyses (PSA) were carried out to test the robustness of the results. RESULTS: Ten clinical experts were interviewed, and six of them participated in the expert elicitation exercise. According to the most likely estimate, the yearly cost per nmCRPC patient is €4,710 (range, €2,243 to €8,243). Diagnostic imaging (i.e., number/type of PET scans performed) had the highest impact on cost. The PSA showed a 50 percent chance for the yearly cost per nmCRPC patient to be within €5,048 using a triangular distribution for parameters, and similar results were found using a beta-PERT distribution. CONCLUSIONS: This study estimated the direct healthcare costs of nmCRPC in Italy based on a mixed-methods approach. Delaying metastases may be a reasonable goal also from an economic standpoint. These findings can inform decision-making about treatments at the juncture between non-metastatic and metastatic prostate cancer disease.


Assuntos
Neoplasias de Próstata Resistentes à Castração , Masculino , Humanos , Neoplasias de Próstata Resistentes à Castração/diagnóstico , Neoplasias de Próstata Resistentes à Castração/patologia , Antígeno Prostático Específico , Medicina Estatal , Custos de Cuidados de Saúde , Efeitos Psicossociais da Doença
12.
Adv Exp Med Biol ; 1394: 209-221, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36587390

RESUMO

Malignant brain tumors consist of primary malignant tumors and metastatic brain tumors. The global incidence and prevalence of CNS cancers are increasing, their mortality and morbidity are relatively higher than other cancers (e.g., bladder cancer), and the management of disease utilizes sophisticated and expensive diagnostic and therapeutic technology. Therefore, malignant brain tumors, both primary and metastatic, impose a significant economic burden on patients, their families, and healthcare systems all around the world. To the best of our knowledge, there is no comprehensive and global systematic review for examining the costs of brain tumors, though sporadic reports highlight the importance of the problem. Besides, each study takes place in a setting with different methods (e.g., different treatment methods) and costs to manage brain tumors; therefore, we are unable to compare the costs between countries. Nevertheless, the general patterns seem to suggest that, among all, gliomas and glioblastomas are the most financially burdensome types of malignant brain cancer. Finally, most of the available studies have examined the economic burden of all gliomas or only glioblastoma. Hence, we are left with a substantial gap in knowledge to understand the actual economic burden of metastatic brain tumors, and there is a need for further accurate and internationally comparable studies on the subject, particularly with a focus on indirect and intangible costs.


Assuntos
Neoplasias Encefálicas , Glioma , Humanos , Estresse Financeiro , Efeitos Psicossociais da Doença , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/terapia , Prevalência , Custos de Cuidados de Saúde
13.
Support Care Cancer ; 31(2): 110, 2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36629938

RESUMO

PURPOSE: Financial toxicity has become a global public health issue. The purpose of the study is to investigate and analyze the influencing factors of financial toxicity in patients with non-metastatic colorectal cancer. METHODS: A convenient sample of 250 patients with stage I-III colorectal cancer was investigated in the study. They completed a set of questionnaires, including the Comprehensive Score for Financial Toxicity questionnaire, the Perceived Social Support Scale, and the Hospital Anxiety and Depression Scale. Univariate and multivariate linear regression were performed to investigate the influencing factors of financial toxicity. RESULTS: Over half (52.8%, n = 132) of the colorectal cancer survivors experienced financial toxicity. Multivariate regression analysis showed that the factors associated with financial toxicity were young age, unemployment, low annual household income, chemotherapy, and the lack of sufficient social support (p < 0.05). CONCLUSIONS: Financial toxicity is common among non-metastatic colorectal cancer survivors. Young age, lower annual household income, unemployment, chemotherapy, and insufficient social support were associated with financial toxicity.


Assuntos
Neoplasias Colorretais , Estresse Financeiro , Humanos , Estudos Transversais , Neoplasias Colorretais/cirurgia , Inquéritos e Questionários , Desemprego , Qualidade de Vida , Efeitos Psicossociais da Doença
14.
J Pharm Pharm Sci ; 25: 402-417, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36623477

RESUMO

PURPOSE: To describe patient characteristics, treatment patterns, and the burden of illness among adult migraine patients in Canada prescribed migraine prophylactics. Little is known about the relative persistence of treatments in the real-world setting and the impact of migraine prophylactic therapy on patients. As a result, migraine care in Canada continues to inadequately serve patients suffering from frequent headache days, reflecting a large unmet need. METHODS: This retrospective study used Reformulary Group's longitudinal prescription claims database. Private payer data were analyzed to identify 2007 migraine prophylactic naïve patients, with a prior history of acute therapy, for tracking over 24 months to determine treatment patterns and costs. Patient flow is summarized in a Sankey diagram visualizing persistence and switching across different timepoints. RESULTS: Patient persistence to migraine prophylactic medications was low at 24.9% (n=500); Switching from index medications to another prophylactic medication was common (27%), however 50% of patients discontinued without switching. It was observed that acute treatment and opioid use were much lower when patients established and maintained therapy on migraine prophylactics. Overall, angiotensin receptor blockers and CGRP antagonists had high persistence but were underutilized therapies while the inverse was true for antidepressants and anticonvulsants. CONCLUSION: In a real-word setting, recognizing that many patients may discontinue preventative treatment completely after their first therapy, there is a need to employ migraine-specific prophylactics and/or tolerable medications early. Treatment guidelines aligned to costs savings and/or requiring step therapy may be inadvertently failing patients. Further, the impact of migraine on the day-to-day lives of patients and high societal costs such as its impact on productivity should be weighed in considering migraine's burden of illness and the benefits of treatment.


Assuntos
Substituição de Medicamentos , Transtornos de Enxaqueca , Adulto , Humanos , Analgésicos , Efeitos Psicossociais da Doença , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/prevenção & controle , Estudos Retrospectivos , Canadá
15.
PLoS One ; 18(1): e0280311, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36630469

RESUMO

BACKGROUND: Three major diseases in Japan, cancer, heart disease, and cerebrovascular disease (CVD) are the leading causes of death in Japan. This study aimed to clarify the social burden of these diseases, including long-term care (LTC), and to predict future trends. METHODS: The comprehensive cost of illness (C-COI), a modification of the cost of illness (COI), was used to estimate the social burden of the three major diseases in Japan. The C-COI can macroscopically estimate both direct and indirect costs, including the LTC. A new method for future projections of the C-COI was developed according to the method for future projections of the COI. All data sources were government statistics. RESULTS: The C-COI of cancer, heart diseases, and CVD in 2017 amounted to 11.0 trillion JPY, 5.3 trillion JPY, and 6.5 trillion JPY, respectively. The projected future C-COI in 2029 was 10.3 trillion JPY, 5.3 trillion JPY, and 4.4 trillion JPY, respectively. In 2029, the LTC costs accounted for 4.4%, 12.8%, and 44.1% of the total C-COI, respectively. Informal care costs are projected to be approximately 1.7 times higher, assuming that all family caregivers will be replaced by professional caregivers in 2029. CONCLUSION: Indirect costs for all three diseases were projected to decrease owing to aging of the patient. In contrast to the other two diseases, the LTC cost of CVD accounted for a large proportion of the burden. The burden of CVD is expected to decrease in the future, but informal care by older family caregivers is suggested to reach its limits. In the future, the focus of resource allocation should shift from medical care to LTC, especially support for family caregivers. A method of future projections for the social burden based on the C-COI was considered effective for identifying issues for healthcare policy in the context of the times.


Assuntos
Transtornos Cerebrovasculares , Cardiopatias , Neoplasias , Humanos , Japão/epidemiologia , Efeitos Psicossociais da Doença , Envelhecimento , Transtornos Cerebrovasculares/epidemiologia , Custos de Cuidados de Saúde
16.
BMC Public Health ; 23(1): 122, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36650483

RESUMO

BACKGROUND: Neonatal health is a cornerstone for the healthy development of the next generation and a driving force for the progress of population and society in the future. Updated information on the burden of neonatal disorders (NDs) are of great importance for evidence-based health care planning in China, whereas such an estimate has been lacking at national level. This study aims to estimate the temporal trends and the attributable burdens of selected risk factors of NDs and their specific causes in China from 1990 to 2019, and to predict the possible trends between 2020 and 2024. METHODS: Data was explored from the Global Burden of Disease study (GBD) 2019. Six measures were used: incidence, mortality, prevalence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Absolute numbers and age-standardized rates (with 95% uncertainty intervals) were calculated. The specific causes of NDs mainly included neonatal preterm birth (NPB), neonatal encephalopathy due to birth asphyxia and trauma (NE), neonatal sepsis and other neonatal infections (NS), and hemolytic disease and other neonatal jaundice (HD). An autoregressive integrated moving average (ARIMA) model was used to forecast disease burden from 2020 to 2024. RESULTS: There were notable decreasing trends in the number of deaths (84.3%), incidence (30.3%), DALYs (73.5%) and YLLs (84.3%), while increasing trends in the number of prevalence (102.3%) and YLDs (172.7%) from 1990 to 2019, respectively. The corresponding age-standardized rates changed by -74.9%, 0.1%, -65.8%, -74.9%, 86.8% and 155.1%, respectively. Four specific causes of NDs followed some similar and different patterns. The prediction results of the ARIMA model shown that all measures still maintained the original trends in the next five years. Low birth weight, short gestation, ambient particulate matter pollution and household air pollution from solid fuels were the four leading risk factors. CONCLUSION: The health burden due to NDs is declining and is likely to continue to decline in the future in China. Delaying the increasing burden of disability may be the next target of concern. Targeted prevention and control strategies for specific causes of NDs are urgently needed to reduce the disease burden.


Assuntos
Expectativa de Vida , Nascimento Prematuro , Feminino , Humanos , Recém-Nascido , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Efeitos Psicossociais da Doença , Carga Global da Doença , China/epidemiologia , Saúde Global
19.
Soc Sci Med ; 317: 115583, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36565513

RESUMO

BACKGROUND: A key aim of Universal Health Coverage (UHC) is to protect individuals and households against the financial risk of illness, and large-scale health insurance expansions are a central focus of the UHC agenda. Importantly, however, health insurance does not protect against a key dimension of financial risk associated with illness: forgone wage income. In this paper, we quantify the economic burden of illness in India attributable - separately - to wage loss and to medical care spending, as well as differences in them across the socio-economic distribution. METHODS: We use data from two longitudinal Indian household surveys: (i) the Village Dynamics in South Asia (VDSA) survey (1300 households surveyed every month for 60 months between 2010 and 2015) and (ii) the Indian Human Development Survey (IHDS) (more than 40,000 households surveyed in 2005 and again in 2011). Our regression models include a series of fixed effects that account for time-invariant household- (or individual-) level and time-varying unobservables common across households. FINDINGS: We find that, in the VDSA sample, wage loss accounts for more than 80% of the total economic burden of illness among the poorest households, but only about 20% of the economic burden of illness among the most affluent. Estimates from the IHDS sample confirm that this socio-economic gradient is present in the Indian population generally. CONCLUSIONS: Wage loss accounts for a substantial share of the total economic burden of illness in India - and disproportionately so among the poorest households. Our findings imply that if UHC is to achieve its objective of protecting households against the financial risk of illness - particularly poor households, the inclusion of wage loss insurance or another illness-related income replacement benefit is needed.


Assuntos
Efeitos Psicossociais da Doença , Salários e Benefícios , Humanos , Índia/epidemiologia , Renda , Características da Família , Gastos em Saúde
20.
J Med Econ ; 26(1): 70-83, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36503357

RESUMO

AIMS: Schizophrenia has the highest median societal cost per patient of all mental disorders. This review summarizes the different costs/cost drivers (cost components) associated with schizophrenia in 10 countries, including all cost types and stakeholder perspectives, and highlights aspects of disease associated with greatest costs. MATERIALS AND METHODS: Targeted literature review based on a search of published research from 2006 to 2021 in the United States (US), United Kingdom (UK), France, Germany, Italy, Spain, Canada, Japan, Brazil, and China. RESULTS: Sixty-four published articles (primary studies and literature reviews) were included. Comprehensive data were available on costs in schizophrenia overall, with very limited data for individual countries except the US. Most data is related to direct and not indirect costs, with extremely scarce data for several key cost components (adverse events, suicide, long-term care). Total schizophrenia-related per person per year (PPPY) costs were $2,004-94,229, with considerable variability among countries. Indirect costs were the main cost driver (50-90% of all costs), ranging from $1,852 to $62,431 PPPY. However, indirect costs are not collected systematically or incorporated in health technology assessments. Total schizophrenia-related PPPY direct costs were $4,394-31,798, with inpatient cost as the main cost driver (∼20-99% of direct costs). Intangible costs were not reported. Despite limited evidence, total schizophrenia-related costs were higher in patients with than without negative symptoms, largely due to increased costs of medication and medical visits. LIMITATIONS: As this was not a systematic review, prioritization of studies may have resulted in exclusion of potentially relevant data. All costs were converted to USD but not corrected for inflation or subjected to a gross domestic product deflator. CONCLUSIONS: Direct costs are most commonly reported in schizophrenia. The substantial underreporting of indirect and intangible costs undervalues the true economic burden of schizophrenia from a payer, patient, and societal perspective.


The true costs of diseases such as schizophrenia extend far beyond the obvious direct costs of hospital visits, outpatient appointments and medications to include indirect costs such as loss of productivity among patients and caregivers due to unemployment, early retirement and premature death. This review of literature published between 2006 and 2021 reveals that the indirect costs of schizophrenia actually account for between 50% and 90% of all costs, but are often not taken into account in healthcare planning. In addition, intangible costs, including the pain, suffering, stress, and anxiety experienced by patients and caregivers due to schizophrenia have not been reported in the literature. Costs were also higher for patients with negative symptoms of schizophrenia (where patients appear withdrawn and lacking in emotion, with few social relationships) compared with those with positive symptoms (including delusions or hallucinations). This is largely due to the greater costs for medications and medical visits among patients with negative symptoms. In summary, this review demonstrates that the true cost of schizophrenia, including direct, indirect, and intangible costs, is likely to be substantially higher than the values for the cost of disease currently reported.


Assuntos
Esquizofrenia , Humanos , Estados Unidos , Efeitos Psicossociais da Doença , Assistência de Longa Duração , China , Fatores Socioeconômicos , Custos de Cuidados de Saúde
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