Burden of Illness

Objective.—The periaqueductal gray matter (PAG) is at the center of a powerful descending antinociceptive neuronal network. We studied iron homeostasis in the PAG as an indicator of function in patients with episodic migraine (EM) between attacks and patients with chronic daily headache (CDH) during headache. High‐resolution magnetic resonance techniques were used to map the transverse relaxation rates R2, R2*, and R2′ in the PAG, red nucleus (RN), and substantia nigra (SN). R2′ is a measure of non‐heme iron in tissues.Methods.—Seventeen patients diagnosed with EM with and without aura, 17 patients diagnosed with CDH and medication overuse, and 17 normal adults (N) were imaged with a 3.0‐tesla magnetic resonance imaging system. For each subject, mean values of the relaxation rates, R2 (1/T2), R2* (1/T2*), and R2′ (R2* − R2) were obtained for the PAG, RN, and SN. R2, R2*, and R2′ values of the EM, CDH, and N groups were compared using analysis of variance, Student t test, and correla...

Any disease or condition that can naturally spread from vertebrate animals to humans or from humans to animals is categorized as zoonoses by the World Health Organization (WHO). India ranks first among nations with high zoonotic disease occurrences and is the 7 th largest country in the world. Numerous helminthic illnesses have emerged in both human and animal populations, including paragonimiasis, fasciolopsis, taeniasis and cysticercosis, echinococcosis and hydatidosis, toxoplasmosis, cryptosporidiosis, gnathostomiasis, dirofilariasis and others. More than 70 species of protozoa and approximately 300 species of parasitic helminths, which are derived from both nonhuman primates and other animals, infect humans. Animal health and productivity are adversely affected by a variety of parasites, which results in large global economic losses. Helminths and protozoan intestinal parasite infections are among the most common infections in the globe. Measures and procedures for infection prevention and control can lessen the public's exposure to parasites. The adoption of evidence-based infection prevention and control strategies should be encouraged by surveillance programs in order to lower the prevalence of these illnesses, slow spread and eventually enhance public health. This paper describes the epidemiology, transmission, clinical signs, and treatment of important parasitic zoonoses from the latest literature in this field.

Background: Spinal cord injury (SCI) is impairment of the spinal cord resulting in numerous health problems that considerably affect the quality of life (QOL) of the patients. Moreover, a number of sociodemographic and clinical characteristics may influence the persons’ health-related quality of life (HRQOL). However, there is limited information on the HRQOL and related characteristics among affected persons living in Nigeria. This study explores the HRQOL and related characteristics of persons with SCI in Kano, Northwestern Nigeria. Methods: A prospective cross-sectional survey of 41 subjects with SCI and 40 age and gender matched healthy subjects was conducted from January to December 2016. Subjects' sociodemographic and clinical characteristics and HRQOL (using the SF-36 questionnaire) were collected and analyzed. Results: The majority of the subjects were men in both the SCI (85.4%) and healthy (82.5%) groups. The mean injury duration was 28.4 ± 20.2 months. Road traffic ac...

Background The Veterans Health Administration (VA) is the largest integrated health system in the US and provides access to comprehensive primary care. Women Veterans are the fastest growing segment of new VA users, yet little is known about the characteristics of those who routinely access VA primary care in general or by age group. Objective Describe healthcare needs, utilization, and preferences of women Veterans who routinely use VA primary care. Participants 1,391 women Veterans with 3+ primary care visits within the previous year in 12 VA medical centers (including General Primary Care Clinics, General Primary Care Clinics with designated space for women, and Comprehensive Women’s Health Centers) in nine states. Methods Cross-sectional survey (45% response rate) of sociodemographic characteristics, health status (including chronic disease, mental health, pain, and trauma exposure), utilization, care preferences, and satisfaction. Select utilization data were extracted from adm...

Parents of children with neurodevelopmental disorders (NDDs) face unique challenges and experiences that shape their lives and the well-being of their families. Support networks, both professional and community-based, can help in assisting parents in managing these challenges. This study examined the relationship between Psychological Wellbeing (PWB) and Resilience of parents of children with NDDs. It also seeks to find the moderating role of NDDs to the relationship between the two variables. This also investigated if the domains of PWB are significant predictors of resilience. The participants were selected based on the given criteria. One hundred fifty-four (N=154) parents of children with NDD were able to completely answer the survey questionnaires to measure their level of psychological well-being (PWB) and resilience. Data collection utilized online forms and face-to-face distribution of the Ryffs Psychological Wellbeing Scales and the Brief Resilience Scale (BRS). The result showed a significant positive correlation between PWB and Resilience (r=0.054, p=0.001). Moreover, the majority of the respondents are in the moderately high level of the overall psychological well-being and the medium low level of resilience. When grouped according to the types of NDD, it shows that the overall psychological well-being of parents of children with ASD and GDD predicts resilience, but not with the group of parents of children with ADHD. Moreover, the type of NDD does not moderate the relationship of two variables. Also, the findings provide a basis for the construction of welfare program necessary to support and strengthen resilience of the above-mentioned population.

To study the association between physical illness and suicide in elderly people. Design Case-control with illness determined from interviews with relatives of people who committed suicide and with control participants and from medical records. Setting Gothenburg and two surrounding counties (210 703 people aged 65 years and over). Participants Consecutive records of people who had committed suicide and had undergone forensic examination (46 men, 39 women) and living control participants from the tax register (84 men, 69 women). Main outcome measures Physical illness rated in 13 organ systems according to the cumulative illness rating scale-geriatrics; serious physical illness (organ category score 3 or 4); overall score for burden of physical illness. Results Visual impairment (odds ratio 7.0, 95% confidence interval 2.3 to 21.4), neurological disorders (3.8, 1.5 to 9.4), and malignant disease (3.4, 1.2 to 9.8) were associated with increased risk for suicide. Serious physical illness in any organ category was an independent risk factor for suicide in the multivariate regression model (6.4, 2.0 to 20.0). When the sexes were analysed separately, serious physical illness was associated with suicide in men (4.2, 1.8 to 9.5) as was high burden of physical illness (2.8, 1.2 to 6.5). Such associations were not seen in women, possibly because of the small sample size. Conclusions Visual impairment, neurological disorders, and malignant disease were independently associated with increased risk of suicide in elderly people. Serious physical illness may be a stronger risk factor for suicide in men than in women.

Background Severity of human metapneumovirus (hMPV) lower respiratory illness (LRTI) is considered similar to that observed for respiratory syncytial virus (RSV). However, differences in severity between these pathogens have been noted, suggesting the degree of illness may vary in different populations. Moreover, a potential association between hMPV and asthma also suggests that hMPV may preferentially affect asthmatic subjects. Methods In a population-based surveillance study in children aged <2 years admitted for severe LRTI in Argentina, nasopharyngeal aspirates were tested by RT-PCR for hMPV, RSV, influenza A, and human rhinovirus. Results Of 3947 children, 383 (10%) were infected with hMPV. The hospitalization rate for hMPV LRTI was 2.26 per 1000 children (95% confidence interval [CI], 2.04–2.49). Thirty-nine (10.2%) patients infected with hMPV experienced life-threatening disease (LTD; 0.23 per 1000 children; 95% CI, .16–.31/1000), and 2 died (mortality rate 0.024 per 1000;...

Context: Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions and lower access to care. To examine the effectiveness of a telemedicine intervention to achieve clinical management goals in older, ethnically diverse, medically underserved patients with diabetes. Design, Setting, and Patients: A randomized controlled trial was conducted, comparing telemedicine case management to usual care, with blinded outcome evaluation, in 1,665 Medicare recipients with diabetes, aged Ն 55 years, residing in federally designated medically underserved areas of New York State. Interventions: Home telemedicine unit with nurse case management versus usual care. The primary endpoints assessed over 5 years of follow-up were hemoglobin A1c (HgbA1c), low density lipoprotein (LDL) cholesterol, and blood pressure levels. Results: Intention-to-treat mixed models showed that telemedicine achieved net overall reductions over five years of followup in the primary endpoints (HgbA1c, p ϭ 0.001; LDL, p Ͻ 0.001; systolic and diastolic blood pressure, p ϭ 0.024; p Ͻ 0.001). Estimated differences (95% CI) in year 5 were 0.29 (0.12, 0.46)% for HgbA1c, 3.84 (Ϫ0.08, 7.77) mg/dL for LDL cholesterol, and 4.32 (1.93, 6.72) mm Hg for systolic and 2.64 (1.53, 3.74) mm Hg for diastolic blood pressure. There were 176 deaths in the intervention group and 169 in the usual care group (hazard ratio 1.01 [0.82, 1.24]). Conclusions: Telemedicine case management resulted in net improvements in HgbA1c, LDL-cholesterol and blood pressure levels over 5 years in medically underserved Medicare beneficiaries. Mortality was not different between the groups, although power was limited.

Background Severity of human metapneumovirus (hMPV) lower respiratory illness (LRTI) is considered similar to that observed for respiratory syncytial virus (RSV). However, differences in severity between these pathogens have been noted, suggesting the degree of illness may vary in different populations. Moreover, a potential association between hMPV and asthma also suggests that hMPV may preferentially affect asthmatic subjects. Methods In a population-based surveillance study in children aged <2 years admitted for severe LRTI in Argentina, nasopharyngeal aspirates were tested by RT-PCR for hMPV, RSV, influenza A, and human rhinovirus. Results Of 3947 children, 383 (10%) were infected with hMPV. The hospitalization rate for hMPV LRTI was 2.26 per 1000 children (95% confidence interval [CI], 2.04–2.49). Thirty-nine (10.2%) patients infected with hMPV experienced life-threatening disease (LTD; 0.23 per 1000 children; 95% CI, .16–.31/1000), and 2 died (mortality rate 0.024 per 1000;...

The disease burden of hepatitis C virus (HCV) is expected to more than double in the next two decades. Currently, there is very little information about the costs of HCV treatment for employers who pay for treatment and health plans that cover HCV patients. This study reports the medical costs of HCV for workers with health insurance. A retrospective claims data design was used for this study. A sample of HCV patients with health insurance was drawn from the inpatient, outpatient, and enrollment files of the MEDSTAT Group's MarketScan family of databases for 1993-1998. Patients were grouped into cohorts and studied for up to 2 years before and after HCV diagnosis. Sample size varies according to length of follow-up, peaking at 3,077 patients enrolled for at least 6 months. In the first year following HCV diagnosis, average payments for HCV patients ($10,925) were almost six times as high as payments for all patients in the MarketScan database ($1,186). Doctors are encouraged to test high-risk patients to find HCV patients earlier in the course of their disease and to better manage their care in order to avoid unnecessary illness and expenses for this disease.

The disease burden of hepatitis C virus (HCV) is expected to more than double in the next two decades. Currently, there is very little information about the costs of HCV treatment for employers who pay for treatment and health plans that cover HCV patients. This study reports the medical costs of HCV for workers with health insurance. A retrospective claims data design was used for this study. A sample of HCV patients with health insurance was drawn from the inpatient, outpatient, and enrollment files of the MEDSTAT Group's MarketScan family of databases for 1993-1998. Patients were grouped into cohorts and studied for up to 2 years before and after HCV diagnosis. Sample size varies according to length of follow-up, peaking at 3,077 patients enrolled for at least 6 months. In the first year following HCV diagnosis, average payments for HCV patients ($10,925) were almost six times as high as payments for all patients in the MarketScan database ($1,186). Doctors are encouraged to test high-risk patients to find HCV patients earlier in the course of their disease and to better manage their care in order to avoid unnecessary illness and expenses for this disease.

In 1991, the National Task Force on Health Information recommended that in order to assess the health of Canadians, the health information system should include an aggregate index of population health. This article presents such an index--Health-Adjusted Life Expectancy (HALE)--as one possibility in a range of indicators. In contrast to conventional life expectancy, which considers all years as equal, to calculate HALE, years of life are weighted by health status. To measure health status, the Health Utility Index, obtained from 1994-95 National Population Health Survey data, was used. Traditional life expectancy and HALE figures are compared to estimate the burden of ill health. The societal burden of ill health is higher for women than for men, and is highest among those in "early" old age, not among the most elderly. The data further indicate that sensory problems and pain comprise the largest components of the burden of ill health, and that higher socioeconomic status confers a dual advantage--longer life expectancy and a lower burden of ill health.

In 1991, the National Task Force on Health Information recommended that in order to assess the health of Canadians, the health information system should include an aggregate index of population health. This article presents such an index--Health-Adjusted Life Expectancy (HALE)--as one possibility in a range of indicators. In contrast to conventional life expectancy, which considers all years as equal, to calculate HALE, years of life are weighted by health status. To measure health status, the Health Utility Index, obtained from 1994-95 National Population Health Survey data, was used. Traditional life expectancy and HALE figures are compared to estimate the burden of ill health. The societal burden of ill health is higher for women than for men, and is highest among those in "early" old age, not among the most elderly. The data further indicate that sensory problems and pain comprise the largest components of the burden of ill health, and that higher socioeconomic status ...

The validity of quality of care measurement has important implications for practicing clinicians, their patients, and all involved with health care delivery. We used empirical data from managed care patients enrolled in west coast physician organizations to test the hypothesis that observed changes in health-related quality of life across a 2.5-year window reflecting process of care. Data Sources/Study Setting. Patient self-report data as well as clinically detailed medical record review regarding 963 patients with chronic disease associated with managed care from three west coast states. Study Design. Prospective cohort study of change in health-related quality of life scores across 30 months as measured by change in SF-12 physical component scores. Data Collection/Extraction Methods. Patient self-report and medical record abstraction. Principal Findings. We found a positive relationship between better process scores and higher burden of illness ( po.05). After adjustment for burden of illness, using an instrumental variables approach revealed better process is associated with smaller declines in SF-12 scores across a 30-month observation window ( p 5 .014). The application of the best quartile of process of care to patients currently receiving poor process is associated with a 4.24 increment in d SF-12-physical component summary scores. Conclusions. The use of instrumental variables allowed us to demonstrate a significant relationship between better ambulatory process of care and better health-related quality of life. This finding underscores the importance of efforts to improve the process of care.

To evaluate the annual cost of patients with Wagner grade 3-4-5 diabetic foot ulcer (DFU) from the public payer's perspective in Turkey. This study was conducted focused on a time frame of one year from the public payer's perspective. Cost-ofillness (COI) methodology, which was developed by the World Health Organization, was used in the generation of cost data. By following a clinical path with the COI method, the main total expenses were reached by multiplying the number of uses of each expense item, the percentage of cases that used them and unit costs. Clinical guidelines and real data specific to Turkey were used in the calculation of the direct costs. Monte Carlo Simulation was used in the study as a sensitivity analysis. The following were calculated in DFU treatment from the public payer's perspective: The annual average per patient outpatient costs $579.5 (4.1%), imaging test costs $283.2 (2.0%), laboratory test costs $284.8 (2.0%), annual average per patient cost of intervention, rehabilitation and trainings $2291.7 (16.0%), annual average per patient cost of drugs used $2545.8 (17.8%)

To investigate the relative importance of common physical and mental disorders with regard to the number of days out-of-role (DOR; number of days for which a person is completely unable to work or carry out normal activities because of health problems) in a population-based sample of adults in the Sa ˜o Paulo Metropolitan Area, Brazil. METHODS: The Sa ˜o Paulo Megacity Mental Health Survey was administered during face-to-face interviews with 2,942 adult household residents. The presence of 8 chronic physical disorders and 3 classes of mental disorders (mood, anxiety, and substance use disorders) was assessed for the previous year along with the number of days in the previous month for which each respondent was completely unable to work or carry out normal daily activities due to health problems. Using multiple regression analysis, we examined the associations of the disorders and their comorbidities with the number of days out-of-role while controlling for socio-demographic variables. Both individual-level and population-level associations were assessed. RESULTS: A total of 13.1% of the respondents reported 1 or more days out-of-role in the previous month, with an annual median of 41.4 days out-of-role. The disorders considered in this study accounted for 71.7% of all DOR; the disorders that caused the greatest number of DOR at the individual-level were digestive (22.6), mood (19.9), substance use (15.0), chronic pain (16.5), and anxiety (14.0) disorders. The disorders associated with the highest population-attributable DOR were chronic pain (35.2%), mood (16.5%), and anxiety (15.0%) disorders. CONCLUSIONS: Because pain, anxiety, and mood disorders have high effects at both the individual and societal levels, targeted interventions to reduce the impairments associated with these disorders have the highest potential to reduce the societal burdens of chronic illness in the Sa ˜o Paulo Metropolitan Area.

decreasing personal control over important life domains. Three categories of illnessrelated variables were hypothesized to contribute to increased illness intrusiveness: burden of illness (i.e., direct physical action and effects of disease), functional deficits (i.e., operational deficits in discrete functional systems), andphysical disabilities (i.e., limitations to the integrated performance of more complex functions). Measures of illness intrusiveness, personal control, psychosocial well-being and illness-related variables were obtained from 94 people with MS on three occasions over 18 months. Surprisingly, all disease and psychosocial variables were highly stable. Hierarchical multiple regression analyses, controlling for recent stressful life events, supported the proposed model. Regression analyses also indicated that each of the hypothesized determinants was significantly and uniquely related to the perception of illness intrusiveness. Approximately two-thirds of participants appeared to achieve a positive psychosocial adjustment to MS. However, the remaining one-third reported elevated levels of emotional distress. Chronic disabling conditions disrupt the life styles of affected individuals and their families, interfering with continued involvements in valued activities and interests,

The objective of this study was to assess how disease burden caused by chronic conditions is related to mortality (predictive validity) and other health outcomes (convergent validity). This was studied in 625 community-dwelling adults living in Spain aged 65 years and older. Disease burden was measured with the Disease Burden Morbidity Assessment (DBMA). The association with 5-year mortality was assessed using a Cox model and Kaplan-Meier curves. For convergent validity, mean age, sex ratio, patient-centered outcomes and healthcare utilization were compared for high and low DBMA scores (< 10 vs. ≥ 10). Also, a multivariable linear regression model was used to evaluate the DBMA as a function of these variables. Mean DBMA score in our sample was 7.5. After 5 years, 35 participants had died (5.5%). The Cox model displayed a hazard ratio of 1.07, and the Kaplan-Meier curves showed lower survival for high DBMA scores. Among participants with high DBMA scores, low self-perceived health, disability and female sex were more frequent, and this group showed lower mean scores for quality of life (Personal Wellbeing Index), affect balance (Scale of Positive and Negative Experience) and physical activity (Yale Physical Activity Survey), higher mean age and higher healthcare utilization than persons with low DBMA scores. In the multivariable regression, all variables but age were significantly associated with the DBMA. In conclusion, the DBMA showed satisfactory predictive and convergent validity. In our aging society, it can be applied to better understand and improve care for older persons with multiple chronic conditions. Comorbidity • Health status • Burden of illness • Chronic disease • Aged Responsible editor: D.J.H. Deeg.

Objectives: To evaluate the burden of illness in irritable bowel syndrome (IBS), in terms of resource utilisation (direct and indirect) and health-related quality of life (HR-QOL), in individuals with IBS who meet Rome I and Rome II criteria. A cross-sectional study, carried out by personal interview, on a representative sample (n = 2000) of the Spanish population. Individuals with suspected IBS were identified via a screening question and subsequently given an epidemiological questionnaire to complete. The questionnaire collected information on IBS symptoms, resource utilisation, and HR-QOL [Medical Outcomes Study 36-item Short Form (SF-36)]. Results: Sixty-five individuals met Rome II criteria for IBS, while 146 individuals met exclusively Rome I criteria. Of Rome II individuals, 67.7% had consulted some type of healthcare professional in the previous 12 months, compared with only 41.8% of those individuals meeting exclusively Rome I criteria (p < 0.001). In the same vein, similar findings were observed (p < 0.01) for the variables: 'diagnostic tests' (35.4 vs 17.1%); 'drug consumption' (70.8 vs 45.2%); and 'reduced performance in main activity' (60 vs 27.4%). Compared with the general population, the study sample reported significantly worse HR-QOL scores in four dimensions of the SF-36 ('bodily pain', 'vitality', 'social functioning' and 'role-emotional'. Additionally, individuals meeting Rome II criteria reported worse HR-QOL scores than those individuals meeting exclusively Rome I criteria, especially in the 'bodily pain' and 'general health' dimensions. The burden of illness in IBS is important and correlated to the

As the burden of illness associated with hip fracture extends beyond the initial hospitalization, a longitudinal 1 year cohort study was used to analyze levels of health service use, institutional care and their associated costs, and to examine patient and residency factors contributing to overall 1 year cost. Patients in the study were aged 50 year and over, and had been admitted to an acute care facility for hip fracture in the Hamilton-Wentworth region of Canada from 1 April 1995 to 31 March 1996. Health care resources assessed included initial hospitalization, rehospitalization, rehabilitation, chronic care, home care, long-term care (LTC) and informal care. Regression analysis was used to determine the effects of age, gender, residence, survival and days of follow-up on 1 year cost. The mean 1 year cost of hip fracture for the 504 study patients was 26.527 Canadian dollars (95% Cl: $24.564-$28.490). One year costs were significantly different for patients who returned to the community ($21.385), versus those who were transferred to ($44.156), or readmitted to LTC facilities ($33.729) (p<0.001). Initial hospitalization represented 58% of 1 year cost for community-dwelling patients, compared with 27% for LTC residents. Only 59.4% of community-dwelling patients resided in the community 1 year following hip fracture, and 5.6% of patients who survived their first fracture experienced a subsequent hip fracture. Linear regression indicated place of residence, age and survival were all important contributors to 1 year cost (p<0.001). While the average 1 year cost of care was $26.527, the overall cost varied depending on a patient's place of residence, age, and survival to 1 year. Annual economic implications of hip fracture in Canada are $650 million and are expected to rise to $2.4 billion by 2041.

Little is known about the determinants of parental response when children appear to have a respiratory tract infection (RTI). Our objective was to identify what factors predict that parents will seek medical consultation. In a prospective cohort study we consecutively recruited 400 children aged 2 months to 12 years from the urban, largely middle-class, primary-care practices of 7 pediatricians in Toronto. Baseline demographic data were collected and the children followed by telephone inquiry until an RTI developed or 6 months elapsed. Data about any medical consultation for the RTI were collected. The parents completed a questionnaire on clinical features and parental interpretations and concerns. Potential predictors of consultation were organized into 4 domains: family factors, principal complaints, functional burden of illness (determined with a validated measure, the Canadian Acute Respiratory Illness and Flu Scale [CARIFS]) and parental interpretation of the illness. Key varia...

Objective The Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQ) has been shown to have good psychometric performance in measuring headache impact in migraine patients, but its properties specifically in chronic migraine (CM) patients are unknown. The objective of this study was to evaluate the psychometric properties of the MSQ in a group of CM patients undergoing prophylactic treatment. Methods Measurement properties of the MSQ were examined using two international, multicenter, randomized clinical trials evaluating onabotulinumtoxinA as headache prophylaxis in CM patients (N = 1,376). Confirmatory factor analysis (CFA) was used to test the latent structure of the MSQ in CM patients. The reliability, convergent and discriminant validity, and responsiveness of the MSQ were assessed. Results CFA confirmed the currently proposed three-factor MSQ latent structure across the two studies. Good reliability was observed for all three MSQ scales, across studies and time points. MSQ scale scores strongly correlated with the scores of the Headache Impact Test-6 (HIT-6). Analysis of knowngroups validity indicated that MSQ scale scores discriminated between groups of patients differing in their 28-day headache frequency were as follows\10, 10-14, and C15 days, and the sample-derived quartiles of the total cumulative hours of headache were as follows \140, 140 to \280, 280 to \420, and C420 h (p \ 0.0001), across both studies and time points. MSQ change scores were higher in magnitude in groups experiencing greater decline in headache frequency (p \ 0.001). The MSQ is a psychometrically valid tool that can be used to reliably measure the impact of migraine among CM patients.

Background Severity of human metapneumovirus (hMPV) lower respiratory illness (LRTI) is considered similar to that observed for respiratory syncytial virus (RSV). However, differences in severity between these pathogens have been noted, suggesting the degree of illness may vary in different populations. Moreover, a potential association between hMPV and asthma also suggests that hMPV may preferentially affect asthmatic subjects. Methods In a population-based surveillance study in children aged &lt;2 years admitted for severe LRTI in Argentina, nasopharyngeal aspirates were tested by RT-PCR for hMPV, RSV, influenza A, and human rhinovirus. Results Of 3947 children, 383 (10%) were infected with hMPV. The hospitalization rate for hMPV LRTI was 2.26 per 1000 children (95% confidence interval [CI], 2.04–2.49). Thirty-nine (10.2%) patients infected with hMPV experienced life-threatening disease (LTD; 0.23 per 1000 children; 95% CI, .16–.31/1000), and 2 died (mortality rate 0.024 per 1000;...

The Pictorial Representation of Illness and Self Measure (PRISM) has been introduced as a visual measure of suffering. We explored the validity of a revised version, the PRISM-RII, in diabetes patients as part of the annual review. Participants were 308 adult outpatients with either type 1 or type 2 diabetes. Measures: (1) the PRISM-RII, yielding Self-Illness Separation (SIS) and Illness Perception Measure (IPM); (2) the Problem Areas in Diabetes (PAID) scale, a measure of diabetes-related distress; (3) the WHO-5 Well-Being Index; (4) and a validation question on suffering (SQ). In addition, patients' complication status, comorbidity and glycemic control values(HbA1c) were recorded. Results: Patients with complications did have marginally significant higher scores on IPM, compared to patients without complications. Type 2 patients had higher IPM scores than Type 1 patients. SIS and IPM showed low intercorrelation (r = -.25; p < .01). Convergent validity of PRISM-RII was demonstrated by significant correlations between IPM and PAID (r = 0.50; p < 0.01), WHO-5 (r = -.26; p < 0.01) and SQ (r = 0.36; p < 0.01). SIS showed only significant correlations with PAID (r = -0.28; p < 0.01) and SQ (r = -0.22; p < 0.01). Neither IPM nor SIS was significantly associated with HbA1c. The PRISM-RII appeared easy to use and facilitated discussion with care providers on coping with the burden of diabetes. PRISM-RII appears a promising additional tool to assess the psychological burden of diabetes.

for reviewing or discu,ssing parts of the whole social-cost series, although not necessarily ttus particular report. Of course, we alone are responsible for the contents of this report. 11.6.5 Diesel Particulates (as a cause of lung cancer) .

Background Rates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and identify policy priorities. Methods and Findings We estimated deaths and loss of healthy life years (measured in disability-adjusted life years [DALYs]) in 2004 from a comprehensive list of diseases and injuries, and 16 major risk factors, by sex and age for Mexico and its states. Data sources included the vital statistics, national censuses, health examination surveys, and published epidemiological studies. Mortality statistics were adjusted for underreporting, misreporting of age at death, and for misclassification and incomparability of cause-of-death assignment. Nationally, noncommunicable diseases caused 75% of total deaths and 68% of total DALYs, with another 14% of deaths and 18% of DALYs caused by undernutrition and communicable, maternal, and perinatal diseases. The leading causes of death were ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, and road traffic injuries. High body mass index, high blood glucose, and alcohol use were the leading risk factors for disease burden, causing 5.1%, 5.0%, and 7.3% of total burden of disease, respectively. Mexico City had the lowest mortality rates (4.2 per 1,000) and the Southern region the highest (5.0 per 1,000); under-five mortality in the Southern region was nearly twice that of Mexico City. In the Southern region undernutrition and communicable, maternal, and perinatal diseases caused 23% of DALYs; in Chiapas, they caused 29% of DALYs. At the same time, the absolute rates of noncommunicable disease and injury burdens were highest in the Southern region (105 DALYs per 1,000 population versus 97 nationally for noncommunicable diseases; 22 versus 19 for injuries). Conclusions Mexico is at an advanced stage in the epidemiologic transition, with the majority of the disease and injury burden from noncommunicable diseases. A unique characteristic of the epidemiological transition in Mexico is that overweight and obesity, high blood glucose, and alcohol use are responsible for larger burden of disease than other noncommunicable disease risks such as tobacco smoking. The Southern region is least advanced in the epidemiological transition and suffers from the largest burden of ill health in all disease and injury groups.

ObjectiveTo compare effectiveness of onabotulinumtoxinA and topiramate for chronic migraine (CM) prevention.BackgroundThe efficacy* of onabotulinumtoxinA and topiramate has been established in placebo‐controlled randomized clinical trials (*defined as the benefit of treatment under ideal conditions). The effectiveness* of the 2 preventive treatments, however, has not been established (*the benefit of treatment under real‐world conditions, representing a blend of efficacy and tolerability).MethodsIn this multicenter, randomized, parallel‐group, post‐authorization, open‐label prospective study (FORWARD; ClinicalTrials.gov, NCT02191579), we randomized adults with CM (1:1) to onabotulinumtoxinA 155 U every 12 weeks for 3 cycles or topiramate “immediate release” 50‐100 mg/day to week 36. Primary outcome measure was proportion of patients achieving ≥50% reduction in headache days (weeks 29‐32). Missing values were imputed using baseline observation carried forward (BOCF) methodology. Afte...

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Fundamentos: Dada la carga economica que supone para el sistema sanitario la gripe estacional, se plantea esta revision sistematica cuyo objetivo fue actualizar la evidencia disponible sobre el coste-efectividad de vacunacion contra la gripe estacional en diferentes grupos de edad, incluyendo poblacion infantil. Metodos: Se llevo a cabo una revision sistematica de la literatura de evaluaciones economicas de los programas de vacunacion contra la gripe estacional en ninos y adultos. Se realizaron busquedas en las bases de datos (enero 2013 – abril 2018): Medline y PREMEDLINE, EMBASE, EconLit y en las bases de datos del Centre for Reviews and Dissemination (DARE, HTA, NHS EED). Resultados: Se incluyeron 11 evaluaciones economicas. La calidad metodologica de los estudios incluidos fue buena. La evidencia cientifica muestra que los programas de vacunacion contra la gripe estacional en ninos en edad escolar pueden ser una estrategia coste-efectiva desde la perspectiva sanitaria en paises ...

Acute gastrointestinal illness is an important public-health issue worldwide. Burden-of-illness studies have not previously been conducted in Cuba. The objective of the study was to determine the magnitude, distribution, and burden of self-reported acute gastrointestinal illness in Cuba. A retrospective, cross-sectional survey was conducted in three sentinel sites during June-July 2005 (rainy season) and during November 2005-January 2006 (dry season). Households were randomly selected from a list maintained by the medical offices in each site. One individual per household was selected to complete a questionnaire in a face-to-face interview. The case definition was three or more bouts of loose stools in a 24-hour period within the last 30 days. In total, 97.3% of 6,576 interviews were completed. The overall prevalence of acute gastrointestinal illness was 10.6%. The risk of acute gastrointestinal illness was higher during the rainy season (odds ratio [OR]=3.85, 95% confidence interval [CI] 3.18-4.66) in children (OR=3.12, 95% CI 2.24-4.36) and teens (OR=2.27, 95% CI 1.51-3.41) compared to people aged 25-54 years, in males (OR=1.24, 95% CI 1.04-1.47), and in the municipality of Santiago de Cuba (OR=1.33, 95% CI 1.11-1.61). Of 680 cases, 17.1-38.1% visited a physician, depending on sentinel site. Of the cases who visited a physician, 33.3-53.9% were requested to submit a stool sample, and of those, 72.7-100.0% complied. Of the cases who sought medical care, 16.7-61.5% and 0-31.6% were treated with antidiarrhoeals and antibiotics respectively. Acute gastrointestinal illness represented a substantial burden of health compared to developed countries. Targeting the identified risk factors when allocating resources for education, food safety, and infrastructure might lower the morbidity associated with acute gastrointestinal illness.

Background: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their 'worst.' Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD. Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the 'worst' lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview. Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk.

Background Musculoskeletal disorders are common and costly disorders to workers compensation and motor accident insurance systems and are a leading contributor to the burden of ill-health. In Australia, vocational rehabilitation is provided to workers to assist them to stay in, or return to work. Self-management training may be an innovative addition to improve health and employment outcomes from vocational rehabilitation. Methods/Design The research plan contains mixed methodology consisting of a single blind randomised controlled trial, an economic evaluation and qualitative research. Participants (n = 366) are volunteers with compensated musculoskeletal disorders of 3 months to 3 years in duration who were working at the time of the injury/onset of the chronic disorder. The trial tests the effectiveness of usual vocational rehabilitation plus the Chronic Disease Self-Management Program (CDSMP) to which two additional and newly-developed modules have been added, against vocational...

Five renal centres were investigated. All resources used during the process of dialysis treatment were identified during semi-structured interviews; published costs were applied. Overhead costs were apportioned using standard cost accounting. RESULTS: Annual costs of HD in main units ranged from £33,516 to £45,029 (£30,508 to £46,459 in satellite units). A key differential factor between the units was the overhead costs. HD costs without overheads ranged from £30,055 to £35,138 (£23,110 to £35,227 in satellite units). Annual costs of PD were £14,859 to £17,022 and £22,196 to £24,358 for CAPD and APD, respectively. The key differential cost drivers between HD and PD other than overheads were disposables (averaging £10,117 for HD, £9,349 for CAPD and £16,223 for APD), nursing (£9,921 for HD; £2,775 for PD), anaemia therapy (£7,005 for HD; £2,410 for PD) and transport (£2,352 for HD; £130 for PD). CONCLUSION: Within individual renal centres, the costs of delivering APD range from 32% to 50% lower than HD and for CAPD costs are from 53% to 66% lower than HD.

The worldwide incidence of kidney failure is on the rise and treatment is costly; thus, the global burden of illness is growing. Kidney failure patients require either a kidney transplant or dialysis to maintain life. This review focuses on the economics of dialysis. Alternative dialysis modalities are haemodialysis (HD) and peritoneal dialysis (PD). Important economic factors influencing dialysis modality selection include financing, reimbursement and resource availability. In general, where there is little or no facility or physician reimbursement or payment for PD, the share of PD is very low. Regarding resource availability, when centre HD capacity is high, there is an incentive to use that capacity rather than place patients on home dialysis. In certain countries, there is interest in revising the reimbursement structure to favour home-based therapies, including PD and home HD. Modality selection is influenced by employment status, with an association between being employed and PD as the modality choice. Cost drivers differ for PD and HD. PD is driven mainly by variable costs such as solutions and tubing, while HD is driven mainly by fixed costs of facility space and staff. Many cost comparisons of dialysis modalities have been conducted. A key factor to consider in reviewing cost comparisons is the perspective of the analysis because different costs are relevant for different perspectives. In developed countries, HD is generally more expensive than PD to the payer. Additional research is needed in the developing world before conclusive statements may be made regarding the relative costs of HD and PD.

Objective: This study estimates the productivity losses from different chronic disorders (e.g., heart conditions, diabetes, cancer) and some measures of risk factors (smoking, drinking) in two period of time, 1994 and 2005, among Canadian labour force. Methods: Using the data from the National Population Health Survey 1994 and Canadian Community Health Survey2005, the probability of having disability days, number of

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Objective: To understand the physical, psychosocial, and practical challenges faced by Canadian patients with Inherited Retinal Diseases (IRDs) and their families.

Design: Mixed-methods

Participants: 408 Canadians living with or caring for someone with an IRD (mean age = 51.4 years ± 16.7) completed an online survey. 20 cohort respondents participated in additional telephone interviews.

Calculation of costs and the Burden of Disease (BoD) is useful in developing resource allocation and prioritization strategies in public and environmental health. While useful, the Disability-Adjusted Life Year (DALY) metric disregards subclinical dysfunctions, adheres to stringent causal criteria, and is hampered by gaps in environmental exposure data, especially from industrializing countries. For these reasons, a recently calculated environmental BoD of 5.18% of the total DALYs is likely underestimated. We combined and extended cost calculations for exposures to environmental chemicals, including neurotoxicants, air pollution, and endocrine disrupting chemicals, where sufficient data were available to determine dose-dependent adverse effects. Environmental exposure information allowed cost estimates for the U.S. and the EU, for OECD countries, though less comprehensive for industrializing countries. As a complement to these health economic estimations, we used attributable risk valuations from expert elicitations to as a third approach to assessing the environmental BoD. For comparison of the different estimates, we used country-specific monetary values of each DALY. The main limitation of DALY calculations is that they are available for few environmental chemicals and primarily based on mortality and impact and duration of clinical morbidity, while less serious conditions are mostly disregarded. Our economic estimates based on available exposure information and dose-response data on environmental risk factors need to be seen in conjunction with other assessments of the total cost for these environmental risk factors, as our estimate overlaps only slightly with the previously estimated environmental DALY costs and crude calculations relying on attributable risks for environmental risk factors. The three approaches complement one another and suggest that environmental chemical exposures contribute costs that may exceed 10% of the global domestic product and that current DALY calculations substantially underestimate the economic costs associated with preventable environmental risk factors. By including toxicological and epidemiological information and data on exposure distributions, more representative results can be obtained from utilizing health economic analyses of the adverse effects associated with environmental chemicals.

Background: Information about quality of life of patients with chronic hip or knee complaints in general practice is scarce. This study describes the health-related and overall quality of life (HRQL) of these complaints. Methods: Data were obtained from a cohort study in general practice. HRQL at three months follow-up was analysed. HRQL was measured as: symptoms, physical, psychological and social functioning, and general health perceptions, using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the MOS 36-item short-form-health survey (SF-36). Overall quality of life was measured using a 5-point rating scale. Results: The results show that patients with chronic hip or knee complaints have a substantial lower HRQL compared to patients who had recovered from baseline hip or knee complaints. The largest effect was found on symptoms and physical functioning: up to 2.9 standard deviations below patients who had recovered from baseline hip or knee complaints. Scores of patients with both chronic hip and knee complaints were significantly worse than scores of patients with only knee complaints on most subscales. Conclusion: In patients with chronic hip or knee complaints the worst scores were seen on scales that measure symptoms and physical functioning, but still a substantially lower score was obtained for overall quality of life. Quality of life was poorer for patients with both chronic hip and knee complaints compared to those with chronic hip or knee complaints only.

Resumen Introducción. Es frecuente asistir a familias provenientes de provincias muy distantes de la Capital Federal, que deben permanecer largos períodos de tiempo lejos del hogar, durante todo el tratamiento de su hijo con cáncer, lo que plantea problemas que van más allá de lo asistencial. Objetivos. 1. Detallar las acciones médicas y el comportamiento social de los pacientes pediátricos con cáncer asistidos en el Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" de la Ciudad Autónoma de Buenos Aires, derivados de cinco provincias del nor-noreste argentino. 2. Describir las condiciones y recursos humanos y materiales de hospitales de cabecera de tales provincias, para determinar la factibilidad de integrar centros asistenciales provinciales en la atención del cáncer pediátrico. Población, material y métodos. Se analizó una población pediátrica con cáncer atendida entre 1996 y 1998 en el Hospital Garrahan, procedente de Chaco, Formosa, Misiones, Corrientes y Santiago del Estero. Se excluyeron pacientes que sólo requirieron cirugía o quimioterapias breves y los fallecidos en los primeros 3 meses de tratamiento. Se analizaron variables sociales (estructura familiar, condiciones habitacionales y cobertura social) y médicas (diagnóstico, número de consultas e internaciones y evolución). Se realizó una visita en terreno a los Hospitales "Avelino Castelán" (Chaco) y "Juan Pablo II" (Corrientes), donde se relevó información sobre sus recursos e infraestructura. Resultados. Se analizaron 50 pacientes (26 varones), con una edad mediana de 4,9 años. El 30% de las familias no tenía un vínculo estable y el 88% de los pacientes tenía uno o más hermanos. El 26% de las familias presentaban necesidades básicas insatisfechas. Se trasladaron a través de instituciones públicas o recursos familiares 24 niños (48%). Los pacientes que completaron el tratamiento permanecieron lejos de sus hogares entre 1 y 2 años, y sólo 4 niños, en estadio terminal de la enfermedad, recibieron tratamiento paliativo en sus provincias. El diagnóstico de leucemia fue el predominante (42%). Las complicaciones inherentes a la quimioterapia tuvieron un manejo médico convencional. Hubo 97 internaciones por neutropenia febril (71% episodios de bajo riesgo). Ambos hospitales evaluados cuentan con unidades de internación y de cuidados intensivos, con soporte del laboratorio e imágenes, clínicos, oncólogos pediatras, enfermeras especializadas y cirujanos. Conclusiones. Sería factible completar etapas del tra

Background: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their 'worst.' Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD. Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the 'worst' lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview. Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk.

There is increasing interest in reducing burden of illness in families with childhood epilepsy. Evidence suggests that burden of illness is more related to parents' perception of seizure control than actual seizure control. This study examined the extent to which parents could describe their children's epilepsy and its impact. The degree of concordance between parents' and physicians' perceptions of epilepsy, and its effect on parents' satisfaction with care was also examined. Method: The study involved 37 parents and 1 paediatric neurologist. A questionnaire measured parents' perceptions of seizures and satisfaction with care. A physician questionnaire was piloted for comparison with parent responses. Results: Parents were able to describe and distinguish seizure types, characteristics and impact of epilepsy. Results indicate a low degree of concordance between parents' and physician's perceptions for global, medical and everyday aspects of epilepsy. Preliminary evidence suggests that satisfaction with care may be positively related to degree of concordance. Conclusions: It is feasible to examine burden of illness from the parents' perspective. More attention should be paid to the parent-physician relationship in order for physicians to appreciate parents' perceptions. Future research is needed to replicate the findings in a larger sample of parents and paediatric neurologists.

In Vietnam, illnesses create high out-of-pocket health care expenditures for households. In this study, the burden of illness in the Bavi district, Vietnam is measured based upon individual household health expenditures for communicable and non-communicable illnesses. The focus of the paper is on the relative effect of different illnesses on the total economic burden of health care on households in general and on households that have catastrophic health care spending in particular. The study was performed by twelve monthly follow-up interviews of 621 randomly selected households. The households are part of the FilaBavi project sample--Health System Research Project. The heads of household were interviewed at monthly intervals from July 2001 to June 2002. For the population in the Bavi district, communicable illnesses predominate among the episodes of illness and are the reason for most household health care expenditure. This is the case for almost all groups within the study and for...

Background: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their 'worst.' Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD. Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the 'worst' lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview. Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk.

To examine challenges in forming accurate conclusions from claims data when comparing different patient groups, and to stress the need to adjust for confounding variables through application of statistical methods. Patients who were 60 or older and began amlodipine or felodipine in 1997 or 1998 were identified from a proprietary managed care claims database. Patients had 6 months of medical and outpatient pharmacy benefits coverage before and after initiating therapy. They were stratified on varying degrees of hypertension severity and on all-condition clinical complexity, and quantified with a proprietary Burden of Illness (BOI) score, defined as the expected resource use for the patient.s combined conditions during the 6 months before therapy. Of the 17,667 patients, 10,469 (59.3%) were female. The 12,389 amlodipine users were similar in age to felodipine users (n=5,278), 73 versus 74, respectively. More amlodipine users were assigned to the 2 most clinically complex quintiles of ...

Background Severity of human metapneumovirus (hMPV) lower respiratory illness (LRTI) is considered similar to that observed for respiratory syncytial virus (RSV). However, differences in severity between these pathogens have been noted, suggesting the degree of illness may vary in different populations. Moreover, a potential association between hMPV and asthma also suggests that hMPV may preferentially affect asthmatic subjects. Methods In a population-based surveillance study in children aged &lt;2 years admitted for severe LRTI in Argentina, nasopharyngeal aspirates were tested by RT-PCR for hMPV, RSV, influenza A, and human rhinovirus. Results Of 3947 children, 383 (10%) were infected with hMPV. The hospitalization rate for hMPV LRTI was 2.26 per 1000 children (95% confidence interval [CI], 2.04–2.49). Thirty-nine (10.2%) patients infected with hMPV experienced life-threatening disease (LTD; 0.23 per 1000 children; 95% CI, .16–.31/1000), and 2 died (mortality rate 0.024 per 1000;...