How does comorbidity influence healthcare costs? A population-based cross-sectional study of depression, back pain and osteoarthritis

Objectives To analyse how comorbidity among patients with back pain, depression and osteoarthritis influences healthcare costs per patient. A special focus was made on the distribution of costs for primary healthcare compared with specialist care, hospital care and drugs. Design Population-based cross-sectional study. Setting The County of Östergötland, Sweden. Patients Data on diagnoses and healthcare costs for all 266 354 individuals between 20 and 75 years of age, who were residents of the County of Östergötland, Sweden, in the year 2006, were extracted from the local healthcare register and the national register of drug prescriptions. Main outcome measures The effects of comorbidity on healthcare costs were estimated as interactions in regression models that also included age, sex, number of other health conditions and education. Results The largest diagnosed group was back pain (11 178 patients) followed by depression (7412 patients) and osteoarthritis (5174 patients). The largest comorbidity subgroup was the combination of back pain and depression (772 patients), followed by the combination of back pain and osteoarthritis (527 patients) and the combination of depression and osteoarthritis (206 patients). For patients having both a depression diagnosis and a back pain diagnosis, there was a significant negative interaction effect on total healthcare costs. The average healthcare costs among patients with depression and back pain was SEK 11 806 lower for a patient with both diagnoses. In this comorbidity group, there were tendencies of a positive interaction for general practitioner visits and negative interactions for all other visits and hospital days. Small or no interactions at all were seen between depression diagnoses and osteoarthritis diagnoses. Conclusions A small increase in primary healthcare visits in comorbid back pain and depression patients was accompanied with a substantial reduction in total healthcare costs and in hospital costs. Our results can be of value in analysing the cost effects of comorbidity and how the coordination of primary and secondary care may have an impact on healthcare costs

Клинические и патоморфологические аспекты эффективности лечения беременных с хронической плацентарной недостаточностью Диавитолом и Диаспленом

БЕРЕМЕННОСТИ ОСЛОЖНЕНИЯ /ЛЕК ТЕРПЛАЦЕНТАРНАЯ НЕДОСТАТОЧНОСТЬ /ЛЕК ТЕРПЛАЦЕНТЫ БОЛЕЗНИДИАВИТОЛДИАСПЛЕ

Young Stars and Protostellar Cores near NGC 2023

We investigate the young (proto)stellar population in NGC 2023 and the L 1630 molecular cloud bordering the HII region IC 434, using Spitzer IRAC and MIPS archive data, JCMT SCUBA imaging and spectroscopy as well as targeted BIMA observations of one of the Class 0 protostars, NGC 2023 MM1. We have performed photometry of all IRAC and MIPS images, and used color-color diagrams to identify and classify all young stars seen within a 22'x26' field along the boundary between IC 434 and L 1630. For some stars, which have sufficient optical, IR, and/or sub-millimeter data we have also used the online SED fitting tool for a large 2D archive of axisymmetric radiative transfer models to perform more detailed modeling of the observed SEDs. We identify 5 sub-millimeter cores in our 850 and 450 micron SCUBA images, two of which have embedded class 0 or I protostars. Observations with BIMA are used to refine the position and characteristics of the Class 0 source NGC 2023 MM 1. These observations show that it is embedded in a very cold cloud core, which is strongly enhanced in NH2D. We find that HD 37903 is the most massive member of a cluster with 20 -- 30 PMS stars. We also find smaller groups of PMS stars formed from the Horsehead nebula and another elephant trunk structure to the north of the Horsehead. We refine the spectral classification of HD 37903 to B2 Ve. Our study shows that the expansion of the IC 434 HII region has triggered star formation in some of the dense elephant trunk structures and compressed gas inside the L 1630 molecular cloud. This pre-shock region is seen as a sub-millimeter ridge in which stars have already formed. The cluster associated with NGC 2023 is very young, and has a large fraction of Class I sources.Comment: 21 pages, 11 figures. Accepted for publication in A&A Replaced with higher resolution figure

The Goblet Cell Protein Clca1 (Alias mClca3 or Gob-5) Is Not Required for Intestinal Mucus Synthesis, Structure and Barrier Function in Naive or DSS- Challenged Mice

The secreted, goblet cell-derived protein Clca1 (chloride channel regulator, calcium-activated-1) has been linked to diseases with mucus overproduction, including asthma and cystic fibrosis. In the intestine Clca1 is found in the mucus with an abundance and expression pattern similar to Muc2, the major structural mucus component. We hypothesized that Clca1 is required for the synthesis, structure or barrier function of intestinal mucus and therefore compared wild type and Clca1-deficient mice under naive and at various time points of DSS (dextran sodium sulfate)-challenged conditions. The mucus phenotype in Clca1-deficient compared to wild type mice was systematically characterized by assessment of the mucus protein composition using proteomics, immunofluorescence and expression analysis of selected mucin genes on mRNA level. Mucus barrier integrity was assessed in-vivo by analysis of bacterial penetration into the mucus and translocation into sentinel organs combined analysis of the fecal microbiota and ex-vivo by assessment of mucus penetrability using beads. All of these assays revealed no relevant differences between wild type and Clca1-deficient mice under steady state or DSS-challenged conditions in mouse colon. Clca1 is not required for mucus synthesis, structure and barrier function in the murine colon

Advancing Tests of Relativistic Gravity via Laser Ranging to Phobos

Phobos Laser Ranging (PLR) is a concept for a space mission designed to advance tests of relativistic gravity in the solar system. PLR's primary objective is to measure the curvature of space around the Sun, represented by the Eddington parameter $\gamma$, with an accuracy of two parts in $10^7$, thereby improving today's best result by two orders of magnitude. Other mission goals include measurements of the time-rate-of-change of the gravitational constant, $G$ and of the gravitational inverse square law at 1.5 AU distances--with up to two orders-of-magnitude improvement for each. The science parameters will be estimated using laser ranging measurements of the distance between an Earth station and an active laser transponder on Phobos capable of reaching mm-level range resolution. A transponder on Phobos sending 0.25 mJ, 10 ps pulses at 1 kHz, and receiving asynchronous 1 kHz pulses from earth via a 12 cm aperture will permit links that even at maximum range will exceed a photon per second. A total measurement precision of 50 ps demands a few hundred photons to average to 1 mm (3.3 ps) range precision. Existing satellite laser ranging (SLR) facilities--with appropriate augmentation--may be able to participate in PLR. Since Phobos' orbital period is about 8 hours, each observatory is guaranteed visibility of the Phobos instrument every Earth day. Given the current technology readiness level, PLR could be started in 2011 for launch in 2016 for 3 years of science operations. We discuss the PLR's science objectives, instrument, and mission design. We also present the details of science simulations performed to support the mission's primary objectives.Comment: 25 pages, 10 figures, 9 table

Panel-based Assessment of Ecosystem Condition of Norwegian Barents Sea Shelf Ecosystems - Appendices

publishedVersio

Priority setting in primary health care - dilemmas and opportunities: a focus group study

<p>Abstract</p> <p>Background</p> <p>Swedish health care authorities use three key criteria to produce national guidelines for local priority setting: severity of the health condition, expected patient benefit, and cost-effectiveness of medical intervention. Priority setting in primary health care (PHC) has significant implications for health costs and outcomes in the health care system. Nevertheless, these guidelines have been implemented to a very limited degree in PHC. The objective of the study was to qualitatively assess how general practitioners (GPs) and nurses perceive the application of the three key priority-setting criteria.</p> <p>Methods</p> <p>Focus groups were held with GPs and nurses at primary health care centres, where the staff had a short period of experience in using the criteria for prioritising in their daily work.</p> <p>Results</p> <p>The staff found the three key priority-setting criteria (severity, patient benefit, and cost-effectiveness) to be valuable for priority setting in PHC. However, when the criteria were applied in PHC, three additional dimensions were identified: 1) viewpoint (medical or patient's), 2) timeframe (now or later), and 3) evidence level (group or individual).</p> <p>Conclusions</p> <p>The three key priority-setting criteria were useful. Considering the three additional dimensions might enhance implementation of national guidelines in PHC and is probably a prerequisite for the criteria to be useful in priority setting for individual patients.</p

Panel-based Assessment of Ecosystem Condition of Norwegian Barents Sea Shelf Ecosystems - Appendices

Source at https://hi.no/hi

Panel-based Assessment of Ecosystem Condition of Norwegian Barents Sea Shelf Ecosystems

The System for Assessment of Ecological Condition, coordinated by the Norwegian Environment Agency, is intended to form the foundation for evidence-based assessments of the ecological condition of Norwegian terrestrial and marine ecosystems not covered by the EU Water Framework Directive. The reference condition is defined as “intact ecosystems”, i.e., a condition that is largely unimpacted by modern industrial anthropogenic activities. An ecosystem in good ecological condition is defined as a system that does not deviate substantially from this reference condition in structure, functions or productivity. This means that, in practice, what is assessed here is the extent to which an ecosystem is impacted by anthropogenic drivers. This report describes the first operational assessment of the ecological condition of Norwegian Arctic and Sub-Arctic marine shelf ecosystems in the Barents Sea. The assessment method employed is the Panel-based Assessment of Ecosystem Condition (PAEC1), and the current assessment has considered to what extent the Barents Sea shelf ecosystems deviate from the reference condition2 by evaluating change trajectories

Panel-based Assessment of Ecosystem Condition of Norwegian Barents Sea Shelf Ecosystems

The System for Assessment of Ecological Condition, coordinated by the Norwegian Environment Agency, is intended to form the foundation for evidence-based assessments of the ecological condition of Norwegian terrestrial and marine ecosystems not covered by the EU Water Framework Directive. The reference condition is defined as “intact ecosystems”, i.e., a condition that is largely unimpacted by modern industrial anthropogenic activities. An ecosystem in good ecological condition is defined as a system that does not deviate substantially from this reference condition in structure, functions or productivity. This means that, in practice, what is assessed here is the extent to which an ecosystem is impacted by anthropogenic drivers. This report describes the first operational assessment of the ecological condition of Norwegian Arctic and Sub-Arctic marine shelf ecosystems in the Barents Sea. The assessment method employed is the Panel-based Assessment of Ecosystem Condition (PAEC1), and the current assessment has considered to what extent the Barents Sea shelf ecosystems deviate from the reference condition2 by evaluating change trajectories.Panel-based Assessment of Ecosystem Condition of Norwegian Barents Sea Shelf EcosystemspublishedVersio