Asthma-related productivity losses in Alberta, Canada

Nguyen X Thanh, Arto Ohinmaa, Charles YanInstitute of Health Economics, Edmonton, Alberta, CanadaObjectives: To estimate the number and cost of asthma-related productivity loss days due to absenteeism and presenteeism (at work but not fully functioning) in Alberta in 2005.Methods: Using data from the 2005 Canadian Community Health Survey, this study focused on people of working age (18–64 years), who reported having an asthma diagnosis. Total asthma-related disability days, including in-bed days and activity-restricted days, were estimated by multiplying the difference in the means of total disability days between asthmatics and nonasthmatics adjusted for sociodemographic characteristics and other health conditions by a multiple linear regression, with the number of asthmatics in the population. Number of productivity loss days was a sum between the number of in-bed days (absenteeism) and the number of activity-restricted days multiplied by a reduction in functional level (presenteeism), adjusted for five working days per week. Other data from Alberta or Canadian published literature, such as a reduction in functional level of 20%–30%, a labor participation rate of 73%, and an average wage of $158 per day in 2005, were also used for analyses.Results: The prevalence of asthma was estimated at 8.5$70 (41–99) to $84 ($49–$119) million. Of these, the presenteeism accounted for 42% to 52%.Conclusions: The results suggest that an improvement in the controlling of asthma could have a significant economic impact in Alberta and that presenteeism plays an important role in asthma-related productivity losses and therefore employers should not only pay attention to absenteeism, but also to presenteeism to minimize productivity loss.Keywords: productivity loss, absenteeism, presenteeism, asthma, Albert

Telehealth in substance abuse and addiction: review of the literature on smoking, alcohol, drug abuse and gambling.

Telemedicine and telehealth are defined as sending electronic health/health care information (e.g. data, audio, images) over distances between two or more individuals or sites. The scope of telehealth is somewhat wider than telemedicine since it includes areas such as self-help activities where people look for health related material that may impact their health or health behavior. Many conventional interventions in addictions have been shown to be effective; however, the widespread use of those interventions have often been limited due to a limited number of personal services provided by professionals and the stigma associated with seeking and accessing available services. Telehealth can potentially overcome many of these challenges by offering services over distances and providing these services to large populations at the same time. The aim of the study was to do a systematic review of telehealth studies in addiction/substance abuse and study the effectiveness and/or cost-effectiveness of the different telehealth applications in different addiction problems. Results From the 1521 references identified in the search, 151 publications (9.9% of all abstracts) were ordered for closer review and 145 were received for detailed review. Most of the articles came from the smoking cessation area (78) followed by alcohol (39), illicit drug use (10), and gambling (3). Of the studies, 15 were review articles, mainly from the smoking cessation (10). Through the telehealth activity, the studies were distributed to 64 applications via telephone, 39 via the Internet, 37 via computer/CD-rom and three via videoconferencing. Internet applications were relatively common in alcohol- and smoking-related programs. Internet applications for students had relatively good outcomes, especially if the intervention is directed to those who used alcohol or smoked. The results of primary prevention studies of starting alcohol use or smoking are not promising. The general population applications seem to be more effective, especially for alcohol problems. Getting more individualized programs based on the personal characteristics and increasing the length and frequency of the sessions improve outcomes. Adding the Internet application to other treatments, either simultaneously or after, can be beneficial. A large majority of the studies were large scale randomized controlled trials (RCTs), which indicates that these results are relatively reliable. Similar to the Internet applications, many of the computer-based application programs were directed towards adolescents and college or university students. Most of these programs seem to be beneficial and the effectiveness was better in programs where students already used substances rather than in primary prevention type of programs. Some of the first programs did not use interactive and personalized information and, in general, they were not as effective compared to more theory-based intervention programs published at a later date. Overall, a majority of stand-alone computer applications had positive outcomes or were equivalent to face-to-face outcomes. The greatest uncertainty from the benefits can be seen in the smoking cessation studies where studies did not show clear positive outcome, especially student-based studies. Out of 13 telephone-based applications in alcohol and smoking, 12 showed positive or outcomes that were equivalent to conventional methods. Half of these studies were based on reviews and meta-analysis in telephone applications in smoking cessation where we included only review studies. Most of the applications involved the conventional use of telephone for mediating advice and therapy by distance. The use of cellular phones for text messaging has increased during the last few years; however, there are only a few studies in this category. Conclusion: The results of this review indicate that the Internet, computer, and telephone applications in alcohol and smoking addictions are at least as effective as conventional services, especially when we review more recently published applications that utilize personalized, interactive modular settings. There was some evidence from telehealth in the area of illicit drugs applications, but the number of studies was still relatively small (eight studies). There is a need for further studies which use telehealth for gambling addiction. Although telehealth applications are expected to be less expensive than individual face-to-face therapies, there is no good quality literature in the cost-effectiveness of telehealth applications in the studied addictions

Fecal transplantation for the treatment of Clostridium difficile-associated disease or ulcerative colitis

<p>Fecal transplantation for the treatment of Clostridium difficile-associated disease or ulcerative colitis examines the clinical research evidence on the safety and effects of fecal transplantation in the treatment of patients with Clostridium difficile-associated disease and/or ulcerative colitis. It also provides information on the prevalence and incidence of the two diseases and the availability of fecal transplantation procedure in Alberta and Canada. The Institute of Health Economics prepared this STE report at the request of the Government of Alberta as part of the Institute's ongoing work to support the Alberta Health Technologies Decision Process</p

41:8; doi:3899/jrheum.131449 Personal non-commercial use only

. For patients in DAS28, Boolean, and SDAI remission, savings were seen both in costs directly related to RA and its comorbidities, and in costs for non-RA-related conditions. Conclusion. The magnitude of the healthcare cost savings varies according to the remission definition used in classifying patient disease status. The highest point estimate for cost savings was observed in patients attaining SDAI remission and the least with the CDAI; confidence intervals for these estimates do overlap. Future pharmacoeconomic analyses should employ all response definitions in assessing the influence o

Multilevel predictors of concurrent opioid use during methadone maintenance treatment among drug users with HIV/AIDS.

BACKGROUND: Ongoing drug use during methadone maintenance treatment (MMT) negatively affects outcomes of HIV/AIDS care and treatment for drug users. This study assessed changes in opioid use, and longitudinal predictors of continued opioid use during MMT among HIV-positive drug users in Vietnam, with the aim of identifying changes that might enhance program efficacy. METHODS: We analyze data of 370 HIV-positive drug users (mean age 29.5; 95.7% male) taking MMT at multi-sites. Opioid use was assessed at baseline, 3, 6, and 9 months using interviews and heroin confirmatory urine tests. A social ecological model was applied to explore multilevel predictors of continued opioid use, including individual, interpersonal, community and service influences. Generalized estimating equations (GEE) statistical models were constructed to adjust for intra-individual correlations. RESULTS: Over 9 month follow-up, self-reported opioid use and positive heroin urine test substantially decreased to 14.6% and 14.4%. MMT helped improve referrals and access to health care and social services. However, utilization of social integration services was small. GEE models determined that participants who were older (Adjusted Odd Ratio - AOR = 0.97 for 1 year increase), had economic dependents (AOR = 0.33), or were referred to TB treatment (AOR = 0.53) were less likely to continue opioid use. Significant positive predictors of ongoing opioid use included frequency of opioid use prior to MMT, peer pressure, living with sexual partners, taking antiretroviral treatment, other health concerns and TB treatment. CONCLUSION: These findings show that MMT in the Vietnamese context can dramatically reduce opioid use, which is known to be associated with reduced antiretroviral (ART) adherence. Disease stage and drug interactions between antiretrovirals or TB drugs and MMT could explain some of the observed predictors of ongoing drug use; these findings could inform changes in MMT program design and implementation