Hospital expenditure at the end-of-life: what are the impacts of health status and health risks?

Background: It is important for health policy and expenditure projections to understand the relationship between age, death and expenditure on health care (HC). Research has shown that older age groups incur lower hospital costs than previously anticipated and that remaining time to death (TTD) was a much stronger indicator for expenditure than age. How health behaviour or risk factors impact on HC utilisation and costs at the end of life is relatively unknown. Smoking and Body Mass Index (BMI) have featured most prominently and mixed findings exist as to the exact nature of this association.<p></p> Methods: This paper considers the relationship between TTD, age and expenditure for inpatient care in the last 12 quarters of life; and introduces measures of health status and risks. A longitudinal dataset covering 35 years is utilised, including baseline survey data linked to hospital and death records. The effect of age, TTD and health indicators on expenditure for inpatient care is estimated using a two-part model.<p></p> Results: As individuals approach death costs increase. This effect is highly significant (p<0.01) from the last until the 8th quarter before death and influenced by age. Statistically significant effects on costs were found for: smoking status, systolic blood pressure and lung function (FEV1). On average, smokers incurred lower quarterly costs in their last 12 quarters of life than non-smokers (~7%). Participants’ BMI at baseline did show a negative association with probability of HC utilisation however this effect disappeared when costs were estimated.<p></p> Conclusions: Health risk measures obtained at baseline provide a good indication of individuals’ probability of needing medical attention later in life and incurring costs, despite the small size of the effect. Utilising a linked dataset, where such measures are available can add substantially to our ability to explain the relationship between TTD and costs.<p></p&gt

On the nucleotide distribution in bacterial DNA sequences

It is probable that the distributional structure of DNA sequences arises from the accumulation of many successive stochastic events such as nucleotide deletions, insertions, substitutions and elongations [1, 2, 3, 4, 5, 6, 7]. Although the existence of long-range correlations in non-coding portions of DNA sequences is well established [8, 9, 10, 11], first order Markov chains might well capture aspects of their nucleotide distributions [12]. Here we propose a hidden Markov model based on a coupling of an urn process with a Markov chain to approximate the distributional structure of primitive DNA sequences. Then, by supposing that a bacterial DNA sequence can be derived from uniformly distributed mutations of some primitive DNA, we use the model to explain and predict some distributional properties of bacterial DNA sequences. The distributional properties intrinsic to the model were compared to statistical estimates from 1049 bacterial DNA sequences. In particular, the proposed model provides another possible theoretical explanation for Chargaff’s second parity rule for short oligonucleotides [13, 14]

Cardiopulmonary exercise testing for predicting early outcomes after major cancer resection: A systematic review

Background: Postoperative complications after major surgery are thought to be associated with reduced fitness. Surgical cancer patients are often malnourished, cachexic and subject to neoadjuvant chemotherapy resulting in low preoperative fitness levels. This review examined the associations between aerobic fitness, as determined objectively by preoperative cardiopulmonary exercise testing (CPEX), and short-term morbidity after cancer surgery. Methods: A literature search using databases of PubMed, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Library for studies that examined associations between preoperative CPEX variables and postoperative complications following surgery for the ten commonest cancers. Results: A total of 21 observational studies were identified with 4957 patients that underwent CPEX testing prior to lung, colorectal, liver, oesophagogastric, bladder and pancreas resections. The median sample size was 105 patients (range 64 - 1684). No studies were found for breast or brain cancers or lymphoma. In lung cancer patients undergoing thoracotomy, a VO2peak ≤ 15ml/kg/min was associated with an increased risk of respiratory complications and death. None of the studies in other cancer types had adequate sample sizes to report on mortality. CPEX testing had mostly poor to average discriminatory accuracy to predict postoperative morbidity in other cancer resection surgeries. Findings across studies were inconsistent, and detection and selective reporting biases were likely to be significant. Conclusion: The utility of CPEX testing prior to cancer surgery is questionable and currently should not be used as a discriminatory tool, except in patients undergoing lung cancer resection by thoracotomy. Larger studies with more robust methodologies are currently required to determine the utility of CPEX

Work-related wellbeing in UK prison officers: a benchmarking approach

Purpose-The purpose of this paper is to examine the well-being of UK prison officers by utilising a benchmarking approach. Design/methodology/approach-The Health and Safety Executive (HSE) Stress Indicator Tool is widely used in the UK to assess key psychosocial hazards in the workplace encompassing demands, control, support from managers and co-workers, relationship quality, role and change management. This study utilises this approach to examine the extent to which a sample of UK prison officers meets the HSE recommended minimum standards for the management of work-related well-being. Levels of mental health and job satisfaction in the sector are also assessed using measures with extensive occupational norms. The psychosocial hazards that make the strongest contribution to mental health and job satisfaction are also considered. Findings-Respondents reported lower levels of well-being for all of the hazard categories than recommended. Moreover, mental health and job satisfaction were considerably poorer among prison officers than other occupational groups within the emergency and security services in the UK. Considerable variation was found in the psychosocial hazards that predicted mental health and job satisfaction. Practical implications-The high levels of stressors and strains experienced by UK prison officers gives serious cause for concern. Priority areas for interventions to enhance well-being in the sector are considered and areas for future research discussed. Originality/value-This study highlights the wide-ranging benefits of a benchmarking approach to investigate work-related stressors and strains at the sector level

Movement economy in soccer: Current data and limitations

Soccer is an intermittent team-sport, where performance is determined by a myriad of psychological, technical, tactical, and physical factors. Among the physical factors, endurance appears to play a key role into counteracting the fatigue-related reduction in running performance observed during soccer matches. One physiological determinant of endurance is movement economy, which represents the aerobic energy cost to exercise at a given submaximal velocity. While the role of movement economy has been extensively examined in endurance athletes, it has received little attention in soccer players, but may be an important factor, given the prolonged demands of match play. For this reason, the current review discusses the nature, impact, and trainability of movement economy specific to soccer players. A summary of current knowledge and limitations of movement economy in soccer is provided, with an insight into future research directions, to make this important parameter more valuable when assessing and training soccer players’ running performance