The Economic Burden of Prematurity in Canada

Background Preterm birth is a major risk factor for morbidity and mortality among infants worldwide, and imposes considerable burden on health, education and social services, as well as on families and caregivers. Morbidity and mortality resulting from preterm birth is highest among early (< 28 weeks gestational age) and moderate (28–32 weeks) preterm infants, relative to late preterm infants (33–36 weeks). However, substantial societal burden is associated with late prematurity due to the larger number of late preterm infants relative to early and moderate preterm infants. Methods The aim in this study was to characterize the burden of premature birth in Canada for early, moderate, and late premature infants, including resource utilization, direct medical costs, parental out-of-pocket costs, education costs, and mortality, using a validated and published decision model from the UK, and adapting it to a Canadian setting based on analysis of administrative, population-based data from Québec. Results Two-year survival was estimated at 56.0% for early preterm infants, 92.8% for moderate preterm infants, and 98.4% for late preterm infants. Per infant resource utilization consistently decreased with age. For moderately preterm infants, hospital days ranged from 1.6 at age two to 0.09 at age ten. Cost per infant over the first ten years of life was estimated to be $67,467 for early preterm infants,$52,796 for moderate preterm infants, and id="mce_marker"0,010 for late preterm infants. Based on population sizes this corresponds to total national costs of id="mce_marker"23.3 million for early preterm infants, $255.6 million for moderate preterm infants,$208.2 million for late preterm infants, and $587.1 million for all infants. Conclusion Premature birth results in significant infant morbidity, mortality, healthcare utilization and costs in Canada. A comprehensive decision-model based on analysis of a Canadian population-based administrative data source suggested that the greatest national-level burden is associated with moderate preterm infants due to both a large cost per infant and population size while the highest individual-level burden is in early preterm infants and the largest total population size is in late preterm infants. Although the highest medical costs are incurred during the neonatal period, greater resource utilization and costs extend into childhood

Personal narrative writing workshops for medical students and patients with HIV: narrative medicine in the post-HAART era

Since the advent of highly active antiretroviral therapy(HAART) in the mid-1990's, HIV in the United States has become a chronic and largely controllable disease. Adherence to therapy is one of the most crucial aspects of HIV treatment and control due to the high risk of viral resistance. The main barriers to successful treatment are now psychosocial and structural, including social stigma and the high burden of disease in vulnerable communities. To improve clinical outcomes, physicians today must learn to engage with their patients on the level of their lived experiences, which include their social backgrounds and personal values and priorities. In 2016, supported by a Narrative Medicine Fellowship from Columbia University, we piloted a novel narrative medicine-based medical education intervention in which patients with HIV and medical students from the Keck School of Medicine of the University of Southern California wrote and shared personal narratives with each other. Nine medical students and five patients participated in one of two five-week long workshop series. Patients were recruited from the Maternal, Child, and Adolescent/Adult Clinic at Los Angeles County General.Mixed methods were used to evaluate the feasibility and effectiveness of the intervention. This included the development of a grounded theory of participants’ experiences of the workshop series. Participants articulated how the workshop series expanded their sense of agency, humanity, and empathy toward others, enabling them to explore new ideals for therapeutic physician-patient relationships. The results of the study, as well as the workshop series method and syllabus, will be presented.

My migraine voice survey. aA global study of disease burden among individuals with migraine for whom preventive treatments have failed

Background: Migraine is associated with many debilitating symptoms that affect daily functioning. My Migraine Voice is a large global cross-sectional study aimed at understanding the full burden and impact of migraine directly from patients suffering from ≥4 monthly migraine days (MMDs) with a history of prophylactic treatment failure. Methods: This study was conducted worldwide (31 countries across North and South Americas, Europe, the Middle East and Northern Africa, and the Asia-Pacific region) using an online survey administered to adults with migraine who reported ≥4 MMDs in the 3 months preceding survey administration, with pre-specified criteria of 90% having used preventive migraine treatment (80% with history of ≥1 treatment failure). Prophylactic treatment failure was defined as a reported change in preventive medication by individuals with migraine for any reason, at least once. Results: In total, 11,266 individuals participated in the survey. Seventy-four percent of the participants reported spending time in darkness/isolation due to migraine (average: 19 h/month). While 85% of all respondents reported negative aspects of living with migraine (feeling helpless, depressed, not understood), sleeping difficulties (83%), and fear of the next attack (55%), 57% shared ≥1 positive aspect (learning to cope, becoming a stronger person). Forty-nine percent reported feeling limited in daily activities throughout all migraine phases. Migraine impact on professional, private, or social domains was reported by 87% of respondents (51% in all domains). In the previous 12 months, 38% of respondents had visited the emergency department (average: 3.3 visits), whereas 23% stayed in hospital overnight (average: 3.2 nights) due to migraine. Conclusions: The burden of migraine is substantial among this cohort of individuals with at least 4 migraine days per month and for whom at least 1 preventive migraine treatment had failed. Interestingly, respondents reported some positive aspects in their migraine journey; the greater resilience and strength brought on by coping with migraine suggests that if future treatments could address existing unmet needs, these individuals with migraine will be able to maximize their contribution to society

Late transient acceleration of the universe in string theory on S1/Z2S^{1}/Z_{2}

Recently, in Gong {\em et al} \cite{GWW07} and Wang and Santos \cite{WS07} it was shown that the effective cosmological constant on each of the two orbifold branes can be easily lowered to its current observational value, by using the large extra dimensions in the framework of both M-Theory and string theory on $S^{1}/Z_{2}$. In this paper, we study the current acceleration of the universe, using the formulas developed in \cite{WS07}. We first construct explicitly time-dependent solution to the 10-dimensional bulk of the Neveu-Schwarz/Neveu-Schwarz sector, compactified on a 5-dimensional torus. Then, we write down the generalized Friedmann equations on each of the two dynamical branes, and fit the models to the 182 gold supernova Ia data and the BAO parameter from SDSS, using both of our MINUIT and Monte-Carlo Markov Chain (MCMC) codes. With the best fitting values of the parameters involved as initial conditions, we integrate the generalized Friedmann equations numerically and find the future evolution of the universe. We find that it depends on the choice of the radion potentials $V_{4}^{(I)} (I = 1, 2)$ of the branes. In particular, when choosing them to be the Goldberger-Wise potentials, $V_{4}^{(I)} = \lambda_{4}^{(I)} (\psi^{2} - {v_{I}}^{2})^{2}$, we find that the current acceleration of the universe driven by the effective cosmological constant is only temporary. Due to the effects of the potentials, the universe will be finally in its decelerating expansion phase again. We also study the proper distance between the two branes, and find that it remains almost constant during the whole future evolution of the universe in all the models considered.Comment: revtex4, 18 figures. Typos corrected and new References added. Version to be published in JCA

Perceptions of Mental Health and Help-Seeking Behavior in an Urban Community in Vietnam: An Explorative Study

This explorative study assesses perceptions of mental health and help-seeking behavior among adults in Vietnam. Methods included questionnaires (200) and focus group discussions (eight). Respondents were often unable to name specific mental illnesses. Frequently mentioned symptoms of mental illness were talking nonsense, talking/laughing alone and wandering. Pressure/stress and studying/thinking too much were often identified causes. Most respondents showed a preference for medical treatment options, often in combination with family care. The results show that perceptions of mental health and help-seeking behaviour are influenced by a lack of knowledge and a mix of traditional and modern views

A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity

<p>Abstract</p> <p>Background</p> <p>Meta-analyses of N-acetylcysteine (NAC) for preventing contrast-induced nephrotoxicity (CIN) have led to disparate conclusions. Here we examine and attempt to resolve the heterogeneity evident among these trials.</p> <p>Methods</p> <p>Two reviewers independently extracted and graded the data. Limiting studies to randomized, controlled trials with adequate outcome data yielded 22 reports with 2746 patients.</p> <p>Results</p> <p>Significant heterogeneity was detected among these trials (<it>I</it>²= 37%; <it>p </it>= 0.04). Meta-regression analysis failed to identify significant sources of heterogeneity. A modified L'Abbé plot that substituted groupwise changes in serum creatinine for nephrotoxicity rates, followed by model-based, unsupervised clustering resolved trials into two distinct, significantly different (<it>p </it>< 0.0001) and homogeneous populations (<it>I</it>²= 0 and <it>p </it>> 0.5, for both). Cluster 1 studies (<it>n </it>= 18; 2445 patients) showed no benefit (relative risk (RR) = 0.87; 95% confidence interval (CI) 0.68–1.12, <it>p </it>= 0.28), while cluster 2 studies (<it>n </it>= 4; 301 patients) indicated that NAC was highly beneficial (RR = 0.15; 95% CI 0.07–0.33, <it>p </it>< 0.0001). Benefit in cluster 2 was unexpectedly associated with NAC-induced decreases in creatinine from baseline (<it>p </it>= 0.07). Cluster 2 studies were relatively early, small and of lower quality compared with cluster 1 studies (<it>p </it>= 0.01 for the three factors combined). Dialysis use across all studies (five control, eight treatment; <it>p </it>= 0.42) did not suggest that NAC is beneficial.</p> <p>Conclusion</p> <p>This meta-analysis does not support the efficacy of NAC to prevent CIN.</p

Patients’ perspective on the burden of migraine in Europe: a cross-sectional analysis of survey data in France, Germany, Italy, Spain, and the United Kingdom

Abstract Background Migraine is a distinct neurological disease that imposes a significant burden on patients, society, and the healthcare system. This study aimed to characterize the incremental burden of migraine in individuals who suffer from ≥4 monthly headache days (MHDs) by examining health-related quality of life (HRQoL), impairments to work productivity and daily activities, and healthcare resource utilization (HRU) in the EU5 (France, Germany, Italy, Spain, United Kingdom). Methods This retrospective cross-sectional study used data from the 2016 National Health and Wellness Survey (NHWS; N = 80,600). Short-Form 36-Item Health Survey, version 2 (SF-36v2) physical and mental component summary scores (PCS and MCS), Short-form-6D (SF-6D), and EuroQoL (EQ-5D), impairments to work productivity and daily activities (Work Productivity and Activity Impairment Questionnaire (WPAI), and HRU were compared between migraine respondents suffering from ≥4 MHDs (n = 218) and non-migraine controls (n = 218) by propensity score matching using sociodemographic characteristics. Chi-square, T-tests, and Mann-Whitney tests were performed to determine significant differences between the groups after propensity score matching. Results HRQoL was lower in migraine individuals suffering from ≥4 MHDs compared with non-migraine controls, with reduced SF-36v2 PCS (46.00 vs 50.51) and MCS (37.69 vs 44.82), SF-6D health state utility score (0.62 vs 0.71), and EQ-5D score (0.68 vs 0.81) (for all, p < 0.001). Respondents with migraine suffering from ≥4 MHDs also reported higher levels of absenteeism from work (14.43% vs 9.46%; p = 0.001), presenteeism (35.52% vs 20.97%), overall work impairment (38.70% vs 23.27%), and activity impairment (44.17% vs 27.75%) than non-migraine controls (for all, p < 0.001). Additionally, HRU was significantly higher for individuals with ≥4 MHDs compared to their matched controls. Consistently, migraine subgroups (4–7 MHDs, 8–14 MHDs and CM) had lower HRQoL, greater overall work and activity impairment, and higher HRU compared to non-migraine controls. Conclusions Migraine of ≥4 MHDs was associated with poorer HRQoL, greater work productivity loss, and higher HRU compared with non-migraine controls. The findings of the study suggest that an unmet need exists among individuals suffering from ≥4 MHDs in the EU5 suggesting the need for effective prophylactic treatments to lessen the humanistic and economic burden of migraine