Health care and hospitalisation costs of cardiovascular disease (CVD) in Thailand

Background: Cardiovascular disease (CVD) has become a leading cause of death and disability in Thailand due to the unhealthy lifestyle of the populace; triggering high risk of exposure to CVD, increase in the number of hospital admissions year on year. Objectives: The concerns generated by the inflation in the health care expenditure among service providers motivated this study to examine the costs of hospitalisation of inpatients with (CVD) conditions in Thailand, 2009. Methods: Anonymised secondary data of 327,435 CVD inpatients under “Universal Coverage” (UC) health care scheme were obtained from the National Health Security Office (NHSO), Thailand. The data(51.69%- women and 48.31% - men) were classified using International Classification of Diseases, Tenth Revision (ICD-10) code, of which I20-I25 are Ischemic heart disease (IHD), I60-I69 are stroke and I00- I99areallCVD conditions. Results: Average costs of treatments for all CVD conditions, IHD and stroke were ฿21,921 (£1 = ฿50), ฿32,884 (highest) and ฿25,617.67per patient respectively. Absolute total cost increased with age and the cost of admission of male patients is higher than female. The average (three months) length of stay for stroke patients was found to be the highest. Conclusion: Providers generally spent a total of ฿7,177 million on the treatment of CVD with IHD and stroke taking ฿2,544 million and ฿1,920 million respectivel

The Impact of Risk Factors Reduction Scenarios on Hospital Admissions, Disability-Adjusted Life Years and the Hospitalisation Cost of Cardiovascular Disease in Thailand

Cardiovascular disease (CVD) is considered to be one of the leading health issues in Thailand. CVD not only contributes to an increase in the number of hospital admissions year by year but also impacts on the rising health care expenditure for the treatment and long-term care of CVD patients. Therefore, this study is aimed at examining the impacts of risk reduction strategies on the number of CVD hospital admissions, Disability-Adjusted Life Years (DALYs) and the costs of hospitalisation. To estimate such impacts a CVD cost-offset model was applied using a Microsoft Excel spreadsheet. The number of the mid-year population was classified by age, gender and the CVD risk factor profiles from the recent Thai National Health Examination Survey (NHES) IV. This survey was chosen as the baseline population. The CVD risk factor profiles included age, gender, systolic blood pressure, total cholesterol, and smoking status. The Asia-Pacific Collaborative Cohort Study (APCCS) equation was applied to predict the probability of developing CVD over the next eight-year period. Estimates on the following were obtained from the model: 1) the CVD events both fatal and non-fatal; 2) the difference between the projected number of deaths and the actual number of deaths in that population; 3) the number of patients who are expected to live with CVD; 4) the DALYs from the estimated number of fatal and non-fatal events; 5) the cost of hospital admissions. Four CVD risk strategy scenarios were investigated as follows: 1) the do-nothing scenario; 2) the optimistic scenario; 3) achieve the UN millennium development goal; and 4) the worst-case scenario. The findings showed that over the next eight years, there are likely to be 3,297,428 recorded cases of CVD; 5,870,049 cases of DALYs; and, approximately ฿57,000 million, ($1.9 billion), is projected as the total cost of hospital admissions. However, if the current health policy can reduce the levels of risk factors as defined in the optimistic scenario or such policy meets the specifications of the UN millennium development goal, there would be a significant reduction in the number of hospital admissions. These are estimated to be a reduction of 522,179 male and 515,416 female cases. With these results, it is expected that health care costs would save approximately ฿9000 million, ($298.3 million), for CVD and 900,000 million DALYs over the next eight years. However, if there is an upward trend in the risk factors as predicted in the worst-case scenario, then there will be an increase of 428,220 CVD cases; consequently, DALYs cases may rise by 766,029 while the hospitalisation costs may increase by approximately ฿7000 million, ($232.1 million). Based on our findings, reducing the levels of CVD risk factors in the population will drastically reduce: 1) the number of CVD cases; 2) DALYs cases; and 3) health care costs. Therefore it is recommended that the health policy should enhance the primary prevention programs which would be targeted at reducing the CVD risk factors in the population

Introduction of a non-ported peripheral intravenous catheter with multi-use blood control septum offers improvements in the overall efficiency of the procedure and is clinically well accepted

Financial challenges that the National Health Service (NHS), England, faces may jeopardise its future. This study evaluated the direct cost of using two different safety peripheral intravenous cannulae (SPIVC) with and without a blood control septum, including the cost of device and clinician time. Observation of 103 cannulations demonstrated a 54 second (29%) time reduction per cannulation with the non-ported SPIVC with multi-use blood control septum (Introcan Safety® 3 B Braun), compared to the standard ported SPIVC (Vasofix® Safety B Braun) (P<0.05). The direct cost analysis, including clinician time, demonstrated that the introduction of SPIVC with multi-use blood control septum could offer time efficiency savings equivalent to a reduction in average cannulation costs by 25%. Eighty two per cent of users perceived the insertion of SPIVC with multi-use blood control septum to be easy to use; 82% would choose to use it in clinical practice

A network science-based assessment methodology for robust modular system architectures during early conceptual design

This article describes a methodology to assess, during the early conceptual design stage, the robustness, and modularity of engineering system architectures, which integrates concepts from network science with engineering systems. The application specifically focuses on the architecture of the power, propulsion, and cooling systems of a naval ship. The methodology incorporates a binary Design Structure Matrix as the basis for an assessment of redundancy and modularity effects on robustness, in response to disruption of modules in the architecture. Robustness is used to drive the module selection, which supports the formulation of a robust module configuration subject to the level of redundancy in the system architecture. The case study results demonstrated: redundancy promotes robustness of the architecture and enables modularity; however, high levels of redundancy in comparison to medium level redundancy does not significantly improve robustness. The novel contribution of this article relates to the combined quantitative assessment of redundancy, modularity and robustness in a collective methodology. This methodology supports conceptual design decision making, allowing early prediction of compliance of requirements that enable cost, development time and survivability targets to be achieved

The assembly system for the lipopolysaccharide R2 core-type of Escherichia coli is a hybrid of those found in Escherichia coli K-12 and Salmonella enterica. Structure and function of the R2 WaaK and WaaL homologs.

In Escherichia coli F632, the 14-kilobase pair chromosomal region located between waaC (formerly rfaC) and waaA (kdtA) contains genes encoding enzymes required for the synthesis of the type R2 core oligosaccharide portion of lipopolysaccharide. Ten of the 13 open reading frames encode predicted products sharing greater than 90% total similarity with homologs in E. coli K-12. However, the products of waaK (rfaK) and waaL (rfaL) each resemble homologs in Salmonella enterica serovar Typhimurium but share little similarity with E. coli K-12. The F632 WaaK and WaaL proteins therefore define differences between the type R2 and K-12 outer core oligosaccharides of E. coli lipopolysaccharides. Based on the chemical structure of the core oligosaccharide of an E. coli F632 waaK::aacC1 mutant and in vitro glycosyltransferase analyses, waaK encodes UDP-N-acetylglucosamine:(glucose) lipopolysaccharide alpha1, 2-N-acetylglucosaminyltransferase. The WaaK enzyme adds a terminal GlcNAc side branch substituent that is crucial for the recognition of core oligosaccharide acceptor by the O-polysaccharide ligase, WaaL. Results of complementation analyses of E. coli K-12 and F632 waaL mutants suggest that structural differences between the WaaL proteins play a role in recognition of, and interaction with, terminal lipopolysaccharide core moieties

A network tool to analyse and improve robustness of system architectures

The architecture of a system is decided at the initial stage of the design. However, the robustness of the system is not usually assessed in detail during the initial stages, and the exploration of alternative system architectures is limited due to the influence of previous designs and opinions. This article presents a novel network generator that enables the analysis of the robustness of alternative system architectures in the initial stages of design. The generator is proposed as a network tool for system architectures dictated by their configuration of source and sink components structured in a way to deliver a particular functionality. Its parameters allow exploration with theoretical patterns to define the main structure and hub structure, vary the number, size, and connectivity of hub components, define source and sink components and directionality at the hub level and adapt a redundancy threshold criterion. The methodology in this article assesses the system architecture patterns through robustness and modularity network based metrics and methods. Two naval distributed engineering system architectures are examined as the basis of reference for the simulated networks. The generator provides the capacity to create alternative complex system architecture options with identifiable patterns and key features, aiding in a broader explorative and analytical, in-depth, time and cost-efficient initial design process

Developing a framework for estimating the potential impact of obesity interventions in a European city

Obesity is global challenge for healthy populations. It has given rise to a wide range of public health interventions, focusing on supportive environments and lifestyle change, including diet, physical activity and behavioural change initiatives. Their impact is variable. However, more evidence is slowly becoming available and is being used to develop new interventions. In a period of austerity, momentum is building to review these initiatives and understand what they do, how they do it and how they fit together. Our project seeks to develop a relatively straight forward systematic framework using readily accessible data to map the complex web of initiatives at a policy, population, group and individual level aiming to promote healthy lifestyles, diet and physical activity levels or to reduce obesity through medical treatments in a City or municipality population. It produces a system for classifying different types of interventions into groupings which will enable commissioners to assess the scope and distribution of interventions and make a judgement about gaps in provision and the likely impact on mean body mass index as a proxy measure for health. Estimated impact in each level or type of intervention is based upon a summary of the scientific evidence of clinical and/or cost effectiveness. Finally it seeks, where possible, to quantify the potential effects of different types of interventions on body mass index (BMI) and produce a cost per unit of BMI reduced. This approach is less sophisticated but identifies the areas where more sophisticated evaluation would add value

Risk factors associated with Cardiovascular Disease (CVD) in Thailand from the 4th National Health Examination Survey 2008-2009

Objectives: This study aims to describe the current situation of Cardiovascular Disease (CVD) and to explore the association of the modifiable risk factors with Coronary heart disease (CHD) and stroke in Thailand. Methods: The 4th National Health Examination Survey (NHESIV) dataset has been used in this study. 19,342 participants aged ≥15 years have completed the data gathering process on CVD risk factors have been included in the analysis, which comprises 9,246 men and 10,096 women. The descriptive statistic, the bivariate analysis and the multiple logistic regression have been performed to describe and explore the association among CVD risk factors, CHD and stroke. The modifiable risk factors included in the analysis are age, BMI, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), diabetes and regular smoking. Results: The mean age of the participants is 52.7 years. The prevalence of CHD was 2.5% in men, and 2.3% in women and the prevalence of stroke was 2.5% in men and 1.6% in women. The overall prevalence of diabetes was 10.1%, and regular smoking was 17.9%. When exploring the association of the modifiable risk factors with CHD and stroke, using the bivariate and multivariate analysis, the results show that factors associated with both CHD and stroke are being aged 55 and over, high blood pressure and diabetes. Obesity, high triglyceride level and low HDL-C, only showed association with CHD but does not show any significant association to stroke. Having a high triglyceride level was related to stroke just in women but does not show any association in men. The factors that do not show significant association in both CHD and stroke are high total cholesterol and being a regular smoker. Conclusions: Although the analysis of the cross-sectional data was not able to identify the cause and effect of the factors relating to CHD or stroke, it showed some association with these modifiable risk factors for CVD. The modifiable risk factors, such as high blood pressure, obesity and diabetes need to be of concern in considering the CVD prevention strategies in Thailan

Network-based metrics for assessment of naval distributed system architectures

The architecture of a system is generally established at the end of the conceptual design phase where sixty to eighty percent of the lifetime system costs are committed. The architecture influences the system’s complexity, integrality, modularity and robustness. However, such properties of system architecture are not typically analytically evaluated early on during the conceptual process. System architectures are defined using qualitative experience, and the early stage decisions are subject to the judgement of stakeholders. This article suggests a set of network-based metrics that can potentially function as early evaluation indicators to assess complexity, integrality, modularity and robustness of distributed system architectures during conceptual design. A new robustness metric is proposed that assesses the ability of architecture to support a level functional requirement of the system after a disruption. The new robustness metric is evaluated by an electrical simulation software (MATPOWER). A ship vulnerability assessment software (SURVIVE) was used to find potential disruptive events. Two technical case studies examining existing naval distributed system architectures are elaborated. Conclusions on the network modelling and metrics as early aids to assess system architectures and to choose among alternatives during the conceptual decision phase are presented