ABSTRACT
@#he increased use of health care services by elderly has placed greater pressure to an already strained health care resources. Thus, an accurate economic cost estimation for specific age-related diseases like dementia is essential. The objectives of this project are to estimate costs of treating patient dementia among Malaysian elderly in the hospital settings. Two types of data were collected: Hospital costing data (using costing template) and patient clinical data (using questionaire). The cost analysis for hospital setting was carried out using a step-down costing methodology. The costing template was used to organize costing data into three levels of cost centers in hospitals: overhead cost centers (e.g. administration, consumables, maintenance), intermediate cost centers (e.g. pharmacy, radiology), and final cost centers (all wards and clinics). In estimating the cost for each cost center, both capital cost (building, equipment and furniture cost) and recurrent cost (staff salary and recurrent cost except salary) were combined. Information on activities which reflects the workload such as discharges, inpatient days, number of visit, floor space etc., are gathered to determine an appropriate allocation factor. In addition, for each final cost center, the fully allocated costs are then divided by the total unit of in-patient days to obtain the cost of providing services on a per-patient per-day of stay basis, referred as unit cost. The unit cost is finally multiplied with the individual patient’s length of stay to obtain the cost of care per patient per admission. All these steps were simplified by using the Clinical Cost Modeling Software Version 3.0 (CCM Ver. 3.0). The mean cost of dementia cases per episode of care was RM 12,806 (SD=10,389) with the length of stay of 14.3 (SD=9.9) days per admission. The top three components of cost for the treatment of dementia were the ward services 8,040 (SD=7,512), 62.78% of the total cost, followed by the pharmacy 1,312(SD=1,098), 10.25% of the total cost and Intensive Care Unit 979 (SD=961), 7.64% of the total cost. A multivariable analysis using multiple linear regressions showed that factors which significantly influence (p<0.05) the treatment costs of dementia cases were the length of stay (p<0.001), followed by age (p=0.001), case type severe (p=0.005) and study location (p=0.032). However, the factor length of stay is the tremendous parameter. In conclusion, data collection from selected hospitals as well as patient level data from medical record unit were successfully used to estimate the provider costs of hospital for the elderly with dementia disease. Results from the project will enable an assessment on the economic impact and consequences of cognitive impairment in an aged population. A cost quantification and distributive mapping of the burden of care can assist in policy implementation through targeted intervention for at-risk groups, which will translate into savings by means of delayed onset or progression of dementia.
Subject(s)
DementiaABSTRACT
The epidemiology of sexually transmitted diseases suggests a heightened risk for young adults, especially university students. Unsafe sexual behaviors are one of the high risk factor for HIV transmissions. The study aimed to explore high risk behaviors associated with HIV/AIDS among health science student in Konya, Turkey. A cross-sectional survey was conducted in October 2016 among 246 undergraduate students in Health Science faculty, Necmettin Erbakan University. A self-administered standard questionnaire was used for data collection. Socio-demographic distribution was described using frequency and percentage and Chi-square test was used for analysis of the risk factors. Among the 246 participants in this study, the mean age of the participants was 19.8 ± 1.7, ranged from 18 to 38 years old. Majority of the respondents were female 76% (187). There were 84 (34.1%) respondents from department of nursing, 78 (31.7%) of them were from department of Health Management, 61 (28.8%) of them were from department of social work and 23 (9, 3%) of them were from department of nutrition and dietetics. 13.3% of all respondents had at least 1 risk behavior related to HIV/AIDS transmission. About 4% reported having unprotected sex (sex without condom); 2.4 % had unprotected sex more than 1 sexual partner; 1.4 % had unprotected sex with someone whose HIV status is unknown; 2.8 % had sex with sex workers, and 2.8% had sex under the influence of alcohol; 2.4% had sex by forced against their will. The study found that 13.3% of them reported having at least one high-risk behavior related to sex and unprotected sex.
ABSTRACT
@#Cancellation of surgical cases is increasingly considered as an adverse event that requires routine monitoring because of its effects on utilization of health system resources. The aim of this study was to determine prevalence and identify the reasons of cancellation of scheduled surgery Yazd ShohadaKargar hospital, Iran. This is a retrospectivestudy to descriptivereasons of surgery cancelation.Medical records were reviewed all patients scheduled for elective surgeries in a period of 1 year, starting from 21stof March 2011 to 20thof March2012. The reasons of surgery cancelation were divided as avoidable and unavoidable reasons. Statistical analysis was performed using SPSS version 20 software.A total of 14,670cases were scheduled to undergo elective surgical procedures. Of those, 274 cases were cancelled (1.87%). Majority 184 (67.2%) of cancelation was due to avoidable reasons other 90 (32.8%) due to unavoidable reasons. The highest number of cancelation caseswere occurred in the general surgical service 70 (25.5%) followed by orthopedic surgery 65 (24%) and Gynecology surgery 45 (16.5%). There were many causeswere recorded for cancellation of surgeries, the most common cause was cancellation due to patient medical problems (35.6%) and the second most common cause of cancellations was patient refusing the surgery (28.4%). The least cause of cancellations was due to problem with Facilities(4.4%). In conclusion, majority of the cancelation was due to avoidable reasons. The highest number of cancellation occurred in the general surgical, orthopedic surgery and Gynecology surgery.The most common causes for surgery cancelation were due to patient medical problems and patient refusing the surgery. The least cause was due to problem with Facilities.
ABSTRACT
Streptococcus pneumoniae (pneumococcus) is the most common cause of community-acquired pneumonia, meningitis, and bacteremia in children and adults, including the elderly, and is responsible for high rates of morbidity and mortality worldwide. Aim of this paper to review published articles on incidence of pneumococcal meningitis in children less than 5 years of age in Malaysia, Singapore and Thailand, and compare the incidence of pneumococcal meningitis among the children in the three courtiers. Literature searches were conducted using google scholar, PubMed, the World Health Organization (WHO) website of the Weekly Epidemiological Record, and the countries’ Ministry of Health (MOH) website, and were limited to articles written in English. All relevant publications/abstracts published/presented during the period December 2000 through March 2014. Searches were conducted from April 1, 2014, till July 11, 2014 using various combinations of the following search terms “ Pneumococcal diseases” OR “meningococcal” OR “pneumococcal meningitis” OR “meningococcus”. A total of five articles and abstracts described the incidence of pneumococcal meningitis among children 5 years old. These five documents include two conference abstracts from Malaysia, one published paper from Singapore and two published papers from Thailand. The Malaysian, Singaporean and Thai pneumococcal meningitis incidence rate was 3.8-8.6, 2.3 and 0.10-1.8 per 100,000 children respectively. Our review confirmed that the incidence rate of pneumococcal meningitis was vary among the countries. The highest incidence rate of pneumococcal meningitis was found in Malaysia followed by Singapore and Thailand.
Subject(s)
Child , Meningitis, PneumococcalABSTRACT
Occupational stress is one of the major health hazards among blue and white-collar workers. However there is no data on occupational stress among white-collar workers in Iran. Aim of this study was to investigate occupational stress among white collar employees in Esfahan Steel Company organization (ESCO), Iran. A cross– sectional survey was conducted through face to face interview using validated standardized questionnaire on occupational stress among 200 white-collar workers from ESCO who agreed to participate in the study, the response rate of participation was 100%. The logistic regression test was used to determine significant associated factors of occupational stress among the study sample.. It is found that among the six items measuring source of stress, the highest source of stress related to economic problem, 117 (59.7%). The statistical analysis showed sources of stress such as task type (p=0.0001), economic problem (p=0.0001), work environment (p=0.0001) and children problem (p=0.05) were significantly associated with having stress among the workers. We found that around half of the white collar workers were under stress at ESCO. Main sources of the occupational stress of white colour workers related to their work environment, economic problem; task type, and related their children.
Subject(s)
Stress, Psychological , Occupational HealthABSTRACT
As the Malaysian population ages, the burden of age-related cognitive disorders such as dementia and Alzheimer’s disease will increase concomitantly. This is one of the sub-study under a research project titled by quantify the cost of age-related cognitive impairment in Malaysia, which was undertaken to develop a clinical pathway for Mild Cognitive Impairment (MCI) and Dementia. The clinical pathway (CP) will be used to support the costing studies of MCI and Dementia. An expert group discussion (EGD) was conducted among selected experts from six (6) government hospitals from different states of Malaysia, Ministry of Health, and United Nations University, International Institute for Global Health, UKM and UPM. The expert group includes psychiatrist specialists and public health medicine specialists. A total of 15 participants took part in the EGD. The group was presented with the different approach in managing MCI and Dementia. Finally, the group came to the consensus agreement on the most appropriate and efficient ways of managing the two conditions. In the EGD, an operational definition for MCI and Dementia was agreed upon and a pathway was developed for the usual practice in the Malaysian health system. A typical case used, as a reference is a 60-year-old patient referred to a memory clinic with complaint of “forgetfulness”. After three outpatient visits in the clinic, the diagnosis of MCI and Dementia could be clinically established. The clinical pathways covered all active clinical and non-clinical management of the patient over a period of one year. The experts identified the additional resources required to manage these patients for the whole spectrum of lifetime based on the expected life expectancy. The Clinical pathway (CP) for MCI and Dementia was successfully developed in EGD with strong support from practitioners in the health system. The findings will help the researchers to identify all-important clinical activities and interventions that will be included in the costing study.
ABSTRACT
Rotavirus is a common infection causing 450,000 deaths annually primarily in children 5 years and below. Despite the high burden of disease, little is known about the epidemiology of rotavirus in Libya. The aim of this study was to estimate the rotavirus disease burden among Libyan children. A cross-sectional study was carried out prospectively among children 5 years old and below between August 2012 and April 2013. Stool samples of children with diarrhea attending the outpatient department or admitted to the pediatric wards, at three public hospitals within the northwestern region of Libya were tested for rotavirus. The seasonality, symptomology demographics and outcomes of rotavirus cases were determined and compared to other diarrhea illnesses. An estimated incidence rate per 100,000 children aged 5 years and below was determined. A total of 545 children with diarrhea were identified for participation. Results of rotavirus immunoassays determined 57% of cases were caused by rotavirus. Inpatients were more likely to be rotavirus positive than outpatients [58% vs. 53%, P<0.05], Most rotavirus positive cases [86%] were found among children below 2 years of age. Rotaviral cases peaked in the winter, constituting 76% of diarrheal illness in February and very few rotavirus cases in the summer months. The incidence rate of rotavirus diarrhea was estimated at 640/100,000 children aged 5 years and below. Rotavirus infection poses a significant disease burden in Libya. Preventive measures such as proper hygiene should be emphasized. Introduction of vaccination against rotavirus into the national immunization program should be examined, as it would likely be a cost-effective investment