Multimorbidity and associated outcomes among older adult inpatients with neurological disorders / Multimorbidade e desfechos associados entre idosos hospitalizados com doenças neurológicas

ABSTRACT Background: Multimorbidity is common among adults and associated with socioeconomic deprivation, polypharmacy, poor quality of life, functional impairment, and mortality. Objectives: To identify the frequency of multimorbidity among older adults inpatients with neurological disorders (NDs), stratify clusters of chronic comorbidities associated with NDs in degrees, and verify whether multimorbidity was associated with demographic data, readmission, long length of hospital stay (LOS), and hospital mortality in this population. Methods: We enrolled patients aged ≥60 years successively admitted to a tertiary medical center with NDs between January 1, 2009, and December 31, 2010. Results: Overall, 1,154 NDs and 2,679 comorbidities were identified among 798 inpatients aged ≥60 years (mean: 75.76±9.12). Women comprised 435 (54.51%) of patients. Multimorbidity was detected in 92.61% (739) of patients, with a mean of 3.88±1.67 (median: 4.0), ranging from 2 to 10 chronic diseases. Patients with epilepsy, dementia, and movement disorders had the highest degrees of clusters of chronic morbidities (>50% of them with ≥5 chronic disorders), followed by those with cerebrovascular and neuromuscular disorders. Multimorbidity was associated with long LOS (p<0.001) and readmission (p=0.039), but not with hospital mortality (p=0.999). Conclusions: Multimorbidity was preponderant among older adults inpatients with NDs, and NDs had a high degree of associated chronic comorbidities. Multimorbidity, but not isolated NDs, was associated with readmission and long LOS. These results support ward-based, neurohospitalist-directed, interdisciplinary care for older adults inpatients with NDs to face multimorbidity.

RESUMO Introdução: A multimorbidade é comum entre idosos e está associada a privação socioeconômica, polifarmácia, má qualidade de vida, déficit funcional e mortalidade. Objetivos: Identificar a frequência da multimorbidade entre pacientes idosos hospitalizados com doenças neurológicas (DN), estratificar combinações de comorbidades crônicas associadas às DN em graus e verificar se a multimorbidade foi associada a dados demográficos, readmissão, longo tempo de internação (TDI) e mortalidade hospitalar nessa população. Métodos: Foram incluídos pacientes com ≥60 anos sucessivamente admitidos com DN em um centro médico terciário entre 1º de janeiro de 2009 e 31 de dezembro de 2010. Resultados: Um total de 1.154 DN e 2.679 comorbidades foram identificados entre 798 pacientes com idade ≥60 anos (média: 75,76±9,12). Mulheres representaram 435 (54,51%) dos pacientes. A multimorbidade foi detectada em 92,61% (739) dos pacientes (média de 3,88±1,67; mediana de 4), variando de 2 a 10 doenças crônicas. Pacientes com epilepsia, demência e distúrbios do movimento apresentaram os maiores graus de morbidades crônicas (>50% deles com ≥5 doenças crônicas), seguidos por doenças cerebrovasculares e neuromusculares. A multimorbidade foi associada com longo TDI (p<0,001) e readmissão (p=0,039), mas não com mortalidade hospitalar (p=0,999). Conclusões: A multimorbidade foi preponderante entre os pacientes idosos internados com DN, as quais tiveram altos graus de comorbidades crônicas. A multimorbidade, mas não as DN isoladas, foi associada a readmissões e longo TDI. Esses resultados respaldam uma assistência interdisciplinar para idosos hospitalizados com DN em enfermarias lideradas por neurologistas hospitalistas para enfrentar a multimorbidade.

Retrospective cost-utility and budget impact assessments of Hypericum perforatum in contrast with Fluoxetine treatment for depression in Karachi, Pakistan

In this study we have compared two different types of therapies i.e. herbal and allopathic system of therapies for Depression and studied them from the social perspectives. The Hypericum perforatum is compared with Fluoxetine [HCL] in terms of cost-utility and financial savings thereby evaluating its influence on annual expenditure of depressive patients that were randomly selected from 178 union councils of the city of Karachi, Pakistan. For both system of therapies a total of 356 patients were selected by stratified random sampling. Taking frequency of depression as '1' annually with discount rate at 3% for calculating the burden-of-illness in terms of disability-adjusted-life-years. The cost-utility and the budget-impact assessments were carried out to assess incremental-cost-effectiveness-ratio, and the budget-impact-per-onset as well as budget-impact-per-year values. In comparison with the Fluoxetine therapy, the Hypericum perforatum was found to relieve symptoms in 21.47% less cost; owing 29.23% less disability-adjusted-life-years and 21.45% less budget-impact-per-onset as well as budget-impact-per-year. The annual mean incremental-cost-effectiveness-ratio was found to be at 36.95±270.74 (less than GDP per capita threshold of Rs. 38,173.02). Hypericum perforatum provide the optimal utility with less impact on budget of a patient in comparison with the treatment of symptoms of depression with Fluoxetine.

Influence of Caring Burden and the Way of Coping on Burnout in Caregivers of Cancer Patients / 산업간호학회지

PURPOSE: The aims of this study were to identify the effects of caring burden and the way of coping on burnout in caregivers of cancer patients. METHODS: One-hundred and forty family caregivers of cancer patients who visited the cancer center at one tertiary hospital in metropolitan city B were included. The data collection was conducted from August 1st to October 1st, 2018, using a structured, self-reported questionnaire. The collected data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson correlation coefficients, and multiple regression. RESULTS: In the multiple regression analysis, the subject's gender (β=.12, p=.028) and caring burden (β=.74, p<.001) had a significant effect on burnout. The explanatory power of the subject's gender, education level, religion, caring time, number of family caregivers, monthly income, economic burden, expectation for treatment, caring burden, the way of aggressive coping, and the way of passive coping with burnout was 63.8% (F=23.28, p<.001). CONCLUSION: Reducing the caring burden in family caregivers of cancer patients will ultimately contribute to reducing burnout, thereby contributing to an improvement in the psychological well-being and quality of life of family members, as well as positively contributing to the recovery of patients.

The Burden of Acute Pesticide Poisoning and Pesticide Regulation in Korea

BACKGROUND: This study aimed to estimate the burden of acute pesticide poisoning and to determine its trend with recently implemented pesticide regulations. METHODS: Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) due to acute pesticide poisoning using the methods of the Global Burden of Disease Study 2013. The values of YLLs, YLDs, and DALYs were stratified by sex, age groups, intentionality of poisoning, and causative agents. RESULTS: From 2006 to 2014, DALYs decreased by 69% (from 69,550 to 21,742). The decreasing tendency of DALYs was especially marked from 2011. The total burden of acute pesticide poisoning was mainly caused by YLLs and intentional pesticide poisoning. The highest DALYs due to acute pesticide poisoning occurred in those in their 40s and 50s; however, the decreased rates of DALYs were higher in those aged 10–49 years than in those aged more than 50 years. Herbicides including paraquat contributed to the largest proportion of total DALYs. CONCLUSION: As this is the first study to quantify the burden of acute pesticide poisoning using DALYs, our results provide comprehensive evidence of the importance of using strict regulations to prevent public health hazards due to acute pesticide poisoning.

Prevalence and socioeconomic burden of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by persistent respiratory symptoms and irreversible airflow obstruction. It is caused by smoking, occupational exposure, and air pollution. It shows a high prevalence, both in South Korea and worldwide. The global COPD prevalence is 11.7%, and a similar prevalence has been reported in South Korea. In the Korea National Health and Nutrition Examination Survey 2010–2016, the prevalence of COPD was found to be between 13.1% to 14.6%. The prevalence of COPD is increasing continuously. Aging, male sex, smoking, and air pollution are risk factors of COPD. However, COPD is strikingly under-recognized given its prevalence. Three million people die annually due to COPD, and the mortality burden of COPD is increasing along with population aging. The socioeconomic burden of COPD is becoming enormous.

Economic costs and burden of dengue disease in Cavite Province, Philippines / Custos econômicos e impacto da dengue na Província de Cavite, Filipinas

AIMS: To determine the economic costs and the burden of dengue disease in Cavite Province, one of the areas highly inflicted by dengue disease in the Philippines. METHODS: This study used Disability Adjusted Life Years (DALYs) to calculate burden of dengue disease and quantified direct and indirect costs due to hospitalization and ambulatory dengue cases. DALYs were estimated using methods developed by the World Health Organization and the World Bank. We specifically calculated Years of Life Lost from 2009 to 2014 using patient-level data from hospitals and derived Years Lived with Disability from hospital records of dengue specific type (dengue fever/dengue hemorrhagic fever) in Cavite Province. RESULTS: An annual cost of Philippine Peso (PHP) 99,147,173 which is equivalent to United States Dollar (USD) 2,300,000 was obtained. The average annual cost per dengue case was PHP 32,324 (USD 734). The 21-25 age sub-groups had the highest average annual direct cost which amounted to PHP 243,181 (USD 5,526), followed by the 45-54 age sub-groups which amounted to PHP 201,481 (USD 4,579). From 2009 to 2014, the annual burden of disease was estimated at 178,282 DALYs (equivalent to one DALY lost per 17 persons in Cavite Province). CONCLUSIONS: The estimates of costs and DALYs suggested substantial dengue disease burden and economic costs in Cavite Province, Philippines.

OBJETIVOS: Determinar os custos econômicos e o impacto da dengue na Província de Cavite, uma das áreas altamente infligidas por dengue nas Filipinas. MÉTODOS: Este estudo utilizou os anos de vida ajustados por incapacidade (Disability Adjusted Life Years - DALYs) para calcular o impacto da dengue e quantificar os custos diretos e indiretos devidos aos casos de dengue atendidos em hospital ou em ambulatório. Os DALYs foram estimados usando métodos desenvolvidos pela Organização Mundial de Saúde e pelo Banco Mundial. Calculamos especificamente os anos de vida perdidos entre 2009-2014, usando dados dos pacientes hospitalizados. Os anos vividos com incapacidade foram derivados de registros hospitalares sobre o tipo específico da dengue (dengue clássica / dengue hemorrágica) na Província de Cavite. RESULTADOS: Foi identificado um custo anual de 99.147.173 pesos das Filipinas (PHP), equivalentes a 2.300.000 dólares dos Estados Unidos (USD). O custo médio anual por caso de dengue foi 32.324 PHP (734 USD). O subgrupo etário 21-25 anos teve o maior custo direto anual, que atingiu 243.181 PHP (5.526 USD), seguido pelo subgrupo 45-54 anos, que atingiu 201.481 PHP (4.579 USD). De 2009 a 2014, o impacto anual da doença foi estimado em 178,282 DALYs (equivalentes a um DALY pedido por cada 17 pessoas na Província de Cavite). CONCLUSÕES: As estimativas de custos e os DALYs sugerem um alto impacto e substanciais custos econômicos da dengue na Província de Cavite, Filipinas.

The burden of disease of cancer in the Mexican Social Security Institute / La carga de la enfermedad debida al cáncer en el Instituto Mexicano del Seguro Social

Abstract: Objective: To estimate the disease burden of cancer in the affiliate population of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS) in 2010 by delegation. Materials and methods: The Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability/Disease (YLD) for 21 specific cancers and a subgroup of other malignant neoplasms were calculated based on the methodology of the Global Burden of Disease Study (GBD) for each of the 35 delegations of the IMSS. Results: In 2010, cancer represented the fifth overall leading cause of disease burden in IMSS affiliates (16.72 DALYs/1000 affiliates). A total of 75% of the cancer disease burden in each delegation is due to ten specific cancers, particularly breast cancer, which ranks first in 82% of the delegations. Prostate cancer; tracheal, bronchial, and lung cancers; leukemia, and colorectal and stomach cancers occupy the second to fourth positions in each delegation. With the exception of breast and prostate cancer, for which the contribution of YLD to the DALYs was higher than 50%, the greatest contribution to the DALYs of the other cancers was premature mortality, which accounted for more than 90% of the DALYs in some cases. Conclusion: The results obtained in this study allow for the identification of intervention priorities with regard to cancer at the institutional level and also for the focus at the delegation level to be placed on cancers ranking in the top positions for disease burden.

Resumen: Objetivo: Estimar, por delegación, la carga de enfermedad debida al cáncer en la población derechohabiente del Instituto Mexicano del Seguro Social (IMSS) para el año 2010. Material y métodos: Se calcularon los años de vida perdidos ajustados por discapacidad (AVISA), los años perdidos por muerte prematura (APMP) y los años vividos con discapacidad (AVD) para 21 cánceres específicos y un subgrupo de otras neoplasias malignas, con base en la metodología del Global Burden of Disease Study (GBD) para cada una de las 35 delegaciones en las que se divide el IMSS al interior del país. Resultados: En el año 2010, el cáncer representó la quinta causa de carga de enfermedad en derechohabientes del IMSS (16.72 AVISA/1000 derechohabientes). El 75% de la carga de enfermedad por cáncer en cada delegación se debe a diez cánceres específicos entre los que destaca el cáncer de mama, que ocupa el primer lugar de importancia en 82% de las delegaciones. Los cánceres de próstata, tráquea, bronquios y pulmón, leucemias, de colon y recto, así como el de estómago, se ubican entre las segundas y cuartas posiciones en cada delegación. Con excepción del cáncer de mama y de próstata, cuya contribución de los AVD a los AVISA fue superior a 50%, en los demás cánceres la mayor contribución fue debida a la mortalidad prematura, en algunos superior a 90% de los AVISA. Conclusión: Los resultados obtenidos en este estudio permiten identificar las prioridades de intervención en materia de cáncer a nivel institucional y focalizarlas a nivel delegacional para los cánceres que ocupan los primeros lugares de carga de enfermedad.

Characterizing comorbidities, a step to organize the patient's problems list / Caracterizando comorbidades, um passo para organizar a lista de problemas

Uma lista de problemas precisa e atualizada é essencial em um Registro Eletrônico em Saúde (RES) orientada a problemas. A falta de organização e categorização dos problemas limitam o resultado. Há certos problemas que afetam mais a evolução clínica do paciente, o que denominamos comorbidades. OBJETIVOS: O propósito deste artigo é caracterizar o conceito de comorbidade; bem como, classificar e identificar as comorbidades. MÉTODOS: Realizamos uma busca bibliográfica para caracterizar o conceito de comorbilidade. Posteriormente analisamos a RES do Hospital de Buenos Aires desde 1998 a 2015. Todos os problemas registrados nas epícrises como comorbidades foram tomados para análise. RESULTADOS: 20.849 ID-conceitos foram registrados e identificados inicialmente na epícrises. 90% foi levado para análise individual. 614 conceitos foram identificados como comorbidades (80,24% de registros). CONCLUSÕES: A maioria dos problemas analisados foram caracterizados como comorbidades, condizendo com a observação que gerou uma lista com as comorbidades mais frequentes.(AU)

An accurate and updated problems list is critical in a problem oriented Electronic Health Record (EHR). Thelack of organization and categorization of the problems limits the value of the list. There are certain problems that affect more than others the clinical evolution of the patient, these are known as comorbidities. OBJECTIVS: Characterize the comorbidity concept and identify, and classify the comorbidities. METHODS: A literature search of available definitions to characterize the concept "comorbidity". Then we analyzed theEHR in a Hospital from 1998 to 2015. All recorded problems as comorbidities conditions in patient discharge summaries were taken for analysis. RESULTS: 20,849 ID-concepts were initially obtained as comorbidities in patient discharge summaries. The 90% more frequent were taken for individual analysis. 614 ID-concepts were identied as comorbidities (80.24% of all records). CONCLUSIONS: Most of the problems analyzed were characterized as comorbidities making a list of the most frequently recorded.(AU)

Factors Influencing Burden among Family Caregivers of Elderly Cancer Patients

PURPOSE: This study was to identify factors influencing burden among family caregivers of elderly cancer patients. METHODS: The participants were 217 family caregivers who visited inpatient & outpatient clinics for elderly cancer patients at two general hospitals. Data were collected utilizing the Perceived Health Status Scale, Herth Hope Index Scale, Medical Outcome Study-Social Support Scale, and Caregiver Reaction Assessment Scale. RESULTS: The level of burden in the participants was moderate to high. There were significant correlations among perceived health status, hope, social support and burden. In multiple regression analyses, the most powerful predictor of burden in family caregivers was hope (36.0%). Overall, other caregivers, perceived economic status, caring time, gender, patients' confusion, tangible support, and perceived health status explained 61.0% of the variance of burden among the participants. CONCLUSION: The study highlights the importance of hope on burden in family caregivers. Thereby, integrative interventions are needed to enhance hope and social support and to promote caregivers' health status for alleviating-burden among family caregivers.

Other Side of Breast Cancer: Factors Associated with Caregiver Burden

PURPOSE: This study aimed to determine factors associated with caregiver burden among primary caregivers of women with breast cancer in Iran. METHODS: This was a descriptive correlation study conducted in 2012 on 150 main caregivers of patients with breast cancer who came to the oncology clinic of Shahid Ghazi hospital in Tabriz, Iran. A questionnaire which included caregiving-related factors and the Zarit Burden Interview was used for data collection after its validity and reliability were determined. Data was analyzed using SPSS 13.0 software with descriptive and analytic statistics. The association between significant variables and the dependent variable with an observation of the effects of other variables was assessed using the multiple linear regression model. RESULTS: The mean age of caregivers was 39.60 ± 13.80 years old, and 77 (51.3%) of them were men. The mean score of the Zarit Burden Interview was 30.55 ± 19.18. In the regression model, the mean score of activities of daily living, level of education, gender, and financial status were identified as the determining factors of the burden of caregivers. CONCLUSIONS: Primary caregivers need to be financially supported by the relevant organizations. Care skills training and providing palliative care seem helpful in reducing the pain and the burden of family caregivers for patients with breast cancer.

A Prediction Model for Unmet Needs of Elders with Dementia and Caregiving Experiences of Family Caregivers

PURPOSE: The purposes of this study were to develop and test a prediction model for caregiving experiences including caregiving satisfaction and burden in dementia family caregivers. METHODS: The stress process model and a two factor model were used as the conceptual frameworks. Secondary data analysis was done with 320 family caregivers who were selected from the Seoul Dementia Management Survey (2014) data set. In the hypothesis model, the exogenous variable was patient symptomatology which included cognitive impairment, behavioral problems, dependency in activity of daily living and in instrumental activity of daily living. Endogenous variables were caregiver's perception of dementia patient's unmet needs, caregiving satisfaction and caregiving burden. Data were analysed using SPSS/WINdows and AMOS program. RESULTS: Caregiving burden was explained by patient symptomatology and caregiving satisfaction indicating significant direct effects and significant indirect effect from unmet needs. The proposed model explained 37.8% of the variance. Caregiving satisfaction was explained by patient symptomatology and unmet needs. Mediating effect of unmet needs was significant in the relationship between patient symptomatology and caregiving satisfaction. CONCLUSION: Results indicate that interventions focusing on relieving caregiving burden and enhancing caregiver satisfaction should be provided to caregivers with high levels of dementia patients' unmet needs and low level of caregiving satisfaction.

The burden of human influenza in Malaysia

Seasonal and pandemic influenza causes considerable morbidity and mortality globally, but the burden of disease is understudied and underreported in developing countries such as Malaysia. Before considering the cost-effectiveness of introducing interventions such as vaccines to control influenza, it is imperative to determine clinical and socioeconomic impact of the disease. This review summarises the main available literature on human influenza in Malaysia, the possible reasons for the lack of study and awareness of influenza, and important knowledge gaps for future study.

Economic Burden of Cancer in Korea during 2000-2010 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study estimated the economic burden of cancer in Korea during 2000-2010 by cancer site, gender, age group, and cost component. MATERIALS AND METHODS: Data came from national health insurance claims data and information from Statistics Korea. Based on the cost of illness method, this study calculated direct, morbidity and mortality cost of cancer in the nation during 2000-2010 by cancer site, gender, and age group. RESULTS: With an average annual growth rate of 8.9%, the economic burden of cancer in Korea increased from 11,424 to 20,858 million US$ (current US dollars) during 2000-2010. Colorectal, thyroid, and breast cancers became more significant during the period, i.e., the 5th/837, the 11th/257, and the 7th/529 in 2000 to the 3rd/2,210, the 5th/1,724, and the 6th/1,659 in 2010, respectively (rank/amount in million US$ for the total population). In addition, liver and stomach cancers were prominent during the period in terms of the same measures, i.e., the 1st/2,065 and the 2nd/2,036 in 2000 to the 1st/3,114 and the 2nd/3,046 in 2010, respectively. Finally, the share of mortality cost in the total burden dropped from 71% to 51% in Korea during 2000-2010, led by colorectal, thyroid, breast, and prostate cancers during the period. These results show that the economic burden of cancer in Korea is characterized by an increasing importance of chronic components. CONCLUSION: Incorporation of distinctive epidemiological, sociocultural contexts into Korea's cancer control program, with greater emphasis on primary prevention such as sodium-controlled diet and hepatitis B vaccination, may be needed.

Familia, en la salud y en la enfermedad... mental / Family, Through Mental Health and Sickness

El presente artículo deriva del estudio «Representaciones sociales en el campo de la salud mental¼, la cual se propuso como objetivo abordar las representaciones sociales acerca de la salud y la enfermedad mental con los familiares de personas con trastorno mental mediante un método cualitativo. El corpus fue construido a partir del análisis e interpretación de lo manifestado por los familiares de pacientes con enfermedad mental, en 17 entrevistas individuales, 13 entrevistas grupales y un grupo familiar, convocados a propósito de la asistencia clínica del familiar en tres instituciones hospitalarias de Bogotá. Se configuran tres categorías comprensivas para descifrar la vida cotidiana y analizar la relación con las vivencias de la familia en la salud y la enfermedad mental: a) familia en las buenas y en las malas; b) la enfermedad mental en su correlato familiar, y c) los cuidados y su desdoblamiento como carga. Se concluye que la representación de «familia¼ constituye el tejido estructural de las significaciones de las relaciones familiares para afrontar la enfermedad mental; se cuestiona la representación social de «familia unida¼ cuando el grupo familiar asume el cuidado de un pariente con trastorno mental. La enfermedad mental como representación social entraría una deshumanización que discrimina y estigmatiza, propiciada en el propio círculo filial y la marca del diagnóstico en las formas comunicativas y relacionales del grupo familiar. Los cuidados se sustentan en el ordenamiento patriarcal por asignación y auto asignación, y encuentra alternativas en la institucionalización o en el sino de la carga, porque se considera que la familia no es el mejor espacio de cuidado para la persona con trastorno mental.

The following article arises from the study "Representaciones sociales en el campo de la salud mental" (Social Representations in the Mental Health Field), in which the objective was to address the social representations in the family context; concerning caring, as well as the burden it implies using a qualitative method. The corpus was built based on the analysis and interpretation gathered from families with mental illness members. There were 17 individual interviews, 13 group interviews and one family group of three generations, held regarding the clinical care of the family member. These interviews were held at three different hospitals in Bogota. The representation of "a family" constitutes the structuring of the meanings of family relationships that cope with mental illness built upon the social and historical life of its members. The three comprehensive categories were: a) Family in good times and bad times; b) mental illness in family interactions, and c) Care and burden. Socially speaking, mental illness can lead to dehumanization, in that it discriminates and stigmatizes, even within the family unit. Caring for a family member with mental illness comes about by hierarchical order, self assignation, and by institutionalization. This latter occurs due to lack of caregivers or because the family does not consider their home the best place to care for such a patient.

Nursing Needs and Burden of Family Caregivers of Middle-Aged Hepatocellular Carcinoma Patients

PURPOSE: The purpose of this study was to identify nursing needs and burden of family caregivers of middle-aged patients with hepatocellular carcinoma. METHODS: The participants of this study were 101 family caregivers from 3 university hospitals in D city, South Korea. The levels of nursing needs and burden of family caregivers were measured using structured questionnaires from August 1, 2011 to February 29, 2012. The collected data were analyzed using t-tests, ANOVA, Scheffe tests, and Pearson's correlation coefficients. RESULTS: The greatest nursing need was for information about patients' health status. Among subdomains of burden, financial burden had the greatest mean score. Family caregivers with worsened health status since starting caregiving had significantly higher levels of total nursing needs and total burden. Total burden and physical burden scores showed significant correlations with all subdomains of nursing needs as well as total nursing need scores. CONCLUSION: Findings of this study suggest that family caregivers of middle-aged patients with hepatocellular carcinoma need provision of information about patients' health status and treatment plans, and financial support the most. Also maintaining family caregivers' health needs to be considered when providing nursing intervention for patients with hepatocellular carcinoma and their family caregivers.

Magnitude, Distribution, and Estimated Level of Underreporting of Acute Gastroenteritis in Jamaica.

Jamaica is the third largest island in the Caribbean. The epidemiology of acute gastroenteritis (AGE) is important to Jamaica, particularly in the areas of health, tourism, and because of the potential impact on the local workforce and the economy. Data collected by the National Surveillance Unit on the prevalence of AGE transmitted by food are not accurate. To determine the true magnitude, risk factors, and the extent of underreporting of AGE in Jamaica, we conducted a cross-sectional, population-based retrospective survey during the periods of 21 February–7 March and 14-27 June 2009, corresponding to high- and low-AGE season respectively. Of the total 1,920 persons selected randomly by a multistage cluster-sampling process, 1,264 responded (response rate 65.8%). Trained interviewers administered a standardized, validated questionnaire during face-to-face interviews. The overall prevalence of self-reported AGE was 4.0% (95% CI 2.9-5.1) at a rate of 0.5 episodes/per person-year. The highest monthly prevalence of AGE (14.6%) was found among the 1-4 year(s) age-group and the lowest (2.1%) among the 25-44 years age-group. Of the 18 cases (36%) who sought medical care, 11% were hospitalized, 33% were treated with antibiotics, and 66.7% received oral rehydration fluids. Only 2 cases who sought medical care reportedly submitted stool specimens. The mean duration of diarrhoea was 3.1 days, which resulted in a mean loss of 4 productive days, with over half of the cases requiring someone to care for them. The burden of syndromic AGE for 2009 was extrapolated to be 122,711 cases, showing an underreporting factor of 58.9. For every laboratory-confirmed AGE case, it was estimated that 383 more cases were occurring in the population. This research confirms that the prevalence of AGE is underreported in Jamaica and not being adequately detected by the current surveillance system. The components of the integrated surveillance system for AGE in Jamaica, particularly the laboratory aspect, need to be strengthened.

Determining the Community Prevalence of Acute Gastrointestinal Illness and Gaps in Surveillance of Acute Gastroenteritis and Foodborne Diseases in Guyana.

Guyana is an English-speaking country in South America and, culturally, it is part of the Caribbean. Objective of this study was to determine the community prevalence and true burden and economic impact of acute gastroenteritis (AGE) and foodborne diseases (FBDs) in Guyana. A cross-sectional population-based survey was conducted in 7 of the 10 regions in Guyana during August and November 2009 to capture the high- and low-AGE season respectively. Overall, 1,254 individual surveys were administered at a response rate of 96.5%. The overall monthly prevalence of self-reported cases of AGE was 7.7% (97 cases) (95% CI 6.3-9.3), and the yearly incidence was 1.0 episodes per person-year. The highest monthly prevalence of AGE was observed in region 4 (8.9%) and in children aged 1-4 year(s) (12.7%). Of the 97 AGE cases, 23% sought medical care; 65% reported spending time at home due to their illness [range 1-20 day(s), mean 2.7 days], of whom 51% required other individuals to look after them while ill. The maximum number of stools per 24 hours ranged from 3 to 9 (mean 4.5), and number of days an individual suffered from AGE ranged from 1 to 21 day(s) (mean 2.7 days). The burden of syndromic AGE cases in the population for 2009 was estimated to be 131,012 cases compared to the reported 30,468 cases (76.7% underreporting), which implies that, for every syndromic case of AGE reported, there were additional 4.3 cases occurring in the community. For every laboratory-confirmed case of FBD/AGE pathogen reported, it was estimated that approximately 2,881 more cases were occurring in the population. Giardia was the most common foodborne pathogen isolated. The minimum estimated annual cost associated with the treatment for AGE was US$ 2,358,233.2, showing that AGE and FBD pose a huge economic burden on Guyana. Underreporting of AGE and foodborne pathogens, stool collection, and laboratory capacity were major gaps, affecting the surveillance of AGE in Guyana.

Estimating the Burden of Acute Gastrointestinal Illness in Grenada.

This is the first study conducted in Grenada, with a population of approximately 108,000, to quantify the magnitude, distribution, and burden of self-reported acute gastroenteritis (AGE). A retrospective population survey was conducted in October 2008 and April 2009 and a laboratory survey from October 2008 to September 2009. The estimated monthly prevalence of AGE was 10.7% (95% CI 9.0-12.6; 1.4 episodes/ person-year), with a median of 3 days of illness. Of those who reported AGE, 31% sought medical care (stool samples were requested from 12.5%); 10% took antibiotics; 45% took non-prescribed medication; and 81% reported restricted activity. Prevalence of AGE was significantly higher among children aged <5 years (23.5%, p<0.001). Of the AGE stool samples submitted to the laboratory for analysis, 12.1% were positive for a foodborne pathogen. Salmonella enteritidis was the most common foodborne pathogen associated with AGE-related illness. The estimated percentage of underreporting of syndromic AGE to the Ministry of Health was 69%. In addition, for every laboratory-confirmed foodborne/AGE pathogen, it was estimated that there were 316 additional cases occurring in the population. The minimum estimated cost associated with treatment for AGE was US$ 703,950 each year, showing that AGE has a potentially significant economic impact in Grenada.

Estimating the Burden of Acute Gastrointestinal Illness: A Pilot Study of the Prevalence and Underreporting in Saint Lucia, Eastern Caribbean.

Saint Lucia was the first country to conduct a burden of illness study in the Caribbean to determine the community prevalence and underreporting of acute gastroenteritis (AGE). A retrospective cross-sectional population survey on AGE-related illness was administered to a random sample of residents of Saint Lucia in 20 April–16 May 2008 and 6-13 December 2009 to capture the high- and low-AGE season respectively. Of the selected 1,150 individuals, 1,006 were administered the survey through face-to-face interviews (response rate 87.4%). The overall monthly prevalence of AGE was 3.9%. The yearly incidence rate was 0.52 episodes/person-year. The age-adjusted monthly prevalence was 4.6%. The highest monthly prevalence of AGE was among children aged <5 years (7.5%) and the lowest in persons aged 45-64 years (2.6%). The average number of days an individual suffered from diarrhoea was 3.8 days [range 1-21 day(s)]. Of the reported AGE cases, only seven (18%) sought medical care; however, 83% stayed at home due to the illness [(range 1-16 day(s), mean 2.5]; and 26% required other individuals to take care of them. The estimated underreporting of syndromic AGE and laboratory-confirmed foodborne disease pathogens was 81% and 99% respectively during the study period. The economic cost for treating syndromic AGE was estimated at US$ 3,892.837 per annum. This was a pilot study on the burden of illness (BOI) in the Caribbean. The results of the study should be interpreted within the limitations and challenges of this study. Lessons learnt were used for improving the implementation procedures of other BOI studies in the Caribbean.

Days out-of-role due to common physical and mental health problems: Results from the Sao Paulo Megacity Mental Health Survey, Brazil

OBJECTIVES: To investigate the relative importance of common physical and mental disorders with regard to the number of days out-of-role (DOR; number of days for which a person is completely unable to work or carry out normal activities because of health problems) in a population-based sample of adults in the São Paulo Metropolitan Area, Brazil. METHODS: The São Paulo Megacity Mental Health Survey was administered during face-to-face interviews with 2,942 adult household residents. The presence of 8 chronic physical disorders and 3 classes of mental disorders (mood, anxiety, and substance use disorders) was assessed for the previous year along with the number of days in the previous month for which each respondent was completely unable to work or carry out normal daily activities due to health problems. Using multiple regression analysis, we examined the associations of the disorders and their comorbidities with the number of days out-of-role while controlling for socio-demographic variables. Both individual-level and population-level associations were assessed. RESULTS: A total of 13.1% of the respondents reported 1 or more days out-of-role in the previous month, with an annual median of 41.4 days out-of-role. The disorders considered in this study accounted for 71.7% of all DOR; the disorders that caused the greatest number of DOR at the individual-level were digestive (22.6), mood (19.9), substance use (15.0), chronic pain (16.5), and anxiety (14.0) disorders. The disorders associated with the highest population-attributable DOR were chronic pain (35.2%), mood (16.5%), and anxiety (15.0%) disorders. CONCLUSIONS: Because pain, anxiety, and mood disorders have high effects at both the individual and societal levels, targeted interventions to reduce the impairments associated with these disorders have the highest potential to reduce the societal burdens of chronic illness in the São Paulo Metropolitan Area. .