Factors associated with increased financial toxicity after the completion of radiation treatment for gynecologic cancer.

PURPOSE: We evaluated financial toxicity (FT) in patients with gynecologic cancer treated with radiation and assessed the impact of the COVID-19 pandemic on patients' financial wellbeing. METHODS: Patients completed a survey 1 month after completing radiation from August 2019-March 2020 and November 2020-June 2021. The survey included the COmprehensive Score for Financial Toxicity (COST) tool, EQ-5D to measure quality of life (QOL) and pandemic-related questions for the second survey period. High FT was COST score ≤ 23. RESULTS: Of 97 respondents (92% response rate), 49% completed the survey pre-pandemic and 51% after; the majority were white (76%) and had uterine cancer (64%). Sixty percent received external beam radiation with or without brachytherapy; 40% had only brachytherapy. High FT was associated with worse QOL (r = -0.37, P < 0.001), younger age and type of insurance (both p ≤ 0.03). Respondents with high FT were 6.0 (95% CI 1.0-35.9) times more likely to delay/avoid medical care, 13.6 (95% CI 2.9-64.3) times more likely to borrow money, and 6.9 (95% CI 1.7-27.2) times as likely to reduce spending on basic goods. The pandemic cohort had a smaller proportion of respondents with high FT than the pre-pandemic cohort (20% vs. 35%, p = 0.10) and a higher median COST score (32 (IQR 25-35) vs. 27 (IQR 19-34), p = 0.07). CONCLUSION: Privately insured, younger respondents who received radiation for gynecologic cancer were at risk for FT. High FT was associated with worse QOL and economic cost-coping strategies. We observed less FT in the pandemic cohort, though not statistically different from the pre-pandemic cohort.

Epidemiology and Economic Burden of Acute Infectious Gastroenteritis Among Adults Treated in Outpatient Settings in US Health Systems.

INTRODUCTION: Acute infectious gastroenteritis (AGE) is a common reason for outpatient visits and hospitalizations in the United States. This study aimed to understand the demographic and clinical characteristics, common pathogens detected, health care resource utilization (HRU), and cost among adult outpatients with AGE visiting US health systems. METHODS: A retrospective cohort study was conducted using one of the largest hospital discharge databases (PINC AI Healthcare Database) in the United States. Adult patients (aged ≥18 years) with a principal diagnosis of AGE during an outpatient visit between January 1, 2016, and June 30, 2021, were included. Pathogen detection analysis was performed in those with microbiology data available. RESULTS: Among 248,896 patients, the mean age was 44.3 years (range 18-89+ years), 62.9% were female, and 68.5% were White. More than half (62.0%) of the patients did not have any preexisting comorbidity, and only 18.3% underwent stool workup at the hospital. Most patients (84.7%) were seen in the emergency department, and most (96.4%) were discharged home. Within 30 days of discharge, 1.0% were hospitalized, and 2.8% had another outpatient visit due to AGE. The mean cost of the index visit plus 30-day AGE-related follow-up was $1,338 per patient, amounting to $333,060,182 for the total study population. Among patients with microbiology data available (n = 12,469), common pathogens detected were Clostridioides difficile (32.2%), norovirus (6.3%), and Campylobacter spp. (4.0%). DISCUSSION: AGE is a common and costly disease affecting adults of all ages and more females than males, including individuals with or without baseline conditions in a hospital-based outpatient setting. C. difficile was the most common pathogen detected.

Economic burden of excessive sedentary behaviour in Canada.

OBJECTIVE: To estimate health care and health-related productivity costs associated with excessive sedentary behaviour (> 8 h/day and > 9 h/day) in Canadian adults. METHODS: Three pieces of information were used to estimate costs: (1) the pooled relative risk estimates of adverse health outcomes consistently shown to be associated with excessive sedentary behaviour, gathered from meta-analyses of prospective cohort studies; (2) the prevalence of excessive sedentary behaviour in Canadian men and women, obtained using waist-worn accelerometry in a nationally representative sample of adults (Canadian Health Measures Survey 2018-2019); and (3) the direct (health care) and indirect (lost productivity due to premature mortality) costs of the adverse health outcomes, selected using the Economic Burden of Illness in Canada 2010 data. The 2010 costs were then adjusted to 2021 costs to account for inflation, population growth, and higher average earnings. A Monte Carlo simulation was conducted to account for uncertainty in the model. RESULTS: The total costs of excessive sedentary behaviour in Canada were $2.2 billion (8 h/day cut-point) and $1.8 billion (9 h/day cut-point) in 2021, representing 1.6% and 1.3% of the overall burden of illness costs, respectively. The two most expensive chronic diseases attributable to excessive sedentary behaviour were cardiovascular disease and type 2 diabetes. A 10% decrease in excessive sedentary behaviour (from 87.7% to 77.7%) would save an estimated $219 million per year in costs. CONCLUSION: Excessive sedentary behaviour significantly contributes to the economic burden of illness in Canada. There is a need for evidence-based and cost-effective strategies that reduce excessive sedentary behaviour in the population.

RéSUMé: OBJECTIF: Estimer le coût des soins de santé et le coût de productivité lié à la santé associés au comportement sédentaire excessif (> 8 heures/jour et > 9 heures/jour) chez les Canadiennes et les Canadiens adultes. MéTHODE: Trois informations ont servi à estimer ces coûts : 1) les estimations combinées du risque relatif des résultats sanitaires indésirables uniformément associés au comportement sédentaire excessif, collectées à partir de méta-analyses d'études prospectives de cohortes; 2) la prévalence du comportement sédentaire excessif chez les Canadiennes et les Canadiens, obtenue à l'aide d'un accéléromètre porté à la taille par un échantillon représentatif national d'adultes (Enquête canadienne sur les mesures de la santé 2018-2019); et 3) les coûts directs (soins de santé) et indirects (perte de productivité due à la mortalité prématurée) des résultats sanitaires indésirables sélectionnés, d'après les données du Fardeau économique de la maladie au Canada de 2010. Les coûts de 2010 ont ensuite été ajustés aux coûts de 2021 pour tenir compte de l'inflation, de la croissance démographique et de la hausse moyenne des revenus. Nous avons effectué une simulation de Monte-Carlo pour tenir compte de l'incertitude du modèle. RéSULTATS: Les coûts totaux du comportement sédentaire excessif au Canada étaient de 2,2 milliards de dollars (point de coupure de 8 heures/jour) et de 1,8 milliard de dollars (point de coupure de 9 heures/jour) en 2021, ce qui représente 1,6 % et 1,3 % du fardeau global des coûts des maladies, respectivement. Les deux maladies chroniques les plus chères imputables au comportement sédentaire excessif étaient les maladies cardiovasculaires et le diabète de type 2. Une baisse de 10 % du comportement sédentaire excessif (de 87,7 % à 77,7 %) économiserait environ 219 millions de dollars de coûts par année. CONCLUSION: Le comportement sédentaire excessif contribue de façon significative au fardeau économique de la maladie au Canada. Il nous faut des stratégies fondées sur les preuves et efficaces par rapport au coût pour réduire le comportement sédentaire excessif dans la population.

Modelling the economic burden of SARS-CoV-2 infection in health care workers in four countries.

Health care workers (HCWs) experienced greater risk of SARS-CoV-2 infection during the COVID-19 pandemic. This study applies a cost-of-illness (COI) approach to model the economic burden associated with SARS-CoV-2 infections among HCWs in five low- and middle-income sites (Kenya, Eswatini, Colombia, KwaZulu-Natal province, and Western Cape province of South Africa) during the first year of the pandemic. We find that not only did HCWs have a higher incidence of COVID-19 than the general population, but in all sites except Colombia, viral transmission from infected HCWs to close contacts resulted in substantial secondary SARS-CoV-2 infection and death. Disruption in health services as a result of HCW illness affected maternal and child deaths dramatically. Total economic losses attributable to SARS-CoV-2 infection among HCWs as a share of total health expenditure ranged from 1.51% in Colombia to 8.38% in Western Cape province, South Africa. This economic burden to society highlights the importance of adequate infection prevention and control measures to minimize the risk of SARS-CoV-2 infection in HCWs.

The Cancer Financial Experience (CAFÉ) study: randomized controlled trial of a financial navigation intervention to address cancer-related financial hardship.

BACKGROUND: There is an urgent need for evidence on how interventions can prevent or mitigate cancer-related financial hardship. Our objectives are to compare self-reported financial hardship, quality of life, and health services use between patients receiving a financial navigation intervention versus a comparison group at 12 months follow-up, and to assess patient-level factors associated with dose received of a financial navigation intervention. METHODS: The Cancer Financial Experience (CAFÉ) study is a multi-site randomized controlled trial (RCT) with individual-level randomization. Participants will be offered either brief (one financial navigation cycle, Arm 2) or extended (three financial navigation cycles, Arm 3) financial navigation. The intervention period for both Arms 2 and 3 is 6 months. The comparison group (Arm 1) will receive enhanced usual care. The setting for the CAFÉ study is the medical oncology and radiation oncology clinics at two integrated health systems in the Pacific Northwest. Inclusion criteria includes age 18 or older with a recent cancer diagnosis and visit to a study clinic as identified through administrative data. Outcomes will be assessed at 12-month follow-up. Primary outcomes are self-reported financial distress and health-related quality of life. Secondary outcomes are delayed or foregone care; receipt of medical financial assistance; and account delinquency. A mixed methods exploratory analysis will investigate factors associated with total intervention dose received. DISCUSSION: The CAFÉ study will provide much-needed early trial evidence on the impact of financial navigation in reducing cancer-related financial hardship. It is theory-informed, clinic-based, aligned with patient preferences, and has been developed following preliminary qualitative studies and stakeholder input. By design, it will provide prospective evidence on the potential benefits of financial navigation on patient-relevant cancer outcomes. The CAFÉ trial's strengths include its broad inclusion criteria, its equity-focused sampling plan, its novel intervention developed in partnership with clinical and operations stakeholders, and mixed methods secondary analyses related to intervention dose offered and dose received. The resulting analytic dataset will allow for rich mixed methods analysis and provide critical information related to implementation of the intervention should it prove effective. TRIAL REGISTRATION: ClinicalTrials.gov NCT05018000 . August 23, 2021.

Covid-19 and work dimensions: a socio-historical analysis of impacts affecting men during the pandemic / Covid-19 e as dimensões do trabalho: análise sócio-histórica dos impactos vivenciados por homens na pandemia / COVID-19 y las dimensiones del trabajo: análisis sociohistórico de los impactos experimentados por los hombres en la pandemia

OBJETIVO: Apreender os impactos vivenciados por homens residentes no Brasil na pandemia da Covid-19 em relação às dimensões do trabalho. MÉTODO: Estudo sócio-histórico, qualitativo, realizado durante a pandemia da Covid-19 com 400 adultos e idosos residentes no Brasil. Aplicou-se um formulário on-line. Os dados foram analisados com base no Discurso do Sujeito Coletivo, interpretados à luz do Materialismo Histórico Dialético. RESULTADOS: A pandemia da Covid-19 provocou e intensificou impactos: sobrecarga provocada pelo trabalho home office; inadequações no trabalho e exposição à contaminação pelo Coronavírus; estresse e medo de ser contaminado no trabalho e de perder o emprego; dificuldade na manutenção econômica/financeira e adaptações repentinas no desempenho do trabalho. CONCLUSÃO: As dimensões do mundo do trabalho intensificaram as vulnerabilidades sociais e em saúde de homens no contexto da pandemia da Covid-19. Repercutiram em maior exposição ao SARS-CoV-2 e vivência de estressores na vida cotidiana.

OBJECTIVE: To apprehend the impacts affecting men residing in Brazil during the Covid-19 pandemic concerning work dimensions. METHOD: A socio-historical, qualitative study carried out during the Covid-19 pandemic with 400 adult and old males residing in Brazil. An on-line form was applied. Data were analyzed based on the Discourse of the Collective Subject, interpreted according to the Dialectic Historical Materialism. RESULTS: The Covid-19 pandemic did cause and intensify impacts: overload resulting from home-office jobs; inadequacies as to the work and exposition to contamination by the Coronavirus; stress and fear to be contaminated at work and losing employment; difficulties to maintain economic/financial conditions and unexpected adaptations in work performance. CONCLUSION: The dimensions of the work environment did intensify both social and health vulnerabilities for men in the context of the Covid-19 pandemic, rebounding on even higher exposure to SARS-CoV 2 and daily life stressors.

OBJETIVO: Comprender los impactos experimentados por los hombres residentes en Brasil en la pandemia de COVID-19 respecto a las dimensiones del trabajo. MÉTODO: Estudio sociohistórico, cualitativo, realizado durante la pandemia de COVID-19, con 400 adultos y personas mayores residentes en Brasil. Se aplicó un formulario online. Los datos se analizaron con base en el Discurso del Sujeto Colectivo y fueron interpretados a la luz del Materialismo Histórico Dialéctico. RESULTADOS: La pandemia de COVID-19 ha ocasionado e intensificado los impactos: sobrecarga causada por el teletrabajo; inadecuaciones en el trabajo y exposición a la contaminación por el coronavirus; estrés y miedo a contaminarse en el trabajo y a perder el empleo; dificultad en el mantenimiento económico/financiero y adaptaciones repentinas en el rendimiento del trabajo. CONCLUSIÓN: Las dimensiones del mundo del trabajo han intensificado las vulnerabilidades sociales y de salud de los hombres en el contexto de la pandemia de COVID-19. Han repercutido en una mayor exposición al SARS-CoV-2 y vivencia de estresores en la vida cotidiana.

The causal relationship between COVID-19 and increased intraocular pressure: A bidirectional two-sample Mendelian randomization study.

Background: Coronavirus disease 2019 (COVID-19) has brought great challenges to the global public health system and huge economic burdens to society, the causal effect of COVID-19 and intraocular pressure was blank. Objective: This study aimed to explore the causal association between coronavirus disease (COVID-19) susceptibility, severity and criticality and intraocular pressure (IOP) by bidirectional Mendelian randomization (MR) analysis. Materials and methods: Genetic associations with COVID-19 susceptibility, severity and criticality were obtained from the COVID-19 Host Genetics Initiative. Genetic associations with IOP were obtained from GWAS summary data. The standard inverse variance weighted (IVW) method was used in the primary assessment of this causality. Other methods were also implemented in supplementary analyses. Finally, sensitivity analysis was performed to evaluate the reliability and stability of the results. Results: The results showed that COVID-19 susceptibility had null effect on IOP (ß = 0.131; Se = 0.211; P = 0.533) as assessed by the IVW method. Moreover, the results revealed that COVID-19 severity, specifically, hospitalization due to COVID-19, had a positive effect on IOP with nominal significance (ß = 0.228; Se = 0.116; P = 0.049). However, there were null effect of COVID-19 criticality on IOP (ß = 0.078; Se = 0.065; P = 0.227). Sensitivity analysis showed that all the results were reliable and stable. The reverse MR analysis revealed that there was null effect of IOP on COVID-19. Conclusions: We demonstrated that hospitalization due to COVID-19 might increase IOP; therefore, greater attention should be given to monitoring IOP in inpatients with COVID-19.

Mental Health, Food Insecurity, and Economic Hardship among College Students during the COVID-19 Pandemic.

The mental health crisis among college students has become one of the most pressing issues, especially during the pandemic. Researchers discuss food insecurity as one of the leading causes of mental distress. The onset and continued impacts of the COVID-19 pandemic appear to compound food insecurity, economic hardship, and mental health. This study aims to understand the mental health of college students in relation to food insecurity and financial struggles to meet basic living expenses and debts during the pandemic. Authors collected survey data from college students in a public urban university in 2020 and conducted a multiple regression (N = 375). Evidence indicated that mental health became significantly worse after the pandemic onset. Mental health was significantly associated with food insecurity and multiple economic hardships, controlling for prepandemic mental health and other characteristics. The findings affirm that food insecurity and dire levels of economic hardship have devastating effects on the mental health of young adults. The article highlights the long-term implications of mental health affected by basic needs insecurity and the emergent need for integrated services and university-community partnerships.

Changes in healthy effects and economic burden of PM2.5 in Beijing after COVID-19.

The COVID-19 lockdown had a positive control effect on urban air quality. However, this effect remains uncertain after the epidemic enters regular management, and furthermore, only limited data are available regarding urban PM2.5 (aerodynamic diameter ≤ 2.5µm) under the impact of the epidemic. We used daily ambient PM2.5 concentration data in Beijing to compare and analyze the changes in urban PM2.5 concentrations before and after the COVID-19 epidemic and to estimate the healthy effects and economic burden associated with PM2.5 before and after the epidemic. The study found that COVID-19 has a significant impact on the urban environmental PM2.5 concentration, which is manifested by the decrease in the PM2.5 concentration in Beijing during the epidemic by 27.8%. Exposure-response models estimated 56.443 (95% CI: 43.084-69.893) thousand people die prematurely in Beijing during the COVID-19 epidemic attributed to long-term PM2.5 exposure, with a 13.3% decrease in the number of premature deaths year-on-year. The total healthy economic losses attributable to PM2.5 in Beijing during the COVID-19 epidemic were 35.76 (95% CI: 28.41-42.44) billion yuan, with a per capita loss of 816.8 yuan. Strict control measures throughout the COVID-19 epidemic had a positive impact on air quality in Beijing, with a decrease in both premature deaths and economic healthy losses attributable to fine particles. This paper helps to enrich and expand the research on the impact of COVID-19 on the urban environment and provides a basis for formulating policies related to air quality improvement in the post-epidemic era.

Evaluation of Employment Loss and Financial Hardship Among US Adults With Disabilities During the COVID-19 Pandemic.

This cross-sectional study estimates the prevalence and determinants of employment loss and financial hardship among adults with disabilities during the COVID-19 pandemic.

Incidence, predictors, clinical outcomes, and economic burden of recurrent acute kidney injury: a retrospective cohort study.

OBJECTIVE: This study aimed to assess the incidence, predictors, mortality, and economic outcomes of recurrent Acute kidney injury (AKI) in Jordan. METHODS: This was a retrospective cohort study that included adult patients who were admitted with AKI to university hospitals in the country from 2010-2019. Recurrent episodes of AKI, laboratory data, baseline medication list, and death dates were retrieved from patient's medical records. The incidence rate of recurrent AKI was estimated. Predictors of recurrent AKI and mortality during the five years post-discharge was evaluated. Total admission charges were described and evaluated in total and by service provided. RESULTS: Among 1162 AKI patients, 57 patients (4.9%) died during the index admission (first admission during the study period), and among the survivors, 220 patients were re-hospitalized with a recurrent AKI during five years of follow-up. Patients with higher discharge serum creatinine level (SCr) at index admission had higher odds of AKI recurrence (OR = 1.001). Patients who were on respiratory, antineoplastic, or anticoagulant medications were also more susceptible to recurrence; ORs were 1.69, 2.77, and 4.16, respectively. Patients who were elderly, with recurrent AKI episodes, or with a more extended hospital stay at index admission were more likely to die during the five years post discharge. The median charge of recurrent admissions was higher than the median charge of the index admissions; 1519.17 JOD ($2142.7) versus 1362.85 JOD ($1922.2), respectively. CONCLUSIONS: Recurrent AKI is associated with increased mortality and health expenditures. Higher discharge SCr levels at index admission, and chronic comorbidities are associated with a higher likelihood of AKI recurrence.

Lessening the Impact of Financial Toxicity (LIFT): a protocol for a multi-site, single-arm trial examining the effect of financial navigation on financial toxicity in adult patients with cancer in rural and non-rural settings.

BACKGROUND: Almost half of the patients with cancer report cancer-related financial hardship, termed "financial toxicity" (FT), which affects health-related quality of life, care retention, and, in extreme cases, mortality. This increasingly prevalent hardship warrants urgent intervention. Financial navigation (FN) targets FT by systematically identifying patients at high risk, assessing eligibility for existing resources, clarifying treatment cost expectations, and working with patients and caregivers to develop a plan to cope with cancer costs. This trial seeks to (1) identify FN implementation determinants and implementation outcomes, and (2) evaluate the effectiveness of FN in improving patient outcomes. METHODS: The Lessening the Impact of Financial Toxicity (LIFT) study is a multi-site Phase 2 clinical trial. We use a pre-/post- single-arm intervention to examine the effect of FN on FT in adults with cancer. The LIFT trial is being conducted at nine oncology care settings across North Carolina in the United States. Sites vary in geography (five rural, four non-rural), size (21-974 inpatient beds), and ownership structure (governmental, non-profit). The study will enroll 780 patients total over approximately 2 years. Eligible patients must be 18 years or older, have a confirmed cancer diagnosis (any type) within the past 5 years or be living with advanced disease, and screen positive for cancer-related financial distress. LIFT will be delivered by full- or part-time financial navigators and consists of 3 components: (1) systematic FT screening identification and comprehensive intake assessment; (2) connecting patients experiencing FT to financial support resources via trained oncology financial navigators; and (3) ongoing check-ins and electronic tracking of patients' progress and outcomes by financial navigators. We will measure intervention effectiveness by evaluating change in FT (via the validated Comprehensive Score of Financial Toxicity, or COST instrument) (primary outcome), as well as health-related quality of life (PROMIS Global Health Questionnaire), and patient-reported delayed or forgone care due to cost. We also assess patient- and stakeholder-reported implementation and service outcomes post-intervention, including uptake, fidelity, acceptability, cost, patient-centeredness, and timeliness. DISCUSSION: This study adds to the growing evidence on FN by evaluating its implementation and effectiveness across diverse oncology care settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT04931251. Registered on June 18, 2021.

Measurement and Validation of the Comprehensive Score for Financial Toxicity (COST) in a Population With Diabetes.

OBJECTIVE: The Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) is a validated instrument measuring financial distress among people with cancer. The reliability and construct validity of the 11-item COST-FACIT were examined in adults with diabetes and high A1C. RESEARCH DESIGN AND METHODS: We examined the factor structure (exploratory factor analysis), internal consistency reliability (Cronbach α), floor/ceiling effects, known-groups validity, and predictive validity among a sample of 600 adults with diabetes and high A1C. RESULTS: COST-FACIT demonstrated a two-factor structure with high internal consistency: general financial situation (7-items, α = 0.86) and impact of illness on financial situation (4-items, α = 0.73). The measure demonstrated a ceiling effect for 2% of participants and floor effects for 7%. Worse financial toxicity scores were observed among adults who were women, were below the poverty line, had government-sponsored health insurance, were middle-aged, were not in the workforce, and had less educational attainment (P < 0.01). Worse financial toxicity was observed for those engaging in cost coping behaviors, such as taking less or skipping medicines, delaying care, borrowing money, "maxing out" the limit on credit cards, and not paying bills (P < 0.01). In regression models for the full measure and its two factors, worse financial toxicity was correlated with higher A1C (P < 0.01), higher levels of diabetes distress (P < 0.01), more chronic conditions (P < 0.01), and more depressive symptoms (P < 0.01). CONCLUSIONS: Findings support both the reliability and validity of the COST-FACIT tool among adults with diabetes and high A1C levels. More research is needed to support the use of the COST-FACIT tool as a clinically relevant patient-centered instrument for diabetes care.

[Narratives on changes in health-related behaviours during lockdown in Spain according to gender]. / Narrativas sobre cambios de conductas en salud durante el confinamiento en España según género.

OBJECTIVE: To explore experiences related to health-oriented behaviours during lockdown in the Spanish resident population from a gender perspective. METHOD: Qualitative research with a critical and feminist approach. Twenty-nine semi-structured interviews (17 women and 12 men) were conducted between June and July 2020 via telephone with people who had previously answered an online survey. The interviews were transcribed and a thematic content analysis was carried out, differentiating between the experiences of women and men. The data were triangulated by the research team. RESULTS: Among women, greater diversity emerged in terms of health behaviours. Among them, the difficult experiences related to COVID-19, the complexity of living together and doing unpaid care work, as well as the importance of support networks, stood out. Among men, there were different attitudes towards sport, self-care and having time for healthy eating were positively valued, and there was a good assessment of coexistence and organisation in household chores. In both men and women, work overload and economic problems were related to emotional distress and difficulties in carrying out healthy activities. CONCLUSIONS: Health-oriented behaviours during lockdown differed according to gender. They were mostly limited to COVID-19 experiences, socio-economic conditions and burden of care. It is essential to tailor public health and primary care programmes according to people's life moments, taking into account their social context and questioning traditional gender roles.

Prevalence and economic burden of depression and anxiety symptoms among Singaporean adults: results from a 2022 web panel.

BACKGROUND: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are leading causes of disability and premature mortality. At a global level, over 300 million people are estimated to suffer from major depressive disorders, equivalent to 4·4% of the world's population. Pandemic era stressors have increased rates for depression and anxiety by upwards of 25%. The goal of this study is to estimate the prevalence and economic burden of depression and anxiety symptoms in Singapore after the peak of the COVID-19 pandemic. METHODS: An existing web panel was queried between April 2022 and June 2022. Adult participants aged > 21 years old who screened positive for depression and anxiety symptoms based on the Patient Health Questionnaire-4 (PHQ-4) Screener were eligible for participation. Prevalence estimates were quantified by dividing the number of respondents who screened positive for these symptoms by the total number of respondents. Participants who screened positive were asked about healthcare utilization, days missed from work, and reduced productivity due to these symptoms. These values were then monetized and scaled based on prevalence and population counts to generate per capita and total annual costs. RESULTS: Two thousand three hundred forty-eight respondents filled out the PHQ-4 depression/anxiety screener on behalf of the 5,725 adults living in their households (including respondents themselves). Prevalence estimates were calculated based on the responses recorded for these 5,725 adults. 14.1% adults had symptoms consistent with depression and 15.2% had symptoms consistent with anxiety. In total, 20.0% may experience symptoms consistent with at least one of these two conditions, yet approximately half reported never being formally diagnosed. 350 respondents screened positive for depression or anxiety symptoms and thus were eligible to fill out the healthcare utilization, presenteeism, and absenteeism survey. Direct annual healthcare costs due to depression and anxiety symptoms averaged Singapore dollar (SGD) $1,050 for these respondents. The employed subset (n = 304) missed an extra 17.7 days of work on average per year, which translates to SGD $4,980 per worker. These workers also reported being ~ 40% less productive at work, which equates to SGD $28,720 in economic losses annually. In total, these symptoms caused SGD $15.7 billion in increased costs. Presenteeism accounts for 81.6% of this total (SGD $12.8 billion), absenteeism for 14.2% (SGD $2.3 billion) and healthcare accounts for 4.2% (SGD $0.7 billion). CONCLUSIONS: The health and economic burden associated with depression and anxiety symptoms is large in Singapore, representing 2.9% of Singapore's gross domestic product (GDP). Employers and governments should look to identify effective remediation strategies, including strategies to address the high rates of undiagnosed cases. Increasing psychiatric resources, general practitioner mental health competency, access to peer support, and increased efforts to reduce mental health stigma should be considered to address this growing public health crisis.

Economic Burden of the 2020 COVID-19 Hospitalizations in Spain.

This economic evaluation reports the total and per patient costs of inpatient care for COVID-19 in Spain in 2020.

Estimating the excess bed days and economic burden of healthcare-associated infections in Singapore public acute-care hospitals.

We estimated the annual bed days lost and economic burden of healthcare-associated infections to Singapore hospitals using Monte Carlo simulation. The mean (standard deviation) cost of a single healthcare-associated infection was S$1,809 (S$440) [or US$1,362 (US$331)]. This translated to annual lost bed days and economic burden of 55,978 (20,506) days and S$152.0 million (S$37.1 million) [or US$114.4 million (US$27.9 million)], respectively.

Patient well-being and the clinical and economic burdens associated with obesity in the United States.

Obesity is a serious, progressive, chronic disease that is associated with a spectrum of complications and poor outcomes (eg, premature death, diminished quality of life) and is a risk factor for several other diseases. Obesity increases the risk of developing type 2 diabetes, cardiovascular disease, and certain cancers. More recently, obesity was recognized as a risk factor for poor outcomes in patients with COVID-19. When experienced concurrently with a serious disease, obesity may increase the risk of negative health outcomes. Furthermore, individuals with obesity are more likely to experience social stigma and discrimination at work and in educational and health care settings; these may impact mental and physical health and contribute to increased adiposity. In the United States, the economic burden of obesity is immense-according to estimates, hundreds of billions of dollars are spent annually on direct medical needs and lost productivity associated with obesity. More severe classes of obesity greatly impact both the health of individuals and health care expenditures. As obesity becomes more prevalent, policy makers, health care professionals, and payers must consider its clinical, social, and economic implications.