The cost-of-illness due to rheumatic heart disease: national estimates for Fiji.

BACKGROUND: Rheumatic heart disease (RHD) is a chronic valvular heart disease that is responsible for a heavy burden of premature mortality in low- and middle-income countries. The total costs of RHD are important to health policy and research investment decisions. We estimate for the first time the total cost of RHD for Fiji (2008-2012) using a cost-of-illness approach and novel primary data on RHD disease burden and costs. METHODS: RHD cases were identified using probabilistic record linkage across four routine data sources: (1) the Fiji RHD Control Program, (2) national hospital admissions records, (3) the Ministry of Health database of cause-specific deaths and (4) hospital ECG clinic registers. For each individual with RHD, we obtained information on RHD hospital admissions, treatment and death. We conducted a prevalence-based cost-of-illness analysis, including bottom-up assessment of indirect and direct (healthcare) costs. RESULTS: The estimated cost of RHD in Fiji for 2008-2012 was year-2010 $FJ91.6 million (approximately US$47.7 million). Productivity losses from premature mortality constituted the majority of costs (71.4%). Indirect costs were 27-fold larger than the direct costs. CONCLUSIONS: RHD leads to a heavy economic burden in Fiji. Improved prevention strategies for RHD will likely confer substantial economic benefits to the country.

'I think we've had a health screen': New offshore screening, new refugee health guidelines, new Syrian and Iraqi cohorts: Recommendations, reality, results and review.

AIM: To examine refugee health assessments in Syrian and Iraqi children in the context of changes to offshore immigration screening, updated Australian refugee health guidelines and the primary care refugee health model in Victoria. METHODS: This is a retrospective audit of Syrian and Iraqi children aged 0-17 years attending a specialist immigrant health service from January 2015 to September 2017. RESULTS: We saw 128 children (7 months-16 years, 64.8% male). Prior to arrival, 58.9% of children had experienced trauma, and 67.9% had missed at least 1 year of school. Almost all children (93.3%) were linked with a regular general practitioner in Australia, and 23.6% children were linked with a refugee health nurse; offshore health records were infrequently available. Of school-aged children, 25% were not enrolled in school 3 months after arrival. Only 2 of 113 (1.8%) children had completed a recommended refugee health assessment, and 55.1% had commenced appropriate catch-up vaccination in primary care. After screening completion, the most prevalent conditions were low vitamin D (63.6%); growth/nutrition (24.2%), neurological/metabolic (16.4%), learning/behaviour (15.6%) and mental health (12.5%) concerns; latent tuberculosis infection (11.8%); and developmental delay (10.2%). Sixteen children required surgery after arrival, and six children had life-threatening medical conditions on arrival - only one had an offshore critical alert; care for the other five children resulted in 133 unanticipated hospital admission days. CONCLUSIONS: There are substantial challenges with the current primary care screening model in Victoria. Disability, developmental and mental health concerns were prominent in this cohort, and many children had delays in education access, compounding prior disadvantage.

An epidemiological study to assess the true incidence and prevalence of rheumatic heart disease and acute rheumatic fever in New Caledonian school children.

AIM: To provide in New Caledonian school children (i) the prevalence of rheumatic heart disease (RHD) detected by annual screening program using new World Heart Federation diagnostic criteria; (ii) the point prevalence of acute rheumatic fever (ARF); and (iii) to investigate socio-demographic risk factors associated with RHD. METHODS: This study linked data from national ARF/RHD programs by combining ARF incidence data from the register with RHD prevalence data from echocardiographic screening data for a single age year of the population for overall point prevalence ARF/RHD rates. For the analysis, cases of echocardiographic detection of RHD are presumed to be synonymous with undiagnosed ARF. All results were weighted to minimise the bias introduced from absent pupils of each annual screening program. Incidence and prevalence were age-standardised to the WHO World Standard Population. Each 2013 cumulative prevalence of definite and borderline RHD was studied using a multivariate logistic regression adjusted for socio-demographic factors. RESULTS: The overall age-standardised incidence of clinical and undiagnosed ARF (i.e. echocardiographic-detected RHD) was combined as point prevalence and estimated to be 99/10 000 cases in 2012 and 114/10 000 cases in 2013. This included 40/10 000 prevalent cases of asymptomatic RHD detected by screening each year. Being Melanesian, OR 23.2 (95% CI: 3.4-157.3), or Polynesian, OR 21.5 (95% CI: 2.9-157.7), was associated with a higher prevalence of having definite RHD compared with being Caucasian. Being a girl was associated with a higher risk of having borderline RHD, OR 1.9 (95% CI: 1.03-3.3). CONCLUSION: Without echocardiographic screening, ARF/RHD burden is substantially underestimated.

The content and structure of Australian television reportage on health and medicine, 2005-2009: parameters to guide health workers.

OBJECTIVE: To describe the content and structure of health and medical news and current affairs reportage on free-to-air television in Sydney, New South Wales. DESIGN AND SETTING: Review of content of all health-related evening news and current affairs items recorded over 47 months (May 2005-March 2009). MAIN OUTCOME MEASURES: Number and length of health-related items on news and current affairs programs, and topics covered in these (21 broad content areas and the leading 50/237 specific content areas); use of news actors, soundbite duration and apparent news triggers. RESULTS: 11,393 news items and 2309 current affairs items were analysed. Health news items lasted a median of 97 seconds. In a randomly selected sample of 251 items, items featured a mean of 2.2 news actors (3.9 in longer current affairs items). Median soundbite duration was 7.2 seconds for news items and 8.9 seconds for current affairs items. People affected by disease or injury were the most commonly featured news actors (84% of items), followed by experts and health professionals (56%). Many items (42%) appeared to be triggered by incidents, but a further 42% could have been triggered by press releases and other forms of publicity. CONCLUSIONS: Health workers wishing to participate in news coverage should be aware that complex issues are reduced to fit the time constraints and presentational formulae of the news media. Advocates should plan their communication strategies to accommodate these constraints.