Histopathological changes of mice tissues in course of the envenomation by the Macrovipera lebetina obtusa venom and the neutralizing effect of the ovine-derived experimental antivenom.

Viper bites pose a significant public health issue in Armenia, even within urban areas, often resulting in clotting disorders, hypofibrinogenemia, and tissue necrosis in humans. This study investigates histopathological changes in various tissues during mice envenomation by West-Asian blunt-nosed viper (Macrovipera lebetina obtusa) venom, as well as the recovery process aided by experimental antivenom derived from sheep. The high venom dose caused substantial damage to the heart, lungs, liver, and kidneys in mice, indicating systemic harm. While antivenom administration can prevent mortality in mice envenomation, it may not fully mitigate histological damage in affected organs. Additionally, the study highlights the importance of timing antivenom administration, as the severity of tissue alterations can vary depending on the duration of envenomation. These findings shed light on antivenom's effects on viper envenomation and stress the need for further research to optimize its timing and dosage for minimizing histological damage and enhancing clinical outcomes.

Evaluation of the therapeutic action of original antiviral drug in SARS-CoV-2.

Purpose of this article is to study the possible direct antiviral effect of "Armenikum" on SARS-CoV-2, conduct an in vitro study on the SARS-CoV-2 encephalomocarditis virus, and an in vivo study on the Syrian hamster model. Human coronavirus SARS-CoV-2 (delta strain) was used as the virus. Two groups of four-specimen hamsters were used to study the therapeutic activity of the drug during 48 h after infecting. One group of hamsters served as positive control and was infected with the virus at a similar dose as experimental one and was used as a control of pathology induced by the viral infection till the end of the experiment. Another group of hamsters (four of them) was injected physiological solution and was used as a control. The Syrian hamsters underwent a clinical blood test and computed tomography. "Armenikum" in the form of an injection has a significant antiviral effect on the human coronavirus SARS-CoV-2, credibly reducing the titers of the virus and the time of its elimination from the Syrian hamsters, significantly mitigating the viral infection. "Armenikum" in the form of an injection drug almost completely removes the pathological effect of the virus in the lungs of the hamsters.

A post-earthquake psychopathological investigation in Armenia: methodology, summary of findings, and follow-up.

The post-earthquake psychopathological investigation (PEPSI) was designed to probe the short-and long-term effects of the earthquake in northern Armenia on 7 December 1988 on survivors' mental and physical health. Four phases of this study have been conducted to date, and, overall, more than 80 per cent of a sub-sample of 1,773 drawn from an initial cohort of 32,743 was successfully followed during 2012. This paper describes the methodology employed in the evaluation, summarises previous findings, details the current objectives, and examines the general characteristics of the sample based on the most recent follow-up phase outcomes. Despite a significant decrease in psychopathology rates between 1990 and 2012, prevalence rates of post-traumatic stress disorder and depression among study participants in 2012 were greater than 15 and 26 per cent, respectively. The paper also notes the strengths and limitations of the study vis-à-vis future research and highlights the importance and potential practical implications of similar assessments and their outcomes.

Functional dyspepsia impacts absenteeism and direct and indirect costs.

BACKGROUND & AIMS: Functional dyspepsia (FD) is a common morbid condition but data are limited on the direct and indirect costs for employees with FD or on its impact on productivity. Few data on absenteeism and no objective information are available. This study aimed to assess the impact of FD on costs and effects on absenteeism and work output (productivity). METHODS: We performed a retrospective analysis of payroll data and adjudicated health insurance medical and prescription claims collected over a 4-year study period (January 1, 2001 to December 31, 2004) from more than 300,000 employees. Data from employees with and without (controls) FD were compared using 2-part regression techniques. Outcome measures included medical (total and by place of service) and prescription costs, absenteeism, and objectively measured productivity output. RESULTS: Employees with FD (N = 1669) had greater average annual medical and prescription drug costs and indirect costs (owing to sick leave and short- and long-term disability absences) than controls (N = 274,206). Compared with controls, the FD employees incurred costs that were $5138 greater and had greater costs for each place of service (all P < .0001). The employees with FD had an additional 0.83 absence days per year and produced 12% fewer units per hour than controls (both P < .05). CONCLUSIONS: Employees with FD have greater costs at all places of service and lower productivity than employees without FD.

Effect of antihypertensive medication adherence among employees with hypertension.

OBJECTIVES: To determine if antihypertensive medication adherence is associated with decreased medical and drug costs, medical service utilization, and work absence days. STUDY DESIGN: Retrospective database study using medical, pharmacy, sick leave, short-term and long-term disability, and workers' compensation claims data from multiple large US employers from 2001 to 2008. METHODS: We used medical and pharmacy claims to identify employees with hypertension. The index date was the date of the first hypertension-related pharmacy claim. Eligible employees had health plan enrollment 6 months before the index date and at least 12 months after the index date. Employees younger than 45 years were excluded from the study. Regression models estimated the effect of the proportion of days covered (PDC) by hypertension medication on outcomes after the index date, including health benefit costs, medical service utilization, and work absence days, as well as some clinical outcomes calculated separately for high-prior-cost and low-prior-cost employees. High-prior-cost employees were those who accounted for the top 60.0% of total medical costs during the 6 months before the index date. The regression models controlled for demographics, job-related variables, and comorbidities. RESULTS: Among low-prior-cost employees, high PDC was associated with increased medical and drug costs and work absence days. Among high-prior-cost employees, high PDC was associated with decreased medical and drug costs, fewer work absence days and inpatient hospital days, and increased hypertension-specific medical costs. CONCLUSION: Antihypertensive medication adherence was associated with improvement in some short-term utilization measures among high-prior-cost employees, but significant short-term improvement was not seen among low-prior-cost employees.

Burden of fibromyalgia and comparisons with osteoarthritis in the workforce.

OBJECTIVES: To calculate the fibromyalgia (FM) burden of illness (BOI) from the employer perspective and to compare annual prevalence, work output, absence, and health benefit costs of employees with FM versus osteoarthritis (OA). METHODS: Retrospective regression model analysis comparing objective work output, total health benefit (health care, prescription drug, sick leave, disability, workers' compensation) costs, and absence days for FM, versus OA and NoFM cohorts, while controlling for differences in patient characteristics. RESULTS: FM prevalence was 0.73%; OA 0.90%. Total health benefit costs for FM were $8452 versus $11,253 (P < 0.0001) for OA and $4013 (P < 0.0001) for NoFM, with BOI = $4439. Total absence days were 16.8 versus 19.8 (P < 0.0001) and 6.4 (P < 0.0001), respectively. FM had significantly lower annual work output than NoFM (19.5%, P = 0.003) but comparable with OA. CONCLUSION: FM places a significant cost, absence, and productivity burden on employers.

Incremental employee health benefit costs, absence days, and turnover among employees with ADHD and among employees with children with ADHD.

OBJECTIVE: To assess employer economic burden of attention-deficit/hyperactivity disorder (ADHD) for employees with ADHD and employee caregivers of children with ADHD. METHODS: A large multi-employer database was used to compare: 1) employees diagnosed with ADHD versus employees without ADHD and 2) employee caregivers of children with ADHD versus employee caregivers of children without ADHD. Regression modeling compared many employer-relevant outcomes. RESULTS: The study found significantly higher annual health benefit costs ($6885 versus $4242), absence days (8.86 versus 7.16), and turnover (8.99% versus 5.26%) for employees with ADHD (n = 539) versus employees without ADHD (n = 93,722), respectively (all P < 0.01). Similar results were found for employee caregivers of children with ADHD. CONCLUSIONS: Employees with ADHD and those caring for children with ADHD are associated with a significantly higher burden in employer-relevant outcomes such as health benefit costs, absences, and terminations.

Health benefit costs and absenteeism due to insomnia from the employer's perspective: a retrospective, case-control, database study.

OBJECTIVE: To objectively assess the economic impact of insomnia on direct medical and prescription costs and indirect absence-related salary replacement costs and on absences and to compare the prevalence and costs of comorbidities in employees with and without insomnia. METHOD: A retrospective analysis was performed on employee data from the Human Capital Management Services Research Reference Database (January 2001-September 2007). Employees were identified as having insomnia (ICD-9 criteria) based on history of receiving medications used to treat insomnia or physician's diagnosis of insomnia. Control employees had no history of medications used to treat insomnia and no insomnia diagnosis. Annual costs and number of absences were compared using 2-part regression models, controlling for demographics, job information, geographic region, comorbid disorders, and the Charlson Comorbidity Index score. Comorbidity prevalence, costs, and services were compared. RESULTS: Data were collected for 299,188 employees (17,230 employees with insomnia and 281,958 control employees). Annual mean incremental costs were $2,053 greater (in total) for employees with insomnia compared with controls (specific increments: medical $751, drug $735, sick leave $208, short-term disability $179, long-term disability $10, and workers' compensation $170). Employees with insomnia missed a mean of 3.10 more workdays annually than those without insomnia. Nearly all comorbid conditions were more prevalent, were more costly, and resulted in a greater utilization of services in employees with insomnia compared to those without. All of the above comparisons were significant (P < .05). CONCLUSION: Insomnia was associated with increased costs, greater absenteeism, and an increased number of comorbid conditions in an employed population. Consistent with other analyses based on these data, the study estimated the annual cost of insomnia in the US civilian labor force to be approximately $15.0-17.7 billion (US dollars).

Absenteeism and health-benefit costs among employees with MS.

OBJECTIVE: The purpose of this analysis was to assess the differences in lost time and health-benefit costs (HBCs) among employees treated with disease modifying treatments (DMTs) for multiple sclerosis (MS). STUDY DESIGN: Employees with an MS diagnostic code (ICD-9 340.xx) and a DMT prescription claim (1/1/2001-6/30/2007) were identified from the HCMS Research Reference Database and assigned to DMT cohorts. The first prescription for the DMT was used as each person's index date. One-year outcomes included HBCs and absenteeism (lost time, comprising sick leave [SL], short- and long-term disability [STD/LTD], and workers' compensation). METHODS: Demographics were compared using t-tests for continuous variables and chi-square tests for discrete variables. Two-part multivariate regression modeling (logistic regression combined with generalized linear regression) was used to determine annual HBCs and absenteeism for each cohort controlling for age, gender, job-related variables, and Charlson Comorbidity Score. All cost variables were inflated to US$2007. RESULTS: Annual ranges among the DMTs were: HBCs $17,953-26,970 and absenteeism 7.33-20.67 days. Compared with glatiramer acetate ('C'), IFN-beta1a IM ('A') users had lower SL ($445, p = 0.0469) and STD ($969, p = 0.0164) costs; and IFN-beta1b ('B') users had lower medical costs ($2143, p = 0.0091). In addition, those treated with 'A' had 4.2 fewer SL days (p = 0.0101) compared with those treated with 'C'. CONCLUSIONS: Patients treated with 'A' reported significantly lower SL costs, SL days, and STD costs than patients treated with 'C', suggestive of greater real world benefits with 'A'. Despite small sample sizes and the retrospective nature, the study provides interesting insights into the use of DMTs in MS. The study also revealed important areas of future research, specifically the need for development of methods to determine which MS patient groups respond best to which DMT treatments.

The impact of morbid obesity and bariatric surgery on comorbid conditions: a comprehensive examination of comorbidities in an employed population.

OBJECTIVE: Find conditions with significantly different prevalence among employees diagnosed with morbid obesity (DMO). Examine the effect of bariatric surgery on the prevalence of all categories of comorbid conditions after surgery. METHODS: This large employer retrospective database analysis used matching to create two cohorts: Those with a DMO and those without. RESULTS: The DMO cohort had higher diagnosis rates in every Agency for Healthcare Research and Quality major diagnostic category except pregnancy, and it had significantly higher prevalence in 147 of 261 Agency for Health care Research and Quality specific categories. Those electing to undergo bariatric surgery experienced significant prevalence decreases in 26 of 261 specific categories. CONCLUSION: Employees DMO are at higher risk for many serious diseases. Bariatric surgery has been effective in promoting weight loss and decreasing the rates of many serious comorbidities.

The impact of gout on work absence and productivity.

OBJECTIVE: The goal of this analysis was to evaluate the impact of gout, a painful inflammatory arthritis condition, on an employed population's health-related work absence and objectively measured productivity output. METHODS: Payroll, demographic, medical, pharmaceutical, sick leave, short- and long-term disability, and workers' compensation data were collected from multiple large employers with employees widely dispersed across the United States. Data were collected during the time period of 2001 to 2004 from approximately 300,000 employees. Objective productivity output data were also available for a subset of employees (captured electronically in the form of units of work processed per person). T-tests and chi-square tests were used to compare demographic data. Two-stage multivariate regression models were used to compare annual work absence and at-work productivity between employees with and without gout, while controlling for group differences in demographics, salary, other work-related variables, and comorbidities (using the Charlson Comorbidity Index). RESULTS: The annual prevalence of gout was 4.7 per 1000 employees from 2001 to 2004. Employees with gout had 4.56 more annual absence days for all categories of health-related work absence than those without gout. Objective productivity (units of work processed) results were only available for a small subsample of employees (86 with gout and 27,472 without gout). Employees with gout processed 3.51% fewer units per hour worked and 2.38% fewer units per year than employees without gout (nonsignificant at P = 0.49 and P = 0.78, respectively). CONCLUSION: This study suggests that gout has a substantial impact on work absence and may also negatively impact productivity.

Metabolic syndrome-related conditions among people with and without gout: prevalence and resource use.

OBJECTIVE: A cohort of employees with gout were compared to those without to evaluate the differences in prevalence of disorders associated with metabolic syndrome (both those considered underlying and those associated with end-stage morbidity and mortality) as well as the cost of annual medical services (AMS) required for treatment of these conditions. METHODS: Employees with gout were identified by International Classification of Diseases-9 (ICD-9) code during the calendar years of 2001-2004 and compared to propensity-score matched employees without gout using the Human Capital Management Services Research Reference Database. T-tests were then used to compare prevalence and average AMS of comorbid disorders defined from Agency for Healthcare and Research Quality (AHRQ) diagnostic categories. RESULTS: 'Hyperlipidemia', 'essential hypertension', and 'diabetes mellitus without complications' ranked in the top 10 categories of mean number of AMS for employees with gout using AHRQ specific categories; the values were higher than found for those without gout (all p < 0.0001). 'Essential hypertension', 'hyperlipidemia', 'diabetes mellitus without complications', and 'coronary atherosclerosis' showed an approximate 2:1 prevalence ratio for employees with gout over those without (p < or = 0.05). Main study limitations include the small number of subjects with gout, retrospective study design, and possible miscoding and/or non-coding of individuals with the studied disorders. CONCLUSION: These results support the continued need for patients with gout and their clinicians to be aware of the possibility of the increased risk of associated metabolic syndrome and related comorbidities in these individuals, emphasizing the need for prevention when possible and treatment when necessary.

The economic burden of gout on an employed population.

OBJECTIVE: To examine the economic burden of illness of gout in an employed population, quantifying the impact on employers annual health benefit costs for medical and prescription claims, sick leave, short- and long-term disability, and workers' compensation. METHODS: Adjudicated claims data from 300000 employees from 2001 through 2004 were utilized. T-tests were used to compare demographic data and medical costs and services by Agency for Healthcare Research and Quality (AHRQ) diagnostic categories. Two-part models were used to determine average annual health benefit costs overall and medical costs by place of delivery. A risk stratification quintile analysis was also performed utilizing gout-specific medical and pharmaceutical costs. RESULTS: There were 1171 employees with gout identified (total n = 249 038). All demographic variables between the two groups were statistically different (p

Risk factors for depression in the survivors of the 1988 earthquake in Armenia.

Most studies of psychopathology following disasters are concerned with posttraumatic stress disorder (PTSD). The present analyses sought to assess the rate and determinants of depression in adult survivors of the 1988 earthquake in Armenia. Unlike previous studies of earthquakes, the present analyses derive from a well-defined cohort of survivors who underwent diagnostic interviewing to characterize psychiatric morbidity. As part of a cohort study of 32,743 survivors of the 1988 earthquake in Armenia, a stratified population sample of 1,785 persons was interviewed about 2 years following the disaster using a special questionnaire based on the National Institute of Mental Health (NIMH) Disaster Interview Schedule/Disaster Supplement. 52% met the criteria for major depression. Of these, a total of 177 cases of depression with no other psychiatric diagnosis or comorbidity were compared with 583 controls from the same interviewed group who did not fulfill the criteria for any psychiatric disorder. Cases and controls were compared as to data obtained independently at the aftermath of the disaster on a number of exposures and characteristics related to the earthquake. More of the cases involved females (odds ratio [OR] for males 0.7 [95% confidence interval [CI] 0.5-0.9]) and from the city of Gumri, which had some of the worst destruction (OR for residents of Gumri 5.9 [95% CI 4.0-8.8]). Being with someone in the same building at the moment of the earthquake was protective for depression (OR for presence of other people 0.5 [95% CI 0.3-0.6]), and the risk of depression increased with the amount of loss that the family sustained as a result of the earthquake (OR for highest level of loss 2.5 [95% CI 1.3-4.8]). The use of alcohol was protective for depression (OR for those who drink 0.5 [95% CI 0.3-0.8]). In various models of multivariate adjustment and analysis, the increased risk of depression with loss, geographic location, and female gender was maintained. Also, being with someone during the disaster, receiving assistance and support after the earthquake, and alcohol use were protective for depression in these multivariate analyses. Depression is a common sequel to an earthquake. As with our previous study of PTSD, we were able to relate intensity of the disaster and loss to the risk of depression in a general population sample. The role of social support during and after the disaster as a protective mechanism against adverse psychological outcome was highlighted again. Whereas alcohol use in our previous study was not related to PTSD outcome, it is noteworthy that in the present analyses it emerged as a protective factor for depression.

Long term mortality and morbidity related to degree of damage following the 1988 earthquake in Armenia

To assess the relation of increased mortality and morbidity to personal loss and damage following the 1988 earthquare in Armenia. The findings were similar with regard to the relation of damage and loss to newly reported hypertension. diabetes mellitus and arthritis. The finding of this study support the hypothesis that longer term increased rates of heart disease and chronic disease morbidity following an earthquake are related to the intensity of exposure to disaters-related damage and losses (AU)