Category: Nevin Manimala

Health Econ. 2021 Jul 3. doi: 10.1002/hec.4378. Online ahead of print.

ABSTRACT

We analyze the timing, magnitude, and income dependence of pharmaceutical panic buying around the outbreak of the COVID-19 pandemic in Hungary. We use district-level monthly and daily administrative data on detailed categories of pharmaceutical purchases, merge them to income statistics, and estimate multilevel panel models. Our main results are as follows. First, the days of therapy (DOT) of pharmaceutical purchases increased by more than 30% in March 2020, when major lockdown measures were announced. This pattern holds for almost all categories of pharmaceuticals. Second, shortly after the panic reactions, the aggregate amount of pharmaceutical purchases returned to their preshock levels; however, the frequency of pharmacy visits decreased. Third, the panic buying reaction was significantly stronger in richer geographical areas, where-according to the daily data-people also reacted earlier to the pandemic-related news. Overall, the results suggest that panic buying of pharmaceuticals can have detrimental effects on vulnerable populations.

PMID:34218496 | DOI:10.1002/hec.4378

Int J Health Plann Manage. 2021 Jul 3. doi: 10.1002/hpm.3275. Online ahead of print.

ABSTRACT

BACKGROUND: Despite improvements in many health indicators, providing access to affordable healthcare remains a considerable challenge in Bangladesh. Financing incidence analysis will enable an evaluation of how well the healthcare system performs to achieve equity in health financing. The objective of this study is to assess the burden of out-of-pocket (OOP) cost on different socio-economic groups by assessing the health financing incidence because OOP cost dominates household expenditure on health in Bangladesh.

METHODS: The study was conducted using latest Household Income and Expenditure Survey (HIES) 2016. We focused mainly on four specific indicators: level of monthly household OOP cost on in-patient care, urban-rural differences in OOP cost, socio-economic status differences in different payment mechanisms and the Kakwani index. Descriptive statistics were employed to analyse and summarise the selected variables based on the SES and location of residence (e.g., rural and urban).

RESULTS: The study showed the overall OOP healthcare expenditure was 7.7% of the household monthly income while the poorer income group suffered more and spent up to 35% of their household income on healthcare. The Kakwani index indicated that the poorest quintile spends a greater share of their income on healthcare services than the richest quintile.

CONCLUSIONS: This study observed that OOP cost in Bangladesh is regressive, that is, poorer members of society contribute a greater share of their income. Therefore, policymakers should initiate health reforms for developing and implementing risk-pooling financing mechanisms such as social health insurance to achieve the Universal Health Coverage in Bangladesh.

PMID:34218437 | DOI:10.1002/hpm.3275

Clin Anat. 2021 Jul 4. doi: 10.1002/ca.23763. Online ahead of print.

ABSTRACT

INTRODUCTION: No clinical studies to date have compared the airway luminal area between supine and standing positions. Our aim was therefore to compare the airway luminal area between these two positions on computed tomography (CT) and to determine its correlation with forced expiratory volume in 1s (FEV1).

MATERIALS AND METHODS: Thirty-two asymptomatic volunteers underwent both conventional (supine position) and upright (standing position) CT during deep inspiration breath-holding. Pulmonary function tests were conducted on the same day. We measured the airway luminal area on CT in each position. Paired t-tests and Pearson’s correlation coefficients were used for statistical analysis.

RESULTS: The average luminal areas of the trachea, right and left main bronchi, and average third-generation airway were greater in the standing than the supine position by 3.4%, 6.1%, 5.5%, and 5.2%, respectively. The correlation coefficients between airway luminal areas and FEV1 tended to be higher in the standing than the supine position; this correlation was highest for the average third-generation airway (r=0.70, P <0.0001).

CONCLUSION: The airway luminal areas of the trachea, bilateral main bronchi, and average third-generation airway were greater in the standing than the supine position. The average third-generation airway area in the standing position had the highest correlation with FEV1. This article is protected by copyright. All rights reserved.

PMID:34218460 | DOI:10.1002/ca.23763

Theory Biosci. 2021 Jul 3. doi: 10.1007/s12064-021-00352-8. Online ahead of print.

ABSTRACT

This theoretical analysis considers a biomechanical model in which the Carreau fluid model characterizes the viscoelastic nature of growing human embryo and secreted fluid. This model incorporates transport mechanisms that involve the swaying motions of ciliary cells, peristaltic contractions of smooth muscle cells and pressure gradient at the ampullar region entrance. Series form solutions of the resulting partial differential equations are obtained using the regular perturbation method. A theoretical estimate of effects of the condition of pressure gradient, geometric parameters and fluid model parameters on the flow variables that have relevance to the problem of growing embryo transport in the human fallopian tube is presented through the discussion of graphs. Furthermore, an analogy between the linearly viscous fluid, and the shear thinning and shear thickening characteristics of the Carreau fluid model is also presented. The pertinence of the obtained results with growing embryo transport in the human fallopian tube revealed that when shear thickening characteristics of the Carreau fluid model are considered then complete mitotic divisions take place properly with an estimated appropriate residue time about 3-4 days. Smaller size trapped boluses of the secreted fluid make the smooth forwarding of the growing embryo in the human fallopian tube when shear thinning characteristics of the Carreau fluid model are taken into account. Key modulators: progesterone ([Formula: see text] and estradiol ([Formula: see text]), prostaglandin [Formula: see text] ([Formula: see text]) and prostaglandin [Formula: see text] ([Formula: see text]) constraint the growing embryo transport.

PMID:34218412 | DOI:10.1007/s12064-021-00352-8

Acta Neurol Belg. 2021 Jul 3. doi: 10.1007/s13760-021-01727-w. Online ahead of print.

ABSTRACT

Migraine is considered an underdiagnosed disease in general population. Different studies show a higher prevalence in neurologists. However, there are few studies about its prevalence in doctors of other specialties, where it could also be superior than in general population. Our aim was to define migraine lifetime prevalence among doctors according to three parameters (previous diagnosis, self-diagnosis and positivity of a screening test). Single-center, descriptive, cross-sectional study based on online surveys with collection of sociodemographic and clinical variables, addressed to doctors of a tertiary hospital. Participants who reported 5 or more headaches throughout their lives were considered “headache sufferers” and were divided in different groups according to their position (specialists or trainees) and their specialty (medical, medical-surgical and surgical or specialties with no direct contact with the patient). The Spanish validated version of the Migraine Screen Questionnaire (MS-Q) was used as screening test. There were 217 participants (response rate of 29%), 72% were women and 56% trainees, mean age 34 years (SD10). 77% were “headache sufferers” Among all participants, migraine lifetime prevalence according to diagnosis by another physician was 15.2%, self-diagnosis 38.2% and positivity of the MS-Q 20.3%; those categories were not mutually exclusive Greater but not statistically significant coexistence of self-diagnosis and positive MS-Q was seen in specialists compared to trainees and in medical specialties. Migraine prevalence among doctors in a tertiary care hospital was higher than in general population, according to all three parameters analyzed. Self-diagnosis was the highest which could reflect an overdiagnosis; further studies are needed to determine this possibility.

PMID:34218428 | DOI:10.1007/s13760-021-01727-w

Acta Gastroenterol Belg. 2021 Apr-Jun;84(2):311-316. doi: 10.51821/84.2.311.

ABSTRACT

BACKGROUND: Hepatitis C is a viral infection caused by the hepatitis C virus (HCV) with people who inject drugs as the main group at risk worldwide.

AIM: This study investigated the differences in uptake for HCV screening and treatment between persons in opioid substitution therapy (OST) and the other members of the Christian Health Insurance Fund in Belgium.

METHODS: Invoice data were retrospectively collected from the Christian Health Insurance Fund, representing 42% of the healthcare users. Information on demographics, screening, diagnostic tests, treatment and disease progression was obtained from 2008 till 2013. All people in this study were aged 20-65 year. Persons in the OST group were identified as having at least one prescription reimbursed for methadone. This group was compared to the other members of the Insurance Fund not on OST (NOST).

RESULTS: The Insurance Fund registered 8,409 unique OST and 3,525,190 members in the general group. HCV RNA screening rate was higher in the OST group after correction for age and gender (4.3% vs. 0.2%). Ribavirin reimbursement, did not differ between the OST and NOST group screened for HCV RNA (16.9% vs. 14.4%), though the probability of having ribavirin reimbursed was smaller for females than for males. Procedures concerning disease progression were reimbursed less frequently in the HCV RNA screened OST group compared to the NOST group (0.3% vs. 1.2%).

CONCLUSION: People on OST were screened more often for HCV RNA. However, the general uptake for HCV screening and treatment in both populations remained suboptimal.

PMID:34217181 | DOI:10.51821/84.2.311

Acta Gastroenterol Belg. 2021 Apr-Jun;84(2):289-294. doi: 10.51821/84.2.289.

ABSTRACT

BACKGROUND AND STUDY AIM: In principle, additional surgery is performed after endoscopic submucosal dissection for early gastric cancer if the vertical margin is positive, regardless of lesion damage. The recurrence rate of vertical margin-positive lesions due to lesion damage after endoscopic submucosal dissection is unknown, and unnecessary surgeries may be performed. In this study, we investigated whether there was a difference in the recurrence rate between vertical margin-positive lesions due to lesion damage and vertical margin-negative lesions.

PATIENTS AND METHODS: We included 1,294 intramucosal gastric cancer lesions that were resected by endoscopic submucosal dissection between January 2008 and December 2016, without additional surgery. The lesions were divided into the Damage and No damage groups based on vertical margin status. The Damage group had only one non-curative indication: a positive vertical margin due to lesion damage. The No damage group had no non curative indications. We compared the recurrence rate between the Damage and No damage groups.

RESULTS: The recurrence rates of the Damage and No damage groups were 0% (0/23; 95% confidence interval: 0-14.8%) and 0% (0/1,271; 95% confidence interval: 0-0.003%), respectively, with no statistically significant difference.

CONCLUSIONS: In intramucosal gastric cancer, the recurrence rate of vertical margin-positive lesions due to lesion damage was 0%, which did not differ from that of vertical margin-negative lesions with curative resection. Follow-up, instead of additional surgery, may be an option for patients with non-curative resection when the only non-curative indication is a positive vertical margin due to lesion damage.

PMID:34217177 | DOI:10.51821/84.2.289

Acta Gastroenterol Belg. 2021 Apr-Jun;84(2):295-298. doi: 10.51821/84.2.295.

ABSTRACT

BACKGROUND AND STUDY AIMS: Transanal irrigation (TAI) is used in children to treat constipation and incontinence. Belgium has 2 systems available: Colotip® (cheaper, however not designed for TAI) or Peristeen®.

PATIENTS AND METHODS: This patient-control switch study is the first to compare 2 TAI systems. Children regularly using Colotip® for TAI were asked to participate, after consent, a visual analogue scale (VAS) rating the system and a 2-week diary (fecal continence, self-reliance, time spent on the toilet, pain, Bristol stool scale, irrigation volume and frequency of enema) were completed. Non-parametric statistics were used.

RESULTS: Out of 26 children using Colotip®, 18 (69%) children participated and 5 refused (fear n=1, satisfaction Colotip® system n=7). Of these 18 children (interquartile range: 3-18 years, median 12.5 years, 9 girls) 5 patients stopped Peristeen® (pain n=1, fear n=1 and balloon loss n=3) and 2 were lost from follow up. Dropouts and included patients showed no statistical difference. In the 11 remaining patients, pseudo-continence (p 0.015), independence (p 0.01) and VAS score (p 0.007) were significantly better with Peristeen®, no difference was found in time spent on the toilet (p 0.288) and presence of pain (p 0.785).

CONCLUSIONS: In children Peristeen® offered significantly higher pseudo-continence and independency. 30% refused participation because of satisfaction with the Colotip® and 30% spina bifida patients reported rectal balloon loss due to sphincter hypotony. To diminish Peristeen® failure, a test-catheter could be of value. Considering Colotip® satisfaction, both systems should be available. Patient selection for Peristeen® needs further research.

PMID:34217178 | DOI:10.51821/84.2.295

Turk J Med Sci. 2021 Jul 4. doi: 10.3906/sag-2011-254. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: Currently, the elderly population in the world is rapidly increasing due to technological developments and convenient access to health services. Due to comorbidities in elderly patients, hip fractures are frequently observed after exposure to environmental trauma. To reduce pain during positioning in spinal anesthesia, fascia iliaca compartment block (FICB) can be applied easily and reliably. In our study, we aim to compare the analgesic effects and duration of Fascia iliaca compartment blocks performed Usg guided or Landmark approach methods in relieving spinal anesthesia position pain.

MATERIALS AND METHODS: Our study included 100 patients undergoing operations due to hip fracture and administered spinal anesthesia after FICB. The group USG guided FICB(USG) had the blockage needle advanced to the compartment under the fascia iliaca and 15 mL bupivacaine + 10 mL 2% lidocaine was administered. Sitting position was given for spinal anesthesia 20 minutes later and procedure duration and Numerating Rating Scale(NRS) scores were recorded. In the group Landmark approach FICB(LAND), the spina iliaca anterior superior (SIAS) and pubic tubercle were connected with a line. The same amount of local anesthetic was administered to the external 1/3 portion of this line with the double pop technique. Procedure duration and NRS scores were recorded.

RESULTS: There was no statistically significant difference between two groups in terms of NRS scores (p>0.05). There was a statistical difference duration of FICB administration between two groups(p<0.05).

CONCLUSION: Both USG-guided and landmark approach FICB methods provide adequate and similar analgesia for positioning spinal anesthesia. However, in cases where there is no problem of access to the ultrasound device or time problem, a safer blockage can be made by imaging neurovascular structures with ultrasound.

PMID:34217171 | DOI:10.3906/sag-2011-254

Neuro Endocrinol Lett. 2021 May 4;42(2):70-80. Online ahead of print.

ABSTRACT

BACKGROUND: Sectional image of the peripheral nerves is a prerequisite for studying the morphological parameters of fascicular groups. Ultra-high precision MicroCT scan can explicitly display the internal morphology of physiological tissues. This study aimed to quantitatively measure the basic morphological parameters of fascicular groups of a peripheral nerve on MicroCT images, obtain the statistical principles and investigate the variation pattern of these morphological parameters during the process of fascicular group extension.

METHODS: Peripheral nerve specimens were processed with fat removal, decellularization, freezing, and drying, etc. The morphological parameters including area, perimeter, and the degree of circularity of each fascicular group in the peripheral nerve on MicroCT images were obtained by the image processing method. The cross-sectional area, cross-sectional perimeter, and cross-sectional degree of circularity of the single fascicular group were analyzed. Correlation between the cross-sectional area of single fascicular group and fascicular group extension, the correlation between the perimeter of cross-sectional single fascicular group and fascicular group extension, and correlation between the cross-sectional degree of circularity of single fascicular group and fascicular group extension were analyzed.

RESULTS: The cross-sectional area of fascicular groups confirmed the Beta distribution with a dominant proportion of small-area fascicular groups and a low percentage of large-area fascicular groups. Within the range of 3 mm, no significant correlation was observed between the cross-sectional area and the spatial extension of fascicular groups. The perimeter of the fascicular group section was normally distributed. The perimeter of the fascicular group section that did not remain stable immediately after the fascicular group – was split or merged, but it gradually became stable after the fascicular groups extended to a certain distance. The cross-sectional area of the fascicular groups did not change significantly during this period. The degree of circularity of the fascicular group section followed the t distribution pattern with scale/position parameters. Similarly, it gradually approached the average value only after the fascicular groups extended to a certain length.

CONCLUSION: Current study revealed the general rules of the basic morphometric parameters of fascicular groups in the process of spatial extension, which provided a pivotal basis for the repair of peripheral nerves and the diagnosis and treatment of neurological diseases and was of academic value and significance.

PMID:34217163