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Bio RB, Akweongo P, Koduah A, Adomah-Afari A. Economic burden and coping mechanisms by tuberculosis treatment supporters: a mixed method approach from Bono Region, Ghana. BMC Health Serv Res 2024; 24:148. [PMID: 38291448 PMCID: PMC10826066 DOI: 10.1186/s12913-024-10611-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The Directly Observed Therapy Short Course (DOTS) strategy recommended by World Health Organization for tuberculosis control requires multiple clinic visits which may place economic burden on treatment supporters especially those with low socio-economic status. The End tuberculosis goal targeted eliminating all tuberculosis associated costs. However, the economic burden and coping mechanisms by treatment supporters is unknown in Ghana. OBJECTIVES The study determined the economic burden and coping mechanism by treatment supporters in Bono Region of Ghana. METHODS Cross-sectional study using mixed method approach for data collection. For the quantitative data, a validated questionnaire was administered to 385 treatment supporters. Sixty in-depth interviews with treatment supporters to elicit information about their coping mechanisms using a semi-structured interview guide for the qualitative data. Descriptive statistics, costs estimation, thematic analysis and bivariate techniques were used for the data analysis. RESULTS Averagely, each treatment supporter spent GHS 112.4 (US$21.1) on treatment support activities per month which is about 19% of their monthly income. Borrowing of money, sale of assets, used up saving were the major coping mechanisms used by treatment supporters. Highest level of education, household size, marital status and income level significantly influence both the direct and indirect costs associated with tuberculosis treatment support. The significant levels were set at 95% confidence interval and p < 0.05. CONCLUSION We concludes that the estimated cost and coping mechanisms associated with assisting tuberculosis patients with treatment is significant to the tuberculosis treatment supporters. If not mitigated these costs have the tendency to worsen the socio-economic status and future welfare of tuberculosis treatment supporters.
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Rupani MP, Vyas S. A sequential explanatory mixed-methods study on costs incurred by patients with tuberculosis comorbid with diabetes in Bhavnagar, western India. Sci Rep 2023; 13:150. [PMID: 36600031 PMCID: PMC9811877 DOI: 10.1038/s41598-023-27494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 01/03/2023] [Indexed: 01/05/2023] Open
Abstract
Diabetes is one of the commonest morbidity among patients with tuberculosis (TB). We conducted this study to estimate the costs incurred by patients with TB comorbid with diabetes and to explore the perspectives of program managers as well as patients on the reasons and solutions for the costs incurred due to TB-diabetes. We conducted a descriptive cross-sectional study to estimate costs among 304 patients with TB-diabetes comorbidity registered in the public health system during 2017-2020 in the Bhavnagar region of western India, which was followed by in-depth interviews among program functionaries and patients to explore solutions for reducing the costs. Costs, when exceeded 20% of annual household income, were defined as catastrophic as this cut-off was most significantly related to adverse TB outcomes. Among the 304 patients with TB-diabetes comorbidity, 72% were male and the median (interquartile IQR) monthly family income was Indian rupees (INR) 9000 (8000-11,000) [~ US$ 132 (118-162)]. The median (IQR) total costs due to combined TB-diabetes were INR 1314 (788-3170) [~ US$ 19 (12-47)], while that due to TB were INR 618 (378-1933) [~ US$ 9 (6-28)]. Catastrophic costs due to TB were 4%, which increased to 5% on adding the costs due to diabetes. Health system strengthening, an increase in cash assistance, and other benefits such as a nutritious food kit were suggested for reducing the costs incurred. We conclude that, in addition to a marginal increase in the percentage of catastrophic costs, co-existent diabetes nearly doubled the median total costs incurred among patients with TB. Strengthening the TB-diabetes bi-directional activities, tailoring the cash transfer scheme for comorbid patients, and making the common two-drug combination diabetes tablets available at government drug stores would help TB-diabetes comorbid patients cope with the costs of care.
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Affiliation(s)
- Mihir P. Rupani
- grid.413227.10000 0004 1801 0602Department of Community Medicine, Government Medical College Bhavnagar (Maharaja Krishnakumarsinhji Bhavnagar University), Near ST Bus Stand, Jail Road, Bhavnagar, Gujarat 364001 India ,grid.411877.c0000 0001 2152 424XGujarat University, Ahmedabad, Gujarat 380009 India ,grid.415578.a0000 0004 0500 0771Present Address: Clinical Epidemiology, Division of Health Sciences, ICMR - National Institute of Occupational Health (NIOH), Indian Council of Medical Research, Meghaninagar, near Raksha Shakti University, Ahmedabad, Gujarat 380016 India
| | - Sheetal Vyas
- grid.411877.c0000 0001 2152 424XGujarat University, Ahmedabad, Gujarat 380009 India ,grid.411494.d0000 0001 2154 7601Department of Community Medicine, AMC-MET Medical College, Maninagar, Ahmedabad, Gujarat 380008 India
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Karan A, Farooqui HH, Hussain S, Hussain MA, Selvaraj S, Mathur MR. Multimorbidity, healthcare use and catastrophic health expenditure by households in India: a cross-section analysis of self-reported morbidity from national sample survey data 2017-18. BMC Health Serv Res 2022; 22:1151. [PMID: 36096819 PMCID: PMC9469515 DOI: 10.1186/s12913-022-08509-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this research is to generate new evidence on the economic consequences of multimorbidity on households in terms of out-of-pocket (OOP) expenditures and their implications for catastrophic OOP expenditure. METHODS We analyzed Social Consumption Health data from National Sample Survey Organization (NSSO) 75th round conducted in the year 2017-2018 in India. The sample included 1,13,823 households (64,552 rural and 49,271 urban) through a multistage stratified random sampling process. Prevalence of multimorbidity and related OOP expenditure were estimated. Using Coarsened Exact Matching (CEM) we estimated the mean OOP expenditure for individuals reporting multimorbidity and single morbidity for each episode of outpatient visits and hospital admission. We also estimated implications in terms of catastrophic OOP expenditure for households. RESULTS Results suggest that outpatient OOP expenditure is invariably lower in the presence of multimorbidity as compared with single conditions of the selected Non-Communicable Diseases(NCDs) (overall, INR 720 [USD 11.3] for multimorbidity vs. INR 880 [USD 14.8] for single). In the case of hospitalization, the OOP expenditures were mostly higher for the same NCD conditions in the presence of multimorbidity as compared with single conditions, except for cancers and cardiovascular diseases. For cancers and cardiovascular, OOP expenditures in the presence of multimorbidity were lower by 39% and 14% respectively). Furthermore, around 46.7% (46.674-46.676) households reported incurring catastrophic spending (10% threshold) because of any NCD in the standalone disease scenario which rose to 63.3% (63.359-63.361) under the multimorbidity scenario. The catastrophic implications of cancer among individual diseases was the highest. CONCLUSIONS Multimorbidity leads to high and catastrophic OOP payments by households and treatment of high expenditure diseases like cancers and cardiovascular are under-financed by households in the presence of competing multimorbidity conditions. Multimorbidity should be considered as an integrated treatment strategy under the existing financial risk protection measures (Ayushman Bharat) to reduce the burden of household OOP expenditure at the country level.
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Affiliation(s)
- Anup Karan
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurugram, 122002, India
| | | | - Suhaib Hussain
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurugram, 122002, India
| | | | - Sakthivel Selvaraj
- Health Economics, Financing and Policy, Public Health Foundation of India, Gurugram, 122002, India
| | - Manu Raj Mathur
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurugram, 122002, India. .,Institute of Dentistry, Bart's and The London School of Medicine and Dentistry, New Road, London, E1 2AT, UK.
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4
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Thunström AO, Sarajlic Vukovic I, Ali L, Larson T, Steingrimsson S. Prevalence of virtual reality (VR) games found through mental health categories on STEAM: a first look at VR on commercial platforms as tools for therapy. Nord J Psychiatry 2022; 76:474-485. [PMID: 34851240 DOI: 10.1080/08039488.2021.2003859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Immersive virtual reality (VR) games are increasingly becoming part of everyday life. Several studies support immersive VR technology as a treatment method for mental health problems. There is however little insight into the prevalence of commercially available VR games for treatment of mental health problems on commercial platforms such as STEAM, and to what extent they can be used as tools for treatment or add-on treatment of mental health problems. OBJECTIVE The aim of this study was to take a first look at the prevalence and overview of content of commercially available games. The games were found using search words related to psychiatric diagnosis or care. METHODS We performed a search for keywords related to symptoms, diagnosis, and treatment strategies of mental health problems. The search was performed November 2020 on STEAM. A scheme was created for elimination and inclusion of games, eliminating those games which were irrelevant to mental health or had triggering elements such as violence, excessive movement which could trigger nausea, horror and pornographic imagery. RESULTS In total, 735 hits were found, 565 unique games. After the games were reviewed for content via trailers, descriptions and screenshots, 32%, i.e. 182 games passed the inclusion criteria. Majority of the games which were excluded were either not connected to mental health, contained violence, adult content or were in other ways irrelevant or inappropriate. CONCLUSIONS Commercial platforms are only at the beginning of the development towards therapeutic content. Currently the quality and usability for therapeutic use is scarce but holds great potential.
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Affiliation(s)
- Almira Osmanovic Thunström
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Iris Sarajlic Vukovic
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lilas Ali
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tomas Larson
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Steinn Steingrimsson
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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González-González AI, Brünn R, Nothacker J, Schwarz C, Nury E, Dinh TS, Brueckle MS, Dieckelmann M, Müller BS, van den Akker M. Everyday Lives of Middle-Aged Persons with Multimorbidity: A Mixed Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:6. [PMID: 35010264 PMCID: PMC8751163 DOI: 10.3390/ijerph19010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 01/01/2023]
Abstract
The healthcare burden of patients with multimorbidity may negatively affect their family lives, leisure time and professional activities. This mixed methods systematic review synthesizes studies to assess how multimorbidity affects the everyday lives of middle-aged persons, and identifies skills and resources that may help them overcome that burden. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool (MMAT) to assess risk of bias (RoB). We synthesized findings from 44 studies (49,519 patients) narratively and, where possible, quantitatively. Over half the studies provided insufficient information to assess representativeness or response bias. Two studies assessed global functioning, 15 examined physical functioning, 18 psychosocial functioning and 28 work functioning. Nineteen studies explored skills and resources that help people cope with multimorbidity. Middle-aged persons with multimorbidity have greater impairment in global, physical and psychosocial functioning, as well as lower employment rates and work productivity, than those without. Certain skills and resources help them cope with their everyday lives. To provide holistic and dynamic health care plans that meet the needs of middle-aged persons, health professionals need greater understanding of the experience of coping with multimorbidity and the associated healthcare burden.
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Affiliation(s)
- Ana Isabel González-González
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
- Health Services Research on Chronic Patients Network (REDISSEC), 28035 Madrid, Spain
| | - Robin Brünn
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
| | - Julia Nothacker
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.N.); (E.N.)
| | | | - Edris Nury
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.N.); (E.N.)
| | - Truc Sophia Dinh
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
| | - Maria-Sophie Brueckle
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
| | - Mirjam Dieckelmann
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
| | - Beate Sigrid Müller
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
- Department of Family Medicine, School CAPHRI, Maastricht University, 6200 Maastricht, The Netherlands
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
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6
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Liu S, Ren W, Yu J, Li C, Tang S. Identification of Hub Genes Associated with Diabetes Mellitus and Tuberculosis Using Bioinformatic Analysis. Int J Gen Med 2021; 14:4061-4072. [PMID: 34354368 PMCID: PMC8331204 DOI: 10.2147/ijgm.s318071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate the potential pathophysiological association between tuberculosis (TB) and diabetes mellitus (DM) using bioinformatic analyses. Patients and Methods Gene expression datasets for healthy controls (HCs), TB patients, DM patients, TB+DM patients (GSE114192), and metformin-treated cells (GSE102677) were obtained from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified from pairwise dataset comparisons TB vs HCs and DM vs HCs. DEGs were verified by comparing them to DEGs for TB+DM vs HCs. Enrichment analysis of DEGs common to all three dataset comparisons was conducted using DAVID. The protein–protein interaction (PPI) network was established via STRING and visualised in Cytoscape. Hub genes were identified using the Cytoscape plug-in cytoHubba and then were verified using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis. Targeted miRNA prediction analysis identified metformin treatment-induced gene expression changes in peripheral blood mononuclear cells. Results A total of 422 DEGs were common to all three dataset comparisons. Functional enrichment analysis revealed these DEGs were enriched for functional terms of type I interferon signaling pathway, innate immune response, inflammatory response, and infectious diseases. Ten hub genes identified using PPI network analysis were screened for interactions with metformin target gene INS using cytoHubba based on maximal clique centrality (MCC) score. Subsequently, five hub genes were predicted to functionally interact with INS, including STAT1, IFIT3, RSAD2, IFI44L, and XAF1, as verified by RT-qPCR. Meanwhile, seven miRNAs (miR-3680-3p, miR-3059-5p, miR-629-3p, miR-29b-2-5p, miR-514b-5p, miR-4755-5p, miR-4691-3p) were associated with regulation of hub genes. Notably, six hub genes (STAT1, IFIT3, RSAD2, ISG15, IFI44, IFI6) were down-regulated in cells exposed to both metformin and Mycobacterium tuberculosis antigens. Conclusion Network hub genes hold promise as disease status biomarkers and as metformin treatment targets for alleviating TB and DM. This study describes a strategy for exploring pathogenic mechanisms of diseases such as TB and DM.
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Affiliation(s)
- Shengsheng Liu
- Department of Bacteriology and Immunology, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, 101149, People's Republic of China.,Multidisciplinary Diagnosis and Treatment Centre for Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, 101149, People's Republic of China.,Department of Tuberculosis, Anhui Chest Hospital, Anhui, 230022, People's Republic of China
| | - Weicong Ren
- Department of Bacteriology and Immunology, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, 101149, People's Republic of China
| | - Jiajia Yu
- Department of Bacteriology and Immunology, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, 101149, People's Republic of China.,Multidisciplinary Diagnosis and Treatment Centre for Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, 101149, People's Republic of China
| | - Chuanyou Li
- Department of Bacteriology and Immunology, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, 101149, People's Republic of China
| | - Shenjie Tang
- Multidisciplinary Diagnosis and Treatment Centre for Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, 101149, People's Republic of China
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Gurung SC, Rai B, Dixit K, Worrall E, Paudel PR, Dhital R, Sah MK, Pandit RN, Aryal TP, Majhi G, Wingfield T, Squire B, Lönnroth K, Levy JW, Viney K, van Rest J, Ramsay A, Santos da Costa RM, Basnyat B, Thapa A, Mishra G, Moreira Pescarini J, Caws M, Teixeira de Siqueira-Filha N. How to reduce household costs for people with tuberculosis: a longitudinal costing survey in Nepal. Health Policy Plan 2021; 36:594-605. [PMID: 33341891 PMCID: PMC8173598 DOI: 10.1093/heapol/czaa156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to compare costs and socio-economic impact of tuberculosis (TB) for patients diagnosed through active (ACF) and passive case finding (PCF) in Nepal. A longitudinal costing survey was conducted in four districts of Nepal from April 2018 to October 2019. Costs were collected using the WHO TB Patient Costs Survey at three time points: intensive phase of treatment, continuation phase of treatment and at treatment completion. Direct and indirect costs and socio-economic impact (poverty headcount, employment status and coping strategies) were evaluated throughout the treatment. Prevalence of catastrophic costs was estimated using the WHO threshold. Logistic regression and generalized estimating equation were used to evaluate risk of incurring high costs, catastrophic costs and socio-economic impact of TB over time. A total of 111 ACF and 110 PCF patients were included. ACF patients were more likely to have no education (75% vs 57%, P = 0.006) and informal employment (42% vs 24%, P = 0.005) Compared with the PCF group, ACF patients incurred lower costs during the pretreatment period (mean total cost: US$55 vs US$87, P < 0.001) and during the pretreatment plus treatment periods (mean total direct costs: US$72 vs US$101, P < 0.001). Socio-economic impact was severe for both groups throughout the whole treatment, with 32% of households incurring catastrophic costs. Catastrophic costs were associated with 'no education' status [odds ratio = 2.53(95% confidence interval = 1.16-5.50)]. There is a severe and sustained socio-economic impact of TB on affected households in Nepal. The community-based ACF approach mitigated costs and reached the most vulnerable patients. Alongside ACF, social protection policies must be extended to achieve the zero catastrophic costs milestone of the End TB strategy.
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Affiliation(s)
- Suman Chandra Gurung
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Bhola Rai
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
| | - Kritika Dixit
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
- Karolinska Institutet, Department of Global Public Health, 171 77, Stockholm, Sweden
| | - Eve Worrall
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Puskar Raj Paudel
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
- KNCV Tuberculosis Foundation, Maanweg 174, 2516 AB, Den Haag, the The Netherlands
| | - Raghu Dhital
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
| | - Manoj Kumar Sah
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
| | | | | | - Govinda Majhi
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
| | - Tom Wingfield
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Karolinska Institutet, Department of Global Public Health, 171 77, Stockholm, Sweden
| | - Bertie Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Knut Lönnroth
- Karolinska Institutet, Department of Global Public Health, 171 77, Stockholm, Sweden
| | - Jens W Levy
- KNCV Tuberculosis Foundation, Maanweg 174, 2516 AB, Den Haag, the The Netherlands
| | - Kerri Viney
- Karolinska Institutet, Department of Global Public Health, 171 77, Stockholm, Sweden
- Australian National University, Research School of Population Health, College of Health & Medicine, Canberra, ACT 2600, Australia
| | - Job van Rest
- KNCV Tuberculosis Foundation, Maanweg 174, 2516 AB, Den Haag, the The Netherlands
| | - Andrew Ramsay
- University of St Andrews, College Gate St Andrews, KY16 9AJ, UK
| | - Rafaely Marcia Santos da Costa
- Oswaldo Cruz Foundation, Centro de Pesquisa Aggeu Magalhaes, Av. Professor Moraes Rego, s/n – Cidade Universitária – Recife/PE, CEP 50.740-465, Brazil
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, P. O. Box 26500, Kathmandu, Nepal
| | - Anil Thapa
- National Tuberculosis Control Centre, Thimi, Bhaktapur, Nepal
| | - Gokul Mishra
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Julia Moreira Pescarini
- Oswaldo Cruz Foundation, Centro de Integracao de Dados e Conhecimentos para Saude, Rua Mundo, 121, Trobogy, Salvador - Bahia, CEP 41745-715, Brazil
| | - Maxine Caws
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Noemia Teixeira de Siqueira-Filha
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- University of York, Department of Helarh Sciences, Heslington, YO10 5DD, York, UK
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Murphy A, McGowan C, McKee M, Suhrcke M, Hanson K. Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review. BMJ Glob Health 2019; 4:e001475. [PMID: 31543984 PMCID: PMC6730576 DOI: 10.1136/bmjgh-2019-001475] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Experiencing illness in low-income and middle-income countries (LMICs) can incur very high out-of-pocket (OOP) payments for healthcare and, while the existing literature typically focuses on levels of expenditure, it rarely examines what happens when households do not have the necessary money. Some will adopt one or more 'coping strategies', such as borrowing money, perhaps at exorbitant interest rates, or selling assets, some necessary for their future income, with detrimental long-term effects. This is particularly relevant for chronic illnesses that require consistent, long-term OOP payments. We systematically review the literature on strategies for financing OOP costs of chronic illnesses in LMICs, their correlates and their impacts on households. METHODS We searched MEDLINE, EconLit, EMBASE, Global Health and Scopus on 22 October 2018 for literature published on or after 1 January 2000. We included qualitative or quantitative studies describing at least one coping strategy for chronic illness OOP payments in a LMIC context. Our narrative review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. RESULTS Forty-seven papers were included. Studies identified coping strategies for chronic illness costs that are not traditionally addressed in financial risk protection research (eg, taking children out of school, sending them to work, reducing expenditure on food or education, quitting work to give care). Twenty studies reported socioeconomic or other correlates of coping strategies, with poorer households and those with more advanced disease more vulnerable to detrimental strategies. Only six studies (three cross-sectional and three qualitative) included evidence of impacts of coping strategies on households, including increased labour to repay debts and discontinuing treatment. CONCLUSIONS Monitoring of financial risk protection provides an incomplete picture if it fails to capture the effect of coping strategies. This will require qualitative and longitudinal research to understand the long-term effects, especially those associated with chronic illness in LMICs.
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Affiliation(s)
- Adrianna Murphy
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine McGowan
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Humanitarian Public Health Technical Unit, Save the Children UK, London, United Kingdom
| | - Martin McKee
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, UK
- Luxembourg Institute of Socio-economic Research (LISER), Belval, Luxembourg
| | - Kara Hanson
- Department of Global Health Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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9
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Mulyasari R, Agustini N, Rustina Y. Coping Strategies and Quality of Life of Children with Type 1 Diabetes Mellitus: A Preliminary Study. Compr Child Adolesc Nurs 2019; 42:217-225. [PMID: 31192712 DOI: 10.1080/24694193.2019.1594453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Rina Mulyasari
- Puskesmas Cikajang, Garut, West Java, Indonesia
- Pediatric Nursing Department of Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Nur Agustini
- Pediatric Nursing Department of Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Yeni Rustina
- Pediatric Nursing Department of Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
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McMurry HS, Mendenhall E, Rajendrakumar A, Nambiar L, Satyanarayana S, Shivashankar R. Coprevalence of type 2 diabetes mellitus and tuberculosis in low-income and middle-income countries: A systematic review. Diabetes Metab Res Rev 2019; 35:e3066. [PMID: 30144270 DOI: 10.1002/dmrr.3066] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/12/2018] [Accepted: 08/18/2018] [Indexed: 11/09/2022]
Abstract
Increasing coprevalence of diabetes mellitus (DM) and tuberculosis (TB) in low-income and middle-income countries (LMICs) indicates a rising threat to the decades of progress made against TB and requires global attention. This systematic review provides a summary of type 2 diabetes and tuberculosis coprevalence in various LMICs. We searched PubMed, Ovid Medline, Embase, and PsychINFO databases for studies that provided estimates of TB-DM coprevalence in LMICs published between 1990 and 2016. Studies that were non-English and exclusively conducted in multidrug resistant-tuberculosis or type 1 diabetes and inpatient settings were excluded. We reviewed 84 studies from 31 countries. There were huge diversity of study designs and diagnostic methods used to estimate coprevalence, and this precluded pooling of the results. Most studies (n = 78) were from small, localized settings. The DM prevalence among TB patients in various LMICs varied from 1.8% to 45%, with the majority (n = 44) between 10% and 30%. The TB prevalence among people with DM ranged from 0.1% to 6.0% with most studies (n = 9) reporting prevalences less than 2%. Coprevalence of TB-DM was higher than general population prevalence of either diseases in these countries. This study underscores the need for intervention and more focused research on TB DM bidirectional screening programs in low-income and middle-income countries as well as integrated chronic disease management.
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Affiliation(s)
- Hannah Stowe McMurry
- University of Miami Miller School of Medicine, Miami, FL, USA
- Centre for Chronic Disease Control, Delhi, India
| | - Emily Mendenhall
- Science, Technology, and International Affairs Program, School of Foreign Service, Georgetown University, Washington, DC, USA
| | | | - Lavanya Nambiar
- Public Health Foundation of India, Delhi, India
- Department of Health Policy, Management Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Roopa Shivashankar
- Centre for Chronic Disease Control, Delhi, India
- Public Health Foundation of India, Delhi, India
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Yerramilli P, Fernández Ó, Thomson S. Financial protection in Europe: a systematic review of the literature and mapping of data availability. Health Policy 2018; 122:493-508. [DOI: 10.1016/j.healthpol.2018.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 10/18/2022]
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Alexander J, Edwards RA, Savoldelli A, Manca L, Grugni R, Emir B, Whalen E, Watt S, Brodsky M, Parsons B. Integrating data from randomized controlled trials and observational studies to predict the response to pregabalin in patients with painful diabetic peripheral neuropathy. BMC Med Res Methodol 2017; 17:113. [PMID: 28728577 PMCID: PMC5520324 DOI: 10.1186/s12874-017-0389-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/10/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND More patient-specific medical care is expected as more is learned about variations in patient responses to medical treatments. Analytical tools enable insights by linking treatment responses from different types of studies, such as randomized controlled trials (RCTs) and observational studies. Given the importance of evidence from both types of studies, our goal was to integrate these types of data into a single predictive platform to help predict response to pregabalin in individual patients with painful diabetic peripheral neuropathy (pDPN). METHODS We utilized three pivotal RCTs of pregabalin (398 North American patients) and the largest observational study of pregabalin (3159 German patients). We implemented a hierarchical cluster analysis to identify patient clusters in the Observational Study to which RCT patients could be matched using the coarsened exact matching (CEM) technique, thereby creating a matched dataset. We then developed autoregressive moving average models (ARMAXs) to estimate weekly pain scores for pregabalin-treated patients in each cluster in the matched dataset using the maximum likelihood method. Finally, we validated ARMAX models using Observational Study patients who had not matched with RCT patients, using t tests between observed and predicted pain scores. RESULTS Cluster analysis yielded six clusters (287-777 patients each) with the following clustering variables: gender, age, pDPN duration, body mass index, depression history, pregabalin monotherapy, prior gabapentin use, baseline pain score, and baseline sleep interference. CEM yielded 1528 unique patients in the matched dataset. The reduction in global imbalance scores for the clusters after adding the RCT patients (ranging from 6 to 63% depending on the cluster) demonstrated that the process reduced the bias of covariates in five of the six clusters. ARMAX models of pain score performed well (R 2 : 0.85-0.91; root mean square errors: 0.53-0.57). t tests did not show differences between observed and predicted pain scores in the 1955 patients who had not matched with RCT patients. CONCLUSION The combination of cluster analyses, CEM, and ARMAX modeling enabled strong predictive capabilities with respect to pain scores. Integrating RCT and Observational Study data using CEM enabled effective use of Observational Study data to predict patient responses.
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Affiliation(s)
- Joe Alexander
- Pfizer Inc, 235 E 42nd St, New York, NY, 10017, USA.
| | - Roger A Edwards
- Health Services Consulting Corporation, 169 Summer Road, Boxborough, MA, 01719, USA
| | | | - Luigi Manca
- Fair Dynamics Consulting, srl, Via Carlo Farini, 5, 20154, Milan, Italy
| | - Roberto Grugni
- Fair Dynamics Consulting, srl, Via Carlo Farini, 5, 20154, Milan, Italy
| | - Birol Emir
- Pfizer Inc, 235 E 42nd St, New York, NY, 10017, USA
| | - Ed Whalen
- Pfizer Inc, Eastern Point Rd, Groton, CT, 06340, USA
| | - Stephen Watt
- Pfizer Inc, 235 E 42nd St, New York, NY, 10017, USA
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13
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Affiliation(s)
| | - Anoop Misra
- Fortis CDOC Hopsital for Diabetes and Metabolic Diseases
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14
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Qiu S, Sun XH, Liu WY, Kanu JS, Li R, Yu QY, Huang FX, Li B, Zhang YX. Prevalence and correlates of psychological distress among diabetes mellitus adults in the Jilin province in China: a cross-sectional study. PeerJ 2017; 5:e2869. [PMID: 28123907 PMCID: PMC5244878 DOI: 10.7717/peerj.2869] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/06/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Psychological disorders are common in diabetes mellitus (DM) patients, and the aim of this study was to estimate the prevalence of psychological distress and to determine the influence factors associated with psychological distress among DM patients in the Jilin province of China. METHODS AND MATERIALS Multistage, stratified cluster sampling was used in this cross-sectional study. The 12-item General Health Questionnaire (GHQ-12) was used to assess psychological status with the total score of ≥4 as the threshold for psychological distress. RESULTS A total of 1,956 subjects with DM were included in the study. Out of this total diabetic participants, 524 (26.8%) had psychological distress. Multiple logistic regression analysis showed that low educational level, divorce or separation from one's spouse, low family average monthly income, short sleep duration, being aware of DM status, and multiple co-morbidities are positively associated with psychological distress (all P < 0.05). CONCLUSIONS This study revealed a high rate of psychological distress among DM population in Jilin province. Low educational level, divorce or separation from one's spouse, low family average monthly income, short sleep duration, awareness of DM status, and multiple co-morbidities are all associated with psychological distress among our study subjects. Interventions to control these factors are needed to address the psychological problems among diabetics in Jilin Province.
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Affiliation(s)
- Shuang Qiu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Xuan Hong Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Wen Ya Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Joseph Sam Kanu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Ri Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Qin Ya Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Feng Xu Huang
- Illawarra Health and Medical Research Institute, School of Medicine, University of Wollongong, Wollongong, Australia
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yang Xiang Zhang
- Psychiatry Research Center, Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
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15
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Zheng C, Hu M, Gao F. Diabetes and pulmonary tuberculosis: a global overview with special focus on the situation in Asian countries with high TB-DM burden. Glob Health Action 2017; 10:1-11. [PMID: 28245710 PMCID: PMC5328328 DOI: 10.1080/16549716.2016.1264702] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/11/2016] [Accepted: 11/20/2016] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The double burden of tuberculosis (TB) and diabetes mellitus (DM) is hitting certain Asian countries harder than other areas. In a global estimate, 15% of all TB cases could be attributable to DM, with 40% of those cases coming from India and China. Many other countries of South, East, and South-East Asia are of particular concern given their TB burdens, large projected increases in DM prevalence, and population size. OBJECTIVE In this narrative review, we aimed to: (i) give an overall insight into the evidence on TB-DM epidemiology from high double burden Asian countries, (ii) present the evidence on bi-directional screening implementation in this region, (iii) discuss possible factors related to higher TB susceptibility of Asian diabetic patients, and (iv) identify TB-DM comorbidity treatment challenges. METHODS The PubMed and Google Scholar databases were searched for all studies addressing DM/TB epidemiology, bi-directional screening and management in South, East and South-East Asia. RESULTS We identified the DM prevalences among TB patients as ranging from approximately 5% to more than 50%, whereas TB prevalences among diabetic patients were 1.8-9.5 times higher than in the general population in developing Asian countries. Evidence from studies designed to address diagnosis and treatment of the dual disease in these critical regions is scarce as well as the evidence related to possible DM patients' genetic and acquired predisposition for TB. CONCLUSION More prospective studies specifically designed to address adequate screening techniques, identify patients at risk, and define an adequate treatment of dual disease in this region are needed without delay.
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Affiliation(s)
- Chunlan Zheng
- Department of Internal Medicine – Section 5, Wuhan Pulmonary Hospital (Wuhan Tuberculosis Control Institute), Wuhan, P.R. China
| | - Minhui Hu
- Department of Internal Medicine – Section 5, Wuhan Pulmonary Hospital (Wuhan Tuberculosis Control Institute), Wuhan, P.R. China
| | - Feng Gao
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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