Class of 2010 Abstract / OBJECTIVES: The purpose of this study was to determine the number of inpatient discharges and burden of illness due to testicular cancer with data from the national database Healthcare Cost and Utilization Project (HCUP). METHODS: This retrospective study looked at hospital discharge records to obtain information regarding the inpatient burden of illness of testicular cancer patients. The study looked at procedures, co-­‐morbidities, hospital characteristics, case-­‐mix control, and the Deyo-­‐Charlson to see how they were associated with the charges, length of stay, and inpatient mortality. Also included in the study was information regarding patient age, method of payment, and hospital type and size. A linear multivariate regression was performed to estimate determinates of hospital costs. RESULTS: During the 5-­‐year time frame of the study, 28,985 inpatient admissions with testicular cancer were identified. For the overall sample, the average total charges per hospitalization were $29,857. For the 717 patients that died while receiving inpatient treatment, the associated charges averaged $73,800, more than double that associated with the overall sample. The gamma regression of charges for the overall sample showed an association between increased charges and age, length of stay, number of procedures, all admission years in reference to 2002, admission to a large-­‐sized hospital in reference to a small hospital, admission to an urban hospital in reference to a rural hospital, admission to a teaching in reference to a nonteaching hospital and the Deyo-­‐Charlson score. CONCLUSIONS: Testicular cancer is on the rise worldwide and is associated with a high inpatient burden of illness.

Class of 2007 Abstract / Objectives: To explore the economic burden of illness and outcomes associated with in-patient related cases of asthma. Methods: This retrospective database study used Healthcare Cost and Utilization Project’s National Inpatient Survey to investigate the total number of discharges, length of stay and health care costs of patients with a primary diagnosis of asthma based on gender, payer and level of income. Data was analyzed using a non-parametric z-test to determine if results were significant. Results: A total of 418,789 patients (164,045 male, 251,264 female, 3,479 missing) were admitted with the category diagnosis of asthma in 2004. Females had a longer mean length of stay, higher mean charges and higher aggregate charges than males. These apparent differences were found to be significant. Medicaid had a larger number of total discharged and higher aggregate charges. Both these outcomes were found to be significant when compared to all other payers, expect there was no significance between Medicaid and Medicare in regards to aggregate charges. Medicare had a longer mean length of stay and higher mean charges which were found to be significant when compared to all other payers. Not low median income had more discharges, longer mean length of stay and higher mean and aggregate charges compared to low median income. These apparent differences were found to be significant. Conclusions: Being of female gender, or part of a government funded program (Medicaid or Medicare) or having an income of $36,000+ would result in higher discharge rates, longer mean length of stay and higher mean and aggregate charges in respect to asthma hospitalizations.

Thesis (M. P. H.)--University of Hong Kong, 2007.

Thesis (M. P. H.)--University of Hong Kong, 2007. / Also available in print.

This dissertation looks at how African countries can mitigate the effects of external debt burden. African countries are enmeshed in unsustainable external debts that have led to debt overhang problems, declining output, escalating current account deficits and worsening human welfare indicators. These external debt burdens are further worsened by the structural weaknesses of these economies. The World Bank and the International Monetary Fund have initiated strategies aimed at trying to arrest the escalating debt burden such as rescheduling, structural adjustment programs and the highly indebted poor countries initiative. However, African countries continue to experience difficulties in servicing external debts. The objective of this study is to find ways by which African countries can effectively manage their debt burden and possibly come up with self pre-qualification schemes that would forestall future external debt problems. The questions the study seeks to answer are: how can African countries effectively manage their current debt burden? What can African countries do to forestall the pervasive external debt accumulation in the future? To address these questions, I develop a dynamic stochastic general equilibrium model of external debt burden for Africa. The model is estimated using the maximum likelihood method by applying the Kalman filter to the state space representation of the model. Empirical results of the model suggest that African countries need to refine their basket of imports and mainly import inputs that can be used in the production sector as opposed to importing consumption goods. Most importantly, these countries must re-think their export products and markets, and perhaps endeavor to export final goods as opposed to exporting primary commodities. Furthermore, simulations of the model show that an expansionary monetary shock and a favourable world commodity price shock leads to an increase in external debt. On the other hand, the world interest rate shock leads to a fall in external debt. An interesting result worth highlighting is that a favourable commodity price shock leads to an increase in imported investments but the increase in imported investments does not translate into increased output. On the other hand, an unfavourable world interest rate shock leads to a fall in imported investments. Generally, these findings suggest that African countries are vulnerable to external shocks. In pursuit of the second objective – possible ways of sourcing external debt and managing it sustainably – I find that the appropriate threshold level for debt sustainability is a ratio of external debt to gross domestic product of between 40%-60% for Africa compared to 120%-150% for Latin America. Surprisingly, East Asia has the lowest significant debt sustainability threshold of the three emerging market regions. On liquidity, which is captured by the short-term debt to reserves ratio, the threshold is 60%-80% for all the three regions. On governance, a stable political environment plays a crucial role in determining the external debt burden of African countries. An improvement in the legal system and a stable political environment leads to an increase in exports and a fall in consumption imports. These in turn reduce foreign debt. These findings suggest that African countries must pursue proper governance practices if they are to appropriately and effectively manage their external debt in ways that enhance economic progress instead of economic retardation.

No / As the prevalence and incidence of wounds are predicted to increase due to an ageing population with increasing comorbidities, reducing the burden of wounds by optimising healing is seen as a key factor in lowering wound care costs. Inappropriate or delayed treatment adversely affects the time to wound healing, impacting quality of life, and increasing the burden on patients, their families and carers, society and the health economy. Identifying non-healing wounds is vital to cost reduction. Failure to recognise wounds not progressing towards healing increases the subsequent risk of non-healing and places the patient at unnecessary increased risk of wound complications.

No / The recently published ‘Burden of Wounds’ study (Guest et al, 2015a) not only highlighted the cost of delivering wound care in the UK but also revealed a number of shortcomings in the method of care delivery, many of which could potentially have adversely affected patient outcome. This paper looks more closely at some of the clinical and service issues raised by the published data from the study and combines this with observations made by the research team when reviewing the patient records to generate a number of recommendations for improvements in staff engagement, documentation, clinical management and service delivery. By implementing these recommendations variations in care standards should be reduced, delayed and non- healing be recognised earlier and as a result cost savings generated.

Background: Food allergy, an abnormal immunologic response to food protein, has an estimated prevalence of 6% in young children and 3.7% in adults in the U.S. The only proven therapy for food allergy is strict elimination of the offending allergens. As a result, caregivers and patients could experience constant anxiety and stress that affects their quality of life. Additionally, food allergy can lead to significant economic impact on the health care system, since severe reactions often lead to ED visits and hospitalizations. Objectives: The first major objective was to determine the economic burden of Food Allergy and Anaphylaxis (FAA) patients in the U.S. by estimating the direct medical and indirect costs. The second principal objective involved assessing the Health Related Quality of Life (HRQL) of food allergic patients by measuring their health utilities and disease specific quality of life. Methods: Economic burden was estimated by measuring certain direct medical and indirect costs from a societal perspective. Costs were estimated using a bottom-up approach -- calculating the average cost of illness per patient and multiplying it by reported prevalence estimates. FAA patients with an emergency department (ED) visit, office based physician visit, outpatient department visit, and hospital admission were identified from a list of federally administered databases using ICD-9 codes. Sensitivity analyses were conducted to measure the robustness of the estimates. The cross-sectional HRQL study measured health utilities in food allergic adults and children, and quality of life in allergic adults using EQ-5D and FAQL-AF questionnaires respectively. These questionnaires were administered in an online survey format. Regression models were specified to explore the deviations in HRQL scores between patients with different disease related characteristics. Results: The findings reveal that for a given year (2007), direct medical costs worth $225 million and indirect costs worth $115 million were incurred. Owing to the irregularities in the reporting and diagnosis of food allergy, these values might be an underestimation. Simulations from probabilistic sensitivity analysis generated mean direct medical costs of $307 million and indirect costs of $203 million. Survey responses were collected online for eight months, during which 45 adults and 94 parents (acting as proxy for their food allergic child) responded. Adults reported a mean utility of 0.874 compared to 0.918 for children. Gender, number of food allergies and frequency of carrying epinephrine device had significant impacts on HRQL scores. An effect size of 0.003 was estimated comparing health utilities of food allergic adults with the general U.S. population. Conclusions: This was the first research to examine economic burden of FAA, and elucidate health utilities for food allergic patients. A large proportion of costs were incurred due to ambulatory visits. Effect size calculation revealed that health utilities of food allergic patients were very similar to the general U.S. population.

Background: In Sweden, eight percent of all people by the age of 65 years or older have a dementia disease. The healthy spouse received or unconsciously took the role as caregiver in the home which could cause psychological and physical stress. Therefore it is important that nurses have good understanding of how the healthy spouses experience their life situation. Aim: The aim of this study was to describe spouses´experiences of living with a partner with dementia disease. Methods: This literature study was performed with a qualitative method. Nine scientific articles have been quality checked and analyzed with inspiration from Friberg´s way of thinking. The databases Cinahl and PubMed were used. Results: The literature study resulted in the construction of five categories followed by 13 subcategories. The result of the literature study shows that the healthy spouses are affected physically and mentally by living with a partner with dementia disease. A change in the life situation, which entails that the healthy spouse must adapt and change everyday life for the dementia suffering partner's abilities and skills. Conclusion: Living with a partner with dementia disease means a strain for the healthy spouses. It is important for nurses to pay attention to the healthy spouses´well-being. By this study the nurses hopefully understand that it is important to focus on both partners´ needs.

Drilling and blasting are seen as sub-systems of size reducing operations in mining. To have better design parameters for economical excavation of mineral production and fragmentation, the comminution and fragmentation operations need to be studied and optimized independently, as well as together, to create optimized use of energy and cost-effective operation. When there is a change in drillhole diameter or fragmentation specification, changes in the blast design parameters are required affecting the cost of a drilling and blasting operation. A model was developed to calculate blast design parameters and costs on the basis of the required 80% fragment size needed for crusher operation. The model is based on previously developed fragmentation models, found in the literature. The model examines the effect of drilling diameter on blasting requirements to achieve certain fragmentation targets and calculates blast design parameters and costs for a range of diameters from 75 to 350 mm. To examine the effectiveness of this model, two different 80% passing sizes of fragments have been considered. It was shown that cost optimization occurs at an intermediate diameter, since there are opposing trends of the effect of diameter on powder factor and accessories needed. To achieve a certain fragmentation target, the total cost of drilling and blasting shows a clear trend allowing an optimum selection of diameter. The selected diameter also allows the examination of the suitability of the drill machine under the given geological and operational conditions of the drilling site. / Thesis (Master, Mining Engineering) -- Queen's University, 2009-03-27 07:34:33.787