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Mar 2021 DOI 10.14302/issn.2641-4538.jphi-21-3765
A. Weber SimonCorresponding author
Cellogic GmbH, Niedstrasse 21, 12159 Berlin, Germany
Acute post-operative delirium (POD) and long-term post-operative cognitive dysfunction (POCD) are frequent and associated with increased mortality, dependency on care giving and institutionalization rates. The POCD-related cost burden on the German long-term care insurance provides an indication for the savings potential from risk-adapted treatment schemes. Comprehensive estimates have not been assessed or published so far. A model-based cost-analysis was designed to estimate POCD-related costs in the long-term care insurance. Comprehensive analysis of inpatient operations and procedures (OPS-codes) served as the base for case number calculations, which were then used as input to the actual cost model. POCD-incidence rates were obtained from the BioCog study. Various sensitivity analyses were performed to assess uncertainty of the model results. Total POCD related annual costs in the German long-term care insurance account for approximately 1.6 billion EUR according to the base case of our analysis. Total annual costs for all POCD cases depend on surgery numbers, incidence rates, other assumptions, and uncertain input parameters. The financial burden to the long-term care insurance is substantial, even in a conservative scenario of the cost model. Variability of results stems from uncertain assumptions, POCD-incidence rates and from uncertain patient numbers who are undergoing surgery and are therefore at risk to develop POCD.
Apr 2020 DOI 10.14302/issn.2474-7785.jarh-20-3301
Amjad KarismaCorresponding author
PhD Fellow, Institute of Social Welfare and Research, University of Dhaka, Bangladesh.
Bangladesh many older people spend their life in not only the unwell health but also in poverty which is major risk for the elderly population. This is especially true for older women, who suffer from various difficulties ensuing from prejudices to gender, widowhood and old age. Climate migrants start living in urban slums are in search of better and secure life. But urban slums located mostly in low lying environmentally hazardous area coupled with inadequate facilities like food, shelter, sanitation, health care make their life even worse. Older Women are the vulnerable groups in society in terms of climate change, movement; haphazard growth and unhealthy environment are the target group for this research. This study represents the nature and extent of elderly abuse of climate migrant urban poor women slum dwellers in Dhaka city in Bangladesh context. Besides, this paper also observe the socio-economic status of the study respondents and try to find out the self-stated reasons of elderly abuse. This study conducted both quantitative and qualitative types study on two slums of Dhaka with purposive sample survey, KII and in depth qualitative interview of selected climate migrant slum dwellers while purposive sample size of 50. Decreasing in earning capacity, inability and economic dependency, health hazard, maladjustment, changing social values have a separate role in the connection of older abuse. Planned migration, awareness program implantations against elderly abuse and secured socioeconomic factors are suggested through this paper to lessen exposure to further neglecting of elderly climate migrant women in urban slums.
Feb 2019
Mohamed Alsanosy RashadCorresponding author
College of Medicine, Substance Abuse Research Centre, Jazan University, Jazan, Saudi Arabia
Objectives This study was designed to assess the demographic characteristics, prevalence of metabolic syndrome (MetSy) among patients with schizophrenia in Saudi Arabia. Methods This is a disease-oriented and observational study. Schizophrenia was defined by DSM-IV criteria. MetSy were assessed based on the international criteria (NCEP-ATP III and AHA/NHLB). Results 90% of the participants are without a university degree and 56.4% are single. Chronic and acute cases of schizophrenia were 95% and 5%, respectively. The treatment of schizophrenia was combination therapy and monotherapy with percentages of 56% and 44%, respectively. Systolic and diastolic blood pressures were 121.92±11.07 mmHg and 77.29±0.45 mmHg, respectively. Surprisingly, all patients have abnormal HDL. A mean waist circumference of 90.23±14.88 cm for men, and 93.38±15.28 cm for women. The analysis of 101 patients showed a prevalence of the MetSy is 15.8%. Chi-square test of independence showed lack of independency of MetSy on type of therapy. Modeling of MetSy and risk factors was also conducted. Conclusion The metabolic syndrome is greatly established among schizophrenic patients. It signifies a vital hazard for metabolic and cardiovascular ailments. Evaluation of the incidence and examining of the related threats of the metabolic syndrome should be an element of the clinical managing of patients cured with antipsychotics.
Mar 2018 DOI 10.14302/issn.2574-4518.jsdr-17-1785
W Chang-LitCorresponding author
Mount Sinai Beth Israel
Sleep is vital for the maintenance of physical health and mental wellbeing. Sleep also plays a cardinal role in the process of healing. It is estimated that 50 to 70 million Americans suffer chronically from sleep disturbances and insufficiency, which not only hinders daily functioning but also adversely affects health, quality of life and longevity.1 Deficient sleep is associated with an increased risk of developing chronic diseases such as hypertension, diabetes, obesity, heart disease, stroke, depression, frequent mental distress, as well as increased mortality, and reduced quality of life and productivity.1,2Aging, medical conditions, pain, and mental illness further aggravate sleep disturbances such as insomnia, sleep fragmentation and daytime sleepiness.3, 4, 5, 6, 7, 8 The a common treatment for sleep disturbances and insomnia is pharmacological therapy. Benzodiazepines may have negative long-term side effects including residual daytime sedation and tolerance development. Withdrawal difficulties may increase dependency. In the older patient there are safety issues related to daytime sedation including increase risk of falls. With the importance of sleep in hospital recovery and the side effects of sleep medication becoming more widely recognized, there has been an impetus to s use nonpharmacological alternatives , such as music.. This pilot study builds on the potential impact of music’s effectivity by introducing music therapy as a safe, cost effective and culturally sensitive intervention.
Dec 2017 DOI 10.14302/issn.2576-6694.jbbs-17-1860
P. Solyanikova InnaCorresponding author
Laboratory of enzymatic degradation of organic compounds, G.K. Skryabin Institute of Biochemistry and Physiology of Microorganisms of the Russian Academy of Sciences, Pushchino, Russia.
We explored the effect of a change in substrate-benzoate (as sole carbon and energy source) concentration in growth medium on the activity of benzoate 1,2-dioxygenase (BDO) of R.opacus 1CP cells, where BDO is the enzyme mediated the initial attack of benzoate. The activity of the enzyme was estimated by a change of respiration of whole freshly harvested bacterial cells (growth of the cells on benzoate) in response to injection of benzoate. It was shown that when concentration of growth substrate-benzoate decreased from 6 g/L to 250 mg/L, the curves of the dependency of the response rate to benzoate on the initial concentration of benzoate demonstrated that kinetics of the process changes from hyperbolic saturation kinetics, or typical Michaelis-Menten kinetics, to sigmoidal dependency of V on S. The semisaturation constant as a characteristic of the strength of substrate binding with BDO changed simultaneously. These changes were accompanied by the increase in the Hill coefficient from 1.02 up to 3.06, hence positive kinetic cooperativity by a substrate was observed for BDO of R.opacus 1CP cells. The influence of this type of cooperativity on viability of rhodococcus in natural environment and causes of the changes mentioned are discussed. It was hypothesized that an increase in substrate concentration in the medium for the growth of the bacterium not only stimulated synthesis of the inducible enzyme (BDO) in the cell but also led to the change in BDO conformation followed by the change in interaction between substrate-binding active sites of enzymes.
Aug 2016 DOI 10.14302/issn.2470-5020.jnrt-16-1200
Alhashemi HashemCorresponding author
Physical Medicine & Rehabilitation consultant, Department of Medicine, KAMC Jeddah, Assistant Professor at KSAU-HS
Objective: To assess mortality, medical complications, and care indicators among stroke patients admitted to general medical units at King Abdulaziz Medical City-Jeddah-Saudi Arabia. Methods: This retrospective cohort study included all adult patients (>16 years) admitted to KAMC-Jeddah between January 1, 2014, and June 30, 2015, with acute stroke. Data regarding in-hospital stroke mortality and medical complications (pressure ulcer, pneumonia, venous thromboembolism dysphagia, and wheelchair dependency) and stroke care indicators (time-to-CT, carotid imaging, lipid profile, physical therapy, swallowing assessment, nutritional assessment, and length of stay) were collected. Results: Patients included were 208. Acute stroke mortality was 19%, while wheelchair dependency, and dysphagia on discharge were 39% and 56% respectively in general medical units. The incidence of pressure ulcers, pneumonia, and venous thromboembolism was 17%, 14%, and 3%, respectively. Pneumonia (odds ratio OR, 5.5; P = 0.002; 95% confidence interval CI, 1.9–16), abnormal troponin level (OR, 4.4; P = 0.002; 95% CI, 1.7–11),hemorrhagic stroke (OR, 3.9; P = 0.015; 95% CI, 1.3–12), and pressure ulcers (OR, 3.0; P = 0.036; 95% CI, 1.1–8.0) were significantly associated with increased mortality. Median time to CT scan was 117 minutes. Carotid imaging was performed for 67% of ischemic stroke patients, and 65% underwent fasting lipid profile assessment. Assessment by nutritionist, physiotherapist, and swallowing therapist was done for 90%, 76%, and 53% of stroke patients respectively. The median length of stay was 12 days. Conclusion: Acute stroke mortality was 19 %, while wheelchair dependency, and dysphagia on discharge were 39% and 56% respectively in general medical units at KAMC Jeddah. Pneumonia, abnormal troponin, hemorrhagic stroke, and pressure ulcers are associated with increased mortality. Future research is needed to compare outcomes of stroke care between general units and specialized stroke units nationally.