Investigation of the Effect of Aging on Health Costs: A Systematic Review

Background & Objectives: Aging and the need for more health care in the elderly population have incurred large expenditures. Based on the importance of the aging population phenomenon and the increase in lifetime in recent decades, this study aimed to systematically review the studies on costs of elderly health care. Methods: In this systematic review, the articles published in PubMed Google Scholar, Science Direct, Scopus, and Ovid Medline databases from 2000 to 2017 were derived using a systematic search strategy. Results: The results of the reviewed studies showed that by increasing the consumption of long-term care and home care, the costs would increase and by reducing the consumption of acute hospital care, such costs would decrease. Based on the results, the average cost of elderly health care in the reviewed studies was 48101 US dollars in 2015. Moreover, the highest average costs were for inpatient services (19003US dollars) and long-term care and home care (12583US dollars). Conclusion: Considering the high costs of hospitalization of the elderly, measures like establishment of day care centers and home care instead of hospitalization should be taken into consideration in the elderly health care programs to reduce the number of hospitalizations. Key¬words: Aging, the Elderly, Health Costs, Hospital Costs, Systematic Review Citation: Rezapour A, Arabloo J, Alipour V, Alipour S. Investigation of the Effect of Aging on Health Costs: A Systematic Review. Journal of Health Based Research 2020; 5(4): 411-22. [In Persian

Dimensões e componentes da economia da informação como uma nova economia uma revisão sistemática

Objective of the Study: Despite the critical role and impact of the information economy in the modern world, the dimensions and components of this multi-faceted concept remain understudied and unknown. The complexity and vagueness of information economy and its dimensions has made it challenging, especially for developing countries, to create value and wealth from the appropriate usage of information. This study aims to identify the dimensions and components of the information economy at the micro and macro level.Methodology/Approach: A systematic review guided by PRISMA recommendations was carried out in which 20 papers that met the inclusion criteria were analyzed. ScienceDirect, Google Scholar, Embase, PubMed, Emerald, Scopus, Web of Science and Econlit databases were searched to find relevant English documents.Originality/Relevance: This study conceptualizes and determines the dimensions and components of information economy through a systematic review of the literature.Main Results: The analysis determined eight themes (i.e., dimensions) for the information economy, including human capital, economic factors, governing laws and regulations, political factors, information and communication technology, cultural factors, stakeholders, and information. These themes had a total of 15 sub-themes and 60 codes.Theoretical/Methodological Contribution: This study conceptualizes information economy by identifying and defining its various dimensions and components. The results can be used to develop information economy strategies at the managerial level, especially in developing countries.Objetivo del estudio: A pesar del papel crítico y el impacto de la economía de la información en el mundo moderno, las dimensiones y los componentes de este concepto multifacético siguen siendo poco estudiados y desconocidos. La complejidad y vaguedad de la economía de la información y sus dimensiones han hecho que sea un desafío, especialmente para los países en desarrollo, crear valor y riqueza a partir del uso apropiado de la información. Este estudio tiene como objetivo identificar las dimensiones y componentes de la economía de la información a nivel micro y macro.Metodología/Enfoque: se realizó una revisión sistemática guiada por las recomendaciones PRISMA en la que se analizaron 20 artículos que cumplieron con los criterios de inclusión. Se realizaron búsquedas en las bases de datos ScienceDirect, Google Scholar, Embase, PubMed, Emerald, Scopus, Web of Science y Econlit para encontrar documentos en inglés relevantes.Originalidad/Relevancia: Este estudio conceptualiza y determina las dimensiones y componentes de la economía de la información a través de la revisión sistemática de la literatura.Resultados principales: El análisis resultó en la determinación de ocho temas (es decir, dimensiones) para la economía de la información, incluidos el capital humano, los factores económicos, las leyes y reglamentos vigentes, los factores políticos, la tecnología de la información y la comunicación, los factores culturales, las partes interesadas y la información. Estos temas tenían un total de 15 subtemas y 60 códigos.Aporte Teórico/Metodológico: Este estudio contribuye a conceptualizar la economía de la información al identificar y definir sus diversas dimensiones y componentes. Los resultados pueden utilizarse para desarrollar estrategias de economía de la información a nivel gerencial, especialmente en los países en desarrollo.Objetivo do Estudo: Apesar do papel crítico e do impacto da economia da informação no mundo moderno, as dimensões e os componentes desse conceito multifacetado permanecem pouco estudados e desconhecidos. A complexidade e imprecisão da economia da informação e suas dimensões tornaram desafiador, especialmente os países em desenvolvimento, criar valor e riqueza a partir do uso adequado da informação. Este estudo visa identificar as dimensões e componentes da economia da informação no nível micro e macro.Metodologia/Abordagem: foi realizada uma revisão sistemática guiada pelas recomendações do PRISMA na qual foram analisados 20 artigos que atenderam aos critérios de inclusão. As bases de dados ScienceDirect, Google Scholar, Embase, PubMed, Emerald, Scopus, Web of Science e Econlit foram pesquisadas para encontrar documentos relevantes em inglês.Originalidade/Relevância: Este estudo conceitua e determina as dimensões e componentes da economia da informação por meio da revisão sistemática da literatura.Principais resultados: A análise resultou na determinação de oito temas (ou seja, dimensões) para a economia da informação, incluindo capital humano, fatores econômicos, leis e regulamentos governamentais, fatores políticos, tecnologia da informação e comunicação, fatores culturais, partes interessadas e informação. Esses temas tiveram um total de 15 subtemas e 60 códigos.Contribuição Teórico/Metodológica: Este estudo contribui para a conceituação da economia da informação, identificando e definindo suas diversas dimensões e componentes. Os resultados podem ser usados para desenvolver estratégias de economia da informação no nível gerencial, especialmente em países em desenvolvimento

Comparison of video-assisted thoracoscopic surgery with thoracotomy for treatment of chronic empyema: A systematic review study

Context:Empyema is a respiratory disease that has increased seriously in the past two decades. The usual treatments for stage III patients include thoracotomy and video-assisted thoracoscopic surgery. Hence, a systematic review of the literature was conducted to investigate the effectiveness and safety of the two procedures. Methods:Electronic databases of PubMed, Cochrane Library, Scopus, NIHR HTA, Embase, Magiran, and SID were searched from 1990 until the end of June 2018. We used the Critical Appraisal Skills Programme (CASP) checklist for quality assessment. Data analysis was performed in Stata software. The pooled effectiveness results were demonstrated in Forest plats. Results:Among 2,228 records initially retrieved, four studies entered the final stage of review, among which three were included in the meta-analysis. The findings showed no significant difference between the two methods of thoracoscopic surgery and thoracotomy in the treatment of organizational empyema in terms of duration of surgical operation (MD = 1.33, %95 CI:-0.66-3.31, P = 0.18). Postoperative hospital stay was not statistically different between the two surgical methods (MD = 1.68, %95 CI:-0.20-3.56, P = 0.08). In terms of safety, there was no particular risk for patients across the surgeries. Conclusions:There is no statistically significant difference between video-assisted thoracoscopic surgery and thoracotomy in terms of effectiveness and safety. Nevertheless, the results should be considered cautiously due to the little number of included studies

Educational Costs of Residents in a Teaching Hospital: a case study

Background & Objectives: Residents spend much of their time at the hospitals to earn their required educational skills and although they act as a kind of human resource in the hospital, they increase hospital costs. The present study was designed to calculate the share of educational costs of different medical residents in hospitals. Methods: In this descriptive and applied study performed in one of the hospitals affiliated to Iran University of Medical Sciences, the hospital cost items of education of residents in different medical fields during the academic year of 2017-2018 were identified by use of two scenarios. Results: In short, mean educational cost of one resident in the studied academic year was about 5357$based on the first scenario and about 5404$ according to the second scenario. Based on both scenarios, salaries paid to residents accounted for more than 50% of the costs followed by the cost of consumed materials by residents. Forensic Medicine and Anesthesiology residency programs had respectively the lowest and highest share of costs in both scenarios. Conclusion: The cost of training in the hospital is different among residency fields based on the required tests and errors in each field. But, in order to save hospital costs, the culture of optimal use of materials as well as medical equipment should be taught to residents. Key­words: Education Economics, Costing, Direct Costs, Residents, Teaching hospital ­Citation: Aleboyeh MR, Reza pour A, Meshkani Z, Alipour V, Soleimani movahed M. Educational Costs of Residents in a Teaching Hospital: a case study. Journal of Health Based Research 2019; 5(2): 117-30

Post-operative ascites of unknown origin after laparoscopic cholecystectomy: Case report

Introduction and importance: Post Laparoscopic cholecystectomy ascites is a rare complication that might be due to biliary leak, lymph duct injuries, infections, peritoneal reaction bowel injuries, malignancies and etc.& nbsp;Case presentation: Here we have reported post-cholecystectomy ascites presented with hypovolemic shock in a women of unknown origin. Different possible etiologies have been ruled out for her but her intra-peritoneal secretions had been decreased about one week of hospitalization and was discharged without figuring out its etiology.& nbsp;Clinical discussion: Post-cholecystectomy ascites is a rare condition that could be caused by biliary leak, lymphatic leak, ovarian hyper stimulation syndrome, infections, peritoneal reactions and malignancies that all of them should be considered for these patients to manage their problem.& nbsp;Conclusion: The exact cause of ascites in the presented case was still unknown and the condition was controlled by administration of corticosteroids, octreotide, albumin, and insertion of the stents in biliary ducts. More investigation esp. on immunologic causes are needed

Economic burden of cardiovascular diseases before and after Iran’s health transformation plan: Evidence from a referral hospital of Iran

Background: Different countries have set different policies to control and decrease the costs of cardiovascular diseases (CVDs). Iran was aiming to reduce the economic burden of different disease by a recent reform from named as health transformation plan (HTP). This study aimed to examine the economic burden of CVDs before and after of HTP. Methods: This cross-sectional study was conducted on 600 patients with CVDs, who were randomly selected from a specialized cardiovascular hospital in the north-west of Iran. Direct and indirect costs of CVDs were calculated using the cost of illness and human capital approaches. Data were collected using a researcher-made checklist obtained from several sources including structured interviews, the Statistical Center of Iran, Iran’s Ministry of Cooperatives, Labor, and Social Welfare, the central bank of Iran, and the data of global burden of disease obtained from the Institute for Health Metrics and Evaluation to estimate direct and mortality costs. All costs were calculated in Iranian Rials (IRR). Results: Total costs of CVDs were about 5571 and 6700 billion IRR before and after the HTP, respectively. More than 62% of the total costs of CVDs accounted for premature death before (64.89%) and after (62.01%) the HTP. The total hospitalization costs of CVDs was significantly increased after the HTP (p = 0.038). In both times, surgical services and visiting had the highest and lowest share of hospitalization costs, respectively. The OOP expenditure decreased significantly and reached from 54.2 to 36.7%. All hospitalization costs, except patients’ OOP expenditure, were significantly increased after the HTP about 1.3 times. Direct non-medical costs reached from 2.4 to 3.3 billion before and after the HTP, respectively. Conclusion: Economic burden of CVDs increased in the north-west of Iran after the HTP due to the increase of all direct and indirect costs, except the OOP expenditure. Non-allocation of defined resources, which coincided with the international and national political and economic challenges in Iran, led to unsustainable resources of the HTP. So, no results of this study can be attributed solely to the HTP. Therefore, more detailed studies should be carried out on the reasons for the significant increase in CVDs costs in the region

Comparison of Insulin Expression Levels in White Blood Cells of infants with and without Family History of Type II Diabetes

Background: Type II diabetes is known as one of the most important, prevalent, and expensive diseases of mankind. Late diagnosis and subsequent delayed initiation of treatment or surveillance of patients create a variety of problems for affected individuals. This has raised increasing concerns for public health authorities throughout the world. In the current study, we aimed to find a new approach for early identification of high-risk individuals at initial months of their life. This allows us to take preventive measures as early as possible.Materials and Methods: In our study, 102 infants - from one to six months - were selected and placed in two case and control groups. The case group contained 52 babies with at least one of their parents identified as a type II diabetic patient. The control group comprised 50 babies with no family history of type II diabetes in paternal and maternal first-degree relatives. Afterwards, the expression level of insulin gene was analyzed in white blood cells of both groups. Information related to infants - referred to outpatient and inpatient wards of three main pediatric hospitals placed in Tehran - and their parents were collected through questionnaires within a two-year period. The study inclusion criteria for infants were confirmed type II diabetes in at least one of their parents, the absence of any metabolic disorder, and the absence of any disturbing vital signs. After drawing 2 ml of babies’ peripheral blood, total RNA of white blood cells (WBC) was extracted, and used for cDNA synthesis. Real-Time PCR was then applied to quantitatively evaluate the expression levels of insulin gene. The results of Real-Time PCR were statistically analyzed by non-parametric tests of Mann-Whitney and Kruskal-Wallis.Results: The expression of insulin gene was observed in white blood cells of all samples. However, there was a significant difference in expression levels between case and control groups (p<0.05). There was a statistically significant difference in mean levels of gene expression among babies with diabetic mother, and healthy groups (RQ=0.5, P-value=0.002), but this value wasn’t significant for babies with diabetic father (RQ=0.78, P>0.05).Conclusion: Numerous genes contribute to the development of diabetes and novel disease-causing genes are increasingly being discovered. Identification of disease-prone individuals through examining merely one underlying gene is complicated and challenging. Interestingly, all of these abnormally functioning genes finally manifest themselves in the altered expression levels of insulin gene. The expression status of insulin gene in WBCs could be suggested as a useful approach for identification of individuals at high risk for developing diabetes. This paves the way for taking appropriate measures at infancy period in order to prevent the disease as well as inhibit its various side effects in the following years of patient’s life

Comparing the Results of two Cost Sharing Approaches in Calculating the Cost of Hospital Services: a case study

Background & Objectives: Calculation of hospital services costs, especially the allocated costs, is a complicated process due to the great number of hospital services, as well as the interdependence between different centers. Considering the interrelationships between all departments in the hospital, cost analysis is possible only through the mutul sharing approach, which can provide more accurate information for researchers and managers in order to decide on a costs analysis. Methods: The present study was a descriptive study that was conducted in 2017 in a selected educational hospital affiliated to Iran University of Medical Sciences. Data collection was done through observation, interview and investigating financial documents. After identifying the active centers and the appropriate cost drivers, the cost of important services in final sectors was calculated by using two methods of one-way sharing and mutual sharing through simultaneous equations. Results: In comparison of one-way and mutaul sharing approach, all overhead, intermediate and total costs showed deviation. The greatest deviation between these two approaches was found in the parturition and ophthalmology departments and related to the cesarean with 16 million rials and the lacrimal duct cathetering with 13 million rials, respectively. Conclusion: The findings of this study showed that if hospitals managers calculate their services costs by activity-based cost and through mutual cost sharing approach, they can benefit from the correct costreportings and by having a clear image can make management decisions appropriately. Key¬words: Activity-based costing, One-way sharing, Mutual sharing, Teaching hospital Citation: Alipour V , Rezapour A , Meshkani Z, Farabi H, Mazdaki A, Hakimi N. Comparing the Results of two Cost Sharing Approaches in Calculating the Cost of Hospital Services: a case study. Journal of Health Based Research 2018; 4(3): 273-87. [In Persian

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI