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Ochsner Journal 2014Pain can significantly influence an individual's health status and can have serious negative consequences: poor nutrition, decreased appetite, abnormal sleep patterns,... (Review)
Review
BACKGROUND
Pain can significantly influence an individual's health status and can have serious negative consequences: poor nutrition, decreased appetite, abnormal sleep patterns, fatigue, and impairment of daily living activities. Pain can cause psychological impairment and decrease healing and recovery from injuries and illness. A hallmark of many chronic conditions, pain affects more patients' lives than diabetes mellitus, heart disease, and cancer combined. However, many chronic sufferers do not have access to effective pain management for a variety of reasons, including limited access, restrictions, and personal and cultural biases.
METHODS
This review summarizes issues of access, distribution, and cultural bias with regard to opioid agents and seeks to clarify the challenges related to opioid delivery. The considerable negative physical and mental consequences of chronic pain are discussed for the general and palliative care population.
RESULTS
Opioids are an effective treatment for various intractable painful conditions, but problems in global opioid access for safe and rational use in pain management contribute to unnecessary suffering. These problems persist despite increased understanding in recent years of the pathophysiology of pain.
CONCLUSIONS
Comprehensive guidelines for goal-directed and patient-friendly chronic opiate therapy will potentially enhance the outlook for future chronic pain management. The improvement of pain education in undergraduate and postgraduate training will benefit patients and clinicians. The promise of new medications, along with the utilization of multimodal approaches, has the potential to provide effective pain relief to future generations of sufferers.
PubMed: 24940131
DOI: No ID Found -
Circulation May 2015
Topics: Diagnosis-Related Groups; Fee-for-Service Plans; Hospital Mortality; Humans; Length of Stay; Medical Indigency; Medicare; Motivation; Outcome Assessment, Health Care; Patient Discharge; Patient Protection and Affordable Care Act; Patient Readmission; Quality Improvement; Social Security; United States
PubMed: 25986448
DOI: 10.1161/CIRCULATIONAHA.114.010270 -
PloS One 2020In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the...
In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.
Topics: Adolescent; Adult; Aged; Analysis of Variance; Betacoronavirus; COVID-19; Child; Child, Preschool; Chronic Disease; Comorbidity; Coronavirus Infections; Developing Countries; Disabled Persons; Ethnicity; Family Characteristics; Female; Food; Health Expenditures; Humans; Income; Infant; Infant, Newborn; Male; Medical Indigency; Middle Aged; Pandemics; Pneumonia, Viral; Poverty; SARS-CoV-2; Socioeconomic Factors; Sri Lanka; Surveys and Questionnaires; Young Adult
PubMed: 33113548
DOI: 10.1371/journal.pone.0239576 -
CMAJ : Canadian Medical Association... Jan 2015
Topics: Aid to Families with Dependent Children; Canada; Capital Financing; Child; Efficiency, Organizational; Female; Humans; Maternal-Child Health Centers; Medical Indigency; Models, Organizational; Privatization; United States
PubMed: 25452316
DOI: 10.1503/cmaj.109-4951 -
CMAJ : Canadian Medical Association... May 2016
Topics: Canada; Humans; Medical Indigency; Population Groups; Practice Guidelines as Topic; Racism
PubMed: 27067819
DOI: 10.1503/cmaj.109-5257 -
BMC Medicine Aug 2015One of the biggest obstacles to developing policies in cancer care in Southeast Asia is lack of reliable data on disease burden and economic consequences. In 2012, we...
BACKGROUND
One of the biggest obstacles to developing policies in cancer care in Southeast Asia is lack of reliable data on disease burden and economic consequences. In 2012, we instigated a study of new cancer patients in the Association of Southeast Asian Nations (ASEAN) region - the Asean CosTs In ONcology (ACTION) study - to assess the economic impact of cancer.
METHODS
The ACTION study is a prospective longitudinal study of 9,513 consecutively recruited adult patients with an initial diagnosis of cancer. Twelve months after diagnosis, we recorded death and household financial catastrophe (out-of-pocket medical costs exceeding 30% of annual household income). We assessed the effect on these two outcomes of a range of socio-demographic, clinical, and economic predictors using a multinomial regression model.
RESULTS
The mean age of participants was 52 years; 64% were women. A year after diagnosis, 29% had died, 48% experienced financial catastrophe, and just 23% were alive with no financial catastrophe. The risk of dying from cancer and facing catastrophic payments was associated with clinical variables, such as a more advanced disease stage at diagnosis, and socioeconomic status pre-diagnosis. Participants in the low income category within each country had significantly higher odds of financial catastrophe (odds ratio, 5.86; 95% confidence interval, 4.76-7.23) and death (5.52; 4.34-7.02) than participants with high income. Those without insurance were also more likely to experience financial catastrophe (1.27; 1.05-1.52) and die (1.51; 1.21-1.88) than participants with insurance.
CONCLUSIONS
A cancer diagnosis in Southeast Asia is potentially disastrous, with over 75% of patients experiencing death or financial catastrophe within one year. This study adds compelling evidence to the argument for policies that improve access to care and provide adequate financial protection from the costs of illness.
Topics: Adult; Aged; Asia, Southeastern; Cost of Illness; Demography; Female; Health Expenditures; Humans; Longitudinal Studies; Male; Medical Indigency; Middle Aged; Neoplasms; Odds Ratio; Prospective Studies; Socioeconomic Factors
PubMed: 26282128
DOI: 10.1186/s12916-015-0433-1 -
Maternal and Child Health Journal Jun 2016Objectives To examine retention of Medicaid coverage over time for children in the child welfare system. Methods We linked a national survey of children with histories...
Objectives To examine retention of Medicaid coverage over time for children in the child welfare system. Methods We linked a national survey of children with histories of abuse and neglect to their Medicaid claims files from 36 states, and followed these children over a 4 year period. We estimated a Cox proportional hazards model on time to first disenrollment from Medicaid. Results Half of our sample (50 %) retained Medicaid coverage across 4 years of follow up. Most disenrollments occurred in year 4. Being 3-5 years of age and rural residence were associated with increased hazard of insurance loss. Fee-for-service Medicaid and other non-managed insurance arrangements were associated with a lower hazard of insurance loss. Conclusions for Practice A considerable number of children entering child environments seem to retain Medicaid coverage over multiple years. Finding ways to promote entry of child welfare-involved children into health insurance coverage will be critical to assure services for this highly vulnerable population.
Topics: Child; Child Abuse; Child Health Services; Child Protective Services; Child Welfare; Child, Preschool; Female; Humans; Insurance Coverage; Male; Medicaid; Medical Indigency; Medically Uninsured; Residence Characteristics; Rural Population; United States
PubMed: 27017228
DOI: 10.1007/s10995-016-1929-9 -
Journal of Clinical Oncology : Official... Dec 2016
Topics: Drug Approval; Drug Costs; Drug Industry; Government Regulation; Health Services Accessibility; Humans; Medical Indigency; Medically Uninsured; Orphan Drug Production; Policy Making; United States; United States Dept. of Health and Human Services; United States Food and Drug Administration
PubMed: 27998222
DOI: 10.1200/JCO.2016.68.2989