Academic literature on the topic 'Medico-economic consequences'

While in the early neogene, tectonic and to a lesser extent climatic factors impacted on the sea level, at the present stage climatic, man-made and anthropogenic factors are at the forefront. As a result of an increase in the level of the Caspian Sea by more than 2.4 m, 35-40 thousand square meters km of territory was flooded, during the flooding and flooding of the coastal territory for the period 1978-1995 led to a change in natural, socio-economic and medico-ecological conditions. The consequences of rising sea levels led to the resettlement of about 100 thousand people living in the coastal flooded zone of the Northern Caspian Sea and many industrial facilities.

SummaryTherapeutic effects of neuroleptics (NLP) in schizophrenia are well established in numerous international studies. Varying modalities of evolution under NLP treatment are described and require a clinical analysis. Neuroleptics are a necessary but insufficient condition for the therapy of schizophrenia. Via NLP treatment, other therapeutic approaches, such as psychotherapy, or sociotherapy become more effective. Consecutively, we present the effects of two compounds with dopaminergic selective activity (amisulpride, remoxipride) and of two other compounds with non-selective activity (risperidone, clozapine) regarding rehabilitation in schizophrenic patients. Data were collected from international studies with a medico-economic perspective and from French experience of clozapine in refractory schizophrenic patients. All these data stress the importance of several areas of study: clinical features, everyday life consequences and therapeutical effects observed with the atypical neuroleptics.

The article is devoted to the analysis of medico-social factors that determine the outlook Image of the system of medical care for victims in emergency situations in the Arctic Zone of the Russian Federation. The social and economic development of the Russian Arctic zone is a strategic priority of the Russian Federation’s state policy in the Arctic. The goals of Russia’s state policy in the Arctic are to expand the resource base of the Arctic zone, to support the necessary combat potential of groups of troops of the Armed forces of the Russian Federation in the region, to preserve the natural environment, to ensure an adequate level of fundamental and applied scientific research, etc. Strategic priorities of the state policy of the Russian Federation in the Arctic are determined to increase the efforts of the Arctic States in creating a unified regional system of search and rescue, as well as prevention of man-made disasters and elimination of their consequences, including coordination of rescue forces; improving the quality of life of indigenous people and social conditions of economic activity in the Arctic. The main areas of development of the Russian Arctic include hydrocarbon production, fisheries, improvement of transport infrastructure and tourism. Three directions of socio-economic transformation of the Arctic zone of Russia, in the near future, can affect the formation of the appearance of the system of medical care for victims of emergencies: spatial expansion and increase of the economic potential of the Arctic zone of Russia; orientation to the concept of Trinity « innovative economy of energy efficiency sustainable development»; implementation of the concept of the formation in the Arctic eight reference zones of socio-economic development, of which the Kola, Nenets and Yamalo-Nenets reference zones are defined as pilot.

Premature birth is a significant medical, social and economic problem worldwide. In the 21st Century in developed countries, this problem accounts for over two thirds of neonatal deaths. In Bulgaria, statistics show that 10-12% of all pregnancies end with premature birth. Despite the number of studies in this field and the efforts made by obstetricians and gynecologists, the tendency to increase the number of preterm births has continued in the last decade. Its consequences are multiple complications who lead to a high neonatal mortality in the national and global world. Preterm birth is characterized by complex and vague etiology. A specific cause of premature birth can not be defined, but a set of risk factors is considered, divided into three main groups of etiological factors: socio-economic, medical-biological, and behavioral. Associated with preterm birth socio-economic and behavioral risk factors include poverty, unemployment, low education, poor prenatal care, harmful habits such as smoking, alcohol, drugs and other harmful substances, unhealthy family environment, severe and prolonged stress, excessive physical exercise (lifting weights), trauma (hits or violence), new pregnancies less than 6 months after previous birth, unhealthy diet and low mother BMI, etc. Essential for the preterm birth is also the medico - biological etiological factors. One of these is uterine enlargement, as the main reason for this may be the presence of: multiple pregnancies that occurred naturally or after using assisted reproductive technologies or polyhydramnios (increased amount of amniotic fluid). Other risk factors include: placenta previa, incorrect position of the fetus, myoma, uterine cervix malformations (including cerebrovascular insufficiency), preeclampsia, uterine contractions, acute infections during pregnancy (vaginal - chlamydia, trichomonas, mycoplasma , toxoplasmosis, bacterial vaginosis, viral rubella, cytomegalovirus, herpes, influenza, adenovirus infection, chronic diseases (hypertension, cardiovascular diseases, diseases of the lungs, liver or kidney anemia and etc.), genetic factors, previous premature birth, etc. These risk indicators are subject to detailed analysis in the work of a number of authors. To limit preterm births, a number of studies have been conducted to identify and identify the risk factors that are relevant to it. Identifying and recognizing their effects and impact leading to premature birth will significantly reduce the severe health, economic and social consequences as well as reduce the risk of neonatal death. In order to reduce the frequency of preterm births, adequate and specialized prenatal care is essential. They must be individually tailored for each particular case of pregnancy and take into account the complex of risk predispositions.

There are considered special social and economic aspects of the epidemiology of Helicobacter pylori. These aspects acquired the particular importance for the last time due to the fact that the provision of the people with pure water has been becoming the focus of the attention of geopolitical and socio-economic interests in a number of countries. The availability ofpure drinking water serves a marker of the socio-economic state of the territory and the population living there. In Russia where different climatic conditions are deposited by considerable regional differences in the conditions of communal services caused both by various level of the socio-economic development of the territory, the supplementation with pure drinking water serves as the social determinant of the ecological conditions of the population’s life. This particularly has impact on the unfeasible technical state of the water distribution systems, microorganism ecology of which can substantially affect public health. The performed by authors a specialized screening ofpresented at the official web site of the joint-stock company «Mosvodokanal» current data concerning the quality of drinking water consumed by 2500 Moscovites, tested for the Helicobacter pylori infection revealed no deviations from the sanitary standards in the water received by the consumers. Along with that, the comparison of the map documents of the distribution of the Helicobacter pylori infection in Moscow with the distribution of citizens’ complaints of the decline of the quality of tap water has revealed a territorial fastening of the high values of the population infection rate of n^ylori and the urban sites with the greatest number of complaints. In the microbial ecology of water-distribution systems there are tightly aligned problems of their epidemiological safety, technical state and economic damage caused by corrosion as a result of microbiotic activity. In contrast to acute bacterial and viral infections which are deemed of the greatest importance when assessing the sanitary condition of water sources and water-distribution systems, the consequences of infection with H. pylori may not be manifestedfor a long time but some years later they may be manifested as serious chronic diseases (from gastritis to adenocarcinoma of the stomach and a wide range of extraintestinal pathologies), which causes great social and economic losses. Thus, the socio-economic aspect of the epidemiology of helicobacteriosis includes at least two components: the technic - the maintenance of the feasible technic and sanitary state of the water distribution systems and the medico-social - expenditures for screening and treatment of infected patients. In total they are an inseparable part of the prevention of socially-important diseases in the public health system.

The authors classify and investigate the losses caused by the military conflict in the east of Ukraine and the annexation of Crimea, as well as the approaches to their assessment. The authors studied the results of scientific research, current legislation, and information-analytical materials and came to the conclusion that there are no common standards (approaches) or detailed approaches to loss assessment for different entities (state, individual enterprises, and citizens), and the mechanism of compensation for losses is undeveloped as well. This can cause many problems both for experts in substantiating the volume of damages and for courts in considering relevant cases for losses. The authors considered the damage caused to Ukraine by the military conflict with Russia, which resulted in the annexation of the Crimean peninsula and the occupation of Luhansk and Donetsk regions, and interpreted this damage as assessed consequences of these events and classified them by place and time of manifestation on direct, indirect, complete and general, and by spheres of manifestation of consequences on medico-biological, military-political, socio-economic, external and internal political and ecological ones. To characterize each of these types of damage, the authors have identified certain components that can have quantitative and qualitative forms of expression. Taken into account that the qualitative assessment of the consequences of armed conflict is subjective to some extent and depends on the coverage of expert opinions, the authors focused on those components that can be quantified (in monetary terms). To assess them, in the article there were formed certain groups of indicators that have a quantitative form of expression. At the same time, first of all, the authors take into account indicators that make it possible to assess the direct damage from the armed conflict. The authors, based on the analysis and generalization of the values of these indicators in the dynamics, determine the estimated amount of direct damage caused to Ukraine during the conflict (2014-2019), and give a forecast of its growth if this conflict continues. Also, we propose the option of calculating the lost benefit from the impossibility of using a part of the country’s territory (currently uncontrolled) based on its potential.

Background: The global health burden from domestic violence against women in reproductive age group is about 9.5 million disability adjusted life years (DALYs). Women suffering from violence have more chances of suffering from physical, emotional, and mental problems such as anxiety, depression and post-traumatic stress disorder. The objectives of the present study are to find the prevalence and awareness of domestic violence in an urban slum of Gurugram and to elicit associated risk factors and the reasons for tolerance of domestic violence.Methods: A community based, cross sectional study was conducted among married women (18-45 years) using a semi structured questionnaire in a rural area of Gurugram by systematic random sampling. Sample size collected was 900. Study population was enquired about the awareness regarding domestic violence, self-experience about domestic violence and about the form of violence experienced and the reasons for their tolerance. Data was entered and analyzed using Epi Info ver 7.Results: Total 980 subjects were enquired about their awareness and self-experience of domestic violence. Overall prevalence of domestic violence in the study population was 28%. Prevalence of domestic violence was statistically significantly associated with education, employment, duration of marriage (p value <0.05).The prevalence was highest of emotional violence (40.5%), followed by physical (33.4%), economic (21.4%) and sexual violence (4.7%).Conclusions: Public health professionals should emphasis on measures to raise public awareness so that women can talk freely about domestic violence and its consequences and help in mitigating this medico-social problem.

This research article presents the main results of zoning of the Kemerovo Oblast based on the level of technogenic load and environmental factor. Based on the analysis of a huge amount of statistical material, information data obtained from government reports, regional reports, strategies for socio-economic development, scientific publications, synthesized multispectral shooting (multispectral images), an assessment was made and relationships were established between the negative impact on the environment and its impact on people's lives of the region with different levels of technogenic load. The relationship between the ecological capacity and the negative impact on the environment is also considered, depending on the volume of coal production in the territory of Kuzbass (the Kuznetsk Basin). The raw material region was ranked according to the area of disturbed lands using synthesized multispectral analysis of space images. As a result of the comprehensive analysis, it was revealed that all municipalities with a high anthropogenic load are characterized by a decrease in environmental indicators of the sustainability of the development of the territory and an increase in negative consequences of both a medico-demographic and socio-economic nature. Analysis of the dynamics of coal mining and emissions of pollutants into the atmosphere showed a proportional relationship between an increase in coal production and an increase in indicators for cancer. It was also revealed that the overall level of diseases in the territories of intensive technogenesis is almost 2 times higher than in areas with a low level of technogenesis. Another tendency was found in urban districts with a high technogenic load – the average annual quantitative growth of negative medical and demographic indicators is proportional to the growth of coal production. Based on this, the author considered various ways to reduce the level of anthropogenic impact on the environment of the Kemerovo Oblast and gave general recommendations for improving the ecological situation in this region. The visualized result of this scientific work is the schematic maps, which reflect the ecological zoning of the region's territory according to the level of anthropogenic load.

Abstract As of 2014, there were few reliable publication sources of epidemiology data for Non-Hodgkin Lymphoma (NHL) in France, particularly with regard to indolent forms such as Follicular Lymphoma (FL), Waldenström Macroglobulinemia (WM) and Marginal Zone Lymphoma (MZL). In addition, epidemiology registries provide useful data on disease incidence but no information can be directly obtained on the number of relapsed patients, especially in the rare iNHL subtypes. At the same time, many new and effective drugs will be made available to the Hematologist/Oncologist community. As a consequence, there will be an increase in the complexity of therapeutic algorithms. We undertook an innovative modeling approach to address the need for a greater understanding of the number of relapsed patients available to these new therapies. The objective of the model was to determine the yearly incidence of first line and later lines of therapy patients from 2014 to 2018 and in consequence, provide relevant data to determine precisely which population might be in need for the new compounds and bring accurate data that could be implemented into a prospective economic model. First, we used the “Registre Régional des Hémopathies Malignes de Basse-Normandie” (RRHMBN) to collect real world patient characteristics, such as patient subgroups and tumor staging. The RRHMBN is dedicated to Hematological malignancies and supported by official Health Authorities: “Institut National du Cancer“(INCA) and “Institut National de Veille Sanitaire” (INVS). Then, we applied these data to the French National Network of Registers “FRANCIM” incidence and survival data (table 1 below). Table 1 Yearly number of patients newly diagnosed Table 1. Yearly number of patients newly diagnosed Finally, we applied the results from medical literature to progression free survival for each standard of care treatment in our epidemiological model. The table below shows yearly the number of patients in need for treatment in first and subsequent lines of therapy as produced by our model. Table 2 Yearly number of patients in need for treatment in first and subsequent lines Table 2. Yearly number of patients in need for treatment in first and subsequent lines Our modeling approach compensates for a lack of real world information on relapsed iNHL. We have shown that there is a significant number of relapsed patients who are in need of new treatments in France. The model is able to answer the question of how many patients are in need of novel therapies in later lines through 2018 and provide for iNHL investigators efficient prospective data that can be integrated into medico-economic model development. Furthermore, these data address a current medical need for the development of a new iNHL algorithm, necessitated by the expected arrival of new treatment options for patients in the relapsed setting. Disclosures No relevant conflicts of interest to declare.

Abstract Chronic lymphocytic leukemia (CLL) is a slowly progressing but incurable disease with high unmet medical needs. As of 2014, there were few reliable publication sources of epidemiology data for CLL in France, particularly with regard to relapsed patient population. In addition, epidemiology registries provide useful data on disease incidence but no information can be directly obtained on the number of relapsed patients. At the same time, several new and effective drugs will be made available to the Hematologist/Oncologist community. As a consequence, there will be an increase in the complexity of therapeutic algorithms. We undertook an innovative modeling approach to address the need for a greater understanding of the number of relapsed patients available to these new therapies. The objective of the model was to determine the yearly incidence of first line and later lines of therapy patients from 2014 to 2018 and in consequence, provide relevant data to help determine which population might be in need for the new compounds and bring accurate data that could be implemented into a prospective economic model. First, we used the “Registre Régional des Hémopathies Malignes de Basse-Normandie” (RRHMBN) to collect real world patient characteristics, such as tumor staging (based on Binet Classification), fitness status, and deletion 17p. The RRHMBN is dedicated to Hematological malignancies and supported by official Health Authorities: “Institut National du Cancer“(INCA) and “Institut National de Veille Sanitaire” (INVS). Following that, we applied these data to the French National Network of Registers “FRANCIM” incidence and survival data. 27.6% of patients were under 65 years. 50% of patients over 65 years had unfit status. 77% of patients had stage A, 14% stage B and 8% stage C. 2/3 of stage A were not treated and 1/3 evolved to stage B or C. 5% of patients had a 17p deletion at diagnosis (Table 1 below). Table 1. Yearly number of patients newly diagnosed Figure 1 Figure 1. Finally, we applied the results from medical literature to progression free survival for each standard of care treatment in our epidemiological model, Fludarabine (F) – Cyclophosphamide (C) – Rituximab (R) regimen with a PFS equal to 51.8 months for patients under 65 years. (R) – Bendamustine (B) regimen with a PFS equal to 33.9 months for patients fit and over 65 years. For unfit patients over 65 years, ofatumumab (O) – Chlorambucil (C) regimen with a PFS equal to 27 months. The table below (Table 2) shows the yearly number of patients eligible for treatment in first and subsequent lines of therapy as produced by our model. Table 2. Yearly number of patients in need for treatment in first and subsequent lines Figure 2 Figure 2. Our modeling approach compensates for a lack of real world information on relapsed CLL. We have shown that there is a significant number of relapsed patients who are in need of new treatments in France. The model is able to answer the question of how many patients are in need of novel therapies in later lines through 2018 and provide for CLL investigators efficient prospective data that can be integrated into medico-economic model development. Furthermore, these data address a current medical need for the development of a new CLL algorithm for patient management, necessitated by the expected arrival of new treatment options for patients in the relapsed setting. Disclosures No relevant conflicts of interest to declare.

L’objectif de ce travail était d’évaluer la pertinence de la réponse d’un centre de réception et de régulation des appels (Crra) du service d’aide médicale urgente (SAMU) à des appels pour une urgence médicale. Notre étude a aussi cherché à évaluer les conséquences médico-économiques de la réponse de ce type de centre d’appels ainsi que l’impact d'événements exceptionnels sur l’activité de la régulation médicale. Dans ces buts, nous avons réalisé des études cliniques prospectives, comparatives et observationnelles. Nos principaux résultats ont permis de montrer que le recours à la télémédecine constituait une réponse pertinente en termes d’efficience et de satisfaction. Concernant des pathologies marqueuses bénignes mais fréquentes comme la fièvre ou la gastroentérite ou bien alors des pathologies graves au cours de maladies rares comme la crise d’angiœdème héréditaire, le conseil téléphonique à distance retrouvait une observance excellente et constituait une réponse adaptée. L’analyse médico-économique démontrait un bénéfice sociétal pour le conseil médical téléphonique pratiqué par un Crra. Nous avons montré que des événements sanitaires exceptionnels pouvaient être détectés par des variations d’activités du Crra. L’ensemble de ces recherches a permis, pour la première fois, d’objectiver la pertinence de la régulation médicale. Les résultats démontrent un réel service rendu pour le patient et un impact médico-économique synonyme d’économie en terme de consommation de ressources de santé comme l’hospitalisation aux urgences ou la consultation auprès des médecins généralistes. Notre étude ouvre la voie aux futures recherches sur l’efficience de la télémédecine
The principal objective of this study was to assess the adequacy of the response of an Emergency Medical Assistance (EMS) call reception and dispatch centre (CRDC) to telephone calls for medical emergencies. The study also aimed to evaluate the medico-economic consequences of call management by this type of call centre, as well as the impact of unusual public health events on the activities of the CRDC. With a view to this, prospective, comparative and observational clinical studies were conducted. The main results show that the recourse to telemedicine constitutes an appropriate response to emergency medical calls in terms of efficiency and satisfaction. With regard to benign but frequent indicator complaints, such as fever or gastroenteritis, or indeed severe pathologies which arise as part of rare medical conditions such as hereditary angio-oedema, distant telephone advice resulted in excellent patient compliance and was an appropriate response. Medico-economic analysis demonstrated a societal benefit from the medical telephone advice delivered by the CRDC. It was also shown that unusual public health situations could be detected through changes in the activity of a CRDC. Together these studies allow, for the first time, to objectively measure the appropriateness of medical call management. The results demonstrate a real benefit to patients, as well as a medicoeconomic efficiency in terms of healthcare use such as Emergency Department attendances or General Practice consultations. This study opens the path to future research into the efficiency of telemedicine