This study aimed to investigate the patterns and predictive factors of healthcare-seeking behavior among older Chinese adults. A sample of 10,914 participants aged ≥60 years from the 2011, 2013 and 2015 China Health and Retirement Longitudinal Study (CHARLS) was included. The bivariate analyses and Heckman selection model was used to identify predictors of healthcare-seeking behavior. Results shows that the utilization rate of outpatient services increased from 21.61% in 2011 to 32.41% in 2015, and that of inpatient services increased from 12.44% to 17.68%. In 2015, 71.93% and 92.18% chose public medical institutions for outpatient and inpatient services, 57.63% and 17.00% chose primary medical institutions. The individuals who were female, were younger, lived in urban, central or western regions, had medical insurance, had poor self-rated health and exhibited activity of daily living (ADL) impairment were more inclined to outpatient and inpatient services. Transportation, medical expenses, the out-of-pocket ratio and the urgency of the disease were associated with provider selection. The universal medical insurance schemes improved health service utilization for the elderly population but had little impact on the choice of medical institutions. The older adults preferred public institutions to private institutions, preferred primary institutions for outpatient care, and higher-level hospitals for hospitalization.
BackgroundTo investigate the relationship 25-hydroxy vitamin D (25OHD) level among children and in children with type 1 diabetes mellitus (T1DM).MethodsA case–control study was conducted to compare the serum 25OHD levels between cases and controls. This study recruited 296 T1DM children (106 newly diagnosed T1DM patients and 190 established T1DM patients), and 295 age- and gender-matched healthy subjects as controls.ResultsThe mean serum 25OHD in T1DM children was 48.69 ± 15.26 nmol/L and in the controls was 57.93 ± 19.03 nmol/L. The mean serum 25OHD in T1DM children was lower than that of controls (P < 0.01). The mean serum 25OHD level (50.42 ± 14.74 nmol/L) in the newly diagnosed T1DM children was higher than that (47.70 ± 15.50 nmol/L) in the established T1DM children but the difference was not statistically significant (P = 0.16). HbA1c values were associated with 25OHD levels in established T1DM children (r = 0.264, P < 0.01), and there was no association between 25OHD and HbA1c in newly diagnosed T1DM children (r = 0.164; P > 0.05).ConclusionVitamin D deficiency is common in T1DM children, and it should be worthy of attention on the lack of vitamin D in established T1DM children.
Objectives: Vaccination would lead to reduce the incidence and mortality of an infectious disease and then increase the years of life and productivity for entire society. But, determination of vaccination coverage rate is usually not taken its economic burden into account. This study aims to use a transmission dynamic model (TDM) based on a susceptible-infectious-recovered (SIR) model, a system of differential equations, to find optimal vaccination coverage rate based on the economic burden of an infectious disease. MethOds: Vaccination for pneumococcus diseases was used as an example to demonstrate the main purpose. 23-valent pneumococcal polysaccharide vaccines (PPV23) and13-valent pneumococcal conjugate vaccines (PCV13) have been shown their cost-effectiveness in elderly and children, respectively. Scenarios analysis of PPV23 to the elderly aged 65+ years and PCV13 to children 5 years and under was applied to assess the optimal vaccination coverage rate based on the economic burden. All epidemiological parameters were derived from the Taiwan's National Health Insurance Research Database, all cost parameter were derived from the Taiwan's Ministry of the Interior and the vaccine efficacy was obtained from the literatures. Various vaccination coverage rate, the vaccine efficacy and all epidemiological parameters were all substituted into to TDM and all differential equations were solved using the fourth-order Runge-Kutta method implemented in R Statistical Software. Results: If the he coverage rate of PPV23 for the elderly and PCV23 for the children both reach to 50%, the economic burden due to pneumococcus disease will be minimized approximately. cOnclusiOns: This study provided an alternative perspective from the economic burden of diseases to obtain a vaccination coverage rate using the TDM. This will provide valuable information for vaccination policy decision makers.Objectives: Decision makers are frequently faced with the question of how realistic are cost-effectiveness models. Overall survival (OS) is a desired clinical trial and health technology assessment endpoint but frequently unrealistic or elusive at the point of new drugs financing decision. We aim to compare the overall survival from lenalidomide treatment in relapsed/refractory multiple myeloma (rrMM) patients estimated from modelling clinical trial data in a cost-effectiveness analysis (CEA) and compare it with real-word data (RWD) from South Korea. MethOds: In this CEA of lenalidomide-plus-dexamethasone OS outcomes were indirectly estimated using a quantitative relationship between time-to-progression/progression-freesurvival derived with a censored normal weighted Tobit regression model with data from a literature review of 153 studies containing 230 treatment arms and 22,696 MM patients. Real world data was from a retrospective analysis of 110 heavily pre-treated patients from 20 hospitals. These patients were treated with lenalidomide-plus-dexamethasone in the Korean patient access program between 2008 and 2012. Results: The RWD was availabl...
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