The cost of influenza and other respiratory virus infections should be determined to analyze the real burden of these diseases. We aimed to investigate the clinical outcomes and cost of illness due to respiratory virus infections in hospitalized adult patients. Hospitalized patients who had nasal swab sampling for a suspected viral infection between August 1, 2018 to March 31, 2019 were included. Outcome variables were oxygen requirement, mechanical ventilation need, intensive care unit admission, and cost. At least one viral pathogen was detected in 125 (47.7%) of 262 patients who were included in the study. Fifty‐five (20.9%) of the patients were infected with influenza. Influenza‐positive patients had higher rates for respiratory support, intensive care unit admission, and mortality compared to all other patients. The average cost of hospitalization per person was 2879.76 USD in the influenza‐negative group, while the same cost was 3274.03 USD in the influenza‐positive group. Although all of the vaccinated influenza‐positive patients needed oxygen support, neither of them required invasive mechanical ventilation or intensive care unit admission. The average hospitalization cost per person was 779.70 USD in the vaccinated group compared to 3762.01 USD in the unvaccinated group. Disease‐related direct cost of influenza in the community was estimated as 22 776 075.61 USD in the 18−65 years of age group and 15 756 120.02 USD in the 65 years of age and over group per year. Influenza, compared to other respiratory virus infections, can lead to untoward clinical outcomes and mortality as well as higher direct medical costs in adults.
Venous thromboembolism (VTE) is often associated with malignant diseases and notably contributes to morbidity and mortality in patients with cancer. Cancer‐associated thrombosis (CAT) brings additional costs to health expenditures and has a negative impact on oncological outcomes. Either the recurrence rate of VTE or bleeding complications are also higher in patients with cancer. Prophylactic anticoagulation has been recommended in peri‐surgical periods, inpatient settings, and high‐risk ambulatory patients. Although various risk stratification scores are used, none are ideal for identifying patients who can benefit from anticoagulant prophylaxis. New risk scoring systems or biomarkers are needed to identify patients who are more likely to benefit from prophylaxis with low bleeding risk. The questions about the patients who will be given prophylaxis and those who develop thromboembolism, with which drug, and how long they will be treated are still not fully answered. Anticoagulation is the cornerstone of the treatment, but management of CAT remains complex. Low molecular weight heparins and direct oral anticoagulants are effective and safe options for the treatment of CAT. Recognizing adverse effects, drug–drug interactions, and accompanying conditions that cause dose adjustment is crucial. Prevention and treatment of VTE in patients with cancer require a multidisciplinary and patient‐based approach.Plain Language Summary Cancer‐associated thrombosis is a significant cause of mortality and morbidity in patients with cancer. Chemotherapy, surgery, and/or use of central venous access remarkably increase the risk of thrombosis. Prophylactic anticoagulation should be considered not only in inpatient follow‐up and during peri‐surgical period but also ambulatory patients with a high risk of thrombosis. Many parameters, such as drug–drug interactions, primary side of cancer, and comorbidities of patients should be considered when selecting anticoagulant drugs. More accurate risk stratification scores or biomarkers are still an unmet need.
Objectives: Data from the Demographic and Health Surveys (DHS) in Ethiopia show that full immunization coverage among children aged 12-23 months increased from 14.3% in 2000 to 38.5% in 2016. However, factors contributing to the increment are poorly understood. This study aims to identify the driving factors behind the change in childhood immunization coverage in Ethiopia between 2000 and 2016. Methods: Data from two rounds of the Ethiopian DHS (2000 and 2016) were used. Oaxaca-Blinder decomposition analysis was used to identify the contribution of the underlining determinants to the change in full immunization coverage over time. The analysis partitioned the observed change in childhood immunization coverage into "explained" and "unexplained" parts. The "explained" part is due to differences in levels of determinants between the two time periods whereas the "unexplained" part arises due to the differential effect of the determinants and other factors not included in the model on full immunization coverage between the two time periods. Results: The decomposition analysis estimated that about 39% (p,0.001) of the overall change in immunization coverage was due to differences in the level of the determinants between 2000 and 2016. Decrement in the proportion of mothers with no education and increments in the levels of antenatal care utilization between the two time periods were significant sources of this change. The remaining 61% (p,0.001) of the change is attributed to the difference in the effect of determinants. Conclusions: Several factors contributed to the change in childhood immunization coverage in Ethiopia. Further improvements in antenatal care utilization and maternal education can enhance the national immunization coverage. This study also highlight the need to understand how various factors affect immunization behavior in order to sustain the observed change.
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