Search

Objective To assess how the returns on investment from correcting refractive errors and cataracts in low- and middle- income countries compare with the returns from other global development interventions. Methods We adopted two complementary approaches to estimate benefit-cost ratios from eye health investment. First, we systematically searched PubMed[R] and Web of Science[TM] on 14 August 2023 for studies conducted in low-and-middle-income countries, which have measured welfare impacts associated with correcting refractive errors and cataracts. Using benefit-cost analysis, we compared these impacts to costs. Second, we employed an economic modelling analysis to estimate benefit-cost ratios from eye health investments in India. We compared the returns from eye health to returns in other domains across global health and development. Findings We identified 21 studies from 10 countries. Thirteen outcomes highlighted impacts from refractive error correction for school students. From the systematic review, we used 17 out of 33 outcomes for benefit- cost analyses, with the median benefit- cost ratio being 36. The economic modelling approach for India generated benefit-cost ratios ranging from 28 for vision centres to 42 for school eye screening, with an aggregate ratio of 31. Comparing our findings to the typical investment in global development shows that eye health investment returns six times more benefits (median benefit-cost ratio: 36 vs 6). Conclusion Eye health investments provide economic benefits with varying degrees based on the intervention type and location. Our findings underline the importance of incorporating eye health initiatives into broader development strategies for substantial societal returns. Objectif Comparer les retours sur investissement d'une correction des defauts de refraction et des cataractes dans les pays a revenu faible et intermediaire avec ceux d'autres interventions liees au developpement mondial. Methodes Nous avons adopte deux approches complementaires afin d'estimer les rapports couts/avantages d'un investissement dans la sante oculaire. Tout d'abord, nous avons passe au crible PubMed[R] et Web of Science[TM] le 14 aout 2023, a la recherche d'etudes menees dans des pays a revenu faible et intermediaire sur l'impact d'une correction des defauts de refraction et des cataractes, puis nous avons procede a une analyse couts/avantages dans le but de comparer cet impact aux depenses engendrees. Ensuite, nous avons effectue une analyse par modelisation economique afin de determiner les rapports couts/ avantages des investissements dans la sante oculaire en Inde. Enfin, nous avons compare les retours sur investissement dans ce domaine avec ceux d'autres domaines lies a la sante et au developpement a l'echelle mondiale. Resultats Nous avons identifie 21 etudes portant sur 10 pays. Parmi les resultats obtenus, 13 mettaient en evidence l'impact qu'une correction des defauts de refraction representait pour les etudiants. A l'issue de notre revue systematique, nous avons utilise 17 des 33 resultats pour nos analyses couts/avantages, le rapport median s'elevant a 36. Lapproche par modelisation economique pour l'Inde a debouche sur des rapports couts/avantages allant de 28 pour les centres de la vision a 42 pour le depistage des troubles de la vue en milieu scolaire, avec une proportion globale de 31. En comparant nos resultats avec les depenses classiques en matiere de developpement mondial, nous avons constate qu'investir dans la sante oculaire permettait de multiplier les avantages par six (rapport couts/avantages median: 36 contre 6). Conclusion Les investissements dans la sante oculaire s'accompagnent d'avantages economiques a differents niveaux, en fonction du lieu et du type d'intervention. Nos resultats montrent a quel point l'integration d'initiatives de sante oculaire au sein de strategies de developpement plus vastes est importante dans la realisation de benefices considerables pour la societe. Objetivo Evaluar la rentabilidad de la inversion en la correccion de los defectos de refraccion y las cataratas en los paises de ingresos bajos y medios en comparacion con la rentabilidad de otras intervenciones de desarrollo a escala mundial. Metodos Se adoptaron dos enfoques complementarios para estimar la relacion coste-beneficio de la inversion en salud ocular. En primer lugar, se realizo una busqueda sistematica en PubMed[R] y Web of Science[TM] el 14 de agosto de 2023 sobre estudios realizados en paises de ingresos bajos y medios, que han medido los efectos en el bienestar asociados a la correccion de los errores de refraccion y las cataratas. Mediante el analisis beneficio-coste, se compararon estos efectos con los costes. En segundo lugar, se empleo un analisis de modelos economicos para estimar la relacion beneficio-coste de las inversiones en salud ocular en la India. Asimismo, se compararon las rentabilidades de la salud ocular con las de otros sectores de la salud y el desarrollo mundiales. Resultados Se identificaron 21 estudios de 10 paises. Trece resultados destacaron los efectos de la correccion de los defectos de refraccion en estudiantes. A partir de la revision sistematica, se utilizaron 17 de los 33 resultados para los analisis de beneficio-coste, en los que la mediana de esta relacion fue de 36. El enfoque de modelacion economica para la India genero relaciones beneficio-coste que van de 28 para los centros oftalmologicos a 42 para el cribado ocular en las escuelas, con una relacion agregada de 31. Si se comparan los resultados obtenidos con la inversion tipica en desarrollo mundial, se observa que la inversion en salud ocular genera una rentabilidad seis veces mayor (relacion beneficio-coste mediana: 36 frente a 6). Conclusion Las inversiones en salud ocular aportan beneficios economicos de diversa magnitud segun el tipo de intervencion y la ubicacion. Los resultados obtenidos destacan la importancia de incorporar las iniciativas de salud ocular a estrategias de desarrollo mas amplias para obtener una rentabilidad social significativa., Introduction Although vision impairment affects 2.2 billion people, (1) eye health services are underfunded and undervalued in global health policy. Notably, Transforming our world: the 2030 agenda for sustainable development [...]

BackgroundThe Multi-Ethnic Study of Atherosclerosis (MESA) showed that the addition of coronary artery calcium (CAC) to traditional risk factors improves risk classification, particularly in intermediate risk asymptomatic patients with LDL cholesterol levels

Although educational attainment has been consistently related to cognition in adulthood, the mechanisms are still unclear. Early education, and other social learning experiences, may provide the skills, knowledge, and interest to pursue intellectual challenges across the life course. Therefore, cognition in adulthood might reflect continued engagement with cognitively complex environments. Using baseline data from the Baltimore Experience Corps Trial, multiple mediation models were applied to examine the combined and unique contributions of intellectual, social, physical, creative, and passive lifestyle activities on the relationship between education and cognition. Separate models were tested for each cognitive outcome (i.e., reading ability, processing speed, memory). With the exception of memory tasks, findings suggest that education-cognition relations are partially explained by frequent participation in intellectual activities. The association between education and cognition was not completely eliminated, however, suggesting that other factors may drive these associations.

Background Informed decisions on myopia management require an understanding of financial impact. We describe methodology for estimating lifetime myopia costs, with comparison across management options, using exemplars in Australia and China. Methods We demonstrate a process for modelling lifetime costs of traditional myopia management (TMM=full, single-vision correction) and active myopia management (AMM) options with clinically meaningful treatment efficacy. Evidence-based, location-specific and ethnicity-specific progression data determined the likelihood of all possible refractive outcomes. Myopia care costs were collected from published sources and key informants. Refractive and ocular health decisions were based on standard clinical protocols that responded to the speed of progression, level of myopia, and associated risks of pathology and vision impairment. We used the progressions, costs, protocols and risks to estimate and compare lifetime cost of myopia under each scenario and tested the effect of 0%, 3% and 5% annual discounting, where discounting adjusts future costs to 2020 value. Results Low-dose atropine, antimyopia spectacles, antimyopia multifocal soft contact lenses and orthokeratology met our AMM inclusion criteria. Lifetime cost for TMM with 3% discounting was US$7437 (CI US$4953 to US$10 740) in Australia and US$8006 (CI US$3026 to US$13 707) in China. The lowest lifetime cost options with 3% discounting were antimyopia spectacles (US$7280, CI US$5246 to US$9888) in Australia and low-dose atropine (US$4453, CI US$2136 to US$9115) in China. Conclusions Financial investment in AMM during childhood may be balanced or exceeded across a lifetime by reduced refractive progression, simpler lenses, and reduced risk of pathology and vision loss. Our methodology can be applied to estimate cost in comparable scenarios. [ABSTRACT FROM AUTHOR]

To develop a simple but more precise model to calculate potential annual productivity losses due to blindness and moderate and severe vision impairment (MSVI) at the national, regional, and global level. Productivity loss was defined as the loss of minimum wage/Gross National Income per capita (GNI) incurred by people aged 50–64 years with blindness or MSVI, who were not able to work or worked with reduced earnings in 2020. We developed a global list of minimum wage data from on-line sources. All other model data were sourced from international, standardised, and open-access databases. For blindness, the total productivity loss (not working) incurred by 64%–90% of the affected population was summed up with partial productivity loss, defined as 10%–36% of the affected population earning one-third of that of the sighted population. For MSVI, the total productivity loss for 30%–55% of the affected population was summed with the partial productivity loss, defined as 45%–70% of the affected population having 35% reduced earnings. The costs of blindness and MSVI were summed to obtain the cost of combined vision loss. The global cost of vision loss based on minimum wage was US$160-US$216.32 billion for 2020. The global cost of vision loss using GNI was US$449.36-US$584.66 billion. A parsimonious model that considers minimum wage and GNI potentially lost due to blindness and MSVI can be used for eye care programming planning and advocacy at the national, regional, and global level. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between surgeon volume and operative morbidity and mortality for laryngectomy. Data Sources: The Nationwide Inpatient Sample was used to identify 45,156 patients who underwent laryngectomy procedures for laryngeal or hypopharyngeal cancer between 2001 and 2011. Hospital and surgeon laryngectomy volume were modeled as categorical variables. Methods: Relationships between hospital and surgeon volume and mortality, surgical complications, and acute medical complications were examined using multivariable regression. Results: Higher‐volume surgeons were more likely to operate at large, teaching, nonprofit hospitals and were more likely to treat patients who were white, had private insurance, hypopharyngeal cancer, low comorbidity, admitted electively, and to perform partial laryngectomy, concurrent neck dissection, and flap reconstruction. Surgeons treating more than 5 cases per year were associated with lower odds of medical and surgical complications, with a greater reduction in the odds of complications with increasing surgical volume. Surgeons in the top volume quintile (>9 cases/year) were associated with a decreased odds of in‐hospital mortality (OR = 0.09 [0.01–0.74]), postoperative surgical complications (OR = 0.58 [0.45–0.74]), and acute medical complications (OR = 0.49 [0.37–0.64]). Surgeon volume accounted for 95% of the effect of hospital volume on mortality and 16%–47% of the effect of hospital volume on postoperative morbidity. Conclusion: There is a strong volume‐outcome relationship for laryngectomy, with reduced mortality and morbidity associated with higher surgeon and higher hospital volumes. Observed associations between hospital volume and operative morbidity and mortality are mediated by surgeon volume, suggesting that surgeon volume is an important component of the favorable outcomes of high‐volume hospital care. Laryngoscope, 133:834–840, 2023 [ABSTRACT FROM AUTHOR]

Objective: To describe the annual operational costs of a mature Experience Corps[R] program in elementary schools in the Baltimore City Public School System. Methods: Systematic records of expenditures kept by the community partner, Greater Homewood Community Corporation, to be reported to funders were made available for analysis. Expenditures were aggregated to the level of fiscal year and grouped in categories in consultation with the community partner. Results: Expenditures to provide reimbursement to volunteers and to administer this complex volunteer program in an environment in which the school district needed additional management resources for such a program dominate the total expenditures. In the 2008 fiscal year, the program provided 158,305 hours of older adult volunteer service to public elementary schools in Baltimore City and the cost per volunteer hour was $9.79; in the 2009 fiscal year the program provided 157,238 hours of older adult volunteer service and the cost per volunteer hour was $9.60. This suggests consistency and may also suggest that the program is becoming more efficient over time. Conclusion: The costs presented represent the costs of running a mature program after an initial investment has been made. These costs would need to be compared with the short-term and long-term benefits to the older adult volunteers, the school children, other school personnel, and the schools' and volunteers' communities to perform a comprehensive benefit-cost analysis to inform public policy. (Contains 3 tables.)

Purpose: Guided Care (GC) is a model of health care for multimorbid older adults that is provided by a registered nurse who works with the patients' primary care physician (PCP). The purpose of this study was to determine whether GC improves patients' primary caregivers' depressive symptoms, strain, productivity, and perceptions of the quality of care recipients' chronic illness care. Design and Methods: A cluster-randomized controlled trial of GC was conducted within 14 PCP teams. The study sample included 196 primary caregivers who completed baseline and 18-month surveys and whose care recipients remained alive and enrolled in the GC study for 18 months. Caregiver outcomes included the following: depressive symptoms (Center for Epidemiological Studies-Depression scale), strain (Modified Caregiver Strain Index), the quality of care recipients' chronic illness care [Patient Assessment of Chronic Illness Care (PACIC)], and personal productivity (Work Productivity and Activity Impairment questionnaire, adapted for caregiving). Results: In multivariate regression models, between-group differences in depression, strain, work productivity, and regular activity productivity were not statistically significant after 18 months, but GC caregivers reported the overall quality of their recipients' chronic illness care to be significantly higher (adjusted beta = 0.40, 95% confidence interval: 0.14-0.67). Quality was significantly higher in 4 of 5 PACIC subscales, reflecting the dimensions of goal setting, coordination of care, decision support, and patient activation. Implications: GC improved the quality of chronic illness care received by multimorbid care recipients but did not improve caregivers' depressive symptoms, affect, or productivity.

Teacher attrition is a costly and persistent problem in urban schools. The objective of this study was to evaluate senior volunteers' potential impact for improving teacher retention. We conducted interviews with six principals, 20 teachers, and six retired educators participating in the Experience Corps Baltimore program. Findings indicate that older adult volunteers may enhance teacher retention by improving classroom environments and by positively influencing some factors related to teacher attrition, including effort and satisfaction, as well as reducing absenteeism. While all senior volunteers can provide benefits with adequate training, retired teachers may provide greater benefits in teacher retention. (Contains 3 tables.)