• Prophylactic Treatment in People with Severe Hemophilia B in the US: An Analysis of Real-World Healthcare System Costs and Clinical Outcomes

      Noone, Declan; Pedra, Gabriel; Asghar, Sohaib; O'Hara, Jamie; Sawyer, Eileen K; Li, Nanxin (Nick) (American Society of Hematology, 2019-11-13)
      Introduction The treatment paradigm for people with severe hemophilia B in the US typically involves prophylaxis with factor IX (FIX) replacement therapy, the primary aim of which is to provide sufficient FIX levels to reduce the frequency of bleeding events. The clinical benefits of FIX prophylaxis are well understood, however the cost of FIX products as well as costs associated with healthcare resource utilization present a significant burden to the healthcare system. Substantive costs may also accrue in patients who continue to bleed while on prophylaxis, due to the impact on both short and long-term joint-related outcomes. In the absence of existing data in the US, the 'Cost of Hemophilia Across the USA: a Socioeconomic Survey' (CHESS US) study was conducted to establish a population-based estimate of the real-world US healthcare system burden associated with severe hemophilia. Using data drawn from the CHESS US study, this analysis examines the real-world healthcare system costs and clinical outcomes of people with severe hemophilia B on FIX prophylaxis. Methods CHESS US, a retrospective, cross-sectional dataset of adults with severe hemophilia in the USA, gathered information on patient cost via a patient record form. Data on the following parameters are included in this analysis: FIX consumption, annualized bleeding rate (ABR), the presence of one or more chronically damaged joints ("problem joint"), as well as costs associated with annual (prophylactic) factor consumption and hospitalizations (i.e., number of admissions, number of day cases, total inpatient days, and total intensive care unit [ICU] days). All variables report retrospective data of the 12 months prior to enrolment in the study. Results are presented as mean (± standard deviation) or N (%). Results In total, 132 of 576 patients profiled in the CHESS US study had severe hemophilia B. Among them, 77 patients were on FIX prophylaxis, of whom 44 patients reported FIX dosing regimen and were included in the current analyses. Among them, 20 patients were treated with conventional FIX and 24 patients with extended half-life (EHL) FIX products. The cohort has a mean age of 27.64 (± 11.05) and mean weight (kg) of 75.71 (± 13.41). In the last 12 months, the mean number of international units (IU) prescribed for FIX prophylaxis across the full cohort was 257,216 IU (± 213,591), with an associated annual cost of $610,966 (± $495,869). Among patients treated with conventional FIX, mean prescribed FIX was 287,141 IU (± 264,906) at an annual cost of $397,491 (± $359,788), while patients treated with EHL FIX reported a mean prescribed FIX of 232,278 IU (± 160,914) at an annual cost of $788,861 (± $529,258). The cohort reported a mean ABR of 1.73 (± 1.39); 8 (18%) were reported to have a target joint meeting the International Society on Thrombosis and Haemostasis (ISTH) definition; and 11% were reported to have had at least one chronically damaged joint (i.e., problem joint). Healthcare resource utilization associated with bleed events were reported as follows: hospital admissions days [0.18 (± 0.62)]; inpatient days [0.34 (± 1.22)]; and ICU days [0.23 (± 0.86)]. The direct medical cost to the healthcare system was $2,885 (± $7,857; excluding FIX cost) and $614,886 (± $498,839; including FIX cost). Discussion Data from the CHESS US study showed substantial costs and resource utilization among patients with severe hemophilia B receiving FIX prophylaxis, of which the cost of FIX replacement therapy constituted most of the total cost to healthcare system. Although the ABR observed in the analysis population was low, bleed-related hospitalizations comprised a significant non-drug cost to the healthcare system. A proportion of patients also still experienced joint arthropathy. Such substantial clinical and economic burden highlights that unmet needs remain in patients with severe hemophilia B on FIX prophylaxis in the US. Disclosures Noone: HCD Economics: Employment. Pedra:HCD Economics: Employment. Asghar:HCD Economics: Employment. O'Hara:HCD Economics: Employment, Equity Ownership. Sawyer:uniQure Inc.: Employment. Li:uniQure Inc.: Employment.
    • Psychiatric morbidity in medically ill patients using Spanish version of GMHAT/PC

      Tejada, Paola A.; Jaramillo, Luís Eduardo; Polo, Gilberto; Sharma, Vimal; University of Chester (Taylor and Francis, 2016-12-14)
      The study aimed to assess psychiatric morbidity in medically ill patients and to examine the use of GMHAT/PC Spanish version in a general health setting. We recruited patients who were hospitalized at the services of Internal Medicine, Surgery and G/O during a period of 1 month for each service. The diagnosis of a medical illness was supported by specialists in each service. A trained GP conducted a psychiatric assessment of all the participants using GMHAT/PC. The interview was carried out at patients’ bedside. Of 455 medically ill patients, 4.8% had a mental illness identified by GMHAT/PC interview. Anxiety, depression and organic disorders were the most frequently identified mental disorders in internal medicine and surgery. Cancer had a significantly higher prevalence of comorbid mental illness. In this study the proportion of medically ill with mental disorders was less compared to other studies. The GMHAT/PC is more close to identifying clinical cases of mental illness and also patients who need help. The GMHAT is more a diagnostic instrument than a screening instrument. Physicians and practitioners can be trained to identify mental illness using computer-assisted tools such as GMHAT/PC. A holistic approach of providing care to such patients may improve their overall outcome and quality of life.
    • The psychological distress in healthcare workers: Current perspectives and challenges

      Mitchell, Andrew E.P.; University of Chester
      Aims and objectives. The review presents evidenced-based literature on psychological distress amongst health care professionals; the work is not a systematic review but covers a wide selection of contemporary literature and covers the COVID-19 pandemic. The review discusses several reasons why psychological distress within health care professionals requires separate consideration and strategies to support resilience and access to support. Background. Health care workers report high workplace stress levels, burnout, psychological distress, and an increased risk of mental health problems. This is when the World Health Organisation recommends supporting health care professionals’ mental health and social aspects. It is also accepted that the physical and mental ill-health in health care workers can impact operational effectiveness and delivery of patient outcomes. Literature review. The integrative review utilized keywords to undertake a search of the literature. The following key terms ‘healthcare worker,’ ‘health professional,’ ‘mental health,’ ‘resilience,’ ‘support,’ ‘social risk factors,’ ‘physical risk factors’ and ‘Intervention.’ The PsycINFO, CINAHL and Embase and the Cochrane library were searched to find contemporary research articles. Conclusions. The review has collated the available evidence and recommendations for supporting healthcare workers. It is recognized that stressors can increase the prevalence of psychological distress and lead to recruitment and retention issues. Stressors for psychological distress in health care professionals are the impact of patient-specific situations, interprofessional working relationships and perceived workload burden.
    • Psychological distress in student nurses undertaking an educational programme with professional registration as a nurse: their perceived barriers and facilitators in seeking psychological support

      Mitchell, Andrew E. P.; University of Chester (Wiley, 2018-03-06)
      Introduction. The present study adds to the existing international evidence on psychological distress in the student population by focusing on student nurses. It quantitatively assesses psychological distress with comparative norms and investigates service uptake in in a single study. Aim. Investigate the level of psychological distress in students and compare this with population norms and highlight potential facilitators and barriers to help seeking. Methods. This study recruited N=121 student nurses from one university in a cross sectional design. Data were analysed using descriptive statistics, independent t-tests and one-way ANOVA’s. Findings. The key findings show high levels of psychological distress which is above levels seen in the general population. The main barriers to seeking support was fear of disclosure and the perceived impact on their suitability as a student nurse. Discussion. The study highlights that high levels of distress identified in the literature are seen in student nurses and that fear of disclosure may account for some not seeking support. Relevance. The fear of disclosure and low levels of seeking support suggest there is a need for mental health nurses and academics to play a key role in mental health literacy and evidence-based interventions such as mindfulness to combat these issues.
    • Public acceptability of public health policy to improve population health: A population‐based survey

      Bellis, Mark A.; Hughes, Karen; Di Lemma, Lisa; Public Health Collaborating Unit, School of Health Sciences, Bangor University, Wrexham; Public Health Wales; University of Chester
      Background: For public health policies to be effective, it is critical that they are acceptable to the public as acceptance levels impact success rate. Objective: To explore public acceptance of public health statements and examine differences in acceptability across socio-demographics, health behaviours (physical activity, diet, binge drinking and smoking), health status and well-being. Method: A cross-sectional survey was conducted with a nationally representative sample (N = 1001) using a random stratified sampling method. Face-to-face interviews were conducted at homes of residents in Wales aged 16+ years. Individuals reported whether they agreed, had no opinion, or disagreed with 12 public health statements. Results: More than half of the sample were supportive of 10 out of 12 statements. The three statements with the greatest support (>80% agreement) reflected the importance of: a safe and loving childhood to becoming a healthy adult, schools teaching about health, and healthier foods costing less. Individuals who engaged in unhealthy behaviours were less likely to agree with some of the statements (eg 39.8% of binge drinkers agreed alcohol adverts should be banned compared to 57.6% of those who never binge drink; P < .001). Conclusions: Findings show an appetite for public health policies among the majority of the public. The relationship between supporting policies and engaging in healthy behaviours suggests a feedback loop that is potentially capable of shifting both public opinion and the opportunities for policy intervention. If a nation becomes healthier, this could illicit greater support for stronger policies which could encourage more people to move in a healthier direction.
    • Public health and adults

      Phillips, Sue; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses the range of activities and professions involved in public health.
    • Public health and contemporary health issues

      Thomas, Mike; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses contemporary public health issues.
    • Public health and health promotion

      Wilson, Frances; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses health promotion as a unique discipline within modern public health.
    • Public health and mental health

      Coyle, David L.; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses mental health issues.
    • Public health and population dynamics

      Mabhala, Mzwandile A.; El Ansari, Walid; University of Chester ; University of Gloucestershire (SAGE, 2008-11-20)
      This book chapter discusses the effect that population growth will have on the health of the population, and on the economy and the environment.
    • Public health and the natural environment

      Greening, Kim; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses how nature and the natural environment impact on public health.
    • Public health and the older person

      Cooke, Irene; Mannix, Jean; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses the diverse social, personal, and healthcare needs of older people.
    • Public health and the pre-school child

      Mannix, Jean; Horley, John; University of Chester (SAGE, 2009-11-19)
      This book chapter discusses child public health.
    • Public health and the schools community

      Rabie, Gabrielle; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses how the school acts as a 'key setting' for the health and education of children and young people, in particular the National Healthy School Programme.
    • Public health and young people

      Rabie, Gabrielle; Cooke, Irene; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses health problems and long-term health conditions associated with youth.
    • Public health in nurse education

      Mabhala, Mzwandile; University of Chester
      This study is about PHNEs’ knowledge of teaching public health, and therefore it was considered worthwhile to explore the literature relating to the pedagogies used generally in nursing education, and to teach public health in particular. The exploration of literature revealed two broad pedagogic approaches that underpin nursing education: conventional and interpretive pedagogies. This section presents three examples of interpretive pedagogies – narrative, critical and transformative –that were found to be commonly used in public health nursing.
    • Public health in the workplace

      Massey, Alan; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses how health can be improved in the workplace.
    • Public health nurse educators’ Conceptualisation of public health as a strategy to reduce health inequalities: A qualitative study

      Mabhala, Mzwandile A.; University of Chester (BioMed Central, 2015-02-03)
      Background Nurses have long been identified as key contributors to strategies to reduce health inequalities. However, health inequalities are increasing in the UK despite policy measures put in place to reduce them. This raises questions about: convergence between policy makers’ and nurses’ understanding of how inequalities in health are created and sustained and educational preparation for the role as contributors in reducing health inequalities. Aim The aim of this qualitative research project is to determine public health nurse educators’ understanding of public health as a strategy to reduce health inequalities. Method 26 semi-structured interviews were conducted with higher education institution-based public health nurse educators. Findings Public health nurse educators described health inequalities as the foundation on which a public health framework should be built. Two distinct views emerged of how health inequalities should be tackled: some proposed a population approach focusing on upstream preventive strategies, whilst others proposed behavioural approaches focusing on empowering vulnerable individuals to improve their own health. Conclusion Despite upstream interventions to reduce inequalities in health being proved to have more leverage than individual behavioural interventions in tackling the fundamental causes of health inequalities, some nurses have a better understanding of individual interventions than take population approaches.
    • Public health theories

      Bryan, Ann; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses the value and limitations of the traditional theory base of public health.
    • Publication Preview Source Effectiveness of nitric oxide agents in preventing the early onset of pre-eclampsia and possible modification of metabolic factors in high-risk pregnancies: a systematic review protocol

      Nnate, Daniel A; Mabhala, Mzwandile A.; Massey, Alan; University of Chester
      Objectives: To determine the effectiveness of nitric oxide agents in modifying the metabolic factors of pre-eclampsia and its effectiveness in preventing the onset of pre-eclampsia in high-risk pregnancies. Introduction: Pre-eclampsia is a major cause of maternal death during the prenatal and neonatal periods. Nitric oxide is a vasodilator and platelet aggregation inhibitor responsible for the vascular adaptation of the placenta. Although various studies have established that nitric oxide is effective in preventing complications from pre-eclampsia, there is limited evidence to show that administering nitric oxide agents to the high-risk women before 20 weeks’ gestation will prevent the onset of pre-eclampsia. Inclusion criteria: This review will consider randomized controlled trials that compare nitric oxide donors and precursors with a placebo or no intervention on pregnant women (18 to 44 years) with ≤ 20-week gestational age that are at high risk of pre-eclampsia. The primary outcome of interest will be the onset of pre-eclampsia. Secondary outcomes include increased systolic and diastolic blood pressure, elevated asymmetric dimethylarginine levels, decreased endothelial nitric oxide synthase activity, reduced maternal placental vasculature, and abnormal Doppler ultrasound waveforms. Methods: Data sources will be drawn up from MEDLINE, CINAHL, ProQuest (Health and Medicine) and Web of Science from inception till current date. No language restrictions will be applied in the search strategy. Selected studies will be assessed against the JBI critical appraisal checklist, and the certainty of evidence and strength of recommendations from findings will also be ascertained. Systematic review registration number: CRD42018099298