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Doss, Cheryl R. "Is Risk Fully Pooled within the Household? Evidence from Ghana". Economic Development and Cultural Change 50, n.º 1 (outubro de 2001): 101–30. http://dx.doi.org/10.1086/340009.
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Petit, Geneviève, Philippe De Wals, Barbara Law, Theresa Tam, Lonny James Erickson, Maryse Guay e Alicia Framarin. "Epidemiological and Economic Burden of Pneumococcal Disease in Canadian Children". Canadian Journal of Infectious Diseases 14, n.º 4 (2003): 215–20. http://dx.doi.org/10.1155/2003/781794.
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BACKGROUND: With the arrival of a new conjugate pneumococcal vaccine, it is important to estimate the burden of pneumococcal diseases in Canadian children. The epidemiological data and the economic cost of these diseases are crucial elements in evaluating the relevance of a vaccination program.METHODS: Using provincial databases, ad hoc surveys and published data, age-specific incidence rates of pneumococcal infections were estimated in a cohort of 340,000 children between six months and nine years of age. The costs of these diseases to the health system and to families were also evaluated using data from Quebec and Manitoba.RESULTS: Cumulative risks were one in 5000 for pneumococcal meningitis, one in 500 for bacteremia and one in 20 for pneumonia, leading to 16 deaths in the cohort. About 262,000 otitis media episodes and 32,000 cases of myringotomy with ventilation tube insertion were attributable toStreptococcus pneumoniae. Societal costs were estimated at $125 million, of which 32% was borne by the health system and 68% was borne by families. Invasive infections represented only 2% of total costs, while 84% were generated by otitis media.CONCLUSION: Pneumococcal infections represent a significant burden for Canadian children and society that could be significantly reduced through immunization.
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Petit, G., P. De Wals, B. Law, T. Tam, LJ Erickson, M. Guay e A. Framarin. "<p>Epidemiological and economic burden of pneumococcal diseases in Canadian children</p>". Community Ear and Hearing Health 8, n.º 11 (1 de dezembro de 2011): 5. http://dx.doi.org/10.56920/cehh.108.
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Background: With the arrival of a new conjugate pneumococcal vaccine, it is important to estimate the burden of pneumococcal diseases in Canadian children. The epidemiological data and the economic cost of these diseases are crucial elements in evaluating the relevance of a vaccination program.
Methods: Using provincial databases, ad hoc surveys and published data, agespecific incidence rates of pneumococcal infections were estimated in a cohort of 340,000 children between six months and nine years of age. The costs of these diseases to the health system and to families were also evaluated using data from Quebec and Manitoba.
Results: Cumulative risks were one in 5000 for pneumococcal meningitis, one in 500 for bacteremia and one in 20 for pneumonia, leading to 16 deaths in the cohort. About 262,000 otitis media episodes and 32,000 cases of myringotomy with ventilation tube insertion were attributable to Streptococcus pneumoniae. Societal costs were estimated at $125 million, of which 32% was borne by the health system and 68% was borne by families. Invasive infections represented only 2% of total costs, while 84% were generated by otitis media.
Conclusion: Pneumococcal infections represent a significant burden for Canadian children and society that could be significantly reduced through immunization.
Published courtesy of: Can J Infect Dis. 2003; 14(4): 215-220.
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Shin, Gyeongseon, Daewon Kang, Hee Jin Cheong e Sang-Eun Choi. "Cost-Effectiveness of Extending the National Influenza Vaccination Program in South Korea: Does Vaccination of Older Adults Provide Health Benefits to the Entire Population?" Vaccines 10, n.º 6 (10 de junho de 2022): 932. http://dx.doi.org/10.3390/vaccines10060932.
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The South Korean government has successfully improved influenza vaccination coverage for individuals aged 65 years or older as part of its National Immunization Program (NIP). Those aged 50–64 years without funded vaccination care have significantly lower vaccination rates and face a substantial risk of influenza-related complications. We use a dynamic epidemiological and economic model to investigate the cost-effectiveness of expanding the universal vaccine fund to include those aged 50–64. The epidemiological model is estimated using the susceptibility-infection-recovery model and influenza and influenza-like illness incidence rates, which were calculated by the National Health Insurance Service–National Sample Cohort from the 2008/09 to 2012/13 influenza seasons but excluding the 2009/10 season for pandemic influenza A (H1N1). The decision tree economic model is assessed from societal and healthcare sector perspectives. The proposed policy would eliminate 340,000 annual influenza cases and prevent 119 unnecessary deaths. From a societal perspective, the proposed policy would reduce costs by USD 68 million. From a healthcare perspective, the cost is USD 4318 per quality-adjusted life years. Within the study range, sensitivity analyses found consistent cost-effectiveness results. The influenza vaccine for adults aged 50–64 appears to be cost-saving or cost-effective and, thus, should be considered for the NIP.
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Wang, Danni, Yuting Zhao, Wenxue Yang, Kexin Ma, Tianxing Hao, Jingwei Zhao, Rong Tang et al. "Ecological–Economic Assessment and Managerial Significance of Water Conservation in the Headwaters of the Yellow River". Water 14, n.º 16 (19 de agosto de 2022): 2553. http://dx.doi.org/10.3390/w14162553.
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The water conservation function plays a vital role in the land–water cycle. As the “Chinese water tower”, the headwaters of the Yellow River are of great significance to the safety of the Yellow River basin and even the global ecosystem. Taking the grassland ecosystem in the Yellow River source area as the research object, the InVEST water yield model with modified parameters and the ecological value evaluation of the modified equivalent factor method were used to explore the simulated spatio-temporal changes and the value of grassland water conservation from 2001 to 2020. The results show that: (1) the average total amount of water conservation in the source area is 549 × 108 m3, which is 16% of the runoff in the Yellow River basin, with a growth rate of 7.5 mm/year 1 and a contribution rate of 30%; (2) the total ecological value of grassland water conservation in 2020 is USD 340.03 × 108. The proportion of improved grassland in ecological restoration and management is only 0.51%, while the proportion of original alpine meadow reaches 67% and its ecological function and value are irreplaceable; (3) based on the comprehensive indicators of water conservation capacity, value and importance, Qumalai, Chengduo and Maduo counties are ranked as priority areas for the ecological protection of water resources.
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Haci, Sogukpinar, Bozkurt Ismail e Cag Serkan. "Turkey’s Energy Strategy for 2023 Targets after 2000 MW Giant Renewable Energy Contract". E3S Web of Conferences 64 (2018): 01001. http://dx.doi.org/10.1051/e3sconf/20186401001.
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Turkey wants to become the world’s 10th largest economy in the 100th anniversary of the foundation of the republic of Turkey. In order to achieve this goal, there are many breakthroughs in the political, economic and in energy fields. Turkey’s installed power capacity was 85000 MW in 2017 but installed power of 125.000MW is targeted to achieve the objective of 2023 targets. The government is aiming to increase the total production of renewable energy share by 30% in 2023, while foreseeing the increase in capacity due to nuclear and fossil fuel consumption. Targets for different technologies are 34000 MW hydroelectric, 20000 MW wind energy, 5000 MW solar energy (photovoltaic and condensed solar energy), 1000 MW geothermal energy and 1000 MW biomass. Capacity utilization in hydroelectricity is 62%, wind power is 14%, and geothermal power is 33%. The total installed capacity of Biogas, Biomass, Waste Heat and Pyrolytic Oil Power Plants is 530 MW. Theoretical total power capacity of the solar energy for Turkey as 300 TWh/year and reached 45% of the 2023 target in 2017 in the last three years. However, it is estimated that the targets of 2023 in solar energy can be exceeded. Government offers attractive incentive packages for renewable and other energy sector to achieve 2023 goals. In order to encourage domestic production, a total of 2000 MW wind and solar energy installation bid was carried out in 2017. This contract is expected to make Turkey as energy hub both in terms of installation and technology. In this study, Turkey’s renewable energy potential, and energy strategies and breakthroughs for this were investigated and discussed.
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Saraswati, Suprabadevi Ayumayasari, Lumban Nauli Lumban Toruan, Yulianto Suteja, Dadang Karmen e Putu Eddy Purna Wijaya. "Rob Potential in the Coastal City of Kupang, East Nusa Tenggara (NTT)". Journal of Aquaculture and Fish Health 10, n.º 3 (31 de agosto de 2021): 304. http://dx.doi.org/10.20473/jafh.v10i3.23463.
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Coastal areas are dynamic and vulnerable to environmental changes, both due to natural processes and human activities, the coastal waters in Kupang City are strategic in supporting the development of the economic sector. Coastal areas have unique characteristics, both in terms of bio-geophysics and social, economic and cultural aspects. Some have a high level of vulnerability to global warming. The high value of vulnerability is inseparable from the geomorphological conditions of Kupang City in the form of sandy beaches and coastal erosion. This condition caused Kupang City to become one of the areas affected by tidal flooding. This research is a preliminary study which aims to determine the potential for rob in the coastal city of East Nusa Tenggara that occurred in February 2014. The impact of the tidal floods submerged residents' houses above the knees of adults as high as 70 cm.. The results of this study were to determine the potential for tidal reoccurrence in the city of Kupang, NTT based on tidal forecasting data. Based on the results of the analysis using the Admiralty method, it was found that the Formzhal (F) value for the coast of Kupang City was 25.82, the position of the lowest water level at Oesapa 2 Beach was 206.9 cm, while the sea level elevation position reached the highest peak on Kelapa Lima 2 Beach, namely 478, 5 cm. The value of the harmonic analysis results from the coastal area of Kupang City has HHWL (Highest High Water Level) which is 340.09 cm, the MSL (Mean Sea Level) value is 212.07 cm, and LLWL (Lowest Low Water Level) is 73.36 cm based on these results. The Kupang coast has the potential for tidal flooding.
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Mohd Azmi, Amirul Faiz, Hasliza Abu Hassim, Norhariani Mohd Nor, Hafandi Ahmad, Goh Yong Meng, Punimin Abdullah, Md Zuki Abu Bakar et al. "Comparative Growth and Economic Performances between Indigenous Swamp and Murrah Crossbred Buffaloes in Malaysia". Animals 11, n.º 4 (30 de março de 2021): 957. http://dx.doi.org/10.3390/ani11040957.
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This study was conducted to compare the growth and economic performances between Swamp and Murrah crossbred buffaloes. The records of 108 Swamp and 276 Murrah crossbred buffaloes born between January 2010 and December 2015 were used in this study. The farm was practicing an extensive grazing system without supplementation from January 2010 to December 2011 (pre-intervention) and a new implementation of supplement in the feeding regime from January 2012 to December 2015 (post-intervention). The birth, weaning, and body weight at three monthly intervals, number of calves born, and mortality rate of calves at different years and during pre- and post-intervention were analyzed using a general linear model procedure. The interventions in 2012 had a positive effect on increasing the number of calves born for both breeds, average birth weight, economic performance, and reduce mortality calf rate. As a result, the birth weight of Murrah crossbred buffaloes was higher (36.63 ± 0.50 kg) than Swamp buffaloes (34.69 ± 0.40 kg) (p < 0.05). The average pre-weaning daily weight gain for Swamp and Murrah crossbred buffaloes was 0.73 and 0.98 kg/day (p < 0.05), while the average post-weaning daily weight gain was 0.39 and 0.44 kg/day, respectively (p < 0.05). The Swamp and Murrah crossbred buffaloes achieved the targeted market weight of 250 kg at 18 and 15 months old, respectively, while the targeted breeding weight of 385 kg was achieved at 30 and 26 months old, respectively. In this farm, on average a total of 64 calves were born yearly, with the ratio number of born calves per number of mated dams recorded higher in Murrah crossbred buffaloes as compared to Swamp buffalo (0.64 vs. 0.37) (p < 0.05). Furthermore, the average number of calves born in the post-intervention period (January 2012–December 2015) was significantly higher than in the pre-intervention period (January 2010–December 2011), respectively (Swamp: 23 vs. 8 and Murrah crossbred: 53 vs. 31, respectively) (p < 0.05). Partial budget method was used to estimate the net gain or loss between the two breeds. The average annual revenue was 2304.14 MYR (566.13 USD) for Swamp buffaloes and 4531.50 MYR (1113.39 USD) for Murrah crossbred buffaloes. The average annual cost saving was 340.02 MYR (83.54 USD) for Swamp and 215.75 MYR (53.01 USD) for Murrah crossbred buffaloes. On the other hand, annual added cost was 84.95 MYR (20.87 USD) for Swamp and 96.76 MYR (23.77 USD) for Murrah crossbred buffaloes. Therefore, the annual net benefit was 2559.21 MYR (628.80 USD) for Swamp and 4650.49 MYR (1142.63 USD) for Murrah crossbred buffaloes. As a conclusion, this study had shown that the higher average daily weight gain contributes to better cost savings, as shown by the crossbred buffaloes.
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Larionov, Gennadiy, Elena Yatrusheva e Olesya Checheneshkina. "Comparative analysis of the use of udder treatment agents in the prevention of mastitis and improving the quality of milk in cows". Agrarian Bulletin of the 210, n.º 07 (21 de setembro de 2021): 66–74. http://dx.doi.org/10.32417/1997-4868-2021-210-07-66-74.
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Abstract. The aim of this study is to study the effectiveness of the use of various means for treating the udder of cows in order to prevent the incidence of mastitis and improve the quality of milk. Since in order to prevent the development of mastitis for a long time, it is necessary not only to destroy the disease itself and fight its symptoms, but also to take all kinds of measures to prevent the disease. Methods. To conduct a scientific and economic experiment, 4 groups were formed, of which 3 are experimental and 1 control, according to the method of pairs-analogs using a tethered method of keeping in stalls in all four groups. To treat the udder, agents based on iodine, chlorhexidine, chlorhexidine digluconate and probiotic bacteria were used. Results. The summer use of Priolit Vortex and Algavit Vortex in 1 experimental group showed a decrease in the number of mesophilic aerobic facultative anaerobic microorganisms in cow's milk from 200,000 to 97,000 CFU/cm3, which is 48.5 % less than at the beginning of the experiment. Treatment with disinfectants Priolit Vortex and Elovit Vortex in the 2 nd experimental group made it possible to reduce the number of mesophilic aerobic facultative anaerobic microorganisms by 68.4 %. The use of probiotic agents Skin Cleaner and PIP Cow Teat Cleaner for treating the udder of cows allowed to reduce the number of mesophilic aerobic facultative anaerobic microorganisms in the milk of cows in experimental group 3 from 180,000 to 110,000 CFU / in 1 cm3, which is 61.1 % less than the initial indicators. Somatic cells in the milk of cows of the 1st experimental group decreased from 750,000 to 120,000 in 1 cm3, in the 2nd experimental group the number of somatic cells decreased from 250,000 to 180,000 in 1 cm3, in the 3rd experimental group from 390,000 to 340,000 in 1 cm3. In the control group, an increase in the number of somatic cells was found by 84 %.
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Riduwan, Muhammad, e Dika Virginia. "Perencanaan Pengiriman Pasokan Bahan Bakar Liquid Natural Gas (LNG) untuk Pemenuhan Pembangkit Listrik di Wilayah Indonesia Timur". Jurnal Penelitian Transportasi Laut 22, n.º 2 (5 de março de 2021): 111–24. http://dx.doi.org/10.25104/transla.v22i2.1663.
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Pertumbuhan ekonomi Indonesia yang berada pada rata rata 5,8% per tahun tidak hanya berdampak pada peningkatan kesejahteraan masyarakat secara umum tetapi juga peningkatan kebutuhan tenaga listrik. Antisipasi peningkatan permintaan tenaga listrik perlu direncanakan guna pengembangan pembangkit listrik. Penelitian ini bertujuan untuk menentukan model transportasi terpadu angkutan LNG untuk pembangkit di Kepulauan Maluku dan Papua. Metode yang digunakan dalam penelitian ini adalah metode optimasi menggunakan linear programming untuk mendapatkan tipe kapal yang sesuai pada rute terpilih yang memberikan biaya satuan minimum. Hasil optimasi menunjukkan bahwa 9 titik terminal penerima akhir disuplai langsung dari Kilang Tangguh dengan biaya satuan terendah adalah tujuan Sorong sebesar Rp230.000/m³, 6 titik melalui Hub Ambon dengan biaya satuan terendah adalah tujuan Kulur sebesar Rp280.000/ m³, 7 titik disuplai Hub Ternate dengan biaya satuan terendah adalah tujuan Tidore sebesar Rp230.000/ m³ dan 5 sisanya disuplai melalui Hub Manokwari dengan biaya satuan terendah adalah tujuan Biak sebesar Rp340.000/ m³.Planning for Delivery of Liquid Natural Gas (LNG) Fuel for Fulfillment of Power Plants in Eastern Indonesia. Indonesia's economic growth, which is at an average of 5.8% per year, not only has an impact on improving the welfare of the community in general but also increases the demand for electricity. PT PLN (Persero) has anticipated an increase in demand for electricity by making a power plant development plan. This study aims to determine an integrated transportation model for LNG transportation for power plants in the Maluku Islands and Papua. The method used in this research is the linear programming optimization method to obtain the appropriate ship type on the selected route, which provides a minimum unit cost. The optimization results show that 9 points of the final terminal will be supplied directly from the Tangguh Refinery which the lowest unit cost is in Sorong as the destination, 6 points through the Ambon Hub which the lowest unit cost is in Kulur as the destination, 7 points supplied by the Ternate Hub which the lowest unit cost is in Tidore as the destination of, and the remaining 5 will be supplied via the Manokwari Hub which the lowest unit cost is in Biak as the destination, IDR 230,000 / m³, IDR 280,000 / m³, IDR 230,000 / m³, IDR 340,000 / m³, respectively.
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Яшин, А. В., Ю. В. Полывяный e П. Н. Хорев. "THE RESULTS OF EXPERIMENTAL STUDIES OF BUTTER PRESS". Niva Povolzh`ia, n.º 4(58) (31 de março de 2021): 116–25. http://dx.doi.org/10.36461/np.2020.57.4.013.
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Главной задачей сельского хозяйства страны и молочного животноводства, в частности, является дальнейшее увеличение производства молочной продукции, необходимой для населения, на основе снижения ее себестоимости и создание общедоступных решений по механизации обработки молочной продукции с минимизированными трудозатратами. В государственной программе развития сельского хозяйства в Российской Федерации на 2013-2020 гг. одним из приоритетных направлений является развитие малых форм хозяйствования – крестьянских (фермерских) и личных подсобных хозяйств. В нашей стране уже функционируют свыше 340 тыс. крестьянских (фермерских) хозяйств, причем по ситуации на 2016 год К(Ф)Х и ЛПХ произвели порядка 1,5 млн. тонн молока, с процентом товарности в 69 %, на их долю приходится более 1,1 млн голов коров. С введением социально экономических мер в августе 2014 года, позволивших освободить от ввозимой продукции до 20 % российского рынка молочной продукции, образовавшуюся нишу начали заполнять отечественные производители сыров и сливочного масла. The main objective of the country's agriculture and dairy production, in particular, is to further increase the production of dairy products necessary for the population, based on reducing its cost, and to create generally available solutions for mechanizing the processing of dairy products with minimized labor costs. In the state programme for the development of agriculture in the Russian Federation for 2013-2020, one of the priority areas is the development of small forms of farming - peasant (farm) enterprises and personal subsidiary farms (PSF). There are already more than 340,000 peasant (farm) enterprises (P(F)E) in our country. In 2016, P(F)E and PSF produced about 1.5 million tons of milk, with a percentage of 69%, they account for more than 1.1 million head of cows. In our country, more than 340 thousand peasant (farm) farms are already functioning, and according to the situation in 2016, P(F)E and private household plots produced about 1.5 million tons of milk, with a marketability percentage of 69%. They account for more than 1.1 million cows. With the introduction of economic and social measures in August 2014, which made it possible to free up to 20% of the Russian dairy market from imported products, domestic producers of cheeses and butter began to fill the gap.
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Grytten, Ola Honningdal, e Viktoriia Koilo. "Evidence of the Environmental Kuznets Curve in Emerging Eastern European Economies". SSRN Electronic Journal, 2019. http://dx.doi.org/10.2139/ssrn.3400004.
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Juliana Widyastuti Wahyuningsih, Juliana Widyastuti Wahyuningsih. "FAKTOR-FAKTOR YANG MEMPENGARUHI PERNIKAHAN DINI REMAJA PUTRI DI DESA SEMETEH MUARA LAKITAN KABUPATEN MUSI RAWAS". Jurnal Kebidanan : Jurnal Medical Science Ilmu Kesehatan Akademi Kebidanan Budi Mulia Palembang 8, n.º 1 (24 de abril de 2019). http://dx.doi.org/10.35325/kebidanan.v8i1.118.
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Pernikahan dini adalah pernikahan yang dilakukan seorang wanita pada usia 13 – 16 tahun atau pria berusia 17 – 18 tahun (BKKBN,2016). Menurut Laporan Badan Pusat Statistik, 2015 menunjukkan bahwa prevalensi perkawinan usia anak di Indonesia tidak hanya tetap tinggi (dengan lebih dari seperenam anak perempuan menikah sebelum mencapai usia dewasa (usia 18 tahun) atau sekitar 340.000 anak perempuan setiap tahunnya) tetapi prevalensi tersebut juga telah kembali meningkat. Tujuan dari penelitian ini adalah Mengetahui gambaran faktor – Faktor yang mempengaruhi Pernikahan dini Remaja Putri di Desa Semeteh Kecamatan Muara Lakitan Kabupaten Musi Rawas. Penelitian ini dilakukan secara kualitatif di Wilayah Desa Semeteh Muara Lakitan Kabupaten Musi Rawas.dengan jumlah responden 5 orang dari jumlah sampel 11 orang. Hasil penelitian menggambarkan bahwa pernikahan dini dilakukan oleh mereka yang berpendidikan SD atau SLTP, dan berpengetahuan cukup. Pernikahan dini dianggap sesuatu hal yang lazim dan menurunkan tanggung jawab ekonomi orang tua. Selain itu media punya andil terjadinya pernikahan dini. Penelitian ini diharapkan dapat bermanfaat bagi pasangan remaja calon pengantin, mahasiswa dan institusi profesi kebidanan khususnya dalam memberikan pendidikan kesehatan reproduksi remaja terkait dengan masalah pernikahan dini.
ABSTRACK
Early marriage is a marriage made by a woman at the age of 13-16 years or a man aged 17-18 years (BKKBN, 2016). According to the Central Bureau of Statistics Report, 2015 shows that the prevalence of marriage in Indonesian age is not only high (with more than one-sixth married girls before reaching adulthood (age 18) or about 340,000 girls annually) but the prevalence has also returned increased. The purpose of this study is to know the description of factors - Factors affecting early marriage of Young Women in the Semeteh Village Muara Lakitan Musi Rawas District. This study was conducted qualitatively in Semeteh Village, Muara Lakitan, Musi Rawas District with 5 people as the respondents of the 11 samples. The results of the study indicated that the early marriage was conducted by people who had educated in elementary or junior high schools, and had sufficient knowledge. Early marriage was considered as a usual something and could decrease economic responsibility of their parents. In addition, the media had contributed to the incidence of early marriages. This study is expected to be useful for couples of young people who will get to be married, students and midwifery profession institutions particularly in providing reproductive health education for the adolescences in accordance with the early marriage.
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Faria, Helder Henrique de, Andréa Soares Pires e Fernanda D. Abra. "Monitoring of highway impact on fauna as a component of management of a protected area in the Brazilian Atlantic Forest". Periódico Eletrônico Fórum Ambiental da Alta Paulista 18, n.º 1 (21 de janeiro de 2022). http://dx.doi.org/10.17271/1980082718120223103.
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Although being conceived with economical and social significance, building roads is a high impact mechanism of landscape fragmentation, in which the involved environmental factors are not fully considered. The SP-613 highway segments the forest and divides in half the 34000 ha of Morro do Diabo State Park (MDSP), representing the major source of disturbance to the protected area’s wildlife. A random monitoring was performed between 1989-1999 and counted 158 animals and 23 wild species killed in collisions with vehicles. Among these, 16% were endangered species. Data compiled between 2002 and 2010, following the same previous methodology, counted 46 dead animals and 15 species, indicating the geographic localizations of the collisions. A new stage of the monitoring was performed, with systematic data collection throughout two different periods: the first one with 197 days of monitoring and 56 days of sampling; the second one with 292 days of monitoring and 83 days of sampling. The species, sex, when possible, date, place and carcass conditions were registered, resulting in 29 individuals and 16 wild species. The three rounds of monitoring totaled 233 registered animals among 15 orders, 28 families and 33 impacted species. In this work, we revisit the data from the first two monitorings and present the analysis of the last survey, the most impacted species and the mortality rates after the adoption of measures aiming to diminish the fauna mortality along the highway.
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Carlassara, Lucrezia, Giordano Pastori, Umberto Savi, Marco Pasqualetto, Morena Giozzet e Andrea Bandera. "MO898NEW ORGANISATIONAL MODEL OF HOME HEMODIALYSIS: THE EXPERIENCE OF THE PROVINCE OF BELLUNO". Nephrology Dialysis Transplantation 36, Supplement_1 (1 de maio de 2021). http://dx.doi.org/10.1093/ndt/gfab100.0023.
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Abstract Background and Aims Belluno is a mountainous province of 3610 Km2, with a low population density (56 people/Km2), and an high ISTAT old age index of 228. Four HemoDialysis (HD) Centers assist 112 patients, who spend up to 8 hours/week by ambulance to arrive at the HD Center, with a CO2 estimated emission (EE) up to 6.6 ton/year patient. The cost of in-Center HD may reach up to 61.000 €/year patient. Giving these premisis, we consider as first choice either Peritoneal Dialysis or Home HD (HDD), otherwise than in-Center HD. HHD can be Not assited HHD (NHHD), performed by the patient himself, or Assisted HHD (AHHD), the new HHD service which involves a nurse assistance at home. Both HHDs enables patients to stay at home, may improve patient’s quality of life, reduce the HD costs (32.000-34000 €/year patient), and may reduce the environmental burden of the healthcare procedures (CO2 EE of 0-2.3 ton/year patient). Method One patient have undertaken NHHD and other two the AHHD. Patient 1, on NHHD, is a 50 year old (y.o.) male, on HD since 9/2013. His Past Medical History (PMH) encompasses End Stage Renal Disease (ESRD) due to IgA Nephropathy, a previous kidney transplant, and hypertensive cardiopathy. Patient 2, on AHHD, is a 88y.o. woman, on HD since 01/2020. Her PMH includes ESRD due to multiple myeloma, and hypertension. Patient 3, on AHHD, is a 95y.o. male on HD since 09/2009. His PMH includes ESRD due to hypertensive nephropathy, atrioventricular block with pacemaker, hepatopathy. HHD is performed utilising: the NxStage System (Fresenius®) for NHHD, and the Dialog iQ® System (B.BRAUN®) for AHHD. The HD prescription plans 2 hours treatment for 6 times/week for NHHD, and 4 hours treatment for 3 times/week for AHHD. The total amount of the economical resoureces employed for HD comprise: HD equipment, healthcare-worker, and ambulance transportation (Figure). The EE of CO2 have been determined using a calculator (www.myclimate.org). The EE of CO2 for in-Centre HD comprise both those caused by patients and nurses (Figure). We assumed the same fuel consumption of a diesel Van for the ambulances one. We assumed that nurses use a diesel compact car to commute. Results All patients reported a significantly improved quality of life because they were able to avoid many hours of travel to reach the HD Center. Moreover, the patient on NHHD, appreciated an increased subjective wellness, a greater independence in setting the daily work and personal appointments, and a wider freedom in the eating and drinking habits. The economical resources that may be riallocated by the Healthcare System are up to 30.000 €/year patient. Finally, the environmental burden of the HD procedures may be significantly reduced, with a CO2 EE saved up to 6.6 ton/year patient (equal to 3 round-trip flights Venice-NY). Conclusion Home HD enable patients and their families to substantially improve their quality of life, provide a safe and effective dialysis treatment for the patients, contribute to operational efficiency of the healthcare system, and reduce both the economical impact and the environmental burden of hemodialysis. In conclusion, we believe both HHDs are exellent solution, in particular NHHD for active young patients, and AHHD for fragile patients without a caregiver, resulting in a better management and outcome.