METHODOLOGY: Multiple approaches including assessing utilization and prices of insulins including biosimilars among six Asian countries and comparing the findings especially with other middle-income countries.
RESULTS: Typically, there was increasing use of long-acting insulin analogues among the selected Asian countries. This was especially the case enhanced by biosimilars in Bangladesh, India, and Malaysia reflecting their perceived benefits. However, there was limited use in Pakistan due to issues of affordability similar to a number of African countries. The high use of biosimilars in Bangladesh, India and Malaysia was helped by issues of affordability and local production. The limited use of biosimilars in Japan and Korea reflects limited price reductions and demand-side initiatives similar to a number of European countries.
CONCLUSIONS: Increasing use of long-acting insulin analogues across countries is welcomed, adding to the range of insulins available, which increasingly includes biosimilars. A number of activities are needed to enhance the use of long-acting insulin analogue biosimilars in Japan, Korea and Pakistan.
DESIGN: This was a retrospective cohort study.
SETTING: We used administrative claims data from April 2014 to March 2017.
PARTICIPANTS: We included 18 347 residents of Fukuoka Prefecture, Japan, who received home care during the period, and aged ≥75 years with certified care needs of at least level 3. Participants were categorised based on home care facility use (ie, general clinics, Home Care Support Clinics/Hospitals (HCSCs), enhanced HCSCs with beds and enhanced HCSCs without beds).
PRIMARY AND SECONDARY OUTCOME MEASURES: We used generalised linear models (GLMs) to estimate care utilisation and the incidence of medical institutional death, as well as the potential influence of sex, age, care needs level and Charlson comorbidity index as risk factors.
RESULTS: The results of GLMs showed the inpatient days were 54.3, 69.9, 64.7 and 75.0 for users of enhanced HCSCs with beds, enhanced HCSCs without beds, HCSCs and general clinics, respectively. Correspondingly, the numbers of home care days were 63.8, 51.0, 57.8 and 29.0. Our multivariable logistic regression model estimated medical institutional death rate among participants who died during the study period (n=9919) was 2.32 times higher (p<0.001) for general clinic users than enhanced HCSCs with beds users (relative risks=1.69, p<0.001).
CONCLUSIONS: Participants who used enhanced HCSCs with beds had a relatively low inpatient utilisation, medical institutional deaths, and a high utilisation of home care and home-based end-of-life care. Findings suggest enhanced HCSCs with beds could reduce hospitalisation days and medical institutional deaths. Our study warrants further investigations of home care as part of community-based integrated care.
METHODS: Twenty volumes of interests consisting of six anterior and fourteen posterior edentulous regions were obtained from human mandibular cadavers. A CBCT system with a resolution of 80 µm (3D Accuitomo 170, J. Morita, Kyoto, Japan) and a µCT system with a resolution of 35 µm (SkyScan 1173, Kontich, Belgium) were used to scan the mandibles. Three structural parameters namely, trabecular number (Tb.N), trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp) were analysed using CTAn software (v 1.11, SkyScan, Kontich, Belgium). For each system, the measurements obtained from anterior and posterior regions were tested using independent sample t-test. Subsequently, all measurements between systems were tested using paired t-test.
RESULTS: In CBCT, all parameters of the anterior and posterior mandible showed no significant differences (p > 0.05). However, µCT showed a significant different of Tb.Th (p = 0.023) between anterior and posterior region. Regardless of regions, the measurements obtained using both imaging systems were significantly different (p ≤ 0.021) for Tb.Th and Tb.N.
CONCLUSIONS: The current study demonstrated that only the variation of Tb.Th between anterior and posterior edentulous region of mandible can be detected using µCT. In addition, CBCT is less feasible than µCT in assessing trabecular bone microstructures at both regions.