An observational diagnostic accuracy study comparing the urine dipstick with a consensus-based reference standard for the diagnosis of urinary tract infections in older adults.

Sickle cell disease (SCD) is a group of hereditary haemoglobinopathies that results in considerable burden for patients and their families, while also exerting rising economic pressure worldwide [, ]. SCD is caused by β-globin gene mutations, resulting in sickle-shaped erythrocytes [, ]. The major clinical features of the disease are driven by haemolytic anaemia and vaso-occlusion with ischaemia-reperfusion injury []. In the SHAPE study, symptoms associated with anaemia, particularly fatigue, and vaso-occlusive crises (VOC), particularly pain crises, were most common in adults with SCD, followed by low mood or depression and headaches []. Acute VOC events, such as priapism and acute chest syndrome, require urgent intervention in hospital [, , ]. Over an individual’s life with SCD, patients may develop chronic complications such as osteonecrosis, pulmonary hypertension, or chronic kidney disease [, , ]. Regular transfusion therapy (RTT) and automated red cell exchange therapy (ARCET) are used to manage symptoms and prevent development of acute and chronic complications [–], with the latter having an estimated annual procedure cost of more than £40,000 []. Patients with SCD may miss workdays due to illness or the need to attend healthcare facilities for monitoring or treatment, resulting in lost productivity and lost wages [, –]. Frequent periods of sickness absence can lead to a reduced ability to obtain and retain regular employment and may lead to long-term unemployment [, –]. While the direct economic burden of SCD and its complications on healthcare systems has been reported in several countries [–], the indirect costs of this chronic, inherited disease for patients and wider society are less clear. Observational studies from the USA found individuals with SCD are less likely to be employed than their siblings without SCD [], and that increased frequency of pain is associated with unemployment []. A qualitative study from the USA showed that 76% of patients at a single centre were unemployed [], which is similar to estimates from a province in Brazil, where 72% of individuals with SCD were not in active employment. Other chronic diseases affecting younger adults with flares in disease activity, such as systemic lupus erythematosus (SLE) and multiple sclerosis (MS), and genetic conditions such as cystic fibrosis (CF) have substantial labour-market losses, though lower than reported for SCD. In Californian and Dutch SLE patient survey studies, more than half of patients reported being unemployed (55% and 59%, respectively) [, ]. A European multi-country registry study for MS reported unemployment to be between 47% (in Poland) and 80% in Sweden []. Finally, a UK registry-based study also reported 50% employment amongst patients with CF [].