Health state utilities associated with weight loss: preferences of people with type 2 diabetes and obesity in Japan.

AIMS: Health state utilities associated with weight change are needed for cost-utility analyses (CUAs) examining the value of treatments for type 2 diabetes and obesity. Previous studies have estimated the utility benefits associated with various amounts of weight reduction in the US and Europe, but preferences for weight change in Asian cultures may differ from these published values. The purpose of this study was to estimate utilities associated with reductions in body weight based on preferences of individuals with type 2 diabetes and obesity in Japan. METHODS: Health state vignettes represented type 2 diabetes with respondents' own current weight and weight reductions of 2.5%, 5%, 7.5%, 10%, 12.5%, 15%, and 20%. Utilities were elicited in time trade-off interviews with a sample of respondents in Japan with type 2 diabetes and body mass index (BMI) ≥25 kg/m2 (the cutoff for obesity in Japan). RESULTS: Analyses were conducted with data from 138 respondents (84.8% male; mean age = 58.0 years; mean BMI = 29.4 kg/m2) from all eight regions of Japan. Utility gains gradually increased with rising percentage of weight reductions ranging from 2.5% to 15%. Weight reductions of 2.5% to 15% resulted in utility increases of 0.013 to 0.048. The health state representing a 20% weight reduction yielded a wide range of preferences (mean utility increase of 0.044). Equations are recommended for estimating utility change based on any percentage of weight reduction (up to 20%) in Japanese people with type 2 diabetes and obesity. LIMITATIONS: This study was conducted in a sample with limited representation of patients with BMI >35 kg/m2 (n = 13) and relatively few women (n = 21). CONCLUSION: Results may be used to provide inputs for CUAs examining the value of treatments that are associated with weight loss in patients with type 2 diabetes and obesity in Japan.

Impact of COVID-19 Containment Measures on Unemployment: A Multi-country Analysis Using a Difference-in-Differences Framework.

BACKGROUND: At the start of the coronavirus disease 2019 (COVID-19) pandemic, in the absence of pharmaceutical interventions, countries resorted to containment measures to stem the spread of the disease. In this paper, we have conducted a global study using a sample of 46 countries to evaluate whether these containment measures resulted in unemployment. METHODS: We use a difference-in-differences (DID) specification with a heterogenous intervention to show the varying intensity effect of containment measures on unemployment, on a sample of 46 countries. We explain variations in unemployment from January-June 2020 using stringency of containment measures, controlling for gross domestic product (GDP) growth, inflation rate, exports, cases of COVID-19 per million, COVID-19-specific fiscal spending, time fixed effects, region fixed effects, and region trends. We conduct further subset analyses by COVID-cases quintiles and gross national income (GNI) per capita quintiles. RESULTS: The median level of containment stringency in our sample was 43.7. Our model found that increasing stringency to this level would result in unemployment increasing by 1.87 percentage points (or 1.67 pp, after controlling for confounding). For countries with below median COVID-19 cases and below median GNI per capita, this effect is larger. CONCLUSION: Containment measures have a strong impact on unemployment. This effect is larger in poorer countries and countries with low COVID-19 cases. Given that unemployment has profound effects on mortality and morbidity, this consequence of containment measures may compound the adverse health effects of the pandemic for the most vulnerable groups. It is necessary for governments to consider this in future pandemic management, and to attempt to alleviate the impact of containment measures via effective fiscal spending.

Cost-effectiveness of a mental health drop-in centre for young people with long-term physical conditions.

BACKGROUND: Paediatric patients being treated for long-term physical health conditions (LTCs) have elevated mental health needs. However, mental health services in the community are difficult to access in the usual course of care for these patients. The Lucy Project - a self-referral drop-in access point-was a program to address this gap by enrolling patients for low-intensity psychological interventions during their treatment for LTCs. In this paper, we evaluate the cost-effectiveness of the Lucy Project. METHODS: Using a pre-post design, we evaluate the cost-effectiveness of the intervention by calculating the base-case incremental cost-effectiveness ratio (ICER) using outcomes data and expenses recorded by project staff. The target population was paediatric patients enrolled in the program with an average age of 9 years, treated over a time horizon of 6 months. Outcome data were collected via the Paediatric Quality of Life Inventory, which was converted to health utility scores using an instrument found in the literature. The QALYs were estimated using these health utility scores and the length of the intervention. We calculate a second, practical-case incremental cost-effectiveness ratio using streamlined costing figures with maximum capacity patient enrolment within a one-year time horizon, and capturing lessons learned post-trial. RESULTS: The base-case model showed an ICER of £21,220/Quality Adjusted Life Years (QALY) gained, while the practical model showed an ICER of £4,359/QALY gained. The practical model suggests the intervention garners significant gains in quality of life at an average cost of £309 per patient. Sensitivity analyses reveal use of staff time was the greatest determinant of the ICER, and the intervention is cost-effective 75% of the time in the base-case model, and 94% of the time in the practical-case model at a cost-effectiveness threshold of £20,000/QALY gained. CONCLUSIONS: We find the base-case intervention improves patient outcomes and can be considered cost-effective according to the National Institute for Health and Care Excellence (NICE) threshold of £20,000-£30,000/QALY gained, and the practical-case intervention is roughly four times as cost-effective as the base-case. We recommend future studies incorporate a control group to corroborate the effect size of the intervention.

COVID-19 attributed mortality and ambient temperature: a global ecological study using a two-stage regression model.

A negative correlation between ambient temperature and COVID-19 mortality has been observed. However, the World Meteorological Organization (WMO) has reinforced the importance of government interventions and warned countries against relaxing control measures due to warmer temperatures. Further understanding of this relationship is needed to help plan vaccination campaigns opportunely. Using a two-stage regression model, we conducted cross-sectional and longitudinal analyses to evaluate the association between monthly ambient temperature lagged by one month with the COVID-19 number of deaths and the probability of high-level of COVID-19 mortality in 150 countries during time t = 60, 90, and 120 days since the onset. First, we computed a log-linear regression to predict the pre-COVID-19 respiratory disease mortality to homogenize the baseline disease burden within countries. Second, we employed negative binomial and logistic regressions to analyze the linkage between the ambient temperature and our outcomes, adjusting by pre-COVID-19 respiratory disease mortality rate, among other factors. The increase of one Celsius degree in ambient temperature decreases the incidence of COVID-19 deaths (IRR = 0.93; SE: 0.026, p-value<0.001) and the probability of high-level COVID-19 mortality (OR = 0.96; SE: 0.019; p-value<0.001) over time. High-income countries from the northern hemisphere had lower temperatures and were most affected by pre-COVID respiratory disease mortality and COVID-19 mortality. This study provides a global perspective corroborating the negative association between COVID-19 mortality and ambient temperature. Our longitudinal findings support the statement made by the WMO. Effective, opportune, and sustained reaction from countries can help capitalize on higher temperatures' protective role including the timely rollout of vaccination campaigns.

Country-level factors associated with the early spread of COVID-19 cases at 5, 10 and 15 days since the onset.

The COVID-19 pandemic is causing a significant global health crisis. As the disease continues to spread worldwide, little is known about the country-level factors affecting the transmission in the early weeks. The present study objective was to explore the country-level factors, including government actions that explain the variation in the cumulative cases of COVID-19 within the first 15 days since the first case reported. Using publicly available sources, country socioeconomic, demographic and health-related risk factors, together with government measures to contain COVID-19 spread, were analysed as predictors of the cumulative number of COVID-19 cases at three time points (t = 5, 10 and 15) since the first case reported (n = 134 countries). Drawing on negative binomial multivariate regression models, HDI, healthcare expenditure and resources, and the variation in the measures taken by the governments, significantly predicted the incidence risk ratios of COVID-19 cases at the three time points. The estimates were robust to different modelling techniques and specifications. Although wealthier countries have elevated human development and healthcare capacity in respect to their counterparts (low- and middle-income countries) the early implementation of effective and incremental measures taken by the governments are crucial to controlling the spread of COVID-19 in the early weeks.

Relationship of denture cast measurements to width of maxillary anterior teeth.

STATEMENT OF PROBLEM: When making complete dentures, clinicians may have difficulty with selection of properly sized denture teeth. PURPOSE: The purpose of this study was to determine if there are specific measurements made on an edentulous cast that could be useful to clinicians for selection of proper maxillary anterior denture tooth width. MATERIAL AND METHODS: Following Institutional Review Board approval, measurements were made on 50 maxillary and mandibular sets of complete denture casts and their marked and contoured occlusion rims and record bases consecutively submitted to a dental laboratory. The following 6 measurements were recorded for each set of casts: left mid-maxillary to right mid-maxillary, representing the distance between the respective residual ridge crest points adjacent to each canine eminence; left retromolar pad to right retromolar pad; incisive papilla to left hamular notch; incisive papilla to right hamular notch; left hamular notch to right hamular notch; and incisive papilla to vibrating line. These measurements were statistically compared with the control, the canine-to-canine distance as marked on the contoured maxillary occlusion rim to indicate the relaxed commissures. The casts were also classified as small, medium or large based upon the tooth width specified by the commercial mold guide for their respective canine-to-canine control measurement. The estimation bias was determined for each of the 6 measurements, and for those measurements for which the bias was significantly different from zero, a bias-correction was applied. St. Laurent's coefficient was used to describe the agreement between each (bias-corrected) measurement and the canine-to-canine control. A commercial guide was used to determine the accuracy of each of the 6 bias-corrected measurements in classifying denture teeth width as small, medium or large as compared to the same classification using the canine-to-canine control. RESULTS: The bias-corrected measurement from the left hamular notch mark to the right hamular notch mark, obtained by adding 10 mm, exhibited the greatest degree of agreement with the control. This measurement was also the only one of the 6 that correctly classified more than 50% of both the medium and large casts. None of the 6 measurements classified more than 30% of the small casts correctly. CONCLUSIONS: Of the 6 measurements considered here, the bias-corrected measurement from left hamular notch mark to right hamular notch mark was preferred for selecting denture teeth width.

The impact of dental devices on neurostimulators.

Spinal cord stimulation has been a therapeutic option for chronic pain for over 40 years. The neurostimulator (NS) is a device consisting of three primary components: an electrode array configured either as a paddle or wire; an implantable pulse generator (IPG) consisting of a minicomputer, a transceiver/antenna, an electrical generator, and a battery; and insulated wiring connecting the electrode to the IPG. The electrode array can be implanted into the epidural space overlying the dorsal spinal cord or along a peripheral nerve. The device generates pulsed electrical signals that stimulate the underlying dorsal columns of the spinal cord resulting in the perception of paresthesia by the patient. When overlapped with painful areas, the paresthesia can help decrease the patient's level of pain. The increased applications and indications for this technology enhance the likelihood that the NS patient will be seen in the dental practice. Therefore, the purpose of this study was to investigate whether electromagnetic interference of the NS occurred during the operation of the apex locator, the electric pulp tester (EPT), or the electrocautery unit. An NS was implanted into the epidural space of a human cadaver. The dental devices were used intraorally, and the implant's circuitry was tested after each trial. Two apex locators, two EPTs, and one electrocautery unit were tested. Seventy trials were used by each dental device on each tissue. Using the exact binomial method of determining confidence intervals, the probability of damage to the NS by any of the devices was negligible.