Cost of treating rheumatoid arthritis in the primary care public health system in Ireland: A time-driven activity-based cost analysis.

Background: Chronic diseases are at epidemic proportions and continuing to increase in both incidence and prevalence globally. Therefore, there is a growing need to assess and improve on the value currently provided within chronic care pathways. Examining the costs associated with care pathways is a critical part of assessing this value in order to better understand and introduce potential cost-saving interventions. Objectives: Examining one such chronic disease, Rheumatoid Arthritis (RA), this study aimed to assess the cost associated with RA in primary care within the Health Service Executive (HSE) in Ireland. Methods: Following mapping of the care pathway, patient vignettes based on exemplar RA patient types were used to conduct semi-structed interviews with every member (N = 21) of the primary care RA pathway. Time-Driven Activity-Based Costing (TDABC) was then used to calculate the overall cost of each patient (vignette) type. Results: RA is an expensive condition regardless of disease stage. However, newly diagnosed patients as well as those with advanced disease in need of surgical interventions demonstrated the highest costs in terms of primary care personnel use. Additionally, patients prescribed Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) cost significantly more than those on Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs) regardless of disease stage or personnel resource use. Conclusion: RA and a subset of RA patients that exert the highest healthcare costs are growing in prevalence. Therefore, this study contributes by assessing the costs associated with RA in HSE primary care that can facilitate better understanding the current value being provided and improve upon the current care pathway to cut future costs.

Dynamic life cycle assessment of commercial and household food waste: A critical global review of emerging techniques.

DLCA has been applied to several food waste streams, however, to date no critical assessment of its strengths, weaknesses, opportunities, and threats (SWOT) is available in the scientific literature. Accordingly, the present review aims to provide a comprehensive overview of the available literature on DLCA and its application to Household and Commercial Food Waste (HCFW) by providing critical assessment and perspectives for future research. The Population, Intervention, Comparison, and Outcome (PICO) framework for literature review was employed, with just 12 relevant studies identified between 1999 and 2022, highlighting a dearth of research on DLCA of food waste and the need for further research. Identified studies exhibit significant variations with respect to DLCA methodology, boundary settings, and data quality and reporting, with more attention typically given to combining conventional LCA with dynamic characterization models, thus making it difficult to draw conclusive findings or identify consistent trends. Additionally, most identified studies employed DLCA for a specific case study and comparison with traditional LCA outcomes was typically ignored; just one study presented the projected impact from both LCA and DLCA for the entire life cycle of a product. Employed functional/reference units ranged from specific quantities such as 1 kg of refined crystals or syrup, 1 g L-1 Sophorolipid solution, and 1 kg of dry food with packaging material, to broader indicators like 1 kg of biofuel or 1 MJ of primary energy. Monte Carlo simulation was the most frequently employed method for uncertainty analyses within identified studies. Sensitivity analyses were conducted in just 4 studies, but it was not always clearly reported. While DLCA is undoubtedly a more realistic approach to impact assessment, and thus likely more accurate, a need exists for increasingly standardized and regulated versions of DLCA for global and multi-criteria practices.

A review of alternative proteins for vegan diets: Sources, physico-chemical properties, nutritional equivalency, and consumer acceptance.

Alternate proteins are gaining popularity as a more sustainable and environmentally friendly alternative to animal-based proteins. These proteins are often considered healthier and are suitable for people following a vegetarian or vegan diet. Alternative proteins can be recovered from natural sources like legumes, grains, nuts, and seeds, while single cell proteins (mycoproteins), and algal proteins are being developed using cutting-edge technology to grow fungus, yeast and algal cells in a controlled environment, creating a more sustainable source of protein. Although, the demand for alternative protein products is increasing, there still happens to be a large gap in use among the general consumers mainly stemming from its lower bioavailability, lack of nutritional equivalency and reduced digestibility compared to animal proteins. The focus of the review is to emphasize on various sources and technologies for recovering alternative proteins for vegan diets. The review discusses physicochemical properties of alternative proteins and emphasise on the role of various processing technologies that can change the digestibility and bioavailability of these proteins. It further accentuates the nutritional equivalency and environmental sustainability of alternative protein against the conventional proteins from animals. The food laws surrounding alternative proteins as well as the commercial potential and consumer acceptance of alternative protein products are also highlighted. Finally, key challenges to improve the consumer acceptability and market value of plant-based proteins would be in achieving nutrient equivalency and enhance bioavailability and digestibility while maintaining the same physicochemical properties, taste, texture, as animal proteins, has also been highlighted.

Identifying Novel Data-Driven Dietary Patterns via Dimensionality Reduction and Associations with Socioeconomic Profile and Health Outcomes in Ireland.

Dietary patterns and body mass index (BMI) play a significant role in the development of noncommunicable diseases (NCDs), which are the leading cause of mortality worldwide, including Ireland. A cross-sectional survey was conducted across Ireland to collate respondents' socioeconomic profiles, health status, and dietary patterns with a representative sample size of 957 adult respondents. Principal component analysis (PCA) and statistical analyses were subsequently employed. To the author's knowledge, this is the first study to use recent (2021) nationally representative data to characterise dietary patterns in Ireland via dimensionality reduction. Five distinct dietary patterns ("meat-focused", "dairy/ovo-focused", "vegetable-focused", "seafood-focused", and "potato-focused") were identified and statistically characterised. The "potato-focused" group exhibited the highest mean BMI (26.88 kg/m2), while the "vegetable-focused" group had the lowest (24.68 kg/m2). "Vegetable-focused" respondents were more likely to be associated with a categorically healthy BMI (OR = 1.90) and urban residency (OR = 2.03). Conversely, "meat-focused" respondents were more likely to have obesity (OR = 1.46) and rural residency (OR = 1.72) along with the "potato-focused" group (OR = 2.15). Results show that data-derived dietary patterns may better predict health outcomes than self-reported dietary patterns, and transitioning to diets focusing on vegetables, seafood, and lower meat consumption may improve health.

"Mind the Gap" - An overview of the role of the Extensions Community Healthcare Outcomes (ECHO) model in enhancing value in health care delivery.

The ECHO (Extensions Community Healthcare Outcomes) model of healthcare delivery has grown rapidly since its establishment and increased in popularity in recent years. This expansion has developed alongside the growing incidence of chronic diseases and the need to better manage them. The increasing uptake in ECHO has presented a requirement to assess its true value as healthcare costs are increasing globally, resulting in a growing demand by governments and policy makers to ensure chronic disease management strategies provide true value. Therefore, the aim of this review is to examine the impact that ECHO has on clinical practice and how such impacts are measured or evaluated. A narrative literature review is carried out to examine the outcomes assessed in ECHO-related studies. Three key academic databases were utilised for the literature search: Web of Science, PubMed, and Medline. Keywords relating to the review were chosen and searched for. Papers were screened using specified inclusion and exclusion criteria relating to years of publication (2000-2020), type of publication (original research, review papers and meta-analyses) and language requirements (English language only). This review found that while the ECHO model is expanding, and improving the so-called "knowledge gap" between specialists and primary care physicians, there is also a gap in the ways value is examined within ECHO. Most studies on ECHO lack an examination of patient reported health outcomes and appropriate, comparative costing methods. Current ECHO-related studies lack vital components that demonstrate the value of the model. Such components include patient reported health outcomes and detailed costing comparisons between the ECHO model and the traditional care pathway it is replacing.

Review of Current Healthcare Waste Management Methods and Their Effect on Global Health.

Healthcare is a rapidly growing industry as medical treatments become more sophisticated, more in demand due to increasing incidence of chronic disease and more widely available worldwide. This booming industry is also creating more waste than ever before and, as such, there is a growing need to treat and dispose of this waste. Healthcare waste (HCW) disposal includes a multitude of disposal methods, including incineration, landfilling and chemical treatments. These rudimentary methods and their growing use present their own problems that negatively impact both the environment and, in turn, damage public health, thus contributing to a global healthcare crisis. The aim of this review was to examine the current HCW disposal methods in place and the harmful effects they have on the environment and on public health. The findings accumulated in this review demonstrate a heavy reliance on basic, low tech HCW disposal techniques and uncovered the negative impacts of these methods. There is a notable lack of employment of "greener" HCW disposal methods on a largescale due to cost, access and feasibility. Despite innovations in HCW disposal, there is no scalable, global green solution at present. Further, the review highlights that global health consequences of HCW disposal methods often differ depending on how developed the country is.

A study of consumer behaviour towards food-waste in Ireland: Attitudes, quantities and global warming potentials.

This study aimed to investigate consumer behaviour towards food waste in Ireland by analysing their attitudes and quantities of food waste generated. Global warming potential of the food waste generated weekly is then assessed. A total of 2115 participants from all over the Republic of Ireland contributed to the survey (of which 2062 were included in this research). Using factor and cluster analysis, two clusters of consumers were formed based on their attitudes towards food waste, and it was found that 62.56% of the sample were 'uncaring' consumers and 37.44% were 'caring' consumers. The uncaring consumers consisted of more young males and were relatively unphased by food waste and take minimal precautions to reduce food waste at all stages of consumption. In contrast, caring consumers consisted of older and female consumers and were deeply disturbed by food waste, taking all precautions to reduce food waste at every stage of consumption. Regarding food waste quantities, uncaring consumers produced on average, 0.74 kg of food waste weekly, accounting for 2.74 kg of CO2 equivalent in global warming potential, whereas caring consumers produced only half this amount. Our results thus suggest that consumers attitudes towards food waste directly impact the food waste quantities they generate and consequently the global warming effects. However, in Ireland all consumer groups can benefit from more information about food waste and our study contributes by providing information that can inform strategic communication campaigns at policy or organisational level, to educates consumers about food waste and how they are contributing to global warming.

Emerging food processing technologies and factors impacting their industrial adoption.

Innovative food processing technologies have been widely investigated in food processing research in recent years. These technologies offer key advantages for advancing the preservation and quality of conventional foods, for combatting the growing challenges posed by globalization, increased competitive pressures and diverse consumer demands. However, there is a need to increase the level of adoption of novel technologies to ensure the potential benefits of these technologies are exploited more by the food industry. This review outlines emerging thermal and non-thermal food processing technologies with regard to their mechanisms, applications and commercial aspects. The level of adoption of novel food processing technologies by the food industry is outlined and the factors that impact their industrial adoption are discussed. At an industry level, the technological capabilities of individual companies, their size, market share as well as their absorptive capacity impact adoption of a novel technology. Characteristics of the technology itself such as costs involved in its development and commercialization, associated risks and relative advantage, and level of complexity and compatibility influence the technology's adoption. The review concludes that a deep understanding of the development and application of a technology along with the factors influencing its acceptance are critical to ensure its commercial adoption.

Food Safety Knowledge and Practices among Saudi Mothers.

This study examines food safety knowledge and practices of mothers in Saudi Arabia. A total of 979 respondents participated in the study and completed a questionnaire that assessed their knowledge of food storage, food handling, usage, and maintenance of kitchen facilities, personal hygiene, and food poisoning. Results showed that mothers in Saudi Arabia had moderate knowledge of food storage (passing rate 64.9%) and usage and maintenance of kitchen facilities (passing rate 66.5%). While they had good knowledge of personal hygiene (passing rate 83.8%) and food poisoning (passing rate 78.5%), their knowledge with regard to food handling was poor (passing rate 30.4%). Results also highlighted that food safety knowledge and practices amongst mothers in Saudi Arabia improved with the level of education, while their age, employment status, monthly income, and number of children had no significant association with their food safety knowledge and practices. This research revealed the importance of education and that advance education and training program can further improve mothers' food safety knowledge and practices and thereby result in reducing the risks of foodborne illnesses at homes.