Effectiveness of Aerobic Training for Adverse Symptoms Related to Chemotherapy During Treatment: Protocol for a Randomized Controlled Trial With Cost-Effectiveness Assessment.

BACKGROUND: One strategy to prevent adverse effects resulting from chemotherapy treatment is to perform physical exercises during treatment. However, there is still no consensus on the best type and intensity of exercise, nor when it should be started. Most studies have been carried out in patients with breast cancer, usually a few weeks after starting chemotherapy, on an outpatient basis 2 to 3 times a week. The main differences in our study are that we carried out physical training in hospitalized patients undergoing a cycle of chemotherapy for cancer treatment and that this training was carried out 5 times a week and was not restricted to a specific type of cancer. OBJECTIVE: We aimed to evaluate the effects of aerobic training on symptoms related to chemotherapy (nausea, vomiting, asthenia, and sensation of weakness), fatigue, mobility, clinical complications, and length of hospital stay of patients during the drug treatment cycle. We also evaluated patient satisfaction with the proposed intervention, the adverse effects of aerobics training, and the cost-effectiveness of this intervention. METHODS: This is a controlled and randomized trial with blinded evaluation that will include 94 hospitalized patients with cancer for 1 or more cycles of chemotherapy. The intervention group will perform aerobic training during a cycle of chemotherapy. The control group will receive a booklet with guidelines for staying active during the hospitalization period. The groups will be compared using a linear mixed model for fatigue, mobility, and chemotherapy-related symptoms before and after the intervention. The length of hospital stay will also be compared between groups using Kaplan-Meier survival analysis. The incidence of complications will be compared using the χ2 test. Cost-effectiveness and cost-utility analyses will be performed for the impact of exercise and quality-adjusted life years with the EQ-5D-3L-21 quality of life trials. The implementation variables (acceptability, suitability, and feasibility) will be evaluated by frequencies. RESULTS: The clinical trial registration was approved in March 2023. Recruitment and data collection for the trial are ongoing, and the results of this study are likely to be published in late 2025. CONCLUSIONS: Chemotherapy has side effects that negatively impact the quality of life of patients with cancer. Aerobic exercise can reduce these side effects in a simple and inexpensive way. The field of work of physical therapists could be expanded to oncology if the intervention works. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos RBR-6b4zwx3; https://tinyurl.com/39c4c7wz. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/60828.

Relevance of farm-scale indicators and tools for farmers to assess sustainability of their mixed crop-ruminant livestock systems.

Ensuring the sustainability and circularity of mixed crop-ruminant livestock systems is essential if they are to deliver on the enhancement of long-term productivity and profitability with a smaller footprint. The objectives of this study were to select indicators in the environmental, economic and social dimensions of sustainability of crop-livestock systems, to assess if these indicators are relevant in the operational schedule of farmers, and to score the indicators in these farm systems. The scoring system was based on relevance to farmers, data availability, frequency of use, and policy. The study was successful in the assemblage of a suite of indicators comprising three dimensions of sustainability and the development of criteria to assess the usefulness of these indicators in crop-ruminant livestock systems in distinct agro-climatic regions across the globe. Except for ammonia emissions, indicators within the Emissions to air theme obtained high scores, as expected from mixed crop-ruminant systems in countries transitioning towards low emission production systems. Despite the inherent association between nutrient losses and water quality, the sum of scores was numerically greater for the former, attributed to a mix of economic and policy incentives. The sum of indicator scores within the Profitability theme (farm net income, expenditure and revenue) received the highest scores in the economic dimension. The Workforce theme (diversity, education, succession) stood out within the social dimension, reflecting the need for an engaged labor force that requires knowledge and skills in both crop and livestock husbandry. The development of surveys with farmers/stakeholders to assess the relevance of farm-scale indicators and tools is important to support direct actions and policies in support of sustainable mixed crop-ruminant livestock farm systems.

Efficiency of periodontal treatment to improve type 2 diabetes mellitus outcomes: A systematic review and meta-analysis of economic evaluations.

BACKGROUND: To assess the efficiency of periodontal treatment (PT) in improving diabetes-related outcomes in adults with type 2 diabetes mellitus (T2DM) and periodontitis, providing an updated and comprehensive synthesis from economic evaluations (EE). METHODS: Seven databases and one register were independently searched by two reviewers for articles published up to 8 May 2024. Studies that assessed the efficiency of PT versus no treatment or other dental treatments were included. Risk of bias was assessed using the Cochrane RoB 2, ROBINS-I and ECOBIAS tools for the first stage of EE and the CHEERS checklist and NICE quality appraisal tool for overall EE. Qualitative and quantitative syntheses of the articles were conducted and assessed using the GRADE approach. RESULTS: Eleven studies were included. PT reduces total healthcare costs, including inpatient and outpatient, diabetes-related costs and other drug costs (low to moderate certainty). A total incremental net benefit of USD 12 348 (2022 currency, 95% CI 12 195-12 500) was estimated from three high-quality model-based cost-utility analyses (high certainty). DISCUSSION: The inclusion of PT in the comprehensive treatment of patients with T2DM and periodontitis is cost-effective. Future research is required to ensure the transferability of these findings and inform decision makers from different countries. REGISTRATION: PROSPERO CRD42023443146.

Cost of hemophilia A in Brazil: a microcosting study.

BACKGROUND: Patients with Hemophilia are continually monitored at treatment centers to avoid and control bleeding episodes. This study estimated the direct and indirect costs per patient with hemophilia A in Brazil and evaluated the cost variability across different age groups. METHODS: A prospective observational research was conducted with retrospective data collection of patients assisted at three referral blood centers in Brazil. Time-driven Activity-based Costing method was used to analyze direct costs, while indirect costs were estimated based on interviews with family and caregivers. Cost per patient was analyzed according to age categories, stratified into 3 groups (0-11;12-18 or older than 19 years old). The non-parametric Mann-Whitney test was used to confirm the differences in costs across groups. RESULTS: Data from 140 hemophilia A patients were analyzed; 53 were 0-11 years, 29 were 12-18 years, and the remaining were older than 19 years. The median cost per patient per year was R$450,831 (IQR R$219,842; R$785,149; $174,566), being possible to confirm age as a cost driver: older patients had higher costs than younger's (p = 0.001; median cost: 0-11 yrs R$299,320; 12-18 yrs R$521,936; ≥19 yrs R$718,969). CONCLUSION: This study is innovative in providing cost information for hemophilia A using a microcosting technique. The variation in costs across patient age groups can sustain more accurate health policies driven to increase access to cutting-edge technologies and reduce the burden of the disease.

Time-frequency co-movements between commodities and global economic policy uncertainty across different crises.

Commodity futures constitute an attractive asset class for portfolio managers. Propelled by their low correlation with other assets, commodities begin gaining popularity among investors, as they allow to capture diversification benefits. This comprehensive study examines the time and frequency spillovers between the Economic Policy Uncertainty [1] and a broad set of commodities encompassing ferrous, non-ferrous, and precious metals, food, and energy commodities over a period from December 1997 to April 2022, which includes various political, economic and health crises. The novelty of this research lies in its extensive temporal and categorical coverage, providing an understanding of how different types of commodities respond to various crises. Furthermore, our study breaks new ground by employing wavelet analysis to gain detailed insights in both time and frequency domains in the financial time series of interest, providing a deeper understanding of the co-movements and lead-lag relationships. Specifically, we introduce the Cross Wavelet Transform (XWT) and Wavelet Coherence (WTC) analysis. Our findings demonstrate that not all crises uniformly impact commodities. Notably, during the global financial crisis and the COVID-19 pandemic, co-movements between commodities became significantly stronger. These results highlight the heterogeneity within the commodity asset class, where individual commodities exhibit diverse underlying dynamics. Importantly, the proposed methodology facilitates the extraction of robust results even when dealing with nonlinearities and nonstationary time series data. Consequently, our work offers valuable insights for policymakers (including regulatory bodies), investors, and fund managers.

The Role of Race in Deaths of Despair in Brazil: Is it a White People Problem?

BACKGROUND: A new paradigm has been discussed regarding the impact of economic cycles on the mortality pattern from specific causes. These causes are called deaths of despair, and they selectively impact specific demographic groups. Also, low- and middle-income countries are most affected due to their economic and social instability. In this sense, the objective of study was to compare the magnitude of disparity in deaths from despair according to sex, age, and race in Brazil. METHODS: We performed Poisson regression modeling to estimate the magnitude of the association between sex, age group, race, and deaths from despair. Also, we estimated the relationship of time as a proxy of economic crisis phase and deaths of despair. RESULTS: We found an association between mortality from despair and male sex (PR = 6.15, 95%CI 6.09-6.22); emphasis on the age groups from 40 to 49 years old (PR = 2.45, 95% CI 2.41-2.48) and 50 to 59 years old (PR = 2.39, 95% CI 2.36-2.43); and brown (PR = 1.21, 95% CI 1.20-1.22) and black race (PR = 1.36, 95% CI 1.34-1.37). CONCLUSIONS: The present study preliminarily presents the effect of the economic crisis and mortality in the population, with demographic differences. Association with race was opposite to that verified in the original study in the USA, which suggests that this variable should be analyzed in the light of structural context.

Mortality of Young Women due to Breast Cancer in Low, Middle and High-Income Countries: Systematic Literature Review and Meta-Analysis.

OBJECTIVE: To identify the difference in breast cancer mortality rates among young women according to countries' economic classification. METHODS: A systematic literature review included retrospective studies on breast cancer mortality rates in women aged 20 to 49 years. Databases used were PubMed, Web of Science, Scopus, and Virtual Health Library, with articles selected in English, Portuguese, and Spanish. The study selection and analysis were conducted by two pairs of researchers. Data from 54 countries were extracted, including 39 high-income, 12 upper-middle-income, and 3 lower-middle-income countries. A meta-analysis was performed with the quantitative data from two studies. RESULTS: Six articles met the inclusion criteria. Four were analyzed descriptively due to data diversity, and two were included in the meta-analysis. The pooled mortality rate for high-income countries was 10.2 per 100,000 women (95% CI: 9.8-10.6), while for upper-middle-income countries, it was 15.5 per 100,000 women (95% CI: 14.9-16.1). Lower-middle-income countries had a pooled mortality rate of 20.3 per 100,000 women (95% CI: 19.5-21.1). The decrease in mortality rates in high-income countries was statistically significant (p<0.05). CONCLUSION: Mortality rates for breast cancer among young women have decreased significantly in high-income countries but have increased in lower-income countries. This disparity underscores the impact of insufficient investment in preventive measures, health promotion, early diagnosis, and treatment on young women's mortality in lower-income countries.

Economic Burden of Otitis Media Globally and an Overview of the Current Scenario to Alleviate the Disease Burden: A Systematic Review.

Introduction The prevalence of otitis media (OM) is substantial all over the world. Epidemiological data related to the economic burden of OM globally is minimal. The present systematic review was undertaken to estimate the economic burden of this disease in various parts of the world. Objectives An extensive literature search was done using PRISMA guidelines to identify relevant studies that estimated the economic burden of OM in monetary terms. The databases searched were PubMed Central, Ovid, and Embase. The cost estimation was done for one specific year and then compared considering the inflation rate. Data Synthesis The literature search led to the inclusion of 10 studies. The studies evaluated direct and indirect costs in monetary terms. Direct costs (health system and patient perspective) ranged from USD (United States Dollar) 122.64 (Netherlands) to USD 633.6 (USA) per episode of OM. Looking at only the patient perspective, the costs ranged from USD 19.32 (Oman) to USD 80.5 (Saudi Arabia). The total costs (direct and indirect) ranged from USD 232.7 to USD 977 (UK) per episode of OM. The economic burden per year was highest in the USA (USD 5 billion). The incidence of OM episodes was found more in children < 5 years old. Introduction of pneumococcal conjugate vaccines decreased the incidence in children and now the prevalence in adults is of concern. Conclusion The economic burden of OM is relatively high globally and addressing this public health burden is important. Approaches for the prevention, diagnosis, and treatment should be undertaken by the health system to alleviate this disease burden.

Economic growth and electricity consumption: Fresh evidence of panel data for LAC.

This study reexamines the causal nexus among electricity consumption (EC) and economic growth (EG) for a panel of 31 countries in Latin America and the Caribbean between 1980 and 2021. We find that there are statistically significant feedback impacts among the research variables in the long run. A 1 percent augment in EC raises EG by 0.5 percent and a 1 percent augment in EG produces a 1.54 percent increase in EC which reflects the nature of the latter as a luxury good and implies a tradeoff between economy and environment, since although greater electrical infrastructure drives EG, the latter also increases the EC whose use in a non-responsible manner could lead to environmental degradation through higher CO2 emissions. Therefore, the main policy implication is that, it is necessary to promote EG based on infrastructure focused on sustainable development, ensuring the well-being of present and future generations.

Environmental, socioeconomic, and health factors associated with gut microbiome species and strains in isolated Honduras villages.

Despite a growing interest in the gut microbiome of non-industrialized countries, data linking deeply sequenced microbiomes from such settings to diverse host phenotypes and situational factors remain uncommon. Using metagenomic data from a community-based cohort of 1,871 people from 19 isolated villages in the Mesoamerican highlands of western Honduras, we report associations between bacterial species and human phenotypes and factors. Among them, socioeconomic factors account for 51.44% of the total associations. Meta-analysis of species-level profiles across several datasets identified several species associated with body mass index, consistent with previous findings. Furthermore, the inclusion of strain-phylogenetic information modifies the overall relationship between the gut microbiome and the phenotypes, especially for some factors like household wealth (e.g., wealthier individuals harbor different strains of Eubacterium rectale). Our analysis suggests a role that gut microbiome surveillance can play in understanding broad features of individual and public health.

Incentivizing adherence to pre-exposure prophylaxis for HIV prevention: a randomized pilot trial among male sex workers in Mexico.

Low adherence to preventative medications against life-long health conditions is a major contributor to global morbidity and mortality. We implemented a pilot randomized controlled trial in Mexico to measure the extent to which conditional economic incentives help male sex workers increase their adherence to pre-exposure prophylaxis (PrEP) for HIV prevention. We followed n = 110 male sex workers over 6 months. At each quarterly visit (at months 0, 3, and 6), all workers received a $10 transport reimbursement, a free 3-month PrEP supply, and completed socio-behavioral surveys. The primary outcome was an objective biomarker of medication adherence based on tenofovir (TFV) drug concentration levels in hair collected at each visit. Individuals randomized to the intervention received incentives based on a grading system as a function of PrEP adherence: those with high (> 0.043 ng/mg TFV concentration), medium (0.011 to 0.042 ng/mg), or low (< 0.011 ng/mg) adherence received $20, $10, or $0, respectively. Six-month pooled effects of incentives on PrEP adherence were analyzed using population-averaged gamma generalized estimating equation models. We estimated heterogeneous treatment effects by sex worker characteristics. The incentive intervention led to a 28.7% increase in hair antiretroviral concentration levels over 6 months consistent with increased PrEP adherence (p = 0.05). The effect of incentives on PrEP adherence was greater for male sex workers who were street-based (vs. internet) workers (p < 0.10). These pilot findings suggest that modest conditional economic incentives could be effective, at scale, for improving PrEP adherence among male sex workers, and should be tested in larger implementation trials. ClinicalTrials.gov Identifier: NCT03674983.

Cost Reduction in the Production of Green Dwarf Coconut Palm Seedlings Biostimulated with Bacillus cereus.

The production of coconut tree seedlings is an important step in the production process, as it substantially affects the productive performance of the adult plant, and the way of obtaining seedlings directly reflects the added costs. To minimize costs, the introduction of biostimulants can be considered a viable and sustainable technology. This study aimed to evaluate the effects of applying Bacillus cereus in promoting growth and reducing the costs of producing Brazilgreen dwarf coconut seedlings. The study has two stages, the first was an experiment carried out in a commercial nursery in the state of Pará-Brazil. The design was completely randomized, with two treatments: control with water (100% mineral fertilization) and B. cereus inoculation (50% mineral fertilization), with 10 replicates each. Biometric parameters and the quality of seedlings were evaluated. In the second stage, the production of stimulated seedlings was compared to that of commercial seedlings, and the effective operating cost (COE) and the total operating cost (TOC) were determined. Biostimulation with B. cereus promotes the growth of coconut tree seedlings, increases seedling quality, and reduces nursery time. In addition, the cost of production is reduced by 10%. Thus, microbial technology is a positive strategy for the production of Brazilian green dwarf coconut seedlings. Using B. cereus can guarantee obtaining seedlings with high performance and at a lower cost. These results may favor obtaining adult plants with high productivity. Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-023-01163-9.

Different light intensity on Messastrum gracile growth under phototrophic cultivation in laboratory.

The present research evaluates the effects of three different lighting intensities, 60 (control), 30 and 120 µmol photons m- 2 s- 1 on Messastrum gracile growth. The observations indicated that a light intensity of 60 µmol photons m- 2 s- 1 resulted in higher cell density during experimental period. The light intensity of 120 µmol photons m- 2 s- 1 had a strong negative impact on M. gracile growth. Parameters such as lipid and protein content, cell density, chlorophyll-a and biomass were lower compared to the other light intensities. On the 14th and 21st growth days, the biomass, lipid and protein content were higher at 60 µmol photons m- 2 s- 1 with 800 mg L- 1, 5.7% and 34.4% biomass dry weight, respectively. The study also highlighted the economic aspects of M. gracile cultivation. The light intensities 30 and 60 µmol photons m- 2 s- 1 were found to be more advantageous than 120 µmol photons m- 2 s- 1 in terms of biomass, unit cost, lipid and protein content. Based on these findings, it was concluded that the light intensities of 30 and 60 µmol photons m- 2 s- 1 are more viable for M. gracile cultivation in laboratory under conditions used.

Environmental impacts of medium-scale pig farming at technical and economic optimum production weight in Mexico.

Medium-scale pig production systems, which make up 30 % of Mexico's pig farms, face two key obstacles impacting their economic and financial performance. The first is the absence of a sales plan based on pigs' weight, which negatively affects both profitability and resource management. The second obstacle is inadequate waste management, which hampers efforts to mitigate environmental impacts generated by pig farms. Based on this criterion, this study aims to determine technical and economic optimum levels of a medium-scale pig farm and evaluate its associated environmental impacts. Based on the last farm sale weight (116.3 kg - base scenario), technical and economic optimum levels were estimated using a production function, resulting in a technical optimum of 155 kg and an economic optimum of 127 kg. An environmental assessment of the pig fattening process was carried out following the principles of the Life Cycle Analysis methodological framework. Using a cradle-to-farm gate perspective, and establishing 1 kg of live-weight pig as the functional unit. The results indicated that production at maximum weight level (155 kg), increased environmental impacts by 60 % to 75 % compared to the base scenario. In contrast, at the maximum economic benefit level (127 kg), environmental impacts increased by 5 % to 10 %. Feed production represented the largest contribution (over 74 %) in six impact categories. The results provide valuable information for medium-scale pig farms to mitigate the environmental burdens associated with the optimal production weight and to direct efforts towards achieving future economic and environmental efficiency.

The Financial Implications of Pancreatic Surgery: The Hospital Is the Big Winner, Not the Surgeon!

Background: High-volume pancreatic surgery centers require a significant investment in expertise, time, and resources to achieve optimal patient outcomes. A detailed understanding of the economics of major pancreatic surgery is limited among many clinicians and hospital administrators. A greater consideration of these financial aspects may in fact have implications for enhancing clinical care and for a broader sustainability of high-volume pancreatic surgery programs. Methods: In this retrospective observational study, patients who underwent pancreaticoduodenectomy (PD), total pancreatectomy, or distal pancreatectomy at one academic medical center during the fiscal year 2021 were evaluated. Detailed hospital charges and professional fees were obtained for patients using the Qlik perioperative database. Clinical data for the study cohort were gathered from a prospectively maintained, IRB-approved pancreatic surgery database. Charges for the 91-day perioperative period were included. A P < 0.05 was considered significant. Results: During the study period, 159 evaluable patients underwent 1 of 3 designated pancreatic resections included in the analysis. Ninety-seven patients (61%) were diagnosed with adenocarcinoma and 70% (n = 110) underwent PD. The total charges (combined professional and hospital charges) for the cohort encompassing the entire perioperative period were $20,661,759. The median charge per patient was $130,306 (interquartile range [IQR], $34,534). The median direct cost of care was $23,219 (IQR, $6321) and the median contribution margin per case was $10,092 (IQR, $22,949). The median surgeon professional fee charges were $7700 per patient (IQR, $1296) as compared to $3453 (IQR, $1,144) for professional fee receipts (45% of the surgeon charge). The differences between the professional fee charges and receipts per patient were also considerable for other health care professionals such as anesthesiologists ($4945 charges vs $1406 receipts [28%]) and pathologists ($3035 charges vs $680 receipts [22%]). The surgeon professional fees were only 6% of the total charges, while the professional fees for anesthesiology and pathology were 4% and 2% of the total charges, respectively. Supply charges were 3% of the total charges. Longer operative time was correlated with increased hospital and anesthesia charges, without a significant increase in surgeon charges (P < 0.001, P < 0.001, and P = 0.2, respectively). Male sex, diabetes, and low serum albumin correlated with greater total hospital charges (P = 0.01, P = 0.01, and P = 0.03, respectively). Conclusions: The role of the surgeon in the perioperative clinical care of major pancreatic resection patients is crucial and important and is by no means limited to the operative day. Nevertheless, in the context of the current US health care system, the reimbursement to the surgeon in the form of professional fees is a relatively small fraction of the total health care receipts for these patients. This imbalance necessitates a substantial financial partnership between hospitals and their pancreatic surgery units to ensure the long-term viability of these programs.

Impact of stoma site marking on healthcare costs in patient care / Impacto da demarcação da estomia de eliminação nos custos assistenciais do cuidado ao paciente / Impacto de la demarcación de laostomía de eliminación en los costos de atención al paciente

Objetivo: Analisar o impacto da demarcação da estomia de eliminação nos custos assistenciais do cuidado aos pacientes demarcados e não demarcados e seus desdobramentos. Método: Pesquisa de avaliação econômica em saúde baseada em dados primários retrospectivos. Os dados foram obtidos dos prontuários de pacientes do Serviço de Atenção à Saúde da Pessoa Ostomizada, em Belo Horizonte (MG), atendidos entre 2015 e 2021. A amostra foi composta de 40 pacientes, sendo 20 demarcado e 20 não demarcado. Foi aplicado o teste de Mann-Whitney para amostras independentes e analisado o tamanho do efeito, que foi corrigido com o uso do teste g de Hedge, considerando o risco de baixo poder amostral. Resultados: Identificou-se o custo médio de R$ 5.201.47 para o grupo dos pacientes não demarcados, que foi 23,88% maior que o custo de R$ 3.959,27 para o grupo dos demarcados. A maioria dos pacientes eram do sexo feminino, com idade média de 60,7 anos, casados e pardos. O câncer colorretal foi a causa mais comum em estomias, enquanto a dermatite foi a complicação mais frequente. Observou-se que as complicações implicaram o aumento dos custos. Conclusão: A demarcação impacta os custos dos cuidados de saúde das pessoas com estomia de eliminação. (AU)

Objetivo: Analizar el impacto de la demarcación de la ostomía de eliminación en los costos asistenciales del cuidado a los pacientes demarcados y no demarcados y sus desdoblamientos. Método: Investigación de evaluación económica en salud basada en datos primarios retrospectivos. Los datos fueron obtenidos de los prontuarios de pacientes del Servicio de Atención a la Salud de Personas Ostomizadas, en Belo Horizonte (Minas Gerais ­ MG), Brasil, atendidos entre 2015 y 2021. La muestra estuvo compuesta por 40 pacientes, 20 demarcados y 20 no demarcados. Se realizó la prueba de Mann-Whitney para muestras independientes y el análisis del tamaño del efecto corregido se realizó mediante la prueba de Hedge g considerando el riesgo de bajo poder muestral. Resultados: Se identificó un costo promedio de R$ 5.201,47 para el grupo de pacientes no demarcados, que fue un 23,88% superior al costo de R$ 3.959,27 en el grupo de pacientes demarcados. La mayoría de los pacientes eran mujeres, con una edad media de 60,7 años, casadas y de raza mixta. El cáncer colorrectal fue la causa más común de estomías, mientras que la dermatitis fue la complicación más frecuente. Se observó que las complicaciones resultaron en un aumento de los costos. Conclusión: La demarcación tiene un impacto en los costos de atención de la salud de las personas con estomía de eliminación. (AU)

Objective: To analyze the impact of stoma site marking on healthcare costs for patients who underwent marking and those who did not, as well as the subsequent outcomes. Method: We conducted an economic evaluation in healthcare based on retrospective primary data. We obtained the data from the medical records of patients treated at the Health Care Service for Ostomy Patients in Belo Horizonte, Minas Gerais, Brazil, between 2015 and 2021. The sample consisted of 40 patients, with 20 who underwent stoma site marking and 20 who did not. We applied the Mann-Whitney test for independent samples and analyzed the effect size, which was adjusted using Hedge's g test, considering the risk of low sample power. Results: The study identified an average cost of R$5,201.47 (US$938.19) for the group of patients who did not undergo stoma site marking, which was 23.88% higher than the cost of R$3,959.27 (US$938.19) for the group who did. Most patients were female, with an average age of 60.7 years, married, and of mixed race. Colorectal cancer was the most common cause of stoma creation, while dermatitis was the most frequent complication. We observed that complications led to increased costs. Conclusion: Stoma site marking significantly affects the healthcare costs for individuals with elimination stomas. (AU)

Cost-Effectiveness of the Prenatal Detection of Congenital Heart Diseases: A Systematic Literature Review.

Background: Congenital heart disease is the most common congenital condition worldwide, with a prevalence of 80 cases per 10 000 live births. In addition to perinatal morbidity and mortality, it entails long-term consequences such as multiple surgeries, prolonged hospitalizations, lifelong cardiac follow-up, reduced quality of life, risk of heart failure, and premature mortality in adulthood. This significant health and economic burden on healthcare systems and families highlights the relevance of evaluating the cost-effectiveness of methods for early detection of this condition. Objective: To conduct a systematic literature review (SLR) to identify and analyze existing economic evaluations on prenatal detection of congenital heart diseases through ultrasound, focusing on the reported cost-effectiveness results and the methodological quality of the evaluated studies according to established criteria. Methods: An SLR of economic evaluations was conducted following PRISMA guidelines. A quantitative synthesis of key methodological components of each economic evaluation was performed. The incremental medical costs, effectiveness measures, and cost-effectiveness ratios reported in each study were compiled and compared. The methodological quality was assessed according to compliance with the 24 CHEERS criteria. Results: We found 785 articles, of which only 7 met all inclusion criteria. Most were cost-effectiveness analyses, with the most common outcome being number of cases detected. Screening with only 4-chamber views interpreted by general practitioners or cardiologists were dominant strategies compared with screening with 4-chamber plus outflow views interpreted by a general practitioner. Fetal echocardiography was most effective but most expensive. Screening with 4-chamber and outflow view, followed by referral to a specialist, were recommended as the least expensive strategy per defect detected. On average, articles met 17 of the 24 CHEERS criteria. Discussion: While recent cost-effectiveness analyses demonstrated improved methodological quality, there was a lack of homogeneity due to differences in comparators and population subgroups analyzed. Despite this heterogeneity, fetal ultrasonography screening was consistently identified as a cost-effective strategy, with its cost-effectiveness heavily influenced by the expertise of the interpreting physician. Conclusion: Most studies recommend implementing obstetric ultrasonography screening, without routine fetal echocardiography, for detecting congenital heart diseases.

Cost-effectiveness of restorative treatments for permanent molars with severe molar incisor hypomineralization: perspectives for the Brazilian public health system.

OBJECTIVES: To undertake a cost-effectiveness analysis of restorative treatments for a first permanent molar with severe molar incisor hypomineralization from the perspective of the Brazilian public system. MATERIALS AND METHODS: Two models were constructed: a one-year decision tree and a ten-year Markov model, each based on a hypothetical cohort of one thousand individuals through Monte Carlo simulation. Eight restorative strategies were evaluated: high viscosity glass ionomer cement (HVGIC); encapsulated GIC; etch and rinse adhesive + composite; self-etch adhesive + composite; preformed stainless steel crown; HVGIC + etch and rinse adhesive + composite; HVGIC + self-etch adhesive + composite, and encapsulated GIC + etch and rinse adhesive + composite. Effectiveness data were sourced from the literature. Micro-costing was applied using 2022 USD market averages with a 5% variation. Incremental cost-effectiveness ratio (ICER), net monetary benefit (%NMB), and the budgetary impact were obtained. RESULTS: Cost-effective treatments included HVGIC (%NMB = 0%/ 0%), encapsulated GIC (%NMB = 19.4%/ 19.7%), and encapsulated GIC + etch and rinse adhesive + composite (%NMB = 23.4%/ 24.5%) at 1 year and 10 years, respectively. The benefit gain of encapsulated GIC + etch and rinse adhesive + composite in relation to encapsulated GIC was small when compared to the cost increase at 1 year (gain of 3.28% and increase of USD 24.26) and 10 years (gain of 4% and increase of USD 15.54). CONCLUSION: Within the horizon and perspective analyzed, the most cost-effective treatment was encapsulated GIC restoration. CLINICAL RELEVANCE: This study can provide information for decision-making.

Epigenetic mechanisms linking early-life adversities and mental health.

Early-life adversities, whether prenatal or postnatal exposure, have been linked to adverse mental health outcomes later in life increasing the risk of several psychiatric disorders. Research on its neurobiological consequences demonstrated an association between exposure to adversities and persistent alterations in the structure, function, and connectivity of the brain. Consistent evidence supports the idea that regulation of gene expression through epigenetic mechanisms are involved in embedding the impact of early-life experiences in the genome and mediate between social environments and later behavioral phenotypes. In addition, studies from rodent models and humans suggest that these experiences and the acquired risk factors can be transmitted through epigenetic mechanisms to offspring and the following generations potentially contributing to a cycle of disease or disease risk. However, one of the important aspects of epigenetic mechanisms, unlike genetic sequences that are fixed and unchangeable, is that although the epigenetic markings are long-lasting, they are nevertheless potentially reversible. In this review, we summarize our current understanding of the epigenetic mechanisms involved in the mental health consequences derived from early-life exposure to malnutrition, maltreatment and poverty, adversities with huge and pervasive impact on mental health. We also discuss the evidence about transgenerational epigenetic inheritance in mammals and experimental data suggesting that suitable social and pharmacological interventions could reverse adverse epigenetic modifications induced by early-life negative social experiences. In this regard, these studies must be accompanied by efforts to determine the causes that promote these adversities and that result in health inequity in the population.

Experimental study, simulation and technical-economic feasibility of an interesterification plant for hydrocarbons synthesis by using plastics and frying oil waste.

This work presents the experimental assessment of a 20 mL batch reactor's efficacy in converting plastic and oil residues into biofuels. The reactor, designed for ease of use, is heated using a metallic system. The experiments explore plastic solubilization at various temperatures and residence times, employing a mixture of distilled water and ethylene glycol as the solvent. Initial findings reveal that plastic solubilization requires a temperature of 350 °C with an ethylene glycol mole fraction of 0.35, whereas 250 °C suffices with a mole fraction of 0.58. Additionally, the study includes a process simulation of a plant utilizing a double fluidized bed gasifier and an economic evaluation of the interesterification/pyrolysis plant. Simulation results support project feasibility, estimating a total investment cost of approximately $12.99 million and annual operating expenses of around $17.98 million, with a projected payback period of about 5 years.