Nurse-delivered sleep restriction therapy to improve insomnia disorder in primary care: the HABIT RCT.

Background: Insomnia is a prevalent and distressing sleep disorder. Multicomponent cognitive-behavioural therapy is the recommended first-line treatment, but access remains extremely limited, particularly in primary care where insomnia is managed. One principal component of cognitive-behavioural therapy is a behavioural treatment called sleep restriction therapy, which could potentially be delivered as a brief single-component intervention by generalists in primary care. Objectives: The primary objective of the Health-professional Administered Brief Insomnia Therapy trial was to establish whether nurse-delivered sleep restriction therapy in primary care improves insomnia relative to sleep hygiene. Secondary objectives were to establish whether nurse-delivered sleep restriction therapy was cost-effective, and to undertake a process evaluation to understand intervention delivery, fidelity and acceptability. Design: Pragmatic, multicentre, individually randomised, parallel-group, superiority trial with embedded process evaluation. Setting: National Health Service general practice in three regions of England. Participants: Adults aged ≥ 18 years with insomnia disorder were randomised using a validated web-based randomisation programme. Interventions: Participants in the intervention group were offered a brief four-session nurse-delivered behavioural treatment involving two in-person sessions and two by phone. Participants were supported to follow a prescribed sleep schedule with the aim of restricting and standardising time in bed. Participants were also provided with a sleep hygiene leaflet. The control group received the same sleep hygiene leaflet by e-mail or post. There was no restriction on usual care. Main outcome measures: Outcomes were assessed at 3, 6 and 12 months. Participants were included in the primary analysis if they contributed at least one post-randomisation outcome. The primary end point was self-reported insomnia severity with the Insomnia Severity Index at 6 months. Secondary outcomes were health-related and sleep-related quality of life, depressive symptoms, work productivity and activity impairment, self-reported and actigraphy-defined sleep, and hypnotic medication use. Cost-effectiveness was evaluated using the incremental cost per quality-adjusted life-year. For the process evaluation, semistructured interviews were carried out with participants, nurses and practice managers or general practitioners. Due to the nature of the intervention, both participants and nurses were aware of group allocation. Results: We recruited 642 participants (n = 321 for sleep restriction therapy; n = 321 for sleep hygiene) between 29 August 2018 and 23 March 2020. Five hundred and eighty participants (90.3%) provided data at a minimum of one follow-up time point; 257 (80.1%) participants in the sleep restriction therapy arm and 291 (90.7%) participants in the sleep hygiene arm provided primary outcome data at 6 months. The estimated adjusted mean difference on the Insomnia Severity Index was -3.05 (95% confidence interval -3.83 to -2.28; p < 0.001, Cohen's d = -0.74), indicating that participants in the sleep restriction therapy arm [mean (standard deviation) Insomnia Severity Index = 10.9 (5.5)] reported lower insomnia severity compared to sleep hygiene [mean (standard deviation) Insomnia Severity Index = 13.9 (5.2)]. Large treatment effects were also found at 3 (d = -0.95) and 12 months (d = -0.72). Superiority of sleep restriction therapy over sleep hygiene was evident at 3, 6 and 12 months for self-reported sleep, mental health-related quality of life, depressive symptoms, work productivity impairment and sleep-related quality of life. Eight participants in each group experienced serious adverse events but none were judged to be related to the intervention. The incremental cost per quality-adjusted life-year gained was £2075.71, giving a 95.3% probability that the intervention is cost-effective at a cost-effectiveness threshold of £20,000. The process evaluation found that sleep restriction therapy was acceptable to both nurses and patients, and delivered with high fidelity. Limitations: While we recruited a clinical sample, 97% were of white ethnic background and 50% had a university degree, which may limit generalisability to the insomnia population in England. Conclusions: Brief nurse-delivered sleep restriction therapy in primary care is clinically effective for insomnia disorder, safe, and likely to be cost-effective. Future work: Future work should examine the place of sleep restriction therapy in the insomnia treatment pathway, assess generalisability across diverse primary care patients with insomnia, and consider additional methods to enhance patient engagement with treatment. Trial registration: This trial is registered as ISRCTN42499563. Funding: The award was funded by the National Institute of Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/84/01) and is published in full in Health Technology Assessment; Vol. 28, No. 36. See the NIHR Funding and Awards website for further award information.

Insomnia refers to problems with falling asleep or staying asleep, which affects 10% of the adult population. The recommended treatment for insomnia is a psychological treatment called cognitive­behavioural therapy. Research shows this to be a very effective and long-lasting treatment, but there are not enough trained therapists to support the large number of poor sleepers in the United Kingdom. We have developed a brief version of cognitive­behavioural therapy, called sleep restriction therapy, which involves supporting the patient to follow a new sleep­wake pattern. We carried out this study to see if sleep restriction therapy, given by nurses working in general practice, can improve insomnia and quality of life. We searched general practice records and invited people with insomnia to take part. Six hundred and forty-two participants were assigned, by chance, to either sleep restriction therapy or a comparison treatment, called sleep hygiene. Sleep restriction therapy involved meeting with a nurse on four occasions and following a prescribed sleep schedule. Sleep hygiene involved receiving a leaflet of sleep 'do's and dont's'. Those receiving sleep restriction therapy were also provided with the same sleep hygiene leaflet so that the difference between the two groups was whether or not they received nurse treatment. We measured sleep, quality of life, daytime functioning and use of sleep medication through questionnaires, before and after treatment. We calculated the cost to deliver the treatment, as well as the cost of other National Health Service treatments that participants accessed during the study. We also interviewed participants and nurses to understand their views of the treatment. We found that participants in the sleep restriction therapy group experienced greater reduction in their insomnia symptoms compared to sleep hygiene. They also experienced improved sleep, mental health, quality of life and work productivity. The two groups did not differ in their use of prescribed sleep medication. Our results suggest that the treatment is likely to represent good value for money for the National Health Service. Both nurses and participants considered the treatment to be acceptable and beneficial, and they suggested some potential refinements. The study shows that nurse-delivered sleep restriction therapy is likely to be a clinically effective approach to the treatment of insomnia, and good value for money for the National Health Service.

Cost-Benefit Analysis of the CT of the Face in the Evaluation of Traumatic Facial Fractures in an Appalachian Tri-state Geriatric Population.

OBJECTIVE: This study aimed to evaluate the cost vs. benefits of the CT face imaging study in the trauma workup of those over the age of 65. METHODS: We performed a retrospective chart review of 169 trauma patients in our trauma database aged 65 years or older who underwent a CT of the head, a CT of the face, or a CT of the head and CT of the face that resulted in findings of a facial fracture from 2017-2022. Injuries and the treatment they received were documented. If a patient underwent both a CT of the face and a CT of the head, then the author first viewed the CT of the head, documented any injury, and then recorded treatment based on the CT of the head. The CT of the face was then viewed, injuries were recorded, and treatment based on the CT of the face was documented. Statistical analysis was then performed using the paired T-test, McNemar test, and number needed to harm analysis. RESULTS: Of the 169 patients sampled, 159 underwent both CT of the head and the face. There were no patients who underwent a CT of the face exclusively, and only 10 patients underwent a CT of the head exclusively. Of the 159 that had both a CT of the head and the face, the average number of injuries noted on CT of the head + CT of the face vs. CT of the head was 2.42 vs. 1.36, P<.0.0001. The number needed to avoid missing a surgical facial fracture when only a CT of the head was obtained was 14.68. CONCLUSION: The risks of missing a surgical facial fracture outweigh the monetary, radiation, and patient-desired necessity benefits of only performing a CT of the head. A CT of the face should be included in the trauma workup for those over the age of 65 when facial fractures are suspected.

Cost-benefit analysis of 3D-printed vascular models in abdominal free flap breast reconstruction.

3D-printed vascular models can enhance flap harvesting efficiency in abdominal free flap breast reconstruction, reducing the use of operating room time. However, no economic analyses with respect to model use in this context have been conducted to date. As such, this study examines model cost-benefit tradeoffs for use in abdominal free flap breast reconstruction.

Estimating the cost of young stock mortality in livestock systems-An application to sheep farming in Ethiopia.

Introduction: In sub-Saharan Africa, pre-weaning young stock mortality (YSM) is in the order of 20 to 30% across most livestock species and production systems. High YSM has significant economic implications for livestock keepers, but few studies provide estimates of the "cost of YSM." This study explores a bio-economic herd modeling approach to estimate the "cost of YSM" at farming/livestock system level. Methods: The static zero-growth version of DYNMOD was used to calculate the annual physical and monetary output of a sheep flock consisting of 100 breeding females at different levels of lamb mortality. Production parameter values and prices were taken from recently published research. Calculations were carried out for values of lamb mortality decreasing from 30% to 0% in 5% intervals, with 20% representing the "baseline" YSM. Calculations were repeated for a "high" fertility scenario (100% vs. 59% parturition rate) to gauge the sensitivity of the cost of YSM to another parameter determining flock productivity. Results: The relation of revenue per head and YSM is close to linear over the range of analyzed YSM with 1% decrease in YSM resulting in an increase in revenue per animal of approximately 1%. At the higher fertility rate, the absolute cost of YSM to sheep farmers is higher while the relative increase in revenue per animal resulting from YSM reduction is lower. The estimated difference in revenue of the 100-ewe flock between the 20% and 0% lamb mortality scenarios (at baseline fertility) amounts to approximately USD 90 per additionally surviving lamb, which is far above its market value. Discussion: Reduced lamb mortality ultimately impacts flock revenue through increased sales of "mature" animals, which embody the value of a lamb plus the revenue/profit from raising it to marketable age/weight. The modeling results suggest that foregone profit is an important component of the systemic "cost of YSM." Consequently, expected profit per animal, in addition to its current market value, is essential for estimating the absolute cost of YSM at farming system level.

Adjuvant Therapy with Immune Checkpoint Inhibitors after Carbon Ion Radiotherapy for Mucosal Melanoma of the Head and Neck: A Case-Control Study.

The development of new treatment strategies to improve the prognosis of mucosal malignant melanoma of the head and neck (MMHN) after carbon ion radiotherapy (CIRT) is essential because of the risk of distant metastases. Therefore, our objective was to evaluate the outcomes of immune checkpoint inhibitor (ICI) treatment to justify its inclusion in the regimen after CIRT. Thirty-four patients who received CIRT as an initial treatment were included in the analysis and stratified into three groups: those who did not receive ICIs (Group A), those who received ICIs after recurrence or metastasis (Group B), and those who received ICIs as adjuvant therapy after CIRT (Group C). In total, 62% of the patients (n = 21) received ICIs. The 2-year local control and overall survival (OS) rates for all patients were 90.0% and 66.8%, respectively. The 2-year OS rates for patients in Groups A, B, and C were 50.8%, 66.7%, and 100%, respectively. No significant differences were observed between Groups A and B (p = 0.192) and Groups B and C (p = 0.112). However, a significant difference was confirmed between Groups A and C (p = 0.017). Adjuvant therapy following CIRT for MMHN may be a promising treatment modality that can extend patient survival.

Cost-benefit analysis of the National Immunization Program in Spain.

Broad benefits of vaccination programs are well acknowledged but difficult to measure, especially when considering all vaccines included in a National Immunization Program (NIP). The aim was to conduct a cost-benefit analysis of the entire NIP in Spain, and an expanded NIP including four potential additional programs. A cost-benefit analysis was performed in Excel to assess the economic and health benefits (€) of vaccinating a single cohort of newborns over a lifetime horizon compared to no vaccination, from a societal perspective: firstly, according to the 2020 NIP in Spain (including 2021 recommendation for herpes zoster in 65-year-olds); and secondly, with an expanded NIP (adding rotavirus and meningococcal B in infants, and pertussis booster in adults aged >65 years and herpes zoster in all adults >50 years). The main inputs were taken from published literature and Spanish databases. Results were presented as a benefit-cost ratio (economic benefit per €1 invested). A cohort of 343,126 newborns were included in the analysis. The total investment needed to vaccinate the cohort throughout their lifetime, according to the 2020 NIP and the expanded NIP, was estimated at €168.5 million and €275.5 million, respectively. Potential economic benefits were €772.2 million and €803.0 million, respectively. The societal benefit-cost ratio was €4.58 and €2.91 per €1 invested, respectively. Even with the addition of new vaccination programs, the Spanish NIP yielded positive benefit-cost ratios from the societal perspective, demonstrating that NIPs spanning the full life course are an efficient public health measure.

The costs, health and economic impact of air pollution control strategies: a systematic review.

BACKGROUND: Air pollution poses a significant threat to global public health. While broad mitigation policies exist, an understanding of the economic consequences, both in terms of health benefits and mitigation costs, remains lacking. This study systematically reviewed the existing economic implications of air pollution control strategies worldwide. METHODS: A predefined search strategy, without limitations on region or study design, was employed to search the PubMed, Scopus, Cochrane Library, Embase, Web of Science, and CEA registry databases for studies from their inception to November 2023 using keywords such as "cost-benefit analyses", "air pollution", and "particulate matter". Focus was placed on studies that specifically considered the health benefits of air pollution control strategies. The evidence was summarized by pollution control strategy and reported using principle economic evaluation measurements such as net benefits and benefit-cost ratios. RESULTS: The search yielded 104 studies that met the inclusion criteria. A total of 75, 21, and 8 studies assessed the costs and benefits of outdoor, indoor, and mixed control strategies, respectively, of which 54, 15, and 3 reported that the benefits of the control strategy exceeded the mitigation costs. Source reduction (n = 42) and end-of-pipe treatments (n = 15) were the most commonly employed pollution control methodologies. The association between particulate matter (PM) and mortality was the most widely assessed exposure-effect relationship and had the largest health gains (n = 42). A total of 32 studies employed a broader benefits framework, examining the impacts of air pollution control strategies on the environment, ecology, and society. Of these, 31 studies reported partially or entirely positive economic evidence. However, despite overwhelming evidence in support of these strategies, the studies also highlighted some policy flaws concerning equity, optimization, and uncertainty characterization. CONCLUSIONS: Nearly 70% of the reviewed studies reported that the economic benefits of implementing air pollution control strategies outweighed the relative costs. This was primarily due to the improved mortality and morbidity rates associated with lowering PM levels. In addition to health benefits, air pollution control strategies were also associated with other environmental and social benefits, strengthening the economic case for implementation. However, future air pollution control strategy designs will need to address some of the existing policy limitations.

Assessing the societal value of health lost to alcohol use in India compared to excise taxes on alcohol sales.

INTRODUCTION: We retrospectively studied the societal value of lost health due to alcohol use and compared it with excise taxes on alcohol sales for India in 2019. METHODS: We estimated the overall alcohol-attributable disease burden using disability-adjusted life-years (DALY) for India and its 30 states for all causes with alcohol use as a risk factor from the GBD 2019 Study. The societal value of lost health was calculated using value of life-year (VLY) approach by multiplying region-specific factors from 'Global Health 2035', 2019-2020 GDP per capita and DALYs. We acquired the national and state-level (top 10 states) alcohol sales excise taxes from the Reserve Bank of India. Net losses were assessed by subtracting the revenue collected from excise taxes from VLY. All values are in Indian rupees (INR). RESULTS: The societal value of health lost due to alcohol use in India was 6.2 (95% uncertainty interval 4.8, 7.8) trillion INR in 2019. The absolute state-level values varied from 7.3 (4.7, 10.4) billion INR in Mizoram to 1.1 (0.8, 1.4) trillion INR in Maharashtra. The per capita values ranged from 950.2 (642.9, 1285.3) INR for Bihar to 61,332 (39,273.7, 87,288.5) INR for Mizoram. Nationally, excise tax collection from alcohol sales was 1.8 trillion INR depicting a net loss of 4.4 (3.1, 6.0) trillion. Maharashtra had the largest absolute and per capita net loss. DISCUSSION AND CONCLUSIONS: These are novel estimates depicting the net losses due to alcohol use in India with direct policy implications to disincentivise sales and adequately raise taxes.

Identifying the optimal type and locations of natural water retention measures using spatial modeling and cost-benefit analysis.

Water management has shifted from solely technical and engineering approaches towards nature-based solutions (NBS), like natural water retention measures (NWRM), offering benefits beyond hydrology, such as improved well-being and biodiversity conservation. Determining the best type and location of these measures is challenging due to diverse options with varying benefits and effects depending on measure type and location characteristics. While most studies regarding the optimal allocation and implementation of NBS focus on the urban environment, this study presents a methodology for decision-makers focusing on inter-urban regions with limited data on NWRM implementation. Through hydrological modeling and cost-benefit analysis (CBA), we identify Pareto optimal NWRM sites and types, considering water quantity and quality alongside economic, environmental, and social objectives. We defined optimal locations that seek the most significant reduction of runoff, sediment, and pollutants, whilst optimal NWRM types are defined to seek the most cost-effective measures based on hydrological, ecological, and social criteria. Using the Open Non-point Source Pollution and Erosion Comparison Tool (OpenNSPECT), we simulated increased infiltration in different inter-urban areas and identified the optimal placement. The criteria for selecting suitable NWRM types for the identified areas are derived from the EU Directorate General for the Environment (DG-ENV) NWRM database. The results show different effective areas for reducing runoff, sediment, and pollutants. While one NWRM (natural bank stabilization) was identified as most beneficial for reducing sediment, several measures were selected for runoff reduction. Interestingly, measures with high potential for pollutant reduction seem to offer limited social and biodiversity benefits, suggesting conflicting objectives and highlighting the importance of accounting for multiple criteria. By employing simplified models and qualitative benefit assessments, this paper presents a practical decision-making approach to facilitate NWRM implementation in data-scarce areas.

Preventing Vertical Transmission of Chagas Disease: An Emerging Public Health Issue in Perinatal Care.

Chagas [shah-guhs] disease, caused by the Trypanosoma cruzi parasite, presents a growing concern for health care providers overseeing perinatal care in the United States due to existing and expanding vector-borne transmission and population migration. This life-threatening disease can be transmitted vertically during pregnancy, although adequate testing and treatment can effectively reduce morbidity and mortality caused by Chagas disease. This article presents an overview of the disease burden in the United States and its implications for perinatal care providers including recommended testing and treatment practices and the information needed for patient education and shared decision-making regarding the management of care for individuals at risk of Chagas disease. Being informed about Chagas disease and its implications is needed for all individuals providing perinatal care and is especially critical for those overseeing the care of refugee and immigrant populations.

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.

Economic evaluations of eHealth interventions targeting mental health problems in the workplace: a systematic review.

BACKGROUND: Work-related mental health problems impose significant economic and personal burdens. eHealth interventions may offer low-cost, practical solutions, but guidance on their cost-effectiveness in workplace mental health is limited. OBJECTIVE: The objective of this study was to systematically review economic evaluations of workplace eHealth interventions for mental health, offering insights into methodologies and cost-effectiveness outcomes. METHODS: Adhering to PRISMA guidelines, searches were conducted in Embase, MEDLINE, Web of Science, Google Scholar, Cochrane library, PsycInfo and EconLit databases in May 2022, selecting peer-reviewed papers that performed economic evaluations on workplace eHealth interventions for adult mental health. Quality was assessed using the Drummond checklist. RESULTS: From 3213 references, eight met the inclusion criteria. These studies varied in economic perspective, types of economic analysis type, primary outcome measures, intervention focus (e.g. stress, alcohol, insomnia & return-to-work) and direct non-medical costs. Five eHealth interventions were found to be cost-effective and/or have a positive return on investment, with seven studies rated as high quality according to the Drummond checklist. CONCLUSIONS: The study outcomes unveiled the potential cost-effectiveness of eHealth interventions targeting mental health issues, particularly these focusing on workplace stress. However, generalization is challenging due to variations in the methodologies across studies.

A Cost-Benefit Analysis of Alternative Management Strategies for Red Deer in Denmark.

In this paper, we conduct a cost-benefit analysis (CBA) of five alternative management strategies for red deer in Denmark: free harvest, trophy hunting, maximum harvest and two cases for natural demographic population compositions. To capture the outcome under each strategy we use a biological sex- and age-structured population model. The net benefit function includes meat values, recreational values, browsing damage costs and traffic damage costs and these values and costs are assumed to differ for the various sex and age classes of red deer. We show that the maximum harvest strategy leads to a reasonably high positive total net benefit, while the free harvest strategy yields a small positive net benefit. On the other hand, the trophy hunting strategy generates a high negative net benefit, while small negative net benefits are obtained under the two strategies for natural demographic population compositions.

Comparing Costs: Does Extreme Oncoplastic Breast-Conserving Surgery Confer a Cost Benefit When Compared with Mastectomy and Reconstruction?

INTRODUCTION: Extreme oncoplastic breast-conserving surgery (eOBCS) describes the application of OBCS to patients who would otherwise need a mastectomy, and its safety has been previously described. OBJECTIVE: We aimed to compare the costs of eOBCS and mastectomy. METHODS: We reviewed our institutional database to identify breast cancer patients treated surgically from 2018 to 2023. We included patients with a large disease span (≥5 cm) and multifocal/multicentric disease. Patients were grouped by their surgical approach, i.e. eOBCS or mastectomy. The direct costs of care were determined and compared; however, indirect costs were not included. RESULTS: Eighty-six patients met the inclusion criteria, 10 (11.6%) of whom underwent mastectomy and 76 (88.4%) who underwent eOBCS. Six mastectomy patients (60%) had reconstruction and 6 (60%) underwent external beam radiation therapy (EBRT). Reconstructions were completed in a staged fashion, and the mean cost of the index operation (mastectomy and tissue expander) was $17,816. These patients had one to three subsequent surgeries to complete their reconstruction, at a mean cost of $45,904. The mean cost of EBRT was $5542. Thirty-four eOBCS patients (44.7%) underwent 44 margin re-excisions, including 6 (7.9%) who underwent mastectomy. Sixty (78.9%) of the eOBCS patients had EBRT. The mean cost of their index operation was $6345; the mean cost of a re-excision was $3615; the mean cost of their mastectomies with reconstruction was $49,400; and the mean cost of EBRT was $6807. The cost of care for eOBCS patients remained lower than that for mastectomy patients, i.e. $17,318 versus $57,416. CONCLUSION: eOBCS is associated with a lower cost than mastectomy and had a low conversion rate to mastectomy.

A new look at the occupational fatigue challenge in the future of ergonomics research.

BACKGROUND: Due to the negative effects of occupational fatigue on health, absenteeism, and economic cost it is essential to control and manage its risk factors effectively. OBJECTIVE: This study seeks to draw researchers' attention to the research requirements concerning occupational fatigue. METHODS: The study briefly explores the consequences of occupational fatigue and discusses tools for its assessment. It then addresses the challenge of integrating risk factors and identifying efficient interventions. Lastly, it emphasizes the importance of addressing occupational fatigue related to new technologies. RESULTS: Wearable sensors, biomarkers in biological samples, and image processing are valuable tools for accurately assessing occupational fatigue. Artificial intelligence (AI) models can integrate multiple risk factors; while economic evaluations can help assess the effectiveness of control measures. Employers and researchers should be prepared to manage and monitor occupational fatigue resulting from interactions with new technologies. CONCLUSIONS: This commentary highlights the research gap in the field of occupational fatigue to better manage this phenomenon in today's evolving world.

Efficiency and Cost-Benefit Analysis of the Manual and Intelligent Venous Blood Sampling in Outpatient Area of Hospital.

To evaluate the efficiency and cost-benefit of the manual and intelligent venous blood sampling in outpatient area. The hospital selected had two branches with the outpatient area in Branch A using manual venous blood sampling as the control group and the outpatient area in Branch B using intelligent venous blood sampling as the experimental group. Analyze the differences between the two groups in operation time, cost-benefit, and service efficiency through on-site investigation and project cost methods. Compared with manual venous blood sampling, intelligent venous blood sampling project is more optimized with shorter operation time and higher nursing service efficiency. But both groups have negative returns. The intelligent venous blood sampling process is more optimized, combined with dynamic job implementation, resulting in lower labor costs and higher job service efficiency compared to manual venous blood sampling.

A systematic review of economic evaluations conducted on gender-transformative interventions aimed at preventing unintended pregnancy and promoting sexual health in adolescents.

AIMS: We synthesised the best-available evidence on economic evaluations of gender-transformative interventions that prevent unintended pregnancy and promote sexual-health in adolescents. We also assessed the methodological quality of the economic-evaluation studies and identified gaps in the economic-evaluation evidence. DESIGN: A systematic review (SR) of economic evaluations reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2020. DATA SOURCES: We searched the following bibliographic databases for economic evaluations that met our selection criteria; PubMed, Cochrane, National Health Service EE database, SCOPUS, CINHAL, Web of Science and Paediatric EE Database. We also conducted a grey literature search. We included articles published from January 1, 1990 to December 31, 2021, in English, including adolescents aged 10-19. Two independent reviewers conducted the title and full-text screening. DATA EXTRACTION AND SYNTHESIS: One reviewer conducted data extraction and quality assessment, which a second reviewer checked. We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement and Consensus on Health Economic Criteria (CHEC) checklist to measure the reporting and methodological quality. Synthesis was done narratively and using summary tables. RESULTS: Twenty-two studies were included, with 16 full and six partial economic evaluations. The quality of studies was moderate to high for most. The most reported outcomes were incremental cost-effectiveness ratio, costs per averted sexually transmitted infection, quality-adjusted life years saved per averted infection and costs per averted pregnancy. Most studies were cost-effective or cost-saving. CONCLUSIONS: Most of the economic evaluations are cost-effective. There is a scarcity of available economic evaluations for most existing gender-transformative interventions, with most included studies originating from high-income countries (HICs). There is a need to develop guidance specific to economic evaluations of gender-transformative interventions.

Carbon capture and utilisation (CCU) solutions: Assessing environmental, economic, and social impacts using a new integrated methodology.

Carbon Capture and Utilisation (CCU) technologies play a significant role in climate change mitigation, as these platforms aim to capture and convert CO2 that would be otherwise emitted into the atmosphere. Effective and economically sustainable technologies are crucial to support the transition to renewable and low-carbon energy sources by 2030 and beyond. Currently, studies exploring the financial viability of CCU technologies besides the joint analyses of life-cycle costs and environmental and social impacts are still limited. In this context, the study developed and validated an innovative and integrated methodology, called Life Cycle Cost and Sustainability Assessment (LCC-SA) which allows the joint assessment of (i) project life-cycle costs, (ii) socio-cultural and environmental externalities. This tool was validated with an application to an algal photobioreactors (PBRs) and allowed to assess the economic and environmental sustainability besides identifying the main critical issues to be addressed during the transition from pilot-scale plant to industrial application. The methodology's implementation estimated benefits in two main areas: (i) environmental, including CO2 removal and avoidance through biodiesel production instead of fossil-derived diesel; (ii) socio-cultural, encompassing new patents, knowledge spillovers, human capital formation, and knowledge outputs. The analysis returned as main result that the present value of the social externalities amounts to around EUR 550,000 and the present value of the costs to approximately EUR 60,000. The Economic Net Present Value (ENPV) is EUR 487,394, which shows the significance of the extra-financial effects generated by the research project. At full-scale application, environmental benefits include capturing 187 to 1867 tons of CO2 per year and avoiding 1.7 to 16.7 tons of CO2 annually through biodiesel production instead of fossil-derived diesel.

Abbott realtime MTB assay for detecting Mycobacterium tuberculosis complex in respiratory specimens: a cost-benefit analysis.

PURPOSE: Molecular screening for Mycobacterium tuberculosis (MTB) can lead to rapid empirical treatment inception and reduce hospitalization time and complementary diagnostic tests. However, in low-prevalence settings, the cost-benefit balance remains controversial due to the high cost. METHODS: We used a Markov model to perform an economic analysis to evaluate the profit after implementing molecular MTB screening (Period B) compared with conventional culture testing (Period A) in respiratory samples from 7,452 consecutive subjects with presumed tuberculosis (TB). RESULTS: The proportion of positivity was comparable between both periods (P > 0.05), with a total of 2.16 and 1.78 samples/patient requested in periods A and B, respectively (P < 0.001). The mean length of hospital stay was 8.66 days (95%CI: 7.63-9.70) in Period B and 11.51 days (95%CI: 10.15-12.87) in Period A (P = 0.001). The healthcare costs associated with diagnosing patients with presumed TB were reduced by €717.95 per patient with PCR screening. The probability of remaining hospitalized and the need for a greater number of outpatient specialty care visits were the variables with the most weight in the model. CONCLUSION: Employing PCR as an MTB screening method in a low-prevalence setting may increase the profits to the system.