Exploring the influencing factors of scrub typhus in Gannan region, China, based on spatial regression modelling and geographical detector.

Scrub typhus is a significant public health issue with a wide distribution and is influenced by various determinants. However, in order to effectively eradicate scrub typhus, it is crucial to identify the specific factors that contribute to its incidence at a detailed level. Therefore, the objective of our study is to identify these influencing factors, examine the spatial variations in incidence, and analyze the interplay of two factors on scrub typhus incidence, so as to provide valuable experience for the prevention and treatment of scrub typhus in Gannan and to alleviate the economic burden of the local population.This study employed spatial autocorrelation analyses to examine the dependent variable and ordinary least squares model residuals. Additionally, spatial regression modelling and geographical detector were used to analyze the factors influencing the annual mean 14-year incidence of scrub typhus in the streets/townships of Gannan region from 2008 to 2021. The results of spatial1 autocorrelation analyses indicated the presence of spatial correlation. Among the global spatial regression models, the spatial lag model was found to be the best fitting model (log likelihood ratio = -319.3029, AIC = 666.6059). The results from the SLM analysis indicated that DEM, mean temperature, and mean wind speed were the primary factors influencing the occurrence of scrub typhus. For the local spatial regression models, the multiscale geographically weighted regression was determined to be the best fitting model (adjusted R2 = 0.443, AICc = 726.489). Further analysis using the MGWR model revealed that DEM had a greater impact in Xinfeng and Longnan, while the southern region was found to be more susceptible to scrub typhus due to mean wind speed. The geographical detector results revealed that the incidence of scrub typhus was primarily influenced by annual average normalized difference vegetation index. Additionally, the interaction between GDP and the percentage of grassland area had a significant impact on the incidence of scrub typhus (q = 0.357). This study illustrated the individual and interactive effects of natural environmental factors and socio-economic factors on the incidence of scrub typhus; and elucidated the specific factors affecting the incidence of scrub typhus in various streets/townships. The findings of this study can be used to develop effective interventions for the prevention and control of scrub typhus.

Combining slow-release fertilizer and plastic film mulching reduced the carbon footprint and enhanced maize yield on the Loess Plateau.

Agricultural practices significantly contribute to greenhouse gas (GHG) emissions, necessitating cleaner production technologies to reduce environmental pressure and achieve sustainable maize production. Plastic film mulching is commonly used in the Loess Plateau region. Incorporating slow-release fertilizers as a replacement for urea within this practice can reduce nitrogen losses and enhance crop productivity. Combining these techniques represents a novel agricultural approach in semi-arid areas. However, the impact of this integration on soil carbon storage (SOCS), carbon footprint (CF), and economic benefits has received limited research attention. Therefore, we conducted an eight-year study (2015-2022) in the semi-arid northwestern region to quantify the effects of four treatments [urea supplied without plastic film mulching (CK-U), slow-release fertilizer supplied without plastic film mulching (CK-S), urea supplied with plastic film mulching (PM-U), and slow-release fertilizer supplied with plastic film mulching (PM-S)] on soil fertility, economic and environmental benefits. The results revealed that nitrogen fertilizer was the primary contributor to total GHG emissions (≥71.97%). Compared to other treatments, PM-S increased average grain yield by 12.01%-37.89%, water use efficiency by 9.19%-23.33%, nitrogen accumulation by 27.07%-66.19%, and net return by 6.21%-29.57%. Furthermore, PM-S decreased CF by 12.87%-44.31% and CF per net return by 14.25%-41.16%. After eight years, PM-S increased SOCS (0-40 cm) by 2.46%, while PM-U decreased it by 7.09%. These findings highlight the positive effects of PM-S on surface soil fertility, economic gains, and environmental benefits in spring maize production on the Loess Plateau, underscoring its potential for widespread adoption and application.

Trends in Lower-Risk Gambling by Age and Net Income among Finnish Men and Women in 2011, 2015, and 2019.

Lower-risk Gambling Guidelines (LRGGs) were developed in Canada to reduce the risk of gambling-related harm. The LRGGs, published in 2021, consist of three limits: gamble no more than 1% of household income per month; gamble no more than four days per month; and avoid regularly gambling at more than two types of games. All three limits should be followed at the same time. This study focuses on the situation in Finland before the LRGGs were published. The aim of this study is to investigate trends in lower-risk gambling by age and net income among men and women in the Finnish adult population in 2011, 2015, and 2019. Data were drawn from cross-sectional Finnish Gambling population surveys, including permanent residents in Mainland Finland aged 15-74 with Finnish, Swedish or Sámi as their mother tongue (2011; n = 4,484, 2015; n = 4,515, and 2019; n = 3,994). The results showed an increase in the prevalence of lower-risk gambling, rising from 29% in 2011 to 39% in 2019. This upward trend was observed among both men and women, with the prevalence among men increasing from 23 to 33%, and among women from 34 to 45%. The lowest prevalence of lower-risk gambling was found among individuals aged 60-74, especially regarding expenditure guidelines, as well as among women in the lowest income tertile. In conclusion, although the prevalence of lower-risk gambling has increased in Finland, there is still potential for further improvement to minimize harm.

Mediterranean Diet Adherence in Italian Children: How much do Demographic Factors and Socio-Economic Status Matter?

OBJECTIVES: . This cross-sectional study aimed to evaluate the degree of children's adherence to the Mediterranean Diet (MD), to estimate the weekly cost of MD, and to assess the role of food cost and demographic/socio-economic factors as potential barriers to comply with a healthy dietary model. METHODS: . Data collection was conducted through an online questionnaire sent to parents of children (6-11 years old) living in Italy. This survey allowed the collection of demographic/socio-economic information about the family and their dietary habits. Adherence to the MD in children was assessed through the KIDMED index. The weekly diet cost was calculated based on the food prices of two Italian supermarket chains. Descriptive statistics and inferential tests were run to evaluate the sample's characteristics and correlations between diet cost, socio-demographics, and adherence to MD. RESULTS: . Data highlighted that 31.5% of the children achieved high compliance with the MD, whereas 22.2% showed low adherence. The average diet cost increased significantly with the increasing level of adherence to the MD (Spearman's Rho = 0.322, p = 0.018). Moreover, results showed that a high parent educational level was positively associated with the KIDMED score (Spearman's Rho = 0.323, p = 0.017). No significant correlations were found between dietary cost and other characteristics such as economic status and house type. CONCLUSIONS FOR PRACTICE: . Despite the small sample size, our results suggest that nutrition education interventions targeted at children and their parents/caregivers might favour more conscious dietary choices, which in turn will help reduce the differences in diet quality caused by the educational level gaps existing in families.

Medical Costs and Caregiver Burden of Delivering Disease-Modifying Alzheimer's Treatments with Different Duration and Route of Administration.

BACKGROUND: Multiple disease modifying treatment for Alzheimer's disease are currently in clinical development or have been recently approved for use. They have vastly different treatment properties but so far, little work has been done to quantify the impact of treatment properties on the treatment's value in terms of medical and social care costs and caregiver burden. OBJECTIVES: This study aims to analyze how the mode of treatment administration, treatment frequency and duration, and monitoring requirements affect the value of disease modifying treatments. In order to isolate these effects, we compare five hypothetical disease modifying treatments with equal efficacy and safety: (1) chronic bi-weekly intravenous infusion, (2) chronic four-weekly intravenous infusion, (3) 52 weeks fixed duration four-weekly intravenous infusion, (4) chronic subcutaneous injections, and (5) chronic oral prescription on their direct medical costs, caregiver burden, and preservation of treatment value. DESIGN: Survey of Alzheimer's disease treatment clinics and retrospective data analysis. SETTING: United States. MEASUREMENTS: Direct medical cost and caregiver burden of treatment administration and monitoring compared to gross treatment benefit. RESULTS: Chronic bi-weekly infusion treatment had the highest direct medical cost ($45,208) and caregiver burden ($6,095), reducing the treatment value by 44%, while oral treatment with the lowest direct medical cost ($1,983) and caregiver burden ($457) reduced the treatment value by only 2%. Substantial caregiver burden was reported from the survey, with a reported average of 2.3 hours for an office visit and infusion, 44 minutes of round-trip travel time, and 78% of patients being accompanied by a caregiver for treatment. CONCLUSION: Burden of chronic intravenous treatments exceed the gross medical and social care cost savings and value of caregiver benefit. The results suggest the need for less complex treatments that require fewer clinic visits to preserve the economic value of disease modifying treatments.

Who should be screened for colorectal cancer and how can it be prevented more effectively?

In this editorial, we comment on the article published by Agatsuma et al in a recent issue of the World J Gastroenterol (2024; 30: 1368-1376). We firmly concur with Agatsuma et al regarding the vital significance of colorectal cancer (CRC) screening as a public health strategy to diminish disease burden. Individuals exposed to risk factors for CRC, those with comorbid conditions, and those with limited health literacy should undergo screening. However, we believe that more regular screenings should be accompanied by a greater focus on primary prevention (PP) of CRC. CRC remains a significant global health challenge, and its incidence is strongly linked to age, lifestyle, and socioeconomic factors. It is particularly noteworthy that the majority of CRC patients are diagnosed outside of established screening pathways and frequently at an advanced stage of the disease, and the majority of patients possess inadequate or even nonexistent knowledge regarding CRC, which significantly impacts the prognosis and imposes a substantial economic burden. This study revealed that CRC identified during hospital visits for comorbid conditions was typically diagnosed at an earlier stage than detected via symptomatic pathways. Remarkably, early incidental detection of CRC aligns closely with the timing of discovery through routine cancer screenings. This suggests that by adopting more inclusive screening protocols that combine opportunistic testing with traditional screening methods, health care systems can create a more comprehensive safety net for individuals at risk of CRC. However, before maximizing the health benefits of screening programs, it is essential to make additional efforts prior to screening, such as raising awareness via public education, risk assessment, and personalized recommendations, enhancing the knowledge and skills of health care professionals, optimizing the accessibility and convenience of screening processes, ensuring the quality and safety of screening services, strengthening follow-up and support systems, and providing policy support and financial investment. The establishment of a comprehensive screening system often requires substantial investment in human, material, and financial resources, which can be challenging to achieve in regions with limited health care resources. Strengthening PP strategies can reduce the disease burden by targeting the cause, representing a more cost-effective and impactful approach. Establishing a comprehensive cancer PP service platform that integrates authoritative public education on malignant tumor PP, individualized malignant tumor risk assessment, and self-health management assistance accessible to the entire population will significantly enhance the overall effectiveness of CRC PP strategies.

Individual cognitive empowerment and in-role performance: a matched-pair study.

The study examines the model fit of individual cognitive empowerment, which includes psychological and environmental factors, and investigates the direct effect of environmental empowerment specifically work methods, work criteria, and work schedules on in-role performance in Malaysia's Electrical and Electronic (E&E) manufacturing firms. Data were obtained from 173 engineers and 173 managers, matched in pairs, who have worked together for at least 1 year in 73 E&E manufacturing firms. The study found that the model fit of psychological and environmental factors is stronger for individual cognitive empowerment. Work methods show a positive direct effect on in-role performance. However, work schedules and work criteria do not appear to have a direct effect on in-role performance. This study highlights the importance of considering work methods in the engagement between engineer and manager pairs in the E&E manufacturing sector to enhance in-role performance.

Like a fire brigade, but without pay - Experiences of temporary employment among workers in Swedish elder care.

This study investigates experiences of temporary work among care personnel in elder care. Semi-structured interviews were performed with fifteen temporarily employed care personnel in municipal nursing homes or home care and analysed using phenomenography. The informants' experiences of having temporary employment were characterised by either a sense of flexibility or, more commonly, uncertainty, lack of control over life, time and economic situation, as well as difficulties associated with always being available. The informants' experiences of working as temporary employees were characterised by the enjoyment of work and job satisfaction, differing experiences regarding the division of work and communication, but also being in an exposed position. The results reflect an experience of being in a vulnerable position. Taking these results into consideration in developing interventions to enhance the working conditions for temporarily employed might as a secondary result decrease the turnover and increase the continuity of the care for the elder.

Can Australian plantation forest carbon offset methods increase carbon storage and timber supply? A case study from the Green Triangle plantation forestry region in Australia.

The plantation forestry estate in Australia has been in decline for a decade or more. Previous studies attribute observed investment inertia to factors including the long-term nature of forestry investments, high up front establishment cost and more recently water resource constraints. The introduction of plantation forestry methods as part of the Australian Carbon Credit Unit Scheme in 2017 has generated renewed interest in plantation forestry as a carbon abatement option. To assess this opportunity, we performed high spatial resolution bioeconomic modelling of southeastern Australia's Green Triangle forestry region to understand the joint influence of site productivity, species selection and spatially variable costs including agricultural land prices and transport distances on land use change and additional future timber flows. We found that additional plantations may be economically viable at a carbon price of AU$39/t CO2e. New softwood (P. radiata) plantations provide the lowest cost option across the region when compared to hardwood (E. globulus). However, at carbon prices below AU$50/t CO2e comparatively little technically feasible abatement is possible for both plantation species with only 632,000 t CO2e from hardwood and 12.9 Mt CO2e, from softwood under economically optimised conditions which equates to 0.13 and 2.5 percent of Australia's 2023 emissions respectively. We found however that this may translate to significant additional timber flows for the region's processing industry even at lower carbon prices. We estimated an additional 62,600 green metric tonnes of hardwood (1 percent of annual Australian plantation hardwood harvest) and 6.6 million m3 of cumulative softwood (44 percent supply of annual Australian plantation softwood harvest) over a 50-year period at AU$40/t CO2e. However, the results were found to be sensitive to discount rate assumptions. The discussion focuses on the economic and policy factors that may enable/limit the use of carbon markets to expand the Australian plantation forestry estate.

The economic burden of recurrence in elderly patients with completely resected, stage IIB/IIC or III melanoma: an analysis of the Surveillance, Epidemiology, and End Results-Medicare linked database.

AIMS: To compare healthcare resource utilization (HRU) and costs between patients with or without melanoma recurrence and between patients with distant or locoregional melanoma recurrence. METHODS: Patients aged ≥65 years with completely resected, stage IIB/IIC or III melanoma were identified from Surveillance, Epidemiology, and End Results-Medicare data and stratified based on whether they experienced a recurrence, and whether it was distant or locoregional (separately for each stage). The index date was the date of recurrence (recurrence group) or a randomly assigned date (non-recurrence group). Patients in the recurrence and non-recurrence groups were propensity score-matched 1:1 based on patient characteristics; HRU and healthcare costs were compared between the 2 groups and between patients with distant or locoregional recurrence during the ≤24 months following index. RESULTS: After matching, 507 pairs of patients with recurrent or non-recurrent stage IIB/IIC melanoma (236 patients with distant recurrence, 271 with locoregional) and 141 pairs of patients with recurrent or non-recurrent stage III melanoma (50 patients with distant recurrence, 91 with locoregional) were included. During the first year following recurrence, unadjusted HRU was generally higher in patients with versus without recurrence and patients with distant versus locoregional recurrence among both stage IIB/IIC and III cohorts. Patients who experienced recurrence incurred $6,474 (stage IIB/IIC) or $6,112 (stage III) per patient per month (PPPM) more in unadjusted, all-cause, total healthcare costs than patients without recurrence (both p < 0.001). Patients with distant recurrence incurred $7,292 (stage IIB/IIC) or $5,436 (stage III) PPPM more in unadjusted, all-cause, total healthcare costs than patients with locoregional recurrence (both p < 0.05). LIMITATIONS: Melanoma recurrence was identified using a claims-based algorithm. CONCLUSIONS: Economic burden is higher in patients with versus without melanoma recurrence and patients with distant versus locoregional recurrence. There is a high unmet need for adjuvant therapies that may help to prevent or delay recurrence.

The Implications of Sanctions on Civilian Mental Health and Quality of life Iranian: An overview.

BACKGROUND: The Islamic Republic of Iran has been under sanctions since 1979. These sanctions were further reinforced between the years 2005 and 2012. This study utilizes available data from Iran post-sanctions to review the impact of economic sanctions on both the mental health and the quality of life of Iranian citizens. METHODS: A comprehensive scoping review was conducted to identify studies examining the impact of sanctions on health in Iran. Searches were initiated in 2012 using PubMed/Medline, Embase, Web of Science, Scopus, and the Scientific Information Database (Iranian Database) with keywords such as sanctions, implications, mental health, quality of life, civilian mental health, and Iran. Subsequent to the screening process, secondary reports and letters to the editor were excluded. Only original studies-those collecting data via observation, interviews, surveys, experiments, or literature reviews-were retained for analysis. In addition to these search strategies, reference scanning was undertaken to identify additional articles pertinent to the scope of the current study. This thorough approach facilitated the discovery of relevant and significant articles exploring the effects of sanctions against Iran on the mental health and overall well-being of its civilian population. Following the search, duplicate articles were meticulously identified and removed by the authors. Data were subsequently extracted and summarized, focusing on study characteristics and the observed effects of sanctions on civilian mental health and quality of life in Iran. RESULT: Out of 165 items identified in the preliminary search, ten articles met the inclusion criteria. These selected articles highlighted the pronounced effects of sanctions on various health-related domains. CONCLUSION: Since 2012, Iran has been subject to intensified sanctions. There is evidence to suggest that the economic sanctions, imposed by Western nations, and have exerted a negative and detrimental impact on the health of individual Iranians.

Inclusion of phase III clinical trial costs in health economic evaluations.

INTRODUCTION: Protocol-driven trial activities contribute to the utility gain demonstrated in the phase III clinical trial of a new drug. If this utility gain cannot be distinguished from the effects of the new drug itself, protocol-driven trial costs cannot be easily dismissed for consistency reasons. This study aims to estimate the impact of including per-patient costs of phase III clinical trials on the incremental cost-effectiveness ratio (ICER). METHODS: The analysis utilized a modeling approach with secondary data from an ad-hoc literature review, considering both societal and payer perspectives. While the costs of phase III clinical trials may cancel out during the period of "normal" life-years due to the incremental cost calculation, they do not cancel out when differential early treatment termination occurs (e.g., due to differential mortality). Assuming the presence of differential mortality, per-patient phase III trial costs were calculated for the period of added life-years. These costs were then included in the ICER of a new drug, under the assumption that direct patient-related costs constitute 30-70% of the total trial costs. Capital costs were also incorporated from a societal perspective. RESULTS: Based on assumptions of $40,000 out-of-pocket expenses per patient enrolled in a phase III trial and a life expectancy gain of three months, incremental costs increased by $27,000 from a societal perspective. From a payer perspective, the estimate was $12,000. CONCLUSIONS: The costs of phase III trials are a relevant component of the ICER, and excluding it is generally not appropriate for consistency reasons. Properly considering these trial costs is essential for a comprehensive evaluation of a new drug's cost-effectiveness.

Bounded risk disposition explains Turing patterns and tipping points during spatial contagions.

Spatial contagions, such as pandemics, opinion polarization, infodemics and civil unrest, exhibit non-trivial spatio-temporal patterns and dynamics driven by complex human behaviours and population mobility. Here, we propose a concise generic framework to model different contagion types within a suitably defined contagion vulnerability space. This space comprises risk disposition, considered in terms of bounded risk aversion and adaptive responsiveness and a generalized susceptibility acquisition. We show that resultant geospatial contagion configurations follow intricate Turing patterns observed in reaction-diffusion systems. Pattern formation is shown to be highly sensitive to changes in underlying vulnerability parameters. The identified critical regimes (tipping points) imply that slight changes in susceptibility acquisition and perceived local risks can significantly alter the population flow and resultant contagion patterns. We examine several case studies using Australian datasets (COVID-19 pandemic; crime incidence; conflict exposure during COVID-19 protests; real estate businesses and residential building approvals) and demonstrate that these spatial contagions generated Turing patterns in accordance with the proposed model.

Cost of Using Laser Powder Bed Fusion to Fabricate a Molten Salt-to-Supercritial Carbon Dioxide Heat Exchanger for Concentrating Solar Power.

Advances in manufacturing technologies and materials are crucial to the commercial deployment of energy technologies. We present the case of concentrating solar power (CSP) with molten salt (MS) thermal storage, where low-cost, high-efficiency heat exchangers (HXs) are needed to achieve cost competitiveness. The materials required to tolerate the extreme operating conditions in CSP systems make it difficult or infeasible to produce them using conventional manufacturing processes. Although it is technically possible to produce HXs with adequate performance using additive manufacturing, specifically laser powder bed fusion (LPBF), here we assess whether doing so is cost-effective. We describe a process-based cost model (PBCM) to estimate the cost of fabricating a MS-to-supercritical carbon dioxide HX using LPBF. The PBCM is designed to identify modifications to designs, process choices, and manufacturing innovations that have the greatest effect on manufacturing cost. Our PBCM identified HX design and LPBF process modifications that reduced projected HX cost from $750 per kilo-Watt thermal (kW-th) ($8/cm3) to $350/kW-th ($6/cm3) using currently available LPBF technology, and down to $220/kW-th ($4/cm3) with improvements in LPBF technology that are likely to be achieved in the near term. The PBCM also informed a redesign of the HX design that reduced projected costs to $140-160/kW-th ($3/cm3).

A critical review of health and financial implications of obesity during the COVID-19 pandemic.

The COVID-19 was reported in Wuhan, China, in December 2019. There is a link between increased mortality and obese individuals with the disease. The disease has been claimed to have disproportionately affected non-Hispanic blacks and Hispanics. The rise in food accessibility and the drop in the relative cost of junk food items are the two most significant changes in dietary patterns. Around the world, 2.8 million people die from being overweight or obese, and those with more body fat also have a higher risk of diabetes (44%) and heart disease (23%). Obesity weakens the immune system because adipose cells infiltrate the bone marrow, spleen, and thymus. Obesity was substantially more common among COVID-19 patients who were hospitalized than those who were not hospitalized. Over 900 000 adults in the United States are hospitalized due to a COVID-19 infection. Hospitalizations in 271 700 (30.2%) cases have been attributed to obesity. Obese patients may be experiencing reduced thoracic expansion following bariatric surgery. Less tracheal collapse and air-trapping at end-expiration chest computed tomography (CT) were observed post-surgery, and patients reported reduced dyspnea. COVID-19 is estimated to cost the European Union €13.9 billion in secondary care, with 76% of that cost attributed to treatment for overweight and obese individuals. The average price per hospitalized patient also increased with increasing BMI. Screening for obesity, preventive measures, and recommendations for healthy lifestyle changes should be of the utmost importance to decrease both the health and financial implications of COVID-19.

Socio-economic factors and rural-urban differences in patients undergoing emergency laparotomy.

Background: Emergency laparotomy (EL) is a common surgical procedure with high rates of mortality and complications. Socio-economic circumstances and regional differences have an influence on the utilization of care and outcomes in many diagnostic groups, but there are only a few studies focusing on their effect in EL population. The aim of this study was to examine the socio-economic and regional differences in the rate of EL within one tertiary care hospital district. Methods: Retrospective single-center study of 573 patients who underwent EL in Oulu University Hospital between May 2015 and December 2017. The postal code area of each patient's home address was used to determine the socio-economic status and rurality of the location of residence. Results: The age-adjusted rate of EL was higher in patients from low-income areas compared to patients from high-income areas [1.46 ((95% CI 1.27-1.64)) vs. 1.15 (95% CI, 0.96-1.34)]. The rate of EL was higher in rural areas compared to urban areas [1.29 (95% CI 1.17-1.41 vs. 1.42 (1.18-1.67)]. Peritonitis was more common in patients living in low-income areas. There were no differences in operation types or mortality between the groups. Conclusions: The study findings suggest that there are socio-economic and regional differences in the need of EL. The patients living in low-income areas had a higher rate of EL and a higher rate of peritonitis. These differences cannot be explained by patient demographics or comorbidities alone.

Economic estimates of invasive wild ungulate damage to livestock producers in Hawai'i.

BACKGROUND: Invasive ungulates (hoofed mammals), including deer, feral pigs, feral goats, and feral sheep, are known to cause damage to agriculture, property, natural resources, and many other commodities. Most of the information regarding the economic impacts of wild ungulates is from North America, where some of these species are native. To evaluate invasive ungulate damage to livestock producers in the Hawaiian Islands, which have no native ungulates, a survey was distributed to livestock producers across the state. RESULTS: Survey results described how total annual costs are distributed among damage, control, and repairs for survey respondents, who represented a significant percentage of total ranchland acreage across the islands. The estimates, excluding fixed fence installation, revealed an annual cost to livestock producers who responded to the survey of US$1.42 million, which ranged from $3.6 million to $7.5 million when extrapolated to the entire state. The large cost contributors included damage to property, pastureland repair, control costs (excluding fencing), supplemental feed, and predation of calves by wild pigs. Additionally, producers reported spending more than $2 million in upfront fence installation costs. Most of these costs were reported by respondents on the islands of Hawai'i and Moloka'i. CONCLUSION: Study results revealed substantial damage to state livestock producers due to wild ungulates and are useful in determining an invasive ungulate management strategy that can appropriately aid the most impacted sectors of Hawai'i. © 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Hemophilia A: Economic burden, therapeutic advances, and future forecasts in the Middle East and North Africa region.

Hemophilia A, a severe hereditary hemorrhagic disorder characterized by a deficiency in blood clotting factors, imposes a significant economic burden on individuals, healthcare systems, and society, with inhibitors exacerbating the socioeconomic impact. The detrimental impact on the quality of life for patients and caregivers, including functional limitations, is particularly pronounced during bleeding episodes and in the presence of inhibitors. The increasing prevalence of Hemophilia A across the MENA region is evident, marked by the approval of various therapies and intensified research and development efforts focusing on treatment innovations. Despite commendable progress in Hemophilia management, challenges persist in providing care for Hemophilia patients in the region. This review aims to shed light on the current landscape, challenges, and market forecasts for Hemophilia A in the MENA region. Additionally, it strives to provide valuable insights for the future, emphasizing the need for clear approaches to ensure comprehensive care for individuals with Hemophilia.

The effect of two speech and language approaches on speech problems in people with Parkinson's disease: the PD COMM RCT.

Background: Speech impairments are common with Parkinson's disease (reported prevalence 68%), increasing conversational demands, reliance on family and social withdrawal. Objective(s): The PD COMM trial compared the clinical and cost-effectiveness of two speech and language therapy approaches: Lee Silverman Voice Treatment LOUD and National Health Service speech and language therapy for the treatment of speech or voice problems in people with Parkinson's disease to no speech and language therapy (control) and against each other. Design: PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Participants were randomised in a 1 : 1 : 1 ratio to control, National Health Service speech and language therapy or Lee Silverman Voice Treatment LOUD via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Mixed-methods process and health economic evaluations were conducted. Setting: United Kingdom outpatient and home settings. Participants: People with idiopathic Parkinson's disease, with self-reported or carer-reported speech or voice problems. We excluded people with dementia, laryngeal pathology and those within 24 months of previous speech and language therapy. Interventions: The Lee Silverman Voice Treatment LOUD intervention included maximum effort drills and high-effort speech production tasks delivered over four 50-minute therapist-led personalised sessions per week, for 4 weeks with prescribed daily home practice. National Health Service speech and language therapy content and dosage reflected local non-Lee Silverman Voice Treatment speech and language therapy practices, usually 1 hour, once weekly, for 6 weeks. Trained, experienced speech and language therapists or assistants provided interventions. The control was no speech and language therapy until the trial was completed. Main outcome measures: Primary outcome: Voice Handicap Index total score at 3 months. Secondary outcomes: Voice Handicap Index subscales, Parkinson's Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5L; ICEpop Capabilities Measure for Older Adults; Parkinson's Disease Questionnaire - Carers; resource utilisation; and adverse events. Assessments were completed pre-randomisation and at 3, 6 and 12 months post randomisation. Results: Three hundred and eighty-eight participants were randomised to Lee Silverman Voice Treatment LOUD (n = 130), National Health Service speech and language therapy (n = 129) and control (n = 129). The impact of voice problems at 3 months after randomisation was lower for Lee Silverman Voice Treatment LOUD participants than control [-8.0 (99% confidence interval: -13.3, -2.6); p = 0.001]. There was no evidence of improvement for those with access to National Health Service speech and language therapy when compared to control [1.7 (99% confidence interval: -3.8, 7.1); p = 0.4]. Participants randomised to Lee Silverman Voice Treatment LOUD reported a lower impact of their voice problems than participants randomised to National Health Service speech and language therapy [99% confidence interval: -9.6 (-14.9, -4.4); p < 0.0001]. There were no reports of serious adverse events. Staff were confident with the trial interventions; a range of patient and therapist enablers of implementing Lee Silverman Voice Treatment LOUD were identified. The economic evaluation results suggested Lee Silverman Voice Treatment LOUD was more expensive and more effective than control or National Health Service speech and language therapy but was not cost-effective with incremental cost-effectiveness ratios of £197,772 per quality-adjusted life-year gained and £77,017 per quality-adjusted life-year gained, respectively. Limitations: The number of participants recruited to the trial did not meet the pre-specified power. Conclusions: People that had access to Lee Silverman Voice Treatment LOUD described a significantly greater reduction in the impact of their Parkinson's disease-related speech problems 3 months after randomisation compared to people that had no speech and language therapy. There was no evidence of a difference between National Health Service speech and language therapy and those that received no speech and language therapy. Lee Silverman Voice Treatment LOUD resulted in a significantly lower impact of voice problems compared to National Health Service speech and language therapy 3 months after randomisation which was still present after 12 months; however, Lee Silverman Voice Treatment LOUD was not found to be cost-effective. Future work: Implementing Lee Silverman Voice Treatment LOUD in the National Health Service and identifying alternatives to Lee Silverman Voice Treatment LOUD for those who cannot tolerate it. Investigation of less costly alternative options for Lee Silverman Voice Treatment delivery require investigation, with economic evaluation using a preference-based outcome measure that captures improvement in communication. Study registration: This study is registered as ISRCTN12421382. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 10/135/02) and is published in full in Health Technology Assessment; Vol. 28, No. 58. See the NIHR Funding and Awards website for further award information.

Most people with Parkinson's disease develop difficulties with their speech and voice. Communicating becomes difficult. This affects their relationships, work, social life and how they feel about themselves. Our PD COMM trial compared two types of speech and language therapy to find out if they helped the speech and voice problems people with Parkinson's have. We measured changes in the way their voice and speech problems affected their lives and how much therapy cost the National Health Service and families. Everyone taking part had speech or voice problems because of their Parkinson's disease. People could not take part if they had dementia, evidence of laryngeal pathology or previous laryngeal surgery or received speech and therapy for Parkinson's disease in the last 2 years. People who agreed to take part joined one of three groups, which were alike except for the therapy they received. A computer decided which group they joined by chance. National Health Service speech and language therapy Lee Silverman Voice Treatment LOUD No speech and language therapy for 12 months The 388 people who took part came from 41 outpatient clinics in Scotland, England and Wales. Most were older men. The people that received Lee Silverman Voice Treatment LOUD felt better about their speech and voice after 3 months compared to people in the other groups. A year later, they still felt better about it. People that received National Health Service therapy had no benefit compared to people with no access to therapy. Analysis of cost-effectiveness indicated that Lee Silverman Voice Treatment LOUD did not offer value for money and the intervention cost more because more speech and language therapy time was needed to deliver it. Our next question is to ask how we can provide Lee Silverman Voice Treatment LOUD in a way that costs less, for example, using therapy assistants and computer packages or at home. Clear speech and language therapy approaches for people with Parkinson's disease and speech or voice problems should be tested in trials that measure changes in people's lives.

Preventive drug treatments for adults with chronic migraine: a systematic review with economic modelling.

Background: Chronic migraine is a disabling condition, affecting 2-4% of adults globally. With the introduction of expensive calcitonin gene-related peptide monoclonal antibodies, it is timely to compare the clinical effectiveness and cost-effectiveness of preventive drugs for chronic migraine. Objective: To assess the clinical effectiveness and cost-effectiveness of medications used for chronic migraine through systematic reviews and economic modelling. Eligibility criteria: Randomised controlled trials of drug treatments for efficacy with > 100 participants with chronic migraine per arm; for adverse events > 100 participants with episodic or chronic migraine per arm. Previous economic analyses of preventive drugs for chronic migraine. Data sources: Eight databases. Reviews methods: Systematic reviews, network meta-analysis and economic modelling. Outcomes: Monthly headache days, monthly migraine days, headache-related quality of life, cost-effectiveness. Results: We found 51 individual articles, reporting 11 randomised controlled trials, testing 6 drugs (topiramate, Botox, eptinezumab, erenumab, fremanezumab, galcanezumab), versus placebo, on 7352 adults with chronic migraine. Calcitonin gene-related peptide monoclonal antibodies, Botox and topiramate reduced headache/migraine days by 2.0-2.5, just under two, or by less than 1.5 days per month, respectively. In the network meta-analysis, eptinezumab 300 mg and fremanezumab monthly ranked in first place in both monthly headache day and monthly migraine day analyses. The calcitonin gene-related peptide monoclonal antibodies were consistently the best choices for headache/migraine days and headache-related quality of life. Topiramate was very unlikely to be the best choice for headache/migraine days and headache-related quality of life when compared to calcitonin gene-related peptide monoclonal antibodies or Botox. We found no trials of the commonly used drugs, such as propranolol or amitriptyline, to include in the analysis. The adverse events review included 40 randomised controlled trials with 25,891 participants; 3 additional drugs, amitriptyline, atogepant and rimegepant, were included. There were very few serious adverse events - none of which were linked to the use of these medications. Adverse events were common. Most people using some calcitonin gene-related peptide monoclonal antibodies reported injection site issues; and people using topiramate or amitriptyline had nervous system or gastrointestinal issues. The cost-effectiveness review identified 16 studies evaluating chronic migraine medications in adults. The newer, injected drugs are more costly than the oral preventatives, but they were cost-effective. Our economic model showed that topiramate was the least costly option and had the fewest quality-adjusted life-year gains, whereas eptinezumab 300 mg was more costly but generated the most quality-adjusted life-year gains. The cost-effectiveness acceptability frontier showed that topiramate was the most cost-effective medication if the decision maker is willing to pay up to £50,000 per quality-adjusted life-year. Our consensus workshop brought together people with chronic migraine and headache experts. Consensus was reached on the top three recommendations for future research on medications to prevent chronic migraine: (1) calcitonin gene-related peptide monoclonal antibodies and Botox versus calcitonin gene-related peptide monoclonal antibodies, (2) candesartan versus placebo and (3) flunarizine versus placebo. Limitations: Topiramate was the only oral drug for which we were able to include data. We did not find sufficient quality evidence to support the use of other oral drugs. Conclusions: We did not find evidence that the calcitonin gene-related peptide monoclonal antibodies are more clinically and cost-effective when compared to topiramate or Botox. We identified directions for future research these drugs might take. Study registration: This study is registered as PROSPERO CRD42021265990, CRD42021265993 and CRD42021265995. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR132803) and is published in full in Health Technology Assessment; Vol. 28, No. 63. See the NIHR Funding and Awards website for further award information.

Chronic migraine is a disabling condition that can destroy work and family life. Treatments include cheap tablets (e.g. amitriptyline, propranolol and topiramate), Botox and expensive new drugs (the calcitonin gene-related peptide monoclonal antibodies). It is not known which of these drugs is the best choice. We wanted to find out which of these drugs works best. We wanted to know if they reduced the number of headache/migraine days and improved headache-related quality of life, how many side effects people experienced, and if they provided good value for the National Health Service. We first looked for research comparing these drugs to placebo (fake) drugs, and to each other. We then worked out which provide best value for money. Calcitonin gene-related peptide monoclonal antibodies reduced headache/migraine days by 2.0­2.5 days per month; Botox reduced headache/migraine days per month by around 1.9; and topiramate reduced headache/migraine days by 1.1­1.5 days per month. Many people taking topiramate or amitriptyline have nervous system and/or stomach/bowel side effects. Some people using calcitonin gene-related peptide monoclonal antibodies reported side effects associated with injections. Some calcitonin gene-related peptide monoclonal antibodies and Botox provide worthwhile benefits on headache-related quality of life. We were not able to identify any studies of sufficient quality to assess the effectiveness of other oral drugs. The best value drug was topiramate which gave better health outcomes at a lower cost than the placebos. After sharing the results with a panel of people with chronic migraine and headache experts, we identified a need for new studies comparing commonly used cheap oral drugs with placebo, Botox and calcitonin gene-related peptide monoclonal antibodies.