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.

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.

Health literacy and cumulative social disadvantage are associated with survival and transplant in patients with hepatocellular carcinoma: a prospective study.

OBJECTIVE: To investigate how individual social determinants of health (SDOH) and cumulative social disadvantage (CSD) affect survival and receipt of liver transplant (LT) in patients with hepatocellular carcinoma (HCC). METHODS: We enrolled 139 adult patients from two Indianapolis hospital systems between June 2019 and April 2022. Structured questionnaires collected SDOH and social risk factor data. We compared SDOH and CSD by race, gender and disease aetiology, assigning one point per adverse SDOH. Multivariable competing risk survival analysis assessed associations between SDOH, CSD, survival and LT receipt. RESULTS: Black patients experienced higher CSD than white patients in the cohort (5.4±2.5 vs 3.2±2.1, p<0.001). Black patients were significantly more likely to have household incomes

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.

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.

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.

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.

Navigating the sea level rise: Exploring the interplay of climate change, sea level rise, and coastal communities in india.

This research article investigates the intricate interplay between climate change, global sea level rise (SLR), and the impacts of sea level rise on the coastal regions of India. Through an interdisciplinary approach, this paper provides an overview of the global consequences of SLR on coastal communities, exploring economic, social, and environmental impacts on agriculture, communities, and coastal areas. The study examines the displacement of communities and its impact on food security, infrastructure, tourism, and ecological loss based on a comprehensive literature review. This paper emphasizes the sustainable preservation of coastal ecosystems and the development of climate-resilient infrastructure. This research aims to offer a detailed understanding of the evolving landscape of coastal livelihoods, providing valuable insights for adaptive strategies, policy formulation, and sustainable development. Ultimately, this article contributes to the scientific discourse by shedding light on the complex dynamics between climate change, SLR, and coastal communities, guiding efforts toward a resilient and sustainable future. The insights are drawn from secondary data resources, including books, scholarly journals, and reports from organizations such as the IPCC and NOAA. Based on a thorough review of the relevant literature, it critically examines the existing and potential consequences of sea level rise induced by climate change.

Pursuing beauty: socio-cultural and labor-economic determinants of cosmetic surgery consideration among female college students in China.

BACKGROUND: Cosmetic surgery has a profound impact on health and other aspects. As a means of enhancing physical attractiveness, it is increasingly being considered by female college students in China. However, current knowledge about the determinants of cosmetic surgery consideration among Chinese female college students still needs to be improved due to the lack of systematic perspectives and large-scale representative data sets. This study aimed to contribute to the literature in these two aspects. METHODS: We framed cosmetic surgery consideration as a function of two broad sets of determinants: socio-cultural and labor-economic. We used data from a large, nationally representative sample of female college students in China (N = 6658, mean age = 20.3 years). RESULTS: In terms of socio-cultural oriented factors, we found that family socioeconomic status, peers' cosmetic surgery practices, and media exposure were positively associated with the likelihood of considering cosmetic surgery. In terms of labor-economic oriented factors, we found that self-rated physical appearance, higher grades, and expected income after graduation were positively associated with a higher likelihood of considering cosmetic surgery. CONCLUSIONS: These findings suggest that the decision-making process for cosmetic surgery among Chinese female college students goes beyond personal factors and is significantly influenced by structural factors.

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.

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.

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.