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.

Early health technology assessment of gene silencing therapies for lowering lipoprotein(a) in the secondary prevention of coronary heart disease.

BACKGROUND: Olpasiran and pelacarsen are gene-silencing therapies that lower lipoprotein(a). Cardiovascular outcome trials are ongoing. Mendelian randomisation studies estimated clinical benefits from lipoprotein(a) lowering. OBJECTIVE: Our study estimated prices at which olpasiran and pelacarsen, in addition to standard-of-care, would be deemed cost-effective in reducing risk of recurrent coronary heart disease (CHD) events in the Australian healthcare system. METHODS: We developed a decision tree and lifetime Markov model. For olpasiran, participants had CHD and lipoprotein(a) 260 nmol/L at baseline and three-monthly injections, profiled on OCEAN(a) Outcomes trial (NCT05581303). Baseline risks of CHD, costs and utilities were obtained from published sources. Clinical trial data were used to derive reductions in lipoprotein(a) from treatment. Mendelian randomisation study data were used to estimate downstream clinical benefits. Annual discounting was 5 %. For pelacarsen, participants had CHD and lipoprotein(a) 226 nmol/L at baseline and one- monthly injections, profiled on Lp(a) HORIZON (NCT04023552) trial. RESULTS: Olpasiran in addition to standard-of-care saved 0.87 discounted quality-adjusted life years (QALYs) per person. Olpasiran in addition to standard-of-care would be cost- effective at annual prices of AU$1867 (AU$467 per dose) at threshold AU$28,000 per QALY. Pelacarsen would be cost-effective at annual prices of AU$984 (AU$82 per dose). For ICER threshold AU$50,000 per QALY, olpasiran and pelacarsen would be cost-effective at annual prices AU$4207 and AU$2464 respectively. CONCLUSION: This early health technology assessment model used inclusion criteria from clinical trials. Olpasiran and pelacarsen would be cost-effective if annual treatment prices were AU$1867 and AU$984 respectively, from the Australian healthcare perspective.

Global-scale water security and desertification management amidst climate change.

Deserts and semi-arid environments are habitats to rare species, rich cultural heritage, and essential ecological processes. Approximately 46% of the world's surface area is covered by drylands (arid, semi-arid, and dry sub-humid areas), where 3 billion people live and unfortunately witness water insecurity and desertification implications. In this context, the present study argued that reduced dryland ecosystem services and decreased ecosystem health have resulted from the individual and compounding impacts of desertification, water scarcity, and climate change. At 1.5 °C, 2 °C, and 3 °C of global warming, under the shared socio-economic pathway SSP2, the number of people living in drylands who will be affected by various effects on water, energy, and land sectors is projected to reach 951 million, 1152 million, and 1285 million, respectively. Due to combinations of land use change, rainfall variations, fire suppression, and CO2 fertilization, as well as unsustainable management, widespread woody encroachment has occurred in many shrublands and savannas in Africa, Australia, North America, and South America. This has altered biodiversity and reduces ecosystem services, such as water availability and grazing potential. The north side of the Mediterranean, southern Africa, and North and South America are projected to have the most semiarid expansion. Contrarily, drylands are expected to shrink in India, northern China, eastern equatorial Africa, and the southern Sahara. Growing research evidence highlights the adoption of policy frameworks deriving the solutions from soil land management (SLM), indigenous and local knowledge (ILK), early warning systems coupled with adaptation and mitigation responses, and targets of sustainable development goals (SDGs).

Multi-Scale analysis of the impacts of soil and water conservation practices and landscape on grain yield and return on investment in the sub-humid ethiopian highlands.

Ethiopia's sub-humid highlands face a critical challenge in balancing agricultural productivity with land degradation. This study explores the effectiveness of soil and water conservation practices (SWCPs) in addressing this challenge. We investigated the interaction effects of types of SWCPs, landscape positions, and location on Teff (Eragrostis teff) and wheat (Triticum aestivum) yield. In addition, we assessed the economic viability of SWCPs using cost-benefit analysis with farmer-funded and cost-sharing scenarios. The results indicated that yield was significantly affected by the interactions between factors like SWCP type and landscape position. Soil bunds consistently increased crop yield across diverse locations and landscapes, indicating superior erosion control benefits. Lower landscape positions on foot slopes benefited most from SWCP implementation. Teff yield increased by 188 % and wheat yield by 181 % under soil bunds. The cost-benefit analysis confirmed the financial viability of SWCPs, particularly for Teff (NPV = 4499.35 USD, IRR = 50 %, and BCR = 1.51) and wheat (NPV = 544.35 USD, IRR = 16 %, and BCR = 1.06) grown on lower landscapes with farmer-funded investment scenarios. Positive return on investment was observed in both scenarios, with cost-sharing offering greater economic benefits for farmers. These findings highlight the importance of an integrated approach to SWC implementation for achieving multiple Sustainable Development Goals (SDGs) by enhancing food security, improving farmer incomes, and promoting sustainable and productive landscape management practices. Future research should explore the long-term sustainability of SWCPs, their adaptation across diverse agroecological zones and landscapes, the incorporation of various crops, the broader socioeconomic impacts, and the development of effective extension programs for wider adoption by farmers.

Enhancing circular plastic waste management: Reducing GHG emissions and increasing economic value in Rayong province, Thailand.

This study evaluates the greenhouse gas (GHG) emissions and economic value creation of plastic waste (PW) management in Rayong, Thailand, a city on the eastern Gulf Coast with a significant amount of generated and leaked PW. By analyzing current practices, and developing and evaluating improvement scenarios, the study explores strategies for reducing GHG and enhancing economic benefits across the PW management chain. Four primary routes with varying capacities handle approximately 5,445.55 tonnes of PW via source separation recycling (5.18 %), post-sorting recycling (9.30 %), energy recovery (54.86 %), and landfills or opened dump disposal (30.66 %). About 83.21 % of the 16 ± 6.9 % PW in municipal solid waste (MSW) is recyclable, primarily consisting of high-density polyethylene (HDPE), polypropylene (PP), low-density polyethylene (LDPE), linear low-density polyethylene (LLDPE), and polyethylene terephthalate (PET). The current management practice generates an economic benefit of approximately 1.68 million USD/yr or 310 USD/t of PW, compared to the proposed scenarios, which enhances recycling efficiency and reduces landfill and energy recovery waste, yielding 2.27-6.48 million USD/yr or 420.64-1200.33 USD/t of PW. The practice emits about 7,028.47 tCO2e annually, while improved source and post-sorting efficiencies reduce GHG emissions by 2.86-3.17 times or -2.83 to -2.42 tCO2e/t of PW or a total of over 13,078.60-15,268.44 tCO2e. Burning PW increases approximately 1.6 times or 11,841.36 tCO2e/yr. Enhancing recycling efficiency, particularly through source separation, is key to promoting more productive and valuable PW separation, increasing economic value and GHG mitigation by approximately 3.87 and 3.17 times, respectively. These findings provide valuable insights for local authorities and policymakers to develop strategic interventions and policies that align with the improved scenario by enhancing source separation and recycling. The results demonstrate that improving the efficiency of separation at the source is critical for transitioning from a linear PW management strategy to a circular economy, significantly reducing landfill waste and mitigating environmental threats.

Advancing multiple ecosystem service assessment in the tropics: Evidence from Barekese and Owabi watersheds in Ghana.

Watershed ecosystems are important for the provision of multiple ecosystem services (ES) that are critical to human welfare. Few studies particularly in the tropics assess the multiple ecosystem services, economic value, and effect of land use change on economic value. This paper provides evidence of the quantitative. economic value and effect of land use change on the economic value of watershed ESs from Barekese and Owabi in Ghana. Geospatial analysis and the stated preference method were used for the study. Primary and secondary data were collected from households, institutions, and other sources to quantify and estimate ecosystem services. The geospatial analysis showed that forest degradation and deforestation have increased over the last three decades in the watershed with settlements and cropland being the major land use changes. The two watersheds provide many ecosystem services, including provisioning services (water, fuelwood, bushmeat, fish), regulating services (carbon sequestration, water supply, water purification, soil fertility), and cultural services (ecotourism). An aggregated economic value for the ESs of GH₵ 707.701 x 106 ($144.428 x 106) was estimated for the two watersheds. For the different sites, the economic value for the Barekese and Owabi watersheds were $110.645 x 106 ($6609.06/ha/yr) and $33.783 x 106 ($5857.76/ha/yr) respectively. Our analysis showed that conversion of forest to other land uses resulted in a significant reduction in the value of ecosystem services. Conversion of the watershed to Tree Crop, Food Crop, Grassland or Settlement could reduce the economic value of ESs by 4%-80 %. The study demonstrates that ecosystem services assessment could provide important information for conservation and development policies related to watershed management in the tropics. To ensure ecosystem service supply, the risks of land use change should be considered in watershed conservation strategies including land use zoning and adaptive management systems.

Economic Evaluation of a Novel Treatment of Attention-Deficit/Hyperactivity Disorder in US Motor Vehicle Drivers.

Background: Attention-deficit/hyperactivity disorder (ADHD) affects approximately 4.4% of US adults. ADHD is associated with high-risk driving behavior and costly motor vehicle accidents. DYANAVEL XR (DXR) (Tris Pharma, Inc.) is a once-daily fast-acting amphetamine developed for ADHD treatment. A randomized controlled trial showed that DXR patients were 43% less likely to crash during a driving simulation than individuals taking placebo. Study outcomes suggest a DXR crash rate similar to that of a driver without ADHD, while patients treated with the current standard of care (SOC) have a 52% higher crash risk than non-ADHD drivers. Objective: The aim was to evaluate the economic benefits attributable to improved driving abilities and avoided crashes in DXR patients compared with patients treated with the SOC or those who are untreated. Methods: A cost-impact model estimated 1-year crash-related cost outcomes for DXR-treated patients compared with SOC-treated and untreated ADHD patients. SOC was assumed to consist of a combination of short-, intermediate-, and long-acting ADHD stimulant and non-stimulant medications. DXR crash risk was assumed equivalent to the non-ADHD population risk, as supported by trial data. Crash risk for untreated and SOC-treated ADHD patients were assumed to be 99% and 52% higher than the general US population, respectively. Model outcomes included the cost impact (medication- and crash-related costs) and the number of crashes, injuries, and fatalities avoided with DXR. Results: Treatment with DXR would avoid 0.82 crashes, 0.016 injuries, and 0.036 fatalities per year compared with untreated patients, and 0.036 crashes, 0.007 injuries, and 0.0001 fatalities per year compared with SOC-treated patients. Compared with a population of 25% SOC-treated patients and 75% untreated patients, DXR use would save an average of 4581 p e r p e r s o n p e r y e a r a c r o s s a l l a g e g r o u p s w h e n p r i c e d a t 80 per month, assuming all SOC-treated and untreated patients utilized DXR. When the value of quality-of-life improvement is considered, savings increase over 7-fold. Discussion: Outcomes suggest that DXR may be an economically beneficial treatment compared with SOC for ADHD patients. Conclusions: The economic model showed that DXR is cost-saving compared with no treatment and SOC by reducing the number of motor vehicle crashes in the ADHD population.

Behavioral and economic traits reflect distinct resource acquisition strategies in tendril vines and stem twining vines.

Climbing plants are important components of tropical and many temperate forest ecosystems. Current studies regard climbing plants as a single ecological plant type and ignore the ecological differences resulting from their climbing mechanisms, which may lead to a misrepresentation of the role of climbing plants in forest dynamics. Based on behavioral traits and economic traits of climbing plants, we test the hypothesis that tendril climbers and stem twiners are characterized by different resource acquisition strategies. We quantified and compared 4 behavioral traits and 7 economic traits of four stem twining vines and four tendril vines in a temperate oak forest and further tested their differences in resource acquisition strategy. Our study found that tendril vines were scattered in a group distinct from stem twining vines along the first axes of the principal component analysis using four behavioral traits and seven economic traits, being located at the more acquisitive end with more hosts, a larger distance to length ratio of stem, higher leaf and root nitrogen concentrations, and lower leaf carbon content, while stem twining vines showed the opposite trends. These results indicate that tendril vines have a more acquisitive strategy than stem twining vines. The findings suggest a functional variability among the different climbing mechanisms, and which should be accounted for in future studies.

The trajectories of free sugar intake during childhood, their main sources and its association with socio-economic factors: generation XXI birth cohort.

The study aimed to describe trajectories of free sugar (FS) intake, its main sources and the associations with socio-economic status (SES) in Portuguese children/adolescents evaluated at 4, 7, 10 and 13 years of age from Generation XXI birth-cohort. Dietary intake was assessed through 3-day food diaries (n 5268). Added sugar intake was estimated following a systematic methodology, and FS was based on the WHO definition. A mixed-effects model with linear and quadratic terms for time was used to estimate FS trajectories and its association with SES, adjusting for children's sex, age, BMI and SES. The FS mean intake (g/day) was 37, 47, 51 and 48 at 4, 7, 10 and 13 years, respectively. FS intake increased 4·6 g/year (CI 95 %: 4·20, 5·04), but velocity decreased by 0·3 g/year2 until 13 years. At all ages, the main food source was sweets. Some item's consumption declined (sweets 25-21 % and yoghurts 22-7 %) as children grew older. Inversely, soft drink intake increased (9-18 %). Boys and children from younger mothers had higher FS intake, whereas higher maternal-SES was associated with lower children's FS intake: occupational status (ß = -3·5; 95 % CI: -4·97, -1·94), years of education (ß = -3·7; 95 % CI: -4·93, -2·40) and household income (ß = -4·9; 95 % CI: -6·50, -3·27). The FS trajectories were similar by SES categories but different by obesity status (interaction term ß = -1·04; CI 95 % (-1·50, -0·59)). An increasing FS trajectory during childhood is mainly driven by an increasing intake of soft drinks and nectars. The FS trajectory pattern did not change according to SES categories, but children's FS intake was always higher when their mothers had a lower SES.

A novel bio-coagulation/co-digestion/pyrolysis scheme for banana pseudostem waste management: techno­economic and sustainability approaches.

While several studies have focused on utilizing banana pseudostem waste (BPW) for wastewater treatment via bio-coagulation, this process still suffers from secondary pollution caused by the disposal of generated sludge. To avoid this pollution transfer issue, this study is the first to focus on the recyclability of post-coagulation sludge (PCS) to recover added-value products. For this purpose, BPW was used as a model bio-coagulant for the decontamination of laundry wastewater (LWW), followed by anaerobic digestion and pyrolysis schemes to recover biogas and biochar, respectively. In the first experiment, BPW succeeded in removing 55.44 ± 1.21%, 90.40 ± 3.09%, and 78.13 ± 2.44% of chemical oxygen demand (COD), turbidity, and surfactant, respectively, at the optimized condition (pH = 3.5, dosage = 2.34 g/L, stirring speed = 160.6 rpm, and settling time = 55.5 min). Inoculating the spent bio-coagulant with cattle manure (CM), with a mixing ratio of 1:1 (w:w), showed a biogas yield of 110.33 ± 6.02 mL/g COD. The synergetic effect of spent coagulant and microbes of CM was further validated by performing a COD mass balance, showing that about 31.52 ± 1.63% of CODfeed was converted to bio-CH4 (as COD). Further, the thermal treatment of digestate was successfully employed for biochar recovery at a yield of 0.58 ± 0.05 g biochar/g dry digestate. The study also revealed that the triple LWW treatment/biogas/biochar strategy could gain economic benefits with a payback period of 4.4 years. Hence, BPW could be used as a promising feedstock for pollution reduction, energy generation, and gaining profits.

The impact of economic agglomeration on China's urban public health.

Introduction: This study aims to explore the impact of economic agglomeration on the urban prosperity through economies of scale and agglomeration, it may also affect the public health of the agglomeration area. Methods: This paper takes 280 cities in China as the research object, and explores the impact of economic agglomeration on public health through a two-way fixed effects model, instrumental variable method, and generalized moment estimation. Results: The results indicate that: (1) the improvement of China's economic agglomeration can significantly promote urban public health, and economic agglomeration is a prerequisite for the improvement of urban public health, but there is no reverse causal relationship. (2) The enhancement of economic agglomeration in Northeast China has the greatest promotion effect on public health, followed by the eastern, western, and central regions; The economic agglomeration enhancement of the pilot medical group in closely connected cities has a greater promoting effect on public health than the pilot medical group in non-closely connected cities. (3) Empirical results based on micro sample data show that the improvement of economic agglomeration will also promote the increase of the number of public hospitals in cities. Discussion: This study emphasizes the important role of economic accumulation in the improvement of urban public health and provides empirical support for future economic development policies and practices.

Social status mediates the propagation of unfairness.

Fairness constitutes a cornerstone of social norms, emphasizing equal treatment and equitable distribution in interpersonal relationships. Unfair treatment often leads to direct responses and can spread to others through a phenomenon known as pay-it-forward (PIF) reciprocity. This study examined how unfairness spreads in interactions with new partners who have higher, equal, or lower status than the participants. In the present study, participants (N = 47, all Korean) were given either fair or unfair treatment in the first round of a dictator game. They then allocated monetary resources among partners positioned at various hierarchical levels in the second round. Our main goal was to determine if the severity of inequity inflicted on new partners was influenced by their hierarchical status. The results revealed an inclination among participants to act more generously towards partners of higher ranking despite prior instances of unfair treatment, whereas a tendency for harsher treatment was directed towards those with lower ranking. The interaction between the fairness in the first round (DG1) and the hierarchical status of the partner in the second round (DG2) was significant, indicating that the effect of previous fairness on decision-making differed depending on the ranking of the new partners. This study, therefore, validates the presence of unfairness PIF reciprocity within hierarchical contexts.

The Knowledge and Application of Economics in Healthcare in a High-Income Country Today: The Case of Belgium.

Healthcare is a huge business sector in many countries, focusing on the social function of delivering quality health when people develop illness. The system is essentially financed by public funds based on the solidarity principle. With a large financial outlay, the sector must use economic evaluation methods to achieve better efficiency. The objective of our study was to evaluate and to understand how health economics is used today, taking Belgium as an example of a high-income country. The evaluation started with a historical view of healthcare development and ended with potential projections for its future. A literature review focused on country-specific evaluation reports to identify the health economic methods used, with a search for potential gaps. The first results indicated that Belgium in 2021 devoted 11% of its GDP, 17% of its total tax revenue, and 30% of the national Social Security Fund to health-related activities, totalizing EUR 55.5 billion spending. The main health economic method used was a cost-effectiveness analysis linked to budget impact, assigning reimbursable monetary values to new products becoming available. However, these evaluation methods only impacted at most 20% of the money circulating in healthcare. The remaining 80% was subject to financial regulations (70%) and budgeting (10%), which could use many other techniques of an economic analysis. The evaluation indicated two potentially important changes in health economic use in Belgium. One was an increased focus on budgeting with plans, time frames, and quantified treatment objectives on specific disease problems. Economic models with simulations are very supportive in those settings. The other was the application of constrained optimization methods, which may become the new standard of practice when switching from fee-for-service to pay-per-performance as promoted by value-based healthcare and value-based health management. This economic refocusing to a more constrained approach may help to keep the healthcare system sustainable and affordable in the face of the many future challenges including ageing, climate change, migration, pandemics, logistical limitations, and financial instability.

Socioeconomic Moderators of the Association Between Delayed Breastfeeding Initiation and Place of Delivery: Cross-Sectional Study.

BACKGROUND: Breastfeeding is a crucial and irreplaceable method of feeding infants. Despite the well-established advantages of early breastfeeding initiation, its progress remains constrained. Over half of Indian mothers witness delayed breastfeeding initiation. Various factors have been implicated to influence breastfeeding initiation, with institutional deliveries emerging as a crucial factor among them. OBJECTIVE: We tested the hypothesized association between institutional delivery and initiation delays and identified how various socioeconomic variables moderate (weaken, strengthen, or reverse) the association between breastfeeding initiation delays and place of delivery. METHODS: This cross-sectional study analyses data of 106,569 breastfeeding mothers from the NFHS-5 (National Family Health Survey, 2019-21). Missing data were managed by using a complete case analysis approach. The outcome variable was the timing of breastfeeding initiation for the most recent child, with the place of delivery being the explanatory variable. Socioeconomic factors including age, education level, marital status, place of residence, and wealth index were considered moderating variables. Logistic regression-based moderation analysis explored how these variables influence the relationship between breastfeeding initiation delays and place of delivery. Separate binary logistic regression models analyzed the effect of each moderating variable. Statistical analysis was conducted using IBM SPSS Statistics 26. RESULTS: The highest occurrence of delayed breastfeeding initiation was observed among mothers aged ≥36 years (58.3%), lacking formal education (60.9%), belonging to lower wealth groups (58.1%), residing in rural areas (57.4%), and having home births (64.1%). Results confirmed the primary hypothesis that institutional delivery significantly and negatively affects delayed breastfeeding initiation (odds ratio [OR] 0.705, 95% CI 0.676-0.735, P<.001). Age as a moderating variable significantly affected this association (adjusted OR [aOR] 0.757, 95% CI 0.696-1.307, P=.02 for the 15-25 age group). Notably, education level (aOR 0.616, 95% CI 0.429-1.930, P=.005 for no education and aOR 0.510, 95% CI 0.429-1.772, P=.04 for primary education) and poor wealth index (aOR 0.672, 95% CI 0.528-1.432, P=.004) as moderating factors significantly strengthened the negative effect of institutional delivery on delayed initiation. Poor mothers and those without education or a lower level of education (primary) when delivering the child at the health institution further reduced the chances of witnessing delayed initiation. CONCLUSIONS: Institutional delivery significantly lowers the likelihood of delayed breastfeeding initiation, and this negative effect is significantly strengthened when uneducated women or lesser-educated women and those with lower wealth deliver their children at the institutional facilities, underscoring the significance of these moderating factors. Developing strategies targeting these socioeconomic moderating factors is crucial. Tailored awareness programs crafted to address the needs of uneducated mothers from economically disadvantaged backgrounds can enhance coverage. Outreach initiatives aimed at promoting health care service use during pregnancy and delivery, as well as raising awareness about breastfeeding practices, are warranted for the adoption and implementation of early breastfeeding initiation.

Fluoride removal using a rotating anode electro-coagulation reactor: Parametric optimization using response surface methodology, isotherms and kinetic studies, economic analysis and sludge characterization.

The presence of fluoride in drinking water can cause various diseases, such as dental fluorosis and skeletal fluorosis. The present study aims to intensify the fluoride removal using a rotating anode electro-coagulation (EC) reactor with providing the proper hydrodynamics conditions. This fluoride removal is modeled and optimized using Response Surface Methodology (RSM) and central composite design (CCD) with varying operational parameters (rotation speed: 20-80 RPM, current: 0.2-1.0 A, initial fluoride concentration: 8-40 mg/L and time: 15-75 min). The maximum fluoride removal is obtained as 96.87% (predicted) and 95.40% (experimental) for the optimized process parameters, initial concentration of 32 mg/L, 0.8 A current, 60 min, and 60 RPM of rotating speed. Kinetic analysis reveals that the removal process adheres to a second-order kinetic model, suggesting that the rate of fluoride removal is dependent on the concentration of fluoride ions present. Isothermal studies indicate that the effective sorption of fluoride onto the generated flocs follows a sips isotherm. The optimal cost analysis is carried out to determine the operational cost as 0.256 USD/m3 for F removal of 93.49% at initial concentration 24 mg/L, time 50 min, current 0.7 A, and rotation 70 rpm and presenting a cost-effective solution for fluoride mitigation. Further, characterizations of the resultant sludge through X-Ray Diffraction (XRD), Fourier-Transform Infrared Spectroscopy (FTIR), and the Toxicity Characteristic Leaching Procedure (TCLP) confirmed the safe disposal potential of the sludge. The findings show a promising approach for fluoride removal, combining high efficiency, economic viability, and environmental safety.

The Nursing Human Capital Value Model.

Nursing's economic value is presently framed within the dominant "outcomes-over-cost" value framework. Within this context, organizations employing nurses often use nursing budget reductions as a cost-minimization strategy, with the intent of retaining high quality outcomes. However, persistent issues such as nurse understaffing, burnout, and turnover threaten healthcare systems' capacity to deliver the quality, equitable, affordable patient care that the public requires. In this paper, we propose a new conceptual model and definition of nursing's economic value. The model development is guided by the convergence of three classic economic frameworks: human capital theory, production theory, and value theory. Grounded in these theories, we envision nursing as a value-adding human capital asset and explicitly link nursing staff characteristics and allocation to the production of healthcare services and organizational financial outcomes. We redefine nursing's economic value as the return on investment (ROI) in nursing human capital reflected in the improvement of consumer, nurse, and organizational outcomes. This new conceptual model, termed the Nursing Human Capital Value Model, presents a cycle of value creation that starts with investments in growing, developing and sustaining an organization's nursing human capital. Nurses, as a human capital asset, deliver nursing care-a foundational ingredient to the production of healthcare services and consumer outcomes. Improved outcomes, subsequently, drive organizational revenue growth. Finally, the accrued revenue is reinvested in nursing, further propelling the cycle's continuation. This innovative model, which is applicable across health systems financed through both governmental and private/non-governmental payor sources, highlights that investment in nursing human capital development is essential for sustainable value generation, identifying opportunities for optimizing nurses' contributions to the value cycle. By directly incorporating economic theories of human capital, production, and value, our model paves the way for future research on the dynamic scope of nursing's economic contribution within healthcare organizations and systems and underscores its necessity for the long-term sustainability and growth of the nursing profession. Tweetable abstract: The economic value of nursing lies in the return on investment in nursing human capital. #nurses #ROI #healthcare.

Epidemiology and burden of chronic insomnia disorder in Europe: an analysis of the 2020 National Health and Wellness Survey.

INTRODUCTION: Chronic insomnia disorder (CID) is considered a significant worldwide public health concern; however, its exact burden is unknown. We estimate its prevalence across France, Germany, Italy, Spain, and the United Kingdom, and assess the economic and humanistic burden for a broader insomnia population. METHODS: This retrospective, cross-sectional, observational study used 2020 National Health and Wellness Survey (NHWS) data. Patients reporting insomnia were characterized to define CID. Health-related quality of life (HRQoL), work productivity, and healthcare resource use (HCRU) outcomes were assessed in four cohorts according to insomnia diagnosis and treatment status and examined using multivariable analyses according to Insomnia Severity Index categories. RESULTS: Among 62,319 respondents, 9,035 (21.2%) reported experiencing insomnia over the previous 12 months. CID prevalence rates were 5.5% to 6.7% across the five countries and 6.0% overall. HRQoL outcomes were persistently poorer in cohorts of patients diagnosed with insomnia than those with undiagnosed insomnia. Undiagnosed and treated insomnia patients reported the highest work presenteeism and total work productivity impairment and the highest number of emergency room and hospitalization visits than patients with insomnia (either treated or untreated). After adjusting for covariates, patients with severe insomnia reported significantly worse EQ-5D-5L utility scores, higher absenteeism and presenteeism rates, and more healthcare provider visits over the past 6 months than patients without insomnia (all p < 0.01). CONCLUSIONS: Our prevalence rates for CID align with published literature. A diagnosis of insomnia, use of sleep medications, and severity of insomnia are associated with poor quality of life, loss of work productivity, and higher HCRU, confirming the high unmet need and substantial humanistic and economic burden of CID.

Many people experience poor quality of sleep, also known as insomnia, due to difficulties falling asleep, staying asleep, or problems waking up too early. While this may be short-lived for some people, others may experience long-term issues with their sleep quality. However, our understanding of the number of people affected by long-term sleep issues, and the burden that this can cause, is poorly known. The aim of this study was to update estimates of the percentage of adults across France, Germany, Italy, Spain, and the United Kingdom who experience chronic insomnia. The burden of chronic insomnia was also assessed. Our results show that 5.5% to 6.7% of adults across the five countries experience chronic insomnia. Diagnosed and treated insomnia patients reported the poorest quality of life, decreased work productivity, and higher healthcare resource use. It was also apparent that people experiencing moderate to severe insomnia had poor outcomes on an ongoing basis, despite receiving treatment for their sleep problems. Consequently, the burden of insomnia is substantial and comparable in size to other notoriously debilitating conditions. We conclude that ongoing poor sleep quality is costly for patients, healthcare systems, employers, and society.

Socio-economic inequalities and heart failure morbidity and mortality: A systematic review and data synthesis.

Socio-economic status (SES) has been associated with incident and prevalent heart failure (HF), as well as its morbidity and mortality. However, the precise nature of the relationship between SES and HF remains unclear due to inconsistent data. This study aims to provide a comprehensive assessment and data synthesis of the relationship between SES and HF morbidity and mortality. We performed a systematic search and data synthesis using six databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. The included studies comprised observational studies that reported on HF incidence and prevalence, HF hospitalizations, worsening HF (WHF) and all-cause mortality, as well as treatment options (medical, device and advanced HF therapies). SES was measured on both individual and area levels, encompassing single (e.g., income, education, employment, social risk score, living conditions and housing characteristics) and composite indicators. Among the 4124 studies screened, 79 were included, with an additional 5 identified through cross-referencing. In the majority of studies, a low SES was associated with an increased HF incidence (72%) and prevalence (75%). For mortality, we demonstrated that low SES was associated with increased mortality in 45% of the studies, with 18% of the studies showing mixed results (depending on the indicator, gender or follow-up) and 38% showing non-significant results. Similar patterns were observed for the association between SES, WHF, medical therapy prescriptions and the utilization of devices and advanced HF therapies. There was no clear pattern in the used SES indicators and HF outcomes. This systematic review, using contemporary data, shows that while socio-economic disparity may influence HF incidence, management and subsequent adverse events, these associations are not uniformly predictive. Our review highlights that the impact of SES varies depending on the specific indicators used, reflecting the complexity of its influence on health disparities. Assessment and recognition of SES as an important risk factor can assist clinicians in early detection and customizing HF treatment, while also aiding policymakers in optimizing resource allocation.

Exploring the Association between Socioeconomic Environment, Eating Habits and Level of Nutrition in Children of High School Age: A Part of National Survey.

BACKGROUND/OBJECTIVES: One of the raising public health problems in the adolescent population is obesity, which has reached epidemic proportions worldwide. The aim of this work is to determine the prevalence of obesity in the population of children of secondary school, age 15 to 19 years in Serbia and the determinate connection with demographic and socio-economic characteristics of the respondents and their eating habits and physical activity. METHODS: The research is part of the fourth National Population Health Survey conducted in 2019, which was conducted by the Republic Institute of Statistics, in cooperation with the Institute of Public Health of Serbia and the Ministry of Health of the Republic of Serbia. As a research instrument, questionnaires were used in accordance with the methodology of the European Health Survey. For the purposes of this research, data on the adult population aged 15-19 and over were used. RESULTS: The association of overweight with demographic and socioeconomic characteristics was examined using binary regression. In the univariate model, male gender (OR = 1.95), younger age (OR = 1.57) and Region of Vojvodina (OR = 2.47) stood out as significant predictors of overweight, which was confirmed by the multivariate model. CONCLUSIONS: The results of our study emphasize that the prevalence of obesity in the population of high school youth is at a significant level and that a lot more needs to be done to promote healthy lifestyles and raise awareness of their benefits on health status.