Hospice care and the value of a statistical life year (VSLY).

INTRODUCTION: In this study, we aim to refine the value of a statistical life (VSL) framework to align with hospice care's focus on quality over quantity of life, recognising the necessity for age-sensitive economic assessments. METHODS: We developed an adapted VSL model that incorporates patient and family preferences, which may guide resource distribution and policymaking in end-of-life care. Methods include a multidisciplinary analysis that merges economic and humanistic perspectives to advocate for policies that support adequate funding and compassionate care. RESULTS: Results indicate that our adjusted VSL model promotes a more equitable assessment of hospice care, advocating for enhanced patient dignity and comfort. CONCLUSIONS: This paper presents a novel, ethically and economically balanced approach to evaluating hospice care, emphasising dignity and comfort in terminal care.

ß cell acetate production and release are negligible.

BACKGROUND: Studies suggest that short chain fatty acids (SCFAs), which are primarily produced from fermentation of fiber, regulate insulin secretion through free fatty acid receptors 2 and 3 (FFA2 and FFA3). As these are G-protein coupled receptors (GPCRs), they have potential therapeutic value as targets for treating type 2 diabetes (T2D). The exact mechanism by which these receptors regulate insulin secretion and other aspects of pancreatic ß cell function is unclear. It has been reported that glucose-dependent release of acetate from pancreatic ß cells negatively regulates glucose stimulated insulin secretion. While these data raise the possibility of acetate's potential autocrine action on these receptors, these findings have not been independently confirmed, and multiple concerns exist with this observation, particularly the lack of specificity and precision of the acetate detection methodology used. METHODS: Using Min6 cells and mouse islets, we assessed acetate and pyruvate production and secretion in response to different glucose concentrations, via liquid chromatography mass spectrometry. RESULTS: Using Min6 cells and mouse islets, we showed that both intracellular pyruvate and acetate increased with high glucose conditions; however, intracellular acetate level increased only slightly and exclusively in Min6 cells but not in the islets. Further, extracellular acetate levels were not affected by the concentration of glucose in the incubation medium of either Min6 cells or islets. CONCLUSIONS: Our findings do not substantiate the glucose-dependent release of acetate from pancreatic ß cells, and therefore, invalidate the possibility of an autocrine inhibitory effect on glucose stimulated insulin secretion.

From Acute Infection to Prolonged Health Consequences: Understanding Health Disparities and Economic Implications in Long COVID Worldwide.

The COVID-19 pandemic has resulted in a growing number of patients experiencing persistent symptoms and physiological changes after recovering from acute SARS-CoV-2 infection, known as Long COVID. Long COVID is characterized by recurring symptoms and inflammation across multiple organ systems. Diagnosis can be challenging, influenced by factors like demographics, comorbidities, and immune responses. Long COVID impacts various organ systems and can have neuropsychological effects. Health disparities, particularly related to race, contribute to a higher burden of infection and ongoing symptoms in minority populations. Managing Long COVID entails addressing a spectrum of symptoms that encompass physical, cognitive, and psychological aspects. The recovery period for patients with Long COVID can vary significantly, influenced by factors like the severity of the disease, hospitalization, comorbidities, and age. Currently, there are no universally effective treatments, although certain interventions show promise, necessitating further research. Self-management and rehabilitation programs can provide relief, but more research is needed to establish their effectiveness. Preventive measures such as vaccination and the use of antiviral medications and metformin. It is imperative to conduct further research to develop evidence-based guidelines and gain a better understanding of the long-term implications of COVID-19. Long COVID could have substantial economic impact on the labor market, productivity, healthcare expenditures, and overall economic growth. To address the challenges patients with long-term complications face, there is a focus on strategies like promoting telework and flexible work arrangements to accommodate diverse symptoms, particularly chronic fatigue and other Long COVID effects. In conclusion, this review emphasizes the multifaceted complexity of Long COVID and the ongoing need to address its potential long-term health and economic impacts.

Corrigendum: Reproducibility and rigor in rheumatology research.

[This corrects the article DOI: 10.3389/fmed.2022.1073551.].

Geographic variation in the association between Hashimoto's thyroiditis and Papillary thyroid carcinoma, a meta-analysis.

PURPOSE: The association between papillary thyroid cancer (PTC) and Hashimoto's thyroiditis (HT) remains a matter of debate. Several genetic and environmental factors have been found to influence this association. Because of the variation in these factors among different populations, we conducted a country- and region-based meta-analysis to examine whether the geographic area influences this association. METHODS: We searched PubMed and Web of Science databases for original articles that investigated the association between HT and PTC from February 1955 to February 28, 2023. The included studies were stratified according to their country and region of origin. Various subgroup analyses were conducted. The primary outcome was the pooled relative risk (RR) and its 95% confidence interval (CI) for each region and country. RESULTS: Forty-six studies including a total of 93,970 participants met our inclusion criteria. They originated from 16 countries distributed in five regions. Significant variation was found among countries but not among regions. Upon analysis of all 46 included studies, countries were classified based on their RR and its 95% CI. Excluding countries with pooled sample sizes <500, Sri Lanka (RR 4.23, 95% CI 2.91-6.14), Poland (RR 3.16, 95% CI 2.79-3.57) and Japan (2.68, 2.14-3.36) showed the strongest association between HT and PTC while Greece (RR 1.06, 95% CI 1.00-1.13), Spain (RR 0.70, 95% CI 0.23-2.11), and Jordan (0.62, 0.32-1.32) showed no significant association. CONCLUSION: Our findings revealed a variation in the association between HT and PTC among countries but not among regions. The country-to-country variation could be due to certain genetic and/or environmental factors subject to geographic variation that influence this association. These findings may help guide health policies aiming to mitigate the risk of PTC in the HT population by helping identify high-risk and low-risk countries.

Liver-specific overexpression of HKDC1 increases hepatocyte size and proliferative capacity.

A primary role of the liver is to regulate whole body glucose homeostasis. Glucokinase (GCK) is the main hexokinase (HK) expressed in hepatocytes and functions to phosphorylate the glucose that enters via GLUT transporters to become glucose-6-phosphate (G6P), which subsequently commits glucose to enter downstream anabolic and catabolic pathways. In the recent years, hexokinase domain-containing-1 (HKDC1), a novel 5th HK, has been characterized by our group and others. Its expression profile varies but has been identified to have low basal expression in normal liver but increases during states of stress including pregnancy, nonalcoholic fatty liver disease (NAFLD), and liver cancer. Here, we have developed a stable overexpression model of hepatic HKDC1 in mice to examine its effect on metabolic regulation. We found that HKDC1 overexpression, over time, causes impaired glucose homeostasis in male mice and shifts glucose metabolism towards anabolic pathways with an increase in nucleotide synthesis. Furthermore, we observed these mice to have larger liver sizes due to greater hepatocyte proliferative potential and cell size, which in part, is mediated via yes-associated protein (YAP) signaling.

Reproducibility and rigor in rheumatology research.

The pillars of scientific progress in rheumatology are experimentation and observation, followed by the publication of reliable and credible results. These data must then be independently verified, validated, and replicated. Peer and journal-specific technical and statistical reviews are paramount to improving rigor and reproducibility. In addition, research integrity, ethics, and responsible conduct training can help to reduce research misconduct and improve scientific evidence. As the number of published articles in rheumatology grows, the field has become critical for determining reproducibility. Prospective, longitudinal, randomized controlled clinical trials are the gold standard for evaluating clinical intervention efficacy and safety in this space. However, their applicability to larger, more representative patient populations with rheumatological disorders worldwide could be limited due to time, technical, and cost constraints involved with large-scale clinical trials. Accordingly, analysis of real-world, patient-centered clinical data retrieved from established healthcare inventories, such as electronic health records, medical billing reports, and disease registries, are increasingly used to report patient outcomes. Unfortunately, it is unknown whether this clinical research paradigm in rheumatology could be deployed in medically underserved regions.

Smoking Behavior among Jordanians: Physical, Psychological, Social, and Economic Reasons.

OBJECTIVES: To highlight the physical, psychological, social, and economic reasons related to sex differences in smoking behaviors in Jordan. METHODS: A cross-sectional questionnaire-based survey was conducted among Jordanian adult smokers. RESULTS: Sex was a significant predictor of physical reasons related to smoking; when controlling for other factors (t765 = 5.027; P < 0.001), women were more affected by physical factors than were men. In addition, work status was a significant predictor of physical reasons (t765 = -2.563; P = 0.011), as was the price of cigarettes (t765 = 2.224; P = 0.026). Age was a significant predictor of psychological reasons (t765 = -3.092; P = 0.002): younger individuals were more likely to state psychological factors as their reason for smoking than were older individuals. Conversely, sex was a significant predictor (t765 = 2.798; P = 0.005) of social reasons for smoking, with more men than women reporting social motivations. CONCLUSIONS: Women were more likely to smoke for physical factors that are positively correlated with the price of cigarettes, rendering them less responsive to an increase in the price of cigarettes. Conversely, men were more likely to smoke for social reasons that are negatively correlated with the price of cigarettes; thus, men are more responsive to an increase in the price of cigarettes. Future public policies aiming to combat smoking in Jordan should consider sex differences in smoking behavior because one policy may not necessarily fit all.

Cigarette demand is responsive to higher prices: findings from a survey of University students in Jordan.

OBJECTIVE: To estimate the price elasticity of cigarette demand for university students aged 18-24 years in Jordan. METHODS: Questions from the Global Adult Tobacco Survey were adapted and administered to students from 10 public universities in Jordan in 2014. A two-part econometric model of cigarette demand was estimated. RESULTS: Nearly one-third of university students in Jordan smoke, purchasing 33.2 packs per month and paying 1.70 Jordanian dinars on average (US$2.40) for a pack of 20 cigarettes. The price elasticity of cigarette demand was estimated to be -1.15. CONCLUSIONS: Higher taxes may be particularly effective in reducing smoking among University students in Jordan.

The economics of tobacco use in Jordan.

INTRODUCTION: We conducted an independent survey of tobacco use in Jordan following the methods and template of the Global Adult Tobacco Survey. Using data collected on cigarette use and cigarette prices, we estimated the price elasticity of cigarette demand in Jordan. METHODS: We used a 2-part model of cigarette demand. In the first part, we estimate the impact of prices on the decision to smoke while controlling for individual demographic and environmental characteristics. Conditional on smoking, we then estimate the effect of price on the number of cigarettes smoked. RESULTS: The total price elasticity of cigarette demand in Jordan was estimated to be -0.6. Smoking among women was found to be relatively unresponsive to price (elasticity of -0.01), whereas smoking among men was much more responsive to price (elasticity of -0.81). CONCLUSIONS: The price elasticity estimates suggest that significant increases in tobacco taxes are likely to be effective in reducing smoking in Jordan, particularly smoking among men.

Critical appraisal of tocilizumab in the treatment of moderate to severe rheumatoid arthritis.

Recent advances in our understanding of the role of interleukin (IL)-6 in autoimmunity and in particular rheumatoid arthritis (RA) have brought about important changes in the way we think about autoimmune diseases. Encouraging data from several phase III clinical trials of tocilizumab, a humanized monoclonal antibody against IL-6R, have led to its approval in Europe for the treatment of moderate to severe RA. Data on clinical efficacy, patient-reported outcomes, safety, and cost-effectiveness with the use of tocilizumab in patients with RA will be summarized in this review, with particular emphasis on phase III clinical trials. Furthermore, adverse events associated with the use of tocilizumab will be reviewed. Future clinical trials will evaluate the role of tocilizumab in other autoimmune diseases. The goal of this review is to describe the current understanding of the role of IL-6 in mediating the inflammatory response in RA, as well as the role of tocilizumab in the treatment of RA and the evolving role of this agent in other autoimmune diseases.