Nonpharmacological intervention therapies for dementia: potential break-even intervention price and savings for selected risk factors in the European healthcare system.

BACKGROUND: New effective treatments for dementia are lacking, and early prevention focusing on risk factors of dementia is important. Non-pharmacological intervention therapies aimed at these factors may provide a valuable tool for reducing the incidence of dementia. This study focused on the development of a mathematical model to predict the number of individuals with neurodegenerative diseases, specifically Alzheimer's disease, Parkinson's disease, vascular dementia, and amyotrophic lateral sclerosis. Scenarios for non-pharmacological intervention therapies based on risk factor reduction were also assessed. The estimated total costs and potential cost savings from societal were included. METHODS: Based on demographic and financial data from the EU, a mathematical model was developed to predict the prevalence and resulting care costs of neurodegenerative diseases in the population. Each disease (Alzheimer's disease, Parkinson's disease, vascular dementia, and amyotrophic lateral sclerosis) used parameters that included prevalence, incidence, and death risk ratio, and the simulation is related to the age of the cohort and the disease stage. RESULTS: A replicable simulation for predicting the prevalence and resulting cost of care for neurodegenerative diseases in the population exhibited an increase in treatment costs from 267 billion EUR in 2021 to 528 billion EUR by 2050 in the EU alone. Scenarios related to the reduction of the prevalence of dementia by up to 20% per decade led to total discounted treatment cost savings of up to 558 billion EUR. CONCLUSION: The model indicates the magnitude of the financial burden placed on EU healthcare systems due to the growth in the population prevalence of neurodegenerative diseases in the coming decades. Lifestyle interventions based on reducing the most common risk factors could serve as a prevention strategy to reduce the incidence of dementia with substantial cost-savings potential. These findings could support the implementation of public health approaches throughout life to ultimately prevent premature mortality and promote a healthier and more active lifestyle in older individuals.

Systematic Review of the Cost-Effectiveness of Home-Based Palliative Care Interventions in Patients with Cancer: A Critical Analysis.

Background: The increased prevalence of cancer and the negative impact of pain on the quality of life of patients underscore the need to implement efficient palliative care interventions and management of pain. The cost-effectiveness of palliative care interventions for cancer, mostly pharmacological and delivered through home-based palliative care services, is unclear. Most of the studies do not take into account indirect costs nor consider variations across different geographical regions. Objective: To describe existing and cutting-edge knowledge on cost-effectiveness or item costs related to palliative home-based care for patients with cancer. We evaluated various costs, including direct medical, non-medical, and indirect costs in different geographical regions and analysed how different options for care affect the patients' quality of life and associated expenses. Methods: This Prospero-registered systematic review (CRD42023404217) adhered to the PRISMA criteria. Following a multistep selection process, we selected 22 articles published between 2013 and 2023 focused on quality of life outcomes and cost-effectiveness of home-based palliative care for cancer patients. Results: Home-based palliative care decreases the number of hospital visits, while its influence on patients quality of life is currently difficult to demonstrate across geographic regions based on available evidence. Overall, home care decreases the costs associated to the palliative care of patients with cancer. The cost structure analysis revealed that besides healthcare costs, informal care expenses and productivity losses represent a significant proportion of overall expenses). In Europe, the direct medical, non-medical, and indirect costs (in purchasing power parity) were on average $1,941, $842, and $1,241, per month per person, respectively. In the USA and Asia, direct medical and indirect costs are on average $1,095 (USA) vs $1,444 (Asia) and $2,192 (USA) vs $1,162 (Asia). Conclusion: In conclusion, the studies reviewed highlight significant cost variations and potential savings associated with palliative home-based care for cancer patients. Home-based palliative care, particularly involving medications, has shown favorable cost-effectiveness compared to hospital care. Specialized palliative home care, psychological interventions, and outpatient services further contribute to overall cost savings. However, the economic impact varies across different geographical contexts and cost categories, emphasizing the need for tailored approaches in palliative care planning and implementation.

Do Regulatory Changes Seriously Affect the Medical Devices Industry? Evidence From the Czech Republic.

Background: Within the EU, some of the challenges and perceived risks now facing medical device (MD) developers result from changes in the regulatory framework, emphasizing safety. Therefore, medical technology companies must adopt stricter quality assurance measures so that individual devices can be speedily tracked and retrieved in emergency situations. Objectives: We highlight the challenges and risks faced by the European medical devices industry, particularly those faced by SMEs in the Czech Republic. We address two important research questions: Q1. Do advantages from increased regulation outweigh the additional expenses? Q2. As many MD developers are SMEs, will the new regulatory regime result in some of those companies going out of business and therefore impede future innovation? Methods: The paper focuses on a single case study, with the situation and outcomes discussed in the context of the financial results of a further 50 medical device manufacturers marketing in the Czech Republic. Results: Our findings suggest that the new legislation will result in improved safety, facilitate product recalls, but the cost and administrative burden may be high. The evidence also indicates that some SMEs may be forced to diversify to "non-medical" products, with the inevitable loss of innovative MDs being made available to patients and healthcare providers.

The effect of music on the perception of outdoor urban environment.

Music may modify the impression of a visual environment. Most studies have explored the effect of music on the perception of various service settings, but the effect of music on the perception of outdoor environments has not yet been adequately explored. Music may make an environment more pleasant and enhance the relaxation effect of outdoor recreational activities. This study investigated the effect of music on the evaluation of urban built and urban natural environments. The participants (N = 94) were asked to evaluate five environments in terms of spatio-cognitive and emotional dimensions while listening to music. Two types of music were selected: music with a fast tempo and music with a slow tempo. In contrast with a previous study by Yamasaki, Yamada & Laukka (2015), our experiment revealed that there was only a slight and not significant influence of music on the evaluation of the environment. The effect of music was mediated by the liking of music, but only in the dimensions of Pleasant and Mystery. The environmental features of the evaluated locations had a stronger effect than music on the evaluation of the environments. Environments with natural elements were perceived as more pleasant, interesting, coherent, and mysterious than urban built environments regardless of the music. It is suggested that the intensity of music may be an important factor in addition to the research methodology, individual variables, and cultural differences.

Effect of birdsongs and traffic noise on pedestrian walking speed during different seasons.

Many studies have explored the effects of auditory and visual stimuli on the perception of an environment. However, there is a lack of investigations examining direct behavioral responses to noise in specific environments. In this study, a behavioral variable, walking speed, was analyzed, as a response to the sounds and visual features of a specific environment. The study examined the effects of birdsongs compared to traffic noise on walking speed in a real outdoor urban environment. It was supposed that the interaction of audition and vision in the perception of an environment may also be shaped by the perceived congruence of the visual and auditory features of the environment. The participants (N = 87 and N = 65), young university students, walked along a 1.8-km urban route. They listened to a soundtrack of crowded city noise or birdsongs, or they walked in the real outdoor environment without listening to any acoustic stimuli. To investigate the effect of the congruence between acoustic and visual stimuli, the experiment was conducted in two different seasons (fall and spring). The results did not show significant differences between the crowded city noise condition and the real outdoor condition. Listening to the soundtrack with birdsongs decreased walking speed, but this effect was significant only in the experiment conducted in spring. These findings can be explained in terms of the congruence between the sounds and the visual environment. The findings raise questions regarding the restorative function of urban greenery during different seasons.

Effect of Traffic Noise and Relaxations Sounds on Pedestrian Walking Speed.

Exposure to noise in everyday urban life is considered to be an environmental stressor. A specific outcome of reactions to environmental stress is a fast pace of life that also includes a faster pedestrian walking speed. The present study examined the effect of listening to annoying acoustical stimuli (traffic noise) compared with relaxation sounds (forest birdsong) on walking speed in a real outdoor urban environment. The participants (N = 83) walked along an urban route of 1.8 km. They listened to either traffic noise or forest birdsong, or they walked without listening to any acoustical stimuli in the control condition. The results showed that participants listening to traffic noise walked significantly faster on the route than both the participants listening to forest birdsong sounds and the participants in the control condition. Participants who listened to forest birdsong walked slightly slower than those under control conditions; however, this difference was not significant. Analysis of the walk experience showed that participants who listened to forest birdsong during the walk liked the route more than those who listened to traffic sounds. The study demonstrated that exposure to traffic noise led to an immediate increase in walking speed. It was also shown that exposure to noise may influence participants' perception of an environment. The same environment may be more liked in the absence of noise or in the presence of relaxation sounds. The study also documented the positive effect of listening to various kinds of relaxation sounds while walking in an outdoor environment with traffic noise.

The Effect of Priming with Photographs of Environmental Settings on Walking Speed in an Outdoor Environment.

This study examined the effect of priming with photographs of various environmental settings on the speed of a subsequent outdoor walk in an urban environment. Either photographs of urban greenery, conifer forests, or shopping malls were presented or no prime was employed. Three experiments were conducted (N = 126, N = 88, and N = 121). After being exposed to the priming or no-priming conditions, the participants were asked to walk along an urban route 1.9 km long with vegetation and mature trees (Experiment 1, Experiment 3) or along a route in a modern suburb (Experiment 2). In accord with the concept of approach-avoidance behavior, it was expected that priming with photographs congruent with the environmental setting of the walking route would result in slower walking speed. Conversely, priming with photographs incongruent with the environmental setting should result in faster walking speed. The results showed that priming with the photographs with vegetation caused a decrease in overall walking speed on the route relative to other experimental conditions. However, priming with incongruent primes did not lead to a significant increase in walking speed. In all experimental conditions, the slowest walking speed was found in sections with the highest natural character. The results are explained in terms of congruency between the prime and the environment, as well as by the positive psychological effects of viewing nature.

Tempo and walking speed with music in the urban context.

The study explored the effect of music on the temporal aspects of walking behavior in a real outdoor urban setting. First, spontaneous synchronization between the beat of the music and step tempo was explored. The effect of motivational and non-motivational music (Karageorghis et al., 1999) on the walking speed was also studied. Finally, we investigated whether music can mask the effects of visual aspects of the walking route environment, which involve fluctuation of walking speed as a response to particular environmental settings. In two experiments, we asked participants to walk around an urban route that was 1.8 km in length through various environments in the downtown area of Hradec Králové. In Experiment 1, the participants listened to a musical track consisting of world pop music with a clear beat. In Experiment 2, participants were walking either with motivational music, which had a fast tempo and a strong rhythm, or with non-motivational music, which was slower, nice music, but with no strong implication to movement. Musical beat, as well as the sonic character of the music listened to while walking, influenced walking speed but did not lead to precise synchronization. It was found that many subjects did not spontaneously synchronize with the beat of the music at all, and some subjects synchronized only part of the time. The fast, energetic music increases the speed of the walking tempo, while slower, relaxing music makes the walking tempo slower. Further, it was found that listening to music with headphones while walking can mask the influence of the surrounding environment to some extent. Both motivational music and non-motivational music had a larger effect than the world pop music from Experiment 1. Individual differences in responses to the music listened to while walking that were linked to extraversion and neuroticism were also observed. The findings described here could be useful in rhythmic stimulation for enhancing or recovering the features of movement performance.