Economic Burden Research Articles

Concepts of Implied Interventions for Treating Depression: A Comprehensive Review

Hence, answering the question how a person is able to secure and maintain lifelong good mood would facilitate in deceiphering depression; a common and etiologically complex multi factorial mental health disorder which affects over 264 m individuals worldwide with tremendous effect on morbidity and economic burden. Here, our study results from more than 100 experimental and observational studies with respect to effective treatments for depression across three main groups such as: Pharmacological interventions, Psychotherapeutic approaches, and Emerging digital health solutions have been effective as implied interventions to tret Depression. While antidepressants, particularly selective serotonergic reuptake inhibitors (SSRIs), continued as the bedrock of therapy; Novel therapies with Ketamine have shown potential for treatment failure cases. Large-scale studies of Psychotherapeutic methods, such as Cognitive Behavioural Therapy (CBT) and Interpersonal Therapy (IPT), show high effectiveness rates in most populations. Digital health interventions, such as e-therapy, were potential alternatives and particularly suitable for patients in rural areas. Integrating these modalities will allow clinicians to offer more individualised and tailored care. This review provided an overview of the mechanisms of each intervention for depression as a clinical aid to inform decisions by clinicians as well as policy makers seeking to improve treatment pathways for individuals with Mood disorders and Depression.

Influence of Age and Weight Change Patterns on Knee Osteoarthritis

Background: Knee osteoarthritis is a globally alarming condition. People are now dependent and adapting to new living standards and not taking all the necessary precautions to lead day-to-day life, somehow this is accelerating the degenerative process in the body. So, aiming to find out the prevalence of knee osteoarthritis will help improve the activity of daily living performance and reduce the economic burden of society due to knee osteoarthritis. Methodology: An observational descriptive analytic study, the target population was individuals between the age group 25 to 50 years of both genders. Results: From a total of 5514 individual participants, those aged <40 years had a 7.28%, and ages >40 years had a 16.32% prevalence of knee osteoarthritis. Participants with BMI level <25 kg/m2 had 5.08%, and others having BMI of >25 kg/m2 had a 22.23% prevalence of knee osteoarthritis. Conclusion: The participants of the age group ≥40 years and with BMI ≥25 kg/m2 reported a high prevalence of knee osteoarthritis.Abbreviations: Knee osteoarthritis (KOA), & body mass index (BMI).

National Trends in Healthcare Expenditures for the Management of Skin Cancer in the United States.

Malignant melanoma and keratinocyte carcinomas account for a substantial proportion of healthcare expenditures in the United States. To estimate trends in the economic burden of skin cancer in the United States between 1996 and 2016. The Disease Expenditure Project and Global Burden of Disease databases were used to estimate annual total costs and population-standardized rates of change for skin cancer-related healthcare spending. Skin cancer expenditures totaled $23.4 billion in 2016, of which $1.4 billion (95% CI: $1.3-$1.6 billion) was melanoma-related and $22 billion (95% CI: $18-$28 billion) was keratinocyte carcinoma-related. Most spending on skin cancer management occurred in ambulatory care settings [60.7% (95% CI: 57.7%-64.3%) for melanoma and 87.8% (95% CI: 87.2%-88.2%) for keratinocyte carcinoma]. Pharmaceutical costs for melanoma have increased since 2010 to $365 million (95% CI: $327-$416 million), which represents 26.1% (95% CI: 22.6%-29.3%) of total melanoma expenditure. Skin cancer management in the United States is costly. Expenditures have increased substantially since 1996 without signs of plateauing in recent years.

Developing a Knowledge-Based Online Recommendation System to Guide STD Patients Through Their Journey

Sexually transmitted diseases (STDs) significantly impact public health, affecting one in five U.S. adults and imposing substantial economic burdens. Many at-risk individuals seek information and support online rather than through regular testing, facing challenges due to fragmented information and a lack of personalized recommendations. This study develops an online health recommendation system (OHRS) tailored for STD patients, integrating informational and emotional support based on their disease journey. Using a BERT-based named entity recognition (NER) algorithm, the system identifies patient emotions and stages from online posts, providing relevant support resources. Data collection for designing a recommendation engine included analyzing online posts and consulting healthcare experts. The system's effectiveness was validated through user-based simulation studies. Key contributions include developing text-mining algorithms, creating a knowledge-based recommendation system, and proposing design principles for AI-driven support systems for stigmatized conditions.

Economic Burden of Haemophilia from a Societal Perspective: A Scoping Review.

Haemophilia is a rare genetic bleeding disorder that leads to musculoskeletal complications. The high cost of haemophilia treatment necessitates a thorough evaluation of its economic burden. However, due to the difficulty of estimating direct non-medical, indirect, and intangible costs, studies often underestimate the actual economic burden of haemophilia. This scoping review aims to summarise economic studies in haemophilia conducted from a societal perspective. A systematic search across eight scholarly databases, grey literature, and reference lists until the5th of July 2023 was conducted to identify relevant studies. The inclusion criteria encompassed full-text, English-language publications of economic analyses in congenital haemophilia from a societal perspective. Model-based studies and those adopting a payer perspective were excluded. Costs were adjusted to international dollars (I$) and US dollars (US$) in 2022 for comparability. Out of 2993 potential sources identified, 25 studies met the inclusion criteria, covering 7226 persons with haemophilia across 22 countries. All studies reported direct medical costs, with four excluding the cost of haemostatic therapy. Fifteen studies reported direct formal non-medical costs, while eight reported direct informal non-medical costs. All but one study reported the indirect costs. The average annual costs of haemophilia varied widely based on treatment modality, disease severity, geographical location, and included cost categories. When including the cost of clotting factor replacement therapy (CFRT), the total cost for severe haemophilia without inhibitors ranged from 1566 I$ to 700,070 I$ per person per year (lowest value reported in India and highest in the United States). CFRT represented up to 99.9% of the total cost for those receiving prophylaxis and up to 95.1% for episodic treatment. Haemostatic therapies accounted for 82% of the total cost in patients with inhibitors. There is a significant heterogeneity in defining cost categories required for a comprehensive economic analysis from a societal perspective. While haemostatic therapies constitute a substantial portion of the overall cost, direct non-medical and indirect costs are crucial as they are often paid out-of-pocket and may impede access to treatment. It is essential for haematologists and economists to establish a standardised costing framework for future studies, particularly in the era of novel therapies.

CHALLENGES FACING SUSTAINABLE ENTREPRENEURSHIP

The concept of sustainable entrepreneurship is becoming an increasingly pivotal area of focus in the global effort to address a range of pressing challenges, including climate change, resource scarcity, and social inequality. Entrepreneurs who integrate economic, environmental, and social goals into their business models can serve as pivotal agents in achieving both profitability and societal well-being. Nevertheless, despite the growing interest in sustainable business models, entrepreneurs encounter considerable obstacles that impede the scalability and success of their ventures. This study focuses on the identification and analysis of the principal obstacles across five key dimensions: economic, regulatory, social, technological, and environmental. The aim of this research is to examine the difficulties encountered by those engaged in sustainable entrepreneurship and to suggest strategies for surmounting these challenges. Methodologically, the study employs a multi-dimensional approach, with each challenge examined through qualitative analysis. The economic challenges, including the high initial costs and difficulties in accessing funding, are identified as some of the most significant barriers. The presence of regulatory challenges, such as inconsistent environmental policies and the absence of governmental incentives, serves to further complicate the business landscape. Furthermore, social challenges, such as consumer reluctance to pay higher prices for sustainable products and resistance to adopting new, eco-friendly habits, also play a crucial role in hindering the success of sustainable ventures. Furthermore, the absence of access to sophisticated green technologies and the requisite expertise to deploy them constitutes a substantial technological impediment for entrepreneurs. The results of the study indicate the existence of several potential avenues for addressing these challenges. For example, the increasing consumer demand for environmentally friendly products and services, in conjunction with technological advancements, presents a substantial opportunity for sustainable entrepreneurship. The practical value of the research lies in its strategic recommendations, which encourage collaboration between policymakers, businesses, and investors. Such collaborative endeavours can facilitate the creation of an enabling environment for sustainable entrepreneurship, thereby reducing economic and regulatory burdens while simultaneously promoting technological advancements. In conclusion, the study emphasises the necessity of a coordinated approach in order to overcome the barriers faced by sustainable entrepreneurs. By capitalising on emerging opportunities and cultivating a supportive ecosystem, entrepreneurs can simultaneously achieve financial success and a positive impact on society and the environment.

Annual Clinical and Economic Burden of Medically Attended Lower Respiratory Tract Illnesses Due to Respiratory Syncytial Virus among US Infants Aged

We developed a model to project the expected annual clinical and economic burden of medically attended lower respiratory tract illnesses due to respiratory syncytial virus (RSV-LRTI) among US infants aged <12 months by combining information on population size, disease rates, mortality rates, and unit costs. Among the 3.7 million US infants aged <12 months each year, a total of 592,700 cases of RSV-LRTI (hospitalizations: 48,499; emergency department visits: 144,599; outpatient clinic visits: 399,602) were projected to occur, yielding total annual costs of $1.6 billion. The annual burden of RSV-LRTI among US infants is considerable, especially among those aged <3 months, who account for 43% of total costs.

Global and Regional Economic Burden of Eating Disorders: A Systematic Review and Critique of Methods.

This systematic review aims to comprehensively examine up-to-date evidence on the economic burden of eating disorders (EDs), both globally and by region. A comprehensive search within five electronic databases, MEDLINE, Embase, CINAHL, PsycINFO, and EconLit, retrieved studies published from August 1, 2013, to June 30, 2024. Cost of illness (COI) studies, burden of disease, and other cost studies that reported costs in monetary values were included, and cost-effectiveness analysis studies were excluded. The quality of COI studies was assessed using Schnitzler's checklist. All cost estimates were converted into 2024 USD purchasing power parity (PPP). The PROSPERO registration number is CRD42022358136. Twenty-six studies were identified for inclusion in this review, with 11 COI studies. The nationwide annual financial cost of EDs is estimated at PPP-USD 70.5 billion. Indirect costs contributed 70%-93% of total financial costs in the reviewed studies. Intangible costs (burden of disease) were estimated to be PPP-USD 355.6 billion. About half of the COI studies met 60% of the elements of Schnitzler's checklist, either completely or partly. The number of COI studies has more than doubled in the last 10 years. Findings can inform healthcare administrators/policymakers to understand the magnitude of this burden when setting healthcare priorities and allocating resources to maximize social welfare. However, there are variations in the methods (thus quality) and perspectives used to assess this economic burden. Findings suggest that there is potential for enhancing the methodological rigor of future research.

Urgent Reversal of Direct Oral Anticoagulants in Critical and Life-Threatening Bleeding: A Multidisciplinary Expert Consensus

Direct oral anticoagulants (DOACs) are increasingly being used due to their improved efficacy/safety ratio and lower clinical and economic burden when compared to vitamin K antagonists. However, bleeding is still the most frequent complication associated with DOACs, and although rare, bleeding episodes can be life-threatening or critical. The impact of DOAC anticoagulation activity during a bleeding event must be evaluated according to patient clinical assessment, dosage and time from last intake, the presence of comorbidities (especially kidney and liver dysfunction), and, whenever possible, coagulation tests. Unfortunately, DOACs’ anticoagulation activity is not easily or usually detectable in routine common coagulation testing. Specific DOAC tests allow for specific drug monitoring, but they are too time consuming, and are usually unavailable in routine emergency practice. If a clinically relevant DOAC plasma concentration is assumed or proven in a severe bleeding scenario, DOAC reversal is needed to restore hemostasis. This experts’ consensus provides a narrative review about DOAC reversal and practical life-threatening bleeding management in several scenarios (trauma, intracranial hemorrhage and gastrointestinal bleeding), focusing on the selection of patients to whom specific reversal agents should be given.

Using Chronic Kidney Disease as a Model Framework to Estimate Healthcare-Related Environmental Impact.

While the economic and clinical burden of chronic diseases are well documented, their environmental impact remains poorly understood. We developed a framework to estimate the environmental impact of a disease care pathway using chronic kidney disease (CKD) as an example. A life cycle assessment framework was developed for the CKD care pathway and validated by experts. Life cycle stages were characterised for resource utilisation based on a literature review and ecoinvent database inputs, in ten countries. The ReCiPe impact assessment method was used to calculate impacts across multiple environmental dimensions. At CKD stage5, kidney replacement therapies (KRT) have highest impact; emissions ranged between 3.5 and 43.9kg carbon dioxide equivalents (CO2e) per session depending on dialysis modality, and 336-2022kgCO2e for kidney transplant surgery, depending on donor type. Hospitalisations have a substantial environmental impact: a 1-day intensive care stay had highest impact (66.4-143.6kgCO2e), followed by a 1-day hospital stay (28.8-63.9kgCO2e) and an 8-h emergency room visit (14.4-27.5kgCO2e). Patient transport to and from healthcare sites was a key driver of environmental impact for all life cycle stages, representing up to 99.5% of total CO2e emissions. Full care pathways should be analysed alongside specific healthcare processes. Application of this framework enables quantification of the environmental benefits of preventative medicine and effective management of chronic diseases. For CKD, early diagnosis, and proactive management to reduce the need for KRT and hospitalisations could improve patient outcomes and reduce environmental burden.

The California collaborative network to promote data driven care and improve outcomes in early psychosis (EPI-CAL) project: rationale, background, design and methodology.

A prolonged first episode of psychosis (FEP) without adequate treatment is a predictor of poor clinical, functional, and health outcomes and significant economic burden. Team-based "coordinated specialty care" (CSC) for early psychosis (EP) has established effectiveness in promoting clinical and functional recovery. However, California's CSC program implementation has been unsystematic and could benefit from standardizing its processes and data collection infrastructure. To address this, we established a consortium of EP clinics across the state via a Learning Health Care Network (LHCN) framework to develop the Early Psychosis Intervention Network of California (EPI-CAL). EPI-CAL's LHCN developed a core battery of evidence-based measures for service users and family members and linked them together using a unique data collection and visualization application, Beehive. EPI-CAL's LHCN collects, visualizes, and aggregates data at the individual and clinic level for EP programs across California via Beehive. Beehive was designed to: (1) collect outcomes data from service users receiving care at EP programs and their support persons, (2) provide the data to providers on a secure web-based dashboard to support measurement-based care, and (3) allow data to be used for program or research analysis. We will (1) determine the feasibility of implementing an LHCN across a diverse, decentralized network of early psychosis programs, (2) determine if the implementation of an LHCN increases the delivery of measurement-based care, and (3) determine if the implementation of measurement-based care is associated with significant improvements in key service user outcomes. EPI-CAL's network will contribute data to the Early Psychosis Intervention Network (EPINET) program. The current study aims to establish an LHCN of EP clinics in California that implements harmonized data collection using Beehive and assesses the feasibility of establishing such a network. Our goal is for this harmonized data collection approach to be used to inform decisions and develop learning opportunities for service users, staff, and administrators, and to improve outcomes for service users and their supporters in CSC care. Further, the data will enable programs and research teams to examine what elements of care lead to program success and improved treatment outcomes for service users. www. gov , identifier NCT04007510; registered 07/05/2019.

Direct Visualization of Hepatitis C Virus RNA in Living Cells and Mice.

RNA virus infection is a global health issue with a significant economic burden. Direct visualization of the viral RNA genome in living cells is crucial for virological research and early clinical diagnosis. Thus, the need to continue research to find imaging toolkits is urgent. The RNA G-quadruplex (G4), a noncanonical secondary structure with stacked planar G-quartets, has recently been demonstrated in the RNA genomes of various viruses, especially the hepatitis C virus (HCV). Recent advancements in small molecular fluorescent probes have paved the way for a novel method of visualizing RNA G4s. Herein, we describe a fluorogenic probe-based RNA G4s light-up system for visualizing the HCV genome in living host cells and HCV RNA-presenting mini-organ-bearing mice without complicated sample pretreatment. Using this approach, we achieved (i) the visualization of HCV RNA genome in living cells, (ii) the investigation of viral RNA subcellular distribution, (iii) the dynamic tracking of native HCV infection and propagation in the host cell, and (iv) the high-contrast HCV RNA imaging in living mice bearing the HCV RNA-presenting mini-organ.

Global, Regional, and Country-Level Economic Impacts of Oral Conditions in 2019.

The recent World Health Organization (WHO) Oral Health Resolution and the subsequent WHO Global Oral Health Action Plan highlight the key relevance of providing information on the economic impacts of oral conditions. The purpose of this study was to provide updated estimates for the global, regional, and country-level economic impacts of oral conditions in 2019. Extending previously established methods, dental expenditures (costs for treatments) and productivity losses for 5 oral conditions (caries in deciduous and permanent teeth, periodontitis, edentulism, other oral diseases) were estimated for the year 2019. The estimated total worldwide economic impacts of oral conditions in 2019 were US $710B, of which US $387B (US $327B to US $404B) was due to direct costs and US $323B (US $186 to US $460) was due to productivity losses for the 5 main oral conditions. Low-income countries spent an average of US $0.52 (US $0.22 to US $0.96) per capita on dental care, while high-income countries spent an average of US $260 (US $257 to US $268) per capita-a 500-fold difference. These findings suggest that oral conditions continue to substantiate an enormous economic burden to individuals and society. The comprehensiveness of estimates supersedes that of previous work as the primary information on direct costs was identified for a larger number of countries. The need for more and better routine reporting and monitoring of the economic impact of oral conditions is emphasized. The relevance of such information is also highlighted by its inclusion in the first-ever WHO Global Oral Health Status Report and Global Strategy on Oral health 2023 to 2030. Given the persistently high economic burden of oral conditions, there is a key role for better prioritization of cost-efficient oral health programs as well as needs-responsive capacity planning.

ACSL3 is a promising therapeutic target for alleviating anxiety and depression in Alzheimer's disease.

Alzheimer's disease (AD), the leading cause of dementia, affects over 55 million people worldwide and is often accompanied by depression and anxiety. Both significantly impact patients' quality of life and impose substantial societal and economic burdens on healthcare systems. Identifying the complex regulatory mechanisms that contribute to the psychological and emotional deficits in AD will provide promising therapeutic targets. Biosynthesis of omega-3 (ω3) and omega-6 fatty acids (ω6-FA) through long-chain acyl-CoA synthetases (ACSL) is crucial for cell function and survival. This is due to ω3/6-FA's imperative role in modulating the plasma membrane, energy production, and inflammation. While ACSL dysfunction is known to cause heart, liver, and kidney diseases, the role of ACSL in pathological conditions in the central nervous system (e.g., depression and anxiety) remains largely unexplored. The impact of ACSLs on AD-related depression and anxiety was investigated in a mouse model of Alzheimer's disease (3xTg-AD). ACSL3 levels were significantly reduced in the hippocampus of aged 3xTg-AD mice (via capillary-based immunoassay). This reduction in ACAL3 was closely associated with increased depression and anxiety-like behavior (via forced swim, tail suspension, elevated plus maze, and sucrose preference test). Upregulation of ACSL3 via adenovirus in aged 3xTg-AD mice led to increased protein levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor C (VEGF-C) (via brain histology, capillary-based immunoassay), resulting in alleviation of depression and anxiety symptoms. The present study highlights a novel neuroprotective role of ACSL3 in the brain. Targeting ACSL3 will offer an innovative approach for treating AD-related depression and anxiety.

The economic burden of nosocomial infections for hospitals: evidence from Germany.

Nosocomial infections (NI) significantly worsen patient outcomes, resulting in higher mortality rates and reduced health-related quality of life. Furthermore, they pose substantial economic strain on healthcare systems and hospitals. For instance, patients with nosocomial infections (NIs) experience prolonged hospital stays compared to those without NIs. These extended stays result in occupied bed-days, leading to opportunity costs for hospitals. This study aimed to estimate the opportunity costs for a German hospital based on hospital stays, daily revenue, and occupancy rates (OCR). We analysed cost data obtained from routine records maintained by the accounting department of a German hospital's surgical and orthopedic units from 2018 to 2019 for the "HygArzt" research project. To ensure balance, we employed genetic matching. We estimated the differences in length of stay (LOS) and daily revenue between patients with and without nosocomial infections (NI) using linear regression. Finally, we calculated the opportunity cost borne by the hospital by treating NI patients instead of non-NI patients. All costs are reported in 2018 Euros. The final sample included 81 patients with NI matched with 207 patients without NI. The majority of the NI patients (77.0%) had surgical site infection (SSI). Compared to non-NI patients, we observed that NI patients had a longer LOS (10 days, p < 0.001) and lower daily revenue (€400, p < 0.001). We also found that comorbidities and the frequency of operations had significant impact on the LOS. Using a baseline 30 to 50% preventable NIs, successful prevention of a single NI could potentially reduce the length of hospital stay by 3 to 5 days and increase hospital revenue by approximately €120 to €200 per day per prevented NI. Consequently, the hospital saves 3 to 5 more bed-days to backfill and generate more revenue, and/or make more efficient resource allocation by changing bed-capacity and staffing. The resulting opportunity costs can potentially exceed €1,000 per preventable case. NIs pose a substantial economic burden for hospitals. From a health economics' perspective, there are strong economic incentives for hospitals to implement infection control interventions, such as the involvement of a prevention link physician/nurse.

Public health and economic impact of COVID-19 vaccination with the Pfizer-BioNTech COVID-19 Vaccine, KP.2, among adults in 2024/2025 in the United States

ABSTRACT Objectives To assess the public health and economic impact of vaccination with the Pfizer-BioNTech COVID-19 vaccine, KP.2, in 2024/2025 in the United States. Methods A combined cohort Markov-decision tree model was used to estimate the cost-effectiveness and budget impact of vaccination versus no vaccination in adults aged ≥18 years. The adult population was further stratified into 18-64 years and ≥65 years age groups. Public health surveillance data informed the annual proportion of individuals infected with and vaccinated against SARS-CoV-2 and the proportion of those infected who were hospitalized, stratified by age. Other age-stratified clinical, cost, and vaccine effectiveness parameters were informed by literature. The budget impact analysis was based on a hypothetical 1-million-member plan and used a payer perspective. Parameter uncertainty was tested in sensitivity analyses. Results Without vaccination, the model projected 21.4 million new symptomatic cases, 15,793 deaths, 629,098 hospitalizations, $115.5 billion in total costs, and 1 million QALYs lost among adults aged ≥18 years, with the greatest health burden observed among older adults aged ≥65 years (72% of hospitalizations and 86% of deaths) and the greatest economic burden in adults aged 18 to 64 years (62% of total costs). Vaccination was projected to prevent 915,501 cases, 1,057 deaths, and 37,489 hospitalizations, resulting in cost savings of $513 million, 9,173 LYs gained, 56,482 QALYs gained, and a dominant ICER. In the budget impact analysis, vaccination was estimated to result in total incremental cost savings for the population aged ≥ 65 years and a modest budget increase for the population aged 18 to 64 years. Conclusions Vaccination with the Pfizer BioNTech COVID-19 vaccine, KP.2, is a cost-effective measure from the societal perspective at a willingness-to-pay threshold of $50,000 that could reduce the health and economic burden of COVID-19.

Effectiveness of a Complementary Telehealth Education Program as a Preventive Treatment for Chronic Migraine: A Randomized Pilot Study

Background/Objectives: Chronic migraine (CM) is a neurological disorder that causes significant disability, loss of productivity, and economic burden. Preventive treatments, including pharmacological and educational interventions, are crucial for managing CM effectively. The aim of this study was to analyze whether adding a therapeutic telehealth education program (TTEP) to pharmacological treatment achieved a greater reduction in the number of headache days experienced by patients with CM. Methods: A randomized, double-blind, controlled pilot study with two parallel groups was performed. Patients with a diagnosis of CM and who were being treated with Botulinum Toxin were randomly assigned to either the EG (therapeutic education program about the neuroscience of pain, migraine, pain strategies, sleep habits, exercise, nutrition, postural habits, and relaxation strategies) or CG (general health recommendations with no specific content about migraine). The intervention lasted a total of eight weeks and was delivered via a telehealth application (APP). Headache frequency, migraine frequency, pain intensity, headache impact, allodynia, fear of movement, pain catastrophizing, chronic pain self-efficacy, anxiety and depression, sleep quality, and sedentary lifestyle were measured at baseline (M0), one month after the intervention started (M1), at the end of the intervention (M2), and one month after the intervention was completed for follow-up (M3). Results: In total, 48 patients participated. There were differences between the groups in the following outcomes in favor of EG for headache frequency at the one-month follow-up (p = 0.03; d = 0.681); chronic pain self-efficacy at post-treatment (p = 0.007; d = 0.885) and at the one-month follow-up (p &lt; 0.001; d = 0.998); and sleep quality at post-treatment (p = 0.013; d = 0.786) and at the one-month follow-up (p &lt; 0.001; d = 1.086). No differences existed between the groups for the other outcomes examined (p &lt; 0.05). Conclusions: The use of TTEP reduced the number of headache days, improved sleep quality, and increased self-efficacy in managing pain. This pilot study suggests that the addition of a specialized TTPE to pharmacological treatments may be more effective than a general health recommendation program for migraine.

The association between adipokines dysregulation and the occurrence of atrial fibrillation and obese patients, is it relevant?

Atrial fibrillation (AF) is the most common arrhythmia, affecting approximately 33.5 millions of people worldwide. Unfortunately, the prevalence of this arrhythmia will increase within the following two decades, resulting in a higher mortality rate and a higher economic burden for public health services. Obesity, specifically central obesity, plays an essential role in developing AF by increasing pericardial fat and epicardial adipose tissue thickness, generating a chronic inflammation state where dysregulation of the serum concentration of several proinflammatory proteins occurs and indirectly promotes AF. Therefore, recent research has focused on analyzing the circulating concentration of different molecules, including pro and anti-inflammatory adipokines, and their association with AF. Herein, we review several studies addressing the association of adipokines with the onset or recurrence of AF to establish such association as a potential biomarker for the prevention or adequate treatment of this arrhythmia. We concluded that the insight into this topic is very controversial and needs further research.

Mapping gaps and exploring impairment and disability prevalence in South Asian (SAARC) countries: a scoping review

Despite the considerable health and economic burden of disability in the South Asian (SA) region, there is limited evidence of impairments and disabilities prevalence and the need for Assistive Technologies (ATs). This scoping review aims to synthesise the evidence of the impairments and disabilities in SA countries. This review followed Arksey and O’Malley’s methodological framework. EBSCOhost, EMBASE, PubMed, and Web of Science databases were searched for original research articles from SA countries. In this study, impairment and disability refer to functional limitations restricting individuals from performing activities, including visual, hearing, speaking, cognitive, mobility, and self-care difficulties. The review included full-text, English-language articles addressing any impairment and disability, without restrictions on publication date. This review identified 105 articles distributed over the six impairment and disability domains: visual, hearing, mobility, self-care, speaking, and cognitive. Most evidence originated from India (50.5%) and focused on visual impairments (53.3%). The review identified that heterogeneity in methodologies, case identification definitions, and study settings contributed to variations in prevalence estimation and restricted the comparability within and across countries. Besides, the uneven distribution of studies across countries suggests varying inclinations of countries toward specific impairment and disability domains. The review identified variations in prevalence due to differences in methodologies, definitions, and contexts. The review also identified the uneven distribution of studies, limited evidence on ATs, reliance on self-reported data, and lack of nationally representative research. Future research should use standardised case identification and evidence-based approaches to enhance comparability and minimise response biases.

Reducing healthcare costs by timely diagnosis and management in functional motor disorders.

Functional motor disorders (FMDs) are prevalent and highly disabling conditions among young adults, leading to reduced independence. Despite advancements in diagnosis and treatment, the economic burden of FMDs remains largely unknown. This study evaluates the impact of accurate FMDs diagnosis on direct healthcare costs within the Italian National Health System by comparing healthcare utilization and costs before and after diagnosis. This before-after study included 40 patients with a definite diagnosis of FMDs. Retrospective data on healthcare utilization, including diagnostic tests, specialist visits, hospitalizations, Emergency Room (ER) visits, and rehabilitation services, were collected from diaries and documents two years before and after diagnosis. Healthcare direct costs decreased by 67%, from an average of €4,467 [95% CI 3,604-5,329] to €1,461 [95% CI 945-1,976] after diagnosis. Hospitalization costs fell from €2,618 [95% CI 1,899-3,336] to €492 [95% CI 162-821], and ER costs dropped from €403 [95% CI 177-628] to €43 [95% CI 6-78]. Diagnostic procedure costs decreased significantly, from €403 [95% CI 177-628] to €43 [95% CI 6-78]. Specialist visit costs remained unchanged. Rehabilitation costs increased from €371 [95% CI 194-547] to €635 [95% CI 318-915], but this rise was not statistically significant. Accurate diagnosis of FMDs significantly reduces healthcare costs by minimizing unnecessary tests, hospitalizations, and ER visits while emphasizing rehabilitation. This highlights the economic and clinical benefits of improved diagnostic accuracy and specific multidisciplinary intervention. Investing in cost-effective diagnostic tools is crucial for earlier diagnosis and reducing delays.