Economic Burden Research Articles

Comparison of economic burden of disease and quality of life in patients with premature ejaculation and erectile dysfunction

To compare the economic burden of disease and quality of life in patients with premature ejaculation (PE) and erectile dysfunction (ED). A convenience sampling method was used, and self-designed general information questionnaire, disease economic burden questionnaire, and SF-12 quality of life questionnaire were used to investigate 494 patients with ED and 285 patients with PE who attended a tertiary hospital in Taiyuan City from October 2021 to May 2023, and the relevant data were analysed using SPSS26.0 statistical software. The direct, indirect, intangible, and total economic burdens of the two groups were compared, and the differences were statistically significant (P < 0.05), and the direct, indirect, intangible, and total economic burdens of ED patients were higher than those of PE patients; the scores of the two groups in the dimensions of PF (physical function), RP (role physical), RE (role emotion), and MH (mental health) as well as in the MCS (mental component score), and overall quality of life scores, the differences were statistically significant (P < 0.05), with ED patients having lower quality of life scores than PE patients. Compared with PE patients, ED patients have a heavier economic burden of disease and lower quality of life, suggesting that the government and relevant departments of society should pay attention to the economic burden of disease and quality of life of ED patients and take appropriate measures to improve them.

First investigation of Ostreid herpesvirus-1 and human enteric viruses in a major scallop production area in Brazil.

Bivalve mollusks may be affected by numerous infectious diseases, which cause high mortality rates and economic burdens for producers. Another challenge for bivalve aquaculture is the protection of farms from human contamination, such as sewage and stormwater discharges. Ilha Grande Bay (IGB), located in Rio de Janeiro state, is the largest Brazilian producer of scallops (Nodipecten nodosus). This region has recently suffered a mass mortality of mollusks, and several environmental contaminants have been reported in the area. To contribute to the elucidation of scallop collapse and better characterize the human impacts, this study assessed the circulation of mollusk (Ostreid herpesvirus-1 [OsHV-1]) and human (mastadenovirus [HAdV] and norovirus GII) viral pathogens in waters and animals produced at IGB. Neither water nor animals were positive for OsHV-1. However, of the 7 points analyzed, 5 points showed contamination by HAdV or norovirus. HAdV and norovirus were detected in 5.5 and 6.9% of the analyzed water samples, respectively, in concentrations ranging from 2.39 × 103 to 1 × 105 genome copies/L. One scallop sample was positive for norovirus (4.5%). These results demonstrate human contamination in the region, presenting a risk of consumer contamination, and a non-association between OsHV-1 and the mass mortality described in scallops.

Pioneering sustainable treatment delivery in childhood leukemia through synchronous telemedicine-A pilot study.

Cancer care places a heavy economic burden on families and health systems, driven by high treatment costs, lengthy hospital stays, and the necessity for extensive travel to specialized facilities. To address this challenge, an integrated health care network (IHCN) was implemented for maintenance treatment in acute leukemia. The IHCN encompassed outpatient services provided by local physicians and synchronous telemedicine consultation with pediatric oncologists. This study included twenty-two pediatric patients (eleven [50.0%] females; twenty [90.9%] with B-ALL and two [9.1%] with AML). The IHCN was offered to all rural patients (n = 17) with a one-way driving distance more than 30 km, while urban patients (n = 5) received regular cancer care. Throughout the study, rural patients had a total of 510 routine clinical visits, with 367 (72%) conducted through the IHCN. Physical examinations revealed similar frequency of new abnormal findings for urban and rural patients (22.4% vs. 17.8%; p = .31). Laboratory tests indicated no significant difference in the frequency of abnormal values for various parameters between both groups. Similarly, there was no discrepancy of drug modifications or interruption in maintenance therapy between the two settings (p = .85). Moreover, patients' health-related quality of life remained within the normative range, and user satisfaction with the IHCN was notably high. The implementation of the IHCN resulted in savings of 70,158 km, 950 h of travel, and 12,277 kg CO2 emissions. This pilot study underscores the efficacy of a telemedicine-based IHCN, ensuring safety, quality of care, cost reduction, and satisfaction for both families and health care providers in pediatric leukemia management.

Combating Antimicrobial Resistance Through a Data-Driven Approach to Optimize Antibiotic Use and Improve Patient Outcomes: Protocol for a Mixed Methods Study.

It is projected that drug-resistant infections will lead to 10 million deaths annually by 2050 if left unabated. Despite this threat, surveillance data from resource-limited settings are scarce and often lack antimicrobial resistance (AMR)-related clinical outcomes and economic burden. We aim to build an AMR and antimicrobial use (AMU) data warehouse, describe the trends of resistance and antibiotic use, determine the economic burden of AMR in Uganda, and develop a machine learning algorithm to predict AMR-related clinical outcomes. The overall objective of the study is to use data-driven approaches to optimize antibiotic use and combat antimicrobial-resistant infections in Uganda. We aim to (1) build a dynamic AMR and antimicrobial use and consumption (AMUC) data warehouse to support research in AMR and AMUC to inform AMR-related interventions and public health policy, (2) evaluate the trends in AMR and antibiotic use based on annual antibiotic and point prevalence survey data collected at 9 regional referral hospitals over a 5-year period, (3) develop a machine learning model to predict the clinical outcomes of patients with bacterial infectious syndromes due to drug-resistant pathogens, and (4) estimate the annual economic burden of AMR in Uganda using the cost-of-illness approach. We will conduct a study involving data curation, machine learning-based modeling, and cost-of-illness analysis using AMR and AMU data abstracted from procurement, human resources, and clinical records of patients with bacterial infectious syndromes at 9 regional referral hospitals in Uganda collected between 2018 and 2026. We will use data curation procedures, FLAIR (Findable, Linkable, Accessible, Interactable and Repeatable) principles, and role-based access control to build a robust and dynamic AMR and AMU data warehouse. We will also apply machine learning algorithms to model AMR-related clinical outcomes, advanced statistical analysis to study AMR and AMU trends, and cost-of-illness analysis to determine the AMR-related economic burden. The study received funding from the Wellcome Trust through the Centers for Antimicrobial Optimisation Network (CAMO-Net) in April 2023. As of October 28, 2024, we completed data warehouse development, which is now under testing; completed data curation of the historical Fleming Fund surveillance data (2020-2023); and collected retrospective AMR records for 599 patients that contained clinical outcomes and cost-of-illness economic burden data across 9 surveillance sites for objectives 3 and 4, respectively. The data warehouse will promote access to rich and interlinked AMR and AMU data sets to answer AMR program and research questions using a wide evidence base. The AMR-related clinical outcomes model and cost data will facilitate improvement in the clinical management of AMR patients and guide resource allocation to support AMR surveillance and interventions. PRR1-10.2196/58116.

A qualitative study on the current status and problems of pharmacists in home healthcare from the viewpoint of care managers in medically underpopulated areas in Japan

BackgroundUnlike in urban areas, community healthcare in medically underpopulated areas in Japan is constantly challenged because of the uncertainty in effectively using the limited resources. However, no study has focused on human resources or identified the actual state of pharmacists’ support in the community. Therefore, our study identified the actual status and problems of pharmacists involved in home medical care in medically underpopulated areas and discussed the roles required of pharmacists and specific methods of support.MethodsThe content of semi-structured interviews with care managers involved in home healthcare in Misugi town, Tsu City, between November 10, 2023 and March 13, 2024, was analyzed qualitatively using the grounded theory approach.ResultsFive care managers participated in the study. Semi-structured interviews on the actual situation and challenges faced by pharmacists indicated that the following roles were required for pharmacists: as in other regions, it was observed that elderly people with dementia and those living alone managed their medicines, adjusted leftover medicines, collaborated with other professions, bridged with physicians, checked medication status through frequent visits, and adhered to internal medication regimens. Issues related to the characteristics of depopulated areas were identified including human resources, limitations of healthcare resources, economic burden, limits on the number of visits by pharmacists. As a characteristic of communities with no pharmacies and only in-hospital prescribing, pharmacists were expected by care managers to manage the problems caused by in-hospital prescribing.ConclusionsOur findings suggest that pharmacists should ensure the number of visits and collaborate with attending physicians, visiting nurses, and care managers to conduct drug management for patients with dementia and older adults living alone. Community healthcare specialists and those involved in the healthcare planning system can also utilize these findings while planning home healthcare to those who live in medically underpopulated areas in Japan.

MicroRNAs regulating autophagy: opportunities in treating neurodegenerative diseases

Neurodegenerative diseases (NDs) are increasingly prevalent in our aging population, imposing significant social and economic burdens. Currently, most ND patients receive only symptomatic treatment due to limited understanding of their underlying causes. Consequently, there is a pressing need for comprehensive research into the pathological mechanisms of NDs by both researchers and clinicians. Autophagy, a cellular mechanism responsible for maintaining cellular equilibrium by removing dysfunctional organelles and misfolded proteins, plays a vital role in cell health and is implicated in various diseases. MicroRNAs (miRNAs) exert influence on autophagy and hold promise for treating these diseases. These small oligonucleotides bind to the 3’-untranslated region (UTR) of target mRNAs, leading to mRNA silencing, degradation, or translation blockade. This review explores recent findings on the regulation of autophagy and autophagy-related genes by different miRNAs in various pathological conditions, including neurodegeneration and inflammation-related diseases. The recognition of miRNAs as key regulators of autophagy in human diseases has spurred investigations into pharmacological compounds and traditional medicines targeting these miRNAs in disease models. This has catalyzed a new wave of therapeutic interventions aimed at modulating autophagy.

Benchmarking the medication efficiency and technological progress of diabetes drugs

BackgroundDiabetes poses a serious global challenge, given its increasing prevalence, detrimental effects on public health, and substantial economic burden. Since 1950s, tens of drugs have been approved by the United States (US) Food and Drug Administration (FDA). In the past decade, the medical community and regulatory agencies have moved away from the glucose-centric paradigm and increasingly call for a holistic approach to assess different treatments’ benefits and harms.ObjectiveThis study aimed to assess the medication efficiency and technological progress of Type 2 Diabetes (T2D) drugs, by considering their physiological outcomes, including both benefits (i.e., glucose lowering and weight loss) and adverse effects (mortality), relative to dosing frequency.MethodsTo derive medication efficiency, this study utilized data from the US FDA and prominent meta-analyses. Given that both the benefits and adverse effects of medications are multidimensional, this study employed a nonparametric frontier method, the data envelopment analysis (DEA) model, to integrate these factors into a measure of medication efficiency. Physiological outcomes could assume both positive and negative values. Adverse effects were regarded undesirable outputs. The DEA model was built under the framework of directional distance function and was able to handle negative and undesirable values which naturally arose in the case of T2D medications.ResultsThe paper presented a ranking of 20 T2D drugs in terms of medication efficiency. Three of them were able to attain the highest medication efficiency, all of which were in the GLP-1 class, including oral Semaglutide, subcutaneous Semaglutide and Dulaglutide. However, the other two GLP-1 drugs, Lixisenatide and Liraglutide, were less efficient. The average medication efficiency of drugs approved post-2010 was significantly higher than pre-2010 drugs. High dose frequency, low HbA1c reduction and insignificant weight loss were the main driving factors behind inefficiencies. Overall, medication efficiency provided an alternative perspective on treatment effectiveness other than conventional measures such as cost-effectiveness.

Hospitalization costs in patients with stroke in southeastern China: a retrospective population-based cohort study, 2019–2022

IntroductionStroke remains a predominant cause of mortality and accounts for one-third of all stroke-related fatalities worldwide. Increasing expenses associated with stroke are a matter of significant concern; however, this aspect has been insufficiently examined.MethodsThe purpose of this study was to analyze in-hospital stroke costs and explore potential factors influencing them across stroke subtypes. The records of stroke patients from 50 hospitals in southeastern China between 2019 and 2022 were reviewed using multistage stratified cluster random sampling. We focused on the cost patterns of four stroke types and used multivariate linear regression to identify cost determinants.ResultsA total of 417 (1.1%) patients had subarachnoid hemorrhage (SAH), 9309 (25.9%) had intracerebral hemorrhage (ICH), 22,248 (61.8%) had ischemic stroke (IS), and 4025 had transient ischemic attack (TIA). The number of stroke patients has sharply increased since the onset of COVID-19, with a majority of them being male (72.2%). Despite the fact that hospitalization costs are highest in tertiary hospitals (Chinese yuan [CNY] 30610.8/United States dollar [USD] 4551.0, interquartile range [IQR] 9944.9, 29668.4/1478.6, 4410.9), the majority of patients are admitted to tertiary hospitals (74.6%) or public hospitals (90.2%). Across all stroke subtypes, patients with SAH had the highest costs (CNY 93,454.9/USD13894.4, IQR 12273.2, 169920.0/1824.7, 25262.8), followed by those with ICH (CNY 48,724.2/USD 7244.0, IQR 16789.6, 57540.7/2496.2, 8554.8), IS (CNY 26,550.3/USD3947.4, IQR 8684.2, 28697.7/1291.1, 4266.6), and TIA (CNY 11,170.1/USD1660.7, IQR 6823.7, 12965.2/1014.5, 1927.6). Therapy fees comprised a significant portion of costs in ICH and IS cases (47.9% and 42.7%, respectively). Materials accounted for the highest proportion of expenses for SAH (56.1%), whereas patients with TIA spent more time on examinations (34.1%). Linear regression analysis revealed that length of stay (LOS), stroke subtype, hospital level, and stroke type were key factors influencing hospitalization costsDiscussionThe visiting rate and charges were highest in tertiary public hospitals, and hospitalization costs were higher in hemorrhagic types of stroke than in ischemic types of stroke; the proportion of hospitalization cost categories varied among different types of stroke, with LOS, hospital type, and level substantially affecting hospitalization costs. Enhancing medical insurance reimbursement rates for hemorrhagic strokes, implementing a hierarchical medical system, tailoring cost categories to accommodate varying stroke subtypes, and shortening LOS may help alleviate the economic burden of stroke.

H2 protects H9c2 cells from hypoxia/reoxygenation injury by inhibiting the Wnt/CX3CR1 signaling pathway.

Myocardial ischemia-reperfusion injury is a severe cardiovascular disease, and its treatment and prevention are crucial for improving patient prognosis and reducing the economic burden. This study aimed to explore the impact of hydrogen (H2) on hypoxia/reoxygenation (H/R) injury in H9c2 cells (derived from rat embryonic heart tissue) induced by hydrogen peroxide (H2O2) and to elucidate its underlying mechanism. An H/R injury model was established in H9c2 cells via exposure to 15 μM H2O2 for 3 hours, followed by incubation in a 5% CO2 atmosphere at 37°C for 24 hours. Then, the cells were treated with H2 (50%) for 6, 12 or 24 hours. The results demonstrated that H9c2 cells exposed to H2O2 and subjected to H/R injury presented a marked decrease in the cell survival rate, accompanied by severe morphological alterations, such as curling and wrinkling, and elevated lactate dehydrogenase levels. Notably, H2 mitigated H/R injury induced by H2O2 in a time-dependent manner, improving the morphological damage observed in H9c2 cells and decreasing lactate dehydrogenase levels. Compared with the model group, treatment with H2 increased the activities of antioxidant enzymes, including catalase, superoxide dismutase, and glutathione peroxidase, while concurrently reducing the level of malondialdehyde, an indicator of cellular damage. Furthermore, H2 treatment downregulated the expression of inflammatory cytokines and inflammatory-related factors, specifically interleukin-6, high-mobility group box 1, tumor necrosis factor-alpha, and Toll-like receptor 4, in H9c2 cells post-H/R injury. Furthermore, H2 treatment resulted in a marked decrease in the expression levels of proteins associated with the Wnt/C-X3-C-motif receptor 1 signaling pathway, such as β-catenin, glycogen synthase kinase-3 beta, adenomatous polyposis coli, and Wnt and C-X3-C-motif receptor 1. This observation suggests a potential mechanism for its protective effects against H/R injury. Therefore, H2 exerts a protective effect against H/R injury in H9c2 cells induced by H2O2, potentially by inhibiting the activated Wnt/C-X3-C-motif receptor 1 signaling pathway. This inhibition, in turn, prevents the generation of oxidative stress, inflammatory cytokines, and inflammation-associated factors.

Wearable sensors for cardiological monitoring in the SUS: regulatory challenges and impacts on Brazilian Public Health

Cardiovascular diseases are the leading cause of death in Brazil, with approximately 400,000 deaths annually, which corresponds to almost 30% of all deaths in the country. In addition to the impact on mortality, these conditions generate an enormous economic burden for the health system, with costs associated with the treatment of diseases such as heart attack and heart failure exceeding R$50 billion per year. In this context, the use of wearable devices for continuous monitoring of cardiovascular parameters emerges as an opportunity to improve the management and prevention of these diseases. This study conducts a scoping review of the regulatory challenges involved in the incorporation of wearables into the Unified Health System (SUS), with a focus on cardiological monitoring. Articles published between 2019 and 2024 were analyzed, discussing issues such as data accuracy, interoperability between systems, protection of sensitive data, and training of health professionals. In addition, the study examines the economic and social implications of the adoption of these technologies in a context of profound socioeconomic inequalities. The results indicate that, although wearables have the potential to transform cardiovascular care in Brazil, regulatory and technical barriers still limit their large-scale adoption in the SUS. Adequate regulation, aligned with the General Data Protection Law (LGPD), and investments in infrastructure and training are essential for the safe and effective integration of these technologies into public health.

Estimated frequency and economic burden of incident fragility fractures during 2023 in Mexico.

Osteoporosis and its fractures impose a high clinical and economic burden. The objective of this analysis was to estimate the frequency and costs owing to incident fragility fractures (FFs) during the year 2023 in Mexico. This is an incidence-based cost-of-illness study. The target population is adults ≥ 50years old sustaining a fracture related to osteoporosis (caused by a fall on the same level). The model estimates the costs and productivity losses associated with their treatment within 1year post-fracture. National epidemiologic databases supplemented with information, derived from literature when appropriate, were used to estimate the frequency of new FFs during 2023 in the study population. Resource use included surgical and non-surgical inpatient or ambulatory care the patients received immediately after fracture plus the outpatient physiotherapy post-discharge and the eventual follow-up with a specialist who may prescribe pharmacotherapy. Sick days taken in employed patients were estimated from the literature. Local unitary costs of services and drugs for both public and private settings as well as average income in those occupied were applied. All costs are reported in Mexican pesos (MXN) from 2023. The model estimated a total of 229,239 FFs, among which 63% were classified as a major osteoporotic fracture, including 53,842 and 41,459 fractures located at the hip and vertebral, respectively. The total costs were estimated at 15,593 million MXN; most of them (75.2%) were attributable to acute-phase care. Fragility fractures represent a serious health problem for Mexico. Better preventive/therapeutic strategies may help to mitigate their significant financial toll.

COMPARATIVE ANALYSIS OF LIPID PROFILE IN PATIENTS WITH HEMORRHAGIC VERSUS ISCHEMIC STROKE: A CROSS-SECTIONAL STUDY

Objective: Stroke is a major cause of morbidity and mortality worldwide resulting from either an ischemic insult or rupture of a blood vessel in the brain. It not only leads to significant physical disability but also imposes emotional and economic burdens on patients and their families. Assessing the lipid profile in stroke patients is crucial, especially in ischemic stroke, where dyslipidemia plays a key role in atherosclerosis development. Elevated low-density lipoprotein (LDL) and triglycerides (TG) are important modifiable risk factors, and managing these can reduce the incidence and recurrence of strokes. Comprehensive lipid management should be a core component of stroke prevention and treatment strategies. Methods: This was a cross-sectional study in which 80 adult stroke patients (40 ischemic and 40 hemorrhagic strokes) were included on the basis of a predefined inclusion and exclusion criteria. The diagnosis of stroke was made on the basis of imaging and neurological examination. A comprehensive medical history, physical measurements (including body mass index), and lipid profiles (total cholesterol [TC], LDL, High-density lipoprotein [HDL], and TG) were recorded for all participants. Blood samples were taken after overnight fasting to ensure accuracy. Statistical analysis using SPSS version 21.0 compared lipid levels between the groups. An unpaired t-test and Chi-square test were used, with significance defined as a p&lt;0.05. Results: There was a significant difference in lipid profiles between ischemic and hemorrhagic stroke patients. Ischemic stroke patients had markedly higher levels of LDL with a mean of 129.84±36.54 mg/dL compared to 106.32±26.68 mg/dL in hemorrhagic stroke patients (p=0.0015). TC levels were also significantly elevated in ischemic stroke patients, averaging 236.22±56.26 mg/dL versus 196.48±46.24 mg/dL in hemorrhagic stroke patients (p=0.0009). Total TG were higher in ischemic stroke patients (158.54±44.68 mg/dL) compared to hemorrhagic stroke patients (128.62±39.16 mg/dL, p=0.0021). HDL levels were slightly lower in ischemic stroke patients (34.54±8.26 mg/dL) compared to hemorrhagic stroke patients (38.12±9.12 mg/dL), although this difference was not statistically significant (p=0.0696). Conclusion: There were significant differences in lipid profiles between ischemic and hemorrhagic stroke patients. Ischemic stroke patients had higher levels of LDL, TC, and TG, indicating a stronger association with dyslipidemia and atherosclerosis. These findings highlight the importance of aggressive lipid management in ischemic stroke patients to reduce recurrence risk and improve outcomes.

RNF13 protects neurons against ischemia-reperfusion injury via stabilizing p62-mediated Nrf2/HO-1 signaling pathway

BackgroundCerebral ischemia/reperfusion injury (CIRI), a common, universal clinical problem that costs a large proportion of the economic and disease burden. Identifying the key regulators of cerebral I/R injury could provide potential strategies for clinically improving the prognosis of stroke. Ring finger protein 13 (RNF13) has been proven to be involved in the inflammatory response. Here, we aimed to identify the role of RNF13 in cerebral I/R injury and further reveal its immanent mechanisms.MethodsThe CRISPR/Cas9 based knockout mice, RNA sequencing, mass spectrometry, co-immunoprecipitation, GST-pull down, immunofluorescent staining, western blot, RT-PCR were used to investigate biodistribution, function and mechanism of RNF13 during cerebral I/R injury.ResultsIn the present study, we found that RNF13 was significantly up-regulated in patients, mice and primary neurons after I/R injury. Deficiency of RNF13 aggravated I/R-induced neurological impairment, inflammatory response and apoptosis while overexpression of RNF13 inhibited I/R injury. Mechanistically, this inhibitory effect of RNF13 during I/R injury was confirmed to be dependent on the blocking of TRIM21-mediated autophagy-dependent degradation of p62 and the stabilization of the p62-mediated Nrf2/HO-1 signaling pathway.ConclusionRNF13 is a crucial regulator of cerebral I/R injury that plays its role in inhibiting cell apoptosis and inflammatory response by preventing the autophagy-medicated degradation of the p62/Nrf2/HO-1 signaling pathway via blocking the interaction of TRIM21-p62 complex. Therefore, RNF13 represents a potential pharmacological target in acute ischemia stroke therapy.

Experiences of Immigrants During Disasters in the US: A Systematic Literature Review.

As a vulnerable population, immigrants can be disproportionately affected by disasters. Because of their legal and migratory status, immigrants may have different challenges, needs, and possibilities when facing a disaster. Yet, within disaster studies, immigrants are rarely studied alone. Instead, they are often considered part of the large heterogeneous group of racial and ethnic minorities in the United States. This racial classification points to a gap in the literature and in our understanding of how disadvantaged groups may cope with disasters. To address this gap, the current study hypothesizes that: (1) Immigrants have unique experiences and disaster impacts compared to the broader aggregated category of racial and ethnic minorities in the U.S. and (2) There are variations in disaster experiences and impacts across different types of immigrant subgroups beyond refugees. To explore these hypotheses, a study of the literature across six databases from 2018 to 2023was conducted. The review identified a total of 17 articles discussing immigrant experiences during disasters. Major cross-cutting themes on immigrant disaster experiences include fear of deportation, restrictive immigration status, excessive economic burden and labor exploitation, employment rigidity, adverse health outcomes, limited informational resources and limited social capital, selective disaster relief measures, and infrastructural challenges as regards to housing and transportation. Many of the themes identified are unique to immigrants, such as the fear of deportation, restrictive immigration status and visa policies, and selective disaster relief measures.

Epigenomic biomarkers of cardiometabolic disease: How far are we from daily practice?

Determining whether someone has cardiometabolic disease (CMD), especially in the early stages, can be complicated. Risk stratification ordinarily depends on an extended process relying on medical history that typically considers blood pressure, cholesterol, smoking and diabetes status. Physicians have long relied on these key patient characteristics to assess CMD risk. However, these widely used clinical assessments are often identified later in life and by definition, in those individuals with progressed disease. This is partly because the onset of CMD naturally occurs in adulthood, however, the underlying processes can occur much earlier in life, even in the absence of obvious symptoms. For one thing, the pathways towards pathology may exist for years before symptom onset. Thus, among other things, there are opportunities to provide doctors with better insights into future disease prediction especially in younger adults with diabetes. The rapid rise in CMD together with the increased rates of obesity and diabetes in this population only emphasises the importance of predictive molecular biomarkers. One notable aspect is that traditional risk scores, such as those based on cholesterol measurements, are frequently found to be within normal ranges in younger populations. At the same time, given the significant overlap in risk factors for cardiovascular disease (CVD) and diabetes, the unmet clinical need is for early biomarkers of CMD that may help improve risk assessment in younger adults. This editorial highlights advances in the use of polygenic risk scores and emerging utility of genetic biomarkers to define intermediate CMD phenotypes discussing new classification criteria involving DNA methylation of genes to improve risk assessment. CMD is the number one cause of mortality and accounts for 31% of all global deaths. CMD is also multifactorial, comprising cardiovascular disease (CVD) and diabetes that have significant overlap in risk factors and disease biology. Diabetes is arguably the strongest risk factor for CVD development. Accounting for almost 90% of diabetes cases worldwide, type 2 diabetes (T2D) affects about 527 million people. The global economic burden is estimated at 1.3 trillion USD annually and is close to 1.8% of global GDP [1]. Despite the progress in preventive and therapeutic measures of CVD, the increasing CMD rates only underscore the important need of molecular biomarkers for early detection [2]. Determining whether someone has CMD usually involves an extended diagnostic process that has become essential for risk stratification and disease prevention [3]. While the onset of CMD typically occurs in adulthood, disease development commences much earlier, and this has scientists questioning whether molecular biomarkers could improve current prognostic risk scores. Predicting which people with T2D are most likely to develop CVD remains a significant challenge despite the recent advances in genetic mapping.Graphical abstract

At a glance: pressure injuries.

Pressure injuries, also known as pressure ulcers or 'bed sores', are caused by prolonged pressure on the skin and underlying tissues and are common in healthcare settings. They result from a variety of factors including pressure, moisture and friction, with a higher risk among older adults, post‑surgical patients and those with limited mobility or long‑term conditions. These injuries can extend hospital stays and significantly impact patient recovery and mortality risk. Prevention includes regular repositioning, the use of pressure‑relieving devices, skin care and nutritional support. The National Institute for Health and Care Excellence provides guidelines to mitigate these risks through systematic risk assessments and targeted interventions. Early detection and specialist care by a multidisciplinary team are crucial to improving patient outcomes. Consistent pplication of prevention strategies are needed to reduce incidence, improve patient care and alleviate the economic burden of thesex injuries on the NHS.

The socio-economic burden of migraine: yesterday and today

Migraine is the most frequent and costly type of headache. The analysis of the «cost of the disease» implies an assessment of direct and indirect costs expressed in monetary units. Drastic changes have recently occurred in approaches to the treatment of the disease, in connection with which there are large differences in the structure of the economic burden «yesterday and today». «Yesterday» knowledge about the pathophysiology of migraine was insufficient and various nonspecific agents were used to treat the disease, the antimigrenous effect of which was manifested as an additional one. The relatively low prices of these ineffective drugs for relieving attacks and preventing migraines were accompanied by high indirect costs due to temporary disability of patients, frequent time off from work, decreased labor productivity, family troubles, etc. Therefore, «yesterday»: the indirect costs associated with migraine therapy outweighed the direct costs. «Today» the cost of drugs for the prevention and pathogenetic agents for the relief of migraine attacks has become significantly higher and their costs are the main part of the costs of migraine therapy, However, the effectiveness of new pathogenetic agents for the treatment of migraines helps to reduce indirect costs and improve the quality of life. Awareness of the change in the ratio of direct and indirect costs, as well as the causes of this phenomenon, will increase patient compliance, correctly allocate costs and ultimately save personal and public financial resources.

Economic burden of inpatient hospitalizations for pediatric chronic kidney disease in the US.

Children with chronic kidney disease (CKD) face extensive healthcare needs, leading to substantial financial strain on both families and healthcare systems due to costly kidney replacement therapies and associated comorbidities. Limited research on inpatient healthcare utilization is available for the individual stages of pediatric CKD. This retrospective cohort study included inpatient encounters for pediatric patients (≤ 18years) using the Pediatric Health Information System Database (PHIS) between January 2016 and December 2022, with an ICD-10 code for any CKD stage (1-5). Hospitalization cost, length of stay (LOS), morbidity, and mortality data were collected. We identified 23,980 pediatric CKD cases [stage 1: 5,059, stage 2: 6,763, stage 3: 7,012, stage 4: 3,102, and stage 5: 2,044] across 49 different children's hospitals in the United States. Mortality rates were observed to increase with increasing CKD severity, but no clear trend was observed for surgical, medical, and infection rates by CKD stage.The LOS for patients with CKDstage4 and CKDstage5was56% and71% longer relative to the LOS of a typical hospitalization for a patient without CKD, and thebilled chargesfor these hospitalizations were92% and147% higher than those of a typical hospitalization. LOS and hospitalization costs were significantly higher for patients with CKD than for patients without CKD. Furthermore, pediatric patients with stage 5 CKD had significantly higher in-patient costs and all-cause hospitalization LOS compared to those with CKD stages 1-4.

Economic burden of cardiovascular diseases among elderly patients in Iran: a case from a developing country

BackgroundCardiovascular diseases (CVDs) are the leading cause of mortality and morbidity worldwide, particularly among the aging population. This study aims to evaluate the economic burden of CVDs among Iranians aged 60 years and older.MethodsA cost-of-illness study was conducted using a prevalence-based approach from a societal perspective. Cost analysis employed the bottom-up micro-costing method to assess direct medical and non-medical costs, while indirect costs were calculated using the human capital approach. Data were sourced from medical records of individuals aged 60 and older with CVDs registered in the hospital information systems of public and private hospitals in southeastern Iran. Additionally, structured face-to-face interviews were conducted with 160 caregivers or relatives serving as companions of elderly patients, using a structured questionnaire to gather data on healthcare utilization. Sensitivity analyses were performed, along with projections of the future economic burden of CVDs.ResultsThe annual total cost of CVDs among people aged 60 years and above in Iran was estimated at US$ 1,885,091,171.7 (about 1.88 billion), equivalent to 1.27% of the Iran’s GDP in 2021. Direct medical costs accounted for 90.62% of the total, with 54.72% attributed to ambulatory care. The average cost of CVDs per patient was US$ 446.2. The results of two-way sensitivity analysis provided an estimated cost range between US$ 1.2 billion and US$ 2.7 billion. By 2030, the total cost of CVDs is projected to reach US$ 21 billion.ConclusionsThe elderly population with CVDs imposes a growing economic burden on Iran’s healthcare system and society. This underscores the urgent need for effective and cost-effective interventions to prevent and manage CVDs in Iran.

Computational design and evaluation of a polyvalent vaccine for viral nervous necrosis (VNN) in fish to combat Betanodavirus infection

Viral nervous necrosis (VNN) poses a significant threat to the aquaculture industry, causing substantial losses and economic burdens. The disease, attributed to nervous necrosis viruses within the Betanodavirus genus, is particularly pervasive in the Mediterranean region, affecting various fish species across all production stages with mortality rates reaching 100%. Developing effective preventive measures against VNN is imperative. In this study, we employed rigorous immunoinformatics techniques to design a novel multi-epitope vaccine targeting VNN. Five RNA-directed RNA polymerases, crucial to the lifecycle of Betanodavirus, were selected as vaccine targets. The antigenicity and favorable physicochemical properties of these proteins were confirmed, and epitope mapping identified cytotoxic T lymphocyte, helper T lymphocyte, and linear B lymphocyte epitopes essential for eliciting a robust immune response. The selected epitopes, characterized by high antigenicity, non-allergenicity, and non-toxicity, were further enhanced by adding PADRE sequences and hBD adjuvants to increase immunogenicity. Two vaccine constructs were developed by linking epitopes using appropriate linkers, demonstrating high antigenicity, solubility, and stability. Molecular dynamics simulations revealed stable interactions between the vaccine constructs and Toll-like receptors (TLRs), essential for pathogen recognition and immune response activation in fish. Notably, vaccine construct V2 exhibited superior stability and binding affinity with TLR8, suggesting its potential as a promising candidate for VNN prevention. Overall, our study presents a comprehensive approach to VNN vaccine design utilizing immunoinformatics, offering safe, immunogenic, and effective solutions across multiple Betanodavirus species. Further experimental validation in model animals is recommended to fully assess the vaccine’s efficacy. This research contributes to improved vaccine development against diverse fish pathogens by addressing emerging challenges and individualized immunization requirements in aquaculture.