Economic Outcomes Research Articles

Real-world effectiveness of a new powered stapling system with gripping surface technology on the intraoperative clinical and economic outcomes of gastrectomy for gastric cancer

BackgroundSurgical staplers have been widely used to facilitate surgeries, and this study aimed to examine the real-world effectiveness of a new powered stapling system with Gripping Surface Technology (GST) on intraoperative outcomes of gastrectomy for gastric cancer.MethodThe data were extracted from the Fourth Hospital of Hebei Medical University’s (FHHMU) medical records system. Participants (N = 121 patients) were classified into the GST (n = 59) or non-GST group (n = 62), based on the use of the GST system. The intraoperative outcomes such as bleeding were assessed by reviewing video records. T-tests, Chi-square tests, and Mann–Whitney-U tests were used to compare the baseline characteristics between groups. Multivariate logistic regression was conducted for adjusting outcomes to study the effect of variables.ResultsCompared with the non-GST group, the GST group had significantly lower risks for intraoperative bleeding, intraoperative anastomosis intervention rate, intraoperative suture, and intraoperative pression (aORs: 0.0853 (p < 0.0001), 0.076 (p = 0.0003), 0.167 (p = 0.0012), and 0.221 (p = 0.0107), respectively). The GST group also consumed one fewer cartridge than the non-GST group (GST:5 vs non-GST: 6, p = 0.0241).ConclusionThe use of the GST system was associated with better intraoperative outcomes and lower cartridge consumption in Chinese real-world settings.

Progress toward universal health coverage in Vietnam: Evidence on dispensing trends of diabetes medications from 2015 to 2021.

This study aims to investigate the trends in treatment coverage through dispensing diabetes medications in Vietnam from 2015 to 2021. The findings will serve to inform health policies to mitigate the health burden of Type 2 diabetes mellitus (T2DM). We collected information on major antidiabetic medicines from General Department of Vietnam Customs and payments for antidiabetics via national health insurance. We applied ordinary least squares models, accounting for economic and health outcome characteristics, to estimate the association between the annual mass of medications and related factors. Nationally, the total mass/doses of all antidiabetic drugs increased rapidly from 2015 to 2021, based on both databases. Metformin was the most frequently prescribed medicine, with the total mass increasing nearly threefold over the study period. Gliclazide, a Sulfonylureas drug, ranked second. In the multivariate regression analysis, a one-unit increase in adults with diabetes (in 1000 s) was associated with 0·11 % (95 %CI = 0.0005; 0.0076) and 0·13 % (95 %CI = 0.0007; 0.0242) higher mass of Metformin and Glimepiride, respectively. Policies changes were related to significant increase of diabetes medication dispenses in Vietnam. The high treatment coverage indicates impressive progress in achieving universal health coverage in Vietnam, meeting the UN Sustainable Development Goal (SDG).

Continuity of care between dyslipidemia patients and multiple providers: A cohort study.

This study aimed to investigate the impacts of continuity of care (COC) between patients and multiple providers, i.e., doctors and community pharmacists, on clinical and economic outcomes. This is a retrospective cohort study and analyzed Korean national claims data for ambulatory care setting between 2007 and 2018. Patients with dyslipidemia newly diagnosed in 2008 were identified. COC between providers and patients was computed using the continuity of care index (COCI). Based on COCIs, the study patients were allocated to four groups: HM/HP, HM/LP, LM/HP, and LM/LP. Each symbol represents H for high, L for low, M for doctor, and P for pharmacist. The primary study outcome was the incidence of atherosclerotic cardiovascular disease (ASCVD). 126,710 patients were included. Percentages of patients in the four study groups were as follows: HM/HP 35%, HM/LP 19%, LM/HP 12%, and LM/LP 34%. During the seven-year outcome period, 8,337 patients (6.6%) developed an ASCVD, and percentages in the study groups were as follows; HM/HP 6.2%, HM/LP 6.3%, LM/HP 6.8%, and LM/LP 7.1%. After adjusting for confounding covariates, only the LM/LP group had a significantly higher risk of ASCVD than the reference group, HM/HP (aHR = 1.16 [95% confidence interval = 1.10~1.22]). The risk of inappropriate medication adherence gradually increased 1.03-fold in the HM/LP group, 1.67-fold in the LM/HP, and 2.26-fold in the LM/LP group versus the HM/HP group after adjusting for covariates. Disease-related costs were lower in the HM/HP and LM/HP groups. The study shows that patients with high relational care continuity with doctors and pharmacists achieved better clinical results and utilized health care less, resulting in reduced expenses. Further exploration for the group that exhibits an ongoing relationship solely with pharmacists is warranted.

Costs and health care resource utilization among Medicare beneficiaries diagnosed with chronic lymphocytic leukemia.

Chronic lymphocytic leukemia (CLL) is the most common type of leukemia. However, published studies of CLL have either only focused on costs among individuals diagnosed with CLL without a non-CLL comparator group or focused on costs associated with specific CLL treatments. An examination of utilization and costs across different care settings provides a holistic view of utilization associated with CLL. To quantify the health care costs and resource utilization types attributable to CLL among Medicare beneficiaries and identify predictors associated with each of the economic outcomes among beneficiaries diagnosed with CLL. This retrospective study used a random 20% sample of the Medicare Chronic Conditions Data Warehouse (CCW) database covering the 2017-2019 period. The study population consisted of individuals with and without CLL. The CLL cohort and non-CLL cohort were matched using a 1:5 hard match based on baseline categorical variables. We characterized economic outcomes over 360 days across cost categories and places of services. We estimated average marginal effects using multivariable generalized linear regression models of total costs and across type of services. Total cost was compared between CLL and non-CLL cohorts using the matched sample. We used generalized linear models appropriate for the count or binary outcome to identify factors associated with various categories of health care resource utilization, such as inpatient admissions, emergency department (ED) visits, and oncologist/hematologist visits. A total of 2,736 beneficiaries in the CLL cohort and 13,571 beneficiaries in the non-CLL matched cohort were identified. Compared with the non-CLL cohort, the annual cost for the CLL cohort was higher (CLL vs non-CLL, mean [SD]: $22,781 [$37,592] vs $13,901 [$24,725]), mainly driven by health care provider costs ($6,535 vs $3,915) and Part D prescription drug costs ($5,916 vs $2,556). The main categories of health care resource utilization were physician evaluation/management visits, oncologist/hematologist visits, and laboratory services. Compared with beneficiaries aged 65-74 years, beneficiaries aged 85 years or older had lower use and cost in maintenance services (ie, oncologist visits, hospital outpatient costs, and prescription drug cost) but higher use and cost in acute services (ie, ED). Compared with residency in a metropolitan area, living in a nonmetropolitan area was associated with fewer physician visits but higher ED visits and hospitalizations. The cooccurrence of lower utilization of routine care services, along with higher utilization of acute care services among some individuals, has implications for patient burden and warrants further study.

Toward governance, resilience, and economic outcomes in urban energy transition based on renewable energy allocation

Toward governance, resilience, and economic outcomes in urban energy transition based on renewable energy allocation

The prevalence of common mental disorders across 18 ethnic groups in Britain during the COVID-19 pandemic: Evidence for Equality National Survey (EVENS).

The COVID-19 pandemic negatively impacted mental health in the general population in Britain. Ethnic minority people suffered disproportionately, in terms of health and economic outcomes, which may contribute to poorer mental health. We compare the prevalence of depression and anxiety across 18 ethnic groups in Britain during the COVID-19 pandemic. Secondary analysis of cross-sectional data (February-November 2021) from 12,161 participants aged 18-60 years old (N with data on outcomes = 11,540 for depression & 11,825 for anxiety), obtained from the Evidence for Equality National Survey (EVENS). Data were weighted to account for selection bias and coverage bias. Weighted regression models examined ethnic differences in depression (Centre for Epidemiologic Studies Depression Scale) and anxiety (Generalised Anxiety Disorder-7). Effect modification analyses explored whether ethnic differences in outcomes were consistent within age and sex sub-groups. Compared to White British people, greater odds of anxiety caseness (and greater anxiety symptoms) were observed for Arab (OR = 2.57; 95 % CI = 1.35-4.91), Mixed White and Black Caribbean (1.57; 1.07-2.30), any other Black (2.22, 1.28-3.87) and any other Mixed (1.58; 1.08-2.31) ethnic groups. Lower odds of depression caseness (and lower depressive symptoms) were identified for Chinese (0.63; 0.46-0.85), Black African (0.60; 0.46-0.79), and any other Asian (0.55; 0.42-0.72) ethnic groups. Cross-sectional data limits the opportunity to identify changes in ethnic inequalities in mental health over time. We have identified certain ethnic groups who may require more targeted mental health support to ensure equitable recovery post-pandemic. Despite finding lower levels of depression for some ethnic groups, approximately one third of people within each ethnic group met criteria for depression.

Garlic-specific Fertilizer Improves Economic and Environmental Outcomes in China

Traditional methods of garlic fertilization involve large amounts of balanced fertilizer with equal proportions of N, P, and K, leading to nutrient imbalances, reduced yield and nutritional quality, and elevated risk of environmental pollution. This study for the first time measured garlic nutrient absorption and mineral elements status in garlic fields. In addition, a garlic-specific fertilizer formula and recommended rate were designed and applied in multiple garlic fields during the 2019–21 growing season. We assessed the performance of garlic-specific fertilizer in terms of yield, quality, and nutrient utilization efficiency. We showed that garlic prefers to absorb N and K, and its absorption of P was much lower. Deficiencies in Cl, Mn, S, and Fe are found in 98.7%, 56.1%, 22.8%, and 11.9% of garlic fields. Compared with farmer fertilization, the garlic-specific fertilizers increased sprout yield by 12.9% to 30.5%, bulb yield by 11.0% to 33.5%, and net income by 18.2% to 45.6%. Furthermore, it improved the nutritional quality [vitamin C (Vc), soluble sugar (SS), and soluble protein] of the garlic and reduced the accumulation of nitrate. The formula of special fertilizer was more in line with the law of garlic nutrient absorption, increasing the nutrient utilization effect, reducing the environmental risks. Application of specific fertilizer increased N, P, and K partial productivity by 26.6% to 50.1%, 82.6% to 116.5%, and 54.6% to 83.3%, respectively. These results suggest that replacing balanced fertilizers in the garlic market with garlic-specific fertilizers can improve garlic farmers' incomes and soil health.

Research and development expenditure gap: does women’s political empowerment matter?

ABSTRACT Sustained economic growth has been high on the list of priorities of many developed and developing nations, and the importance of new technology to sustained economic growth has long been recognized in the literature. Despite the extent of this literature and the importance of innovation to economic outcomes, surprisingly little is known about the effect of women’s political empowerment in the research sector. This study proposes filling this gap by examining the effect of women’s political empowerment on research and development expenditure. Using data from 66 developed and developing countries and system GMM estimation, we show that women’s political empowerment has exerted, on average, a positive effect on research and development investment. Moreover, further study shows that women's level of participation in civil society has the largest effect, followed by women’s civil liberties. By analyzing these underlying transmission channels, we find that this effect is partly due to the positive effects of women's political empowerment on the accumulation of human capital and on institutional quality, which in turn improve the level of spending on research and development. Based on these results, economic policy implications are discussed.

Do natural disasters affect stock price crash risk? Evidence from emerging markets

This study shows a significantly positive relationship between natural disasters and firm-level stock price crash risk using a sample of listed firms from emerging markets.The channel tests suggest that natural disasters affect crash risk by increasing corporate risk-taking, dampening firm fundamentals, and aggravating bad news hoarding. The research further identifies that the effect of natural disasters on crash risk is moderated by country-level and firm-level characteristics. Overall, our findings contribute to a broader understanding of the economic outcomes of natural disasters in emerging markets.

Impact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis

BackgroundTelemedicine, a method of healthcare service delivery bridging geographic distances between patients and providers, has gained prominence. This modality is particularly advantageous for outpatient consultations, addressing inherent barriers of travel...

An economic assessment of alternative antimicrobial use scenarios on pig farms

This paper explores the theoretical economic outcome of management changes that result in different levels of antimicrobial use (AMU) in two types of UK pig farm. A static farm economic pig production model (FEPM) was used on a representative ‘Top-third’ most profitable farm and a representative ‘Mid-range’ profitable farm. Three AMU theoretical management scenarios were investigated; (a) management changes leading to a reduction of AMU by 35% (AMU35); (b) more extensive management changes leading to a reduction of AMU by 95% (AMU95); and (c) implementing depopulation of the herd (AMU Depop). A sensitivity analysis was conducted to determine the effect of increases or decreases in pig revenue and feed price on farm gross margin under these scenarios. Over a single year, the AMU35 scenario was estimated to have a small positive impact (+3%) on both farm types. The other two AMU reduction scenarios had higher AMU reduction on farms but required higher variable cost and hence they resulted in lower farm profitability. There was a substantial reduction (up to −50%) in farm gross margin under these two AMU reduction scenarios in the modeled short-term time-period. The impact of the alternative AMU scenarios was slightly higher on a farm representing the ‘Top-third’ farm type, reducing farm gross margin further by 7% compared to the ‘Mid-range’ farm. Nevertheless, both farm types stay profitable under all three AMU scenarios. The results showed that in the modeled short-term implementing management changes that result in a reduction of on-farm AMU by 35% had a good economic outcome. In practice, the other two scenarios would be considered as longer-term strategies. Although both require higher initial costs to implement, the improved biosecurity and hygiene will benefit from lower disease occurrence for a longer term. Farm gross margins were, however, found to be highly sensitive to changes on market prices especially increasing feed prices. An increase of more than 15% in feed price moved a profitable farm into a loss-making farm. It will be economically challenging for uptakes of these, or similar, AMU reduction scenarios on farms if the market prices become un-favorable to pig farmers.

Social Vulnerability and COVID-19 Pandemic Outcomes: Evidence from Spatial Quantile Regression

This paper evaluates the empirical relevance of a prominent social vulnerability measure to local economic and public health outcomes at two distinct stages of the COVID-19 pandemic. In contrast to traditional least-squares regression, conditional quantile regression offers stronger evidence in support of social vulnerability for predicting the pandemic’s uneven economic devastation and death tolls across the United States. An extension of the spatial autoregressive geographically weighted regression model to conditional quantile regression reveals the varying role of social vulnerability within and across broad regions that were exposed to different levels of pandemic impacts.

Women’s leadership in climate-resilient agrifood systems: defining a future research agenda

Women’s leadership is increasingly considered critical for achieving climate-resilient agrifood systems. Numerous initiatives and policies highlight the business case for women’s leadership to deliver a range of positive social, economic and environmental outcomes. In this Perspective, we examine the business case, finding uneven evidence linking women’s leadership to increased resilience to climate change. We problematize the ways women’s leadership is typically understood in this area and argue that, despite the value and utility of understanding the pathways through which women’s leadership can strengthen climate-resilient agrifood systems, support for increasing women’s leadership should not be contingent on proving the business case or its instrumental value. Rather, increasing the leadership of women in all their diversity in climate action is a moral imperative and non-negotiable due to women’s human right to have meaningful influence in the decisions that affect their lives. Finally, we propose ways to reframe the debate on women’s leadership in climate and agrifood systems and suggest priorities for future research in this area.

Single-Center Experiences: A Comparison of Intracorporeal and Extracorporeal Anastomosis Outcomes in Right Hemicolectomy.

Background Anastomosis formed in minimally invasive laparoscopic right hemicolectomy (LRH) may be achieved intra-corporeally (ICA) or extra-corporeally (ECA). This study compared the return of bowel function and other associated early patient outcomes and morbidity rates after an ICA or ECA in LRH. Methodology The study conducted a single-center retrospective cohort study of elective LRH from January 2021 to September 2023. Patient demographics, surgical techniques, and outcomes were analyzed using IBM SPSS Statistics for Windows, Version 29.0 (IBM Corp.,Armonk, NY). Results Ninety participants underwent LRH, and the anastomotic type was evenly distributed - with male patients comprising 53 (58.9%) of the total. The mean age was 64 (standard deviation [SD] ±16.8) years, and the median body mass index (BMI) was 27.0 (interquartile range [IQR] = 7.8). The mean follow-up period was 5.1 (SD ± 6.0) months. Univariate analysis showed that ICA had a shorter time for return of bowel function (P < 0.01). Additionally, ICA was associated with lower pain scores (P < 0.01), low morbidity (P = 0.02), and shorter hospital stays (P = 0.01). When comparing ICA to ECA, no significant difference was observed for procedure duration (P = 0.13), anastomotic leak (AL,P = 1.00), surgical-site infections (P = 0.36), lymph node yield (P = 0.26), and any-cause mortality. Multivariate logistic regression, controlling for statistically insignificant confounding factors, revealed that ECA was significantly and independently associated with increased time to first flatus (odds ratio [OR] 2.3, P = 0.01) and higher average postoperative pain (OR 1.5, P = 0.02) compared to ICA. Conclusions This single-center experience showed that ICA is associated with a quicker return to normal bowel function and low morbidity outcomes. ICA participants were positively associated with clinically relevant and health economics outcomes of shorter hospital stays without significantly adding to the procedure's duration times or compromising principles of oncological resection yield.

Core components of pharmacist-led medication reviews and their relationship to outcomes: a systematic review

Abstract Introduction Medication reviews are a recognised intervention undertaken by healthcare professionals to support patients prescribed multiple medicines or with complex medication regimens. Pharmacist-led medication reviews are now an established intervention in policy and practice. There are different types of medication review, each implemented differently. Huiskes et al. demonstrated that medication reviews undertaken by any professional in any setting had minimal effects on clinical outcomes and that evidence is lacking about their effect on economic outcomes.[1] The implementation of medication reviews in practice was recognised as a factor which may impact outcomes, but this has not been explored further. Aim To develop an initial programme theory that links the core components of pharmacist-led medication reviews to outcomes in different contexts. Methods A systematic review was conducted to identify randomised controlled trials of medication reviews in adults (18+). The review updated that by Huiskes et al. and used the same search strategy in the MEDLINE, EMBASE and Web of Science databases.[1] The search terms used were related to ‘medication review’, ‘pharmacist’ and ‘randomised controlled trial’. Medication review was defined as “a consultation between a pharmacist and a patient to review the patient’s total medicines use with a view to improve patient health outcomes and minimise medicines related problems”. Studies reporting any outcomes were included. Papers not published in English or not available as full texts were excluded. The Cochrane Risk of Bias 2.0 tool was used to assess the studies. Data were extracted using a previously piloted bespoke data collection form. Descriptions of the medication reviews’ core components, implementation and outcomes were narratively synthesised to draw out common themes. The GRADE framework informed the overall assessment of the quality of the evidence from the studies.[2] Results Records screened n=10947, total reports of studies included n=68. Of the 50 individual studies that were identified, 66% were assessed as having a high risk of bias. Narrative synthesis of the data extracted relating to the description and implementation of the medication reviews, and where and how this may have affected outcomes, is presented in our programme theory as core components. Collaborative working may help reduce medicines-related problems and number of medicines prescribed. Patient involvement in goal setting and action planning may improve patients’ ability to take medicines as prescribed and help them achieve their treatment goals. Additional support and follow-up may lead to improved blood pressure, diabetes control, quality of life and a reduction of medicines-related problems. Conclusion This is an extensive systematic review that has explored pharmacist-led medication reviews in all settings and resulted in the production of a draft programme theory. It is best practice for stakeholders to be involved in the development of a programme theory. Providers of medication reviews can evaluate their processes and consider if and how these core components are implemented in their service provision. This initial programme theory will be refined and discussed in future research.

Sustainable coffee: A review of the diverse initiatives and governance dimensions of global coffee supply chains.

With a global footprint of 10 million hectares across 12.5 million farms, coffee is among the world's most traded commodities. The coffee industry has launched a variety of initiatives designed to reduce coffee's contribution to climate change and biodiversity loss and enhance the socio-economic conditions of coffee producers. We systematically reviewed the literature on the sustainability and governance of coffee production and developed a typology of eleven sustainability initiatives. Our review shows that coffee sustainability research has focused primarily on the economic outcomes of certification schemes. The typology expands our knowledge of novel sustainability initiatives being led by coffee farming communities themselves, allowing for an improved consideration of power dynamics in sustainability governance. Sustainability initiatives governed by local actors can improve sustainability outcomes by empowering local decision makers to assess direct risks and benefits of sustainable practices to the local environment, economy, and culture.

Improving Economic Learning Outcomes Through Problem-Based Learning Using Augmented Reality Media

This study discusses the improvement of economic learning outcomes through a problem-based learning approach using Augmented Reality (AR) media. With a focus on the application of innovative concepts in education, this study explores how the combination of an effective problem-based learning approach and engaging AR technology can improve students' understanding of economic concepts. The results show that the use of AR in economics learning can significantly improve student engagement, concept understanding, and learning outcomes. In addition, the problem-based learning approach also proved effective in improving students' critical thinking and problem-solving skills. Despite challenges related to technology availability and teacher training, the conclusions of this study emphasize the importance of integrating AR technology and innovative learning approaches in creating a more engaging and effective learning environment in the context of economics education. Further research is needed to optimize the use of this technology and evaluate its effectiveness in various educational contexts.

Performance evaluation of a novel fuel cell and wind-powered multigeneration system

The introduction of promising energy sources to satisfy human desires is extremely crucial. The present work studies the performance of an original solid oxide fuel cell-wind-based polygeneration system for producing hydrogen, sodium hypochlorite, potable water, heating, cooling, and electrical power. In the methodological concept, energy, exergy, economic, and exergoenvironmental assessments are carried out to evaluate the system performance concerning different parameters. The technical outcomes depict that the system can produce 363 kW of electrical power, 162 kW of cooling, and 46.5 kW of heating at the design operating settings while the energy and exergy efficiencies are 55.5% and 38.1%, respectively. Moreover, over a year of operation, the system can provide 19.9 × 10 4 m3 gaseous hydrogen, 50.9 ×‎ 103 m3 potable water, and 5.31 tonnes of sodium hypochlorite to increase the gained benefits from this efficient and cost-effective system. To evaluate the prevalence of the designed system, the economic outcomes demonstrate that the payback period is 1.5 years while the internal rate of return is 0.70. Moreover, the system presents relatively proper environmental benefits based on the obtained outcomes from the exergoenvironmental study; the exergoenvironmental factor, exergy stability factor, and sustainability index are 0.50, 0.56, and 1.6, respectively.

A two–stage bayesian model for assessing the geography of racialized economic segregation and premature mortality across US counties

Racialized economic segregation, a key metric that simultaneously accounts for spatial, social and income polarization in communities, has been linked to adverse health outcomes, including morbidity and mortality. Due to the spatial nature of this metric, the association between health outcomes and racialized economic segregation could also change with space. Most studies assessing the relationship between racialized economic segregation and health outcomes have always treated racialized economic segregation as a fixed effect and ignored the spatial nature of it. This paper proposes a two–stage Bayesian statistical framework that provides a broad, flexible approach to studying the spatially varying association between premature mortality and racialized economic segregation while accounting for neighborhood–level latent health factors across US counties. The two–stage framework reduces the dimensionality of spatially correlated data and highlights the importance of accounting for spatial autocorrelation in racialized economic segregation measures, in health equity focused settings.

On Some Demographic Structures and Economic Growth in Nigeria (2003–2022)

Effective development planning necessitates the integration of sound social and economic planning strategies. In Nigeria, demographic  and population data play a crucial role in shaping these plans. This research investigates the impact of demographic structure on the  country's economy, with a specific focus on key characteristics such as population size, birth rate, mortality rate, growth rate, GDP growth  rate, and fertility rate. The study analyzes demographic features alongside GDP growth rate data spanning from 2003 to 2022.  The findings reveal a robust correlation between birth rates and GDP growth, indicating that population dynamics significantly influence  economic development. Additionally, positive relationships are identified between death rates and GDP growth, underscoring the impact  of mortality issues on economic outcomes. The regression model demonstrates that demographic factors collectively mold Nigeria's  economic growth trajectory, shedding light on the intricate dynamics between demography and economic development. Through time  series analysis, the model exhibits low errors and high explanatory power. However, residual analysis highlights serial association,  emphasizing the temporal demographic effects on economic growth. Ultimately, the study underscores the potential contributions of  demographic characteristics to Nigeria's economy. Policymakers and economists keen on leveraging demographic shifts for economic  advancement will find valuable insights in this research. As demographic considerations increasingly play a pivotal role in Nigeria's  economic growth, strategic planning and decision-making must take these factors into account.