Future Health Benefits Research Articles

Awareness of Human Papilloma Virus and Its Association with Cervical Cancer among Female University Students: A Study from United Arab Emirates

Cervical cancer is the neoplasm of the uterine cervix in women, which is highly preventable. With the advent of vaccination against HPV infection, a gradual decline in the incidence of cervical cancer cases has been observed in developing countries. The developing nations bear the brunt of cervical cancer incidence due to low acceptance of vaccination. This survey-based study was designed to assess the awareness and opinions of female university students regarding human papilloma virus, vaccination and cervical cancer. A survey questionnaire was distributed among female expatriate students (18 to 26 years of age) of a private university. The survey sought information on socio-demographic characteristics, family and personal health history, knowledge of cervical cancer, its association with HPV, preventive care and their opinions on vaccination. GraphPad was used for statistical calculations. Of the 269 respondents, only 6% had attended awareness programs and 11% reported having read any information leaflet. 78% of the respondents did not know how HPV infection occurs and less than 40% of the participants believed that cervical cancer is preventable. 75% of the respondents had not heard about the PAP smear test. 20% of the participants stated that they were uninterested in taking the vaccination and only 5% of the survey respondents had received vaccination. Majority of the respondents (78%) demonstrated positive attitude towards practices related to influence of nutrition in having a disease-free life. The present study indicates low levels of awareness regarding HPV and its role in cervical cancer among female university-going students. It was found that the awareness of HPV, their role in cervical cancer development and the availability of information regarding vaccination was very low. The authors recommend that educational institutions and government health authorities must offer a well-designed comprehensive awareness cum vaccination camp in order to educate young women about HPV infection and risk of developing cervical cancer. This will help ensure future economic and health benefits for all.

Potential health benefits of sustained air quality improvements in New York City: A simulation based on air pollution levels during the COVID-19 shutdown

New York City (NYC) experienced a sharp decline in air pollution during the COVID-19 shutdown period (March 15, 2020 to May 15, 2020)—albeit at high social and economic costs. It provided a unique opportunity to simulate a scenario in which the city-wide air quality improvement during the shutdown were sustained over the five-year period, 2021 through 2025, allowing us to estimate the potential public health benefits to children and adults and their associated economic benefits.We focused on fine particulate matter (PM2.5) and modeled potential future health benefits to children and adults. The analysis considered outcomes in children that have not generally been accounted for in clean air benefits assessments, including preterm birth, term low birthweight, infant mortality, child asthma incidence, child asthma hospital admissions and emergency department visits, autism spectrum disorder, as well as adult mortality.We estimated a city-wide 23% improvement in PM2.5 levels during the COVID-19 shutdown months compared to the average level for those months in 2015–2018 (the business as usual period). Based on the data for 2020, we extrapolated the ambient levels of PM2.5 for the following five-year period. The estimated cumulative benefits for 2021–2025 included thousands of avoided cases of illness and death, with associated economic benefits from $31.8 billion to $77 billion.This “natural experiment,” tragic though the cause, has provided a hypothetical clean air scenario that can be considered aspirational—one that could be achieved through transportation, climate, and environmental policies that support robust economic recovery with similarly reduced emissions.

Simulating the impact of health behavior interventions in the SNAP-Ed population.

In 2020, the US invested $441 million dollars in the Supplement Nutrition Assistance Program Education (SNAP-Ed), a program that encourages a healthy diet and promotes physical activity. Understanding the long-term health outcomes associated with promoting physical activity versus weight loss among the low-income population it serves could help guide the direction of future program efforts. We used the Future Americans Model (FAM), a microsimulation, to model over 10years the impacts of changes in Body Mass Index (BMI) and exercise interventions on future health outcomes among adults aged 25 and older that could potentially accrue from SNAP-Ed interventions. We applied data from the Panel Study of Income Dynamics and data collected from 2,323 SNAP-Ed eligible adults in Los Angeles County in 2019. By 2029 interventions that increased vigorous physical activity by 20% would reduce the prevalence of difficulties with activities of daily living (ADL) by 4.72%. Interventions that would reduce BMI by 0.5 could decrease the prevalence of diabetes and heart disease by 5.34% and 0.66%, respectively. Helping people maintain weight loss, even as little as 3-4lb, results in significant future health benefits. Given continued increases in weight at the population level, weight maintenance should be a focus of future interventions.

The Health Benefits of Dietary Fibre.

Background: Dietary fibre consists of non-digestible forms of carbohydrate, usually as polysaccharides that originate from plant-based foods. Over recent decades, our diet within Westernised societies has changed radically from that of our hominid ancestors, with implications for our co-evolved gut microbiota. This includes increased ingestion of ultra-processed foods that are typically impoverished of dietary fibre, and associated reduction in the intake of fibre-replete plant-based foods. Over recent decades, there has been a transformation in our understanding of the health benefits of dietary fibre. Objective: To explore the current medical literature on the health benefits of dietary fibre, with a focus on overall metabolic health. Data Sources: We performed a narrative review, based on relevant articles written in English from a PubMed search, using the terms ‘dietary fibre and metabolic health’. Results: In the Western world, our diets are impoverished of fibre. Dietary fibre intake associates with overall metabolic health (through key pathways that include insulin sensitivity) and a variety of other pathologies that include cardiovascular disease, colonic health, gut motility and risk for colorectal carcinoma. Dietary fibre intake also correlates with mortality. The gut microflora functions as an important mediator of the beneficial effects of dietary fibre, including the regulation of appetite, metabolic processes and chronic inflammatory pathways. Conclusions: Multiple factors contribute to our fibre-impoverished modern diet. Given the plethora of scientific evidence that corroborate the multiple and varied health benefits of dietary fibre, and the risks associated with a diet that lacks fibre, the optimization of fibre within our diets represents an important public health strategy to improve both metabolic and overall health. If implemented successfully, this strategy would likely result in substantial future health benefits for the population.

Cost-effectiveness of treatment of women aged 70years and older with both osteopenia and microstructural deterioration.

Treatment is usually withheld from women with osteopenia even though they are the source of over 70% of all women having fragility fractures. As microstructural deterioration increases fracture risk and zoledronate reduces it, we aimed to determine whether identifying and treating women with osteopenia and severe microstructural deterioration is cost-effective. We also compared the health economic outcomes of 'global' versus 'targeted' treatment using SFS of women aged ≥70years with osteopenia. We assessed the cost-effectiveness from using a Markov model that simulated 10-year follow up of women with osteopenia. Decision analysis compared measurement of distal radial microstructure using high resolution peripheral computed tomography (at a cost of USD $210) to target women with severe microstructural deterioration for zoledronate treatment, compared to standard care defined as measurement of bone mineral density (BMD) with treatment recommended when femoral neck BMD T score is ≤-2.5 SD with or without a prevalent fracture. In the 'global' treatment approach, high resolution peripheral quantitative tomography (HRpQCT) was not undertaken. US healthcare system. A hypothetical cohort of 1000 women aged ≥70years with osteopenia and no previous fractures was studied. Fractures, deaths, years of life lived, quality-adjusted life years (QALYs) lived and costs. Data inputs were obtained from published sources. A 3% annual discount rate was applied to future health benefits and costs. Women in the standard care group incurred 327 fractures during 7341.0years and 4914.2 QALYs lived. Women in the intervention group incurred 300 fractures (number needed to treat 37) during 7359.2years and 4928.8 QALYs lived. Net costs were USD $4,862,669 and $4,952,004, respectively, equating to 18.1years of life saved and 14.6 QALYs saved, and incremental cost-effectiveness ratios of $4992 per year of life saved and $6135 per QALY saved. These ratios are well within the threshold considered to be cost-effective. Sensitivity analyses indicated the results were robust. Relative to standard of care, 'global' and 'targeted' treatment respectively resulted in 0.0364 vs. 0.0181years of life (YoLS) saved per person, and 0.0292 and 0.0146 QALYs saved per person. The net costs per person for the respective approaches were $US 359 and $US 89. The incremental cost-effectiveness ratios were $9864 per YoLS and $12,290 per QALY saved for the 'global' approach and $4992 per YoLS and $6135 per QALY saved for the 'targeted' approach. Identifying and treating women ≥70years of age with osteopenia and microstructural deterioration with zoledronate cost-effectively reduces the morbidity and mortality imposed by fragility fractures. This 'targeted' approach is more cost-effective than a 'global' approach and incurs only 25% of total costs. Women with osteopenia with bone fragility due to microstructural deterioration should be identified and targeted for treatment. Women with osteopenia have 70% of fractures. Treating those with microstructural deterioration conferred an incremental cost-effectiveness ratio of $4992/year of life saved and $6135 per QALY saved.

Clinical And Cost Efficacy Of Immunotherapy As A First Line Of Treatment Of Nonsquamous Metastatic Non-Small-Cell Lung Cancer

The aim of the study was to model ling local data on costs and health benefits of alternative immunotherapies for first-line treatment of patients with non-squamous metastatic non-small cell lung cancer (ncqNSCLS) and to make an indirect comparison of their health cost ratios and benefits based on network meta-analysis. The inputs data for the model were measured and evaluated clinical endpoints in the randomized multicentre clinical trials IM power 130, KEYNOTE 189, and Check Mate 026. Modelling data for future health benefits and costs after the end of clinical trials using Markov model had three health states, one of which is an absorbent condition. Tree Age Pro Healthcare software was used to modelling the data. Atezolizumab in combination with chemotherapy (nab-paclitaxel, carboplatin) is a cost-effective first-line therapy for patients with nsqNSCLC compared to pembrolizumab in combination with chemotherapy (pemetrexed, carboplatin) and nivolumab immunotherapy alone. A probabilistic susceptibility analysis found that the probability of atezolizumab in combination with chemotherapy being a cost-effective therapy compared to pembrolizumab in combination with chemotherapy and compared to nivolumab monotherapy was 88% and 75%, respectively. Modelling data on health benefits and costs after the end of clinical trials creates some uncertainty about therapeutic efficacy and safety in the long-term monitoring.

Application of the Minority Stress Theory: Understanding the Mental Health of Undocumented Latinx Immigrants.

This paper applies the Minority Stress framework to data collected from an ongoing community-based participatory research project with health and social service agencies in Southeast Michigan. We examine the stressors and coping strategies employed by undocumented Latinx immigrants and their families to manage immigration-related stress. We conducted in-depth interviews with 23 immigrant clients at Federally Qualified Health Care Centers (FQHC) in Southeast Michigan and 28 in-depth interviews with staff at two FQHC's and a non-profit agency serving immigrants. Findings suggest that immigrants face heightened anxiety and adverse mental health outcomes because of unique minority identity-related stressors created by a growing anti-immigrant social environment. Chronic stress experienced stems from restrictive immigration policies, anti-immigrant rhetoric in the media and by political leaders, fear of deportation, discriminatory events, concealment, and internalized anti-immigrant sentiment. Though identity can be an important effect modifier in the stress process, social isolation in the immigrant community has heightened the impact of stress and impeded coping strategies. These stressors have resulted in distrust in community resources, uncertainty about future health benefits, delayed medical care, and adverse mental health outcomes. Findings provide a framework for understanding the unique stressors experienced by immigrants and strategies for interventions by social service agencies.

Transglycosylation toward naringenin-7-O-glucoside using an N180H mutant of Coprinopsis cinerea endo-β-N-acetylglucosaminidase

Flavonoids are generally glycosylated, and the glycan moieties of flavonoid glycosides are known to greatly affect their physicochemical and biological properties. Thus, the development of a variety of tools for glycan remodeling of flavonoid glycosides is highly desired. An endo-β-N-acetylglucosaminidase mutant Endo-CC N180H, which is developed as an excellent chemoenzymatic tool for creating sialylglycoproteins, was employed for the glycosylation of flavonoids. Endo-CC N180H transferred the sialyl biantennary glycans from the sialylglyco peptide to pNP-GlcNAc and narigenin-7-O-glucoside. The kinetic parameters of Endo-CC N180H towards SGP and pNP-GlcNAc were determined. Flavonoid glucosides harboring a 1,3-diol structure in the glucose moieties acted as substrates of Endo-CC N180H. We proposed that the sialyl biantennary glycan transfer to the flavonoid by Endo-CC N180H could pave the way for the improvement of the inherent biological functions of the flavonoids and creation of novel flavonoid glycoside derivatives for future human health benefits including foods and drugs.

Measles vaccination of young infants in China: A cost-effectiveness analysis

BackgroundAlthough global progress in measles control has been realized, achieving elimination has proven difficult in many regions of the world. China has adopted a goal of measles elimination but recent outbreaks predominantly affecting children <8 months who are ineligible for vaccination and incompletely protected by maternal antibodies has impeded progress. We assess the cost-effectiveness of adding an initial measles vaccine dose in China to earlier than the currently recommended 8 months of age. MethodsWe conducted a cost-utility analysis comparing the costs and health benefits associated with adding a measles vaccine dose to the routine schedule at 4, 5, 6 or 7 months compared to the current recommendation for the first dose at age 8 months. A decision analytic model was developed in Microsoft Excel, including five non-severe and two fatal health outcomes associated with measles infection. Model parameters were informed by the literature and surveillance data. Future costs and health benefits were discounted at 3%. Primary outcomes included costs, Quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) over a lifetime time horizon. ResultsLowering the recommended age for initiating the measles vaccination series to address susceptibility in children <8 months provided incremental health gains compared to minimal costs at the individual-level. The ICER was most favorable ($232.70 per QALY gain) for administering an initial dose at 4 months of age due to fewer incremental program costs when shifting measles administration to an immunization visit already established under the Chinese vaccination program. ConclusionWe found potential beneficial health gains at a minimum cost associated with adding an earlier measles dose <8 months of age in China. Further investigation about disease transmission dynamics is required to more fully assess the tradeoffs of administering measles at a younger age to infants in China.

Meal Regularity Plays a Role in Shaping the Saliva Microbiota.

BackgroundDiet may influence health directly or indirectly via the human microbiota, emphasizing the need to unravel these complex relationships for future health benefits. Associations between eating habits and gut microbiota have been shown, but less is known about the association between eating habits and saliva microbiota.ObjectiveThe aim of this study was to investigate if eating habits and meal patterns are associated with the saliva microbiota.MethodsIn total, 842 adolescents, aged 11–14 years, from the Finnish Health in Teens (Fin-HIT) study cohort were included in this study. Eating habits and breakfast and dinner patterns were derived from a web-based questionnaire answered in school. Three major eating habit groups were identified: fruit and vegetable avoiders (FV avoiders), healthy and unhealthy. Microbiota profiles were produced from 16S rRNA gene (V3–V4) sequencing of DNA from the saliva samples. Statistical models were adjusted for gender, age, parental language, body mass index (BMI) categories, and sequencing depth.ResultsRegular breakfast eaters had a higher alpha diversity (Shannon index with mean (standard error of means) 2.27 (0.03) vs. 2.22 (0.03), p = 0.06, inverse Simpson’s index with 6.27 (0.17) vs. 5.80 (0.02), p = 0.01), and slight differences in bacterial composition (PERMANOVA: p = 0.001) compared with irregular breakfast eaters. A similar trend in alpha diversity was observed between regular and irregular dinner eaters (Shannon index with 2.27 (0.03) vs. 2.22 (0.03), p = 0.054, inverse Simpson’s index with 6.23 (0.17) vs. 6.04 (0.22), p = 0.28), while no difference was found in composition (PERMANOVA: p = 0.08). No differences were identified between eating habit groups and saliva microbiota diversity (Shannon index p = 0.77, inverse Simpson’s index p = 0.94) or composition (PERMANOVA: p = 0.13). FV avoiders, irregular breakfast eaters and irregular dinner eaters had high abundances of Prevotella.ConclusionRegularity of eating, especially breakfast eating, was associated with more diverse saliva microbiota and different composition compared with irregular eaters. However, the dissimilarities in composition were small between regular and irregular breakfast eaters. Our results suggest that Prevotella abundances in saliva were common in FV avoiders and meal skippers. However, the clinical implications of these findings need to be evaluated in future studies.

Cost-Effectiveness Analysis of Supervised Exercise Training in Men with Prostate Cancer Previously Treated with Radiation Therapy and Androgen-Deprivation Therapy.

Exercise for prostate cancer (PCa) survivors has been shown to be effective in addressing metabolic function and associated co-morbidities, as well as sarcopenia and significant functional impairment resulting from long-term androgen deprivation. Evidence on the cost-effectiveness of exercise interventions for PCa, however, is lacking, thus the aim of this study was to determine the cost-effectiveness of a supervised exercise intervention for long-term PCa survivors who previously received radiation therapy and androgen-deprivation therapy. Cost-effectiveness analysis from an Australian healthcare-payer perspective was conducted using patient-level data from a multicentre randomised controlled trial (RCT) of supervised exercise training (resistance and aerobic) compared to receiving printed exercise material and a recommendation to exercise in long-term PCa survivors (> 5years post-diagnosis). Analysis was undertaken for the 6-month supervised exercise portion of the intervention, which involved 100 men aged between 62 and 85years, 50 in each arm. The primary outcome was cost per quality-adjusted life-years (QALYs). A 6-month supervised exercise intervention for PCa survivors resulted in an incremental cost-effectiveness ratio of AU$64,235 (2018 AUD) at an incremental cost of AU$546 per person and a QALY gain of 0.0085. At a willingness-to-pay of AU$50,000, the probability that the intervention is cost-effective was 41%. Sensitivity analysis showed that maintenance of benefits via a 6-month home-based intervention, immediately following the supervised intervention, lowered the cost per QALY gained to AU$32,051. This is the first cost-effectiveness analysis of exercise for PCa survivors. The intervention was effective, but unlikely to be cost-effective at the generally accepted willingness-to-pay of AU$50,000 per QALY. It is likely that evidence to support cost savings from post-intervention outcomes would reveal greater benefits and contribute to a more comprehensive cost-effectiveness analysis. Future RCTs should incorporate longer follow-up durations and collection of data to support modelling to capture future health benefits. Measures of quality of life or utility more sensitive to the impact of physical activity would also improve future economic evaluations.

Health Benefits of Sustained Air Quality Improvements in New York City: A Simulation Based on Air Pollution Levels During the COVID-19 Shutdown

New York City (NYC) experienced a sharp decline in air pollution during the COVID-19 shutdown period (March 15, 2020 to May 15, 2020) — albeit at high social and economic costs. It provided a unique opportunity to simulate a scenario in which the city-wide air quality improvement during the shutdown was sustained over the five-year period, 2021 through 2025, allowing us to estimate the potential public health benefits to children and adults and their associated economic benefits. We focused on fine particulate matter (PM2.5) and modelled potential future health benefits to children and adults. The analysis considered outcomes in children that have not generally been accounted for in clean air benefits assessments, including preterm birth, term low birthweight, infant mortality, child asthma incidence, child asthma hospital admissions and emergency department visits, autism spectrum disorder, as well as adult mortality. We estimated a city-wide 23% improvement in PM2.5 levels during the COVID-19 shutdown months compared to the average level for those months in 2015-2018 (the business as usual period). Based on the data for 2020, we extrapolated the ambient levels of PM2.5 for the following five-year period. The estimated cumulative benefits for 2021-2025 included thousands of avoided cases of illness and death, with associated economic benefits from $31.8 billion to $77 billion.This “natural experiment,” tragic though the cause, resulted in a clean air scenario that can be considered aspirational — one that could be achieved through transportation, climate, and environmental policies that support robust economic recovery with similarly reduced emissions.Funding Statement: This study was supported by the Environmental Protection Agency (EPA) RD83615401 and National Institute of Environmental Health Sciences (NIEHS) P50ES09600, The John Merck Fund (JMF), and New York Community Trust (NYCT).Declaration of Interests: The authors declare no competing interests.

Time Preferences and Medication Adherence: A Field Experiment With Pregnant Women in South Africa

The effectiveness of health recommendations and treatment plans depends on the extent to which individuals follow them. For the individual, medication adherence involves an inter-temporal trade-off between expected future health benefits and immediate effort costs. Therefore examining time preferences may help us to understand why some people fail to follow health recommendations and treatment plans. In this paper, we use a simple, real-effort task implemented via text message to elicit the time preferences of pregnant women in South Africa. We find evidence that high discounters are significantly less likely to report to adhere to the recommendation of taking daily iron supplements daily during pregnancy. There is some indication that time-inconsistency also negatively affects adherence. Together our results suggest that measuring time preferences could help predict medication adherence and thus be used to improve preventive health care measures.

Nutrients and bioactive components from vinegar: A fermented and functional food

Abstract Vinegar has been widely used as acidic condiment worldwide for thousands of years. Vinegar contains various nutrients and bioactive components, which are brewed by liquid-state and solid-state fermentation techniques. This review highlights the nutrients and bioactive components in different types of vinegars and their functional properties. Nutrients in vinegar include amino acids, sugars, vitamins, and minerals. The functions of these nutrients were providence energy, regulation of cell metabolism regulation, immunoregulation, antioxidation, anticoagulation and improvement of brain development. In addition, the bioactive components in vinegar include organic acids, polyphenols, melanoidins, and tetramethylpyrazine, which have the functions of antioxidative activity, regulation of lipid metabolism, liver protection, blood pressure and glucose control, anti-fatigue and anti-tumor. However, further studies are needed to explore the novel functional compounds in vinegars and their molecular mechanisms on health benefits in future.

On discount rates for economic evaluations in global health.

Choices on discount rates have important implications for the outcomes of economic evaluations of health interventions and policies. In global health, such evaluations typically apply a discount rate of 3% for health outcomes and costs, mirroring guidance developed for high-income countries, notably the USA. The article investigates the suitability of these guidelines for global health [i.e. with a focus on low- and middle-income countries (LMICs)] and seeks to identify best practice. Our analysis builds on an overview of the academic literature on discounting in health evaluations, existing academic or government-related guidelines on discounting, a review on discount rates applied in economic evaluations in global health, and cross-country macroeconomic data. The social discount rate generally applied in global health of 3% annually is inconsistent with rates of economic growth experienced outside the most advanced economies. For low- and lower-middle-income countries, a discount rate of at least 5% is more appropriate, and one around 4% for upper-middle-income countries. Alternative approaches-e.g. motivated by the returns to alternative investments or by the cost of financing-could usefully be applied, dependent on policy context. The current practise could lead to systematic bias towards over-valuing the future costs and health benefits of interventions. For health economic evaluations in global health, guidelines on discounting need to be adapted to take account of the different economic contexts of LMICs.

Is Muscular Fitness Associated with Future Health Benefits in Children and Adolescents? A Systematic Review and Meta-Analysis of Longitudinal Studies.

No previous systematic review has quantitatively examined the association between muscular fitness during childhood and adolescence and health parameters later in life. The aim was to systematically review and meta-analyze the current evidence for a prospective association between muscular fitness in childhood and adolescence and future health status. Two authors systematically searched MEDLINE, EMBASE and SPORTDiscus electronic databases and conducted manual searching of reference lists of selected articles. Relevant articles were identified by the following criteria: apparently healthy children and adolescents aged 3-18years with muscular fitness assessed at baseline (e.g., handgrip, standing long jump, sit-ups, among others), and a follow-up period of ≥ 1year. The outcome measures were anthropometric and adiposity measurements and cardiometabolic, bone and musculoskeletal health parameters. Two authors independently extracted data. Thirty studies were included in the meta-analysis, yielding a total of 21,686 participants. The meta-analysis found a significant, moderate-large (p < 0.05) effect size between muscular fitness at baseline and body mass index (r = - 0.14; 95% confidence interval (CI) - 0.21 to - 0.07), skinfold thickness (r = - 0.32; 95% CI - 0.40 to - 0.23), homeostasis model assessment estimated insulin resistance (r = - 0.10; 95% CI - 0.16 to - 0.05), triglycerides (r = - 0.22; 95% CI - 0.30 to - 0.13), cardiovascular disease risk score (r = - 0.29; 95% CI - 0.39 to - 0.18), and bone mineral density (r = 0.166; 95% CI 0.086 to 0.243) at follow-up. A prospective negative association was observed between muscular fitness in childhood/adolescence and adiposity and cardiometabolic parameters in later life, together with a positive association for bone health. There is inconclusive evidence for low back pain benefits.

Estimated Increase in Mean Lifetime Survival for Glioblastoma Patients Age 65 Years and Older Treated with Tumor Treating Fields and Temozolomide Compared to Patients Treated with Temozolomide Alone

Tumor treating fields (TTFields) is a device-delivered treatment for glioblastoma (GBM) brain tumors. Post-hoc analysis of the EF-14 Trial demonstrated that the subgroup of patients age 65 or older obtained the greatest survival beneft from TTFields compared to temozolomide (TMZ) alone (HR = 0.51). The final analysis of the EF-14 Trial reported that for the subgroup of patients older than age 65, 5-year overall survival was 15% for patients treated with TTFields and maintenance TMZ, compared to no survivors in the TMZ alone arm. The objective of this analysis was to estimate the mean lifetime survival benefit of TTFields treatment for patients age 65 or older with newly diagnosed GBM. We constructed an integrated survival model that incorporated subgroup data for patients age 65 or older from the EF-14 Trial with epidemiological data on long-term GBM survival. We perfomed a literature search in the Medline database to identify epidemiological data to estimate survival in this age subgroup after the 5-year trial period. A discount rate of 3% was applied to future survival benefits. We also perfomed one-way and probabilistic sensitivity analyses and compared the results of our integrated survival model to regression based extrapolations of the trial data. Patients in this subgroup treated with TTFields and TMZ achieved an undiscounted mean lifetime survival of 3.8 years compared to 1.3 years for patients treated with TMZ alone. The resulting increase in mean lifetime survival after applying the discount rate to future health benefits was 1.8 years. Survival was 10% at 10-years and 8% at 15-years for patients treated with TTFields and TMZ. The results were most sensitive to uncertainty in long-term conditional survival estimates. This analysis of the subgroup of patients age 65 and older in the EF-14 trial demonstrated that treatment with TTFields and maintenance TMZ produced a notable increase in mean lifetime survival compared to treatment with TMZ alone. The lifetime survival benefit was achieved despite the relatively advanced age of the subgroup, reflecting the substantial survival benefit observed in the trial. The results of this analysis can inform future evaluations of the cost-effectiveness of TTFields for older patients with newly diagnosed GBM.

Limiting Dietary Sugar Improves Pediatric Sinonasal Symptoms and Reduces Inflammation.

Excessive sugar consumption is associated with many chronic inflammatory diseases in adults. The effects of excessive sugar consumption in children have not been determined. In this study, we hypothesized that sinonasal symptoms and proinflammatory cytokine levels would be related and could be altered through reduction in sugar-sweetened beverage (SSB) consumption. To test this, we conducted a pilot study involving behavior modification and a 2-week follow-up. Seventeen children participants were recruited, and eleven completed the study. The experimental group presented with chronic nasal congestion or rhinorrhea defined by daily symptoms without acute illness for at least 3 months. The control group presented for non-nasal problems. Both groups received counseling to decrease SSB consumption. The Sinus and Nasal Quality of Life (SN-5) Survey was administered, and a blood sample was obtained by venipuncture at baseline and 2 weeks after counseling. Participants kept a 2-week food diary to document sugar intake. Serum lipid profile and inflammatory cytokines were measured. The experimental group reduced daily sugar intake, 46% versus 11% in the control. Baseline SN-5 scores were significantly worse in the experimental group and normalized to controls after intervention. Inflammatory cytokine levels were not different at baseline, but the experimental group significantly reduced in proinflammatory markers and increased the levels of anti-inflammatory markers after intervention. Our pilot data demonstrate higher sugar consumption may be associated with increased inflammatory stress and sinonasal symptoms. Reducing SSB and controlling inflammation in early childhood may have future health benefits.

Financial security and public health: How basic income & cash transfers can promote health

ABSTRACTInadequate financial resources are a major driver for poor health. Financial insecurity contributes to health inequities in mutually reinforcing ways, with some effects lasting years. Fostering financial security to reduce the likelihood or magnitude of such pressures would have significant present and future health benefits. We review several models for bolstering financial security to determine which have the most significant health contributions based on current evidence and their theoretical potential. We hypothesise that basic income guarantees might have the greatest positive health impact for beneficiaries, though this is heavily contingent on programme design and how financing affects other social welfare programmes. Cash transfer programmes also contribute to financial security and promote health, with particularly strong evidence for the health benefits of conditional cash transfers, and may be more feasible programmes in some contexts.

LIFELONG HEALTH INSURANCE COVERS WITH SURRENDER VALUES: UPDATING MECHANISMS IN THE PRESENCE OF MEDICAL INFLATION

AbstractThis paper considers the problem of a lifelong health insurance cover where medical inflation is not sufficiently incorporated in the level premium determined at policy issue. We focus on the setting where changes in health benefits, driven by medical inflation, are accounted for by an appropriate update or indexation of the level premium, the policy value, or both premium and policy value, during the term of the contract. Such an updating mechanism is necessary to restore the actuarial equivalence between future health benefits and surrender values on the one hand, and available policy values and future premiums on the other hand. We extend existing literature (Vercruysse et al., 2013; Denuit et al., 2017) by developing updating mechanisms in a discrete-time framework, where medical inflation is only taken into account ex-post as it emerges over time and where surrender values are allowed for. We propose and design two types of surrender values: based on the ageing provision on the one hand and based directly on the premiums paid until surrender on the other hand. We illustrate our updating strategy with numerical examples, using Belgian data, and investigate the sensitivity of our findings with respect to elements from the technical basis (in particular: the lapse rates) used in the actuarial calculations. Our updating mechanism is generic and useful for a wide range of products in life and health insurance, where some elements of the technical basis are guaranteed while others are subject to revision according to policy conditions.