Year Of Life Research Articles

Fetal Alcohol Syndrome: Impact on Neurodevelopment, Diagnosis, Early Intervention and Motor Disorders in Children under 3 Years

Fetal Alcohol Syndrome (FAS) is the most severe outcome of prenatal alcohol exposure, characterized by a combination of somatic and neurological abnormalities, including facial dysmorphism, growth deficits, and neurocognitive impairments. Fetal Alcohol Spectrum Disorders (FASD) encompass a broader range of outcomes from prenatal alcohol exposure, with varying degrees of severity. Alcohol consumption during pregnancy can disrupt fetal development, with no known safe threshold for its intake at any stage of gestation. The consequences are particularly profound on the central nervous system (CNS), where damage to structures like the cerebellum can lead to motor dysfunctions, balance issues, and cognitive impairments. Early identification and diagnosis of FAS or FASD, especially during the critical first years of life, is essential for improving developmental outcomes. Intervention strategies, including physical and cognitive therapy, can help mitigate long-term disabilities associated with these conditions. Diagnostic methods, such as ultrasound for fetal structural abnormalities and the AUDIT screening tool, are integral for early detection. This review highlights the impact of prenatal alcohol exposure on motor skill development, particularly the persistence of primitive reflexes in infants with FAS, which is indicative of CNS immaturity and necessitates early therapeutic interventions. Understanding these motor and neurological markers is critical for providing appropriate support and improving outcomes for affected children.

The global, regional, and national disease burden of colorectal cancer attributable to low physical activity from 1990 to 2021: an analysis of the Global Burden of Disease Study 2021

ObjectivesThis study aims to estimate the spatiotemporal variation in the burden of colorectal cancer (CRC) attributable to low physical activity (LPA) at global, regional, and national levels from 1990 to 2021.Study designCross-sectional study.MethodsAnnual data on deaths of CRC related to LPA, age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), and the age-standardized DALYs rate (ASDR) for 204 countries and territories from 1990 to 2021 was extracted from the Global Health Data Exchange website. They were retrieved by age (5-year age groups from 25 to 94 years, and 95+ years), gender (male and female), and Socio-demographic Index (SDI). The association between age-standardized rates and SDI values was assessed by Spearman’s correlation.ResultsBetween 1990 and 2021, there was nearly a twofold increase in DALYs and mortality globally for CRC related to LPA, despite decreases in ASMR and ASDR (EAPC: −0.82% and −0.83%, respectively). However, on a national scale, ASMR and ASDR increased in more than half of the world’s countries and territories. Moreover, a greater burden of CRC related to LPA was observed in older populations, females, and those residing in regions with an SDI near 0.77.ConclusionThese findings indicate the critical need to raise awareness about the preventive role of physical activity in CRC. Policymakers should prioritize developing and implementing strategies that ensure equitable access to sports resources, enabling more people to meet the World Health Organization guidelines.

Addition of continuous glucose monitoring to glucagon-like peptide 1 receptor agonist treatment for type 2 diabetes mellitus - An economic evaluation.

Both glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and continuous glucose monitoring (CGM) have been shown to improve glycated hemoglobin A1c (A1c) levels among patients with type 2 diabetes mellitus (T2DM). Recently, a US real-world study found statistically significant improvements in A1c levels among patients using GLP-1 RA and a CGM device, compared with a matched cohort receiving only GLP-1 RA. To assess the cost-effectiveness from a US payer perspective of initiating CGM (FreeStyle Libre Systems) in people living with T2DM using a GLP-1 RA therapy, compared with GLP-1 RA alone. A patient-level microsimulation model was run for 10,000 patients over a lifetime horizon with 3.0% discounting for costs and utilities. Patient characteristics were based on the overall population of the US real-world study and the subgroup of patients not using intensive insulin. The effect of CGM was modeled as a persistent reduction in A1c compared with GLP-1 RA alone (overall = 0.37%; patients not using intensive insulin = 0.34%). Costs ($2,023) and disutilities were applied to diabetes complications and acute diabetic events. Outcomes were assessed as quality-adjusted life years (QALYs). The base-case incremental cost-effectiveness ratio (incremental costs/incremental QALYs) for GLP-1 RA plus CGM vs GLP-1 RA alone was $40,968/QALY in the overall cohort (cost = $484,180 vs $473,938; QALYs = 13.37 vs 13.12). Among patients not using intensive insulin, the incremental cost-effectiveness ratio was $43,095/QALY. Scenario analysis showed that the model results were robust to changing assumptions. Probabilistic sensitivity analysis showed that GLP-1 RA plus CGM had a 64% probability of being cost-effective at a willingness-to-pay threshold of $100,000 per QALY. From a US payer perspective, CGM is cost-effective when added to GLP-1 RA therapies for the treatment of T2DM, including for patients not using intensive insulin.

Prevalence of Anti-HIV Antibodies at 12 Months of Age in Infants Exposed to HIV.

This study determined the prevalence of reactive HIV serology at 12 months of age in infants exposed to HIV in utero. Of the 80 patients analyzed, 50 (63.3%) were anti-HIV reactive. This study suggests that it is probably not helpful to perform HIV antibody testing in HIV-exposed non-breastfed infants who have met virologic criteria to exclude HIV infection in the first year of life.

Early Intervention for Children With Developmental Disabilities and Their Families via Telehealth: Systematic Review.

Early intervention during the first 3 years of life is crucial for children with developmental disabilities to optimize developmental outcomes. However, access to such services is often limited by geographical distance and resource constraints. Telehealth can be part of a solution for overcoming these barriers, enabling the delivery of early intervention services. However, a comprehensive understanding of the efficacy and implementation of telehealth in early interventions remains elusive, particularly for children aged 0-3 years. This systematic review aims to synthesize existing research on the effectiveness and implementation of telehealth interventions in infants and toddlers (aged 0-3 years) who are at risk of or diagnosed with developmental disabilities. The primary objective of the study is to evaluate the ways that telehealth compares to conventional in-person interventions in improving developmental outcomes for children and supporting family well-being. A systematic search was conducted of 4 electronic databases (PubMed, Embase, CINAHL, and Web of Science), focusing on studies published between 2010 and 2024. The inclusion criteria were studies involving telehealth interventions for children aged 0-3 years who were at high risk or had developmental disabilities, which involved active interactions between the providers and the families. Study quality was assessed using the mixed methods appraisal tool, and a narrative synthesis was used to analyze the data. Eighteen studies met the inclusion criteria: 12 single-case designs, 4 randomized controlled trials, and 2 nonequivalent control group designs. All studies involved caregiver-child dyads, with child ages ranging from 5 to 37 months and having or at risk of autistic spectrum disorder (n=10, 56%), cerebral palsy (n=4, 22%), and other conditions (n=4, 22%). Synchronous videoconferencing was the primary modality for caregiver training and coaching (n=17, 94%) while 1 intervention used an Internet of Things system. Outcomes were identified in child communication (n=9, 50%), physical (n=6, 33%), social or emotional (n=6, 33%), and adaptive behavior (n=4, 22%), as well as caregiver implementation (n=12, 66%). Telehealth demonstrated comparable or superior effectiveness to traditional in-person methods in 2 studies. However, the focus on specific conditions and limited research on cognitive development were notable gaps. Telehealth can be a viable alternative to traditional in-person early interventions for young children who have developmental disabilities and their families. It enhances accessibility and interactions between families and providers at a distance while promoting family-centered care. Challenges exist, including those of technological literacy, and the lack of research on cognitive outcomes must be addressed. Future work should explore more comprehensive interventions, including multidisciplinary approaches and expanded family outcomes, to solidify the role that telehealth plays in early intervention. PROSPERO CRD42024551286; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=551286.

Innovative Approach to Pavement Rehabilitation Analysis and Design of Runway (R/W) 15L-33R at George Bush Intercontinental Airport (IAH) in Houston, TX

In late 2003, the City of Houston determined Runway (R/W) 15L-33R at George Bush Intercontinental Airport/Houston (IAH) should be rehabilitated in order to provide an additional 20 years of useful life. The City required the Engineering Consultants to provide two possible pavement rehabilitation options one of which to include a PCC overlay or remove and reinstall the keel section. The existing runway was originally constructed under 3 different contracts. The original contract constructed the North 2440 m (sta 0+003 to sta 0+027) in 1968 and consisted of a 200 mm sand-shell sub-base with a 304 mm PCC slab which was later overlaid with a 457 mm PCC partially bonded overlay in 1976. At the same time, a 1220 m extension was added on the south end (sta 0+027 to sta 0+039) which consisted of a 533 mm PCC layer over a 152 mm asphalt treated sub-base. The rehabilitation strategy proposed for this project was developed by using an innovative approach to interlayer stiffness in determining the existing condition of the runway, performing both fatigue and deflection analyses on the existing pavement structure for each section, and finally identifying pavement design criteria to configure each rehabilitation strategy. The fatigue analysis was not elaborate and was determined by the Layered Elastic Airport Pavement Design software (LEDFAA v1.3), taking into account damage by the critical stress imposed by each aircraft included in the runway traffic mix. Since LEDFAA does not consider the accumulation of permanent deformation in the subgrade under deflection imposed by each aircraft, deflection criteria was developed in order to give a more complete picture of what different rehabilitation options offer performance-wise. Deflection design criteria was formulated to prevent permanent deformation in the subgrade due to loads imposed by the heavy aircraft included in the runway traffic mix. Permanent deformation of this nature may lead to loss of support below the slab. As greater demands are being placed on our airport systems by increasing traffic and loading, improved pavement rehabilitation analysis and design methods are needed to fully account for all factors manifest in the condition of the pavement. This paper presents an innovative approach to account for the many factors influencing concrete pavement stiffness regarding the design and analysis of rehabilitation alternatives. The approach described affords practitioners a tool to realistically take into account current pavement conditions and future traffic loadings.

A systematic epidemiological trends analysis study in global burden of multiple myeloma and 29 years forecast

Multiple myeloma is a prevalent hematologic cancer. This investigation analyzes the latest global, regional, and national data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. Data on the incidence, prevalence, disability-adjusted life years, and mortality rates of multiple myeloma, including estimates and 95% uncertainty intervals, were sourced from the 2021 Global Burden of Diseases Study. Furthermore, we explored the trends affecting the multiple myeloma burden from 1990 to 2021, breaking it down by demographic, age, and epidemiological factors. By 2021, the global incidence of multiple myeloma involved 148,754.63 reported cases, with confidence intervals ranging from 131,780.43 to 162,049.23. Worldwide, the number of mortality attributed to multiple myeloma reached 116,359.63, with the confidence interval lying between 103,078.62 and 128,470.57, and an age-standardized mortality rate of 1.37 per 100,000 individuals, the confidence interval for which was 1.22 to 1.52. There was a consistent increase in the incidence, prevalence, and disability-adjusted life years associated with multiple myeloma. Most of the disease burdens were seen in high income countries though its incidence is on the rise in low-income countries. Forecast for the years 2022–2050 showed the further increase in the incidence, prevalence, disability-adjusted life years, and age-standardized death rates of multiple myeloma.

Burden of disease attributable to high body mass index in Belgium: a comparative risk assessment analysis

Background and methodsHigh body mass index (BMI) is a major risk factor for several non-communicable diseases. The increasing concern about the health and economic burden of BMI makes it essential...

Review of methods for assessing the cost-effectiveness of medical interventions

Assessment of the effectiveness of a drug is a complex process. Currently, the standard method for assessing the effectiveness of a medical intervention is the quality-adjusted life years (QALY). In the summer of 2024, a description of a new method for assessing the effectiveness of medical interventions — Standard of Living Valuation (SoLV) was published. The proposed method is more difficult than QALY, but its capabilities are broader. However, this method is also not optimal. The problem of creating an optimal method for assessing the cost-effectiveness of health technologies remains open.

Cost-effectiveness of digoxin versus beta blockers in permanent atrial fibrillation: the Rate Control Therapy Evaluation in Permanent Atrial Fibrillation (RATE-AF) randomised trial

BackgroundAtrial fibrillation (AF) is a major and increasing burden on health services. This study aimed to evaluate the cost-effectiveness of digoxin versus beta-blockers for heart rate control in patients with...

Mode of Delivery and Subsequent Motor Function in Children With Myelomeningocele Without In Utero Repair.

To assess the association between mode of delivery and 2-year motor function in children with prenatal diagnosis of myelomeningocele. A multisite retrospective cohort study of children with myelomeningocele across 14 NAFTNet (North American Fetal Therapy Network) centers born between 2007 and 2020 who had a physical examination available at 2 years of life. Exclusion criteria were in utero myelomeningocele repair, postnatal myelomeningocele diagnosis, missing data on fetal presentation at delivery, and contraindications to labor. The primary outcome was the difference between the anatomic level of the spinal lesion and functional motor level at age 2 years. A general linear model was used to determine the effect of mode of delivery on the primary outcome, and multivariable analysis was performed to control for presence of labor, gestational age at delivery, defect size and origin level, and presence of ventriculomegaly. Of 566 children with myelomeningocele, 305 met inclusion criteria, with 216 (70.8%) having been delivered by cesarean and 89 (29.2%) having been delivered vaginally. Children delivered by cesarean had a mean±SE level of motor function of 0.07±0.21 segments below the anatomic level at age 2 years compared with 0.57±0.32 for children delivered vaginally (P=.19). After controlling for potential confounders, both groups improved in motor function by age 2 years compared with anatomic level. However, there was no difference in motor improvement between groups by mode of delivery (0.07 cesarean vs 0.57 vaginal delivery, adjusted difference 0.37 segments, P=.63). In this multisite NAFTNet cohort, mode of delivery was not associated with lower-extremity motor function at age 2 years.

Generalised anxiety disorder and its determinants amongst patients with diabetes in primary healthcare clinics: a cross-sectional study in Kuwait City, 2024

BackgroundAnxiety disorders are the second most common mental health disorders in terms of disability-adjusted life years and years of life lost across all age groups. A bidirectional relationship between anxiety disorders and diabetes mellitus has been documented. This study aimed to determine the prevalence of anxiety and its associated factors among patients with diabetes receiving care at public primary care clinics in Kuwait during the first quarter of 2024.MethodologyA cross-sectional study was conducted in the first quarter of 2024 at three primary healthcare centres within the Capital Governate in Kuwait City. Adults with diabetes mellitus for longer than six months duration were requested to participate by the health promoters and the Generalised Anxiety Disorder questionnaire was shared via a mobile link/QR scan. Data were collected through self-or interviewer-administered surveys, cleaned and coded in Microsoft Excel, and analysed using STATA version 18. Descriptive analysis was initially conducted followed by bivariate and multivariate analysis with a p < 0.05 and a 95% confidence interval used to determine the association between demographic and clinical factors and GAD.ResultsA total of 554 patients participated, yielding an 80% response rate. Anxiety symptoms were observed in 48% of respondents, though only 4% (n = 25) had a GAD score > 10. Among participants with moderate-to-severe anxiety (n = 21), 52% were aged 50–59 years, 90% were non-native Kuwaiti citizens, and 62% had an HbA1C measurement > 7 mmol/L. Multivariate analysis indicated that non-native Kuwait citizens were significantly more likely to have moderate-to-severe anxiety (AOR: 6.99, 95% CI: 1.42–34.43) compared to Kuwaiti nationals. Conversely, participants attending clinic visits every two months were less likely (AOR: 0.30, 95% CI: 0.00–0.50) to report moderate-to-severe anxiety symptoms than those attending monthly.ConclusionWhile nearly half of patients with diabetes displayed anxiety symptoms, only a small proportion (4%) experienced moderate-to-severe anxiety. Non-native Kuwaiti residents were significantly more likely to have GAD scores > 10. Integrating anxiety screening into diabetes care may improve outcomes for this high-risk group.

The long-term effects of cardiometabolic risk factors on mortality and life expectancy: evidence from a health check-up cohort study

ObjectiveCardiometabolic risk factors significantly contribute to disease burden. This study explored the effects of hypertension (HTN), diabetes mellitus (DM), and hyperlipidemia (HLP) on mortality. It stratified findings by age group and comorbidity severity using the Charlson Comorbidity Index (CCI) score. Additionally, it assessed the compounded effects of comorbid conditions to estimate life expectancy (LE) and years of life lost (YLL) in individuals with various cardiometabolic risk factor combinations.MethodsUsing data from the MJ Health Check-up Database (2002–2017), linked with the National Health Insurance Research Database (2000–2017) and the Death Registry (2002–2019), this study employed Cox proportional hazards models to determine mortality risk associated with various cardiometabolic risk factors. Adjusted Kaplan–Meier curves were constructed to evaluate survival rates across different risk factors and CCI scores. Survival rates were extrapolated to estimate confounder-adjusted LE and YLL for age-comorbidity combinations.ResultsAmong the three age groups (20–39, 40–59, 60–79), HLP was the most common single risk factor, followed by HTN. In participants with dual risk factors, HTN and HLP were the most frequent pair, with diabetes and HLP second. An increased number of cardiometabolic risk factors elevated mortality risk, particularly in the 20–39 age group. LE, adjusted for confounders, declined with age, higher CCI scores, and more risk factors. YLL decreased with age but increased with higher CCI scores and more risk factors.ConclusionsPromoting health awareness, early disease detection, and timely medical access can reduce cardiometabolic risk factors and associated comorbidities, thereby alleviating disease burden.

Hypothalamic Hamartoma Presenting as Gelastic Epilepsy: When it Goes Unnoticed

A 5-year-old boy presented with episodes of ocular retroversion occurring over the past 4 weeks. Further investigation revealed frequent bilateral epileptiform frontal activity on electroencephalogram and a nodular formation in the hypothalamus on cerebral computed tomography scan. Magnetic resonance imaging characterized the lesion as a hamartoma of the tuber cinereum. After questioning, episodes of unprovoked laughter since the first year of life, consistent with gelastic seizures, were reported. During follow-up, an increase in testicular volume was noted, and a GnRH stimulation test confirmed the diagnosis of central precocious puberty. The boy underwent treatment with antiepileptic drugs and GnRH analogs. Surgical resection of the hamartoma was performed, resulting in cessation of seizures and behavior’s improvement. Hypothalamic hamartomas can present with precocious puberty and gelastic epilepsy. Diagnosis is challenging and often the symptoms go unnoticed for years. Long-term follow-up and multidisciplinary management are essential for optimal patient care and monitoring.

A decision-analytic method to evaluate the cost-effectiveness of remote monitoring technology for chronic depression.

Advances in mobile apps, remote sensing, and big data have enabled remote monitoring of mental health conditions, but the cost-effectiveness is unknown. This study proposed a systematic framework integrating computational tools and decision-analytic modeling to assess cost-effectiveness and guide emerging monitoring technologies development. Using a novel decision-analytic Markov-cohort model, we simulated chronic depression patients' disease progression over 2 years, allowing treatment modifications at follow-up visits. The cost-effectiveness, from a payer's viewpoint, of five monitoring strategies was evaluated for patients in low-, medium-, and high-risk groups: (i) remote monitoring technology scheduling follow-up visits upon detecting treatment change necessity; (ii) rule-based follow-up strategy assigning the next follow-up based on the patient's current health state; and (iii-v) fixed frequency follow-up at two-month, four-month, and six-month intervals. Health outcomes (effects) were measured in quality-adjusted life-years (QALYs). Base case results showed that remote monitoring technology is cost-effective in the three risk groups under a willingness-to-pay (WTP) threshold of U.S. GDP per capita in year 2023. Full scenario analyses showed that, compared to rule-based follow-up, remote technology is 74 percent, 67 percent, and 74 percent cost-effective in the high-risk, medium-risk, and low-risk groups, respectively, and it is cost-effective especially if the treatment is effective and if remote monitoring is highly sensitive and specific. Remote monitoring for chronic depression proves cost-effective and potentially cost-saving in the majority of simulated scenarios. This framework can assess emerging remote monitoring technologies and identify requirements for the technologies to be cost-effective in psychiatric and chronic care delivery.

Global burden of bacterial skin diseases from 1990 to 2045: an analysis based on global burden disease data.

Bacterial skin diseases are a category of inflammatory skin conditions caused by bacterial infections, which impose a significant global disease burden. However, they have not been well assessed or predicted on a global scale. It is necessary to update the estimates and forecast future trends of the global burden of bacterial skin diseases to evaluate the impact of past healthcare policies and to provide guidance and information for new national and international healthcare strategies. We aimed to describe the burden and trend of bacterial skin diseases and to predict the burden up to 2045. To achieve this, we employed a cross-sectional analysis based on Global Burden of Disease (GBD) data, utilizing advanced statistical models to quantify trends and forecast future burdens. Data on incidence and disability-adjusted life years (DALYs) of bacterial skin diseases were obtained from Global Burden of Disease 2021. We used average annual percent change (AAPC) by Joinpoint Regression to quantify the temporal trends. We conducted decomposition analysis to understand the contribution of aging, epidemiological changes, and population growth. Bayesian Age-Period-Cohort model was used to predict burden up to 2045. Global incidence rate of bacterial skin diseases increased from 8,988.74 per 100,000 in 1990 to 10,823.88 per 100,000, with AAPC of 0.62% (0.61 ~ 0.63%). The highest incidence rate was in low Socio-demographic Index (SDI) region and population aged < 35. The DALYs rate increased from 20.82 per 100,000 in 1990 to 25.45 per 100,000 in 2021, with AAPC of -0.11% (-0.34 ~ 0.13%). The highest increase of DALYs was in high SDI region and population aged > 85. Among the three evaluated factors of decomposition analysis, the major drivers of incident case rise were population growth, followed by epidemiological changes; the major drivers of DALYs case rise were population growth, followed by aging. The number of incidence cases has increased since 1990, reaching nearly 90million in 2021 and expected to hit 1.2billion in 2045. The incidence rate has also risen. Meanwhile, DALYs showed an upward trend from 1990 to 2005, peaking at 32/100,000, then a downward trend. Our findings align with our initial objectives, demonstrating a significant increase in the global incidence of bacterial skin diseases and highlighting the need for targeted prevention and treatment strategies. The variation in burden across different regions and age groups underscores the importance of tailored public health interventions. Predictive models suggest a continued rise in incidence rates and incident cases through 2045, emphasizing the urgency for action. This study provides a foundation for future research and policy development aimed at reducing the burden of bacterial skin diseases worldwide.

The global, regional, and national burden of type 2 diabetes mellitus attributable to low physical activity from 1990 to 2021: a systematic analysis of the global burden of disease study 2021

BackgroundLow physical activity (LPA) is a leading risk factor for type 2 diabetes mellitus (T2DM). We examine the temporal and spatial trends in the burden of T2DM attributable to LPA at the global, regional, and country scales.MethodsData were obtained from the Global Burden of Disease Study 2021. The numbers of deaths and disability-adjusted life years (DALYs) of LPA-related T2DM, and the corresponding age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) were compared across regions and countries by age, sex, and sociodemographic index (SDI). The annual percentage changes (EAPCs) in the ASMR or ASDR were calculated to quantify temporal trends from 1990 to 2021. We also quantified the relationship between SDI and the ASMR and ASDR of T2DM attributable to LPA.ResultsGlobally, the number of T2DM deaths and DALYs attributable to LPA were approximately 0.15 million and 5.52 million respectively in 2021, which more than doubled compared to 1990. Over the past 32 years, the global EAPCs of ASMR and ASDR were 0.26 (95% CI: 0.20, 0.31) and 0.97 (95% CI: 0.93, 1.02), respectively. The ASMR or ASDR had a reverse U-shaped relationship with the SDI, with the most severe burden observed in the low-middle and middle SDI regions. The age group older than 60 years had the highest rate of DALYs for LPA-related T2DM in 2021, while the 25–44 age group showed the largest increase between 1990 and 2021.ConclusionsOver the past 32 years, the global burden of LPA-related T2DM has continued to increase at an alarming rate in almost all countries, particularly in regions with low-middle and middle SDI. Substantial increases in national action are urgently needed to target elder populations especially in low-middle and middle SDI regions, and special efforts should be made to promote physical activity in young adults with LPA.

Patterns and trends in burden of asthma and its attributable risk factors from 1990 to 2021 among south Asian countries: a systematic analysis for the Global Burden of Disease Study 2021

Objective Asthma poses a significant health burden in South Asia, with increasing incidence and mortality despite a global decline in age-standardized prevalence rates. This study aims to analyze asthma trends from 1990 to 2021, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs) across South Asia. The study also assesses the impact of risk factors like high body mass index (BMI), smoking, and occupational exposures on asthma outcomes. Method We extracted asthma data from the Global Burden of Disease (GBD) database for South Asia (1990–2021). Joinpoint regression analysis was used to assess temporal trends in asthma burden. Annual percentage changes in age-standardized rates (ASR) of incidence, mortality, and DALYs were calculated. Data were stratified by gender, and the contribution of risk factors was evaluated. Results Asthma-related mortality in South Asia decreased by 37%, from 27.78 per 100,000 (1990) to 17.54 per 100,000 (2021). The Maldives showed the most significant reduction in mortality (78.31%), while Bangladesh recorded a 47.44% reduction in prevalence and a 62.64% decrease in DALYs. High BMI, smoking, and environmental risks contributed significantly to DALYs, with environmental factors playing a major role in countries like Afghanistan (20.73%) and Bhutan (18.58%). Females, particularly those over 20, experienced higher asthma-related DALYs than males. Conclusion Asthma burden in South Asia has reduced over the past three decades, yet the absolute number of cases continues to rise, driven by population growth and environmental risk factors. Targeted interventions addressing risk factors and healthcare disparities are essential for further reducing asthma burden.

Cost-utility and cost–benefit analysis of a multi-component intervention (NEXpro) for neck-related symptoms in Swiss office workers

BackgroundNeck pain is a significant public health issue, especially among office workers, with a prevalence ranging from 42 to 68%. This study aimed to evaluate the cost-utility and cost-benefit of a multi-component intervention targeting neck pain in the general population of office workers in Switzerland. The 12-week multi-component intervention consisted of neck exercises, health promotion information workshops, and workplace ergonomics sessions.MethodsThe study was designed as a stepped-wedge cluster randomized controlled trial and assessed using an employer’s perspective. The main analysis focused on the immediate post-intervention period. Long-term effects were examined in a subsample at the 4, 8, and 12-month follow-ups. The intervention effects on costs and quality-adjusted life years (QALYs) were estimated using generalized linear mixed-effects models, controlling for confounding factors. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were presented, along with calculations of the break-even point and the return on investment. Various sensitivity analyses were performed.ResultsA total of 120 office workers participated in the trial, with 100 completing the intervention period and 94 completing the entire study. The main analysis included 392 observations. The intervention had a significant positive effect on QALYs and a nonsignificant effect on costs. The ICER was estimated at -25,325 per QALY gain, and the probability of the intervention being cost saving was estimated at 88%. The break-even point was reached one week after the end of the intervention.ConclusionThe multi-component intervention is likely to reduce company costs and simultaneously improve the quality of life of employees. However, the implementation of such interventions critically depends on evidence of their cost-effectiveness. As there is still a large research gap in this area, future studies are needed.Trial registrationClinicalTrials.gov, NCT04169646. Registered 15 November 2019-Retrospectively registered.Trial protocolAegerter AM, Deforth M, Johnston V, Ernst MJ, Volken T, Luomajoki H, et al. On-site multi-component intervention to improve productivity and reduce the economic and personal burden of neck pain in Swiss office-workers (NEXpro): protocol for a cluster-randomized controlled trial. BMC Musculoskelet Disord. 2020;21(1):391. https://doi.org/10.1186/s12891-020-03388-x.

Hemostatic powder TC-325 as first-line treatment option for malignant gastrointestinal bleeding: a cost-utility analysis in the United Kingdom.

Randomized controlled trials have shown that hemostatic powder (TC-325) results in greater immediate hemostasis and lower 30-day rebleeding rates than standard endoscopic therapy (SET) for management of malignant upper gastrointestinal bleeding (MUGIB). We explored whether TC-325 would be a cost-effective first-line option for patients with MUGIB compared with SET in the United Kingdom. A decision tree was developed for patients with MUGIB, assessing initial therapy with TC-325 or SET over a 30-day period. Patients with failed initial hemostasis or a rebleed within 30 days underwent further endoscopic treatment, escalation to either transcatheter arterial embolization or surgery, or radiotherapy. Overall 30-day mortality was applied. Costs, in GBP, were based on the United Kingdom National Health Services costs for 2023/2024. Results were reported as incremental differences in cost, quality-adjusted life years (QALY), and net monetary benefit. Deterministic and probabilistic sensitivity analyses and scenario analyses were performed. The cost of treating MUGIB patients with TC-325 was £245.88 lower than treatment with SET, with an incremental increase of 0.001 QALYs. TC-325 remained a cost-saving approach in sensitivity and scenario analyses. Probabilistic sensitivity analysis revealed that TC-325 was more effective and cost saving in 80.1% of simulations (range 67.5%-98.63%). Initial treatment of MUGIB with TC-325 compared with SET was more effective (higher primary hemostasis and lower 30-day rebleeding) and cost saving owing to the requirement for fewer interventions, readmissions, and length of stay. Additional studies are needed to address model uncertainties in the follow-up management of these complex patients.