Reduce Health Care Costs Research Articles

Why do companies adopt workforce well-being programs?*

Economic evaluations of workforce well-being programs (WWPs) typically focus on return on investment (ROI) analyses to demonstrate that WWPs generate financial savings through reduced health care costs or improved labor productivity. Although the outcomes considered by WWP evaluations should be linked to businesses’ strategies to provide policy-relevant evidence, there are not empirical studies linking companies’ stated reasons for adopting WWPs to their choice of specific programming. This study used a large convenience sample of employer survey data to empirically link companies’ stated reasons for adopting WWPs to specific program implementation choices. In so doing, it analyzed the assumption that financial savings drive the adoption of WWPs and provides evidence of the extent to which ROI expectations drive WWP adoption. Our findings provide evidence that ROI is not necessarily the main objective of companies implementing WWPs and the current state of the literature does not align the evaluation metric with true company values, strategic objectives, and characteristics.

Sleep disturbances across two weeks predict future mental healthcare utilization.

Insufficient sleep costs the U.S. economy over $411 billion per year. However, most studies investigating economic costs of sleep rely on one-time measures of sleep, which may be prone to recall bias and cannot capture variability in sleep. To address these gaps, we examined how sleep metrics captured from daily sleep diaries predicted medical expenditures. Participants were 391 World Trade Center responders enrolled in the World Trade Center Health Program (mean age = 54.97 years, 89% men). At baseline, participants completed 14 days of self-reported sleep and stress measures. Mean sleep, variability in sleep, and a novel measure of sleep reactivity (i.e., how much people's sleep changes in response to daily stress) were used to predict the subsequent year's medical expenditures, covarying for age, race/ethnicity, sex, medical diagnoses, and body mass index. Mean sleep efficiency did not predict mental healthcare utilization. However, greater sleep efficiency reactivity to stress (b=$191.75, p=.027), sleep duration reactivity to stress (b=$206.33, p=.040), variability in sleep efficiency (b=$339.33, p=.002), variability in sleep duration (b=$260.87, p=.004), and quadratic mean sleep duration (b=$182.37, p=.001) all predicted greater mental healthcare expenditures. Together, these sleep variables explained 12% of the unique variance in mental healthcare expenditures. No sleep variables were significantly associated with physical healthcare expenditures. People with more irregular sleep, more sleep reactivity, and either short or long sleep engage in more mental healthcare utilization. It may be important to address these individuals' sleep problems to improve mental health and reduce healthcare costs.

A systematic review on the early detection of oral cancer using artificial intelligence and electronic tongue technology

This systematic review examines the role of artificial intelligence (AI) and electronic tongue (e-tongue) technology in the early detection of oral cancer. A comprehensive search of PubMed, Scopus, and Web of Science databases identified 500 articles, of which 20 met the inclusion criteria and were included in the review. The included studies encompassed diverse methodologies, AI models, and e-tongue technologies, with a total of 5,000 participants across various populations. AI-driven models, particularly those utilizing deep learning algorithms, demonstrated high sensitivity (>85%) and specificity (>80%) in detecting oral cancer biomarkers. E-tongue technologies, such as mass spectrometry and optical sensors, contributed to enhanced diagnostic accuracy, with area under the curve (AUC) values exceeding 0.85 in several studies. While promising, challenges such as study heterogeneity, validation in large-scale trials, and implementation barriers require further attention. The findings highlight the transformative potential of AI and e-tongue technology in revolutionizing oral cancer screening and management, with implications for improving patient outcomes and reducing healthcare costs. Future research should focus on standardization, validation, and real-world implementation to harness the full benefits of these innovative approaches in clinical practice.

Diagnostic Value of T2-MRI in Incidental Cystic Renal Masses on Lumbar Spine MRI

Background: Cystic renal masses (CRM) are found incidentally in many patients undergoing lumbar MRI. cysts. Objectives: The present study aimed to determine the diagnostic value of T2-weighted imaging features of CRM on lumbar spine MRI and their reliability in differentiating complex renal lesions from simple Methods: All lumbar MRIs performed between 2019 and 2021 were included in this prospective study. Patients with simple cysts on MRI underwent a renal ultrasound by an expert radiologist. Patients with complex or suspicious cysts, based on sonographic characteristics, were subjected to a CT scan with contrast. For complex cysts identified on MRI, patients underwent a CT scan with contrast without first undergoing an ultrasound examination. Finally, the sensitivity, specificity, and positive and negative predictive values of T2 lumbar MRI images were calculated to determine the nature of the cysts. Results: A total of 2,789 lumbar MRIs were performed during the study period. Of these, 169 cases (6.05%) were reported to have incidental kidney cysts. No significant differences were found between the age and sex of the patients. The size of the cysts differed significantly between complex and simple cysts. The sensitivity, specificity, and positive and negative predictive values of MRI in determining the nature of the cyst were calculated to be 100%, 98%, 83%, and 100%, respectively. Conclusions: The results of the present study showed that further examinations using ultrasound and CT scans in patients with simple renal cysts on lumbar MRI are not recommended, which can significantly reduce health care costs.

Non-Adherence to Peripheral Venous Catheter Care Protocols Significantly Decreases Patient Safety and Impacts Costs: A Retrospective Observational Study.

In the healthcare field, the effective implementation of clinical protocols is crucial to ensuring patient safety and well-being. In this context, this study evaluates nurses' adherence to the maintenance and replacement protocol of peripheral venous catheters (PVCs) in a university hospital in Spain, examining the impact of compliance with the protocol on the loss of PVCs and on patient safety in addition to analyzing the related costs. A retrospective observational study was conducted with 590 patients who were admitted in 2018 and 2019. The chi-square test or Fisher's exact test, as appropriate, was used to see the association between the study variables; with the dependent variable being the loss of PVCs (including, as a dependent variable, the loss of PVCs before 48 h). The patients' electronic and physical medical records were reviewed to analyze nursing interventions related to the management of PVCs. A total of 24% of patients experienced PVC loss within the first 24 h after insertion. Failure to comply with the protocol resulted in 80% more catheter loss and increased the cost of cannulation by 46.84%. Low compliance with PVC care protocols significantly increases the risk of catheter loss, suggesting the need for increased training and strict protocol implementation. The findings emphasize the critical role of nursing in ensuring patient safety through adherence to evidence-based protocols. Continuing education and diligent protocol implementation are essential to reducing healthcare costs and improving patient outcomes.

Nursing Interventions Targeting Fatigue in Inflammatory Bowel Disease: A Systematic Review

A prevalent symptom among Inflammatory Bowel Disease (IBD) patients is fatigue, characterized by a persistent sense of energy depletion that affects all aspects of daily life. This review aims to evaluate nursing interventions reported in the literature to alleviate fatigue in IBD patients. A comprehensive search was conducted across four electronic databases—PubMed, CINAHL, Cochrane, and Scopus—and four scientific journals: “Gastroenterology”, “Inflammatory Bowel Disease”, “Journal of Crohn’s and Colitis”, and “United European Gastroenterology Journal”. Inclusion criteria were clinical trials involving adult IBD patients in remission or mild disease activity. Out of 234 studies, 2 were selected for review. These studies assess the effectiveness of Solution-Focused Therapy (SFT) that emphasizes solving problems and developing strategies for improvement, and Problem-Solving Therapy (PST) that focuses on identifying problems and coping strategies. SFT showed a positive impact on fatigue with a significant improvement in the Checklist Individual Strength after three months: 45.5% in the control group, 85.7% in the SFT group, and 60% in the PST group, but its impact declined over time. Additionally, SFT demonstrated potential for reducing healthcare costs compared to standard of care and PST. Further research is needed to provide nurses interventions for managing fatigue in IBD patients. The review protocol has been registered at OSF.io.

Tele-Assisted Home-Based Palliative Care Reduces Health Care Costs for Terminal Cancer Patients: Real-World Evidence From a Regional Hospital in Taiwan.

Background: Tele-assisted home-based palliative care (THPC) usually fulfills the desire of terminal patients to pass away at home. The overall costs of such a service deserve evaluation. Objectives: This study aims to determine health care utilization and costs for cancer patients at the end of life, stratified by THPC service. Design: Patients who received THPC were matched 1:1 based on age, gender, year of death, and propensity score with those who did not receive THPC. Setting/Subjects: A total of 773 cancer patients passed away in a regional hospital in Taiwan during the period of 2012-2020, of which 293 received THPC. Measurements: We measured the rates and costs of outpatient clinic visits, emergency department (ED) visits, hospitalizations, and intensive care unit (ICU) admissions during the last week, the last two weeks and the last month before death. In addition, we estimated the driving times and expenses required for transportation from each cancer patient's home to the hospital using Google Maps. National Health Insurance (NHI) reimbursements and out-of-pocket expenses were also calculated. Results: In comparison with patients without THPC, those who received THPC had a 50% lower likelihood of visiting the ED or being hospitalized, a more than 90% reduced chance of ICU admission, but were four times more likely to obtain their medicines from outpatient clinics. THPC patients had similar out-of-pocket expenditures, approximately half of the NHI costs, and lower rates and costs for ambulance transportation to the ED. Conclusions: THPC reduced health care costs for terminal cancer patients in the last week, the last two weeks, and the last month before death, while also increasing the likelihood of patients being able to rest and pass away at home.

Artificial intelligence for early-stage detection of chronic kidney disease

Early-stage detection of chronic kidney disease (CKD) is crucial in research to enable timely intervention, enhance understanding of disease progression, reduce healthcare costs and support public health initiatives. The traditional approaches on early-stage chronic kidney disease detection often suffer from slow convergence and not integrate advanced technologies, impacting their effectiveness. Additionally, security and privacy concerns related to patient data are ineffectively addressed. To overcome these issues, this research incorporates novel optimized artificial intelligence-based approaches. The main aim is to enhance detection process through enhanced hybrid mud ring network (EHMRN), a novel detection technique combining light gradient boosting machine and MobileNet, involving extensive data collection, including a large dataset of 100,000 instances. The introduced network is optimized through the mud ring optimization to attain enhanced performance. Incorporating spark ensures secure cloud-based storage, enhancing privacy and compliance with healthcare data regulations. This approach represents a significant advancement in primary stage detection more effectively and promptly. The results show that the introduced approach outperforms traditional approaches in terms of accuracy (99.96%), F1-score (99.91%), precision (100%), specificity (99.98%), recall (100%) and execution time (0.09 s).

An Investigation Into the Risk Factors for Transfusion Need After Neck of Femur Fracture Surgery.

A common surgical procedure in the elderly is the operation on neck of femur fractures, with a primary complication being the need for a postoperative blood transfusion. Consequently, current standard practice involves cross-matching two units of red blood cells for each patient preoperatively. This incurs significant costs and is associated with blood product complications for transfused patients who are at low risk. This study aims to identify factors that could increase the risk of requiring a blood transfusion, thereby facilitating the adaptation of preoperative cross-matching practices to reflect individual patient risks rather than using a generalised approach. A retrospective analysis was conducted of 319 patients from a major acute teaching hospital between June 2023 and January 2024, examining risk factors including preoperative haemoglobin levels, age, gender, type and duration of surgery, type of fracture, BMI, use of anticoagulants, and comorbidities (diabetes, hypertension, cancer, chronic obstructive pulmonary disease (COPD)/asthma, heart disease). Binary logistic regression and odds ratios were used to assess their impact on blood loss and transfusion need. Ninety-nine patients (31%) in our cohort received a blood transfusion. Preoperative haemoglobin (p<0.001) and age (p=0.039) were the only factors found to be significant predictors of the likelihood of needing a blood transfusion. The exponentiation of the B coefficient (Exp(B)) values were 0.920 and 1.040, respectively, indicating a negative correlation for preoperative haemoglobin and a positive correlation for age. Statistical analysis between the group receiving a transfusion versus those who did not showed that patients were significantly older (p<0.001), had lower BMI (p=0.037), and had lower preoperative haemoglobin (p<0.001) in the transfused group. Odds ratios indicated that females (1.34) and patients with hypertension (1.19), cancer (1.09), COPD or asthma (1.06), and heart disease (1.45) were more likely to receive transfusions. Intracapsular fractures (undisplaced 0.12, displaced 0.38) and arthroplasty (0.38) showed lower odds compared to intramedullary (IM) nailing (3.13). The odds ratio changes to less than one for haemoglobin values >110 g/L (<0.7) and increases to values greater than one for age above 80 (>1.27). Increased age and low preoperative haemoglobin significantly raise the risk of hidden blood loss and transfusion need following neck of femur surgery. We suggest further development of a risk prediction model to improve surgical outcomes, reduce healthcare costs, and optimise resource utilisation.

Iron-related Biomarkers in the Diagnosis and Management of Iron Disorders.

Iron deficiency and iron-related disorders are common health issues worldwide, affecting a significant proportion of the population. Diagnosis and management of these disorders rely heavily on using various iron-related biomarkers that can provide valuable clinical information. This review article provides an overview of the most commonly used iron-related biomarkers, including serum ferritin, transferrin saturation, soluble transferrin receptor, zinc protoporphyrin, and free erythrocyte protoporphyrin. Other emerging biomarkers, such as hepcidin and retinol-binding protein 4, are also discussed. Iron plays a vital role in various physiological processes, including oxygen transport, energy metabolism, and DNA synthesis. The article highlights the advantages and limitations of iron biomarkers and their clinical applications in diagnosing and managing iron deficiency and iron-related anemia. Using iron-related biomarkers in screening and monitoring programs can improve patient outcomes and reduce healthcare costs.

Recurrent respiratory papillomatosis: comparing in-office and operating room treatments.

We report the management of recurrent respiratory papillomatosis (RRP) employing a protocol that includes both office-based (OB) and general anaesthesia (GA) procedures. Quality of life (QoL) outcomes in the OB cohort were compared to those obtained from an historical cohort treated only under GA. Patients affected by RRP from 2019 until 2023 ("new protocol") and from 2012 to 2019 ("historical protocol") were enrolled. In both groups the Derkay site score (DSS) was calculated. In patients adhering to the new protocol, questionnaires measuring QoL were prospectively administered (voice handicap hindex-10 [VHI-10] along with a specific questionnaire to measure the tolerance to the OB procedures). A cost analysis was also performed. In all, 35 patients composed the new protocol cohort and 13 the historical. In the first group, patients underwent a median of 4 treatments. At 2 years, 68% of patients were treated exclusively in the office. Overall, for the new protocol, median DSS and VHI-10 after one year were both significantly lower than those at baseline [2 vs 4 and 3 vs 14, respectively; p < 0.001]. No differences were found between the new and the historical protocol cohorts considering DSS over time. Treatment of RRP may be conducted successfully in an office-based setting reducing healthcare costs.

Safety and Efficacy of Tubeless Percutaneous Nephrolithotomy: A Prospective Randomized Study

Background: Urinary lithiasis, or kidney stone disease, is a common and longstanding health issue characterized by significant morbidity and recurrence. Despite advancements in treatment modalities, managing large or complex renal stones continues to pose challenges. The evolution of surgical techniques, such as percutaneous nephrolithotomy (PCNL), has significantly impacted the management of kidney stones. This study aims to evaluate the safety and efficacy of tubeless PCNL compared to conventional PCNL in patients with renal and upper ureteric stones. Methods: A prospective randomized study was conducted at the Urology and Nephrology University Hospital, Assiut University, Egypt, from September 2016 to September 2019. The study included 60 patients who met the inclusion criteria and were randomly assigned into two groups: Group 1 (conventional PCNL) and Group 2 (tubeless PCNL). Postoperative outcomes, including pain scores, fever, blood loss, urinary leakage, length of hospitalization, need for re-hospitalization, and stone-free rates, were evaluated. Statistical analyses were performed using SPSS version 20.0, with a p-value of less than 0.05 considered statistically significant. Results: A total of 60 patients were included in the final analysis, equally divided into two groups. There were no statistically significant differences between the groups regarding demographic data, stone characteristics, hemoglobin levels, creatinine levels, or blood loss. However, the duration of surgery was significantly longer in the tubeless group (Group 2) compared to the conventional group (Group 1) (P-value = 0.034). Both groups achieved comparable stone-free rates with no significant differences in postoperative complications. Conclusion: Tubeless PCNL is a safe and effective alternative to conventional PCNL for managing renal and ureteral stones, with comparable outcomes in terms of blood loss, creatinine, and hemoglobin levels. The main advantage of tubeless PCNL is the potential for reduced postoperative discomfort and quicker recovery, although it requires a longer operative time. These findings support the use of tubeless PCNL as a viable option in appropriately selected patients, with implications for improving patient outcomes and reducing healthcare costs associated with kidney stone management.

Validation of multispectral imaging-based tissue oxygen saturation detecting system for wound healing recognition on open wounds.

The multispectral imaging-based tissue oxygen saturation detecting (TOSD) system offers deeper penetration ( to 3mm) and comprehensive tissue oxygen saturation ( ) assessment and recognizes the wound healing phase at a low cost and computational requirement. The potential for miniaturization and integration of TOSD into telemedicine platforms could revolutionize wound care in the challenging pandemic era. We aim to validate TOSD's application in detecting by comparing it with wound closure rates and laser speckle contrast imaging (LSCI), demonstrating TOSD's ability to recognize the wound healing process. Utilizing a murine model, we compared TOSD with digital photography and LSCI for comprehensive wound observation in five mice with 6-mm back wounds. Sequential biochemical analysis of wound discharge was investigated for the translational relevance of TOSD. TOSD demonstrated constant signals on unwounded skin with differential changes on open wounds. Compared with LSCI, TOSD provides indicative recognition of the proliferative phase during wound healing, with a higher correlation coefficient to wound closure rate (TOSD: 0.58; LSCI: 0.44). detected by TOSD was further correlated with proliferative phase angiogenesis markers. Our findings suggest TOSD's enhanced utility in wound management protocols, evaluating clinical staging and therapeutic outcomes. By offering a noncontact, convenient monitoring tool, TOSD can be applied to telemedicine, aiming to advance wound care and regeneration, potentially improving patient outcomes and reducing healthcare costs associated with chronic wounds.

Effect of a single pill concept on clinical and pharmacoeconomic outcomes in cardiovascular diseases.

Our study aimed to assess whether a single pill concept (SPC) is superior to a multi pill concept (MPC) in reducing cardiovascular (CV) events, all-cause death, and costs in CV patients. Anonymized medical claims data covering 2012-2018, including patients with hypertension, dyslipidemia, and CV diseases who started a drug therapy either as SPC or identical MPC were analyzed after 1:1-Propensity Score Matching (PSM). Hospitalizations with predefined CV events, all-cause mortality, and costs were studied in 25,311 patients with SPC and 25,311 patients with MPC using incidence rate ratios (IRRs) and non-parametric tests for continuous variables.IRRs were significantly lower for SPC: stroke (IRR=0.77; 95% CI 0.67-0.88; p<0.001), transitory ischemic attack (IRR=0.61; 95% CI 0.48-0.78; p<0.001), myocardial infarction (IRR=0.76; 95% CI 0.63-0.90; p=0.0016), coronary artery disease (IRR=0.66; 95% CI 0.57-0.77; p<0.001), heart failure (IRR=0.59; 95% CI 0.54-0.64; p<0.001), acute renal failure (IRR=0.54; 95% CI 0.56-0.64; p<0.001), all cause hospitalization (IRR=0.72; 95% CI 0.71-0.74; p<0.001), CV hospitalization (IRR=0.63; 95% CI 0.57-0.69; p<0.001), and all-cause mortality (IRR=0.62; 95% CI 0.57-0.68; p<0.001). Mean time to first events and time to death were also in favor of SPC. Mean total costs were 4,708 € for SPC vs. 5.669 € for MPC, respectively (MR 0.830, p<0.001). SPC is associated with lower incidence rates of CV events, time to CV events, and all-cause death, and is superior regarding pharmacoeconomic parameters and should therefore become standard of care to improve outcomes and reduce healthcare costs.

Impact of Referring High-Risk Patients to Intensive Outpatient Primary Care Services: A Propensity Score-Matched Analysis.

Many healthcare systems have implemented intensive outpatient primary care programs with the hopes of reducing healthcare costs. The Veterans Health Administration (VHA) piloted primary care intensive management (PIM) for patients at high risk for hospitalization or death, or "high-risk." We evaluated whether a referral model would decrease high-risk patient costs. Retrospective cohort study using a quasi-experimental design comparing 456 high-risk patients referred to PIM from October 2017 to September 2018 to 415 high-risk patients matched on propensity score. Veterans in the top 10th percentile of risk for 90-day hospitalization or death and recent hospitalization or emergency department (ED) visit. PIM consisted of interdisciplinary teams that performed comprehensive assessments, intensive case management, and care coordination services. Change in VHA and non-VHA outpatient utilization, inpatient admissions, and costs 12months pre- and post-index date. Of the 456 patients referred to PIM, 301 (66%) enrolled. High-risk patients referred to PIM had a marginal reduction in ED visits (- 0.7; [95% CI - 1.50 to 0.08]; p = 0.08) compared to propensity-matched high-risk patients; overall outpatient costs were similar. High-risk patients referred to PIM had similar number of medical/surgical hospitalizations (- 0.2; [95% CI, - 0.6 to 0.16]; p = 0.2), significant increases in length of stay (6.36; [CI, - 0.01 to 12.72]; p = 0.05), and higher inpatient costs ($22,628, [CI, $3587 to $41,669]; p = 0.02) than those not referred to PIM. VHA intensive outpatient primary care was associated with higher costs. Referral to intensive case management programs targets the most complex patients and may lead to increased utilization and costs, particularly in an integrated healthcare setting with robust patient-centered medical homes. PIM 2.0: Patient Aligned Care Team (PACT) Intensive Management (PIM) Project (PIM2). NCT04521816. https://clinicaltrials.gov/study/NCT04521816.

Psychosocial Interventions to Reduce Post operative Pain in Total Knee Arthroplasty: A Systematic Review

Background: Total knee arthroplasty (TKA) is a common surgical remedy for patients with end-stage osteoarthritis. Although TKA is generally effective, a significant number of patients experience chronic post-surgical pain. Psychosocial interventions have increasingly become an area of interest in pain management following surgical procedures. Purpose: We aimed to evaluate the impact of pre-operative, peri-operative, and post-operative psychosocial interventions on reducing the likelihood of developing chronic pain after TKA. Methods: We performed a systematic review following the Cochrane guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A comprehensive search strategy was employed using PubMed, Embase, and Cochrane Central Register of Controlled Trials. Inclusion criteria were (1) patients undergoing; (2) pain outcome assessed ≥1 month post-operatively; (3) prospective and longitudinal study design (eg, randomized controlled trial, experimental non-randomized trial, cohort, case-control studies with measurement of exposure prior to outcome); (4) English language; and (5) psychosocial intervention (cognitive-behavioral, biopsychosocial, dialectical behavioral, psychoeducation, mindfulness, meditation, psychotherapy, relaxation, mind-body therapies, hypnosis). Exclusion criteria were non-primary literature (eg, review articles), non–peer-reviewed studies, and conference proceedings. The methodological quality of included studies was assessed using Cochrane’s tool for Risk of Bias 2 (RoB 2), the methodological index for non-randomized studies (MINORS), and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I). Results: Of 4297 studies reviewed with title and abstract, 4160 were excluded. Of the remaining 137 studies that underwent full-text review, 122 were excluded using the same inclusion and exclusion criteria, and 15 studies were included. Our review indicates a variable but positive impact of psychosocial interventions, such as pre-operative education, relaxation techniques, and cognitive-behavioral therapy, on post-TKA pain. Of the 15 included studies, 9 studies found that psychosocial interventions reduced post-TKA pain. Our review also suggests that cognitive-behavioral therapy may aid in reducing kinesiophobia, pain catastrophizing, and knee pain intensity. For the 12 randomized studies, the risk of bias was deemed “high” concerns for 3 studies, “some” concerns for 5 studies, and “low” concerns for 4 studies. For the 3 non-randomized studies, the risk of bias was deemed “moderate” due to confounding bias. Conclusions: This systematic review of level-I and level-II studies found that the integration of psychosocial interventions into care protocols for TKA offers benefits including improved patient satisfaction and quality of life and reduced health care costs. Limitations include heterogeneity in intervention types and outcomes measured and the varying levels of risk of bias across studies, which may affect the generalizability of the findings. The findings support a broader adoption of holistic, patient-centered approaches in pain management after TKA, emphasizing the importance of psychological well-being for optimal patient outcomes. However, the evidence is limited and constitutes a strong impetus for the further study of these interventions.

Setting Ranges in Potential Biomarkers for Type 2 Diabetes Mellitus Patients Early Detection By Sex-An Approach with Machine Learning Algorithms.

Type 2 diabetes mellitus (T2DM) is one of the most common metabolic diseases in the world and poses a significant public health challenge. Early detection and management of this metabolic disorder is crucial to prevent complications and improve outcomes. This paper aims to find core differences in male and female markers to detect T2DM by their clinic and anthropometric features, seeking out ranges in potential biomarkers identified to provide useful information as a pre-diagnostic tool whie excluding glucose-related biomarkers using machine learning (ML) models. We used a dataset containing clinical and anthropometric variables from patients diagnosed with T2DM and patients without TD2M as control. We applied feature selection with three different techniques to identify relevant biomarker models: an improved recursive feature elimination (RFE) evaluating each set from all the features to one feature with the Akaike information criterion (AIC) to find optimal outputs; Least Absolute Shrinkage and Selection Operator (LASSO) with glmnet; and Genetic Algorithms (GA) with GALGO and forward selection (FS) applied to GALGO output. We then used these for comparison with the AIC to measure the performance of each technique and collect the optimal set of global features. Then, an implementation and comparison of five different ML models was carried out to identify the most accurate and interpretable one, considering the following models: logistic regression (LR), artificial neural network (ANN), support vector machine (SVM), k-nearest neighbors (KNN), and nearest centroid (Nearcent). The models were then combined in an ensemble to provide a more robust approximation. The results showed that potential biomarkers such as systolic blood pressure (SBP) and triglycerides are together significantly associated with T2DM. This approach also identified triglycerides, cholesterol, and diastolic blood pressure as biomarkers with differences between male and female actors that have not been previously reported in the literature. The most accurate ML model was selection with RFE and random forest (RF) as the estimator improved with the AIC, which achieved an accuracy of 0.8820. In conclusion, this study demonstrates the potential of ML models in identifying potential biomarkers for early detection of T2DM, excluding glucose-related biomarkers as well as differences between male and female anthropometric and clinic profiles. These findings may help to improve early detection and management of the T2DM by accounting for differences between male and female subjects in terms of anthropometric and clinic profiles, potentially reducing healthcare costs and improving personalized patient attention. Further research is needed to validate these potential biomarkers ranges in other populations and clinical settings.

Nurse Practitioners (NPs) as Game Changers in Tanzania Health Delivery System: Lessons Learnt from Fujita Bantane Hospital in Japan

AbstractShortage of physicians/doctors in the primary health care system has been evidenced in various countries. Among other things, these countries deployed nurse practitioners (NPs) in the health care delivery system to address this shortage. Countries in America, Europe, and Asia use NPs to address physicians/doctors shortage in the primary health care delivery systems. Various studies have shown that NPs have been deployed in primary health care facilities to curb these shortages.While in Tanzania shortage of physicians/doctors and other health professionals is evidenced in every sector of the health care system, nurses play a crucial role to cover this shortage by providing care and support for individuals and communities. Nurses work in various settings from being a nurse, counselor, laboratory technologist, social worker, educationist, and physician, to name a few. Nurses play a key role in preventing, diagnosing, and attending to common health problems. The question is, “When will the Tanzanian health delivery system recognize the pivotal role of these nurses and upgrade them to NPs?” This study suggests that deployment of NPs in Tanzania's health care systems could be a “game changer.” As a fellow on Critical Care Nursing Course at Fujita Health University Bantane Hospital in Japan, witnessed deployment of NPs in health care delivery and the reaped benefits are enormous; increased access to health care services, reduction in health care costs, reduced hospital stays, and customer satisfaction through client empowerment and comfort. This is an observational study of tasks performed by NPs in Fujita Health University Bantane Hospital and their relevance as a positive innovation to curb physician shortages for effective health care delivery. The duration of the study at Bantane Hospital was 2 months from January 15 to March 16, 2024. One-to-one interviews with NPs on duty were conducted. Also, collected and reviewed information from Tanzanian government Web sites, published government documents, and academic literature. Results show that NPs perform a lot of procedures that physicians/doctors were supposed to do. In the wards, theater, laboratories, and clinics, they play a pivotal role to curb shortage of physicians/doctors in health settings. NPs are an effective addition to medical facilities. They perform various procedures in the absence of the doctors. The findings from this study have important implications for improving health care delivery in Tanzania. NPs could be “game changers” in the health care landscape in Tanzania. Investment on nurses' education, proper training, and policy changes in nurse practice regulations are key for this to succeed.

Dietary Protein and Physical Exercise for the Treatment of Sarcopenia.

Sarcopenia is a multifactorial age-related disorder that causes a decrease in muscle mass, strength, and function, leading to alteration of movement, risk of falls, and hospitalization. This article aims to review recent findings on the factors underlying sarcopenia and the strategies required to delay and counteract its symptoms. We focus on molecular factors linked to ageing, on the role of low-grade chronic and acute inflammatory conditions such as cancer, which contributes to the onset of sarcopenia, and on the clinical criteria for its diagnosis. The use of drugs against sarcopenia is still subject to debate, and the suggested approaches to restore muscle health are based on adequate dietary protein intake and physical exercise. We also highlight the difference in the amount and quality of amino acids within animal- and plant-based diets, as studies have often shown varying results regarding their effect on sarcopenia in elderly people. In addition, many studies have reported that non-pharmacological approaches, such as an optimization of dietary protein intake and training programs based on resistance exercise, can be effective in preventing and delaying sarcopenia. These approaches not only improve the maintenance of skeletal muscle function, but also reduce health care costs and improve life expectancy and quality in elderly people.

Immediate Postpartum Long-Acting Reversible Contraception for Preventing Severe Maternal Morbidity: A Cost-Effectiveness Analysis.

To estimate the cost effectiveness of Medicaid covering immediate postpartum long-acting reversible contraception (LARC) as a strategy to reduce future short interpregnancy interval (IPI), severe maternal morbidity (SMM), and preterm birth. We built a decision analytic model using TreeAge software to compare maternal health and cost outcomes in two settings, one in which immediate postpartum LARC is a covered option and the other where it is not, among a theoretical cohort of 100,000 people with Medicaid insurance who were immediately postpartum and did not have permanent contraception. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represents the incremental cost increase per an incremental quality-adjusted life-years (QALY) gained from one health intervention compared with another. Secondary outcomes included subsequent short IPI, defined as time between last delivery and conception of less than 18 months, as well as SMM, preterm birth, overall costs, and QALYs. We performed sensitivity analyses on all costs, probabilities, and utilities. Use of immediate postpartum LARC was the cost-effective strategy, with an ICER of -11,880,220,102. Use of immediate postpartum LARC resulted in 299 fewer repeat births overall, 178 fewer births with short IPI, two fewer cases of SMM, and 34 fewer preterm births. Coverage of immediate postpartum LARC resulted in 25 additional QALYs and saved $2,968,796. Coverage of immediate postpartum LARC at the time of index delivery can improve quality of life and reduce health care costs for Medicaid programs. Expanding coverage to include immediate postpartum LARC can help to achieve optimal IPI and decrease SMM and preterm birth.