BACKGROUND AND OBJECTIVE: Bladder cancer (BCa) imposes a substantial economic burden on health care systems and patients. Understanding these financial implications is crucial for effective resource allocation and optimization of treatment cost effectiveness. Here, we aim to systematically review and analyze the financial burden of BCa from the health care and patient perspectives. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant systematic review was conducted, searching PubMed/Medline, Embase, and public sources for studies evaluating the financial impact of BCa, encompassing costs, cost effectiveness, and financial toxicity (FT). KEY FINDINGS AND LIMITATIONS: Non-muscle-invasive BCa (NMIBC) incurs significant costs for surveillance and treatment, with costs exceeding $200 000 after 5 yr for high-risk NMIBC patients progressing after bacillus Calmette-Guerin (BCG) treatment (including inpatient, outpatient, and physician service expenses). Muscle-invasive BCa generates substantial costs from radical cystectomy (RC) and neoadjuvant chemotherapy, averaging $30 000-40 000 from surgical costs of RC, with additional expenses in case of complications. Trimodal therapy has higher costs (1-yr management cost >$200 000) than RC because of higher outpatient, radiology, and medication costs. Metastatic BCa incurs the highest financial burden, with systemic therapy costs ranging from $40 000 to over $100 000 per five-cycle course, increasing further with combination therapies (ie, enfortumab vedotin and pembrolizumab), treatment-related toxicity, and supportive care. FT is particularly prevalent among younger, less educated, and minority populations. CONCLUSIONS AND CLINICAL IMPLICATIONS: BCa treatment, particularly in advanced stages, imposes a substantial economic burden. Innovations in care, while improving oncologic outcomes, necessitate detailed cost-effectiveness assessments. Addressing these economic challenges is essential for optimizing BCa management, targeting patients at a higher risk of FT, and improving patient quality of life.
- MeSH
- Cost-Benefit Analysis MeSH
- Cystectomy economics adverse effects MeSH
- Humans MeSH
- Neoplasm Metastasis MeSH
- Urinary Bladder Neoplasms * economics therapy pathology MeSH
- Health Care Costs * MeSH
- Cost of Illness * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Systematic Review MeSH
Bacterial biofilms pose significant challenges, from healthcare-associated infections to biofouling in industrial systems, resulting in significant health impacts and financial losses globally. Classic antimicrobial methods often fail to eradicate sessile microbial communities within biofilms, requiring innovative approaches. This review explores the structure, formation, and role of biofilms, highlighting the critical importance of exopolysaccharides in biofilm stability and resistance mechanisms. We emphasize the potential of microbial enzymatic approaches, particularly focusing on glycosidases, proteases, and deoxyribonucleases, which can disrupt biofilm matrices effectively. We also delve into the importance of enzymes such as cellobiose dehydrogenase, which disrupts biofilms by degrading polysaccharides. This enzyme is mainly sourced from Aspergillus niger and Sclerotium rolfsii, with optimized production strategies enhancing its efficacy. Additionally, we explore levan hydrolase, alginate lyase, α-amylase, protease, and lysostaphin as potent antibiofilm agents, discussing their microbial origins and production optimization strategies. These enzymes offer promising avenues for combating biofilm-related challenges in healthcare, environmental, and industrial settings. Ultimately, enzymatic strategies present environmentally friendly solutions with high potential for biofilm management and infection control.
Face transplantation is a viable reconstructive approach for severe craniofacial defects. Despite the evolution witnessed in the field, ethical aspects, clinical and psychosocial implications, public perception, and economic sustainability remain the subject of debate and unanswered questions. Furthermore, poor data reporting and sharing, the absence of standardized metrics for outcome evaluation, and the lack of consensus definitions of success and failure have hampered the development of a "transplantation culture" on a global scale. We completed a 2-round online modified Delphi process with 35 international face transplant stakeholders, including surgeons, clinicians, psychologists, psychiatrists, ethicists, policymakers, and researchers, with a representation of 10 of the 19 face transplant teams that had already performed the procedure and 73% of face transplants. Themes addressed included patient assessment and selection, indications, social support networks, clinical framework, surgical considerations, data on patient progress and outcomes, definitions of success and failure, public image and perception, and financial sustainability. The presented recommendations are the product of a shared commitment of face transplant teams to foster the development of face transplantation and are aimed at providing a gold standard of practice and policy.
- MeSH
- Delphi Technique MeSH
- Consensus MeSH
- Humans MeSH
- Facial Transplantation * methods MeSH
- Vascularized Composite Allotransplantation * MeSH
- Research Design MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Face transplantation is a viable reconstructive approach for severe craniofacial defects. Despite the evolution witnessed in the field, ethical aspects, clinical and psychosocial implications, public perception, and economic sustainability remain the subject of debate and unanswered questions. Furthermore, poor data reporting and sharing, the absence of standardized metrics for outcome evaluation, and the lack of consensus definitions of success and failure have hampered the development of a "transplantation culture" on a global scale. We completed a 2-round online modified Delphi process with 35 international face transplant stakeholders, including surgeons, clinicians, psychologists, psychiatrists, ethicists, policymakers, and researchers, with a representation of 10 of the 19 face transplant teams that had already performed the procedure and 73% of face transplants. Themes addressed included patient assessment and selection, indications, social support networks, clinical framework, surgical considerations, data on patient progress and outcomes, definitions of success and failure, public image and perception, and financial sustainability. The presented recommendations are the product of a shared commitment of face transplant teams to foster the development of face transplantation and are aimed at providing a gold standard of practice and policy.
- MeSH
- Delphi Technique MeSH
- Consensus MeSH
- Humans MeSH
- Facial Transplantation * methods MeSH
- Vascularized Composite Allotransplantation * MeSH
- Research Design MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: The association between cannabis use and positive symptoms in schizophrenia spectrum disorders is well documented, especially via meta-analyses. Yet, findings are inconsistent regarding negative symptoms, while other dimensions such as disorganization, depression, and excitement, have not been investigated. In addition, meta-analyses use aggregated data discarding important confounding variables which is a source of bias. METHODS: PubMed, ScienceDirect and PsycINFO were used to search for publications from inception to September 27, 2022. We contacted the authors of relevant studies to extract raw datasets and perform an Individual Participant Data meta-analysis (IPDMA). Inclusion criteria were: psychopathology of individuals with schizophrenia spectrum disorders assessed by the Positive and Negative Syndrome Scale (PANSS); cannabis-users had to either have a diagnosis of cannabis use disorder or use cannabis at least twice a week. The main outcomes were the PANSS subscores extracted via the 3-factor (positive, negative and general) and 5-factor (positive, negative, disorganization, depression, excitement) structures. Preregistration is accessible via Prospero: ID CRD42022329172. FINDINGS: Among the 1149 identified studies, 65 were eligible and 21 datasets were shared, totaling 3677 IPD and 3053 complete cases. The adjusted multivariate analysis revealed that relative to non-use, cannabis use was associated with higher severity of positive dimension (3-factor: Adjusted Mean Difference, aMD = 0.34, 95% Confidence Interval, CI = [0.03; 0.66]; 5-factor: aMD = 0.38, 95% CI = [0.08; 0.63]), lower severity of negative dimension (3-factor: aMD = -0.49, 95% CI [-0.90; -0.09]; 5-factor: aMD = -0.50, 95% CI = [-0.91; -0.08]), higher severity of excitement dimension (aMD = 0.16, 95% CI = [0.03; 0.28]). No association was found between cannabis use and disorganization (aMD = -0.13, 95% CI = [-0.42; 0.17]) or depression (aMD = -0.14, 95% CI = [-0.34; 0.06]). INTERPRETATION: No causal relationship can be inferred from the current results. The findings could be in favor of both a detrimental and beneficial effect of cannabis on positive and negative symptoms, respectively. Longitudinal designs are needed to understand the role of cannabis is this association. The reported effect sizes are small and CIs are wide, the interpretation of findings should be taken with caution. FUNDING: This research did not receive any specific grant or funding. Primary financial support for authors was provided by Le Vinatier Psychiatric Hospital.
- Publication type
- Journal Article MeSH
This article focuses on leadership and the role of managers in the field of non-profit sports organisations, knowing that this area of activity is still largely neglected by research. The main goal of this research was to find out what roles managers currently play in the management of non-profit organisations in the field of sports. The method of a quantitative questionnaire survey was applied and the respondents were 270 non-profit sports organisation managers. The research shows that the roles of managers of non-profit sports organisations have significantly affected interpersonal activities to fulfil the mission of these organisations more than to strengthen their economic performance. The overshadowing of some managerial roles creates an incentive to focus on the creation of educational offers aimed at strengthening leadership, management of subsidies from public sources, and the possibility of using marketing in the field of creating their own financial resources.
Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease. Insufficient investment across the spectrum of kidney health and kidney care is a fundamental source of inequity. In addition, social and structural inequities, including inequities in access to primary health care, education and preventative strategies, are major risk factors for, and contribute to, poorer outcomes for individuals living with kidney diseases. Access to affordable kidney care is also highly inequitable, resulting in financial hardship and catastrophic health expenditure for the most vulnerable. Solutions to these injustices require leadership and political will. The nephrology community has an important role in advocacy and in identifying and implementing solutions to dismantle inequities that affect kidney health.
- MeSH
- Health Services Accessibility * MeSH
- Kidney MeSH
- Humans MeSH
- Kidney Diseases * MeSH
- Health Expenditures MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
This study proposes an approach to the external evaluation of medical education programs' quality based on a combination of indicators, including international rankings, external stakeholders' input, and independent agencies' assessments. We modify the success equation with a detailed consideration of the skill component and its decomposition into internal and external quality assurance elements along with authority. We carried out a bibliometric analysis regarding the problem of medical education quality assessment in the context of achieving sustainable development goals. We described the calculation model of external quality assessment indicators through the algorithms of independent education quality assurance agencies' activity and rating indicators shown in the modified Mauboussin's equation. The model considers the economic component (the consequence of achievement) of skill, which is expressed in raising funds from external sources to implement educational and scientific activities. The proposed algorithm for assessing the educational program quality can be applied to benchmark educational program components, complete educational programs within the subject area, and the educational institution for different areas. We propose a "financial" model for educational program quality based on the analysis results. The model makes it possible to determine the need for additional focused funding of the educational program based on the individual analysis of the external evaluation criteria of the achievement level. This study analyzes the accreditation results of more than 110 educational programs in 2020 and 8 months of 2021 within the direction 22 "Medicine" (according to the national classification of fields of knowledge) (state and private Ukrainian medical universities).
- MeSH
- Education, Medical * MeSH
- Educational Measurement * MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Cíl práce: Cílem našeho projektu bylo ověřit vliv sportovního aktivačního programu na následnou pohybovou aktivitu a duševní zdraví psychiatrických pacientů v ambulantní péči. Materiál a metoda: 19 pacientů s diagnózou schizofrenie (10 mužů, medián věku = 37, a 9 žen, medián věku = 52) a 9 pacientů s diagnózou bipolární porucha (5 mužů, medián věku = 36, a 4 ženy, medián věku = 59) v ambulantní péči se zúčastnilo prostředky výzkumu plně hrazeného 6denního aktivačního pobytu se 6 hodinami individuálně zvolené pohybové aktivity denně a motivačními pohovory a následně jim byly hrazeny 2 lekce vybraného sportu týdně po dobu 6 měsíců. Dalších 7 měsíců cvičili samostatně na vlastní náklady. Před začátkem programu, po 6denním pobytu, po 6 měsících a po 13 měsících byly sledovány následující proměnné: čas a frekvence lehké a těžké pohybové aktivity pomocí International Physical Activity Questionnaire, vnímaná tělesná vytrvalost, obratnost a síla na vlastní 10bodové škále, psychomotorické tempo pomocí testu Trail Making Test, míra úzkosti a deprese pomocí Hospital Anxiety and Depression Scale a aktuální funkční výkonnost pomocí Global Assessment of Functioning Scale. Výsledky: U pacientů s diagnózou schizofrenie pohybový program statisticky významně zvýšil frekvenci lehké pohybové aktivity u žen (p = 0,034, W = 0,455) , zvýšil vnímanou sílu (p < 0,001, W = 0,637) a vytrvalost (p = 0,034, W = 0, 287) u mužů a vnímanou obratnost (p = 0,002, W = 0,473) u žen. Zlepšil ukazatele psychomotorického tempa u mužů (p < 0,001, W = 0,843) i u žen (p = 0, 002, W = 0,766). U mužů došlo v průběhu programu k mírnému zvýšení úzkosti (p < 0,001, W = 0,818) a deprese (p < 0,001, W = 0,837), u žen ke změně nedošlo. Aktuální funkční výkonnost vzrostla z 60 na 75 bodů u mužů a z 60 na 80 u žen; 2 muži a 1 žena nadále pokračují v pravidelném cvičení. U pacientů s diagnózou bipolární porucha došlo u mužů k statisticky významnému zlepšení psychomotorického tempa (p = 0,027, W = 0,762) a mírnému snížení hladiny úzkosti (p = 0,045, W = 0,669). U obou pohlaví došlo ke zvýšení aktuální funkční výkonnosti u žen ze 70 na 80 bodů, u mužů z 50 na 70. Ostatní měřené proměnné se nezměnily. V pravidelné pohybové aktivitě pokračuje nadále 1 muž a 1 žena. Závěr: V průběhu účasti v aktivačním pohybovém programu došlo u pacientů k pozitivním změnám v oblasti psychomotorického tempa a funkční výkonnosti. Možným vysvětlením je zvýšení tělesného sebehodnocení a začlenění se do společnosti při pohybových aktivitách, což některým umožnilo nechat se zaměstnat, jiným častěji využívat podpůrné programy. Úzkostné a depresivní příznaky byly programem ovlivněny spíše situačně, celkově došlo pouze k mírnému posunu. Naše studie naznačuje, že psychiatričtí pacienti mohou být pravidelně fyzicky aktivní, pokud jim bude poskytnuta vhodná motivace a podpora, včetně finanční.
Objective: The goal of our project was to verify the effect of a sports activation program on the subsequent physical activity and mental health of psychiatric patients in outpatient care. Material and method: 19 patients with a diagnosis of schizophrenia (10 men, median age = 37, and 9 women, median age = 52) and 9 patients with a diagnosis of bipolar disorder (5 men, median age = 36, and 4 women, median age = 59) in outpatient care participated in the research. They took part in fully paid 6-day activation stay with 6 hours of individually chosen physical activity per day and motivational interviews. They attended 2 lessons (again fully paid from the study) of the chosen sport per week for subsequent 6 months. For the next 7 months, they practiced independently at their own expense. Before the start of the program, after a 6-day stay, after 6 months and after 13 months, the following variables were measured: time and frequency of light and heavy physical activity using the International Physical Activity Questionnaire, perceived physical endurance, agility and strength on 10-point scale, psychomotor pace using the Trail Making Test, the level of anxiety and depression using the Hospital Anxiety and Depression Scale and current functioning score using the Global Assessment of Functioning Scale. Results: In patients diagnosed with schizophrenia, the exercise program statistically significantly increased the frequency of light physical activity in women (p = 0.034, W = 0.455), increased perceived strength (p < 0.001, W = 0.637) and endurance (p = 0.034, W = 0.287) in men and perceived dexterity (p = 0.002, W = 0.473) in women. It improved psychomotor pace indicators in men (p < 0.001, W = 0.843) and in women (p = 0.002, W = 0.766). In men, anxiety (p < 0.001, W = 0.818) and depression (p < 0.001, W = 0.837) slightly increased, there was no change in women. Current functional performance increased from 60 to 75 points in men and from 60 to 80 in women; 2 men and 1 woman continue to exercise regularly. In men with a diagnosis of bipolar disorder, there was a statistically significant improvement in psychomotor pace (p = 0.027, W = 0.762) and a slight decrease in the level of anxiety (p = 0.045, W = 0.669). For both sexes, there was an increase in current functional performance for women from 70 to 80 points, for men from 50 to 70. The other measured variables did not change; 1 man and 1 woman continue to exercise regularly. Conclusion: During the participation in the activation movement program, the patients experienced positive changes in the area of psychomotor pace and functional performance. A possible explanation is an increase in body self-esteem and integration into society during physical activities, which enabled some to get employed, others to use support programs more often. Anxiety and depressive symptoms were affected by the program rather situationally, overall there was only a slight shift. Our study suggests that psychiatric patients can be physically active on a regular basis if given appropriate motivation and support, including financial support.
BACKGROUND: Breast cancer (BC) poses a public health challenge as the most commonly diagnosed cancer among women globally. While BC mortality has declined across Europe in the past three decades, an opposite trend has been reported in some transitional European countries. This analysis estimates the mortality burden and the cost of lost productivity due to BC deaths in nine Central and Eastern Europe (CEE) countries: Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia, and Slovenia, that have defied the favorable cancer mortality trends. These estimates may provide relevant evidence to aid decision-makers in the prioritization of BC-targeted policies. METHODS: The human capital approach (HCA) was used to estimate years of life lost (YLL) and productivity losses due to premature death from BC (ICD-10 code: C50 Malignant neoplasm of breast). YLL and present value of future lost productivity (PVFLP) were calculated using age and gender-specific mortality, wages, and employment rates. Data were sourced from the World Health Organization (WHO), Eurostat, and the World Bank. RESULTS: In 2019, there were 19,726 BC deaths in the nine CEE countries. This study estimated BC deaths resulted in 267,184 YLL. Annual PVFLP was estimated to be €85 M in Poland, €46 M in Romania, €39 M in Hungary, €21 M in Slovakia, €18 M in Serbia, €16 M in Czech Republic, €15 M in Bulgaria, €13 M in Croatia, and €7 M in Slovenia. CONCLUSION: Premature death from BC leads to substantial YLL and productivity losses. Lost productivity costs due to premature BC-related mortality exceeded €259 million in 2019 alone. The data modeled provide important evidence toward resource allocation priorities for BC prevention, screening, and treatment that could potentially decrease productivity losses. Careful consideration should be given to BC-specific policies, such as surveillance programs and the availability of new treatments in CEE countries to decrease the medical and financial burden of the disease.
- MeSH
- Humans MeSH
- Breast Neoplasms * MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
- Europe MeSH
- Poland MeSH
- Europe, Eastern MeSH
