A Mobile Health Intervention for Patients With Depressive Symptoms: Protocol for an Economic Evaluation Alongside Two Randomized Trials in Brazil and Peru

BACKGROUND: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. OBJECTIVE: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. METHODS: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top-down and bottom-up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. RESULTS: The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. CONCLUSIONS: We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26164

Production of neutron-rich radioactive beams in region of mass A=10 to 15

Investigação da estrutura de núcleos exóticos é uma área bastante ativa da Física Nuclear atual. O desenvolvimento dessa área foi acentuado com a possibilidade de uso de feixes radioativos. Inspirados nessa possibilidade, laboratórios espalhados pelo mundo estão se desenvolvendo para produzir feixes radioativos de núcleos cada vez mais ricos em prótons ou em nêutrons. O uso de elementos radioativos como feixes têm oferecido oportunidades novas e únicas para pesquisa em física nuclear. Questões fundamentais tais como qual a natureza da matéria nuclear e como elementos pesados são sintetizados em novas, supernovas e estrelas de nêutrons podem ser abordadas em investigações utilizando-se feixes radioativos. Neste trabalho abordamos a produção de alguns desses feixes na região de massa A=10 e 15, especificamente, 10Be, 12B, 14C e 15C. Descrevemos métodos de produção e aplicamos simulações para produção de feixes com esses núcleos. Abordamos as peculiaridades na produção de cada um deles com o intuito de produzir feixes o mais intenso e puros possíveis. Nas simulações utilizamos a plataforma Lise++ baseada em método de Monte Carlo e foi dada ênfase na utilização de um sistema de duplo-solenoides. As simulações foram comparadas com resultados experimentais obtidos com esse sistema para os feixes de 12B e 14C, onde um bom acordo foi obtido.Nuclear Structure Investigations of exotic nuclei is currently a very active area of Nuclear Physics. Many laboratories around the world are developing their system to produce radioactive beams of nuclei rich in protons or neutrons. The use of these radioactive elements as beams has offered new and unique opportunities for research in nuclear physics. Fundamental questions such as what the nature of nuclear matter is and how heavy elements are synthesized in novae, supernovae and neutron stars can be addressed in investigations using radioactive beams. In this work we address the production of some of these beams in the region of mass A = 10 and 15, specifically 10Be, 12B e 14,15C. We describe production methods and apply simulations using the plataforma Lise++ with Monte Carlo method. We addressed the peculiarities related to the production of each of them, in the sense to get the most intense and pure secondary radioactive beams possible. In the simulations, emphasis was given to the use of a double-solenoid system. The simulations were compared with experimental results obtained with these systems for the 12B and 14C beams, where a good agreement was obtained