Evaluating Trastuzumab and Lapatinib's Economic Impact in the Treatment of Metastatic Breast Cancer in Veneto Region Cohort

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The "Snacking Child" and its social network: some insights from an italian survey

<p>Abstract</p> <p>Background</p> <p>The hypothesis underlying this work is that the social network of a child might have an impact on the alimentary behaviors, in particular for what concerns snack consumption patterns.</p> <p>Methods</p> <p>1215 Italian children 6-10 ys old were interviewed using a CATI facility in January 2010. 608 "snackers" and 607 "no-snackers" were identified. Information regarding family composition, child and relatives BMI, mother perception of child weight, child, father and mother physical activity, TV watching, social network, leisure time habits and dietary habits of peers, were collected. Association of variables with the status of snacker was investigated using a multivariable logistic regression model.</p> <p>Results</p> <p>Snackers children seem to be part of more numerous social network (1.40 friends vs 1.14, p = 0.042) where the majority of peers are also eating snacks, this percentage being significantly higher (89.5 vs 76.3, p < 0.001) than in the "no-snacker" group. The snacking group is identified by the fact that it tends to practice at least 4 hours per week of physical activity (OR: 1.36, CI: 1.03-1.9). No evidence of an association between snacking consumption and overweight status has been shown by our study.</p> <p>Conclusions</p> <p>The snacking child has more active peer-to-peer social relationships, mostly related with sport activities. However, spending leisure time in sportive activities implies being part of a social environment which is definitely a positive one from the point of view of obesity control, and indeed, no increase of overweight/obesity is seen in relation to snack consumption.</p

Supply Chain Simulation for Production Strategy Evaluation

The Consumer Product Goods (CPG) industry such as the bottled water business is subject to bottlenecks, due in part to both product characteristics, stochastic nature of the demand of products, and customer lead time volatility. Nevertheless, CPG companies are expected to be able to serve customers that rely on their products, even as demand can be unpredictable and erratic. In CPG companies, where the multi-stock keeping units (SKUs) and multi-period nature of manufacturing systems are taking place, finding the right balance between Make-To-Order (MTO) and Make-To-Stock (MTS) production strategy proves difficult. To ensure customers' demand is fulfilled, this capstone analyzes the current production strategy of the capstone sponsor, a bottled water company, and incorporates the dynamic market demand and customer lead time volatility to determine the best production strategy that will be capable to meet 90% fulfilment rate In this capstone, we developed a System Dynamics (SD) and Discrete Event Simulation (DES) to understand the overall drivers of supply chain and production strategy that minimizes the total relevant costs (inventory holding and change over costs) whilst producing the highest fulfilment rate. We analyzed live orders, forecast orders, economic production quantity (EPQ), safety stock (SS) of 10 key SKUs and ABC SKU segmentation of 1300 SKUs for one production plant over the last year. Scenarios of demand, forecast and lead time uncertainty were simulated to provide insights into key drivers of the model behavior and guide insights into useful production policies. Our findings demonstrate that in manufacturing systems characterized by stochastic demand and volatile lead times, understanding SKU characteristics (EPQ, SS, and Inventory levels) is critical to meet market demand with the optimal cost more so than the order patterns

Cost Impact of Bevacizumab and Cetuximab Associated Therapies in Colorectal Cancer in Veneto Region

Objective: To assess the economic impact of the introduction of bevacizumab and cetuximab, in 1st and 2nd line treatment of mCRC patients in Veneto region (North-East of Italy). Methods: A Markov state decision model was implemented to evaluate the cost impact of bevacizumab and cetuximab use in patients with mCRC for a lapse of time of three years in Veneto public hospitals. The Markov model expressed transition probabilities from three different states, comparing in addition the expected deaths and the monthly survival rates in treatment and no-treatment groups, along the lines of previously published studies. Results: The cost impact of bevacizumab administration in patients with mCRC accounted a mean value of 18268788 \u20ac within the first 6 months. Cetuximab therapy for those refractory to 1st line treatment, increased costs of almost 833340 \u20ac in the first 6 months, increasing in the following period due to a higher portion of patients switching from a stable status to a progressive one. Discussion: The cost impact of monoclonal antibodies on health expenses is very high. For a regional cohort like the Veneto's one, figure sets around 19000000 \u20ac in 6 months, when considering 1st and 2nd line treatment, reaching the level of 50000000 \u20ac within three years

Economic Impact of Sunitinib and Sorafenib Use in Metastatic Renal Cell Carcinoma Treatment in Veneto Region, Italy

Objective: To evaluate the impact of multitargeted tyrosine kinase inhibitors (TKI) considering 1st and 2nd line treatment for a full period of 3 years in the eligible patients of Veneto Region. Methods: A Markov state decision model was selected to evaluate the cost impact of sunitinib and sorafenib use for a lapse of time of three years in Veneto public hospitals, considering transition probabilities from three different states and by comparing the expected deaths and the monthly survival rates in treatment and no-treatment groups. Results: From the initial cohort of 357 patients eligible for sunitinib treatment, stable ones (139) were considered in order to evaluate the impact of the multitargeted agent on overall progression of the disease. Results showed that a smaller portion of patients receiving sunitinib transited from a stable to a progressive state, with respect to the patients who were not receiving sunitinib. The cost of 6 months treatment with sunitinib reached a median value of 2532666\u20ac, increasing till 3607807\u20ac, as cumulative amount at 12 months. Costs after the 1st year flattened around the same figure (3800000\u20ac) due to the transition towards death or 2nd line treatments. Discussion: the costs of the first 6 months therapy with sunitinib have a very high impact on public health expenses in the Regione Veneto. 2nd line treatment with sorafenib instead increased overall expenses of a reduced proportion, due to the small proportion of patients undergoing this treatment and the relative inferior cost of the drug. Conclusion: From what came out from our simulated model on costs borne by the SSN for the treatment of patients with mRCC, we can conclude that they are effective on the progression of the disease the greatest impact being the cost for the 1st line pharmacological treatment

Evaluating Trastuzumab and Lapatinib's Economic Impact in the Treatment of Metastatic Breast Cancer in Veneto Region Cohort

Objective: To evaluate the impact of multitargeted tyrosine kinase inhibitors (TKI) considering 1st and 2nd line treatment for a full period of 3 years in the eligible patients of Veneto Region. Methods: A Markov state decision model was selected to evaluate the cost impact of sunitinib and sorafenib use for a lapse of time of three years in Veneto public hospitals, considering transition probabilities from three different states and by comparing the expected deaths and the monthly survival rates in treatment and no-treatment groups. Results: From the initial cohort of 357 patients eligible for sunitinib treatment, stable ones (139) were considered in order to evaluate the impact of the multitargeted agent on overall progression of the disease. Results showed that a smaller portion of patients receiving sunitinib transited from a stable to a progressive state, with respect to the patients who were not receiving sunitinib. The cost of 6 months treatment with sunitinib reached a median value of 2532666\u20ac, increasing till 3607807\u20ac, as cumulative amount at 12 months. Costs after the 1st year flattened around the same figure (3800000\u20ac) due to the transition towards death or 2nd line treatments. Discussion: the costs of the first 6 months therapy with sunitinib have a very high impact on public health expenses in the Regione Veneto. 2nd line treatment with sorafenib instead increased overall expenses of a reduced proportion, due to the small proportion of patients undergoing this treatment and the relative inferior cost of the drug. Conclusion: From what came out from our simulated model on costs borne by the SSN for the treatment of patients with mRCC, we can conclude that they are effective on the progression of the disease the greatest impact being the cost for the 1st line pharmacological treatment

Retrospective study on Romanian foreign bodies injuries in children.

BACKGROUND: Foreign bodies (FB) injuries are an issue that has been recognized and investigated since many years; despite that, the impact of this subject in literature and research is still small. Such kind of injuries identifies all incidents due to ingestion, inhalation, insertion and aspiration of an object into the aero digestive tract. FBs injuries located in the upper airways can be a very serious event, sometimes resulting in fatal outcome. METHODS: A retrospective study was performed on FB injuries in the aerodigestive tract in paediatric patients 1-17 years old, recorded from the ENT Department of the M. S. Curie Hospital in Bucharest. RESULTS: 455 cases were reported from the M. S. Curie Hospital, ENT Department. Prevalence in female patients is higher than the males (225 males and 230 females). Mean age observed was 4.12 years. The distribution of injuries according to the retrieval location showed a higher prevalence in the nose (44.62% of cases), with a higher occurrence in females (50.74%) followed by the digestive system (24.28% of cases) were the distribution between males and females is equal. The highest prevalence was represented by nuts and seed (23.96%), followed by marble and coins (respectively 12.75% and 12.53%). CONCLUSIONS: As generally described in scientific literature, injuries usually concerned toddlers and preschoolers, while school-aged children less often place foreign objects in their noses. Our results confirm the fact that when passive preventive strategies are not practical, active strategies that promote behaviour change are necessary. Active strategies require that a caregiver changes his or her behaviour each time the child begins an activity that has the potential to cause injury. Education is critical to these active strategies and plays a complementary role to environmental changes and legal mandates

مظاهرالهشاشة بالمجال الواحي المغربي، حالة واحات إقليم كلميم

Les oasis de Guelmim, à l'instar des oasis marocaines, ont été témoins de la stabilitéhumaine, qui a acquis une culture et un patrimoine historique qui le distingue du reste du pays, en raison de son équilibre dans divers domaines malgré les dures conditions naturelles et les faibles possibilités économiques et techniques. Donc cet article vise à aborder un problème fondamental lié aux diverses phénomènes de la vulnérabilité dans les oasis de la province de Guelmim, en identifiant les facteurs les plus importants responsables de cette vulnérabilité et en soulignant les divers impacts. À cet égard, nous avons adopté l’approche descriptive et analytique en énumérant les divers défis auxquels le milieu est confronté, ainsi que son impact spatial sur le système oasien de la province de Guelmim. Cette étude a conclu que la combinaison des facteurs naturels et anthropiques aurait entraîné une dégradation du milieu physique de la région et que la gravité de ces facteurs varie en fonction de leur impact sur le terrain. Toutefois, cela ne diminue en rien l'importance des ressources et des qualifications dans la région, qui peuvent servir de base au développement durable, ce qui est une occasion pour les acteurs du développement durable dans les oasis de Guelmi

Nuts and seed: a natural yet dangerous foreign body.

Abstract RATIONALE AND AIM: This paper has the object to present the impact of nuts' and seeds' injuries withdrawing data from the Susy Safe registry, highlighting that as for other foreign bodies the main item efficiently and substantially susceptible to changes to decrease the accidents' rates is the education of adults and children, that can be shared with parents both from pediatricians and general practitioners. Indeed labeling and age related warnings have also a fundamental relevance in prevention. METHODS: The present study draws its data from the Susy Safe registry. Details on injuries are entered in the Susy Safe Web-registry through a standardized case report form, that includes information regarding: children age and gender, features of the object, circumstances of injury (presence of parents and activity) and hospitalization's details (lasting, complications and removal details). Cases are prospectively collected using the Susy Safe system from 06/2005; moreover, also information regarding past consecutive cases available in each centre adhering to the project have been entered in the Susy Safe registry. RESULTS: Nuts and seeds are one of the most common food item retrieved in foreign bodies injuries in children. In Susy Safe registry they represent the 38% in food group, and almost the 10% in general cases. Trachea, bronchi and lungs were the main location of FB's retrieval, showing an incidence of 68%. Hospitalization occurred in 83% of cases, showing the major frequency for foreign bodies located in trachea. This location was also the principal site of complications, with a frequency of 68%. There were no significant associations between these outcomes and the age class of the children. The most common complications seen (22.4%) was bronchitis, followed by pneumonia (19.7%). Adult presence was recorded as positive in 71.2% of cases, showing an association (p value 0.009) between the adult supervision and the hospitalization outcome. On the contrary there was a non significant association between adult presence and the occurrence of complications. In 80.7% of cases, the incident happened while the child was eating. Among those cases, 88.6% interested trachea, lungs and bronchi. CONCLUSIONS: Food-related aspiration injuries are common events for young children, particularly under 4 years of age, and may lead to severe complication. There is a need to study in more depth specific characteristics of foreign bodies associated with increased hazard, such as size, shape, hardness or firmness, lubricity, pliability and elasticity, in order to better identify risky foods, and more precisely described the pathogenetic pathway. Parents are not adequately conscious and aware toward this risk; therefore, the number and severity of the injuries could be reduced by educating parents and children. Information about food safety should be included in all visits to pediatricians in order to make parents able to understand, select, and identify key characteristics of hazardous foods and better control the hazard level of various foods. Finally, preventive measures including warning labels on high-risk foods could be implemented