Clinical indications, utilization, and funding of bariatric surgery in Europe

The objective of this study was to evaluate the current utilization, the level of endorsement by professional societies, and health technology assessment bodies, as well as the reimbursement levels for bariatric surgery in European countries. We performed an analysis of the indications for bariatric surgery based on national clinical and commissioning guidelines, current utilization of surgery, characteristics of patients who underwent surgery, and reimbursement tariffs in Belgium, Denmark, England, France, Germany, Italy, and Sweden. Data were obtained from national patient registries, administrative databases, and published literature for the year 2012. Despite clear consensus outlined in clinical guidelines, significant differences were found in the eligibility criteria for surgery. Patients with no significant comorbidities were deemed eligible if they had a body mass index (BMI) of 40 or 50 kg/m(2) in Denmark. Irrespective of the country, patients with comorbidities were eligible if they had a BMI of 35 kg/m(2). The highest utilization of bariatric surgery (number of surgeries per 1 M population) was observed in Belgium (928), Sweden (761), and France (571) while Italy (128), England (117), and Germany (72) had the lowest utilization. There was a strong negative correlation between utilization and average BMI level of the patient population (r = -.909, p = 0.005). The annual per capita spending on surgery differed significantly between countries, ranging from a,not sign0.54 in Germany to a,not sign4.33 in Belgium. There are significant variations in the clinical indications, utilization, and funding of bariatric surgery in European countries

Bariatric Surgery can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model.

The objective of the present study was to evaluate the cost-utility of bariatric surgery in a lifetime horizon from a Swedish health care payer perspective. A decision analytic model using the Markov process was developed covering cardiovascular diseases, type 2 diabetes, and surgical complications. Clinical effectiveness and safety were based on the literature and data from the Scandinavian Obesity Surgery Registry. Gastric bypass, sleeve gastrectomy, and gastric banding were included in the analysis. Cost data were obtained from Swedish sources. Bariatric surgery was cost saving in comparison with conservative management. It also led to a substantial reduction in lifetime risk of events: from a 16 % reduction in the risk of transient ischaemic attacks to a 62 % reduction in the incidence of type 2 diabetes. Over a lifetime, surgery led to savings of a,not sign8408 and generated an additional 0.8 years of life and 4.1 quality-adjusted life years (QALYs) per patient, which translates into gains of 32,390 quality-adjusted person-years and savings of a,not sign66 million for the cohort, operated in 2012. Analysis of the consequences of a 3-year delay in surgery provision showed that the overall lifetime cost of treatment may be increased in patients with diabetes or a body mass index > 40 kg/m(2). Delays in surgery may also lead to a loss of clinical benefits: up to 0.6 life years and 1.2 QALYs per patient over a lifetime. Bariatric surgery, over a lifetime horizon, may lead to significant cost savings to health care systems in addition to the known clinical benefits

Kebiasaan Makanan Belangkas, Tachypleus gigas (Müller 1785) dan Carcinoscorpius rotundicauda (Latreille 1802) di Perairan Pesisir Balikpapan, Kalimantan Timur

Horseshoe crabs are living fossils found in Indonesia. This study examined the food habit of horseshoe crabs (Carcinoscorpius rotundicauda and Tachypleus gigas)  collected from Balikpapan coastal waters, East Kalimantan. Horseshoe crabs were captured using gill nets and picked by hand along the Balikpapan coast. The width of the prosoma and the body weight of each individual were measured, and the gut contents were analysed to determine the preponderance index, food niche breadth, and niche overlap. Carcinoscorpius rotundicauda prosoma widths ranged from 4.1 to 15.4 cm and those of Tachypleus gigas ranged from 2.8 to 24 cm. Eight food items were found in the gut of the horseshoe crabs, namely: bivalves, gastropods, scaphopoda, polychaetes, echinoderms, crustaceans, leaf litter and others. Based on the preponderance index, gastropods were the main food item of the two horseshoe crab species. In accordance to the food composition the horseshoe crabs inhabiting Balikpapan coastal waters are categorized as benthivores

Phenological dynamics of four populations of Handroanthus spongiosus in seasonally dry tropical forest in Brazil.

The scarcity of phenological studies based on different populations of tropical forest trees limits seed management and collection for reforestation efforts. Precipitation is the primary factor driving tropical plant phenology in seasonal environments, although other environmental variables and plant traits may be associated. We examined the seasonality, synchrony, and intensities of the vegetative and reproductive phenophases of four populations of Handroanthus spongiosus, an endangered species, under similar climate regimes in a seasonally dry tropical forest, in northeastern Brazil. We expected to observe some divergence in the phenologies of the populations related to distinct functional traits selected for by differences in rainfall and soil properties. Mature trees (n = 87) were monitored during a three-year period. Seasonality was examined using circular statistics, and the influences of environmental variables on phenophases were investigated using generalized additive models. Variations in intensities and activity indices were identified among the different populations. Vegetative phenophases were seasonal, driven by precipitation and photoperiod, with leaf longevity of up to 7 months; budding peaked in February-March, while leaf fall peaked in April and October. The reproductive phenophases were found to be seasonal, during the rainy season (November to April), influenced by temperature and photoperiod. The slight divergences noted among the phenological behaviors of the populations were related to distinct functional traits (e.g., tree height, stem diameter) selected for by differences in certain environmental variables (rainfall volumes and soil properties). Given ongoing global climate changes, increases in leaf fall and reductions of flowering intensity, as verified here, will likely be observed