PRM97 – Evaluating the cost-effectiveness of multicomponent rehabilitation guidelines

Objectives: The Dutch guideline for cancer rehabilitation recommends patients to engage in multicomponent interventions, i.e. several single interventions combined into a rehabilitation programme. To perform a health economic evaluation of this guideline, data on the cost-effectiveness of these multicomponent interventions is required. However, to date, the interventions´ (cost-)effectiveness is almost exclusively assessed for the single interventions, rather than for the multicomponent intervention, which challenges the health economic analysis of the multicomponent interventions. The objective of this study was to identify or develop a method that allows to deduct the cost-effectiveness of multicomponent interventions from published data of the single interventions.Methods: We searched the literature for articles offering a method or ideas for the development of a method for assessing the cost-effectiveness of multicomponent interventions on the basis of data on the single interventions. The cost-effectiveness gap analysis method, which can be used for assessing the maximum cost of an intervention given a certain willingness-to-pay, was identified as suitable and was further developed to allow assessing if a multidimensional programmes is cost-effective, based on the (cost-)effectiveness data of the single interventions.Results: Cost-effectiveness gap analysis was identified in the literature as being a suitable method, with further refinement. We suggested to first calculate the costs of all interventions. Given the effectiveness of one intervention it is then possible to estimate how much additional effectiveness a second (or any subsequent) intervention would have to provide so that the multicomponent intervention remains cost-effective, given a range of ceiling ratios. Recommendations for methods for estimating the additional effect of subsequent interventions were deducted from the literature identified.Conclusions: We suggest estimating the cost-effectiveness of the combined interventions as recommended in clinical guidelines by performing a refined cost-effectiveness gap analysis metho

PCN77 – Cost-effectiveness of cognitive-behavioral therapy and physical exercise for alleviating treatment-induced menopausal symptoms in breast cancer patients

Objectives Many breast cancer patients suffer from (severe) menopausal symptoms after an early onset of menopause caused by cancer treatment. The standard treatment for these complaints is hormone replacement therapy, which, however, is contraindicated for this group, as it may have tumor-promoting effects. The aim of this study was to assess the cost-effectiveness of three interventions aimed at alleviating these symptoms: cognitive-behavioral therapy (CBT), physical exercise (PE), and the combination of both (CBT+PE). Methods A cost-effectiveness analysis was performed from a health care system perspective. The primary outcome was incremental health care costs (IHCC) per patient with a clinically relevant improvement after six months of treatments. The secondary outcome was incremental costs per quality-adjusted life years (QALYs) gained over a five-year time period. This was assessed using a Markov model, populated with data from a recent randomized controlled trial evaluating the effectiveness of CBT, PE, and CBT+PE in the clinical setting and additional cost data. The robustness of the results was analyzed through one-way and probabilistic sensitivity analyses. Results IHCCs for alleviating one patient of the perceived symptom burden by a clinically relevant difference after six months of treatment were EUR€605 for CBT, EUR€1,847 for CBT+PT, and EUR€1,250 for PE alone, compared to the waiting list control group. CBT generated 0.009 additional QALYs at an additional cost of EUR€162, compared to the control group, leading to an Incremental Cost Utility Ratio (ICUR) of EUR€18,655 per QALY gained and The ICUR of CBT+PE was EUR€42,375 per QALY in comparison to the control group. CBT had a high probability (circa 61%) of being cost-effective at prevailing ceiling ratios. Conclusions CBT is likely the most cost-effective of the three interventions investigated for alleviating treatment-induced menopausal symptoms in breast cancer patient

The impact of genetic groups (Alentejano and F1 Landrace x Large White pigs) and body weight (90, 120 and 160kg) on blood metabolites

Áreas de pesquisa: AgricultureThis research work was carried out with the goal of studying the impact of genetic groups-GG (Alentejano-AL, n = 30, and F1 Landrace*Large White-F1 pigs, n = 30) and body weight-BW (90, 120 and 160 kg) on plasma metabolites. Blood parameters were correlated with animal production traits, carcass measurements and meat quality. Individual records for feed conversion index (CI) and daily feed intake were recorded on a weekly basis, for a period of 15 weeks. Compared to the F1, AL pigs displayed (P <0.05) higher average levels of glucose, total cholesterol-TC, triglycerides-TG, HDL-cholesterol (HDL), LDL-cholesterol (LDL) and total protein (TP), by about 14.0, 21.0, 42.2, 18.2, 21.2 and 5.0%, respectively. AL pigs (120–160 kg) showed higher TG levels, when compared to the values at 90 kg (2.6 and 1.6 times higher). High TG levels occurred when animals exhibited high daily feed intake (0.450 and 1.810 kg, for AL and F1 pigs). In the AL high TG levels were correlated with high fat deposition, at 120 kg (r = 0.51). At 90 kg, however, high fat deposition was related to HDL (r = 0.59), a lipoprotein associated to cholesterol transport. A progressive increase in ALB was found in the F1, as expected, but AL pigs showed higher and similar ALB means at 90, 120 and 160 kg. As for meat color, AL pigs with high cholesterol were negatively associated to L*, while high TG levels were associated to low b*. Animals with high ALB produced more tender meats (low shear force). Pigs with higher levels of lipid metabolism showed Longissimus thoracis muscles with decreased luminosity and yellowness (meats of a less attractive appearance). However, these meats were tenderer.info:eu-repo/semantics/publishedVersio

Alzheimers Dement

INTRODUCTION: Inferring the timeline from mild cognitive impairment (MCI) to severe dementia is pivotal for patients, clinicians, and researchers. Literature is sparse and often contains few patients. We aim to determine the time spent in MCI, mild-, moderate-, severe dementia, and institutionalization until death. METHODS: Multistate modeling with Cox regression was used to obtain the sojourn time. Covariates were age at baseline, sex, amyloid status, and Alzheimer's disease (AD) or other dementia diagnosis. The sample included a register (SveDem) and memory clinics (Amsterdam Dementia Cohort and Memento). RESULTS: Using 80,543 patients, the sojourn time from clinically identified MCI to death across all patient groups ranged from 6.20 (95% confidence interval [CI]: 5.57-6.98) to 10.08 (8.94-12.18) years. DISCUSSION: Generally, sojourn time was inversely associated with older age at baseline, males, and AD diagnosis. The results provide key estimates for researchers and clinicians to estimate prognosis

Protecção integrada das culturas agrícolas e florestais no sul de Portugal

A b s t r a c t : A r e v i e w i s g i v e n o f t h e a c t i v i t i e s a i n n e d a t t h e i n t e g r a t e d p r o t e c t i o n o f a g r i c u l t u r a l c r o p s a n d f o r e s t t r e e s i n A l e n t e j o ( S o u t h e r n P o r t u g a l ) . T o m a t o c r o p s a r e i n f e s t e d b y m a n y s p e c i e s o f i n s e c t s a n d m i t e s , Heliothis armigera b e i n g t h e m a j o r p e s t . Trichogramma e g g - p a r a s i t e s a n d g r e e n l a c e w i n g s , Chrysoperla cárnea, a r e m a s s - p r o d u c e d a n d r e l e a s e d f o r t h e c o n t r o l o f Heliothis. T w o s t e m b o r e r s , Sesamia nonagrioides a n d Ostrinia nubilalis, h e a v i l y i n f e s t t h e m a i z e c r o p . S t u d i e s o n t h e i r p o p u l a t i o n d y n a m i c s a n d c o n t r o l b y a n t a g o n i s t s w e r e c a r r i e d o u t . A c e r a m b y c i d b e e t i e , Phoracantha semipunctata, i n t r o d u c e d r e c e n t l y i n t o E u r o p e , i s a n i m p o r t a n t p e s t i n Eucalyptus p l a n t a t i o n s . R e s e r a c h a c t i v i t i e s a r e c o n c e n t r a t e d o n i d e n t i f y i n g t h e c h e m i c a l s u b s t a n c e s e m i t t e d b y t h e t r e e s w h i c h a t t r a c t t h e b e e t i e s . I n o r d e r t o r e e s t a b l i s h n a t u r a l e q u i l i b r i u m i n c i t r u s o r c h a r d s , t h e m a s s - p r o d u c t i o n a n d s u b s e q u e n t r e l e a s e o f p r e d a t o r s ( l a d y b i r d - b e e t i e s a n d l a c e w i n g s ) i s p l a n n e d

A study of sertraline in dialysis (ASSertID) : a protocol for a pilot randomised controlled trial of drug treatment for depression in patients undergoing haemodialysis

© 2015 Friedli et al. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedBACKGROUND: The prevalence of depression in people receiving haemodialysis is high with estimates varying between 20 and 40 %. There is little research on the effectiveness of antidepressants in dialysis patients with the few clinical trials suffering significant methodological issues. We plan to carry out a study to evaluate the feasibility of conducting a randomised controlled trial in patients on haemodialysis who have diagnosed Major Depressive Disorder.METHODS/DESIGN: The study has two phases, a screening phase and the randomised controlled trial. Patients will be screened initially with the Beck Depression Inventory to estimate the number of patients who score 16 or above. These patients will be invited to an interview with a psychiatrist who will invite those with a diagnosis of Major Depressive Disorder to take part in the trial. Consenting patients will be randomised to either Sertraline or placebo. Patients will be followed-up for 6 months. Demographic and clinical data will be collected at screening interview, baseline interview and 2 weeks, and every month (up to 6 months) after baseline. The primary outcome is to evaluate the feasibility of conducting a randomised, double blind, placebo pilot trial in haemodialysis patients with depression. Secondary outcomes include estimation of the variability in the outcome measures for the treatment and placebo arms, which will allow for a future adequately powered definitive trial. Analysis will primarily be descriptive, including the number of patients eligible for the trial, drug exposure of Sertraline in haemodialysis patients and the patient experience of participating in this trial.DISCUSSION: There is an urgent need for this research in the dialysis population because of the dearth of good quality and adequately powered studies. Research with renal patients is particularly difficult as they often have complex medical needs. This research will therefore not only assess the outcome of anti-depressants in haemodialysis patients with depression but also the process of running a randomised controlled trial in this population. Hence, the outputs of this feasibility study will be used to inform the design and methodology of a definitive study, adequately powered to determine the efficacy of anti-depressants in patient on haemodialysis with depression.TRIAL REGISTRATION: ISRCTN registry ISRCTN06146268 and EudraCT reference: 2012-000547-27.Peer reviewedFinal Published versio

The Oral Health Status of Incarcerated Youth at a Toronto-area Youth Centre

Canadian correctional institutions provide dental services to incarcerated young people, but data on the dental health of these groups do not exist. Objective: To determine the oral health status of youth in a closed-custody youth facility in the country’s largest urban centre. Methods: A cross-sectional study of male and female youth incarcerated at a Toronto-area facility was conducted from September 2010 till July 2011. Participants completed a survey on social, correctional and dental histories, and underwent oral examination. Results: The 101 adolescent participants had a mean DMFT of 4.39 with 81.2% having DMFT>0. The proportion of DT when DMFT>0 was 0.51. Race, custody history and dental pain were indicators of poor oral health. Conclusions: By quantifying the need for dental services and by identifying variables associated with greater dental disease experience, these findings may assist health care providers in youth correctional facilities with their program planning for their high-needs wards.MAS

Luta biológica contra as pragas em Cabo Verde: Situação actual e programas futuros.

GTZ / Centros Estudo Agrário