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Objectives: To perform a budget impact analysis (BIA) of introducing olaparib as maintenance therapy in women who have BRCA mutations (BRCAm) with platinum-sensitive recurrent ovarian cancer (PSROC) in combination with bevacizumab in Argentina.A BIA model was used to analyse over a 5-year time horizon the change in the health system’s budget following the adoption of olaparib as maintenance therapy in BRCAm patients with PSROC. The BIA for each year was estimated by comparing the cost difference between the current scenario (treatment with bevacizumab) and the new scenario (the addition of olaparib) for a third-party payer. The BIA is estimated at the national health system level, and by healthcare sectors in Argentina (public sector, social security and private sector). International and national epidemiological data were used to determine the target patient population. Clinical efficacy, safety outcomes and duration of treatments were obtained from the pivotal clinical study report. Relevant direct medical costs were obtained from public data in Argentina and expert consultation. All the costs are reported in US dollars as of October 2022 ($1 = 152.59 Argentine pesos). A scenario analysis assessed the full coverage of the homologous recombination deficiency (HRD) test in Argentina. In addition, one-way sensitivity analysis was conducted to evaluate the model robustness.For a third-party payer with a cohort of 1,000,000 women covered, the estimated target population was 2 individuals in year 1 and 6 individuals in year 5. The incorporation of olaparib, with a wholesale price per pack of $3176.32, was associated with a weighted average of the budget impact per member per month (PMPM) of $0.062 for the national health system, being above the estimated health system budget impact threshold ($0.0153). By healthcare sector, the results of budget impact PMPM for year 5 ranged between $0.08 (public sector) and $0.114 (private sector). For all perspectives, the variables that most influenced the budget impact was the incidence of ovarian cancer, the drug acquisition cost and the treatment duration.The introduction of olaparib for the treatment of BRCAm women with PSROC has a high budget impact for all three health systems in Argentina.Methods: To perform a budget impact analysis (BIA) of introducing olaparib as maintenance therapy in women who have BRCA mutations (BRCAm) with platinum-sensitive recurrent ovarian cancer (PSROC) in combination with bevacizumab in Argentina.A BIA model was used to analyse over a 5-year time horizon the change in the health system’s budget following the adoption of olaparib as maintenance therapy in BRCAm patients with PSROC. The BIA for each year was estimated by comparing the cost difference between the current scenario (treatment with bevacizumab) and the new scenario (the addition of olaparib) for a third-party payer. The BIA is estimated at the national health system level, and by healthcare sectors in Argentina (public sector, social security and private sector). International and national epidemiological data were used to determine the target patient population. Clinical efficacy, safety outcomes and duration of treatments were obtained from the pivotal clinical study report. Relevant direct medical costs were obtained from public data in Argentina and expert consultation. All the costs are reported in US dollars as of October 2022 ($1 = 152.59 Argentine pesos). A scenario analysis assessed the full coverage of the homologous recombination deficiency (HRD) test in Argentina. In addition, one-way sensitivity analysis was conducted to evaluate the model robustness.For a third-party payer with a cohort of 1,000,000 women covered, the estimated target population was 2 individuals in year 1 and 6 individuals in year 5. The incorporation of olaparib, with a wholesale price per pack of $3176.32, was associated with a weighted average of the budget impact per member per month (PMPM) of $0.062 for the national health system, being above the estimated health system budget impact threshold ($0.0153). By healthcare sector, the results of budget impact PMPM for year 5 ranged between $0.08 (public sector) and $0.114 (private sector). For all perspectives, the variables that most influenced the budget impact was the incidence of ovarian cancer, the drug acquisition cost and the treatment duration.The introduction of olaparib for the treatment of BRCAm women with PSROC has a high budget impact for all three health systems in Argentina.Results: To perform a budget impact analysis (BIA) of introducing olaparib as maintenance therapy in women who have BRCA mutations (BRCAm) with platinum-sensitive recurrent ovarian cancer (PSROC) in combination with bevacizumab in Argentina.A BIA model was used to analyse over a 5-year time horizon the change in the health system’s budget following the adoption of olaparib as maintenance therapy in BRCAm patients with PSROC. The BIA for each year was estimated by comparing the cost difference between the current scenario (treatment with bevacizumab) and the new scenario (the addition of olaparib) for a third-party payer. The BIA is estimated at the national health system level, and by healthcare sectors in Argentina (public sector, social security and private sector). International and national epidemiological data were used to determine the target patient population. Clinical efficacy, safety outcomes and duration of treatments were obtained from the pivotal clinical study report. Relevant direct medical costs were obtained from public data in Argentina and expert consultation. All the costs are reported in US dollars as of October 2022 ($1 = 152.59 Argentine pesos). A scenario analysis assessed the full coverage of the homologous recombination deficiency (HRD) test in Argentina. In addition, one-way sensitivity analysis was conducted to evaluate the model robustness.For a third-party payer with a cohort of 1,000,000 women covered, the estimated target population was 2 individuals in year 1 and 6 individuals in year 5. The incorporation of olaparib, with a wholesale price per pack of $3176.32, was associated with a weighted average of the budget impact per member per month (PMPM) of $0.062 for the national health system, being above the estimated health system budget impact threshold ($0.0153). By healthcare sector, the results of budget impact PMPM for year 5 ranged between $0.08 (public sector) and $0.114 (private sector). For all perspectives, the variables that most influenced the budget impact was the incidence of ovarian cancer, the drug acquisition cost and the treatment duration.The introduction of olaparib for the treatment of BRCAm women with PSROC has a high budget impact for all three health systems in Argentina.Conclusions: To perform a budget impact analysis (BIA) of introducing olaparib as maintenance therapy in women who have BRCA mutations (BRCAm) with platinum-sensitive recurrent ovarian cancer (PSROC) in combination with bevacizumab in Argentina.A BIA model was used to analyse over a 5-year time horizon the change in the health system’s budget following the adoption of olaparib as maintenance therapy in BRCAm patients with PSROC. The BIA for each year was estimated by comparing the cost difference between the current scenario (treatment with bevacizumab) and the new scenario (the addition of olaparib) for a third-party payer. The BIA is estimated at the national health system level, and by healthcare sectors in Argentina (public sector, social security and private sector). International and national epidemiological data were used to determine the target patient population. Clinical efficacy, safety outcomes and duration of treatments were obtained from the pivotal clinical study report. Relevant direct medical costs were obtained from public data in Argentina and expert consultation. All the costs are reported in US dollars as of October 2022 ($1 = 152.59 Argentine pesos). A scenario analysis assessed the full coverage of the homologous recombination deficiency (HRD) test in Argentina. In addition, one-way sensitivity analysis was conducted to evaluate the model robustness.For a third-party payer with a cohort of 1,000,000 women covered, the estimated target population was 2 individuals in year 1 and 6 individuals in year 5. The incorporation of olaparib, with a wholesale price per pack of $3176.32, was associated with a weighted average of the budget impact per member per month (PMPM) of $0.062 for the national health system, being above the estimated health system budget impact threshold ($0.0153). By healthcare sector, the results of budget impact PMPM for year 5 ranged between $0.08 (public sector) and $0.114 (private sector). For all perspectives, the variables that most influenced the budget impact was the incidence of ovarian cancer, the drug acquisition cost and the treatment duration.The introduction of olaparib for the treatment of BRCAm women with PSROC has a high budget impact for all three health systems in Argentina. [ABSTRACT FROM AUTHOR]

Low calcium intake and its impact on maternal and child health are a major concern in low‐ and middle‐income countries. Given the low calcium in diet, as well as the low adherence and acceptability of calcium pills in those settings, the discussion about policies to increase calcium intake has moved toward staple food fortification strategies. Nevertheless, there is scarce information on the economic feasibility of implementing these strategies. We aimed to design and propose a novel costing tool to estimate the cost of the flour fortification with calcium by carrying out a literature review about costing studies for staple food fortification programs and costing tools previously developed. A deliberative meeting with stakeholders was held to discuss and face‐validate the conceptual framework proposed. We showed the costing tool application for the case of Costa Rica (a country with a population with low calcium intake), including the absolute cost of the staple food fortification production process, the incremental cost of fortification according to the public/private sector, and the incremental cost by target population. This open‐source and publicly available costing tool can be useful to inform policymaking in countries considering the implementation of staple food fortification programs. [ABSTRACT FROM AUTHOR]

The objective of the research was analyze the personal finances during the COVID-19 pandemic in inhabitants of the rural area Kunurana Bajo. The research is qualitative, exploratory and developed with the phenomenological technique, the instrument applied for data collection was a structured interview with fifteen merchant mothers from the aforementioned area, once the data was collected they were analyzed in the ATLAS ti software In this way, obtaining reliable results, it was observed that there was a decrease in monthly income, difficulty in paying their financial obligations, increased expenses and use of savings. [ABSTRACT FROM AUTHOR]

• Before-and-after impact analysis of public transport (PT) interventions is crucial. • Open-ended (OE) questions complement the information of closed-ended (CE) questions. • OE questions generate insights to adjust CE questions in follow-up surveys. • Latent Dirichlet Allocation (LDA) is reliable for capturing PT users' perceptions. • LDA converts OE replies into useful insights for follow-up marketing interventions. Parents' perceptions regarding public transport and active modes influence the youth's acceptance and support for sustainable school commuting. Urban mobility surveys can gather such insights by utilizing closed and open-ended questions. The latter, particularly, holds the potential for nuanced expectations and insights from Public Transport (PT) users, often absent in closed-ended responses. This paper proposes a methodology utilizing Latent Dirichlet Allocation (LDA) to extract valuable information from open-ended survey responses, shedding light on parents' expectations regarding their children's school commute via PT. Analyzing responses from two surveys involving 448 households, with a focus on parents in the Lisbon Metro Area, spanning the school years of 2017–2018 and 2018–2019, and pre-and post-field interventions, our study employs LDA to assess households' criticisms and recommendations for improving public transport services. Our findings illustrate a shift from general criticisms in the initial survey to proactive suggestions in the subsequent one, aligning with marketing efforts to foster more sustainable school commuting with PT. Empirically, our study underscores LDA's efficacy in capturing users' feedback often neglected by closed-ended questions. Effective preprocessing of textual data facilitates streamlined field interventions. Overall, our contribution provides user-centered insights to inform PT policymakers, promoting the incorporation of user-driven enhancements. [ABSTRACT FROM AUTHOR]

Background: The CardioMEMS® sensor is a wireless pulmonary artery pressure device used for monitoring symptomatic heart failure (HF). The use of CardioMEMS was associated with a reduction of hospitalizations of HF patients, but the acquisition cost could be high in low-and-middle income countries. Evidence of cost-effectiveness is needed to help decision-makers to allocate resources according to "value for money". This study is aimed at estimating the cost-effectiveness of CardioMEMS used in HF patients from the third-party payer perspective -Social Security (SS) and Private Sector (PS)- in Argentina. Methods: A Markov model was developed to estimate the cost-effectiveness of CardioMEMS versus usual medical care over a lifetime horizon. The model was applied to a hypothetical population of patients with HF functional class III with at least one hospitalization in the previous 12 months. The main outcome was the incremental cost-effectiveness ratio (ICER). To populate the model we retrieved clinical, epidemiological and utility parameters from the literature, whilst direct medical costs were estimated through a micro-costing approach (exchange rate USD 1 = ARS 76.95). Uncertainties in all parameters were assessed by deterministic, probabilistic and scenario sensitivity analysis. Results: Compared with the usual medical care, CardioMEMS increased quality-adjusted life years (QALY) by 0.37 and increased costs per patient by ARS 1,081,703 for SS and ARS 919,051 for PS. The resultant ICER was ARS 2,937,756 per QALY and ARS 2,496,015 per QALY for SS and PS, respectively. ICER was most sensitive to the hazard ratio of HF hospital admission and the acquisition price of CardioMEMS. The probability that CardioMEMS is cost-effective at one (ARS 700,473), three (ARS 2,101,419,) and five (ARS 3,502,363) Gross Domestic Product per capita is 0.6, 17.9 and 64.1% for SS and 5.4, 33.3 and 73.2% for PS. Conclusions: CardioMEMS was more effective and more costly than usual care in class III HF patients. Since in Argentina there is no current explicit threshold, the final decision to determine its cost-effectiveness will depend on the willingness-to-pay for QALYs in each health subsector. [ABSTRACT FROM AUTHOR]

Background: Peru is one of the countries with the lowest percentage of population with access to safe drinking water in the Latin American region. This study aimed to describe and estimate, according to city size, socioeconomic inequalities in access to safe drinking water in Peruvian households from 2008 to 2018. Methods: Secondary analysis of cross-sectional data using data from the 2008–2018 ENAHO survey. Access to safe drinking water, determined based on the presence of chlorinated water supplied by the public network, as well as socioeconomic variables were analyzed. A trend analysis from 2008 to 2018, and comparisons between 2008 versus 2018 were performed to understand and describe changes in access to safe drinking water, according to city size. Concentration curves and Erreygers concentration index (ECI) were estimated to measure inequalities in access to safe drinking water. Results: In 2008, 47% of Peruvian households had access to safe drinking water, increasing to 52% by 2018 (p for trend < 0.001). For small cities, access to safe drinking water did not show changes between 2018 and 2008 (difference in proportions − 0.2 percentage points, p = 0.741); however, there was an increase in access to safe drinking water in medium (difference in proportions 3.3 percentage points, p < 0.001) and large cities (difference in proportions 12.8 percentage points, p < 0.001). The poorest households showed a decreasing trend in access to safe drinking water, while the wealthiest households showed an increasing trend. In small cities, socioeconomic inequalities showed an increase between 2008 and 2018 (ECI 0.045 and 0.140, p < 0.001), while in larger cities, socioeconomic inequality reduced in the same period (ECI: 0.087 and 0.018, p = 0.036). Conclusions: We report a widening gap in the access to safe drinking water between the wealthiest and the poorest households over the study period. Progress in access to safe drinking water has not been equally distributed throughout the Peruvian population. Promoting and supporting effective implementation of policies and strategies to safe drinking water, including equity-oriented infrastructure development and resource allocation for most vulnerable settings, including emerging small cities, is a priority. [ABSTRACT FROM AUTHOR]

• We modeled crash severity in run-off-the-road crashes. • Two mixed logit models were developed. • Results confirmed the contribution of roadway geometric design features to injuries. • The study provides valuable information to improve roadside design policies. Roadway departure (RwD) crashes, comprising run-off-road (ROR) and cross-median/centerline head-on collisions, are one of the most lethal crash types. According to the FHWA, between 2015 and 2017, an average of 52 percent of motor vehicle traffic fatalities occurred each year due to roadway departure crashes. An avoidance maneuver, inattention or fatigue, or traveling too fast with respect to weather or geometric road conditions are among the most common reasons a driver leaves the travel lane. Roadway and roadside geometric design features such as clear zones play a significant role in whether human error results in a crash. Method : In this paper, we used mixed-logit models to investigate the contributing factors on injury severity of single-vehicle ROR crashes. To that end, we obtained five years' (2010–2014) of crash data related to roadway departures (i.e., overturn and fixed-object crashes) from the Federal Highway Administration's Highway Safety Information System Database. Results : The results indicate that factors such as driver conditions (e.g., age), environmental conditions (e.g., weather conditions), roadway geometric design features (e.g., shoulder width), and vehicle conditions significantly contributed to the severity of ROR crashes. Conclusions : Our results provide valuable information for traffic design and management agencies to improve roadside design policies and implementing appropriately forgiving roadsides for errant vehicles. Practical applications : Our results show that increasing shoulder width and keeping fences at the road can reduce ROR crash severity significantly. Also, increasing road friction by innovative materials and raising awareness campaigns for careful driving at daylight can decrease the ROR crash severity. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to conduct a systematic review of the literature to identify, categorise, assess, and synthesise the healthcare costs of patients with breast cancer (BC) and their relatives in Latin America and the Caribbean (LAC).Methods: In December 2020, we searched for published data in PubMed, LILACS, EMBASE, and other sources, including the grey literature. Studies were eligible if they were conducted in LAC and reported the direct medical costs, productivity loss costs, out-of-pocket expenditure, and other costs to patients with BC and their relatives. No restrictions were imposed on the type of BC population (metastatic BC or human epidermal growth factor receptor 2-positive/negative BC, among others). We summarised the characteristics and methodological approach of each study and the healthcare costs by cancer stage. We also developed and applied an original ad hoc instrument to assess the quality of the cost estimation studies.Results: We identified 2725 references and 63 included studies. In total, 79.3% of the studies solely reported direct medical costs and five solely reported costs to patients and their relatives. Only 14.3% of the studies were classified as of high quality. The pooled weighted average direct medical cost per patient-year (year 2020 international dollars [I$]) by BC stage was I$13,179 for stage I, I$15,556 for stage II, I$23,444 for stage III, and I$28,910 for stage IV.Conclusion: This review provides the first synthesis of BC costs in LAC. Our findings show few high-quality costing studies in BC and a gap in the literature measuring costs to patients and their relatives. The high costs associated with the advanced stages of BC call into question the affordability of treatments and their accessibility for patients. Registered in PROSPERO (CRD42018106835). [ABSTRACT FROM AUTHOR]

Objectives. To estimate satisfaction with the healthcare received at facilities of the Ministry of Health (MINSA) of Peru and determine its associated factors in Peruvian adults. Materials and Methods. Analytical cross-sectional study using data from the National Household Survey on Living Conditions and Poverty (ENAHO) 2018. Satisfaction with healthcare received was rated as very bad, bad, good, and very good. The characteristics of the study population were described using weighted frequencies and proportions. To determine the factors associated with satisfaction with the care received, a generalized ordinal logistic model was estimated. Results. The study included a total of 14,206 adults (expanded population: 7,684,602) who reported having been treated at a MINSA healthcare facility. At the national level, 74.3% of users reported satisfaction with the service received as "good or very good". Having a chronic illness, having a native mother tongue, or living in a population with agglomerations of more than 2000 people were associated with lower satisfaction with the care received. Living in the jungle area was associated with a report of greater satisfaction with the care. Conclusions. Three out of four external users rate the care received at MINSA facilities as good or very good. There are population subgroups with less satisfaction with the care received. Improving the satisfaction of these users would improve the quality of care at the facilities of MINSA, the largest health provider in Peru. [ABSTRACT FROM AUTHOR]

• We identify co-occurrence patterns of attributes related to crashes and interventions • Latent Dirichlet allocation was applied to analyse the topics of RSI reports • Results reveal associations among conditions that have previously gone unreported • Results aid to determine if road authorities can implement compliance with standards Under the Safe System framework, Road Authorities have a responsibility to deliver inherently safe roads and streets. Addressing this problem depends on knowledge of the road network safety conditions and the number of funds available for new road safety interventions. It also requires the prioritisation of the various interventions that may generate benefits, increasing safety, while ensuring that reasonable steps are taken to remedy the deficiencies detected within a reasonable timeframe. In this context, Road Safety Inspections (RSI) are a proactive tool for identifying safety issues, consisting of a regular, systematic, on-site inspection of existing roads, covering the whole road network, carried out by trained safety expert teams. This paper aims to describe how topic modelling can be effectively used to identify co-occurrence patterns of attributes related to the run-off-road crashes, as well as the corresponding patterns of road safety interventions, as described in the RSI reports. We apply latent Dirichlet allocation (LDA), a widespread method for fitting a topic model, to analyse the topics mentioned in RSI reports, divided into two groups: problems found; and proposed solutions. For this study, 54 RSI gathered over six years (2012–2017) were analysed, covering 4011 km of Irish roads. The results indicate that important keywords relating to the "forgiving roadside" and "clear zone" concepts, as well as the relevant European technical standards (CEN-EN1317 and EN 12,767), are absent from the extracted latent topics. We also found that the frequency of topics related to roadside safety is higher in the problems record set than in the solutions record set, meaning that problems are more easily identified and related to the roadside area than interventions may be. This paper presents methodological empirical evidence that the LDA is appropriate for identifying the co-occurrence patterns of attributes related to the ROR crashes in road safety inspections' reports, as well as the interventions' patterns associated with these crashes. Also, it provides valuable information aimed to determine the extent to which national road authorities in Europe and their contractors are currently capable of implementing and maintaining compliance with roadside standards and guidelines throughout the life cycle of roads. [ABSTRACT FROM AUTHOR]

Highlights • We modeled the distance traveled by an errant vehicle in a ROR crash. • Two Cox mixed-effects regression models were developed. • Results confirmed the contribution of roadside obstacles to the distance travelled. • Results suggest that clear-zone distances proposed in guidelines should be evaluated. • This study can facilitate the appropriate planning and design of forgiving roadsides. Abstract Roadway departure (RwD) crashes, comprising run-off-road (ROR) and cross-median/centerline head-on collisions, are one of the most lethal crash types. Nationwide, from 2014 to 2016, annual RwD crashes accounted for 53% of all motor vehicle traffic fatalities. Several factors may cause a driver leave the travel lane, including an avoidance maneuver and inattention or fatigue. Roadway and roadside geometric design features (e.g., lane widths and clear zones) play a significant role in whether human error results in a crash. In this paper, we present a hazard-based duration model to investigate the distance traveled by an errant vehicle in a run-off-road crash, the stopping hazard rates, and associated risk factors. For this study, we obtained five years' (2010–2014) of crash data related to roadway departures (i.e., overturn and fixed-object crashes) from the Federal Highway Administration's Highway Safety Information System Database. The results indicate that over 50% of the observed vehicles traveled no more than 36 ft. in a ROR crash and 25% of the observed vehicles traveled at least 78 ft. We also found that seasonal, roadway, and crash variables, along with vehicle information and driver characteristics significantly contributed to the distances traveled by errant vehicles in ROR crashes. This paper presents methodological empirical evidence that the Cox proportional-hazards model is appropriate for investigating the distances traveled by errant vehicles in ROR crashes. In addition, it also provides valuable information for traffic design and management agencies to improve roadside design policies and implementing appropriately forgiving roadsides for errant vehicles. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic inequalities in the population influence access to health services and constitute a challenge for health systems, especially in low- and middle-income countries. In Peru, an increase in the use of medical services has been estimated; however, the study of inequalities in the use of medical services is limited. Therefore, the objective of this research was to analyze and decompose socioeconomic inequalities in the use of medical consultation services in Peru. Methods: A cross-sectional analytical study was conducted using data from the National Household Survey 2019. The outcome variable was the use of a consultation attended by a physician in the last 4 weeks in persons who presented symptom or discomfort, illness, relapse of chronic disease and/or accident. Concentration curves and Erreygers concentration indices were used to determine socioeconomic inequalities, and a generalized linear regression model was used for the decomposition analysis of inequalities. Results: A total of 52,715 persons were included in the study. The frequency of medical consultation was 25.4% (95% confidence interval: 24.8 − 26.1%). In the inequality analysis, it was found that the use of medical consultations was concentrated among the wealthiest individuals. The main contributing factors were having another type of health insurance (social health insurance [EsSalud], private health insurance, health provider, the Armed Forces, and the Police), residing in an urban area, belonging to the richest wealth quintile, having a chronic disease, and residing in the highlands of Peru. Conclusions: Based on our findings, government institutions seeking to achieve equitable access to health services should consider the main factors contributing to this inequality in the formulation of strategies to lessen the negative impact of inadequate disease control in the population. [ABSTRACT FROM AUTHOR]

Objectives. To estimate out-of-pocket spending on health (GBS) and identify its associated factors in Peruvian older adults. Materials and Methods. Analytical cross-sectional study of the National Household Survey on Living Conditions and Poverty (ENAHO) 2017. Older adults were considered to be all individuals aged 60 and over and the GBS was considered the main study variable. Prevalence ratios (PR) and adjusted prevalence ratios (PRa) were estimated for each of the factors associated with GBS. GBS means were estimated using a generalized linear model with gamma distribution and log binding function. All confidence intervals (95%) of the estimators were calculated by bootstrapping with the normal-based method. Results. Eighteen 386 older adults were included, of which 56.5% reported GBS. The mean and median GBS is S/. 140.8 (USD 43.2) and S/. 34.5 (USD 10.6), respectively. Factors such as urban origin, a higher level of education, chronic diseases and higher per capita expenses increase the probability of GBS by up to 1.6 times. In those affiliated to the Integral Health Insurance (SIS), the GBS is reduced by 63.0 soles (USD 19.3) compared to those without any health insurance. Conclusions. Six out of ten older Peruvian adults reported GBS to attend to their health needs. This generates an access inequity in terms of health services, mainly for socially-vulnerable groups. We suggest researching into the economic impact of health insurance and the preventive-promotional approach to chronic diseases, in order to reduce GBS and improve the efficiency of the Peruvian health system. [ABSTRACT FROM AUTHOR]

Variability in growth and reproductive characteristics, seed traits, quality and oil content of six accessions of Jatropha curcas growing in Murcia (Spain) under greenhouse conditions were analysed. Differences were found among accessions in branch length, ratio female to male flowers (F/M), productions, seed weight, endosperm weight, percentage of endosperm and percentage of aborted seeds oil contents, fatty acids composition and quality indexes of the biodiesel. Two genotypes (8-8 and 6-3) have shown a good vigor plant, the best F/M ratio, and appropriate average productions. In addition, these accessions showed the highest average single seed weights, and the best average endosperm weights. The highest total seed oil percentages were observed in the accessions 4-5 (42.42 ± 0.26), 6-3 (41.51 ± 0.20), and 8-8 (40.41 ± 0.73), whereas percentages lower than 30% were recorded in the others. The percentage of endosperm oil ranged from 42.72 ± 0.98% to 65.71 ± 0.36%. In relation to the fatty acids composition, the highest monounsaturated fatty acids percentages with the highest concentration of oleic acid and the lowest concentration of linolenic acid were observed in three genotypes (4-5, 8-8 and 6-3). The biodiesel obtained from these accessions presented high cetane number and low iodine value, which indicates the good ignition quality and stability of the oil. The knowledge of plant growth parameters and oil quality of the studied genotypes could be useful to choose the appropriate ones to be grown under subtropical climatic conditions or to be used as parents in a breeding program. [ABSTRACT FROM AUTHOR]

Background Detailed information is needed on the dynamic pattern of antimicrobial resistance (AMR) in Neisseria gonorrhoeae in Latin America and the Caribbean (LAC). Objectives To conduct a systematic review of AMR in N. gonorrhoeae in LAC. Methods Electronic searches without language restrictions were conducted in PubMed, Embase, Cochrane Library, EconLIT, Cumulative Index of Nursing and Allied Health Literature, Centre for Reviews and Dissemination, and Latin American and Caribbean Literature in Health Sciences. Studies were eligible if published between 1 January 2011 and 13 February 2021, conducted in any LAC country (regardless of age, sex and population) and measured frequency and/or patterns of AMR to any antimicrobial in N. gonorrhoeae. The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO-GASP) for LAC countries and Latin American AMR Surveillance Network databases were searched. AMR study quality was evaluated according to WHO recommendations. Results AMR data for 38, 417 isolates collected in 1990–2018 were included from 31 publications, reporting data from Argentina, Brazil, Colombia, Peru, Uruguay, Venezuela and WHO-GASP. Resistance to extended-spectrum cephalosporins was infrequent (0.09%–8.5%). Resistance to azithromycin was up to 32% in the published studies and up to 61% in WHO-GASP. Resistance to penicillin, tetracycline and ciprofloxacin was high (17.6%–98%, 20.7%–90% and 5.9%–89%, respectively). Resistance to gentamicin was not reported, and resistance to spectinomycin was reported in one study. Conclusions This review provides data on resistance to azithromycin, potentially important given its use as first-line empirical treatment, and indicates the need for improved surveillance of gonococcal AMR in LAC. Trial registration: Registered in PROSPERO, CRD42021253342. [ABSTRACT FROM AUTHOR]

The objective of this paper is to study the contributors influencing ran-off-road (ROR) crash severities in a setting that has not been analysed in the literature, namely on freeways not designed according to the “ forgiving roadside ” concept. To accomplish the analysis, ROR crash data were collected on freeway road sections in Portugal and multinomial and mixed logit models were estimated using the driver injury and the most severely injured occupant as outcome variables. Our results are in line with previous findings reported in the literature on ROR crash severity in a number of distinct settings. Most importantly, this study shows the contribution of critical slopes and vehicle rollover towards fatal injuries and highlights the importance of introducing the “ forgiving roadside ” concept to mitigate ROR crash severity in Portuguese freeways. The study also indicates the importance of protecting errant vehicles particularly in horizontal curves, as these are linked with fatalities. Finally, the empirical findings from the developed models revealed problems in current Portuguese roadside design, especially with regards to criteria for forgiving slopes provision and warrants for safety barrier installation. [ABSTRACT FROM AUTHOR]

Collisions with dangerous roadside obstacles and rollovers are responsible for many injuries and deaths in highways worldwide. International crash data indicate that roadside characteristics contribute to more than half of all run-off-road injury crashes (RORIC) involving serious injury or death. Furthermore, roadside geometric characteristics are believed to be the leading cause of rollover in single-vehicle RORIC. Differences in each country’s road network features, car vehicle stock, driving behavior, characteristics of roadside obstacles and economical aspects justify the need for evaluating the merit of specific approaches to roadside safety issues. Results from recent studies carried out at the Laboratório Nacional de Engenharia Civil – LNEC have shown that important differences exist between RORIC in Portuguese roads, when they are compared with RORIC in roads from other countries. A framework was developed for assisting in cost-effective decisions as regards roadside safety interventions, which is based on results from the analysis of registered data and the observation of inservice performance of installed equipments on Portuguese roads. A brief description is provided of cost–benefit analysis software tools for safety evaluation and simulation of roadside scenarios, which were developed at LNEC under a dedicated research project – SAFESIDE-roadside safety. The software contains a list of roadside safety measures (including the present value of their implementation costs and their safety effects) and an accident categorization (based on predictive models for crash frequencies and crash costs). The software is being disseminated by road authorities and relevant technical stakeholders, within the current revision of Portuguese road design standards. [ABSTRACT FROM AUTHOR]

The Catholic Church, as a crucial part in the forging of the Mexican state, played a decisive role during the independence war of Mexico, assuming a determinate factor for the state. The church as an institution in training and strengthened by the materialized richness possessions expressed in land, brotherhoods, hospitals, schools and still more decisive way the affection and identification of individuals through the creed, allowed in the form of organization and action of the political power. His act governed by the principle of protection and maintenance of privileges to the middle and upper clergy, exercise that claiming take a position on the pretensions of those who formed the political - governmental apparatus, as a crucial understood for the establishment of the Mexican State and the permanence in politics. The reproduction and socialization of these ideas started an effort for establishing the identity and attachment between religious institutions and individuals; the object of the church with a spiritual purpose was well maintained, that is why the purpose to establish in the depths of an emerging nation, through religion did not go unnoticed. From the point of view of history, the church served as a link between the state power and the citizens. However, in the period of independence, liberalism and the bad situation of the state turned the church on a point of controversy concerning institution; because such was his influenced that reached the degree of causing loss of identity in individuals. The purpose of this work is to expose the role played by the Catholic Church in the consolidation of the Mexican State during the period 1810-1857, showing in a punctual manner some current aspects identified. That's the reason we will discuss the conflicts between the Catholic Church and the Mexican State, its effects and the importance of their convergence. [ABSTRACT FROM AUTHOR]

Highlights: [•] We model crash frequency in run-off-the-road injury crashes. [•] Different functional forms relating crash frequency and traffic flow are analyzed. [•] Run-off-the-road crashes should be modelled with a modified Ricker model. [ABSTRACT FROM AUTHOR]

We report the case of a patient diagnosed with a clinical relapse of acquired immune-mediated thrombotic thrombocytopenic purpura (TTP) who was successfully treated with low-dose rituximab plus corticosteroids without the use of plasma exchange (PEx), which was unavailable at the time due to the COVID-19 pandemic. Rituximab 100 mg weekly for 4 weeks was administered, combined with 1 mg/kg of prednisone, obtaining a complete hematological response in 6 weeks. This case suggests that PEx may be unnecessary for a subset of patients with relapsed TTP who are clinically stable without significant end-organ damage. A brief literature review regarding TTP patients treated without plasma exchange is also included. [ABSTRACT FROM AUTHOR]

Background: Centrifugal-flow pumps are novel treatment options for patients with advanced heart failure (HF). This study estimated the incremental cost-effectiveness ratio (ICER) of centrifugal-flow pumps for patients with advanced HF in Argentina. Methods: Two Markov models were developed to estimate the cost-effectiveness of a centrifugal-flow pump as destination therapy (DT) in patients with contraindication for heart transplantation, and as bridge-to-transplant (BTT), with a lifetime horizon using the third-party payer Social Security (SS) and Private Sector (PS) perspectives. Clinical, epidemiological, and quality-adjusted life years (QALY) parameters were retrieved from the literature. Direct medical costs were estimated through a micro-costing approach (exchange rate USD 1 = ARS 59.95). Results: The centrifugal-flow pump as a DT increased the per patient QALYs by 3.5 and costs by ARS 8.1 million in both the SS and PS, with an ICER of ARS 2.3 million per QALY. Corresponding values for a centrifugal-flow pump as BTT were 0.74 QALYs and more than ARS 8 million, yielding ICERs of ARS 11 million per QALY (highly dependent on waiting times). For the 1, 3, and 5 GDP per QALY thresholds, the probability of a centrifugal-flow pump to be cost-effective for DT/BTT was around 2%/0%, 40%/0%, and 80%/1%, respectively. Conclusion: The centrifugal-flow pump prolongs life and improves the quality of life at significantly higher costs. As in Argentina there is no current explicit cost-effectiveness threshold, the final decision on reimbursement will depend on the willingness to pay in each subsector. Nevertheless, the centrifugal-flow pump as a DT was more cost-effective than as a BTT. [ABSTRACT FROM AUTHOR]

This article aims to identify the factors associated with intimate partner violence (IPV) using data from the latest available nationwide survey in Nicaragua. A secondary analysis of the 2011–2012 Nicaraguan Demography and Health Survey (ENDESA 2011–2012) was conducted. A total of 12,605 women aged 15–49 years who had reported being married or united were included. IPV (yes/no) was defined as the outcome variable, and it was considered if a woman suffered verbal, psychological, physical, or sexual violence during the previous 12 months. Crude and adjusted odds ratios with 95% CI were calculated using a bivariate and multivariate logistic regression model. A p value <.05 was considered statistically significant and did not correct p values for multiple testing. The overall prevalence of IPV was 17.5%. Women living in urban setting (AOR: 1.51, 95% CI: 1.26–1.80), women who self-identify as native (AOR: 1.34, 95% CI: 1.34–1.61) or women who have a history of abuse as a child (AOR: 1.96, 95% CI: 1.69–2.27) were more likely to suffer IPV compared to their counterparts. Age was found to be a protective factor for IPV. Variables such as educational level and wealth index, do not report any association with IPV. Our findings shows that IPV in Nicaragua continues to be a frequent event. The results provide evidence of drivers for IPV at a national level. These findings are useful for the design of intervention policies and strategies for the prevention of IPV. [ABSTRACT FROM AUTHOR]

• Previous studies have established that in high-altitude regions there is a higher prevalence of depression. • An increase in meters above sea level of residence was positively and significantly associated with the depressive symptoms score. • This relationship is also observed according to the sex, age, number of comorbidities, marital status, area of residence, current smoking status, and pattern of alcohol consumption. • For the sensitivity analysis, altitude having no significant effect on the low scores (p10) of depressive symptoms, and the high scores of depressive symptoms are associated with the high altitude. In high altitude regions, people experience biological, inflammatory and brain structure changes that increase the risk of depressive symptoms. The aim of this study was to determine the association between altitude and depressive symptoms in the Peruvian population, adjusting by demographic, socioeconomic and exposure to health risk factors. We performed a cross-sectional analytical study of data collected annually by the Demographic and Family Health Survey during the period 2013–2020. The presence of depressive symptoms during the last 14 days prior to the survey were measured using scores obtained from the Patient Health Questionnaire-9 (PHQ-9). A generalized linear model (GLM) of gamma family and log link function was used to report the crude and adjusted β coefficients. A quantile regression model was performed as a sensitivity analysis. Data from a total of 215,409 participants were included. After adjusting for demographic, socioeconomic and health risk exposures, the GLM showed that an increase in every 100 m of altitude of residence was positively and significantly associated with the depressive symptoms score (β=0•01 [95% confidence interval: 0•01–0•01]). The length of residence in high altitude areas of the population included cannot be established, requiring future research to determine if the results of the present study are similar in native people or permanent residents of high altitude regions. Altitude was positively associated with depressive symptom scores. Our results will allow the development of mental health interventions based on factors that increase the likelihood of depressive symptoms in high-altitudes. [ABSTRACT FROM AUTHOR]

Background: In high altitude regions, people experience biological, inflammatory and brain structure changes that increase the risk of depressive symptoms. The aim of this study was to determine the association between altitude and depressive symptoms in the Peruvian population, adjusting by demographic, socioeconomic and exposure to health risk factors.Methods: We performed a cross-sectional analytical study of data collected annually by the Demographic and Family Health Survey during the period 2013-2020. The presence of depressive symptoms during the last 14 days prior to the survey were measured using scores obtained from the Patient Health Questionnaire-9 (PHQ-9). A generalized linear model (GLM) of gamma family and log link function was used to report the crude and adjusted β coefficients. A quantile regression model was performed as a sensitivity analysis.Results: Data from a total of 215,409 participants were included. After adjusting for demographic, socioeconomic and health risk exposures, the GLM showed that an increase in every 100 m of altitude of residence was positively and significantly associated with the depressive symptoms score (β=0•01 [95% confidence interval: 0•01-0•01]).Limitations: The length of residence in high altitude areas of the population included cannot be established, requiring future research to determine if the results of the present study are similar in native people or permanent residents of high altitude regions.Conclusions: Altitude was positively associated with depressive symptom scores. Our results will allow the development of mental health interventions based on factors that increase the likelihood of depressive symptoms in high-altitudes. [ABSTRACT FROM AUTHOR]

Background and Aims Given the lack of specific studies on floral development in melon (Cucumis melo L.), we carried out an extensive study involving morphological and transcriptomic analyses to characterize floral development in this species. Methods Using an andromonoecious line, we analysed the development of floral buds in male and hermaphrodite flowers with both light microscopy and scanning electron microscopy. Based on flower lengths, we established a correlation between the developmental stages and four main episodes of floral development and conducted an extensive RNA sequencing analysis of these episodes. Key Results We identified 12 stages of floral development, from the appearance of the floral meristems to anthesis. The main structural differences between male and hermaphrodite flowers appeared between stages 6 and 7; later stages of development leading to the formation of organs and structures in both types of flowers were also described. We analysed the gene expression patterns of the four episodes in flower development to find the genes that were specific to each given episode. Among others, we identified genes that defined the passage from one episode to the next according to the ABCDE model of floral development. Conclusions This work combines a detailed morphological analysis and a comprehensive transcriptomic study to enable characterization of the structural and molecular mechanisms that determine the floral development of an andromonoecious genotype in melon. Taken together, our results provide a first insight into gene regulation networks in melon floral development that are crucial for flowering and pollen formation, highlighting potential targets for genetic manipulation to improve crop yield of melon in the future. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to estimate the budget impact of the incorporation of venetoclax for the treatment of patients with Acute Myeloid Leukemia (AML) over 75 years of age or those with comorbidities and contraindications for the use of intensive chemotherapy, from the perspective of the social security and the private third-party payers in Argentina. Methods: A budget impact model was adapted to estimate the cost difference between the current scenario (azacitidine, decitabine and low doses of cytarabine) and the new scenario (incorporation of venetoclax) for a third-party payer over a time horizon of three years. Input parameters were obtained from a literature review, validated or complemented by expert opinion using a modified Panel Delphi approach. All direct medical costs were estimated by the micro-costing approach and were expressed in US dollars (USD) as of September 2020 (1 USD = 76.18 Argentine pesos). Results: For a third-party payer with a cohort of 1,000,000 individuals covered, incorporating venetoclax was associated with an average budget impact per-member per-month (PMPM) of $0.11 USD for the social security sector and $0.07 USD for the private sector. The duration of treatment with venetoclax was the most influential parameter in the budget impact results. Conclusion: The introduction of venetoclax was associated with a positive and slight budget impact. These findings are informative to support policy decisions aimed to expand the current treatment landscape of AML. [ABSTRACT FROM AUTHOR]

Background: The high fragmentation and decentralization in the provision of health care services that characterizes Argentina's health system, as well as the economic and social inequalities, challenge the achievement of the Universal Health Coverage (UHC). The objective of this study is to measure socioeconomic-related inequality and horizontal inequity in the use of health care services in Argentina as well as identify the factors that contribute to these disparities. Methods: The 2013 National Risk Factor Survey, developed by the Ministry of Health of Argentina, was used to measure socioeconomic-related inequality and inequity in the use of health care services through concentration curves, the Erreygers concentration index, and the index of horizontal inequity. Econometric micro-decomposition was applied to estimate the contribution of each determining factor to inequality in the use of health care services. Results: The Erreygers concentration index for the use of health care services was 0.1223, evidencing pro-rich inequalities. By adding variables of health care needs, the horizontal inequity index was 0.1296. Non-need factors such as education and health coverage with social security increase pro-rich inequality. Conclusions: The Argentine health system shows pro-rich inequality in the use of health care services. It is necessary to design strategies to improve articulation between the three coverage subsectors and national, provincial, and municipal governments to keep the commitment of "not leaving anyone behind." The results showed here could provide lessons for countries with similar contexts and challenges in public health. [ABSTRACT FROM AUTHOR]

Objective. To estimate the prevalence and determine the factors associated with the non-utilization of healthcare facilities (NUHCF) among adult Venezuelan migrants in Peru. Materials and Methods. An analytical cross-sectional study of the "Survey of the Venezuelan Population Residing in Peru" 2018. We calculated the proportion of immigrants with NUHCF (immigrants with some symptom or malaise, illness, relapse of chronic illness, accident and discomfort, or other problem such as depression, fear, anger, anxiety, and stress, and who did not consider that it was serious or that they needed to visit a healthcare facility). Raw and adjusted (PRa) prevalence ratios (PR) for presenting NUHCF were estimated using generalized linear models. Results. The study included 2,144 Venezuelan migrants: 57.2% presented NUHCF, reporting reasons such as: not having money (64.5%), lack of health insurance (24.3%), self-medication (12.8%), and not having time (8.4%). Living in Arequipa (PRa: 0.69; 95% CI: 0.57-0.83) or Trujillo (PRa: 0.87; 95% CI: 0.76-0.99), suffering from a chronic disease (PRa: 0.83; 95% CI: 0.71-0.97), and being enrolled in the Seguro Integral de Salud (SIS) insurance (PRa: 0.28; 95% CI: 0.13-0.61) was associated with a lower probability of NUHCF. Belonging to an age group under 60 years was associated with a higher probability of NUHCF. Conclusions. One out of two Venezuelan migrants in Peru presents NUHCF. Having SIS increases the likelihood of Venezuelan migrants in Peruvian territory seeking medical attention. Increasing public health insurance for this population, which is currently low, could increase the utilization of health services. [ABSTRACT FROM AUTHOR]

Objectives. To identify the prevalence and factors associated with the use of oral health services in Peruvian older adults (OA) during 2018. Materials and Methods. Secondary analysis of data on 4,874 Peruvian OAs from the Demographic and Family Health Survey (ENDES) carried out in 2018. The use of oral health services was considered (yes/no) based on the six months prior to the application of the survey as a dependent variable. The independent variables were sex, age, area of residence, educational level, marital status, geographical domain, physical limitation, health insurance, spoken language, and welfare index quintile. A descriptive analysis was performed using absolute frequencies and weighted proportions, and a multivariate analysis using generalized linear models (Poisson regression). Results. From the total of OAs, 52.6% were women, 52.9% belonged to the 60-69 age group, 77% belonged to the urban area, and 81.1% had a health insurance. The prevalence of the use of dental care services in the last six months was 24.9%. Multivariate analysis found association with area of residence (p<0.001), higher educational level (p=0.001), health insurance affiliation (p<0.001), geographic domain (p=0.019), and all welfare index quintiles (p<0.001). Conclusions. The prevalence of the use of dental care services in OAs was low, and its associated factors were the area of residence, educational level, health insurance, geographic domain, and welfare index quintiles. [ABSTRACT FROM AUTHOR]

Arterial obstruction in small diameter (<6 mm) vessels are many times treated with grafts, however autologous aren't always available and synthetic have a high rate of complications. Decellularization of umbilical arteries may provide a solution, but the ideal method is debatable. We compare effectiveness between SDS and Triton X-100. Umbilical cords obtained from full term pregnancies with normal development and no evident complications in the newborn, were micro-dissected within 12 h and stored in phosphate buffered saline without freezing. Arteries were then processed for decellularization using 0.1 % and 1 % SDS, and 1 % Triton X- 100 protocols. Evaluation of cellular and nuclear material, collagen fibers, elastic fibers, and glycosoaminoglycans of the extracellular matrix (ECM) were evaluated as well as morphometric analysis under histological and immunohistochemical techniques. Triton X-100 was ineffective, preserving nuclear remains identified by immunofluorescence, had the most notable damage to elastic fibers, and decrease in collagen. SDS effectively eliminated the nuclei and had a less decrease in elastic fibers and collagen. Laminin was preserved in all groups. No significant differences were identified in luminal diameters; however the middle layer decreased due to decellularization of muscle cells. In conclusion, 0.1 % SDS decellularization was the most effective in eliminating cells and preserving the main components of the ECM. [ABSTRACT FROM AUTHOR]

Introduction: Neisseria gonorrhoeae causes gonorrhoea, a globally neglected but increasing disease. This systematic review and meta-analysis reviewed the epidemiology and economic burden of gonorrhoea in Latin America and the Caribbean (LAC). Methods: We searched PubMed, EMBase, Cochrane Library, EconLIT, CINAHL, CRD, LILACS, Global Health, Global Dissertations and Theses, SciELO, Web of Science databases, countries' ministries of health, and the IHME's Global Burden of Disease databases. Studies published in the last 10 years (20 years for economic studies) were included if conducted in any LAC country, without language restrictions. The main outcome measures were incidence/prevalence, proportion of co-infections, case fatality rates, specific mortality/hospitalisation rates, direct/indirect costs, and impact of gonorrhoea on quality of life. To assess evidence quality, we used a checklist developed by the US National Heart, Lung, and Blood Institute for observational studies and trial control arms, the Cochrane Effective Practice Organization of Care Group tool for randomised controlled trials, and the CICERO checklist for economic studies. Results: We identified 1290 articles; 115 included epidemiological studies and one included an economic study. Ministry of health data from Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay were identified. Gonorrhoea prevalence was 1.46% (95% confidence interval [CI] 1.00–2.00%) from 48 studies and 5.68% (95% CI 4.23–7.32%) from 58 studies for non-high-risk and high-risk populations, respectively. Cumulative incidence for the high-risk population was 2.05 cases per 100 persons/year. Few published studies were rated as "good" in the risk of bias assessments. Variations in the methodology of the sources and limited information found in the countries' surveillance systems hinder the comparison of data. Conclusion: The burden of gonorrhoea in LAC is not negligible. Our results provide public health and clinical decision support to assess potential interventions to prevent gonorrhoea. Trial Registration: The protocol is registered on PROSPERO (CRD42021253342). The study was funded by GlaxoSmithKline Biologicals SA (GSK study identifier VEO-000025). [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to perform a budget impact analysis (BIA) of introducing olaparib treatment for adult patients with metastatic castration-resistant prostate cancer in Argentina.A BIA model was used to estimate the cost difference between the current scenario (without olaparib) and the new scenario (incorporation of olaparib) for a third-party payer over a 5-year time horizon. The budgetary impact is estimated at the national health system level and by healthcare sectors in Argentina. Input parameters were obtained from the literature and validated by local expert opinion. Direct medical costs were obtained from both the Institute for Clinical Effectiveness and Health Policy (IECS) unit cost database and public data in Argentina. The microcosting estimation was used for key variables of the analysis. All costs are reported in US dollars (US$) as for October 2022 (1 US$ = 152.59 Argentine pesos). One-way sensitivity analyses and scenario analyses were conducted to evaluate the model robustness.The incorporation of olaparib, with a wholesale price per pack of US$3176, was associated with a weighted average of the budget impact per member per month (PMPM) of US$0.0191 for the national health system, being slightly higher than the estimated budgeted high impact threshold (US$0.0153). The PMPM budget impact for a 5-year average ranged between US$0.007 (public sector) and US$0.033 (private sector). The duration of treatment with olaparib was the most influential parameter in the budget impact results.The introduction of olaparib for the treatment of metastatic castration-resistant prostate cancer has a high budget impact for Argentina's health system. These findings are informative to support policy decisions aimed to expand the current treatment landscape for prostate cancer.Methods: The aim of this study was to perform a budget impact analysis (BIA) of introducing olaparib treatment for adult patients with metastatic castration-resistant prostate cancer in Argentina.A BIA model was used to estimate the cost difference between the current scenario (without olaparib) and the new scenario (incorporation of olaparib) for a third-party payer over a 5-year time horizon. The budgetary impact is estimated at the national health system level and by healthcare sectors in Argentina. Input parameters were obtained from the literature and validated by local expert opinion. Direct medical costs were obtained from both the Institute for Clinical Effectiveness and Health Policy (IECS) unit cost database and public data in Argentina. The microcosting estimation was used for key variables of the analysis. All costs are reported in US dollars (US$) as for October 2022 (1 US$ = 152.59 Argentine pesos). One-way sensitivity analyses and scenario analyses were conducted to evaluate the model robustness.The incorporation of olaparib, with a wholesale price per pack of US$3176, was associated with a weighted average of the budget impact per member per month (PMPM) of US$0.0191 for the national health system, being slightly higher than the estimated budgeted high impact threshold (US$0.0153). The PMPM budget impact for a 5-year average ranged between US$0.007 (public sector) and US$0.033 (private sector). The duration of treatment with olaparib was the most influential parameter in the budget impact results.The introduction of olaparib for the treatment of metastatic castration-resistant prostate cancer has a high budget impact for Argentina's health system. These findings are informative to support policy decisions aimed to expand the current treatment landscape for prostate cancer.Results: The aim of this study was to perform a budget impact analysis (BIA) of introducing olaparib treatment for adult patients with metastatic castration-resistant prostate cancer in Argentina.A BIA model was used to estimate the cost difference between the current scenario (without olaparib) and the new scenario (incorporation of olaparib) for a third-party payer over a 5-year time horizon. The budgetary impact is estimated at the national health system level and by healthcare sectors in Argentina. Input parameters were obtained from the literature and validated by local expert opinion. Direct medical costs were obtained from both the Institute for Clinical Effectiveness and Health Policy (IECS) unit cost database and public data in Argentina. The microcosting estimation was used for key variables of the analysis. All costs are reported in US dollars (US$) as for October 2022 (1 US$ = 152.59 Argentine pesos). One-way sensitivity analyses and scenario analyses were conducted to evaluate the model robustness.The incorporation of olaparib, with a wholesale price per pack of US$3176, was associated with a weighted average of the budget impact per member per month (PMPM) of US$0.0191 for the national health system, being slightly higher than the estimated budgeted high impact threshold (US$0.0153). The PMPM budget impact for a 5-year average ranged between US$0.007 (public sector) and US$0.033 (private sector). The duration of treatment with olaparib was the most influential parameter in the budget impact results.The introduction of olaparib for the treatment of metastatic castration-resistant prostate cancer has a high budget impact for Argentina's health system. These findings are informative to support policy decisions aimed to expand the current treatment landscape for prostate cancer.Conclusions: The aim of this study was to perform a budget impact analysis (BIA) of introducing olaparib treatment for adult patients with metastatic castration-resistant prostate cancer in Argentina.A BIA model was used to estimate the cost difference between the current scenario (without olaparib) and the new scenario (incorporation of olaparib) for a third-party payer over a 5-year time horizon. The budgetary impact is estimated at the national health system level and by healthcare sectors in Argentina. Input parameters were obtained from the literature and validated by local expert opinion. Direct medical costs were obtained from both the Institute for Clinical Effectiveness and Health Policy (IECS) unit cost database and public data in Argentina. The microcosting estimation was used for key variables of the analysis. All costs are reported in US dollars (US$) as for October 2022 (1 US$ = 152.59 Argentine pesos). One-way sensitivity analyses and scenario analyses were conducted to evaluate the model robustness.The incorporation of olaparib, with a wholesale price per pack of US$3176, was associated with a weighted average of the budget impact per member per month (PMPM) of US$0.0191 for the national health system, being slightly higher than the estimated budgeted high impact threshold (US$0.0153). The PMPM budget impact for a 5-year average ranged between US$0.007 (public sector) and US$0.033 (private sector). The duration of treatment with olaparib was the most influential parameter in the budget impact results.The introduction of olaparib for the treatment of metastatic castration-resistant prostate cancer has a high budget impact for Argentina's health system. These findings are informative to support policy decisions aimed to expand the current treatment landscape for prostate cancer. [ABSTRACT FROM AUTHOR]

• Novel study of pedestrian crash severity based on traveled distance. • 25 % of severe crashes near homes; 50 % within 0.8434 miles. • Insights into spatial patterns of pedestrian crashes. Pedestrian safety remains a significant concern, with the growing number of severe pedestrian crashes resulting in substantial human and economic costs. Previous research into pedestrian crashes has extensively analyzed the influences of weather, lighting, and pedestrian demographics. However, these studies often overlook the critical spatial variables that contribute to pedestrian crashes. Our study aims to explore these overlooked spatial variables by examining the distance pedestrians travel before encountering a severe crash. This approach provides a supplementary perspective in safety analysis, emphasizing the importance of pedestrian movement patterns. The model considers various factors that may influence pedestrian traveled distance before being involved in a severe crash, such as weather conditions, lighting conditions, and pedestrian demographics. Ohio's pedestrian-involved crashes were gathered and analyzed as a case study. The results indicated that 50 % of fatal pedestrian crashes occurred within 0.84 miles of the pedestrians' residences. Moreover, it was shown that factors including lighting condition, pedestrian age, drug toxication, and the location at impact significantly influence the pedestrians traveled distance. These findings provide valuable insights into the spatial distribution of pedestrian crashes and shed light on the factors contributing to their severity. By understanding these relationships, policymakers and urban planners can design targeted interventions such as improving street lighting, implementing traffic calming measures, and developing safety awareness campaigns for specific age groups, to enhance pedestrian safety and reduce the incidence of severe crashes. [ABSTRACT FROM AUTHOR]

Objectives.: To assess how and in what extent the electronic nicotine delivery systems (ENDS) use substituted the consumption of traditional combustible cigarettes (c-cigarettes, c-cig). Materials and methods.: We performed a systematic review of the literature up to August 2019 in scientific databases. Primary outcomes were proportion of complete or partial substitution of conventional to electronic cigarettes and related economic aspects. Secondary outcomes were odds ratio of substitution and country-wise time trends. Results.: We retrieved 3,628 references and included 49 studies, providing economic and epidemiological data. Economic studies of cross-price elasticity showed that combustible cigarettes are partially substitutable for electronic cigarettes. Most studies reported that electronic cigarettes consumption prevalence increased over time. Three studies reported a significant reduction of combustible cigarettes consumed per day among dual users (combustible- plus electronic- cigarettes users) versus combustible-cigarettes users. The pooled adjusted odds ratio of quitting combustible cigarettes among electronic cigarettes users versus never or past electronic cigarettes (e-cigarettes, e-cig) users was 1.19 (95% confidence interval 1.09 to 1.30; heterogeneity score 0%). Longitudinal studies showed globally a growing prevalence of electronic cigarettes use, mainly in adolescents. A negative relationship between consumption and price increase of electronic and combustible cigarettes was found. Conclusion.: The chance of quitting smoking combustible cigarettes among current electronic nicotine delivery systems users was increased with respect to never- or past- electronic nicotine delivery systems users. Economic studies reported that electronic cigarette is partially substitutable for combustible cigarettes. [ABSTRACT FROM AUTHOR]

Objectives. To assess how and in what extent the electronic nicotine delivery systems (ENDS) use substituted the consumption of traditional combustible cigarettes (c-cigarettes, c-cig). Materials and Methods. We performed a systematic review of the literature up to August 2019 in scientific databases. Primary outcomes were proportion of complete or partial substitution of conventional to electronic cigarettes and related economic aspects. Secondary outcomes were odds ratio of substitution and country-wise time trends. Results. We retrieved 3,628 references and included 49 studies, providing economic and epidemiological data. Economic studies of cross-price elasticity showed that combustible cigarettes are partially substitutable for electronic cigarettes. Most studies reported that electronic cigarettes consumption prevalence increased over time. Three studies reported a significant reduction of combustible cigarettes consumed per day among dual users (combustible-plus electronic-cigarettes users) versus combustible-cigarettes users. The pooled adjusted odds ratio of quitting combustible cigarettes among electronic cigarettes users versus never or past electronic cigarettes (e-cigarettes, e-cig) users was 1.19 (95% confidence interval 1.09 to 1.30; heterogeneity score 0%). Longitudinal studies showed globally a growing prevalence of electronic cigarettes use, mainly in adolescents. A negative relationship between consumption and price increase of electronic and combustible cigarettes was found. Conclusion. The chance of quitting smoking combustible cigarettes among current electronic nicotine delivery systems users was increased with respect to never- or pastelectronic nicotine delivery systems users. Economic studies reported that electronic cigarette is partially substitutable for combustible cigarettes. [ABSTRACT FROM AUTHOR]

Objectives: Abdominal obesity (AO) has become a public health issue due to its impact on health, society and the economy. The relationship between socioeconomic disparities and the prevalence of AO has yet to be studied in Peru. Thus, our aim was to analyze the socioeconomic inequalities in AO distribution defined using the International Diabetes Federation (IDF) cut-off points in Peruvian adults in 2018–2019. Methods: This was a cross-sectional study using data from the 2018–2019 Demographic and Family Health Survey (ENDES) of Peru. We analyzed a representative sample of 62,138 adults over 18 years of age of both sexes from urban and rural areas. Subjects were grouped into quintiles of the wealth to calculate a concentration curve and the Erreygers Concentration Index (ECI) in order to measure the inequality of AO distribution. Finally, we performed a decomposition analysis to evaluate the major determinants of inequalities. Results: The prevalence of AO among Peruvian adults was 73.8%, being higher among women than men (85.1% and 61.1% respectively, p < 0.001). Socioeconomic inequality in AO was more prominent among men (ECI = 0.342, standard error (SE) = 0.0065 vs. ECI = 0.082, SE = 0.0043). The factors that contributed most to inequality in the prevalence of AO for both sexes were having the highest wealth index (men 37.2%, women 45.6%, p < 0.001), a higher education (men 34.4%, women 41.4%, p < 0.001) and living in an urban setting (men 22.0%, women 57.5%, p < 0.001). Conclusions: In Peru the wealthy concentrate a greater percentage of AO. The inequality gap is greater among men, although AO is more prevalent among women. The variables that most contributed to inequality were the wealth index, educational level and area of residence. There is a need for effective individual and community interventions to reduce these inequalities. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is caused by severe acute respiratory syndrome coronavirus 2, a new and different coronavirus. Since almost every continent in the world has been affected, the global actions have been focused on prevention, detection, and patient monitoring with no specific treatment until now. Classical and historical interventions have remerged as options including convalescent plasma. The use of convalescent plasma has become more important during large-scale epidemics, such as Mid-East respiratory syndrome-CoV and influenza pneumonia, data regarding support its clinical use. Unfortunately, published clinical data on the usefulness of convalescent plasma in patients with COVID-19 are scarce, but it has shown good clinical outcomes. There are no reports of adverse events in clinical trials of patients receiving convalescent plasma treatment for COVID-19. Nevertheless, FDA has issued its recommendations for the use of convalescent plasma as an option that may provide clinical effect for treatment during the public health emergency caused by COVID-19, with recommendations to avoid adverse effects in centers developing clinical trials with coronavirus convalescent plasma. [ABSTRACT FROM AUTHOR]

Globally, the question of how to improve the living standards of the inhabitants of informal settlements is a key political concern. These neighborhoods are characterized by economic vulnerability, social marginalization, and inaccessibility of basic services. The aim of this study is to provide evidence about the environmental risk factors faced by these populations in Argentina, and to identify whether their greater exposure to risk factors is associated with greater accessibility of healthcare services. We analyzed an original database that provides information about basic characteristics of the neighborhood, environmental risk factors (proximity to garbage dumps, industrial waste, and high-voltage towers), and accessibility of basic healthcare services on over 2000 informal settlements in Argentina. We calculated descriptive statistics and developed multivariate econometric models to estimate the probability of accessibility of healthcare services. On average, 31% of informal settlements were close to a garbage dump, 19% were close to a high-voltage tower, and 10% were close to industrial waste. In addition, 39% of these neighborhoods do not have a healthcare center nearby, 65% do not have an accessible hospital, and 39% are not consistently served by ambulances in the event of an emergency. The econometric estimates suggest that the accessibility of hospital healthcare service and to an ambulance service is positively associated with the age of the neighborhood, and whether the neighborhood is a slum, but there is no evidence of association with the exposure to environmental risk factors. In short, the populations living in informal settlements in Argentina are exposed to harmful environmental risk factors. Access to basic healthcare services is limited and does not reflect the elevated exposure to environmental risks. Health, environmental, and economic dimensions should be considered when designing and implementing public policies for vulnerable populations. • People in informal settlements are often exposed to environmental risk factors. • Yet, in these neighborhoods, access to basic healthcare services is limited. • More services are needed to respond to disproportionate exposure and advance equity. [ABSTRACT FROM AUTHOR]