Impacts of bariatric surgery in health outcomes and health care costs in Brazil: Interrupted time series analysis of multi-panel data

Background The increasing burden of obesity generates significant socioeconomic impacts for individuals, populations, and national health systems worldwide. The literature on impacts and cost-effectiveness of obesity-related interventions for prevention and treatment of moderate to severe obesity indicate that bariatric surgery presents high costs associated with high effectiveness in improving health status referring to certain outcomes; however, there is a lack of robust evidence at an individual-level estimation of its impacts on multiple health outcomes related to obesity comorbidities. Methods The study encompasses a single-centre retrospective longitudinal analysis of patient-level data using micro-costing technique to estimate direct health care costs with cost-effectiveness for multiple health outcomes pre-and post-bariatric surgery. Data from 114 patients who had bariatric surgery at the Hospital of Clinics of the University of Sao Paulo during 2018 were investigated through interrupted time-series analysis with generalised estimating equations and marginal effects, including information on patients' characteristics, lifestyle, anthropometric measures, hemodynamic measures, biochemical exams, and utilisation of health care resources during screening (180 days before) and follow-up (180 days after) of bariatric surgery. Results The preliminary statistical analysis showed that health outcomes presented improvement, except cholesterol and VLDL, and overall direct health care costs increased after the intervention. However, interrupted time series analysis showed that the rise in health care costs is attributable to the high cost of bariatric surgery, followed by a statistically significant decrease in post-intervention health care costs. Changes in health outcomes were also statistically significant in general, except in cholesterol and LDL, leading to significant improvements in patients' health status after the intervention. Conclusions Trends multiple health outcomes showed statistically significant improvements in patients' health status post-intervention compared to trends pre-intervention, resulting in reduced direct health care costs and the burden of obesity.

Setting up a drug treatment service in a COVID-protect hotel in inner London

At the start of the UK's COVID-19 lockdown, the government announced an ‘Everyone In’ strategy to get homeless people off the streets and into accommodation. An Inner London borough opened a hotel to house up to 100 homeless people to address their health needs. Local healthcare providers were asked to provide in-reach services. This article describes the setting up and delivery of a drug treatment service to provide substitute opioid therapy. Thirty-five people were taken into drug treatment in the hotel between April and December 2020. During this time various challenges had to be addressed including same-day prescribing, delivering and supervising controlled drugs and responding to drug dealing in the hotel. Partnership work between the different healthcare providers was essential for the success of this project and offers a model that could be used going forward to deliver comprehensive wrap-around services to hard-to-engage individuals with multiple health needs.

Effect of Trachyspermum ammi essential oil, fractions and its derivatives on resistant fungal Strains

Persistentantimicrobial drugs treatmenthas resulted in antimicrobial resistance in fungi. There is always a gap for newer antifungal agent. As fungi are associated with multiple health risks in humans and many diseases in crops as well.Objective: To find alternate natural antimicrobial agent as compared to the synthetic one. Method:Essential oil of Trachyspermumammi was isolated, fractionated, and subjected to GC-MS analysis. Components from fractions were derivatized to check their antimicrobial potential against fungal resistant strains. Results:Analysis showed γ -terpinene (39%), α-phellandrene (1.3%), α-pinene (0.5%), Sabinene (0.15%), β-pinene (4.40%), β-myrcene (1.14%), O-cymene (15.78%), p-cymefne (38.78%), and other components were less than 1%. Fractional components were derivatised and their antifungal action was studied. Conclusion: Ajwain oil components found to be good against resistant fungal strains. While some derivatives showed more and some less antimicrobial action.

Implementing Coordinated Care Networks: The Interplay of Individual and Distributed Leadership Practices

How does leadership emerge and function when multiple health care organizations come together to form a network? In this qualitative comparative case study, we draw on distributed leadership theory to examine the leadership practices that manifested during the implementation of three coordinated care networks. Thirty leaders and care providers participated in semistructured interviews. Interview data were inductively analyzed using thematic analysis. Although established in response to the same policy initiative, each case differed in its leadership approach and implementation strategy. We found that manifestation of distributed leadership was contingent on the presence of an individual leader who acted as a unifying force across their respective network. Our findings suggest that policies to encourage the development of interorganizational networks should include sufficient resources to support an individual leader who enables distributed leadership.

Metabolites Produced by Fungi against Fungal Phytopathogens: Review, Implementation and Perspectives

Many fungi, especially endophytes, have been found to produce multiple benefits in their plant hosts, with many of these benefits associated with the protection of plants against fungal diseases. This fact could be used in the development of new bio-products that could gradually reduce the need for chemical fungicides, which have been associated with multiple health and environmental problems. However, the utilization of the living organism may present several issues, such as an inconsistency in the results obtained and more complicated management and application, as fungal species are highly influenced by environmental conditions, the type of relationship with the plant host and interaction with other microorganisms. These issues could be addressed by using the bioactive compounds produced by the fungus, in cases where they were responsible for positive effects, instead of the living organism. Multiple bioactive compounds produced by fungal species, especially endophytes, with antifungal properties have been previously reported in the literature. However, despite the large amount of these metabolites and their potential, extensive in-field application on a large scale has not yet been implemented. In the present review, the main aspects explaining this limited implementation are analyzed, and the present and future perspectives for its development are discussed.

Influence of Perceived Stress and Stress Coping Adequacy on Multiple Health-Related Lifestyle Behaviors

Stress is a primary target of national health promotion efforts such as Healthy Japan in the 21st century (HJ21). However, little is known about how the combination of perceived stress and coping adequacy influence health-related lifestyle behaviors in line with national health promotion. This study assessed the association between combined perceived stress and coping adequacy and multiple health-related lifestyle behaviors in HJ21 practices. This cross-sectional survey that included specialists in health management comprehensively assessed multiple health-related lifestyle behaviors in accordance with HJ21. Total health-related lifestyle behavior scores were calculated and perceived stress and coping adequacy were recorded and categorized into four groups with group 1 to 4 being high to none, and highly adequate to not at all, respectively. The average total lifestyle behavior scores (standard deviation [SD]) were 35.1 (3.5), 33.7 (3.6), 31.8 (3.8), and 30.5 (4.9) for groups 1 to 4 of coping adequacy (p < 0.001). Further, individuals who had higher stress coping adequacy had better multiple health-related lifestyle behaviors after adjusting for demographic factors and perceived stress in the linear trend among the groups. Stress coping skills might be an essential target for stress reduction, ultimately leading to health promotion for disease prevention and longevity.

Collective Perceptions of Aging and Older Persons Held by Students From Eight Healthcare Professions

In order to increase the number of students entering the geriatric workforce, an understanding of factors influencing career preference and what may prevent students from pursuing geriatric careers is necessary. Using a convergent parallel mixed methods approach, the aim of this study was to provide insight for geriatric educators regarding the collective perceptions of aging and older persons held by 864 students from eight healthcare professions. Quantitative questions assessed students’ attitudes (Geriatric Attitudes Scale). Student responses to four open-ended questions were assessed using conventional content analysis. Results included rich narrative examples of healthcare professions students’ perceptions and understanding of the aging process, as well as myths and misconceptions of aging and older persons that can be used to inform geriatric curricula across multiple health professions training and education programs. Geriatric education is a critical avenue to correct misperceptions, quell ageism and address the current shortage in the geriatrician workforce.

A Scalable Solution to Detect Behavior Changes of Elderly People Living Alone

As the world population is ageing rapidly and old age comes with multiple health issues, the need for medical services is likely to increase in a couple of decades beyond the limits of the medical systems of almost any country. In response to this trend, a variety of technologies have been developed with the aim of helping older people live independently as long as possible and reduce the burden on caregivers. In this paper, we propose a solution to encode the information about the activity of the monitored person, captured by a set of binary sensors, in the form of activity maps that reflect not only the intensity, but also the spatial distribution of the activity between a set of behaviorally meaningful places. Then, we propose a method for automatic analysis of the activity maps in order to detect deviations from the previously recorded routine. We have tested the method on two public activity recognition datasets and found that the proposed solution is not only feasible, but also has several important advantages (it is low cost, scalable, adaptable, requires little expert knowledge for setup and protects the privacy of the monitored persons) that make it applicable on a large scale, including for people with low socio-economic status.

Neutralizing Aminesin Boiler Steam and Humidified Indoor Air

Objective: The health and comfort of the indoor population have been impacted by the humidity. While people are increasingly spending more time indoors, the presence of pollutants and lack of proper humidification in indoor air have significant risk factors that may lead to multiple health problems. Methods: By applying the right air purification and/or humidification system, the adverse effects of poor indoor air quality can be minimized. Direct steam addition is a common technique to humidify the indoor air of a building. Carbon dioxide or other acidic process contaminants may dissolve in steam or steam condensate that will consequently decrease the pH and make it corrosive for the steam distribution system. To avoid that, neutralizing amines are added to steam that keeps the pH neutral or slightly alkaline(pH 7.5-9.0). However, neutralizing amines have some toxic effects. OSHA, FDA, and NIOSH prescribe maximum concentration limits for them in indoor air. The Central Utility Plant (CUP) of National Institutes of Health (NIH) uses a 50:50 blend of cyclohexylamine and diethylaminoethanol as neutralizing agents for the steam. Results: The CUP at NIH presents the results of monitoring the concentration level of amines through mass balance, online monitoring at specified location of the steam distribution system and field measurement in humidified indoor air at buildings on campus. Conclusion Through theoretical calculation backed up by field measurement, the amine concentration of indoor air is determined to be well below the FDA regulated limits.