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Background and aims

In Sweden, up to 7% of people exhibit harmful alcohol use or dependency, but only a small fraction (10–20%) pursue treatment. While Behavioral Self-Control Training (BSCT) and Motivational Enhancement Therapy (MET) are effective for alcohol use disorders (AUD), their cost-effectiveness has not been studied. This research evaluates the cost-effectiveness of BSCT and MET in treating AUD, focusing on achieving controlled drinking from both a healthcare and limited societal perspective.

Design, setting, and participants

A Markov model was created to compare the cost-effectiveness of BSCT and MET for treatment-seeking individuals with AUD. This model simulated a sample of patients with AUD over five years, calculating the costs and outcomes for both treatments. It used a cost-utility analysis to determine the cost per quality-adjusted life year (QALY). The model accounted for varying levels of alcohol intake and related health complications. Efficacy data came from a randomized trial, with complication risks, costs, utilities, and mortality rates drawn from existing literature.

Intervention and comparator

BSCT, consisting of five sessions, was compared to MET, constituted by four sessions.

Measurements

The primary outcome was cost per QALY. Probabilistic and univariate sensitivity analyses were performed to estimate how parameter uncertainty affected model outputs.

Findings

BSCT proved less costly than MET, yielding savings in healthcare costs by $50.52 and societal costs by $118.12 on average per person. Additionally, BSCT demonstrated an advantage in QALYs, with a gain of 0.060 QALYs per patient over MET. Sensitivity analyses confirmed the robustness of these results, indicating that BSCT is the cost-effective treatment option.

Conclusions

In comparison to MET, BSCT is less costly and more beneficial for health, indicating its potential as a valuable treatment option for individuals with AUD targeting controlled drinking. The model can be applied to assess the cost-effectiveness of various other AUD treatment interventions.

 Introduction:  The prevalence of overweight and obesity has increased in the last decades, posing significant health and economic impacts globally. These conditions are related to several non-communicable diseases, including cardiovascular disease, type II diabetes, and cancer. This study estimated the disease burden and healthcare costs associated with overweight and obesity in the adult population in mainland Portugal, in 2018.

 Method:  Burden of disease was measured in disability-adjusted life years (DALYs) following Global Burden of Disease (GBD) methodology. DALYs were calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). The analyses included morbidity, mortality, and related costs directly related to overweight and obesity, as well as the attributable morbidity, mortality, and related costs of 25 selected diseases related to obesity (DrO). A prevalence-based cost analysis was conducted a from the perspective of the public National Health Service, including costs related to inpatient, outpatient care, and pharmacological treatment.

 Results:  In 2018, total DALY amounted to 260,943, with 75% due to premature death (196,438 YLL) and 25% due to disability (64,505 YLD). The economic burden of overweight and obesity was estimated at approximately EUR 1,148 million. Of these, approximately EUR 13.3 million (1%) were costs related to the treatment of obesity, and the remaining were costs of DrO attributed to overweight and obesity. Outpatient care corresponded to 43% of total costs, pharmacological treatment 38%, and inpatient care 19%. Cardiovascular and cerebrovascular diseases were the largest contributor to total costs (38%), followed by type II diabetes (34%).

 Conclusion:  Overweight and obesity incur a large disease and economic burden to the public healthcare sector, representing approximately 0.6% of the country's gross domestic product and 5.8% of public health expenditures.

Introduction: Chronic kidney disease is the fastest-growing chronic disease in terms of prevalence and one of the biggest causes of global mortality according to the Global Burden of Disease Collaboration. This study aimed to project the natural disease progression of this disease in people with diabetes, and to quantify the costs and consequences in the Portuguese context. This was achieved by developing an analytical model reflecting the epidemiology of chronic kidney disease and integrating the various stages of disease progression. Methods: A population-based cohort Markov model was used, to follow an adult cohort of people with diabetes and chronic kidney disease as they progressed through different risk categories, in annual cycles, over a period of 50 years. The model considered the natural progression of chronic kidney disease through 18 risk categories based on the KDIGO classification system, as well as the probability of patients receiving renal replacement therapy, including dialysis and kidney transplantation, and the probability of death. Each stage is associated with an annual cost and a disability weight, so the model allowed survival, years lived with disability and lifetime costs to be estimated for the entire population with chronic kidney disease and for patients in different risk categories. Results: Over the cohort<acute accent>s lifetime, the model estimated, for the total population with chronic kidney disease and diabetes, an average survival of 8.62 years, with 0.59 years lived with disability, and an average cost of <euro>24 613. These figures correspond to a loss of more than 410 000 years lived with disability and a total lifetime cost of 17.0 billion euros. The progression of this disease was associated with lower survival, more years lived with disability and higher costs. Conclusion: The results of this study characterize the natural progression of chronic kidney disease in people with diabetes mellitus type 2, as well as the associated costs and consequences in the national context. Since diabetes mellitus type 2 is a risk factor for chronic kidney disease, it is expected that the real impact will be greater than estimated in the coming decades. Analysis by risk level shows that progression of the disease is associated with worse outcomes.

Background

Breast cancer is the most diagnosed cancer in women worldwide and carries a considerable psychosocial burden. Interventions based on Acceptance and Commitment Therapy (ACT) and compassion-based approaches show promise in improving adjustment and quality of life in people with cancer. The Mind programme is an integrative ACT and compassion-based intervention tailored for women with breast cancer, which aims to prepare women for survivorship by promoting psychological flexibility and self-compassion. A pilot study of the Mind programme has shown acceptability and preliminary efficacy in improving quality of life and psychological health. This paper presents the study protocol of two randomised controlled trials that aim to test the efficacy and cost-effectiveness of an optimised version of the Mind programme in women with breast cancer.

Methods

Participants will be women diagnosed with breast cancer randomly assigned to the Mind programme or a support group intervention (active control) in a 1:1 ratio for study 1, while study 2 includes one more arm (treatment as usual; inactive control) and a 2:2:1 ratio. Both interventions will be delivered weekly via an 8-session face-to-face or online group format. Data will be collected at baseline, post-treatment and 6-month follow-up. The efficacy and cost-effectiveness of the two interventions will be assessed. Treatment outcomes will comprise cancer-specific quality of life (primary outcome), anxiety and depressive symptoms, psychological flexibility, self-compassion, health-related quality of life, resource use, and intervention’s acceptability and feasibility. Study 1 will also include immunological and epigenetic markers associated with breast cancer prognosis and mental health. Outcome assessors will be blind to group allocation. Statistical analyses will be conducted using an intention-to-treat approach. Analyses of moderators and mediators of change will also be performed.

Discussion

These trials examine the efficacy and cost-effectiveness of an integrative ACT and compassion-based intervention tailored for women with breast cancer. Greater improvements in psychosocial, biological and resource use are expected in the Mind group, when compared to the control group(s). Results will likely support the potential benefits of the Mind programme for breast cancer patients and highlight the clinical relevance of integrative and holistic interventions in oncology.

Trials registration {2a, 2b}

ClinicalTrials.gov NCT05642897 and NCT06212414. Registered on December 8, 2022, and January 18, 2024.

Introduction. Premenstrual dysphoric disorder (PMDD) is a cyclic mood disorder affecting around 2%–5% of women of reproductive age. Pharmacological interventions exist, but many patients with PMDD experience residual symptoms, discontinue medications or refrain from them due to side effects. Thus, non-pharmacological treatments are needed as an alternative or additive treatment strategy. Evidence indicates that cognitive behavioural therapy (CBT) is a promising candidate. However, further research is required to establish its efficacy and identify ways to improve the treatment. Specifically, incorporating components targeting emotional and interpersonal dysregulation could theoretically enhance its effects. Furthermore, increasing the generally low accessibility of CBT for PMDD necessitates scalable and cost-effective ways to deliver treatment. The current study aims to evaluate the effects and cost-effectiveness of an internet-delivered CBT (ICBT) intervention for PMDD incorporating skills training in emotion regulation and interpersonal effectiveness.

Methods and analysis. The study is a parallel two-group randomised controlled trial with 1:1 allocation to 8 weeks of therapist-guided ICBT or a waitlist control condition. Following recruitment and inclusion, 164 individuals aged 18–45 years who fulfil the Diagnostic Manual of Mental Disorders-5 criteria for PMDD will be randomly assigned to the two groups. Primary outcomes are pretreatment to post-treatment group differences in premenstrual symptoms and their impact on everyday life, as well as psychological and functional impairment during the premenstrual phase. Secondary outcomes include treatment effects on quality of life and difficulties in emotion regulation. Long-term treatment effects will be assessed 6 and 12 months postintervention. Data will be analysed using latent Gaussian process modelling and linear mixed models. The economic evaluation will analyse individual-level societal costs and outcomes between trial arms. Recruitment is expected to begin in February 2025, with study completion anticipated by February 2028.

Ethics and dissemination. The study has been approved by the Swedish Ethical Review Authority (2023-00655-01). Results will be disseminated via presentations and publications in international journals and national outlets for clinicians and patients with PMDD.

Background/Objectives: Polygenic risk scores (PRSs) have been extensively studied and are increasingly applied in healthcare. One of the most studied and developed areas is predictive medicine for breast cancer, but there is no wider consensus on the indications for the clinical use of PRSs for breast cancer. This current guidance endeavours to articulate the scientific evidence underpinning the clinical utility of PRSs in stratifying breast cancer risk, with a particular emphasis on clinical application.

Methods: This guidance has been prepared by a group of experts who have been active in breast cancer PRS research and development, combining a review of the evidence base with expert opinion for indications for clinical use.

Results: Based on data from various studies and existing breast cancer prevention and screening services, the indications for clinical use of breast cancer PRSs can be divided into the following scenarios: (1) Management of cancer-free women with a family history of cancer; (2) individual personalised breast cancer prevention and screening in healthcare services; and (3) breast cancer screening programs for more personalised screening.

Conclusions: The integration of PRSs into clinical practice enables healthcare providers to deliver more accurate risk assessments, personalised prevention strategies, and optimised screening programmes, thereby improving patient outcomes and enhancing the effectiveness of breast cancer care. PRS testing represents a novel component in clinical breast cancer risk assessment, supporting a personalised, risk-based approach to breast cancer prevention and screening.

Introduction Microsimulation models are computer-based models, which can be employed to simulate the behaviour of microagents, such as children and adolescents, to understand the potential behavioural and economic effects of health interventions or policies. As a result, these models can be useful tools to help guide decision-making. A comprehensive review of the literature on child and adolescent microsimulation models has yet to be undertaken. Moreover, an evaluation of the quality of the existing models can be useful to understand their strengths and limitations and thus inform the development of future models. The aim of this scoping review will be to retrieve, synthesise and critically appraise the literature on existing microsimulation models focused on child and adolescent health.Methods and analysis We will conduct a scoping review using established methods. We will search PubMed (until 23 September 2024), Embase (until 18 September 2024), CINAHL (until 9 September 2024), PsyclNFO (11 September 2024), EconLit (until 9 September 2024) and Scopus (until 10 September 2024), with an update closer to the time of manuscript submission. We will also undertake snowballing, Google searches and searches on specific journal (eg, International Journal of Microsimulation) and websites (eg, https://www.microsimulation.ac.uk/) to complement database searches. We will extract relevant data on all studies retrieved and use the Quality Assessment Reporting for Microsimulation Models checklist to assess the reporting quality of each model. We will use a narrative synthesis with summary tables to describe our findings. Findings will be synthesised by type of health condition, if/where possible.Ethics and dissemination Given that primary data will not be collected in this study, research ethics approval is not required. We will present our findings at relevant conferences and publish our results in an appropriate peer-reviewed academic journal. In addition, we will use this information to guide the development of a microsimulation model on child and adolescent health for use in the Swedish context.Registration details https://osf.io/a8txn/

Problem

The identification of midwifery theories will contribute to the identification of a midwifery model of care for women experiencing low-risk pregnancies, and to support its implementation in Portugal.

Background

Previous research has explored the concept of woman-centredness as the core principle underpinning midwifery practice, mapped existing midwifery models of care, synthesized multiple theories and the scope of midwifery to achieve conceptual integration, and identified the aspects of midwifery care that most significantly contribute to the quality of care for women and their babies. However, to the best of the authors’ knowledge, no other review has mapped the theories that underpin midwifery practice.

Aim

This study aims to map and summarise the theories that underpin midwifery practice.

Methods

The JBI methodology for scoping reviews was used to conduct this review.

Findings

A total of 16 documents were included in this review. Sixteen theories were identified and the differences between them vary in both underpinning philosophical ideas and the methodology used to develop them.

Discussion

The four concepts of the nursing-midwifery metaparadigm were identified in all documents and a fifth concept, midwife's self-knowledge, should be included in the characterisation of a midwifery theory, once it has a strong presence in all four concepts, underpinning them.

Conclusion

This scoping review identified the theories underpinning midwifery practice. The compilation of these theories can be used to strengthen the scientific area and profession: development of theoretical knowledge as professional autonomy and power, internal control for the profession, guidance to professional practice, practice standardization, inter and intra-professional communication, and outcomes assessment and improvement.

BackgroundYoung children with subclinical neurodevelopmental disorders (NDDs) and concurrent emotional and behavioral problems (EBP) are at significant risk of negative short- and long-term outcomes. Although early parenting support interventions are recommended and requested, there is a lack of interventions specifically designed for this group and adapted to the Swedish context. Based on this gap, a parenting support intervention for parents with children aged 2-6 years with subclinical NDDs and EBP has been co-created with clinicians and parents. The project described in this study protocol aims to evaluate the effectiveness and cost-effectiveness of this new group-based parenting intervention.MethodsThe project uses a multiple-baseline single-case experimental design (SCED) with pre-post measures and a 3-month follow-up. The intervention is provided to families with children who are referred to child health psychologists at the child pediatric outpatient clinic in Uppsala Region, Sweden. Outcomes will include child EBP and parent self-efficacy, stress, well-being, and quality of life, as well as costs for the intervention, health care use, and QALYs.DiscussionThe project could lead to improved mental health in both children and parents through participation in the group-based parenting intervention. The study design, with longitudinal data from both children and/or their parents, will provide valuable insights into the trajectories of mental health and well-being within this group. In addition, the inclusion of young children as informants will provide important information about their experiences. Furthermore, the use of pre-, post- and follow-up questionnaires will allow reliable and clinically significant changes to be assessed and our findings to be compared with randomized trials in similar populations. The results of this project will be relevant to children with subclinical NDDs and their parents, as well as to health care organizations and the scientific community. The intervention is well adapted to the end users and the clinical context, as it has been co-created with clinicians and parents.Trial registrationISRCTN10835479 https://doi.org/10.1186/ISRCTN10835479, date of registration 2024-10-08.

To understand patient and public involvement (PPI) and its potential impact in the healthcare services more comprehensively, the social science literature on public participation in governing public services must be integrated with the health science literature. To facilitate planning and evaluation of PPI-activities, the aim of this article is to review conceptual discussions of involvement/participation and impact, and summarize and integrate these in a way that advances the conceptual understanding of impact of PPI in healthcare services. Based on the review, we present a conceptual integration chart of impact areas, categories and types. There are three overarching areas: (i) impact on individuals; (ii) impact on the health system; and (iii) impact on decision-making processes and society. The overarching areas contain the categories: (i) citizens, patients, and decision-makers; (ii) service provision, and public health; and (iii) decision-making, policy and state, and public and society. Under these categories, the most commonly encountered impact types are presented.