Background:Opioid agonist therapy (OAT) is an essential treatment for opioid dependency. However, OAT may lead to endocrinopathy, which may impair the tolerability of treatment. Although the risk of disturbed regulation of the adrenal and gonadal axes has been extensively studied, less is known about how long-term opioid use and corresponding risk factors influence the thyroid axis. The objective of this study was to investigate associations between biomarkers of thyroid function and OAT medication as well as sociodemographic and clinical factors and concurrent use of illicit substances among patients receiving OAT. Methods:We used prospective data from 320 people receiving OAT in Bergen, Norway, from 2016 through 2023. All had 2 health assessments, including serum measurements of TSH. Descriptive statistics and a linear mixed model with coefficient and 95% CIs were performed to investigate the association between serum TSH (measured in mIU/L) and OAT medication as well as age, sex, substance use patterns, injecting use, housing status, and educational attainment at first assessment and over time. Results:Median serum TSH at first assessment in the study population was 1.8 mIU/L (interquartile range: 1.2). No association between OAT medications, sociodemographic, or clinical factors and serum TSH was found at first assessment and over time. Conclusion:The median serum TSH was within the recommended range among people receiving OAT. No association between OAT treatment and thyroid insufficiency was found. This indicates that screening for thyroid function beyond symptomatic assessment is probably not needed among patients receiving OAT.

Introduction Kangaroo mother care (KMC) is a proven, low-cost intervention to reduce neonatal mortality, yet its coverage remains limited in most low- and middle-income countries (LMICs), including India. In this study, we examined the impact of scaling up KMC in India on distribution of health and financial outcomes using an extended cost-effectiveness analysis (ECEA) framework. Methods Building on primary data from a randomised controlled trial (RCT), we modelled the health and financial outcomes of scaling up KMC to 95% coverage nationally. We estimated lives saved, disability-adjusted life-years (DALYs) averted, out-of-pocket expenditure (OOPE) averted and cases of catastrophic healthcare expenditure prevented. Estimates were disaggregated by socioeconomic quintiles and geography. We used deterministic and probabilistic sensitivity analyses to assess the robustness of our findings. Results Scaling up KMC in India could save around 26 000 neonatal lives annually, avert approximately 1.6 million DALYs, reduce OOPE by around US$13 million and prevent an estimated 57 000 households from experiencing catastrophic health expenditures. Three-fourths of the benefits would be concentrated in the lowest two socioeconomic quintiles. Six high-burden states, including Uttar Pradesh, Bihar and Madhya Pradesh, accounted for 90% of the health and financial gains. The incremental cost-effectiveness ratio ranged from 0.08 to 0.17 times gross domestic product per capita for India across different quintiles. Probabilistic sensitivity analysis showed scaling up KMC would be cost-effective in 97.8% of simulations. Conclusion Our findings suggest that scaling up KMC is cost-effective and can reduce health inequities, particularly benefiting the lowest socioeconomic groups and high-burden states. Incorporating geographical disaggregation and using primary RCT data into ECEA enhance its utility for informing evidence-based, equity-focused health policies in LMICs.

Abstract Non-communicable diseases (NCDs) are a growing public health challenge, particularly in low- and middle-income countries (LMICs), where weak health systems limit access to effective care. Achieving Universal Health Coverage (UHC) requires health facilities that are equipped and ready to deliver NCD services. However, evidence on the readiness of health facilities to provide these services in various contexts is limited. This study contributes to filling this gap by assessing the availability and readiness of health facilities to provide essential NCD services in the context of Zanzibar. We employed a facility cross-sectional survey and collected data across all 52 public and parastatal health facilities in Zanzibar using an adapted WHO Service Availability and Readiness Assessment (SARA) tool, incorporating elements from the Pen Plus survey and the Access Bottlenecks, Costs, and Equity (ABCE) survey tools. We generated readiness scores across various strata and used multiple regression analysis to examine factors associated with readiness. Readiness was assessed in terms of availability of trained workforce, essential medicines, diagnostic capacity, financial risk protection mechanisms, and patient registration and follow-up systems. We found an average readiness score of 54% across all facilities, with primary health care centers having the lowest readiness score (29%) compared to the referral hospital (73%). Readiness was particularly low in diagnostic and treatment services (40%), financing and payment mechanisms (31%), and essential medicines (53%), but comparatively higher in healthcare workforce (73%) and infrastructure readiness (69%). Lower-level facilities were associated with lower readiness scores after adjusting for key confounders in the multiple regression analysis. Availability of both inpatient and outpatient care was associated with significantly higher readiness (β = 10.50, p = 0.029). Primary health care facilities remain underprepared to deliver essential NCD services and overall readiness scores mask substantial variation by service type and facility. Strengthening service readiness will require targeted investments in workforce training, diagnostic capacity, supply chain systems, and financial protection measures to advance equitable NCD care as part of UHC efforts.

Context:Low testosterone levels are often considered an adverse effect of chronic opioid use. However, the prevalence of low testosterone levels and the association between testosterone levels and clinical symptoms among males receiving opioid agonist therapy (OAT) remain unclear. Objective:To biochemically investigate the prevalence of low testosterone levels (free testosterone ≤0.22 nmol/L) and the association between free testosterone levels and symptoms of fatigue, measured using the 3-item Fatigue Severity scale, and psychological distress, measured using the 10-item Hopkins Symptoms Checklist. Design and Setting:Prospective cohort study based on data collected between May 2017 and May 2024 from males receiving OAT recruited from OAT clinics at Haukeland University Hospital, Bergen, Norway. Participants:295 males aged 23 to 71 years, with a mean OAT duration of 8 years. Results:A total of 236 (80%) of participants had low testosterone levels at baseline, and 108/148 (73%) had low testosterone levels in 2 consecutive measurements. No association was found between free testosterone and fatigue (baseline: coefficient: -1.0, 95% confidence interval: -6.4; 4.5, Δscore/year: 0.8, -5.2; 6.8) or between free testosterone and psychological distress (baseline: 0.4, -0.3; 1.0, Δscore/year: -0.1, -0.3; 0.2). Conclusion:Eighty percent of males receiving OAT had low testosterone levels. However, testosterone levels were not associated with symptoms of fatigue or psychological distress. These findings should be interpreted with caution due to suboptimal power and potential influence of confounding. Further research is warranted to clarify the clinical significance of biochemical threshold values for low testosterone levels and their relationship to specific clinical symptoms in the OAT population.

Background The high cost of care is a major barrier to access and, in extreme cases, can push families into poverty. Protection from financial hardship due to care seeking is fundamental to universal health coverage. We aim to generate high-quality evidence on care-seeking patterns and associated costs at the household and individual levels to quantify the financial risk from healthcare seeking in India. Method We established a cohort of 3,000 households in Haryana, India. We followed them on a monthly basis and collected data on care seeking and associated costs for all members of the household. Data on household consumption for different food and nonfood items were collected at baseline, at 6 months, and during the endline survey. A short recall period of 1 month was used to capture data for the utilization of preventive, promotive and curative healthcare services. Results We enrolled 15,390 individuals from 3,000 households with a mean household size of five. Most households owned their homes (95.9%) and belonged to marginalized communities, including Scheduled Castes (40.3%) and Other Backward Classes (26.4%). Approximately two-thirds held below poverty line (BPL) cards, and one-third were covered by health insurance. While 82.9% of individuals were literate, only 37.4% of those aged > 14 years were employed, among whom the majority were in private jobs (53.6%). The average monthly consumption expenditure was ₹ 26031; 310.7 USD. Most care-seeking was for communicable and maternal/neonatal diseases (62.2%), with 72.9% relying on informal care sources. Among those who sought care, expenses associated with inpatient care averaged ₹ 13,354.7,159.4 USD (105 individuals), higher than those associated with outpatient (₹ 4882.4; 58.3 USD; 1087 individuals) and informal care (₹ 829.3; 9.9 USD; 4571 individuals). Conclusion We have established a prospective cohort to generate robust, context-specific evidence on out-of-pocket health expenditures, care-seeking patterns, and associated costs in India. Our cohort is comparable to national-level surveys for key parameters such as age and sex distribution. Here, we describe the study design, plan of analysis and baseline characteristics of the enrolled cohort at the household and individual levels.

BACKGROUND:There is a dearth of comprehensive research on the financial burden of cancer in low-resource settings. This study aims to identify factors associated with annual cost of cancer care and catastrophic health expenditure as well as estimate the impoverishment linked with cancer treatment in Nepal. METHODS:This cross-sectional study was conducted in two tertiary public cancer hospitals of Nepal. Face-to-face interviews were conducted with 387 patients undergoing active treatment for lung, breast, cervical, stomach, and oesophagus cancers, recruited using a purposive-consecutive sampling strategy. A generalized linear model was used to identify factors associated with annual cost, while a multivariable logistic regression model was used for catastrophic health expenditure. Pen's Parade diagram was plotted to estimate impoverishment linked to cancer. RESULTS:The annual average cost of cancer care was 3,687 United States Dollar (479,310 Nepalese rupees). Factors significantly associated with higher annual cancer costs included secondary and above education, treatment duration of 6-12 months and above one-year, combined treatment modalities, admission to inpatient care, and prior visits to private health facilities. Cervical cancer (compared to lung cancer) was significantly associated with lower costs. The incidence of catastrophic health expenditure was 96.9% and 83.9% at the 10% and 25% threshold of annual household expenditure, respectively. Treatment duration of 6-12 months, admission to inpatient care, and lowest to higher wealth quintiles were associated with higher odds of catastrophic health expenditure compared to treatment duration of less than six months, no admission to inpatient care, and highest wealth quintiles, respectively. Similarly, 26% of the patients experienced impoverishment associated with cancer treatment expenses. CONCLUSION:Seeking cancer treatment posed a substantial financial risk to patients in Nepal. Most of the patients experienced catastrophic health expenditure while a quarter of the patients experienced impoverishment following cancer treatment expenses, highlighting the need for strengthened social health protection mechanisms.

Abstract Background There is a lack of knowledge on effective treatment methods for comorbid benzodiazepine dependence in populations undergoing opioid agonist treatment (OAT). Tapering and discontinuation of benzodiazepines has long been considered the standard treatment, even though there is limited evidence for this practice. There is also limited research on benzodiazepine agonist treatment; however, peer and clinical experiences indicate that such approaches may be beneficial for a subgroup of the patients with long-lasting benzodiazepine dependence not responding to other treatment approaches. A randomized controlled trial will be conducted to compare the efficacy and safety of stabilizing agonist treatment using prescribed benzodiazepines with standard treatment in reducing illicit benzodiazepine use. Methods The target sample is 108 participants at outpatient OAT clinics in six Norwegian cities/counties (Bergen/Vestland, Tønsberg/Vestfold, Skien/Telemark, Fredrikstad/Østfold, Tromsø/Troms, and Lillestrøm/Akershus). The main inclusion criteria are benzodiazepine dependence of ≥ 5 years, using ≥ 5 days a week during the last month, and previous attempts at tapering. Participants will be randomly assigned to receive either a 26-week benzodiazepine stabilizing treatment (15–30 mg diazepam or 50–100 mg oxazepam daily), or a 20-week tapering using the same medications and equivalent initial dosages. All participants will be given access to consultations from OAT therapists with psychosocial follow-up in accordance with current clinical practice. The primary outcome is the use of illicit benzodiazepines assessed by observed urinary tests at week 24. Secondary outcomes include mental health symptoms, quality of life, cognitive performance, violence risk, other substance use, treatment retention, and life satisfaction. Additionally, the study will assess treatment-related adverse events as well as the cost-effectiveness of the intervention. Discussion This is the first randomized controlled trial of benzodiazepine agonist treatment for benzodiazepine dependence. The research project will assess efficacy and safety of stabilizing treatment with prescribed benzodiazepines compared to benzodiazepine tapering and discontinuation regarding use of illicit benzodiazepines and accordingly well-being of patients with concurrent benzodiazepine and opioid dependence undergoing OAT. If the intervention is found to be efficacious and safe, it will be considered one of the options to standard treatment for this patient group. Trial registration EU trial number: EudraCT: 2021–004981-37. Registered on December 13, 2021.

The level of happiness is low among patients with chronic mental or physical disorders. However, happiness and its association to sociodemographic and clinical factors remain unknown among patients with opioid use disorder (OUD) and people who inject drugs (PWID). This prospective cohort study aimed to examine self-reported happiness levels in patients with OUD/PWID, changes over time, and its associations with sociodemographic factors, opioid agonist therapy (OAT), and substance use. From 2017 to 2023, 967 patients with OUD/PWID were examined at baseline and one-year follow-up assessments in eight OAT outpatient and municipality clinics in Norway. Happiness was assessed with an eleven-point Likert scale and presented as percentage (from 0% “completely unhappy” to 100% “completely happy”). A linear mixed model analysed associations between exposures and outcomes at baseline and over time. Participants were predominantly men (71%), with a mean age of 43 (SD: 11); 87% received OAT. Mean happiness was 45% of min-to-max (95% CI: 35;54) with an 11% improvement over time. High substance use (-24%, 95% CI: -32; -16) was associated with lower self-reported happiness at baseline, but self-reported happiness increased over time among those with more substance use. Living with someone was linked to higher happiness compared to living alone.

Background: Dietary guidelines play a key role in promoting health and preventing chronic diseases. The Nordic Nutrition Recommendations (NNR) 2023 provide updated recommendations for healthy eating relevant for the Nordic and Baltic countries, but the potential benefits have yet to be quantified. Objectives: This study aimed to project the population health benefits, specifically, potential gains in life expectancy in Nordic and Baltic countries resulting from long-term dietary changes from current dietary patterns within each country to NNR2023. Methods: For this population-based mathematical model, using the Food4HealthyLife 2.0 calculator, data were obtained from meta-analyses on associations between each food group and mortality, and background mortality data were derived from the Global Burden of Disease study. Standard life-table methods were used, accounting for the correlation between 14 food groups and the anticipated time delay between dietary changes and health effects. Results: For 40-y-old females and males, projected life expectancy gains were from 1.8 and 2.1 y in Finland to 3.4 and 4.1 y, respectively, in Lithuania, changing to feasible NNR2023. Correspondingly, when changing to full-potential NNR2023, gains ranged from 4.4 and 5.0 y in Finland to 6.1 and 7.3 y, respectively, in Lithuania. The largest gains in life expectancy were linked to consuming more legumes (18%), nuts (17%), whole grains (12%), and less processed meat (14%) and added sugars (13%). Conclusions: Adopting dietary patterns in line with the NNR2023 is associated with considerable gains in life expectancy in the Nordic and Baltic countries. The study contributes to the evidence base to support policy measures to achieve NNR2023.

BACKGROUND:We have previously shown that an integrated intervention package delivered during preconception, pregnancy and early childhood substantially reduces low birth weight and stunting at 24 months of age compared with routine care. Now we conduct a benefit-cost analysis to estimate the return on investment of this integrated approach in India. This increases the policy relevance of trial results, given the low investment in healthcare in India. METHODS:We used data from 13 500 participants in the Women and Infant Integrated Interventions for Growth Study (WINGS). Integrated delivery of healthcare, nutrition, water, sanitation and hygiene (WaSH), and psychosocial care interventions during preconception period, or pregnancy and early childhood, or both (full package), was compared with routine care. We converted reduction in mortality, morbidity and increase in productivity to monetary values and calculated the benefit-cost ratio. We used primary and secondary trial health outcomes from the WINGS trial to calculate benefits, and we collected costs prospectively during the trial. Uncertainty was explored in a one-way sensitivity analysis. We applied a discount rate of 3% per annum to both costs and benefits, considering the purchasing power parity (PPP) of US dollars in 2021. RESULTS:Every dollar invested returned 6.1$ PPP for interventions during preconception, 9.9$ PPP for pregnancy and early childhood interventions and 3.7$ PPP for the full package of interventions compared with routine care in the base case scenario. The return to investment was positive (>4.6$ PPP per 1$ PPP invested) for pregnancy and early childhood interventions in all scenarios of the sensitivity analysis. The net monetary benefits of the interventions ranged between 7364 and 25 917$ PPP. CONCLUSION:Our results suggest that integrated and concurrent delivery of healthcare, nutrition, WaSH and psychosocial care interventions during pregnancy and early childhood yield positive economic returns.

The financial burden of cancer care may significantly impair patients’ health-related quality of life (HRQoL), yet the extent and nature of this relationship remain underexplored, particularly in low-resource settings. This study aimed to report the HRQoL of patients currently receiving treatment for selected cancers (breast, cervical, lung, oesophageal and stomach) in Nepal. We further investigate the association of out-of-pocket expenditure (OOPE) with HRQoL. A cross-sectional survey was conducted from April to May 2024 among 353 patients undergoing cancer treatment in two tertiary cancer hospitals in Nepal. We used the European Quality of Life 5 dimensions (EQ-5D-5L) and the European Quality of Life Visual Analogue Scale (EQ-VAS) to obtain their HRQoL. Similarly, we collected sociodemographic and treatment-related data, including OOPE and patient satisfaction. We used the ordinary least squares estimation with robust standard errors to identify the association between OOPE and HRQoL (EQ-5D-5L index score). The mean (SD) EQ-5D-5L index score was 0.39 (0.42), and the mean (SD) EQ-VAS score was 56.65 (21.71). Anxiety/depression and pain/discomfort were the most common reported problems (> 90

INTRODUCTION:There is limited evidence on how to effectively treat individuals from marginalised populations with dependence on amphetamine and/or methamphetamine (collectively referred to hereafter as amphetamine dependence). The disease burden is extremely high in this population, especially related to psychiatric comorbidities, cardiovascular complications, injection-related infections and poor social functioning. ATLAS4Dependence is a multi-centre randomised, placebo-controlled, double-blind trial that will investigate the effectiveness and safety of substitution treatment with dextroamphetamine compared with placebo in people with amphetamine dependence. METHODS AND ANALYSIS:The trial will recruit 226 adult patients in several outpatient clinics in Norway. Inclusion criteria comprise individuals with amphetamine dependence, defined as use on three or more days per week during the past 28 days, who currently inject or have formerly injected drugs. This includes individuals both with and without comorbid opioid dependence, as well as those currently receiving or not receiving opioid agonist treatment. Participants will be randomly assigned 1:1 to receive either dextroamphetamine or placebo for 12 weeks. Flexible doses within the range of 30-120 mg daily will be provided based on individual assessments. The participants in both arms will be offered standard psychosocial and medical follow-up in accordance with current clinical practice. The endpoint assessments will be conducted at 12 weeks with weekly self-reports and safety assessments and a follow-up assessment at 52 weeks. The primary objective of the study is to assess the impact of 12 weeks daily prescribed oral dextroamphetamine versus placebo on the use of illicit amphetamines as well as on the total amount of amphetamines used (including both illicit and prescribed sources). Secondary outcomes are the differences between the groups at 12 weeks regarding psychological distress, symptoms of psychosis, quality of life, cardiovascular risk factors, injection-related infections, executive functioning, attention-deficit hyperactivity disorder-related symptoms, sleep, violence risk, fatigue, symptoms of craving and withdrawal, treatment retention, days of use of illicit amphetamines and use at 4 weeks and 8 weeks during the intervention period, use of other illicit substances and alcohol, as well as a cost-effectiveness analysis (using private economy, criminal activity and health service utilisation) and a qualitative approach to assess overall experiences with the study intervention. Analysis and reporting will follow the Consolidated Standards of Reporting Trials guidelines. All tests will be two-sided. Descriptive results and the estimated effectiveness will be presented with 95% CIs. The difference between the groups at the primary time point (at the end of the 12-week trial) will be assessed using χ2 test (for use of illicit amphetamines measured by monthly urine tests) and Analysis of Covariance (ANCOVA) (for weekly self-reported total amount of amphetamines). Analyses for the primary endpoint will be undertaken on an intention-to-treat basis and reported on as such, but sensitivity analyses with per protocol analyses will also be presented. ETHICS AND DISSEMINATION:The study is approved by European Medicines Agency, Clinical Trial Information System (CTIS). Written informed consent will be obtained from all patients. Study results will be published in international peer-reviewed medical journals. TRIAL REGISTRATION NUMBER:CTIS 2023-510404-44-00.

Health systems worldwide face challenges in managing resource scarcity, necessitating systematic and fair approaches to prioritize essential health services. Practical guidance on structuring transparent and inclusive priority setting processes remains limited. This paper presents a 10-step method for designing fair priority-setting processes, demonstrated through the revision of the Zanzibar Essential Health Care Package (2019-2022). The 10-step method provides pragmatic and context-specific guidance, bridging the gap between global frameworks and local implementation in resource-limited settings. These 10 steps build upon recognized and accepted conditions and principles for health priorities and include: (1) development of a roadmap, (2) establishment of management, (3) selection of criteria for priority setting, (4) identification of candidate interventions, (5) formulation of financing strategies, (6) evidence generation, (7) employment of analytics, (8) setting priorities, (9) implementation arrangement, and (10) monitoring and evaluation to track implementation. The core team guided each step based on three fundamental principles-stakeholder involvement, transparency, and structured deliberation. In Zanzibar, consensus-building workshops were held to determine the criteria for setting priorities: cost-effectiveness, budget impact, disease burden, and equity. Political/public acceptability emerged as an additional criterion due to the challenges associated with including abortion services. Financial risk protection was deemed significant but was instead incorporated into the implementation and health financing plans. The core team offered preliminary training sessions on health priorities to stakeholders. This structured 10-step method encourages participation and inclusivity of marginalized groups usually excluded from such discussions, trust, and legitimacy in Essential Health Care Package processes, thereby providing policymakers with a tool for improvement.

BACKGROUND:Detailed information on the efficiency of health services targeting opioid use disorder (OUD) and treatment with opioid agonist treatment (OAT) is sparse. Many countries, including Norway, are still falling short of universal health coverage (UHC) of OAT. This study aims to evaluate the incremental lifetime costs and effects of treating OUD with OAT as compared to no OAT in Norway and scaling up the treatment to a universal coverage level using equity-adjusted health economic evaluations. METHODS:We conducted cost-utility and budget impact analyses and constructed a two-state Markov model to compare the lifetime costs and outcomes among patients with OUD with and without OAT. Model inputs were derived from routine health information systems and the literature, with costs reported in 2023 Norwegian Kroner (NOK). The analyses were conducted from a Norwegian extended health-service and societal perspectives, with a lifetime time horizon. Quality-adjusted life years (QALYs) was the metric of health benefits. Outcomes were reported as incremental cost-effectiveness ratios (ICERs). The willingness-to-pay (WTP) threshold was equity-adjusted according to the future prognostic healthy life year loss method in Norway (severity of disease criterion), which is sensitive to the size of future undiscounted healthy life year loss due to the affected conditions. The WTP threshold is NOK 825,000 per QALY gained in Norwegian policy for conditions with undiscounted future QALY loss > 20. Uncertainty in the parameters and robustness of the results were assessed with one-way and probabilistic sensitivity analyses and scenario analyses. FINDINGS:The mean results from probabilistic sensitivity analysis estimated that OAT was associated with 3.03 additional discounted QALYs gain and incremental lifetime discounted cost of NOK 1.45 million, leading to an ICER of NOK 479,099 per QALY gained when compared with not providing OAT, with the extended health-service perspective. From a societal perspective, OAT was cost-saving, i.e. OAT produced greater health benefits while resulting in lower overall societal costs compared to no OAT. The mean undiscounted future health loss was estimated to be 21.34 QALYs for the Norwegian patient group with OUD. A total 5-year budget increase of NOK 1.208 billion was estimated if OAT was going to be scaled up from the current coverage level of 70% to UHC. Compared with the current coverage, 100% coverage of OAT was associated with an additional lifetime cost of NOK 4.332 billion but also an additional 6760 QALYs gained. CONCLUSION:Our analysis suggests that OAT is cost-effective in Norway and has the potential to be cost-saving from a societal perspective. Therefore, Norwegian policy should consider scaling up treatment to extend the coverage of OAT.

Background: Eating healthier is associated with a range of favorable health outcomes. Our previous model estimated the impact of dietary changes on life expectancy gains but did not consider height, weight, or physical activity. Objectives: We aimed to estimate the increase in life expectancy resulting from the transition from typical national dietary patterns to longevityoptimizing dietary changes, more feasible dietary modi fi cations, and optimized vegan dietary changes in China, France, Germany, Iran, Norway, the United Kingdom, and the United States. Methods: Our modeling study used data from meta -analyses presenting dose -response relationships between intake of 15 food groups and mortality. Background mortality data were from the Global Burden of Disease Study. We used national food intake data and adjusted for height, weight, and physical activity level. Results: For 40 -y -olds, estimated life expectancy gains ranged from 6.2 y (with uncertainty interval [UI]: 5.7, 7.5 y) for Chinese females to 9.7 y (UI: 8.1, 11.3 y) for United States males following sustained changes from typical country -speci fi c dietary patterns to longevity -optimized dietary changes, and from 5.2 y (UI: 4.0, 6.5 y) for Chinese females to 8.7 y (UI: 7.1, 10.3 y) for United States males following changes to optimized vegan dietary changes. Conclusions: A sustained change from country -speci fi c typical dietary pattern patterns to longevity -optimized dietary changes, more feasible dietary changes, or optimized vegan dietary changes are all projected to result in substantial life expectancy gains across ages and countries. These changes included more whole grains, legumes, and nuts and less red/processed meats and sugars and sugar -sweetened beverages. The largest gains from dietary changes would be in the United States.

PWID are at high risk of being unhappy. However, to which degree happiness in patients with SUD is linked to infection with HCV and its treatment is unknown. The present study investigated the effect of integrated compared to standard HCV treatment on happiness in this population. This multi-center, randomized controlled trial evaluated happiness as a secondary outcome of integrated HCV treatment. From May 2017 to June 2019, 276 participants in Bergen and Stavanger, Norway, were randomly assigned to receive integrated and standard HCV treatment. Integrated treatment was delivered in eight decentralized outpatient OAT clinics and two community care centers while standard treatment was delivered in outpatient clinics at referral hospitals, with 21% absolute difference in SVR. The level of happiness was assessed with an eleven-point Likert scale and presented as percentage (from 0% “completely unhappy” to 100% “completely happy”) . We applied a LMM to evaluate the impact of integrated HCV treatment on changes in happiness scores. At baseline, the mean happiness score for participants receiving integrated treatment was 49% (SD 26) and 52% (SD 25) for those on standard treatment. Twelve weeks after completed HCV treatment, the mean happiness score for participants receiving integrated treatment was 51% (SD 20) and 52% (SD 23) for those receiving standard treatment. Compared to the standard HCV treatment, the happiness score tends to increase from baseline to end of treatment in the integrated HCV treatment groups, but not significantly. Further research is needed to improve the subjective experience in happiness in this population. Trial registration ClinicalTrials.gov.no NCT03155906, 16/05/2017.

BackgroundNearly 100 million people are pushed into poverty every year due to catastrophic health expenditures (CHE). We evaluated the impact of cash support programs on healthcare utilization and CHE among households participating in a cluster-randomized controlled trial focusing on adolescent childbearing in rural Zambia.Methods and findingsThe trial recruited adolescent girls from 157 rural schools in 12 districts enrolled in grade 7 in 2016 and consisted of control, economic support, and economic support plus community dialogue arms. Economic support included 3 USD/month for the girls, 35 USD/year for their guardians, and up to 150 USD/year for school fees. Interviews were conducted with 3,870 guardians representing 4,110 girls, 1.5–2 years after the intervention period started. Utilization was defined as visits to formal health facilities, and CHE was health payments exceeding 10% of total household expenditures. The degree of inequality was measured using the Concentration Index. In the control arm, 26.1% of the households utilized inpatient care in the previous year compared to 26.7% in the economic arm (RR = 1.0; 95% CI: 0.9–1.2, p = 0.815) and 27.7% in the combined arm (RR = 1.1; 95% CI: 0.9–1.3, p = 0.586). Utilization of outpatient care in the previous 4 weeks was 40.7% in the control arm, 41.3% in the economic support (RR = 1.0; 95% CI: 0.8–1.3, p = 0.805), and 42.9% in the combined arm (RR = 1.1; 95% CI: 0.8–1.3, p = 0.378). About 10.4% of the households in the control arm experienced CHE compared to 11.6% in the economic (RR = 1.1; 95% CI: 0.8–1.5, p = 0.468) and 12.1% in the combined arm (RR = 1.1; 95% CI: 0.8–1.5, p = 0.468). Utilization of outpatient care and the risk of CHE was relatively higher among the least poor than the poorest households, however, the degree of inequality was relatively smaller in the intervention arms than in the control arm.ConclusionsEconomic support alone and in combination with community dialogue aiming to reduce early childbearing did not appear to have a substantial impact on healthcare utilization and CHE in rural Zambia. However, although cash transfer did not significantly improve healthcare utilization, it reduced the degree of inequality in outpatient healthcare utilization and CHE across wealth groups.Trial Registrationhttps://classic.clinicaltrials.gov/ct2/show/NCT02709967, ClinicalTrials.gov, identifier (NCT02709967).