The value of disease prevention vs treatment

Effects of protected complex of bio-factors and antioxidants on growth performance, serum biochemistry, meat quality, and intestinal antioxidant and immunomodulatory-related gene expressions of broiler chickens

One-day-old male broiler chickens (Ross 308) were assigned to 3 dietary treatments in a completely randomized design with 8 replicates per treatment, and 4 birds per replicate. The control group was fed a basal control diet, and the 2 test groups were fed the basal control diet supplemented with 150 and 300 mg/kg of protected complex of biofactors and antioxidants [P(BF+AOX)], respectively. The P(BF+AOx) is a combination of vitamins, L-tryptophan and biofactors such as fermentation extracts (Jefo Nutrition Inc., Saint-Hyacinthe, QC, Canada). Dietary P(BF+AOX) did not affect growth performance and breast meat quality (water holding capacity, cooking loss, shear force, and texture profile analysis), but the addition of 150 mg/kg of P(BF+AOX) decreased the relative weight of liver, heart, and spleen (P < 0.05). The addition of 150 mg/kg of P(BF+AOX) tended to increase (P = 0.051) the cold carcass yield. The addition of 150 and 300 mg/kg of P(BF+AOX) decreased (P = 0.002) the cooler carcass shrink, but the relative weight of fat pad increased (P = 0.032) in chickens fed 300 mg/kg P(BF+AOx) than in those of birds fed the control diet. On the other hand, the addition of 300 mg/kg of P(BF+AOX) decreased (P = 0.041) the serum level of uric acid compared with those of birds fed the basal diet. Broiler chickens fed diets supplemented with 150 mg/kg of diet had higher (P < 0.05) mRNA expressions of jejunal SOD1 and interleukins 6 and 10 (IL-6, IL-10). The findings suggest that P(BF+AOX) could be considered as a functional nutrient in broiler diets up to a concentration of 150 mg/kg because of its favorable effects on maintaining intestinal barrier function as well as carcass traits, while excess levels (300 mg/kg) had exhibited superior effect on the serum level of uric acid compared with those of birds fed the control diet.

Prevention, treatment, and palliative care: The relative value of health improvements under alternative evaluation frameworks

The social value of decreasing health risks can be evaluated using benefit-cost analysis (BCA), cost-effectiveness analysis (CEA), or a social-welfare function (SWF). These frameworks can produce different social preference rankings of interventions depending on how their health effects and costs are distributed in a population. This paper derives social values of marginal decreases in the probability of illness, its severity (decrease in health status), lethality (conditional mortality risk), and cost under BCA, CEA, and three benchmark SWFs: utilitarian, ex ante prioritarian, and ex post prioritarian. The sensitivity of the social values of improvements in health and decreases in cost to individual circumstances are diverse. In contrast, the conditions under which a decrease in risk, severity, or lethality is socially preferred to a decrease in another of these dimensions are identical for BCA, CEA, the utilitarian and ex ante prioritarian SWFs, but can differ for the ex post prioritarian SWF.

Valuing non-marginal changes in mortality and morbidity risk

Many stated-preference studies that seek to estimate the marginal willingness-to-pay (WTP) for reductions in mortality or morbidity risk suffer from inadequate scope sensitivity. One possible reason is that the risk reductions presented to respondents are too small to be meaningful. Survey responses may thus not accurately reflect respondents preferences for health and safety. In this paper we propose a novel approach to estimating the value per statistical life (VSL) or the value per statistical case (VSC) based on larger risk reductions measurable as percent changes. While such non-marginal risk reductions are easier to understand, they introduce well known biases. We propose a methodology to de-bias VSL and VSC estimates derived from the evaluation of non-marginal risk reductions and present a proof of concept using simulated stated preference data.

The application of ascorbic acid as a therapeutic feed additive to boost immunity and antioxidant activity of poultry in heat stress environment

Ascorbic acid, widely known as vtamin C, is an essential nutrient for animals such as poultry. Ascorbic acid in poultry feed improves animal health and thus increases the growth performance of birds. Ascorbic acid can be used in the form of synthetic products or can be naturally obtained from fruits and plants. It is soluble in water and can be easily administered in drinking water and the diet. Poultry can synthesize ascorbic acid in the body. However, the performance of the animals can be improved by adding ascorbic acid to their diet. In addition, ascorbic acid is called an antioxidant and an anti-inflammatory. This increases their resistance to disease during the transition season. Ascorbic acid supplementation positively affects the stress response, especially during the dry season in tropical countries. Furthermore, supplementing ascorbic acid in the poultry’s diet improves resistance to diseases, regulates stress, and helps in the body’s oxidation process. Ultimately, this enhances the laying rate, egg hatch performance, and higher poultry productivity. For layers at the end of the laying period, it helps increase the quality of the eggshell and reduces the proportion of broken eggs. Ascorbic acid has a strong relationship with other vitamins such as vitamin E and other substances such as zinc, safflower oil, folic acid, and a fibrous diet. This review aims to synthesize all the information of ascorbic acid in the poultry’s diet, thereby providing the general role of ascorbic acid for the poultry industry.

Intervention during the first 1000 days in Mexico

Health systems and society are facing the growing problem of obesity and its accompanying comorbidities. New approaches to reduce these problems must be oriented to population groups in which long-lasting effects of interventions may occur. Biological processes occurring during the first 1000 days of life, which may be modulated by environmental modifications and result in phenotypes with differential risk for noncommunicable chronic disease, constitute an opportunity for interventions. The nutritional and general health conditions of pregnant women and the fetus, as well as toddlers, can be improved with interventions during the first 1000 days, offering pregnancy care, promoting breastfeeding, instructing on the use of complementary foods, and educating on the adequacy of the family dietary patterns for children. Evidence that interventions during this period result in promotion of children's growth and development, influencing the risk for development of obesity in infancy, is available. In this article, an ongoing program in Mexico City directed to offer continuum of care during the first 1000 days is described.

Centennial Review: Effects of vitamins A, D, E, and C on the chicken immune system

Vitamins are nutritional elements which are necessary for essential activities such as development, growth, and metabolism of cells. In addition to these conventional functions, vitamins A, D, E, and C have vital roles in normal function of the immune system as their deficiency is known to impair innate and adaptive host responses. By altering transcription of multiple immune system genes and contributing to antioxidant activities, these vitamins influence the immune system in different ways including modulation of cell-mediated and antibody-mediated responses, immunoregulation, and antiinflammatory effects. Furthermore, supplementation of these vitamins to poultry may assist the immune system to combat microbial pathogens while reducing detrimental effects associated with stress and enhancing responses to vaccines. In this article, the relationship between the chicken immune system and vitamins A, D, E, and C is reviewed, and evidence from the literature pertaining to how these vitamins exert their antiinflammatory, regulatory, and antimicrobial effects is discussed.

Theoretical bounds on the value of improved health

Policies that improve health and longevity are often valued by combining expected gains in quality-adjusted life years (QALYs) with a constant willingness-to-pay (WTP) per QALY. This constant is derived by dividing value per statistical life (VSL) estimates by expected future QALYs. We explore the theoretical validity of this practice by studying the properties of WTP for improved health and longevity in a framework that makes minimal assumptions about the shape of an agent's utility function. We find that dividing VSL by expected QALYs results in an upper bound on the WTP for a marginal improvement in the quality of life, as measured by gains in health status or longevity. Calibration results suggest that analysts using this approach to monetize health benefits overestimate the value of a program or policy by a factor of two on average. We also derive a lower bound on the WTP for improved health and longevity that permits a novel empirical test for the descriptive validity of the QALY model. Our calibrations suggest that this lower bound is on average 20% smaller than the actual WTP.

Dread and Risk Elimination Premium for the Value of a Statistical Life

The value of a statistical life (VSL) is a widely used measure for the value of mortality risk reduction. As VSL should reflect preferences and attitudes to risk, there are reasons to believe that it varies depending on the type of risk involved. It has been argued that cancer should be considered a "dread disease," which supports the use of a "cancer premium." The objective of this study is to investigate the existence of a cancer premium (for pancreatic cancer and multiple myeloma) in relation to road traffic accidents, sudden cardiac arrest, and amyotrophic lateral sclerosis (ALS). Data were collected from 500 individuals in the Swedish general population of 50-74-year olds using a web-based questionnaire. Preferences were elicited using the contingent valuation method, and a split-sample design was applied to test scale sensitivity. VSL differs significantly between contexts, being highest for ALS and lowest for road traffic accidents. A premium (92-113%) for cancer was found in relation to road traffic accidents. The premium was higher for cancer with a shorter time from diagnosis to death. A premium was also found for sudden cardiac arrest (73%) and ALS (118%) in relation to road traffic accidents. Eliminating risk was associated with a premium of around 20%. This study provides additional evidence that there exist a dread premium and risk elimination premium. These factors should be considered when searching for an appropriate value for economic evaluation and health technology assessment.

Current practices and perceived implementation barriers for working with alcohol prevention in occupational health services: the WIRUS OHS study

BACKGROUND

Alcohol is associated with detrimental health and work performance outcomes, and one to three out of ten employees may benefit from interventions. The role of occupational health services (OHS) in alcohol prevention has received little attention in research. The primary aims of this study were to explore current practices of alcohol prevention targeting employees in occupational health settings, and examine whether and which perceived implementation barriers were associated with alcohol prevention activity. The secondary aim was to explore whether barriers were differentially associated with primary, secondary and tertiary prevention activities.

METHODS

In this cross-sectional study, survey data were collected from 295 OHS professionals in Norway in 2018. Data were analysed by means of descriptive statistics, one-way analysis of variance, paired samples t-tests, and multivariate linear regression analyses.

RESULTS

Overall, seven out of ten OHS professionals worked with alcohol-related cases less than monthly, while only one out of ten did so on a weekly basis. Their activities were more focused on tertiary prevention than on primary and secondary prevention. Physicians, psychologists and nurses reported to handle alcohol-related issues more often than occupational therapists and physical therapists. Higher levels of implementation barriers internal to the OHS' organisation (competence, time and resources) were associated with lower alcohol prevention activity. Barriers external to the OHS' organisation (barriers concerning employers and employees) were not. This pattern was evident for primary, secondary and tertiary prevention activities. A majority of OHS professionals agreed that employees' alcohol consumption constitute a public health challenge, and that OHS' should focus more on alcohol prevention targeting employees.

CONCLUSIONS

Occupational health settings at workplaces may be particularly serviceable for alcohol prevention programmes since the majority of the population is employed and the majority of employees consume alcohol. An increase in overall prevention activity, and a shift from mainly focusing on tertiary prevention to an increased emphasis on primary and secondary prevention, may both hinge on increased training of OHS professionals, emphasising knowledge on the importance of working with alcohol prevention, and training in administering alcohol prevention programmes. Making alcohol prevention a priority may also require increased allocation of time and resources.

The benefits of avoiding cancer (or dying from cancer): Evidence from a four- country study

We use stated-preference methods to estimate the cancer Value per Statistical Life (VSL) and Value per Statistical Case (VSCC) from a representative sample of 45-60-year olds in four countries in Europe. We ask respondents to report information about their willingness to pay for health risk reductions that are different from those used in earlier valuation work because they are comprised of two probabilities-that of getting cancer, and that of dying from it (conditional on getting it in the first place). The product of these two probabilities is the unconditional cancer mortality risk. Our hypothetical risk reductions also include two severity-related attributes-quality-of-life impacts and pain. The results show that respondents did appear to have an intuitive grasp of compound probabilities, and took into account each component of the unconditional cancer mortality risk when answering the valuation questions. We estimate the cancer VSL to be between approximately € 2 and 5.950 million, depending on whether the (unconditional) mortality risk was reduced by lowering the chance of getting cancer, increasing the chance of surviving cancer, or both. The VSCC is estimated to be up to € 0.578 million euro, and its magnitude depends on the initial (conditional) cancer mortality and on the improvement in survival. The survey responses show that our measures of cancer severity-impacts on daily activities and pain-have little or no effect on the WTP to reduce the adverse health risks.