Search Results (1,247)

Obesity (lipotoxicity) results from a chronic imbalance between energy intake and expenditure. It is strongly associated with type 2 diabetes mellitus (T2DM, glucotoxicity) and considered a major risk factor for the development of metabolic complications. Their convergence constitutes “diabesity”, representing a major challenge for public health worldwide. Limited treatment efficacy highlights the need for novel, multi-targeted therapies. Non-shivering thermogenesis (NST), mediated by brown and beige adipose tissue and skeletal muscle, has emerged as a promising therapy due to its capacity to increase energy expenditure and improve metabolic health. Also, skeletal muscle plays a central role in glucose uptake and lipid oxidation, further highlighting its relevance in diabesity. This review explores current and emerging knowledge on physiological stimuli, including cold exposure, physical activity, and fasting, as well as bioactive ingredients and drugs that stimulate NST in thermogenic tissues. Special emphasis is placed on melatonin as a potential regulator of mitochondrial function and energy balance. The literature search was conducted using MEDLINE and Web of Science. Studies were selected based on scientific relevance, novelty, and mechanistic insight; prioritizing human and high-quality rodent research published in peer-reviewed journals. Evidence shows that multiple interventions enhance NST, leading to improved glucose metabolism, reduced fat accumulation, and increased energy expenditure in humans and/or rodents. Melatonin, in particular, shows promise in modulating thermogenesis through organelle-molecular pathways and mitochondrial protective effects. In conclusion, a multi-target approach through the activation of NST by physiological, nutritional, and pharmacological agents offers an effective and safe treatment for diabesity. Further research is needed to confirm these effects in clinical practice and support their use as effective therapeutic strategies. Full article

Background/Objectives: With rapid population aging, concerns about cognitive health—especially mild cognitive impairment (MCI), a prodromal stage of dementia—are growing. Although MCI prevalence is rising, limited empirical evidence exists on changes in healthcare expenditures associated with its diagnosis. This study aimed to assess shifts in medical spending before and after MCI diagnosis and to identify factors influencing healthcare costs among Korean adults. Methods: We used data from the National Health Insurance Service–National Health Information Database (NHIS–NHID) from 2020 to 2022. This study analyzed 4162 Korean adults aged ≤84 who were newly diagnosed with MCI in 2021. Annual healthcare expenditures were tracked from 2020 to 2022. Generalized estimating equations (GEEs) were employed to examine changes over time, adjusting for sociodemographic characteristics, comorbidities, healthcare utilization, and long-term care insurance (LTCI) enrollment. Results: The average annual healthcare expenditure increased from 74,767 KRW before diagnosis to 87,902 KRW after diagnosis, reflecting a 12.51% rise. Regression analysis showed a significant decrease in costs in the year prior to diagnosis (β = −0.117, p < 0.01) and an increase in the year following diagnosis (β = 0.061, p < 0.01). Higher expenditures were associated with greater outpatient visits (β = 0.385, p < 0.01), longer hospital stays (β = 0.039, p < 0.01), LTCI enrollment (non-graded: β = 0.035, p = 0.02; graded: β = 0.027, p = 0.04) and higher comorbidity levels (CCI = 2: β = 0.088, p < 0.01, CCI ≥ 3: β = 0.192, p < 0.01). Conversely, older age (β = −0.003, p = 0.02) and female sex (β = −0.093, p < 0.01) were associated with lower costs. Sex-stratified analyses revealed consistent cost trends but different predictors for male and female patients. Conclusions: Healthcare expenditures rise significantly after MCI diagnosis. Early identification and interventions tailored to patient characteristics—such as age, sex, and comorbidity status—may help manage future costs and support equitable care for older adults. Full article

The present article is an opinion piece mainly based on selected articles in the field of sarcopenia, with possible relevance for pregnancy. Sarcopenia has gained increasing interest in recent years, since it has emerged that sarcopenia may determine significant health consequences, with related substantial health care expenditure. In particular, some studies suggested that sarcopenia may cause increased risk for several diseases, such as type 2 diabetes, obesity, and major cardiovascular events. On the other hand, some studies have reported that the association between sarcopenia and these diseases may be bidirectional. In particular, this holds for type 2 diabetes, because sarcopenia and type 2 diabetes share many etiological and pathogenetic factors, such as insulin resistance, oxidative stress, low-grade chronic inflammation, and adiposity. It is also worth noting that some studies have shown a non-negligible sarcopenia prevalence even in people below 40 years of age, and therefore of reproductive age. Taken together, the above considerations support the hypothesis that sarcopenia may be present in women with gestational diabetes (GDM), which shares common traits with type 2 diabetes. Notably, we hypothesize that sarcopenia may exacerbate GDM-related complications and may influence maternal–fetal outcomes, such as preterm birth or cesarean delivery. Additionally, since pregnancy often presents with insulin resistance independently of any comorbidity, it is plausible that sarcopenia may be present during pregnancy even in cases of normal glycemia. However, there is a lack of data about sarcopenia prevalence in pregnancy and its potential impact on outcomes. Therefore, future studies addressing these aspects are advisable. Full article

The analysis of household health financing vulnerability and its impact on health service utilization during the COVID-19 pandemic remains inadequately explored in Kenya. This study was designed to examine the impact of health financing vulnerability on health services utilization during the COVID-19 period. A health financing vulnerability index (HFVI) was constructed to assess the financial risk that individuals faced in accessing essential health services. A pooled panel probit model was estimated to measure the effect of HFVI on service uptake. The study found a significant negative association between HFVI and health service utilization, indicating that a high level of health financing vulnerability is linked to poor health in periods of emergencies. To address this issue, the study recommends implementation of multiple policy measures during crisis periods, including enhancing social health insurance, providing financial support to vulnerable households, and increasing public expenditure on primary healthcare systems across counties, especially on drugs, referral logistics, personnel, medical equipment, and diagnostic technologies. Full article

Out-of-pocket expenditure (OOPE) comprises 62% of national health expenditure in India. This heavy reliance on direct payments has engendered economic vulnerability and catastrophic financial pressures (typically defined as out-of-pocket spending exceeding a certain threshold of household income, leading to financial hardship) on households in a country where public health spending remains below targeted levels. The onset of the COVID-19 pandemic intensified these financial hardships further, as both total healthcare spending and OOPE experienced significant escalations due to the increased need for emergency care, vaccination efforts, and expanded health infrastructure. A retrospective, single-center study was conducted using data from COVID-19 patients admitted between June 2020 and June 2022. Patient data were collected from the Medical Records, IT, and Finance departments. A validated proforma was used for data extraction. Descriptive statistics were calculated, and the Shapiro–Wilk test was applied to assess normality of billing and OOPE data. Patients were stratified into three groups based on their insurance status, allowing for comparative analysis of OOPE percentages and absolute expenditures. The 2715 COVID-19 patients were categorized into three groups according to their health financing: those covered under AB-PMJAY (42.76%), private health insurance (22.16%), and the uninsured (35%). While the median billing amounts were comparable across these groups (ranging between INR 85,000 and INR 90,000), a substantial disparity was observed in terms of financial burden. All patients covered under AB-PMJAY incurred no OOPE, whereas privately insured patients had a median OOPE that constituted approximately 21% of their total billing amounts, with significant variability among different insurers. The uninsured group represented 35% of the cases and experienced the highest median OOPE, indicating substantial financial risk. The COVID-19 pandemic has revealed critical gaps in India’s health financing framework. This study emphasizes the strong financial protection provided by AB-PMJAY, while also exposing the limitations of private health insurance in shielding patients from substantial healthcare costs. As the country progresses toward universal health coverage, there is a pressing need to expand public health insurance schemes that are inclusive, equitable, and effectively implemented. Additionally, strengthening regulation and accountability in the private insurance sector is essential. The study findings reinforce that AB-PMJAY has been highly successful in reducing OOPE and enhancing financial risk protection. Although private insurance reduced OOPE, patients still faced considerable expenses. The stark difference in OOPE of 100% for uninsured patients, 21.16% for privately insured, and 0% for AB-PMJAY beneficiaries underscores the importance of further expanding AB-PMJAY to reach more vulnerable populations. Full article

Type 2 diabetes (T2D), a growing global health concern, is closely linked to obesity and sedentary behavior. Central to its development are insulin resistance and impaired glucose metabolism in peripheral tissues, particularly skeletal muscle, which plays a key role in energy expenditure, glucose uptake, and insulin sensitivity. Notably, increased accumulation of lipid metabolites in skeletal muscle is observed both in endurance exercise—associated with improved insulin sensitivity—and in high-fat diets that induce insulin resistance. The review examines the contrasting metabolic adaptations of skeletal muscle to these opposing conditions and highlights the key signaling molecules involved. The focus then shifts to the role of the stress kinase p38α mitogen-activated protein kinase (MAPK) in skeletal muscle adaptation to overnutrition and endurance exercise. p38α enhances mitochondrial oxidative capacity and regulates nutrient utilization, both critical for maintaining metabolic homeostasis. During exercise, it cooperates with AMP-activated protein kinase (AMPK) to boost glucose uptake and fatty acid oxidation, key mechanisms for improving insulin sensitivity. The co-activation of p38α and AMPK in skeletal muscle emerges as a promising therapeutic avenue to combat insulin resistance and T2D. The review explores strategies for selectively enhancing p38α activity in skeletal muscle. In conclusion, it advocates a comprehensive approach to T2D prevention and treatment, combining established caloric intake-reducing therapies, such as GLP-1 receptor agonists, with interventions aimed at increasing energy expenditure via activation of p38α and AMPK signaling pathways. Full article

Background: Healthcare systems are increasingly strained by limited operating room resources and rising demand, a situation intensified by the COVID-19 pandemic. These pressures have resulted in overcrowded surgical departments, prolonged waiting times for elective procedures, worsened patient health outcomes, and increased hospital expenditure costs. Methods: To address these challenges, this study proposes a multi-objective mathematical optimization model as the analytical core of a decision support approach for OR resource allocation. The model considers multiple constrained resources, including OR time, intensive care units, medium care units, and nursing staff, and aims to minimize both elective patients’ waiting times and total incurred costs over a one-week planning horizon. Developed using real hospital data from a large facility in Thailand, the model was implemented in LINGO version 16.0, and a sensitivity analysis was conducted to assess the impact of surgical department priorities and overtime allowances. Results: Compared to current practices, the optimized OR schedule reduced average waiting times by approximately 7% and total costs by 5%, while balancing resource utilization. Conclusions: This study provides a data-driven tool to support hospital resource planning, improve OR efficiency, and respond effectively to future healthcare crises. Full article

Oral contraceptives (OCs) containing estrogen and/or progesterone are the second most common form of female contraception in the United States. While endogenously synthesized estrogen is known to provide protective effects against cardiometabolic diseases, exogenous forms such as OCs have been linked to increased susceptibility to cardiometabolic diseases and an elevated risk of myocardial infarction. The gut microbiota is thought to be a critical regulator of cardiometabolic disease risk; however, its interactions with OC use remain understudied. OBJECTIVE: We aimed to evaluate the effects of OC use on the intestinal microbiota and investigate microbial associations with intestinal estradiol levels, energy homeostasis, and hepatic oxidative stress markers. METHODS: Female C57BL/6J mice were fed a high-fat diet with or without OCs from 7 to 8 weeks of age and maintained for either 12 or 20 weeks. Duodenal, jejunal, cecal, and colonic microbiota, cecal short- and branched-chain fatty acids, and intestinal estradiol levels were assessed. RESULTS: Both 12- and 20-week of OC treatments significantly elevated colonic estradiol levels. Twenty weeks of OC treatment significantly altered the composition of both cecal and colonic microbiota and increased cecal isobutyric acid concentrations, whereas 12 weeks of OC treatment resulted in only trending shifts in the cecal microbiota and did not alter colonic microbiota or fatty acid compositions assessed. In 12-week treated mice, cecal Lactococcus was positively associated with non-resting energy expenditure, whereas in 20-week treated mice, cecal Lachnoclostridium was positively associated with resting energy expenditure. CONCLUSIONS: OC use induces time- and intestinal segment-dependent shifts in the gut microbiota and branched-chain fatty acid production. The OC-induced increase in colonic estradiol could further influence the gut microbiota and health when utilized long-term. These findings provide critical insight into how OC use may contribute to increased cardiometabolic risk through gut microbial alterations. Full article

Primary healthcare is vital to achieving universal health coverage, as emphasized by Sustainable Development Goal 3 (SDG 3). However, energy poverty remains a critical yet overlooked barrier to the efficiency of primary healthcare services in rural China—precisely the focus of this study. It employs panel regression models and threshold analysis methods using data from 31 Chinese provinces for the period 2014–2021, sourced from the EPSDATA data platform. Robustness checks are performed using bootstrap procedures, accompanied by detailed mechanism analyses. The empirical results demonstrate that rural energy poverty significantly reduces primary healthcare efficiency, particularly in provinces initially characterized by lower healthcare performance. The mechanism analysis identifies four critical transmission channels—off-farm employment, internet intensity, food safety, and health education—through which rural energy poverty undermines healthcare outcomes. Furthermore, threshold regressions uncover nonlinear relationships, indicating that the negative impacts of rural energy poverty intensify when household medical expenditures exceed 10.9%, the old-age dependency ratio surpasses 22.61%, and the rural energy poverty index is higher than 0.641. In theoretical terms, this study identifies rural energy poverty as a critical determinant of primary healthcare efficiency, thereby addressing an important gap in the existing literature. At the policy level, the findings emphasize the necessity for integrated measures targeting both rural energy poverty and primary healthcare inefficiencies to achieve SDG 3 and sustainably promote equitable, high-quality healthcare access in rural China. Full article

Handwashing is one of the recommended measures during the COVID-19 period to limit the spread of the disease and also contributes to the prevention of WASH-related illnesses. The objective of this study is to analyze the impact of using a handwashing device on household healthcare expenditures in Cameroon, particularly during the period of strict COVID-19 strict restrictions. The data used were collected in September 2021 from 604 Cameroonian households in the Centre and Littoral regions as part of a study funded by the International Development Research Centre (IDRC). To account for unobserved heterogeneity affecting both the decision to use a handwashing device and household healthcare expenditures, an Endogenous Switching Regression (ESR) model was employed. The results highlight that the main determinants of a household’s decision to use handwashing devices include environmental factors such as the region, given its importance in the implementation of communication strategies, as well as specific characteristics of the household head. Furthermore, the use of this device leads to a reduction of approximately 52% in healthcare expenditures for households that used it, which corresponds to an average amount of 12,900 CFA francs. Full article

Although organizational resilience is well established, refining the systematic quantitative evaluation of health systems resilience (HSR) remains an ongoing opportunity for advancement. Research either focuses on individual HSR indicators, such as social welfare policy, public expenditure, health insurance, healthcare quality, and technology, or broadly examines socio-economic factors, highlighting the need for a more comprehensive methodological approach. This study employed the Slacks-Based Measure (SBM) within Data Envelopment Analysis (DEA) to analyze efficiency by maximizing outputs. It systematically examined key HSR factors across countries, providing insights for improved policymaking and resource allocation. Taking a five-year (2016–2020) dataset that covered 55 to 56 countries and evaluating 17 indicators across governance, health systems, and economic aspects, the paper presents that all sixteen top-ranked countries with a perfect efficiency score of 1 belonged to the high-income group, with ten in Europe, highlighting regional HSR differences. This paper concludes that adequate economic resources form the foundation of HSR and ensure stability and sustained progress. A properly supported healthcare workforce is essential for significantly enhancing health systems and delivering quality care. Last, effective governance and the equitable allocation of resources are crucial for fostering sustainable development and strengthening HSR. Full article

Invasive fungal infections (IFIs) represent a growing global health threat, particularly for immunocompromised populations, with mortality exceeding 1.5 million deaths annually. Despite their clinical and economic burden—costing billions in healthcare expenditures—fungal infections remain underprioritized in public health agendas. This review examines the current landscape of antifungal therapy, focusing on advances, challenges, and future directions. Key drug classes (polyenes, azoles, echinocandins, and novel agents) are analyzed for their mechanisms of action, pharmacokinetics, and clinical applications, alongside emerging resistance patterns in pathogens like Candida auris and azole-resistant Aspergillus fumigatus. The rise of resistance, driven by agricultural fungicide use and nosocomial transmission, underscores the need for innovative antifungals, rapid diagnostics, and stewardship programs. Promising developments include next-generation echinocandins (e.g., rezafungin), triterpenoids (ibrexafungerp), and orotomides (olorofim), which target resistant strains and offer improved safety profiles. The review also highlights the critical role of “One Health” strategies to mitigate environmental and clinical resistance. Future success hinges on multidisciplinary collaboration, enhanced surveillance, and accelerated drug development to address unmet needs in antifungal therapy. Full article

This study assesses the effects of the COVID-19 pandemic on catastrophic health expenditures and income inequality in Benin. A microsimulation was calibrated to estimate the impact of the pandemic under three different shock scenarios: low, moderate, and severe. The analysis relies on secondary data from household living condition surveys. The results indicate that the COVID-19 crisis would lead to a significant average income loss of up to 20% and income inequality, while the number of households with catastrophic health expenditures would increase by 4%. More importantly, the findings reveal heterogeneous impacts across households, with urban residents, younger individuals, more educated households, and male-headed households experiencing the greatest income decline. These findings underscore the need for targeted health coverage and employment policies to better protect vulnerable populations in Benin in the face of future shocks. Full article

The continued migration of physicians from independent practice to affiliation with larger entities has garnered significant scrutiny. These affiliation models include hospitals and health systems, payers and corporate entities, and management services organizations, which may or may not be private equity (PE)-backed. Data on the impact of different physician affiliation models on cost of care is limited. We examined the relationship between provider affiliation model, site of care (SOC), and cost of care for certain high-volume procedures in procedure-intensive specialties for both Medicare and commercial insurance. We found that hospital-affiliated physicians are least likely—and PE-affiliated physicians are most likely—to provide care in lower-cost settings. For both Medicare and commercial insurance, SOC contributes meaningfully to procedure unit price, which is consistently greater in hospital-based settings. These findings suggest that the physician affiliation model and associated SOC cost differentials contribute materially to healthcare expenditures. As the Medicare cost differentials are set by statute and regulations, strategies such as site-neutral payments are needed to mitigate the monetary impact of historical and future physician practice migration. Full article

Objective: The objective of the study was to investigate the relationship between the level of physical activity and body composition, and the levels of motor skills and strength in overweight and obese men. Methods: The research involved 64 men. Body composition, physical activity, motor control, Motor Control Test (MCT), and strength variables were evaluated. Body composition was assessed by DXA, and the participants were classified into two groups according to the percentage of total fat mass: greater and less than 27.65%. Physical activity was assessed using accelerometry, and motor control was measured with posturography, which provided a composite score of motor performance and postural control effectiveness. Strength was assessed using hand, leg, and back dynamometers. Results: The participants with a higher percentage of body fat had a lower DSI (Dynamic Strength Index) (p < 0.001) and significantly reduced PAL (physical activity level) and energy expenditure (p < 0.001). No significant differences were found in the muscle strength of the upper limbs (p = 0.06) and lower limbs (p = 0.419). With regard to MCT, there was a significant difference between groups in the backward direction (p = 0.041), with the group with the highest percentage of body fat showing lower values. Conclusions: Individuals with a higher percentage of body fat tend to have lower levels of strength, physical activity, and energy expenditure, which can lead to impaired balance. The findings highlight the need for targeted interventions to improve body composition and levels of strength and physical activity, with a positive impact on general health and quality of life. Emphasis should be placed on improving physical activity levels in male individuals with a higher percentage of fat mass to improve their body composition and dynamic strength levels, which are beneficial to life, particularly to help improve postural control. Full article