Economics and mental health: the current scenario

Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill‐health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget‐holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost‐effectiveness analysis, cost‐utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification‐plus‐treatment; risk‐reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community‐based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.     

Can knowledge‐based N management produce more staple grain with lower greenhouse gas emission and reactive nitrogen pollution? A meta‐analysis

Knowledge‐based nitrogen (N) management, which is designed for a better synchronization of crop N demand with N supply, is critical for global food security and environmental sustainability. Yet, a comprehensive assessment on how these N management practices affect food production, greenhouse gas emission (GHG), and N pollution in China is lacking. We compiled the results of 376 studies (1166 observations) to evaluate the overall effects of seven knowledge‐based N management practices on crop productivity, nitrous oxide (N₂O) emission, and major reactive N (Nr) losses (ammonia, NH₃; N leaching and runoff), for staple grain (rice, wheat, and corn) production in China. These practices included the application of controlled‐release N fertilizer, nitrification inhibitor (NI) and urease inhibitor (UI), higher splitting frequency of fertilizer N application, lower basal N fertilizer (BF) proportion, deep placement of N fertilizer, and optimal N rate based on soil N test. Our results showed that, compared to traditional N management, these knowledge‐based N practices significantly increased grain yields by 1.3–10.0%, which is attributed to the higher aboveground N uptake (5.1–12.1%) and N use efficiency in grain (8.0–48.2%). Moreover, these N management practices overall reduced GHG emission and Nr losses, by 5.4–39.8% for N₂O emission, 30.7–61.5% for NH₃ emission (except for the NI application), 13.6–37.3% for N leaching, and 15.5–45.0% for N runoff. The use of NI increased NH₃ emission by 27.5% (9.0–56.0%), which deserves extra‐attention. The cost and benefit analysis indicated that the yield profit of these N management practices exceeded the corresponding input cost, which resulted in a significant increase of the net economic benefit by 2.9–12.6%. These results suggest that knowledge‐based N management practice can be considered an effective way to ensure food security and improve environmental sustainability, while increasing economic return.     

Strategy for eliminating gastric cancer in Japan

A study conducted by the Japan Gast Study Group showed that eradication of Helicobacter pylori reduced the risk of gastric cancer by about one-third. However, it did not completely prevent the onset of latent gastric cancer among those at high risk (i.e., with atrophic gastritis). To prevent deaths from gastric cancer, it is necessary to eradicate H. pylori infection. We propose a program of risk stratification based on the presence of H. pylori infection with or without atrophic gastritis followed by targeted interventions. Those at no risk for gastric cancer (no H. pylori, no atrophic gastritis) need no therapy or follow-up. Those at low risk (H. pylori infected, nonatrophic gastritis) need only H. pylori eradication therapy. The smaller groups at high or very high risk need eradication and cancer surveillance. We estimated the costs and the benefits of this strategy. Gastric cancer screening by simultaneous measurement of serum pepsinogen and H. pylori antibody combined with eradication of H. pylori in all individuals at risk would initially increase national healthcare expenditure, but this would be offset by markedly reducing the cost of treating gastric cancer. The proposed strategy should prevent about 150,000 deaths from gastric cancer during the 5 years after its adoption. If the loss caused by these deaths is also taken into account, the economic effect of this strategy becomes enormous. It would probably reduce the incidence of gastric cancer by more than 80-90% within 10 years. The Japanese government should take the initiative to implement this strategy as soon as possible.     

Supramolecular reactive sulphur nanoparticles: a novel and efficient antimicrobial agent

Antimicrobial resistance continues to be an inexorable threat for the biomedical and biochemical researchers. Despite the novel discoveries in drug designing and delivery, high‐throughput screening and surveillance data render the prospects for new antimicrobial agents as bleak as ever. The advent of nanotechnology, however, strengthens pharmacology by offering effective therapeutics to treat this aforementioned problem. Several nanoparticles of the known elements have already been reported for their antimicrobial efficacy. Nanosized fabrication of elemental sulphur with suitable surface modifications offers to retrieve the use of sulphur (man's oldest known ecofriendly microbicide) as a potential antimicrobial agent. Sulphur nanoparticles (SNPs) are effective against both conventionally sulphur‐resistant and sulphur‐susceptible microbes (fungi and bacteria). Moreover, biocompatible polymers present on the surface of SNPs minimize toxicity during application. Here, we focus on various aspects of physicochemical features of SNPs and their biochemical interactions with microbes. The present review also illustrates the effects of SNPs on plants and animals in terms of cytotoxicity and biocompatibility.     

Costs, benefits and the evolution of inducible defences: a case study with Daphnia pulex

Phenotypic plasticity is one major source of variation in natural populations. Inducible defences, which can be considered threshold traits, are a form of plasticity that generates ecological and evolutionary consequences. A simple cost-benefit model underpins the maintenance and evolution of these threshold, inducible traits. In this model, a rank-order switch in expected fitness, defined by costs and benefits of induction between defended and undefended morphs, predicts the risk level at which individuals should induce defences. Here, taking predator-induced morphological defences in Daphnia pulex as a threshold trait, we provide the first comprehensive investigation into the costs and benefits of a threshold trait, and how they combine to reflect fitness and predict the switchpoint at which induction should occur. We develop reaction norms that show genetic variation in switchpoints. Further experiments show that induction can confer a survival benefit and a cost in terms of lifetime reproductive success. Together, these two traits combine to estimate expected fitness and can predict the switchpoint between an undefended and a defended strategy. The predictions match the reaction norm data for clones that experience these costs and benefits, and correspond well to independent field data on induction. However, predictions do not, and cannot, match for clones that do not gain a benefit from induction. This study confirms that a simple theory, based on life history costs and benefits, is a sufficient framework for understanding the ecology and evolution of inducible, threshold traits.     

Liquid-based cytology improves productivity in cervical cytology screening.

Objectives: The ThinPrep test was introduced into our institution on a phased basis over 3 years between January 2002 and December 2004. This study set out to assess its effect on productivity (as measured by output of cases per medical scientist per day) during the changeover period. Numbers of high and low-grade lesions and of unsatisfactory slides were also monitored. Methods: The percentage conversion from conventional preparation to liquid-based cytology (LBC) and output of cases per medical scientist per day were calculated from our database at 6-month intervals. The average backlog, average number of cases received per month and percentage of unsatisfactory and abnormal cases were calculated similarly. Results: Over the study period 92 084 cases were received. The percentage of cases using ThinPrep increased: from 9% in January 2002 to 73% in December 2004. During the study there was an increase in output from 17.0 to 22.3 cases per medical scientist per day, representing a 31% improvement at 73% conversion. Numbers of unsatisfactory cases decreased substantially and the numbers of low and high-grade diagnoses were relatively constant. Conclusions: The change to ThinPrep has improved productivity and decreased the number of unsatisfactory cases. There was no adverse effect on quality during the changeover.