Health of farmed fish: its relation to fish welfare and its utility as welfare indicator

This brief review focuses on health and biological function as cornerstones of fish welfare. From the function-based point of view, good welfare is reflected in the ability of the animal to cope with infectious and non-infectious stressors, thereby maintaining homeostasis and good health, whereas stressful husbandry conditions and protracted suffering will lead to the loss of the coping ability and, thus, to impaired health. In the first part of the review, the physiological processes through which stressful husbandry conditions modulate health of farmed fish are examined. If fish are subjected to unfavourable husbandry conditions, the resulting disruption of internal homeostasis necessitates energy-demanding physiological adjustments (allostasis/acclimation). The ensuing energy drain leads to trade-offs with other energy-demanding processes such as the functioning of the primary epithelial barriers (gut, skin, gills) and the immune system. Understanding of the relation between husbandry conditions, allostatic responses and fish health provides the basis for the second theme developed in this review, the potential use of biological function and health parameters as operational welfare indicators (OWIs). Advantages of function- and health-related parameters are that they are relatively straightforward to recognize and to measure and are routinely monitored in most aquaculture units, thereby providing feasible tools to assess fish welfare under practical farming conditions. As the efforts to improve fish welfare and environmental sustainability lead to increasingly diverse solutions, in particular integrated production, it is imperative that we have objective OWIs to compare with other production forms, such as high-density aquaculture. However, to receive the necessary acceptance for legislation, more robust scientific backing of the health- and function-related OWIs is urgently neede

Cost-effective screening strategy to prevent venous thromboembolism in combined oral contraceptive users

Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of global morbidity and mortality, with a significant societal and economic burden. Combined oral contraceptives (COCs) increase VTE risk by 2- to 6-fold, resulting in approximately 22,925 cases annually in the European Economic Area (EEA). Despite the high associated healthcare costs, which may reach 2.5 billion EUR annually, current international guidelines, including those from the World Health Organization (WHO) and the Faculty of Sexual and Reproductive Healthcare (FSRH), discourage routine thrombophilia screening prior to COC prescription, citing low cost-effectiveness, low prevalence of thrombophilia, and potential unintended consequences, such as reduced contraceptive use. Recent advancements in screening technology challenge these guidelines. The normalized Activated Protein C sensitivity ratio (nAPCsr) assay, a low-cost tool capable of detecting both inherited thrombophilia and acquired COC-induced activated protein C (APC) resistance, offers a promising strategy for targeted screening. Economic models estimate that implementing nAPCsr-based screening could prevent up to 13,500 VTE cases annually, leading to 1.5 billion EUR in annual healthcare savings. Additionally, nAPCsr-guided contraceptive counseling enables personalized decision-making, directing high-risk women toward safer contraceptive options, such as progestin-only pills or COCs containing natural estrogens (estradiol or estetrol), which present a lower thrombotic risk. This manuscript emphasizes the necessity of updating current prevention strategies by integrating innovative screening tools like the nAPCsr assay. By addressing both direct healthcare costs and indirect costs related to productivity loss and long-term complications, such a strategy could improve patient safety, reduce the financial burden on healthcare systems, and promote equitable access to safer contraceptive methods. Furthermore, targeted screening could alleviate the underrepresentation of high-risk women in current cost estimates and significantly mitigate the societal impact of COC-associated VTE. In light of these findings, reconsidering current policy recommendations appears essential to facilitate evidence-based, cost-effective prevention of COC-related thrombotic events, ultimately enhancing public health outcomes

Nuevos anticoagulantes orales en pacientes con enfermedad renal crónica

RESUMEN: Los pacientes con enfermedad renal crónica (ERC) tienen tendencias hemorrágicas y trombóticas, por lo que la indicación de anticoagulación ante la aparición de fibrilación auricular (FA) es compleja. La FA es la arritmia cardíaca crónica más frecuente, siendo el tromboembolismo y el ictus isquémico en particular las complicaciones más importantes. En los últimos an? os se han desarrollado nuevos fármacos anticoagulantes orales que han mostrado superioridad respecto a los clásicos antagonistas de la vitamina K (AVK) en la prevención de ictus, embolismo sistémico y riesgo de sangrado, constituyendo una alternativa eficaz a ellos.ABSTRACT: Patients with chronic kidney disease (CKD) develop bleeding and thrombotic tendencies, so the indication of anticoagulation at the onset of atrial fibrillation (AF) is complex. AF is the most common chronic cardiac arrhythmia, and thromboembolism and ischemic stroke in particular are major complications. In recent years, new oral anticoagulant drugs have been developed, and they have shown superiority over the classical AVK in preventing stroke, systemic embolism and bleeding risk, constituting an effective alternative to those resources