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Introduction: Due to their impact on healthcare systems, the sustainability and optimization of high-cost drugs is an issue of concern for several countries. Different strategies have been implemented such as centralized purchasing to optimize budgetary resources. However, there is still a need for a mechanism to optimize these drugs further., Methods: We conducted this prospective multicenter intervention study in five hospitals in the Andalusian Public Health System of Cádiz (Spain) between July 2019 and September 2021. We developed an online website (Farmastock) and implemented it to determine the availability of high-cost, low-use, and near-expiry medicines in each hospital. We used a simple analysis using operational variables to assess the project intervention's savings impact on managing these high-cost drugs., Results: The implementation of Farmastock in Cádiz resulted in savings of 675,757.52 € for the Andalusian Public Health System, with 238 medicines transferred out of the 373 available. Of these medicines offered, the most considerable percentage were medicines used for pathologies with high clinical instability and accounted for nearly 80% of the medicines optimized by the tool., Conclusions: Farmastock allowed the Andalusian Public Health System to make substantial financial savings by not making new purchases of high-cost drugs available in other centers of this health network that were not being used. Therefore, this tool is a very efficient measure to contribute to the sustainability of the APHS and could be implemented in more hospitals soon., Competing Interests: Conflict of interestThe authors declare that they have no known competing financial conflicts of interest or personal relationships., (© The Author(s) 2022.)

Endometriosis is a complex disease characterized by inflammation and the growth of endometrial- like glands and stroma outside the uterine cavity. The pathophysiology of endometriosis is not entirely understood, however, with a prevalence of ~10% of women in their reproductive years, the disease symptoms significantly affect the quality of life of millions of women globally. Metabolomic studies have previously identified specific metabolites that could be a signature of endometriosis. This approach could potentially be used as a non-invasive tool for early diagnosis and provide a better understanding of endometriosis pathophysiology. This review aims to provide insight as to how endometriosis affects the metabolome by reviewing different studies that have used this approach to design follow-up studies. The search query included the term 'endometriosis' in combination with 'metabolomics', 'lipidomics', or 'sphingolipidomics' published between 2012 and 2020. We included studies in humans and animal models. Most studies reported differences in the metabolome of subjects with endometriosis in comparison to healthy controls and used samples taken from serum, endometrial tissue, follicular fluid, urine, peritoneal fluid, or endometrial fluid. Statistically significant metabolites contributed to group separation between patients and healthy controls. Reported metabolites included amino acids, lipids, organic acids, and other organic compounds. Differences in methods, analytical techniques, and the presence of confounding factors can interfere with results and interpretation of data. Metabolomics seems to be a promising tool for identifying significant metabolites in patients with endometriosis. Nonetheless, more investigation is needed in order to understand the significance of the study results., Lay Summary: Endometriosis is a chronic disease affecting the quality of life in one out of every ten women during their reproductive years, causing pain and infertility. It is characterized by inflammation and growth of tissue like the endometrium (uterus lining) outside the uterine cavity. Studies have searched for a predictor of endometriosis-associated changes by observing small molecules necessary for metabolism on a large scale (metabolomics). Metabolomics could serve to resolve one of the biggest challenges that patients with endometriosis face: a delay in diagnosis. In this review, the authors summarize identified potential biomarkers from various bodily fluids and tissues that are characteristic of metabolic processes observed in endometriosis. Biomarkers include cell growth, cell survival, high energy demand, oxidative stress, and fatty acid levels. A metabolomics approach offers promise as a non-invasive tool to identify significant metabolite changes in patients with endometriosis, potentially leading to earlier diagnoses and new opportunities for back-translational strategies., Competing Interests: C B A and A T R hold a US patent for repurposing the corticotrophin-releasing hormone inhibitor antalarmin to treat endometriosis. C N O declares no conflict of interest., (© 2021 The authors.)

Background: Studies on the barriers to preventive dental care for preschool-aged children in Medicaid often focus on whether parents understand the importance of preventive dental care. Fewer studies have examined the perceptions and experiences of parents once their child begins utilizing dental care. This qualitative study of parents who are using preventive dental care for their preschool-aged, Medicaid enrolled children uses parental perceptions and experiences to help us understand the barriers to preventive dental care., Methods: This qualitative study focused on 41 parents who participated in focus groups designed to uncover barriers and facilitators to preventive dental care use for young children in Medicaid., Results: Parents of preschool-aged children enrolled in Medicaid face a number of barriers when trying to utilize preventive dental care, even when the parents are experienced with accessing care for their young children. These barriers can be broadly categorized into system-level barriers and provider-level barriers. System-level barriers are related to the low number of dentists who accept Medicaid and/or young children. Provider-level barriers are centered on dentist behavior or clinic environment., Conclusion: Families of preschool-aged children in Medicaid continue to encounter barriers to preventive care even after the child initially utilizes care, which suggests that access to dental care is an ongoing problem for young Medicaid-enrolled children. Interventions that address system-level and provider-level barriers to care can help to ensure continual access to preventive dental care through childhood for Medicaid-enrolled children.