Age Pathognomonic Indicators of Injury Predisposition as a Basis for Public Health Preservation during Physical Activity.

A necessary condition for public health maintenance is regular physical activity. A significant increase in the number of musculoskeletal injuries, occurring during physical education and sport activities, actualizes the development of effective measures for their prevention. Early diagnosis of injury predisposition, based on identification of connective tissue dysplasia indicators specific for different age periods, is of particular importance for the prevention of such injuries. The study, performed in accordance to STROBE guidelines, included 78 persons separated into two age subgroups: Group 1 (age 22-35) and Group 2 (age 36-47). Morphometric signs of connective tissue dysplasia and clinical symptoms associated with predisposition to chronic injury were assessed. For persons in Group 1, these indicators included: asthenic body type, joint hypermobility, thin elastic skin, keloid scars, and soft auricles. For the second group: kyphosis, skin hyperpigmentation above the spine, flatfeet, valgus installation, rectus muscles diastasis, atrophic striae, recurrent hernias, and lower-limb varicosity. Universal pathognomonic indicators, such as "crunching" in the temporomandibular joint, gothic palate, altered chest shape, scoliosis, and X- and O-shaped legs are significant at any age. The established pathognomonic indicators will promote early diagnosis of injury predisposition help, and develop effective measures of their prevention and public health preservation during physical activity.

Streamlining the screening cascade for active Hepatitis C in Russia: A cost-effectiveness analysis.

OBJECTIVE: Screening for hepatitis C in Russia is a complex process that involves several visits and stepwise testing, limiting adherence and substantially reducing the yield in the identification of active infections. We aimed to evaluate the cost-effectiveness of different screening algorithms from a health system perspective. METHODS: A decision analytic model was applied to a hypothetical adult population eligible to participate in a general screening program for hepatitis C in Russia. The standard pathway (I: Screen for anti-HCV antibodies followed by a nucleic acid test for HCV RNA on antibody positives) was compared to three alternatives (II: Screen for antibodies, a reflexed test for HCV antigen on antibody positives, and RNA on antigen negatives; III: Screen for antibodies, a reflexed test for HCV antigen on antibody positives; IV: Screen for antigen). Each strategy considered a cascade of events (referral, adherence, testing, diagnosis) that must occur for screening to be effective. The primary measure of effectiveness was the number of diagnosed active infections. Calculations followed a health system perspective with costs derived from 2017 reimbursement rates and a willingness-to-pay of 2,000RUB ($82) per diagnosed active infection. Model was tested with deterministic and probabilistic sensitivity analyses. RESULTS: Non-adherence to screening stages reduced the capture rate of active infections in Strategy I from 79.0% to 40.6%. Strategies II, III, and IV were less affected and identified 69%, 67%, and 104% more infections. Average costs per diagnosed infection were decreased by 41% from 89,599RUB ($3,681) for I to 53,072RUB ($2,180), 53,004RUB ($2,177), and 59,633RUB ($2,450) for II, III, and IV, respectively. With a probability of 97%, Strategy III was most cost-effective with an incremental cost-effectiveness ratio vs. I of -1,373RUB (CI: -5,011RUB to -2,033RUB; $-56; CI: -$206 to -$84). Below a willingness-to-pay of 91,000RUB ($3,738), Strategy IV was not cost-effective. Sensitivity analyses confirmed the robustness of results. CONCLUSIONS: Testing strategies for hepatitis C with HCV antigen on HCV antibody positive cases offer a streamlining opportunity for population screening programs. Those shall increase the chances for detecting active infections and are cost-effective over current practice in Russia.