Methods for Economic Evaluations of Novel Oral Anticoagulants in Patients with Atrial Fibrillation: A Systematic Review.

BACKGROUND: Atrial fibrillation (AF) is a severe epidemiological and public health concern among the elderly population worldwide, with substantial economic and social burdens. Economic evaluations can play an essential role in optimizing the utilization of scarce resources. In recent years, the number of economic evaluation studies related to AF has increased due to the rising number of AF patients, the continuous updating of clinical data, and the emergence of real-world evidence. However, there are still deficiencies in model settings and parameter sources in relevant studies. OBJECTIVE: This study aims to review the existing economic evaluations of novel oral anticoagulants (NOACs) in patients with AF and summarize the evidence and methods applied. METHODS: A comprehensive and systematic search was conducted on electronic databases, including PubMed, Embase, Web of Science (WOS), and The Cochrane Library, from the date of database creation to November 2022. The reporting quality of included literature was assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement. RESULTS: A total of 102 studies were included in the review, with 200 comparisons between NOACs and vitamin K antagonists (VKAs), as well as 58 comparisons between different NOACs. The healthcare sector and payer perspectives were the most common, and accordingly, the majority of the evaluations considered only direct medical costs. Most studies used Markov cohort models with the number of health states ranging from 4 to 29. Of included studies, 80 (78%) considered event recurrence and complications, and 78 (76%) considered discontinuation and second-line therapy. All of the studies applied uncertainty analysis to explore the robustness of the results. Of all 200 NOACs-VKAs comparisons, 149 (75%) showed that NOACs were more cost-effective; this proportion was 84% (139 out of 165) in high-income countries but decreased to 29% (10 out of 35) in middle- and low-income countries. Most (82%) of the 28 items in the CHEERS 2022 checklist were elucidated in the majority of included studies. A minority (only 39%) of included studies demonstrated high reporting quality. CONCLUSION: NOACs may be more cost-effective than VKAs in patients with AF, but this conclusion applies to high-income countries, whereas VKAs may be more cost-effective in middle- and low-income countries. The reporting quality of included studies was variable, and certain methodological issues were presented. This study highlights the economic evaluation methodology of NOACs in patients with AF and provides recommendations for modeling methods and future studies.

Estimating the cost-effectiveness threshold of advanced non-small cell lung cancer in China using mean opportunity cost and contingent valuation method.

OBJECTIVES: Monetizing health has sparked controversy and has implications for pricing strategies of emerging health technologies. Medical insurance payers typically set up thresholds for quality-adjusted life years (QALY) gains based on health productivity and budget affordability, but they rarely consider patient willingness-to-pay (WTP). Our study aims to compare Chinese payer threshold and patient WTP toward QALY gain of advanced non-small cell lung cancer (NSCLC) and to inform a potential inclusion of patient WTP under more complex decision-making scenarios. METHODS: A regression model was constructed with cost as the independent variable and QALY as the dependent variable, where the regression coefficients reflect mean opportunity cost, and by transforming these coefficients, the payer threshold can be obtained. Patient WTP was elicited through a contingent valuation method survey. The robustness of the findings was examined through sensitivity analyses of model parameters and patient heterogeneity. RESULTS: The payer mean threshold in the base-case was estimated at 150,962 yuan (1.86 times per capita GDP, 95% CI 144,041-159,204). The two scenarios analysis generated by different utility inputs yielded thresholds of 112,324 yuan (1.39 times per capita GDP) and 111,824 yuan (1.38 times per capita GDP), respectively. The survey included 85 patients, with a mean WTP of 148,443 yuan (1.83 times per capita GDP, 95% CI 120,994-175,893) and median value was 106,667 yuan (1.32 times the GDP per capita). Due to the substantial degree of dispersion, the median was more representative. The payer threshold was found to have a high probability (98.5%) of falling within the range of 1-2 times per capita GDP, while the robustness of patient WTP was relatively weak. CONCLUSIONS: In China, a country with a copayment system, payer threshold was higher than patient WTP, indicating that medical insurance holds significant decision-making authority, thus temporarily negating the need to consider patient WTP.

[Characteristics and Health Risk Assessment of Trace Elements in Atmospheric PM1 During Autumn and Winter in Qingdao].

From November 1,2018 to January 31,2019 (OP2018-2019) and from November 1,2019 to January 20, 2020 (OP2019-2020), PM1 measurement was conducted daily for two consecutive years. The concentration of trace elements in the atmospheric PM1 in Qingdao in autumn and winter was analyzed. The observation period was divided into four air quality levels (Level Ⅰ, Level Ⅱ, Level Ⅲ, and Level Ⅳ), and the characteristics and sources of the concentration of trace elements in PM1 were analyzed. The non-carcinogenic risks (Zn, Pb, Mn, Cu, and V) and carcinogenic risks (As, Cr, Ni, Cd, and Co) of different people with different air quality levels were evaluated. The results showed that the changes in total metal element concentrations were associated with changes in Ca, K, and Al concentrations at different air quality classes during OP2019-2020 compared to those during OP2018-2019 and were more influenced by dust and biomass combustion sources. Compared with that during OP2018-2019, the V concentration in different air quality levels (Level Ⅰ, Level Ⅱ, Level Ⅲ, and Level Ⅳ) during OP2019-2020 decreased by 19.0%, 60.5%, 82.7%, and 77.5%, respectively. This was presumed to be related to the implementation of the Domestic Emission Control Area (DECA) policy for ships, which led to the significant reduction in V concentration due to the change in fuel quality of ships in the waters around Qingdao. The results of the enrichment factor, the ratio method, and the backward trajectory of airflow further indicated that the changes in V concentrations were mainly influenced by the DECA policy. However, after the implementation of the DECA, the V/Ni value as a limit for judging the influence of ship sources in the area required further exploration. The health risk assessment results showed that the risk factor of Mn ranged from 0.07 to 1.22 during OP2018-2019 and OP2019-2020. It was recommended to strengthen the management and control of Mn-containing pollution sources. The lifetime carcinogenic risk (ILCR) value of As and Cd under different air qualities during OP2018-2019 and OP2019-2020 was lower than 10-4 but higher than 10-6, indicating that there was a carcinogenic probability, although it was still at an acceptable level. During OP2018-2019, when the air quality was Ⅳ, the ILCR value of Cr was higher than 10-4, and there was a risk of cancer.

Inequalities in changing mortality and life expectancy in Jiading District, Shanghai, 2002-2018.

BACKGROUND: Improvements of population health in China have been unevenly distributed among different sexes and regions. Mortality Registration System provides an opportunity for timely assessments of mortality trend and inequalities. METHODS: Causes of death were reclassified following the method of Global Burden of Disease Study (GBD). Age-standardized mortality rate (ASMR) and ring-map of the rate by town were used to describe inequalities in changing mortality. Life expectancy (LE) and cause-deleted LE were calculated on the basis of life table technique. RESULTS: The burden of death from 2002 to 2018 was dominated by cardiovascular diseases (CVD), neoplasms, chronic respiratory diseases and injuries in Jiading district, accounting for almost 80% of total deaths. The overall ASMR dropped from 407.6/100000 to 227.1/100000, and LE increased from 77.86 years to 82.31 years. Women lived about 3.0-3.5 years longer than men. Besides, a cluster of lower LE was found for CVD in the southeast corner and one cluster for neoplasms in the southern corner of the district. The largest individual contributor to increment in LE was neoplasms, ranged from 2.41 to 3.63 years for males, and from 1.60 to 2.36 years for females. CONCLUSIONS: Improvement in health was mainly attributed to the decline of deaths caused by CVD and neoplasms, but was distributed with sex and town. This study served as a reflection of health inequality, is conducive to formulate localized health policies and measures.

Correction to: Medical expenditure for patients with hemophilia in urban China: data from medical insurance information system from 2013 to 2015.

An amendment to this paper has been published and can be accessed via the original article.

Q-Matrix Designs of Longitudinal Diagnostic Classification Models With Hierarchical Attributes for Formative Assessment.

Longitudinal diagnostic classification models (DCMs) with hierarchical attributes can characterize learning trajectories in terms of the transition between attribute profiles for formative assessment. A longitudinal DCM for hierarchical attributes was proposed by imposing model constraints on the transition DCM. To facilitate the applications of longitudinal DCMs, this paper explored the critical topic of the Q-matrix design with a simulation study. The results suggest that including the transpose of the R-matrix in the Q-matrix improved the classification accuracy. Moreover, 10-item tests measuring three linear attributes across three time points provided satisfactory classification accuracy for low-stakes assessment; lower classification rates were observed with independent or divergent attributes. Q-matrix design recommendations were provided for the short-test situation. Implications and future directions were discussed.

α-Satellite: An AI-Driven System and Benchmark Datasets for Dynamic COVID-19 Risk Assessment in the United States.

The fast evolving and deadly outbreak of coronavirus disease (COVID-19) has posed grand challenges to human society. To slow the spread of virus infections and better respond for community mitigation, by advancing capabilities of artificial intelligence (AI) and leveraging the large-scale and up-to-date data generated from heterogeneous sources (e.g., disease related data, demographic, mobility and social media data), in this work, we propose and develop an AI-driven system (named α-Satellite), as an initial offering, to provide dynamic COVID-19 risk assessment in the United States. More specifically, given a point of interest (POI), the system will automatically provide risk indices associated with it in a hierarchical manner (e.g., state, county, POI) to enable people to select appropriate actions for protection while minimizing disruptions to daily life. To comprehensively evaluate our system for dynamic COVID-19 risk assessment, we first conduct a set of empirical studies; and then we validate it based on a real-world dataset consisting of 5,060 annotated POIs, which achieves the area of under curve (AUC) of 0.9202. As of June 18, 2020, α-Satellite has had 56,980 users. Based on the feedback from its large-scale users, we perform further analysis and have three key findings: i) people from more severe regions (i.e., with larger numbers of COVID-19 cases) have stronger interests using our system to assist with actionable information; ii) users are more concerned about their nearby areas in terms of COVID-19 risks; iii) the user feedback about their perceptions towards COVID-19 risks of their query POIs indicate the challenge of public concerns about the safety versus its negative effects on society and the economy. Our system and generated datasets have been made publicly accessible via our website.

Medical expenditure for patients with hemophilia in urban China: data from medical insurance information system from 2013 to 2015.

BACKGROUND: Hemophilia, a high-cost disease, is the only rare disease covered by basic medical insurance in all province of China. However, very few studies have estimated the medical expenditure of patients with this rare disease Therefore, this study is aimed at evaluating the medical expenditure of patients with hemophilia and identifying its determinants. METHODS: The study population included 450 patients with hemophilia who were extracted from the national insurance database between 2014 and 2016. An independent-sample Kolmogorov-Smirnov test was performed to compare the medical expenditure of patients with hemophilia covered under urban employee basic medical insurance (UEBMI) and urban residence basic medical insurance (URBMI). Quantile regression analysis was conducted to explore the factors that affect the medical expenditure of patients with hemophilia. RESULTS: The total annual medical expenditure of patients with hemophilia in 2013, 2014, and 2015 had median of ¥7167 (US$ 1156), ¥3522 (US$ 577), and ¥4197 (US$ 677), respectively. The median medical expenditures of patients with hemophilia covered by UEBMI were ¥10,991 (US$ 1773), ¥2301 (US$ 377) and ¥8074 (US$ 1302), those of patients covered by URBMI were ¥4000 (US$ 645), ¥5717 (US$ 937) and ¥3141 (US$ 507) from 2013 to 2015. The differences in the medical expenditure of patients with hemophilia between UEBMI and URBMI from 2013 to 2015 were statistically significant. The number of admissions and the number of hospital days were statistically significant and positive for all quantiles. The types of medical service were statistically significant and negative for 50th quantile, and the reimbursement ratio was statistically significant and positive for 50th and 75th quantiles. (p < 0.05). CONCLUSION: The medical expenditure of patients with hemophilia was lower than that of patients with other common rare diseases that were not included in the scope of basic medical insurance reimbursement. It was also observed that the medical expenditure was mainly influenced by the severity of disease, and partly affected by the reimbursement rate.

Out-of-pocket expenses for myasthenia gravis patients in China: a study on patients insured by basic medical insurance in China, 2013-2015.

BACKGROUND: Myasthenia gravis is a rare autoimmune neuromuscular disorder. The disorder requires long-term use of expensive medication to control clinical symptoms. This study analyzed the change in trends of total medical expenses and out-of-pocket expenses for patients with myasthenia gravis and explored the factors influencing them. METHODS: In this retrospective study, data were derived from a survey of medical service utilization for patients insured by the Urban Basic Medical Insurance in China from 2013 to 2015. The cost data of 3347 patients with myasthenia gravis were included in this study. The baseline characteristics and medical expenses for patients with myasthenia gravis were analyzed using a descriptive method. The difference and influencing factors of the out-of-pocket ratio were analyzed from both outpatient and inpatient expenses by using the quantile regression method. RESULTS: The total expenses reimbursed by the Urban Basic Medicine Insurance for all patients with myasthenia gravis fell progressively from 73.1 to 58.7% during the study period. Patients' out-of-pocket expenses increased gradually, of which expenses within the scope of Basic Medicine Insurance increased from 14.7 to 22.6% and expenses outside of the Basic Medicine Insurance scope increased from 12.6 to 18.7%. Moreover, the panel quantile results showed a positive correlation between the year of receiving treatment and the out-of-pocket ratio. In addition to the 25th quantile of the out-of-pocket ratio among outpatients with myasthenia gravis, there were significant differences in medical insurance and medical institution among all the other quantiles. Significant regional differences were found in all quantiles of the out-of-pocket ratio, except for the 75th quantile among inpatients. Lastly, age had a negative effect on inpatients with myasthenia gravis across all quantiles, but not on outpatients. CONCLUSIONS: From 2013 to 2015, patients with myasthenia gravis's out-of-pocket expenses increased progressively. Moreover, the individual out-of-pocket ratio was affected by the year, medical insurance, medical institution, region, and age. The current medical insurance policy for the general public has a low ability to cater for patients with myasthenia gravis.

Effect of the catastrophic medical insurance on household catastrophic health expenditure: evidence from China.

OBJECTIVE: China launched an innovative program of catastrophic medical insurance (CMI) to protect households from catastrophic health expenditure (CHE) and impoverishment. This article assesses the effect of CMI on relieving CHE and impoverishment from catastrophic illnesses in urban and rural China. METHOD: In total, 8378 cases are included in the analysis. We employed descriptive statistical analysis to compare the incidence and intensity of CHE at five health expenditure levels, from 1 June 2014 to 31 May 2015. To illustrate the different protection of the policy, we analyzed the data in two lines, the covered medical expenses and the total medical expenses. RESULTS: CMI drop down CHE incidence from 4.8% to 0.1% and the mean catastrophic payment gap from 7.9% to zero when only considering covered medical expenses. CMI drop down CHE incidence from 15.5% to 7.9% and the mean catastrophic payment gap from 31.2% to 14.7% when considering total medical expenses. If CMI reimburse uncovered medical expenses at 30%, the mean catastrophic payment gap could be 7.9% and insured person's annual premium will increase US$2.19. CONCLUSIONS: China CMI perfectly meet the pursued policy objectives when only considering the covered medical expenses. However, when considering the total medical expenses, the CMI is only partially effective in protecting households from CHE. The considerable gap is the result of the limitation of CMI list.

Preclinical assessment of histone deacetylase inhibitor quisinostat as a therapeutic agent against esophageal squamous cell carcinoma.

Esophageal squamous cell carcinoma (ESCC) is one of the most serious life-threatening malignancies. Although chemotherapeutic targets and agents for ESCC have made much progress recently, the efficacy is still unsatisfactory. Therefore, there is still an unmet medical need for patients with ESCC. Here, we report the expression status of HDAC1 in human ESCC and matched paracancerous tissues, and the results indicated that HDAC1 was generally upregulated in ESCC specimens. Furthermore, we comprehensively assessed the anti-ESCC activity of a highly active HDAC1 inhibitor quisinostat. Quisinostat could effectively suppress cellular viability and proliferation of ESCC cells, as well as induce cell cycle arrest and apoptosis even at low treatment concentrations. The effectiveness was also observed in KYSE150 xenograft model when quisinostat was administered at tolerated doses (3 mg/kg and 10 mg/kg). Meanwhile, quisinostat also had the ability to suppress the migration and invasion (pivotal steps of tumor metastasis) of ESCC cells. Western blot analysis indicated that quisinostat exerted its anti-ESCC effects mainly through blockade of Akt/mTOR and MAPK/ERK signaling cascades. Overall, HDAC1 may serve as a potential therapeutic target for ESCC, and quisinostat deserves to be further assessed as a promising drug candidate for the treatment of ESCC.

Analysis on Medical Expenses of Hypertensive Inpatients in Urban Areas from 2010 to 2013-Evidence from Two Provinces in South of China.

Along with the development of society and the rapid economic growth in the past decades, hypertension and other chronic diseases have become important reasons for people's poverty caused by illness in China. This study collected a total of 5857 people from 2010 to 2013 randomly from the database of the Medical Insurance Department (MID), including 3229 people in Hubei province and 2628 people in Guangdong province. One-way ANOVA was used to compare the total medical expense, out-of-pocket (OOP) expense and hospital stay between variables. A multiple linear regression analysis was done to identify possible risk factors of total medical expense. The results showed that the average total medical expense per capita was 5709.89 yuan, and the medical expense per capita was 7053.58 and 4555.97 yuan in Guangdong province and Hubei province, respectively. The medical expense of hypertensive inpatients decreased from 7222.32 yuan in 2012 to 4894.66 yuan in 2013. There were no significant differences in medical expenses between different genders of hypertensive patients (P>0.05). People of different ages, provinces, medical insurances and medical institution levels showed significant differences in medical expenses. The government should increase the investment in chronic disease management and treatment in the central and western regions to narrow the gap with the eastern region. Medical insurance fund payment should be improved to ensure the fairness of the use of medical services in different medical insurances. And measures should be taken to encourage chronic patients to visit primary medical institutions to effectively reduce medical expenses.

Assessment of Sugar Components and Genes Involved in the Regulation of Sucrose Accumulation in Peach Fruit.

Soluble sugar contents in mature fruits of 45 peach accessions were quantified using gas chromatography analysis. Sucrose is the predominant sugar in mature fruit, followed by glucose and fructose, which have similar concentrations. Overall, sucrose metabolism and accumulation are crucial determinants of sugar content in peach fruit, and there is a wide range of sucrose concentrations among peach genotypes. To understand the mechanisms regulating sucrose accumulation in peach fruit, expression profiles of genes involved in sucrose metabolism and transport were compared among four genotypes. Two sucrose-cleaving enzyme genes (SUS4 and NINV8), one gene involved in sucrose resynthesis (SPS3), and three sugar transporter genes (SUT2, SUT4, and TMT2) were prevalently expressed in peach fruit, and their expression levels are significantly correlated with sucrose accumulation. In contrast, the VAINV genes responsible for sucrose cleavage in the vacuole were weakly expressed in mature fruit, suggesting that the sucrose-cleaving reaction is not active in the vacuole of sink cells of mature peach fruit. This study suggests that sucrose accumulation in peach fruit involves the coordinated interaction of genes related to sucrose cleavage, resynthesis, and transport, which could be helpful for future peach breeding.

Pollution resistance assessment of existing landscape plants on Beijing streets based on air pollution tolerance index method.

Various plant species of green belt in urban traffic area help to reduce air pollution and beautify the city environment. Those plant species growing healthily under long-term atmospheric pollution environment are considered to be resilient. This study aims to identify plant species that are more tolerant to air pollution from traffic and to give recommendations for future green belt development in urban areas. Leaf samples of 47 plant species were collected from two heavy traffic roadside sites and one suburban site in Beijing during summer 2014. Four parameters in leaves were separately measured including relative water content (RWC), total chlorophyll content (TCH), leaf-extract pH (pH), and ascorbic acid (AA). The air pollution tolerance index (APTI) method was adopted to assess plants' resistance ability based on the above four parameters. The tolerant levels of plant species were classified using two methods, one by comparing the APTI value of individual plant to the average of all species and another by using fixed APTI values as standards. Tolerant species were then selected based on combination results from both methods. The results showed that different tolerance orders of species has been found at the three sampling sites due to varied air pollution and other environmental conditions. In general, plant species Magnolia denudata, Diospyros kaki, Ailanthus altissima, Fraxinus chinensis and Rosa chinensis were identified as tolerant species to air pollution environment and recommend to be planted at various location of the city, especially at heavy traffic roadside.

Are Chinese consumers at risk due to exposure to metals in crayfish? A bioaccessibility-adjusted probabilistic risk assessment.

Freshwater crayfish, the world's third largest crustacean species, has been reported to accumulate high levels of metals, while the current knowledge of potential risk associated with crayfish consumption lags behind that of finfish. We provide the first estimate of human health risk associated with crayfish (Procambarus clarkii) consumption in China, the world's largest producer and consumer of crayfish. We performed Monte Carlo Simulation on a standard risk model parameterized with local data on metal concentrations, bioaccessibility (φ), crayfish consumption rate, and consumer body mass. Bioaccessibility of metals in crayfish was found to be variable (68-95%) and metal-specific, suggesting a potential influence of metal bioaccessibility on effective metal intake. However, sensitivity analysis suggested risk of metals via crayfish consumption was predominantly explained by consumption rate (explaining >92% of total risk estimate variability), rather than metals concentration, bioaccessibility, or body mass. Mean metal concentrations (As, Cd, Cu, Ni, Pb, Se and Zn) in surveyed crayfish samples from 12 provinces in China conformed to national safety standards. However, risk calculation of φ-modified hazard quotient (HQ) and hazard index (HI) suggested that crayfish metals may pose a health risk for very high rate consumers, with a HI of over 24 for the highest rate consumers. Additionally, the φ-modified increased lifetime risk (ILTR) for carcinogenic effects due to the presence of As was above the acceptable level (10(-5)) for both the median (ILTR=2.5×10(-5)) and 90th percentile (ILTR=1.8×10(-4)), highlighting the relatively high risk of As in crayfish. Our results suggest a need to consider crayfish when assessing human dietary exposure to metals and associated health risks, especially for high crayfish-consuming populations, such as in China, USA and Sweden.

Rapid prototyping-assisted maxillofacial reconstruction.

Rapid prototyping (RP) technologies have found many uses in dentistry, and especially oral and maxillofacial surgery, due to its ability to promote product development while at the same time reducing cost and depositing a part of any degree of complexity theoretically. This paper provides an overview of RP technologies for maxillofacial reconstruction covering both fundamentals and applications of the technologies. Key fundamentals of RP technologies involving the history, characteristics, and principles are reviewed. A number of RP applications to the main fields of oral and maxillofacial surgery, including restoration of maxillofacial deformities and defects, reduction of functional bone tissues, correction of dento-maxillofacial deformities, and fabrication of maxillofacial prostheses, are discussed. The most remarkable challenges for development of RP-assisted maxillofacial surgery and promising solutions are also elaborated.

Factors implicated in the assessment of aminolevulinic acid-induced protoporphyrin IX fluorescence.

BACKGROUND: Photodynamic therapy and photodiagnosis of cancer requires preferential accumulation of fluorescent photosensitizers in tumors. Clinical evidence documents feasibility of ALA-based photodiagnosis for tumor detection. However, false positive results and large variations in fluorescence intensities are also reported. Furthermore, selective accumulation of fluorescent species of photosensitizers in tumor cell lines, as compared to normal ones, when cultured in vitro, is not always observed. To understand this discrepancy we analyzed the impact of various factors on the intensity of detected PpIX fluorescence. METHODS: Impacts of cell type, mitochondrial potential, cell-cell interactions and relocalization of PpIX among different cell types in co-cultures of different cell lines were analyzed by confocal microscopy and flow cytometry. Fluorescence spectroscopy was used to estimate absolute amounts of ALA-induced PpIX in individual cell lines. Immunofluorescence staining was applied to evaluate the ability of cell lines to produce collagen. RESULTS: Higher ALA-induced PpIX fluorescence in cancer cell lines as compared to normal ones was not detected by all the methods used. Mitochondrial activity was heterogeneous throughout the cell monolayers and could not be clearly correlated with PpIX fluorescence. Positive collagen staining was detected in all cell lines tested. CONCLUSIONS: Contrary to in vivo situation, ALA-induced PpIX production by cell lines in vitro may not result in higher PpIX fluorescence signals in tumor cells than in normal ones. We suggest that a combination of several properties of tumor tissue, instead of tumor cells only, is responsible for increased ALA-induced PpIX fluorescence in solid tumors. GENERAL SIGNIFICANCE: Understanding the reasons of increased ALA-induced PpIX fluorescence in tumors is necessary for reliable ALA-based photodiagnosis, which is used in various oncological fields.

Morphologic assessment for glaucoma in the Multicenter Uveitis Steroid Treatment (MUST) trial.

PURPOSE: To compare Reading Center (RC) cup-to-disc ratio (CDR) assessment from stereoscopic photographs with clinician estimation in a uveitis clinical trial. METHODS: Clinical estimation of CDR was performed by ophthalmologists via dilated biomicroscopy. Photographic evaluation was performed at an independent RC by masked, certified evaluators. Quality control was performed by repeat grading of 77 randomly selected images. RESULTS: Among 479 eyes with uveitis, 353 eyes had clinical and photographic grades for CDR. Agreement between clinical and RC grading was fair, with exact agreement of 29%. Agreement within 0.1 and 0.2 CDR was 70 and 93%, respectively (weighted κ = .34). Intergrader reproducibility at the RC was better (weighted κ = .59, ICC 0.74). CONCLUSION: Morphologic assessment of cup to disc ratio is an important outcome and safety measure for determining glaucomatous damage in clinical trials. Masked RC measurements are more likely to be accurate than biomicroscopic grading in identifying meaningful anatomical change associated with glaucoma.

Assessing the disease burden of Yi people by years of life lost in Shilin county of Yunnan province, China.

BACKGROUND: Years of Life Lost (YLL) is one of the methods used to estimate the duration of time lost due to premature death. While previous studies of disease burden have been reported using YLL, there have been no studies investigating YLL of Yi people in rural China. Yunnan Province ranks first in terms of Yi people in China. This paper uses YLL to estimate the disease burden of Yi people in Shilin county of Yunnan Province. This study aims to address the differentials about YLL between Yi people and Han people for providing useful information for health planning. METHODS: We applied the Global Burden of Disease (GBD) method created by WHO. YLL rate per 1,000 were calculated from medical death certificates in 2003 in Shilin Yi Nationality Autonomous County (Shilin county). RESULTS: The male had greater YLL rate per 1,000 than did the female almost in each age group. It demonstrated a higher premature mortality burden due to injuries in Shilin county. Among the top non-communicable diseases, respiratory diseases are the most common mortality burden. Yi people are still suffering from maternal conditions, with two times the burden rates of Han people. For Yi people, while malignant neoplasm was one of the least burden of disease for male, it was the greatest for female, which is the opposite to Han people. CONCLUSION: Strategies of economic development should be reviewed to enhance the prevention and treatment of injuries, maternal conditions and respiratory diseases for Yi people.