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1.
Sci Rep ; 14(1): 12690, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38830916

RESUMO

A random initialization of the search particles is a strong argument in favor of the deployment of nature-inspired metaheuristic algorithms when the knowledge of a good initial guess is lacked. This article analyses the impact of the type of randomization on the working of algorithms and the acquired solutions. In this study, five different types of randomizations are applied to the Accelerated Particle Swarm Optimization (APSO) and Squirrel Search Algorithm (SSA) during the initializations and proceedings of the search particles for selective harmonics elimination (SHE). The types of randomizations include exponential, normal, Rayleigh, uniform, and Weibull characteristics. The statistical analysis shows that the type of randomization does impact the working of optimization algorithms and the fittest value of the objective function.

2.
Parasit Vectors ; 17(1): 263, 2024 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-38886811

RESUMO

BACKGROUND: Schistosomiasis is a debilitating neglected tropical disease endemic in sub-Saharan Africa. The role of health facilities in the prevention, diagnosis, control, and elimination of schistosomiasis is poorly documented. In a setting targeted for schistosomiasis elimination in Zanzibar, we assessed the prevalence of Schistosoma haematobium among patients seeking care in a health facility and investigated schistosomiasis-related knowledge of staff, and health facilities' capacities and needs for schistosomiasis diagnosis and management. METHODS: We conducted a health facility-based mixed-method study on Pemba Island from June to August 2023. Patients aged ≥ 4 years seeking care in four health facilities were screened for S. haematobium infection using urine filtration and reagent strips. Those patients aged ≥ 10 years were additionally interviewed about signs and symptoms. Staff from 23 health facilities responded to a questionnaire assessing knowledge and practices. Ten staff participated in a focus group discussion (FGD) about capacities and needs for schistosomiasis diagnosis and management. RESULTS: The prevalence of S. haematobium infection in patients attending the health facilities, as determined by the presence of eggs in urine, was 1.1% (8/712). Microhaematuria was detected in 13.3% (95/712) of the patients using reagent strips. Among patients responding to the questionnaire, pelvic pain, pain during sex, and painful urination were reported by 38.0% (237/623), 6.3% (39/623), and 3.2% (20/623), respectively. Among the health facility staff, 90.0% (44/49) and 87.8% (43/49) identified blood in urine and pelvic pain, respectively, as symptoms of urogenital schistosomiasis, 81.6% (40/49) and 93.9% (46/49) reported collecting a urine sample and pursuing a reagent strip test, respectively, for diagnosis, and 87.8% (43/49) administered praziquantel for treatment. The most reoccurring themes in the FGD were the need for more staff training about schistosomiasis, requests for diagnostic equipment, and the need to improve community response to schistosomiasis services in health facilities. CONCLUSIONS: The prevalence of S. haematobium infection in patients seeking care in health facilities in Pemba is very low and similar to what has been reported from recent community-based cross-sectional surveys. The health facility staff had good schistosomiasis-related knowledge and practices. However, to integrate schistosomiasis patient management more durably into routine health facility activities, scalable screening pathways need to be identified and capacities need to be improved by regular staff training, and an unbroken supply of accurate point-of-care diagnostics and praziquantel for the treatment of cases.


Assuntos
Instalações de Saúde , Schistosoma haematobium , Esquistossomose Urinária , Humanos , Feminino , Masculino , Criança , Prevalência , Esquistossomose Urinária/diagnóstico , Esquistossomose Urinária/epidemiologia , Esquistossomose Urinária/tratamento farmacológico , Esquistossomose Urinária/prevenção & controle , Adulto , Schistosoma haematobium/isolamento & purificação , Animais , Adolescente , Erradicação de Doenças , Adulto Jovem , Pré-Escolar , Pessoa de Meia-Idade , Tanzânia/epidemiologia , Inquéritos e Questionários , Esquistossomose/diagnóstico , Esquistossomose/epidemiologia , Esquistossomose/tratamento farmacológico , Esquistossomose/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Idoso , Pessoal de Saúde
3.
Int J Equity Health ; 23(1): 104, 2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38783326

RESUMO

BACKGROUND: Rabies is a neglected tropical disease endemic in 150 countries, including India where it is present in all states and union territories except Andaman and Nicobar Islands Lakshadweep. Kerala reports high incidence of animal bites. This article discusses the preventable death of a 17-year-old tribal girl due to rabies in Kerala and the equity concerns it raises. METHODS: The case study was conducted using qualitative methods such as rapid key informant interviews, interactions in tribal assembly meetings, unstructured participant observations, and document verification. Thematic analysis was used, and the results are presented as an ethnographic summary with the use of quotes to substantiate the observations. RESULTS: The girl had gone to a town with her sister for a few days when she developed difficulty in eating, behavioral abnormalities, and injuries on her body. She subsequently died, and a post-mortem revealed Negri bodies in her brain, confirming rabies as the cause of death. The girl had been bitten by a puppy from the forest eight months prior, but she did not receive post-exposure prophylaxis. Multiple dogs are kept in each household in the settlement, and the community takes good care of them since they protect them from wild animals. However, awareness about the need for post-exposure prophylaxis is low, and access to it is difficult for this population. The social problems in the settlement affect their quality of life and their interactions with the outside world. CONCLUSIONS: To prevent such deaths, it is essential to increase awareness and ensure equitable access to life-saving vaccines and immunoglobulin in hard-to-reach tribal areas. The cost-effectiveness of pre-exposure prophylaxis for children in high-risk areas such as this tribal settlement should be evaluated and compared with the WHO-recommended strategies of mass canine vaccination and One Health.


Assuntos
Mordeduras e Picadas , Raiva , Adolescente , Animais , Cães , Feminino , Humanos , Mordeduras e Picadas/complicações , Índia , Profilaxia Pós-Exposição , Vacina Antirrábica/uso terapêutico
4.
Clin Infect Dis ; 78(Supplement_2): S138-S145, 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38662693

RESUMO

BACKGROUND: Concerns that annual mass administration of ivermectin, the predominant strategy for onchocerciasis control and elimination, may not lead to elimination of parasite transmission (EoT) in all endemic areas have increased interest in alternative treatment strategies. One such strategy is moxidectin. We performed an updated economic assessment of moxidectin- relative to ivermectin-based strategies. METHODS: We investigated annual and biannual community-directed treatment with ivermectin (aCDTI, bCDTI) and moxidectin (aCDTM, bCDTM) with minimal or enhanced coverage (65% or 80% of total population taking the drug, respectively) in intervention-naive areas with 30%, 50%, or 70% microfilarial baseline prevalence (representative of hypo-, meso-, and hyperendemic areas). We compared programmatic delivery costs for the number of treatments achieving 90% probability of EoT (EoT90), calculated with the individual-based stochastic transmission model EPIONCHO-IBM. We used the costs for 40 years of program delivery when EoT90 was not reached earlier. The delivery costs do not include drug costs. RESULTS: aCDTM and bCDTM achieved EoT90 with lower programmatic delivery costs than aCDTI with 1 exception: aCDTM with minimal coverage did not achieve EoT90 in hyperendemic areas within 40 years. With minimal coverage, bCDTI delivery costs as much or more than aCDTM and bCDTM. With enhanced coverage, programmatic delivery costs for aCDTM and bCDTM were lower than for aCDTI and bCDTI. CONCLUSIONS: Moxidectin-based strategies could accelerate progress toward EoT and reduce programmatic delivery costs compared with ivermectin-based strategies. The costs of moxidectin to national programs are needed to quantify whether delivery cost reductions will translate into overall program cost reduction.


Assuntos
Ivermectina , Macrolídeos , Oncocercose , Macrolídeos/uso terapêutico , Macrolídeos/economia , Macrolídeos/administração & dosagem , Oncocercose/tratamento farmacológico , Oncocercose/prevenção & controle , Oncocercose/economia , Oncocercose/epidemiologia , Humanos , Ivermectina/economia , Ivermectina/uso terapêutico , Ivermectina/administração & dosagem , Administração Massiva de Medicamentos/economia , Erradicação de Doenças/economia , Análise Custo-Benefício
5.
Clin Infect Dis ; 78(Supplement_2): S160-S168, 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38662697

RESUMO

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis (GPELF) aims to reduce and maintain infection levels through mass drug administration (MDA), but there is evidence of ongoing transmission after MDA in areas where Culex mosquitoes are the main transmission vector, suggesting that a more stringent criterion is required for MDA decision making in these settings. METHODS: We use a transmission model to investigate how a lower prevalence threshold (<1% antigenemia [Ag] prevalence compared with <2% Ag prevalence) for MDA decision making would affect the probability of local elimination, health outcomes, the number of MDA rounds, including restarts, and program costs associated with MDA and surveys across different scenarios. To determine the cost-effectiveness of switching to a lower threshold, we simulated 65% and 80% MDA coverage of the total population for different willingness to pay per disability-adjusted life-year averted for India ($446.07), Tanzania ($389.83), and Haiti ($219.84). RESULTS: Our results suggest that with a lower Ag threshold, there is a small proportion of simulations where extra rounds are required to reach the target, but this also reduces the need to restart MDA later in the program. For 80% coverage, the lower threshold is cost-effective across all baseline prevalences for India, Tanzania, and Haiti. For 65% MDA coverage, the lower threshold is not cost-effective due to additional MDA rounds, although it increases the probability of local elimination. Valuing the benefits of elimination to align with the GPELF goals, we find that a willingness to pay per capita government expenditure of approximately $1000-$4000 for 1% increase in the probability of local elimination would be required to make a lower threshold cost-effective. CONCLUSIONS: Lower Ag thresholds for stopping MDAs generally mean a higher probability of local elimination, reducing long-term costs and health impacts. However, they may also lead to an increased number of MDA rounds required to reach the lower threshold and, therefore, increased short-term costs. Collectively, our analyses highlight that lower target Ag thresholds have the potential to assist programs in achieving lymphatic filariasis goals.


Assuntos
Análise Custo-Benefício , Filariose Linfática , Administração Massiva de Medicamentos , Filariose Linfática/prevenção & controle , Filariose Linfática/epidemiologia , Filariose Linfática/economia , Humanos , Administração Massiva de Medicamentos/economia , Haiti/epidemiologia , Tanzânia/epidemiologia , Prevalência , Índia/epidemiologia , Animais , Erradicação de Doenças/economia , Erradicação de Doenças/métodos , Filaricidas/uso terapêutico , Filaricidas/administração & dosagem , Filaricidas/economia , Antígenos de Helmintos/sangue , Culex
6.
Expert Rev Pharmacoecon Outcomes Res ; 24(5): 589-597, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38665122

RESUMO

INTRODUCTION: Introduction of direct acting antivirals (DAA) has transformed treatment of chronic hepatitis C (HCV) and made the elimination of HCV an achievable goal set forward by World Health Organization by 2030. Multiple barriers need to be overcome for successful eradication of HCV. Availability of pan-genotypic HCV regimens has decreased the need for genotype testing but maintained high efficacy associated with DAAs. AREAS COVERED: In this review, we will assess the cost-effectiveness of DAA treatment in patients with chronic HCV disease, with emphasis on general, cirrhosis, and vulnerable populations. EXPERT OPINION: Multiple barriers exist limiting eradication of HCV, including cost to treatment, access, simplified testing, and implementing policy to foster treatment for all groups of HCV patients. Clinically, DAAs have drastically changed the landscape of HCV, but focused targeting of vulnerable groups is needed. Public policy will continue to play a strong role in eliminating HCV. While we will focus on the cost-effectiveness of DAA, several other factors regarding HCV require on going attention, such as increasing public awareness and decreasing social stigma associated with HCV, offering universal screening followed by linkage to treatment and improving preventive interventions to decrease spread of HCV.


Assuntos
Antivirais , Análise Custo-Benefício , Genótipo , Hepatite C Crônica , Humanos , Antivirais/economia , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/economia , Acessibilidade aos Serviços de Saúde/economia , Populações Vulneráveis , Cirrose Hepática/economia , Política de Saúde , Hepacivirus/efeitos dos fármacos , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Análise de Custo-Efetividade
7.
Lancet Reg Health Southeast Asia ; 22: 100327, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38482155

RESUMO

The WHO's "End TB" initiative aims to reduce catastrophic expenses, incidence, and mortality by 90%, 80%, and 0%, respectively by 2030 and Government of India has committed to reaching these goals by 2025. Despite tremendous progress, tuberculosis (TB) remains one of the main public health issues. To limit TB transmission and expedite reduction in incidence, further measures are needed. These milestones and objectives remain aspirational until we achieve "Universal access" to high-quality TB diagnosis and treatment. The goals of the study include outlining the process of 'Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana-Arogya Karnataka' (AB-PMJAY-ArK) integration with the National TB Elimination Program (NTEP) in Karnataka, the types of TB patients who used AB-PMJAY-ArK services, and calculating the cost per TB patient at primary, secondary, and tertiary healthcare facilities, both public and private, stratified by type of service. Increased coverage, elimination of treatment delays, early and free treatment, and prevention of missing patients are benefits of integrating NTEP with Ayushman Bharat-PMJAY.

8.
J Infect Dis ; 2024 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-38537267

RESUMO

BACKGROUND: The global incidence target for the elimination of hepatitis C among people who inject drugs (PWID) is <2/100. In Norway, the hepatitis C epidemic is concentrated in PWID. Immigrants are the second most important risk group for chronic infection. We modelled the incidence of hepatitis C among active PWID, and the prevalence of chronic infection among active PWID, ex-PWID and immigrants in Norway until 2022. METHODS: We built a stochastic compartmental model, which was informed using data from national data sources, literature, and expert opinion. We report median values with 95% credible intervals (CrI). RESULTS: The model estimated 30 (95% Crl: 13-52) new infections among active PWID in 2022, or 0.37/100 (95% Crl: 0.17-0.65), down from a peak of 726 (95% Crl: 506-1,067) in 2000. Across all groups, the model estimated 3,202 (95% Crl: 1,273-6,601) chronically infected persons in 2022. Results were robust in sensitivity analyses. CONCLUSIONS: Norway provides an example of the feasibility of hepatitis C elimination in a setting with a concentrated epidemic, high coverage of harm reduction services and no treatment restrictions. Continued momentum is needed to further reduce the transmission and burden of hepatitis C in Norway.

9.
Int J Drug Policy ; 126: 104386, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38492433

RESUMO

BACKGROUND: Carceral settings are a key focus of the 2030 WHO global hepatitis C virus (HCV) elimination goals. Despite this, access to HCV testing and treatment services in prisons remains low globally, limiting opportunities to achieve these goals. Advocacy efforts are needed to address service inequities and mobilise support for enhanced HCV programs in prisons globally. INHSU Prisons, a special interest group of the International Network on Health and Hepatitis in Substance Users (INHSU) is developing a Prisons HCV Advocacy Toolkit to address this need. Here we present findings of a mixed study to inform the development of the Toolkit. METHODS: The aim of this study was to inform the development of the Toolkit, including understanding barriers for scaling up prison-based HCV services globally and advocacy needs to address these. An online survey (n = 181) and in-depth interviews (n = 25) were conducted with key stakeholders from countries of different economic status globally. Quantitative data were statistically analysed using R Studio and qualitative data were analysed thematically. The data sets were merged using a convergent design. RESULTS: Key barriers for enhanced prison-based HCV services included lack of political will and action, lack of prison-based healthcare resources, and poor awareness about HCV and the importance of prison-based HCV services. These findings underscore how advocacy efforts are needed to motivate policymakers to prioritise HCV healthcare in prisons and ensure funds are available for services (including diagnostic tools and treatment, healthcare teams to implement services, and systems to measure their success). Advocacy resources to raise the awareness of policy makers, people working in the prison sector, and incarcerated populations were also identified as key to increasing HCV service uptake. CONCLUSION: The Toolkit has the potential to support advocacy efforts for reaching HCV elimination targets. By understanding the advocacy needs of potential Toolkit end-users, the findings can inform its development and increase its accessibility, acceptability, and uptake for a globally diverse audience.


Assuntos
Acessibilidade aos Serviços de Saúde , Hepatite C , Prisões , Humanos , Hepatite C/epidemiologia , Prisões/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Defesa do Paciente , Inquéritos e Questionários , Prisioneiros , Saúde Global
10.
Infect Dis Poverty ; 13(1): 20, 2024 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-38414000

RESUMO

BACKGROUND: The disease burden of tuberculosis (TB) was heavy in Hainan Province, China, and the information on transmission patterns was limited with few studies. This atudy aims to further explore the epidemiological characteristics and influencing factors of TB in Hainan Province, and thereby contribute valuable scientific evidences for TB elimination in Hainan Province. METHODS: The TB notification data in Hainan Province from 2013 to 2022 were collected from the Chinese National Disease Control Information System Tuberculosis Surveillance System, along with socio-economic data. The spatial-temporal and population distributions were analyzed, and spatial autocorrelation analysis was conducted to explore TB notification rate clustering. In addition, the epidemiological characteristics of the cases among in-country migrants were described, and the delay pattern in seeking medical care was investigated. Finally, a geographically and temporally weighted regression (GTWR) model was adopted to analyze the relationship between TB notification rate and socio-economic indicators. The tailored control suggestions in different regions for TB elimination was provided by understanding epidemiological characteristics and risk factors obtained by GTWR. RESULTS: From 2013 to 2022, 64,042 cases of TB were notified in Hainan Province. The estimated annual percentage change of TB notification rate in Hainan Province from 2013 to 2020 was - 6.88% [95% confidence interval (CI): - 5.30%, - 3.69%], with higher rates in central and southern regions. The majority of patients were males (76.33%) and farmers (67.80%). Cases among in-country migrants primarily originated from Sichuan (369 cases), Heilongjiang (267 cases), Hunan (236 cases), Guangdong (174 cases), and Guangxi (139 cases), accounting for 53%. The majority (98.83%) of TB cases were notified through passive case finding approaches, with delay in seeking care. The GTWR analysis showed that gross domestic product per capita, the number of medical institutions and health personnel per 10,000 people were main factors affecting the high TB notification rates in some regions in Hainan Province. Different regional tailored measures such as more TB specialized hospitals were proposed based on the characteristics of each region. CONCLUSIONS: The notification rate of TB in Hainan Province has been declining overall but still remained high in central and southern regions. Particular attention should be paid to the prevalence of TB among males, farmers, and out-of-province migrant populations. The notification rate was also influenced by economic development and medical conditions, indicating the need of more TB specialized hospitals, active surveillance and other tailored prevention and control measures to promote the progress of TB elimination in Hainan Province.


Assuntos
Tuberculose , Masculino , Humanos , Feminino , China/epidemiologia , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Fatores de Risco , Análise Espacial , Regressão Espacial
11.
Public Health ; 228: 186-193, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38387115

RESUMO

OBJECTIVES: China has the largest number of hepatitis C virus (HCV) infection in the world, but current levels of diagnosis and treatment are low. The objective of this study was to assess the cost-effectiveness of various universal HCV screening and treatment strategies in China and inform decisions on health policy. STUDY DESIGN: A cost-effectiveness analytical study. METHODS: We developed a Markov model to investigate cost-effectiveness of different HCV screening and treatment strategies in China. We simulated several screening scenarios for Chinese people aged 18-70 years. We estimated incremental cost-effectiveness ratios (ICERs) of different intervention scenarios compared with status quo. RESULTS: Expanded HCV screening and treatment strategy with prioritisation for high-risk groups (Scenario S5) was the most cost-effective strategy (ICER: USD $11,667.71/quality-adjusted life-year [QALY] gained), which resulted in great reduction in HCV-related diseases and deaths, with a 67.11% reduction in cases of chronic HCV. Universal HCV screening and treatment implementation remains a cost-effective strategy when delayed until 2025 (ICER: USD $17,093.69/QALY), yet the delayed strategy is less effective in reducing HCV-related deaths. CONCLUSIONS: Expanded HCV screening and treatment strategy with prioritisation for high-risk groups is the most cost-effective strategy and has lead to a significant reduction in both HCV morbidity and mortality in China, which would essentially eliminate HCV as a public threat.


Assuntos
Hepatite C Crônica , Programas de Rastreamento , Humanos , Antivirais/uso terapêutico , China/epidemiologia , Análise Custo-Benefício , População do Leste Asiático , Hepacivirus , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso
12.
Health Sci Rep ; 7(1): e1749, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38186937

RESUMO

Introduction: High-dose methotrexate (HDMTX) is administered for the treatment of some malignancies. Serious complications after the administration of HDMTX are rare, but occasionally MTX may precipitate in the renal tubes causing a delayed elimination leading to renal, multiorgan toxicities and to life-threatening complications. This study aims to estimate the incidence and clinical management of delayed MTX elimination in France, Germany, Italy, and the UK. Methods: Twelve haemato-oncology and pediatric oncology clinical experts from leading European hospitals participated in the study. A two-round Delphi methodology was used to gather data on different variables relevant to evaluate the HDMTX induced-toxicity impact. For quantitative data, median and interquartile ranges were calculated. Data on prevalence was calculated considering the number of patients in each hospital and the population they cover, and then, extrapolated to the country population. Results: The total number of patients treated annually with HDMTX in France, Germany, Italy, and the UK is estimated in 7155. Of these, 16% are estimated to develop delayed MTX elimination and around 9% may develop HDMTX-induced acute kidney injury (AKI). Leucovorin, hyperhydration and urine alkalinization are applied to prevent MTX toxicity and precipitation whilst glucarpidase, hemofiltration and hemodialysis are being used for persisting toxic MTX serum levels. Grade 3 systemic toxicities are common in these patients, hematologic and gastrointestinal being the most common ones. Conclusions: This report provides expert clinical practice experience and opinion of the incidence and management of HDMTX-delayed elimination in France, Germany, Italy and the UK, thereby contributing to the evidence available on this relevant medical condition which can be life-threatening.

13.
Eur J Health Econ ; 2024 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-38280068

RESUMO

BACKGROUND AND AIMS: Italy has the greatest burden of hepatitis C virus (HCV) infection in Western Europe. The screening strategy represents a crucial prevention tool to achieve HCV elimination in Italy. We evaluated the cost-consequences of different screening strategies for the diagnosis of HCV active infection in the birth cohort 1948-1968 to achieve the HCV elimination goal. METHODS: We designed a probabilistic model to estimate the clinical, and economic outcomes of different screening coverage uptakes, considering the direct costs of HCV management according to each liver fibrosis stage, in the Italian context. A decision probabilistic tree simulates 4 years of HCV testing of the 1948-1968 general population birth cohort, (15,485,565 individuals to be tested) considering different coverage rates. A No-screening scenario was compared with two alternative screening scenarios that represented different coverage rates each year: (1) Incremental approach (coverage rates equal to 5%, 10%, 30%, and 50% at years 1, 2, 3, and 4, respectively) and (2) Fast approach (50% coverage rate at years 1, 2, 3 and 4). Overall 106,200 cases were previously estimated to have an HCV active infection. A liver disease progression Markov model was considered for an additional 6 years (horizon-time 10 years). RESULTS: The highest increased number of deaths and clinical events are reported for the No-screening scenario (21,719 cumulative deaths at the end of ten years; 10,148 cases with HCC and/or 7618 cases with Decompensated Cirrhosis). Following the Fast-screening scenario, the reductions in clinical outcomes and deaths were higher compared with No-screening and Incremental-screening. At ten years time horizon, less than 5696 liver deaths (PSA CI95%: - 3873 to 7519), 3,549 HCC (PSA CI95%: - 2413 to 4684) and less than 3005 liver decompensations (PSA CI 95%: - 2104 to 3907) were estimated compared with the Incremental-scenario. The overall costs of the Fast-screening, including the costs of the DAA and liver disease management of the infected patients for 10 years, are estimated to be € 43,107,543 more than no-investment in screening and € 62,289,549 less compared with the overall costs estimated by the Incremental-scenario. CONCLUSION: It is necessary to guarantee dedicated funds and efficiency of the system for the cost-efficacious screening of the 1948-1968 birth cohort in Italy. A delay in HCV diagnosis and treatment in the general population, yet not addressed for the HCV free-of-charge screening, will have important clinical and economic consequences in Italy.

14.
Environ Sci Technol ; 58(5): 2260-2270, 2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38252093

RESUMO

Multiple pieces of evidence have shown that prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances (PFASs) is closely related to adverse birth outcomes for infants. However, difficult access to human samples limits our understanding of PFASs transport and metabolism across the human placental barrier, as well as the accurate assessment of fetal PFASs exposure. Herein, we assess fetal exposure to 28 PFASs based on paired serum, placenta, and meconium samples. Overall, 21 PFASs were identified first to be exposed to the fetus prenatally and to be metabolized and excreted by the fetus. In meconium samples, 25 PFASs were detected, with perfluorooctane sulfonate and perfluorohexane sulfonic acid being the dominant congeners, suggesting the metabolism and excretion of PFASs through meconium. Perfluoroalkyl sulfonic acids might be more easily eliminated through the meconium than perfluorinated carboxylic acids. Importantly, based on molecular docking, MRP1, OATP2B1, ASCT1, and P-gp were identified as crucial transporters in the dynamic placental transfer of PFASs between the mother and the fetus. ATSC5p and PubchemFP679 were recognized as critical structural features that affect the metabolism and secretion of PFASs through meconium. With increasing carbon chain length, both the transplacental transfer efficiency and meconium excretion efficiency of PFASs showed a structure-dependent manner. This study reports, for the first time, that meconium, which is a noninvasive and stable biological matrix, can be strong evidence of prenatal PFASs exposure.


Assuntos
Ácidos Alcanossulfônicos , Fluorocarbonos , Recém-Nascido , Gravidez , Humanos , Feminino , Placenta , Mecônio/metabolismo , Simulação de Acoplamento Molecular , Ácidos Alcanossulfônicos/metabolismo , Ácidos Carboxílicos/metabolismo
15.
Children (Basel) ; 11(1)2024 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-38255416

RESUMO

Low human papillomavirus (HPV) vaccine uptake is a key barrier to cervical cancer elimination. We aimed to evaluate the health impact and cost-effectiveness of introducing different HPV vaccines into immunization programs and scaling up the screening program in Guangdong. We used a dynamic compartmental model to estimate the impact of intervention strategies during 2023-2100. We implemented the incremental cost-effectiveness ratio (ICER) in costs per averted disability-adjusted life year (DALY) as an indicator to assess the effectiveness of the intervention. We used an age-standardized incidence of 4 cases per 100,000 women as the threshold for the elimination of cervical cancer. Compared with the status quo, scaling up cervical cancer screening coverage alone would prevent 215,000 (95% CI: 205,000 to 227,000) cervical cancer cases and 49,000 (95% CI: 48,000 to 52,000) deaths during 2023-2100. If the coverage of vaccination reached 90%, domestic two-dose 2vHPV vaccination would be more cost-effective than single-dose and two-dose 9vHPV vaccination. If Guangdong introduced domestic two-dose 2vHPV vaccination at 90% coverage for schoolgirls from 2023 and increased the screening coverage, cervical cancer would be eliminated by 2049 (95% CI 2047 to 2051). Introducing two doses of domestic 2vHPV vaccination for schoolgirls and expanding cervical cancer screening is estimated to be highly cost-effective to accelerate the elimination of cervical cancer in Guangdong.

16.
Respir Physiol Neurobiol ; 320: 104199, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38000708

RESUMO

PURPOSE: To investigate the correlation between volume of carbon dioxide elimination (V̇CO2) and end-tidal carbon dioxide (PETCO2) with cardiac output (CO) in a swine pediatric acute respiratory distress syndrome (ARDS) model. METHODS: Respiratory and hemodynamic variables were collected from twenty-six mechanically ventilated juvenile pigs under general anesthesia before and after inducing ARDS, using oleic acid infusion. RESULTS: Prior to ARDS induction, mean (SD) CO, V̇CO2, PETCO2, and dead space to tidal volume ratio (Vd/Vt) were 4.16 (1.10) L/min, 103.69 (18.06) ml/min, 40.72 (3.88) mmHg and 0.25 (0.09) respectively. Partial correlation coefficients between average CO, V̇CO2, and PETCO2 were 0.44 (95% confidence interval: 0.18-0.69) and 0.50 (0.18-0.74), respectively. After ARDS induction, mean CO, V̇CO2, PETCO2, and Vd/Vt were 3.33 (0.97) L/min, 113.71 (22.97) ml/min, 50.17 (9.73) mmHg and 0.40 (0.08). Partial correlations between CO and V̇CO2 was 0.01 (-0.31 to 0.37) and between CO and PETCO2 was 0.35 (-0.002 to 0.65). CONCLUSION: ARDS may limit the utility of volumetric capnography to monitor CO.


Assuntos
Dióxido de Carbono , Síndrome do Desconforto Respiratório , Humanos , Criança , Animais , Suínos , Volume de Ventilação Pulmonar , Débito Cardíaco , Capnografia , Respiração Artificial
17.
Public Health ; 226: 215-227, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38091810

RESUMO

OBJECTIVES: We set out to characterise chronic hepatitis B (CHB) in the primary care population in England and investigate risk factors for progression to hepatocellular carcinoma (HCC). STUDY DESIGN: Retrospective cohort study. METHODS: We identified 8039 individuals with CHB in individuals aged ≥18 years between 1999 and 2019 in the English primary care database QResearch. HCC risk factors were investigated using Cox proportional hazards modelling. RESULTS: Most of those with a record of CHB were males (60%) of non-White ethnicity (>70%), and a high proportion were in the most deprived Townsend deprivation quintile (44%). Among 7029 individuals with longitudinal data, 161 HCC cases occurred. Increased HCC hazards were significantly associated with male sex (adjusted hazards ratio [aHR] 3.17, 95% confidence interval [95% CI] 1.92-5.23), in the fifth deprivation quintile as compared to the third quintile (aHR 1.69, 95% CI 1.01-2.84), with older age (for age groups 56-65 and ≥66 years, compared to 26-35 years, aHRs 2.82 [95% CI 1.45-5.46] and 3.76 [95% CI 1.79-7.9], respectively), Caribbean ethnicity (aHR 3.32, 95% CI 1.43-7.71, compared to White ethnicity), ascites (aHR 3.15, 95% CI 1.30-7.67), cirrhosis (aHR 6.55, 95% CI 4.57-9.38) and peptic ulcer disease (aHR 2.26, 95% CI 1.45-3.51). CONCLUSIONS: Targeting interventions and HCC surveillance at vulnerable groups is essential to improve CHB outcomes and to support progress towards international goals for the elimination of hepatitis infection as a public health threat.


Assuntos
Carcinoma Hepatocelular , Hepatite B Crônica , Neoplasias Hepáticas , Humanos , Masculino , Adolescente , Adulto , Idoso , Feminino , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/patologia , Vírus da Hepatite B , Neoplasias Hepáticas/epidemiologia , Hepatite B Crônica/complicações , Hepatite B Crônica/epidemiologia , Hepatite B Crônica/tratamento farmacológico , Estudos Retrospectivos , Registros Eletrônicos de Saúde , Cirrose Hepática/complicações , Cirrose Hepática/epidemiologia , Pobreza , Atenção Primária à Saúde , Antivirais/uso terapêutico
18.
J Chromatogr A ; 1715: 464612, 2024 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-38159404

RESUMO

The most crucial purpose of the measurement is to obtain a reliable result that reflects the actual qualitative and/or quantitative features of the tested material. The overriding goal of analytical chemistry is to obtain accurate results after compensating of various interference effects as well as non-linear calibration dependence. A new approach based on an integrated calibration method (ICM) supported by H-point standard addition method (HPSAM) has been used to improve the quality of analytical results. The proposed methodological approach was extended using the step-by-step dilution procedure, and five measurement conditions were used to eliminate multiplicative, additive, and non-linear interferences. On this basis, a set of estimations is obtained to improve the quality of the analytical results. The analytical usefulness of the proposed approach was tested on the example of the determination of three compounds from the group of bisphenols (BPs) using the chromatographic technique - HPLC-DAD (high-performance liquid chromatography with diode array detection). Compared to the reference method - fluorescence spectroscopy - the obtained results were characterized by excellent accuracy (RE=3 % in most cases). The developed methodology allowed to carry out a risk assessment on BPA, BPF, and BPS present in samples of shop receipts and canned food. Store clerks have been shown to be particularly vulnerable to PBF and BPS in receipts due to skin permeation (exposure factors were equal to 308.97 µg/g for BPF and 181.89 µg/g for BPS). Consumers should also pay close attention to the BPA found in canned food samples (the average concentration was equal to 20.61 µg/mL, and the tolerable daily intake was exceeded over 165.000 times). The analytical method and the methodological approach were evaluated using the RGB model and the AGREE approach - it was shown that the method can be successfully used for other analytical purposes (the method is White) and is environmentally friendly (Significance=0.63).


Assuntos
Compostos Benzidrílicos , Fenóis , Calibragem , Cromatografia Líquida de Alta Pressão/métodos , Fenóis/análise , Compostos Benzidrílicos/análise
19.
Assessment ; 31(1): 3-23, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37303168

RESUMO

Developmental disorders are diverse, common, and impairing; still, many clinicians lack comprehensive training in their assessment. This review presents thorough guidelines for the evaluation and diagnosis of common communication, sleeping, feeding, and elimination disorders that often onset in the early developmental period and that are commonly encountered in clinical practice. Thorough guidance on the evidence-based assessment of developmental disorders is critical, as they are prevalent, impairing, and commonly comorbid with other psychiatric disorders of childhood. This review is the first of its kind-providing critically needed, step-by-step guidance on the existing evidence-based methodologies and assessment tools available for diagnosis. This review also makes clear the dire need for further development and validation of relevant screening and diagnostic measure and calls for specific attention to the development of specific screening and diagnostic assessment measures for feeding disorders and elimination disorders in particular. Clinicians and researchers alike may find this article useful in guiding diagnostic, treatment, and research procedures.


Assuntos
Deficiências do Desenvolvimento , Prática Clínica Baseada em Evidências , Criança , Humanos , Deficiências do Desenvolvimento/diagnóstico
20.
EFSA J ; 21(Suppl 1): e211014, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38047122

RESUMO

Human pathogenic Salmonella enterica strains have been infecting people since historical times. The original human pathogens, typhoid Salmonella strains (e.g. S. Typhi) played a huge role in the previous centuries but nowadays in the developed world the number of cases or outbreaks caused by these serotypes deceased due to the development of personal and public hygiene. Nowadays in these regions the animal-borne zoonotic serotypes (e.g. S. Enteritidis) became more important because of their high prevalence in intensive animal husbandry. But these bacteria can also appear in fruits and vegetables. The fellow joined the scientific work of the Polytechnic University of Cartagena, Spain about the safety of plant-based products, where he could gain experience in microbiological laboratory exercises and theoretical calculations of statistics and modelling. The activities in the laboratory were part of the research lines already established at the host institution, being based on the protocols they have already implemented. Nonetheless, the fellow had the opportunity to design his own experiment, do the experimental work required and analysed the data within the context of a qualitative microbiological risk assessment. The main focus was on the heat resistance of two strains of zoonotic Salmonella spp. at different temperatures. Experiments were done using a reference strain and an extremely resistant variant to evaluate this rare phenotype. The experiments were executed using a Mastia thermoresistometer, a device patented by the host institution that provides more control when studying thermal treatments than traditional methods. The data was analysed using the principles of predictive microbiology, using the D-value as an estimate of heat resistance that provides insight into the bacterial behaviour. For this, the fellow used the bioinactivation software, developed within the host group. Through the work and results the fellow learned the principles of quantitative microbiological risk assessment (QMRA) and predictive microbiology, which was the aim for the EU-FORA programme.

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