Burden of COPD in China and the global from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019.

OBJECTIVE: To investigate the current disease burden of chronic obstructive pulmonary disease (COPD) in China and globally using the Global Burden of Disease (GBD) data in 2019, as well as to analyse the changes in its risk factors, providing a scientific basis for the formulation of a comprehensive prevention and control strategy for COPD in China. STUDY DESIGN: An observational study based on the GBDs. METHODS: Based on the GBD 2019 database, we obtained data on incidence, prevalence, mortality, disability-adjusted life years (DALYs) and corresponding age-standardised rates of COPD in China and the global, and analysed and described the changing trends of COPD burden in China and the global from 1990 to 2019. RESULTS: In 2019, the total number of COPD deaths in China was 1.04 (95% uncertainty intervals (95% UI): 0.89-1.27) million cases, the number of patients with COPD was 45.16 (95% UI: 41.13-49.62) million cases, and the number of new cases was 4.0 (95% UI: 3.6-4.4) million cases. DALYs were 74.4 (95% UI: 68.2-80.2) million years. Compared with 1990, the number of new incident cases and the overall prevalence of COPD in China in 2019 increased by 66.20% and 66.76%, respectively, which is lower than the overall global level. CONCLUSION: From 1990 to 2019, the age-standardized prevalence rate (ASPR), the age-standardized incidence rate (ASIR) and the age-standardized death rate (ASDR) in China and the global all showed a downward trend, and the rate of decline in China was much higher than the overall level of the world, indicating that China has made specific achievements in the prevention and treatment of COPD, but overall the disease burden of COPD is still hefty, and the number of affected individuals is still increasing.

Using 5 consecutive years of NICE guidance to describe the characteristics and influencing factors on the economic evaluation of orphan oncology drugs.

Objective: Orphan oncology drugs used in this article were defined by the type of disease treated by drugs, as drugs used to treat rare diseases with a prevalence of ≤ 500 per million people per year. In this article, our concern was to explore focus on the economic evaluation of the National Institute for Health and Care Excellence (NICE), when orphan oncology drugs were appraised for reimbursement, and provide advice and suggestions to decision-makers. Methods: A retrospective study was used in this study. Thirty guidance were gathered as our subject by NICE from 2016 to 2020, excluded drugs were not identified as orphan by European Medicines Agency (EMA) and orphan drugs were not used for cancer, and orphan oncology drugs were terminated at the time of data collection at NICE. Qualitative analysis, descriptive statistics, and Fisher's exact test were conducted. Results: Of all guidance, the partitioned survival model was used most to appraise orphan oncology drugs, and every drug had a kind of commercial arrangement such as patient access scheme (PAS), managed access arrangements (MAAs), and commercial access agreement (CAAs). End of life is an important indicator that had been defined by NICE in the methods of technology appraisal in 2013, and drugs that met the criterion would be given a higher threshold of ICER. In addition, we found that potential health benefits were increasingly concerned such as drug delivery. Conclusion: In the setting of uncertain clinical and cost efficacy, orphan oncology drugs are comprehensively evaluated in multiple additional dimensions, which include life-extending benefits, and innovation. NICE uses a combination of special considerations for incomplete data, appropriate economic models, and appropriate health technology assessment (HTA) methods during the assessment process, besides, orphan oncology drugs with insufficiency evidence were recommended Cancer Drugs fund (CDF) to afford for patients, which would obtain more availability and accessibility, based on which, high-quality drugs for treating rare cancers can fall within the scope of affordable healthcare provided by the English medical insurance fund.

Public perceptions and preventive behaviours during the early phase of the COVID-19 pandemic: a comparative study between Hong Kong and the United Kingdom

BackgroundIn the absence of treatments and vaccines, the mitigation of COVID-19 relies on population engagement in non-pharmaceutical interventions, which is driven by their risk perception, anxiety level and knowledge. There may also be regional discrepancies in these drivers due to different historical exposure to disease outbreaks, government responses and cultures. As such, this study compared psycho-behavioral responses in two regions during the early phase of the pandemic. MethodsComparable cross-sectional surveys were administered among adults in Hong Kong (HK) and the United Kingdom (UK) during the early phase of each respective epidemic. Explanatory variables included demographics, risk perception and knowledge of COVID-19, anxiety level and preventive behaviors. Responses were weighted according to census data. Logistic regression models, including interaction terms to quantify regional differences, were used to assess the association between explanatory variables and the adoption of social-distancing measures. ResultsData of 3431 complete responses (HK:1663; UK:1768) were analysed. Perceived severity differed by region (HK: 97.5%; UK: 20.7%). A large proportion of respondents were abnormally/borderline anxious (HK:64.8%; UK:45.9%) and regarded direct contact with infected individuals as the transmission route of COVID-19 (HK:94.0-98.5%; UK:69.2-93.5%), with HK identifying additional routes. HK reported high levels of adoption of social-distancing (HK:32.4-93.7%; UK:17.6-59.0%) and mask-wearing (HK:98.8%; UK:3.1%). The impact of perceived severity and perceived ease of transmission on the adoption of social-distancing varied by region. In HK, they had no impact, whereas in the UK, those who perceived severity as "high" were more likely to adopt social-distancing (aOR:1.58-3.01), and those who perceived transmission as "easy" were prone to both general social-distancing (aOR:2.00, 95% CI:1.57, 2.55) and contact avoidance (aOR:1.80, 95% CI: 1.41, 2.30). The impact of anxiety on adopting social-distancing did not vary by region. DiscussionThese results suggest that health officials should ascertain and consider baseline levels of risk perception and knowledge in the populations, as well as prior sensitisation to infectious disease outbreaks, during the development of mitigation strategies. Risk communication should be done through suitable media channels - and trust should be maintained - while early intervention remains the cornerstone of effective outbreak response.

Role of p16, Ki-67 and human papilloma virus type in the shunt treatment of cervical intraepithelial neoplasiaⅡ / 肿瘤研究与临床

Objective To investigate the role of p16,Ki-67 and human papilloma virus(HPV)type in the shunt treatment of cervical intraepithelial neoplasia (CIN) Ⅱ. Methods The paraffin block on file and the pathological results from loop electrosurgical excision procedure (LEEP) of 377 CIN Ⅱpatients diagnosed with colposcope examination accompanied by cervical high-risk HPV infection in the Affiliated Hospital of Inner Mongolia Medical University of Obstetrics and Gynecology Department from January 2014 to October 2016 were collected. The paraffin sections were stained with p16 and Ki-67 immunohistochemistry. The correlation between the expression of p16 and Ki-67 in biopsy tissues and the pathological results after LEEP was analyzed.HPV type and pathological results after LEEP were also analyzed.Results LEEP postoperative pathological grade in 337 cases of CINⅡpatients was divided into two groups(＜CINⅡ and ≥CINⅡ). There was no statistical difference in age between the two groups (t = 3.078, P = 0.063). There were statistical differences in the expressions of p16+and Ki-67+between the two groups[3.6 %(8/233) vs. 88.5 % (92/104), χ 2=235.54,P<0.001; 3.0 %(7/233) vs. 76.9 % (80/104), χ 2= 197.63, P< 0.001]. There was a statistical difference in HPV infection type between the two groups (χ2= 12.713, P = 0.005). The sensitivity and specificity of p16+and Ki-67+for LEEP postoperative≥CINⅡ was 88.89 % vs.77.78 % and 95.96 % vs.95.80 % respectively. There was a statistical difference in group type of p16 and Ki-67 in both groups (χ2=304.28, P< 0.001). The sensitivity of p16+Ki-67+was 90.73 % and the specificity was 98.74 % in CINⅡpatients for LEEP postoperative. Conclusions The expressions of p16 and Ki-67 can guide the colposcopic biopsy for the treatment of CINⅡ. For CINⅡpatients with p16+Ki-67+, the active treatment should be taken. Close observation needs to follow for p16 and Ki-67 single negative or double negative patients. Active treatment should be performed for CINⅡpatients with HPV16 type infection in CINII. Age can not be used as the basis for the patients with shunt CINⅡ.