Dengue vaccine acceptance and willingness to pay: a systematic review and meta-analysis.

OBJECTIVE: Dengue is the most important human vector-borne disease in terms of disease burden. A first dengue vaccine has recently been licenced, and others are in advanced stages of development. However, to date, none of these vaccines has achieved balanced efficacy and safety for all dengue serotypes. The aim of this systematic review and meta-analysis was to assess the global acceptance and willingness to pay for unspecified dengue vaccines. METHODS: This systematic review and meta-analysis included cross-sectional and cohort studies that reported values for vaccine acceptance (percentage) and willingness to pay for currently available or hypothetical vaccines. These values were pooled using random-effects models for the acceptance, while weighted linear regression was chosen for willingness to pay. Heterogeneity between studies was assessed using prediction intervals (PIs), and a domain-based tool was used to assess the risk of bias. Subgroup and sensitivity analyses were performed where appropriate. This study was registered with PROSPERO (CRD42021255784). RESULTS: We included 19 studies from the Americas and Asia in the quantitative meta-analysis. The risk of bias was mainly related to the selection of participants and to the assumptions about the safety and efficacy of the vaccines. The percentage of vaccine acceptance was 88.3% (95% CI: 81.0%-93.0%), with some heterogeneity between studies (80% PI: 52.9%-98.1%). Willingness to pay was US$ 46.7 (95% CI: 25.9-67.5) per vaccine recipient. There were differences between continents, with higher acceptance in the Americas. CONCLUSIONS: We were able to obtain global estimates of vaccine acceptance and willingness to pay and identify the associated factors that influence these values. This knowledge is relevant for the planning of future vaccination strategies.

The Progetto Nazionale Emorragia Digestiva (PNED) system vs. the Rockall score as mortality predictors in patients with nonvariceal upper gastrointestinal bleeding: A multicenter prospective study. / Sistema Progetto Nazionale Emorragia Digestiva (PNED) vs. escala de Rockall como predictores de mortalidad en pacientes con hemorragia de tubo digestivo alto no variceal: un estudio multicéntrico prospectivo.

BACKGROUND: The predictive scale for mortality risk in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) proposed by Italy's PNED (Progetto Nazionale Emorragia Digestiva) group has not been validated in Latin America since its original publication. AIM: To compare the PNED system and the Rockall score as mortality predictors in patients hospitalized for NVUGIB. MATERIAL AND METHODS: A multicenter, prospective, cross-sectional, analytic study was conducted that recruited patients diagnosed with nonvariceal upper gastrointestinal bleeding within the time frame of 2011 to 2015. Six Mexican hospital centers participated in the study. The Rockall and PNED system scores were calculated, classifying the patients as having mild, moderate, or severe disease. The association between mortality and risk was determined through the chi-square test and relative risk (RR) calculation. Statistical significance was set at a P<.05. RESULTS: Information on 198 patients was collected. Only 8 patients (4%) died from causes directly associated with bleeding. According to the Rockall score, 46 patients had severe disease (23.2%), 5 of whom died, with a RR of 5.5 (CI 1.35-22.02, P=.006). In relation to the PNED, only 8 patients had severe disease (4%), 5 of whom died, with a RR of 38.7 (CI 11.4-137.3, P=.001). CONCLUSIONS: The PNED system was more selective for classifying a case as severe, but it had a greater predictive capacity for mortality, compared with the Rockall score.

Hiatal hernia repair with biologic mesh reinforcement reduces recurrence rate in small hiatal hernias.

The utility of mesh reinforcement for small hiatal hernia found especially during antireflux surgery is unknown. Initial reports for the use of biological mesh for crural reinforcement during repair for defects greater than 5 cm have been shown to decrease recurrence rates. This study compares patients with small hiatal hernias who underwent onlay biologic mesh buttress repair versus those with suture cruroplasty alone. This is a single-institution retrospective review of all patients undergoing repair of hiatal hernia measuring 1-5 cm between 2002 and 2009. The patients were evaluated based on surgical repair: one group undergoing crural reinforcement with onlay biologic mesh and other group with suture cruroplasty only. Seventy patients with hiatal hernia measuring 1-5 cm were identified. Thirty-eight patients had hernia repair with biologic mesh, and 32 patients had repair with suture cruroplasty only. Recurrence rate at 1 year was 16% (5/32) in patients who had suture cruroplasty only and 0% (0/38) in the group with crural reinforcement with absorbable mesh (statistically significant, P = 0.017). Suture cruroplasty alone appears to be inadequate for hiatal hernias measuring 1-5 cm with significant recurrence rate and failure of antireflux surgery. Crural reinforcement with absorbable mesh may reduce hiatal hernia recurrence rate in small hiatal hernias.

Protection of trivalent inactivated influenza vaccine against hospitalizations among pandemic influenza A (H1N1) cases in Argentina.

The aim of this study was to estimate the effectiveness of 2009 seasonal trivalent inactivated vaccine in reducing hospitalizations due to the novel influenza A H1N1 virus among positive cases. Data collected from Argentina's national epidemiological surveillance system were analyzed. All patients had a clinical diagnosis and underwent positive serological tests for pandemic influenza A H1N1. Logistic regression was used to estimate vaccine effectiveness to prevent severe cases of the disease, measured as hospitalizations. The adjusted effectiveness of the vaccine was 50% (95% CI: 40-59%). Vaccination was significantly associated with hospitalizations in all age groups, and within groups that had and had not received antiviral treatment. These results suggest that seasonal influenza vaccine might have conferred partial protection against severe cases due to the novel pandemic influenza.

Assessment of the ozone-nitrogen oxide-volatile organic compound sensitivity of Mexico City through an indicator-based approach: measurements and numerical simulations comparison.

The ozone (O3) sensitivity to nitrogen oxides (NOx, or nitric oxide [NO] + nitrogen dioxide [NO2]) versus volatile organic compounds (VOCs) in the Mexico City metropolitan area (MCMA) is a current issue of scientific controversy. To shed light on this issue, we compared measurements of the indicator species O3/NOy (where NOy represents the sum of NO + NO2 + nitric acid [HNO3] + peroxyacetyl nitrate [PAN] + others), NOy, and the semiempirically derived O3/NOz(surrogate) (where NOz(surrogate) is the derived surrogate NOz, and NOz represents NOx reaction products, or NOy - NOx) with results of numerical predictions reproducing the transition regimes between NOx and VOC sensitivities. Ambient air concentrations of O3, NOx, and NOy were measured from April 14 to 25, 2004 in one downwind receptor site of photochemically aged air masses within Mexico City. MCMA-derived transition values for an episode day occurring during the same monitoring period were obtained through a series of photochemical simulations using the Multiscale Climate and Chemistry Model (MCCM). The comparison between the measured indicator species and the simulated spatial distribution of the indicators O3/ NOy, O3/NOz(surrogate), and NOy in MCMA suggest that O3 in this megacity is likely VOC-sensitive. This is in opposition to past studies that, on the basis of the observed morning VOC/NOx ratios, have concluded that O3 in Mexico City is NOx-sensitive. Simulated MCMA-derived sensitive transition values for O3/NOy, hydrogen peroxide (H2O2)/HNO3, and NOy were found to be in agreement with threshold criteria proposed for other regions in North America and Europe, although the transition crossover for O3/NOz and O3/HNO3 was not consistent with values reported elsewhere. An additional empirical evaluation of weekend/weekday differences in average maximum O3 concentrations and 6:00- to 9:00-a.m. NOx and NO levels registered at the same site in April 2004 indirectly confirmed the above results. A preliminary conclusion is that additional reductions in NOx emissions in MCMA might cause an increase in presently high O3 levels.

Esophageal papillomatosis complicated by squamous cell carcinoma in situ.

We present a case of esophageal papillomatosis with underlying squamous cell carcinoma in situ. An esophageal lesion resected from a 74-year-old woman demonstrated histological findings characteristic of squamous cell papilloma (fibrovascular core and numerous finger-like projections covered with hyperplastic squamous epithelium) and severe dysplasia characteristic of squamous cell carcinoma. The relation of squamous papilloma and squamous cell carcinoma is discussed. It is suggested that esophageal squamous cell papilloma is a premalignant lesion.

Solution properties of full length and truncated forms of myosin subfragment 1 from Dictyostelium discoideum.

The atomic structures for several myosin head isoforms in different nucleotide states have been determined in recent years. The comparison of these structures is complicated by the use of myosin subfragment 1 (S1) constructs of different length in different studies. Several atomic structures of the S1 nucleotide complex were obtained using Dictyostelium discoideum S1dC, a genetically truncated form of S1 lacking the light chain binding domain (LCBD) and both light chains. The goal of the present study has been to assess the effects of such a truncation on the solution properties of S1 and in particular, on its active site, actin binding site and the converter region. The nucleotide and actin binding properties, CD spectra and the reactivities of Lys-84 (corresponds to the 'reactive lysine', Lys-83 in rabbit skeletal S1) and Cys-678 (corresponds to the 'SH2-group', Cys-697 in rabbit S1) were compared for the full length (flS1) and the truncated (S1dC) forms of Dictyostelium S1. The two forms showed similar nucleotide binding properties. However, SldC had a lower structural stability and a significantly higher Km value for actin-activated ATPase as compared to flS1. Differences were found also in the near-UV CD spectrum between flS1 and S1dC. SH2 reactivity in SldC appeared to be greatly inhibited compared with that in flS1. The modification of Lys-84 caused a greater increase in the MgATPase activity in S1dC than in flS1. ADP inhibited this activation for both SldC and flS1. Taken together our results identify both truncation-caused differences between S1dC and flS1, as well as isoform-related differences between skeletal and Dictyostelium S1.

The development and validation of Spanish versions of the State and Trait Food Cravings Questionnaires.

OBJECTIVE: We developed and tested the psychometric properties of Spanish versions of the Trait and State Food Cravings Questionnaires (FCQ-T and FCQ-S respectively). METHOD: The instruments were translated and adapted to Spanish and administered to undergraduate students from a Southern university in Spain (N = 271). The data were analyzed using confirmatory factor analysis to compare the factor structure of the English and Spanish versions of both questionnaires. RESULTS: The factors structure of both questionnaires obtained excellent fit indices across their Spanish versions with the one exception that some factors of the FCQ-S were more highly intercorrelated among the Spanish sample than the American. DISCUSSION: This study supports the conceptualization of food cravings as universal multidimensional motivational states that can be reliably measured and supports the use of the Spanish versions of the FCQ.

Associative tolerance to nicotine analgesia in the rat: tail-flick and hot-plate tests.

Previous assessments of associative nicotine tolerance may have confounded associative effects with novelty-induced stress effects, instrumental learning effects, or both. That is, subjects were tested in novel environments, allowed to practice the test response, or both during the tolerance development phase. In the first study, 32 male Sprague-Dawley rats were injected with various doses of nicotine and tested for nociception in the tail-flick and hot-plate tests to assess nicotine's analgesic effects. In the second study, 35 rats received nicotine explicitly paired or unpaired with a distinctive test context. All animals were equally preexposed to the test environment, and none had the opportunity to practice the test response. Paired rats developed greater nicotine tolerance than unpaired rats. This context-dependent (associative) tolerance effect was found with both tail-flick and hot-plate tests.

Genetic variability in Guadalupe fur seals.

The Guadalupe fur seal (Arctocephalus townsendi) population underwent one or two severe bottlenecks due to commercial sealing in the late 19th century. Since then the protected population has been growing steadily around their only rookery, Isla de Guadalupe, Mexico. We probed both nuclear and mitochondrial genomes using multilocus nuclear DNA profiling and mitochondrial DNA sequencing to estimate the level of genetic variability of the present population. Unlike other pinniped populations that have experienced similar historical bottlenecks, such as Hawaiian monk seals and northern elephant seals, high levels of genetic variability were found.

Improving health service quality from within: the case of United Leeds Teaching Hospitals NHS Trust.

Illustrates how the implementation of the internal customer concept has assisted United Leeds Teaching Hospitals NHS Trust to establish a culture for quality. Explains the conceptual framework on which the notion of the internal customer is derived. Describes how, from 1992 to date, the Trust's quality management approach was designed to apply these management principles in a large teaching hospital setting. Outlines how this quality management approach has been successful in enabling departmental managers to recognize, develop and improve internal customer/supplier relationships. Concludes by explaining that business process re-engineering is now being applied as a prime quality tool to help deliver a major culture change throughout the organization.

Comportamiento epidemiológico de las defunciones maternas en República Dominicana / Epidemiologic behavior of maternal disfunctions in the Dominican Republic

Se realizó un estudio descriptivo retrospectivo en los archivos de la división de estadísticas de la Secretaría de Estado de Salud Pública y Asistencia Social (SESPAS), con el propósito de determinar el comportamiento epidemiológico de la mortalidad materna en la República Dominicana durante el período 1981-1990. Las informaciones obtenidas que la mortalidad materna aparenta ser de difícil evaluación en función de las potenciales muertes por abortos clandestinos que no se registran como tales. La misma se consideró como elevada, obteniéndose cifras de mortalidad materna que aumentaron de cinco a diecinueve por diez mil (5-19 x 10,000) durante la década pasada, observándose una tendencia decreciente a partir del año 1990. Siendo dicha mortalidad mayor en menores de veinte (20) años y de veinte a treinta y cuatro (20-34) años. La cifra promedio de mortalidad materna para la década pasada fue de diez punto cuatro por diez mil (10.4 x 10,000). Por último se destaca, que a pesar del subregistro, la toxemia, las hemorragias y los abortos siguen siendo las causas más importantes de mortalidad materna en la República Dominicana