Correction: Modelling the effects of quadrivalent Human Papillomavirus (HPV) vaccination in Puerto Rico.

[This corrects the article DOI: 10.1371/journal.pone.0184540.].

Measuring herpes zoster disease burden in São Paulo, Brazil: a clinico-epidemiological single-center study.

OBJECTIVES: Herpes zoster is characterized by acute neuritis and post-herpetic neuralgia. Currently, data concerning the zoster-associated impact on quality of life and healthcare resource utilization in Brazil are scarce. This study measured the zoster-associated burden in a Brazilian population. METHODS: This was a prospective, observational, single-cohort study conducted in a primary hospital's emergency room in São Paulo, Brazil. Patients enrolled at various timepoints during a zoster episode were followed over 180 days. The Zoster Brief Pain Inventory and the Initial Zoster Impact Questionnaire assessed zoster-associated pain. The EuroQoL assessed the impact of herpes zoster and/or zoster-associated pain on quality of life. Healthcare resource utilization was assessed by patient-reported questionnaires. RESULTS: One-hundred forty-six zoster patients were enrolled [mean (SD) age of 69.9 (10.9) years]. Mean (SD) worst pain scores decreased from 5.3 (3.5) at baseline to 1.9 (3.0) 180 days following rash onset. Mean (SD) EuroQoL scores significantly decreased from 0.9 (0.2) before rash appearance to 0.7 (0.2) after rash onset (p<0.001), followed by gradual improvements in quality of life over 180 days, with pre-herpes zoster quality of life achieved at the end of the observation period. The majority of patients purchased prescription medications (89.7%) and required doctor's office visits (65.8%) for zoster episodes. CONCLUSIONS: Herpes zoster is associated with a significant disease burden, including zoster-associated pain, impaired quality of life and increased healthcare resource utilization in Brazil. These results support the implementation of early intervention and prevention programs such as vaccinations to reduce the herpes zoster-associated disease burden in Brazil.

Measuring herpes zoster disease burden in São Paulo, Brazil: a clinico-epidemiological single-center study

OBJECTIVES: Herpes zoster is characterized by acute neuritis and post-herpetic neuralgia. Currently, data concerning the zoster-associated impact on quality of life and healthcare resource utilization in Brazil are scarce. This study measured the zoster-associated burden in a Brazilian population. METHODS: This was a prospective, observational, single-cohort study conducted in a primary hospital's emergency room in São Paulo, Brazil. Patients enrolled at various timepoints during a zoster episode were followed over 180 days. The Zoster Brief Pain Inventory and the Initial Zoster Impact Questionnaire assessed zoster-associated pain. The EuroQoL assessed the impact of herpes zoster and/or zoster-associated pain on quality of life. Healthcare resource utilization was assessed by patient-reported questionnaires. RESULTS: One-hundred forty-six zoster patients were enrolled [mean (SD) age of 69.9 (10.9) years]. Mean (SD) worst pain scores decreased from 5.3 (3.5) at baseline to 1.9 (3.0) 180 days following rash onset. Mean (SD) EuroQoL scores significantly decreased from 0.9 (0.2) before rash appearance to 0.7 (0.2) after rash onset (p<0.001), followed by gradual improvements in quality of life over 180 days, with pre-herpes zoster quality of life achieved at the end of the observation period. The majority of patients purchased prescription medications (89.7%) and required doctor's office visits (65.8%) for zoster episodes. CONCLUSIONS: Herpes zoster is associated with a significant disease burden, including zoster-associated pain, impaired quality of life and increased healthcare resource utilization in Brazil. These results support the implementation of early intervention and prevention programs such as vaccinations to reduce the herpes zoster-associated disease burden in Brazil.

Modelling the effects of quadrivalent Human Papillomavirus (HPV) vaccination in Puerto Rico.

BACKGROUND: No study has estimated the potential impact of Human Papillomavirus (HPV) vaccination in Puerto Rico, a population with considerable burden of HPV-related morbidities. We evaluated the health and economic impacts of implementing a vaccination strategy for females and males in Puerto Rico, with the quadrivalent HPV (HPV4) vaccine, under different vaccination scenarios. METHODS: We adapted a mathematical model which estimates the direct and indirect health benefits and costs of HPV4 vaccination in a dynamic population. The model compared three vaccination scenarios against screening only (no-vaccination) for three doses of HPV4 vaccine among individuals aged 11-15 years in Puerto Rico: 1) 34% for females and 13% for males (34%F/13%M), 2) 50% for females and 40% for males (50%F/40%M), and 3) 80% for female and 64% for male (80%F/64%M). Data specific to Puerto Rico was used. When not available, values from the United States were used. Input data consisted of demographic, behavioral, epidemiological, screening, and economic parameters. RESULTS: The model predicted decreases in: 1) HPV infection prevalence for females and males, 2) cervical intraepithelial neoplasia and cervical cancer incidence for females, 3) genital warts incidence for females and males, and 4) cervical cancer deaths among females, when various vaccination program scenarios were considered. In addition, when the vaccination percentage was increased in every scenario, the reduction was greater and began earlier. The analysis also evidenced an incremental cost effectiveness ratio (ICER) of $1,964 per quality-adjusted life year gained for the 80%F/64%M uptake scenario. CONCLUSIONS: HPV vaccine can prove its cost effectiveness and substantially reduce the burden and costs associated to various HPV-related conditions when targeted to the adequate population together with an organized HPV vaccination program.

Measuring the burden of herpes zoster disease in Costa Rica

AbstractBackground: Herpes zoster is a distressing illness that significantly reduces patients' quality of life. However, Costa Rican data regarding the clinical burden of herpes zoster and associated health care resource utilization is limited. This study aimed to assess the zoster-associated burden evaluating pain, impact on quality of life and health care resource utilization in a Costa Rican sample.Methods:Herpes zoster patients recruited in Costa Rica at a private geriatric practice were enrolled at various time points during a zoster episode and were actively followed over 6 months. Outcomes including zoster-associated pain, quality of life and health care resource utilization were assessed via patient self-reported questionnaires.Results: 50 zoster patients were included [68.0% female, mean (SD) age = 69.5 (10.8) years]. Zoster-associated pain decreased over time while quality of life improved though without full base recovery. The highest health care resource utilization included doctor's office (98.0%), emergency room (60.0%) and specialists (60.0%) visits. Sixteen (32.0%) patients were hospitalized [mean (SD)= 4.3 (4.1) days].Conclusion: Similar to other Latin American countries, high herpes zoster burden was observed in a private geriatric practice in Costa Rica, supporting the need for early intervention and preventive strategies, one of such could be the implementation of a HZ vaccination program.

ResumenJustificación: El herpes zoster es una enfermedad estresante que reduce significativamente la calidad de vida de los pacientes. Sin embargo, datos relativos a la carga clínica de herpes zoster y la utilización de recursos de salud son limitados en Costa Rica. El objetivo de este estudio fue evaluar la carga asociada al herpes zoster evaluando dolor, impacto sobre la calidad de vida y utilización de recursos de salud en una muestra costarricense.Métodos:Pacientes con herpes zoster fueron reclutados en una práctica geriátrica privada en diferentes etapas de un episodio de zoster y fueron activamente seguidos durante 6 meses. Se evaluaron los resultados en el paciente, incluyendo el dolor asociado a zoster, calidad de vida y utilización de recursos de salud mediante cuestionarios autoadministrados.Resultados: Se incluyeron 50 pacientes con herpes zoster [68,0% mujeres, media de edad (SD) = 69.5 (10.8) años]. El dolor asociado a zoster disminuyó con el tiempo mientras que calidad de vida mejoró, aunque sin plena recuperación comparado con la calidad de vida inicial. La utilización de recursos de salud más alta fue visitas al consultorio (98.0%), visitas a sala de urgencias (60.0%) y visitas a especialistas (60.0%). Dieciséis pacientes (32.0%) fueron hospitalizados [media (SD) = 4.3 (4.1) días].Conclusión: Similar a otros países de América Latina, se observó una alta carga de enfermedad debido a herpes zoster en una práctica privada geriátrica en Costa Rica, lo cual respalda la necesidad de la intervención temprana y uso de estrategias preventivas, una de las cuales podría ser la implementación de un programa de vacunación a herpes zoster.

Dolor, calidad de vida relacionada con la salud y utilización de servicios médicos asociados al herpes zoster en Argentina / Herpes zoster-associated pain, health-related quality of life, and healthcare utilization in Argentina

El herpes zoster (HZ) es causado por reactivación del virus varicela-zoster latente. Se caracteriza por exantema vesicular unilateral, neuri-tis aguda y neuralgia posherpética. Aún hay escasos datos sobre el do-lor asociado al HZ (DAZ), su repercusión en la calidad de vida (CdV) y la utilización de recursos sanitarios (URS) asociada en Argentina. En este estudio prospectivo, observacio-nal, de una cohorte, realizado en 3 centros argenti-nos se valuó la carga de morbilidad asociada al HZ en Argentina en contextos clínicos reales. Los pa-cientes fueron enrolados en diversos momentos du-rante un episodio herpético, y seguidos activamen-te los días 14, 21, 30, 60, 90, 120, 150 y 180. Hubo 96 enrolados(edad 70±10,7 años; tiempo desde el inicio del exantema 16±16,9 días[media±DE]). El puntaje del peor dolor (media±DE) disminuyó de 5,5±3,1 en el enrolamiento a 0,2±0,7 a los 180 días de seguimiento. El puntaje del cuestionario de cali-dad de vida EQ-5D (media±DE) disminuyó significa-tivamente de 0,8±0,1 antes del inicio del exantema a 0,6±0,2 tras su inicio (P<0,001), con mejoría gra-dual de la CdV durante 180 días (0,9±0,1), hasta un puntaje similar al previo al inicio del exantema. La URS más frecuente fueron visitas al consultorio mé-dico (96,9%). La gran mayoría de pacientes compró medicamentos recetados (95,8%) y de venta sin receta (83,3%) para los episodios herpéticos. El DAZ estuvo asociado a gran carga de morbili-dad, deterioro de CdV, aumento de URS y costos asociados en Argenti-na. Esto subraya la importancia de estrategias de intervención precoz o prevención para disminuir la carga de morbilidad asociada al HZ

Herpes zoster (HZ) is caused by re-activation of latent varicella zoster virus and is characterized by unilateral, vesicular cutaneous eruptions, acute neuritis, and post-herpetic neuralgia. To date, data on HZ associated pain (ZAP) and its impact on quality of life (QoL) and associated healthcare resource utilization use (HCRU) in Argentina is scarce. This study assessed the burden of illness associated with HZ in Argentina in a real-life clinical setting. This was a prospective, observational, single-cohort study conducted in 3 sites across Argentina. Patients were enrolled at various time points during the course of a zoster episode and were actively followed on days 14, 21, 30, 60, 90, 120, 150, and 180. There were 96 HZ patients enrolled with a mean±SD age and time since rash onset of 70±10. 7 years and 16±16. 9 days, respectively. Mean±SD worst pain score decreased from 5. 5±3. 1 at enrollment to 0. 2±0.7 at 180 days of follow-up. The mean±SD EQ-5D score significantly decreased from 0. 8±0. 1 before rash onset to 0. 6±0. 2 after rash onset (P <0.001) followed by gradual improvement in QoL over 180 days (0. 9±0.) reaching a similar score to that prior to rash onset. The most common HCRU was visits to the doctor's office with 96.9%. The vast majority of patients purchased prescription medications (95.8%) and over-the-counter medications (83.3%) for HZ episodes. ZAP was found to be associated with severe burden of illness, impaired QoL, increased HCRU, and associated cost in Argentina; highlighting the importance of early intervention or prevention strategies to reduce HZ-associated disease burden

The Puerto Rico Cardiovascular Risk-Estimation Study (PRCaRES): an exploratory assessment of new patients in physicians' offices.

OBJECTIVE: To determine the risk of developing coronary heart disease (CHD) in a cross-sectional sample of Puerto Rico residents through an analysis of the 10-year Framingham risk score. METHODS: An exploratory, retrospective, cross-sectional study of the medical records of patients 35 years or older who each visited the office of 1 of the 4 participating physicians on or after July 1, 2007. RESULTS: Data for 453 patients were extracted from the medical records, but 96 cases were excluded because of incomplete data or the patients' not fulfilling the inclusion criteria, thus yielding a total sample of 357 patients. The average patient age was 58 years old (+/- 11.8); the majority (58%) was female. Eight of 10 patients were either overweight or obese. Eighty-five percent reported having at least 1 cardio-metabolic condition. Of these, 72.3% self-reported having hypertension; 38.4%, dyslipidemia; and 37.8%, diabetes. Many patients were not at goal for blood pressure or for lipid and glucose parameters nor were these patients taking any medication for these conditions. Nearly one-third of the participants had a 10% or greater 10-year risk of developing CHD. Compared with women, men were 3.3 times more likely to have a 10-year CHD risk of 10% or greater and 4.2 times more likely to have a risk of 20% or greater. CONCLUSION: A substantial number of patients had risk factors for developing CHD and were not at goal for specific parameters. Larger scale epidemiological studies should be conducted to assess CHD risk in Puerto Rico so that public health initiatives to reduce this risk might be proposed.

Level of awareness about osteoporosis among women 50 years and older in Puerto Rico.

Osteoporosis is an established and well-defined disease that affects millions of people around the world and is a major cause of morbidity. Not much is known about the level of awareness of the condition among the general population in Puerto Rico. The objectives of this study were: 1) to determine the level of awareness and knowledge about osteoporosis among women 50 years and older in Puerto Rico, and 2) to describe the differences in level of awareness and knowledge among women who have been diagnosed with osteoporosis and those who have not. Telephone interviews were conducted among a sample of women 50 years and older who were residents of Puerto Rico during the month on February, 2005. A four-page questionnaire was developed to address the study objectives. Of the total number of women contacted (342), 28 (8%) indicated they did not know anything about osteoporosis and could not answer the remainder of the questionnaire. In spite of widespread awareness about the condition, more than one in ten women responded they did not know what factors contribute to the development of osteoporosis and nearly one in five women did not know the complications associated with osteoporosis. Public education campaigns must address risk factors and the strategies to overcome those that are modifiable in order to prevent the development of osteoporosis and its complications.

Screening, monitoring, and educating patients with diabetes in an independent community pharmacy in Puerto Rico

OBJECTIVE: Increase the awareness about the importance of Diabetes mellitus (DM) management and assess the educational and monitoring needs of patients visiting a community pharmacy in Puerto Rico. METHODS: A community service activity focusing on DM was held in a community pharmacy. The educational and monitoring needs of the participants were assessed using a questionnaire. Glucose tests were conducted in the pharmacy by medical technologists. Educational activities consisted of presentations and printed materials. RESULTS: Two-thirds of the fasting people had blood glucose levels higher than 140 mg/dl. Seventy-nine percent of the patients with diabetes were not aware of the glycosilated hemoglobin test. Most of the patients were interested in learning more about how to manage their condition. CONCLUSION: A greater understanding is needed among patients with DM that blood glucose control decreases diabetes related complications. Community pharmacists are in an excellent position to collaborate with other health professionals in screening, monitoring and educating patients with DM to prevent long-term complications.

Adoption of a pharmacist concience clause by professional associations and boards of pharmacy in the United States

OBJECTIVE: To determine the number of professional associations and boards of pharmacy in the United States that have adopted or are considering to adopt a conscience clause as part of their codes of ethics, rules, laws or regulations. BACKGROUND: Pharmacists are often exposed to ethical dilemmas in their day-to-day practice and their response depends on a number of factors, including the personal beliefs and values of those involved. This has lead some professional associations to address whether their members have the right to refuse to participate in procedures which are contrary to their conscience or moral convictions. The outcome of these discussions is usually the development and adoption of a conscience clause. METHODS: A one-page self-administered questionnaire was sent by Fax to the highest ranking officer of 108 pharmacy organizations in the United States. RESULTS: Thirty-five completed questionnaires were received for a 32.4 percent response rate. In general, it was found that there is a lack of knowledge as to what a conscience clause is. Only two state associations and one board of pharmacy responded that they have a conscience clause as part of their code of ethics or regulations. Reasons given for not having a conscience clause included lack of interest and low priority. Nevertheless, four state associations, one national association and one board of pharmacy responded that they are considering developing a pharmacist conscience clause. More professional associations than boards of pharmacy expressed interest to obtain information about conscience clauses. CONCLUSION: Although many state associations and boards of pharmacy that responded do not have a conscience clause as part of their codes of ethics, laws or regulations, this survey shows an increasing interest to learn about it. This is expected as the pharmacist assumes increasing responsibility in patient care.