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1.
Infect Dis Poverty ; 9(1): 84, 2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641123

RESUMO

BACKGROUND: It was recommended that malaria rapid diagnostic tests (RDTs) should be available in all epidemiological situations. But evidence was limited on the implementation of RDTs and its effectiveness in malaria elimination settings. This study examined the implementation of RDTs and how it affected the diagnosis of imported malaria patients in Jiangsu Province, China. METHODS: To scale up RDTs, this study developed an intervention package with four major elements covering the supply of RDT test, the training on RDTs, the monitoring and management of RDT use, and the advocacy of RDTs. By using a pretest-posttest control group design, we implemented the interventions in 4 cities in Jiangsu Province with the rest nine cities as controlled areas, from January 2017 to January 2018. Difference-in-Difference approach was used to evaluate the impact of the scale-up of RDTs on the identification of malaria cases. Three binary outcome measures were included to indicate delayed malaria diagnosis, malaria cases with confirmed malaria diagnosis at township-level institutions, and severe malaria cases, respectively. Linear probability regression was performed with time and group fixed effects and the interaction term between time and group. RESULTS: Intervention areas received sufficient RDT test supply, regular professional training programs, monthly tracking and management of RDT supply and use, and health education to targeted population. The implementation of interventions was associated with 10.8% (P = 0.021) fewer patients with delayed diagnosis. But intervention areas did not see a higher likelihood of having confirmed diagnosis from township-level institutions (coefficient = -0.038, P = 0.185) or reduced severe malaria cases (coef. = 0.040, P = 0.592). CONCLUSIONS: The comprehensive package of RDT implementation in this study is promising in scaling up RDT use and improving access to care among malaria patients, especially in malaria elimination settings.

2.
Aging (Albany NY) ; 12(12): 11878-11892, 2020 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-32568098

RESUMO

BACKGROUND: Primary hepatocellular carcinoma (PHCC) has a poor prognosis and high short-term mortality rate, even after resection. Thus, early diagnosis in PHCC cases can help improve quality of life via personalized management strategies. RESULTS: The risk score system (RSS) were classified as low risk (<5 points), medium risk (5-10 points), or high risk (>10 points). The areas under the receiver operating characteristic curves were 0.80 in the training cohort and 0.69 in the validation cohort, which indicated satisfactory prognostic performance. The Hosmer-Lemeshow goodness of fit test (P>0.05) revealed consistent performance in both groups. The concordance index (C-index: 0.663, 95% CI: 0.618-0.708) revealed excellent discrimination and good calibration in the validation cohort. CONCLUSIONS: This simple RSS, which is based on clinical and laboratory data from patients undergoing resection of PHCC, might allow clinicians and medical staff to better manage PHCC. MATERIALS AND METHODS: A total of 672 PHCC cases were retrospectively obtained from the First Affiliated Hospital of Wenzhou Medical University between January 2007 and February 2015. Cox proportional hazard models were used to identify independent predictors of mortality. Kaplan-Meier curves and the log-rank test were used to examine the relationships between the prognostic factors and overall mortality.

3.
J Dermatol ; 47(5): 503-511, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32189395

RESUMO

Genital warts are a common sexually transmitted disease caused by human papillomavirus (HPV) infections. The prevalence of dementia is 4-8% in those aged 65 years or older in Taiwanese community studies, with a high social and economic burden for patients, family caregivers, the community and society. Previous studies have shown that viral infections such as herpes simplex and herpes zoster were associated with dementia. This study aimed to investigate the association between dementia and HPV infections. A population-based cohort study using data from Taiwan's National Health Insurance Research Database was conducted. Fine and Grays's survival analysis was employed to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for the association between genital warts and dementia. From all of the potential participants aged 50 years or more, a total of 16 116 patients were enrolled, including 4029 genital warts-infected patients, with 12 087 sex-, age- and indexed date-matched controls (1:3). The cumulative incidences of dementia were 10.72 per 103  person-years and 6.43 per 103  person-years in the genital warts and control group, respectively. There were 475 dementia cases from the genital warts cohort during the follow-up period of 15 years. The adjusted HR for dementia was 1.485 (95% CI, 1.321-1.668; P < 0.001) for genital warts patients after adjusting for all of the covariates. Our study indicates that genital warts infection may increase the risk of dementia.

4.
J Dermatol ; 47(5): 470-475, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32124495

RESUMO

Vitiligo is an autoimmune skin disease that has a major impact on the quality of life of patients. However, a nationwide study of the association between vitiligo and the incidence of inclusive psychiatric diseases has not been conducted in the Asian population. Therefore, this study aimed to analyze the association between vitiligo and the risk of psychiatric disorders using a nationwide database in Taiwan. Data were collected from the National Health Insurance Research Database of Taiwan from 2000 to 2013. In total, 1432 subjects with vitiligo and 5728 age-, sex- and index year-matched controls were enrolled in this study. Patients with vitiligo tend to have more coexisting psychiatric disorders than healthy individuals, regardless of their sex, age group and facility level of care. After adjusting for sex, age, comorbidity, urbanization and facility level of care, the adjusted hazard ratio of overall psychiatric disorders for patients with vitiligo was 2.926 (95% confidence interval [CI], 2.646-3.236; P < 0.001). Among them, the highest adjusted hazard ratios were found for obsessive-compulsive disorder, at 10.790 (95% CI, 9.756-11.932; P < 0.001). Vitiligo is associated with an increased risk of various psychiatric disorders. By providing a better understanding of the psychosocial burden associated with vitiligo, these results emphasize the need to evaluate the mental health of patients with vitiligo by treating physicians.

5.
J Dermatol ; 47(5): 458-463, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32141100

RESUMO

This study examined the association between digoxin use and subsequent psoriasis risk using a population-based database in Taiwan. This cohort study enrolled 15 545 digoxin users and 15 545 propensity score-matched non-users from the Taiwan National Health Insurance Research Database. Each patient was independently followed up for 5 years to confirm whether they had been diagnosed with psoriasis. Cox proportional hazard regression was used to estimate psoriasis risk among digoxin users. Subgroup and sensitivity analyses were also performed. The psoriasis incidence rates were 3.02 and 2.27 per 1000 person-years among digoxin users and non-users, respectively. After adjustment for confounders, psoriasis risk was significantly higher among digoxin users than among non-users. Notably, in most subgroup analyses, digoxin use tended to increase psoriasis risk, particularly among patients with heart failure, diabetes, hypertension and hyperlipidaemia. Moreover, significantly increased psoriasis risk was noted over 2, 3, 4 and 5 years of digoxin use. In conclusion, our findings confirm that digoxin use increases subsequent psoriasis risk. Thus, physicians should be aware of this association and accordingly estimate the risks and benefits of digoxin use. Nevertheless, some patient variables, such as body mass index and obesity, were unavailable in this study. The findings in this study should be elucidated carefully because the potential effects of these factors could not be considered.

6.
J Rheumatol ; 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941803

RESUMO

OBJECTIVE: Bidirectional relationships between some autoimmune diseases and non- Hodgkin's lymphoma (NHL) may exist. We conducted this nationwide populationbased study in Taiwan to investigate whether there is a bidirectional relationship between primary Sjögren's syndrome (pSS) and non-Hodgkin's lymphoma (NHL). METHODS: Using the National Health Insurance Research Database of Taiwan, we identified 15,636 patients with new-onset pSS without previous cancer and 25,074 patients with new-onset NHL without previous pSS as two non-overlapping cohorts from 1998-2012, and followed them until 2013. Standardized incidence ratio (SIR) for NHL in the patients with pSS and SIR for pSS in the patients with NHL were compared with the general population. RESULTS: Among the 15,636 patients with pSS, 741 developed cancers, including 51 with NHL. The highest SIR of specific cancer risk in patients with pSS was that for NHL (SIR 4.6, 95% CI 3.4-6.0). Among the 25,074 patients with NHL, 49 developed pSS; the SIR was also increased (SIR 3.2, 95% CI 2.4-4.2). The risk was highest within one year after the diagnosis of each disease. CONCLUSION: This nationwide population-based study is the first study to report a bidirectional relationship between pSS and NHL. Our findings may suggest being alert for the patients with pSS or NHL who have early signs of the other disease in the clinical care. The underlying mechanisms of the bidirectional relationship merit further investigation.

9.
Clin Chim Acta ; 500: 34-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31655054

RESUMO

BACKGROUND: Several international staging or scoring systems don't accurately predict overall survival (OS) after resection of primary hepatocellular carcinoma (PHCC). Therefore, we attempted to overcome this limitation by constructing the A-index and its associated nomogram. METHODS: We selected 672 patients who underwent curative resection of PHCC between January 2007 and February 2015 at the first affiliated hospital of the Wenzhou medical university. These subjects were randomly divided into the training (n = 470) and the validation group (n = 202) according to the ratio of 7:3. RESULTS: We prepared the nomogram using eight independent risk factors including the A-index (calculated by 100 × aspartate transaminase /albumin /albumin) in the training cohort. The concordance index (C-index) of the nomogram for both training and validation set was similar in indicating the OS rate. The nomogram showed the strongest predictive power for the 1-year, 3-year, and 5-year OS, with the area under the ROC curve being 0.8182, 0.7892, and 0.7669, respectively. Correction curves showed consistent performance for both groups, stratification of the Kaplan-Meier curve was significant (P < 0.001), and decision curve analysis (DCA) showed the superiority of nomograms considering clinical effects. CONCLUSIONS: The predictive power of the nomogram integrating the A-index for OS was optimal.

10.
Arch Dermatol Res ; 312(1): 69-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31599341

RESUMO

This study aimed to evaluate the association of autoimmune bullous diseases [bullous pemphigoid (BP) and pemphigus vulgaris (PV)] with radiotherapy (RT) among patients with breast cancer from a population-based Taiwanese database. The case-control study included 365 women with BP or PV and 1460 randomly selected propensity score-matched controls without BP or PV. We compared the prevalences of prior RT and breast cancer between the cases and controls. In addition, we performed multivariable logistic regression analysis to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for developing BP or PV according to previous RT and/or breast cancer status. Among the 1825 subjects, 680 patients (37.16%) had previously undergone RT, including 196 cases (53.41%) and 484 controls (33.08%) (P < 0.001). 288 of the 1825 subjects (15.78%) had breast cancer, including 90 cases (24.66%) and 198 controls (13.56%) (P < 0.001). The multivariable logistic regression analysis indicated that, after adjusting for comorbidities, urbanization level, level of care, and monthly income, elevated risks of developing BP or PV were associated with prior RT (adjusted OR: 1.744, 95% CI 1.343-2.511) and having breast cancer (adjusted OR: 1.574, 95% CI 1.025-1.889). An even greater risk of BP or PV was associated with the combination of previous RT plus having breast cancer (adjusted OR: 2.896, 95% CI 1.882-7.013). The present study's findings suggest that a significantly elevated risk of developing BP or PV is associated with previous RT and/or breast cancer.

11.
J Dermatol ; 47(3): 245-250, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31885117

RESUMO

Recent studies revealed the risk of bullous pemphigoid (BP) in patients with diabetes mellitus (DM) taking dipeptidyl peptidase 4 (DPP-4) inhibitors. To clarify the relationship between taking DPP-4 inhibitors and the risk of BP among patients with DM, we conducted a cohort study by using the National Health Insurance Research Database of Taiwan from 1 January 2009 to 31 December 2015. We identified 6340 patients with DM taking DPP-4 inhibitors and 25 360 DM patients who had not taken DPP-4 inhibitors during the 7-year follow-up period. Compared with the non-DPP-4 inhibitor group, patients taking DDP-4 inhibitors had a higher risk of BP (adjusted hazard ratio [aHR], 2.382; 95% confidence interval (CI), 1.163-4.883; P = 0.017]. Among the DPP-4 inhibitors available in Taiwan, vildagliptin showed the highest risk of BP (aHR, 2.849; 95% CI, 1.893-4.215; P < 0.001), followed by saxagliptin (aHR, 2.657; 95% CI, 1.770-3.934; P < 0.001). Subgroup analysis revealed that the higher risk of BP was observed in patients older than 65 years (aHR, 2.403; 95% CI, 1.590-3.627; P < 0.001). This study revealed that treatment with DPP-4 inhibitors, especially vildagliptin, was significantly associated with an increased risk of BP among DM patients.

12.
J Fish Dis ; 43(1): 57-68, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31691318

RESUMO

Susceptibility of hard clams Meretrix lusoria to birnavirus (BV) infections caused by temperature variations, from a mechanistic perspective, has rarely been explored. We used a deterministic susceptible-infectious-mortality (SIM) model to derive temperature-dependent key epidemiologic parameters based on data sets of viral infections in hard clams subjected to acute temperature changes. To parameterize seasonal pattern dependence, we estimated monthly based cumulative mortality and basic reproduction numbers (R0 ) between 1997 and 2017 by way of statistical analysis. Two alternative disease control models were also proposed to assess status of controlled temperature-mediated BV infection by using, respectively, control reproduction number (RC )-control line criterion and removal strategy-based control measure. We showed that based on RC -control strategy, when temperatures ranged from 15 to 26.8°C, proportion of susceptible hard clams removed should be at least 0.22%. Based on removal-control strategy, we found that by limiting pond water temperature to 25-30°C, together with increased removal rates and periods to remove hard clams, it is better to remove hard clams from June and August to reduce both mortality rate and spread of BV. Our results can be used to monitor BV transmission potential in hard clams that will contribute to government control strategy to eradicate future BV epidemics.


Assuntos
Birnaviridae/fisiologia , Bivalves/virologia , Temperatura Baixa , Temperatura Alta , Animais , Aquicultura
13.
Math Biosci Eng ; 17(1): 893-909, 2019 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-31731383

RESUMO

This paper performs qualitative analysis on a reaction-diffusion SIRS epidemic system with ratio-dependent incidence rate in spatially heterogeneous environment. The threshold dynamics in the term of the basic reproduction number R0 is established. And the asymptotic profile of endemic equilibrium is determined if the diffusion rate of the susceptible individuals is small. The results show that restricting the movement of susceptible individuals can effectively control the number of infectious individuals.

15.
Math Biosci Eng ; 16(5): 3988-4006, 2019 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-31499646

RESUMO

In this paper, we make a detailed descriptions for the local and global bifurcation structure of nonconstant positive steady states of a modified Holling-Tanner predator-prey system under homogeneous Neumann boundary condition. We first give the stability of constant steady state solution to the model, and show that the system exhibits Turing instability. Second, we establish the local structure of the steady states bifurcating from double eigenvalues by the techniques of space decomposition and implicit function theorem. It is shown that under certain conditions, the local bifurcation can be extended to the global bifurcation.

16.
Cancer Manag Res ; 11: 6567-6579, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31410055

RESUMO

Background: Differentiated embryo chondrocyte 1 (DEC1) is a helix-loop-helix transcription factor that directly binds to the class B E-box in target genes. DEC1 exerts both pro-survival and pro-apoptotic effects in a cell- and tissue-dependent manner. Its actions play role the progression of cancer remains unclear. Methods: We first examined the functional roles of DEC1 using the transient promoter reporter assay. Then, the knockdown of DEC1 expression was performed with the short hairpin RNA strategy in HeLa and A2058 cancer cell lines to check the cell cycle and mitochondrial function profile using the flow cytometry and Seahorse assays. We later clarified the role of DEC1 in the tumorigenesis using the colony formation, anchorage-independent growth assay, and cellular proliferation analysis. Results: In the present study, we tested two guanide-containing drugs, metformin and phenformin, and found that both exhibit cytotoxicity against HeLa cervical carcinoma and A2058 melanoma cells. This effect was mediated, at least in part, through activation of the AMPK pathway; degradation of important cellular proteins, such as DEC1 and p53; and suppression of mitochondrial function, colony formation, and anchorage-independent cell proliferation. Our results further suggest that the cytotoxicity of metformin and phenformin reflect the impact of the repressive actions of DEC1 on gene expression, including DEC1 itself. This in turn suppresses both anchorage-independent growth and cell proliferation. Conclusion: These findings provide several lines of evidence suggesting that DEC1 activity contributes to tumorigenicity and that the antitumor properties of biguanides reflect their ability to inhibit DEC1 functions.

17.
J Dermatol ; 46(10): 867-873, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31389066

RESUMO

Hidradenitis suppurativa (HS) has been reported to be associated with metabolic syndrome and coronary artery disease (CAD). Nevertheless, a nationwide study of this relationship in the Asian population has not been conducted. The aim of the present study was to clarify the cardiovascular disease risk factors, and the occurrence of CAD and cerebral infarction among patients with HS by using a nationwide database in Taiwan. We obtained data from the National Health Insurance Research Database of Taiwan. After adjusting for confounding factors, we used Cox proportional hazards analysis to reveal the risk of incident hypertension (HTN), diabetes mellitus (DM), dyslipidemia, CAD and cerebral infarction in HS patients. We identified 478 patients with newly diagnosed HS and 1912 patients in the control cohort during the 10-year follow-up period. Compared with the controls, HS patients had a higher risk of dyslipidemia (adjusted hazard ratio [aHR], 3.858; 95% confidence interval [CI], 2.785-5.346; P < 0.001), HTN (aHR, 1.910; 95% CI, 1.463-2.493; P < 0.001), DM (aHR, 1.709; 95% CI, 1.127-2.591; P = 0.012). Regarding comorbidities, our results also revealed a higher risk of CAD in HS patients (aHR, 2.722; 95% CI, 1.628-4.553; P < 0.001), but not cerebral infarction (aHR, 0.514; 95% CI, 0.119-2.231; P = 0.375). Our results indicate that there is a higher risk of dyslipidemia, HTN, DM and CAD in HS patients.


Assuntos
Infarto Cerebral/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Hidradenite Supurativa/epidemiologia , Hipertensão/epidemiologia , Adulto , Idoso , Comorbidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
18.
World J Clin Cases ; 7(11): 1262-1269, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31236390

RESUMO

BACKGROUND: Inflammatory cytokines play a vital role in the occurrence of osteoarticular injury and inflammation. Whether inflammation-associated factors interleukin-1ß (IL-1ß), IL-6, tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) are involved in the pathogenesis of keen articular cartilage injury remains poorly understood. AIM: To measure the levels of inflammatory factors [IL-1ß, IL-6, TNF-α and VEGF] in patients with knee articular cartilage injury. METHODS: Fifty-five patients with knee articular cartilage injury were selected as patient groups, who were divided into three grades [mild (n = 20), moderate (n = 19) and severe (n = 16)] according to disease severity and X-ray examinations. Meanwhile, 30 healthy individuals who underwent physical examination were selected as the control group. The levels of IL-1ß, IL-6, TNF-α and VEGF were measured by ELISA and immunohistochemical staining. RESULTS: Compared with the control group, patient groups displayed significantly higher levels of IL-1ß, IL-6, TNF-α and VEGF, and the extent of increase was directly proportional to the severity of injury (P < 0.05). In addition, the number of cells with positive staining of IL-1ß, IL-6, TNF-α and VEGF in the synovial membrane were significantly increased, along with increased disease severity (P < 0.05). After treatment, the scores of visual analogue scale and the Western Ontario and McMaster University of Orthopaedic Index in patient groups were 2.26 ± 1.13 and 15.56 ± 7.12 points, respectively, which were significantly lower than those before treatment (6.98 ± 1.32 and 49.48 ± 8.96). Correlation analysis suggested that IL-1ß and TNF-α were positively correlated with VEGF. CONCLUSION: IL-1ß, IL-6, TNF-α and VEGF levels are increased in patients with knee articular cartilage injury, and are associated with the disease severity, indicating they might play an important role in the occurrence and development of knee articular cartilage injury. Furthermore, therapeutically targeting them might be a novel approach for the treatment of keen articular cartilage injury.

19.
Curr Med Sci ; 39(3): 410-414, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31209811

RESUMO

6-phosphofructo-2-kinase/fructose-2, 6-biphosphatase 3 (PFKFB3), an enzyme producing fructose 2, 6-bisphosphate (F-2, 6-BP), serves as a switch to activate phosphofructokinase-1, and is a critical enzyme for endothelial glycolysis, mediating circadian control of carcinogenesis. Also, tumor-associated macrophages (TAMs) play an important role in the progression and prognosis of numerous cancers. However, the role and clinical significance of PFKFB3 and TAMs in oral squamous cell carcinoma (OSCC) have not been elucidated. The present study was designed to investigate the correlation between PFKFB3 expression, CD163+ TAMs infiltration and tumor angiogenesis in OSCC by tissue microarray. Tissue microarrays containing 117 OSCC specimens and 56 matched paracarcinoma tissues were studied by immunohistochemistry. The expression levels of PFKFB3, CD163 and CD31 were significantly increased in OSCC specimens as compared with normal oral mucosa (P<0.05), and PFKFB was signifcantly correlated with tumor differentiation and tumor size (P<0.05), and CD163 was significantly correlated with areca nut chewing habit among OSCC tissues (P<0.05). Furthermore, Pearson's correlation analysis revealed that PFKFB3 was signifcantly correlated with both CD163 and CD31 (P<0.05), meanwhile CD163 was signifcantly correlated with CD31 (P<0.001), suggesting PFKFB3 may promote angiogenesis in tumor progression and metastases by regulating CD163+ TAMs infiltration in OSCC.


Assuntos
Antígenos CD/genética , Antígenos de Diferenciação Mielomonocítica/genética , Carcinoma de Células Escamosas/genética , Regulação Neoplásica da Expressão Gênica , Neoplasias Bucais/genética , Neovascularização Patológica/genética , Fosfofrutoquinase-2/genética , Molécula-1 de Adesão Celular Endotelial a Plaquetas/genética , Receptores de Superfície Celular/genética , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Areca/química , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patologia , Movimento Celular , Progressão da Doença , Humanos , Metástase Linfática , Macrófagos/metabolismo , Macrófagos/patologia , Mastigação , Neoplasias Bucais/etiologia , Neoplasias Bucais/metabolismo , Neoplasias Bucais/patologia , Gradação de Tumores , Neovascularização Patológica/etiologia , Neovascularização Patológica/metabolismo , Neovascularização Patológica/patologia , Nozes/efeitos adversos , Nozes/química , Fosfofrutoquinase-2/metabolismo , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Receptores de Superfície Celular/metabolismo , Análise Serial de Tecidos , Carga Tumoral
20.
Math Biosci Eng ; 16(4): 2168-2188, 2019 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-31137205

RESUMO

Background: Several outbreaks of severe hand-foot-mouth disease (HFMD) in East Asia and Southwest Asia in recent years have had a serious impact on the countries. However, the factors that contribute to annual multiple-peak pattern of HFMD outbreaks, and how and when do these factors play the decisive role in the HFMD transmission is still unclear. METHODS: Based on the surveillance data of HFMD between 1 January 2010 to 31 December 2015 in Wenzhou, China, the daily modelfree basic reproduction number and its annual average were first estimated by incorporating incubation and infection information, then the annual model-based basic reproduction number was computed by the proposed kinetic model, and finally the potential impact factors of multiple-peak pattern are assessed through the global and time-varying sensitivity analyses. RESULTS: All annual model-based and model-free basic reproduction numbers were significantly higher than one. The school opening both in the spring and fall semester, meteorological e ect in the spring semester, and the interactions among them were strongly correlated with the annual model-based basic reproduction number, which were the main underlying factors on the annual multiple-peak pattern of HFMD outbreaks. CONCLUSIONS: School opening was primarily responsible for peaks of HFMD outbreaks and meteorological factors in the spring semester should also be highly concerned. The optimum timing for social distance implementation is at the beginning of every school semester and health education focusing on personal hygiene and good sanitation should be highlighted in the spring semester.


Assuntos
Número Básico de Reprodução , Surtos de Doenças , Enterovirus , Doença de Mão, Pé e Boca/epidemiologia , China/epidemiologia , Simulação por Computador , Epidemias , Doença de Mão, Pé e Boca/virologia , Humanos , Incidência , Cadeias de Markov , Modelos Teóricos , Método de Monte Carlo , Reprodutibilidade dos Testes , Estações do Ano
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