Search

Abstract Accumulating evidence suggests that oral supplementation with myo-Inositol (myo-Ins) is able to reduce the amount of gonadotropins and days of controlled ovarian hyperstimulation (COS) necessary to achieve adequate oocyte maturation in assisted reproduction technology (ART) protocols, particularly in women affected by polycystic ovary syndrome (PCOS). We used computational calculations based on simulation modellings. We simulated in vitro fertilization (IVF) procedures—with or without intracytoplasmic sperm injection (ICSI)—with 100,000 virtual patients, accounting for all the stages of the entire IVF procedure. A Monte Carlo technique was used to account for data uncertainty and to generate the outcome distribution at each stage. We considered virtual patients with PCOS undergoing IVF cycles to achieve pregnancy. Computational data were retrieved from clinical experience and published data. We investigated three parameters related to ART protocols: cost of single procedure; efficacy to achieve ongoing pregnancy at 12 gestational weeks; overall cost per single pregnancy. The administration of oral myo-Ins during COH protocols, compared to the standard COH with recombinant Follicle Stimulating Hormone (rFSH) only, may be considered a potential strategy to reduce costs of ART for the Italian Health System.

Abstract Background The FLURESP project is a public health research funded by the European Commission, with the objective to design a methodological framework to assess the cost-effectiveness of existing public health measures against human influenza pandemics. A dataset has been specifically collected in the frame of the Italian health system. As most of interventions against human influenza are relavant against other respiratory diseases pandemics, potential interests in COVID-19 are discussed. Methods Ten public health measures against human influenza pandemics pandemic were selected to be also relevant to other respiratory virus pandemics such as COVID 19: individual (hand washing, using masks), border control (quarantine, fever screening, border closure), community infection (school closure, class dismissal, social distancing, limitation of public transport), reduction of secondary infections (implementation of antibiotic therapy guidelines), pneumococcal vaccination for at-risk people, development of Intensive Care Unit (ICU) capacity, implementation of life support equipments in ICU, screening interventions, vaccination programs targeting health professional and targeting general population. Results Using mortality reduction as effectiveness criteria, the most cost-effective strategies are “reduction of secondary infections” and “implementation of life support equipment in ICU”. The least cost-effective option whatever the level of pandemic events are screening interventions and mass vaccination. Conclusions A number of intervention strategies against human influenza pandemics appears relevant against every respiratory virus, including the COVID-19 event. Measures against pandemics should be considered according to their expected effectiveness but also their costs for the society because they impose substantial burden to the population, confirming the interest of considering cost-effectiveness of public health measures to enlighten decision making.

Responsible Research and Innovation (RRI) associated with public health emergency preparedness (PHEP) and response pose major challenges to the scientific community and civil society because a multistakeholder and interdisciplinary methodology is needed to foster public engagement. In 2017, within “Action plan on Science in Society related issues in Epidemics and Total pandemics”, twenty-three initiatives in eleven cities—Athens, Brussels, Bucharest, Dublin, Geneva, Haifa, Lyon, Milan, Oslo, Rome, and Sofia—represented effective opportunities for Mobilization and Mutual Learning on RRI issues in the matter of PHEP with different community-level groups. These experiences show that to effectively address a discourse on RRI-related issues in PHEP it is necessary to engage the local population and stakeholders, which is challenging because of needed competencies and resources. Under coronavirus disease 2019 (COVID-19) pandemic, we are proven that such a diversified multistakeholder engagement on RRI related to PHEP locally needs further elaboration and practical development.

Objective Clinical data comparing diagnostic strategies in the management of Helicobacter pylori-associated diseases are limited. Invasive and noninvasive diagnostic tests for detecting H. pylori infection are used in the clinical care of patients with dyspeptic symptoms. Modelling studies might help to identify the most cost-effective strategies. The objective of the study is to assess the cost-effectiveness of a ‘test-and-treat’ strategy with the urea breath test (UBT) compared with other strategies, in managing patients with H. pylori-associated dyspepsia and preventing peptic ulcer in the UK.Design Cost-effectiveness models compared four strategies: ‘test-and-treat’ with either UBT or faecal antigen test (FAT), ‘endoscopy-based strategy’ and ‘symptomatic treatment’. A probabilistic cost-effectiveness analysis was performed using a simulation model in order to identify probabilities and costs associated with relief of dyspepsia symptoms (over a 4-week time horizon) and with prevention of peptic ulcers (over a 10-year time horizon). Clinical and cost inputs to the model were derived from routine medical practice in the UK.Results For relief of dyspepsia symptoms, ‘test-and-treat’ strategies with either UBT (€526/success) and FAT (€518/success) were the most cost-effective strategies compared with ‘endoscopy-based strategy’ (€1317/success) and ‘symptomatic treatment’ (€1 029/success). For the prevention of peptic ulcers, ‘test-and-treat’ strategies with either UBT (€208/ulcer avoided/year) or FAT (€191/ulcer avoided/year) were the most cost-effective strategies compared with ‘endoscopy-based strategy’ (€717/ulcer avoided/year) and ‘symptomatic treatment’ (€651/ulcer avoided/year) (1 EUR=0,871487 GBP at the time of the study).Conclusion ‘Test-and-treat’ strategies with either UBT or FAT are the most cost-effective medical approaches for the management of H. pylori-associated dyspepsia and the prevention of peptic ulcer in the UK. A ‘test-and-treat’ strategy with UBT has comparable cost-effectiveness outcomes to the current standard of care using FAT in the UK.

This study assessed the psychometric properties of a recently developed health-related quality of life (HRQOL) instrument (Vecu et Sante Percue de l'Adolescent -Malade, VSP-AM) in 172 adolescents receiving growth hormone. The VSP-AM was cross-culturally adapted into English and tested for internal consistency (@a=0.78-0.89 subscales, 0.74 Summary Score), construct and criterion validity, and responsiveness. Correlations with other scales demonstrated convergent validity. Adolescents who reported HRQOL as high or low had significantly different scores (all p<0.001). Adolescents receiving growth hormone therapy differed significantly from adolescents with medical, surgical or psychiatric disorders. The VSP-AM shows reliability and validity for HRQOL measurement in adolescents with growth disorders.

Objective To develop a tool for evaluating the risk that an outbreak of meningitis will occur in a particular district of the Niger after outbreaks have been reported in other, specified districts of the country. Methods A Bayesian network was represented by a graph composed of 38 nodes (one for each district in the Niger) connected by arrows. In the graph, each node directly influenced each of the 'child' nodes that lay at the ends of the arrows arising from that node, according to conditional probabilities. The probabilities between 'influencing' and 'influenced' districts were estimated by analysis of databases that held weekly records of meningitis outbreaks in the Niger between 1986 and 2005. For each week of interest, each district was given a Boolean-variable score of 1 (if meningitis incidence in the district reached an epidemic threshold in that week) or 0. Findings The Bayesian network approach provided important and original information, allowing the identification of the districts that influence meningitis risk in other districts (and the districts that are influenced by any particular district) and the evaluation of the level of influence between each pair of districts. Conclusion Bayesian networks offer a promising approach to understanding the dynamics of epidemics, estimating the risk of outbreaks in particular areas and allowing control interventions to be targeted at high-risk areas. Une approche de reseau bayesien de l'etude des bases de donnees epidemiologiques historiques: la modelisation des noussees de meningite au Niger/ Un enfoque de red bayesiana para el estudio de bases historicas de datos epidemiologicos: modelo de brotes de meningitis en Niger Objectif Developper un outil permettant d'evaluer le risque d'apparition d'une poussee de meningite dans un district particulier du Niger apres le signalement d'autres poussees dans d'autres districts specifies du pays. Methocles Un reseau bayesien a ete represente par un graphique compose de 38 nceuds (un pour chaque district du Niger) relies par des fleches. Dans le graphique, chaque nceud a directement influence chacun des noeuds <> aux extremites des fleches resultant de ces nceuds, selon les probabilites conditionnelles. Les probabilites entre les districts <> et <> ont ete estimees par I'analyse des bases de donnees qui contenaient les enregistrements hebdomadaires des poussees de meningite au Niger entre 1986 et 2005. Pour chaque semaine d'interet, on a attribue a chaque district un score booleen variable de 1 (si I'incidence de meningite dans le district atteignait un seuil epidemique au cours de cette semaine) ou de 0. Resultats L'approche de reseau bayesien a fourni des informations originates et importantes, permettant d'identifier les districts q'ui influencent le risque de meningite dans d'autres districts (et les districts qui sont influences par un district particulier) et d'evaluer le niveau d'influence entre chaque couple de districts. Conclusion Les reseaux bayesiens offrent une approche prometteuse pour comprendre la dynamique des epidemies, evaluant le risque de poussees dans des zones particulieres et permettant de cibler les interventions de lutte contre la maladie dans les zones a risque eleve. Objetivo Desarrollar una herramienta para evaluar el riesgo de la aparicion de un brote de meningitis en un distrito determinado dei Niger despues de que se haya informado acerca de otros brotes en otros distritos especificos dei pais. Metodos Se represento una red bayesiana con un grafico compuesto por 38 nodos (uno por cada distrito en el Niger) conectados mediante flechas. En el grafico, cada nodo influia directamente en cada uno de los nodos de 'nioos' que se encuentran en los extremos de las flechas que surgen de dicho nodo, de acuerdo con las probabilidades condicionales. Se calcularon las probabilidades entre distritos 'influyentes' e 'influidos' mediante el analisis de bases de datos que recogian registros semanales de los brotes de meningitis en Niger entre 1986 y 2005. Por cada sema na de interes, se adjudicaba a cada uno de los distritos un valor de variable booleana de 1 (si la incidencia de meningitis en el distrito alcanzaba un umbral epidemico en esa semana) o de 0. Resultados El enfoque de red bayesiana proporciona informacion importante y original, lo que permite identificar cuales son los distritos que influyen en el riesgo de meningitis de otros distritos (y cuales estan bajo la influencia de cualquier distrito determinado) y evaluar el nivel de influencia entre cada par de distritos. Conclusion Las redes bayesianas ofrecen un enfoque prometedor para entender las dinamicas de las epidemias, permiten calcular el riesgo de brotes en areas determinadas y concentrar las intervenciones de control objetivo en las areas de alto riesgo., Abstracts in [TEXT NOT REPRODUCIBLE IN ASCII], Francais, [TEXT NOT REPRODUCIBLE IN ASCII] and Espanol at the end of each article. Introduction Throughout the African 'meningitis belt', epidemics of meningococcal [...]

OBJECTIVE: To develop a tool for evaluating the risk that an outbreak of meningitis will occur in a particular district of the Niger after outbreaks have been reported in other, specified districts of the country. METHODS: A Bayesian network was represented by a graph composed of 38 nodes (one for each district in the Niger) connected by arrows. In the graph, each node directly influenced each of the "child" nodes that lay at the ends of the arrows arising from that node, according to conditional probabilities. The probabilities between "influencing" and "influenced" districts were estimated by analysis of databases that held weekly records of meningitis outbreaks in the Niger between 1986 and 2005. For each week of interest, each district was given a Boolean-variable score of 1 (if meningitis incidence in the district reached an epidemic threshold in that week) or 0. FINDINGS: The Bayesian network approach provided important and original information, allowing the identification of the districts that influence meningitis risk in other districts (and the districts that are influenced by any particular district) and the evaluation of the level of influence between each pair of districts. CONCLUSION: Bayesian networks offer a promising approach to understanding the dynamics of epidemics, estimating the risk of outbreaks in particular areas and allowing control interventions to be targeted at high-risk areas.

Background. The objective of this simulation model was to assess the cost-effectiveness of different biological treatment strategies based on levels of disease activity in Spain, in patients with moderate to severe active RA and an insufficient response to at least one anti-TNF agent. Methods. Clinically meaningful effectiveness criteria were defined using DAS28 scores: remission and Low Disease Activity State (LDAS) thresholds. Monte-Carlo simulations were conducted to assess cost-effectiveness over 2 years of four biological sequential strategies composed of anti-TNF agents (adalimumab, infliximab), abatacept or rituximab, in patients with moderate to severe active RA and an insufficient response to etanercept as first biological agent. Results. The sequential strategy including etanercept, abatacept and adalimumab appeared more efficacious over 2 years (102 days in LDAS) compared to the same sequence including rituximab as second biological option (82 days in LDAS). Cost-effectiveness ratios showed lower costs per day in LDAS with abatacept (427 €) compared to rituximab as second biological option (508 €). All comparisons were confirmed when using remission criteria. Conclusion. Model results suggest that in patients with an insufficient response to anti-TNF agents, the biological sequences including abatacept appear more efficacious and cost-effective than similar sequences including rituximab or cycled anti-TNF agents.

BACKGROUND: Yellow fever (YF) virtually disappeared in francophone West African countries as a result of YF mass vaccination campaigns carried out between 1940 and 1953. However, because of the failure to continue mass vaccination campaigns, a resurgence of the deadly disease in many African countries began in the early 1980s. We developed an original modeling approach to assess YF epidemic risk (vulnerability) and to prioritize the populations to be vaccinated. METHODS AND FINDINGS: We chose a two-step assessment of vulnerability at district level consisting of a quantitative and qualitative assessment per country. Quantitative assessment starts with data collection on six risk factors: five risk factors associated with "exposure" to virus/vector and one with "susceptibility" of a district to YF epidemics. The multiple correspondence analysis (MCA) modeling method was specifically adapted to reduce the five exposure variables to one aggregated exposure indicator. Health districts were then projected onto a two-dimensional graph to define different levels of vulnerability. Districts are presented on risk maps for qualitative analysis in consensus groups, allowing the addition of factors, such as population migrations or vector density, that could not be included in MCA. The example of rural districts in Burkina Faso show five distinct clusters of risk profiles. Based on this assessment, 32 of 55 districts comprising over 7 million people were prioritized for preventive vaccination campaigns. CONCLUSION: This assessment of yellow fever epidemic risk at the district level includes MCA modeling and consensus group modification. MCA provides a standardized way to reduce complexity. It supports an informed public health decision-making process that empowers local stakeholders through the consensus group. This original approach can be applied to any disease with documented risk factors.