Search

Introdução/objetivos: Dados brasileiros sobre a carga do vírus sincicial respiratório (VSR) em adultos são limitados. As vacinas contra o VSR recentemente aprovadas visam reduzir a carga do VSR em adultos mais velhos. Este estudo tem como objetivo usar uma abordagem de modelagem para estimar a carga do VSR e projetar o potencial impacto na saúde pública da introdução da Vacina VSR Adjuvantada (RSVPreF3) para imunização de adultos com 60 anos ou mais no Brasil. Materiais e métodos: Um modelo de Markov estático de ciclo mensal foi desenvolvido para avaliar o número de casos sintomáticos de VSR com e sem vacinação. O modelo captura casos de VSR em pacientes com doença respiratória aguda (DRA-VSR), doença do trato respiratório inferior (DTRI-VSR), doença do trato respiratório superior (DTRS-VSR), complicações de pneumonia devido à DTRI-VSR, hospitalizações (assumidas conservadoramente apenas às DTRI-VSR) e mortes em um período de três anos. A cobertura vacinal para uma dose única considerada no modelo foi de 30% a 70%. Os dados demográficos são valores específicos do Brasil (2024) provenientes das Nações Unidas. Os dados epidemiológicos foram recuperados de banco de dados público (FluNet) e complementados por revisão sistemática da literatura. A eficácia da vacina foi obtida do estudo clínico de fase 3 AReSVi-006 (NCT04886596). Resultados: No Brasil, a coorte incluiu 33.859.754 adultos ≥ 60 anos. Na ausência de vacinação, o modelo projetou 6.641.784 casos de DRA-VSR (3.480.113 de DTRS-VSR e 3.161.671 de DTRI- VSR), 243.205 casos de pneumonia, 264.214 hospitalizações e 25.083 mortes por VSR em três anos. Com a cobertura aumentando de 30% para 70%, o modelo projetou que a vacinação pode prevenir de 780.189 a 1.820.442 casos de DRA-VSR (264.146 a 616.341 de DTRS-VSR e 516.043 a 1.204.101 de DTRI-VSR), 39.696 a 92.623 casos de pneumonia, 43.125 a 100.624 hospitalizações e 4.094 a 9.553 mortes por VSR. O número necessário para vacinar para prevenir um caso de DRA-VSR e um caso de DTRI-VSR foi estimado em 13 e 20, respectivamente. Conclusões: Os resultados revelam que aproximadamente 20% da população brasileira com idade ≥ 60 anos está em risco de infecção por VSR nos próximos três anos, e a carga ao sistema de saúde é substancial. A prevenção por meio da vacinação com RSVPreF3 tem o potencial de produzir consideráveis benefícios, reduzindo a morbidade, a utilização de serviços de saúde e a mortalidade associadas às infecções por VSR. Palavras-chave: Vírus Sincicial Respiratório, Vacina VSR Adjuvantada, ≥ 60 anos. Conflitos de interesse: RH, AG, BdV, LM, OC, DVO and JG are GSK employees. AG and JG hold shares in GSK. These authors declare no other financial and non-financial relationships and activities. Ética e financiamentos: Estudo financiado por: GlaxoSmithKline Biologicals SA (GSK study identifier: VEO-000975).

Abstract Introduction Herpes zoster (HZ) can cause substantial patient morbidity and lead to large healthcare costs. However, the disease burden of HZ in Southeast Asia may be underestimated. This study aimed to estimate the public health burden of HZ and the impact of vaccinating adults aged ≥ 50 years old in five Southeast Asian countries (Indonesia, Malaysia, Philippines, Thailand, and Vietnam), with adjuvanted recombinant zoster vaccine (RZV) compared with no vaccination. Methods For each country, we adapted a static multicohort Markov model developed with a 1-year cycle length and lifetime horizon. Demographics were obtained from the World Health Organization, HZ incidence from a worldwide meta-regression reporting Asian-specific values, proportions of postherpetic neuralgia (PHN) and non-PHN complications from local/regional studies, and vaccine efficacy from a long-term follow-up trial. First-dose coverage and second-dose compliance were assumed to be 30% and 70%, respectively. A one-way deterministic sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA) were performed to assess the robustness and uncertainty of inputs for each country. Results Without RZV, it was estimated that there would be a total of approximately 10 million HZ cases, 2.1 million PHN cases, and 1.4 million non-PHN complications in individuals aged ≥ 50 years included in the model. Introducing RZV under 30% coverage could avoid approximately 2.2 million (22%) HZ cases, almost 500,000 (21%) PHN cases, and around 300,000 (22%) non-PHN complications. OWSA showed that first-dose coverage and initial HZ incidence had the largest impact on the estimated number of HZ cases avoided. The number needed to vaccinate ranged from 15 to 21 to prevent one case of HZ and from 68 to 104 to prevent one case of PHN across each country. Conclusions This study demonstrated that there is substantial HZ disease burden in older adults for the five selected countries in Southeast Asia, negatively impacting national healthcare systems. Introducing RZV could potentially reduce this burden. A graphical abstract is available with this article. Graphical Abstract

AIM: To evaluate the cost-utility of iStent inject® with cataract surgery vs cataract surgery alone in patients with mild-to-moderate primary open angle glaucoma (POAG) in the Japanese setting from a public payer's perspective. METHODS: A Markov model was adapted to estimate the cost-utility of iStent inject® plus cataract surgery vs cataract surgery alone in one eye in patients with mild-to-moderate POAG over lifetime horizon from the perspective of Japanese public payer. Japanese sources were used for patients' characteristics, clinical data, utility, and costs whenever available. Non-Japanese data were validated by Japanese clinical experts. RESULTS: In the probabilistic base case analysis, iStent inject® with cataract surgery was found to be cost-effective compared with cataract surgery alone over a lifetime horizon when using the ¥5 000 000/quality-adjusted life year (QALY) willingness-to-pay threshold. The incremental cost-utility ratio (ICUR) was estimated to be ¥1 430 647/QALY gained and the incremental cost-utility ratio (ICER) was estimated to be ¥12 845 154/blind eye avoided. iStent inject® with cataract surgery vs cataract surgery alone was found to increase costs (¥1 025 785 vs ¥933 759, respectively) but was more effective in increasing QALYs (12.80 vs 12.74) and avoiding blinded eyes (0.133 vs 0.141). The differences in costs were mainly driven by costs of primary surgery (¥279 903 vs ¥121 349). In the scenario analysis from a societal perspective, which included caregiver burden, iStent inject® with cataract surgery was found to dominate cataract surgery alone. CONCLUSION: The iStent inject® with cataract surgery is a cost-effective strategy over cataract surgery alone from the public payer's perspective and cost-saving from the societal perspective in patients with mild-to-moderate POAG in Japan.

This study aimed to: (1) estimate the disease burden of herpes zoster (HZ) and (2) assess the potential public health impact of introducing adjuvanted recombinant zoster vaccine (RZV) compared with no vaccination in adults aged ≥50 years in Argentina, Brazil, Mexico, Chile, and Colombia using the ZOster ecoNomic Analysis (ZONA) static multicohort Markov model. The model followed individuals aged ≥50 years from administration of RZV over their remaining lifetime. Inputs were based, most often, on local data. First dose coverage was assumed to be 35%, with 75% second dose compliance. It was predicted that without RZV, there would be 23,558,675 HZ cases, 6,115,981 post-herpetic neuralgia (PHN) cases, and 7,058,779 non-PHN complications in the five countries, but introducing RZV under assumed coverage could avoid 4,583,787 (19%) HZ cases, 1,130,751 (18%) PHN cases, and 1,373,419 (19%) non-PHN complications. Also, 10427,504 (20%) doctor’s office visits and 1,630,201 (19%) days of hospitalization could be averted in the three countries (Argentina, Brazil, and Mexico) with available input data. The numbers needed to be vaccinated to avoid one case of HZ were 9–10 across countries, and to avoid one case of PHN, 35–40. One-way sensitivity analyses showed that the input parameters with the largest impact on the estimated number of HZ cases avoided were first dose coverage, initial HZ incidence, and vaccine efficacy waning. In conclusion, the introduction of RZV for older adults in Latin America could greatly reduce the public health burden of HZ and reduce the related doctor visits and hospitalization days.

Introdução: O herpes-zoster (HZ) manifesta-se normalmente em idosos ou indivíduos imunocomprometidos a partir da reativação do vírus varicela zoster latente. Sem vacinação, até 30% das pessoas estão sob o risco de desenvolver HZ durante a vida, com aumento significativo do risco após os 50 anos de idade. Após a fase aguda da doença, caracterizada por manifestações cutâneas dolorosas, no Brasil, 22,1% dos pacientes desenvolvem dor neuropática crônica devido a neuralgia pós-herpética (NPH). Outras complicações (oftálmicas, neurológicas e outras) podem ocorrer e gerar danos de longo prazo. Em 2017, a vacina recombinante contra o herpes-zoster (VZR) foi recomendada como preferencial nos EUA e então aprovada em outros países, incluindo o Brasil em 2021. Objetivo: Analisar o potencial impacto em saúde pública da introdução da VZR na população brasileira com 50 anos ou mais comparada com a não vacinação. Método: A análise econômica de Zoster, um modelo estático de Markov por simulação de coortes, com horizonte temporal lifetime e duração anual dos ciclos foi adaptado para o cenário brasileiro. O tamanho da população e a mortalidade por todas as causas (2019) foram obtidos do website do Instituto Brasileiro de Geografia e Estatística. A incidência de HZ foi obtida a partir de uma meta-regressão global; as proporções de NPH e de outras complicações, o número de consultas médicas e as hospitalizações foram obtidas de estudos brasileiros e a eficácia da vacina dos ensaios clínicos de fase III (ZOE-50 e ZOE-70). Assumiu-se que cobertura da VZR seria de 35% com uma adesão de 80% à segunda dose. Resultados: No caso base, a vacinação de 35% da população de 50 anos ou mais com VZR poderia evitar 2.383.489 casos de HZ; 592.311 casos de NPH; 714.154 de outras complicações ao longo da vida da população. Na perspectiva do uso de recursos de saúde, 5.489.176 consultas médicas e 1.230.357 hospitalizações poderiam ser evitadas. A faixa etária na qual houve a maior redução no número de casos de HZ, suas complicações e uso de recursos relacionados foi de 50 a 59 anos. Nove e 34 indivíduos precisariam ser vacinados para prevenir um caso de HZ e um caso de NPH, respectivamente. Na análise de sensibilidade univariada, os três parâmetros mais influentes foram a cobertura vacinal, incidência anual de HZ e adesão à segunda dose da VZR. Conclusão: A vacinação com VZR demonstra potencial de redução substancial do impacto em saúde pública causado pela HZ em indivíduos com 50 anos ou mais no Brasil.Ag. Financiadora: Glaxosmithkline Biologicals AS.

In this paper, a vertically stacked nanosheet gate-all-around field-effect transistor (GAA-NSFET) as a label-free biosensor has been proposed and investigated. The influences of different biomolecules on the biosensor’s electrical properties are analyzed, and the proposed biosensor exhibits good sensitivity for both neutral and charged biomolecules. Furthermore, a deep sensitivity analysis is performed to evaluate the sensing ability of biosensors with different channel structures. The sensitivity variation of biosensors is analyzed in terms of subthreshold swing ( $SS $ ), threshold voltage ( $V_{\text {th}}$ ), and current switching ratio ( $I_{\text {on}} / I_{\text {off}}$ ). The results show that GAA-NSFET-based biosensor obtains the best sensitivity compared with other biosensors (including nanowire FET-based biosensor and vertically stacked nanowire FET-based biosensor) due to its larger channel width and multi-channels. Also, the influences of filling position on sensitivity are analyzed in various cases for the proposed biosensor. Its sensitivity depends on the filling amounts of biomolecules instead of the filling position. Finally, a status map is presented, which plots the sensitivity of some important works in biosensing application along with the sensitivity of the proposed biosensor, and GAA-NSFET-based biosensor is more sensitive compared with those works in terms of $I_{\text {on}}/I_{\text {off}}$ sensitivity.

In this study, a transition metal-based perovskite oxide catalyst with high CH3OH yield was successfully developed. The A-site substitution by Pr3+ in La1-xPrxMn0.6Ni0.4O3-δ can effectively adjust the activity of the perovskite catalysts for the direct conversion of CO2 and H2O into hydrocarbon fuels, especially CH3OH. Based on the designed photo-thermo synergetic photosynthesis strategy, the first hour CH3OH yield of La1-xPrxMn0.6Ni0.4O3-δ reached 3.97 mmol g−1, while only 0.24 μmol g−1 under normal photocatalysis mode. The synergistic photo-thermo catalysis was demonstrated to be a promising strategy for the future artificial photosynthesis development.

Abstract Background Although significant improvement in efficacy measured by a sustained virological response, the high acquisition costs of direct-acting antivirals limit the access for patients and influence the costs of healthcare resource utilisation in hepatitis C. It is important to have the latest estimates of prevalence, especially in high-risk groups, for cost of illness, cost-effectiveness and budget impact studies. Methods Original studies on the estimates of the prevalence among general and high-risk groups in the European Union/European Economic Area (EU/EEA) were retrieved from Medline and Embase for the period from 2015 to 2018. All included studies were evaluated for risk of selection bias and summarised together in a narrative form. Results from previous reviews and updated searches were compared per country among different populations, respectively. Results Among the 3871 studies identified, 46 studies were included: 20 studies were used for the estimate of the general population; 3 for men who have sex with men (MSM); 6 for prisoners; and 17 for people who inject drugs (PWID). Compared with the results reported in previous systematic reviews, the updated estimates were lower than previously in most available countries. Anti-HCV general population prevalence estimates ranged from 0.54 to 1.50% by country. The highest prevalence of anti-HCV was found among PWID (range of 7.90–82.00%), followed by prisoners (7.00–41.00%), HIV-positive MSM (1.80–7.10%), HIV-negative MSM (0.20–1.80%), pregnant women (0.10–1.32%) and first-time blood donors (0.03–0.09%). Conclusions Our study highlights the heterogeneity in anti-HCV prevalence across different population groups in EU/EEA. The prevalence also varies widely between European countries. There are many countries that are not represented in our results, highlighting the need for the development of robust epidemiological studies.

Background and objective: Although the treatment of chronic hepatitis C (CHC) has significantly evolved with the introduction of direct-acting antivirals, the treatment uptake rates have been low especially among marginalized groups in the UK, such as people who inject drug (PWID) and men who have sex with men (MSM). Cutting health inequality is a major focus of healthcare agencies. This study aims to identify the optimal allocation of treatment budget for chronic hepatitis CHC among populations and treatments in the UK so that liver-related mortality in patients with CHC is minimized, given the constraint of treatment budget and equity issue. Methods: A constrained optimization modelling of resource allocation for the treatment of CHC was developed in Excel from the perspective of the UK National Health System over a lifetime horizon. The model was designated with the objective function of minimizing liver-related deaths by varying the decision variables, representing the number of patients receiving each treatment (elbasvir-grazoprevir, ombitasvir-paritaprevir-ritonavir-dasabuvir, sofosbuvir-ledipasvir, and pegylated interferon-ribavirin) in each population (the general population, PWID, and MSM). Two main constraints were formulated including treatment budget and the issue of equity. The model was populated with UK local data applying linear programming and underwent internal and external validation. Scenario analyses were performed to assess the robustness of model results. Results: Within the constraints of no additional funding over original spending in status quo and the consideration of the issue of equity among populations, the optimal allocation from the constrained optimization modelling (treating 13,122 PWID, 160 MSM, and 904 general patients with ombitasvir-paritaprevir-ritonavir-dasabuvir) was found to treat 2,430 more patients (relative change: 20.7%) and avert 78 liver-related deaths (relative change: 0.3%) compared with the current allocation. The number of patients receiving treatment increased 4,928 (relative change: 60.1%) among PWID and 42 (relative change: 35.8%) among MSM. Conclusion: The current allocation of treatment budget for CHC is not optimal in the UK. More patients would be treated, and more liver-related deaths would be avoided using a new allocation from a constrained optimization modelling without incurring additional spending and considering the issue of equity.

Purpose A international registry analysis led by Mehra et al. to investigate the use of hydroxychloroquine (HCQ) and chloroquine (CQ) with or without a macrolide in 96,032 hospitalised COVID-19 patients were published on Lancet, which has raised considerable discussions in the public health community. This study aimed to critically review the quality and limitations of the Mehra et al. publication and discuss the potential influences on the use of HCQ/CQ worldwide. Method A critical review of this publication was conducted to examine the potential study bias in the study objectives, methodology, confounding factors and outcomes and summarise the external reviews. Results The very high homogeneity of the patients’ characteristics at baseline was inconsistent with region specific epidemiology and several critical confounding factors. The results indicated that angiotensin converting enzyme inhibitors were associated with a hazard ratio of 0.5, which suggested a technical problem in the estimation of the propensity scores. Several major risk factors for mortality identified in the analysis were treated as a minor risk or neutral or even protective factors. Antiviral treatments were recognised as an effective method to reduce mortality and were neither further studied nor integrated in the multivariate Cox model. Conclusion This research appeared to carry multiple biases. An extensive audit of the study, conditions of review and acceptance for publication in the Lancet of that study are requested to avoid damage to the publics’ trust on the scientific community at this critical time of COVID-19 pandemic.

Background and Objective: China has managed to control the coronavirus disease (COVID-19) with confinement measurements and treatment strategies, while other countries are struggling to contain the spread. This study discusses the guidelines related to COVID-19 in China in order to provide important references for other countries in the fight against COVID-19. Methods: Chinese guidelines relevant to COVID-19 were systematically searched via the China National Knowledge Infrastructure database, YiMaiTong database, and World Health Organization (WHO) COVID-19 database on March 20th, 2020. Guideline information was extracted, including date of publication, source, objectives and the target population. Guidelines specific to the pharmacological treatment of COVID-19 were further investigated to identify the types of antivirus drugs recommended and to report on how treatment recommendations for COVID-19 have evolved overtime. Results: A total of 100 guidelines were identified, of which 74 were national guidelines and 26 were regional guidelines. The scope of included guidelines consisted of: the diagnosis and treatment of COVID-19, the management of hospital departments and specific diseases during the outbreak of COVID-19. Fifty-one of the included guidelines targeted overall COVID-19 patients, while the remaining guidelines concentrated on special patient populations (i.e. geriatric population, pediatric population, and pregnant population) or patients with coexisting diseases. Fifteen guidelines focused on the pharmacological treatments for all COVID-19 patients. Interferon, Lopinavir/Ritonavir, Ribavirin, Chloroquine, and Umifenovir represented the most recommended antivirus drugs. Among them, 7 Chinese guidelines have recommended Chloroquine Phosphate or Hydroxychloroquine for the treatment of COVID-19. Conclusions: China has generated a plethora of guidelines covering almost all aspects of COVID-19. Chloroquine, as one widely affordable treatment, was recommended by Chinese national guidelines and provincial guidelines. Considering the continuous debates around Chloroquine, confirmatory studies with robust methodology are awaited to address the unanswered questions on its potential benefits and risks on COVID-19.

Background: In order to generate data on the burden of foodborne diseases in Shandong Province, we aimed to use the case monitoring data of foodborne diseases from 2016 to 2017 to estimate. Methods: Data were obtained from the foodborne disease surveillance reporting system with dates of onset from Jan 1, 2016, to Dec 31, 2017, in Shandong, China. Results: The places of food exposure were categorized by settings as follows: private home, catering facility, collective canteens, retail markets, rural banquets and other. Exposed food is divided into 23 categories. Overall incidence rate and proportions by exposure categories, age, and sex-specific incidence rates were calculated and sex proportions compared. Approximately 75.00% of cases who had at least one exposure settings were in private homes. The most frequently reported exposed food was a variety of food (meaning more than two kinds of food). The two-year average incidence rate was 75.78/100,000, sex-specific incidence rate was much higher for females compared to males (78.23 vs. 74.69 cases per 100,000 population). An age-specific trend was observed in the cases reported (Chi-Square for linear trend, χ2=4.39, P=0.036

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Transition metal‐catalyzed carbonylation functionalization reaction of alkenes is an attractive research area in modern organic chemistry. However, there have been very few reports on silver‐catalyzed reactions in carbonylation reactions. Herein we developed a silver‐catalyzed carbamoylation and carbonylative cyclization of alkenes with oxamic acids to obtain 2‐acetylamino‐1‐tetralone derivatives. Various desired cyclized products were formed in moderate to good yields through radical intermediates. [ABSTRACT FROM AUTHOR]

Star identification algorithms can be applied to resident space object (RSO) surveillance, which includes a large number of stars and false stars. This paper proposes an efficient, robust star identification algorithm for RSO surveillance based on a neural network. First, a feature called equal-frequency binning radial feature (EFB-RF) is proposed for guide stars, and a superficial neural network is constructed for feature classification. Then the training set is generated based on EFB-RF. Finally, the remaining stars are identified using a residual star matching method. The simulation experiment and results show that the identification rate of our algorithm can reach 99.82% under 1 pixel position noise, and it can reach 99.54% under 5% false stars. When the percentage of missing stars is 15%, it can reach 99.40%. The algorithm is verified by RSO surveillance. [ABSTRACT FROM AUTHOR]