RESUMO
Coronary artery disease (CAD) has significant social and economic implications. It is necessary to create tools to identify the most cost-effectiveness treatments, which can assist clinicians in their therapeutic decisions so that the maximum possible benefit is reached with the lowest possible cost. Effectiveness must be measured by final treatment goals in which the most effective interventions are those with the lowest costs. This study is aimed to systematically review and compare the studies conducted on the cost-effectiveness of the three coronary artery disease treatment strategies (medical treatment, percutaneous coronary intervention, and coronary artery bypass graft). In this systematic review, the databases NHS Economic Evaluation Database, Embase, MEDLINE, Science Direct, and Scopus were searched for studies on the cost-effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) compared to medical therapy (MT) in patients with coronary artery disease between 1 January 2004 to 30 September 2018. The quality appraisal of the included studies was examined using the Consolidated Health Economics Evaluation Reporting Standards (CHEERS) statement. Out of 186 unique retrievals, 8 studies were included. The results showed that the all studies clearly stated the time horizon of the study and included direct medical costs in their analysis. In addition, in most of the studies, quality-adjusted life years (QALY) were the main outcome used for measuring the effectiveness. The studies reported various ranges of the incremental cost-effectiveness ratio (ICER); accordingly, the highest ratio was observed in the USA ($212,800) for PCI v MT and the lowest ratio was observed in Brazil ($4403) for CABG v MT. Although the results of the studies were different in terms of a number of aspects, such as the viewpoint of the study, the study horizons, and the costs of expenditure items, they reached similar results. Based on the result of the present study, it seems that each three treatment strategies for CAD yielded improvements in QALY.
Assuntos
Ponte de Artéria Coronária/economia , Doença da Artéria Coronariana/cirurgia , Análise Custo-Benefício/métodos , Intervenção Coronária Percutânea/economia , Argentina/epidemiologia , Áustria/epidemiologia , Brasil/epidemiologia , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/psicologia , República Tcheca/epidemiologia , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologia , Países Baixos/epidemiologia , Intervenção Coronária Percutânea/métodos , Anos de Vida Ajustados por Qualidade de Vida , Suíça/epidemiologia , Resultado do Tratamento , Estados Unidos/epidemiologia , País de Gales/epidemiologiaRESUMO
There are limited epilepsy mortality data from developing countries and Latin America in particular. We examined national epilepsy mortality data from Cuba and contrasted them with comparable data from England and Wales. National epilepsy mortality data for Cuba between the years 1987 and 2010 were obtained from the Medical Records and Health Statistics Bureau of the Cuban Public Health Ministry (www.sld.cu/sitios/dne/) with the corresponding mortality data from England and Wales obtained from the UK Office of National Statistics (ONS, www.ons.gov.uk). Indirect standardization with calculation of a standardized mortality ratio (SMR) was used to compare trends. The overall trend was of a slight decrease in mortality rates over the 23â¯years in Cuba, with higher mortality rates primarily occurring in young people. Annual age-adjusted rates were consistently lower in Cuba than those seen in England and Wales, with the SMR ranging from 0.35 (95% confidence interval (CI): 0.30 to 0.48) in 2007 to 1.00 (95% CI: 0.85 to 1.15) in 1994. Cuban epilepsy mortality rates are consistently lower than those of England and Wales. Reasons for this disparity in mortality rates are not immediately apparent but are likely to be multifactorial.
Assuntos
Países em Desenvolvimento , Epilepsia/diagnóstico , Epilepsia/mortalidade , Adolescente , Adulto , Cuba/epidemiologia , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , País de Gales/epidemiologiaRESUMO
OBJECTIVE: Diabetic ketoacidosis (DKA) in children and adolescents with established type 1 diabetes is a major problem with considerable morbidity, mortality, and associated costs to patients, families, and health care systems. We analyzed data from three multinational type 1 diabetes registries/audits with similarly advanced, yet differing, health care systems with an aim to identify factors associated with DKA admissions. RESEARCH DESIGN AND METHODS: Data from 49,859 individuals <18 years with type 1 diabetes duration ≥1 year from the Prospective Diabetes Follow-up Registry (DPV) initiative (n = 22,397, Austria and Germany), the National Paediatric Diabetes Audit (NPDA; n = 16,314, England and Wales), and the T1D Exchange (T1DX; n = 11,148, U.S.) were included. DKA was defined as ≥1 hospitalization for hyperglycemia with a pH <7.3 during the prior year. Data were analyzed using multivariable logistic regression models. RESULTS: The frequency of DKA was 5.0% in DPV, 6.4% in NPDA, and 7.1% in T1DX, with differences persisting after demographic adjustment (P < 0.0001). In multivariable analyses, higher odds of DKA were found in females (odds ratio [OR] 1.23, 99% CI 1.10-1.37), ethnic minorities (OR 1.27, 99% CI 1.11-1.44), and HbA1c ≥7.5% (≥58 mmol/mol) (OR 2.54, 99% CI 2.09-3.09 for HbA1c from 7.5 to <9% [58 to <75 mmol/mol] and OR 8.74, 99% CI 7.18-10.63 for HbA1c ≥9.0% [≥75 mmol/mol]). CONCLUSIONS: These multinational data demonstrate high rates of DKA in childhood type 1 diabetes across three registries/audits and five nations. Females, ethnic minorities, and HbA1c above target were all associated with an increased risk of DKA. Targeted DKA prevention programs could result in substantial health care cost reduction and reduced patient morbidity and mortality.
Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Cetoacidose Diabética/epidemiologia , Adolescente , Idade de Início , Áustria/epidemiologia , Criança , Pré-Escolar , Inglaterra/epidemiologia , Feminino , Alemanha/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Hiperglicemia/epidemiologia , Lactente , Modelos Logísticos , Masculino , Estudos Prospectivos , Sistema de Registros , Estados Unidos/epidemiologia , País de Gales/epidemiologiaRESUMO
BACKGROUND: Preference for sons in India has resulted in a skewed sex ratio at live birth, probably as a consequence of female feticide. However, it is unclear if these cultural preferences are also currently present in communities who have emigrated from India to England and Wales. METHODS: Data of all live births in England and Wales from 2007-2011 were obtained from the Office of National Statistics. A logistic regression analysis was used to compare the probability of having a male infant in mothers born inside the United Kingdom (UK) to those born outside the UK, stratified by mothers' region and country of birth. RESULTS: Mothers born in India were not observed to be giving birth to disproportionately more boys than mothers that were born in the UK (Odds Ratio OR: 1.00, 95% Confidence Interval CI: 0.98-1.02), although an excess of male births were observed in mothers born in South-East Asia (OR 1.03; 95% CI: 1.01-1.05, p = 0.005), the Middle East (OR 1.02; 95% CI: 1.00-1.05, p = 0.047), and South America (1.04; 95% CI: 1.00-1.07, p = 0.025). Mothers who were born in Africa were found to be less likely to give birth to boys than girls when compared to mothers born in the UK (OR: 0.98, 95% CI: 0.97-0.99), and this observation was attributable to women born in East and West Africa. CONCLUSION: There was no evidence of an excess of males born to women from India in England and Wales. An excess of males were observed in mothers born in South-East Asia, the Middle East and South America. Women born in Africa are less likely to give birth to boys than UK born mothers, an observation that is consistent with previous data.
Assuntos
Nascido Vivo , Razão de Masculinidade , África Oriental/etnologia , África Ocidental/etnologia , Sudeste Asiático/etnologia , Inglaterra/epidemiologia , Feminino , Humanos , Índia/etnologia , Recém-Nascido , Masculino , Oriente Médio/etnologia , América do Sul/etnologia , País de Gales/epidemiologiaRESUMO
BACKGROUND: There is a dearth of information on suicidal thoughts and acts or other acts of deliberate self-harm by offenders under community supervision. AIMS: The objective of this study is to estimate lifetime and one month prevalence of deliberate self-harm and to determine ongoing risk among offenders in the community under probation supervision. METHODS: One hundred and seventy-three randomly selected offenders under supervision by the probation service in one county in England were screened for mental illness. All 88 screened cases and a one-in-five sample of non-cases were interviewed according to the Mini International Neuropsychiatric Inventory Module-B. False negatives (n = 17) were used to weight calculations and estimate prevalence for the whole group. RESULTS: A third of the interviewed sample (n = 56) had a lifetime history of suicide attempts, and 9 (5%) had self-harmed in the month prior to interview. Lifetime suicide history was associated with suicidal ideation and deliberate self-harm in the prior month. CONCLUSIONS AND IMPLICATIONS: Our adjusted findings indicate that 25-40% of offenders serving all or part of their sentence in the community have a lifetime history of self-harm, which is similar to the rate among prisoners, and are at very much higher risk of further such acts or completed suicide than the general population. At a time of change in delivery of probation services the implications are that rates of suicide and other forms of deliberate self-harm should be continually assessed in all probation areas, particularly with reference to service changes;the relationship between deliberate acts of self-harm, suicidal ideation and completion of suicide should be investigated prospectively in larger studies;probation services are likely to need mental health expertise to manage these risks.
Assuntos
Criminosos/psicologia , Prisioneiros/psicologia , Comportamento Autodestrutivo/epidemiologia , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Criminosos/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/epidemiologia , Prevalência , Prisioneiros/estatística & dados numéricos , Características de Residência , Estudos Retrospectivos , Fatores de Risco , Autorrelato , Comportamento Autodestrutivo/psicologia , Tentativa de Suicídio/psicologia , País de Gales/epidemiologiaRESUMO
BACKGROUND: Prevalence surveillance methodology is the systematic observation of the occurrence and distribution of healthcare-associated infections (HCAIs) so that appropriate actions can be taken. AIM: The objectives of a prevalence survey with an international validated methodology were to determine the prevalence of HCAIs for the first time in Argentina, and to provide data which could be used for international benchmarking. METHODS: In 2008, an HCAI prevalence survey was carried out in 39 hospitals in seven of 23 provinces in Argentina, with methodology identical to that employed by the Hospital Infection Society in the third prevalence survey of HCAIs in acute hospitals in the British Isles. Data collected were processed and analysed at the Northern Ireland Healthcare-Associated Infection Surveillance Centre at Belfast. FINDINGS: A total of 4249 patients were surveyed; 480 of these had at least one HCAI, resulting in a prevalence of 11.3% of patients. Male prevalence was 13.6% and female 9.0%. The most common HCAIs were pneumonia (3.3%), urinary tract infection (3.1%), surgical site infection (2.9%), primary bloodstream infection (1.5%), and soft tissue infections (1.2%). Among the 1027 patients who underwent surgery, the prevalence of surgical site infection was 10.2%. The prevalence of meticillin-resistant Staphylococcus aureus was 1.1%, accounting for 10.0% of all HCAI isolates. The results for Argentina show higher HCAI rates compared with corresponding findings for England, Wales, Northern Ireland and South Africa. CONCLUSION: This survey will contribute to the prioritization of resources and help to inform Departments of Health and hospitals in the continuing effort to reduce HCAIs.
Assuntos
Infecção Hospitalar/epidemiologia , Vigilância da População/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Bacteriemia/epidemiologia , Infecção Hospitalar/etiologia , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Irlanda do Norte/epidemiologia , Pneumonia/epidemiologia , África do Sul/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecções Urinárias/epidemiologia , País de Gales/epidemiologia , Adulto JovemRESUMO
Previous epidemiologic studies showed four times increased risk of acute lymphoblastic leukemia (ALL) in children of women with multiple sclerosis (MS). MS shows a risk association with Human leukocyte antigens (HLA)-DRA single nucleotide polymorphism (SNP) rs3135388, which is a proxy marker for DRB1*1501. We examined the relevance of rs3135388 in childhood ALL risk along with two other HLA-DRA SNPs in two case-control groups: 114 cases and 388 controls from South Wales (UK) and 100 Mexican Mestizo cases and 253 controls. We first confirmed the correlation between rs3135388 and DRB1*1501 in HLA-typed reference cell lines. We noted a female-specific risk association in childhood ALL (pooled odds ratio (OR) = 2.6, 95% confidence interval (CI) = 1.5-4.5, Mantel-Haenszel P = 0.0009) similar to the stronger association of DRB1*1501 in females with MS. Examination of an HLA-C 5' flanking region SNP rs9264942, known to correlate with HLA-C expression, showed a protective association in girls (OR = 0.4, 95% CI = 0.2-0.7, Mantel-Haenszel P = 0.0003) similar to the protective HLA-Cw*05 association in MS. In a reference cell line panel, HLA-Cw5 homozygous samples (n = 8) were also homozygous for the minor allele of the SNP. Likewise, the male-specific protective association of interferon-gamma (IFNG) SNP rs2069727 in MS was replicated with the same sex specificity in childhood ALL (OR = 0.6, 95% CI = 0.4-1.0, Mantel-Haenszel P = 0.03). Two other SNPs in superkiller viralicidic activity 2-like and tenascin XB that are markers for systemic lupus erythematosus susceptibility showed female-specific associations but due to linkage disequilibrium with HLA-DRB1*15. Our observations supported the epidemiologic link between MS and childhood ALL and added the sex effect to this connection. It appears that only girls born to mothers with MS may have an increased risk of ALL. Investigating the mechanism of these sex-specific associations may help understand the pathogenesis of MS and ALL.
Assuntos
Antígenos HLA-C/imunologia , Antígenos HLA-DR/imunologia , Interferon gama/imunologia , Esclerose Múltipla/imunologia , Polimorfismo de Nucleotídeo Único/imunologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/etiologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , DNA/química , DNA/genética , DNA Helicases/genética , DNA Helicases/imunologia , Feminino , Genótipo , Antígenos HLA-C/genética , Antígenos HLA-DR/genética , Cadeias alfa de HLA-DR , Humanos , Interferon gama/genética , Modelos Logísticos , Masculino , México/epidemiologia , Esclerose Múltipla/genética , Reação em Cadeia da Polimerase , Polimorfismo de Nucleotídeo Único/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Tenascina/genética , Tenascina/imunologia , País de Gales/epidemiologiaRESUMO
Ecologists have become aware of the role played by interannual climatic variability on the temporal dynamics of infectious diseases. In this report, I present evidence from data on measles cases in England and Wales showing that during the post-vaccination period, the interannual variability of winter weather (represented by the North Atlantic Oscillation, NAO) influences the annual dynamics of the disease. Using annual measles data from seven cities and simple logistic models, this study reveals how, after vaccination, NAO increases its effects on measles fluctuations. In addition, this study shows that vaccination may be represented as a simple vertical and lateral perturbation effect (Royama's classification), by reducing the maximum per capita growth rate and the equilibrium number of infected individuals. The results suggest that vaccination will not lead to outbreaks of measles from regular cyclic to irregular chaotic dynamics. In contrast, because of the reduction in per capita growth rates, the disease dynamics appear to be more stable than during the pre-vaccination period. The analysis of annual data on infectious diseases may be useful for detecting long-term effects of climate and complements the classical analyses and modeling based on monthly or seasonal time-step data.
Assuntos
Vacina contra Sarampo/administração & dosagem , Vacina contra Sarampo/imunologia , Sarampo/epidemiologia , Oceano Atlântico , Clima , Inglaterra/epidemiologia , Humanos , Modelos Logísticos , Modelos Biológicos , Estações do Ano , Fatores de Tempo , Vacinação , País de Gales/epidemiologiaRESUMO
The aim of this study was to investigate variations in infant mortality from 1983 to 2001 by birthweight, registration status, father's social class, age of mother at birth and cause of death, among babies of mothers born in countries that represent the largest ethnic minority groups in England and Wales. A total of 70,208 infant death registration records linked to their corresponding birth registration records were used. The study focused on infant deaths of babies of mothers born in the UK, Republic of Ireland, Caribbean, West Africa, East Africa, India, Pakistan and Bangladesh. From 1983 to 2001 infant mortality rates decreased overall, and this was also apparent in the rates by mother's country of birth. Overall, babies of mothers born in Pakistan consistently had the highest infant mortality rates. Low-birthweight babies of mothers born in West Africa had the highest infant, neonatal and postneonatal death rates. Differences were also seen by registration status, mother's age and between manual and non-manual occupations for all countries from 1983 to 2001. For babies of mothers born in the UK, Caribbean and West Africa, immaturity-related conditions were the most common cause of infant deaths. The leading cause of infant death among babies of mothers born in Pakistan and Bangladesh was congenital anomalies.
Assuntos
Etnicidade , Mortalidade Infantil , Mães , Adulto , África/etnologia , Ásia Ocidental/etnologia , Causas de Morte/tendências , Inglaterra/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Irlanda/etnologia , Masculino , Estado Civil , Idade Materna , Irlanda do Norte/etnologia , Ocupações , Classe Social , País de Gales/epidemiologia , Índias Ocidentais/etnologiaRESUMO
OBJECTIVES: To examine the epidemiology of HIV among black and minority ethnic (BME) men who have sex with men (MSM) in England and Wales (E&W). METHODS: Ethnicity data from two national HIV/AIDS surveillance systems were reviewed (1997-2002 inclusive), providing information on new HIV diagnoses and those accessing NHS HIV treatment and care services. In addition, undiagnosed HIV prevalence among MSM attending 14 genitourinary medicine (GUM) clinics participating in the Unlinked Anonymous Prevalence Monitoring Programme and having routine syphilis serology was examined by world region of birth. RESULTS: Between 1997 and 2002, 1040 BME MSM were newly diagnosed with HIV in E&W, representing 12% of all new diagnoses reported among MSM. Of the 1040 BME MSM, 27% were black Caribbean, 12% black African, 10% black other, 8% Indian/Pakistani/Bangladeshi, and 44% other/mixed. Where reported (n = 395), 58% of BME MSM were probably infected in the United Kingdom. An estimated 7.4% (approximate 95% CI: 4.4% to 12.5%) of BME MSM aged 16-44 in E&W were living with diagnosed HIV in 2002 compared with 3.2% (approximate 95% CI: 2.6% to 3.9%) of white MSM (p<0.001). Of Caribbean born MSM attending GUM clinics between 1997 and 2002, the proportion with undiagnosed HIV infection was 15.8% (95% CI: 11.7% to 20.8%), while among MSM born in other regions it remained below 6.0%. CONCLUSIONS: Between 1997-2002, BME MSM accounted for just over one in 10 new HIV diagnoses among MSM in E & W; more than half probably acquired their infection in the United Kingdom. In 2002, the proportion of BME MSM living with diagnosed HIV in E&W was significantly higher than white MSM. Undiagnosed HIV prevalence in Caribbean born MSM was high. These data confirm the need to remain alert to the sexual health needs and evolving epidemiology of HIV among BME MSM in E&W.