Projections of the current and future disease burden of hepatitis C virus infection in Malaysia

The prevalence of hepatitis C virus (HCV) infection in Malaysia has been estimated at 2.5% of the adult population. Our objective, satisfying one of the directives of the WHO Framework for Global Action on Viral Hepatitis, was to forecast the HCV disease burden in Malaysia using modelling methods.An age-structured multi-state Markov model was developed to simulate the natural history of HCV infection. We tested three historical incidence scenarios that would give rise to the estimated prevalence in 2009, and calculated the incidence of cirrhosis, end-stage liver disease, and death, and disability-adjusted life-years (DALYs) under each scenario, to the year 2039. In the baseline scenario, current antiviral treatment levels were extended from 2014 to the end of the simulation period. To estimate the disease burden averted under current sustained virological response rates and treatment levels, the baseline scenario was compared to a counterfactual scenario in which no past or future treatment is assumed.In the baseline scenario, the projected disease burden for the year 2039 is 94,900 DALYs/year (95% credible interval (CrI): 77,100 to 124,500), with 2,002 (95% CrI: 1340 to 3040) and 540 (95% CrI: 251 to 1,030) individuals predicted to develop decompensated cirrhosis and hepatocellular carcinoma, respectively, in that year. Although current treatment practice is estimated to avert a cumulative total of 2,200 deaths from DC or HCC, a cumulative total of 63,900 HCV-related deaths is projected by 2039.The HCV-related disease burden is already high and is forecast to rise steeply over the coming decades under current levels of antiviral treatment. Increased governmental resources to improve HCV screening and treatment rates and to reduce transmission are essential to address the high projected HCV disease burden in Malaysia

Integrating Smart Health in the US Health Care System: Infodemiology Study of Asthma Monitoring in the Google Era

Background: With the internet’s penetration and use constantly expanding, this vast amount of information can be employed in order to better assess issues in the US health care system. Google Trends, a popular tool in big data analytics, has been widely used in the past to examine interest in various medical and health-related topics and has shown great potential in forecastings, predictions, and nowcastings. As empirical relationships between online queries and human behavior have been shown to exist, a new opportunity to explore the behavior toward asthma—a common respiratory disease—is present. Objective: This study aimed at forecasting the online behavior toward asthma and examined the correlations between queries and reported cases in order to explore the possibility of nowcasting asthma prevalence in the United States using online search traffic data. Methods: Applying Holt-Winters exponential smoothing to Google Trends time series from 2004 to 2015 for the term “asthma,” forecasts for online queries at state and national levels are estimated from 2016 to 2020 and validated against available Google query data from January 2016 to June 2017. Correlations among yearly Google queries and between Google queries and reported asthma cases are examined. Results: Our analysis shows that search queries exhibit seasonality within each year and the relationships between each 2 years’ queries are statistically significant (P < .05). Estimated forecasting models for a 5-year period (2016 through 2020) for Google queries are robust and validated against available data from January 2016 to June 2017. Significant correlations were found between (1) online queries and National Health Interview Survey lifetime asthma (r=–.82, P=.001) and current asthma (r=–.77, P=.004) rates from 2004 to 2015 and (2) between online queries and Behavioral Risk Factor Surveillance System lifetime (r=–.78, P=.003) and current asthma (r=–.79, P=.002) rates from 2004 to 2014. The correlations are negative, but lag analysis to identify the period of response cannot be employed until short-interval data on asthma prevalence are made available. Conclusions: Online behavior toward asthma can be accurately predicted, and significant correlations between online queries and reported cases exist. This method of forecasting Google queries can be used by health care officials to nowcast asthma prevalence by city, state, or nationally, subject to future availability of daily, weekly, or monthly data on reported cases. This method could therefore be used for improved monitoring and assessment of the needs surrounding the current population of patients with asthma

Μελέτη της νοηματοδότησης της έννοιας του απείρου από μαθητές της Β΄Λυκείου κατά την επίλυση προβλημάτων με χρήση εργαλείων ψηφιακής τεχνολογίας

Έχουν καταγραφεί σοβαρά προβλήματα κατά τη διδασκαλία εννοιών λογισμού με εκπαιδευόμενους να εμφανίζουν έλλειψη εννοιολογικού υπόβαθρου εννοιών λογισμού, αδυναμία συνδέσεων, ελλιπείς νοηματοδοτήσεις ως προς τις εικόνες των εννοιών. Προβλήματα που πηγάζουν από τη μαθησιακή διαδικασία αλλά και από επιστημολογικά εμπόδια των ίδιων των εννοιών. Όταν συζητάμε για έννοιες του λογισμού αναφερόμαστε σε έννοιες όπως οι πραγματικοί αριθμοί, οι ακολουθίες, οι σειρές, το όριο, η συνέχεια κτλ., που στη θεωρητική τους βάση έχουν το άπειρο, μια έννοια που προκαλεί συγκρούσεις και παράδοξα. Η παρούσα έρευνα είναι μια προσπάθεια να μελετήσει τις νοηματοδοτήσεις εννοιών λογισμού, μαθητών λυκείου οι οποίοι δεν έχουν διδαχθεί τυπικά τέτοιες έννοιες καθώς και το ρόλο των πλαισίων, των περιβαλλόντων εργασίας, των tasks και των αναπαραστάσεων, στην κατασκευή τέτοιων νοημάτων. Οι μαθητές διερεύνησαν ένα ρεαλιστικό πρόβλημα και ένα γεωμετρικό αναπτύσσοντας στρατηγικές στο στατικό περιβάλλον χαρτί – μολύβι, σε ένα μικρόκοσμο και στο περιβάλλον δυναμικής γεωμετρίας geogebra. Συγκεκριμένα η ενσωμάτωση του μικρόκοσμου με τη δυνατότητα συντονισμού μέσω ενός κώδικα των αναπαραστάσεων (οπτικών, αριθμητικών, συμβολικών) που προσφέρει, είχε ως στόχο την κατασκευή διάφορων μορφών αναπαραστάσεων, το δυναμικό συντονισμό και χειρισμό αυτών και τη δημιουργία συνδέσεων μεταξύ αυτών. Στα αποτελέσματα της έρευνας κατεγράφησαν επεισόδια στα οποία οι μαθητές κατασκεύασαν νοήματα, μέσω στρατηγικών που αναφέρθηκαν πιο πάνω, ενώ παρατηρήθηκαν και περιστατικά που οι μαθητές εδραίωσαν τις νοηματοδοτήσεις τους κάνοντας συνδέσεις μεταξύ των προβλημάτων και μεταφέροντας αντιλήψεις από το ένα πλαίσιο στο άλλο.It is well documented that serious problems occur in calculus courses where the students demonstrate lack of conceptual background, inability for connections, defective understanding of concept images. The aforementioned problems originate from the learning process and from the relevant epistemological obstacles. Examples of calculus concepts are the real numbers, sequences, series, limits, continuity etc. The common theoretical basis is the concept of infinity which is inherently paradoxical and produces conflicts. In this thesis, we study the conceptual understanding of high school students that didn’t have a formal course in such matters and the role of the contexts, the tasks and the representations in the development of their ideas. The students first worked on a realistic problem and then on a geometrical one. They developed problem solving strategies using a static environment (pencil and paper), an appropriate microworld and a dynamic geometry environment (GeoGebra). More specifically the microworld’s integration offered the ability to coordinate the representations (optical, arithmetical, symbolic) through the use of appropriate code, the ability to dynamically manipulate the representations and the power to create relevant connections. In the results of our study we record incidents where the students constructed new meanings using the aforementioned strategies and incidents where the students consolidated their understanding through appropriate connections and the use of multiple context

Estimation of Non-Linear Parameters with Data Collected Using Respondent-Driven Sampling

Respondent-driven sampling (RDS) is a snowball-type sampling method used to survey hidden populations, that is, those that lack a sampling frame. In this work, we consider the problem of regression modeling and association for continuous RDS data. We propose a new sample weight method for estimating non-linear parameters such as the covariance and the correlation coefficient. We also estimate the variances of the proposed estimators. As an illustration, we performed a simulation study and an application to an ethnic example. The proposed estimators are consistent and asymptotically unbiased. We discuss the applicability of the method as well as future research.Ministerio de Economia, Industria y Competitividad, Spain MTM2015-63609-

The interferon receptor-1 promoter polymorphisms affect the outcome of Caucasians with HBeAg-negative chronic HBV infection

The outcome of HBeAg-negative chronic hepatitis B virus (HBV) patients who may remain in the inactive carrier state (IC) or progress to HBeAg-negative chronic hepatitis B may be affected by the host genetic profile. Genetic polymorphisms within not only the promoter but also the coding sequence of the interferon receptor 1 (INFAR1) gene have been associated with susceptibility to chronic HBV infection, but their role on the outcomes of HBeAg-negative patients has not been evaluated. We examined the association of INFAR1 promoter polymorphisms with the phase of chronic HBV infection in a demographically characterized Caucasian cohort of 183 consecutive HBeAg-negative chronic HBV patients.Using a combination of conventional and allele-specific polymerase chain reactions, bidirectional sequencing and DNA-fragment analysis, we performed typing of three Single Nucleotide Polymorphisms (SNPs -568G/C, -408C/T, -3C/T) and one Variable Number Tandem Repeat [VNTR -77(GT)n] within the INFR1 promoter sequence.The genetic polymorphisms examined were found to be associated with the phase of HBeAg-negative chronic HBV patients. Using a multiple logistic regression model adjusting for age, gender and origin of the individuals, we found that patients with linked genotypes -408CT_-3CT were more likely to be ICs (OR = 2.42 vs. CC, P = 0.036). Also, given the partial linkage between SNP -568G/C and VNTR -77(GT)n, we found that linked genotypes -77(GT)n ≤ 8/≤8_-568GC and -77(GT)n ≤ 8/≤8_-568CC were detected more frequently among ICs (OR = 11.69, P = 0.005 and OR = 7.56, P = 0.001 vs. -77(GT)n >8/>8_-568GG respectively).These findings suggest that these genetic variations represent important factors associated with the clinical phase of HBeAg-negative chronic HBV infection

Patient characteristics and prediction of CoViD-19 in-hospital mortality: a retrospective cohort study in Crete, Greece before and after the onset of a targeted vaccination strategy in 2021

Background: CoviD-19 in-hospital mortality rates show variations across time, setting, patient populations and health-systems. Aim: The aim of the present study was to explore the association of patient characteristics with in-hospital mortality taking into consideration temporal changes of CoViD-19 prevention and treatment, focusing on the negative predictive value of specific biomarker thresholds for death and oxygen requirements. Methods: This retrospective study included a sample of 425 vaccine-naive patients hospitalized for CoViD-19 in Crete, Greece. Time-specific mortality rates and negative predictive values of biomarkers on admission were calculated. The association of patient characteristics with mortality was assessed using multivariate logistic regression models. Results: The overall in hospital case fatality rate (CFR) was 19.53%.  The in-hospital CFR [95% CI] dropped from 22.74% [17.96-27.52] to 11.9% [6.17-17.63] before and after 31/03/2021, as did the mean age of hospitalized patients. LDH &amp; D-dimers ≥240 or ≥0.5), CRP &amp; D-dimers (≥3 or ≥0.5), CRP &amp; Ferritin (≥3 or ≥205) had negative predictive values [95% CI] for mortality of 100% [86.7-100], 96.1% [80.3-99.9] and 95.4% [84.5-99.4] %, but the respective negative predictive values for oxygen requirements were 19.2% [6.5-39.3], 19.2% [6.5-39.3] and 27.2% [14.9-42.7] . Conclusion: A decreasing trend of in-hospital case fatality rates over the course of our study was associated with a decreasing age of hospitalized patients, which could be associated with community vaccination uptake in people over 60 in Greece through reduction of persons “susceptible” to severe disease. Mortality prediction formulas incorporating biomarkers should be used cautiously for the risk stratification of patients with CoViD-19 in the setting of the emergency department assessment

Estimating the Disease Burden of 2009 Pandemic Influenza A(H1N1) from Surveillance and Household Surveys in Greece

The aim of this study was to assess the disease burden of the 2009 pandemic influenza A(H1N1) in Greece.Data on influenza-like illness (ILI), collected through cross-sectional nationwide telephone surveys of 1,000 households in Greece repeated for 25 consecutive weeks, were combined with data from H1N1 virologic surveillance to estimate the incidence and the clinical attack rate (CAR) of influenza A(H1N1). Alternative definitions of ILI (cough or sore throat and fever>38°C [ILI-38] or fever 37.1-38°C [ILI-37]) were used to estimate the number of symptomatic infections. The infection attack rate (IAR) was approximated using estimates from published studies on the frequency of fever in infected individuals. Data on H1N1 morbidity and mortality were used to estimate ICU admission and case fatality (CFR) rates. The epidemic peaked on week 48/2009 with approximately 750-1,500 new cases/100,000 population per week, depending on ILI-38 or ILI-37 case definition, respectively. By week 6/2010, 7.1%-15.6% of the population in Greece was estimated to be symptomatically infected with H1N1. Children 5-19 years represented the most affected population group (CAR:27%-54%), whereas individuals older than 64 years were the least affected (CAR:0.6%-2.2%). The IAR (95% CI) of influenza A(H1N1) was estimated to be 19.7% (13.3%, 26.1%). Per 1,000 symptomatic cases, based on ILI-38 case definition, 416 attended health services, 108 visited hospital emergency departments and 15 were admitted to hospitals. ICU admission rate and CFR were 37 and 17.5 per 100,000 symptomatic cases or 13.4 and 6.3 per 100,000 infections, respectively.Influenza A(H1N1) infected one fifth and caused symptomatic infection in up to 15% of the Greek population. Although individuals older than 65 years were the least affected age group in terms of attack rate, they had 55 and 185 times higher risk of ICU admission and CFR, respectively

Predictive performance of newer Asian hepatocellular carcinoma risk scores in treated Caucasians with chronic hepatitis B

Cirrosi; Tenofovir; PrediccióCirrosis; Tenofovir; PredicciónCirrhosis; Tenofovir; PredictionBackground & Aims Recently, several risk scores for prediction of hepatocellular carcinoma (HCC) were developed in cohorts of treated Asian patients with chronic hepatitis B (CHB), but they have not been assessed in non-Asian patients. We evaluated the predictability and comparative utility of our PAGE-B and recent Asian HCC risk scores in nucleos(t)ide analogue (NA)-treated adult Caucasian patients with CHB, with or without well-documented compensated cirrhosis but not previous diagnosis of HCC. Methods We included 1,951 patients treated with entecavir/tenofovir and followed up for a median of 7.6 years. The c-statistic was used to estimate the predictability of PAGE-B, HCC-Rescue, CAMD, mPAGE-B, and AASL score for HCC development within 5 or 10 years. The low- and high-risk group cut-offs were used for estimation of negative (NPV) and positive predictive values (PPV), respectively. Results HCC developed in 103/1,951 (5.3%) patients during the first 5 years and in another 39/1,428 (2.7%) patients between years 5 and 10. The 3-, 5-, and 10-year cumulative HCC rates were 3.3%, 5.9%, and 9.6%, respectively. All scores offered good 5- and 10-year HCC prediction (c-statistic: 0.78–0.82). NPVs were always >99% (99.3–100%), whereas PPV ranged between 13% and 24%. Conclusions In NA-treated Caucasian patients with CHB including compensated cirrhosis, HCC risk scores developed in NA-treated Asian patients offer good 5- and 10-year HCC predictability, similar to that of PAGE-B. PAGE-B and mPAGE-B scores are simpler in clinical practice, as they do not require an accurate diagnosis of cirrhosis, but the addition of albumin in mPAGE-B score does not seem to offer an advantage in patients with well compensated liver disease. Lay summary Several risk scores for prediction of hepatocellular carcinoma (HCC) were recently developed in cohorts of treated Asian patients with chronic hepatitis B (CHB). In Caucasian patients with CHB treated with oral antivirals, newer Asian HCC risk scores offer good 5- and 10-year HCC predictability, similar to that of PAGE-B. For clinical practice, PAGE-B and mPAGE-B scores are simpler, as they do not require an accurate diagnosis of cirrhosis

Management of KPC-Producing Klebsiella pneumoniae Infections

Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) has become one of the most important contemporary pathogens, especially in endemic areas

Standardising monitoring data on drug-related infectious diseases among people who inject drugs in Europe – an update of the European Union Drugs Agency technical protocol, 2024

Drug-related infectious diseases (DRID), such as HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV), contribute to high morbidity and mortality among people who inject drugs (PWID). The European Union Drugs Agency (EUDA) is responsible for monitoring DRID and related behaviours for PWID in Europe. We updated the EUDA DRID technical protocol which cov-ers all steps from planning to data analysis needed for a survey among PWID. Drug-related infectious disease-specific indicators were revised. To enable a more effective monitoring of the current epidemio-logical situation, we added specific core indicators, such as prevalence of viraemic HBV, HCV and HIV care cascades and harm reduction-related indicators. HIV pre-exposure prophylaxis and take-home naloxone were added as optional indicators. The process was informed by a European working group, who shared best-practice examples of (repeated) cross-sectional and cohort surveys using different methods in vari-ous settings. To reach the World Health Organization’s goal of ending HIV and the viral hepatitis epidemics, comprehensive DRID monitoring among the dispropor-tionately affected PWID population is needed.</p