Budget impact analysis of cervical cancer screening in Portugal: comparison of cytology and primary HPV screening strategies

BACKGROUND: Primary Human Papilloma Virus (HPV) testing is the currently recommended cervical cancer (CxCa) screening strategy by the Portuguese Society of Gynecology (SPG) clinical consensus. However, primary HPV testing has not yet been adopted by the Portuguese organized screening programs. This modelling study compares clinical benefits and costs of replacing the current practice, namely cytology with ASCUS HPV triage, with 2 comparative strategies: 1) HPV (pooled) test with cytology triage, or 2) HPV test with 16/18 genotyping and cytology triage, in organized CxCa screenings in Portugal. METHODS: A budget impact model compares screening performance, clinical outcomes and budget impact of the 3 screening strategies. A hypothetical cohort of 2,078,039 Portuguese women aged 25-64 years old women is followed for two screening cycles. Screening intervals are 3 years for cytology and 5 years for the HPV strategies. Model inputs include epidemiological, test performance and medical cost data. Clinical impacts are assessed with the numbers of CIN2-3 and CxCa detected. Annual costs, budget impact and cost of detecting one CIN2+ were calculated from a public healthcare payer's perspective. RESULTS: HPV testing with HPV16/18 genotyping and cytology triage (comparator 2) shows the best clinical outcomes at the same cost as comparator 1 and is the most cost-effective CxCa screening strategy in the Portuguese context. Compared to screening with cytology, it would reduce annual CxCa incidence from 9.3 to 5.3 per 100,000, and CxCa mortality from 2.7 to 1.1 per 100,000. Further, it generates substantial cost savings by reducing the annual costs by €9.16 million (- 24%). The cost of detecting CIN2+ decreases from the current €15,845 to €12,795. On the other hand, HPV (pooled) test with cytology triage (comparator 1) reduces annual incidence of CxCa to 6.9 per 100,000 and CxCa mortality to 1.6 per 100,000, with a cost of €13,227 per CIN2+ detected with annual savings of €9.36 million (- 24%). The savings are mainly caused by increasing the length of routine screening intervals from three to five years. CONCLUSION: The results support current clinical recommendations to replace cytology with HPV with 16/18 genotyping with cytology triage as screening algorithm.info:eu-repo/semantics/publishedVersio

Control of quality and silo storage of sunflower seeds using near infrared technology

En este trabajo se evalúa la espectroscopía de infrarrojo cercano para su uso en el control de calidad y almacenamiento de semillas de girasol. Los resultados indican que el método analítico empleado puede utilizarse como método de determinación rápida de humedad, grasa y contenidos altos/bajos de ácido oleico. Los rangos de aplicación son comparables con los valores que se han determinado mediante métodos clásicos de análisis, encontrándose entre 4.6-21.4% la humedad, 38.4-49.6% la grasa y 60.0- 93.1% de ácido oleico del total de los ácidos grasos. Además se ha utilizado un análisis discriminarte lineal por pasos determinando las longitudes de onda más adecuadas para la clasificación de semillas de girasol en los grupos alto/bajo oleico. El modelo generado permitió la clasificación de semillas de girasol en los grupos alto y bajo oleico con unos porcentajes de muestras correctamente clasificadas de un 90.5% en validación interna y de un 89.4% en validación cruzadaThis work assesses the application of near infrared spectroscopy technology for the quality control of sunflower seeds direct from farmers and from a storage silo. The results show that the analytical method employing near infrared spectroscopy can be used as a rapid and non-destructive tool for the determination of moisture, fat and high/low oleic acid contents in samples of sunflower seeds. The ranges obtained were comparable to those reported for classic chemical methods, and were between 4.6-21.4% for moisture; 38.4-49.6% for fat, and 60.0-93.1% for oleic acid expressed as percentage of total fatty acids. A stepwise discriminant analysis was performed to determine the most useful wavelengths for classifying sunflower seeds in terms of their (high/low) oleic acid composition. The discriminant model allows the classification of sunflower seeds with high or low oleicacid contents, with a prediction rate of 90.5% for internal validation and of 89.4% for cross-validatio

Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App: Analysis of Real-World, Medium-Term Feasibility Studies

Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support. Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use. Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app ≥30 days was used as the cut-off for higher app use. Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25-P75) 16-36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3-45] days, translated on a median use rate of 15 [3-38]%. Median inhaler adherence assessed through the app was 34 [4-73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6-83]% and 43 [3-73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen. Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.info:eu-repo/semantics/publishedVersio

Grape seed characterization by NIR hyperspectral imaging

Currently, the time of grape harvest is normally determined according to the sugar level in the pulp of the berry. Nonetheless, the stage of maturation in grape seeds should be taken into account more frequently to decide the appropriate harvest period. There are chemical and sensory analyses available to assess stage of maturation of grape seeds but they are destructive and time-consuming. Hyperspectral imaging is an alternative technology to characterize the grape seeds according to their chemical attributes, and the current work aimed to non-destructively characterize grape seeds in regard of the variety and stage of maturation. For this purpose, 56 samples of seeds from two red grape varieties (Tempranillo and Syrah) and one white variety (Zalema) in two kinds of soil were selected to assess their features based on the reflectance in the near-infrared (NIR) spectra by using prediction models (partial least squares regression) and multivariate analysis methods (principal component analysis and general discriminant analysis). In this study, a reliable methodology for predicting the stage of maturation was developed, and it was shown that it was possible to distinguish the variety of grape and even the type of soil from hyperspectral images of grape seeds.Ministerio de Economía y Competitividad AGL2011-30254-C02Junta de Andalucía P10-AGR633

Tumor-Infiltrating T Cells in Skin Basal Cell Carcinomas and Squamous Cell Carcinomas: Global Th1 Preponderance with Th17 Enrichment—A Cross-Sectional Study

Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are high-incidence, non-melanoma skin cancers (NMSCs). The success of immune-targeted therapies in advanced NMSCs led us to anticipate that NMSCs harbored significant populations of tumor-infiltrating lymphocytes with potential anti-tumor activity. The main aim of this study was to characterize T cells infiltrating NMSCs. Flow cytometry and immunohistochemistry were used to assess, respectively, the proportions and densities of T cell subpopulations in BCCs (n = 118), SCCs (n = 33), and normal skin (NS, n = 30). CD8+ T cells, CD4+ T cell subsets, namely, Th1, Th2, Th17, Th9, and regulatory T cells (Tregs), CD8+ and CD4+ memory T cells, and γδ T cells were compared between NMSCs and NS samples. Remarkably, both BCCs and SCCs featured a significantly higher Th1/Th2 ratio (~four-fold) and an enrichment for Th17 cells. NMSCs also showed a significant enrichment for IFN-γ-producing CD8+T cells, and a depletion of γδ T cells. Using immunohistochemistry, NMSCs featured denser T cell infiltrates (CD4+, CD8+, and Tregs) than NS. Overall, these data favor a Th1-predominant response in BCCs and SCCs, providing support for immune-based treatments in NMSCs. Th17-mediated inflammation may play a role in the progression of NMSCs and thus become a potential therapeutic target in NMSCs

Olive yields and tree nutritional status during a four year period without nitrogen and boron fertilization

Nitrogen (N) and boron (B) are mobile elements in soil. Therefore, the application of these nutrients is typically performed annually, as a single dose, or even splitting it into several fractions in the case of N. In olive (Olea europaea L.), however, controversial literature has suggested that yearly application of N may not be required. In the case of B some authors indicated that one single application is sufficient for three or four years. Thus, the effect of these elements on olive yield, leaf N and B concentrations, as well as soil available N and B were investigated during a field trial performed in an olive orchard located in NE Portugal, in which N and B were not applied for four consecutive growing seasons. Fertilizer treatments consisted of the following: the control, which was a ‘complete’ fertilization plan where N and B were included (N+B treatment); –N treatment, with N excluded from the fertilization plan; and –B treatment, with B excluded. Available soil N and B were estimated from a pot experiment with Italian ryegrass (Lolium multiflorum L.) and from chemical laboratory extractions. Olive yield decreased significantly in the –N treatment in comparison to the control. A slight yield reduction in the –B treatment in comparison to the control was also observed. Leaf N and B concentrations decreased significantly in the –N and –B treatments, respectively, in comparison to the N+B treatment. Soil available N and B at the end of the experiment were significantly lower in the –N and –B treatments, respectively, in comparison to the N+B control. The results showed a continuous decrease in olive yield and leaf N and B concentrations, which reflected the reduction in soil available N and B in the treatments lacking the respective nutrient. Therefore, it seems prudent the recommendation of adjusted rates of N and B every year to prevent reduction in tree crop performance and improve nutrient use efficiency

Manual de Boas Práticas Gestão do Solo e da Água em Espécies Produtoras de Frutos Secos

info:eu-repo/semantics/publishedVersio