Development of a Disease-Specific Version of the EQ-5D-5L for Use in Patients Suffering from Psoriasis: Lessons Learned from a Feasibility Study in the UK

AbstractObjectivesThe EuroQol five-dimensional (EQ-5D) questionnaire is a generic measure widely used for the assessment of health status. Research has suggested that it may be insensitive to the burdens associated with particular conditions. This study was designed to explore the feasibility of developing and valuing a disease-specific “bolt-on” version of the EQ-5D questionnaire for use in psoriasis.MethodsA series of steps were undertaken to develop, test, and evaluate dimensions for a psoriasis-specific version of the EQ-5D questionnaire (hereafter referred to as the EQ-PSO questionnaire). Candidate dimensions were explored through a review of published literature, in-depth qualitative interviews with patients, and consultation with a clinical expert. A psychometric validation exercise was then undertaken to establish how well dimensions functioned. Two dimensions were selected for inclusion in a draft measure alongside the existing EQ-5D questionnaire dimensions: “skin irritation” and “self-confidence.” Last, a time trade-off valuation exercise was conducted with 300 members of the UK general public to derive utilities for health states described by the measure.ResultsThe psychometric analyses indicated that the two new candidate dimensions captured additional variance over and above the existing five dimensions. Data from the valuation exercise were analyzed by using different models. A collapsed random effects model was put forward as a parsimonious and accurate approach. Based on this model, estimated utilities ranged from 0.98 ± 0.02 for state “1111111” to 0.03 ± 0.29 for state “5555555.”ConclusionsThis study has developed the EQ-PSO questionnaire to support future psoriasis research and has informed the development of future bolt-on versions of the EQ-5D questionnaire

Gestión de abastecimiento para incrementar la rentabilidad de servicios industriales en la Corporación Horus Mar S.A.C. – Nuevo Chimbote, 2019

La presente investigación titulada "Gestión de abastecimiento para incrementar la rentabilidad de la Corporación Horus Mar S.A.C"; ha tenido como principal objetivo determinar en qué medida la gestión de abastecimiento incrementa la rentabilidad de la empresa Horus Mar S.A.C; para lograrlo, se implementó modelos estratégicos que influenciaron directamente con el sistema de aprovisionamiento, para ello se involucró a todos los que laboran en el área logística de la empresa. La metodología de estudio tuvo diseño experimental y de tipo preexperimental. La población y muestra fueron el número de reparaciones que se realizaron en el año 2018; la validación de instrumentos se realizó a través del criterio de juicio de expertos. Como resultados principales se obtuvieron que al aplicar modelos de inventario estratégicos la eficiencia mejora en un 15 %, a la vez que el margen de utilidad mejoró un 0.68% con respecto al año 2018. Se recomendó obtener un mejor sistema digital para el control logístico de la empresa y actualizar trimestralmente los datos con respecto a los volúmenes de materiales utilizados en los servicios brindados

Psoriasis Area and Severity Index response in moderate-severe psoriatic patients switched to adalimumab: results from the OPPSA study

Background: Few studies have compared the efficacy of switching to adalimumab in the real-life setting in plaque psoriasis patients. Objective: To evaluate the effect of adalimumab in psoriasis patients previously treated with other biologics. Methods: In this multicentre study, psoriasis patients (N = 262) treated with an anti-TNF-alpha agent, ustekinumab or naïve to biologics then switched to adalimumab were included. Disease severity was assessed by the Psoriasis Area and Severity Index (PASI) at baseline and after 3, 6, 12, 24 and 36 months. The association between clinical risk factors and achievement of PASI response was evaluated by logistic regression. Results: Adalimumab treatment resulted in a decrease in PASI (15.1 ± 6.2 at baseline vs. 2.7 ± 4.8 at 6 months, P < 0.0001), regardless of previous biologic treatment. Furthermore, adalimumab allowed 92.5%, 79% and 56% of patients to achieve PASI response (PASI 50, 75 and 90, respectively) and complete remission (PASI 100 response) in 48.4% of patients, by 6 months and maintained over 3 years, independent of prior biologic treatment. The absence of metabolic syndrome, dyslipidemia, hypertension and lower PASI and lower age at baseline was associated with achievement of PASI response at 3, 6 and 12 months, whereas at later time points (24 and 36 months), PASI 90 and PASI 100 response was associated with diagnosis of psoriasis/psoriatic arthritis. Conclusion: Adalimumab was effective at reducing PASI score over 3 years, irrespective of whether patients were biologic naïve or previously treated with a TNF-alpha or IL-12/23 inhibitor

Determination of maximum water infiltration areas in Vacacaí-Mirim Basin in southern Brazil

Determining the rates of water infiltration into the soil is of extreme importance, because it does not only determine the recharge of aquifers, but also estimates the vulnerability to soil contamination. Considering this, the present study aims to determine the rate of water infiltration into the soil using the DRASTIC method in the Vacacaí-Mirim basin in Rio Grande do Sul state, Brazil. To determine these rates, the analysis of physical parameters was obtained in the soil physics laboratory at the Federal University of Santa Maria, campus of Frederico Westphalen, in the state of Rio Grande do Sul. The ease infiltration rates in the years 2010 and 2011 ranged from 10 (slightly cracked areas) to 30 (areas with high drilling). Regarding the areas of maximum infiltration in 2010, 24% of the basin area showed this condition, and in 2011, the percentage decreased to 18.55%. According to the results, the methodology is proven to be significant to determine the infiltration rates of water in the Vacacaí-Mirim basin. The areas that stood out with the highest infiltration rates are in the floodplains of the river basin, where rice cultivation prevails. Therefore, it is incredibly important to preserve these areas to maintain the local quality and quantity of the groundwaterA determinação das taxas de infiltração de água no solo é de fundamental importância, pois além de determinar a recarga de aquíferos, estima a vulnerabilidade à contaminação do solo. Com base nisso, o presente trabalho tem por objetivo determinar o índice de infiltração de água no solo pelo método DRASTIC na bacia hidrográfica do rio Vacacaí-Mirim, no estado do Rio Grande do Sul. Para a determinação desses índices, as análises dos parâmetros físicos foram obtidas no laboratório de física do solo da Universidade Federal de Santa Maria, campus de Frederico Westphalen-RS. Os índices de facilidade a infiltração nos anos de 2010 e 2011 variaram de 10 (áreas pouco fissuradas) a 30 (áreas com altas perfurações). Com relação as áreas de infiltração máxima, no ano de 2010, 24% da área da bacia apresentou tal condição, já para o ano de 2011, esse percentual caiu para 18,55%. Com base nisso, a metodologia se mostra interessante para a determinação das taxas de infiltração de água na bacia hidrográfica do rio Vacacaí-Mirim. As áreas que mais se destacaram com as taxas de infiltração máxima localizam-se nas várzeas da bacia hidrográfica, onde predominam o cultivo de arroz, sendo assim é de fundamental importância a preservação de tais áreas com vista a manutenção da quali/quantidade da água subterrânea no local

Burden of non-communicable diseases and behavioural risk factors in Mexico: Trends and gender observational analysis

BACKGROUND: There is scarce gender-disaggregated evidence on the burden of disease (BD) worldwide and this is particularly prominent in low- and middle-income countries. The objective of this study is to compare the BD caused by non-communicable diseases (NCDs) and related risk factors by gender in Mexican adults. METHODS: We retrieved disability-adjusted life years (DALYs) estimates for diabetes, cancers and neoplasms, chronic cardiovascular diseases (CVDs), chronic respiratory diseases (CRDs), and chronic kidney disease (CKD) from the Global Burden of Disease (GBD) Study from 1990-2019. Age-standardized death rates were calculated using official mortality microdata from 2000 to 2020. Then, we analysed national health surveys to depict tobacco and alcohol use and physical inactivity from 2000-2018. Women-to-men DALYs and mortality rates and prevalence ratios (WMR) were calculated as a measure of gender gap. FINDINGS: Regarding DALYs, WMR was >1 for diabetes, cancers, and CKD in 1990, indicating a higher burden in women. WMR decreased over time in all NCDs, except for CRDs, which increased to 0.78. However, WMR was 1 for diabetes and cardiovascular diseases in 2000 and 1 and increasing. CONCLUSIONS: The gender gap has changed for selected NCDs in favour of women, except for CRDs. Women face a lower BD and are less affected by tobacco and alcohol use but face a higher risk of physical inactivity. Policymakers should consider a gendered approach for designing effective policies to reduce the burden of NCDs and health inequities

Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING: Bill & Melinda Gates Foundation

Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

The UN’s Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today’s gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016