Economic evaluations in paediatric dentistry clinical trials

Economic evaluations play an important role in identifying the cost‐effectiveness of alternative healthcare programmes, informing decisions surrounding funding and the allocation of resources. This paper outlines the basic principles of economic evaluation and how it can be conducted alongside a clinical trial. Furthermore, it considers the ways in which evidence from these studies can be used, and the challenges researchers are faced with when conducting economic evaluations in the field of children’s oral health

The Self Model and the Conception of Biological Identity in Immunology

The self/non-self model, first proposed by F.M. Burnet, has dominated immunology for sixty years now. According to this model, any foreign element will trigger an immune reaction in an organism, whereas endogenous elements will not, in normal circumstances, induce an immune reaction. In this paper we show that the self/non-self model is no longer an appropriate explanation of experimental data in immunology, and that this inadequacy may be rooted in an excessively strong metaphysical conception of biological identity. We suggest that another hypothesis, one based on the notion of continuity, gives a better account of immune phenomena. Finally, we underscore the mapping between this metaphysical deflation from self to continuity in immunology and the philosophical debate between substantialism and empiricism about identity

Emergence of phlebotomine sandflies (Diptera: Psychodidade) in non-flooded forest floor in Central Amazon, Brazil: a modified emergence trap model

Information concerning the potential natural breeding sites of phlebotomine sandflies are of high epidemiological importance. However, few studies have been conducted on the subject. This is due especially to the difficulties in finding as well as extracting immature sandflies that develop in the soil and organic matter of the forest floor. In the present study, a modified emergence trap model was tested in order to find potential breeding sites. This model was tested in the Pitinga Village, situated in the Presidente Figueredo municipality, in the State of Amazonas. Twenty-seven individuals belonging to nine species (Lutzomyia umbratilis,L. monstruosa,L. ayrozai,L. anduzei,L. trichopyga,L. davisi,L. geniculata,L. georgii e L. saulensis.) were collected. Lutzomyia umbratilis showed the highest number of individuals (37.1%) of all species captured in the area. The phlebotomine productivity was estimated as 2.2 sandflies per 100 m²/day. September showed the highest density of individuals, with a productivity of 5.8.Informações acerca de potenciais criadouros naturais de flebotomíneos sempre foram de fundamental interesse epidemiológico. Contudo, são poucas as informações advindas dos diversos estudos realizados até o momento. Isto se deve principalmente às dificuldades de localização e extração dos imaturos que se desenvolvem no solo e matéria orgânica do chão de florestas. No presente estudo o modelo modificado de armadilha de emergência foi testado na Vila do Pitinga, município de Presidente Figueiredo, Estado do Amazonas, a fim de localizar potenciais criadouros naturais. Vinte e sete indivíduos de nove espécies (Lutzomyia umbratilis,L. monstruosa,L. ayrozai,L. anduzei,L. trichopyga,L. davisi,L. geniculata,L. georgii e L. saulensis) foram coletados. Lutzomyia umbratilis foi a espécie com maior número de indivíduos, 10, representando 37,1% do total. A produção de flebotomíneos foi estimada em 2,2 flebotomíneos por 100 m² por dia. Em setembro, mês com maior número de indivíduos, esta produção foi de 5,8

Rhesus macaques self-curing from a schistosome infection can display complete immunity to challenge

To date there is only one single drug with modest efficacy and no vaccine available to protect from schistosomiasis. Here, Amaral et al. characterize the self-cure process of rhesus macaques following primary infection and secondary challenge with Schistosoma mansoni to inform future vaccine development studies.The rhesus macaque provides a unique model of acquired immunity against schistosomes, which afflict >200 million people worldwide. By monitoring bloodstream levels of parasite-gut-derived antigen, we show that from week 10 onwards an established infection with Schistosoma mansoni is cleared in an exponential manner, eliciting resistance to reinfection. Secondary challenge at week 42 demonstrates that protection is strong in all animals and complete in some. Antibody profiles suggest that antigens mediating protection are the released products of developing schistosomula. In culture they are killed by addition of rhesus plasma, collected from week 8 post-infection onwards, and even more efficiently with post-challenge plasma. Furthermore, cultured schistosomula lose chromatin activating marks at the transcription start site of genes related to worm development and show decreased expression of genes related to lysosomes and lytic vacuoles involved with autophagy. Overall, our results indicate that enhanced antibody responses against the challenge migrating larvae mediate the naturally acquired protective immunity and will inform the route to an effective vaccine.Cancer Signaling networks and Molecular Therapeutic

The economic impact of two diagnostic strategies in the management of restorations in primary teeth : a health economic analysis plan for a trial-based economic evaluation

Background Different approaches have been used by dentists to base their decision. Among them, there are the aesthetical issues that may lead to more interventionist approaches. Indeed, using a more interventionist strategy (the World Dental Federation - FDI), more replacements tend to be indicated than using a minimally invasive one (based on the Caries Around Restorations and Sealants—CARS). Since the resources related to the long-term health effects of these strategies have not been explored, the economic impact of using the less-invasive strategy is still uncertain. Thus, this health economic analysis plan aims to describe methodologic approaches for conducting a trial-based economic evaluation that aims to assess whether a minimally invasive strategy is more efficient in allocating resources than the conventional strategy for managing restorations in primary teeth and extrapolating these findings to a longer time horizon. Methods A trial-based economic evaluation will be conducted, including three cost-effectiveness analyses (CEA) and one cost-utility analysis (CUA). These analyses will be based on the main trial (CARDEC-03/NCT03520309), in which children aged 3 to 10 were included and randomized to one of the diagnostic strategies (based on FDI or CARS). An examiner will assess children’s restorations using the randomized strategy, and treatment will be recommended according to the same criteria. The time horizon for this study is 2 years, and we will adopt the societal perspective. The average costs per child for 24 months will be calculated. Three different cost-effectiveness analyses (CEA) will be performed. For CEAs, the effects will be the number of operative interventions (primary CEA analysis), the time to these new interventions, the percentage of patients who did not need new interventions in the follow-up, and changes in children’s oral health-related quality of life (secondary analyses). For CUA, the effect will be tooth-related quality-adjusted life years (QALYs). Intention-to-treat analyses will be conducted. Finally, we will assess the difference when using the minimally invasive strategy for each health effect (∆effect) compared to the conventional strategy (based on FDI) as the reference strategy. The same will be calculated for related costs (∆cost). The discount rate of 5% will be applied for costs and effects. We will perform deterministic and probabilistic sensitivity analyses to handle uncertainties. The net benefit will be calculated, and acceptability curves plotted using different willingness-to-pay thresholds. Using Markov models, a longer-term economic evaluation will be carried out with trial results extrapolated over a primary tooth lifetime horizon. Discussion The main trial is ongoing, and data collection is still not finished. Therefore, economic evaluation has not commenced. We hypothesize that conventional strategy will be associated with more need for replacements of restorations in primary molars. These replacements may lead to more reinterventions, leading to higher costs after 2 years. The health effects will be a crucial aspect to take into account when deciding whether the minimally invasive strategy will be more efficient in allocating resources than the conventional strategy when considering the management of restorations in primary teeth. Finally, patients/parents preferences and consequent utility values may also influence this final conclusion about the economic aspects of implementing the minimally invasive approach for managing restorations in clinical practice. Therefore, these trial-based economic evaluations may bring actual evidence of the economic impact of such interventions. Trial registration NCT03520309. Registered May 9, 2018. Economic evaluations (the focus of this plan) are not initiated at the moment