56 research outputs found
To screen or not to screen. How do we decide on which cancer screening activities to embark upon?
The management of cervical intra-epithelial neoplasia (CIN): Extensiveness and costs in The Netherlands
In order to provide greater insight into both the extensiveness and the medical costs of the diagnosis and treatment of screen-detected cervical intra-epithelial neoplasia (CIN) in general medical practice in The Netherlands, data from national registries and gynaecology departments were retrieved, and experts were interviewed. Of the 5060 women diagnosed with CIN in 1988, more than 50% were treated in hospital with conisation or hysterectomy, which on average took 5.5 days stay per admission. The assessed average duration of the total pre- and post-treatment period is 4.6 years. The average total medical costs in women with detected CIN III are Dfl 3700 per woman. The diagnosis of CIN I and II involves more medical procedures and time than CIN III, but fewer women have conisation or hysterectomy, resulting in lower total medical costs (Dfl 2572). The overall extent and costs of the management of CIN should be accounted for when balancing the benefits, unfavourable effects and costs of cervical cancer screening
A decision-analytic approach to define poor prognosis patients: A case study for non-seminomatous germ cell cancer patients
Background. Classification systems may be useful to direct more aggressive treatment to cancer patients with a relatively poor prognosis. The definition of 'poor prognosis' often lacks a formal basis. We propose a decision analytic approach to weigh benefits and harms explicitly to define the treatment threshold for more aggressive treatment. This approach is illustrated by a case study in advanced testicular cancer, where patients with a high risk of mortality under standard treatment may be eligible for high-dose chemotherapy with stem cell support, which is currently defined by the IGCC classification. Methods. We use
Blood transfusions for severe malaria-related anemia in Africa: a decision analysis
Severe childhood malarial anemia is commonly treated using blood
transfusion. Although transfusion may decrease short-term mortality, the
risk of human immunodeficiency virus (HIV) transmission is considerable in
Africa. We constructed a decision tree to weigh the short-term mortality
benefit of transfusion against HIV infection risk. Probability estimates
were derived from published studies. The base-case was a two-year-old
child with a 13.5% mortality risk to be transfused with screened or
unscreened blood (1% or 13% HIV contamination risk, respectively), with
reduction of mortality to 5.5% by transfusion (odds ratio=2.7), and a 2.4%
risk of fatal transfusion complications. A sensitivity analysis was
performed to assess the influence of variation in these estimates. If a
child developed acquired immunodeficiency syndrome, survival was weighed
as one-tenth of normal survival. For the base-case, we found that
transfusion with screened blood provided a survival benefit of 5%. In
contrast, transfusion with unscreened blood decreased survival by 2%.
Patients with a mortality risk < 5% derived no benefit from a transfusion
with screened blood. Other important factors for the benefit of
transfusion were the effectiv
The reproductive lifespan of Onchocerca volvulus in West African savanna
Abstract
The epidemiological model ONCHOSIM — a model and computer simulation program for the transmission and control of onchocerciasis — has been used to determine the range of plausible values for the reproductive lifespan of Onchocerca volvulus. Model predictions based on different lifespan quantifications were compared with the results of longitudinal skin-snip surveys undertaken in 4 reference villages during 13 to 14 years of successful vector control in the Onchocerciasis Control Programme in West Africa. Good fits between predicted and observed trends in skin microfilarial loads could be obtained for all villages. It is concluded that the reproductive lifespan of the savanna strain of O. volvulus lies between 9 and 11 years, and that 95% of the parasites reach the end of reproduction before the age of 13 to 14 years
LYMFASIM, a simulation model for predicting the impact of lymphatic filariasis control: quantification for African villages.
LYMFASIM is a simulation model for lymphatic filariasis transmission and control. We quantified its parameters to simulate Wuchereria bancrofti transmission by Anopheles mosquitoes in African villages, using a wide variety of reported data. The developed model captures the general epidemiological patterns, but also the differences between communities. It was calibrated to represent the relationship between mosquito biting rate and the prevalence of microfilariae (mf) in the human population, the age-pattern in mf prevalence, and the relation between mf prevalence and geometric mean mf intensity. Explorative simulations suggest that the impact of mass treatment depends strongly on the mosquito biting rate and on the assumed coverage, compliance and efficacy. Our sensitivity analysis showed that some biological parameters strongly influence the predicted equilibrium pre-treatment mf prevalence (e.g. the lifespan of adult worms and mf). Other parameters primarily affect the post-treatment trends (e.g. severity of density dependence in the mosquito uptake of infection from the human blood, between-person variability in exposure to mosquito bites). The longitudinal data, which are being collected for evaluation of ongoing elimination programmes, can help to further validate the model. The model can help to assess when ongoing elimination activities in African populations can be stopped and to design surveillance schemes. It can be a valuable tool for decision making in the Global Programme to Eliminate Lymphatic Filariasis
Disappearance of leprosy from Norway: an exploration of critical factors using an epidemiological modelling approach
BACKGROUND: By the middle of the 19th century, leprosy was a serious
public health problem in Norway. By 1920, new cases only rarely occurred.
This study aims to explain the disappearance of leprosy from Norway.
METHODS: Data from the National Leprosy Registry of Norway and population
censuses were used. The patient data include year of birth, onset of
disease, registration, hospital admission, death, and emigration. The
Norwegian data were analysed using epidemiological models of disease
transmission and control. RESULTS: The time trend in leprosy new case
detection in Norway can be reproduced adequately. The shift in new case
detection towards older ages which occurred over time is accounted for by
assuming that infected individuals may have a very long incubation period.
The decline cannot be explained fully by the Norwegian policy of isolation
of patients: an autonomous decrease in transmission, reflecting
improvements in for instance living conditions, must also be assumed. The
estimated contribution of the isolation policy to the decline in new case
detection very much depends on assumptions made on build-up of
contagiousness during the incubation period and waning of transmission
opportunities due to rapid transmission to close contacts. CONCLUSION: The
impact of isolation on interruption of transmission remains uncertain.
This uncertainty also applies to contemporary leprosy control that mainly
relies on chemotherapy treatment. Further research is needed to establish
the impact of leprosy interventions on transmission
The effect of HIV, behavioural change, and STD syndromic management on STD epidemiology in sub-Saharan Africa: simulations of Uganda
An assessment was made of how the HIV epidemic may have influenced
sexually transmitted disease (STD) epidemiology in Uganda, and how HIV
would affect the effectiveness of syndromic STD treatment programmes
during different stages of the epidemic. The dynamic transmission model
STDSIM was used to simulate the spread of HIV and four bacterial and one
viral STD. Model parameters were quantified using demographic,
behavioural, and epidemiological data from rural Rakai and ot
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