The cost-effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis

International audienceBackgroundCongenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of congenital toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments.MethodTo identify cost-effective strategies, prenatal and neonatal screenings were compared using a decision-analytic model based on French guidelines and current knowledge of long-term evolution of the disease in treated children. Epidemiological data were extracted from the scientific literature and clinical data from the French Lyon cohort. Strategies were compared at one year of age, when infection can be definitively evaluated, and at 15 years of age, after which validated outcome data become scarce. The analysis was performed from the French Health Insurance System perspective and included direct medical costs for pregnant women and their children.ResultsThe 1-year Incremental Cost-Effectiveness Ratio showed that prenatal screening would require investing €14,826 to avoid one adverse event (liveborn with CT, fetal loss, neonatal death or pregnancy termination) compared to neonatal screening. Extra investment increased up to €21,472 when considering the 15-year endpoint.ConclusionsPrenatal screening is cost-effective as compared to neonatal screening in moderate prevalence areas with predominant Type II strains. In addition, prenatal screening, by providing closer follow-up of women at risk increases the number of occasions for education avoiding toxoplasmosis

Composition of the Venus mesosphere measured by SOIR on board Venus Express

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Erben in Europa

Erbschaftsforschung ist G enerationenforschung. Die meisten Erbschaften stammen von den Eltern. Die Bedeutung der Nachlässe geht allerdings weit über den engen Familienkreis hinaus. Für die Erbchancen sind neben Opportunitäten, Bedürfnissen und Familienstrukturen insbesondere gesellschaftliche Kontexte von großer Tragweite. Allerdings sind gerade internationale Vergleiche zum Erbgeschehen Mangelware. Die vorliegende Studie umfasst 14 europäische Länder, von Schweden bis Italien, von Irland bis Polen. Es werden sowohl bisherige als auch zukünftig erwartete Erbschaften in den Blick genommen. Dabei zeigen sich deutliche Unterschiede zwischen den Ländern: In Schweden, D änemark, Belgien und in der Schweiz wird besonders häufig geerbt, in den ehemals sozialistischen Staaten besonders selten. Große Diskrepanzen existieren auch zwischen West- und Ostdeutschland. Darüber hinaus bestätigen die Befunde länderübergreifend das Matthäus-Prinzip: Wer hat, dem wird gegeben

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed