Patient preferences in the treatment of hemophilia A: impact of storage conditions on product choice

Objectives: To gain insights into the usage of factor VIII (FVIII) products by patients diagnosed with moderate/severe hemophilia A, and to assess the impact and perceived importance of product storage. Methods: In this study, 200 patients diagnosed with moderate or severe hemophilia A across seven countries participated. Data were collected via a 30-minute, face-to-face interview in six countries and via a web-based survey in the seventh country. The questionnaire evaluated the effect of six features associated with FVIII products on the choice of the product; the structure and flow of data collection was designed to eliminate potential bias. Results: Two-thirds of the respondents were using recombinant FVIII products. Only 17% were generally dissatisfied with current FVIII products, whereas 40% of the respondents were dissatisfied with frequency of administration and storage issues when traveling. The majority noted restrictions in their daily activities, particularly travel and sports. Most of them (85%), stored their product in the refrigerator and of these, 88% believed that it should always be stored there. These patients were also less satisfied with the product overall, more concerned about storage temperature, more restricted in daily activities, and spent more time on preparation and injection compared with patients who stored their product at room temperature. Conjoint analysis revealed that origin of FVIII (plasma-derived vs recombinant) was the strongest driver of product choice among all respondents, followed by storage flexibility (temperature), reconstitution device, and administration frequency. In this study, we did not investigate the efficacy and safety of the product. Conclusion: Not refrigerating FVIII products was associated with greater patient satisfaction and less restriction on daily activities. If efficacy and safety are unaffected, then storing FVIII at room temperature might have a positive impact on product choice. Few patients were aware that FVIII can be stored without refrigeration, suggesting that health care professionals who treat hemophilia should communicate this aspect to the patient (depending on the labeled option); this approach might offer patients greater flexibility when traveling and require less time for reconstitution

Information and communication technologies and skills socioemotional outcomes of medical students from a private university in Lima, 2023

El presente estudio tuvo como objetivo establecer la relación entre el uso de las tecnologías de la información y comunicación (TIC) y las competencias socioemocionales de estudiantes de medicina de una universidad privada de Lima, 2023. Se empleó el método hipotético deductivo con enfoque cuantitativo, con diseño no experimental y de corte transversal correlacional. La muestra estuvo conformada por 330 estudiantes de medicina de una universidad privada de Lima en el año 2023, el muestreo fue probabilístico por estratos. Para la recolección de datos se usaron dos instrumentos debidamente validados, ambos con 38 preguntas cada uno. Los resultados mostraron una correlación positiva moderada entre el uso TIC y las competencias socioemocionales con un Rho de Spearman 0.628 (p < 0.001); del mismo modo se encontró relación positiva moderada entre el uso de las TIC y tres dimensiones de la segunda variable: capacidades cognoscitivas, logro y acción y relaciones interpersonales; respecto a la relación entre el uso de las TIC y la dimensión eficacia personal la correlación fue positiva débil. Por lo anterior mente expuesto, se concluye que existe relación significativa entre el uso de las TIC y las competencias socioemocionale

The temporal patterns of disease severity and prevalence in schistosomiasis

Schistosomiasis is one of the most widespread public health problems in the world. In this work, we introduce an eco-epidemiological model for its transmission and dynamics with the purpose of explaining both intra-and inter-annual fluctuations of disease severity and prevalence. The model takes the form of a system of nonlinear differential equations that incorporate biological complexity associated with schistosome's life cycle, including a prepatent period in snails (i.e., the time between initial infection and onset of infectiousness). Nonlinear analysis is used to explore the parametric conditions that produce different temporal patterns (stationary, endemic, periodic, and chaotic). For the time-invariant model, we identify a transcritical and a Hopf bifurcation in the space of the human and snail infection parameters. The first corresponds to the occurrence of an endemic equilibrium, while the latter marks the transition to interannual periodic oscillations. We then investigate a more realistic time-varying model in which fertility of the intermediate host population is assumed to seasonally vary. We show that seasonality can give rise to a cascade of period-doubling bifurcations leading to chaos for larger, though realistic, values of the amplitude of the seasonal variation of fertility. (C) 2015 AIP Publishing LLC

Movement Strategies of Seed Predators as Determinants of Plant Recruitment Patterns

Plant recruitment in nature exhibits several distinctive patterns ranging from hump shaped to monotonically decreasing with distance from the seed source. We investigate the role of post-dispersal seed predation in shaping these patterns, introducing a new mechanistic model that explicitly accounts for the movement strategy used by seed eaters. The model consists of two partial differential equations describing the spatiotemporal dynamics of both seed and predator densities. The movement strategy is defined by how predators move in response to the different cues they can use to search for seeds. These cues may be seed density, seed intake, distance from the plant, density of conspecific foragers, or a mixture of these four.The model is able to reproduce all the basic plant recruitment pat-terns found in the field. We compare the results to those of the ideal free distribution (IFD) theory and show that hump-shaped plant recruitment patterns cannot be generated by IFD predators and, in general, by foragers that respond exclusively to seed density. These foragers can produce only non increasing patterns, the shapes of which are determined by the foragers’ navigation capacities. In contrast, hump-shaped patterns can be produced by distance-responsive predators or by foragers that use conspecifics as a cue for seed abundanc

Ansiedade e consumo de ansiolíticos entre estudantes de enfermagem de uma universidade pública

Trata-se de estudo transversal, descritivo, de abordagem quantitativa realizado em uma escola pública de enfermagem do estado de São Paulo, que avaliou a incidência de ansiedade entre os estudantes, seu conhecimento sobre os ansiolíticos e o padrão de consumo destes medicamentos. Dos 308 estudantes, 16% estavam utilizando ansiolíticos no período em que a pesquisa foi realizada ou já usaram em algum momento de suas vidas; destes, 35% apresentaram ansiedade severa, de acordo com a aplicação do Inventário de Ansiedade de Beck. Mesmo tendo recebido orientação, a maioria dos usuários referiram possuir dúvidas, especialmente no que diz respeito à interação com outros fármacos, efeitos colaterais e seu potencial para causar dependência. Destaca-se a importância do reconhecimento e tratamento da ansiedade entre os estudantes, uma vez que sua presença, quando em níveis mais altos, pode afetar de forma significativa a formação da identidade do estudante e sua qualidade de vida

Results of five years monitoring for Toxoplasma gondii infection in animals by the official Italian Zoonoses Informative System (SINZOO)

In order to drive effective public health preventive measures for human toxoplasmosis a scrupulous epidemiological monitoring of animal toxoplasmosis is essential. BACKGROUND AND AIM:T. gondii is the fourth most important parasite in the world and second out of 14 foodborne pathogens in the USA and in Europe. Meat-borne transmission of T. gondii causes most of food-borne infections in Europe (EFSA-European Food Safety Authority). SINZOO is part of the Veterinary Informative System of the Italian Ministry of Health. It collects and transmit data to EFSA, published in the annual EFSA/ECDC summary reports on zoonoses. The aim of this study was to evaluate the effectiveness of SINZOO for epidemiological surveillance of toxoplasmosis in Italy. METHODS:Among animal species tested in Italy between 2015 and 2019 the ones most commonly reared for human consumption (sheep, cattle, pig, goats) were selected, moreover wild boars, wild ruminants, cats. RESULTS:Infection rates ranged from 0.73% in wild boars to 45.72% in sheep. Total number of tested animals ranged from 37 pigs in 2015 to 3449 sheep in 2018. Besides a relevant incidence among wild boars in 2018 (45%) and 2019 (32%), higher infection rates were more often reported among sheep and pigs. Between 2018 and 2019 67% of the overall analyses were carried out in one region (Sardinia), mostly on one species (sheep) and emerged from targeted research or clinical investigation. In fact in 2019 83.45% of analyses were performed following clinical suspicions while only 8.43% came from official controls, highlighting toxoplasmosis underestimation by the national veterinary health system. CONCLUSIONS:Despite EFSA recognizes the relevance of toxoplasmosis, this is not included among zoonoses under mandatory notification, making animal epidemiological surveillance rather scarce and uneven. Data reported to SINZOO suggest that T. gondii is still a relevant hazard to monitor by meat inspection and in-farm survey, for effective epidemiological evaluations and appropriate public health interventions. This issue characterizes Italy and Europe, highlighting that toxoplasmosis monitoring should be made mandatory and with uniform rules

Toxoplasma gondii in animals and food: results of four-years monitoring by the official italian zoonoses informative system.

When considering human toxoplasmosis, food remains the main source of infection. Whether is meat from susceptible animals that naturally harbour Toxoplasma gondii tissue cysts or food like fresh vegetables or fishery products (mussels, fish) contaminated by environmentally derived oocysts, information about animal toxoplasmosis prevalence should continue to be under the spotlight. Directive 2003/99/EC of the European Parliament and the Council classifies toxoplasmosis and its causative agent as a class B zoonosis/agent for which monitoring depends on the epidemiological situation. Surveillance systems on animal toxoplasmosis are different across Europe and regulated by national legislation. In Italy, administrative regions are called annually to submit data on animal toxoplasmosis to SINZOO (Zoonoses Informative System) that is part of the Veterinary Informative System managed by the Italian Ministry of Health. Foodborne zoonoses data collected at the national level are then processed and summarized by EFSA to became part of the annual EFSA/ECDC joint European Union summary reports on trends and sources of zoonoses, zoonotic agents and foodborne outbreaks. No foodborne outbreaks of toxoplasmosis have been reported in Italy during 2017, the most recent year for which a report is available. Unfortunately, prevalence data are often the results of fragmented researches or clinical investigations but, nevertheless, they provide baseline data to monitor epidemiological trends for guiding public health preventive measures. Over the past four years (2014-2017), in Italy, sheep, cattle, pig, goats, wild boars and wild ruminants were the main species tested besides pet animals. Prevalence of the infection ranged: 3.49-11.10% in cattle (209 to 2289 animals tested); 11.46-34.55% in pigs (37 to 2051 animals tested); 18.01-45.72% in sheep (912 to 2682 animals tested); 5.98-23.25% in goats (234 to 432 animals tested. Positive among wildlife ranged from 0 to 10.24% for wild boars (26 to 901 animals tested) and from 0.76 to 11.25% for wild ruminants (240 to 394 animals tested). For cats, that are solely responsible for contamination with environmentally-resistant oocysts, the prevalence ranged from 19.48 to 34.77% (77 to 696 animals tested). Although these data cannot support epidemiological analyses, they suggest that pigs and small ruminants are still the major sources of meatborne toxoplasmosis. Cattle are also under a special watch list since beef consumption has been predicted as the most important source of meatborne toxoplasmosis at least in Italy and the Netherlands as resulting from quantitative risk assessment studies. Cattle are often found positive to serological screening although direct detection of T. gondii via biological assay or PCR is uncommon with lack of concordance between antibodies and parasite DNA detection. The informative system also reports very limited information on food such as fresh vegetables or fishery products that can be contaminated by T. gondii oocysts dispersed in the environment although 1 sample of mussels and 3 samples of fish resulted positive by PCR in 2017. These findings suggest that surveillance on animal toxoplasmosis and meat and other food contamination with T. gondii should be enhanced since it is one of the few effective tools to control the parasite diffusion and prevent the transmission of the zoonosis

Spatially explicit effective reproduction numbers from incidence and mobility data

Current methods for near real-time estimation of effective reproduction numbers from surveillance data overlook mobility fluxes of infectors and susceptible individuals within a spatially connected network (the metapopulation). Exchanges of infections among different communities may thus be misrepresented unless explicitly measured and accounted for in the renewal equations. Here, we first derive the equations that include spatially explicit effective reproduction numbers, ℛk(t), in an arbitrary community k. These equations embed a suitable connection matrix blending mobility among connected communities and mobility-related containment measures. Then, we propose a tool to estimate, in a Bayesian framework involving particle filtering, the values of ℛk(t) maximizing a suitable likelihood function reproducing observed patterns of infections in space and time. We validate our tools against synthetic data and apply them to real COVID-19 epidemiological records in a severely affected and carefully monitored Italian region. Differences arising between connected and disconnected reproduction numbers (the latter being calculated with existing methods, to which our formulation reduces by setting mobility to zero) suggest that current standards may be improved in their estimation of disease transmission over time

Big-data-driven modeling unveils country-wide drivers of endemic schistosomiasis

Schistosomiasis is a parasitic infection that is widespread in sub-Saharan Africa, where it represents a major health problem. We study the drivers of its geographical distribution in Senegal via a spatially explicit network model accounting for epidemiological dynamics driven by local socioeconomic and environmental conditions, and human mobility. The model is parameterized by tapping several available geodatabases and a large dataset of mobile phone traces. It reliably reproduces the observed spatial patterns of regional schistosomiasis prevalence throughout the country, provided that spatial heterogeneity and human mobility are suitably accounted for. Specifically, a fine-grained description of the socioeconomic and environmental heterogeneities involved in local disease transmission is crucial to capturing the spatial variability of disease prevalence, while the inclusion of human mobility significantly improves the explanatory power of the model. Concerning human movement, we find that moderate mobility may reduce disease prevalence, whereas either high or low mobility may result in increased prevalence of infection. The effects of control strategies based on exposure and contamination reduction via improved access to safe water or educational campaigns are also analyzed. To our knowledge, this represents the first application of an integrative schistosomiasis transmission model at a whole-country scale

The spatial spread of schistosomiasis: A multidimensional network model applied to Saint-Louis region, Senegal

AbstractSchistosomiasis is a parasitic, water-related disease that is prevalent in tropical and subtropical areas of the world, causing severe and chronic consequences especially among children. Here we study the spatial spread of this disease within a network of connected villages in the endemic region of the Lower Basin of the Senegal River, in Senegal. The analysis is performed by means of a spatially explicit metapopulation model that couples local-scale eco-epidemiological dynamics with spatial mechanisms related to human mobility (estimated from anonymized mobile phone records), snail dispersal and hydrological transport of schistosome larvae along the main water bodies of the region. Results show that the model produces epidemiological patterns consistent with field observations, and point out the key role of spatial connectivity on the spread of the disease. These findings underline the importance of considering different transport pathways in order to elaborate disease control strategies that can be effective within a network of connected populations