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1.
Human papillomavirus (HPV) vaccine effectiveness may differ between settings. Here we present the first real-world effectiveness study of HPV vaccination on high-grade cervical lesions from Norway, among women who received HPV vaccine outside the routine program. We performed an observational study of all Norwegian women born 1975 to 1996 and retrieved individual data from nationwide registries on HPV vaccination status and incidence of histologically verified high-grade cervical neoplasia during 2006 to 2016. We estimated the incidence rate ratio (IRR) and 95% confidence intervals (CI) for vaccination vs no vaccination by Poisson regression stratified by age at vaccination <20 years and ≥20 years. The cohort consisted of 832 732 women, of which 46 381 (5.6%) received at least one dose of HPV vaccine by the end of 2016. The incidence rate of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) increased with age regardless of vaccination status and was highest at age 25 to 29, at 637/100 000 among unvaccinated women, 487/100 000 among women vaccinated before age 20 and 831/100 000 among women vaccinated at age 20 or older. The adjusted IRR of CIN2+ between vaccinated and unvaccinated women was 0.62 (95% CI: 0.46-0.84) for women vaccinated below age 20, and 1.22 (95% CI: 1.03-1.43) for women vaccinated at age 20 or older. These findings indicate that HPV vaccination among women too old to be eligible for routine HPV vaccination is effective among women who are vaccinated below age 20 but may not have the desired impact among women who are vaccinated at age 20 or older.  相似文献   
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Health systems around world are increasingly adopting cost-effectiveness (CE) analysis to inform decisions about access and reimbursement. We study how CE thresholds imposed by a health plan for granting reimbursement affect drug producers’ pricing incentives and patients’ access to new drugs. Analysing a sequential pricing game between an incumbent drug producer and a potential entrant with a new drug, we show that CE thresholds may have adverse effects for payers and patients. A stricter CE threshold may induce the incumbent to switch pricing strategy from entry accommodation to entry deterrence, limiting patients’ access to the new drug. Otherwise, irrespective of whether entry is deterred or accommodated, a stricter CE threshold is never pro-competitive and may in fact facilitate a collusive outcome with higher prices of both drugs. Compared to a laissez-faire policy, the use of CE thresholds when an incumbent monopolist is challenged by therapeutic substitutes can only increase the surplus of a health plan if it leads to entry deterrence. In this case the price reduction by the incumbent necessary to deter entry outweighs the health loss to patients who do not get access to the new drug.  相似文献   
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IntroductionThe recommendation for pertussis vaccination in pregnancy was established in Catalonia in February 2014. The objective of this study was to compare the hospitalization rate for pertussis in children under one year of age before and after the implementation of the vaccination program.MethodsObservational and retrospective study of patients under one year of age admitted to hospital with a diagnosis of pertussis. The hospitalization rate of patients under one year of age of the period prior to the vaccination program (2008-2013) was compared with the period with vaccination program (2014-2019) in the total of children under one year of age and in 2 subgroups: children under 3 months and between 3-11 months.ResultsHospitalization rate was significantly lower in the period with vaccination program in children under one year of age and specifically in children under 3 months (2.43 vs. 4.72 per 1,000 person-years and 6.47 vs. 13.11 per 1,000 person-years, respectively). The rate ratios were: 0.51 (95% CI 0.36-0.73) for children under one year of age; 0.49 (95% CI 0.32-0.75) for those younger than 3 months and 0.56 (95% CI 0.30-1.03) for those with 3-11 months. No statistically significant differences were observed in the clinical severity between both periods.ConclusionThe introduction of the pertussis vaccination program in pregnancy was associated with a global lower hospitalization rate for pertussis in children under one year of age and specifically in those under 3 months of age.  相似文献   
4.
Intracerebral hemorrhage accounts for approximately 15% of the 115,000 strokes occurring each year in France. Although therapeutic strategies are more limited than for ischemic stroke, major points in the management of intracerebral hemorrhage can reduce short term morbidity and mortality by limiting the expansion of the hematoma and the occurrence of early complications, and long term patients’ outcome by reducing the risk of recurrence. This article aims to update the key elements that contribute to improve of the prognosis of intracerebral hemorrhage patients.  相似文献   
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盐酸曲唑酮缓释剂作为一种多受体结合药物,不同剂量可发挥不同的药理作用、改善多种精神障碍。为进一步规范盐酸曲唑酮缓释剂的临床应用,本专家撰写组整合了国内外临床试验、临床实践指南、处方指南及临床用药经验,撰写了此临床应用专家建议。本文提到盐酸曲唑酮缓释剂在临床上适用于抑郁症、各种原因引起的失眠,还应用于广泛性焦虑障碍、性功能障碍、创伤后应激障碍、物质依赖和戒断反应及强迫障碍,并说明了药物用法用量、相互作用,以及特殊人群使用的注意事项,以期为临床医生提供科学、全面的用药指导。  相似文献   
10.
目的:基于丙戊酸钠的体内代谢过程具有显著的年龄发育特征,本研究旨在考察不同年龄段儿童癫痫患者使用丙戊酸钠后的稳态血药浓度特征及其与癫痫控制情况、药品不良反应(ADR)之间的关联,以此获得丙戊酸钠在儿科使用的安全性和有效性数据。方法:纳入2017年1月至2020年6月该院神经科确诊为癫痫并使用丙戊酸钠的患儿748例,采集其口服给药3 d后的清晨空腹静脉血,检测血浆中丙戊酸钠浓度并记录其癫痫发作频率,神经系统、胃肠道和皮肤方面的ADR发生情况。结果:丙戊酸钠的稳态血药浓度随年龄呈现显著的阶梯式升高特征,<1岁癫痫患儿的丙戊酸钠平均血药浓度为(50.06±28.18)mg/L;1~2岁患儿为(51.08±18.71)mg/L;>2~6岁患儿为(59.87±22.07)mg/L,显著高于1~2岁患儿,差异有统计学意义(P<0.05);>6~14岁患儿为(63.23±26.67)mg/L,高于>2~6岁患儿,但差异无统计学意义(P>0.05),明显高于1~2岁患儿(P<0.001)和<1岁患儿(P<0.01),差异均有统计学意义。丙戊酸钠低剂量组患儿[<20 mg/(kg·d)]的稳态血药浓度低于中剂量组[20~30 mg/(kg·d)]、高剂量组[>30 mg/(kg·d)],但是中、高剂量组患儿中丙戊酸钠血药浓度并不呈现剂量相关性。丙戊酸钠中、高血药浓度组患儿的癫痫控制率分别为90.0%(387/430)和91.1%(41/45),显著高于低血药浓度组的70.0%(191/273),差异均有统计学意义(P<0.05)。共收集39例ADR,发生率较高的ADR为神经系统反应(14例)、肝功能受损(11例)和消化系统反应(9例)。ADR发生率随丙戊酸钠血药浓度升高而有升高趋势,且呈年龄相关性,≤2岁的低年龄段癫痫患儿使用丙戊酸钠的ADR发生率显著高于其他年龄段(>2~14岁)癫痫患儿。结论:(1)儿童的丙戊酸钠血药浓度和ADR有年龄段特异性分布特征,婴幼儿(≤2岁)的丙戊酸钠血药浓度易低于最低治疗浓度,但更易发生ADR,在临床用药过程中应注意密切监测;(2)儿童群体血药浓度控制在50~100 mg/L范围内时,丙戊酸钠的安全性和有效性均较为理想;(3)相对于成人,儿童的肝损伤发生率较高,使用丙戊酸钠过程中应加强肝功能指标的监测。  相似文献   
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