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71.
Francesca Di Giallonardo Angie N Pinto Phillip Keen Ansari Shaik Alex Carrera Hanan Salem Christine Selvey Steven J Nigro Neil Fraser Karen Price Joanne Holden Frederick J Lee Dominic E Dwyer Benjamin R Bavinton Jemma L Geoghegan Andrew E Grulich Anthony D Kelleher the NSW HIV Prevention Partnership Project 《Journal of the International AIDS Society》2021,24(1)
IntroductionThe human immunodeficiency virus 1 (HIV‐1) pandemic is characterized by numerous distinct sub‐epidemics (clusters) that continually fuel local transmission. The aims of this study were to identify active growing clusters, to understand which factors most influence the transmission dynamics, how these vary between different subtypes and how this information might contribute to effective public health responses.MethodsWe used HIV‐1 genomic sequence data linked to demographic factors that accounted for approximately 70% of all new HIV‐1 notifications in New South Wales (NSW). We assessed differences in transmission cluster dynamics between subtype B and circulating recombinant form 01_AE (CRF01_AE). Separate phylogenetic trees were estimated using 2919 subtype B and 473 CRF01_AE sequences sampled between 2004 and 2018 in combination with global sequence data and NSW‐specific clades were classified as clusters, pairs or singletons. Significant differences in demographics between subtypes were assessed with Chi‐Square statistics.ResultsWe identified 104 subtype B and 11 CRF01_AE growing clusters containing a maximum of 29 and 11 sequences for subtype B and CRF01_AE respectively. We observed a > 2‐fold increase in the number of NSW‐specific CRF01_AE clades over time. Subtype B clusters were associated with individuals reporting men who have sex with men (MSM) as their transmission risk factor, being born in Australia, and being diagnosed during the early stage of infection (p < 0.01). CRF01_AE infections clusters were associated with infections among individuals diagnosed during the early stage of infection (p < 0.05) and CRF01_AE singletons were more likely to be from infections among individuals reporting heterosexual transmission (p < 0.05). We found six subtype B clusters with an above‐average growth rate (>1.5 sequences / 6‐months) and which consisted of a majority of infections among MSM. We also found four active growing CRF01_AE clusters containing only infections among MSM. Finally, we found 47 subtype B and seven CRF01_AE clusters that contained a large gap in time (>1 year) between infections and may be indicative of intermediate transmissions via undiagnosed individuals.ConclusionsThe large number of active and growing clusters among MSM are the driving force of the ongoing epidemic in NSW for subtype B and CRF01_AE. 相似文献
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74.
Canonical Wnt signals are essential for homeostasis of the intestinal epithelium 总被引:25,自引:0,他引:25 下载免费PDF全文
To assess the critical role of Wnt signals in intestinal crypts, we generated transgenic mice ectopically expressing Dickkopf1 (Dkk1), a secreted Wnt inhibitor. We find that epithelial proliferation is greatly reduced coincidentally with the loss of crypts. Although enterocyte differentiation appears unaffected, secretory cell lineages are largely absent. Disrupted intestinal homeostasis is reflected by an absence of nuclear beta-catenin, inhibition of c-myc expression, and subsequent up-regulation of p21CIP1/WAF1. Thus, our data are the first to establish a direct requirement for Wnt ligands in driving proliferation in the intestinal epithelium, and also define an unexpected role for Wnts in controlling secretory cell differentiation. 相似文献
75.
Economic evaluation of pharmaceuticals: a European perspective 总被引:1,自引:0,他引:1
Drummond M Rutten F Brenna A Pinto CG Horisberger B Jönsson B Le Pen C Rovira J von der Schulenburg MG Sintonen H 《PharmacoEconomics》1993,4(3):173-186
In recent years there has been a large increase in the number of economic evaluations of pharmaceuticals. Many of these studies have been commissioned by individual pharmaceutical companies, in support of new or existing products. In 2 countries, Australia and Canada (in the province of Ontario), draft guidelines issued by the government have outlined the requirements for economic evaluations to be submitted in support of requests for reimbursement (government subsidy) of particular products. One consequence of the guidelines is that they clarify what is required, and in specifying the procedure for submission of dossiers, identify a clear audience for the economic evaluation. In contrast, the situation in Europe is diverse. A wide range of healthcare systems exist, including national health services and more liberal systems, involving a wide range of insurers and providers. European countries also differ widely in their approach to the pricing and reimbursement of pharmaceuticals. Because of this diversity, the nature, conduct and impact of economic evaluation in Europe is not clear. It is therefore difficult for pharmaceutical companies to develop appropriate strategies for economic evaluation and for analysts to decide on appropriate study methodology. This article reviews the nature of any official guidance or requirements for economic evaluation, the potential for use of economic evaluation, the range of studies carried out and the identifiable impacts. There is currently no official guidance in any country, although some countries are considering issuing guidelines. In some countries there is official encouragement to pharmaceutical companies to undertake studies, and where economic data have been presented they have been considered by the relevant committees. The potential uses of economic evaluation vary widely from country to country. These can be classified in terms of a potential role in undertaking national price negotiations, deciding on reimbursement status or copayment level, deciding on inclusion in local formularies or in treatment guidelines, or in improving prescribing decisions. Approximately 80 economic evaluations of pharmaceutical products have been conducted to date in Europe, covering a wide range of clinical areas. There are relatively few examples of identifiable effects of such studies. In part this is because it is often difficult to assess the part played by various items of data. Nevertheless, the overriding conclusion is that economic evaluation of medicines is likely to be more relevant in Europe in the future. The problem for the pharmaceutical industry is in determining when and how. 相似文献
76.
Competition in the health care market has intensified in recent years. Health care providers are increasingly adopting innovative marketing techniques to secure their positions in the marketplace. This paper examines an innovative marketing technique, situational segmentation, and assesses its applicability to the health care market. Situational segmentation has proven useful in many consumer goods markets but has received little attention in the context of health care marketing. A two-stage research process is used to develop a taxonomy of situational factors pertinent to health care choice. In stage one, focus group interviews are used to gather information which is instrumental to questionnaire development. In stage two, the responses of 151 subjects to a 51 item questionnaire are factor analyzed. The results demonstrate that situational segmentation is a viable strategy in the health care market. 相似文献
77.
Pinto LF 《Jornal de pediatria》1995,71(5):248-254
The author describes television as a factor of influence in the sexual (mis)education in adolescence. He considers the role of eroticism in television as a dysfunctional factor in the sexual education of youth. In accordance with its pervasion, accessibility and attractive and seductive contents TV may be considered an alternative source and an efficient instrument of sexual (mis)education, because adolescents find in it a lot of information that satisfies their curiosity about the sexual world of adults. This occurs through a process of more and more explicit eroticism that abuses the freedom of sexual expression and exhibition and transmits all kinds of sexual information: faithful, correct, tendentious, preconceptual, ambiguous and distorted. 相似文献
78.
Lutz S Greene J Fitzgerald J Pinto C Jaklevic MC Japsen B Kertesz L Moore JD Pallarito K Scott L 《Modern healthcare》1995,25(38):31-2, 36, 38-42 passim
Modern Healthcare's Up & Comers are working to improve the quality of medical care, expand access to healthcare and formulate a cost-efficient delivery system best suited to the needs of the 21st century. These professionals, 40 or younger, are nominated by our staff and readers as examples of the best healthcare has to offer. 相似文献
79.
The paper addresses some limitations of the QALY approach and outlines a valuation procedure that may overcome these limitations. In particular, we focus on the following issues: the distinction between assessing individual utility and assessing societal value of health care; the need to incorporate concerns for severity of illness as an independent factor in a numerical model of societal valuations of health outcomes; similarly, the need to incorporate reluctance to discriminate against patients that happen to have lesser potentials for health than others; and finally, the need to combine measurements of health-related quality of life obtained from actual patients (or former patients) with measurements of distributive preferences in the general population when estimating societal value. We show how equity weights may serve to incorporate concerns for severity and potentials for health in QALY calculations. We also suggest that for chronically ill or disabled people a life year gained should count as one and no less than one as long as the year is considered preferable to being dead by the person concerned. We call our approach 'cost-value analysis'. 相似文献
80.
The purpose of this investigation was to analyse nurse's role in the organization of the health work at the Informatics Department of the Health Bureau of the city of Ribeir?o Preto, regarding the process of municipalization. We verified that nurses were involved in the organization of this area since its implementation. Nurses also performed organization and control activities related to the production, storage and analysis of the necessary data about the different stages of the health care, as well as training and supervising activities of the individuals who work with the information system. 相似文献