Large Target Population Research Articles

Acidentes de Trabalho em Hospital Central: uma visão holística

Introduction All over the world, workers are exposed to hazards in the workplace, which can result in accidents. Hospitals are environments rich in dangers and, therefore, Work accidents are more likely to occur with subsequent musculoskeletal injuries, or risk of transmission of biological agents. Objectives To know the characteristics of accidents in the work context that occur in a Central Hospital. By describing and analyzing them, it is possible to make an adequate risk assessment, allowing in the future to adopt preventive measures that reduce or eliminate the existing dangers in the hospital environment. Materials and methods Observational, cross-sectional, descriptive and analytical study. As a data collection instrument, a database belonging to the Occupational Health Service of a Central Hospital, with information on injured Health Professionals, was used. Only mechanical accidents or those with exposure to biological fluids were selected. The normality of the distributions was tested and the Chi-Square, Fisher or Mann-Whitney tests were applied, considering the significance level for rejection of the null hypothesis of 5%. Results A total of 265 Work Accidents were analyzed, 36.2% mechanical and the remaining with exposure to biological fluids. The groups with the highest number of victims were the nurses (49.4%) and aged between 21 and 30 years (36.2%). Between January and March 2021 there was a peak in the number of accidents (n=51) and the median time from admission to the occurrence of the accident was lower in those who had exposure to biological fluids compared to mechanical ones. The attribution of Absolute Temporary Disability to the victims was 84.5%, highlighting that there were no associations between independent variables and the attribution of temporary disability (absolute or partial). Discussion and conclusions The characteristics of the population that suffered Work Accidents at the Central Hospital under analysis is identical to those of other studies. During the peak of hospitalizations in the COVID-19 pandemic, the number of accidents in the Hospital increased, suggesting that the pandemic and the associated high workload may be a possible cause. The high incidence of accidents with exposure to biological fluids, in professionals with less experience, may be related to the lack of dexterity in the handling of materials and equipment and the high attribution of Absolute Temporary Incapacity can be attributed to the low notification of less serious accidents. In this way, the Occupational Health Service should intercede with the Health Professionals to promote the notification of accidents, particularly the less serious ones that are often devalued, allowing to take measures to minimize these events. It will be important to strengthen preventive measures, which, considering the characteristics of accidents, may be the use of equipment or materials for the mobilization of loads, use of appropriate footwear, improvement of the Hospital’s infrastructures, awareness of existing risks and, especially in accidents with exposure to biological fluids, training to improve the technical skills of professionals in the handling of materials and equipment. No predictors were identified for the existence of temporary disability after a Work Accident, studies with a larger target population, an increase in time span and, eventually, longitudinal studies to identify possible associations are recommended. KEY WORDS: Musculoskeletal Injuries, Biological Agents, Work Accidents, Risk Assessment, COVID-19.

Evaluating interactive weekly mobile phone text messaging plus motivational interviewing for breastfeeding promotion among women living with HIV, giving normal birth at a primary healthcare facility in South Africa: a feasibility randomised controlled trial

ObjectivesWe assessed the feasibility of an appropriately powered randomised trial by evaluating whether participants could be recruited and retained, and sought preliminary information on exclusive breastfeeding rates.SettingPrimary healthcare facility, serving...

Systematically missing data in causally interpretable meta-analysis.

Causally interpretable meta-analysis combines information from a collection of randomized controlled trials to estimate treatment effects in a target population in which experimentation may not be possible but from which covariate information can be obtained. In such analyses, a key practical challenge is the presence of systematically missing data when some trials have collected data on one or more baseline covariates, but other trials have not, such that the covariate information is missing for all participants in the latter. In this article, we provide identification results for potential (counterfactual) outcome means and average treatment effects in the target population when covariate data are systematically missing from some of the trials in the meta-analysis. We propose three estimators for the average treatment effect in the target population, examine their asymptotic properties, and show that they have good finite-sample performance in simulation studies. We use the estimators to analyze data from two large lung cancer screening trials and target population data from the National Health and Nutrition Examination Survey (NHANES). To accommodate the complex survey design of the NHANES, we modify the methods to incorporate survey sampling weights and allow for clustering.

Physiological and psychological effects of a 12-week home-based telemonitored training in metabolic syndrome.

Metabolic Syndrome (MetS) increases the risk of cardiovascular diseases (CVD) and affects around one fourth of the population worldwide. In the prevention and treatment regular exercise trainings are inevitable. Providing personal supervision in out/inpatient care settings for such a large target population challenges the healthcare systems, but using telemonitoring of the home-performed trainings could be a promising and widely available option. The aim of this study was to evaluate the physiological and psychological effects of a 12-week home-based physical training program, telemonitored by widely available fitness devices on parameters of MetS patients. A total of 55 MetS patients (mean age 49.19 ± 7.93 years) were involved in the study. They were asked to perform 3-5 sessions of exercise activity (min. 150 min) each week for 12 weeks. Trainings were monitored off-line by heart rate sensors, a fitness application and a cloud-based data transfer system. Physiotherapists supervised, coached, and feedback the trainings through an online coach system. We investigated different anthropometric parameters, maximum exercise and functional capacity levels, laboratory parameters, the level of depression, insomnia, vital exhaustion, and wellbeing as well. The average weekly training time was 152.0 ± 116.2 min. Out of the 55 participants who completed the program, 22 patients (40%) performed the recommended 150 min or more weekly. Patients showed statistically significant changes in: all the measured waist and hip circumferences; 6-min walk distance (6MWD; from 539.69 ± 78.62 to 569.72 ± 79.96 m, p < 0.001); maximal exercise capacity (11.02 ± 2.6 to 12.14 ± 2 MET, p < 0.001), stress-electrocardiogram duration time (13.74 ± 3.29 to 15.66 ± 2.64 min, p < 0.001); body weight (98.72 ± 21.7 to 97.45 ± 21.76 kg, p = 0.004); high-density lipoprotein cholesterol (n = 45, 1.28 ± 0.31 to 1.68 ± 0.36 mmol/L, p < 0.001); fasting plasma glucose (FPG; n = 47, 6.16 ± 1.26 to 5.44 ± 1.31 mmol/L, p = 0.001); glycated hemoglobin A1c (HbA1c; n = 41, 6.22 ± 0.68 to 5.87 ± 0.78%, p = 0.01). Out of the 55 patients who finished the program 38 patients (70%) completed all the psychological questionnaires. We found statistically significant decrease of the overall scores of the Maastricht Vital Exhaustion Questionnaire, from 3.37 ± 2.97 points to 2.63 ± 2.70 points (p < 0.05) and a significant increase of the overall scores of the WHO Wellbeing Scale from 9.92 ± 2.59 points to 10.61 ± 2.76 points (p < 0.05). We have not found any statistically significant changes in the scores of the Beck Depression Inventory and the Athens Insomnia Scale. A 12-week home-based telemonitored training supported by an affordable, commonly available device system produces positive, statistically significant changes in many core components in MetS patients. Telemonitoring is a cheap method for coaching and feeding back the home-based interventions.

Bacterial and fungal coinfections among patients with COVID-19 in Zanjan, Northwest of Iran; a single-center observational with meta-analysis of the literature.

There is a poor understanding about the prevalence and characteristics of secondary bacterial and fungal infections among Coronavirus diseases 2019 (COVID-19) superinfection in hospitalized patients. Four hundred COVID-19-proven patients were enrolled in this study. Nasal swabs for molecular assay (Real-time PCR) and sputum samples for further microbiological assays were collected. Following a broad-spectrum search, a meta-analysis was performed using StatsDirect software (version 2.7.9) according to the DerSimonian and Laird method applying the random-effects models. Streptococcus spp. (21.5%) and Staphylococcus spp. (16.7%) had the highest prevalence of bacterial coinfection among the COVID-19 patients, while Acinetobacter spp. had the lowest prevalence (4.2%). Among fungal coinfections, Candida albicans was the most prevalent (6.7%), and Aspergillus spp. was the lowest (2%). Males, elderly patients, patients with a history of underlying diseases and drug use, patients who showed acute clinical symptoms, and patients with a prolonged hospital stay had a higher incidence of secondary infections (P-value <0.05). The pooled prevalence for bacterial and fungal coinfections was 33.52% (95% CI: 18.12 to 50.98; I2: 99.4%; P-value: <0.0001). We suggest designing additional research with a larger target population and diagnostic molecular analyses to depict a more realistic view of the coinfection status.

Dementia prevention: The potential long-term cost-effectiveness of the FINGER prevention program.

The aim of this study was to estimate the potential cost-effectiveness of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) program. A life-time Markov model with societal perspective, simulating a cohort of people at risk of dementia reflecting usual care and the FINGER program. Costs were 1,653,275 and 1,635,346 SEK and quality-adjusted life years (QALYs) were 8.636 and 8.679 for usual care and the FINGER program, respectively, resulting in savings of 16,928 SEK (2023 US$) and 0.043 QALY gains per person, supporting extended dominance for the FINGER program. A total of 1623 dementia cases were avoided with 0.17 fewer person-years living with dementia. The sensitivity analysis confirmed the conclusions in most scenarios. The model provides support that programs like FINGER have the potential to be cost-effective in preventing dementia. Results at the individual level are rather modest, but the societal benefits can be substantial because of the large potential target population.

Evaluating the Serum Levels of Inflammatory Cytokines in Women with Various Causes of Infertility during Controlled Ovarian Stimulation Cycles

Introduction: Concentration of inflammatory cytokines in serum levels and their role in the success of reproductive cycles with female infertility factors is unknown, so the aim of this study was to evaluate the serum levels of inflammatory cytokines in women with different causes of female infertility during controlled ovarian stimulation cycles.&#x0D; Methods: In this case-control study, 25 infertile women with female infertility or unknown causes (case group) and 24 infertile women with male infertility causes (control group) participated in controlled ovarian stimulation cycles. 5 cc of blood was taken from them on the day of ovulation and after serum isolation, serum IL6 and TNFα levels were measured by ELISA.&#x0D; Results: In this study, there was no significant difference in TNFα and IL6 levels between case and control groups (P&gt; 0.05). There was also no significant difference in TNFα levels in terms of causes of infertility (P&gt; 0.05). However, there was a significant difference in IL6 level in terms of various causes of infertility (P = 0.02). There was a significant difference between polycystic ovarian as well as unknown group and male factor group considering serum levels of interleukin-6 (P = 0.008, P = 0.02, respectively). Furthermore, the highest level of IL6 (28.3 ±20.36) belonged to the infertility group with unknown cause and a significant relationship was found between IL6 level and the number of oocytes and embryos (P &lt;0.01).&#x0D; Conclusion: Higher serum IL6 levels in the infertility group with unknown cause could be considered as a factor in the pathogenesis of infertility in the patients with unknown causes and a parameter affecting the number of oocytes and embryos in this group. However, studies with a larger target population are needed to explain this potential indicator.

Decision-making in screening positive participants who follow up with colonoscopy in the Dutch colorectal cancer screening programme: A mixed-method study.

ObjectiveTo explore worry and decision‐making processes used by faecal immunochemical test (FIT)‐positive participants in the Dutch national screening programme for colorectal cancer.MethodsA mixed‐methods study consisting of 22 semi‐structured interviews in FIT‐positive participants who underwent the recommended colonoscopy within 4–6 months after the FIT result, followed by a widespread questionnaire in a larger target population (N = 1495).ResultsIn the interviews, we recognised two different decision‐making processes. The first is an affective heuristic decision process where the decision to participate is made instantly and is paired with high‐risk perception, worry and (severe) emotional turmoil. The second is a more time‐consuming analytical decision process in which participants describe discussing options with others. In the questionnaire, high levels of cancer worry (CWS > 9) were reported by 34% of respondents. Decisional difficulties were reported by 15% of respondents, and 34% of respondents reported discussing the positive FIT result with their GP. Individuals with high levels of cancer worry contacted their GP less often than those with low levels.ConclusionsThe Dutch two‐step screening programme may result in high levels of cancer worry in a non‐cancer population. More research is needed to monitor worry and its role in decision‐making in cancer screening, as well as ways to facilitate decision‐making for participants.

Factors associated with secondary traumatic stress and burnout in neonatal care staff: A cross-sectional survey study.

High rates of secondary traumatic stress and burnout have been found across nursing populations. However, few studies have focused on neonatal staff. The objectives of this article are to explore the prevalence and severity of secondary traumatic stress (STS) and burnout in neonatal staff, and identify risk factors and protective factors for STS and burnout within this population with the aim of informing future staff support. A quantitative, cross-sectional study using a survey design was conducted; 246 neonatal staff reported measures of STS, burnout, self-compassion and satisfaction with ward climate. Neonatal staff reported high rates of moderate-severe STS and burnout. STS and burnout were negatively associated with self-compassion and satisfaction with ward climate, suggesting them to be protective factors against STS and burnout. STS was found to be a risk factor for burnout and vice versa. Interventions that increase understanding of STS and burnout, nurture self-compassion, provide support and enhance stress management could help mitigate the impact of STS and burnout amongst neonatal staff.

Optimal Policies for Vaccine Campaign: The Case of COVID-19

We model the Coronavirus disease 2019 (COVID-19) vaccine uptake by assuming (based on the most updated surveys) that the target population has mixed beliefs and is composed of three (rational, skeptic, negationist) types. We calibrate the model with the most reliable historical or forecasted likelihoods of COVID-19 contagion, health effects from contagion, vaccine efficacy and vaccine harm for the Italian population by considering its original features with respect to other vaccines (differential effects on age classes, compressed time for vaccine testing, risk of lockdown, effects of web and social media communication, large scale target population). Our findings show that the vaccine campaign can get close to (but not reach) herd immunity if the under 16 are not vaccinated and the negationist remain contrary to vaccination. Policies that can raise the vaccinated share are communication of news about short term positive outcome of the first vaccinated group to the skeptic group and campaigns creating solidarity frames in the young. We as well discuss the options of mandatory rules and/or soft constraints (introduced by the private or the government sector) versus voluntariness. We however show that sub-herd immunity equilibria can be sufficient to reduce significantly pressure on hospitals thereby creating conditions to bring social and economic life to normality.

Effect of Access to Healthcare due to Rural Electrification on the Household Wellbeing among Proprietors of Micro and Small Enterprises in Kenya

Kenya’s Medium-Term Plan III (2018-2022) promises that the health sector will pay special attention to the ‘Big Four’ initiatives with particular focus on the achievement of Universal Health Coverage by implementing programmeslike rural electrification that increase access to quality healthcare services. Kenya’s electricity demand for rural electrification has been steadily rising in the recent past. Households in Kenya are willing and able to pay for improved energy services based on renewable energy resources at reasonable rates. It’s against this background that this study sought to investigate the effect of access to healthcare due to rural electrification on household wellbeing among proprietors of micro and small enterprises in Kenya. The study adopted a cross-sectional descriptive survey design. The target population for this study comprised 172,554 proprietorsofmicro and small enterprises registered in Kenya by 2015. The study used multistage sampling involving s ystematic and simple random sampling procedures due to the large target population involved . Primary data from proprietors of rural micro and small enterprises in eight counties namely; Kakamega, Bungoma, Nakuru, Busia, Bomet, Siaya, Kericho and Kirinyaga forming a sample size of 418 was used. The data collection instrument was pilot tested on 5% of the sample size. Pearson correlation analysis showed that there was a moderate positive relationship between access to healthcare due to rural electrification and household wellbeing among proprietors of micro and small enterprises. Regression analysis results revealed that access to healthcare contribute significantly to household wellbeing. It was concluded that there was a statistical significant relationship between access to healthcare and household wellbeing among proprietors of micro and small enterprises. It is recommended that t he Kenyan government should promote universal access to electricity in all health facilities to a higher level on the political agenda, supporting these commitments with strategic plans, clear policies and dedicated establishments.

Evaluating the effects of polices on nursing care as promoted by the Veneto region: the research protocol and its implications for public health.

Multi-centre mixed-method study design organised into several phases. The Veneto region has recently defined a set of policies on nursing care by determining the needed amount of daily care in minutes and by initiating a systematic measurement of nursing outcomes; also, with a more recent policy, missed nursing care (MNC) has been established as a process measure of interest. To measure the effect of these policies, a research protocol - aimed at evaluating several end points - has been designed, involving a large target population and hospital units. The aim of this manuscript is to briefly present the research protocol and to discuss the public health implications of its expected end-points. The endpoints of the protocol are: (a) to describe the frequency of MNC as perceived by nurses; (b) to identify contributing factors; (c) to identify practices adopted in low-occurrence MNC units and to assess the effectiveness of implementing them in units with higher levels of MNC; (d) to explore the relationship between the amount of nursing care provided, MNC, and patient outcomes; and (e) to validate a tool that measures MNC as perceived by patients/caregivers. A total of 3,460 nurses, 5,000 patient/day and 160 nursing coordinators of the medical and surgical units of public hospitals in the Veneto Region will be included. Measuring the association between the amount of nursing care and patient outcomes, as well as evaluating the role of MNC as perceived by nurses and patients in hindering or increasing the risk of some patient outcomes can provide a body of evidence capable of further informing policies in the field, both at the national and at the international level. Moreover, emerging good practices capable of preventing or minimising MNC, sharing and implementing them in other units where high levels of missed care are reported and evaluating their effectiveness, can also inform public health policies.

Diclofenac diethylamine emulgel delivery via nano plum-blossom needle for acute gouty arthritis: study protocol for a single-center blind randomized controlled trial

Background Patients with acute gouty arthritis experienc severe pain and often have concomitant limited joint movement. High-dose intake of anti-inflammatory analgesics often results in adverse reactions, such as nausea, vomiting, and diarrhea, and might increase the risk of gastrointestinal bleeding. In order to reduce the adverse reactions by oral intake, local use of externally useddrugs with the same active ingredients as the oral intake is an option in clinical practice. However, externally useddrugs take effect slowly and efficacy to reduce painful feelingis unsatisfactory. Therefore, it is demanding to develop a safe and effective treatment plan. In this regard, researchers have put up a hypothesis. The skin of the human body has a dense stratum corneum, which is difficult for externally used drugs to penetrate effectively; if the keratin barrier of the skin around affected joints can be broken without further damaging the skin, externally applied drugs may safely and effectively alleviate the local symptoms of acute gouty arthritis. The nano plum blossom needle is made of a modern new material. The needle body is thin and the diameter of the needle tip is only 300 nm. The needle is used clinically to break through the keratin barrier of the human skin and promote the absorption of external medicine. Therefore, this trial was designed to preliminarily evaluate the safety and effectiveness of using the nano plum blossom needle for the introduction of diclofenac diethylamine emulgel in the treatment of acute gouty arthritis. Methods A randomized controlled trial including 83 patients with acute gouty arthritis was conducted, who was assigned to three groups, the intervention group, control group 1, and control group 2 in a ratio of 2:2:1, respectively. The nano plum blossom needle was used for the introduction of diclofenac diethylamine emulgel in the intervention group; the nano plum blossom needle was used as a placebo along with the local use of diclofenac diethylamine emulgel in control group 1; and the nano plum blossom needle was used alone in control group 2. The treatments were applied once a day until the pain was completely relieved and the course of treatment lasted up to 7 days. The primary outcome measurement was the visual analog scale for evaluating the degree of pain. The secondary outcome indicators included scoring of the symptoms and signs with comprehensive consideration of the joint skin color, local tenderness, and degree of joint motion, the time and dose of emergency medication usage during trial, and adverse events. Discussion This trial couldprovide preliminary evidence for evidence-based practice of using nano plum blossom needle transdermal drug delivery technology for diclofenac diethylamine emulgel for the treatment of acute gouty arthritis, and provide a reference for sample size calculation and experimental design of future clinical trials verifying the effectiveness and safety of such a technical scheme in a larger target population. Registration information This study has been registered in the China Clinical Trial Registry Centerwith the registration code of ChiCTR-IOR-17012154. Key words: Clinical protocols; Randomized controlled trials as topic; Arthritis, gouty; Plum blossom needle therapy; Nanotechnology

The Current State and Future Prospects of Population Pharmacokinetic Research in Post-marketing Clinical Studies in Japan

Population pharmacokinetics (PPK) is a useful approach to the evaluation of drug pharmacokinetics in patients and is a widely used method for the evaluation of pharmacokinetics in clinical trials. PPK uses a statistical model to calculate population parameters, their variance, and covariates from sparse and unbalanced data in a large target population. Population parameters can subsequently be used to establish individual prescribing regimens for specific patients. Post-marketing clinical studies using PPK analysis have been reported by medical and academic institutions in order to complement the poor pharmacokinetics information, thus increasing the available pharmacokinetics information. However, because, in many cases, PPK information is not indicated in the package insert (PI), pharmacokinetics information such as pharmacokinetics parameters and associated variable factors is insufficient. We investigated what kind of new information was obtained in the post-marketing clinical studies using PPK analysis and whether these PPK results were described in Japan PI and/or interview form (IF). We showed that many post-marketing clinical studies were conducted as a single-center and observational study in order to supplement deficient pharmacokinetics data. Also, most PPK results obtained from post-marketing studies were not included in Japan PI and/or IF presumably due to lack of quality of PPK models. If sufficient post-marketing clinical studies using high-quality PPK models are performed, PPK models based on patients with diverse backgrounds, which take inter-individual variability into consideration, can be constructed and PPK information can contribute to the proper use of drugs and the promotion of individualized treatment strategies.

Rapid Characterization of the Genetic Loci Controlling Commodity Traits of Chinese Hami Melon (Cucumis melo var. Saccharinensis Naud.) through Multiplexed Shotgun Genotyping

The genetic architecture and the genetic loci controlling commodity traits in this Hami melon have not been characterized. Multiplexed shotgun genotyping (MSG) was used to genotype an F2 population of 370 Chinese Hami melon progeny. A total of 47,609 single nucleotide polymorphism (SNP) markers were obtained after strict filtering. Thebins were used to construct a genetic linkage map with a total length of 1572.954 cM. Quantitative trait locus (QTL) analysis revealed that fruit color was controlled by one major gene about 2 Mb region on chr09, while exocarp color (EC) was controlled by one major gene about 1.9 Mb on chr04, and skin spotting was controlled by two dominant genes, one in the same region of chr04as the EC QTL and the other in the 1031.05 kb region on chr02. Two major QTLs on chr03 and chr05 were related pleiotropically to several quantitative fruit traits, namely, edge sugar content (ES), center sugar content (CS), fruit weight (FW), and fruit length (FL). A further QTL on chr09 also influenced ES, while five other QTLs affected FL. This study was the first to conduct genetic architecture analysis and QTL mapping in Chinese Hami melon with high-density markers and a large target population.

Candiduria in hospitalized patients: an investigation with the Sysmex UF-1000i urine analyzer.

BackgroundCandiduria is common in hospitalized patients. Its management is limited because of inadequate understanding. Previous epidemiological studies based on culture assay have been limited to small study populations. Therefore, data collected by automated systems from a large target population are necessary for more comprehensive understanding of candiduria in hospitalized patients.MethodsTo determine the performance of the Sysmex UF-1000i in detecting candiduria, a cross-sectional study was designed and conducted. A total of 203 yeast-like cell (YLC)-positive and 127 negative samples were randomly chosen and subjected to microbiologic analysis. The receiver operating characteristic curve (ROC) was used to evaluate the ability of YLC counts as measured by the Sysmex UF1000i to predict candiduria. Urinalysis data from 31,648 hospitalized patients were retrospectively investigated, and statistical analysis was applied to the data collected.ResultsUsing a cutoff value of 84.6 YLCs/µL, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the yeast like cell (YLC) counts to predict candiduria were 61.7%, 84.1%, 88.6% and 66.3%, respectively. C. glabrata (33.6%) and C. tropicalis (31.4%) were more prevalent than C. albicans (24.3%) in the present study. Of the investigated hospitalized patients, 509 (1.61%) were considered candiduria-positive. Age, gender and basic condition were associated with candiduria in hospitalized patients. In the ICU setting, urinary catheterization appeared to be the only independent risk factor contributing to candiduria according to our investigation. Although antibiotic therapy has been reported to be a very important risk factor, we could not confirm its significance in ICU candiduria patients because of excessive antibiotic usage in our hospital.ConclusionsThe YLC measured by Sysmex UF-1000i is a practical and convenient tool for clinical candiduria screening prior to microbiologic culture. Candiduria is common in hospitalized patients, and its incidence varies according to age, gender and the wards where it is isolated. Candiduria had no direct connection with mortality but might be considered a marker of seriously ill patients who need particular attention in the clinic.

PHP218 - HOW HIGH CAN YOU GO? - THE IMPACT OF INDICATION EXPANSION AND MARKET COMPETITION ON DRUG PRICES IN THE EU5

To examine the impact of indication extension and market competition on the prices of expensive immuno-oncology (IO) therapies and biologics used for immune-related disorders in the EU5. A targeted search was conducted in PubMed and the EMA website to identify IO drugs and biologics for immune-related disorders, approved for >1 indication. As several biologic treatments are available for immune-related diseases, only drugs with a major market share (>10%) were considered. For each drug, the launch date per indication was identified based on when the reimbursement recommendation was published. Where possible, historical list prices for the IO drugs (nivolumab, pembrolizumab, trastuzumab) and biologics (adalimumab, etanercept, infliximab) were obtained for the launch years from country-specific official journals. In the absence of official historical price sources, sales revenue and volume estimates from the IQVIATM database - IMS MIDAS Quantum, were used to determine price fluctuations Prices decline following an indication expansion across the EU5. Among IO drugs, the prices of nivolumab and pembrolizumab declined substantially following reimbursement of their second indication. This decline in price varies considerably across the EU5; ∼10%-38%. This could be attributed to the fact that both drugs were initially approved for a narrow/orphan indication and then subsequently for an indication with a larger target population. Until recently, the prices of adalimumab, etanercept and infliximab declined marginally following reimbursement approval for an additional indication. A sharp decline in prices was observed in 2017 for adalimumab, 2015 for etanercept and 2014 for Remicade, potentially associated with the launch of biosimilars. For most drugs, the decline in prices was higher in France compared to Germany and the UK Evidence shows that in general, prices decline substantially following an indication expansion. The extent of price reduction depends on various factors such as the size of the new target population and market dynamics.

Preliminary Findings From A Stealth Physical Activity Intervention Targeting Inactive Dog Owners

Given that 60 million American households own at least one dog, there is growing interest in promoting dog walking to increase physical activity at the population level. An estimated 40% of dog owners do not walk the dog regularly, providing a large target population for intervention. Dog obedience training could plausibly serve as a stealth physical activity intervention as it aims to strengthen the dog-owner bond, a construct strongly associated with dog walking behavior. PURPOSE: To examine changes in dog owners’ self-reported dog walking behavior and device-measured moderate-to-vigorous physical activity (MVPA) after completing basic obedience training. METHODS: Forty-one healthy but inactive individuals (85% female; mean age=40) who reported walking their dog ≤3 d/wk were randomized to a 6-week basic obedience training class (INT; n=21) or wait list control group (CON; n=20). Participants recorded all dog walking bouts and wore an Actigraph GT3X+ on their right hip for 7d at baseline and 6-weeks. T-tests assessed group differences in self-reported dog walking and device-measured MVPA change scores. RESULTS: At baseline, participants reported 48.5±62.7 min/wk of dog walking and averaged 22.0±14.0 min/d of MVPA. Intervention participants that completed post-program assessments (n=17) attended an average 5.6 of 6 training classes. Preliminary analyses of n=31 participants (n=13 INT) with valid Actigraph data (≥4d with ≥8hrs weartime at both time points) found a differential change in self-reported dog walking behavior between groups (+36.1±58.4min/wk versus -26.7±90.3min/wk in INT and CON participants, respectively; p=0.04), but no differential change in MVPA (+7.4±22.2min/d versus +1.6±11.3min/d in INT and CON participants, respectively; p=0.35). CONCLUSIONS: In this small pilot study, dog obedience training led to increases in self-reported dog walking behavior but no change in device-measured MVPA as compared to a waitlist control group. There was large variability in both physical activity outcomes measures, so results should be interpreted with caution. This approach should be tested in a larger sample and should specifically target inactive dog owners that intend to or would like to walk the dog regularly but report barriers (rather than owners that do not intend to walk the dog).

Authorship Correction: Sampling Key Populations for HIV Surveillance: Results From Eight Cross-Sectional Studies Using Respondent-Driven Sampling and Venue-Based Snowball Sampling.

[This corrects the article DOI: 10.2196/publichealth.8116.].

Pay or preserve: a new approach to valuing cultural heritage

PurposeThe purpose of this paper is to initiate a new approach to cultural heritage value through the highly revealing example of Chefchaouen city, Morocco. This study relates to approaching the valuation of cultural heritage per se. It does not evaluate or assess the economic value or the economic impacts of the cultural heritage. It tries to assess and measure the “culturality” of heritage based on local population opinion about urban heritage of the medina. This paper aims at obtaining information about their feeling and perceptions in respect of this heritage which may be useful for people democratic participation in decision making about heritage.Design/methodology/approachA survey using direct interviews with a sample of lower middle-class citizens coupled with direct administration of a questionnaire is carried out. The medina (but not the city) of Chefchaouen is the basis of the surveys conducted recently. The interviews are centered on the idea of preservation and participation instead of any monetized valuation.FindingsThe study has shown that there is a strong commitment of social category to participate in any type of activity leading to preserve the medina because it is their source of living and a source of profound affection. Therefore, this “willingness to preserve” may be seen as a key to define a new variable or attribute to measure the intrinsic value of heritage assets and justify the introduction in the national and international heritage list.Research limitations/implicationsThis study should have been achieved with much larger target population and preferably through a funded project destined to preserve work and training. Funding for better experiences is severely lacking.Practical implicationsLocal authorities may use this research and be inspired by it new and open dimensions. Serious collaboration between authorities and people should have the most promising results.Social implicationsLocal authorities are more sensitive to population; therefore, they may include them in preservation planning and create employment by using the available funding.Originality/valueThis paper tries to enhance heritage study field at methodological level. It suggests a parameter shift to a more simple approach based on the local population opinion toward their heritage. Decision making about heritage should include people opinions and not people’s wishes.