Cost-effectiveness of screening and valacyclovir-based treatment strategies for first-trimester cytomegalovirus primary infection in pregnant women in France.

OBJECTIVE: To assess the effectiveness, cost and cost-effectiveness of four screening strategies for first-trimester (T1) cytomegalovirus (CMV) primary infection (PI) in pregnant women in France. METHODS: In a simulated pregnant population of 800 000 (approximate number of pregnancies each year in France), using costs based on the year 2022, we compared four CMV maternal screening strategies: Strategy S1, no systematic screening (current public health recommendations in France); Strategy S2, screening of 25-50% of the pregnant population (current screening practice in France); Strategy S3, universal screening (current medical recommendations in France); Strategy S4, universal screening (as in Strategy S3) in conjunction with valacyclovir in case of T1 PI. Outcomes were total cost, effectiveness (number of congenital infections, number of diagnosed infections) and incremental cost-effectiveness ratio (ICER). Two ICERs were calculated, comparing Strategies S1, S2 and S3 in terms of euros (€) per additional diagnosis, and comparing Strategies S1 and S4 in € per avoided congenital infection. RESULTS: Compared with Strategy S1, Strategy S3 enabled diagnosis of 536 more infected fetuses and Strategy S4 prevented 375 congenital infections. Strategy S1 was the least expensive strategy (€98.3m total lifetime cost), followed by Strategy S4 (€98.6m), Strategy S2 (€106.0m) and Strategy S3 (€118.9m). In the first analysis, Strategy S2 was dominated and Strategy S3 led to an additional €38 552 per additional in-utero diagnosis, compared with Strategy S1. In the second analysis, Strategy S4 led to an additional €893 per avoided congenital infection compared with Strategy S1, and was cost-saving compared with Strategy S2. CONCLUSIONS: In France, current screening practice for CMV PI during pregnancy is no longer acceptable in terms of cost-effectiveness because this strategy was dominated by universal screening. Moreover, universal screening in conjunction with valacyclovir treatment would be cost-effective compared with current recommendations and is cost-saving compared with current practice. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Use of The Global Alliance for Musculoskeletal Health survey module for estimating the population prevalence of musculoskeletal pain: findings from the Solomon Islands.

BACKGROUND: Musculoskeletal (MSK) conditions are common and the biggest global cause of physical disability. The objective of the current study was to estimate the population prevalence of MSK-related pain using a standardized global MSK survey module for the first time. METHODS: A MSK survey module was constructed by the Global Alliance for Musculoskeletal Health Surveillance Taskforce and the Global Burden of Disease MSK Expert Group. The MSK module was included in the 2015 Solomon Islands Demographic and Health Survey. The sampling design was a two-stage stratified, nationally representative sample of households. RESULTS: A total of 9214 participants aged 15-49 years were included in the analysis. The age-standardized four-week prevalence of activity-limiting low back pain, neck pain, and hip and/or knee pain was 16.8, 8.9, and 10.8%, respectively. Prevalence tended to increase with age, and be higher in those with lower levels of education. CONCLUSIONS: Prevalence of activity-limited pain was high in all measured MSK sites. This indicates an important public health issue for the Solomon Islands that needs to be addressed. Efforts should be underpinned by integration with strategies for other non-communicable diseases, aging, disability, and rehabilitation, and with other sectors such as social services, education, industry, and agriculture. Primary prevention strategies and strategies aimed at self-management are likely to have the greatest and most cost-effective impact.

Constraints imposed by pollinator behaviour on the ecology and evolution of plant mating systems.

Most flowering plants rely on pollinators for their reproduction. Plant-pollinator interactions, although mutualistic, involve an inherent conflict of interest between both partners and may constrain plant mating systems at multiple levels: the immediate ecological plant selfing rates, their distribution in and contribution to pollination networks, and their evolution. Here, we review experimental evidence that pollinator behaviour influences plant selfing rates in pairs of interacting species, and that plants can modify pollinator behaviour through plastic and evolutionary changes in floral traits. We also examine how theoretical studies include pollinators, implicitly or explicitly, to investigate the role of their foraging behaviour in plant mating system evolution. In doing so, we call for more evolutionary models combining ecological and genetic factors, and additional experimental data, particularly to describe pollinator foraging behaviour. Finally, we show that recent developments in ecological network theory help clarify the impact of community-level interactions on plant selfing rates and their evolution and suggest new research avenues to expand the study of mating systems of animal-pollinated plant species to the level of the plant-pollinator networks.

Mutagenicity and clastogenicity of native airborne particulate matter samples collected under industrial, urban or rural influence.

Airborne particulate matter has recently been classified by the IARC as carcinogenic to humans (group 1). However, the link between PM chemical composition and its carcinogenicity is still unclear. The aim of the present study was to evaluate and to compare genotoxic potencies of 6 native PM samples collected in spring-summer or autumn-winter, either in industrial, urban or rural area. We evaluated their mutagenicity through Ames test on YG1041, TA98, and TA102 tester strains, and their clastogenicity on human bronchial epithelial BEAS-2B cells using comet assay, γ-H2AX quantification, and micronucleus assay. Ames test results showed a strong positive response, presumably associated with nitro-aromatics content. In addition, at least 2 positive responses were observed out of the 3 genotoxicity assays for each of the 6 samples, demonstrating their clastogenicity. Our data suggest that PM samples collected in autumn-winter season are more genotoxic than those collected in spring-summer, potentially because of higher concentrations of adsorbed organic compounds. Taken together, our results showed the mutagenicity and clastogenicity of native PM2.5 samples from different origins, and bring additional elements to explain the newly recognized carcinogenicity of outdoor air pollution.

Analyzing the benefit of optical transmission systems based on Root Raised Cosine PS-QPSK and a flexible channel grid.

We numerically investigate the multi-channel transmission performance of Polarization Switched Quadrature Phase Shift Keying (PS-QPSK) and we compare it to the performance of Polarization-Division-Multiplexed QPSK (PDM-QPSK), using Root Raised Cosine (RRC) spectral shaping, in the context of a flexible channel grid. We point out the impact of the roll-off factor and the potential influence of different dispersion compensation scenarios. Finally, the advantage of PS-QPSK against PDM-QPSK is presented as a function of the system parameters, while we also discuss the benefit of a RRC spectral shaping against a tight filtering at the transmitter side with a 2nd order super-Gaussian-shaped filter.

[Malaria in 1988 in a village of the Malagasy Highland Plateaux. Epidemiological findings]. / Le paludisme en 1988 dans un village des hauts plateaux malgaches. Données épidémiologiques.

In 1988, the Malaria Research Unit of the Madagascar Pasteur Institute settled an out-patients clinic in Manarintsoa, a village of the Highland Plateaux where epidemic malaria appeared recently. 2776 consultants presented between January and June. In addition, the 200 schoolchildren were examined thrice. For each individual, clinical examination and thick and thin blood smears were performed. In the out-patients, parasite rates were above 50% each month and in each age group; the mean parasite rate being 74%. Splenomegaly rates were above 60% in individuals less than 15 years of age, and around 20% in adults. In schoolchildren, parasite and splenomegaly rates are consistently above 50%. Gametocyte indexes were 7.5% and 7% in May and October, respectively. Plasmodium falciparum is the most encountered species (in 85% of the cases), but P. vivax and P. ovale are also present. P. malariae is very rare. Early diagnosis and adequate therapy were very effective against mortality. During the high transmission time, monthly mortality rates varied from 12% before our arrival to 0.66% after. The number of malaria attacks was estimated at 2 per man and per year. In this area of unstable malaria, presence of fever appears to be of poor predictive value of the malaria infection. Systematic chloroquine therapy of fevers would be adapted to only 43% of the cases.