银耳多糖益生元效应的研究

银耳是一种非常重要的食用菌和药用真菌,具有非常多的药理作用。本研究通过体外实验研究了银耳多糖的益生元效应,研究结果表明,银耳多糖能够促进双歧杆菌和乳酸杆菌的生长,且成剂量关系;0.5%的银耳多糖对青春双歧杆菌、长双歧杆菌婴儿亚种、嗜酸乳杆菌及鼠李糖乳杆菌的生长促进效果最显著;同时可以通过降低pH,提高B/E值,增强肠道有益微生物定植。     

A cost-effectiveness analysis of levodopa/carbidopa intestinal gel compared to standard care in late stage Parkinson’s disease in the UK

Abstract

Objective:

Evaluation of cost-effectiveness of levodopa/carbidopa intestinal gel (LCIG), compared to standard care (SC) in patients with advanced Parkinson’s disease (aPD) in the UK.

Design:

Markov model to quantify costs and outcomes associated with LCIG versus SC in aPD patients at Hoehn and Yahr (H&Y) stages 3, 4 or 5 experiencing >50% OFF time per day. Time horizon was lifetime, LCIG treatment was assumed to last maximal 5 years after which patients revert to SC. Model comprised 12 aPD health states according to H&Y status and daily time spent in OFF state. Cost analyses are reported from a UK NHS and Personal Social Services perspective. Uncertainties were assessed through one-way sensitivity analyses.

Comparators:

LCIG, providing patients with continuous dopaminergic stimulation to maximise functional ON time during the day and SC, defined as medically determined best available oral medication.

Main outcome measures:

Cost-effectiveness, based on quality adjusted life years gained, presented as an incremental cost-effectiveness ratio.

Results:

Lifetime analysis yields an incremental cost per QALY of £36,024 for LCIG compared to SC (incremental cost £39,644, QALY gain 1.1). Results were sensitive to time on treatment, health state on treatment initiation, and estimates of long term benefit (OWSA results from £32,127 to £66,421 per QALY). Findings must be considered in the context of the study limitations which were mainly due to data availability constraints.

Conclusions:

LCIG is an effective treatment, reducing OFF time and improving quality of life in advanced PD. It provides value for money in levodopa-responsive aPD patients with severe motor fluctuations when no other treatment options are effective or suitable. Given LCIG is an orphan drug, it is reasonable to suggest that it may be considered cost-effective in the UK setting. However, further research is needed to complete current data gaps and increase robustness of the model.     

嘉兴地区农村居民肠道传染病预防知识的调查与分析

采用调查问卷方式,随机对150名嘉兴地区农村居民,进行肠道传染病预防知识和个人卫生习惯状况抽样调查。调查结果显示,本地区有78.7%的农村居民以自来水作为饮用水水源,而以井水和水箱水作为饮用水水源的分别为15.3%和6.0%,肠道传染病预防知识的知晓率为54.0%,84.7%的农村居民认为在当地进行肠道传染病的预防知识的宣教干预十分必要。因此,卫生防疫部门,应采取具有针对性的措施,加大本地区农村居民肠道传染病预防知识的宣教干预力度。     

Neglected Rural Public Health Issue： The Case of Intestinal Roundworms

Despite increasing institutional and financial support, certain public health issues are still neglected by the Chinese Government. The present paper examines the soil-transmitted helminth （STH） infection and reinfection rates by conducting a survey on 1724 children in Guizhou Province, China. Our results indicate that 37.5 percent of children had been infected with one or more of the three types of tested STH. However, only 50.4 percent of children reported having taken deworming medicine during the 18-month period before the survey. Of those who reported being dewormed, 34.6 percent tested positive for STH infections. Poverty and number of siblings are significantly and positively correlated with infection and reinfection, and parental education is significantly and negatively correlated with infection and reinfection. Given the ineffectiveness of treatment in these areas to date, for anthelminthic campaigns to actually succeed, China must pay more attention to local- level incentives to improve children＇s health.     

The cost-effectiveness of levodopa/carbidopa intestinal gel compared to standard care in advanced Parkinson’s disease

Background: Parkinson’s disease (PD) is an incurable, progressive neurological condition, with symptoms impacting movement, walking, and posture that eventually become severely disabling. Advanced PD (aPD) has a significant impact on quality-of-life (QoL) for patients and their caregivers/families. Levodopa/carbidopa intestinal gel (LCIG) is indicated for the treatment of advanced levodopa-responsive PD with severe motor fluctuations and hyper-/dyskinesia when available combinations of therapy have not given satisfactory results.

Aims: To determine the cost-effectiveness of LCIG vs standard of care (SoC) for the treatment of aPD patients.

Methods: A Markov model was used to evaluate LCIG vs SoC in a hypothetical cohort of 100 aPD patients with severe motor fluctuations from an Irish healthcare perspective. Model health states were defined by Hoehn &; Yahr (H&;Y) scale—combined with amount of time in OFF-time—and death. SoC comprised of standard oral therapy?±?subcutaneous apomorphine infusion and standard follow-up visits. Clinical efficacy, utilities, and transition probabilities were derived from published studies. Resource use was estimated from individual patient-level data from Adelphi 2012 UK dataset, using Irish costs, where possible. Time horizon was 20 years. Costs and outcomes were discounted at 4%. Both one-way and probabilistic sensitivity analyses were conducted.

Results: The incremental cost-effectiveness ratio for LCIG vs SOC was €26,944/quality adjusted life year (QALY) (total costs and QALYs for LCIG vs SoC: €537,687 vs €514,037 and 4.37 vs 3.49, respectively). LCIG is cost-effective at a payer threshold of €45,000. The model was most sensitive to health state costs.

Conclusion: LCIG is a cost-effective treatment option compared with SoC in patients with aPD.     

生物多样性视角下的植物花粉致敏问题 溯源及景观设计对策研究

工业革命后,世界花粉过敏症发病率不断提高。回 溯了大量医学、生态、环境等领域的相关研究,从生物多样性 的视角总结了花粉致敏现象加剧的原因、作用机制和影响路 径。研究发现,伴随着工业革命后普遍的生境退化和生物多样 性丧失,人体免疫调节回路中的重要环节——环境微生物群落 也在改变和丧失,进而引发了人体免疫功能障碍,表现为过敏 等疾病发病率的上升;而部分绿地中致敏植物种植密度高、植 物多样性低,提升了植物花粉致敏原的浓度,更增加了居民罹 患过敏相关疾病的风险。基于上述发现,提出从源头对致敏植 物进行识别和致敏性评估,因地制宜、合理选用,从而控制空 气中的花粉致敏原;在传播过程中利用空间营造阻挡消解一定 的致敏花粉;通过生境修复和再野化环境微生物群落为人体提 供有益的免疫保护,帮促还原人体微生物与环境微生物在长期 互动中形成的平衡状态。为常见的花粉致敏问题提供了景观研 究思路,为健康导向的景观设计提供了创新视角和理论借鉴, 以期促进基于自然的健康干预计划与环境修复相结合,推动生 物多样性保护与人类健康共同发展。     

Cost-utility analysis of levodopa carbidopa intestinal gel (Duodopa) in the treatment of advanced Parkinson’s disease in patients in Scotland and Wales

Aims: To carry out a cost-utility analysis comparing the cost-effectiveness of levodopa carbidopa intestinal gel (LCIG) with standard of care (SOC) in patients with advanced Parkinson’s Disease (aPD) unsuitable for apomorphine or deep brain stimulation (DBS). LCIG is the only treatment option in this small, but clinically important, population.

Methods: A Markov model with 25 disease states based on disease stage and off-time status plus death. Patients enter the model with aPD spending >50% of their waking day in the off-state. Patients progress through the model in 6-monthly cycles for 20 years to approximate lifetime treatment and capture long-term costs and effects of therapy. Inputs are based on LCIG clinical trials for clinical outcomes and health state utilities, the literature for health state transitions and use UK-based input data wherever possible (drug costs, disease/adverse event management costs, discontinuation rates, mortality rates).

Limitations: Data collection can be challenging in this small, elderly population with advanced disease, therefore some model inputs were estimated, rather than collected directly. It was assumed that a reduction in off-time was the only benefit after the first year of treatment with LCIG; this is a conservative approach, since there may be additional clinical benefits.

Results: There is a considerable incremental gain in quality adjusted life years (QALYs) for patients treated with LCIG of 1.26 QALY with an associated incremental cost-effectiveness ratio (ICER) of £52,110. If the impact on caregivers is included, the ICER reduces to £47,266.

Conclusions: In cases where there is an orphan population, with no alternative treatment options, HTA assessments have a broader decision-making framework and the ICER is interpreted in this context. In the setting of a very small population, with considerable unmet need, LCIG represents value for money, as reflected by funding approval across the UK.