PLoS Medicine最新文献

{"title":"The potential global health impact and cost-effectiveness of next-generation influenza vaccines: A modelling analysis.","authors":"Lucy Goodfellow, Simon R Procter, Mihaly Koltai, Naomi R Waterlow, Johnny A N Filipe, Carlos K H Wong, Edwin van Leeuwen, Rosalind M Eggo, Mark Jit","doi":"10.1371/journal.pmed.1004655","DOIUrl":"https://doi.org/10.1371/journal.pmed.1004655","url":null,"abstract":"<p><strong>Background: </strong>Next-generation influenza vaccines (NGIVs) are in development and have the potential to achieve substantial reductions in influenza burden, with resulting widespread health and economic benefits. The prices at which their market can be sustained and which vaccination strategies may maximise health impact and cost-effectiveness, particularly in low- and middle-income countries, are unknown, yet such an understanding could provide a valuable tool for vaccine development and investment decision-making at a national and global level. To address this evidence gap, we projected the health and economic impact of NGIVs in 186 countries and territories.</p><p><strong>Methods and findings: </strong>We inferred current influenza transmission parameters from World Health Organization (WHO) FluNet data in regions defined by their seasonal influenza timing and positivity, and projected 30 years of influenza epidemics, accounting for demographic changes. We considered vaccines including current seasonal vaccines, vaccines with increased efficacy, duration, and breadth of protection, and universal vaccines, defined in line with WHO Preferred Product Characteristics. We estimated cost-effectiveness of different vaccination scenarios using novel estimates of key health outcomes and costs. NGIVs have the potential to substantially reduce influenza burden: compared to no vaccination, vaccinating 50% of children aged under 18 annually prevented 1.3 (95% uncertainty range (UR): 1.2-1.5) billion infections using current vaccines, 2.6 (95% UR: 2.4-2.9) billion infections using vaccines with improved efficacy or breadth, and 3.0 (95% UR: 2.7-3.3) billion infections using universal vaccines. In many countries, NGIVs were cost-effective at higher prices than typically paid for existing seasonal vaccines. However, tiered prices may be necessary for improved vaccines to be cost-effective in lower income countries. This study is limited by the availability of accurate data on influenza incidence and influenza-associated health outcomes and costs. Furthermore, the model involves simplifying assumptions around vaccination coverage and administration, and does not account for societal costs or budget impact of NGIVs. How NGIVs will compare to the vaccine types considered in this model when developed is unknown. We conducted sensitivity analyses to investigate key model parameters.</p><p><strong>Conclusions: </strong>This study highlights the considerable potential health and economic benefits of NGIVs, but also the variation in cost-effectiveness between high-income and low- and middle-income countries. This work provides a framework for long-term global cost-effectiveness evaluations, and the findings can inform a pathway to developing NGIVs and rolling them out globally.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 6","pages":"e1004655"},"PeriodicalIF":15.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular-kidney-metabolic syndrome and all-cause and cardiovascular mortality: A retrospective cohort study.","authors":"Min-Kuang Tsai, Juliana Tze-Wah Kao, Chung-Shun Wong, Chia-Te Liao, Wei-Cheng Lo, Kuo-Liong Chien, Chi-Pang Wen, Mai-Szu Wu, Mei-Yi Wu","doi":"10.1371/journal.pmed.1004629","DOIUrl":"10.1371/journal.pmed.1004629","url":null,"abstract":"<p><strong>Background: </strong>The American Heart Association recently issued guidelines introducing the concept of cardiovascular-kidney-metabolic (CKM) syndrome to emphasize the importance of multidisciplinary approaches to prevention, risk stratification, and treatment for these diseases. This study assessed the prevalence of CKM syndrome stages and the mortality risk associated with its components in a large Asian cohort.</p><p><strong>Methods and findings: </strong>We analyzed a retrospective cohort of 515,602 participants aged ≥20 years from a health screening program conducted between 1996 and 2017 in Taiwan. We assessed the associations of all-cause mortality, cardiovascular disease (CVD) mortality, and cause-specific mortality with CKM stages and its components-hypertension, diabetes mellitus, chronic kidney disease (CKD), metabolic syndrome, and hyperlipidemia. All participants were followed for a median of 16.5 years (interquartile range: 11.5, 21.2 years). Multivariate Cox proportional hazards models, adjusted for age, sex, educational level, smoking status, alcohol drinking status, and physical activity groups, were used to calculate hazard ratios (HRs). We used Chiang's life table method to estimate years of life lost due to each CKM component. Among all participants, 257,535 (49.9%) were female. The majority of participants (n = 368,578 participants, (71.5%)) met criteria for CKM syndrome, with prevalence rates of 19.5%, 46.3%, 1.9%, and 3.8% for stages 1, 2, 3, and 4, respectively. CKM syndrome was associated with higher risks of all-cause mortality (HR: 1.33; 95% confidence interval, CI: 1.28, 1.39), CVD mortality (HR: 2.81; 95% CI: 2.45, 3.22), and incident end-stage kidney disease (ESKD) (HR: 10.15; 95% CI: 7.54, 13.67). Each additional CKM component was associated with a 22% increase in the risk of all-cause mortality (HR: 1.22; 95% CI: 1.21, 1.23), a 37% increase in the risk of CVD mortality (HR: 1.37; 95% CI: 1.35, 1.40) compared with those without any CKM components. In addition, each additional component reduced average life expectancy by 3 years. The population-attributable fractions of CKM syndrome were 18.7% (95% CI: 15.8, 21.7) for all-cause mortality and 55.0% (95% CI: 49.0, 60.4) for CVD mortality. We estimated that failing to include CKD in CKM syndrome could result in the missed attribution of 11% of CVD deaths. The primary limitation is that our analysis relied on baseline measurements only, without accounting for longitudinal changes.</p><p><strong>Conclusions: </strong>In the large cohort study, the prevalence of CKM syndrome and its components were associated with risks of all-cause mortality, CVD mortality, and ESKD. These findings highlight the clinical need for integrated care within CKM health.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 6","pages":"e1004629"},"PeriodicalIF":15.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12200875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural cycle versus hormone replacement therapy as endometrial preparation in ovulatory women undergoing frozen-thawed embryo transfer: The compete open-label randomized controlled trial.","authors":"Xitong Liu, Wentao Li, Wen Wen, Ting Wang, Tao Wang, Ting Sun, Na Zhang, Dan Pan, Jinlin Xie, Xiaojuan Liu, He Cai, Xiaofang Li, Zan Shi, Rui Wang, Na Lu, Haiyan Bai, Rong Pan, Li Tian, Bin Meng, Xin Mu, Hongran Jia, Hanying Zhou, Xu Cao, Tianxing Liu, Pengfei Qu, Danmeng Liu, Ben W Mol, Juanzi Shi","doi":"10.1371/journal.pmed.1004630","DOIUrl":"10.1371/journal.pmed.1004630","url":null,"abstract":"<p><strong>Background: </strong>Different endometrial preparation protocols are used prior to frozen-thawed embryo transfer (FET). Optimization of endometrial preparation protocols is mandatory to improve live birth rate and obstetric and perinatal outcomes. In the Comparison of Endometrial Preparation Protocols for Frozen Embryo Transfer (COMPETE) trial, our primary objective is to evaluate whether natural cycles (NCs) lead to a higher live birth rate after the first FET cycle compared to hormone replacement therapy (HRT) cycles in women with a regular ovulatory cycle.</p><p><strong>Methods and findings: </strong>We performed a single-center, parallel, open-label randomized controlled trial between December 2020 and December 2022 in a single assisted reproduction center in Xi'an, China. Women with a regular menstrual cycle undergoing in vitro fertilization (IVF) scheduled for FET were randomly assigned (1:1) to endometrial preparation in the NC or with HRT, using a web-based electronic data capture system. The primary outcome was live birth rate after the initial FET. The analysis was conducted based on the intention-to-treat principle. Obstetric and perinatal outcomes in all randomly assigned women were reported in this study. We randomly assigned 902 women to receive either NC (n = 448) or HRT (n = 454). In the NC group, 101 women received HRT because of no ovulation, while in the HRT group, 29 women received NC because of spontaneous ovulation. The number of live births was 242 (54.0%) in the NC group versus 195 (43.0%) in the HRT group (absolute difference, 11.1 percentage points, 95% CI 4.6 to 17.5; risk ratio (RR) 1.26, 95% CI 1.10 to 1.44). Miscarriage rates (RR 0.61, 95% CI 0.41 to 0.89) and the antepartum hemorrhage rates (RR 0.63, 95%CI 0.42 to 0.93) were lower in the NC group, with other obstetric and perinatal outcomes not significantly different.</p><p><strong>Conclusions: </strong>In women with a regular menstrual cycle undergoing FET, a strategy starting with NC endometrial preparation results in higher live birth rates than endometrial preparation with HRT. However, the permitted cross-over between arms limits certainty in directly assessing NC versus HRT efficacy.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry: ChiCTR2000040640.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 6","pages":"e1004630"},"PeriodicalIF":15.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12193059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of retinal markers and incident amyotrophic lateral sclerosis: An optical coherence tomography-based cohort study.","authors":"Chunyang Pang, Yaojia Li, Wenhua Jiang, Haobo Xie, Wen Cao, Huan Yu, Zhiyang Lin, Yifan Cheng, Dongsheng Fan, Binbin Deng","doi":"10.1371/journal.pmed.1004545","DOIUrl":"10.1371/journal.pmed.1004545","url":null,"abstract":"<p><strong>Background: </strong>Biomarkers are widely recognized as crucial breakthroughs in tackling amyotrophic lateral sclerosis (ALS). Among them, retina markers may hold promise due to the close retina-brain connection and non-invasive, portable detection methods. Thus, using optical coherence tomography (OCT), we investigated the link between baseline cell-level retinal features and future ALS risk.</p><p><strong>Methods and findings: </strong>Participants from the UK Biobank underwent OCT scans to assess retinal layers, macula, and optic disc parameters. Follow-up commenced two years after the baseline period (2006-2010), during which ALS cases were identified using International Classification of Diseases (ICD) codes from medical and assessment records. Cox proportional hazards models were applied to examine the relationship between retinal markers and incident ALS. Over a median follow-up of 14.11 years, 70 ALS cases occurred among 53,824 participants (incidence 10.58 per 100,000 person-years). Most participants were White (94.6%), 44.8% male, with a median age of 58 years. After adjusting for demographics and comorbidities affecting the retina, a standard deviation (SD) decrease of 15.19 µm in photoreceptor layer (PRL) thickness was associated with a 19% (95% confidence interval [7, 29]; p = 0.002) increased risk of ALS, while a SD increase of 26.11 µm in retinal pigment epithelium (RPE) thickness corresponded to a 20% (95% CI [7, 34]; p = 0.002) higher risk. Sensitivity analyses excluding follow-ups of less than 4 and 6 years yielded consistent results. Subgroup analyses showed these findings were more pronounced in smokers. The main limitation of this study is its single time point observational design.</p><p><strong>Conclusion: </strong>A thinner PRL and thicker RPE may precede the clinical diagnosis of ALS, offering potential clues for early diagnosis and insights into the disease's pathogenesis.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 6","pages":"e1004545"},"PeriodicalIF":15.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12193630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial resistance in Africa: A retrospective analysis of data from 14 countries, 2016-2019.","authors":"Gilbert Osena, Geetanjali Kapoor, Erta Kalanxhi, Timothée Ouassa, Edwin Shumba, Sehr Brar, Yewande Alimi, Manuel Moreira, Martin Matu, Abdourahmane Sow, Eili Klein, Pascale Ondoa, Ramanan Laxminarayan","doi":"10.1371/journal.pmed.1004638","DOIUrl":"10.1371/journal.pmed.1004638","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a major global health issue that exacerbates the burden of infectious diseases and healthcare costs. However, the scarcity of national-level AMR data in African countries hampers our understanding of its scale and contributing factors in the region. To gain insights into AMR prevalence in Africa, we collected and analyzed retrospective AMR data from 14 countries.</p><p><strong>Methods and findings: </strong>We estimated bacterial AMR prevalence, defined as the proportion of resistant human isolates tested from antimicrobial susceptibility (AST) data collected retrospectively for 2016-2019 from 205 laboratories across 14 African countries. We generated 95% confidence intervals (CIs) for aggregated AMR estimates to account for data quality disparities across countries; the median data quality score was 73.1%, ranging from 56.4% to 80.8%. We assessed 819,584 culture records covering 9,266 pathogen-drug combinations, of which 187,832 (22.9%) were positive cultures with AST results. The most frequently cultured specimens were urine (32.0%) and purulent samples (28.1%), and the most frequently isolated pathogens were Escherichia coli (22.2%) and Staphylococcus aureus (15.0%). Aggregated AMR estimates did not change significantly across the years studied (p > 0.337); however, there were significant variations in AMR prevalence estimates in culture-positive samples across countries, regions, patient departments (inpatient/outpatient), and specimen sources (p < 0.05). Male sex (adjusted odds ratio [aOR] 1.15; 95% CI [1.09,1.21]; p < 0.0001), ages above 65 (aOR 1.28; 95% CI [1.16-1.41]; p < 0.0001), and inpatient department (aOR 1.24; 95% CI [1.13-1.35]; p < 0.0001) were associated with higher AMR prevalence among culture-positive samples. The lack of routine testing, as reflected in the low data volume from most contributing laboratories, and the absence of patient clinical information, represent significant limitations of this study.</p><p><strong>Conclusion: </strong>Analysis of the largest retrospective AMR dataset in Africa indicates high variability in AMR prevalence across countries, coupled with differences in AMR testing capacities, data quality, and AMR estimates. Gaps in AST practices and inadequate digital infrastructures for data collection and reporting represent barriers to estimating the true AMR burden in the region. These barriers warrant large-scale investments to expand healthcare access and strengthen bacteriology laboratory capacities.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 6","pages":"e1004638"},"PeriodicalIF":15.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal infections during pregnancy and offspring cognitive outcome: A nationwide full-sibling cohort study.","authors":"Anders Husby, Kim D Jakobsen, Jan Wohlfahrt, Mads Melbye","doi":"10.1371/journal.pmed.1004657","DOIUrl":"https://doi.org/10.1371/journal.pmed.1004657","url":null,"abstract":"<p><strong>Background: </strong>Maternal infections are common during pregnancy, but it is unclear how they impact the cognitive outcome of the offspring, with many studies suggesting adverse effects. Using long-term follow-up of a nationwide sibling cohort in Denmark with information on maternal antimicrobial prescriptions in community pharmacies and in-patient hospitalizations for infection, we aimed to estimate the effect of maternal infections during pregnancy on offspring school grades and intelligence test results in adolescence.</p><p><strong>Methods and findings: </strong>From population-based national registries we defined a cohort of all full-siblings, born from January 1, 1996 to December 31, 2,003 in Denmark, and linked them to maternal filled prescription for antimicrobial pharmaceuticals and maternal hospitalizations for infection during pregnancy. Standardized examination grades in language and mathematics at the final year of compulsory schooling, in addition to intelligence test scores (calculated as IQ) for a nested sub-cohort of full brothers, were used as outcomes. Among 274,166 children in the full-sibling cohort, 80,817 (29.5%) had a mother who during her pregnancy filled a prescription for a systemic antimicrobial, while 5,628 (2.1%) had a mother who during her pregnancy was hospitalized due to an infection. We found no consistent difference in school grades in language (z-score difference, 0.0, 95% confidence interval [CI] [-0.0,0.0]; p = 0.920) and mathematics (z-score difference, -0.0, 95% CI [-0.0,-0.0]; p = 0.042), and in IQ (IQ-difference, 0.3, 95% CI [-0.2,0.7]; p = 0.217), in children whose mother filled one antimicrobial prescription compared with children whose mother did not fill any, when taking shared family factors into account, while many associations were consistently significant when not taking shared family factors into account. Furthermore, we found no indication of an impact of maternal in-patient hospitalizations for infections during pregnancy on school grades (z-score difference for language, -0.0, 95% CI [-0.1,0.0]; p = 0.103; z-score difference for mathematics, 0.0, 95% CI [-0.0,0.0]; p = 0.809) or IQ (IQ-difference, 0.4, 95% CI [-0.8,1.6]; p = 0.545), when also taking shared family factors into account. Similar findings were found when considering infections in bi-weekly exposure periods during gestation. The main limitations of the study were lacking information on within hospital pharmaceutical prescriptions and the underlying pathogenic microorganisms.</p><p><strong>Conclusions: </strong>Our study does not support major effects of common maternal infections during pregnancy on offspring cognitive outcomes, and support the safety of commonly prescribed antimicrobials during pregnancy with respect to the long-term cognitive outcomes of the offspring.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 6","pages":"e1004657"},"PeriodicalIF":15.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Fetal Region-specific Optimized Growth Standard (FROGS)-A fetal and birthweight centile calculator validated in a national population.","authors":"Natasha L Pritchard, Stephen Tong, Teresa MacDonald, Elizabeth McCarthy, Lisa Hui, Michael Bethune, Hannah G Gordon, Roxanne Hastie, Emerson Keenan, Michael Permezel, Susan P Walker, Anthea C Lindquist","doi":"10.1371/journal.pmed.1004634","DOIUrl":"10.1371/journal.pmed.1004634","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is no universally agreed upon obstetric growth standard for use during pregnancy. We aimed to design a simple novel growth standard, which incorporates key beneficial features identified in prior research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and findings: &lt;/strong&gt;We developed the Fetal Region-specific Optimized Growth Standard (FROGS), then validated it following International Federation of Gynaecology and Obstetrics (FIGO) guidelines. FROGS follows the shape of the fetal (ultrasound-based) Hadlock curve. It is region-specific; allowing adjustment for the mean birthweight and standard deviation of babies born at term in the local population where it will be applied. It provides an exact centile for each gestational day (rather than rounding off by weeks) and is optionally adjustable for fetal sex. Further, FROGS provides an 'estimate range' for the estimated fetal weight centile, assuming a 10% ultrasound measurement error. Following development, we validated FROGS in a retrospective cohort study by comparing its ability to identify small babies with an increased risk of adverse perinatal outcomes to four charts in current use: (1) population birthweight chart (Australian Institute of Health and Welfare, AIHW chart); (2) Hadlock's 1991 fetal chart; (3) Mikolajczyk's global fetal and birthweight centile chart; and (4) INTERGROWTH-21st fetal growth standards. To do this, we identified infants classified as small for gestational age (&lt;10th centile) by each chart. We then identified non-overlapping &lt;10th centile populations, i.e., infants classified as small by one chart, but not another. We compared rates of stillbirth and adverse perinatal outcomes between the non-overlapping populations. All charts except INTERGROWTH classified similar proportions of infants as &lt;10th centile (10.4% FROGS, 9.3% AIHW, 11.1% Hadlock, 10.9% global, 4.4% INTERGROWTH). Of the three charts that classified similar proportions as &lt;10th centile, infants classified by FROGS were at the highest risk of adverse perinatal outcomes. The infants classified as &lt;10th centile by only FROGS had significantly increased relative risk (RR) of stillbirth, compared to the infants classified as &lt;10th centile by only AIHW (RR 13.1, 95% CI 6.5-26.5), only Hadlock (RR 2.1, 95% CI 1.28-3.56) or only the global chart (RR 1.54, 95% CI 1.00-2.37). The FROGS chart outperformed these three charts in identifying infants at risk of other adverse perinatal outcomes associated with being small for gestational age, such as neonatal intensive care admission, Apgar scores &lt;7 at 5 min, and operative (instrumental) vaginal birth for suspected fetal compromise. The cohort of infants classified as small for gestational age by INTERGROWTH was, in size and risk, closer to the cohort classified as &lt;3rd centile by FROGS (3.4% of infants &lt;3rd). This study is limited in that it retrospectively assesses birthweight, which may have different implications to a prospective evaluation of estimat","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 6","pages":"e1004634"},"PeriodicalIF":15.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccination strategies, public health impact and cost-effectiveness of dengue vaccine TAK-003: A modeling case study in Thailand.","authors":"Jing Shen, Elizaveta Kharitonova, Anna Tytula, Justyna Zawieja, Samuel Aballea, Shibadas Biswal, Mayuri Sharma, Supattra Rungmaitree, Rosarin Sruamsiri, Derek Wallace, Riona Hanley","doi":"10.1371/journal.pmed.1004631","DOIUrl":"10.1371/journal.pmed.1004631","url":null,"abstract":"<p><strong>Background: </strong>Dengue is an increasing global problem associated with negative health and economic impacts. Vaccination is an important measure to reduce the significant public health and economic burden caused by dengue. Our study assesses the public health impact and cost-effectiveness of a new dengue vaccine, TAK-003, using Thailand as a case study.</p><p><strong>Methods and findings: </strong>We developed a dynamic transmission model with both host and vector populations, 4 serotype-specific infections, seasonality, and other key elements of dengue natural history. We estimated efficacy of TAK-003 from the DEN-301 trial. We first used the model to determine the optimal cohort age for different vaccination strategies with TAK-003, based on Thai dengue epidemiology. Secondly, we assessed the public health impact of a pragmatic strategy integrating TAK-003 into an existing national immunization program in Thailand. Cost-effectiveness was evaluated from a societal perspective using disability-adjusted life-years (DALYs) over a 20-year horizon. TAK-003 is estimated to prevent 41%-57% of symptomatic cases and 47%-70% of hospitalizations, with the greatest impact observed when routinely vaccinating children aged 6 years with 10 additional catch-up cohorts. This strategy resulted in 104,415 fewer DALYs and savings of US$1,786 million. If introduced into the national immunization program at 11 years of age (alongside the existing human papillomavirus vaccine), TAK-003 is estimated to prevent 44% of symptomatic cases and 53% of hospitalizations. This strategy prevented 87,715 DALYs and saved US$1,346 million. Sensitivity analyses demonstrated that the results were robust. The main limitations were inherent to the assumptions and simplifications made in the model, which are unavoidable when approximating the impact of vaccination in the real world.</p><p><strong>Conclusions: </strong>TAK-003 can considerably reduce dengue burden and lead to cost savings in Thailand. These benefits can be maximized by identifying optimal age cohorts for vaccination and adding catch-up programs. Our model can be used to assess the vaccination impact in other dengue-endemic countries.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 6","pages":"e1004631"},"PeriodicalIF":15.8,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making social sciences foundational to academic medicine.","authors":"Sahar Sadjadi, Lisa Barkley, Rebecca Jordan-Young, Helena Hansen","doi":"10.1371/journal.pmed.1004649","DOIUrl":"10.1371/journal.pmed.1004649","url":null,"abstract":"<p><p>Despite longstanding evidence of the enormous impact of socioeconomic conditions on population health, social sciences remain marginal to academic medicine. In this Perspective, we propose the integration of social sciences into the three pillars of academic medicine-education, research, and clinical practice-to build the theoretical and methodological foundations for identifying the mechanisms through which social and community factors shape health and disease, and to advance sustainable community engagement in the creation of medical knowledge.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 6","pages":"e1004649"},"PeriodicalIF":15.8,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community health worker-facilitated telehealth for moderate-severe hypertension care in Kenya and Uganda: A randomized controlled trial.","authors":"Matthew D Hickey, Asiphas Owaraganise, Sabina Ogachi, Norton Sang, Erick M Wafula, Jane Kabami, Nicole Sutter, Jennifer Temple, Anthony Muiru, Gabriel Chamie, Elijah Kakande, Maya L Petersen, Laura B Balzer, Diane V Havlir, Moses R Kamya, James Ayieko","doi":"10.1371/journal.pmed.1004632","DOIUrl":"10.1371/journal.pmed.1004632","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is underdiagnosed and undertreated in sub-Saharan Africa. Improving hypertension treatment within primary health centers can improve cardiovascular disease outcomes; however, individuals with moderate-severe hypertension face additional barriers to care, including the need for frequent clinic visits to titrate medications. We conducted a pilot study to test whether a clinician-driven, community health worker (CHW)-facilitated telehealth intervention would improve hypertension control among adults with severe hypertension in rural Uganda and Kenya.</p><p><strong>Methods and findings: </strong>We conducted a pilot randomized controlled trial (RCT) of hypertension treatment delivered via telehealth by a clinician (adherence assessment, counseling, decision-making) and facilitated by a CHW in the participant's home, compared to clinic-based hypertension care (NCT04810650). We recruited adults ≥40 years with BP ≥ 160/100 mmHg at household screening by CHWs, with no restrictions by HIV status. After initial evaluation at the clinic, participants were randomized to telehealth or clinic-based hypertension follow-up. Randomization assignment was not blinded, except for the study statistician. All participants were treated using standard country guideline-based antihypertensive drugs. The primary outcome was hypertension control at 24 weeks (BP < 140/90 mmHg). We also assessed hypertension control at 48 weeks. In intention-to-treat analyses, we compared outcomes between randomized arms with targeted minimum loss-based estimation using sample-splitting to select optimal adjustment covariates (candidates: age, sex, baseline hypertension severity, and country). We screened 2,965 adults ≥40 years, identifying 266 (9%) with severe hypertension and enrolling 200 (98 telehealth arms, 102 clinic arms). Participants were 67% women, median age of 62 years (Q1-Q3 51-72); 14% with HIV. Week 24 blood pressure was measured in 96/99 intervention and 99/102 control participants; week 24 hypertension control was 77% in telehealth and 51% in clinic arms (risk difference (RD) 26%, 95% confidence interval (CI) [14%, 38%], p < 0.001). Week 48 hypertension control was 86% in telehealth and 44% in clinic arms (RD 42%, 95% CI [30%, 53%], p < 0.001). Three participants died (telehealth: 2, clinic: 1); all deaths were unrelated to the study interventions. Our study was limited by its small sample size, although findings are strengthened by being conducted in three primary health centers across two countries.</p><p><strong>Conclusion: </strong>In this pilot, RCT, clinician-driven, CHW-facilitated telehealth for hypertension management improved hypertension control and reduced severe hypertension compared to clinic-based care. Telehealth focused on individuals with moderate-severe hypertension is a promising approach to improve outcomes among those with the highest risk for CVD.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 6","pages":"e1004632"},"PeriodicalIF":15.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}