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This study aimed to assess the costs and clinical benefits of the 13-valent pneumococcal conjugate vaccine (PCV13) administered annually to the 65-year-old cohort in Spain versus the alternative of not vaccinating patients and treating them only when infected.
Cases of pneumococcal disease avoided were calculated through a dynamic model based on the work of Anderson and May (1999). Sixty-six percent of the 65-year-old cohort was assumed to have been vaccinated with one PCV13 dose (304,492 subjects). Base-case estimated vaccine effectiveness and serotype coverage were 58% and 60%, respectively. Disease-related costs were calculated based on published data.
Over the 5-year period, a total of 125,906 cases of pneumococcal disease would be avoided. Net savings of €102 million would be obtained. The cost-saving distribution was not homogeneous, starting in the 2nd year and increasing through the 5th. To demonstrate model robustness, an additional scenario analysis was performed using extreme values of model parameters (vaccination programme coverage, vaccine effectiveness, discount rate and disease costs). Under those scenarios, net savings were always achieved.
Based on the assumptions of the model, the 65-year-cohort pneumococcal vaccination campaign appears to be a cost-saving intervention in the Spanish population under different scenarios.
Budget impact analysis of a pneumococcal vaccination programme in the 65-year-old Spanish cohort using a dynamic model
Roberto Pradas,corresponding author1 Angel Gil de Miguel,2 Alejandro alvaro,2 Ruth Gil-Prieto,2 Reyes Lorente,1 Cristina Mendez,3 Pablo Guijarro,3 and Fernando AntoNanzas1
Helopanoplia distincta is an extinct soft-shelled turtle (Pan-Trionychidae) for which the type specimen is a fragmentary costal and the inguinal notch portion of the left hypoplastron from the Late Cretaceous (Maastrichtian) Lance Formation of Wyoming, USA that bear a distinct surface sculpture pattern consisting of raised tubercles. Over the course of the past few decades, a number of additional, fragmentary specimens from the Late Cretaceous (Maastrichtian) Hell Creek Formation of Montana and North Dakota have been referred to this taxon based on the presence of these tubercles, but a more complete understanding of the anatomy and phylogenetic relationships of this distinctive soft-shelled turtle is still outstanding.
We here figure and describe shell remains of eight fossils referable to Helopanoplia distincta from the Hell Creek Formation of Montana and North Dakota that, in combination, document nearly all aspects of the shell morphology of this taxon. We furthermore explore the relationships of this fossil turtle by inserting it into a modified phylogenetic analysis of pan-trionychid relationships.
The new fossil material thoroughly supports the validity of Helopanoplia distincta. In addition to its unique surface sculpture pattern, this turtle can be diagnosed relative to all other named pan-trionychids by the presence of a distinct corner along the margin of costals II, the complete covering of costal ribs I-VI by metaplastic bone, midline contact of the main plastral elements, hyoplastral shoulder, presence of a lateral, upturned margin on the hyo/hypoplastron that is covered dorsally and laterally by sculptured metaplastic bone, a single, lateral hyoplastral process, and the apomorphic presence of fine scallops along the margin of costals VIII, formation of a laterally embraced, rounded nuchal, anteriorly rounded costals I, distally expanded costals II, and narrow costals VII. A phylogenetic analysis places Helopanoplia distincta as sister to the clade formed by Plastomenus thomasii and Hutchemys spp., thereby confirming its identity as a plastomenid. The vast majority of Helopanoplia distincta material has been recovered from fine-grained overbank deposits, thereby supporting the hypothesis that this turtle favored ponded waters.
Maastrichtian, Testudines, Trionychidae, Cryptodira, Helopanoplia distincta, Hell Creek Formation, Plastomenidae, Late Cretaceous, Lance Formation
The shell morphology of the latest Cretaceous (Maastrichtian) trionychid turtle Helopanoplia distincta
Walter G. Joycecorresponding author1 and Tyler R. Lyson2
Business owners in the Republic of Korea must take part in the workers’ general health examination. However, there have been few formal analyses of the uptake of this examination by employees. In the present study, we examined the rates of participation in medical examinations according to age group, health insurance type, and enterprise size, and then compared these results with those of the national general health screening. Furthermore, we determined the distribution of patients with abnormal results for diabetes and hypertension, and outlined the significance and history of domestic health examinations.
We started by comparing participation rates extracted from the among health examination data of the National Health Insurance Service from 2006-2013 by sex, age, insurance type, and enterprise size of workplace health insurance beneficiaries (i.e., those whose insurance is provided by their workplace). In addition, we analyzed the prevalence rates of abnormal results for hypertension and diabetes, and explored the history and significance of health examinations in the Republic of Korea.
The overall participation rate in the primary health examination in 2006 was 56%, and this increased to 72% in 2013. However, the rates of the secondary screening did not increase much. Among workplace policyholders (i.e., those whose insurance is provided by their workplace), the participation rates of workers in enterprises with less than 50 employees were lower than were those in enterprises with 50 or more employees. Notably, the rates and odds ratios of patients with abnormal results for diabetes and hypertension were relatively high, particularly among those working in smaller enterprises.
Although the workers’ general health examination has been replaced with the national general health screening, it remains necessary to ensure uniform health management services among all workers in the Republic of Korea. This can, in turn, promote occupational health and improve working conditions throughout the Republic of Korea.
National health screening system, Worker's general health examination, National general examination, History of periodic health examination, Participation rate, Hypertension prevalence, Diabetes prevalence, Small enterprise, Health inequality
The current condition of the workers’ general health examination in South Korea: a retrospective study
Young Joong Kang, Jun-Pyo Myong, Huisu Eom, Bowha Choi, Jong Heon Park, and Eun-A L Kimcorresponding author