Cost-benefit analysis, cost-effectiveness analysis, and impact of antiepileptic drugs on the risk of fracture in patients with epilepsy: A nationwide cohort study

Cost-Benefit Analysis of Human Papillomavirus Vaccine in Iran

Despite increasing global attention to the national human papillomavirus (HPV) immunization program, this program is controversial in Iran. Evidence indicates that HPV vaccination is not cost-effective in Iran. Using cost-effectiveness analysis for decision-making about public health interventions such as vaccination is controversial because its potential benefits may not fit this framework. This study aimed to evaluate the economic effects of the HPV vaccination by cost-benefit analysis (CBA) using bivalent and quadrivalent in Iran in 2020. We performed a CBA from a societal perspective. We used two approaches of the vaccine's economic benefits: willingness to pay by discrete choice experiment and cost of illness. Costs only included the vaccine cost. The cost of two doses of bivalent and quadrivalent vaccines were US $29 and the US $151, respectively (US $1 = IRR 42,000). The benefits of bivalent and quadrivalent vaccines were US $ - 432, US $380 per person using the willingness to pay approach, and they were US $7375 and US $6590 thorough cost-of-illness approach. The cost-benefit ratio (CBR) of bivalent and quadrivalent vaccines was - 15.11 and 2.51 by the willingness to pay approach, and 258.12 and 43.51 by the cost of illness approach. This study confirms the benefits of the national bivalent and quadrivalent vaccination programs and provides reliable evidence for policy-makers programming HPV vaccination.

Complications associated with the use of enzyme-inducing and non-enzyme-inducing anti-seizure medications in the Japanese population: A retrospective cohort study

OBJECTIVE

Enzyme-inducing anti-seizure medications (EIASMs) may contribute to the development of complications such as fracture and cardiovascular disease. The objective of the study was to determine whether the use of EIASMs is associated with a higher risk of fracture and cardiovascular outcome in young Japanese patients with epilepsy.

METHOD

Adult patients diagnosed with epilepsy and initiated a monotherapy with an anti-seizure medication (ASM) between 2008 and 2018 were included in the study. The primary outcomes were the occurrence of acute myocardial infarction (AMI) or stroke. The secondary outcome was fracture. We performed a propensity score-matched analysis (1:1) to control for imbalances in patient characteristics, and the matched hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models.

RESULT

Of the 7115 eligible patients, 626 (8.79%) initiated treatment with EIASMs. The median age of the patients was 44 years (interquartile range: 31-54 years), and 56.2% were male. Propensity score matching generated 626 matched pairs of patients treated with EIASMs and non-EIASMs. There were no significant differences in the risk of stroke (EIASM group: n = 28[4.47%], non-EIASM group: n = 22[3.51%], HR: 1.47, 95% CI: 0.79-2.72, p = 0.22) or fracture (EIASM group: n = 7[1.12%], non-EIASM group: n = 5[0.80%], HR: 1.00, 95% CI: 0.29-3.45, p = 1.00) between the two groups. The hazard ratio for the occurrence of AMI could not be calculated due to the small number of events (EIASM group: n = 0[0.00], non-EIASM group: n = 2[0.32]).

SIGNIFICANCE

Our cohort study did not find increased risk of the occurrence of stroke, AMI, or fracture hospitalization with the use of enzyme-inducing ASMs. Although the findings suggested that exposure to EIASMs does not appear to increase the risk of complications in young patients, caution should be taken as patients with epilepsy tend to take medication in the long run.

Differentially expressed circRNA and functional pathways in the hippocampus of epileptic mice based on next-generation sequencing

Epilepsy is a clinical syndrome caused by the highly synchronized abnormal discharge of brain neurons. It has the characteristics of paroxysmal, transient, repetitive, and stereotyped. Circular RNAs (circRNAs) are a recently discovered type of noncoding RNA with diverse cellular functions related to their excellent stability; additionally, some circRNAs can bind and regulate microRNAs (miRNAs). The present study was designed to screen the differentially expressed circRNA in an acute seizure model of epilepsy in mice, analyze the related miRNA and mRNA, and study their participating functions and enrichment pathways. In order to obtain the differential expression of circRNA in epilepsy and infer their function, we used next-generation sequencing and found significantly different transcripts. CIRI (circRNA identifier) software was used to predict circRNA from the hippocampus cDNA, EdgeR was applied for the differential circRNA analysis between samples, and Cytoscape 3.7.2 software was used to draw the network diagram. A total of 10,388 differentially expressed circRNAs were identified, of which 34 were upregulated and 66 were downregulated. Among them, mm9_circ_008777 and mm9_circ_004424 were the key upregulated genes, and their expression in the epilepsy group was verified using Quantitative real-time PCR (QPCR). The analysis indicated that the extracted gene ontology terms and Kyoto Encyclopedia of Genes and Genomes pathways were closely related to several epilepsy-associated processes. This study determined that mm9_circ_008777 and mm9_circ_004424 are potential biomarkers of epilepsy, which play important roles in epilepsy-related pathways. These results could help improve the understanding of the biological mechanisms of circRNAs and epilepsy treatments.

Depression and anxiety symptoms among returning workers during the COVID-19 period in East China

PURPOSE

To determine the prevalence of depression and anxiety and associated factors among returning workers with different epidemic experience in East China.

METHODS

A cross-sectional study was conducted among 2435 employees from the enterprises located in Deqing (low-risk epidemic area) and Taizhou (high-risk epidemic area) of East China in March 2020. An online questionnaire covered information on sociodemographic and lifestyle factors as well as knowledge, attitude, behavior and experience about COVID-19. The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) were applied to assess depression and anxiety symptoms, respectively. Logistic regression model was used to estimate adjusted odds ratios (aORs) and their 95% confidence intervals (CIs) for depression and anxiety symptoms associated with risk factors.

RESULTS

The participants were aged 36.3 ± 9.2 years on average, and nearly half of them were female. Overall, the prevalence of depression, anxiety and both were 19.4%, 12.3% and 9.8%, and decreased with age. After adjustment for covariates, 16 or more years of education, being a white-collar worker or working in the high-risk epidemic area were significantly associated with increased risks of both depression and anxiety, in contract regular physical exercise was associated with decreased risks of both mental disorders.

CONCLUSION

The depression and anxiety problems were prevalent among returning workers during the COVID-19 period. Targeted psychological interventions should be developed and implemented to improve their mental health.