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Mohy A, Page N, Boyce W, Gomez JA. Economic Evaluation of Rotavirus Vaccination in Children Aged Under Five Years in South Africa. Clin Drug Investig 2023; 43:851-863. [PMID: 37831397 PMCID: PMC10632264 DOI: 10.1007/s40261-023-01312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Evidence on the economic value of rotavirus vaccines in middle-income countries is limited. We aimed to model the implementation of three vaccines (human rotavirus, live, attenuated, oral vaccine [HRV, 2 doses]; rotavirus vaccine, live, oral, pentavalent [HBRV, 3 doses] and rotavirus vaccine, live attenuated oral, freeze-dried [BRV-PV, 3 doses] presented in 1-dose and 2-dose vials) into the South African National Immunisation Programme. METHODS Cost and cost-effectiveness analyses were conducted to compare three rotavirus vaccines using a static, deterministic, population model in children aged <5 years in South Africa from country payer and societal perspectives. Deterministic and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty in model inputs. RESULTS The human rotavirus, live, attenuated, oral vaccine (HRV) was associated with cost savings versus HBRV from both perspectives, and versus BRV-PV 1-dose vial from the societal perspective. In the cost-effectiveness analysis, HRV was estimated to avoid 1,107 home care rotavirus gastroenteritis (RVGE) events, 247 medical visits, 35 hospitalisations, and 4 RVGE-related deaths versus HBRV and BRV-PV. This translated to 73 quality-adjusted life years gained. HRV was associated with lower costs versus HBRV from both payer (-$3.9M) and societal (-$11.5M) perspectives and versus BRV-PV 1-dose vial from the societal perspective (-$3.8M), dominating those options. HRV was associated with higher costs versus BRV-PV 1-dose vial from the payer perspective and versus BRV-PV 2‑dose vial from both payer and societal perspectives (ICERs: $51,834, $121,171, and $16,717, respectively), exceeding the assumed cost-effectiveness threshold of 0.5 GDP per capita. CONCLUSION Vaccination with a 2-dose schedule of HRV may lead to better health outcomes for children in South Africa compared with the 3-dose schedule rotavirus vaccines.
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Affiliation(s)
- Ahmed Mohy
- GSK, Value Evidence and Outcomes, Emerging Markets, GSK Vaccines, Wavre, Belgium.
| | - Nicola Page
- Center for Enteric Diseases, National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Jorge A Gomez
- GSK, Value Evidence and Outcomes, Emerging Markets, Buenos Aires, Argentina
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Madhi SA, Mutsaerts EA, Izu A, Boyce W, Bhikha S, Ikulinda BT, Jose L, Koen A, Nana AJ, Moultrie A, Roalfe L, Hunt A, Goldblatt D, Cutland CL, Dorfman JR. Immunogenicity of a single-dose compared with a two-dose primary series followed by a booster dose of ten-valent or 13-valent pneumococcal conjugate vaccine in South African children: an open-label, randomised, non-inferiority trial. Lancet Infect Dis 2020; 20:1426-1436. [PMID: 32857992 PMCID: PMC7689288 DOI: 10.1016/s1473-3099(20)30289-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/04/2020] [Accepted: 04/02/2020] [Indexed: 11/24/2022]
Abstract
Background Routine childhood immunisation with pneumococcal conjugate vaccine (PCV) has changed the epidemiology of pneumococcal disease across age groups, providing an opportunity to reconsider PCV dosing schedules. We aimed to evaluate the post-booster dose immunogenicity of ten-valent (PCV10) and 13-valent (PCV13) PCVs between infants randomly assigned to receive a single-dose compared with a two-dose primary series. Methods We did an open-label, non-inferiority, randomised study in HIV-unexposed infants at a single centre in Soweto, South Africa. Infants were randomly assigned to receive one priming dose of PCV10 or PCV13 at ages 6 weeks (6w + 1 PCV10 and 6w + 1 PCV13 groups) or 14 weeks (14w + 1 PCV10 and 14w + 1 PCV13 groups) or two priming doses of PCV10 or PCV13, one each at ages 6 weeks and 14 weeks (2 + 1 PCV10 and 2 + 1 PCV13 groups); all participants then received a booster dose of PCV10 or PCV13 at 40 weeks of age. The primary endpoint was geometric mean concentrations (GMCs) of serotype-specific IgG 1 month after the booster dose, which was assessed in all participants who received PCV10 or PCV13 as per the assigned randomisation group and for whom laboratory results were available at that timepoint. The 1 + 1 vaccine schedule was considered non-inferior to the 2 + 1 vaccine schedule if the lower bound of the 96% CI for the GMC ratio was greater than 0·5 for at least ten PCV13 serotypes and eight PCV10 serotypes. Safety was a secondary endpoint. This trial is registered with ClinicalTrials.gov (NCT02943902) and is ongoing. Findings Of 1695 children assessed, 600 were enrolled and randomly assigned to one of the six groups between Jan 9 and Sept 20, 2017; 542 were included in the final analysis of the primary endpoint (86–93 per group). For both PCV13 and PCV10, a 1+1 dosing schedule (either beginning at 6 or 14 weeks) was non-inferior to a 2 + 1 schedule. For PCV13, the lower limit of the 96% CI for the ratio of GMCs between the 1 + 1 and 2 + 1 groups was higher than 0·5 for ten serotypes in the 6w+1 group (excluding 6B, 14, and 23F) and 11 serotypes in the 14w + 1 group (excluding 6B and 23F). For PCV10, the lower limit of the 96% CI for the ratio of GMCs was higher than 0·5 for all ten serotypes in the 6w+1 and 14w + 1 groups. 84 serious adverse events were reported in 72 (12%) of 600 participants. 15 occurred within 28 days of vaccination, but none were considered to be related to PCV injection. There were no cases of culture-confirmed invasive pneumococcal disease. Interpretation The non-inferiority in post-booster immune responses following a single-dose compared with a two-dose primary series of PCV13 or PCV10 indicates the potential for reducing PCV dosing schedules from a 2 + 1 to 1 + 1 series in low-income and middle-income settings with well established PCV immunisation programmes. Funding The Bill & Melinda Gates Foundation (OPP1 + 152352).
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Affiliation(s)
- Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Science, National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa.
| | - Eleonora Aml Mutsaerts
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Science, National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Alane Izu
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Science, National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Welekazi Boyce
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Science, National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Sutika Bhikha
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Science, National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Benit T Ikulinda
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Science, National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Lisa Jose
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Science, National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Anthonet Koen
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Science, National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Amit J Nana
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Science, National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Andrew Moultrie
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Science, National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Lucy Roalfe
- Immunobiology Section, University College London, Great Ormond Street Institute of Child Health Biomedical Research Centre, London, UK
| | - Adam Hunt
- Immunobiology Section, University College London, Great Ormond Street Institute of Child Health Biomedical Research Centre, London, UK
| | - David Goldblatt
- Immunobiology Section, University College London, Great Ormond Street Institute of Child Health Biomedical Research Centre, London, UK
| | - Clare L Cutland
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Science, National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Jeffrey R Dorfman
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Science, National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
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Mutsaerts EAML, Nunes MC, Bhikha S, Ikulinda BT, Boyce W, Jose L, Koen A, Moultrie A, Cutland CL, Grobbee DE, Klipstein-Grobusch K, Madhi SA. Immunogenicity and Safety of an Early Measles Vaccination Schedule at 6 and 12 Months of Age in Human Immunodeficiency Virus (HIV)-Unexposed and HIV-Exposed, Uninfected South African Children. J Infect Dis 2020; 220:1529-1538. [PMID: 31282539 DOI: 10.1093/infdis/jiz348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/04/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Measles morbidity and mortality rates are greatest in children <12 months old, with increased susceptibility in human immunodeficiency virus (HIV)-exposed children. We evaluated the immunogenicity and safety of an early 2-dose measles vaccine regimen administered at 6 and 12 months of age in South Africa. METHODS HIV-unexposed (HU) (n = 212) and HIV-exposed, uninfected (HEU) (n = 71) children received measles vaccination (CAM-70) at 6 and 12 months of age. Measles immunoglobulin G titers were measured by means of enzyme-linked immunosorbent assay before and 1 month after each vaccine dose. RESULTS The majority of children (88.2% HU and 95.8% HEU; P = .04) were seronegative (<150 mIU/mL) to measles at 4.2 months of age. This was particularly evident among infants of mothers born from 1992 onwards (year of public nationwide measles vaccine availability). One month after the first measles vaccine, 42.3% of HU and 46.4% of HEU children were seropositive (≥330 mIU/mL). After the second dose, the proportion seropositive increased to 99.0% in HU and 95.3% in HEU children. Safety profiles were similar between HU and HEU children. CONCLUSIONS Early 2-dose measles vaccination at 6 and 12 months of age was safe and induced antibody responses in HU and HEU children, which could partly offset the early loss of maternally derived antibodies in infants born to predominantly measles-vaccinated mothers. CLINICAL TRIALS REGISTRATION NCT03330171.
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Affiliation(s)
- Eleonora A M L Mutsaerts
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marta C Nunes
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sutika Bhikha
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Benit T Ikulinda
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Welekazi Boyce
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Jose
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anthonet Koen
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Moultrie
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare L Cutland
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diederick E Grobbee
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Zambon A, Morgan A, Vereecken C, Colombini S, Boyce W, Mazur J, Lemma P, Cavallo F. The contribution of club participation to adolescent health: evidence from six countries. J Epidemiol Community Health 2011; 64:89-95. [PMID: 20007634 DOI: 10.1136/jech.2009.088443] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Social networks have been recognised as an important factor for enhancing the health of people and communities. Bridging social capital, characterised by numerous and varied weak ties, exemplifies a particular type of network that can help people reach their goals and improve their health. This study seeks to contribute to the evidence base on the use of positive social networks for young people's health by exploring the importance of club participation in predicting the health and health-related behaviours of 15-year-old girls and boys across Europe and North America. METHODS Data are derived from a 2005-6 World Health Organization collaborative study, to establish the relationships between different types of club and a range of health outcomes (self-perceived health, wellbeing and symptoms) and health-related behaviours (smoking, drinking). Multi-level logistic regression was used to assess the independent effects of club participation by controlling for gender and socioeconomic position. Data were compared across six countries. RESULTS All the considered outcomes, both in terms of perceived health and wellbeing and health behaviours were associated with participation in formal associations. The associations are in the expected direction (participation corresponding to better health) except for some particular association types. CONCLUSIONS Participation in formal associations seems supportive for good health and health behaviours in adolescence, and should be promoted in this age group.
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Affiliation(s)
- A Zambon
- University of Turin, Dept. of Public Health, Via Santena, 5bis - I-10126 Turin, Italy.
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Due P, Damsgaard MT, Rasmussen M, Holstein BE, Wardle J, Merlo J, Currie C, Ahluwalia N, Sørensen TIA, Lynch J, Borraccino A, Borup I, Boyce W, Elgar F, Gabhainn SN, Krølner R, Svastisalee C, Matos MC, Nansel T, Al Sabbah H, Vereecken C, Valimaa R. Socioeconomic position, macroeconomic environment and overweight among adolescents in 35 countries. Int J Obes (Lond) 2009; 33:1084-93. [PMID: 19621018 DOI: 10.1038/ijo.2009.128] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE It is important to understand levels and social inequalities in childhood overweight within and between countries. This study examined prevalence and social inequality in adolescent overweight in 35 countries, and associations with macroeconomic factors. DESIGN International cross-sectional survey in national samples of schools. SUBJECTS A total of 11-, 13- and 15-year-olds from 35 countries in Europe and North America in 2001-2002 (N=162 305). MEASUREMENTS The main outcome measure was overweight based on self-reported height and weight (body mass index cut-points corresponding to body mass index of 25 kg/m(2) at the age of 18 years). Measures included family and school affluence (within countries), and average country income and economic inequality (between countries). RESULTS There were large variations in adolescent overweight, from 3.5% in Lithuanian girls to 31.7% in boys from Malta. Prevalence of overweight was higher among children from less affluent families in 21 of 24 Western and 5 of 10 Central European countries. However, children from more affluent families were at higher risk of overweight in Croatia, Estonia and Latvia. In Poland, Lithuania, Macedonia and Finland, girls from less affluent families were more overweight whereas the opposite was found for boys. Average country income was associated with prevalence and inequality in overweight when considering all countries together. However, economic inequality as measured by the Gini coefficient was differentially associated with prevalence and socioeconomic inequality in overweight among the 23-high income and 10-middle income countries, with a positive relationship among the high income countries and a negative association among the middle income countries. CONCLUSION The direction and magnitude of social inequality in adolescent overweight shows large international variation, with negative social gradients in most countries, but positive social gradients, especially for boys, in some Central European countries. Macroeconomic factors are associated with the heterogeneity in prevalence and social inequality of adolescent overweight.
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Affiliation(s)
- P Due
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Hublet A, De Bacquer D, Boyce W, Godeau E, Schmid H, Vereecken C, De Baets F, Maes L. Smoking in young people with asthma. J Public Health (Oxf) 2007; 29:343-9. [PMID: 17675644 DOI: 10.1093/pubmed/fdm047] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Modern guidelines for the management of asthma state that asthmatic patients should be strongly advised not to smoke. However, it remains unclear to what extend young people with asthma actually behave like this. This study compares the prevalence of daily smoking between 15-year adolescents with diagnosed asthma and without asthma, and evaluates to what extent risk factors for smoking play a comparable role in the smoking behaviour of these two groups. METHODS The study is part of the 2001-2002 international HBSC study. Besides questions about health behaviour, individual and social resources, a set of asthma questions were included in six countries. RESULTS Adolescents with diagnosed asthma are more likely to be daily smokers than non-asthmatic adolescents. In asthmatic and non-asthmatic adolescents, similar associations with risk factors are found for daily smoking (drunkenness, cannabis use, low life satisfaction, spending evenings with friends, having smoking parents and peers). Diagnosed asthmatics are more prone to score high on these factors than non-asthmatics. CONCLUSIONS Smoking in adolescents with asthma is a public health problem. Smoking prevention efforts directed towards young people should pay attention to young people with asthma and the curative sector should increase their efforts to motivate asthmatic adolescents not to smoke.
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Affiliation(s)
- A Hublet
- Department of Public Health, Ghent University, 9000 Ghent, Belgium.
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Giacaman R, Abu-Rmeileh N, Husseini A, Saab H, Boyce W. Response to commentary. Public Health 2007. [DOI: 10.1016/j.puhe.2006.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hublet A, Andersen A, Godeau E, Vereecken C, Välimaa R, Tynjälä J, Boyce W, Maes L. Asthma and wheezing symptoms in young people in six Western countries. Rev Epidemiol Sante Publique 2006; 54:305-12. [PMID: 17088695 DOI: 10.1016/s0398-7620(06)76726-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Asthma diagnosed in children shows wide geographical variations. Large scale surveys identify children with diagnosed asthma, but neglect the group of youngsters with multiple asthmatic complaints. METHODS A short validated asthma questionnaire was included in six national surveys of the Health Behaviour in School-Aged Children Study. Prevalence rates are presented by country, gender and age. Gender and age differences are analysed using binary and multinomial logistic regressions controlling for age and smoking. RESULTS Large country differences are observed in the prevalence rates of diagnosed asthma (8.6%-20.9% in boys, 6.9%-18.5% in girls) and young people with "asthma-like symptoms" (9.6%-20.2% in boys, 9.2%-23.1% in girls). When controlling for age and smoking, significant gender differences are observed (more diagnosed asthma in boys, more asthmatic symptoms in girls). Age differences were observed in adolescents with "asthma-like symptoms", but not in diagnosed asthma. CONCLUSIONS Using a short asthma questionnaire, large differences in diagnosed asthma and wheezing symptoms are observed between the countries. A considerable group of youngsters with "asthma-like symptoms" is detected in all countries, and may be an unrecognised risk group in health promotion.
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Affiliation(s)
- A Hublet
- Department of Public Health, Ghent University, University Hospital-bloc A-2nd floor, De Pintelaan 185, 9000 Ghent, Belgium.
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Abstract
PURPOSE The purpose of this paper is to offer a descriptive framework to analyse the participation of people with disabilities in policy advocacy over the past 20 years. METHODS The study used a qualitative research design to describe and analyse organizations participating in policy advocacy on behalf of people with disabilities in Canada between 1981 and the present. Data for the study were assembled through interviews with key informants who had participated in three policy cases: the Charter of Rights and Freedoms, 1982 (federal); the Canada Clause of the Charlottetown Accord, 1991 (federal); the Ontario Consent to Treatment, Advocacy and Substitute Decision-making bills, 1993-1995 (provincial). For each of the three cases, key informants were identified who could report with authority on the participation of individuals or groups representing people with disabilities. Interviews with key informants were conducted by the investigators, transcribed and coded to produce five dimensions along which advocates described their organizations. RESULTS Three ideological dimensions were identified to describe organizations representing people with disabilities: purpose, tactics, and view of disability. Two practical dimensions were also identified: membership and resources. Each of these dimensions is described in detail with quotes from the interviews to illustrate. DISCUSSION AND CONCLUSIONS These five dimensions result in a descriptive framework for discussion and comparison of organizational characteristics of advocacy organizations representing people with disabilities. Further, the framework affords a vehicle for discussion of the relative success of policy participation on issues affecting the lives of people with disabilities.
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Affiliation(s)
- M A McColl
- Queen's University, Kingston, ON, Canada K7L-3N6.
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Bloomston M, Boyce W, Mamel J, Albrink M, Murr M, Durkin A, Rosemurgy A. Videoscopic Heller myotomy for achalasia--results beyond short-term follow-up. J Surg Res 2000; 92:150-6. [PMID: 10896815 DOI: 10.1006/jsre.2000.5886] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Heller myotomy has long been utilized for patients failing nonoperative management of achalasia. Videoscopy has been advocated to decrease the morbidity of Heller myotomy; however, few reports document outcome beyond 1 year after videoscopic Heller myotomy. PURPOSE To determine perioperative morbidity, relief of dysphagia, and the incidence of postoperative reflux symptoms following videoscopic Heller myotomy with follow-up to over 4 years. METHODS Patients with achalasia documented by barium esophogram and esophageal manometry underwent videoscopic Heller myotomy beginning in 1992. Intraoperative peroral endoscopy was utilized to guide the cephalad and caudad extent of myotomy. A barium esophogram was undertaken in the immediate postoperative period to evaluate for subclinical leak and assess esophageal emptying. RESULTS Seventy-eight patients underwent videoscopic Heller myotomy. The mean age was 51 years +/- 19 (range 14 to 91). Most (62%) patients had undergone pneumatic dilation prior to surgical consultation and 54% had previous botox injections. All patients complained of dysphagia and 40% had symptoms of heartburn prior to myotomy. After myotomy, 91% of patients stated that their swallowing was improved with myotomy. Thirteen patients (18%) experience heartburn more than once per week after myotomy. The average length of stay was 2 +/- 2 days, with 72% of patients spending 2 days or fewer in the hospital. Six (7.7%) major complications occurred: five esophageal perforations and one enterotomy without long-term sequellae. Three procedures (3.8%) were converted to "open" procedures. No deaths occurred. We conclude that videoscopic Heller myotomy is safe and efficacious, with low morbidity and mortality. Videoscopic myotomy provides relief beyond the short term for dysphagia due to achalasia with minimal reflux symptoms. We advocate videoscopic Heller myotomy in the treatment of severe dysphagia due to achalasia not adequately palliated by or amenable to nonoperative management.
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Affiliation(s)
- M Bloomston
- Department of Surgery, University of South Florida College of Medicine, Tampa, Florida, 33601, USA
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Abstract
Two bighorn sheep (Ovis canadensis) in New Mexico (USA) were found to be naturally infected with Elaeophora schneideri. An adult ram examined in 1997 in the Fra Cristobal Mountains had 26 nematodes in the carotid and iliac arteries, and microfilariae were present in the skin, nasal mucosa, brain, and lungs. This ram was markedly debilitated prior to euthanasia and extensive crusty, scabby lesions were observed on its head. In 1998, a yearling ewe found dead adjacent to Watson Mountain near the Gila Wilderness area was found to have 13 nematodes present in its heart. This is the first report of E. schneideri in bighorn sheep, and we suggest that bighorn sheep are susceptible to E. schneideri infection wherever they coexist with mule deer (Odocoileus hemionus hemionus) and appropriate tabanid vectors.
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Affiliation(s)
- W Boyce
- Department of Pathology, Microbiology, and Immunology, University of California, Davis 95616, USA.
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Abstract
This study explored the attitudes of south Indian Community Based Rehabilitation (CBR) workers towards people with disabilities. The research presents a demographic profile of the CBR worker, provides a measure of their attitudes towards people with disabilities, and investigates the factors that influence the formation of these attitudes, in particular the role of CBR education programmes. A questionnaire and an attitude measurement instrument, specifically developed for the Indian context, provided descriptive data. Interviews provided background information on south Indian culture and CBR educational programmes. Analysis of the data revealed that CBR workers in south India tend to be young, female and lacking in work experience. They have positive attitudes towards people with disabilities, which are influenced by their amount of education. CBR educational programmes appeared to have little effect on workers' attitudes, perhaps reflecting a lack of educational strategies directed specifically at attitude development.
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Affiliation(s)
- J Paterson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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13
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Abstract
One of the strategies which non-government organizations (NGOs) involved in Community Based Rehabilitation (CBR) use to develop their organizations and maximize their impact is through collaboration with other partners. A survey conducted by the International Centre for the Advancement of CBR identified collaboration styles, concerns, opportunities, and barriers among NGOs working in disability. Discussion focuses on differences between collaboration in industrialized and less developed countries; on resource dependency; and on structural characteristics of organizations that influence their interactions. The limited public concern for disability issues is viewed as a principal reason for the broad collaboration patterns which are seen in this field.
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Affiliation(s)
- W Boyce
- International Centre for the Advancement of Community Based Rehabilitation (ICACBR), Queen's University, Kingston, Ontario, Canada
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14
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Abstract
Scaling-up is the expansion or development of organizational activities to achieve a greater impact. Scaling-up among non-government organizations (NGOs) involved in community based rehabilitation (CBR) is a recent phenomenon. Case study materials from NGOs in India, Canada, and Indonesia are used to illustrate four pathways to scaling-up in CBR and the use of collaboration strategies in these efforts. Discussion focuses on differences between scaling-up in industrialized and less developed countries and on structural characteristics of organizations which influence their pathways.
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Affiliation(s)
- W Boyce
- School of Rehabilitation Therapy, ICACBR, Queen's University, Kingston, Ontario, Canada
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15
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Abstract
The Hospital and Rehabilitation Centre for Disabled Children (HRDC) in Nepal identified the need to evaluate their in-hospital and community programmes. An instrument was developed to provide information regarding the functional level of the children treated by the HRDC as well as to provide information regarding care-givers' attitudes towards disability. Inter-rater reliability of the measure was tested in three regions of Nepal with 49 children. Six HRDC field workers travelled in pairs to the childrens' homes and alternated in roles as test administrator and observer. Correlations between the scores documented by the administrator and observer were used to estimate inter-rater reliability. Inter-rater reliability coefficients, calculated using a weighted kappa statistic, varied from 0.60 to 1.0. We conclude that the instrument demonstrated an acceptable level of inter-rater reliability in the field setting. Future studies to measure construct and concurrent validity, test-retest reliability and responsiveness of the instrument are recommended as well as testing the instrument in different cultures.
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Affiliation(s)
- C Beach
- Nanyang Polytechnic School of Health Sciences, Singapore
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16
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Goff W, Stiller D, Jessup D, Msolla P, Boyce W, Foreyt W. Characterization of an Anaplasma ovis isolate from desert bighorn sheep in southern California. J Wildl Dis 1993; 29:540-6. [PMID: 8258851 DOI: 10.7589/0090-3558-29.4.540] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To understand the role of bighorn sheep (Ovis canadensis) in the epidemiology of anaplasmosis, we recovered a field isolate from a suspected enzootic area in southern California (USA). Whole blood was collected from three desert bighorn sheep (Ovis canadensis nelsoni) and inoculated into a susceptible splenectomized domestic sheep, calf and a susceptible spleen-intact bighorn sheep. No infection occurred in the calf, but a detectable infection developed in both the domestic sheep and bighorn sheep 24 days after inoculation. The infection in both domestic and bighorn sheep resulted in severe clinical disease but was resolved with the use of tetracycline. Using monoclonal antibodies and DNA probes, we confirmed that the isolate was Anaplasma ovis.
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Affiliation(s)
- W Goff
- Animal Disease Research Unit, United States Department of Agriculture, Pullman, Washington 99164
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17
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Boyce W, Kjemtrup A. Wildlife health and the urban-wildlife interface. J Am Vet Med Assoc 1993; 202:1082-4. [PMID: 8473218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- W Boyce
- Department of Veterinary Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis 95616
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18
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Abstract
Critical care medicine programs must provide outpatient experience for their fellowship trainees. We have developed an unusual follow-up plan allowing critical care fellows to contact their patients months after their intensive care unit stay. We evaluated responses of 46 patients after a mean interval of 8.6 months since their initial intensive care unit stay. Patients were stratified by severity of disease by using the APACHE scoring system. Diagnostically, the patients represented the typical medical-surgical intensive care unit population. Patients were asked 11 questions concerning their health and socio-emotional status as it related to their hospitalization and intensive care unit stay. Our results established a practical method of providing outpatient follow-up that may fulfill residency review requirements for critical care fellowships, confirmed previously speculative ideas about ICU experiences, and suggested future research opportunities to study intensive care unit patients following discharge.
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19
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Friedman BC, Boyce W, Bekes CE. Long-term follow-up of ICU patients. Am J Crit Care 1992; 1:115-7. [PMID: 1339174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Critical care medicine programs must provide outpatient experience for their fellowship trainees. We have developed an unusual follow-up plan allowing critical care fellows to contact their patients months after their intensive care unit stay. We evaluated responses of 46 patients after a mean interval of 8.6 months since their initial intensive care unit stay. Patients were stratified by severity of disease by using the APACHE scoring system. Diagnostically, the patients represented the typical medical-surgical intensive care unit population. Patients were asked 11 questions concerning their health and socio-emotional status as it related to their hospitalization and intensive care unit stay. Our results established a practical method of providing outpatient follow-up that may fulfill residency review requirements for critical care fellowships, confirmed previously speculative ideas about ICU experiences, and suggested future research opportunities to study intensive care unit patients following discharge.
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Affiliation(s)
- B C Friedman
- Cooper Hospital/University Medical Center (CHUMC), Camden, NJ 08103
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20
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Boyce W, Gowland C, Rosenbaum P, Lane M, Plews N, Goldsmith C, Russell D, Wright V, Zdrobov S, Harding D. Gross motor performance measure for children with cerebral palsy: study design and preliminary findings. Can J Public Health 1992; 83 Suppl 2:S34-40. [PMID: 1468047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This project investigated the validity, reliability and responsiveness of the Gross Motor Performance Measure (GMPM). The GMPM was developed as an observational instrument to measure changes in quality of movement in children with cerebral palsy. Physical therapists from 3 children's treatment centres assessed 107 children with CP, 18 children with head injury and 33 non-disabled children. Assessments were conducted on 2 occasions, 4 to 6 months apart. The measurement protocol included assessment with the GMPM and the Gross Motor Function Measure (GMFM). Validity was tested by comparing changes in GMPM scores to parent and therapist independent ratings of the children's motor performance. Also, a sample (n = 30) of paired assessments was videotaped for 'masked' evaluation by therapists. Inter-rater, intra-rater and test-retest reliability studies (n = 30) were conducted. Responsiveness to change was determined through parent and therapist ratings of the importance of observed changes in quality of movement. Data collection for this study has just been completed. Validation hypotheses have been postulated regarding correlations between changes in GMPM scores; GMFM scores; age of children; diagnosis; severity of condition; parent, therapist and 'masked' evaluator judgement of change. Correlation analysis, t-test and analysis of variance results will be presented. Reliability data for the GMPM and parent/therapist rating scales will be presented using intra-class correlation coefficients. Data supporting responsiveness of the GMPM will be presented using an analysis of variance model for 'stable' and 'responsive' groups.
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Affiliation(s)
- W Boyce
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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21
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Boyce W, Yuill T, Homan J, Jessup D. A role for veterinarians in wildlife health and conservation biology. J Am Vet Med Assoc 1992; 200:435-7. [PMID: 1559884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- W Boyce
- Department of Veterinary Microbiology, School of Veterinary Medicine, University of California, Davis 95616
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22
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Foreyt W, Rickard LG, Boyce W. Psoroptes sp. in two llamas (Lama glama) in Washington. J Parasitol 1992; 78:153-5. [PMID: 1738060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Psoroptes sp. mites were isolated from two llamas (Lama glama), a 4-mo-old male and its dam, in Washington. Mites were restricted to the ears and were responsible for head-shaking and incoordination. Infestations were treated successfully with a subcutaneous injection of ivermectin at 0.2 mg/kg of body weight and with 2 drops of ivermectin diluted in saline given topically in each ear. This is the first known report of Psoroptes sp. in llamas in the United States.
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Affiliation(s)
- W Foreyt
- Department of Veterinary Microbiology and Pathology, Washington State University, Pullman 99164
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23
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Boyce W, Allen J, Himmelwright C, Elliott L, Mikolon A, Mazet J, Gardner I. Implementation and evaluation of a strategic parasite control program for captive exotic ungulates. J Am Vet Med Assoc 1991; 198:1972-6. [PMID: 1874679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A parasite control program was designed for greater than 1,200 exotic ungulates maintained in mixed-species enclosures at the San Diego Wild Animal Park. Three strategically-timed anthelmintic treatments were given during 1988-1989, and their success was evaluated by monitoring pretreatment and posttreatment fecal egg counts. Adequate parasite control was achieved for animals in 52 ungulate species, as evidenced by low pretreatment egg counts and the absence of egg-shedding after treatment. However, animals belonging to 11 species in the subfamilies Antilopinae, Hippotraginae, and Caprinae were identified as important targets for more intensive control efforts because they shed either greater than 100 eggs/g of feces before treatment, or greater than 0 eggs/g after treatment, at 2 or more sampling periods. These results and observations were used to generate management recommendations and illustrate how a model parasite control program can be developed for collections of exotic ungulates.
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Affiliation(s)
- W Boyce
- Department of Veterinary Microbiology & Immunology, School of Veterinary Medicine, University of California, Davis 95616
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24
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Boyce W, Elliott L, Clark R, Jessup D. Morphometric analysis of Psoroptes spp. mites from bighorn sheep, mule deer, cattle, and rabbits. J Parasitol 1990; 76:823-8. [PMID: 2254816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A morphometric study of Psoroptes spp. mites was conducted to address difficulties encountered in species identification and to provide insights into the phylogenetic relationships between mites found on different hosts. A discriminant analysis employing 9 morphologic characters revealed that the lengths of the outer opisthosomal setae and the lateral margins of the opisthosomal knobs were the 2 most important characters for grouping mites according to host species. This analysis clearly separated mites collected from allopatric populations of bighorn sheep, rabbits, and cattle into discrete groups. However, differences were not detected between mites collected from sympatric populations of infested mule deer and bighorn sheep, suggesting that these mites were not host specific and represented a single interbreeding population. Differences also were not detected among mites collected from the ears and body of bighorn sheep and rabbits, demonstrating that the location of mites on a given host should not be used as a primary criterion in species identification.
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Affiliation(s)
- W Boyce
- Department of Veterinary Microbiology and Immunology, University of California, Davis 95616
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25
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Allen JL, Kollias GV, Greiner EC, Boyce W. Subcutaneous filariasis (Pelecitus sp.) in a yellow-collared macaw (Ara auricollis). Avian Dis 1985; 29:891-4. [PMID: 3840995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Clinical manifestations of subcutaneous filariasis in a yellow-collared macaw (Ara auricollis) included lameness induced by subcutaneous nodule formation, which was attributed to the presence of the filarial parasite Pelecitus sp. Following anthelmintic and corticosteroid therapeutic failure, the problem was resolved by surgically removing the adult worms.
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26
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Allen JL, Kollias GV, Greiner EC, Boyce W. Subcutaneous Filariasis (Pelecitus sp.) in a Yellow-Collared Macaw (Ara auricollis). Avian Dis 1985. [DOI: 10.2307/1590686] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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27
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Boyce W, Cardeilhac P, Lane T, Buergelt C, King M. Sebekiosis in captive alligator hatchlings. J Am Vet Med Assoc 1984; 185:1419-20. [PMID: 6548997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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28
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Boyce W, Kollias G, Courtney CH, Allen J, Chalmers E. Efficacy of ivermectin against gastrointestinal nematodes in dromedary camels. J Am Vet Med Assoc 1984; 185:1307-8. [PMID: 6548996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
The anthelmintic activity of ivermectin when administered orally and subcutaneously at a dosage of 0.2 mg/kg of body weight was evaluated in 4 trials involving 20 dromedary camels (Camelus dromedarius). Fecal egg counts were made on the day of treatment and at 2, 4, and 10 weeks after treatment. Trichostrongylid egg counts were reduced by a maximum of 100% when ivermectin was administered orally and by greater than 88% when given subcutaneously. Egg counts of Trichuris spp were reduced by greater than 85% with oral administration, but increased following subcutaneous treatment. No adverse local or systemic reactions were observed following treatment with ivermectin by either route.
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29
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Abstract
Clinical and pathological features of 135 tubular carcinomas are discussed. Tumor size varied from 0.2 to 2.5 cm with a mean diameter of 0.9 cm. In situ carcinoma was found associated with tubular cancer in 86 cases (63.6%). In 82 of 86 (95.3%) it was of micropapillary/cribriform intraductal type. Twelve of 109 patients in whom axillary dissection was performed were found to have axillary metastases. Six patients (4%) developed recurrent or disseminated metastatic carcinoma during a mean follow-up period of 7.2 years. Two of these patients are dead of disease. Tubular carcinoma should be distinguished from microglandular adenosis, an uncommon form of sclerosing adenosis.
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30
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Harrison L, Cass A, Cox C, Boyce W. Role of bladder infection in the etiology of vesicoureteral reflux in dogs. Invest Urol 1974; 12:123-4. [PMID: 4854158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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31
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Schallhorn RG, Hiatt WH, Boyce W. [Transplantation of the iliac crest in periodontal therapy]. Mondo Odontostomatol 1974; 16:159-67. [PMID: 4530895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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32
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Boyce W, Witzleben CL. Bilirubin as a cholestatic agent. II. Effect of variable doses of bilirubin on the severity of manganese-bilirubin cholestasis. Am J Pathol 1973; 72:427-32. [PMID: 4728892 PMCID: PMC1904029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
These experiments demonstrate that the cholestasis following manganese-bilirubin administration varies directly in severity in relation to the amount of bilirubin administered. This suggests that the cholestasis is related to critical bilirubin accumulation in some compartment of the biliary excretory pathway. However, in the immediate precholestatic period, the levels of bilirubin in all three compartments of blood, liver and bile also vary in direct relation to the amount of bilirubin administered. The critical site of bilirubin accumulation or concentration is not, therefore, defined by these experiments.
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33
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34
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35
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Boyce W, Bishop D. Polaroid endophotography. Gastrointest Endosc 1968; 14:186-9. [PMID: 5650026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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