A Model to Estimate the Effect of International Traffic on Malaria Cases: The Case of Japan from 1999 to 2021

Aiming to identify the potentially reduced malaria cases by stagnation of international traffic after the COVID-19 pandemic, a longitudinal analysis of malaria cases as well as entries of Japanese and foreigners was conducted using data from 5 April 1999 to 30 September 2021 in Japan. Multivariable risk ratios were calculated with the Poison regression model as a predictive model of malaria cases by the number of entries for Japanese and foreigners. A generalized regression model was used to examine an association of time trend with entries for Japanese and foreigners using data before 2019, to estimate the potentially reduced number of entries after 2020. The potentially reduced number of malaria cases was estimated by the potentially reduced number of entries for Japanese and foreigners after 2020 using a multivariable Poison regression model. The multivariable risk ratio (95% confidence intervals) of malaria case numbers per 100,000 persons increment of entries per day was 3.41 (1.50–7.77) for Japanese and 1.47 (0.92–2.35) for foreigners. During 2020, a potential reduction of 28 (95% confidence limit: 22–34) malaria cases was estimated, which accounted for 58% (52–63%) of malaria cases in Japan. These finding suggest that the stagnation of international traffic during the COVID-19 pandemic reduced the number of malaria cases in Japan. This model may be helpful for countries without indigenous malaria to predict future trends of imported malaria cases.

Supportive treatment of vascular dysfunction in pediatric subjects with obesity: the OBELIX study

Introduction Overweight or obese children develop abnormal endothelial cell dysfunction and arterial intima–media thickening with increased vasomotor tone and inflammation. Curcumin, resveratrol, zinc, magnesium, selenium, and vitamin D have shown beneficial effects on endothelial function. We test, among overweight and obese pediatric subjects, the effects on the endothelium of a combination of curcumin, resveratrol, zinc, magnesium, selenium, and vitamin D. Methods Forty-eight subjects (6–17 years) were randomized into two groups (placebo vs treatment) attended three visits at 0, 3, and 6 months (±15 days). Endothelial function was assessed by means of a post-occlusive release hyperemic (PORH) test for estimation of delta flow (DF) and hyperemic AUC index, and a heat provocation test (HPT) to measure DF HPT (DFHPT). Results Significant DF difference was noted at 6 months in both groups (p < 0.001). Overall time trend was significantly different between baseline, 3 months, and 6 months both in placebo (p < 0.05) and treatment (p < 0.001) groups and their comparison (p < 0.001). No differences were noted in hyperemic AUC index (3 and 6 months), whilst there were significant differences in time trends of rreatment (p < 0.001) and placebo (p < 0.05) groups and their comparison (p < 0.001). DFHPT difference between groups was significant at 3 and 6 months (p < 0.05). The overall time trend was significant exclusively in Treatment group between 3 and 6 months (p < 0.05). Correlation with anthropometrics was found for DF and body mass index (r = 0.677 6 months, p < 0.05), as well as for hyperemic AUC index and males (r = 0.348, p < 0.05), while DFHPT showed no correlation. Conclusion Curcumin, resveratrol, zinc, magnesium, selenium, and vitamin D appear to be promising in enhancing endothelial function by improvement of both DF in the PORH test and DF in the HPT, lowering the risk of developing cardiovascular diseases in overweight and obese pediatric subjects.

Time trends with response-adaptive randomization: The inevitability of inefficiency

Response-adaptive randomization, which changes the randomization ratio as a randomized clinical trial progresses, is inefficient as compared to a fixed 1:1 randomization ratio in terms of increased required sample size. It is also known that response-adaptive randomization leads to biased treatment effects if there are time trends in the accruing outcome data, for example, due to changes in the patient population being accrued, evaluation methods, or concomitant treatments. Response-adaptive-randomization analysis methods that account for potential time trends, such as time-block stratification or re-randomization, can eliminate this bias. However, as shown in this Commentary, these analysis methods cause a large additional inefficiency of response-adaptive randomization, regardless of whether a time trend actually exists.

The probabilities of type I and II error of null of cointegration tests: A Monte Carlo comparison

This paper evaluates the performance of eight tests with null hypothesis of cointegration on basis of probabilities of type I and II errors using Monte Carlo simulations. This study uses a variety of 132 different data generations covering three cases of deterministic part and four sample sizes. The three cases of deterministic part considered are: absence of both intercept and linear time trend, presence of only the intercept and presence of both the intercept and linear time trend. It is found that all of tests have either larger or smaller probabilities of type I error and concluded that tests face either problems of over rejection or under rejection, when asymptotic critical values are used. It is also concluded that use of simulated critical values leads to controlled probability of type I error. So, the use of asymptotic critical values may be avoided, and the use of simulated critical values is highly recommended. It is found and concluded that the simple LM test based on KPSS statistic performs better than rest for all specifications of deterministic part and sample sizes.

Analysis of financial resources for public health in Brazilian capitals: a time trend ecological study

This study aimed to analyze part of the financial resources used to fund public health actions in the 26-Brazilian capitals, from 2008 to 2018. This is a time-trend ecological study involving revenue and expenditure indicators provided by the Information System on Public Budget for Health (SIOPS). The values were deflated based on the Extended National Consumer Price Index of 2018 in Brazil to allow the comparison over the years. The mean annual variation of health investments, in Brazilian Reais (BRL) was assessed using linear regressions. Pearson’s correlation coefficients were estimated between federal revenues and expenditures with the capitals’ resources. All capitals presented statistically significant positive correlations for the origin of the budget resource invested in health. The lowest coefficient was found in the capital city of Macapá (Amapá State) (r = 0.860) and the highest, in Fortaleza (Ceará State) (r = 0.997). Belo Horizonte (Minas Gerais State) was the capital with the highest annual increase in federal transfers (about BRL 67.91 per year) and Teresina (Piauí State) presented the highest annual increase in health expenditures among the capitals (about BRL 55.42 per year). We found a increase in the transfers of the Brazilian Unified National Health System (SUS) and municipal resources in almost all capitals, but there are still inequalities in the distribution of financial resources among Brazilian capitals from different regions. Health funding is affected by the municipalization of SUS and it is not the single factor affecting the access and quality of health services.

Low Levels of Influenza Vaccine Uptake among the Diabetic Population in Spain: A Time Trend Study from 2011 to 2020

(1) Background: In this work, we aim to describe influenza vaccine uptake among the diabetic population in Spain to assess the time trend from 2011 to 2020 and identify predictors of vaccine uptake among diabetes patients. (2) Methods: We conducted a descriptive cross-sectional study using the European Health Interview Survey for Spain (2014 and 2020) and the Spanish National Health Surveys (2011 and 2017). The independent variables analysed included socio-demographic characteristics, health-related variables and lifestyle variables. We matched each participant with diabetes with a non-diabetic participant based on age, sex, place of residence and year of survey. (3) Results: The overall coverage among diabetic adults was 52.1% compared to 40.6% for matched participants without diabetes (p < 0.01). The vaccine uptake among adults with diabetes was 52.6% in 2011, 54.38% in 2014 and 53.4% in 2017. The adjusted OR of having been vaccinated in 2020, with respect to 2011, was not significant at 0.87 (95% CI: 0.72–1.06). Factors such as being male, higher age, being affected by respiratory disease or cancer and being physically active were identified as positive predictors for influenza vaccination uptake, while smoking was a negative predictor. (4) Conclusions: The influenza vaccine uptake is below desirable levels among the adult diabetic population in Spain and has not improved from 2011 to 2020. More efforts should be made to increase influenza vaccine uptake in this high-risk group, especially for women, those aged 18–64 years, without other high-risk conditions and smokers.