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OBJECTIVE: To investigate the impact of the current strategy for the elimination of leprosy on its incidence and to assess the consequences of failure to sustain this strategy. METHODS: Scenarios for assessing the impact of the elimination strategy were implemented in a computer simulation program. The scenarios reflected the assumptions made regarding contagiousness, transmission and bacille Calmette-Guérin (BCG) vaccination. The trend in case detection rate for the main countries in which leprosy was endemic during 1985-98 was fitted, and incidence up to 2020 was projected. FINDINGS: Owing to the gradual shortening of delays in detection up to 1998, and because of the low relapse rate that occurs with multidrug treatment MDT, incidence is predicted to decrease beyond 2000 in all scenarios. The annual decline was a few per cent higher when favourable assumptions were made about protection and coverage of BCG vaccination. Overall, the predicted annual decline in incidences ranged from 2% to 12%. CONCLUSION: The elimination strategy reduces transmission, but the decline may be slow. Relaxation of control after 2005 is unjustified given the uncertainty about the rate of decline and the adverse effects of longer delays in detection. A long-term strategy for leprosy control should be adopted.

Using a sexually transmitted diseases simulation model (STDSIM), we made projections of HIV spread for four profiles of sexual behaviour reflecting patterns encountered across the developing world: 1) much commercial sex, no short relationships; 2) commercial sex, concurrent short relationships; 3) concurrent relationships, no commercial sex; 4) serial short relationships, some commercial sex. We studied the effects of increasing condom use in three target groups: commercial sex workers (CSWs); men engaging in commercial contacts and short relationships; and females in steady relationships. The projections indicated that the CSW and male strategies were more effective in reducing HIV incidence than the strategy focusing on females in steady relationships. In the long run, even the group of men and women with one recent partner were better protected against HIV infection by condom use in high-risk contacts than by condom use in steady relationships. Furthermore, the numbers of HIV cases prevented per condom used were 7 to 500 times higher for condoms used by CSWs or men engaging in short relationships and commercial sex than for ones used by females in steady relationships. The results indicated the merit of focusing on high-risk groups irrespective of the pattern of sexual behaviour, even in epidemics that had already spread throughout populations.

Anaplasma phagocytophilum, Borrelia burgdorferi sensu lato, spotted fever group (SFG) rickettsiae, and Francisella tularensis are the causative agents of human granulocytic anaplasmosis, Lyme disease, spotted fever, and tularemia, respectively. These [...]

Background Traumatic brain injury (TBI) is a leading cause of death and disability. A reliable prediction of outcome on admission is of great clinical relevance. We aimed to develop prognostic models with readily available traditional and novel predictors. Methods and Findings Prospectively collected individual patient data were analyzed from 11 studies. We considered predictors available at admission in logistic regression models to predict mortality and unfavorable outcome according to the Glasgow Outcome Scale at 6 mo after injury. Prognostic models were developed in 8,509 patients with severe or moderate TBI, with cross-validation by omission of each of the 11 studies in turn. External validation was on 6,681 patients from the recent Medical Research Council Corticosteroid Randomisation after Significant Head Injury (MRC CRASH) trial. We found that the strongest predictors of outcome were age, motor score, pupillary reactivity, and CT characteristics, including the presence of traumatic subarachnoid hemorrhage. A prognostic model that combined age, motor score, and pupillary reactivity had an area under the receiver operating characteristic curve (AUC) between 0.66 and 0.84 at cross-validation. This performance could be improved (AUC increased by approximately 0.05) by considering CT characteristics, secondary insults (hypotension and hypoxia), and laboratory parameters (glucose and hemoglobin). External validation confirmed that the discriminative ability of the model was adequate (AUC 0.80). Outcomes were systematically worse than predicted, but less so in 1,588 patients who were from high-income countries in the CRASH trial. Conclusions Prognostic models using baseline characteristics provide adequate discrimination between patients with good and poor 6 mo outcomes after TBI, especially if CT and laboratory findings are considered in addition to traditional predictors. The model predictions may support clinical practice and research, including the design and analysis of randomized controlled trials. The editor's Summary of this article follows the references/, Introduction Traumatic brain injury (TBI) is a leading cause of death and disability. Establishing a reliable prognosis early after injury is notoriously difficult, as is captured in the Hippocratic aphorism, [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2005.04.020 Byline: Adrian V. Hernandez (a), Eric Boersma (b), Gordon D. Murray (c), J. Dik F. Habbema (a), Ewout W. Steyerberg (a) Abstract: Treatment decisions in clinical cardiology are directed by results from randomized clinical trials (RCTs). We studied the appropriateness of the use and interpretation of subgroup analysis in current therapeutic cardiovascular RCTs. Author Affiliation: (a) Center for Clinical Decision Sciences, Department of Public Health, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands (b) Clinical Epidemiology Unit, Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands (c) Division of Community Health Sciences, Public Health Sciences, University of Edinburgh Medical School, Edinburgh, United Kingdom Article History: Received 8 February 2005; Accepted 28 April 2005 Article Note: (miscellaneous) This study was supported by a grant from the Netherlands Organization for Scientific Research (ZON/MW 908-02-117) (The Hague, The Netherlands) (Dr Adrian V. Hernandez).

The relative and absolute contributions of screening mammography and adjuvant treatment to the reduction in breast-cancer mortality in the US from 1975 to 2000 is assessed using modeling techniques. The statistical models reveal that both screening mammography and treatment have helped reduce the rate of death from breast cancer in the US.

The value of a dichotomous diagnostic test is often described in terms of sensitivity, specificity, and likelihood ratios (LRs). Although it is known that these test characteristics vary between subgroups [...]

A modeling study is conducted to explore whether differences between the study populations could explain the magnitude of the differences in observed trial impacts and to predict the effectiveness of each intervention strategy in leach population. The findings support the hypothesis that differences between study populations and not intervention strategy were the main determinants of the contrasting HIV impacts in Rakai, Masaka, and Mwanza.

Incidence rates of pulmonary tuberculosis among immigrants from high incidence countries remain high for at least a decade after immigration into the Netherlands. Possible explanations are reactivation of old infections [...]