Health economics: potential applications in HIV/AIDS control in Africa

There is growing evidence that HIV/ AIDS has enormous negative impact on health status and economic development of individuals, households, communities and nations in the African region. Thus, there is urgent need for various disciplines to demonstrate how they can contribute in curbing the spread of this deadly disease in the African region. This paper, using an extended version of Professor Alan Williams schema as the conceptual framework, attempts to demonstrate how health economics can be used to inform policy and managerial choices related to HIV/AIDS advocacy, prevention, treatment and management. It argues that the discipline of health economics (and economics generally) is extremely valuable in: measuring health impacts of the disease and interventions; evaluating the relationships between health care-seeking behaviour of individuals and health system specific attributes; the estimation of determinants of compliance of HIV/AIDS patients with treatment regimen; establishing of health institutions efficiency in combating AIDS; guiding choices of HIV/AIDS interventions; assessing the relationships between HIV/AIDS, development, poverty, and trade; programme planning, monitoring and evaluation; and assessing health system's overall performance. The paper is a modest attempt to show how the discipline of health economics can elucidate, and help in resolving practical and conceptual issues in HIV/AIDS control in Africa.     

Influence of naloxone infusion on prolactin and growth hormone response to growth hormone-releasing hormone in anorexia nervosa

Anorexia nervosa (AN) is frequently associated with anomalies of growth hormone (GH) and prolactin (PRL) secretion. We studied the GH and PRL responses to GHRH_1–44 (50 μg ) and the effect of a naloxone infusion (1.6 mg/hr), started 1 hr before GHRH administration, on this response in 12 female patients with AN, aged 15–30 yr, and in seven normal women, aged 19–27 yr, during the follicular phase as controls. In AN, GHRH induced an increase in GH levels similar to that observed in normal subjects.

A significant inhibition of the GH response to GHRH was observed during naloxone infusion, similar to the inhibition in normal female subjects during the follicular phase. PRL levels showed a significant increment after GHRH alone and a slight, nonsignificant, PRL increment after GHRH during naloxone infusion in AN patients. In contrast a slight PRL decrease was observed after GHRH, both before and during naloxone infusion, in the normal subjects.

Our study demonstrates that endogenous opioids play a role in influencing PRL secretion in patients with AN different from their role in normal subjects.     

Antibodies against terminal galactosyl α(1–3) galactose epitopes in patients with idiopathic myelofibrosis

Summary Sera from patients with myelofibrosis were analysed for circulating antibodies against an antigenic determinant characterized by two molecules of galactose in α 1–3 linkage (anti-Gal antibodies).
500% of patients were found to have values above the 90th percentile of the values of control sera chosen as a cut-off. The median level of the antibodies was significantly higher than the value detected in normal controls, but no difference coulti be found between patients with idiopathic myelofibrosis and those with myelofibrosis associated to a chronic myeloproliferative disorder.
Anti-Gal antibodies were found to correlate with disease activity and with platelet count whereas no correlation was detected with other haematological parameters.
Furthermore, for evaluation of disease activity, determination of serum anti-Gal antibodies was a sensitive and specific parameter.
We conclude that humoral immunity against Galα1–3Gal may provide a sensitive tool to detect disease activity in patients with idiopathic myelofibrosis and may be important for understanding its pathogenesis.     

Bilateral eye hemorrhage after laparoscopic cholecystectomy

A case of bilateral eye hemorrhage after laparoscopic cholecystectomy, probably caused by an increase in venous blood pressure due to carbon dioxide insufflation, is reported.     

Economic burden of diabetes mellitus in the WHO African region

Background  

Human rights violations have adverse consequences for health. However, to date, there remains little empirical evidence documenting this association, beyond the obvious physical and psychological effects of torture. The primary aim of this study was to investigate whether Australian asylum policies and practices, which arguably violate human rights, are associated with adverse health outcomes.     

Economic burden of diabetes mellitus in the WHO African region

Background  

In 2000, the prevalence of diabetes among the 46 countries of the WHO African Region was estimated at 7.02 million people. Evidence from North America, Europe, Asia, Latin America and the Caribbean indicates that diabetes exerts a heavy health and economic burden on society. Unfortunately, there is a dearth of such evidence in the WHO African Region. The objective of this study was to estimate the economic burden associated with diabetes mellitus in the countries in the African Region.     

Knowing you care: Effects of perceived empathy and attachment style on pain perception

Other people can have a significant impact on one’s pain. Although correlational data abound, causal relationships between one’s pain experience, individual traits of social relating (e.g. attachment style), and social factors (e.g. empathy) have not been investigated. Here, we studied whether the presence of others and ‘perceived empathy’ (defined as participants’ knowledge of the extent to which observers felt they understood and shared their pain) can modulate subjective and autonomic responses to pain; and whether these influences can be explained by individual traits of pain coping and social attachment. Participants received noxious thermal stimuli via a thermode attached to their forearm and were asked to rate their pain. In separate blocks they were witnessed by (a) high-empathic and (b) low-empathic unfamiliar observers, and in a third condition (c) no observer was present (alone condition). We found that the effects of social presence and empathy on pain ratings depended on individual differences in attachment style. Higher scores on attachment anxiety predicted higher pain ratings in the low-empathy than in the high-empathy condition; and higher scores on attachment avoidance predicted lower pain ratings in the alone condition than with social presence. In addition, social presence decreased autonomic responses to pain irrespective of individual personality traits. To our knowledge this is the first time that adult attachment style has been shown to modulate the effects of social presence and ‘perceived empathy’ on experimentally induced pain. The results are discussed in relation to recent cognitive models of pain coping and attachment theory.