Who pays for measles? The economic arguments for sustained immunization

Increasing international commitment to Universal Child Immunization(UCI) intensifies pressures on already scarce health resources.The costs of the 1989/90 measles epidemic were measured in theState of Guerrero, Mexico, from the perspective of the healthservices and 43 representative communities. Financial loss wasincurred from illness in families of 70% of the 1211 measlescases in a study population of 50294. Some 30% of these familiesdid not have sufficient cash reserves and sold labour, farmanimals or other assets. Among those families, 20% took loansin order to pay the health care costs of their children's measles,19% sold grain stores and 4% indentured their future labour. Standardizing household expenditure on local labour costs, itwas possible to quantify out-of-pocket expenditure and lossof work time. The average cost of a measles case to the communityamounted to the local equivalent of 18.8 work days of an unskilledlabourer, with 27 work days per household affected, excludingincome foregone due to early deaths. Hastings and colleaguescalculated the average cost of measles to British families in1985 to be UK£11.09, considerably less than a day's wagefor a British unskilled labourer at that time. Applying thecosts in the 43 communities to the whole State of Guerrero,without placing a cash value on some 4000 children aged underfive who died from measles, the epidemic cost the communitythe equivalent of 1.6 million work days. The health servicesspent 10% of this value on the epidemic. The cost of vaccinatingall children in the State could be sustained for five years,and increase by 10% per year, and it would still be lower thanthe economic cost of an epidemic to the communities.     

Hyperhomocysteinaemia—a common finding in a psychogeriatric population

Abstract. Plasma homocysteine concentration is a sensitive marker for cobalamin and folate deficiency. The previously reported high incidence of increased plasma homocysteine in psychogeriatric patients and the association between reduced concentrations of cobalamin, folate and neuropsychiatric symptoms led to the present study on 741 consecutive psychogeriatric patients. The concentrations of plasma homocysteine correlated significantly with blood folate, serum cobalamin and serum creatinine both in demented ( n = 295) and in non-demented patients with other psychiatric disorders ( n = 215). Plasma homocysteine concentrations were significantly increased in both the demented and the non-demented patients, whereas only the demented patients had lower blood folate and serum creatinine concentrations than 163 control subjects. Almost all of the different diagnostic groups of demented and non-demented patients exhibited significantly increased plasma homocysteine concentrations compared with control subjects. Significantly decreased blood folate concentrations were mainly found in the different diagnosis groups of demented patients. Plasma homocysteine concentrations in both demented and non-demented patients with serum cobalamin and blood folate above the lower 20th percentile of these vitamins in the control subjects were also studied. Despite these vitamin concentrations, both groups of patients still exhibited significantly higher plasma homocysteine concentrations than the control subjects, which may indicate an increased frequency of impaired genetic capacity to metabolize homocysteine in these patients. Patients with either dementia of vascular cause or a history of other occlusive arterial disease had a significantly higher plasma homocysteine concentration than those without a history of vascular disease.     

Long-term Survival in Giant Cell Arteritis Including Temporal Arteritis and Polymyalgia Rheumatica

ABSTRACT Ninety patients with giant cell arteritis (GCA) were followed for 9–16 years after diagnosis. Corticosteroids were given to all but one patient. Forty-two patients died during the observation period (27 women and 15 men). The survival was compared with that in the general population and found not to be reduced among the GCA patients. In fact, we found a lower mortality than expected after five years from diagnosis (p<0.05). We did not see any increase in deaths due to vascular or malignant diseases in our patients.