Do individuals consider expected income when valuing health states?

OBJECTIVES: The purpose of this study was to empirically explore whether individuals take their expected income into consideration when directly valuing predefined health states. This was intended to help determine how to handle productivity costs due to morbidity in a cost-effectiveness analysis. METHODS: Two hundred students each valued four hypothetical health states by using time trade-off (TTO) and a visual analogue scale (VAS). The students were randomly assigned to two groups. One group was simply asked, without mentioning income, to value the different health states (the non-income group). The other group was explicitly asked to consider their expected income in relation to the health states in their valuations (the income group). RESULTS: For health states that are usually assumed to have a large effect on income, the valuations made by the income group seemed to be lower than the valuations made by the non-income group. Among the students in the non-income group, 96 percent stated that they had not thought about their expected income when they valued the health states. In the income group, 40 percent believed that their expected income had affected their valuations of the health states. CONCLUSION: The results show that, as long as income is not mentioned, most individuals do not seem to consider their expected income when they value health states. This indicates that productivity costs due to morbidity are not captured within individuals' health state valuations. These findings, therefore, suggest that productivity costs due to morbidity should be included as a cost in cost-effectiveness analyses.     

Stability of the screw joints in patients with implant-supported fixed prostheses in edentulous jaws: a 1-year follow-up study

PURPOSE: The purpose of this follow-up study was to evaluate the stability of the screw joint in edentulous patients 1 year after treatment with implant-supported fixed prostheses (Br?nemark system). MATERIALS AND METHODS: A total of 20 patients were included, 10 treated in the maxilla and 10 in the mandible. The fixed prostheses were removed approximately 1 year after insertion, and the stability of the screw joints was evaluated using a rating scale based upon the CDA quality evaluation criteria of dental care. RESULTS: All implant-supported fixed prostheses were recorded as stable before the prosthetic screws (gold screws) were unscrewed. "Unacceptable loosening" was observed in 4% of the prosthetic screws and in 29% of the abutment screws. CONCLUSION: In this study, only a few of the prosthetic screws showed unacceptable loosening after 1 year of function. The clinical relevance of the observed high occurrence of loose abutment screws could be questioned, as all fixed prostheses were initially recorded as stable.     

Implant-supported fixed partial prostheses: a retrospective study

PURPOSE: The purpose of this retrospective study was to present treatment outcome and patient reactions to rehabilitation with implant-supported fixed partial prostheses. MATERIALS AND METHODS: Eighty-three patients were consecutively treated with implant-supported fixed partial prostheses (Br?nemark system) from 1986 to 1995. Seventy-six of these 83 patients were examined (66 maxillary and 31 mandibular prostheses). The mean observation time was 53.9 months. In total, 285 implants were placed. Eleven implants were lost before loading. The first 41 prostheses were removed and the implants examined regarding the criteria for "success" and tightness of the screw joints. Only one implant had lost integration. RESULTS: The survival rate before and after loading was 96%, which included implants placed in augmented bone. All prostheses were stable at the time of examination. In prostheses with cantilevers (98 implants), 12% of the gold screws and 17% of the abutment screws showed a "not acceptable" loosening, compared to none in the prostheses without cantilevers (17 implants). The difference was not statistically significant. The mean marginal bone loss was 0.4 mm for the first year after prosthesis insertion and less than 0.1 mm per year in the following years. The most frequent prosthesis design was one pontic supported by two implants. Prostheses made in gold acrylic and titanium acrylic had more complications and showed a higher need for repair than metal-ceramic restorations. Patients reacted very positively to the esthetic results and comfort with eating, and were overall satisfied with their prostheses. CONCLUSION: Implant-supported fixed partial prostheses seem to have a very good prognosis and are well-accepted by patients.     

Potentiation of naphthoxyloside cytotoxicity on human tumor cells by difluoromethylornithine and spermine-NONOate

Here we demonstrate a synergistic and tumor selective cytotoxic effect by combined treatment with naphthoxylosides, polyamine synthesis inhibitor, and polyamine based nitric oxide (NO) donor, using in vitro human tumor models. We have earlier reported that heparan sulfate priming naphthoxyloside, 2-(6-hydroxynaphthyl)-O-beta-D-xylopyranoside, which inhibits growth of human tumor cells in vitro and in vivo models, undergoes NO dependent cleavage and accumulates in the nuclei of tumor cells. Polyamine depletion using alpha-difluoromethylornithine (DFMO) increases both the number of NO sensitive sites in heparan sulfate and uptake of the polyamine based NO donor, spermineNONOate, thereby enhancing formation of growth-inhibitory NO induced heparan sulfate products with specific cytotoxic effect on tumor cells. We also show that peracetylation of xylosides doubles the antiproliferative effect towards human cancer cells by making these compounds more permeable to the cells.     

Intrahepatic cholestasis of pregnancy: Amelioration of pruritus by UDCA is associated with decreased progesterone disulphates in urine

Intrahepatic cholestasis of pregnancy (ICP) is characterized by pruritus, elevated bile acids, and, specifically, elevated disulphated progesterone metabolites. We aimed to study changes in these parameters during treatment with dexamethasone or ursodeoxycholic acid (UDCA) in 40 out of 130 women included in the Swedish ICP intervention trial (26 randomized to placebo or UDCA, 14 randomized to dexamethasone). Serum bile acid profiles and urinary steroid hormone metabolites were analyzed using isotope-dilution gas chromatography-mass spectrometry and electrospray-mass spectrometry. We found that all patients displayed ICP-typical serum bile acid profiles with >50% cholic acid at baseline but almost 80% UDCA upon treatment with this bile acid. In UDCA-treated patients, relative amounts of disulphated progesterone metabolites in urine decreased by 34%, 48% (P < 0.05), and 55% (P < 0.05) after 1, 2, and 3 weeks of treatment, respectively, which was significantly correlated to improvements of pruritus scores but not to serum bile acid levels. In contrast, in patients randomized to dexamethasone or placebo, no changes in steroid metabolites or pruritus scores were observed. Conclusion: UDCA treatment in ICP decreased urinary excretion of disulphated progesterone metabolites, suggesting that amelioration of pruritus is connected to stimulation of hepatobiliary excretion of progesterone disulphates.     

Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid

Intrahepatic cholestasis of pregnancy (ICP) is characterized by troublesome maternal pruritus, elevated serum bile acids (> or =10 micromol/L) and increased fetal risk. Recently we determined a cutoff level of serum bile acids, > or =40 micromol/L, to be associated with impaired fetal outcome. We have now studied the effects of ursodeoxycholic acid (UDCA) and dexamethasone on pruritus, biochemical markers of cholestasis, and fetal complication rates in a double-blind, placebo-controlled trial. For this purpose, 130 women with ICP were randomly allocated to UDCA (1 g/day for three weeks), or dexamethasone (12 mg/day for 1 week and placebo during weeks 2 and 3), or placebo for 3 weeks. Pruritus and biochemical markers of cholestasis were analyzed at inclusion and after 3 weeks of treatment. Fetal complications (spontaneous preterm delivery; asphyxial events; and meconium staining of amniotic fluid, placenta, and membranes) were registered at delivery. An intention-to-treat analysis showed significant reduction of alanine aminotransferase (ALT) (P = .01) and bilirubin (P = .002) in the UDCA group only. In a subgroup analysis of ICP women with serum bile acids > or =40 micromol/L at inclusion (n = 34), UDCA had significant effects on pruritus (-75%), bile acids (-79%), ALT (-80%), and bilirubin (-50%) as well, but not on fetal complication rates. Dexamethasone yielded no alleviation of pruritus or reduction of ALT and was less effective than UDCA at reducing bile acids and bilirubin. In conclusion, 3 weeks of UDCA treatment improved some biochemical markers of ICP irrespective of disease severity, whereas significant relief from pruritus and marked reduction of serum bile acids were only found in patients with severe ICP.     

Influence of iron and zinc status on cadmium accumulation in Bangladeshi women

Cadmium is a widespread environmental contaminant present in food. The absorption in the intestine increases in individuals with low iron stores, but the effect of zinc deficiency is not clear. The aim of the present study was to assess the influence of iron and zinc status on cadmium accumulation in pregnant Bangladeshi women. We measured cadmium in urine from 890 women using inductively coupled plasma mass spectrometry (ICPMS). Further, we also measured ferritin and zinc in plasma. The median cadmium concentration in urine was 0.59 microg/L (adjusted to mean specific gravity of 1.012 g/mL). Analysis of covariance (ANCOVA) showed that urinary cadmium was associated with plasma ferritin and plasma zinc via a significant interaction between dichotomized plasma ferritin and plasma zinc. The analysis was adjusted for age and socioeconomic status. Women with low iron stores and adequate zinc status had significantly higher urinary cadmium compared to women with both adequate iron stores and zinc status. There was no difference in urinary cadmium between women with both low iron stores and zinc status compared to those with both adequate iron stores and zinc status. In conclusion, low iron stores were associated with increased cadmium accumulation, but only at adequate zinc status.     

Arsenic Exposure During Pregnancy and Size at Birth: A Prospective Cohort Study in Bangladesh

The authors evaluated the association of prenatal arsenic exposurewith size at birth (birth weight, birth length, head and chestcircumferences). This prospective cohort study, based on 1,578mother-infant pairs, was conducted in Matlab, Bangladesh, in2002–2003. Arsenic exposure was assessed by analysis ofarsenic in urine collected at around gestational weeks 8 and30. The association of arsenic exposure with size at birth wasassessed by linear regression analyses. In analysis over thefull range of exposure (6–978 µg/L), no dose-effectassociation was found with birth size. However, significantnegative dose effects were found with birth weight and headand chest circumferences at a low level of arsenic exposure(<100 µg/L in urine). In this range of exposure, birthweight decreased by 1.68 (standard error (SE), 0.62) g for each1-µg/L increase of arsenic in urine. For head and chestcircumferences, the corresponding reductions were 0.05 (SE,0.03) mm and 0.14 (SE, 0.03) mm per 1 µg/L, respectively.No further negative effects were shown at higher levels of arsenicexposure. The indicated negative effect on birth size at a lowlevel of arsenic exposure warrants further investigation. arsenic; Bangladesh; birth weight; cohort studies; maternal exposure; urine     

炎症性肠病易感基因与移植后不良结局相关证据不足

欧洲有研究指出携带NOD2／CARD15和IL-23R基因变异体的供体或受体与异体造血干细胞移植后不良临床结局相关。本研究验证上述研究结果并分析炎症性肠病易感基因（IRGM）与移植后临床结局的相关性。