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.     

The critical C-terminus of the small subunit of herpes simplex virus ribonucleotide reductase is mobile and conformationally similar to C-terminal peptides

The C-terminus of the small subunit of class I ribonucleotide reductases is essential for subunit association and enzymatic activity. ¹H NMR analysis of the small subunit (2 × 38 kDa as a homodimer) of herpes simplex virus ribonucleotide reductase shows that this critical binding site is mobile and exposed in relation to the rest of the protein. Assignments of six C-terminal amino acids are made by comparing the TOCSY and NOESY spectra of the small subunit with the spectra of an identical protein truncated by seven amino acids at the C-terminus and the spectra of an analogous 15 amino acid peptide. The mobility of the C-terminus may be important for subunit recognition and could be general for other ribonucleotide reductases. The spectral comparisons also suggest that the six C-terminal amino acids of the small subunit and peptide are confor-mationally similar. This observation may be important for the design of inhibitors of ribonucleotide reductase subunit association. © Munksgaard 1994.     

Estimating hidden populations: a new method of calculating the prevalence of drug-injecting and non-injecting female street prostitution

This paper outlines a new method we have developed for estimating the prevalence of streetworking prostitution and the proportions of female street-working prostitutes who are injecting drug users. This method is based on the capture/recapture approach and involves distinguishing new fieldwork contacts from repeat field work contacts. The size of the overall population can be modelled from records of the increasing ratio of repeat to new fieldwork contacts. The method may have a relevance beyond a concern with prostitution and drug injecting, and may be of value in estimating other hidden populations.     

Effect of Coronary Perfusion of Heptanol on Conduction and Ventricular Arrhythmias in Infarcted Canine Myocardium

Effect of Heptanol in Healed Infarction. Introduction : Abnormal cellular coupling is a major constituent of the slow, dissociated conduction that supports ventricular tachycardia (VT) following myocardial infarction. Agents that modulate cellular coupling may exert either proarrhythmic or antiarrhythmic effects.
Methods and Results : The effects of modulating cellular coupling on conduction and susceptibility to inducible VT were studied in 11 dogs with healed left anterior descending (LAD) infarction. The LAD circulation was isolated and supplied with arterial blood via a constant-flow bypass system. Localized intracoronary infusion of heptanol, an agent with relatively specific effects on intracellular coupling, was performed using this bypass system. Heptanol produced dose-dependent changes in cardiac conduction, assessed by delayed local activation times in sinus rhythm (0.5 mM: 11.9%± 11.0% change, P = 0.005; 1.0 mM: 45.8%± 25.5% change, P = 0.0004) and slowed conduction velocity both transverse and longitudinal to fiber orientation. Sustained VT was not induced in any of the control animals. During infusion of 0.5 mM heptanol, uniform sustained VT was inducible in 4 of 11 animals (P = 0.027). During infusion of 1.0 mM heptanol, sustained VT was induced in only 1 of 9 animals.
Concltisions : In the canine model of healed myocardial infarction, heptanol had a bimodal effect on susceptibility to inducible VT. Low-dose heptanol facilitated the induction of sustained VT, and high-dose heptanol had an antiarrhythmic effect. This suggests that agents that modulate coupling may significantly modify susceptibility to VT following myocardial infarction.     

Outcome of neonatal intensive care: obstetric implications for a regional service

Summary. Data from 634 newborn babies with birthweights ≤2000 g admitted to the South West Thames Regional Neonatal Unit in St George's Hospital since its opening in 1980 were analysed. Only 271 (43%) of the pregnancies were booked there; 200 (32%) of the babies were transferred in utero and 162 (26%) after delivery. Weight-specific neonatal survival rates, calculated after exclusion of lethal abnormalities showed that between 1001 and 1500 g, 79 (96%) of the 82 babies transferred in utero survived in 1981–1984, compared with only 57 (79%) of the 72 postnatal transfers (P<0.02). Under 1000 g, no such differences were found, possibly because paediatricians transferred only the fitter babies in this weight range. The birth of very-low-birthweight babies of short gestation in units unable to provide immediate resuscitation, adequate stabilization and full neonatal intensive care is a major risk factor for increased neonatal mortality. These findings support the role of regional perinatal centres as service units for antenatal transfer and neonatal intensive care, and as teaching centres.     

Stimulus dimensions of the cold pressor test and the associated patterns of cardiovascular response

Hemodynamics of the cold pressor response in relation to its pain and nonpain stimulus components were investigated in normotensive college men using the foot and forehead cold pressor tasks. Mechanisms of pain- and non-pain-related increases in blood pressure were analyzed as residual effects of concurrent changes in total peripheral resistance and cardiac output. The identified partial relationships suggested that the response pattern associated with pain included positive change both in cardiac output and in total peripheral resistance, whereas the nonpain-related response was limited to an increase in total peripheral resistance. Analyses of individual differences in car-diovascular responses to pain further indicated that pain-related increments in blood pressure were mediated by a steeper rise in total peripheral resistance, an increase in heart rate, and an apparent increase in preload. At baseline, high reactors to pain manifested relatively elevated total perpheral resistance, diminished cardiac output, and an indication of a reduced inotropic state, suggesting that altered basal homeostasis may discriminate normotensive individuals displaying heightened cardiovascular reactivity to aversive cold stimulation.     

Clinical Trial of a Novel Filler Material for Soft Tissue Augmentation of the Face Containing Synthetic Calcium Hydroxylapatite Microspheres

BACKGROUND: The ideal injectable filler should yield great, long-lasting results, be biocompatible, reliable, safe, easy to use, and inexpensive. Radiesse (Bioform Inc., Franksville, WI) is a synthetic calcium hydroxylaptic filler that has all of the above qualities. OBJECTIVE To evaluate the effectiveness of Radiese as an injectable filler. METHODS: Eighty-two patients who underwent facial soft tissue augmentation using Radiese from April 2003 to 2004 were enrolled in this study. Pre-filled sterile syringes were used to inject the material into the soft tissues of the face. At the 3 month and six month visits, the physicians and the patients were asked to evaluate the result. RESULTS: Eighty-two patients were injected with Radiesse. The most common area of injection was the melolabial folds. All patients were evaluated during the 3 month follow up visit. There was an overwhelmingly positive response to the look and feel of the implant, averaging 4.6 on a grading scale from 1 to 5, for the patients as well as the injecting physicians. Similar responses were found at the 6 month follow up visit. CONCLUSION: Preliminary data indicate that Radiesse is easy to use and effective with little or no associated morbidity.