Economic evaluation of vaccination programmes: a consensus statement focusing on viral hepatitis

The methods that have been used to estimate the clinical and economic impact of vaccination programmes are not always uniform, which makes it difficult to compare results between economic analyses. Furthermore, the relative efficiency of vaccination programmes can be sensitive to some of the more controversial aspects covered by general guidelines for the economic evaluation of healthcare programmes, such as discounting of health gains and the treatment of future unrelated costs. In view of this, we interpret some aspects of these guidelines with respect to vaccination and offer recommendations for future analyses. These recommendations include more transparency and validation, more careful choice of models (tailored to the infection and the target groups), more extensive sensitivity analyses, and for all economic evaluations (also nonvaccine related) to be in better accordance with general guidelines. We use these recommendations to interpret the evidence provided by economic evaluation applied to viral hepatitis vaccination. We conclude that universal hepatitis B vaccination (of neonates, infants or adolescents) seems to be the most optimal strategy worldwide, except in the few areas of very low endemicity, where the evidence to enable a choice between selective and universal vaccination remains inconclusive. While targeted hepatitis A vaccination seems economically unattractive, universal hepatitis A vaccination strategies have not yet been sufficiently investigated to draw general conclusions.     

Cerebrovascular disease and late-life depression: a latent-variable analysis of depressive symptoms after stroke.

OBJECTIVE: The author used a structural-equation modeling approach to examine depression symptom endorsement between geriatric stroke patients and general-medical geriatric patients. From the literature related to cerebrovascular disease and depression, he predicted that geriatric stroke patients would be more likely to endorse symptoms of withdrawal and affective flattening, and less agitation. METHODS: Data from 576 geriatric rehabilitation patients were utilized (N=176 with stroke). Confirmatory factor analysis of the Geriatric Depression Scale was conducted to determine the optimal factor structure for examining symptom endorsement differences between the two groups. MIMIC (Multiple Indicators, Multiple Causes) model analyses were incorporated to examine group differences in depression severity and symptom-cluster endorsement. RESULTS: Results indicate that stroke patients did not demonstrate greater depression severity. There were no differences in endorsement of depressive mood. However, stroke patients were more likely to endorse social withdrawal and less likely to endorse agitation symptoms. CONCLUSIONS: The current results suggest that geriatric stroke patients were more likely, after controlling for depression severity, to endorse greater social withdrawal and less agitation, but not depressed mood. These findings have implications for the types of symptoms evaluated in the context of geriatric stroke and depression.     

Internal fixation technique in pathological fractures of the extremities

Summary More often than not, the standard methods of internal fixation are insufficient to meet the demands of treatment of pathological fractures. In malignant diseases with improved survival rates, durability of the osteosynthesis is needed. The seemingly convenient prosthetic replacement therefore has to be regarded with caution. Good results without complications cannot be expected unless the fixation of the components is in healthy bone. In the younger patient with a curable disease, late complications have to be considered. We describe methods of internal fixation that satisfy these particular requirements, and pertinent clinical examples elucidate the techniques.

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Zusammenfassung Standardmethoden der Osteosynthese sind häufig ungenugend für die Anforderungen, die von pathologischen Frakturen gestellt werden. Auch bei terminalen Erkrankungen muß eine gewisse Dauerhaftigkeit der Fixation gewährleistet sein, erlaubt doch die heutige Medizin zum Teil beträchtliche Überlebensraten. Aus diesem Grund muß der naheliegende prothetische Ersatz mit Vorsicht betrachtet werden. Die ihm gestellte Aufgabe kann nur erbracht werden, falls seine Fixation im gesunden Knochen erfolgen kann. Beim jüngeren Patienten sind dessen Spätkomplikationen zu berücksichtigen. Es werden osteosynthetische Methoden aufgezeigt, die den speziellen Anforderungen nahekommen. Typische Fallbeispiele erläutern die Verfahren.

     

Alleviation of avoidance deficits by approach alternatives in 10-day old rats

Ten-day old rat pups were exposed to alternative mothers, trained to approach one of these mothers, and then punished for the approach response. Punished pups quickly learned to avoid the shock area, most often by running to the alternative mother, while nonpunished controls continued in their trained approach response. Free choice and retention control subjects showed no preference for either mother. The data indicated previously reported avoidance deficits in rats at very early stages of development can be overcome provided a response alternative appropriate for both their species and age is provided.     

A behavioral window on the mind of the market: an application of the response time paradigm

This article focuses on the role of implicit knowledge consumers have about particular brands, products or names. The major findings of several studies, conducted at the Mind of the Market Laboratory at Harvard Business School, are presented with specific emphasis on studies in which response time measurements were the core method. The results revealed that implicit measures provide a rich understanding of the meaning conveyed by a product or brand. Moreover, there is also considerable evidence that implicit measures may be better than traditional explicit measures as predictors of consumer behavior. We discuss the implications for the study of consumer behavior and the importance of combining several methods including neuroimaging, which has received recent attention by marketers, economists and social scientists.     

In vitro flow evaluation of recombinant tissue factor pathway inhibitor immobilized on collagen impregnated Dacron

Recombinant tissue factor pathway inhibitor (rTFPI) was immobilized on collagen impregnated (CI) knitted Dacron surfaces and its resistance to fibrin deposition evaluated following exposure to nonanticoagulated whole blood. Recombinant TFPI readily adsorbed to the CI Dacron surface and maintained its inhibitory activity. Under static conditions, rTFPI treated CI Dacron showed little fibrin deposition when compared with untreated surfaces. Treated samples exposed to flowing native blood at wall shear rates of 100 or 200 sec(-1) also demonstrated reduced fibrin deposition (up to 56%) compared with untreated samples. To assess the relative roles of the contact and tissue factor pathways in fibrin formation on artificial grafts, flow studies were performed with whole blood containing corn trypsin inhibitor, a potent inhibitor of FXIIa and contact activation. Corn trypsin inhibitor reduced fibrin deposition on untreated CI Dacron by 40%. Immobilized rTFPI alone, or corn trypsin inhibitor in combination with immobilized rTFPI, reduced fibrin deposition by 58% and 61%, respectively. These data suggest that immobilized rTFPI slows fibrin deposition on the vascular graft material by inhibiting both the contact pathway and blood borne tissue factor procoagulant activity arising from either the alternatively spliced form of tissue factor or from tissue factor containing microparticles.