Establishing the health and economic impact of influenza vaccination within the European Union 25 countries

BACKGROUND: In 2003, the World Health Assembly (WHA) issued a resolution for prevention and control of influenza pandemics and annual epidemics, which urges the European Union 25 (EU-25) Member States to (1) establish and implement strategies to increase vaccination coverage of all people at high risk, including the elderly and people with underlying disease, with the goal of attaining vaccination coverage of the elderly population of at least 50% by 2006 and 75% by 2010; (2) to assess the disease burden and economic impact of annual influenza epidemics as a basis for framing and implementing influenza prevention policies. This resolution was reinforced by the European Union (EU), where Member States agreed to make additional efforts to improve uptake on their territory in accordance with their own recommendations and to achieve the World Health Organisation (WHO) target of 75% in high risk groups before 2010. It was also noted that the changing demographic profile of the EU population would result in an increasing number of elderly people falling within the current target groups. OBJECTIVES: To establish the number of people who may be eligible for influenza vaccination in the EU, and estimate the costs and consequences of not vaccinating this population for five EU Member States, France, Germany, Italy, Spain, and the UK. METHODS: A mathematical model has previously been developed, in which vaccine distribution data are combined with demographic and health economics data to model the public health consequences of influenza and possible intervention strategies. We have extended that model using specific EU-25 demographic data on populations at risk of influenza during the inter-pandemic period. For each country, the total population and age breakdown was calculated to estimate the percentage of the population that falls under the WHA recommendations. Other target groups for influenza vaccination were identified by analysing estimating the proportion of the population with respiratory or cardiovascular related diseases, diabetes, AIDS or transplantation, as well as health care professionals. Target population size and possible vaccination coverage rates across the EU-25 Member States, along with the potential cost and health consequence impact is estimated. RESULTS: For the EU-25, it was estimated that up to 49.1% of the population (or 223.4 million people) should be vaccinated against influenza. This ranged from 41.6% in Cyprus to 56.4% in the UK. There were, on average, 174 vaccine doses distributed per 1000 population within the EU-25, which leads to an average vaccination rate of the target population of 35.4% based on current supply constraints. As a consequence, up to 144.4 million people who could be considered "at risk" may not currently be vaccinated. Implementing a 100% vaccination rate programme for all risk groups across the EU-25 would lead to an estimated reduction of number of influenza cases of 7.22 million, 1.96 million reduced PCP visits for influenza treatment, 796,743 less hospital admissions and 68,537 fewer influenza related deaths for all EU-25 countries. The implementation of a 100% vaccination rate programme for all risk groups in France, Germany, Italy, Spain and UK would require an additional 1.52 billion Euro. This would result in estimated savings of 39.45 million Euro of reduced primary care visits and further savings of 1.59 billion Euro in reduced hospitalisations respectively in these countries. CONCLUSIONS: There is a gap between current vaccination coverage and the EU recommendations. The public health consequences of low vaccination coverage include increased morbidity, hospitalisations and mortality associated with influenza-related complications. This model is a powerful tool to: (1) support EU public health officials in implementing recommendations; (2) to visualize the need for increased vaccination rates for better influenza control; (3) the consequences of low vaccine coverage.     

Mortality and cancer incidence among children and adolescents in Hawaii 20 years after a heptachlor contamination episode.

In 1982, dairy products were recalled from all stores on Oahu, Hawaii, after heptachlor epoxide was detected in milk at concentrations exceeding the federal action level. At the time, an increase in human exposure to heptachlor in children was detected, but no evidence of serious health effects was observed. In an ecologic study design, this report compares mortality and cancer incidence rates of children and adolescents born from 1980 to 1982 to rates of children born before and after the heptachlor episode. Children born from 1980 to 1982 on Oahu were considered to be the exposed population, whereas children born during the same time on the other Hawaiian islands and all children born before 1980 and after 1982 constituted the unexposed population. Poisson regression was used to compare rates by age group, year, birth cohort, and place of residence. Death rates among children born from 1980 to 1982 were consistent with the overall declining mortality trend in children; the rates were consistently lower on Oahu than on the other islands. In agreement with the national trend, cancer incidence rates increased slightly in Hawaii during the last 25 years. Across all ages, cancer risk did not differ significantly between children born between 1980 and 1982 and those born during earlier and later years. However, a slightly higher occurrence of cancer for the heptachlor-exposed cohort when they were 15-19 years old deserves continued observation in the future. Overall, this report found no indication of higher mortality or cancer incidence among children born during the heptachlor contamination period.     

Breast density assessment in adolescent girls using dual-energy X-ray absorptiometry: a feasibility study

Breast density, the radiographically opaque fraction of the breast in a mammogram, is one of the strongest biomarkers of breast cancer risk. However, younger populations do not typically have mammograms due to radiation concerns. This study explored a commercially available dual-energy X-ray absorptiometer (DXA) system as a low-dose method to measure breast fibroglandular density in adolescent girls. Eighteen girls (13-14 years old) indicated their breast development according to Tanner and underwent three dedicated DXA scans, two of their left and one of their right breasts. Total projected breast area was manually delineated on each image and percent fibroglandular volume density (%FGV), absolute fibroglandular volume (FGV), total breast area, and volume were computed. It was possible to image breasts representing all five Tanner stages; %FGV ranged from 31.9% to 92.2% with a mean of 71.1 +/- 14.8%, whereas FGV ranged from 80 to 270 cm(3) with a mean of 168 +/- 54 cm(3). Left and right breast %FGV were highly correlated (r(p) = 0.97, P < 0.0001) and of the same magnitude (P = 0.18). However, left total volume and FGV were larger than the right by 38 cm(3) (P = 0.04) and 19 cm(3) (P = 0.02), respectively. Total volume and FGV increased by Tanner stage, whereas %FGV did not. Our method had excellent precision for %FGV and moderate precision for FGV (root mean square SDs of 2.4% and 16.6 cm(3)). These pilot data indicate that dedicated DXA breast scans may be useful in studies exploring breast density in girls.     

Mature teratoma of the pancreas: CT and MR findings

European Radiology - Mature teratoma of the pancreas is an unusual tumor. Like all teratomas it results from abnormal embryonal development of toti potent cells. Their contents may vary and may...     

Do mountain bikers have a higher risk of scrotal disorders than on-road cyclists?

OBJECTIVE: To sonographically investigate whether mountain bikers have a higher prevalence of scrotal abnormalities compared with on-road cyclists. DESIGN: We studied 85 male mountain bikers (mean age: 25 years; range 17-45 years) and 50 male on-road cyclists (mean age: 23 years, range 15-46 years) with regard to scrotal findings on ultrasound (US). SETTING: Medical University Innsbruck, Austria. PARTICIPANTS: Only males who gave a history of extensive mountain biking or on-road bicycling (2 hours or more per day on 6 days a week with a covered distance of more than 5,000 km/year) were entered in our study. INTERVENTIONS: In addition to clinical evaluation, a standard ultrasonographic examination of the scrotum was performed using a linear array transducer operating at a frequency of 8.0 MHz (Acuson Sequoia 512). MAIN OUTCOME MEASUREMENTS: The sonographic findings obtained in mountain bikers were compared with those obtained in on-road cyclists. RESULTS: Eighty of 85 mountain bikers (94%) and 24 of 50 on-road cyclists (48%) presented with abnormal findings on scrotal US. Abnormal US findings in mountain bikers included scrotoliths in 69 bikers (81%), spermatoceles in 39 bikers (46%), and epididymal calcifications in 34 bikers (40%). US findings in on-road cyclists were scrotoliths in 8 cyclists (16%), spermatoceles in 13 cyclists (26%), and epididymal calcifications in 6 cyclists (12%). The overall number of scrotal abnormalities was significantly greater in mountain bikers than in on-road cyclists (P < 0.001). CONCLUSIONS: Mountain bikers compared with on-road cyclists have shown to be at a higher risk for scrotal disorders on US examination. Not only protective measures but also the awareness of the bikers are required to reduce the potential risk. Further studies should be undertaken to determine the clinical significance of the sonographic changes.     

Developmental neuroplasticity and the origin of neurodegenerative diseases

Objectives. Neurodegenerative diseases like Alzheimer's and Parkinson's Disease, marked by characteristic protein aggregations, are more and more accepted to be synaptic disorders and to arise from a combination of genetic and environmental factors. In this review we propose our concept that neuroplasticity might constitute a link between early life challenges and neurodegeneration. Methods. After introducing the general principles of neuroplasticity, we show how adverse environmental stimuli during development impact adult neuroplasticity and might lead to neurodegenerative processes. Results. There are significant overlaps between neurodevelopmental and neurodegenerative processes. Proteins that represent hallmarks of neurodegeneration are involved in plastic processes under physiological conditions. Brain regions – particularly the hippocampus – that retain life-long plastic capacities are the key targets of neurodegeneration. Neuroplasticity is highest in young age making the brain more susceptible to external influences than later in life. Impacts during critical periods have life-long consequences on neuroplasticity and structural self-organization and are known to be common risk factors for neurodegenerative diseases. Conclusions. Several lines of evidence support a link between developmental neuroplasticity and neurodegenerative processes later in life. A deeper insight into these processes is necessary to design strategies to mitigate or even prevent neurodegenerative pathologies.     

Posterolateral plate fixation with Talarlock® is more stable than screw fixation in ankle arthrodesis in a biomechanical cadaver study

Background

A number of studies report on limitations of the screw arthrodesis in severe malalignment of the hindfoot, neuropathic deformity, poor bone quality and osteoporosis.

Memory performance related to organic and psychosocial illness attributions in somatoform pain disorder patients

Objective

Somatoform disorders are characterized by patterns of persistent bodily complaints. Organic illness attributions are assumed to represent a central supporting factor in the development and maintenance of somatoform disorders. Using group control design, we aimed to investigate the processing of illness-belief-related word stimuli in somatoform pain disorder patients.

Methods

Organic-related, psychosocial-related, and neutral word stimuli were presented to 14 somatoform pain patients with a predominantly organic illness attribution, 14 somatoform pain patients with a predominantly psychosocial illness attribution, and 14 control participants. Behavioral measures were taken during free recall and recognition tasks.

Results

Our study revealed cognitive impairment in somatoform pain patients with an organic attribution of pain symptoms as compared to somatoform pain patients with a psychosocial attribution and healthy controls in both free recall test and recognition test. However, selective processing of word stimuli was not observed for patient groups.

Conclusion

We conclude that the observed impairment of memory performance in somatoform pain patients with an organic illness attribution may play an important role in the illness behavior of this patient group and ultimately result in the maintenance of symptoms and a more critical clinical outcome.