Cost-effectiveness analysis of a proposed public health legislative/educational strategy to reduce tap water scald injuries in children.

OBJECTIVE: To determine the cost effectiveness of a public health legislative/educational strategy to reduce tap water scalds in children less than 10 years of age. DESIGN: Cost-effectiveness analysis conducted from the government perspective over a 10-year time horizon. POPULATION: Children under 10 years of age in Ontario, Canada INTERVENTIONS: Legislation to set thermostat settings on new domestic water heaters to lower temperatures (maximum 49 degrees C) plus annual educational notices to utility customers versus status quo. MAIN OUTCOME MEASURES: The burden of tap water scalds, healthcare resource utilization, the cost and effectiveness of the proposed intervention, and the probabilities assigned to health outcomes were modeled in a decision analysis based on population-based data, patient charts, and the published medical literature. All costs and health outcomes beyond 1 year were discounted at 3%. RESULTS: An estimated 182 children under 10 require medical care for tap water scald injuries annually in Ontario (13.98 per 100,000). Of these, 65 require emergency department (ED) care only (median cost $C149 per injury), 103 require ED care with clinic follow-up ($C577 per injury), 14 require hospital admission ($C5203 per injury), and two require surgical skin grafting ($C28,526 per injury). The estimated cost of the intervention was $C51,000 annually, with a projected 56% reduction in tap water scald injuries. Over 10 years, the intervention group would show total costs of $C1.17 million and 704 scalds, compared with $C1.65 million and 1599 scalds in the status quo group. Therefore, the intervention would be cost saving, with an incremental ratio of $C531 saved per scald averted. Sensitivity analyses showed that the intervention would remain cost saving through a wide range of variable estimates. CONCLUSIONS: Legislation to lower thermostat settings on domestic water heaters plus annual educational notices to utility customers would generate cost savings while reducing the morbidity from tap water scalds in children.     

慢性病儿童的过渡医疗——医务人员需要尽可能地适应病人及其家属的变化

近期的BMJ中，一位囊性纤维化病人讲述了自己伴随疾病从儿童到成人的经历（见本期第309页）。在很多的艰难险阻当中，她提到了从儿童期到成人期治疗的过渡是一条“崎岖之路”。她说当16岁时，她宁愿倾家荡产进入一家过渡诊所，也不愿意直接去另一家医院的成人诊所。[第一段]     

Atypical Kawasaki disease and gastrointestinal manifestations

Kawasaki disease is a syndrome that usually occurs in infants and children. It is characterized by an exanthem, enanthem, fever, lymphadenopathy, and polyarteritis of variable severity. The present report describes cases in which an initial presentation of Kawasaki disease included abdominal and gastrointestinal symptomatology.     

Associative plasticity in striatal transplants

Striatal lesions disrupt both motor and cognitive performance in rats, many aspects of which can be restored by striatal transplants. Because the normal striatum is involved in the formation and maintenance of motor habits, it has been hypothesized that grafted animals may require explicit retraining to relearn previously established habits that have been disrupted by the lesions. We have used a lateralized-discrimination task to reproduce this "learning to use the transplant" effect, combined with a transfer-of-training paradigm to demonstrate that recovery requires relearning specific lateralized stimulus-response associations and cannot be explained simply by a generalized training-dependent improvement in motor skill. These results have clear implications for developing appropriate strategies for the rehabilitation of Huntington's disease patients participating in clinical transplantation programs.     

Similarities in the action of Ro 60-0175, a 5-HT2C receptor agonist, and d-fenfluramine on feeding patterns in the rat

RATIONALE: Activation of 5-HT2C receptors is thought to enhance satiety and to mediate the action of the prototypical anorectic drug d-fenfluramine. OBJECTIVE: Four experiments investigated the role of the 5-HT2C receptor in the modulation of feeding by comparison of the effects of the putative selective 5-HT2C receptor agonist Ro 60-0175 and d-fenfluramine on feeding behaviour. METHODS: Microstructural analyses of meal patterning and drinking of a palatable solution were made over a range of drug doses administered to male Lister hooded rats. RESULTS: Ro 60-0175 increased the latency to the first meal (3 mg/kg) and reduced meal size (1 mg/kg). d-Fenfluramine (1 mg/kg) produced a similar behavioural pattern, but 3 mg/kg produced a more profound hypophagia that persisted for 10-12 h. Ro 60-0175 (1, 3 mg/kg) and d-fenfluramine (1.5 mg/kg) reduced ingestion of a palatable glucose/saccharin solution, by a reduction in the number of bouts of licking, with little effect on the size of individual bouts. d-Fenfluramine-induced hypophagia (2.1 mg/kg) was challenged by the administration of the selective 5-HT2C receptor antagonist SB 242084 (1, 3 mg/kg) in the meal patterning paradigm. SB 242084 significantly attenuated the decrease in feeding rate and increase in latency to feed produced by d-fenfluramine, but had no effect on the fenfluramine-induced reduction in meal size. A similar pattern of results was obtained when Ro 60-0175-induced hypophagia (3 mg/kg) was challenged by SB 242084 (1, 3 mg/kg). CONCLUSIONS: These results demonstrate that Ro 60-0175 is a useful probe of the importance of 5-HT2C activation in the control of food intake and support the hypothesis that activation of 5-HT2C receptors is a critical aspect of the hypophagic action of d-fenfluramine. The 5-HT2C receptor may prove to be a useful target in the development of clinically effective drugs for the treatment of obesity.     

From the Cover: Thuricin CD,a posttranslationally modified bacteriocin with a narrow spectrum of activity against Clostridium difficile

The last decade has seen numerous outbreaks of Clostridium difficile-associated disease (CDAD), which presented significant challenges for healthcare facilities worldwide. We have identified and purified thuricin CD, a two-component antimicrobial that shows activity against C. difficile in the nanomolar range. Thuricin CD is produced by Bacillus thuringiensis DPC 6431, a bacterial strain isolated from a human fecal sample, and it consists of two distinct peptides, Trn-α and Trn-β, that act synergistically to kill a wide range of clinical C. difficile isolates, including ribotypes commonly associated with CDAD (e.g., ribotype 027). However, this bacteriocin thuricin CD has little impact on most other genera, including many gastrointestinal commensals. Complete amino acid sequencing using infusion tandem mass spectrometry indicated that each peptide is posttranslationally modified at its respective 21st, 25th, and 28th residues. Solution NMR studies on [¹³C,¹⁵N] Trn-α and [¹³C,¹⁵N]Trn-β were used to characterize these modifications. Analysis of multidimensional NOESY data shows that specific cysteines are linked to the α-carbons of the modified residues, forming three sulfur to α-carbon bridges. Complete sequencing of the thuricin CD gene cluster revealed genes capable of encoding two S′-adenosylmethionine proteins that are characteristically associated with unusual posttranslational modifications. Thuricin CD is a two-component antimicrobial peptide system with sulfur to α-carbon linkages, and it may have potential as a targeted therapy in the treatment of CDAD while also reducing collateral impact on the commensal flora.