Cost consequences due to reduced ulcer healing times – analyses based on the Swedish Registry of Ulcer Treatment

Resource use and costs for topical treatment of hard‐to‐heal ulcers based on data from the Swedish Registry of Ulcer Treatment (RUT) were analysed in patients recorded in RUT as having healed between 2009 and 2012, in order to estimate potential cost savings from reductions in frequency of dressing changes and healing times. RUT is used to capture areas of improvement in ulcer care and to enable structured wound management by registering patients with hard‐to‐heal leg, foot and pressure ulcers. Patients included in the registry are treated in primary care, community care, private care, and inpatient hospital care. Cost calculations were based on resource use data on healing time and frequency of dressing changes in Swedish patients with hard‐to‐heal ulcers who healed between 2009 and 2012. Per‐patient treatment costs decreased from SEK38 223 in 2009 to SEK20 496 in 2012, mainly because of shorter healing times. Frequency of dressing changes was essentially the same during these years, varying from 1·4 to 1·6 per week. The total healing time was reduced by 38%. Treatment costs for the management of hard‐to‐heal ulcers can be reduced with well‐developed treatment strategies resulting in shortened healing times as shown in RUT.     

The caries decline: a review of reviews

The aim of this paper is to review publications discussing the declining prevalence of dental caries in the industrialized countries during the past decades, focusing on some main conferences addressing this issue. Has there been a real decline in the prevalence of dental caries? Several excellent papers and reviews have been published, and there is a general agreement that a marked reduction in caries prevalence has occurred among children in most of the developed countries in recent decades. This fact has stimulated much debate and attempts to identify the most likely explanations for this change. The conclusion made from this review is that the various authors believe that the use of fluoride in various forms has contributed most significantly to the decline in dental caries prevalence. A number of other factors must, however, also be taken into consideration, and such factors have been extensively discussed in the various publications.     

Is satisfaction with doctors’ care related to health‐related quality of life,anxiety and depression among patients with carcinoid tumours? A longitudinal report

The aim of this study was to investigate (i) whether specific aspects of the initial consultation (IC) and/or patients' satisfaction with doctors' care are related to health-related quality of life (HRQoL), anxiety and depression among patients with carcinoid tumours and (ii) whether patients' satisfaction with doctors' care changes over time. The study has a longitudinal design. The HRQoL and psychosocial function among patients who met the doctors showing good ability to identify patients' worry and wish for information were compared with those patients who met doctors showing less good ability. Patients' HRQoL, anxiety, depression and satisfaction with doctors' care were assessed longitudinally, shortly after each of the first four admissions to specialist care. Patients who met doctors showing good ability to identify their wish for information at the IC reported higher levels of cognitive function. Higher satisfaction with doctors' care was related to higher emotional and cognitive function, to higher global QoL, and to lower levels of problems with diarrhoea, financial difficulties, constipation, anxiety and depression shortly after each of the first three admissions, although not after the fourth admission to the specialist care. Although most patients with carcinoid tumours report high satisfaction with care, it is important to be aware of the fact that some patients may be less satisfied. Doctors should provide patients with information which matches the individual patients' needs and preferences as patients' satisfaction with doctors' provision of information is related to patients' HRQoL, anxiety and depression.     

Trends of HIV-1 and HIV-2 prevalence among pregnant women in Guinea-Bissau, West Africa: possible effect of the civil war 1998 1999

Objectives

Sentinel surveys in Bissau, the capital of Guinea‐Bissau, have shown low prevalence of HIV‐1 but high HIV‐2 prevalence before 1998. Guinea‐Bissau experienced a civil war in 1998–1999. To examine specifically the trends of HIV prevalence from antenatal surveys in Bissau, Guinea‐Bissau in 1987–2004, and whether the civil war in 1998–1999 could have an effect on HIV prevalence levels after the conflict.

Methods

Since 1987, anonymous HIV testing in delivering women has been performed at the maternity clinic, Simão Mendes National Hospital, Bissau, as part of the national sentinel surveillance programme. Consecutive sampling was performed for approximately 3 months between September and December each year. Serological analyses were performed at the National Public Health Laboratory in Guinea‐Bissau.

Results

A total of 20 422 women were tested for HIV between 1987 and 2004. The total HIV‐1 prevalence increased from 0.0% in 1987 to 4.8% in 2004 and the total HIV‐2 prevalence decreased from 8.3% in 1987 to 2.5% in 2004. The HIV‐1 prevalence increased from 2.5% in 1997 to 5.2% in 1999, but stabilized in subsequent years.

Conclusions

There was a significant increase in HIV‐1 prevalence in the years 1987–2004 and a significant decline in HIV‐2 prevalence over the same period. The civil war in 1998–1999 may have sparked HIV‐1 transmission, as HIV‐1 prevalence more than doubled between 1997 and 1999, but there is no evidence of a long‐term effect on the trends of HIV‐1 or HIV‐2 prevalence.     

Regulation of Serum Amyloid A3 (SAA3) in Mouse Colonic Epithelium and Adipose Tissue by the Intestinal Microbiota

The gut microbiota has been proposed as an environmental factor that affects the development of metabolic and inflammatory diseases in mammals. Recent reports indicate that gut bacteria-derived lipopolysaccharide (LPS) can initiate obesity and insulin resistance in mice; however, the molecular interactions responsible for microbial regulation of host metabolism and mediators of inflammation have not been studied in detail. Hepatic serum amyloid A (SAA) proteins are markers and proposed mediators of inflammation that exhibit increased levels in serum of insulin-resistant mice. Adipose tissue-derived SAA3 displays monocyte chemotactic activity and may play a role in metabolic inflammation associated with obesity and insulin resistance. To investigate a potential mechanistic link between the intestinal microbiota and induction of proinflammatory host factors, we performed molecular analyses of germ-free, conventionally raised and genetically modified Myd88−/− mouse models. SAA3 expression was determined to be significantly augmented in adipose (9.9±1.9-fold; P<0.001) and colonic tissue (7.0±2.3-fold; P<0.05) by the presence of intestinal microbes. In the colon, we provided evidence that SAA3 is partially regulated through the Toll-like receptor (TLR)/MyD88/NF-kappaB signaling axis. We identified epithelial cells and macrophages as cellular sources of SAA3 in the colon and found that colonic epithelial expression of SAA3 may be part of an NF-kappaB-dependent response to LPS from gut bacteria. In vitro experiments showed that LPS treatments of both epithelial cells and macrophages induced SAA3 expression (27.1±2.5-fold vs. 1.6±0.1-fold, respectively). Our data suggest that LPS, and potentially other products of the indigenous gut microbiota, might elevate cytokine expression in tissues and thus exacerbate chronic low-grade inflammation observed in obesity.     

Ethical conflicts in placebo treatment

In this paper the pros and cons of using placebo are discussed from the point of view of ethical theories and principles. The effects of placebo are exemplified by findings from previous studies, and an authentic case serves to illustrate ethical dilemmas arising both for the caregiver and the patient in conjunction with the use of placebo. Placebo treatment is discussed from deontological and utilitarianist points of view, and violation of the ethical principles, beneficence, non-maleficence, justice, autonomy and truth-telling, are considered.     

Chronic Toxic Encephalopathy: Social Consequences and Experiences from a Rehabilitation Program

This study evaluates a rehabilitation program designed to address the social function issues of patients with solvent-induced chronic toxic encephalopathy (TE) and their families. Fourteen newly diagnosed men and their spouses participated in group sessions. The patients were given cognitive training, and crisis intervention measures were implemented. Their spouses were given information about the disease and had an opportunity to talk about their emotions and the disease's impact on the family's functioning. Interviews after the program showed that patients and their spouses were experiencing less psychological distress and increased social activity and had begun reestablishing contacts with friends. Their psychiatric symptoms, measured during a structured interview by a nurse, decreased significantly immediately after the treatment period but increased again after 6 months. Only a long-term follow-up study comparing the experiences of these patients with those of untreated TE patients can determine whether improvement can be sustained over the long term.     

Caries risk assessment in school children using a reduced Cariogram model without saliva tests

Background  

To investigate the caries predictive ability of a reduced Cariogram model without salivary tests in schoolchildren.