A sleep disturbance in high risk for SIDS infants

A developmentally immature sleep pattern has been identified in infants with a recent history of an unexplained life-threatening episode of sleep apnoea who are considered at risk for SIDS. In these infants there is a persistence of Sleep Onset REM Periods (SOREMPS) after prolonged wakefulness when compared to controls matched for age, sex, birthweight and race. This sleep characteristic has not been previously reported.     

Carbapenem-Resistant Enterobacteriaceae in Children,United States, 1999–2012

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) infections is increasing in the United States. However, few studies have addressed their epidemiology in children. To phenotypically identify CRE isolates cultured from patients 1–17 years of age, we used antimicrobial susceptibilities of Enterobacteriaceae reported to 300 laboratories participating in The Surveillance Network–USA database during January 1999–July 2012. Of 316,253 isolates analyzed, 266 (0.08%) were identified as CRE. CRE infection rate increases were highest for Enterobacter species, blood culture isolates, and isolates from intensive care units, increasing from 0.0% in 1999–2000 to 5.2%, 4.5%, and 3.2%, respectively, in 2011–2012. CRE occurrence in children is increasing but remains low and is less common than that for extended-spectrum β-lactamase–producing Enterobacteriaceae. The molecular characterization of CRE isolates from children and clinical epidemiology of infection are essential for development of effective prevention strategies.     

Universal Public Finance of Tuberculosis Treatment in India: An Extended Cost‐Effectiveness Analysis

Universal public finance (UPF)—government financing of an intervention irrespective of who is receiving it—for a health intervention entails consequences in multiple domains. First, UPF increases intervention uptake and hence the extent of consequent health gains. Second, UPF generates financial consequences including the crowding out of private expenditures. Finally, UPF provides insurance either by covering catastrophic expenditures, which would otherwise throw households into poverty or by preventing diseases that cause them. This paper develops a method—extended cost‐effectiveness analysis (ECEA)—for evaluating the consequences of UPF in each of these domains. It then illustrates ECEA with an evaluation of UPF for tuberculosis treatment in India. Using plausible values for key parameters, our base case ECEA concludes that the health gains and insurance value of UPF would accrue primarily to the poor. Reductions in out‐of‐pocket expenditures are more uniformly distributed across income quintiles. A variant on our base case suggests that lowering costs of borrowing for the poor could potentially achieve some of the health gains of UPF, but at the cost of leaving the poor more deeply in debt. © 2014 The Authors. Health Economics published by John Wiley Ltd.     

Cost Per DALY Averted in a Surgical Unit of a Private Hospital in India

Backgrounds

Cost-effectiveness analysis plays an important role to guide resource allocation decisions, however, information on cost per disability-adjusted life year (DALY) averted by health facilities is not available in many developing economies, including India. We estimated cost per DALY averted for 2611 patients admitted for surgical interventions in a 106-bed private for-profit hospital in northern India.

Methods

Costs were calculated using standard costing methods for the financial year 2012–2013, and effectiveness was measured in DALYs averted using risk of death/disability, effectiveness of treatment and disability weights from 2010 global burden of disease study.

Results

During the study period, total operating cost of the hospital for treating surgical patients was USD 1,554,406 and the hospital averted 9401 DALYs resulting in a cost per DALY averted of USD 165.

Conclusions

Even though this study was based on one hospital in India, however, the hospital is a private hospital which is expected to have less surgical case load compared to government health facilities, cost per DALY averted for the surgical interventions is much lower than the cost-effectiveness threshold for India (USD 1508 in 2012). This study therefore provides evidence to re-think the common notion that surgical care is expensive and therefore of lower value than other health interventions.

     

Transanal pullthrough for Hirschsprung disease: Matched case–control comparison of Soave and Swenson techniques

Background

Both the Swenson and the Soave procedures have been adapted to a transanal approach. The purpose of this study was to compare outcomes following the transanal Swenson and Soave procedures using a matched case control analysis.

Methods

A retrospective chart review was performed to identify all transanal Soave and Swenson pullthroughs done at 2 tertiary care children’s hospitals between 2000 and 2010. Patients were matched for gestational age, mean weight at time of the operation, level of aganglionosis, and presence of co-morbidities. Student’s t-test and chi-squared analysis were performed.

Results

Fifty-four patients (Soave 27, Swenson 27) had adequate data for matching and analysis. Mean follow-up was 4 ± 1.6 years and 3.2 ± 2.7 years for the Soave and Swenson groups, respectively. No significant differences in mean operating time (Soave:191 ± 55, Swenson:167 ± 61 min, p = 0.6), overall hospital stay (6 ± 4vs7.8 ± 5 days, p = 0.7), and number with intra-operative complications (3 vs 4, p = 1.0), post-operative obstructive symptoms (6 vs 9, p = 0.5), enterocolitis episodes (4 vs 4, p = 1.0), or fecal incontinence (0 vs 2, p = 0.4) were noted.

Conclusion

After controlling for potential confounders, there were no significant differences in the short and intermediate term outcome between transanal Soave and transanal Swenson pullthrough procedures.