Reduction In New Cases Research Articles

HIV infection in the era of highly active antiretroviral therapy: the Malaga Study.

We analyse the characteristics of patients diagnosed with HIV infection in the highly active antiretroviral therapy era in the southeast of Spain. Data were collected on 470 HIV patients diagnosed between January 1997 and December 2002. The number of cases fell over recent years and HIV transmission was sexual in 70.5%. The mean CD4 lymphocyte count was 302.1 x 10(6)/L and the mean viral load 4.70 log(10). Diagnosis of HIV coincided with an AIDS-defining opportunistic illness in 30.6% of patients and a late diagnosis (CD4 < 200 x 10(6)/L) was made in 48.3% of patients. A late diagnosis was related to male gender (OR 2.50; 95% CI 1.20-5.12; P < 0.001) and AIDS case (OR 18.80; 95% CI 10.50-33.80; P < 0.00001). These results suggest that there has been a progressive reduction in new cases of HIV-infected patients, with the main route of transmission being sexual and that the diagnosis was late in almost half the patients.

Comparative Cost Effectiveness of Angiotensin II Receptor Blockers in a US Managed Care Setting

To compare the cost effectiveness of the angiotensin II receptor blockers (ARBs) olmesartan medoxomil, losartan, valsartan and irbesartan for the treatment of hypertension, from the perspective of a US managed care setting. The evaluation was based on a recently completed, prospective, randomised, double-blind clinical trial comparing the antihypertensive efficacy of these agents. Differences in diastolic blood pressure reductions among the comparative agents were used to estimate reductions in the annualised risk of cardiovascular (CV) and cerebrovascular events using the Framingham model. These annualised risks were translated into reductions in healthcare expenditures associated with treating CV events covered by managed care in the US. Data sources included: the recently published clinical trial of ARB antihypertensive efficacy, the Framingham Heart Study and a managed care database. Actual reimbursed amounts were used. Based on antihypertensive efficacy data versus irbesartan, the use of olmesartan medoxomil is expected to reduce the number of new cases of CV disease, resulting in a first-year reduction in cost in a cohort of 100,000 patients of 906,000 US dollars. Similarly, a reduction in new cases of coronary heart disease (CHD) resulted in a cost reduction of 701,000 US dollars; a cost reduction of 196,000 US dollars for fewer myocardial infarctions (MI); and a cost reduction of 28,000 US dollars for fewer strokes. Over 5 years, these estimates increase to 5,410,000 US dollars for fewer cases of CV disease; 3,975,000 US dollars for fewer cases of CHD; 1,430,000 US dollars for fewer MI; and 497,000 US dollars for fewer strokes. Compared with valsartan, the use of olmesartan medoxomil is estimated to reduce by 3,397,000 US dollars the expected cost of treating a cohort of 100 000 patients in the first year for fewer cases of CV disease; by 2,426,000 US dollars for fewer cases of CHD; by 565,000 US dollars for fewer MI; and by 124,000 US dollars for fewer strokes. Over 5 years, these estimates increase to 16,231,000 US dollars for CV disease; 11,955,000 US dollars for CHD; 4,505,000 US dollars for MI; and 1,741,000 dollars for stroke. Compared with losartan, the estimated reduction in first-year cost is 2,969,000 US dollars for CV disease for the cohort of 100,000 patients; 2,163,000 US dollars for CHD; 732,000 US dollars for MI; and 124,000 US dollars for stroke. Over 5 years, these estimates increase to 15,149,000 US dollars for CV disease; 11,107,000 US dollars for CHD; 4,057,000 US dollars for MI; and 1,437,000 dollars for stroke. Based on comparative antihypertensive efficacy data, treatment of hypertensive patients with olmesartan medoxomil instead of the other leading ARBs has the potential to reduce overall cost of medical care in a US managed care setting.

Losartan reduces the burden and cost of ESRD: Public health implications from the RENAAL study for the European Union

Type 2 diabetes is the leading cause of end-stage renal disease (ESRD) in most industrialized countries in Europe. The RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) Study evaluated the renal protective effects of losartan versus placebo on a background of non-ACE-I/non-AIIA conventional antihypertensive therapy in 1513 patients with type 2 diabetes and nephropathy. Losartan reduced the incidence of doubling of serum creatinine, end-stage renal disease (ESRD), or death by 16% (P=0.022) and reduced the risk of progression to ESRD, defined as the initiation of dialysis or transplantation, by 29% (P=0.002). We set out to estimate the potential effect of losartan on the burden and costs associated with ESRD over 3.5 years in the European Union (EU). The risk reduction in new cases of ESRD was calculated by combining type 2 diabetes population estimates for the EU with the percent absolute risk reduction of ESRD in patients treated with losartan as observed in RENAAL. The number of days each patient experienced ESRD was defined as the length of time from onset of ESRD until the minimum of death or 3.5 years. ESRD-free person-years avoided with losartan treatment were calculated by combining the population estimate with the ESRD days avoided divided by number of days in a year. ESRD costs from Germany were used to approximate the potential cost savings from reduced time with ESRD and fewer ESRD cases on a EU wide basis. There are approximately 700,000 diagnosed type 2 diabetes patients with proteinuria (urine albumin/creatinine >or=300 mg/g) in the EU. The addition of losartan to the treatment regimen of these patients is expected to lead to a reduction of 44,100 cases of ESRD, 64,400 fewer person-years with ESRD, and reduce ESRD-related costs by euro 2.6 billion over 3.5 years based on RENAAL data. Treatment with losartan not only reduced the incidence of ESRD, but also can result in substantial cost savings in the European Union.

Natural history and disease manifestations of hepatitis C infection.

Approximately 4 million persons in the United States are currently infected with the hepatitis C virus (HCV). The Centers for Disease Control and Prevention has estimated that during the 1980s, an average of 230,000 new infections occurred each year (Centers for Disease Control and Prevention 1998). Data from 1996 suggest that the annual incidence has declined to 36,000 new cases (ALTER 1997a). While changes in blood donation practices and screening of blood products with highly sensitive assays undoubtedly resulted in a significant reduction of new cases, the major change in incident cases comes from a reduction of cases in injecting-drug users (Centers for Disease Control and Prevention 1998). To better understand the rationale for treatment of this disease, an understanding of the natural history of HCV infection is imperative.KeywordsChronic HepatitisMixed CryoglobulinemiaPorphyria Cutanea TardaLine Probe AssayEssential Mixed CryoglobulinemiaThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Reducing the incidence of stomatitis using a quality assessment and improvement approach

Stomatitis occurs in approximately 40% of the patients receiving systemic administration of chemotherapy and cancer treatments such as radiation to the head and neck. The presence of stomatitis affects the course of treatment and a patient's quality of life. An oncology nursing unit developed a quality assessment and improvement indicator addressing stomatitis. Oral cavity screening, dental consultations, oral care techniques, and patient teaching were included in the nursing interventions, which resulted in a marked reduction of new cases of stomatitis.

Portable medical record for the homeless mentally ill.

gramme, the time may be right to investigate circum? stances leading to cases of infants affected by Rh haemolytic disease rather than deaths. This is especially important if the death rate is falling while new cases are still occurring at the same rate. Computerised blood transfusion centres could provide information to interested clinicians about new cases occurring. This could be a topic for a regional obstetric audit group. In summary, we think that the overall outlook for almost complete prevention of Rh haemolytic disease deaths is good. The introduction of monoclonal anti-D is on the horizon and, when it is readily available, will contribute to a reduction in new cases of sensitisa tion.' We are grateful to Professor P L Mollison for advice on the classification of cases, and Professor Charles Rodeck and Dr L A P Tovey for commenting on the changing rates of death in 1988 and 1989. The Office of Population Censuses and Surveys kindly forwarded the death information and Mrs E Batty typed the manuscript. The work is supported by the Mersey Regional Research Committee.

A Twelve-Year Clinical and Immunologic Evaluation of Workers Involved in the Manufacture of Trimellitic Anhydride (TMA)

The spectrum of immunologic lung disease occurring in a population of 196 workers involved in the manufacture of trimellitic anhydride (TMA) was assessed from January 1976 through December 1987. Workers were evaluated clinically by history, blood counts and chemistries, chest x-ray, and pulmonary function studies. Immunologic tests included skin testing with trimellityl-human serum albumin (TM-HSA) and assay of total antibody (TA) and of IgE antibody binding of 125I-TM-HSA. Seventeen workers had IgE-mediated asthma/rhinitis with a positive prick test to TM-HSA and IgE antibody of 0.8-57 ng of TM-HSA bound/ml. Seven workers had a late respiratory systemic syndrome with TA from 760-56,000 ng of TM-HSA bound/ml. Four had both syndromes. Three had late onset asthma with TA of 3,700-10,000 and trace levels of IgE to TM-HSA. One had marked arthralgia and myalgia occurring hours after TMA exposure, without respiratory symptoms, with an elevated TA level of 24,000. Of 46 workers reporting no symptoms, 8% had low TA levels, while 16% of 113 with irritant symptoms had low TA levels. There was a reduction in the number of workers exhibiting an immunologic syndrome during 1982-1987-8% (7 of 85) compared to 23% (26 of 111) during 1976-1981--in spite of increased TMA production. This paralleled environmental control and worker education efforts. Cooperative research by an academic Allergy-Immunology program and industry has defined TMA clinical syndromes and provided methods of immunologic monitoring, resulting in a reduction in new cases in spite of increased production of TMA.

SHJGELLOSIS AT A CARIBBEAN RESORT

During a three-week period in 1984, 339 tourists and expatriate employees with diarrhea visited the infirmary at a Caribbean resort club. Epidemiologic studies suggested that over 60% of the 1,893 tourists at the resort club during that time may have been ill. Shigella flexneri 4a was isolated from seven of 18 stool specimens. A few cases of diarrheal illness occurred at the resort club before the onset of the outbreak, which was temporally related to illness in a butcher. North American residence, eating raw or very rare hamburger, having a roommate who was ill and younger age were significantly associated with acquiring disease. Control measures, principally elimination of ill food handlers from the kitchens, were followed by a prompt and marked reduction in new cases. Isolated resorts pose problems in disease control similar to those on cruise ships, with hundreds of foods available, large numbers of short-stay visitors with few outside exposures, and many food handlers in whom pathogens can persist between groups of visitors. Resort clubs can reduce the risk of traveler's diarrhea, without using mass prophylaxis against pathogenic bacteria, by appropriate handling and preparation of food and by surveillance for diarrheal illnesses.

Patient Age Distribution in Thalassemia Major: Changes From 1973 to 1985

Major advances have occurred in the treatment and prevention of thalassemia major, but their impact on incidence and survival have not been well assessed. In 1973, a survey was done of the ages of 243 living patients with thalassemia major followed at 12 centers in the United States and Canada. Twenty-two percent were younger than 5 years and 2.1% were older than 25 years of age (mean 11.4 +/- 6.7 [SD] years). In 1985, there were 303 patients at the same centers; 11% were younger than 5 years and 7.9% were older than 25 years (mean 14.2 +/- 7.3 years). A similar pattern was found in Connecticut, characterized by a marked decrease of new cases of thalassemia major during the past 15 years. This was not a result of fewer persons at genetic risk or a change in marital ethnic choices. Eleven of 14 families who had a child with thalassemia major assured that another affected child would not be born by having no more children, using prenatal diagnosis, or having therapeutic abortions. Extensive community programs of education and testing for thalassemia trait in Connecticut may also have contributed to the observed reduction in new cases.

HLA-related heterogeneity in seasonal patterns of diagnosis in Type 1 (insulin-dependent) diabetes.

HLA type, time of year of diagnosis, and age at diagnosis were studied in 52 new cases of Type 1 diabetes in Seattle, Washington. Diagnosis was found to be seasonal in diabetic patients positive for DR3 (p less than 0.005), with the expected marked reduction in new cases during the summer months. This seasonality was not age-related (p greater than 0.13). Cases who were DR3-negative did not show significant seasonality of diagnosis (p greater than 0.5). However, when age at diagnosis was adjusted for, a seasonal effect was found in the DR3-negative group (p less than 0.006), with older cases favouring a spring onset and younger cases favouring an autumn onset. Thus, DR3-positive cases showed a seasonal diagnosis pattern that did not depend on age, while DR3-negative cases showed an age-dependent seasonal pattern. These differences may reflect the predominance of different aetiological mechanisms in these two genetic groups.

Effect of the Postmilking Teat Dip “Bovadine” on the Incidence of Staphylococcus aureus and Mastitis

The University milking dairy herd was divided into two groups according to breed. Diagonally opposite teats of each cow were dipped with “Bovadine” after each milking. The remaining two teats served as controls. The Wisconsin Catalase Test, Wisconsin Mastitis Test, and Direct Microscopic Somatic Cell Count were used to detect incidence of mastitis in composite samples from dipped and control teats. Samples of milk were plated on Baird-Parker Agar to detect staphlococci. The postmilking teat dip caused a 31.4% reduction in new cases of mastitis and 42.3% reduction in staphylococcal infections during the 19 months of the study. The teat dip caused a reduction in new cases of staphylococcal infections and in number of quarters infected with mastitis; however, these reductions were non-significant. The WMT had the highest correlation when compared with all the other tests used to detect mastitis. Results indicated that the WMT would be the best single test to use to detect cows with mastitis.