Emerging sexually transmitted viral infections: Review of human T-lymphotropic virus-1 disease

Human T-lymphotropic virus-1 is a preventable sexually transmitted infection. In the majority of people it is asymptomatic, remaining undiagnosed and thereby contributing to its silent transmission. When it does manifest it causes significant morbidity and mortality. This review summarises the existing evidence for its role in sexual transmission and offers suggestions for those working in the area of sexual health. This is the third part of a series looking at novel sexually transmitted infections.

Emerging sexually transmitted viral infections: 2. Review of Zika virus disease

A sudden increase in the number of newborn infants with microcephaly in Brazil in 2015 brought Zika virus (ZIKV), a less-known infection, to public attention. The rapid increase in the number of cases across the Americas and the devastating complications of infection with ZIKV highlighted the gravity of the situation. Within a relatively short period of time, our knowledge of this infection has significantly increased. This includes the realisation that ZIKV can be sexually transmitted. The aim of the present article is to provide a concise summary on this novel sexually transmitted infection linked to human birth defects and Guillain-Barre Syndrome. According to World Health Organization, individuals living outside areas of ZIKV mosquito transmission where one or both partners have been exposed to ZIKV should abstain from sex or have sex with condoms for at least six months after the last day of possible exposure.

Utility of therapeutic drug monitoring in the management of HIV-infected pregnant women in receipt of lopinavir

The pharmacokinetics of antiretroviral drugs in pregnancy is poorly understood. We reviewed the use of therapeutic drug monitoring (TDM) in clinical settings to document plasma concentrations of lopinavir during pregnancy and investigated how clinicians acted upon TDM results. A retrospective review was carried out of all HIV-infected pregnant women taking boosted lopinavir-based highly active antiretroviral therapy (HAART) at five National Health Service (NHS) centres in the UK between May 2004 and March 2007. Seventy-three women in receipt of lopinavir were identified, of whom 89% had plasma lopinavir concentrations above the suggested minimum recommended for wild-type HIV. Initial TDM results prompted dosage change in 10% and assessment of adherence and/or pharmacist review in 11%. TDM was repeated in 29%. TDM can play an important role in the clinical management of HIV-positive pregnant women, allowing informed dose modification and an alternative measure of adherence.

Discharging older patients from home care: who decides and when?

Who is involved in the decisions to discharge patients from home care and how much lead-in time for planning is observed? How does the process of discharging patients from home care differ by reason for discharge? These questions are addressed in this study of 383 Medicare-funded patients discharged from home care agencies in central Ohio.

Predictors of dental use for low-income, urban elderly persons upon removal of financial barriers

This study examines a low-income, urban elderly population of dental and medical, nondental users. A total of 1,378 medical, nondental users and 2,086 dental users were identified using longitudinal claims data (1983-1992) from a Medicare-waiver program that reimbursed for health care services at cost. Dental users were more likely to be from a younger age cohort (born after 1910, p = .0001) and were more likely to be black (63.3% vs 35.7%, P = .0001) than medical, nondental users. Medical, nondental users had more medical visits (p = .0001), higher medical and pharmacy charges (p = .0001), and more prescriptions (p = .0001) than did the dental users. These findings indicate that among this population of urban elderly, dental users were more likely to be black and have lower medical utilization than nondental users.

Quality of life in nurse case management of persons with AIDS receiving home care

Effects of case management on quality of life were tested with 57 home care patients with AIDS, randomly assigning individuals to either usual care or case-managed care over the duration of home services (ranging from 5 days to over 2 years). Participants were primarily male (93%), white (79%), and never married (82%). Quality of life was measured monthly using the quality of Well-Being Index (QWB). Case-managed patients showed advantages over the usual care group in descriptive analyses of quality of life and survival. Large standard deviations in the QWB scores resulting from high fatality among subjects impeded statistical analyses of effects.

Determinants of dental user groups among an elderly, low-income population

OBJECTIVE

We test whether or not there are differences for selected variables among five dental user groups and one nondental group within an elderly, low-income population.

DATA SOURCE

We used ten years of Medicare Part B claims data from the Cincinnati Health Department for all clinic users 62 years of age and older who participated in the Municipal Health Services Program.

STUDY DESIGN

A polychotomous logistic regression model determined the ability to differentiate between the groups for each of the selected variables, controlling for race. Next, a polychotomous stepwise logistic regression was used in finding a multivariate model for determining dental user group membership. Logistic regression was used to ascertain which variables were discriminators between any two types of dental users.

PRINCIPAL FINDINGS

Mean number of medical visits, mean number of prescriptions filled, and race are determinants of group membership, with the nondental group having more medical visits and more likely to be white. Although year of birth cohort is statistically significant in determining dental user types, the direction of effect is not constant across the comparisons. However, the relative risk for being in the two complete denture groups, compared to both compliant subgroups, increases with each older cohort.

CONCLUSIONS

Higher levels of medical use may "crowd out" dental use, even when it is without user cost, either because the medical problems are treated as a higher priority, or because dealing with medical needs leaves too little perceived time or energy to seek dental care. Even in a low-income population seeking dental care, there appears to be a birth cohort effect with a decline in the younger elderly who require two complete dentures.

Measuring the impact of P.L. 99-252: an economist's view

This paper examines ways in which standard economic analysis may be used to predict and evaluate the impact of P.L. 99-252, the Comprehensive Smokeless Tobacco Health Education Act of 1986. Simple supply and demand models are used to illustrate the range of possible effects of the act. Analysis indicates that the act should reduce demand, though the magnitude of the impact can only be determined empirically. Given that the act affects only one of the principal determinants of demand, consumer preferences, the impact may be rather limited in magnitude. The impact on supply is more ambiguous, but it is possible that restrictions on advertising might lower the smokeless tobacco producers' costs in ways that would lead to an increase in supply. Several suggestions for empirical measurement of impact are made. Three other issues are identified and discussed: potential negative consequences of the act's required health warnings (as a liability defense for firms); the importance of point of view in dealing with the costs of smokeless tobacco use; and a comparison of the act to alternative strategies to reduce smokeless tobacco use, such as taxation.

Costs of training drug-administration technicians

The costs associated with training drug-administration pharmacy technicians in a 1000-bed university teaching hospital were determined. Data were collected between January 1 and December 31, 1983, for the personnel acquisition phase and four training phases of the technician training program. The study phases were further divided into direct and indirect costs. The pharmacy department interviewed 56 applicants for the training program, of which 19 were accepted; 15 of the 19 (79%) trainees successfully completed the program and were hired. Four nine-week training sessions were conducted. The cost per training hour was $15.69, the cost per trainee was $5,683, and the total training cost of the program was $85,245. Although these cost data are specific to this hospital, they may assist other hospitals in the financial management of pharmacy technician training programs.

Cost analysis of the Ohio nursing home industry

This study was part of a major review of long-term care policy in the state of Ohio. The authors analyzed 1532 cost reports filed by nursing homes in 1975-1976 with the Ohio Medical Assistance (Medicaid) program. The objective was to guide policy on size (economies of scale), ownership, certification status, and reimbursement. Economies of scale were not found important: skilled nursing facilities (SNFs) offered the only evidence of operation below optimal scale, and the savings attributable to achieving optimal scale (increasing average bed size from 108 to 143) amounted to only $0.20 per patient day. Proprietary facilities were consistently less costly than voluntary or governmental facilities; however, quality measures were not available, and the largest cost differential was in direct cost where quality might be affected. Hypothesized greater efficiency in proprietary facilities could not be rejected--if accurate, the cost savings were very large ($3.92 to $9.14 per patient day for all homes together). As expected, skilled facilities were more costly than intermediate care facilities (ICFs), and the differential ($3.31 per patient day) was large enough to suggest transfer of misplaced patients. High proportional Medicaid utilization of a home tended to reduce cost, possibly because of the very low ceiling rates paid by the Ohio Medicaid program during the period of this study (1975-76 data). High utilization in general reduced average cost, presumably by spreading fixed cost.