Authors of this paper attempted to evaluate the cost of treatment of hypothetical patient with ischaemic heart disease during the period 16 years. The medical costs (costs of medicines, diagnostic procedures, coronary angioplasty and bypass surgery) and indirect costs of lost productivity have been estimated.

The aim of research was to estimate treatment costs of platelet inhibitors and application the medicals as: salicylic acid, ticlopidynum, clopidogrel and abciximab. The analysis was based on multicenter prospective, costs study in the group of 140 patients in three varying in respect of reference degree. We conclude that the A highest costs of antiplotelet treatment associated with dicoproteins inhibitor - abciximab. Relatively low costs of antiplatelet treatment were generated in first and second reference level hospitals which do not perform PCI. In higher reference level hospitals the antiplatelet treatment costs connected with the intervention constituted 94% of total costs of pharmacotherapy.

One of the guiding principles of health policy in many European countries is equitable access to health care services. One of the life saving procedures is percutaneous transluminal coronary angioplasty (PTCA) performed after coronary angiography. Introducing payment for these procedures would limit access for low-income patients. Fortunately, despite political debate, invasive cardiology develops well in Poland. It is important to notice that within the European Union Polish citizens would be able to receive this treatment in other member states and, according to a European Court of Justice ruling, the costs would have to be reimbursed by the National Health Fund. The wider implication is that the 10 new EU member states now have to realise that health care is no longer a matter of national sovereignty - a fact legislators and health care managers in the 15 member states of the pre-accession EU are still struggling with.

PURPOSE:: This study investigates how perception-induced stress (barrier) and social capital (facilitator) affect the health of female managers. METHODS AND MEASUREMENT:: On the basis of the responses of 229 valid questionnaires of middle- and high-level female managers in large-scale hospitals, using a multilevel data analysis approach, this study investigates how perception-induced stress and social capital influence self-reported poor health of female managers. RESULTS:: Analysis results indicate that all 3 perception-induced stresses (i.e., promotion-related procedural justice, promotion rate, and work-family conflict) and 2 social capital variables (i.e., mentor-assisted promotion and higher ranking mentor in other departments) are significantly associated with the health of female mangers. Factors involving the career success of women also affect their health. IMPLICATIONS AND CONCLUSIONS:: Health care organizations expecting to benefit from the long-term contribution of female elites must promote organizational equity and more heavily emphasize flexible work schedules, family-friendly policies, and perception management practices. In addition, adequately designed mentorship practices can greatly benefit female managers.

BACKGROUND:: Posttraumatic stress disorder is a prevalent and disabling psychologic pathology. Longitudinal research on the predictors of posttraumatic stress symptomatology is limited. METHODS:: We recruited 2752 participants to a prospective, population-based cohort study by conducting a telephone survey of adult residents of the New York City metropolitan area in 2002; participants completed 3 follow-up interviews over a 30-month period. Censoring weights were estimated to account for potential bias. We used generalized estimating equation logistic regression models with bootstrapped confidence intervals to assess the predictors of posttraumatic stress over time in multivariable models. RESULTS:: Predictors of posttraumatic stress over time included ongoing stressors (odds ratio [OR]= 1.91 per 1 unit increase in number of stressors,[95% confidence interval = 1.55-2.36]) and traumatic events (OR = 1.92 per 1 unit increase in number of traumatic events [CI = 1.71-2.22]), social support (compared with high levels, OR = 1.71 for medium [1.09-2.52]; OR = 1.57 for low [1.08-2.35]), low income (OR = 0.87 per $10,000 increase [0.81-0.92]), female sex (1.60 [1.11-2.23]), and Latino ethnicity (compared with white, OR = 1.74 [1.05-2.97]). CONCLUSIONS:: These findings suggest that ongoing stressors play a central role in explaining the trajectory of posttraumatic stress over time, and that factors beyond the experience of stressors and traumas may account for sex and ethnic differences in posttraumatic stress risk. Interventions that focus on reducing ongoing adversity may help mitigate the consequences of traumatic events.

OBJECTIVE: We examine whether the pervasive income gradient in health among senior citizens can be explained in part by multiple risk exposure. METHOD: A representative sample of 457 older persons (M = 74.29 years) living independently at home were assessed in a longitudinal study. Health was assessed with a standard self-report index. Risks included loss of a loved one, caregiver burden, low housing quality, and low social integration. RESULTS: The prospective link between income and subsequent health 2 years later is largely explained by exposure to a confluence of multiple risk factors during the 2-year period. These findings incorporate controls for negative affectivity. DISCUSSION: Low-income, older persons are significantly more likely to have lost a loved one or close friend, be burdened by extensive caregiving demands for someone else, be more socially isolated, and live in lower quality housing. These risk exposures, in turn, largely account for the prospective link between income and health.

This study was designed to (1) provide information on the prevalence of pediatric pain as well as other pain related characteristics in a sample of schoolchildren, and (2) study the suitability of a system to grade the severity of chronic pain problems among children. Participants in this cross-sectional study included 561 schoolchildren between the ages of 8 and 16 years. Besides collecting information about the presence of pain at the time of interview, and in the preceding 3 months, several characteristics of participants' pain experiences and several indicators of participants' quality of life were requested. Results showed that 37.3% had chronic pain, but only 5.1% had moderate or severe chronic pain problems. Gender and age differences were found in the prevalence of pain conditions. Children who had a chronic pain condition reported a worse quality of life, missed more days from school, and were more likely to use pain medication and seek medical care for pain relief. Our study shows that chronic pain is a highly prevalent condition in the community, one that can exert negative consequence for the child. But the prevalence of severe chronic pain cases is low. New studies are needed to further empirically test the proposed method of grading the severity of chronic pain in children. PERSPECTIVE: This article provides information on pain problems among schoolchildren. It also suggests a new grading system of chronic pediatric problems. This new system could help clinicians and researchers to diagnose pain problems in youth and design treatments suited to patients' characteristics and needs.

SummaryThis study examined the hypothesis that multiple dimensions of gender inequality increase women's risk for HIV infection using a population-based survey of 1418 women aged 20 to 44 in Moshi, Tanzania. Three forms of HIV exposures were assessed reflecting gender power imbalance: economic exposures (age difference between partners and partner's contributions to children's expenses), physical exposures (coerced first sex and intimate partner violence) and social exposures (ever had problems conceiving). Behavioural risk factors included number of sexual partners for women in the last three years, partner had other wives or girlfriends, non-use of condom and alcohol use at least once a week in the last 12 months. Multivariate logistic regression analysis showed that a woman had a significantly elevated risk for HIV if she had a partner more than 10 years older (OR=2.5), her partner made low financial contributions to children's expenses (OR=1.7), or she experienced coerced first sex before age 18 years (OR=2.0) even after taking into account the effects of risk behaviour factors. The association between ever had problem conceiving and HIV infection was explained away by risk behaviour factors. The findings lend support to the hypothesis that economic deprivation and experience of sexual violence increase women's vulnerability to HIV, providing further evidence for extending the behavioural approach to HIV interventions to incorporate women's economic empowerment, elimination of gender-based violence and promotion of changing attitudes and behaviours among men.

SUMMARYThis paper provides one of the first assessments of the burden of both the public health investigation and the economic costs associated with an apparent outbreak of Legionnaires' disease (LD) in South East London. In addition to epidemiological, microbiological and environmental investigations, we collected data on the staff time and resources committed by the 11 main organizations responsible for managing the outbreak. Of the overall estimated costs of pound455 856, only 14%( pound64 264) was spent on investigation and control of the outbreak compared with 86%( pound391 592) spent on the hospital treatment of the patients. The time and money spent on public health services in this investigation appear to represent good value for money considering the potential costs of a major outbreak, including the high case-fatality rate in LD generally and the high health-care costs. Further research is needed to determine optimum strategies for the cost-effective use of health system resources in investigations of LD. Whether the threshold for investigation of cases should be based on observed incidence rates or the cost-effectiveness of investigations, or both, should be debated further.

Purpose: Based on available epidemiologic, health economic, and international population statistics literature, the cost of epilepsy in Europe was estimated. Methods: Europe was defined as the 25 European Union member countries, Iceland, Norway, and Switzerland. Guidelines for epidemiological studies on epilepsy were used for a case definition. A bottom-up prevalence-based cost-of-illness approach, the societal perspective for including the cost items, and the human capital approach as valuation principle for indirect costs were used. The cost estimates were based on selected studies with common methodology and valuation principles. Results: The estimated prevalence of epilepsy in Europe in 2004 was 4.3-7.8 per 1,000. The estimated total cost of the disease in Europe was euro15.5 billion in 2004, indirect cost being the single most dominant cost category (euro8.6 billion). Direct health care costs were euro2.8 billion, outpatient care comprising the largest part (euro1.3 billion). Direct nonmedical cost was euro4.2 billion. That of antiepileptic drugs was euro400 million. The total cost per case was euro2,000-11,500 and the estimated cost per European inhabitant was euro33. Conclusions: Epilepsy is a relevant socioeconomic burden at individual, family, health services, and societal level in Europe. The greater proportion of such burden is outside the formal health care sector, antiepileptic drugs representing a smaller proportion. Lack of economic data from several European countries and other methodological limitations make this report an initial estimate of the cost of epilepsy in Europe. Prospective incidence cost-of-illness studies from well-defined populations and common methodology are encouraged.

Aim. The purpose of this study was to quantify the service needs of residents in community-based long-term care (LTC) facilities and to determine their predictors. Background. Disabled older family members in Taiwan are often eventually sent to community-based LTC facilities. Many service needs of these residents are likely to go unmet. Methods. A cross-sectional survey was used. This involved purposive sampling of 132 residents from 10 LTC facilities in Taipei City. A previously developed LTC service need assessment scale was used to collect information about the residents' needs in terms of five kinds of LTC services, namely health education, skilled nursing services, referral services, activities of daily living (ADL) assistance and instrumental activities of daily living assistance. Results. The mean age of residents was 75.2 years. The average period of institutionalization was 21.93 months. Overall, 70% of the residents had either complete or partial ADL function dependency. Among the specific ADL function dependencies of the residents, inability to take a bath was the most common. The most significant predictors of service needs were health status, age, number of children, number of medical diagnoses and whether the stay is self-choice. These combined variables explained between 25.5% and 41.6% of the variance of the need for LTC services. Conclusion. The findings of this study show that age, health status, number of children, number of medical diagnoses and whether the stay is self-choice are significant determinants of residents' needs in terms of LTC. Assessment of the extent to which facilities meet the residents' needs is the first step in providing the most cost-effective allocation of scarce resources. Relevance to clinical practice. It is suggested that, if reimbursement by the National Health Insurance system of physician visits, including psychiatric visits, to LTC facilities were allowed, this would improve quality of care.

BACKGROUND: Invasive fungal infections in neutropenic patients treated for haematological malignancies are associated with a high mortality rate and, therefore, require early treatment. As the diagnosis of invasive fungal infections is difficult, effective antifungal prophylaxis is desirable. So far, fluconazole has been the most commonly used. OBJECTIVE: To assess the cost effectiveness of itraconazole compared with both fluconazole and no prophylaxis for the prevention of invasive fungal infections in haematological patients, mean age 51 years, in Germany and The Netherlands. STUDY DESIGN: We designed a probabilistic decision model to fully incorporate the uncertainty associated with the risk estimates of acquiring an invasive fungal infection. These risk estimates were extracted from two meta-analyses, evaluating the effectiveness of fluconazole and itraconazole and no prophylaxis. The perspective of the analysis was that of the healthcare sector; only medical costs were taken into account. All costs were reported in euro, year 2004 values.Cost effectiveness was expressed as net costs per invasive fungal infection averted. No discounting was performed, as the model followed patients during their neutropenic period, which was assumed to be less than 1 year. RESULTS: According to our probabilistic decision model, the monetary benefits of averted healthcare exceed the costs of itraconazole prophylaxis under baseline assumptions (95% CI: from cost-saving to euro5000 per invasive fungal infection averted). Compared with fluconazole, itraconazole is estimated to be both more effective and more economically favourable, with a probability of almost 98%. CONCLUSIONS: In specific groups of neutropenic patients treated for haematological malignancies, itraconazole prophylaxis could potentially reduce overall healthcare expenditure, without harming effectiveness, in settings where fluconazole is common practice in the prophylaxis of invasive fungal infections.