Willingness to pay to enhance pandemic preparedness in Mauritius.

OBJECTIVES: The objective of this study is to assess the determinants of willingness to pay to enhance pandemic preparedness in Mauritius. STUDY DESIGN: A contingent valuation method is used to estimate willingness to pay to pay for enhancing pandemic preparedness using a sample of working people in Mauritius. METHODS: A two-phase decision process analysis is carried out to model the willingness to pay to enhance pandemic preparedness. The first phase is to analyse the respondents' decision of whether or not to pay for enhancing pandemic preparedness using a Probit model. The second phase is to estimate the determinants of the amount of money respondents are willing to pay using a Tobit model. RESULTS: Income earners are willing to pay an average of Rs. 1,900 (approximately USD 50) per annum to enhance pandemic preparedness. 'Perceived Response Efficacy', 'Awareness of the Need and Responsibility for Paying', 'Subjective Obligation to Pay' and the 'Theory of Planned Behaviour' are found to affect both stages of of the decision-making process. Knowledge on COVID-19 is found to have a positive impact on the decision to pay and health responsibility attitude is found to have a negative impact on the amount people are willing to pay. CONCLUSIONS: On average, the government can potentially expect to mobilise an additional Rs. 1,047,470,000 (USD 27,565,000) from taxpayers to spend on enhancing pandemic preparedness in Mauritius. To increase willingness to pay for enhanced pandemic preparedness, the government can focus on improving knowledge on a pandemic, perceived response efficacy and awareness on need and responsibility of paying.

Force plate gait analysis at the walk and trot in dogs with low-grade hindlimb lameness.

OBJECTIVE: To evaluate the accuracy of force plate gait analysis at the walk and trot in dogs with low-grade hindlimb lameness. MATERIAL AND METHODS: Nineteen healthy dogs and 41 dogs with low-grade unilateral hindlimb lameness due to stifle or hip joint problems were walked and trotted over a force plate. Peak vertical forces (PVF) were recorded, and a symmetry index (SI) was calculated from the PVF of the hindlimbs. 'Cut-off' values were determined from the SI of the normal dogs. These cut-off values were used to discriminate lame dogs from normal ones. Sensitivity and specificity were evaluated for measurements at walk and trot, and the Cohen's Kappa coefficient (k) was used to determine the agreement between clinical lameness and force plate measurements, and between force plate results at walk and trot. Receiver Operating Characteristics (ROC) curve were plotted for both gaits to evaluate accuracy. RESULTS: The sensitivity of the measurements at walk was 0.63, and specifity was 0.95. The sensitivity of the measurements at trot was 0.90, and specificity was 1.0. Moderate agreement was found between force plate measurements at walk and trot, and between clinical gait assessment and force plate measurements at walk. Good agreement was found between clinical gait assessment and measurements at trot. ROC analyses revealed the trot (94.7% [91.7%; 97.7%]) to be the more accurate test than the walk (85.0% [80.1%; 89.9%]). CONCLUSION: The trotting gait was more sensitive and accurate than the walking gait for the differentiation of dogs with a low-grade hindlimb lameness from normal ones using force plate gait analysis.

The relationship between psychotherapist and prescribing psychiatrist. Some considerations.

We have reviewed the vagaries and vicissitudes of an increasingly common arrangement in contemporary mental health treatment, namely, the collaboration between psychotherapist and prescribing psychiatrist in the treatment of the patient who requires both psychotherapy and pharmacotherapy. Such a collaboration raises practical, legal, transference, counter-transference, economic, and training issues. It is our hope that this review of these issues will lead to further discussion as, in our experience, they have until now received scant attention in the mental health literature, in the day-to-day work of practitioners, and in supervision and training. We believe that successful collaboration can be achieved when sufficient awareness and planning are present at the outset.

Is auricular acupuncture beneficial in the inpatient treatment of substance-abusing patients? A pilot study.

Patients with comorbid substance abuse problems who were admitted to a psychiatric unit of a general hospital over an 11-month period were offered treatment with auricular acupuncture. Subsequently and retrospectively, the medical records of these patients were examined to assess compliance, side effects, impact on course, and acceptance of discharge recommendations. Patient's continuation of treatment in destination programs was also followed. Seventy-seven patients were offered acupuncture: 30 patients refused or had four or fewer treatments (control group), and 47 had acupuncture five or more times (treatment group). The treatment group did significantly better than the control group as indicated by the following findings: compliance with psychiatric/substance abuse treatment on the unit was 75% in the treatment group vs. 20% in the control group, noncompliance or AMA discharge rate was 2% in the treatment group vs. 40% in the control group, acceptance of staff's discharge recommendations was 77% in the treatment group vs. 37% in the control group, and 58% of the treatment group patients remained in follow-up treatment for at least 4 months, vs. only 26% of the control group patients. Average inpatient length of stay was 22 days for the treatment group patients compared to 16 days for the control group patients. Side effects in the treated patients were negligible. Auricular acupuncture thus appears to be a safe and inexpensive treatment modality that is easily administered and produces significant results. Its wider application in substance abuse treatment appears warranted.

Influence of gender and age on performance of rats in the elevated plus maze apparatus.

We have compared the performance of male and female Wistar rats at different ages (45, 60, 90, 120 and 150 days) in the elevated plus-maze test, a reliable animal model of anxiety. Up to 60 days of age, rats of both sexes exhibited a high number of entries and of time spent on open arms (50% or above). At 120 days of age or more, rats of both sexes characteristically exhibited a reduction in the number of entries and of the time spent on open arms (below 50%). Within the range of 60 and 120 days there are statistically significant sex differences. At 90 days of age male rats showed a marked switch in their performance in the apparatus, reaching levels of the latter stage, whereas in females it happened around 120 days. These results suggest an ontogenetic difference in rats that accounts for at least two distinct performances for rats placed in an elevated plus-maze. Gender effects were found in a certain range, suggesting caution on interpreting data obtained in rats within 60 and 120 days old. Also, the results obtained highlight the importance of carefully controlling animal age in studies using the elevated plus-maze.

Confocal microscopy in microgravity research.

We have studied the application and the feasibility of confocal scanning laser microscopy (CSLM) in microgravity research. Its superior spatial resolution and 3D imaging capabilities and its use of light as a probe, render this instrument ideally suited for the study of living biological material on a (sub-)cellular level. In this paper a number of pertinent biological microgravity experiments is listed, concentrating on the direct observation of developing cells and cellular structures under microgravity condition. A conceptual instrument design is also presented, aimed at sounding rocket application followed by Biorack/Biolab application at a later stage.

Managing morale and productivity in central service.

Financial constraints resulting in limitations of human resources present management challenges throughout the healthcare industry. Lack of job security can cause fear and unrest among employees to spread like brush fire throughout the institution. Employees at all ends of the organizational chart may feel a sense of helplessness and powerlessness over the situation. This doesn't have to be the situation in Central Service. Rather than putting out fires and crisis management, a master plan for increasing department morale and productivity can be developed--a plan which ultimately benefits the Central Service staff and management. If a positive productivity cycle can be initiated, personnel can see how their behavior affects productivity. Once employees understand how productivity indicators are tied into the budgetary staffing allotments, their commitment to improving productivity becomes a personal one--they can work together to assure job security. This also provides some measure of control over the prevailing economic forces.

Plasma exchange in the treatment of heterozygous familial hypercholesterolaemia.

Five patients with heterozygous familial hypercholesterolaemia, whose response to diet and medication was inadequate, received additional treatment with plasma exchange (PE). Two and a half to three liters of plasma were replaced by a 5% albumin solution once every 3 weeks. Treatment with diet and cholestyramine was continued. This resulted in a reduction of serum total cholesterol (Tot-c) by 21.8-52.2% compared to pretreatment values. Normocholesterolaemia was not achieved. Since the mean Tot-c curve after PE exceeded the upper limit of the normal range approximately 10 days after exchange, the PE frequency was increased to once every 10 days. Tot-c was reduced by 42.6-57.5% and normocholesterolaemia was achieved in most cases. We conclude that normocholesterolaemia can be achieved by treatment which includes PE in all patients with heterozygous familial hypercholesterolaemia and inadequate response to the usual therapy. Individual adjustment of the PE frequency, based on the mean Tot-c curve after PE, is advised.

Differential precipitation of the Clq subcomponent of the first complement component (C1) by polyethylene glycol from normal human serum and sera of patients with collagen diseases.

Sera were, under strictly standardized conditions, centrifuged in the presence of 0-5% PEG and the Clq concentration in the precipitates was measured by radial immunodiffusion. The presence of circulating immune complexes and rheumatoid factor(s) resulted in a shift of Clq precipitation to lower PEG concentrations. Clq precipitation at 1.5% PEG was shown to be specific for sera containing immune complexes. Under similar conditions addition of aggregated IgG to normal human serum gave rise to Clq precipitation directly proportional to the amount of aggregated IgG. Precipitation of endogenous Clq at 1.5% PEG and assay by radial immunodiffusion may therefore be useful for the detection and quantitation of immune complexes in human serum.

Countertransferential and attitudinal considerations in the treatment of drug abuse and addiction.

This article explores countertransferential and attitudinal considerations in relation to their impact on the evaluation, diagnosis, and therapeutic management of drug-dependent individuals. Following a literature survey of the manner in which countertransference has been applied to the treatment of drug dependency, the authors discuss the status of the drug-dependent individual as a psychiatric patient and the resultant treatment implications when such a patient is viewed from within, rather than exclusive of, the mental health treatment delivery system. A number of examples are provided of patient-induced countertransferential reactions, in addition to specific attitudinal factors often present in the treatment of addiction.

Effects of plasma exchange on serum cholesterol levels in heterozygous familial hypercholesterolemia.

This study describes the cholesterol-lowering effect of plasma exchange (PE) in seven patients with heterozygous familial hypercholesterolemia. All patients followed an identical protocol consisting of one PE per three weeks during 27 weeks. A cholesterol-lowering diet was prescribed in addition. No supporting cholesterol-lowering medication was given. PE leads to a momentary marked decrease in serum concentrations of both total cholesterol (Tot-c) and high density lipoprotein cholesterol (HDL-c). HDL-c concentration returns more rapidly to the plateau value than Tot-c concentration resulting in a transient favourable Tot-c/HDL-c ratio that disappears after 10-14 days. No reducing or increasing effect of PE on HDL-c concentration was observed after 27 weeks of treatment. Nor was any convincing reducing effect on Tot-c concentration observed.