Costs of nosocomial infection in a neonatal unit.

Hospital costs for 61 neonates with acquired nosocomial infection were compared with 61 matched, uninfected controls. The increase in length of hospital stay (+23 per cent) added to the number of laboratory tests increase total hospitalization costs to 32 per cent. An additional US $1250 for each case of infection is the cost to the Social Security system. The importance of this increase, contrasted with the generally benign nature of the infections studied, justifies the maintenance of high standards of quality in neonatal care.

Recovery of function after brain damage: differential effects of blocking calcium uptake during the recovery of a learned behavior and the performance of the recovered behavior following neocortical brain injury.

The recovery of a learned behavior following brain damage is typically considered to have occurred when the brain-injured individual reattains the performance criterion that defined original preoperative learning. While this is obviously correct from an operational point of view, it does not necessarily mean that the consequences of the brain injury have been reversed, particularly with regard to the sustained performance of the supposedly recovered behavior. The present research attempted a more comprehensive evaluation of the behavioral effects of localized neocortical injury by investigating how a calcium channel blocker would effect (a) the original preoperative acquisition, (b) the initial postoperative recovery, and (c) the subsequent long-term performance of a brightness discrimination learned by rats subjected to injuries of their visual neocortex. The results demonstrated that notwithstanding the brain-injured rat's ability to reattain the performance criterion used to define preoperative learning, its long-term performance of this recovered behavior was significantly inferior to that of a normal rat. More importantly, the present data suggest that there are important differences between the initial postoperative recovery of a behavior and its long-term performance since the same drug that will facilitate initial recovery has just the opposite effect with respect to the animals long-term postoperative performance of the behavior.

Reduction of noise-induced hearing loss using L-NAC and salicylate in the chinchilla.

The effects of a combination of two antioxidant compounds were studied in a chinchilla model of noise-induced hearing loss. After obtaining baseline hearing thresholds using inferior colliculus evoked potentials, chinchillas were exposed for 6 h to octave band noise centered at 4 kHz (105 dB SPL). Post-noise thresholds were obtained 1 h after the noise exposure, and then animals received either saline or salicylate and N-L-acetylcysteine combination. Another group received antioxidant treatment 1 h prior to noise. Hearing was tested at 1, 2 and 3 weeks post-noise. Subsequently, the cochleae were harvested, and cytocochleograms were prepared. There was a 20-40 dB SPL threshold shift at 3 weeks for tested controls. Permanent threshold shifts (PTS) were significantly reduced (P<0.05) to approximately 10 dB for the pre-treatment group at week 3. The PTS for the post-treatment group at week 3 was similar to the pre-treatment group at 1 and 2 kHz (0-10 dB) but was intermediate between the control and pre-treatment groups at 4 and 8 kHz (23 dB). Animals pre-treated with antioxidant had a significant reduction in hair cell loss but those post-treated with antioxidant had no protection from hair cell loss. These findings demonstrate the feasibility of reduction of noise-induced hearing loss using clinically available antioxidant compounds.

[Care of non-severe acute diarrhea in infants: a socioeconomic approach]. / Prise en charge des diarrhées aiguës non graves du nourrisson: approche socio-économique.

During a period of 3 months, 267 children with non severe acute diarrhea (NSAD) were treated by one of four modalities of care: in the private office of a general practitioner (n = 58), or of a paediatrician (n = 109), in a hospital emergency service (n = 62), or as hospital inpatients (n = 38). The socio-economic status and the cost of treatment for each of these children was subsequently assessed. The children admitted to hospital were mainly referred by hospital out-patient departments (47%) and general practitioners (37%) who, unlike paediatricians, care for more socially disadvantaged patients. The main reason for hospitalization was the presence of diarrhea with vomiting (55%). Several measures are proposed to redefine the role of the hospital and to improve cooperation with doctors in office practice, which would reduce both the number of hospitalizations due to NSAD and the length of hospital stay. Since the cost of treating NSAD hospital is 60 time greater than care at home, these measures are economically important.

[Prospects of the cost of AIDS-related death in France (1970-2020)]. / Prospective du coût de la mortalité associée au SIDA en France (1970-2020).

Levels of seropositivity prevalence, estimated by the Brunet-Valleron report, are projected through the year 2020 on the basis of 4 scenarios. Cost of AIDS-related deaths is composed of 2 elements: (i) the indemnification to the victims of blood transfusion; (ii) the loss of years of life of the victims. The annual cost of AIDS-related deaths in France can be estimated between 10 and 12 billion in 1989 and between 18 and 20 billion in 1992. Beyond the year 2000, the trend varies according to the development of the epidemic. The cumulated cost of AIDS-related deaths during the 90's will be 10 to 40 times higher than the simple amount of indemnification paid to the victims of blood transfusion.

[The health of developed countries: which is the most cost effective delivery system?]. / La santé des peuples occidentaux: quel est le meilleur rapport cout-efficacité?

Several attempts have been undertaken to classify national health care systems according to their merits. The best known is the one published recently by the World Health Organization. The works conducted by the author have produced an other one. Among developed countries, it appears that the model they have adopted--that of Chancelor Bismarck (health services financed by contributions from employers and employees) or that of Lord Beveridge (health services financed by taxes)--does not play a crucial role. Universal access to health services and their provision free of charge do not automatically guarantee equity and efficiency. Equity means that the same treatment is applied to everybody. Efficiency means that health expenditures are kept under control, taking into account the health results obtained. In this respect, the USA are ranked at the lowest level, whatever the classification system used.