Health economic evaluation: cost-effective strategies in humanitarian and disaster relief medicine.

The health economic evaluation is a tool used in disaster relief medicine to generate a cost-benefit analysis. Like all areas of healthcare, disaster relief operations must use finite financial resources, much of which comes from charitable donations and foreign aid. Interventions can be assessed using cost-effectiveness tools and equity assessments. Through these tools, interventions that maximise benefit for a given cost are highlighted in the immediate rapid response phase where food, clean water and shelter are prioritised, often with military support. Beyond this, applications of technology and pre-response training are discussed as cost-effective investments made in anticipation of a disaster. In particular, novel technology-based approaches are being explored to deliver medical advice remotely through telemedicine and remote consulting. This strategy allows medical specialists to operate remotely without the logistical and financial challenges of forward basing at the disaster site. Interventions in disaster relief medicine are often expensive. A specific and regularly reviewed health economic assessment ensures that healthcare interventions yield a maximal impact while limiting waste and working within the budgetary constraints of a disaster medicine response. This is a paper commissioned as part of the humanitarian and disaster relief operations special issue of BMJ Military Health.

Breaking the poor health-poverty link in the 21st Century: do health systems help or hinder?

It is depressing but true that, at the beginning of the 21st Century, poverty and ill-health are still closely interrelated. This review traces the current pathways from poor health to poverty in low- and middle-income countries, first at the national level, then at the household level. Ill health can have a substantial impact on gross domestic product, holding countries back from economic development, the fruits of which could be used to improve population health. At the household level, people may be pushed into poverty as a result of paying for health care. Households are forced to pay for the direct and indirect costs of health care at precisely the time when their incomes may be lowered by ill health. For this reason, many forego care, or rely on self-care or informal care, which may hasten the decline in their health and reduce their productivity. Sick people face a double jeopardy: their ill-health puts them at greater risk of poverty, and their poverty is likely to damage their health still further. The review goes on to discuss the role of health systems in the generation of poverty, before concluding with pointers as to how health systems can become part of the solution, rather than part of the problem.

Design and manufacture of monoclonal antibodies for radioimmunotherapy.

antibodies is fundamental to their use for radioimmunotherapy. Besides the right selection of antibody specificity and affinity, recombinant antibodies can be designed to simplify manufacture and minimise unwanted side effects. Although many innovative new technologies have been developed in recent years, antibodies are still most commonly produced from mammalian cells and purified by column chromatography. Purification methods have to be designed and validated to remove potential contaminants, especially retroviruses, which in principle might be present in mammalian cell lines. Adherence to relevant ''Good Manufacturing Practices'' is mandatory in the production of any medicinal product and there are numerous guidelines regarding the manufacture of antibodies. This article outlines some methods used for fermentation, purification and quality control of antibodies intended for radiolabelling.

Construction and immunological assessment of Salmonella typhimurium expressing fox sperm LDH-C4.

This study examined immune responses of foxes to oral doses of recombinant Salmonella typhimurium expressing fox sperm-specific lactate dehydrogenase (fLDH). The cDNA for fLDH was cloned into the expression plasmid pKK233.2 (pKKfLDH). Salmonella typhimurium aroA- (SL3261) was transformed with either the pKK233.2 plasmid alone (SpKK) or the pKKfLDH construct (SpKfLDH). The fLDH expressed by SpKfLDH retained enzymatic activity and was recognized by human LDH-C4-specific antibody. Male European red foxes (Vulpes vulpes) were given an initial oral dose of 1 x 10(11) cfu of either SpKK (control, n = 3) or SpKfLDH (test, n = 6), followed four weeks later with a further dose of 1 x 10(11) cfu. Antibodies to Salmonella lipopolysaccharide (LPS-04) and fLDH were measured in plasma and saliva for eight consecutive weeks after the initial doses. Both LPS-04 IgG- and IgA-specific antibodies as well as fLDH-specific IgG antibodies were detected in plasma and saliva. However, there was a marked fLDH-specific IgA response in saliva consistent with induction of the common mucosal immune system. The antibody measurements demonstrated the feasibility of using recombinant Salmonella as an oral vaccine to elicit gamete antigen-specific mucosal immune responses in foxes.

Australian Dental Research Fund Trebitsch Scholarship. Immunohistological analysis of an in vivo Porphyromonas gingivalis-induced lesion in mice.

Animal models have been used to study the pathogenic ability of putative periodontopathic bacteria. Injection of mice with live Porphyromonas gingivalis extracts has been shown to induce primary lesions which develop at the site of injection within one day and secondary lesions which develop at a distant site some 3-5 days later. These lesions are primarily polymorphonuclear cell (PMN) infiltrates. Recently, extensive data have shown that PMN activity may in part be controlled by T cells. Hence the aim of this report was to use the mouse model to determine the presence of T cells and macrophages in primary lesions in order to describe a baseline to be used for comparison in future studies.

The separation of human serum IgG into subclass fractions by immunoaffinity chromatography and assessment of specific antibody activity.

Murine monoclonal antibodies ( McAbs ) with specificity for subclass-specific or subclass-restricted determinants on human IgG have been coupled to Sepharose to generate affinity columns. The judicial use of positive and negative chromatography and the exploitation of the special properties of individual McAb affinity columns has allowed the preparation of individual IgG subclasses from polyclonal IgG containing less than 1% contamination by any other IgG subclass. The specificity of the antibodies present in each polyclonal IgG subclass preparation has been assayed against a bacterial toxoid (tetanus), 2 bacterial cell wall antigens (E. coli and pneumococcal) and coat antigen(s) of a DNA virus (CMV). Antibodies were predominantly IgG1 to tetanus toxoid, IgG2 to pneumovax and E. coli cell walls, and IgG1, 2 and 3 to CMV coat antigens.