Mortality and employment after in-patient opiate detoxification.

AIM: We considered that completed opiate detoxification resulted in increased life expectancy and earning capacity as compared to non-completed detoxification. METHODS: The cohort study sample included pure opioid or poly-substance addicts admitted for voluntary in-patient detoxification between 1997 and 2004. Of 404 patients, 58.7% completed the detoxification program and 41.3% did not. The Austrian Social Security Institution supplied data on survival and employment records for every single day in the individual observation period between discharge and December 2007. Statistical analyses included the calculation of standardized mortality rates for the follow-up period of up to 11 years. RESULTS: The standardized mortality ratios (SMRs) were between 13.5 and 17.9 during the first five years after discharge, thereafter they fell clearly with time. Mortality did not differ statistically significantly between completers and non-completers. The median employment rate was insignificantly higher in completers (12.0%) than in non-completers (5.5%). The odds for being employed were higher in pure opioid addicts than in poly-substance addicts (p=0.003). CONCLUSIONS: The assumption that completers of detoxification treatment have a better outcome than non-completers has not been confirmed. The decrease in mortality with time elapsed since detoxification is interesting. Pure opioid addicts had better employment prospects than poly-substance addicts.

Ultrasonographic assessment and ultrasound-guided biopsy of the retropharyngeal lymph nodes in Asian elephants (Elephas maximus).

Endotheliotropic herpesvirus causes a fatal disease in young Asian elephants, but there are no methods for identifying latent carriers of the virus. During the postmortem study of one female African elephant and three male and two female Asian elephants, a lymph node located bilaterally caudoventral to the parotid gland, approximately 1.5 to 5 cm below the skin, was identified as suitable for transcutaneous ultrasound-guided biopsy. An ultrasonographic assessment and two biopsies were performed on 39 Asian elephants, and these lymph nodes were classified ultrasonographically as active, inactive or chronically active. The calculated mean (se) volume of 10 active lymph nodes was 17.4 (6.9) cm(3), and that of three chronically active lymph nodes was 10.6 (1.0) cm(3), whereas the mean volume of 17 inactive lymph nodes was 3.1 (0.6) cm(3). The presence of lymph node tissue in samples obtained by ultrasound-guided biopsy from three animals that were maintained under conditions that allowed for additional sampling was confirmed histologically. The dna extracted from the lymphoid tissue and the whole blood of all the elephants was negative for endotheliotropic herpesvirus by PCR.

Effect of HIV reporting by name on use of HIV testing in publicly funded counseling and testing programs.

CONTEXT: Policies requiring confidential reporting by name to state health departments of persons infected with the human immunodeficiency virus (HIV) have potential to cause some of them to avoid HIV testing. OBJECTIVE: To describe trends in use of HIV testing services at publicly funded HIV counseling and testing sites before and after the implementation of HIV reporting policies. DESIGN AND SETTING: Analysis of service provision data from 6 state health departments (Louisiana, Michigan, Nebraska, Nevada, New Jersey, and Tennessee) 12 months before and 12 months after HIV reporting was introduced. MAIN OUTCOME MEASURE: Percent change in numbers of persons tested at publicly funded HIV counseling and testing sites after implementation of confidential HIV reporting by risk group. RESULTS: No significant declines in the total number of HIV tests provided at counseling and testing sites in the months immediately after implementation of HIV reporting occurred in any state, other than those expected from trends present before HIV reporting. Increases occurred in Nebraska (15.8%), Nevada (48.4%), New Jersey (21.3%), and Tennessee (62.8%). Predicted decreases occurred in Louisiana (10.5%) and Michigan (2.0%). In all areas, testing of at-risk heterosexuals increased in the year after HIV reporting was implemented (Louisiana, 10.5%; Michigan, 225.1 %; Nebraska, 5.7%; Nevada, 303.3%; New Jersey, 462.9%; Tennessee, 603.8%). Declines in testing occurred among men who have sex with men in Louisiana (4.3%) and Tennessee (4.1%) after HIV reporting; testing increased for this group in Michigan (5.3%), Nebraska (19.6%), Nevada (12.5%), and New Jersey (22.4%). Among injection drug users, testing declined in Louisiana (15%), Michigan (34.3%), and New Jersey (0.6%) and increased in Nebraska (1.7%), Nevada (18.9%), and Tennessee (16.6%). CONCLUSIONS: Confidential HIV reporting by name did not appear to affect use of HIV testing in publicly funded counseling and testing programs.

Trends in HIV seropositivity in publicly funded HIV counseling and testing programs: implications for prevention policy.

INTRODUCTION: We describe trends in seropositivity among clients attending publicly funded HIV counseling and testing sites across the United States and discuss implications for prevention policy. METHODS: The present analysis used client-level data from 1990 through 1994 for 26 of 65 state, territorial, and local health departments receiving Centers for Disease Control and Prevention funds. Logistic regression was used to predict the proportion of HIV tests that were positive. Curves were created representing adjusted HIV seropositivity trends for 1990 through 1994. RESULTS: HIV seropositivity rates were higher before 1992. Throughout, rates were higher among men, most racial/ethnic minorities tested, and persons 30 years or older. Although rates for men remained higher than those for women, the gap has narrowed in recent years. For both men and women, rates remained low for those reporting heterosexual activity as their only potential risk for HIV. Over time, more high-risk seronegatives are being repeatedly tested. CONCLUSIONS: Lower, stabilized seropositivity rates after 1992 reflect large increases in testing volume, increasing frequency of repeat testing, and fewer asymptomatic-infected persons entering this public system. Various program innovations including enhanced outreach, improved access, rapid testing, and client-centered counseling should be considered as strategies to increase the number of infected persons who learn their serostatus early and enter into medical care.

Publicly funded HIV counseling and testing in the United States, 1992-1995.

Data are collected and reported through the Centers for Disease Control and Prevention (CDC) Counseling and Testing System (CTS) on episodes of publicly funded counseling and HIV testing in the Unites States. The objective of this analysis is to describe testing data reported from 1992 through 1995. In 1992, 2,689,056 tests were performed, and 55,024 (2.0%) were positive; in 1995, 2,491,434 tests were performed, of which 40,605 (1.6%) were positive. Among tests reported with client-level data, the proportion of tests of men and women at higher risk for HIV infection remained stable or declined; the proportion of tests of persons who had been previously tested increased each year; and in 1995, the proportion of tests that included posttest counseling was 86% for anonymous and 70% for confidential tests. Although information collected through CTS could be improved by changing the system so that individuals could be distinguished from testing episodes, the CTS does provide important monitoring information to local and state health departments.

Moral community and animal research in medicine.

The invocation of moral rights in moral/social debate today is a recipe for deadlock in our consideration of substantive issues. How we treat animals and humans in part should derive from the value of their lives, which is a function of the quality of their lives, which in turn is a function of the richness of their lives. Consistency in argument requires that humans with a low quality of life should be chosen as experimental subjects over animals with a higher quality of life.

Attention, the intersection of cost and quality in health care.

A method for assessing health care technology that models the demand on the clinician's attention exerted by patients' data (diagnostic and therapeutic) can provide a means for simultaneously reducing the cost and improving the quality of health care. The attentional demand exerted by patients' data can be measured by the amount of uncertainty in the data. Uncertainty can be expressed mathematically by the concept of entropy in information theory.

Coalitions on health care cost.

Many alternatives exist for the health care field at a time when everyone involved is concerned with containing costs. The Minnesota Coalition is an example of one approach. The Coalition includes buyers and sellers of medical care, hospitals, physicians, providers, labor, and third-party payors. Several important goals and accomplishments are defined and addressed.

[External costs of energy illustrated by the example of mortality and morbidity]. / Externe Kosten der Energie am Beispiel von Mortalitat und Morbiditat

"The social costs of energy production and consumption in terms of increased mortality and morbidity are estimated for Switzerland using recent empirical studies on air pollution and health in the United States. These costs were between 100 and 300 million Swiss francs 1980 and occurred mainly as externalities. The paper illustrates how these externalities could be corrected via a Pigou tax. However, there is uncertainty about the epidemiological basis and the imputed values for health and mortality reductions making the imposition of such a tax infeasible until better cost estimates are available." (summary in ENG, FRE)