Economic issues in vaccination against highly pathogenic avian influenza in developing countries.

We consider the use of vaccination against highly pathogenic avian influenza (HPAI) in three contexts: as part of a stamping-out programme, as a government-led action for disease prevention and as private insurance by farmers. Poultry systems in developing countries cover all four of the poultry sectors defined by FAO and the OIE, each with particular economic aspects that might motivate farmers to take part in vaccination programmes or to initiate and finance them. Outbreaks in flocks of different types have different potential impacts in terms of disease spread and economic effects, which influence the potential benefits of vaccination as a means to prevent or control outbreaks. We use data from three countries to illustrate the costs of vaccination and discuss measures of cost-effectiveness and ways to improve it. We also consider the question of funding sources and their impact on the sustainability of vaccination programmes.

Psychological consequences of surgery.

The purpose of the present study was to assess changes in psychological distress and memory complaint following a wide variety of surgeries. In addition, variables reflecting type of surgery, demographic characteristics, history of mental illness, and health factors were evaluated as predictors of postoperative psychological distress and memory complaint. Using the Brief Symptom Inventory (BSI), it was found that 10.9% of patients had high levels of psychological distress the day before surgery compared to 13.9% of patients three months after surgery. Complaints of memory disturbance also increased significantly. Only the anxiety subscale of the BSI showed a significant decrease at three months postsurgery. Hierarchical multiple regression revealed that younger age, lower social status, being male, having a history of mental illness, higher presurgery BSI, and poorer postsurgery health were significant predictors of postsurgery psychological distress. The results of the study suggest that, although patients become less anxious after surgery, other forms of emotional distress increase, perhaps due to factors such as slower than anticipated recovery. Results also suggest that medical factors may play an indirect rather than a direct role in psychological consequences of surgery.

Evaluation of five different cochlear implant designs: audiologic assessment and predictors of performance.

The audiologic performance of 54 postlingually deafened adults wearing cochlear implants was uniformly evaluated. The participants had 9 months' or more experience with one of five different cochlear prostheses (Los Angeles Single Channel (N = 11), Vienna Single Channel (N = 4), Melbourne Multichannel (N = 18), Utah Multichannel (N = 19), San Francisco Multichannel (N = 2). The multichannel designs enabled participants to recognize more environmental sounds, provided more speech reading enhancement, and enabled most users to understand limited speech in the sound-only condition, compared to the single-channel implant group.

Evaluation of a new screening system for enteric pathogens.

The two-hour Rapid SST strip (DMS Laboratories, Inc.) was compared with our standard screening system (triple sugar iron agar, lysine iron agar, and urea) for enteric pathogens. We tested 50 stock cultures of enteric pathogens and 213 stool cultures received in the Barnes Hospital Clinical Microbiology Laboratory over a two-month period. All enteric pathogens from the stock cultures and clinical specimens were identified correctly with the Rapid SST system. More false-positive reactions were observed with the Rapid SST system (34%) than with the conventional system (23%). However, the costs associated with using both systems were equivalent and the test results were available one day faster with the Rapid SST system. Thus, the Rapid SST is a rapid, accurate, and cost-effective method for screening stool specimens for enteric pathogens.

Diazepam and learning: assessment of acquisition deficits.

Subjects treated with diazepam (0.3 mg/kg) showed significant reductions in performance on multiple-trial free recall, paired-associate learning, and serial learning tasks compared to placebo control subjects. The free recall task showed the largest drug effect with diazepam subjects failing in six acquisition trials to attain the level of performance achieved by placebo subjects on the first trial. Serial position curves in the serial learning task were changed by the diazepam treatment from their usual skewed form to symmetrical functions. Results indicate that diazepam exerts its greatest memory influence on the acquisition of new information.