Investigating patterns of millennials' interest in gluten-free beer in Poland: A question of beer price and alcohol content.

The quality perception of gluten-free beer was explored using conjoint analysis with a panel of Polish millennials (n = 200; aged 20 to 35), who were given 64 gluten-free beer concepts to evaluate and score on a 9-point scale of interest (1 = not interested at all; 9 = extremely interested). The constituent factors of the beer concepts were alcohol content, color, type of malt, price, drinking location and occasion, bottle size, label claims, type of farming, type of brewer, and bottle closure. Consumers judged price (38.4%) and alcohol (28.8%) five times more important than the other factors. Bottle size (5.3%), claims (4.8%), type of brewer (4.8%), malt type (4.6%), bottle closure (4.0%), beer color (3.6%), drinking location (2.3%), drinking occasion (2.0%), and type of farming (1.3%) were considered of little importance. The interest of Polish Millennials in gluten-free beer resulted moderate and not linked to medical needs. Males were more interested in gluten-free beers and gave more importance to alcohol content and less importance to price, compared to females. However, for both genders, interest and price were inversely correlated, while interest and alcohol content were directly correlated. PRACTICAL APPLICATION: The identification of the product factors that are preferred by consumers is paramount to translate consumers' needs and expectations into a beer designed to produce the best possible product in a relatively short period. Including information directly obtained from consumers before final design decisions are taken on the final beer output, helps ensuring development directions are on target and constitutes a cost-competitive approach to product development.

Cost-effectiveness analysis of chlorhexidine-alcohol versus povidone iodine-alcohol solution in the prevention of intravascular-catheter-related bloodstream infections in France.

OBJECTIVE: To perform a cost-effectiveness analysis of skin antiseptic solutions (chlorhexidine-alcohol (CHG) versus povidone iodine-alcohol solution (PVI)) for the prevention of intravascular-catheter-related bloodstream infections (CRBSI) in intensive care unit (ICU) in France based on an open-label, multicentre, randomised, controlled trial (CLEAN). DESIGN: A 100-day time semi-markovian model was performed to be fitted to longitudinal individual patient data from CLEAN database. This model includes eight health states and probabilistic sensitivity analyses on cost and effectiveness were performed. Costs of intensive care unit stay are based on a French multicentre study and the cost-effectiveness criterion is the cost per patient with catheter-related bloodstream infection avoided. PATIENTS: 2,349 patients (age≥18 years) were analyzed to compare the 1-time CHG group (CHG-T1, 588 patients), the 4-time CHG group (CHG-T4, 580 patients), the 1-time PVI group (PVI-T1, 587 patients), and the 4-time PVI group (PVI-T4, 594 patients). INTERVENTION: 2% chlorhexidine-70% isopropyl alcohol (chlorhexidine-alcohol) compared to 5% povidone iodine-69% ethanol (povidone iodine-alcohol). RESULTS: The mean cost per alive, discharged or dead patient was of €23,798 (95% confidence interval: €20,584; €34,331), €21,822 (€18,635; €29,701), €24,874 (€21,011; €31,678), and €24,201 (€20,507; €29,136) for CHG-T1, CHG-T4, PVI-T1, and PVI-T4, respectively. The mean number of patients with CRBSI per 1000 patients was of 3.49 (0.42; 12.57), 6.82 (1.86; 17.38), 26.04 (14.64; 42.58), and 23.05 (12.32; 39.09) for CHG-T1, CHG-T4, PVI-T1, and PVI-T4, respectively. In comparison to the 1-time PVI solution, the 1-time CHG solution avoids 22.55 CRBSI /1,000 patients, and saves €1,076 per patient. This saving is not statistically significant at a 0.05 level because of the overlap of 95% confidence intervals for mean costs per patient in each group. Conversely, the difference in effectiveness between the CHG-T1 solution and the PVI-T1 solution is statistically significant. CONCLUSIONS: The CHG-T1 solution is more effective at the same cost than the PVI-T1 solution. CHG-T1, CHG-T4 and PVI-T4 solutions are statistically comparable for cost and effectiveness. This study is based on the data from the RCT from 11 French intensive care units registered with www.clinicaltrials.gov (NCT01629550).

A pilot study to assess the effectiveness and cost of routine universal use of peracetic acid sporicidal wipes in a real clinical environment.

BACKGROUND: Peracetic acid sporicidal wipes have been shown to be an effective disinfectant, but in controlled test environments. Their high cost may restrict use. AIMS: This pilot study investigated the efficacy and compared the costs of routine universal use of peracetic acid sporicidal wipes versus sporicidal quaternary ammonium compound and alcohol wipes in the disinfection of a hospital environment. METHODS: The routine universal use of peracetic acid wipes (Clinell Sporicidal; GAMA Healthcare Ltd, London, UK) was allocated to a study ward, whereas the control ward continued with the use of quaternary ammonium compound wipes (Tuffie 5; Vernacare, Bolton, UK) and alcohol wipes (PDI Sani-Cloth 70; PDI, Flint, UK). Twenty high-touch areas in the 2 wards were sampled for the presence of indicator organisms. The weekly detection rates of indicator organisms and weekly healthcare associated infection (HCAI) rates in the 2 wards were compared and examined for decreasing trends over the trial period. RESULTS: The detection rates of indicator organisms and HCAI rates were not significantly different in the 2 wards, and did not decrease significantly over the trial period. However, the peracetic acid wipes seem to be more effective against gram-negative organisms but at a significantly higher cost. CONCLUSIONS: Further prospective studies are needed to assess the cost-effectiveness of peracetic acid wipes.

Understanding the development of minimum unit pricing of alcohol in Scotland: a qualitative study of the policy process.

BACKGROUND: Minimum unit pricing of alcohol is a novel public health policy with the potential to improve population health and reduce health inequalities. Theories of the policy process may help to understand the development of policy innovation and in turn identify lessons for future public health research and practice. This study aims to explain minimum unit pricing's development by taking a 'multiple-lenses' approach to understanding the policy process. In particular, we apply three perspectives of the policy process (Kingdon's multiple streams, Punctuated-Equilibrium Theory, Multi-Level Governance) to understand how and why minimum unit pricing has developed in Scotland and describe implications for efforts to develop evidence-informed policymaking. METHODS: Semi-structured interviews were conducted with policy actors (politicians, civil servants, academics, advocates, industry representatives) involved in the development of MUP (n = 36). Interviewees were asked about the policy process and the role of evidence in policy development. Data from two other sources (a review of policy documents and an analysis of evidence submission documents to the Scottish Parliament) were used for triangulation. FINDINGS: The three perspectives provide complementary understandings of the policy process. Evidence has played an important role in presenting the policy issue of alcohol as a problem requiring action. Scotland-specific data and a change in the policy 'image' to a population-based problem contributed to making alcohol-related harms a priority for action. The limited powers of Scottish Government help explain the type of price intervention pursued while distinct aspects of the Scottish political climate favoured the pursuit of price-based interventions. CONCLUSIONS: Evidence has played a crucial but complex role in the development of an innovative policy. Utilising different political science theories helps explain different aspects of the policy process, with Multi-Level Governance particularly useful for highlighting important lessons for the future of public health policy.

A comparison of the contrast stains, Chicago blue, chlorazole black, and Parker ink, for the rapid diagnosis of skin and nail infections.

BACKGROUND: The cheapest, most rapid method for the diagnosis of mycotic skin and nail infections is direct examination of samples using a KOH preparation. The standard KOH wet mount lacks a color contrast. Various contrast dyes are available. Parker ink is one which has been extensively used, however in recent times the stain no longer provides a suitable color contrast. Two other dyes that are available are Chicago blue and chlorazole black. METHODS: 100 samples of skin or nails were prospectively examined using Chicago blue, chlorazole black, and Parker ink-KOH stains. The samples were also cultured, with culture being the diagnostic gold standard. RESULTS: The sensitivities and specificities of the Chicago blue, chlorazole black and Parker ink stains were 78% & 96%; 63% & 97%; and 48% and 96%, respectively. CONCLUSION: The Chicago blue-KOH stain provides a good color contrast and is a suitable replacement for the Parker ink-KOH stain. It is suitable for use in the dermatologist's office or in the laboratory.

Surrogate alcohol drinking in Estonia.

BACKGROUND: Surrogate, nonbeverage alcohols, provide a cheap and concentrated source of ethanol for drinking that has been associated with premature mortality. The aim of this study was to provide the first estimate of the prevalence of surrogate alcohol consumption in a national population sample of Estonia. METHODS: The Estonian Health Interview Survey conducted in 2006 to 2007 was a nationally representative sample of the population aged 15 to 84 years (N = 6,370). The age-standardized percentage prevalences of ever having drunk surrogates were estimated. The association of age, ethnicity, and education with the prevalence of surrogate drinking was estimated using logistic regression. RESULTS: Of all respondents who reported drinking at least once in their lifetime (N = 5,423), 65% had consumed alcohol during the previous 4 weeks. In this group (N = 3,525), the age-standardized prevalence rate of surrogate drinking was 1.4% (2.3% men, 0.3% women). Among men, surrogate drinking was rare under the age of 35 years (0.3%). Ethnicity and education were both related to surrogate drinking: relative to Estonian men, non-Estonians (mainly Russians) had an odds ratio (OR) for surrogate drinking (adjusted for age and education) of 2.58 (95% CI 1.41, 4.72), while relative to those with higher education those with secondary education had an OR (adjusted for age and ethnicity) of 2.28 (0.78, 6.67) and those with basic education an OR of 3.91 (1.29, 11.84). CONCLUSION: Surrogate alcohols are drunk in Estonia, particularly among men. This behavior shows pronounced variation in prevalence by ethnicity and education. Reducing consumption of these substances needs to be part of any strategy to reduce the burden of alcohol-related problems in Estonia today.

A practical guide to alcohol-based hand hygiene infrastructure in a resource-poor pediatric hospital.

BACKGROUND: Resource-poor hospitals have many barriers to proper hand hygiene (HH). Alcohol-based HH can compensate for inadequate infrastructure and supplies. We describe the implementation of alcohol-based HH in five high-risk wards of a pediatric hospital in El Salvador. METHODS: In 5 high-risk wards for nosocomial infections, we evaluated the accessibility, supplies, and cleanliness of the hand-washing sinks at 132 time points. We then installed gel dispensers, identified a local gel supplier, and trained nursing staff to maintain the dispensers. We evaluated user acceptance, costs, and the practice and technique of HH before and after installation. RESULTS: Access and cleanliness were adequate at 18.9% and 11.3% of observation points, and towels and soap were available at 61.3% and 93.18% of points. Placement of 35 gel dispensers increased the ratio of HH stations to beds from 1:6.2 to 1:1.8. Alcohol gel was better tolerated than hand washing among 60 surveyed staff. Installation cost $2558 (US) and the monthly gel supply, $731 (US). HH practice increased from 33.8% to 40.5%; use of correct technique increased from 73.8% to 95.2%. CONCLUSION: Alcohol gel can address some of the barriers to effective HH at resource-poor institutions, and its cost may be offset by reduction of nosocomial infection.

Cost analysis of hand hygiene using antimicrobial soap and water versus an alcohol-based hand rub.

Proper hand hygiene is acknowledged as the most critical element of an adequate infection control program in the oral healthcare setting. However, adherence to proper hand hygiene protocols is often lacking. Poor compliance with hand hygiene protocols has been attributed to such factors as lack of time, hand irritation, hand dryness, forgetfulness, skepticism over importance, understaffing, perceived low risk of cross-infection, inconvenience, and the belief gloves alone offer protection. In the medical environment the use of alcohol-based hand rubs now represent the preferred method of performing hand hygiene when delivering non-surgical care. In this study we compared the costs associated with traditional hand washing against an alcohol-based hand rub protocol in the dental setting. The results indicate an alcohol-based hand rub protocol is less costly and less time consuming when compared to traditional handwashing in the dental setting, creating a new paradigm for hand hygiene in the dental office.

Cost implications of successful hand hygiene promotion.

We evaluated the costs associated with a sustained and successful campaign for hand hygiene promotion that emphasized alcohol-based handrubs. The total cost of the hand hygiene promotion corresponded to less than 1% of the costs associated with nosocomial infections. Successful hand hygiene promotion is probably cost-saving.