Prevalence of drink driving and speeding in China: a time series analysis from two cities.

OBJECTIVES: To confront the public health challenge imposed by road traffic injuries in China. STUDY DESIGN: A consortium of international partners designed and implemented targeted interventions, such as social media campaigns, advocacy for legislative change and law enforcement training, to reduce the percentage of drink driving and speeding in two Chinese cities, Dalian and Suzhou, from 2010 to 2014. METHODS: Time series models were developed to detect changes in the prevalence of drink driving and speeding using data collected through four years of observational studies. RESULTS: This analysis, based on 15 rounds of data, shows that from May 2011 to November 2014, the percentage of vehicles driving above the speed limit decreased from 31.8% (95% confidence interval [CI]: 29.2-34.5) to 7.4% (95% CI: 7.0-7.9) in Dalian and from 13.5% (95% CI: 11.7-15.5) to 6.9% (95% CI: 6.4-7.4) in Suzhou. Drink driving decreased from 1.7% (95% CI: 1.1-2.4) in January 2011 to 0.5% (95% CI: 0.2-0.9) in November 2014 in Dalian and from 6.4% (95% CI: 5.4-7.4) to 0.5% (95% CI: 0.1-2.4) in Suzhou during approximately the same period. Time series models confirmed declining trends in both risk factors in both cities (P-value: 0.06 for speeding prevalence in Suzhou; all other P-values are below 0.05). Disaggregated by vehicle type, saloon cars and SUVs were more likely to exceed the posted speed limit than other types of vehicles in both cities. The speeding rate was higher where the posted speed limit is lower. In Dalian, more drivers were driving above the posted speed limit on weekdays than on weekends (11.4% vs 6.8%); Suzhou had a similar pattern, but the difference was smaller (14.0% vs 12.2%). CONCLUSION: Despite the challenge in accurately attributing the observed changes to one programme, the substantial reduction in the prevalence of the two risk factors suggests that through coordinated actions, internationally recognized best practices in road safety may be effective in improving road traffic safety in China.

Cost-effectiveness of tuberculosis screening and isoniazid treatment in the TB/HIV in Rio (THRio) Study.

OBJECTIVE: To estimate the incremental cost-effectiveness of tuberculosis (TB) screening and isoniazid preventive therapy (IPT) among human immunodeficiency virus (HIV) infected adults in Rio de Janeiro, Brazil. DESIGN: We used decision analysis, populated by data from a cluster-randomized trial, to project the costs (in 2010 USD) and effectiveness (in disability-adjusted life years [DALYs] averted) of training health care workers to implement the tuberculin skin test (TST), followed by IPT for TST-positive patients with no evidence of active TB. This intervention was compared to a baseline of usual care. We used time horizons of 1 year for the intervention and 20 years for disease outcomes, with all future DALYs and medical costs discounted at 3% per year. RESULTS: Providing this intervention to 100 people would avert 1.14 discounted DALYs (1.57 undiscounted DALYs). The median estimated incremental cost-effectiveness ratio was $2273 (IQR $1779-$3135) per DALY averted, less than Brazil's 2010 per capita gross domestic product (GDP) of $11,700. Results were most sensitive to the cost of providing the training. CONCLUSION: Training health care workers to screen HIV-infected adults with TST and provide IPT to those with latent tuberculous infection can be considered cost-effective relative to the Brazilian GDP per capita.

Cost and sustainability of a successful package of interventions to improve vaccination coverage for children in urban slums of Bangladesh.

OBJECTIVE: To estimate the incremental economic costs and explore satisfaction with a highly effective intervention for improving immunization coverage among slum populations in Dhaka, Bangladesh. A package of interventions based on extended clinic hours, vaccinator training, active surveillance, and community participation was piloted in two slum areas of Dhaka, and resulted in an increase in valid fully immunized children (FIC) from 43% pre-intervention to 99% post-intervention. METHODS: Cost data and stakeholder perspectives were collected January-February 2010 via document review and 10 key stakeholders interviews to estimate the financial and opportunity costs of the intervention, including uncompensated time, training and supervision costs. RESULTS: The total economic cost of the 1-year intervention was $18,300, comprised of external management and supervision (73%), training (11%), coordination costs (1%), uncompensated staff time and clinic costs (2%), and communications, supplies and other costs (13%). An estimated 874 additional children were correctly and fully immunized due to the intervention, at an average cost of $20.95 per valid FIC. Key stakeholders ranked extended clinic hours and vaccinator training as the most important components of the intervention. External supervision was viewed as the most important factor for the intervention's success but also the costliest. All stakeholders would like to reinstate the intervention because it was effective, but additional funding would be needed to make the intervention sustainable. CONCLUSION: Targeting slum populations with an intensive immunization intervention was highly effective but would nearly triple the amount spent on immunization per FIC in slum areas. Those committed to increasing vaccination coverage for hard-to-reach children need to be prepared for substantially higher costs to achieve results.

Cost-effectiveness of misoprostol to control postpartum hemorrhage in low-resource settings.

OBJECTIVE: To test the cost-effectiveness of training traditional birth attendants (TBAs) to recognize postpartum hemorrhage (PPH) and administer a rectal dose of misoprostol in areas with low access to modern delivery facilities. METHOD: A cost-effectiveness analysis, modeling two hypothetical cohorts of 10,000 women each giving birth with TBAs: one under standard treatment (TBA referral to hospital after blood loss >or=500 ml), and one attended by TBAs trained to recognize PPH and to administer 1000 microg of misoprostol at blood loss >or=500 ml. RESULT: The misoprostol strategy could prevent 1647 cases of severe PPH (range: 810-2920) and save $115,335 in costs of referral, IV therapy and transfusions (range: $13,991-$1,563,593) per 10,000 births. By preventing severe disease and saving money, it dominates the standard approach. CONCLUSION: Training TBAs to administer misoprostol to treat PPH has the potential to both save money and improve the health of mothers in low-resource settings.

Modeling the economic benefits of better TB vaccines.

OBJECTIVE: To describe the economic benefits of a better tuberculosis (TB) vaccine by modeling prevented TB medical spending and lost productivity throughout the world. DESIGN: One model is based on benefits obtained from reducing the impact of TB on health spending. An alternative model is based on minimizing the impact of TB on health spending and lost productivity due to death and disability. Both models are applied to various world populations based on secondary data. RESULTS: In terms of avoided medical spending, preventing 100% of the TB risk in a single individual is estimated to be worth from $38 for males in formerly socialist countries to S0.23 for children in Asia. More than 1 billion people would reckon their expected medical savings to exceed $25.00 if they received a 75% effective vaccine of 10 years' duration. Preventing lost productivity is worth substantially more throughout the world. CONCLUSIONS: Improved TB vaccines would be of substantial immediate financial value to most of the populations of the world, including the poorest. The scientific uncertainties surrounding the development of a better vaccine could be a larger obstacle than investor uncertainty over whether a vaccine would be profitable.

The willingness to pay for wait reduction: the disutility of queues for cataract surgery in Canada, Denmark, and Spain.

We estimate demand curves for a one month reduction in waiting time for cataract surgery based on survey data collected in 1992 in Manitoba, Barcelona, and Denmark. Patients answered, "Would you be willing to pay [Bid, B] to reduce your waiting time for cataract surgery to less than one month?" Controlling for SES and visual status, Barcelonan patients have greater WTP for shortened waiting time than the Danes and Manitobans. We estimate the value (in 1992 $) of lost consumer surplus due to the cataract surgery queue at $128 per patient in Manitoba, $160 in Denmark, and $243 in Barcelona.

Infant mortality time series are random walks with drift: are they cointegrated with socioeconomic variables?

Previous time series analyses of infant mortality have failed to provide evidence to support their implicit assumption that infant mortality data used behaved as a stationary time series. The present study applies the augmented Dickey Fuller Test to infant mortality time series for Sweden (1800-1989), United Kingdom (1839-1989) and United States (1915-1989). The null hypothesis that each of these series is non-stationary is accepted at standard levels of significance. A conceptual framework of infant mortality which uses a combination of physical and social overhead capital as factors in a production function is developed to explain the finding of non-stationarity as derivative from the non-stationarity of a stock of health-enhancing capital. Estimation of econometric models of the socioeconomic determinants of infant mortality using differenced data with ARIMA estimation is inconclusive. Estimation of a bivariate cointegration model supports the hypothesis that infant survival and GNP/Capita are cointegrated for 19th century Sweden but not for 19th century UK. Bivariate analysis of 20th century Sweden, UK, and US data demonstrated no cointegration. This may be due to the onset of disequilibrium in the economic determination of infant mortality in the present era as technological advances and demographic shifts began to play a larger role. Supplementing the bivariate analysis with measures of unemployment, and crude birth rate in the 20th century permitted the detection of cointegration in US and UK. The multivariate results may suggest that improvements in 20th century UK GNP/capita have had greater impact on infant survival relative to US GNP/capita.

Vaccine storage practices in pediatric offices.

Fifty pediatric offices and clinics in the metropolitan Los Angeles area were visited to assess vaccine storage practices. Questionnaires were administered to the personnel responsible for vaccine storage and the vaccine refrigerators were inspected. Only 16% of vaccine storage coordinators could cite appropriate storage temperatures for vaccines and 18% were unaware that heat can harm certain vaccines. Refrigerator thermometers were checked at least weekly in only 20% of offices, and 22% of the refrigerators had inappropriately high temperatures. Vaccines were routinely stored outside of the refrigerator uninsulated during the practice day in 16% of the offices visited. It is concluded that vaccine storage errors occur in pediatric offices at an unacceptably high frequency. Pediatricians should familiarize themselves with the guidelines for optimal vaccine storage in order to minimize the potential for vaccine failure in primary care practice.

Current progress toward the prevention of the Wernicke-Korsakoff syndrome.

The Wernicke-Korsakoff syndrome is a rare neurological disorder which strikes primarily alcoholics and is caused, at least in part, by insufficient bioavailability of thiamin. Because of the low cost of preventing this disease by adding thiamin to alcoholic beverages relative to the cost of the long-term care of patients with the chronic phase of the disease, there has been a need to determine the feasibility of this particular preventive strategy. Recent data demonstrating normal levels of erythrocyte transketolase in patients presenting with Wernicke's encephalopathy has led some to question the link between thiamin deficiency, and the development of the syndrome, despite the fact that virtually all patients with Wernicke's encephalopathy will respond favorably to parenteral thiamin, and the evidence that rats deprived of thiamin develop lesions that are characteristic of the disease. Thiamin is nontoxic, is stable in alcoholic beverages, and is undetectable in beer to professional taste-testers at levels theoretically sufficient to guarantee adequate absorption. Although there is much inter-subject variability it appears that thiamin at therapeutic concentrations can be absorbed by the jejunum in the presence of alcohol. Evidence that patients with the Wernicke-Korsakoff syndrome have an altered thiamin-requiring isoenzyme and evidence that six patients with Wernicke's encephalopathy failed to respond to oral thiamin has caused some doubt as to whether the target population would be able to benefit from the measure. Other determinants of thiamin utilization, such as folate and magnesium status, also may figure in the etiology of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)