Nutritional recovery in HIV-infected and HIV-uninfected children with severe acute malnutrition.

OBJECTIVE: Few studies have reported on nutritional recovery, survival and growth among severely malnourished children with HIV. This study explores nutritional recovery in HIV-infected and HIV-uninfected children during inpatient nutrition rehabilitation and 4 months of follow-up. DESIGN: Prospective cohort study. SETTING: Lilongwe district, Malawi. MAIN OUTCOME MEASURES: Weight gain, anthropometrics. RESULTS: In our sample of 454 children with severe acute malnutrition (SAM), 17.4% (n = 79) of children were HIV infected. None of the children were on antiretroviral therapy upon admission. Among the HIV-infected children, 35.4% (28/79) died, compared with 10.4% (39/375) in HIV-uninfected children (p<0.001). All children who survived achieved nutritional recovery (>85% weight for height and no oedema), regardless of HIV status. HIV-infected children had similar weight gain to HIV-uninfected children (8.9 vs 8.0 g/kg/d, not significant (NS)). Mean increases in z-scores for both subscapular (2.72 vs 2.69, NS) and triceps (1.26 vs 1.48, NS) skinfolds were similar between HIV-infected and HIV-uninfected children, respectively, during nutrition rehabilitation. 362 children were followed for 4 months, at which time mean weight for height z-score was similar in HIV-infected and HIV-uninfected children (-0.85 vs -0.64, NS). CONCLUSIONS: HIV-infected children with SAM have higher mortality rates than HIV-uninfected children. Among those who survive, however, nutritional recovery is similar in HIV-infected and HIV-uninfected children.

Organizing the present, looking to the future: an online knowledge repository to facilitate collaboration.

BACKGROUND: Comprehensive data available in the Canadian province of Manitoba since 1970 have aided study of the interaction between population health, health care utilization, and structural features of the health care system. Given a complex linked database and many ongoing projects, better organization of available epidemiological, institutional, and technical information was needed. OBJECTIVE: The Manitoba Centre for Health Policy and Evaluation wished to develop a knowledge repository to handle data, document research Methods, and facilitate both internal communication and collaboration with other sites. METHODS: This evolving knowledge repository consists of both public and internal (restricted access) pages on the World Wide Web (WWW). Information can be accessed using an indexed logical format or queried to allow entry at user-defined points. The main topics are: Concept Dictionary, Research Definitions, Meta-Index, and Glossary. The Concept Dictionary operationalizes concepts used in health research using administrative data, outlining the creation of complex variables. Research Definitions specify the codes for common surgical procedures, tests, and diagnoses. The Meta-Index organizes concepts and definitions according to the Medical Sub-Heading (MeSH) system developed by the National Library of Medicine. The Glossary facilitates navigation through the research terms and abbreviations in the knowledge repository. An Education Resources heading presents a web-based graduate course using substantial amounts of material in the Concept Dictionary, a lecture in the Epidemiology Supercourse, and material for Manitoba's Regional Health Authorities. Confidential information (including Data Dictionaries) is available on the Centre's internal website. RESULTS: Use of the public pages has increased dramatically since January 1998, with almost 6,000 page hits from 250 different hosts in May 1999. More recently, the number of page hits has averaged around 4,000 per month, while the number of unique hosts has climbed to around 400. CONCLUSIONS: This knowledge repository promotes standardization and increases efficiency by placing concepts and associated programming in the Centre's collective memory. Collaboration and project management are facilitated.

Managing health services: how the Population Health Information System (POPULIS) works for policymakers.

OBJECTIVES: University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for answering such questions as: Which populations need more physician services? Which need fewer? Are high-risk populations poorly served? or do they have poor health outcomes despite being well served? Does high utilization represent overuse? or is it related to high need? More specifically, this system provides decision makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served. The integrated database has also facilitated outcomes research across hospitals and countries, utilization review within a single hospital, and longitudinal research on health reform. The discussion highlights the strengths of integrated population-based information in analyzing the health care system and raising important questions about the relationship between health care and health.

Managing health services: how administrative data and population-based analyses can focus the agenda.

University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for providing answers to such questions as: which populations need more physician services? Which need fewer? Are high-risk populations poorly served or do they have poor health outcomes despite being well served? Does high utilization represent overuse or utilization related to high need? More specifically, this system provides decision-makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics, and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served. The integrated database has also facilitated outcomes research across hospitals and counties, utilization review within a single hospital, and longitudinal research on health reform. A particularly interesting application to planning physician supply and distribution is discussed. The discussion highlights the strengths of integrated population-based information in analyzing the health care system and raising important questions about the relationship between health care and health.

Hepatitis B immunization in a low-incidence province of Canada: comparing alternative strategies.

This study provides a comparative cost-effectiveness analysis of three universal immunization programs for hepatitis B virus (HBV). Using three theoretical cohorts of infants, 10-year-olds, and 12-year-olds, a universal immunization program was compared with a prenatal screening/newborn immunization program involving testing of prepartum women and immunization of newborns of HBsAg-positive mothers. A Markov long-term outcome model used Manitoba data to estimate costs and health outcomes across the lifespan. The model was based on an HBV incidence rate of 19/100,000 and a discount rate of 5% and incorporated the most recent treatment advances (interferon therapy). Cost-effectiveness was calculated as the ratio of dollars spent per year of life saved, with costs determined from the perspective of a third-party payer. The universal infant-immunization program, although not cost-saving, was associated with a low, economically attractive cost-effectiveness ratio of $15,900 (Canadian) per year of life saved, a figure substantially lower than the ratios of $97,600 and $184,800 (Canadian) associated with the universal programs for 10- and 12-year-olds, respectively. Cost-effectiveness ratios were found to be sensitive to changes in immunization costs, HBV incidence rates, and the rate at which protective antibody levels are lost over time: If these variables move in the directions suggested by current trends, the authors anticipate an increasing economic appeal of universal programs well into the future. A universal program of HBV immunization for infants appears to be economically practical in regions where HBV infection rates are low and stable.

The relationship between panic attacks and chemical dependencies.

The purposes of the present study were to (a) determine the prevalence and characteristics of panic attacks in an alcohol/drug abuse inpatient population, (b) compare patients who reported experiencing panic attacks to patients who have never experienced a panic attack on various self-report measures of psychopathology and on ratings completed by Caregivers, and (c) to examine differences within groups of panickers. One hundred forty-four patients completed the questionnaires over a 17 week period. Over 50% of the patients reported experiencing one or more attacks in the three weeks prior to testing. These panickers scored higher than non-panickers on various measures of psychopathology. Over 83% of panickers reported using alcohol to self-medicate their panic attacks with almost 72% of them believing this procedure to be effective for preventing or reducing panic attacks. Male panickers differed from female panickers on several measures as did panickers who reported their panic attacks began before the alcohol abuse compared to those who did not believe this. The mean history of panic attacks was 103.4 months while the mean history of alcohol abuse was 134.6 months.