糖尿病合并肺结核55例临床分析

探讨糖尿病合并肺结核的临床疗效，回顾性分析了我院附属医院收治的糖尿病合并初治肺结核55例，比较分析抗痨前后患者晨痰结核菌、肺部结核空洞及结核病灶范围的变化。在44例糖尿病控制良好患者中（A组），痰菌阴转率，空洞缩小或关闭率以及结核病灶吸收好转率分别为94．74％，95．45％。11例糖尿病无好转患者中（B）组，其痰菌持续阳性，空洞未见缩小或关闭、结核病灶吸收率仅为18．20％。两组病例痰菌阴转率和病灶吸收好转率，经统计分析存在显著性差异（P〈0．01）。糖尿病对肺结核抗痨效果有显著影响，只有糖尿病得到有效控制后，抗痨治疗才能取得较好疗效。     

结核分枝杆菌诱导抗原提呈细胞Toll样受体表达差异性研究进展

该文结核分枝杆菌感染后,抗原提呈细胞表面Toll样受体(toll-like receptors,TLR)表达差异、抗原提呈细胞的增殖、分化以及相关信号通路作一阐述.     

试论2011年全国结核病医院效益分析

2011年全国结核病医院运营良好,资产规模扩张速度快,工作效率有待提高,应加强资产管理,提高资产利用率,加强成本核算,节约成本费用,控制成本支出,加强流动资金利用和外部资金的利用能力。     

Farmers’ Willingness to Pay for a Tuberculosis Cattle Vaccine

We use contingent valuation (CV) and choice experiment (CE) methods to assess cattle farmers’ attitudes to and willingness to pay (WTP) for a bovine tuberculosis (bTB) cattle vaccine, to help inform vaccine development and policy. A survey questionnaire was administered by means of telephone interviews to a stratified sample of 300 cattle farmers in annually bTB‐tested areas in England and Wales. Farmers felt that bTB was a major risk for the cattle industry and that there was a high risk of their cattle getting the disease. The CE estimate produced a mean WTP of £35 per animal per single dose for a vaccine that is 90% effective at reducing the risk of a bTB breakdown and an estimated £55 for such a vaccine backed by 100% insurance of loss if a breakdown should occur. The CV estimate produced a mean WTP of nearly £17 per dose/per animal/per year for a vaccine (including 100% insurance) which, given the average lifespan of cattle, is comparable to the CE estimate. These WTP estimates are substantially higher than the expected cost of a vaccine which suggests that farmers in high risk bTB ‘hotspot’ areas perceive a substantial net benefit from buying the vaccine.     

The relationship between employment and mental and physical health in South Africa

This paper estimated the relationship between employment and depression, hypertension, diabetes and tuberculosis in South Africa between 2008 and 2014. South Africa has high levels of economic inactivity and unemployment as well as a high disease burden occasioned by depression, other non-communicable diseases and tuberculosis. Data came from the National Income Dynamics Study panel dataset. Using fixed effects, random effects and pooled ordinary least squares regressions, depression and diabetes were associated with a 4–6 percentage point decline in employment probability, while tuberculosis was associated with a 12–13 percentage point employment decline. The results suggested that the employment-health relationship possibly operated through illness being associated with increased economic inactivity, rather than through making the search efforts of the unemployed unsuccessful. Moreover, the employment-health relationship not only existed contemporaneously, but extended into the future (especially for the physical health indicators).     

Canadian beef and dairy farmers’ attitudes towards animal vaccines

The willingness to pay (WTP) approach is increasingly being used in different disciplines to assess peoples’ readiness to accept change. This paper assesses the potential for two subunit vaccines for the prevention and control of bovine tuberculosis and paratuberculosis in cattle. A survey of beef and dairy farmers was conducted across Canada to identify factors that influence their WTP for subunit vaccines. Estimated results of the interval‐data model indicate that the size of a farmer’s cattle herd, neighbourhood effect, and buyer recommendations for vaccination significantly influence farmers’ WTP while veterinarians appear to be the most critical pathway for farmers to source information on new vaccine options. The mean willingness to pay amounts for both vaccines reveals that farmers are likely to use the vaccines if the costs are kept at reasonable level.     

Characterizing the financial burden of pulmonary arterial hypertension within an integrated healthcare delivery system

Abstract

Purpose:

Financial burden associated with providing healthcare to patients with pulmonary arterial hypertension (PAH) is poorly characterized. This study sought to quantify 3-year healthcare expenditures and determine whether expenditures differed between incident and prevalent PAH cases.

Methods:

This was a retrospective cohort study of Kaiser Permanente Colorado (KPCO) patients with confirmed diagnosis of PAH. Included patients were followed from study entry until 3 years, death, or termination of KPCO membership, whichever came first. All expenditures were reported in 2011 US dollars from the KPCO perspective.

Results:

In total, 157 patients were included: 44 (28%) prevalent and 113 (72%) incident cases. Mean age (prevalent vs incident cases) was 61 years vs 67 years and 13.6% vs 27.4% were males. The majority of patients (55%) were classified as WHO Group 1 PAH. Prevalent cases had less follow-up (843 vs 975 days; p?=?0.033). Overall, median total per patient per day (PPPD) and 3-year total expenditures were $56 (interquartile range (IQR?=?$29–$166) and $50,599 (IQR?=?$25,958–$135,535), respectively. After adjustment for patient characteristics and chronic disease burden, median PPPD ($54 vs $56; p?=?0.950) and 3-year ($37,340 vs $55,073; p?=?0.111) total expenditures were equivalent between prevalent and incident cases; however, the risk of death during the 3-year follow-up was lower among incident cases (hazard ratio?=?0.41, 95% CI?=?0.18–0.91). No significant differences were detected in pharmacy, inpatient, medical office, emergency department, or other expenditures. Median PAH specialty medication PPPD expenditures were also equivalent, also ($226 vs $223 among specialty medication users; p?=?0.861).

Conclusion:

Healthcare expenditures related to PAH represent substantial financial burden. Significant differences according to prevalent or incident case status appeared to be driven by median ED and inpatient expenditures; however, PAH specialty medication expenditures represented a substantial cost-driver overall. Future efforts should focus on optimizing care for patients with PAH to avoid unnecessary harm or waste.     

Co-calibrating quality-of-life scores from three pulmonary disorders: implications for comparative-effectiveness research

Background Efficient use of health resources requires accurate outcome assessment. Disease-specific patient-reported outcome (PRO) measures are designed to be highly relevant to patients with a specific disease. They have advantages over generic PROs that lack relevance to patient groups and miss crucial impacts of illness. It is thought that disease-specific measurement cannot be used in comparative effectiveness research (CER). The present study provides further evidence of the value of disease-specific measures in making valid comparisons across diseases.

Methods The Asthma Life Impact Scale (ALIS, 22 items), Living with Chronic Obstructive Pulmonary Disease (LCOPD, 22 items) scale, and Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR, 25 items) were completed by 140, 162, and 91 patients, respectively. The three samples were analyzed for fit to the Rasch model, then combined into a scale consisting of 58 unique items and re-analyzed. Raw scores on the three measures were co-calibrated and a transformation table produced.

Results The scales fit the Rasch model individually (ALIS Chi² probability value (p-Chi²)?=?0.05; LCOPD p-Chi^2?=^?0.38; CAMPHOR p-Chi^2?=^?0.92). The combined data also fit the Rasch model (p-Chi^2?=^?0.22). There was no differential item functioning related to age, gender, or disease. The co-calibrated scales successfully distinguished between perceived severity groups (p?<?0.001).

Limitations The samples were drawn from different sources. For scales to be co-calibrated using a common item design, they must be based on the same theoretical construct, be unidimensional, and have overlapping items.

Conclusions The results showed that it is possible to co-calibrate scores from disease-specific PRO measures. This will permit more accurate and sensitive outcome measurement to be incorporated into CER. The co-calibration of needs-based disease-specific measures allows the calculation of γ scores that can be used to compare directly the impact of any type of interventions on any diseases included in the co-calibration.     

耐多药肺结核介入治疗术前护理干预效果观察

为减轻耐多药肺结核患者进行介入治疗的心理负担和术中不适,同时增强疗效,特对患者进行术前心理干预.结果显示,进行心理干预的观察组负反应明显小于对照组,疗效优于对照组.因此,介入治疗前的心理干预可提高该方法的效果.     

The Value of Badger Populations and Control of Tuberculosis in Cattle in England and Wales: A Note

This note reports on the results of a choice experiment survey of 400 people in England and Wales, conducted to estimate the value that society places on changes to the size of the badger population. The study was undertaken in the context of the possible need to reduce the badger population by culling to help control bovine tuberculosis in cattle. The study found that people were concerned about the problem of bovine tuberculosis in cattle, which was reflected in their willingness to pay to control the disease, and gave a relatively low value to changes in the size of the badger population (within limits). However, people did not like the idea of a policy that intentionally killed large numbers of badgers and had a relatively very high willingness to pay not to have such a policy.