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BackgroundA low-cost bubble continuous positive airway pressure (bCPAP) device has been shown to be an excellent clinical alternative to nasal oxygen for the care of neonates with respiratory difficulty. However, the delivery of bCPAP requires more resources than the current routine care using nasal oxygen. We performed an economic evaluation to determine the cost-effectiveness of a low-cost bCPAP device in providing ventilatory support for neonates in Malawi.MethodsWe used patient-level clinical data from a previously published non-randomized controlled study. Economic data were based on the purchase price of supplies and equipment, adjusted for shelf life, as well as hospital cost data from the World Health Organization. Costs and benefits were discounted at 3%. The outcomes were measured in terms of cost, discounted life expectancy, cost/life year gained and net benefits of using bCPAP or nasal oxygen. The incremental cost-effectiveness ratio and incremental net benefits determined the value of one intervention compared to the other. Subgroup analysis on several parameters (birth weight categories, diagnosis of respiratory distress syndrome, and comorbidity of sepsis) was conducted to evaluate the effect of these parameters on the cost-effectiveness.ResultsNasal oxygen therapy was less costly (US$29.29) than the low-cost bCPAP device ($57.78). Incremental effectiveness associated with bCPAP was 6.78 life years (LYs). In the base case analysis, the incremental cost-effectiveness ratio for bCPAP relative to nasal oxygen therapy was determined to be $4.20 (95% confidence interval, US$2.29–US$16.67) per LY gained. The results were highly sensitive for all tested subgroups, particularly for neonates with birth weight 1– < 1.5 kg, respiratory distress syndrome, or comorbidity of sepsis; these subgroups had a higher probability that bCPAP would be cost effective.ConclusionThe bCPAP is a highly cost-effective strategy in providing ventilatory support for neonates in Malawi.

This paper examines how protein snacks are marketed as good food choices through their packaging and how these packages reproduce a discoursewhat we see as a mythof the benefits of high protein intake. Research shows that consumers believe high protein food has a positive impact on physical performance and body composition, although there is very little evidence of this. Protein foods and beverages are nevertheless one of the fastest growing sectors in the food market and we now see food companies exploit peoples' beliefs by adding protein to food that was formerly seen as unhealthy. Adopting a Multimodal Critical Discourse Analysis (MCDA) we look in detail at the packaging of a group of snacks that are usually high in fat and sugar but now appear as good food options, particularly through accentuating the protein content. The analysis shows that the packages market these products as an outcome of scientific modern technology, but this is done in playful and comforting ways. This goes along with neoliberal ideas about wellness and demands of an active lifestyle. From these findings, we discuss the limitations of existing regulations as marketing shape and capitalize on discourses of health.

Purpose: To report a case of herpes zoster ophthalmicus (HZO) reactivation after recombinant zoster vaccination. Methods: A 78-year-old woman, with a history of HZO 20 years ago, was referred for progressive corneal thinning in her left eye that started 1 week after her second dose of recombinant zoster vaccination. Results: At presentation, visual acuity was counting fingers. Corneal sensation was markedly decreased. Slit lamp examination revealed a temporal paracentral epithelial defect 1.5 × 2.0 mm in size with 40% thinning and surrounding stromal inflammation suggestive of stromal keratitis with ulceration. The patient was started on oral valacyclovir, topical erythromycin ointment, and hourly topical lubrication. A bandage contact lens was placed and was replaced 1 week later with self-retained cryopreserved amniotic membrane ring. The ring was removed in the following week when the thinned area was epithelialized with no further evidence of stromal lysis. Conclusions: HZO reactivation after recombinant zoster vaccination is uncommon but possible. Ophthalmologists should remain aware of potential risks of zoster vaccination and take special precautions in patients with HZO history.