Standardization of fluoride levels in bottled waters and labelling of fluoride content should become mandatory.
Background Lack of effective early screening is a major obstacle for reducing the fatality rate and disease burden of dengue. In light of this, the government of Tamil Nadu has adopted a decentralized dengue screening strategy at the primary healthcare (PHC) facilities using blood platelet count. Our objective was to determine the cost-effectiveness of a decentralized screening strategy for dengue at PHC facilities compared with the current strategy at the tertiary health facility (THC) level. Methods Decision tree analysis followed a hypothetical cohort of 1000 suspected dengue cases entering the model. The cost-effectiveness analysis was performed at a 3% discount rate for the proposed and current strategy. The outcomes are expressed in incremental cost-effectiveness ratios (ICERs) per quality-adjusted life years gained. One-way sensitivity analysis and probabilistic sensitivity analysis were done to check the uncertainty in the outcome. Results The proposed strategy was found to be cost-saving and ICER was estimated to be −41 197. PSA showed that the proposed strategy had a 0.84 probability of being an economically dominant strategy. Conclusions The proposed strategy is cost-saving, however, it is recommended to consider optimal population coverage, costs to economic human resources and collateral benefits of equipment.
Background:Changes occurring in childhood due to JIA leads to activity and work impairment during their transition to adulthood. The factors impairing work and overall activity among adults with JIA need to be explored to formulate policy decisions and rehabilitation measures.Objectives:· To assess the level of academic achievement, employment, work productivity and activity impairment among adults suffering from JIA· To identify factors determining activity impairment among adults with JIAMethods:Consecutive adults classified as JIA (1) were included. Consenting patients filled a questionnaire comprising of demographic details, occupational/educational status, Indian health associated questionnaire (iHAQ), Work Productivity and Activity Impairment score (WPAI) (2)in the language of their choice. Clinical evaluation for disease activity and damage was done and remission was assessed by Wallace criteria. Remission was defined as ever remission: >3 months and sustained remission: > 6 months of disease control. Appropriate statistical tests to assess association and correlation of various factors with WPAI were used.Results:Demography (n=51) is depicted in table 1. Never attaining remission resulted in significantly higher college dropouts (8 vs 17, p<0.05), functional impairment (mean iHAQ 1.08 vs 0.5, p<0.05) and articular damage (mean JADI A 3 vs 8, p<0.01). Disease duration, JADI A and iHAQ correlated well (r2 >.400, p<0.05) with measures of WPAI (table 2). Assessment of patient variables like gender, occupation, disease activity and remission status (figure 1) showed that women, especially the homemakers and individuals with moderate to high disease activity had significant activity impairment (P<0.05).Conclusion:Early effective treatment directly impacts employment levels and activity in adults with JIA. Homemakers in middle- and low-income countries have the most impairment in activity as they cannot alter their work. Replacement costs for homemakers would be an added financial burden to the family and is seldom captured by studies. Our study highlights the need to look further into the indirect and intangible costs involving women that will help policy makers formulate effective economic policies for individuals with JIA.References:[1] Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004Feb;31(2):390–2.[2] Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993Nov;4(5):353–65.Table 1 Demographic, educational, occupational, health profile and WPAI measures of adults with JIA S.No Parameter (N=51)MedianIQR 1 2 3 Age Disease duration (years) Duration of treatment (years) 22958105 4 WPAI Measures (in percentage)Overall Activity ImpairmentOverall Work Impairment (N=14)Presentism (N=12)Absenteeism (N=14)4064.064033.035061.6672.0551.14 Frequency (n) ...
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