Objectives. This study examines how the American Legacy Foundation's “truth” campaign and Philip Morris's “Think. Don't Smoke” campaign have influenced youths' attitudes, beliefs, and intentions toward tobacco. Methods. We analyzed 2 telephone surveys of 12- to 17-year-olds with multivariate logistic regressions: a baseline survey conducted before the launch of “truth” and a second survey 10 months into the “truth” campaign. Results. Exposure to “truth” countermarketing advertisements was consistently associated with an increase in anti-tobacco attitudes and beliefs, whereas exposure to Philip Morris advertisements generally was not. In addition, those exposed to Philip Morris advertisements were more likely to be open to the idea of smoking. Conclusions. Whereas exposure to the “truth” campaign positively changed youths' attitudes toward tobacco, the Philip Morris campaign had a counterproductive influence. (Am J Public Health. 2002;92:901–907)

EVAR and open repair. In the current study, the authors sought to analyze the cost-effectiveness and cost-utility of EVAR compared with a standard open repair in the treatment of rAAA, with costs per 30-day and 6-month survival as outcome parameters. Resource use was determined from the Amsterdam Acute Aneurysm trial data. Analysis was performed from a provider perspective. All costs were calculated as if patients had been treated in the same teaching hospital (Onze Lieve Vrouwe Gasthuis). The study randomized 116 patients. The 30-day mortality was 21% after EVAR and 25% after open repair, for an absolute risk reduction of 4.4% (95% confidence interval [CI], À11.0% to 19.7%). At 6 months, the total mortality rate for EVAR was 28% compared with 31% for those assigned to open repair (absolute risk reduction, 2.4%; 95% CI, À14.2% to 19.0%). The mean cost difference between EVAR and OR was €5306 (95% CI, À€1854 to €12,659) at 30 days and €10,189 (95% CI, e€2477 to €24,506) at 6 months. The incremental cost-effectiveness ratio per prevented death was €120,591 at 30 days and €424,542 at 6 months. There was no significant difference in quality of life between EVAR and OR. EVAR was not superior regarding cost-utility, either. In this study, the mean costs of the EVAR group were substantially raised by eight patients who required conversion to open repair. At 6 months, the mean difference between the converted and nonconverted groups was €19,981. The total costs required to save one person's life with EVAR was €120,446. At 6 months, this leads to a number needed to treat of 41.7 patients at €424,881 per life saved.Comment: Overall, the Amsterdam Ruptured Aneurysm Study has indicated that EVAR for treatment of rAAA is associated with a slightly lower mortality rate but a considerably higher cost. The paper raises the interesting point: At what point are advances in medical technology affordable, and at what point do they become cost-prohibitive?

No abstract

Axonal degeneration is a prominent feature of many forms of neurodegeneration, and also an early event in blast-mediated traumatic brain injury (TBI), the signature injury of soldiers in Iraq and Afghanistan. It is not known, however, whether this axonal degeneration is what drives development of subsequent neurologic deficits after the injury. The Wallerian degeneration slow strain (WldS) of mice is resistant to some forms of axonal degeneration because of a triplicated fusion gene encoding the first 70 amino acids of Ufd2a, a ubiquitin-chain assembly factor, that is linked to the complete coding sequence of nicotinamide mononucleotide adenylyltransferase 1 (NMAT1). Here, we demonstrate that resistance of WldS mice to axonal degeneration after blast-mediated TBI is associated with preserved function in hippocampal-dependent spatial memory, cerebellar-dependent motor balance, and retinal and optic nerve–dependent visual function. Thus, early axonal degeneration is likely a critical driver of subsequent neurobehavioral complications of blast-mediated TBI. Future therapeutic strategies targeted specifically at mitigating axonal degeneration may provide a uniquely beneficial approach to treating patients suffering from the effects of blast-mediated TBI.