Screening for Chlamydia trachomatis: a systematic review of the economic evaluations and modelling

OBJECTIVE: To review systematically and critically, evidence used to derive estimates of costs and cost effectiveness of chlamydia screening. METHODS: Systematic review. A search of 11 electronic bibliographic databases from the earliest date available to August 2004 using keywords including chlamydia, pelvic inflammatory disease, economic evaluation, and cost. We included studies of chlamydia screening in males and/or females over 14 years, including studies of diagnostic tests, contact tracing, and treatment as part of a screening programme. Outcomes included cases of chlamydia identified and major outcomes averted. We assessed methodological quality and the modelling approach used. RESULTS: Of 713 identified papers we included 57 formal economic evaluations and two cost studies. Most studies found chlamydia screening to be cost effective, partner notification to be an effective adjunct, and testing with nucleic acid amplification tests, and treatment with azithromycin to be cost effective. Methodological problems limited the validity of these findings: most studies used static models that are inappropriate for infectious diseases; restricted outcomes were used as a basis for policy recommendations; and high estimates of the probability of chlamydia associated complications might have overestimated cost effectiveness. Two high quality dynamic modelling studies found opportunistic screening to be cost effective but poor reporting or uncertainty about complication rates make interpretation difficult. CONCLUSION: The inappropriate use of static models to study interventions to prevent a communicable disease means that uncertainty remains about whether chlamydia screening programmes are cost effective or not. The results of this review can be used by health service managers in the allocation of resources, and health economists and other researchers who are considering further research in this area.

Variability of SCCmec in the Zurich area

A periodic survey of methicillin-resistant Staphylococcus aureus (MRSA) in Zurich in 2004 and 2006 revealed a consistently low prevalence of MRSA. SCCmec and ccr typing showed fluctuations in the proportions of SCCmec types and in the carriage of mobile virulence determinants. Together with the presence of variant SCCmecs these findings suggest a high clonal diversity and level of SCCmec recombination. The prevalence of a local "drug clone", associated with low-level methicillin resistance and rapid growth, significantly decreased. This clone had spread among intraveneous drug users, steadily increasing from 1994 to 2001 and was dominant in 2001. Apparently, changes in the management of the Zurich drug scene have restricted the spread of this clone.

Nouvelle méthode d’analyse de l’exploration visuelle

The term visual field corresponds to the angular field of view that is seen by the eyes when they are fixed on a point straight-ahead. In neurological patients--e.g. stroke, trauma, or tumour patients--visual field function can be restricted, depending on lesion site and size. In contrast, the term "functional visual field" describes the area of visual field responsiveness under more ordinary viewing conditions. The visual exploration, i.e. the capacity to explore and analyze our visual world, is dependent on the integrity of the visual system and the oculomotor system which has to move the fovea from one object of interest to the next. In this paper, we present a new method to assess the functional visual field, conceptualized as the area that a patient actively scans with eye movements to detect predefined targets placed on everyday scenes. This method allows us to compare three levels of visual field function: (a) the spatial distribution of successful search (hits, i.e. which targets did the patient find?), (b) the spatial distribution of fixations (i.e. where did the patient preferentially search for targets?), and (c) the retinotopic level (i.e. the visual field assessed by perimetry). By integrating these three levels, one can evaluate functional outcomes of visual field disorders. Of particular importance is the question of how a patient compensates for a visual field loss with appropriate eye movements. A further clinical application of this method is the comparison of pre- with post-treatment data. Patients with visual field disorders usually undergo specific exploration trainings, aimed at enhancing the number and amplitude of saccades towards the region of the visual field deficit. The first experiences and clinical application with this method are presented here.

Consistent nuclear expression of thyroid transcription factor 1 in subependymal giant cell astrocytomas suggests lineage-restricted histogenesis.

Thyroid transcription factor 1 (TTF-1) is encoded by the NKX2-1 homeobox gene. Besides specifying thyroid and pulmonary organogenesis, it is also temporarily expressed during embryonic development of the ventral forebrain. We recently observed widespread immunoreactivity for TTF-1 in a case of subependymal giant cell astrocytoma (SEGA, WHO grade I) – a defining lesion of the tuberous sclerosis complex (TSC). This prompted us to investigate additional SEGAs in this regard. We found tumor cells in all 7 specimens analyzed to be TTF-1 positive. In contrast, we did not find TTF-1 immunoreactivity in a cortical tuber or two renal angiomyolipomas resected from TSC patients. We propose our finding of consistent TTF-1 expression in SEGAs to indicate lineage-committed derivation of these tumors from a regionally specified cell of origin. The medial ganglionic eminence, ventral septal region, and preoptic area of the developing brain may represent candidates for the origin of SEGAs. Such lineagerestricted histogenesis may also explain the stereotypic distribution of SEGAs along the caudate nucleus in the lateral ventricles.

Job-shadowing: Swiss health librarians observing experienced search specialists and information skills trainers in London

Abstract As librarians of the Social & Preventive Medicine Library in Bern, we help researchers perform systematic literature searches and teach students to use medical databases. We developed our skills mainly “on the job”, and we wondered how other health librarians in Europe were trained to become experts in searching. We had a great opportunity to “job shadow” specialists in this area of library service during a 5-day-internship at the Royal Free Hospital Medical Library in London, Great Britain.