Cost-benefit evaluation of routine influenza immunisation in people 65-74 years of age

OBJECTIVES: To determine the cost-effectiveness of influenza vaccination in people aged 65-74 years in the absence of co-morbidity. DESIGN: Primary research: randomised controlled trial. SETTING: Primary care. PARTICIPANTS: People without risk factors for influenza or contraindications to vaccination were identified from 20 general practitioner (GP) practices in Liverpool in September 1999 and invited to participate in the study. There were 5875/9727 (60.4%) people aged 65-74 years identified as potentially eligible and, of these, 729 (12%) were randomised. INTERVENTION: Participants were randomised to receive either influenza vaccine or placebo (ratio 3:1), with all individuals receiving pneumococcal vaccine unless administered in the previous 10 years. Of the 729 people randomised, 552 received vaccine and 177 received placebo; 726 individuals were administered pneumococcal vaccine. MAIN OUTCOME MEASURES AND METHODOLOGY OF ECONOMIC EVALUATION: GP attendance with influenza-like illness (ILI) or pneumonia (primary outcome measure); or any respiratory symptoms; hospitalisation with a respiratory illness; death; participant self-reported ILI; quality of life (QoL) measures at 2, 4 and 6 months post-study vaccination; adverse reactions 3 days after vaccination. A cost-effectiveness analysis was undertaken to identify the incremental cost associated with the avoidance of episodes of influenza in the vaccination population and an impact model was used to extrapolate the cost-effectiveness results obtained from the trial to assess their generalisability throughout the NHS. RESULTS: In England and Wales, weekly consultations for influenza and ILI remained at baseline levels (less than 50 per 100,000 population) until week 50/1999 and then increased rapidly, peaking during week 2/2000 with a rate of 231/100,000. This rate fell within the range of 'higher than expected seasonal activity' of 200-400/100,000. Rates then quickly declined, returning to baseline levels by week 5/2000. The predominant circulating strain during this period was influenza A (H3N2). Five (0.9%) people in the vaccine group were diagnosed by their GP with an ILI compared to two (1.1%) in the placebo group [relative risk (RR), 0.8; 95% confidence interval (CI) = 0.16 to 4.1]. No participants were diagnosed with pneumonia by their GP and there were no hospitalisations for respiratory illness in either group. Significantly fewer vaccinated individuals self-reported a single ILI (4.6% vs 8.9%, RR, 0.51; 95% CI for RR, 0.28 to 0.96). There was no significant difference in any of the QoL measurements over time between the two groups. Reported systemic side-effects showed no significant differences between groups. Local side-effects occurred with a significantly increased incidence in the vaccine group (11.3% vs 5.1%, p = 0.02). Each GP consultation avoided by vaccination was estimated from trial data to generate a net NHS cost of 174 pounds. CONCLUSIONS: No difference was seen between groups for the primary outcome measure, although the trial was underpowered to demonstrate a true difference. Vaccination had no significant effect on any of the QoL measures used, although vaccinated individuals were less likely to self-report ILI. The analysis did not suggest that influenza vaccination in healthy people aged 65-74 years would lead to lower NHS costs. Future research should look at ways to maximise vaccine uptake in people at greatest risk from influenza and also the level of vaccine protection afforded to people from different age and socio-economic populations.

Is influenza vaccination cost effective for healthy people between ages 65 and 74 years? A randomised controlled trial

The aim of this study was to determine the cost effectiveness of influenza vaccination for healthy people aged 65-74 years living in the UK. People without risk factors for influenza (chronic heart, lung or renal disease, diabetic, immuno-suppressed or those living in an institution) were identified from 20 general practitioner (GP) practices in Liverpool in September 1999. 729/5875 (12.4%) eligible individuals were recruited and randomised to receive either influenza vaccine or placebo (ratio 3: 1)! with all participants receiving 23-valent-pneumococcal polysaccharide vaccine unless already administered. The primary analysis was the frequency of influenza as recorded by a GP diagnosis of pneumonia or influenza like illness. In 2000, the UK vaccination policy was changed with influenza vaccine becoming available. for all people aged 65 years and over irrespective of risk. As a consequence of this policy change. the study had to be fundamentally restructured and only results obtained over a one rather than the originally planned two-year randomised controlled trial framework were used. Results from 1999/2000 demonstrated no significant difference between groups for the primary outcome (relative risk 0.8, 95%, CI 0.16-4.1). In addition. there were no deaths or hospitalisations for influenza associated respiratory illness in either group. The subsequent analysis. using both national and local sources of evidence, estimated the following cost effectiveness indicators: (1) incremental NHS cost per GP consultation avoided = pound2000; (2) incremental NHS cost per hospital admission avoided = pound61,000: (3) incremental NHS cost per death avoided = pound1.900.000 and (4) incremental NHS cost per QALY gained = pound304,000. The analysis suggested that influenza vaccination in this Population would not be cost effective. (C) 2004 Elsevier Ltd. All rights reserved.

Meta-analysis of the INSIG2 association with obesity including 74,345 individuals: does heterogeneity of estimates relate to study design?

The INSIG2 rs7566605 polymorphism was identified for obesity (BMI> or =30 kg/m(2)) in one of the first genome-wide association studies, but replications were inconsistent. We collected statistics from 34 studies (n = 74,345), including general population (GP) studies, population-based studies with subjects selected for conditions related to a better health status ('healthy population', HP), and obesity studies (OB). We tested five hypotheses to explore potential sources of heterogeneity. The meta-analysis of 27 studies on Caucasian adults (n = 66,213) combining the different study designs did not support overall association of the CC-genotype with obesity, yielding an odds ratio (OR) of 1.05 (p-value = 0.27). The I(2) measure of 41% (p-value = 0.015) indicated between-study heterogeneity. Restricting to GP studies resulted in a declined I(2) measure of 11% (p-value = 0.33) and an OR of 1.10 (p-value = 0.015). Regarding the five hypotheses, our data showed (a) some difference between GP and HP studies (p-value = 0.012) and (b) an association in extreme comparisons (BMI> or =32.5, 35.0, 37.5, 40.0 kg/m(2) versus BMI<25 kg/m(2)) yielding ORs of 1.16, 1.18, 1.22, or 1.27 (p-values 0.001 to 0.003), which was also underscored by significantly increased CC-genotype frequencies across BMI categories (10.4% to 12.5%, p-value for trend = 0.0002). We did not find evidence for differential ORs (c) among studies with higher than average obesity prevalence compared to lower, (d) among studies with BMI assessment after the year 2000 compared to those before, or (e) among studies from older populations compared to younger. Analysis of non-Caucasian adults (n = 4889) or children (n = 3243) yielded ORs of 1.01 (p-value = 0.94) or 1.15 (p-value = 0.22), respectively. There was no evidence for overall association of the rs7566605 polymorphism with obesity. Our data suggested an association with extreme degrees of obesity, and consequently heterogeneous effects from different study designs may mask an underlying association when unaccounted for. The importance of study design might be under-recognized in gene discovery and association replication so far.

Cocrystalline copolyimides of poly(ethylene 2,6-naphthalate)

Copolycondensation of N,N′-bis(2-hydroxyethyl)-biphenyl-3,4,3′,4′-tetracarboxylic diimide (5–25 mol %) with bis(2-hydroxyethyl)-2,6-naphthalate affords a series of cocrystalline, poly(ethylene 2,6-naphthalate) (PEN)-based poly(ester imide)s. The glass transition temperature rises with the level of comonomer, from 118 °C for PEN itself to 148 °C for the 25% diimide copolymer. X-ray powder and fiber diffraction studies show that, when 5 mol % or more of diimide is present, the α-PEN crystal structure is replaced by a new crystalline phase arising from isomorphic substitution of biphenyldiimide for PEN residues in the polymer crystal lattice. This new phase is provisionally identified as monoclinic, C2/m, with two chains per unit cell, a = 10.56, b = 6.74, c = 13.25 Å, and β = 143.0°.

Conformational Properties of Angiotensin II and Its Active and Inactive TOAC-Labeled Analogs in the Presence of Micelles. Electron Paramagnetic Resonance, Fluorescence, and Circular Dichroism Studies

The interaction between angiotensin II (AII, DRVYIHPF) and its analogs carrying 2,2,6,6-tetramethylpiperidine-1-oxyl-4-amino-4-carboxylic acid (TOAC) and detergents-negatively charged sodium dodecyl sulfate (SDS) and zwitterionic N-hexadecyl-N,N-dimethyl-3-ammonio-1-propanesulfonate (HPS)-was examined by means of EPR, CD, and fluorescence. EPR spectra of partially active TOAC(1)-AII and inactive TOAC(3)-AII in aqueous solution indicated fast tumbling, the freedom of motion being greater at the N-terminus. Line broadening occurred upon interaction with micelles. Below SDS critical micelle concentration, broader lines indicated complex formation with tighter molecular packing than in micelles. Small changes in hyperfine splittings evinced TOAC location at the micelle-water interface. The interaction with anionic micelles was more effective than with zwitterionic micelles. Peptide-micelle interaction caused fluorescence increase. The TOAC-promoted intramolecular fluorescence quenching was more, pronounced for TOAC(3)-AII because of the proximity between the nitroxide and Tyr(4). CD spectra showed that although both AII and TOAC(1)-AII presented flexible conformations in water, TOAC(3)-AII displayed conformational restriction because of the TOAC-imposed bend (Schreier et al., Biopolymers 2004, 74, 389). In HPS, conformational changes were observed for the labeled peptides at neutral and basic pH. In SDS, all peptides underwent pH-dependent conformational changes. Although the spectra suggested similar folds for All and TOAC(1)-AII, different conformations were acquired by TOAC(3)-AII. The membrane environment has been hypothesized to shift conformational equilibria so as to stabilize the receptor-bound conformation of ligands. The fact that TOAC(3)-AII is unable to acquire conformations similar to those of native AII and partially active TOAC(1)-AII is probably the explanation for its lack of biological activity. (C) 2009 Wiley Periodicals, Inc. Biopolymers (Pept Sci) 92: 525-537, 2009.

Planejamento agricola a nivel federal : uma analise do periodo - 1960/74

O planejamento do setor agrícola tem como objeti vo básico a integração da agricultura com os demais setores, de modo a permitir uma visão global da economia, facilitar a sele ção de alternativas de prioridades e maximizar a rentabilidade sócio-econômica dos recursos à disposição do setor. A conscientização, cada vez mais crescente, da ne cessidade de adoção do planejamento como técnica que auxilia o atingimento dos objetivos de desenvolvimento nacional é enfoca do no Capítulo I. A partir de 1939; ocorrem várias tentativas de institucionalização do planejamento global no Brasil. Três fa ses são caracterizadas: a do planejamento "Ocasional", a do "Empírico" e a do "Científico". Estas tentativas sao analisa das no Capítulo 11. Os aspectos de conceituação e de princípios do planejamento setorial, num sentido amplo, e des do planejamento setorial agrícola, inclusive guras e etapas são abordados no Capítulo 111. as peculiarid~ os níveis, fi No Capítulo IV são tratados os aspectos de insti tucionalização do planejamento agrícola a nível federal, no p~ ríodo de 1960 a 1974, em três fases distintas: a "ComissionaI" (1960/66), a "Escritorial"(1967/70) e a "Secretarial" (1971/74). No Capítulo V são abordadas as políticas públicas comumente ad~ tadas, enfatizando-se com maior detalhe a política de preços mínimos, por ser a mais contínua do período. Finalmente, no Capítulo VI, são apresentadas as conclus6es, onde se mostra que alguns resultados positivos têm sido alcançados, embora existam, ainda,pontos débeis a serem atacados, tendo em vista a consolidação de uma forte organização para o planejqmento.

"Dos haveres e dos fazeres da reforma administrativa do Estado de Sergipe : (uma analise do discurso modernizante, no periodo l969/74)"

Esta monografia teve a intenção de buscar as razoes pelas quais nem as reformas nem as revoltas e, muito menos, a moder nização conseguem implementar a sua racionalidade tecnicà. Procurou mostrar como essa pretensa racionalidade aparentemente ignora - ou despreza - a rede das relações entre o saber e o poder e, atraves de um estudo de caso, procurou mostrar ainda a superficialidade do discurso modernizante e a falicia da modernização administrativa como vetor de desenvolvimento. Nesse sentido, reconstitui a genealogia d~s relaç~es de força, da estrategia e da titica reformista, utilizando com alguns "riscos" a genealogia do poder de Michel Foucault na ani l1se do discurso desenvolvimentista - modernizante, onde ficou evidenciada a burocratização do saber. Mostra, tambem, como a institucionalização dos .sistemas de administração geral e de planejamento na Administração Pública brasileira teve a pretensao de acelerar o da sociedade disciplinar. fortalecimento Pinalmente, deixa assinalado que o processo de burocratizaçãolevou o saber seculo xx a viver realim~ntando-se num discurso tautológico em detrimento da produção de saber que possibilitasse espaços de ruptura. Exemplifica, mostrando a teoria da modernização aliou um certo tipo de saber a específico campo de exercício de poder.

A ação educativa dos projetos de desenvolvimento de comunidades periféricas no Município de São Luis: 1971-74 e 1976-78: uma visão crítica

O objeto do presente estudo é a descrição e análise dos projetos de desenvolvimento de comunidade implantados em São Luís do Maranhão, pela Secretaria de Educação e Ação Comunitária, nos períodos 1971-74 (Projeto Euterpe) e 1976-78 (Proj eto Desafio), no que se refere à participação das populações carentes da periferia de são Luís na ação educativa dos referidos projetos.

História de uma escola para o povo: projeto João-de-Barro: Maranhão 1967-74

Centrado no contexto político e sócio-econô mico do Estado do Maranhão, o presente trabalho trata da atuação da escola "Jo~o-de-Barro", como proposta oficial de educação para o meio rural, no período 1967/1974. Conce bida como alternativa de solução para os problemas educa cionais, a escola "Jo~o-de-Barro" surgiu num momento de mudanças político-ideológicas e econômicas, propondo in serir o homem no processo de desenvolvimento planejado e determinado pelo Estado.

Condições de saúde bucal e autopercepção de saúde bucal da população do grupo etário de 65-74 anos da região da serra/Rio Grande do Sul (RS)

Este estudo tem como objetivo compreender a autopercepção das condições de saúde bucal do grupo etário de 65-74 anos da Região da Serra/RS. Utilizou dados do SBBrasil, coletados pela SES/RS. A população final da amostra foi constituída de 618 idosos, sendo 57% de mulheres. Esta coleta foi realizada através de um questionário com questões fechadas sobre dados sócio-demográficos e questões de autopercepção em saúde bucal, bem como de um exame bucal. A análise dos dados foi feita através da regressão logística multinomial. O exame clínico revelou que quase a metade dos idosos está desdentada e classificou sua saúde bucal como boa ou ótima. Em relação a presença de dor, 28,8% dos indivíduos relataram que sentiram dor nos seis meses que antecederam a entrevista. A dor permaneceu estatisticamente associada à classificação da saúde bucal (OR= 2,3; IC95%: 1,24-4,44) e da mastigação (OR=1,9; IC%95: 1,07-3,24). A necessidade de prótese total permaneceu associada, após o ajuste, com a classificação da aparência dos dentes e gengiva (OR=0,3; IC95%: 0,11-0,78), da mastigação (OR=0,2; IC95%: 0,09- 0,46) e da autopercepção da influência da saúde bucal nos relacionamentos (OR=3,4; IC95%: 1,47-7,75). A renda pessoal manteve associação, após o ajuste, com a classificação da fala (OR=4,5; IC95%: 1,34- 15,12). A escolaridade, após o ajuste, manteve associação com a autopercepção da influência da saúde bucal nos relacionamentos (OR=1,9; IC95%: 1,06-3,43). Conclui-se que a dor e a necessidade de prótese total têm forte relação com as questões de autopercepção em saúde bucal.

Efeitos de reguladores e estimulantes vegetais no desenvolvimento do milho (Zea mays L. cv. c-525)

Estudou-se, sob condições de casa de vegetação, o efeito da aplicação de reguladores e estimulantes vegetais no desenvolvimento do milho cultivar Cargill -525. Os reguladores e estimulantes utilizados foram: giberelina 100 ppm, ethephon 600 ppm, Agrostemin 0,8 g/l e Triacontanol 0,5 mg/l; aplicados por pulverização 34 dias após a semeadura, além do controle, foram determinados os parâmetros relativos a altura da planta, número de folhas, área foliar e peso da materia seca de raiz, caule e folhas. A partir dos dados de área foliar e peso da matéria seca total obtidos em 4coletas realizadas com intervalos de 14 dias, foram calculadas a taxa assimilatória líquida (TAL), taxa de crescimento relativo (TCR) e razão de área foliar (RAF). Giberelina 100 ppm aumentou inicialmente a altura das plantas de milho, sendo que ethephon 600 ppm reduziu a altura média do milho. 0 número de folhas foi diminuído nas plantas tratadas com giberelina, tendendo a aumentar no tratamento com ethephon. Giberelina reduziu o peso da matéria seca das plantas de milho, sendo que ethephon incrementou o peso de raízes, colmo e folhos. Triacontanol promoveu redução na TAL e na TCR do milho 'Cargill - 525' . Giberelina e ethephon tenderam a diminuir a RAF das plantas de Zea mays L.

Effect of silica coating on flexural strength of fiber posts

Purpose: Fiber-reinforced composite (FRC) posts can be air-abraded to obtain good attachment to the resin cement. This study tested the effect of silica coating on the flexural strength of carbon, opaque, and translucent quartz FRC posts. Materials and Methods: Six experimental groups of FRC posts (n = 10 per group) were tested, either as received from the manufacturer or after chairside silica coating (30-μm CoJet-Sand). Results: There was no significant difference in the flexural strength of nonconditioned (504 to 525 MPa) and silica-coated (514 to 565 MPa) specimens (P > .05) (analysis of variance). The type of post did have a significant effect on flexural strength (P < .05). Conclusion: Chairside silica coating did not affect the flexural strength of both carbon and quartz FRC posts.