The Effect of Social Mixing Controls on the Spread of Smallpox - A Two-Level Model

Health Care Management Science, V. 8, No. 4, pp 277-289.Responding to a possible bioterror attack of Smallpox has become a major concern to governments, local public officials and health authorites. This concern has been reflected in numerous studies that model and evaluate possible response strategies. Many of these studies consider only vaccination policies and assume homogeneous mixing, where all instances of contacts in the population are equally like;y. Such a mixing pattern is rather unlikely to represent population interaction in a modern urban setting, which typically is separated into households on the one hand, and into daily meeting sites such as schools and offices on the other hand. In this paper we develop a two-level social interaction model where an individual moves back and forth between home and a daily meeting site, possibly passing through a general meeting site such as mass transit systems or other crowded areas. Based on the model, we evaluate the effect of social mixing controls, situational awareness of the public health system and mass vaccination on the spread of smallpox. It is shown that mixing controls and alertness of the response system may have a significant impact on the spread of the epidemic. Some policy recommendations are discussed

Comparison of atovaquone (566C80) with trimethoprim-sulfamethoxazole to treat Pneumocystis Carinii pneumonia in patients with aids

Background. Both trimethoprim-sulfamethoxazole and pentamidine are effective as treatments for Pneumocystis carinii pneumonia, but adverse effects frequently limit their use. Atovaquone (566C80) is a new hydroxynaphthoquinone with activity against P. carinii. Methods. We conducted a double-blind, multicenter study in patients with the acquired immunodeficiency syndrome and mild or moderately severe P. carinii pneumonia. They were randomly assigned to 21 days of orally administered treatment three times daily with either atovaquone (750 mg) or trimethoprim (320 mg) plus sulfamethoxazole (1600 mg). Results. Of the 322 patients with histologically confirmed P. carinii pneumonia, 160 received atovaquone and 162 received trimethoprim-sulfamethoxazole. Of those who could be evaluated for therapeutic efficacy, 28 of 138 patients given atovaquone (20 percent) and 10 of 146 patients given trimethoprim-sulfamethoxazole (7 percent) did not respond (P = 0.002). Treatment-limiting adverse effects required a change of therapy in 11 patients in the atovaquone group (7 percent) and 33 patients in the trimethoprim-sulfamethoxazole group (20 percent) (P = 0.001), Therapy involving only the initial drug was successful and free of adverse effects in 62 percent of those assigned to atovaquone and 64 percent of those assigned to trimethoprim-sulfamethoxazole. Within four weeks of the completion of treatment, there were 11 deaths in the atovaquone group (4 due to P. carinii pneumonia) and 1 death in the trimethoprim-sulfamethoxazole group (P = 0.003). Diarrhea at entry was associated with lower plasma drug concentrations (P = 0.009), therapeutic failure (P<0.001), and death (P<0.001 ) in the atovaquone group but not in the trimethoprim-sulfamethoxazole group. Conclusions. For the treatment of P. carinii pneumonia, atovaquone is less effective than trimethoprim-sulfamethoxazole, but it has fewer treatment-limiting adverse effects.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Corticosteroids as adjunctive therapy for pneumocystis pneumonia in patients with aids

To the Editor: The National Institutes of Health (NIH)—University of California Expert Panel has concluded (Nov. 22 issue)1 that early adjunctive corticosteroid therapy benefits patients with moderate-to-severe Pneumocystis carinii pneumonia. The consensus panel has recommended the regimen used by the California Collaborative Treatment Group, which provides an initial daily dose of 80 mg of oral prednisone, tapered to 20 mg during a 21-day course.2 An alternative approach, not studied in any of the recent trials, was used by my colleagues and me in one of the early reports of successful adjunctive corticosteroid therapy for P. carinii pneumonia.3 Three patients had. © 1991, Massachusetts Medical Society. All rights reserved.SCOPUS: le.jinfo:eu-repo/semantics/publishe

The Influence of Psychological Variables on Health-Related Quality of Life among HIV-Positive Individuals with a History of Intravenous Drug Use

OBJECTIVE: Intravenous drug use (IDU) remains a prominent pathway of HIV transmission in the United States, though little is know about modifiable factors influencing quality of life among IDUs. The goal of this study was to evaluate the influence of psychological variables (e.g., depression and anxiety) on health related quality of life among HIV-positive individuals with a history of IDU who were enrolled in outpatient treatment for opioid dependence. METHOD: 108 HIV-positive individuals with a history of IDU and participating in current outpatient treatment for opiate dependence who were screened for participation in a depression and adherence study reported sociodemographic data, depressive and anxiety symptoms and health-related quality of life (HRQoL; Multidimensional Health Assessment using the ACTG-SF 21). RESULTS: Multiple regression models controlling for disease stage and background characteristics identified significant negative relationships between General Health Perception and Functioning without Pain for anxiety and depression, and between Role Functioning and Physical Functioning for anxiety. CD4 cell count was significantly related to Physical Functioning only. CONCLUSIONS: Results indicate that distress (both depression and anxiety) contribute significantly to variation in HRQoL over and above the effects of disease variables. Effective depression and anxiety treatment may result in improved overall functioning