Use and cost of hospital and community service provision for children with HIV infection at an English HIV referral centre

Objective: To describe the use of hospital and community services for children infected with HIV and estimate the cost per patient-year by stage of HIV infection during the era of antiretroviral monotherapy. Design: Data on the use of hospital services were collected from case notes; the use of statutory and nonstatutory community services was recorded through diaries and interviews. Total cost estimates were calculated from unit costs from relevant hospital departments and community organisations. Setting: Children managed at St. Mary’s Hospital (London, England) between 1 January 1986 and 31 December 1994, some of whom used statutory and nonstatutory community services in South East England between 1 November 1994 and 31 May 1996. Patients and participants: 118 children with positive HIV antibody status. Main outcome measures and results: Mean inpatient days, outpatient visits, tests and procedures performed, drugs prescribed, community services used, associated unit costs and average cost estimates per patient-year by stage of HIV infection (1995/1996 values), and lifetime costs. Service provision during the study period was predominantly hospital-based. The use of services increased for different stages of HIV infection and increased with increasing severity of HIV infection. A shift from an inpatient-based to an outpatient-based service was seen between the periods 1986 to 1991 and 1992 to 1994. As symptoms evolved, children used more hospital inpatient services, with an accompanying shift in the use of community services from general services, such as schooling, to increased use of nurses, social care and home help. The estimated total cost of hospital and community care was £18 600 per symptomatic non-AIDS patient per year and £46 600 per AIDS patient per year. Similar estimates for children with indeterminate HIV infection and asymptomatic infection amounted to £8300 and £4800 per patient-year, respectively. Nondiscounted lifetime costs for hospital care amounted to £152 400 (£44 300 to £266 800) compared with discounted lifetime costs of £122 700 (£42 000 to £182 200); nondiscounted lifetime costs for community care amounted to £24 300 (£7900 to £41600) compared with discounted lifetime costs of £21 000 (£6800 to £32 000). Conclusions: The continued emphasis on the use of hospital services may be due to the small number of children infected with HIV, most of whom lived in the London metropolitan area where specialist care was concentrated in a few centres. A shift from an inpatient- to an outpatient-based service was observed over time; the advent of the use of combination antiretroviral therapy in this population may further facilitate a shift in service provision and promote shared care between specialist centres, local hospitals and community-based services

Effects of age on arterial stiffness and central blood pressure after an acute bout of resistance exercise

Purpose To investigate the influence of age on arterial stiffness and blood pressure after performing a resistance exercise bout. Methods Recreationally active men were separated into young (YG, n = 12, 26.5 ± 3.3 years), middle (MG, n = 14, 49.4 ± 5.7 years), and old (OG, n = 10, 67.4 ± 6.3 years)-aged groups. In a randomized cross-over design, participants performed control and exercise conditions with at least 3 days separating conditions. The exercise condition consisted of leg press, chest press, knee flexion, lat pulldown and knee extension at ~65 % one-repetition maximum for three sets of 10 repetitions. Brachial and central blood pressures, augmented pressure, augmentation index, central and peripheral pulse wave velocities were measured prior to each condition and starting at 5 min post-exercise. Results Brachial systolic blood pressure (SBP) significantly increased similarly after exercise for all age groups (YG, 8 ± 8 mmHg; MG, 5 ± 5 mmHg; OG, 5 ± 6 mmHg; p \u3c 0.05). However, central SBP did not significantly increase for any age group after exercise. Augmentation index significantly increased after exercise only in the YG (11 ± 8 %, p \u3c 0.05). Central pulse wave velocity did not significantly increase in any age group after exercise when compared to the control condition. Conclusions When performing a whole body moderate resistance exercise bout, acute changes in arterial stiffness and blood pressure appear to be minimally affected by age

Dealing with Work Stress and Strain: Is the Perception of Support more Important than its Use?

The authors conducted a study of the relationship between the perception and use of support in one's work environment and their effects on perceived stress and strain. The analytic sample consisted of 480 social workers drawn from a national directory, who answered a 1O-page questionnaire with items addressing burnout and social support. The resulting data indicate that those who used existing support systems within their organizations generally reported benefiting from this, although the use of support does not necessarily result in positive outcomes. The study also indicated that one is more likely to use support if one perceives the work environment to be supportive. Implications for organizations and individuals are presented.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67367/2/10.1177_0021886388242005.pd

New Modalities for Challenging Targets in Drug Discovery

An ever increasing understanding of biological systems is providing a range of exciting novel biological targets whose modulation may enable novel therapeutic options in many diseases. These targets include protein-protein and protein-nucleic acid interactions, which are, however, often refractory to classical small molecule approaches. Other types of molecules, or modalities, are therefore required to address these targets, which has led several academic research groups and pharmaceutical companies to increasingly use the concept of so-called 'New Modalities'. This review defines for the first time the scope of this term, which includes novel peptidic scaffolds, oligonucleotides, hybrids, molecular conjugates as well as new uses of classical small molecules. We provide herein a journey through the most representative examples of these modalities to target large binding surface areas such as those found in protein-protein interactions and for biological processes at the center of cell regulation