The Budget Impact of Oral Nutritional Supplements for Disease Related Malnutrition in Elderly in the Community Setting

A health economic analysis was performed to assess the economic impact on the national health care budget of using oral nutritional supplements (ONS), being a food for special medical purposes also known as medical nutrition, for the treatment of disease related malnutrition (DRM) in the community in the Netherlands. An economic model was developed to calculate the budget impact of using ONS in community dwelling elderly (>5 years) with DRM in the Netherlands. The model reflects the costs of DRM and the cost reductions resulting from improvement in DRM due to treatment with ONS. Using ONS for the treatment of DRM in community dwelling elderly, leads to a total annual cost savings of € 13 million (18.9% savings), when all eligible patients are treated. The additional costs of ONS (€ 57 million) are more than balanced by a reduction of other health care costs, e.g., re-/hospitalization (€ 70 million). Sensitivity analyses were performed on all parameters, including duration of treatment with ONS and the prevalence of DRM. This budget impact analysis shows that the use of ONS for treatment of DRM in elderly patients in the community may lead to cost savings in the Netherlands

Application of the Convection–Dispersion Equation to Modelling Oral Drug Absorption

Models of systemic drug absorption after oral administration are frequently based on a direct or a delayed first-order rate process. In practice, the use of the first-order approach to predict drug concentrations in blood plasma frequently yields a considerable mismatch between predicted and measured concentration profiles. This is particularly true for the upswing of the plasma concentration after oral administration. The current investigation explores an alternative model to describe the absorption rate based on the convection–dispersion equation describing the transport of chemicals through the GI tract. This equation is governed by two parameters, transport velocity and dispersion coefficient. One solution of this equation for a specific set of initial and boundary conditions was used to model absorption of paracetamol in a 22-year-old man after oral administration. The GI-tract passage rate in this subject was influenced by co-administration of drugs that stimulate or delay gastric emptying. The transport-limited absorption function is more accurate in describing the plasma concentration versus time curve after oral administration than the first-order model. Additionally, it provides a mechanistic explanation for the observed curve through the differences in GI-tract passage rate

Pharmacokinetic Modeling of Non-Linear Brain Distribution of Fluvoxamine in the Rat

Introduction. A pharmacokinetic (PK) model is proposed for estimation of total and free brain concentrations of fluvoxamine. Materials and methods. Rats with arterial and venous cannulas and a microdialysis probe in the frontal cortex received intravenous infusions of 1, 3.7 or 7.3 mg.kg j1 of fluvoxamine. Analysis. With increasing dose a disproportional increase in brain concentrations was observed. Th

Risicoschatting van deoxynivalenol in voedsel. Blootstelling en effecten in Nederland

This report describes a risk assessment of deoxynivalenol (DON) in food in the Netherlands. Based on monitoring data of DON in wheat and wheat containing food products (sampling period September 1998 - January 2000) and data on the food consumption pattern in the Netherlands we carried out a probabilistic exposure assessment. Young children showed the highest relative intake. The probabilistic effect assessment indicated that considering the 95th percentile of DON-intake of one-year-olds health effects might occur. At the then occurring exposure levels of DON in children, suppressive effects on body weights (growth retardation) and relative liver weight are estimated at 2.2 and 2.7%. However, large confidence intervals around these estimates exist indicating that the magnitudes of these effects are uncertain. Whether such estimated effect levels are considered (un)acceptable, is a matter of debate and forms part of the risk management process. The probabilistic effect assessment is based on extrapolation of observations in animal experiments to humans. At present, there is no evidence (yet) that the estimated effects will occur in the human population.De probabilistische blootstellingsschatting van deoxynivalenol (DON) werd uitgevoerd aan de hand van de monitoringsgegevens van DON in tarwe en tarwebevattende voedingsmiddelen (monsternameperiode sept. 1998 - jan. 2000) en de gegevens over het consumptiepatroon in Nederland. De inname van DON in Nederland in de betreffende periode overschreed de voorlopige TDI van 1.1 ug per kg lichaamsgewicht, met name in kinderen. Brood vormt de belangrijkste bron van DON. Bij eenjarigen vormt ook pap een belangrijke bron van DON inname. De probabilistische effectschatting toonde aan dat, uitgaande van het 95e percentiel van DON-inname bij eenjarigen, gezondheidseffecten mogelijk zijn. Bij dit innameniveau worden de suppressieve effecten op het lichaamsgewicht (groeivertraging) en het relatieve levergewicht geschat op respectievelijk 2.2 en 2.7%. De betrouwbaarheidsintervallen zijn echter groot, hetgeen aangeeft dat de grootte van deze effecten onzeker zijn. Of de geschatte effectniveaus (on)acceptabel zijn is voor discussie vatbaar en maakt onderdeel uit van het risico'management' proces. De probabilistische effectschatting is gebaseerd op extrapolatie van observaties in proefdieronderzoek. Momenteel bestaat er (nog) geen evidentie dat dergelijke effecten zullen optreden in de humane populatie

Risicoschatting van deoxynivalenol in voedsel. Blootstelling en effecten in Nederland

De probabilistische blootstellingsschatting van deoxynivalenol (DON) werd uitgevoerd aan de hand van de monitoringsgegevens van DON in tarwe en tarwebevattende voedingsmiddelen (monsternameperiode sept. 1998 - jan. 2000) en de gegevens over het consumptiepatroon in Nederland. De inname van DON in Nederland in de betreffende periode overschreed de voorlopige TDI van 1.1 ug per kg lichaamsgewicht, met name in kinderen. Brood vormt de belangrijkste bron van DON. Bij eenjarigen vormt ook pap een belangrijke bron van DON inname. De probabilistische effectschatting toonde aan dat, uitgaande van het 95e percentiel van DON-inname bij eenjarigen, gezondheidseffecten mogelijk zijn. Bij dit innameniveau worden de suppressieve effecten op het lichaamsgewicht (groeivertraging) en het relatieve levergewicht geschat op respectievelijk 2.2 en 2.7%. De betrouwbaarheidsintervallen zijn echter groot, hetgeen aangeeft dat de grootte van deze effecten onzeker zijn. Of de geschatte effectniveaus (on)acceptabel zijn is voor discussie vatbaar en maakt onderdeel uit van het risico'management' proces. De probabilistische effectschatting is gebaseerd op extrapolatie van observaties in proefdieronderzoek. Momenteel bestaat er (nog) geen evidentie dat dergelijke effecten zullen optreden in de humane populatie.This report describes a risk assessment of deoxynivalenol (DON) in food in the Netherlands. Based on monitoring data of DON in wheat and wheat containing food products (sampling period September 1998 - January 2000) and data on the food consumption pattern in the Netherlands we carried out a probabilistic exposure assessment. Young children showed the highest relative intake. The probabilistic effect assessment indicated that considering the 95th percentile of DON-intake of one-year-olds health effects might occur. At the then occurring exposure levels of DON in children, suppressive effects on body weights (growth retardation) and relative liver weight are estimated at 2.2 and 2.7%. However, large confidence intervals around these estimates exist indicating that the magnitudes of these effects are uncertain. Whether such estimated effect levels are considered (un)acceptable, is a matter of debate and forms part of the risk management process. The probabilistic effect assessment is based on extrapolation of observations in animal experiments to humans. At present, there is no evidence (yet) that the estimated effects will occur in the human population.VW

Profiling the subjective effects of 9-tetrahydrocannabinol using visual analogue scales

Stress-related psychiatric disorders across the life spa