ECONOMIC BURDEN OF SALMONELLA INFECTIONS IN THE UNITED STATES

The aim of this study is to evaluate medical expenditures and lost productivity associated with burden of Salmonella infections. We used laboratory confirmed number of Salmonella cases and corresponding multipliers to estimate the burden of illness using the method adopted by Foodborne Diseases Active Surveillance Network (FoodNet) at Centers for Disease Control and Prevention (CDC). The medical costs estimates are retrospective analysis of reimbursement records from MarketScan data. We identified patients with a diagnosis of salmonellosis using ICD-9 CM codes from the MarketScan 1993-2001 databases. Productivity loss from the nonfatal cases of Salmonella was calculated using the distributions of lost workdays and household services due to the illness. Statistical value of life approach was used to estimate the costs due to premature deaths. We also compared the costs for the gastrointestinal salmonellosis to the cost for the invasive salmonellosis. Confidence intervals around the cost estimates were calculated using a Monte Carlo simulation technique. Estimated average economic burden due to Salmonella was $210 per outpatient,$5,797 per inpatient with gastrointestinal infection, $16,441 per impatient with invasive infection and$4.63 million per premature death. Total economic buren due to Salmonella in the United States was estimated at $2.8 billion (95$1.6 to $5.3 billion) annually, which is approximately$2,472 per case of Salmonella infection. The cost estimate is largely driven by the number of premature deaths followed by average cost of hospitalization. Defining the risk factors for fatal outcomes may help target treatment and preventive strategies.Food Consumption/Nutrition/Food Safety,

Dynamic wetting with two competing adsorbates

We study the dynamic properties of a model for wetting with two competing adsorbates on a planar substrate. The two species of particles have identical properties and repel each other. Starting with a flat interface one observes the formation of homogeneous droplets of the respective type separated by nonwet regions where the interface remains pinned. The wet phase is characterized by slow coarsening of competing droplets. Moreover, in 2+1 dimensions an additional line of continuous phase transition emerges in the bound phase, which separates an unordered phase from an ordered one. The symmetry under interchange of the particle types is spontaneously broken in this region and finite systems exhibit two metastable states, each dominated by one of the species. The critical properties of this transition are analyzed by numeric simulations.Comment: 11 pages, 12 figures, final version published in PR

Non-dipole recollision-gated double ionization and observable effects

Using a three-dimensional semiclassical model, we study double ionization for strongly-driven He fully accounting for magnetic field effects. For linearly and slightly elliptically polarized laser fields, we show that recollisions and the magnetic field combined act as a gate. This gate favors more transverse - with respect to the electric field - initial momenta of the tunneling electron that are opposite to the propagation direction of the laser field. In the absence of non-dipole effects, the transverse initial momentum is symmetric with respect to zero. We find that this asymmetry in the transverse initial momentum gives rise to an asymmetry in a double ionization observable. Finally, we show that this asymmetry in the transverse initial momentum of the tunneling electron accounts for a recently-reported unexpectedly large average sum of the electron momenta parallel to the propagation direction of the laser field.Comment: Amended the focus of the paper and discussion. 9 pages, 7 figure

The hidden burden of adult allergic rhinitis : UK healthcare resource utilisation survey

Funding Funding for this survey was provided by Meda Pharma.Peer reviewedPublisher PD

Bimodal release ondansetron for acute gastroenteritis among adolescents and adults: A randomized clinical trial

Importance: Vomiting resulting from acute gastroenteritis is commonly treated with intravenous antiemetics in acute care settings. If oral treatment were beneficial, patients might not need intravenous administered hydration or medication. Furthermore, a long-acting treatment could provide sustained relief from nausea and vomiting. Objective: To determine whether an experimental long-acting bimodal release ondansetron tablet decreases gastroenteritis-related vomiting and eliminates the need for intravenous therapy for 24 hours after administration. Design, Setting, and Participants: This placebo-controlled, double-blind, randomized clinical trial included patients from 19 emergency departments and 2 urgent care centers in the United States from December 8, 2014, to February 17, 2017. Patients 12 years and older with at least 2 vomiting episodes from presumed gastroenteritis in the previous 4 hours and symptoms with less than 36 hours\u27 duration were randomized using a 3:2 active to placebo ratio. Analyses were performed on an intent-to-treat basis and conducted from June 1, 2017, to November 1, 2017. Intervention: Bimodal release ondansetron tablet containing 6 mg of immediate release ondansetron and 18 mg of a 24-hour release matrix for a total of 24 mg of ondansetron. Main Outcomes and Measures: Treatment success was defined as no further vomiting, no need for rescue medication, and no intravenous hydration for 24 hours after bimodal release ondansetron administration. Results: Analysis included 321 patients (mean [SD] age, 29.0 [11.1] years; 195 [60.7%] women), with 192 patients in the bimodal release ondansetron group and 129 patients in the placebo group. Treatment successes were observed in 126 patients in the bimodal release ondansetron group (65.6%) compared with 70 patients in the placebo group (54.3%), with an 11.4% (95% CI, 0.3%-22.4%) absolute probability difference. The proportion of treatment success was 21% higher among patients who received bimodal release ondansetron compared with those who received a placebo (relative risk, 1.21; 95% CI, 1.00-1.46; P = .04). In an analysis including only patients with a discharge diagnosis of acute gastroenteritis and no major protocol violations, there were 123 treatment successes (69.5%) in the bimodal release ondansetron group compared with 67 treatment successes (54.9%) in the placebo group (relative risk, 1.27; 95% CI, 1.05-1.53; P = .01). Adverse effects were infrequent and similar to the known safety profile of ondansetron. Conclusions and Relevance: This randomized clinical trial found that a long-acting bimodal release oral ondansetron tablet was an effective antiemetic among adolescents and adults with moderate to severe vomiting from acute gastroenteritis. The drug benefits extended to 24 hours after administration. Bimodal release ondansetron may decrease the need for intravenous access and emergency department care to manage acute gastroenteritis. Trial Registration: ClinicalTrials.gov identifier: NCT02246439

Future costs in cost-effectiveness analysis: an empirical assessment

To assess the usage of cost-utility analysis (CUA) in oral health interventions and to evaluate the methods used and the reporting quality of CUA in publications on oral health interventions

Traffic-Related Air Pollution and All-Cause Mortality during Tuberculosis Treatment in California.

BackgroundAmbient air pollution and tuberculosis (TB) have an impact on public health worldwide, yet associations between the two remain uncertain.ObjectiveWe determined the impact of residential traffic on mortality during treatment of active TB.MethodsFrom 2000-2012, we enrolled 32,875 patients in California with active TB and followed them throughout treatment. We obtained patient data from the California Tuberculosis Registry and calculated traffic volumes and traffic densities in 100- to 400-m radius buffers around residential addresses. We used Cox models to determine mortality hazard ratios, controlling for demographic, socioeconomic, and clinical potential confounders. We categorized traffic exposures as quintiles and determined trends using Wald tests.ResultsParticipants contributed 22,576 person-years at risk. There were 2,305 deaths during treatment for a crude mortality rate of 1,021 deaths per 10,000 person-years. Traffic volumes and traffic densities in all buffers around patient residences were associated with increased mortality during TB treatment, although the findings were not statistically significant in all buffers. As the buffer size decreased, fifth-quintile mortality hazards increased, and trends across quintiles of traffic exposure became more statistically significant. Increasing quintiles of nearest-road traffic volumes in the 100-m buffer were associated with 3%, 14%, 19%, and 28% increased risk of death during TB treatment [first quintile, referent; second quintile hazard ratio (HR)=1.03 [95% confidence interval (CI): 0.86, 1.25]; third quintile HR=1.14 (95% CI: 0.95, 1.37); fourth quintile HR=1.19 (95% CI: 0.99, 1.43); fifth quintile HR=1.28 (95% CI: 1.07, 1.53), respectively; p-trend=0.002].ConclusionsResidential proximity to road traffic volumes and traffic density were associated with increased all-cause mortality in patients undergoing treatment for active tuberculosis even after adjusting for multiple demographic, socioeconomic, and clinical factors, suggesting that TB patients are susceptible to the adverse health effects of traffic-related air pollution. https://doi.org/10.1289/EHP1699

Allergic Rhinitis and its Associated Co-Morbidities at Bugando Medical Centre in Northwestern Tanzania; A Prospective Review of 190 Cases.

Allergic rhinitis is one of the commonest atopic diseases which contribute to significant morbidity world wide while its epidemiology in Tanzania remains sparse. There was paucity of information regarding allergic rhinitis in our setting; therefore it was important to conduct this study to describe our experience on allergic rhinitis, associated co-morbidities and treatment outcome in patients attending Bugando Medical Centre. This was descriptive cross-sectional study involving all patients with a clinical diagnosis of allergic rhinitis at Bugando Medical Centre over a three-month period between June 2011 and August 2011. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software version 17.0. A total of 190 patients were studied giving the prevalence of allergic rhinitis 14.7%. The median age of the patients was 8.5 years. The male to female ratio was 1:1. Adenoid hypertrophy, tonsillitis, hypertrophy of inferior turbinate, nasal polyps, otitis media and sinusitis were the most common co-morbidities affecting 92.6% of cases and were the major reason for attending hospital services. Sleep disturbance was common in children with adenoids hypertrophy (χ2 = 28.691, P = 0.000). Allergic conjunctivitis was found in 51.9%. The most common identified triggers were dust, strong perfume odors and cold weather (P < 0.05). Strong perfume odors affect female than males (χ2 = 4.583, P = 0.032). In this study family history of allergic rhinitis was not a significant risk factor (P =0.423). The majority of patients (68.8%) were treated surgically for allergic rhinitis co morbidities. Post operative complication and mortality rates were 2.9% and 1.6% respectively. The overall median duration of hospital stay of in-patients was 3 days (2 - 28 days). Most patients (98.4%) had satisfactory results at discharge. The study shows that allergic rhinitis is common in our settings representing 14.7% of all otorhinolaryngology and commonly affecting children and adolescent. Sufferers seek medical services due to co-morbidities of which combination of surgical and medical treatment was needed. High index of suspicions in diagnosing allergic rhinitis and early treatment is recommended