Economic impact of epilepsy in the United States.

PURPOSE: To assess differences in medical care expenditures and informal care received for adults and children by individuals' self-reported epilepsy status and to estimate the total economic impact of epilepsy in the United States. METHODS: Pooled medical expenditure panel survey data from 1996-2004 were used. Children's regression analyses were adjusted for race, sex, general self-reported health status, family size, and age. Adults' analyses were also adjusted for income and education. The national annual economic impact was estimated by multiplying the average individual differences by previously published national prevalence data. RESULTS: The results of regressions appropriately weighted to account for study design indicate excess medical expenditures for those with epilepsy of $4,523 [95% confidence interval: $3,184-$5,862]. Excess expenditures were similar for adults and children. Adults with epilepsy received 1.2 extra days of informal care [95% confidence interval: 0.2-2.3]. The national impact included $9.6 billion of medical expenditures and informal care. DISCUSSION: Epilepsy has significant impact on individual medical expenditure and generates a national impact in the billions of dollar.

Evaluation of pathways for release of Rift Valley fever virus into domestic ruminant livestock, ruminant wildlife, and human populations in the continental United States.

OBJECTIVE: To evaluate the feasibility for Rift Valley fever virus (RVFV) to enter the continental United States by various routes as well as to identify states in which domestic and wild ruminant and human populations would be most vulnerable to exposure to RVFV. STUDY DESIGN: Pathways analysis. SAMPLE POPULATION: Animals, commodities, and humans transported from RVFV-endemic countries to the continental United States between 2000 and 2005. PROCEDURES: Initially, agent, host, and environmental factors important in the epidemiologic aspects of RVFV were used to develop a list of potential pathways for release of RVFV into the continental United States. Next, the feasibility of each pathway was evaluated by use of data contained in governmental and public domain sources. Finally, entry points into the continental United States for each feasible pathway were used to identify the domestic and wild ruminant and human populations at risk for exposure to RVFV. RESULTS: Feasible pathways for entry of RVFV into the continental United States were importation of RVFV-infected animals, entry of RVFV-infected people, mechanical transport of RVFV-infected insect vectors, and smuggling of live virus. CONCLUSIONS AND CLINICAL RELEVANCE: Domestic ruminant livestock, ruminant wildlife, and people in 14 states (Alabama, California, Florida, Georgia, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, South Carolina, Texas, and Virginia) appeared to be most vulnerable to exposure to RVFV. Pathways analysis can provide the requisite information needed to construct an effective targeted surveillance plan for RVFV to enable rapid detection and response by animal health and public health officials.

Living Well II: a review of progress since 2003.

Epilepsy as an issue for the public health community has a relatively short history in the United States. Not since the 1970s, when Congress established the Commission for the Control of Epilepsy and Its Consequences and the publication of its formal report, "Plan for Nationwide Action on Epilepsy," has significant attention been paid to the public health implications of epilepsy. In fact, until the U.S. Congress established a small epilepsy program at the Centers for Disease Control and Prevention (CDC) 12 years ago, the condition was practically invisible at all levels of organized public health. Since then, two major conferences, and the recommendations arising from them, have generated a substantially increased level of activity in research, surveillance, and the production and distribution of public education materials, as well as a national initiative to improve access to care and to prevent epilepsy's negative social impact. Even at the state level, long devoid of any attention to epilepsy in public health planning or provision of services, things are beginning to change, and new demonstration programs designed to identify and serve vulnerable populations with epilepsy are underway. This review highlights these activities, reflects a new and heightened level of attention to epilepsy, and speculates on what may lie ahead in the ongoing effort to give epilepsy greater visibility and higher priority in the public health arena.