Cost-effectiveness analysis of prenatal screening and vaccination against hepatitis B virus--the case of Belgium.

The study examines the cost-effectiveness of screening pregnant women in Belgium for the presence of hepatitis B virus (HBV) and of vaccinating the newborns if necessary. The alternative strategy considered is 'doing nothing'. The rate of carriership among a sample of pregnant women in Belgium amounts to 0.67%. If a pregnant woman is a carrier of the virus, there is an average probability of 30% that she will transmit the virus to her newborn. Later in life, this baby will be at risk from serious complications, such as chronic active hepatitis, cirrhosis and primary hepatocellular cancer. However, medical costs will be induced by screening and vaccination campaigns, lab-tests, vaccine costs, etc. On the other hand, resources will be saved by the prevention of severe complications of the disease. However, costs dominate savings, the incremental cost-effectiveness ratio for the screening and vaccination strategy amounting to 583,581 BEF per life-year saved. To check the stability of the cost-effectiveness ratio, a sensitivity analysis has been performed on some crucial parameters: the ratio is found to be sensitive to the prevalence of HBV among pregnant women, to the costs for screening and vaccination and to the discount rate. Increasing the treatment costs for a HBV complication hardly changes the cost-effectiveness ratio.

Cervical cancer screening and detection of genital HPV-infection and chlamydial infection by PCR in different groups of Kenyan women.

A pilot study was conducted in Nairobi, Kenya, to evaluate the feasibility of a larger study on the prevalence of cervical cancer and precancerous lesions and on the role of Sexually Transmitted Diseases (STD) as risk factors for cervical cancer in Kenya. 692 women were screened for cervical cancer by cytology in 3 City Commission family planning clinics and in 1 City Commission STD referral clinic in Nairobi. In one family planning clinic and in the STD clinic, a sample of the participating women (n = 212) was also screened for genital Human Papillomavirus (HPV) and chlamydial infection by Polymerase Chain Reaction (PCR). Of all women screened for cancer, 5.1% had a PAP smear showing mild dysplasia, 1.2% moderate dysplasia and 0.15% severe dysplasia or worse. Of the women screened for genital HPV infection and for chlamydial infection, the following results can be reported: in women attending the family planning clinic, HPV-DNA was detected in 3.7% (0.9% HPV6/11 and 2.8% HPV 16/18/31/33) and Chlamydia trachomatis in 6.4%; in women attending the STD clinic, HPV-DNA was detected in 16.5% (1% HPV6/11 and 2.8% HPV 16/18/31/33) and Chlamydia trachomatis in 4%. A significantly higher frequency of HPV-infection was observed in the STD clinic, while this was not the case for chlamydial infection.

Daily chromium intake by infants in Belgium.

The chromium content of human breast milk, infant formulae, cow's milk and beikost was measured by graphite furnace atomic absorption spectrometry following different digestion steps. No significant variation in chromium concentration during lactation was found. The mean concentration was 0.18 ng/ml. The daily chromium intake for Belgian infants of 3 months of age using different types of food was estimated. Exclusively breast fed infants consumed 0.1 microgram/day, while for infants fed cow's milk the intake was five times higher. The exclusive use of commercial infant formulas resulted in an intake of 2 up to 10 micrograms chromium a day.

Lead pollution in Antwerpen, Belgium.

Environmental pollution by trace metals was found to be important in the vicinity of a smelter situated in Hoboken, a suburb of Antwerpen, Belgium. Lead content of surface soil ranged from 147-693 ppm, while dust samples contained up to 7% of lead. The annual average ambient air concentration decreased from 3.79 micrograms Pb/m3 in 1974 to 1.25 micrograms Pb/m3 in 1982. Lead deposition in fall-out samples was about 20 mg/m2/day at 500 m from the smelter. In 1978 the mean blood lead level of 11-13 years old children was 26.9 micrograms/100 ml within 1 km from the smelter, compared to 16.3 micrograms/100 at 2.5 km and 11.2 micrograms/100 ml in a rural control group. Younger children even proved to be at higher risk of lead impregnation. Out of 359 children, 3-12 years old, attending schools within 1 km of the smelter, 23 belonged to class III of the CDC risk classification and 3 to class IV. 17 of them showed reduced nerve conduction velocities. The mean dentine lead level of 51 exposed children was 31.94 +/- 6.98 ppm compared to 9.63 +/- 1.50 ppm in an urban control group. A programme aimed at reducing exposure was enforced: reduction of emission and wind blown dust from ore-piles, decontamination of houses and soils, closing down of schools near the smelter, motivation of families for moving away from the area, screening of the children, etc. Although an important reduction of ambient air lead levels could be realized, lead deposition did not decrease significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

The selenium status of Belgian population groups : I. Healthy adults.

A moderate level of selenium (Se) was demonstrated in the blood (123 ng/mL), erythrocytes (RBC) (161 ng/mL), and plasma (97 ng/mL) of 110 male and 54 healthy female Belgian adults by using hydride-generation atomic absorption spectrometry. These values agree well with those found in neighboring countries. The study is the first one to report on normal values for these parameters in Belgians.Glutathione peroxidase (GSH-Px) activity has also been assayed. The group in considered nondeficient. Neither the concentration of Se in blood, plasma, or RBC, nor the activity of GSH-Px in the latter, were related to age, sex, blood pressure, or smoking habits. Oral contraception was associated with elevated plasma Se levels as compared to controls (P<0.01).A statistically significant positive relationship existed between the Se concentrations in whole blood or in red blood cells and red blood cell GSH-Px activity (r=0.31,p<0.005).

The selenium status of Belgian population groups : II. Newborns, children, and the aged.

The selenium state of 40 elderly Belgian people, residing in geriatric homes, has been evaluated. Data are presented on the selenium (Se) contents of their blood, plasma, and erythrocytes. The activity of glutathione peroxidase (GSH-Px) has been assayed. All data were compared with those obtained for 164 young, working adults as presented in Part I of this study. Plasma selenium levels were significantly lower in the old (73 ng/mL) as compared to the young people (97 ng/mL), but erythrocyte Se levels (200 ng/mL) and GSH-Px activity were significantly higher.The selenium concentration in plasma during infancy has also been estimated. The results reveal a very low Se level during the first months of life, with a gradual increase with age. The results are discussed in the light of literature data.

Serological evidence for syphilis in different population groups in Rwanda.

The prevalence of serological syphilis, based on qualitative VDRL slide test was studied in different population groups in Rwanda. A positive VDRL was found in 0.7% of female students of a social school, in 2.2% of male and female premarital consultants, in 3.2% of prenatal consultants, in 6.5% of soldiers, and in 27.9% of prostitutes. As the first groups were not exposed to venereal disease, VDRL reactivity due to biological false positive reaction or to yaws antecedents is estimated at 0.5 to 2%. Accordingly, VDRL reactivity due to syphilis is estimated at 1 to 2% in prenatal consultants, 5 to 6% in soldiers and 25 to 26% in prostitutes. It is concluded that syphilis is not yet an important public health problem except in certain promiscuous population groups in towns, as soldiers, migrant workers and prostitutes.

The electrocardiogram of athletes. Comparison with untrained subjects.

The resting electrocardiograms of 30 cyclists currently involved in competitive sport were compared with those of an equal number of healthy controls matched for age, height, and weight. The cyclists had significantly lower heart rates, longer PQ,QRS, and QTc intervals, higher T waves in lead II, left axis deviation of the T wave, higher R waves in the right and deeper S waves in the left praecordial leads, and deeper S waves in the right and higher R waves in the left praecordial leads.The possible significance of these findings should be assessed by prolonged prospective studies in athletes and untrained control subjects.