Cost of varicella-related hospitalisations in an Italian paediatric hospital: comparison with possible vaccination expenses.

OBJECTIVE: The aims of the study were to evaluate the economic burden of hospitalisations due to varicella in an Italian paediatric hospital during a 1-year period and to compare the data with potential expenses projected for a varicella mass vaccination programme. RESEARCH DESIGN AND METHODS: An observational, retrospective, cohort study was designed to measure hospital admission costs in a cohort of paediatric patients with varicella in a 12-month period. A cost comparison with a vaccination programme planned to prevent varicella in a whole birth cohort was performed. All children 0-16 years referred to the Anna Meyer Children's Hospital (AMCH) were considered. Since AMCH is a tertiary-level hospital and accept patients from other Italian regions, in order to avoid overestimation of hospitalisation expenses, all analyses pertaining to both vaccination and hospitalisation costs were uniquely calculated on the basis of the cohort of residents in the district of Florence. RESULTS: A total of 279 children were examined in the emergency department for varicella; 47/279 (16.8%) were sent to the inpatient clinic. The highest rate of hospitalisation (85.1%) was found in children < 4 years of age, and the largest number of complications (87.2%) occurred in previously healthy children. Mean length of hospitalisation (5.7 +/- 0.6 days) was similar to that reported in other western countries. CONCLUSION: Excluding any indirect cost, permanent sequelae and serious outcomes such as death, hospital expenses (corresponding to euro239 654 in a 1-year period), would account for around 80% of total expenses for vaccinating an entire birth cohort (euro310353).

[Pulmonary edema and tocolysis with beta-agonists]. / OEdème pulmonaire et tocolyse par bêta-mimétiques.

It is not unusual for respiratory specialists to be called to deal with respiratory problems in pregnancy. However, some conditions, such as tocolysis-induced pulmonary edema, although common, are largely unknown to our specialty. We report on the cases of three pregnant women, who developed pulmonary edema in the context of tocolysis with the intra-venous infusion of B-agonists. In all three patients, tocolysis was required because contraction developed well before term. Triple pregnancy was present in one patient. In another patient, mechanical ventilation was required. The outcome was good with full recovery in all three cases.

Severe fetal cytomegalic inclusion disease after documented maternal reactivation of cytomegalovirus infection during pregnancy.

Recurrent cytomegalovirus infection during pregnancy is considered less dangerous for the fetus than primary infection. We present a case of severe fetal cytomegalic inclusion disease after maternal reactivation of cytomegalovirus during the first trimester of pregnancy. The possibility of such fetal injury is an argument for prenatal diagnosis in seropositive pregnant women when ultrasonographic findings suggest cytomegalovirus infection.

Image decorrelation for in situ diagnostics of wooden artifacts.

Local decorrelation of speckle patterns scattered by a surface is used for nondestructive evaluation of the state of conservation of wooden artifacts. Some experiments have been carried out on models with simulated internal flaws and on real, ancient, wooden panel paintings. The setup is very simple and can easily be used by nonoptically skilled operators.

[Evaluation of the costs of mammographic screening program in the city of Florence]. / La valutazione dei costi del programma di screening mammografico nella città di Firenze.

This paper investigated differential direct costs determined by the difference between implementation of mammographic screening program for breast cancer detection in the city of Florence (PFD) and the "absence" of the PFD. The involved resources have been identified, quantified and evaluated. The results of the I round (1991/92) of the PFD involve the following different phases: invitations, mass screening, diagnostic assessment. Differential net costs aumonted to 780 million for total cost, and to 53,000 per screened woman. The PFD invited 27,325 women per year; at the I round, the PFD registered an attendance rate of 53.9% and a recall rate of 4.3%, with a total cost of about one thousand million and a cost per screened woman of about L. 64,000. Instead, economic results of alternative "absence" of screening registered a total cost of 170 million and a cost per screened woman of about L. 100,000. Costs for detected cancer amount about to 8.2 million for PFD and 5.7 million for "absence" of the Program. Sensitivity analysis has been performed texting the fundamental parameters of the PFD: attendance rate, recall rate and life time average of the investiments. The sensitivity analysis, performed on the PFD, registered a variation of total cost from 859 million to 1,216 million and a variation of the total cost per woman screened from L. 43,500 to L. 80,000. Sensitivity analysis results highlighted the fundamental role played by women's attendance and by the percentage of women recalled for diagnostic assessment.

A system for the sampling of inhalable airborne particles.

This paper describes an instrument developed for the semi-continuous measurement of aerosol mass and its classification into three classes. These classes have been chosen to evaluate the health hazards caused by inhalable particles. The instrument takes samples through three probes, each providing different cut-off points ( approximately 15 microm, approximately 4 microm, approximately 2 microm) and collects airborne particles on circular membrane filters. The increase in weight is measured by the beta-ray attenuation method.

Measurement of the costs in two mammographic screening programmes in the province of Florence, Italy.

OBJECTIVES: To estimate and to compare the cost per woman examined and per breast cancer detected in two mammographic screening programmes in the province of Florence. SETTING: Two ongoing, population based, mammographic screening programmes in the province of Florence. The first (district project) was started in the seventies in a rural area, whereas the second (city project) was started in the city at the end of 1990. METHODS: All relevant resources consumed by the programmes (costs) were listed and measured. The costs are related to 1993. The unit cost for each phase (recruitment, screening, assessment) of the screening process was estimated by dividing the total cost of the phase by the number of women examined. The cost per cancer detected was obtained by dividing the total cost of the programme by the number of cancers detected at screening. RESULTS: The costs per woman examined were $38.1 and $41.1 in the district and city programmes respectively. The cost per breast cancer detected was $7424 in the district programme and $5180 in the city programme. Staff accounted for more than 50% of the total cost. The unit cost in the screening phase was higher in the district programme, whereas it was lower in the assessment phase. CONCLUSIONS: Our results are consistent with, although slightly lower than, published estimates of the cost per woman screened. Important parameters for determining the efficiency of a mammographic screening programme are the compliance rate and the recall rate.

Artwork diagnostics with fiber-optic digital speckle pattern interferometry.

The possibility of employing a digital speckle pattern interferometer with optical fibers for nondestructive testing of artwork has been evaluated. A simple and accurate fiber-optic interferometer, able to perform real-time measurements in a hostile environment, has been realized with a minimum of optical components and a minimum of adjustments. As a result a deformation map of wooden panel paintings or mural frescoes under thermal stress may be depicted. Experimental results, obtained by the application of this interferometer both to laboratory models and to mural frescoes in situ, are presented.

Clinical investigation on the hypolipidemic effect of simvastatin in primary hypercholesterolemia.

Simvastatin, 20 mg daily, was given orally to 21 hypercholesterolemic outpatients for 16 weeks. During treatment a significant reduction was found in plasma total and LDL cholesterol; plasma HDL-cholesterol levels increased during the treatment. Results indicate that simvastatin, because of its activity and lack of toxicity and side effects, can be considered a drug of first-choice for the treatment of primary hypercholesterolemia.

A planar second-order DC SQUID gradiometer.

In this work we describe a DC SQUID gradiometer, sensitive to the second spatial derivative of the magnetic field. The sensitive area of the gradiometer is the inductive body of the DC SQUID itself. The isoflux line distribution generated by a dipolar source, obtained by performing magnetic measurements with an array of such detectors, is relatively complicated, but its localisation capability is similar to that one usually achieves with axial detector arrays. Planar gradiometers also show a better resolution for near sources and a stronger rejection of far disturbances. The final device is expected to have an inductance of a few hundreds of pH in order to obtain performances typical of a low noise DC SQUID. The pick-up coils will be the combination of four square holes of 500 microns side with a 1.05 cm baseline. Due to the magnetic field concentration (in the final device it can be a factor 10) the gradiometer will have a sensitivity of 10(-11) T m-2 Hz-1/2 and a field sensitivity of about 2 fT Hz-1/2. Some preliminary results, obtained on detectors with an intermediate area between the prototype and final device, are reported here. The process used to fabricate this second-order gradiometer is based on Nb-NbO chi-PbAuIn Josephson tunnel junctions. Some possible improvements will also be described.

Antihypertensive and metabolic effects of nitrendipine in hypertensive diabetic patients.

The subjects were 15 patients, aged 53 to 74 years, with noninsulin-dependent diabetes mellitus and mild to moderate hypertension. Each received 20 to 40 mg of nitrendipine daily for six months. Mean supine blood pressures decreased significantly from 177/102 mmHg before treatment to 164/95 mmHg at three months and continued to decline during the following three months. Diastolic blood pressure was reduced to less than 90 mmHg in eight of the 15 patients. No changes in heart rate, glycemic control (serum levels of glucose, C-peptide, glycosylated hemoglobin, and fructosamine), or serum lipid levels (cholesterol and its lipoprotein fractions, triglycerides, and apolipoproteins A1 and B) were noted. It is concluded that nitrendipine is safe and effective in the treatment of hypertension in diabetic patients.

[Immunopathological syndrome with pleural and systemic localization observed in patients with endocavitary electrostimulators]. / Su una sindrome di tipo immunopatico a localizzazione pleurica e sistemica osservata in portatori di elettrostimolatori endocavitari.

Four cases of recurrent pleural effusion that proved particularly resistant to medico-depletive management were observed in patients with intracavitary pacemakers. The picture included fever, high ESR, intense antismooth muscle antibody movement, serum and pleural liquid L.E. phenomenon and positive rheuma test, and mainly igG hypergammaglobulinaemia. The clinical and laboratory data suggested three pathogenetic explanations: 1) autoimmune disease secondary to surgical denaturation of myocardial, endocardial, venous or muscular autoantigens; 2) systemic autoimmune disease due to congenital or acquired instability of the immunological equilibrium; 3) pleural, monosymptomatic L.E. with delayed and dramatic clinical onset. Some practical considerations are expressed with respect to the syndrome and the position in the future.