Cost-effectiveness analysis of internet-mediated cognitive behavioural therapy for depression in the primary care setting: results based on a controlled trial.

OBJECTIVE: To perform a cost-effectiveness analysis of a randomised controlled trial of internet-mediated cognitive behavioural therapy (ICBT) compared with treatment as usual (TaU) for patients with mild to moderate depression in the Swedish primary care setting. In particular, the objective was to assess from a healthcare and societal perspective the incremental cost-effectiveness ratio (ICER) of ICBT versus TaU at 12 months follow-up. DESIGN: A cost-effectiveness analysis alongside a pragmatic effectiveness trial. SETTING: Sixteen primary care centres (PCCs) in south-west Sweden. PARTICIPANTS: Ninety patients diagnosed with mild to moderate depression at the PCCs. MAIN OUTCOME MEASURE: ICERs calculated as (CostICBT-CostTaU)/(Health outcomeICBT-Health outcomeTaU)=ΔCost/ΔHealth outcomes, the health outcomes being changes in the Beck Depression Inventory-II (BDI-II) score and quality-adjusted life-years (QALYs). RESULTS: The total cost per patient for ICBT was 4044 Swedish kronor (SEK) (€426) (healthcare perspective) and SEK47 679 (€5028) (societal perspective). The total cost per patient for TaU was SEK4434 (€468) and SEK50 343 (€5308). In both groups, the largest cost was associated with productivity loss. The differences in cost per patient were not statistically significant. The mean reduction in BDI-II score was 13.4 and 13.8 units in the ICBT and TaU groups, respectively. The mean QALYs per patient was 0.74 and 0.79 in the ICBT and TaU groups, respectively. The differences in BDI-II score reduction and mean QALYs were not statistically significant. The uncertainty of the study estimates when assessed by bootstrapping indicated that no firm conclusion could be drawn as to whether ICBT treatment compared with TaU was the most cost-effective use of resources. CONCLUSIONS: ICBT was regarded to be as cost-effective as TaU as costs, health outcomes and cost-effectiveness were similar for ICBT and TaU, both from a healthcare and societal perspective. TRIAL REGISTRATION NUMBER: ID NR 30511.

[Extravasation injuries in newborns: our experience about 15 cases]. / Les accidents d'extravasation perfusionnelle chez le nouveau-né : une expérience de 15 cas.

Extravasation injuries are common complications that occur during infusion for diagnostic or therapeutic purposes by the peripheral or central venous catheters. In pediatric settings, iatrogenic extravasations are serious. When they are viewed late, they are sources of functional sequelae. The purpose of this study was to report our experience with the management of iatrogenic extravasations for therapeutic purposes. Between January 2010 and December 2012, fifteen newborns were supported for accidents of infusion of the upper and the lower limbs. The male was mostly affected. The mean age was 3.6days, with extremes of one and nine days. The average birth weight was 2900g. The range was 1200g and 3550g. Serum 10 % glucose and calcium chloride were implicated in all cases. The lesions were seen in the late stages III in six cases and IV in nine cases. The upper limbs were frequently affected. Nine lesions were in the upper limbs and six in the lower limbs. The dorsal surfaces, feet and hands were frequently affected in six and five cases, respectively. Two lesions were in the anterior aspect of the forearm and elbow. Elbows lesions were circular and realized a tourniquet effect. Treatment was conservative in eleven cases: five pro-inflammatory fatty dressings and six alcoholic dressings. The surgery was delayed in four cases. It combined excision-full thickness skin graft, excision-dressing-thin skin grafting, debridement and two-full thickness skin graft for retractable wrist scars. Two deaths were related to associate pathologies. One patient was lost for follow-up. Our results were satisfactory in functional, aesthetic and psychological aspects. Extravasation injuries are serious iatrogenic lesions. If the lesions are seen at an early stage in usual circumstances, in extreme exercise, they are seen late, sometimes at the stage of functional, psychological and cosmetic sequelae. The difficulty of the therapeutic management of these lesions requires prevention through the development of protocols and the permanent training of nursing staff for an efficient practice of infusion.

International and collaborative strategies to enhance genetic health in purebred dogs.

Health problems in pedigree dogs have recently been highlighted in the media worldwide and verified internationally by cynological organisations. Collaborative actions are now needed to deal with both existing and future issues. In this article, potential roles for various stakeholders are discussed and the value of national and international platforms for collaborations is stressed. Development of specific strategies for action must be based on criteria of significance, such as severity, prevalence and inheritance, as well as availability of effective preventive measures. Assessment of options should be founded on evidence from appropriate populations-at-risk and consider broader issues, such as demographics and human-animal interactions. Existing data, such as those from insurance statistics and health surveys, should be used as a reference until representative national/international population-level breed-specific data are available. Key issues and challenges, as well as possible strategies to address them, are discussed.

Rules, regulations, strategies and activities within the Fédération Cynologique Internationale (FCI) to promote canine genetic health.

The structure and aims of the Fédération Cynologique Internationale (FCI) are outlined, with a focus on the rules and regulations that are relevant to breeding and genetic health of dogs. Recently adopted strategies to enhance canine genetic health and activities to counteract exaggerated anatomical features are highlighted. Actions by the FCI regarding recognition of breeds and doping rules, under direct control by cynological organisations, are included, based on their relevance to canine health.

The elimination of the onchocerciasis vector from the island of Bioko as a result of larviciding by the WHO African Programme for Onchocerciasis Control.

The island of Bioko is part of the Republic of Equatorial Guinea and is the only island in the World to have endemic onchocerciasis. The disease is hyperendemic and shows a forest-type epidemiology with low levels of blindness and high levels of skin disease, and the whole population of 68,000 is estimated to be at risk. Control of onchocerciasis began in 1990 using ivermectin and this yielded significant clinical benefits but transmission was not interrupted. Feasibility and preparatory studies carried out between 1995 and 2002 confirmed the probable isolation of the vector on the island, the high vectorial efficiency of the Bioko form of Simulium yahense, the seasonality of river flow, blackfly breeding and biting densities, and the distribution of the vector breeding sites. It was proposed that larviciding should be carried out from January to April, when most of the island's rivers were dry or too low to support Simulium damnosum s.l., and that most rivers would not need to be treated above 500 m altitude because they were too small to support the breeding of S. damnosum s.l. Larviciding (with temephos) would need to be carried out by helicopter (because of problems of access by land), supplemented by ground-based delivery. Insecticide susceptibility trials showed that the Bioko form was highly susceptible to temephos, and insecticide carry was tested in the rivers by assessing the length of river in which S. damnosum s.l. larvae were killed below a temephos dosing point. Regular fly catching points were established in 1999 to provide pre-control biting densities, and to act as monitoring points for control efforts. An environmental impact assessment concluded that the proposed control programme could be expected to do little damage, and a large-scale larviciding trial using ground-based applications of temephos (Abate 20EC) throughout the northern (accessible) part of the island was carried out for five weeks from 12 February 2001. Following this, a first attempt to eliminate the vectors was conducted using helicopter and ground-based applications of temephos from February to May 2003, but this was not successful because some vector populations persisted and subsequently spread throughout the island. A second attempt from January to May 2005 aimed to treat all flowing watercourses and greatly increased the number of treatment points. This led to the successful elimination of the vector. The last biting S. damnosum s.l. was caught in March 2005 and none have been found since then for more than 3 years.

Uptake and kinetic properties of choline and ethanolamine in Plasmodium falciparum

Purpose: The asexual proliferation of Plasmodium; inside the erythrocyte; is accompanied by the synthesis of huge quantities of phosphatidylcholine (PtdCho) and phospha- tidylethanolamine (PtdEtn). These needful phospholipids for the cytoplasmic membrane of the merozoites are provided by the precursors choline and ethanolamine. PtdCho and PtdEtn are synthesized by the parasite because the erythrocyte is unable to do it. In order to assess the dynamism of the phospholipid pathways; we aimed to inves- tigate the respective shape of the uptake of choline and ethanolamine by Plasmodium falciparum. Method: Time-course experiments and kinetic assays were performed respectively with fixed and ranged concentrations of radioactively-labelled choline and ethanolamine. The labelled-precursors were added in the culture of P. falciparum infected-erythrocytes and the incorporated molecules in phospholipids were measured with a scintigraph counter. Result: The results showed that the incorpo- ration of precursors in the infected-erythrocyte occurred with a Michaelis-Menten's kinetic shape. According to the maximum rate (Vmax); the pathway of ethanolamine incorpo- ration was faster than that of choline. Similarly; affinity for ethanolamine was greater than that of choline. Conclusion: Although PtdCho is the major phospholipid in the membrane; this study rules out that the influx of ethanolamine in the infected-erythrocyte; in vivo conditions; is more dynamic than choline

[Immunoquantification of serum lipoprotein(a) in healthy Ivorian subject: a comparative evaluation of two methods]. / Valeurs sériques de la lipoprotéine(a) chez l'Ivoirien présumé sain: étude comparée de deux méthodes de dosage immunochimiques.

We have determined the concentration of Lp(a) in an Ivory Coast population (n=102) using two immunochemical methods: Laurell's monodimensional electro-immunodiffusion (EID) and immunonephelometry (IN). Within-run and between-run precision was respectively 3.07% and 3.97% by IN and 1.52% and 4.48% by EID method. As regard the exactitude, the bias goals in two methods were 3.5% and 3.0% respectively with IN and EID. The two methods were correlated (r=0.84; p=0.006). Mean values of Lp(a) were significantly (p=0.0007) higher by IN than EID: 0.48+/-0.34 g/L versus 0.32+/-0.19 g/L. The Lp(a) distributions were non-Gaussian, skewed towards high values, with median value of 0.47 g/L and 0.32 g/L respectively for IN and EID methods. Therefore, we conclude that although both methods showed a satisfactory precision, and results were correlated, Lp(a) values were higher by INP. Furthermore, mean values of Lp(a) in presumed healthy Ivorian is higher than in Caucasians.

[Lipids and apolipoproteins A1 and B alterations in stroke]. / Lipides et apolipoprotéines A1 et B dans les accidents vasculaires cérébraux.

The purpose of this case-control study was to determine the variations of lipoproteins during stroke in adults from Ivory Coast. The survey included 72 subjects presenting with hemorrhagic stroke and 58 of ischemic stroke, aged of 25 at 93 years. Lipids parameters have been measured by a colorimetric enzymatic method. Apolipoproteins have been determined by immunoturbidimetry. Results showed significant decrease of HDL-cholesterol and apoprotein A1 in patients by comparison with control subjects. More over, an increase of the atherogenicity index expressed as total/HDL-cholesterol or apolipoprotein B /apolipoprotein A1, of the triglycerides and apolipoprotein B has been observed.