An Eco-Epidemiological Study on Zoonotic Cutaneous Leishmaniasis in Central Iran.

BACKGROUND: Leishmaniasis is an expanding neglected tropical disease in the world reporting from 98 countries including Iran. This study focused on eco-epidemiological determinants of the disease following a rapid and unexpected increase of leishmaniasis incidence in a strategic residential district in North-East of Isfahan County, Iran. METHODS: This study was accomplished from Apr 2012 to Jan 2014 in a strategic residential zone in North-East of Isfahan County, Esfahan, Iran. Monthly activity, parity, Leishmania infection and susceptibility tests, were determined on sand flies. Some portion of inhabitants and school children were surveyed to find active or passive cases of leishmaniasis and also wild rodents were collected to determine reservoir host. RESULTS: Totally 5223 sand flies belonging to Phlebotomus and Sergentomyia genus were collected and identified; Ph. papa-tasi was the dominant species and started to appear in May and disappeared in Oct. The majority of living dissected sand flies were unfed and parous. Ph. papatasi showed 4.6% Leishmania infection through direct examination and 39.54% by nested-PCR respectively. Phlebotomus papatasi was susceptible against deltametrin 0.05%. Totally 2149 people were surveyed and incidence and prevalence of zoonotic cutaneous leishmaniasis estimated as 45.39 and 314.40 per 1000 population. Rodents showed 73.91% and 80% Leishmania infection by direct examination and nested-PCR respectively. CONCLUSION: Cutaneous leishmaniasis due to L. major has been established in this area. Rodent control operation and personal protection are highly recommended to control the disease in this focus.

Effects of ownership, subsidization and teaching activities on hospital costs in Switzerland.

This paper explores the cost structure of Swiss hospitals, focusing on differences due to teaching activities and those related to ownership and subsidization types. A stochastic total cost frontier with a Cobb-Douglas functional form has been estimated for a panel of 148 general hospitals over the six-year period from 1998 to 2003. Inpatient cases adjusted by DRG cost weights and ambulatory revenues are considered as two separate outputs. The adopted econometric specification allows for unobserved heterogeneity across hospitals. The results suggest that teaching activities are an important cost-driving factor and hospitals that have a broader range of specialization are relatively more costly. The excess costs of university hospitals can be explained by more extensive teaching activities as well as the relative complexity of the offered medical treatments from a teaching point of view. However, even after controlling for such differences university hospitals have shown a relatively low cost-efficiency especially in the first two or three years of the sample period. The analysis does not provide any evidence of significant efficiency differences across ownership/subsidy categories.

A statistical analysis of pain relief after surgical operations.

OBJECTIVES: Administering pain relief measures requires information about development of post-operative pain. Such information can be obtained from studying the patients' perception of pain. The aim of this study is to develop a statistical model that predicts the level of pain in different periods after the operation and the time effects of analgesics. The results can be used for an effective and timely application of pain medications. METHODS: This paper applies an ordered response model to a sample of 392 observations from 49 patients undergoing orthopedic surgeries. The patients' subjective pain levels have been recorded for several intervals up to 24h after their respective operations. The adopted statistical model accounts for the unobserved heterogeneity among patients through random coefficients. Such heterogeneity could be due to differences in patients' perception of pain as well as their health status and sensitivity. RESULTS: The analysis indicates that post-operative pain gradually increases over time but with a slightly diminishing rate. The results suggest that analgesics are quite effective in containing the development of pain. However, the analgesic effects manifest gradually, at a rate more or less similar to that of post-operative pain. CONCLUSION: Highlighting the importance of pain from both clinical and economic perspectives, the analysis indicates that a timely application of analgesics is crucial for an effective pain relief after surgical operations. In particular, the results indicate that the optimal time of administering analgesics is immediately after the operation. The main policy implication of this finding is that preemptive measures of pain relief could be most effective and should be favored to similar analgesic treatments after the manifestation of pain. The results also show that the post-operative pain risks differ significantly across individual cases, which suggests that case-specific clinical assessments supersede any statistical analysis. The proposed statistical model can be used to identify high-risk categories and explore the variations across different analgesic types.

Estimating the out-of-hospital mortality rate using patient discharge data.

This paper explores the hospital quality measures based on routine administrative data such as patient discharge records. Most of the measures used in the literature are based on in-hospital mortality risks rather than post-discharge events. The in-hospital outcomes are sensitive to the hospital's discharge policy, thus could bias the quality estimates. This study aims at identifying out-of-hospital mortality risks and disentangling discharge and re-hospitalization rates from mortality rates using patient discharge data. It is shown that these objectives can be achieved without post-discharge death records. This is an example of the use of public use administrative data for estimating empirical relations when key dependent variables are not available. Using data on the lengths of hospitalizations and out-of-hospital spells, the mortality rates before and after discharge are estimated for a sample of heart-attack patients hospitalized in California between 1992 and 1998. The results suggest that the quality assessments that ignore the variation of discharge rates among hospitals could be misleading.

Changes in hospital quality after conversion in ownership status.

This paper examines the effects of conversions between For-Profit and Not-For-Profit forms on quality of medical care in California hospitals. The sample includes elderly patients treated in California's private hospitals from 1990 to 1998 for Acute Myocardial Infarction and Congestive Heart Failure. The results suggest that converted hospitals have experienced quality changes before conversion and that ignoring these changes may bias the estimates of conversion effects. Both conversions are found to have some adverse consequences: Hospitals that converted to FP form show an increase in AMI mortality rates, while those converted to NFP status indicate an increase in CHF mortality outcomes.