Search

Achieving global polio eradication requires that global stakeholders coordinate and cooperate to invest human and financial resources in interventions that prevent virus transmission. Reaching this goal depends on effective tools [...]

Public health budget constraints force policy makers to prioritize resources toward those interventions that yield the highest perceived benefits. Intuitively, it appears optimal to focus resources on affordable interventions against prevalent diseases. However, due to the dynamics of infectious disease eradication, policies focusing on a static perception of priorities may lead to economically suboptimal outcomes. Using a hypothetical two-disease dynamic transmission model, we explore several different decision rules with respect to vaccination policy for eradicable diseases. The simulations show that cost-effectiveness decreases as the extent of priority shifting increases. This model suggests the need for a longer-term dynamic perspective to appropriately recognize costs and benefits of different policies for eradicable diseases. Key words: infectious diseases; disease eradication; health economics; stochastic model; system dynamics; perception delay; benefit-cost analysis History: Received November 5, 2007; accepted September 23, 2008, by Linda V. Green, public sector applications. Published online in Articles in Advance January 28, 2009., 1. Introduction Economic evaluations represent well-accepted tools to help inform decision makers in public health. For example, standardized cost-effectiveness analyses for different public health interventions facilitate allocation of available resources [...]

Objectives. We assessed the costs, risks, and benefits of possible future major policy decisions on vaccination, surveillance, response plans, and containment following global eradication of wild polioviruses. Methods. We developed a decision analytic model to estimate the incremental cost-effectiveness ratios and net benefits of risk management options for polio for the 20-year period and stratified the world according to income level to capture important variability between nations. Results. For low-, lower-middle-, and upper-middle-income groups currently using oral poliovirus vaccine (OPV), we found that after successful eradication of wild polioviruses, OPV cessation would save both costs and lives when compared with continued use of OPV without supplemental immunization activities. We found cost-effectiveness ratios for switching from OPV to inactivated poliovirus vaccine to be higher (i.e., less desirable) than other health investment opportunities, depending on the actual inactivated poliovirus vaccine costs and assumptions about whether supplemental immunization activities with OPV would continue. Conclusions. Eradication promises billions of dollars of net benefits, although global health policy leaders face difficult choices about future policies. Until successful eradication and coordination of posteradication policies, health authorities should continue routine polio vaccination and supplemental immunization activities.

Keywords: sensitivity analysis; uncertainty analysis; cost-effectiveness analysis; economic evaluation; decision analysis; design of experiments; dynamic infection transmission model. 182 Uncertainty and Sensitivity Analyses of a Dynamic Economic Evaluation Model for [...]

The US federal regulations allow institutional review boards (IRBs) to approve pediatric research that does not offer a prospect of direct benefit only when the risks are minimal or when the risks are a minor increase over minimal risk. Data suggest that IRBs may be categorizing as greater than minimal risk many research procedures that qualify, under the federal regulations, as posing no greater than minimal risk to pediatric participants.

The violence and bloodshed in videogames is a source of public outcry and the content in the video games played by adolescents and older children are compared with the rating information provided to consumers by the Entertainment Software Rating Board (ESRB). It was found that a significant amount of content in the Teen-rated video games did not match the ESRB and these videos may be a source of exposure to a wide range of unexpected content.

Air bags in cars appear to be cost-effective when compared to other health interventions. Researchers used a spreadsheet to calculate the cost-effectiveness of air bags in a fleet of 10 million new vehicles over a 20-year period. The analysis included cars with seat belts only, cars with a driver-side air bag and cars with driver and passenger air bags. Adding a driver-side air bag to a car with seat belts led to a cost of $24,000 per quality-adjusted years of life saved (QALY). Adding a passenger-side air bag increased the cost to $61,000 per QALY. These costs could be reduced if infants and children are placed in the back seat., Context.--Motor vehicle crashes continue to cause significant mortality and morbidity in the United States. Installation of air bags in new passenger vehicles is a major initiative in the field of injury prevention. Objective.--To assess the net health consequences and cost-effectiveness of driver's side and front passenger air bags from a societal perspective, taking into account the increased risk to children who occupy the front passenger seat and the diminished effectiveness for older adults. Design.--A deterministic state transition model tracked a hypothetical cohort of new vehicles over a 20-year period for 3 strategies: (1) installation of safety belts, (2) installation of driver's side air bags in addition to safety belts, and (3) installation of front passenger air bags in addition to safety belts and driver's side air bags. Changes in health outcomes, valued in terms of quality-adjusted life-years (QALYs) and costs (in 1993 dollars), were projected following the recommendations of the Panel on Cost-effectiveness in Health and Medicine. Participants.--US population-based and convenience sample data were used. Main Outcome Measure.--Incremental cost-effectiveness ratios. Results.--Safety belts are cost saving, even at 50% use. The addition of driver's side air bags to safety belts results in net health benefits at an incremental cost of $24 000 per QALY saved. The further addition of front passenger air bags results in an incremental net benefit at a higher incremental cost of $61000 per QALY saved. Results were sensitive to the unit cost of air bag systems, their effectiveness, baseline fatality rates, the ratio of injuries to fatalities, and the real discount rate. Conclusions.--Both air bag systems save life-years at costs that are comparable to many medical and public health practices. Immediate steps can be taken to enhance the cost-effectiveness of front passenger air bags, such as moving children to the rear seat. JAMA. 1997:278:1418-1425

Many video games require violent actions, such as killing or injuring an opponent, and this is not necessarily mentioned in the content description. Sixty-four percent of 55 games analyzed involved intentional violence, and 44% of the video games that did not mention violence in the content description involved intentional violence.

Substance use represents an area of critical concern to practicing pediatricians and parents, and numerous studies suggest the prevalence of the depiction of substances in popular media.[1-10] Although the link [...], Objective. To quantify and characterize the depiction of alcohol, tobacco, and other substances in G-rated animated feature films. Method. The content of all G-rated animated feature films released in theaters between 1937 and 2000, recorded in English, and available on videocassette in the United States by October 31, 2000, was reviewed for portrayals of alcohol, tobacco, and other substances and their use. Duration of scenes depicting alcohol, tobacco, or other substances; type of characters using them (good, neutral, or bad); and correlation of amount and type used with character type and movie type were evaluated. Results. Of the 81 films reviewed, 38 films (47%) showed alcohol use (mean exposure: 42 seconds per film; range: 2 seconds to 2.9 minutes) and 35 films (43%) showed tobacco use (mean exposure: 2.1 minutes per film; range: 2 seconds to 10.5 minutes). Analysis of time trends showed a significant decrease in both tobacco and alcohol use over time (both corrected for total screen duration and uncorrected.) No films showed the use of illicit drugs, although 3 films showed characters consuming a substance that transfigured them and 2 films showed characters injected with a drug. Analysis of the correlation of alcohol and tobacco depiction revealed several scenes in which alcohol and tobacco were shown in use in the same scene and that bar scenes in these movies depict a significant amount of drinking, smoking, and violence. Three films contained a message that a character should stop smoking but none contained messages about restricting consumption of alcohol. Conclusions. The depiction of alcohol and tobacco use in G-rated animated films seems to be decreasing over time. Nonetheless, parents should be aware that nearly half of the G-rated animated feature films available on videocassette show alcohol and tobacco use as normative behavior and do not convey the long-term consequences of this use. Pediatrics 2001;107:1369-1374; alcohol, tobacco, children, film, media.

ABBREVIATION. CPSC, US Consumer Product Safety Commission. Mouthing and sucking activity among infants and young children is a very common and necessary part of early childhood behavior that satisfies both [...], Objective. Mouthing behavior in infants and young children [is less than] 3 years old is a poorly quantified yet normal part of early childhood development. Increasingly, safety and risk assessments involving materials that may be mouthed depend on accurate estimates of oral contact time. This study reports the results of an observational study performed to investigate and obtain data on mouthing behavior of objects for children up to 3 years old. Methodology. The study used a standard diary form with instructions for participating parents to observe their child in a normal environment (primarily home), and to document both the type and duration of each item mouthed. Phase I (pilot) consisted of 30 children each observed for 1 day, divided equally between the ages of 0 to 18 months (n = 15) and 19 to 36 months (n = 15), whereas Phase II included more participants (n = 92 aged 0-18 months; n = 95 aged 19-36 months). Phase III included observations for 5 nonconsecutive days over a 2-month period on 168 children between the ages of 3 to 18 months (at study initiation), and focused on total mouthing time of objects, exclusive of pacifiers. Results. The data collected during the first 2 phases were pooled and analyzed together. For all participants between the ages of 0 and 18 months (n = 107), the average daily duration of mouthing objects included: pacifiers (108 minutes), plastic toys (17 minutes), teethers (6 minutes), and other objects (9 minutes). The results for children 19 to 36 months old (n = 110) included: pacifiers (126 minutes), plastic toys (2 minutes), teethers (0 minutes), and other objects (2 minutes). Although no significant difference existed between the 2 age ranges for pacifier mouthing duration, a statistically significant difference was observed for nonpacifier objects. For Phase III, the average daily mouthing time for all objects (excluding pacifiers), based on 5 nonconsecutive days of observation for 168 children, was 36 minutes (n = 793 valid child observation days). Conclusions. Results of this study indicate that mouthing behavior is dependent on age and the types of items that are mouthed. Duration of mouthing varies among children, with some consistently not mouthing any objects and with a very small number mouthing objects for [is greater than] 2 hours a day. The study also revealed wide variability in the types of objects mouthed, including many nontoy objects. Children mouth pacifiers significantly longer than other objects, regardless of age. Significantly increased mouthing time of all nonpacifier objects is reported for children in the 0- to 18-month range compared with the 19- to 36-month range. Pediatrics 2001;107:135-142; toys, mouthing behavior, exposure, young children, mouthing duration.

Objectives. This study assessed the accuracy of driver perceptions of the distance between the driver's nose and the steering wheel of the vehicle as a factor in considering driver disconnection of an airbag contained in the steering wheel for preventing injury to the driver in an accident. Methods. A cross-sectional survey of 1000 drivers was done to obtain perceived and objective measurements of the distance between the driver's nose and the steering wheel of the vehicle. Results. Of 234 drivers who believed that they sat within 12 inches of the steering wheel, only 8 (3%) actually did so, whereas of 658 drivers who did not believe that they sat within 12 inches of the wheel, 14 (2%) did so. Shorter drivers were more likely than taller ones to both underestimate and overestimate their seating distance. Conclusions. Considerable misperception of drivers' distance from the wheel indicates that drivers should objectively measure this distance. (Am J Public Health. 1999;89:1109-1111)

Priority shifting and the dynamics of managing eradicable infectious diseases (p. 650) Managers using simple rules of thumb to allocate resources between different dynamic processes may get suboptimal results. In [...]