Search

The aim of this study is to explore whether a time-geographic life charting, combined with a survey of a person's coping capacities over time, elucidates the pathway to suicidal behaviour, and therefore could be useful in suicide prevention. Twenty-three patients were recruited shortly after a suicide attempt. A time-geographic life charting and COPE inventory ratings were used separately and in combination. According to COPE ratings, the participants could be divided into three groups using different coping strategies: (1) adaptive, (2) maladaptive, and (3) both adaptive and maladaptive coping. Within these subgroups, three different pathways to suicidal behaviour were described and illustrated. We conclude that time-geographic life charting used in combination with the pattern of coping strategies may be helpful when assessing risk of suicidal behaviour, because this approach strengthens the comprehensive picture of the patient's life situation. [ABSTRACT FROM AUTHOR]

Summary: We develop a conceptual framework elucidating the main determinants of the impact of Conditional Cash Transfer (CCT) and Payments for Environmental Services (PES) programs. Using a simple multi-agent model and evaluations of existing programs, we show that (1) the share of the population who would meet the program’s conditions in the absence of payments is a powerful predictor of program efficiency, and that (2) program efficiency is eroded by selection bias (people who already meet conditions self-select into the programs at higher rates than others). We then discuss possibilities for increasing efficiency and criteria for evaluating and choosing between CCTs/PES or other policy instruments. [Copyright &y& Elsevier]

Any system to compensate countries for reduced emissions from deforestation and forest degradation (REDD+) requires a historical reference level against which future performance can be measured. Here we examine the possibilities Sri Lanka, a small forest country with limited data on forest carbon stocks, has to get ready for REDD+. We construct a historical reference level using available forest inventory data combined with updated 2008 and 2009 in situ carbon density data for Sri Lankan forests. Furthermore, we use a combination of qualitative and quantitative data to attribute the clearing of Sri Lankan forests in the latest years for which national forest inventory data are available, 1992–1996, to various proximate drivers and to estimate the opportunity cost of forest conservation. We estimate that baseline deforestation emissions in Sri Lanka amounted to 17MtCO2 yr−1 in the 1992–1996 period, but conclude that it is challenging for Sri Lanka to produce a robust and accurate reference level due to the lack of nationally based inventories. We find that the majority of forest clearing (87%) is due to small-scale, rainfed farming, with the two other major drivers being rice and tea cultivation. Further, Sri Lankan revenues from REDD+ participation could be substantial, but they are sensitive to REDD+ policy transaction cost, highly uncertain timber revenues, and particularly the carbon price paid for emission reductions. The latter needs to be higher than $5–10/tCO2 if there are to be substantial incentives for Sri Lanka to participate in REDD+. There is, however, a large gap in the knowledge of deforestation drivers that needs to be filled if Sri Lanka is to formulate an effective policy response to forest degradation in REDD+. For successful REDD+ implementation in Sri Lanka to happen, technological assistance, readiness assistance, and continued political momentum are crucial. [Copyright &y& Elsevier]

Summary Background As moderate to severe psoriasis is a systemic disease with large effects on health-related quality of life, generic measures that include overall health, not only skin involvement, are necessary. Knowledge about the relationship between the generic preference-based EuroQol 5D (EQ-5D) and dermatology-specific measures in psoriasis is limited. Objectives To analyse EQ-5D, the Dermatology Life Quality Index (DLQI) and the Psoriasis Area and Severity Index (PASI) in patients with moderate to severe psoriasis in Swedish clinical practice by demographic characteristics, to compare EQ-5D among patients vs. Swedish population values, and to analyse the relationships between EQ-5D, DLQI and PASI. Methods This observational cohort study was based on PsoReg, the Swedish National Registry for Systemic Treatment of Psoriasis. EQ-5D was compared among patients with psoriasis vs. a defined general population in Sweden, retrieved from a previous study. Relationships between measures were examined with correlation tests and regression analysis. Results In total, 2450 patients (1479 men and 971 women) were included. Median EQ-5D, DLQI and PASI scores were 0·769, 4 and 4·7, respectively. Patients with psoriasis had a significantly lower EQ-5D compared with the defined general population. EQ-5D correlated moderately with DLQI (−0·55) and weakly with PASI (−0·25) ( P < 0·001). Conclusions When assessing psoriasis treatments and making decisions about treatment guidelines and resource allocation, EQ-5D, DLQI and PASI provide a useful set of complementary tools, answering to different needs. If EQ-5D is not included in the original trial the second-best option in cost-effectiveness studies is to use mapping between DLQI and EQ-5D. [ABSTRACT FROM AUTHOR]

Abstract: The land competition between tropical bioenergy plantations and payments for forest carbon conservation (e.g., through an international scheme for Reduced emissions from deforestation and forest degradation, REDD+) is modeled using spatially explicit data on biofuel feedstock (oil palm and sugar cane) suitability and forest biomass carbon stocks. The results show that a price on the (avoided) carbon emissions from deforestation at the same level as those from fossil fuel use makes clearing for high yielding bioenergy crops unprofitable on about 60% of the tropical evergreen forest area. For the remaining 40% deforestation remains the most profitable option. Continued profitability of forest clearing is most pronounced for oil palm bioenergy systems in Latin America and Africa, with REDD+ making deforestation for sugar cane plantations unprofitable on 97% of evergreen forest land. Results are shown to be relatively robust to assumptions regarding potential yields and to the addition of a ‘biodiversity premium’ on land use change emissions. While REDD+ may play an important role in stemming biodiversity loss and reducing carbon emissions from tropical deforestation in the near future, in the longer run reliance on a system that values forests solely for their carbon retention capacities poses a serious risk. It is imperative that the institutions and policies currently being established as part of REDD+ readiness activities are resilient to future changes in the incentive structures facing tropical forest countries due to, e.g., climate policy induced demand for biofuels. [Copyright &y& Elsevier]

Lökk J, Borg S, Svensson J, Persson U, Ljunggren G. Drug and treatment costs in Parkinson's disease patients in Sweden. Acta Neurol Scand: 2012: 125: 142-147. © 2011 John Wiley & Sons A/S. Background - Parkinson's disease (PD) is a chronic neurodegenerative disease expected to cause great costs. The aim of this study was to calculate drug and treatment costs in patients with PD in Sweden. Method - All healthcare contacts of patients with PD in Stockholm County, Sweden, were extracted from registers together with information on reimbursements from the authorities to the caregivers. PD-related costs were calculated together with non-PD-related costs. Cost per patient was calculated and extrapolated to the whole Swedish population, taking population demographics into consideration. In addition, nationwide PD drug sales statistics were included. Results - The PD prevalence of Stockholm County was estimated to 196 per 100,000 inhabitants, resulting in an estimated total of about 22,000 patients with PD in Sweden. The cost per patient was estimated to SEK 76,000 of which drug costs accounted for SEK 15,880. The annual direct costs in patients with PD in Sweden were SEK 1.7 billion in 2009. Conclusion - Our study estimates high direct costs in patients with PD in Sweden, SEK 1.7 billion, 52% for inpatient care, 27% for outpatient care and 21% for drugs. With an ageing population and the medical progress, the financial burden on society will most probably increase in the future. This study might initiate and provide information for discussions about future cost allocations and healthcare priorities. [ABSTRACT FROM AUTHOR]

The objective of this paper was to address the importance of dealing systematically and comprehensively with uncertainty in a budget impact analysis (BIA) in more detail. The handling of uncertainty in health economics was used as a point of reference for addressing the uncertainty in a BIA. This overview shows that standard methods of sensitivity analysis, which are used for standard data set in a health economic model (clinical probabilities, treatment patterns, resource utilisation and prices/tariffs), cannot always be used for the input data for the BIA model beyond the health economic data set for various reasons. Whereas in a health economic model, only limited data may come from a Delphi panel, a BIA model often relies on a majority of data taken from a Delphi panel. In addition, the dataset in a BIA model also includes forecasts (e.g. annual growth, uptakes curves, substitution effects, changes in prescription restrictions and guidelines, future distribution of the available treatment modalities, off-label use). As a consequence, the use of standard sensitivity analyses for BIA data set might be limited because of the lack of appropriate distributions as data sources are limited, or because of the need for forecasting. Therefore, scenario analyses might be more appropriate to capture the uncertainty in the BIA data set in the overall BIA model. [ABSTRACT FROM AUTHOR]

Aims: We compared the prevalence of noise-related artefacts and lesion perception on three-dimensional (3D) CT colonography (CTC) at standard and low radiation doses.Methods: Forty-eight patients underwent CTC (64 x 0.625 mm collimation; tube rotation time 0.5 s; automatic tube current modulation: standard dose 40-160 mA, low dose 10-50 mA). Low- and standard-dose acquisitions were performed in the supine position, one after the other. The presence of artefacts (cobblestone and snow artefacts, irregularly delineated folds) and the presence of polyps were evaluated by five radiologists on 3D images at standard dose, the original low dose and a modified low dose, i.e. after manipulation of opacity on 3D.Results: The mean effective dose was 3.9 +/- 1.3 mSv at standard dose and 1.03 +/- 0.4 mSv at low dose. The number of images showing cobblestone artefacts and irregularly delineated folds at original and modified low doses was significantly higher than at standard dose (P < 0.0001). Most of the artefacts on modified low-dose images were mild. No significant difference in sensitivity between the dose levels was found for polyps > or =6 mm.Conclusions: Reduction of the effective dose to 1 mSv significantly affects image quality on 3D CTC, but the perception of > or =6 mm lesions is not significantly impaired. [ABSTRACT FROM AUTHOR]

Climate policy will create both disincentives and incentives for tropical deforestation. Disincentives if the carbon emissions from forest clearing are priced, as is currently being discussed within the United Nations Framework Convention on Climate Change (UNFCCC); incentives as a price on carbon will increase the demand for carbon-neutral energy sources, including bioenergy, making deforestation for biomass cultivation increasingly profitable. The question is whether the increased cost for forest clearing, through the price on carbon emissions, will be enough to counter-balance the increased profitability of deforestation through the escalating value of agricultural land. In an attempt to answer this question we analyze the profitability of tropical deforestation and subsequent bioenergy production, taking oil palm plantations an an illustrative example. We estimate that deforesting for palm oil bioenergy production is likely to remain highly profitable, even in the face of a price on the carbon emissions from forest clearing. Current efforts to include carbon emissions from tropical deforestation in a future international climate regime, while a step in the right direction, may therefore not suffice as protection for the world's tropical forests. Additional, and stronger, protection measures for the world's tropical forests will still be needed. [ABSTRACT FROM AUTHOR]

Abstract: Recently taping techniques with the primary purpose of altering muscle activity have become a part of clinical physiotherapy practice. A firmly applied tape across the fibres of the vastus lateralis (VL) muscle has been proposed to decrease the VL muscle activity. The primary aim of this study was to assess the effects of an inhibitory muscle tape applied over the vastus lateralis (VL) muscle during stair climbing. Twenty five subjects without lower limb pathology were recruited. Normalised integrated EMG (IEMG) was analysed from VL, vastus medialis obliquus (VMO), biceps femoris (BF) and soleus muscles during stair climbing. The subjects were assessed during three conditions: no tape (untaped), (no tension) control tape and (tensioned tape) VL inhibitory taping application. There was a significant decrease (p <0.05) in the VL IEMG during the initial stance phase during both stair ascent and descent. The inhibition if the VL muscle occurred with both control and VL inhibitory tape applied. No significant differences (p >0.05) were noted in any of the other muscles assessed. The results demonstrated that there was a significant decrease in the IEMG of the VL both during stair ascent and descent with VL inhibitory tape and control tape applied in normal subjects. [Copyright &y& Elsevier]

The article offers comments of several critics on the article "Why Economic Analysis Supports Strong Action on Climate Change," by Simon Dietz and Nicholas Stern. According to Robert Mendelsohn, Dietz and Stern in their article focus on climate advocacy rather than environmental economics. However, Thomas Sterner and U. Martin Persson supported Dietz and Stern, in highlighting the combined weight of ethical considerations and the large-scale risks that climate change poses.

The economic benefits of a multi-gas approach to climate change mitigation are clear. However, there is still a debate on how to make the trade-off between different greenhouse gases (GHGs). The trade-off debate has mainly centered on the use of Global Warming Potentials (GWPs), governing the trade-off under the Kyoto Protocol, with results showing that the cost-effective valuation of short-lived GHGs, like methane (CH4), should be lower than its current GWP value if the ultimate aim is to stabilize the anthropogenic temperature change. However, contrary to this, there have also been proposals that early mitigation mainly should be targeted on short-lived GHGs. In this paper we analyze the cost-effective trade-off between a short-lived GHG, CH4, and a long-lived GHG, carbon dioxide (CO2), when a temperature target is to be met, taking into consideration the current uncertainty of the climate sensitivity as well as the likelihood that this will be reduced in the future. The analysis is carried out using an integrated climate and economic model (MiMiC) and the results from this model are explored and explained using a simplified analytical economic model. The main finding is that the introduction of uncertainty and learning about the climate sensitivity increases the near-term cost-effective valuation of CH4 relative to CO2. The larger the uncertainty span, the higher the valuation of the shortlived gas. For an uncertainty span of ±1°C around an expected climate sensitivity of 3°C, CH4 is cost-effectively valued 6.8 times as high as CO2 in year 2005. This is almost twice as high as the valuation in a deterministic case, but still significantly lower than its GWP100 value. [ABSTRACT FROM AUTHOR]

The possibility of adopting national targets for carbon dioxide (CO2) emissions from tropical deforestation in a future international climate treaty has received increasing attention recently. This attention has been prompted by proposals to this end and more intensified talks on possible commitments for developing countries beyond the United Nations Framework Convention on Climate Change Kyoto Protocol. We analyze four main scientific and political challenges associated with national targets for emissions from tropical deforestation: (1) reducing the uncertainties in emission inventories, (2) preserving the environmental integrity of the treaty, (3) promoting political acceptance and participation in the regime, and (4) providing economic incentives for reduced deforestation. We draw the following conclusions. (1) Although there are large uncertainties in carbon flux from deforestation, these are in the same range as for other emissions included in the current Kyoto protocol (i.e., non-CO2 GHGs), and they can be reduced. However, for forest degradation processes the uncertainties are larger. A large challenge lies in building competence and institutions for monitoring the full spectrum of land use changes in developing countries. (2 and 3) Setting targets for deforestation is difficult, and uncertainties in future emissions imply a risk of creating 'tropical hot air'. However, there are proposals that may sufficiently deal with this, and these proposals may also have the advantage of making the targets more attractive, politically speaking. Moreover, we conclude that while a full carbon accounting system will likely be politically unacceptable for tropical countries, the current carbon accounting system should be broadened to include forest degradation in order to safeguard environmental integrity. (4) Doubts can be cast over the possible effect a climate regime alone will have on deforestation rates. [ABSTRACT FROM AUTHOR]

Since many years, life charting has been used to describe the life course and life events of psychiatric patients. The aim of the present study was to describe and evaluate time geographic life charts of 11 former psychiatric patients in order to promote systematic descriptions of their life events over time. Information on all events which was gathered from the life charts was analysed by manifest content analysis and reduced to four categories: information received by asking only about moves, social capacity, predisposing life events and/or stressful as well as precipitating life events. Our findings showed that this kind of life charts offered a comprehensive and structured picture. They describe a detailed life situation from one time period to another, where geographical sites serve as anchors. The patients expressed satisfaction with this method of combining an interview with a time geographic life line. [ABSTRACT FROM AUTHOR]

The metric governing the trade-off between different greenhouse gases in the Kyoto Protocol, the Global Warming Potentials (GWPs), has received ample critique from both scientific and economic points of view. Here we use an integrated climate-economic optimization model to estimate the cost-effective trade-off between CO2, CH4 and N2O when meeting a temperature stabilization target. We then estimate the increased cost from using GWPs when meeting the same temperature target. Although the efficient valuation of the gases differs significantly from their respective GWPs, the potential economic benefit of valuing them in a more correct way amounts to 3.8 percent of the overall costs of meeting the temperature stabilization target in the base case. In absolute value, this corresponds to an additional net present value cost of US$2000100 billion. To corroborate our findings we perform a Monte Carlo-analysis where several key parameters are randomly varied simultaneously. The result from this exercise shows that our main result is robust to a wide range of changes in the key parameter values, giving a median economic loss from using GWPs of 4.2 percent. [ABSTRACT FROM AUTHOR]

Introduction: The dispensing of drugs in medical care systems is, in most countries, strictly regulated, and nurses are responsible for distributing drugs to in-patients.Aim: To describe the perceptions of patients with rheumatic diseases regarding traditional drug dispensing during in-patient care and rehabilitation in a specialized rheumatological care unit.Method: Twenty in-patients who stayed in the Spenshult Hospital unit for 3-4 weeks and who were on continuous medication were chosen for the study. The phenomenographic approach was used for the collection and analysis of data.Findings: Three descriptive categories emerged--Relief, Active Participation and Dependence. These descriptive categories comprised: three perceptions for Relief (to experience security, to be 'served', to dare to bother) , two for Active Participation (to rely on one's own ability, to search for knowledge) and two for Dependence (lack of independence, lack of information) .Conclusion: The patients experienced relief due to the nurse assuming responsibility for the medication and its dispensation. Patients expressed a wish to be more active in the management of their medication, as they trusted their own ability. The patients articulated that they were dependent on the nurse to give them the correct medication and they also asked for more information about their medication. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Anaemia is characterised by an insufficient number of red blood cells (RBCs) and might occur for different reasons, e.g. surgical procedures are often with associated blood loss. Patients who suffer from anaemia have the option of treatment with blood transfusion or medical treatment. In this study, the societal cost, for the case of Sweden, of RBC transfusion using three different techniques, i.e. allogeneic, autologous and intraoperative transfusion, was estimated. The analysis was based on information from interviews with hospital staff at large Swedish hospitals and from published data. The average cost for a 2 units transfusion was found to be Swedish kronor (SEK) 6330 (€702) for filtered allogeneic RBCs and SEK5394 (€598) for autologous RBCs for surgery patients. Transfusion reactions accounted for almost 35 per cent of the costs of allogeneic RBC transfusions. The administration cost was found to be much higher for autologous transfusions compared with allogeneic transfusions. The cost of intraoperative erythrocyte salvage was calculated to be SEK2567 (€285) per transfusion (>4 units). [ABSTRACT FROM AUTHOR]

A retrospective chart review was performed at 3 Swedish hospitals to evaluate the utilization, outcomes, and cost of using epoetin alfa or darbepoetin alfa to treat cancer patients with chemotherapy-related anemia. Data on dosage, duration of treatment, hematologic response, red blood cell transfusions, and healthcare resource consumption were collected and analyzed at various time points following the initiation of drug therapy. A significantly faster hematologic response and increase in hemoglobin were observed in patients treated with epoetin alfa. Dosages used in clinical practice appeared to be lower than those recommended by Swedish treatment guidelines. There were no significant differences in resource utilization or healthcare costs between the 2 treatment groups. By day 112, the mean treatment cost per patient, in Swedish kronors (SEK), was SEK74,701 (approximately US$9800 or approximately 8300) with epoetin alfa and SEK85,285 (approximately US$11,000 or approximately 9500) with darbepoetin alfa. Drug acquisition and administration accounted for 81% and 67% of the total cost of epoetin alfa and darbepoetin alfa therapy, respectively; the remainder of the total cost was for hospitalization and transfusions. [ABSTRACT FROM AUTHOR]

Summary:The article presents views and recommendations of the World Marrow Donor Association regarding the need for donor and liability insurance for hematopoietic stem cell donor registries, and donor and collection centers.Bone Marrow Transplantation (2004) 33, 467-470. doi:10.1038/sj.bmt.1704387 Published online 22 December 2003 [ABSTRACT FROM AUTHOR]

An estimate of the average cost of treatment (COT) was assessed for 53 patients with pancreatic cancer treated between 1997 and 1999 in four hospitals in southern Sweden. Average COT was estimated to Euro18 947, 55% of which was attributable to hospitalization (including surgical procedures), 20% to long-term care and 11% to chemotherapy. Diagnostics and radiotherapy accounted for 9% and 4%, respectively. Median survival was 5.6 months (mean 6.3 months). Treatment costs per patient were negatively correlated with age but were higher for patients receiving chemo/radiotherapy and surgical treatment than for patients receiving only standard supportive care. Disease stage and type of hospital (university versus regional/local hospitals) were not significant predictors of COT per se. Assuming that our estimate of the average cost is representative for Sweden, the total healthcare cost for pancreatic cancer was Euro16 million (dollar14 million), i.e about 2-3% of the COT for all cancer diseases in Sweden. In the USA the cost of pancreatic cancer accounted for the same proportion. However, our estimated cost per patient was about half the amount of the US estimate. The distribution of costs between the different types of treatment services did not differ greatly between Sweden and the USA. [ABSTRACT FROM AUTHOR]

Objective: The primary objective of this study was to estimate the cost effectiveness of treating diabetic foot ulcers with becaplermin (Regranex) plus good wound care (GWC) compared with GWC alone in a variety of European healthcare settings. A secondary objective was to analyse the effect of different treatment practices on the economics of caring for diabetic foot ulcers.Design and Setting: Markov-based simulation study from the perspective of a national health system.Methods: A 12-month Markov computer simulation model was used to assess the cost effectiveness in 4 European countries of treating diabetic foot ulcers with becaplermin plus GWC versus GWC alone. Transition probabilities were taken from a prospective study of 183 patients and becaplermin efficacy was based on 20-week healing rates in a recent meta-analysis of clinical trials involving 449 patients. Country-specific treatment cost data were collected in collaboration with local economic consultations and combined with the disease model to estimate the incremental cost per ulcer-free month gained. The model was then run using hypothetical low- and high-intensity resource usage profiles to investigate the economics of caring for diabetic foot ulcers.Results: Over the course of 1 year, individuals who received becaplermin plus GWC were, on average, predicted to spend an additional 0.81 months (24% longer) free of ulcers and to experience a 9% lower risk of undergoing a lower extremity amputation than individuals who received GWC alone. Consequently, becaplermin plus GWC was estimated to be net cost saving in Sweden, Switzerland and the UK. In France, the addition of becaplermin was estimated to add $US19 (1999 values) for each additional ulcer-free month gained. There were substantial intercountry differences in treatment practices and the costs of treating diabetic foot ulcers.Conclusions: Becaplermin may be a cost-effective treatment for neuropathic diabetic foot ulcers in a wide range of European settings. In Sweden, Switzerland and the UK, becaplermin may even be cost saving. Substantial intercountry differences in resource patterns appear, at least partly, to be the logical outcome of differences in unit costs. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a major cause of morbidity and mortality in the elderly and, in particular, among postmenopausal women. Hormone replacement therapy (HRT) has been shown to protect against fractures, as well as to alleviate climacteric symptoms related to menopause. Unfortunately, HRT has a number of adverse effects and many patients are noncompliant. Tibolone, a synthetic steroid with tissue-specific estrogenic, progestogenic and androgenic effects, has been shown to prevent the loss of bone mass as well as to relieve climacteric symptoms in postmenopausal women, with fewer accompanying adverse effects. Objective: To estimate the economic impact in Sweden of administering tibolone 2.5 mg/day to postmenopausal women at risk for osteoporosis-related bone fractures relative to a policy of no intervention. Design and Setting: Modelling study performed from the national health system perspective in Sweden. Methodology: Disease modelling was used to simulate the risks of osteoporosis-related hip, vertebral and forearm fractures over time in hypothetical cohorts of postmenopausal women. The occurrence of fractures was predicted using risk functions estimated with data from actual cohorts of women in Sweden as well as the USA. Sweden-specific cost data were then used to estimate the economic impact with cost-effectiveness tools. Results: The model predicts that 22% of hip fractures and 13% of combined hip, vertebral and forearm fractures can be avoided over a 25-year time-period by administering tibolone to osteoporotic women. Depending on the severity of loss in bone mass and the values assumed for key parameters, estimates of the cost effectiveness of treatment range from cost saving to incremental costs per quality-adjusted life-year (QALY) gained of around SEK200 000. Delaying treatment to late menopause tends to decrease cost effectiveness. Conclusion: Our findings suggest that, relative to no treatment, tibolone is a cost-effective treatment in Sweden for the prevention of fractures in women with low bone mass, especially when treatment is initiated around the onset of menopause and is administered for 5 years. [ABSTRACT FROM AUTHOR]