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Introduction Cost-effectiveness analysis of health sector interventions was first applied in the 1960s based on methods developed to analyse military investments (1). Since 1970, the number of published studies using [...], The role of health systems infrastructure in studies of cost-effectiveness analysis and health resou allocation is discussed, and previous health sector cost-effectiveness analyses are cited. Two subst difficulties concerning the nature of health system costs and the policy choices are presented. First, the issue of health system infrastructure can be addressed by use of computer models such as the Health Resource Allocation Model (HRAM) developed at Harvard, which integrates cost-effectivenes and burden of disease data. It was found that a model which allows for expansion in health infrastru yields nearly 40% more total DALYs for a hypothetical sub-Saharan African country than a model which neglects infrastructure expansion. Widespread use of cost-effectiveness databases for resource allocations in the health sector will require that cost-effectiveness analyses shift from r costs to reporting production functions. Second, three distinct policy questions can be treated usin these tools, each necessitating its own inputs and constraints: allocations when given a fixed budge and health infrastructure, or when given resources for marginal expansion, or when given a political constrained situation of expanding resources. Confusion concerning which question is being addressed must be avoided through development of a consistent and rigorous approach to using cost-effectivenes data for informing resource allocations.

Aims: To assess the effectiveness of acupuncture for the symptomatic treatment of temporomandibular disorders (TMD) from a review of studies using randomized controlled trials (RCTs). Methods: Electronic databases were systematically searched for articles reporting RCTs investigating acupuncture for TMD. The methodological qualities of eligible studies were assessed using the criteria described in the Cochrane Handbook. Results: Nineteen reports were systematically reviewed. There was moderate evidence that classical acupuncture had a positive influence beyond those of placebo (three trials, 65 participants); had positive effects similar to those of occlusal splint therapy (three trials, 160 participants); and was more effective for TMD symptoms than physical therapy (four trials, 397 participants), indomethacin plus vitamin B1 (two trials, 85 participants), and a wait-list control (three trials, 138 participants). Only two RCTs addressed adverse events and reported no serious adverse events. Conclusion: This systematic review noted moderate evidence that acupuncture is an effective intervention to reduce symptoms associated with TMD. There is a need for acupuncture trials with adequate sample sizes that address the long-term efficacy or effectiveness of acupuncture.J Orofac Pain 2010;24:152-162. [ABSTRACT FROM AUTHOR]

On the surface electrocardiogram, an abnormally wide QRS|T angle reflects changes in the regional action potential duration profiles and in the direction of the repolarization sequence, which is thought to increase the risk of ventricular arrhythmia. We investigated the relation between an abnormal QRS|T angle and mortality in a nationally representative sample of subjects without clinically evident heart disease. We studied 7,052 participants ≥40 years old in the third National Health and Nutrition Examination Survey with 12-lead electrocardiograms. Those with self-reported or electrocardiographic evidence of a previous myocardial infarction, QRS duration of ≥120 ms, or history of heart failure were excluded. Borderline and abnormal spatial QRS|T angles were defined according to gender-specific 75th and 95th percentiles of frequency distributions. All-cause (1,093 women and 1,191 men) and cardiovascular (462 women and 455 men) mortality during the 14-year period was assessed through linkage with the National Death Index. On multivariate analyses, an abnormal spatial QRS|T angle was associated with an increased hazard ratio (HR) for cardiovascular mortality in women (HR 1.82, 95% confidence interval 1.05 to 3.14) and men (HR 2.21, 95% confidence interval 1.32 to 3.68). Also, the multivariate adjusted HR for all-cause mortality associated with an abnormal QRS|T angle was 1.30 (95% confidence interval 0.95 to 1.78) for women and 1.87 (95% confidence interval 1.29 to 2.7) for men. A borderline QRS|T angle was not associated with an increased risk of all-cause or cardiovascular mortality. In conclusion, an abnormal QRS|T angle, as measured on a 12-lead electrocardiogram, was associated with an increased risk of cardiovascular and all-cause mortality in this population-based sample without known heart disease. [ABSTRACT FROM AUTHOR]

Reactive oxygen species (ROS) and their derivatives play important roles in the development of diseases such as, cardiovascular disease, ischemic disease, and aging. Much effort has been devoted to finding both an effective and non-toxic antioxidant traditional Chinese medicine (TCM) herbal formula. Tianwang Buxin Pills (TBPs) have been used in TCM to treat mild cognitive impairment and palpitations. Recently, research has revealed that TBPs are effective against oxidative stress and psychological stress in experimental studies. However, randomized controlled trials (RCT) are rare. This study was conducted to assess the antioxidative and anti-stress effects of TBPs by analyzing (determination) reactive oxygen metabolites (d-ROMs test) of the blood, the stress response inventory (SRI), and the Korean version of the WHO Quality of Life Scale Abbreviated Version (WHOQOL-BREF) in 39 healthy volunteers (Placebo group = 20, TBPs group = 19) before and after oral administration of TBPs for 4 weeks. However, d-ROMs test, SRI, and WHOQOL-BREF values did not differ significantly between the two groups. These results indicate that TBPs do not effectively restrain ROS or their derivatives. [ABSTRACT FROM AUTHOR]

Diabetic patients have substantially greater long-term mortality after acute myocardial infarction (AMI) than nondiabetic patients. Traditionally, cardiac autonomic neuropathy is believed to contribute significantly to the increased mortality rate in patients with diabetes mellitus. In contrast, a recent study suggested that RR-interval variability (RRV) did not predict mortality after AMI in diabetic patients. We compared, in diabetic and nondiabetic patients, the relation between low RRV and long-term mortality in the Multicenter Post Infarction Program (MPIP), a longitudinal observational study of 715 survivors of AMI, including 117 diabetic patients. We studied the association between mortality and 6 frequency-domain measurements and 1 time-domain measurement of RRV. We tested 2 hypotheses: (1) RRV is lower in diabetic patients; and (2) low RRV is less predictive of mortality in diabetic patients. Reduced RRV was significantly more frequent in diabetic patients than nondiabetic patients for all measurements, except high-frequency (HF) power. In diabetic patients, the association between reduced RRV and long-term mortality was at least as strong as it was in nondiabetic patients for all measurements except HF power; this pattern was found for all-cause, cardiac, and arrhythmic death. In multivariable models, reduced RRV was significantly associated with all-cause mortality in diabetic patients even when adjusted for left ventricular ejection fraction, heart failure class, and ventricular arrhythmias. In our post-AMI sample, RRV provided valuable prognostic information among diabetic patients. Our findings suggest that cardiac autonomic neuropathy plays a role in the high mortality rate seen in diabetic patients after AMI. [ABSTRACT FROM AUTHOR]

PURPOSE: The recent Breast Cancer Prevention Trial has shown that tamoxifen may prevent invasive breast cancer. We used a Markov model to estimate the long-term effects of chemoprevention with tamoxifen on survival, quality-adjusted survival, and health care costs. METHODS: We used a hypothetical cohort of women with breast-cancer risk similar to that of participants in the Breast Cancer Prevention Trial, and a computer-based decision analysis (Markov model and 500 Monte Carlo simulations) to model the outcomes of interest. Survival calculations were from Surveillance, Epidemiology, and End-Results (SEER) data; preference ratings from a time trade-off questionnaire administered to a group of average-risk women; and cost estimates from the Group Health Cooperative of Puget Sound and the Health Care Financing Administration. We obtained utility measures for quality-adjustment by administering a time trade-off questionnaire to a group of community-based women. RESULTS: Use of tamoxifen prolonged the average survival of cohort members by 69 days (95% probability interval [PI] 27 to 117) for those who started use at age 35 years; 40 days (95% PI 16 to 67) for those who started use at age 50 years; and 27 days (95% PI 14 to 40) for those who started use at age 60 years. Tamoxifen extended quality-adjusted survival by 38 days (95% PI 0.1 to 82) at age 35, 25 days (95% PI 0 to 50) at age 50, and 22 days (95% PI 5 to 39) days at age 60. Chemoprevention with tamoxifen cost $46,619 (95% PI $27,928 to $98,796) per life year life saved for women who started at age 35; for women over age 50, it cost more than $50,000 per life year saved. DISCUSSION: Tamoxifen use may improve long-term survival and quality-adjusted survival among women who are at increased risk of breast cancer, but this benefit diminishes with age. Tamoxifen is cost-effective in comparison with other cancer treatment strategies for younger women only. [ABSTRACT FROM AUTHOR]

PURPOSE: Recent randomized controlled trials have shown that tamoxifen and raloxifene may prevent invasive breast cancer. This decision analysis study compares the outcomes of chemoprevention with tamoxifen, raloxifene, or oral contraceptives with the outcomes of prophylactic surgery among women with high-risk BRCA1/2 mutations. PATIENTS AND METHODS: We used a simulated cohort of 30-year-old women who tested positive for BRCA1/2 mutations and constructed a Markov model with Monte Carlo simulations, incorporating cumulative breast and ovarian cancer incidence rates from the literature and survival figures from SEER data. We assumed that prophylactic surgery reduces ovarian cancer risk by 45% and breast cancer risk by 90%, that tamoxifen reduces invasive breast cancer risk by 49%, and that raloxifene has similar efficacy and safety in premenopausal and postmenopausal women. We used data obtained from high-risk women by a time trade-off questionnaire to calculate quality-adjusted life-years. We based our cost estimates for hospital and ambulatory care on Health Care Financing Administration payments, the SEER-HCFA database, and the Pharmacy Fundamental Reference. RESULTS: In our model, a 30-year-old BRCA1/2+ woman could prolong survival by 0.9 years (95% probability interval, 0.4-1.2 years) by having bilateral oophorectomy, 3.4 years (2.7-3.7 years) by having bilateral mastectomy, and 4.3 years (3.6-4.6 years) by having both procedures instead of surveillance alone. Chemoprevention with tamoxifen and raloxifene increased survival by 1.6 years (1.0-2.1 years) and 2.2 years (1.3-2.8 years), respectively. Chemoprevention yielded more quality-adjusted life-years than did prophylactic surgery, even when treatment was delayed to age 40 or 50 years. All these procedures were cost-effective or cost-saving compared with surveillance alone. DISCUSSION: Our model suggests that although surgery may yield more substantial survival and cost benefits, quality of life issues may make chemoprevention a more attractive option for young women at high genetic risk. [ABSTRACT FROM AUTHOR]

Natural product studies explore potential and interesting new compounds to discover innovative drugs. Nigella sativa (N. sativa) (Ranunculaceae) is traditionally used to treat diabetes. Flavonoids and triterpenoid mostly show anti-diabetic activity. The current study aim to identify new compounds by a systematic study of the anti-oxidant and anti-diabetic activity of aerial parts of N. sativa concerning. Phytochemicals were isolated from the methanolic extract of aerial parts of the plant by column chromatography and identified by nuclear magnetic resonance spectroscopy and mass spectroscopy. A new triterpenoid saponin glycoside was isolated along with flavonoids. The anti-diabetic study was carried out by DPPH, ABTS, α -glucosidase, and protein tyrosine phosphatase 1B assays at doses of 12.5 to 250 µM. The isolated phytochemicals were identified as 3-O-(β-d-xylopyranosyl-(1-3)-α-l-rhamnopyrnaosyl-(1-2)-α-l-arabinopyranosyl]-28-O-(α-l-rhamno-pyranosyl-(1-4)-β-d-glucopyranosyl-(1-6)-β-d-glucopyranosyl] hederagenin (1), flaccidoside III (2), catechol (3), quercetin-3-gentiobiosides (4), magnoflorine (5), nigelflavonoside B (6), nigelloside (7), quercetin sphorotrioside (8), kaempferol-3, 7-diglucoside (9), kaempferol 3-O-rutinoside (10), rutin (11), 3-O-[α-l-rhamnopyranosyl-(1→2)-α-l-arabinopyranpsylhederagenin (12), 3β,23,28-trihydroxyolean-12-ene-3-O-α-l-arabinopyranoside(1→4)-a-rhamnopyranosyl,(1→4)-β-d-gluco-pyranoside (13), 3-O-α-l-rhamnopyranosyl-(1→2)-α-l-arabinopyranpsyl]-28-O-β-d-gluco-pyranosyl hederagenin (14), and α-hederin (15). These were isolated and are reported for the first time in this study. Compared 13 was identified as a new compound. Compound 2 was isolated for first time from the genus Nigella. Compound 6 was found to be the most active in the DPPH, and ABTS assays and compound 10 was found to be the most active in the α-glucosidase assay, with IC50 32.7 ± 0.1, 95.18 ± 0.9, 214.5 ± 0.0 µΜ, respectively. Compound 12, at a dose of 125 µΜ, showed anti-diabetic activity in a PTP1B assay with IC50 91.30 ± 2.5 µΜ. In conclusion, the anti-diabetic activity of N. sativa is due to its flavonoids and TTSGs. Therefore, our studies suggest that the aerial parts of N. sativa are also a valuable and alternate source of valuable phytochemicals that could be used to develop anti-oxidant and anti-diabetic medicines.