British medical bulletin
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Varicella zoster virus infection (VZV) is widespread and clinically important as the cause of varicella pneumonitis and meningoencephalitis (a complication of primary infection/zoster) and post-herpetic neuralgia (a complication of zoster/secondary infection). The use of live-attenuated varicella vaccine to reduce the burden of these diseases has been established in many countries for a number of years. ⋯ No international consensus exists: measurement of VZV immunity or cost-effectiveness of introducing VZV vaccination to a country. Decisive factors will include the pre-vaccination burden of VZV-associated disease.
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British medical bulletin · Sep 2012
ReviewHealth economic decision-making: a comparison between UK and Spain.
This review examines the impact of economic evaluation in informing national or local policies within both jurisdictions. We focus on the factors that have made the economic evaluation evolves differently in both settings. ⋯ Cost-effectiveness approach is based on the assumption of health maximization subject to a budget constraint. Decision-makers are not only interested in health maximization alone. This may result in policy-makers failing to consider economic evaluations into their allocation decisions. AREAS TO DEVELOP RESEARCH: Methods that incorporate wider decision-makers goals (mainly local) and research to study the real impact of economic evaluation in terms of improved efficiency and equity are particularly required.
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The prevalence of knee osteoarthritis (OA) is rising and the search for interventions to mitigate risk is intensifying. This review considers the contribution of occupational activities to disease occurrence and the lessons for prevention. ⋯ Reasonably good evidence exists that physical work activities (especially kneeling, squatting, lifting and climbing) can cause and/or aggravate knee OA. These exposures should be reduced where possible. Obese workers with such exposures are at additional risk of knee OA and should therefore particularly be encouraged to lose weight. AREAS OF UNCERTAINTY/RESEARCH NEED: Workplace interventions and policies to prevent knee OA have seldom been evaluated. Moreover, their implementation can be problematic. However, the need for research to optimize the design of work in relation to knee OA is pressing, given population trends towards extended working life.
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British medical bulletin · Jan 2012
ReviewSport activity following joint arthroplasty: a systematic review.
Although the clinical and functional outcomes of patients undergoing knee arthroplasty have widely been investigated, there is little information on the postoperative sport activity status. ⋯ There is a need to perform appropriately powered randomized clinical trials using standard diagnostic assessment, and a common and validated scoring system comparing reported outcomes and the duration of follow-up >2 years.
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British medical bulletin · Jan 2012
ReviewNeurological disorders and the potential role for stem cells as a therapy.
Introduction Neurological disorders are routinely characterized by loss of cells in response to an injury or a progressive insult. Stem cells could therefore be useful to treat these disorders. Sources of data Pubmed searches of recent literature. ⋯ Whereas the potential tumorigenic capability of stem cells is a concern, most studies do not support this notion. Further determination of the optimal cell type, and whether to perform allogeneic or autologous transplants warrant investigation before the full potential of stem cells can be realized. In addition, the use of stem cells to develop disease models should not be overlooked.