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Biomedical subjects

R H Behrens

Publications and source records attributed to R H Behrens.

At least 55 records · Page 3Linked to original sources
PubMed1994

Should British soldiers be vaccinated against hepatitis A? An economic analysis.

We conducted a study to analyse the efficiency of introducing vaccination against hepatitis A to the schedule for troops in the British Army. The study design included a cost-effectiveness analysis (CEA) of cost per case avoided comparing active and passive immunization and a cost-benefit analysis (CBA). The study population comprised all British Army personnel as well as those soldiers assumed to be deployed to high-risk areas a variable number of times in 5 years. The average cost of one case of hepatitis A avoided by vaccination was calculated and compared with the average cost of achieving the same outcome by passive immunization. In a 5-year four-exposure scenario at a low incidence and using a 3% discount rate, avoiding one case of hepatitis A by vaccination would cost 52,865 pounds, against 97,305 pounds by passive immunization. The equivalent cost-benefit ratios are 13.4 for gammaglobulin and 7.2 for vaccine. For fewer exposures the break-even point for vaccine is two exposures in 4 years. Although our estimates are sensitive to direct costs and relatively sensitive to the estimated incidence, vaccinating troops against hepatitis A appears to be a more efficient procedure than passive immunization, especially as a long-term investment in troops likely to effect several operational deployments. Given the difficulty of forecasting which troops would deploy, the best-buy strategy may be vaccination of troops most likely to deploy repeatedly.

Cost-Benefit Analysis↗
PubMed1993

Diarrhoeal disease: current concepts and future challenges. The impact of oral rehydration and other therapies on the management of acute diarrhoea.

The development of oral rehydration therapy (ORT) has resulted in clear and practical methods for replacing fluid and electrolyte losses during diarrhoea. Rehydration salts can be provided in 3 ways; a pre-packed, easy to use, package which requires controlled formulation and distribution, a cereal-based formula from widely available ingredients which require preparation and cooking, or a home-made recipe of sugar with salt, which is relatively easily prepared. Poor retention of knowledge on the correct way to prepare solutions, inadequate availability of ingredients and practical problems of home production are major problems in ORT programmes. Although ORT may be life saving in severe dehydrating diarrhoea, it may not have an impact on milder illness, dysentery or persistent diarrhoea. Breast feeding is a natural and effective method for preventing and reducing diarrhoeal morbidity and its role needs repeated promotion. Early feeding in diarrhoea reduces duration, severity and adverse nutritional sequelae. The benefit of vitamin A and folic acid supplements are as yet unproved; zinc may have a role in aiding recovery of malnourished children. Drug treatment should be limited to parasitic gut infections, cholera or dysenteric disease. Widespread prescribing of drugs for diarrhoea by health workers may be hindering the success of ORT.

Acute Disease↗
PubMed1993

Malaria in travellers: epidemiology and prevention.

Malaria continues to be a serious health risk for travellers. The malaria parasites which infect humans can only be naturally transmitted by female mosquitoes of the genus Anopheles. Travellers to malaria endemic areas require detailed advice on appropriate chemoprophylaxis against malaria and personal protection against mosquito bites. The decision on an appropriate chemoprophylaxis or standby therapy regimen should reflect the malaria risk, pattern of drug resistance, and the toxicity of available drugs. Currently travellers encounter a number of problems in protecting themselves against malaria. Advice is often both inadequate and inaccurate; and all the recommended drug regimens are associated with minor, and occasionally major adverse reactions. Because of poor compliance to drug prophylaxis and to reduce the impact of drug resistance, protection against mosquitoes has a critical role in protecting travellers from malaria. Compliance to methods of personal protection not only reduces the malaria risk but also limits the nuisance and loss of sleep from biting insects.

Antimalarials↗
PubMed1993

The changing pattern of imported malaria in British visitors to Kenya 1987-1990.

Following a sudden increase of imported malaria from Kenya in December 1989-January 1990, an investigation was set up to identify risk factors for travellers' malaria. A questionnaire asking for details of travel patterns and compliance with prophylaxis was sent to cases reported over the 6-month Kenyan winter period. Quarterly malaria attack rates between January 1987 and June 1991 were calculated and linked to meteorological conditions in Mombasa. The number of travellers to Kenya has doubled in the 4 years studied and the quarterly rates varied 4-fold over this period. There was no clear seasonal pattern of malaria in travellers, nor was there any clear relation of malaria to coastal rainfall. Compliance with chemoprophylaxis was poor, with only 16% of cases using currently advised regimens. While the annual malaria attack rate per 10,000 travellers decreased by 37% over the study period, the total numbers of malaria cases imported from Kenya rose by 61%, reflecting the increase in the numbers of travellers to the region. As the popularity of East Africa as a tourist destination continues to increase, Kenya will remain an important and significant source of malaria imported into the UK.

Adult↗
PubMed1992

Travellers' malaria.

The risk of malaria poses travellers and their advisers with difficult problems as drug resistance spreads worldwide. Protection against infection rests on travellers' knowledge of the risk of malaria, on their avoidance of malaria vectors and on their compliant use of chemoprophylaxis. In this article, Robert Ste f fen and Ronald Behrens explain that one of the priorities for reducing malaria morbidity is to improve travellers' use of personal protection against mosquito bites. They show that none of the drugs, or combinations thereof, provide a 100% efficacy, owing to increasing drug resistance, mainly of Plasmodium falciparum. The commonly used drugs for malaria prophylaxis (mefloquine, doxycycline, chloroquine and proguanil) often cause minor side effects. All, except proguanil, have also been occasionally associated with severe adverse effects. Other drugs (pyrimethaminelsul fadoxine, amodioquine) are not suitable for chemoprophylaxis because of unacceptable adverse reactions. The use of drugs for self therapy is constrained by limitations of toxicity and efficacy, and the added difficulties of defining indications for safe and appropriate use.

Journal Article↗
PubMed1992

Impact of zinc supplementation on intestinal permeability in Bangladeshi children with acute diarrhoea and persistent diarrhoea syndrome.

Zinc has been shown to enhance intestinal mucosal repair in patients suffering from acrodermatitis enteropathica; but the impact on mucosal integrity during acute (AD) or persistent (PD) diarrhoea is unknown. One hundred eleven children with AD and 190 with PD aged between 3 and 24 months received, randomly and blind to the investigators, either an elemental zinc supplement of 5 mg/kg body wt/day or placebo in multivitamin syrup for 2 weeks while intestinal permeability and, biochemical and anthropometric markers were serially monitored. The permeability test was administered as an oral dose of 5 g lactulose/l g mannitol in a 20-ml solution followed by a 5-h urine collection. The ratio of the urinary probe sugars was correlated to clinical, biochemical, and microbiological parameters. At presentation, lactulose excretion was increased and mannitol excretion decreased in both AD and PD as compared with age-matched asymptomatic children. The lactulose/mannitol ratio (L/M) was higher in subjects with mucosal invasive pathogens (rotavirus and enteropathogenic Escherichia coli) compared with children excreting Vibrio cholera and enterotoxigenic E. coli. Two-week zinc supplementation significantly reduced lactulose excretion in both AD and PD, whereas the change in mannitol excretion and L/M was similar between study groups in both studies. Changes in lactulose excretion were significantly influenced by zinc supplementation in children with E. coli, Shigella sp., and Campylobacter jejuni stool isolates. The greatest reduction in total lactulose excretion was seen in supplemented children who on presentation were lighter (wt/age less than 80%), thinner (wt/ht less than 85%), and undernourished [middle upper arm circumference (MUAC) less than 12.5 cm] or with hypozincaemia (less than 14 mumol/L).(ABSTRACT TRUNCATED AT 250 WORDS)

Acrodermatitis↗
PubMed1991

Cholera.

Explore the source record for details and available documents.

Cholera↗
PubMed1991

Measurement of acute phase proteins for assessing severity of Plasmodium falciparum malaria.

Seventeen adult patients with acute Plasmodium falciparum malaria, admitted to the Hospital for Tropical Diseases, were studied. Serial measurements of the serum concentration of C-reactive protein, serum amyloid A protein, and percentage parasitaemia were determined, together with initial measurement of serum electrolytes, liver function, haemoglobin, white cell and platelet counts. Initial C-reactive protein and serum amyloid A concentrations were increased (C-reactive protein mean 49.0 mg/l serum amyloid A 28 mg/l) falling towards the normal range by the seventh day of treatment. There was a significant correlation between the pretreatment parasite count and clinical and laboratory markers of inflammation. C-reactive protein and serum amyloid A concentrations correlated inversely with the serum sodium. These results indicate that measurement of acute phase reactants such as C-reactive protein and serum amyloid A may prove valuable in assessing the severity of P falciparum malaria, and in following the response to antimalarial treatment.

Acute Disease↗
PubMed1991

Evaluation of a computerized field data collection system for health surveys.

A customized field data collection system (FDCS) has been developed for a hand-held computer to collect and check questionnaire data. The data quality, preparation time, and user acceptability of the system were evaluated during a malaria morbidity survey in Bakau, the Gambia. Eight field-workers collected data with either the FDCS or on paper questionnaire forms in alternate weeks over a 6-week period. Significantly fewer item errors occurred with the FDCS, and by the end of the survey period interview times were significantly less with the FDCS than with the paper and pencil questionnaire. Advanced appropriate technology may have a useful role in providing accurate and rapid information, particularly in overcoming bottlenecks in data processing, and in obviating the need for costly expertise and equipment. In developing countries this could help to improve the quality of data on health care.

Data Collection↗