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Health problems of developed nations in the 21st century are mainly discussed. As the forthcoming century is a continuation of the present century, health in Japan in the latter half of the 20th century is reviewed as an example of the transition of the nation's health, which has been remarkable. Health problems in the 21st century are then presumed and a possible solution is suggested.
OBJECTIVES: To explore how British American Tobacco (BAT), having established cigarette imports, responded to the opportunities for investment in cigarette manufacturing in the former Soviet Union (FSU). DESIGN: Analysis of documents held at the BAT archive in Guildford, UK. RESULTS: Considerable priority was attached to investing in the FSU. This led BAT to undertake a major organisational change and to intense competition to acquire assets. BAT used flawed economic arguments to persuade cash starved governments that its investment would reap economic rewards. It offered excise advice that disadvantaged governments while benefiting BAT, confused issues over pricing, and avoided competitive tendering. BAT targeted agriculture ministries, using its expertise in leaf production to differentiate itself from other potential investors. It subverted the principles of corporate social responsibility to promote itself as a business partner. BAT's task was made easier by the naivety of post-Soviet governments and by the international financial organisations' support for rapid economic reform. The latter permitted tobacco transnationals to penetrate markets before effective competitive tendering processes had been established, giving them the opportunity to minimise prices and establish monopolies. CONCLUSIONS: Many of the arguments employed when penetrating post-Soviet markets were highly misleading but governments lacked expertise to realise this. There is a need to build tobacco control capacity in transition economies, within and outside government, to ensure that governments are better informed of the true economic and health impacts of tobacco. Rapid transition from socialist to market economies without establishing regulatory institutional structures may be dangerous when investing companies use business practices that fall short of international standards.
Modern health system research emphasises the transition from mortality statistics via morbidity and risk factors observations to comparative site explorations in defined areas. The health of women from the perspective of their gender has become a priority in medical research over the last decade. Studies of morbidity have been called for as necessary intermediary stage for hypothesis generation, and the formulation and inception of epidemiological projects which are recognized as essential for attaining knowledge on the factors and circumstances that determine diseases and wellbeing in the general population. This applies especially to cancer, where the importance of seeing disease, from a ecological, cultural as well as gender context is evident. We made a comparative analysis of the hospitalization for somatic diseases during 1986-1987 at the Heraklion University Hospital on Crete, and the commensurable Linköping University Hospital in the country of Ostergötland, Sweden. They are representative of their complementary Europian situations and comprise the total hospital admissions in their regions. Large differences were found, notably regarding both cardiovascular diseases and cancer, with lower morbidity in the more 'arcadian', rural circumstances. The results provide unique data on traits and patterns intermediate to the pioneering observations of the Seven Countries survey on the rapidly changing European scene. In the field of cancer the data are effectively unmatched both as raw data and as a platform for further investigation, which we are presently pursuing under the emblem of 'Ariadne's thread'. From a salutogenetic point of view the elderly rural women on Crete, and from a pathogenetic point of view the elderly urban women in Linköping warrant particular attention.
This paper describes some of the major points of progress and challenges in health management of dairy cattle in the last 25 yr. A selection of the leading contributors in the field is acknowledged. Specific advances in the areas of transition cow management, epidemiology, udder health, applied immunology, housing design, calf health, and health-monitoring tools are described. The greatest advances in dairy health in the last 25 yr have been the shifts to disease prevention, rather than treatment, as well as from focus on individual animals to groups and herds. A fundamental advancement has been recognition of the multifactorial nature of almost all diseases of importance in dairy cattle. Epidemiology has been a critical new tool used to describe and quantify the interconnected risk factors that produce disease. Another major advance has been redefining disease more broadly, to include subclinical conditions (e.g., subclinical mastitis, ketosis, rumen acidosis, and endometritis). This expansion resulted both from improved technology to measure function at the organ level and, just as importantly, from the evolution of the health management paradigm in which any factor that limits animal or herd performance might be considered a component of disease. Links between cattle and people through consideration of environmental or ecosystem health are likely to further expand the concept of disease prevention in the future. Notable successes are decreases in the incidence of milk fever, clinical respiratory disease in adults, contagious mastitis, and clinical parasitism. There has also been improved protection through vaccination against coliform mastitis and bovine virus diarrhea. Since 1980, average herd size and milk production per cow have increased dramatically. Despite these increased demands on cows' metabolism and humans' management skills, the incidence of most common and important diseases has remained stable. Great progress has been made in understanding the biology of energy metabolism and immune function in transition dairy cows, the time at which the majority of disease occurs. Coupled with an emerging understanding of how best to provide for dairy cows' behavioral needs, transition cow management promises to be the foundation for progress in maintenance and enhancement of the health of dairy cows in the next 25 yr.
The transition to CFC-free pressurised metered dose inhalers (pMDIs) is not optional and cannot be ignored. The UK Government intends that CFCs will be removed from all medicinal products by the end of 1999. An overall strategy is needed to guide health professionals and patients through the transition process. Collaborative working between the pharmaceutical industry, health authorities and relevant health professionals is essential to ensure a smooth transition with minimal disruption to patients. The factors that need to be taken into consideration for a smooth transition and the role of national and local drivers in this process are outlined. The main focus around change must be on patients' confidence in their medication.
OBJECTIVE: To determine whether the preterm birth rate was elevated in two urban areas of Ukraine, a former eastern bloc country that experienced serious economic, social, and health problems during its transition from a socialist republic. METHODS: We identified every pregnancy in a defined period in two urban sites where a separate study of pregnancy and childhood was being conducted. We obtained gestational age and vital status at delivery for each. Information about onset of labor and conduct of delivery was available for the subgroup enrolled in the collaborating study. RESULTS: Among 17,137 pregnancies, all but 6774 were terminated voluntarily. Among the continuing pregnancies, the preterm birth rate was 6.6% for live-born singletons of 20 or more weeks' gestation. Only 12% of preterm births involved medical intervention, the rest were idiopathic. The preterm birth rate was higher than in Europe (4.0% to 5.4%) and Canada (5.9%) but lower than for whites in the United States (8.4%). CONCLUSION: Live-born preterm birth rates are influenced by whether infants survive to be included in calculations. The high fetal mortality rate in Ukraine causes many preterm births to be excluded, thus lowering the rate. Frequent pregnancy termination and lack of ultrasound dating in Ukraine also might cause the preterm birth rate to be lower. Preterm birth rates, especially among live-born infants, are difficult to interpret and treacherous to compare across nations. Survival of the fetus and its health and development at birth are better indicators of reproductive outcome.
The establishment of the Dublin Hospitals Initiative and the Efficiency Review Group as first steps in an "action" plan was based on the report in 1989 of the Commission of Health Funding which suggested that "the solution to the problem facing the Irish health services...(lies) primarily...in the way that services are planned, organised and delivered". Our health service is in transition from the phase of facility management into that of functional management. This will involve facing the fact of the limit on resources, introducing information systems and getting the co-operation of hospital doctors. The most senior executive in a hospital must firstly be a good general manager with sufficient power to manage. Hospitals should be divided into centres of responsibility made up of one or more centres of activity. Formal education for hospital administrators should be extended. There is a need for training at all levels, particularly of those administrative and medical staff who have direct interaction with the computer-based system. There should be a commitment to management development particularly by means of teamwork and action learning.
PURPOSE: To describe and analyze the process of transitioning HIV-infected youths from the point of HIV diagnosis into HIV treatment. Rather than simply offering HIV positive youths a list of referrals, the youth-focused SPNS grantees (AWAC) found it vital that youths were immediately assisted with linkage to a medical provider. METHODS: From February 1997 to December 2000, 107 identified HIV-infected youths from the five adolescent SPNS projects were surveyed on needs and barriers. The time interval between HIV testing and youth linkage to care was also noted. RESULTS: Nine percent of youth reported perceived barriers to accessing health care. Perceived needs were identified as Mental Health (44.9%; n = 48); Alcohol and drug treatment (14%; n = 15); transportation to health care settings (40.2%; n = 43); and housing (46.7%; N = 50). At sites tracking linkage to care, the time of being transitioned into a medical setting ranged from 5 to 55 days (average 26 days). CONCLUSIONS: The period of transitioning identified HIV-infected youths into care can be reduced from 1-5 years to as short as 5-55 days. Success with linking these youth to care involves establishing a series of contacts at outreach sites wherein program staff seeks to build trusting relationships with youths, is able to track these youths and identify and address perceived needs.
OBJECTIVES: To examine trends in life expectancy at birth and age and cause specific patterns of mortality in the former German Democratic Republic (GDR) and Poland during political transition and throughout the 1990s in both parts of Germany and in Poland. METHODS: Decomposition of life expectancy by age and cause of death. Changes in life expectancy during transition by cause of death were examined using data for 1988/89 and 1990/91 for the former GDR and Poland; examination of life expectancy changes after transition were based on 1992-97 data for Germany and 1991-96 data for Poland. RESULTS: In both the former GDR and Poland male life expectancy at birth declined by almost one year during transition, mainly attributable to rising death rates from external causes and circulatory diseases. Female life expectancy in Poland deteriorated by 0.3 years, largely attributable to increasing circulatory mortality among the old, while in East German female rising death rates in children and young adults were nearly outbalanced by declining circulatory mortality among those over 70. Between 1991/92 and 1996/97, male life expectancy at birth increased by 2.4 years in the former GDR, 1.2 years in old Federal Republic, and 2.0 years in Poland (women: 2.3, 0.9, and 1.2 years). In East Germany and Poland, the overall improvement was largely attributable to falling mortality among men aged 40-64, while those over 65 contributed the largest proportion to life expectancy gains in women. The change in deaths among men aged 15-39 accounted for 0.4 of a year to life expectancy at birth in East Germany and Poland, attributable largely to greater decreases from external causes. Among those over 40, absolute contributions to changing life expectancy were greater in the former GDR than in the other two entities in both sexes, largely attributable to circulatory diseases. A persisting East-west life expectancy gap in Germany of 2.1 years in men in 1997 was largely attributable to external causes, diseases of the digestive system and circulatory diseases. Higher death rates from circulatory diseases among the elderly largely explain the female life expectancy gap of approximately one year. CONCLUSIONS: This study provides further insights into the health effects of political transition. Post-transition improvements in life expectancy and mortality have been much steeper in East Germany compared with Poland. Changes in dietary pattern and, in Germany, medical care may have been important factors in shaping post-transition mortality trends.
This study summarizes patterns of educational differentials in wanted and unwanted fertility at different stages of the fertility transition. The data are from Demographic and Health Surveys in 57 less developed countries. As the transition proceeds, educational differentials in wanted fertility tend to decline and differentials in unwanted fertility tend to rise. An assessment of fertility patterns in developed and less developed countries with low fertility concludes that these differentials are likely to remain substantial when less developed countries reach the end of their transitions. This conclusion implies that the educational composition of the population remains a key predictor of overall fertility in late transitional countries and that low levels of schooling can be a cause of stalling fertility.
BACKGROUND: Public concern about exposure to emissions from the regional industrial park (IP), including 17 chemical plants and the national industrial toxic waste site, initiated this study of the possible association between major congenital malformations (MCM) and residence near the IP in Israel's Southern District. METHODS: The study was conducted during the period 1995-2000 and included 63,850 deliveries. Data on deliveries and MCM detected at births were obtained from the regional medical center, and stratified by ethnicity and type of locality. As exposure indicator we used distance categories (proximal and distant) and predominant wind direction from the IP. Distance stratification was based on the geographical distribution of the localities and complaints about the odor related to IP emissions. Based on these complaints, localities up to 20 km from the IP were considered proximal to the IP. RESULTS: Average rates of MCM were 5.0% and 4.1% for Bedouin and Jewish newborns, respectively. The rate of MCM for Bedouin from proximal localities was significantly greater compared with distant localities (5.6% vs. 4.8%; RR = 1.17 with 95% CI: 1.04-1.29). In the proximal Bedouin permanent localities, the MCM rate reached 8.2 %, which was significantly higher than in distant areas (RR = 1.63, 95% CI: 1.39-1.80). Significant risk increase of central nervous system MCM was found in these localities, compared to distant ones (RR = 2.27, 95% CI: 1.44-3.60). Among newborns from the traditional tribal settlements, proximity to the IP was associated with increased rates of the following MCM: 1) all combined, 2) those associated with chromosomal abnormalities, and 3) those defined as "others unclassified MCM." Comparison of autosomal recessive disease rates by proximity to the IP in Bedouin newborns indicates that the observed increased risk of MCM is not explained by consanguineous marriages. The rates of MCM in the Jewish population were similar among "exposed" and "unexposed" inhabitants. CONCLUSION: Residential proximity to the IP is associated with increased rates of MCM among Arab-Beduin but not in Jewish populations. These observations indicate the need for public health protection of a vulnerable society in transition, although the relative importance of chemical exposure and health care utilization requires further study.
The second semester of 1999 was a transition period for the implementation of the Special Indigenous Health District on the Xapecó Indigenous Reserve in western Santa Catarina State. The health clinic in the main village provided treatment with a staff including a general practitioner/obstetrician, pediatrician, dentist, nurse, two nursing assistants, and four nursing technicians. This paper presents the preliminary results of research on the organization of these health care services, their use by the community, and the health/disease profile of the Kaingáng, using patient files as the source of information. In September 1999, a total of 222 Indians were treated (children and adults), 50.5% of whom residing in the main village. Among the Indians ages 0 to 14 years, infectious and parasitic diseases were the most frequent, supporting the idea that the Kaingáng have precarious sanitary and nutritional conditions. Use of the clinic by adults was more varied, since of the 116 who appeared for consultation, 27 were pregnant women (out of a total of 86 women). In addition, prescriptions were written up for children and adults in 85.0% and 81.8% of the consultations, respectively.
The collapse of the Soviet Union was the most important historical event at the close of the 20th century. The jarring nature of this transition has resulted in large fluctuations in household resources and increased uncertainty in all facets of life for the individuals concerned. Much academic research and popular writing has explored the socioeconomic and political ramifications of bringing these countries into mainstream capitalism. This paper provides a review of the literature examining health outcomes in Eastern Europe and the former Soviet Union during the transition period. The research, which has studied the human face of transition, spans multiple disciplines and it is thus currently difficult for interested researchers to obtain an overview of the basic facts, as well as, the more detailed nuances, concerning developments. This paper highlights what we currently know about health outcomes in transition countries and what we do not know, and suggests future areas of research which may help fill important gaps in our knowledge.
Over the past 20 years, survival of youth with special health care needs, including youth with rheumatic diseases, has markedly improved. Over 90% will survive past their twentieth birthday and health care providers are recognizing a need for transition services to assist youth with disabilities to become successful adults. The barriers to, and the principles of, transition services are outlined. A discussion of available models and assessment tools for transition readiness and lessons learned on how to provide successful transition services is included.
BACKGROUND: The deterioration of the health status of the Romanian population during the economic transition from a centrally planned to a free market economy has been linked to lifestyles factors (e.g. diet) regarded as a main determinants of the disparity in life expectancy between Eastern and Western Europe. Reforms in the health care system in this transition economy aim to focus on preventive action. The purpose of this study was to identify the factors that impact on the individual decision to engage in Dietary Health Preventive Behaviour (DHPB) and investigate their influence in the context of an adapted health cognition model. METHODS: A population-based study recruited 485 adult respondents using random route sampling and face-to-face administered questionnaires. RESULTS AND DISCUSSION: Respondents' health motivation, beliefs that diet can prevent disease, knowledge about nutrition, level of education attainment and age have a positive influence on DHPB. Perceived barriers to healthy eating have a negative impact on alcohol moderation. The information acquisition behaviour (frequency of reading food labels) is negatively predicted by age and positively predicted by health motivation, education, self-reported knowledge about nutrition and household financial status. A significant segment of respondents believe they are not susceptible to the elicited diseases. Health promotion strategies should aim to change the judgments of health risk. CONCLUSION: The adaptation of the Health Belief Model and the Theory of Health Preventive Behaviour represents a valid framework of predicting DHPB. The negative sign of perceived threat of disease on DHPB may suggest that, under an income constraint, consumers tend to trade off long-term health benefits for short-term benefits. This cautions against the use of negative messages in public health campaigns. Raising the awareness of diet-disease relationships, knowledge about nutrition (particularly sources and risks associated with dietary fat and cholesterol) may induce people to adopt preventive dietary habits.
Anorexic and bulimic patients have a highly distorted relationship with food and eating, even though they tend to be knowledgeable about diet and nutrition. The progress of this disease, as well as its complications and associated difficulties, are increasingly understood, while the etiopathogeny of eating disorders remains obscure. The approach that we are proposing involves the study of one of the most fundamental cognitive functions of human reasoning--the cognitive process of categorization. The purpose of this study is to understand the procedures used by these patients to construct representations of food. Categorization, one of the basic features of human cognition, allows individuals to organize their subjective experience of the surrounding environment by structuring its contents. This ability to group different objects into the same category based on their common characteristics is important for explaining the major cognitive activities of planning, memorization, communication and perception. Indeed, our categories reflect our conceptions of the world. They depend on our experiences and representations, as well as the expertise acquired in a specific field. The differences that appear in the categories created by subjects when they are asked to classify objects reveal the properties that are most salient to them and, as a result, the interests, values and ideas associated with these properties. There are three types of properties: perceptive properties, which describe the object's shape, color, odor and texture; structural properties, which relate to the object's components; and functional properties, which specify the way in which the object is used and provide an answer to the question, "What is it used for?". Subjects attribute these functional properties by means of knowledge or inference according to their representation of the object's role; such properties are especially likely to emerge during top-down (theory-driven) processing. The type of processing used (bottom-up or top-down) is dependent on a certain number of factors. We hypothesize, within the context of food product categorization, that patients suffering from eating disorders largely resort to processing based on acquired information or beliefs about the objects, i.e. top-down processing. We present two studies: a naturalistic and exploratory pilot study whose goal is to identify whether the various categorization processes used by eating disorder patients differ from those employed by subjects not suffering from an eating disorder. A second study aims to identify the different categorization procedures. During the first experiment, 68 women (17 control subjects, 17 anorexics, 17 anorexic bulimics and 17 bulimics) aged 18-39 (average age: 26.6) verbalize all representations that come to mind during a limited time period as the name of a food item is read. Eighty-nine food items are presented in alphabetical order. The list is read out loud and all comments are recorded. The data is processed in three ways : an analysis based on the positive or negative valence of each representation, an analysis based on each categories of food and an analysis of representations based on themes expressed. The three analyses (valence, categories of food and theme assigned to the representations) show differences between the representations of the four experimental groups. In fact, the anorexics and anorexic bulimics mainly express strongly negative representations about food, whereas bulimics and control produce representations whose positive and negative valences balances. These negative cognitions concern mainly meat for the control subjects and cakes for the subjects reached of TCA. Concerning theme assigned to the representations, the control subjects produce mainly cognitions relating to the hedonism, the flavor of food and their purpose on health. The anorexics and anorexics-bulimics evoke mainly the fat and sugar content of the foods. The bulimics evoke mainly cognitions relating to the effect on health and the intestinal transit time of food. These results lead one to believe that it is not the bulimic binging and purging of these patients, but rather their restrictive behavior that is the determining factor in the differences in food representations observed between the two experimental groups. During the second experiment, 60 women (15 controls, 15 anorexics, 15 anorexic bulimics and 15 bulimics) aged 18-32 (average age: 25.6) classified 27 food names according to their similarities and differences, and then explained the reasons for their categorizations. The data were analyzed in terms of similarity/difference, and the verbalizations were analyzed by content. The results indicate that 10 of the 27 foods were categorized differently by the controls and the subjects with eating disorders. Subjects classified the following foods: camembert cheese, cold cuts, cheese spread, fruit in syrup, whole milk, mayonnaise, bread, fresh fish, potatoes and plain yogurt. Bulimics and controls use similar classifications for food names, while anorexics and atypical bulimics classify foods in a similar way. Examining the categorization criteria used during verbalizations allows us to better understand these differences. The control group's major criterion seems to be the succession of dishes. These subjects group into separate categories entry foods (beef, eggs, fish, etc.), vegetables, cheese or dairy foods, and finally desserts. Additional foods, like bread and mayonnaise, belong to the same category. Other categories are nutritional criteria (for example, dairy products contain calcium) and biological criteria (for example, bananas and apples are fruits). These categorization criteria include structural properties (which describe what the object is made of) and functional, "academic" properties, those which describe how foods are used, "as in cookbooks or diet books." On the other hand, the categorization criteria expressed by anorexic patients are very different from those used by control subjects: foods that are hard to eliminate, rich, high-fat and therefore indigestible are considered to be similar. Some examples are cold cuts, potatoes, mayonnaise and prepared desserts. A second categorization criterion involves the concept of natural foods : certain foods "are unhealthy because they're processed, so they're bad for you"--one such example is cheese spread. A third criterion concerns the notion of familiar foods: poultry and eggs, for example, are "familiar to us." We are clearly seeing here the importance of functional properties in the categorization of food names: certain foods are indigestible, hard to eliminate, cause heartburn or reflux, are not natural, and thus are avoided. The categorization criteria mentioned by bulimic patients also clearly take into account the functional properties of foods. The criteria are of the following type: "it's filling, it relieves a bulimic attack, it helps prevent heartburn and constipation, etc." It appears that bulimics' categorization criteria are solely associated with these foods' imagined or real effect on the body. The categorization criteria used by anorexic bulimics seem to be especially associated with weight gain or the consumption of such foods during bulimia attacks because "they make you feel full." On the other hand, light foods, which patients allow themselves to eat, are placed in the same category. This study, which seeks to understand the cognitive functioning of eating disorder patients with anorexia and bulimia, has brought new elements to light. All patients exhibit food categorization processes that differ greatly from those displayed by control subjects. Patients also attribute greater significance to the functional properties of foods as compared to controls, who give priority to structural properties. Anorexic and bulimic patients base their food categorizations on the consequences of ingestion, in terms of health, digestion and weight gain. Their processing of food stimuli is therefore radically different and gives a dominating place to top-down processes. Additional studies should supplement these findings in order to gain a better understanding of patients' disturbed processing of information.
CONTEXT: Placing a relative with dementia into a long-term care facility is common among caregivers. Placement transition and factors that affect caregiver health and well-being after placement of the patient are not well described. OBJECTIVE: To assess the impact of placing a relative with dementia in a long-term care facility on caregivers' health and well-being. DESIGN, SETTING, AND PARTICIPANTS: Prospective study from 1996 to 2000 of the placement transition in a sample of 1222 caregiver-patient dyads recruited from 6 US sites. A total of 180 patients were placed in a long-term care facility during the 18-month follow-up period. Data collected before and after placement were analyzed to identify factors associated with placement, the nature of contact between caregivers and their institutionalized relatives after placement, and the relation of both of these factors to health outcomes among dementia caregivers. MAIN OUTCOME MEASURES: Caregiver depression (symptoms on the Center for Epidemiological Studies-Depression [CES-D] scale; range, 0-60) and anxiety (State Trait Inventory; range, 10-40) and use of prescription medications for depression and anxiety. RESULTS: Caregivers who institutionalized their relative reported depressive symptoms and anxiety to be as high as they were while in-home caregivers. Overall CES-D scores for depression did not change from before to after placement (median [IQR], 15.0 [8-24.5] and 15.0 [7.7-28]; P =.64). Overall anxiety scores on the State Trait Inventory also did not change significantly (median [IQR], 22.0 [19-27] before vs 21.1 [18-27] after; P =.21). These effects were most pronounced among caregivers who were married to the patient (P =.02 for depression), visited more frequently (P =.01 for depression and P<.001 for anxiety), and were less satisfied with the help they received from others (P =.003 for depression and P<.001 for anxiety). The use of antidepressants did not change significantly before (21.1%) to after (17.9%) placement (P =.16). The use of anxiolytics before to after placement increased from 14.6% to 19% (P =.02), and nearly half of caregivers (48.3%) were at risk for clinical depression following placement of their relative. CONCLUSIONS: The transition to institutional care is particularly difficult for spouses, almost half of whom visit the patient daily and continue to provide help with physical care during their visits. Clinical interventions that better prepare the caregiver for a placement transition and treat their depression and anxiety following placement may be of great benefit to these individuals.
OBJECTIVE: Two simulation models were developed to analyze the cost-effectiveness of new treatments that affect the progression of rheumatoid arthritis (RA). METHODS: We used data from 2 cohorts of patients with early RA who had been followed up since disease onset (up to 15 years). In the Swedish study, 183 patients were followed up for a mean of 11.3 years. In the UK study, 916 patients were followed up for a mean of 7.8 years. Disease progression over 10 years was modeled as annual transitions between disease states, defined by Health Assessment Questionnaire (HAQ) scores. A regression model was used to estimate transition probabilities conditional on age, sex, and time since onset of disease, in order to allow simulation of different patient cohorts. Costs and utilities associated with different HAQ levels were based on data from the cohort studies and cross-sectional surveys. RESULTS: Costs increase and quality of life decreases as RA progresses. In Sweden, total annual costs range from 4,900 dollars to 33,000 dollars per patient, compared with 4,900 dollars to 14,600 dollars in the UK. Cumulative costs over 10 years for patients starting in disease state 1 (HAQ < 0.6) are 54,600 dollars in Sweden and 26,600 dollars in the UK. The cumulative numbers of quality-adjusted life-years (QALYs) are 5.5 and 5.6, respectively. Both costs and QALYs were discounted at 3%. CONCLUSION: The 2 models, which were based on different patient cohorts, reach a similar conclusion in terms of the effect of RA over 10 years. They appear to accurately capture disease progression and its effects and can therefore be useful in estimating the cost-effectiveness of new treatments in RA.