18 Jan, 11 | by Jackie Cassell, Editor of STI
The cost of Pelvic Inflammatory Disease: a case for the promotion of outpatient services?
A US study on the financial implications of PID in adolescents draws attention to patients’ under-use of appropriate outpatient services and the enormous cost of cases requiring hospitalization. The adolescents in the study, from black, low-income backgrounds, were mostly first seen for care in Emergency Departments. The authors, who favour a “strategic approach to adolescent care”, point out that the care provision by EDs may often be “suboptimal” as compared to outpatient clinics, i.e. general pediatric adolescent medicine and gynaecology clinics. The study evaluates the direct financial costs of existing, apparently very un-strategic, care arrangements: estimated charge for patients treated in outpatient clinics or emergency departments is $7440 lower than the charge for those requiring to be treated as inpatients.
Reference: Maria Trent et al., “Estimating the Direct Costs of Pelvic Inflammatory Disease in Adolescents: A Within-System Analysis”, Sexually Transmitted Diseases, Volume 37, Number 12, December 2010.
Solid evidence for the reproductive sequelae of Chlamydia – especially ectopic pregnancy?
Tubal ectopic pregnancy accounts for 1-2% of all pregnancies in Europe and the US, and is the most common cause of maternal mortality in these countries. Its association with Chlamydia has been demonstrated by epidemiological studies. But there is nothing like fingering the pathological mechanism, when it comes to bringing home the reality and importance of such an association.
The mechanisms of tubal damage are believed to be immunologically mediated, rather than a consequence of tissue destruction. A recent study reported in the American Journal of Pathology seeks to cast light on these mechanisms, thus corroborating the epidemiological link. Alterations in PROK signalling have previously been shown to promote a micro-environment conducive to embryo implantation. This study postulates that Chlamydia infection increases Fallopian Tube PROKR2 via TLR2 and NF?B activation.
Does this add new justification for screening programmes?
Reference: Jule L.V. Shaw et al., “Chlamydia trachomatis Infection Increases Fallopian Tube PROKR2 via TLR2 and NF?B Activiation Resulting in a Microenvironment Predisposed to Ectopic Pregnancy”, The American Journal of Pathology, Volume 178, no. 1, January 2011.
Russia and Ukraine adopt an “ostrich policy” on HIV.
As regards its impact on HIV transmission the benefits of what health-care professionals term the “harm-reduction package” for intravenous drug users (i.e. opiate substitution, and supply of clean needles) is taken for granted in many Western countries. And not just in the West. Last July, harm-reduction was endorsed by the “Vienna Declaration” at the 18th International AIDS Conference. But in Russia and the Ukraine, home to 90% of those infected in HIV in central and eastern Europe, it is quite another story – according to Jon Cohen, author of Shots in the Dark, in a recent opinion piece. Partly, this is due to the government’s failure to bankroll the harm-reduction effort until recently assured by Global Fund money, partly the outright ban on methadone.
Organizers of the Vienna Conference held the meeting in Vienna specifically because “it is the gateway to Eastern Europe”. For the first time, all proceedings were translated into Russian. But no high-level Russian or Ukraininan official attended.