Un grupo de 90 mujeres con antecedente de 2 o más abortos espontáneos de causa desconocida, sin historia de partos anteriores, con estudio inmunológico que determinó ausencia de respuesta aloinmune y un grupo de control de 31 mujeres con antecedentede fertilidad comprobada, se estudiaron para anticuerpos a antígenos nucleares, anticoagulante lúpico y fosfolípidos. Demostramos serológicamente un incremento en la respuesta autoinmune a partir del segundo aborto. Los anticuerpos antifosfolípidos y los anticuerpos antinucleares aparecen presentes ya como epifenómenos ya como factores etiológicos en pacientes con pérdida recurrente del embarazo PRE.La importancia de los hallazgos mencionados y la novedad del presente traba,jo consiste en la identificación del incremento en la respuesta autoinmune a partir del segundo aborto.
We have reported autoimmune serological abnormalities in women with recurrent spontaneous abortions (RSAs).' Incidences of anti-phospholipid antibodies and antinuclear antibodies were significantly increased with each additional pregnancy loss in these women.* This was not seen in healthy, normal multiparous women. We also reported that 42% of women with three or more RSAs who were antiphospholipid antibody ( M A ) negative before the pregnancy became APA positive at the time of mi~carriage.~ Phospholipids are integral components of placental villous membrane, and there is evidence that trophoblastic antigenic stimuli during pregnancy may induce the production of various autoantibodies including antiphospholipid antibodies in failing pregnancies: In this study, we prospectively analyzed women with three or more RSAs and normal healthy women entering a pregnancy for autoantibodies at each trimester of pregnancy including cord blood samples.Thirty-one normal, healthy women with no history of RSAs who received antenatal care at Department of Obstetrics and Gynecology, Hospital Infantil in Bogota, Columbia and 32 women with three or more RSAs who registered at Reproductive Medicine, University of Health S c i e n c e f i e Chicago Medical School were investigated consecutively during the index pregnancy. All normal women were analyzed for IgG antibodies to six phospholipid epitopes, DNA, and histone at each trimester of pregnancy. Cord blood was also analyzed. Women with RSAs, IgM, and IgG APA were followed during pregnancy and at delivery or at the time of a repeated abortion. Titers of APAs were measured by ELISA as previously reported.'We report: (1) In women with a normal pregnancy, there is no APA positivity during pregnancy including cord blood (FIG. 1); (2) 6.5% of normal pregnant women demonstrated low positive ANA during pregnancy; (3) no one developed lupus anticoagulant during the index pregnancy; (4) 3.2% of normal pregnant women demonstrated IgG single-stranded DNA and 3.2% IgG double-stranded DNA. No one developed IgG antibodies to histone; ( 5 ) increased parity in women with a normal 242
A first-order Markov decision-analytic model was developed to compare cost-effectiveness of vaccination with PCV13, PPSV23 and no vaccination in the Czech Republic. PPSV23 effectiveness was derived from literature and PCV13 was extrapolated from impact in children adjusting for immunosenescence in older persons. Pneumonia, bacteremia and meningitis hospitalization and cost data were acquired from health authorities and DRG system in CR; outpatient data were based on retrospective patient survey. The model used a lifetime time horizon and 3% discount rate. RESULTS: Used according to Czech guidelines, PCV13 vaccination is associated with 0.0002 life-years gained for an additional EUR 1.002 on average (EUR 3,812,478 in total) compared to no vaccination and 0.0004 life-years gained for additional EUR 0.97 on average (EUR 3,704,061 in total) compared to PPSV23. This leads to an ICER of EUR/LYG 4,950 and 2,265 under current reimbursement. If all moderate and high risk people were vaccinated, the ICER would increase to EUR/LYG 5,582 and 6,691, respectively, under current reimbursement and to ICER of EUR/LYG 8,676 and 7,057 under full reimbursement. CONCLUSIONS: Confronting the national GDP per capita with the WHO recommendation on health care spending per QALY gained, PCV13 national immunization program in the Czech Republic can be considered cost-effective even under a full reimbursement policy. OBJECTIVES:The Women's Health Initiative (WHI) estrogen+progestin (E+P) clinical trial provides a large sample to estimate health state utility values for post-menopausal women with an intact uterus in the United States. To facilitate future health economic evaluations in this large population sub-group, we estimated utilities for trial participants stratified by age group (50-59, 60-69, 70-79) and randomization assignment (E+P or placebo). METHODS: We measured health state utility values for all 16,608 trial participants with the Short Form-6D (SF-6D) utility index using a validated Bayesian mapping algorithm and U.S. weights. We calculated cross-sectional mean baseline and 1-year utilities, and mean within-patient utility change from baseline to 1-year. Patients included in the baseline analysis completed the SF-36 within 7 days of randomization, and
OBJECTIVES: Estimate potential direct savings for the Mexican Healthcare System generated by the operation of the ЉTechnical Guidelines for distribution of food and beverages in establishments of basic educationЉ targeting population of 6 to 14 years of age. METHODS: The authors use the micro-simulation model ЉChronic Disease Prevention (CDP)Љ developed by the OECD-WHO for projecting health gains and costs of treatment in a period of 100 years. The model was adjusted to accommodate the range of ages stated in the Guidelines and uses information of incidence, prevalence, mortality, population at risk, annual unit costs and relative risk of selected chronic diseases (diabetes mellitus type 2, hypertension, cardio-and cerebro-vascular, hypercholesterolemia) attributable to obesity as well as the treatment of obesity as disease itself for the Mexican context. Sensitivity analyses were developed for most variables used in the model. RESULTS: Under the base case scenario present value of potential savings in total spending on medical care associated with the implementation of the Guidelines amount to USD$1,052.2 million in 2008. Most savings are derived from averted cases of hypertension (32.7%), obesityoverweight (28.6%) and diabetes mellitus type II (17.8%). Results are robust to changes in all parameters analyzed. Amounts obtained are an underestimation of potential savings as neither expensive complications as renal failure nor other chronic diseases attributable to obesity as arthritis, colorectal or breast cancer were included. CONCLUSIONS: The Guidelines, developed by both Ministry of Public Education and Ministry of Health, represent a good example of cooperation among different sectors to solve a complex public health problem. Results shows the importance of implementing preventive interventions aimed at reducing the prevalence of chronic diseases related to poor eating habits, inadequate physical activity and obesity in Mexico. The implementation of the Guidelines involves significant direct savings that can be assigned to other health needs of the Mexican population.
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