Medicine and Health Sciences Commons^™

Implications Of Online Gambling Legalization, William M. Schmidt

Student Publications

The tradition of gambling has been around for thousands of years, but has undergone a recent evolution into what it is perceived as today. This has turned it into an industry of its own, which will only continue to grow with the ongoing legalization of online gambling. Past trends in these legislations would project further economic growth tied to the gambling industry. However, the mental health implications that have been seen to stem from the practice of gambling are as present as ever. This problem associated with the industry will also be expected to climb as gambling becomes both more …

Congenital Chagas Disease In The United States: The Effect Of Commercially Priced Benznidazole On Costs And Benefits Of Maternal Screening, Victoria Perez-Zetune, Stephanie R. Bialek, Susan P. Montgomery, Eileen Stillwaggon

Economics Faculty Publications

Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors, and through transfusions, transplants, insect feces in food, and mother to child during gestation. An estimated 30% of infected persons will develop lifelong, potentially fatal cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment for Chagas disease in the United States, including the cost of commercially available benznidazole. We compare costs of testing and treatment for mothers and infants with the lifetime societal costs without testing and consequent morbidity and …

The Cost-Effectiveness Of Neonatal Versus Prenatal Screening For Congenital Toxoplasmosis, Christine Binquet, Catherine Lejeune, Valérie Seror, François Peyron, Anne-Claire Bertaux, Olivier Scemama, Catherine Quantin, Sophie Béjean, Eileen Stillwaggon, Martine Wallon

Economics Faculty Publications

Congenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of congenital toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments.

Prevention And Mitigation Of Congenital Toxoplasmosis: Economic Costs And Benefits In Diverse Settings, Branko Bobić, Isabelle Villena, Eileen Stillwaggon

Economics Faculty Publications

Congenital toxoplasmosis (CT), the result of a primary infection of pregnant women with Toxoplasma gondii which was transmitted to the fetus, may result in mild to deep injuries occurring in the newborn or later in its development or in adolescence. The visual and cognitive impairment that can result imposes substantial economic costs on the individual and society. Numerous observational studies favor the conclusion that, with preventive measures currently available, it is possible to reduce the incidence of infections in pregnant women, the incidence of fetal infection by preventing transplacental transmission, and the gravity of injury in infected newborns. Treatment of …

Honoring Veterans Means Funding Suicide Prevention, Brendan Cushing-Daniels, Christopher R. Fee

Economics Faculty Publications

Many Americans may not know that it was Dwight D. Eisenhower who in 1954 issued the official proclamation celebrating the service of all veterans by designating Nov. 11, formerly known as Armistice Day, in honor of our vets. Eisenhower, of course, was supreme commander of Allied Forces in Europe during World War II and commander in chief as the 34th president of the United States.

In Ike’s words, “on that day let us solemnly remember the sacrifices of all those who fought so valiantly, on the seas, in the air, and on foreign shores, to preserve our heritage of freedom, …

Congenital Chagas Disease In The United States: Cost Savings Through Maternal Screening, Eileen Stillwaggon, Victoria Perez-Zetune, Stephanie R. Bialek, Susan P. Montgomery

Economics Faculty Publications

Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors through transfusions, transplants, insect feces in food, and from mother to child during gestation. Congenital infection could perpetuate Chagas disease indefinitely, even in countries without vector transmission. An estimated 30% of infected persons will develop lifelong, potentially fatal, cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment of Chagas disease in the United States. We constructed a decision-analytic model to find the lower cost option, comparing costs of testing and …

Congenital Toxoplasmosis In Austria: Prenatal Screening For Prevention Is Cost-Saving, Andrea-Romana Prusa, David C. Kasper, Larry Sawers, Evelyn Walter, Michael Hayde, Eileen Stillwaggon

Economics Faculty Publications

Background:

Primary infection of Toxoplasma gondii during pregnancy can be transmitted to the unborn child and may have serious consequences, including retinochoroiditis, hydrocephaly, cerebral calcifications, encephalitis, splenomegaly, hearing loss, blindness, and death. Austria, a country with moderate seroprevalence, instituted mandatory prenatal screening for toxoplasma infection to minimize the effects of congenital transmission. This work compares the societal costs of congenital toxoplasmosis under the Austrian national prenatal screening program with the societal costs that would have occurred in a No-Screening scenario.

Methodology/Principal Findings:

We retrospectively investigated data from the Austrian Toxoplasmosis Register for birth cohorts from 1992 to 2008, including pediatric …

Economic Costs And Benefits Of A Community-Based Lymphedema Management Program For Lymphatic Filariasis In Odisha State, India, Eileen Stillwaggon, Larry Sawers, Jonathan Rout, David Addiss, Leanne Fox

Economics Faculty Publications

Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Program to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would …

Rush To Judgment: The Sti-Treatment Trials And Hiv In Sub-Saharan Africa, Eileen Stillwaggon, Larry Sawers

Economics Faculty Publications

Introduction: The extraordinarily high incidence of HIV in sub-Saharan Africa led to the search for cofactor infections that could explain the high rates of transmission in the region. Genital inflammation and lesions caused by sexually transmitted infections (STIs) were a probable mechanism, and numerous observational studies indicated several STI cofactors. Nine out of the ten randomized controlled trials (RCTs), however, failed to demonstrate that treating STIs could lower HIV incidence. We evaluate all 10 trials to determine if their design permits the conclusion, widely believed, that STI treatment is ineffective in reducing HIV incidence.

Discussion: Examination of the …

El Mal De Chagas Y Su Potencial De Eliminación, Eileen Stillwaggon

Economics Faculty Publications

La Asamblea Mundial de la Salud ha elegido algunas enfermedades como blancos para la eliminación. Hay mucha esperanza y una alta probabilidad de que varias enfermedades, recientemente llamadas desatendidas, sean eliminadas en las próximas décadas. Vamos a presenciar el fin de la transmisión de la dracunculiasis, la filariosis linfática, la poliomielitis, y en las Américas por lo menos, la oncocercosis. Ya se ven éxitos significativos como la cuasi erradicación de la dracunculiasis y paso importantes en contra de otras aflicciones. [Original Spanish version]

The World Health Assembly has chosen some diseases as targets for elimination. There is much …

Power, Race, And The Neglect Of Science: The Hiv Epidemics In Sub-Saharan Africa, Eileen Stillwaggon, Larry Sawers

Economics Faculty Publications

This work addresses racial stereotyping and the effect it has in distorting AIDS policy for sub-Saharan Africa.

Hiv And Concurrent Sexual Partnerships: Modelling The Role Of Coital Dilution, Larry Sawers, Alan G. Isaac, Eileen Stillwaggon

Economics Faculty Publications

Background: The concurrency hypothesis asserts that high prevalence of overlapping sexual partnerships explains extraordinarily high HIV levels in sub-Saharan Africa. Earlier simulation models show that the network effect of concurrency can increase HIV incidence, but those models do not account for the coital dilution effect (nonprimary partnerships have lower coital frequency than primary partnerships).

Methods: We modify the model of Eaton et al (AIDS and Behavior, September 2010) to incorporate coital dilution by assigning lower coital frequencies to non-primary partnerships. We parameterize coital dilution based on the empirical work of Morris et al (PLoS ONE, December …

Concurrent Sexual Partnerships Do Not Explain The Hiv Epidemics In Africa: A Systematic Review Of The Evidence, Larry Sawers, Eileen Stillwaggon

Economics Faculty Publications

The notion that concurrent sexual partnerships are especially common in sub-Saharan Africa and explain the region’s high HIV prevalence is accepted by many as conventional wisdom. In this paper, we evaluate the quantitative and qualitative evidence offered by the principal proponents of the concurrency hypothesis and analyze the mathematical model they use to establish the plausibility of the hypothesis.

We find that research seeking to establish a statistical correlation between concurrency and HIV prevalence either finds no correlation or has important limitations. Furthermore, in order to simulate rapid spread of HIV, mathematical models require unrealistic assumptions about frequency of sexual …

Complexity, Cofactors, And The Failure Of Aids Policy In Africa, Eileen Stillwaggon

Economics Faculty Publications

Global AIDS policy still treats HIV as an exceptional case, abstracting from the context in which infection occurs. Policy is based on a simplistic theory of HIV causation, and evaluated using outdated tools of health economics. Recent calls for a health systems strategy – preventing and treating HIV within a programme of comprehensive health care – have not yet influenced the silo approach of AIDS policy.

Evidence continues to accumulate, showing that multiple factors, such as malnutrition, malaria and helminthes, increase the risk of sexual and vertical transmission of HIV. Moreover, complementary interventions that reduce viral load, improve immune response, …