MedGenMed : Medscape general medicine最新文献

The citizens of many countries have long traveled to the United States and to the developed countries of Europe to seek the expertise and advanced technology available in leading medical centers. In the recent past, a trend known as medical tourism has emerged wherein citizens of highly developed countries choose to bypass care offered in their own communities and travel to less developed areas of the world to receive a wide variety of medical services. Medical tourism is becoming increasingly popular, and it is projected that as many as 750,000 Americans will seek offshore medical care in 2007. This phenomenon is driven by marketplace forces and occurs outside of the view and control of the organized healthcare system. Medical tourism presents important concerns and challenges as well as potential opportunities. This trend will have increasing impact on the healthcare landscape in industrialized and developing countries around the world.

The question of how healthcare should be structured has been at the forefront of public debate for quite some time. In particular, debate has raged over the acceptability of socialized and rights-oriented approaches to healthcare as opposed to privatized and commodity-oriented approaches. The present discussion looks at the underlying logic of the debate and at the use of outcome measures as a primary determinant. It suggests that outcome measures are of limited use in deciding the issue because they ignore important variables and further suggests that outcome measures are inappropriate tools when comparing distinct healthcare systems because they ignore valuational components that are integral to deciding whether a healthcare system is consistent with a society's principles and values.

Context: Recently, neuropsychiatric events associated with oseltamivir treatment have been reported, mainly in pediatric patients in Japan.

Objective: To explore the influence of oseltamivir treatment on central nervous system (CNS)-related and neuropsychiatric events in adults, children, and adolescents with influenza.

Design: A retrospective cohort study using propensity-matched data for 6 influenza seasons (2000-2006).

Setting: Claims data were obtained from the Thomson Healthcare MarketScan Research Database.

Patients: Patients of all ages and in subgroups aged 12 years or younger, 13-17 years, and 18-49 years diagnosed with influenza.

Main outcome measures: Claims for CNS and neuropsychiatric events within 14 and 30 days following influenza diagnosis were compared between patients prescribed oseltamivir and those not prescribed antiviral treatment.

Results: Data for 40,704 patients prescribed oseltamivir (9599 aged 12 years or younger; 4615, 13-17 years; and 16,910, 18-49 years) and 40,704 matched controls (9599 aged 12 years or younger; 4621, 13-17 years; and 16,898, 18-49 years) were analyzed. None of the CNS-related and neuropsychiatric events was more likely to occur in patients prescribed oseltamivir. Overall, CNS-related or neuropsychiatric events (odds ratio [OR] 0.76; 95% confidence intervals [CI]: 0.68, 0.84), psychiatric events (OR 0.82; 95% CI: 0.70, 0.96), and disturbances of consciousness (OR 0.61; 95% CI: 0.48, 0.76) within 14 days after influenza diagnosis were all less likely in patients given oseltamivir. Findings were similar within the 30-day post-index time window and across all age groups.

Conclusions: No increase in CNS-related and neuropsychiatric events was observed in adults, children, or adolescents with influenza who were prescribed oseltamivir in this study.