The measurement of plasma homocysteine concentrations may be important both in health care and preventive medicine, provided that it is applied correctly, and that blood sampling, transport, and assays are state-of-the art procedures.
In a study designed to compare the cost-effectiveness of three cardiovascular disease prevention programmes, subject to a defined budget, a population was subgrouped according to risk levels. Cost per year of life saved and annual budget expenditure were calculated for each subgroup. Budget expenditure was defined in terms of current direct costs. A ranked list was constructed, and the cut-off level of 'acceptable' cost-effectiveness elicited.
The Scandinavian Neurotrauma Committee (SNC) was created by the Scandinavian Neurosurgical Society in order to develop evidence-based guidelines for improved care of neurotrauma patients. A MEDLINE search identified 475 papers dealing with the management of minimal, mild and moderate head injuries. Forty-two studies presenting Class II evidence on the initial management of such injuries were reviewed, and management guidelines were developed. Implementation of the Head Injury Severity Scale is advocated. Patients with Minimal injuries (no loss of consciousness (LOC), Glasgow Coma Scale (GCS) score 15) can be safely discharged. Routine early computerized tomography (CT) scan is recommended in cases with Mild injuries (history of LOC, GCS 14-15) and patients with normal scans may be discharged. CT scan and admission is mandatory in Moderate injuries (GCS 9-13). All patients with additional risk factors should be scanned and admitted. A flow-chart for clinical decision making and a Head Injury Instruction card is introduced. The SNC suggests guidelines that should be safe and cost-effective for the initial management of minimal, mild and moderate head injuries.
The five major risk factors for stroke are hypertension, smoking, diabetes, atrial fibrillation and physical inactivity. All of these are amenable. In addition, although hypercholesterolemia is not strongly associated with stroke in epidemiological studies, primary prevention with statins provides a modest reduction of stroke risk. Unchanged population levels of blood pressure in Sweden over the last two decades are accompanied by constant stroke incidence rates. The single most cost-effective preventive action is detection and treatment of hypertension in the elderly. Antismoking advice and anticoagulants in patients with atrial fibrillation and other cardiac sources of embolism also have favourable effects relative to costs. There is a dearth of successful population-based programs to prevent stroke.