BACKGROUND:The process by which active pulmonary tuberculosis (TB) is detected can be tediously slow in rural and often roadless Alaska, where several hundred air or boat miles can separate a patient from a chest x-ray and/or sputum collection. Additionally, the only TB reference lab in the state is many hundreds of air miles away, albeit centrally located in Anchorage. Under such conditions, it may take up to a week to process serial sputum AFB smears. This can result in either delayed onset of treatment or unnecessary empiric treatment, all while safety for the community is being considered. This dilemma often results in precautionary hospital isolation of a patient who might otherwise have been able to travel home by air. This article proposes a roadmap for remote health care settings that might bridge our current TB diagnostic ability to a better way in the future.METHODS:Current TB diagnostic guidelines in our area (Yukon-Kuskokwim Delta) were reviewed for integration of the Xpert MTB/ RIF assay with the purpose of improving TB health care while emphasizing patient benefits and cost savings.RESULTS:A clinical guideline that integrates the rapid TB assay into the current TB diagnostic algorithms for adults and adolescents is proposed. Crude cost savings at our hospital resulting from this guideline are estimated to be $316,000 per year.CONCLUSION:The proven utility of a new rapid TB diagnostic, the Xpert MTB/RIF assay, offers the promise of more efficient TB medical care, improved patient human rights and improved hospital and community environmental safety, all with likely huge reduced health care costs in remote Alaska.
This study examines the medical costs of childhood obesity in Alaska, today and in the future. We estimate that 15.2 percent of those ages 2 to 19 in Alaska are obese. Using parameters from published reports and studies, we estimate that the total excess medical costs due to obesity for both adults and children in Alaska in 2012 were $226 million, with medical costs of obese children and adolescents accounting for about $7 million of that total. And those medical costs will get much higher over time, as today's children transition into adulthood. Aside from the 15.2 percent currently obese, another estimated 20 percent of children who aren't currently obese will become obese as adults, if current national patterns continue. We estimate that the 20-year medical costs--discounted to present value--of obesity among the current cohort of Alaska children and adolescents will be $624 million in today's dollars. But those future costs could be decreased if Alaskans found ways to reduce obesity. We consider how reducing obesity in several ways could reduce future medical costs: reducing current rates of childhood obesity, rates of obese children who become obese adults, or rates of non-obese children and adolescents who become obese adults. We undertake modest reductions to showcase the potential cost savings associated with each of these channels. Clearly the financial savings are a direct function of the obesity reductions and therefore the magnitude of the realized savings will vary accordingly. Also keep in mind that these figures are only for the current cohort of children and adolescents; over time more generations of Alaskans will grow from children into adults, repeating the same cycle unless rates of obesity decline. And finally, remember that medical costs are only part of the broader range of social and economic costs obesity creates.
Consumption of undercooked game meat during pregnancy is considered a risk factor for congenital toxoplasmosis, but cases definitively linking ingestion of infected meat to clinical disease are lacking. We report a confirmed case of congenital toxoplasmosis identified because of atrial flutter in the fetus and linked to maternal consumption of Toxoplasma gondii PCR-positive moose meat.
