BBI

One of the most frightening warnings about the grim advance of AIDS throughout the world is from Peter Piot, head ofUNAIDS (New York), who said, "We are only at the beginning of the epidemic."

At the end of last year, the agency estimated that there would be 42 million people who are HIV-positive worldwide, with almost 30 million in sub-Saharan Africa alone. By 2010, India is forecast to have 20 million to 25 million sufferers and China 10 million to 20 million. Russia is the country increasing most rapidly in Europe, reporting around 200,000 new infections in 2002 alone.

Although the official HIV infection rate in India is reported as 1%, UNAIDSsays, "this is not really indicative of the seriousness of the situation the country is in" a diplomatic way of indicating that this underestimates strongly the actual totals. More than 4 million people in India are currently estimated to be seropositive.

In China there were an estimated 1 million seropositives by the middle of last year, with the three provinces of Yunnan, Guangsi and Guangdong being the most affected. There are several epidemics occurring simultaneously with the most serious being an outbreak among peasants who sold their blood to blood banks, who were contaminated by infected equipment and needles and whose blood subsequently contaminated hospital patients. In southern China, bordering the heroin-producing areas of Burma, Thailand and Laos, drug users have become a substantial focus for HIV infections.

In both India and China, there has been an initial reluctance to talk about sexuality, sex and transmission modes for HIV, with both government and sufferers themselves not wanting to admit to the problem.

Crucial to the success of prevention work, argued Alan Whiteside, an AIDS expert at the University of Natal in South Africa, is the willingness of governments to admit a problem exists. "You can throw all the money in the world at it, but if you don't have the right environment, it won't work. In every country where there has been success in dealing with the epidemic, AIDS has been destigmatized (by the government)," he said.

UNAIDS points to early government-supported intervention in Senegal, which headed off an epidemic there. HIV infection numbers are falling in Thailand, Ukraine and Uganda after extensive awareness campaigns, while the rate of infections among young mothers in South Africa and in Addis Ababa, the capital of Ethiopia, is falling significantly."We now have real empirical evidence that prevention works, particularly in young people in poor countries," Piot said. "The benefits of prevention efforts are always seen first among young people. We don't know why, but it seems harder to change the sexual behavior of a 40-year-old."

Three countries' healthcare systems

In the Czech Republic, it is said that it is better to be sick than to be a physician. With close to 400 physicians and 650 hospital beds per 100,000 inhabitants, there is certainly no shortage of capacity!Some 80% of healthcare costs are met by the 10 healthcare insurance organizations that are financed by employees and employers (4.5% and 9% of salary, respectively), with the balance of costs split equally between the state and the individual.

Life expectancy has increased since the fall of communism by a dozen years to 71 for men and 78 for women. Perinatal mortality, a serious problem in communist times, has fallen today to only 2.9 per 1,000 births.Physicians are still badly paid, however, with an average salary of only $500 a month. Nurses also are in short supply, as many have moved to Germany or Austria, where pay rates are much higher.

At first sight the Austrian healthcare system seems very attractive. It is financed by a number of healthcare insurance organizations, with the patient paying nothing up front, but the physician or clinic sending the bill direct to the insurers. However, employees pay 8% of salary to the insurers, which are now moving into a deficit position $148 million in 2001.Because the system is overloaded with frequent waiting lists, many Austrians prefer to use a parallel system with non-state physicians and clinics, and direct private payment of fees. No waiting for medical appointments and a more personalized attention are the main advantages.

In Finland, Nordic and Protestant ethics place pressure on the citizen to be responsible for his/her lifestyle, avoiding excesses of alcohol and tobacco, for instance, and calling on medical assistance only when really necessary. Some 95% of Finns use the public healthcare system, which is decentralized, being locally managed by municipalities, which cover 70% of health costs. The state finances another 20%, with the patient paying the 10% remaining.

On the first visit to the district medical center a patient pays $20, which is non-reimbursable. All subsequent visits for the next year are then free of charge. On hospitalization, there is a daily charge of $22 with no other costs at all. And dental care is completely free.

European Drug Agency hit by budget cuts

The European Agency for the Evaluation of Medicinal Products (EMEA, London) has been advised by its management board of a financial amendment decreasing the 2002 budget by more than 7% to $66 million.The EMEA management board said that the budget decrease reflected the decline in the number of applications received in the first nine months of 2002 the EMEA received only 25 new drug applications, 57% fewer than the equivalent period in 1999.

An EMEA spokesperson said the agency would cut back on working-group meetings and on the hiring of new personnel, raising speculation about how this might affect the biotech and medical device industries. A spokesperson for the BioIndustry Association (London) said, "It is expected that the number of applications will soon increase substantially, and we would be concerned that any reduction in the EMEA budget will greatly delay the handling of new licensing applications and therefore increase the time needed to get regulatory approval."

Laser surgery developments

The Revolix laser system for minimally invasive soft tissue surgery from Lisa Laser Products (Katlenburg-Lindau, Germany) is claimed to combine the surgical cutting properties of a CO₂ laser with the hemostatic effect of a Nd:YAG laser and the narrow damage zone of a holmium laser.The company said the 2 micron continuous-wave laser beam gives a precise cut with neat seams, with tissue damage limited to less than 1 mm beneath the cut. It has been widely used in Germany in the treatment of benign prostatic hyperplasia and the treatment of recurring bladder tumors.

Trumpf Medical Systems (Umkirch, Germany) has launched its latest LITT tumor therapy laser beam system, which uses multi-fiber technology to connect 4 Mikroflexx unbreakable fibers to each laser system. The company claims a superior laser beam quality that is both powerful and reliably stable. Trumpf also has launched the MiniCutter 80 high frequency (HF) surgical unit, which uses neutral electrode monitoring for improved safety and which can be used in monopolar or bipolar versions.

Other European laser surgery manufacturers include Carl Baasel Lasertechnik (Starnberg, Germany), Limmer Medical Technology (Appen, Germany), Mattioli Engineering (Firenze, Italy) and Semac Electronics (Munich, Germany).

Agfa in major Finnish PACS project

The HUSPacs project eventually will link the 21 X-ray departments in the Helsinki and Uusimaa districts of Finland into a single virtual department, sharing one common image database between them. By the end of 2002, 17 hospitals had been integrated into the network and are now completely filmless. By the end of 2003, 21 hospitals, 53 primary healthcare centers, nine primary healthcare hospitals and private clinics will be linked together to handle a total of more than 1 million examinations a year.

Agfa Healthcare (Mechelen, Belgium) is installing more than 100 Impax DS3000 diagnostic workstations and 15 Impax Web1000 web servers. When this is complete, images and reports will always be available on demand, regardless of where they were produced. A further benefit is that patients can choose to attend any of the imaging departments in the community, even if they are not normally treated there, or to attend the mobile imaging service that will be traveling around the districts. Access to images by clinical staff and patients alike eventually will be controlled by "smart cards."

At the recent EuroPACS conference in Oulu, Finland, experts from Agfa, GE Medical Systems (Waukesha, Wisconsin), Siemens (Erlangen, Germany) and Philips (Best, the Netherlands) made a number of presentations showing how future integration profiles will make connections between equipment a lot easier than it is today.

Teleradiology is only one service of networked picture archiving and communications systems (PACS), with new wireless terminal devices enabling access to patient data almost anywhere. Many of the mobile practical experiences presented at the conference have been in Finland, where neurosurgeons are even using smart phones to read computed tomography scans of the head, but developments are also rapidly going ahead in Germany, Korea and Japan.

Longer-life hip implants

More than 800,000 hip implants are made worldwide each year, with a majority using metal femoral heads and polyethylene acetabular cups, first pioneered by Sir John Charnley in the 1960s. While they provide a satisfactory solution for those over 70 and with severe arthritis, they are less suitable for younger and more active populations looking for a prosthesis with a life of more than 10 years.

Charnley-type implants do not wear out after 10 years, but they do release polyethylene wear particles causing chronic inflammation. In about 10% of cases, this can lead to bone resorption and loosening of the implant, a further operation and possibly a less satisfactory outcome because of bone loss.

DePuy Johnson & Johnson (Warsaw, Indiana) has joined in the SUREHIP project together with IonBond and Firth Rixson Superalloys, two specialist British engineering companies, the University of Bradford (Bradford, UK) and the University of Leeds (Leeds, UK) to develop bearing materials giving a greatly extended osteolysis-free life for hip prostheses. Osteolysis is dissolution of the bone through disease.

The major target for the project is a 10-fold reduction in the rate of wear-particle generation, which would hopefully extend the osteolysis-free period beyond the natural life span of the typical younger patient. The international headquarters (outside North America) and R&D facilities of DePuy Johnson & Johnson are in Leeds, and a project team has been set up there to develop the necessary production process. Clinical trials in a number of applications were projected to start in 4Q02.

New monitoring devices

The Pocket WinView PC is an extension of the Infinity Patient Monitoring System of the Electromedical Systems Division of Siemens Medical Solutions (Solna, Sweden) and is a hand-held PC device that provides remote viewing of patient vital signs. It enables clinicians to stay in touch with a patient's electrocardiogram and physiologic condition while remaining mobile. "Clinicians are increasingly using PocketPCs for reference and documentation. Pocket Winview will maximize their existing investment in these devices, while helping to streamline the patient care process," said Siegfried Russwurm, president of Siemens Electromedical Systems.

Philips Medical Systems has taken a somewhat different approach with the IntelliVue Patient Monitoring System. It integrates a wide variety of applications from other vendors on a single screen without the need for a second network connection. The IntelliVue system is designed to provide physicians anywhere in a hospital or from a patient's home PC with vital patient information from diverse sources such as lab results or X-rays. The patient monitor is networked to an information center, a surveillance system with integrated clinical support applications.

Mobile hemodialysis system launched

Fresenius Medical Care (Oberursel, Germany) has developed the Genius 90 dialysis machine which can be used safely in either the intensive care unit or the chronic dialysis center and which can be readily used in either acute or chronic hemodialysis situations. The unit is prepared at the central supply station, the Genius Preparator, filled with up to 90 liters of ready-to-use dialysis fluid and taken to wherever is most convenient for patient and staff. Once treatment is completed the dialysis unit is emptied, disinfected, rinsed and readied for the next patient.

Another unit of the Fresenius group, Fresenius Vial (Brezins, France), has launched the Optima volumetric infusion pump, said to provide higher performance and greater versatility. It is an extension to the existing Pilot line of syringe pumps and Orchestra infusion workstation.