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‣ Poverty, Disease, and the Ecology of Complex Systems

Ngonghala, Calistus N.; Pluciński, Mateusz M.; Murray, Megan B.; Farmer, Paul E.; Barrett, Christopher B.; Keenan, Donald C.; Bonds, Matthew H.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
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Understanding why some human populations remain persistently poor remains a significant challenge for both the social and natural sciences. The extremely poor are generally reliant on their immediate natural resource base for subsistence and suffer high rates of mortality due to parasitic and infectious diseases. Economists have developed a range of models to explain persistent poverty, often characterized as poverty traps, but these rarely account for complex biophysical processes. In this Essay, we argue that by coupling insights from ecology and economics, we can begin to model and understand the complex dynamics that underlie the generation and maintenance of poverty traps, which can then be used to inform analyses and possible intervention policies. To illustrate the utility of this approach, we present a simple coupled model of infectious diseases and economic growth, where poverty traps emerge from nonlinear relationships determined by the number of pathogens in the system. These nonlinearities are comparable to those often incorporated into poverty trap models in the economics literature, but, importantly, here the mechanism is anchored in core ecological principles. Coupled models of this sort could be usefully developed in many economically important biophysical systems—such as agriculture...

‣ Modeling of Novel Diagnostic Strategies for Active Tuberculosis – A Systematic Review: Current Practices and Recommendations

Zwerling, Alice; White, Richard G.; Vassall, Anna; Cohen, Ted; Dowdy, David W.; Houben, Rein M. G. J.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
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Introduction: The field of diagnostics for active tuberculosis (TB) is rapidly developing. TB diagnostic modeling can help to inform policy makers and support complicated decisions on diagnostic strategy, with important budgetary implications. Demand for TB diagnostic modeling is likely to increase, and an evaluation of current practice is important. We aimed to systematically review all studies employing mathematical modeling to evaluate cost-effectiveness or epidemiological impact of novel diagnostic strategies for active TB. Methods: Pubmed, personal libraries and reference lists were searched to identify eligible papers. We extracted data on a wide variety of model structure, parameter choices, sensitivity analyses and study conclusions, which were discussed during a meeting of content experts. Results & Discussion From 5619 records a total of 36 papers were included in the analysis. Sixteen papers included population impact/transmission modeling, 5 were health systems models, and 24 included estimates of cost-effectiveness. Transmission and health systems models included specific structure to explore the importance of the diagnostic pathway (n = 4), key determinants of diagnostic delay (n = 5), operational context (n = 5), and the pre-diagnostic infectious period (n = 1). The majority of models implemented sensitivity analysis...

‣ Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis

Palmer, Karen S.; Agoritsas, Thomas; Martin, Danielle; Scott, Taryn; Mulla, Sohail M.; Miller, Ashley P.; Agarwal, Arnav; Bresnahan, Andrew; Hazzan, Afeez Abiola; Jeffery, Rebecca A.; Merglen, Arnaud; Negm, Ahmed; Siemieniuk, Reed A.; Bhatnagar, Neera; Dh
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
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Background: Activity-based funding (ABF) of hospitals is a policy intervention intended to re-shape incentives across health systems through the use of diagnosis-related groups. Many countries are adopting or actively promoting ABF. We assessed the effect of ABF on key measures potentially affecting patients and health care systems: mortality (acute and post-acute care); readmission rates; discharge rate to post-acute care following hospitalization; severity of illness; volume of care. Methods: We undertook a systematic review and meta-analysis of the worldwide evidence produced since 1980. We included all studies reporting original quantitative data comparing the impact of ABF versus alternative funding systems in acute care settings, regardless of language. We searched 9 electronic databases (OVID MEDLINE, EMBASE, OVID Healthstar, CINAHL, Cochrane CENTRAL, Health Technology Assessment, NHS Economic Evaluation Database, Cochrane Database of Systematic Reviews, and Business Source), hand-searched reference lists, and consulted with experts. Paired reviewers independently screened for eligibility, abstracted data, and assessed study credibility according to a pre-defined scoring system, resolving conflicts by discussion or adjudication. Results: Of 16...

‣ Using Health Care Utilization and Publication Patterns to Characterize the Research Portfolio and to Plan Future Research Investments

Katz, Luba; Fink, Rebecca V.; Bozeman, Samuel R.; McNeil, Barbara J.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
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Objective: Government funders of biomedical research are under increasing pressure to demonstrate societal benefits of their investments. A number of published studies attempted to correlate research funding levels with the societal burden for various diseases, with mixed results. We examined whether research funded by the Department of Veterans Affairs (VA) is well aligned with current and projected veterans’ health needs. The organizational structure of the VA makes it a particularly suitable setting for examining these questions. Methods: We used the publication patterns and dollar expenditures of VA-funded researchers to characterize the VA research portfolio by disease. We used health care utilization data from the VA for the same diseases to define veterans’ health needs. We then measured the level of correlation between the two and identified disease groups that were under- or over-represented in the research portfolio relative to disease expenditures. Finally, we used historic health care utilization trends combined with demographic projections to identify diseases and conditions that are increasing in costs and/or patient volume and consequently represent potential targets for future research investments. Results: We found a significant correlation between research volume/expenditures and health utilization. Some disease groups were slightly under- or over-represented...

‣ Personalized medicine, population genetics and privacy : an empirical study of international gene banks

Holland, Chad D. (Chad Darrel)
Fonte: Massachusetts Institute of Technology Publicador: Massachusetts Institute of Technology
Tipo: Tese de Doutorado Formato: 103 p.; 7472164 bytes; 7477842 bytes; application/pdf; application/pdf
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The promise of personalized medicine lies in its potential to fundamentally change healthcare. In the past, pharmaceuticals were prescribed on a "one size fits all" basis-patients with certain disease phenotypes were given what were thought to be appropriate drugs. There is growing evidence however that the effectiveness of these drugs may differ by individual and by sub-group; presumably due to fundamental genetic differences in disease and metabolic pathways. Drugs like Herceptin, Gleevec and Iressa are part of an emerging trend in the biopharmaceutical arena of drugs that are accompanied by genetic diagnostic tests and prescribed only for patients with genotypes in which the agents are most effective.; by Chad D. Holland.; Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology; and, (S.M.M.O.T.)--Massachusetts Institute of Technology, Sloan School of Management, Management of Technology Program, 2005.; Includes bibliographical references.

‣ Exploring genomic medicine using integrative biology

Butte, Atul J
Fonte: Massachusetts Institute of Technology Publicador: Massachusetts Institute of Technology
Tipo: Tese de Doutorado Formato: 227 p.; 12369532 bytes; 12379139 bytes; application/pdf; application/pdf
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Instead of focusing on the cell, or the genotype, or on any single measurement modality, using integrative biology allows us to think holistically and horizontally. A disease like diabetes can lead to myocardial infarction, nephropathy, and neuropathy; to study diabetes in genomic medicine would require reasoning from a disease to all its various complications to the genome and back. I am studying the process of intersecting nearly-comprehensive data sets in molecular biology, across three representative modalities (microarrays, RNAi and quantitative trait loci) out of the more than 30 available today. This is difficult because the semantics and context of each experiment performed becomes more important, necessitating a detailed knowledge about the biological domain. I addressed this problem by using all public microarray data from NIH, unifying 50 million expression measurements with standard gene identifiers and representing the experimental context of each using the Unified Medical Language System, a vocabulary of over 1 million concepts. I created an automated system to join data sets related by experimental context.; (cont.) I evaluated this system by finding genes significantly involved in multiple experiments directly and indirectly related to diabetes and adipogenesis and found genes known to be involved in these diseases and processes. As a model first step into integrative biology...

‣ Principal component based system identification and its application to the study of cardiovascular regulation

Xiao, Xinshu
Fonte: Massachusetts Institute of Technology Publicador: Massachusetts Institute of Technology
Tipo: Tese de Doutorado Formato: 212 p.; 11487628 bytes; 11478692 bytes; application/pdf; application/pdf
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(cont.) Our methods analyze the coupling between instantaneous lung volume and heart rate and, subsequently, derive representative indices of parasympathetic and sympathetic control based on physiological and experimental findings. The validity of each method is evaluated via experimental data collected following interventions with known effect on the parasympathetic or sympathetic control. With the above techniques, this thesis explores an important topic in the field of space medicine: effects of simulated microgravity on cardiac autonomic control and orthostatic intolerance (OI). Experimental data from a prolonged bed rest study (simulation of microgravity condition) are analyzed and the conclusions are: 1) prolonged bed rest may impair autonomic control of heart rate; 2) orthostatic intolerance after bed rest is associated with impaired sympathetic responsiveness; 3) there may be a pre-bed rest predisposition to the development of OI after bed rest. These findings may have significance for studying Earth-bound orthostatic hypotension as well as for designing effective countermeasures to post-flight OI. In addition, they also indicate the efficacy of our proposed methods for autonomic function quantification.; System identification is an effective approach for the quantitative study of physiologic systems. It deals with the problem of building mathematical models based on observed data and enables a dynamical characterization of the underlying physiologic mechanisms specific to the individual being studied. In this thesis...

‣ Drug deposition and distribution in healthy and atherosclerotic arteries and in models of atherosclerosis following bulk or stent-based drug delivery

Vukmirovic, Neda
Fonte: Massachusetts Institute of Technology Publicador: Massachusetts Institute of Technology
Tipo: Tese de Doutorado Formato: 124 leaves
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Drug eluting stents have revolutionized the practice of medicine and the landscape of medical devices. Yet, more than four years after introduction clinical trial data and clinical use have still not fully clarified what drives the safety and efficacy of these devices. The goal of this thesis was to help fill this void by describing the mechanisms by which stent-eluted drugs are distributed within healthy and atherosclerotic vascular models. In the first part of the thesis we investigated the effect of drug physicochemical properties on drug deposition, retention, and distribution in a healthy vascular model. We found that hydrophobic drugs are deposited to a far greater degree than hydrophilic drugs, with longer retention times, and distribution patterns that likely track with specific and general binding sites. The second part of the thesis investigated how arterial ultrastructure in health and disease modulates the arterial deposition and distribution of hydrophobic antiproliferative drugs used with drug-eluting stents. We tracked the distribution of radiolabeled and FITC-labeled compounds and demonstrated that macrostructural changes in arterial architecture led to profound changes in drug deposition. Paclitaxel in particular was sensitive to tissue state.; (cont.) This drug binds specifically to tubulin and to lesser extent in a general manner to elastic. Drug levels fell as paclitaxel...

‣ Assessing the economic case for stratified medicine; Economic case for stratified medicine

Goren, Amir, S.M. Massachusetts Institute of Technology
Fonte: Massachusetts Institute of Technology Publicador: Massachusetts Institute of Technology
Tipo: Tese de Doutorado Formato: 39 leaves
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The goal of this study is to explore the economic conditions that favor the joint development of therapeutics and companion diagnostics. I hypothesize that predictive biomarkers can generate economic value in drug development by increasing success rates. I construct an economic model of the development of a hypothetical new therapy, and devote particular attention to parameters regarding safety, efficacy, cost, and market size, within a decision-theoretic framework. The results include a characterization of the dynamic net present value trade-offs between stratum size and biomarker success, as well as the identification of two complementary concepts of stratified medicine, namely, disease reclassification and value-based reimbursement. I also identify a strong potential incentive mechanism in the hands of public policy makers that could facilitate a resolution of the tension between patient interests and the interests of pharmaceutical sponsors. The conclusion is that a biomarker can compensate for smaller stratum by increasing success probabilities. However, the effects of longer development time due to biomarker inclusion counter the effects of improved success probabilities. Longer exclusivity periods for stratified medicine may be required in order to resolve the tension between patient interests and the interests of pharmaceutical sponsors.; by Amir Goren.; Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology...

‣ Best care practices in anesthesiology : development and evaluation of an electronic feedback system to improve physician compliance with evidence-based practices

Sarin, Pankaj, M.D. University of Rochester
Fonte: Massachusetts Institute of Technology Publicador: Massachusetts Institute of Technology
Tipo: Tese de Doutorado Formato: 57 leaves
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Recently, hospitals, regulatory agencies, and insurers have renewed their focus on improving patient care and safety. Outcomes based measures are being utilized and hospitals are being asked to report on whether patients are being treated according to a standard of care or a best practice guideline. As peri-operative physicians, anesthesiologists are able to evaluate and, to a great degree, affect the pre-operative, intra-operative, and post-operative course of a patient. However, several barriers exist. Although best practice guidelines exist, current models to risk stratify patients need improvement. Individual anesthesiologists currently have no uniform way to measure patient outcomes, either in an institutional or provider specific manner, and many treat patients based on anecdotal experience rather than on evidence based medicine. We addressed these issues through development of an electronic feedback system. The demonstration system targeted the problem of postoperative nausea and vomiting (PONV) in the ambulatory surgery patient population. Because performance of existing PONV risk prediction models was poor and could not be used for educational purposes, we created a new PONV risk prediction model and compared it against existing models. The new...

‣ Value creation through modernizing Chinese medicine

Sun, Lizhe
Fonte: Massachusetts Institute of Technology Publicador: Massachusetts Institute of Technology
Tipo: Tese de Doutorado Formato: 118 leaves
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My first hypothesis in this thesis is that there is significant value vested in traditional Chinese medicine that can be captured by converting them into ethical drugs through scientific analysis, screening and validation. Further, holistic treatment is a key difference between traditional Chinese medicine and western-type chemical drugs, which makes Chinese medicine a very valuable category of knowledge. Using mixed formula is a primary method of treatment in Chinese medicine. It is the application of distinctive medical philosophies of Chinese herbal medicines in practices, reflecting the uniqueness and advantages of Chinese medicine. For example, there are 96,592 mixed formula recorded by "Dictionary of Chinese Medicine Mixed Formula" published in 1997. My second hypothesis in this thesis is that value can be created and captured, under the globalization context, from mixed herbal formulas for the mainstream world market with the aid of fingerprint technologies. To enter western markets as officially approved drugs through critical pathways, both scientific and regulatory, Chinese herb drugs must demonstrate sound evidence for safety and efficacy. I address in this thesis one of the central concerns of the pharmaceutical companies and FDA...

‣ Cellular and molecular immunotherapeutics derived from the bone marrow stroma; Cellular and molecular immuno therapeutics derived from the bone marrow stroma

Parekkadan, Biju
Fonte: Massachusetts Institute of Technology Publicador: Massachusetts Institute of Technology
Tipo: Tese de Doutorado Formato: 174 p.
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The bone marrow contains a multipotent stromal cell, commonly referred to as a mesenchymal stem cell (MSC). There has been recent interest in the clinical use of MSCs for cell-based therapy because: (1) bone marrow aspiration is a routine method used in medicine thereby allowing for easy accessibility to human MSCs; (2) MSCs are easily isolated and can expand to clinical scales in a relatively short period of time; (3) MSCs can be biopreserved without loss of potency and stored for point-of-care delivery; and (4) human trials of MSCs thus far have shown no adverse reactions to allogeneic versus autologous MSC transplants suggesting that therapy can cross histocompatibility barriers. This thesis describes the development of new modalities and indications for MSC-based treatments by leveraging the endogenous functions of these cells for therapeutic purposes. First, it is known that marrow stromal cells support hematopoiesis by secreting bioactive molecules that aid in the growth, differentiation, function and migration of hematopoietic cells within the marrow cavity. We show that these same secreted molecules derived from MSCs ex vivo can be formulated as an intravenous drug. In a D-galactosamine model of acute liver failure, a bolus injection of a concentrated form of MSC conditioned medium (MSC-CM) led to a significant survival benefit with a one week study endpoint. We employed in vitro and in vivo assays to demonstrate the effect of MSC-CM on leukocytes and resident liver cells. Traditional biochemical approaches were performed to identify active fractions within MSC-CM that were responsible for its therapeutic efficacy. As a corollary to an injectable drug...

‣ Privacy and identifiability in clinical research, personalized medicine, and public health surveillance

Cassa, Christopher A
Fonte: Massachusetts Institute of Technology Publicador: Massachusetts Institute of Technology
Tipo: Tese de Doutorado Formato: 200 p.
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Electronic transmission of protected health information has become pervasive in research, clinical, and public health investigations, posing substantial risk to patient privacy. From clinical genetic screenings to publication of data in research studies, these activities have the potential to disclose identity, medical conditions, and hereditary data. To enable an era of personalized medicine, many research studies are attempting to correlate individual clinical outcomes with genomic data, leading to thousands of new investigations. Critical to the success of many of these studies is research participation by individuals who are willing to share their genotypic and clinical data with investigators, necessitating methods and policies that preserve privacy with such disclosures. We explore quantitative models that allow research participants, patients and investigators to fully understand these complex privacy risks when disclosing medical data. This modeling will improve the informed consent and risk assessment process, for both demographic and medical data, each with distinct domain-specific scenarios. We first discuss the disclosure risk for genomic data, investigating both the risk of re-identification for SNPs and mutations, as well as the disclosure impact on family members. Next...

‣ Impact of a Comprehensive Nutrition and Lifestyle Education Intervention on Body Weight and Health-Related Outcomes in Morbidly-Obese Hispanic-Americans Following Laparoscopic Roux-En Y Gastric Bypass

Petasne Nijamkin, Monica
Fonte: FIU Digital Commons Publicador: FIU Digital Commons
Tipo: Artigo de Revista Científica Formato: application/pdf
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As morbid obesity increasingly affects Hispanic-Americans, the incidence of Roux-en-Y gastric bypass procedures (RYGB) among this population rises. Prospective research on the impact of postoperative educational interventions focused on Hispanic-Americans is needed to prevent premature weight loss plateau, weight regain, nutritional deficiencies, and relapse of obesity-related comorbidities. This randomized-controlled study evaluated the impact of a comprehensive nutrition and lifestyle education intervention (6 biweekly postoperative sessions that incorporated motivational strategies for behavioral change) as compared to a non-comprehensive approach (printed guidelines for healthy lifestyle). The variables to consider are body weight, obesity-related comorbidities (depression, diabetes, dyslipidemia, and others), nutrient status, physical activity, and eating habits in 144 morbidly-obese adult Hispanic-Americans 6 to 12 months following RYGB. Patients were randomly assigned to either the comprehensive intervention (n=72) or the comparison group (n=72). Participants (mean age 44.5 ± 13.5 years) were mainly Cuban-born females (83.3%). Intervention sessions attendance was 64%. At 12 months, both groups lost weight significantly, but those in the comprehensive intervention experienced greater excess weight loss than those in the comparison group (80% vs. 64% from preoperative excess weight...

‣ Attitudes of teachers to evidence based medicine

Kljakovic, Marjan; Love, Tom; Gilbert, Amanda
Fonte: Royal Australian College of General Practitioners; http://www.racgp.org.au/ Publicador: Royal Australian College of General Practitioners; http://www.racgp.org.au/
Tipo: Journal article; Published Version Formato: 3 pages
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AIM: To describe the attitudes of general practitioners and specialist clinical teachers toward teaching evidence based medicine (EBM). PARTICIPANTS AND METHODS: Questionnaire survey of 114 general practitioner and 162 specialist university teachers teaching EBM. RESULTS: Two hundred and six (80%) teachers responded; 196 regularly consulted with patients, 21% had received training, and 40% taught EBM. Those with formal training (68%) taught more often than without (32%) (p=0.0001), 27% had taught EBM for over 5 years. More GPs (57%) than specialists (40%) asked students to assist in finding evidence (p=0.036). Most welcomed EBM and were confident in teaching it. Barriers included antagonism to EBM philosophy, shortage of time, and a need for training in teaching EBM. DISCUSSION: Although not all trained, GPs and specialists teach EBM, enjoy doing so, and want to increase their ability to teach it.; At time of writing, Marjan Kljakovic affiliated with University of Otago, Wellington School of Medicine and Health Sciences, General Practice, Convenor of Evidence Based Medicine Teaching

‣ The Ottawa ankle rules for the use of diagnostic X-ray in after hours medical centres in New Zealand

Wynn-Thomas, Simon; Love, Tom; McLeod, Deborah; Vernall, Sue; Kljakovic, Marjan; Dowell, Antony; Durham, John
Fonte: New Zealand Medical Association; http://www.nzma.org.nz/ Publicador: New Zealand Medical Association; http://www.nzma.org.nz/
Tipo: Journal article; Published Version Formato: 7 pages
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Aims: The aims of this study were to measure baseline use of Ottawa ankle rules (OAR), validate the OAR and, if appropriate, explore the impact of implementing the Rules on X-ray rates in a primary care, after hours medical centre setting. Methods: General practitioners (GPs) were surveyed to find their awareness of ankle injury guidelines. Data concerning diagnosis and X-ray utilisation were collected prospectively for patients presenting with ankle injuries to two after hours medical centres. The OAR were applied retrospectively, and the sensitivity and specificity of the OAR were compared with GPs’ clinical judgement in ordering X-rays. The outcome measures were X-ray utilisation and diagnosis of fracture. Results: Awareness of the OAR was low. The sensitivity of the OAR for diagnosis of fractures was 100% (95% CI: 75.3 – 100) and the specificity was 47% (95% CI: 40.5 – 54.5). The sensitivity of GPs’ clinical judgement was 100% (95% CI: 75.3 – 100) and the specificity was 37% (95% CI: 30.2 – 44.2). Implementing the OAR would reduce X-ray utilisation by 16% (95% CI: approx 10.8 – 21.3). Conclusions: The OAR are valid in a New Zealand primary care setting. Further implementation of the rules would result in some reduction of X-rays ordered for ankle injuries...

‣ Do Ask, Do Tell: High Levels of Acceptability by Patients of Routine Collection of Sexual Orientation and Gender Identity Data in Four Diverse American Community Health Centers

Cahill, Sean; Singal, Robbie; Grasso, Chris; King, Dana; Mayer, Kenneth; Baker, Kellan; Makadon, Harvey
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
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Background: The Institute of Medicine and The Joint Commission have recommended asking sexual orientation and gender identity (SOGI) questions in clinical settings and including such data in Electronic Health Records (EHRs). This is increasingly viewed as a critical step toward systematically documenting and addressing health disparities affecting lesbian, gay, bisexual, and transgender (LGBT) people. The U.S. government is currently considering whether to include SOGI data collection in the Stage 3 guidelines for the incentive program promoting meaningful use of EHR. However, some have questioned whether acceptable standard measures to collect SOGI data in clinical settings exist. Methods: In order to better understand how a diverse group of patients would respond if SOGI questions were asked in primary care settings, 301 randomly selected patients receiving primary care at four health centers across the U.S. were asked SOGI questions and then asked follow-up questions. This sample was mainly heterosexual, racially diverse, and geographically and regionally broad. Results: There was a strong consensus among patients surveyed about the importance of asking SOGI questions. Most of the LGBT respondents thought that the questions presented on the survey allowed them to accurately document their SOGI. Most respondents—heterosexual and LGBT—answered the questions...

‣ Development and Validation of a Social Capital Questionnaire for Adolescent Students (SCQ-AS)

Paiva, Paula Cristina Pelli; de Paiva, Haroldo Neves; de Oliveira Filho, Paulo Messias; Lamounier, Joel Alves; Ferreira, Efigênia Ferreira e; Ferreira, Raquel Conceição; Kawachi, Ichiro; Zarzar, Patrícia Maria
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
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Objectives: Social capital has been studied due to its contextual influence on health. However, no specific assessment tool has been developed and validated for the measurement of social capital among 12-year-old adolescent students. The aim of the present study was to develop and validate a quick, simple assessment tool to measure social capital among adolescent students. Methods: A questionnaire was developed based on a review of relevant literature. For such, searches were made of the Scientific Electronic Library Online, Latin American and Caribbean Health Sciences, The Cochrane Library, ISI Web of Knowledge, International Database for Medical Literature and PubMed Central bibliographical databases from September 2011 to January 2014 for papers addressing assessment tools for the evaluation of social capital. Focus groups were also formed by adolescent students as well as health, educational and social professionals. The final assessment tool was administered to a convenience sample from two public schools (79 students) and one private school (22 students), comprising a final sample of 101 students. Reliability and internal consistency were evaluated using the Kappa coefficient and Cronbach's alpha coefficient, respectively. Content validity was determined by expert consensus as well as exploratory and confirmatory factor analysis. Results: The final version of the questionnaire was made up of 12 items. The total scale demonstrated very good internal consistency (Cronbach's alpha: 0.71). Reproducibility was also very good...

‣ Costs and Cost-Effectiveness of 9-Valent Human Papillomavirus (HPV) Vaccination in Two East African Countries

Kiatpongsan, Sorapop; Kim, Jane J.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
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Background: Current prophylactic vaccines against human papillomavirus (HPV) target two of the most oncogenic types, HPV-16 and -18, which contribute to roughly 70% of cervical cancers worldwide. Second-generation HPV vaccines include a 9-valent vaccine, which targets five additional oncogenic HPV types (i.e., 31, 33, 45, 52, and 58) that contribute to another 15–30% of cervical cancer cases. The objective of this study was to determine a range of vaccine costs for which the 9-valent vaccine would be cost-effective in comparison to the current vaccines in two less developed countries (i.e., Kenya and Uganda). Methods and Findings: The analysis was performed using a natural history disease simulation model of HPV and cervical cancer. The mathematical model simulates individual women from an early age and tracks health events and resource use as they transition through clinically-relevant health states over their lifetime. Epidemiological data on HPV prevalence and cancer incidence were used to adapt the model to Kenya and Uganda. Health benefit, or effectiveness, from HPV vaccination was measured in terms of life expectancy, and costs were measured in international dollars (I$). The incremental cost of the 9-valent vaccine included the added cost of the vaccine counterbalanced by costs averted from additional cancer cases prevented. All future costs and health benefits were discounted at an annual rate of 3% in the base case analysis. We conducted sensitivity analyses to investigate how infection with multiple HPV types...

‣ Adjusting to progress: interactions between the National Library of Medicine and health sciences librarians, 1961–2001*

Humphreys, Betsy L.
Fonte: Medical Library Association Publicador: Medical Library Association
Tipo: Artigo de Revista Científica
Publicado em /01/2002 Português
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Most health sciences librarians would agree that the National Library of Medicine's (NLM's) leadership and its services have been highly beneficial to the field, but this does not prevent specific NLM actions—or lack of action—from being perceived as annoying or infuriating. Over the past forty years, NLM's interactions with health sciences librarians have been affected by significant additions to NLM's mission and services, the expansion of NLM's direct user groups, and the growing range of possible relationships between health sciences librarians and NLM. The greatest friction between NLM and health services librarians occurs when there is a fundamental change in the way NLM carries out its mission—a change that adds to the web of relationships that link librarians and NLM and prompts corresponding changes in the way other libraries do business. Between 1961 and 2001, there were two such fundamental changes: the implementation of the National Network of Libraries of Medicine and the development and promotion of services targeted toward individual health professionals. On a lesser scale, each new service that connects NLM and health sciences librarians is another potential source of irritation, ready to flare up when the service is interrupted...