Education and Control of Risk Factors for Cardiovascular Disease (CVD) in Elderly Patients with CVD in Amirkola

Background and Objective: With increasing age, the burden of chronic diseases such as cardiovascular disease (CVD) increases. Education seems to be effective in controlling the risk factors for cardiovascular disease to prevent the disease and to control the disease after its development. The burden of cardiovascular disease and its associated risk factors is higher in people with low education. The present study was conducted to investigate the effect of education on the control of risk factors for cardiovascular disease in the elderly in Amirkola, northern Iran. Methods: In this cross-sectional study, which is part of the Amirkola Health and Ageing Project, 356 elderly patients with confirmed CVD were studied. Risk factors for cardiovascular disease including body mass index, waist circumference, physical activity, systolic and diastolic blood pressure, blood cholesterol, blood triglycerides, HDL, LDL, smoking status and blood sugar were compared in illiterate and literate elderly. Findings: Out of 356 elderly patients with CVD (177 males and 179 females), 223 patients (62.6%) were illiterate and 133 patients (38.4%) were literate. Patients did not differ significantly except for controlling the risk factor of low physical activity. Education was effective in controlling the risk factor of physical activity in patients with cardiovascular disease (OR=2.295, CI=1.228-4.289) and these people were more active (p=0.009). In addition, 59.87% of risk factors in the literate group and 58.33% of risk factors in the illiterate group were controlled, which did not show a significant difference. Conclusion: The results of the study showed that except for low physical activity, other risk factors were not associated with literacy in the elderly with CVD

Cost-Effectiveness Analysis of the Introduction of HPV Vaccination of 9-Year-Old-Girls in Iran

Objectives: To estimate the cost effectiveness of introducing the quadrivalent human papillomavirus (HPV) vaccine into the national immunization program of Iran. Methods: The CERVIVAC cost-effectiveness model was used to calculate incremental cost per averted disability-adjusted life-year by vaccination compared with no vaccination from both governmental and societal perspectives. Calculations were based on epidemiologic parameters from the Iran National Cancer Registry and other national data sources as well as from literature review. We estimated all direct and indirect costs of cervical cancer treatment and vaccination program. All future costs and benefits were discounted at 3 per year and deterministic sensitivity analysis was used. Results: During a 10-year period, HPV vaccination was estimated to avert 182 cervical cancer cases and 20 deaths at a total vaccination cost of US 23,459,897; total health service cost prevented because of HPV vaccination was estimated to be US 378,646 and US 691,741 from the governmental and societal perspective, respectively. Incremental cost per disability-adjusted life-year averted within 10 years was estimated to be US 15,205 and US 14,999 from the governmental and societal perspective, respectively, and both are higher than 3 times the gross domestic product per capita of Iran (US 14,289). Sensitivity analysis showed variation in vaccine price, and the number of doses has the greatest volatility on the incremental cost-effectiveness ratio. Using a two-dose vaccination program could be cost-effective from the societal perspective (incremental cost-effectiveness ratio = US 11,849). Conclusions: Introducing a three-dose HPV vaccination program is currently not cost-effective in Iran. Because vaccine supplies cost is the most important parameter in this evaluation, considering a two-dose schedule or reducing vaccine prices has an impact on final conclusions. © 201

Cost-Effectiveness Analysis of the Introduction of HPV Vaccination of 9-Year-Old-Girls in Iran

Objectives: To estimate the cost effectiveness of introducing the quadrivalent human papillomavirus (HPV) vaccine into the national immunization program of Iran. Methods: The CERVIVAC cost-effectiveness model was used to calculate incremental cost per averted disability-adjusted life-year by vaccination compared with no vaccination from both governmental and societal perspectives. Calculations were based on epidemiologic parameters from the Iran National Cancer Registry and other national data sources as well as from literature review. We estimated all direct and indirect costs of cervical cancer treatment and vaccination program. All future costs and benefits were discounted at 3 per year and deterministic sensitivity analysis was used. Results: During a 10-year period, HPV vaccination was estimated to avert 182 cervical cancer cases and 20 deaths at a total vaccination cost of US 23,459,897; total health service cost prevented because of HPV vaccination was estimated to be US 378,646 and US 691,741 from the governmental and societal perspective, respectively. Incremental cost per disability-adjusted life-year averted within 10 years was estimated to be US 15,205 and US 14,999 from the governmental and societal perspective, respectively, and both are higher than 3 times the gross domestic product per capita of Iran (US 14,289). Sensitivity analysis showed variation in vaccine price, and the number of doses has the greatest volatility on the incremental cost-effectiveness ratio. Using a two-dose vaccination program could be cost-effective from the societal perspective (incremental cost-effectiveness ratio = US 11,849). Conclusions: Introducing a three-dose HPV vaccination program is currently not cost-effective in Iran. Because vaccine supplies cost is the most important parameter in this evaluation, considering a two-dose schedule or reducing vaccine prices has an impact on final conclusions. © 201

Drivers of Productivity in the Portuguese Nature Tourism Industry

Part of the Smart Innovation, Systems and Technologies book series (SIST, volume 208)Considering the importance of tourism to the world economy, productivity measurement has been raising increasing interest in academia and recognized as critically important for the understanding of the strengths and weaknesses of the tourism sector. Thus, this paper analyses the determinants of firm-level labor productivity of Portuguese nature tourism firms. A fixed effects model was used to analyze the impact of physical capital, human capital, firm size, innovation, competition and agglomeration economies on labor productivity of Portuguese nature tourism firms, for 2014–2017. The sample comprises 369 firms, representing 55% of firms operating in nature tourism in the mainland. Results show that labor productivity is driven by physical capital, suggesting that human resources in nature tourism are more productive when helped by machinery and equipment, for example information technology. By contrast, the negative impact of the number of employees on labor productivity may be triggered by inefficiencies, due to dysfunctions in tourism services with excess of personnel. Also, and in the case of Algarve, the presence of agglomeration economies may hinder labor productivity. Indeed, the existence of many tourism firms in the region and, therefore, several employment opportunities, might dampen the incentive to increase productivity on the part of employees in nature tourism firms. These results can be of significant use to further understand the various dimensions of tourism management.info:eu-repo/semantics/publishedVersio