511 research outputs found
The impact of primary health care and specialist physician supply on amenable mortality in Mexico (2000–2015): Panel data analysis using system-Generalized Method of Moments
The study had a three-fold objective: (i) to estimate the amenable mortality rates and trends at a national and state level between 2000 and 2015 in Mexico; (ii) to estimate the contribution and trends of various causes of death to overall amenable mortality; and (iii) to determine the association between health system inputs and amenable mortality for the period 2000–2015. We used a panel dataset for the period 2000–2015. The following health care inputs were used in the analysis: density of general practitioners, specialists and nurses, as well as density of hospital beds. We find that amenable mortality fell from 136 per 100,000 in 2000, to 124.1 per 100,000 in 2015 nationally, with significant heterogeneity in the trends across states. Mortality due to infectious diseases, diseases of childhood, and cardiovascular diseases decreased, while deaths due to other non-communicable diseases, such as diabetes, increased. There was a significant negative association between the density of general practitioners and specialist physicians, and amenable mortality. Our results indicate that reducing the burden of non-communicable diseases must be a health system priority. Improvements in primary health care could lead to improved disease detection and earlier diagnosis which could further reduce amenable mortality in Mexico
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Disclosure of Information to Potential Subjects on Research Recruitment Web Sites
We examined systematically how a sample of Web sites that recruit participants for research on particular diseases present studies to potential subjects, exploring the presence of information about research benefits, risks, procedures, and incentives, including monetary incentives. Such data can elucidate the degree to which federal guidance is being followed and may have potential implications for policy, suggesting areas that IRBs, policy-makers, and regulators may want to consider further regarding online recruiting of research participant
Applying market shaping approaches to increase access to assistive technology in low- and middle-income countries
Development outcomes are inextricably linked to the health of the marketplace that delivers products and services to people in low- and middle-income countries (LMIC). Shortcomings in the market for assistive technology (AT) contribute to low access in LMIC. Market shaping is aimed at improving a market's specific outcomes, such as access to high quality, affordable AT, by targeting the root causes of these shortcomings. The paper summarizes the findings of market analyses conducted under the UK aid funded AT2030 programme in support of ATscale and aims to discuss how market shaping can help more people gain access to the AT that they need and what are the best mechanisms to unlock markets and commercial opportunity in LMICs. The paper also explores how market shaping for AT markets could be part of a mission-oriented approach AT policy. A mission-oriented approach can help accelerate progress toward a common objective among stakeholders, at country or global level. While market-shaping activities direct the outcomes of the market toward a specific end goal, such as access to quality, affordable products and services, missions are more comprehensive and include other policy interventions and stakeholder collaborations in order to create a robust and sustainable structure
AT innovation ecosystem design – a kenyan case study
Innovations within the AT space frequently fail to get to market and therefore to the people who
could benefit from the products. The Scoping Report which underpins the AT2030 programme
identified the need to test and develop “what works” for AT innovation to ensure new products,
services and approaches are able to scale and reach people, especially people living in low- and
middle-income countries. This paper sets out the initial thinking for an East Africa Innovation
Ecosystem. We present the emerging thinking from initial scoping exercises and product trials which
have helped to shape the newly launched Innovate Now ecosystem. We outline the ecosystem
including the core elements – the accelerator programmes and Live Labs. Live labs will allow for
rapid innovation testing and user feedback. Thus, increasing user-involvement in the design and
development process, and reducing the time to market. The Innovate Now ecosystem is growing and
is being led by AMREF. Successful graduates of innovate Now will be connected into the Innovation
Scale Fund which will be launched by AT2030 next year (2020)
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Levels of acute phase proteins remain stable after ischemic stroke
Background: Inflammation and inflammatory biomarkers play an important role in atherosclerosis and cardiovascular disease. Little information is available, however, on time course of serum markers of inflammation after stroke. Methods: First ischemic stroke patients ≥40 years old had levels of high-sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), and fibrinogen measured in plasma samples drawn at 1, 2, 3, 7, 14, 21 and 28 days after stroke. Levels were log-transformed as needed, and parametric and non-parametric statistical tests were used to test for evidence of a trend in levels over time. Levels of hsCRP and SAA were also compared with levels in a comparable population of stroke-free participants. Results: Mean age of participants with repeated measures (n = 21) was 65.6 ± 11.6 years, and 13 (61.9%) were men, and 15 (71.4%) were Hispanic. Approximately 75% of patients (n = 15) had mild strokes (NIH Stroke Scale score 0–5). There was no evidence of a time trend in levels of hsCRP, SAA, or fibrinogen for any of the markers during the 28 days of follow-up. Mean log(hsCRP) was 1.67 ± 1.07 mg/L (median hsCRP 6.48 mg/L) among stroke participants and 1.00 ± 1.18 mg/L (median 2.82 mg/L) in a group of 1176 randomly selected stroke-free participants from the same community (p = 0.0252). Conclusion: Levels of hsCRP are higher in stroke patients than in stroke-free subjects. Levels of inflammatory biomarkers associated with atherosclerosis, including hsCRP, appear to be stable for at least 28 days after first ischemic stroke
Semi-parametric modeling of SARS-CoV-2 transmission in Orange County, California using tests, cases, deaths, and seroprevalence data
Mechanistic modeling of SARS-CoV-2 transmission dynamics and frequently
estimating model parameters using streaming surveillance data are important
components of the pandemic response toolbox. However, transmission model
parameter estimation can be imprecise, and sometimes even impossible, because
surveillance data are noisy and not informative about all aspects of the
mechanistic model. To partially overcome this obstacle, we propose a Bayesian
modeling framework that integrates multiple surveillance data streams. Our
model uses both SARS-CoV-2 diagnostics test and mortality time series to
estimate our model parameters, while also explicitly integrating seroprevalence
data from cross-sectional studies. Importantly, our data generating model for
incidence data takes into account changes in the total number of tests
performed. We model transmission rate, infection-to-fatality ratio, and a
parameter controlling a functional relationship between the true case incidence
and the fraction of positive tests as time-varying quantities and estimate
changes of these parameters nonparameterically. We apply our Bayesian data
integration method to COVID-19 surveillance data collected in Orange County,
California between March, 2020 and March, 2021 and find that 33-62% of the
Orange County residents experienced SARS-CoV-2 infection by the end of
February, 2021. Despite this high number of infections, our results show that
the abrupt end of the winter surge in January, 2021, was due to both behavioral
changes and a high level of accumulated natural immunity.Comment: 37 pages, 16 pages of main text, including 5 figures, 1 tabl
Impact of interventions to reduce sugar-sweetened beverage intake in children and adults: a protocol for a systematic review and meta-analysis
Background: Sugar-sweetened beverages (SSBs) have been stressed as relevant targets of public health interventions considering the negative outcomes derived from their excessive intake. Though the evidence from published literature grows to support a cause-and-effect association of SSBs with obesity and other diseases, little is known on the effectiveness that strategies alone or as part of multi-component programmes have had to influence this particular dietary behaviour across all ages. Therefore, this review and meta-analysis aim to evaluate the effect that interventions have had to decrease their consumption or increase water intake in children and adults so as to guide the design of future programmes and inform policy making. Methods: Included studies in this review will be randomised controlled trials and quasi-experimental interventions (with a control group) that have reported baseline and post-intervention intakes of SSBs or water and that have been published from 1990 in any language. A thorough search will be performed in MEDLINE, EMBASE, Scopus, Web of Science, Cochrane's central register of controlled trials, and the Global Health Library. Two independent reviewers will conduct initial screening of potentially included articles and will later extract data to analyse domains of intervention design and delivery (with emphasis on behaviour change techniques used as rationale), as well as results in changes on consumption patterns and behavioural determinants. Internal and external validity of each study will also be appraised. A meta-analysis will be performed if a sufficient number of studies are available, and if not, a narrative review will be conducted instead. Discussion: The results from this review aim to strengthen public health initiatives tackling obesity through improvements in non-alcoholic drinking patterns. As a subject of growing attention globally, this review will help determine which strategies available are the most effective in different contexts. Knowledge gained from this work will also aid resource allocation in future research and government agendas
Foodways in transition: food plants, diet and local perceptions of change in a Costa Rican Ngäbe community
Background
Indigenous populations are undergoing rapid ethnobiological, nutritional and socioeconomic transitions while being increasingly integrated into modernizing societies. To better understand the dynamics of these transitions, this article aims to characterize the cultural domain of food plants and analyze its relation with current day diets, and the local perceptions of changes given amongst the Ngäbe people of Southern Conte-Burica, Costa Rica, as production of food plants by its residents is hypothesized to be drastically in recession with an decreased local production in the area and new conservation and development paradigms being implemented.
Methods
Extensive freelisting, interviews and workshops were used to collect the data from 72 participants on their knowledge of food plants, their current dietary practices and their perceptions of change in local foodways, while cultural domain analysis, descriptive statistical analyses and development of fundamental explanatory themes were employed to analyze the data.
Results
Results show a food plants domain composed of 140 species, of which 85 % grow in the area, with a medium level of cultural consensus, and some age-based variation. Although many plants still grow in the area, in many key species a decrease on local production–even abandonment–was found, with much reduced cultivation areas. Yet, the domain appears to be largely theoretical, with little evidence of use; and the diet today is predominantly dependent on foods bought from the store (more than 50 % of basic ingredients), many of which were not salient or not even recognized as ‘food plants’ in freelists exercises. While changes in the importance of food plants were largely deemed a result of changes in cultural preferences for store bought processed food stuffs and changing values associated with farming and being food self-sufficient, Ngäbe were also aware of how changing household livelihood activities, and the subsequent loss of knowledge and use of food plants, were in fact being driven by changes in social and political policies, despite increases in forest cover and biodiversity.
Conclusions
Ngäbe foodways are changing in different and somewhat disconnected ways: knowledge of food plants is varied, reflecting most relevant changes in dietary practices such as lower cultivation areas and greater dependence on food from stores by all families. We attribute dietary shifts to socioeconomic and political changes in recent decades, in particular to a reduction of local production of food, new economic structures and agents related to the State and globalization
Stone clearance in lower pole nephrolithiasis after extra corporeal shock wave lithotripsy – the controversy continues
BACKGROUND: To determine factors influencing the clearance of fragments after extra-corporeal shock wave lithotripsy (ESWL) for lower pole calyceal (LPC) stones. METHODS: In the period between July 1998 and Oct 2001, 100 patients with isolated lower polar calyceal calculi ≤ 20 mm, in patients aged ≥ 14 years, were included in the study. Intravenous urograms (IVU) were reviewed to define the LPC anatomy (width of the infundibulum and pelvicalyceal angle). Study end points i.e. stone free status; number of shock waves used and number of sessions were correlated with variables like LPC anatomy, body mass index and stone size. RESULTS: At three months follow up the clearance for stone size ≤ 10 mm, 11–15 mm and 16–20 mm were 95, 96 and 90% respectively. Patients with acute LPC (<90°) and obtuse angle (>90°) had stone clearance of 94 and 100% respectively. For the infundibular width of < 4 mm, the stone clearance was 93% were as for > 4 mm, it was 100%. For body mass index (BMI) less than and > 30 kg/m(2), the stone clearance was 92 and 95% respectively. CONCLUSIONS: There is a trend towards more ESWL sessions and shock wave requirement in patients with acute pelvi-calyceal angle and narrow infundibulum but it is not statistically significant. Size (≤ 20 mm) and BMI has no relation with stone clearance. With modern lithotripter, stones up to 20 mm could primarily be treated by ESWL, irrespective of an un-favorable lower polar calyceal anatomy and body habitus
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