65 research outputs found

    A comparative analysis of cervical cancer prevention between Nigeria and Nordic countries that have experienced a decline in cervical cancer incidence.

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    BACKGROUND: A modelling analysis carried out in 2014 suggested that, without cervical cancer screening programmes, the incidence of cervical cancer in Denmark, Finland, Norway and Sweden would have been as high as that in some low- and middle-income countries. We compare programme strategies between Nigeria and these Nordic countries and develop translatable recommendations. METHODS: A literature review using a systematic approach through Medline, Popline, Global Health, CINAHL PLUS, Cochrane Library, EMBASE, Google Scholar, Africa Wide and WHO databases was conducted. RESULTS: Fifteen journal articles and two grey literature reports met our criteria. Six descriptive studies from Nigeria noted that services in Nigeria were mainly provided in urban secondary/tertiary facilities and that uptake was low even where screening was free. Trials in Nigeria and Sweden noted that subsidies and free programmes alone did not improve uptake; a Danish trial demonstrated that reminders and invitations issued by general practitioners improved participation. CONCLUSION: Free screening programmes are important but should also consider incentivisation of treatment when needed and demand creation among health workers. Additionally, effective monitoring and evaluation of programme data are key to improving and maintaining quality. More broadly, we suggest that Nigeria can build success through stakeholder-led implementation of well-defined policies with national consensus to ensure coordination and sustainability

    Verifisering av programmet TempSim

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    Hensikten med denne oppgaven er å verifisere TempSim, et program som simulerer både temperatur og fasthet til betong. Dette programmet er sammensatt av flere Excel ark som, ved hjelp av matematiske formler, simulerer temperatur- og fasthetsutviklingen til ulike betongresepter. I denne sammenhengen skal jeg belyse teorien som ligger til grunn for programmet. Dette er avbinding, modenhetsprinsippet, betongens egenskapsutvikling og beregningsmodell for varme- og fasthetsutvikling. Rådataen til programmet TempSim finner jeg fra laboratorieforsøk utført både i Aalborg i Danmark og på Sjursøya i Norge. Denne informasjonen er brukt som input for simulering i TempSim. Resultater hentet fra feltarbeid på ulike byggeplasser i Osloområdet er sammenlignet med temperatursimuleringene fra TempSim. Dersom resultatene fra programmet stemmer overens med resultatene fra feltarbeidet er programmet verifisert. The purpose of this task is to verify the temperature simulation program TempSim. In this context I will illustrate the theory that forms the basis for the program. This is setting time, maturity principle, development of characteristic qualities, and calculation model for heat and strength development. I found the input data to the program TempSim from laboratory experiments conducted in Aalborg in Denmark and Sjursøya in Norway. Actual results obtained from field work at various construction sites in the Oslo area will be compared with simulations from TempSim. If the results from the program are consistent with the results of the fieldwork, the program is verified

    Achievement and Satisfaction in Blended Learning versus Traditional General Health Course Designs

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    Blended learning is a hybrid of classroom and on-line learning that includes some of the conveniences of on-line courses without the complete loss of face-to-face tact. Purpose: The purpose of this study was to evaluate student achievement and satisfaction with blended learning course delivery compared to a traditional face-to-face class format in a general health course. Method: Surveys were distributed to randomly selected classes during the fall 2007 semester: three blended and one traditional sections participated (n=251). Results: Total satisfaction scores between blended (54.986) and traditional (49.788) classes were significantly different (p\u3c 0.01). Achievement by students of blended and traditional sections brought mixed findings, yet blended students’ overall grades were significantly higher (p=0.048). Conclusion: Results indicated that a blended course delivery is preferred over a traditional lecture format, and promising data emerged to challenge teachers’ traditional approach to teaching general health courses at the university level

    Predictive mathematical models for the spread and treatment of hyperoxia-induced photoreceptor degeneration in retinitis pigmentosa

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    Purpose: To determine whether the oxygen toxicity hypothesis can explain the distinctive spatio-temporal patterns of retinal degeneration associated with human retinitis pigmentosa (RP) and to predict the effects of antioxidant and trophic factor treatments under this hypothesis. Methods: Three mathematical models were derived to describe the evolution of the retinal oxygen concentration and photoreceptor density over time. The first model considers only hyperoxia-induced degeneration, while the second and third models include mutation-induced rod and cone loss respectively. The models were formulated as systems of partial differential equations, defined on a two-dimensional domain spanning the region between the foveal center and the ora serrata, and were solved numerically using the finite element method. Results: The mathematical models recapitulate patterns of retinal degeneration which involve preferential loss of photoreceptors in the parafoveal/perifoveal and far-peripheral retina, while those which involve a preferential loss of midperipheral photoreceptors cannot be reproduced. Treatment with antioxidants or trophic factors is predicted to delay, halt, or partially reverse retinal degeneration, depending upon the strength and timing of treatment and disease severity. Conclusions: The model simulations indicate that while the oxygen toxicity hypothesis is sufficient to explain some of the patterns of retinal degeneration observed in human RP, additional mechanisms are necessary to explain the full range of behaviors. The models further suggest that antioxidant and trophic factor treatments have the potential to reduce hyperoxia-induced disease severity and that, where possible, these treatments should be targeted at retinal regions with low photoreceptor density to maximize their efficacy

    Cost-effectiveness of tenofovir gel in urban South Africa: model projections of HIV impact and threshold product prices.

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    BACKGROUND: There is urgent need for effective HIV prevention methods that women can initiate. The CAPRISA 004 trial showed that a tenofovir-based vaginal microbicide had significant impact on HIV incidence among women. This study uses the trial findings to estimate the population-level impact of the gel on HIV and HSV-2 transmission, and price thresholds at which widespread product introduction would be as cost-effective as male circumcision in urban South Africa. METHODS: The estimated 'per sex-act' HIV and HSV-2 efficacies were imputed from CAPRISA 004. A dynamic HIV/STI transmission model, parameterised and fitted to Gauteng (HIV prevalence of 16.9% in 2008), South Africa, was used to estimate the impact of gel use over 15 years. Uptake was assumed to increase linearly to 30% over 10 years, with gel use in 72% of sex-acts. Full economic programme and averted HIV treatment costs were modelled. Cost per DALY averted is estimated and a microbicide price that equalises its cost-effectiveness to that of male circumcision is estimated. RESULTS: Using plausible assumptions about product introduction, we predict that tenofovir gel use could lead to a 12.5% and 4.9% reduction in HIV and HSV-2 incidence respectively, by year 15. Microbicide introduction is predicted to be highly cost-effective (under 300perDALYaverted),thoughthedosepricewouldneedtobejust300 per DALY averted), though the dose price would need to be just 0.12 to be equally cost-effective as male circumcision. A single dose or highly effective (83% HIV efficacy per sex-act) regimen would allow for more realistic threshold prices (0.25and0.25 and 0.33 per dose, respectively). CONCLUSIONS: These findings show that an effective coitally-dependent microbicide could reduce HIV incidence by 12.5% in this setting, if current condom use is maintained. For microbicides to be in the range of the most cost-effective HIV prevention interventions, product costs will need to decrease substantially

    The effect of parental opportunism, IJV's autonomy and tacit knowledge on IJV instability: A comparison of multi-variate regression and fuzzy-set qualitative comparative analysis

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    This study uses an agency theory perspective to examine how the factors that influence principal (IJV parents) and agent (IJV) relationship may affect IJV instability in China. The study proposes a framework that bridges knowledge-based theory (of tacit knowledge) and agency theory (of parental opportunism) by incorporating reactance theory (of autonomy). By comparing the empirical results of fuzzy-set qualitative comparative analysis (fsQCA) and multiple regression analysis, using a sample of 203 Chinese-foreign IJVs, the study add further evidence to growing methodological consideration regarding complexity theory. The results from multiple regressions show that parental opportunism and IJV’s autonomy has a positive effect on IJV’s instability, and that the interaction of autonomy and tacit knowledge moderates the effect of parental opportunism on IJV instability. However, fsQCA uncovers more causal paths than findings from multiple regression analysis

    Falls Assessment Clinical Trial (FACT): design, interventions, recruitment strategies and participant characteristics

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    <p>Abstract</p> <p>Background</p> <p>Guidelines recommend multifactorial intervention programmes to prevent falls in older adults but there are few randomised controlled trials in a real life health care setting. We describe the rationale, intervention, study design, recruitment strategies and baseline characteristics of participants in a randomised controlled trial of a multifactorial falls prevention programme in primary health care.</p> <p>Methods</p> <p>Participants are patients from 19 primary care practices in Hutt Valley, New Zealand aged 75 years and over who have fallen in the past year and live independently. Two recruitment strategies were used – waiting room screening and practice mail-out. Intervention participants receive a community based nurse assessment of falls and fracture risk factors, home hazards, referral to appropriate community interventions, and strength and balance exercise programme. Control participants receive usual care and social visits. Outcome measures include number of falls and injuries over 12 months, balance, strength, falls efficacy, activities of daily living, quality of life, and physical activity levels.</p> <p>Results</p> <p>312 participants were recruited (69% women). Of those who had fallen, 58% of people screened in the practice waiting rooms and 40% when screened by practice letter were willing to participate. Characteristics of participants recruited using the two methods are similar (p > 0.05). Mean age of all participants was 81 years (SD 5). On average participants have 7 medical conditions, take 5.5 medications (29% on psychotropics) with a median of 2 falls (interquartile range 1, 3) in the previous year.</p> <p>Conclusion</p> <p>The two recruitment strategies and the community based intervention delivery were feasible and successful, identifying a high risk group with multiple falls. Recruitment in the waiting room gave higher response rates but was less efficient than practice mail-out. Testing the effectiveness of an evidence based intervention in a 'real life' setting is important.</p> <p>Trial registration</p> <p>Australian Clinical Trials Register ID 12605000054617.</p

    Clinical outcomes and response to treatment of patients receiving topical treatments for pyoderma gangrenosum: a prospective cohort study

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    Background: pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment. Objective: to estimate the effectiveness of topical therapies in the treatment of PG. Methods: prospective cohort study of UK secondary care patients with a clinical diagnosis of PG suitable for topical treatment (recruited July 2009 to June 2012). Participants received topical therapy following normal clinical practice (mainly Class I-III topical corticosteroids, tacrolimus 0.03% or 0.1%). Primary outcome: speed of healing at 6 weeks. Secondary outcomes: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality-of-life; treatment failure and recurrence. Results: Sixty-six patients (22 to 85 years) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28/66 (43.8%) of ulcers healed by 6 months. Median time-to-healing was 145 days (95% CI: 96 days, ∞). Initial ulcer size was a significant predictor of time-to-healing (hazard ratio 0.94 (0.88;80 1.00); p = 0.043). Four patients (15%) had a recurrence. Limitations: No randomised comparator Conclusion: Topical therapy is potentially an effective first-line treatment for PG that avoids possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone
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