Reframing noncommunicable diseases and injuries for the poorest Malawians: the Malawi National NCDI Poverty Commission

Noncommunicable diseases and injuries (NCDIs) account for nearly 70% of deaths worldwide, with an estimated 75% of these deaths occurring in low- and middle-income countries. Globally, the burden of disease from noncommunicable diseases (NCDs) is most often caused by the “big 4,” namely: diabetes, cardiovascular diseases, cancer, and chronic lung diseases. However, in Malawi, these 4 conditions account for only 29% of the NCDI disease burden.The Malawi National NCDI Poverty Commission was launched in November 2016 and will describe and evaluate the current NCDI situation in Malawi, with a focus on the poorest populations. The National Commission will investigate which NCDIs cause the biggest burden, which are more present in the young, and which interventions are available to avert death and disability from NCDIs in Malawi, particularly among the poorest segments of the population.The evidence gained through the work of this Commission will help inform research, policy, and programme interventions, all through an advocacy lens, as we strive to address the impact of NCDIs among all populations in Malawi

Improving the screening and treatment of hypertension in people living with HIV: An evidence-based policy brief by Malawi’s Knowledge Translation Platform

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Do You Need a Foot-in-the-Door or Is A Toe Enough? Scripting Introductions That Induce Tailoring and Increase Participation in Telephone Interviews

Substantial research and practical experience shows that a telephone interviewer is most successful at gaining cooperation and avoiding refusals when they are free to tailor their introductory pitch to the potential respondent or household informant they reach. However, survey designers are often uncomfortable allowing interviewers to work “off-script,” and instruct interviewers to read introductory text verbatim. Further, some interviewers report being more comfortable with a script than without one. To bridge this gap between research and practice we asked, “Can we create a scripted introduction that engages the potential respondent, gets a foot-in-the-door, and facilitates interviewer tailoring?” This paper reports on a randomized experimental test of two such scripts, each implemented within the Washington Behavioral Risk Factor Surveillance System (BRFSS), a random digit dial (RDD) phone survey. In both phases of the experiment, sampled phone numbers were randomized to the standard BRFSS introduction or the new script. Phase 1 (August, 2018) implemented a “conversational” introduction that added or revised three features of the standard BRFSS introduction: First, the introduction included three “hook questions” (e.g., “Have you heard of the survey?”). One hook question was randomly displayed each time a phone number was called. Second, the script displayed on the first three CATI screens was modified to sound more conversational and less abrupt. Third, pause points were created to make sure the interviewer slows down and listens to the potential respondent. Each of these features is hypothesized to increase tailoring, and thus cooperation, by encouraging interaction between the interviewer and potential respondent. Phase 2 (September, 2018) replaced the conversational introduction with a “progressive scheduling” script that instructed interviewers to ask for a good time to call back to complete the interview rather than asking for complete cooperation on the call. This approach encourages a dynamic that shows respect for the respondent’s time. It also changes a large, unexpected request to a small one that the respondent can plan. While call-backs are sometimes considered undesirable outcomes, they can be a good “toe-in-the-door” technique that leads to full cooperation later. Our primary outcomes are cooperation, scheduled callbacks, and refusals. Additionally, a more conversational introduction might influence answers to questions within the interview, such as if increased rapport depresses reports of sensitive behaviors. Thus, we will also assess the effect of the modified scripts on responses to assess the nonresponse / measurement error trade-offs of this approach

Technical Change and the Wage Structure During the Second Industrial Revolution: Evidence from the Merchant Marine, 1865-1912*

ABSTRACT Using a large, individual-level wage data set, we examine the impact of a major technological innovation-the steam engine-on skill demand and the wage structure in the merchant shipping industry. We find that the technical change created a new demand for skilled workers, the engineers, while destroying demand for workers with skills relevant only to sail. It had a deskilling effect on production work-able-bodied seamen (essentially, artisans) were replaced by unskilled engine room operatives. On the other hand, mates and able-bodied seamen employed on steam earned a premium relative to their counterparts on sail. A wholesale switch from sail to steam would increase the 90/10 wage ratio by 40%, with most of the rise in inequality coming from the creation of the engineer occupation

Silymarin Ascending Multiple Oral Dosing Phase I Study in Noncirrhotic Patients With Chronic Hepatitis C

Silymarin, derived from the milk thistle plant Silybum marianum, is widely used for self-treatment of liver diseases, including hepatitis C virus (HCV), and its antiviral activity has been demonstrated in vitro and in HCV patients administered an intravenous formulation of the major silymarin flavonolignans, silybin A and silybin B. The safety and dose-exposure relationships of higher than customary oral doses of silymarin and its acute effects on serum HCV RNA were evaluated in noncirrhotic HCV patients. Four cohorts of 8 patients with well-compensated, chronic noncirrhotic HCV who failed interferon-based therapy were randomized 3:1 to silymarin or placebo. Oral doses of 140, 280, 560, or 700 mg silymarin were administered every 8 hours for 7 days. Steady-state exposures for silybin A and silybin B increased 11-fold and 38-fold, respectively, with a 5-fold increase in dose, suggesting nonlinear pharmacokinetics. No drug-related adverse events were reported, and no clinically meaningful reductions from baseline serum transaminases or HCV RNA titer were observed. Oral doses of silymarin up to 2.1 g per day were safe and well tolerated. The nonlinear pharmacokinetics of silybin A and silybin B suggests low bioavailability associated with customary doses of silymarin may be overcome with doses above 700 mg

Do You Need a Foot-in-the-Door or Is A Toe Enough? Scripting Introductions That Induce Tailoring and Increase Participation in Telephone Interviews

Substantial research and practical experience shows that a telephone interviewer is most successful at gaining cooperation and avoiding refusals when they are free to tailor their introductory pitch to the potential respondent or household informant they reach. However, survey designers are often uncomfortable allowing interviewers to work “off-script,” and instruct interviewers to read introductory text verbatim. Further, some interviewers report being more comfortable with a script than without one. To bridge this gap between research and practice we asked, “Can we create a scripted introduction that engages the potential respondent, gets a foot-in-the-door, and facilitates interviewer tailoring?” This paper reports on a randomized experimental test of two such scripts, each implemented within the Washington Behavioral Risk Factor Surveillance System (BRFSS), a random digit dial (RDD) phone survey. In both phases of the experiment, sampled phone numbers were randomized to the standard BRFSS introduction or the new script. Phase 1 (August, 2018) implemented a “conversational” introduction that added or revised three features of the standard BRFSS introduction: First, the introduction included three “hook questions” (e.g., “Have you heard of the survey?”). One hook question was randomly displayed each time a phone number was called. Second, the script displayed on the first three CATI screens was modified to sound more conversational and less abrupt. Third, pause points were created to make sure the interviewer slows down and listens to the potential respondent. Each of these features is hypothesized to increase tailoring, and thus cooperation, by encouraging interaction between the interviewer and potential respondent. Phase 2 (September, 2018) replaced the conversational introduction with a “progressive scheduling” script that instructed interviewers to ask for a good time to call back to complete the interview rather than asking for complete cooperation on the call. This approach encourages a dynamic that shows respect for the respondent’s time. It also changes a large, unexpected request to a small one that the respondent can plan. While call-backs are sometimes considered undesirable outcomes, they can be a good “toe-in-the-door” technique that leads to full cooperation later. Our primary outcomes are cooperation, scheduled callbacks, and refusals. Additionally, a more conversational introduction might influence answers to questions within the interview, such as if increased rapport depresses reports of sensitive behaviors. Thus, we will also assess the effect of the modified scripts on responses to assess the nonresponse / measurement error trade-offs of this approach

Mean ITS target number of quantifiable weekly and daily air samples for <i>Es</i>. <i>africanus</i> fit on the standard curve.

<p><b>Note:</b> Five standards were used to generate the standard curve; however, only three standards are shown in these figures to increase the visibility and separation of the test samples. A) Weekly air samples B) Daily air samples.</p