58 research outputs found
Population screening for hereditary haemochromatosis in Australia: Construction and validation of a state-transition cost-effectiveness model
INTRODUCTION: HFE-associated haemochromatosis, the most common monogenic disorder amongst populations of northern European ancestry, is characterised by iron overload. Excess iron is stored in parenchymal tissues, leading to morbidity and mortality. Population screening programmes are likely to improve early diagnosis, thereby decreasing associated disease. Our aim was to develop and validate a health economics model of screening using utilities and costs from a haemochromatosis cohort. METHODS: A state-transition model was developed with Markov states based on disease severity. Australian males (aged 30 years) and females (aged 45 years) of northern European ancestry were the target populations. The screening strategy was the status quo approach in Australia; the model was run over a lifetime horizon. Costs were estimated from the government perspective and reported in 2015 Australian dollars (A22,737 (3670-85,793) for males and $A13,840 (1335-67,377) for females. Sensitivity analyses revealed discount rates and prevalence had the greatest impacts on outcomes. CONCLUSION: We have developed a transparent, validated health economics model of C282Y homozygote haemochromatosis. The model will be useful to decision makers to identify cost-effective screening strategies
Visualising the invisible: a network approach to reveal the informal social side of student learning
World-wide, universities in health sciences have transformed their curriculum to include collaborative learning and facilitate the students’ learning process. Interaction has been acknowledged to be the synergistic element in this learning context. However, students spend the majority of their time outside their classroom and interaction does not stop outside the classroom. Therefore we studied how informal social interaction influences student learning. Moreover, to explore what really matters in the students learning process, a model was tested how the generally known important constructs—prior performance, motivation and social integration—relate to informal social interaction and student learning. 301 undergraduate medical students participated in this cross-sectional quantitative study. Informal social interaction was assessed using self-reported surveys following the network approach. Students’ individual motivation, social integration and prior performance were assessed by the Academic Motivation Scale, the College Adaption Questionnaire and students’ GPA respectively. A factual knowledge test represented student’ learning. All social networks were positively associated with student learning significantly: friendships (β = 0.11), providing information to other students (β = 0.16), receiving information from other students (β = 0.25). Structural equation modelling revealed a model in which social networks increased student learning (r = 0.43), followed by prior performance (r = 0.31). In contrast to prior literature, students’ academic motivation and social integration were not associated with students’ learning. Students’ informal social interaction is strongly associated with students’ learning. These findings underline the need to change our focus from the formal context (classroom) to the informal context to optimize student learning and deliver modern medics
An exploration of scenarios to support sustainable land management using integrated environmental socio-economic models
Scenario analysis constitutes a valuable deployment method for scientific models to inform environmental decision-making, particularly for evaluating land degradation mitigation options, which are rarely based on formal analysis. In this paper we demonstrate such an assessment using the PESERA–DESMICE modeling framework with various scenarios for 13 global land degradation hotspots. Starting with an initial assessment representing land degradation and productivity under current conditions, options to combat instances of land degradation are explored by determining: (1) Which technologies are most biophysically appropriate and most financially viable in which locations; we term these the “technology scenarios”; (2) how policy instruments such as subsidies influence upfront investment requirements and financial viability and how they lead to reduced levels of land degradation; we term these the “policy scenarios”; and (3) how technology adoption affects development issues such as food production and livelihoods; we term these the “global scenarios”. Technology scenarios help choose the best technology for a given area in biophysical and financial terms, thereby outlining where policy support may be needed to promote adoption; policy scenarios assess whether a policy alternative leads to a greater extent of technology adoption; while global scenarios demonstrate how implementing technologies may serve wider sustainable development goals. Scenarios are applied to assess spatial variation within study sites as well as to compare across different sites. Our results show significant scope to combat land degradation and raise agricultural productivity at moderate cost. We conclude that scenario assessment can provide informative input to multi-level land management decision-making processes
Nutrition in children with CRF and on dialysis
The objectives of this study are: (1) to understand the importance of nutrition in normal growth; (2) to review the methods of assessing nutritional status; (3) to review the dietary requirements of normal children throughout childhood, including protein, energy, vitamins and minerals; (4) to review recommendations for the nutritional requirements of children with chronic renal failure (CRF) and on dialysis; (5) to review reports of spontaneous nutritional intake in children with CRF and on dialysis; (6) to review the epidemiology of nutritional disturbances in renal disease, including height, weight and body composition; (7) to review the pathological mechanisms underlying poor appetite, abnormal metabolic rate and endocrine disturbances in renal disease; (8) to review the evidence for the benefit of dietetic input, dietary supplementation, nasogastric and gastrostomy feeds and intradialytic nutrition; (9) to review the effect of dialysis adequacy on nutrition; (10) to review the effect of nutrition on outcome
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