Ética e investigación en la historia de la malaria

Resumen La investigacion cientifica en clinica es absolutamente necesaria para el desarrollo del saber medico. No obstante, no siempre el gran progreso alcanzado por la Medicina se ha obtenido respetando la persona humana. En particular, a partir de 1880, cuando Laveran constato por primera vez la naturaleza protozoaria de la malaria, el desarrollo del conocimiento sobre el paludismo ha sido muy notable, pero hasta la mitad del siglo XX estos logros fueron, en muchos casos, fruto de experimentos que hoy resultan en extremo discutibles desde el punto de vista etico, tanto los dedicados al estudio de la biologia y de la fisiopatologia, como especialmente los ensayos de caracter farmacologi-co efectuados en individuos sanos para probar scrapbookpages.com/dachauscrapbook/Dachau Trials/Klaus moleculas con accion antimalarica real o presunta. Schilling.html Referencias 1.- Zakon S J. Alexander Samoilovitch Rosenblium. His contri-His contri-bution to fever therapy. Arch Derm Syph 1943; 48: 52-9. 2.- Codell Carter, K. The rise of causal concepts of disease: case histories. Ashgate Publishing Ltd, UK 2003; 165-6. 3.- Marchiafava E, Celli A. Nuove ricerche sulla infezione malarica. Annali di Agricoltura 1885; 96: 1-33. 4.- Massani, M. Le molte vite dell'Ospedale di S. Spirito dalle sue origini ai nostri giorni. Giornale di Medizina Militare 1983; 103 (1): 54-66.5.- Snowden F M. La conquista della malaria. Una moderniz-zazione italiana 1900-1962. Giulio Einaudi editore, Torino 2000; 46.6.- Columella. Los doce libros de agricultura que escribiera en latin Lucio Junio Moderato Columela, traducidos al castellano por D. Juan Maria Alvarez de Sotomayor y Rubio. Imprenta de D. Miguel de Burgos, Madrid 1824; I (5): 22. 7.- Fantini B. Uno zoologo e la malaria : Battista Grassi e la scoperta del ciclo di trasmissione della malaria. En: Grassi B. Studi di uno zoologo sulla malaria. Giunti Gruppo Edito-riale, Firenze 1998; 22. 8.- Grassi B. Studi di uno zoologo sulla malaria. Biblioteca del-la scienza italiana. Giunti Gruppo Editoriale, Firenze 1998; 89-276.9.- Consejo de Organizaciones Internacionales de las Ciencias Medicas (CIOMS). Pautas eticas internacionales para la investigacion biomedica en seres humanos. Ginebra 2002.10.- Verhage D F, Telgt D S C, Bousema J T, Hermsen C C, van Gemert G J A, van der Meer J W M, et al. Clinical outcome of experimental human malaria induced b

Determining the best population-level alcohol consumption model and its impact on estimates of alcohol-attributable harms

BACKGROUND: The goals of our study are to determine the most appropriate model for alcohol consumption as an exposure for burden of disease, to analyze the effect of the chosen alcohol consumption distribution on the estimation of the alcohol Population- Attributable Fractions (PAFs), and to characterize the chosen alcohol consumption distribution by exploring if there is a global relationship within the distribution. METHODS: To identify the best model, the Log-Normal, Gamma, and Weibull prevalence distributions were examined using data from 41 surveys from Gender, Alcohol and Culture: An International Study (GENACIS) and from the European Comparative Alcohol Study. To assess the effect of these distributions on the estimated alcohol PAFs, we calculated the alcohol PAF for diabetes, breast cancer, and pancreatitis using the three above-named distributions and using the more traditional approach based on categories. The relationship between the mean and the standard deviation from the Gamma distribution was estimated using data from 851 datasets for 66 countries from GENACIS and from the STEPwise approach to Surveillance from the World Health Organization. RESULTS: The Log-Normal distribution provided a poor fit for the survey data, with Gamma and Weibull distributions providing better fits. Additionally, our analyses showed that there were no marked differences for the alcohol PAF estimates based on the Gamma or Weibull distributions compared to PAFs based on categorical alcohol consumption estimates. The standard deviation of the alcohol distribution was highly dependent on the mean, with a unit increase in alcohol consumption associated with a unit increase in the mean of 1.258 (95% CI: 1.223 to 1.293) (R2 = 0.9207) for women and 1.171 (95% CI: 1.144 to 1.197) (R2 = 0. 9474) for men. CONCLUSIONS: Although the Gamma distribution and the Weibull distribution provided similar results, the Gamma distribution is recommended to model alcohol consumption from population surveys due to its fit, flexibility, and the ease with which it can be modified. The results showed that a large degree of variance of the standard deviation of the alcohol consumption Gamma distribution was explained by the mean alcohol consumption, allowing for alcohol consumption to be modeled through a Gamma distribution using only average consumption

Once the shovel hits the ground : Evaluating the management of complex implementation processes of public-private partnership infrastructure projects with qualitative comparative analysis

Much attention is being paid to the planning of public-private partnership (PPP) infrastructure projects. The subsequent implementation phase – when the contract has been signed and the project ‘starts rolling’ – has received less attention. However, sound agreements and good intentions in project planning can easily fail in project implementation. Implementing PPP infrastructure projects is complex, but what does this complexity entail? How are projects managed, and how do public and private partners cooperate in implementation? What are effective management strategies to achieve satisfactory outcomes? This is the fi rst set of questions addressed in this thesis. Importantly, the complexity of PPP infrastructure development imposes requirements on the evaluation methods that can be applied for studying these questions. Evaluation methods that ignore complexity do not create a realistic understanding of PPP implementation processes, with the consequence that evaluations tell us little about what works and what does not, in which contexts, and why. This hampers learning from evaluations. What are the requirements for a complexity-informed evaluation method? And how does qualitative comparative analysis (QCA) meet these requirements? This is the second set of questions addressed in this thesis