Access to infertility consultations: what women tell us about it?

The main objective of the present paper is to evaluate the perception of women concerning the barriers and access to infertility consultations. Socio cultural and economic access to infertility consultations is detached and three municipalities of the northwest of Portugal were chosen as an example of a peripheral country. A quantitative/qualitative study was done with 60 women. Three dimensions were evaluated: geographic and structural and functional access; economic access; and sociocultural access. The main barriers were mainly identified in the last two dimensions. The economic access was the less well evaluated by women being the cost of treatment (medication, and concentration of costs in a short period) difficult to bear. This can justify a greater involvement of the Portuguese Government, by developing policies for the reimbursement of part of the costs. Also, some changes in structural and functional access must be done with special regard to the separation of the infertility consultations from the reproductive medicine section. The setting of the teams, with a follow-up by the same team of health professionals is also needed

Upgrading under globalization in health-related industries in Tanzania: the case for dynamic industrial deepening

Globalization of markets and production networks has made it progressively harder for low income countries to industrialize. This article addresses a conundrum facing industrial firms and industrial policy in a low-income African country: how to achieve upgrading necessary for sustained competitiveness. Using data from a study of manufacturers of health products in Tanzania, we document the double ‘squeeze’ on firms’ profits exerted by sharp price competition alongside competitive pressure for rising product quality within globalized markets. Drawing on Sutton’s model of competing on capabilities, and the sectoral systems of innovation and production framework, we argue that ‘dynamic industrial deepening’, strengthening domestic inter-firm linkages, is a key requirement for sustainable development of these health industries. We present evidence that sectoral industrial support for the health industries can promote sustainable technological upgrading, and reflect on the challenge of building developmental linkages where external investment to support upgrading is transforming existing business structures

Sistema de Informação e Cidadania: a Falta de Usabilidade Continua Impedindo o Pleno Exercício da Democracia?

A Internet possui um papel importante na sociedade do conhecimento, principalmente no que se refere à popularização da informação, atuando como vetor importante no processo democrático social. Os candidatos políticos têm na Internet um espaço abrangente e globalizado para disseminar suas campanhas. Nesta pesquisa avaliam-se os sites de candidatos políticos nas eleições de 2008 em Belo Horizonte e percebe-se a falta de usabilidade desses sites, dificultando o acesso às informações relevantes e ao exercício da cidadania no processo decisório eleitoral

Systematic review identifies the design and methodological conduct of studies on machine learning-based prediction models

Background and ObjectivesWe sought to summarize the study design, modelling strategies, and performance measures reported in studies on clinical prediction models developed using machine learning techniques.MethodsWe search PubMed for articles published between 01/01/2018 and 31/12/2019, describing the development or the development with external validation of a multivariable prediction model using any supervised machine learning technique. No restrictions were made based on study design, data source, or predicted patient-related health outcomes.ResultsWe included 152 studies, 58 (38.2% [95% CI 30.8–46.1]) were diagnostic and 94 (61.8% [95% CI 53.9–69.2]) prognostic studies. Most studies reported only the development of prediction models (n = 133, 87.5% [95% CI 81.3–91.8]), focused on binary outcomes (n = 131, 86.2% [95% CI 79.8–90.8), and did not report a sample size calculation (n = 125, 82.2% [95% CI 75.4–87.5]). The most common algorithms used were support vector machine (n = 86/522, 16.5% [95% CI 13.5–19.9]) and random forest (n = 73/522, 14% [95% CI 11.3–17.2]). Values for area under the Receiver Operating Characteristic curve ranged from 0.45 to 1.00. Calibration metrics were often missed (n = 494/522, 94.6% [95% CI 92.4–96.3]).ConclusionOur review revealed that focus is required on handling of missing values, methods for internal validation, and reporting of calibration to improve the methodological conduct of studies on machine learning–based prediction models

Rethinking health sector procurement as developmental linkages in East Africa

Health care forms a large economic sector in all countries, and procurement of medicines and other essential commodities necessarily creates economic linkages between a country's health sector and local and international industrial development. These procurement processes may be positive or negative in their effects on populations' access to appropriate treatment and on local industrial development, yet procurement in low and middle income countries (LMICs) remains under-studied: generally analysed, when addressed at all, as a public sector technical and organisational challenge rather than a social and economic element of health system governance shaping its links to the wider economy. This article uses fieldwork in Tanzania and Kenya in 2012–15 to analyse procurement of essential medicines and supplies as a governance process for the health system and its industrial links, drawing on aspects of global value chain theory. We describe procurement work processes as experienced by front line staff in public, faith-based and private sectors, linking these experiences to wholesale funding sources and purchasing practices, and examining their implications for medicines access and for local industrial development within these East African countries. We show that in a context of poor access to reliable medicines, extensive reliance on private medicines purchase, and increasing globalisation of procurement systems, domestic linkages between health and industrial sectors have been weakened, especially in Tanzania. We argue in consequence for a more developmental perspective on health sector procurement design, including closer policy attention to strengthening vertical and horizontal relational working within local health-industry value chains, in the interests of both wider access to treatment and improved industrial development in Africa

Chemical composition and toxicity of essential oils of Piper spp. against larvae of Aedes aegypti L. (Diptera: Culicidae)

Aedes aegypti L. é um dos vetores do dengue. No Brasil, tem ganhado muita atenção no setor da saúde pública, uma vez que esta doença tem se tornando mais agressiva na forma hemorrágica na popula- ção. Esse estudo teve como objetivo investigar o efeito de óleos essenciais de Piper aduncum, Piper marginatum e Piper nigrum contra larvas de Aedes aegypti. Em um esforço para encontrar uma maneira natural, eficaz e acessível para controlar esta doença endêmica, as atividades dos óleos essenciais, a partir das plantas, foram analisadas por comparação através da medida da CL50 . Os óleos essenciais obtidos por hidrodestilação foram analisados por CG/EM. Os principais componentes identificados foram: β-pineno (32,7%) e E-cariofileno (17,1%) em P. aduncum; isoelemecina (21,7%) e apiol (20,1%) em P. marginatum e E-cariofileno (24,2%) e Óxido-cariofileno (20,1%) em P. nigrum. Os resultados mostram que Piper marginatum apresentou CL50 de 8,29 μg/mL e este trabalho é o primeiro relato de atividade larvicida de P. aduncum. Estes resultados sugerem que os óleos essenciais de espécies do gênero Piper são promissores como larvicidas contra larvas de A. aegypti.Aedes aegypti L. is one of the vectors of dengue fever. In Brazil it has gain much attention in the Public Health sector since this disease has becoming more aggressive in the hemorrhagic form in the population. This study aimed to investigate the effect of Piper aduncum, Piper marginatum and Piper nigrum essential oils against Aedes aegypti larvae. In an effort to find a natural effective and affordable way to control this endemic disease, the larvicidal activities of essential oils from the plants were analyzed for activity comparison by measurement of their LC50 . The essential oils isolated by hydrodistillation were analyzed by GC/MS. The main components identified were: β-pinene (32.7%) and E-caryophyllene (17.1%) in P. aduncum; isoelemecin (21.7%) and apiole (20.1%) in P. marginatum and E-caryophyllene (24.2%) and caryophyllene oxide (20.1%) in P. nigrum. The results show that Piper marginatum presented the LC50 of 8.29 μg/mL and these are the first report about the larvicidal activity of P. aduncum. These results suggest that the essential oil of Piper species are promising as larvicide against A. aegypti larvae.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Fusarium wilt incidence and common bean yield according to the preceding crop and the soil tillage system

The objective of this work was to evaluate the effects of preceding crops and tillage systems on the incidence of Fusarium wilt (Fusarium oxysporum f. sp. phaseoli) and common bean (Phaseolus vulgaris) yield. The cultivar BRS Valente was cultivated under center‑pivot irrigation in the winter seasons of 2003, 2004 and 2005, after several preceding crops established in the summer seasons. Preceding crops included the legumes Cajanus cajan (pigeon pea), Stylosanthes guianensis, and Crotalaria spectabilis; the grasses Pennisetum glaucum (millet), Sorghum bicolor (forage sorghum), Panicum maximum, and Urochloa brizantha; and a consortium of maize (Zea mays) and U. brizantha (Santa Fé system). Experiments followed a strip‑plot design, with four replicates. Fusarium wilt incidence was higher in the no‑tillage system. Higher disease incidences corresponded to lower bean yields in 2003 and 2004. Previous summer cropping with U. brizantha, U. brizantha + maize consortium, and millet showed the lowest disease incidence. Therefore, the choice of preceding crops must be taken into account for managing Fusarium wilt on irrigated common bean crops in the Brazilian Cerrado

Transparent reporting of multivariable prediction models for individual prognosis or diagnosis: checklist for systematic reviews and meta-analyses (TRIPOD-SRMA)

Most clinical specialties have a plethora of studies that develop or validate one or more prediction models, for example, to inform diagnosis or prognosis. Having many prediction model studies in a particular clinical field motivates the need for systematic reviews and meta-analyses, to evaluate and summarise the overall evidence available from prediction model studies, in particular about the predictive performance of existing models. Such reviews are fast emerging, and should be reported completely, transparently, and accurately. To help ensure this type of reporting, this article describes a new reporting guideline for systematic reviews and meta-analyses of prediction model research

Systematic review finds "Spin" practices and poor reporting standards in studies on machine learning-based prediction models

Objectives: We evaluated the presence and frequency of spin practices and poor reporting standards in studies that developed and/or validated clinical prediction models using supervised machine learning techniques. Study Design and Setting: We systematically searched PubMed from 01/2018 to 12/2019 to identify diagnostic and prognostic prediction model studies using supervised machine learning. No restrictions were placed on data source, outcome, or clinical specialty. Results: We included 152 studies: 38% reported diagnostic models and 62% prognostic models. When reported, discrimination was described without precision estimates in 53/71 abstracts (74.6% [95% CI 63.4–83.3]) and 53/81 main texts (65.4% [95% CI 54.6–74.9]). Of the 21 abstracts that recommended the model to be used in daily practice, 20 (95.2% [95% CI 77.3–99.8]) lacked any external validation of the developed models. Likewise, 74/133 (55.6% [95% CI 47.2–63.8]) studies made recommendations for clinical use in their main text without any external validation. Reporting guidelines were cited in 13/152 (8.6% [95% CI 5.1–14.1]) studies. Conclusion: Spin practices and poor reporting standards are also present in studies on prediction models using machine learning techniques. A tailored framework for the identification of spin will enhance the sound reporting of prediction model studies