31 research outputs found
Evidence Acquisition and Evaluation for Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives
Recognizing the need for evidence to inform US Government and
governments of the low- and middleincome countries on efficient,
effective maternal health policies, strategies, and programmes, the US
Government convened the Evidence Summit on Enhancing Provision and Use
of Maternal Health Services through Financial Incentives in April 2012
in Washington, DC, USA. This paper summarizes the background and
methods for the acquisition and evaluation of the evidence used for
achieving the goals of the Summit. The goal of the Summit was to obtain
multidisciplinary expert review of literature to inform both US
Government and governments of the low- and middle-income countries on
evidence-informed practice, policies, and strategies for financial
incentives. Several steps were undertaken to define the tasks for the
Summit and identify the appropriate evidence for review. The process
began by identifying focal questions intended to inform governments of
the low-and middle-income countries and the US Government about the
efficacy of supply- and demand-side financial incentives for enhanced
provision and use of quality maternal health services. Experts were
selected representing the research and programme communities, academia,
relevant non-governmental organizations, and government agencies and
were assembled into Evidence Review Teams. This was followed by a
systematic process to gather relevant peer-reviewed literature that
would inform the focal questions. Members of the Evidence Review Teams
were invited to add relevant papers not identified in the initial
literature review to complete the bibliography. The Evidence Review
Teams were asked to comply with a specific evaluation framework for
recommendations on practice and policy based on both expert opinion and
the quality of the data. Details of the search processes and methods
used for screening and quality reviews are described
Financial Incentives and Maternal Health: Where Do We Go from Here?
Health financing strategies that incorporate financial incentives are
being applied in many low- and middle-income countries, and improving
maternal and neonatal health is often a central goal. As yet, there
have been few reviews of such programmes and their impact on maternal
health. The US Government Evidence Summit on Enhancing Provision and
use of Maternal Health Services through Financial Incentives was
convened on 24-25 April 2012 to address this gap. This article, the
final in a series assessing the effects of financial
incentives\u2014performance-based incentives (PBIs), insurance, user
fee exemption programmes, conditional cash transfers, and
vouchers\u2014summarizes the evidence and discusses issues of context,
programme design and implementation, cost-effectiveness, and
sustainability. We suggest key areas to consider when designing and
implementing financial incentive programmes for enhancing maternal
health and highlight gaps in evidence that could benefit from
additional research. Although the methodological rigor of studies
varies, the evidence, overall, suggests that financial incentives can
enhance demand for and improve the supply of maternal health services.
Definitive evidence demonstrating a link between incentives and
improved health outcomes is lacking; however, the evidence suggests
that financial incentives can increase the quantity and quality of
maternal health services and address health systems and financial
barriers that prevent women from accessing and providers from
delivering quality, lifesaving maternal healthcare
Evaluation of the cocaine.like discriminative stimulus effects and reinforcing effects of modafinil
Abstract Modafinil [(diphenyl-methyl)sulphinyl-2-acetamide] is a novel psychostimulant drug which is effective in the treatment of narcolepsy and idiopathic hypersomnia. It also has neuroprotective effects in animal models of striatal neuropathology. Although the cellular mechanisms of action of modafinil are poorly understood, it has been shown to have a profile of pharmacological effects that differs considerably from that of amphetamine-like stimulants. There is some evidence that modafinil has central cq-adrenergic agonist effects. In the present study modafinil was evaluated for cocaine-like discriminative stimulus effects in rats and for reinforcing effects in rhesus monkeys maintained on intravenous cocaine self-administration. Modafinil, /-ephedrine and d-amphetamine all produced dose dependent increases in cocaine-lever responding, with maximal levels of 67%, 82% and 100%, respectively. Modafinil produced full substitution in four out of the six rats tested while the highest levels of substitution were associated with substantial response rate decreasing effects. Little evidence was obtained that the discriminative stimulus effects ofmodafinil were produced by ~l-adrenergic activation, based upon results of tests performed in combination with prazosin. In the selfadministration procedure, modafinil and /-ephedrine functioned as reinforcers in rhesus monkeys. The reinforcing and discriminative stimulus effects of modafinil required very high doses: modafinit was over 200 times less potent than d-amphetamine and was also less potent than /-ephedrine. These results show that modafinil has some cocaine-like discriminative stinmlus effects and, like other abused stimulants, can serve as a reinforcer at high doses
The selfadministration of MK-801 can depend upon drug-reinforcement history, and its discriminative stimulus properties are phencyclidine-like in rhesus monkeys
ABSTRACT ABBREVIATIONS: MK-801 , (+)-5-methyl-10,1 1-dihydro-5H-dibenzo(a,d)cyclohepten-5,10-imine maleate; NMDA, N-methyl-o-aspartate; PCP, phencyclidine HCI; FR, fixed ratio
Summary of the Report of the Ad Hoc Task Force on Psychopharmacology of the American Psychological Association
The American Psychological Association Board of Directors established an ad hoc task force on psychopharmacology to explore the desirability and feasibility of psychopharmacology prescription privileges for psychologists. In this context, the Task Force\u27s charges were to determine the competence criteria necessary for training psychologists to provide service to patients receiving medications and to develop and evaluate the necessary curricular models. This article summarizes the Task Force\u27s major recommendations and provides specific information regarding its training recommendations . It is hoped that this article will encourage broad discussion of psychology\u27s most appropriate integration of psychopharmacology knowledge and its applications into its training programs and professional activities
Preclinical Evaluation of the Abuse Potential of the Analgesic Bicifadine
The abuse liability of the analgesic bicifadine was investigated in animal models used to predict the abuse potential of psychostimulants in humans. Bicifadine, cocaine, d-amphetamine, bupropion, and desipramine were evaluated for the production of cocaine-like discriminative stimulus effects in rats. Cocaine, d-amphetamine, and bupropion dose-dependently and fully substituted for cocaine. Bicifadine and desipramine produced a maximum mean cocaine-lever selection of 80 and 69%, respectively, but doses yielding peak substitution strongly suppressed response rates. Microdialysis studies in normal waking rats indicated that d-amphetamine increased dopamine levels in the nucleus accumbens and striatum to a much greater degree than bicifadine, but bicifadine increased 5-hydroxytryptamine levels in the nucleus accumbens and striatum more than d-amphetamine. Bicifadine was also tested for intravenous self-administration in rhesus monkeys experienced with cocaine administration. Reinforcing effects of bicifadine were observed in only two of four subjects, whereas cocaine, d-amphetamine, and bupropion served as reinforcers in all four monkeys. When evaluated under a progressive ratio procedure, no dose of bicifadine maintained responding to the extent of cocaine, d-amphetamine, or bupropion. The discriminative stimulus effects associated with bicifadine were similar, but not identical, to those of psychostimulants. Although bicifadine maintained self-administration behavior in some subjects, its reinforcing efficacy was very low relative to cocaine, d-amphetamine, and bupropion. These results are consistent with the microdialysis findings of lower dopamine levels and higher 5-hydroxytryptamine levels after administration of bicifadine relative to d-amphetamine. Overall, the current findings support a low abuse potential of bicifadine, more resembling that of antidepressants than psychostimulants