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1.

Valuing inter-sectoral costs and benefits of interventions in the healthcare sector: methods for obtaining unit prices.

Drost, Ruben M W A; Paulus, Aggie T G; Ruwaard, Dirk; Evers, Silvia M A A
| Idioma(s): Inglés
INTRODUCTION: There is a lack of knowledge about methods for valuing health intervention-related costs and monetary benefits in the education and criminal justice sectors, also known as 'inter-sectoral costs and benefits' (ICBs). The objective of this study was to develop methods for obtaining unit prices for the valuation of ICBs. METHODS: By conducting an exploratory literature study and expert interviews, several generic methods were developed. The methods' feasibility was assessed through application in the Netherlands. Results were validated in an expert meeting, which was attended by policy makers, public health experts, health economists and HTA-experts, and discussed at several international conferences and symposia. RESULTS: The study resulted in four methods, including the opportunity cost method (A) and valuation using available unit prices (B), self-constructed unit prices (C) or hourly labor costs (D). DISCUSSION: The methods developed can be used internationally and are valuable for the broad international field of HTA.
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2.

Effectiveness of Percutaneous Celiac Plexus Ablation in the Treatment of Severe Cancer Pain in Upper Abdomen and Evaluation of Health Economics.

Cao, Jun; He, Yang; Liu, Hongqiang; Wang, Saibo; Zhao, Baocheng; Zheng, Xiaohui; Yang, Kai; Xie, Donghao
| Idioma(s): Inglés
OBJECTIVE: To compare the effectiveness, adverse effects, and cost-effectiveness of percutaneous neurolytic celiac plexus block (NCPB) versus traditional medication strategies for the treatment of patients with advanced cancer having severe upper abdominal cancer pain. METHODS: This retrospective study included 81 patients with advanced upper abdominal cancer admitted to The Sixth People's Hospital Affiliated to Shanghai Jiaotong University between January 2013 and July 2014. The patients were divided into percutaneous NCPB (treatment) and medication for pain (control) groups. The outcomes were measured in terms of Numeric Rating Scale (NRS) score and Karnofsky Performance Status (KPS) score before treatment and on the 3rd, 7th, 14th, and 28th days posttreatment. The effectiveness and cost-effectiveness of the therapy were assessed using analysis of the health economics. RESULTS: The improvements in NRS score (1.42 ± 1.09 vs 4.03 ± 0.96, P < .01) and KPS score (65.55 ± 9.09 vs 63.03 ± 8.961, P < .01) in the treatment group were significantly superior compared to the control group on the 7th day of treatment, followed by no significant difference between the 2 groups on the 14th and the 28th day of treatment. Health economics evaluation revealed that the medicine-specific costs and total health care costs were significantly reduced in the treatment group compared to the control group ( P < .05), but no significant differences between the 2 groups ( P > .05) were seen in the costs of hospitalization, examinations, and treatment. CONCLUSION: The percutaneous NCPB method shows promising results and better cost-effectiveness for treating patients with advanced cancer having severe upper abdominal pain.
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3.

Estimation of the health and economic burden of neurocysticercosis in India.

Singh, B B; Khatkar, M S; Gill, J P S; Dhand, N K
| Idioma(s): Inglés
Taenia solium is an endemic parasite in India which occurs in two forms in humans: cysticercosis (infection of soft tissues) and taeniosis (intestinal infection). Neurocysticercosis (NCC) is the most severe form of cysticercosis in which cysts develop in the central nervous system. This study was conducted to estimate health and economic impact due to human NCC-associated active epilepsy in India. Input data were sourced from published research literature, census data and other official records. Economic losses due to NCC-associated active epilepsy were estimated based on cost of treatment, hospitalisation and severe injury as well as loss of income. The disability-adjusted life years (DALYs) due to NCC were estimated by combining years of life lost due to early death and the number of years compromised due to disability taking the disease incidence into account. DALYs were estimated for five age groups, two genders and four regions, and then combined. To account for uncertainty, probability distributions were used for disease incidence data and other input parameters. In addition, sensitivity analyses were conducted to determine the impact of certain input parameters on health and economic estimates. It was estimated that in 2011, human NCC-associated active epilepsy caused an annual median loss of Rupees 12.03 billion (uncertainty interval [95% UI] Rs. 9.16-15.57 billion; US $ 185.14 million) with losses of Rs. 9.78 billion (95% UI Rs. 7.24-13.0 billion; US $ 150.56 million) from the North and Rs. 2.22 billion (95% UI Rs. 1.58-3.06 billion; US $ 34.14 million) from the South. The disease resulted in a total of 2.10 million (95% UI 0.99-4.10 million) DALYs per annum without age weighting and time discounting with 1.81 million (95% UI 0.84-3.57 million) DALYs from the North and 0.28 million (95% UI 0.13-0.55 million) from the South. The health burden per thousand persons per year was 1.73 DALYs (95% UI 0.82-3.39). The results indicate that human NCC causes significant health and economic impact in India. Programs for controlling the disease should be initiated to reduce the socio-economic impact of the disease in India.
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4.

The critical role of communications in a multilevel obesity-prevention intervention: Lessons learned for alcohol educators.

Hatfield, Daniel P; Sliwa, Sarah A; Folta, Sara C; Economos, Christina D; Goldberg, Jeanne P
| Idioma(s): Inglés
OBJECTIVE: Multilevel interventions to prevent underage drinking are more effective than individual-level strategies, and messaging campaigns are key to such approaches. Recognizing the benefits of translating best practices across public health domains, this paper details the communications campaign from Shape Up Somerville (SUS), an exemplar for multilevel community-based approaches to address pediatric obesity, highlighting lessons learned for alcohol educators. METHODS: All elements of SUS, including the communications strategy, were developed collaboratively with local partners. Communication initiatives included community-engaged brand development to unify diverse intervention components; school-based communications to promote new opportunities for healthy eating and physical activity; and media partnerships to promote healthy behaviors community-wide. RESULTS: The overall SUS intervention was effective in reducing prevalence of overweight/obesity among first- to third-graders in Somerville relative to control communities. Process evaluation showed that communications successfully reached diverse community segments and raised awareness of and receptivity to changes. CONCLUSIONS AND PRACTICE IMPLICATIONS: Communications campaigns are essential components of multilevel interventions addressing public health challenges including obesity and underage drinking. Such communications should be developed collaboratively with the target audience and stakeholders, designed to engage community members at multiple levels through multiple channels within a systems framework, and sustained through local partnerships.
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5.

An Open Architecture to Support Social and Health Services in a Smart TV Environment.

Costa, Carlos Rivas; Anido-Rifon, Luis E; Fernandez-Iglesias, Manuel J
| Idioma(s): Inglés
OBJECTIVE: To design, implement, and test a solution to provide social and health services for the elderly at home based on smart TV technologies and access to all services. METHODS: The architecture proposed is based on an open software platform and standard personal computing hardware. This provides great flexibility to develop new applications over the underlying infrastructure or to integrate new devices, for instance to monitor a broad range of vital signs in those cases where home monitoring is required. RESULTS: An actual system as a proof-of-concept was designed, implemented, and deployed. Applications range from social network clients to vital signs monitoring; from interactive TV contests to conventional online care applications such as medication reminders or telemedicine. CONCLUSION: In both cases, the results have been very positive, confirming the initial perception of the TV as a convenient, easy-to-use technology to provide social and health care. The TV set is a much more familiar computing interface for most senior users, and as a consequence, smart TVs become a most convenient solution for the design and implementation of applications and services targeted to this user group. SIGNIFICANCE: This proposal has been tested in real setting with 62 senior people at their homes. Users included both individuals with experience using computers and others reluctant to them.
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6.

Consensus Planning Toward a Community-Based Approach to Promote Physical Activity in Youth with Cerebral Palsy.

Gorter, Jan Willem; Galuppi, Barbara E; Gulko, Roman; Wright, Marilyn; Godkin, Erin
| Idioma(s): Inglés
AIMS: To engage researchers and knowledge-users in six Ontario communities in knowledge translation initiatives to identify community-informed elements to guide the development of an optimal physical activity program for youth with cerebral palsy (CP) and to support research efforts. METHODS: The project included three iterative steps, i.e., an environmental scan of five communities, six regional planning meetings, and a member-checking survey, followed by a Delphi survey to reach consensus on the elements deemed most important. RESULTS: Twenty-four elements were identified to include in programs promoting physical activity in youth with CP, which were organized in five categories: raise awareness of the options and opportunities (n = 4); pique interest and motivate youth to become and stay active (n = 9); ensure community programs are ready for youth with a disability (n = 2); be fit, fit in, and finding the best fit (n = 5); and explore the layers of physical activity and how they interact (n = 4). CONCLUSIONS: The 24 elements established characterize the key concepts that families and community stakeholders value when developing physical activity programs for youth with CP. When incorporated into clinical practice, each of the elements may be used to evaluate key aspects of outcome for individuals with CP.
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7.

Relationship between socioeconomic status and accessibility for endoscopic resection among gastric cancer patients: using National Health Insurance Cohort in Korea: poverty and endoscopic resection.

Kim, Na Yeon; Oh, Jun Seok; Choi, Young; Shin, Jaeyong; Park, Eun-Cheol
| Idioma(s): Inglés
BACKGROUND: Gastric cancer is one of the most common types of cancer among patients in Korea. We measured the inequity in accessibility to endoscopic mucosal/submucosal resection (EMR) for early and curable gastric cancer treatment among different income classes in patients diagnosed from late 2011 to 2013. METHODS: Data were obtained from the National Health Insurance Cooperation Claim Data from patients diagnosed from late 2011 until the end of 2013, to provide a total of 1,671 patients with newly diagnosed carcinoma in situ of gastric and gastric cancer among 1,025,340 enrollees. Multiple logistic regression analysis was conducted to investigate the associations between independent variables and the rate of treatment with EMR. RESULTS: Among 1671 gastric cancer patients, 317 (19.0 %) subjects were treated with EMR. The 'lowest' income group was associated with a statistically significant lower rate of EMR treatment [odds ratio (OR) = 0.55, 95 % confidence index (CI) 0.34-0.89] compared to the 'highest' income group. The ORs for the 'low-middle' and 'middle-high' income groups were both higher than for the reference group, although these were not significantly different. According to the subgroup analysis by gender, rate of EMR treatment of 'lowest' income group (OR = 0.37, 95 % CI 0.18-0.74) was significantly lower only among men. CONCLUSION: In conclusion, we suggest that although universal health insurance in Korea has covered EMR treatment since August 2011, patients from the lowest income group are less likely to receive this treatment. Thus, we need to detect more eligible early-stage gastric cancer and treatment for individuals of low socioeconomic status.
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8.

Towards Canine Rabies Elimination in South-Eastern Tanzania: Assessment of Health Economic Data.

Hatch, B; Anderson, A; Sambo, M; Maziku, M; Mchau, G; Mbunda, E; Mtema, Z; Rupprecht, C E; Shwiff, S A; Nel, L
| Idioma(s): Inglés
An estimated 59 000 people die annually from rabies, keeping this zoonosis on the forefront of neglected diseases, especially in the developing world. Most deaths occur after being bitten by a rabid dog. Those exposed to a suspect rabid animal should receive appropriate post-exposure prophylaxis (PEP) or risk death. However, vaccination of dogs to control and eliminate canine rabies at the source has been implemented in many places around the world. Here, we analysed the vaccination and cost data for one such campaign in the area surrounding and including Dar es Salaam, Tanzania and estimated the cost per dog vaccinated. We also estimated the cost of human PEP. We found that the cost per dog vaccinated ranged from $2.50 to $22.49 across districts and phases, with the phase average ranging from $7.30 to $11.27. These figures were influenced by over purchase of vaccine in the early phases of the programme and the significant costs associated with purchasing equipment for a programme starting from scratch. The cost per human PEP course administered was approximately $24.41, with the average patient receiving 2.5 of the recommended four vaccine doses per suspect bite. This study provides valuable financial insights into programme managers and policymakers working towards rabies elimination.
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9.

The Ponseti Method for Clubfoot Treatment in Low and Middle-Income Countries: A Systematic Review of Barriers and Solutions to Service Delivery.

Johnson, Rachel R; Friedman, James M; Becker, Andrew M; Spiegel, David A
| Idioma(s): Inglés
BACKGROUND: Use of the minimally invasive Ponseti method has been increasing in low and middle-income countries, where most of the world's children with clubfoot are born. This method requires a system of service delivery involving screening, serial casting with or without a tenotomy to achieve correction, and long-term use of an orthosis to maintain correction. The goal of this systematic review is to evaluate the barriers to service delivery and the solutions that have been proposed or implemented to address these barriers. METHODS: A literature search of Medline, Embase, and SCOPUS produced 3251 results. Twenty-four papers were selected for final review. Barriers and their attempted solutions were organized into a previously described health barrier model. We reported on high-impact, sustainable solutions that are feasible for organizations to implement, as opposed to solutions that require major policy or country-wide infrastructure changes. RESULTS: Common barriers found to have the most impact on patient care included financial constraints, transportation, difficulties with brace and cast care, self-perceived health status, lack of physical resources, and provider's lack of knowledge and skill. The most common solutions detailed were education of the provider or patient and financial assistance for patients. CONCLUSIONS: Recognizing that contextually relevant solutions to the challenges of setting up a system for clubfoot service delivery are required, several common barriers have emerged within this systematic review of papers from multiple countries, including spatial accessibility, affordability, and availability. Programs can best prepare for challenges by placing clinics close to population centers and/or allocating funds to subsidize transportation, ensuring that an adequate supply of materials are available for the casting and tenotomy, and enhancing the education of families and health providers. Strengthening communication and establishing partnerships between individuals and organizations promoting the Ponseti method will improve systems for service delivery. LEVEL OF EVIDENCE: Level IV-prognostic study.
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10.

Polycyclic aromatic hydrocarbons (PAHs) in water and sediment from a river basin: sediment-water partitioning, source identification and environmental health risk assessment.

Sun, Caiyun; Zhang, Jiquan; Ma, Qiyun; Chen, Yanan; Ju, Hanyu
| Idioma(s): Inglés
The information on concentration levels, partitioning and sources of pollutants in aquatic environment is quite necessary for pollution treatment and quality criteria. In this work, sixteen priority polycyclic aromatic hydrocarbons (PAHs) recommended by U.S. Environmental Protection Agency in the water and sediment of Yinma River Basin were firstly investigated. Among 16 individual PAHs, naphthalene was the highest average concentration in water samples as well as in sediment samples, 67.2 ng/L and 825.06 ng/g, respectively, whereas benzo(g,h,i)perylene was undetected in water samples nor in sediment samples. For three PAH compositional patterns, concentrations of light (2-3 ring) PAHs were dominant in water and sediment, accounting for 71.69 and 86.98 % respectively. The PAH partitioning in the sediment-water system was studied, results showed that PAH partitioning was in an unsteady state and tended to accumulate in the sediment. The possible sources of PAHs in water and sediment were both identified as a mixed source of petroleum and combustion. The benzo(a)pyrene equivalents (EBaP) values for PAHs in the water and sediment in some sites were relatively higher, suggesting the existence of environmental health risk.
Resultados  1-10 de 6.785