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1.
Proc Biol Sci ; 283(1828)2016 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-27053751

RESUMO

Animal behaviour and the ecology and evolution of parasites are inextricably linked. For this reason, animal behaviourists and disease ecologists have been interested in the intersection of their respective fields for decades. Despite this interest, most research at the behaviour-disease interface focuses either on how host behaviour affects parasites or how parasites affect behaviour, with little overlap between the two. Yet, the majority of interactions between hosts and parasites are probably reciprocal, such that host behaviour feeds back on parasites and vice versa. Explicitly considering these feedbacks is essential for understanding the complex connections between animal behaviour and parasite ecology and evolution. To illustrate this point, we discuss how host behaviour-parasite feedbacks might operate and explore the consequences of feedback for studies of animal behaviour and parasites. For example, ignoring the feedback of host social structure on parasite dynamics can limit the accuracy of predictions about parasite spread. Likewise, considering feedback in studies of parasites and animal personalities may provide unique insight about the maintenance of variation in personality types. Finally, applying the feedback concept to links between host behaviour and beneficial, rather than pathogenic, microbes may shed new light on transitions between mutualism and parasitism. More generally, accounting for host behaviour-parasite feedbacks can help identify critical gaps in our understanding of how key host behaviours and parasite traits evolve and are maintained.


Assuntos
Comportamento Animal , Interações Hospedeiro-Parasita , Animais , Modelos Biológicos , Personalidade , Dinâmica Populacional , Comportamento Social
2.
J Am Pharm Assoc (2003) ; 56(1): 47-53, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26802920

RESUMO

BACKGROUND: A new service model integrates the specialty pharmacy's comprehensive service with the retail pharmacy's patient contact, giving patients options for medication delivery to home, pharmacy, or doctor's office. OBJECTIVE: Evaluate the impact of the new service model on medication adherence. DESIGN: Retrospective cohort study SETTINGS: One hundred fifteen CVS retail stores in Philadelphia participated in a pilot from May 2012 to October 2013, and 115 matched CVS retail stores from around the nation served as controls. PATIENTS: All eligible patients from the intervention and control stores received specialty medications through CVS retail pharmacies prior to implementation of the new service model. INTERVENTION: The intervention patients were transitioned from retail pharmacy service to the specialty pharmacy with delivery options. The control patients received standard retail pharmacy services. MAIN OUTCOME MEASURES: Proportion of days covered and first fill persistence were tracked for 12 months before and after program implementation. RESULTS: Under the new service model, 228 patients new to therapy in the post period had a 17.5% increase in the rate of obtaining a second fill as compared to matched controls. Patients on therapy in both the pre- and the post-periods had a pre-post increase of 6.6% in average adherence rates and a pre-post increase of 10.8% in optimal adherence rates as compared to 326 matched controls. CONCLUSION: The study demonstrated significant improvement in both adherence to therapy and first-fill persistence among patients in the new service model integrating specialty pharmacy's comprehensive services with the retail pharmacy's patient contact and medication delivery choices.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Adesão à Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos
3.
Proc Biol Sci ; 280(1766): 20131381, 2013 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-23843398

RESUMO

Behavioural fever, defined as an acute change in thermal preference driven by pathogen recognition, has been reported in a variety of invertebrates and ectothermic vertebrates. It has been suggested, but so far not confirmed, that such changes in thermal regime favour the immune response and thus promote survival. Here, we show that zebrafish display behavioural fever that acts to promote extensive and highly specific temperature-dependent changes in the brain transcriptome. The observed coupling of the immune response to fever acts at the gene-environment level to promote a robust, highly specific time-dependent anti-viral response that, under viral infection, increases survival. Fish that are not offered a choice of temperatures and that therefore cannot express behavioural fever show decreased survival under viral challenge. This phenomenon provides an underlying explanation for the varied functional responses observed during systemic fever. Given the effects of behavioural fever on survival and the fact that it exists across considerable phylogenetic space, such immunity-environment interactions are likely to be under strong positive selection.


Assuntos
Comportamento Animal , Imunidade Inata , Temperatura , Peixe-Zebra/fisiologia , Animais , Encéfalo/imunologia , Encéfalo/fisiologia , Encéfalo/virologia , RNA Mensageiro/metabolismo , Transdução de Sinais , Transcriptoma , Regulação para Cima , Peixe-Zebra/imunologia , Peixe-Zebra/virologia , Proteínas de Peixe-Zebra/genética , Proteínas de Peixe-Zebra/metabolismo
4.
J Exp Biol ; 216(Pt 1): 11-7, 2013 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-23225862

RESUMO

An animal with a parasite is not likely to behave like a similar animal without that parasite. This is a simple enough concept, one that is now widely recognized as true, but if we move beyond that statement, the light that it casts on behavior fades quickly: the world of parasites, hosts and behavior is shadowy, and boundaries are ill-defined. For instance, at first glance, the growing list of altered behaviors tells us very little about how those alterations happen, much less how they evolved. Some cases of parasite-induced behavioral change are truly manipulative, with the parasite standing to benefit from the changed behavior. In other cases, the altered behavior has an almost curative, if not prophylactic, effect; in those cases, the host benefits. This paper will provide an overview of the conflicting (and coinciding) demands on parasite and host, using examples from a wide range of taxa and posing questions for the future. In particular, what does the larger world of animal behavior tell us about how to go about seeking insights - or at least, what not to do? By asking questions about the sensory-perceptual world of hosts, we can identify those associations that hold the greatest promise for neuroethological studies of parasite-induced behavioral alterations, and those studies can, in turn, help guide our understanding of how parasite-induced alterations evolved, and how they are maintained.


Assuntos
Interações Hospedeiro-Parasita , Parasitos/fisiologia , Adaptação Psicológica , Animais , Comportamento Animal , Quirópteros/parasitologia , Variação Genética , Humanos
5.
Issue Brief (Commonw Fund) ; 24: 1-13, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23012765

RESUMO

The Pre-Existing Condition Insurance Plan (PCIP) is the temporary, federal high-risk pool created under the Affordable Care Act to provide coverage to uninsured individuals with preexisting conditions until 2014, when exchange coverage becomes avail­able to them. Nearly 78,000 people have enrolled since the program was implemented two years ago. This issue brief compares the PCIP with state-based high-risk pools that existed prior to the Affordable Care Act and considers programmatic differences that may have resulted in lower-than-anticipated enrollment and higher-than-anticipated costs for the PCIP. PCIP coverage, like state high-risk pool coverage, likely remains unaffordable to most lower-income individuals with preexisting conditions, but provides much needed access to care for those able to afford it. Operational costs of these programs are also quite high, making them less than optimal as a means of broader coverage expansion.


Assuntos
Dedutíveis e Cosseguros/economia , Dedutíveis e Cosseguros/legislação & jurisprudência , Definição da Elegibilidade/economia , Definição da Elegibilidade/legislação & jurisprudência , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Cobertura do Seguro/economia , Cobertura do Seguro/legislação & jurisprudência , Fundos de Seguro/economia , Fundos de Seguro/legislação & jurisprudência , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Pessoas sem Cobertura de Seguro de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/economia , Patient Protection and Affordable Care Act/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Nível de Saúde , Humanos , Pobreza , Governo Estadual , Estados Unidos
6.
Issue Brief (Commonw Fund) ; 6: 1-20, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21678623

RESUMO

The Pre-Existing Condition Insurance Plan (PCIP) is a temporary program implemented under the Patient Protection and Affordable Care Act to make health insurance coverage available to uninsured individuals with preexisting conditions until 2014, when exchange-based health insurance becomes available to all. The PCIP program began enrolling applicants in July 2010. This issue brief examines enrollment trends, early changes to plan structures and premiums, and estimates of out-of-pocket costs by utilization pattern and type of plan. It also provides information about the age and medical conditions of early PCIP enrollees. Although PCIP enrollment has been lower than expected due to affordability issues, a lack of public awareness, and the requirement that applicants be uninsured for six months, the plans are nonetheless playing an important role in making coverage available to otherwise uninsurable Americans with preexisting conditions.


Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Cobertura do Seguro/legislação & jurisprudência , Seguro Saúde/economia , Pessoas sem Cobertura de Seguro de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act , Custo Compartilhado de Seguro , Definição da Elegibilidade , Financiamento Pessoal , Programas Governamentais , Reforma dos Serviços de Saúde/economia , Humanos , Cobertura do Seguro/economia , Governo Estadual , Estados Unidos
7.
Am J Health Promot ; 24(5): 304-10, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20465143

RESUMO

PURPOSE: To better understand the relationship between health insurance coverage and health care behaviors of persons with potentially disabling conditions enrolled in a state high-risk insurance pool. DESIGN: Six focus groups with risk pool enrollees at two sites. SETTING: Suburban areas in the state of Kansas. PARTICIPANTS: Forty-two individuals 29 to 62 years, all with potentially disabling physical or mental health conditions. METHOD: Qualitative analysis of focus group transcripts using pile sorting and theme identification. RESULTS: High premiums and deductibles limit participants' ability to afford basic health services and access to prescription medications despite their middle-class socioeconomic status. Participants report delaying or forgoing needed medical care because of lack of coverage and/or out-of-pocket costs. They employ numerous and potentially dangerous strategies to minimize costs, especially for prescription medications. Some report "saving up" needed procedures until their total costs will exceed that year's deductible. CONCLUSION: Individuals in the risk pool were making medical decisions on the basis of cost rather than need. Many shared stories of medical complications as a result of delayed care, and most expressed stress related to the difficulty of making decisions about their care and use of prescribed medications. The individual, nongroup insurance market, with its higher out-of-pocket costs, may not meet the needs of people with chronic health conditions.


Assuntos
Doença Crônica , Tomada de Decisões , Pessoas com Deficiência , Grupos Focais , Comportamentos Relacionados com a Saúde , Fundos de Seguro , Adolescente , Adulto , Fatores Etários , Idoso , Educação , Humanos , Renda , Kansas , Pessoa de Meia-Idade , Pesquisa , Estudos de Amostragem , Autocuidado
8.
Issue Brief (Commonw Fund) ; 100: 1-20, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20922855

RESUMO

The Patient Protection and Affordable Care Act includes a provision for the establishment of a temporary high-risk pool, also called the Pre-Existing Condition Insurance Plan (PCIP), to quickly make health insurance available to uninsured individuals with preexisting conditions, many of whom previously had been denied coverage. Twenty-seven states elected to administer the PCIPs for their citizens, while the remaining states and the District of Columbia chose to let their PCIPs be federally administered. This issue brief examines eligibility, benefits, premiums, cost-sharing, and oversight of the PCIP programs, as well as variation of the plans from state to state. The PCIPs will run through December 31, 2013, at which time participants will be transitioned to exchange coverage.


Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Benefícios do Seguro/legislação & jurisprudência , Cobertura do Seguro/legislação & jurisprudência , Fundos de Seguro/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Custo Compartilhado de Seguro , Dedutíveis e Cosseguros/economia , Dedutíveis e Cosseguros/legislação & jurisprudência , Definição da Elegibilidade , Reforma dos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde , Humanos , Benefícios do Seguro/economia , Cobertura do Seguro/economia , Fundos de Seguro/economia , Seguro Saúde/economia , Risco , Governo Estadual , Estados Unidos
9.
Inquiry ; 45(3): 340-52, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19069014

RESUMO

State high-risk insurance pools serve people denied coverage because of pre-existing conditions. With benefit plans modeled on the individual market, these pools generally require higher out-of-pocket expenditures and provide fewer benefits than employer-sponsored plans, while their beneficiaries have very intensive needs. We profile 416 working adults enrolled in a state high-risk pool and document their health conditions and health care utilization. High-risk pool and federal employee benefits are compared to assess insurance structure and implications for health and disability outcomes.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Fundos de Seguro/estatística & dados numéricos , Adolescente , Adulto , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Revisão da Utilização de Seguros , Fundos de Seguro/organização & administração , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
10.
Health Care Financ Rev ; 28(4): 31-41, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17722749

RESUMO

Medicaid's drug expenditures have grown at double-digit inflation rates since 2000. These prescription drug costs are important contributors to increasing health care costs for disabled persons. In spite of this knowledge, little has been reported about specific patterns of medication use among disabled enrollees. We analyzed Kansas Medicaid data to describe trends in medication use patterns across 3 years among disabled beneficiaries. The marked shifts toward newer medications and disproportionate contributions of newer, more expensive medications to overall prescription costs for antipsychotics, antidepressants, anticonvulsants, antiulcer medications, anti-inflammatory agents, and opioids have implications for both policy and practice.


Assuntos
Pessoas com Deficiência , Tratamento Farmacológico/economia , Medicaid , Adolescente , Adulto , Estudos Transversais , Feminino , Gastos em Saúde/tendências , Humanos , Kansas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
11.
Behav Processes ; 72(1): 1-5, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16406372

RESUMO

Examples of behavioural manipulation by parasites are numerous, but the processes underlying these changes are not well characterized. From an evolutionary point of view, behavioural changes in infected hosts have often been interpreted as illustrations of the extended phenotype concept, in which genes in one organism (the parasite) have phenotypic effects on another organism (the host). Here, we approach the problem differently, suggesting that hosts, by cooperating with manipulative parasites rather than resisting them, might mitigate fitness costs associated with manipulation. By imposing extra fitness costs on their hosts in the absence of compliance, parasites theoretically have the potential to select for cooperative behaviour by their hosts. Although this 'mafia-like' strategy remains poorly documented, we believe that it has substantial potential to resolve issues specific to the evolution of behavioural alterations induced by parasites.


Assuntos
Controle Comportamental , Evolução Biológica , Aves , Interações Hospedeiro-Parasita , Virulência , Animais , Aves/genética , Aves/imunologia , Comportamento Cooperativo , Interações Hospedeiro-Parasita/genética , Interações Hospedeiro-Parasita/imunologia , Doenças Parasitárias/genética , Doenças Parasitárias/imunologia , Fenótipo , Seleção Genética , Virulência/genética , Virulência/imunologia
12.
Health Aff (Millwood) ; 35(7): 1222-9, 2016 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-27385237

RESUMO

Adverse drug events and the challenges of clarifying and adhering to complex medication regimens are central drivers of hospital readmissions. Medication reconciliation programs can reduce the incidence of adverse drug events after discharge, but evidence regarding the impact of medication reconciliation on readmission rates and health care costs is less clear. We studied an insurer-initiated care transition program based on medication reconciliation delivered by pharmacists via home visits and telephone and explored its effects on high-risk patients. We examined whether voluntary program participation was associated with improved medication use, reduced readmissions, and savings net of program costs. Program participants had a 50 percent reduced relative risk of readmission within thirty days of discharge and an absolute risk reduction of 11.1 percent. The program saved $2 for every $1 spent. These results represent real-world evidence that insurer-initiated, pharmacist-led care transition programs, focused on but not limited to medication reconciliation, have the potential to both improve clinical outcomes and reduce total costs of care.


Assuntos
Redução de Custos , Atenção à Saúde/organização & administração , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/economia , Seguradoras/economia , Reconciliação de Medicamentos/economia , Readmissão do Paciente/economia , Adulto , Idoso , Estudos de Coortes , Continuidade da Assistência ao Paciente/economia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Feminino , Humanos , Masculino , Reconciliação de Medicamentos/métodos , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Transferência de Pacientes , Farmacêuticos , Papel Profissional , Pontuação de Propensão , Estados Unidos
13.
Clin Nurs Res ; 14(2): 191-205, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15793275

RESUMO

This pilot study tested a videotape intervention designed to improve patient self-management of heart failure (HF). Content of the video series (produced professionally under a federal grant) is based on national, scientifically validated guidelines for HF home management. Outcomes tested were HF knowledge, symptom reporting, and functional status. Participants were 10 newly diagnosed HF patients (mean age 67). After viewing the tapes, data indicated participants had a clinically relevant improvement in HF knowledge, and improved or maintained HF health status. None were rehospitalized during the 60-day follow-up period. One patient contacted his/her physician to report weight gain, as prompted by the videotapes. The cost data indicated that patients paid $177 out of pocket monthly for medications and all were low income. These results indicate the need for further testing of the videotape as a potentially cost-effective method of teaching about HF self-management and daily home self-monitoring.


Assuntos
Insuficiência Cardíaca/enfermagem , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos , Gravação de Videoteipe , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
14.
Int J Parasitol ; 33(8): 799-805, 2003 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-12865080

RESUMO

Adult acanthocephalan body sizes vary interspecifically over more than two orders of magnitude; yet, despite its importance for our understanding of the coevolutionary links between hosts and parasites, this variation remains unexplained. Here, we used a comparative analysis to investigate how final adult sizes and relative increments in size following establishment in the definitive host are influenced by three potential determinants of acanthocephalan sizes: initial (cystacanth) size at infection, host body mass, and the thermal regime experienced during growth, i.e. whether the definitive host is an ectotherm or an endotherm. Relative growth from the cystacanth stage to the adult stage ranged from twofold to more than 10,000-fold across acanthocephalan species, averaging just over 100-fold. However, this relative increment in size did not correlate with host mass, and did not differ between acanthocephalan species using ectothermic hosts and those growing in endothermic hosts. In contrast, final acanthocephalan adult sizes correlated positively with host mass, and after correction for host mass, final adult sizes were higher in species parasitising endotherms than in those found in ectotherms. The relationship between host mass and acanthocephalan adult size practically disappears, however, once phylogenetic influences are taken into account. Positive relationships between adult acanthocephalan size, cystacanth size and egg size indicate that a given relative size is a feature of an acanthocephalan species at all stages of its life cycle. These relationships also suggest that adult size is to some extent determined by cystacanth size, and that the characteristics of the definitive host are not the sole determinants of parasite life history traits.


Assuntos
Acantocéfalos/anatomia & histologia , Constituição Corporal , Helmintíase Animal/parasitologia , Acantocéfalos/crescimento & desenvolvimento , Animais , Biometria , Regulação da Temperatura Corporal , Interações Hospedeiro-Parasita , Estágios do Ciclo de Vida , Óvulo/citologia , Filogenia , Especificidade da Espécie
15.
Oecologia ; 133(2): 261-266, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28547314

RESUMO

Cockroaches parasitized by the temperature-sensitive acanthocephalan Moniliformis moniliformis exhibit a variety of behavioral alterations, so we asked if parasitized cockroaches defended themselves against the parasite with altered thermal choices. We tested the null hypothesis that cockroaches infected with M. moniliformis do not alter temperature choice in two ways: by direct observation and, indirectly, by observation of parasite development after a prolonged developmental period. When we compared acanthocephalan development in cockroaches that were allowed to use thermal gradients to acanthocephalan development in cockroaches held at constant temperatures, we found that in two cockroach species (Supella longipalpa and Blatta orientalis), acanthocephalan development was greatly retarded, a result that is consistent with the cockroaches spending time in cold temperatures. Parasitized animals exhibit behavioral alterations that can have profound effects on parasite transmission and host well-being; neither the beneficiaries of those alterations nor the alterations themselves are easily predictable.

16.
J Parasitol ; 90(4): 673-7, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15357051

RESUMO

The fitness of infected organisms can vary greatly depending on the temperature at which they find themselves. Understanding the role of temperature in the fitness of infected organisms can be crucial to population studies, epidemiological studies, and when screening for biological control agents. We measured the effect of parasitism on host survival and reproduction at 4 constant temperatures using the acanthocephalan parasite Moniliformis moniliformis and its intermediate host, the cockroach Supella longipalpa. Infection did not affect cockroach survival at any temperature. Infection had a negative impact on cockroach fecundity but only at higher temperatures (28 and 31 C) and only later in infection (>20 days postinfection). At lower temperatures, infected and uninfected cockroaches had similar fecundities throughout the duration of the experiment (120 days). This study, along with previous studies, suggests that researchers would do well to consider environmental variables when exploring the effects of parasitism.


Assuntos
Blattellidae/fisiologia , Blattellidae/parasitologia , Moniliformis/fisiologia , Temperatura , Análise de Variância , Animais , Feminino , Fertilidade , Masculino , Modelos de Riscos Proporcionais , Distribuição Aleatória , Análise de Sobrevida
17.
Integr Comp Biol ; 54(2): 177-83, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24737785

RESUMO

Dung beetles (genus Phanaeus) consume feces in both their larval and adults forms and because of their unique dietary niche, and behaviors associated with the burial of feces, are considered ecosystem engineers. In addition, because these insects subsist on a diet composed exclusively of feces, it is likely they encounter parasitic propagules more frequently than other animals do. Parasites often alter their host's behavior, so we set out to test whether Physocephalus sexalatus (a cosmopolitan nematode parasite of ungulates) does so in ways that affect the dung beetle's role as an ecosystem engineer and/or its predator-prey relationships (transmission of the parasite). Classic tests of anti-predator behavior did not reveal behavioral differences based on the beetles' infection status. However, this parasite did alter the beetles' behaviors in ways that could be critical for its role in fecal processing and therefore ecosystem engineering. Infected beetles exhibited anorexic behavior and consumed only half the amount of feces ingested by similar uninfected beetles. Infected beetles also buried less feces and did so in tunnels that were significantly shorter than those created by uninfected beetles. Fecal burial is naturally beneficial because it aerates the soil, incorporates nitrogenous compounds, and increases the flow of water thereby making soil and pastureland more productive. We showed that the nematode parasite P. sexalatus itself becomes an ecosystem engineer as it modifies the behavior of its already influential intermediate host.


Assuntos
Besouros/fisiologia , Besouros/parasitologia , Espirurídios/fisiologia , Animais , Comportamento Alimentar , Comportamento de Nidação , Texas
18.
Int J Parasitol ; 44(13): 969-75, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25200352

RESUMO

Odour-related behaviours in aquatic invertebrates are important and effective anti-predator behaviours. Parasites often alter invertebrate host behaviours to increase transmission to hosts. This study investigated the responses of the amphipod Hyalella azteca when presented with two predator chemical cues: (i) alarm pheromones produced by conspecifics and (ii) kairomones produced by a predatory Green Sunfish (Lepomis cyanellus). We compared the responses of amphipods uninfected and infected with the acanthocepalan parasite Leptorhynchiodes thecatus. Uninfected amphipods reduced activity and increased refuge use after detecting both the alarm pheromones and predator kairomones. Infected amphipods spent significantly more time being active and less time on the refuge than uninfected amphipods, and behaved as if they had not detected the chemical stimulus. Therefore, L. thecatus infections disrupt the amphipods' anti-predator behaviours and likely make their hosts more susceptible to predation.


Assuntos
Acantocéfalos/fisiologia , Anfípodes/fisiologia , Anfípodes/parasitologia , Odorantes , Feromônios/farmacologia , Animais , Organismos Aquáticos/parasitologia , Comportamento Animal , Sinais (Psicologia) , Interações Hospedeiro-Parasita/fisiologia , Comportamento Predatório
20.
J Manag Care Pharm ; 19(3): 228-36, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23537457

RESUMO

BACKGROUND: The medication therapy management (MTM) program identified high-risk members in a large employer group and invited them to participate in an MTM program. The intervention consisted of at least 3 consultations with a clinical pharmacist to review and discuss drug therapy. The goal was to improve drug therapy adherence and clinical outcomes. OBJECTIVE: To assess the impact of MTM on plan-paid health care costs, utilization of medical services, overall days supply of targeted medications, and medication possession ratios (MPRs). METHODS: The MTM and control group comprised eligible members of a large employer prescription benefit plan who were identified between October 1, 2007, and November 12, 2008, and invited to participate. Control group members were selected from targeted members who declined. After propensity score matching to ensure similarity of groups at baseline, each group had 2,250 members. Baseline comparisons and post-period impact analyses between groups were conducted using bivariate analysis. Post-period analyses used tests for paired comparisons. The MTM and control group members were studied for the year before and after their individual program invitations. We measured pre-post differences between the MTM members and controls in total heath care costs, inpatient visits, emergency room (ER) visits, total days supply, and MPRs for 5 conditions: diabetes, hypertension, dyslipidemia, depression, and asthma. RESULTS: MTM members significantly reduced their plan-paid health care costs by 10.3% or $977, compared with an increase of 0.7% or $62 in the control group (P = 0.048). Inpatient visits in the MTM group decreased by 18.6%, while the control group experienced an increase of 24.2% (P less than 0.001). While both groups had decreases in ER visits, the groups were not significantly different (P = 0.399). Average days supply for the MTM group increased by 72.7 days over baseline; for the control group, it decreased by 111.1 days (P less than 0.001). MTM members with hypertension and dyslipidemia had pre-post increases in MPR of 2.29% and 2.10%, respectively, while the control group had decreases of 2.31% and 2.61% (both P less than 0.001). The mean MPRs for members with diabetes, depression, and asthma did not change in either group. Program costs per patient in 2009 were estimated to be $478. The program had a return on investment (ROI) of 2.0 in 2009. CONCLUSIONS: This study found that the pharmacist-managed MTM program to reconcile the medication therapies of high-risk patients and improve adherence, as measured by MPR, was effective in reducing total health care costs. The results show that those patients in the intervention group with hypertension and dyslipidemia had significant improvements in medication adherence, as compared with the control group. In fact, the intervention group used significantly more days of therapy in the intervention period, and the control group used significantly fewer days than either group used during the baseline period. MTM interventions were associated with a significant decrease in the MTM members' overall plan-paid health care costs, driven largely by decreases in inpatient utilization and mediated by increases in average days supply and in MPR increases for hypertension and dyslipidemia. Overall, the MTM program was cost-effective. The ROI estimated for this program of 2.0 is only slightly lower than the average disease management ROIs reported in the literature.


Assuntos
Planos de Assistência de Saúde para Empregados/economia , Conduta do Tratamento Medicamentoso , Assistência Centrada no Paciente/economia , Idoso , Doença Crônica/tratamento farmacológico , Feminino , Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Adesão à Medicação , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos
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