Prototipação de game educativo para prevenção de acidentes na infância / Prototyping of educational game for prevention of childhood accidents

Objetivo: Descrever o desenvolvimento de um protótipo de game educativo para prevenção de acidentes comuns na infância. Metodologia: Estudo descritivo sobre desenvolvimento tecnológico de um protótipo de game educativo, proveniente de pesquisa original sobre utilização da gamificação como ferramenta educativa para prevenção de acidentes na infância. O desenvolvimento do protótipo guiou-se pela estratégia Design Thinking, com uso do software educacional Scratch que é uma plataforma online, gratuita. Os cenários e personagens foram construídos com figuras disponíveis em acesso livre na internet. Resultados: O protótipo do game foi intitulado "Detetives do perigo", com público alvo crianças entre 8 a 10 anos de idade. As fases do game apresenta situações de risco de acidente na rotina diária da criança, e explica de forma simples e interativa como evitá-los. O game é composto por dez cenários, sendo quatro de orientações e seis dos ambientes domiciliar, escolar, via e parque público, onde são expostas as situações de risco de acidente. Conclusão: O uso de ferramentas tecnológicas nas ações de educação em saúde, permite que a criança seja protagonista no cuidado com sua saúde e bem-estar, o despertar do senso crítico compatível com sua faixa etária, pode contribuir na redução de acidentes na infância. (AU)

Objective: To describe the development of an educational game prototype for the prevention of common accidents in childhood. Methods: Descriptive study on technological development of an educational game prototype, from original research on the use of gamification as an educational tool for the prevention of childhood accidents. The development of the prototype was guided by the Design Thinking strategy, using scratch educational software which is a free online platform. The scenarios and characters were built with figures available in free internet access. Results: The prototype of the game was titled "Danger Detectives", with audience targeting children between 8 to 10 years of age. The phases of the game presents situations of risk of accident in the daily routine of the child and explains in a simple and interactive way how to avoid them. The game consists of ten scenarios, four of which are guidelines and six of the home, school, road and public park environments, where accident risk situations are exposed. Conclusion: The use of technological tools in health education actions allows the child to be a protagonist in the care of their health and well-being, the awakening of critical sense compatible with their age group can contribute to the reduction of accidents in childhood. (AU)

Objetivo: Describir el desarrollo de un prototipo de juego educativo para la prevención de accidentes comunes en la infância. Methods: Estudio descriptivo sobre desarrollo tecnológico de un prototipo de juego educativo, derivado de la investigación original sobre el uso de la gamificación como herramienta educativa para la prevención de accidentes infantiles. El desarrollo del prototipo fue guiado por la estrategia Design Thinking, utilizando software educativo scratch que es una plataforma en línea gratuita. Los escenarios y personajes fueron construidos con figuras disponibles en acceso gratuito a Internet. Resultados: El prototipo del juego se tituló "Detectives de peligro", con un público dirigido a niños de entre 8 y 10 años de edad. Las fases del juego presentan situaciones de riesgo de accidente en la rutina diaria del niño, y explican de una manera sencilla e interactiva cómo evitarlos. El juego consta de diez escenarios, cuatro de los cuales son pautas y seis de los ambientes de hogar, escuela, carretera y parque público, donde las situaciones de riesgo de accidentes están expuestas. Conclusión: El uso de herramientas tecnológicas en las acciones de educación sanitaria permite al niño ser protagonista en el cuidado de su salud y bienestar, el despertar del sentido crítico compatible con su grupo de edad puede contribuir a la reducción de los accidentes en la infancia. (AU)

When more is less in financial decision-making: financial literacy magnifies framing effects.

In recent years, the financial world has become more complex and intricate. In this context, numeracy and, particularly, financial literacy, are seen as paramount in providing consumers with the knowledge and confidence required to take part in financial markets. Despite some indicative empirical findings, it is still to be ascertained how the two competences differentially contribute to the quality of decision-making in financial contexts. Furthermore, it is still unknown to what degree financial literacy and numeracy, taken as relevant mind-ware for financial decision-making, are effective in guarding against well-documented biases such as loss aversion and framing effects. This study aims to clarify these issues by employing an experimental task, conceived as an approximation to real-world decision-making involving the sale of shares. Our results suggest that numeracy and financial literacy affect decision-making differently in a pattern that, in part, runs counter to conventional economic theory. The data indicate that numeracy promotes a pattern of choices closer to economic rationality, while financial literacy can prove counterproductive and may amplify cognitive biases, namely framing effects and loss aversion. The outcomes are interpreted in light of dual-process theories, and the political implications discussed.

The use of biologic response modifiers in polyarticular-course juvenile idiopathic arthritis: a systematic review.

OBJECTIVE: To systematically review the clinical efficacy and safety evidence of biologic drugs used to treat the polyarticular category of juvenile idiopathic arthritis (JIA). METHODS: The literature was searched between 2000 and September 2012 for randomized controlled trials (RCTs), non-randomized comparative studies, and non-comparative observational cohort studies. The drugs evaluated included etanercept, infliximab, adalimumab, abatacept, anakinra, and ritixumab. Eligible studies included 20 or more patients with JIA, the majority of whom had polyarticular course disease. Outcomes of interest were disease improvement defined by the American College of Rheumatology criteria for Pediatrics, disease flares, rates of inactive disease, remissions, discontinuations, and adverse events (severe and non-severe). RESULTS: Thirty-seven studies were included, the majority focused on etanercept. Seven RCTs were identified, including one each for etanercept, infliximab, adalimumab, abatacept, and anakinra, and one each looking at etanercept or infliximab as first-line therapies. There was strong evidence to support the efficacy and safety of biologics over the short-term, but a lack of long-term data for treatments other than etanercept. Several high-quality patient registries confirmed the efficacy and safety of etanercept over the long-term. CONCLUSIONS: Current evidence shows that a short-term improvement in treatment response is achieved when patients with polyarticular JIA with an inadequate response to conventional treatment are treated with biologics. Long-term effectiveness data, however, are sparse leaving many questions regarding switches between biologics, handling patients that achieve disease remission, and long-term safety. Study designs other than RCTs may be important in understanding the role of biologics in JIA over the long-term.

Cost-effectiveness of biologics in polyarticular-course juvenile idiopathic arthritis patients unresponsive to disease-modifying antirheumatic drugs.

OBJECTIVE: Juvenile idiopathic arthritis (JIA) is the most common chronic pediatric rheumatic disease and can have long-term effects leading to disability in adulthood. Biologics are a new class of drugs increasingly used to treat JIA. The primary study objective was to determine the incremental costs of biologics per additional responder compared to conventional treatment (methotrexate). METHODS: A separate decision model was created for etanercept, infliximab, adalimumab, and abatacept. The study population consisted of polyarticular-course JIA patients with a prior inadequate response or intolerance to disease-modifying antirheumatic drugs (DMARDs). The effectiveness measure was the proportion of patients who had a treatment response at 1 year according to the American College of Rheumatology (ACR) Pediatric 30 (Pedi 30) improvement criteria. Direct and indirect costs were calculated in 2008 Canadian dollars. Incremental cost-effectiveness ratios and 95% confidence intervals (95% CIs) were calculated for each biologic agent using probabilistic sensitivity analyses. RESULTS: The additional costs per additional ACR Pedi 30 responder at 1 year were $26,061 (95% CI $17,070, $41,834), $46,711 (95% CI $30,042, $75,787), $16,204 (95% CI $11,393, $22,608), and $31,209 (95% CI $16,659, $66,220) for etanercept, adalimumab, abatacept, and infliximab, respectively. CONCLUSION: Biologics are more effective than methotrexate in achieving a short-term response in JIA patients with prior inadequate responses to DMARDs; however, this comes at a high annual cost. Adequate long-term data with respect to both safety and effectiveness are not currently available, nor are utility estimates. Such data will be important to estimate value for money for treating JIA with biologic drugs over the long term.

The cost-effectiveness of stem cell transplantations from unrelated donors in adult patients with acute leukemia.

OBJECTIVE: Hematopoietic stem cell transplantation is an accepted treatment of hematological malignancies, but the cost-effectiveness of this technology has not been fully explored. This study aims to assess the cost-effectiveness of stem cell transplantation from either cord blood or bone marrow/peripheral blood compared with no transplantation in adult patients with acute leukemias not expected to be cured with chemotherapy. METHODS: A systematic review was performed to estimate the efficacy of unrelated cord blood and bone marrow/peripheral blood stem cells (BM/PBSC) transplantations in adults with acute leukemia. A Markov decision analysis model using Monte Carlo simulations was used to calculate the incremental cost-effectiveness ratio (ICER) and 95% confidence intervals (CIs). RESULTS: The estimated cumulative survival at 1 and 10 years were 27.9% and 14%, respectively, for cord blood recipients and 47% and 17.7%, respectively, for BM/PBSC recipients. Using conservative assumptions, the cost per life-year gained compared with no transplantation was US 16,346 dollars (95% CI 8695 dollars, 38,006 dollars) for BM/PBSC transplantation and US 34,360 dollars (95% CI 23,101 dollars, 89,417 dollars) for cord blood transplantation. CONCLUSIONS: Although both types of stem cell transplantations are associated with a high short-term mortality and high cost, the cumulative gains in life-years of survivors can be substantial, resulting in ICERs compared with no transplantation that are usually considered acceptable. However there is less certainty about this conclusion with cord blood transplantation.

Drotrecogin alfa (activated) in severe sepsis: a systematic review and new cost-effectiveness analysis.

BACKGROUND: Activated drotrecogin alfa (human activated protein C, rhAPC), is produced by recombinant DNA technology, and purports to improve clinical outcomes by counteracting the inflammatory and thrombotic consequences of severe sepsis. Controversy exists around the clinical benefits of this drug and an updated economic study that considers this variability is needed. METHODS: A systematic literature review was performed using Medline, Embase and the International Network of Agencies for Health Technology Assessment (INAHTA) databases to determine efficacy, safety and previous economic studies. Our economic model was populated with systematic estimates of these parameters and with population life tables for longer term survival information. Monte Carlo simulations were used to estimate the incremental cost-effectiveness ratios (ICERs) and variance for the decision analytic models. RESULTS: Two randomized clinical trials (RCTS) of drotrecogin alfa in adults with severe sepsis and 8 previous economic studies were identified. Although associated with statistical heterogeneity, a pooled analysis of the RCTs did not show a statistically significant 28-day mortality benefit for drotrecogin alfa compared to placebo either for all patients (RR: 0.93, 95% CI: 0.69, 1.26) or those at highest risk as measured by APACHE II >or= 25 (RR: 0.90, 95% CI: 0.54, 1.49). Our economic analysis based on the totality of the available clinical evidence suggests that the cost-effectiveness of drotrecogin alfa is uncertain (< 59% probability that incremental cost-effectiveness ratio (ICER) life year gained (LYG) or= 25 (93% probability ICER