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1.
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1535347

RESUMO

In a context where different protocols for recommended practices in clinical voice assessment exist, while there are gaps in the literature regarding the evidence base supporting assessment procedures and measures, clinicians from regions where a strong community holding expertise in clinical and scientific voice practices lack can struggle to confidently develop their voice assessment practices. In an effort to improve voice assessment practices and strengthen professional identity among speech-language pathologists in Quebec, Canada, a community of practice (CoP) was established, with the aim of promoting knowledge sharing, implementing change in clinical practice, and improving professional identity. Thirty-nine participants took part in the CoP activities conducted over a four-month period, including virtual meetings and in-person workshops. Participants had a high rate of attendance (> 74% participation rate in virtual meetings), and were highly satisfied with their participation and intended to remain involved after the project's end. Statistically significant changes in voice assessment practices were observed post-CoP, regarding probability of performing assessments (p < .001), and perceived importance of assessment for evaluative purposes (p <.001), as well as improvements in assessment specific confidence, specifically for procedure of auditory-perceptual assessment (p < .001) and purpose of aerodynamic assessment (p = .05). Moreover, there was an increase in professional identity post-CoP (p < .001) and participants felt they made significant learnings. The present study highlighted the need to involve SLPs in future research to identify assessments that are relevant to the specific evaluative objectives of SLPs working with voice, and suggests CoPs are an efficient tool for that purpose.


En un contexto en el que existen diferentes protocolos para las prácticas recomendadas en la evaluación vocal clínica, y en el que se presentan vacíos en la literatura respecto a la base de evidencia que respalda los procedimientos y medidas de evaluación, los profesionales de regiones donde no hay una comunidad sólida con experiencia en prácticas vocales clínicas y científicas pueden enfrentar dificultades para desarrollar con confianza sus prácticas de evaluación vocal. Con el propósito de mejorar las prácticas de evaluación vocal y fortalecer la identidad profesional entre los logopedas de Quebec, Canadá, se estableció una comunidad de práctica (CdP). Esta tenía como objetivo fomentar el intercambio de conocimientos, implementar cambios en la práctica clínica y mejorar la identidad profesional. Un total de treinta y nueve participantes se involucraron en las actividades de la CdP, llevadas a cabo durante un período de cuatro meses, que incluyeron reuniones virtuales y talleres presenciales. Los participantes tuvieron una alta tasa de asistencia (> 74% de participación en las reuniones virtuales) y expresaron un alto grado de satisfacción con su participación, manifestando su intención de continuar involucrados después de la finalización del proyecto. Se observaron cambios estadísticamente significativos en las prácticas de evaluación vocal posterior a la CdP, en lo que respecta a la probabilidad de llevar a cabo evaluaciones (p < .001) y la percepción de la importancia de la evaluación con fines evaluativos (p < .001), así como mejoras en la confianza específica en la evaluación, particularmente en el procedimiento de evaluación auditivo-perceptual (p < .001) y el propósito de la evaluación aerodinámica (p = .05). Además, se registró un aumento en la identidad profesional posterior a la CdP (p < .001) y los participantes sintieron que obtuvieron aprendizajes significativos. El presente estudio destacó la necesidad de involucrar a los logopedas en investigaciones futuras, para identificar evaluaciones pertinentes a los objetivos evaluativos específicos de los logopedas que trabajan con la voz, y sugiere que las CdP son una herramienta eficiente con ese propósito.

2.
J Am Heart Assoc ; 13(8): e031578, 2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38563379

RESUMO

BACKGROUND: In 2009, a workplace-based hypertension management program was launched among men with hypertension in the Kailuan study. This program involved monitoring blood pressure semimonthly, providing free antihypertensive medications, and offering personalized health consultations. However, the cost-effectiveness of this program remains unclear. METHODS AND RESULTS: This analysis included 12 240 participants, with 6120 in each of the management and control groups. Using a microsimulation model derived from 10-year follow-up data, we estimated costs, quality-adjusted life years (QALYs), life-years, and incremental cost-effectiveness ratios (ICERs) for workplace-based management compared with routine care in both the study period and over a lifetime. Analyses are conducted from the societal perspective. Over the 10-year follow-up, patients in the management group experienced an average gain of 0.06 QALYs with associated incremental costs of $633.17 (4366.85 RMB). Projecting over a lifetime, the management group was estimated to increase by 0.88 QALYs or 0.92 life-years compared with the control group, with an incremental cost of $1638.64 (11 301.37 RMB). This results in an incremental cost-effectiveness ratio of $1855.47 per QALY gained and $1780.27 per life-year gained, respectively, when comparing workplace-based management with routine care. In probabilistic sensitivity analyses, with a threshold willingness-to-pay of $30 765 per QALY (3 times 2019 gross domestic product per capita), the management group showed a 100% likelihood of being cost-effective in 10 000 samples. CONCLUSIONS: Workplace-based management, compared with routine care for Chinese men with hypertension, could be cost-effective both during the study period and over a lifetime, and might be considered in working populations in China and elsewhere.


Assuntos
Hipertensão , Masculino , Humanos , Análise Custo-Benefício , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/uso terapêutico , Local de Trabalho , China/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida
3.
Int J Gynaecol Obstet ; 165(2): 480-486, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38563795

RESUMO

OBJECTIVE: Surgery for obstetric fistula is a highly effective treatment to restore continence and improve quality of life. However, a lack of data on the cost-effectiveness of this procedure limits prioritization of this essential treatment. This study measures the effectiveness of fistula surgeries using disability-adjusted life years (DALYs) averted. METHODS: In 2021 and 2022, the Fistula Foundation funded 20 179 fistula surgeries and related procedures at 143 hospitals among 27 countries. We calculated DALYs averted specifically for vesicovaginal fistula and rectovaginal fistula procedure types (n = 13 235 surgeries) by using disability weights from the 2019 Global Burden of Disease study. We based cost calculations on direct treatment expenses, including medical supplies, health provider fees, and preoperative and postoperative care. We measured effectiveness using data on the risk of permanent disability, country-specific average life spans, and treatment outcomes. RESULTS: The total treatment cost was $7.6 million, and a total of 131 433 DALYs were averted. Thus, the cost per DALY averted-the cost to restore 1 year of healthy life-was $58. For this analysis, we took a cautious approach and weighted only surgeries that resulted in a closed fistula with restored continence. We calculated DALYs averted by country. Limitations of the study include data entry errors inherent in patient logs and lack of long-term outcomes. CONCLUSION: The current study demonstrates that obstetric fistula surgery, along with having a significant positive impact on maternal health outcomes, is highly cost-effective in comparison with other interventions. The study therefore highlights the benefits of prioritizing fistula treatment as part of the global agenda for maternal health care.


Assuntos
Fístula Vesicovaginal , Feminino , Gravidez , Humanos , Análise Custo-Benefício , Anos de Vida Ajustados por Qualidade de Vida , Fístula Vesicovaginal/cirurgia , Qualidade de Vida , Fístula Retovaginal/cirurgia
4.
Front Public Health ; 12: 1333081, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38566790

RESUMO

Introduction: Many researchers have focused their studies on hypertension due to its over-representation among COVID-19 patients. Both retrospective and observational studies conducted close to the Wuhan area have reported that hypertension is the most common comorbidity observed in patients affected by COVID-19. Objective: Our objective is that patients with arterial hypertension have a worse prognosis in terms of evolution leading to higher costs. Methods: A retrospective cross-sectional study was conducted. A total of 3,581 patients from La Paz University Hospital (LPUH) during the period between 15 July 2020 and 31 July 2020 were included in this study. Results: It should be noted that 40.71% of the patients were hypertensive. As expected, hypertension was associated with men, among whom we observed a higher prevalence and a higher age (median age of 77 years (IQI: 65-85) versus 52 years (IQI: 37-64), p-value < 0.001). Hypertensive patients had a higher prevalence of dyspnea (52.14% vs. 47.15%, p-value = 0.004) and altered awareness (14.89% vs. 4.30%, p-value <0.001). The non-parametric Kaplan-Meier curve estimates the survival of patients in the two study groups. We can see how patients with hypertension have a higher associated mortality, with the difference being statistically significant, p-value (log-rank) = 0.004. Only for the appearance of complications during hospitalization, the group of hypertensive patients reached the figure of €1,355,901.71 compared to the total of 421,403.48 € for normotensive patients. Conclusion: Our study shows the worse clinical evolution of patients with COVID-19 in terms of associated morbidity and mortality. It also shows that the cost of managing patients with hypertension is greater than that of managing normotensive patients.


Assuntos
COVID-19 , Hipertensão , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , COVID-19/epidemiologia , Estudos Transversais , Atenção à Saúde , Hipertensão/epidemiologia , Estudos Retrospectivos , Adulto , Idoso de 80 Anos ou mais , Feminino
5.
Environ Sci Technol ; 58(15): 6457-6474, 2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38568682

RESUMO

The circular economy (CE) aims to decouple the growth of the economy from the consumption of finite resources through strategies, such as eliminating waste, circulating materials in use, and regenerating natural systems. Due to the rapid development of data science (DS), promising progress has been made in the transition toward CE in the past decade. DS offers various methods to achieve accurate predictions, accelerate product sustainable design, prolong asset life, optimize the infrastructure needed to circulate materials, and provide evidence-based insights. Despite the exciting scientific advances in this field, there still lacks a comprehensive review on this topic to summarize past achievements, synthesize knowledge gained, and navigate future research directions. In this paper, we try to summarize how DS accelerated the transition to CE. We conducted a critical review of where and how DS has helped the CE transition with a focus on four areas including (1) characterizing socioeconomic metabolism, (2) reducing unnecessary waste generation by enhancing material efficiency and optimizing product design, (3) extending product lifetime through repair, and (4) facilitating waste reuse and recycling. We also introduced the limitations and challenges in the current applications and discussed opportunities to provide a clear roadmap for future research in this field.


Assuntos
Ciência de Dados , Gerenciamento de Resíduos , Reciclagem
6.
BMC Med Educ ; 24(1): 363, 2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38570769

RESUMO

BACKGROUND: Female breast cancer is the most frequently diagnosed cancer, and knowledge of breast cancer risk factors, and symptoms is crucial for early diagnosis and prevention. This study aims to evaluate breast cancer awareness among female students at a pharmacy faculty in Turkey. METHODS: A cross-sectional online survey study was conducted among female students at the Suleyman Demirel University Faculty of Pharmacy between 2 November and 17 November 2023, in Isparta, Turkey. RESULTS: This survey was answered by 237 (74.5%) female students. The median breast cancer risk factors score was 8 (IQR, 5-11), and the median breast cancer symptoms score was 5 (IQR, 2-8). Additionally, the breast cancer risk factors score was 46.16% (mean/max = 8.31/18, SD = 4.33) and the breast cancer symptom score was 58.5% (mean/max = 4.68/8, SD = 2.8). Few of the respondents (26.2%, and 20.3%, respectively) knew breast cancer risk factors such as late menopause, and no childbirth experience. Most respondents correctly answered symptoms of breast cancer, such as a painless and palpable breast lump, indrawing of the nipple, and sudden changes in breast shape (76.8%,44.3%, and 67.1% respectively). The students' sources of information were medical websites (29.5%), social media (27%), physicians (22.8%), friends & family (14.8%), and pharmacists (5.9%). CONCLUSIONS: This study showed that students' knowledge of breast cancer risk factors was poor, but their knowledge of breast cancer symptoms was acceptable. Breast cancer awareness courses should be included in faculties. Additionally, more attention should be given to different educational interventions such as social media, television, and brochure distribution.


Assuntos
Neoplasias da Mama , Estudantes de Farmácia , Feminino , Humanos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Turquia , Universidades
7.
Innov Aging ; 8(4): igad111, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38572405

RESUMO

In Kenya, the number of adults aged ≥60 is expected to nearly quadruple by 2050, making it one of the most rapidly aging countries in Sub-Saharan Africa (SSA). Accordingly, we designed the Longitudinal Study of Health and Ageing in Kenya (LOSHAK) to generate novel data to address the health and economic consequences of this demographic transition. Specifically, LOSHAK will investigate the social, economic, environmental, biological, and policy processes that shape late-life health and economic well-being in Kenya. Modeled on the U.S. Health and Retirement Study (HRS), LOSHAK joins a network of harmonized studies on aging in >45 countries worldwide; however, LOSHAK will be only the 2nd such study in SSA. The current feasibility and pilot phase of LOSHAK will validate measures and data collection procedures in a purposive sample of Kenyan adults aged ≥45 years. We have linguistically and culturally translated instruments while aiming to maintain harmonization with both existing HRS network studies and the ongoing Kenya Life Panel Survey. The current phase of LOSHAK is nested within the Kaloleni/Rabai Community Health and Demographic Surveillance System on the coast of Kenya. LOSHAK will advance population aging research in low- and middle-income countries through the study of (a) biomarkers and physiological measures; (b) the impacts of air pollution and climate vulnerability; (c) Alzheimer's disease and related dementias, mental health, disability, caregiving, and psychosocial wellbeing; and (d) economic security, including the impact of social welfare. LOSHAK will inform future public health and economic policy to address challenges related to rapid aging in Kenya and throughout SSA. Accordingly, this paper aims to introduce and provide a description of LOSHAK and its aims and objectives, as well as to inform the scientific community of current study activities being used to build toward the full population-representative study.

8.
Environ Sci Technol ; 58(15): 6540-6551, 2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38574283

RESUMO

Water age in drinking water systems is often used as a proxy for water quality but is rarely used as a direct input in assessing microbial risk. This study directly linked water ages in a premise plumbing system to concentrations of Legionella pneumophila via a growth model. In turn, the L. pneumophila concentrations were used for a quantitative microbial risk assessment to calculate the associated probabilities of infection (Pinf) and clinically severe illness (Pcsi) due to showering. Risk reductions achieved by purging devices, which reduce water age, were also quantified. The median annual Pinf exceeded the commonly used 1 in 10,000 (10-4) risk benchmark in all scenarios, but the median annual Pcsi was always 1-3 orders of magnitude below 10-4. The median annual Pcsi was lower in homes with two occupants (4.7 × 10-7) than with one occupant (7.5 × 10-7) due to more frequent use of water fixtures, which reduced water ages. The median annual Pcsi for homes with one occupant was reduced by 39-43% with scheduled purging 1-2 times per day. Smart purging devices, which purge only after a certain period of nonuse, maintained these lower annual Pcsi values while reducing additional water consumption by 45-62%.


Assuntos
Água Potável , Legionella pneumophila , Legionella , Abastecimento de Água , Microbiologia da Água , Engenharia Sanitária , Medição de Risco
9.
Comput Biol Med ; 173: 108382, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38574530

RESUMO

Research evidence shows that physical rehabilitation exercises prescribed by medical experts can assist in restoring physical function, improving life quality, and promoting independence for physically disabled individuals. In response to the absence of immediate expert feedback on performed actions, developing a Human Action Evaluation (HAE) system emerges as a valuable automated solution, addressing the need for accurate assessment of exercises and guidance during physical rehabilitation. Previous HAE systems developed for the rehabilitation exercises have focused on developing models that utilize skeleton data as input to compute a quality score for each action performed by the patient. However, existing studies have focused on improving scoring performance while often overlooking computational efficiency. In this research, we propose LightPRA (Light Physical Rehabilitation Assessment) system, an innovative architectural solution based on a Temporal Convolutional Network (TCN), which harnesses the capabilities of dilated causal Convolutional Neural Networks (CNNs). This approach efficiently captures complex temporal features and characteristics of the skeleton data with lower computational complexity, making it suitable for real-time feedback provided on resource-constrained devices such as Internet of Things (IoT) devices and Edge computing frameworks. Through empirical analysis performed on the University of Idaho-Physical Rehabilitation Movement Data (UI-PRMD) and KInematic assessment of MOvement for remote monitoring of physical REhabilitation (KIMORE) datasets, our proposed LightPRA model demonstrates superior performance over several state-of-the-art approaches such as Spatial-Temporal Graph Convolutional Network (STGCN) and Long Short-Term Memory (LSTM)-based models in scoring human activity performance, while exhibiting lower computational cost and complexity.


Assuntos
Terapia por Exercício , Medicina , Humanos , Exercício Físico , Movimento , Redes Neurais de Computação , Compostos Radiofarmacêuticos
11.
Sci Total Environ ; 927: 172145, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38569974

RESUMO

Copper (Cu) has sparked widespread global concern as one of the most hazardous metals to aquatic animals. Ocean acidification (OA) and warming (OW) are expected to alter copper's bioavailability based on pH and temperature-sensitive effects; research on their effects on copper on marine organisms is still in its infancy. Therefore, under representative concentration pathways (RCP) 2.6, 4.5, and 8.5, we used the multiple linear regression-water quality criteria (MLR-WQC) method to assess the effects of OA and OW on the ecological risk posed by copper in the Ocean of East China (OEC), which includes the Bohai Sea, Yellow Sea, and East China Sea. The results showed that there was a positive correlation between temperature and copper toxicity, while there was a negative correlation between pH and copper toxicity. The short-term water quality criteria (WQC) values were 1.53, 1.41, 1.30 and 1.13 µg·L-1, while the long-term WQC values were 0.58, 0.48, 0.40 and 0.29 µg·L-1 for 2020, 2099-RCP2.6, 2099-RCP4.5 and 2099-RCP8.5, respectively. Cu in the OEC poses a moderate ecological risk. Under the current copper exposure situation, strict intervention (RCP2.6) only increases the ecological risk of copper exposure by 20 %, and no intervention (RCP8.5) will increase the ecological risk of copper exposure by nearly double. The results indicate that intervention on carbon emissions can slow down the rate at which OA and OW worsen the damage copper poses to marine creatures. This study can provide valuable information for a comprehensive understanding of the combined impacts of climate change and copper on marine organisms.

12.
J Med Internet Res ; 26: e47017, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38557504

RESUMO

The mortality rate in intensive care units (ICUs) is notably high, with patients often relying on surrogates for critical medical decisions due to their compromised state. This paper provides a comprehensive overview of eHealth. The challenges of applying eHealth tools, including economic disparities and information inaccuracies are addressed. This study then introduces eHealth literacy and the assessment tools to evaluate users' capability and literacy levels in using eHealth resources. A clinical scenario involving surrogate decision-making is presented. This simulated case involves a patient with a hemorrhagic stroke who has lost consciousness and requires medical procedures such as tracheostomy. However, due to the medical surrogate's lack of familiarity with eHealth devices and limited literacy in using eHealth resources, difficulties arise in assisting the patient in making medical decisions. This scenario highlights challenges related to eHealth literacy and solution strategies are proposed. In conclusion, effective ICU decision-making with eHealth tools requires a careful balance between efficiency with inclusivity. Tailoring communication strategies and providing diverse materials are essential for effective eHealth decision resources in the ICU setting. Health professionals should adopt a patient-centered approach to enhance the decision-making experience, particularly for individuals with limited eHealth literacy.


Assuntos
Letramento em Saúde , Telemedicina , Humanos , Tomada de Decisões , Unidades de Terapia Intensiva , Comunicação , Pessoal de Saúde
14.
ACS Chem Neurosci ; 15(8): 1684-1701, 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38564598

RESUMO

Copper oxide nanoparticles (CuO-NPs) are commonly used metal oxides. Betaine possesses antioxidant and neuroprotective activities. The current study aimed to investigate the neurotoxic effect of CuO-NPs on rats and the capability of betaine to mitigate neurotoxicity. Forty rats; 4 groups: group I a control, group II intraperitoneally CuO-NPs (0.5 mg/kg/day), group III orally betaine (250 mg/kg/day) and CuO-NPs, group IV orally betaine for 28 days. Rats were subjected to neurobehavioral assessments. Brain samples were processed for biochemical, molecular, histopathological, and immunohistochemical analyses. Behavioral performance of betaine demonstrated increasing locomotion and cognitive abilities. Group II exhibited significantly elevated malondialdehyde (MDA), overexpression of interleukin-1 beta (IL-1ß), and tumor necrosis factor-alpha (TNF-α). Significant decrease in glutathione (GSH), and downregulation of acetylcholine esterase (AChE), nuclear factor erythroid 2-like protein 2 (Nrf-2), and superoxide dismutase (SOD). Histopathological alterations; neuronal degeneration, pericellular spaces, and neuropillar vacuolation. Immunohistochemically, an intense immunoreactivity is observed against IL-1ß and glial fibrillary acidic protein (GFAP). Betaine partially neuroprotected against CuO-NPs associated alterations. A significant decrease at MDA, downregulation of IL-1ß, and TNF-α, a significant increase at GSH, and upregulation of AChE, Nrf-2, and SOD. Histopathological alterations partially ameliorated. Immunohistochemical intensity of IL-1ß and GFAP reduced. It is concluded that betaine neuroprotected against most of CuO-NP neurotoxic effects through antioxidant and cell redox system stimulating efficacy.


Assuntos
Cobre , Nanopartículas , Ratos , Animais , Cobre/metabolismo , Antioxidantes/farmacologia , Antioxidantes/metabolismo , Betaína/farmacologia , Estresse Oxidativo , Fator de Necrose Tumoral alfa/metabolismo , Superóxido Dismutase/metabolismo , Glutationa/metabolismo , Encéfalo/metabolismo , Óxidos/metabolismo , Óxidos/farmacologia
15.
Adv Healthc Mater ; : e2303461, 2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38569196

RESUMO

Cardiovascular diseases represent a significant threat to the overall well-being of the global population. Continuous monitoring of vital signs related to cardiovascular health is essential for improving daily health management. Currently, there has been remarkable proliferation of technology focused on collecting data related to cardiovascular diseases through daily electronic skin monitoring. However, concerns have arisen regarding potential skin irritation and inflammation due to the necessity for prolonged wear of wearable devices. To ensure comfortable and uninterrupted cardiovascular health monitoring, the concept of biocompatible electronic skin has gained substantial attention. In this review, biocompatible electronic skins for cardiovascular health monitoring are comprehensively summarized and discussed. The recent achievements of biocompatible electronic skin in cardiovascular health monitoring are introduced. Their working principles, fabrication processes, and performances in sensing technologies, materials, and integration systems are highlighted, and comparisons are made with other electronic skins used for cardiovascular monitoring. In addition, the significance of integrating sensing systems and the updating wireless communication for the development of the smart medical field is explored. Finally, the opportunities and challenges for wearable electronic skin are also examined.

16.
J Agric Food Chem ; 72(15): 8434-8443, 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38572831

RESUMO

Volatile organic compounds (VOCs) carry crucial information about chicken egg fertility. Assessing the fertility before incubation holds immense potential for poultry industry efficiency. Our study used headspace sorptive extraction-gas chromatography-mass spectrometry to analyze egg VOCs before and during the initial 12 incubation days. A total of 162 VOCs were identified. Hexanal was significantly higher in unfertilized eggs, whereas compounds such as propan-2-ol, propan-2-one, and carboxylic acids were higher in fertilized eggs. Furthermore, the obtained multiple logistic regression model outperformed the partial least-squares-discriminant analysis (PLS-DA) model, demonstrating lower complexity and superior performance. Fertile eggs were accurately identified in the validation set in 68-75% of the cases during the initial 4 days, to 85 and 100% on days 6 and 8. Finally, hierarchical cluster analysis in fertilized eggs revealed the clustering of VOCs of the same chemical class, indicative of their shared biochemical origin. This suggests a promising direction for future research aimed at understanding the biological information embedded in VOCs and their relationship to biochemical processes during embryo development.


Assuntos
Compostos Orgânicos Voláteis , Animais , Compostos Orgânicos Voláteis/análise , Cromatografia Gasosa-Espectrometria de Massas/métodos , Galinhas , Análise Multivariada , Fertilidade
17.
S Afr Fam Pract (2004) ; 66(1): e1-e5, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38572877

RESUMO

BACKGROUND:  Literature shows that in South Africa there are insufficient resources to meet mental healthcare needs. At general or district hospital level, the non-specialist doctor is often responsible for the holistic assessment and management of mental health service users. Such situations inevitably increase doctors' care load as they are required to treat across disciplines. We highlight the particular challenges faced by a community service (CS) doctor in this context. METHODS:  The presented case study formed part of a larger project that investigated public mental healthcare provision in the Eastern Cape province. Data were collected through a once-off semi-structured interview with the participant. The interview was transcribed and data analysed by utilising thematic analysis to yield results. RESULTS:  The study suggests that the CS doctor experiences being overloaded with duties, and feels overwhelmed in a healthcare context that lacks resources needed for service provision, which may lead to inadequate mental healthcare provision to public health service users. CONCLUSION:  Healthcare facilities in rural parts of the Eastern Cape province are in need of assistance. This in-depth account highlighted the consequences of working on the front line of a disadvantaged and under-resourced health system. The presented account can be interpreted as a cry for help by CS doctors for relevant authorities to improve access and provision of mental healthcare in the area.Contribution: The paper provides an exploration of the circumstances wherein mental healthcare is provided in rural parts of South Africa.


Assuntos
Serviços de Saúde Mental , Médicos , Humanos , Atenção à Saúde , Instalações de Saúde , Seguridade Social
18.
S Afr Fam Pract (2004) ; 66(1): e1-e10, 2024 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-38572875

RESUMO

BACKGROUND:  Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI. METHODS:  This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling. RESULTS:  Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level. CONCLUSION:  Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level.Contribution: This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level.


Assuntos
Programas Nacionais de Saúde , Médicos de Família , Humanos , África do Sul , Política de Saúde , Atenção à Saúde
19.
ACS Appl Mater Interfaces ; 16(15): 19014-19025, 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38573769

RESUMO

Rechargeable magnesium batteries (RMBs) are one of the most promising "post-lithium" battery technologies, but the electrochemical performance is still far from expectation due to the sluggish reaction kinetics of divalent Mg2+ ions. Herein, we report a low-cost, high-performance Mg-organic battery based on the combination of a fluorinated alkoxyaluminate electrolyte and a carbonyl polymer cathode material. First, the one-pot synthesized Mg[Al(HFIP)4]2 (HFIP = hexafluoro-2-propanol) is proved superior to the Mg[B(HFIP)4]2 analogue in both Mg anode compatibility and electrochemical window, as the electrolyte salt in the G2-DME (G2 = diethylene glycol dimethyl ether; DME = 1,2-dimethoxyethane) mixture solvent. Second, a simple wet grinding method is proposed to effectively improve the dispersion uniformity of the poly(benzoquinone-pyrrole) (PBQPy) active material in the cathode. Third, the elaborate Mg-PBQPy battery exhibits superior electrochemical performance within 0.4-3.0 V, including a high reversible capacity of 197 mA h g-1, a high average discharge voltage of 1.6 V, and a high capacity retention of 71% after 500 cycles. Finally, based on various electrochemical analysis and ex situ characterization results, we propose a general microscopic structure evolution model to reveal the electrochemical behaviors of carbonyl polymer cathode in RMBs, including the swelling of polymer active material, trapping of Mg2+ ions, and reversible redox reaction.

20.
Epidemiol Psychiatr Sci ; 33: e21, 2024 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-38576239

RESUMO

AIMS: The effectiveness and cost-effectiveness of early intervention for psychosis (EIP) services are well established in high-income countries but not in low- and middle-income countries (LMICs). Despite the scarcity of local evidence, several EIP services have been implemented in LMICs. Local evaluations are warranted before adopting speciality models of care in LMICs. We aimed to estimate the cost-effectiveness of implementing EIP services in Brazil. METHODS: A model-based economic evaluation of EIP services was conducted from the Brazilian healthcare system perspective. A Markov model was developed using a cohort study conducted in São Paulo. Cost data were retrieved from local sources. The outcome of interest was the incremental cost-effectiveness ratio (ICER) measured as the incremental costs over the incremental quality-adjusted life-years (QALYs). Sensitivity analyses were performed to test the robustness of the results. RESULTS: The study included 357 participants (38% female), with a mean (SD) age of 26 (7.38) years. According to the model, implementing EIP services in Brazil would result in a mean incremental cost of 4,478 Brazilian reals (R$) and a mean incremental benefit of 0.29 QALYs. The resulting ICER of R$ 15,495 (US dollar [USD] 7,640 adjusted for purchase power parity [PPP]) per QALY can be considered cost-effective at a willingness-to-pay threshold of 1 Gross domestic product (GDP) per capita (R$ 18,254; USD 9,000 PPP adjusted). The model results were robust to sensitivity analyses. CONCLUSIONS: This study supports the economic advantages of implementing EIP services in Brazil. Although cultural adaptations are required, these data suggest EIP services might be cost-effective even in less-resourced countries.


Assuntos
Países em Desenvolvimento , Transtornos Psicóticos , Humanos , Feminino , Adulto , Masculino , Análise Custo-Benefício , Estudos de Coortes , Brasil , Transtornos Psicóticos/terapia
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