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INTRODUCTION: Due to the Democratic Republic of the Congo's (DRC) precarious health system that provides only limited access to health care, the European Union, via Memisa Belgium, implemented a program to strengthen provision of and access to health care (known as PRO DS) in the provinces of Kongo Central and Ituri. This program took a holistic approach, seeking to improve equitable access and combat malnutrition. METHODS: To measure the program's social return on investment and to estimate the cost per capita and effectiveness per euro invested (efficiency), a 61-month (1 July 2017 to 31 July 2022) cost-effectiveness evaluation with a societal perspective was carried out. The double-difference method was used to compare the results of PRO DS and non-PRO DS zones. The social return on investment was assessed via the ratio of effectiveness to costs. RESULTS: Analyses revealed the program cost between 3.72 and 3.96 euros per capita per year (2022) in Kongo Central, and between 3.12 and 3.36 euros in Ituri. Importantly, it was cost-effective in the areas of reproductive health, nutrition, and the use of health and nutrition services. CONCLUSIONS: The program's strong nutritional component and overall holistic vision may explain why it was so efficient. PRO DS stands out from other programs that focus solely on one specific problem or population. Although the program has some limitations, it would be worthwhile for the government to invest in it.
Introduction: Face à l'accès limité aux soins et à la précarité des structures sanitaires en République démocratique du Congo, l'Union européenne par l'intermédiaire de Memisa Belgique avait mis en Åuvre le Programme de renforcement de l'offre et développement de l'accès aux soins de santé (PRO DS) dans les provinces du Kongo-Central et de l'Ituri. Ce programme se caractérisait par une approche holistique d'équité d'accès et de lutte contre la malnutrition. Méthodes: Pour mesurer le retour social sur investissement du programme et estimer son coût par habitant et son efficacité par euros investis (efficience), une évaluation coûts-efficacité avec une perspective sociétale de 61 mois (1er juillet 2017 au 31 juillet 2022) a été réalisée. La méthode de double différence, qui compare les résultats des zones PRO DS et des zones non PRO DS, a été utilisée. Le retour social sur investissement a été évalué par le biais du rapport entre l'efficacité et les coûts. Résultats: Les analyses ont montré que le programme coûtait par année et par habitant entre 3,72 et 3,96 euros (2022) au Kongo-Central, et entre 3,12 et 3,36 euros en Ituri. De plus, il était coût-efficace dans plusieurs domaines, telles la santé de la reproduction, la nutrition, l'utilisation des services de santé et nutritionnels. Conclusions: L'efficience du programme pourrait s'expliquer par sa vision holistique avec un fort volet « Nutrition ¼. PRO DS se démarque d'autres programmes qui agissent uniquement sur une problématique ou population spécifique. Malgré ses quelques imperfections, le gouvernement mériterait d'y investir.
Assuntos
Atenção à Saúde , Desnutrição , Humanos , República Democrática do Congo/epidemiologiaRESUMO
BACKGROUND: Complementary and alternative medicines (CAM) are sometimes used by individuals who desire to improve the outcomes of their fertility treatment and/or mental health during fertility treatment. However, there is little comprehensive information available that analyzes various CAM methods across treatment outcomes and includes information that is published in languages other than English. METHOD: This scoping review examines the evidence for 12 different CAM methods used to improve female and male fertility outcomes as well as their association with improving mental health outcomes during fertility treatment. Using predefined key words, online medical databases were searched for articles (n = 270). After exclusion criteria were applied, 148 articles were analyzed in terms of their level of evidence and the potential for methodological and author bias. RESULTS: Surveying the literature on a range of techniques, this scoping review finds a lack of high quality evidence that complementary and alternative medicine (CAM) improves fertility or mental health outcomes for men or women. Acupuncture has the highest level of evidence for its use in improving male and female fertility outcomes although this evidence is inconclusive. CONCLUSION: Overall, the quality of the evidence across CAM methods was poor not only because of the use of research designs that do not yield conclusive results, but also because results were contradictory. There is a need for more research using strong methods such as randomized controlled trials to determine the effectiveness of CAM in relation to fertility treatment, and to help physicians and patients make evidence-based decisions about CAM use during fertility treatment.
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Terapias Complementares , Infertilidade/terapia , Terapia por Acupuntura , Feminino , Humanos , Masculino , Saúde ReprodutivaRESUMO
The object of this study was to establish a minimum dose of ultraviolet B (UVB) radiation capable of producing an erythemal reaction in budgerigars (Melopsittacus undulatus), to determine a threshold dose of UVB for vitamin D photoconversion, and to investigate the use of safer UVB wavelengths. In each of 5 experiments of this study, 20 birds were divided into a control group (n = 10) and a UVB irradiated group (n = 10). Light sources that provide broadband UVB wavelengths (280-315 nm) and narrowband UVB (310-320 nm) were used. Varied doses of UVB radiation were administered to budgerigars by altering exposure time and irradiance. Safety was determined by observing body weight and incidence of photokeratitis and photodermatitis. Efficacy was evaluated by measuring changes in serum 25-hydroxycholecalciferol levels. Serum corticosterone was measured in 1 experiment to monitor stress levels. The results demonstrated that exposure to 180 mJ/cm2 broadband UVB induced vitamin D photoconversion, decreased body weights, and increased serum corticosterone levels. At these wavelengths, UVB-induced lesions were observed. A broadband UVB of 150 to 300 mJ/cm2 was determined as the minimum erythema dose, and the threshold dose for vitamin D photoconversion was calculated to be in the range of 113-225 mJ/cm2. No erythemal lesions or vitamin D photoconversion took place after exposure to up to 1730 mJ/cm2 narrowband UVB radiation. A minimum erythema dose and a threshold dose for vitamin D conversion need to be determined for each species if phototherapy is to be considered as a safe and effective therapeutic or husbandry tool.
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Eritema/veterinária , Melopsittacus , Raios Ultravioleta/efeitos adversos , 25-Hidroxivitamina D 2/sangue , Animais , Corticosterona/sangue , Relação Dose-Resposta à Radiação , Masculino , Projetos PilotoRESUMO
To compare the efficacy of treatment protocols recommended to aid passage of metallic foreign objects from the ventriculus of birds, a 1-mm metal sphere, made from solder wire, was placed into the crop of each of 44 budgerigars (Melopsittacus undulatus). After survey radiographs confirmed the spheres were lodged in the ventriculus, birds were divided into 6 groups. Each group received 1 of 6 different treatment protocols: psyllium with grit, acidic drinking water, fine grit, coarse grit, cathartic emollients (peanut butter and mineral oil), and a control group. All birds were treated simultaneously with a chelating agent, dimercaptosuccinic acid (DMSA), to prevent heavy-metal toxicosis. Successive survey radiographs were used to monitor elimination of the spheres from the digestive tract. Of all protocols tested, birds treated with either fine or large grit had the shortest mean elimination time of the metal spheres. These results indicate that administration of grit particles, either fine or coarse, appears to be effective in hastening the passage of metallic foreign objects from the ventriculus of budgerigars.