Patient and family financial burden associated with cancer treatment in Canada: a national study.

GOAL: To determine patient-reported financial and family burden associated with treatment of cancer in the previous 28 days across Canada. METHODS: A self-administered questionnaire (P-SAFE v7.2.4) was completed by 901 patients with cancer from twenty cancer centres nationally (344 breast, 183 colorectal, 158 lung, 216 prostate) measuring direct and indirect costs related to cancer treatment and foregone care. Monthly self-reported out-of-pocket-costs (OOPCs) included drugs, homecare, homemaking, complementary/ alternative medicines, vitamins/supplements, family care, accommodations, devices, and "other" costs. Travel and parking costs were captured separately. Patients indicated if OOPC, travel, parking, and lost income were a financial burden. RESULTS: Mean 28-day OOPCs were CA$518 (US Purchase Price Parity [PPP] $416), plus CA$179 (US PPP $144) for travel and CA$84 (US PPP $67) for parking. Patients self-reporting high financial burden had total OOPCs (33%), of CA$961 (US PPP $772), while low-burden participants (66%) had OOPCs of CA$300 (US PPP $241). "Worst burden" respondents spent a mean of 50.7% of their monthly income on OOPCs (median 20.8%). Among the 29.4% who took time off work, patients averaged 18.0 days off. Among the 26.0% of patients whose caregivers took time off work, caregivers averaged 11.5 days off. Lastly, 41% of all patients had to reduce spending. Fifty-two per cent of those who reduced spending were families earning < CA$50,000/year. CONCLUSIONS: In our Canadian sample, high levels of financial burden exist for 33% of patients, and the severity of burden is higher for those with lower household incomes.

When are Pharmaceuticals Priced Fairly? An Alternative Risk-Sharing Model for Pharmaceutical Pricing.

The most common solutions to the problem of high pharmaceutical prices have taken the form of regulations, price negotiations, or changes in drug coverage by insurers. These measures for the most part transfer the burden of drug expenditures between pharmaceutical companies and payers or between payers. The aim of this study is to propose an alternative model for the relationship between the main stakeholders (the pharmaceutical companies, third party payers, and the public) involved in the price setting and purchasing of pharmaceuticals, one that encourages a more cooperative approach. We draw from principles of ethics and health economics and apply them to the context of the pharmaceutical industry. The model prioritises two objectives, (1) to make drugs financially accessible to the patients who need them, and (2) to keep pharmaceutical companies viable and profitable. It is centered around the sharing of financial risk between the main stakeholders, which we describe as 'enlightened risk sharing'. After establishing the foundations of this model, we expand on the type of policies that can follow these principles with current day examples.

Design of effective interventions for smoking cessation through financial and non-financial incentives.

Smoking has a tremendous negative impact on the Canadian economy and contributes to growing costs in the healthcare system. Efforts to reduce smoking rates may therefore reduce strain on the healthcare system and free up scarce resources. Academic literature on economic smoking cessation incentives presents a countless variety of interventions that have met with varying degrees of success. This study reviews six different variables used in the design of incentives in smoking cessation interventions: direction, form, magnitude, certainty, recipient grouping, and target demographic. The purpose of this study is to provide analysis and recommendations about the contribution of each variable into the overall effectiveness of smoking cessation programs and help health leaders design better interventions according to their specific needs.

Long-term biostability of self-assembling protein polymers in the absence of covalent crosslinking.

Unless chemically crosslinked, matrix proteins, such as collagen or silk, display a limited lifetime in vivo with significant degradation observed over a period of weeks. Likewise, amphiphilic peptides, lipopeptides, or glycolipids that self-assemble through hydrophobic interactions to form thin films, fiber networks, or vesicles do not demonstrate in vivo biostability beyond a few days. We report herein that a self-assembling, recombinant elastin-mimetic triblock copolymer elicited minimal inflammatory response and displayed robust in vivo stability for periods exceeding 1 year, in the absence of either chemical or ionic crosslinking. Specifically, neither a significant inflammatory response nor calcification was observed upon implantation of test materials into the peritoneal cavity or subcutaneous space of a mouse model. Moreover, serial quantitative magnetic resonance imaging, evaluation of pre- and post-explant ultrastructure by cryo-high resolution scanning electron microscopy, and an examination of implant mechanical responses revealed substantial preservation of form, material architecture, and biomechanical properties, providing convincing evidence of a non-chemically or ionically crosslinked protein polymer system that exhibits long-term stability in vivo.

The use of deoxycholic acid to enhance the oral bioavailability of biodegradable nanoparticles.

Oral delivery of nanoparticles encapsulating drugs and proteins remains a challenging route for administration due to the many barriers in the gastrointestinal tract that limit bioavailability. We hypothesized that bile salts could be used to improve the bioavailability of poly(lactide-co-glycolide) (PLGA) nanoparticles by protecting them during their transport through the gastrointestinal tract and enhancing their absorption by the intestinal epithelia. A deoxycholic acid emulsion is shown to protect PLGA nanoparticles from degradation in acidic conditions and enhance their permeability across a Caco-2 cell monolayer, an in vitro model of human epithelium. Oral administration of loaded PLGA nanoparticles to mice, using a deoxycholic acid emulsion, produced sustained levels of the encapsulant in the blood over 24-48 h with a relative bioavailability of 1.81. Encapsulant concentration was highest in the liver, demonstrating a novel means for targeted delivery to the liver by the oral route.

Guia Ilustrada para el Adiestramiento de Promotores / sss

Este texto pretende ser una guía ilustrada para el promotor, como un recordatorio de sus funciones en cada una de las etapas del programa en el control de las vinchucas. Tomando en cuenta que el promotor es una persona clave, que es parte de la comunidad, organizando, enseñando, informando

Guia de entrenamiento de promotores / sss

Esta guía pretende orientar las actividades técnicas del promotor dentro de un sistema de trabajo en la participación comunitaria; trata de ser lo más flexible posible para su adaptación a diferentes modalidades de trabajo.Consta de cuatro partes: La primera define al promotor y plantea los criterios de selección del mismo; la segunda, explica brevemente la epidemiología de la enfermedad de Chagas; la tercera, define las funciones y actividades del promotor; la cuarta, plantea las reglas de supervisión y evaluación de las actividades del promotor

Manual de mejoramiento físico de viviendas

La medida más segura, duradera y barata para hacer desaparecer las vinchucas es mejorar las condiciones de construcción de nuestras casas, además de su adecuada utilización y ordenamiento. El mejoramiento de las paredes mediante el revoque por fuera y por dentro para eliminar las grietas y los huecos donde las vinchucas se ocultan o se multiplican tienen que ser completo; empezando por los corrales. los hornos, los patios y las habitaciones; para asegurarnos de que no quede lugar alguno donde las vinchucas puedan multiplicarse. Los techos son otro lugar de criaderos de vinchucas ; en este manual, sugerimos revocar por dentro y colocar un tumbado para evitar que las vinchucas transiten libremente entre el techo y las habitaciones. El arreglo de las puertas y ventanas también es importante, cuando éstas cierran bien y dejan espacios entre los marcos y las paredes, las vinchucas no podrán ingresar a nuestras habitaciones.

Campo

La preparación de este manual de operaciones de campo responde a esa necesidad, en él que queremos dar la información básica de la estructura del programa de control, los puntos importantes de información a la comunidad, especificar las acciones de cada uno de los componentes de las brigadas de campo y de laboratorio en el transcurso de las diferentes etapas que son: la línea de base, el mejoramiento de las viviendas y el uso de químicos. Este manual no pretende ser una guía definitiva sino más bien consideramos que es inicio de una sistematización de todas las actividades en función al logro del objetivo. En el futuro se espera enriquecer este manual con la experiencia adquirida por cada uno de los funcionarios pues su aporte será de mucho valor

Prevalencia de la Leishmaniasis Tegumentaria en dos grupo de localidades con antiguedad de asentamiento diferente / Prevalence of tegumentary leishmaniasis in two groups of locations with different settlement age

Se ha efectuado un estudio de las prevalencias de las diferentes etapas de la leishmaniasis tegumentaria en 11 localidades (colonias) agrupadas en dos centrales sindicales con historia de asentamiento de antiguedad diferente en Carrasco tropical del Departamento de Cochabamba. La prevalencia de ulceras cutaneas puras mas las combinadas con cicatrices (Infecciones anteriores) fue 4.6 por ciento en 24 de Octubre (colonias mas recientes) y 1.9 por ciento en Tamboradas. La prevalencia de cicatrices cutaneas puras fue de 11.5 por ciento en 24 de Octubre y 15.8 por ciento en Tamboradas. 1 solo paciente con lesiones mucosas en 24 de Octubre (prev 0.8 por ciento ) y 2 en Tamboradas (prev 0.9 por ciento ) fueron encontrados.

Asociación de vectores de arbovirus con galerías arboreas y el medio doméstico en el sureste de Bolivia / Association of arbovirus vectors with gallery forests and domestic environments in southeastern Bolivia

Con motivo de los brotes simultáneos de fiebre amarilla y dengue presunto entre los indios ayoreos durante el primer trimestre de 1982, se procedió a la captura de mosquitos domésticos y silvestres en Rincón del Tigre, Bolivia, del 8 al 27 de mayo de 1982. No se detectó la presencia de Aedes aegypti. Vectores silvestres del virus de la fiebre amarilla, encontrados en las galerías arbóreas de la zona, eran probablemente los responsables de los casos humanos de fiebre amarilla. Pese a las pruebas serológicas de infecciones anteriores por virus del dengue en Rincón del Tigre, no se obtuvieron aislamientos ni otros indicios que manifestaran la presencia del virus del dengue. Este artículo presenta observaciones sobre la fauna de mosquitos asociados con los medios domésticos y silvestre y expone en detalle los patrones de actividad hematófaga diurna de las especies más abundantes capturadas con cebo humano (AU)