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1.
Eval Health Prof ; 43(2): 135-137, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32383409

RESUMEN

The novel 2019 Coronavirus Disease (COVID-19) pandemic has led to the closing of all but essential businesses in California. However, several nonessential businesses have remained open in Southern California despite the mandated "stay at home" order issued by the governor. As part of an ongoing vape shop project involving 88 participating shops, this study investigated the number of vape shops that remained open amidst the coronavirus outbreak and related mandates. Examination of shop social media websites and telephone calls to shops revealed that 61.4% (n = 54) have remained open, particularly within Korean/Asian and Hispanic/Latino ethnic locations (32 of the 54 shops). Importantly, walk-in service was much higher within Hispanic/Latino locations compared to African American, Korean/Asian, or non-Hispanic White neighborhoods (p = 0.03). It is not known if shops that stayed open were in direct violation of the order, didn't know all the details of the order, or found a loophole in the order and believed that they were an essential business. Better communication between the vape shop industry and public health officials during this pandemic is needed.


Asunto(s)
Comercio , Coronavirus , Características de la Residencia , Políticas de Control Social , Vapeo , Betacoronavirus , California , Comunicación , Conducta Cooperativa , Infecciones por Coronavirus/epidemiología , Sistemas Electrónicos de Liberación de Nicotina , Grupos Étnicos , Humanos , Pandemias , Neumonía Viral/epidemiología
3.
J Glob Health ; 10(1): 010807, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32257170

RESUMEN

Background: The concept of healthy aging has become a global health strategy in response to the population aging. In China, old-aged migrants are facing serious health care challenges due to the obstacles in the utilization of health services, social integration and ignored public policies. We aimed to examine the old-aged migrants' utilization of the essential public health services and its underlying factors on account of change of residence, and social support. Methods: Data came from the senior sample (aged over 65 years, n = 11 161) of the 2015 National Migrant Dynamic Monitoring Survey in China that employed Probability Proportionate to Size method as a sampling strategy. χ2 tests and binary multilevel model were conducted to analyze the difference and the underlying factors of the utilization of essential health services among old-aged migrants. Results: Approximately 66.2% of old-aged migrants did not receive free physician examination services from health institutions in the past year, and 34.6% of old-aged migrants with chronic disease have been followed up by doctors. There were significant differences in the utilization of essential public health services among old-aged migrants across different individuals and families. It showed that exercise time, migrating range, migrating reason, physical health condition, chronic disease, local friends, health insurance, household expenditure, and income were significantly associated with the elderly migrants' utilization of essential public health services. Conclusions: The utilization of essential public health services among old-aged migrants was insufficient in comparison with the general population. The government should launch targeted policies such as production and work-related injuries for the floating population. The supply side should promote the equalization of essential public health services for migrants. Social organizations and community should undertake the responsibility in social support for old-aged migrants.


Asunto(s)
Servicios de Salud Comunitaria/estadística & datos numéricos , Prestación de Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud , Seguro de Salud/estadística & datos numéricos , Migrantes , Adulto , Anciano , Grupo de Ascendencia Continental Asiática , China/epidemiología , Empleo , Femenino , Humanos , Renta , Masculino , Persona de Mediana Edad , Características de la Residencia , Población Rural , Apoyo Social , Población Urbana
5.
Acta Cir Bras ; 35(2): e202000207, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32320996

RESUMEN

PURPOSE: To develop a database with social, demographic and professional information of all graduates of the two post-graduate programs in Ophthalmology of EPM-UNIFESP, including their opinions on quality, application, and contribution of the courses received in their professional careers. METHODS: The survey was conducted in the digital and physical archives of the University and by telephone contact. When the graduates' e-mails were all collected, the electronic questionnaire was applied. The responses were compiled. Descriptive analysis of the results obtained in this cross-sectional study was performed, and analyzed by the authors and by statistical professionals, through Excel graphs. RESULTS: The database suggests that most graduates were born and work in the state of São Paulo. A significant fraction of 66.77% is dedicated to academic work, but only 36.2% hold management positions. Most of them receive amounts of one to 56 minimum wages monthly. The main motivation was to improve their professional careers. CONCLUSION: For post-graduate programs, a database with information of its graduates can elucidate whether the goals were achieved based on the proposed teaching, as well as can generate reflections to improve the quality, the courses expectations and the vision that students have of the University.


Asunto(s)
Bases de Datos Factuales , Oftalmología/educación , Estudiantes de Medicina , Adulto , Anciano , Estudios Transversales , Bases de Datos Factuales/normas , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oftalmología/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
6.
Hu Li Za Zhi ; 67(2): 45-57, 2020 Apr.
Artículo en Chino | MEDLINE | ID: mdl-32281082

RESUMEN

BACKGROUND: Relocating from home to a long-term facility is frequently a stressful event for older persons with diabetes. Therefore, it is important that nurses have available an intervention program that effectively reduces relocation anxiety and promotes adaptation in this population. PURPOSE: To evaluate the effectiveness of a mindfulness-based intervention in reducing relocation anxiety and promoting adaptation in older persons with diabetes. METHODS: Four long-term care facilities in Kaohsiung City were selected as the study sites. Residents of these facilities who had diabetes and who had moved in within the previous year were recruited as participants using a simple random-sampling method. The experimental group (n = 34) received a 9-week mindfulness-based intervention and the control group (n = 32) received routine diabetes care and maintained their normal daily routine. Outcome measurements included a demographic datasheet, the Taiwanese version of the State Anxiety Inventory, and the individual mental factors subscale of the elderly adaptation problem scale. These measures were administered at baseline and upon completion of the intervention. RESULTS: Thirty participants in each group completed the study. The mean differences between the baseline and post-test scores in the experimental group for relocation anxiety (t = 5.15, p < .01) and adaptation (t = -5.57, p < .01) were both significant. Among the participants who tested positive for relocation anxiety at pretest (a mean score > 30.13; 83.3% of the participants), those in the experimental group reported a more significant decrease (p < .05) in relocation anxiety at posttest than their control group peers. Among the participants who tested as having poor adaptation pretest (a mean scores < 45.62; 71.7% of the participants), those in the experimental group reported a more significant improvement (p < .05) in adaptation at posttest than their control group peers. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results indicate that the 9-week intervention has the potential to help older people with diabetes improve their relocation anxiety and adaptation. This study may be used as a reference to improve emotional distress among residents of long-term care facilities.


Asunto(s)
Adaptación Psicológica , Ansiedad/psicología , Diabetes Mellitus/psicología , Atención Plena , Características de la Residencia , Anciano , Diabetes Mellitus/epidemiología , Humanos , Evaluación de Programas y Proyectos de Salud , Instituciones Residenciales , Taiwán/epidemiología
7.
Rev Cardiovasc Med ; 21(1): 1-7, 2020 03 30.
Artículo en Inglés | MEDLINE | ID: mdl-32259899

RESUMEN

Approximately 90 days of the SARS-CoV-2 (COVID-19) spreading originally from Wuhan, China, and across the globe has led to a widespread chain of events with imminent threats to the fragile relationship between community health and economic health. Despite near hourly reporting on this crisis, there has been no regular, updated, or accurate reporting of hospitalizations for COVID-19. It is known that many test-positive individuals may not develop symptoms or have a mild self-limited viral syndrome consisting of fever, malaise, dry cough, and constitutional symptoms. However some individuals develop a more fulminant syndrome including viral pneumonia, respiratory failure requiring oxygen, acute respiratory distress syndrome requiring mechanical ventilation, and in substantial fractions leading to death attributable to COVID-19. The pandemic is evolving in a clustered, non-inform fashion resulting in many hospitals with preparedness but few or no cases, and others that are completely overwhelmed. Thus, a considerable risk of spread when personal protection equipment becomes exhausted and a large fraction of mortality in those not offered mechanical ventilation are both attributable to a crisis due to maldistribution of resources. The pandemic is amenable to self-reporting through a mobile phone application that could obtain critical information on suspected cases and report on the results of self testing and actions taken. The only method to understand the clustering and the immediate hospital resource needs is mandatory, uniform, daily reporting of hospital censuses of COVID-19 cases admitted to hospital wards and intensive care units. Current reports of hospitalizations are delayed, uncertain, and wholly inadequate. This paper urges all the relevant stakeholders to take up self-reporting and reporting of hospitalizations of COVID-19 as an urgent task in combating this devastating pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Recursos en Salud/provisión & distribución , Recursos en Salud/estadística & datos numéricos , Notificación Obligatoria , Aplicaciones Móviles/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Atención Ambulatoria/estadística & datos numéricos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Cuidados Críticos/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Características de la Residencia/estadística & datos numéricos , Autoinforme/estadística & datos numéricos
8.
Cent Eur J Public Health ; 28(1): 33-39, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32228814

RESUMEN

OBJECTIVE: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. METHODS: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. RESULTS: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. CONCLUSIONS: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.


Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Medicina Física y Rehabilitación/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Anciano , Humanos , Turquia
9.
Cent Eur J Public Health ; 28(1): 44-47, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32228816

RESUMEN

OBJECTIVES: The exposure of embryos or foetuses to ionising radiation can cause serious detriments to health. Thus, an enhanced incidence of spontaneous abortions and congenital anomalies might be expected in the vicinity of a uranium processing plant. We analysed the situation in the vicinity of MAPE Mydlovary, a facility about 20 km from Ceské Budejovice, South Bohemia, Czech Republic, which was in operation from 1963 to 1992. METHODS: No relevant data are available for the period of operation of the uranium processing plant. Statistical data have only been collected since 1994. As sanitation work in the area was initiated at around that time and has yet to be completed, we considered a study of possible prenatal effects in the vicinity of MAPE Mydlovary to still be of interest. Data were provided by the Institute of Health Information and Statistics of the Czech Republic for the years 1994-2013. RESULTS: We tested whether there are demonstrable, statistically significant differences between the microregions of the four closest villages (Mydlovary, Olesník, Zahájí, and Zliv), the District of Ceské Budejovice, the South-Bohemian Region, and the Czech Republic. CONCLUSIONS: No increase was found in the incidence of spontaneous abortions and congenital anomalies in the vicinity of this former uranium processing plant compared to the surrounding District of Ceské Budejovice, the South Bohemian Region, or the Czech Republic as a whole.


Asunto(s)
Aborto Espontáneo/epidemiología , Anomalías Congénitas/epidemiología , Centrales Eléctricas/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Uranio , República Checa/epidemiología , Femenino , Humanos , Incidencia , Embarazo
10.
J Environ Manage ; 262: 110301, 2020 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-32250785

RESUMEN

Previous studies of the residents' willingness to pay (WTP) for air quality improvement are likely suffering various endogeneity biases. Exploiting the unique opportunity of a recent quasi-experiment operation of the world's first SFT (Smog Free Tower) in China's northwestern city Xi'an, this paper reliably calibrates local residents' WTP for less exposure to haze by analyzing the price responses of housings in the neighborhoods of SFT. The hedonic regression is applied in the DID (difference-in-difference) setting, with further assistances of the PSM (propensity score matching) method, quantile regression and placebo test. The regression results consistently suggest that housing price responded positively to the installment of the SFT, and the impact estimates are closely centered around 4%. The study also indicates high-priced housings response much more to the operation of the SFT than cheap-priced housings, suggesting uneven distribution of welfare gains of air quality improvement. A cost-benefit analysis of the SFT project indicates that the economic benefits of this project far outweigh the costs involved. The paper concludes with discussions of policy implications of this paper for environment governance.


Asunto(s)
Contaminación del Aire , China , Ciudades , Vivienda , Características de la Residencia
11.
Lancet ; 395(10229): 1039-1046, 2020 03 28.
Artículo en Inglés | MEDLINE | ID: mdl-32192580

RESUMEN

BACKGROUND: Three clusters of coronavirus disease 2019 (COVID-19) linked to a tour group from China, a company conference, and a church were identified in Singapore in February, 2020. METHODS: We gathered epidemiological and clinical data from individuals with confirmed COVID-19, via interviews and inpatient medical records, and we did field investigations to assess interactions and possible modes of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Open source reports were obtained for overseas cases. We reported the median (IQR) incubation period of SARS-CoV-2. FINDINGS: As of Feb 15, 2020, 36 cases of COVID-19 were linked epidemiologically to the first three clusters of circumscribed local transmission in Singapore. 425 close contacts were quarantined. Direct or prolonged close contact was reported among affected individuals, although indirect transmission (eg, via fomites and shared food) could not be excluded. The median incubation period of SARS-CoV-2 was 4 days (IQR 3-6). The serial interval between transmission pairs ranged between 3 days and 8 days. INTERPRETATION: SARS-CoV-2 is transmissible in community settings, and local clusters of COVID-19 are expected in countries with high travel volume from China before the lockdown of Wuhan and institution of travel restrictions. Enhanced surveillance and contact tracing is essential to minimise the risk of widespread transmission in the community. FUNDING: None.


Asunto(s)
Trazado de Contacto , Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Neumonía Viral/epidemiología , Vigilancia de la Población , Adulto , Betacoronavirus , Defensa Civil , Congresos como Asunto , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Control de Infecciones , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/transmisión , Características de la Residencia , Singapur , Viaje
12.
West Afr J Med ; 37(2): 107-112, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32150627

RESUMEN

BACKGROUND: There are few reports on socioeconomic status (SES) of patients with chronic kidney disease (CKD) in Nigeria and indeed Africa, South of the Sahara. Identifying SES as an important factor for disability in people with CKD would provide a means for early identification of those at risk and, possible intervention. OBJECTIVE: To determine the SES of CKD patients attending renal clinic in the University of Nigeria Teaching Hospital. METHODS: Cross-sectional descriptive design was adopted using pretested questionnaire to elicit data on SES (age, place of residence, household asset ownership, source of drinking water; source of cooking energy; and type of toilet facility) from one hundred and forty-five (145) CKD patients attending renal clinic in the University of Nigeria Teaching Hospital. Principal component analysis was used to classify the SES into five quintiles. RESULTS: Majority of the respondents (patients) in stages 4 and 5 CKD, constituting 17.2% and 39.3% respectively were from the lower SES. There was significant correlation between SES and age of the patients; place of residence; hypertension history; ownership of some household assets; source of drinking water; source of cooking energy; and type of toilet facility. CONCLUSION: This study demonstrated that many of our patients were from the lower SES. It is recommended that both governmental and non-governmental agencies should help these patients with some form of health insurance to alleviate their healthcare cost burden.


Asunto(s)
Enfermedades Renales/epidemiología , Insuficiencia Renal Crónica , Características de la Residencia , Clase Social , Estudios Transversales , Hospitales de Enseñanza , Humanos , Enfermedades Renales/diagnóstico , Enfermedades Renales/etiología , Nigeria/epidemiología , Pobreza/estadística & datos numéricos , Factores Socioeconómicos
13.
Medicine (Baltimore) ; 99(12): e19454, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195941

RESUMEN

Pain is a significant burden among different communities, but little is known regarding the epidemiology of pain, particularly with respect to socioeconomic status (SES).The aim of the study was to estimate the prevalence of body pain and to identify risk factors of pain in middle-aged and older Chinese.The data were extracted from the 2008 Chinese Suboptimal Health Study that consisted of 18,316 Chinese subjects aged 18 to 65 years. Information on SES including occupation and education levels and body pain were collected. A Likert scale was used to evaluate reported body pain. We used the multiple logistic regression model to examine the association between SES and body pain.Overall, 65.34% reported body pain (male: 60.93%; female: 69.73%). After adjustments based on sex, age, education, area of residence, marital status, smoking, drinking and health status, the results showed that students (odds ratio [OR] = 1.51; 95% confidence interval [CI]: 1.32-1.74) and professionals (OR = 1.22; 95% CI: 1.08-1.37) had significant high risk for body pain, compared with civil servants and farmers (OR = 0.64; 95% CI: 0.55-0.75) who significantly lower risk of body pain. The study demonstrates there is a significant negative association between education and reported body pain.The results indicated an association between SES and body pain within the Chinese community. Body pain varied among different Chinese occupation-related population and people with higher education level are less like to have body pain.


Asunto(s)
Dolor/epidemiología , Factores Socioeconómicos , Adolescente , Adulto , Factores de Edad , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Características de la Residencia , Factores Sexuales , Fumar/epidemiología , Adulto Joven
14.
Rev Bras Epidemiol ; 23: e200018, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32159628

RESUMEN

INTRODUCTION: Malaria is an infectious disease of high transmission in the Amazon region, but its dynamics and spatial distribution may vary depending on the interaction of environmental, socio-cultural, economic, political and health services factors. OBJECTIVE: To verify the existence of malaria case patterns in consonance with the fluviometric regimes in Amazon basin. METHOD: Methods of descriptive and inferential statistics were used in malaria and water level data for 35 municipalities in the Amazonas State, in the period from 2003 to 2014. RESULTS: The existence of a tendency to modulate the seasonality of malaria cases due to distinct periods of rivers flooding has been demonstrated. Differences were observed in the annual hydrological variability accompanied by different patterns of malaria cases, showing a trend of remodeling of the epidemiological profile as a function of the flood pulse. CONCLUSION: The study suggests the implementation of regional and local strategies considering the hydrological regimes of the Amazon basin, enabling municipal actions to attenuate the malaria in the Amazonas State.


Asunto(s)
Hidrología , Malaria/epidemiología , Estaciones del Año , Brasil/epidemiología , Humanos , Incidencia , Malaria/diagnóstico , Características de la Residencia , Ríos , Movimientos del Agua
15.
Rev Bras Epidemiol ; 23: e200019, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32159629

RESUMEN

OBJECTIVE: To characterize spatiotemporal patterns of operational indicators for leprosy control in the state of Bahia from 2001 to 2014. METHODS: This is a population-based ecological study, with spatial distribution and autocorrelation of operational indicators for leprosy control. RESULTS: From 2001 to 2007, 42.7% (n=178) of the municipalities presented a cure rate lower than 75%, increasing to 61.4% (n =291) from 2009 to 2014. Between 2001 and 2007, 32.5% (n=54) of the municipalities reported more than 10% of the total number of relapses in the state, increasing to 36.9% (n=75) between 2008 and 2014. From 2001 to 2014, 38% (n=159) of the municipalities presented an assessment index of disability grading at the time of diagnosis within the regular performance parameter. Between 2009 and 2014, the number of municipalities with a high incidence of grade 2 disability (G2D) at the time of diagnosis increased, reaching 55.3% (n=230) of the municipalities. Most municipalities in the state of Bahia showed poor performance in the implementation of planned actions for leprosy control, with little change or relative worsening in the patterns of operational indicators throughout the historical series. CONCLUSION: The operational context in Bahia indicates significant institutional vulnerability, leading to the need for expansion and qualification of the surveillance and health care network in the different regions and conditions analyzed in the public health system (Sistema Único de Saúde - SUS).


Asunto(s)
Personas con Discapacidad , Enfermedades Endémicas/estadística & datos numéricos , Lepra/prevención & control , Brasil/epidemiología , Ciudades , Estudios de Cohortes , Evaluación de la Discapacidad , Humanos , Incidencia , Lepra/epidemiología , Vigilancia de la Población , Características de la Residencia , Factores de Riesgo , Análisis Espacio-Temporal
18.
Nat Med ; 26(3): 374-378, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32066973

RESUMEN

Replacement of regular salt with potassium-enriched substitutes reduces blood pressure in controlled situations, mainly among people with hypertension. We report on a population-wide implementation of this strategy in a stepped-wedge cluster randomized trial (NCT01960972). The regular salt in enrolled households was retrieved and replaced, free of charge, with a combination of 75% NaCl and 25% KCl. A total of 2,376 participants were enrolled in 6 villages in Tumbes, Peru. The fully adjusted intention-to-treat analysis showed an average reduction of 1.29 mm Hg (95% confidence interval (95% CI) (-2.17, -0.41)) in systolic and 0.76 mm Hg (95% CI (-1.39, -0.13)) in diastolic blood pressure. Among participants without hypertension at baseline, in the time- and cluster-adjusted model, the use of the salt substitute was associated with a 51% (95% CI (29%, 66%)) reduced risk of developing hypertension compared with the control group. In 24-h urine samples, there was no evidence of differences in sodium levels (mean difference 0.01; 95% CI (0.25, -0.23)), but potassium levels were higher at the end of the study than at baseline (mean difference 0.63; 95% CI (0.78, 0.47)). Our results support a case for implementing a pragmatic, population-wide, salt-substitution strategy for reducing blood pressure and hypertension incidence.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Características de la Residencia , Cloruro de Sodio Dietético/efectos adversos , Adulto , Estudios de Casos y Controles , Diástole , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/orina , Incidencia , Masculino , Perú/epidemiología , Potasio/orina , Sodio/orina , Encuestas y Cuestionarios , Sístole
19.
PLoS One ; 15(2): e0227702, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32027655

RESUMEN

The One-to-one Pickup and Delivery Problem with Shortest-path Transport along Real-life Paths (OPDPSTRP) is presented in this paper. It is a variation of the One-to-one Pickup and Delivery Problem (OPDP), which is common in daily life, such as the Passenger Train Operation Plans (PTOP) and partial Taxi-sharing Problem. Unlike the classical OPDP, in the OPDPSTRP, (1) each demand must be transported along the shortest path according to passengers/shippers requirements, and (2) each vehicle should travel along a real-life path. First, six route structure rules are proposed for the OPDPSTRP, and a kind of Mixed-Integer Programming (MIP) models is formulated for it. Second, A Variable Neighborhood Descent (VND), a Variable Neighborhood Research (VNS), a Multi-Start VND (MS_VND) and a Multi-Start VNS (MS_VNS) with five neighborhood operators has been developed to solve the problem. Finally, The Gurobi solver, the VND, the VNS, the MS_VND and the MS_VNS have been compared with each other by 84 random instances partitioned in small size connected graphs, medium size connected graphs and large size connected graphs. From the test results we found that solutions generated by these approaches are often comparable with those found by the Gurobi solver, and the solutions found by these approaches are better than the solutions found by the Gurobi solver when solving instances with larger numbers of demands. In almost all instances, the MS_VND significantly outperforms the VND and the VNS in terms of solution quality, and outperforms the MS_VNS both in terms of solution quality and CPU time. In the instances with large numbers of demands, the MS_VND is still able to generate good feasible solutions in a reasonable CPU time, which is of vital practical significance for real-life instances.


Asunto(s)
Algoritmos , Heurística , Transportes , Automóviles , Estudios de Factibilidad , Modelos Teóricos , Características de la Residencia
20.
PLoS One ; 15(1): e0228207, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32004348

RESUMEN

BACKGROUND: Primaquine is an approved radical cure treatment for Plasmodium vivax malaria but treatment can result in life-threatening hemolysis if given to a glucose-6-phosphate dehydrogenase deficient (G6PDd) patient. There is a need for reliable point-of-care G6PD diagnostic tests. OBJECTIVES: To evaluate the performance of the CareStart™ rapid diagnostic test (RDT) in the hands of healthcare workers (HCWs) and village malaria workers (VMWs) in field settings, and to better understand user perceptions about the risks and benefits of PQ treatment guided by RDT results. METHODS: This study enrolled 105 HCWs and VMWs, herein referred to as trainees, who tested 1,543 healthy adult male volunteers from 84 villages in Cambodia. The trainees were instructed on G6PD screening, primaquine case management, and completed pre and post-training questionnaires. Each trainee tested up to 16 volunteers in the field under observation by the study staff. RESULTS: Out of 1,542 evaluable G6PD volunteers, 251 (16.28%) had quantitative enzymatic activity less than 30% of an adjusted male median (8.30 U/g Hb). There was no significant difference in test sensitivity in detecting G6PDd between trainees (97.21%), expert study staff in the field (98.01%), and in a laboratory setting (95.62%) (p = 0.229); however, test specificity was different for trainees (96.62%), expert study staff in the field (98.14%), and experts in the laboratory (98.99%) (p < 0.001). Negative predictive values were not statistically different for trainees, expert staff, and laboratory testing: 99.44%, 99.61%, and 99.15%, respectively. Knowledge scores increased significantly post-training, with 98.7% willing to prescribe primaquine for P.vivax malaria, an improvement from 40.6% pre-training (p < 0.001). CONCLUSION: This study demonstrated ability of medical staff with different background to accurately use CareStart™ RDT to identify G6PDd in male patients, which may enable safer prescribing of primaquine; however, pharmacovigilance is required to address possible G6PDd misclassifications.


Asunto(s)
Pruebas Diagnósticas de Rutina , Deficiencia de Glucosafosfato Deshidrogenasa/diagnóstico , Primaquina/efectos adversos , Características de la Residencia , Adulto , Cambodia , Femenino , Glucosafosfato Deshidrogenasa/metabolismo , Deficiencia de Glucosafosfato Deshidrogenasa/metabolismo , Humanos , Malaria Vivax/tratamiento farmacológico , Masculino , Sistemas de Atención de Punto , Primaquina/uso terapéutico , Medición de Riesgo , Adulto Joven
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