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Conventional and food-to-food fortification: An appraisal of past practices and lessons learned
Chadare, Flora Josiane ; Idohou, Rodrigue ; Nago, Eunice ; Affonfere, Marius ; Agossadou, Julienne ; Fassinou, Toyi Kévin ; Kénou, Christel ; Honfo, Sewanou ; Azokpota, Paulin ; Linnemann, Anita R. ; Hounhouigan, Djidjoho J. - \ 2019
Food Science and Nutrition 7 (2019)9. - ISSN 2048-7177 - p. 2781 - 2795.
food fortification - malnutrition - micronutrient deficiencies - outcomes
Food fortification is an important nutrition intervention to fight micronutrient deficiencies and to reduce their incidence in many low- and middle-income countries. Food fortification approaches experienced a significant rise in the recent years and have generated a lot of criticism. The present review aimed to shed light on the actual effect of food fortification approaches on the reduction of malnutrition. A set of 100 articles and reports, which have dealt with the impact of food fortification on malnutrition, were included in this review. This review identified a broad selection of local raw materials suitable for a food-to-food fortification approach.
Learning-based intervention for river restoration: analyzing the lack of outcomes in the Ljusnan River basin, Sweden
Rudberg, P.M. ; Smits, M. - \ 2018
Ecology and Society 23 (2018)4. - ISSN 1708-3087 - 14 p.
hydropower - learning-based intervention - outcomes - river restoration - Sweden
We focus on a large and sustained stakeholder process for river restoration related to hydropower production that failed to reach any significant natural resource management outcomes. We explore to what extent the stakeholder process can be characterized as a learning-based intervention as well as the reasons for the lack of outcomes. The analysis draws on insights from existing literature of procedural and institutional factors identified to foster and hinder social learning in stakeholder processes. The analysis finds that the stakeholder process featured virtually all fostering procedural factors as well as various fostering institutional factors identified in the literature. The main hindering institutional element consisted of strong pre-existing water rights, granted by the legislation governing hydropower production and river restoration in Sweden. Existing legislation provided a key stakeholder with the power to successfully reach its objective through the unilateral action of exiting the stakeholder process. Our results demonstrate that various learning outcomes, including knowledge acquisition, trust building, and the creation of networks are possible in stakeholder processes that feature power imbalances. The results also suggest that, ultimately, the power imbalance limited the process from reaching significant natural resource management outcomes, both in the short and longer terms. Based on comparison with international cases, the results reveal the need to focus attention on the national scale to remediate power imbalances in stakeholder processes that arise from a share of stakeholders possessing strong prior rights to the use of natural resources. In such cases, sustainable management of natural resources could be better served by efforts to modify existing legislation, rather than investments in resource-intensive learning-based interventions.
Assessing treatment-as-usual provided to control groups in adherence trials: Exploring the use of an open-ended questionnaire for identifying behaviour change techniques
Oberje, E.J.M. ; Dima, A.L. ; Pijnappel, F.J. ; Prins, J.M. ; Bruin, M. de - \ 2015
Psychology and Health 30 (2015)8. - ISSN 0887-0446 - p. 897 - 910.
active antiretroviral therapy - randomized-controlled-trials - hiv-infected patients - standardized patients - change interventions - care - quality - vignettes - outcomes - health
Objective: Reporting guidelines call for descriptions of control group support in equal detail as for interventions. However, how to assess the active content (behaviour change techniques (BCTs)) of treatment-as-usual (TAU) delivered to control groups in trials remains unclear. The objective of this study is to pre-test a method of assessing TAU in a multicentre cost-effectiveness trial of an HIV-treatment adherence intervention. Design: HIV-nurses (N = 21) completed a semi-structured open-ended questionnaire enquiring about TAU adherence counselling. Two coders independently coded BCTs. Main outcome measures: Completeness and clarity of nurse responses, inter-coder reliabilities and the type of BCTs reported were examined. Results: The clarity and completeness of nurse responses were adequate. Twenty-three of the 26 identified BCTs could be reliably coded (mean ¿ = .79; mean agreement rate = 96%) and three BCTs scored below ¿ = .60. Total number of BCTs reported per nurse ranged between 7 and 19 (M = 13.86, SD = 3.35). Conclusions: This study suggests that the TAU open-ended questionnaire is a feasible and reliable tool to capture active content of support provided to control participants in a multicentre adherence intervention trial. Considerable variability in the number of BCTs provided to control patients was observed, illustrating the importance of reliably collecting and accurately reporting control group support. KEYWORDS: behaviour change techniques; control group; randomised controlled trial; treatment-as-usual
A Story of Large Land Owners and Math Skills: Inequality and Human Capital Formation in the Long-Run Development, 1820-2000
Baten, J. ; Juif, D.T. - \ 2014
Journal of Comparative Economics 42 (2014)2. - ISSN 0147-5967 - p. 375 - 401.
factor endowments - income-distribution - economic-growth - institutions - history - divergence - geography - numeracy - outcomes - africa
We create a new dataset to test the influence of land inequality on long-run human capital formation in a global cross-country study and assess the importance of land inequality relative to income inequality. Our results show that early land inequality has a detrimental influence on math and science skills even a century later. We find that this influence is causal, using an instrumental variable (IV) approach with geological, climatic and other variables that are intrinsically exogenous. A second major contribution of our study is our assessment of the persistence of numerical cognitive skills, which are an important component of modern human capital measures. Early numeracy around 1820 is estimated using the age-heaping strategy. We argue that countries with early investments in numerical education entered a path-dependency of human capital-intensive industries, including skill-intensive agriculture and services. The combined long-run effects of land inequality and human capital path-dependence are assessed for the first time in this article.
Use of an Interculturally Enriched Collaboration Script in Computer-Supported Collaborative Learning in Higher Education
Popov, V. ; Biemans, H.J.A. ; Kuznetsov, A.N. ; Mulder, M. - \ 2014
Technology, Pedagogy and Education 23 (2014)3. - ISSN 1475-939X - p. 349 - 374.
environment - behaviors - cognition - students - outcomes - culture - dyads - teams - cscl
In this exploratory study, the authors introduced an interculturally enriched collaboration script (IECS) for working in culturally diverse groups within a computer-supported collaborative learning (CSCL) environment and then assessed student online collaborative behaviour, learning performance and experiences. The question was if and how these variables differed for the groups that used an IECS versus groups that used a general collaboration script (CS) that did not include intercultural elements. Using a web conferencing tool, 47 students from a university in Ukraine and a university in the Netherlands worked together in groups to develop project plans on an environmental problem. The groups in the IECS condition showed a higher frequency of so-called contributing behaviour but a lower frequency of planning behaviour, seeking input and social interaction than the groups in the CS condition. The IECS groups also produced better project plans than the CS groups. Future study using a similar experimental set-up but with larger samples is recommended to see if the present results can be replicated.
Use of Two-Part Regression Calibration Model to Correct for Measurement Error in Episodically Consumed Foods in a Single-Replicate Study Design: EPIC Case Study
Agogo, G.O. ; Voet, H. van der; Veer, P. van 't; Ferrari, P. ; Leenders, M. ; Muller, D.C. ; Sánchez-Cantalejo, E. ; Bamia, C. ; Braaten, T. ; Knüppel, S. ; Johansson, I. ; Eeuwijk, F.A. van; Boshuizen, H.C. - \ 2014
PLoS ONE 9 (2014)11. - ISSN 1932-6203 - 15 p.
dietary self-report - nutrition - cancer - instruments - outcomes - disease - markers
In epidemiologic studies, measurement error in dietary variables often attenuates association between dietary intake and disease occurrence. To adjust for the attenuation caused by error in dietary intake, regression calibration is commonly used. To apply regression calibration, unbiased reference measurements are required. Short-term reference measurements for foods that are not consumed daily contain excess zeroes that pose challenges in the calibration model. We adapted two-part regression calibration model, initially developed for multiple replicates of reference measurements per individual to a single-replicate setting. We showed how to handle excess zero reference measurements by two-step modeling approach, how to explore heteroscedasticity in the consumed amount with variance-mean graph, how to explore nonlinearity with the generalized additive modeling (GAM) and the empirical logit approaches, and how to select covariates in the calibration model. The performance of two-part calibration model was compared with the one-part counterpart. We used vegetable intake and mortality data from European Prospective Investigation on Cancer and Nutrition (EPIC) study. In the EPIC, reference measurements were taken with 24-hour recalls. For each of the three vegetable subgroups assessed separately, correcting for error with an appropriately specified two-part calibration model resulted in about three fold increase in the strength of association with all-cause mortality, as measured by the log hazard ratio. Further found is that the standard way of including covariates in the calibration model can lead to over fitting the two-part calibration model. Moreover, the extent of adjusting for error is influenced by the number and forms of covariates in the calibration model. For episodically consumed foods, we advise researchers to pay special attention to response distribution, nonlinearity, and covariate inclusion in specifying the calibration model.
Implementation of The World Starts With Me, a comprehensive rights-based sex education programme in Uganda
Rijsdijk, L.E. ; Bos, A.E.R. ; Lie, R. ; Leerlooijer, J.N. ; Eiling, E. ; Atema, V. ; Gebhardt, W.A. ; Ruiter, R.A.C. - \ 2014
Health Education Research 29 (2014)2. - ISSN 0268-1153 - p. 340 - 353.
south-african schools - sub-saharan africa - secondary-schools - aids education - health-promotion - hiv prevention - hiv/aids - interventions - outcomes - fidelity
This article presents a process evaluation of the implementation of the sex education programme the World Starts With Me (WSWM) for secondary school students in Uganda. The purpose of this mixed-methods study was to examine factors associated with dose delivered (number of lessons implemented) and fidelity of implementation (implementation according to the manual), as well as to identify the main barriers and facilitators of implementation. Teachers’ confidence in teaching WSWM was negatively associated with dose delivered. Confidence in educating and discussing sexuality issues in class was positively associated with fidelity of implementation, whereas the importance teachers attached to open sex education showed a negative association with fidelity. Main barriers for implementing WSWM were lack of time, unavailability of computers, lack of student manuals and lack of financial support and rewards. Other barriers for successful implementation were related to high turnover of staff and insufficient training and guidance of teachers. Teachers’ beliefs/attitudes towards sexuality of adolescents, condom use and sex education were found to be important socio-cognitive factors intervening with full fidelity of implementation. These findings can be used to improve the intervention implementation and to better plan for large-scale dissemination of school-based sex education programmes in sub-Saharan Africa.
The visibility of trust: Exploring the connection between trust and interaction in a Dutch collaborative governance boardroom
Oortmerssen, L.A. van; Woerkum, C. van; Aarts, N. - \ 2014
Public Management Review 16 (2014)5. - ISSN 1471-9037 - p. 666 - 685.
communication - negotiation - impact - cooperation - alliances - networks - outcomes - climate - teams
In multi-stakeholder collaboration settings, trust plays a significant role. We explore the connection between trust and interaction over time in a collaborative governance board. To this end, we conducted a case study of the board of a collaborative governance arrangement in professional education. The results include an increase in trust within the board as well as three changes in the interaction pattern during board meetings: more openness, more responsiveness and more speed. It is argued that the increase in trust and the changes in interaction are related, implying that trust is visible in interaction content, interaction atmosphere and interaction process.
Long-Term Physical Functioning and Its Association With Somatic Comorbidity and Comorbid Depression in Patients With Established Rheumatoid Arthritis: A Longitudinal Study
Hoek, J. ; Roorda, L.D. ; Boshuizen, H.C. ; Hees, J. van; Rupp, I. ; Tijhuis, G.J. ; Dekker, J. ; Bos, G.A.M. van den - \ 2013
Arthritis Care & Research 65 (2013)7. - ISSN 2151-464X - p. 1157 - 1165.
quality-of-life - chronic disease - health survey - co-morbidity - metaanalysis - prevalence - classification - outcomes - impact - sf-36
ObjectiveTo describe long-term physical functioning and its association with somatic comorbidity and comorbid depression in patients with established rheumatoid arthritis (RA). MethodsLongitudinal data over a period of 11 years were collected from 882 patients with RA at study inclusion. Patient-reported outcomes were collected in 1997, 1998, 1999, 2002, and 2008. Physical functioning was measured with the Health Assessment Questionnaire and the physical component summary score of the Short Form 36 health survey. Somatic comorbidity was measured by a questionnaire including 12 chronic diseases. Comorbid depression was measured with the Center for Epidemiologic Studies Depression Scale. We distinguished 4 groups of patients based on comorbidity at baseline. ResultsSeventy-two percent of the patients at baseline were women. The mean +/- SD age was 59.3 +/- 14.8 years and the median disease duration was 5.0 years (interquartile range 2.0-14.0 years). For the total group of patients with RA, physical functioning improved over time. Patients with somatic comorbidity, comorbid depression, or both demonstrated worse physical functioning than patients without comorbidity at all data collection points. Both groups with comorbid depression had the lowest scores. Only patients with both somatic comorbidity and comorbid depression showed significantly less improvement in physical functioning over time. ConclusionBoth somatic comorbidity and comorbid depression were negatively associated with physical functioning during an 11-year followup period. Furthermore, their combination seems to be especially detrimental to physical functioning over time. These results emphasize the need to take somatic comorbidity and comorbid depression into account in the screening and treatment of patients with RA.
The mucosal factors retinoic acid and TGF-B induce phenotypically and functionally distinct dendritic cell types
Hartog, C.G. den; Altena, S.E.C. van; Savelkoul, H.F.J. ; Neerven, R.J.J. van - \ 2013
International Archives of Allergy and Immunology 162 (2013)3. - ISSN 1018-2438 - p. 225 - 236.
bronchial lymph-node - t-cells - tgf-beta - intestinal inflammation - vitamin-a - tolerance - generation - expression - responses - outcomes
Non-inflammatory dendritic cell (DC) subsets play an essential role in preventing massive inflammation in mucosal tissues. We investigated whether mucosa-related factors, namely retinoic acid (RA) and transforming growth factor-ß (TGF-ß1), can induce such DC types. DCs were differentiated from monocytes in the absence or presence TGF-ß1 and RA. The phenotype as well as responsiveness to bacterial ligands was studied in detail. Compared to monocyte-derived DCs (moDCs), the expression of co-stimulatory molecule CD86 and DC maturation marker CD83 were strongly reduced by RA and TGF-ß1. In addition, both RA- and TGF-ß1-induced DCs showed strongly decreased responsiveness to stimulation with the bacterial ligands lipopolysaccharide and peptidoglycan, and produced significantly lower levels of the pro-inflammatory cytokines IL-12 and TNF-a compared to moDCs, whilst IL-10 production was not significantly reduced. DCs differentiated under the influence of RA uniquely expressed markers related to intestinal homing (CD103 and integrin ß7). In addition, CCR7, which mediates homing to lymph nodes, was expressed by DCs differentiated in the presence of RA, and also to a lesser extent by the other DC types. Furthermore, whereas moDCs and TGF-ß1-derived moDCs expressed high levels of CD32, RA-derived DCs lacked CD32 expression but expressed high levels of CD64, suggesting that RA-DCs may primarily respond to soluble proteins and moDCs, and TGF-ß DCs to immune complexes. The data presented here support the hypothesis that the mucosal factors TGF-ß1 and RA, which can also be provided through dietary intake of dairy products, result in functionally and phenotypically distinct DC types with non-inflammatory properties.
Harming others’ task-related efforts: The distinct competitive effects of ranking information on performance and mastery goal individuals
Poortvliet, P.M. - \ 2013
Social Psychology 44 (2013)6. - ISSN 1864-9335 - p. 373 - 379.
achievement goals - conflict regulation - orientations - exchange - context - pleasure - behavior - outcomes - impact - pain
This paper demonstrates that, when individuals with mastery goals and their exchange partners occupy increasingly higher ranks on a task (#4 and #5 vs. #51 and #52 or #96 and #97, on a top-100), they display stronger interpersonally harmful behavior in order to interfere with exchange partners’ task performance. In contrast, performance goal individuals damage the task performance of others more when ranks are low or high rather than average (#4 and #5 or #96 and #97 vs. #51 and #52). These results signify that social comparison information is processed differently by mastery and performance goal individuals. The resulting interpersonally harmful behaviors depend on whether such behavior is instrumental for their particular achievement goal pursuit or not
Mental budgeting and the management of household finance
Antonides, G. ; Groot, I.M. de; Raaij, W. van - \ 2011
Journal of Economic Psychology 32 (2011)4. - ISSN 0167-4870 - p. 546 - 555.
future consequences - behavior - decisions - choice - consumption - hypothesis - psychology - outcomes - income - money
Mental budgeting and financial management were investigated in a large sample of the Dutch population. Mental budgeting was quite common, and was explained from general education, having saving goals, financial knowledge, time orientation, and financial situation. Also, mental budgeting, in addition to effects of financial situation, time orientation and financial knowledge, was positively associated with having an overview of expenses and current accounts, and household financial management
Lifestyle counseling for type 2 diabetes risk reduction in Dutch primary care: results of the APHRODITE study after 0.5 and 1.5 years
Vermunt, P.W. ; Milder, I.E.J. ; Wielaard, F. ; Vries, J.H.M. de; Oers, H. van; Westert, G.P. - \ 2011
Diabetes Care 34 (2011)9. - ISSN 0149-5992 - p. 1919 - 1925.
prevention program - health-care - follow-up - intervention - community - implementation - questionnaire - metaanalysis - validity - outcomes
OBJECTIVE To study the overall effect of the Active Prevention in High-Risk Individuals of Diabetes Type 2 in and Around Eindhoven (APHRODITE) lifestyle intervention on type 2 diabetes risk reduction in Dutch primary care after 0.5 and 1.5 years and to evaluate the variability between general practices. RESEARCH DESIGN AND METHODS Individuals at high risk for type 2 diabetes (Finnish Diabetes Risk Score =13) were randomly assigned into an intervention group (n = 479) or a usual-care group (n = 446). Comparisons were made between study groups and between general practices regarding changes in clinical and lifestyle measures over 1.5 years. Participant, general practitioner, and nurse practitioner characteristics were compared between individuals who lost weight or maintained a stable weight and individuals who gained weight. RESULTS Both groups showed modest changes in glucose values, weight measures, physical activity, energy intake, and fiber intake. Differences between groups were significant only for total physical activity, saturated fat intake, and fiber intake. Differences between general practices were significant for BMI and 2-h glucose but not for energy intake and physical activity. In the intervention group, the nurse practitioners’ mean years of work experience was significantly longer in individuals who were successful at losing weight or maintaining a stable weight compared with unsuccessful individuals. Furthermore, successful individuals more often had a partner. CONCLUSIONS Risk factors for type 2 diabetes could be significantly reduced by lifestyle counseling in Dutch primary care. The small differences in changes over time between the two study groups suggest that additional intervention effects are modest. In particular, the level of experience of the nurse practitioner and the availability of partner support seem to facilitate intervention success. With a global prevalence of 285 million diagnosed individuals (1), type 2 diabetes poses a major public health concern. Moreover, the prevalence of the disease is estimated to rise to 438 million in 20 years (1). Several studies in experimental settings have shown that type 2 diabetes incidence and risk can be significantly reduced by lifestyle intervention in high-risk individuals (2). Furthermore, the beneficial effect of behavioral change can be sustained long after counseling is stopped (3,4). In daily-life settings, less resources for program implementation and delivery may be available than in experimental settings, which may influence results (5,6). Individual dietary counseling or extensive exercise programs, for example, may be too expensive. Nevertheless, significant reductions in type 2 diabetes risk were found in recent studies in the community and in primary and occupational health care (7–12). However, in most of these studies in daily-life settings, usual-care comparison groups were lacking, and therefore, the additional effectiveness of the interventions could not be determined (5). Furthermore, differences between health care institutions were not reported. The Active Prevention in High-Risk Individuals of Diabetes Type 2 in and Around Eindhoven (APHRODITE) study investigates the effectiveness and feasibility of type 2 diabetes prevention by lifestyle intervention in Dutch general practice. In this article, we report the overall effect of the APHRODITE lifestyle intervention on type 2 diabetes risk reduction in Dutch primary care after 0.5 and 1.5 years. Furthermore, we evaluate differences in risk-factor reduction between practices and investigate the characteristics of participants and health care providers that may facilitate success
Electronic Monitoring-Based Counseling to Enhance Adherence Among HIV-Infected Patients: A Randomized Controlled Trial
Bruin, M. de; Hospers, H.J. ; Breukelen, G.J.P. ; Kok, G. ; Koevoets, W.M. ; Prins, J.M. - \ 2010
Health Psychology 29 (2010)4. - ISSN 0278-6133 - p. 421 - 428.
antiretroviral therapy adherence - viral load - protease inhibitors - improve adherence - clinical-trials - interventions - care - outcomes - failure - medications
Objective: To investigated the effectiveness of an adherence intervention (AIMS) designed to fit HIV-clinics' routine care procedures. Design: Through block randomization, patients were allocated to the intervention or control group. The study included 2 months baseline measurement, 3 months intervention, and 4 months follow-up. HIV-nurses delivered a minimal intervention (“adherence sustaining”) to patients scoring >95% adherence at baseline, and an intensive intervention (“adherence improving”) to patients with
Care farms in the Netherlands: Attractive empowerment-oriented and strengths-based practices in the community
Hassink, J. ; Elings, M. ; Zweekhorst, M. ; Nieuwenhuizen, N. van den; Smit, A. - \ 2010
Health & Place 16 (2010)2010. - ISSN 1353-8292 - p. 423 - 430.
quality-of-life - case-management - mental-health - recovery - perspectives - outcomes - people - model
Empowerment-oriented and strengths-based practices focusing on community integration have gained recognition for various client groups in recent decades. This paper discusses whether care farms in the Netherlands are relevant examples of such practices. We identify characteristics associated with care farms that are relevant for three different client groups: clients with severe mental health problems, clients from youth care backgrounds, and frail elderly clients. We interviewed 41 clients, 33 care farmers, and 27 health professionals. The study shows that care farms are experienced as unique services because of a combination of different types of characteristic qualities: the personal and involved attitude of the farmer, a safe community, useful and diverse activities, and a green environment. This leads to an informal context that is close to normal life. We found no essential differences in the assessment of characteristics between different client groups and between clients, farmers, and health professionals. Care farms can be considered as an innovative example of community-based services that can improve the quality of life of clients.Keywords: Care farm; Mental illness; Youth; Elderly; Community care; Empowerment and strength
Anemia Prevalence among Pregnant Women and Birth Weight in Five Areas in China
Ma, A.G. ; Schouten, E.G. ; Wang, Y. ; Xu, R.X. ; Zheng, M.C. ; Li, Y. ; Sun, Y.Y. ; Wang, Q.Z. - \ 2009
Medical Principles and Practice 18 (2009)5. - ISSN 1011-7571 - p. 368 - 372.
randomized controlled-trial - iron status - supplementation - deficiency - outcomes
Objectives: To investigate the current prevalence of anemia among pregnant women in different areas of China and the association with birth weight and educational level. Methods: A total of 6,413 women aged 24-37 in the third trimester of pregnancy from five areas were randomly selected from all gravidas who gave birth in the hospitals from 1999 to 2003. Blood hemoglobin concentration (Hb) was measured by the cyanomethemoglobin method; Hb <110 g/l was considered as anemia. Results: The overall prevalence of anemia was 58.6%, ranging from 48.1 to 70.5% in the five areas. There was a significant difference in the prevalence of anemia between women who have mental jobs and those who have physical jobs (52.3 vs. 61.1%, p <0.01). The prevalence of anemia depended on the level of education: with 52.9, 62.4 and 66.5%, for college, secondary school and primary education, respectively, and the difference was statistically significant (p = 0.005). Results showed that higher birth weight was associated with Hb concentrations ranging from 90 to 140 g/l, whereas lower birth weight occurred below 80 g/l and above 140 g/l Hb. Conclusions: The prevalence of anemia in Chinese pregnant women was high both in rural areas and towns. Area of residence, education level and type of job influenced the prevalence of anemia. Low maternal Hb concentrations influenced birth weight.
Long-Acting Methylphenidate-OROS in Youths with Attention-Deficit Hyperactivity Disorder Suboptimally Controlled with Immediate-Release Methylphenidate. A study of cost effectiveness in The Netherlands.
Faber, A. ; Agthoven, M. van; Kalverdijk, L.J. ; Tobi, H. ; Jong-van den Berg, L.T.W. de; Annemans, L. ; Postma, M.J. - \ 2008
CNS Drugs 22 (2008)2. - ISSN 1172-7047 - p. 157 - 170.
once-a-day - deficit/hyperactivity-disorder - children - stimulants - care - adolescents - population - outcomes - trial
BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is the most common mental health disorder in youths. Stimulants are the drugs of first choice in the treatment of ADHD. It has been suggested that full costs associated with the treatment of ADHD may be reduced by once-daily administration regimens of stimulants. OBJECTIVES: To estimate the cost effectiveness of treatment with long-acting methylphenidate osmotic release oral system (OROS) [Concerta((R))] for youths with ADHD for whom treatment with immediate-release (IR) methylphenidate is suboptimal. STUDY DESIGN: We developed a Markov model to obtain an incremental cost-effectiveness ratio (ICER). The analysis covered 10 years, with a Markov cycle of 1 day. Costs (in 2005 euros [euro]) included medication, consultations and treatment interventions, and additional costs for attending special education. Quality-adjusted life-years (QALYs) were used as the effectiveness measure. Outcome probabilities were taken from the medical literature and an expert panel of five child psychiatrists and paediatricians. Univariate sensitivity analyses were performed to assess the robustness of the base-case estimate. Multivariate sensitivity analysis was used to estimate a worst- and best-case ICER. RESULTS: The ICER of methylphenidate-OROS treatment in youths with ADHD for whom treatment with IR methylphenidate is suboptimal was euro2004 per QALY. Total costs after 10 years were euro15 739 for the IR methylphenidate pathway and euro16 015 for the methylphenidate-OROS pathway. In the univariate sensitivity analysis, the ICER was sensitive to changes in resource use and the probability of stopping stimulant treatment in favour of IR methylphenidate. An ICER of 0 was reached with a 6.2% price reduction of methylphenidate-OROS. CONCLUSION: Methylphenidate-OROS is a cost-effective treatment for youths with ADHD for whom treatment with IR methylphenidate is suboptimal. Higher medication costs of methylphenidate-OROS were compensated for by savings on resource use, yielding similar 10-year costs compared with treatment with IR methylphenidate. Our analysis is sensitive to both clinical parameters and (differences in) resource utilization and costs between the groups modelled, warranting further research within clinical trials and observational databases, and into the full scope of costs.
Reducing pesticide exposure and associated neurotoxic burden in an Ecuadorian small farm population
Cole, D.C. ; Sherwood, S.G. ; Paredes Chauca, M.C. ; Sanin, L.H. ; Crissman, C. ; Espinosa, P. ; Munoz, F. - \ 2007
International Journal of Occupational and Environmental Health 13 (2007)3. - ISSN 1077-3525 - p. 281 - 289.
integrated pest-management - potato production - health - risk - performance - outcomes - impacts - state
The contribution of community-based interventions, including farmer field schools (FFSs) in integrated pest management (IPM), to reducing pesticide exposures and associated neurotoxic burden among small-farm families in Ecuador was assessed in three Andean farming communities in a co-design of targeted action-research. Baseline questionnaire surveys elicited pesticide-related knowledge, practices, and exposure and neurobehavioral assessments were done using an adapted WHO battery. Pesticide applications on plots farmed by FFS versus non-FFS participants were compared. A year later, repeated surveys of participating households (n = 29) and neurobehavioral testing of individuals (n = 63) permitted comparisons of pre- and post-intervention values. The FFS graduates applied pesticides on their plots less frequently (p = 0.171). FFS households had increased pesticide-related knowledge of labels and exposure risk factors (both p <0.004), better pesticide-handling practices (p <0.01), and less skin exposure (p <0.01). Neurobehavioural status had improved, particularly digit span and visuo-spatial function, resulting in overall z-score increases. Thus, community interventions reduced pesticide use, reported skin exposure, and neurotoxic burden among smallholder farm families
The gap between evidence-based medicine and daily practice in the management of paediatric asthma. A pharmacy-based population study from The Netherlands.
Vries, T.W. de; Tobi, H. ; Schirm, E. ; Berg, P. van den; Duiverman, E.J. ; Jong-van den Berg, L.T.W. de - \ 2006
European Journal of Clinical Pharmacology 62 (2006)1. - ISSN 0031-6970 - p. 51 - 55.
primary-care - children - prevalence - guidelines - outcomes - improve
Objective: We evaluated the adherence to national guidelines for the treatment of asthma in childhood. Methods: Prescriptions for anti-asthma medication for children (0-14 years of age) were retrieved from the InterAction DataBase (IABD) for the year 2002. These were compared with recommendations found in national guidelines. Results: Anti-asthma medication was prescribed for 3,612 children (5%) of the paediatric population. Inhaled medication was prescribed for 3,554 (98%) children. In 1,940 of 1,993 (97%) of the children under the age of 6 years pressurised metered dose inhalers (pMDIs) were given. Short-acting ß2-agonists had not been prescribed in the previous 2-year period in 559 children (15%), 543 children older than 8 years (36%) did not receive a prescription for a dry powder inhalator and 239 children (7%) had more than one type of inhalator. Long-acting ß2-agonists were prescribed in 396 children, but without concomitant inhaled corticosteroids (ICS) in 35 children (9%). Conclusions: Inhalation therapy as the method of choice in asthma therapy and the use of pMDI in preschool children are widely accepted in the Netherlands. Not all children have been prescribed bronchodilators. Some children have more than one type of inhaler device and others use long-acting ß2-agonists not in combination with ICS. Although national and international guidelines about the treatment of asthma in children offer evidence-based advice, important principles are not followed. Effective interventions aimed at implementing existing guidelines into daily practice are urgently needed
Long-term results of peripheral arterial disease rehabilitation
Menard, J.R. ; Smith, H.E. ; Riebe, D. ; Braun, C.M. ; Blissmer, B. ; Patterson, R.B. - \ 2004
Journal of Vascular Surgery 39 (2004)6. - ISSN 0741-5214 - p. 1186 - 1192.
randomized controlled trial - intermittent claudication - exercise rehabilitation - functional status - angioplasty - outcomes - therapy - program
Purpose Although the Peripheral Arterial Disease Rehabilitation Program (PADRx) improves walking ability and quality of life over brief periods of follow-up, the long-term durability of results has not been established. This study examined functional status, walking ability, and quality of life in patients several months after completion of a 12-week PADRx. Methods Patients who completed a PADRx were eligible for participation. A Medical Outcomes Study 36-Item Short Form (SF-36), Walking Impairment Questionnaire (WIQ), and physical activity questionnaire were administered by telephone. A progressive treadmill test was performed on-site. Results Of 63 eligible patients, 14 were lost to follow-up, 11 refused participation, and four died. Thirty-four patients had completed PADRx 20 to 80 months previously (mean, 48.2 ± 13.7 months), and completed the phone survey. Fifteen patients reported exercising a minimum of 60 min/wk for 3 months (EX group), and 19 had not exercised in the preceding 3 months (SED group). Self-reported SF-36 values were significantly different between the EX and SED groups for Physical Function (43.3 ± 8.2 vs 34.2 ± 7.8), Role–Physical Function (41.2 ± 7.7 vs 32.8 ± 9.2), and Bodily Pain (46.9 ± 8.8 vs 38.9 ± 7.1), as well as the Physical Composite (43.5 ± 6.5 vs 34.0 vs 5.8) domains of the SF-36. Similarly the WIQ demonstrated significant differences in Walking Distance (46.8 ± 36.2 vs 7.8 ± 9.4), Walking Speed (47.5 ± 32.6 vs 14.5 ± 13.9), and Stair Climbing (60.6 ± 36.6 vs 37.1 ± 27.6), favoring the EX group. Sixteen patients, equally distributed between the EX and SED groups, completed the progressive treadmill test. Both groups had experienced improvement (P <.05) in claudication pain time and maximal walking time after completing the 12-week supervised program. The EX group maintained increased claudication pain time of 121% and maximum walking time of 109% over baseline, whereas the SED group values had returned to baseline (P <.05). Conclusions Patients with claudication realize symptomatic and functional improvement with supervised exercise programs. Those who continue to exercise will potentially maintain these benefits and experience improved health-related quality of life.