Jurnal Fakultas Ekonomi UM Metro (Universitas Muhammadiyah)
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Handboek destigmatisering bij psychische aandoeningen:Principes, perspectieven en praktijken
No full textSingle dose sublingual testosterone and oral sildenafil versus a dual-route/dual-release fixed-dose combination tablet:a pharmacokinetic comparison
No full textAIM: To compare the pharmacokinetic profiles of two formulations of a combination drug product containing 0.5 mg testosterone and 50 mg sildenafil for Female Sexual Interest/Arousal Disorder. The prototype (formulation 1), consists of a testosterone solution for sublingual administration, and a sildenafil tablet that is administered 2.5 hours later. The dual-route/dual-release fixed-dose combination tablet (formulation 2) employs a sublingual and an oral route for systemic uptake. This tablet has an inner-core of sildenafil with a polymeric time-delay coating and an outer polymeric coating containing testosterone. It was designed to increase dosing practicality and decrease potential temporal nonadherence through circumventing the relatively complex temporal dosing scheme.METHODS: 12 healthy premenopausal subjects received both formulations randomly on separate days. Blood was sampled frequently to determine the pharmacokinetics of free testosterone, total testosterone, dihydrotestosterone, sildenafil and N-desmethyl-sildenafil.RESULTS: Formulation 2 had a higher maximum concentration (Cmax ) for testosterone, 8.06 ng/ml (95% confidence interval [CI] 6.84-9.28) and higher area under the plasma concentration-time curve (AUC), 7.69 ng*h/mL (95% CI 6.22-9.16) than formulation 1; 5.66 ng/ml (95% CI 4.63-6.69) and 5.12 ng*h/mL (95% CI 4.51-5.73), respectively. Formulation 2 had a lower Cmax for sildenafil, 173 ng/ml (95% CI 126-220) and a lower AUC, 476 ng*h/mL (95% CI 401-551) than formulation 1; 268 ng/ml (95% CI 188-348) and 577 ng*h/mL (95% CI 462-692), respectively. Formulation 2 released sildenafil after 2.75 h (95% CI 2.40-3.10).CONCLUSIONS: The dual-route/dual-release fixed-dose combination tablet fulfilled its design-criteria and is considered suitable for further clinical testing.</p
Impact of using different blood donor subpopulations and models on the estimation of transfusion transmission residual risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in Zimbabwe
No full textBACKGROUND: Various models for estimating the residual risk (RR) of transmission of infections by blood transfusion have been published mainly based on data from high-income countries. However, to obtain the data required for such an assessment remains challenging for most developing settings. The National Blood Service Zimbabwe (NBSZ) adapted a published incidence-window period (IWP) model, which has less demanding data requirements. In this study we assess the impact of various definitions of blood donor subpopulations and models on RR estimates. We compared the outcomes of two published models and an adapted NBSZ model.STUDY DESIGN AND METHODS: The Schreiber IWP model (Model 1), an amended version (Model 2), and an adapted NBSZ model (Model 3) were applied. Variably the three models include prevalence, incidence, preseroconversion intervals, mean lifetime risk, and person-years at risk. Annual mean RR estimates and 95% confidence intervals for each of the three models for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) were determined using NBSZ blood donor data from 2002 through 2011.RESULTS: The annual mean RR estimates for Models 1 through 3 were 1 in 6542, 5805, and 6418, respectively for HIV; 1 in 1978, 2027, and 1628 for HBV; and 1 in 9588, 15,126, and 7750, for HCV.CONCLUSIONS: The adapted NBSZ model provided comparable results to the published methods and these highlight the high occurrence of HBV in Zimbabwe. The adapted NBSZ model could be used as an alternative to estimate RRs when in settings where two repeat donations are not available.</p
Vaccination against Oncoproteins of HPV16 for Noninvasive Vulvar/Vaginal Lesions:Lesion Clearance Is Related to the Strength of the T-Cell Response
No full textPurpose: Therapeutic vaccination with human papillomavirus type 16 (HPV16) E6 and E7 synthetic long peptides (SLP) is effective against HPV16-induced high-grade vulvar and vaginal intraepithelial neoplasia (VIN/VaIN). However, clinical non-responders displayed weak CD8(+) T-cell reactivity. Here, we studied if imiquimod applied at the vaccine site could improve CD8(+) T-cell reactivity, clinical efficacy, and safety of HPV16-SLP (ISA101).Experimental Design: A multicenter open-label, randomized controlled trial was conducted in patients with HPV16(-) high-grade VIN/VaIN. Patients received ISA101 vaccination with or without application of 5% imiquimod at the vaccine site. The primary objective was the induction of a directly ex vivo detectable HPV16-specific CD8(+) T-cell response. The secondary objectives were clinical responses (lesion size, histology, and virology) and their relation with the strength of vaccination-induced immune responses.Results: Forty-three patients were assigned to either ISA101 with imiquimod (n = 21) or ISA101 only (n = 22). Imiquimod did not improve the outcomes of vaccination. However, vaccine-induced clinical responses were observed in 18 of 34 (53%; 95% CI, 35.1-70.2) patients at 3 months and in 15 of 29 (52%; 95% CI, 32.5-70.6) patients, 8 of whom displayed a complete histologic response, at 12 months after the last vaccination. All patients displayed vaccine-induced T-cell responses, which were significantly stronger in patients with complete responses. Importantly, viral clearance occurred in all but one of the patients with complete histologic clearance.Conclusions: This new study confirms that clinical efficacy of ISA101 vaccination is related to the strength of vaccine-induced HPV16-specific T-cell immunity and is an effective therapy for HPV16-induced high-grade VIN/VaIN. (C) 2016 AACR.</p
Competition and Constraint: Economic Globalization and Human Resource Practices in 23 European Countries
No full textPurpose - The purpose of this paper is to investigate three distinct hypotheses about the relationship between human resource (HR) practices (discretion and skill enhancement) and the level of trade openness and foreign direct investments of countries.Design/methodology/approach - The study applies multilevel analysis using data of 16,701 employees living in 23 European countries.Findings - Based on the multilevel analysis mixed support is found for the hypothesis stating that economic openness is curvilinearly related (an inverted U) to the use of HR practices. While this holds for discretion, it does not for skill enhancement.Originality/value - While economic globalization is often mentioned as an important factor in understanding organizational relations, there have only been few international comparative studies explicitly linking measures of economic openness and HR practices. This study investigate whether economic globalization is important or not.</p
Developing an exergame for unsupervised home-based balance training in older adults
No full textMore than one third of community living individuals aged 65 years and older falls at least once per year. Fall incidents are among the leading causes of injury and disability in seniors and the cost of falls in the Netherlands are estimated at €780 million per year. Age-related deterioration of balance control is one of the major causes of falls. The aim of this dissertation is to develop and test an exercise videogame (an exergame) that enables older adults to train balance at home and without supervision. In the exergame, the user controls a virtual ice skater on a frozen canal by making lateral whole-body sway movements. These movements are captured using a 3D camera (Kinect) and used to animate the virtual skater, which is displayed on TV. It was found that Kinect captures movement patterns accurately and that these patterns contain information about balance control. Implementing these pattern recognition algorithms in exergames hold the potential of measuring balance control during exergaming, thereby adjusting the game to the individual user.The exergame was developed together with older adults to ensure a good understanding of the user requirements. A prototype of the game was tested in a pilot study in which older adults (age 65-88) played the exergame 3 times per week for a period of 6 weeks. All participants completed the program, and played even more than requested. The results showed an improvement in balance control in some participants and a difference in rate of improvement between participants. These findings underline the importance of individualized training programs
Higher Adherence During Reimbursement of Pharmacological Smoking Cessation Treatments
No full textIntroduction: In the Netherlands, pharmacologic Smoking Cessation Treatments (pSCTs) were reimbursed in 2011. In 2012 the reimbursement was discontinued. As of 2013, pSCTs were again reimbursed, provided they are accompanied by behavioral counseling. The aim of this article is to assess the impact of changes in reimbursement policy on use of-and adherence to-pSCTs.Methods: A retrospective dispensing database analysis was performed on real-world observational data (2010-2013) from the Netherlands. Data on use and adherence was collected, in patients who were dispensed bupropion or varenicline in community pharmacies for the first time. Using the InterActionDataBase (iadb.nl), adherence per patient that initiated varenicline or bupropion was calculated by adding up all dispenses between initiation of the therapy and the 120 days thereafter. Good adherence was defined as using minimal 80% of the recommended duration and intensity of use.Results: The prevalence of patients initiating pSCTs was stable at 0.4 per 1000 inhabitants per quarter during 2010. In 2011, the prevalence was on average 0.7, with peaks in the first (0.8 per 1000) and fourth (1.0 per 1000) quarters of 2011. In 2012, the prevalence was stable again at 0.3. In 2013, prevalence was on average 0.4, with a small peak in the first quarter. Adherence was 15.4% in 2010 versus 20.1% in 2011 (P =.002). In 2012, adherence was 13.9%, compared with 18.9% in 2013 (P =.008).Conclusions: Not only the likelihood of initiating pSCTs, but also the extent of adherence to these treatments, although generally low, seems higher during reimbursement.</p
