1,721,026 research outputs found
How do we determine whether community health workers are cost-effective? Some core methodological issues.
No full textSince the Alma-Ata Conference in 1978 reiterated the goal of "Health for All by the Year 2000", health service delivery programs promoting the primary health care approach using community health workers (CHWs) have been established in many developing countries. These programs are expected to improve the cost-effectiveness of health care systems by reaching large numbers of previously underserved people with high-impact basic services at low cost. However, there is a dearth of data on the cost-effectiveness of CHW programs to confirm these views. This may be because conventional approaches to economic evaluation, particularly cost-effectiveness, tend not to capture the institutional features of CHW programs. Therefore, this paper aims to examine the means by which economic methods can be extended to provide evidence regarding the cost-effectiveness of CHWs in developing countries
An economic analysis of midwifery training programmes in South Kalimantan, Indonesia.
Full text linkIn order to improve the knowledge and skills of midwives at health facilities and those based in villages in South Kalimantan, Indonesia, three in-service training programmes were carried out during 1995-98. A scheme used for both facility and village midwives included training at training centres, peer review and continuing education. One restricted to village midwives involved an internship programme in district hospitals. The incremental cost-effectiveness of these programmes was assessed from the standpoint of the health care provider. It was estimated that the first scheme could be expanded to increase the number of competent midwives based in facilities and villages in South Kalimantan by 1% at incremental costs of US 1175.7 respectively, and that replication beyond South Kalimantan could increase the number of competent midwives based in facilities and villages by 1% at incremental costs of US 1786.4 per midwife respectively. It was also estimated that the number of competent village midwives could be increased by 1% at an incremental cost of US 146.2 per intern for expanding the scheme in South Kalimantan. It was not clear whether the training programmes were more or less cost-effective than other safe motherhood interventions because the nature of the outcome measures hindered comparison
The cost effectiveness of universal antenatal screening for HIV in New Zealand.
No full textOBJECTIVE: To model the incremental costs and benefits of a universal antenatal HIV screening programme in New Zealand (NZ). DESIGN: Cost effectiveness analysis, including only health service costs, using secondary data sources and expert opinion. Uncertainty assessed in multi-way sensitivity analyses. SETTING: The NZ Health Care System. SUBJECTS: Antenatal population of NZ. INTERVENTION: Universal antenatal HIV screening programme. MAIN OUTCOME MEASURES: Incremental cost per true-positive HIV case detected in mothers; incremental cost per HIV case avoided in babies; and incremental cost per discounted life-year gained, for mothers and babies, due to screening. RESULTS: Using base case values the application of universal screening would cost an additional US 307 917) and would lead to the identification of an additional 6.25 true-positive women. After terminations have been excluded, the screening programme would detect five HIV exposed babies. There would be 1.15 avoided cases of HIV infection in babies and a net gain of 41.97 discounted life-years, for mothers and babies combined. The cost per incremental HIV-positive woman detected was US 49 301), HIV infected baby avoided US 267 944) and discounted life-year gained US 7336). CONCLUSION: The discounted cost per life gained in NZ compares favourably to estimates reported in studies of similar interventions in other developed countries and other health care interventions in NZ. The decision of whether to implement universal screening in NZ would be clarified if the prevalence of antenatal HIV infection was known and policy makers identified their willingness to pay for an additional life-year gained
Interleukin-10, Interleukin-6, And Interferon- In Advanced Malignancy: Prognostic Relevance And Impact Of Low-Molecular-Weight Heparin Administration
No full text
Protein C deficiency: A database of mutations for the protein C and S subcommittee of the scientific and standardization committee of the International Society on Thrombosis and Haemostasis
No full textThe first database of mutations in Protein C deficiency and thrombophili
Characterization of the intracellular signalling capacity of natural FXa mutants with reduced pro-coagulant activity
No full textIntroduction: Factor X (FX) is a serine-protease playing a crucial
role in the blood coagulation pathway and triggering intracellular signalling in
a variety of cells via protease-activated receptors (PARs). By exploiting
naturally occurring variants (V342A and G381D, catalytic domain; E19A, γ-
carboxyglutamic acid (GLA)-rich domain), we investigated the relationship
between the pro-coagulant activity and the signal transduction capacity of FX.
Materials and methods: Recombinant FX (rFX) variants were expressed in Human
Embryonic Kidney cells and purified by immunoaffinity chromatography. Activated
rFX (rFXa) variants were characterized for pro-coagulant, amidolytic and
thrombin generation activity. rFXa signalling was assessed through evaluation of
extracellular signal-regulated kinase 1 and 2 (ERK1/2) phosphorylation in C2C12
myoblasts.
Results and conclusions: rFX variants showed reduced (rFX-342A, 29%; rFX-19A,
12%) or not detectable (rFX-381D) amidolytic activity. Thrombin generation
activity in a plasma system was also decreased either upon activation by
Russell's viper venom (rFX-342A, 38%; rFX-19A, 7%; rFX-381D, not detectable) or
by the extrinsic pathway (rFX-342A, 36%; rFX-19A, rFX-381D, not detectable). The
rFXa-381D mutant displayed little or no enzymatic activity, and did not induce
any appreciable signal transduction capacity. The rFXa-342A mutant induced a
dose-dependent signalling with a 50% reduced signalling capacity. At the highest
concentration (174 nM), signalling progressed with a time course similar to that
of rFXa-wt. Zymogen rFX-19A showed defective and incomplete activation resulting
in strongly reduced enzymatic activity and signalling. Taken together our data
are consistent with a close correlation between pro-coagulant activity and
intracellular signalling capacity
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