Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

Mobilidades Urbanas - Indovation: A middle-class consumption ethic in India

Em uma conjuntura de expansão urbana, intensificação do consumo, mudança climática e escassez de petróleo, o tema das mobilidades assume inquestionável importância econômica, social e ambiental. O seminário internacional "Mobilidades Urbanas: Alicerces para Pesquisas Transnacionais" volta-se, por um lado, para a fomentação do debate em torno do paradigma das novas mobilidades - envolvendo mobilidade espacial e socioeconômica, entre outras - e de sua aplicabilidade no contexto brasileiro; por outro, para a capacitação de pesquisadores cujas investigações tematizam os processos de mobilidade social e espacial a partir de perspectivas comparativas e transnacionais.

Mhealth entrepreneurship: an exploratory research for a managerial model for mhealth start ups in low and middle income countries

Since some years, mobile technologies in healthcare (mHealth) stand for the transformational force to improve health issues in low- and middle-income countries (LMICs). Although several studies have identified the prevailing issue of inconsistent evidence and new evaluation frameworks have been proposed, few have explored the role of entrepreneurship to create disruptive change in a traditionally conservative sector. I argue that improving the effectiveness of mHealth entrepreneurs might increase the adoption of mHealth solutions. Thus, this study aims at proposing a managerial model for the analysis of mHealth solutions from the entrepreneurial perspective in the context of LMICs. I identified the Khoja–Durrani–Scott (KDS) framework as theoretical basis for the managerial model, due to its explicit focus on the context of LMICs. In the subsequent exploratory research I, first, used semi-structured interviews with five specialists in mHealth, local healthcare systems and investment to identify necessary adaptations to the model. The findings of the interviews proposed that especially the economic theme had to be clarified and an additional entrepreneurial theme was necessary. Additionally, an evaluation questionnaire was proposed. In the second phase, I applied the questionnaire to five start-ups, operating in Brazil and Tanzania, and conducted semi-structured interviews with the entrepreneurs to gain practical insights for the theoretical development. Three of five entrepreneurs perceived that the results correlated with the entrepreneurs' expectations of the strengths and weaknesses of the start-ups. Main shortcomings of the model related to the ambiguity of some questions. In addition to the findings for the model, the results of the scores were analyzed. The analysis suggested that across the participating mHealth start-ups the ‘behavioral and socio-technical’ outcomes were the strongest and the ‘policy’ outcomes were the weakest themes. The managerial model integrates several perspectives, structured around the entrepreneur. In order to validate the model, future research may link the development of a start-up with the evolution of the scores in longitudinal case studies or large-scale tests.

Correlation between the intensity of venous reflux in the saphenofemoral junction and morphological changes of the great saphenous vein by duplex scanning in patients with primary varicosis

Aim. One of the major causes of chronic venous disease is venous reflux, the identification and quantification of which are important for diagnosis. Duplex scanning allows for the detection and quantification of reflux in individual veins. Evaluation of the great saphenous vein in primary varicosis is necessary for its preservation. Objective of the study is to evaluate a possible correlation between the intensity of reflux at the saphenofemoral junction, diameter alterations of the incompetent great saphenous vein and the practical effect of such correlation. Also to compare the clinical severity of the CEAP classification with such parameters.Methods. Three hundred limbs were submitted to duplex evaluation of their insufficient saphenous veins. Vein diameter was measured on five different points. Velocity and flow at reflux peak and reflux time were determined. The saphenous vein's diameters were correlated with velocity, flow and time. The three latter parameters and diameters were compared with clinical severity according to CEAP.Results. Correlation was found between the saphenous vein's diameters, velocity and flow. No correlation was observed between time and diameter in the thigh's upper and middle thirds. When comparing diameter, velocity and flow with CEAP clinical severity classification, an association was observed. The correlation between reflux time with clinical severity was weak.Conclusion. Reflux time is a good parameter for identifying the presence of reflux, but not for quantifying it. Velocity and peak flow were better parameters for evaluating reflux intensity as they were correlated with great saphenous vein alterations, and were associated with the disease's clinical severity. [Int Angiol 2010;29:323-30]

Almost strict total positivity and a class of Hurwitz polynomials

We establish sufficient conditions for a matrix to be almost totally positive, thus extending a result of Craven and Csordas who proved that the corresponding conditions guarantee that a matrix is strictly totally positive. Then we apply our main result in order to obtain a new criteria for a real algebraic polynomial to be a Hurwitz one. The properties of the corresponding extremal Hurwitz polynomials are discussed. (C) 2004 Elsevier B.V. All rights reserved.

On negative flows of the AKNS hierarchy and a class of deformations of a bihamiltonian structure of hydrodynamic type

A deformation parameter of a bihamiltonian structure of hydrodynamic type is shown to parametrize different extensions of the AKNS hierarchy to include negative flows. This construction establishes a purely algebraic link between, on the one hand, two realizations of the first negative flow of the AKNS model and, on the other, two-component generalizations of Camassa-Holmand Dym-type equations. The two-component generalizations of Camassa-Holm- and Dym-type equations can be obtained from the negative-order Hamiltonians constructed from the Lenard relations recursively applied on the Casimir of the first Poisson bracket of hydrodynamic type. The positive-order Hamiltonians, which follow froth the Lenard scheme applied on the Casimir of the second Poisson bracket of hydrodynamic type, are shown to coincide with the Hamiltonians of the AKNS model. The AKNS Hamiltonians give rise to charges conserved with respect to equations of motion of two-component Camassa-Holm- and two-component Dym-type equations.

Repetition of Suicide Attempts Data from Emergency Care Settings in Five Culturally Different Low- and Middle-Income Countries Participating in the WHO SUPRE-MISS Study

Background: Attempted suicide is a strong risk factor for subsequent suicidal behaviors. Innovative strategies to deal with people who have attempted suicide are needed, particularly in resource-poor settings. Aims: To evaluate a brief educational intervention and periodic follow-up contacts (BIC) for suicide attempters in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, People's Republic of China) as part of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS). Methods: Among the 1,867 suicide attempters enrolled in the emergency departments of the participating sites, 922 (49.4%) were randomly assigned to a brief intervention and contact (BIC) group and 945 (50.6%) to a treatment as usual (TAU) group. Repeated suicide attempts over the 18 months following the index attempt - the secondary outcome measure presented in this paper - were identified by follow-up calls or visits. Subsequent completed suicide - the primary outcome measure has been reported in a previous paper. Results: Overall, the proportion of subjects with repeated suicide attempts was similar in the BIC and TAU groups (7.6% vs. 7.5%, chi(2) = 0.013; p = .909), but there were differences in rates across the five sites. Conclusions: This study from five low-and middle-income countries does not confirm the effectiveness of brief educational intervention and follow-up contacts for suicide attempters in reducing subsequent repetition of suicide attempts up to 18 months after discharge from emergency departments.

Electromyographic validation of the trapezius and serratus anterior muscles in military press exercises with open and middle grip

Electromyographic activity of the trapezius muscle and serratus anterior muscle was analysed in 4 different modalities of military press exercises, each of them with 2 grips: open and middle. It was analyzed 24 male volunteers using a 2-channel TECA TE 4 electromyograph and Hewlett Packard surface electrodes. The TS and SI muscles acted with high and very high activity in all the modalities of military press exercises. Statistically, they did not show significative difference in the performance of the exercises with open and middle grip, justifying the inclusion of this group of exercises with both grips for the physical conditioning programmes.

Financing for development and middle income-countries: new challenges

Spanish version avalilable at the Library

Poverty and income distribution in Latin America: on the complementarities between trade policy and social public spending

Includes bibliography

Electromyographic validation of the deltoid (anterior portion) and pectoralis major (clavicular portion) in military press exercises with open and middle grips

The deltoid (anterior portion) and pectoralis major (clavicular portion) were evaluated in several execution ways of military press exercises with open and middle grips in order to know their behavior pattern. It was analyzed 24 male volunteers, using a 2-channel TECA TE4 electromyograph and Hewllet Packard surface electrodes. It was observed that the execution variation with open and middle grips does not present any significant difference as for the demanding level neither for the pectoralis major muscle nor the deltoid muscle.

The effects of acute and chronic administration of phosphatidylserine on cell proliferation and survival in the dentate gyms of adult and middle-aged rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

17 beta-Estradiol replacement in young, adult and middle-aged female ovariectomized rats promotes improvement of spatial reference memory and an antidepressant effect and alters monoamines and BDNF levels in memory- and depression-related brain areas

Clinical and experimental evidence suggest that estrogens have a major impact on cognition, presenting neurotrophic and neuroprotective actions in regions involved in such function. In opposite, some studies indicate that certain hormone therapy regimens may provoke detrimental effects over female cognitive and neurological function. Therefore, we decided to investigate how estrogen treatment would influence cognition and depression in different ages. For that matter, this study assessed the effects of chronic 17 beta-estradiol treatment over cognition and depressive-like behaviors of young (3 months old), adult (7 months old) and middle-aged (12 months old) reproductive female Wistar rats. These functions were also correlated with alterations in the serotonergic system, as well as hippocampal BDNF. 17 beta-Estradiol treatment did not influence animals' locomotor activity and exploratory behavior, but it was able to improve the performance of adult and middle-aged rats in the Morris water maze, the latter being more responsive to the treatment. Young and adult rats displayed decreased immobility time in the forced swimming test, suggesting an effect of 17 beta-estradiol also over such depressive-like behavior. This same test revealed increased swimming behavior, triggered by serotonergic pathway, in adult rats. Neurochemical evaluations indicated that 17 beta-estradiol treatment was able to increase serotonin turnover rate in the hippocampus of adult rats. Interestingly, estrogen treatment increased BDNF levels from animals of all ages. These findings support the notion that the beneficial effects of 17 beta-estradiol over spatial reference memory and depressive-like behavior are evident only when hormone therapy occurs at early ages and early stages of hormonal decline. (C) 2011 Elsevier B.V. All rights reserved.