Cost-effectiveness analysis of the first-line therapies for nicotine dependence.

BACKGROUND: Nicotine dependence is the major obstacle for smokers who want to quit. Guidelines have identified five effective first-line therapies, four nicotine replacement therapies (NRTs)--gum, patch, nasal spray and inhaler--and bupropion. Studying the extent to which these various treatments are cost-effective requires additional research. OBJECTIVES: To determine cost-effectiveness (CE) ratios of pharmacotherapies for nicotine dependence provided by general practitioners (GPs) during routine visits as an adjunct to cessation counselling. METHODS: We used a Markov model to generate two cohorts of one-pack-a-day smokers: (1) the reference cohort received only cessation counselling from a GP during routine office visits; (2) the second cohort received the same counselling plus an offer to use a pharmacological treatment to help them quit smoking. The effectiveness of adjunctive therapy was expressed in terms of the resultant differential in mortality rate between the two cohorts. Data on the effectiveness of therapies came from meta-analyses, and we used odds ratio for quitting as the measure of effectiveness. The costs of pharmacotherapies were based on the cost of the additional time spent by GPs offering, prescribing and following-up treatment, and on the retail prices of the therapies. We used the third-party-payer perspective. Results are expressed as the incremental cost per life-year saved. RESULTS: The cost per life-year saved for only counselling ranged from Euro 385 to Euro 622 for men and from Euro 468 to Euro 796 for women. The CE ratios for the five pharmacological treatments varied from Euro 1768 to Euro 6879 for men, and from Euro 2146 to Euro 8799 for women. Significant variations in CE ratios among the five treatments were primarily due to differences in retail prices. The most cost-effective treatments were bupropion and the patch, and, then, in descending order, the spray, the inhaler and, lastly, gum. Differences in CE between men and women across treatments were due to the shape of their respective mortality curve. The lowest CE ratio in men was for the 45- to 49-year-old group and for women in the 50- to 54-year-old group. Sensitivity analysis showed that changes in treatment efficacy produced effects only for less-well proven treatments (spray, inhaler, and bupropion) and revealed a strong influence of the discount rate and natural quit rate on the CE of pharmacological treatments. CONCLUSION: The CE of first-line treatments for nicotine dependence varied widely with age and sex and was sensitive to the assumption for the natural quit rate. Bupropion and the nicotine patch were the two most cost-effective treatments.

Um estudo sobre os aspectos que contribuem para a adoção do canal on-line para compra de livros, CDs e DVDs

O objetivo neste estudo foi identificar os fatores relevantes na adoção do canal on-line para a realização de compras, tendo como principais referências os modelos Unified Theory of Acceptance and Use of Technology (UTAUT), de Venkatesh et al. (2003), de Heijden, Verhagen e Creemers (2003) e de Bramall, Schoefer e McKechnie (2004). Além da revisão da literatura dos assuntos pertinentes, foi realizada uma pesquisa de campo descritiva, de natureza quantitativa com uma amostra de 172 pessoas residentes na cidade de São Paulo, pertencentes às classes socioeconômicas A, B e C (critério Brasil), compradores de livros, CDs ou DVDs no canal off-line. Os dados coletados foram analisados com o uso de técnicas estatísticas nos contextos uni, bi e multivariado. Aplicou-se a técnica de modelagem de equações estruturais (MEE ou Structural Equation Modeling - SEM) para serem identificadas relações de dependência entre construtos e a contribuição de cada um deles na estimação das intenções de adoção da compra pela Internet. Entre os principais resultados encontrados, a atitude em relação ao uso da tecnologia, a confiança e a expectativa de desempenho figuraram como os aspectos mais relevantes para uma possível adoção do canal on-line.

Luteinizing hormone (LH) and prolactin-releasing pituitary tumor: possible malignant transformation of the LH cell line.

A pituitary tumor was diagnosed in a prepubertal 13-yr-old girl, who had elevated plasma LH (58 mIU/ml) and PRL (93 ng/ml) levels; decreased GH, ACTH, and FSH secretion; and diabetes insipidus. After surgery, plasma LH and PRL declined, but not to normal levels. Conventional external radiotherapy to the pituitary was immediately followed by a decrease in LH to prepubertal values (0.7 mIU/ml), while PRL levels became normal only after a long course of bromocriptine therapy. The pituitary tumor was composed of two distinct cell types: small polygonal cells, which were PRL positive by immunohistochemistry, and clusters of pleomorphic large frequently mitotic polynucleated cells, which were LH positive, some of them also being positive for the alpha-subunit or beta LH but not for beta FSH. Four years after surgery and radiotherapy, the patient deteriorated neurologically. Computed tomographic scan showed widespread frontal and periventricular tumor, which had the histological features of a poorly differentiated carcinoma. No PRL, LH, or alpha- or beta-subunits were detectable on immunocytochemistry. While the PRL-positive cells of the pituitary tumor displayed the histological and clinical features of PRL adenomas, the morphological characteristics of LH cells and the sharp decline of plasma LH levels after radiotherapy were suggestive of malignant transformation. In this context, the later brain tumor could have been the result of subependymal spread of the pituitary tumor after it lost its hormone-secreting capacity.

Tree line shifts in the Swiss Alps: Climate change or land abandonment?

Questions: Did the forest area in the Swiss Alps increase between 1985 and 1997? Does the forest expansion near the tree line represent an invasion into abandoned grasslands (ingrowth) or a true upward shift of the local tree line? What land cover / land use classes did primarily regenerate to forest, and what forest structural types did primarily regenerate? And, what are possible drivers of forest regeneration in the tree line ecotone, climate and/or land use change? Location: Swiss Alps. Methods: Forest expansion was quantified using data from the repeated Swiss land use statistics GEOSTAT. A moving window algorithm was developed to distinguish between forest ingrowth and upward shift. To test a possible climate change influence, the resulting upward shifts were compared to a potential regional tree line. Results: A significant increase of forest cover was found between 1650 to and 2450 m. Above 1650 m, 10% of the new forest areas were identified as true upward shifts whereas 90% represented ingrowth, and we identified both land use and climate change as likely drivers. Most upward shift activities were found to occur within a band of 300 m below the potential regional tree line, indicating land use as the most likely driver. Only 4% of the upward shifts were identified to rise above the potential regional tree line, thus indicating climate change. Conclusions: Land abandonment was the most dominant driver for the establishment of new forest areas, even at the tree line ecotone. However, a small fraction of upwards shift can be attributed to the recent climate warming, a fraction that is likely to increase further if climate continues to warm, and with a longer time-span between warming and measurement of forest cover.

Disseny i implementació d'una aplicació web per a la reserva on-line de localitats d'espectacles

Aquest treball presenta un terminal de reserva d'espectacles. Es tracta d'una aplicació web que permet als seus usuaris registrats reservar localitats de diferents tipus d'espectacles a través d'internet i amb total llibertat d'horaris. L'aplicació s'ha dissenyat amb tecnologia Java (servlets, JSP, beans ...) i s'ha llicenciat com a aplicació de programari lliure amb la llicència GPL.

Desenvolvimento de um curso on-line sobre o tema administração de medicamentos

O estudo descreveu o desenvolvimento de um curso on-line sobre o processo da administração de medicamentos - vias. Para tanto se utilizou o World Wide Web Course Tools (WebCT), que é um software que fornece várias ferramentas a supervisores e acesso a estudantes providos de uma senha a diversos ambientes. O material do curso foi subdivido em oito tópicos ilustrados: administração de medicamentos por via oral, sublingual, via parenteral, intradérmica, subcutânea, intramuscular, endovenosa e aplicação tópica e instilação, além das questões para avaliação de conhecimentos. Uma amostra de alunos de graduação da Escola de Enfermagem de Ribeirão Preto - USP avaliou positivamente o curso. Pretende-se agora inseri-lo em disciplina curricular do ensino de graduação, como um recurso adicional à aprendizagem dos alunos.

First-line therapies in inflammatory bowel disease.

Background and Aims: Medical therapy of inflammatory bowel disease (IBD) is becoming more complex, given the increasing choice of drugs to treat Crohn's disease (CD) and ulcerative colitis (UC). We aimed to summarize the current guidelines for first-line treatments in IBD. Methods: An extensive literature search with focus on the guidelines of the European Crohn's and Colitis Organisation for the diagnosis and treatment of CD and UC was performed. First-line treatments were defined as the following drug categories: 5-aminosalicylates, budesonide, systemic steroids, azathioprine, 6-mercaptopurine, methotrexate, infliximab, adalimumab and certolizumab pegol. The following drug categories were not included: cyclosporine and tacrolimus (not yet approved by Swissmedic for IBD treatment). Results: Treatment recommendations for the following clinically frequent situations are presented according to disease severity: ileocecal CD, colonic CD, proximal small bowel CD and perianal CD. For UC the following situations are presented: ulcerative proctitis, left-sided colitis and pancolitis. Conclusions: We provide a summary on the use of first-line therapies for clinically frequent situations in patients with CD and UC.

Panorama brasileiro do ensino de Enfermagem On-line

O objetivo deste estudo foi identificar os cursos de Ensino Superior Nacional de EAD por área de concentração, região geográfica, nível de formação e os cursos de EAD no ensino superior de Enfermagem. O método adotado foi um estudo exploratório descritivo em que foi realizado um levantamento nos sites e portais governamentais e não-governamentais relacionados à educação nacional e EAD das Instituições de Ensino Superior (IES) que praticam EAD. Nos resultados foram identificados apenas dois cursos de pós-graduação lato sensu oferecidos especificamente em Enfermagem. Assim, há necessidade de maior investimento das IES de Enfermagem na criação e avaliação de cursos de EAD, bem como de infra-estrutura e de implementação de uma política de capacitação tecnológica.

Gestión de encuestas on-line dinámicas con estímulo (GEODE)

El presente proyecto ha sido pergeñado como una aplicación que pretende resolver las dos carencias principales detectadas en los sistemas clásicos de encuestas on-line gratuitos: por un lado, resultan estáticos (en el sentido de que las encuestas no son dinámicas en función de las respuestas acumuladas) y, por otro, no ofrecen al individuo encuestado el conocimiento que necesita (como máximo devolverán información agrupada de acuerdo a los resultados globales obtenidos sin retornar un análisis comparativo del grupo frente a la del usuario).

The Lunch Line, Vol. 52, no. 2, November 2001

Newsletter produced by Department of Education, Bureau of Food and Nutrition

The Lunch Line, Vol. 52, no. 3, January, 2002

Newsleter produced by Department of Education, Bureau of Food and Nutrition

The Lunch Line, Vol. 52, no. 4, March 2002

Newsleter produced by Department of Education, Bureau of Food and Nutrition

The Lunch Line, Vol. 52, no. 5, May 2002

Newsletter produced by Department of Education, Bureau of Food and Nutrition

The Lunch Line, Vol. 52, no. 4, April 2003

Newsletter produced by Department of Education, Bureau of Food and Nutrition