Desarrollo de una metodología para la creación de indicadores de evaluación del ProAire León 2008-2012

El uso de indicadores es una herramienta muy útil cuando intervienen varios factores dentro de un mismo estudio o comparación. En el presente proyecto se ha propuesto una metodología para evaluar un programa específico de acciones para la mejora de la calidad del aire (ProAire) en la ciudad guanajuatense de León, México. Se trata de la propuesta de indicadores ambientales, de salud, económicos y sociales que puedan aplicar en acciones del ProAire para evaluar su puesta en marcha y cómo, mediante toda la información recopilada a lo largo de este estudio, se van a aplicar estos indicadores, que van a dar una idea sobre cómo se está desarrollando el ProAire y si éste requiere de alguna modificación para mejorar. Al aplicarse los indicadores, se realiza un balance de cuáles son las acciones más importantes ambientalmente y socialmente y se hace hincapié en la necesidad de prestarles mayor atención. También se describen varias propuestas de mejora y consejos a aplicar en el programa para que éste sea más eficiente y los actores implicados puedan desarrollar sus acciones con mayor rapidez. Mediante el presente estudio se puede comprobar cómo de importante es la sociedad y los recursos económicos dentro de la problemática medioambiental.

Immune response to the mumps component of the MMR vaccine in the routine of immunisation services in the Brazilian National Immunisation Program

A non-controlled longitudinal study was conducted to evaluate the combined vaccine against measles, mumps and rubella (MMR) immunogenicity in 150 children vaccinated in the routine of three health units in the city of Rio de Janeiro, Brazil, 2008-2009, without other vaccines administered during the period from 30 days before to 30 days after vaccination. A previous study conducted in Brazil in 2007, in 1,769 children ranging from 12-15 months of age vaccinated against yellow fever and MMR simultaneously or at intervals of 30 days or more between doses, had shown low seroconversion for mumps regardless of the interval between administration of the two vaccines. The current study showed 89.5% (95% confidence interval: 83.3; 94.0) seroconversion rate for mumps. All children seroconverted for measles and rubella. After revaccination, high antibody titres and seroconversion rates were achieved against mumps. The results of this study and others suggest that two MMR doses confer optimal immunoresponses for all three antigens and the possible need for additional doses should be studied taking into account not only serological, but also epidemiological data, as there is no serological correlate of protection for mumps.

An interdisciplinary HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoring.

To ensure successful treatment, HIV patients must maintain a high degree of medication adherence over time. Since August 2004, patients who are (or are at risk of) experiencing problems with their HIV antiretroviral therapy (ART) have been referred by their physicians to an interdisciplinary HIV-adherence program. The program consists of a multifactorial intervention along with electronic drug monitoring (MEMS(TM)). The pharmacists organize individualized semi-structured motivational interviews based on cognitive, emotional, behavioral, and social issues. At the end of each session, the patient brings an adherence report to the physician. This enables the physician to use the adherence results to evaluate the treatment plan. The aim of this study was to retrospectively analyze this on-going interdisciplinary HIV-adherence program. All patients who were included between August 2004 and the end of April 2008 were analyzed. One hundred and four patients were included (59% women, median age 39 (31.0, 46.0) years, 42% black ethnicity). Eighty (77%) patients were ART-experienced patients and 59% had a protease inhibitor-based treatment. The retention rate was high (92%) in the program. Patient inclusion in this HIV-adherence program was determined by patient issues for naive patients and by nonadherence or suboptimal clinical outcomes for ART-experienced patients. The median time spent by a subject at the pharmacy was 35 (25.0, 48.0) minutes, half for the medication handling and half for the interview. The adherence results showed a persistence of 87% and an execution of 88%. Proportion of undetectable subjects increased during study. In conclusion, retention and persistence rates were high in this highly selected problematic population.

Using the costs of drug therapy to screen patients for a community pharmacy-based medication review program

Objectives: To measure the positive predictive value (PPV) of the cost of drug therapy (threshold = 2000 Swiss francs [CHF], US$1440, <euro>1360) as a screening criterion for identifying patients who may benefit from medication review (MR). To describe identified drug-related problems (DRPs) and expense problems (EPs), and to estimate potential savings if all recommendations were accepted. Setting Five voluntary Swiss community pharmacies. Methods: Of 12,680 patients, 592 (4.7%) had drug therapy costs exceeding 2000 CHF over a six-month period from July 1 to December 31, 2002. This threshold limit was set to identify high-risk patients for DRPs and EPs. Three pharmacists consecutively conducted a medication review based on the pharmaceutical charts of 125 sampled patients who met the inclusion criterion. Main outcome measure: The PPV of a threshold of 2000 CHF for identifying patients who might benefit from a MR: true positives were patients with at least one DRP, while false positives were patients with no DRP. Results: The selection based on this criterion had a PPV of 86% for detecting patients with at least one DRP and 95% if EPs were also considered. There was a mean of 2.64 (SD = 2.20) DRPs per patient and a mean of 2.14 (SD = 1.39) EPs per patient. Of these patients, 90% were over 65 years old or were treated with at least five chronic medications, two common criteria for identifying patients at risk of DRPs. The main types of DRPs were drug-drug interactions, compliance problems and duplicate drugs. Mean daily drug cost per patient was CHF 14.87 (US$10.70, <euro>10.10). A potential savings of CHF 1.67 (US$1.20, <euro>1.14) per day (11%) was estimated if all recommendations to solve DRPs and EPs suggested herein were implemented. Conclusion: Further studies should investigate whether the potential benefit of medication reviews in preventing DRPs and containing costs in this patient group can be confirmed in a real practice environment. [Authors]

Indicateurs de résultats du Promedro III, situation en 2008 : rapport final

[Table des matières] 1. Introduction. 1.1. Rappel du mandat. 1.2. Méthode. 2. Résultats. 2.1. Indicateurs du nombre de consommateurs. 2.2. Indicateurs des problèmes en relation (ou non) avec les drogues chez les jeunes. 2.3. Indicateurs en relation avec la consommation problématique de drogues dures en général. 2.4. Indicateurs des conséquences négatives pour les usagers de drogues illégales. 2.5. Indicateurs des conséquences négatives pour la société. 3. Annexe.

A fast-track program reduces complications and length of hospital stay after open colonic surgery.

BACKGROUND & AIMS: A fast-track program is a multimodal approach for patients undergoing colonic surgery that combines stringent regimens of perioperative care (fluid restriction, optimized analgesia, forced mobilization, and early oral feeding) to reduce perioperative morbidity, hospital stay, and cost. We investigated the impact of a fast-track protocol on postoperative morbidity in patients after open colonic surgery. METHODS: A randomized trial of patients in 4 teaching hospitals in Switzerland included 156 patients undergoing elective open colonic surgery who were assigned to either a fast-track program or standard care. The primary end point was the 30-day complication rate. Secondary end points were severity of complications, hospital stay, and compliance with the fast-track protocol. RESULTS: The fast-track protocol significantly decreased the number of complications (16 of 76 in the fast-track group vs 37 of 75 in the standard care group; P = .0014), resulting in shorter hospital stays (median, 5 days; range, 2-30 vs 9 days, respectively; range, 6-30; P < .0001). There was a trend toward less severe complications in the fast-track group. A multiple logistic regression analysis revealed fluid administration greater than the restriction limits (odds ratio, 4.198; 95% confidence interval, 1.7-10.366; P = .002) and a nonfunctioning epidural analgesia (odds ratio, 3.365; 95% confidence interval, 1.367-8.283; P = .008) as independent predictors of postoperative complications. CONCLUSIONS: The fast-track program reduces the rate of postoperative complications and length of hospital stay and should be considered as standard care. Fluid restriction and an effective epidural analgesia are the key factors that determine outcome of the fast-track program.

Development and evaluation of a shaken baby syndrome prevention program.

OBJECTIVE: To evaluate parents' and nurses' opinions regarding the adequacy of an educational program on shaken baby syndrome: the Perinatal Shaken Baby Syndrome Prevention Program (PSBSPP). DESIGN: Qualitative and quantitative assessments in the form of interviews and questionnaires administered in French. SETTING: Two birthing institutions in Montréal, QC, Canada: a university hospital and a regional center. PARTICIPANTS: Two hundred and sixty-three parents (73.8% mothers, 26.2% fathers) received the intervention after the birth of their child, and 69 nurses administered it. METHODS: Parents' and nurses' assessments of the adequacy and relevance of the program and nurses' assessments of the training they received to administer the program were evaluated. RESULTS: Both parents and nurses supported this initiative. Most parents appreciated the usefulness of the information. Nurses believed the program was adequate, and their training to deliver the program was satisfactory. All participants reported that the program was highly relevant, especially for new parents. CONCLUSION: The Perinatal Shaken Baby Syndrome Prevention Program achieves the goals of (a) increasing parents' knowledge about infant crying, anger, and shaken baby syndrome and (b) helping parents identify coping strategies. The relevance of introducing the PSBSPP in all birthing institutions is supported. Future studies should focus on vulnerable and culturally diverse populations, and longitudinal follow-up could help determine if the PSBSPP reduces the incidence of shaken baby syndrome.

Differential Gene Expression between Fall- and Spring-Run Chinook Salmon Assessed by Long Serial Analysis of Gene Expression

Of all Pacific salmonids, Chinook salmon Oncorhynchus tshawytscha display the greatest variability in return times to freshwater. The molecular mechanisms of these differential return times have not been well described. Current methods, such as long serial analysis of gene expression (LongSAGE) and microarrays, allow gene expression to be analyzed for thousands of genes simultaneously. To investigate whether differential gene expression is observed between fall- and spring-run Chinook salmon from California's Central Valley, LongSAGE libraries were constructed. Three libraries containing between 25,512 and 29,372 sequenced tags (21 base pairs/tag) were generated using messenger RNA from the brains of adult Chinook salmon returning in fall and spring and from one ocean-caught Chinook salmon. Tags were annotated to genes using complementary DNA libraries from Atlantic salmon Salmo salar and rainbow trout O. mykiss. Differentially expressed genes, as estimated by differences in the number of sequence tags, were found in all pairwise comparisons of libraries (freshwater versus saltwater = 40 genes; fall versus spring = 11 genes: and spawning versus nonspawning = 51 genes). The gene for ependymin, an extracellular glycoprotein involved in behavioral plasticity in fish, exhibited the most differential expression among the three groupings. Reverse transcription polymerase chain reaction analysis verified the differential expression of ependymin between the fall- and spring-run samples. These LongSAGE libraries, the first reported for Chinook salmon, provide a window of the transcriptional changes during Chinook salmon return migration to freshwater and spawning and increase the amount of expressed sequence data.

Developing an Effective Construction Training Program for Hispanic Supervisors and Craft Workers, January 2004

Hispanics make up a growing percentage of the craft workers entering the construction industry, and this has created several challenges for American construction companies. This study addresses the situation by investigating training needs for Hispanic construction craft workers and developing a training program for them within the industry. In order to evaluate current craft workers’ conditions within the construction industry, Iowa State University researchers conducted a survey, with 98 Hispanic craft workers as respondents from 10 construction companies, to determine current working conditions. The results confirm that the language barrier is an obstacle for both the Hispanic workers and the English-speaking employees involved in construction projects. As a part of this research, two training courses were designed to help both American construction companies and their Hispanic labor force to overcome the barriers that keep them from succeeding safely and productively. A training course titled English as a Second Language Survival Course was developed to facilitate basic communication between Hispanic workers and their American supervisors using construction-focused terminology. This course was delivered once as a trial run for a two-hour duration and twice for a full-length duration of eight hours. Important feedback was obtained from participants as part of the evaluations of the course. “How much of the course contents will be useful in your working environment” was asked; 40% of workers said “all of it” and 60% said “most of it.” Another question was “Was it worth taking the time to attend the course?” to which 94% answered “definitely” and 6% answered “yes.” A second training course titled Stepping Up to Supervisor Course for Hispanic Construction Workers was also developed to provide an effective tool to help companies promote those Hispanic craft workers whose willingness and skills meet the requirements to advance to a supervisory position in an American construction company. This course will be offered in the spring of 2004.

Iowa EHDI News, Spring 2006

The purpose of the newsletter is to communicate with parents and professionals about newborn hearing screening in Iowa. We will share information about: Hearing screenings Intervention Resources available for parents and professionals “Best practices” by hospitals, AEAs (Area Education Agencies), or private practive audiology offices System goals Family stories Highlights from the EHDI Advisory Committee Updates on Iowa’s EHDI program It is important to point out that we are a diverse team of individuals working together to ensure that all newborns and toddlers with hearing loss are identified as early as possible and provided with timely and appropriate audiological, educational and medical intervention. Each newsletter will introduce you to various team members of the EHDI system in Iowa.

ASSIST With Windows Newsletter, Spring 2005

The purpose of Project ASSIST is to provide computer training to individuals who are blind, visually-impaired or deaf-blind. Our training materials address all levels of users, from beginners to advanced users. We have tutorials, keyboard guides and diagrams, and course packets. These materials can be used by individuals who want to learn popular computer programs on their own and by professional trainers for their organization's computer training program. We also offer instructor-led training through our ASSIST Online distance learning program.

Big Spring Retrospective, March 2002

Part of Iowa's Water Ambient monitoring Program, produced by the Iowa Department of Natural Resources.

State of Iowa Workforce Plan 2006-2008,

Iowa state government, as well as other state governments, other public jurisdictions and other employers in general, finds itself at the beginning of a unique demographic phenomenon, the aging of the workforce and the concomitant mass exodus of many workers. Anticipation of this trend alone has raised the profile of and interest in workforce planning. In 2000, the Iowa Department of Personnel, the predecessor agency of the Department of Administrative Services Human Resources Enterprise (DAS-HRE), undertook several initiatives as foundational steps in establishing a workforce planning program.

Audit report on the Iowa Water Pollution Control Works Financing Program and the Iowa Drinking Water Facilities Financing Program, joint programs of the Iowa Finance Authority and the Iowa Department of Natural Resources for the year ended June 30, 2007

Audit report on the Iowa Water Pollution Control Works Financing Program and the Iowa Drinking Water Facilities Financing Program, joint programs of the Iowa Finance Authority and the Iowa Department of Natural Resources for the year ended June 30, 2007

B-1 Monthly Report of Medical Services Provided under Title XIX of the Social Security Act, April 2008

B-1 Medicaid Reports The monthly Medicaid series of eight reports provide summaries of Medicaid eligibles, recipients served, and total payments by county, category of service, and aid category. These reports may also be known as the B-1 Reports. These reports are each available as a PDF for printing or as a CSV file for data analysis. Report name Report number Medically Needy by County - No Spenddown and With Spenddown IAMM1800-R001 Total Medically Needy, All Other Medicaid, and Grand Total by County IAMM1800-R002 Monthly Expenditures by Category of Service IAMM2200-R002 Fiscal YTD Expenditures by Category of Service IAMM2200-R003 ICF & ICF-MR Vendor Payments by County IAMM3800-R001 Monthly Expenditures by Eligibility Program IAMM4400-R001 Monthly Expenditures by Category of Service by Program IAMM4400-R002 Elderly Waiver Summary by County IAMM4600-R002