Impact of type of drug insurance on adherence, persistence and costs of antidepressant drugs : a Quebec population-based study

Contexte: À date, il existe peu de données sur l’adhésion, la persistance et les coûts associés aux antidépresseurs selon le type d’assurance médicament (privé ou public). Objectif: Comparer selon le régime d’assurance médicament (privé ou public), l'adhésion, la persistance et les coûts des antidépresseurs. Méthodes de recherche: Une étude de cohorte appariée a été réalisée en utilisant des bases de données du Québec. Sujets: Nous avons sélectionné 194 patients assurés par un régime privé et 1923 patients assurés par le régime public de la Régie de l’assurance maladie du Québec (RAMQ) (18-64 ans) qui ont rempli au moins une ordonnance pour un antidépresseur entre décembre 2007 et septembre 2009. Mesures: L’adhésion, mesurée sur une période d’un an, a été estimée en utilisant le proportion of prescribed days covered (PPDC). Un modèle de régression linéaire a été utilisé afin d’estimer la différence moyenne en PPDC entre les patients assurés par un régime privé et ceux assurés par le régime public de la RAMQ. La persistance a été comparé entre ces deux groupes avec un modèle de régression de survie Cox, et le coût mensuel d'antidépresseurs ($ CAN) a été comparé entre ces deux groupes en utilisant un modèle de régression linéaire. Résultats: Le PPDC parmi les patients assurés par un régime privé était de 86,4% (intervalle de confiance (IC) 95%: 83,3%-89,5%) versus 81,3% (IC 95%: 80,1%-82,5%) pour les patients assurés par le régime public de la RAMQ, pour une différence moyenne ajustée de 6,7% (IC 95%: 3,0%-10,4%). La persistance après un an parmi les patients assurés par un régime privé était de 49,5% versus 18,9% pour les patients assurés par le régime public de la RAMQ (p <0,001), et le rapport de risque ajusté était de 0,48 (IC 95%: 0,30-0,76). Comparativement aux patients assurés par le régime public de la RAMQ, les patients ayant une assurance privée ont payé 14,94 $ CAD (95% CI: $12,30-$17,58) de plus par mois en moyenne pour leurs antidépresseurs. Conclusion: Les patients assurés par un régime privé avaient une meilleure adhésion, persistance, mais avaient aussi un plus haut coût pour leurs antidépresseurs que ceux assurés par le régime public de la RAMQ. Cette différence de coûts peut être due aux différentes exigences de paiement en pharmacie entre les deux régimes ainsi qu’aux limites des honoraires des pharmaciens imposés par le régime public.

Choosing Thesis Juries: The Costs of Taking a Strict Line on Conflicts of Interest

Étude de cas / Case study

Analysing artefacts dependencies to evolving software systems

Les logiciels sont en constante évolution, nécessitant une maintenance et un développement continus. Ils subissent des changements tout au long de leur vie, que ce soit pendant l'ajout de nouvelles fonctionnalités ou la correction de bogues. Lorsque les logiciels évoluent, leurs architectures ont tendance à se dégrader et deviennent moins adaptables aux nouvelles spécifications des utilisateurs. En effet, les architectures de ces logiciels deviennent plus complexes et plus difficiles à maintenir à cause des nombreuses dépendances entre les artefacts. Par conséquent, les développeurs doivent comprendre les dépendances entre les artefacts des logiciels pour prendre des mesures proactives qui facilitent les futurs changements et ralentissent la dégradation des architectures des logiciels. D'une part, le maintien d'un logiciel sans la compréhension des les dépendances entre ses artefacts peut conduire à l'introduction de défauts. D'autre part, lorsque les développeurs manquent de connaissances sur l'impact de leurs activités de maintenance, ils peuvent introduire des défauts de conception, qui ont un impact négatif sur l'évolution du logiciel. Ainsi, les développeurs ont besoin de mécanismes pour comprendre comment le changement d'un artefact impacte le reste du logiciel. Dans cette thèse, nous proposons trois contributions principales : La spécification de deux nouveaux patrons de changement et leurs utilisations pour fournir aux développeurs des informations utiles concernant les dépendances de co-changement. La spécification de la relation entre les patrons d'évolutions des artefacts et les fautes. La découverte de la relation entre les dépendances des anti-patrons et la prédisposition des différentes composantes d'un logiciel aux fautes.

Comparative costs and outcomes of traumatic brain injury from biking accidents with or without helmet use

Contexte: Évaluer les déterminants de maladies évitables et leurs coûts est nécessaire dans le contexte d’assurance maladie universelle. Le moment d’évaluer les impacts des traumatismes crâniocérébraux (TCC) survenus lors d’accidents de vélo est idéal vu la popularité récente du cyclisme au Québec. Objectifs: Comparer les caractéristiques démographiques et médicales, ainsi que les coûts sociétaux qu’engendrent les TCC de cyclistes portant ou non un casque. Méthodologie: Étude rétrospective de 128 cyclistes avec TCC admis à l’Hôpital Général de Montréal entre 2007 et 2011. Les variables indépendantes sont sociodémographiques, cliniques et le port du casque. Les variables dépendantes sont la durée de séjour, l’échelle GOS-E, l’échelle ISS, l’orientation au congé, les décès et les coûts à la société. Résultats: Le groupe portant un casque était plus vieux, plus éduqué, retraité et marié; au niveau médical, ils avaient des TCCs moins sévères à l’imagerie, des hospitalisations aux soins intensifs plus courtes et moins de neurochirurgies. Les coûts médians à la société pour les TCC isolés de cyclistes avec casque étaient significativement moindres. Conclusion: Dans cette étude, le port du casque semblait prévenir certaines complications des TCC et permettait de faire économiser de l’argent à l’état. Le port de casque est recommandé.

The costs of alcohol, illegal drugs, and tobacco in Canada, 2002.

Objective: The aim of this study was to estimate costs attributable to substance use and misuse in Canada in 2002. Method: Based on information about prevalence of exposure and risk relations for more than 80 disease categories, deaths, years of life lost, and hospitalizations attributable to substance use and misuse were estimated. In addition, substance-attributable fractions for criminal justice expenditures were derived. Indirect costs were estimated using a modified human capital approach. Results: Costs of substance use and misuse totaled almost Can. $40 billion in 2002. The total cost per capita for substance use and misuse was about Can. $1,267: Can. $463 for alcohol, Can. $262 for illegal drugs, and Can. $541 for tobacco. Legal substances accounted for the vast majority of these costs (tobacco: almost 43% of total costs; alcohol: 37%). Indirect costs or productivity losses were the largest cost category (61%), followed by health care (22%) and law enforcement costs (14%). More than 40,000 people died in Canada in 2002 because of substance use and misuse: 37,209 deaths were attributable to tobacco, 4,258 were attributable to alcohol, and 1,695 were attributable to illegal drugs. A total of about 3.8 million hospital days were attributable to substance use and misuse, again mainly to tobacco. Conclusions: Substance use and misuse imposes a considerable economic toll on Canadian society and requires more preventive efforts.

Transaction costs of farmers’ participation in forest management: Policy implications of payments for environmental services schemes in Vietnam

Recent research on payments for environmental services (PES) has observed that high transaction costs (TCs) are incurred through the implementation of PES schemes and farmer participation. TCs incurred by households are considered to be an obstacle to the participation in and efficiency of PES policies. This study aims to understand transactions related to previous forest plantation programmes and to estimate the actual TCs incurred by farmers who participated in these programmes in a mountainous area of northwestern Vietnam. In addition, this study examines determinants of households’ TCs to test the hypothesis of whether the amount of TCs varies according to household characteristics. Results show that average TCs are not likely to be a constraint for participation since they are about 200,000 VND (USD 10) per household per contract, which is equivalent to one person’s average earnings for about two days of labour. However, TCs amount to more than one-third of the programmes’ benefits, which is relatively high compared to PES programmes in developed countries. This implies that rather than aiming to reduce TCs, an appropriate agenda for policy improvement is to balance the level of TCs with PES programme benefits to enhance the overall attractiveness of afforestation programmes for smallholder farmers. Regression analysis reveals that education, gender and perception towards PES programmes have significant effects on the magnitude of TCs. The analyses also points out the importance of local conditions on the level of TCs, with some unexpected results.

Probabilistic Independence Networks for Hidden Markov Probability Models

Graphical techniques for modeling the dependencies of randomvariables have been explored in a variety of different areas includingstatistics, statistical physics, artificial intelligence, speech recognition, image processing, and genetics.Formalisms for manipulating these models have been developedrelatively independently in these research communities. In this paper weexplore hidden Markov models (HMMs) and related structures within the general framework of probabilistic independencenetworks (PINs). The paper contains a self-contained review of the basic principles of PINs.It is shown that the well-known forward-backward (F-B) and Viterbialgorithms for HMMs are special cases of more general inference algorithms forarbitrary PINs. Furthermore, the existence of inference and estimationalgorithms for more general graphical models provides a set of analysistools for HMM practitioners who wish to explore a richer class of HMMstructures.Examples of relatively complex models to handle sensorfusion and coarticulationin speech recognitionare introduced and treated within the graphical model framework toillustrate the advantages of the general approach.

Factorial Hidden Markov Models

We present a framework for learning in hidden Markov models with distributed state representations. Within this framework, we derive a learning algorithm based on the Expectation--Maximization (EM) procedure for maximum likelihood estimation. Analogous to the standard Baum-Welch update rules, the M-step of our algorithm is exact and can be solved analytically. However, due to the combinatorial nature of the hidden state representation, the exact E-step is intractable. A simple and tractable mean field approximation is derived. Empirical results on a set of problems suggest that both the mean field approximation and Gibbs sampling are viable alternatives to the computationally expensive exact algorithm.

Estimating Dependency Structure as a Hidden Variable

This paper introduces a probability model, the mixture of trees that can account for sparse, dynamically changing dependence relationships. We present a family of efficient algorithms that use EMand the Minimum Spanning Tree algorithm to find the ML and MAP mixtureof trees for a variety of priors, including the Dirichlet and the MDL priors.

Estimating Dependency Structure as a Hidden Variable

This paper introduces a probability model, the mixture of trees that can account for sparse, dynamically changing dependence relationships. We present a family of efficient algorithms that use EM and the Minimum Spanning Tree algorithm to find the ML and MAP mixture of trees for a variety of priors, including the Dirichlet and the MDL priors. We also show that the single tree classifier acts like an implicit feature selector, thus making the classification performance insensitive to irrelevant attributes. Experimental results demonstrate the excellent performance of the new model both in density estimation and in classification.

Testing for Hidden Information and Action in Automobile Insurance Market

I test the presence of hidden information and action in the automobile insurance market using a data set from several Colombian insurers. To identify the presence of hidden information I find a common knowledge variable providing information on policyholder s risk type which is related to both experienced risk and insurance demand and that was excluded from the pricing mechanism. Such unused variable is the record of policyholder s traffic offenses. I find evidence of adverse selection in six of the nine insurance companies for which the test is performed. From the point of view of hidden action I develop a dynamic model of effort in accident prevention given an insurance contract with bonus experience rating scheme and I show that individual accident probability decreases with previous accidents. This result brings a testable implication for the empirical identification of hidden action and based on that result I estimate an econometric model of the time spans between the purchase of the insurance and the first claim, between the first claim and the second one, and so on. I find strong evidence on the existence of unobserved heterogeneity that deceives the testable implication. Once the unobserved heterogeneity is controlled, I find conclusive statistical grounds supporting the presence of moral hazard in the Colombian insurance market.

Informalidad laboral: ineficiencia fiscal y desprotección social

La informalidad laboral ha sido durante d ecadas el com un denominador entre las econom ías latinoamericanas. En Colombia, a pesar de haberse despertado un inter es por realizar un seguimiento a este segmento del mercado de trabajo desde el año 1986, parece no haberse dado ning ún tipo de regulaci ón o polí tica que pretendiese reducir la proporci on de los informales dentro del total de la poblaci on ocupada. Siendo la informalidad laboral un factor contrací clico con un coefi ciente de correlaci ón bastante bajo y dadas las modestas tasas de crecimiento de la economía colombiana, hasta febrero de 2010, un 57,8% de la poblaci on urbana ocupada del pa ís a un pertenece a tan indeseado sector del mercado laboral. Este trabajo pretende mostrar por qu e la informalidad laboral es un indicador relevante de la situaci ón de la economía colombiana, y por qu e debe tenerse en cuenta a la hora de tomar diversos tipos de decisiones y polí ticas econ ómicas, sin que este indicador quede a la sombra de la tasa de desempleo. Para esto se hace una clasi caci ón y posterior estimaci on de los costos fiscales consecuentes del actual escenario de formalidad-informalidad y, fi nalmente, se calcula un índice que pretende mostrar los efectos de la informalidad sobre la sostenibilidad fiscal del Sector Salud en el paí s.

User Experience (a hidden barrier) in OER

More Open Education Resources (OER) and learning environments are being created and starting to mature and there are a number of barriers to learning and creator participation. One often overlooked barrier that has been given less attention, especially within OERs, is user experience (UX). UX is the way a person feels about using a product, system or service. We are creatures with emotional needs and, in the rush to get great content open and available sometimes the usability, the wow factor and good design principles get left by the wayside. I will demonstrate ways to think about UX for your OER and learning environments and why this is an important factor in helping engage learners with our educational materials. ‘The real payoff comes when we can make that remarkability last. When we can make people continually feel our work is worthy of discussion. When—for weeks, months, maybe even years— the people who engage with our work continue to sing its praises to everybody they meet’– (Jared Spool in Walter, A. Designing for Emotion). Walter, A. (2011) Designing for Emotion, A Book Apart. http://www.abookapart.com/products/designing-for-emotion

Identification of plasmodium vivax proteins with potential role in invasion using sequence redundancy reduction and profile hidden markov models

Background: This study describes a bioinformatics approach designed to identify Plasmodium vivax proteins potentially involved in reticulocyte invasion. Specifically, different protein training sets were built and tuned based on different biological parameters, such as experimental evidence of secretion and/or involvement in invasion-related processes. A profile-based sequence method supported by hidden Markov models (HMMs) was then used to build classifiers to search for biologically-related proteins. The transcriptional profile of the P. vivax intra-erythrocyte developmental cycle was then screened using these classifiers. Results: A bioinformatics methodology for identifying potentially secreted P. vivax proteins was designed using sequence redundancy reduction and probabilistic profiles. This methodology led to identifying a set of 45 proteins that are potentially secreted during the P. vivax intra-erythrocyte development cycle and could be involved in cell invasion. Thirteen of the 45 proteins have already been described as vaccine candidates; there is experimental evidence of protein expression for 7 of the 32 remaining ones, while no previous studies of expression, function or immunology have been carried out for the additional 25. Conclusions: The results support the idea that probabilistic techniques like profile HMMs improve similarity searches. Also, different adjustments such as sequence redundancy reduction using Pisces or Cd-Hit allowed data clustering based on rational reproducible measurements. This kind of approach for selecting proteins with specific functions is highly important for supporting large-scale analyses that could aid in the identification of genes encoding potential new target antigens for vaccine development and drug design. The present study has led to targeting 32 proteins for further testing regarding their ability to induce protective immune responses against P. vivax malaria.