Cost risk benefit analysis to support chemoprophylaxis policy for travellers to malaria endemic countries

Background: In a number of malaria endemic regions, tourists and travellers face a declining risk of travel associated malaria, in part due to successful malaria control. Many millions of visitors to these regions are recommended, via national and international policy, to use chemoprophylaxis which has a well recognized morbidity profile. To evaluate whether current malaria chemo-prophylactic policy for travellers is cost effective when adjusted for endemic transmission risk and duration of exposure. a framework, based on partial cost-benefit analysis was used Methods: Using a three component model combining a probability component, a cost component and a malaria risk component, the study estimated health costs avoided through use of chemoprophylaxis and costs of disease prevention (including adverse events and pre-travel advice for visits to five popular high and low malaria endemic regions) and malaria transmission risk using imported malaria cases and numbers of travellers to malarious countries. By calculating the minimal threshold malaria risk below which the economic costs of chemoprophylaxis are greater than the avoided health costs we were able to identify the point at which chemoprophylaxis would be economically rational. Results: The threshold incidence at which malaria chemoprophylaxis policy becomes cost effective for UK travellers is an accumulated risk of 1.13% assuming a given set of cost parameters. The period a travellers need to remain exposed to achieve this accumulated risk varied from 30 to more than 365 days, depending on the regions intensity of malaria transmission. Conclusions: The cost-benefit analysis identified that chemoprophylaxis use was not a cost-effective policy for travellers to Thailand or the Amazon region of Brazil, but was cost-effective for travel to West Africa and for those staying longer than 45 days in India and Indonesia.

Cross-National Analysis of the Associations between Traumatic Events and Suicidal Behavior: Findings from the WHO World Mental Health Surveys

Background: Community and clinical data have suggested there is an association between trauma exposure and suicidal behavior (i.e., suicide ideation, plans and attempts). However, few studies have assessed which traumas are uniquely predictive of: the first onset of suicidal behavior, the progression from suicide ideation to plans and attempts, or the persistence of each form of suicidal behavior over time. Moreover, few data are available on such associations in developing countries. The current study addresses each of these issues. Methodology/Principal Findings: Data on trauma exposure and subsequent first onset of suicidal behavior were collected via structured interviews conducted in the households of 102,245 (age 18+) respondents from 21 countries participating in the WHO World Mental Health Surveys. Bivariate and multivariate survival models tested the relationship between the type and number of traumatic events and subsequent suicidal behavior. A range of traumatic events are associated with suicidal behavior, with sexual and interpersonal violence consistently showing the strongest effects. There is a dose-response relationship between the number of traumatic events and suicide ideation/attempt; however, there is decay in the strength of the association with more events. Although a range of traumatic events are associated with the onset of suicide ideation, fewer events predict which people with suicide ideation progress to suicide plan and attempt, or the persistence of suicidal behavior over time. Associations generally are consistent across high-, middle-, and low-income countries. Conclusions/Significance: This study provides more detailed information than previously available on the relationship between traumatic events and suicidal behavior and indicates that this association is fairly consistent across developed and developing countries. These data reinforce the importance of psychological trauma as a major public health problem, and highlight the significance of screening for the presence and accumulation of traumatic exposures as a risk factor for suicide ideation and attempt.

Interference with Hemozoin Formation Represents an Important Mechanism of Schistosomicidal Action of Antimalarial Quinoline Methanols

Background: The parasitic trematode Schistosoma mansoni is one of the major causative agents of human schistosomiasis, which afflicts 200 million people worldwide. Praziquantel remains the main drug used for schistosomiasis treatment, and reliance on the single therapy has been prompting the search for new therapeutic compounds against this disease. Our group has demonstrated that heme crystallization into hemozoin (Hz) within the S. mansoni gut is a major heme detoxification route with lipid droplets involved in this process and acting as a potential chemotherapeutical target. In the present work, we investigated the effects of three antimalarial compounds, quinine (QN), quinidine (QND) and quinacrine (QCR) in a murine schistosomiasis model by using a combination of biochemical, cell biology and molecular biology approaches. Methodology/Principal Findings: Treatment of S. mansoni-infected female Swiss mice with daily intraperitoneal injections of QN, and QND (75 mg/kg/day) from the 11(th) to 17(th) day after infection caused significant decreases in worm burden (39%-61%) and egg production (42%-98%). Hz formation was significantly inhibited (40%-65%) in female worms recovered from QN- and QND-treated mice and correlated with reduction in the female worm burden. We also observed that QN treatment promoted remarkable ultrastructural changes in male and female worms, particularly in the gut epithelium and reduced the granulomatous reaction to parasite eggs trapped in the liver. Microarray gene expression analysis indicated that QN treatment increased the expression of transcripts related to musculature, protein synthesis and repair mechanisms. Conclusions: The overall significant reduction in several disease burden parameters by the antimalarial quinoline methanols indicates that interference with Hz formation in S. mansoni represents an important mechanism of schistosomicidal action of these compounds and points out the heme crystallization process as a valid chemotherapeutic target to treat schistosomiasis.

New perspectives on the processing and release of public information

This article discusses issues related to the organization and reception of information in the context of services and public information systems driven by technology. It stems from the assumption that in a ""technologized"" society, the distance between users and information is almost always of cognitive and socio-cultural nature, a product of our effort to design communication. In this context, we favor the approach of the information sign, seeking to answer how a documentary message turns into information, i.e. a structure recognized as socially useful. Observing the structural, cognitive and communicative aspects of the documentary message, based on Documentary Linguistics, Terminology, as well as on Textual Linguistics, the policy of knowledge management and innovation of the Government of the State of Sao Paulo is analyzed, which authorizes the use of Web 2.0, also questioning to what extent this initiative represents innovation in the environment of libraries.

Communism and Public Opinion in Queensland, 1939-1951 : An Explanation of Queensland's Vote in the 1951 Anti-Communist Referendum

The starting point of this thesis was a desire to explain the rapid demise in the popularity which the Communist Party enjoyed in Queensland during the second world war. Wartime Queensland gave the Australian Communist Party its highest state vote and six years later Queensland again gave the Communist Party its highest state vote - this time however, to ban the Party. From this I was led into exploring the changing policies, beliefs and strategies of the Party, as well as the many sub-groups on its periphery, and the shifts in public response to these. In 1939 Townsville elected Australia's first Communist alderman. Five years later, Bowen elected not only Australia's first but also the British Empire's first, Communist state government member. Of the five electorates the Australian Communist Party contested in the 1944 Queensland State elections, in none did the Party's candidate receive less than twenty per-cent of the formal vote. Not only was the Party seemingly enjoying considerable popular support but this was occurring in a State which, but for the Depression years (May 1929 - June 1932) had elected a Labor State Government at every state election since 1915. In the September 1951 Constitution Alteration Referendum, 'Powers To Deal With Communists and Communism', Queensland regist¬ered the nation's highest "Yes" majority - 55.76% of the valid vote. Only two other states registered a majority in favour of the referendum's proposals, Western Australia and Tasmania. As this research was undertaken it became evident that while various trends exhibited at the time, anti-Communism, the work of the Industrial Groups, Labor opportunism, local area feelings, ideological shifts of the Party, tactics of Communist-led unions, etc., were present throughout the entire period, they were best seen when divided into three chronological phases of the Party's history and popularity. The first period covers the consolidation of the Party's post-Depression popularity during the war years as it benefited from the Soviet Union's colossal contribution to the Allied war efforts, and this support continued for some six months or so after the war. Throughout the period Communist strength within the trade union movement greatly increased as did total Party membership. The second period was marked by a rapid series of events starting in March 1946, with Winston Churchill's "Official Opening" of the Cold War by his sweeping attack on Communism and Russia, at Fulton. Several days later the first of a series of long and bitter strikes in Communist-led unions occurred, as the Party mobil¬ized for what it believed would be a series of attacks on the working class from a ruling class, defending a capitalist system on the verge of an economic collapse. It was a period when the Party believed this ruling class was using Labor reformism as a last desperate 'carrot' to get workers to accept their lot within a capitalist economic framework. Out of the Meat Strike emerged the Industrial Groups, who waged not only a determined war against Communist trade union leadership but also encouraged the A.W.U.-influenced State Labor apparatus to even greater anti-Communist antagonisms. The Communist Party's increasing militancy and Labor's resistance to it, ended finally in the collapse of the Chifley Labor government. Characteristically the third period opens with the Communist Party making an another about-face, desperately trying to form an alliance with the Labor Party and curbing its former adventurist industrial policy, as it prepared for Menzies' direct assault. The Communist Party's activities were greatly reduced, a function of both a declining member-ship and, furthermore, a membership reluctant to confront an increasingly hostile society. In examining the changing policies, beliefs and strategies of the Party and the shifts in public response to these, I have tried to distinguish between general trends occurring within Australia and the national party, and trends peculiar to Queensland and the Queensland branch of the Party, The Communist Party suffered a decline in support and membership right across Australia throughout this period as a result of the national policies of the Party, and the changing nature of world politics. There were particular features of this decline that were peculiar to Queensland. I have, however, singled out three features of particular importance throughout the period for a short but more specifically detailed analysis, than would be possible in a purely chronological study: i.e. the Party's structure, the Party's ideological subservience to Moscow, and the general effect upon it of the Cold War.

Public policy in knowledge-based economies: Foundations and frameworks

Knowledge is a product of human social systems and, therefore, the foundations of the knowledge-based economy are social and cultural. Communication is central to knowledge creation and diffusion, and Public Policy in Knowledge-Based Economies highlights specific social and cultural conditions that can enhance the communication, use and creation of knowledge in a society.The purpose of this book is to illustrate how these social and cultural conditions are identified and analysed through new conceptual frameworks. Such frameworks are necessary to penetrate the surface features of knowledge-based economies - science and technology - and disclose what drives such economies.This book will provide policymakers, analysts and academics with the fundamental tools needed for the development of policy in this little understood and emerging area.

Screening for leprosy in immigrants: A decision analysis model

Almost all leprosy cases reported in industrialized countries occur amongst immigrants or refugees from developing countries where leprosy continues to be an important health issue. Screening for leprosy is an important question for governments in countries with immigration and refugee programmes. A decision analysis framework is used to evaluate leprosy screening. The analysis uses a set of criteria and parameters regarding leprosy screening, and available data to estimate the number of cases which would be detected by a leprosy screening programme of immigrants from countries with different leprosy prevalences, compared with a policy of waiting for immigrants who develop symptomatic clinical diseases to present for health care. In a cohort of 100,000 immigrants from high leprosy prevalence regions (3.6/10,000), screening would detect 32 of the 42 cases which would arise in the destination country over the 14 years after migration; from medium prevalence areas (0.7/10,000) 6.3 of the total 8.1 cases would be detected, and from low prevalence regions (0.2/10,600) 1.8 of 2.3 cases. Using Australian data, the migrant mix would produce 74 leprosy cases from 10 years intake; screening would detect 54, and 19 would be diagnosed subsequently after migration. Screening would only produce significant case-yield amongst immigrants from regions or social groups with high leprosy prevalence. Since the number of immigrants to Australia from countries of higher endemnicity is not large routine leprosy screening would have a small impact on case incidence.

A costs structure analysis of the Brazilian sugar and ethanol companies

The Brazil consolidated itself as the largest world producer of sugarcane, sugar and ethanol. The creation of the Programa Nacional do Alcool - PROALCOOL and the growing use of cars with flexible motors were some of the factors that helped to motivate still more the production. Evolutions in the agricultural and industrial research did the Brazilian competitiveness in sugar and ethanol globally elevated, what is evidenced when comparing the amount produced at the country and the production costs, which turned a big one differential. Therefore, the administration of costs is of great relevance to the sugar and ethanol companies, for representing a significant rationalization in the production processes, with economy of resources and the reach of better earnings, besides reducing the operational risk pertinent at the fixed costs of production. Thus, the present work has for objective to analyze the costs structure of sugar and ethanol companies of the Center-south area of the country through an empiric-analytical study based in methodologies and concepts extracted of the costs accounting. It is verified that great part of the costs and operational expenses have variable behavior, a positive factor for the sector reducing the operational risk of the activity. The main restraint of this study is the sample of five years and 10% of the number of plants in Brazil that although they represent 30% of the national production, don`t allow the generalization of the model.

Decline in homicide rates in Sao Paulo, Brasil: a descriptive analysis

Objective. To describe homicide mortality in the municipality of Sao Paulo according to type of weapon, sex, race or skin color, age, and areas of socioeconomic inequalities, between 1996 and 2008. Method. For this ecological time-series study, data about deaths in the municipality of Sao Paulo were collected from the municipal program for improvement of mortality information, using International Classification of Diseases, 10th revision (ICD-10) codes. Homicide mortality rates (HMR) were calculated for the overall population and specifically for each sex, race or skin color, age range, type of weapon, and occurrence in social deprivation/affluence areas. HMR were adjusted for age using the direct method. The percentage age of variation in HMR was calculated for the study period. For areas of socioeconomic inequalities, the relative risk of death from homicide was calculated. Results. HMR fell 73.7% between 2001 and 2008. A reduction in HMR was observed in all groups, especially males (-74.5%), young men between 15 and 24 years of age (-78.0%), and residents in areas of extreme socioeconomic deprivation (-79.3%). The reduction occurred mostly in firearm homicide rates (-74.1%). The relative risk of death from homicide in areas of extreme socioeconomic deprivation, as compared to areas with some degree of socioeconomic deprivation, was 2.77 in 1996, 3.9 in 2001, and 2.13 in 2008. In areas of high socioeconomic deprivation, the relative risk was 2.07 in 1996 and 1.96 in 2008. Conclusions. To understand the reduction in homicide rates in the municipality of Sao Paulo, it is important to take into consideration macrodeterminants that affect the entire municipality and all population subgroups, as well as micro/local determinants that have special impact on homicides committed with firearms and on subgroups such as the young, males, and residents of areas of high socioeconomic deprivation.

Computer technology - A political player in social policy processes

The absence of considerations of technology in policy studies reinforces the popular notion that technology is a neutral tool, Through an analysis of the role played by computers in the policy processes of Australia's Department of Social Security, this paper argues that computers are political players in policy processes, Findings indicate that computers make aspects of the social domain knowable and therefore governable, The use of computers makes previously infeasible policies possible, Computers also operate as bureaucrats and as agents of client surveillance. Increased policy change, reduced discretion and increasingly targeted and complex policies can be attributed to the use of computer technology, If policy processes are to be adequately understood and analysed, then the role of technology in those processes must be considered.