Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

OBJECTIVES: To investigate epidemiological, social, diagnostic and economic aspects of chlamydia screening in non-genitourinary medicine settings. METHODS: Linked studies around a cross-sectional population-based survey of adult men and women invited to collect urine and (for women) vulvovaginal swab specimens at home and mail these to a laboratory for testing for Chlamydia trachomatis. Specimens were used in laboratory evaluations of an amplified enzyme immunoassay (PCE EIA) and two nucleic acid amplification tests [Cobas polymerase chain reaction (PCR), Becton Dickinson strand displacement amplification (SDA)]. Chlamydia-positive cases and two negative controls completed a risk factor questionnaire. Chlamydia-positive cases were invited into a randomised controlled trial of partner notification strategies. Samples of individuals testing negative completed psychological questionnaires before and after screening. In-depth interviews were conducted at all stages of screening. Chlamydia transmission and cost-effectiveness of screening were investigated in a transmission dynamic model. SETTING AND PARTICIPANTS: General population in the Bristol and Birmingham areas of England. In total, 19,773 women and men aged 16-39 years were randomly selected from 27 general practice lists. RESULTS: Screening invitations reached 73% (14,382/19,773). Uptake (4731 participants), weighted for sampling, was 39.5% (95% CI 37.7, 40.8%) in women and 29.5% (95% CI 28.0, 31.0%) in men aged 16-39 years. Chlamydia prevalence (219 positive results) in 16-24 year olds was 6.2% (95% CI 4.9, 7.8%) in women and 5.3% (95% CI 4.4, 6.3%) in men. The case-control study did not identify any additional factors that would help target screening. Screening did not adversely affect anxiety, depression or self-esteem. Participants welcomed the convenience and privacy of home-sampling. The relative sensitivity of PCR on male urine specimens was 100% (95% CI 89.1, 100%). The combined relative sensitivities of PCR and SDA using female urine and vulvovaginal swabs were 91.8% (86.1, 95.7, 134/146) and 97.3% (93.1, 99.2%, 142/146). A total of 140 people (74% of eligible) participated in the randomised trial. Compared with referral to a genitourinary medicine clinic, partner notification by practice nurses resulted in 12.4% (95% CI -3.7, 28.6%) more patients with at least one partner treated and 22.0% (95% CI 6.1, 37.8%) more patients with all partners treated. The health service and patients costs (2005 prices) of home-based postal chlamydia screening were 21.47 pounds (95% CI 19.91 pounds, 25.99) per screening invitation and 28.56 pounds (95% CI 22.10 pounds, 30.43) per accepted offer. Preliminary modelling found an incremental cost-effectiveness ratio (2003 prices) comparing screening men and women annually to no screening in the base case of 27,000 pounds/major outcome averted at 8 years. If estimated screening uptake and pelvic inflammatory disease incidence were increased, the cost-effectiveness ratio fell to 3700 pounds/major outcome averted. CONCLUSIONS: Proactive screening for chlamydia in women and men using home-collected specimens was feasible and acceptable. Chlamydia prevalence rates in men and women in the general population are similar. Nucleic acid amplification tests can be used on first-catch urine specimens and vulvovaginal swabs. The administrative costs of proactive screening were similar to those for opportunistic screening. Using empirical estimates of screening uptake and incidence of complications, screening was not cost-effective.

Fuelwood collection and consumption: a case study in Lupeta Tanzania

Fuelwood is a major resource in rural areas. Fuelwood collection and consumption habits were monitored in Lupeta, Tanzania through household interviews and fuelwood collection walks. Social dimensions, economic aspects of fuelwood, and alternative fuel sources were also examined. The study found that for all wealth classes, fuelwood is the primary source of fuel used within the village, with the middle and upper classes occasionally supplementing fuelwood with charcoal. Women collect and consume fuelwood for cooking. The majority of women (69%) prefer to use charcoal because fuelwood collection is labor intensive and time consuming. While the use of charcoal would provide more time for other required household activities, local economic constraints inhibit their adoption. The fuel shift from biomass fuels to transition fuels is happening slowly in Lupeta from fuelwood to charcoal. As fuelwood becomes scarcer, improved methods will need to be adopted or the fuel source will change.

Sustaining the Economic Rent of Oceanic Resources: The Case of Marine Protected Areas

This paper investigates economic aspects of marine protected areas (MPAs) that are closely related to the underlying marine biota. Many marine scientists recognize that enough is now known about the marine biology for the scientific siting of MPAs to protect marine environments that create associated economic values. Marine scientists have identified several objectives of MPAs. These include protection of genetic and biodiversity, increase in population levels and structures (e.g., age, size, fecundity), enrichment of ecosystems by promoting species interactions, and the protection of continental shelf landscapes from invasive human actions. Indeed, some marine scientists and fisheries economists view MPAs as an 'insurance policy' against over-fishing and other human uses of oceanic resources that have damaged so many of the world's fisheries. The economic analysis presented here pays attention to optimal zoning, policies to maintain sustainable economic rents, and the optimal policing of MPAs.

Na 1 Nachlass Max Horkheimer, 692 - "The Economic and Social Consequences of Preparedness Economics" (p. IX 167.1-7)

"The Economic and Social Consequences of Preparedness Economics" (1937-1939):; 1. "First Draft of a Memorandum on a Research Project on The Economic Consequences of Preparedness Economics, planned by the International Instittute of Social Research" (13.12.1938). Typoskript mit handschriftlichen Ergänzungen, 2 Blatt; 2. Albert Lauterbach: "Project submitted to the Social Science Research Council: Sociological and Economic Aspects of Preparedness Economics". Typoskript, 3 Blatt; 3. Günther Reimann: "The Economics of Chemical Production". Typoskript, 4 Blatt; 4. Franz Neumann: "Bemerkungen zum Exposé Dr. Heiders 'Die Rolle der Bürokratie im totalitären Staat'" (22.2.1937). Typoskript, 1 Blatt; 5. Joseph Soudek: "Soziale und wirtschaftliche Aspekte der Wehrwirtschaft". Typoskript mit handschriftlichen Korrekturen und Ergänzungen von Friedrich Pollock (16.1.1939), 5 Blatt; 6. "Recovery and Boom Politics", Gliederungsentwurf, 3 Blatt; 7. "Interventionism and Business Cycles", Gliederungsentwurf, 7 Blatt;

A review of economic analysis in the vaccination program; decision making and governance: Adivisory Committee on Immunization Practices (ACIP)

The Advisory Committee on Immunization Practices (ACIP) develops written recommendations for the routine administration of vaccines to children and adults in the U.S. civilian population. The ACIP is the only entity in the federal government that makes such recommendations. ACIP elaborates on selection of its members and rules out concerns regarding its integrity, but fails to provide information about the importance of economic analysis in vaccine selection. ACIP recommendations can have large health and economic consequences. Emphasis on economic evaluation in health is a likely response to severe pressures of the federal and state health budget. This study describes the economic aspects considered by the ACIP while sanctioning a vaccine, and reviews the economic evaluations (our economic data) provided for vaccine deliberations. A five year study period from 2004 to 2009 is adopted. Publicly available data from ACIP web database is used. Drummond et al. (2005) checklist serves as a guide to assess the quality of economic evaluations presented. Drummond et al.'s checklist is a comprehensive hence it is unrealistic to expect every ACIP deliberation to meet all of their criteria. For practical purposes we have selected seven criteria that we judge to be significant criteria provided by Drummond et al. Twenty-four data points were obtained in a five year period. Our results show that out of the total twenty-four data point‘s (economic evaluations) only five data points received a score of six; that is six items on the list of seven were met. None of the data points received a perfect score of seven. Seven of the twenty-four data points received a score of five. A minimum of a two score was received by only one of the economic analyses. The type of economic evaluation along with the model criteria and ICER/QALY criteria met at 0.875 (87.5%). These three criteria were met at the highest rate among the seven criteria studied. Our study findings demonstrate that the perspective criteria met at 0.583 (58.3%) followed by source and sensitivity analysis criteria both tied at 0.541 (54.1%). The discount factor was met at 0.250 (25.0%).^ Economic analysis is not a novel concept to the ACIP. It has been practiced and presented at these meetings on a regular basis for more than five years. ACIP‘s stated goal is to utilize good quality epidemiologic, clinical and economic analyses to help policy makers choose among alternatives presented and thus achieve a better informed decision. As seen in our study the economic analyses over the years are inconsistent. The large variability coupled with lack of a standardized format may compromise the utility of the economic information for decision-making. While making recommendations, the ACIP takes into account all available information about a vaccine. Thus it is vital that standardized high quality economic information is provided at the ACIP meetings. Our study may provide a call for the ACIP to further investigate deficiencies within the system and thereby to improve economic evaluation data presented. ^

El campesino griego : Sujeto de derecho en la Pólis

El campesinado en la Grecia antigua sufrió transformaciones en su estatus impositivo, desde una ausencia total de tributos en su perjuicio hasta el padecimiento de onerosas cargas fiscales. En ambos extremos de un mismo y único proceso se verifica un idéntico fenómeno, esto es, la incorporación del campesinado antiguo a la comunidad política, como miembro pleno con todos los derechos. El modelo de organización y participación política del campesinado rehúye las categorías sociológicas de sociedad primitiva, sociedad campesina o sociedad industrial. El objetivo del presente trabajo consiste en proponer una mirada de este sujeto que contemple su especificidad política, social y económica, desde una perspectiva cultural

A formulação das políticas públicas para a juventude rural no Brasil e os elementos constitutivos desse processo social

The construction of the research problem occurred in trying to investigate the configuration of public policies for the rural youth and how this political agenda was introduced in the State of the Brazil. The main issue in the research is how the process of configuration of public policies for rural youth in federal government has occurred. The methodology for this study used was qualitative research procedures were triggered participant observation, interviews and documentary analysis. During the research the actors, the formulated policies and rural youth category expressed during this process were highlighted

A formulação das políticas públicas para a juventude rural no Brasil e os elementos constitutivos desse processo social

The construction of the research problem occurred in trying to investigate the configuration of public policies for the rural youth and how this political agenda was introduced in the State of the Brazil. The main issue in the research is how the process of configuration of public policies for rural youth in federal government has occurred. The methodology for this study used was qualitative research procedures were triggered participant observation, interviews and documentary analysis. During the research the actors, the formulated policies and rural youth category expressed during this process were highlighted

El campesino griego : Sujeto de derecho en la Pólis

El campesinado en la Grecia antigua sufrió transformaciones en su estatus impositivo, desde una ausencia total de tributos en su perjuicio hasta el padecimiento de onerosas cargas fiscales. En ambos extremos de un mismo y único proceso se verifica un idéntico fenómeno, esto es, la incorporación del campesinado antiguo a la comunidad política, como miembro pleno con todos los derechos. El modelo de organización y participación política del campesinado rehúye las categorías sociológicas de sociedad primitiva, sociedad campesina o sociedad industrial. El objetivo del presente trabajo consiste en proponer una mirada de este sujeto que contemple su especificidad política, social y económica, desde una perspectiva cultural

El campesino griego : Sujeto de derecho en la Pólis

El campesinado en la Grecia antigua sufrió transformaciones en su estatus impositivo, desde una ausencia total de tributos en su perjuicio hasta el padecimiento de onerosas cargas fiscales. En ambos extremos de un mismo y único proceso se verifica un idéntico fenómeno, esto es, la incorporación del campesinado antiguo a la comunidad política, como miembro pleno con todos los derechos. El modelo de organización y participación política del campesinado rehúye las categorías sociológicas de sociedad primitiva, sociedad campesina o sociedad industrial. El objetivo del presente trabajo consiste en proponer una mirada de este sujeto que contemple su especificidad política, social y económica, desde una perspectiva cultural

A formulação das políticas públicas para a juventude rural no Brasil e os elementos constitutivos desse processo social

The construction of the research problem occurred in trying to investigate the configuration of public policies for the rural youth and how this political agenda was introduced in the State of the Brazil. The main issue in the research is how the process of configuration of public policies for rural youth in federal government has occurred. The methodology for this study used was qualitative research procedures were triggered participant observation, interviews and documentary analysis. During the research the actors, the formulated policies and rural youth category expressed during this process were highlighted

Migration and Wellbeing at the Lower Echelons of the Economy: A Study of Delhi Slums

This paper based on a primary survey of households (2004-05) in the slum clusters of Delhi examines whether migrants are likely to experience upward mobility in their place of destination or alternatively, if they merely transfer their poverty from rural areas to large cities. First, a simple bifurcation of population in terms of poor and non-poor sub-groups is examined along with the incidence of poverty across different categories of occupations and non-workers. Then, an explanation of the variations in per capita expenditure across households is provided, and a binomial logit model (poor/non-poor) is developed identifying the variables which raise (or reduce) the probability of being non-poor (or poor). Next, an estimate of the wellbeing (deprivation) index is derived from factor analysis of a large number of variables including demographic and economic aspects of households. Empirical findings suggest that while duration of migration and the wellbeing index do not have a definite relationship, migrant households who have been in the city for a very long time have a higher wellbeing index on average than those who migrated in the last ten years. This tends to support the view that migrants do not merely transfer rural poverty to urban areas, and further that population mobility yields improvement in the living standard, if only in the very long term. Implementation of "employment-cum-shelter" support schemes in the urban areas may contribute to their wellbeing.

O SNRC e os novos instrumentos de financiamento do agronegócio: o mercado de crédito rural brasileiro entre dois modelos

Esta pesquisa mostra como o desenvolvimento do sistema jurídico institucional do mercado de crédito rural no Brasil se desenvolveu a ponto de permitir a convivência de dois modelos normalmente considerados antitéticos: o modelo de economia de mercado coordenado via bancos públicos e o modelo de economia de mercado liberal. O primeiro capítulo da dissertação reconstrói como a teoria do Law and Finance que permite identificar adequadamente esse resultado de pesquisa se desenvolve a partir da crise das postulações e premissas da teoria econômica neoclássica. O segundo capítulo narra o desenvolvimento e crise do modelo do Sistema Nacional de Crédito Rural entre as décadas de 1960 e 1980, partindo de uma análise sobre sua estrutura, regulação e institutos. Passando dos modelos de organização financeira para as modalidades de crédito rural, o capítulo narra a lógica, estrutura e evolução do modelo calcado na alocação de recursos por banco públicos, de modo que essa elucidação de contexto histórico permite que se verifique a grande ruptura que é introduzida no sistema de financiamento rural a partir dos anos 2000. O terceiro capítulo narra e descreve o surgimento da estrutura, regulação e institutos regidos pela lógica de mercado liberal, até então ausente no SNCR para, após, realizar uma apreciação do resultado alcançado. Ao final, a conclusão reúne os principais achados dessa pesquisa, destaca os principais pontos de sua narrativa e os problematiza para uma agenda de pesquisa futura.

Coastal Erosion--Causes, Erosion Control Methods, Economic and Environmental Impacts, and Best Management Practices

Coastal erosion is an important and constant issue facing coastal areas all over the world today. The rate of coastal development over the years has increased, in turn requiring that action be taken to protect structures from the threat of erosion. A review of the causes of coastal erosion and the methods implemented to control it was conducted in order to determine the best course of action in response to coastal erosion issues. The potential positive and negative economic and environmental impacts are key concerns in determining whether or not to restore an eroding beach and which erosion control method(s) to implement. Results focus on providing a comparison of these concerns as well as recommendations for addressing coastal erosion issues.