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Effective Delivery (effective + delivery)
Selected AbstractsDistrict health systems in a neoliberal world: a review of five key policy areas,INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2003Malcolm Segall Abstract District health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity. The relegation in the World Health Report 2000 of primary health care to a ,second generation' reform,to be superseded by third generation reforms with a market orientation,flows from an analysis that is historically flawed and ideologically biased. Primary health care has struggled against economic crisis and adjustment and a neoliberal ideology often averse to its principles. To ascribe failures of primary health care to a weakness in policy design, when the political economy has starved it of resources, is to blame the victim. Improvement in the working and living conditions of health workers is a precondition for the effective delivery of public health services. A multidimensional programme of health worker rehabilitation should be developed as the foundation for health service recovery. District health systems can and should be financed (at least mainly) from public funds. Although in certain situations user fees have improved the quality and increased the utilization of primary care services, direct charges deter health care use by the poor and can result in further impoverishment. Direct user fees should be replaced progressively by increased public finance and, where possible, by prepayment schemes based on principles of social health insurance with public subsidization. Priority setting should be driven mainly by the objective to achieve equity in health and wellbeing outcomes. Cost effectiveness should enter into the selection of treatments for people (productive efficiency), but not into the selection of people for treatment (allocative efficiency). Decentralization is likely to be advantageous in most health systems, although the exact form(s) should be selected with care and implementation should be phased in after adequate preparation. The public health service should usually play the lead provider role in district health systems, but non-government providers can be contracted if needed. There is little or no evidence to support proactive privatization, marketization or provider competition. Democratization of political and popular involvement in health enhances the benefits of decentralization and community participation. Integrated district health systems are the means by which specific health programmes can best be delivered in the context of overall health care needs. International assistance should address communicable disease control priorities in ways that strengthen local health systems and do not undermine them. The Global Fund to Fight AIDS, Tuberculosis and Malaria should not repeat the mistakes of the mass compaigns of past decades. In particular, it should not set programme targets that are driven by an international agenda and which are achievable only at the cost of an adverse impact on sustainable health systems. Above all the targets must not retard the development of the district health systems so badly needed by the rural poor. Copyright © 2003 John Wiley & Sons, Ltd. [source] A brief introduction to cell-penetrating peptidesJOURNAL OF MOLECULAR RECOGNITION, Issue 5 2003Pontus Lundberg Abstract Cell membranes act as protective walls to exclude most molecules that are not actively imported by living cells. This is an efficient way for a cell to prevent uncontrolled influx or efflux of solutes, which otherwise would be harmful to it. Only compounds within a narrow range of molecular size, polarity and net charge are able to diffuse effectively through cell membranes. In order to overcome this barrier for effective delivery of membrane-impermeable molecules, several chemical and physical methods have been developed. These methods, e.g. electroporation, and more recent methods as cationic lipids/liposomes, have been shown to be effective for delivering hydrophobic macromolecules. The drawbacks of these harsh methods are, primarily, the unwanted cellular effects exerted by them, and, secondly, their limitation to in vitro applications. The last decade's discovery of cell-penetrating peptides translocating themselves across cell membranes of various cell lines, along with a cargo 100-fold their own size, via a seemingly energy-independent process, opens up the possibility for efficient delivery of DNA, antisense peptide nucleic acids, oligonucleotides, proteins and small molecules into cells both in vitro and in vivo. Copyright © 2003 John Wiley & Sons, Ltd. [source] Compartmental transport model of microbicide delivery by an intravaginal ringJOURNAL OF PHARMACEUTICAL SCIENCES, Issue 8 2010Anthony R. Geonnotti Abstract Topical antimicrobials, or microbicides, are being developed to prevent HIV transmission through local, mucosal delivery of antiviral compounds. While hydrogel vehicles deliver the majority of current microbicide products, intravaginal rings (IVRs) are an alternative microbicide modality in preclinical development. IVRs provide a long-term dosing alternative to hydrogel use, and might provide improved user adherence. IVR efficacy requires sustained delivery of antiviral compounds to the entire vaginal compartment. A two-dimensional, compartmental vaginal drug transport model was created to evaluate the delivery of drugs from an intravaginal ring. The model utilized MRI-derived ring geometry and location, experimentally defined ring fluxes and vaginal fluid velocities, and biophysically relevant transport theory. Model outputs indicated the presence of potentially inhibitory concentrations of antiviral compounds along the entire vaginal canal within 24,h following IVR insertion. Distributions of inhibitory concentrations of antiviral compounds were substantially influenced by vaginal fluid flow and production, while showing little change due to changes in diffusion coefficients or ring fluxes. Additionally, model results were predictive of in vivo concentrations obtained in clinical trials. Overall, this analysis initiates a mechanistic computational framework, heretofore missing, to understand and evaluate the potential of IVRs for effective delivery of antiviral compounds. © 2010 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 99:3514,3521, 2010 [source] A novel approach to treating eating disorders in a day-hospital treatment programNUTRITION & DIETETICS, Issue 3 2010Mellisa ASHLEY Abstract Aim:, The aim of the present study was to evaluate the short-term effectiveness of an adult day-hospital program that uses a novel approach to delivering nutritional interventions. Methods:, Fifty-six adult eating disorder patients of the Sydney West Area Eating Disorders Day Treatment Program participated in the study. Participants completed standardised self-reported questionnaires designed to measure eating disorder symptoms, at the commencement of treatment and after 12 weeks. Results:, Participation in day-hospital treatment was associated with increases in weight, reductions in number of binge-eating and purging episodes, and frequency of exercise sessions. Participants also experienced improvements in their eating attitudes, drive for thinness, bulimia, depression and anxiety symptoms. Conclusion:, These findings add to the growing body of literature supporting the use of day-hospital programs in the treatment of eating disorders. A number of strategies are suggested for the effective delivery of nutritional interventions in day-hospital programs, such as methods that assist with integrating new information, having an experiential focus and the use of collaborative education processes. [source] Pulmonary mucus: Pediatric perspectivePEDIATRIC PULMONOLOGY, Issue 3 2003Duncan F. Rogers PhD Abstract Airway mucus hypersecretion is a clinical feature of a number of childhood diseases, including asthma and bronchitis-associated conditions. However, compared with adults, there is relatively scarce information concerning mucus pathophysiology in respiratory diseases in children. The available evidence indicates many similarities between adult and childhood respiratory hypersecretory conditions, including goblet-cell hyperplasia and submucosal gland hypertrophy, and airway mucus plugging in asthma. Consequently, it is likely that treatments that are effective in adults would be effective in children. Numerous therapeutic targets are linked to the pathophysiology of airway mucus hypersecretion in experimental models and adults with respiratory disease. Whether or not these same targets are relevant in children is for the most part unclear. These targets include the inflammatory cells mediating the inflammatory response that generates the hypersecretory phenotype, and highly specific cellular elements such as epidermal growth factor receptor tyrosine kinase and calcium-activated chloride (CACL) channels. Identification of these factors is linked with the development of different classes of pharmacotherapeutic molecules directed at these targets. Compounds with a broader spectrum of anti-inflammatory activity are likely to be more effective than compounds with restricted activity. However, certain highly specific targets, such as human CACL1 channels, appear to be strongly associated with the development of an airway hypersecretory phenotype. Data from current clinical trials in adults with blockers of these specific targets are awaited with great interest. The hope is that, if effective, pediatric trials with these compounds could be initiated with a view to alleviation of the clinical impact of airway mucus hypersecretion in children. A significant challenge to the therapeutic progression of these new compounds is effective delivery to the airways in children, with the research effort into development of new compounds matched by advances in inhaler design. Pediatr Pulmonol. 2003; 36:178,188. © 2003 Wiley-Liss, Inc. [source] Permeation of urea through various polyurethane membranesPEST MANAGEMENT SCIENCE (FORMERLY: PESTICIDE SCIENCE), Issue 11 2009Atsushi Watanabe Abstract BACKGROUND: Controlled-release systems using polymer membranes are very important in agriculture for labour-saving and effective delivery of pesticides and other agents. Polymer-coated granules are one of the most useful formulations, and a study of the factors for polymer design is necessary to achieve various release patterns. A permeation study using plain membranes was carried out in order to clarify parameters, and the results were compared with the release from polymer-coated granules. RESULTS: The permeation coefficient of urea through a plain polyurethane membrane decreased significantly as the urethane and alkyl side chain content increased. The glass transition temperature and crosslink density of the polyurethanes hardly influenced its permeability. The release rate from polyurethane-coated granules was also reduced by alkyl side chains. However, it was faster than that through a plain membrane because of capsule expansion by continuous water penetration and structural changes in the membrane. CONCLUSION: The release rate of urea through a polyurethane plain membrane and from polyurethane-coated granules can be controlled by changing the chemical properties of the membrane. In addition, physical properties such as the glass transition temperature Tg or crosslink density should be considered to assess the release profile from polyurethane-coated granules. Copyright © 2009 Society of Chemical Industry [source] Adolescent and Therapist Perception of Barriers to Outpatient Substance Abuse TreatmentTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 2006Janell Lynn Mensinger PhD Attrition is one of the most vexing problems for the effective delivery of behavioral health services. Most prior studies focus on patient demographics and psychopathology factors predicting dropout. We examined patient and therapist post-treatment reports of barriers to attending treatment. Six hundred adolescents and their therapists completed the Perceived Barriers to Treatment scale (PBT) at discharge from a brief substance abuse intervention. After adjusting for covariates, results suggest that perceived barriers, in particular, practical obstacles, lack of treatment readiness, relevance, and compatibility, are related to sessions attended. Shifting to a more patient-centered approach for understanding treatment retention is discussed. [source] Amphoteric liposomes enable systemic antigen-presenting cell,directed delivery of CD40 antisense and are therapeutically effective in experimental arthritisARTHRITIS & RHEUMATISM, Issue 4 2009Evangelos Andreakos Objective Mediation of RNA interference by oligonucleotides constitutes a powerful approach for the silencing of genes involved in the pathogenesis of inflammatory disease, but in vivo application of this technique requires effective delivery to immune cells and/or sites of inflammation. The aim of the present study was to develop a new carrier system to mediate systemic administration of oligonucleotides to rheumatoid arthritis (RA) joints, and to develop an antisense oligonucleotide (ASO),based approach to interfere with CD40,CD154 interactions in an experimental model of RA. Methods A novel liposomal carrier with amphoteric properties, termed Nov038, was developed and assessed for its ability to systemically deliver an ASO directed against CD40 (CD40-ASO). Male DBA/1 mice with collagen-induced arthritis were treated with Nov038-encapsulated CD40-ASO, and the effects of treatment on various parameters of disease activity, including clinical score, paw swelling, lymph node responses, and inflammatory cytokine production in the joints, were assessed. Results Nov038 was well tolerated, devoid of immune-stimulatory effects, and efficacious in mediating systemic oligonucleotide delivery to sites of inflammation. In mice with collagen-induced arthritis, Nov038 enabled the therapeutic administration of CD40-ASO and improved established disease, while unassisted CD40-ASO was ineffective, and anti,tumor necrosis factor , (anti-TNF,) treatment was less effective in this model. Nov038/CD40-ASO efficacy was attributed to its tropism for monocyte/macrophages and myeloid dendritic cells (DCs), resulting in rapid down-regulation of CD40, inhibition of DC antigen presentation, and reduction in collagen-specific T cell responses, as well as decreased levels of TNF,, interleukin-6 (IL-6), and IL-17 in arthritic joints. Conclusion Amphoteric liposomes represent a novel carrier concept for systemic and antigen-presenting cell,targeted oligonucleotide delivery with clinical applicability and numerous potential applications, including target validation in vivo and inflammatory disease therapeutics. Moreover, Nov038/CD40-ASO constitutes a potent alternative to monoclonal antibody,based approaches for interfering with CD40,CD40L interactions. [source] | |||||||||||||