The stockpiling of neuraminidase inhibitor (NAI) antivirals as a defence against pandemic influenza is a significant public health policy decision that must be made despite a lack of conclusive ...evidence from randomised controlled trials regarding the effectiveness of NAIs on important clinical end points such as mortality. The objective of this study was to determine whether NAIs should be stockpiled for treatment of pandemic influenza on the basis of current evidence.
: A decision model for stockpiling was designed. Data on previous pandemic influenza epidemiology was combined with data on the effectiveness of NAIs in reducing mortality obtained from a recent individual participant meta-analysis using observational data. Evidence synthesis techniques and a bias modelling method for observational data were used to incorporate the evidence into the model. The stockpiling decision was modelled for adults (≥16 years old) and the United Kingdom was used as an example. The main outcome was the expected net benefits of stockpiling in monetary terms. Health benefits were estimated from deaths averted through stockpiling.
: After adjusting for biases in the estimated effectiveness of NAIs, the expected net benefit of stockpiling in the baseline analysis was £444 million, assuming a willingness to pay of £20,000/QALY ($31,000/QALY). The decision would therefore be to stockpile NAIs. There was a greater probability that the stockpile would not be utilised than utilised. However, the rare but catastrophic losses from a severe pandemic justified the decision to stockpile.
: Taking into account the available epidemiological data and evidence of effectiveness of NAIs in reducing mortality, including potential biases, a decision maker should stockpile anti-influenza medication in keeping with the postulated decision rule.
The town of Sivakasi in Tamil Nadu's Virudhunagar district in India produces majority of the country's consumption of firework items. Handling numerous chemicals is a necessary part of the firework ...industry's manufacturing process. As a result, the firework industry is commonly reported to be highly dangerous because of the hazardous nature of the chemicals used to create the sparkling effects during the ignition of firework crackers. Previous research have focused on harmful behaviors and hazardous conditions, pointing to human error as the primary cause of many accidents. According to the findings of this study, the majority of explosions were caused by the improper handling of hazardous chemicals and carelessness when making fireworks. Therefore, a method was presented in this paper which aims to examine the likelihood of human error in the fireworks industry. The proposed method uses task analysis and prediction of human error to shape the performance elements. The presented model can also be used to examine potential accident scenarios. The results show that the presented greedy-based process compared with the rule mining-based approach gives better accuracy and outcomes for the prediction of human error possibilities in the fireworks industry.
Background: Intimate partner violence against women (IPVAW) is a serious public health issue, conferring immediate and long-term threats to women's health. IPVAW exposure has often been associated ...with increased vulnerability to human immunodeficiency virus (HIV) and negative reproductive health outcomes. One factor that has recently been acknowledged as one of the strongest predictors, however, is attitudes towards IPVAW. Despite the growing evidence supporting a link between neighborhood context and health and health behavior, only a limited number of studies have investigated the relationship between neighborhood characteristics and IPVAW net of individual-level characteristics. Much research has focused on individual-level factors. Beyond the communities, individuals will be influenced by national policies which affect the proximate determinants of health and health behavior and attitudes.Aims: We described and compared attitudes toward intimate partner violence and associated socio-demographic, structural, and attitudinal factors among men and women from sub-Saharan Africa (SSA) (Study I) and explored plausible gender differences to examine societal level factors associated with it (Study II). We also examined if there are any evidence for area- and societal-level social inequalities on women’ attitudes toward IPVAW to further understand the pathway by which the broader social environment could influence the individual attitude (Study III). We further studied the association between gender inequality and exposure to IPVAW (Study IV) and examined whether men’s and women's attitudes (i.e. believing that IPVAW is justified) are directly linked to exposure and perpetuation of violence (Study V)Methods: We utilised data from 17 Demographic and Health Surveys (DHS) conducted between 2003 and 2007 among 165,983 women and 68,501 men nested within 7465 communities from 17 countries in SSA. We used multiple logistic regression models estimated by likelihood ratio test to explore factors associated with attitudes towards IPVAW (Study I). In Study II, we used meta-analytic methods to examine relationship between societal-level measures of socioeconomic position (SEP) and gender differences in attitude towards IPVAW. In Study III & IV, We applied multivariable multilevel logistic regression analysis. In study V, we used multilevel structural equation modelling.Results: We found that IPVAW was widely accepted under certain circumstances by men and women in all the countries studied (Study I).Women were more likely to justify IPVAW than men (Studies I, II & III). “Neglecting the children” was the most common reason agreed to by both women and men for justifying IPVAW followed by “going out without informing husband” and “arguing back with the husband” (Study I). Increasing wealth status, education attainment, urbanization, access to media, and joint decision making were associated with decreased odds of justifying IPVAW in most countries (Study I). The magnitude in gender disparity in attitudes towards IPVAW increased with increasing percentage of men practicing polygamy in each country (Study II). Men and women living in disadvantaged communities had higher rates of justifying IPVAW compared with their counterparts residing in the most advantaged communities after adjustment for individual SEP (Study III). In addition, women whose husband had higher education and women whose husband had more than one wife were more likely to accept IPVAW than other women (Study IV). Women who with positive attitudes towards IPVAW and those that had witnessed IPVAW were more likely to have reported spousal abuse (Study V).Conclusions: This large comparative analysis has provided evidence that IPVAW was widely acceptable under certain circumstances and more such among women, younger people, less educated, poorest, those living in rural areas, those with less access to media and single decision makers. We found that individual, community and societal context in which people live is associated with attitudes towards IPVAW.
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