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: Introduction: In 2018, the Mozambique Ministry of Health launched guidelines for implementing differentiated service delivery models (DSDMs) to optimize HIV service delivery, improve retention in care, and ultimately reduce HIV‐associated mortality. The models were fast‐track, 3‐month antiretrovirals dispensing, community antiretroviral therapy groups, adherence clubs, family approach and three one‐stop shop models: adolescent‐friendly health services, maternal and child health, and tuberculosis. We conducted a cost‐effectiveness analysis and budget impact analysis to compare these models to conventional services. Methods: We constructed a decision tree model based on the percentage of enrolment in each model and the probability of the outcome (12‐month retention in treatment) for each year of the study period—three for the cost‐effectiveness analysis (2019–2021) and three for the budget impact analysis (2022–2024). Costs for these analyses were primarily estimated per client‐year from the health system perspective. A secondary cost‐effectiveness analysis was conducted from the societal perspective. Budget impact analysis costs included antiretrovirals, laboratory tests and service provision interactions. Cost‐effectiveness analysis additionally included start‐up, training and clients’ opportunity costs. Effectiveness was estimated using an uncontrolled interrupted time series analysis comparing the outcome before and after the implementation of the differentiated models. A one‐way sensitivity analysis was conducted to identify drivers of uncertainty. Results: After implementation of the DSDMs, there was a mean increase of 14.9 percentage points (95% CI: 12.2, 17.8) in 12‐month retention, from 47.6% (95% CI, 44.9–50.2) to 62.5% (95% CI, 60.9–64.1). The mean cost difference comparing DSDMs and conventional care was US$ –6 million (173,391,277 vs. 179,461,668) and –32.5 million (394,705,618 vs. 433,232,289) from the health system and the societal perspective, respectively. Therefore, DSDMs dominated conventional care. Results were most sensitive to conventional care interaction costs in the one‐way sensitivity analysis. For a population of 1.5 million, the base‐case 3‐year financial costs associated with the DSDMs was US$550 million, compared with US$564 million for conventional care. Conclusions: DSDMs were less expensive and more effective in retaining clients 12 months after antiretroviral therapy initiation and were estimated to save approximately US$14 million for the health system from 2022 to 2024., INTRODUCTION In November 2018, Mozambique's Ministry of Health (MISAU) launched guidelines for the nationwide implementation of eight differentiated service delivery models (DSDMs) to increase efficiency and reduce HIV‐associated mortality. The [...]

Sixty-year-old Albert Einstein relaxed at a beach house rental in Peconic, Long Island, N.Y., in July 1939. The theoretical physicist and Nobel laureate relished occasional respite. A surprise visit from [...]

Introduction: In 2004, Mozambique, supported by large increases in international disease‐specific funding, initiated a national rapid scale‐up of antiretroviral treatment (ART) and HIV care through a vertical “Day Hospital” approach. Though this model showed substantial increases in people receiving treatment, it diverted scarce resources away from the primary health care (PHC) system. In 2005, the Ministry of Health (MOH) began an effort to use HIV/AIDS treatment and care resources as a means to strengthen their PHC system. The MOH worked closely with a number of NGOs to integrate HIV programs more effectively into existing public‐sector PHC services. Case Description: In 2005, the Ministry of Health and Health Alliance International initiated an effort in two provinces to integrate ART into the existing primary health care system through health units distributed across 23 districts. Integration included: a) placing ART services in existing units; b) retraining existing workers; c) strengthening laboratories, testing, and referral linkages; e) expanding testing in TB wards; f) integrating HIV and antenatal services; and g) improving district‐level management. Discussion: By 2008, treatment was available in nearly 67 health facilities in 23 districts. Nearly 30,000 adults were on ART. Over 80,000 enrolled in the HIV/AIDS program. Loss to follow‐up from antenatal and TB testing to ART services has declined from 70% to less than 10% in many integrated sites. Average time from HIV testing to ART initiation is significantly faster and adherence to ART is better in smaller peripheral clinics than in vertical day hospitals. Integration has also improved other non‐HIV aspects of primary health care. Conclusion: The integration approach enables the public sector PHC system to test more patients for HIV, place more patients on ART more quickly and efficiently, reduce loss‐to‐follow‐up, and achieve greater geographic HIV care coverage compared to the vertical model. Through the integration process, HIV resources have been used to rehabilitate PHC infrastructure (including laboratories and pharmacies), strengthen supervision, fill workforce gaps, and improve patient flow between services and facilities in ways that can benefit all programs. Using aid resources to integrate and better link HIV care with existing services can strengthen wider PHC systems., Introduction The rapid scale up of antiretroviral treatment (ART) and HIV care across Africa over the past five years has provoked an important and lively debate about the impact of [...]

Objectives. We explored the relationship between the preparedness of master of public health (MPH) graduates in public health law and ethics and their completion of courses in these areas. Methods. We reviewed accredited public health schools and programs to assess the supply of required and elective courses in law and ethics. In addition, we conducted an Internet-based scenario survey of MPH graduates. Survey results were analyzed, and relationships between scenario responses and completion of law and ethics courses were assessed. Results. Of the 93 programs and schools reviewed, 14% required a course in ethics and 16% required a course in law. The majority (range = 55%-76%) of the survey respondents indicated being 'prepared' or 'very prepared' for each of the 9 public health scenarios. There were no significant relationships between scenario responses and completion of an ethics course. Responses to 2 scenarios (one involving food code violations and one involving a prison population) were significantly related to participants' completion of a course in law. Conclusions. Few public health schools and programs require graduate courses in ethics and law. Most MPH graduates report being prepared to address public health challenges. Additional research is necessary to improve techniques for measuring preparedness. (doi:10.2105/AJPH.2007.133173)

A pathological hallmark of Alzheimer's disease is an accumulation of insoluble plaque containing the amyloid-β peptide of 40-42 amino acid residues (1). Prefibrillar, soluble oligomers of amyloid-β have been recognized to be early and key intermediates in Alzheimer's-disease-related synaptic dysfunction (2-9). At nanomolar concentrations, soluble amyloid-β oligomers block hippocampal long-term potentiation (7), cause dendritec spine retraction from pyramidal cells (5,8) and impair rodent spatial memory (2). Soluble amyloid-β oligomers have been prepared from chemical syntheses, transfected cell culture supernatants, transgenic mouse brain and human Alzheimer's disease brain (2,4,7,9). Together, these data imply a high-affinity cell-surface receptor for soluble amyloid-β oligomers on neurons-one that is central to the pathophysiological process in Alzheimer's disease. Here we identify the cellular prion protein ([PrP.sup.C]) as an amyloid-β-oligomer receptor by expression cloning. Amyloid-β oligomers bind with nanomolar affinity to [PrP.sup.C], but the interaction does not require the infectious [PrP.sup.Sc] conformation. Synaptic responsiveness in hippocampal slices from young adult PrP null mice is normal, but the amyloid-β oligomer blockade of long-term potentiation is absent. Anti-PrP antibodies prevent amyloid-β-oligomer binding to [PrP.sup.C] and rescue synaptic plasticity in hippocampal slices from oligomeric amyloid-β. Thus, [PrP.sup.C] is a mediator of amyloid-β-oligomer-induced synaptic dysfunction, and [PrP.sup.C]-specific pharmaceuticals may have therapeutic potential for Alzheimer's disease., To characterize amyloid-β-oligomer-binding sites, we synthesized amyloid-β(1-42) peptide conjugated to biotin through the α amino group (biotin-Aβ42), and then denatured the peptide and allowed oligomers to form as described for [...]

The challenges facing efforts in Africa to increase access to antiretroviral HIV treatment underscore the urgent need to strengthen national health systems across the continent. However, donor aid to developing countries continues to be disproportionately channeled to international nongovernmental organizations (NGOs) rather than to ministries of health. The rapid proliferation of NGOs has provoked 'brain drain' from the public sector by luring workers away with higher salaries, fragmentation of services, and increased management burdens for local authorities in many countries. Projects by NGOs sometimes can undermine the strengthening of public primary health care systems. We argue for a return to a public focus for donor aid, and for NGOs to adopt a code of conduct that establishes standards and best practices for NGO relationships with public sector health systems. doi:10.2105/AJPH. 2007.125989

The recent expansion of Pentecostalism and independent churches in Africa has generated growing interest among social scientists. This attention parallels a renewed interest among Africanists on witchcraft and occult activities, also believed by many to be increasing. Some suggest the two trends may be related, but it remains unclear how and why. Drawing on a study of Pentecostalism and health in the city of Chimoio, Mozambique, in 2002-03 that focused on attitudes toward recent social change, we argue that structural adjustment economic reforms have deepened economic inequality and exacerbated household stresses that affect men and women differently. Women increasingly seek spiritual help for reproductive health problems from Pentecostal churches, whereas men disproportionately pay traditional healers tO engage 'occult' practices to manage misfortune related to employment. The increased resort to both spiritual resources reveals social distress caused by economic adjustment, with important implications for health programs. [Keywords: Pentecostal, African Independent Churches, Mozambique, inequality, neoliberal]

Problem New WHO strategies for control of malaria in pregnancy (MiP) recommend intermittent preventive treatment (IPTp), bednet use and improved case management. Approach A pilot MiP programme in Mozambique was designed to determine requirements for scale-up. Local setting The Ministry of Health worked with a nongovernmental organization and an academic institution to establish and monitor a pilot programme in two impoverished malaria-endemic districts. Relevant changes Implementing the pilot programme required provision of additional sulfadoxine-pyrimethamine (SP), materials for directly observed SP administration, bednets and a modified antenatal card. National-level formulary restrictions on SP needed to be waived. The original protocol required modification because imprecision in estimation of gestational age led to missed SP doses. Multiple incompatibilities with other health initiatives (including programmes for control of syphilis, anaemia and HIV) were discovered and overcome. Key outputs and impacts were measured; 92.5% of 7911 women received at least 1 dose of SP, with the mean number of SP doses received being 2.2. At the second antenatal visit, 13.5% of women used bednets. In subgroups (1167 for laboratory analyses; 2600 births), SP use was significantly associated with higher haemoglobin levels (10.9 g/dL if 3 doses, 10.3 if none), less malaria parasitaemia (prevalence 7.5% if 3 doses, 39.3% if none), and fewer low-birth-weight infants (7.3% if 3 doses, 12.5% if none). Lessons learned National-level scale-up will require attention to staffing, supplies, bednet availability, drug policy, gestational-age estimation and harmonization of vertical initiatives. Resume Traitement preventif intermittent contre le paludisme des femmes enceintes dans le centre du Mozambique Problematique Les nouvelles strategies de l'OMS pour la lutte contre le paludisme pendant la grossesse preconisent un traitement antipaludique preventif intermittent, l'utilisation de moustiquaires de lit et une amelioration de la prise en charge des cas. Demarche Un programme pilote pour la Mozambique de lutte contre le paludisme pendant la grossesse a ete concu pour determiner les besoins lies au passage a l'echelle superieure. Contexte local Le ministere de la sante a collabore avec une organisation non gouvernementale et un etablissement d'enseignement superieur dans la mise au point et le suivi d'un programme pilote applique dans deux districts appauvris d'endemie du paludisme. Modifications pertinentes Pour la mise en oeuvre du programme pilote, il a fallu fournir une quantite supplementaire de sulfadoxine-pyrimethamine (SP), du materiel pour l'administration sous surveillance directe de ce medicament et des moustiquaires. Il a egalement fallu modifier la fiche antenatale et obtenir une derogation au guide national de prescription concernant la SP. Le protocole de depart a du etre modifie car l'imprecision dans l'evaluation de l'age gestationnel conduisait a une prise incomplete des doses de SP. Plusieurs incompatibilites avec d'autres initiatives sanitaires (y compris des programmes de lutte contre la syphilis, l'anemie et le VIH) ont ete decouvertes et surmontees. Les principaux resultats et effets ont ete mesures: 92,5 % des 7911 femmes enceintes ont recu au moins une dose de SP, le nombre moyen de doses de SP recues etant de 2,2. Lors de la deuxieme visite antenatale, 13,5 % des femmes utilisaient une moustiquaire de lit. Parmi les sous-groupes (1167 personnes pour les analyses en laboratoire, 2600 naissances), on a releve une association significative entre l'utilisation de SP et une elevation du taux d'hemoglobine (10,9 g/dl pour la prise de 3 doses de SP contre 10,3 g/dl en l'absence de toute dose de SP), une baisse de la prevalence des parasites du paludisme (7,5 % pour la prise de 3 doses contre 39,3 % en l'absence de toute prise de SP) et une baisse de la proportion d'enfants de petit poids a la naissance (7,3 % pour la prise de 3 doses contre 12,5 % en cas l'absence de toute prise de SP). Enseignements tires Le passage a l'echelle nationale du programme imposera de s'interesser aux besoins en personnel, en fournitures et en moustiquaires, a la politique en matiere de medicaments, a l'estimation de l'age gestationnel et a l'harmonisation des initiatives verticales. Une traduction en francais de ce resume figure a la fin de l'article. Resumen Tratamiento preventivo intermitente de la malaria durante el embarazo en el centro de Mozambique Problema En las nuevas estrategias de la OMS para combatir la malaria durante el embarazo se recomienda el tratamiento preventivo intermitente, el uso de mosquiteros y una mejor gestion de los casos. Enfoque Se diseno un programa piloto de control de la malaria en el embarazo en Mozambique a fin de determinar las condiciones necesarias para emprender una expansion masiva. Entorno local El Ministerio de Salud colaboro con una organizacion no gubernamental y una institucion academica para establecer y seguir de cerca un programa piloto en dos distritos pobres con malaria endemica. Cambios relevantes La aplicacion del programa piloto se baso en el suministro de sulfadoxina-pirimetamina (SP), material para la administracion de SP bajo observacion directa, mosquiteros y una tarjeta prenatal modificada. Fue necesario levantar las restricciones formales aplicables a nivel nacional a la SP, y hubo que modificar el protocolo original porque la imprecisiOn de las estimaciones de la edad gestacional conllevaba la omision de dosis de SP. Se descubrieron y resolvieron numerosas incompatibilidades con otras iniciativas de salud (incluidos programas de control de la sifilis, la anemia y el VIH), y se midieron diversos resultados e impactos: el 92,5% de 7911 mujeres recibieron al menos una dosis de SP, y el numero medio de dosis de SP recibidas fue de 2,2. En la segunda visita prenatal, el 13,5% de las mujeres usaban mosquiteros. Por subgrupos (1167 para analisis de laboratorio; 2600 nacimientos), el uso de SP se asocio de forma significativa a concentraciones de hemoglobina mayores (10,9 g/dl en caso de 3 dosis; 10,3 si no se habia recibido ninguna dosis), una menor parasitemia malarica (prevalencia del 7,5% en caso de 3 dosis; 39,3% si no se habia recibido ninguna dosis) y un menor nomero de lactantes con bajo peso al nacer (7,3% frente a 12,5% en caso de 3 o cero dosis, respectivamente). Ensenanzas extraidas Para extender masivamente las medidas de control a nivel nacional habra que prestar atencion al personal necesario, los suministros, la disponibilidad de mosquiteros, la politica farmaceutica, la estimacion de la edad gestacional y la armonizacion de las iniciativas verticales. Al final del articulo se facilita una traduccion al espanol. [TEXT NOT REPRODUCIBLE IN ASCII.], Background The magnitude and burden of malaria infection during pregnancy (MiP) have been well documented. (1,2) The need for action has been recognized by WHO, which now recommends that sub-Saharan [...]

Rotator cuff tears frequently occur and can lead to pain and decreased shoulder function. Repair of the torn tendon back to bone is often successful in relieving pain, but failure of the repair commonly occurs. Post-operative activity level is an important treatment component that has received minimal attention for the shoulder, but may have the potential to enhance tendon to bone healing. The objective of this study was to investigate the effect of short and long durations of various activity levels on the healing supraspinatus tendon to bone insertion site. Rotator cuff tears were surgically created in Sprague-Dawley rats by detaching the supraspinatus tendon from its insertion on the humerus and these tears were immediately repaired back to the insertion site. The post-operative activity level was controlled through shoulder immobilization (IM), cage activity (CA), or moderate exercise (EX) for durations of 4 or 16 weeks. The healing tissue was evaluated utilizing biomechanical testing and a quantitative polarized light microscopy method. We found that activity level had no effect on the elastic properties (stiffness, modulus) of the insertion site at four weeks post injury, and repair, and a decreased activity level had a positive effect on these properties at 16 weeks (IM > CA=EX). Furthermore, a decreased activity level had the greatest positive effect on these properties over time (IM > CA=EX). The angular deviation of the collagen, a measure of disorganization, was decreased with a decrease in activity level at 4 weeks (IM Keywords: shoulder, rotator cuff, supraspinatus, tendon healing, activity level

Electronic article surveillance (EAS) systems are widely implemented in public spaces and can adversely affect the performance of pacemakers and implantable cardioverter defibrillators. The interaction between implantable devices and EAS [...]

The 'Stand by Your Ad' (SBYA) provision of the Bipartisan Campaign Reform Act requires federal candidates to claim responsibility for their advertising content. Using an experimental survey design to show respondents actual campaign ads with and without the SBYA language, we find that SB YA produces no effect on respondents' levels of trust in candidates or the ads themselves. However, there is a statistically significant effect on respondents' confidence in the campaign as well as on respondents' support for the ads sponsor. In ads sponsored by the presidential candidates, respondents' reactions to the ads were further filtered through their predispositions toward the candidates., In a typical candidate-sponsored presidential campaign advertisement during 2004, President George W. Bush finished the ad by looking into the camera to pronounce, 'I'm George W. Bush, and I approve [...]