Programa de Política de Drogas

Background: A large body of research has investigated the rise of injection drug use and HIV transmission in Tijuana and Ciudad Juarez (CJ). However, little is known about the dynamics of injecting in Hermosillo. This study compares drug-related behaviors and risk environment for HIV of people who inject drugs (PWID) across Tijuana, CJ, and Hermosillo to identify factors that could explain differences in HIV prevalence.

This paper presents an implementation of an ef- fective synchronization between a registration and a stimula- tion module that form part of a steady state visual evoked potential (SSVEP)-based Brain Computer Interface (BCI). Each of the synchronized modules were created and designed in two different platforms as well as in two different worksta- tions, so a particular objective of this work consisted in finding the best platforms to stimulate and register the EEG in order to create a communication channel and protocol between the two different modules. The resulting synchronization was tested with an existing SSVEP stimulation protocol in one subject. Even though the results were promising, a test on a bigger population is needed.

OBJECTIVE: To estimate monetary costs and benefits of activities for prevention of HIV and other sexually transmitted infections (STIs) among migrant populations in Mexico and Central America.
BACKGROUND: The risks of HIV transmission for migrant populations are high, particularly in border towns where commercial sex is highly prevalent. The governments of Central America countries and Mexico, partly financed by donors and international organizations, provide important financial outlays for HIV prevention, and even more for treatment of HIV (particularly in Mexico where the goal is to have universal access to antiretrovirals).
METHODS: Costs and benefits were estimated for prevention activities including: 1) Condom distribution; 2) Voluntary counseling and testing (VCT) for HIV, and 3) Testing and treatment of STIs. An ingredients approach was utilized for costing each intervention; data on direct costs were collected from administrative records and through semi-structured interviews with implementers and key informants. Cost components included: condoms distributed, rapid tests, medicines for STIs, and human resources. Benefits of the prevention were modeled in terms of future potential savings (in HIV & STI treatment) from the point of view of the government. Transition probabilities into infection and treatment were estimated with coefficients taken from the published literature. Costs were modeled for a hypothetical cohort of 10,000 migrants served with prevention interventions in Year 1; benefits were estimated for the HIV infections averted as potential savings in antiretroviral costs in Years 10-20, discounted at rates of 3, 5 and 7%.
RESULTS: The costs of testing and treatment for STIs, VCT and condom distribution were relatively low in comparison with the high potential costs of HIV treatment using highly-active antiretrovirals. Nevertheless, the low potential effectiveness of the interventions requires that high numbers of people participate in the programs to obtain sufficient prevented cases of HIV.
CONCLUSION: The cost benefit ratio of the prevention interventions in migrant populations was below unity under most assumptions; however, VCT was less cost beneficial than STI treatment and condom distribution. The results held with various scenarios about the number of people treated for HIV, the effectiveness of the interventions in the prevention of HIV cases, and the migrant probability of returning/staying in the country of origin as an HIV positive person in need of antiretroviral treatment.

Abstract—This paper presents an implementation of an effective synchronization between a registration and a stimulation module that form part of a steady state visual evoked potential (SSVEP)-based Brain Computer Interface (BCI). Each of the synchronized modules were created and designed in two different platforms as well as in two different workstations, so a particular objective of this work consisted in finding the best platforms to stimulate and register the EEG in order to create a communication channel and protocol between the ...

To quantify the costs and benefits of three HIV prevention interventions in migrants in Central America: voluntary counseling and testing, treatment of sexually transmitted infections, and condom distribution. The methods were: a) identification and quantification of costs; b) quantification of benefits, defined as the potential savings in antiretroviral treatment of HIV cases prevented; and c) estimation of the cost-benefit ratio. The model estimated that 9, 21 and 8 cases of HIV were prevented by voluntary counseling and testing, treatment for sexually transmitted infections and condom distribution per 10 000 migrants, respectively. In Panama, condom distribution and treatment for sexually transmitted infections had a return of US$131/USD and US$69.8/USD. Returns in El Salvador were US$2.0/USD and US$42.3/USD in voluntary counseling and testing and condom distribution, respectively. The potential savings on prevention have a large variation between countries. Nevertheless, the cos...

Abstract—This paper presents an implementation of an effective synchronization between a registration and a stimulation module that form part of a steady state visual evoked potential (SSVEP)-based Brain Computer Interface (BCI). Each of the synchronized modules were created and designed in two different platforms as well as in two different workstations, so a particular objective of this work consisted in finding the best platforms to stimulate and register the EEG in order to create a communication channel and protocol between the ...

ABSTRACT: Background: One in nine US infants is born before 37 weeks’ gestation, incurring medical costs 10 times higher than full-term infants. One in three infants is born by cesarean; cesarean births cost twice as much as vaginal births. We compared rates of preterm and cesarean birth among Medicaid recipients with prenatal access to doula care (nonmedical maternal support) with similar women regionally. We used data on this association to mathematically model the potential cost-effectiveness of Medicaid coverage of doula services. Methods: Data came from two sources: all Medicaid-funded, singleton births at hospitals in the West North Central and East North Central US (n = 65,147) in the 2012 Nationwide Inpatient Sample, and all Medicaid-funded singleton births (n = 1,935) supported by a community-based doula organization in the Upper Midwest from 2010 to 2014. We analyzed routinely collected, de-identified administrative data. Multivariable regression analysis was used to estimate associations between doula care and outcomes. A probabilistic decision-analytic model was used for cost-effectiveness estimates. Results: Women who received doula support had lower preterm and cesarean birth rates than Medicaid beneficiaries regionally (4.7 vs 6.3%, and 20.4 vs 34.2%). After adjustment for covariates, women with doula care had 22 percent lower odds of preterm birth (AOR 0.77 [95% CI 0.61–0.96]). Cost-effectiveness analyses indicate potential savings associated with doula support reimbursed at an average of $986 (ranging from $929 to $1,047 across states). Conclusions: Based on associations between doula care and preterm and cesarean birth, coverage reimbursement for doula services would likely be cost saving or cost-effective for state Medicaid programs. (BIRTH 2016)

As the complexity of health decision science applications increases, high-level programming languages are increasingly adopted for statistical analyses and numerical computations. These programming languages facilitate sophisticated modeling, model documentation, and analysis reproducibility. Among the high-level programming languages, the statistical programming framework R is gaining increased recognition. R is freely available, cross-platform compatible, and open source. A large community of users who have generated an extensive collection of well-documented packages and functions supports it. These functions facilitate applications of health decision science methodology as well as the visualiza-tion and communication of results. Although R's popularity is increasing among health decision scientists, methodologi-cal extensions of R in the field of decision analysis remain isolated. The purpose of this article is to provide an overview of existing R functionality that is applicable to the various stages of decision analysis, including model design, input parameter estimation, and analysis of model outputs.

The Affordable Care Act imposes a 40 percent excise tax on high-cost “Cadillac” health insurance plans in excess of defined thresholds beginning in 2020. Using economic theory and a microsimulation model, we predict how employers will respond to the Cadillac tax by adjusting wages and health insurance benefits. In its first year, 13.34 percent of individual and 16.73 percent of family employer-sponsored health insurance plan holders will be affected by the Cadillac tax; these percentages will increase to 35.33 and 42.01 percent, respectively, by 2025. Over 99 percent of those affected will reduce their health insurance benefits to the thresholds. Effectively, the Cadillac Tax will impose a hard cap on health insurance benefits, causing a clustering of benefits at the thresholds and a sharp reduction in the variance of benefits. Revenue from the Cadillac tax through 2025 will total $204 billion, all but $42 million of which will stem from “indirect” revenues – health insurance benefits shifted into taxable wages. This shift will increase wage growth and decrease benefit growth for those affected by the Cadillac tax. We simulate a cap on the tax exclusion of employer-sponsored insurance premiums and conduct sensitivity analyses with linear regression metamodeling.