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Dépistage de l'asthme professionnel en médecine du travail : faisabilité et utilité des tests objectifs

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Objectifs: L’objectif de cette étude est d’évaluer la faisabilité et l’utilité d’une stratégie de dépistage de l’asthme professionnel basée sur des mesures répétées et supervisées de la spirométrie au poste de travail chez des sujets rapportant des symptômes asthmatiques exacerbés au travail. Méthodes: L’étude a été réalisée chez des travailleurs, tous secteurs confondus, qui avaient répondu préalablement à un questionnaire visant à identifier le lien entre les symptômes asthmatiques et le travail. Sur base des réponses, deux groupes de sujets ont été distingués: ceux présentant des symptômes asthmatiques au travail (SAT) et ceux ayant un asthme non aggravé au travail (ANAT). En outre, un groupe contrôle de collègues volontaires asymptomatiques exposés aux mêmes risques que les travailleurs SAT a été étudié. Cinq mesures spirométriques ont été réalisées au poste de travail à l’aide d’un spiromètre portable le premier jour de la semaine, après un congé de deux jours et l’arrêt des traitements antiasthmatiques. Résultats: Les tests ont été réalisés chez 18 des 39 sujets SAT identifiés et 15 des 48 sujets ANAT, ainsi que chez 17 sujets contrôles asymptomatiques. Des 87 travailleurs identifiés par questionnaire, 25 n’ont pas pu être contactés, 12 n’étaient plus exposés aux risques et dans 12 autres cas l’organisation du travail n’a pas permis la réalisation des mesures. Quatre travailleurs et un seul employeur ont refusé de participer au projet. Il n’y avait pas de différences significatives entre les trois groupes de sujets étudiés en ce qui concerne l’âge, le sexe et les paramètres spirométriques pré-exposition. Des analyses ANOVA et une analyse de régression par équations d’estimation généralisées (GEE) n’ont pas décelé de modifications statistiquement significatives des paramètres spirométriques pendant l’exposition au travail dans aucun des trois groupes. Seulement un travailleur ANAT a présenté une chute du Volume expiratoire Maximale en une seconde (VEMS) supérieure à 20% de la valeur pré-exposition. Conclusions : Les mesures spirométriques répétées et supervisées sur les lieux de travail sont une procédure de dépistage bien acceptée qui pourrait être exécutée dans le cadre d’une surveillance médicale au sein des entreprises. Cependant, cette procédure ne devrait être utilisée que chez des travailleurs présentant une suspicion clinique élevée d’asthme lié au travail dans la mesure où le questionnaire portant sur les symptômes respiratoires au travail est très peu spécifique de l’asthme professionnel. Par ailleurs, les mesures de la spirométrie au poste de travail devraient être réalisées par du personnel paramédical spécialement formé afin d’en diminuer le coût. L’étude met en relief la nécessité de développer et valider des index de prédiction de cette affection basés sur les questionnaires


Book
Teaching Mathematics Effectively to Primary Students in Developing Countries : Insights from Neuroscience and Psychology of Mathematics.
Authors: ---
Year: 2008 Publisher: Washington, D.C. : The World Bank,

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This paper uses research from neuroscience and the psychology of mathematics to arrive at useful recommendations for teaching mathematics at primary level to poor students in developing countries. The enrollment rates of the poorer students have improved tremendously in the last decade. And the global Net Enrollment Ratio (NER) has improved since 2001 from 83.2 percent to 90-95 percent except in Sub-Saharan Africa and South Asia. Making teaching of math and other subjects efficient for the poor in developing countries is a great challenge, particularly in south Asia and Sub-Saharan Africa. Many developing countries have explored new means of teaching math and other subjects. Mongolia changed its mathematics education, aiming to build a new set of priorities and practices, given the abandonment of earlier traditions. Similar to international trends of the time, South Africa in the 1990s extensively applied the constructivist learning philosophy which relied on exploration and discovery, with little emphasis on memorization, drill, In conformity with a belief that teachers could develop their own learning programs, there was virtual absence of a national or provincial syllabus or textbooks. Students were expected to develop their own methods for arithmetic operations, but most found it impossible to progress on their own from counting to actual calculating. This study integrates pertinent research from neuroscience and the psychology of mathematics to arrive at recommendations for curricular and efficient means of mathematics instruction particularly for developing countries and poor students at primary level. Specifically, the latest research in neuroscience, cognitive science, and discussions of national benchmarks for primary school mathematics learning, form the basis of our recommendations. These recommendations have a reasonable chance of working in the situational contexts of developing countries, with their traditions and resources.


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What Religions Don't Want You to Know.An Exposé of Belief Systems
Authors: ---
ISBN: 9781463607227 Year: 2011 Publisher: S.L. R.K. Sidler


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Evaluating SME Support Programs in Chile Using Panel Firm Data
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Year: 2009 Publisher: Washington, D.C., The World Bank,

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This paper evaluates small and medium enterprise (SME) support programs in Chile using a firm-level panel for the 1992-2006 period on two groups of firms - a treatment group that participated in SME programs and a control group that did not. These unique panel data provide an unprecedented opportunity to address several issues that have plagued impact evaluations of SME programs - selectivity bias from observed and unobserved firm heterogeneity, identification of an appropriate control group, and inability to track firms over a long enough period of time for performance outcomes to be realized. Using difference-in-differences models combined with propensity score matching methods, the paper finds evidence that participation in SME programs in Chile is associated with improvements in intermediate outcomes (training, adoption of new technology and organizational practices), and causally with positive and statistically significant impacts on sales, production, labor productivity, wages and exports. The mixed results of previous studies may be attributable in part to the confounding effects of unobserved heterogeneity motivating selection into programs of firms with relatively low productivity levels, and in part to time-effects of program participation occurring in years after the time horizon of most impact evaluation studies.


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Evaluating SME Support Programs in Chile Using Panel Firm Data
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Year: 2009 Publisher: Washington, D.C., The World Bank,

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This paper evaluates small and medium enterprise (SME) support programs in Chile using a firm-level panel for the 1992-2006 period on two groups of firms - a treatment group that participated in SME programs and a control group that did not. These unique panel data provide an unprecedented opportunity to address several issues that have plagued impact evaluations of SME programs - selectivity bias from observed and unobserved firm heterogeneity, identification of an appropriate control group, and inability to track firms over a long enough period of time for performance outcomes to be realized. Using difference-in-differences models combined with propensity score matching methods, the paper finds evidence that participation in SME programs in Chile is associated with improvements in intermediate outcomes (training, adoption of new technology and organizational practices), and causally with positive and statistically significant impacts on sales, production, labor productivity, wages and exports. The mixed results of previous studies may be attributable in part to the confounding effects of unobserved heterogeneity motivating selection into programs of firms with relatively low productivity levels, and in part to time-effects of program participation occurring in years after the time horizon of most impact evaluation studies.


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The Distributional Consequences of Group Procurement : Evidence from a Randomized Trial of a Food Security Program in Rural India
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Year: 2015 Publisher: Washington, D.C. : The World Bank,

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Public transfer programs that allow beneficiaries to choose the transferred good may be more efficient, but the poorest beneficiaries may not participate if the good chosen is too costly. A model shows that program targeting and consumption impacts are tied to selected quality of the provided good. Evidence from a randomized trial in rural India in which groups of beneficiaries choose the variety of rice to be offered as a subsidized loan confirms that choosing lower cost goods self-targets the program towards the poorest beneficiaries. Consumption impacts are biggest for wealthiest households and may be negative for moderately poor households.


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Gender Dimensions of Community-Driven Development Operations : A Toolkit for Practitioners.
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Year: 2011 Publisher: Washington, D.C. : The World Bank,

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Community-development development (CDD) programs require monitoring and evaluation (M&E) to tell those implementing and funding the programs whether they are on track to deliver, or have delivered, desired outcomes such as improved services, economic activity, and empowerment. The objective of this toolkit is to provide practical guidance to World Bank EAP operational task teams and other CDD practitioners (i.e. government/non-government organization (NGO) staff) on how to measure the gendered impact of CDD operations. First, this is necessary because CDD program reviews have found that gender indicators are not widely used. Second, several governments in the East Asia and Pacific (EAP) region have identified gender as an important pillar in poverty alleviation strategies, in the light of evidence suggesting that societies promoting more equal opportunities for men and women have higher growth, lower poverty, and better development outcomes. Third, gender mainstreaming is a critical facet of World Bank policy and programs. Fourth, as this toolkit demonstrates, it is straightforward to add gender indicators to a results framework. It involves disaggregating some of the indicators that will already be in the results framework by gender, as well as adding a limited number of specific gender indicators. This toolkit takes CDD practitioners and other interested readers through the necessary steps to identify where to track gender in the results framework, as well as suggesting possible indicators. This toolkit is organized in three sections: section one set out why gender matters for CDD mentoring and evaluation (M&E); section two provides an introduction (and pointers to further reading) on M&E topics that the non-specialist will find useful when constructing gender indicators. This includes a generic CDD results framework structure that provides convenient categories for incorporating gender M&E indicators; section three uses these categories to provide examples of indicators (and other evidence) from the EAP region and illustrates how gender M&E can be added to CDD program results frameworks.


Book
Integrated Intervention Tool : Integration Strategies for Urban Poor Areas and Disadvantaged Communities.
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Year: 2013 Publisher: Washington, D.C. : The World Bank,

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For the 2014-2020 programming period, the Government of Romania (GoR) is considering a new approach presented by the European Commission (EC) - community-led local development (CLLD). Through CLLD, empowered communities have the opportunity to directly shape and own the process of local development, during all stages of EU - funded interventions, from concept design through implementation. If Romania ultimately pursues CLLD, the critical task facing the government is to design an optimal implementation framework for the new approach - this is precisely the focus and scope of the current integrated intervention tool (IIT). The preparation of this IIT entailed a number of steps, including extensive field work to define relevant subtypes of urban marginalized communities and to review past experiences with urban integration in Romania. This summary covers multiple sections, in line with the key chapters of the main IIT report. It first reviews CLLD's main features and best practice principles at the EU level. It focuses on Romania, making some recommendations for where CLLD can apply and what it will require in terms of coordinating different sources of funding. It also covers the main six stages of operationalizing CLLD in Romania, as follows: launch: preparations through capacity building and information campaigns; call for expressions of interest regarding the potential submission of local integration strategies (LISs); mobilization of the community for the establishment of local action groups (LAG) and development of LIS by each LAG; selection of strategies to be financed; implementation of LISs approved for financing, including selection and implementation of individual projects under these strategies; and phase-out activities and evaluation.


Book
Employment Generation in Rural Africa : Mid-Term Results from an Experimental Evaluation of the Youth Opportunities Program in Northern Uganda.
Authors: --- ---
Year: 2011 Publisher: Washington, D.C. : The World Bank,

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Can cash transfers promote employment and reduce poverty in rural Africa? Will lower youth unemployment and poverty reduce the risk of social instability? The authors experimentally evaluate one of Uganda's largest development programs, which provided thousands of young people nearly unconditional, unsupervised cash transfers to pay for vocational training, tools, and business start-up costs. Mid-term results after two years suggest four main findings. First, despite a lack of central monitoring and accountability, most youth invest the transfer in vocational skills and tools. Second, the economic impacts of the transfer are large: hours of non-household employment double and cash earnings increase by nearly 50 percent relative to the control group. The authors estimate the transfer yields a real annual return on capital of 35 percent on average. Third, the evidence suggests that poor access to credit is a major reason youth cannot start these vocations in the absence of aid. Much of the heterogeneity in impacts is unexplained, however, and is unrelated to conventional economic measures of ability, suggesting we have much to learn about the determinants of entrepreneurship. Finally, these economic gains result in modest improvements in social stability. Measures of social cohesion and community support improve mildly, by roughly 5 to 10 percent, especially among males, most likely because the youth becomes a net giver rather than a net taker in his kin and community network. Most strikingly, we see a 50 percent fall in interpersonal aggression and disputes among males, but a 50 percent increase among females. Neither change seems related to economic performance nor does social cohesion a puzzle to be explored in the next phase of the study. These results suggest that increasing access to credit and capital could stimulate employment growth in rural Africa. In particular, unconditional and unsupervised cash transfers may be a more effective and cost-efficient forming of large-scale aid than commonly believed. A second stage of data collection in 2012 will collect longitudinal economic impacts, additional data on political violence and behavior, and explore alternative theoretical mechanisms.


Periodical
Controlled clinical trials.
Author:
ISSN: 1879050X Year: 1980 Publisher: New York, NY : Elsevier Science Pub. Co.,

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Keywords

Clinical trials --- Clinical Trials. --- Études cliniques --- Clinical trials. --- Périodiques. --- Controlled clinical trials --- Patient trials of new treatments --- Randomized clinical trials --- Trials, Clinical --- Clinical Trials --- periodicals. --- Clinical Trials as Topic. --- Clinical medicine --- Human experimentation in medicine --- Research --- Clinical Trial as Topic --- Clinical Protocols --- Drug Evaluation --- Drugs, Investigational --- Clinical Trials Data Monitoring Committees --- Therapies, Investigational --- Research Design. --- Data Adjustment --- Data Reporting --- Design, Experimental --- Designs, Experimental --- Error Sources --- Experimental Designs --- Matched Groups --- Methodology, Research --- Problem Formulation --- Research Methodology --- Research Proposal --- Research Strategy --- Research Technics --- Research Techniques --- Scoring Methods --- Experimental Design --- Adjustment, Data --- Adjustments, Data --- Data Adjustments --- Design, Research --- Designs, Research --- Error Source --- Formulation, Problem --- Formulations, Problem --- Group, Matched --- Groups, Matched --- Matched Group --- Method, Scoring --- Methods, Scoring --- Problem Formulations --- Proposal, Research --- Proposals, Research --- Reporting, Data --- Research Designs --- Research Proposals --- Research Strategies --- Research Technic --- Research Technique --- Scoring Method --- Source, Error --- Sources, Error --- Strategies, Research --- Strategy, Research --- Technic, Research --- Technics, Research --- Technique, Research --- Techniques, Research --- methods --- Clinical Trials as Topic --- Periodicals. --- Controlled Clinical Trials as Topic. --- Clinical Trials, Controlled as Topic --- Control Groups --- Controlled Clinical Trials as Topic

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