Initiation and adherence to isoniazid preventive therapy in children under 5 years of age in Manhiça, Southern Mozambique.

The WHO recommends preventive treatment for all pediatric contacts of a confirmed TB case, but coverage remains low in many high TB burden countries. We aimed to assess the coverage and adherence of the isoniazid preventive therapy (IPT) program among children under 5 years of age with household exposure to an adult pulmonary TB case in a rural district of Southern Mozambique. The estimated IPT coverage was 11.7%. A longer distance to the health center and lower age of the children hindered IPT initiation. Among patients who started IPT, 12/18 (69.9%) were adherent to the 6-month treatment.

Perfiles de salud en pacientes con enfermedades crónicas en una institución de salud de alta complejidad / Health profiles in patients with chronic diseases in a high-complexity health institution / Perfis de saúde em pacientes com doenças crônicas numa instituição de saúde de alta complexidade

Objetivo: describir los diferentes perfiles, en términos de calidad de vida relacionada con la salud, en pacientes con enfermedades crónicas en una institución de salud de alta complejidad. Metodología: estudio transversal descriptivo. Se evaluó la calidad de vida relacionada con la salud mediante el instrumento EQ-5D en pacientes con enfermedades crónicas que consultaron a medicina interna y sus subespecialidades, en el servicio de consulta externa de una institución de salud de alta complejidad de la ciudad de Medellín durante el año 2017. Resultados: fueron encuestados 158 pacientes. La mediana de la edad fue 58 (46-68) años. El tiempo aproximado de evolución entre la edad de realización del diagnóstico principal y la edad del paciente al momento de la encuesta fue de 8.7 años, un total de 117 pacientes (74.1%) eran de sexo femenino. El estado de salud general de los pacientes de endocrinología y reumatología fue de 80 puntos, siendo los factores que afectaron la calidad de vida los denominados "dolor o malestar" y "ansiedad o depresión". Además, en los pacientes con patologías infecciosas el estado de salud general fue el más bajo, 62.5, donde el factor "dolor o malestar" fue el más común. Conclusiones: se identifica mayor alteración en las variables del EQ-5D de "dolor o malestar" y "ansiedad o depresión" en la población general, así mismo, cuando se trata del sexo femenino y de las áreas de endocrinología y reumatología.

Objective: to describe the different profiles in terms of health-related quality of life found in patients with chronic diseases in a high-complexity health institution. Methodology: cross-sectional descriptive study that evaluated the health-related quality of life through the EQ-5D instrument, in patients with chronic diseases that consulted Internal Medicine and its subspecialties in the outpatient service of a highly-complexity health institution in the city of Medellin, during the year 2017. Results: 158 patients between the ages 46-68 (an average of 58-year-old) were surveyed. A total of 117 patients (74.1%) were female. The time of evolution from the age when the diagnostic was run to the actual age of the patient when surveyed was 8.7 years. The general health status of the patients from Endocrinology and Rheumatology was found to be of 80 points, being the feelings of "pain or discomfort" and "anxiety or depression" the ones that most affected the quality of life. Additionally, in patients with infectious pathologies the general health status was the lowest (62.5); the most common factor was "pain or discomfort). Conclusions: it is evident that there is greater alteration in the variables of the EQ-5D of "pain or discomfort" and "anxiety or depression" in the general population, as well as in the females and the areas of Endocrinology and Rheumatology.

Objetivo: descrever os diferentes perfis, em termos de qualidade de vida relacionada com a saúde, em pacientes com doenças crônicas numa instituição de saúde de alta complexidade. Metodologia: estudo transversal descritivo. Se avaliou a qualidade de vida relacionada com a saúde mediante o instrumento EQ-5D em pacientes com doenças crônicas que consultaram a medicina interna e suas subespecialidades, no serviço de consulta externa de uma instituição de saúde de alta complexidade da cidade de Medellín durante o ano 2017. Resultados: foram entrevistados 158 pacientes. A média de idade foi 58 (46-68) anos. O tempo aproximado de evolução entre a idade de realização do diagnóstico principal e a idade do paciente ao momento da enquete foi de 8.7 anos, um total de 117 pacientes (74.1%) eram de sexo feminino. O estado de saúde geral dos pacientes de endocrinologia e reumatologia foi de 80 pontos, sendo os fatores que afetaram a qualidade de vida os denominados "dores ou mal-estar" e "ansiedade ou depressão". Ademais, nos pacientes com patologias infecciosas o estado de saúde geral foi o mais baixo, 62.5, donde o fator "dor ou mal-estar" foi o mais comum. Conclusões: se identifica maior alteração nas variáveis de EQ-5D de "dor ou mal-estar" e "ansiedade ou depressão" na população geral, assim mesmo, quando se trata do sexo feminino e das áreas de endocrinologia e reumatologia.

Lessons from collaborative governance and sociobiology theories for reinforcing sustained cooperation: a government food security case study.

OBJECTIVES: This research aimed to understand how cooperation and collaboration work in interagency arrangements using a case study of the public management of food security and nutrition in Bogotá, Colombia. STUDY DESIGN: This study explored the available scientific literature on Collaborative Governance within the Public Management body of knowledge and the literature on Cooperation from the Sociobiology field. Then, proposals were developed for testing on the ground through an action-research effort that was documented as a case study. Finally, observations were used to test the proposals and some analytical generalizations were developed. METHODS: To document the case study, several personal interviews, file reviews and normative reviews were conducted to generate a case study database. RESULTS: Collaboration and cooperation concepts within the framework of interagency public management can be understood as a shared desirable outcome that unites different agencies in committing efforts and resources to the accomplishment of a common goal for society, as seen in obtaining food and nutrition security for a specific territory. Collaboration emerges when the following conditions exist and decreases when they are absent: (1) a strong sponsorship that may come from a central government policy or from a distributed interagency consensus; (2) a clear definition of the participating agencies; (3) stability of the staff assigned to the coordination system; and (4) a fitness function for the staff, some mechanism to reward or punish the collaboration level of each individual in the interagency effort. CONCLUSIONS: As this research investigated only one case study, the findings must be taken with care and any generalization made from this study needs to be analytical in nature. Additionally, research must be done to accept these results universally. Food security and nutrition efforts are interagency in nature. For collaboration between agencies to emerge, a minimum set of characteristics that were established during the merging of the public management and sociobiology fields of knowledge and validated by means of a case study must be accomplished.

[Improving drug prescribing in the elderly: a new edition of STOPP/START criteria]. / Mejorando la prescripción de medicamentos en las personas mayores: una nueva edición de los criterios STOPP-START.

Inappropriate use of drugs in older patients may have an adverse impact on several individual health outcomes, such as increasing the prevalence of adverse drug reactions, morbidity and mortality, and geriatric syndromes, as well as on health care systems, such as increased costs and longer hospital stays. Explicit criteria of drug appropriateness are increasingly used to detect and prevent inappropriate use of drugs, either within a comprehensive geriatric assessment or as tool used by different multidisciplinary geriatric teams. STOPP-START criteria, first published in 2008 (in Spanish in 2009), are being adopted as reference criteria throughout Europe. The Spanish version of the new 2014 edition (recently published in English) of the STOPP-START criteria is presented here. A review of all the papers published in Spain using the former version of these criteria is also presented, with the intention of promoting their use and for research in different health care levels.

Trends in the prevalences of congenital anomalies and age at motherhood in a Southern European region: a population-based study.

OBJECTIVES: To estimate the prevalences of the main groups of congenital anomalies and to assess their trend over time. DESIGN: Population-based study of prevalences. SETTING: The Basque Country, Spain. PARTICIPANTS: All births and all congenital anomalies diagnosed prenatally, at birth or during the first year of age, in all hospitals of the country, from 1999 to 2008. MAIN OUTCOMES MEASURES: Total diagnosed prevalences and prevalences at birth of all chromosomal and non-chromosomal anomalies, Down's syndrome, anomalies of the nervous system, urinary, limbs, digestive system and congenital heart defects. RESULTS: Mean age (SD) of women at childbirth and the proportion of them over 35 years of age shifted from 32.1 (4.5) years, with 18.3% in 1999-2001, to 32.3 (4.7) years, with 23.9% in 2006-2008. Between 1999 and 2008, 991 cases of chromosomal anomalies and 3090 of non-chromosomal anomalies were diagnosed, which yields, respectively, total prevalences of 5.2‰ and of 16.2‰. Among chromosomal anomalies, Down's syndrome is the most frequent (2.9‰). With marginal statistical significance, the results point at an increasing trend in total diagnosed chromosomal anomalies, but a decreasing one in prevalences at birth. Among non-chromosomal congenital anomalies, congenital heart defects are the most frequent (5.2‰) one. Rates of all non-chromosomal, urinary and limb anomalies grew during the study period, whereas those of congenital heart defects and anomalies of the digestive system did not change significantly. CONCLUSIONS: In the Basque Country, rates of chromosomal anomalies are higher than the overall estimated prevalence in European countries, and continue to increase slightly, which may be related to the rise in maternal age. Rates of non-chromosomal anomalies are within the European frequent range of values, and the increases observed need to be checked in the following years.

[Magnetic resonance imaging and spectrometric study of the distribution of thermotherapeutic magnetofluid after intra-arterial administration in an experimental model of liver metastases]. / Administración intrarterial de un magnetofluido termoterapéutico en un modelo experimental de metástasis hepáticas. Estudio de distribución con resonancia magnética y espectrometría.

OBJECTIVE: To use imaging and laboratory techniques to evaluate the vascular distribution of magnetofluid in a rat model of liver metastases. MATERIAL AND METHODS: The livers of 33 WAG/Rij Crl rats were seeded with CC-531 colorectal cancer cells. After we checked tumor development, 10 rats received hepatic intra-arterial infusions of Lipiodol(®) with nanoparticles of Fe(3)O(4) in suspension, and 5 were reserved as controls. Axial STIR (TR: 3,600 ms/TE: 29 ms/TI: 130 ms) and gradient-echo (GE) (120/4 and 120/14) MRI sequences were acquired on a 1.5 T scanner. After necropsy, rats were classified into one of two stages according to tumor development: early (<10 metastases, each < 3mm) or advanced (>10 metastases, each >3 mm). Samples of liver and of metastases were taken from the 15 animals for quantification of iron concentrations by inductively coupled plasma mass spectrometry (ICP-MS). The data were analyzed using nonparametric tests; values of p < 0.05 were considered significant. RESULTS: Five animals had early tumor development and five had advanced tumor development. In the GE sequences, early stage metastases showed homogeneous signal reduction attributable to the presence of magnetofluid. Spectrometry found significant differences between the iron concentration in rats with early stage metastases and controls (p=0.002) as well as between rats with early stage metastases and those with late stage metastases (p=0.001). The ratio of exogenous iron in metastases and in liver in early stage rats was 2.6:1. The concentration of exogenous iron in the liver was significantly different from that in tumors only in early stage animals (p=0.043). CONCLUSIONS: MRI and spectrometry made it possible to evaluate the vascular distribution of magnetofluid in the liver and revealed the differences in its affinity for metastases in different stages of disease.

The burden of mental disorders in primary care.

OBJECTIVES: To describe and compare the prevalence of mental disorders across primary care populations, and estimate their impact on quality of life. METHODS: Cross-sectional multilevel analysis of a systematic sample of 2539 attendees to eight primary care centres in different regions of Spain, assessed with the WHO Composite International Diagnostic Interview (CIDI 1.1), the Short Form Health Survey (SF-36) quality of life questionnaire and the SF-6D utility index. RESULTS: The 12-month prevalence of any mental disorder was 23% (95% confidence interval: 21-24%), 10% had mood, 9% anxiety, 5% organic, 4% somatoform, and 1% alcohol use disorders, with a significant between-centre variability (P<0.001). People with mental disorders had one standard deviation lower mental quality of life than the general population. We estimated that 1831 quality-adjusted life-years (QALYs) are lost annually per 100,000 patients due to mental disorders, without considering mortality. Mood disorders have the worst impact with an annual loss of 1124 QALYs per 100,000 patients, excluding mortality (95% confidence interval: 912-1351). CONCLUSIONS: Prevalence rates were similar to those obtained in international studies using the same diagnostic instrument and, given the significant between-centre variability found, it is recommended that mental health statistics be considered at small area level. Mental disorders, and especially mood disorders, are associated with very poor quality of life and higher scores on disability indexes than other common chronic conditions.

Mortality in small geographical areas and proximity to air polluting industries in the Basque Country (Spain).

OBJECTIVES: To study the association between proximity to air polluting industrial facilities and mortality in the Basque Country (Spain) in the 1996-2003 period. METHODS: A cross-sectional ecological study with 1465 census sections (CS) as units of analysis with a mean population of 1257 inhabitants. Association of CS mortality with proximity of industries of the European Pollutant Emission Register was studied by type of industrial activity and adjusted for social deprivation. Two distance thresholds (1 km and 2 km) were used as proxies for exposure in a 'near versus far' analysis. Causes of mortality studied were: all causes; tracheal, bronchial, and lung cancer; haematological tumours; ischaemic heart disease; cerebrovascular diseases; chronic diseases of the lower respiratory tract; and breast cancer (in women). Poisson's generalised linear mixed models (GLMM) with two random effects (heterogeneity and structured spatial variability) were used in a fully Bayesian environment. RESULTS: Men living in sections within 1 km from energy production industries had greater mortality from tracheal, bronchial, and lung cancer [CI(90%) 6% to 53%] as compared with people living further. Women had greater mortality from ischaemic heart disease [CI(90%) 1% to 17%] and respiratory illness [CI(90%) 1% to 24%] within 2 km from metal-processing industries. On the contrary, within the 1 km buffer from mineral industries, mortality was lower for all causes [CI(90%) -20% to -6%] and for ischaemic heart disease [CI(90%) -40% to -10%] in women, and from respiratory diseases in men [CI(90%) -39% to -4%], while it was greater for breast cancer in women [CI(90%) 2% to 28%] within the 2 km buffer. CONCLUSIONS: Analysis of mortality by census sections is a helpful exploratory tool for investigating environmental risk factors and directing actions to sites and risk factors with a greater impact on health. Further epidemiological and environmental investigations around metal-processing and energy-producing plants are required.

Cigarette smoking and short-term addiction treatment outcome.

Cigarette smoking is common among patients in cocaine and opioid dependence treatment, and may influence treatment outcome. We addressed this issue in a secondary analysis of data from an outpatient clinical trial of buprenorphine treatment for concurrent cocaine and opioid dependence (13 weeks, N=200). The association between cigarette smoking (lifetime cigarette smoking status, number of cigarettes smoked per day prior to study entry) and short-term treatment outcome (% of urine samples positive for cocaine or opioids, treatment retention) was evaluated with analysis of covariance, bivariate correlations, and multivariate linear regression. Nicotine-dependent smokers (66% of participants) had a significantly higher percentage of cocaine-positive urine samples than non-smokers (12% of participants) (76% vs. 62%), but did not differ in percentage of opioid-positive urine samples or treatment retention. Number of cigarettes smoked per day at baseline was positively associated with percentage of cocaine-positive urine samples, even after controlling for baseline sociodemographic and drug use characteristics, but was not significantly associated with percentage of opioid-positive urine samples or treatment retention. These results suggest that cigarette smoking is associated with poorer short-term outcome of outpatient treatment for cocaine dependence, but perhaps not of concurrent opioid dependence, and support the importance of offering smoking cessation treatment to cocaine-dependent patients.

[Ultrasonographic characterization of an experimental model of liver metastases from colon carcinoma in rats]. / Caracterización ecográfica de un modelo experimental de metástasis hepáticas de carcinoma de colon.

OBJECTIVE: To determine the ultrasonographic characteristics of liver metastases induced in a rat model; to evaluate the usefulness of ultrasonography in the noninvasive evaluation of tumor infiltration. MATERIAL AND METHODS: We seeded the livers of 46 WAG/RijCrl rats with CC-531 syngeneic colorectal carcinoma cells by intrasplenic inoculation. At 21, 28, 35, 42, 70 days after tumor seeding, we performed a series of ultrasonographic examinations to evaluate tumor induction in different groups of animals: 37 rats were studied with a 10 MHz linear probe and 9 were studied with a 6-18 MHz multifrequency probe. The following signs were considered indicative of tumor development: intrahepatic nodules, sinuate liver borders, lobe enlargement, and extrahepatic masses. Ultrasonographic findings were verified at autopsy. We determined the number of implants, size (less than 3mm, between 3 and 7 mm, or greater than 7 mm), and lobe location for each technique. RESULTS: Compared to the autopsy results, ultrasonography detected 64% of the animals with disease. All the extrahepatic masses were correctly diagnosed. Metastases were identified in 90% of the rats with lesions greater than 7 mm, in 75% of those with implants between 3 and 7 mm, and in 25% of those with lesions less than 3mm. In the group in which we used the 6-18 MHz probe, we detected 50% of the lesions less than 3mm. CONCLUSION: Ultrasonography was useful for monitoring the experimental model and enabled the noninvasive oncologic evaluation of the rat liver with reasonable sensitivity.

A comparison of psychosocial barriers among welfare recipients: implications for drug treatment.

Implementation of Temporary Assistance for Needy Families (TANF) presents welfare recipients with time-limited benefits and work requirements. However, it is estimated that over 140,000 welfare recipients meet the DSM-IV criteria for "drug dependence". In this study, samples of chronic drug using and non-drug using female TANF recipients were compared with regard to: current employment, psychological functioning, self-perceived employment skills, barriers to employment, and need for help in seeking employment. It was found that non-drug using study participants were significantly more likely to be employed and reported significantly higher self-perceived work skills than users. Chronic users reported significantly greater barriers to seeking employment.

Changes in economically disadvantaged adolescents' knowledge and beliefs about HIV/AIDS.

PURPOSE: The purpose of this study was to compare HIV/AIDS related knowledge and beliefs in two cohorts of economically disadvantaged adolescents (n = 132). Participants were between 15 and 21 years old, predominately African-American and Hispanic, and participants in a Job Training Partnership Act (JTPA) summer program. The hypothesis was that adolescent HIV/AIDS-related knowledge would be higher in 1999 than in 1994. METHODS: A cohort of sixty-six (66) adolescents were surveyed in 1994 and another cohort of 66 adolescents was surveyed again in 1999, all participating in the JTPA program. Participants' knowledge and beliefs were assessed using the National Adolescent Student Health Survey. RESULTS: A statistically significant increase in overall HIV/AIDS knowledge occurred between the two measurements. Fifty-five percent (55.6%) of the 1999 cohort believed that HIV could be contracted by donating blood, compared to 47.5% of the 1994 cohort. Belief that it is more likely to become infected with the AIDS virus through male to male sex was higher in 1999 by 2% and was 10% higher for female to female sex. CONCLUSIONS: Adolescent misconceptions/misinformation, gender-based lack of knowledge, increased perception of immunity from HIV infection, and a reported reduction in health education courses were all factors in the adolescents' continued engagement in risky sexual activities. Given these findings, and that AIDS is predicted to be one of the top five causes of death among young people, increased gender- and ethnic-specific HIV intervention programs are recommended.

Adolescent illegal drug use: the impact of personality, family, and environmental factors.

This study examined the relationship between the domains of environmental factors, family illegal drug use, parental child-rearing practices, maternal and adolescent personality attributes, and adolescent illegal drug use. A nonclinical sample of 2,837 Colombian youths and their mothers were interviewed about intrapersonal, interpersonal, and environmental factors in their lives. Results indicated that certain environmental factors (e.g., violence, drug availability, and machismo), family drug use, a distant parent-child relationship, and unconventional behavior are risk factors for adolescent illegal drug use. As hypothesized, results showed that the adverse effects of family illegal drug use on adolescent drug use can be buffered by protective parental child-rearing practices and environmental factors, leading to less adolescent illegal drug use. Prevention and treatment efforts should incorporate protective environmental, familial, and intrapersonal components in order to reduce adolescent illegal drug use.

Health services implications of DNA testing.

This review article summarizes the state of the art in genetic testing and discusses the many issues that new technologies have raised. A health services perspective is offered to aid in providing laboratorians with an understanding of the dilemma that society faces with the exponential advances in knowledge. Unmistakably, these new technologies are a mixed blessing: on the one hand, diagnoses can be made with greater accuracy and preventive measures implemented more fruitfully and individuals may be more conclusively identified and/or exonerated for forensic purposes. On the other hand, however, are the very real concerns that discrimination under a medical guise will be encouraged and that privacy rights may be compromised. Another important issue is how the laboratory profession will serve in moving these new technologies from research to practice. We examine the role of the CLS in moving forward to a role of patient counselor and advocate in the emerging complex world of DNA-related biotechnology.

Partner concordance in reports of joint risk behaviors.

OBJECTIVE: To evaluate the accuracy of self reports on sexual and drug use behaviors. METHODS: Data from a network study of HIV transmission among a sample of drug users and nonusers are used to compare reports of sexual and drug use behaviors by partners who engaged in those behaviors. Partner concordance (self-report agreement between two people) was used as an estimate of validity. RESULTS: Results showed that persons are able to recall and report about 85% of their recent partners (15%-20% less for recent drug use partners). For relationships that were reported by both partners, a high degree of concordance existed about recent behaviors (83%-96%) and variable agreement about frequency (0.48

Psychiatric care of patients with depression and comorbid substance use disorders.

BACKGROUND: The goal of this study was to describe the sociodemographic and clinical characteristics and routine psychiatric care of depressed patients with or without substance use disorders (SUDs) and to assess the association between the presence of comorbid SUD and the psychiatric management of patients with depression. METHOD: Each of a sample of 531 psychiatrists participating in the Practice Research Network (PRN) of the American Psychiatric Institute for Research and Education was asked to provide information about 3 randomly chosen patients. Data were collected using a self-administered questionnaire, which generated detailed diagnostic and clinical data on 1228 psychiatric patients. Weighted data were analyzed using the SUDAAN software package. Multivariate logistic regression was used to compare depressed patients with and without SUD. RESULTS: A total of 595 patients (48.4%) were diagnosed with depression (DSM-IV criteria). The prevalence of SUD (excluding nicotine dependence) in this group was 18.1%. The group with SUD had a significantly larger proportion of males, young adults, patients seen in public general hospitals, and non-managed care public plans. No significant group differences were found for primary payer, locus of care, length of treatment, type of current or past treatment, and prescription of medications. Only 2.2% of SUD patients were prescribed with an anti-SUD medication (i.e., disulfiram and naltrexone). CONCLUSION: Concomitant SUDs have little effect on the routine psychiatric care of depressed patients. Efforts should be made to improve the identification and management of depressed patients with SUD.

Access as a managed care marketing outcomes measure.

As their position in the health care market diminishes, HMOs are feeling the pinch from the competition. Purchasers of health plans have many more options available today than in the past. Employers can select from single or consolidated health plans, plans offered by coalitions, or plans offered by provider systems. Following closely behind the withstanding issue of controlling costs is quality of care and customer satisfaction. The bad press surrounding managed care is making employers demand assurances that employees will receive the best quality of care their money can buy. To assist in this endeavor managed care companies are focusing more on their customers. To this end marketers use report cards to assess purchaser and enrollee satisfactions, with the hope that if they have a happy customer, s/he will be a loyal one. This paper reviews current marketing strategies of managed care companies and their level of usefulness with respect to sustaining customers and hence market share.

Normative influence on condom use in the personal networks of female cocaine smokers.

Attitudes-norms research (the theories of planned behavior and reasoned action) has been successful in accounting for many types of behavior change. One of the strengths of this approach has been to combine individual beliefs and normative influences in the explanation of behavior change. However, the conceptualization of normative influence in these theories makes very strong assumptions about self-awareness in the selection of normative referents. These assumptions are particularly problematic when applied to female cocaine smokers, who report frequent sex while under duress or while cognitively impaired. In this study the original conceptualization of normative influence and two alternatives (assuming emotion-based and interaction-based selection of normative referents) are operationalized to evaluate stage of change for condom use among women who are heavy crack cocaine users with multiple sex partners. Results show that stage of change for use of condoms with nonmain partners is best accounted for by interaction-based selection of normative referents.

Labor force participation in a sample of substance users.

This paper reviews the microeconomic theory underlying the work/leisure tradeoff and how this tradeoff may be manifested among substance users. The effects of drug use, demographic factors, and income factors on the probability of labor force participation are analyzed in a sample of 687 male and 327 female drug users. The decision not to seek employment appears to be associated primarily with non-job-related sources of income (including illegal sources).