Enhancing community based health programs in Iran: a multi-objective location-allocation model.

Community Based Organizations (CBOs) are important health system stakeholders with the mission of addressing the social and economic needs of individuals and groups in a defined geographic area, usually no larger than a county. The access and success efforts of CBOs vary, depending on the integration between health care providers and CBOs but also in relation to the community participation level. To achieve widespread results, it is important to carefully design an efficient network which can serve as a bridge between the community and the health care system. This study addresses this challenge through a location-allocation model that deals with the hierarchical nature of the system explicitly. To reflect social welfare concerns of equity, local accessibility, and efficiency, we develop the model in a multi-objective framework, capturing the ambiguity in the decision makers' aspiration levels through a fuzzy goal programming approach. This study reports the findings for the real case of Shiraz city, Fars province, Iran, obtained by a thorough analysis of the results.

Reacción reversal tardia en la enfermedad de Hansen / Late reversal reactions in Hansen's disease

Las reacciones reversales tardías son episodios agudos producidos por un incremento de la inmunidad celular, en pacientes de lepra que ya han concluído su períodod de tratamiento. En estas circunstancias, su diagnóstico diferencial con la recidiva de la enfermedad, es a menudo dificultoso, e implica una conducta terapéutica diferentre que llevará a la reanudación de la poliquimioterapia en el último caso. Si bien existen algunos criterios que orientan la diferenciación entre ambas, debido a la importancia del compromiso neuronal que generalmente acompaña a las reacciones reversales, se preconiza el tratamiento precoz con esteroides, no sólo como prueba terapéutica sino como un método para prevenir importantes secuelas discapacitantes