Health information technologies for sexual and reproductive health: Mapping the evidence in Latin America and the Caribbean.

In Latin America and the Caribbean (LAC), the sexual and reproductive health (SRH) of populations is a high priority for governments. Health information technologies (HITs) have been proposed as tools to close access gaps for SRH services. We developed an "evidence map" through a systematic search of articles published between 2005 and 2015 about the use of HITs to enhance SRH services in LAC countries. Two hundred and thirty-two registries were identified and screened. Thirty-one were eligible for full-text assessment. Most of the documents retrieved correspond to information provided by technology developers, targeting primarily the prevention of sexually transmitted infections and adolescent health. Although there has been clear progress in the use of HITs for SRH in the region, many institutional and technological challenges persist. Further studies should be carried out to test the beneficial effects of HITs on improving access to SRH services.

Iron deficiency in patients with solid tumours: prevalence and management in clinical practice.

PURPOSE: The objective of the present study was to describe the prevalence and management of anaemia and iron deficiency (ID) in treatment-naïve patients with solid tumours in Spain and the incidence of anaemia over 4 months of cancer treatment in clinical practice. METHODS: Multicentre, prospective and observational study in newly diagnosed cancer patients. Data on anaemia and iron parameters and its management were collected prior to the initiation of chemotherapy, at each cycle of chemotherapy and after 4 months of treatment. The main outcomes of the study were the prevalence of anaemia at baseline, its incidence during cancer treatment and the prevalence of absolute ID (AID) and functional ID (FID) prior to chemotherapy initiation. RESULTS: A total of 295 patients were included in the study. Anaemia was present at diagnosis in 38.6 % of patients and was treated only in 32.5 % of those. A total of 106 patients (60.2 %) without anaemia at baseline developed anaemia during cancer treatment. Serum ferritin and transferrin saturation data were available for 151 of the patients (51.2 %) included in the study. The overall prevalence of ID was 59 %: 48 patients (31.8 %) presented with AID and 41 patients (27.2 %) presented with FID before starting anti-cancer therapy. Thirty-three of 44 non-anaemic iron-deficient patients did not receive any type of iron supplementation before initiating cancer therapy. CONCLUSIONS: Iron parameters are not commonly measured in newly diagnosed cancer patients. A correct evaluation and early management of ID could reduce the incidence of treatment-related anaemia in cancer patients.

The patient journey: a report of skin cancer care across Europe.

BACKGROUND: There are poorly documented variations in the journey a skin cancer patient will follow from diagnosis to treatment in the European Union. OBJECTIVES: To investigate the possible difficulties or obstacles that a person with a skin malignancy in the European Union may have to overcome in order to receive adequate medical screening and care for his/her condition. In addition, we wished to explore differences in European health systems, which may lead to health inequalities and health inequities within Europe. METHODS: Ten European countries took part in this investigation (in alphabetical order): Finland, Germany, Greece, Italy, Malta, Poland, Romania, Spain, the Netherlands and the U.K. The individual participants undertook local and national enquiries within their own country and completed a questionnaire. RESULTS: This exercise has identified important differences in the management of a skin cancer patient, reflecting major disparities in health care between European countries. CONCLUSIONS: Further investigation of health disparities and efforts to address health inequalities should lead to improvements in European health care quality and reduction in morbidity from skin cancer.

Risk assessment of the lead intake by consumption of red deer and wild boar meat in Southern Spain.

The presence of heavy metals in big game meat may pose a risk to human health. The main objective of this paper is to carry out a risk assessment study (using a probabilistic and point-estimate approach) of lead intake by consumption of red deer and wild boar meat in Southern Spain based on Spanish data collected in the period 2003-2006. In general, the concentration levels found for wild boar meat (mean = 1291 µg kg(-1)) were much higher than those observed in red deer meat (mean = 326 µg kg(-1)). The results from a point-estimate risk assessment showed that the estimated average intake of lead among different exposure scenarios varied from 0.1 to 6.5 and from 0.3 to 38 µg kg(-1) week(-1) for red deer and wild boar meat, respectively; and from 0.3 to 35 µg kg(-1) week(-1) for individuals consuming both red deer and wild boar meat, and that the estimated intake of lead by consumption of big game meat differed significantly between hunters and non-hunters, it being higher for hunters. Besides this, results from the probabilistic risk assessment study corroborated the fact that risk is greater in hunter populations, reaching a maximum in individuals consuming only wild boar and both types of meat, with 0.4% and 0.2% of the population above the provisional tolerable weekly intake (PTWI), respectively. Likewise, the hunter populations consuming wild boar and both types of big game meat (red deer and wild boar meat) were exposed to the maximum lead level (56 µg kg(-1) week(-1)), which corresponded approximately to 224% of the PTWI. Further data and studies will be needed to give a complete risk estimation in which it will be crucial to consider the contribution to the lead intake level of other foods in the diet of both population groups.

[An economic analysis of presurgical teledermatology in patients with nonmelanoma skin cancer]. / Teledermatología prequirúrgica en pacientes con cáncer cutáneo no melanoma. Evaluación económica.

INTRODUCTION: In patients with nonmelanoma skin cancer, store-and-forward teledermatology allows satisfactory diagnosis and surgical planning, thus shortening waiting lists and reducing travel requirements for patients in special situations. OBJECTIVE: The aim of this study was to undertake an economic analysis of presurgical teledermatology, comparing it with a conventional health care approach. MATERIAL AND METHODS: The cost and cost-effectiveness of presurgical teledermatology were analyzed from a societal perspective in the setting of a public hospital with a corporate intranet. The mean delay in surgery was used to measure effectiveness. Over a 12-month period, teledermatology was used in 134 patients with nonmelanoma skin cancer. The unit cost of each intervention (teledermatology and conventional health care approach), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated. We distinguished between 2 groups of patients: those with and those without physical impediments for travel. RESULTS: The unit cost of the patients in whom teledermatology was used was euro 156.40 compared to euro 278.42 per patient in the conventional system; the conventional system was therefore 1.78 times more expensive than presurgical teledermatology. Teledermatology was more cost-effective, with an incremental cost-effectiveness ratio of euro 3.10 per patient and per day of delay avoided in patients without impediments for travel and euro 4.87 in those with impediments for travel. CONCLUSION: Teledermatology used for remote presurgical planning and preparation in patients with nonmelanoma skin cancer is more cost-effective than the conventional referral system in a health setting with a communication network available.

[Resilience and risk in children with learning disabilities]. / Resiliencia y riesgo en niños con dificultades de aprendizaje.

AIM: To stress the desirability of considering the resilience approach as a complement to the risk approach in the study and intervention of children with learning disabilities (LD). DEVELOPMENT: Most of the research carried out into LD has used the correlational methodology, which has given rise to chance inferences being made and to considering them as being a risk factor for development in their own right. Yet, the findings from more recent longitudinal studies make it necessary to reconsider the inevitability of negative results in the development of children with LD and to identify the processes and the factors underlying successful development, i.e. personal and social skills (self-efficiency, emotional coping, effective use of help, discrete view of difficulty, unconditional acceptance and support, and so on). CONCLUSIONS: The resilience approach is not an alternative that excludes the risk approach, but rather they complement each other and are both necessary in order to gain an understanding of LD and intervention. Optimising the development of individuals with LD is a task that can be made easier by assuming that resilience is a capacity that is present in all individuals and can also be improved.

Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients.

It was postulated that home hospitalisation (HH) of selected chronic obstructive pulmonary disease (COPD) exacerbations admitted at the emergency room (ER) could facilitate a better outcome than conventional hospitalisation. To this end, 222 COPD patients (3.2% female; 71+/-10 yrs (mean+/-SD)) were randomly assigned to HH (n=121) or conventional care (n=101). During HH, integrated care was delivered by a specialised nurse with the patient's free-phone access to the nurse ensured for an 8-week follow-up period. Mortality (HH: 4.1%; controls: 6.9%) and hospital readmissions (HH: 0.24+/-0.57 controls: 0.38+/-0.70) were similar in both groups. However, at the end of the follow-up period, HH patients showed: 1) a lower rate of ER visits (0.13+/-0.43 versus 0.31+/-0.62); and 2) a noticeable improvement of quality of life (delta St George's Respiratory Questionnaire (SGRQ), -6.9 versus -2.4). Furthermore, a higher percentage of patients had a better knowledge of the disease (58% versus 27%), a better self-management of their condition (81% versus 48%), and the patient's satisfaction was greater. The average overall direct cost per HH patient was 62% of the costs of conventional care, essentially due to fewer days of inpatient hospitalisation (1.7+/-2.3 versus 4.2+/-4.1 days). A comprehensive home care intervention in selected chronic obstructive pulmonary disease exacerbations appears as cost effective. The home hospitalisation intervention generates better outcomes at lower costs than conventional care.

[Assessment and intervention of preschool children with attention deficit hyperactivity disorder symptoms and disruptive behavior]. / Evaluación e intervención en niños preescolares con manifestaciones de trastorno por déficit de atención con hiperactividad y conducta disruptiva.

Attention deficit hyperactivity disorder (ADHD) constitutes one of the most common childhood syndromes and its negative outcomes on all the child's functional domains have been consistently reported in the literature. As a result, their early identification is becoming a topic of increasing concern among the researchers from the field. However, given that many of the behaviors of interest are normative behaviors during this period, diagnosis in preschool years is controversial. Specifically, from a developmental perspective, although it is well known that high levels of motor activity, poor self control, and lack of attention are typical during these years, both expression and intensity of these behaviors are markedly higher on the group of ADHD preschool children. Consequently, their negative interference with daily living, produce significant maladjustments in the child's natural settings. All these ideas justify the need of considering and studying the most appropriate assessment techniques to reliably identify the deficits of ADHD in preschool children. On the basis of these statements, this paper offers a theoretical overview of the most recent developments regarding ADHD assessment and intervention techniques directed to the prevention of cognitive deficits as well as the achievement of a better school and social adjustment of ADHD preschool children.

Laparoscopic management of peptic ulcer disease.

Laparoscopic surgery has heralded a new era for the operative management of peptic ulcer disease. With a mean hospital stay of 3.5 days,22 a recurrence rate of 4% to 11%,1,3 and a morbidity from dumping and diarrhea of 1% to 2%,21 laparoscopic proximal gastric vagotomy can truly provide a good alternative to medical therapy. Despite the high cost of medical care and surgical equipment, a laparoscopic vagotomy should be cost effective compared with life-long pharmacologic management of peptic ulcer disease. Several different operative procedures have been discussed, with similar outcomes. The surgeon has a choice of several approaches, depending on his or her training and level of skill. As surgeons gain experience with laparoscopic surgery, we are able to offer consistently good results with low recurrence rates and negligible morbidity and mortality. Minimally invasive surgery has rekindled the operative treatment of peptic ulcer disease.

[Analysis of direct costs of controlling arterial hypertension]. / Análisis de los costes directos del control de la hipertensión arterial.

OBJECTIVE: To analyse the number of attendances and the direct cost of pharmaceutical prescription arising from a year-long monitoring of hypertense patients. SETTING: Health Centre. DESIGN: A prospective observation study. PATIENTS: 220 hypertense patients, undergoing arterial pressure (AP) monitoring, were chosen by means of systematic random sampling. MEASUREMENTS AND MAIN RESULTS: The variables of age, gender, cardiovascular risk factors, AP, monitoring level (criterion AP < 160-90 mmHg), attendances and treatment used were analysed. The pharmaceutical cost was calculated in line with the dosages and according to the 1990 Vademecum. The monitoring level was 43.6%. The total number of attendances per patient were 12.8 +/- 6.43 and those for hypertension, 7.9 +/- 3.5. Diabetics attended more for hypertension (8.8 vs 7.5, p < 0.05). Pharmaceutical treatment was prescribed for 183 people (83.2%). The number of drugs was correlated with the severity of the hypertension and the number of attendances. Overall drug cost was 429,571 pesetas per month. Average monthly cost per patient was 2,348.69 +/- 2,318.92 pesetas (range 90.5-12,856.5). Angiotensin enzyme conversion inhibitors (AECI) made for the greatest monthly mean cost per patient (4,352.9 pesetas) and diuretics, the least (322.2 pesetas). CONCLUSION: Frequency of attendance is related to the presence of diabetes and the number of drugs prescribed. The introduction of AECI and Calcium antagonists into first-line treatment represents an important increase in the cost of controlling Hypertension.

Nutritional status assessment of HIV-positive drug addicts.

Since human immunodeficiency virus (HIV) is known to lead to modifications of immune function and interrelationships among malnutrition, anergy and drug addiction have been shown, the aim of this work was to assess the nutritional status of 36 male heroin addicts under a period of detoxication (3 months). They were divided into two groups: (1) HIV negative (n = 20) and (2) HIV positive (n = 16); heights, weights and serum albumin concentration were measured and immune function was tested, using delayed hypersensitivity skin tests containing 7 antigens. No significant differences in anthropometric measurements were found between both groups, but anthropometric improvement was shown in every patient after the detoxication period. Serum albumin, often used as a classical index of malnutrition, remained within the normal values in both groups. The whole response to skin tests was depressed in both groups and no significant differences were shown between them. Therefore, these results might suggest that in spite of the apparent anthropometric recovery and the normal values of albumin, a subclinical malnutrition was indicated by the depressed immune function, which was more noticeable in the HIV-positive group.