Evaluation of the economic benefits, administration times, and patient preferences associated with the use of biotechnological drugs administered subcutaneously and intravenously in patients with cancer: a systematic review.

INTRODUCTION: Cancer imposes a high economic burden with medical care and medication costs. We evaluate the costs, the use of resources, the administration time, and the patient preferences associated with the use of biotechnological drugs in SC and IV presentations. METHODOLOGY: A systematic literature search was conducted in PubMed, Embase, and seven additional databases. The search was carried out in September 2021 and included only studies directly comparing SC and IV presentations. Evidence was synthesized narratively. RESULTS: 34 references were included, which only analyzed bortezomib, daratumumab, rituximab, and trastuzumab. Reduction in preparation costs of SC compared to IV presentations ranged from 6.6% to 50.1%, and in administration costs from 4.5% to 95.3%. SC administration of rituximab and trastuzumab resulted in less productivity loss. More than 68% of patients reported greater satisfaction with the SC route. A reduction of time in the infusion chair, lower costs of resources for preparation, and health personnel for the administration process were identified with SC administration. CONCLUSIONS: The use of SC daratumumab, rituximab, and trastuzumab in patients with cancer reduces direct and indirect costs and adverse events compared to IV use. Patients prefer the SC administration, perceiving more comfort, and less pain at the administration site.

Novel Validated Five-point Photonumeric Scales for Assessment of Static and Dynamic Forehead Lines.

Background: The objective of this investigation was to create and validate five-point photonumeric scales which assess static and dynamic forehead lines. Methods: Two different novel five-point photonumeric scales for the assessment of static and dynamic forehead lines were developed. Moreover, a photoguide was created, including subjects from both sexes, all age groups, and different Fitzpatrick skin types. A total of 11 raters from all over the world were involved in the digital validation, whereas four raters performed a live validation. Results: The Croma Static Forehead Lines-Assessment Scale showed almost perfect inter and intra-rater agreement in both the digital and the live setting with inter-rater intraclass correlation coefficients of 0.86 [95% confidence interval (CI): 0.82-0.89] in the first digital rating and 0.82 [95% CI: 0.78-0.86] in the second digital rating. The Croma Dynamic Forehead Lines-Assessment Scale showed almost perfect inter and intra-rater agreement in the digital setting with inter-rater intraclass correlation coefficients of 0.83 [95% CI: 0.79-0.86] in the first digital rating and 0.80 [95% CI: 0.75-0.84] in the second rating and almost substantial agreement in the live setting. Conclusions: The Croma Static Forehead Lines-Assessment Scale and the Croma Dynamic Forehead Lines-Assessment Scale have excellent inter and intra-rater agreements to be justifiably used in the clinical and study setting, both digitally and live across ethnic groups.

Novel, Validated, 5-Point Photonumeric Scales for Assessment of the Perioral Region.

BACKGROUND: The use of validated scales is still considered the gold standard for evaluating the severity of an aesthetic facial condition. OBJECTIVES: The aim of this investigation was to create and validate 5-point photonumeric scales for the assessment of perioral lines and marionette lines. METHODS: A medical team created 2 different novel 5-point photonumeric scales for the assessment of perioral lines and marionette lines. Eleven international raters were involved in the digital validation, and 4 raters performed a live validation. RESULTS: For the Croma Static Perioral Lines-Assessment Scale, the digital interrater intraclass correlation coefficients (ICCs) were 0.88 (95% CI, 0.85-0.91) in the first rating and 0.87 (95% CI, 0.83-0.90) in the second rating. The digital intrarater ICCs were 0.90 (95% CI, 0.87-0.92). In the live rating, the interrater ICCs were 0.89 (95% CI, 0.85-0.93) in the first rating and 0.91 (95% CI, 0.87-0.93) in the second rating with an intrarater ICC of 0.91 (95% CI, 0.88-0.95). For the Croma Marionette Lines-Assessment Scale, the digital rating interrater ICCs were 0.85 (95% CI, 0.81-0.89) in the first rating and 0.87 (95% CI, 0.84-0.90) in the second rating with an intrarater ICC of 0.89 (95% CI, 0.88-0.91). In the live rating, the interrater ICCs were 0.73 (95% CI, 0.54-0.83) in the first rating and 0.79 (95% CI, 0.65-0.87) in the second rating with an intrarater ICC of 0.88 (95% CI, 0.83-0.94). CONCLUSIONS: The Croma Static Perioral Lines-Assessment Scale and the Croma Marionette Lines-Assessment Scale have exceptional inter- and intrarater agreements that justify their use in clinical and study settings for all ethnic groups.

Novel, Validated 5-Point Photonumeric Scales for Assessment of the Neck and Décolleté.

BACKGROUND: There is a scarcity of scales that assess platysmal bands, wrinkles in the décolleté, and horizontal neck lines in the digital and live setting. OBJECTIVES: The objective of this investigation was to create and validate 5-point photonumeric scales that assess horizontal neck lines, platysmal bands, and wrinkles in the décolleté. METHODS: A medical team created 3 different novel 5-point photonumeric scales for the assessment of horizontal neck lines, platysmal bands, and décolleté wrinkling. Eleven international raters were involved in the digital validation, and 4 raters performed a live validation. RESULTS: The Croma (Leobendorf, Austria) Horizontal Neck Lines Assessment Scale showed substantial interrater agreement and almost perfect intrarater agreement in the digital and live validations, respectively. The Croma Platysmal Bands Assessment Scale showed substantial intrarater agreement in both digital and live validations. For the décolleté, a static scale and a dynamic scale were created and validated. The Croma Static Décolleté Wrinkles Assessment Scale showed substantial and almost perfect interrater agreement in the digital and live validations, respectively, and the intrarater agreement in both was almost perfect. The Croma Dynamic Décolleté Wrinkles Assessment Scale showed almost perfect agreement in both validation settings for both interrater and intrarater measures. CONCLUSIONS: The Croma Horizontal Neck Lines Assessment Scale and the Croma Static and Dynamic Décolleté Wrinkles Assessment Scales have sufficient interrater and intrarater agreement for justifiable use in clinical and research settings.

Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica.

ANTECEDENTES: Las enfermedades cardiovasculares son la principal causa mundial de mortalidad y México no es la excepción. Los datos epidemiológicos obtenidos en 1990 mostraron que los padecimientos cardiovasculares representaron el 19.8% de todas las causas de muerte en nuestro país; esta cifra se incrementó de manera significativa a un 25.5% para 2015. Diversas encuestas nacionales sugieren que más del 60% de la población adulta tiene al menos un factor de riesgo para padecer enfermedades cardiovasculares (obesidad o sobrepeso, hipertensión, tabaquismo, diabetes, dislipidemias). Por otro lado, datos de la Organización Panamericana de la Salud han relacionado el proceso de aterosclerosis como la primer causa de muerte prematura, reduciendo la expectativa de vida de manera sensible, lo que tiene una enorme repercusión social. OBJETIVO: Este documento constituye la guía de práctica clínica (GPC) elaborada por iniciativa de la Sociedad Mexicana de Cardiología en colaboración con la Sociedad Mexicana de Nutrición y Endocrinología, A.C., Asociación Nacional de Cardiólogos de México, A.C., Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, A.C., Comité Normativo Nacional de Medicina General, A.C., Colegio Nacional de Medicina Geriátrica, A.C., Colegio de Medicina Interna de México, A.C., Sociedad Mexicana de Angiología y Cirugía Vascular y Endovenosa, A.C., Instituto Mexicano de Investigaciones Nefrológicas, A.C. y la Academia Mexicana de Neurología, A.C.; con el apoyo metodológico de la Agencia Iberoamericana de Desarrollo y Evaluación de Tecnologías en Salud, con la finalidad de establecer recomendaciones basadas en la mejor evidencia disponible y consensuadas por un grupo interdisciplinario de expertos. El objetivo de este documento es el de brindar recomendaciones basadas en evidencia para ayudar a los tomadores de decisión en el diagnóstico y tratamiento de las dislipidemias en nuestro país. MATERIAL Y MÉTODOS: Este documento cumple con estándares internacionales de calidad, como los descritos por el Instituto de Medicina de EE.UU., el Instituto de Excelencia Clínica de Gran Bretaña, la Red Colegiada para el Desarrollo de Guías de Escocia y la Red Internacional de Guías de Práctica Clínica. Se integró un grupo multidisciplinario de expertos clínicos y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. Se consensuó un documento de alcances, se establecieron las preguntas clínicas relevantes, se identificó de manera exhaustiva la mejor evidencia disponible evaluada críticamente en revisiones sistemáticas de la literatura y se desarrollaron las recomendaciones clínicas. Se utilizó la metodología de Panel Delphi modificado para lograr un nivel de consenso adecuado en cada una de las recomendaciones contenidas en esta GPC. RESULTADOS: Se consensuaron 23 preguntas clínicas que dieron origen a sus respectivas recomendaciones clínicas. CONCLUSIONES: Esperamos que este documento contribuya a la mejor toma de decisiones clínicas y se convierta en un punto de referencia para los clínicos y pacientes en el manejo de las dislipidemias y esto contribuya a disminuir la morbilidad y mortalidad derivada de los eventos cardiovasculares ateroscleróticos en nuestro país. BACKGROUND: Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. OBJECTIVE: This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. MATERIAL AND METHODS: This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. RESULTS: 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. CONCLUSIONS: We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.

Validated 5 - Point photonumeric scales for the assessment of hand atrophy.

OBJECTIVE: Quantifying the degree of dorsal hand atrophy is a challenging endeavor, but often necessary, in both the clinical and the research setting. The aim of this investigation was to create and consecutively validate a 5-point photonumeric scale for assessment of dorsal hand atrophy. MATERIAL AND METHODS: A medical team created a novel 5-point photonumeric scale. Twelve international raters were involved in the digital validation, while five raters performed a live validation. RESULTS: For the digital validation of the Croma Hand Atrophy Assessment Scale, a total of 72 subjects (58 females, 14 males) with a mean age of 43.0 ± 14.4 years [18-73 years] were assessed. For the live validation, 88 subjects (73 females, 15 males) with a mean age of 45.0 ± 14.1 years [20-73 years] were rated. The results revealed almost perfect intra-rater (ICC: 0.90 [95% CI: 0.88-0.92]) and inter-rater agreements (ICC: 0.85 [95% CI: 0.81-0.89] and 0.86 [95% CI:0.82-0.89]) in the digital validation and substantial intra-rater (ICC: 0.79 [95% CI: 0.75-0.82]) and inter-rater agreements (ICC: 0.75 [95% CI: 0.68-0.81] and ICC: 0.67 [95% CI: 0.54-0.77]) in the live validation. CONCLUSION: The created scale to assess dorsal hand atrophy has been shown to provide substantial-to-almost perfect agreement in the digital and live validation cycles and reached comparable intra-rater and inter-rater agreement to already published and validated scales. It is expected that the created scale will help physicians and researchers in the assessment of hand atrophy in the clinical and research setting in the future.

Validated 5-point photonumeric scales for the assessment of the periorbital region.

OBJECTIVE: The objective of this investigation was to create and validate 5-point photonumeric scales for the assessment of dynamic crow's feet, static crow's feet, and infraorbital hollows. MATERIAL AND METHODS: Three novel 5-point photonumeric scales were created by a medical team. A total of 12 raters from all over the world performed a digital validation, and a total of 5 raters a live validation of the created scale. RESULTS: The statistical analysis revealed almost perfect intra-rater and inter-rater reliability in the digital validation of the scales for the assessment of static and dynamic crow's feet as well as infraorbital hollows. In the live validation, both crow's feet scales showed almost perfect intra-rater reliability, while the Croma Infraorbital Hollow Assessment Scale showed substantial intra-rater reliability. Inter-rater reliability was substantial for all three scales in the live validation. All three scales, the Croma Dynamic Crow's Feet Assessment Scale, Croma Static Crow's Feet Assessment Scale, and Croma Infraorbital Hollow Assessment Scale, were validated digitally and in a live setting. CONCLUSION: The created scales to assess infraorbital hollowing, dynamic and static crow's feet have been shown to provide substantial to almost perfect agreement in the digital and live validation and can thus be considered as helpful tools in the clinical and research setting. While technical methods and appliances to assess the degrees of severity of age-dependent features are advancing, validated scales are of great importance due to their ease of use and, as shown by the validations, reliability, and reproducibility.

Validated 5-point photonumeric scales for the assessment of the jowls and chin.

OBJECTIVE: The objective of this investigation was to create and to examine the reproducibility and validity of 5-point photonumeric assessment scales that allow objective assessment of chin retrusion and jawline sagging using a digital and a live validation. MATERIAL AND METHODS: Two new 5-point photonumeric scales created to assess chin projection and jawline sagging were validated by 12 experts in a digital validation and by 5 experts in a live validation setting. Intra-rater agreement and inter-rater agreement were assessed. RESULTS: For the digital validation, an almost perfect intra-rater (Kappa: 0.89 [95% CI: 0.86-0.91]) and almost perfect inter-rater agreement in both sessions (Kappa: 0.80 [95% CI: 0.74-0.86] and 0.80 [95% CI: 0.74-0.86]) was achieved for the Croma Chin Projection Assessment Scale, while intra-rater agreement (Kappa: 0.88 [95% CI: 0.85-0.91]) was almost perfect for the Croma Jawline Sagging Assessment Scale and inter-rater agreement being substantial in the first session (Kappa: 0.76 [95% CI: 0.71-0.81]) and almost perfect in the second session (Kappa: 0.81 [95%CI: 0.76-0.85]). For the live validation, intra-rater agreement was almost perfect for the Croma Chin Projection Assessment Scale (Kappa: 0.82 [95%CI: 0.74-0.90]) and the Croma Jawline Sagging Assessment Scale (Kappa: 0.83 [95%CI: 0.77-0.89]), while inter-rater agreement was substantial in both sessions for both scales. CONCLUSION: The created chin and jawline photonumeric grading scales are valid and reliable tools for assessing chin projection and jawline sagging. The scales will be of value for standardized chin evaluation and quantifying outcomes in clinical research and daily practice.

The Influence of Different Light Angles During Standardized Patient Photographic Assessment on the Aesthetic Perception of the Face.

BACKGROUND: 2D baseline and follow-up clinical images are potentially subject to inconsistency due to alteration of imaging parameters. However, no study to date has attempted to quantify the magnitude by which such images can be influenced. OBJECTIVE: The objective of the present study is to identify the magnitude by which images can be influenced by changing the imaging light angle. METHODS: This study is based on the evaluation of 2D frontal images of the face and included a total of 51 subjects of which n = 14 were males and n = 37 were females. Faces were photographed at 0°, 30°, and 60° light angle under identical and standardized conditions. Images were randomized and rated by 27 blinded raters for age, facial attractiveness, body mass index (BMI), temporal hollowing, lower cheek fullness, nasolabial sulcus severity, and jawline contour. RESULTS: Facial attractiveness decreased, facial unattractiveness increased and the evaluated BMI (based on facial assessment) increased statistically significantly at 60°. The assessment of regional facial scores, i.e., temporal hollowing, lower cheek fullness, and jawline contour, showed no statistically meaningful changes both at 30° and at 60° light angle. CONCLUSION: The results indicate that there might be an observed blind range in light angle (0°-30°) which does not influence facial assessment. Increasing the light angle past the threshold value to 60° might result in a statistically significant impact on facial perception which should be accounted for when documenting and/or presenting facial 2D images. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Características epidemiológicas y costos de la atención de las heridas en unidades médicas de la Secretaría de Salud / Epidemiological characteristics and wound care costs in medical units of the Secretaria de Salud

Resumen

Introducción: la atención de las heridas implica una importante inversión económica, relacionada con la formación y contratación de recursos humanos especializados en el cuidado de heridas, la adquisición de insumos de alta tecnología y el incremento en los días de estancia hospitalaria de los pacientes o del número de reingresos.

Objetivo: describir las características epidemiológicas y los costos directos de la atención de las heridas en las unidades médicas de la Secretaría de Salud.

Metodología: estudio descriptivo, prospectivo y transversal, en una muestra de 159 unidades médicas de la Secretaría de Salud con un total de 36 022 casos de heridas.

Resultados: la atención de las heridas principalmente fue en unidades de segundo nivel (79.4%) y ambulatorias (75.1%). Las heridas más recurrentes fueron las heridas traumáticas (26.6%) y las úlceras de pie diabético (23.4%). Los costos directos mensuales fueron estimados en $46 563 070.76 (ambulatorio) y $1 864 124 436.89 (hospitalización).

Conclusión: las heridas continúan siendo un problema de salud pública que representa un elevado gasto económico para las unidades médicas de la Secretaría de Salud.

Abstract

Introduction: Wound care involves an important economic investment, related to the training and hiring of specialized human resources in the care of wounds, the acquisition of high technology inputs and the increase in days of hospital stay of patients and/or the number of réadmissions. Objective: To describe the epidemiological characteristics and the direct costs of wound care in the medical units of the Mexican Secretaria de Salud (Ministry of Health).

Methods: Descriptive, prospective and cross-sectional study, in a sample of 159 medical units of the Secretaria de Salud with a total of 36 022 cases of injuries.

Results: The attention of the wounds was mainly in units of second level (79.4%) and ambulatory (75.1%); the most recurrent were traumatic injuries (26.6%) and diabetic foot ulcers (23.4%). The direct monthly costs were estimated at 46 563 070.76 MXN (outpatient) and $ 1 864 124 436.89 MXN (hospitalization).

Conclusion: Wounds continue to be a public health problem that represents a high economic cost for the medical units of the Secretaria de Salud.

Real Time Monitoring of Children, and Adults with Mental Disabilities Using a Low-Cost Non-Invasive Electronic Device.

There are a growing number of small children-as well as adults-with mental disabilities (including elderly citizens with Alzheimer's disease or other forms of age-related dementia) that are getting lost in rural and urban areas for various reasons. Establishing their location within the first 72 h is crucial because lost people are exposed to all kinds of adverse conditions and in the case of the elderly, this is further aggravated if prescribed medication is needed. Herein we describe a non-invasive, low-cost electronic device that operates constantly, keeping track of time, the geographical location and the identification of the subject using it. The prototype was made using commercial low-cost electronic components. This electronic device shows high connectivity in open and closed areas and identifies the geographical location of a lost subject. We freely provide the software and technical diagrams of the prototypes.

Adquisición de tecnología biomédica en IPS colombianas: comparación y mejores prácticas / Acquisition of Biomedical Technology in Colombian IPS: Comparison and Best Practices / Aquisição de tecnologia biomédica nas IPS colombianas: comparação e melhores práticas

Resumen En este artículo de investigación se analizó el proceso de adquisición tecnológica en las instituciones prestadoras de servicios de salud (IPS) en Colombia. Para este propósito se aplicó una metodología de diagnóstico empresarial denominada benchmarking en seis IPS del departamento de Antioquia (tanto del sector público como del sector privado), lo que permitió identificar las principales formas de adquirir tecnología biomédica, la priorización de las necesidades tecnológicas, los métodos empleados por las instituciones hospitalarias para la evaluación del equipamiento médico, las fuentes de identificación de necesidades, los requisitos legales y técnicos exigidos en el momento de la compra, así como la proporción de búsqueda de alertas nacionales e internacionales en bases de datos relacionadas con los dispositivos. De esta manera, se desarrolló un ejercicio de referenciación comparativa y competitiva como herramienta de gestión que promueve la caracterización e incorporación de las posibles mejores prácticas ejercidas por las clínicas y hospitales del país.

Abstract We analyzed in this research article the process of technology acquisition in Colombian health service provider institutions (IPS). For this purpose we applied a business assessment methodology called benchmarking in six different IPS of the Antioquia department (both in the public and private sectors). This allowed us to identify the main ways to acquire biomedical technology; the prioritization of technological needs; the methods used by hospitals to assess medical equipment; the sources for the identification of needs; the legal and technical requirements requested at the moment of purchase; and also the amount of searches performed regarding national and international alerts in databases related to the devices. In this way, we developed a comparative and competitive referencing work as a management tool promoting characterization and the inclusion of the possible practical improvements carried out by clinics and hospitals across the country.

Resumo Neste artigo de pesquisa foi analisado o processo de aquisição de tecnologia nas instituições que prestam serviços de saúde (IPS, pelas suas siglas em espanhol) na Colômbia. Para o efeito, foi aplicada uma metodologia de diagnóstico empresarial chamada de benchmarking em seis IPS do departamento de Antioquia (tanto do sector público como do privado), o que permitiu identificar as principais maneiras de adquirir tecnologia biomédica, a priorização das necessidades de tecnologia, métodos empregados pelos hospitais para avaliação de equipamentos médicos, fontes de identificação das necessidades, requerimentos legais e técnicos necessários no momento da compra, assim como a proporção de procura de alarmes nacionais e internacionais em bases de dados relacionadas com dispositivos. Assim, um exercício de avaliação comparativa e competitiva foi desenvolvido como ferramenta de gestão que promove a caracterização e incorporação da possível melhor prática exercida por clínicas e hospitais do pais.

Incremental cost of implementing residual insecticide treatment with delthametrine on top of intensive routine Aedes aegypti control.

OBJECTIVE: Information on the cost of implementing residual insecticide treatment (RIT) for Aedes control is scarce. We evaluated the incremental cost on top of intensive conventional routine activities of the Aedes control programme (ACP) in the city of Santiago de Cuba, Cuba. METHODS: We conducted the cost analysis study in 2011-2012, from the perspective of the ACP. Data sources were bookkeeping records, activity registers of the Provincial ACP Centre and the accounts of an RIT implementation study in 21 clusters of on average four house blocks comprising 5180 premises. RESULTS: The annual cost of the routine ACP activities was 19.66 US$ per household. RIT applications in rounds at 4-month intervals covering, on average, 97.2% and using 8.5 g of delthametrine annually per household, cost 3.06 US$ per household per year. Delthametrine comprised 66.5% of this cost; the additional cost for deploying RIT comprised 15.6% of the total ACP routine cost and 27% of the cost related to routine adult stage Aedes control. CONCLUSIONS: The incremental cost of implementing RIT is high. It should be weighed against the incremental effect on the burden caused by the array of pathogens transmitted by Aedes. The cost could be reduced if the insecticide became cheaper, by limiting the number of yearly applications or by targeting transmission hot spots.

Comparison of sunscreen availability in Chicago Hispanic and non-Hispanic neighborhoods.

BACKGROUND: Poorer survival rates from melanoma among Hispanics have been previously reported. There is little information regarding sunscreen acquisition behaviors or availability/access to products that may help reduce the risk of skin cancer in Hispanic communities. This study sought to understand perceptions regarding sun protection and skin cancer risk and whether the availability of over-the-counter sunscreen products differed in three Chicago neighborhoods with different ethnic compositions. METHODS: We drew on interviews with 65 adult Spanish speaking Hispanics (23-72 years) recruited from faith-based institutions to better understand sunscreen use perceptions. Commercial establishments open to the general public were physically canvassed to determine whether there were any differences in sunscreen products availability. RESULTS: Stores carrying sun protection products are nearly twice as common in non Hispanic White neighborhoods versus Hispanic. In addition, when sunscreens are available for sale, Hispanics have fewer sunscreens to choose from. DISCUSSION: Emergent themes that were elicited during the interviews revealed that barriers to increased sunscreen use include economic and erroneous perceptions regarding skin cancer incidence and risk. Environmental factors that may reinforce these beliefs include lower availability and variety of sun protection products in Hispanic neighborhoods. CONCLUSION: These findings indicate that providing culturally appropriate public health information encouraging the use of sunscreen and improving its availability in Hispanic communities are potential points of intervention in attempts to improve morbidity from skin cancer.

Strategies for improving the Office of Minority Health.

The Office of Minority Health (OMH) was established in 1986 to improve and protect the health of racial and ethnic minority populations in the United States through the development of health policies and programs that will eliminate health disparities. Since its initial congressional mandate, it has produced multiple programs, campaigns, publications, and educational materials promoting the health of ethnic minorities. However, its continued existence is by no means assured. Recently, it faced harsh criticism regarding the success of its programs, and congressional leaders have introduced legislation designed to modify the office and its minority focus. In this report, we review 1) the accomplishments and inefficiencies of the current office and 2) provide recommendations to improve OMH's effectiveness in reducing health disparities and addressing health issues in minority populations.

Limitantes en la utilización del servicio de Medicina Preventiva para la DOC / Restrictions in the use of the Preventive Medicine services for the DOC

Introducción: El Cáncer Cervicouterino (CaCu) es un grave problema de salud pública, con diferencias regionales en su ocurrencia, 80% de los casos se presentan en los países en vías de desarrollo. Objetivo: Determinar los factores que limitan a las mujeres para no acudir a la realización de la detección oportuna de CaCu (DOC). Material y métodos: Se realizó un estudio observacional transversal, en la Unidad de Medicina Familiar N° 4 del Instituto Mexicano del Seguro Social en Zacatecas; mediante la aplicación de encuestas. Se incluyeron: mujeres derechohabientes de 12 a 49 años, con vida sexual activa. Resultados: Se realizaron 100 entrevistas; el promedio de edad de las mujeres fue 28 años desviación estándar de 8.5 y un rango de 33 años de edad; 60% se realizó la DOC. El número de embarazos (OR=24.6; 95% IC 5.05-162.6), la edad (OR = 13.35; 95% IC 4.57-40.5), la escolaridad (OR=1.85; 95% IC 0.68-4.87), el inicio de vida sexual activa (OR=1.42: 95% IC 0.59-3.43) mostraron asociación para no acudir a la detección. Discusión: La cobertura en la población blanco (16 a 26 años) no es la deseable ya que la mayor parte de los displasias son diagnosticados en mujeres > 20 años. Conclusiones: Es imperativo promover la importancia de este estudio en la población femenina en general

Introduction: The frequency of cervicouterine cancer (CaCu) widely accordingto the several etnicas forms worldwide, in some countries of continuous Latin American being the first cause in the female population. Objective: To identify factors that influence refusing opportune detection of cancer cervicouterine. Material and methods: Across secctional, observational study in the Familiar Medicine Unit No 4 of the of Social Security Mexican Institute at Zacatecas by the aplication of surveys in medicare women, during 2000. Incluyed in study women rightful claimants of 15 to 49 years whit active sexual life were interviewed with a questionnaire to evaluate their personal attitudes toward DOC. Results: A total of 100 individuals was studied, an average of the women of 28 years with a rank of 33 years and one desviation to estandar 8.5, the 60% made the Opportuned Detection of Cancer (DOC). Risk factors were (OR=24.6; Cl 95% 5.05 to 162.6), the number of pregnancies(OR=24.6; Cl 95% 5.05 to 162.6), the age (OR= 13.35; Cl 95% 4.57-40.5), the school grade (OR=1.85; 095% 0.68-4.87), the beginning of active sexual life (OR=1.42: Cl 95% 0.59-3.43) showed association among the attitudes that influence refusing to attended to DOC. Conclusions: Among women who don't attendat DOC have more weight personal attitude toward DOC have more than knowledge on the subject.