Critical appraisal of the Colombian clinical practice guide for the prevention, diagnosis and treatment of suicidal ideation and/or behaviour (adoption).

INTRODUCTION: Suicide is a complex, global public health problem. The Colombian clinical practice guideline provides relevant input for its prevention, diagnosis and treatment. The objective was to evaluate the methodological quality, credibility and applicability of the Colombian clinical practice guideline for suicidal behaviour. METHODS: An academic group of 12 evaluators was established to assess the guide and its recommendations in a standardised way, using the AGREE-II and AGREE-REX instruments. The evaluations were given in the range of 0.0-1.0 with 0.7 as a cut-off point for appropriate quality. RESULTS: The global assessment of the AGREE-II was greater than 0.7 in the dimensions: "scope and objective" (0.86), "clarity of presentation" (0.89), "applicability" (0.73) and "editorial independence" (0.89). The lowest scores were for "participation of those involved" (0.67) and "rigour in preparation" (0.69). With the AGREE-REX, the results in all dimensions were below 0.70, which indicates lower quality and suitability for use. CONCLUSIONS: The adoption process of the Colombian guideline for suicidal behaviour was a rigorous methodological process, while the practice recommendations were valued as of low applicability due to low support in local evidence. It is necessary to strengthen the generation and synthesis of evidence at the national level to give greater support and applicability to the practice recommendations.

Epidemiology of childhood acute leukemias in marginalized populations of the central-south region of Mexico: results from a population-based registry.

Introduction: Acute leukemias (AL) are the main types of cancer in children worldwide. In Mexico, they represent one of the main causes of death in children under 20 years of age. Most of the studies on the incidence of AL in Mexico have been developed in the urban context of Greater Mexico City and no previous studies have been conducted in the central-south of the country through a population-based study. The aim of the present work was to identify the general and specific incidence rates of pediatric AL in three states of the south-central region of Mexico considered as some of the marginalized populations of Mexico (Puebla, Tlaxcala, and Oaxaca). Methods: A population-based study was conducted. Children aged less than 20 years, resident in these states, and newly diagnosed with AL in public/private hospitals during the period 2021-2022 were identified. Crude incidence rates (cIR), standardized incidence rates (ASIRw), and incidence rates by state subregions (ASIRsr) were calculated. Rates were calculated using the direct and indirect method and reported per million children under 20 years of age. In addition, specific rates were calculated by age group, sex, leukemia subtype, and immunophenotype. Results: A total of 388 cases with AL were registered. In the three states, the ASIRw for AL was 51.5 cases per million (0-14 years); in Puebla, it was 53.2, Tlaxcala 54.7, and Oaxaca de 47.7. In the age group between 0-19 years, the ASIRw were 44.3, 46.4, 48.2, and 49.6, in Puebla, Tlaxcala, and Oaxaca, respectively. B-cell acute lymphoblastic leukemia was the most common subtype across the three states. Conclusion: The incidence of childhood AL in the central-south region of Mexico is within the range of rates reported in other populations of Latin American origin. Two incidence peaks were identified for lymphoblastic and myeloid leukemias. In addition, differences in the incidence of the disease were observed among state subregions which could be attributed to social factors linked to the ethnic origin of the inhabitants. Nonetheless, this hypothesis requires further investigation.

Application of the ASCO value framework to evaluate the clinical and economic value of enzalutamide and apalutamide in the early stages of prostate cancer in Colombia.

Introduction: Prostate cancer has increased in recent years, increasing the costs associated with its treatment. Second-generation oral antiandrogens have emerged as an attractive therapeutic option. Objective: To compare the health value provided by enzalutamide and apalutamide, by evaluating two stages of prostate cancer: non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic hormone-sensitive prostate cancer (mHSPC). Methods: To establish, through the American Society of Clinical Oncology (ASCO) value framework, a contrast between two technologies in two stages of prostate cancer. The monthly cost of the two technologies was calculated according to the current price regulation norm in Colombia. Results: Enzalutamide showed a higher net health benefit score compared to apalutamide for both nmCRPC (48.33 versus 33.46) and mHSPC (52.0 versus 40.75). The cost per net health benefit point for the nmCRPC stage was $214,723 Colombian Pesos (COP) ($54.84 USD) with enzalutamide compared to $291,925 COP ($74.56 USD) with apalutamide, and for the mHSPC stage was $199,692 COP ($51.00 USD) with enzalutamide and $239,701 COP ($61.22 USD) with apalutamide. Conclusion: After comparing enzalutamide versus apalutamide in the nmCRPC and mHSPC stages through the ASCO value framework, enzalutamide showed a more prominent net clinical benefit and a lower investment per point awarded.

Economic pressures of Covid-19 lockdowns result in increased timber extraction within a critically endangered region: A case study from the Pacific Forest of Ecuador.

Although the COVID-19 lockdowns in 2020 had some environmental benefits, the pandemic's impact on the global economy has also had conservation repercussions, especially in biodiverse nations. Ecuador, which is heavily reliant on petroleum, agricultural exports, and ecotourism, experienced a rise in poverty in response to pandemic shutdowns. In this study, we sought to quantify levels of illegal timber extraction and poaching before and after the start of COVID-19 lockdowns throughout two protected areas (Reserva Jama Coaque [JCR] and Bosque Seco Lalo Loor [BSLL]) in the endangered Pacific Forest of Ecuador. We analyzed chainsaw and gunshot acoustic data recorded from devices installed in the forest canopy from December 2019 to March 2020 and October 2020 to March 2021. Results from generalized linear mixed effects models indicated less chainsaw activity before lockdowns (ßpost.lockdown = 0.568 ± 0.266 SE, p-value = .030), although increased average rainfall also seemed to negatively affect chainsaw activity (ßavg.rainfall = -0.002 ± 0.0006 SE, p-value = .003). Gunshots were too infrequent to conduct statistical models; however, 87% of gunshots were detected during the 'lockdown' period. Observational data collected by rangers from these protected areas also noted an increase in poaching activities beginning mid to late 2020 and persisting into 2021. These results add to the steadily growing literature indicating an increase in environmental crime, particularly in biodiverse nations, catalyzed by COVID-19-related economic hardships. Identifying areas where environmental crime increased during pandemic lockdowns is vital to address both socioeconomic drivers and enforcement deficiencies to prevent further biodiversity loss and disease outbreaks and to promote ecosystem resilience. Our study also demonstrates the utility of passive acoustic monitoring to detect illegal resource extraction patterns, which can inform strategies such as game theory modeling for ranger patrol circuits and placement of real-time acoustic detection technologies to monitor and mitigate environmental crimes.

Cost-effectiveness analysis of defibrotide in the treatment of patients with severe veno-occlusive disease/sinusoidal obstructive syndrome with multiorgan dysfunction following hematopoietic cell transplantation in Spain.

AIMS: This study evaluated cost-effectiveness of defibrotide vs best supportive care (BSC) for the treatment of hepatic veno-occlusive disease/sinusoidal obstructive syndrome (VOD/SOS) with multiorgan dysfunction (MOD) post-hematopoietic cell transplantation (HCT) in Spain. MATERIALS AND METHODS: A two-phase Markov model, comprising a 1-year acute phase with daily cycles and a lifetime long-term phase with annual cycles, was adapted to the Spanish setting. The model included a cohort of patients with severe VOD/SOS (defined as VOD/SOS with MOD) post-HCT. For the acute phase, efficacy and VOD/SOS-related length of stay were obtained from a phase 3 defibrotide study (NCT00358501). VOD/SOS-related hospital stays were 7.5 and 23.2 days in defibrotide-treated and BSC patients, respectively. Defibrotide-treated patients spent 30% of their stay in the intensive care unit vs 60% in BSC patients. Assumptions for the long-term phase and utility values were obtained from the literature. Costs were from the Spanish Health System perspective (€2019). Defibrotide cost was based on 25 mg/kg/day over 17.5 days, using local expert opinion. Life-years (LYs), quality-adjusted LYs (QALYs), and costs were estimated over a lifetime horizon, applying a 3% discount rate for costs and outcomes. Sensitivity analyses assessed the robustness of the results. RESULTS: Defibrotide produced an additional 1.214 QALYs and 1.348 LYs vs BSC, with a total cost of €33,708 more than BSC alone. However, defibrotide resulted in savings up to €16,644/patient for cost of hospital stay. Difference between costs and effective measures led to ratios of €27,757/QALY and €25,007/LY gained. Additional hospital stays had the greatest influence on base-case results. Probabilistic analysis confirmed the robustness of the deterministic results. LIMITATIONS: Limitations include use of historical controls and assumptions extrapolated from the literature. CONCLUSIONS: This cost-effectiveness model, adapted to the Spanish setting, showed that defibrotide is a cost-effective alternative to BSC alone in patients with severe VOD/SOS post-HCT.

Socioeconomic effects of protected areas in Spain across spatial scales and protection levels.

Impacts of the legal designation of protected areas (PAs) may have contrasting implications for different stakeholders, and at different spatial scales. In this study, we analysed the organisational perception on the socioeconomic effects of PA designation from all sectors of activity in Spain, accounting for PAs' legal stringency. A semi-structured questionnaire was administered to 68 organisations at national, regional (Andalusia) and local scales (two municipalities in the Almeria province, Andalusia) through an online survey. Local stakeholders and the primary, secondary and tertiary sectors were most concerned about the social and economic impacts of PAs designation on their organisations. By contrast, organisations at the national or regional scales together with public institutions, the quaternary sector and other miscellaneous stakeholders perceived predominantly positive effects. Only national organisations perceived an increase in local social and economic effects from the designation of legally stringent PAs with regard to multiple-use PAs.

Pre-emptive deceased-donor kidney transplant: A matched cohort study. / Una aproximación al trasplante renal anticipado de donante cadáver. Estudio de cohortes emparejadas.

INTRODUCTION: Currently, kidney transplantation is the treatment of choice for patients with kidney disease who require replacement therapy. Dialysis is a necessary step, but not mandatory prior to transplantation. There is the possibility of pre-emptive transplantation or transplantation in pre-dialysis, that is, without previous dialysis. The aim of the present study is to evaluate the result of our experience with a pre-emptive kidney transplant from a deceased donor. MATERIALS AND METHODS: Retrospective, observational, matched cohort study. We compared 66 pre-emptive with 66 non pre-emptive recipients, who received a first renal graft performed at our centre, matched by age and gender of donors and recipients, time of transplant, immunological risk, immunosuppression and cold ischaemia time. Early graft loss, incidence of acute rejection, delayed graft function, renal function at 12 and 36 months and graft and recipient survival were assessed in this period. RESULTS: The percentage of recipients who presented early graft loss, delayed graft function and acute rejection was similar in both groups. No differences were observed in their renal function at 12 and 36 months after transplantation, as well as the actuarial survival of patients (P=0.801) and grafts (P=0.693) in the studied period. The total calculated cost of the period on dialysis for the control group was 8,033,893.16 euros. CONCLUSIONS: Pre-emptive transplantation can yield comparable outcomes to those for post-dialysis kidney transplantation, and results in better quality of life for patients with end-stage kidney disease, as well as a reduced cost.

Situación de salud de gestantes migrantes venezolanas en el Caribe colombiano: primer reporte para una respuesta rápida en Salud Pública / Health situation of Venezuelan pregnant migrants in the Colombian Caribbean: first report for a rapid response in Public Health

Resumen Introducción: En el fenómeno migratorio desde Venezuela hacia Colombia, las mujeres representan una proporción significativa entre los migrantes irregulares; de ellas, las gestantes han sido priorizadas por sus condiciones particulares de vulnerabilidad. Sin embargo, se desconocen sus condiciones de salud. Objetivos: Caracterizar multidimensionalmente la situación de salud de las gestantes venezolanas migrantes irregulares, residentes en las principales ciudades receptoras del Caribe colombiano: Barranquilla y Riohacha. Metodología: Estudio descriptivo de corte transversal en 520 gestantes venezolanas migrantes irregulares, captadas por muestreo sistemático en hospitales públicos, y comunitariamente a través de búsqueda activa en bola de nieve entre agosto de 2018 y mayo de 2019. Con un cuestionario estandarizado se evaluaron los principales problemas de salud, estado nutricional, seguridad alimentaria, presencia de síntomas depresivos, accesibilidad y satisfacción con los servicios de salud. Resultados: La mitad percibía su salud durante el embarazo como buena o muy buena (53,4%). El 51,3% presentó anemia ferropénica y la mayoría algún grado de inseguridad alimentaria (87,5%). La prevalencia de síntomas depresivos clínicamente significativos fue del 32,1%. Una alta proporción reportó algún tipo de violencia por parte de su pareja (90,2%). El 25,9% requirió atención sanitaria por urgencias independiente de la atención prenatal. El 62,7% calificó la atención por urgencias como muy buena o buena, mientras que el 73,1% piensa que le brindaron la atención necesaria para su problema de salud. Conclusiones: Los principales problemas de salud en gestantes que participaron en el estudio corresponden a la inseguridad alimentaria, anemia, síntomas depresivos, violencia de pareja y ausencia de controles prenatales. Su situación de salud debe considerarse en el marco del proceso migratorio y desde los determinantes sociales de la salida, tránsito, llegada y retorno. Las medidas de atención primaria para esta población deben seguir siendo fortalecidas por el sistema de salud a nivel territorial y basadas en evidencia.

Abstract Introduction: In the current migration from Venezuela to Colombia, women represent a significant proportion of the irregular migrant population, and those who are pregnant have been a priority given their particularly vulnerable condition. Nevertheless, their health conditions are not known. Objectives: To obtain a multi-dimensional characterization of the health situation of irregular Venezuelan migrants who are pregnant and residing in the main receiving the Caribbean region of Colombia: Barranquilla and Riohacha. Methods: We carried out a descriptive, cross-sectional study with 520 pregnant women surveyed from August 2018 to May 2019 with a systematic sampling in public hospitals and an active community search using snowball sampling. We used a standardized questionnaire to evaluate the main health problems, nutritional status, food security, presence of depressive symptoms and accessibility/ satisfaction with health services. Results: Half of the participants perceived their health during pregnancy as good or very good (53.4%), 51.3% presented iron deficiency anemia, and the majority (87.5%) experienced some lack of food security. The prevalence of clinically significant depressive symptoms was 32.1%. A high proportion reported some type of intimate partner violence (90.2%). 25.9% required urgent medical care, irrespective of the prenatal care they received. With regard to quality of care in the emergency service, 62.7% rated it as very good or good, and 73.1% reported that they received the care that was needed for their health problem. Conclusions: Food insecurity, anemia, depressive symptoms, violence committed by the partner and lack of prenatal care were the main health problems for pregnant women who participated in the study. Their health situation should be viewed in the context of the migration process, based on the social determinants of emigration, transit, arrival, and return. The health care system should continue to strengthen primary care measures for this population at the local level and based on the evidence.

Perception of effective access to health services in Territorial Spaces for Training and Reincorporation, one year after the peace accords in Colombia: a cross-sectional study.

Backgrounds: The signing of the peace accords in Colombia created challenges that are inherent to post-conflict transitions. One of those is the process of reintegrating ex-combatants into society, in which ensuring their rights to health is a particularly significant challenge in rural areas affected by armed conflict. These areas, known as Territorial Spaces for Training and ReintegrationReincorporation (ETCR, in Spanish), are geographically dispersed throughout 24 municipalities and 13 departments in Colombia. This study aimed to describe how ex-combatants in ETCR regions perceived access to health services one year after the signing of the peace accords. Methods: A descriptive, cross-sectional study was performed between September and October 2018. It included 591 adults and their families, from 23 ETCRs. The study was designed, culturally validated, and piloted. Interviewers were trained and a structured survey was administered containing five dimensions that characterized the perception of effective access to health services. Results: The majority of interviewees were women, heads of household, young adults, ex-combatants, and residents in an ETCR. In total of 96.4% were enrolled in Colombia's subsidized health system, and 20.8% indicated that a member of their household required emergency health services. The regional health center provided the majority of the services. Most of those surveyed (96.0%) reported that they did not have to pay for the services, and that they received respectful (91.6%) and good quality (66.6%) care. There were few referrals to disease prevention and health promotion activities, and only 19.0% of households reported having been visited by extramural health care teams, whose activities were highly valued (80%). Lastly, there was little knowledge about community health activities. Conclusions: While residents of ETCR regions have a favorable perception of their access to health services, they need to be made aware of extramural and public health activities.

A Low Complexity System Based on Multiple Weighted Decision Trees for Indoor Localization.

Indoor position estimation has become an attractive research topic due to growing interest in location-aware services. Nevertheless, satisfying solutions have not been found with the considerations of both accuracy and system complexity. From the perspective of lightweight mobile devices, they are extremely important characteristics, because both the processor power and energy availability are limited. Hence, an indoor localization system with high computational complexity can cause complete battery drain within a few hours. In our research, we use a data mining technique named boosting to develop a localization system based on multiple weighted decision trees to predict the device location, since it has high accuracy and low computational complexity. The localization system is built using a dataset from sensor fusion, which combines the strength of radio signals from different wireless local area network access points and device orientation information from a digital compass built-in mobile device, so that extra sensors are unnecessary. Experimental results indicate that the proposed system leads to substantial improvements on computational complexity over the widely-used traditional fingerprinting methods, and it has a better accuracy than they have.

Pre-exposure prophylaxis accessibility research and evaluation (PrEPARE Study).

Tenofovir-emtricitabine (TDF-FTC) has demonstrated effectiveness as HIV preexposure prophylaxis (PrEP), but it is not commonly prescribed. Our study was designed to determine the barriers preventing utilization of PrEP among men who have sex with men (MSM), the group at greatest risk for HIV infection in the United States. A population-based sample of MSM presenting for HIV testing at 'Early Test' HIV testing and counseling sites in San Diego, California were offered PrEP and education about potential efficacy. Eligible individuals reported having unprotected sex within the past 12 months and who tested negative for HIV were offered study participation. Despite offering procedures for evaluation and prescription for PrEP to 416 eligible subjects, less than 0.5 % of participants received the drug. Surveys collected from 54 of those who declined study participation revealed multiple barriers to PrEP among MSM including cost, low perceived risk of infection and concerns about taking a daily medication and potential long-term side effects. Efforts should be made to address these barriers, especially lowering the cost of TDF-FTC, education about PrEP side effects and awareness of HIV risks.

Personal genomic testing as part of the complete breast cancer risk assessment: a case report.

Patient access and utilization of personal genomic testing is becoming increasingly common. We present a case of a patient's personal genomic screening results leading to early detection of infiltrating breast ductal cell carcinoma via MRI scan. This case exemplifies the successful integration of personal genomic testing into the primary care setting, with the guidance and support of genetic counseling services. We discuss the scientific basis of the patient's genome scan results and risk assessment, and how this informed her decision-making and subsequent screening. We also expound upon the role of personal genomic testing as compared to other screening tests in the complete breast cancer risk assessment.

Necessary and sufficient detection efficiency for the mermin inequalities.

We prove that the threshold detection efficiency for a loophole-free Bell experiment using an n-qubit Greenberger-Horne-Zeilinger state and the correlations appearing in the n-partite Mermin inequality is n/(2n-2). If the detection efficiency is equal to or lower than this value, there are local hidden variable models that can simulate all the quantum predictions. If the detection efficiency is above this value, there is no local hidden variable model that can simulate all the quantum predictions.

Intraobserver and interobserver reproducibility of 3-dimensional power Doppler vascular indices in assessment of solid and cystic-solid adnexal masses.

OBJECTIVE: The purpose of this study was to assess the intraobserver and interobserver reproducibility of 3-dimensional (3D) power Doppler angiography-derived vascular indices in evaluation of vascularized solid and cystic-solid adnexal masses. METHODS: Stored 3D power Doppler angiographic volume data from 12 consecutive women with a diagnosis of a complex adnexal mass (6 cystic-solid and 6 solid) evaluated and treated at our institution were retrieved from our database for analysis. Two examiners performed the calculations blinded to each other. Calculations were performed offline in a computer using Virtual Organ Computer-Aided Analysis software (plane A, 9 degrees rotation step) to assess volume and vascularization (vascularization index, flow index, and vascularization-flow index) from solid areas within the tumor. In all cases, a definitive histologic diagnosis was obtained. Intraobserver and interobserver reproducibility was assessed by calculating the intraclass and interclass correlation coefficients for each index. RESULTS: All tumors proved to be malignant after surgical removal. Intraobserver reproducibility for both examiners and interobserver reproducibility were high for all indices (interclass correlation coefficient > 0.95). CONCLUSIONS: Three-dimensional power Doppler angiography is a reproducible technique for offline assessment of stored 3D volume data of vascularized adnexal masses.

How much uncompensated care do doctors provide?

The magnitude of provider uncompensated care has become an important public policy issue. Yet existing measures of uncompensated care are flawed because they compare uninsured payments to list prices, not to the prices actually paid by the insured. We address this issue using a novel source of data from a vendor that processes financial data for almost 4000 physicians. We measure uncompensated care as the net amount that physicians lose by lower payments from the uninsured than from the insured. Our best estimate is that physicians provide negative uncompensated care to the uninsured, earning more on uninsured patients than on insured patients with comparable treatments. Even our most conservative estimates suggest that uncompensated care amounts to only 0.8% of revenues, or at most $3.2 billion nationally. These results highlight the important distinction between charges and payments, and point to the need for a re-definition of uncompensated care in the health sector going forward.

Costo de producción de un litro de leche en una ganadería de el sistema doble propósito, Magangué, Bolívar / Production cost of a liter of milk in a livestock bovine double purpose system, Magangué, Bolivar

vacuno doble propósito en la Región Caribe, como herramienta para la medición de la eficiencia del sistema. Materiales y métodos. La metodología implementada consideró la estructura de costos de la actividad de ordeño, incluyó el costo del arrendamiento de la tierra, más el valor de los kilogramos de carne que deja de ganar el ternero durante la etapa de lactancia, respecto al sistema vacuno cría, donde no se ordeña la vaca. Resultados. Se halló un costo medio anual de US$ 0,11 por litro de leche producida (48,38 por ciento costos fijos y 51,62 por ciento costos variables). Existió una relación de inversa proporcionalidad entre los costos y el volumen de producción y venta de leche en el período analizado, con un coeficiente de determinación de 82,34 por ciento. Conclusión. La metodología permitió determinar el costo de producción de un litro de leche. La actividad lechera resultó rentable, ya que el 47,36 por ciento del precio de venta de la leche equivalió al costo de producirla. El punto de equilibrio en unidades producidas e ingresos fue de 29,47 por ciento (60 litros/día), respecto a la producción diaria de leche

Objective. To design a methodology to calculate the cost of milk production in a system bovine double purpose in the Caribbean Region as tool to measure the system efficiency. Materials andmethods. The implemented methodology considered the costs structure of milking activity, it included the cost of land rent, plus the value of beef kilogram that stops to win the calf during lactating stage regarding bovine breeding system where the cow is not milked. Results. It was found an annual average cost of US$0,11 per liter of produced milk (48,38% fixed costs and 51,62% variable costs). There was a relation of inverse proportionality between costs and production volume and milk salein the analyzed period with a coefficient of determination of 82,34%. Conclusion. The methodology allowed to determine the production cost of a liter of milk. The milkmaid activity was profitable since the 47,36% of milk sale price was equal to cost of producing it. The balance point in produced units and revenues was of 29,47% (60 liters/day), regarding the daily production of milk.