Comparison of analytical performance and economic value of two biosurveillance methods for tracking SARS-COV-2 variants of concern.

The development of biosurveillance programs with strong analytical performance and economically accessible protocols is essential for monitoring viral pathogens. Throughout the COVID-19 pandemic, whole-genome sequencing (WGS) has been the prevailing technology for SARS-CoV-2 variant of concern (VOC) detection. While WGS offers benefits, it is a lengthy process, financially and technically straining for scalable viral tracking. The aim of this study was to compare the analytical performance and economic feasibility of WGS and PCR mutation panels for distinguishing six known VOCs: Alpha (B.1.1.7 and Q.4), Gamma (P.1), Delta (B.1.617.2 and AY.4.2), and Omicron. (B.1.1.529.1). In all, 78 SARS-CoV-2-positive samples were collected from April to December 2021 at Northeastern University (Cabot Testing Site, Boston, MA, USA) for genotyping PCR and WGS analysis. MagMax Viral/Pathogen II Nucleic Acid Isolation and TaqPath COVID-19 Combo Kits were used for RNA extraction and SARS-CoV-2 confirmation. VOC discrimination was assessed using two TaqMan SARS-CoV-2 single nucleotide polymorphism (SNP) assay layouts, and Ion Torrent WGS. In November 2021, the mutation panel demonstrated marked versatility by detecting the emerging Omicron variant reported by South Africa. SNP panel analysis yielded the following 78 VOC identifications: Alpha B.1.1.7 (N = 20), Alpha Q.4 (N = 3), Gamma P.1 (N = 1), Delta B.1.617.2 (N = 30), Delta AY.4.2 (N = 3), and Omicron B.1.1.529.1 (N = 20) with one undetermined (N = 1) sample. Genotyping mutation panels designated lineages in 77 of 78 samples, 46/78 were confirmed by WGS, while 32 samples failed WGS lineage assignment. RT-PCR genotyping panels offer pronounced throughput and sensitivity and provide an economically advantageous technique for SARS-CoV-2 biosurveillance.IMPORTANCEThe results presented in our manuscript demonstrate how the value of simplistic and reliable molecular assays coupled with the core scientific principle of standardization can be overlooked by the charm of more sophisticated assays and instrumentation. This effect can often be amplified during tumultuous public health events, such as the COVID-19 pandemic. By adapting standardized PCR mutation panels to detect prominently circulating SARS-CoV-2 variants, we were able to better assess the potential health impacts of rising positivity rates and transmission clusters within the Northeastern University population. While several literature publications utilizing genotyping PCR and NGS have a similar scope to ours, many investigations lack sufficiently standardized genotyping PCR and NGS bioinformatics inclusionary/exclusionary criteria for SARS-CoV-2 variant identification. Finally, the economic benefits of standardized PCR mutation panels would allow for global implementation of biosurveillance, rather than reserving biosurveillance to more economically developed nations.

Association of Socioeconomic Status With Life's Essential 8 Varies by Race and Ethnicity.

Background The American Heart Association's Life's Essential 8 (LE8) are 8 risk factors for cardiovascular disease, with poor attainment across all racial, ethnic, and socioeconomic groups. Attainment is lowest among Americans of low socioeconomic status (SES). Evidence suggests the association of SES with LE8 may vary by race and ethnicity. Methods and Results The association of 4 SES categories (education, income-to-poverty line ratio, employment, insurance) with LE8 was computed in age-adjusted linear regression models, with an interaction term for race and ethnicity, using National Health and Nutrition Examination Survey data, years 2011 to 2018. The sample (n=13 529) had a median age of 48 years (51% female) with weighting to be representative of the US population. The magnitude of positive association of college education (relative to ≤high school) with LE8 was greater among non-Hispanic White Americans (NHWA) compared with non-Hispanic Black Americans, Hispanic Americans, and non-Hispanic Asian Americans (all interactions P<0.001). NHWA had a greater magnitude of positive association of income-to-poverty line ratio with LE8, compared with non-Hispanic Black Americans, Hispanic Americans, and non-Hispanic Asian Americans (all interactions P<0.001). NHWA with Medicaid compared with private insurance had a greater magnitude of negative association with LE8 compared with non-Hispanic Black Americans, non-Hispanic Asian Americans, or Hispanic Americans (all interactions P<0.01). NHWA unemployed due to disability or health condition (compared with employed) had a greater magnitude of negative association with LE8 than non-Hispanic Black Americans, non-Hispanic Asian Americans, or Hispanic Americans (all interactions P<0.05). Conclusions The magnitude of association of SES with LE8 is greatest among NHWA. More research is needed on SES's role in LE8 attainment in minority group populations.

[Opinions and experiences of healthcare professionals in the nutritional management of oncology patients: the ONA study]. / Opiniones y experiencias de profesionales sanitarios en el manejo nutricional del paciente oncológico: estudio ONA.

Introduction: Objectives: an inadequate approach to prevent malnutrition in cancer patients may worsen their quality of life and reduce their response to treatment. This study aims to describe the nutritional management of cancer patients in clinical practice, as well as the opinions of the healthcare professionals (HCPs) involved. Methods: this was an observational, descriptive, cross-sectional study addressed to HCPs in the Spanish healthcare setting. The online questionnaire was designed based on a literature review, one focus group of patients (n = 6), and the experience of the multidisciplinary scientific committee (n = 5), and was distributed by the scientific societies endorsing the study. Results: a total of 461 HCPs answered the survey. Most of them considered that a nutrition expert (95.0 %) is essential for the nutritional management of patients. However, 22.8 % of HCPs did not have access to this expert, and only 49.0 % had received training. Nutritional screening or patient referral for screening was performed by 58.4 % of HCPs. Of the total of HCPs, 86.6 % stated that nutritional information is provided to patients and considered them moderately satisfied with the information received. In malnourished patients or in those at risk of malnutrition, a complete nutritional assessment was performed by HCPs (73.1 %). Most HCPs (87.4 %) reported prescribing or recommending nutritional support if needed, and assessing adherence (86.8 %). Conclusions: despite malnutrition being a common problem in cancer patients, almost half of professionals do not perform any nutritional screening. In addition, patient information and assessment of nutritional adherence appear to be suboptimal.

Introducción: Objetivos: un abordaje inadecuado de la desnutrición en el paciente con cáncer puede conducir a un empeoramiento de su calidad de vida y una respuesta deficiente al tratamiento. El estudio ONA (Oncología, Nutrición y Adherencia) tiene como objetivo describir el manejo nutricional del paciente con cáncer en la práctica clínica, así como las opiniones de los profesionales sanitarios involucrados en el mismo. Métodos: estudio observacional, descriptivo y transversal dirigido a profesionales sanitarios españoles. El cuestionario online fue diseñado a partir de una revisión bibliográfica, un grupo focal de pacientes (n = 6) y un comité científico multidisciplinar (n = 5), y distribuido por las sociedades científicas que avalan el estudio. Resultados: de los 461 profesionales sanitarios participantes, el 95,0 % consideraron fundamental la figura del profesional sanitario con formación específica en nutrición, pero el 22,8 % no tenían acceso a ella y solo el 49,0 % habían recibido formación. El 58,4 % afirmaron realizar el cribado nutricional o derivar al paciente para este fin. El 86,6 % de los participantes indicaron que se informa al paciente sobre aspectos nutricionales y consideraron que este estaba moderadamente satisfecho con la información recibida. En caso de detectarse desnutrición o riesgo de desnutrición, los profesionales afirmaron realizar una evaluación nutricional completa (73,1 %) y, de necesitarse soporte nutricional, este se prescribiría/recomendaría (87,4 %), evaluándose la adherencia al mismo (86,8 %). Conclusiones: a pesar de que la desnutrición es un problema común en el paciente con cáncer, casi la mitad de los profesionales no realizan un cribado nutricional. Además, el proceso de información y evaluación de la adherencia nutricional es subóptimo.

Healthcare resource utilization and costs in pediatric pulmonary arterial hypertension in a third-level hospital in Mexico.

Aim: The objective of this study was to evaluate the healthcare costs and resource utilization of pediatric pulmonary arterial hypertension management at a third-level hospital in Mexico. Methods: A retrospective cohort study was conducted in a pediatric population with pulmonary arterial hypertension. Only direct medical costs, derived from pharmacological treatment, laboratory tests, physician visits and hospitalizations, were considered. From an institutional perspective, all costs were accounted for in 2019 US dollars. Results: A total of 82 patients were included. Of these, 55% were female and the mean age was 6.9 (standard deviation ± 4) years. The mean annual cost was $17,452.14 (standard deviation ± $38,944.10), with a median cost of $8832.75. Conclusion: Pulmonary arterial hypertension is a costly disease, with hospitalization and pharmacological treatment being areas with a higher economic burden. Functional class IV has greater resource utilization and costs.

Nurse and Nursing Students´ Opinions and Perceptions of Enteral Nutrition by Nasogastric Tube in Palliative Care.

It is widely accepted that nursing staff play a key role in palliative care (PC). The use of Nasogastric tubes (NG tubes) for Enteral Nutrition (EN) administration is still controversial in patients who receive PC. The aim of this study was to describe nurses' and nursing students´ opinions and perceptions about EN using NG tubes in adult patients in palliative care. To achieve this goal, a cross-sectional descriptive study was carried out. A self-administered, semi-structured questionnaire intended for nurses and nursing students was used. Data was descriptively and inferentially analyzed using a chi-square test to determine the differential frequency of responses. In addition, a multivariate logistic regression model was also conducted. A total of 511 participants completed the questionnaire. Among them, nursing staff represented 74.9% (n = 383) whereas nursing students were 25.1% (n = 128). When life expectancy was above six months, 90.0% (n = 460) reported that EN using NG should be implemented. In contrast, when life expectancy is less than a month, 57.5% (n = 294) discouraged it. Significant differences within groups were found when life expectancy was <1 month (p = 0.044). It was also found that 491 participants (96.1%) reported that patient´s autonomy must be carefully respected for deciding whether continuing EN by NG tube or not. Finally, it was concluded for both nurses and nursing students that life expectancy should be the mean reason for implementing and withdrawing EN by NG tube. Major differences were found regarding when it should be ceased, suggesting perceptions may change as nurses graduate and move into their professional roles.

Call to Action: Structural Racism as a Fundamental Driver of Health Disparities: A Presidential Advisory From the American Heart Association.

Structural racism has been and remains a fundamental cause of persistent health disparities in the United States. The coronavirus disease 2019 (COVID-19) pandemic and the police killings of George Floyd, Breonna Taylor, and multiple others have been reminders that structural racism persists and restricts the opportunities for long, healthy lives of Black Americans and other historically disenfranchised groups. The American Heart Association has previously published statements addressing cardiovascular and cerebrovascular risk and disparities among racial and ethnic groups in the United States, but these statements have not adequately recognized structural racism as a fundamental cause of poor health and disparities in cardiovascular disease. This presidential advisory reviews the historical context, current state, and potential solutions to address structural racism in our country. Several principles emerge from our review: racism persists; racism is experienced; and the task of dismantling racism must belong to all of society. It cannot be accomplished by affected individuals alone. The path forward requires our commitment to transforming the conditions of historically marginalized communities, improving the quality of housing and neighborhood environments of these populations, advocating for policies that eliminate inequities in access to economic opportunities, quality education, and health care, and enhancing allyship among racial and ethnic groups. Future research on racism must be accelerated and should investigate the joint effects of multiple domains of racism (structural, interpersonal, cultural, anti-Black). The American Heart Association must look internally to correct its own shortcomings and advance antiracist policies and practices regarding science, public and professional education, and advocacy. With this advisory, the American Heart Association declares its unequivocal support of antiracist principles.

Sociodemographic Determinants of Life's Simple 7: Implications for Achieving Cardiovascular Health and Health Equity Goals.

Background: Life's Simple 7 (LS7; nutrition, physical activity, cigarette use, body mass index, blood pressure, cholesterol, glucose) predicts cardiovascular health. The principal objective of our study was to define demographic and socioeconomic factors associated with LS7 to better inform programs addressing cardiovascular health and health equity. Methods: National Health and Nutrition Examination Surveys 1999-2016 data were analyzed on non-Hispanic White [NHW], NH Black [NHB], and Hispanic adults aged ≥20 years without cardiovascular disease. Each LS7 variable was assigned 0, 1, or 2 points for poor, intermediate, and ideal levels, respectively. Composite LS7 scores were grouped as poor (0-4 points), intermediate (5-9), and ideal (10-14). Results: 32,803 adults were included. Mean composite LS7 scores were below ideal across race/ethnicity groups. After adjusting for confounders, NHBs were less likely to have optimal LS7 scores than NHW (multivariable odds ratios (OR .44; 95% CI .37-.53), whereas Hispanics tended to have better scores (1.18; .96-1.44). Hispanics had more ideal LS7 scores than NHBs, although Hispanics had lower incomes and less education, which were independently associated with fewer ideal LS7 scores. Adults aged ≥45 years were less likely to have ideal LS7 scores (.11; .09-.12) than adults aged <45 years. Conclusions: NHBs were the least likely to have optimal scores, despite higher incomes and more education than Hispanics, consistent with structural racism and Hispanic paradox. Programs to optimize lifestyle should begin in childhood to mitigate precipitous age-related declines in LS7 scores, especially in at-risk groups. Promoting higher education and reducing poverty are also important.

Sedative and Anxiolytic Activities of Opuntia ficus indica (L.) Mill.: An Experimental Assessment in Mice.

Ethnobotanical field surveys revealed the use of fruits of Opuntia ficus indica (L.) Mill. for treating diabetes, burns, bronchial asthma, constipation, kidney stones, and rheumatic pains and as a sedative in Turkish folk medicine. This study aimed to verify the efficacy of the fruits of O. ficus indica experimentally and to define components responsible for the activity using bioassay-guided procedures. The crude methanolic extract of the fruits was sequentially fractionated into five subextracts: n-hexane, dichloromethane, ethyl acetate, n-butanol, and water. Further experiments were carried out on the most active subextract, that is, the ethyl acetate (EtOAc) subextract, which was further subjected to fractionation through successive column chromatographic applications on Sephadex LH-20. For activity assessment, each extract or fraction was submitted to bioassay systems; traction test, fireplace test, hole-board test, elevated plus-maze test, and open-field test were used for sedative and anxiolytic effects, and a thiopental-induced sleeping test was used for the hypnotic effect. Among the subextracts obtained from the methanolic extract, the EtOAc subextract showed significant sedative and anxiolytic effects in the bioassay systems. From the EtOAc subextract, major components were isolated, and their structures were determined as isorhamnetin, isorhamnetin 3-O-glucoside, isorhamnetin 3-O-rutinoside, and kaempferol 3-O-rutinoside using spectral techniques. In conclusion, this study confirmed the claimed use of the plant against anxiety in Turkish folk medicine.

Determinants of out-of-pocket spending on health among the poor population served by public services of health in Peru, 2010–2014

[ABSTRACT]. Objective. To ascertain which factors affect out-of-pocket spending on health services provided by the Ministry of Health of Peru and regional governments to the population living in relative poverty between 2010 and 2014. Materials and methods. Cross-sectional, descriptive, nationwide, econometric, year-on-year (2010-2014) study using information from household surveys. The dependent variable was out-of-pocket spending by people in relative poverty to pay for medical care at public services in health. The independent variables were affiliation with the Comprehensive Health Insurance (SIS) scheme, level of family expenditure per capita, age group 0-5 years, being a woman of childbearing age (15-49 years), being an older adult (over age 60 years), family burden (using the number of members of the household as a proxy indicator), and the level of complexity of the service provider. Results. Only 5% of the rural population in the study were treated at higher-complexity facilities (hospitals), compared to 16% of the population in urban centers. Drugs accounted for the majority of household expenditures: 44% among those insured via SIS and 62% among the uninsured (2014). Out-of-pocket spending on health was positively associated with not being insured via SIS, higher level of provider complexity, level of family spending per capita, and being an older adult. Conclusions. Comprehensive Health Insurance coverage is a relevant policy variable to reduce out-of-pocket spending in poor households. The lower out-of-pocket spending among the rural poor––an especially vulnerable group––was strongly associated with near-exclusive use of services delivered by primary health care providers. Specific policies are needed to protect older adults living in poverty. To achieve universal health coverage, Peru needs to implement more intensive financial protection policies and restructure its public service offering.

Determinantes del gasto de bolsillo en salud de la población pobre atendida en servicios de salud públicos en Perú, 2010–2014

[RESUMEN]. Objetivo. El objetivo de este estudio fue averiguar qué factores afectan el gasto de bolsillo en servicios de salud prestados por el MINSA y los gobiernos regionales a la población en condiciones de pobreza monetaria relativa entre 2010 y 2014. Materiales y métodos. Estudio transversal descriptivo econométrico con cortes anuales (2010-2014) a nivel nacional con información de encuestas de hogares. La variable dependiente fue el gasto de bolsillo en salud de las personas en situación de pobreza monetaria relativa para costear su atención médica en servicios de salud públicos. Las variables independientes fueron la afiliación al Seguro Integral de Salud (SIS), el nivel de gasto familiar per capita, el grupo de edad (0-5 años), ser mujer en edad fértil (15-49 años), ser persona adulta mayor (mayor de 60 años)), la carga familiar (cuyo indicador proxy fue el número de miembros en el hogar), y el nivel de complejidad del prestador de servicios. Resultados. Sólo 5% de la población rural objeto de estudio fue atendida en centros de mayor nivel de complejidad (hospital) frente a 16% de la del medio urbano. Los medicamentos concentraron el mayor gasto de hogares: 44% en los asegurados en el SIS y 62% en los no asegurados (2014). El gasto de bolsillo en salud se asoció positivamente con no estar afiliado en el SIS, el mayor nivel de complejidad del prestador, el nivel del gasto familiar per capita y ser adulto mayor. Conclusiones. La afiliación al SIS es una variable de política relevante para disminuir el gasto de bolsillo en hogares pobres. El menor gasto de bolsillo de la población rural pobre, especialmente vulnerable, está fuertemente asociado con el uso casi exclusivo de servicios provistos por prestadores del primer nivel de atención. Se necesitan políticas específicas de protección de la población adulta mayor en condiciones de pobreza. Para lograr la cobertura universal en salud, Perú necesita políticas más intensivas de protección financiera y de reestructuración de su oferta pública.

[ABSTRACT]. Objective. To ascertain which factors affect out-of-pocket spending on health services provided by the Ministry of Health of Peru and regional governments to the population living in relative poverty between 2010 and 2014. Materials and methods. Cross-sectional, descriptive, nationwide, econometric, year-on- year (2010-2014) study using information from household surveys. The dependent variable was out-of-pocket spending by people in relative poverty to pay for medical care at public health services. The independent variables were affiliation to the Comprehensive Health Insurance (SIS) scheme, level of family expenditure per capita, age group 0-5 years, being a woman of childbearing age (15-49 years), being an older adult (over age 60 years), family burden (using the number of members of the household as a proxy indicator), and the level of complexity of the service provider. Results. Only 5% of the rural population in the study were treated at higher-complexity facilities (hospitals), compared to 16% of the population in urban centers. Drugs accounted for the majority of household expenditures: 44% among those insured via SIS and 62% among the uninsured (2014). Out-of-pocket spending on health was positively associated with not being insured via SIS, higher level of provider complexity, level of family spending per capita, and being an older adult. Conclusions. Comprehensive Health Insurance coverage is a relevant policy variable to reduce out-of-pocket spending in poor households. The lower out-of-pocket spending among the rural poor––an especially vulnerable group––was strongly associated with near-exclusive use of services delivered by primary health care providers. Specific policies are needed to protect older adults living in poverty. To achieve universal health coverage, Peru needs to implement more intensive financial protection policies and restructure its public service offering.

[RESUMO]. Objetivo. Examinar os fatores que influem na despesa por conta própria em serviços de saúde prestados pelos governos federal (Ministério da Saúde) e regionais à população em situação de relativa pobreza entre 2010 e 2014. Materiais e métodos. Estudo transversal descritivo econométrico com recortes anuais (2010-2014) realizado em nível nacional com dados de pesquisas domiciliares. A variável dependente foi despesa por conta própria em saúde de pessoas em situação de relativa pobreza para custear o atendimento médico em serviços públicos de saúde. As variáveis independentes foram ser segurado do Seguro Integral de Saúde (SIS) da rede pública, despesa familiar per capita, faixa etária (0-5 anos), ser mulher em idade reprodutiva (15-49 anos), ser idoso (acima de 60 anos), carga familiar (cujo indicador substituto foi o número de pessoas por domicílio) e nível de complexidade do prestador de serviços. Resultados. Apenas 5% da população rural estudada foram atendidos em centros com nível de complexidade mais alto (hospitais) em comparação a 16% da população urbana. Os medicamentos representaram o maior gasto das famílias: 44% para os segurados do SIS e 62% para não segurados (2014). A despesa por conta própria em saúde foi positivamente associada a não ser segurado do SIS, nível de complexidade mais alto do prestador de serviços, nível de gasto familiar per capita e ser idoso. Conclusões. Ser segurado do SIS é uma variável de política importante para reducir a despesa por conta própria em famílias pobres. A menor despesa por conta própria na população rural pobre, particularmente vulnerável, está muito associada ao uso quase exclusivo de serviços de atenção primária. Fazem-se necessárias políticas específicas de proteção da população idosa vivendo em situação de pobreza. Para alcançar a cobertura universal de saúde, o Peru precisa de políticas mais firmes de proteção financeira e reestruturação da oferta pública.

The effect of marital status on social and gender inequalities in diabetes mortality in Andalusia. / El efecto del estado civil sobre las desigualdades sociales y de género en la mortalidad por diabetes mellitus en Andalucía.

OBJECTIVE: To assess the modifying effect of marital status on social and gender inequalities in mortality from diabetes mellitus (DM) in Andalusia. MATERIAL AND METHODS: A cross-sectional study was conducted using the Andalusian Longitudinal Population Database. DM deaths between 2002 and 2013 were analyzed by educational level and marital status. Age-adjusted rates (AARs) and mortality rate ratios (MRRs) were calculated using Poisson regression models, controlling for several social and demographic variables. The modifying effect of marital status on the association between educational level and DM mortality was evaluated by introducing an interaction term into the models. All analyses were performed separately for men and women. RESULTS: There were 18,158 DM deaths (10,635 women and 7,523 men) among the 4,229,791 people included in the study. The risk of death increased as the educational level decreased. Marital status modified social inequality in DM mortality in a different way in each sex. Widowed and separated/divorced women with the lowest educational level had the highest MRRs, 5,1 (95%CI: 3,6-7,3) and 5,6 (95% CI:3,6-8,5) respectively, while single men had the highest MRR, 3,1 (95%CI: 2,7-3,6). CONCLUSIONS: Educational level is a key determinant of DM mortality in both sexes, and is more relevant in women, while marital status also plays an outstanding role in men. Our results suggest that in order to address inequalities in DM mortality, the current focus on individual factors and self-care should be extended to interventions on the family, the community, and the social contexts closest to patients.

[Determinants of out-of-pocket spending on health among the poor population served by public health services in Peru, 2010-2014Determinantes da despesa por conta própria em saúde da população pobre atendida em serviços públicos de saúde, Peru, 2010-2014]. / Determinantes del gasto de bolsillo en salud de la población pobre atendida en servicios de salud públicos en Perú, 2010­2014.

OBJECTIVE: To ascertain which factors affect out-of-pocket spending on health services provided by the Ministry of Health of Peru and regional governments to the population living in relative poverty between 2010 and 2014. MATERIALS AND METHODS: Cross-sectional, descriptive, nationwide, econometric, year-on-year (2010-2014) study using information from household surveys. The dependent variable was out-of-pocket spending by people in relative poverty to pay for medical care at public health services. The independent variables were affiliation to the Comprehensive Health Insurance (SIS) scheme, level of family expenditure per capita, age group 0-5 years, being a woman of childbearing age (15-49 years), being an older adult (over age 60 years), family burden (using the number of members of the household as a proxy indicator), and the level of complexity of the service provider. RESULTS: Only 5% of the rural population in the study were treated at higher-complexity facilities (hospitals), compared to 16% of the population in urban centers. Drugs accounted for the majority of household expenditures: 44% among those insured via SIS and 62% among the uninsured (2014). Out-of-pocket spending on health was positively associated with not being insured via SIS, higher level of provider complexity, level of family spending per capita, and being an older adult. CONCLUSIONS: Comprehensive Health Insurance coverage is a relevant policy variable to reduce out-of-pocket spending in poor households. The lower out-of-pocket spending among the rural poor--an especially vulnerable group--was strongly associated with near-exclusive use of services delivered by primary health care providers. Specific policies are needed to protect older adults living in poverty. To achieve universal health coverage, Peru needs to implement more intensive financial protection policies and restructure its public service offering.

OBJETIVO: Examinar os fatores que influem na despesa por conta própria em serviços de saúde prestados pelos governos federal (Ministério da Saúde) e regionais à população em situação de relativa pobreza entre 2010 e 2014. MATERIAIS E MÉTODOS: Estudo transversal descritivo econométrico com recortes anuais (2010-2014) realizado em nível nacional com dados de pesquisas domiciliares. A variável dependente foi despesa por conta própria em saúde de pessoas em situação de relativa pobreza para custear o atendimento médico em serviços públicos de saúde. As variáveis independentes foram ser segurado do Seguro Integral de Saúde (SIS) da rede pública, despesa familiar per capita, faixa etária (0-5 anos), ser mulher em idade reprodutiva (15-49 anos), ser idoso (acima de 60 anos), carga familiar (cujo indicador substituto foi o número de pessoas por domicílio) e nível de complexidade do prestador de serviços. RESULTADOS: Apenas 5% da população rural estudada foram atendidos em centros com nível de complexidade mais alto (hospitais) em comparação a 16% da população urbana. Os medicamentos representaram o maior gasto das famílias: 44% para os segurados do SIS e 62% para não segurados (2014). A despesa por conta própria em saúde foi positivamente associada a não ser segurado do SIS, nível de complexidade mais alto do prestador de serviços, nível de gasto familiar per capita e ser idoso. CONCLUSÕES: Ser segurado do SIS é uma variável de política importante para reduzir a despesa por conta própria em famílias pobres. A menor despesa por conta própria na população rural pobre, particularmente vulnerável, está muito associada ao uso quase exclusivo de serviços de atenção primária. Fazem-se necessárias políticas específicas de proteção da população idosa vivendo em situação de pobreza. Para alcançar a cobertura universal de saúde, o Peru precisa de políticas mais firmes de proteção financeira e reestruturação da oferta pública.

Determinantes del gasto de bolsillo en salud de la población pobre atendida en servicios de salud públicos en Perú, 2010-2014 / Determinants of out-of-pocket spending on health among the poor population served by public health services in Peru, 2010-2014 / Determinantes da despesa por conta própria em saúde da população pobre atendida em serviços públicos de saúde, Peru, 2010-2014

RESUMEN Objetivo El objetivo de este estudio fue averiguar qué factores afectan el gasto de bolsillo en servicios de salud prestados por el MINSA y los gobiernos regionales a la población en condiciones de pobreza monetaria relativa entre 2010 y 2014. Materiales y métodos Estudio transversal descriptivo econométrico con cortes anuales (2010-2014) a nivel nacional con información de encuestas de hogares. La variable dependiente fue el gasto de bolsillo en salud de las personas en situación de pobreza monetaria relativa para costear su atención médica en servicios de salud públicos. Las variables independientes fueron la afiliación al Seguro Integral de Salud (SIS), el nivel de gasto familiar per capita, el grupo de edad (0-5 años), ser mujer en edad fértil (15-49 años), ser persona adulta mayor (mayor de 60 años)), la carga familiar (cuyo indicador proxy fue el número de miembros en el hogar), y el nivel de complejidad del prestador de servicios. Resultados Sólo 5% de la población rural objeto de estudio fue atendida en centros de mayor nivel de complejidad (hospital) frente a 16% de la del medio urbano. Los medicamentos concentraron el mayor gasto de hogares: 44% en los asegurados en el SIS y 62% en los no asegurados (2014). El gasto de bolsillo en salud se asoció positivamente con no estar afiliado en el SIS, el mayor nivel de complejidad del prestador, el nivel del gasto familiar per capita y ser adulto mayor. Conclusiones La afiliación al SIS es una variable de política relevante para disminuir el gasto de bolsillo en hogares pobres. El menor gasto de bolsillo de la población rural pobre, especialmente vulnerable, está fuertemente asociado con el uso casi exclusivo de servicios provistos por prestadores del primer nivel de atención. Se necesitan políticas específicas de protección de la población adulta mayor en condiciones de pobreza. Para lograr la cobertura universal en salud, Perú necesita políticas más intensivas de protección financiera y de reestructuración de su oferta pública.

ABSTRACT Objective To ascertain which factors affect out-of-pocket spending on health services provided by the Ministry of Health of Peru and regional governments to the population living in relative poverty between 2010 and 2014. Materials and methods Cross-sectional, descriptive, nationwide, econometric, year-on-year (2010-2014) study using information from household surveys. The dependent variable was out-of-pocket spending by people in relative poverty to pay for medical care at public health services. The independent variables were affiliation to the Comprehensive Health Insurance (SIS) scheme, level of family expenditure per capita, age group 0-5 years, being a woman of childbearing age (15-49 years), being an older adult (over age 60 years), family burden (using the number of members of the household as a proxy indicator), and the level of complexity of the service provider. Results Only 5% of the rural population in the study were treated at higher-complexity facilities (hospitals), compared to 16% of the population in urban centers. Drugs accounted for the majority of household expenditures: 44% among those insured via SIS and 62% among the uninsured (2014). Out-of-pocket spending on health was positively associated with not being insured via SIS, higher level of provider complexity, level of family spending per capita, and being an older adult. Conclusions Comprehensive Health Insurance coverage is a relevant policy variable to reduce out-of-pocket spending in poor households. The lower out-of-pocket spending among the rural poor--an especially vulnerable group--was strongly associated with near-exclusive use of services delivered by primary health care providers. Specific policies are needed to protect older adults living in poverty. To achieve universal health coverage, Peru needs to implement more intensive financial protection policies and restructure its public service offering.

RESUMO Objetivo Examinar os fatores que influem na despesa por conta própria em serviços de saúde prestados pelos governos federal (Ministério da Saúde) e regionais à população em situação de relativa pobreza entre 2010 e 2014. Materiais e métodos Estudo transversal descritivo econométrico com recortes anuais (2010-2014) realizado em nível nacional com dados de pesquisas domiciliares. A variável dependente foi despesa por conta própria em saúde de pessoas em situação de relativa pobreza para custear o atendimento médico em serviços públicos de saúde. As variáveis independentes foram ser segurado do Seguro Integral de Saúde (SIS) da rede pública, despesa familiar per capita, faixa etária (0-5 anos), ser mulher em idade reprodutiva (15-49 anos), ser idoso (acima de 60 anos), carga familiar (cujo indicador substituto foi o número de pessoas por domicílio) e nível de complexidade do prestador de serviços. Resultados Apenas 5% da população rural estudada foram atendidos em centros com nível de complexidade mais alto (hospitais) em comparação a 16% da população urbana. Os medicamentos representaram o maior gasto das famílias: 44% para os segurados do SIS e 62% para não segurados (2014). A despesa por conta própria em saúde foi positivamente associada a não ser segurado do SIS, nível de complexidade mais alto do prestador de serviços, nível de gasto familiar per capita e ser idoso. Conclusões Ser segurado do SIS é uma variável de política importante para reduzir a despesa por conta própria em famílias pobres. A menor despesa por conta própria na população rural pobre, particularmente vulnerável, está muito associada ao uso quase exclusivo de serviços de atenção primária. Fazem-se necessárias políticas específicas de proteção da população idosa vivendo em situação de pobreza. Para alcançar a cobertura universal de saúde, o Peru precisa de políticas mais firmes de proteção financeira e reestruturação da oferta pública.

Favorable Cardiovascular Health Is Associated With Lower Health Care Expenditures and Resource Utilization in a Large US Employee Population: The Baptist Health South Florida Employee Study.

OBJECTIVE: To examine the association of favorable cardiovascular health (CVH) status with 1-year health care expenditures and resource utilization in a large health care employee population. PARTICIPANTS AND METHODS: Employees of Baptist Health South Florida participated in a health risk assessment from January 1 through September 30, 2014. Information on dietary patterns, physical activity, blood pressure, blood glucose level, total cholesterol level, and smoking were collected. Participants were categorized into CVH profiles using the American Heart Association's ideal CVH construct as optimal (6-7 metrics), moderate (3-5 metrics), and low (0-2 metrics). Two-part econometric models were used to analyze health care expenditures. RESULTS: Of 9097 participants (mean ± SD age, 42.7±12.1 years), 1054 (11.6%) had optimal, 6945 (76.3%) had moderate, and 1098 (12.1%) had low CVH profiles. The mean annual health care expenditures among those with a low CVH profile was $10,104 (95% CI, $8633-$11,576) compared with $5824 (95% CI, $5485-$6164) and $4282 (95% CI, $3639-$4926) in employees with moderate and optimal CVH profiles, respectively. In adjusted analyses, persons with optimal and moderate CVH had a $2021 (95% CI, -$3241 to -$801) and $940 (95% CI, -$1560 to $80) lower mean expenditure, respectively, than those with low CVH. This trend remained even after adjusting for demographic characteristics and comorbid conditions as well as across all demographic subgroups. Similarly, health care resource utilization was significantly lower in those with optimal CVH profiles compared with those with moderate or low CVH profiles. CONCLUSION: Favorable CVH profile is associated with significantly lower total medical expenditures and health care utilization in a large, young, ethnically diverse, and fully insured employee population.

Phytochemicals for human disease: An update on plant-derived compounds antibacterial activity.

In recent years, many studies have shown that phytochemicals exert their antibacterial activity through different mechanisms of action, such as damage to the bacterial membrane and suppression of virulence factors, including inhibition of the activity of enzymes and toxins, and bacterial biofilm formation. In this review, we summarise data from the available literature regarding the antibacterial effects of the main phytochemicals belonging to different chemical classes, alkaloids, sulfur-containing phytochemicals, terpenoids, and polyphenols. Some phytochemicals, besides having direct antimicrobial activity, showed an in vitro synergistic effect when tested in combination with conventional antibiotics, modifying antibiotic resistance. Review of the literature showed that phytochemicals represent a possible source of effective, cheap and safe antimicrobial agents, though much work must still be carried out, especially in in vivo conditions to ensure the selection of effective antimicrobial substances with low side and adverse effects.

Reducing Health Inequities in the U.S.: Recommendations From the NHLBI's Health Inequities Think Tank Meeting.

The National, Heart, Lung, and Blood Institute convened a Think Tank meeting to obtain insight and recommendations regarding the objectives and design of the next generation of research aimed at reducing health inequities in the United States. The panel recommended several specific actions, including: 1) embrace broad and inclusive research themes; 2) develop research platforms that optimize the ability to conduct informative and innovative research, and promote systems science approaches; 3) develop networks of collaborators and stakeholders, and launch transformative studies that can serve as benchmarks; 4) optimize the use of new data sources, platforms, and natural experiments; and 5) develop unique transdisciplinary training programs to build research capacity. Confronting health inequities will require engaging multiple disciplines and sectors (including communities), using systems science, and intervening through combinations of individual, family, provider, health system, and community-targeted approaches. Details of the panel's remarks and recommendations are provided in this report.

[FACTORS WHICH INFLUENCE THE LEAN MASS LOSS IN CANCER PATIENTS]. / FACTORES QUE INFLUYEN EN LA PÉRDIDA DE MASA MAGRA EN PACIENTES ONCOLÓGICOS.

INTRODUCTION: cancer is an important illness in the sanitary field due to phisic and functional consequences involved in it. Among these consequences there is the malnutrition which can cause a loss of lean mass and with it a decrease in the Quality of Life, an increase in hospital stays, social and health costs and so on. The aim of this research is to know which factors can influence in the loss of the lean mass. MATERIAL AND METHODS: it is a cross-sectional study in a sample of 72 patients who receive a radiotherapy with curative intent during a period from February 07th and May 14th, 2014. RESULTS: from this pattern Of the total 64 patients were studied, of which 43.7% of the patients presented loss of lean mass, with 21.8% the percentage of patients losing < 2%, 4.7% those with a loss between 2-5% and > 5%, 17.2% of patients. Among the factors studied that can influence the loss of lean mass, only the presence of digestive symptoms have statistical significance (OR = 3.3 or 6.6, as we take as a reference the percentage loss). CONCLUSIONS: the aim of the health staff who are working with these patients is to avoid the consequences that accompanies the loss of lean mass. For all this, it is very important to act before the digestive symptoms, by anticipating to them, or early implementation of an individualized nutritional intervention.

Introducción: el cáncer es una enfermedad de gran importancia sanitaria debido a las consecuencias físicas y funcionales que conlleva. Entre estas consecuencias está la desnutrición, que puede provocar una pérdida de masa magra y con ello una disminución de la calidad de vida, aumento de las estancias hospitalarias, costes sanitarios, etc. El objetivo de este estudio es conocer qué factores influyen en la pérdida de masa magra. Material y métodos: se trata de un estudio transversal en una muestra de 72 pacientes que reciben tratamiento radioterápico con finalidad curativa en un período comprendido entre el 7 de febrero y el 14 de mayo de 2014. Resultados: del total de pacientes se estudiaron 64, de los cuales el 43,7% presentan pérdida de masa magra, siendo el porcentaje de 21,8% los pacientes que pierden < 2%, el 4,7% los que presentan una pérdida entre el 2-5% y > 5%, el 17,2% de los pacientes. De entre los factores estudiados que pueden influir en la pérdida de masa magra, solo la presencia de síntomas digestivos poseen significación estadísitca (OR = 3,3 o 6,6, según tomemos como referencia el porcentaje de pérdida). Conclusiones: el objetivo del personal sanitario que trabaja con estos pacientes de evitar las consecuencias que acompañan a la pérdida de masa magra. Por todo esto, es importante actuar antes de la aparición de síntomas digestivos, mediante la prevención de los mismos, o la aplicación precoz de una intervención nutricional individualizada.