Information needs and research priorities in long-term survivorship of breast cancer: Patients and health professionals' perspectives.

OBJECTIVE: The objective of this work is to identify unmet information needs of long-term-survivors of breast cancer (BC) and future research needs from the perspectives of patients and health care professionals. METHODS: Two online Delphi surveys were conducted. Participants in Survey 1 were patients. Participants in Survey 2 were health care professionals from both primary and secondary care involved in BC care. Both surveys included three successive rounds. The first round aimed to identify research and information needs; the second round aimed to rank the relative importance of those needs; the third round aimed to find consensus. RESULTS: The most important information needs were self-management recommendations of common health problems after treatment and complications of breast reconstruction after 5 years. The most important research priorities were related to interventions and tools to increase information provision by professionals about certain tests, diet, and coordinated action between primary and specialised care during follow-up, and indications and safety issues of pregnancy in survivors. CONCLUSIONS: Two fundamental ideas were identified: (1) Patients request information about self-management common health problems after treatment and breast reconstruction complications. (2) Health care professionals emphasise the need for a standardised approach based on protocols, recommendations, and coordinated actions in the provision of information. IMPLICATIONS FOR CANCER SURVIVORS: Given the increasing number of BC survivors, it is essential to identify information and research needs to improve their care and health outcomes.

Neonicotinoids exposure assessment in Africanized honey bees (Apis mellifera L.) by using an environmentally-friendly sample preparation technique followed by UPLC-MS/MS.

A miniaturized QuEChERS extraction method followed by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) was developed to analyze thiamethoxam and imidacloprid in 0.3 g of lyophilized Africanized honey bees (Apis mellifera L.). The work aimed to estimate honey bees' exposure to pesticides at the nanogram/gram (ng g-1) levels, using small sample and reagent quantities. Low amounts of solvents and salts were employed - 15× less than used in traditional methods. Average recoveries ranged from 64.5% to 99.7%, with repeatability below 20% for samples spiked at 3 and 167 ng g-1. LOD and LOQ were 0.7, and 3 ng g-1 for both pesticides. Applying the proposed approach, honey bee samples from different apiaries from the State of São Paulo (Brazil) were analyzed. The pesticides were detected in concentrations between 7.0 and 27.0 ng g-1. Thus, the proposed method can be used as a greener alternative to analyze the two neonicotinoids at trace levels in small quantities of bees, consequently saving chemicals and waste.

Aproximación a la experiencia de personas viejas que viven solas en contextos precarios: Ciudad Bolívar, Bogotá-Colombia / Approach to the experience of older people living alone in precarious contexts: Ciudad Bolívar, Bogotá-Colombia

Resumen Este artículo presenta los resultados de una aproximación cualitativa de las condiciones percibidas de la ciudad por parte de adultos mayores, en un contexto urbano precario de Bogotá-Colombia. Para esta aproximación se usaron algunos dominios del modelo de Ciudades amigables con la vejez de la Organización Mundial de la Salud entre ellos: la habitación, la habitabilidad, el transporte, el soporte comunitario, las redes sociales, el apoyo, la participación social, la empleabilidad, el respeto y la inclusión social como centrales para evaluar desde la perspectiva de los sujetos hasta una ciudad amigable con la vejez y su percepción de salud. A partir de la aplicación de herramientas cualitativas en un contexto urbano se exploró en estos dominios específicos la interpretación y los recursos que los mayores tienen frente a la experiencia de vivir solo.

Abstract This article presents the results of a qualitative approximation of the city conditions perceived by older adults in a precarious urban context of Bogotá-Colombia. For this approach, some domains of the "Age-friendly Cities" models, by the World Health Organization, were used, such as: habitation, habitability, transportation, community support, social networks, support, social participation, employability, respect and social inclusion, all this considered central to evaluate from the perspective of the individuals to an age-friendly city and their perception of health. Based on the application of qualitative tools in an urban context, the interpretation and resources that older people have, compared to the experience of living alone, were explored in these specific domains.

[Teen pregnancy in migrants: socioeconomic, gynecobstetric, and neonatal variables]. / Embarazo en adolescentes migrantes: características sociodemográficas, ginecoobstétricas y neonatales.

OBJECTIVE: Identify and correlate characteristics of adolescent mothers in a border city of Mexico with their migratory status. METHODS: We surveyed post partum adolescent mothers in the discharge rooms of two public hospitals in Tijuana, Mexico. We assessed obstetric, gynecologic, socioeconomic and neonatal variables. Mothers living fewer than 5 years in the area were designated as 'migrant.' RESULTS: 324 adolescent mothers were identified; 86% had healthy babies; 27% had previous pregnancies; age of onset of sexual activity was 15.5 +/- 1.4 years. 115 (36%) were identified as 'migrant,' among whom we found they had interrupted their studies (24% vs. 33%; OR 2.62: CI 95% 1.39-4.94), had a higher incidence of failure to use contraception (74% vs. 62%; OR 1.79: C.I. 95% 1.07-3.01) and a lower incidence of prenatal care (28% vs. 38%; OR 1.8: C.I. 95% 1.04-3.15). A larger percentage of migrant adolescents already lived with their partner (39% vs. 24%; OR 2.00: C.I. 95% 1.21-3.30) and expressed a desire to become pregnant (55% vs. 37%; OR 2.10: C.I. 95% 1.31-3.37). The observed association persisted in multivariate analysis. We did not observe differences between other ob-gyn and neonatal variables. CONCLUSIONS: Being a female migrant should be considered a risk factor in the reproductive health of adolescent mothers.

[The use of the Health Popular Insurance Program in pregnant women]. / Utilización del Seguro Popular de Salud en mujeres embarazadas.

OBJECTIVE: To evaluate the use of the Popular Insurance of health (PIH) during the pregnancy and the factors associated with its adquisicition. METHODS: From November of 2006 to January of the 2007, women in puerperal immediate hospitalized in the General Hospital of Tijuana, BC were invited to participate in the study. A direct interrogation through a structured questionnaire was applied, exploring sociodemographic variables, variables related to the pregnancy, trimester in which SPS was acquired, consumption of tobacco and alcohol, drug use, prenatal control, complications during the pregnancy, childbirth and time of hospital stay. Descriptive and bivaried analysis was performed to identify association between variables and the use of PIH. RESULTS: 730 women where studied. The average age was of 23-6 +/- 6.3, schooling 7.4 +/- 2.8 years and 72 % cohabitated. Five hundred and forty women (74 %) acquired PIH during pregnancy, 36 women never assist to antennal visits despite to have PIH and only 15 % already had it from the first trimester of pregnancy. Women with SPS had statically significant higher levels of schooling (7.8 versus. 6.8 p = 0.003), minor smoker frequency during pregnancy (1.5 % versus 4.2 %, p = 0.002) and minor rate of premature childbirth (3.7 versus 8.9, p=. 005). The mean catasthropic expenditure in women with not PIH was 2546 +/- 131 Mexican pesos. CONCLUSIONS: Fifty per cent of women acquired the PIH in the third trimester of pregnancy this could be related more to protecting households during periods of financial crisis than for utilization of prenatal care services.

Enfermedades de alto costo en afiliados a un sistema institucional de aseguramiento y prestación de servicios de salud / High cost diseases in users of a health insurance company

Introducción: las enfermedades de alto costo (EAC) representan un gran riesgo para el equilibrio financiero de las empresas de salud y pueden ser un factor determinante para su supervivencia en el mercado. Conocerlas mejor es esencial para prever su impacto en el sistema de prestación de servicios de salud. Metodología: se estudia toda la facturación relacionada con las EAC en los 8.347 afiliados a un sistema institucional de aseguramiento y prestación de servicios en salud durante un período de cinco años (1999-2003). Resultados: se registran 245 casos que generaron un costo de 3.520 millones de pesos durante el periodo estudiado. En el último año las EAC consumen 36 por ciento de los costos totales por servicios de salud. Tres enfermedades, las cardiovasculares, las neoplasias y la insuficiencia renal, consumen 65 por ciento de estos costos. El 30 por ciento de los dineros por EAC se aplicaron a personas que fallecieron en el proceso de tratamiento. La edad y la cronicidad del padecimiento están asociadas a estas complicaciones. Conclusiones: las EAC representan una severa carga para el sistema de prestación del servicio de salud. La situación parece ser el resultado de acceder a los avances médicos con altas especificaciones técnicas, pero a un costo muy alto, y en una intervención muy tardía, cuando ya no puede obtenerse un beneficio significativo para la salud del paciente. Parece evidente que el camino de la prevención y la promoción de la salud se imponen como alternativa inteligente, si no por razones humanas y sociales, al menos por razones económicas.