Health education can save the environment from medicine residues

Abstract The incorrect disposal of medicines and their environmental impact has been related to the health medicalization and the improper use of medication by society. In this sense, it is very important to know the profile of drug disposal for foster health policies. The aim was to identify the profile of disposal of medicines by the population, including the cost perspective. This is an inquiry descriptive study that began in September 2019. Medicine disposal health education program was carried out over six months in two University pharmacies. A questionnaire for sociodemographic and discarded medicines data collection was applied. Logistic regression analysis for variables association of correct disposal and the chi-square and t-student analysis for comparison between disposal programs were performed for a level of 5% and test power of 80%. Medicines weighed 23.3 kg and 28.5 kg, with the cost variation from US$ 13.5 to US$ 16.1 until the final treatment. The correct disposal was strongly associated with the disposal reason (p=0.013), source of information (p=0.006), prescription (p=0.03), form of use (p=0.01), acquisition source (p=0.001), cost with medication (p=0.0001), education (p=0.028) and age (p=0.05). The correct medicine disposal was associated with important features of the community related to education health.

e-Healthcare service quality: consumer satisfaction and its association with demographic characteristics.

PURPOSE: Use of technology for quality healthcare services has developed into a new field known as "e-Healthcare services." Healthcare providers often judge their quality of services with consumer satisfaction. With e-Healthcare services, consumer satisfaction is influenced by the quality of healthcare services provided and the demographic characteristics. The purpose of the present case study is to recognize the important predictors of quality, which are significant for consumer satisfaction with e-Healthcare services by using Zineldin's 5Qs model. It also aims to find the strength of association among the predictors of consumer satisfaction and the demographic characteristics of the respondents. DESIGN/METHODOLOGY/APPROACH: A questionnaire-based study was conducted at a public (PGIMER, Chandigarh) and a private hospital (Fortis Hospital, Mohali) of Punjab, India, from February 2018 to March 2019. The structured, closed-ended questionnaire, to be marked on a 1-5 point Likert scale, was adapted from Zineldin's 5Qs model and was distributed to the respondents sitting in the waiting halls of the selected hospitals. The respondents comprised of both the patients and their attendants who were aware of e-Healthcare services and were using them. FINDINGS: The analysis identified quality of interaction, quality of hospital atmosphere and quality of object to be the key predictors of consumer satisfaction with e-Healthcare services. The results reveal a strong association between different demographic characteristics and overall consumer satisfaction with e-Healthcare services. PRACTICAL IMPLICATIONS: The results suggest that improvements in the quality of interaction, quality of hospital atmosphere and quality of object may result in higher consumer satisfaction with e-Healthcare services. Working on the identified dimensions of quality will help the e-Healthcare providers in identifying functional problems of e-Healthcare services and developing improvement strategies, which will also result in better health and quality outcomes. The results of this study will help the e-Healthcare providers in better segmentation of e-Healthcare consumers based on their demographic characteristics and in developing better marketing strategies. ORIGINALITY/VALUE: This paper focuses on the quality of e-Healthcare services only and attempts to identify the quality dimensions, which leads to the satisfaction of e-Healthcare consumers. The identified quality dimensions will help in designing better e-Healthcare services and framing policies. It also highlights the association of demographic characteristics with important quality dimensions.

Health promotion with physiolytics: What is driving people to subscribe in a data-driven health plan.

Data-driven health promotion programs and health plans try to harness the new possibilities of ubiquitous and pervasive physiolytics devices. In this paper we seek to explore what drives people to subscribe to such a data-driven health plan. Our study reveals that the decision to subscribe to a data-driven health plan is strongly influenced by the beliefs of seeing physiolytics as enabler for positive health behavior change and of perceiving health insurances as trustworthy organizations that are capable of securely and righteously manage the data collected by physiolytics.

Planejamento organizacional no contexto de pandemia por COVID-19: implicações para a gestão em enfermagem / Organizational planning in pandemic context by COVID-19: implications for nursing management / Planificación organizativa en el contexto pandémico por COVID-19: implicaciones para la gestión de enfermería

Objetivo: refletir sobre o planejamento organizacional no contexto da pandemia por COVID-19 e as implicações para a gestão em enfermagem. Método: estudo téoricoreflexivo, realizado entre os dias 01 e 09 de junho de 2020 e baseado nos documentos emanados pela Direção Geral da Saúde de Portugal para o planejamento organizacional no contexto hospitalar, durante o período de 03 de março a 03 de junho de 2020. Resultados: foram identificados nove documentos do tipo normas ou orientações emitidas pela Direção Geral da Saúde, referentes às medidas para controle da pandemia da COVID-19, sendo possível a organização dos dados em duas macrocategorias: estruturas, materiais e procedimentos e exercício profissional dos enfermeiros, com enfoque no papel do enfermeiro gestor. Conclusão: a Direção-Geral da Saúde de Portugal, através da disseminação de documentos orientadores, permitiu um planejamento organizacional, ajustado às necessidades dos pacientes com COVID-19. O enfermeiro gestor teve de reorganizar a gestão de estruturas e materiais, assim como a gestão dos enfermeiros para cumprir as orientações emanadas e continuar a assegurar cuidados de qualidade aos pacientes internados em sua unidade.(AU)

Objective: to reflect on organizational planning in the context of the COVID-19 pandemic and the implications for nursing management. Method: theoretical-reflective study, carried out between 01 and 09 June 2020 and based on documents issued by the General Directorate of Health of Portugal for organizational planning in the hospital context, during the period from March 03 to June 03, 2020. Results: nine documents of the norms or guidelines issued by the Directorate-General for Health were identified, referring to the measures to control the pandemic of COVID-19, making it possible to organize the data in two macro categories: structures, materials and procedures and professional practice of nurses, focusing on the role of nurse manager. Conclusion: the Directorate-General for Health of Portugal, through the dissemination of guiding documents, allowed for organizational planning, adjusted to the needs of patients with COVID-19. The nurse manager had to reorganize the management of structures and materials, as well as the management of nurses to comply with the guidelines issued and continue to ensure quality care for patients admitted to his unit.(AU)

Objetivo: reflexionar sobre la planificación organizacional en el contexto de la pandemia COVID-19 y las implicaciones para el manejo de enfermería. Método: estudio teórico-reflexivo, realizado entre el 01 y el 09 de junio de 2020 y basado en documentos emitidos por la Dirección General de Salud de Portugal para la planificación organizativa en el contexto hospitalario, durante el período del 03 de marzo al 03 de junio. 2020. Resultados: se identificaron nueve documentos de las normas o directrices emitidas por la Dirección General de Salud, en relación con las medidas para controlar la pandemia de COVID-19, que permiten organizar los datos en dos macro categorías: estructuras, materiales y procedimientos y práctica profesional. de enfermeras, centrándose en el papel de gerente de enfermería. Conclusión: la Dirección General de Salud de Portugal, a través de la difusión de documentos guía, permitió la planificación organizacional, ajustada a las necesidades de los pacientes con COVID-19. El gerente de enfermería tuvo que reorganizar la gestión de estructuras y materiales, así como la gestión de las enfermeras para cumplir con las directrices emitidas y continuar garantizando una atención de calidad para los pacientes ingresados en su unidad.(AU)

Lessons Learned: Recommendations For Implementing a Longitudinal Study Using Wearable and Environmental Sensors in a Health Care Organization.

Although traditional methods of data collection in naturalistic settings can shed light on constructs of interest to researchers, advances in sensor-based technology allow researchers to capture continuous physiological and behavioral data to provide a more comprehensive understanding of the constructs that are examined in a dynamic health care setting. This study gives examples for implementing technology-facilitated approaches and provides the following recommendations for conducting such longitudinal, sensor-based research, with both environmental and wearable sensors in a health care setting: pilot test sensors and software early and often; build trust with key stakeholders and with potential participants who may be wary of sensor-based data collection and concerned about privacy; generate excitement for novel, new technology during recruitment; monitor incoming sensor data to troubleshoot sensor issues; and consider the logistical constraints of sensor-based research. The study describes how these recommendations were successfully implemented by providing examples from a large-scale, longitudinal, sensor-based study of hospital employees at a large hospital in California. The knowledge gained from this study may be helpful to researchers interested in obtaining dynamic, longitudinal sensor data from both wearable and environmental sensors in a health care setting (eg, a hospital) to obtain a more comprehensive understanding of constructs of interest in an ecologically valid, secure, and efficient way.

Terapias biológicas del cáncer: un enfoque a favor de la accesibilidad / Biological cancer therapies: an approach towards accessibility

RESUMEN Los anticuerpos monoclonales son una poderosa herramienta para el diagnóstico de laboratorio y un instrumento cada vez más utilizado en el tratamiento de diversas enfermedades, siendo uno de los grupos más importantes de drogas en el tratamiento del cáncer. La revolución en el mundo de los anticuerpos ocurre en 1975 cuando Milstein y Köhler desarrollan la técnica de las hibridomas en Cambridge. Objetivo Hacer una revisión del uso de anticuerpos monoclonales en medicina y, en particular, en el tratamiento del cáncer. Se busca aportar una visión generalizada del concepto de anticuerpo monoclonal para explicar su aplicabilidad terapéutica y abordar un enfoque económico y sociosanitario de la obtención y acceso a las nuevas terapias. Método En la caracterización del fenómeno de investigación se empleó el estudio descriptivo, de recolección de datos documental y la correlación entre las distintas fuentes. Discusión Son aún elevados los costos tanto para el paciente como para los sistemas de salud pública, y se ha de optimizar la valoración costo-efectividad de modo que la rentabilidad y el acceso a tiempo para los pacientes puedan ser compatibles. Se deja abierto el reto del desarrollo de nuevos mAbs dirigidos a nuevas dianas, mejorar el perfil de seguridad, evitando o reduciendo las reacciones adversas inmunes y conseguir el abaratamiento del coste de producción mediante mejoras en la biotecnología.(AU)

ABSTRACT Monoclonal antibodies are a useful tool for laboratory diagnosis and an instrument used in the treatment of various diseases and represent one of the most important groups of new drugs for the treatment of cancer. The revolution in the world occured in 1975 when Milstein and Köhler discovered monoclonal antibodies in Cambridge. Objective To review the use of monoclonal antibodies in medicine and in the treatment of cancer. To provide a generalized vision of the concept of monoclonal antibody to explain its therapeutic applicability, and to approach an economic, health-care approach to obtaining and accessing new therapies. Method In the characterization of the research phenomenon, the descriptive study, the collection of documentary data and the correlation between the different sources were used. Discussion However, the costs for both the patient and the public health systems are still high, and the cost-effectiveness assessment must be optimized so that cost-effectiveness and access to time for patients can be compatible. And the challenge of developing new mAbs aimed at new targets, improving the safety profile, avoiding, or reducing adverse immune reactions and achieving lower production costs through improvements in biotechnology, is left open.(AU)

Recommendations for using the Revised Safer Dx Instrument to help measure and improve diagnostic safety.

The medical record continues to be one of the most useful and accessible sources of information to examine the diagnostic process. However, medical record review studies of diagnostic errors have often used subjective judgments and found low inter-rater agreement among reviewers when determining the presence or absence of diagnostic error. In our previous work, we developed a structured data-collection instrument, called the Safer Dx Instrument, consisting of objective criteria to improve the accuracy of assessing diagnostic errors in primary care. This paper proposes recommendations on how clinicians and health care organizations could use the Revised Safer Dx Instrument in identifying and understanding missed opportunities to make correct and timely diagnoses. The instrument revisions addressed both methodological and implementation issues identified during initial use and included refinements to the instrument to allow broader application across all health care settings. In addition to leveraging knowledge from piloting the instrument in several health care settings, we gained insights from multiple researchers who had used the instrument in studies involving emergency care, inpatient care and intensive care unit settings. This allowed us to enhance and extend the scope of this previously validated data collection instrument. In this paper, we describe the refinement process and provide recommendations for application and use of the Revised Safer Dx Instrument across a broad range of health care settings. The instrument can help users identify potential diagnostic errors in a standardized way for further analysis and safety improvement efforts as well as provide data for clinician feedback and reflection. With wider adoption and use by clinicians and health systems, the Revised Safer Dx Instrument could help propel the science of measuring and reducing diagnostic errors forward.

Using electronic tablets for data collection for healthcare service and maternal health assessments in low resource settings: lessons learnt.

BACKGROUND: Health service and health outcome data collection across many low- and middle-income countries (LMICs) is, to date largely paper-based. With the development and increased availability of reliable technology, electronic tablets could be used for electronic data collection in such settings. This paper describes our experiences with implementing electronic data collection methods, using electronic tablets, across different settings in four LMICs. METHODS: Within our research centre, the use of electronic data collection using electronic tablets was piloted during a healthcare facility assessment study in Ghana. After further development, we then used electronic data collection in a multi-country, cross-sectional study to measure ill-health in women during and after pregnancy, in India, Kenya and Pakistan. All data was transferred electronically to a central research team in the UK where it was processed, cleaned, analysed and stored. RESULTS: The healthcare facility assessment study in Ghana demonstrated the feasibility and acceptability to healthcare providers of using electronic tablets to collect data from seven healthcare facilities. In the maternal morbidity study, electronic data collection proved to be an effective way for healthcare providers to document over 400 maternal health variables, in 8530 women during and after pregnancy in India, Kenya and Pakistan. CONCLUSIONS: Electronic data collection provides an effective platform which can be used successfully to collect data from healthcare facility registers and from patients during health consultations; and to transfer large quantities of data. To ensure successful electronic data collection and transfer between settings, we recommend that close attention is paid to study design, data collection, tool design, local internet access and device security.

System Accuracy Assessment of a Blood Glucose Meter With Wireless Internet Access Associated With Unusual Hypoglycemia Patterns in Clinical Trials.

BACKGROUND: In recent randomized clinical trials, an unusual reporting pattern of glycemic data and hypoglycemic events potentially related to an internet enabled blood glucose meter (MyGlucoHealth, BGM) was observed. Therefore, this clinical study was conducted to evaluate the system accuracy of the BGM in accordance with the ISO15197:2015 guidelines with additional data collection. METHODS: To investigate system accuracy, 10 of 3088 devices and 6 of 23 strip lots, used in the trials, were selected by a randomization procedure and a standard repeatability assessment. YSI 2300 STAT Plus was used as the standard reference method. The samples were distributed as per the ISO15197:2015 recommendations with 20 additional samples in the hypoglycemic range. Each sample was tested with 6 devices and 6 strip lots with double determinations. RESULTS: Overall, 121 subjects with blood glucose values 26-423 mg/dL were analyzed, resulting in 1452 data points. In all, 186/1452 readings (12.8%) did not meet the ISO acceptance criteria. Data evaluated according to the FDA guidelines showed that 336/1452 (23.1%) readings did not meet the acceptance criteria. A clear bias toward elevated values was observed for BG <100 mg/dL (MARD: 11.0%). CONCLUSIONS: The results show that the BGM, although approved according to standard regulatory guidelines, did not meet the level of analytical accuracy required for clinical treatment decisions according to ISO 15197:2015 and FDA requirements. In general, caution should be exercised before selection of BGMs for patients and in clinical trials.

ZOO: an automatic data-collection system for high-throughput structure analysis in protein microcrystallography.

Owing to the development of brilliant microfocus beamlines, rapid-readout detectors and sample changers, protein microcrystallography is rapidly becoming a popular technique for accessing structural information from complex biological samples. However, the method is time-consuming and labor-intensive and requires technical expertise to obtain high-resolution protein crystal structures. At SPring-8, an automated data-collection system named ZOO has been developed. This system enables faster data collection, facilitates advanced data-collection and data-processing techniques, and permits the collection of higher quality data. In this paper, the key features of the functionality put in place on the SPring-8 microbeam beamline BL32XU are described and the major advantages of this system are outlined. The ZOO system will be a major driving force in the evolution of the macromolecular crystallography beamlines at SPring-8.

Evaluation of Electronic and Paper-Pen Data Capturing Tools for Data Quality in a Public Health Survey in a Health and Demographic Surveillance Site, Ethiopia: Randomized Controlled Crossover Health Care Information Technology Evaluation.

BACKGROUND: Periodic demographic health surveillance and surveys are the main sources of health information in developing countries. Conducting a survey requires extensive use of paper-pen and manual work and lengthy processes to generate the required information. Despite the rise of popularity in using electronic data collection systems to alleviate the problems, sufficient evidence is not available to support the use of electronic data capture (EDC) tools in interviewer-administered data collection processes. OBJECTIVE: This study aimed to compare data quality parameters in the data collected using mobile electronic and standard paper-based data capture tools in one of the health and demographic surveillance sites in northwest Ethiopia. METHODS: A randomized controlled crossover health care information technology evaluation was conducted from May 10, 2016, to June 3, 2016, in a demographic and surveillance site. A total of 12 interviewers, as 2 individuals (one of them with a tablet computer and the other with a paper-based questionnaire) in 6 groups were assigned in the 6 towns of the surveillance premises. Data collectors switched the data collection method based on computer-generated random order. Data were cleaned using a MySQL program and transferred to SPSS (IBM SPSS Statistics for Windows, Version 24.0) and R statistical software (R version 3.4.3, the R Foundation for Statistical Computing Platform) for analysis. Descriptive and mixed ordinal logistic analyses were employed. The qualitative interview audio record from the system users was transcribed, coded, categorized, and linked to the International Organization for Standardization 9241-part 10 dialogue principles for system usability. The usability of this open data kit-based system was assessed using quantitative System Usability Scale (SUS) and matching of qualitative data with the isometric dialogue principles. RESULTS: From the submitted 1246 complete records of questionnaires in each tool, 41.89% (522/1246) of the paper and pen data capture (PPDC) and 30.89% (385/1246) of the EDC tool questionnaires had one or more types of data quality errors. The overall error rates were 1.67% and 0.60% for PPDC and EDC, respectively. The chances of more errors on the PPDC tool were multiplied by 1.015 for each additional question in the interview compared with EDC. The SUS score of the data collectors was 85.6. In the qualitative data response mapping, EDC had more positive suitability of task responses with few error tolerance characteristics. CONCLUSIONS: EDC possessed significantly better data quality and efficiency compared with PPDC, explained with fewer errors, instant data submission, and easy handling. The EDC proved to be a usable data collection tool in the rural study setting. Implementation organization needs to consider consistent power source, decent internet connection, standby technical support, and security assurance for the mobile device users for planning full-fledged implementation and integration of the system in the surveillance site.

Feasibility and relative validity of a digital photo-based dietary assessment: results from the Nutris-Phone study.

OBJECTIVE: For dietary assessment, mobile devices with a camera can be used as an alternative to hand-written paper records. The Nutritional Tracking Information Smartphone (Nutris-Phone) study aimed to examine relative validity and feasibility of a photo-based dietary record in everyday life. DESIGN: Parallel to the photo-based technique, a weighed record was performed. Participant satisfaction was assessed by questionnaire. A trained nutrition scientist evaluated portion sizes and nutrient content was calculated (DGExpert). Spearman correlation and Bland-Altman analyses were applied. SETTING: Healthy, non-pregnant volunteers (≥18 years) without intent to lose weight recruited at Ulm University, Germany. SUBJECTS: Sixty-six participants (36 % males, median age 22·0 (interquartile range 20·0-25·0) years) took pictures of foods and beverages consumed with a commercially available mobile phone. RESULTS: Significant correlation between the photo-based and weighed record was observed: energy (r=0·991), carbohydrate (r=0·980), fat (r=0·972), protein (r=0·988), fibre (r=0·941). Bland-Altman analyses indicated comparable means and acceptable 95 % limits of agreement (energy: -345·2 to 302·9 kJ (-82·5 to 72·4 kcal); carbohydrate: -15·2 to 13·1 g; fat: -6·4 to 6·4 g; protein: -5·9 to 5·6 g; fibre: -2·7 to 2·5 g). However, with increasing intake level, underestimation by the digital method was present (except for fat, all P<0·01). Over 80 % of participants were satisfied with the photo-based record. In nearly 90 %, technical implementation was without major problems. CONCLUSIONS: Compared with a weighed record, the photo-based dietary record seems to be valid, feasible and user-friendly to estimate energy, macronutrient and fibre intakes, although a systematic bias with increasing levels of intake should be kept in mind.

Developing a smartphone-based ecological momentary assessment protocol to collect biopsychosocial data with community-dwelling late-middle-aged and older adults.

Although ecological momentary assessment (EMA) has been used in youth and adult populations, very few of the studies provided evidence of the feasibility and utility of smartphone-based EMA protocols to collect biopsychosocial data from aging populations. This study aimed to describe the design and implementation of a smartphone-based EMA protocol, and to evaluate the feasibility and utility of this EMA protocol among community-dwelling late-middle-aged and older Chinese. A sample of 78 community-dwelling Chinese aged between 50 and 70 years was trained to participate in a 1-week EMA data collection, during which each participant carried an Android smartphone loaded with a researcher-developed EMA application and a smartphone-based electrocardiogram (ECG) monitor to provide psychosocial (e.g., daily activities, social interaction, affect) data and ECG recordings six times daily. Adherence was demonstrated with a total response rate of 91.5% of all scheduled assessments (n = 3,822) and a moderately high level of perceived feasibility. Female participants reported higher compliance to the study and rated the overall experience as more pleasant and interesting than male participants. Our study provided the first evidence of the feasibility and utility of smartphone-based EMA protocols among late-middle-aged and older Chinese. Key areas for improvement in future design and implementation of mobile-based EMA include the incorporation of usable technology, adequate and training, and timely assistance.

Violência física contra lésbicas, gays, bissexuais, travestis e transexuais no interior do nordeste brasileiro / Physical violence against lesbian, gay, bisexual, transvestite and transgender individuals from Brazil / Violencia física contra lesbianas, gais, bisexuales, travestis y transexuales de Brasil

RESUMO Objetivo Determinar o perfil de violência física perpetrada contra integrantes lésbicas, gays, bissexuais, travestis e transexuais (LGBTT). Método Estudo descritivo, de abordagem quantitativa, realizado com minorias sexuais nos municípios de Juazeiro do Norte e Crato, Ceará, Brasil. Utilizou-se um formulário estruturado para coleta de dados. O estudo teve aprovação prévia de Comitê de Ética em Pesquisa. Resultados Um total de 316 integrantes LGBTT, em sua maioria gays, solteiros, pardos e com idade média de 24,3 anos, participaram do estudo. Dentre as violências sofridas ao longo da vida, as físicas ocuparam a segunda colocação (31,3%). Frente a estas, prevaleceram os empurrões (21,8%) e socos (17,4%). O local preferencial para os ataques foi a face (84,4%) e a maioria dos agressores são pessoas desconhecidas (13,6%). Discussão A vitimização LGBTT constitui-se em grave violação aos direitos humanos, com repercussões negativas à saúde. Os resultados apontam para um quadro de homofobia social, semelhante ao observado em todo o território brasileiro mediante relatórios produzidos pela Secretaria de Direitos Humanos da Presidência da República. Minorias sexuais são vítimas de agressões cotidianas que resultam em sequelas temporárias e/ou permanentes a exemplo de torções e fraturas. A ameaça de agressão é constante, visto os maiores agressores serem pessoas transeuntes desconhecidas. Conclusão Integrantes LGBTT são vítimas de violência física e suas repercussões negativas. O enfrentamento desta realidade implica em elaboração de estratégias políticas e sociais, de setores governamentais e não governamentais, para o combate e a redução deste tipo de violência dirigida ao grupo.(AU)

ABSTRACT Objective To determine the physical violence profile against lesbians, gays, bisexuals, transvestites and transsexuals (LGBTT). Method Descriptive study, with a quantitative approach, carried out with sexual minorities of the municipalities of Juazeiro do Norte and Crato, Ceará, Brazil. A structured form was used to collect data. The study was previously approved by a Research Ethics Committee. Results 316 LGBTT members, mostly gays, single, mestizo and with a mean age of 24.3 years, took part in the study. Among the types of violence suffered throughout life, physical violence ranked second (31.3%); in this category, pushes (21.8%) and hits (17.4%) prevailed. The preferred place for attacks was the face (84.4%), and most of the aggressors are unknown persons (13.6%). Discussion LGBTT victimization is a serious violation of human rights, with negative repercussions on health. The results point to a picture of social homophobia, similar to that observed across the Brazilian territory through reports published by the Secretariat for Human Rights of the Presidency of the Republic. Sexual minorities are victims of routine attacks that result in temporary and/or permanent sequels, such as torsions and fractures. The threat of attack is constant, since the major attackers are unknown bystanders. Conclusion The LGBTT community is victim of physical violence and its negative repercussions. The confrontation of this reality implies the elaboration of political and social strategies, from governmental and non-governmental sectors, in order to counteract and reduce this type of violence directed to this group.(AU)

RESUMEN Objetivo Determinar el perfil de violencia física cometida contra integrantes lesbianas, gays, bisexuales, travestis y transexuales (LGBTT). Método Estudio descriptivo, con enfoque cuantitativo, realizado con minorías sexuales en los municipios de Juazeiro do Norte y Crato, Ceará, Brasil. Se utilizó un formulario estructurado para recoger los datos. El estudio tuvo aprobación previa de un Comité de Ética en Investigación. Resultados Un total de 316 integrantes LGBTT, en su mayoría gays, solteros, pardos y con edad promedio de 24,3 años, participaron del estudio. Entre las violencias sufridas a lo largo de la vida, las físicas ocuparon la segunda colocación (31,3%). En la frente de estas, prevalecieron los empujones (21,8%) y golpes (17,4%). El lugar preferente para los ataques fue la cara (84,4%), y la mayoría de los agresores son personas desconocidas (13,6%). Discusión La victimización LGBTT se constituye en una grave violación a los derechos humanos, con repercusiones negativas en la salud. Los resultados apuntan a un cuadro de homofobia social, similar al observado en todo el territorio brasileño mediante informes producidos por la Secretaría de Derechos Humanos de la Presidencia de la República. Minorías sexuales son víctimas de agresiones cotidianas que resultan en secuelas temporales y/o permanentes, por ejemplo, torsiones y fracturas. La amenaza de agresión es constante, ya que los mayores agresores son personas transeúntes desconocidas. Conclusión Integrantes LGBTT son víctimas de violencia física y sus repercusiones negativas. El enfrentamiento de esta realidad implica la elaboración de estrategias políticas y sociales, de sectores gubernamentales y no gubernamentales, con el fin de combatir y reducir este tipo de violencia dirigida al grupo.(AU)

Uncertainty in monetary cost estimates for assessing working postures using inclinometry, observation or self-report.

OBJECTIVE: To assess uncertainty in cost estimates for collecting posture data by inclinometry, observations and self-report. METHOD: In a study addressing physical workloads at a paper mill, costs were calculated for measuring postures of twenty-eight workers during three shifts. Uncertainty in costs was assessed for all three methods as the range between an assumed best case (lowest cost) and worst case (highest cost) using scenario analysis. RESULTS: The cost for observation was larger, but also more uncertain (€16506 and €89552 in the best and worst case, respectively) than that of inclinometry (€7613 - €45896). Self-report costs were both lower and less uncertain (€3743 - €23368). CONCLUSIONS: The extent of uncertainty in cost estimates implies that observation could be less expensive than inclinometry, e.g., in a scenario where experienced observers could use existing software, while inclinometers would have to be purchased. We propose adding uncertainty assessments to cost estimates when selecting a method for measuring working postures, and offer guidance in how to proceed in a specific setting.

Ecological Momentary Assessment Methodology in Chronic Pain Research: A Systematic Review.

Self-reported pain intensity assessments are central to chronic pain research. Ecological momentary assessment (EMA) methodologies are uniquely positioned to collect these data, and are indeed being used in the field. However, EMA protocols are complex, and many decisions are necessary in the design of EMA research studies. A systematic literature review identified 105 articles drawing from 62 quantitative EMA research projects examining pain intensity in adult chronic pain patients. Study characteristics were tabulated to summarize and describe the use of EMA, with an emphasis placed on various dimensions of decision-making involved in executing EMA methodologies. Most identified studies considered within-person relationships between pain and other variables, and a few examined interventions on chronic pain. There was a trend toward the use of smartphones as EMA data collection devices more recently, and completion rates were not reported in nearly one third of studies. Pain intensity items varied widely with respect to number of scale points, anchor labels, and length of reporting period; most used numeric rating scales. Recommendations are provided for reporting to improve reproducibility, comparability, and interpretation of results, and for opportunities to clarify the importance of design decisions. PERSPECTIVE: Studies that use EMA methodologies to assess pain intensity are heterogeneous. Aspects of protocol design, including data input modality and pain item construction, have the potential to influence the data collected. Thorough reporting on design features and completion rates therefore facilitates reproducibility, comparability, and interpretation of study results.

Frailty Assessment in Patients Utilizing a Free Clinic.

PURPOSE: Frailty is most commonly associated with older adults; however, it has also been identified in vulnerable populations, including homeless adults. Patients who seek health care services in a free clinic often report physical exhaustion, difficulty coping with stressors, chronic disease states, environmental limitations, and a lack of social support, which may contribute to a state of frailty. This pilot study (N = 38) was conducted in adults ages 40-64 years who utilized a free clinic to determine if factors suggestive of frailty were present. METHODS: The Comprehensive Frailty Assessment Instrument (CFAI) was the primary data collection instrument. Anthropometrics and physical performance data were also collected. RESULTS: Physical indicators of frailty were present in 60% of the sample. Psychological, social, and environmental factors affecting health were identified. Sixty-three percent of the participants scored frail or very frail on the CFAI. A larger study is needed to confirm these findings.

Man Versus Machine: Comparing Double Data Entry and Optical Mark Recognition for Processing CAHPS Survey Data.

OBJECTIVE: Historically, double data entry (DDE) has been considered the criterion standard for minimizing data entry errors. However, previous studies considered data entry alternatives through the limited lens of data accuracy. This study supplies information regarding data accuracy, operational efficiency, and cost for DDE and Optical Mark Recognition (OMR) for processing the Consumer Assessment of Healthcare Providers and Systems 5.0 survey. METHODS: To assess data accuracy, we compared error rates for DDE and OMR by dividing the number of surveys that were arbitrated by the total number of surveys processed for each method. To assess operational efficiency, we tallied the cost of data entry for DDE and OMR after survey receipt. Costs were calculated on the basis of personnel, depreciation for capital equipment, and costs of noncapital equipment. RESULTS: The cost savings attributed to this method were negated by the operational efficiency of OMR. There was a statistical significance between rates of arbitration between DDE and OMR; however, this statistical significance did not create a practical significance. CONCLUSIONS: The potential benefits of DDE in terms of data accuracy did not outweigh the operational efficiency and thereby financial savings of OMR.