Neither 10- nor 14-Day Sequential Treatment is better than Standard Triple Therapy for Helicobacter Pylori Eradication.

OBJECTIVE: Helicobacter pylori is a bacterial pathogen associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa associated lymphoid tissue lymphoma. Current treatment guidelines support a 7- to 14-day, triple-drug protocol consisting of a proton-pump inhibitor (PPI), clarithromycin, and either amoxicillin or an imidazole. The initial eradication rates for this regimen were 80 to 90%. Nevertheless its effectiveness has declined as the antibiotic resistance to clarithromycin and metronidazole has emerged. In Puerto Rico the reported resistance of H. pylori to clarithromycin is 16% and to metronidazole, 3.7%. Sequential therapy for H. pylori eradication, 5 days of treatment with a PPI and amoxicillin followed by 5 days of treatment with the PPI and 2 other antibiotics (clarithromycin and an imidazole), was introduced as an effective alternate regimen. This is a prospective clinical trial intended to compare the efficacy of first-line, standard 10-day tripledrug therapy with those of both 10- and 14-day sequential therapy in eradicating H. pylori at the San Juan Veterans Affairs Hospital in a population that is naïve to previous treatment. METHODS: This was a prospective, open-label, randomized clinical trial. RESULTS: Based on the intention-to-treat analysis, the eradication rate was 83.7% (72 of 86 patients) in the standard triple-therapy group, 80.0% (68/85) in the 10- day sequential-therapy group, and 79.1% (68/86) in the 14-day sequential-therapy group. There were no significant statistical differences between the eradication rates among therapies. CONCLUSION: Sequential-therapy treatment regimens are not better than standard triple therapy for the eradication of H. pylori infection, regardless of the treatment duration.

Medir desigualdades e inequidades para mejorar las políticas de salud / Measuring inequalities and inequities in order to improve health policies

Este documento, en su primera parte, explicita las nociones de desigualdad, inequidad y protección social en que la desigualdad se relaciona con el diagnóstico; la inequidad con las desigualdades evitables, es decir, las que pueden amortiguarse con políticas adecuadas; y, la protección social es la evaluación del impacto de las políticas de salud; en la segunda, se usarán criterios de gradientes en salud para, mediante aplicaciones estadísticas e indicadores seleccionados se expliciten las inequidades, en tercer lugar, se enfatiza en los aspectos financieros, especialmente el impacto de los gastos de bolsillo sobre la inequidad. El aporte relevante es ejemplificar la noción de gradientes con niveles de ingresos por decil para identificar las inequidades y sugerir que el sentido de las políticas de protección social que reduzcan la inequidad y la desigualdad deben considerar estos determinantes sociales y, muy particularmente el impacto de los diferenciales de ingresos entre grupos poblacionales.

We define inequality, inequity and social protection in health. Inequality is related to diagnosis; inequity is related to avoidable inequalities, i.e., those that can be reduced through appropriate policies; and social protection deals with the impact of health policies. Inequities are measured by means of health status indicators. Regarding social protection, emphasis is laid on the financial aspects and particularly, on the impact of out of pocket expenditure on inequity. Our main contribution consists in the exemplification of the relationship between health gradients and income differentials in order to show inequities. We suggest that social protection policies aimed at the reduction of inequity and inequality in health should consider the socio economic determinants and, above all, the impact of income gradients among population groups.