Implementation approaches for leprosy prevention with single-dose rifampicin: A support tool for decision making.

BACKGROUND: In the past 15 years, the decline in annually detected leprosy patients has stagnated. To reduce the transmission of Mycobacterium leprae, the World Health Organization recommends single-dose rifampicin (SDR) as post-exposure prophylaxis (PEP) for contacts of leprosy patients. Various approaches to administer SDR-PEP have been piloted. However, requirements and criteria to select the most suitable approach were missing. The aims of this study were to develop an evidence-informed decision tool to support leprosy programme managers in selecting an SDR-PEP implementation approach, and to assess its user-friendliness among stakeholders without SDR-PEP experience. METHODOLOGY: The development process comprised two phases. First, a draft tool was developed based on a literature review and semi-structured interviews with experts from various countries, organisations and institutes. This led to: an overview of existing SDR-PEP approaches and their characteristics; understanding the requirements and best circumstances for these approaches; and, identification of relevant criteria to select an approach. In the second phase the tool's usability and applicability was assessed, through interviews and a focus group discussion with intended, inexperienced users; leprosy programme managers and non-governmental organization (NGO) staff. PRINCIPAL FINDINGS: Five SDR-PEP implementation approaches were identified. The levels of endemicity and stigma, and the accessibility of an area were identified as most relevant criteria to select an approach. There was an information gap on cost-effectiveness, while successful implementation depends on availability of resources. Five basic requirements, irrespective of the approach, were identified: stakeholder support; availability of medication; compliant health system; trained health staff; and health education. Two added benefits of the tool were identified: its potential value for advocacy and for training. CONCLUSION: An evidence-informed SDR-PEP decision tool to support the selection of implementation approaches for leprosy prevention was developed. While the tool was evaluated by potential users, more research is needed to further improve the tool, especially health-economic studies, to ensure efficient and cost-effective implementation of SDR-PEP.

Sistemas de Informação em Saúde: inconsistências de informações no contexto da Atenção Primária / Information Systems in Health: inconsistencies of information in the context of Primary Care / Sistemas de Información en Salud: inconsistencias de la información en el contexto de la Atención Primaria

Objetivo: Este artigo pretende comparar os dados referentes à hipertensão, diabetes, tuberculose e hanseníase entre o SIAB e os sistemas SISHIPERDIA e SINAN. Método: Trata-se de um estudo transversal de caráter descritivo, com abordagem quantitativa, realizado a partir dos dados de UBS pertencentes ao território do Distrito Sanitário III do município de João Pessoa-PB, considerando a série histórica produzida por estes sistemas no período de julho a dezembro de 2013. Resultados: Os resultados mostram as divergências encontradas entre estes sistemas de informações. Comparando-se o SIAB e o HIPERDIA, este apresentou um número superior de cadastrados, já o inverso ocorreu com os dados apresentados pelo SINAN, pois esse sistema apresentou um quantitativo de cadastros inferior ao SIAB. Conclusão: observou-se que a fragmentação dos referidos sistemas gera excesso e duplicidade de informações, dificultando o cruzamento e a consolidação de dados importantes para o processo de tomada de decisão na atenção primária à saúde.

Objective: This article aims to compare the data of hypertension, diabetes, tuberculosis, and leprosy between SIAB, SISHIPERDIA, and SINAN systems. Method: This is a cross-sectional descriptive study with quantitative approach. The data were obtained from the Basic Health Units within Sanitary District III of the city of João Pessoa-PB in Brazil. It was considered the historical series produced by these systems in the period of July to December 2013. Results: The results show the differences between these information systems. Comparing SIAB and HIPERDIA systems, the last presented a higher number of registered users, although the reverse occurred with the data presented by SINAN because it showed less registered users than SIAB. Conclusion: It was seen that fragmentation of these systems generate excess and duplication of information, making it difficult to cross and consolidate data that are important for decision-making in the primary health care procedures.

Objetivo: El presente artículo tiene como objetivo comparar los datos sobre la hipertensión, la diabetes, la tuberculosis y la lepra entre SIAB y sistemas SISHIPERDIA y SINAN. Método: Se realizó un estudio descriptivo transversal, con abordaje cuantitativo, realizado a partir de datos de UBS que pertenecen al territorio de la Jurisdicción Sanitaria III de la ciudad de João Pessoa-PB, considerando la serie histórica producida por estos sistemas en el período julio a diciembre de 2013. Resultados: Los resultados muestran las diferencias encontradas entre estos sistemas de información. Comparando el SIAB y el HIPERDIA, este presenta un mayor número de domicilio desde la inversa ocurrió con los datos presentados por el SINAN porque este sistema mostró un cuantitativos entradas inferiores a la SIAB. Conclusión: Se observó que la fragmentación de estos sistemas generan exceso y la duplicación de la información, por lo que es difícil de cruzar y la consolidación de los datos importantes para la toma de decisiones en la atención primaria de salud.

Stability criteria for nonoperative ankle fracture management.

BACKGROUND: This study was designed to see if stability based criteria are useful in choosing between nonoperative and operative treatment of ankle fractures. MATERIALS AND METHODS: One hundred sixty ankle fractures in skeletally mature patients were retrospectively analyzed to obtain an epidemiological profile in a population of about 130,000. One hundred thirty patients had followup of more than 2 years. A decision between operative and nonoperative treatment was made by the surgeon-on-duty, based on accepted stability criteria. Fractures were classified according to Weber and Lauge-Hansen systems. Clinical outcome was assessed using the scoring systems of Olerud-Molander, the RAND 36-Item Health Survey and the Visual Analogue Scale (VAS), measuring pain and function. RESULTS: The overall incidence of ankle fractures was 154/100,000. Nonoperatively treated patients had more displacement of the distal fibula after treatment, but less pain and better Olerud-Molander (good or excellent, 89% vs. 71%) and VAS functional scores. Independent factors for worse outcome were female gender, older age, unstable fracture and co-morbidity. No nonoperatively treated patients needed operative fixation during followup. CONCLUSION: Stability-based fracture classification was a simple and useful tool in decision-making for the treatment of ankle fractures. We found lateral malleolar fractures could be treated nonoperatively with success if the ankle mortise was stable. Displacement of the distal fibula after treatment did not affect functional scores or pain.

Clinical roundtable monograph: a multidisciplinary approach to the use of oncotype DX in clinical practice.

Recently, recommendations for the use of the Oncotype DX assay in estrogen receptor-positive node-negative breast cancer patients were incorporated into guidelines from both the American Society of Clinical Oncology and the National Comprehensive Cancer Network. The Oncotype DX assay is a diagnostic test which measures changes in a set of 21 genes in order to predict the likelihood of disease recurrence and also to predict which patients are most likely to respond to chemotherapy. Oncotype DX has been available commercially since January 2004 and has been used for more than 85,000 patients. Drs. William J. Gradishar, Nora M. Hansen, and Barbara Susnik answered questions regarding the incorporation of the Oncotype DX breast cancer assay into routine clinical practice. This expert dialog offers an update and clinical insights into when, how, and why clinicians might incorporate the Oncotype DX assay into the management of their breast cancer patients. Also, the latest research into the benefit of the Oncotype DX assay in node-positive patients is discussed. Finally, sample case studies offer clinically relevant examples of the practical application of the Oncotype DX assay.

Exemption policies and community preferences for tropical endemic diseases in the Bamako initiative programme in Nigeria.

We determined the actual written policies/guidelines and practices of fee exemptions aimed at the primary health-care level for tropical diseases treatment within the Bamako initiative system and the community's and decision makers' preferences for exemption in Nigeria. Health policy documents from the federal and state ministries of health were reviewed to determine the guidelines for exemptions, services, goods and category of people to receive exemptions. The records of the local government areas, health centres and community health committees were also reviewed to check who had received exemptions and modalities for doing so. In addition, household surveys using questionnaires was conducted. There is no clear-cut national policy regarding exemption. In areas where exemption exists, these are largely unofficial, as no official documents exist to support exemption. A total of 1594 individuals were surveyed. Community members prefer pregnant women, children and patients with TB, malaria, onchocerciasis and leprosy to be exempted from payment of fees: decision makers prefer the poor, children and patients with malaria, TB and leprosy to be exempted from payment for drugs, registration, consultation and preventive services such as immunization and antenatal services. One area of divergence between the preferences of the community and decision makers is the issue of exempting people with malaria and HIV/AIDS.

The precise time course of lexical activation: MEG measurements of the effects of frequency, probability, and density in lexical decision.

Visually presented letter strings consistently yield three MEG response components: the M170, associated with letter-string processing (Tarkiainen, Helenius, Hansen, Cornelissen, & Salmelin, 1999); the M250, affected by phonotactic probability, (Pylkkänen, Stringfellow, & Marantz, 2002); and the M350, responsive to lexical frequency (Embick, Hackl, Schaeffer, Kelepir, & Marantz, 2001). Pylkkänen et al. found evidence that the M350 reflects lexical activation prior to competition among phonologically similar words. We investigate the effects of lexical and sublexical frequency and neighborhood density on the M250 and M350 through orthogonal manipulation of phonotactic probability, density, and frequency. The results confirm that probability but not density affects the latency of the M250 and M350; however, an interaction between probability and density on M350 latencies suggests an earlier influence of neighborhoods than previously reported.