Child friendly spaces impact across five humanitarian settings: a meta-analysis.

BACKGROUND: Humanitarian crises present major threats to the wellbeing of children. These threats include risks of violence, abduction and abuse, emotional distress and the disruption of development. Humanitarian response efforts frequently address these threats through psychosocial programming. Systematic reviews have demonstrated the weak evidence-base regarding the impact of such interventions. This analysis assesses the impact of Child Friendly Spaces (CFS), one such commonly implemented intervention after humanitarian emergencies. METHODS: We completed baseline and endline (three-six months post-baseline) assessments regarding protection concerns, psychosocial wellbeing, developmental assets and community resources for a total of 1010 children and 1312 carers in catchment areas for interventions with humanitarian populations in Ethiopia, Uganda, Iraq, Jordan, and Nepal. We estimated intervention effect-sizes with Cohen's d for difference in mean difference scores between attenders and non-attenders - who proved comparable on baseline measures - by site. We then pooled findings for a meta-analysis summarizing overall impacts across domains. RESULTS: Amongst children aged 6-11, significant intervention impacts were observed through site-level analysis for protection concerns (Ethiopia, Cohen's d = 0.48, 95% CI 0.08-0.88), psychosocial wellbeing (Ethiopia, d = 0.51, 95% CI 0.10-0.91; and Uganda, d = 0.21, 95% CI 0.02-0.40), and developmental assets (Uganda, d = 0.37, 95% CI 0.15-0.59; and Iraq, d = 0.86, 95% CI 0.18-1.54). Pooled analyses for this age group found impacts of intervention to be significant only for psychosocial wellbeing (d = 0.18, 95% CI 0.03-0.33). Among children aged 12-17, site-level analysis indicated intervention impact for protection concerns in one site (Iraq, d = 0.58, 95% CI 0.07-1.09), with pooled analysis indicating no significant impacts. CONCLUSION: CFS can provide - albeit inconsistently - a protective and promotive environment for younger children. CFS show no impact with older children and in connecting children and carers with wider community resources. A major reappraisal of programming approaches and quality assurance mechanisms is required.

Digital health for real-time monitoring of a national immunisation campaign in Indonesia: a large-scale effectiveness evaluation.

OBJECTIVE: To assess the contribution of a digital health real-time monitoring platform towards the achievement of coverage targets during a national immunisation campaign in Indonesia. INTERVENTIONS: A digital health platform was introduced to facilitate real-time reporting and data visualisation. Health workers submitted reports of children immunised each day by geolocation using mobile phones. Automated reports were generated for programme managers at all levels to enable early responses to coverage gaps. METHODS: Risk profiles were generated for each district to assess precampaign immunisation programme performance. Digital health platform use and progress towards targets were monitored continuously throughout the campaign. Study outcomes were total coverage and time to achieve full (100%) coverage. Kaplan-Meier, Cox and linear regression analyses were used to estimate the associations and outcomes after adjusting for district risk profiles. A complementary qualitative assessment explored user experiences and acceptance through interviews with vaccinators and programme managers in provinces and districts selected through multistage random sampling. RESULTS: Between August and December 2018, 6462 health facilities registered to use the digital health platform across 28 provinces and 395 districts. After adjusting for precampaign district risk profile and intracampaign delays due to vaccine hesitancy, districts with greater platform utilisation demonstrated higher coverage overall (R2=0.28, p<0.0001) and a shorter interval to achieving full coverage (>75% reporting compliance; Risk Ratio 15.4, 95% CI 5.8 to 40.6). Stronger effects were observed among districts experiencing implementation delays due to vaccine hesitancy. Results from 106 key informant interviews conducted in 6 provinces and 18 districts suggest high degrees of acceptability, ease of use and satisfaction. CONCLUSION: A digital health platform introduced for real-time monitoring of a national immunisation campaign in Indonesia was feasible, well liked and associated with improved problem solving and programme performance, particularly among districts affected by vaccine hesitancy. TRIAL REGISTRATION NUMBER: ISRCTN10850448.

Adelgazamiento con tratamiento alternativo de Medicina Natural y Tradicional para dermolipectomía / Weight loss with alternative treatment of natural and traditional medicine for dermolipectomy

Introducción: la obesidad es una enfermedad crónica multifactorial en la que están implicados factores genéticos, psicológicos y socioeconómicos. Supone un factor de riesgo para otras patologías como enfermedades cardiovasculares, diabetes, hipertensión, dislipemias e incluso determinados tipos de tumores. Su tratamiento representa un gran gasto para el sistema de salud. El continuo aumento de su prevalencia ha alertado a funcionarios de salud pública, epidemiólogos y economistas. Sin duda los pacientes con grandes adelgazamientos son los que más se benefician de este tipo de intervención. Presentan gran laxitud tanto del plano cutáneo graso debido a la pérdida del excedente graso, como del plano músculo-aponeurótico debido a la pérdida de la grasa intramuscular y de la grasa visceral intra-abdominal. Esto permite resecciones agresivas y al mismo tiempo seguras, pues ofrecen un cierre sin tensión. Caso clínico: se trata de una paciente de 45 años con obesidad mórbida (IMC: 54,6 kg/m²) asociada a hipertensión arterial y daños psicológicos e higiénicos considerables, que necesita reducir peso para someterse a dermolipectomía. Conclusiones: después de realizar varios tratamientos médicos convencionales fallidos para adelgazar la paciente se somete de forma exclusiva a dieta, implantación de catgut y homeopatía. Utilizando esta terapia económica e inocua después de 6 meses de evolución clínica bajo tratamiento la paciente redujo 40 kg de peso, lo que facilitó el éxito de la dermolipectomía abdominal, con buenos resultados estéticos y sin aparición de temidas complicaciones como lipolisis, seromas y necrosis.

Introduction: Obesity is a chronic multifactorial disease involving genetic, psychological and socioeconomic factors. It represents a risk factor for other diseases such as cardiovascular disease, diabetes, hypertension, dyslipidemia and even certain types of tumors. Its treatment represents a large expense for the health system. The continued increase in prevalence has alerted public health officials, epidemiologists and economists. Certainly, patients with much weight loss are the most benefited from this type of intervention. They have great laxity in both the fatty skin plane due to the loss of excess fat, and the musculoaponeurotic plane due to loss of intramuscular fat and intra-abdominal visceral fat. This allows aggressive resections and safe at the same time, because they offer a closing without tension. Clinical case: female patient of 45 years of age with morbid obesity (BMI: 54.6 kg/m2) associated with arterial hypertension and considerable psychological and hygienic damages, who need to lose weight to undergo a dermolipectomy. Conclusions: after carrying out several failed conventional medical treatments for the patient to thin, she is undergone diet exclusively, catgut implantation and homeopathy. Using this economical and safe therapy after six months of clinical evolution under treatment the patient dropped 40 kg of weight, which facilitated the success of the abdominoplasty, with good aesthetic results without appearance of dreaded complications as lipolysis, seroma and necrosis.

Diagnóstico de masas intracraneales primarias por medio imagenológicos / Diagnosis of intracranial masses using imaging techniques

Se realizó un estudio descriptivo, longitudinal y transversal que incluyó a los pacientes operados de neoplasia del sistema nervioso central intracraneal en el Hospital General Docente "Abel Santamaría Cuadrado " de la provincia Pinar del Río, durante el período comprendido desde el 1 de enero de 2010 hasta el 31 de diciembre del mismo año. Se incluyeron todos los pacientes egresados a los que se les había realizado tomografía computarizada o resonancia magnética y poseían diagnóstico histológico postoperatorio de neoplasia primaria del sistema nervioso central (SNC) intracraneal. Se concluyó que las neoplasias primarias fueron más frecuentes en el sexo femenino y en grupo de edad de 70 años y más. Las localizaciones más frecuentes de las neoplasias primarias del sistema nervioso central fueron las masas intraaxiales y supratentoriales y el tipo histológico más prevalente fue el glioma. Todas se comportaron imagenológicamente captantes de contraste, con poca hemorragia y calcificación intermediamente con efecto de masa y hipointensas en T1 hiperintensas en T2.

A descriptive, longitudinal and cross-sectional study including the patients operated on intracranial central nervous system neoplasm was carried out at "Abel Santamaria Cuadrado" University Hospital, Pinar del Rio during January 1, 2010 to December 31, 2010. All patients discharged from the hospital with Computerized Axial Tomography or Magnetic Resonance Imaging and having post-operative histological diagnosis of primary intracranial neoplasm of the central nervous system (CNS) were included. Primary neoplasm was the most frequent in female sex and in the age-bracket of 70 years old or older. The most repeated localizations of primary neoplasm in the CNS were in intra-axial and supratentorial masses, glioma was the most prevailing histological type. Contrast examinations could be performed in all masses, presenting not much hemorrhage, with intermediate-mass-effect calcifications and hypo-intensive in T1 and hyper-intensive in T2.

Diagnóstico ultrasonográfico del embarazo ectópico como urgencia ginecobstétrica / Sonographic diagnosis of ectopic pregnancy as a gynecological-obstetric emergency

Se realizó un estudio descriptivo longitudinal transversal que incluyó a las pacientes intervenidas quirúrgicamente con embarazo ectópico en el Hospital General Docente "Abel Santamaría Cuadrado" de la provincia Pinar del Río, durante el período comprendido desde el 1 de enero de 2010 hasta el 31 de diciembre de 2010. Se incluyeron todas las pacientes egresadas a las que se les había realizado ultrasonografía y poseían un diagnóstico histológico postoperatorio de esta entidad. El embarazo ectópico durante el período estudiado fue más frecuente en grupo de mujeres comprendidas entre los 20-29años, del color de piel blanca, con un alto predomino en la localización tubárica, y con una condición física del EE roto, cuya forma de presentación ultrasonográfica más frecuentemente observada fue la de líquido libre intraabdominal, y de imagen de masa anexial.

A descriptive, longitudinal, cross-sectional study which included patients operated on ectopic pregnancy at "Abel Santamaria Cuadrado" University Hospital, Pinar del Rio was conducted from January 1st, 2010 to December 31, 2010. All patients discharged from the hospital with sonographic diagnosis and having post-operative histological diagnosis of this entity were included in the study. The ectopic pregnancy was more frequent found, (in the period of the study) in women from 20 to 29 years old, tubal localization prevailed in Caucasian race having a physical condition of broken ectopic pregnancy, the most frequent presentation observed in sonographic images were intrabdominal free fluids and a mass in annexa.