Costo-efectividad de la calidad del control prenatal con respecto al bajo peso al nacer en el Cauca / Antenatal control quality cost-effectiveness regarding low birth weight in Cauca

Antecedentes: El departamento del Cauca en Colombia es multiétnico, multicultural y biodiverso, también con grandes diferencias en bajo peso al nacer (BPN), mortalidad perinatal y mortalidad neonatal tardía entre municipios. Objetivo: Determinar la relación de costo-efectividad del control prenatal (CPN) cuando ha tenido buena calidad frente al que ha tenido calidad deficiente con respecto al BPN en el departamento del Cauca entre 2018 y 2020. Método: Evaluación económica con diseño epidemiológico de una cohorte histórica desde la perspectiva de la institución pagadora. Se calculó la razón incremental de costo-efectividad (RICE), análisis de sensibilidad e impacto presupuestal. Resultados: La incidencia de BPN fue del 8,3% (348/4182). La calidad deficiente en el CPN incrementó el riesgo de BPN (OR: 3,38; IC95%: 1,05-8,2) y la buena calidad tuvo una mejor relación de costo-efectividad (RICE: USD 2727,75), con posición dominante frente a la calidad deficiente (6,14 veces el PIB per cápita de ahorro) y con un impacto presupuestal de USD 2.904.392. Conclusiones: La buena calidad del CPN en el departamento del Cauca durante 2018-2020 fue costo-efectiva y dominante por ser de menor costo y mayor efectividad.

Background: The department of Cauca in Colombia is multiethnic, multicultural, and biodiverse, also with large differences in low birth weight (LBW), perinatal mortality, and late neonatal mortality among municipalities. Objective: To determine the cost-effectiveness relationship of antenatal care (ANC) when it has had good quality compared to that which has had poor quality with respect to low birth weight in the department of Cauca between 2018 and 2019. Method: Economic evaluation with epidemiological cohort design historical from the perspective of the payer institution. Incremental cost-effectiveness ratio (RICE), sensitivity analysis, and budgetary impact were calculated. Results: The incidence of LBW was 8.3% (348/4182). Poor quality in ANC increased the risk of LBW (OR: 3.38; CI95%: 1.05-8.2), good quality had a better cost-effectiveness ratio (RICE: USD 2727.75), with dominant position against poor quality (6.14 times the GDP/capita savings) with a budgetary impact of USD 2,904,392. Conclusions: The good quality of the ANC in the department of Cauca during 2018-2020 was cost-effective and dominant because it is lower cost and more effective.

Las arrugas del arcoíris: Prolegómeno para un estudio teórico-metodológico sobre la importancia de la salud mental de los adultos mayores gais costarricenses / The wrinkles of the rainbow: Introduction of a theoretical-methodological study on the importance of the mental health of (Costa Rican) older gay men / As rugas do arco-íris: Introdução a um estudo teórico-metodológico sobre a importância da saúde mental de velhos gays costa-riquenhos

Vejez y homosexualidad son considerados temas tabú en nuestra sociedad. Ambos son significantes usualmente relacionados con la invisibilidad y el estigma. Así, el presente artículo indaga sobre los diferentes procesos referentes a la salud mental y psicológica de los adultos mayores homosexuales costarricenses, tomando en cuenta su doble estatus de minoría (edad y sexual). Este estudio introductorio pretende arrojar información pertinente sobre la importancia de la salud mental de esta cohorte mediante una serie de investigaciones realizadas al respecto.

Old age and homosexuality are considered taboo subjects in our society. Both are signifiers usually related to invisibility and stigma. Hence, this article looks into the different processes of mental health of Costa Rican gay older men, pondering their double minority status of age and sexuality. This introductory study intends to generate relevant information on the importance of the metal health of this cohort through a series of researches already carried out.

Velhice e homossexualidade são considerados temas-tabu em nossa sociedade. Ambos são significantes usualmenterelacionados àinvisibilidade e estigma. Assim, o presente artigo investigaos diferentes processos referentes à saúde mental e psicológica deidosos homossexuais costariquenhos, levando-seem consideração seu duplo status de minoria etária e sexual. Este estudo introdutório visa a apresentarinformações relevantes sobre a importância da saúde mental dessa coorte,por meio de uma série de estudos realizados a respeito.

Satisfacción del usuario de servicios sanitarios: lista de verificación de calidad metodológica / User satisfaction of the health services: A methodological quality checklist

RESUMEN Objetivo Describir las características metodológicas de estudios observacionales del campo de evaluación de la satisfacción del usuario de servicios de Atención Primaria de Salud a nivel regional mediante la aplicación de una nueva lista de verificación generada por los autores. Métodos Estudio descriptivo transversal, llevado a cabo entre abril y agosto 2017, que incluyó 17 publicaciones sobre satisfacción en atención primaria en salud publicados en revistas latinoamericanas. Resultados En la calificación de acuerdo con la lista de verificación aplicada a 17 publicaciones regionales, ambos revisores coincidieron en ítems como no inclusión de aspectos de ética (10/17; 58,8%); no declaración de población/universo (6/17, 35,3%); no cumple con objetivo declarado inicialmente (5/17; 29,4%), no declaran período de realización del estudio (4/17; 25,3%); no declara tipo de estudio (3/17; 17,6%). Valor de la correlación de Spearman RHO de ítems calificados entre ambos revisores (r=0,653). Conclusiones Los abordajes metodológicos de las publicaciones caracterizadas son de tipo descriptivo, transversal con ausencia de ítems o características metodológicas importantes en casi todos los casos, lo que dificulta la reproducibilidad metodológica; con pocas publicaciones cuyos hallazgos son reproducibles. La lista propuesta mostró ser una herramienta práctica para verificación metodológica de estudios observacionales sobre satisfacción del usuario de servicios sanitarios en atención primaria de salud.(AU)

ABSTRACT Objective Describe the methodological characteristics of observational studies in the field of evaluation of user satisfaction of PHC services at the regional level by applying a new checklist generated by the authors. Methods A cross-sectional descriptive study, carried out between April and August 2017, included 17 publications on satisfaction in Primary Health Care published in Latin American journals. Results In the classification according to the proposed checklist, both reviewers agreed on items such as: no inclusion of ethical aspects (10/17; 58,8%), no declaration of population/universe (6/17; 35,3%); does not comply with the initially declared objective (5/17; 29,4%), does not declare period of study completion (4/17; 25,3%) publications, does not declare study type (3/17; 17,6%). Value of the Spearman RHO correlation of qualified items between both reviewers (r=0,653). Conclusions The methodological approaches of the characterized publications are descriptive, cross-sectional with the absence of important items or methodological characteristics in almost all cases, which makes methodological reproducibility difficult; with few publications whose findings are reproducible. The proposed list proved to be a practical tool for methodological verification of observational studies on user satisfaction of health services in Primary Health Care.(AU)

[User satisfaction of the health services: A methodological quality checklist]. / Satisfacción del usuario de servicios sanitarios: lista de verificación de calidad metodológica.

OBJECTIVE: Describe the methodological characteristics of observational studies in the field of evaluation of user satisfaction of PHC services at the regional level by applying a new checklist generated by the authors. METHODS: A cross-sectional descriptive study, carried out between April and August 2017, included 17 publications on satisfaction in Primary Health Care published in Latin American journals. RESULTS: In the classification according to the proposed checklist, both reviewers agreed on items such as: no inclusion of ethical aspects (10/17; 58,8%), no declaration of population/universe (6/17; 35,3%); does not comply with the initially declared objective (5/17; 29,4%), does not declare period of study completion (4/17; 25,3%) publications, does not declare study type (3/17; 17,6%). Value of the Spearman RHO correlation of qualified items between both reviewers (r=0,653). CONCLUSIONS: The methodological approaches of the characterized publications are descriptive, cross-sectional with the absence of important items or methodological characteristics in almost all cases, which makes methodological reproducibility difficult; with few publications whose findings are reproducible. The proposed list proved to be a practical tool for methodological verification of observational studies on user satisfaction of health services in Primary Health Care.

OBJETIVO: Describir las características metodológicas de estudios observacionales del campo de evaluación de la satisfacción del usuario de servicios de Atención Primaria de Salud a nivel regional mediante la aplicación de una nueva lista de verificación generada por los autores. MÉTODOS: Estudio descriptivo transversal, llevado a cabo entre abril y agosto 2017, que incluyó 17 publicaciones sobre satisfacción en atención primaria en salud publicados en revistas latinoamericanas. RESULTADOS: En la calificación de acuerdo con la lista de verificación aplicada a 17 publicaciones regionales, ambos revisores coincidieron en ítems como no inclusión de aspectos de ética (10/17; 58,8%); no declaración de población/universo (6/17, 35,3%); no cumple con objetivo declarado inicialmente (5/17; 29,4%), no declaran período de realización del estudio (4/17; 25,3%); no declara tipo de estudio (3/17; 17,6%). Valor de la correlación de Spearman RHO de ítems calificados entre ambos revisores (r=0,653). CONCLUSIONES: Los abordajes metodológicos de las publicaciones caracterizadas son de tipo descriptivo, transversal con ausencia de ítems o características metodológicas importantes en casi todos los casos, lo que dificulta la reproducibilidad metodológica; con pocas publicaciones cuyos hallazgos son reproducibles. La lista propuesta mostró ser una herramienta práctica para verificación metodológica de estudios observacionales sobre satisfacción del usuario de servicios sanitarios en atención primaria de salud.

Asymmetric headgear for differential molar movement: a study using finite element analysis.

OBJECTIVE: To compare the effects of four different asymmetric headgear systems. DESIGN: A mathematical method for three-dimensional data called finite element analysis. SETTING: The Orthodontic Department, the Federal University of Rio de Janeiro and the Metallurgical Engineering Department of the Fluminense Federal University. METHODS: Four systems of delivering an asymmetrical force to headgear were studied: using face-bow arms of different lengths, a symmetric face-bow with one of the arms bent outward in relation to the internal arch, a symmetric face-bow used in combination with a transpalatal arch activated to produce an asymmetric force, and a symmetric face-bow with the outer bow soldered to the inner bow on the side where a larger force will be applied. RESULTS: All four systems were effective in promoting asymmetric distal movement of the molars. However, the symmetrical face-bow with the outer bow soldered to the inner bow (system 4) could be used in asymmetric mechanics if the bows are soldered on the opposite side to the proposed distalization. Lateral and occlusal displacing forces were observed in all systems as well as tip-back and rotational movements. CONCLUSION: The simulated computer model used in this investigation suggests that a face-bow with a symmetrically soldered joint and arms of equal lengths used in combination with a transpalatal arch is the best headgear option when asymmetric movement of upper molars is desired.

Quality of life and voice: study of a Brazilian population using the voice-related quality of life measure.

OBJECTIVE: The goal of the present study was to characterize a large population of Brazilian individuals using the Brazilian Portuguese version of the Voice-Related Quality of Life (V-RQOL) Measure. PATIENTS AND METHODS: We studied a population of 2,214 Brazilian subjects who completed the V-RQOL questionnaire consisting of 10 questions from two domains: physical functioning and social-emotional functioning. The subjects were divided into two groups according to the presence of vocal complaints: group 1, with vocal complaints (1,304 individuals); group 2, without vocal complaints (910 individuals). Subject age ranged from 14 to 90 years in both groups. All subjects self-rated their voice quality upon a five-point categorical scale ranging from poor to excellent. Moreover, the respondents' professions were classified into four categories according to their level of voice usage. RESULTS: Results indicate that the worse the self-assessment of the voice, the lower the V-RQOL scores, with higher significance in the group with vocal complaints. The total V-RQOL score was 97 for excellent voices, 92 for very good, 84 for good, 65 for fair, and 45 for poor voices. Main correlations for both groups were: total and physical scores (0.96), total and social-emotional scores (0.82); physical and social-emotional scores (0.69); self-assessment of the voice and total score (0.61); self-assessment of the voice and physical score (0.58), and self-assessment of the voice and social-emotional score (0.52). Two interesting negative correlations were found between age and self-assessment of the voice (-0.271), and age and social-emotional score (-0.184). Group 1, with vocal complaints, presented lower scores than group 2. CONCLUSIONS: The relationship between self-assessment of voice quality and V-RQOL scores was very clear and statistically significant, especially when considering the group with a known voice disorder.

Neonatal renal venous thrombosis: clinical outcomes and prevalence of prothrombotic disorders.

OBJECTIVE: To determine clinical outcomes and the prevalence of prothrombotic conditions in patients who had neonatal renal venous thrombosis (RVT). STUDY DESIGN: A retrospective cohort of neonates with RVT who were admitted to 4 pediatric centers from 1980 to 2001 was identified. Information on clinical presentation, laboratory and radiological investigation, and treatment were abstracted. Survivors were evaluated for renal status and prothrombotic conditions. RESULTS: Forty-three patients with neonatal RVT were identified. RVT was unilateral in 24 patients (56%) and associated with 2thrombi at other sites in 32 patienets (74%). Clinical presentations included renal failure in 24 patients (56%), thrombocytopenia, anemia, or both in 22 patients (51%), and renal mass in 21 patients (49%). Neonatal interventions included anti-coagulants in 28 patients (65%), antihypertensive medications in 9 patients (21%), peritoneal dialysis in 2 patients (5%), and nephrectomy in 2 patients (5%). The median age at follow-up was 3.7 years (range, 0.5-20.2 years). Thirteen patients (34%) had hypertension, and 11 patients (29%) had renal failure. End-stage renal disease developed in 3 patients, and they underwent live-related renal transplants. Twelve of the 28 patients (43%) examined had prothrombotic abnormalities. CONCLUSION: Neonatal RVT is associated with significant renal morbidity and a high prevalence of prothrombotic abnormalities.

Hypercalciuria in Beckwith-Wiedemann syndrome.

We determined the incidence of hypercalciuria (HC) and its association with nephrocalcinosis and nephrolithiasis in 18 consecutive patients with Beckwith-Weidemann syndrome (BWS). Random, nonfasting urine samples were obtained from each patient. All patients had abdominal ultrasonography, most on several occasions. Four patients (22%) had HC. Of these, 2 had nephrocalcinosis, one had hyperechoic kidneys, and one had normal renal imaging. Serum calcium was normal in all patients with HC. Because we found that an increased prevalence in the occurrence of HC and its complications in a group of children with BWS, any child with BWS should be evaluated for HC.

OKT3 monoclonal antibody in pediatric kidney transplant recipients with recurrent and resistant allograft rejection.

Twelve pediatric patients, aged 28 months to 17 years, received OKT3 to reverse renal allograft rejection. In 11 patients, the rejection crisis was resistant to conventional antirejection therapy with high doses of prednisone or polyclonal antithymocyte globulin. Reversal of rejection was successful in 10 patients who completed a treatment course. Because of recurring resistant rejection, five patients received a second course of OKT3, which was successful in reversing the rejection crisis in two. Among these patients, the persistence or the appearance of high levels of circulating T3 lymphocytes after initiating the second treatment course correlated with treatment failure. The immediate side effects associated with OKT3 therapy were transient and medically manageable. We conclude that this monoclonal antibody preparation is a safe and effective treatment for pediatric renal allograft in recipients experiencing rejection crisis resistant to conventional therapy. However, the potential impact of this immunosuppressive medication on long-term renal allograft survival in this patient population remains to be determined.