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1.
Rev Panam Salud Publica ; 44: e111, 2020.
Artículo en Español | MEDLINE | ID: mdl-32994789

RESUMEN

This report proposes a conceptual model on workplace environment and working conditions that integrates the available evidence to facilitate the design and evaluation of interventions aimed at improving the attraction, recruitment and retention of health personnel at the first level of care in rural and remote areas. Theoretical, empirical and testimonial evidence was consulted to support the model, and 15 frameworks disseminated in the last 20 years were synthesized. The article shows the diversity of perspectives and the complexity involved in establishing the dimensions to be considered in a proposal that is useful to apply to human resources for health policies.The proposed model includes four categories of components: factors of the external context, organizational factors, employment and work conditions, and individual factors. The boundaries between the components -as well as the weight and influence of each one- vary according to the interrelationship among them and the interaction with the environment, and thus its interpretation must be adapted to the context in which it is intended to be applied.Based on this conceptual model, the design and evaluation of interventions aimed at increasing the availability of health personnel -particularly at the primary care level in rural and remote areas of the Region of the Americas- should emerge from an interaction between health and employment policies, and the realities and expectations of workers and the communities.

2.
Rev Panam Salud Publica ; 44: e112, 2020.
Artículo en Español | MEDLINE | ID: mdl-32952534

RESUMEN

Objective: To identify and systematize available empirical evidence on factors and interventions that affect working conditions and environment in order to increase the attraction, recruitment and retention of human resources for health at the primary care level in rural, remote or underserved areas. Methods: Rapid review of reviews selected according to relevance, eligibility and inclusion criteria. The search was conducted on electronic and manual databases, including grey literature. AMSTAR I was used to assess the quality of systematic reviews and a thematic analysis for synthesis of the results. Results: Sixteen reviews were included, one of which contained 14 reviews. Of the total, 20 reviews analyzed factors and 9 evaluated the effectiveness of interventions. The evidence on factors is abundant, but of limited quality. Individual, family and "previous exposure to a rural setting" factors were associated with higher recruitment; organizational and external context factors were important for human resource retention. Networking and professional support influenced recruitment and retention. Evidence on the effectiveness of interventions was limited, both in quantity and quality. The most frequently used intervention was incentives. Conclusions: Evidence on factors that are positively related to recruitment and retention of workers at the first level of care in rural, remote or underserved areas is sufficient and should be taken into account when designing interventions. Quality evidence on the effectiveness of interventions is scarce. More controlled studies with methodological rigor are needed, particularly in the Americas.

3.
Rev Panam Salud Publica ; 44, sept. 2020
Artículo en Español | PAHO-IRIS | ID: phr-52708

RESUMEN

Se propone un modelo conceptual sobre condiciones y medio ambiente de trabajo en salud que integra la evidencia disponible para facilitar el diseño y la evaluación de intervenciones orientadas a mejorar la atracción, captación y retención del personal de salud en el primer nivel de atención de áreas rurales y remotas. Se consultó la evidencia teórica, empírica y testimonial para fundamentar la propuesta y se sintetizaron 15 modelos difundidos en los últimos 20 años. El artículo da cuenta de la diversidad de perspectivas y la complejidad que conlleva establecer las dimensiones que deben considerarse en una propuesta que sea útil para aplicar a las políticas de recursos humanos en salud. El modelo propuesto incluye cuatro categorías de componentes: factores del contexto externo, factores organizacionales, condiciones del empleo y del trabajo, y factores individuales. Los límites entre los componentes –así como el peso y la influencia de cada uno– varían en función de la relación entre ellos y de la interacción con el medio, por lo que su interpretación debe adecuarse al ámbito en que se pretenda aplicar. A partir de este modelo conceptual, el diseño y la evaluación de las intervenciones dirigidas a incrementar la disponibilidad de personal de salud –en particular en el primer nivel de atención de áreas rurales y remotas de la Región de las Américas– deberían surgir de una interacción entre las políticas de salud y empleo, y las realidades y expectativas de los trabajadores y las comunidades.


This report proposes a conceptual model on workplace environment and working conditions that integrates the available evidence to facilitate the design and evaluation of interventions aimed at improving the attraction, recruitment and retention of health personnel at the first level of care in rural and remote areas. Theoretical, empirical and testimonial evidence was consulted to support the model, and 15 frameworks disseminated in the last 20 years were synthesized. The article shows the diversity of perspectives and the complexity involved in establishing the dimensions to be considered in a proposal that is useful to apply to human resources for health policies. The proposed model includes four categories of components: factors of the external context, organizational factors, employment and work conditions, and individual factors. The boundaries between the components – as well as the weight and influence of each one– vary according to the interrelationship among them and the interaction with the environment, and thus its interpretation must be adapted to the context in which it is intended to be applied. Based on this conceptual model, the design and evaluation of interventions aimed at increasing the availability of health personnel –particularly at the primary care level in rural and remote areas of the Region of the Americas– should emerge from an interaction between health and employment policies, and the realities and expectations of workers and the communities.


Asunto(s)
Condiciones de Trabajo , Modelos Teóricos , Salud Rural , Zonas Remotas , Fuerza Laboral en Salud , Medio Ambiente y Salud Pública , Condiciones de Trabajo , Modelos Teóricos , Salud Rural , Instalaciones para Atención de Salud, Recursos Humanos y Servicios , Zonas Remotas , Américas
4.
Rev Panam Salud Publica ; 44, sept. 2020
Artículo en Español | PAHO-IRIS | ID: phr-52651

RESUMEN

Objetivo. Identificar y sistematizar la evidencia empírica disponible sobre factores e intervenciones que inciden en las condiciones y medio ambiente de trabajo para incrementar la atracción, captación y retención de recursos humanos en salud en el primer nivel de atención de áreas rurales, remotas o desatendidas. Métodos. Revisión rápida de revisiones, seleccionadas según criterios de pertinencia, elegibilidad e inclusión con búsquedas en bases de datos electrónicas, de literatura gris y manual. Se empleó el AMSTAR I para evaluar la calidad de revisiones sistemáticas y un análisis temático para síntesis de resultados. Resultados. Se incluyeron 16 revisiones, una de las cuales contenía a su vez 14 revisiones. Del total, 20 revisiones analizaron factores y 9 evaluaron efectividad de intervenciones. La evidencia sobre factores es abundante, pero de limitada calidad. Los factores individuales, familiares y la “exposición rural previa” se asociaron a mayor captación; factores organizacionales y del contexto externo fueron gravitantes en la retención. El trabajo en red y el apoyo profesional incidieron en la captación y retención. La evidencia sobre efectividad de intervenciones fue limitada, en cantidad y calidad. El tipo de intervención más frecuentemente empleada fueron los incentivos. Conclusiones. La evidencia sobre factores que se relacionan positivamente con la captación y retención de trabajadores en el primer nivel de atención de áreas rurales, remotas o desatendidas es suficiente y debería ser tenida en cuenta al diseñar intervenciones. La evidencia de calidad sobre la efectividad de intervenciones es escasa. Se requieren más estudios controlados con rigurosidad metodológica, particularmente en las Américas. Palabras clave Condiciones de trabajo


Objective. To identify and systematize available empirical evidence on factors and interventions that affect working conditions and environment in order to increase the attraction, recruitment and retention of human resources for health at the primary care level in rural, remote or underserved areas. Methods. Rapid review of reviews selected according to relevance, eligibility and inclusion criteria. The search was conducted on electronic and manual databases, including grey literature. AMSTAR I was used to assess the quality of systematic reviews and a thematic analysis for synthesis of the results. Results. Sixteen reviews were included, one of which contained 14 reviews. Of the total, 20 reviews analyzed factors and 9 evaluated the effectiveness of interventions. The evidence on factors is abundant, but of limited quality. Individual, family and “previous exposure to a rural setting” factors were associated with higher recruitment; organizational and external context factors were important for human resource retention. Networking and professional support influenced recruitment and retention. Evidence on the effectiveness of interventions was limited, both in quantity and quality. The most frequently used intervention was incentives. Conclusions. Evidence on factors that are positively related to recruitment and retention of workers at the first level of care in rural, remote or underserved areas is sufficient and should be taken into account when designing interventions. Quality evidence on the effectiveness of interventions is scarce. More controlled studies with methodological rigor are needed, particularly in the Americas.


Asunto(s)
Condiciones de Trabajo , Medio Rural , Zonas Remotas , Área sin Atención Médica , Recursos Humanos , Atención Primaria de Salud , Selección de Personal , Condiciones de Trabajo , Medio Rural , Zonas Remotas , Selección de Personal , Atención Primaria de Salud
5.
Medicina (B Aires) ; 80 Suppl 3: 16-24, 2020.
Artículo en Español | MEDLINE | ID: mdl-32658843

RESUMEN

The COVID-19 pandemic affected the organization of health services and had consequences for health teams, according to the pre-existing safety and working conditions. During the first week of April 2020, a cross sectional study was carried out with a qualitative-quantitative approach. The aim was to explore the conditions determining the organizational climate: leadership, communication, institutional resources, cohesion/conflict management, and training; and how these were perceived by health personnel to deal with the pandemic. A total of 5670 healthcare workers participated in an online survey and 50 were interviewed, from all subsectors of the Argentinean health system (public, private and union-health insurance); 72.9% were women, 51.4% were physicians, and the predominant age group was under 40 years. In the qualitative sample (interviews), 52% were men, 62% were physicians, and the average age was 44.8 years. The dimensions of the organizational climate were stratified and five independent predictors of perception of conditions were identified: age, gender, tasks performed, health system subsector, and jurisdiction. The condition most frequently perceived as inadequate were the inaccessibility of institutional resources and the access to personal protective equipment was a major concern. Claims included the need of institutional strategies to support healthcare workers and of a clear and uniform communication. In conclusion, at the time of the study, the health personnel perceived serious deficits in their organizations regarding the conditions necessary to confront COVID-19, with differences among subsectors of the health system.


Asunto(s)
Infecciones por Coronavirus , Personal de Salud/psicología , Servicios de Salud/estadística & datos numéricos , Pandemias , Equipo de Protección Personal/provisión & distribución , Neumonía Viral , Lugar de Trabajo/organización & administración , Adolescente , Adulto , Anciano , Betacoronavirus , Niño , Infecciones por Coronavirus/epidemiología , Estudios Transversales , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Investigación Cualitativa , Encuestas y Cuestionarios
6.
Medicina (B.Aires) ; 80(supl.3): 16-24, June 2020. tab
Artículo en Español | LILACS-Express | LILACS | ID: biblio-1135186

RESUMEN

La pandemia por COVID-19 afectó la organización de los servicios de salud y tuvo consecuencias en los equipos de salud, según las condiciones laborales y de bioseguridad pre-existentes en cada institución. Durante la primera semana de abril de 2020 se realizó un estudio de corte transversal. El objetivo fue indagar acerca de las condiciones que determinan el clima organizacional: liderazgo, comunicación, recursos institucionales, cohesión/gestión de conflictos y capacitación; y cómo éstas eran percibidas por el personal de salud para hacer frente a la pandemia. Se realizaron 5670 encuestas a trabajadores/as y 50 entrevistas a informantes clave de los tres subsectores del sistema de salud (público, privado y de seguridad social). En las encuestas, el 72.9% fueron mujeres, el 51.4% médicos/as y el grupo etario predominante fue el de menores de 40 años. El 47.8% de los/as participantes refirió pluriempleo. En las entrevistas, el 52% fueron varones, el 60% médicos/ as, la edad media 44.8 años. Se estratificaron las dimensiones y se identificaron predictores independientes de percepción: edad, género, tipo de tareas, subsector y jurisdicción. La dimensión percibida con mayor frecuencia como inadecuada fue la de recursos institucionales y la disponibilidad de equipos de protección personal fue identificada como una de las principales preocupaciones. Surgieron demandas de estrategias de contención para el personal de salud y de comunicación institucional clara y uniforme. En conclusión, al momento del estudio el personal de salud percibía serios déficits en sus organizaciones respecto de las condiciones necesarias para enfrentar la pandemia, con diferencias entre subsectores del sistema.


The COVID-19 pandemic affected the organization of health services and had consequences for health teams, according to the pre-existing safety and working conditions. During the first week of April 2020, a cross sectional study was carried out with a qualitative-quantitative approach. The aim was to explore the conditions determining the organizational climate: leadership, communication, institutional resources, cohesion/conflict management, and training; and how these were perceived by health personnel to deal with the pandemic. A total of 5670 healthcare workers participated in an online survey and 50 were interviewed, from all subsectors of the Argentinean health system (public, private and union-health insurance); 72.9% were women, 51.4% were physicians, and the predominant age group was under 40 years. In the qualitative sample (interviews), 52% were men, 62% were physicians, and the average age was 44.8 years. The dimensions of the organizational climate were stratified and five independent predictors of perception of conditions were identified: age, gender, tasks performed, health system subsector, and jurisdiction. The condition most frequently perceived as inadequate were the inaccessibility of institutional resources and the access to personal protective equipment was a major concern. Claims included the need of institutional strategies to support healthcare workers and of a clear and uniform communication. In conclusion, at the time of the study, the health personnel perceived serious deficits in their organizations regarding the conditions necessary to confront COVID-19, with differences among subsectors of the health system.

7.
Health Policy Plan ; 33(5): 654-665, 2018 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-29668967

RESUMEN

Retinopathy of prematurity (ROP) is a largely avoidable cause of blindness in children worldwide, requiring high-quality neonatal care, early detection and treatment. In middle-income countries throughout Latin America, Eastern Europe and South Asia, there has been a rise in ROP blindness due to a combination of increased survival of preterm infants, resource-scarce medical environments and lack of policies, training and human resources. However, Argentina is an example of country where rates of ROP blindness have declined and ROP programmes have been successfully and effectively embedded within the health and legal system. The purpose of this study is to describe the activities and stakeholders, including Ministry of Health (MoH) and UNICEF, involved in the process, from recognition of an epidemic of ROP blindness to the development of national guidelines, policies and legislation for control. Using a retrospective mixed methods case study design, data on rates of severe ROP was collected from 13 neonatal intensive care units from 1999 to 2012, and on the proportion of children blind from ROP in nine blind schools in seven provinces. Legislative document review, focus group discussions and key informant interviews were conducted with neonatologists, ophthalmologists, neonatal nurses, parents, MoH officials, clinical societies, legislators and UNICEF officials in seven provinces. Results are presented combining the stages heuristic policy framework and Shiffman including: agenda setting, policy formulation, implementation and evaluation. By 2012, ROP had declined as a cause of blindness in children in schools for the blind as had rates of severe ROP needing treatment in the NICUs visited. Multiple factors played a role in reducing blindness from ROP in Argentina and successfully coordinating its control including national advocacy, leadership, legislation and international collaboration. Lessons learned in Argentina can potentially be scaled to other LMICs in Latin America and beyond with further context-specific research.


Asunto(s)
Ceguera/prevención & control , Defensa del Niño , Conducta Cooperativa , Implementación de Plan de Salud , Política de Salud , Retinopatía de la Prematuridad/epidemiología , Argentina/epidemiología , Grupos Focales , Humanos , Lactante , Recién Nacido , Estudios Retrospectivos
8.
Arch. argent. pediatr ; 113(6): 510-518, dic. 2015. ilus, tab
Artículo en Inglés, Español | LILACS, BINACIS | ID: biblio-838138

RESUMEN

Introducción. En 2010, se lanzó la iniciativa Maternidad Segura y Centrada en la Familia con el propósito de transformar las grandes maternidades públicas en espacios donde se implementaran prácticas seguras y se garantizaran los derechos de mujeres, recién nacidos y sus familias, lo que propuso un cambio de paradigma en la atención perinatal. El artículo reporta los hallazgos acerca de la cultura organizacional como insumo para la implementación de la iniciativa. Población y métodos. Se seleccionó una muestra no probabilística de 29 hospitales públicos de la provincia de Buenos Aires adheridos a la iniciativa. Durante 2011 y 2012, se aplicó una encuesta autoadministrada anónima a los integrantes de los servicios de Neonatología y Obstetricia, en la que se recogió información sobre tres dimensiones de la cultura organizational: clima organizational, prácticas seguras y facilitación para el cambio. Resultados. Se recolectaron 1828 encuestas; el 51% expresó la necesidad de mejorar la comunicación mediante más reuniones y el 60% evaluó positivamente algunos aspectos del liderazgo. La sobrecarga de trabajo fue reconocida como la principal causa de conflictos por el 60%. Aproximadamente, 25% expresó acuerdo y compromiso con la transformación de las maternidades en dirección a la iniciativa. La adhesión a las prácticas resultó dispar según cuáles fueran, aunque la mitad de los encuestados reportó que había razones legítimas para el cambio. Conclusiones. El diagnóstico de la cultura organizacional demostró que falta consolidar el compromiso con la iniciativa Maternidad Segura y Centrada en la Familia y que la evaluación del liderazgo no es integral. La sobrecarga de trabajo y las fallas de comunicación son las más importantes fuentes de conflicto.


Introduction. In 2010, the Safe and Family-Centered Maternity Hospitals initiative was launched in order to transform large public maternity centers into settings where safe practices are implemented and the rights of women, newborn infants and families are warranted. As a result, the paradigm of perinatal care was modified. This article reports on the findings of organizational culture as a component for the implementation of the initiative. Population and Methods. The sample was selected in a non-probabilistic way and was made up of 29 public hospitals located in the province of Buenos Aires that participated in the initiative. During 2011 and 2012, an anonymous, self-administered survey was completed by members of the Department of Neonatology and the Department of Obstetrics. The survey collected information on three dimensions of the organizational culture: organizational environment, safe practices, and facilitation of change. Results. A total of 1828 surveys were collected; 51% of survey respondents stated that there is a need to improve communicationby having more meetings, while 60% made a positive assessment of various aspects of leadership. Work overload was described as the main cause of conflicts by 60%. Approximately 25% agreed and showed commitment with the initiative of transforming maternity centers. Adherence to practices was dissimilar depending on the practice, but half of survey respondents reported that there were genuine reasons for change. Conclusions. The assessment of the organizational culture showed that commitment to the Safe and Family-Centered Maternity Hospitals initiative is yet to be consolidated, and the evaluation of leadership is not comprehensive. Work overload and communication failures are the main reasons for conflict.


Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Cultura Organizacional , Encuestas y Cuestionarios , Comunicación , Atención Perinatal , Maternidades/organización & administración
9.
Arch Argent Pediatr ; 113(6): 510-8, 2015 Dec 01.
Artículo en Español | MEDLINE | ID: mdl-26593796

RESUMEN

INTRODUCTION: In 2010, the Safe and Family-Centered Maternity Hospitals initiative was launched in order to transform large public maternity centers into settings where safe practices are implemented and the rights of women, newborn infants and families are warranted. As a result, the paradigm of perinatal care was modified. This article reports on the findings of organizational culture as a component for the implementation of the initiative. POPULATION AND METHODS: The sample was selected in a non-probabilistic way and was made up of 29 public hospitals located in the province of Buenos Aires that participated in the initiative. During 2011 and 2012, an anonymous, self-administered survey was completed by members of the Department of Neonatology and the Department of Obstetrics. The survey collected information on three dimensions of the organizational culture: organizational environment, safe practices, and facilitation of change. RESULTS: A total of 1828 surveys were collected; 51% of survey respondents stated that there is a need to improve communication by having more meetings, while 60% made a positive assessment of various aspects of leadership. Work overload was described as the main cause of conflicts by 60%. Approximately 25% agreed and showed commitment with the initiative of transforming maternity centers. Adherence to practices was dissimilar depending on the practice, but half of survey respondents reported that there were genuine reasons for change. CONCLUSIONS: The assessment of the organizational culture showed that commitment to the Safe and Family-Centered Maternity Hospitals initiative is yet to be consolidated, and the evaluation of leadership is not comprehensive. Work overload and communication failures are the main reasons for conflict.


Asunto(s)
Maternidades/organización & administración , Cultura Organizacional , Argentina , Comunicación , Femenino , Humanos , Recién Nacido , Atención Perinatal , Embarazo , Encuestas y Cuestionarios
10.
Bol. Acad. Nac. Med. B.Aires ; 92(2): 281-290, jul.-dic. 2014. tab, ilus
Artículo en Español | LILACS | ID: biblio-998719

RESUMEN

Las Fisuras Labio Palatinas son anomalías congénitas que consisten en una hendidura o separación en el labio superior. Se presentan, frecuentemente, acompañadas de paladar hendido. El presente trabajo tiene por objetivo estudiar la complejidad y grado de adherencia, estudiando el grado de abandono en la rehabilitación del paciente FLAP que concurre a instituciones o servicios adheridos a la Red de Servicios / Instituciones de la Argentina. De un total de 749 pacientes fueron contactados aquellos con más de 200 días de inasistencia al servicio en un total de 162 (21,6%), de los cuales 55 (11,4%) manifestó abandono de tratamiento. El 46,8% de los pacientes no cuentan con cobertura por obra social / prepaga o mutual. El 18,2% posee certificado de discapacidad. El 47,8% de los pacientes requieren entre 1 a 2 horas de traslado para su atención, y el 27,3% más de 2 horas, a lo que se debe sumar los tiempos de espera en las instituciones. Del análisis de las variables seleccionadas se podría estimar que la edad, severidad de la lesión, número de convivientes en el domicilio y ausencia de certificado de discapacidad podrían ser utilizados como indicadores de posible abandono en el tratamiento.


Cleft lip palate is a congenital anomaly consisting of a crack or separation in the upper lip. It is often accompanied by cleft palate. The aims of the study it is to analyze the complexity and degree of rehabilitation adhesion, by abandonment analysis, of the FLAP patient who attends institutions or services belonging to the network of services / institutions in Argentina. A total of 749 patients were contacted those with more than 200 days of absenteeism to the service in a total of 162 (21,6%), of which 55 (11,4%) said abandonment of treatment. 46,8% of patients do not have coverage for work social/insurance/mutual. 18,2% possesses a certificate of disability. 47,8% of patients require between 1-2 hours of transfer for your attention, and 27,3% more than 2 hours, what to add the waiting time at the institutions. Analysis of selected variables you could estimate that the age, severity of injury, number of cohabitants in the domicile and absence of disability certificate could be used as indicators of possible abandonment in the treatment.


Asunto(s)
Humanos , Labio Leporino/terapia , Labio Leporino/epidemiología , Fisura del Paladar/terapia , Fisura del Paladar/epidemiología , Cooperación del Paciente , Epidemiología Descriptiva , Negativa al Tratamiento , Anomalías Maxilomandibulares/genética , Anomalías Maxilomandibulares/epidemiología
11.
J Rheumatol ; 41(6): 1049-60, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24737913

RESUMEN

OBJECTIVE: To perform a systematic review of the benefits and harms of folic acid and folinic acid in reducing the mucosal, gastrointestinal, hepatic, and hematologic side effects of methotrexate (MTX); and to assess whether folic or folinic acid supplementation has any effect on MTX benefit. METHODS: We searched the Cochrane Library, MEDLINE, EMBASE, and US National Institutes of Health clinical trials registry from inception to March 2012. We selected all double-blind, randomized, placebo-controlled clinical trials in which adult patients with rheumatoid arthritis (RA) were treated with MTX (dose ≤ 25 mg/week) concurrently with folate supplementation. We included only trials using low-dose folic or folinic acid (a starting dose of ≤ 7 mg weekly) because the high dose is no longer recommended or used. Data were extracted from the trials, and the trials were independently assessed for risk of bias using a predetermined set of criteria. RESULTS: Six trials with 624 patients were eligible for inclusion. Most studies had low or unclear risk of bias for key domains. The quality of the evidence was rated as "moderate" for each outcome as assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group, with the exception of hematologic side effects, which were rated as "low." There was no significant heterogeneity between trials, including where folic acid and folinic acid studies were pooled. For patients supplemented with any form of exogenous folate (either folic or folinic acid) while receiving MTX therapy for RA, a 26% relative (9% absolute) risk reduction was seen for the incidence of gastrointestinal side effects such as nausea, vomiting, or abdominal pain (RR 0.74, 95% CI 0.59 to 0.92; p = 0.008). Folic and folinic acid also appear to be protective against abnormal serum transaminase elevation caused by MTX, with a 76.9% relative (16% absolute) risk reduction (RR 0.23, 95% CI 0.15 to 0.34; p < 0.00001), as well as reducing patient withdrawal from MTX for any reason [60.8% relative (15.2% absolute) risk reduction, RR 0.39, 95% CI 0.28 to 0.53; p < 0.00001]. CONCLUSION: The results support a protective effect of supplementation with either folic or folinic acid for patients with RA during treatment with MTX. There was a clinically important significant reduction shown in the incidence of GI side effects and hepatic dysfunction (as measured by elevated serum transaminase levels), as well as a clinically important significant reduction in discontinuation of MTX treatment for any reason.


Asunto(s)
Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Ácido Fólico/uso terapéutico , Leucovorina/uso terapéutico , Metotrexato/efectos adversos , Adulto , Antirreumáticos/uso terapéutico , Femenino , Ácido Fólico/efectos adversos , Humanos , Leucovorina/efectos adversos , Masculino , Metotrexato/uso terapéutico
12.
Cochrane Database Syst Rev ; (5): CD000951, 2013 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-23728635

RESUMEN

BACKGROUND: Methotrexate (MTX) is a disease modifying antirheumatic drug (DMARD) used as a first line agent for treating rheumatoid arthritis (RA). Pharmacologically, it is classified as an antimetabolite due to its antagonistic effect on folic acid metabolism. Many patients treated with MTX experience mucosal, gastrointestinal, hepatic or haematologic side effects. Supplementation with folic or folinic acid during treatment with MTX may ameliorate these side effects. OBJECTIVES: To identify trials of supplementation with folic acid or folinic acid during MTX therapy for rheumatoid arthritis and to assess the benefits and harms of folic acid and folinic acid (a) in reducing the mucosal, gastrointestinal (GI), hepatic and haematologic side effects of MTX, and (b) whether or not folic or folinic acid supplementation has any effect on MTX benefit. SEARCH METHODS: We originally performed MEDLINE searches, from January 1966 to June 1999. During the update of this review, we searched additional databases and used a sensitive search strategy designed to retrieve all trials on folic acid or folinic acid for rheumatoid arthritis from 1999 up to 2 March 2012. SELECTION CRITERIA: We selected all double-blind, randomised, placebo-controlled clinical trials (RCTs) in which adult patients with rheumatoid arthritis were treated with MTX (at a dose equal to or less than 25 mg/week) concurrently with folate supplementation. In this update of the review we only included trials using 'low dose' folic or folinic acid (a starting dose of ≤ 7 mg weekly). DATA COLLECTION AND ANALYSIS: Data were extracted from the trials, and the trials were independently assessed for risk of bias using a predetermined set of criteria. MAIN RESULTS: Six trials with 624 patients were eligible for inclusion. Most studies had low or unclear risk of bias for key domains. The quality of the evidence was rated as 'moderate' for each outcome as assessed by GRADE, with the exception of haematologic side effects which were rated as 'low'. There was no significant heterogeneity between trials, including where folic acid and folinic acid studies were pooled.For patients supplemented with any form of exogenous folate (either folic or folinic acid) whilst on MTX therapy for rheumatoid arthritis, a 26% relative (9% absolute) risk reduction was seen for the incidence of GI side effects such as nausea, vomiting or abdominal pain (RR 0.74, 95% CI 0.59 to 0.92; P = 0.008). Folic and folinic acid also appear to be protective against abnormal serum transaminase elevation caused by MTX, with a 76.9% relative (16% absolute) risk reduction (RR 0.23, 95% CI 0.15 to 0.34; P < 0.00001), as well as reducing patient withdrawal from MTX for any reason (60.8% relative (15.2% absolute) risk reduction, RR 0.39, 95% CI 0.28 to 0.53; P < 0.00001).We analysed the effect of folic or folinic acid on the incidence of stomatitis / mouth sores, and whilst showing a trend towards reduction in risk, the results were not statistically significant (RR 0.72, 95% CI 0.49 to 1.06)It was not possible to draw meaningful conclusions on the effect of folic or folinic acid on haematologic side effects of methotrexate due to small numbers of events and poor reporting of this outcome in included trials.It does not appear that supplementation with either folic or folinic acid has a statistically significant effect on the efficacy of MTX in treating RA (as measured by RA disease activity parameters such as tender and swollen joint counts, or physician's global assessment scores). AUTHORS' CONCLUSIONS: The results support a protective effect of supplementation with either folic or folinic acid for patients with rheumatoid arthritis during treatment with MTX.There was a significant reduction shown in the incidence of GI side effects, hepatic dysfunction (asmeasured by elevated serum transaminase levels) as well as a significant reduction in discontinuation of MTX treatment for any reason. A trend towards a reduction in stomatitis was demonstrated however this did not reach statistical significance.This updated review with its focus on lower doses of folic acid and folinic acid and updated assessment of risk of bias aimed to give a more precise and more clinically relevant estimate of the benefit of folate supplementation for patients with rheumatoid arthritis receiving methotrexate.


Asunto(s)
Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Antagonistas del Ácido Fólico/efectos adversos , Ácido Fólico/uso terapéutico , Leucovorina/uso terapéutico , Metotrexato/efectos adversos , Dolor Abdominal/inducido químicamente , Dolor Abdominal/prevención & control , Adulto , Antirreumáticos/uso terapéutico , Ácido Fólico/administración & dosificación , Antagonistas del Ácido Fólico/uso terapéutico , Enfermedades Gastrointestinales/inducido químicamente , Enfermedades Gastrointestinales/prevención & control , Enfermedades Hematológicas/inducido químicamente , Enfermedades Hematológicas/prevención & control , Humanos , Leucovorina/administración & dosificación , Metotrexato/uso terapéutico , Náusea/inducido químicamente , Náusea/prevención & control , Vómitos/inducido químicamente , Vómitos/prevención & control
13.
PLoS One ; 8(1): e54056, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23349785

RESUMEN

BACKGROUND: Limited knowledge on the prevalence and distribution of risk factors impairs the planning and implementation of cardiovascular prevention programs in the Latin American and Caribbean (LAC) region. METHODS AND FINDINGS: Prevalence of hypertension, diabetes mellitus, abnormal lipoprotein levels, obesity, and smoking were estimated from individual-level patient data pooled from population-based surveys (1998-2007, n=31,009) from eight LAC countries and from a national survey of the United States (US) population (1999-2004) Age and gender specific prevalence were estimated and age-gender adjusted comparisons between both populations were conducted. Prevalence of diabetes mellitus, hypertension, and low high-density lipoprotein (HDL)-cholesterol in LAC were 5% (95% confidence interval [95% CI]: 3.4, 7.9), 20.2% (95% CI: 12.5, 31), and 53.3% (95% CI: 47, 63.4), respectively. Compared to LAC region's average, the prevalence of each risk factor tended to be lower in Peru and higher in Chile. LAC women had higher prevalence of obesity and low HDL-cholesterol than men. Obesity, hypercholesterolemia, and hypertriglyceridemia were more prevalent in the US population than in LAC population (31 vs. 16.1%, 16.8 vs. 8.9%, and 36.2 vs. 26.5%, respectively). However, the prevalence of low HDL-cholesterol was higher in LAC than in the US (53.3 vs. 33.7%). CONCLUSIONS: Major cardiovascular risk factors are highly prevalent in LAC region, in particular low HDL-cholesterol. In addition, marked differences do exist in this prevalence profile between LAC and the US. The observed patterns of obesity-related risk factors and their current and future impact on the burden of cardiovascular diseases remain to be explained.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Obesidad/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Enfermedades Cardiovasculares/sangre , Chile/epidemiología , Colesterol/sangre , HDL-Colesterol/sangre , Colombia/epidemiología , Costa Rica/epidemiología , República Dominicana/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Obesidad/sangre , Perú/epidemiología , Prevalencia , Puerto Rico/epidemiología , Factores de Riesgo , Triglicéridos/sangre , Estados Unidos/epidemiología , Venezuela/epidemiología , Adulto Joven
14.
Rev. panam. salud pública ; 30(5): 445-452, nov. 2011. ilus, tab
Artículo en Inglés | LILACS | ID: lil-610071

RESUMEN

OBJECTIVE: To review and analyze the regulatory framework of clinical trial registration, use of existing tools (publicly accessible national/international registration databases), and users' perspectives to identify possible barriers to registration compliance by sponsors and researchers in Argentina. METHODS: Internationally registered trials recruiting patients in Argentina were found through clincialtrials.gov and the International Clinical Trial Registration Platform (ICTRP) and compared with publically available clinical trials registered through the National Administration of Drugs, Foods, and Medical Devices (ANMAT). A questionnaire addressing hypothesized attitudinal, knowledge-related, idiomatic, technical, economic, and regulatory barriers that could discourage or impede registration of clinical trials was developed, and semi-structured, in-depth interviews were conducted with a purposively selected sample of researchers (investigators, sponsors, and monitors) in Argentina. RESULTS: A response rate of 74.3 percent (n = 29) was achieved, and 27 interviews were ultimately used for analysis. Results suggested that the high proportion of foreign-sponsored or multinational trials (64.8 percent of all protocols approved by ANMAT from 1994-2006) may contribute to a communication gap between locally based investigators and foreign-based administrative officials. A lack of knowledge about available international registration tools and limited awareness of the importance of registration were also identified as limiting factors for local investigators and sponsors. CONCLUSIONS: To increase compliance and promote clinical trial registration in Argentina, national health authorities, sponsors, and local investigators could take the following steps: implement a grassroots educational campaign to improve clinical trial regulation, support local investigator-sponsor-initiated clinical trials, and/or encourage local and regional scientific...


OBJETIVO: Examinar y analizar el marco normativo del registro de ensayos clínicos, el uso de los instrumentos existentes (bases de datos de registro nacionales o internacionales de acceso público), y las perspectivas de los investigadores para determinar posibles obstßculos al cumplimiento del registro por los patrocinadores y los investigadores en la Argentina. MÉTODOS: Se realizó una búsqueda en el sitio web clinicaltrials.gov y en la Plataforma Internacional de Registro de Ensayos Clínicos (ICTRP) de los ensayos clínicos registrados en el ßmbito internacional que reclutan pacientes en la Argentina y los resultados se compararon con los ensayos clínicos incluidos en el registro de acceso público de la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT). Se elaboró un cuestionario que abordaba los hipotéticos obstßculos relacionados con la actitud hacia el registro y el conocimiento de este, así como obstßculos idiomßticos, técnicos y económicos que podrían desalentar o dificultar el registro de los ensayos clínicos, y se llevaron a cabo entrevistas semiestructuradas exhaustivas en una muestra de investigadores seleccionada para este fin (investigadores clínicos, patrocinadores y monitores) en la Argentina. RESULTADOS: Se obtuvo una tasa de respuesta de 74,3 por ciento (n = 29) y finalmente se analizaron 27 entrevistas. Los resultados sugieren que la proporción elevada de ensayos clínicos con patrocinadores extranjeros o los ensayos multinacionales (64,8 por ciento de los protocolos aprobados por la ANMAT entre 1994 y el 2006) pueden contribuir a una deficiencia de comunicación entre los investigadores locales y los funcionarios administrativos ubicados en el extranjero. También se identificaron como factores limitantes para los investigadores y los patrocinadores locales la falta de conocimiento de los recursos internacionales disponibles para el registro y el escaso reconocimiento de la importancia del registro...


Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos como Asunto/legislación & jurisprudencia , Investigadores/psicología , Argentina , Barreras de Comunicación , Ensayos Clínicos como Asunto/métodos , Recolección de Datos , Políticas Editoriales , Adhesión a Directriz , Cooperación Internacional , Internacionalidad , Internet , Entrevistas como Asunto , Conocimiento , Selección de Paciente , Sesgo de Publicación , Publicaciones Periódicas como Asunto/normas , Edición/normas , Sistema de Registros/normas , Encuestas y Cuestionarios
15.
Bol. Acad. Nac. Med. B.Aires ; 89(1): 107-119, ene.-jun. 2011.
Artículo en Español | LILACS | ID: lil-646721

RESUMEN

La Organización Panamericana de la Salud (OPS) solicitó, entre enero y marzo de 2011, al Instituto de Investigaciones Epidemiológicas (lE) un reporte que pretendió responder, de manera informada, a tres preguntas relacionadas con las políticas públicas y el acceso al Agua Potable, Higiene y Saneamiento (AHS) en América Latina y El Caribe (ALC). Objetivo: Identificar las políticas de AHS que contribuyen a cumplir con los Derechos Humanos, garantizan un acceso equitativo e influencian sobre la salud. Metodología: Se formularon criterios de elegibilidad e inclusión y se realizó una búsqueda con las recomendaciones de la Colaboración Cochrane. A partir de la revisión y síntesis de la literatura, se elaboró un reporte. Resultados: Se recuperaron 3675 citas, de las cuales 69 fueron consideradas. Pocos países de ALC reconocen el derecho al agua en sus Constituciones. Éste es el primer paso para garantizar el cumplimiento, lo que debe complementarse con políticas de AHS con enfoque de derechos. Las situaciones de inequidad en el acceso evidencian la necesidad de este enfoque y de experimentar maneras articuladas de aproximarse a la problemática. El acceso adecuado al AHS tiene variados beneficios, que transcienden al ámbito de la salud. Conclusión: Aún cuando es un tema complejo y se solicitó una respuesta rápida, esta experiencia mostró que es posible elaborar un reporte basado en evidencia accesible a los responsables de las políticas de AHS que dé respuesta a los interrogantes planteados.


The Pan American Health Organization (PAHO) requested, between January and March of 2011, to the Epidemiological Research Institute (l/E) a report to answer, in an informed way, three questions related with public policy and access to water, hygiene and sanitation (WHS) in Latin America and The Caribbean (LAC). Objective: Recognize policies in WHS that contribute to the fulfillment of Human Rights, ensure equitable access and influence health. Methodology: Eligibility and inclusion criteria were defined, and a search was made according to the recommendations of the Cochrane Collaboration. A report was made with the review and synthesis of the literature. Results: 3675 citations were retrieved, from which 69 were considered. Few counties in LAC recognized the right to water in their Constitutions. This is the first step to ensure its fulfillment, and must be supplemented with policies in WHS with rights approach. The inequality in access shows the need of this approach and to experience articulated ways to manage this issue. Proper access to WHS has many benefits, beyond health sector. Conclusion: Even though the topic is complex and time given short, the experience shows that it is feasible to prepare a report based in evidence, accessible to policy makers in WHS, which gives answer to the three questions submitted.


Asunto(s)
Saneamiento Básico , Higiene , Impactos en la Salud , Política Pública , Distribución de Agua , Región del Caribe , Equidad en el Acceso al Agua , Derechos Humanos , Inequidad Social/políticas , América Latina , Informe de Investigación
16.
Rev Panam Salud Publica ; 30(5): 445-52, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22262271

RESUMEN

OBJECTIVE: To review and analyze the regulatory framework of clinical trial registration, use of existing tools (publicly accessible national/international registration databases), and users' perspectives to identify possible barriers to registration compliance by sponsors and researchers in Argentina. METHODS: Internationally registered trials recruiting patients in Argentina were found through clincialtrials.gov and the International Clinical Trial Registration Platform (ICTRP) and compared with publically available clinical trials registered through the National Administration of Drugs, Foods, and Medical Devices (ANMAT). A questionnaire addressing hypothesized attitudinal, knowledge-related, idiomatic, technical, economic, and regulatory barriers that could discourage or impede registration of clinical trials was developed, and semi-structured, in-depth interviews were conducted with a purposively selected sample of researchers (investigators, sponsors, and monitors) in Argentina. RESULTS: A response rate of 74.3% (n = 29) was achieved, and 27 interviews were ultimately used for analysis. Results suggested that the high proportion of foreign-sponsored or multinational trials (64.8% of all protocols approved by ANMAT from 1994-2006) may contribute to a communication gap between locally based investigators and foreign-based administrative officials. A lack of knowledge about available international registration tools and limited awareness of the importance of registration were also identified as limiting factors for local investigators and sponsors. CONCLUSIONS: To increase compliance and promote clinical trial registration in Argentina, national health authorities, sponsors, and local investigators could take the following steps: implement a grassroots educational campaign to improve clinical trial regulation, support local investigator-sponsor-initiated clinical trials, and/or encourage local and regional scientific journal compliance with standards from the International Committee of Medical Journal Editors (ICMJE) and/or the World Association of Medical Editors (WAME).


Asunto(s)
Ensayos Clínicos como Asunto/legislación & jurisprudencia , Investigadores/psicología , Adulto , Argentina , Ensayos Clínicos como Asunto/métodos , Barreras de Comunicación , Recolección de Datos , Políticas Editoriales , Femenino , Adhesión a Directriz , Humanos , Cooperación Internacional , Internacionalidad , Internet , Entrevistas como Asunto , Conocimiento , Masculino , Persona de Mediana Edad , Selección de Paciente , Publicaciones Periódicas como Asunto/normas , Sesgo de Publicación , Edición/normas , Sistema de Registros/normas , Encuestas y Cuestionarios
18.
Bol. Acad. Nac. Med. B.Aires ; 88(1): 97-107, ene.-jun. 2010. graf
Artículo en Español | LILACS | ID: lil-606178

RESUMEN

Los reportes rápidos basados en la evidencia constituyen una de las estrategias para la reducción de la brecha del conocimiento a la acción. Objetivo: comunicar los resultados y lecciones aprendidas a partir de la elaboración de un reporte rápido sobre la efectividad y seguridad del uso de vacunas y antivirales para la influenza pandémica en embarazadas. Métodos: revisión sistemática sobre efectividad y seguridad del uso de antivirales y vacunas para influenza tipo A (H1N1) en embarazadas. Resultados: se recuperaron 166 citas: aunque sólo 88 cumplieron los criterios de inclusión. Los reportes epidemiológicos de la afectación de la pandemia señalan un riesgo de hospitalización tres a cinco veces más alto en embarazadas en comparación con la población general. Dos revisiones recientes indican que el oseltaminivir no estaría asociado con un mayor riesgo teratogénico. La evidencia sobre el zanamivir es escasa, absorción sistémica. A noviembre de 2009, la evidencia sobre la efectividad y seguridad de la vacuna para influenza A (H1N1) en embarazadas era escasa (dos ensayos en curso). Conclusión: los reportes rápidos constituyen una estrategia eficiente para el intercambio de conocimiento entre investigadores y decisores, aún en el contexto de una pandemia; sin embargo, es necesario encontrar métodos que permitan optimizar su implementación de manera sistemática y transparente.


Evidence-based rapid reviews constitute one of the knowledge to action GAP reduction strategies. Objective: to communicate the results and learned lessons during the elaboration of an evidence-based rapid review about the effectiveness and safety of vaccines and antivirals for influenza pandemic in pregnant women. Methods: all document containing evidence on adverse events and / or vaccines for influenza type A (H1N1) in pregnant women or that describes the evolution of the pandemic in this population was considered for analysis. Results: 166 articles were retrieved, although only 88 accomplished the inclusion criteria. Epidemiological reports of the pandemic situation indicate three to five times higher risk of hospitalization in pregnant women compared with the general population. Two recent reviews indicate that oseltamivir would not be associated with increased teratogenic risk. The evidence on the zanamivir is scarce, but the risk associated with its use is considered low because of its reduced systemic absortion. Through november 2009, evidence on effectiveness and safety of the H1N1 vaccine in pregnant women was scarce (two on-going clinical trials). Conclusion: evidence-based rapid reviews constitute an efficient strategy for researchers and decision-makers knowledge exchange, even in the context of a pandemic. However, methods that optimize its implementation through a systematic and transparent way are needed.


Asunto(s)
Humanos , Femenino , Embarazo , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Gripe Humana/terapia , Subtipo H1N1 del Virus de la Influenza A , Oseltamivir/farmacología , Pandemias , Complicaciones Infecciosas del Embarazo , Vacunas contra la Influenza/uso terapéutico , Zanamivir/farmacología
19.
Rev. argent. salud publica ; 1(1): 6-11, dic. 2009. tab
Artículo en Español | LILACS | ID: lil-644301

RESUMEN

La seguridad del paciente es un problema grave de salud pública en todo el mundo. El análisis causal con un enfoque sistemático y participativo es una herramienta útil para mejorar la seguridad. OBJETIVOS: Aplicar un análisis causa raíz (ACR) y proponer acciones para corregir estas causas y/o minimizar el riesgo de ocurrencia de eventos similares. MÉTODOS: Análisis Causa Raíz de un evento centinela ocurrido en Unidad de Cuidados Intensivos Neonatales del Hospital Penna de Bahía Blanca, Argentina, en las siguientes etapas: 1) Identificación y selección del evento; 2) Recopilación de la información y descripción del evento; 3) Construcción del mapa de los hechos; 4) Análisis de los factores contribuyentes y estudio de las barreras (físicas, administrativas, organizacionales) que pueden prevenir daños, 5) Desarrollo de soluciones y plan de acción. RESULTADOS: Se seleccionó un brote intra-hospitalario por Staphylococcus aureus meticilino resistente, calificado como catastrófico(muerte de un neonato y de frecuencia ocasional). Con el análisis causal se identificaron los factores humanos proximales y las fallas latentes del sistema relacionadas con aspectos de la organización, la gestión de la información, el manejo del contexto y la cultura corporativa. Como principales barreras de contención se reconocieron la adecuada comunicación entre los profesionales de la salud y la sistematización de los procesos relacionados con la adherencia del personal a las normas de bioseguridad. Luego se diseñó un plan de acción destinado a fortalecer estas barreras. CONCLUSIONES: El ACR es un método factible de implementar para el equipo de salud. Su uso permitiría mejorar la seguridad de los pacientes a través de la identificación y corrección de las fallas latentes del sistema


Patient safety is a serious global public health issue.The causal analysis with a systematic and participatory approachis a useful tool for improving safety. OBJECTIVE: to perform the causal analysis of a sentinel event in order to identify improvement opportunities, propose actions aimed at increasing patient safety and promote a collaborative approach by the health team. METHODS: Root Cause Analysis (RCA) of a sentinel event occurred in the Neonatal Intensive Care Unit of Hospital Penna de Bahía Blanca, Argentina, which included the following steps: 1)identification and selection of the event; 2) information collection and description of the event; 3) construction on the map of the facts; 4) analysis of contributing factors and study of the barriers(physical, administrative, organizational) that may prevent damage, 5) Developing solutions and action plan. RESULTS: an intrahospital methicillin-resistant Staphylococcus aureus out break that affected six new borns and caused one death was selected. The causal analysis permitted the identification of proximal human factors as well as latent system failures associated with organizational factors and factors related to information management, context management and corporative culture. Appropriate communication between health professionals and systematization of processes aimed at guarantying personal adherence to bio-security norms were identified as the main barriers. Interventions oriented to strengthen these barriers were proposed. CONCLUSIONS: ACR is a feasible method to be implemented by the health team. Its use permitted patient safety improvement through the identification and correction of the latent failures of the system


Asunto(s)
Humanos , Recién Nacido , Recolección de Datos , Infección Hospitalaria/prevención & control , Registros Médicos , Prevención Primaria/organización & administración , Staphylococcus aureus
20.
Ciudad Autónoma de Buenos Aires; Ministerio de Salud de la Nación; Octubre 2009. 89 p. ilus.
Monografía en Español | BINACIS, ARGMSAL | ID: biblio-1052969

RESUMEN

El dengue es la principal enfermedad viral transmitida por artrópodos en el mundo. Puede tener signos y síntomas leves pero también puede ser grave y hasta causar la muerte. Cualquier persona puede enfermarse,independientemente de su edad, sexo,raza o clase social.El propósito fundamental de esta guía es ofrecer herramientas conceptuales y prácticas, que ayuden a promoverla participación y la movilización social en las comunidades para: • Prevenir la transmisión del dengue a través del control del mosquito; • Reducir la intensidad de la transmisión durante las epidemias; • Reducir las múltiples infecciones del dengue, disminuyendo de esta manera el riesgo de adquirir formas graves de dengue; • Mejorar la salud ambiental.


Asunto(s)
Aedes , Dengue/prevención & control , Dengue/tratamiento farmacológico
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