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2.
Nature ; 577(7790): 318, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31937966
7.
Medicine (Baltimore) ; 99(1): e18611, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895812

RESUMEN

BACKGROUND: This systematic review protocol aims to examine the evidence of effectiveness and cost-effectiveness of interventions for children and adolescents with, or at risk of developing mental disorders in low- and middle-income countries (LAMICs). METHODS: We will search Medline Ovid, EMBASE Ovid, PsycINFO Ovid, CINAHL, LILACS, BDENF and IBECS. We will include randomised and non-randomised controlled trials, economic modelling studies and economic evaluations. Participants are 6 to 18 year-old children and adolescents who live in a LAMIC and who present with, or are at high risk of developing, one or more of the conditions: depression, anxiety, behavioural disorders, eating disorders, psychosis, substance abuse, autism and intellectual disabilities as defined by the DSM-V. Interventions which address suicide, self-harm will also be included, if identified during the extraction process. We will include in person or e-health interventions which have some evidence of effectiveness (in relation to clinical and/or functional outcomes) and which have been delivered to young people in LAMICs. We will consider a wide range of delivery channels (e.g., in person, web-based or virtual, phone), different practitioners (healthcare practitioners, teachers, lay health care providers) and sectors (i.e., primary, secondary and tertiary health care, education, guardianship councils). In the pilot of screening procedures, 5% of all references will be screened by two reviewers. Divergences will be resolved by one expert in mental health research. Reviewers will be retrained afterwards to ensure reliability. The remaining 95% will be screened by one reviewer. Covidence web-based tool will be used to perform screening of references and full text paper, and data extraction. RESULTS: The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. The results will be presented descriptively and, if possible, meta-analysis will be conducted. Ethical approval is not needed for anonymised secondary data. CONCLUSION: the systematic review could help health specialists and other professionals to identify evidence-based strategies to deal with child and adolescents with mental health conditions.


Asunto(s)
Países en Desarrollo , Trastornos del Neurodesarrollo/terapia , Niño , Humanos , Trastornos del Neurodesarrollo/economía , Revisiones Sistemáticas como Asunto
8.
Lancet ; 395(10220): 285-293, 2020 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-31982074

RESUMEN

BACKGROUND: Preterm birth remains a common cause of neonatal mortality, with a disproportionately high burden in low-income and middle-income countries. Meta-analyses of low-dose aspirin to prevent pre-eclampsia suggest that the incidence of preterm birth might also be decreased, particularly if initiated before 16 weeks of gestation. METHODS: ASPIRIN was a randomised, multicountry, double-masked, placebo-controlled trial of low-dose aspirin (81 mg daily) initiated between 6 weeks and 0 days of pregnancy, and 13 weeks and 6 days of pregnancy, in nulliparous women with an ultrasound confirming gestational age and a singleton viable pregnancy. Participants were enrolled at seven community sites in six countries (two sites in India and one site each in the Democratic Republic of the Congo, Guatemala, Kenya, Pakistan, and Zambia). Participants were randomly assigned (1:1, stratified by site) to receive aspirin or placebo tablets of identical appearance, via a sequence generated centrally by the data coordinating centre at Research Triangle Institute International (Research Triangle Park, NC, USA). Treatment was masked to research staff, health providers, and patients, and continued until 36 weeks and 7 days of gestation or delivery. The primary outcome of incidence of preterm birth, defined as the number of deliveries before 37 weeks' gestational age, was analysed in randomly assigned women with pregnancy outcomes at or after 20 weeks, according to a modified intention-to-treat (mITT) protocol. Analyses of our binary primary outcome involved a Cochran-Mantel-Haenszel test stratified by site, and generalised linear models to obtain relative risk (RR) estimates and associated confidence intervals. Serious adverse events were assessed in all women who received at least one dose of drug or placebo. This study is registered with ClinicalTrials.gov, NCT02409680, and the Clinical Trial Registry-India, CTRI/2016/05/006970. FINDINGS: From March 23, 2016 to June 30, 2018, 14 361 women were screened for inclusion and 11 976 women aged 14-40 years were randomly assigned to receive low-dose aspirin (5990 women) or placebo (5986 women). 5780 women in the aspirin group and 5764 in the placebo group were evaluable for the primary outcome. Preterm birth before 37 weeks occurred in 668 (11·6%) of the women who took aspirin and 754 (13·1%) of those who took placebo (RR 0·89 [95% CI 0·81 to 0·98], p=0·012). In women taking aspirin, we also observed significant reductions in perinatal mortality (0·86 [0·73-1·00], p=0·048), fetal loss (infant death after 16 weeks' gestation and before 7 days post partum; 0·86 [0·74-1·00], p=0·039), early preterm delivery (<34 weeks; 0·75 [0·61-0·93], p=0·039), and the incidence of women who delivered before 34 weeks with hypertensive disorders of pregnancy (0·38 [0·17-0·85], p=0·015). Other adverse maternal and neonatal events were similar between the two groups. INTERPRETATION: In populations of nulliparous women with singleton pregnancies from low-income and middle-income countries, low-dose aspirin initiated between 6 weeks and 0 days of gestation and 13 weeks and 6 days of gestation resulted in a reduced incidence of preterm delivery before 37 weeks, and reduced perinatal mortality. FUNDING: Eunice Kennedy Shriver National Institute of Child Health and Human Development.


Asunto(s)
Aspirina/administración & dosificación , Preeclampsia/epidemiología , Nacimiento Prematuro/epidemiología , Adolescente , Adulto , Aspirina/efectos adversos , Presión Sanguínea , Parto Obstétrico/estadística & datos numéricos , Países en Desarrollo , Método Doble Ciego , Femenino , Humanos , Preeclampsia/prevención & control , Embarazo , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/prevención & control , Adulto Joven
9.
Plast Reconstr Surg ; 145(2): 471-481, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985644

RESUMEN

BACKGROUND: Hand surgeons can alleviate the burden associated with various congenital anomalies, burn sequelae, and trauma that debilitate individuals in low- and middle-income countries. Because few surgeons in these areas have the necessary resources to perform complex hand surgery, surgical trips provide essential surgical care. The authors aimed to determine the economic benefit of hand surgical trips to low- and middle-income countries to comprehensively determine the economic implications of hand surgery trips in low-resource settings. METHODS: The authors collected data from two major global hand surgery organizations to analyze the economic benefit of hand surgery trips in low- and middle-income countries. The authors used both the human capital approach and the value of a statistical life-year approach to conduct this cost-benefit analysis. To demonstrate the economic gain, the authors subtracted the budgeted cost of each trip from the economic benefit. RESULTS: The authors analyzed a total of 15 trips to low- and middle-income countries. The costs of the trips ranged from $3453 to $87,434 (average, $24,869). The total cost for all the surgical trips was $373,040. The authors calculated a net economic benefit of $3,576,845 using the human capital approach and $8,650,745 using the value of a statistical life-year approach. CONCLUSIONS: The authors found a substantial return on investment using both the human capital approach and the value of a statistical life-year approach. In addition, the authors found that trips emphasizing education had a net economic benefit. Cost-benefit analyses have substantial financial implications and will aid policy makers in developing cost-reduction strategies to promote surgery in low- and middle-income countries.


Asunto(s)
Países en Desarrollo/economía , Deformidades Congénitas de la Mano/economía , Traumatismos de la Mano/economía , Mano/cirugía , Adolescente , Adulto , Anciano , Niño , Preescolar , Análisis Costo-Beneficio , Prestación de Atención de Salud/economía , Femenino , Deformidades Congénitas de la Mano/cirugía , Traumatismos de la Mano/cirugía , Humanos , Masculino , Turismo Médico/economía , Área sin Atención Médica , Persona de Mediana Edad , Embarazo , Años de Vida Ajustados por Calidad de Vida , Estudios Retrospectivos , Viaje/economía , Viaje/estadística & datos numéricos , Adulto Joven
12.
Waste Manag Res ; 38(2): 173-183, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31752628

RESUMEN

e-Waste is generated at the staggering rate of 6.1 kg per person. In 2016, 44.7 million tonnes was generated globally, and the amount is estimated to reach 52 million tonnes annually by 2021. The management of this huge quantity of e-waste is a major problem across the world, primarily in developing countries. An effective e-waste management system is linked to the sustainability of e-waste processing plants, and currently it is plagued with different supply chain network (SCN) issues. To address the issues and challenges of SCN, there is a need to prioritize and address the constructs. The study thus combines two multiple criteria decision making (MCDM) tools, the analytical hierarchy process (AHP) and quality function deployment, to prioritize the constructs identified from literature and supported by field studies. The house of quality (HOQ) has been used for analyzing different stakeholders' requirements. The degree of importance for HOQ-1 has been derived using the AHP tool. The study revealed the most intriguing issues and challenges of e-waste processing plants considering the requirements of different stakeholders. The results showed formal collection, storage, semi-informal collection, and e-waste quality to be the major issues of processing plants. The findings obtained from MCDM analysis have been validated though two case studies in India and China. If the results obtained are applied to the existing e-waste SCN, a holistic e-waste management system can be achieved for developing countries.


Asunto(s)
Residuos Electrónicos , Administración de Residuos , China , Países en Desarrollo , India
13.
Bioresour Technol ; 297: 122364, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31732416

RESUMEN

Sugarcane scum (SCS) is a waste from the non-centrifugal cane sugar making process. Due to its physicochemical characteristics, it has a high-energy potential to produce biomethane via anaerobic digestion (AD). However, (i) the total solids concentration in the SCS exceeds the limit for wet digestion and (ii) the SCS has a low pH. The aim of this research was to evaluate the utilization capacity of the SCS for methane production through a biochemical methane potential test and extent of disintegration, using dilution pretreatment. The highest methane yield, 0.227 N m3 CH4 kg-1 VS, was achieved at a 12.5% SCS dilution, with an organic matter removal greater than 70% and an extent of disintegration of 34.5%. This is evidence that the AD process is a feasible alternative for SCS treatment.


Asunto(s)
Biocombustibles , Saccharum , Anaerobiosis , Reactores Biológicos , Bastones , Países en Desarrollo , Metano , Azúcares
14.
Br J Anaesth ; 124(2): 206-213, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31839255

RESUMEN

BACKGROUND: Short educational programmes are important in building global anaesthesia workforce capacity. The Vital Anaesthesia Simulation Training (VAST) course is a 3-day immersive simulation-based programme concentrating on core clinical challenges and non-technical skills required by anaesthesia providers in low-resource settings. METHODS: This mixed methods study prospectively evaluated the impact of VAST in Rwanda. Anaesthetists' Non-Technical Skills (ANTS) scores were quantitatively assessed for 30 course participants at three time points (pre-, post-, and 4 months after VAST). Qualitative data were gathered during focus groups (4 months after VAST) to learn of participants' experiences implementing new knowledge into clinical practice. RESULTS: The ANTS total scores improved from pre- (11.0 [2.3]) (mean [standard deviation]) to post-test (14.0 [1.6]), and improvements were maintained at retention (14.2 [1.7]). A similar pattern was observed when data were analysed using the four ANTS categories (all P<0.001). The key theme that emerged during focus group discussions was that the use of cognitive aids and clinical algorithms, repeated and reinforced across simulated scenarios, encouraged a systematic approach to patient care. The participants attributed the systematic approach to improving their problem-solving skills and confidence, particularly during emergencies. They found value in well-functioning teams and shared decision-making. After VAST, the participants described empowerment to advocate for better patient care and system improvement. CONCLUSIONS: VAST offers a simulation-based training to anaesthesia providers working in low-resource settings. Skills retention and self-reported application of learning into the workplace reflect the scope of impact of this training.


Asunto(s)
Anestesiología/educación , Competencia Clínica/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/métodos , Entrenamiento Simulado/métodos , Anestesistas , Países en Desarrollo , Estudios de Seguimiento , Humanos , Estudios Prospectivos , Rwanda
15.
Lancet Psychiatry ; 7(1): 78-92, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31474568

RESUMEN

Integration of services into primary health care for people with common mental disorders is considered a key strategy to improve access to mental health care in low-income and middle-income countries, yet services at the primary care level are largely unavailable. We did a systematic review to understand the barriers and facilitators in the implementation of mental health programmes. We searched five databases and included studies published between Jan 1, 1990, and Sept 1, 2017, that used qualitative methods to assess the implementation of programmes for adults with common mental disorders at primary health-care settings in low-income and middle-income countries. The Critical Appraisal Skills Programme Qualitative Checklist was used to assess the quality of eligible papers. We used the so-called best fit framework approach to synthesise findings according to the Consolidated Framework for Implementation Research. We identified 24 papers for inclusion. These papers described the implementation of nine programmes in 11 countries. Key factors included: the extent to which an organisation is ready for implementation; the attributes, knowledge, and beliefs of providers; complex service user needs; adaptability and perceived advantage of interventions; and the processes of planning and evaluating the implementation. Evidence on implementation of mental health programmes in low-income and middle-income countries is scarce. Synthesising results according to the Consolidated Framework for Implementation Research helped to identify key areas for future action, including investment in primary health-care strengthening, capacity building for health providers, and increased support to address the social needs of service users.


Asunto(s)
Prestación Integrada de Atención de Salud , Planificación en Salud , Trastornos Mentales , Servicios de Salud Mental , Atención Primaria de Salud , Adulto , Países en Desarrollo , Accesibilidad a los Servicios de Salud , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Servicios de Salud Mental/economía , Servicios de Salud Mental/organización & administración , Pobreza
17.
Acta Trop ; 201: 105183, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31542372

RESUMEN

Leptospirosis is a zoonotic disease caused by the pathogenic helical spirochetes, Leptospira. Symptoms include sudden-onset fever, severe headaches, muscle pain, nausea and chills. Leptospirosis is endemic in developing countries such as Malaysia, India, Sri Lanka, and Brazil where thousands of cases are reported annually. The disease risk factors include the high population of reservoirs, environmental factors, recreational factors, and occupational factors. To end the endemicity of leptospirosis, these factors need to be tackled. The management of leptospirosis needs to be refined. Early diagnosis remains a challenge due to a lack of clinical suspicion among physicians, its non-specific symptoms and a limited availability of rapid point-of-care diagnostic tests. The purpose of this review is to provide insight into the status of leptospirosis in developing countries focusing on the risk factors and to propose methods for the improved management of the disease.


Asunto(s)
Leptospirosis/epidemiología , Animales , Brasil/epidemiología , Países en Desarrollo , Humanos , India/epidemiología , Leptospirosis/prevención & control , Malasia/epidemiología , Masculino , Sri Lanka/epidemiología , Zoonosis
18.
Int J Radiat Oncol Biol Phys ; 106(1): 67-72, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31622698

RESUMEN

PURPOSE: Patients with locally advanced and metastatic esophageal cancer are usually affected by cancer-related symptoms, which worsen their performance status and quality of life. The aim of this study was to determine the efficacy of short-course accelerated radiation therapy for symptomatic palliation in a low resourced setting where only a 2-dimensional radiation therapy (RT) technique was available. METHODS AND MATERIALS: A phase II trial based on Simon's 2-stage design was planned. A total dose of 12 Gy in 4 fractions, twice per day, over 2 days, ≥8 hours apart, using a 2-dimensional conventional RT technique was delivered with a Cobalt 60 unit (Equinox, Best Theratronics, Ottawa, Ontario). Symptoms were graded using the International Atomic Energy Agency scoring system. RESULTS: A total of 17 patients were treated (male/female = 10/7; median age, 50.0 years; range, 27-78 years; histology: 6 adenocarcinomas and 11 squamous cell carcinomas; tumor site: 4 gastresophageal junction and 13 esophagus). The most frequent baseline symptoms were dysphagia or regurgitation (100%), odynophagia (76%), and chest or back pain (53%). At 1 month after RT, all patients were alive with palliative response rates (complete plus partial) for dysphagia, regurgitation, odynophagia, and chest or back pain of 76%, 82%, 69%, and 56%, respectively. No patients presented acute ≥G3 toxicity. CONCLUSIONS: Short-course accelerated radiation therapy treatment, planned and delivered using a conventional 2-dimensional RT technique, was effective and well tolerated for the symptomatic palliation of locally advanced or metastatic esophageal cancer. This schedule may be useful for RT centers in developing countries to reduce treatment times, costs, and patient waiting times before treatment.


Asunto(s)
Adenocarcinoma/radioterapia , Carcinoma de Células Escamosas/radioterapia , Neoplasias Esofágicas/radioterapia , Cuidados Paliativos/métodos , Adulto , Anciano , Trastornos de Deglución/etiología , Países en Desarrollo , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Unión Esofagogástrica , Etiopía , Femenino , Humanos , Estado de Ejecución de Karnofsky , Reflujo Laringofaríngeo/etiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Hipofraccionamiento de la Dosis de Radiación
19.
J Surg Res ; 245: 587-592, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31499364

RESUMEN

BACKGROUND: Surgical disease increasingly contributes to global mortality and morbidity. The Lancet Commission on Global Surgery found that global cost-effectiveness data are lacking for a wide range of essential surgical procedures. This study helps to address this gap by defining the cost-effectiveness of exploratory laparotomies in a regional referral hospital in Uganda. MATERIALS AND METHODS: A time-and-motion analysis was utilized to calculate operating theater personnel costs per case. Ward personnel, administrative, medication, and supply costs were recorded and calculated using a microcosting approach. The cost in 2018 US Dollars (USD, $) per disability-adjusted life year (DALY) averted was calculated based on age-specific life expectancies for otherwise fatal cases. RESULTS: Data for 103 surgical patients requiring exploratory laparotomy at the Soroti Regional Referral Hospital were collected over 8 mo. The most common cause for laparotomy was small bowel obstruction (32% of total cases). The average cost per patient was $75.50. The postoperative mortality was 11.7%, and 7.8% of patients had complications. The average number of DALYs averted per patient was 18.51. The cost in USD per DALY averted was $4.08. CONCLUSIONS: This investigation provides evidence that exploratory laparotomy is cost-effective compared with other public health interventions. Relative cost-effectiveness includes a comparison with bed nets for malaria prevention ($6.48-22.04/DALY averted), tuberculosis, tetanus, measles, and polio vaccines ($12.96-25.93/DALY averted), and HIV treatment with multidrug antiretroviral therapy ($453.74-648.20/DALY averted). Given that the total burden of surgically treatable conditions in DALYs is more than that of malaria, tuberculosis, and HIV combined, our findings strengthen the argument for greater investment in primary surgical capacity in low- and middle-income countries.


Asunto(s)
Análisis Costo-Beneficio , Países en Desarrollo/economía , Laparotomía/economía , Centros de Atención Terciaria/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Países en Desarrollo/estadística & datos numéricos , Equipos y Suministros de Hospitales/economía , Femenino , Fuerza Laboral en Salud/economía , Fuerza Laboral en Salud/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Laparotomía/estadística & datos numéricos , Esperanza de Vida , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Años de Vida Ajustados por Calidad de Vida , Regionalización/economía , Centros de Atención Terciaria/estadística & datos numéricos , Uganda , Adulto Joven
20.
J Environ Manage ; 254: 109807, 2020 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-31733472

RESUMEN

This study explored willingness of households to adopt a greywater treatment and reuse system using the theory of planned behaviour in its original form and an extended model including personal norms. The study was conducted among 478 household heads in the central region of Ghana. The results indicate the original theory of planned behaviour (TPB) model explained about 54% of the variance in respondents' intentions to adopt this system and the extended model which includes personal norms explained 59% of the intentions. The extended model turned out to be the better model to predict willingness to adopt this household greywater and treatment system. The findings of this study shed more light on the role of personal norms in households' willingness to adopt a greywater treatment and reuse system and may inform interventions aimed at promoting such systems.


Asunto(s)
Países en Desarrollo , Teoría Psicológica , Composición Familiar , Ghana , Intención , Encuestas y Cuestionarios
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