Politics and political determinants of health policy and systems research funding in Latin America and the Caribbean.

Objectives and importance of study: The importance of health policy and systems research (HPSR) has been acknowledged since 2004 and was recognised by the United Nations World Health Assembly in 2005. However, many factors influence its development. This paper aims to analyse the impact of politics and political determinants on HPSR funding in selected countries of Latin America and the Caribbean. METHODS: Using a standardised protocol, we performed an analysis of available data and financing structures for health research and HPSR, based on research in eight countries, including interviews with key stakeholders (n = 42). RESULTS: Dollar depreciation and gross national product growth in the region may play a role in how governments fund research. There have been shifts in the political spectrum in governments, which have affected research coordination and funding in positive and negative ways. HPSR funding in some countries was dependent on budget decisions and although some have improved funding, others have regressed by decreasing funding or have completely cancelled financing mechanisms. Caribbean countries rely mainly on institutional funding. HPSR is recognised as important but remains underfunded; stakeholders believed it should be used more in decision making. CONCLUSION: Although HPSR is recognised as valuable for decision making and policy development, it does not have the financial support required to flourish in Latin America and the Carribean. Data on health research financing were not easy to access. There was little or no evidence of published reports or papers about research financing, health research funding, and HPSR funding in particular in the studied countries. Because of the fragility of health systems highlighted by the coronavirus disease 2019 (COVID-19) pandemic, HPSR should be of great relevance and value to both policy makers and funders.

Therapeutic Communities In Latin America: An International Descriptive Study In Different Countries Across Latin America / Comunidades terapéuticas en Latinoamérica: un estudio descriptivo en varios países de Latinoamérica

ABSTRACT Objective: In Latin America is not known for certain the quantity or quality of therapeutic communities (TCs) available in the region. The objective of this study is to describe and quantify the quantity and quality of the existing TCs in 5 different countries. Design: A multicenter quantitative description of the TCs was conducted in Argentina, Brazil, Colombia, Mexico and Peru. Methods: A survey was realized through the TCs regulatory entities of each country that accepted to participate in the study. Results: Of the 285 TCs identified in the 5 countries, 176 (62%) accepted to participate in this study. The TCs quality vas evaluated according to the scoring system stablished by De Leon, finding that 70% of the facilities have scores of 11/12 or 12/12 using these criteria. We also found that the majority of the De Leon criteria are known by more than 90% of the institutions, however, the dimensions of "separation of the community" and "encounter groups between residents" were the least known with 63 and 85% respectively. The main reasons for abandonment of TCs were "not accepting the rules of the institution", "lack of money" and "not feeling comfortable with the facilities". 98% of the TCs provided services to other substance abuse problems, 94% for alcohol and 40% for other types of substances. Conclusions: The majority of the TCs identified in our sample meet the quality criteria stablished by De Leon, mostly providing services for substance abuse. However, they should put in place additional policies to improve the unfulfilled conditions and investigate the reasons for the dissatisfaction and abandonment of these institutions.

RESUMEN Objetivo: En Latinoamérica no se conoce a ciencia cierta la cantidad o la calidad de las comunidades terapéuticas disponibles en los distintos países de la región. El objetivo de este estudio es identificar y describir la cantidad y la calidad de las comunidades terapéuticas existentes en 5 países de la región. Diseño: Se realizó un estudio multicéntrico descriptivo cuantitativo de las comunidades terapéuticas en Argentina, Brasil, Colombia, México y Perú. Métodos: Mediante las entidades reguladoras de las comunidades terapéuticas de cada país, se realizó una encuesta a las que aceptaran participar en el estudio. Resultados: De las 285 comunidades terapéuticas identificadas en los 5 países, 176 (62%) aceptaron participar en el estudio. La calidad de las comunidades terapéuticas se evaluó por las puntuaciones establecidas con los criterios de De León; se encontró que el 70% de las instituciones tienen puntuaciones de 11/12 o 12/12 según estos criterios. También se encontró que cumplen la mayoría de los criterios de De León más del 90% de las instituciones; sin embargo, las dimensiones «separación de la comunidad¼ y «grupos de encuentro entre residentes¼ fueron los menos cumplidos (el 63 y el 85% de las comunidades respectivamente). Las principales razones de abandono de las comunidades terapéuticas fueron no aceptar las normas de la institución, falta de recursos económicos y no sentirse a gusto con ella. El 98% de las comunidades terapéuticas prestaban servicios para problemas de abuso de otras sustancias, el 94% para abuso de alcohol y el 40% para otros tipos de abusos. Conclusiones: La mayoría de las comunidades terapéuticas identificadas en nuestra muestra cumplen los criterios de calidad establecidos por De León, y en su gran mayoría prestan servicios para abuso de sustancias, pero deben instaurarse políticas para mejorar las condiciones no cumplidas e indagar los motivos de las disconformidades y el abandono de estas instituciones.

Therapeutic Communities In Latin America: An International Descriptive Study In Different Countries Across Latin America.

OBJECTIVE: In Latin America is not known for certain the quantity or quality of therapeutic communities (TCs) available in the region. The objective of this study is to describe and quantify the quantity and quality of the existing TCs in 5 different countries. DESIGN: A multicenter quantitative description of the TCs was conducted in Argentina, Brazil, Colombia, Mexico and Peru. METHODS: A survey was realized through the TCs regulatory entities of each country that accepted to participate in the study. RESULTS: Of the 285 TCs identified in the 5 countries, 176 (62%) accepted to participate in this study. The TCs quality vas evaluated according to the scoring system stablished by De Leon, finding that 70% of the facilities have scores of 11/12 or 12/12 using these criteria. We also found that the majority of the De Leon criteria are known by more than 90% of the institutions, however, the dimensions of "separation of the community" and "encounter groups between residents" were the least known with 63 and 85% respectively. The main reasons for abandonment of TCs were "not accepting the rules of the institution", "lack of money" and "not feeling comfortable with the facilities". 98% of the TCs provided services to other substance abuse problems, 94% for alcohol and 40% for other types of substances. CONCLUSIONS: The majority of the TCs identified in our sample meet the quality criteria stablished by De Leon, mostly providing services for substance abuse. However, they should put in place additional policies to improve the unfulfilled conditions and investigate the reasons for the dissatisfaction and abandonment of these institutions.

Quality measurers of therapeutic communities for substance dependence: an international collaborative study survey in Latin America.

BACKGROUND: In Latin America, substance related disorders are highly prevalent and one of the treatment strategies is the Therapeutic Communities (TCs), however, in Latin America there is scarce data about this treatment strategies, their quality, drop-out rates and patient satisfaction. METHODS: Based on a previous study in 5 Latin American countries, the TCs who had a score equal or higher than 9 according to the De Leon criteria which are some fundamental items that the TCs should meet, were selected to carry out a descriptive and retrospective study of qualitative and quantitative characteristics of the TCs. RESULTS: Data from 58 TCs in 5 countries were included, with a sample of 1414 patients interviewed, of which most were single men, with no hospitalization history in a therapeutic community. Marijuana was the most commonly substance used in the 30 days prior to hospitalization, with 78% of interviewees referring alcohol consumption in the last 6 months and an average onset of psychoactive substances at 16 years of age. A 79% of the patients interviewed perceived some improvement during their stay in the TCs. The less fulfilled Quality Indicators by the TCs were "Requesting a professional qualification to former addicts that belonged to the program" and "Work as part of the therapeutic program". Among the reasons for discharge found in the database, 44% were due to therapeutic discharge with fulfillment of the treatment plan and 44% withdraws. CONCLUSION: The user satisfaction with TCs, in terms of infrastructure and quality are quite high, as the fulfillment of essential quality items, however, the follow up information to evaluate effectiveness of the treatment is poor or in some cases unknown.

Latin American Clinical Epidemiology Network Series - Paper 6: The influence of alcohol in traffic accidents and health care costs of it in Bogotá-Colombia.

OBJECTIVES: In Colombia, some studies have estimated medical costs associated to traffic accidents. It is required to assess results by city or region and determine the influence of variables such as alcohol consumption. The main objective of this study was to identify health care costs associated to traffic accidents in Bogota and determine whether alcohol consumption can increase them. STUDY DESIGN AND SETTING: Cross-sectional costs study conducted in patients over 18 years treated in the emergency rooms of six different hospitals in Bogota, Colombia. RESULTS: The average total cost of medical care per patient was 628 USD, in Bogota-Colombia. The average cost per accident was estimated at 1,349 USD. On average, the total cost for health care for patients with positive blood alcohol level was 1.8 times higher than those who did not consume alcohol. The indirect costs were on average 115.3 USD per injured person. Numbers are expressed in 2011 U.S. dollars. CONCLUSION: Alcohol consumption increases the risk of traffic accidents and direct medical health costs.

Dermatozoonosis inespecífico por coleótero: reporte de tres casos en la regiòn del Chaco Paraguayo / Nonspecific dermatozoonoses by beetle: three case reports in the Chaco Paraguayo region

Las dermatozoonosis son afecciones cutáneas o cutáneo-sistémicas causadas por animales. Se analizaron tres casos de dermatitis de contacto producidas por sustancias vesicantes presentes en las familias de insectos Staphylinidae y Meloidae en residentes de la región del Chaco Boreal. La dermatitis de contacto por Staphylinidae y Meloidae, mejor llamada como dermatitis de contacto por paederina o cantaridina respectivamente, es una afección común en Paraguay pero frecuentemente subdiagnosticada o confundida con Herpes Zoster debido a sus características. Al informar sobre la epidemiología, condiciones clínicas y tratamiento de esta afección se puede prevenir su incidencia, ayudar en su proceso resolutivo y evitar diagnósticos errados que lleven a un tratamiento innecesario.

Dermatozoonosis are cutaneus or cutaneoussistemic afections caused by animals. Three cases of contact dermatitis produced by vesicant substances present in Staphylinidae and Meloidaeinsect families in residents ChacoBorealregionwere analyzed. Contact dermatitis due to Staphylinidae and Meloidae, better called Paederinor Cantharidin contact dermatitis respectively, isa common disease in Paraguay but it’s frequentlyunderdiagnosed or confused with Herpes Zoster be cause of their characteristics. Reporting on epidemiology, clinical conditions and treatment of these illness, it can prevent its occurrence, assistin their resolution process and avoid misdiagnosis that lead to an unnecessary treatment.

Costos directos de atención médica de accidentes de tránsito en Bogotá D. C / Direct costs involved in providing medical attention associated with traffic accidents in Bogotá

Objetivo Determinar los costos de atención médica generados por la accidentalidad vial en Bogotá. Metodología Estudio observacional prospectivo con datos de pacientes mayores de edad atendidos en la central de urgencias de 6 instituciones hospitalarias. Resultados El promedio del costo totalde atención por paciente fue de $1'112.000 El costo promedio día de paciente hospitalizado fue de $1'200.000. Pacientes con atención ambulatoria tuvieron un costo promedio de $247.400. El costo promedio por accidente se calculó en $2'333.700. Los costos médicos por accidentes en el periodo de análisis en Bogotá fueron aproximadamente $2.301'028.200. Cifras en pesos de 2011. Conclusiones Los costos de la atención médica de los accidentes de tránsito constituyen una carga económica considerable.

Objective To determine the cost of medical attention associated with traffic accidents in Bogotá, Colombia. Methods Prospective observational study with data from adult patients attended to in the emergency centers of 6 hospitals. Results Average total cost per patient was $1'112.000 COP. Average daily cost of hospitalized patients was $1'200.000 COP. Average cost of ambulatory treated patients ascended to $247.400 COP. Cost per accident calculated was $2'333.700 COP. In the whole city during study period, total medical costs were around $2.301'028.200 COP. All data was expressed in 2011 Colombian pesos. Conclusion The medical cost of transit accidents is a significant economic burden.

Los suplementos dietéticos y el anestesiólogo: resultados de investigación y estado del arte / Dietary supplements and the anesthesiologist: Research results and state of the art

RESUMEN Introducción: Hay una creciente tendencia mundial hacia el consumo de suplementos nutricionales. Los pacientes que consumen dichas sustancias y que van a ser llevados a cirugía tienen un riesgo potencial de presentar interacciones medicamentosas entre estas sustancias y los medicamentos del período perioperatorio. Objetivos: Realizar una caracterización sociodemográfica y determinar la prevalencia del consumo de suplementos nutricionales en personas que van a ser llevadas a cirugía; además, servir como guía de consulta para tomar conductas en la consulta preanestésica. Metodología: Se llevó a cabo un estudio observacional descriptivo de corte transversal, con pacientes que se presentaban a la consulta preanestésica, en 13 ciudades del país. A 1.130 pacientes se les interrogó acerca del consumo de estas sustancias. Resultados: La prevalencia de consumo fue de un 20,7%, siendo mayor en el sexo femenino, con un 62,8%, frente al sexo masculino; el consumo en personas mayores de 41 años fue del 63,2%; se automedicaron un 72,8%; a mayor edad, mayor consumo; entre los estratos medio y alto el consumo fue del 63%; a mayor nivel educativo, más consumo; el 36,6% piensan seguir consumiendo a pesar del procedimiento. Conclusiones: El alto índice de consumo de suplementos nutricionales en pacientes que van a someterse a una cirugía, las posibles interacciones con los medicamentos del perioperatorio y los efectos adversos de algunas hierbas medicinales deben poner en alerta el anestesiólogo que realiza la consulta preanestésica; es necesario incluir este tema en el interrogatorio y tomar conductas al respecto. Es aconsejable solicitar los empaques de los productos que consume.

ABSTRACT Background: There is a growing worldwide trend towards the consumption of nutritional supplements. Patients scheduled for surgery who are users of dietary supplements run the risk of interactions between these substances and drugs used in the perioperative period. Objectives: To conduct a socio-demographic characterization, and determine the prevalence of nutritional supplement use in people taken to surgery; to offer a reference guideline for use during pre-anesthetic consultation. Methods: The research team conducted an observational descriptive and cross-sectional study of patients presenting to the pre-anesthetic consultation in thirteen cities; 1130 patients were asked about the use of these substances. Results: The prevalence of use was 20.7%, higher among females at 62.8%, compared to males; consumption in people over 41 years was 63.2%; self-medication in 72.8%; increased consumption with age; in middle and high socioeconomic brackets, consumption was 63%; the higher the education, the higher the consumption; 36.6% plan to continue consumption despite the surgical procedure. Conclusions: The high rate of consumption of nutritional supplements in patients about to undergo surgery, possible drug interactions, and adverse effects of perioperative consumption of some herbs should trigger an alarm in the anesthesiologist performing the pre-anesthetic consultation; it is necessary to include this in the interview and act accordingly. We recommend always asking to see product packaging.

[Direct costs involved in providing medical attention associated with traffic accidents in Bogotá]. / Costos directos de atención médica de accidentes de tránsito en Bogotá D.C.

OBJECTIVE: To determine the cost of medical attention associated with traffic accidents in Bogotá, Colombia. METHODS: Prospective observational study with data from adult patients attended to in the emergency centers of 6 hospitals. RESULTS: Average total cost per patient was $1'112.000 COP. Average daily cost of hospitalized patients was $1'200.000 COP. Average cost of ambulatory treated patients ascended to $247.400 COP. Cost per accident calculated was $2'333.700 COP. In the whole city during study period, total medical costs were around $2.301'028.200 COP. All data was expressed in 2011 Colombian pesos. CONCLUSION: The medical cost of transit accidents is a significant economic burden.

Brucella canis causing infection in an HIV-infected patient.

From the blood culture of an HIV-positive patient with a febrile syndrome (CD4 count 385 cells/microL and viral load nondetectable), Brucella canis was isolated. The patient was presumptively infected from his dogs, which tested positive, and showed good outcome after the therapy with doxycycline-ciprofloxacin, and the HIV infection would seem not to have been influenced by brucellosis. To our knowledge, no other case of B. canis in the setting of HIV infection has been reported in the literature, and the emerging zoonotic potential of the disease in urban areas should be considered.

Reactivación de tuberculosis pulmonar asociada a seroconversión al virus de inmunodeficiencia humana / Reactivation of Pulmonary Tuberculosis associated with Human Immunodeficiency Virus (HIV) seroconversion

Entre un 40-90% de los pacientes que adquieren la infección por HIV presentan un conjunto de síntomas durante el periodo de la seroconversión, habitualmente denominado "Síndrome Retroviral Agudo" (SRA)...(AU)

It is estimated that between 40 and 90% of HIV infected patients experience some sympotoms during HIV seroconversion, attributable to an acute retroviral syndrome (ARS)...(AU)

Reactivación de tuberculosis pulmonar asociada a seroconversión al virus de inmunodeficiencia humana / Reactivation of Pulmonary Tuberculosis associated with Human Immunodeficiency Virus (HIV) seroconversion

Entre un 40-90% de los pacientes que adquieren la infección por HIV presentan un conjunto de síntomas durante el periodo de la seroconversión, habitualmente denominado "Síndrome Retroviral Agudo" (SRA)...

It is estimated that between 40 and 90% of HIV infected patients experience some sympotoms during HIV seroconversion, attributable to an acute retroviral syndrome (ARS)...

Otomastoiditis por Tsukamurella tyrosinosolvens, en un paciente HIV positivo / Tsukamurella tyrosinosolvens, otomastoiditis in an HIV positive patient

Tsukamurella spp. es un bacilo gram positivo, aeróbico, catalasa positivo, no móvil, no esporulado, que pertenece al orden de los actinomicetales. Los géneros incluidos en este orden son Nocardia, Gordonia, dietza, Skermania, Williamsia, Turicella, Streptomyces y Rhodococcus. Otros géneros relacionados son Corynebacterium y Mycobacterium. Las infecciones por esos microorganismos se han asociado con neumopatías crónicas, inmunodepresión (leucemia, tumores, infección por el HIV) e infecciones postoperatorias de heridas. Se notificó la presencia de tsukamurella en hemocultivos asociada al uso de sondas o catéteres, otros dispositivos médicos y en casos individuales de tenosinovitis necrosante con abscesos subcutáneos, infecciones óseas y cutáneas, meningitis, peritonitis y conjuntivitis y también como germen colonizante. Se presenta un caso de otomastoiditis en un paciente HIV positivo causado por este germen.

Commercial valerian interactions with [3H]Flunitrazepam and [3H]MK-801 binding to rat synaptic membranes.

Valeriana officinalis extracts are used in folkloric medicine for their sedative, hypnotic and tranquilizer effects. Using [3H]flunitrazepam binding as an indicator, the interactions of commercial Valerian extracts with GABA(A) receptors were examined. There was considerable fluctuation among the different extracts, some mildly enhanced [3H]flunitrazepam binding, others had no effect and others had inhibitory effects, independent of standardization by valerenic acid. Central depression can also be accomplished by a reduction of excitatory transmission. Valerian extracts had modest inhibitory effects on [3H]MK-801 binding, an indicator of NMDA-Valerian interactions. Spectral analyses (UV region) did not show marked differences among the different extracts. The inhibitory effects of one of the extracts on [3H]flunitrazepam binding was somewhat stable, while on [3H]MK-801 binding the inhibitory effects were lost within months. These results suggest that particular care should be taken in analysing and interpreting results from commercial Valerian preparations.

Biopsia core de la mama con guía ecográfica / Biopsy core of the breast with guide ultrasongraphy

La biopsia percutánea de mama con aguja CORE guiada por ultrasonido es una buena alternativa a la biopsia quirúrgica de lesiones mamarias. Es un procedimiento indicado tanto en lesiones como no palpables, ofrece múltiples ventajas y es de buena eficiencia, sin embargo, este procedimiento aún no se constituye como rutina en nuestro medio. El presente trabajo tiene por finalidad exponer y evaluar la experiencia en nuestra institución con el uso de esta técnica en el diagnóstico del cáncer de mama. Desde enero del 2001 hasta mayo del 2003 se han registrado 103 biopsias percutáneas de la mama bajo guía ecográfica, de las cuales, 95 se realizaron con aguja tipo CORE. De estas 95 pacientes, 35 tuvieron. Posteriormente biopsias y/o tratamiento quirúrgico y 60 tuvieron seguimiento clínico. Del primer grupo de 35 pacientes, la biopsia quirúrgica reportó 18 con cáncer de mama y 17 sin evidencia de cáncer. De los 18 diagnósticos de cáncer por cirugía, 15 coincidieron con los diagnosticados por guía ecográfica, en tanto que 3 fueron subdiagnosticados por este método. Los restantes 17, coincidieron en el diagnóstico de no cáncer, con ambos procedimientos. De estos resultados se infiere que los falsos negativos representa el 16,7 por ciento y no presenta falsos positivos, con lo que la sensibilidad fue de 83.3 por ciento, la especificidad de 100 por ciento y el valor predictivo del resultado positivo cáncer fue de 100 por ciento. No se presentaron ningún tipo de complicaciones. En conclusión, nuestra experiencia avala lo ya publicado por numerosos autores y confirma el buen rendimiento de la biopsia de lesiones mamarias con aguja CORE bajo guía ecográfica en el diagnóstico de cáncer de mama y ratifica las bondades de este procedimiento. Se recomienda su uso en nuestro medio.

Evaluación del formulario 005, implementado en un hospital estatal de la ciudad de Quito como proyecto piloto / Evaluation of form 005, implemented in a state hospital of the city of Quito like project pilot

En la evaluación del formulario 005 implementado como prueba piloto en el hospital Eugenio Espejo, es importante hacer referencia a la historia clínica, en la cual este formulario ocupa un lugar de gran valor. La historia clínica, para ser utilizada en nuestro país, se base en la creación de ésta en los Estados Unidos, país que en cierta forma lanza un modelo de la misma, teniendo como antecedente la gran variedad de conceptos emitidos por autores expertos en cátedras administrativas. En nuestro país se hacen evidentes todas estas transformaciones en el hospital San Juan de Dios, uno de los más antíguos de América Latina, en los años 1925 a 1927 se habla de una historia clínica, que constaba de dos formatos; el primero con datos de filiación del paciente, anamnesis y examen físico y, el segundo con evolución, prescripciones médicas y notas de enfermería. de 1928 hasta 1940, estos formularios sufren una modificación. Al primer formulario se le divide en dos hojas la una que contenía datos de filiación hasta el examen fisíco; y la otra hoja desde el diagnóstico provisional hasta la autopsia...