Eastern Mediterranean Health Journal [2022; Vol.28, Issue 12]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

O FeliciLab, a inovação e a pandemia de covid-19 / FeliciLab, innovation and the covid-19 pandemic / El FeliciLab, la innovación y la pandemia de covid-19

Com o fim de propiciar um ambiente que possibilite decisões ágeis, criativas e efetivas no sistema de saúde, o Laboratório de Inovações no SUS do Ceará (FeliciLab) tem adotado o uso de métodos inovadores de gestão de projetos. Este relato de experiência tem como objetivo apresentar como a Escola de Saúde Pública do Ceará (ESP/CE) conseguiu, através do FeliciLab, orquestrar um conjunto de pessoas, métodos e tecnologias capazes de provocar uma quebra em padrões até então apresentados no mercado de tecnologias direcionadas para o sistema de saúde, diante da crise sanitária ocasionada pela pandemia de covid-19. Com adoção de metodologias mais ágeis de condução de trabalho e gerenciamento de crises, ampliou-se a percepção de valor da tecnologia da informação (TI) da ESP/CE, nutrida pela compreensão de que inovar é mais do que produzir e implantar tecnologias: trata-se de transformar os modos de criar e consumir soluções, de forma a impactar os contextos e as experiências das pessoas.

In order to provide an environment with agile, creative, and effective decisions in the health system, the Felicilab laboratory has been adopting the use of innovative project management methods. This experience report aims to present how the Escola de Saúde Pública do Ceará (ESP/CE), Brazil, had managed to orchestrate, through FeliciLab, a set of people, methods, and technologies from a disruptive perspective of standards hitherto presented in the market of technologies directed to the health system, in face of the health crisis caused by the covid-19 pandemic. With the adoption of more agile methodologies for conducting work and managing crisis, the perception of the value of the Information technology (IT) used at ESP/CE was expanded, understanding that innovating is more than producing and implementing technologies: it means transforming the ways of creating and consume solutions in order to impact on personal experiences and their context.

A fin de propiciar un ambiente con decisiones ágiles, creativas y efectivas en el sistema de salud, el Laboratório de Inovações no SUS do Ceará (FeliciLab) tiene adoptado el uso de métodos innovadores de gestión de proyectos. Este relato de experiencia tiene como objetivo presentar cómo la Escola de Saúde Pública do Ceará (ESP/CE), a través del FeliciLab, ha conseguido orquestar un conjunto de personas,nmétodos y tecnologías capaces para quebrar estándares hasta entonces presentados en el mercado de tecnologías dirigidas al sistema de salud, frente a la crisis de salud provocada por la pandemia de Covid-19. Con la adopción de metodologías más ágiles para la realización del trabajo y la gestión de crisis, se amplió la percepción del valor de la tecnología de la información (TI) ESP/CE, alimentada por el entendimiento de que innovar es más que producir e implementar tecnologías: se trata de transformar formas de crear y consumir soluciones para impactar los contextos y las experiencias de las personas.

Sarcoidosis con compromiso cutáneo casuística del Servicio de Dermatología del Hospital Nacional- período 2010-2020 / Sarcoidosis with skin engagement casuistics of the National Hospital Dermatology Service - period 2010-2020

Introducción: La sarcoidosis es una enfermedad inflamatoria, granulomatosa de etiología desconocida. Puede afectar cualquier órgano siendo la afectación pulmonar la más frecuente. La piel se compromete en aproximadamente 30% de los casos, pudiendo ser inicial o único. La sarcoidosis es muy rara en el Paraguay. Objetivos: Realizar una revisión de los casos de sarcoidosis observados en el Servicio de Dermatología del Hospital Nacional en el periodo 2010-2020; determinando sus características demográficas, clínicas, laboratoriales y evolutivas. Materiales y métodos: Estudio retrospectivo, descriptivo y observacional. Resultados: Se diagnosticaron 5 casos, todas mujeres de raza blanca, con edades que oscilaban de 41 a 63 años. Las formas clínicas fueron papulosa en 3 casos, en placa 1 y mixta 1. Las lesiones cutáneas eran asintomáticas y estaban ubicadas preferentemente en rostro (4 casos). El compromiso sistémico se objetivó en las primeras consultas en 2 casos (pulmonar, ocular y ganglionar en 1 y del aparato lagrimal en otro). En todos los casos el diagnóstico se fundamentó en la correlación clínico-histológica, con el hallazgo de los granulomas sarcoides. Todos recibieron clobetasol tópico, 3 pacientes ciclos de prednisona y 2 hidroxicloroquina. La evolución fue favorable en 3 casos y 2 no volvieron a sus controles. Conclusión: La sarcoidosis con manifestaciones cutáneas es rara en nuestro Servicio, pero representa un desafío diagnóstico, que debe ser oportuno para diferenciarla de otras patologías más prevalentes en nuestro medio

Introduction: Sarcoidosis is an inflammatory, granulomatous disease of unknown etiology. It can affect any organ, lung involvement being the most frequent. The skin is compromised in approximately 30% of the cases, and can be initial or unique. Sarcoidosis is very rare in Paraguay. Objectives: To carry out a review of the sarcoidosis cases observed in the Dermatology Service of the National Hospital in the period 2010-2020; determining their demographic, clinical, laboratory and evolutionary characteristics. Materials and methods: Retrospective, descriptive and observational study. Results: 5 cases were diagnosed; all white women; with ages ranging from 41 to 63 years. The clinical forms were papular in 3 cases, in plate 1 and mixed 1. The skin lesions were asymptomatic and were preferably located on the face (4 cases). Systemic involvement was observed in the first consultations in 2 cases (pulmonary, ocular and lymph node in 1 and the lacrimal apparatus in another). In all cases the diagnosis was based on the clinical-histological correlation, with the finding of sarcoid granulomas. All received topical clobetasol, 3 patients received prednisone cycles and 2 hydroxychloroquine. The evolution was favorable in 3 cases and 2 did not return to their controls. Conclusion: Sarcoidosis with skin manifestations is rare in our Service, but it represents a diagnostic challenge that must be timely to differentiate it from other more prevalent pathologies in our setting

Diferenças entre medidas autorreferidas e laboratoriais de diabetes, doença renal crônica e hipercolesterolemia / Differences between self-reported and laboratory measures of diabetes, chronic kidney disease, and hypercholesterolemia

Resumo O objetivo deste artigo é comparar as prevalências autorreferidas e medidas por exames laboratoriais, assim como a ocorrência de valores de falsos positivos e negativos, para diabetes, doença renal crônica e hipercolesterolemia. Foram utilizadas informações da entrevista e exames laboratoriais da Pesquisa Nacional de Saúde (2013, 2014-2015). Foram calculadas a sensibilidade e a especificidade, segundo sexo, idade, escolaridade, ter plano de saúde e tempo desde a última consulta médica. Por meio de regressão logística, foram analisados fatores associados à ocorrência de falsos positivos e falsos negativos. A sensibilidade foi mais elevada para o diabetes e entre os idosos e os que tiveram consulta médica mais recentemente. A especificidade foi alta para todas as doenças, com melhor desempenho entre os jovens, os com alta escolaridade e os que consultaram há mais de um ano. As chances de falsos positivos e falsos negativos diminuíram com a escolaridade e aumentaram com a idade. A sensibilidade baixa indica que as prevalências podem ser mais elevadas que as medidas autoreferidas apontam.

Abstract This paper aims to compare the self-reported prevalence measured by laboratory tests and the false positive and negative values for diabetes, chronic kidney disease, and hypercholesterolemia. We used information from the interview and laboratory tests of the National Health Survey (2013, 2014-2015). Sensitivity and specificity were calculated by gender, age, schooling, having health insurance, and time since the last medical visit. We used logistic regression to analyze associated factors with false positives and negatives. Sensitivity was higher for diabetes and among older adults and those who had a medical visit more recently. Specificity was high for all diseases, with better performance among younger people, those with high schooling, and a visit more than one year ago. The likelihood of false positives and negatives decreased with schooling and increased with age. Low sensitivity suggests that prevalence might be higher than indicated by self-reported measures.

Clinical, laboratory, and functional characteristics of asthma-COPD overlap in patients with a primary diagnosis of COPD / Características clínicas, laboratoriais e funcionais da sobreposição asma-DPOC em pacientes previamente diagnosticados com DPOC

ABSTRACT Objective: To evaluate the frequency of asthma-COPD overlap (ACO) in patients with COPD and to compare, from a clinical, laboratory, and functional point of view, patients with and without ACO, according to different diagnostic criteria. Methods: The participants underwent evaluation by a pulmonologist, together with spirometry and blood tests. All of the patients were instructed to record their PEF twice a day. The diagnosis of ACO was based on the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO, Latin American Project for the Investigation of Obstructive Lung Disease) criteria, the American Thoracic Society (ATS) Roundtable criteria, and the Spanish criteria. We investigated patient histories of exacerbations and hospitalizations, after which we applied the COPD Assessment Test and the modified Medical Research Council scale, to classify risk and symptoms in accordance with the GOLD criteria. Results: Of the 51 COPD patients, 14 (27.5%), 8 (12.2%), and 18 (40.0) were diagnosed with ACO on the basis of the PLATINO, ATS Roundtable, and Spanish criteria, respectively. The values for pre-bronchodilator FVC, post-bronchodilator FVC, and pre-bronchodilator FEV1 were significantly lower among the patients with ACO than among those with COPD only (1.9 ± 0.4 L vs. 2.4 ± 0.7 L, 2.1 ± 0.5 L vs. 2.5 ± 0.8 L, and 1.0 ± 0.3 L vs. 1.3 ± 0.5 L, respectively). When the Spanish criteria were applied, IgE levels were significantly higher among the patients with ACO than among those with COPD only (363.7 ± 525.9 kU/L vs. 58.2 ± 81.6 kU/L). A history of asthma was more common among the patients with ACO (p < 0.001 for all criteria). Conclusions: In our sample, patients with ACO were more likely to report previous episodes of asthma and had worse lung function than did those with COPD only. The ATS Roundtable criteria appear to be the most judicious, although concordance was greatest between the PLATINO and the Spanish criteria.

RESUMO Objetivo: Avaliar a frequência de asthma-COPD overlap (ACO, sobreposição asma-DPOC) em pacientes com DPOC e comparar, do ponto de vista clínico, laboratorial e funcional, os pacientes com e sem essa sobreposição conforme diferentes critérios diagnósticos. Métodos: Os participantes foram submetidos à avaliação com pneumologista, espirometria e exame sanguíneo, sendo orientados a manter o registro do PFE duas vezes ao dia. O diagnóstico de ACO deu-se através dos critérios Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO), American Thoracic Society (ATS) Roundtable e Espanhol. Foram investigados os históricos de exacerbações e hospitalizações e aplicados os instrumentos COPD Assessment Test e escala Medical Research Council modificada, utilizados para a classificação de risco e sintomas da GOLD. Resultados: Entre os 51 pacientes com DPOC, 14 (27,5%), 8 (12,2%) e 18 (40,0) foram diagnosticados com ACO segundo os critérios PLATINO, ATS Roundtable e Espanhol, respectivamente. Pacientes com sobreposição significativamente apresentaram pior CVF pré-broncodilatador (1,9 ± 0,4 L vs. 2,4 ± 0,7 L), CVF pós-broncodilatador (2,1 ± 0,5 L vs. 2,5 ± 0,8 L) e VEF1 pré-broncodilatador (1,0 ± 0,3 L vs. 1,3 ± 0,5 L) quando comparados a pacientes com DPOC. Os níveis de IgE foram significativamente mais elevados em pacientes com sobreposição diagnosticados pelo critério Espanhol (363,7 ± 525,9 kU/L vs. 58,2 ± 81,6 kU/L). O histórico de asma foi mais frequente em pacientes com a sobreposição (p < 0,001 para todos os critérios). Conclusões: Nesta amostra, pacientes com ACO relataram asma prévia com maior frequência e possuíam pior função pulmonar quando comparados a pacientes com DPOC. O critério ATS Roundtable aparenta ser o mais criterioso em sua definição, enquanto os critérios PLATINO e Espanhol apresentaram maior concordância entre si.

Perfil bioquímico de pacientes diabéticos de um laboratório privado da região sul do Brasil / Biochemical profile of diabetic patients in a private laboratory in southern Brazil

O diabetes é uma doença crônica decorrente de hiperglicemia permanente. A hemoglobina glicada (HbA1c) resulta da ligação não enzimática entre a hemoglobina e a glicose. A dosagem da mesma é o principal determinante para avaliação do controle glicêmico em pacientes diabéticos. Este estudo objetivou correlacionar idade, perfil glicêmico e lipídico em uma amostra de prontuários de portadores de Diabetes Melito (DM), em um laboratório privado da região sul do Brasil. Foram analisados 776 prontuários no período entre janeiro a março de 2018, sendo que os prontuários foram obtidos a partir de registros dos meses entre março de 2016 a março de 2018. Analisamos HbA1c, glicose, triglicerídeos, colesterol total, LDL-colesterol e HDL-colesterol. Nossos resultados mostram predominância de mulheres idosas (61%), não havendo variação de idade entre os gêneros, em ambos foi possível observar correlação negativa e significativa entre idade e LDL-C. Não houve clara associação entre HbA1c e perfil lipídico na amostra estudada. Os resultados demonstraram aumento nos níveis de HbA1c e redução no colesterol total e LDL-C nos pacientes acima de 60 anos. Encontramos uma forte correlação positiva entre os parâmetros HbA1c e glicose, em ambos os gêneros. As correlações entre idade e demais variáveis foram fracas, entre ambos. (AU)

Diabetes is a chronic disease characterized by the presence of permanent hyperglycemia. Glycated Hemoglobin (HbA1c) is formed through the non-enzymatic binding of hemoglobin and glucose. Its dosage in blood is one of the most relevant factors in the evaluation of the glycemic control. The aim of this study is to correlate age, glycemic and lipid profiles in a sample of 776 patients diagnosed with Diabetes Mellitus (DM), from a laboratory in southern Brazil. A total of 776 medical records were analyzed between January and March 2018, and the records were obtained from the records of the months between March 2016 and March 2018. HbA1c, glucose, triglyceride, total cholesterol, LDL-cholesterol and HDL-cholesterol values were analyzed. Our results show a predominance of elderly women (61%), with no age variation between genders, in both it was possible to observe negative and significant correlation between age and LDL-C. There was no clear association between HbA1c and lipid profile. The results showed increased levels of HbA1c and a reduction in total cholesterol and LDL-C in patients over 60 years. A strong positive correlation was found between HbA1c and glucose parameters in both genders. The correlations between age and other variables were weak between both. (AU)

Síndromes coronarios agudos en instituciones póblicas y no póblicas de Argentina / Acute coronary syndromes in public and non-public institutions of Argentina

El tratamiento del síndrome coronario agudo (SCA) puede diferir segó;ºn la cobertura de salud. El objetivo fue comparar características demográficas de pacientes con SCA atendidos en instituciones del sector pó;ºblico, o en el no-pó;ºblico de Argentina, las terapó;©uticas y su relació;n con los recursos de cada sector. Analizamos internaciones en instituciones de un registro nacional, voluntario, prospectivo y multicó;©ntrico. Entre marzo 2006 y mayo 2016 ingresaron 11 072 SCA en 64 instituciones, 39% pó;ºblicas (44% con laboratorio de hemodinamia) y 61% no pó;ºblicas (82% con hemodinamia). Los centros pó;ºblicos presentaron menos estructura y atendieron mayor proporció;n de SCA con elevació;n del segmento ST (SCACEST) (52.5% vs. 36.1%, p < 0.001). Los pacientes del sector pó;ºblico fueron más jó;venes, más frecuentemente hombres, fumadores, y menos dislipó;©micos. La proporció;n de reperfundidos entre SCA con elevació;n del ST (SCACEST) fue similar en ambos sectores. La utilizació;n de coronariografía en SCA sin elevació;n del ST (SCASEST) fue mayor en el sector pó;ºblico, cuyos pacientes presentaron más frecuentemente cambios electrocardiográficos y biomarcadores elevados. Un 80.2% de los SCA en instituciones pó;ºblicas y 90.1% en las no pó;ºblicas fueron incorporados por centros con hemodinamia. La disponibilidad de hemodinamia fue la variable más asociada a reperfusió;n entre SCACEST y al tratamiento invasivo entre SCASEST. Se demuestra la complejidad del análisis comparativo de sectores de salud, por la relevancia que adquieren los recursos instalados y las diferencias demográficas de la població;n, por encima de la simple diferencia de pertenecer al sistema pó;ºblico o al no pó;ºblico.

Treatment of acute coronary syndrome (ACS) may differ according to the health system coverage. The objective of this study was to evaluate demographic characteristics of patients with ACS assisted in public sector institutions compared to the non-public sector of Argentina, as well as the therapeutic and its relationship with the resources of each sector. We analyzed patients hospitalized in institutions of a national, voluntary, prospective and multicenter registry. Between March 2006 and May 2016, 11 072 ACSs were registered in 64 institutions, 39% public (44% have hemodynamic laboratory) and 61% non-public (82% with hemodynamic). Public centers presented less structure and assisted a higher proportion of ST elevation acute coronary syndrome (STE-ACS). (52.5% vs. 36.1%, p < 0.001). Public sector patients were younger, more frequently men, smokers, and less dyslipemics. The proportion of patients reperfused in the STE-ACS was similar in both sectors. The use of coronary angiography in non-ST elevation acute coronary syndrome (NSTE-ACS) was higher in the public sector, whose patients presented more frequently electrocardiographic changes and biomarker elevation. Considering all ACS, 80.2% of patients in public and 90.1% in non-public institutions were incorporated by haemodynamic centers. The availability of hemodynamics was the variable most associated with reperfusion in NSTE-ACS, and invasive treatment in NSTE-ACS. This research demonstrates the complexity of a comparative analysis of health sectors, due to the relevance acquired by the level of resources installed and the demographic differences of the inpatient population, above the simple difference of belonging to the public or non-public system.

Evaluación de la calidad del diagnóstico de malaria en la red local de laboratorios y en los laboratorios intermedios en el contexto de la eliminación de la enfermedad en Ecuador / Quality evaluation of malaria diagnosis in the local laboratories network and in intermediate laboratories in a setting towards the disease elimination in Ecuador

Resumen Introducción. El cumplimiento de la meta de eliminación de la malaria en Ecuador en el 2020 exige contar con la capacidad requerida para el diagnóstico microscópico ajustado a los estándares de calidad de la Organización Mundial de la Salud (OMS) y de la Organización Panamericana de la Salud (OPS) y proveer el tratamiento adecuado a los pacientes. Objetivo. Conocer la idoneidad o competencia de los microscopistas de la red pública local para el diagnóstico parasitológico de la malaria y el desempeño de los laboratorios intermedios de referencia. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal a partir de la información obtenida en los talleres de evaluación de idoneidad en el diagnóstico microscópico de la red de laboratorios en las coordinaciones zonales de salud utilizando un panel de láminas para evaluar la concordancia del diagnóstico. Además, se calificó el desempeño de los laboratorios intermedios en el diagnóstico en el marco del programa de evaluación externa del desempeño. Los resultados se compararon con los obtenidos por el laboratorio supranacional de Perú. Resultados. En los 11 talleres realizados, se evaluó la idoneidad de 191 microscopistas, de los cuales 153 (80,1 %) aprobaron las pruebas. Las medianas de los indicadores fueron las siguientes: concordancia entre la detección y el resultado, 100 % (Q1- Q3: 96-100); concordancia en la especie, 100 % (Q1- Q3: 93-100); concordancia en el estadio, 93,0 % (Q1- Q3: 86-95) y concordancia en el recuento, 77 % (Q1- Q3: 71-82). En el programa de evaluación externa de desempeño, los tres laboratorios intermedios obtuvieron una concordancia del 100 % en el resultado y una del 96 % en la especie. Conclusiones. Los indicadores de competencia de la red local y de desempeño de los laboratorios intermedios alcanzaron altos estándares de calidad acordes con el proceso de entrenamiento implementado en el país.

Abstract Introduction: To reach the goal of malaria elimination in Ecuador for the year 2020, it is necessary to have a laboratory network with the capacity to perform microscopic diagnosis according to the WHO/PAHO quality standards and to provide the adequate treatment of cases. Objective: To determine the level of competence for parasitological diagnosis of the microscopists from the local public network and the performance of intermediate reference laboratories. Materials and methods: We conducted a cross-sectional study based on the information collected in workshops carried out to appraise the competence for microscopic diagnosis of the local laboratory network (zonal health coordinating offices 1 to 8) using a slide panel to evaluate diagnosis agreement, as well as the diagnostic performance of the intermediate laboratories using an external quality assessment program. The results were compared against the reference standards of the supranational laboratory in Perú. Results: We evaluated the competencies of 191 microscopists in 11 workshops and 153 (80.1%) of them were approved. The medians of the indicators were the following: concordance for parasite detection, 100% (Q1- Q3: 96-100), concordance for species identification, 100% (Q1- Q3: 93-100), and concordances for stage identification, 93.0% (Q1- Q3: 86-95) and parasite counting, 77.0% (Q1- Q3: 71-82). In the external quality assessment, the three intermediate laboratories obtained 100% in parasite detection concordance and 96% for species detection concordance. Conclusions: The results for the primary network and the performance indicators for the intermediate laboratories showed the high-quality standards of the training program implemented in the country.

An imperial laboratory: the investigation and treatment of treponematoses in occupied Haiti, 1915-1934 / Um laboratório imperial: investigação e tratamento da treponematose no Haiti ocupado, 1915-1934

This article examines anti-treponematoses work as part of US occupation public health policy in Haiti, a unique event in the history of international health. Yaws was highly prevalent in Haiti, but occupation doctors initially ignored it because of its close association with syphilis and stigmas attached to sexually transmitted disease. This changed when C.S. Butler asserted that yaws was "innocent" and that the two diseases should therefore be considered as one. Treatment increased as an anti-treponematoses campaign was now believed to hold great benefits for the occupation's paternalist and strategic aims, even though it ultimately failed. This work reflected Haiti's status as a public health "laboratory" which affected Haitian medicine for years to come and significantly influenced future campaigns aimed at disease eradication.

Este artigo investiga o trabalho anti-treponêmico como parte da política norte-americana de saúde pública na ocupação do Haiti, evento inédito na história da saúde internacional. Era alta a incidência da bouba no Haiti, mas médicos da ocupação a ignoravam por ser parecida com a sífilis e pelos estigmas da doença sexualmente transmitida. A situação mudou quando C.S. Butler afirmou que a bouba era "inocente" e que as duas doenças deveriam ser consideradas uma. Surgiram mais tratamentos com uma campanha anti-treponêmica que trazia benefícios aos objetivos paternalistas e estratégicos da ocupação, apesar do seu fracasso final. Esse trabalho ilustra o Haiti como "laboratório" de saúde pública, o que afetou a medicina haitiana por anos e influenciou campanhas futuras para erradicar a doença.

Выработка национальной политики развития лабораторной службы: Документ по надлежащей практике и руководство для координаторов

В данном документе даны рекомендации по мероприятиям, необходимым для выработки национальной политики развития лабораторной службы. В Разделе 1 правительства, участники и координаторы найдут краткий обзор действий по выработке собственной национальной политики развития лабораторной службы, пользующейся широкой поддержкой. Выработка национальной политики развития лабораторной службы. Документ по надлежащей практике и руководство для координаторов 7 В Разделе 2 даны сведения об основных акторах, их функциях и обязанностях. Раздел 3 содержит практические рекомендации для координаторов семинаров, посвященных выработке национальной политики развития лабораторной службы. В руководстве для координаторов приведены подробные, поэтапные программы вместе с описанием мероприятий, упражнениями, презентациями и примерными результатами. Все это поможет в проведении семинаров.

Development of national laboratory policies: best practices document and facilitators’ guide

This document provides guidance to the activities needed to develop a national laboratory policy. Section 1 provides governments, participants and facilitators with an overview of the activities needed to develop a national laboratory policy that is nationally owned and widely supported. Section 2 provides information on the main actors and their roles and responsibilities. Section 3 provides a practical guide for facilitators of the workshops to develop a national laboratory policy. The facilitators’ guide includes detailed, step-by-step agendas, complete with descriptions of the activities, exercises, presentations and example outcomes that can be used for the facilitation of the workshops.

Medicalización más allá de los médicos: marketing farmacéutico en torno al trastorno por déficit de atención e hiperactividad en Argentina y Brasil (1998-2014) / Medicalization beyond physicians: pharmaceutical marketing on attention deficit and hyperactivity disorder in Argentina and Brazil (1998-2014)

Desde un análisis crítico de los estudios de la medicalización, y como un aporte a estas perspectivas, describimos y analizamos los modos en que la industria farmacéutica transnacional penetra en diversos espacios sociales, con diferentes estrategias de marketing, interviniendo en la consolidación de procesos medicalizadores en Argentina y Brasil. Se analizan dos modalidades de expansión de los procesos de medicalización, y se desarrollan aspectos y tendencias específicas del diagnóstico y tratamiento del TDAH en ambos países: la incidencia de la industria farmacéutica en los grupos de apoyo en Brasil y las estrategias de marketing farmacéutico orientadas a actores no médicos en Argentina. Estas dos modalidades se caracterizan por no involucrar sólo al profesional médico. La metodología incluye datos de investigaciones conducidas en Argentina y Brasil entre 1998 y 2014, con sede en la Universidad de Buenos Aires y la Universidade Estadual do Rio de Janeiro, orientadas al estudio de los procesos de diagnóstico y tratamiento del TDAH y el consumo de metilfenidato en ambos países. Se emplearon técnicas de entrevista semiestructurada individual y grupal a profesores y profesionales de salud, estadísticas oficiales y de organizaciones profesionales, y revisión de bibliografía general y especializada nacional e internacional. Concluimos que los fenómenos documentados en Argentina y Brasil ponen de relieve la importancia de efectuar investigaciones que contemplen aspectos singulares de los casos empíricos, y sus múltiples vinculaciones con entramados más amplios y en tensión de saberes, dispositivos, normativas y actores involucrados en la medicalización en el siglo XXI.

From a critical analysis of medicalization studies, and as a contribution to these perspectives, we describe and analyze the ways in which the transnational pharmaceutical industry penetrates diverse social spaces, with different marketing strategies, to consolidate medicalized processes in Argentina and Brazil. We analyzed two expansion methods of medicalization processes and specific ADHD diagnostic and treatment aspects and trends were developed in both countries: the impact of the pharmaceutical industry on advocacy groups in Brazil and pharmaceutical marketing strategies aimed at non-medical actors in Argentina. These two methods are characterized by involving other actors than medical professionals. The methodology includes data from research conducted in Argentina and Brazil between 1998 and 2014, based in the University of Buenos Aires and in the State University of Rio de Janeiro, focused on the study of ADHD diagnostic and treatment processes and methylphenidate consumption in both countries. We used individual and group semi-structured interview techniques with professors and health professionals, official and professional organization statistics, and national and international general and specialized literature. We concluded that the phenomena documented in Argentina and Brazil highlight the importance of conducting investigations that covers specific aspects of empirical cases and their multiple connections with broader and intense knowledges networks, dispositives, normatives and actors involved in the medicalization in the 21st century.

Development policy for the Brazilian health industry and qualification of national public laboratories / La política de desarrollo productivo en salud en Brasil y la cualificación de los laboratorios públicos nacionales / A política de desenvolvimento produtivo da saúde e a capacitação dos laboratórios públicos nacionais

Abstract: Technological innovations play a decisive role in societies' development by contributing to economic growth and the population's welfare. The state has a key role in this process by inducing innovative behavior, strategies, and decisions. This study addresses Brazil's current policy for development of the health industry and its effects on qualification of national public laboratories by contextualizing different cycles of interaction between health policy and the industrial base, discussing the government's development strategy and the transfer and absorption of health technology (through Industrial Development Partnerships), and presenting two current partnerships involving public laboratories in the production of medicines and vaccines.

Resumen: Las innovaciones tecnológicas juegan un papel decisivo en el proceso de desarrollo de las sociedades, pues contribuyen a generar crecimiento económico y bienestar de la población. El Estado tiene una gran importancia y centralidad en este proceso, pues puede inducir fuertemente el comportamiento, las estratégicas y las decisiones relativas a la innovación. El presente artículo tiene por objetivo investigar la actual política de desarrollo productivo en salud en Brasil y sus reflejos sobre la capacitación de los laboratorios públicos nacionales. Con este fin, contextualiza los diferentes ciclos de interacción entre la política de salud y su base productiva, discute la estrategia del gobierno brasileño para el desarrollo, la transferencia y absorción de tecnología en el área de salud (las colaboraciones para el desarrollo productivo) y presenta dos modelos de colaboración vigentes, involucrando laboratorios públicos para la producción de medicamentos y vacunas.

Resumo: As inovações tecnológicas jogam papel decisivo no processo de desenvolvimento das sociedades, visto que contribuem para gerar crescimento econômico e bem-estar da população. O Estado possui grande importância e centralidade nesse processo, pois pode induzir fortemente o comportamento, as estratégias e as decisões relativas à inovação. O presente artigo tem por objetivo investigar a atual política de desenvolvimento produtivo em saúde no Brasil e seus reflexos sobre a capacitação dos laboratórios públicos nacionais. Para essa finalidade, contextualiza os diferentes ciclos de interação entre a política de saúde e a sua base produtiva, discute a estratégia do governo brasileiro para o desenvolvimento, a transferência e a absorção de tecnologia na área da saúde (as parcerias para o desenvolvimento produtivo) e apresenta duas parcerias vigentes envolvendo laboratórios públicos para a produção de medicamentos e vacinas.

Tuberculosis intestinal: reporte de caso y revisión de la literatura / Intestinal tuberculosis: case report and review of the literature

La tuberculosis sigue siendo endémica en nuestro medio, y es una causa importante de morbimortalidad en Colombia y en la mayoría de países en vías de desarrollo. El tracto gastrointestinal es el sexto lugar extrapulmonar más comprometido. Las manifestaciones clínicas de esta patología no son específicas y pueden simular diversas enfermedades, lo que hace que el diagnóstico preciso no sea fácil. En este artículo presentamos 2 casos de tuberculosis intestinal que fueron diagnosticados y tratados por nuestro servicio, se describen los principales hallazgos clínicos y paraclínicos de estos y se presenta una revisión de la literatura.

Tuberculosis is still an endemic disease and remains an important cause of morbidity and mortality in Colombia and in too many developing countries. The gastrointestinal tract is the sixth commonest extrapulmonary site to be affected. Manifestations are non-specific and mimic many conditions, what makes really hard to get an accurate diagnosis. We, herein, report two cases of intestinal tuberculosis diagnosed and treated in our service, the main clinical and laboratory findings are shown. We also present a review of the literature regarding this interesting disease.

Hemoglobina glicosilada A1c vs. glucemia plasmática en ayunas de pacientes ambulatorios de un laboratorio médico / Glycosylated haemoglobin A1c compared to fasting plasma glucose in outpatients referred to a medical laboratory

Objetivo Comparar la prueba hemoglobina glicosilada (HbA1c) en diferentes puntos de corte, con la prueba de glucemia plasmática en ayunas (GPA); para medición de glucosa en sangre en pacientes ambulatorios de un laboratorio médico de la ciudad de Medellín, entre marzo y abril de 2010. Métodos Estudio en 1016 muestras de sangre de pacientes referidos a un laboratorio médico. Se obtuvo la concordancia entre las pruebas (Índice de Kappa), se calcularon sensibilidad y especificidad, además se evaluaron diferentes puntos de corte para la prueba HbA1c con la curva ROC. Se usó correlación de Spearman para establecer la asociación entre GPA y HbA1c. Resultados El valor promedio de HbA1c fue 5,7 % ±0,8 y de la GPA fue 96 mg/dL±26,1; y esta última fue mayor en hombres (99,04±32,7). El 75,4 % de las muestras fueron normales para diagnóstico de diabetes con la prueba GPA, y con la HbA1c el 51,4 % clasificaron en este rango. El punto de corte donde la combinación sensibilidad-especificidad presenta los mejores valores para HbA1c fue 6,2 %. Discusión La prueba HbA1c presentó valores altos de sensibilidad y especificidad, por lo que su uso rutinario en el diagnóstico de diabetes mellitus podría contribuir a la búsqueda activa y la detección precoz de casos, que aseguren un mejor control de los factores de riesgo.

Objective Comparing haemoglobin A glycosylate (HbA1c) at different cutoff points for blood glucose measurement to the fasting plasma glucose (FPG) test in outpatients visiting a medical laboratory in the city of Medellin between March and April 2010. Methods 1,016 blood samples were studied from patients who had been referred to a medical laboratory. Agreement was obtained between tests (Kappa index); sensitivity and specificity were calculated. Different cutoff points for the HbA1c test were also evaluated with the ROC curve. Spearman correlation was used to establish association between FPG and Hb A1c. Results Average HbA1c was 5.7 %±0.8 and average FPG was 96 mg/dL±26.1; this was higher in men (99.04±32.7). 75.4 % of the samples came within the normal range for diagnosing diabetes with the FPG test, compared to 51.4 % with the HbA1c test. The cutoff point where combined sensitivity and specificity presented the best HbA1c value in this study group was 6.2 %. Discussion The HbA1c test had high sensitivity and specificity values, so its routine use in diagnosing diabetes mellitus could contribute towards active and early detection of cases to ensure better control of risk factors.

Costo oportunidad de adolescentes en unidades de medicina familiar / Opportunity cost for adolescents at family medicine clinics

Objective: To determine the opportunity cost for adolescents requiring care at Family Medicine Clinics. Material and Methods: Study of cost performed on 624 patients, 10-19 years of age, Family Medicine Clinics, Pharmacy and Laboratory. A conglomerate sample technique was used (Medical Unit), and proportional sampling internally. Several sociodemographic variables were evaluated, including transfer, waiting time and care. Statistical evaluation included averages, percentages, and confidence intervals of 95 percent. Results: The cost-opportunity for Family Medicine and Pharmacy in the situations evaluated was $10.22 for the teenager, $71.43 for the first family member, and $14.28 for the second person accompanying the child. When they attend all three services, the cost is $12.26, $82.71 and $16.54 respectively. A weighted average cost of opportunity IFOR all three services is $93.18. Conclusions: The largest cost of opportunity for adolescents occurs when waiting for care in Family Medicine. It is suggested that strategies be implemented to decrese waiting times in the various services.

Objetivo. Determinar el costo oportunidad de los adolescentes que demandan atención en las Unidades de Medicina Familiar. Material y Métodos. Estudio de costo oportunidad realizado en 624 usuarios de 10 a 19 años de edad atendidos en tres Unidades de Medicina Familiar, en los servicios de Medicina Familiar, Farmacia y Laboratorio. Se empleó la técnica muestral por conglomerados (Unidad Médica) y al interior por cuota. Se estudiaron variables sociodemográficas y número de acompañantes; se estimó el costo oportunidad para el traslado, espera y atención. El análisis estadístico incluyó promedios, porcentajes e intervalos de confianza del 95 por ciento. Resultados: El costo oportunidad promedio para Medicina Familiar y Farmacia es de $10.22 para el adolescente, de S 71.43 para el acompañante 1 y de $14.28 para el acompañante 2; cuando acuden a los tres servicios es de $12.26, $82.71 y $16.54 respectivamente. El costo oportunidad promedio ponderado cuando acuden a los tres servicios es de $93.18. Conclusión: El mayor costo oportunidad para los adolescentes corresponde a la espera en el servicio de Medicina Familiar. Por lo que se sugiere implementar estrategias que disminuyan el tiempo de espera en los diferentes servicios.