La situación de discapacidad en el proceso de determinación de pobreza y el acceso a programas sociales de transferencia monetaria: caso Programa Nacional Contigo-Región Lima

La presente investigación aborda el siguiente problema: ¿Cómo el proceso de clasificación socioeconómica para la determinación de pobreza de los hogares con uno o más integrantes con discapacidad limita su acceso o permanencia en programas sociales de transferencia monetaria? Y tiene como objetivo analizar, identificar y proponer los criterios o aspectos de clasificación socioeconómica de hogares, lo que permitirá recoger y procesar la información de un hogar con uno o más integrantes con discapacidad para la determinación de su situación de pobreza en relación a su acceso y permanencia en programas sociales: Caso Programa CONTIGO. Así, el estudio involucra el análisis del actual procedimiento de determinación de la clasificación socioeconómica, la identificación de los roles de los actores con competencia en discapacidad en el proceso de determinación de pobreza de hogares con uno o más integrantes con discapacidad, y el desarrollo de una propuesta de inclusión y/o mejora de criterios y/o aspectos en el proceso de clasificación socioeconómica de un hogar con uno o más integrantes con discapacidad, que contribuya a su acceso y permanencia en programas sociales. Para tal efecto, se realizó una investigación de tipo cualitativa, teniendo en cuenta la aplicación de encuestas a hogares con uno o más integrantes con discapacidad y entrevistas semiestructuradas a actores nacionales, regionales y locales con competencia en discapacidad como representantes del Consejo Nacional para la Integración de la Persona con Discapacidad - CONADIS, Ministerio de Salud- MINSA, Programa Nacional CONTIGO, responsables de las Oficinas Regionales de Atención a la Persona con Discapacidad - OREDIS, Oficinas Municipales de Atención a las Persona con Discapacidad - OMAPED. Finalmente, se presenta la propuesta de inclusión/mejora de criterios y/o aspectos para ser incorporados en el proceso de clasificación socioeconómica de hogares desde una perspectiva de discapacidad, desde la metodología que permita identificar las necesidades e intereses de los hogares con uno o más integrantes con discapacidad; la tabulación de los datos recogidos sobre discapacidad recogidos en la Ficha Socioeconómica Única - FSU, la homogenización de la información recogida respecto al tipo de limitaciones, la inclusión del información del MINSA y CONADIS en las Base de Datos Administrativa- BDA, la inclusión de un proceso de oficio para solicitud de la CSE que permita llegar a los ciudadanos en situación de vulnerabilidad en el marco de una gestión pública centrada en el ciudadano. Asimismo, es importante considerar la participación activa de CONADIS como ente rector de discapacidad que asegure el funcionamiento de la operatividad del sistema de focalización en los tres niveles de gobiernos como se establece en el Sistema Nacional de Focalización de Hogares-SINAFOH

Comparison of 10-year overall survival between patients with G1 and G2 grade Ta bladder tumors

To compare long-term overall survival (OS) in patients with G1 and G2 grade Ta bladder cancer after transurethral resection of bladder tumors (TURBTs). Secondary aim was to investigate clinical and pathologic prognostic factors for OS of Ta patients, except G3/high grade (HG). A total of 243 patients, retrospectively selected, with Ta nonmuscle invasive bladder cancer (NMIBC) underwent TURBT between January 2006 and December 2008 (median follow-up 109 months). Inclusion criteria were: Ta at first manifestation, G1 or G2 grade with no associated carcinoma in situ (CIS). Seventy-nine patients were excluded due to concomitant CIS (1), G3/HG tumors (47), and lost to follow-up (31). Ethical approval was obtained from the Ethical Committee of the Mures County Hospital. Statistical analysis was performed using STATA 11.0. Following inclusion criteria, 164 patients with primary G1 or G2 Ta tumors, were enrolled. Recurrence was observed in 26 (15.8%) and progression in 5 (3%) patients. Ten-year survival in G1 patients was 67.8% (CI 54.3-78.1) and in G2 patients 59% (CI 49-67.3) (P=.31). Univariable and multivariable logistic regression analysis underlined that advanced age at diagnosis (hazard ratio [HR] 1.10) and no Bacillus Calmette-Guerin (BCG) treatment (HR 0.24 and 0.29) were independent predictors for death at 10 years after diagnosis. Long-term analysis confirms that patients with well differentiated (G1) and moderately well differentiated (G2) Ta tumors have similar OS. A longer OS was even reported in those who underwent BCG adjuvant therapy

Leiomiom al vezicii urinare (prezentare de caz)

Abstract Bladder leiomyoma is a benign tumour, with a rather low incidence, 0,43%, at about 200 cases presented in the literature. The authors present a case of a female patient aged 70 years, who was treated in the Clinic of Urology Târgu-Mureş presenting dysuria and polakysuria. The abdominal ultrasound examination, IVU, cystoscopy revealed a tumour (5x5 cm dimension) localised near the bladder neck on the left lateral wall of the bladder. This tumour had an omogenous structure, produced bladder outlet obstruction, the residual urine was about 150 ml. A transurethral resection was performed for the tumour (weight 50 gr). The endoscopic control revealed a tumour covered with normal urothelium, localised on the left lateral bladder wall near neck. The macroscopic aspect of the tumour was like the adenomatous tissue of the prostate in man. The histopathological finding (hematoxilin eosing dying, imunohistochemical ex.) revealed leiomyoma of the bladder (no signs of malignancy). The patient had no bladder obstruction after the endoscopic procedure. Bladder leiomyoma is a very rare, benign tumour. The one presented is an endovezical one causing bladder obstruction. The endoscopia procedure solved the case, the 3 month follow up revealed a normal bladder. Introducere. Leiomiomul vezicii urinare este o tumoră benignă mezenchimală cu incidenţă scăzută sub 0,43%, în literatura de specialitate raportându-se aproximativ 200 de cazuri. Localizarea leiomiomului poate fi endovezicală, intramurală şi extravezicală. Materiale şi metode. Prezentăm cazul unei bolnave U.V. în vârstă de 70 ani, internată în clinica noastră între 15.11.- 21.11.2005 pentru acuze urinare de tip obstructiv (disurie, polakiurie). Examinările paraclinice (ecografie, urografie în faza cistografică, cistoscopie) pun în evidenţă o formaţiune tumorală de 5/5 cm situată în vecinătatea colului vezical ataşat peretelui stîng al vezicii urinare. Investigaţiile efectuate sugerau existenţa unei tumori bine delimitate, cu structură omogenă şi cu caracter obstructiv tip clapetă pe colul vezical, pacienta având un reziduu urinar de 150 ml. Sunt prezentate imagini radiologice, ecografice, endoscopice şi histologice ale tumorii vezicale benigne. Bolnava a fost supusă unei intervenţii transuretrale cu rezecţia în totalitate a tumorii, în greutate de 50 gr. Rezultate şi discuţii. Intervenţia endoscopică a pus în evidenţă formaţiunea tumorală descrisă, acoperită de un uroteliu normal, având baza de inserţie pe peretele stîng în imediata vecinătate a colului, cu caracterele obstructive amintite. Rezecţia transuretrală a dus la îndepărtarea tumorii în totalitate. Aspectul macroscopic al ţesutului rezecat fiind asemănător cu cel al adenomului de prostată de la bărbat. Ex. histopatologic (coloraţiile hematoxilinăeozină, imunohistochimice) pun diagnosticul de leiomiom al vezicii urinare fără elemente atipice. După îndepărtarea sondei uretrovezicale, fenomenele obstructive semnalate de pacientă au dispărut. Concluzii. Leiomiomul vezical este o tumoră benignă extrem de rară. Forma prezentată în poster este endovezicală obstructivă. Intervenţia endoscopică a dus la îndepărtarea tumorii în totalitate, cu dispariţia simptomatologiei. Controlul endoscopic la 3 luni a relevat o vezică urinară normală

Motoric Cognitive Risk Syndrome: Prevalence and Cognitive Performance. A cross-sectional study

Background Motoric Cognitive Risk Syndrome (MCR) is a predementia stage where slow gait speed and subjective memory complaints are present. The purpose of this study was to estimate the prevalence of MCR and assess its relationship with sociodemographic factors and chronic conditions. Methods This is a secondary analysis of the SABE Colombia study conducted in 2015. The analytic sample consisted of 17·577 participants. After determining MCR prevalence, logistic regression was performed to examine the correlates of MCR. Findings The prevalence of MCR was 10·71 %. The median age was 71 years and women composed 74·63 % of the MCR group. After adjusting for confounding variables MCR was associated with increasing age (OR 1·69, CI 1·43 - 1·92), no or low education (OR 1·99, CI 1·67- 2·37), MMSE (OR 0·93, CI 0·91 - 0·95) and chronic conditions such as mental disorders (OR 1·36, CI 1·11-1·67), history of myocardial infarction (OR 1·24, CI 1·04 - 1·47), hypertension (OR 1·23, CI 1·08 - 1·40) and diabetes (OR 1.18, CI 1.01 – 1.37). Interpretation This study found a prevalence of 10·71 % of MCR in Colombian older adults. Additionally, MCR was associated with chronic conditions and sociodemographic factors identified in prior studies. These results increase the awareness of a novel predementia stage whose identification can be performed by clinicians in the outpatient clinic, minimizing the cost of a full neuropsychologic evaluation performed in a memory clinic.publishedVersio

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

RARE-Bestpractices: a platform for sharing best practices for the management of rare diseases

No abstract available

RARE-Bestpractices: a platform for sharing best practices for the management of rare diseases

No abstract available

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication