Commentaries on ‘Hand washing for preventing diarrhoea’, with a response from the review authors

944-950These are commentaries on a Cochrane review, published in this issue of EBCH, first published as: Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing for preventing diarrhoea. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004265. DOI: 10.1002/14651858.CD004265.pub2

Prevalencia de depresión y factores asociados con ella en la población colombiana The prevalence of and factors associated with depression in Colombia

OBJETIVOS: Analizar la prevalencia del síndrome depresivo y los factores asociados con la depresión en Colombia entre los años 2000 y 2001. MÉTODOS: Para este estudio descriptivo de corte transversal se aplicó una encuesta entre noviembre de 2000 y enero de 2001 a 1 116 adultos de 18 años de edad o más de uno u otro sexo que residían en viviendas particulares seleccionadas mediante un muestreo representativo nacional polietápico, estratificado según el grado de urbanización del área incluida en el muestreo. La depresión se clasificó en breve, subclínica o clínica (leve, moderada o grave) en los 30 días y los 12 meses previos a la entrevista. Se calcularon las frecuencias simples y estratificadas por la edad y el sexo, y los intervalos de confianza de 95% (IC95%) de más de 500 variables. La asociación de las variables seleccionadas con episodios depresivos se evaluó mediante un modelo de regresión logística con múltiples variables. RESULTADOS: De las personas estudiadas, 10,0% (IC95%: 9,2 a 10,7) presentaron algún episodio depresivo en los 12 meses previos a la encuesta y 8,5% (IC95%: 7,8 a 9,2) sufrieron alguno durante el último mes. Hubo una mayor proporción de mujeres con depresión en ambos períodos. Más de 50% de los episodios fueron moderados, tanto en hombres como en mujeres, y las mayores prevalencias se encontraron en las personas mayores de 45 años. Los factores asociados con la depresión en el último mes fueron ser mujer, considerar el estado de salud propio como regular o malo, sufrir de dolores o molestias, tener dificultades en las relaciones interpersonales, consumir marihuana o sustancias adictivas, medicamentos estimulantes o calmantes, tener dependencia del alcohol, o estar desempleado con discapacidad. CONCLUSIÓN: La depresión es una afección frecuente en Colombia. Se deben poner en marcha medidas dirigidas a reducir el riesgo de depresión, especialmente en mujeres y en personas mayores de 45 años de edad.OBJECTIVES: To analyze the prevalence of depression and the factors associated with it in Colombia in 2000 and 2001. METHODS: For this descriptive cross-sectional study a survey was conducted between November 2000 and January 2001 with 1 116 men and women 18 years of age or older who were living in private homes that were selected through a multistage national representative sampling, stratified according to the degree of urbanization of the area included in the sampling. Depression was classified as brief recurrent depression, subclinical depression, or mild, moderate, or serious clinical depressive episodes in the 30 days and in the 12 months prior to the interview. Simple and stratified frequencies of over 500 variables, along with their 95% confidence intervals (95% CIs), were calculated by age and gender. The association that the selected variables had with depressive episodes was evaluated through a multivariate logistic regression model. RESULTS: Of the persons studied, 10.0% of them (95% CI: 9.2% to 10.7%) had had a depressive episode in the 12 months prior to the survey, and 8.5% (95% CI: 7.8% to 9.2%) had suffered a depressive episode in the preceding month. There was a higher proportion of women with depression in both of the periods. More than 50% of the episodes were moderate, in both men and women. There were higher prevalences of depression in persons older than 45 years. The factors associated with depression in the preceding month were: female gender; considering one's health to be moderate or bad; suffering from pain or discomfort; having difficulties in interpersonal relations; consuming marijuana, addictive substances, stimulants, or tranquilizers; being dependent on alcohol; and being unemployed and unable to work. CONCLUSIONS: Depression is a frequent disorder in Colombia. Measures directed at reducing the risk of depression should be implemented, especially among women and in persons over 45 years old

Application of machine learning methodology to assess the performance of DIABETIMSS program for patients with type 2 diabetes in family medicine clinics in Mexico

BACKGROUND: The study aimed to assess the performance of a multidisciplinary-team diabetes care program called DIABETIMSS on glycemic control of type 2 diabetes (T2D) patients, by using available observational patient data and machine-learning-based targeted learning methods. METHODS: We analyzed electronic health records and laboratory databases from the year 2012 to 2016 of T2D patients from six family medicine clinics (FMCs) delivering the DIABETIMSS program, and five FMCs providing routine care. All FMCs belong to the Mexican Institute of Social Security and are in Mexico City and the State of Mexico. The primary outcome was glycemic control. The study covariates included: patient sex, age, anthropometric data, history of glycemic control, diabetic complications and comorbidity. We measured the effects of DIABETIMSS program through 1) simple unadjusted mean differences; 2) adjusted via standard logistic regression and 3) adjusted via targeted machine learning. We treated the data as a serial cross-sectional study, conducted a standard principal components analysis to explore the distribution of covariates among clinics, and performed regression tree on data transformed to use the prediction model to identify patient sub-groups in whom the program was most successful. To explore the robustness of the machine learning approaches, we conducted a set of simulations and the sensitivity analysis with process-of-care indicators as possible confounders. RESULTS: The study included 78,894 T2D patients, from which 37,767patients received care through DIABETIMSS. The impact of DIABETIMSS ranged, among clinics, from 2 to 8% improvement in glycemic control, with an overall (pooled) estimate of 5% improvement. T2D patients with fewer complications have more significant benefit from DIABETIMSS than those with more complications. At the FMCs delivering the conventional model the predicted impacts were like what was observed empirically in the DIABETIMSS clinics. The sensitivity analysis did not change the overall estimate average across clinics. CONCLUSIONS: DIABETIMSS program had a small, but significant increase in glycemic control. The use of machine learning methods yields both population-level effects and pinpoints the sub-groups of patients the program benefits the most. These methods exploit the potential of routine observational patient data within complex healthcare systems to inform decision-makers