Stigma, extreme poverty and residential situation: Residential segregation, household conditions and social relationship satisfaction among trash pickers in Leon, Nicaragua.

This study analyses the housing characteristics, residential situation, household conditions and satisfaction with social relations of trash pickers (N=99) in León, Nicaragua. Results show that the trash pickers in León live in slum households. A large percentage of the trash pickers live in a situation of residential segregation, although a substantial number of them are scattered across different neighbourhoods in the city. However, this does not seem to affect the widespread social rejection perceived by those interviewed. The trash pickers live in overcrowded conditions, despite reporting a high level of satisfaction with their relationships with their relative

Characteristics and needs of people living homeless in Leon (Nicaragua): Similarities and differences with other groups in severe social exclusion.

The study examines various aspects (e.g. socio-demographic characteristics, access to economic resources, social support, chronicity and access to new technologies) in a sample of homeless people living in León (Nicaragua; n=68). A questionnaire was used to collect the data. The results showed that people experiencing homelessness in León (Nicaragua) have enormous social difficulty, with high levels of chronification. Despite the major cultural and developmental differences between Spain and Nicaragua, there are considerable similarities between people living homeless in the two countries, while there are significant differences compared with waste pickers in León (Nicaragua) regarding the same aspects

Intersecting vulnerabilities, intersectional discrimination, and stigmatization among people living homeless in Nicaragua.

Objective: The main objective of this study is to examine the intersecting vulnerabilities, intersectional discrimination and stigmatization experienced by homeless people living in León (Nicaragua). Method: The data analyzed come from a Point-In-Time count carried out in the city of León, which identified 82 people living homeless. Forty-seven of the people identified responded to a brief questionnaire that provided more accurate information. Results: The results obtained showed that people living homeless in León largely presented "non-white" ethnic-racial traits, poor personal hygiene, readily visible physical health problems, and observable symptoms associated with mental health problems and alcohol and/or drug abuse. Conclusions: The information we obtained showed that people living homeless in León were subject to multiple intersecting vulnerabilities and aggravated forms of intersectional discrimination and social stigmatization, with a cumulative effect that could be highly detrimental to their social inclusion processes, leading to high levels of chronification of homelessness

Homeless people in León (Nicaragua): Conceptualising and measuring homelessness in a developing country.

Homelessness is a global phenomenon that affects groups in situations of poverty and social exclusion, in both developed and developing nations. However, the scientific literature on homeless people in developing countries is scant. This work shows the difficulties defining homelessness and examines the necessary criteria for who will be deemed a homeless person in a developing country. Furthermore, the results of the Point-In-Time (PIT) count of homeless people?a measure of the number of homeless people on a specific day?done in the city of León, Nicaragua (population: 185,000). Throughout the PIT count, 82 unduplicated people living in homelessness were tallied (76% male, 23% female), of which 47 answered a questionnaire. Most of the homeless people in León are male, mestizo, of Nicaraguan nationality, with a primary level education or less, and in a situation of chronic homelessness. Results showed a mean age of 47 years for these individuals. Most of the homeless people showed a bad physical appearance, had poor personal hygiene, and wore dirty clothing. Around half of the homeless observed seemed to have problems related to mental health, alcohol, and/or drugs.Universidad de Alcal

Real-world characteristics and outcome of patients treated with single-agent ibrutinib for chronic lymphocytic leukemia in Spain (IBRORS-LLC Study)

Background: Ibrutinib demonstrated remarkable efficacy and favorable tolerability in patients with untreated or relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL), including those with high-risk genetic alterations. The IBRORS-CLL study assessed the characteristics, clinical management and outcome of CLL patients receiving ibrutinib in routine clinical practice in Spain. Patients: Observational, retrospective, multicenter study in CLL patients who started single-agent ibrutinib as first-line treatment or at first or second relapse between January 2016 and January 2019. Results: A total of 269 patients were included (median age: 70.9 years; cardiovascular comorbidity: 55.4%, including hypertension [47.6%] and atrial fibrillation [AF] [7.1%]). Overall, 96.7% and 69% of patients underwent molecular testing for del(17p)/TP53 mutation and IGHV mutation status. High-risk genetic features included unmutated IGHV (79%) and del(17p)/TP53 mutation (first-line: 66.3%; second-line: 23.1%). Overall, 84 (31.2%) patients received ibrutinib as first-line treatment, and it was used as second- and third-line therapy in 121 (45.0%) and 64 (23.8%) patients. The median progression-free survival and overall survival were not reached irrespective of del(17p)/TP53, or unmutated IGHV. Common grade ≥3 adverse events were infections (12.2%) and bleeding (3%). Grade ≥3 AF occurred in 1.5% of patients. Conclusion: This real-world study shows that single-agent ibrutinib is an effective therapy for CLL, regardless of age and high-risk molecular features, consistent with clinical trials. Additionally, single-agent ibrutinib was well tolerated, with a low rate of cardiovascular events. This study also emphasized a high molecular testing rate of del(17p)/TP53 mutation and IGHV mutation status in clinical practice according to guideline recommendations

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially