Ethnic group inequalities in coverage with reproductive, maternal and child health interventions:cross-sectional analyses of national surveys in 16 Latin American and Caribbean countries

Background Latin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among these groups in population coverage with reproductive, maternal, newborn, and child health interventions. Methods We analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15-49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12-23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), woman's education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression. Findings Ethnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0.82, IQR 0.66-0.92), antenatal care (0.86, 0.75-0.94), and skilled birth attendants (0.75, 0.68-0.92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries. Interpretation The lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level-such as vaccines-show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes.Entidad financiadora: Bill & Melinda Gates Foundation; Wellcome Trus

Effects of transdermal nitroglicerin patches on inflammation and vascular lesion biomarkers in preeclamptic patients

El objetivo de la investigación fue establecer los efectos detratamiento con parches de nitroglicerina sobre las concentracionesde los bio-marcadores de inflamación y lesión vascularen preeclámpticas. La muestra fue de preeclámpticasnulíparas con embarazos de más de 25 semanas que acudierona la emergencia obstétrica del Hospital Central ‘‘Dr.Urquinaona’’, Maracaibo, Venezuela. Se midieron las concentracionesinterleucinas 6 y 10, factor de necrosis tumoralalfa, interferón gamma, proteína C reactiva, selectinas (P, Ey L) y dimetilarginina asimétrica. El tratamiento fue con parchestransdérmicos de nitroglicerina de 5 mg, aplicado en laregión torácica anterior o lumbar de las pacientes por un períodode 12 horas, por un tiempo total de 48 horas. La edadmaterna promedio fue de 21,77 ± 3,07 años y la edad gestacionalfue de 34,23 ± 1,85 semanas. Se observó una disminuciónsignificativa en la presión arterial sistólica y diastólicaal comparar los valores antes y después del tratamiento (p <0,05). Sin embargo, no se encontraron modificaciones en lasconcentraciones plasmáticas de interleucina 6, interleucina10, factor de necrosis tumoral alfa, interferón gamma, proteínaC reactiva, selectinas y dimetilarginina asimétrica luegodel uso de los parches de nitroglicerina al compararlo con losvalores iniciales (p = ns). Se concluye que el tratamiento conparches de nitroglicerina no produce modificaciones en lasconcentraciones séricas de bio-marcadores de inflamación ylesión vascular en pre-eclámpticas

Ethnic group inequalities in coverage with reproductive, maternal and child health interventions: cross-sectional analyses of national surveys in 16 Latin American and Caribbean countries

Summary: Background: Latin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among these groups in population coverage with reproductive, maternal, newborn, and child health interventions. Methods: We analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15–49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12–23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), woman's education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression. Findings: Ethnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0·82, IQR 0·66–0·92), antenatal care (0·86, 0·75–0·94), and skilled birth attendants (0·75, 0·68–0·92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries. Interpretation: The lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level—such as vaccines—show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes. Funding: The Bill & Melinda Gates Foundation (through the Countdown to 2030 initiative) and the Wellcome Trust

Tópicos de marketing

Lograr un equilibrio entre acciones humanas, armonía con la naturaleza, y satisfacer las necesidades del mercado actual sin poner en riesgo aquellos recursos que pudieran precisar las futuras generaciones, es lo importante de impulsar la aplicación del marketing sostenible en las organizaciones. Esto se logra a través de la elaboración de un plan de marketing sostenible que permitirá promover un consumo responsable a través de información clara y oportuna sobre los beneficios personales y sociales que genera la adquisición de productos sostenibles; implantar el reciclado a través de la logística de reversa, procedimiento que origina poca o nula generación de desechos, proporcionar empleos seguros, apoyar al medio ambiente y con responsabilidad social, son algunos beneficios que aporta. El presente capítulo tiene como objetivo proporcionar los principales aspectos que abordan el marketing sostenible, mostrar la importancia de la realización de este marketing para las empresas, así como aportar los pasos para desarrollar un plan de marketing sostenible

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