The effectiveness and cost-effectiveness of integrating mental health services in primary care in low- and middle-income countries : systematic review

Q1Artículo original1-13Aims and method This systematic review examines the effectiveness and costeffectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries. Results Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models. Clinical implications Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models

A case-control study of Burkitt lymphoma in East Africa: are local health facilities an appropriate source of representative controls?

Abstract Background We investigated the feasibility and appropriateness of enrolling controls for Burkitt lymphoma (BL) from local health facilities in two regions in Uganda. Methods BL case data were compiled from two local hospitals with capacity to diagnose and treat BL in North-west and North-central regions of Uganda during 1997 to 2009. Local health facility data were compiled from children attending four representative local health facilities in the two regions over a two week period in May/June 2010. Age and sex patterns of BL cases and children at local facilities were compared and contrasted using frequency tables. Results There were 999 BL cases diagnosed in the study area (92% of all BL cases treated at the hospitals): 64% were from North-central and 36% from North-west region. The mean age of BL cases was 7.0 years (standard deviation [SD] 3.0). Boys were younger than girls (6.6 years versus 7.2 years, P = 0.004) and cases from North-central region were younger than cases from North-west region (6.8 years versus 7.3 years, P = 0.014). There were 1012 children recorded at the four local health facilities: 91% at facilities in North-central region and 9% from facilities in North-west region. Daily attendance varied between 1 to 75 children per day. The mean age of children at health facilities was 2.2 years (SD 2.8); it did not differ by sex. Children at North-central region facilities were younger than children at North-west region facilities (1.8 years versus 6.6 years, P < 0.001). Conclusions While many children attend local health facilities, confirming feasibility of obtaining controls, their mean age is much lower than BL cases. Health facilities may be suitable for obtaining young, but not older, controls

Health-related quality of life and health literacy among adult primary care patients with subsidized or contributive health insurance in Colombia

Q3Context Colombia passed Law 100 in 1993 with the goal of providing universal health care coverage, and by 2013, over 96% of the Colombian population had health insurance coverage. However, little is known about how health-related quality of life (HRQoL) and health literacy are related among those with the two most common types of health insurance coverage: subsidised (those with lower incomes) and contributory (those with higher incomes) coverage. Objectives and methods In the current exploratory investigation, data from adults visiting six primary care clinics in Colombia were analysed to examine the relationship between HRQoL (assessed as problems with mobility, self-care, completing usual activities, pain/discomfort, and anxiety/depression), demographics, the two health insurance types, and health literacy. Analyses also assessed whether, within insurance types, health literacy was related to HRQoL. Results Results showed that those with contributory health insurance coverage had greater health literacy than those with subsidised coverage, and this was accounted for by differences in education and socioeconomic status. HRQoL did not differ by insurance type. Although lower health literacy was related to worse HRQoL in the overall sample, in subgroup analyses lower health literacy significantly related to worse HRQoL only among those with subsidised health insurance coverage. Conclusion Targeting skills which contribute to health literacy, such as interpreting medical information or filling out forms, may improve HRQoL, particularly in those with subsidised insurance coverage.Revista Internacional - Indexad

Mickalene Thomas : Femmes Noires

"Mickalene Thomas's vivid paintings, collages, and photographs explode off the wall. Their larger-than-life women stare back and down at the viewer, confronting them head on. Over the course of her prolific career, Thomas has created a body of work that expands notions of beauty, gender, sexuality, and race, offering a complex vision of what it means to be a Black woman. In Femmes Noires, Thomas moves breezily between pop culture and the long history of Western and African art, inserting images of Black women into iconic paintings. At times she poses them nude; at other times, she draws on elements as diverse as 1970s black-is-beautiful images of women, Edouard Mamet's odalisque figures, the mise-en-scène studio portraiture of James Van Der Zee and Malick Sidibé, and her own collection of personal portraits and staged scenes. Her ability to detect and contain contradictions and to wrestle with stereotypes translates into powerful, self-possessed depictions of Black women that confront and subvert stereotypes." -- Distributor's website

Implementing Technology-Supported Care for Depression and Alcohol Use Disorder in Primary Care in Colombia : Preliminary Findings

Q2Q1Artículo completo1-6Objective: Depression and alcohol use disorder are among the most common causes of disability and death worldwide. Health care systems are seeking ways to leverage technology to screen, evaluate, and treat these conditions, because workforce interventions alone, particularly in low- and middle-income countries, are insufficient. This article reports data from the first year of implementation of a technology-supported, systematic approach to identify and care for persons with these disorders in primary care in Colombia. Methods: A care process that includes waiting room kiosks to screen primary care patients, decision support tablets to guide doctors in diagnosis and treatment, and access to digital therapeutics as a treatment option was implemented in two primary care clinics, one urban and one in a small town. The project collected data on the number of people screened, diagnosed, and engaged in the research and their demographic characteristics. Results: In the first year, 2,656 individuals were screened for depression and unhealthy alcohol use in the two clinics. Primary care doctors increased the percentage of patients diagnosed as having depression and alcohol use disorder from next to 0% to 17% and 2%, respectively. Conclusions: Early experience with implementing technology-supported screening and decision support for depression and alcohol use disorder into theworkflowof busy primary care clinics in Colombia indicates that this caremodel is feasible and leads to dramatically higher rates of diagnoses of these conditions. Diagnosis in these settings appeared to be easier for depression than for alcohol use disorder

Addressing harmful alcohol use in primary care in Colombia : understanding the sociocultural context

Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategQ3Q3Revista Nacional - Indexada