Comprehensive evaluation of male health in four communities in rural Honduras.

PODEMOS (Partnership for Ongoing Developmental, Educational and Medical Outreach Solutions) has been a long-standing healthcare provider in 4 communities in northern rural Honduras. In this study, we sought to understand and quantify the health challenges faced by men in the rural communities served by PODEMOS in order to improve the way PODEMOS delivers healthcare. Between June and July of 2015, we conducted 104 structured survey interviews with men 18 years and older in rural Honduras. We found that most men face significant economic limitations in their ability to pay for healthcare and health-determining services and due to low formal education levels face health literacy challenges. Furthermore, we found that a quarter are at risk for health problems due to smoking, and the majority are at risk for musculoskeletal problems due to work in strenuous outdoor labor. However, we found that zero respondents drank alcohol heavily, which is defined as more than 14 drinks in one week. Lastly, we found varying opinions on female contraception use. Our findings indicate that medical brigades to the developing world should understand and quantify the relevant health challenges faced by their target populations.

Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System.

BACKGROUND: Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit planning for outpatient care. This follow-up to our pilot study aimed to conduct pragmatic testing of a novel electronic health record-tethered framework and its effects on advance care planning delivery in a real-world primary care setting. OBJECTIVE: Our intervention tested a previsit advance care planning workflow centered around a framework sent via secure electronic health record-linked patient portal in a real-world clinical setting. The primary objective of this study was to determine its impact on frequency and quality of advance care planning documentation. METHODS: We conducted a pragmatic trial including 2 sister clinical sites, one site implementing the intervention and the other continuing standard care. A total of 419 patients aged between 50 and 93 years with active portal accounts received intervention (n=200) or standard care (n=219). Chart review analyzed the presence of advance care planning and its quality and was graded with previously established scoring criteria based on advance care planning best practice guidelines from multiple nations. RESULTS: A total of 19.5% (39/200) of patients who received previsit planning responded to the framework. We found that the intervention site had statistically significant improvement in new advance care planning documentation rates (P<.01) and quality (P<.01) among all eligible patients. Advance care planning documentation rates increased by 105% (19/39 to 39/39) and quality improved among all patients who engaged in the previsit planning framework (n=39). Among eligible patients aged between 50 and 60 years at the intervention site, advance care planning documentation rates increased by 37% (27/96 to 37/96). Advance care planning documentation rates increased 34% among high users (27/67 to 36/67). CONCLUSIONS: Advance care planning previsit planning using a secure electronic health record-supported patient portal framework yielded improvement in the presence of advance care planning documentation, with highest improvement in active patient portal users and patients aged between 50 and 60 years. Targeted previsit patient portal advance care planning delivery in these populations can potentially improve the quality of care in these populations.

Carboxymethyl derivative of scleroglucan: a novel thermosensitive hydrogel forming polysaccharide for drug delivery applications.

A carboxymethyl derivative of scleroglucan (Scl-CM) with a derivatization degree of 65 +/- 5% was synthesized. The rheological behaviour of this novel polymer was studied and compared with that of the starting polymer. We observed that the charged moieties carried on the chains could prevent the triple helix formation of Scl. Scl-CM aqueous solutions behave like true polymer solutions up to 1% w/v, whereas above this concentration a weak gel behaviour was observed. CaCl(2) addition to aqueous Scl-CM solutions led to a physical gel formation; the hydrogel strength was related to polymer and CaCl(2) concentrations. Temperature sweeps, registered at 1 Hz on hydrogels differing in CaCl(2) concentration, evidenced a gel --> sol transition in the range of 30-40 degrees C, depending on the molar ratio between carboxylic groups and Ca(+2). In order to verify a possible use of these hydrogels as drug delivery systems, acyclovir was loaded into the network. Rheological analysis evidenced that the loaded drug can affect the hydrogel elastic modulus. The release of acyclovir in phosphate buffer was evaluated at different temperatures in order to assess the suitability of this novel drug delivery system in topical applications.

Influence of the formulation components on the properties of the system SLN-dextran hydrogel for the modified release of drugs.

A system composed by solid lipid nanoparticles (SLN) entrapped into a chemical hydrogel of dextran was recently proposed for the controlled release of lipophilic drugs in oral formulations. This study reports now an extension of such study focused on the investigation of how the nature and the amount of the formulation components are able to modify the properties of the system. In particular the concentration of the two surfactants used for the nanosuspension stabilization, the nature of the lipid phase used for the nanoparticles preparation, as well as the concentration and the derivatization degree of the polymer employed for the gel preparation were investigated. The effects of these variables on the physicochemical properties of the nanoparticles and/or on the release profiles of the model drug (S)-(+)-2-(4-isobutylphenyl)-propionic acid (ibuprofen) were reported and discussed. Rheological experiments on samples of SLN, dextran hydrogel, and SLN-dextran hydrogel were also performed.

pH-sensitive hydrogels of dextran: synthesis, characterization and in vivo studies.

pH-Sensitive hydrogels of dextran were synthesized by photochemical cross-linking reaction of methacrylate dextran (DEX-MA) at different derivatization degree, functionalized with acidic residues through reaction with phthalic anhydride. The hydrogels were characterized by FT-IR spectra, swelling measurements, experiments of chemical and enzymatic hydrolyses. The swelling data agreed with the formation of networks having pH-sensitive behaviour. This property was confirmed by the morphological examination performed by scanning electron microscopy on samples maintained in media at different pH. (S)-4-Isobutyl-2-phenylpropionic acid (ibuprofen) was loaded into the polymeric matrices. The analysis of the release profiles of the drug from the three networks showed that all the matrices were able to retain ibuprofen during the transit through the stomach, releasing it in a sustained way in the intestinal tract at a rate strictly dependent on the derivatization degree in methacrylic groups. In vivo studies verified the biocompatibility of the materials. Moreover, when the matrix loaded with ibuprofen was administered to rats, it was able to protect them from the ulcerogenic effects of the drug.

Physical gels of a carboxymethyl derivative of scleroglucan: synthesis and characterization.

A carboxymethyl derivative of scleroglucan (Scl-CM) was synthesized and characterized through FT-IR, 1H NMR and potentiometer titration. Rheological studies allowed evidencing the effect produced by the introduction of the carboxymethyl moiety on the native polymer. The mechanical spectrum of the scleroglucan solution showed a weak gel behaviour, while the derivative one looked like a system near the gel point, that evolved to a gel state depending on the concentration. This difference could be related to conformational changes due to the introduction of the negative charges on the chains. Different concentrations of Ca2+, added to the aqueous solutions of Scl-CM, were able to deeply modify the resulting system, showing a sharp transition toward a gel like behaviour. Acyclovir was loaded into the hydrogels obtained with different amounts of polymer and salt. The release rate of the drug from these systems was strictly related to both concentrations of salt and polymer. The obtained results suggest a possible employment of these new hydrogels for topical formulations or in situ implantation.

Hydrogels of dextran containing nonsteroidal anti-inflammatory drugs as pendant agents.

The oral administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is often associated with upper gastrointestinal tract side effects. To reduce these effects and improve the therapeutic efficacy, NSAIDs are often formulated as controlled release systems. We have prepared a new formulation consisting of dextran hydrogels containing NSAIDs as pendant agents, through ultraviolet irradiation of solutions of dextran functionalized with methacrylic groups in the presence of the drug derivatized in the same way. Release studies of different drugs from this system, carried out in media simulating the gastrointestinal tract, have demonstrated that the amount of released drug is strictly related to the concentration of the polymer in the solution submitted to irradiation as well as to its derivatization degree. Our obtained data confirm that the system is able to realize a colon-specific drug delivery.

Solid lipid nanoparticles incorporated in dextran hydrogels: a new drug delivery system for oral formulations.

Solid lipid nanoparticles (SLN) containing or not (S)-(+)-2-(4-isobutylphenyl)propionic acid (ibuprofen) were prepared with Preciol ATO 5 as lipid phase by the hot homogenization technique and characterized through particle size analyses and zeta potential measurements. DSC experiments carried out on the freeze-dried samples of loaded SLN showed a shift of the melting endotherm of the lipid phase, with the maximum at a temperature value higher then that of the "empty" SLN. (1)H NMR of the nanosuspension allowed to calculate the encapsulation efficiency of the particles that was 52+/-3%. By adding dextran methacrylate (DEX-MA) to the aqueous phase and submitting the mixture to UV irradiation, systems of SLN (drug-loaded and unloaded) incorporated into a dextran hydrogel were prepared. Finally, dissolution studies of ibuprofen from the freeze-dried samples were performed. The comparison among the release profiles of ibuprofen from SLN, DEX-MA hydrogel and SLN/DEX-MA-hydrogel allows to affirm that this last system, retaining about 60% of the drug after 2h in acid medium and releasing it slowly in neutral solution, is suitable for modified delivery oral formulations.