Hepatitis C mortality trends in Mexico from 2001 to 2017.

INTRODUCTION AND OBJECTIVES: We aimed to analyze the trends of total and sex-stratified mortality from hepatitis C virus (HCV) and to estimate the proportion of non-alcoholic liver disease deaths in Mexico attributable to HCV from 2001-2017. MATERIALS AND METHODS: Using the mortality multiple-cause dataset, we selected the codes for acute HCV and chronic HCV to analyze trends from 2001 to 2017. We then estimated the proportion of HCV-related deaths out of non-alcoholic chronic liver disease deaths, by including in the denominator: other acute and chronic viral hepatitis, malignant neoplasm of the liver, liver failure, chronic hepatitis, fibrosis, and cirrhosis of the liver, and other inflammatory diseases of the liver. Average percent change (APC) for trends, overall and by sex, were estimated using Joinpoint regression. RESULTS: The trend in crude mortality rate significantly increased from 2001-2005 (APC 18.4%; 95%CI=12.5, 24.5; p value<0.001), and then significantly decreased from 2013-2017 (APC -6.5%; 95%CI=-10.1, -2.9; p value<0.001). Stratified by sex women experienced a more rapid decline in the 2014-2017 period than men. CONCLUSIONS: HCV mortality seems to have started to decrease, but much remains to be done in terms of prevention, diagnosis, and timely access to treatment.

Leveraging Administrative Data to Better Understand and Address Child Maltreatment: A Scoping Review of Data Linkage Studies.

BACKGROUND: This scoping review aimed to overview studies that used administrative data linkage in the context of child maltreatment to improve our understanding of the value that data linkage may confer for policy, practice, and research. METHODS: We searched MEDLINE, Embase, PsycINFO, CINAHL, and ERIC electronic databases in June 2019 and May 2020 for studies that linked two or more datasets (at least one of which was administrative in nature) to study child maltreatment. We report findings with numerical and narrative summary. RESULTS: We included 121 studies, mainly from the United States or Australia and published in the past decade. Data came primarily from social services and health sectors, and linkage processes and data quality were often not described in sufficient detail to align with current reporting guidelines. Most studies were descriptive in nature and research questions addressed fell under eight themes: descriptive epidemiology, risk factors, outcomes, intergenerational transmission, predictive modelling, intervention/service evaluation, multi-sector involvement, and methodological considerations/advancements. CONCLUSIONS: Included studies demonstrated the wide variety of ways in which data linkage can contribute to the public health response to child maltreatment. However, how research using linked data can be translated into effective service development and monitoring, or targeting of interventions, is underexplored in terms of privacy protection, ethics and governance, data quality, and evidence of effectiveness.

Política de acesso, acessibilidade e inclusão educacional da pessoa com deficiência: revisão integrativa / Policy of access, accessibility and educational inclusion for persons with disabilities: integrative review / Política de acceso, accesibilidad e inclusión educativa de personas con discapacidad: revisión integradora

Objetivo: conhecer os aspectos abordados pela produção científica em relação à temática da inclusão da pessoa com deficiência nas instituições de ensino. Método: revisão integrativa da literatura nas bases de dados Medical Literature and Retrivial Sistem on Line, Web of science, SCOPUS e Directory of Open Access Journals. Recorte da busca de 2015 a 2019. Resultados: foram analisados vinte e um artigos. As publicações apresentaram temáticas relacionadas à Políticas de acesso, cotas e currículos e Barreiras e facilitadores da inclusão na educação. Considerações finais: os aspectos abordados pela produção científica evidenciaram que entraves são transversais à vivência dos estudantes em suas experiências acadêmicas. Lacunas curriculares, estereotipação do corpo, crenças, falta de capacitação do corpo docente cerca-nos de evidências de que mais do que quebra de paradigmas diante da pessoa com deficiência, é preciso que existam avanços nas práticas políticas para que barreiras como preconceito, discriminação e segregação não definam as relações humanas.

Objective: to learn what concerns are addressed by scientific production on the theme of inclusion for people with disabilities in educational institutions. Method: this integrative literature review searched the Medical Literature Analysis and Retrieval System on Line, Web of Science, SCOPUS and Directory of Open Access Journals database entries from 2015 to 2019. Results: the twenty-one articles examined addressed themes relating to access policies, quotas and curricula, and barriers and facilitators of inclusion in education. Final considerations: the concerns addressed by the scientific production showed that obstacles are transversal to the students' experience in their academic life. Gaps in curricula, body stereotyping, beliefs, lack of capacity-building for teaching staffs surrounded us with evidence that, more than breaking paradigms regarding people with disabilities, there must be advances in political practices, so that barriers such as prejudice, discrimination, and segregation cease to define human relationships.

Objetivo: conocer los aspectos abordados por la producción científica en relación con el tema de la inclusión de personas con discapacidad en las instituciones de enseñanza. Método: revisión integradora de la literatura en las bases de datos Medical Literature and Retrivial Sistem on Line, Web of science, SCOPUS y Directory of Open Access Journals. Recorte de búsqueda de 2015 a 2019. Resultados: se analizaron veintiún artículos. Las publicaciones presentaron temas relacionados con políticas de acceso, cuotas y currículos y Barreras y facilitadores de la inclusión en la educación. Consideraciones finales: los aspectos abordados por la producción científica mostraron que los obstáculos son transversales a la vivencia de los estudiantes en sus experiencias académicas. Lagunas curriculares, estereotipos del cuerpo, creencias, falta de formación del profesorado nos rodean con evidencias de que, más allá de romper paradigmas ante las personas con discapacidad, son necesarios avances en las prácticas políticas para que barreras como el prejuicio, la discriminación y la segregación no definan las relaciones humanas.

Yield of whole exome sequencing in undiagnosed patients facing insurance coverage barriers to genetic testing.

BACKGROUND: Despite growing evidence of diagnostic yield and clinical utility of whole exome sequencing (WES) in patients with undiagnosed diseases, there remain significant cost and reimbursement barriers limiting access to such testing. The diagnostic yield and resulting clinical actions of WES for patients who previously faced insurance coverage barriers have not yet been explored. METHODS: We performed a retrospective descriptive analysis of clinical WES outcomes for patients facing insurance coverage barriers prior to clinical WES and who subsequently enrolled in the Undiagnosed Diseases Network (UDN). Clinical WES was completed as a result of participation in the UDN. Payer type, molecular diagnostic yield, and resulting clinical actions were evaluated. RESULTS: Sixty-six patients in the UDN faced insurance coverage barriers to WES at the time of enrollment (67% public payer, 26% private payer). Forty-two of 66 (64%) received insurance denial for clinician-ordered WES, 19/66 (29%) had health insurance through a payer known not to cover WES, and 5/66 (8%) had previous payer denial of other genetic tests. Clinical WES results yielded a molecular diagnosis in 23 of 66 patients (35% [78% pediatric, 65% neurologic indication]). Molecular diagnosis resulted in clinical actions in 14 of 23 patients (61%). CONCLUSIONS: These data demonstrate that a substantial proportion of patients who encountered insurance coverage barriers to WES had a clinically actionable molecular diagnosis, supporting the notion that WES has value as a covered benefit for patients who remain undiagnosed despite objective clinical findings.

Peer-reviewed public health journals from Arabic-speaking countries: An updated snapshot.

There is a positive association between availability of regional peer-reviewed public health information systems and progressive change in community and population health. The objective of this brief report was to identify public health journals in Arabic-speaking countries actively publishing as of 2016. We conducted an electronic search in several electronic database records for public health journals using a combination of search terms. We excluded journals that focused on human medicine, veterinary medicine, nursing, and other discipline-specific or clinical health professions. We identified twenty-five public health journals for review. Five journals were interrupted or discontinued. Only three journals had a consistent, uninterrupted active publication history of greater than 20 years. Most journals were not in the regional native language. Introduction of regional public health-dedicated journals with in-print and electronic availability and also to be published in region-native languages may require interdisciplinary partnerships. Region-wide public health journals such as the Eastern Mediterranean Health Journal could serve as an ideal model for the establishment of additional local and regional public health journals in Arabic-speaking countries.

¿EL PRINCIPIO DE PRECAUCIÓN HACE PARTE DEL PLAN DECENAL DE SALUD PÚBLICA DE COLOMBIA 2012-2021? / IS THE PRECAUTIONARY PRINCIPLE PART OF THE DECENAL PUBLIC HEALTH PLAN OF COLOMBIA 2012-2021?

El presente artículo está basado en el informe final del proyecto de investigación titulado El Principio de Precaución en el Plan Decenal de Salud Pública de Colombia. Aportes conceptuales para su implementación en Manizales y Caldas. A partir de la metodología cualitativa y mediante la técnica de análisis documental, se hizo rastreo de la inclusión del Principio de Precaución (PP) en la agenda mundial y la legislación nacional, analizando su incorporación en los diferentes lineamientos del actual Plan Decenal de Salud Pública (PDSP) para Colombia, relacionando estos aspectos con el derecho a la salud, la vida y a un ambiente sano. A través de los resultados se comprobó que no hay inclusión de manera explícita del PP en el actual PDSP, caracterizándose más bien por un enfoque preventivo. En algunos de sus lineamientos exhorta a la realización de acciones anticipatorias que prevengan el daño y el manejo de la incertidumbre en la evaluación del riesgo y el desarrollo de estrategias para identificarlo, manejarlo y mitigarlo, lo cual se considera un avance en relación con el anterior Plan Nacional de Salud Pública, pero los hallazgos de la investigación mostraron que las acciones se centran principalmente en el bienestar humano (principalmente en lo relacionado con la prevención de riesgos) y no se incluyen de manera directa las demás especies que hacen parte del entorno (en las dimensiones del Plan no se inserta la perspectiva compleja de la interacción entre el medio natural y el humano), lo cual demuestra una visión antropocentrista fuerte y poco ecológica en la formulación del Plan. Los hallazgos del estudio permitieron brindar aportes conceptuales para que entidades como la Dirección Territorial de Salud de Caldas y la Secretaría de Salud Pública de Manizales incorporen el PP en los planes, programas y proyectos derivados del PDSP.

This article is based on the final report of the research project El Principio de Precaución en el Plan Decenal de Salud Pública de Colombia. Aportes conceptuales para su implementación en Manizales y Caldas (The Precautionary Principle in the Ten-year Plan of Public Health in Colombia. Conceptual contributions for its implementation in Manizales and Caldas). From the qualitative methodology and through the documentary analysis technique, the inclusion of the Principio de Precaución -Precautionary Principle- (PP) was tracked on the global agenda and in the national legislation, analyzing its incorporation on the different points of the current Plan Decenal de Salud Pública (PDSP), -Ten-year Colombia Public Health Plan by linking these aspects with the right to health, to life and to a healthy environment. Through the results, it was found that there is not an explicit inclusion of the PP in the current PDSP, characterized rather by a preventive approach. In some of its guidelines the PDSP encourages the implementation of anticipatory actions that prevent damage and the management of uncertainty in risk assessment and in the development of strategies to identify it, manage it and mitigate it, which is considered an advance in relation to the previous Plan Nacional de Salud Pública -National Public Health Plan. However, the findings of the research showed that actions mainly focus on human welfare (mainly, related to risk prevention), and the other species that make part of the environment are not included directly (the complex perspective of the interaction between the natural environment and the human being are not inserted in the dimensions of the Plan), which demonstrates a strong anthropocentric and not very ecological vision in the formulation of the Plan. The findings of the study allowed to provide conceptual contributions for entities such as the Dirección Territorial de Salud de Caldas (Territorial Health Department of Caldas) and the Secretaría de Salud Pública de Manizales (Public Health Secretary of Manizales) to incorporate the PP plans, programs and projects derived from the PDSP.

[Bad results obtained from the current public health policies and recommendations of hydration].

INTRODUCTION: Achieving an adequate intake of water is crucial within a balanced diet. For that purpose, dietary guidelines for healthy eating and drinking are an important consideration and need to be updated and disseminated to the population. AIM: We aimed to evaluate the liquid intake habits of a Mediterranean and Latin American population (Spain-Portugal and Mexico-Uruguay) and if they support the current recommendations of hydration by the EFSA. METHODS: A record of fluid intake was obtained from 1168 participants from 4 countries above; and then compared with current consensus about hydration 1600 mL/day (female) and 2000 mL/day (male). RESULTS: The average fluid intake slightly surpassed the recommended: mean of 2049 mL/day (2,223 mL in males, 1,938 mL in females). Portugal stood out due to its lower intake (mean of 1,365 mL/day). Water contributed the largest part to total fluid intake (37%) in all countries (mean of 1365 mL/day). Hot beverages (18%) and milk and derivates (17%) follow water in highest consumption. The 20% of males and only 0.3% of females knew recommendations of hydration, while 63.3% of males and 62% of females followed them. Only 8.4% of people who follow the recommendations know them. CONCLUSION: The people studied surpassed the recommendation, although majority they didn´t know it. Future research should examine actual beverage consumption patterns and evaluate if the current consensuses are correctly adapted to the population needs. Hydration's policies should be transmitted to the population for their knowledge and adequate compliance.

Sobre fazer viver a participação dos usuários da saúde mental na produção de saúde / About do live the participation of mental health users in health production

O artigo problematiza o envolvimento participativo de usuários do campo da saúde mental no campo da atenção básica em saúde e analisa essa participação à luz dos mecanismos do biopoder. Os processos participativos foram investigados com base na metodologia de pesquisa-intervenção, com análise cartográfica de narrativas retiradas de grupos e entrevistas. Relaciona o tema ao contexto biopolítico de nosso tempo, que, tal como estudado por Michel Foucault, imprime marcas nos modos de subjetivação de todos os atores envolvidos. Aponta, ao final, a necessidade de que se estreitem relações entre os pontos da rede de atenção psicossocial, a fim de incrementar os processos participativos que existem, mas que não necessariamente se realizam em sua melhor potência nos espaços oficiais que o sistema hoje lhes destina. (AU)

This paper discusses the participatory involvement of mental health users in the field of primary care and analyzes this participation considering the biopower mechanisms. Participatory processes were investigated through intervention research methodology, cartographic analysis withdrawn from groups’ narratives and interviews. These methods relate the subject to the current biopolitics context, as studied by Michel Foucault, which prints marks in modes of the subjectivity of all the actors involved. The results point out some participatory process, although these processes do not necessarily occur in its best potency in the official spaces that the system designated for them today.As a conclusion, the necessity of a closer relationship between the Brazilian's services providing psychosocial care network is signaled in order to enhance participatory processes that already exist. (AU)

Accesibilidad a los servicios de salud mental con perspectiva diversidad de género. En el primer y segundo nivel de atención en la localidad de Alta Gracia

En décadas recientes, organizaciones sociales y políticas a nivel internacional y local han rebatido las perspectivas psi-hegemónicas que consideran a las identidades desde una visión normativa y polarizada en relación al género y a las sexualidades, entre ellas, la consideración de las identidades transgénero como una expresión patológica del género y la sexualidad que no tienen en cuenta el contexto social, cultural y político del binomio hombre/mujer y sexo/género. En base a estas situaciones de discriminación vividas por las personas LGBTI (Lesbianas, Gays, Bisexuales, Transgénerxs, Intersexuales) en su cotidianeidad, en los servicios de salud en particular; y por otro lado, por las recientemente aprobadas leyes de Salud Mental a nivel nacional y provincial, la Modificación del Matrimonio Civil entre personas del mismo sexo y la ley de Identidad de Género, enmarcadas en el paradigma de los derechos humanos se propone como objetivo: Identificar los obstáculos y facilitadores a la Accesibilidad de los Servicios de Salud Mental del Primer y Segundo Nivel de Atención en la ciudad de Alta Gracia de las personas con identidades LGBTI. A tal efecto, se trabajó desde la Metodología Cualitativa con un Estudio de Tipo Interpretativo y se realizaron entrevistas en profundidad a tres grupos de personas: profesionales de Salud Mental, Organizaciones Socio-Políticas de Diversidad de Género y personas que se autodefinen como LGBTI. Los datos producidos fueron sistematizados y analizados con el M.C.C –Método Comparativo Constante- una de las estrategias principales de la teoría fundamentada, con la utilización del programa de análisis cualitativo Atlas...

In recent decades, social policy and international and local organizations have challenged the psi - hegemonic perspectives that consider the identities from a normative and polarized vision in relation to gender and sexualities, including consideration of transgender identities as a pathological expression of gender and sexuality that do not take into account the social, cultural and political context of the binomial man / woman and sex / gender. Based on these situations of discrimination experienced by LGBTI ( Lesbians, Gays, Bisexual, Transgénerxs , Intersex ) in their daily lives , in particular health services and on the other hand, recently approved by the laws of Mental Health at national and provincial Modification Civil Marriage between same sex and gender identity law , framed in the paradigm of human rights has as objective: To identify barriers and facilitators to the Accessibility of Mental Health Services first and second level of care in the city of Alta Gracia people with LGBTI identities. For this purpose, we worked from a Qualitative methodology Interpretive Study type and three groups of people interviews were conducted in depth: Mental Health professionals, Socio- Political Organizations Diversity Gender and people who define themselves as LGBTI. The data produced were systematized and analyzed with the constant comparative method - MCC - one of the main strategies of grounded theory, the use of qualitative analysis software Atlas...