Producing comparable cost and quality results from all-payer claims databases.

OBJECTIVES: To describe how all-payer claims databases (APCDs) can be used for multistate analysis, evaluating the feasibility of overcoming the common barrier of a lack of standardization across data sets to produce comparable cost and quality results for 4 states. This study is part of a larger project to better understand the cost and quality of healthcare services across delivery organizations. STUDY DESIGN: Descriptive account of the process followed to produce healthcare quality and cost measures across and within 4 regional APCDs. METHODS: Partners from Colorado, Massachusetts, Oregon, and Utah standardized the calculations for a set of cost and quality measures using 2014 commercial claims data collected in each state. This work required a detailed understanding of the data sets, collaborative relationships with each other and local partners, and broad standardization. Partners standardized rules for including payers, data set elements, measure specifications, SAS code, and adjustments for population differences in age and gender. RESULTS: This study resulted in the development of a Uniform Data Structure file format that can be scaled across populations, measures, and research dimensions to provide a consistent method to produce comparable findings. CONCLUSIONS: This study demonstrates the feasibility of using state-based claims data sets and standardized processes to develop comparable healthcare performance measures that inform state, regional, and organizational healthcare policy.

Genetic variability of Aedes aegypti in the department of Sucre, Colombia, by analysis of the nucleotide sequence of the mitochondrial ND4 gene

Introduction. Aedes aegypti is the most important mosquito species in America for the transmission of viruses of dengue, Zika, Chikungunya and yellow fever. Ecological factors as well as chemical controls can affect the genetic composition of Ae. aegypti populations, which is why its genetic characterization is necessary. Objective. To determine the genetic variability of Ae. aegypti populations in four municipalities of Sucre department, Colombia. Materials and methods. Larvae of Ae. aegypti, collected in the municipalities of Sincelejo, Sampués, Corozal and Guaranda, Sucre department, were reared under laboratory conditions to adult stage. A segment of the mitochondrial ND4 gene which codes for the subunit 4 of the enzyme NADH-dehydrogenase was used as genetic marker. The genetic analysis included the estimation of parameters of nucleotide and haplotype diversity, genetic structure and gene flow. Results. One hundred and eight partial sequences of 357 nucleotides and four nucleotide haplotypes of the ND4 gene of Ae. aegypti were obtained. A significantly high genetic differentiation was found between the Sampués and Guaranda populations (FST=0.59467), Sincelejo and Sampués (FST=0.25637), and Corozal and Guaranda (FST=0.22237). A high gene flow (Nm=infinite) was observed among the populations of Sincelejo and Corozal. Conclusion. There are genetic differences between the Ae. aegypti populations from the municipalities of Sucre department. The presence of a new haplotype of the mitochondrial ND4 gene of Ae. aegypti in Colombia was recorded, detected in the municipality of Sincelejo.

Variabilidad genética de Aedes aegypti en el departamento de Sucre, Colombia, mediante el análisis de la secuencia de nucleótidos del gen mitocondrial ND4 / Genetic variability of Aedes aegypti in the department of Sucre, Colombia, by analysis of the nucleotide sequence of the mitochondrial ND4 gene

Resumen Introducción. Aedes aegypti es la especie de mosquito de mayor relevancia en América por transmitir los virus del dengue, del Zika, del chikungunya y de la fiebre amarilla. Tanto factores ecológicos como el control químico, pueden influir en la composición genética de las poblaciones de Ae. aegypti, por lo cual es necesaria su caracterización. Objetivo. Determinar la variabilidad genética de las poblaciones de Ae. aegypti en cuatro municipios del departamento de Sucre, Colombia. Materiales y métodos. Larvas de Ae. aegypti, recolectadas en los municipios de Sincelejo, Sampués, Corozal y Guaranda del departamento de Sucre, fueron criadas en laboratorio hasta el estado adulto. Como marcador genético, se utilizó un segmento del gen mitocondrial ND4, que codifica para la subunidad 4 de la enzima NADH-deshidrogenasa. El análisis genético incluyó la estimación de parámetros de diversidad de nucleótidos, haplotipos, de estructura genética y de flujo de genes. Resultados. Se obtuvieron 108 secuencias parciales de 357 nucleótidos y cuatro haplotipos de nucleótidos del gen ND4 de Ae. aegypti. Se encontró una diferenciación genética significativamente alta entre las poblaciones de Sampués y Guaranda mediante el índice de fijación (F ST =0,59467), las de Sincelejo y Sampués (F ST = 0,25637), y las de Corozal y Guaranda (F ST = 0,22237). Se evidenció un gran flujo de genes (Nm=infinito) entre las poblaciones de Sincelejo y Corozal. Conclusión. Existen diferencias genéticas entre las poblaciones del mosquito Ae. aegypti de los municipios del departamento de Sucre. Se registra la presencia de un nuevo haplotipo del gen mitocondrial ND4 de Ae. aegypti en Colombia, el cual fue detectado en el municipio de Sincelejo.

Abstract Introduction. Aedes aegypti is the most important mosquito species in America for the transmission of viruses of dengue, Zika, Chikungunya and yellow fever. Ecological factors as well as chemical controls can affect the genetic composition of Ae. aegypti populations, which is why its genetic characterization is necessary. Objective. To determine the genetic variability of Ae. aegypti populations in four municipalities of Sucre department, Colombia. Materials and methods. Larvae of Ae. aegypti, collected in the municipalities of Sincelejo, Sampués, Corozal and Guaranda, Sucre department, were reared under laboratory conditions to adult stage. A segment of the mitochondrial ND4 gene which codes for the subunit 4 of the enzyme NADH-dehydrogenase was used as genetic marker. The genetic analysis included the estimation of parameters of nucleotide and haplotype diversity, genetic structure and gene flow. Results. One hundred and eight partial sequences of 357 nucleotides and four nucleotide haplotypes of the ND4 gene of Ae. aegypti were obtained. A significantly high genetic differentiation was found between the Sampués and Guaranda populations (F ST =0.59467),Sincelejo and Sampués (F ST =0.25637), and Corozal and Guaranda (F ST =0.22237). A high gene flow (Nm=infinite) was observed among the populations of Sincelejo and Corozal. Conclusion. There are genetic differences between the Ae. aegypti populations from the municipalities of Sucre department. The presence of a new haplotype of the mitochondrial ND4 gene of Ae. aegypti in Colombia was recorded, detected in the municipality of Sincelejo.

[First report of the F1534C mutation associated with cross-resistance to DDT and pyrethroids in Aedes aegypti from Colombia].

INTRODUCTION: The main strategy for the control of Aedes aegypti, vector of dengue, chikungunya and Zika viruses, is based on the use of insecticides to reduce its populations. However, their use has led to insect resistance to these chemicals. Objective: To determine the presence of the F1534C mutation associated with cross-resistance to DDT and pyrethroids in A. aegypti in Sincelejo, Colombia. Materials and methods: We studied nine specimens of A. aegypti that showed resistance to lambdacyhalothrin in bioassays developed by the Secretaría de Salud de Sucre. We used a semi-nested PCR as previously described by Harris, et al., to amplify exon 31 of the para gene of the voltage-dependent sodium channel of A. aegypti. We sequenced, edited, and analyzed PCR products with the MEGA 5 software. Results: We detected the wild and mutant alleles of exon 31 in all of the nine mosquitoes tested, and observed the substitution of thymine for guanine in the nucleotide sequence of the mutant allele, producing a change to UGC in the UUC codon, which led to the replacement of phenylalanine by cysteine in residue 1534 of the protein. Conclusion: The nine mosquitoes analyzed presented a heterozygote genotype for the F1534C mutation, whose phenotypic effect is knockdown resistance (kdr) to DDT and pyrethroids.

Cólera en Haití: lecciones aprendidas por la Brigada Médica Cubana / Cholera in Haiti: lessons learned by the Cuban Medical Brigade

El libro relata la experiencia de la Brigada Médica Cubana en Haití, es el resultado del trabajo práctico en el terreno desde una posición científica avalada por toda la experiencia internacional y en Cuba para la prevención y control del cólera, el uso en los servicios de salud y la investigación. Constituye una herramienta de gran utilidad para los profesionales de la salud sobre la actualización del Plan de Prevención y Control del Cólera.

Stress, coping, and health: a comparison of Mexican immigrants, Mexican-Americans, and non-Hispanic whites.

Mexican immigrants, Mexican-Americans, and non-Hispanic white Americans all face different stressors. Stress-coping strategies may vary for each group as well. We compared relationships among perceived stress, stress-coping strategies, and health-related quality of life (HRQL) in a rural sample of Mexican citizens living in the United States, Mexican-Americans, and non-Hispanic whites. Health-related quality of life and stress-coping styles varied among the three groups. Mexican citizens reported significantly better physical functioning than did non-Hispanic whites or Mexican-Americans. Mexican-Americans reported significantly better mental health functioning than did non-Hispanic whites or Mexican citizens. Mexican citizens were more likely to use positive reframing, denial, and religion, and less likely to use substance abuse and self-distraction, as stress-coping strategies. Stress-coping style may be a potentially modifiable predictor of physical and mental HRQL, and may account for part of the Hispanic health paradox.

Expectativas y evaluación de la actividad musical de pacientes del Hospital Psiquiatrico de la Habana / Expectations and assessment of the musical activity in patients from the Psychiatric Hospital of Havana

Treinta estudiantes de Psicología (venezolanos) y 60 estudiantes de Medicina (40 por ciento) cubanos y 60(por ciento)( extranjeros) fueron explorados mediante encuesta termómetro anónima autoaplicable, antes y después de participar en un espectáculo musical desarrollado por pacientes de larga estadía (82(por ciento) esquizofrénicos) del Hospital Psiquiátrico de La Habana , con el propósito de identificar sus expectativas y evaluaciones del desempeño de los pacientes-artistas. En todos los aspectos explorados se evidenciaron resultados de alta significación estadística entre lo esperado y lo presenciado. Todas las encuestas fueron útiles y se recogieron criterios muy favorables sobre el valor de la músico - terapia como recurso rehabilitatorio

Expectativas y evaluación de la actividad musical de pacientes del Hospital Psiquiatrico de la Habana / Expectations and assessment of the musical activity in patients from the Psychiatric Hospital of Havana

Treinta estudiantes de Psicología (venezolanos) y 60 estudiantes de Medicina (40 por ciento) cubanos y 60(por ciento)( extranjeros) fueron explorados mediante encuesta termómetro anónima autoaplicable, antes y después de participar en un espectáculo musical desarrollado por pacientes de larga estadía (82(por ciento) esquizofrénicos) del Hospital Psiquiátrico de La Habana , con el propósito de identificar sus expectativas y evaluaciones del desempeño de los pacientes-artistas. En todos los aspectos explorados se evidenciaron resultados de alta significación estadística entre lo esperado y lo presenciado. Todas las encuestas fueron útiles y se recogieron criterios muy favorables sobre el valor de la músico - terapia como recurso rehabilitatorio(AU)

A program to improve access to health care among Mexican immigrants in rural Colorado.

CONTEXT: Migration to the United States from Mexico is increasing every year. Mexican immigrants tend to be poor, uninsured, monolingual Spanish speakers without adequate access to appropriate medical care. As a further barrier, many are also undocumented. PURPOSE: This article describes a program developed to improve access to health care among Mexican immigrants in northern Colorado. METHODS: The program was implemented by a migrant/community health center in rural northern Colorado based on findings from an in-depth health needs survey of the target population. The program consists of community outreach services vertically integrated into the main medical clinics, which comprise Salud Family Health Centers. A mobile unit went to nontraditional areas identified by community workers as gathering places for Mexican immigrants. Services provided included preventive health care (screening for diabetes, hypertension, mental health problems, dental problems, and HIV); education; and primary care for acute problems. Patients were referred to a health care home for ongoing care. RESULTS: In the first 6 months, 1,553 Mexican immigrants were seen on the mobile unit. Hypertension and psychosocial problems were the most common problems in this population. Thirty-five percent of patients who received consultation in the mobile unit have visited any of the clinics for follow-up within the following year. CONCLUSIONS: A community-based mobile outreach program targeted toward Mexican immigrants can be effective in uncovering medical and mental illness and in directing patients to a health care home. This is an important first step in eliminating health disparities among this population.

Hospital Psiquiatrico de la Habana: recorrido por su historia y realidad / Psychiatric Hosptal of the Havana: traveled y their history and reality

Los autores se desplazan a través de la historia de una institución que ha dejado profundas huellas, primero como señaló nuestro Comandante en Jefe Fidel Castro, era ¨ El Infierno de Dante ¨, y ahora como bien reza un enunciado tomado de un texto escrito por el Director Fundador, Dr. Eduardo Bernabé Ordaz Ducungé, es un ¨ Jardín de la Esperanza ¨, en el cual rige como principio un profundo humanismo y que todo paciente puede ser rehabilitado. En el trabajo describimos las tres etapas por las que ha transitado nuestra institución, y en la etapa revolucionaria expresamos la presente misión y visión del hospital, así como la proyección general de este en todos sus ámbitos; estructura organizativa; servicios; atención especializada; docencia, e investigaciones

Arte, salud y comunidad / Art, health and community

Arte, Salud y Comunidad constituyen tres categorías inseparables. El proceso creador artístico es inherente a todos los seres humanos. El arte se vincula a la salud mental desde tiempos remotos, sin embargo no es hasta el siglo XX que se convierte en una técnica estructurada de tratamiento con una base metodológica definida. Se exponen los criterios del Hospital Psiquiátrico de la Habana y se brinda una explicación general de su aplicación

Arte, salud y comunidad / Art, health and community

Arte, Salud y Comunidad constituyen tres categorías inseparables. El proceso creador artístico es inherente a todos los seres humanos. El arte se vincula a la salud mental desde tiempos remotos, sin embargo no es hasta el siglo XX que se convierte en una técnica estructurada de tratamiento con una base metodológica definida. Se exponen los criterios del Hospital Psiquiátrico de la Habana y se brinda una explicación general de su aplicación(AU)