Brain-Derived Neurotrophic Factor (BDNF) as a Predictor of Treatment Response in Major Depressive Disorder (MDD): A Systematic Review.

Brain-derived neurotrophic factor (BDNF) has been studied as a biomarker of major depressive disorder (MDD). Besides diagnostic biomarkers, clinically useful biomarkers can inform response to treatment. We aimed to review all studies that sought to relate BDNF baseline levels, or BDNF polymorphisms, with response to treatment in MDD. In order to achieve this, we performed a systematic review of studies that explored the relation of BDNF with both pharmacological and non-pharmacological treatment. Finally, we reviewed the evidence that relates peripheral levels of BDNF and BDNF polymorphisms with the development and management of treatment-resistant depression.

Cost Analysis of Surgical and Medical Uterine Evacuation Methods for First-Trimester Abortion Used in Public Hospitals in Mexico.

Background: Data on abortion procedures costs are scarce in low- and middle-income countries. In Mexico, the only known study was conducted more than a decade ago, with data from years before the abortion legislation. This study estimated the costs, from the health system's perspective, of surgical and medical abortion methods commonly used by women who undergo first-trimester abortion in Mexico. Methods: Data were collected on staff time, salaries, medications, consumables, equipment, imaging, and lab studies, at 5 public general hospitals. A bottom-up micro-costing approach was used. Results: Surgical abortion costs were US$201 for manual vacuum aspiration and US$298 for sharp curettage. The cost of medical abortion with misoprostol was US$85. The use of cervical ripening increases the costs by up to 18%. Staff comprised up to 72% of total costs in surgical abortions. Hospitalization was the area where most of the spending occurred, due to the staff and post-surgical surveillance required. Conclusions: Our estimates reflect the costs of "real-life" implementation and highlight the impact on costs of the overuse of resources not routinely recommended by clinical guidelines, such as cervical ripening for surgical abortion. This information will help decision-makers to generate policies that contribute to more efficient use of resources.

[Construction of text resources for automatic identification of clinical information in unstructured narratives]. / Construcción de recursos de texto para la identificación automática de información clínica en narrativas no estructuradas.

BACKGROUND: A significant proportion of the clinical record is in free text format, making it difficult to extract key information and make secondary use of patient data. Automatic detection of information within narratives initially requires humans, following specific protocols and rules, to identify medical entities of interest. AIM: To build a linguistic resource of annotated medical entities on texts produced in Chilean hospitals. MATERIAL AND METHODS: A clinical corpus was constructed using 150 referrals in public hospitals. Three annotators identified six medical entities: clinical findings, diagnoses, body parts, medications, abbreviations, and family members. An annotation scheme was designed, and an iterative approach to train the annotators was applied. The F1-Score metric was used to assess the progress of the annotator's agreement during their training. RESULTS: An average F1-Score of 0.73 was observed at the beginning of the project. After the training period, it increased to 0.87. Annotation of clinical findings and body parts showed significant discrepancy, while abbreviations, medications, and family members showed high agreement. CONCLUSIONS: A linguistic resource with annotated medical entities on texts produced in Chilean hospitals was built and made available, working with annotators related to medicine. The iterative annotation approach allowed us to improve performance metrics. The corpus and annotation protocols will be released to the research community.

Factors affecting the persistent use of sharp curettage for abortion in public hospitals in Mexico.

OBJECTIVES: Dilation and curettage is an outdated abortion procedure no longer recommended by the World Health Organization. However, use of dilation and curettage remains high in some countries, including Mexico. We aim to understand the factors that contribute to persistent use of dilation and curettage in Mexico. METHODS: We conducted a mixed-methods study in two phases: (1) secondary quantitative data analysis from 40 Ipas-supported public hospitals in Mexico and (2) 28 in-depth interviews in 9 Ipas-affiliated hospitals with doctors, nurses, and hospital administrators. RESULTS: Among our sample, 41% of abortions less than 13 weeks performed in 2019 were treated with dilation and curettage, while this increased to 67% of abortions at or above 13 weeks. Only 18% of induced abortions were performed with dilation and curettage compared to 44% of post-abortion care procedures. The main factor identified as determining use of dilation and curettage in in-depth interviews was availability of abortion supplies, both in terms of cleaning, storage, and maintenance of supplies and in the budgeting and procurement of supplies. Other factors included confidence in the efficacy of other methods, attitudes toward different methods, skill and training, and perceived benefits to patients. CONCLUSION: Ensuring supplies for recommended abortion methods are available is a key lever for any intervention aimed at reducing dilation and curettage use. However, as the doctor performing the abortion decides which method to use, individual factors such as lack of skill and mistrust in other procedures can become a particularly obstinate barrier to recommended method use. Localizing decision-making power in the hands of doctors is problematic in that it places the doctor's preference above that of the person receiving the abortion. It is important to look deeply at the power structures that contribute to doctor-oriented models of abortion care.

Construcción de recursos de texto para la identificación automática de información clínica en narrativas no estructuradas / Construction of text resources for automatic identification of clinical information in unstructured narratives

Background: A significant proportion of the clinical record is in free text format, making it difficult to extract key information and make secondary use of patient data. Automatic detection of information within narratives initially requires humans, following specific protocols and rules, to identify medical entities of interest. Aim: To build a linguistic resource of annotated medical entities on texts produced in Chilean hospitals. Material and Methods: A clinical corpus was constructed using 150 referrals in public hospitals. Three annotators identified six medical entities: clinical findings, diagnoses, body parts, medications, abbreviations, and family members. An annotation scheme was designed, and an iterative approach to train the annotators was applied. The F1-Score metric was used to assess the progress of the annotator's agreement during their training. Results: An average F1-Score of 0.73 was observed at the beginning of the project. After the training period, it increased to 0.87. Annotation of clinical findings and body parts showed significant discrepancy, while abbreviations, medications, and family members showed high agreement. Conclusions: A linguistic resource with annotated medical entities on texts produced in Chilean hospitals was built and made available, working with annotators related to medicine. The iterative annotation approach allowed us to improve performance metrics. The corpus and annotation protocols will be released to the research community.

Invisibilidad del adulto mayor con VIH/SIDA: La percepción del médico de atención primaria en Tabasco (México) / Invisibility of older adults with HIV/AIDS: The primary care physician's perception in Tabasco (Mexico)

RESUMEN Objetivo: Interpretar la percepción de los médicos de atención primaria sobre las condiciones sociales y sanitarias que intervienen en la invisibilidad del paciente adulto mayor con VIH/SIDA en Tabasco (México). Materiales y métodos: Bajo el enfoque de teoría fundamentada se realizó un estudio cualitativo durante agosto de 2018. Se formó un grupo focal integrado por médicos tratantes de diversas instituciones del sistema de salud. Se empleó una guía de entrevista y para su análisis se utilizó el software MAXQDA versión 2018.2. Resultados: La invisibilidad del paciente adulto mayor en el ámbito sanitario se refleja en las limitaciones institucionales relacionadas con el tiempo de atención que no facilitan la labor del médico para reconocer los aspectos clínicos y emocionales. Otro factor es la hegemonía médica que no permite tomar en cuenta la opinión del enfermo y no explora la existencia de la práctica sexual en esa fase de la vida. Ambos aspectos son condicionantes de un diagnóstico tardío de VIH/SIDA. Conclusiones: El constante aumento de adultos mayores infectados y la expansión geográfica de la enfermedad deben ser indicadores potenciales para los gestores y profesiones de salud para establecer prioridades en la atención y el control del VIH/SIDA.

ABSTRACT Objective: To read into the perception of primary care physicians about the social and sanitary conditions which deals with the older adults patient invisibility with AIDS in Tabasco (México). Materials and methods: Focusing through the sustained theory a qualitative study was done during August 2018. A focal group integrated of treating physicians from different Health Systems institutions was formed. It was used an interview guide and it was also used the MAXQDA software version 2018.2 for analysing it. Results: The invisibility of the older adult patients in the sanitary scope is reflected in the institutional related limitations with the care time which do not facilitate the physicians work to recognize the clinical and emotional aspects. Another factor is the physician hegemony that does not allow to take into account the opinion of the patient and does not explore the existence of sexual practice in this phase of life. Both aspects are condition of HIV/AIDS late diagnosis. Conclusions: The constant older adults infected increase and the geographic expansion of the sickness, must be potential indicators to health professionals and promoters to establish priorities in HIV/AIDS attention and control.

Adequate vegetative cover decreases nitrous oxide emissions from cattle urine deposited in grazed pastures under rainy season conditions.

A decline in pasture productivity is often associated with a reduction in vegetative cover. We hypothesize that nitrogen (N) in urine deposited by grazing cattle on degraded pastures, with low vegetative cover, is highly susceptible to losses. Here, we quantified the magnitude of urine-based nitrous oxide (N2O) lost from soil under paired degraded (low vegetative cover) and non-degraded (adequate vegetative cover) pastures across five countries of the Latin America and the Caribbean (LAC) region and estimated urine-N emission factors. Soil N2O emissions from simulated cattle urine patches were quantified with closed static chambers and gas chromatography. At the regional level, rainy season cumulative N2O emissions (3.31 versus 1.91 kg N2O-N ha-1) and emission factors (0.42 versus 0.18%) were higher for low vegetative cover compared to adequate vegetative cover pastures. Findings indicate that under rainy season conditions, adequate vegetative cover through proper pasture management could help reduce urine-induced N2O emissions from grazed pastures.

Incorporating human rights into reproductive health care provider education programs in Nicaragua and El Salvador.

Health care providers play a central role in the promotion and protection of human rights in patient care. Consequently, the World Medical Association, among others, has called on medical and nursing schools to incorporate human rights education into their training programs. This report describes the efforts of one Central American nongovernmental organization to include human rights - related content into reproductive health care provider training programs in Nicaragua and El Salvador. Baseline findings suggest that health care providers are not being adequately prepared to fulfill their duty to protect and promote human rights in patient care. Medical and nursing school administrators, faculty, and students recognize the need to strengthen training in this area and are enthusiastic about incorporating human rights content into their education programs. Evaluation findings suggest that exposure to educational materials and methodologies that emphasize the relationship between human rights and reproductive health may lead to changes in health care provider attitudes and behaviors that help promote and safeguard human rights in patient care.

Incorporating human rights into reproductive health care provider education programs in Nicaragua and El Salvador / Incorporación de los derechos humanos a los programas de formación de los proveedores de atención de salud reproductiva en Nicaragua y El Salvador

Health care providers play a central role in the promotion and protection of human rights in patient care. Consequently, the World Medical Association, among others, has called on medical and nursing schools to incorporate human rights education into their training programs. This report describes the efforts of one Central American nongovernmental organization to include human rights - related content into reproductive health care provider training programs in Nicaragua and El Salvador. Baseline findings suggest that health care providers are not being adequately prepared to fulfill their duty to protect and promote human rights in patient care. Medical and nursing school administrators, faculty, and students recognize the need to strengthen training in this area and are enthusiastic about incorporating human rights content into their education programs. Evaluation findings suggest that exposure to educational materials and methodologies that emphasize the relationship between human rights and reproductive health may lead to changes in health care provider attitudes and behaviors that help promote and safeguard human rights in patient care.

Los proveedores de atención sanitaria desempeñan una función esencial en la promoción y la protección de los derechos humanos en la atención al paciente. En consecuencia, la Asociación Médica Mundial, entre otras instituciones, ha exhortado a las facultades de medicina y de enfermería a incorporar la formación en materia de derechos humanos en sus programas de capacitación. Este informe describe las iniciativas de una organización no gubernamental centroamericana para que se introduzcan contenidos relacionados con los derechos humanos en los programas de capacitación de los proveedores de atención de salud reproductiva en Nicaragua y El Salvador. Las conclusiones iniciales indican que no se prepara adecuadamente a los proveedores de atención de salud para cumplir su responsabilidad de proteger y promover los derechos humanos en la atención al paciente. Los administradores de las facultades de medicina y de enfermería, el profesorado y los estudiantes reconocen la necesidad de fortalecer la capacitación en esta área y son entusiastas acerca de incorporar contenidos relacionados con los derechos humanos en sus programas de formación. Los resultados de la evaluación indican que la exposición a materiales y métodos didácticos que subrayen la relación entre los derechos humanos y la salud reproductiva puede conducir a cambios en las actitudes y los comportamientos de los proveedores de atención de salud que contribuyan a promover y proteger los derechos humanos en la atención al paciente.

An assessment of health sector guidelines and services for treatment of sexual violence in El Salvador, Guatemala, Honduras and Nicaragua.

In Central America, approximately 12% of women report ever having been forced to have sex by an intimate male partner, and sexual violence by others is also a frequent experience. All Central American countries are signatories to human rights agreements that oblige States to ensure access to comprehensive health services for victims of sexual violence, but there is limited information as to whether these agreements have been translated into policy and practice. This article critically examines health sector guidelines for the treatment of sexual violence in El Salvador, Guatemala, Honduras and Nicaragua, and reports on an assessment of services in 34 private- and public-sector facilities in the four countries. Overall, policies were consistent with international agreements and included guidance on detection and documentation of violence, forensic examination, treatment, referral and follow-up care. However, only a small proportion of women who experience sexual violence actually seek care. The challenge facing all four countries is to turn policy into practice. Screening practices were inconsistent, and policies needed to indicate more clearly the roles and responsibilities of health care providers and forensic specialists. Finally, women's right to privacy and confidentiality in reports of cases to legal authorities needed further consideration, as well as the importance of providing all services at a single location.