RESUMEN

Prevalence estimates of sibling bullying indicate it occurs more frequently and with more negative consequences than peer bullying, yet many countries do not track or investigate the phenomenon. University students from Argentina, Estonia, and the United States were surveyed to investigate their retrospective experiences involving sibling bullying, how often it occurred, the roles held, and the forms communicated. In the aggregated data, roughly 50 % of the sampled emerging adults (N = 3477) reported experience with sibling bullying, with the dual role of bully-victim being the most frequently reported role held by males and females, with the second role being bully for males and victim for females. Verbal forms of bullying were most frequently reported by males and females, with physical, relational, and technological forms occurring less frequently, indicating the importance of studying the messages conveyed during bullying incidents. Variations between biological sex, bullying role and form were detected that indicate siblings experience bullying in ways that are unique from peer bullying. Country comparisons revealed bullying frequencies varied among males and females, suggesting sibling bullying experiences are likely to be culturally influenced. More research is warranted to examine the negative impact bullying has on sibling psycho-social development and the potential transfer to non-familial relationships and contexts. Discussion of these findings and the implications for academics and practitioners alike is provided.

Asunto(s)

Acoso Escolar , Humanos , Masculino , Femenino , Acoso Escolar/estadística & datos numéricos , Adulto Joven , Prevalencia , Adulto , Estados Unidos/epidemiología , Argentina/epidemiología , Adolescente , Estonia/epidemiología , Relaciones entre Hermanos , Estudiantes/estadística & datos numéricos , Estudiantes/psicología , Comparación Transcultural , Hermanos , Víctimas de Crimen/estadística & datos numéricos , Víctimas de Crimen/psicología

RESUMEN

OBJECTIVE: The COVID-19 pandemic has caused a global public health crisis with social, psychological and long-lasting economical damages. Weather-related dynamics have an impact on the pattern of human health and disease. The present study aimed to investigate the impact of heat and humidity on daily basis incidence and mortality due to COVID-19 pandemic in ten of the world's hottest countries compared to ten of the coldest ones. MATERIALS AND METHODS: Worldwide, we selected 20 countries; 10 hottest countries with the highest temperatures and 10 coldest countries with the lowest temperature. The selection of the countries was based on the daily basis mean temperature from the date of appearance of the initial cases of COVID-19, Dec 29, 2019 to May 12, 2020. In the world's 10 hottest countries, the mean temperature was (26.31±1.51) and humidity (44.67±4.97). However, in the world's 10 coldest countries the mean temperature was (6.19±1.61) and humidity (57.26±2.35). The data on the global outbreak of COVID-19, daily new cases and deaths were recorded from World Health Organization, and daily information on temperature and humidity was obtained from metrological web "Time and Date". RESULTS: In countries with high temperatures and low humidity, the mean daily cases incidence were (407.12±24.33); cumulative cases (9094.34±708.29); and cumulative deaths (452.84±43.30) were significantly low compared to countries with low temperatures and high humidity: daily cases (1876.72±207.37); cumulative cases (44232.38±5875.11); and cumulative deaths (2008.29±310.13). Moreover, COVID-19 cases and deaths per million population were significantly low in countries with high temperatures (cases 711.23, and deaths 16.27) compared to countries with low temperatures (cases 1685.99; and deaths 86.40). Furthermore, in hottest countries, a 1% increase in humidity reduced number of cases and deaths by (ß = -5.40, p<0.001) and (ß = -0.187, p=0.004) respectively. A similar trend was seen with a 1°C increase in temperature, reducing the number of deaths by (ß = -1.35. p<0.001). CONCLUSIONS: The results revealed a significant decrease in incidence of daily cases and deaths in countries with high temperatures and low humidity (warmest countries), compared to those countries with low temperatures and high humidity (coldest countries). The findings could be of interest to the policymakers and the health officials on the epidemiological trends of COVID-19 pandemic and weather changes.

Asunto(s)

Clima , Infecciones por Coronavirus/epidemiología , Calor , Humedad , Neumonía Viral/epidemiología , Argelia/epidemiología , Austria/epidemiología , Betacoronavirus , COVID-19 , Canadá/epidemiología , Infecciones por Coronavirus/mortalidad , Estonia/epidemiología , Finlandia/epidemiología , Ghana/epidemiología , Humanos , Incidencia , India/epidemiología , Irán/epidemiología , Kazajstán/epidemiología , Kuwait/epidemiología , México/epidemiología , Mortalidad , Noruega/epidemiología , Omán/epidemiología , Pakistán/epidemiología , Pandemias , Neumonía Viral/mortalidad , Análisis de Regresión , República de Belarús/epidemiología , Federación de Rusia/epidemiología , SARS-CoV-2 , Arabia Saudita/epidemiología , Suecia/epidemiología , Emiratos Árabes Unidos/epidemiología , Estados Unidos/epidemiología

RESUMEN

We studied cognitive inhibitory processes and verbal regulation of behavior of individuals with different levels of education (including adult illiterates) in Brazil (N = 136) and in Estonia (N = 560) with person-oriented methods of data analysis. Our aim was to discover whether dominant type of word meaning structure (WMS) can define the "Great Divide", the single breaking point that universally defines certain direction of subsequent to it cultural evolution. We found that both cognitive inhibition of irrelevant for the task at hand information or actions as well as correct activation of relevant information or actions is significantly more common in individuals who rely predominantly on logical concepts in their thinking. The higher level of education was also associated with more efficient cognitive inhibition and activation. The patterns of test performance also suggest that there can be a qualitative difference in the efficiency of cognitive inhibition-activation processes between everyday conceptual and logical conceptual thinkers. The former group of individuals may achieve much higher performance levels than any individual in the former group. We also discuss cognitive similarities and differences between adults with low or no formal education on the one hand and children and educated adults with brain damage on the other. The results are in agreement with the theory of unilineal hierarchic cultural evolution. Individual psychic development and cultural evolution can be both understood in terms of the WMS development.

Asunto(s)

Inhibición Psicológica , Alfabetización , Adulto , Brasil , Niño , Cognición , Estonia , Humanos , Conducta Verbal

RESUMEN

We studied visual-perceptual abilities of individuals with different levels of education (including adult illiterates) in Brazil (N = 136) and in Estonia (N = 560) with person-oriented methods of data analysis. Our aim was to discover whether dominant type of word meaning structure (WMS) can define the "Great Divide", the single breaking point that universally defines certain direction of subsequent to it cultural evolution. We particularly focused on the everyday concept-logical concept shift that takes place in the formal education system. We found that logical concepts were rarely available for illiterates; availability of logical conceptual thought increases together with the level of education. Most illiterates were able to find figures of concrete objects from complex overlapping and embedded contour figures but none of them could find all abstract figures from the same complex figures. Also none of the illiterates could perform beyond chance level in both mental rotation tasks together. Ability to perform correctly on all visual-spatial tasks increased with the increase in logical concepts and with the increasing level of education. The distribution of respondents according to the WMS level, level of education, and performance on the visual-spatial tasks indicated that individuals are developmentally heterogeneous: achievement of the tertiary level of education and logical conceptual thinking mechanisms does not guarantee high level performance on the visual-spatial tasks. The results are in agreement with the theory of unilineal hierarchic cultural evolution. Individual psychic development and cultural evolution can be both understood in terms of the WMS development.

Asunto(s)

Alfabetización , Percepción Visual , Adulto , Brasil , Escolaridad , Estonia , Humanos

RESUMEN

PURPOSE: Patients with stage III non-small-cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT) in low- and middle-income countries (LMIC) continue to have a poor prognosis. It is known that FDG PET/CT improves staging, treatment selection and target volume delineation (TVD), and although its use has grown rapidly, it is still not widely available in LMIC. CRT is often used as sequential treatment, but is known to be more effective when given concurrently. The aim of the PERTAIN study was to assess the impact of introducing FDG PET/CT-guided concurrent CRT, supported by training and quality control (QC), on the overall survival (OS) and progression-free survival (PFS) of patients with stage III NSCLC. METHODS: The study included patients with stage III NSCLC from nine medical centres in seven countries. A retrospective cohort was managed according to local practices between January 2010 and July 2014, which involved only optional diagnostic FDG PET/CT for staging (not for TVD), followed by sequential or concurrent CRT. A prospective cohort between August 2015 and October 2018 was treated according to the study protocol including FDG PET/CT in treatment position for staging and multimodal TVD followed by concurrent CRT by specialists trained in protocol-specific TVD and with TVD QC. Kaplan-Meier analysis was used to assess OS and PFS in the retrospective and prospective cohorts. RESULTS: Guidelines for FDG PET/CT image acquisition and TVD were developed and published. All specialists involved in the PERTAIN study received training between June 2014 and May 2016. The PET/CT scanners used received EARL accreditation. In November 2018 a planned interim analysis was performed including 230 patients in the retrospective cohort with a median follow-up of 14 months and 128 patients in the prospective cohort, of whom 69 had a follow-up of at least 1 year. Using the Kaplan-Meier method, OS was significantly longer in the prospective cohort than in the retrospective cohort (23 vs. 14 months, p = 0.012). In addition, median PFS was significantly longer in the prospective cohort than in the retrospective cohort (17 vs. 11 months, p = 0.012). CONCLUSION: In the PERTAIN study, the preliminary results indicate that introducing FDG PET/CT-guided concurrent CRT for patients with stage III NSCLC in LMIC resulted in a significant improvement in OS and PFS. The final study results based on complete data are expected in 2020.

Asunto(s)

Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Quimioradioterapia , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Carcinoma de Pulmón de Células no Pequeñas/terapia , Supervivencia sin Enfermedad , Estonia , Femenino , Fluorodesoxiglucosa F18 , Humanos , Procesamiento de Imagen Asistido por Computador , India , Jordania , Estimación de Kaplan-Meier , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Pakistán , Estudios Prospectivos , Control de Calidad , Planificación de la Radioterapia Asistida por Computador , Estudios Retrospectivos , Resultado del Tratamiento , Turquía , Vietnam

Asunto(s)

Enfermedad de Parkinson , Causas de Muerte , Muerte Súbita , Estonia , Humanos , Prevalencia

RESUMEN

BACKGROUND: Less than one-third of patients who are estimated to be infected with multidrug-resistant tuberculosis (MDR-TB) receive MDR-TB treatment regimens, and only 48% of those who received treatment have successful outcomes. Despite current regimens, newer, more effective and cost-effective approaches to treatment are needed. The aim of the study was to project health outcomes and impact on healthcare resources of adding bedaquiline to the treatment regimen of MDR-TB in selected high burden countries: Estonia, Russia, South Africa, Peru, China, the Philippines, and India. METHODS: This study adapted an existing Markov model to estimate the health outcomes and impact on total healthcare costs of adding bedaquiline to current MDR-TB treatment regimens. A price threshold analysis was conducted to determine the price range at which bedaquiline would be cost-effective. RESULTS: Adding bedaquiline to the background regimen (BR) resulted in increased disability-adjusted life years (DALYs) averted, and reduced total healthcare costs (excluding treatment acquisition costs) compared with BR alone in all countries analyzed. Addition of bedaquiline to BR resulted in savings to healthcare costs compared with BR alone in all countries analyzed, with the highest impact expected in Russia (US$194 million) and South Africa (US$43 million). The price per regimen at which bedaquiline would be cost-effective ranged between US$23,904-US$203,492 in Estonia, Russia, Peru, South Africa, and China (high and upper middle-income countries) and between US$6,996-US$20,323 in the Philippines and India (lower middle-income countries); however, these cost-effective prices do not necessarily address concerns about affordability. CONCLUSIONS: Adding bedaquiline to BR provides improvements in health outcomes and reductions in healthcare costs in high MDR-TB burden countries. The range of prices per regimen for which bedaquiline would be cost-effective varied between countries.

Asunto(s)

Antituberculosos/administración & dosificación , Diarilquinolinas/administración & dosificación , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Antituberculosos/economía , China , Protocolos Clínicos , Análisis Costo-Beneficio , Diarilquinolinas/economía , Estonia , Costos de la Atención en Salud/tendencias , Humanos , India , Cadenas de Markov , Evaluación de Resultado en la Atención de Salud , Perú , Filipinas , Años de Vida Ajustados por Calidad de Vida , Federación de Rusia , Sudáfrica

RESUMEN

Estonia has a population of 1.3 million, which makes it one of the least populous member states of the European Union. The fertility rate was 1.65 in 2011, and the average age of women at first child birth was 4 years higher than in the early 1990s. Medical care is free for all children in Estonia. For the last 20 years, family doctors have been responsible for the primary care of children. Pediatric subspecialists work mainly in 2 children's hospitals: the Children's Clinic of Tartu University Hospital and Tallinn Children's Hospital. The average duration of hospital stay has decreased year by year. Pediatric subspecialists take care of children with long-term conditions and chronic diseases. In recent years, electronic case reports and digital receipts have been in use in Estonia. New diagnostic tests and expensive medications, which are available, make the cost of medical care very high.

Asunto(s)

Servicios de Salud del Niño , Salud Infantil , Adolescente , Niño , Preescolar , Estonia , Humanos

RESUMEN

We summarize the pediatric health care system in Georgia. In the 1990s, the socialist health insurance system was abandoned and replaced by a private health insurance system. In general, Georgia has a relatively high number of physicians per capita, and there are 3 times as many physicians per unit of population in Tbilisi than in other region. Furthermore, the country's universities produce far more physicians than needed. Currently, there are approximately 3000 pediatricians. The Georgian National Center of Disease Control provides guidelines for early detection and screening of diseases, immunization, and mother and child health care. Although Georgia has a limited health budget, it has performed major health reforms. It aims at achieving the highest possible standard of care for children with chronic and disabling conditions, however, future development will depend on the access to more advanced diagnostic and therapeutic technologies.

Asunto(s)

Servicios de Salud del Niño , Atención a la Salud , Niño , Preescolar , Estonia , Humanos

RESUMEN

Adherence to antiretroviral (ART) medication is vital to reducing morbidity and mortality among HIV positive persons. People who inject drugs (PWID) are at high risk for HIV infection in transitional/low/middle income countries (TLMIC). We conducted a systematic review of studies reporting adherence to ART among persons with active injection drug use and/or histories of injection drug use in TLMIC. Meta-regression was performed to examine relationships between location, adherence measurements, and follow-up period. Fifteen studies were included from seven countries. Adherence levels ranged from 33 to 97 %; mean weighted adherence was 72 %. ART adherence was associated with different methods of measuring adherence and studies conducted in Eastern Europe and East Asia. The great heterogeneity observed precludes generalization to TLMIC as a whole. Given the critical importance of ART adherence more research is needed on ART adherence among PWID in TLMIC, including the use of standardized methods for reporting adherence to ART.

Asunto(s)

Terapia Antirretroviral Altamente Activa , Consumidores de Drogas/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Brasil/epidemiología , China/epidemiología , Comorbilidad , Estonia/epidemiología , Infecciones por VIH/epidemiología , Humanos , India/epidemiología , Indonesia/epidemiología , Federación de Rusia/epidemiología , Vietnam/epidemiología

RESUMEN

BACKGROUND: Several studies have reported weak associations between religious or spiritual belief and psychological health. However, most have been cross-sectional surveys in the U.S.A., limiting inference about generalizability. An international longitudinal study of incidence of major depression gave us the opportunity to investigate this relationship further. METHOD: Data were collected in a prospective cohort study of adult general practice attendees across seven countries. Participants were followed at 6 and 12 months. Spiritual and religious beliefs were assessed using a standardized questionnaire, and DSM-IV diagnosis of major depression was made using the Composite International Diagnostic Interview (CIDI). Logistic regression was used to estimate incidence rates and odds ratios (ORs), after multiple imputation of missing data. RESULTS: The analyses included 8318 attendees. Of participants reporting a spiritual understanding of life at baseline, 10.5% had an episode of depression in the following year compared to 10.3% of religious participants and 7.0% of the secular group (p<0.001). However, the findings varied significantly across countries, with the difference being significant only in the U.K., where spiritual participants were nearly three times more likely to experience an episode of depression than the secular group [OR 2.73, 95% confidence interval (CI) 1.59­4.68]. The strength of belief also had an effect, with participants with strong belief having twice the risk of participants with weak belief. There was no evidence of religion acting as a buffer to prevent depression after a serious life event. CONCLUSIONS: These results do not support the notion that religious and spiritual life views enhance psychological well-being.

Asunto(s)

Comparación Transcultural , Trastorno Depresivo Mayor/etnología , Espiritualidad , Adolescente , Adulto , Anciano , Chile/etnología , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/etiología , Estonia/etnología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/etnología , Portugal/etnología , Estudios Prospectivos , Factores de Riesgo , Eslovenia/etnología , España/etnología , Reino Unido/etnología , Adulto Joven

RESUMEN

The Objective of this analysis was to identify predictors of death, failure, and default among MDR-TB patients treated with second-line drugs in DOTS-plus projects in Estonia, Latvia, Philippines, Russia, and Peru, 2000-2004. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using multivariable regression. Of 1768 patients, treatment outcomes were: cure/completed - 1156 (65%), died - 200 (11%), default - 241 (14%), failure - 118 (7%). Independent predictors of death included: age>45 years (RR = 1.90 (95%CI 1.29-2.80), HIV infection (RR = 4.22 (2.65-6.72)), extrapulmonary disease (RR = 1.54 (1.04-2.26)), BMI<18.5 (RR = 2.71 (1.91-3.85)), previous use of fluoroquinolones (RR = 1.91 (1.31-2.78)), resistance to any thioamide (RR = 1.59 (1.14-2.22)), baseline positive smear (RR = 2.22 (1.60-3.10)), no culture conversion by 3rd month of treatment (RR = 1.69 (1.19-2.41)); failure: cavitary disease (RR = 1.73 (1.07-2.80)), resistance to any fluoroquinolone (RR = 2.73 (1.71-4.37)) and any thioamide (RR = 1.62 (1.12-2.34)), and no culture conversion by 3rd month (RR = 5.84 (3.02-11.27)); default: unemployment (RR = 1.50 (1.12-2.01)), homelessness (RR = 1.52 (1.00-2.31)), imprisonment (RR = 1.86 (1.42-2.45)), alcohol abuse (RR = 1.60 (1.18-2.16)), and baseline positive smear (RR = 1.35 (1.07-1.71)). Patients with biomedical risk factors for treatment failure or death should receive heightened medical attention. To prevent treatment default, management of patients who are unemployed, homeless, alcoholic, or have a prison history requires extra measures to insure treatment completion.

Asunto(s)

Antituberculosos/administración & dosificación , Terapia por Observación Directa , Seropositividad para VIH/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Adulto , Factores de Edad , Índice de Masa Corporal , Estonia/epidemiología , Femenino , Seropositividad para VIH/tratamiento farmacológico , Seropositividad para VIH/mortalidad , Humanos , Letonia/epidemiología , Masculino , Oportunidad Relativa , Evaluación de Resultado en la Atención de Salud , Perú/epidemiología , Filipinas/epidemiología , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Federación de Rusia/epidemiología , Factores Socioeconómicos , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/mortalidad

RESUMEN

Analyses of the structure and function of microbial communities are highly constrained by the diversity of organisms present within most environmental samples. A common approach is to rely almost entirely on DNA sequence data for estimates of microbial diversity, but to date there is no objective method of clustering sequences into groups that is grounded in evolutionary theory of what constitutes a biological lineage. The general mixed Yule-coalescent (GMYC) model uses a likelihood-based approach to distinguish population-level processes within lineages from processes associated with speciation and extinction, thus identifying a distinct point where extant lineages became independent. Using two independent surveys of DNA sequences associated with a group of ubiquitous plant-symbiotic fungi, we compared estimates of species richness derived using the GMYC model to those based on operational taxonomic units (OTUs) defined by fixed levels of sequence similarity. The model predicted lower species richness in these surveys than did traditional methods of sequence similarity. Here, we show for the first time that groups delineated by the GMYC model better explained variation in the distribution of fungi in relation to putative niche-based variables associated with host species identity, edaphic factors, and aspects of how the sampled ecosystems were managed. Our results suggest the coalescent-based GMYC model successfully groups environmental sequences of fungi into clusters that are ecologically more meaningful than more arbitrary approaches for estimating species richness.

Asunto(s)

Biodiversidad , Biología Computacional/métodos , Hongos/clasificación , Hongos/genética , ARN Ribosómico 18S/genética , Evolución Biológica , Análisis por Conglomerados , ADN de Hongos/química , ADN de Hongos/genética , ADN Ribosómico/química , ADN Ribosómico/genética , Ecuador , Estonia , Especiación Genética , Variación Genética , Funciones de Verosimilitud , Modelos Genéticos , Filogenia , ARN de Hongos/genética , Análisis de Secuencia de ADN , Especificidad de la Especie , Factores de Tiempo

RESUMEN

BACKGROUND: Multidrug-resistant tuberculosis programs in DOTS-Plus pilot sites in five countries. OBJECTIVES: To calculate sputum conversion time and its relationship to treatment outcome, document the frequency of culture reversions and examine concordance of smear and culture to assess the potential consequences of monitoring by smear microscopy alone. DESIGN: Retrospective cohort analysis of 1926 patients receiving individualized, second-line therapy. RESULTS: Among 1385 sputum culture-positive cases at baseline, 1146 (83%) experienced at least one culture conversion during treatment. Conversion, however, was not sustained in all patients: 201 (15%) experienced initial culture conversion and at least one subsequent culture reversion to positive; 1064 (77%) achieved sustained culture conversion. Median time to culture conversion was 3 months. Among 206 patients whose nal conversion occurred 7-18 months after the initiation of therapy, 71% were cured or had completed treatment. CONCLUSIONS: Prolonged treatment for patients with delayed conversion may be beneficial, as 71% of late converters still achieved cure or completed treatment. This has implications for programs with de ned end points for treatment failure. The interval between rst and nal conversion among patients whose initial con- version is not sustained raises concern with respect to the ongoing debate regarding duration of treatment and the definition of cure.

Asunto(s)

Antituberculosos/administración & dosificación , Técnicas Bacteriológicas , Terapia por Observación Directa , Monitoreo de Drogas/métodos , Farmacorresistencia Bacteriana Múltiple , Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Esquema de Medicación , Estonia , Femenino , Humanos , Letonia , Masculino , Pruebas de Sensibilidad Microbiana , Microscopía , Mycobacterium tuberculosis/aislamiento & purificación , Perú , Filipinas , Proyectos Piloto , Estudios Retrospectivos , Federación de Rusia , Esputo/microbiología , Factores de Tiempo , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/microbiología

RESUMEN

This cross-cultural study investigates whether religiosity assessed in three dimensions has a protective effect against attempted suicide. Community controls (n = 5484) were more likely than suicide attempters (n = 2819) to report religious denomination in Estonia (OR = 0.5) and subjective religiosity in four countries: Brazil (OR = 0.2), Estonia (OR = 0.5), Islamic Republic of Iran (OR = 0.6), and Sri Lanka (OR = 0.4). In South Africa, the effect was exceptional both for religious denomination (OR = 5.9) and subjective religiosity (OR = 2.7). No effects were found in India and Vietnam. Organizational religiosity gave controversial results. In particular, subjective religiosity (considering him/herself as religious person) may serve as a protective factor against non-fatal suicidal behavior in some cultures.

Asunto(s)

Actitud Frente a la Salud/etnología , Características Culturales , Religión y Psicología , Autoimagen , Espiritualidad , Intento de Suicidio/etnología , Brasil/epidemiología , Comparación Transcultural , Estudios Transversales , Estonia/epidemiología , Humanos , Relaciones Interpersonales , Irán/epidemiología , Factores Socioeconómicos , Sri Lanka/epidemiología , Intento de Suicidio/psicología

RESUMEN

The emergence of antibiotic resistance in Mycobacterium tuberculosis has raised the concern that pathogen strains that are virtually untreatable may become widespread. The acquisition of resistance to antibiotics results in a longer duration of infection in a host, but this resistance may come at a cost through a decreased transmission rate. This raises the question of whether the overall fitness of drug-resistant strains is higher than that of sensitive strains--essential information for predicting the spread of the disease. Here, we directly estimate the transmission cost of drug resistance, the rate at which resistance evolves, and the relative fitness of resistant strains. These estimates are made by using explicit models of the transmission and evolution of sensitive and resistant strains of M. tuberculosis, using approximate Bayesian computation, and molecular epidemiology data from Cuba, Estonia, and Venezuela. We find that the transmission cost of drug resistance relative to sensitivity can be as low as 10%, that resistance evolves at rates of approximately 0.0025-0.02 per case per year, and that the overall fitness of resistant strains is comparable with that of sensitive strains. Furthermore, the contribution of transmission to the spread of drug resistance is very high compared with acquired resistance due to treatment failure (up to 99%). Estimating such parameters directly from in vivo data will be critical to understanding and responding to antibiotic resistance. For instance, projections using our estimates suggest that the prevalence of tuberculosis may decline with successful treatment, but the proportion of cases associated with resistance is likely to increase.

Asunto(s)

Antituberculosos/uso terapéutico , Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Algoritmos , Teorema de Bayes , Cuba/epidemiología , Farmacorresistencia Bacteriana Múltiple , Estonia/epidemiología , Humanos , Modelos Teóricos , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/transmisión , Venezuela/epidemiología

RESUMEN

Evidence of successful management of multidrug-resistant tuberculosis (MDRTB) is mainly generated from referral hospitals in high-income countries. We evaluate the management of MDRTB in 5 resource-limited countries: Estonia, Latvia, Peru, the Philippines, and the Russian Federation. All projects were approved by the Green Light Committee for access to quality-assured second-line drugs provided at reduced price for MDRTB management. Of 1047 MDRTB patients evaluated, 119 (11%) were new, and 928 (89%) had received treatment previously. More than 50% of previously treated patients had received both first- and second-line drugs, and 65% of all patients had infections that were resistant to both first- and second-line drugs. Treatment was successful in 70% of all patients, but success rate was higher among new (77%) than among previously treated patients (69%). In resource-limited settings, treatment of MDRTB provided through, or in collaboration with, national TB programs can yield results similar to those from wealthier settings.

Asunto(s)

Antituberculosos , Países en Desarrollo , Programas de Gobierno , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/prevención & control , Antituberculosos/administración & dosificación , Antituberculosos/uso terapéutico , Control de Enfermedades Transmisibles/métodos , Esquema de Medicación , Estonia/epidemiología , Humanos , Letonia/epidemiología , Perú/epidemiología , Filipinas/epidemiología , Evaluación de Programas y Proyectos de Salud , Federación de Rusia/epidemiología , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/microbiología

RESUMEN

BACKGROUND: The objectives were to assess thoughts about suicide, plans to commit suicide and suicide attempts in the community, to investigate the use of health services following a suicide attempt, and to describe basic socio-cultural indices of the community. METHOD: The community survey was one component of the larger WHO multisite intervention study on suicidal behaviours (SUPRE-MISS). In each site, it aimed at randomly selecting and interviewing at least 500 subjects of the general population living in the catchment area of the emergency department where the intervention component of the study was conducted. Communities of eight SUPRE-MISS sites (in Brazil, China, Estonia, India, Iran, South Africa, Sri Lanka, and Viet Nam) participated plus two additional sites from Australia and Sweden conducting similar surveys. RESULTS: Suicide attempts (0.4-4.2%), plans (1.1-15.6%), and ideation (2.6-25.4%) varied by a factor of 10-14 across sites, but remained mostly within the ranges of previously published data. Depending on the site, the ratios between attempts, plans, and thoughts of suicide differed substantially. Medical attention following a suicide attempt varied between 22% and 88% of the attempts. CONCLUSIONS: The idea of the suicidal process as a continuous and smooth evolution from thoughts to plans and attempts of suicide needs to be further investigated as it seems to be dependent on the cultural setting. There are indications, that the burden of undetected attempted suicide is high in different cultures; an improved response from the health sector on how to identify and support these individuals is needed.

Asunto(s)

Intento de Suicidio/etnología , Encuestas y Cuestionarios , Pensamiento , Adulto , Australia/epidemiología , Brasil/epidemiología , China/epidemiología , Comparación Transcultural , Estonia/epidemiología , Femenino , Humanos , India/epidemiología , Irán/epidemiología , Masculino , Sudáfrica/epidemiología , Sri Lanka/epidemiología , Intento de Suicidio/estadística & datos numéricos , Suecia/epidemiología , Vietnam/epidemiología

RESUMEN

BACKGROUND: The objective was to describe patients presenting themselves at emergency-care settings following a suicide attempt in eight culturally different sites [Campinas (Brazil), Chennai (India), Colombo (Sri Lanka), Durban (South Africa), Hanoi (Viet Nam), Karaj (Iran), Tallinn (Estonia), and Yuncheng, (China)]. METHOD: Subjects seen for suicide attempts, as identified by the medical staff in the emergency units of 18 collaborating hospitals were asked to participate in a 45-minute structured interview administered by trained health personnel after the patient was medically stable. RESULTS: Self-poisoning was the main method of attempting suicide in all eight sites. Self-poisoning by pesticides played a particularly important role in Yuncheng (71.6% females, 61.5% males), in Colombo (43.2% males, 19.6% females), and in Chennai (33.8% males, 23.8% females). The suicide attempt resulted in danger to life in the majority of patients in Yuncheng and in Chennai (over 65%). In four of the eight sites less than one-third of subjects received any type of referral for follow-up evaluation or care. CONCLUSIONS: Action for the prevention of suicide attempts can be started immediately in the sites investigated by addressing the one most important method of attempted suicide, namely self-poisoning. Regulations for the access to drugs, medicaments, pesticides, and other toxic substances need to be improved and revised regulations must be implemented by integrating the efforts of different sectors, such as health, agriculture, education, and justice. The care of patients who attempt suicide needs to include routine psychiatric and psychosocial assessment and systematic referral to professional services after discharge.

Asunto(s)

Servicios de Urgencia Psiquiátrica , Hospitales Generales , Renta , Intento de Suicidio , Adulto , Brasil/epidemiología , China/epidemiología , Cultura , Estonia/epidemiología , Femenino , Humanos , India/epidemiología , Irán/epidemiología , Masculino , Intoxicación/epidemiología , Factores Socioeconómicos , Sudáfrica/epidemiología , Sri Lanka/epidemiología , Intento de Suicidio/etnología , Intento de Suicidio/prevención & control , Intento de Suicidio/psicología , Encuestas y Cuestionarios , Vietnam/epidemiología

RESUMEN

Adverse events associated with second-line drugs have been mentioned as obstacles in the management of multidrug-resistant tuberculosis (MDR-TB). Data on adverse events were collected from five DOTS-Plus sites in Estonia, Latvia, Peru (Lima), the Philippines (Manila) and the Russian Federation (Tomsk Oblast). The results show that among 818 patients enrolled on MDR-TB treatment only 2% of patients stopped treatment, but 30% required removal of the suspected drug(s) from the regimen due to adverse events. The study shows that adverse events are manageable in the treatment of MDR-TB in resource-limited settings provided that standard management strategies are applied.

Asunto(s)

Antituberculosos/efectos adversos , Terapia por Observación Directa , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adulto , Estonia , Femenino , Humanos , Letonia , Masculino , Cumplimiento de la Medicación , Perú , Filipinas , Estudios Retrospectivos , Federación de Rusia , Resultado del Tratamiento