Cidronio Albavera-Hernández

Safety of botulinum toxin type A among children with spasticity secondary to cerebral palsy: a systematic review of randomized clinical trials

Objective: To assess the safety of botulinum toxin type A for children with cerebral palsy using data from randomized clinical trials. Data sources: A search was conducted of MEDLINE database for the period January 1990 to February 2008. A complementary search was carried out of references from previous reviews. From 122 articles, 20 randomized clinical trials were selected for the review. Review methods: Two authors independently assessed eligibility of the studies and methodological quality of those according to CONSORT guidelines. For each adverse effect, relative risk was calculated, and when more than one study reported adverse effects, a meta-analysis was carried out. Sensitivity analyses with different continuity corrections factors were performed when zero cases were reported in a study arm. Results: There were 882 participants in the 20 studies included in the meta-analysis. Six studies reported zero adverse effects. Thirty-five different adverse events were reported. Botulinum toxin type A use was related to respiratory tract infection, bronchitis, pharyngytis, asthma, muscle weakness, urinary incontinence, falls, seizures, fever and unspecified pain. Two deaths were reported in the study with higher person-time follow-up (relative risk (RR) 4.69, 95% confidence interval (CI) 0.23—95). Conclusions: Botulinum toxin type A has a good safety profile during the first months of use. However the occurrence of adverse events is more frequent among children with cerebral palsy than individuals with other conditions. Severe adverse events are potentially related with the use of botulinum toxin type A, but data are sparse and additional study is required to clarify the causal relation.

Applying the Fuzzy Delphi Method for determining socio-ecological factors that influence adherence to mammography screening in rural areas of Mexico

En Mexico la participacion regular en mastografia reporta baja frecuencia, aun cuando esta incrementa la supervivencia. El objetivo de esta investigacion es destacar procedimientos que necesitan ser optimizados y areas necesitadas de inversion, con el fin de incrementar la concientizacion acerca de los beneficios del diagnostico temprano. Tales caracteristicas socioecologicas (comunitarias, interpersonales e individuales) fueron puestas en listas a traves de la revision de la literatura especifica y el modelo de interaccion espacial del uso de mastografia, desarrollado por Mobley et al. La opinion de los expertos, respecto a la importancia de dichas caracteristicas, fue recogida por una encuesta, aplicando el metodo Fuzzy Delphi para reducir la incertidumbre implicita. Nuestros hallazgos sugieren que las conductas de salud de la poblacion, proximidad y densidad de facilidades y medicos, asi como factores de predisposicion, son necesarios para incrementar las tasas de examen. El uso de grupos de expertos desiguales en tamano podria afectar a la fiabilidad de las conclusiones. La aplicacion de un metodo de agregacion modificado proporciono un consenso grupal menos sensible a una malinterpretacion, ademas de ponderar la importancia de cada experto segun su experiencia en investigaciones con mastografia.In Mexico, regular participation in mammography screening is low, despite higher survival rates. The objective of our research is to highlight healthcare procedures to be optimized and target areas to encourage investment and to raise awareness about the benefits of early diagnosis. Those socio-ecological factors (community, interpersonal and individual) were collected through a review of literature and based on the spatial interaction model of mammography use developed by Mobley et al. The opinion of diverse groups of experts on the importance of those factors was collected by survey. The Fuzzy Delphi Method helped to solve the inherent uncertainty of the survey process. Our findings suggest that population health behaviors, proximity-density to facilities/ physicians and predisposing factors are needed to increase the screening rate. Variations in expert group size could affect the accuracy of the conclusions. However, the application of the enhanced aggregation method provided a group consensus that is less susceptible to misinterpretation and that weighs the opinion of each expert according to their clinical experience in mammography research.

Social epidemiology of a large outbreak of chickenpox in the Colombian sugar cane producer region: a set theory-based analysis

There are few social epidemiologic studies on chickenpox outbreaks, although previous findings suggested the important role of social determinants. This study describes the context of a large outbreak of chickenpox in the Cauca Valley region, Colombia (2003 to 2007), with an emphasis on macro-determinants. We explored the temporal trends in chickenpox incidence in 42 municipalities to identify the places with higher occurrences. We analyzed municipal characteristics (education quality, vaccination coverage, performance of health care services, violence-related immigration, and area size of planted sugar cane) through analyses based on set theory. Edwards-Venn diagrams were used to present the main findings. The results indicated that three municipalities had higher incidences and that poor quality education was the attribute most prone to a higher incidence. Potential use of set theory for exploratory outbreak analyses is discussed. It is a tool potentially useful to contrast units when only small sample sizes are available.

Socioecological determinants of mammography screening in Mexican rural areas

Purpose – The purpose of this paper is to determine which socioecological factors encourage rural women to participate in mammographies rather than avoiding taking the test. Design/methodology/approach – The study mainly uses data from the 2007 Rural Households Evaluation Survey (ENCEL-2007). These crossover data are analyzed using the framework proposed in the Spatial-Interaction Model of Mammography Use (SIMMU), through a three-level logistic regression model to examine the likelihood that a woman will choose to participate in a mammography. Findings – At the woman-household level, the completion of the Pap smear and the asset index is the strongest determinant of mammography participation. Obtaining preventive medicine services or being enrolled in the Popular Insurance System prevent women from undergoing screening. At the interpersonal level, the probability of screening use decreases with lower social coverage. At the intermediate level, availability of health centers is negatively related to the us...

Letter to the editor on 'Safety of botulinum toxin type A among children with spasticity secondary to cerebral palsy: a systematic review of randomized clinical trials'.

In the published version of our paper ‘Safety of botulinum toxin type A among children with spasticity secondary to cerebral palsy: a systematic review of randomized clinical trials’, there was one error. This was detected by Dr Marie Blackmore from the Centre for Cerebral Palsy/ Curtin University of Technology. Australia. We acknowledge her advice and help. The correct forest plot for muscle weakness is shown here in Figure 1. In addition, after the submission to Clinical Rehabilitation but before the publication of our systematic review, two new randomized clinical trials fulfilling the inclusion criteria were published. This is a frequent phenomenon in science since the fast growth of evidence, and an excellent opportunity to actualize and to test the generated hypotheses expressed in the paper. In our article the main conclusions were the toxin was related to respiratory tract infection, bronchitis, pharyngytis, asthma, muscle weakness, urinary incontinence, falls, seizures, fever and unspecified pain. We indicated the need to study the potential association with severe adverse events as deaths. In addition we suggested that botulinum toxin type A has a good safety profile during the first months of use. One of these clinical trials, described in two publications with different outcomes, did not report adverse effects. However, in a very well-designed, randomized, double-blind, placebo-controlled study with two years follow-up (5548 persons-week), Moore et al. evaluated the efficacy and safety of botulinum toxin type A (Dysport) in the treatment of leg spasticity among 58 children with cerebral palsy. The participants received injections of up to 30mU/kg every three months if their clinical manifestations required it. An interesting methodological aspect of this clinical trial was the fact that an independent safety committee monitored adverse effects data. With the different adverse effects reported we recalculated the pooled relative risks and 95% confidence intervals of each event. Findings of the new analyses are summarized in Table 1. Note that there are two types of results: (1) significant relative risk with narrower confidence interval: pharyngytis, localized pain, falls, seizures,

Abordagem Fuzzy Delphi para determinar os fatores socioecológicos que influenciam a adesão à mamografia de rastreio em áreas rurais do México

En Mexico la participacion regular en mastografia reporta baja frecuencia, aun cuando esta incrementa la supervivencia. El objetivo de esta investigacion es destacar procedimientos que necesitan ser optimizados y areas necesitadas de inversion, con el fin de incrementar la concientizacion acerca de los beneficios del diagnostico temprano. Tales caracteristicas socioecologicas (comunitarias, interpersonales e individuales) fueron puestas en listas a traves de la revision de la literatura especifica y el modelo de interaccion espacial del uso de mastografia, desarrollado por Mobley et al. La opinion de los expertos, respecto a la importancia de dichas caracteristicas, fue recogida por una encuesta, aplicando el metodo Fuzzy Delphi para reducir la incertidumbre implicita. Nuestros hallazgos sugieren que las conductas de salud de la poblacion, proximidad y densidad de facilidades y medicos, asi como factores de predisposicion, son necesarios para incrementar las tasas de examen. El uso de grupos de expertos desiguales en tamano podria afectar a la fiabilidad de las conclusiones. La aplicacion de un metodo de agregacion modificado proporciono un consenso grupal menos sensible a una malinterpretacion, ademas de ponderar la importancia de cada experto segun su experiencia en investigaciones con mastografia.In Mexico, regular participation in mammography screening is low, despite higher survival rates. The objective of our research is to highlight healthcare procedures to be optimized and target areas to encourage investment and to raise awareness about the benefits of early diagnosis. Those socio-ecological factors (community, interpersonal and individual) were collected through a review of literature and based on the spatial interaction model of mammography use developed by Mobley et al. The opinion of diverse groups of experts on the importance of those factors was collected by survey. The Fuzzy Delphi Method helped to solve the inherent uncertainty of the survey process. Our findings suggest that population health behaviors, proximity-density to facilities/ physicians and predisposing factors are needed to increase the screening rate. Variations in expert group size could affect the accuracy of the conclusions. However, the application of the enhanced aggregation method provided a group consensus that is less susceptible to misinterpretation and that weighs the opinion of each expert according to their clinical experience in mammography research.

Aproximación Fuzzy Delphi para determinar los factores socioecológicos que influyen en la adherencia a la mastografía en áreas rurales de México

En Mexico la participacion regular en mastografia reporta baja frecuencia, aun cuando esta incrementa la supervivencia. El objetivo de esta investigacion es destacar procedimientos que necesitan ser optimizados y areas necesitadas de inversion, con el fin de incrementar la concientizacion acerca de los beneficios del diagnostico temprano. Tales caracteristicas socioecologicas (comunitarias, interpersonales e individuales) fueron puestas en listas a traves de la revision de la literatura especifica y el modelo de interaccion espacial del uso de mastografia, desarrollado por Mobley et al. La opinion de los expertos, respecto a la importancia de dichas caracteristicas, fue recogida por una encuesta, aplicando el metodo Fuzzy Delphi para reducir la incertidumbre implicita. Nuestros hallazgos sugieren que las conductas de salud de la poblacion, proximidad y densidad de facilidades y medicos, asi como factores de predisposicion, son necesarios para incrementar las tasas de examen. El uso de grupos de expertos desiguales en tamano podria afectar a la fiabilidad de las conclusiones. La aplicacion de un metodo de agregacion modificado proporciono un consenso grupal menos sensible a una malinterpretacion, ademas de ponderar la importancia de cada experto segun su experiencia en investigaciones con mastografia.In Mexico, regular participation in mammography screening is low, despite higher survival rates. The objective of our research is to highlight healthcare procedures to be optimized and target areas to encourage investment and to raise awareness about the benefits of early diagnosis. Those socio-ecological factors (community, interpersonal and individual) were collected through a review of literature and based on the spatial interaction model of mammography use developed by Mobley et al. The opinion of diverse groups of experts on the importance of those factors was collected by survey. The Fuzzy Delphi Method helped to solve the inherent uncertainty of the survey process. Our findings suggest that population health behaviors, proximity-density to facilities/ physicians and predisposing factors are needed to increase the screening rate. Variations in expert group size could affect the accuracy of the conclusions. However, the application of the enhanced aggregation method provided a group consensus that is less susceptible to misinterpretation and that weighs the opinion of each expert according to their clinical experience in mammography research.