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ObjectivesMethods to develop core outcome sets, the minimum outcomes that should be measured in research in a topic area, vary. We applied social network analysis methods to understand outcome co-occurrence patterns in human immunodeficiency virus (HIV)/AIDS systematic reviews and identify outcomes central to the network of outcomes in HIV/AIDS.Study design and settingWe examined all Cochrane reviews of HIV/AIDS as of June 2013. We defined a tie as two outcomes (nodes) co-occurring in ≥2 reviews. To identify central outcomes, we used normalized node betweenness centrality (nNBC) (the extent to which connections between other outcomes in a network rely on that outcome as an intermediary). We conducted a subgroup analysis by HIV/AIDS intervention type (i.e., clinical management, biomedical prevention, behavioral prevention, and health services).ResultsThe 140 included reviews examined 1,140 outcomes, 294 of which were unique. The most central outcome overall was all-cause mortality (nNBC = 23.9). The most central and most frequent outcomes differed overall and within subgroups. For example, "adverse events (specified)" was among the most central but not among the most frequent outcomes, overall.ConclusionSocial network analysis methods are a novel application to identify central outcomes, which provides additional information potentially useful for developing core outcome sets.

This review provides a comprehensive summary of evidence to explore the role and value of differential diagnosis in the management of Acute Respiratory Infections (ARIs) through point-of-care (POC) rapid testing in a post-pandemic scenario, paying particular attention to coronavirus disease 2019 (COVID-19), influenza, and respiratory syncytial virus (RSV). The document builds on a review of literature and policies and a process of validation and feedback by a group of seven experts from Latin America (LATAM). Evidence was collected to understand scientific and policy perspectives on the differential diagnosis of ARIs and POC rapid testing, with a focus on seven countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. The evidence indicates that POC rapid testing can serve to improve ARI case management, epidemiological surveillance, research and innovation, and evidence-based decision-making. With multiple types of rapid tests available for POC, decisions regarding which tests to use require the consideration of the testing purpose, available resources, and test characteristics regarding accuracy, accessibility, affordability, and results turnaround time. Based on the understanding of the current situation, this document provides a set of recommendations for the implementation of POC rapid testing in LATAM, supporting decision-making and guiding efforts by a broad range of stakeholders. [ABSTRACT FROM AUTHOR]

Objective To evaluate the performance of diagnostic tools for diabetes mellitus, Including laboratory methods and clinical risk scores, In newly-diagnosed pulmonary tuberculosis patients from four middle-income countries.Methods In a multicentre, prospective study, we recruited 2185 patients with pulmonary tuberculosis from sites in Indonesia, Peru, Romania ' and South Africa from January 2014 to September 2016. Using laboratory-measured glycated haemoglobin (HbA1c) as the gold standard, we measured the diagnostic accuracy of random plasma glucose, point-of-care HbA1c, fasting blood glucose, urine dipstick, published and newly derived diabetes mellitus risk scores and anthropometric measurements. We also analysed combinations of tests, including a two-step test using point-of-care HbA1cwhen Initial random plasma glucose was [greater than or equal to] 6.1 mmol/L.Findings The overall crude prevalence of diabetes mellitus among newly diagnosed tuberculosis patients was 283/2185 (13.0%; 95% confidence interval, CI: 11.6-14.4). The marker with the best diagnostic accuracy was point-of-care HbA1c (area under receiver operating characteristic curve: 0.81; 95% CI: 0.75-0.86). A risk score derived using age, point-of-care HbA1c and random plasma glucose had the best overall diagnostic accuracy (area under curve: 0.85; 95% CI: 0.81-0.90). There was substantial heterogeneity between sites for all markers, but the two-step combination test performed well in Indonesia and Peru.Conclusion Random plasma glucose followed by point-of-care HbA1c testing can accurately diagnose diabetes in tuberculosis patients, particularly those with substantial hyperglycaemla, while reducing the need for more expensive point-of-care HbA1c testing. Risk scores with or without biochemical data may be useful but require validation.Objectif Evaluer la performance des outils de diagnostic du diabete sucre, et notamment les methodes de laboratoire et les cotes de risque clinique, chez les patients souffrant d'une tuberculose pulmonaire recemment diagnostiquee dans quatre pays a revenu intermediaire.Methodes Dans le cadre d'une etude multicentrique et prospective, nous avons recrute 2185 patients atteints de tuberculose pulmonaire dans differents endroits en Afrique du Sud, en Indonesie, au Perou et en Roumanie entre janvier 2014 et septembre 2016. En utilisant comme referencel'hemoglobineglyquee (HbA1c) mesuree en laboratoire, nous avons evalue la precision diagnostique de la glycemie aleatoire, de l'HbAI c sur le lieu d'intervention, de la glycemie a jeun, de la bandelette urinaire, des cotes de risque deja publiees et recemment obtenues pour le diabete sucre et des mesures anthropometriques. Nous avons egalement analyse des combinaisons de tests, et notamment un test en deux etapes qui utilise l'HbA1c sur le lieu d'intervention lorsque la glycemie aleatoire initiale est [greater than or equal to] 6,1 mmol/LResultats La prevalence brute generale du diabete sucre chez les patients souffrant d'une tuberculose recemment diagnostiquee etait de 283/2185 (13,0%; intervalle de confiance, IC, a 95%: 11,6-14,4). Le marqueur fournissant la meilleure precision diagnostique etait l'HbA1c sur le lieu d'intervention (aire sous la courbe ROC: 0,81; IC a 95%: 0,75-0,86). La meilleure precision diagnostique generale a ete obtenue a l'aide d'une cote de risque calculee au moyen de l'age, de l'HbA1c sur le lieu d'intervention et de la glycemie aleatoire (aire sous la courbe ROC: 0,85; IC a 95%: 0,81-0,90). Une forte heterogeneite entre les differents endrolts a ete constatee pourtous les marqueurs, mais le test en deux etapes a donne de bons resultats en Indonesie et au Perou.Conclusion L'utilisation de la glycemie aleatoire suivie de l'HbA1c sur le lieu d'intervention permet de diagnostiquer avec precision le diabete chez les patients atteints de tuberculose, en particulier lorsqu'ils souffrent d'une importante hyperglycemie, tout en diminuant le besoin de tests HbA1c sur le lieu d'intervention, plus couteux. Les cotes de risque associees ou non a des donnees biochimiques peuvent etre utiles, mais doivent etre validees.Objetivo Evaluar el rendimiento de las herramientas de diagnostico para la diabetes mellitus, incluidos los metodos de laboratorio y los indices de riesgo clinico, en pacientes recien diagnosticados con tuberculosis pulmonar de cuatro paises de ingresos medios.Metodos En un estudio prospectivo multicentrico, se seleccionaron 2185 pacientes con tuberculosis pulmonar de algunas regiones de Indonesia, Peru, Rumania y Sudafrica entre enero de 2014 y septiembre de 2016. Usando hemoglobina glicosilada medida en laboratorio (HbA1 c) como el patron de excelencia, se midio la precision diagnostica de glucosa plasmatica al azar, estando HbA1 c en el punto de atencion, glucemia en sangre en ayunas, tira reactiva de orina, indices de riesgo de diabetes mellitus publicados recientemente y medidas antropometricas. Tambien se analizaron combinaciones de pruebas, incluida una prueba de dos pasos con HbA1c en el punto de atencion cuando la glucosa plasmatica aleatoria inicial fue [greater than or equal to] 6,1 mmol/L.Resultados La prevalencia general cruda de diabetes mellitus entre los pacientes con tuberculosis recien diagnosticados fue de 283/2185 (13,0 %, intervalo de confianza del 95 %, IC: 11,6-14,4). El marcador con la mejor precision diagnostica fue la HbA1c en el punto de atencion (area bajo la curva caracteristica operativa del receptor: 0,81; IC del 95 %: 0,75-0,86). Un indice de riesgo derivado de la edad, la HbA1c en el punto de atencion y la glucosa plasmatica al azar obtuvieron la mejor precision diagnostica general (area bajo la curva: 0,85; IC del 95 %: 0,81 -0,90). Hubo una heterogeneidad sustancial entre las regiones para todos los marcadores, pero la prueba combinada de dos pasos funciono de manera correcta en Indonesia y Peru.Conclusion La glucosa plasmatica al azar seguida de la prueba de HbA1c en el punto de atencion puede diagnosticar con precision la diabetes en pacientes con tuberculosis, particularmente en aquellos con hiperglucemia sustancial, mientras se reduce la necesidad de pruebas mas costosas de HbA1 c en el punto de atencion. Los indices de riesgo con o sin datos bioquimicos pueden ser utiles, pero requieren validacion., [phrase omitted]IntroductionTuberculosis is a major global public health concern. In 2016, the World Health Organization (WHO) estimated that there were 10.4 million new tuberculosis patients worldwide and 1.8 million tuberculosis-related [...]

The contribution made by the private sector to health care in a low- or middle- income country may affect levels of physician emigration from that country. The increasing importance of the private sector in health care in the developing world has resulted in newfound academic interest in that sector's influences on many aspects of national health systems. The growth in physician emigration from the developing world has led to several attempts to identify both the factors that cause physicians to emigrate and the effects of physician emigration on primary care and population health in the countries that the physicians leave. When the relevant data on the emerging economies of Ghana, India and Peru were investigated, it appeared that the proportion of physicians participating in private health-care delivery, the percentage of health-care costs financed publicly and the amount of private health-care financing per capita were each inversely related to the level of physician expatriation. It therefore appears that private health-care delivery and financing may decrease physician emigration. There is clearly a need for similar research in other low- and middle-income countries, and for studies to see if, at the country level, temporal trends in the contribution made to health care by the private sector can be related to the corresponding trends in physician emigration. The ways in which private health care may be associated with access problems for the poor and therefore reduced equity also merit further investigation. The results should be of interest to policy-makers who aim to improve health systems worldwide. La contribution apportee par le secteur prive aux soins de sante dans les pays a revenu faible ou intermediaire peut modifier les taux d'emigration des medecins de ces pays. L'importance croissante du secteur prive dans les soins de sante dans les pays en voie de developpement a suscite un regain d'interet academique dans les influences de ce secteur sur de nombreux aspects des systemes de sante nationaux. La croissance de l'emigration des medecins des pays en voie de developpement a conduit a plusieurs tentatives d'identifier a la fois les facteurs qui incitent les medecins a emigrer et les effets de l'emigration des medecins sur les soins primaires et la sante de la population dans les pays qu'ils quittent. Lorsque les donnees pertinentes sur les economies emergentes du Ghana, de l'lnde et du Perou ont ete etudiees, il est apparu que la proportion de medecins qui participent a la prestation des soins prives, le pourcentage de depenses de sante financees publiquement et le montant du financement des soins de sante prives par habitant ont ete chacun inversement proportionnels au taux d'expatriation des medecins. Ainsi, la prestation et le financement de soins de sante prives peuvent reduire l'emigration des medecins. Il existe clairement un besoin de recherches similaires dans d'autres pays a revenus faible et intermediaire, ainsi que d'etudes pour voir si, au niveau du pays, les tendances temporelles de la contribution aux soins de sante par le secteur prive peuvent etre liees aux tendances correspondantes de l'emigration des medecins. Les facons dont les soins de sante prives peuvent etre associes a des problemes d'acces pour les pauvres et, par consequent l'equite reduite, meritent egalement une enquete plus approfondie. Les resultats devraient interesser les decideurs politiques qui visent a ameliorer les systemes de sante a travers le monde. La aportacion del sector privado a la atencion sanitaria en un pais de ingresos medios o bajos puede repercutir en los indices de emigracion de medicos de dicho pais. La importancia creciente del sector privado en la atencion sanitaria en los paises en desarrollo ha suscitado un nuevo interes entre los academicos respecto a las influencias de dicho sector sobre muchos aspectos de los sistemas sanitarios nacionales. El aumento de la emigracion de medicos procedentes de paises en desarrollo ha conducido a varios intentos de identificar, por un lado, los factores implicados en la emigracion de medicos y, por otro lado, los efectos de la emigracion de medicos sobre la atencion primaria y la salud de la poblacion de los paises de donde parten los medicos. Tras investigar la informacion pertinente sobre las economias emergentes de Ghana, India y Peru, se hallo una relacion inversa entre el indice de medicos expatriados y cada uno de los siguientes factores: la proporcion de medicos que prestan atencion sanitaria dentro del sector sanitario privado, el porcentaje de los costes sanitarios financiados con fondos publicos y la cuantia de la financiacion per capita del sector sanitario privado. Por consiguiente, parece ser que la prestacion de servicios sanitarios por parte del sector privado y la financiacion pueden reducir la emigracion de medicos. Resulta evidente la necesidad de realizar investigaciones similares en otros paises de renta media y baja, asi como estudios que esclarezcan si, a escala nacional, se pueden vincular las tendencias temporales de la contribucion por parte del sector privado con las correspondientes tendencias de la emigracion de medicos. Como la sanidad privada puede relacionarse con los problemas de acceso para los pobres y, por lo tanto, con la reduccion de la equidad, merece asimismo mayor investigacion. Los resultados podrian ser de interes para los responsables politicos que aspiren a mejorar los sistemas sanitarios a escala mundial., Introduction There has been considerable academic interest in the growth of the private sector in the delivery and financing of health care in developing countries. In a recent editorial, Forsberg [...]