Background Systematic reviews allow health decisions to be informed by the best available research evidence. However, their number is proliferating quickly, and many skills are required to identify all the relevant reviews for a specific question. Methods and findings We screen 10 bibliographic databases on a daily or weekly basis, to identify systematic reviews relevant for health decision-making. Using a machine-based approach developed for this project we select reviews, which are then validated by a network of more than 1000 collaborators. After screening over 1,400,000 records we have identified more than 300,000 systematic reviews, which are now stored in a single place and accessible through an easy-to-use search engine. This makes Epistemonikos the largest database of its kind. Conclusions Using a systematic approach, recruiting a broad network of collaborators and implementing automated methods, we developed a one-stop shop for systematic reviews relevant for health decision making.
BackgroundScientific knowledge is a fundamental tool for making informed health policy decisions, but the link between health research and public policy decision-making is often missing. This study aims to identify and prioritize a national set of research gaps in mental health.MethodsA multi-approach method to identify gaps in knowledge was developed, including (1) document analysis and identification of possible research questions, (2) interviews to Ministry of Health key informants, (3) focus groups with different stakeholders, and (4) a web consultation addressed to academics. The identified gaps were translated to a standardized format of research questions. Criteria for prioritization were extracted from interviews and focus groups. Then, a team of various professionals applied them for scoring each question research.FindingsFifty-four people participated in the knowledge gaps identification process through an online consultation (n = 23) and focus groups (n = 18). Prioritization criteria identified were: extent of the knowledge gap, size of the objective population, potential benefit, vulnerability, urgency and applicability. 155 research questions were prioritized, of which 44% were related to evaluation of systems and/or health programs, and 26% to evaluation of interventions, including questions related to cost-effectiveness. 30% of the research questions came from the online consultation, and 36% from key informants. Users groups contributed with 10% of total research questions.ConclusionA final priority setting for mental health research was reached, making available for authorities and research agencies a list of 155 research questions ordered by relevance. The experience documented here could serve to other countries interested in developing a similar process.Electronic supplementary materialThe online version of this article (doi:10.1186/s13033-017-0168-9) contains supplementary material, which is available to authorized users.
Access to social networks and health care among extremely poor people Background: Extremely poor people have more problems to have access to social networks and health care. Aim: To evaluate the access to health services and the perception about these services of adults living in conditions of extreme poverty. Material and methods: A survey was applied to 361 people living in slums aged 15 to 77 years (83% females), that were living in these conditions for a mean of 11 years. Twenty six in-depth interviews were also performed to prototypical subjects living in extreme poverty. Results: Ten percent of subjects were illiterate. Sixty two percent were unsatisfied with their access to health services and 32% were not registered in primary health clinics. Among children of less than 6 years of age, 22% were delayed in their vaccination schedule and 32% were not withdrawing the milk delivered by the complementary feeding program of the clinic. The qualitative analysis revealed that the lack of access to health care is associated with the feeling of exclusion, mutual distrust and lack of resolution of health problems. Conclusions: People living in extreme poverty are distrustful and perceive obstacles to have access to the health care system (Rev Méd Chile 2009; 137: 753-8). (
Background Evidence suggests the incidence of non-affective psychotic disorders (NAPDs) varies across persons and places, but data from the Global South is scarce. We aimed to estimate the treated incidence of NAPD in Chile, and variance by person, place and time. Methods We used national register data from Chile including all people, 10–65 years, with the first episode of NAPD (International Classification of Diseases, Tenth Revision: F20–F29) between 1 January 2005 and 29 August 2018. Denominators were estimated from Chilean National Census data. Our main outcome was treated incidence of NAPD and age group, sex, calendar year and regional-level population density, multidimensional poverty and latitude were exposures of interest. Results We identified 32 358 NAPD cases [12 136 (39.5%) women; median age-at-first-contact: 24 years (interquartile range 18–39 years)] during 171.1 million person-years [crude incidence: 18.9 per 100 000 person-years; 95% confidence interval (CI) 18.7–19.1]. Multilevel Poisson regression identified a strong age–sex interaction in incidence, with rates peaking in men (57.6 per 100 000 person-years; 95% CI 56.0–59.2) and women (29.5 per 100 000 person-years; 95% CI 28.4–30.7) between 15 and 19 years old. Rates also decreased (non-linearly) over time for women, but not men. We observed a non-linear association with multidimensional poverty and latitude, with the highest rates in the poorest regions and those immediately south of Santiago; no association with regional population density was observed. Conclusion Our findings inform the aetiology of NAPDs, replicating typical associations with age, sex and multidimensional poverty in a Global South context. The absence of association with population density suggests this risk may be context-dependent.
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