Effectiveness of the booster dose of COVID-19 vaccine in the Basque Country during the sixth wave: A nationwide cohort study.

The aim of the study was to assess the effect of a booster dose of COVID-19 vaccine on the rates of hospital ward and intensive care unit (ICU) admissions around the time of emergence of the Omicron variant in the Basque Country. A retrospective cohort population-based study was conducted. The population with any records related to COVID-19 vaccination up to 28 February 2022 was classified into four cohorts by vaccination status. For every cohort, the hospital ward and ICU admission rates were calculated for each day between November 2021 and February 2022. Generalized linear models with a negative binomial distribution were used to estimate the age-adjusted hospitalization rate ratio of the cohort of individuals who had received a booster compared to the other cohorts. The age-adjusted rates of hospital ward and ICU admissions were 70.4 % and 72.0 % lower, respectively, in the fully vaccinated plus booster group compared to the fully vaccinated but no booster group. Analysing changes in the 14-day admission incidence rates showed that as the prevalence of the Omicron variant increased, the corresponding rate ratios decreased. The immunity acquired with the booster dose allowed the hospital network to meet all the demand for hospitalization during a period of high incidence of COVID-19, despite the fact that vaccine protection decreased as the prevalence of the Omicron variant increased.

Implementing the WHO Safe Childbirth Checklist: lessons from a global collaboration.

The WHO Safe Childbirth Checklist (SCC) was developed to ensure the delivery of essential maternal and perinatal care practices around the time of childbirth. A research collaboration was subsequently established to explore factors that influence use of the Checklist in a range of settings around the world. This analysis article presents an overview of the WHO SCC Collaboration and the lessons garnered from implementing the Checklist across a diverse range of settings. Project leads from each collaboration site were asked to distribute two surveys. The first was given to end users, and the second to implementation teams to describe their respective experiences using the Checklist. A total of 134 end users and 38 implementation teams responded to the surveys, from 19 countries across all levels of income. End users were willing to adopt the SCC and found it easy to use. Training and the provision of supervision while using the Checklist, alongside leadership engagement and local ownership, were important factors which helped facilitate initial implementation and successful uptake of the Checklist. Teams identified several challenges, but more importantly successfully implemented the WHO SCC. A critical step in all settings was the adaptation of the Checklist to reflect local context and national protocols and standards. These findings were invaluable in developing the final version of the WHO SCC and its associated implementation guide. Our experience will provide useful insights for any institution wishing to implement the Checklist.

Reform of primary health care: the case of Spain.

Different approaches to health reform are proposed in many countries to overcome inefficiencies in care delivery. This paper assesses an incremental reform initiated in Spain 10 years ago, which sought to improve the efficiency of the entire health system through changes in the organization and delivery of primary care. In this study, aspects of accessibility, comprehensiveness, longitudinality and technical quality of reformed versus unreformed care were assessed for respondents to a household interview survey conducted in the Basque Region of Spain in 1992. According to this study, aspects of care such as longitudinality and technical quality seemed improved with the reform, whereas other aspects such as accessibility and comprehensiveness remained unchanged. The authors conclude that system related characteristics (more associated with access and comprehensiveness) may be impeding the achievement of the goals of the reform and argue that attempts to encourage more autonomy of care delivery may be required.

[Lateness in the treatment of diabetic retinopathy: the efficacy of an effective treatment]. / Tardanza en el tratamiento de la retinopatía diabética: effectividad de un tratamiento eficaz.

Despite the efficacy of laser photocoagulation as the treatment for diabetic retinopathy, this condition is the leading cause of blindness in developed countries. In this survey we have tried to find out whether this lack of effectiveness is due to a lack of adequate control and screening. As a proxy measure for this we have developed an indicator called "lateness" and we have followed a sample of diabetics drawn from the two public hospitals in Vizcaya (Spain). Seventy five percent of them were not at regular intervals and half of the sample was late for treatment. Among these, Insulin-dependent diabetics of older age and with more years of the disease are at a higher of entering late for treatment. We could not find any risk factor lateness among non insulin dependent diabetics. We concluded that most of diabetics are not adequately followed up for the prevention of diabetic retinopathy, and when they are referred to treatment it is too take the most advantage of it.

[Public health professionals and professional competences debate]. / La profesión de salud pública y el debate de las competencias profesionales.

Despite its historical contribution to the improvement of health, public health occupies a marginal position in health systems. This lack of correspondence between impact and power is related in part to its scarce recognition as a profession, and in consequence to the lack of recognition of the professionals in the field. The strengthening of the public health profession requires recognising the coherence of their objectives and scientific basis, but it also requires the establishment of mechanisms to guarantee professional competence. Generally, the institutionalisation of these necessary mechanisms to articulate public health objectives into effective professional practice has been lacking. In other words, the so-called professional competencies lacked development in public health. Progress in this strategy calls for the definition of the professional content based on a functional analysis of public health. That is, an analysis of the functions that these professionals must contribute to society and of the specific activities necessary to achieve the desired outcomes. The aim of this work is to stimulate a debate along these lines taking into account the experiences of other countries. The authors propose to reconsider a further reconstruction of public health, based on an analysis of its objectives, functions and competences, in order to grow away from its marginal position, and improve its social function.

Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital.

OBJECTIVE: To assess the frequency and nature of adverse events to patients in selected hospitals in developing or transitional economies. DESIGN: Retrospective medical record review of hospital admissions during 2005 in eight countries. SETTING: Ministries of Health of Egypt, Jordan, Kenya, Morocco, Tunisia, Sudan, South Africa and Yemen; the World Health Organisation (WHO) Eastern Mediterranean and African Regions (EMRO and AFRO), and WHO Patient Safety. PARTICIPANTS: Convenience sample of 26 hospitals from which 15,548 patient records were randomly sampled. MAIN OUTCOME MEASURES: Two stage screening. Initial screening based on 18 explicit criteria. Records that screened positive were then reviewed by a senior physician for determination of adverse event, its preventability, and the resulting disability. RESULTS: Of the 15,548 records reviewed, 8.2% showed at least one adverse event, with a range of 2.5% to 18.4% per country. Of these events, 83% were judged to be preventable, while about 30% were associated with death of the patient. About 34% adverse events were from therapeutic errors in relatively non-complex clinical situations. Inadequate training and supervision of clinical staff or the failure to follow policies or protocols contributed to most events. CONCLUSIONS: Unsafe patient care represents a serious and considerable danger to patients in the hospitals that were studied, and hence should be a high priority public health problem. Many other developing and transitional economies will probably share similar rates of harm and similar contributory factors. The convenience sampling of hospitals might limit the interpretation of results, but the identified adverse event rates show an estimate that should stimulate and facilitate the urgent institution of appropriate remedial action and also to trigger more research. Prevention of these adverse events will be complex and involves improving basic clinical processes and does not simply depend on the provision of more resources.

Prevalence of adverse events in the hospitals of five Latin American countries: results of the 'Iberoamerican Study of Adverse Events' (IBEAS).

BACKGROUND: Interest in patient safety (PS) is growing exponentially, fuelled by epidemiological research unveiling the extent of unsafe care. However, there is little information about the frequency of harm in developing and transitional countries. To address this issue, the authors performed a study known as the Iberoamerican Adverse Event Study, through a collaborative between the governments of Argentina, Colombia, Costa Rica, Mexico and Peru, the Spanish Ministry of Health, Social Policy and Equality, the Pan American Health Organization and the WHO Patient Safety. METHODS: The study used a cross-sectional design, involving 58 hospitals in the five Latin American countries, to measure the point prevalence of patients presenting an adverse event (AE) on the day of observation. All inpatients at the time of the study were included. RESULTS: A total of 11 379 inpatients were surveyed. Of these, 1191 had at least one AE that the reviewer judged to be related to the care received rather than to the underlying conditions. The estimated point prevalence rate was 10.5% (95% CI 9.91 to 11.04), with more than 28% of AE causing disability and another 6% associated with the death of the patient. Almost 60% of AE were considered preventable. CONCLUSIONS: The high rate of prevalent AE found suggests that PS may represent an important public-health issue in the participating hospitals. While new studies may be needed to confirm these results, these may already be useful to inspire new PS-improvement policies in those settings.

Patient safety research: an overview of the global evidence.

BACKGROUND: Unsafe medical care may cause substantial morbidity and mortality globally, despite imprecise estimates of the magnitude of the problem. To better understand the extent and nature of the problem of unsafe care, the WHO World Alliance for Patient Safety commissioned an overview of the world's literature on patient safety research. METHODS: Major patient safety topics were identified through a consultative and investigative process and were categorised into the framework of structure, process and outcomes of unsafe care. Lead experts examined current evidence and identified major knowledge gaps relating to topics in developing, transitional and developed nations. The report was reviewed by internal and external experts and underwent improvements based on the feedback. FINDINGS: Twenty-three major patient safety topics were examined. Much of the evidence of the outcomes of unsafe care is from developed nations, where prevalence studies demonstrate that between 3% and 16% of hospitalised patients suffer harm from medical care. Data from transitional and developing countries also suggest substantial harm from medical care. However, considerable gaps in knowledge about the structural and process factors that underlie unsafe care globally make solutions difficult to identify, especially in resource-poor settings. INTERPRETATION: Harm from medical care appears to pose a substantial burden to the world's population. However, much of the evidence base comes from developed nations. Understanding the scope of and solutions for unsafe care for the rest of the world is a critical component of delivering safe, effective care to all of the world's citizens.

Measures of patient safety in developing and emerging countries: a review of the literature.

CONTEXT: The World Alliance for Patient Safety was formed to accelerate worldwide research progress towards measurably improving patient safety. Although rates of adverse events have been studied in industrialised countries, little is known about the rates of adverse events in developing and emerging countries. PURPOSE: To review the literature on patient safety issues in developing and emerging countries, to identify patient safety measures presently used in these countries and to propose a method of measurably improving patient safety measurement in these countries. METHODS: Using the Medline database for 1998 to 2007, we identified and reviewed 23 English-language articles that examined patient safety measurement in developing and emerging countries. Results Our review included 12 studies that prospectively measured patient safety and 11 studies that retrospectively measured safety. Two studies used measures of structure and the remaining used process measures, outcome measures or both. Whereas a few studies used surveys or direct observation, most studies used chart audits to measure patient safety. Most studies addressed safety at a single facility. CONCLUSIONS: Investigation of patient safety in developing and emerging countries has been infrequent and limited in scope. Establishing fundamental safe patient practices, integrating those processes into routine health services delivery and developing patients' expectations that such processes be present are necessary prerequisites to measuring and monitoring progress towards safe patient care in emerging and developing countries.

How effective is the referral chain for diabetic retinopathy?

Despite the availability of effective photocoagulation treatment, diabetic retinopathy remains the main cause of blindness in persons aged between 20 and 64 years. We have examined the effectiveness of the referral chain for retinopathy by auditing medical records for a representative sample being 226 diabetic patients (35% of attenders) referred to a special photocoagulation clinic. Patients were classified as 'late' or 'not late' by using an algorithm which accounted for the state of retinopathy at referral and the previous frequency of eye examination. Forty-four patients (19%) were considered to have been referred late. These were mainly younger onset patients, aged between 30 and 40, and not attending a diabetic clinic. Patients not attending any other outpatient clinic were 27 times more likely to be referred late.