Propiedades diagnósticas de las definiciones de caso sospechoso de COVID-19 en Chile, 2020 / Diagnostic properties of case definitions of suspected COVID-19 in Chile, 2020 / Características diagnósticas das definições de caso suspeito de COVID-19 no Chile, 2020

RESUMEN Objetivo. Comparar las propiedades diagnósticas de cinco definiciones de caso sospechoso de COVID-19 utilizadas o propuestas en Chile durante los primeros ocho meses de la pandemia. Métodos. Se analizaron las propiedades diagnósticas (sensibilidad, especificidad, y valores predictivos positivo y negativo) de tres definiciones de caso sospechoso de COVID-19 utilizadas en Chile entre marzo y octubre del 2020, y dos propuestas de definición alternativas. La muestra fue de 2 019 personas con resultados conocidos a la prueba de la reacción en cadena de la polimerasa (PCR) para SARS-CoV-2. Para elaborar el criterio 5 se aplicó una regresión logística escalonada (stepwise) optimizando los valores de sensibilidad y especificidad. Se exploró la asociación de variables demográficas, síntomas y signos con la positividad a la PCR mediante regresión logística multifactorial. Se analizaron diferentes escenarios de positividad y se compararon las curvas ROC. Resultados. La presencia de anosmia (OR = 8,00; IC95%: 5,34-11,99) y fiebre (OR = 2,15; IC95%: 1,28-3,59) y el haber tenido contacto estrecho previo con una persona enferma de COVID-19 (OR = 2,89; IC95%: 2,16-3,87) se asociaron con un resultado positivo de la PCR. Según el análisis de las curvas ROC, el criterio 5 tuvo la mayor capacidad de discriminación, aunque sin diferencias significativas con los otros cuatro criterios. Conclusiones. El criterio 5 —basado en la anosmia, el contacto estrecho con personas enfermas de COVID-19 y la fiebre como elementos únicos suficientes— tuvo la mayor sensibilidad para identificar los casos sospechosos de COVID-19, aspecto fundamental para controlar la propagación de la pandemia.

ABSTRACT Objective. Compare the diagnostic properties of five case definitions of suspected COVID-19 that were used or proposed in Chile during the first eight months of the pandemic. Methods. An analysis was done of the diagnostic properties (sensitivity, specificity, and positive and negative predictive values) of three case definitions of suspected COVID-19 used in Chile between March and October 2020, as well as two alternative proposed definitions. The sample was 2,019 people with known results for the polymerase chain reaction (PCR) test for SARS-CoV-2. Stepwise logistic regression was used to develop criterion 5, optimizing sensitivity and specificity values. Multifactor logistic regression was used to explore the association between demographic variables, symptoms and signs, and PCR positivity. Different positivity scenarios were analyzed and ROC curves were compared. Results. The presence of anosmia (OR = 8.00; CI95%: 5.34-11.99), fever (OR = 2.15; CI95%: 1.28-3.59), and having been in close contact with a person sick with COVID-19 (OR = 2.89; CI95%: 2.16-3.87) were associated with a positive PCR result. According to the analysis of the ROC curve, criterion 5 had the highest capacity for discrimination, although there were no significant differences with the other four criteria. Conclusions. Criterion 5—based on anosmia, close contact with people with COVID-19, and fever as sufficient unique elements—was the most sensitive in identifying suspected cases of COVID-19, a key aspect in controlling the spread of the pandemic.

RESUMO Objetivo. Comparar as características diagnósticas de cinco critérios das definições de caso suspeito de COVID-19 usados ou propostos no Chile nos oito primeiros meses de pandemia. Métodos. Foram avaliadas as características diagnósticas (sensibilidade, especificidade e valores preditivos positivo e negativo) de três critérios das definições de caso suspeito de COVID-19 usados no Chile entre março e outubro de 2020 e de duas alternativas propostas para definição de caso. A amostra do estudo consistiu 2 019 pessoas com resultados conhecidos no exame de reação em cadeia da polimerase (PCR) para SARS-CoV-2. Para elaborar o critério 5, uma regressão logística com método stepwise foi realizada otimizando os valores de sensibilidade e especificidade. A associação entre variáveis demográficas, sintomas e sinais e resultado positivo no exame de PCR foi testada em um modelo de regressão logística multifatorial. Situações diferentes de resultado positivo foram testadas com uma análise comparativa das curvas ROC. Resultados. Presença de anosmia (OR 8,00; IC95% 5,34-11,99), febre (OR 2,15; IC95% 1,28-3,59) e contato próximo anterior com uma pessoa com COVID-19 (OR 2,89; IC95% 2,16-3,87) foram associados a um resultado positivo no exame de PCR. De acordo com a análise das curvas ROC, o critério 5 demonstrou maior capacidade discriminatória, apesar de não existir diferença significativa com os outros quatro critérios. Conclusão. O critério 5 - presença de anosmia, febre e contato próximo com uma pessoa com COVID-19 como elementos únicos e suficientes - demonstrou maior sensibilidade para identificar casos suspeitos de COVID-19, o que é fundamental para controlar a disseminação da pandemia.

Utilisation of mammography by women with mobility impairment in the UK: secondary analysis of cross-sectional data.

OBJECTIVES: Research has shown that people with physical impairment report lower utilisation of preventive services. The aim of this study was to examine whether women with mobility impairments have lower odds of using mammography compared with women with no such impairment, and explore the factors that are associated with lower utilisation. SAMPLE AND DESIGN: We performed secondary analysis, using logistic regressions, of deidentified cross-sectional data from the European Health Interview Survey, Wave 2. The sample included 9491 women from across the UK, 2697 of whom had mobility impairment. The survey method involved face-to-face and telephone interviews. OUTCOME MEASURES: Self-report of the last time a mammogram was undertaken. RESULTS: Adjusting for various demographic and socioeconomic variables, women with mobility impairment had 1.3 times (95% CI 0.70 to 0.92) lower odds of having a mammogram than women without mobility impairment. Concerning women with mobility impairment, married women had more than twice the odds of having a mammogram than women that had never been married (OR 2.07, 95% CI 1.49 to 2.88). Women in Scotland had 1.5 times (95% CI 1.08 to 2.10) higher odds of undertaking the test than women in England. Women with upper secondary education had 1.4 times (95% CI 1.10 to 1.67) higher odds of undergoing the test than women with primary or lower secondary education. Also, women from higher quintiles (third and fifth quintiles) had higher odds of using mammography, with the women in the fifth quintile having 1.5 times (95% CI 1.02 to 2.15) higher odds than women from the first quintile. CONCLUSIONS: In order to achieve equitable access to mammography for all women, it is important to acknowledge the barriers that impede women with mobility impairment from using the service. These barriers can refer to structural disadvantage, such as lower income and employment rate, transportation barriers, or previous negative experiences, among others.

Utilisation of cancer screening services by disabled women in Chile.

BACKGROUND: Research has shown that women with disabilities face additional challenges in accessing and using healthcare services compared to non-disabled women. However, relatively little is known about the utilisation of cancer screening services for women with disabilities. This study addresses this gap by examining the utilisation of the Papanicolaou test and mammography for disabled women in Chile. METHODS: We used cross-sectional data, taken from a 2015 nationally-representative survey. Initially, we employed logistic regressions to test for differences in utilisation rates for the Papanicolaou test (66,281 observations) and the mammogram (35,294 observations) between disabled and non-disabled women. Next, logistic regressions were used to investigate the demographic, socioeconomic, and health-related factors affecting utilisation rates for cancer screening services for disabled women (sample sizes: 5,823 observations for the Papanicolaou test and 5,731 observations for the mammogram). RESULTS: Disabled women were less likely to undergo screening tests than non-disabled women. For the Papanicolaou test and mammography, the multivariable regression models showed that living in rural areas, having higher education, being affiliated with a private health insurance company, giving a good health self-assessment score, and being under medical treatment for other illnesses were associated with higher utilisation rates. On the other hand, being single, inactive with regard to employment, and having a better income were linked with lower utilisation. While utilisation rates for both disabled and non-disabled women have increased since 2006, the utilisation disparity has slightly increased. CONCLUSIONS: This study shows the influence of various factors in the utilisation rates of preventive cancer screening services for disabled women. To develop effective initiatives targeting inequalities in the utilisation of cancer screening tests, it is important to move beyond an exclusively single-disease approach and acknowledge the complexity of the patient population.