Systematic and progressive implementation of the centers of excellence for rheumatoid arthritis: a methodological proposal.

The implementation of excellence centers in specific diseases has been gaining recognition in the field of health; specifically in rheumatoid arthritis, where the prognosis of the disease is related to an early diagnosis and a timely intervention, it is necessary that the provision of health services is developed in an environment of quality, opportunity, and safety with the highest standards of care. A methodology that allows this implementation in such a way that is achievable by the most of the care centers is a priority to achieve a better attention to populations with this disease. In this paper, we propose a systematic and progressive methodology that will help all the institutions to develop successful models without faltering in the process. The expected impact on public health is defined by a better effective coverage of high-quality treatments, obtaining better health outcomes with safety and accessibility that reduces the budgetary impact for the health systems of our countries.

Population-based surveillance for invasive pneumococcal disease and pneumonia in infants and young children in Bogotá, Colombia.

BACKGROUND: In children <5 years of age, Streptococcus pneumoniae (SP) is, globally, the leading cause of vaccine-preventable death. Surveillance conducted in Bogotá, Colombia estimated incidence rates of invasive pneumococcal disease (IPD), clinical and chest radiograph-confirmed pneumonia (CXR+Pn); SP serotype distribution and antimicrobial susceptibility. METHODS: This prospective population-based surveillance was conducted from 2006 to 2008 in children 28 days to <36 months of age seeking care at SaludCoop centers. We determined incidence rates of IPD and pneumonia (clinical and CXR+Pn). Eligibility criteria included: temperature ≥39.0°C within 24h and/or clinical suspicion of IPD or pneumonia. Blood was obtained for culture in all children. Other sterile site specimens were obtained per routine practice. RESULTS: Of 8261 subjects enrolled, a total of 64 had invasive pneumococcal disease detected by isolation of SP from nonduplicative cultures (62) or detected solely by PCR and a clinical picture consistent with IPD (2). The overall IPD incidence rates for culture-positive only cases for children aged 28 days to <36 months was 76.4/100,000 per year for years 1 and 2 combined. Age stratification found the highest rates in children 6-12 and 12 to <24 months of age. IPD incidence rates were assessed for bacteremic pneumonia (54.2/100,000), bacteremia (17.2/100,000), meningitis (3.7/100,000), and sepsis (1.2/100,000). Most common serotypes causing IPD were: 14 (51.6%), 6B (9.7%), and 19F (9.7%). Coverage of IPD cases by pneumococcal conjugate vaccine (PCV) 7, PCV10, and PCV13 was 77.4%, 85.5%, and 91.9%, respectively. Twenty-eight isolates (45.2%) were penicillin-nonsusceptible; PCV7 covered 96.3% of these; PCV10 covered 96.3% and PCV13 covered 100%. The overall incidence of clinical pneumonia and CXR+Pn was 6276/100,000 and 2120/100,000, respectively. CONCLUSION: Pneumococcal disease and pneumonia burden is considerable in children in Bogotá, Colombia. Vaccination with pneumococcal conjugate vaccines has the potential to decrease this burden. Epidemiologic data are critical in assessing the potential impact of introduction of PCVs into national immunization schedules.