Elixhauser comorbidity method in predicting death of Spanish inpatients with asplenia and pneumococcal pneumonia.

BACKGROUND: Pneumococcal pneumonia (PP) is a serious infection caused by Streptococcus pneumoniae (pneumococcus), with a wide spectrum of clinical manifestations. The aim of this study was to analyze the comorbidity factors that influenced the mortality in patients with asplenia according to PP. METHODS: Discharge reports from the Spanish Minimum Basic Data Set (MBDS) was used to retrospectively analyze patients with asplenia and PP, from 1997 to 2021. Elixhauser Comorbidity Index (ECI) was calculated to predict in-hospital mortality (IHM). RESULTS: 97,922 patients with asplenia were included and 381 cases of PP were identified. The average age for men was 63.87 years and for women 65.99 years. In all years, ECI was larger for splenectomized than for non-splenectomized patients, with men having a higher mean ECI than women. An association was found between risk factors ECI, splenectomy, age group, sex, pneumococcal pneumonia, and increased mortality (OR = 0.98; 95% CI: 0.97-0.99; p < 0.001). The IHM increased steadily with the number of comorbidities and index scores in 1997-2021. CONCLUSIONS: Asplenia remain a relevant cause of hospitalization in Spain. Comorbidities reflected a great impact in patients with asplenia and PP, which would mean higher risk of mortality.

The invisible problem of early adolescent pregnancy in the Dominican Republic: a descriptive analysis.

Study objectives: The aim of this article is to describe the problem of pregnancy in girls under 15 years of age in the Dominican Republic in the period 2000-2021, to develop a specific indicator for this age group and describing the related factors. Methods: This is an exploratory ecological study, based on secondary data sources, such as birth records from the National Statistics Office (NSO) and the Ministry of Public Health (MPH). We calculated the rates of fertility and pregnancy in early adolescence, as well as analyzed their main determining factors and consequences. Results: Fertility Rate in Early Adolescence (FREA) decreases from 6.27 to 1.04 per thousand in the period 2001-2021. The average FREA for 2015-2021 was 1.78. The average Estimated Rate of Pregnancy in Early Adolescence (ERPEA) for the same period was 3.39. Disability-Adjusted Life Years (DALYs) were 11,620 years. Years of Life Lost (YLL) were 9,665.9 years. The prevalence of Low Birth Weight (LBW) in the under 15-year-old age group was 14.2 %. Conclusions: Pregnancy in childhood implies risks for both the mother and the child, including low birth weight. The official fertility rate is substantially underreported (2.84 vs. 1.79).The fertility rate indicator traditionally used does not accurately measure the number of pregnancies in women, particularly in specific age groups or populations where pregnancies may be interrupted by various factors. Therefore, the use of ERPEA is recommended.We emphasize the need for implementing the proposed indicator for the target group, as well as monitoring Sustainable Development Goal indicator 3.7.2.

Tracking the impact of the COVID-19 pandemic on routine infant vaccinations in the Dominican Republic.

As the COVID-19 pandemic progresses, millions of infants are unprotected against immune-preventable diseases due to interruptions in vaccination services. The direct effects of the pandemic, as well as the non-pharmacological interventions for its containment, mitigation and suppression adopted by many countries, have affected their vaccination programs. We conducted an ecological study analyzing the performance of the vaccination program in the Dominican Republic before (2019) and during the COVID-19 pandemic (2020). We compared annual public coverage data, analyzed trends and changes in coverage, dropout rate, and number of partially and unvaccinated infants by geographic area and COVID-19 incidence rate. Compared to baseline, coverage for all vaccines decreased by 10.4 (SD, 3.6) percent; among these, coverage for the third dose of the pentavalent vaccine decreased from 90.1% in 2019 to 81.1% in 2020. The number of partially vaccinated (n = 34,185) and unvaccinated (n = 5,593) infants increased 66% and 376%, respectively. The slight increase in the annual dropout rate (1.1%) was directly proportional to the number of COVID-19 cases per month. We found a significant association between the annual absolute change of Penta3 and the subnational Human Development Index. The pandemic significantly weakened the performance of the routine vaccination program. Interventions are needed to recover and maintain lost vaccination coverage, reducing the risk of outbreaks of preventable diseases, especially in those provinces with less human development.

Effect of a surgical care bundle on the incidence of surgical site infection in colorectal surgery: a quasi-experimental intervention

Background: Surgical site infections (SSI) have an important impact on morbidity and mortality. Objective: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. Methods: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). Results: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. Conclusions: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.

Effect of a Surgical Care Bundle on the Incidence of Surgical Site Infection in Colorectal Surgery: A Quasi-Experimental Intervention.

BACKGROUND: Surgical site infections (SSI) have an important impact on morbidity and mortality. OBJECTIVE: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. METHODS: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). RESULTS: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. CONCLUSIONS: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.

Monitoring inequality changes in full immunization coverage in infants in Latin America and the Caribbean

[ABSTRACT]. Objective. To compare inequalities in full infant vaccination coverage at two different time points between 1992 and 2016 in Latin American and Caribbean countries. Methods. Analysis is based on recent available data from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Reproductive Health Surveys conducted in 18 countries between 1992 and 2016. Full immunization data from children 12–23 months of age were disaggregated by wealth quintile. Absolute and relative inequalities between the richest and the poorest quintile were measured. Differences were measured for 14 countries with data available for two time points. Significance was determined using 95% confidence intervals. Results. The overall median full immunization coverage was 69.9%. Approximately one-third of the countries have a high-income inequality gap, with a median difference of 5.6 percentage points in 8 of 18 countries. Bolivia, Colombia, El Salvador, and Peru have achieved the greatest progress in improving coverage among the poorest quintiles of their population in recent years. Conclusion. Full immunization coverage in the countries in the study shows higher-income inequality gaps that are not seen by observing national coverage only, but these differences appear to be reduced over time. Actions monitoring immunization coverage based on income inequalities should be considered for inclusion in the assessment of public health policies to appropriately reduce the gaps in immunization for infants in the lowest-income quintile.

[RESUMEN]. Objetivo. Comparar las desigualdades en cuanto a la cobertura de la inmunización completa en los lactantes en países de América Latina y el Caribe. en dos puntos diferentes en el tiempo: 1992 y el 2016. Métodos. El análisis se basa en datos obtenidos recientemente a partir de las encuestas demográficas y de salud, las encuestas de grupos de indicadores múltiples y las encuestas de salud reproductiva realizadas en 18 países entre 1992 y el 2016. Los datos de la cobertura de la inmunización completa en lactantes (de 12 a 23 meses de edad) fueron desglosados por quintil de riqueza. Se midieron las desigualdades absolutas y relativas entre el quintil de ingresos más altos y el quintil de ingresos más bajos. Se midieron las diferencias en 14 países a partir de los datos disponibles para dos puntos en el tiempo. Se determinó la significación mediante intervalos de confianza del 95%. Resultados. La mediana general de los niveles de cobertura de inmunización total fue de 69,9%. Aproximadamente un tercio de los países presentan una brecha de desigualdad con respecto al quintil de ingresos más altos, con una diferencia entre medianas de 5,6 puntos porcentuales en 8 de 18 países. En los últimos años, Bolivia, Colombia, Perú y El Salvador han logrado el mayor avance en cuanto a la mejora de la cobertura en términos de la población correspondiente al quintil de ingresos más bajos. Conclusiones. En este estudio, la cobertura de inmunización completa en los países muestra brechas de desigualdad con respecto al quintil de ingresos más altos que no se evidencian con tan solo observar el nivel de cobertura a nivel nacional. Sin embargo, estas desigualdades parecen disminuir con el transcurso del tiempo. Debería considerarse la posibilidad de que las medidas de seguimiento de la cobertura de inmunización con base en las desigualdades de los ingresos sean incluidas en la evaluación de las políticas de salud pública. Esto permitiría reducir de manera apropiada las brechas en cuanto a la inmunización en los lactantes en el quintil de ingresos más bajos.

[RESUMO]. Objetivo. Comparar as desigualdades na cobertura vacinal completa infantil em dois momentos distintos entre 1992 e 2016 em países da América Latina e Caribe. Métodos. A análise se baseou em dados recentes provenientes de Pesquisas Nacionais de Demografia e Saúde, Inquéritos por Conglomerados de Múltiplos Indicadores e Pesquisas de Saúde Reprodutiva realizados em 18 países entre 1992 e 2016. Os dados de cobertura vacinal completa em crianças entre 12 e 23 meses de idade foram desagregados por quintis de renda. Foi mensurada a desigualdade absoluta e relativa entre os quintis de maior e menor renda. A magnitude destas diferenças foi avaliada em 14 países com dados disponíveis nos dois momentos considerados. O nível de significância foi determinado com o uso de intervalos de confiança de 95%. Resultados. A mediana global de cobertura vacinal completa foi de 69,9%. Cerca de um terço dos países apresenta alto nível de desigualdade de renda, com uma diferença mediana de 5,6 pontos percentuais em 8 dos 18 países. Bolívia, Colômbia, El Salvador e Peru obtiveram maior avanço nos últimos anos com o aumento do nível de cobertura na população nos quintis de menor renda destes países. Conclusões. A análise da cobertura vacinal completa infantil nos países estudados indica altos níveis de desigualdade de renda que não são evidentes quando se observa somente a cobertura nacional. No entanto, estas diferenças parecem que vêm diminuindo. Deve-se considerar incluir ações de monitoramento da cobertura vacinal com base nas desigualdades de renda ao se avaliar as políticas de saúde pública a fim de reduzir apropriadamente a disparidade na cobertura vacinal de lactentes pertencentes ao quintil de menor renda.

Monitoring inequality changes in full immunization coverage in infants in Latin America and the Caribbean / Seguimiento de los cambios en las desigualdades con respecto a la cobertura de la inmunización completa en lactantes en América Latina y el Caribe / Monitoramento do avanço das desigualdades na cobertura vacinal completa em lactentes na América Latina e no Caribe

ABSTRACT Objective. To compare inequalities in full infant vaccination coverage at two different time points between 1992 and 2016 in Latin American and Caribbean countries. Methods. Analysis is based on recent available data from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Reproductive Health Surveys conducted in 18 countries between 1992 and 2016. Full immunization data from children 12-23 months of age were disaggregated by wealth quintile. Absolute and relative inequalities between the richest and the poorest quintile were measured. Differences were measured for 14 countries with data available for two time points. Significance was determined using 95% confidence intervals. Results. The overall median full immunization coverage was 69.9%. Approximately one-third of the countries have a high-income inequality gap, with a median difference of 5.6 percentage points in 8 of 18 countries. Bolivia, Colombia, El Salvador, and Peru have achieved the greatest progress in improving coverage among the poorest quintiles of their population in recent years. Conclusion. Full immunization coverage in the countries in the study shows higher-income inequality gaps that are not seen by observing national coverage only, but these differences appear to be reduced over time. Actions monitoring immunization coverage based on income inequalities should be considered for inclusion in the assessment of public health policies to appropriately reduce the gaps in immunization for infants in the lowest-income quintile.(AU)

RESUMEN Objetivo. Comparar las desigualdades en cuanto a la cobertura de la inmunización completa en los lactantes en países de América Latina y el Caribe. en dos puntos diferentes en el tiempo: 1992 y el 2016. Métodos. El análisis se basa en datos obtenidos recientemente a partir de las encuestas demográficas y de salud, las encuestas de grupos de indicadores múltiples y las encuestas de salud reproductiva realizadas en 18 países entre 1992 y el 2016. Los datos de la cobertura de la inmunización completa en lactantes (de 12 a 23 meses de edad) fueron desglosados por quintil de riqueza. Se midieron las desigualdades absolutas y relativas entre el quintil de ingresos más altos y el quintil de ingresos más bajos. Se midieron las diferencias en 14 países a partir de los datos disponibles para dos puntos en el tiempo. Se determinó la significación mediante intervalos de confianza del 95%. Resultados. La mediana general de los niveles de cobertura de inmunización total fue de 69,9%. Aproximadamente un tercio de los países presentan una brecha de desigualdad con respecto al quintil de ingresos más altos, con una diferencia entre medianas de 5,6 puntos porcentuales en 8 de 18 países. En los últimos años, Bolivia, Colombia, Perú y El Salvador han logrado el mayor avance en cuanto a la mejora de la cobertura en términos de la población correspondiente al quintil de ingresos más bajos. Conclusiones. En este estudio, la cobertura de inmunización completa en los países muestra brechas de desigualdad con respecto al quintil de ingresos más altos que no se evidencian con tan solo observar el nivel de cobertura a nivel nacional. Sin embargo, estas desigualdades parecen disminuir con el transcurso del tiempo. Debería considerarse la posibilidad de que las medidas de seguimiento de la cobertura de inmunización con base en las desigualdades de los ingresos sean incluidas en la evaluación de las políticas de salud pública. Esto permitiría reducir de manera apropiada las brechas en cuanto a la inmunización en los lactantes en el quintil de ingresos más bajos.(AU)

RESUMO Objetivo. Comparar as desigualdades na cobertura vacinal completa infantil em dois momentos distintos entre 1992 e 2016 em países da América Latina e Caribe. Métodos. A análise se baseou em dados recentes provenientes de Pesquisas Nacionais de Demografia e Saúde, Inquéritos por Conglomerados de Múltiplos Indicadores e Pesquisas de Saúde Reprodutiva realizados em 18 países entre 1992 e 2016. Os dados de cobertura vacinal completa em crianças entre 12 e 23 meses de idade foram desagregados por quintis de renda. Foi mensurada a desigualdade absoluta e relativa entre os quintis de maior e menor renda. A magnitude destas diferenças foi avaliada em 14 países com dados disponíveis nos dois momentos considerados. O nível de significância foi determinado com o uso de intervalos de confiança de 95%. Resultados. A mediana global de cobertura vacinal completa foi de 69,9%. Cerca de um terço dos países apresenta alto nível de desigualdade de renda, com uma diferença mediana de 5,6 pontos percentuais em 8 dos 18 países. Bolívia, Colômbia, El Salvador e Peru obtiveram maior avanço nos últimos anos com o aumento do nível de cobertura na população nos quintis de menor renda destes países. Conclusões. A análise da cobertura vacinal completa infantil nos países estudados indica altos níveis de desigualdade de renda que não são evidentes quando se observa somente a cobertura nacional. No entanto, estas diferenças parecem que vêm diminuindo. Deve-se considerar incluir ações de monitoramento da cobertura vacinal com base nas desigualdades de renda ao se avaliar as políticas de saúde pública a fim de reduzir apropriadamente a disparidade na cobertura vacinal de lactentes pertencentes ao quintil de menor renda.(AU)

[Water pollution in sources close to oil-producing fields of Bolivia]. / Contaminación del agua en fuentes cercanas a campos petrolíferos de Bolivia.

OBJECTIVE: to determine the concentrations of petrochemical compounds in the drinking water sources of communities located near oil-producing fields in the Bolivian Chaco region. METHODS: data were collected on total petroleum hydrocarbons (TPH), 16 polycyclic aromatic hydrocarbons (PAH), including benzene, toluene, ethylbenzene, and xylenes (BTEX), and 22 metals in samples from 42 sources of water for human consumption located less than 30 km from an oil-producing field. Distribution of the concentration and adherence to the standards contained in the Bolivian, European, and United States regulations, as well as the recommendations of the World Health Organization, were analyzed. RESULTS: in 76.19% of the samples, some petrochemical contaminant was found in concentrations higher than permissible in any of the four sets of regulations mentioned. The water samples with the highest contamination levels were from faucets and rivers. The most common contaminants were TPH, PAH, aluminum, arsenic, manganese, and iron. CONCLUSIONS: communities within a 30 km radius of the oil-producing fields in the Bolivian Chaco region consume water with TPH, PAH, and metal concentrations well above the levels permitted in the Bolivian regulations and international standards, putting the public health of their residents at serious risk.

Contaminación del agua en fuentes cercanas a campos petrolíferos de Bolivia / Water pollution in sources close to oil-producing fields of Bolivia

OBJETIVO: Determinar las concentraciones de compuestos petroquímicos en las fuentes de agua de consumo para comunidades cercanas a campos petrolíferos del Chaco Boliviano. MÉTODOS: Se recogieron datos sobre concentraciones de hidrocarburos totales de petróleo (HTP), 16 hidrocarburos aromáticos policíclicos (HAP), incluidos el benceno, tolueno, etilbenceno y xilenos (BTEX), y 22 metales en muestras de 42 fuentes de agua de consumo humano situadas a menos de 30 km de un campo de extracción de petróleo. Se analizó la distribución de la concentración y el cumplimiento de los estándares definidos en las normativas boliviana, europea y estadounidense, así como en las recomendaciones de la Organización Mundial de la Salud. RESULTADOS: En 76,19 por ciento de las muestras se halló algún contaminante petroquímico en concentraciones superiores a alguna de las cuatro normativas de referencia. Las muestras de agua que presentaron mayor contaminación fueron las provenientes de grifos y ríos. Los contaminantes más frecuentes fueron HTP, HAP, aluminio, arsénico, manganeso y hierro. CONCLUSIONES: Las comunidades del Chaco Boliviano ubicadas en un radio de 30 km alrededor de los campos de extracción de petróleo consumen agua con concentraciones de HTP, HAP y metales muy por encima de los niveles permitidos por la normativa boliviana y los estándares internacionales, poniendo en grave riesgo la salud pública de sus habitantes.

OBJECTIVE: To determine the concentrations of petrochemical compounds in the drinking water sources of communities located near oil-producing fields in the Bolivian Chaco region. METHODS: Data were collected on total petroleum hydrocarbons (TPH), 16 polycyclic aromatic hydrocarbons (PAH), including benzene, toluene, ethylbenzene, and xylenes (BTEX), and 22 metals in samples from 42 sources of water for human consumption located less than 30 km from an oil-producing field. Distribution of the concentration and adherence to the standards contained in the Bolivian, European, and United States regulations, as well as the recommendations of the World Health Organization, were analyzed. RESULTS: In 76.19 percent of the samples, some petrochemical contaminant was found in concentrations higher than permissible in any of the four sets of regulations mentioned. The water samples with the highest contamination levels were from faucets and rivers. The most common contaminants were TPH, PAH, aluminum, arsenic, manganese, and iron. CONCLUSIONS: Communities within a 30 km radius of the oil-producing fields in the Bolivian Chaco region consume water with TPH, PAH, and metal concentrations well above the levels permitted in the Bolivian regulations and international standards, putting the public health of their residents at serious risk.

Manual de epidemiología y salud pública para licenciaturas y diplomaturas en ciencias de la salud

Introducción a la salud pública y los servicios sanitarios. Epidemiología, estadística y demografía sanitaria. Estrategias epidemiológicas específicas y prevención de problemas de salud. Gestión sanitaria y programas de salud.

Manual de epidemiología y salud pública para licenciaturas y diplomaturas en ciencias de la salud

Introducción a la salud pública y los servicios sanitarios. Epidemiología, estadística y demografía sanitaria. Estrategias epidemiológicas específicas y prevención de problemas de salud. Gestión sanitaria y programas de salud.