Conceptual framework of equity-focused implementation research for health programs (EquIR).

BACKGROUND: Implementation research is increasingly used to identify common implementation problems and key barriers and facilitators influencing efficient access to health interventions. OBJECTIVE: To develop and propose an equity-based framework for Implementation Research (EquIR) of health programs, policies and systems. METHODS: A systematic search of models and conceptual frameworks involving equity in the implementation of health programs, policies and systems was conducted in Medline (PubMed), Embase, LILACS, Scopus and grey literature. Key characteristics of models and conceptual frameworks were summarized. We identified key aspects of equity in the context of seven Latin American countries-focused health programs We gathered information related to the awareness of inequalities in health policy, systems and programs, the potential negative impact of increasing inequalities in disadvantaged populations, and the strategies used to reduce them. RESULTS: A conceptual framework of EquIR was developed. It includes elements of equity-focused implementation research, but it also links the population health status before and after the implementation, including relevant aspects of health equity before, during and after the implementation. Additionally, health sectors were included, linked with social determinants of health through the "health in all policies" proposal affecting universal health and the potential impact of the public health and public policies. CONCLUSION: EquIR is a conceptual framework that is proposed for use by decision makers and researchers during the implementation of programs, policies or health interventions, with a focus on equity, which aims to reduce or prevent the increase of existing inequalities during implementation.

[Prevention of cardiovascular diseases by an antihypertensive program in the elderly, a cohort study]. / Prevención de eventos cardiovasculares en hipertensos mayores de 65 años bajo el cuidado de un programa de control. Estudio de cohorte.

INTRODUCTION: We started on year 2000 a Complex Intervention Program addressed at hypertension control among our patients. AIM: To compare the risk of cardiovascular events and of dying in hypertensive patients under Program care. METHOD: We started follow-up of a cohort of 1922 patients over 65 years in August 2000. Hipertension diagnosis was ascertained if patient reported to be hypertensive, or was under anti hypertensive treatment or if he/she had two blood pressure measurements = 140/90 mm Hg. Cardiovascular events were considered to be admissions due to coronary disease, cardiac insufficiency or stroke. Incidence is reported by 100 person years follow-up. Relative risks between hypertensive and normotensive patients were calculated and Cox regresión was used to adjust for potential confounders. We compared time to first cardiovascular event and to death with Log Rank Test. RESULTS: Fourty eight point three percent of patients were hypertensive and differed from normotensive patients as to age (79 (5) years vs. 77 (5) p < 0.001), proportion of diabetic patients (16.1% vs. 7.6% p < 0.001). Mean follow-up time was 28 months. Mortality RR was 1.04 (95% CI 0.69-1.58). As to incidence of cardiovascular events it was 1.86 in normotensive vs. 3.02 (RR 1.62 95% CI 1.09-2.42). When adjusted by age, sex, smoking, dislipemia and diabetes, OR was 1.3 (95% CI 0.86-1.98). CONCLUSIONS: Hypertension did not increase the risk in cardiovascular events among our hypertensive patients at 2.3 years follow-up.

Vigilancia epidemiológica de las infecciones intrahospitalarias: estudios sistematizados de prevalencia (1993-1994) / Epidemiological surveillance in intrahospital infections: systemic studies of prevalence (1993-1994)

A partir de la sistematización de los estudios de prevalencia en 1993, continuamos con la presentación de los datos obtenidos en 1994, en conjunto con los del peíodo anterior. Esto permite tener una visualización gráfica de los resultados obtenidos pudiéndose analizar así sus tendencias. Si bien la metodología básica de los estudios no se ha modificado, a partir de diciembre de 1993 se incorporó al análisis, un sistema subjetivo que permite estratificar el nivel de gravedad de los pacientes y relacionarlo con el riesgo de infección intrahospitalaria. Este modelo fue validado a partir de los estudios de diciembre de 1993, abril y agosto de 1994, evaluándose además su reproducibilidad. El análisis comparativo de los estudios de prevalencia, muestra la persistencia de una proporción elevada de pacientes con acceso vascular (>50 por ciento) y catéter urinario (>20 por ciento), lo que determina un riesgo incrementado de desarrollar infecciones asociadas a estos factores. La tasa de prevalencia de infecciones intrahospitalarias se mantuvo por encima del 10 por ciento...

Vigilancia epidemiológica de las infecciones intrahospitalarias: estudios sistematizados de prevalencia (1993-1994) / Epidemiological surveillance in intrahospital infections: systemic studies of prevalence (1993-1994)

A partir de la sistematización de los estudios de prevalencia en 1993, continuamos con la presentación de los datos obtenidos en 1994, en conjunto con los del peíodo anterior. Esto permite tener una visualización gráfica de los resultados obtenidos pudiéndose analizar así sus tendencias. Si bien la metodología básica de los estudios no se ha modificado, a partir de diciembre de 1993 se incorporó al análisis, un sistema subjetivo que permite estratificar el nivel de gravedad de los pacientes y relacionarlo con el riesgo de infección intrahospitalaria. Este modelo fue validado a partir de los estudios de diciembre de 1993, abril y agosto de 1994, evaluándose además su reproducibilidad. El análisis comparativo de los estudios de prevalencia, muestra la persistencia de una proporción elevada de pacientes con acceso vascular (>50 por ciento) y catéter urinario (>20 por ciento), lo que determina un riesgo incrementado de desarrollar infecciones asociadas a estos factores. La tasa de prevalencia de infecciones intrahospitalarias se mantuvo por encima del 10 por ciento...(AU)