ABSTRACT
OBJECTIVE: To determine the magnitude of the impact of the current COVID-19 pandemic on the delivery of essential health services at all levels of care in Paraguay. METHODS: Descriptive and cross-sectional observational research. Indicators of services of the Ministry of Public Health and Social Welfare monitored in the country were analyzed. To compare the behavior of these indicators over time, data from the first four months (January-April) of 2017-2020 were used. To calculate the impact on each indicator, the same four-month period of 2019 and 2020 was compared, and the percentages of increase or decrease between these years were calculated. RESULTS: Since 2017, the number of visits has increased for all indicators; however, in 2020 visits related to almost all indicators have decreased to a variable degree. The most affected indicators (more than 30% decrease) were visits for digestive, hemolymphopoietic and ocular conditions. The number of visits related to the indicators control of diabetes mellitus and health control in children under 5 years increased 10.5% and 3.9%, respectively. CONCLUSIONS: Health care related to essential services has been affected by the pandemic with a reduction of visits for non-COVID-19 causes, which should serve as an alert for the health system in order not to lose the ground gained on this front.
ABSTRACT
[RESUMEN]. Objetivo. Determinar la magnitud del impacto de la actual pandemia de enfermedad por el nuevo coronavirus (COVID-19) en la prestación de servicios de salud esenciales en todos los niveles de atención de Paraguay. Métodos. Investigación observacional descriptiva y transversal. Se utilizaron indicadores de servicios del Ministerio de Salud Pública y Bienestar Social que se monitorean en el país. Para comparar el comportamiento de dichos indicadores en el tiempo, se utilizaron datos del primer cuatrimestre (enero-abril) de los años 2017-2020. Para el cálculo del impacto en cada indicador se comparó el mismo cuatrimestre de 2019 y de 2020, y se calcularon los porcentajes de incremento o decremento entre estos años. Resultados. Desde el año 2017, se ha incrementado el número de consultas en todos los indicadores; sin embargo, en 2020 casi todos han disminuido en grado variable. Los más afectados (más de 30% de reducción) son la atención por alteraciones digestivas, hemolinfopoyéticas y oculares. Para los indicadores control de diabetes mellitus y control de salud en menores de 5años se observó un incremento del número de consultas de 10,5% y 3,9%, respectivamente. Conclusiones. La atención sanitaria en servicios esenciales se ha visto afectada por la pandemia debido a la reducción del número de consultas por causas ajenas a la COVID-19, lo que debe servir de alerta el sistema de salud a fin no perder el terreno ganado en este frente.
[ABSTRACT]. Objective. To determine the magnitude of the impact of the current COVID-19 pandemic on the delivery of essential health services at all levels of care in Paraguay. Methods. Descriptive and cross-sectional observational research. Indicators of services of the Ministry of Public Health and Social Welfare monitored in the country were analyzed. To compare the behavior of these indicators over time, data from the first four months (January-April) of 2017-2020 were used. To calculate the impact on each indicator, the same four-month period of 2019 and 2020 was compared, and the percentages of increase or decrease between these years were calculated. Results. Since 2017, the number of visits has increased for all indicators; however, in 2020 visits related to almost all indicators have decreased to a variable degree. The most affected indicators (more than 30% decrease) were visits for digestive, hemolymphopoietic and ocular conditions. The number of visits related to the indicators control of diabetes mellitus and health control in children under 5 years increased 10.5% and 3.9%, respectively. Conclusions. Health care related to essential services has been affected by the pandemic with a reduction of visits for non-COVID-19 causes, which should serve as an alert for the health system in order not to lose the ground gained on this front.
Subject(s)
COVID-19 , Coronavirus Infections , Coronavirus , Essential Public Health Functions , Paraguay , Coronavirus Infections , Essential Public Health FunctionsABSTRACT
PURPOSE: EGFR is a well-validated target for patients with non-small cell lung cancer (NSCLC). CIMAvax-EGF is a therapeutic cancer vaccine composed of human recombinant EGF conjugated to a carrier protein and Montanide ISA51 as adjuvant. The vaccine is intended to induce antibodies against self EGFs that block EGF-EGFR interaction. EXPERIMENTAL DESIGN: To evaluate overall survival, safety, immunogenicity, and EGF concentration in serum after CIMAvax-EGF, a randomized phase III trial was done in patients with advanced NSCLC. Four to 6 weeks after first-line chemotherapy, 405 patients with stage IIIB/IV NSCLC were randomly assigned to a vaccine group, which received CIMAvax-EGF or a control group, treated with best supportive care. RESULTS: Long-term vaccination was very safe. Most frequent adverse reactions were grade 1 or 2 injection-site pain, fever, vomiting, and headache. Vaccination induced anti-EGF antibodies and decreased serum EGF concentration. In the safety population, median survival time (MST) was 10.83 months in the vaccine arm versus 8.86 months in the control arm. These differences were not significant according the standard log rank (HR, 0.82; P = 0.100), but according a weighted log rank (P = 0.04) that was applied once the nonproportionality of the HR was verified. Survival benefit was significant (HR, 0.77; P = 0.036) in the per-protocol setting (patients receiving at least four vaccine doses): MST was 12.43 months for the vaccine arm versus 9.43 months for the control arm. MST was higher (14.66 months) for vaccinated patients with high EGF concentration at baseline. CONCLUSIONS: Switch maintenance with CIMAvax-EGF was well tolerated and significantly increased MST of patients that completed induction vaccination. Baseline EGF concentration predicted survival benefit. Clin Cancer Res; 22(15); 3782-90. ©2016 AACR.
