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1.
Glob Heart ; 16(1): 15, 2021 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-33833939

RESUMEN

Background: SARS-CoV-2 pandemic has modified the cardiovascular care of ambulatory patients. The aim of this survey was to study changes in lifestyle habits, treatment adherence, and mental health status in patients with cardiometabolic disease, but no clinical evidence of COVID-19. Methods: A cross-sectional survey was conducted in ambulatory patients with cardiometabolic disease using paper/digital surveys. Variables investigated included socioeconomic status, physical activity, diet, tobacco use, alcohol intake, treatment discontinuation, and psychological symptoms. Results: A total of 4,216 patients (50.9% males, mean age 60.3 ± 15.3 years old) from 13 Spanish-speaking Latin American countries were enrolled. Among the study population, 46.4% of patients did not have contact with a healthcare provider, 31.5% reported access barriers to treatments and 17% discontinued some medication. Multivariate analysis showed that non-adherence to treatment was more prevalent in the secondary prevention group: peripheral vascular disease (OR 1.55, CI 1.08-2.24; p = 0.018), heart failure (OR 1.36, CI 1.05-1.75; p = 0.017), and coronary artery disease (OR 1.29 CI 1.04-1.60; p = 0.018). No physical activity was reported by 38% of patients. Only 15% of patients met minimum recommendations of physical activity (more than 150 minutes/week) and vegetable and fruit intake. Low/very low income (45.5%) was associated with a lower level of physical activity (p < 0.0001), less fruit and vegetables intake (p < 0.0001), more tobacco use (p < 0.001) and perception of depression (p < 0.001). Low educational level was also associated with the perception of depression (OR 1.46, CI 1.26-1.70; p < 0.01). Conclusions: Patients with cardiometabolic disease but without clinical evidence of COVID-19 showed significant medication non-adherence, especially in secondary prevention patients. Deterioration in lifestyle habits and appearance of depressive symptoms during the pandemic were frequent and related to socioeconomic status.


Asunto(s)
Enfermedades Cardiovasculares/terapia , Depresión/psicología , Diabetes Mellitus/terapia , Dieta , Dislipidemias/terapia , Ejercicio Físico , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Adulto , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Arritmias Cardíacas/terapia , Fumar Cigarrillos/epidemiología , Enfermedad de la Arteria Coronaria/terapia , Escolaridad , Femenino , Accesibilidad a los Servicios de Salud , Insuficiencia Cardíaca/terapia , Humanos , Hipertensión/terapia , América Latina/epidemiología , Masculino , Salud Mental , Persona de Mediana Edad , Pacientes Ambulatorios , Enfermedades Vasculares Periféricas/terapia , Prevención Secundaria , Clase Social , Encuestas y Cuestionarios
4.
BMC Pregnancy Childbirth ; 21(1): 247, 2021 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-33761892

RESUMEN

BACKGROUND: Coronavirus disease (COVID-19) has been associated with adverse pregnancy outcomes. Due to the lack of effective treatments for COVID-19, it becomes imperative to assess the geographical differences and trends in the current clinical care and outcomes of COVID-19 in pregnant women. METHODS: A PubMed search was performed to screen articles reporting therapeutics and outcomes of confirmed COVID-19 in pregnant women prior to August 27, 2020. We performed searches, quality assessments of eligible studies, extracted and reported data according to PRISMA guidelines. Meta-analyses and cumulative meta-analyses of proportions were performed for estimating each outcome and their pattern over time respectively. RESULTS: One thousand two hundred thirty nine pregnant women with COVID-19 from 66 studies were analyzed. In case series analysis reflecting average-risk patients, the proportion of oxygen support, antibiotics, antivirals, and plasma therapy administration except for hydroxychloroquine was substantially higher in Asian studies (55, 78, 80, 6, and 0%) compared to the US (7, 1, 12, 0, and 7%) or European (33, 12, 14, 1, and 26%) studies, respectively. The highest preterm birth and the average length of hospital stay (35%, 11.9 days) were estimated in Asian studies compared to the US studies (13%, 9.4 days) and European studies (29%, 7.3 days), respectively. Even in case reports reflecting severe cases, the use of antivirals and antibiotics was higher in Asian studies compared to the US, Latin American, and European studies. A significant decline in the use of most therapeutics along with adverse outcomes of COVID-19 in pregnant women was observed. CONCLUSIONS: Geographical differences in therapeutic practice of COVID-19 were observed with differential rates of maternal and clinical outcomes. Minimizing the use of some therapeutics particularly antibiotics, antivirals, oxygen therapy, immunosuppressants, and hydroxychloroquine by risk stratification and careful consideration may further improve maternal and clinical outcomes.


Asunto(s)
Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , /terapia , Hidroxicloroquina/uso terapéutico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Respiración Artificial , Adulto , Asia/epidemiología , Cesárea , Europa (Continente)/epidemiología , Femenino , Humanos , Inmunización Pasiva , Recién Nacido , América Latina/epidemiología , Tiempo de Internación , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo , Nacimiento Prematuro , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto Joven
5.
Nat Med ; 27(3): 373-375, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33664489
6.
Washington; Organización Panamericana de la Salud; mar. 18, 2021. 291 p. ilus..
Monografía en Español | LILACS | ID: biblio-1151053

RESUMEN

Por ende, la comunidad de enfermeras que conforma la Red de Salud del Adulto Mayor (REDESAM ­ Brasil), en alianza con las 12 Redes de América Latina, propusieron la elaboración de este E-book, titulado "El Cuidado del Adulto Mayor en la Atención Primaria en Salud en Tiempos de COVID-19". Teniendo como objetivo contemplar a las enfermeras de América Latina y Portugal junto a sus propuestas de intervención en enfermería para la Atención Primaria en salud del adulto mayor durante el período pandémico y post-pandémico de COVID-19; Es evidente que el futuro de la Enfermería Gerontológica ha llegado, incluso de cara a la adversidad de la sociedad. En el actual contexto, sociodemográfico, pandémico y de evolución tecnológica, se ha destacado a un grupo de población con mayor riesgo de vulnerabilidad (física, social y emocional) en las diversas dimensiones humanas: "El Adulto Mayor". La esperanza de vida y el número de personas adulto mayor ha aumentado exponencialmente a un ritmo que exige y urge un movimiento de la sociedad en busca de estrategias que conduzcan a nuevas y mejores formas de vida. Ante esta perspectiva, la Red de Salud del Adulto Mayor (REDESAM ­ Brasil), en conjunto con algunos profesionales de esta en América Latina se han comprometido a incrementar y avanzar en el desarrollo de la investigación y la difusión de nuevas estrategias asistenciales para el control de la pandemia COVID-19. Recientemente, la pandemia de COVID-19 impuso una carga de trabajo adicional a los profesionales de la salud, especialmente a los enfermeros. Cada día, han demostrado su fuerza de trabajo en la asistencia y en el descubrimiento de nuevas formas de enseñar e investigar temas sobre el Adulto Mayor, dándole una gran visibilidad social a dicha profesión.


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Anciano , Neumonía Viral/epidemiología , Atención Primaria de Salud/organización & administración , Infecciones por Coronavirus/epidemiología , Pandemias/prevención & control , Enfermería Geriátrica/organización & administración , Anciano de 80 o más Años , Salud del Anciano , América Latina/epidemiología
7.
Arch Osteoporos ; 16(1): 23, 2021 02 02.
Artículo en Inglés | MEDLINE | ID: mdl-33528678

RESUMEN

Latin America and the Caribbean region account for 8% of the world's total population. Experts from 18 countries were invited to contribute to this article to provide the best available data on the number, types, and quality of densitometry, DXA experts, the local/national incidence and prevalence of osteoporosis and fragility fractures, and other uses and information on the challenges and opportunities for quality densitometry with examples of local initiatives. Osteoporosis is the primary reason for densitometry in our region, which is not a priority for public health in most countries. Access and quality are major challenges, and there is a clear trend to concentrate on densitometry services in the largest cities. Urgent action is needed to face the rapidly increasing burden of osteoporosis in our region, including robust and up to date epidemiology, access to health professionals, and quality densitometry. Health professionals require better access to training, courses, and other activities at a more local or regional level.


Asunto(s)
Osteoporosis , Región del Caribe , Densitometría , Humanos , Incidencia , América Latina/epidemiología , Osteoporosis/diagnóstico por imagen , Osteoporosis/epidemiología
8.
Braz J Infect Dis ; 25(1): 101539, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33607082

RESUMEN

BACKGROUND: Community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) emerged in the 1990s as a global community pathogen primarily involved in skin and soft tissue infections (SSTIs) and pneumonia. To date, the CG-MRSA SSTI burden in Latin America (LA) has not been assessed. OBJECTIVE: The main objective of this study was to report the rate and genotypes of community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) causing community-onset skin and soft tissue infections (CO-SSTIs) in LA over the last two decades. In addition, this research determined relevant data related to SSTIs due to CG-MRSA, including risk factors, other invasive diseases, and mortality. DATA SOURCES: Relevant literature was searched and extracted from five major databases: Embase, PubMed, LILACS, SciELO, and Web of Science. METHODS: A systematic review was performed, and a narrative review was constructed. RESULTS: An analysis of 11 studies identified epidemiological data across LA, with Argentina presenting the highest percentage of SSTIs caused by CG-MRSA (88%). Other countries had rates of CG-MRSA infection ranging from 0 to 51%. Brazil had one of the lowest rates of CG-MRSA SSTI (4.5-25%). In Argentina, being younger than 50 years of age and having purulent lesions were predictive factors for CG-MRSA CO-SSTIs. In addition, the predominant genetic lineages in LA belonged to sequence types 8, 30, and 5 (ST8, ST30, and ST5). CONCLUSION: There are significant regional differences in the rates of CG-MRSA causing CO-SSTIs. It is not possible to conclude whether or not CG-MRSA CO-SSTIs resulted in more severe SSTI presentations or in a higher mortality rate.


Asunto(s)
Infecciones Comunitarias Adquiridas , Staphylococcus aureus Resistente a Meticilina , Infecciones de los Tejidos Blandos , Infecciones Estafilocócicas , Infecciones Cutáneas Estafilocócicas , Antibacterianos/uso terapéutico , Argentina , Brasil , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/epidemiología , Genotipo , Humanos , América Latina/epidemiología , Staphylococcus aureus Resistente a Meticilina/genética , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Infecciones de los Tejidos Blandos/epidemiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología , Infecciones Cutáneas Estafilocócicas/tratamiento farmacológico , Infecciones Cutáneas Estafilocócicas/epidemiología
9.
JCO Glob Oncol ; 7: 162-172, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33529077

RESUMEN

PURPOSE: The COVID-19 pandemic has affected healthcare systems globally, leading to reorganization of medical activities. We performed an international survey aimed to investigate the medium- and long-term impact on oncology units. MATERIALS AND METHODS: An 82-item survey was distributed from June 17 to July 14, 2020 among medical oncologists worldwide. RESULTS: One hundred nine medical oncologists from 18 countries in Europe (n = 93), United States (n = 5), and Latin America (n = 11) answered the survey. A systematic tracing of COVID-19-positive patients was continued in the postacute phase by 77.1% of the centers; 64.2% of the respondents participated in a local registry and 56% in international or national registries of infected patients. Treatment adaptations were introduced, and surgery was the most affected modality being delayed or canceled in more than 10% of patients in 34% of the centers, whereas early cessation of palliative treatment was reported in 32.1% of the centers; 64.2% of respondents reported paying attention to avoid undertreatments. The use of telemedicine has been largely increased. Similarly, virtual tools are increasingly used particularly for medical education and international or national or multidisciplinary meetings. 60.6% of the participants reduced clinical activity, and 28.4% compensated by increasing their research activity. Significant reduction of clinical trial activities is expected in 37% of centers this year. The well-being of healthcare staff would not recover by the end of the year according to 18% of the participants. CONCLUSION: The COVID-19 outbreak has had a major impact on oncologic activity, which will persist in the future, irrespective of geographical areas.


Asunto(s)
/epidemiología , Oncología Médica/tendencias , Neoplasias/terapia , Pandemias , Adulto , Ensayos Clínicos como Asunto , Europa (Continente)/epidemiología , Femenino , Geografía , Humanos , Comunicación Interdisciplinaria , Internet , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Cuidados Paliativos/organización & administración , Sistema de Registros , Encuestas y Cuestionarios , Telemedicina , Estados Unidos/epidemiología
10.
Artículo en Inglés | MEDLINE | ID: mdl-33573228

RESUMEN

Previous research connecting health-related quality of life (HRQoL) in people with traumatic brain injury (TBI) and caregiver mental health has primarily been conducted cross-sectionally in the U.S. and Western Europe. This study, therefore, examined how HRQoL in individuals immediately after their TBI predicts longitudinal caregiver depression symptom trajectories in Latin America. A sample of 109 patients with an acute TBI and 109 caregivers (total n = 218) was recruited from three hospitals in Mexico City, Mexico, and in Cali and Neiva, Colombia. TBI patients reported their HRQoL while they were still in hospital, and caregivers reported their depression symptoms at the same time and at 2 and 4 months later. Hierarchal linear models (HLM) found that caregiver depression symptom scores decreased over time, and lower patient mental health and pain-related quality of life at baseline (higher pain) predicted higher overall caregiver depression symptom trajectories across the three time points. These findings suggest that in Latin America, there is an identifiable relationship between psychological and pain-related symptoms after TBI and caregiver depression symptom outcomes. The results highlight the importance of early detection of caregiver mental health needs based in part upon patient HRQoL and a culturally informed approach to rehabilitation services for Latin American TBI caregivers.


Asunto(s)
Lesiones Traumáticas del Encéfalo , Calidad de Vida , Cuidadores , Colombia/epidemiología , Depresión/epidemiología , Europa (Continente) , Humanos , América Latina/epidemiología , México/epidemiología
11.
Curr Probl Cardiol ; 46(4): 100737, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33412349

RESUMEN

BACKGROUND: The COVID-19 pandemic's mental health consequences remain unknown. AIM: To assess the mental health status of ambulatory cardiometabolic patients during COVID-19 pandemic lockdown in Spanish speaking Latin American countries. METHODS: Cardiometabolic patients without COVID-19 evidence in 13 Latin American countries answered a survey between June 15th and July 15th, 2020. The Diagnosis Manual of Mental Disorders fifth edition was used to identify the presence of major depressive symptoms. RESULTS: The sample included 4216 patients, 1590 (37.71%; IC95% 36.24-39.19) were considered suffering major depression. Female gender, consuming ≥5 medications day, physical activity <100 minutes weekly, low fruits and vegetables intake, poor treatment adherence, reduced food consumption were independently associated to the presence of major depressive symptoms. CONCLUSIONS: The CorCOVID Latam Psy study showed that one-third of the Latin American Spanish speaking population is suffering from major depressive symptoms during the COVID-19 outbreak.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Depresión/epidemiología , Trastorno Depresivo Mayor/epidemiología , Diabetes Mellitus/epidemiología , Síndrome Metabólico/epidemiología , Adulto , Anciano , Enfermedades Cardiovasculares/psicología , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/psicología , Depresión/psicología , Trastorno Depresivo Mayor/psicología , Diabetes Mellitus/psicología , Dieta/estadística & datos numéricos , Dislipidemias/epidemiología , Dislipidemias/psicología , Ingestión de Alimentos , Ejercicio Físico/psicología , Femenino , Frutas , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/psicología , Humanos , Hipertensión/epidemiología , Hipertensión/psicología , América Latina/epidemiología , Masculino , Salud Mental , Síndrome Metabólico/psicología , Persona de Mediana Edad , Factores Sexuales , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/psicología , Encuestas y Cuestionarios , Cumplimiento y Adherencia al Tratamiento/psicología , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Verduras
12.
J Public Health Policy ; 42(1): 27-40, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33510400

RESUMEN

This article examines how Argentina, Brazil, Chile, Colombia, Mexico, and Peru addressed the COVID-19 pandemic and the effectiveness of these policy responses from the date each country declared a sanitary emergency, between middle and late March 2020 to the most recent available measurement on 23 September 2020. To analyze how governments responded to the COVID-19 pandemic in these six Latin American countries, we use an index of government response, created by the University of Oxford. To explore the effects of these governmental mitigation policies on reducing social mobility, we use Google mobility reports. We also analyze how these policies may have influenced COVID-19 mortality rates. Overall, the results showed that both timelier and more stringent implementation of the public policies analyzed to address the COVID-19 pandemic seem to be associated with higher mobility reductions and lower mortality rates. We draw five policy lessons from the way each country implemented these mitigation policies. KEY MESSAGE: Timelier and more stringent implementation of these public policies may contribute to a higher mobility reduction in several public spaces and to lower mortality rates. The effectiveness of the closure and containment policies in each Latin American country seem to depend on the degree of compliance of their respective populations and to their socioeconomic living conditions. Economic and social policies of income support and debt relief provided by governments allowed people to comply with closure and containment policies. Health systems should maintain high levels of policy stringency together with effective surveillance through testing policy and contact tracing.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/métodos , Práctica de Salud Pública , Política Pública , Humanos , América Latina/epidemiología , Pandemias
13.
Nat Med ; 27(3): 463-470, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33495602

RESUMEN

The concept of a so-called urban advantage in health ignores the possibility of heterogeneity in health outcomes across cities. Using a harmonized dataset from the SALURBAL project, we describe variability and predictors of life expectancy and proportionate mortality in 363 cities across nine Latin American countries. Life expectancy differed substantially across cities within the same country. Cause-specific mortality also varied across cities, with some causes of death (unintentional and violent injuries and deaths) showing large variation within countries, whereas other causes of death (communicable, maternal, neonatal and nutritional, cancer, cardiovascular disease and other noncommunicable diseases) varied substantially between countries. In multivariable mixed models, higher levels of education, water access and sanitation and less overcrowding were associated with longer life expectancy, a relatively lower proportion of communicable, maternal, neonatal and nutritional deaths and a higher proportion of deaths from cancer, cardiovascular disease and other noncommunicable diseases. These results highlight considerable heterogeneity in life expectancy and causes of death across cities of Latin America, revealing modifiable factors that could be amenable to urban policies aimed toward improving urban health in Latin America and more generally in other urban environments.


Asunto(s)
Esperanza de Vida , Mortalidad , Adulto , Ciudades , Femenino , Humanos , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Adulto Joven
15.
J Med Microbiol ; 70(2)2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33416465

RESUMEN

Cholera is a severe diarrhoeal disease that spreads rapidly and affects millions of people each year, resulting in tens of thousands of deaths. The disease is caused by Vibrio cholerae O1 and is characterized by watery diarrhoea that can be lethal if not properly treated. Cholera had not been reported in South America from the late 1800s until 1991, when it was introduced in Peru, wreaking havoc in one of the biggest epidemics reported to date. Within a year, the disease had spread to most of the Latin American region, resulting in millions of cases and thousands of deaths in all affected countries. Despite its aggressive entry, cholera virtually disappeared from the continent after 1999. The progression of the entire epidemic was well documented, making it an ideal model to understand cholera dynamics. In this review, we highlight how the synergy of socioeconomic, political and ecological factors led to the emergence, rapid spread and eventual disappearance of cholera in Latin America. We discuss how measures implemented during the cholera epidemic drastically changed its course and continental dynamics. Finally, we synthesize our findings and highlight potential lessons that can be learned for efficient and standardized cholera management programmes during future outbreaks in non-endemic areas.


Asunto(s)
Cólera/epidemiología , Control de Enfermedades Transmisibles/métodos , Vibrio cholerae O1/aislamiento & purificación , Cólera/patología , Cambio Climático , Epidemias , Humanos , América Latina/epidemiología , Política , Factores Socioeconómicos , América del Sur/epidemiología , Vibrio cholerae O1/inmunología
16.
Artículo en Inglés | MEDLINE | ID: mdl-33436482

RESUMEN

BACKGROUND AND AIMS: Digestive endoscopy is considered a high-risk procedure for COVID-19. Recommendations have been made for its practice during the pandemic. This study was conducted to determine adherence to recommendations for endoscopy practice during the COVID-19 pandemic in Latin America (LA). METHODS: A survey was conducted of endoscopists from LA consisting of 43 questions for the evaluation of four items: general and sociodemographic features, and preprocedure, intraprocedure and postprocedure aspects. RESULTS: A response was obtained from 338 endoscopists (response rate 34.5%) across 15 countries in LA. In preprocedure aspects (hand washing, use of face masks for patients, respiratory triage area, training for the placement/removal of personal protective equipment (PPE) and availability of specific area for the placement/removal of PPE), there was adherence in <75%. Regarding postprocedure aspects, 77% (261/338) had reused PPE, mainly the N95 respirator or higher, and this was with a standardised decontamination procedure only in 32% (108/338) of the time. Postprocedure room decontamination was carried out by 47% on >75% of occasions. In relationship to intraprocedure aspects (knowledge of risk and type of endoscopic procedures, use of PPE, airway management in patients and infrastructure), there was adherence in >75% for all the parameters and 78% of endoscopists only performed emergencies or time-sensitive procedures. CONCLUSIONS: Adherence to the recommendations for endoscopy practice during the COVID-19 pandemic is adequate in the intraprocedure aspect. However, it is deficient in the preprocedure and postprocedure aspects.


Asunto(s)
Endoscopía Gastrointestinal , Adhesión a Directriz , Guías de Práctica Clínica como Asunto , Adulto , /prevención & control , Femenino , Encuestas de Atención de la Salud , Humanos , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Equipo de Protección Personal , Estudios Prospectivos , Factores de Riesgo
17.
Ann Hepatol ; 21: 100298, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33359234

RESUMEN

INTRODUCTION & OBJECTIVES: The independent effect of liver biochemistries as a prognostic factor in patients with COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnormal liver tests on admission of hospitalized patients with COVID-19. MATERIALS & METHODS: We performed a prospective cohort study including 1611 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters, including liver function tests, on admission and during hospitalization. All patients were followed until discharge or death. We fit multivariable logistic regression models, further post-estimation effect through margins and inverse probability weighting. RESULTS: Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liver disease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7-47.7) of the cohort (n = 726). Overall, 15.1% (CI 13.4-16.9) of patients died (n = 244). Patients with abnormal liver tests on admission presented higher mortality 18.7% (CI 15.9-21.7), compared to those with normal liver biochemistries 12.2% (CI 10.1-14.6); P < .0001). After excluding patients with history of chronic liver disease, abnormal liver tests on admission were independently associated with death [OR 1.5 (CI 1.1-2.0); P = 0.01], and severe COVID-19 (2.6 [2.0-3.3], P < .0001), both adjusted by age, gender, diabetes, pneumonia and body mass index >30. CONCLUSIONS: The presence of abnormal liver tests on admission is independently associated with mortality and severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogate marker of inflammation. CLINICALTRIALS.GOV: NCT04358380.


Asunto(s)
/epidemiología , Hospitalización/estadística & datos numéricos , Hepatopatías/epidemiología , Comorbilidad , Femenino , Humanos , América Latina/epidemiología , Hepatopatías/diagnóstico , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo
18.
Pediatr Infect Dis J ; 40(1): e1-e6, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33055501

RESUMEN

BACKGROUND: To date, there are no comprehensive data on pediatric COVID-19 from Latin America. This study aims to assess COVID-19 and Multisystem Inflammatory Syndrome (MIS-C) in Latin American children, to appropriately plan and allocate resources to face the pandemic on a local and international level. METHODS: Ambispective multicenter cohort study from 5 Latin American countries. Children 18 years of age or younger with microbiologically confirmed SARS-CoV-2 infection or fulfilling MIS-C definition were included. FINDINGS: Four hundred nine children were included, with a median age of 3.0 years (interquartile range 0.6-9.0). Of these, 95 (23.2%) were diagnosed with MIS-C. One hundred ninety-one (46.7%) children were admitted to hospital and 52 (12.7%) required admission to a pediatric intensive care unit. Ninety-two (22.5%) patients required oxygen support: 8 (2%) were started on continuous positive airway pressure and 29 (7%) on mechanical ventilation. Thirty-five (8.5%) patients required inotropic support. The following factors were associated with pediatric intensive care unit admission: preexisting medical condition (P < 0.0001), immunodeficiency (P = 0.01), lower respiratory tract infection (P < 0.0001), gastrointestinal symptoms (P = 0.006), radiologic changes suggestive of pneumonia and acute respiratory distress syndrome (P < 0.0001) and low socioeconomic conditions (P = 0.009). CONCLUSIONS: This study shows a generally more severe form of COVID-19 and a high number of MIS-C in Latin American children, compared with studies from China, Europe and North America, and support current evidence of a more severe disease in Latin/Hispanic children or in people of lower socioeconomic level. The findings highlight an urgent need for more data on COVID-19 in Latin America.


Asunto(s)
/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/patología , Adolescente , /terapia , Niño , Preescolar , Estudios de Cohortes , Cuidados Críticos , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , América Latina/epidemiología , Masculino , Factores de Riesgo , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/terapia
19.
BMJ Open ; 10(12): e042869, 2020 12 12.
Artículo en Inglés | MEDLINE | ID: mdl-33310811

RESUMEN

OBJECTIVES: To summarise the occurrence of congenital Zika syndrome (CZS) in Latin America and the Caribbean from 2015 to 2017 using two outcome measures derived from infectious disease surveillance reports and to assess the completeness of these reports. DESIGN: Surveillance study. SETTING: Pan American Health Organization (PAHO)/WHO epidemiology reports on confirmed and suspected Zika virus infection and cases of CZS. PARTICIPANTS: Populations of 47 countries in the South and Central Americas, Mexico and the Caribbean. PRIMARY AND SECONDARY OUTCOME MEASURES: The number of CZS cases per 1000 births (using 2016-2017 births as a denominator) and the number of CZS cases per 1000 births in women with Zika virus infection during pregnancy. RESULTS: By 4 January 2018, 548623 suspected and 239063 confirmed Zika virus infections had been reported to PAHO/WHO from 47 countries. In 25 countries, over 80% of infections were reported as suspected. There were 3617 confirmed CZS cases in 25 countries; 2952 (82%) had occurred in Brazil. The number of CZS cases per 1000 births varied considerably with Brazil and several Caribbean island communities (Puerto Rico, St Martin, Martinique, Guadeloupe and Grenada) having the highest CZS prevalence above 0.5 per 1000 births. Analysing the number of CZS cases per 1000 births in women infected with Zika virus during their pregnancy highlighted the inaccuracies of the data, with Venezuela likely to have had severe under-reporting of CZS. CONCLUSIONS: Expressing data on CZS in relation to total births, rather than as absolute numbers, better illustrates the burden of disease, providing that under-reporting of CZS is not too severe. Data on infections in pregnant women enable potential under-reporting of CZS to be identified. Both measures are recommended for future PAHO/WHO publications. Evidence of severe under-reporting of Zika virus infections and CZS makes interpretation of the data and comparisons between countries challenging.


Asunto(s)
Enfermedades Transmisibles , Epidemias , Microcefalia , Complicaciones Infecciosas del Embarazo , Infección por el Virus Zika , Virus Zika , Brasil , Femenino , Grenada/epidemiología , Humanos , Recién Nacido , América Latina/epidemiología , Martinica/epidemiología , México/epidemiología , Microcefalia/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Puerto Rico/epidemiología , Venezuela/epidemiología , Infección por el Virus Zika/epidemiología
20.
PLoS Med ; 17(12): e1003443, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33373361

RESUMEN

BACKGROUND: Adolescents and young people (10-24 years old) in the Latin America and the Caribbean (LAC) region represent approximately 25% of the region's population. Since the 2008 global economic crisis, the pace of reduction in poverty and income inequality in the LAC region has stalled. The region is characterised by high levels of inequities and is also vulnerable to many natural disasters. Food systems are changing with increased availability and marketing of packaged and fast foods and sugar-sweetened drinks. Adolescence is a formative phase of the life course with multiple physical, emotional and social changes which can make them vulnerable to health problems. We assess the potential impact of macro-determinants, human and economic development as well as income inequality, on 2 top-ranking regional priorities for adolescent nutrition and mental health, using measures of overweight and suicidal ideation and planning which some have shown to be associated. METHODS AND FINDINGS: The Global School-based Health Survey (GSHS) is a nationally representative self-administered, school-based survey. We examined overweight/obesity and suicidal ideation with planning by gross domestic product (GDP) per capita or human development index (HDI) in 10-19-year-old adolescents from 21 LAC countries between 2009 and 2013. Sample sizes varied from 943 in Anguilla to 27,988 in Argentina. A total of 55,295 adolescents had a measure of overweight/obesity status, and 59,061 adolescents reported about suicidal ideation with planning. There was equal representation by sex in the surveys (52% girls and 48% boys). A total of 28.8% of boys and 28.1% of girls had overweight/obesity, and 7.5% of boys and 17.5% of girls reported suicidal ideation with planning over the last 12 months. Adjusted for individual socioeconomic and risk behaviours, and relative to the highest GDP per capita tertile, the middle tertile was associated with 42% (95% confidence interval (CI) 59% to 17%, p = 0.003) and 32% (95% CI 60% to 5%, p = 0.023), and the lowest tertile with 40% (95% CI 55% to 19%, p = 0.001) and 46% (95% CI 59% to 29%, p < 0.001) lower chances of overweight/obesity for girls and boys, respectively. A similar positive effect was seen with HDI, with lowest chances of overweight in the lowest tertile compared with the highest tertile for both sexes. Overweight/obesity was positively related with suicidal ideation with planning for girls (odds ratio (OR) 1.12, 95% CI 1.02 to 1.22, p = 0.009) and weakly related for boys (OR 1.09, 95% CI 0.96 to 1.24, p = 0.182). In contrast to overweight/obesity status, suicidal ideation with planning was not related to macro-level indices despite both outcomes sharing common individual socioeconomic and risk behaviour correlates. Limitations include the dominance of Argentinians in the sample (40%), the exclusion of vulnerable adolescents who dropped out of school, and reporting bias due to stigma of mental health-related issues. CONCLUSIONS: This study shows that economic and human development were positively associated with adolescent overweight/obesity but not with suicidal ideation with planning. We also observed an interconnectedness between overweight/obesity and suicide ideation with planning among girls. These findings highlight the importance of strategies that engage with both upstream and downstream determinants to improve adolescent nutrition and mental health.


Asunto(s)
Conducta del Adolescente , Conducta Infantil , Obesidad Pediátrica/psicología , Ideación Suicida , Adolescente , Factores de Edad , Región del Caribe/epidemiología , Niño , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , América Latina/epidemiología , Masculino , Salud Mental , Obesidad Pediátrica/diagnóstico , Obesidad Pediátrica/epidemiología , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Adulto Joven
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