Mathematical and statistical models for the control of mosquito-borne diseases: the experience of Costa Rica.

Objective: To summarize the results of research conducted in Costa Rica in which mathematical and statistical methods were implemented to study the transmission dynamics of mosquito-borne diseases. Methods: Three articles with mathematical and statistical analysis on vector-borne diseases in Costa Rica were selected and reviewed. These papers show the value and relevance of using different quantitative methods to understand disease dynamics and support decision-making. Results: The results of these investigations: 1) show the impact on dengue case reports when a second pathogen emerges, such as chikungunya; 2) recover key parameters in Zika dynamics using Bayesian inference; and 3) show the use of machine learning algorithms and climatic variables to forecast the dengue relative risk in five different locations. Conclusions: Mathematical and statistical modeling enables the description of mosquito-borne disease transmission dynamics, providing quantitative information to support prevention/control methods and resource allocation planning.

Mathematical and statistical models for the control of mosquito-borne diseases: the experience of Costa Rica

[ABSTRACT]. Objective. To summarize the results of research conducted in Costa Rica in which mathematical and statistical methods were implemented to study the transmission dynamics of mosquito-borne diseases. Methods. Three articles with mathematical and statistical analysis on vector-borne diseases in Costa Rica were selected and reviewed. These papers show the value and relevance of using different quantitative methods to understand disease dynamics and support decision-making. Results. The results of these investigations: 1) show the impact on dengue case reports when a second pathogen emerges, such as chikungunya; 2) recover key parameters in Zika dynamics using Bayesian inference; and 3) show the use of machine learning algorithms and climatic variables to forecast the dengue relative risk in five different locations. Conclusions. Mathematical and statistical modeling enables the description of mosquito-borne disease transmission dynamics, providing quantitative information to support prevention/control methods and resource allocation planning.

[RESUMEN]. Objetivo. Resumir los resultados de las investigaciones realizadas en Costa Rica en las que se aplicaron métodos matemáticos y estadísticos para estudiar la dinámica de transmisión de las enfermedades transmitidas por mosquitos. Métodos. Se seleccionaron y analizaron tres artículos con análisis matemáticos y estadísticos sobre enfermedades transmitidas por vectores en Costa Rica. En estos artículos se muestra el valor y la pertinencia de emplear diferentes métodos cuantitativos para comprender la dinámica de la enfermedad y brindar apoyo a la toma de decisiones. Resultados. Los resultados de estas investigaciones: 1) muestran la repercusión en los informes de casos de dengue cuando surge un segundo agente patógeno, como el chikunguña; 2) recuperan parámetros clave en la dinámica del Zika mediante la inferencia bayesiana; y 3) muestran el uso de los algoritmos de aprendizaje automático y las variables climáticas para pronosticar el riesgo relativo de dengue en cinco lugares diferentes. Conclusiones. Los modelos matemáticos y estadísticos permiten describir la dinámica de transmisión de las enfermedades transmitidas por mosquitos, mediante la provisión de información cuantitativa para brindar apoyo a los métodos de prevención y control y a la planificación de la asignación de recursos.

[RESUMO]. Objetivo. Resumir os resultados de estudos realizados na Costa Rica em que foram aplicados métodos matemáticos e estatísticos para estudar a dinâmica de transmissão de doenças transmitidas por mosquitos. Métodos. Foram selecionados e revisados três artigos com análises matemáticas e estatísticas sobre doenças transmitidas por vetores na Costa Rica. Esses artigos mostram o valor e a pertinência do uso de diferentes métodos quantitativos para compreender a dinâmica das doenças e apoiar a tomada de decisões. Resultados. Os resultados dessas investigações: 1) mostram o impacto nas notificações de casos de dengue quando surge um segundo patógeno, como o chikungunya; 2) recuperam parâmetros-chave na dinâmica do zika, usando a inferência bayesiana; e 3) mostram o uso de algoritmos de aprendizagem por máquina e variáveis climáticas para prever o risco relativo da dengue em cinco locais diferentes. Conclusões. A modelagem matemática e estatística permite a descrição da dinâmica de transmissão de doenças transmitidas por mosquitos ao oferecer informações quantitativas para apoiar métodos de prevenção e/ou controle e o planejamento da alocação de recursos.

Maternal mortality linked to COVID-19 in Latin America: Results from a multi-country collaborative database of 447 deaths.

Background: This study aimed to describe the clinical characteristics of maternal deaths associated with COVID-19 registered in a collaborative Latin-American multi-country database. Methods: This was an observational study implemented from March 1st 2020 to November 29th 2021 in eight Latin American countries. Information was based on the Perinatal Information System from the Latin American Center for Perinatology, Women and Reproductive Health. We summarized categorical variables as frequencies and percentages and continuous variables into median with interquartile ranges. Findings: We identified a total of 447 deaths. The median maternal age was 31 years. 86·4% of women were infected antepartum, with most of the cases (60·3%) detected in the third trimester of pregnancy. The most frequent symptoms at first consultation and admission were dyspnea (73·0%), fever (69·0%), and cough (59·0%). Organ dysfunction was reported in 90·4% of women during admission. A total of 64·8% women were admitted to critical care for a median length of eight days. In most cases, the death occurred during the puerperium, with a median of seven days between delivery and death. Preterm delivery was the most common perinatal complication (76·9%) and 59·9% were low birth weight. Interpretation: This study describes the characteristics of maternal deaths in a comprehensive multi-country database in Latin America during the COVID-19 pandemic. Barriers faced by Latin American pregnant women to access intensive care services when required were also revealed. Decision-makers should strengthen severity awareness, and referral strategies to avoid potential delays. Funding: Latin American Center for Perinatology, Women and Reproductive Health.

Antecedentes: Este estudio tuvo el objetivo de describir las características clínicas de las muertes maternas asociadas a COVID-19 registradas en una base de datos latinoamericana multipaís. Métodos: Se implementó un estudio observacional descriptivo en el que participaron ochos países Latinoamericanos desde el 1ero de marzo 2020 al 29 de noviembre 2021. La información se obtuvo del Sistema Informático Perinatal del Centro Latino Americano de Perinatología, Salud de la Mujer y Reproductiva. Presentamos las variables categóricas como frecuencias y porcentajes y las variables continuas en medianas con rangos inter cuartiles. Resultados: Identificamos un total de 447 muertes. La mediana de edad materna fue de 31 años. 86·4% de las mujeres se infectaron ante del parto, siendo la mayoría de los casos detectados en el tercer trimestre del embarazo (60·3%). Los síntomas más frecuentes en la primera consulta y la admisión fueron disnea (73·0%), fiebre (69·0%), y tos (59·0%). Se reportaron disfunciones orgánicas en 90·4% de las mujeres durante la admisión. Un total de 64·8% de las mujeres fueron ingresadas a cuidados críticos por una mediana de ocho días de estadía. En la mayoría de los casos la muerte ocurrió durante el puerperio, con una media de siete días entre el parto y su ocurrencia. El parto prematuro fue la complicación perinatal más frecuente (76·9%) y 59·9% tuvo bajo peso al nacer. Interpretación: Este estudio describe las características de las muertes maternas durante la pandemia por COVID-19 a partir de una base colaborativa multipaís. Se observaron barreras para el acceso a cuidados intensivos. Los tomadores de decisión deberían trabajar en el fortalecimiento de la conciencia de gravedad, y en estrategias de referencia para evitar potenciales demoras. Financiamiento: Centro Latino Americano de Perinatología, Salud de la Mujer y Reproductiva.

A multilayer network model of Covid-19: Implications in public health policy in Costa Rica.

Successful partnerships between researchers, experts, and public health authorities have been critical to navigate the challenges of the Covid-19 pandemic worldwide. In this collaboration, mathematical models have played a decisive role in informing public policy, with findings effectively translated into public health measures that have shaped the pandemic in Costa Rica. As a result of interdisciplinary and cross-institutional collaboration, we constructed a multilayer network model that incorporates a diverse contact structure for each individual. In July 2020, we used this model to test the effect of lifting restrictions on population mobility after a so-called "epidemiological fence" imposed to contain the country's first big wave of cases. Later, in August 2020, we used it to predict the effects of an open and close strategy (the Hammer and Dance). Scenarios constructed in July 2020 showed that lifting restrictions on population mobility after less than three weeks of epidemiological fence would produce a sharp increase in cases. Results from scenarios in August 2020 indicated that the Hammer and Dance strategy would only work with 50% of the population adhering to mobility restrictions. The development, evolution, and applications of a multilayer network model of Covid-19 in Costa Rica has guided decision-makers to anticipate implementing sanitary measures and contributed to gain valuable time to increase hospital capacity.

Projecting the impact of Covid-19 variants and vaccination strategies in disease transmission using a multilayer network model in Costa Rica.

For countries starting to receive steady supplies of vaccines against SARS-CoV-2, the course of Covid-19 for the following months will be determined by the emergence of new variants and successful roll-out of vaccination campaigns. To anticipate this scenario, we used a multilayer network model developed to forecast the transmission dynamics of Covid-19 in Costa Rica, and to estimate the impact of the introduction of the Delta variant in the country, under two plausible vaccination scenarios, one sustaining Costa Rica's July 2021 vaccination pace of 30,000 doses per day and with high acceptance from the population and another with declining vaccination pace to 13,000 doses per day and with lower acceptance. Results suggest that the introduction and gradual dominance of the Delta variant would increase Covid-19 hospitalizations and ICU admissions by [Formula: see text] and [Formula: see text], respectively, from August 2021 to December 2021, depending on vaccine administration and acceptance. In the presence of the Delta variant, new Covid-19 hospitalizations and ICU admissions are estimated to increase around [Formula: see text] and [Formula: see text], respectively, in the same period if the vaccination pace drops. Our results can help decision-makers better prepare for the Covid-19 pandemic in the months to come.

Mathematical and statistical models for the control of mosquito-borne diseases: the experience of Costa Rica / Modelos matemáticos y estadísticos para el control de enfermedades transmitidas por mosquitos: la experiencia de Costa Rica / Modelos matemáticos e estatísticos para o controle de doenças transmitidas por mosquitos: a experiência da Costa Rica

ABSTRACT Objective. To summarize the results of research conducted in Costa Rica in which mathematical and statistical methods were implemented to study the transmission dynamics of mosquito-borne diseases. Methods. Three articles with mathematical and statistical analysis on vector-borne diseases in Costa Rica were selected and reviewed. These papers show the value and relevance of using different quantitative methods to understand disease dynamics and support decision-making. Results. The results of these investigations: 1) show the impact on dengue case reports when a second pathogen emerges, such as chikungunya; 2) recover key parameters in Zika dynamics using Bayesian inference; and 3) show the use of machine learning algorithms and climatic variables to forecast the dengue relative risk in five different locations. Conclusions. Mathematical and statistical modeling enables the description of mosquito-borne disease transmission dynamics, providing quantitative information to support prevention/control methods and resource allocation planning.

RESUMEN Objetivo. Resumir los resultados de las investigaciones realizadas en Costa Rica en las que se aplicaron métodos matemáticos y estadísticos para estudiar la dinámica de transmisión de las enfermedades transmitidas por mosquitos. Métodos. Se seleccionaron y analizaron tres artículos con análisis matemáticos y estadísticos sobre enfermedades transmitidas por vectores en Costa Rica. En estos artículos se muestra el valor y la pertinencia de emplear diferentes métodos cuantitativos para comprender la dinámica de la enfermedad y brindar apoyo a la toma de decisiones. Resultados. Los resultados de estas investigaciones: 1) muestran la repercusión en los informes de casos de dengue cuando surge un segundo agente patógeno, como el chikunguña; 2) recuperan parámetros clave en la dinámica del Zika mediante la inferencia bayesiana; y 3) muestran el uso de los algoritmos de aprendizaje automático y las variables climáticas para pronosticar el riesgo relativo de dengue en cinco lugares diferentes. Conclusiones. Los modelos matemáticos y estadísticos permiten describir la dinámica de transmisión de las enfermedades transmitidas por mosquitos, mediante la provisión de información cuantitativa para brindar apoyo a los métodos de prevención y control y a la planificación de la asignación de recursos.

RESUMO Objetivo. Resumir os resultados de estudos realizados na Costa Rica em que foram aplicados métodos matemáticos e estatísticos para estudar a dinâmica de transmissão de doenças transmitidas por mosquitos. Métodos. Foram selecionados e revisados três artigos com análises matemáticas e estatísticas sobre doenças transmitidas por vetores na Costa Rica. Esses artigos mostram o valor e a pertinência do uso de diferentes métodos quantitativos para compreender a dinâmica das doenças e apoiar a tomada de decisões. Resultados. Os resultados dessas investigações: 1) mostram o impacto nas notificações de casos de dengue quando surge um segundo patógeno, como o chikungunya; 2) recuperam parâmetros-chave na dinâmica do zika, usando a inferência bayesiana; e 3) mostram o uso de algoritmos de aprendizagem por máquina e variáveis climáticas para prever o risco relativo da dengue em cinco locais diferentes. Conclusões. A modelagem matemática e estatística permite a descrição da dinâmica de transmissão de doenças transmitidas por mosquitos ao oferecer informações quantitativas para apoiar métodos de prevenção e/ou controle e o planejamento da alocação de recursos.

The Role of Mobility and Sanitary Measures on the Delay of Community Transmission of COVID-19 in Costa Rica.

The aim of this paper is to infer the effects that change on human mobility had on the transmission dynamics during the first four months of the SARS-CoV-2 pandemic in Costa Rica, which could have played a role in delaying community transmission in the country. First, by using parametric and non-parametric change-point detection techniques, we were able to identify two different periods when the trend of daily new cases significantly changed. Second, we explored the association of these changes with data on population mobility. This also allowed us to estimate the lag between changes in human mobility and rates of daily new cases. The information was then used to establish an association between changes in population mobility and the sanitary measures adopted during the study period. Results showed that during the initial two months of the pandemic in Costa Rica, the implementation of sanitary measures and their impact on reducing human mobility translated to a mean reduction of 54% in the number of daily cases from the projected number, delaying community transmission.

What do we mean when we talk about the Triple Aim? A systematic review of evolving definitions and adaptations of the framework at the health system level.

Notwithstanding important contributions of the Triple Aim, uncritical enthusiasm regarding the implications of the framework may be leading to inconsistent use, particularly when applied at the health system level, which goes beyond the original positioning of the framework as a strategic organizing principle to guide improvement initiatives at the organizational or local community level. We systematically identified uses of the Triple Aim that extended beyond its original intention to focus on uses at the whole health system level, to assess convergence and divergence with the original definition. We also attempted to identify consistencies in the way the Triple Aim was adapted for different contexts and settings. Data sources were indexed databases, web search engines, and international experts. Forty-seven articles were included in the analysis. We found that the definition of the Triple Aim has been subject to important modifications when the framework is used to define goals for whole health care systems or globally. Despite widespread recognition of the name, what constitutes the Triple Aim framework varies. We identified the need to consider the inclusion of at least two additional aims of health care systems - the provider experience of care, and the desire to achieve health equity for populations.

Evaluating investment in quality improvement capacity building: a systematic review.

PURPOSE: Leading health systems have invested in substantial quality improvement (QI) capacity building, but little is known about the aggregate effect of these investments at the health system level. We conducted a systematic review to identify key steps and elements that should be considered for system-level evaluations of investment in QI capacity building. METHODS: We searched for evaluations of QI capacity building and evaluations of QI training programmes. We included the most relevant indexed databases in the field and a strategic search of the grey literature. The latter included direct electronic scanning of 85 relevant government and institutional websites internationally. Data were extracted regarding evaluation design and common assessment themes and components. RESULTS: 48 articles met the inclusion criteria. 46 articles described initiative-level non-economic evaluations of QI capacity building/training, while 2 studies included economic evaluations of QI capacity building/training, also at the initiative level. No system-level QI capacity building/training evaluations were found. We identified 17 evaluation components that fit within 5 overarching dimensions (characteristics of QI training; characteristics of QI activity; individual capacity; organisational capacity and impact) that should be considered in evaluations of QI capacity building. 8 key steps in return-on-investment (ROI) assessments in QI capacity building were identified: (1) planning-stakeholder perspective; (2) planning-temporal perspective; (3) identifying costs; (4) identifying benefits; (5) identifying intangible benefits that will not be included in the ROI estimation; (6) discerning attribution; (7) ROI calculations; (8) sensitivity analysis. CONCLUSIONS: The literature on QI capacity building evaluation is limited in the number and scope of studies. Our findings, summarised in a Framework to Guide Evaluations of QI Capacity Building, can be used to start closing this knowledge gap.

The determinants of the propensity to receive publicly funded home care services for the elderly in Canada: a panel two-stage residual inclusion approach.

The role of Home Care (HC) services for the elderly will be increasingly important in meeting populations' future needs for care. HC services include Home Health Care (HHC) and Homemaking/Personal Support (HMPS), distinction rarely seen in the literature. This paper argues that it is important to distinguish between these types of HC, since the factors that drive the likelihood of the receipt of each type of care may differ, and also to investigate the interrelationship between them. We explored the interrelationship between receipt of publicly funded HMPS and HHC, and the determinants of the receipt of each type of services. A Panel Two-Stage Residual Inclusion approach was applied to estimate the likelihood of the receipt of HC services using data for those aged 65 and over from 9 biannual waves of the Canadian National Population Health Survey (1994-95 to 2010-11). We found that there are in fact differences in the determinants of the likelihood of HHC and HMPS receipt. Moreover, receipt of publicly funded HMPS was found to be complementary with receipt of publicly funded HHC services after adjusting for functional and health status. Dependence on help with activities of daily living, health status, household arrangement, and income were found to be determinants of the propensity to receive both publicly funded HHC and HMPS services. This study aims to contribute to the existent literature by taking a step toward explicitly modelling the potential interaction between the determinants of the receipt of different types of HC services simultaneously, as a system. Our methodological approach, a Panel Two-Stage Residual Inclusion method, seems to effectively address problems that are known to be a source of bias in the literature.