Has COVID-19 Affected DTP3 Vaccination in the Americas?

BACKGROUND: In the Americas, deaths by diseases avoidable with vaccines are a significant contributor to child mortality. An essential means of reducing this is through broad vaccine coverage. The COVID-19 pandemic has posed a potential disruption to vaccine coverage due to its effects on the healthcare system. OBJECTIVES: this study aims to evaluate the impact of the COVID-19 pandemic on DTP3 vaccination coverage in the Americas, investigating trends from 2012 to 2022 to identify significant changes, regional disparities, and the overall effect of the pandemic on progress towards global immunization targets. METHODS: This study used the coverage data for the third dose of the diphtheria, tetanus, and pertussis vaccine (DTP3) pulled from UNICEF databases spanning 2012 to 2022. We conducted a Joinpoint regression to identify points of significant trend changes. The annual percentage change (APC) and 95% confidence intervals (95% CIs) were calculated for America and its regions. We also used segmented regression analysis. Using the Chi-square test, we compared DTP3 vaccination coverage for each country between 2019 and 2022. RESULTS: Overall, America saw a decrease in vaccine coverage during this period, with an APC of -1.4 (95% CI -1.8; -1.0). This trend varied across regions. In North America, the decrease was negligible (-0.1% APC). South America showed the steepest decrease, with an APC of -2.5%. Central America also declined, with an APC of -1.3%. Our findings suggest a concerning trend of declining DTP-vaccination rates in the Americas, exacerbated in certain regions, in the wake of the COVID-19 pandemic. The absolute decrease in vaccine coverage in the Americas was -4% between 2019 and 2022, with the most important drop being in Central America (-7%). However, six countries reported increased vaccination rates post-COVID-19, led by Brazil, with a 7% increase. Conversely, twenty-two countries registered a decline in DTP3 vaccine coverage, with the average decrease being -7.37%. This decline poses an important challenge to achieving the WHO's target of 90% coverage for the third dose of DTP by 2030, as evidenced by the reduction in the number of countries meeting this target from 2019 to 2022. CONCLUSIONS: The COVID-19 pandemic has impacted vaccine coverage in America, leading to a decrease, especially across Central America.

Evaluating the Efficacy of ChatGPT in Navigating the Spanish Medical Residency Entrance Examination (MIR): Promising Horizons for AI in Clinical Medicine.

The rapid progress in artificial intelligence, machine learning, and natural language processing has led to increasingly sophisticated large language models (LLMs) for use in healthcare. This study assesses the performance of two LLMs, the GPT-3.5 and GPT-4 models, in passing the MIR medical examination for access to medical specialist training in Spain. Our objectives included gauging the model's overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. MATERIAL AND METHODS: We studied the 2022 Spanish MIR examination results after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM GPT-4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length, sequence, and performance. We also analyzed the 23 questions with images, using GPT-4's new image analysis capability. RESULTS: GPT-4 outperformed GPT-3.5, scoring 86.81% in Spanish (p < 0.001). English translations had a slightly enhanced performance. GPT-4 scored 26.1% of the questions with images in English. The results were worse when the questions were in Spanish, 13.0%, although the differences were not statistically significant (p = 0.250). Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, and the Pharmacology, Critical Care, and Infectious Diseases specialties showed lower performance. The error analysis revealed that while a 13.2% error rate existed, the gravest categories, such as "error requiring intervention to sustain life" and "error resulting in death", had a 0% rate. CONCLUSIONS: GPT-4 performs robustly on the Spanish MIR examination, with varying capabilities to discriminate knowledge across specialties. While the model's high success rate is commendable, understanding the error severity is critical, especially when considering AI's potential role in real-world medical practice and its implications for patient safety.

Trends, Projections, and Regional Disparities of Maternal Mortality in Africa (1990-2030): An ARIMA Forecasting Approach.

With the United Nations Sustainable Development Goals (SDG) (2015-2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990-2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of -2.6% (95% CI -2.7; -2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target.

COVID-19 Impact on DTP Vaccination Trends in Africa: A Joinpoint Regression Analysis.

BACKGROUND: Deaths due to vaccine-preventable diseases are one of the leading causes of death among African children. Vaccine coverage is an essential measure to decrease infant mortality. The COVID-19 pandemic has affected the healthcare system and may have disrupted vaccine coverage. METHODS: DTP third doses (DTP3) Vaccine Coverage was extracted from UNICEF databases from 2012 to 2021 (the last available date). Joinpoint regression was performed to detect the point where the trend changed. The annual percentage change (APC) with 95% confidence intervals (95% CI) was calculated for Africa and the regions. We compared DTP3 vaccination coverage in 2019-2021 in each country using the Chi-square test. RESULT: During the whole period, the vaccine coverage in Africa increased with an Annual Percent change of 1.2% (IC 95% 0.9-1.5): We detected one joinpoint in 2019. In 2019-2021, there was a decrease in DTP3 coverage with an APC of -3.5 (95% -6.0; -0,9). (p < 0.001). Vaccination rates decreased in many regions of Sub-Saharan Africa, especially in Eastern and Southern Africa. There were 26 countries (Angola, Cabo Verde, Comoros, Congo, Côte d'Ivoire, Democratic Republic of the Congo, Djibouti, Ethiopia, Eswatini, The Gambia, Guinea-Bissau, Liberia, Madagascar, Malawi, Mauritania, Mauritius, Mozambique, Rwanda, Senegal, Seychelles, Sierra Leone, Sudan, Tanzania, Togo, Tunisia, Uganda, and Zimbabwe) where the vaccine coverage during the two years decreased. There were 10 countries (Angola, Cabo Verde, Comoros, Democratic Republic of the Congo, Eswatini, The Gambia, Mozambique, Rwanda, Senegal, and Sudan) where the joinpoint regression detected a change in the trend. CONCLUSIONS: COVID-19 has disrupted vaccine coverage, decreasing it all over Africa.

A low dose of subperiosteal anaesthesia injection versus a high dose of infiltration anaesthesia to minimise the risk of nerve damage at implant placement: A randomised controlled trial.

PURPOSE: To evaluate whether a low-dose subperiosteal anaesthesia is effective in minimising risks of inferior alveolar nerve damage at implant placement when compared to high-dose infiltration anaesthesia. MATERIAL AND METHODS: One hundred and twenty patients requiring the placement of a single implant in order to replace a missing first mandibular were randomly allocated to two groups: group A (awake hemilip) subperiosteal crestal injection equal to 0.9 ml of articaine with 0.5% epinephrine and group B (numb hemilip) infiltration equal to 7.2 ml of articaine with 0.5% epinephrine in the vestibular fundus. Intraoperative sensory control using sensory tests was carried out in all patients. Outcome measures were neurological complications, intraoperative and postoperative visual analogue scale (VAS) scores for pain and swelling, and a questionnaire evaluating patient satisfaction. Patients were followed for 1 week postoperatively. RESULTS: There were no cases of nerve injury. Seven days after surgery the postoperative VAS score for pain and swelling was lower in group A in a statistically significant manner (difference = -3.41%; 95% CI: -5.57, -1.26; P = 0.002 and difference = -3.33%; 95% CI: -5.41, -1.25; P = 0.002, respectively). CONCLUSIONS: No nerve damage occurred using either anaesthesia types, therefore the choice of type of anaesthesia is a subjective clinical decision, however it may be preferable to use a low dose (0.9 ml) of subperiosteal anaesthesia, since it is unnecessary to deliver 7.2 ml of articaine to anaesthetise a single mandibular molar implant site.

Working hours and incidence of metabolic syndrome and its components in a Mediterranean cohort: the SUN project.

BACKGROUND: Metabolic syndrome (MetS) is an important and priority public health problem globally. Long working hours have been proposed as a modifiable risk factor for MetS, despite sparse epidemiological evidence. Thus, the aim of this study was to prospectively evaluate the associations between working hours and incidence of MetS and each of its components. METHODS: We assessed 6845 participants of a Spanish dynamic prospective cohort of university graduates (the SUN project), initially free of any specific criteria of MetS, and followed-up for a median of 8.3 years. Weekly working hours were collected at baseline and grouped into four categories: >0-24, 25-39, 40-49 and ≥50 h. MetS was defined according to the updated harmonizing criteria. We estimated multivariable adjusted Relative Risks (RR) of MetS and their 95% Confidence Intervals (95% CI), using Poisson regression models. RESULTS: The cumulative incidence of MetS was 6.0%. Working hours were not independently related to MetS (25-39 h/week = RR: 1.42, 95% CI 0.90-2.25; 40-49 h/week = RR: 1.45, 95% CI 0.91-2.30; ≥50 h/week = RR: 1.49, 95% CI 0.91-2.42, P for trend = 0.235) nor to any of its individual definition criteria. CONCLUSION: Our findings do not suggest that long working hours increase the risk of MetS development or each of its components. Further longitudinal studies in general population should be conducted to confirm these results.

Evaluation of the quality of the general health information webpages in Spain: influence of page source.

The Internet, regardless of whether or not it is reliable, is considered the main source of health information. However, the lay-user does not know which sources offer good quality information. The main objective of the present study, therefore, was to evaluate the quality of Spanish health-related webpages, and to determine whether the webpage source influences this quality. To this end, 36 webpages were selected through the PageRank® system. The webpages from all the Regional Health Services of Spain (19 sites) were also included. The quality evaluation, which was carried out by applying the Andalusian Health Quality Agency Test, indicated that the quality information offered by Spanish webpages is very low, since no site reached the maximum score. In addition, several important aspects, including those related with personal data management and the updating of information, were not considered by most of the evaluated pages. In summary, this work shows that quality of the health information webpages in Spain is generally low, and draws particular attention to certain responsibilities, that are not met by most evaluated webpages, including sites from the Regional Health Services.

Evaluación de la calidad de las páginas web sanitarias mediante un cuestionario validado / An evaluation of the quality of health web pages using a validated questionnaire

ObjetivoEl objetivo de este trabajo fue evaluar la calidad de las páginas web de información sanitaria general en español así como las webs oficiales de los servicios de salud de las diferentes comunidades autónomas españolas.DiseñoEs un estudio descriptivo de tipo transversal. Utilizamos un cuestionario previamente validado para conocer el estado actual de la información sanitaria en Internet para un usuario general (no profesional).Participantes e intervencionesA través del PageRank (Google®) se obtuvo un directorio de webs, con un total de 65 páginas web sanitarias. Se aplicaron unos criterios de exclusión y se obtuvieron finalmente 36 webs. Además, analizamos las páginas oficiales de los servicios de salud de España (19 webs) y quedó un total de 54 páginas sanitarias.ResultadosSegún nuestros datos, observamos que, en general, la calidad de las páginas web con información sanitaria es baja, especialmente en referencia a la calidad de la información. Ninguna de las 54 páginas evaluadas alcanzó la puntuación máxima de calidad (19 puntos). La puntuación media fue de 9,8±2,8.ConclusionesEn conclusión, para evitar los problemas derivados de la escasa calidad de la información, se debería enseñar al usuario a evaluar la calidad de la información en Internet a través de campañas u otros medios realizados por profesionales sanitarios(AU)

ObjectiveThe objective of the present study was to evaluate the quality of general health information in Spanish language web pages, and the official Regional Services web pages from the different Autonomous Regions.DesignIt is a cross-sectional study. We have used a previously validated questionnaire to study the present state of the health information on Internet for a lay-user point of view.Participants and interventionsBy mean of PageRank (google®), we obtained a group of webs, including a total of 65 health web pages. We applied some exclusion criteria, and finally obtained a total of 36 webs. We also analyzed the official web pages from the different Health Services in Spain (19 webs), making a total of 54 health web pages.ResultsIn the light of our data, we observed that, the quality of the general information health web pages was generally rather low, especially regarding the information quality. Not one page reached the maximum score (19 points). The mean score of the web pages was of 9.8±2.8.ConclusionsIn conclusion, to avoid the problems arising from the lack of quality, health professionals should design advertising campaigns and other media to teach the lay-user how to evaluate the information quality(AU)

[An evaluation of the quality of health web pages using a validated questionnaire]. / Evaluación de la calidad de las páginas web sanitarias mediante un cuestionario validado.

OBJECTIVE: The objective of the present study was to evaluate the quality of general health information in Spanish language web pages, and the official Regional Services web pages from the different Autonomous Regions. DESIGN: It is a cross-sectional study. We have used a previously validated questionnaire to study the present state of the health information on Internet for a lay-user point of view. PARTICIPANTS AND INTERVENTIONS: By mean of PageRank (Google®), we obtained a group of webs, including a total of 65 health web pages. We applied some exclusion criteria, and finally obtained a total of 36 webs. We also analyzed the official web pages from the different Health Services in Spain (19 webs), making a total of 54 health web pages. RESULTS: In the light of our data, we observed that, the quality of the general information health web pages was generally rather low, especially regarding the information quality. Not one page reached the maximum score (19 points). The mean score of the web pages was of 9.8±2.8. CONCLUSIONS: In conclusion, to avoid the problems arising from the lack of quality, health professionals should design advertising campaigns and other media to teach the lay-user how to evaluate the information quality.

¿Qué pensamos los médicos de familia sobre la medicina basada en la evidencia? Un estudio con grupos focales / What do general practioners think about evidenced-based medicine? A study with focus groups

ObjetivoExplorar las actitudes de una muestra de médicos de familia (MF) hacia la medicina basada en la evidencia (MBE), su utilización y las barreras para su tratamiento en atención primaria (AP).DiseñoEstudio cualitativo mediante grupos focales.EmplazamientoComunidad Autónoma de Murcia, de enero-junio de 2007. Atención primaria.ParticipantesMédicos de familia con práctica clínica en AP del Servicio Murciano de Salud.MétodoDos grupos focales (con/sin formación previa en MBE). Mediante muestreo intencional se seleccionaron 19 MF entre los profesionales de AP. Las discusiones se registraron en vídeo y se transcribieron literalmente. Posteriormente se procedió a segmentar, a categorizar y a interpretar los discursos.ResultadosActitudes: la MBE es útil, permite reducir la variabilidad de la práctica clínica y disminuye la incertidumbre. Se concede gran importancia a la experiencia clínica y se muestra recelo ante el papel que las farmacéuticas y la administración sanitaria puedan tener en su difusión. Utilización: su empleo es aún escaso. Consultar a compañeros sigue siendo la principal fuente de información.ResultadosBarreras: las mayores dificultades identificadas son el escaso tiempo de que disponen, la falta de conocimientos y el idioma.ConclusionesAunque los MF muestran una actitud positiva hacia la MBE todavía son pocos los que reconocen utilizarla en consulta. El principal limitante identificado es la falta de tiempo en consulta derivada de una excesiva presión asistencial. Proponen, para aumentar su uso, mayor actividad formativa, incentivación de una adecuada praxis y reorganización de la labor asistencial(AU)

ObjectiveTo examine the attitudes of a sample of General Practitioners (GPs) towards Evidenced-Based Medicine (EBM) and its use and the obstacles to put into practice in Primary Care (PC).DesignQualitative study using Focus Groups (FG).SettingPrimary Care in the Autonomous Community of Murcia, Spain, January–June 2007.ParticipantsGPs with a clinical practice in PC in the Murcian Health Service.MethodTwo FG (with/without previous training in EBM). Using intentional sampling, 19 GPs were selected from PC professionals. The discussions were recorded on video and transcribed literally. The discussions were then, segmented, categorised and interpreted.ResultsAttitudes: EBM is useful, it helps to reduce variation in clinical practice and decreases uncertainty. Great importance is given to clinical experience and the role of the Pharmaceutical Industry and the Health Administration may have in its promotion is viewed with suspicion. Use: Its use is still limited. To consult with colleagues continues to be the main source of information. Obstacles: The major difficulties identified were the limited time it has been available, lack of experience and the language.ConclusionsAlthough GPs show a positive attitude towards EBM, there are still a few who recognise the use of consultation. The main limitation identified was lack of time in the clinic due to excessive pressure of care work. To increase its use, they proposed, more training activities, motivation by an appropriate process and reorganisation of their care work(AU)

How to apply for research grants in allergology

This is a guide for grant application for researchers seeking research grants in the field of allergy and related diseases for the first time. It outlines how to organize proposals and the potential issues to be considered in order to fulfil the criteria of the funding bodies and thus improve chances of obtaining the desired funding when applying for a research grant. We will use this paper as an example of a grant proposal to be presented to the FIS “Fondo de Investigación Sanitaria” (Health Research Fund) of Spain. The general framework can be used for a research proposal to any funding agency. The main research designs are reviewed. Other topics such as hypothesis, objectives, methodology, ethics and legal issues, and budget are presented (AU)

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