The Health Status of the US Veterans: A Longitudinal Analysis of Surveillance Data Prior to and during the COVID-19 Pandemic.

Chronic diseases affect a disproportionate number of United States (US) veterans, causing significant long-term health issues and affecting entitlement spending. This longitudinal study examined the health status of US veterans as compared to non-veterans pre- and post-COVID-19, utilizing the annual Center for Disease Control and Prevention (CDC) behavioral risk factor surveillance system (BRFSS) survey data. Age-adjusted descriptive point estimates were generated independently for 2003 through 2021, while complex weighted panel data were generated from 2011 and onward. General linear modeling revealed that the average US veteran reports a higher prevalence of disease conditions except for mental health disorders when compared to a non-veteran. These findings were consistent with both pre- and post-COVID-19; however, both groups reported a higher prevalence of mental health issues during the pandemic years. The findings suggest that there have been no improvements in reducing veteran comorbidities to non-veteran levels and that COVID-19 adversely affected the mental health of both populations.

Leveraging Mobile Health to Manage Mental Health/Behavioral Health Disorders: Systematic Literature Review.

BACKGROUND: Mental health is a complex condition, highly related to emotion. The COVID-19 pandemic caused a significant spike in depression (from isolation) and anxiety (event related). Mobile Health (mHealth) and telemedicine offer solutions to augment patient care, provide education, improve symptoms of depression, and assuage fears and anxiety. OBJECTIVE: This review aims to assess the effectiveness of mHealth to provide mental health care by analyzing articles published in the last year in peer-reviewed, academic journals using strong methodology (randomized controlled trial). METHODS: We queried 4 databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ScienceDirect) using a standard Boolean search string. We conducted this systematic literature review in accordance with the Kruse protocol and reported it in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 checklist (n=33). RESULTS: A total of 4 interventions (mostly mHealth) from 14 countries identified improvements in primary outcomes of depression and anxiety as well as in several secondary outcomes, namely, quality of life, mental well-being, cognitive flexibility, distress, sleep, self-efficacy, anger, decision conflict, decision regret, digestive disturbance, pain, and medication adherence. CONCLUSIONS: mHealth interventions can provide education, treatment augmentation, and serve as the primary modality in mental health care. The mHealth modality should be carefully considered when evaluating modes of care. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42022343489; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=343489.

Leveraging mHealth and Wearable Sensors to Manage Alcohol Use Disorders: A Systematic Literature Review.

BACKGROUND: Alcohol use disorder (AUD) is a condition prevalent in many countries around the world, and the public burden of its treatment is close to $130 billion. mHealth offers several possible interventions to assist in the treatment of AUD. OBJECTIVES: To analyze the effectiveness of mHealth and wearable sensors to manage AUD from evidence published over the last 10 years. METHODS: Following the Kruse Protocol and PRISMA 2020, four databases were queried (PubMed, CINAHL, Web of Science, and Science Direct) to identify studies with strong methodologies (n = 25). RESULTS: Five interventions were identified, and 20/25 were effective at reducing alcohol consumption. Other interventions reported a decrease in depression and an increase in medication compliance. Primary barriers to the adoption of mHealth interventions are a requirement to train users, some are equally as effective as the traditional means of treatment, cost, and computer literacy. CONCLUSION: While not all mHealth interventions demonstrated statistically significant reduction in alcohol consumption, most are still clinically effective to treat AUD and provide a patient with their preference of a technologically inclined treatment Most interventions require training of users and some technology literacy, the barriers identified were very few compared with the litany of positive results.

Exploring Health Outcomes for U.S. Veterans Compared to Non-Veterans from 2003 to 2019.

The physical demands on U.S. service members have increased significantly over the past several decades as the number of military operations requiring overseas deployment have expanded in frequency, duration, and intensity. These elevated demands from military operations placed upon a small subset of the population may be resulting in a group of individuals more at-risk for a variety of debilitating health conditions. To better understand how the U.S Veterans health outcomes compared to non-Veterans, this study utilized the U.S. Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) dataset to examine 10 different self-reported morbidities. Yearly age-adjusted, population estimates from 2003 to 2019 were used for Veteran vs. non-Veteran. Complex weights were used to evaluate the panel series for each morbidity overweight/obesity, heart disease, stroke, skin cancer, cancer, COPD, arthritis, mental health, kidney disease, and diabetes. General linear models (GLM's) were created using 2019 data only to investigate any possible explanatory variables associated with these morbidities. The time series analysis showed that Veterans have disproportionately higher self-reported rates of each morbidity with the exception of mental health issues and heart disease. The GLM showed that when taking into account all the variables, Veterans disproportionately self-reported a higher amount of every morbidity with the exception of mental health. These data present an overall poor state of the health of the average U.S. Veteran. Our study findings suggest that when taken as a whole, these morbidities among Veterans could prompt the U.S. Department of Veteran Affairs (VA) to help develop more effective health interventions aimed at improving the overall health of the Veterans.

The Impact of COVID-19 on Telemedicine Utilization Across Multiple Service Lines in the United States.

The impact of COVID-19 on the U.S. healthcare industry cannot be overstated. Telemedicine utilization increased overnight as all healthcare providers rushed to implement this delivery model to ensure accessibility and continuity of patient care. Our research objective was to determine measures that were implemented to accommodate community and individual patient needs to afford access to critical services and to maintain safety standards. We analyzed literature since 2016 from two databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We compared observations, themes, service lines addressed, issues identified, and interventions requiring in-person care. From 44 articles published, we identified ten effectiveness themes overall and drew conclusions on service line successes. COVID-19 has caused rapid expansion in telemedicine. Necessary and required changes in access, risk mitigation, the need for social distancing, compliance, cost, and patient satisfaction are a few of the driving factors. This review showcased the healthcare industry's ability to rapidly acclimate and change despite the pervasive spread of COVID-19 throughout the U.S. Although imperfect, unique responses were developed within telemedicine platforms to mitigate disruptions broadly and effectively in care and treatment modalities.

Obesity and Morbidity Risk in the U.S. Veteran.

The obesity epidemic in the United States has been well documented and serves as the basis for a number of health interventions across the nation. However, those who have served in the U.S. military (Veteran population) suffer from obesity in higher numbers and have an overall disproportionate poorer health status when compared to the health of the older non-Veteran population in the U.S. which may further compound their overall health risk. This study examined both the commonalities and the differences in obesity rates and the associated co-morbidities among the U.S. Veteran population, utilizing data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). These data are considered by the Centers for Disease Control and Prevention (CDC) to be the nation's best source for health-related survey data, and the 2018 version includes 437,467 observations. Study findings show not only a significantly higher risk of obesity in the U.S. Veteran population, but also a significantly higher level (higher odds ratio) of the associated co-morbidities when compared to non-Veterans, including coronary heart disease (CHD) or angina (odds ratio (OR) = 2.63); stroke (OR = 1.86); skin cancer (OR = 2.18); other cancers (OR = 1.73); chronic obstructive pulmonary disease (COPD) (OR = 1.52), emphysema, or chronic bronchitis; arthritis (OR = 1.52), rheumatoid arthritis, gout, lupus, or fibromyalgia; depressive disorders (OR = 0.84), and diabetes (OR = 1.61) at the 0.95 confidence interval level.

Economic Burden of Hearing Loss for the U.S. Military: A Proposed Framework for Estimation.

The goal of this multiphased research is to develop methods to comprehensively determine the economic impact of hearing impairment and noise-induced hearing injury among active duty U.S. Service Members. Several steps were undertaken to develop a framework and model for economic burden analysis: (1) a literature review identifying studies reporting the cost of health conditions and injuries in the Department of Defense, (2) consultation with a panel of subject matter experts who reviewed these cost items, and (3) discussions with DoD data stewards and review of relevant data dictionaries and databases. A Markov model was developed to represent the cumulative economic effect of events along the career span, such as retraining after hearing impairment and injury, by synthesizing inputs from various sources. The model, as developed and proposed in this study, will be a valuable decision-making tool for the DoD to identify high-risk groups, take proactive measures, and develop focused education, customized equipping, and return-to-duty and reintegration programs, thereby maximizing the retention of skilled, experienced, and mission-ready Service Members.

The impact of hearing impairment and noise-induced hearing injury on quality of life in the active-duty military population: challenges to the study of this issue.

The objectives of this research were to 1) summarize the available evidence on the impact of hearing loss on quality of life (QOL) among U.S. active-duty service members, 2) describe the QOL instruments that have been used to quantify the impact of hearing loss on quality of life, 3) examine national population-level secondary databases and report on their utility for studying the impact of hearing loss on QOL among active-duty service members, and 4) provide recommendations for future studies that seek to quantify the impact of hearing loss in this population. There is a lack of literature that addresses the intersection of hearing impairment, the military population, and quality of life measures. For audiological research, U.S. military personnel offer a unique research population, as they are exposed to noise levels and blast environments that are highly unusual in civilian work settings and can serve as a model population for studying the impact on QOL associated with these conditions. Our team recommends conducting a study on the active-duty service member population using a measurement instrument suitable for determining decreases in QOL specifically due to hearing loss.

The Department of Defense Epidemiologic and Economic Burden of Hearing Loss study.

Although studies have examined the relation between military-related noise and hearing, comprehensive data to calculate rates of hearing loss across all Services and to determine economic impact are lacking. The goal of the multiphase Department of Defense (DoD) Epidemiologic and Economic Burden of Hearing Loss (DEEBoHL) project is to examine rates of hearing impairment and noise-induced hearing injury, relevant noise exposures, and to determine the economic burden of these outcomes to the DoD and Service Members. The DoD Hearing Center of Excellence is supporting the following Phase I specific aims, among active duty Service Members to (1) calculate rates of hearing impairment and noise-induced hearing injury, and (2) develop a framework for the DoD to conduct comprehensive economic burden studies for hearing impairment and noise-induced hearing injury. The study is led by a multidisciplinary team from The University of Texas School of Public Health, The University of Texas Health Science Center at San Antonio, and The Geneva Foundation, with guidance from experts who make up the study advisory board. In this article, we focus on an overview of the DEEBoHL study, the methods for the first aim of this effort, and describe future plans for the study.

Simulación de un brote de Influenza A H1N1 en una escuela primaria de Camagüey / Simulation of an outbreak of Influenza A H1N1 in a primary school from Camagüey

La dinámica de la vida moderna demuestra la necesidad del uso de modelos matemáticos y simulaciones para el análisis de la dispersión de enfermedades. Objetivo: mostrar el comportamiento de un posible brote epidémico de Influenza A H1N1, en una escuela primaria a partir de la entrada de un enfermo sin tomar ninguna medida de contención. Método: se realizó una simulación con el modelo Susceptible, Expuesto, Infectado y Recuperado, durante el mes de septiembre de 2009. Se asume en la primera simulación que no se tomó ninguna medida preventiva, en la segunda, que se tomaron medidas sólo a partir de los siete días de comenzar el brote. Se toma un índice de transmisibilidad de 0.35, una duración de la enfermedad de siete días y un período latente de un día. Resultados: el modelo de simulación mostró en el caso de no tomar ninguna medida, cómo se produciría un pico máximo de la enfermedad a los trece días de iniciado el mismo, con un total de 190 enfermos, con 99 recuperados y sólo declina de forma espontánea a los 50 días con el último enfermo, el número reproductivo básico fue de 2.22 Conclusiones: existe de forma libre y gratuita un conjunto de herramientas de cálculos y simulaciones que se pueden utilizar en la provincia por parte de los epidemiólogos y los profesores de esta rama de la Salud Pública (AU)

The dynamics of modern life has demonstrated the need for the use of mathematical models and simulations for the analysis of the spread of diseases. Objective: to show the behavior of a possible outbreak of Influenza A H1N1 in a primary school. Method: a simulation using the model Susceptible, Exposed, Infected and Recovered was performed, during September 2009. It is assumed in the first simulation that was not taken any preventive action, in the second one, those measures were taken only after a week of the outbreak onset. The transmission index of 0.35, the duration of the disease of seven days and a latent period of one day was taken. Results: the simulation model showed in the case of not taking any action, how there would be a peak of the disease to the 13 days of being initiated, with a total of 190 patients, 99 recovered; only decline spontaneously to 50 days with the last patient, the basic reproductive number was 2.22. Conclusions: there is a set of tools for calculations and simulations that may be used in the province by epidemiologists and teachers of this branch of public health for free (AU)

Análisis de eficiencia relativa en el control del Aedes aegypti del municipio Camagüey / Analysis of relative efficiency in the Aedes aegypti control in Camagüey municipality

Es posible identificar instituciones que utilizan de manera efectiva los recursos productivos puestos a su disposición, así como también se puede identificar aquellas unidades ineficientes mediante el análisis envolvente de datos. El Centro de Medicina y Complejidad de la provincia de Camagüey, junto a la Dirección Provincial de Salud y la Dirección Provincial de la lucha contra vectores, trabajan en un proyecto conjunto para la recolección, análisis y procesamiento de datos. Objetivo: realizar un análisis de eficiencia relativa del control del Aedes aegypti del municipio Camagüey, que se pueda incorporar de forma sistemática al sistema creado. Método: se realizó un análisis de eficiencia relativa a las nueve áreas de salud del municipio de Camagüey vinculadas al control del vector del Dengue, correspondiente al mes de julio del año 2010. Se utilizó la técnica de análisis envolvente, en particular el modelo Constant returns to scale, input oriented model in envelopment form. Se empleó el software Ri para su resolución. Para la selección de las variables a introducir en el modelo, se evaluó el aporte de cada una con la técnica estadística de componentes principales, para lo que se utilizó el programa SPSS 18. Resultados: se seleccionaron como entradas o gastos: gasolina, diesel, insecticida, cantidad de hombres involucrados; como salidas o producciones, cantidad de viviendas visitadas, muestras de adultos y de larvas realizadas, y cantidad de depósitos inspeccionados. Se mostró la eficiencia relativa de cada institución, así como las que pueden servir como puntos de referencia a las no eficientes. Se mostró también un sumario de los objetivos para mejorar la eficiencia a lograr en las entradas y en las salidas. Conclusiones: se identificaron áreas que operan con deficiencias productivas. Se puede introducir el modelo Análisis envolvente de datos de forma sistemática con los códigos abiertos del R (AU)

It is possible to identify institutions that use effectively, productive resources placed at their disposal, as well as to identify those inefficient units using data enveloping analysis. The Medicine and Complexity Center of Camagüey province, along with the Provincial Health Office and the Provincial Office of the fight against vectors, work in a joint project for the collection, analysis and data processing. Objective: to perform an analysis of relative efficiency of Aedes aegypti control in Camagüey municipality, which may be incorporated systematically into the created system. Method: an analysis of relative efficiency to nine health areas in Camagüey municipality related to the control of Dengue's vector was performed on July, 2010. The enveloping analysis technique, in particular the model constant returns to scale, input oriented model in envelopment form was used. The Ri software for its resolution was employed. Variables were assessed by its contribution of each with the statistical technique of main components; the 18 SPSS program was used. Results: selected income or expenditure: gasoline, diesel, insecticide, and number of men involved; as outputs or productions: amount of visited homes, samples of adults and larvae was carried out, and inspected deposits amount. The relative efficiency of each institution was showed, as well as the ones may serve as points of reference to the no efficient ones. A summary of the objectives to improve efficiency regarding income or expenditure also was expressed. Conclusions: the areas that operate with productive deficiencies were identified. Data enveloping analysis model may be inserted systematically with Ri open codes (AU)

Factores que pueden afectar la seguridad del paciente / Factors that may affect patient's safety

La seguridad del paciente es la garantía de las personas de estar libres de sufrir cualquier tipo de daño cuando interactúan con alguno de los servicios de salud. Objetivo: determinar factores que podrían afectar la seguridad del paciente a través de una investigación realizada en el Hospital Provincial y en el Hospital Pediátrico. Método: se realizó un estudio descriptivo, mediante la búsqueda de información bibliográfica sobre la temática de la seguridad del paciente, en las bases de datos disponibles en INFOMED. Para la primera etapa se diseña e implementa una encuesta de 49 preguntas que se les realiza en el año 2009 a trabajadores vinculados a la atención de salud. Para la segunda etapa se implementa una encuesta de 23 preguntas derivadas de las preguntas más relevantes de la primera etapa que se implementó en el Hospital Pediátrico y se va a realizar en el Hospital Provincial Univerrsitario Manuel Ascunce Domenech. El método analítico utilizado para ambas encuestas fue la técnica de componentes principales que permitió valorar la coincidencia de cada pregunta en relación a las posibles afectaciones a la seguridad del paciente. Resultados: la encuesta aplicada, para evaluar factores que afectan la seguridad del paciente fue adecuada. La técnica de componentes principales permitió valorar la importancia de cada pregunta en relación a las posibles afectaciones a la seguridad del paciente, las variables de respuesta se agruparon en seis constructos con un 62,1 por ciento de varianza explicada. Las encuestas arrojaron que las afectaciones del ambiente laboral, el nivel general de interconexión y comunicación, el nivel de gestión del conocimiento, la capacidad de enfrentar imprevistos, la capacidad técnica, el cansancio y la pérdida de concentración podrían afectar la seguridad del paciente (AU)

Patient's safety is the guarantee of people to be free of suffering any kind of damage when interacting any of the health services. Objective: to determine factors that may affect patient's safety. Method: a descriptive study through a bibliographic review on patient's safety was conducted. The study was divided into two stages, in which surveys according to the technique of main components were implemented; this allowed value the coincidence of each question in relation to the possible impact to the patient´s safety. Results: the applied survey was appraised of adequate; response variables were grouped into six, with a 62.1 percent of explained variance.The survey showed that affectations on labor atmosphere, general level of interconnection and communication, level on knowledge management, the capacity to face accidental facts, technical capacity, fatigue and loss of concentration could affect patient's safety (AU)

Factores que pueden afectar la seguridad del paciente / Factors that may affect patient's safety

Fundamento: la seguridad del paciente es la garantía de las personas de estar libres de sufrir cualquier tipo de daño cuando interactúan con alguno de los servicios de salud. Objetivo: determinar factores que podrían afectar la seguridad del paciente a través de una investigación realizada en el Hospital Provincial y en el Hospital Pediátrico. Método: se realizó un estudio descriptivo, mediante la búsqueda de información bibliográfica sobre la temática de la seguridad del paciente, en las bases de datos disponibles en INFOMED. Para la primera etapa se diseña e implementa una encuesta de 49 preguntas que se les realiza en el año 2009 a trabajadores vinculados a la atención de salud. Para la segunda etapa se implementa una encuesta de 23 preguntas derivadas de las preguntas más relevantes de la primera etapa que se implementó en el Hospital Pediátrico y se va a realizar en el Hospital Provincial Univerrsitario Manuel Ascunce Domenech. El método analítico utilizado para ambas encuestas fue la técnica de componentes principales que permitió valorar la coincidencia de cada pregunta en relación a las posibles afectaciones a la seguridad del paciente. Resultados: la encuesta aplicada, para evaluar factores que afectan la seguridad del paciente fue adecuada. La técnica de componentes principales permitió valorar la importancia de cada pregunta en relación a las posibles afectaciones a la seguridad del paciente, las variables de respuesta se agruparon en seis constructos con un 62,1 % de varianza explicada. Las encuestas arrojaron que las afectaciones del ambiente laboral, el nivel general de interconexión y comunicación, el nivel de gestión del conocimiento, la capacidad de enfrentar imprevistos, la capacidad técnica, el cansancio y la pérdida de concentración podrían afectar la seguridad del paciente. Conclusiones: es posible obtener información in situ a partir del instrumento final obtenido en la última etapa que permita corregir de forma precoz algunas fallas que pudieran afectar la seguridad del paciente y corregirlas. La técnica de componentes principales resultó adecuada para evaluar estas respuestas en conjunto.

ABSTRACT Background: patient's safety is the guarantee of people to be free of suffering any kind of damage when interacting any of the health services. Objective: to determine factors that may affect patient's safety. Method: a descriptive study through a bibliographic review on patient's safety was conducted. The study was divided into two stages, in which surveys according to the technique of main components were implemented; this allowed value the coincidence of each question in relation to the possible impact to the patient´s safety. Results: the applied survey was appraised of adequate; response variables were grouped into six, with a 62.1 % of explained variance. The survey showed that affectations on labor atmosphere, general level of interconnection and communication, level on knowledge management, the capacity to face accidental facts, technical capacity, fatigue and loss of concentration could affect patient's safety. Conclusions: the information was obtained from the final instrument in the last stage. Some failures that could affect patient´s safety may be corrected early. The technique of main components was adequate to evaluate the answers as a whole.

Simulación de un brote de Influenza A H1N1 en una escuela primaria de Camagüey / Simulation of an outbreak of Influenza A H1N1 in a primary school from Camagüey

Fundamento: la dinámica de la vida moderna demuestra la necesidad del uso de modelos matemáticos y simulaciones para el análisis de la dispersión de enfermedades. Objetivo: mostrar el comportamiento de un posible brote epidémico de Influenza A H1N1, en una escuela primaria a partir de la entrada de un enfermo sin tomar ninguna medida de contención. Método: se realizó una simulación con el modelo Susceptible, Expuesto, Infectado y Recuperado, durante el mes de septiembre de 2009. Se asume en la primera simulación que no se tomó ninguna medida preventiva, en la segunda, que se tomaron medidas sólo a partir de los siete días de comenzar el brote. Se toma un índice de transmisibilidad de 0.35, una duración de la enfermedad de siete días y un período latente de un día. Resultados: el modelo de simulación mostró en el caso de no tomar ninguna medida, cómo se produciría un pico máximo de la enfermedad a los trece días de iniciado el mismo, con un total de 190 enfermos, con 99 recuperados y sólo declina de forma espontánea a los 50 días con el último enfermo, el número reproductivo básico fue de 2.22 Conclusiones: existe de forma libre y gratuita un conjunto de herramientas de cálculos y simulaciones que se pueden utilizar en la provincia por parte de los epidemiólogos y los profesores de esta rama de la Salud Pública.

Background: the dynamics of modern life has demonstrated the need for the use of mathematical models and simulations for the analysis of the spread of diseases. Objective: to show the behavior of a possible outbreak of Influenza A H1N1 in a primary school. Method: a simulation using the model Susceptible, Exposed, Infected and Recovered was performed, during September 2009. It is assumed in the first simulation that was not taken any preventive action, in the second one, those measures were taken only after a week of the outbreak onset. The transmission index of 0.35, the duration of the disease of seven days and a latent period of one day was taken. Results: the simulation model showed in the case of not taking any action, how there would be a peak of the disease to the 13 days of being initiated, with a total of 190 patients, 99 recovered; only decline spontaneously to 50 days with the last patient, the basic reproductive number was 2.22. Conclusions: there is a set of tools for calculations and simulations that may be used in the province by epidemiologists and teachers of this branch of public health for free.

Análisis de eficiencia relativa en el control del Aedes aegypti del municipio Camagüey / Analysis of relative efficiency in the Aedes aegypti control in Camagüey municipality

Fundamento: es posible identificar instituciones que utilizan de manera efectiva los recursos productivos puestos a su disposición, así como también se puede identificar aquellas unidades ineficientes mediante el análisis envolvente de datos. El Centro de Medicina y Complejidad de la provincia de Camagüey, junto a la Dirección Provincial de Salud y la Dirección Provincial de la lucha contra vectores, trabajan en un proyecto conjunto para la recolección, análisis y procesamiento de datos. Objetivo: realizar un análisis de eficiencia relativa del control del Aedes aegypti del municipio Camagüey, que se pueda incorporar de forma sistemática al sistema creado. Método: se realizó un análisis de eficiencia relativa a las nueve áreas de salud del municipio de Camagüey vinculadas al control del vector del Dengue, correspondiente al mes de julio del año 2010. Se utilizó la técnica de análisis envolvente, en particular el modelo Constant returns to scale, input oriented model in envelopment form. Se empleó el software Ri para su resolución. Para la selección de las variables a introducir en el modelo, se evaluó el aporte de cada una con la técnica estadística de componentes principales, para lo que se utilizó el programa SPSS 18. Resultados: se seleccionaron como entradas o gastos: gasolina, diesel, insecticida, cantidad de hombres involucrados; como salidas o producciones, cantidad de viviendas visitadas, muestras de adultos y de larvas realizadas, y cantidad de depósitos inspeccionados. Se mostró la eficiencia relativa de cada institución, así como las que pueden servir como puntos de referencia a las no eficientes. Se mostró también un sumario de los objetivos para mejorar la eficiencia a lograr en las entradas y en las salidas. Conclusiones: se identificaron áreas que operan con deficiencias productivas. Se puede introducir el modelo Análisis envolvente de datos de forma sistemática con los códigos abiertos del R.

Background: it is possible to identify institutions that use effectively, productive resources placed at their disposal, as well as to identify those inefficient units using data enveloping analysis. The Medicine and Complexity Center of Camagüey province, along with the Provincial Health Office and the Provincial Office of the fight against vectors, work in a joint project for the collection, analysis and data processing. Objective: to perform an analysis of relative efficiency of Aedes aegypti control in Camagüey municipality, which may be incorporated systematically into the created system. Method: an analysis of relative efficiency to nine health areas in Camagüey municipality related to the control of Dengue's vector was performed on July, 2010. The enveloping analysis technique, in particular the model constant returns to scale, input oriented model in envelopment form was used. The Ri software for its resolution was employed. Variables were assessed by its contribution of each with the statistical technique of main components; the 18 SPSS program was used. Results: selected income or expenditure: gasoline, diesel, insecticide, and number of men involved; as outputs or productions: amount of visited homes, samples of adults and larvae was carried out, and inspected deposits amount. The relative efficiency of each institution was showed, as well as the ones may serve as points of reference to the no efficient ones. A summary of the objectives to improve efficiency regarding income or expenditure also was expressed. Conclusions: the areas that operate with productive deficiencies were identified. Data enveloping analysis model may be inserted systematically with Ri open codes.

Enfoque de los sistemas complejos en seguridad del paciente / Approach of the complex systems in the patient's safety

Para confeccionar la presente revisión se utilizaron bases de datos disponibles en INFOMED, (EBSCO, PUBMED e HINARI;) utilizando el descriptor patient safety. Se destaca el hecho de que existe abundante bibliografía actualizada en las bases de datos de INFOMED, la cual muestra tendencia internacional al uso de herramientas propias del enfoque de la complejidad tales como el incremento de las conexiones entre elementos del sistema, mejora en las tecnologías de la información y la comunicación que facilitan la interconexión entre estos elementos. La presente revisión se realiza con fines divulgativos y como base para un proyecto de investigación (AU)

To make the present review, available databases were used at INFOMED, (EBSCO, PUBMED and HINARI) using "patient safety" as descriptor. Abundant up-dated bibliography in the INFOMED databases exists, which shows international tendency to the use of typical tools of the complexity approach such as the increment of the connections among elements of the system, improvement in the technologies of the information and communication that facilitate the interconnection among these elements. The present review is carried out with publishing purposes and as basis for an investigation project (AU)

Enfoque de los sistemas complejos en seguridad del paciente: [revisión] / Approach of the complex systems in the patient's safety: [review]

Para confeccionar la presente revisión se utilizaron bases de datos disponibles en INFOMED, (EBSCO, PUBMED e HINARI;) utilizando el descriptor patient safety. Se destaca el hecho de que existe abundante bibliografía actualizada en las bases de datos de INFOMED, la cual muestra tendencia internacional al uso de herramientas propias del enfoque de la complejidad tales como el incremento de las conexiones entre elementos del sistema, mejora en las tecnologías de la información y la comunicación que facilitan la interconexión entre estos elementos. La presente revisión se realiza con fines divulgativos y como base para un proyecto de investigación que se va a emprender entre el Centro de Medicina y Complejidad y el Hospital Universitario Manuel Ascunce Domenech.

To make the present review, available databases were used at INFOMED, (EBSCO, PUBMED and HINARI) using "patient safety" as descriptor. Abundant up-dated bibliography in the INFOMED databases exists, which shows international tendency to the use of typical tools of the complexity approach such as the increment of the connections among elements of the system, improvement in the technologies of the information and communication that facilitate the interconnection among these elements. The present review is carried out with publishing purposes and as basis for an investigation project that will undertake between the Medicine and Complexity Center and the University Hospital Manuel Ascunce Domenech.

Simulación de un brote de enfermedad respiratoria aguda en el municipio de Camagüey / Simulation of an acute respiratory disease outbreak in Camagüey municipality

Fundamento: Los modelos matemáticos constituyen una herramienta poderosa para modelar procesos de la realidad, sus resultados son de gran utilidad para optimizar los recursos, que generalmente están limitados , con ellos se pueden dirigir medidas más efectivas que aumenten la comprensión del fenómeno en estudio, estos deben ser tan simples como sea posible, pero deben ser precisos flexibles y transparentes. Objetivo: Realizar simulaciones con el modelo SIR que se pretende introducir fundamentalmente en la docencia, en los análisis epidemiológicos y en la toma de decisiones. Método: Se analizan en el municipio Camagüey los casos de Enfermedades respiratorias agudas del año 2007, se reportaron ciento sesenta mil cuatrocientos veintidós casos, la población al cierre de ese año fue de 788 058 habitantes... (AU)

Background: The mathematical models constitute a powerful tool to model reality processes, their results are of great utility to optimize the resources that are generally limited, with them may direct effective measures that increase the understanding of the phenomenon in study, these should be as simple as it is possible, but should be precise, flexible and transparent. Objective: To carry out simulations with the SIR pattern that is pretend to introduce fundamentally in teaching, in the epidemic analyses and when taking decisions. Methods: The cases of acute respiratory diseases of the year 2007 in Camagüey municipality, are analyzed, 160 422 cases were reported, the population at the end of that year was about 788 058 inhabitants...(AU)

Simulación de un brote de enfermedad respiratoria aguda en el municipio de Camagüey / Simulation of an acute respiratory disease outbreak in Camagüey municipality

Fundamento: Los modelos matemáticos constituyen una herramienta poderosa para modelar procesos de la realidad, sus resultados son de gran utilidad para optimizar los recursos, que generalmente están limitados , con ellos se pueden dirigir medidas más efectivas que aumenten la comprensión del fenómeno en estudio, estos deben ser tan simples como sea posible, pero deben ser precisos flexibles y transparentes. Objetivo: Realizar simulaciones con el modelo SIR que se pretende introducir fundamentalmente en la docencia, en los análisis epidemiológicos y en la toma de decisiones. Método: Se analizan en el municipio Camagüey los casos de Enfermedades respiratorias agudas del año 2007, se reportaron ciento sesenta mil cuatrocientos veintidós casos, la población al cierre de ese año fue de 788 058 habitantes. En este modelo, “Susceptibles, Infectados y Recuperados”, S+R+I= N, donde N es el total de la población, (?) es el índice de transmisibilidad y (?) el índice de recuperación. Todas estas fórmulas se implementaron en el programa Matlab versión 7,4 del 2006. Resultados: Se muestran diferentes comportamientos para una población sin inmunidad, para esa misma población con la mitad inmunizada y para la situación inicial con aislamiento de enfermos al quinto día del brote epidémico. Se muestran comportamientos diferentes para tres índices de transmisibilidad diferentes. Conclusiones: Es posible utilizar el modelo “Susceptibles, Infectados y Recuperados” para la docencia y para los análisis epidemiológicos y tener en cuenta el indicador llamado “número reproductivo básico”, el cual nos indica los casos secundarios que genera un caso primario, y constituye en la Epidemiología moderna un indicador del avance de las medidas de control y de la severidad de las epidemias.

Background: The mathematical models constitute a powerful tool to model reality processes, their results are of great utility to optimize the resources that are generally limited, with them may direct effective measures that increase the understanding of the phenomenon in study, these should be as simple as it is possible, but should be precise, flexible and transparent. Objective: To carry out simulations with the SIR pattern that is pretend to introduce fundamentally in teaching, in the epidemic analyses and when taking decisions. Methods: The cases of acute respiratory diseases of the year 2007 in Camagüey municipality, are analyzed, 160 422 cases were reported, the population at the end of that year was about 788 058 inhabitants, In this model, "Susceptible, Infected and Recovered", S+R+I=N, where N is the population's total, (?) is the transmissibility index and (Y) the recovery index. All these formulas were carried out in the Matlab version 7,4 program of the 2006. Results: Different behaviors are shown for a population without immunity, for the same population with the half immunized and for the initial situation with the sickpeople isolation at the fifth day of the epidemic outbreak. Different behaviors are shown for three different transmissibility indexes. Conclusions: It is possible to use the "Susceptible, Infected and Recovered" pattern, for teaching and for the epidemic analyses and to keep in mind the indicator called "basic reproductive number", the one which indicates us the secondary cases that generates a primary case, and it constitutes in the modern Epidemiology an indicator of the advance of the control measures and the severity of epidemics.

Caracterización y análisis de series de tiempo de enfermedades respiratorias agudas en la provincia de Camagüey / Characterization and analysis of acute respiratory diseases time series from Camagüey

Fundamentación: En Cuba existe un excelente sistema de vigilancia, pero tiene que enfrentar el reto de constantes cambios demográficos y movimientos de poblaciones dentro y fuera del país, entre otros. Existe un eficiente sistema de alerta y respuesta contra la presentación de enfermedades, pero estos programas deben tener en cuenta el presupuesto para las actividades de la salud pública y la complejidad de la propagación; el uso de modelos matemáticos podría apoyar este esfuerzo. Objetivo: Caracterizar una serie de tiempo de enfermedades respiratorias agudas en la provincia de Camagüey y evaluarla con un método adecuado a su comportamiento(AU)

Background: In Cuba an excellent system of surveillance exists, but has to face the challenge of constant demographic changes and populations' movements inside and outside of the country, among other. An efficient system of alert and answer against the presentation of diseases exists, but these programs may take into account the budget for the public health activities and the complexity of the propagation; the use of mathematical models could support this effort. Objective: To characterize a series of time of acute respiratory diseases in Camagüey province and to evaluate it with an appropriate method to its behavior(AU)