Non-pharmaceutical interventions to combat COVID-19 in the Americas described through daily sub-national data.

This dataset covers national and subnational non-pharmaceutical interventions (NPI) to combat the COVID-19 pandemic in the Americas. Prior to the development of a vaccine, NPI were governments' primary tools to mitigate the spread of COVID-19. Variation in subnational responses to COVID-19 is high and is salient for health outcomes. This dataset captures governments' dynamic, varied NPI to combat COVID-19 for 80% of Latin America's population from each country's first case through December 2021. These daily data encompass all national and subnational units in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru. The dataset includes individual and aggregate indices of nine NPI: school closures, work suspensions, public event cancellations, public transport suspensions, information campaigns, local travel restrictions, international travel controls, stay-at-home orders, and restrictions on the size of gatherings. We also collected data on mask mandates as a separate indicator. Local country-teams drew from multiple data sources, resulting in high-quality, reliable data. The dataset thus allows for consistent, meaningful comparisons of NPI within and across countries during the pandemic.

A partisan pandemic: state government public health policies to combat COVID-19 in Brazil.

INTRODUCTION: To present an analysis of the Brazilian health system and subnational (state) variation in response to the COVID-19 pandemic, based on 10 non-pharmaceutical interventions (NPIs). MATERIALS AND METHODS: We collected daily information on implementation of 10 NPI designed to inform the public of health risks and promote distancing and mask use at the national level for eight countries across the Americas. We then analyse the adoption of the 10 policies across Brazil's 27 states over time, individually and using a composite index. We draw on this index to assess the timeliness and rigour of NPI implementation across the country, from the date of the first case, 26 February 2020. We also compile Google data on population mobility by state to describe changes in mobility throughout the COVID-19 pandemic. RESULTS: Brazil's national NPI response was the least stringent among countries analysed. In the absence of a unified federal response to the pandemic, Brazilian state policy implementation was neither homogenous nor synchronised. The median NPI was no stay-at-home order, a recommendation to wear masks in public space but not a requirement, a full school closure and partial restrictions on businesses, public transportation, intrastate travel, interstate travel and international travel. These restrictions were implemented 45 days after the first case in each state, on average. Rondônia implemented the earliest and most rigorous policies, with school closures, business closures, information campaigns and restrictions on movement 24 days after the first case; Mato Grosso do Sul had the fewest, least stringent restrictions on movement, business operations and no mask recommendation. CONCLUSIONS: The study identifies wide variation in national-level NPI responses to the COVID-19 pandemic. Our focus on Brazil identifies subsequent variability in how and when states implemented NPI to contain COVID-19. States' NPIs and their scores on the composite policy index both align with the governors' political affiliations: opposition governors implemented earlier, more stringent sanitary measures than those supporting the Bolsonaro administration. A strong, unified national response to a pandemic is essential for keeping the population safe and disease-free, both at the outset of an outbreak and as communities begin to reopen. This national response should be aligned with state and municipal implementation of NPI, which we show is not the case in Brazil.

Características basales de los pacientes nonagenarios ingresados por fracaso renal agudo en comparación con otros grupos etarios / Baseline characteristics of nonagenarians hospitalised due to acute kidney injury compared to other age groups

ANTECEDENTES Y OBJETIVO: El aumento en la esperanza de vida ha generado hospitalizaciones de pacientes con edades muy avanzadas. El objetivo de este trabajo es estudiar las características de la población de más de 90 años que ingresa por fracaso renal agudo (FRA) en comparación con otros grupos etarios. MATERIALES Y MÉTODOS: Estudio transversal que incluyó a todos los pacientes hospitalizados entre 2013 y 2014 cuya codificación al alta era de FRA. Recogimos características epidemiológicas, comorbilidad, medicación y datos analíticos basales. Analizamos y comparamos los datos de los mayores de 90 años con los menores de dicha edad. RESULTADOS: Se incluyeron 1.733 pacientes. Del total de pacientes, 264 (15%) tenían una edad superior a 90 años y se encontró una proporción significativamente mayor de mujeres. La causa más frecuente del FRA en los pacientes mayores de 90 años fue la funcional (81%) (p < 0,001 respecto al resto de grupos etarios). La principal causa de ingreso fue la infecciosa. En el grupo de más de 90 años, encontramos mayor prevalencia de hipertensión arterial (HTA) (p = 0,005), enfermedad renal crónica (ERC) (p = 0,014), insuficiencia cardiaca congestiva (ICC) (p = 0,006) y deterioro cognitivo (p < 0,0001). El filtrado glomerular basal por CKD-EPI fue inferior en el grupo de mayores de 90 años (p < 0,0001). Los pacientes hospitalizados por FRA menores de 90 años tenían mayor prevalencia de diabetes mellitus (p < 0,001), dislipemia (p < 0,001) y antecedente de neoplasia (p < 0,001), y un índice de Barthel superior (p < 0,0001). CONCLUSIONES: La causa más frecuente de FRA en nonagenarios es la funcional, presentando los pacientes más HTA, ERC, ICC, mayor dependencia y deterioro cognitivo frente al resto de grupos etarios

BACKGROUND: The increase in life expectancy leads to higher hospitalisation rates in elderly patients. The aim of this work is to study the characteristics of the population over 90 years of age that are admitted due to acute kidney injury (AKI). MATERIAL AND METHODS: A cross-sectional study was conducted that included all patients admitted to hospital with AKI in the years 2013 and 2014. Epidemiological characteristics, comorbidity, medication and baseline analytical data were collected, and a comparison was made between patients with age over 90 years-old and the others. RESULTS: A total of 1733 patients were included, of whom 264 (15%) were over 90 years-old. A significantly higher proportion of these patients were women. The most frequent cause of AKI in patients older than 90 years was functional (81%) (p < 0.001 compared to other age groups). The main cause of hospital admission was infection. In the group of over 90 years of age, a higher prevalence was found for arterial hypertension (p = 0.005), chronic kidney disease (p = 0.014), congestive heart failure (p = 0.006), and cognitive impairment (p < 0.0001). The baseline glomerular filtration rate by CKD-EPI was lower in the group of patients older than 90 years (p < 0.0001). Patients under 90 years admitted to hospital due to AKI, had a higher prevalence of diabetes mellitus (p < 0.001), dyslipidaemia (p < 0.001), history of neoplasia (p < 0.001), and a higher Barthel index (p < 0.0001). CONCLUSIONS: Nonagenarians admitted due to AKI have functional aetiology as the most common factor. These patients have a higher prevalence of hypertension, heart failure, chronic kidney disease, low functional status, and more cognitive impairment

[Baseline characteristics of nonagenarians hospitalised due to acute kidney injury compared to other age groups]. / Características basales de los pacientes nonagenarios ingresados por fracaso renal agudo en comparación con otros grupos etarios.

BACKGROUND: The increase in life expectancy leads to higher hospitalisation rates in elderly patients. The aim of this work is to study the characteristics of the population over 90 years of age that are admitted due to acute kidney injury (AKI). MATERIAL AND METHODS: A cross-sectional study was conducted that included all patients admitted to hospital with AKI in the years 2013 and 2014. Epidemiological characteristics, comorbidity, medication and baseline analytical data were collected, and a comparison was made between patients with age over 90 years-old and the others. RESULTS: A total of 1733 patients were included, of whom 264 (15%) were over 90 years-old. A significantly higher proportion of these patients were women. The most frequent cause of AKI in patients older than 90 years was functional (81%) (p < 0.001 compared to other age groups). The main cause of hospital admission was infection. In the group of over 90 years of age, a higher prevalence was found for arterial hypertension (p = 0.005), chronic kidney disease (p = 0.014), congestive heart failure (p = 0.006), and cognitive impairment (p < 0.0001). The baseline glomerular filtration rate by CKD-EPI was lower in the group of patients older than 90 years (p < 0.0001). Patients under 90 years admitted to hospital due to AKI, had a higher prevalence of diabetes mellitus (p < 0.001), dyslipidaemia (p < 0.001), history of neoplasia (p < 0.001), and a higher Barthel index (p < 0.0001). CONCLUSIONS: Nonagenarians admitted due to AKI have functional aetiology as the most common factor. These patients have a higher prevalence of hypertension, heart failure, chronic kidney disease, low functional status, and more cognitive impairment.

Sistema de referencia-contrarreferencia en pediatría: análisis de la situación en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell / Reference and contrareference in pediatrics

Introducción: en nuestro país, como en el resto del mundo, los sistemas de salud están sometidos a procesos de modernización y reforma con el objetivo de adecuar sus capacidades a las necesidades de la población. En este contexto la estructura y gestión del sistema de salud son vehículos importantes para cumplir el objetivo. A fin de hacer buen uso de esta red,resulta crucial asegurar una buena coordinación entre los diferentes niveles de atención. Un sistema de referencia-contrarreferencia (SRC) constituye una herramienta que pone, a disposición de los médicos, criterios y procedimientos homogéneos que permiten canalizar lademanda para servicios de salud y hacer uso eficiente del sistema de atención.Objetivos: analizar las derivaciones de pacientes al Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR) a través del Departamento de Emergencia (DEP) y de la Policlínica Pediátrica General de Referencia (PPGR). Conclusiones: los resultados hallados muestran una ineficiente utilización de los recursos. Sedeben establecer medidas para racionalizar el sistema de atención y promover su eficacia. Se proponen medidas para mejorar el funcionamiento del SRC y la derivación oportuna y adecuada a especialista en el HP-CHPR.

Introduction: following a global trend, the health system in our country is undergoing modernization and reformprocesses with the purpose of making their capabilities suitable for the needs of the population. Under this framework,the structure and management of the health system are important tools to achieve this goal. To this end, thedifferent levels of health care providers need to be well coordinated. A reference-contrareference system is a tool that provides physicians with criteria and homogeneousprocedures that enable their channeling the demand for health care services and to use the system efficiently.Objectives: the study aims to analyze how patients consulting at the Emergency Department and the GeneralPediatrics Reference Policlinic are referred to the Pereira Rossell Hospital.good in 30 of the cases. Conclusions: results show resources are inefficientlyused. We need to set specific measures to rationalize thehealth care system and promote its efficacy. Measures toimprove functioning of the reference-contrareference systemand the timely and appropriate referral to a specialistat the Perreira Rossell Hospital are suggested.

Introdução: no nosso país, como no resto do mundo, os sistemas de saúde estão submetidos a processos demodernização e reforma buscando adequar sua capacidade às necessidades da população. Dessa forma, a estrutura e a gestão do sistema de saúde são veículos importantespara atingir o objetivo. Para fazer um bom uso dessa rede, é fundamental garantir uma boa coordenação entre os diferentes níveis de atenção. Um sistema de referência e contra-referência (SRC) é uma ferramenta que coloca a disposição dos médicos, critérios e procedimentos homogêneosque permitem canalizar a demanda de serviços de saúde e utilizar o sistema de atenção de forma eficiente.Objetivos: analisar a derivação de pacientes ao Hospital Pediátrico do Centro Hospitalar Pereira Rossell (HPCHPR) através do Departamento de Emergência (DEP) e da Policlínica Pediátrica Geral de Referência (PPGR). Conclusões: os resultados encontrados mostram uma utilização ineficiente dos recursos. É necessário estabelecermedidas para racionalizar o sistema de atenção e promover sua eficácia. Propõem-se medidas para melhorar o funcionamento do SRC e o encaminhamento oportuno e adequado a especialistas no HP-CHPR.