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1.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-22269002

RESUMEN

ObjectivesTo describe the use and findings of cardiopulmonary imaging - chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS)) and/or cardiac magnetic resonance imaging (cMRI) - in COVID-19-associated hospitalizations in Latin America (LATAM) BackgroundThe SARS-Cov-2 is one of the largest and most active threats to healthcare in living memory. There is an information gap on imaging services resources (ISR) used and their findings during the pandemic in LATAM. MethodsThis was a multicenter, prospective, observational study of COVID-19 inpatients conducted from March to December 2020 from 12 high-complexity centers in nine LATAM countries. Adults (> 18 yrs) with at least one imaging modality performed, followed from admission until discharge and/or in-hospital death, were included. ResultsWe studied 1435 hospitalized patients (64% males) with a median age of 58 years classified into three regions: 262 from Mexico (Mx), 428 from Central America and Caribbean (CAC), and 745 from South America (SAm). More frequent comorbidities were overweight/obesity (61%), hypertension (45%), and diabetes (27%). During hospitalization, 58% were admitted to ICU. The in-hospital mortality was 28% (95%CI 25-30) highest in Mx (37%). The most frequent cardiopulmonary imaging performed were cCT (61%)-more frequent in Mx and SAm-, and cX-ray (46%) -significantly used in CAC-. The cEcho was carried out in 18%, similarly among regions, and LUS in 7%, more frequently in Mx. The cMRI was performed in only one patient in the cohort. Abnormal findings on the cX-ray were related to peripheral (63%) or basal infiltrates (52%), and in cCT with ground glass infiltrates (89%). Both were more commonly in Mx. In LUS, interstitial syndrome (56%) was the most related abnormal finding, predominantly in Mx and CAC. ConclusionsThe use and findings of cardiopulmonary imaging in LATAM varied between regions and may have been influenced by clinical needs, the personnel protection measures and/or hospitalization location. Condensed AbstractThe SARS-Cov-2 is one of the largest and most active threats to healthcare in living memory. There is limited information on imaging services resources (ISR) used and their findings during the pandemic in LATAM. To our knowledge, RIMAC aimed the first international, multicenter study at registering the use and findings of cardiopulmonary imaging modalities performed for the diagnosis, prognosis, and treatment of patients hospitalized for infection with SARS-CoV-2 in Latin America. We studied their demographic parameters, comorbidities, in-hospital events, laboratory results, and treatments focusing on their impact in clinical complications.

2.
Washington, D.C.; PAHO; 2022-01-19.
en Inglés, Español | PAHO-IRIS | ID: phr-55631

RESUMEN

[WEEKLY SUMMARY] North America: Overall, influenza activity remained low but increasing, while SARS-CoV-2 activity increased. In Canada, influenza A and B virus co-circulated with influenza A(H3N2) and A(H1N1)pdm09; SARS-CoV-2 activity slightly increased. In Mexico, influenza A(H3N2) prevailed, with B co-circulating and SARS-CoV-2 activity increased at moderate levels. In the United States, influenza A(H3N2) predominated, with SARS-CoV-2 activity increasing, hospitalizations and deaths remained elevated. Respiratory syncytial virus activity remained high in Canada and Mexico. Caribbean: Influenza remained at low activity levels. SARS-CoV-2 activity increased in Jamaica with increased number of pneumonia cases and SARI hospitalizations. In Suriname, SARS-CoV-2 and SARI activity continued at low levels. Central America: Influenza activity continued to increase and SARS-CoV-2 activity decreased to low levels overall. In Guatemala and Honduras, influenza activity increased with the predominance of influenza A(H3N2), and low SARS-CoV-2 circulation; while SARS-CoV-2 activity increased in Costa Rica. RSV activity decreased in the subregion. Andean: Overall, influenza activity remained low and SARS-CoV-2 activity continued at low levels; however, Bolivia, Ecuador and Peru reported increased influenza activity associated with A(H3N2) detections. SARS-CoV-2 activity stands elevated in Bolivia and Ecuador; and in Bolivia, SARI activity was recorded at extraordinary levels. Brazil and Southern Cone: Influenza activity increased to pre-pandemic levels, and SARS-CoV-2 activity continues at low levels, except in Argentina. Influenza A(H3N2) detections continue to rise in Brazil, Chile, Paraguay, and Uruguay. Most activity and increasing A(H3N2) detections are recorded in Brazil and Chile.


[RESUMEN SEMANAL] América del Norte: en general, la actividad de la influenza se mantuvo en aumento a niveles bajos, mientras que la actividad de SARS-CoV-2 aumentó. En Canadá, el virus de la influenza A y B circularon concurrentemente con los virus influenza A(H3N2) y A(H1N1)pdm09; la actividad del SARS-CoV-2 aumentó ligeramente. En México, predominó el virus influenza A(H3N2), con la circulación concurrente de B, y la actividad del SARS-CoV-2 aumentó a niveles moderados. En los Estados Unidos, predominó la influenza A(H3N2), con aumento de la actividad del SARS-CoV-2, las hospitalizaciones y muertes se mantuvieron elevadas. La actividad del virus respiratorio sincitial se mantuvo alta en Canadá y México. Caribe: la influenza se mantuvo en niveles bajos de actividad. La actividad del SARS-CoV-2 en Jamaica aumento en paralelo a mayor número de casos por neumonía y hospitalizaciones por IRAG. En Surinam, la actividad del SARS-CoV-2 e IRAG permaneció a niveles bajos. América Central: la actividad de la influenza continuó en aumento y la actividad del SARS-CoV-2 disminuyó a niveles bajos en general. En Guatemala y Honduras, la actividad de la influenza aumentó con el predominio de la influenza A(H3N2) y baja circulación de SARS-CoV-2; mientras que la actividad del SARS-CoV-2 aumentó en Costa Rica. La actividad del VRS decreció en la subregion. Andina: en general, la actividad de la influenza se mantuvo baja y la actividad de SARS-CoV-2 continuó en aumento; sin embargo, Bolivia, Ecuador y Perú informaron un aumento de la actividad de la influenza asociada con las detecciones de A(H3N2). La actividad de SARS-CoV-2 se mantiene elevada en Bolivia y Ecuador; y en Bolivia, la actividad de IRAG se registró en niveles extraordinarios. Brasil y Cono Sur: la actividad de la influenza aumentó a niveles prepandémicos y la actividad del SARS-CoV-2 continúa en niveles bajos, excepto en Argentina. Las detecciones de influenza A(H3N2) continúan aumentando en Brasil, Chile, Paraguay y Uruguay. La mayor parte de la actividad y las detecciones crecientes de A(H3N2) se registran en Brasil y Chile.


Asunto(s)
Gripe Humana , COVID-19 , SARS-CoV-2 , Betacoronavirus , Reglamento Sanitario Internacional , Urgencias Médicas , Américas , Región del Caribe , Gripe Humana , Reglamento Sanitario Internacional , Urgencias Médicas , Américas , Región del Caribe
3.
Washington, D.C.; PAHO; 2022-01-11.
en Inglés, Español | PAHO-IRIS | ID: phr-55594

RESUMEN

[WEEKLY SUMMARY]. North America: Overall, influenza activity remained low but increasing. In Canada, influenza A and B virus co-circulated with influenza A(H3N2) and A(H1N1)pdm09 among samples where subtyping was performed; SARS-CoV-2 activity slightly increased. In Mexico, influenza A(H3N2) prevailed, with B co-circulating and SARS-CoV-2 activity increased. In the United States, influenza A(H3N2) predominated, with SARS-CoV-2 activity increasing, hospitalizations and deaths remained elevated. Respiratory syncytial virus activity remained high in Canada. Caribbean: Influenza remained at low activity levels. Haiti reported a few detections in recent weeks with the predominance of influenza B/Victoria and A(H1N1)pdm09. In Suriname, SARS-CoV-2 and SARI activity decreased to low levels. Central America: Influenza activity continued low and SARS-CoV-2 activity decreased to low levels overall. In Guatemala, influenza activity decreased with the predominance of influenza A(H3N2) in the previous week, while influenza A(H3N2) circulation increased in Honduras with low SARI and ILI activity. Andean: Overall, influenza activity remained low; however, Bolivia, Ecuador, and Peru reported increased influenza activity associated with A(H3N2) detections. SARS-CoV-2 activity stands elevated in Bolivia and Ecuador; and in Bolivia, SARI activity continued at extraordinary levels. Brazil and Southern Cone: Influenza activity increased to pre-pandemic levels, and SARS-CoV-2 activity continues at low levels, except in Argentina. Influenza A(H3N2) detections continue to rise in Brazil, Chile, Paraguay, and Uruguay. Most activity and increasing A(H3N2) detections are recorded in Brazil and Uruguay. Global: In the temperate zones of the northern hemisphere, influenza activity, although still low, appeared to increase in some countries with detections of mainly influenza A(H3N2) and B Victoria lineage (mainly in China). In Europe, influenza activity continued to increase. Influenza A(H3N2) predominated. In East Asia, influenza activity continued rising in China, while influenza illness indicators and activity remained low in the rest of the subregion. Influenza B/Victoria viruses predominated. In tropical Africa, overall influenza activity continued decreasing, with both influenza A and B detected. In Southern Asia, influenza virus detections of predominately influenza A(H3N2) increased overall, although reducing in a few countries. In South-East Asia, sporadic influenza detections were reported in the Philippines. However, in the temperate zones of the southern hemisphere, influenza activity remained low overall. SARS-CoV-2 percent positivity from sentinel surveillance increased to approximately 30%. Activity remained under 10% positivity in the Eastern Mediterranean, South-East Asian and Western Pacific Regions of WHO. In the other WHO Regions, an increasing trend in positivity was observed in recent weeks. Overall positivity from non-sentinel sites also increased and was at 25%.


[RESUMEN SEMANAL] América del Norte: en general, la actividad de la influenza se mantuvo baja pero en aumento. En Canadá, el virus de la influenza A y B circularon concurrentemente con los virus influenza A(H3N2) y A(H1N1)pdm09 en las muestras a las que se les determinó el subtipo; la actividad del SARS-CoV-2 aumentó ligeramente. En México, predominó el virus influenza A(H3N2), con la circulación concurrente de B, y la actividad del SARS-CoV-2 aumentó. En los Estados Unidos, predominó la influenza A(H3N2), con un aumento de la actividad del SARS-CoV-2, las hospitalizaciones y muertes se mantuvieron elevadas. La actividad del virus respiratorio sincitial se mantuvo alta en Canadá. Caribe: la influenza se mantuvo en niveles bajos de actividad. Haití reportó algunas detecciones en las últimas semanas con predominio de influenza B/Victoria y A(H1N1)pdm09. En Surinam, la actividad del SARS-CoV-2 e IRAG disminuyó a niveles bajos. América Central: la actividad de la influenza continuó baja y la actividad del SARS-CoV-2 disminuyó a niveles bajos en general. En Guatemala, la actividad de la influenza disminuyó con el predominio de la influenza A(H3N2) en semanas previa, mientras que la circulación de la influenza A(H3N2) aumentó en Honduras con baja actividad de IRAG y ETI. Andina: en general, la actividad de la influenza se mantuvo baja; sin embargo, Bolivia, Ecuador y Perú informaron un aumento de la actividad de la influenza asociada con las detecciones de A(H3N2). La actividad de SARS-CoV-2 se mantiene elevada en Bolivia y Ecuador; y en Bolivia, la actividad de la IRAG continuó en niveles extraordinarios. Brasil y Cono Sur: la actividad de la influenza aumentó a niveles prepandémicos y la actividad del SARS-CoV-2 continúa en niveles bajos, excepto en Argentina. Las detecciones de influenza A(H3N2) continúan aumentando en Brasil, Chile, Paraguay y Uruguay. La mayor parte de la actividad y las detecciones crecientes de A(H3N2) se registran en Brasil y en Uruguay. Global: en las zonas templadas del hemisferio norte, la actividad de la influenza, aunque todavía baja, pareció aumentar en algunos países con detecciones de influenza principalmente A(H3N2) y B linaje Victoria (principalmente en China). En Europa, la actividad gripal siguió aumentando. Predominó influenza A(H3N2). En el este de Asia, la actividad de la influenza siguió aumentando en China, mientras que los indicadores y la actividad de la enfermedad por influenza se mantuvieron bajos en el resto de la subregión. Predominaron los virus influenza B linaje Victoria. En África tropical, la actividad general de la influenza continuó disminuyendo y se detectaron tanto la influenza A como la B. En el sur de Asia, en general, las detecciones de los virus de la influenza predominantemente A(H3N2) aumentaron, aunque disminuyeron en algunos países. En el sudeste asiático, en Filipinas se informaron detecciones esporádicas de influenza. Sin embargo, en las zonas templadas del hemisferio sur, la actividad de influenza se mantuvo baja en general. El porcentaje de positividad de SARS-CoV-2 de la vigilancia centinela aumentó a aproximadamente el 30%. La actividad se mantuvo por debajo del 10 % de positividad en las Regiones del Mediterráneo Oriental, Asia Sudoriental y el Pacífico Occidental. En las otras Regiones, se observó una tendencia creciente en la positividad en las últimas semanas. La positividad general de los sitios no centinela también aumentó y fue del 25%.


Asunto(s)
Gripe Humana , COVID-19 , SARS-CoV-2 , Betacoronavirus , Reglamento Sanitario Internacional , Urgencias Médicas , Américas , Región del Caribe , Gripe Humana , Reglamento Sanitario Internacional , Urgencias Médicas , Américas , Región del Caribe
4.
Washington, D.C.; PAHO; 2022-01-04.
en Inglés, Español | PAHO-IRIS | ID: phr-55549

RESUMEN

North America: Influenza activity remained low. In Mexico and the United States, SARS-CoV-2 activity continued elevated and increasing. Caribbean: Influenza activity remained low. In Belize, SARS-CoV-2 activity continued at moderate levels and increasing; RSV detections continue to increase in the country. In Puerto Rico and Saint Lucia, SARS-CoV-2 activity continued to increase. Central America: Influenza activity remained low. Overall, SARS-CoV-2 activity continued at moderate levels in the subregion. In Nicaragua, SARS-CoV-2 activity continued elevated and increasing. Andean: Influenza activity remained low. Overall, SARS-CoV-2 activity continued at moderate levels but decreasing. Brazil and Southern Cone: Influenza activity remained low. Overall, SARS-CoV-2 activity continued at moderate levels but decreasing. In Argentina and Uruguay RSV activity remained elevated and increasing. Global: Despite continued or even increased testing for influenza in some countries, influenza activity remained at lower levels than expected for this time of the year. In the temperate zones of the southern and northern hemispheres, influenza activity remained at inter-seasonal levels. In tropical Africa, influenza detections were reported in some countries in Western and Eastern Africa. In Southern Asia, influenza detections were reported from Bangladesh, India, and Nepal. In South East Asia, one detection of Influenza A(H3N2) was reported from the Philippines. Worldwide, influenza B detections accounted for most of the low number of detections reported.


América del Norte: la actividad de la influenza se mantuvo baja. En México y los Estados Unidos, la actividad de SARS-CoV-2 continuó elevada y en aumento. Caribe: la actividad de la influenza se mantuvo baja. En Belice la actividad del SARS-CoV-2 continuó en niveles moderados y en aumento; las detecciones de VRS continúan aumentando en el país. En Puerto Rico y Santa Lucía, la actividad de SARS-CoV-2 continuó en aumento. América Central: la actividad de la influenza se mantuvo baja. En general, la actividad del SARS-CoV-2 continuó en niveles moderados en la subregión. En Nicaragua, la actividad del SARS-CoV-2 continuó elevada y en aumento. Andina: la actividad de la influenza se mantuvo baja. En general, la actividad del SARS-CoV-2 continuó en niveles moderados, pero en disminución. Brasil y Cono Sur: la actividad de la influenza se mantuvo baja. En general, la actividad del SARS-CoV-2 continuó en niveles moderados, pero disminuyó. En Argentina y Uruguay, la actividad del VRS se mantuvo elevada y en aumento. Global: a pesar de que la realización de pruebas para la detección de influenza continuó o incluso aumentó en algunos países, la actividad del virus de la influenza se mantuvo en niveles más bajos de lo esperado para esta época del año. En las zonas templadas de los hemisferios sur y norte, la actividad de la influenza se mantuvo en niveles entre estaciones. En África tropical, se notificaron detecciones de influenza en algunos países de África occidental y oriental. En el sur de Asia, se informaron detecciones de influenza en Bangladesh, India y Nepal. En el sudeste asiático, se informó de una detección de influenza A(H3N2) en Filipinas. A nivel mundial, las detecciones de influenza B representaron la mayor parte del bajo número de detecciones notificadas.


Asunto(s)
Gripe Humana , COVID-19 , SARS-CoV-2 , Betacoronavirus , Infecciones por Coronavirus , Urgencias Médicas , Reglamento Sanitario Internacional , Infecciones por Coronavirus , Gripe Humana , Urgencias Médicas , Reglamento Sanitario Internacional
5.
Washington, D.C.; OPS; 2022-01-04.
en Inglés, Español | PAHO-IRIS | ID: phr-55548

RESUMEN

North America: Influenza activity remained low overall. In Mexico, SARI activity continued to rise and was associated with high SARS-CoV-2 activity. In the United States, SARS-CoV-2 detections continued to increase, and COVID-19 mortality remained elevated and above the epidemic threshold. Caribbean: Influenza activity remained low overall. In Jamaica, SARS-CoV-2 activity continues to increase, and pneumonia activity continued above moderate levels and rising. In Puerto Rico, SARS-CoV-2 activity continued elevated and increasing. In Saint Lucia, ILI activity in the population five years of age and older continues above the alert threshold and was associated with SARS-CoV-2 activity. Central America: Influenza activity remained low and SARS-CoV-2 activity continued at moderate levels overall. In Nicaragua, SARS-CoV-2 activity continued high and increasing. Andean: Influenza activity remained low and SARS-CoV-2 activity continued at moderate levels overall. In Peru, RSV activity continues to increase. Brazil and Southern Cone: Influenza activity remained low and SARS-CoV-2 activity continued at moderate levels overall. In Argentina, RSV activity remained high and increasing. In Uruguay, SARI activity continued above epidemic levels and rising.


América del Norte: la actividad de la influenza se mantuvo baja en general. En México, la actividad de la IRAG continuó aumentando y se asoció con una alta actividad de SARS-CoV-2. En los Estados Unidos, las detecciones de SARS-CoV-2 continuaron aumentando y la mortalidad por COVID-19 se mantuvo elevada y por encima del umbral epidémico. Caribe: la actividad de la influenza se mantuvo baja en general. En Jamaica, la actividad del SARS-CoV-2 continúa aumentando y la actividad de la neumonía continuó por encima de niveles moderados y en aumento. En Puerto Rico, la actividad del SARS-CoV-2 continuó elevada y en aumento. En Santa Lucía, la actividad de la ETI en la población de cinco años o más continúa por encima del umbral de alerta y se asoció con la actividad del SARS-CoV-2. América Central: la actividad de la influenza se mantuvo baja y la actividad del SARS-CoV-2 continuó a niveles moderados en general. En Nicaragua, la actividad del SARS-CoV-2 continuó elevada y en aumento. Andina: la actividad de la influenza se mantuvo baja y la actividad del SARS-CoV-2 continuó en niveles moderados en general. En Perú, la actividad del VRS sigue en aumento. Brasil y Cono Sur: la actividad de la influenza se mantuvo baja y la actividad del SARS-CoV-2 continuó en niveles moderados en general. En Argentina, la actividad del VRS se mantuvo alta y en aumento. En Uruguay, la actividad de la IRAG continuó por encima de los niveles epidémicos y en aumento.


Asunto(s)
Gripe Humana , SARS-CoV-2 , COVID-19 , Infecciones por Coronavirus , Betacoronavirus , Urgencias Médicas , Reglamento Sanitario Internacional , Gripe Humana , Infecciones por Coronavirus , Urgencias Médicas , Reglamento Sanitario Internacional
6.
Ann Am Thorac Soc ; 2022 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-35030062

RESUMEN

Asthma affects a large number of people living in the Americas, a vast and diverse geographic region comprising 35 nations in the Caribbean and North, Central and South America. The marked variability in the prevalence, morbidity, and mortality from asthma across and within nations in the Americas offers a unique opportunity to improve our understanding of the risk factors and management of asthma phenotypes and endotypes in children and adults. Moreover, a better assessment of the causes and treatment of asthma in less economically developed regions in the Americas would help diagnose and treat individuals migrating from those areas to Canada and the United States. In this focused review, we first assess the epidemiology of asthma, review known and potential risk factors, and examine commonalities and differences in asthma management across the Americas. We then discuss future directions in research and health policies to improve the prevention, diagnosis, and management of pediatric and adult asthma in the Americas, including standardized and periodic assessment of asthma burden across the region; large-scale longitudinal studies including omics and comprehensive environmental data on racially and ethnically diverse populations; and dissemination and implementation of guidelines for asthma management across the spectrum of disease severity. New initiatives should recognize differences in socioeconomic development and health care systems across the region while paying particularly attention to novel or more impactful risk factors for asthma in the Americas, including indoor pollutants such as biomass fuel, tobacco use, infectious agents and the microbiome, and psychosocial stressor and chronic stress.

7.
Rural Remote Health ; 22(1): 6467, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35038387

RESUMEN

INTRODUCTION: For rural and remote clinicians, quality education is often difficult to access because of geographic isolation, travel, time, expense constraints and lack of an onsite educator. The aims of this integrative review were to examine what telehealth education is available to rural practitioners, evaluate the existence and characteristics of telehealth education for rural staff, evaluate current telehealth education models, establish the quality of education provided through telehealth along with the facilitators or enablers of a successful service and develop recommendations for supporting and developing an education model for rural and remote health practitioners through telehealth. METHODS: An integrative review was conducted following the five-stage integrative review process. Searches were conducted in the electronic databases CINAHL, Medline, Nursing & Allied Health (Proquest), PubMed, Johanna Briggs Institute Evidence Based Practice (JBI EBP) and Embase. RESULTS: Initial searches revealed more than 7000 articles; final inclusion and exclusion criteria refined results to 60 articles to be included in this review. Included articles were original research, case studies, reviews or randomised controlled studies. Countries of origin were countries in North and Central America, the UK, Europe, and Africa, and Australia and India. One issue noted with this review was classifying rural and remote; contexts used included rural, remote, regional, isolated, peripheral, native communities and outer regional or inner regional. Sample sizes in the studies ranged from 20 to more than 1000 participants, covering a broad range of health education topics. Delivery was mostly by a didactic approach and case presentations. Some included a mix of videoconferencing with face-to-face sessions. Overall, telehealth education was well received, with participants reporting mostly positive outcomes as signified by feeling less isolated and more supported. One interesting result was that quality in telehealth education is poorly established as there appears to be no definitions or consensus on what constitutes quality in the delivery of telehealth education. Very few studies formally tested increase in skill or knowledge, which is usual with professional development programs that do not result in further qualifications. For those that did assess these, formal knowledge and skills assessment indicated that telehealth using videoconferencing is comparable to face-to-face training with significant benefits related to travel reduction and therefore cost. Recommendations were difficult to synthesise because of the broad issues uncovered and lack of quality in many of the studies. CONCLUSION: The applications for telehealth are still evolving, with some applications having poor evidence to support use. Overall, telehealth education is well received and supported, with positives far outweighing negatives. Anything that can improve connection with a community and decrease isolation experienced by rural clinicians can only be beneficial. However, further planning and evaluation of the quality of delivery of telehealth education and addressing how education outcomes can be measured needs to be addressed in this widely growing area of telehealth.

8.
BMC Health Serv Res ; 22(1): 49, 2022 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-35012514

RESUMEN

BACKGROUND: Health care is a complex economic and social system, which combines market elements and public and social interest. This combination in Brazil, like systems in China and United States of America, is operationalized through the public and private system. The sector represents approximately 9% of the country's GDP, of which 56% is privately sourced and 44% is of public origin. In the private sector includes a structure with 711 private health institutions, 47 million beneficiaries and revenues of US$30 billion a year. METHODS: Therefore, this research describes and analyzes the complementarity of Private Health before the Brazilian Unified Health System, highlighting its main characteristics, scenarios, and trends in the face of the health system and the Brazilian market. This descriptive and exploratory research uses secondary data from various sources, submitted to quantitative data analysis methods. The object of the research is the history of private health in Brazil and its main actors. RESULTS: The data are organized into three groups, each with its approach of collection and analysis. Thus, it is perceived as the notorious growth of large operators, to the detriment of operators with a lower concentration of beneficiaries; the increasing concentration of the market through mergers and acquisitions promoted by large publicly traded corporations, especially in regions with a lower rate of private health coverage; and the growth of the sector through business plans, whose central characteristic is the dependence on the country's employability rate. CONCLUSIONS: It is possible to perceive an intense trend of concentration of Brazilian private health in large institutions that have capitalized and have a great appetite for growth through mergers and acquisitions, whether from smaller operators or health institutions that integrate their health networks, following complementary health models already consolidated in countries such as China, and the United States of America, among others. This concentration projects a market with fewer options and competitiveness, reduction in transaction costs and increase the operational effectiveness of health care.


Asunto(s)
Sector Privado , Sector Público , Brasil , Atención a la Salud , Programas de Gobierno , Humanos
9.
J Cancer Surviv ; 2022 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-35020136

RESUMEN

PURPOSE: Long-term follow-up (LTFU) care is essential to optimise health outcomes in childhood cancer survivors (CCS). We aimed to assess the impact of the COVID-19 pandemic on LTFU services and providers. METHODS: A COVID-19 working group within the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) distributed a questionnaire to LTFU service providers in 37 countries across Europe, Asia, North America, Central/South America, and Australia. The questionnaire assessed how care delivery methods changed during the pandemic and respondents' level of worry about the pandemic's impact on LTFU care delivery, their finances, their health, and that of their family and friends. RESULTS: Among 226 institutions, providers from 178 (79%) responded. Shortly after the initial outbreak, 42% of LTFU clinics closed. Restrictions during the pandemic resulted in fewer in-person consultations and an increased use of telemedicine, telephone, and email consultations. The use of a risk assessment to prioritise the method of LTFU consultation for individual CCS increased from 12 to 47%. While respondents anticipated in-person consultations to remain the primary method for LTFU service delivery, they expected significantly increased use of telemedicine and telephone consultations after the pandemic. On average, respondents reported highest levels of worry about psychosocial well-being of survivors. CONCLUSIONS: The pandemic necessitated changes in LTFU service delivery, including greater use of virtual LTFU care and risk-stratification to identify CCS that need in-person evaluations. IMPLICATIONS FOR CANCER SURVIVORS: Increased utilisation of virtual LTFU care and risk stratification is likely to persist post-pandemic.

10.
Appl Environ Microbiol ; : aem0214921, 2022 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-35020454

RESUMEN

Salmonella enterica (SE) can survive in surface waters (SuWa) and the role of non-host environments in its transmission has acquired increasing relevance. In this study, we conducted comparative genomic analyses of 172 SE isolates collected from SuWa across three months in six states of central Mexico during 2019. SE transmission dynamics were assessed using 87 experimental and 112 public isolates from Mexico collected during 2002-2019. We also studied genetic relatedness between SuWa isolates and human clinical strains collected in North America during 2005-2020. Among experimental isolates, we identified 41 SE serovars and 56 multi-locus sequence types (ST). Predominant serovars were Senftenberg (n=13), Meleagridis, Agona, and Newport (n=12 each), Give (n=10), Anatum (n=8), Adelaide (n=7), and Infantis, Mbandaka, Ohio and Typhimurium (n=6 each). We observed a high genetic diversity in the sample under study, as well as clonal dissemination of strains across distant regions. Some of these strains are epidemiologically important (ST14, ST45, ST118, ST132, ST198, and ST213), and were genotypically close to those involved in clinical cases in North America. Transmission network analysis suggests that SuWa are a relevant source of SE (0.7 source/hub ratio) and contributes to its dissemination as isolates from varied sources and clinical cases have SuWa isolates as common ancestors. Overall, the study shows SuWa act as reservoir of various SE serovars of public health significance. Further research is needed to better understand the mechanisms involved in SuWa contamination by SE, as well as develop interventions to contain its dissemination to food production settings. Study importance Surface waters are heavily used in food production worldwide. Several human pathogens can survive in these waters for long periods and disseminate to food production environments, contaminating our food supply. One of these pathogens is Salmonella enterica, a leading cause of foodborne infections, hospitalizations and deaths in many countries. This research demonstrates the role of surface waters as a vehicle for the transmission of Salmonella along food production chains. It also shows some strains circulating in surface waters are very similar to those implicated in human infections and harbor genes that confer resistance to multiple antibiotics, posing a risk to public health. The study contributes to expand our current knowledge on the ecology and epidemiology of Salmonella in surface waters.

11.
J Oncol Pharm Pract ; : 10781552211073470, 2022 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-35019805

RESUMEN

OBJECTIVE: We conducted this scoping review to map and summarize scientific evidence on the role of clinical pharmacists in the palliative care of adults and elderly patients with cancer. DATA SOURCES: A literature search was performed in MEDLINE, PubMed Central, Embase, Web of Science, Scopus, and BVS/BIREME for studies published until November 22nd, 2020. Studies that reported work experiences adopted by clinical pharmacists in the palliative care of adults and elderly patients with cancer were included. Two independent authors performed study selection and data extraction. Any disagreements were resolved by discussion with the third and fourth authors. The pharmacist interventions identified in the included studies were described based on key domains in the DEPICT v.2. DATA SUMMARY: A total of 586 records were identified, of which 14 studies fully met the eligibility criteria. Most of them were conducted in the United States of America (n = 5) and Canada (n = 5) and described the workplace of the pharmacist in clinic/ambulatory (n = 10). Clinical pharmacists performed several activities and provided services, highlighting medication review (n = 12), patient and caregivers education (n = 12), medication histories and-or medication reconciliation (n = 6). The pharmacist interventions were mostly conducted for patients/caregivers (n = 13), by one-on-one contact (n = 14), and by face-to-face (n = 13). Pharmacists were responsible mainly for change or suggestion for change in therapy (n = 12) and patient counselling (n = 12). Pharmacist interventions were well accepted by the clinical team. Overall, studies showed that pharmacists, within an interdisciplinary team, had significant impacts on measured outcomes. CONCLUSIONS: In recent years, there have been advances in the role of the pharmacist in palliative care of patients with cancer and there are great opportunities in this field. They play an important role in managing cancer pain and other symptoms, as well as resolving drug related problems. We encourage more research to be carried out to strengthen this field and to benefit patients with advanced cancer with higher quality of life.

12.
Food Res Int ; 151: 110902, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34980419

RESUMEN

Latin America has a wide range of native plants spread through its territory. The palms of the Astrocaryum genus are examples of crops occurring in Central and South America, including the large plant life in Brazil. Although not very well known, the Astrocaryum spp. possess edible and non-edible fractions with potential technological and medicinal uses, as evidenced by recent research. Two native Brazilian fruits, tucumã-do-Amazonas (Astrocaryum aculeatum) and tucumã-do-Pará (Astrocaryum vulgare), typically found in the north and northeast of the country, respectively, stand out for their high antioxidant capacity and rich content in bioactive compounds, mainly carotenoids and phenolic compounds. Accordingly, experimental studies indicate their potential to prevent and treat inflammatory and oxidative stress-related conditions, including cancer. The tucumã plants have also been suggested as tools in the industry, for example for biofuel production, activated carbon technology, and as alternative packaging. Considering the importance of bringing light to underestimated yet culturally relevant native crops with potential benefits for small and large communities, this review aims to present and discuss the characteristics, bioactive composition, health effects, and technological potential of tucumã-do-Amazonas and tucumã-do-Pará fruits.

13.
Proc Natl Acad Sci U S A ; 119(2)2022 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-34983875

RESUMEN

Pacific Ocean tuna is among the most-consumed seafood products but contains relatively high levels of the neurotoxin methylmercury. Limited observations suggest tuna mercury levels vary in space and time, yet the drivers are not well understood. Here, we map mercury concentrations in skipjack tuna across the Pacific Ocean and build generalized additive models to quantify the anthropogenic, ecological, and biogeochemical drivers. Skipjack mercury levels display a fivefold spatial gradient, with maximum concentrations in the northwest near Asia, intermediate values in the east, and the lowest levels in the west, southwest, and central Pacific. Large spatial differences can be explained by the depth of the seawater methylmercury peak near low-oxygen zones, leading to enhanced tuna mercury concentrations in regions where oxygen depletion is shallow. Despite this natural biogeochemical control, the mercury hotspot in tuna caught near Asia is explained by elevated atmospheric mercury concentrations and/or mercury river inputs to the coastal shelf. While we cannot ignore the legacy mercury contribution from other regions to the Pacific Ocean (e.g., North America and Europe), our results suggest that recent anthropogenic mercury release, which is currently largest in Asia, contributes directly to present-day human mercury exposure.

14.
Int J Obes (Lond) ; 2022 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-34987203

RESUMEN

BACKGROUND: The structured days hypothesis posits that 'structured days' (i.e., days with pre-planned, segmented, and adult-supervised environments) reduce youth obesogenic behaviors. Structured days may be especially important for adolescents', as adolescence (12-19 years) is a period of developmental milestones and increased autonomy. Therefore, the objective of this systematic review and meta-analysis is to evaluate the relationship between structured days and adolescents' obesogenic behaviors (i.e., physical activity, diet, screen time, and/or sleep). METHODS: From February to April of 2020, four databases (i.e., Embase, PubMed, Web of Science, and PsychINfo) were searched for cross-sectional, longitudinal, and intervention (i.e., baseline data only) studies reporting obesogenic behaviors on more structured versus less structured days (i.e., weekday versus weekend or school year versus summer/holiday). RESULTS: A total of 42,878 unique titles and abstracts were screened with 2767 full-text articles retrieved. After review of full-text articles, 296 studies were identified (sleep k = 147, physical activity k = 88, screen time k = 81, diet k = 8). Most studies were conducted in North America, Europe & Central Asia, or East Asia & the Pacific used self-report measures and compared school days to weekend days. Meta-analyses indicated that adolescents' physical activity (standardized mean difference [SMD] = -0.25 [95%CI - 0.48, -0.03]) and screen time (SMD = -0.48 [95%CI - 0.66, -0.29]) were less healthy on less structured days. Differences did not reach statistical significance for sleep (SMD = -0.23 [95%CI - 0.48, 0.02]) and diet (SMD = -0.13 [95%CI - 0.77, 0.51]), however, sleep timing (SMD = -1.05 [95%CI - 1.31, -0.79]) and diet quantity (SMD = -0.29 [95%CI - 0.35, -0.23]) were less healthy on less structured days. The review identified studies with large heterogeneity. CONCLUSIONS: Findings indicate that adolescents' physical activity, screen time, sleep timing, and diet quantity are less healthy on less structured days. Interventions for adolescents to prevent and treat obesity may be more successful if they are designed to target times that are less structured.

15.
HIV Med ; 2022 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-35068053

RESUMEN

INTRODUCTION: HIV is still a central public health issue in Latin America, disproportionally affecting key populations. Knowledge and access to biomedical prevention strategies, including treatment as prevention (TASP) or undetectable = untransmissible (U=U), pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), are the first steps to increasing uptake. We used data from the Latin American MSM Internet Survey (LAMIS) to describe knowledge and access to biomedical HIV prevention strategies among gay, bisexual, transgender and other men who have sex with men (MSM) living in 18 Latin American countries. METHODS: We compared LAMIS data across countries and according to age categories using frequencies and percentages. We also used multivariable models to explore whether age, gender identity, sexual identity, steady partnership, HIV status and education were independently associated with outcomes. RESULTS: In all, 55 924 participants were included. Most were cisgender (99%) and identified as gay/homosexual (77%) or bisexual (17%). Schooling levels were very high, with 89% reporting highest attained education as tertiary level, university or post-graduation. In total, 16% had been previously diagnosed with HIV; of those, rates of undetectable viral load varied from 60% in Venezuela to 83% in Brazil. Overall, 54%, 54% and 52% of participants already knew about PEP, PrEP and U=U, respectively. Participants from Brazil and those aged between 26 and 55 years, living with diagnosed HIV and having a gay/homosexual identity had greater levels of awareness about biomedical prevention strategies. CONCLUSIONS: Our study highlights gaps in HIV prevention campaigns directed to MSM in Latin America resulting in low uptake of biomedical prevention methods.

16.
Plant Dis ; 2022 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-35072510

RESUMEN

Wheat stem rust has re-emerged as a serious disease caused by new variants of Puccinia graminis f. sp. tritici. Variants with significant virulences and broad geographical distribution (Africa, Central Asia, and Europe) include the Ug99 race group, race TTRTF, and TKTTF race group. Genetic analysis has placed isolates representing these critical new virulent races into 12 genetic groups that make up clades I to IV. Development of molecular diagnostic assay for these 12 genetic groups will be an important component of global surveillance efforts. A single-nucleotide polymorphism database was mined for candidate markers that would differentiate between these 12 genetic groups. Thirty-five candidate markers were screened and a core set of 17 markers were tested against a set of 94 isolates representing a broad range of genotypes and race phenotypes. This core set of markers were 100% accurate in identifying the 12 genetic groups for 52 isolates in clades I to IV and no false positives were observed with non-target isolates. The assay has built-in redundancy so that minor genetic changes, or errors in genotyping calling will not affect the accuracy of the results. This assay is also effective in identifying the genetic groups in clade V from Germany and Georgia, the three main subgroups in North American clade VI, and the clade VII consisting of race TTTTF found in North and South America. This assay provides a rapid diagnostic tool for both living and non-living samples for detecting these critical new race or race groups of P. graminis f. sp. tritici.

17.
Malar J ; 21(1): 17, 2022 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-34998402

RESUMEN

BACKGROUND: In South and Central America, Plasmodium malariae/Plasmodium brasilianum, Plasmodium vivax, Plasmodium simium, and Plasmodium falciparum has been reported in New World primates (NWP). Specifically in Costa Rica, the presence of monkeys positive to P. malariae/P brasilianum has been identified in both captivity and in the wild. The aim of the present study was to determine the presence of P. brasilianum, P. falciparum, and P. vivax, and the potential distribution of these parasites-infecting NWP from Costa Rica. METHODS: The locations with PCR (Polymerase Chain Reaction) positive results and bioclimatic predictors were used to construct ecological niche models based on a modelling environment that uses the Maxent algorithm, named kuenm, capable to manage diverse settings to better estimate the potential distributions and uncertainty indices of the potential distribution. RESULTS: PCR analysis for the Plasmodium presence was conducted in 384 samples of four primates (Howler monkey [n = 130], White-face monkey [n = 132], Squirrel monkey [n = 50], and red spider monkey [n = 72]), from across Costa Rica. Three Plasmodium species were detected in all primate species (P. falciparum, P. malariae/P. brasilianum, and P. vivax). Overall, the infection prevalence was 8.9%, but each Plasmodium species ranged 2.1-3.4%. The niche model approach showed that the Pacific and the Atlantic coastal regions of Costa Rica presented suitable climatic conditions for parasite infections. However, the central pacific coast has a more trustable prediction for malaria in primates. CONCLUSIONS: The results indicate that the regions with higher suitability for Plasmodium transmission in NWP coincide with regions where most human cases have been reported. These regions were also previously identified as areas with high suitability for vector species, suggesting that enzootic and epizootic cycles occur.


Asunto(s)
Alouatta , Ateles geoffroyi , Cebus capucinus , Malaria/veterinaria , Enfermedades de los Monos/epidemiología , Plasmodium/aislamiento & purificación , Saimiri , Animales , Costa Rica/epidemiología , Malaria/epidemiología , Malaria/parasitología , Enfermedades de los Monos/parasitología , Prevalencia , Especificidad de la Especie
18.
Parasit Vectors ; 15(1): 24, 2022 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-35022078

RESUMEN

Baylisascaris procyonis is a nematode parasite of the raccoon (Procyon lotor), and it can be responsible for a severe form of larva migrans in humans. This parasite has been reported from many countries all over the world, after translocation of its natural host outside its native geographic range, North America. In the period between January and August 2021, 21 raccoons were cage-trapped and euthanized in Tuscany (Central Italy), in the context of a plan aimed at eradicating a reproductive population of this non-native species. All the animals were submitted for necroscopic examination. Adult ascariids were found in the small intestine of seven raccoons (prevalence 33.3%). Parasites have been identified as B. procyonis based on both morphometric and molecular approaches. The aim of the present article is to report the first finding of this zoonotic parasite from Italy, highlighting the sanitary risks linked to the introduction of alien vertebrate species in new areas.


Asunto(s)
Infecciones por Ascaridida/veterinaria , Ascaridoidea/aislamiento & purificación , Mapaches/parasitología , Zoonosis/parasitología , Animales , Infecciones por Ascaridida/epidemiología , Infecciones por Ascaridida/parasitología , Femenino , Intestinos/parasitología , Especies Introducidas , Italia/epidemiología , Masculino , Zoonosis/epidemiología
19.
Heliyon ; 8(1): e08718, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35059516

RESUMEN

The development of acaricide resistance in ticks infesting cattle is a major problem in the livestock industry in tropical and subtropical regions worldwide. To determine the current global trends and prevalence of acaricide resistance development (ARD) in tick populations of cattle, a systematic review and meta-analysis with an emphasis on Rhipicephalus (Boophilus) microplus was conducted. Data searches from five English electronic databases yielded 88 journal articles published between 1992 and 2020. In total, 218 in - vitro bioassays were used to investigate 3939 tick populations of cattle; of these, the 57.6% that exhibited ARD were largely limited to South America (Brazil), Central America (Mexico), and Asia (India). A total of 3391 of these tick populations were R. (B.) microplus, of which 2013 exhibited ARD. Random effects meta-analyses indicated that the exhibition of ARD was higher in R. (B.) microplus (66.2%) than in other tick species. Global prevalence estimates of ARD in R. (B.) microplus vary as a function of geography, detection methods, and acaricide compounds. In general, high heterogeneity was noted among the studies. However, homogeneity was observed among studies from India, suggesting the establishment of acaricide resistance in Indian R. (B.) microplus populations. Current tick control interventions are urgently required to limit the evolution and implications of resistance development.

20.
Cochrane Database Syst Rev ; 1: CD002990, 2022 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-35001366

RESUMEN

BACKGROUND: Self-management interventions help people with chronic obstructive pulmonary disease (COPD) to acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable them to control their disease. Since the 2014 update of this review, several studies have been published. OBJECTIVES: Primary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of health-related quality of life (HRQoL) and respiratory-related hospital admissions. To evaluate the safety of COPD self-management interventions compared to usual care in terms of respiratory-related mortality and all-cause mortality. Secondary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of other health outcomes and healthcare utilisation. To evaluate effective characteristics of COPD self-management interventions. SEARCH METHODS: We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, EMBASE, trials registries and the reference lists of included studies up until January 2020. SELECTION CRITERIA: Randomised controlled trials (RCTs) and cluster-randomised trials (CRTs) published since 1995. To be eligible for inclusion, self-management interventions had to include at least two intervention components and include an iterative process between participant and healthcare provider(s) in which goals were formulated and feedback was given on self-management actions by the participant. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. We contacted study authors to obtain additional information and missing outcome data where possible. Primary outcomes were health-related quality of life (HRQoL), number of respiratory-related hospital admissions, respiratory-related mortality, and all-cause mortality. When appropriate, we pooled study results using random-effects modelling meta-analyses. MAIN RESULTS: We included 27 studies involving 6008 participants with COPD. The follow-up time ranged from two-and-a-half to 24 months and the content of the interventions was diverse. Participants' mean age ranged from 57 to 74 years, and the proportion of male participants ranged from 33% to 98%. The post-bronchodilator forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of participants ranged from 33.6% to 57.0%. The FEV1/FVC ratio is a measure used to diagnose COPD and to determine the severity of the disease. Studies were conducted on four different continents (Europe (n = 15), North America (n = 8), Asia (n = 1), and Oceania (n = 4); with one study conducted in both Europe and Oceania). Self-management interventions likely improve HRQoL, as measured by the St. George's Respiratory Questionnaire (SGRQ) total score (lower score represents better HRQoL) with a mean difference (MD) from usual care of -2.86 points (95% confidence interval (CI) -4.87 to -0.85; 14 studies, 2778 participants; low-quality evidence). The pooled MD of -2.86 did not reach the SGRQ minimal clinically important difference (MCID) of four points. Self-management intervention participants were also at a slightly lower risk for at least one respiratory-related hospital admission (odds ratio (OR) 0.75, 95% CI 0.57 to 0.98; 15 studies, 3263 participants; very low-quality evidence). The number needed to treat to prevent one respiratory-related hospital admission over a mean of 9.75 months' follow-up was 15 (95% CI 8 to 399) for participants with high baseline risk and 26 (95% CI 15 to 677) for participants with low baseline risk. No differences were observed in respiratory-related mortality (risk difference (RD) 0.01, 95% CI -0.02 to 0.04; 8 studies, 1572 participants ; low-quality evidence) and all-cause mortality (RD -0.01, 95% CI -0.03 to 0.01; 24 studies, 5719 participants; low-quality evidence). We graded the evidence to be of 'moderate' to 'very low' quality according to GRADE. All studies had a substantial risk of bias, because of lack of blinding of participants and personnel to the interventions, which is inherently impossible in a self-management intervention. In addition, risk of bias was noticeably increased because of insufficient information regarding a) non-protocol interventions, and b) analyses to estimate the effect of adhering to interventions. Consequently, the highest GRADE evidence score that could be obtained by studies was 'moderate'. AUTHORS' CONCLUSIONS: Self-management interventions for people with COPD are associated with improvements in HRQoL, as measured with the SGRQ, and a lower probability of respiratory-related hospital admissions. No excess respiratory-related and all-cause mortality risks were observed, which strengthens the view that COPD self-management interventions are unlikely to cause harm. By using stricter inclusion criteria, we decreased heterogeneity in studies, but also reduced the number of included studies and therefore our capacity to conduct subgroup analyses. Data were therefore still insufficient to reach clear conclusions about effective (intervention) characteristics of COPD self-management interventions. As tailoring of COPD self-management interventions to individuals is desirable, heterogeneity is and will likely remain present in self-management interventions. For future studies, we would urge using only COPD self-management interventions that include iterative interactions between participants and healthcare professionals who are competent using behavioural change techniques (BCTs) to elicit participants' motivation, confidence and competence to positively adapt their health behaviour(s) and develop skills to better manage their disease. In addition, to inform further subgroup and meta-regression analyses and to provide stronger conclusions regarding effective COPD self-management interventions, there is a need for more homogeneity in outcome measures. More attention should be paid to behavioural outcome measures and to providing more detailed, uniform and transparently reported data on self-management intervention components and BCTs. Assessment of outcomes over the long term is also recommended to capture changes in people's behaviour. Finally, information regarding non-protocol interventions as well as analyses to estimate the effect of adhering to interventions should be included to increase the quality of evidence.

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