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1.
Recurso Educacional Abierto en Español | CVSP - Regional | ID: oer-3929

RESUMEN

Tutorial instructivo sobre cómo registrar estrategias de búsqueda en el Repositorio de estrategias de búsqueda de la BVS. Especialmente para países de América Latina y el Caribe. (versión en español)


Asunto(s)
Bibliotecas Digitales
2.
Trab. educ. saúde ; 19: e00310142, jan. 2021. tab
Artículo en Español | LILACS | ID: biblio-1139808

RESUMEN

Resumen América Latina se ha convertido en uno de los epicentros de la pandemia de Covid-19, con una crisis sanitaria y humanitaria. El objetivo del artículo es analizar las medidas para enfrentar la pandemia en países de la Región y el rol de la Atención Primaria de Salud, discutiendo obstáculos y potencialidades. Son analizados los casos de Bolivia, Brasil, Chile, Colombia, Cuba, Uruguay y Venezuela. Los siete países adoptaran medidas de aislamiento social de diferentes alcances, con grados distintos de sostenibilidad. El énfasis de las respuestas estuvo más en la atención hospitalaria que en la vigilancia de la salud, identificación de casos y contactos y disposición de condiciones adecuadas para el confinamiento. En casi todos los países, se subestimó la capacidad de los servicios de atención primária en el territorio. No obstante, iniciativas de enfoque territorial y comunitario buscaron integrar la vigilancia de la salud con actividades de promoción, prevención y cuidado, aunque con alcance parcial. En este contexto la Atención Primaria Integral e integrada toma nuevo sentido y reclama desarrollos que contribuyan a recobrar el equilibrio entre sociedad y medio ambiente. Es necesario repensar los sistemas de salud y la importancia de la atención primaria de salud integrada e integral.


Abstract Latin America has become one of the epicenters of the COVID-19 pandemic, with a health and humanitarian crisis. The objective of the article is to analyze the strategies implemented by countries in the Region to face the pandemic and the role of Primary Health Care, considering obstacles and potential. The cases of Bolivia, Brazil, Chile, Colombia, Cuba, Uruguay and Venezuela were analyzed. The seven countries have adopted diverse social distancing strategies with varying degrees of sustainability. The responses emphasized hospital care more than surveillance, case identification, contact tracking, and enabling adequate conditions for isolation. In almost all cases studied, the capacity of primary care services in the territory was underestimated. Even so, primary care initiatives with a territorial and community focus sought to integrate health surveillance with promotion, prevention and care, despite partial implementation. In this context, comprehensive and integrated primary care takes on new meaning and requires new developments in order to contribute to the recovery of the balance between society and the environment. The pandemic showed the need to rethink health care systems and the importance of primary care for comprehensive and integrated health.


Resumo A América Latina tornou-se um dos epicentros da pandemia de Covid-19, com uma crise sanitária e humanitária. O objetivo do artigo é analisar as estratégias implementadas por países da Região para enfrentar a pandemia e o papel da Atenção Primária à Saúde, ponderando obstáculos e potencialidades. Foram analisados os casos de Bolívia, Brasil, Chile, Colômbia, Cuba, Uruguai e Venezuela. Os sete países adotaram estratégias de distanciamento social diversas com diferentes graus de sustentabilidade. As respostas enfatizaram mais a assistência hospitalar do que a vigilância, a identificação de casos, o rastreamento dos contatos e a viabilização de condições adequadas para isolamento. Em quase todos os casos estudados, foi subestimada a capacidade dos serviços de atenção primária no território. Ainda assim, iniciativas de atenção primária com enfoque territorial e comunitário buscaram integrar a vigilância à saúde com a promoção, prevenção e cuidado, apesar de implantação parcial. Nesse contexto, uma atenção primária integral e integrada adquire novo significado e requisita novos desenvolvimentos de forma a contribuir para a recuperação do equilíbrio entre a sociedade e o meio ambiente. A pandemia mostrou a necessidade de repensar os sistemas de atenção à saúde e a importância da atenção primária à saúde integral e integrada.


Asunto(s)
Humanos , Atención Primaria de Salud , Sistemas de Salud , Infecciones por Coronavirus , Vigilancia en Salud Pública
3.
BMC Infect Dis ; 21(1): 40, 2021 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-33421991

RESUMEN

BACKGROUND: COVID-19 studies are primarily from the inpatient setting, skewing towards severe disease. Race and comorbidities predict hospitalization, however, ambulatory presentation of milder COVID-19 disease and characteristics associated with progression to severe disease is not well-understood. METHODS: We conducted a retrospective chart review including all COVID-19 positive cases from Stanford Health Care (SHC) in March 2020 to assess demographics, comorbidities and symptoms in relationship to: 1) their access point of testing (outpatient, inpatient, and emergency room (ER)) and 2) development of severe disease. RESULTS: Two hundred fifty-seven patients tested positive: 127 (49%), 96 (37%), and 34 (13%) at outpatient, ER and inpatient, respectively. Overall, 61% were age < 55; age > 75 was rarer in outpatient setting (11%) than ER (14%) or inpatient (24%). Most patients presented with cough (86%), fever/chills (76%), or fatigue (63%). 65% of inpatients reported shortness of breath compared to 30-32% of outpatients and ER patients. Ethnic/minority patients had a significantly higher risk of developing severe disease (Asian OR = 4.8 [1.6-14.2], Hispanic OR = 3.6 [1.1-11.9]). Medicare-insured patients were marginally more likely (OR = 4.0 [0.9-17.8]). Other factors associated with developing severe disease included kidney disease (OR = 6.1 [1.0-38.1]), cardiovascular disease (OR = 4.7 [1.0-22.1], shortness of breath (OR = 5.4 [2.3-12.6]) and GI symptoms (OR = 3.3 [1.4-7.7]; hypertension without concomitant CVD or kidney disease was marginally significant (OR = 2.3 [0.8-6.5]). CONCLUSIONS: Early widespread symptomatic testing for COVID-19 in Silicon Valley included many less severely ill patients. Thorough manual review of symptomatology reconfirms the heterogeneity of COVID-19 symptoms, and challenges in using clinical characteristics to predict decline. We re-demonstrate that socio-demographics are consistently associated with severity.


Asunto(s)
/epidemiología , Adulto , Anciano , Grupo de Ascendencia Continental Asiática , /etnología , Comorbilidad , Tos , Disnea , Grupos Étnicos , Femenino , Fiebre , Accesibilidad a los Servicios de Salud , Hispanoamericanos , Hospitalización , Humanos , Masculino , Medicare , Persona de Mediana Edad , Grupos Minoritarios , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Estados Unidos
4.
Int J Qual Health Care ; 33(Supplement_1): 45-50, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-33432981

RESUMEN

BACKGROUND: The importance of human factors/ergonomics (HFE) is well established in all high-reliability systems but only applied in the healthcare sector relatively recently. Across many sectors, low-/middle-income countries (LMICs) lag behind more economically developed countries in their application of this safety science, due to resource and, in some cases, awareness and expertise. Most previous applications of HFE related to occupational ergonomics rather than healthcare safety. METHODS: The paper details how the reputation of HFE is being developed within healthcare communities of Latin America (LatAm), through increasing awareness and understanding of its role as safety science in the healthcare sector. It starts by articulating the need for HFE and then provides examples from Mexico, Colombia and Peru. RESULTS: The practical examples for research and education illustrate a developing awareness of the relevance of HFE to the healthcare sectors in LatAm and an appreciation of its worth to improve health service quality and patient safety through healthcare community engagement. A new LatAm Network of HFE in Healthcare Systems (RELAESA) was formed in 2019, which has provided a platform for HFE advice during the COVID-19 pandemic. CONCLUSION: There is a real opportunity in LatAm and other LMIC health services to make more rapid and sustainable progress in healthcare-embedded HFE than has been experienced within healthcare services of more developed nations.


Asunto(s)
Ergonomía/métodos , Seguridad del Paciente , Calidad de la Atención de Salud , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Humanos , América Latina
5.
Womens Health Issues ; 31(1): 65-74, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33234388

RESUMEN

INTRODUCTION: Prior research has found that some preconception health risks are more prevalent among women in historically minoritized racial and ethnic groups. Preconception health risks are also increased among women with disabilities. Risks could be even greater among women who both have a disability and belong to a minoritized racial or ethnic group. The purpose of this study was to assess preconception health at the intersection of disability and race or ethnicity. METHODS: We analyzed data from the 2016 Behavioral Risk Factor Surveillance System to estimate the prevalence of health behaviors, health status indicators, and preventive healthcare receipt among nonpregnant women 18-44 years of age. We used modified Poisson regression to compare non-Hispanic White women with disabilities and women with and without disabilities in three other race/ethnicity groups (non-Hispanic Black, Hispanic, other race) to a reference group of non-Hispanic White women without disabilities. Disability status was defined based on affirmative response to at least one of six questions about difficulty with seeing, hearing, mobility, cognition, personal care, or independent living tasks. Multivariate analyses adjusted for other sociodemographic characteristics such as age and marital status. RESULTS: In every racial and ethnic group, women with disabilities had a significantly higher prevalence of most preconception health risks than their counterparts without disabilities. The disparity in obesity for Black women with disabilities was additive, with the adjusted prevalence ratio (PR, 1.77; 95% confidence interval [CI], 1.57-2.00) equal to the sum of the prevalence ratios for disability alone (PR, 1.29; 95% CI, 1.19-1.41) and Black race alone (PR, 1.47; 95% CI, 1.36-1.58). CONCLUSIONS: Women at the intersection of disability and minoritized race or ethnicity may be at especially high risk of adverse outcomes. Targeted efforts are needed to improve the health of women of reproductive age in these doubly marginalized populations.


Asunto(s)
Personas con Discapacidad , Grupos Étnicos , Adolescente , Adulto , Afroamericanos , Femenino , Hispanoamericanos , Humanos , Atención Preconceptiva , Embarazo , Estados Unidos/epidemiología , Adulto Joven
6.
J Surg Res ; 257: 246-251, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32862052

RESUMEN

BACKGROUND: Training diverse house staff, including those who are underrepresented in medicine, is vital to provide high-quality patient care for the communities that we serve. In 2018, the Accreditation Council for Graduate Medical Education announced new common program requirements for systematic efforts to recruit and retain a diverse workforce. However, questions remain about how to implement such efforts. MATERIALS AND METHODS: Electronic Residency Application Service (ERAS) data from eight residency programs spanning two recruitment cycles (2017-2018, 2018-2019) was reviewed. The number of candidates at each stage in the process (applicant, invited to interview, interviewed, and matched) was examined by self-identified race or ethnicity. These data were presented to residency program directors at our Graduate Medical Education committee meeting before the next recruitment cycle. Data were analyzed following the 2019-20 residency match. Odds ratios and Pearson's chi-squared test were used to assess statistical significance. RESULTS: A total of 10,445 and 10,982 medical students applied to our 8 core residency programs in 2017 and 2018, respectively. Medical students who applied and self-identified as Asian, Black or African American, and Hispanic or Latino or Spanish origin had lower odds of being invited to interview than those who self-identified as White. After data presentation, the odds of inviting Black or African American applicants to interview increased significantly. The odds of attending an interview once invited were the same across groups. CONCLUSIONS: Sharing ERAS data patterns with residency program directors was associated with a significant year over year change in interviewee diversity. Structured analysis of institutional ERAS data can provide insight into the resident selection process and may be a useful tool to improve house staff diversity.


Asunto(s)
Diversidad Cultural , Fuerza Laboral en Salud/organización & administración , Internado y Residencia/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Selección de Personal/organización & administración , Estudiantes de Medicina/estadística & datos numéricos , Afroamericanos/estadística & datos numéricos , Americanos Asiáticos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Estudios de Factibilidad , Fuerza Laboral en Salud/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Humanos , Internado y Residencia/organización & administración , Solicitud de Empleo , Selección de Personal/estadística & datos numéricos , Estados Unidos
7.
Cultur Divers Ethnic Minor Psychol ; 27(1): 47-59, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32804521

RESUMEN

OBJECTIVE: The Brief Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CVB) is a widely used, multidimensional measure of exposure to ethnic/racial discrimination. The PEDQ-CVB has not been previously validated for use with American Indians, who have endured a unique history of colonization, cultural oppression, and ongoing discrimination. This study examined the measurement invariance of the PEDQ-CVB in American Indians (AIs) and 4 other groups. Additional analyses assessed the scale's convergent and discriminant validity and provided initial evidence of associations with mental and physical health in AIs. METHOD: Primary data were collected from a community sample of urban-dwelling AIs (n = 222), which included measures of ethnic/racial identity, other life stressors, and mental and physical health, along with the PEDQ-CVB. These were supplemented by secondary analysis of PEDQ-CVB data from African Americans (n = 1176), Latinos (n = 564), East Asian Americans (n = 274), and South Asian Americans (n = 242). RESULTS: The PEDQ-CVB demonstrated measurement invariance across the 5 ethnic/racial groups and convergent and discriminant validity in AIs. The PEDQ-CVB was significantly associated with depressive symptoms and physical limitations in AIs, after controlling for relevant demographics. CONCLUSION: This study provides strong evidence that the PEDQ-CVB behaves consistently for AIs and other underrepresented ethnic/racial groups. As such, the PEDQ-CVB allows for documentation of the experiences of different ethnic/racial groups and provides a means to test theoretical models of the antecedents and consequences of perceived discrimination within and across groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Asunto(s)
Racismo , Afroamericanos , Grupos Étnicos , Hispanoamericanos , Humanos , Encuestas y Cuestionarios , Estados Unidos
8.
Environ Sci Pollut Res Int ; 28(2): 1656-1674, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32845465

RESUMEN

The impact of renewable energy consumption on reducing the outdoor air pollution death rate, in nineteen Latin America & the Caribbean countries, from 1990 to 2016, using the econometric technique of quantile regression for panel data, was researched. Results show that economic growth and fossil fuel consumption are positively related to CO2 emissions, while renewable energy consumption bears a negative relationship with it. Furthermore, fossil fuel consumption has a positive impact on the mortality rate and economic growth a negative one. The negative effect of renewable energy consumption on the mortality rate is only observable on the right tail of its distribution. The modelisation reveals two ways in which the consumption of renewable energy can reduce the outdoor air pollution death rates: (i) directly, by increasing renewable energies, and (i) indirectly because the increase in the consumption of renewable energies implies a decrease in the consumption of energy from fossil fuels. The phenomenon of increasing urbanisation is a point where the action of public policymakers is decisive for the reduction of outdoor air pollution death rates. Here, the question is not to reduce the level of urbanisation but to act on the "quality" of urbanisation, to make cities healthier. The research concludes that public policymakers must focus on intensifying the transition from fossil to renewable energies and improving the quality of cities.


Asunto(s)
Contaminación del Aire , Dióxido de Carbono , Contaminación del Aire/análisis , Contaminación del Aire/prevención & control , Dióxido de Carbono/análisis , Región del Caribe , Desarrollo Económico , América Latina , Energía Renovable
9.
Pediatr Infect Dis J ; 40(1): e1-e6, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33055501

RESUMEN

BACKGROUND: To date, there are no comprehensive data on pediatric COVID-19 from Latin America. This study aims to assess COVID-19 and Multisystem Inflammatory Syndrome (MIS-C) in Latin American children, to appropriately plan and allocate resources to face the pandemic on a local and international level. METHODS: Ambispective multicenter cohort study from 5 Latin American countries. Children 18 years of age or younger with microbiologically confirmed SARS-CoV-2 infection or fulfilling MIS-C definition were included. FINDINGS: Four hundred nine children were included, with a median age of 3.0 years (interquartile range 0.6-9.0). Of these, 95 (23.2%) were diagnosed with MIS-C. One hundred ninety-one (46.7%) children were admitted to hospital and 52 (12.7%) required admission to a pediatric intensive care unit. Ninety-two (22.5%) patients required oxygen support: 8 (2%) were started on continuous positive airway pressure and 29 (7%) on mechanical ventilation. Thirty-five (8.5%) patients required inotropic support. The following factors were associated with pediatric intensive care unit admission: preexisting medical condition (P < 0.0001), immunodeficiency (P = 0.01), lower respiratory tract infection (P < 0.0001), gastrointestinal symptoms (P = 0.006), radiologic changes suggestive of pneumonia and acute respiratory distress syndrome (P < 0.0001) and low socioeconomic conditions (P = 0.009). CONCLUSIONS: This study shows a generally more severe form of COVID-19 and a high number of MIS-C in Latin American children, compared with studies from China, Europe and North America, and support current evidence of a more severe disease in Latin/Hispanic children or in people of lower socioeconomic level. The findings highlight an urgent need for more data on COVID-19 in Latin America.


Asunto(s)
/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/patología , Adolescente , /terapia , Niño , Preescolar , Estudios de Cohortes , Cuidados Críticos , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , América Latina/epidemiología , Masculino , Factores de Riesgo , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/terapia
10.
Einstein (Säo Paulo) ; 19: eAO6282, 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1142886

RESUMEN

ABSTRACT Objective Since the rising of coronavirus disease 2019 (COVID-19) pandemic, there is uncertainty regarding the impact of transmission to cancer patients. Evidence on increased severity for patients undergoing antineoplastic treatment is posed against deferring oncologic treatment. We aimed to evaluate the impact of COVID-19 pandemic on patient volumes in a cancer center in an epicenter of the pandemic. Methods Outpatient and inpatient volumes were extracted from electronic health record database. Two intervals were compared: pre-COVID-19 (March to May 2019) and COVID-19 pandemic (March to May 2020) periods. Results The total number of medical appointments declined by 45% in the COVID-19 period, including a 56.2% decrease in new visits. There was a 27.5% reduction in the number of patients undergoing intravenous systemic treatment and a 57.4% decline in initiation of new treatments. Conversely, there was an increase by 309% in new patients undergoing oral chemotherapy regimens and a 5.9% rise in new patients submitted to radiation therapy in the COVID-19 period. There was a 51.2% decline in length of stay and a 60% reduction in the volume of surgical cases during COVID-19. In the stem cell transplant unit, we observed a reduction by 36.5% in length of stay and a 62.5% drop in stem cell transplants. Conclusion A significant decrease in the number of patients undergoing cancer treatment was observed after COVID-19 pandemic. Although this may be partially overcome by alternative therapeutic options, avoiding timely health care due to fear of getting COVID-19 infection might impact on clinical outcomes. Our findings may help support immediate actions to mitigate this hypothesis.


RESUMO Objetivo Desde o surgimento da pandemia da doença pelo coronavírus 2019 (COVID-19), há incerteza quanto ao impacto da transmissão para pacientes com câncer. As evidências sobre o aumento da gravidade para pacientes submetidos a tratamento antineoplásico são contra o adiamento do tratamento oncológico. Nosso objetivo foi avaliar o impacto da pandemia de COVID-19 em volumes de pacientes em um centro oncológico, em um epicentro da pandemia. Métodos Os volumes de pacientes ambulatoriais e de internação foram extraídos do banco de dados de prontuários eletrônicos. Dois intervalos foram comparados: períodos pré-COVID-19 (março a maio de 2019) e pandemia COVID-19 (março a maio de 2020). Resultados O número total de consultas médicas diminuiu 45% no período pandemia COVID-19, inclusive com redução de 56,2% nas novas consultas. Houve redução de 27,5% no número de pacientes em tratamento sistêmico intravenoso e de 57,4% no início de novos tratamentos. Por outro lado, ocorreram aumento de 309% em novos pacientes submetidos a regimes de quimioterapia oral e elevação de 5,9% em novos pacientes submetidos à radioterapia no período pandemia COVID-19. Observaram-se queda de 51,2% nos dias de internação e redução de 60% no volume de casos cirúrgicos durante a COVID-19. Na unidade de transplante de células-tronco, a redução foi de 36,5% nos dias de internação e de 62,5% nos transplantes de células-tronco. Conclusão Foi observado declínio significativo no número de pacientes em tratamento de câncer após a pandemia de COVID-19. Embora isso possa ser parcialmente superado por opções terapêuticas alternativas, evitar cuidados de saúde oportunos devido ao medo de contrair COVID-19 pode impactar nos resultados clínicos. Nossos resultados podem ajudar a apoiar ações imediatas para mitigar essa hipótese.

11.
J Environ Manage ; 278(Pt 2): 111543, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33157467

RESUMEN

Protected areas (PAs) are dedicated and managed to achieve long-term conservation of nature with associated ecosystem services and cultural values. However, few studies have assessed contamination/pollution, one of the top five biodiversity threats, within these areas. In fact, more than 100,000 molecules used in consumer goods are potentially affecting over 250,000 protected areas distributed worldwide. As a result, chemical appraisal within PAs require specific approaches to be feasible. Herein, an approach for assessment of contamination in marine protected areas (MPAs) spread over large continental and/or global areas was proposed and tested using, as a case study, the impact of tributyltin (TBT) within Latin America. This approach included area delimitation, bibliographic survey, construction of attribute tables, data insertion in a Geographic Information System, overlapping with worldwide shapefiles of PAs, identification of affected PAs and evaluation of impacts using the outcomes against specific environmental quality guidelines/directives. A total of 259 records of TBT occurrence and/or its biological effect within 53 marine protected areas (including biosphere reserves, Ramsar sites and National parks) were gathered. Among affected species, were recorded 18 gastropods exhibiting imposex. In addition, 6 bivalves, 1 crustacean, and 3 fish species presenting TBT residues in tissues were seen in MPAs from Brazil, Argentina, Ecuador, Peru, Chile and Venezuela. Since levels of TBT recorded in several studied MPAs were enough do induce deleterious biological responses over marine biota, it was clear that conservancy goals of some "protected" areas are under threat. Considering that only TBT exposure was appraised, and these areas are likely to be concomitantly exposed to other classes of contaminants, the actual scenario can be even more frightening. Although initially applied as a TBT case study, the present approach enables an overview for other chemicals within protected areas worldwide.


Asunto(s)
Ecosistema , Contaminantes Químicos del Agua , Animales , Argentina , Brasil , Chile , Ecuador , Monitoreo del Ambiente , América Latina , Perú , Compuestos de Trialquiltina , Venezuela , Contaminantes Químicos del Agua/análisis
12.
J Surg Res ; 257: 486-492, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32916501

RESUMEN

BACKGROUND: There are well-documented disparities in outcomes for injured Black and Hispanic patients in the United States. However, patient level characteristics cannot fully explain the differences in outcomes and system-level factors, including the trauma center designation of the hospital to which a patient presents, may contribute to their worse outcomes. We aim to determine if Black and Hispanic patients are more likely to be undertriaged, compared with white patients. METHODS: This is a retrospective, cross-sectional, population-based study that uses data from the 2014 Agency for Healthcare Research and Quality Healthcare Costs and Utilization Project State Inpatient Databases. We included data from all states with available State Inpatient Databases data that included both race and hospital characteristics needed for analysis (n = 18). Logistic regression was used to identify predictors of severely injured (Injury Severity Score ≥16) patients being brought to a trauma center. RESULTS: We identified 70,970 severely injured trauma patients with complete data. Non-Hispanic White represented 74.1% of the study population, 9.8% were non-Hispanic Black, and 9.7% were Hispanic. After adjustment for other demographic and injury characteristics, Non-Hispanic Black and Hispanic patients were more likely to be undertriaged, compared with white patients (odds ratio, 1.20; 95% confidence interval, 1.12-1.29 and odds ratio, 1.39; 95% confidence interval, 1.29-1.48, respectively). Male sex and older age were associated with higher odds of undertriage, whereas urban residence, high injury severity, and penetrating injury were associated with lower odds of undertriage. CONCLUSIONS: Severely injured Black and Hispanic trauma patients are more likely to be undertriaged than otherwise similar white patients. The factors that contribute to racial and ethnic disparities in receiving trauma center care need to be identified and addressed to provide equitable trauma care.


Asunto(s)
Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Hispanoamericanos/estadística & datos numéricos , Triaje/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto Joven
13.
Womens Health Issues ; 31(1): 75-81, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33069559

RESUMEN

INTRODUCTION: Racial and ethnic disparities in rates of maternal morbidity and mortality in the United States are striking and persistent. Despite evidence that variation in the quality of care contributes substantially to these disparities, we do not sufficiently understand how experiences of perinatal care differ by race and ethnicity among women with severe maternal morbidity. METHODS: We conducted focus groups with women who experienced a severe maternal morbidity event in a New York City hospital during their most recent pregnancy (n = 20). We organized three focus groups by self-identified race/ethnicity ([1] Black, [2] Latina, and [3] White or Asian) to detect any within- and between-group differences. Discussions were audiotaped and transcribed. The research team coded the transcripts and used content analysis to identify key themes and to compare findings across racial and ethnic groups. RESULTS: Participants reported distressing experiences and lasting emotional consequences after having a severe childbirth complication. Many women appreciated the life-saving care they received. However, poor continuity of care, communication gaps, and a perceived lack of attentiveness to participants' physical and emotional needs led to substantial concern and disappointment in care. Black and Latina women in particular emphasized these themes. CONCLUSIONS: This study highlights missed opportunities for improved clinician communication and continuity of care to address emotional trauma when severe obstetric complications occur, particularly for Black and Latina women. Enhancing communication to ensure that women feel heard and informed throughout the birth process and addressing implicit bias, as a part of the more systemic issue of institutionalized racism, could both decrease disparities in obstetric care quality and improve the patient experience for women of all races and ethnicities.


Asunto(s)
Grupos Étnicos , Periodo Periparto , Afroamericanos , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Ciudad de Nueva York , Embarazo , Estados Unidos
14.
Environ Pollut ; 269: 116194, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33288292

RESUMEN

The present study is a literature-based analysis investigating occurrence and the possible consequences of polycyclic aromatic hydrocarbons (PAH) in marine protected areas (MPAs) of Latin America and Caribbean. The approach using overlapping of georeferenced MPA polygons with data compiled from peer-reviewed literature, published during the last 15 years, showed 341 records of PAH in 9 countries. PAH was reported to occur within the boundaries of 36 MPAs located in Argentina, Brazil, Colombia, Mexico, Nicaragua and Uruguay. According to quality guidelines, low to moderate impacts are expected in MPAs categorized in different management classes. Considering sediment samples, 13% of the records presented concentrations enough to cause occasional toxicity. Such level of risk was also seen in Ramsar sites and in Amazonian MPAs. In addition, based on concentrations reported in biota, occasional deleterious effects on organisms from Biosphere Reserves might occur. Diagnostic ratios pointed out petrogenic and pyrolytic processes as PAH predominant sources, and were mainly attributed to the proximity to ports, industries and urban areas. MPAs located in the vicinity of impact-generating areas may be under threat and require government attention and action, mainly through implementation of contamination monitoring programs.


Asunto(s)
Hidrocarburos Policíclicos Aromáticos , Contaminantes Químicos del Agua , Argentina , Brasil , Región del Caribe , Colombia , Monitoreo del Ambiente , Sedimentos Geológicos , América Latina , México , Hidrocarburos Policíclicos Aromáticos/análisis , Uruguay , Contaminantes Químicos del Agua/análisis
16.
Ann Epidemiol ; 53: 56-62.e2, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32927056

RESUMEN

PURPOSE: To evaluate associations between counties' COVID-19 cases and racial-ethnic and nativity composition, considering heterogeneity across Latin American-origin subgroups and regions of the United States. METHODS: Using county-level data and multilevel negative binomial models, we evaluate associations between COVID-19 cases and percentages of residents that are foreign-born, Latinx, Black, or Asian, presenting estimates for all counties combined and stratifying across regions. Given varying risk factors among Latinx, we also evaluate associations for percentages of residents from specific Latin American-origin groups. RESULTS: Percentage of foreign-born residents is positively associated with COVID-19 case rate (IRR = 1.106; 95% CI: 1.074-1.139). Adjusted associations for percentage Latinx are nonsignificant for all counties combined, but this obscures heterogeneity. Counties with more Central Americans have higher case rates (IRR = 1.130; 95% CI: 1.067-1.197). And, in the Northeast and Midwest, counties with more Puerto Ricans have higher case rates. Associations with percentage Asians are nonsignificant after adjusting for percentage foreign-born. With the confirmation of prior evidence, the percentage of Black residents is positively and robustly associated with COVID-19 case rate (IRR = 1.031; 95% CI: 1.025-1.036). CONCLUSIONS: Counties with more immigrants, as well as more Central American or Black residents, have more COVID-19 cases. In the Northeast and Midwest, counties with more Puerto Rican residents also have more COVID-19 cases.


Asunto(s)
/etnología , Emigrantes e Inmigrantes/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/etnología , Características de la Residencia/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Gobierno Local , Masculino , Persona de Mediana Edad , Pandemias , Clase Social , Estados Unidos/epidemiología , Adulto Joven
18.
Soc Sci Med ; 268: 113554, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33308911

RESUMEN

OBJECTIVES: To quantify the contribution variation in socioeconomic status in predicting the distribution of COVID-19 cases and deaths. METHODS: Analyses used incidence data on daily COVID + case counts from all counties from the initial wave of infections, merged with data from the U.S. census data to measure county-level SES and confounders. Multivariable analyses relied on survival analyses and Poisson regression to examine timing of county-level index cases and of COVID-19 incidence and mortality in infected counties to examine the spread and severity of COVID-19 while adjusting for adjusted for Black race, Hispanic ethnicity, age, gender, and urbanicity. Effect moderation by social distancing parameters was examined. RESULTS: Results indicate that higher SES was associated with earlier incidence of index cases, but that as social distancing took place inequalities in SES inverted so that growth in incidence was slower in higher SES counties, where case-fatality rates were lower. CONCLUSIONS: This study is the first to date to show what happens when an opportunistic disease that could affect anyone meets the American system of inequality and is powerfully shaped by it.


Asunto(s)
/epidemiología , Disparidades en el Estado de Salud , Afroamericanos/estadística & datos numéricos , Anciano , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Incidencia , Masculino , Factores Socioeconómicos , Estados Unidos/epidemiología
20.
Recurso de Internet en Inglés, Español, Portugués | LIS - Localizador de Información en Salud | ID: lis-48006

RESUMEN

Na América Latina, o número de novos casos de infecção por HIV registrou aumento de 21% de 2010 a 2019, segundo informações divulgadas nesta segunda-feira (30) pela Organização Pan-Americana da Saúde (OPAS). Enquanto isso, as mortes por doenças relacionadas à aids diminuíram 8% na última década. Em comparação, no Caribe caíram 37%.


Asunto(s)
América Latina , VIH , Enfermedades de Transmisión Sexual
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