Resultados parciales de condiciones clínicas en pacientes con aneurisma de aorta abdominal (AAA), intervenidos en un hospital de tercer nivel. Bogotá

Identificar condiciones clínicas de los pacientes con Aneurisma de Aorta Abdominal (AAA), intervenidas en un hospital de tercer nivel.Estudio retrospectivo longitudinal, muestreo no probabilístico de tipo censal.La localización más común de AAA fue en el segmento infrarrenal. La hipertensión arterial, EPOC y afecciones cardiacas representaron el 88% de las patologías asociadas y los ateromas, ACV isquémico, nefropatías, coagulopatia y diabetes el 12% de las patologías restantes, 29 pacientes (67%) presentaron masa abdominal alexamen; mortalidad global 35%.Los factores de riesgo están relacionados a la patología de AAA, los pacientes mayores de 70 años fueron el grupo con mayor riesgo en este estudio 67%, se evidenció mortalidad en 15 pacientes.Existe una estrecha asociación clínica entre la enfermedad coronaria y AAA, se confirmó la correlación entre factores de riesgo y AAA la enfermedad ateroesclerótica, edad avanzada, consumo de tabaco, sexo masculino e hipertensión arterial

Measuring the health-related Sustainable Development Goals in 188 countries : a baseline analysis from the Global Burden of Disease Study 2015

Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.2), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the non-MDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Peer reviewe

Estonian Vunimano I Hackathon collected interviews 05.-07.10.2018

This project CoSIE (Co-creation of Service Innovation in Europe) has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 770492.Estonian Vunkimano I Hackathon interviews collected 05-07.10.2018: interviews with hackathon teams, mentors and policy maker

Job satisfaction and perception of workloads among dietitians and nutritionists registered in South Africa

Background: Personal perspective concerning work demands directly impacts quality health care and patient satisfaction. Little is known about job satisfaction amongst dietitians and nutritionist, while workload has not previously been studied in this population. Methods: A descriptive cross-sectional study was performed using an online questionnaire. Data were collected on sociodemography. Job satisfaction was measured with Spector’s Job Satisfaction Survey (JSS) (including an added subscore for resource availability) and workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Results: Respondents (n = 238) had a median age of 32.0 years (IQR: 27−39 years); 92.4% were female; 95.7% were dietitians, 2.4% were nutritionists and 18.9% had a postgraduate degree. Respondents had practised the profession for a median of 8 years (IQR 3−15 years), and 225 were in dietetic and nutrition-related jobs. Median scores indicated that they were slightly satisfied with their jobs (n = 224) and experienced slightly high workload (n = 224). Most respondents were moderately satisfied with the nature of their work and found it rewarding. The median scores for salaries, promotion opportunities, work environment and availability of resources were low. Total JSS was higher in older and more experienced dietitians and nutritionists than in younger ones (p < 0.05). Those employed in the government sector (n = 100) experienced higher physical demands and levels of frustration, and had lower JJS than those employed elsewhere (n = 124), particularly regarding promotion opportunities and resources availability. Conclusion: Despite being generally positive towards practising their profession, South African dietitians and nutritionists, particularly in the public health sector, experienced only slight job satisfaction, related to salary and promotion issues and lack of resources, and were slightly overworked. Understanding the factors that shape perceptions of work within nutrition and dietetics may assist managers in recruiting and retaining a highly skilled workforce, particularly in developing countries with overburdened healthcare systems

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.

BACKGROUND: Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. METHODS: Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS: Globally, 5·8 million (95% uncertainty interval [UI] 5·7-6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7-53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3-43·6) to 2·6 million (2·6-2·7) neonatal deaths and 47·0% (35·1-57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6-3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. INTERPRETATION: Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. FUNDING: Bill & Melinda Gates Foundation