Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

BackgroundHuman immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico.MethodsWe performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017.ResultsAll countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries-apart from Ecuador-across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups-the median age group among decedents ranged from 30 to 45years of age at the municipality level in Brazil, Colombia, and Mexico in 2017.ConclusionsOur subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.Peer reviewe

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries�apart from Ecuador�across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50 or more HIV deaths were concentrated in fewer than 10 of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups�the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths

International nosocomial infection control consortium (INICC) report, data summary of 36 countries, for 2004-2009

The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia). Copyright © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved

Análisis comparativo de motores convencionales y convertidos a gas utilizados en transporte público funcionando a grandes alturas

Este artículo, continuación de otro publicado en el «Segundo Taller Caribeño de Energía y Medio Ambiente», realizado en abril de 1999 en Cienfuegos (Cuba), presenta la metodología seguida y los resultados obtenidos durante los ensayos de una serie de vehículos con motor de encendido por chispa, utilizando combustible convencional, GLP y GNC, los cuales tenían como objeto la evaluación del desempeño mecánico y ambiental de los mismos en la capital colombiana (Santafé de Bogotá, 2600 msnm). El Departamento Técnico Administrativo del Medio Ambiente (DAMA), organismo gubernamental encargado de la gestión ambiental en Santafé de Bogotá, ha promovido el desarrollo de este estudio como una búsqueda de opciones válidas para disminuir la contaminación atmosférica del distrito capital a través de la sustitución de gasolina en el transporte automotor, apostando especialmente por el uso de combustibles gaseosos. Los resultados muestran que el sustituto más limpio para la gasolina motor es el GLP. El GNC para ser usado en motores reconvertidos del tipo dual demostró ser una buena alternativa desde el punto de vista ambiental, pero a costa de desmejorar considerablemente la respuesta mecánica del motor, a causa de la falta de oxígeno por efectos de altura y humedad relativa elevados. Ambos sustitutos, no obstante, demostraron ser tremendamente dependientes de la tecnología empleada

Análisis comparativo de motores convencionales y convertidos a gas utilizados en transporte público funcionando a grandes alturas

Este artículo, continuación de otro publicado en el «Segundo Taller Caribeño de Energía y Medio Ambiente», realizado en abril de 1999 en Cienfuegos (Cuba), presenta la metodología seguida y los resultados obtenidos durante los ensayos de una serie de vehículos con motor de encendido por chispa, utilizando combustible convencional, GLP y GNC, los cuales tenían como objeto la evaluación del desempeño mecánico y ambiental de los mismos en la capital colombiana (Santafé de Bogotá, 2600 msnm). El Departamento Técnico Administrativo del Medio Ambiente (DAMA), organismo gubernamental encargado de la gestión ambiental en Santafé de Bogotá, ha promovido el desarrollo de este estudio como una búsqueda de opciones válidas para disminuir la contaminación atmosférica del distrito capital a través de la sustitución de gasolina en el transporte automotor, apostando especialmente por el uso de combustibles gaseosos. Los resultados muestran que el sustituto más limpio para la gasolina motor es el GLP. El GNC para ser usado en motores reconvertidos del tipo dual demostró ser una buena alternativa desde el punto de vista ambiental, pero a costa de desmejorar considerablemente la respuesta mecánica del motor, a causa de la falta de oxígeno por efectos de altura y humedad relativa elevados. Ambos sustitutos, no obstante, demostraron ser tremendamente dependientes de la tecnología empleada

Toxocara seroprevalence in children from a subtropical city in Argentina Prevalencia de anticuerpos anti Toxocara en niños de una ciudad subtropical de Argentina

Most studies from Argentina have focused on toxocariasis as an environmental problem of big cities, and there are no available data about children infection from small or middle-sized cities. In order to assess the prevalence of anti-Toxocara antibodies in infantile population, 206 children from Resistencia, of both sexes, aged 1-14 years old were studied by Elisa testing with E/S T. canis L2 antigens. Hematological parameters and immunoglobulin levels were determined; five days' stool samples were studied and epidemiological data were obtained by means of a questionnaire to parents. Results showed that 73% of the children had one or more dogs living at home, 57% reported geophagia and 37.9% were positive for Toxocara serology, but there was no significant difference in prevalence neither for boys and girls, nor concerning age. An increased risk of infection was observed in age groups 5-6 and 7-8 for boys, and in age groups 3-4 and 5-6 for girls.<br>La mayoría de los estudios realizados en Argentina, han enfocado a la Toxocariosis como un problema medioambiental propio de las grandes ciudades y no existen datos acerca de esta infección entre los niños de ciudades medianas o pequeñas. A fin de determinar la prevalencia de anticuerpos anti-Toxocara en la población infantil de la ciudad de Resistencia, se estudiaron 206 niños de ambos sexos, con edades comprendidas entre los 1-14 años, mediante el test de Elisa, empleando antígenos E/S de larva L2 de Toxocara canis. También se evaluaron los niveles de inmunoglobulinas séricas y los parámetros hematológicos; se efectuaron análisis coproparasitológico seriados en heces de 5 días y se recolectó información epidemiológica mediante cuestionario a los padres. Los resultados obtenidos señalan que el 73% de los niños tenían uno o mas perros viviendo en la casa, que el 57% tenían antecedentes de geofagia y que el 37.9% tenían serología positiva para Toxocara, aunque no hubo diferencias estadísticamente significativas entre varones y mujeres ni con la edad. Un mayor riesgo de contraer la infección se observó entre los grupos etarios 5-6 y 7-8 de varones y 3-4 y 5-6 de mujeres

Esquistossomose: reprodução e expansão da endemia no Estado de Pernambuco no Brasil Schistosomiasis: reproduction and expansion of the endemic region in Brazil

A esquistossomose continua a ser um problema de saúde pública no Nordeste do Brasil embora o emprego, em larga escala, da quimioterapia venha sendo apontado como um dos fatores responsáveis pela redução das formas graves. O Estado de Pernambuco vem apresentando taxas crescentes de infecção humana para esquistossomose com perfil epidemiológico de prevalências crônicas (até 80%) na região rural e casos recentes de infecção aguda no litoral. Discute-se a reprodução e expansão da esquistossomose a partir de uma concepção estrutural e histórica de causas, onde se inserem fatores não só de ordem biológica mas também sociais, políticos e culturais que vêm contribuindo para a formação dos quadros endêmicos: a forma de ocupação e do uso da terra, desemprego, desnutrição, migração e outros. Questionam-se as crescentes dificuldades para o controle da doença e o papel da investigação epidemiológica na compreensão da essência social do processo saúde/doença.<br>Schistosomiasis mansoni can be considered an important public health problem in Northeastern Brazil, in spite of the reduction in the prevalence of the hepatosplenic clinical forms which have been attributed to the large scale use of chemotherapy in this country. However, the rise in the prevalence rates and the spread of this endemic disease to new areas show that schistosomiasis is assuming its must cruel expression: less lethal but more greatly incapacitating in terms of irreversible physical and moral damage to human beings. The state of Pernambuco presents growing rates for schistosomiasis infection in humans. The epidemiological profile of this disease displays high and consistent prevalence rates (up to 80%) in rural areas, and new cases of acute infection on the coast, where schistosomiasis has recently been introduced. The reproduction and expansion of this endemic disease can be better understood on the basic of a conception of structural and historical causation. The disease construction process should be reconstructed in the light of biological as well as the social, political and cultural factors which are jointly responsible for the present endemic situation. Within that frame work, the historical and socio-economic features that interact with the parasite and give rise to the present proportions of the schistosomiasis epidemic in Pernambuco are discussed. The mode of occupation and use of the land, unemployment, under-nutrition, migration, etc., raise the question of the growing difficulties confronting the control of the disease, both in rural areas where populations are extremely mobile as well as in the poorly organized urban population. Epidemiological investigation is fulfithing its role in its attenpts to understand the complex relationships of an intrinsecally social nature of the health/disease process between health problems and the quality of life for the purpose of producing consistent disease control models