Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

From the fiscal evasion problem to environmental matters : some applications of microeconomic techniques

Tesis (Doctor en Economía)--El Colegio de México, Centro de Estudios Económicos, 201

Agua, pobreza y uso del tiempo en México: Análisis cuantitativo como sustento del diseño de una política pública de doble dividendo

Introducción: Los impactos de la escasez y contaminación del agua afectan a grandes sectores de la población, pero inciden de manera desproporcionada en los sectores de menores ingresos. El acceso al agua ha sido reconocido como un derecho fundamental para una vida digna por las Naciones Unidas (UN, 2010), por lo que si el Estado no pone los medios para el acceso universal al agua, estaría impidiendo la realización de los derechos humanos de una parte de la población. Así, la relación agua - pobreza es de la mayor importancia tanto desde el punto de vista de salud pública como el de equidad social. El presente trabajo estudia la relación entre la falta de acceso al agua, el tiempo destinado a trabajar y los niveles de ingreso. Método: Con información de dos rondas de la Encuesta Nacional sobre Uso del Tiempo 2002 y 2009 del INEGI, se estima la brecha de ingreso y de las horas trabajadas entre la población que destina tiempo en acarrear agua con aquella (estadísticamente comparable) que no realiza esta actividad. Esto se hace a partir de un método de apareamiento (propensity score matching) considerando características personales y del municipio donde éstas viven. Resultados: En ambos casos se observa una diferencia estadísticamente significativa. En el primero, la brecha del ingreso familiar trimestral era de alrededor de 9% en 2002 y de 12% en 2009. En el segundo, se estima que una persona que acarrea agua disminuye el tiempo que destinaba a trabajar en alrededor de 13% tanto en 2002 como en 2009. Estos resultados sugieren que la falta de acceso al agua es una condición que tiene un impacto significativo en hacer más proclive a una persona a caer en una condición de pobreza. Discusión o Conclusión: Una política de cobertura de dicho servicio tiene el doble efecto de atender un satisfactor fundamental de bienestar a la vez que libera a las personas de un tiempo adicional que puede aprovecharse en horas productivas. Ambos factores conducen tanto a una mejor calidad de vida como como a la mitigación en la pobreza monetaria de la población atendida. De allí su doble dividendo. Al respecto, comparamos el valor presente neto del costo promedio de dotar agua a nivel hogar (que estimamos en 5,305 pesos con información de fuentes secundarias) con el valor presente neto del ingreso adicional que se generaría por no tener que acarrear agua (14,500 pesos de acuerdo a nuestro modelo), los resultados indican que la inversión es costo-efectiva y es un vehículo valioso para abatir la pobreza

Los costos de la expansión urbana: aproximación a partir de un modelo de precios hedónicos en la Zona Metropolitana del Valle de México

La Zona Metropolitana del Valle de México (ZMVM) ha experimentado una expansión no proporcional al crecimiento poblacional. Entre otras modalidades de poblamiento, la construcción de grandes conjuntos habitacionales periféricos propicia esa expansión, imponiendo costos individuales y sociales. Se revisan aquí las características de la expansión urbana en la ZMVM y las condiciones de producción de vivienda social periférica, la pérdida de ingreso de los individuos derivada de la distancia a los centros de trabajo y, a través de un modelo de precios hedónicos, se estima el rol de esa distancia en el diferencial de precios entre la vivienda periférica y la intraurbana

Payments for Environmental Services in a Policymix: Spatial and Temporal Articulation in Mexico.

Government based Payments for Ecosystem Services (PES) have been criticized for not maximizing environmental effectiveness through appropriate targeting, while instead prioritizing social side-objectives. In Mexico, existing literature on how the Payments for Ecosystem Services-Hydrological program (PSA-H) has targeted deforestation and forest degradation shows that both the process of identifying the eligible areas and the choice of the selection criteria for enrolling forest parcels have been under the influence of competing agendas. In the present paper we study the influence of the PSA-H multi-level governance on the environmental effectiveness of the program-the degree to which forest at high risk of deforestation is enrolled- building from a "policyscape" framework. In particular, we combine governance analysis with two distinct applications of the policyscape framework: First, at national level we assess the functional overlap between the PSA-H and other environmental and rural programs with regard to the risk of deforestation. Second, at regional level in the states of Chiapas and Yucatan, we describe the changing policy agenda and the role of technical intermediaries in defining the temporal spatialization of the PSA-H eligible and enrolled areas with regard to key socio-economic criteria. We find that, although at national level the PSA-H program has been described as coping with both social and environmental indicators thanks to successful adaptive management, our analysis show that PSA-H is mainly found in communities where deforestation risk is low and in combination with other environmental programs (protected areas and forest management programs). Such inertia is reinforced at regional level as a result of the eligible areas' characteristics and the behaviour of technical intermediaries, which seek to minimise transaction costs and sources of uncertainty. Our project-specific analysis shows the importance of integrating the governance of a program in the policyscape framework as a way to better systematize complex interactions at different spatial and institutional scales between policies and landscape characteristics

Economic spillover from Natural Protected Areas to conventional tourist destinations

En este artículo examinamos el papel de las Áreas Naturales Protegidas (ANPs) como fuente de derrama económica en México atrayendo turistas que no llegarían en ausencia de estas. Para ello, planteamos un modelo econométrico que explica el número de cuartos ocupados de destinos turísticos en función de la proximidad a ANPs, controlado por otras características del sitio. Un estimado conservador indica que 17.7% de los cuartos ocupados por turistas extranjeros estarían explicados por la proximidad a ANPs. Estos resultados plantean posibilidades como un mecanismo de compensación por parte del turismo convencional, propuesta económicamente eficiente y que contribuye al desarrollo sostenible

A Business Case for Marine Protected Areas: Economic Valuation of the Reef Attributes of Cozumel Island

Tourism to Cozumel Island generates USD 762 million annually in local economic activity, and 111 visitors stay in local hotels for each inhabitant. The island’s coast is its principal attraction, yet water quality and reef health are threatened. This paper studies the link between the local economy and management of Arrecifes de Cozumel National Park, using a choice experiment to assess the economic value visitors assign to underwater visibility, biodiversity, and visitor congestion in reef areas. We found that, on average, tourists are willing to pay USD 190 per visit to avoid a projected decrease in biodiversity, USD 120 per visit to prevent a projected decline in visibility, and USD 98 to avoid high congestion during reef visits. We find high heterogeneity in willingness to pay estimates, which may be useful for targeting both conservation and marketing efforts. On the other hand, increasing the reef access fee from USD 2 to USD 6 could fully fund effective protected area management, with no substantial effect on visitors’ consumer surplus. Results suggest that a conservation surcharge could be added to all tours, with little impact on visitation, and that significantly increasing private sector collaboration and government spending on conservation would be good economic choices