Factores asociados a tuberculosis auto-reportada en personas privadas de la libertad de los establecimientos penitenciarios del Perú en el 2016

Introducción: Las medidas de control de la Tuberculosis (TB) deben incluir a los grupos de riesgo como las personas privadas de la libertad (PPL) que presentan una elevada prevalencia y mayor proporción de casos resistentes de TB. Este estudio busca estimar la prevalencia de TB auto-reportada en Establecimientos Penitenciarios (EP) Peruanos y factores asociados. Métodos: Nuestro manuscrito corresponde a un estudio transversal en base al Censo Nacional Penitenciario 2016 de los 66 EP del Perú. Nuestra variable resultado fue definida como el autoreporte de tuberculosis (TBa) diagnosticado en PPL de EP peruanos. Ejecutamos un análisis bivariado seguido de regresión multivariada de Poisson para ajustar las razones de prevalencia (RPa). Adicionalmente utilizamos un modelo multinivel de efectos mixtos. Resultados: Un total de 77 086 penitenciarios en 66 EP participaron en el censo, de los cuales sólo 69 890 registros fueron incluidos en nuestro análisis. De estos, 1 754 PPL autoreportaron tuberculosis de diagnóstico intrapenitenciario, originando una prevalencia de TBa de 2 510/100 000 PPL. En el modelo final, la prevalencia de tuberculosis autoreportada se encontró asociada a la edad de 18 a 35 años (RPa 1,80), sexo masculino (RPa 9,56), no tener educación escolar (RPa 2,60), no tener pareja estable (RPa 1,18), encarcelamiento previo (RPa 1,31) e historia de familiar encarcelado (RPa 1,15). También se encontró asociación con VIH/SIDA (RPa 2,82), Infección de transmisión sexual (ITS) (RPa 2,21), Diabetes Mellitus (DM) (RPa 2,16), Hepatitis viral, el consumo de drogas (RPa 1,41) y alcohol (RPa 1,14). El modelo mixto mostró una varianza significativa para hacinamiento intrapenitenciario (Varianza: 1,97; 0,97 – 3,98) y pertenecer a diferentes EP (Varianza: 3,02; 1,30 – 7,01). Conclusiones: La prevalencia de tuberculosis autoreportada intrapenitenciaria encontrada fue más alta que la de otros países en desarrollo. Factores sociodemográficos, antecedentes patológicos, historia de hábitos nocivos y hacinamiento intrapenitenciario incrementan la probabilidad de tuberculosis autorreportada.Introduction: Tuberculosis (TB) control measures should include risk groups such as persons deprived of liberty (PDL) who have a high prevalence and a higher proportion of resistant TB cases. This study seeks to estimate the prevalence of self-reported TB in Peruvian correctional facilities (CF) and associated factors. Methods: Corresponds to a cross-sectional study based on secondary analysis of the 2016 National Penitentiary Census of the 66 CFs of Peru. Our outcome variable was defined as self-reported TB (sTB) diagnosed by a healthcare professional intrapenitentiary. We performed a bivariate analysis followed by multivariate Poisson regression to adjust the prevalence ratios (PRa). A mixed effects multilevel model was also performed. Results: 77,086 prison inmates in 66 CFs participated in the census, of which only 69,890 were included in our analysis. Of these, 1,754 PDL self-reported TB diagnosed intra-penitentiary, resulting in a sTB prevalence of 2,510/100,000 PDL. In the final model, the prevalence of self-reported tuberculosis was found to be associated with age 18 to 35 years (PRa 1.80), male sex (PRa 9.56), without education (PRa 2.60), marital status without a stable partner (PRa 1.18), previous imprisonment (PRa 1.31) and history of imprisoned relative (PRa 1.15). There was also an association with HIV / AIDS (PRa 2.82), sexually transmitted infection (PRa 2.21), Diabetes Mellitus (PRa 2.16), viral hepatitis, drug use (PRa 1.41) and alcohol consumption (PRa 1.14). The mixed model showed significant variation for belonging to different CFs (3.02; 1.30 – 7.01) and overcrowding (1.97; 0.97 – 3.98). Conclusions: Self-reported TB prevalence found tuberculosis was higher than reported by other lower-middle income countries. Self-reported TB prevalence found was higher than reported by other lower/lower-middle income countries. Demographic factors, individual clinical features, and overcrowding increase the likelihood of self-reported TB.Tesi

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p < 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p<0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p<0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit