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1. Similarity network fusion to identify phenotypes of small-for-gestational-age fetuses

Author: Jezid Miranda, Cristina Paules, Guillaume Noell, Lina Youssef, Angel Paternina-Caicedo, Francesca Crovetto, Nicolau Cañellas, María L. Garcia-Martín, Nuria Amigó, Elisenda Eixarch, Rosa Faner, Francesc Figueras, Rui V. Simões, Fàtima Crispi, and Eduard Gratacós
Subjects: Public health, Pregnancy, Machine learning, Science
Abstract: Summary: Fetal growth restriction (FGR) affects 5–10% of pregnancies, is the largest contributor to fetal death, and can have long-term consequences for the child. Implementation of a standard clinical classification system is hampered by the multiphenotypic spectrum of small fetuses with substantial differences in perinatal risks. Machine learning and multiomics data can potentially revolutionize clinical decision-making in FGR by identifying new phenotypes. Herein, we describe a cluster analysis of FGR based on an unbiased machine-learning method. Our results confirm the existence of two subtypes of human FGR with distinct molecular and clinical features based on multiomic analysis. In addition, we demonstrated that clusters generated by machine learning significantly outperform single data subtype analysis and biologically support the current clinical classification in predicting adverse maternal and neonatal outcomes. Our approach can aid in the refinement of clinical classification systems for FGR supported by molecular and clinical signatures.
Published: 2023
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2. Assessment of Community Awareness and Screening of Chagas Disease in the Latin American Community of Greater New Orleans

Author: Claudia Herrera, Kerlly J. Bernabé, Eric Dumonteil, James DeCuir, Julie M. Thompson, Mariana Avendano, Weihong Tu, Maxwell M. Leonhardt, Bianka A. Northland, Jynx Frederick, Bryn Prieto, Angel Paternina-Caicedo, Emma Ortega, Maria Fonseca, Marcela Hincapie, and Margarita Echeverri
Subjects: Trypanosoma cruzi, diagnostic, surveillance, screening, Chagas disease barriers, Latin American community, Medicine
Abstract: Chagas disease is a public health problem in the Americas, from the southern United States (USA) to Argentina. In the USA, less than 1% of domestic cases have been identified and less than 0.3% of total cases have received treatment. Little is known about affected immigrant Latin American communities. A prospective study was conducted to assess knowledge about Chagas disease among the Latin American community living in the Greater New Orleans area. Participants answered a baseline questionnaire, viewed a short educational video presentation, completed a post-presentation questionnaire, and were screened with an FDA-approved blood rapid diagnostic test (RDT). A total of 154 participants from 18 Latin American countries (n = 138) and the USA (n = 16) were enrolled and screened for Trypanosoma cruzi infection. At baseline, 57% of the participants knew that Chagas disease is transmitted through an insect vector, and 26% recognized images of the vector. Following the administration of an educational intervention, the participants’ knowledge regarding vector transmission increased to 91% and 35% of participants were able to successfully identify images of the vector. Five participants screened positive for T. cruzi infection, indicating a 3.24% [95%CI: 1.1–7.5%] prevalence of Trypanosoma cruzi infection within the Latin American community of the New Orleans area. Results highlight the urgent need for improving access to education and diagnostics of Chagas disease.
Published: 2023
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3. Effectiveness of CoronaVac and BNT162b2 COVID-19 mass vaccination in Colombia: A population-based cohort study

Author: Angel Paternina-Caicedo, Mark Jit, Nelson Alvis-Guzmán, Juan Carlos Fernández, José Hernández, Justo Jesus Paz-Wilches, José Rojas-Suarez, Carmelo Dueñas-Castell, Nelson J. Alvis-Zakzuk, Adrian D. Smith, and Fernando De La Hoz-Restrepo
Subjects: Vaccine effectiveness, Covid-19, Mortality, Vaccines, Public aspects of medicine, RA1-1270
Abstract: Summary: Background: In February 2021, Colombia began mass vaccination against COVID-19 using mainly BNT162b2 and CoronaVac vaccines. We aimed to estimate vaccine effectiveness (VE) to prevent COVID-19 symptomatic cases, hospitalization, critical care admission, and deaths in a cohort of 796,072 insured subjects older than 40 years in northern Colombia, a setting with a high SARS-CoV-2 transmission. Methods: We identified individuals vaccinated between March 1st of 2021 and August 15th of 2021. We included symptomatic cases, hospitalizations, critical care admissions, and deaths in patients with confirmed COVID-19 as main outcomes. We calculated VE for each outcome from the hazard ratio in Cox proportionally hazards regressions (adjusted by age, sex, place of residence, diabetes, human immunodeficiency virus, cancer, hypertension, tuberculosis, neurological diseases, and chronic renal disease), with 95% confidence intervals (CI). Findings: A total of 719,735 insured participants of 40 and more years were followed. We found 21,545 laboratory-confirmed symptomatic COVID-19 among unvaccinated population, along with 2874 hospitalizations, 1061 critical care admissions, and 1329 deaths, for a rate of 207.2 per million person-days, 27.1 per million person-days, 10.0 per million person-days, and 12.5 per million person-days, respectively. We found CoronaVac was not effective for any outcome in subjects above 80 years old; but for people 40-79 years of age, we found two doses of CoronaVac reduced hospitalization (33.1%; 95% CI, 14.5–47.7), critical care admission (47.2%; 95% CI, 18.5–65.8), and death (55.7%; 95% CI, 32.5–70.0). We found BNT162b2 was effective for all outcomes in the entire population of subjects above 40 years of age, significantly declining for subjects ≥80 years. Interpretation: Two doses of either CoronaVac in population between 40 and 79 years of age, or BNT162b2 among vaccinated above 40 years old significantly reduced deaths of confirmed COVID-19 in a cohort of individuals from Colombia. Vaccine effectiveness for CoronaVac and BNT162b2 declined with increasing age. Funding: UK National Institute for Health Research, the European Union's Horizon 2020 research and innovation programme, and the Bill & Melinda Gates Foundation.
Published: 2022
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4. Maternal mortality linked to COVID-19 in Latin America: Results from a multi-country collaborative database of 447 deaths

Author: Fabian Maza-Arnedo, Angel Paternina-Caicedo, Claudio G. Sosa, Bremen de Mucio, José Rojas-Suarez, Lale Say, Jenny A Cresswell, Luis Andrés de Francisco, Suzanne Serruya, Diana Carolina Franco Pulido Lic, Luis Urbina, Erika Saint Hilaire, César V. Munayco, Fabiola Gil, Erick Rousselin, Leonardo Contreras, Allan Stefan, Alvinzy Velásquez Becerra, Evelyn Degraff, Franco Espada, Victor Conde, Gustavo Mery, Víctor Hugo Álvarez Castaño, Aura Liliana Torres Umbarila, Ivy Lorena Talavera Romero, Yeimy Catherine Rodríguez Alfonso, Raquel Lovato Silva, Jakeline Calle, Cynthia Marlene Díaz -Viscensini, Vicente Nicolas Bataglia Frutos, Elodia Vysokolán Laguardia, Haydee Padilla, Alvaro Ciganda, and Mercedes Colomar
Subjects: COVID-19, SARS-CoV-2, Pregnancy, Puerperium, Maternal mortality, Maternal death, Public aspects of medicine, RA1-1270
Abstract: Summary: Background: This study aimed to describe the clinical characteristics of maternal deaths associated with COVID-19 registered in a collaborative Latin-American multi-country database. Methods: This was an observational study implemented from March 1st 2020 to November 29th 2021 in eight Latin American countries. Information was based on the Perinatal Information System from the Latin American Center for Perinatology, Women and Reproductive Health. We summarized categorical variables as frequencies and percentages and continuous variables into median with interquartile ranges. Findings: We identified a total of 447 deaths. The median maternal age was 31 years. 86·4% of women were infected antepartum, with most of the cases (60·3%) detected in the third trimester of pregnancy. The most frequent symptoms at first consultation and admission were dyspnea (73·0%), fever (69·0%), and cough (59·0%). Organ dysfunction was reported in 90·4% of women during admission. A total of 64·8% women were admitted to critical care for a median length of eight days. In most cases, the death occurred during the puerperium, with a median of seven days between delivery and death. Preterm delivery was the most common perinatal complication (76·9%) and 59·9% were low birth weight. Interpretation: This study describes the characteristics of maternal deaths in a comprehensive multi-country database in Latin America during the COVID-19 pandemic. Barriers faced by Latin American pregnant women to access intensive care services when required were also revealed. Decision-makers should strengthen severity awareness, and referral strategies to avoid potential delays. Funding: Latin American Center for Perinatology, Women and Reproductive Health. Resumen: Antecedentes: Este estudio tuvo el objetivo de describir las características clínicas de las muertes maternas asociadas a COVID-19 registradas en una base de datos latinoamericana multipaís. Métodos: Se implementó un estudio observacional descriptivo en el que participaron ochos países Latinoamericanos desde el 1ero de marzo 2020 al 29 de noviembre 2021. La información se obtuvo del Sistema Informático Perinatal del Centro Latino Americano de Perinatología, Salud de la Mujer y Reproductiva. Presentamos las variables categóricas como frecuencias y porcentajes y las variables continuas en medianas con rangos inter cuartiles. Resultados: Identificamos un total de 447 muertes. La mediana de edad materna fue de 31 años. 86·4% de las mujeres se infectaron ante del parto, siendo la mayoría de los casos detectados en el tercer trimestre del embarazo (60·3%). Los síntomas más frecuentes en la primera consulta y la admisión fueron disnea (73·0%), fiebre (69·0%), y tos (59·0%). Se reportaron disfunciones orgánicas en 90·4% de las mujeres durante la admisión. Un total de 64·8% de las mujeres fueron ingresadas a cuidados críticos por una mediana de ocho días de estadía. En la mayoría de los casos la muerte ocurrió durante el puerperio, con una media de siete días entre el parto y su ocurrencia. El parto prematuro fue la complicación perinatal más frecuente (76·9%) y 59·9% tuvo bajo peso al nacer. Interpretación: Este estudio describe las características de las muertes maternas durante la pandemia por COVID-19 a partir de una base colaborativa multipaís. Se observaron barreras para el acceso a cuidados intensivos. Los tomadores de decisión deberían trabajar en el fortalecimiento de la conciencia de gravedad, y en estrategias de referencia para evitar potenciales demoras. Financiamiento: Centro Latino Americano de Perinatología, Salud de la Mujer y Reproductiva.
Published: 2022
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5. Biochemical and Hematological Markers in Workers with Chronical Exposure to Lead and Cadmium in Colombia

Author: Fredy Vergara-Murillo, Katiana Martinez-Yanez, Alvaro Fortich-Revollo, Angel Paternina-Caicedo, and Boris Johnson-Restrepo
Subjects: occupation exposure, toxic metals, Colombia, Chemical technology, TP1-1185
Abstract: The aim of the present study was to find if workers chronically exposed to lead (Pb) and cadmium (Cd) presented changes in their general health and in the clinical parameters of the population under study. We carried out a cross-sectional survey in a sample of informal workers in Cartagena, Colombia. The population under study was composed of male informal workers (≥18 years of age), with experience in their job, selected from occupational settings with potential exposure to Pb and Cd (i.e., mechanics, battery and garbage recyclers, and welders). The median age was 45 years (interquartile range (IQR), 33–53). The median blood Pb level (BLL) was 2 μg/dL (IQR, 0.76–6.22), and the median of blood Cd level (BCL) was 1.22 μg/L (IQR, 0.33–2.01). The study found that 33% of high exposure jobs with BLL > 5 μg/dL (n = 57), whereas in ‘control’ workers, this was 15.3% (n = 9). The highest BLLs were found in battery recyclers (82.1%; n = 23), followed by mechanics (37.3%, n = 22). In the logistic regression model adjusted by age, time on the job, smoking and elevated BCL and BLL increased 3.2 times (95% CI, 1.1–9.7) in mechanics and 29.6 times (95% CI, 7.2–145.6) in battery recyclers. This study found negative changes in the health of workers with higher chronic exposure to lead in Cartagena, Colombia.
Published: 2022
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6. Trends in the mortality of non-traumatic subarachnoid hemorrhage in Colombia: a 10-year analysis of a nationwide registry

Author: Gabriel Alcala-Cerra, Adam M.H. Young, Angel Paternina-Caicedo, and Eduardo Santamaria Carvalhal Ribas
Subjects: aneurisma, hemorragia subaracnoidea, morbidade, mortalidade, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract: Objective To assess trends in mortality from 1999 to 2008 resulting from non-traumatic subarachnoid hemorrhage (SAH) in the Colombian population. Method This population-based study analyzed all deaths by assuming a Poisson model. Results Subarachnoid hemorrhage-related deaths showed a statistically significant increase of 1.6% per year (p
Published: 2013
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7. Maternal mortality in Colombia in 2011: a two level ecological study.

Author: Luz Mery Cárdenas-Cárdenas, Karol Cotes-Cantillo, Pablo Enrique Chaparro-Narváez, Julián Alfredo Fernández-Niño, Angel Paternina-Caicedo, Carlos Castañeda-Orjuela, and Fernando De la Hoz-Restrepo
Subjects: Medicine, Science
Abstract: ObjectiveMaternal mortality reduction is a Millennium Development Goal. In Colombia, there is a large disparity in the maternal mortality ratio (MMR) between and into departments (states) and also between municipalities. We examined socioeconomics variables at the municipal and departmental levels which could be associated to the municipal maternal mortality in Colombia.MethodsA multilevel ecology study was carried out using different national data sources in Colombia. The outcome variable was the MMR at municipal level in 2011 with multidimensional poverty at municipal and department level as the principal independent variables and other measures of the social and economic characteristics at municipal and departmental level were also considered explicative variables (overall fertility municipal rate, percentage of local rural population, health insurance coverage, per capita territorial participation allocated to the health sector, transparency index and Gini coefficient). The association between MMR and socioeconomic contextual conditions at municipal and departmental level was assessed using a multilevel Poisson regression model.ResultsThe MMR in the Colombian municipalities was associated significantly with the multidimensional poverty (relative ratio of MMR: 3.52; CI 95%: 1.09-11.38). This association was stronger in municipalities from departments with the highest poverty (relative ratio of MMR: 7.14; CI 95%: 2.01-25.35). Additionally, the MMR at municipal level was marginally associated with municipally health insurance coverage (relative ratio of MMR: 0.99; CI 95%: 0.98-1.00), and significantly with transparency index at departmental level (relative ratio of MMR: 0.98; CI 95%: 0.97-0.99).ConclusionPoverty and transparency in a contextual level were associated with the increase of the municipal MMR in Colombia. The results of this study are useful evidence for informing the public policies discussion and formulation processes with a differential approach.
Published: 2015
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8. Zika virus in Pregnancy in a Honduran cohort: neurodevelopmental assessment of normocephalic children born to Zika virus exposed and non-exposed pregnant people

Author: Jackeline Alger, María Luisa Cafferata, Raquel López, Lisa D. Wiggins, Allison Callejas, Mario Castillo, Jenny Fúnes, Fátima Rico, Diana Valencia, Douglas Varela, Zulma Alvarez, Mabel Berrueta, Harry Bock, Carolina Bustillo, Alejandra Calderón, Alvaro Ciganda, Jorge García, Kimberly García, Luz Gibbons, Suzanne M. Gilboa, Emily W. Harville, Gustavo Hernández, Wendy López, Ivette Lorenzana, Marco T. Luque, Carlos Maldonado, Cynthia Moore, Carlos Ochoa, Leda Parham, Karla Pastrana, Angel Paternina-Caicedo, Heriberto Rodríguez, Candela Stella, Ayzsa F. Tannis, Dawn Wesson, Concepción Zúniga, Van T. Tong, and Pierre Buekens
Abstract: Background Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results limited by the absence of a comparison group. The present study aimed to assess the neurodevelopmental outcomes among a cohort of children born with normal head circumference from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study between July and December 2016. Methods Enrollment of pregnant people was voluntary and occurred during their first prenatal visit at a health center in Tegucigalpa, with collection of venous blood. Children with the following characteristics were selected for the longitudinal follow-up study: normal birth head circumference, > 6 months of age, born at one of two hospitals in Tegucigalpa, and known in utero ZIKV exposure status. In utero exposure to ZIKV was defined as a positive prenatal ZIKV IgM and/or positive ZIKV RNA result at enrollment. The developmental evaluation included Spanish language versions of the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional, Second Edition (ASQ:SE-2). Results One hundred fifty-two children were assessed between May 2018 and March 2020. The mean age was 2.0 years, and > 93% had adequate anthropometric growth. Sixty children were exposed to ZIKV during pregnancy. BSID-III and ASQ:SE-2 were performed in 151 and 152 children, respectively. Forty-one children had a delay (
Published: 2023
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9. Impact of mobility restrictions on the dynamics of transmission of COVID-19 in Colombian cities

Author: Angel Paternina-Caicedo, Adrian D Smith, Fernando De la Hoz-Restrepo, Nelson Alvis-Guzman, Carmelo Dueñas, and Javier Narvaez
Subjects: 2019-20 coronavirus outbreak, Health (social science), Non pharmacological interventions, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, Incidence, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Public Health, Environmental and Occupational Health, COVID-19, General Medicine, Colombia, Confidence interval, law.invention, Transmission dynamics, Transmission (mechanics), Geography, law, Cases, Humans, Demographic economics, Non-pharmacological interventions, Cities
Abstract: Background Our aim was to study the association between case rates and reductions in urban mobility in state capitals of Colombia. Methods We designed an ecological time-series study to correlate the Colombian incidence rate with reductions in mobility trends of retail stores. Results The meta-analysis of β coefficients describing the association between case rates and reductions in mobility trends of retail stores resulted in a mean estimate of 0.0637 (95% confidence interval 0.027 to 0.101; p Conclusions We recommend continuing to consider mobility restrictions when the number of cases starts to climb in each local jurisdiction.
Published: 2021
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10. Letter to the editor: COVID-19 vaccination uptake among pregnant individuals in a middle-income setting

Author: Elia Lara Lona, Francisco Javier Magos Vázquez, Angel Paternina‐Caicedo, and Pierre Buekens
Subjects: Obstetrics and Gynecology, General Medicine
Published: 2022

11. Cost-Effectiveness Analysis of Strategies of COVID-19 Vaccination in Colombia: Comparison of High-Risk Prioritization and No Prioritization Strategies With the Absence of a Vaccination Plan

Author: Gilberto Morales-Zamora, Oscar Espinosa, Edwin Puertas, Juan Carlos Fernández, José Hernández, Verónica Zakzuk, Magda Cepeda, Nelson Alvis-Gúzman, Carlos Castañeda-Orjuela, and Angel Paternina-Caicedo
Subjects: COVID-19 Vaccines, LEMB, Cost-Benefit Analysis, Health Policy, Economics, Econometrics and Finance (miscellaneous), Vaccination, Modeling, COVID-19, Colombia, Seroepidemiologic Studies, Humans, Severe acute respiratory syndrome coronavirus 2, Cost-effectiveness, Pharmacology, Toxicology and Pharmaceutics (miscellaneous)
Abstract: Objectives: Our study compares two national COVID-19 vaccination plan strategies—high-risk prioritization and no prioritization—and estimates their cost-effectiveness compared with no vaccination, to generate possible recommendations for future vaccination plans. Methods: We developed a Markov discrete-time, compartmental, deterministic model stratified by Colombian departments, healthcare workers, comorbidities, and age groups and calibrated to seroprevalence, cases, and deaths. The model simulates three scenarios: no vaccination, no prioritization of vaccination, and prioritization of high-risk population. The study presents the perspective of the health system of Colombia, including the direct health costs financed by the government and the direct health outcomes related to the infection. We measured symptomatic cases, deaths, and costs for each of the three scenarios from the start of the vaccination rollout to February 20, 2023. Results: Both for the base-case and across multiple sensitivity analyses, the high-risk prioritization proves to be the most cost effective of the considered strategies. An increment of US$255 million results in an incremental cost-effectiveness ratio of US$3339 per disability-adjusted life-year avoided. The simulations show that prioritization of high-risk population reduces symptomatic cases by 3.4% and deaths by 20.1% compared with no vaccination. The no-prioritization strategy is still cost effective, with an incremental cost-effectiveness ratio of US$5223.66, but the sensitivity analysis the show potential risks of losing cost-effectiveness under the cost-effectiveness threshold (one gross domestic product per averted disability adjusted life-year). Conclusions: The high-risk prioritization strategy is consistently more cost-effective than the no-prioritization strategy across multiple scenarios. High-risk prioritization is the recommended strategy in low-resource settings to reduce the burden of disease.
Published: 2022

12. The effectiveness of COVID-19 vaccines in Latin America, 2021: a multicenter regional case–control study

Author: Rebecca Kahn, Cara B. Janusz, Marcia C. Castro, Aline da Rocha Matos, Carla Domingues, Jamie Ponmattam, Gloria Rey-Benito, Cristiana M. Toscano, Lucia Helena de Oliveira, Analia Rearte, Ignacio Leandro Uriarte, Elsa Baumester, Maria Elena Borda, Miguel Diaz Cordoba, Juan Facundo Petrina, Ezequiel Consiglio, Carla Vizzotti, Tatiana Guimarães de Noronha, Maria Paula Gomes Mourão, Jeova Keny Baima Colares, Sonia Mara Raboni, Tazio Vanni, Lely Guzman, Adriana Regina Farias Pontes Lucena, Maria Elena Santolaya, Cinthya Urquidi, Claudia P. Cortes, Pedro Pablo Usedo Lopez, Rosana Benitez, Veronica Menares Latorre, Andrea Moller Roth, Iván Brstilo Cerda, Solange Santillana, Zohra Abaakouk, Angel Paternina Caicedo, Nelson Alvis Guzman, Juan Carlos Fernandez Mercado, Fernando de la Hoz Restrepo, David Santiago Quevedo, Sofia Rios Oliveros, and Diane Moyano Romero
Subjects: Health Policy, Public Health, Environmental and Occupational Health, Internal Medicine
Published: 2023
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13. Covid-19 mortality needs age adjusting for international comparisons

Author: Angel Paternina-Caicedo, Adrian D Smith, Enrique Acosta, Tim Riffe, Christian Garcia-Calavaro, Fernando De la Hoz-Restrepo, and Lee H. Harrison
Subjects: 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), SARS coronavirus, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pandemics, 03 medical and health sciences, 0302 clinical medicine, Virology, Pandemic, Medicine, Humans, 030212 general & internal medicine, Letters to the Editor, virus classification, Letter to the Editor, Virus classification, business.industry, SARS-CoV-2, International comparisons, Age Factors, COVID-19, COVID-19 Drug Treatment, Infectious Diseases, 030211 gastroenterology & hepatology, epidemiology, Severe acute respiratory syndrome coronavirus, business
Abstract: Covid-19 had caused more than 1,4 million deaths worldwide by November 26th, 2020. Age is a strong predictor of Covid-19 mortality. Crude death rates have been used to compare the response of countries, however, this measure does not account for age structure. We report age-adjusted mortality and rates at similar timeframes, ~100 days from the 50th confirmed case, for 51 countries, as well as 50 states in the US and the District of Columbia. We found age-adjusted mortality rate at ~ 100 days is 18 times greater in New Jersey (largest mortality in the U.S.), compared to Maine (lowest mortality in the U.S). Similar patterns were present in world countries. In Japan, the age-adjusted mortality rate was 0.1; while in Peru was 47.6 at ~ 100 days of Covid-19 transmission (476 times higher). Europe, Latin America, and the US, resulted in highest age-adjusted mortality rates worldwide during the first 100 days of transmission. The data suggest that measures taken by different territories might be a factor for the different mortality rates across regions and countries worldwide. Age-adjustments are needed to compare mortality between populations with different age-structures. This article is protected by copyright. All rights reserved.
Published: 2021

14. New obstetric systemic inflammatory response syndrome criteria for early identification of high-risk of sepsis in obstetric patients

Author: Nicole Iriarte, María Cuello, Jeniffer Gonzalez-Hernandez, Fabian Maza, Angel Paternina-Caicedo, Carmelo Dueñas-Castell, Camilo Bello-Muñoz, Jorge E. Tolosa, Jorge Coronado, Mariam Viloria, Oscar Soto, Jezid Miranda, Jose Rojas-Suarez, Camila Meza, Alfonso Ramos, Walter Anichiarico, Jose Santacruz, Jennifer Tymon, and María Piñerez
Subjects: Adult, medicine.medical_specialty, Population, Colombia, Infections, Group A, Risk Assessment, Group B, law.invention, Sepsis, Cohort Studies, 03 medical and health sciences, Leukocyte Count, 0302 clinical medicine, law, Pregnancy, Internal medicine, medicine, Humans, 030212 general & internal medicine, education, Prospective cohort study, education.field_of_study, 030219 obstetrics & reproductive medicine, Receiver operating characteristic, business.industry, Pregnancy Outcome, Obstetrics and Gynecology, medicine.disease, Intensive care unit, Systemic Inflammatory Response Syndrome, Obstetric Labor Complications, Systemic inflammatory response syndrome, Intensive Care Units, Early Diagnosis, Maternal Mortality, Pediatrics, Perinatology and Child Health, Puerperal Infection, Female, Risk Adjustment, Symptom Assessment, business
Abstract: Objectives We aimed to establish new cut-off values for SIRS (Systemic Inflammatory Response Syndrome) variables in the obstetric population. Methods A prospective cohort study in pregnant and postpartum women admitted with systemic infections between December 2017 and January 2019. Patients were divided into three cohorts: Group A, patients with infection but without severe maternal outcomes (SMO); Group B, patients with infection and SMO or admission to the intensive care unit (ICU); and Group C, a control group. Outcome measures were ICU admission and SMO. The relationship between SIRS criteria and SMO was expressed as the area under the receiver operating characteristics curve (AUROC), selecting the best cut-off for each SIRS criterion. Results A total of 541 obstetric patients were enrolled, including 341 with infections and 200 enrolled as the reference group (Group C). The patients with infections included 313 (91.7%) in Group A and 28 (8.2%) in Group B. There were significant differences for all SIRS variables in Group B, compared with Groups A and C, but there were no significant differences between Groups A and C. The best cut-off values were the following: temperature 38.2 °C, OR 4.1 (1.8–9.0); heart rate 120 bpm, OR 2.9 (1.2–7.4); respiratory rate 22 bpm, OR 4.1 (1.6–10.1); and leukocyte count 16,100 per mcl, OR 3.5 (1.6–7.6). Conclusions The cut-off values for SIRS variables did not differ between healthy and infected obstetric patients. However, a higher cut-off may help predict the population with a higher risk of severe maternal outcomes.
Published: 2021

15. Social interventions can lower COVID-19 deaths in middle-income countries

Author: Angel Paternina-Caicedo, Marc Choisy, Christian Garcia-Calavaro, Guido España, José Rojas-Suarez, Carmelo Dueñas, Adrian Smith, and Fernando De la Hoz-Restrepo
Subjects: Intervention (law), Coronavirus disease 2019 (COVID-19), business.industry, Environmental health, Social distance, Pandemic, Psychological intervention, Medicine, Disease, Social isolation, medicine.symptom, China, business
Abstract: Summary paragraphA novel pandemic coronavirus disease (COVID-19) was first detected in late 2019 in Wuhan (China)1,2. COVID-19 has caused 77 national governments worldwide to impose a lockdown in part or all their countries, as of April 4, 20203. The United States and the United Kingdom estimated the effectiveness of non-pharmaceutical interventions to reduce COVID-19 deaths, but there is less evidence to support choice of control measures in middle-income countries4. We used Colombia, an upper-middle income country, as a case-study to assess the effect of social interventions to suppress or mitigate the COVID-19 pandemic. Here we show that a combination of social distancing interventions, triggered by critical care admissions, can suppress and mitigate the peak of COVID-19, resulting in less critical care use, hospitalizations, and deaths. We found, through a mathematical simulation model, that a one-time social intervention may delay the number of critical care admissions and deaths related to the COVID-19 pandemic. However, a series of social interventions (social and work distance and school closures) over a period of a year can reduce the expected burden of COVID-19, however, these interventions imply long periods of lockdown. Colombia would prevent up to 97% of COVID-19 deaths using these triggered series of interventions during the first year. Our analyses could be used by decision-makers from other middle-income countries with similar demographics and contact patterns to Colombia to reduce COVID-19 critical care admissions and deaths in their jurisdictions.
Published: 2020
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16. Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17

Author: Ninuk Hariyani, Benjamin Uzochukwu, Anas M. Saad, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Behzad Karami Matin, Abdallah M. Samy, Roman Topor-Madry, Nelson G.M. Gomes, Afsaneh Arzani, Simin Liu, Maryam Khayamzadeh, Ejaz Ahmad Khan, Asmamaw Bizuneh Demis, Anelisa Jaca, Amir Kasaeian, Fereshteh Ansari, Abdur Razzaque Sarker, Ali Kabir, Jorge Cano, Marcos Roberto Tovani-Palone, Tufa Kolola, Josephine W. Ngunjiri, Roghiyeh Faridnia, Kedir Hussein Abegaz, Hosni Salem, Sharareh Eskandarieh, Norberto Perico, Sergio I. Prada, Fisaha Haile Tesfay, Jai K Das, Ana Isabel Ribeiro, Sameer Vali Gopalani, Dessalegn Haile, Shivakumar Km Marulasiddaiah M. KMShivakumar, Narayan Prasad, Pranab Chatterjee, Shafiu Mohammed, Ravi Prakash Jha, Xiu Ju George Zhao, Farshad Farzadfar, Ahmad Daryani, Pramesh Raj Ghimire, Abbas Mosapour, Ebrahim Babaee, Rajat Das Gupta, Jean Jacques Noubiap, Daniel Bekele Ketema, Teshome Bekele Elema I, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Muktar Beshir Ahmed, Wondimeneh Shibabaw Shiferaw, Mehran Asadi-Aliabadi, Mohamed M. Gad, Eugenio Traini, Milena Santric-Milicevic, Bakhtiar Piroozi, Mohsen Afarideh, Duduzile Ndwandwe, Ibrahim Abdollahpour, Aisha Elsharkawy, Bárbara Niegia Garcia de Goulart, Soufiane Boufous, Obinna Onwujekwe, Seyyed Meysam Mousavi, Azeem Majeed, Meghnath Dhimal, Bruno F. Sunguya, Daniel Adane Endalew, Hosein Shabaninejad, Siddhesh Zadey, Takahiro Tabuchi, Gebrekiros Gebremichael Meles, Davide Guido, Trang Huyen Nguyen, Yonatal Mesfin Tefera, Hala Elhabashy, Devasahayam J. Christopher, Malede Mequanent Sisay, Davide Rasella, Hedayat Abbastabar, Maziar Moradi-Lakeh, Anthony Masaka, Wagaye Fentahun Chanie, B. Suresh Kumar Shetty, Matiwos Soboka Daba, Tesfaye Yitna Yitna Chichiabellu, Arianna Maever L. Amit, Tomohide Yamada, Alireza Rafiei, Reinhard Busse, Abdullah Al Mamun, Genet Melak Alamene, George C Patton, Andem Effiong, Rushdia Ahmed, Jagadish Rao Padubidri, Mohamad-Hani Temsah, Nizal Sarrafzadegan I, Francesco Saverio Violante, Monika Sawhney, Eyal Oren, Kimberly B. Johnson, Benn Sartorius, Shirin Djalalinia, Mohsen Bayati, Merhawi Gebremedhin Tekle, Navid Rabiee, Javad Nazari, Krishna K. Aryal, Kavumpurathu Raman Thankappan, Yoshan Moodley, Anh Kim Dang, Mohammad Khazaei, Parvaiz A Koul, Edson Serván-Mori, Foad Abd-Allah, Seyed Mohammad Riahi, Nader Jahanmehr, Yuming Guo, Sonia Saxena, Bayu Begashaw Bekele, Hagos Degefa de Hidru I, Enayatollah Homaie Rad, Richard C. Franklin, Dara K. Mohammad, Naznin Hossain, Oliver J. Brady, Natalie Maria Cormier, Ghulam Mustafa, Samiah Alam, Guoqing Hu, Yousef Khader, Mohsen Mazidi, Hamed Kalani, Hamideh Salimzadeh, Mayowa O. Owolabi, Ali Bijani, Getu Debalkie Demissie, Tsegaye Lolaso Lenjebo, German Martinez, Elias Merdassa Roro, Hamidreza Komaki, Giovanni Damiani, Nelson Alvis-Guzman, Reza Shirkoohi, Aditya Prasad Dash, Benny Antony, Cheru Tesema Leshargie, Josip Car, Turki Alanzi, Amir Jalali, Shahin Soltani, Arvin Haj-Mirzaian, John S. Ji, Nima Hafezi-Nejad, S. Mohammad Sajadi, Khalid A Altirkawi, Shanshan Li, Hunduma Amensisa Amensisa Bojia I, Estifanos Baye, Hany Aref, Kebreab Paulos, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Felix Lam, Themba G.G. Ginindza, Behnam Heidari, Chukwudi A Nnaji, Kebadnew Mulatu Mihretie, Mostafa Leili, Sohail Ahmad, Babak Moazen, Samad Azari, Feleke Gebremeskel W, Jacqueline Elizabeth Alcalde-Rabanal, Khanh Bao Tran, Okechukwu S Ogah, Bruno Ramos Nascimento, Tefera Chane Mekonnen, Irina Filip, Bogdan Oancea, Lalit Dandona, Desalegn Markos Shifti, Nasir Salam, Binyam Minuye Birihane, Mohammad Ali Mansournia, Mohammad Ebrahimi Kalan, Sheetal D. Lad, Michael R.M. Abrigo, Ken Lee Chin, Masoud Moradi, Temesgen Yihunie Akalu, Behzad Heibati, Ole Frithjof Norheim, Man Mohan Mehndiratta, Mahya Beheshti, Ali Yadollahpour, Gelin Xu, Siamak Sabour, Neda Izadi, Carlos Culquichicón, Tuomo J. Meretoja, Ireneous N. Soyiri, Jacob Olusegun Olusanya, Félix Carvalho, Hamid Yimam Hassen, Dereje Bayissa Demissie, Yun Jin Kim, Rajesh Sagar, Fakher Rahim, Catrin E. Moore, Thomas R. Hird, Amjad Mohamadi-Bolbanabad, Naser Mohammad Gholi Mezerji, Ahamarshan Jayaraman Nagarajan, Anton Sokhan, Faris Lami, Masoud Behzadifar, Ritesh G. Menezes, Amira Hamed Darwish, Mohammad Zamani, Tesleem Kayode Babalola, Navid Manafi, Charles Shey Wiysonge, Diego Augusto Santos Silva, Daniel Diaz, Eleonora Dubljanin, Soraya Nouraei Motlagh, Suraj Bhattarai, Getasew Taddesse Worku, Noore Alam, Jasvinder A. Singh, Catalina Liliana Andrei, Ali Kazemi Karyani, Robert C. Reiner, Mohammedaman Mama Hussen, Fatemeh Heydarpour, Nuruzzaman Khan I, Bach Xuan Tran, Lal B. Rawal, Bereket Duko, Joemer C. Maravilla, Rakhi Dandona, Sandra B. Munro, Jae Il Shin, Julia Moreira Pescarini, Claudiu Herteliu, Ahmed Abdelalim, Manasi Kumar, Pushpendra Kumar, Saleem Muhammad Rana, Hedley Quintana, Akram Pourshams, Franz Castro, Muhammad Aziz Rahman, Beyene Meressa Adhena, Aberash Abay Tasew, Linda Morales, Dawit Zewdu Wondafrash, Wasiq Faraz Rawasia, David Laith Rawaf, Zoubida Zaidi, Tomislav Mestrovic, Rajeev Gupta, Seyyede Masoume Athari, Peter Njenga Keiyoro, Andrea Werdecker, Santi Martini, Fatemeh Rajati, Andre Pascal Kengne, Victor Adekanmbi, Seid Tiku Mereta, Yared Asmare Aynalem, Kewal Krishan, Marzieh Nojomi, Yves Miel H Zuniga, Mohammad Reza Sobhiyeh, Frank B. Osei, Nefsu Awoke, Randah R. Hamadeh, G. K. Mini, Edris Hasanpoor, Ayele Geleto Bali, Moslem Soofi, Prabhat Lamichhane, Peter Azzopardi, Amir Khater, G Anil Kumar, Catherine A. Welgan, Abraham Getachew Kelbore, Jaifred Christian F. Lopez, Senthilkumar Balakrishnan, Mohammad Ali Sahraian, Ahmed I. Hasaballah, Virendra Singh, Arash Ziapour, Zahid A Butt, Hebat Allah Salah A. Yousof, Tewodros Eshete Wonde, Sanjay Zodpey, Amaha Kahsay, Achala Upendra Jayatilleke, Segun Emmanuel Ibitoye, Beriwan Abdulqadir Ali, Simin Mouodi, Salman Rawaf, Iqbal R. F. Elyazar, Ai-Min Wu, Seyed Sina Naghibi Irvani, Yasir Waheed, Delia Hendrie, Hadi Pourjafar, Farnam Mohebi, Naohiro Yonemoto, Ahmad Ghashghaee, Veincent Christian Filipino Pepito, Paulina A. Lindstedt, Nauman Khalid, Sezer Kisa, Chi Linh Hoang, Niranjan Kissoon, Kindie Fentahun Muchie, Valery L. Feigin, Mathew M. Baumann, Alemayehu Toma, Andre Rodrigues Duraes, Benjamin B. Massenburg, Santosh Varughese, Yuan-Pang Wang, Ingan Ukur Tarigan, Ali Kiadaliri, Hamed Zandian, Demelash Woldeyohannes Handiso, Hassan Magdy Abd El Razek, Ketema Bizuwork Gebremedhin, Hafiz Ansar Rasul Suleria, Oluchi Ezekannagha, Getinet Ayano, Bolajoko O. Olusanya, Manu Raj Mathur, Manfred Accrombessi, Christopher J L Murray, Moritz U. G. Kraemer, Saeed Amini, Ziad A. Memish, Yousef Mohammad, Luis Camera, Ernoiz Antriyandarti, Ronny Westerman, Meghdad Pirsaheb, Negar Rezaei, Ted R. Miller, Aziz Eftekhari, Nevine El Nahas, Sebastian Vollmer, Sanjay Basu, Hesham M. Al-Mekhlafi, D. R. Mahadeshwara Prasad, Rufus A. Adedoyin, Miliva Mozaffor I, Mihiretu Kebede, Preeti Dhillon, Dilaram Acharya, Iman El Sayed, Narendar Manohar, Paul S. F. Yip, Ben Lacey, Felix Akpojene Ogbo, Adrian Davis, Dinh-Toi Chu, Ranjani Somayaji, Raaj Kishore Biswas, Taddese Alemu Zerfu, Claudio Alberto Dávila-Cervantes, Sharath Burugina Nagaraja, Getachew Mullu Kassa, Mohan Bairwa, Gurudatta Naik, André Karch, Gudlavalleti V S Murthy, Avula Laxmaiah, Farid Najafi, Birhanu Geta Meharie, Lorenzo Monasta, Amit Arora, Christopher S Yilgwan, Samer Hamidi, Keivan Ahmadi, Kebede Deribe, Ehimario U. Igumbor, Engida Yisma, Henok Biresaw Netsere, Mihajlo Jakovljevic, Ali S. Shalash, Thirunavukkarasu Sathish, Sachin R Atre, Mohamed I Hegazy, Mehedi Hasan, Hamidreza Haririan, Lucas Guimarães Abreu, Nejimu Biza Zepro, Surendra Karki, Krittika Bhattacharyya, Hiroshi Yatsuya, Gbenga A. Kayode, Osayomwanbo Osarenotor, Paul H. Lee, Deepak Paudel, Hagos Tasew Atalay, Hatem S Shehata, Mohammad Fareed, Adnan Kisa, Hisham Atan Edinur, Mehran Alijanzadeh, Shafiur Rahman, Mohammad Hossein Khosravi, Anusha Ganapati Bhat, Bahram Mohajer, Narinder Pal Singh, Shai Linn, Savita Lasrado, Joseph Adel Mattar Banoub, Amir Almasi-Hashiani, Mohd Anisul Karim, Praveen Hoogar, Kerrie E. Doyle, Bedilu Girma Weji, Juan Sanabria, Olatunji O. Adetokunboh, Mohamed Hsairi, Alireza Esteghamati, Seok Jun Yoon, Paramjit Gill, Dabere Nigatu, Tariq Jamal Siddiqi, Muhammad Usman, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Aziz Sheikh, Florian Fischer, Peter Memiah, Rakesh Lodha, Nihal Thomas, Karzan Abdulmuhsin Mohammad, Mohammad Sadegh Rezai, Tanuj Kanchan, Vinay Nangia, Ashraf Nabhan, Gebre Teklemariam Demoz, Eirini Skiadaresi, Aleksandra Barac, Simon I. Hay, Sadaf G. Sepanlou, Michellr L. Bell, Nicola Luigi Bragazzi, Aklilu Endalamaw, Vishnu Renjith, Chinwe Juliana Iwu, Gabrielle B. Britton, Colm McAlinden, Ayenew Negesse Abejie, Smita Pakhale, Doris V.V. Ortega-Altamirano, Noushin Mohammadifard, Deborah Carvalho Malta, Vo Dinh Bay, Kirsten E. Wiens, Hamidreza Karimi-Sari, Mustafa Z. Younis, Shaimaa I. El-Jaafary, Morenike Oluwatoyin Folayan, Phetole Walter Mahasha, Mu'awiyyah Babale Sufiyan, Harish Chander Gugnani, Mohammad Hifz Ur Rahman, Sheikh Mohammed Shariful Islam, Maarten J. Postma, Usman Iqbal, Abdu A. Adamu, Marwa R.Rashad Salem I, Fares Alahdab, Vafa Rahimi-Movaghar, Zulfiqar A. Bhutta, Masoud Foroutan, Muhammad Shahzeb Khan, In-Hwan Oh, Yahya Salimi, Takeshi Fukumoto, Chhabi Lal Ranabhat, Tiffany K. Gill, Angel Paternina-Caicedo, Walter Mendoza, Sojib Bin Zaman, Olayinka Stephen Ilesanmi, Brigette F. Blacker, Anbissa Muleta Senbeta, Subramanian Senthilkumaran, Ambrish Singh, Mehdi Fazlzadeh, Mahesh P A, Carlo La Vecchia, Alex Yeshaneh, Benjamin K. Mayala, Aniruddha Deshpande, Agus Sudaryanto, Neeraj Bedi, Morteza Shamsizadeh, Jemal Abdu Mohammed, Vahid Alipour, Haileab Fekadu Wolde, Boris Bikbov, Ahmed Abualhasan, Ali H. Mokdad, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Jacek Jerzy Jozwiak, Alessandra C. Goulart, Mahmoud Yousefifard, Masood Ali Shaikh, Roya Safari-Faramani, MohammadBagher Shamsi, Aso Mohammad Darwesh, Amir Anoushiravani, Kebede Embaye Gezae, Degena Bahrey Tadesse, Paula Moraga, Maha El Tantawi, Rosario Cárdenas, Assefa Desalew, Vivek Kumar, Mina Anjomshoa, Junaid Khan, Jagdish Khubchandani, Marcel Ausloos, Soraya Siabani, Anwar E. Ahmed, Mohammed Ibrahim Mohialdeen Gubari, Andre M. N. Renzaho, Vuong Minh Nong, Kaushik Sarkar, Bruno Piassi Sao Jose, Yafeng Wang, Mitchell T. Wallin, Edgar Denova-Gutiérrez, Mohammad Hasan Imani-Nasab, Melese Abate Reta, Kala M. Mehta, Yahya Safari, Marufa Sultana, David C. Schwebel, Roghayeh Mohammadibakhsh, Samath D Dharmaratne, Maysaa El Sayed Zaki, Shiwei Liu, Gail Davey, Milena Ilic, Yunquan Zhang, Bahram Armoon, Seyed-Mohammad Fereshtehnejad, Jost B. Jonas, Dian Kusuma, Yawukal chane Kasahun, Beatriz Paulina Ayala Quintanilla, Mohammad Moradi-Joo, Gebrehiwot G. Kassa, Maria Jesus Rios-Blancas, Serge Resnikoff, Seifadin Ahmed Shallo, Bartosz Miazgowski, Huda Basaleem, Jobert Richie Nansseu, Enrico Rubagotti, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Meysam Behzadifar, Maryam Adabi, Saravanan Muthupandian, Soumyadeep Bhaumik, hawariat, Carlos A Castañeda-Orjuela, Bhaskaran Unnikrishnan, Martin Amogre Ayanore, Dragos Virgil Davitoiu, Hossein Poustchi, Moses K. Muriithi, Dharmesh Kumar Lal, Ayman Grada, Rafael Tabarés-Seisdedos, Seyyed Shamsadin Athari, Ashish Pathak, Salvatore Rubino, Kenji Shibuya, Ana Laura Manda, Muluken Bekele Sorrie, Vivekanand Jha, Habtamu Kebebe Kasaye, Mohammad Hoseini, Sonali Kochhar, Van C. Lansingh, Ali Almasi, Amir Radfar, Till Bärnighausen, Marcia R. Weaver, Mowafa Househ, Arya Haj-Mirzaian, Gebremicheal Gebreslassie Kasahun, Arash Etemadi, Getahun Fentaw Mulaw, Zubair Kabir, Cuong Tat Nguyen, Chabila C Mapoma, Aubrey J. Levine, Solomon Gedlu Nigatu, Aslam Pervaiz, Muhammed Magdy Abd El Razek, Nataliya A. Foigt, Andrey Nikolaevich Briko, Sadaf Esteghamati, Chuanhua Yu, Pascual R. Valdez, Jennifer Rickard, Jennifer M. Ross, Ionut Negoi, Hailay Abrha Gesesew, Kamarul Imran Musa, Farshad Pourmalek, Kiomars Sharafi, Sangram Kishor Patel, Vera Marisa Costa, Mostafa Hosseini, Hajer Elkout, Mika Shigematsu, Bryan L. Sykes, Afarin Rahimi-Movaghar, Nuworza Kugbey, Vijay Kumar Chattu, Payman Salamati, Mona M. Khater, Reta Tsegaye Gayesa, Ehsan Sadeghi, Andrew T Olagunju, Govinda Prasad Dhungana, Dina Nur Anggraini Ningrum, Yaschilal Muche Belayneh, Leonardo Roever, Luca Ronfani, Nathaniel J. Henry, Brijesh Sathian, Hamid Sharifi, Liliana Preotescu, Joshua Longbottom, Somayeh Bohlouli, Huong Lan Thi Nguyen, Khaled Khatab, Ziyad Al-Aly, Ghobad Moradi, Ruth W Kimokoti, Jalal Arabloo, Mariam Molokhia, Maciej Banach, Hasan Yusefzadeh, Rahman Shiri, Girmay Teklay Weldesamuel, Mekdes Tigistu Yilma, Taweewat Wiangkham, Soewarta Kosen, Kovin Naidoo, Fernando de la Hoz, Mohammed Shannawaz, Berhe Etsay Tesfay I, Yogesh Sabde, Syed Mohamed Aljunid, Belay Tessema, Reza Malekzadeh, Tinuke O Olagunju, Olatunde Aremu, Mohammad Reza Salahshoor, Derrick A Bennett, Oladimeji M. Adebayo, Teshome Gebre, Narayan Bahadur Mahotra, Nelson J. Alvis-Zakzuk, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Naderi, Mehdi Hosseinzadeh, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Rovshan Khalilov, Ai Koyanagi, Salman Khazaei, Ismael R. Campos-Nonato, Alaa Badawi, Amir Hasanzadeh, Gebreamlak Gebremedhn Gebremeskel, Gessessew Bugssa Hailu, Dessalegn Ajema Berbada, Kate E. LeGrand, Azadeh Shafieesabet, Nikolay Ivanovich Briko, Robert S. Bernstein, Irfan Ullah, Isaac Oluwafemi Dipeolu, Hadi Hassankhani, Keyghobad Ghadiri, Local Burden of Disease Diarrhoea Collaborator, Violante FS, Wiens, KE, Lindstedt, PA, Blacker, BF, Johnson, KB, Yisma, E, Ahmed, Muktar Beshir, Reiner, Robert C, Duko, Bereket, Local Burden of Disease Diarrhoea Collaborators, Microbes in Health and Disease (MHD), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Local Burden Dis Diarrhoea, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, GeoHealth, HUS Comprehensive Cancer Center, Clinicum, Institute for Molecular Medicine Finland, Department of Oncology, University of Helsinki, and Instituto de Saúde Pública da Universidade do Porto
Subjects: RJ101, medicine.medical_treatment, CHILDREN, ZINC, 0302 clinical medicine, 030212 general & internal medicine, media_common, Geography, lcsh:Public aspects of medicine, 1. No poverty, Low income and middle income countries, General Medicine, 3142 Public health care science, environmental and occupational health, 3. Good health, Child, Preschool, A990 Medicine and Dentistry not elsewhere classified, Geographical inequalities, 0605 Microbiology, Diarrhea, AFRICA, Inequality, DEATHS, media_common.quotation_subject, 030231 tropical medicine, Developing country, Article, RS, 1117 Public Health and Health Services, 03 medical and health sciences, MORBIDITY, Environmental health, DIARRHEAL DISEASE, medicine, Humans, Oral rehydration therapy, Healthcare Disparities, Developing Countries, Models, Statistical, CHOLERA, MORTALITY, Infant, Newborn, Infant, lcsh:RA1-1270, Bayes Theorem, Middle income, GLOBAL BURDEN, Child mortality, 0605 Microbiology, 1117 Public Health and Health Services, Health Care Surveys, ITC-ISI-JOURNAL-ARTICLE, Fluid Therapy, NA, Human medicine, ITC-GOLD
Abstract: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. This work was primarily supported by a grant from the Bill & Melinda Gates Foundation (OPP1132415). L G Abreu has received support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance Code 001), Conselho Nacional de Desenvolvimento Científico e Tecnológico and Fundação de Amparo à Pesquisa do Estado de Minas Gerais. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. H T Atalay acknowledges Aksum University. M Ausloos and C Herteliu are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. P S Azzopardi was supported by an Australian National Health and Medical Research Council (NHMRC) early career fellowship. A Badawi is supported by the Public Health Agency of Canada. T W Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research; the EU; the Wellcome Trust; and from National Institute of Child Health and Human Development of National Institutes of Health (NIH; R01-HD084233), National Institute on Aging of NIH (P01-AG041710), National Institute of Allergy and Infectious Diseases of NIH (R01-AI124389 and R01-AI112339), as well as Fogarty International Center of NIH (D43-TW009775). G B Britton is supported by Sistema Nacional de Investigación (SNI) de la Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT) of Panamá. A Barac is funded by the Project of Ministry of Education, Science and Technology of the Republic of Serbia (number III45005). D A Bennett was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health and Social Care. V M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/Ministério da Ciência, Tecnologia e Ensino Superior through national funds. K Deribe is supported by a Wellcome Trust grant (number 201900/Z/16/Z) as part of his International Intermediate Fellowship. C Herteliu is partially supported by a grant co-funded by European Fund for Regional Development through the Operational Program for Competitiveness (project ID P_40_382). P Hoogar thanks Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education, Manipal and Centre for Holistic Development and Research, Kalaghatgi-Karnataka. S M S Islam is funded by a Fellowship from National Heart Foundation of Australia and Deakin University. M Jakovljevic and the Serbian part of this GBD contribution was co-funded through grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. A P Kengne is supported by the South African Medical Research Council. Y J Kim's work was supported by the Research Management Centre, Xiamen University Malaysia, grants number XMUMRF/2018-C2/ITCM/0001. K Krishan is supported by a DST PURSE grant and UGC Center of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar acknowledges K43 TW010716-03. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the British Heart Foundation Centre of Research Excellence, Oxford. P T N Memiah acknowledges the Council for the Development of Social Science Research in Africa. M Molokhia is supported by the NIHR Biomedical Research Center at Guy's and St Thomas' National Health Service Foundation Trust and King's College London. I Moreno Velásquez is supported by the Sistema Nacional de Investigación (SENACYT, Panamá). G C Patton is funded by an NHMRC Fellowship. A M Samy received a fellowship from the Egyptian Fulbright Mission programme. M M Santric-Milicevic acknowledges the support of the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). A Sheikh acknowledges the support of Health Data Research UK. M R Sobhiyeh acknowledges the Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences for their wise advice. R Tabarés-Seisdedos was supported in part by grant PI17/00719 from Instituto de Salud Carlos III–FEDER. B Unnikrishnan acknowledges Manipal Academy of Higher Education, Manipal. M R Weaver was supported by the Bill & Melinda Gates Foundation grant OPP1127433. C S Wiysonge was supported by the South African Medical Research Council.
Published: 2020
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17. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Sorin Hostiuc, Shaun Wen Huey Lee, Jorge R. Ledesma, Carsten Flohr, Masoumeh Sadeghi, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Mehdi Bohluli, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Seyyed Meysam Mousavi, Bernhard T. Baune, Ehsan Ahmadpour, Dinh-Toi Chu, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Mohammad Taghi Khodayari, Gianna Gayle Herrera Amul, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Michael K. Hole, Azeem Majeed, Iman Halvaei, Saqib Ali, Arianna Maever L. Amit, Tomas Y. Yeheyis, John S. Ji, Martin McKee, Jamileh Shadid, Leonardo Roever, Peng Jia, Ettore Beghi, Pablo M. Lavados, Young Eun Kim, Vahid Alipour, Sowmya J. Rao, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nicole K. DeCleene, Ebrahim Babaee, Saman Esmaeilnejad, Boris Bikbov, William M. Gardner, Lydia M. Haile, Luca Ronfani, Azalea M. Thomson, Irena Ilic, Ruth W. Kimokoti, Yingxi Zhao, Guoqing Hu, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Nathaniel J. Henry, Brijesh Sathian, Daniel Kim, Peter Memiah, Mohammad Hadi Abbasi, Andrea Farioli, Zahra Kamiab, Bolajoko O. Olusanya, Matthew C. Doxey, Tommi Vasankari, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Shanshan Li, Tanvir M. Huda, Dillon O Sylte, Rosario Cárdenas, Agegnehu Bante, Helen Ippolito, Alyssa Acebedo, Jeffrey D. Stanaway, Anwar Faraj, João Pedro Silva, Amin Mousavi Khaneghah, Pushpendra Kumar, Sangram Kishor Patel, Josephine W. Ngunjiri, Holly E. Erskine, Eugene Sobngwi, Filippo Ariani, Shane D. Morrison, Mohammad Aghaali, Meghan D. Mooney, Vera Marisa Costa, Palash Chandra Banik, Rupak Desai, Ken Takahashi, Maigeng Zhou, Morteza Oladnabi, Bogdan Oancea, Daniela Ribeiro, Mohammad Farahmand, Irmina Maria Michalek, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Emilie R Maddison, Syed Mohamed Aljunid, Damian G. Hoy, Hosni Salem, V. Prakash, Shuhei Nomura, Inga Dora Sigfusdottir, Anders Larsson, Sharareh Eskandarieh, Abdollah Mohammadian-Hafshejani, Somayeh Bohlouli, Joana Morgado-da-Costa, Siamak Sabour, Theo Vos, Han Yong Wunrow, Khaled Khatab, Alireza Zangeneh, Ann Kristin Knudsen, Marissa B Reitsma, Hannah J. Henrikson, Randah R. Hamadeh, Tuomo J. Meretoja, Ireneous N. Soyiri, Giuseppe Grosso, Ziyad Al-Aly, Taraneh Yousefinezhadi, Joseph L Ward, Roba Khundkar, Ricardo Santiago Gomez, Reza Malekzadeh, John J. McGrath, Sandra B. Munro, Shahin Soltani, Amy E. Peden, Rufus Akinyemi, Marcel Ausloos, Naohiro Yonemoto, Bogdan Wojtyniak, Ahmad Ghashghaee, Guilherme Borges, Sadia Bibi, Farhad Islami, Hamed Mirzaei, Mohammad Ali Sahraian, M. Ashworth Dirac, Hosna Janjani, Kairat Davletov, Hermann Brenner, Yuichiro Yano, Elissa M. 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Bennitt, Maciej Banach, Antonio Biondi, Donal Bisanzio, Josip Car, Ronny Westerman, Shafiu Mohammed, Biniyam Sahiledengle Geberemariyam, Kenji Shibuya, Meghdad Pirsaheb, Milena Santric-Milicevic, Karen M. Tabb, Paula Moraga, Soheil Hassanipour, Hasan Yusefzadeh, Avina Vongpradith, Dara K. Mohammad, Ralph Maddison, Babak Moazen, Getachew Mullu Kassa, Rahman Shiri, Fernando Neves Hugo, Hmwe H Kyu, Zachary V Dingels, Florian Fischer, Valentin Yurievich Skryabin, Rafael Tabarés-Seisdedos, Massimo Cirillo, Nikita Otstavnov, Robert C. Reiner, Van C. Lansingh, Rodrigo Sarmiento-Suarez, Ashkan Afshin, Benjamin A Stark, Mohsen Abbasi-Kangevari, Natalie C. Galles, Behnam Heidari, Eun-Kee Park, Mohammad Ali Jahani, Suzanne Polinder, Mahalaqua Nazli Khatib, Farhad Jadidi-Niaragh, Amir Radfar, Mowafa Househ, Derrick A Bennett, Gaorui Guo, Hesam Ghiasvand, Taweewat Wiangkham, Tamás Joó, Cristiana Abbafati, Kathryn Mei Ming Lau, Anita K. Nandi, Miklós Szócska, Manasi Kumar, Eduardo A. 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L., Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Public Health, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, GBD 2019 Diseases and Injuries Collaborator, Violante FS, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, and UT-I-ITC-ACQUAL
Subjects: Male, Life expectancy, Disability-Adjusted Life Year, Diseases, Disease, communicable disease, systematic analysis, Global Burden of Disease, 0302 clinical medicine, 80 and over, Medicine, 10. No inequality, Child, 11 Medical and Health Sciences, injuries, Aged, 80 and over, education.field_of_study, Sjúkdómar, DEMENTIA, FALLS, General Medicine, Forvarnir, 3. Good health, Child, Preschool, Human, GBD, Population health, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Humans, Global Burden of Disease Study, education, Aged, Spatial Analysis, Global burden, Disability, Prevention, DISABILITY, Infant, Spatial Analysi, Mortality rate, Global Burden of Disease, Diseases, Injuries, Systematic analysis, PREVENTION, Years of potential life lost, Risk factors, Disease study, ITC-ISI-JOURNAL-ARTICLE, RISK-FACTORS, Clinical Medicine, RA, Demography, Fötlun, Dánartíðni, Áhættuþættir, 030204 cardiovascular system & hematology, Risk Factors, Cause of Death, Global health, 030212 general & internal medicine, 1. No poverty, Disability-Adjusted Life Years, Public Health, Global Health, Social Medicine and Epidemiology, Middle Aged, 3142 Public health care science, environmental and occupational health, Adolescent, Adult, Age Distribution, Female, Infant, Newborn, Young Adult, Lýðheilsa, CLINICAL-TRIALS, Population, Settore MED/01 - Statistica Medica, diseases, ITC-HYBRID, Heilbrigðisvísindi, General & Internal Medicine, Mortality, Preschool, Disease burden, business.industry, Risk Factor, Klinisk medicin, Newborn, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Áverkar, Systematic analysis, NA, business
Abstract: Publisher's version (útgefin grein), Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd., Research reported in this publication was supported by the Bill & Melinda Gates Foundation; the University of Melbourne; Queensland Department of Health, Australia; the National Health and Medical Research Council, Australia; Public Health England; the Norwegian Institute of Public Health; St Jude Children's Research Hospital; the Cardiovascular Medical Research and Education Fund; the National Institute on Ageing of the National Institutes of Health (award P30AG047845); and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated, the National Health Service (NHS), the National Institute for Health Research (NIHR), the UK Department of Health and Social Care, or Public Health England; the United States Agency for International Development (USAID), the US Government, or MEASURE Evaluation; or the European Centre for Disease Prevention and Control (ECDC). This research used data from the Chile National Health Survey 2003, 2009-10, and 2016-17. The authors are grateful to the Ministry of Health, the survey copyright owner, for allowing them to have the database. All results of the study are those of the authors and in no way committed to the Ministry. The Costa Rican Longevity and Healthy Aging Study project is a longitudinal study by the University of Costa Rica's Centro Centroamericano de Poblacion and Instituto de Investigaciones en Salud, in collaboration with the University of California at Berkeley. The original pre-1945 cohort was funded by the Wellcome Trust (grant 072406), and the 1945-55 Retirement Cohort was funded by the US National Institute on Aging (grant R01AG031716). The principal investigators are Luis Rosero-Bixby and William H Dow and co-principal investigators are Xinia Fernandez and Gilbert Brenes. The accuracy of the authors' statistical analysis and the findings they report are not the responsibility of ECDC. ECDC is not responsible for conclusions or opinions drawn from the data provided. ECDC is not responsible for the correctness of the data and for data management, data merging and data collation after provision of the data. ECDC shall not be held liable for improper or incorrect use of the data. The Health Behaviour in School-Aged Children (HBSC) study is an international study carried out in collaboration with WHO/EURO. The international coordinator of the 1997-98, 2001-02, 2005-06, and 2009-10 surveys was Candace Currie and the databank manager for the 1997-98 survey was Bente Wold, whereas for the following surveys Oddrun Samdal was the databank manager. A list of principal investigators in each country can be found on the HBSC website. Data used in this paper come from the 2009-10 Ghana Socioeconomic Panel Study Survey, which is a nationally representative survey of more than 5000 households in Ghana. The survey is a joint effort undertaken by the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana and the Economic Growth Centre (EGC) at Yale University. It was funded by EGC. ISSER and the EGC are not responsible for the estimations reported by the analysts. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with license number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. Data for this research was provided by MEASURE Evaluation, funded by USAID. The authors thank the Russia Longitudinal Monitoring Survey, conducted by the National Research University Higher School of Economics and ZAO Demoscope together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology, Russia Academy of Sciences for making data available. This paper uses data from the Bhutan 2014 STEPS survey, implemented by the Ministry of Health with the support of WHO; the Kuwait 2006 and 2014 STEPS surveys, implemented by the Ministry of Health with the support of WHO; the Libya 2009 STEPS survey, implemented by the Secretariat of Health and Environment with the support of WHO; the Malawi 2009 STEPS survey, implemented by Ministry of Health with the support of WHO; and the Moldova 2013 STEPS survey, implemented by the Ministry of Health, the National Bureau of Statistics, and the National Center of Public Health with the support of WHO. This paper uses data from Survey of Health, Ageing and Retirement in Europe (SHARE) Waves 1 (DOI:10.6103/SHARE. w1.700), 2 (10.6103/SHARE.w2.700), 3 (10.6103/SHARE.w3.700), 4 (10.6103/SHARE.w4.700), 5 (10.6103/SHARE.w5.700), 6 (10.6103/SHARE.w6.700), and 7 (10.6103/SHARE.w7.700); see Borsch-Supan and colleagues (2013) for methodological details. The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N degrees 211909, SHARE-LEAP: GA N degrees 227822, SHARE M4: GA N degrees 261982) and Horizon 2020 (SHARE-DEV3: GA N degrees 676536, SERISS: GA N degrees 654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and from various national funding sources is gratefully acknowledged. This study has been realised using the data collected by the Swiss Household Panel, which is based at the Swiss Centre of Expertise in the Social Sciences. The project is financed by the Swiss National Science Foundation. The United States Aging, Demographics, and Memory Study is a supplement to the Health and Retirement Study (HRS), which is sponsored by the National Institute of Aging (grant number NIA U01AG009740). It was conducted jointly by Duke University and the University of Michigan. The HRS is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. This paper uses data from Add Health, a program project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website. No direct support was received from grant P01-HD31921 for this analysis. The data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government. Collection of data for the Mozambique National Survey on the Causes of Death 2007-08 was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00. This manuscript is based on data collected and shared by the International Vaccine Institute (IVI) from an original study IVI conducted. L G Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (Brazil; finance code 001) and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, a Brazilian funding agency). I N Ackerman was supported by a Victorian Health and Medical Research Fellowship awarded by the Victorian Government. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. A Agrawal acknowledges the Wellcome Trust DBT India Alliance Senior Fellowship. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. M Ausloos, C Herteliu, and A Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. A Badawi is supported by the Public Health Agency of Canada. D A Bennett was supported by the NIHR Oxford Biomedical Research Centre. R Bourne acknowledges the Brien Holden Vision Institute, University of Heidelberg, Sightsavers, Fred Hollows Foundation, and Thea Foundation. G B Britton and I Moreno Velasquez were supported by the Sistema Nacional de Investigacion, SNI-SENACYT, Panama. R Buchbinder was supported by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship. J J Carrero was supported by the Swedish Research Council (2019-01059). F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. A R Chang was supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant K23 DK106515. V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundacao para a Ciencia e Tecnologia, IP, under the Norma Transitaria DL57/2016/CP1334/CT0006. A Douiri acknowledges support and funding from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, and support from the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. B B Duncan acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. H E Erskine is the recipient of an Australian NHMRC Early Career Fellowship grant (APP1137969). A J Ferrari was supported by a NHMRC Early Career Fellowship grant (APP1121516). H E Erskine and A J Ferrari are employed by and A M Mantilla-Herrera and D F Santomauro affiliated with the Queensland Centre for Mental Health Research, which receives core funding from the Queensland Department of Health. M L Ferreira holds an NHMRC Research Fellowship. C Flohr was supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust. M Freitas acknowledges financial support from the EU (European Regional Development Fund [FEDER] funds through COMPETE POCI-01-0145-FEDER-029248) and National Funds (Fundacao para a Ciencia e Tecnologia) through project PTDC/NAN-MAT/29248/2017. A L S Guimaraes acknowledges support from CNPq. C Herteliu was partially supported by a grant co-funded by FEDER through Operational Competitiveness Program (project ID P_40_382). P Hoogar acknowledges Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education and Centre for Holistic Development and Research, Kalaghatagi. F N Hugo acknowledges the Visiting Professorship, PRINT Program, CAPES Foundation, Brazil. B-F Hwang was supported by China Medical University (CMU107-Z-04), Taichung, Taiwan. S M S Islam was funded by a National Heart Foundation Senior Research Fellowship and supported by Deakin University. R Q Ivers was supported by a research fellowship from the National Health and Medical Research Council of Australia. M Jakovljevic acknowledges the Serbian part of this GBD-related contribution was co-funded through Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. P Jeemon was supported by a Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust-Department of Biotechnology, India Alliance (2015-20). O John is a recipient of UIPA scholarship from University of New South Wales, Sydney. S V Katikireddi acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13, MC_UU_12017/15), and the Scottish Government Chief Scientist Office (SPHSU13, SPHSU15). C Kieling is a CNPq researcher and a UK Academy of Medical Sciences Newton Advanced Fellow. Y J Kim was supported by Research Management Office, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/00010). K Krishan is supported by UGC Centre of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar was supported by K43 TW 010716 FIC/NIMH. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. J V Lazarus was supported by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III [ISCIII]/ESF, the EU [CP18/00074]). K J Looker thanks the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England, for research support. S Lorkowski was funded by the German Federal Ministry of Education and Research (nutriCARD, grant agreement number 01EA1808A). R A Lyons is supported by Health Data Research UK (HDR-9006), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, NIHR (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. J J McGrath is supported by the Danish National Research Foundation (Niels Bohr Professorship), and the Queensland Health Department (via West Moreton HHS). P T N Memiah acknowledges support from CODESRIA. U O Mueller gratefully acknowledges funding by the German National Cohort Study BMBF grant number 01ER1801D. S Nomura acknowledges the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). A Ortiz was supported by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. S B Patten was supported by the Cuthbertson & Fischer Chair in Pediatric Mental Health at the University of Calgary. G C Patton was supported by an aNHMRC Senior Principal Research Fellowship. M R Phillips was supported in part by the National Natural Science Foundation of China (NSFC, number 81371502 and 81761128031). A Raggi, D Sattin, and S Schiavolin were supported by grants from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4-Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). P Rathi and B Unnikrishnan acknowledge Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. A L P Ribeiro was supported by Brazilian National Research Council, CNPq, and the Minas Gerais State Research Agency, FAPEMIG. D C Ribeiro was supported by The Sir Charles Hercus Health Research Fellowship (#18/111) Health Research Council of New Zealand. D Ribeiro acknowledges financial support from the EU (FEDER funds through the Operational Competitiveness Program; POCI-01-0145-FEDER-029253). P S Sachdev acknowledges funding from the NHMRC of Australia Program Grant. A M Samy was supported by a fellowship from the Egyptian Fulbright Mission Program. M M Santric-Milicevic acknowledges the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). R Sarmiento-Suarez received institutional support from Applied and Environmental Sciences University (Bogota, Colombia) and ISCIII (Madrid, Spain). A E Schutte received support from the South African National Research Foundation SARChI Initiative (GUN 86895) and Medical Research Council. S T S Skou is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council under the EU's Horizon 2020 research and innovation program (grant agreement number 801790). J B Soriano is funded by Centro de Investigacion en Red de Enfermedades Respiratorias, ISCIII. R Tabares-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. N Taveira was partially supported by the European & Developing Countries Clinical Trials Partnership, the EU (LIFE project, reference RIA2016MC-1615). S Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral programme (reference number CD15/00019 from ISCIII-FEDER). S B Zaman received a scholarship from the Australian Government research training programme in support of his academic career., "Peer Reviewed"
Published: 2020
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18. Inequalities on mortality due to acute respiratory infection in children: A Colombian analysis

Author: Carlos Castañeda-Orjuela, Diana Patricia Díaz, Fernando de la Hoz, Karol Cotes, Pablo Chaparro, Nelson Alvis-Guzman, Liliana Castillo, Nelson J. Alvis-Zakzuk, and Angel Paternina-Caicedo
Subjects: Male, medicine.medical_specialty, lcsh:Arctic medicine. Tropical medicine, Inequality, lcsh:RC955-962, poverty, media_common.quotation_subject, Population, lcsh:Medicine, socioeconomic factors, factores socioeconómicos, respiratory tract infections, Infant mortality, Colombia, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, medicine, disparidades en atención de salud, Humans, 030212 general & internal medicine, mortalidad infantil, education, Socioeconomic status, Respiratory Tract Infections, media_common, education.field_of_study, child, Poverty, business.industry, pobreza, Mortality rate, Public health, lcsh:R, niño, Respiratory infection, Infant, Health Status Disparities, healthcare disparities, respiratory tract diseases, infecciones del sistema respiratorio, Socioeconomic Factors, Child, Preschool, Female, business, Demography
Abstract: Introduction: Acute respiratory infections (ARI) are a leading public health issue worldwide. Objective: To explore the inequalities in ARI mortality rates in under-5, according to socioeconomic characteristics. Materials and methods: We conducted an ecological analysis to study inequalities at municipal level due to ARI mortality in children under 5 years. The data were obtained from official death records of the Departamento Administrativo Nacional de Estadística. The analysis of inequalities in the under-5 mortality rate (U5MR) included: 1) Classification of the population in different socio-economic strata, and 2) measurement of the degree of inequality. We used the ARI-U5MR as an outcome measurement. The mortality rates were estimated at national and municipal levels for the years 2000, 2005, 2010, and 2013. Rate ratios, rates differences, and concentration curves were calculated to observe the inequalities. Results: A total of 18,012 children under 5 years died by ARI in Colombia from 2000 to 2013. ARIU5MR was greater in boys than in girls. During this period, an increase in the infant mortality relative gap in both boys and girls was observed. In 2013, the U5MR evidenced that for boys from municipalities with the highest poverty had a 1.6-fold risk to die than those in municipalities with the lowest poverty (low tercile). In girls, the ARI-U5MR for 2005 and 2013 in the poorest tercile was 1.5 and 2 times greater than in the first tercile, respectively. Conclusion: Colombian inequalities in the ARI mortality rate among the poorest municipalities compared to the richest ones continue to be a major challenge in public health. Resumen Introducción. Las infecciones respiratorias agudas (IRA) son un importante problema de salud pública a nivel mundial. Objetivo. Explorar las desigualdades de la tasa de mortalidad debida a IRA en niños menores de 5 años según las variables socioeconómicas. Materiales y métodos. Se hizo un análisis ecológico para estudiar las desigualdades a nivel municipal de las tasas de mortalidad por IRA en menores de 5 años. Los datos se obtuvieron a partir de los registros de muertes del Departamento Administrativo Nacional de Estadística. El análisis de desigualdades incluyó la clasificación de la población por estatus socioeconómico y la medición del grado de desigualdad. Como resultado en salud se utilizó la tasa de mortalidad por IRA en menores de 5 años. Se estimaron tasas a nivel nacional y municipal para 2000, 2005, 2010 y 2013. Se calcularon razones y diferencias de tasas y curvas de concentración para observar las desigualdades. Resultados. Entre 2000 y 2013 murieron por IRA en Colombia 18.012 menores de 5 años. La tasa de mortalidad por ARI fue mayor en niños que en niñas. En el periodo, se observó un incremento en la brecha de mortalidad infantil en ambos sexos. En el 2013, la tasa de niños que murieron en municipios con mayor pobreza fue 1,6 veces mayor que la de niños en aquellos con menos pobreza. En niñas, en el 2005 y el 2013, la tasa en el tercil más pobre fue 1,5 y 2 veces mayor que la del primer tercil, respectivamente. Conclusión. Las desigualdades en la tasa de mortalidad por IRA de los municipios más pobres en comparación con la de los más ricos, continúan siendo un reto importante en salud pública.
Published: 2018

19. Heterogeneity Between States in the Health and Economic Impact of Measles Immunization in the United States

Author: Julia Driessen, Angel Paternina-Caicedo, Mark S. Roberts, and Willem G. van Panhuis
Subjects: Counterfactual thinking, business.industry, vaccine impact, medicine.disease, Measles, 3. Good health, Major Articles, Vaccination, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Oncology, Immunization, measles vaccine, 030225 pediatrics, Environmental health, medicine, measles, 030212 general & internal medicine, Economic impact analysis, National average, Measles vaccine, business, Measles immunization
Abstract: BackgroundVaccines have been used successfully for disease elimination programs in many countries. Evidence on the impact of vaccination programs can support decision-making among medical practitioners and policy makers to improve immunization rates. We estimated the health and economic impact of measles vaccination for each of the 48 contiguous states and the District of Columbia since 1964.MethodsFor each state, we fitted multiple time-series models to prevaccination data and used the best-fitting model to predict counterfactual cases that would have occurred in the absence of vaccination. We then subtracted observed from counterfactual measles cases, deaths, and related costs to estimate the impact of vaccination.ResultsWe estimated that 149 million children were vaccinated against measles in the United States between 1964 and 2014, at a cost of $12.2 billion, and that vaccination prevented 29.8 million cases, 32 000 deaths, and $25.8 billion in societal costs. The impact exceeded the national average in 70% of Western and Northeastern states, compared with only 24% of Southern and Midwestern states.ConclusionsThe significant health and economic benefit of measles vaccination in the United States should encourage continued investments to sustain and expand vaccination programs globally.
Published: 2018

20. Epidemiological and Economic Impact of Monovalent and Pentavalent Rotavirus Vaccines in Low and Middle Income Countries

Author: Fernando De la Hoz-Restrepo, Angel Paternina-Caicedo, and Nelson Alvis-Guzman
Subjects: Microbiology (medical), medicine.medical_specialty, Office Visits, Cost effectiveness, Cost-Benefit Analysis, medicine.disease_cause, Rotavirus Infections, Environmental health, Rotavirus, Epidemiology, Disease Transmission, Infectious, Humans, Medicine, Economic impact analysis, Developing Countries, health care economics and organizations, Models, Statistical, business.industry, Incidence (epidemiology), Infant, Newborn, Rotavirus Vaccines, Infant, Survival Analysis, Rotavirus vaccine, Virology, Hospitalization, Vaccination, Infectious Diseases, Low and middle income countries, Child, Preschool, Pediatrics, Perinatology and Child Health, business
Abstract: Background: The competing choices of vaccination with either RV1 or RV5, the potential budget impact of vaccines on the EPI with different prices and new evidence make important an updated analysis for health decision makers in each country. The objective of this study is to assess cost-effectiveness of the monovalent and pentavalent rotavirus vaccines and impact on children deaths, inpatient and outpatient visits in 116 low and middle income countries that represent approximately 99% of rotavirus mortality. Methods: A decision tree model followed hypothetical cohorts of children from birth up to 5 years of age for each country in 2010. Inputs were gathered from international databases and previous research on incidence and effectiveness of monovalent and pentavalent vaccines. Costs were expressed in 2010 international dollars. Outcomes were reported in terms of cost per disability-adjusted life-year averted, comparing no vaccination with either monovalent or pentavalent mass introduction. Vaccine price was assumed fixed for all world low-income and middle-income countries. Results: Around 292,000 deaths, 3.34 million inpatient cases and 23.09 million outpatient cases would occur with no vaccination. In the base-case scenario, monovalent vaccination would prevent 54.7% of inpatient cases and 45.4% of deaths. Pentavalent vaccination would prevent 51.4% of inpatient cases and 41.1% of deaths. The vaccine was cost-effective in all world countries in the base-case scenario for both vaccines. Cost per disability-adjusted life-year averted in all selected countries was I$372 for monovalent, and I$453 for pentavalent vaccination. Conclusion: Rotavirus vaccine is cost-effective in most analyzed countries. Despite cost-effectiveness analysis is a useful tool for decision making in middle-income countries, for low-income countries health decision makers should also assess the impact of introducing either vaccine on local resources and budget impact analysis of vaccination.
Published: 2015
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21. Effect of rotavirus vaccine on childhood diarrhea mortality in five Latin American countries

Author: Lúcia Helena de Oliveira, Andres Castaño-Zuluaga, Angel Paternina-Caicedo, Karol Cotes-Cantillo, Wilfrido Coronell-Rodríguez, Oscar Gamboa-Garay, Fernando De la Hoz-Restrepo, Umesh D. Parashar, and Nelson Alvis-Guzman
Subjects: Diarrhea, Male, Latin Americans, Rotavirus Infections, Environmental protection, medicine, Humans, Panama, Childhood diarrhea, General Veterinary, General Immunology and Microbiology, business.industry, Incidence, Mortality rate, Infant, Newborn, Rotavirus Vaccines, Public Health, Environmental and Occupational Health, Infant, Survival Analysis, Rotavirus vaccine, Confidence interval, Child mortality, Latin America, Infectious Diseases, Child, Preschool, Molecular Medicine, Female, medicine.symptom, business, Demography
Abstract: The aim of this study was to estimate the association between rotavirus vaccine (RV) introduction and reduction of all-cause diarrhea death rates among children in five Latin American countries that introduced RV in 2006.Diarrhea mortality data was gathered from 2002 until 2009 from the Pan American Health Organization Mortality Database for five "vaccine adopter" countries (Brazil, El Salvador, Mexico, Nicaragua, and Panama) that introduced RV in 2006 and four "control" countries (Argentina, Chile, Costa Rica, and Paraguay) that did not introduce RV by 2009. Time trend analyses were carried out, and effects and 95% confidence intervals (CI) were estimated.Each of the five vaccine adopter countries, except Panama, showed a significant trend in declining mortality rates during the post-vaccine period from 2006 to 2009, whereas no decline was seen in control countries during these years. Furthermore, trends of reduction of all-cause diarrhea mortality in both children1 year of age and5 years of age were greater in the post-vaccination period compared with the pre-vaccine period in all vaccine adopter countries (except for Nicaragua), whereas in control countries, a reverse pattern was seen with greater reduction in the early years from 2002 to 2005 versus 2006-2009. An estimatedtotal of 1777 of annual under-5 deaths were avoided in Brazil, El Salvador, Mexico, and Nicaragua during the post-vaccination period.All vaccine adopter countries, except Panama, showed a significant decrease in all-cause diarrhea-related deaths after RV implementation, even after adjusting for declining trends over time in diarrhea mortality. These data strongly support continuous efforts to increase vaccination coverage of RV vaccines, particularly in countries with high levels of child mortality from diarrhea.
Published: 2015
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22. Sociodemographic Determinants of child nutrition in Colombia

Author: Verena del Carmen Marrugo-Arnedo, Carlos Alberto Marrugo-Arnedo, Robinson Castro-Ávila, Angel Paternina-Caicedo, Nelson Alvis-Guzman, and Deicy Moreno-Ruiz
Subjects: Z score, income, nutrición infantil, salud, puntaje Z, health, General Medicine, ingreso, Child nutrition
Abstract: Objetivo: Estimar los determinantes sociodemográficos de la nutrición infantil en Colombia. Materiales y métodos: Estudio transversal a partir del microdato de la Encuesta Nacional de Demografía y Salud 2010, agrupados por regiones. Se estimaron cuatro modelos de regresión múltiple, en los que las variables dependientes fueron el puntaje Z de la Talla para la Edad (TPE) y del Peso para la Edad (PPE) con el fin de establecer los factores sociodemográficos de mayor incidencia, utilizando el método de Mínimos Cuadrados Ordinarios (MCO). Resultados: La región Caribe y Bogotá presentaron mayores problemas de desnutrición infantil. En el quintil de ingreso más bajo el promedio de TPE en la región Caribe fue de -1,18 (RIC -1,91 a -0,42), mientras que en el quintil más alto fue de -0,29 (RIC -1,57 a -0,12). En Bogotá el promedio fue de -2,22 (RIC -2,37 a -2,06) en el primer quintil de ingreso y -0,83 (RIC-1,38 a -0,26) en el quinto quintil. El ingreso, el índice de masa corporal y la educación de la madre tienen un impacto positivo en la nutrición de los niños. El orden de nacimiento y la edad del niño mostraron que tienen incidencia negativa. Conclusiones: En las regiones las diferencias en la talla de los niños son significativas según la posición socioeconómica del hogar. Elevar el nivel de ingresos de la población y los años de escolaridad, así como la prevención de embarazos en adolescentes, podría jugar un papel fundamental en la disminución de la de desnutrición. Objective: To estimate the Sociodemographic determinants of child nutrition in Colombia. Materials and methods: A cross-sectional study was performed using micro-data from the National Demographic and Health Survey 2010, grouped by region. Four multiple regression models were estimated to explore the relationship between the dependent variables (Z score of height for age (HFA) and Weight for Age (WFA)) and socioeconomic factors in order to establish the factors with higher impact. Ordinary least squares regression was used to model these relationships. Results: The Caribbean region and Bogotá were the regions with larger problems on child malnutrition compared to other regions. In lowest-income quintile, the average of the HFA in the Caribbean region was -1.18 (QIR -0.42 to -1.91 ) while in the higher-income quintile amounted to -0.29 (QIR -1.57 to -0.12). In Bogotá this value corresponded to -2.22 (QIR -2.06 to -2.37) in the first-income quintile and to -0.83 (QIR -1.38 to -0.26) in the fifth quintile. Income, BMI and maternal education have a significant and positive impact on children's nutrition while the birth order and the age of the child showed negative repercussions. Conclusions: Within Regions, differences in the size of the child are significant according to the socioeconomic level of the household. An increased level of incomes and years of schooling, and the prevention of teenage pregnancy could play a key role in the decrease of malnutrition.
Published: 2015
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23. A comprehensive care program achieves high remission rates in rheumatoid arthritis in a middle-income setting. Experience of a center of excellence in Colombia

Author: Pedro Santos-Moreno, Laura Villarreal-Peralta, Nelson J. Alvis-Zakzuk, Nelson Alvis-Guzman, M Carrasquilla-Sotomayor, and Angel Paternina-Caicedo
Subjects: Male, Program evaluation, medicine.medical_specialty, Time Factors, Center of excellence, Patient-centered care, Immunology, Colombia, Severity of Illness Index, Arthritis, Rheumatoid, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Patient-Centered Care, Internal medicine, Health care, Severity of illness, medicine, Humans, Immunology and Allergy, Prospective Studies, 030212 general & internal medicine, Rheumatoid arthritis, Prospective cohort study, Aged, Patient Care Team, 030203 arthritis & rheumatology, Delivery of Health Care, Integrated, business.industry, Incidence (epidemiology), Remission Induction, Treat to target, Middle Aged, medicine.disease, Combined Modality Therapy, Treatment Outcome, Antirheumatic Agents, Models, Organizational, Income, Female, Comprehensive Health Care, business, Program Evaluation
Abstract: Management of rheumatoid arthritis (RA) in many Latin-American countries is impaired by fragmentation and scarce healthcare provision, resulting in obstacles to access, diagnosis, and treatment, and consequently in poor health outcomes. The aim of this study is to propose a comprehensive care program as a model to provide healthcare to RA patients receiving synthetic DMARDs in a Colombian setting by describing the model and its results. Health outcomes were prospectively collected in all patients entering the program. By protocol, patients are followed up during 24 months using a treat-to-target strategy with a patient-centered care (PCC) model, meaning that a patient should be seen by rheumatologist, physical and occupational therapist, physiatrist, nutritionist and psychologist, at least three times a year according to disease activity by DAS28. Otherwise, patients receive standard therapy. The incidence of remission and low disease activity (LDA) was calculated by periods of follow-up. A total of 968 patients entered the program from January 2015 to December 2016; 80.2% were women. At baseline, 41% of patients were in remission, 17% in LDA and 42% in MDS/SDA. At 24 months of follow-up, 66% were in remission, 18% in LDA and only 16% in MDS/SDA. Regarding DAS28, the mean at the beginning of the time analysis was 3.1 (SD 1.0) and after 24 months it was 2.4 (SD 0.7), showing a statistically significant improvement (p
Published: 2018

24. Differential diagnosis of dengue and chikungunya in colombian children using machine learning

Author: Hernando Pinzón-Redondo, William Caicedo-Torres, Angel Paternina-Caicedo, Jairo A. Gutiérrez, Ferme E., Simari G.R., Gutierrez Segura F., and Rodriguez Melquiades J.A.
Subjects: Artificial intelligence, Support vector machine, Computer science, Decision trees, 030231 tropical medicine, Decision tree, Logistic regression, Stratified random sampling, Learning algorithms, Machine learning, computer.software_genre, medicine.disease_cause, Pediatrics, Dengue fever, Dengue, 03 medical and health sciences, 0302 clinical medicine, Logistic regressions, Statistical tests, 030225 pediatrics, Decision tree classifiers, Diagnosis, medicine, CART, Receiver operating characteristics, Chikungunya, Support vector machines, Receiver operating characteristic, business.industry, Logistic Regression modeling, medicine.disease, Stratified sampling, Test set, business, computer, Regression analysis
Abstract: Dengue and chikungunya are vector borne diseases endemic in tropical countries around the world, with very similar clinical presentation, which makes it hard for physicians to tell them apart. Here we propose the use of Machine Learning based classifiers to perform differential diagnosis of dengue and chikungunya in pediatric patients, using simple blood test results as predictors instead of symptoms. Three variables (platelet count, white cell count and hematocrit percentage) from 447 pediatric patients from Hospital Infantil Napoleón Franco Pareja were collected to construct a dataset, later partitioned into train and test sets using Stratified Random Sampling. Grid Search with Stratified 5-Fold Cross-Validation was conducted to assess the performance of Logistic Regression, Support Vector Machine, and CART Decision Tree classifiers. Cross-Validation results show a L2 Logistic Regression model with second degree polynomial features outperforming the other models considered, with a cross-validated Receiver Operating Characteristic Area Under the Curve (ROC AUC) score of 0.8694. Subsequent results over the test set showed a 0.8502 ROC AUC score. Despite a reduced sample and a heavily imbalanced data set, ROC AUC score results are promising and support our approach for dengue and chikungunya differential diagnosis. © Springer Nature Switzerland AG 2018.
Published: 2018

25. Economic Costs of Chikungunya Virus in Colombia

Author: Hernando Pinzón-Redondo, Diana Díaz-Jiménez, Fernando De la Hoz-Restrepo, Nelson J. Alvis-Zakzuk, M Carrasquilla-Sotomayor, Liliana Castillo-Rodríguez, Angel Paternina-Caicedo, Nelson Alvis-Guzman, and Carlos Castañeda-Orjuela
Subjects: Adult, Male, medicine.medical_specialty, 030231 tropical medicine, Economics, Econometrics and Finance (miscellaneous), Colombia, medicine.disease_cause, Disease Outbreaks, 03 medical and health sciences, Indirect costs, 0302 clinical medicine, Cost of Illness, Interquartile range, Economic cost, Environmental health, medicine, Humans, 030212 general & internal medicine, Economic impact analysis, Chikungunya, Pharmacology, Toxicology and Pharmaceutics (miscellaneous), Productivity, health care economics and organizations, Retrospective Studies, business.industry, Health Policy, Public health, Outbreak, Child, Preschool, Chikungunya Fever, Female, Health Expenditures, business, Chikungunya virus
Abstract: Objective The aim of the present study was to estimate the economic impact of chikungunya virus (CHIKV) infection in Colombia from a societal perspective. Methods We conducted a retrospective, bottom-up cost-of-illness study in clinically confirmed cases during the first chikungunya (CHIK) outbreak in Colombia in 2014. Direct and indirect costs were estimated per patient. Economic costs were calculated by the addition of direct costs (direct medical costs and out-of-pocket heath expenditures) and indirect cost as a result of loss of productivity. Results A total of 126 patients (67 children and 59 adults) with CHIK were included. The median of the direct medical cost in children was US$257.9 (interquartile range [IQR] 121.7–563.8), and US$66.6 (IQR 26.5–317.3) for adults. The productivity loss median expenditures reached US$81.3 (IQR 72.2–203.2) per adult patient. The median economic cost in adults as a result of CHIK was US$152.9 (IQR 101.0–539.6), of which 53.2% was a result of indirect costs. Out-of-pocket expenditures comprised 3.3% of all economic costs. Conclusions Our study can help health decision makers to properly assess the burden of disease caused by CHIK in Colombia, an endemic tropical country. We recommend to strength the health information systems and to continue investing in public health measures to prevent CHIK.
Published: 2017

26. Features of Dengue and Chikungunya Infections of Colombian Children under 24 Months of Age Admitted to the Emergency Department

Author: María Auxiliadora Badillo-Viloria, Fernando De la Hoz-Restrepo, Nelson Alvis-Guzman, Dagna Constenla, Angel Paternina-Caicedo, Hernando Pinzón-Redondo, Salim Mattar, Fredi Alexander Diaz-Quijano, William Caicedo-Torres, and Doris Bula-Anichiarico
Subjects: Male, Platelet count, Pediatrics, Complications, Dengue virus, Real time polymerase chain reaction, medicine.disease_cause, Dengue fever, Dengue, 0302 clinical medicine, Medicine, 030212 general & internal medicine, Chikungunya, Prospective Studies, Child, Prospective cohort study, Children, Severe dengue, Diagnostic test accuracy study, Hospital emergency service, Algorithm, Colombian, Retrospective study, Sensitivity and specificity, Infectious Diseases, Differential diagnosis, Female, Emergency Service, Hospital, Chikungunya virus, Algorithms, Human, medicine.medical_specialty, Major clinical study, Colombia, Sensitivity and Specificity, Article, SAÚDE DA CRIANÇA, Diagnosis, Differential, 03 medical and health sciences, 030225 pediatrics, Humans, Prospective study, Retrospective Studies, business.industry, Infant, Newborn, Infant, Retrospective cohort study, Emergency department, Dengue Virus, Newborn, medicine.disease, Confidence interval, Retrospective studies, Clinical feature, Preschool child, Statistics and numerical data, Pediatrics, Perinatology and Child Health, Chikungunya Fever, Comparative study, business, Controlled study
Abstract: We aimed to assess clinical and laboratory differences between dengue and chikungunya in children or < ajpaterninac@unal.edu.co>.
Published: 2017

27. Orthosis for thoracolumbar burst fractures without neurologic deficit: A systematic review of prospective randomized controlled trials

Author: Andrei Fernandes-Joaquim, Luis Rafael Moscote-Salazar, Gabriel Alcalá-Cerra, Cindy Diaz-Becerra, and Angel Paternina-Caicedo
Subjects: medicine.medical_specialty, lcsh:Diseases of the musculoskeletal system, posterior ligamentous complex, law.invention, Physical medicine and rehabilitation, Burst fracture, Quality of life, Randomized controlled trial, law, medicine, Back pain, orthosis, Pooled data, business.industry, Significant difference, thoracolumbar spine, medicine.disease, Brace, instability, Radiological weapon, Physical therapy, Surgery, Original Article, Neurology (clinical), medicine.symptom, lcsh:RC925-935, business
Abstract: Background: Traditionally, conservative treatment of thoracolumbar (TL) burst fractures without neurologic deficit has encompassed the application of an extension brace. However, their effectiveness on maintaining the alignment, preventing posttraumatic deformities, and improving back pain, disability and quality of life is doubtful. Objective: The objective was to identify and summarize the evidence from randomized controlled trials (RCTs) to determine whether bracing patients who suffer TL fractures adds benefices to the conservative manage without bracing. Materials and Methods: Seven databases were searched for relevant RCTs that compared the clinical and radiological outcomes of orthosis versus no-orthosis for TL burst fractures managed conservatively. Primary outcomes were: (1) Loss of kyphotic angle; (2) failure of conservative management requiring subsequent surgery; and (3) disability and pain outcomes. Secondary outcomes were defined by health-related quality of life and in-hospital stay. Results: Based on predefined inclusion criteria, only two eligible high-quality RCTs with a total of 119 patients were included. No significant difference was identified between the two groups regarding loss of kyphotic angle, pain outcome, or in-hospital stay. The pooled data showed higher scores in physical and mental domains of the Short-Form Health Survey 36 in the group treated without orthosis. Conclusion and Recommendation: The current evidence suggests that orthosis could not be necessary when TL burst fractures without neurologic deficit are treated conservatively. However, due to limitations related with number and size of the included studies, more RCTs with high quality are desirable for making recommendations with more certainty.
Published: 2014

28. Tendencias na mortalidade relacionada a hemorragia subaracnoidea na Colombia: analise de um registro nacional de 10 anos

Author: Adam M.H. Young, Gabriel Alcalá-Cerra, Angel Paternina-Caicedo, and Eduardo Carvalhal Ribas
Subjects: Adult, Male, Subarachnoid hemorrhage, Time Factors, subarachnoid hemorrhage, Population, morbidity, Colombia, lcsh:RC321-571, Colombian population, symbols.namesake, Young Adult, Age Distribution, Non traumatic, medicine, Humans, Poisson regression, Poisson Distribution, Young adult, Mortality, Sex Distribution, education, aneurisma, morbidade, lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry, Aged, Aged, 80 and over, education.field_of_study, mortalidade, business.industry, Mortality rate, Middle Aged, Subarachnoid Hemorrhage, medicine.disease, intracranial aneurysm, mortality, hemorragia subaracnoidea, Epidemiological transition, Neurology, symbols, Female, Neurology (clinical), business, Demography
Abstract: Objective To assess trends in mortality from 1999 to 2008 resulting from non-traumatic subarachnoid hemorrhage (SAH) in the Colombian population. Method This population-based study analyzed all deaths by assuming a Poisson model. Results Subarachnoid hemorrhage-related deaths showed a statistically significant increase of 1.6% per year (p
Published: 2013

29. Mortality Risk Prediction With an Updated Acute Physiology and Chronic Health Evaluation II Score in Critically Ill Obstetric Patients

Author: Jezid E. Miranda-Quintero, Angel Paternina-Caicedo, Jose Rojas-Suarez, Ghada Bourjeily, and Carmelo Dueñas-Castel
Subjects: Adult, Critical Illness, Population, Physiology, Colombia, Critical Care and Intensive Care Medicine, Severity of Illness Index, law.invention, Cohort Studies, Pregnancy, law, Peripartum Period, Humans, Medicine, Hospital Mortality, education, APACHE, Retrospective Studies, education.field_of_study, APACHE II, Critically ill, business.industry, Reproducibility of Results, Retrospective cohort study, Prognosis, medicine.disease, Survival Analysis, Intensive care unit, Confidence interval, Pregnancy Complications, Intensive Care Units, Maternal Mortality, ROC Curve, Female, business, Cohort study
Abstract: Background:Acute Physiology and Chronic Health Evaluation II (APACHE II) score has shown low prognostic ability to predict death in the obstetric population. The objective of this study was to evaluate whether an updated form of the APACHE II score would perform better in predicting mortality in critically ill obstetric patients.Methods:A retrospective cohort study of pregnant and postpartum women (up to 42 days after delivery) who were admitted to the intensive care unit (ICU) was carried out at an ICU at Rafael Calvo Maternity Hospital, a large obstetric hospital in Colombia. Data were collected on consecutive obstetric patients admitted to the ICU between 2006 and 2011. A discrimination and calibration analysis was completed on the original APACHE II score and an updated APACHE II score.Results:Data were collected on a total of 726 obstetric patients. The area under the receiver–operating characteristic curve was 0.86 (95% confidence interval [95% CI], 0.80-0.93) for both APACHE II and the updated APACHE II scores. Mortality ratio for the original APACHE II was 0.30 (95% CI, 0.19-0.41) and 0.85 (95% CI, 0.56-1.24) for the updated APACHE II.Conclusions:The APACHE II overestimates mortality in the sample population. The updated APACHE II model predicts mortality more accurately in the obstetric population. This formula may be useful in adapting the existing APACHE II to current mortality risk in obstetric critical care populations.
Published: 2013
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30. Treatment costs of diarrheal disease and all-cause pneumonia among children under-5 years of age in Colombia

Author: Nelson Alvis-Guzman, F. De la Hoz-Restrepo, Luis Alvis-Estrada, Julio Orozco-Africano, Wilfrido Coronell-Rodríguez, D. Jervis-Jálabe, and Angel Paternina-Caicedo
Subjects: Diarrhea, Pediatrics, medicine.medical_specialty, Cost effectiveness, Population, Developing country, Colombia, Cost of Illness, Interquartile range, Health care, medicine, Humans, education, education.field_of_study, General Veterinary, General Immunology and Microbiology, business.industry, Public Health, Environmental and Occupational Health, Infant, Health Care Costs, Pneumonia, medicine.disease, Confidence interval, Hospitalization, Infectious Diseases, Child, Preschool, Molecular Medicine, medicine.symptom, business, Demography
Abstract: Objective We estimate treatment costs associated with diarrheal disease and all-cause pneumonia among children under-5 years of age in Colombia and assess similarities or differences with previous cost estimations in developing countries of the Americas. Methods Macro-costing methods were used to carry out an analysis of diarrhea and all-cause pneumonia costs in Colombia in 2010. The perspective of the health care system was taken. Data were extracted from a health insurer database that includes information on health service utilization among 130,800 children from low-income households. Lengths of stay for hospital admissions and frequencies of cases at all levels of care registered in the database were estimated. Results There were 1456 diarrheal disease cases among the 130,800 children (aged ≥60 months) included in the study. The median cost per case was $27.10 (interquartile range [IQR]: $15.60–77.40). A total of 1545 all-cause pneumonia cases were reported to the insurer in 2010, resulting in a frequency of 1181 cases per 100,000 children (95% confidence interval [CI] = 1122, 1240). The overall cost of all-cause pneumonia cases was $858,791, and the median cost per case treated was $263 (IQR: $27–546). Comparisons by level of care showed that costs were significantly different for the two diseases ( p p > .05). Conclusions Diarrhea and all-cause pneumonia constitute a significant economic and health burden in Colombia. The relatively large size of our sample allowed us to provide reliable national estimates of the costs associated with these diseases. Our results for Colombia are similar to previous estimates from developing countries in the Americas. These data provide valid estimates that may be used decision makers in other countries to make appropriate recommendations on the introduction of rotavirus and pneumococcal vaccines.
Published: 2013
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31. Department of Error

Author: BIJU ABRAHAM, Rajiv Chowdhury, Hassan Magdy Abd El Razek, ZOUBIDA ZAIDI, Marcella Montico, Ileana Beatriz Heredia-Pi, Burcu Kucuk Bicer, Samer Hamidi, Rintaro Mori, Nataliya Foigt, Samir Bhatt, Kalpana Balakrishnan, Lope Barrero, John McGrath, Bishal Gyawali, Ingrid Wolfe, Konstantinos Stroumpoulis, Ibrahim Ginawi, Sibhatu Biadgilign, Carla Farinha, Kenji Shibuya, Sait Mentes Birlik, Vafa Rahimi-Movaghar, RAJESH SAGAR, Pengpeng Ye, Peter Meaney, Boris Bikbov, Sivadasanpillai Harikrishnan, Aleksandra Barac, Daniel Kim, Graeme Hankey, Giancarlo Logroscino, Bruno Sunguya, Heidi J. Larson, Amador Goodridge, Khalid Altirkawi, João Fernandes, Joan B Soriano, Edson Servan-Mori, Francis Mhimbira, Ibrahim Abubakar, Peter Gething, Gholamreza Roshandel, Bemnet Amare Tedla, Rakhi Dandona, Rajaa Al-Raddadi, Rafael Lozano, Scott Patten, Diego Augusto Santos Silva, RAJ VERMA, Maziar Moradi-Lakeh, Norberto Perico, Om Prakash Singh, Eyal Oren, Eduardo Bernabe, Bach Tran, Fisaha Haile Tesfay (PhD), Ben Schöttker, Mustafa Younis, Jiabin Shen, Rafael Tabares-Seisdedos, Mahdi Mahdavi, Yousef Khader, Gizachew A Tessema, Charles Wiysonge, Hajo Zeeb, Ana Maria Nogales Vasconcelos, AMANUEL GEBREMEDHIN, Azmeraw T. Amare, Jacob Olusanya, Angel Paternina-Caicedo, Maria Dolores Sanchez-Niño, Yohannes Adama Melaku, Vivekanand Jha, George Mugambage Ruhago, Olalekan Uthman, Farshad Farzadfar, Nelson Alvis-Guzmán, Khurshid Alam, Srinivas Murthy, Johanna Marianna Geleijnse, Alemayehu Mekonnen, Ivo Rakovac, Soraya Seedat, Amir Kasaeian, Yibeltal Bayou, Andrew Kemp, David Pereira, Raimundas Lunevicius, EMERITO JOSE A. FARAON, Samantha Colquhoun, Ai Koyanagi, Ted Miller, JUNG-CHEN CHANG, Demewoz Haile, Zubair Kabir, Suleman Atique, Richard Franklin, Jose Martinez-Raga, Sergey Soshnikov, Yohannes Kinfu, Konrad Pesudovs, Johan Ärnlöv, Adugnaw Berhane, Alireza Esteghamati, Niranjan Kissoon, Shafiu Mohammed, Jean Nachega, Derrick Bennett, Karzan Mohammad, Hwashin Hyun SHIN, Tissa Wijeratne, and Subas Neupane
Subjects: Child mortality, Burden of disease, 03 medical and health sciences, 030219 obstetrics & reproductive medicine, 0302 clinical medicine, History, 030212 general & internal medicine, General Medicine, Article, 3. Good health, Demography
Abstract: GBD 2015 Child Mortality Collaborators. 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. Lancet 2016; 388: 1725–74—In this Article, Mohsen Naghavi, Michael J Kutz, Chantal Huynh, Samer Hamidi, Addisu Shunu Beyene, and Stephen S Lim should have been listed as authors. The affiliation details for Simon I Hay have been updated. The funding statement for Simon I Hay has been added. These corrections have been made to the online version as of Jan 5, 2017.
Published: 2017

32. How cost effective is universal varicella vaccination in developing countries? A case-study from Colombia

Author: Fernando De la Hoz-Restrepo, Martha Velandia-González, Carlos A Castañeda-Orjuela, Nelson Alvis-Guzman, Oscar Gamboa-Garay, and Angel Paternina-Caicedo
Subjects: medicine.medical_specialty, Cost effectiveness, Cost-Benefit Analysis, Developing country, Colombia, Chickenpox Vaccine, Chickenpox, Environmental health, Epidemiology, Health care, Humans, Medicine, Economic impact analysis, Developing Countries, health care economics and organizations, Models, Statistical, General Veterinary, General Immunology and Microbiology, Cost–benefit analysis, business.industry, Decision Trees, Vaccination, Public Health, Environmental and Occupational Health, medicine.disease, Virology, Infectious Diseases, Costs and Cost Analysis, Molecular Medicine, business
Abstract: Objective Varicella vaccination has not been introduced worldwide, especially in developing countries. The present study assesses the potential epidemiological and economic impact of one-dose and two-dose varicella vaccination schemes in Colombia, a south American upper middle-income country. Methods A decision-tree based model was developed. Varicella cases were estimated based on previous reports of seropositivity within the country. Cost per life-year gained (LYG) was the main outcome measure. Costs from the health care system perspective were expressed in 2008 American dollars. Deterministic and probabilistic sensitivity analyses were performed. Results In Colombia, there would be 700,197 varicella cases in an average year plus 60 yearly deaths without vaccination. It was estimated that health care costs for all cases during 30 years period could be around US $88,734,735 (with discount). Cost per LYG of one-dose vaccination was US $2519 and using a two-dose scheme was US $5728. Conclusion Vaccinating against varicella in Colombia, an upper middle-income South American country is cost-effective under the assumptions used in this study. Decision-makers should consider introducing universal varicella vaccination in Colombia, given the effectiveness, safety and cost-effectiveness of this intervention.
Published: 2013
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33. Concordancia de tres definiciones de síndrome metabólico en pacientes hipertensos

Author: Jaime Paillier Gonzales, Nelson Alvis-Guzman, Gabriel Alcalá-Cerra, Angel Paternina-Caicedo, and Ángela M. Romero-Zarante
Subjects: Public Health, Environmental and Occupational Health
Abstract: Objetivo Determinar la concordancia entre tres definiciones de sindrome metabolico (SMet) en pacientes hipertensos colombianos. Materiales y Metodos Se diseno un estudio descriptivo en 323 pacientes hipertensos de Cartagena de Indias. Se realizo historia clinica, medicion de tension arterial, perimetro abdominal, lipidos sericos y glucosa serica en ayunas. Se comparo la prevalencia de SMet segun la definicion del Adult Treatment Panel III (ATP III), la American Heart Association (AHA), la International Diabetes Federation (IDF), y la IDF modificada (perimetro abdominal ??88 cm en varones). Se evaluo la concordancia mediante el test de Kappa media de Cohen. Resultados El 77,5 % de los pacientes fueron mujeres. La prevalencia global de SMet fue de 59,9 % (ATP III), 83,6 % (AHA), 81,2 % (IDF) y 92.9 % (IDFm). La concordancia fue al menos clara en las comparaciones de definiciones, excepto la comparacion de IDFm con ATP III y AHA. La mayor concordancia se obtuvo en la comparacion IDF-AHA (?? =0,638). Conclusiones La prevalencia de SMet fue mas alta en pacientes hipertensos colombianos que en otros paises. El analisis de concordancia demostro al menos, una clara concordancia la mayoria de las definiciones analizadas. Con una correlacion pobre entre los criterios comparados con el IDFm (excepto con el IDF no modificado).
Published: 2009
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34. Risk Factors for Severity of Chikungunya in Children: A Prospective Assessment

Author: Hernando Pinzón-Redondo, Irina Suley Tirado-Pérez, Rossana Fortich, Katherine Barrios-Redondo, Angel Paternina-Caicedo, Nelson Alvis-Guzman, Andrea Carolina Zarate-Vergara, and Salim Mattar
Subjects: Microbiology (medical), Male, Pediatrics, medicine.medical_specialty, viruses, 030231 tropical medicine, MEDLINE, macromolecular substances, Colombia, Chikungunya fever, medicine.disease_cause, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, parasitic diseases, medicine, Humans, 030212 general & internal medicine, Chikungunya, Prospective Studies, Prospective cohort study, business.industry, Age Factors, virus diseases, Infant, Infectious Diseases, Child, Preschool, Pediatrics, Perinatology and Child Health, Chikungunya Fever, Female, Risk assessment, business, Viral load
Abstract: Chikungunya appeared during the second half of 2014 in Colombia. A prospective cohort study was carried to detect differences and severity between neonates and older children. Of 54 children with chikungunya, neonates had a higher viral load and greater frequency of severe laboratory and clinical findings.
Published: 2016

35. Economic Costs of Bacterial Meningitis: A Systematic Review

Author: M Carrasquilla-Sotomayor, Angel Paternina-Caicedo, D Castillo-Saavedra, N Alvis-Zakzuk, W Coronel-Rodriguez, J Herrera-Arrieta, and N. Alvis-Guzman
Subjects: Text mining, business.industry, Economic cost, Health Policy, Public Health, Environmental and Occupational Health, Medicine, Bacterial meningitis, business, Data science
Published: 2015
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36. Desigualdades de la mortalidad infantil y pobreza en Colombia: Análisis inter-censal (1993 y 2005)

Author: Nelson J. Alvis-Zakzuk, Nelson Alvis-Guzman, M Carrasquilla-Sotomayor, Angel Paternina-Caicedo, and Fernando De la Hoz-Restrepo
Subjects: education.field_of_study, Medicine (General), Population, Mortalidad infantil, General Medicine, Geography, Inequidad social, R5-920, Desigualdades en la salud, education, Pobreza, Humanities, Demography
Abstract: Introduccion: la pobreza es un determinante sensible del estado de salud de una poblacion y directamente relacionado con la presencia de algunas condiciones patologicas. Objetivo : estudiar las desigualdades departamentales y regionales de la tasa de mortalidad infantil en Colombia en 1993 y 2005. Materiales y metodos : se realizo estudio ecologico que mide las desigualdades regionales de la tasa de mortalidad infantil (TMI) en Colombia, para los anos de los censos de poblacion de 1993 y 2005. Para esto se utilizaron indicadores como: razon y diferencia de tasas (RT y DT), indice de efecto y riesgo atribuible poblacional (RAP). Resultados : en 1993 la diferencia absoluta entre los departamentos con mayor y menor pobreza (Choco: 80.4%; Bogota, D.C.:17.3%) fue 63.1%. Para 2005, esta diferencia paso a ser del 70.4%. Para los mismos anos, entre estos departamentos la RT de mortalidad infantil fue de 2.9 y 4.2 y las DT fue de 56.4 y 59.2 respectivamente. La pobreza (NBI) explico en mayor medida la mortalidad infantil en el 2005, comparado con el ano censal de 1993 (R22005: 63.8% versus R21993: 34.2%). El coeficiente β de la regresion lineal para 1993 fue 0.3393 (IC95%:0.1669-0.5518), por cada punto porcentual que disminuyo el NBI en los departamentos, se observo reduccion en la TMI de 0.3393 muertes por cada mil nacidos vivos. Para 2005 esta reduccion fue de 0.6456 por cada mil nacidos vivos (IC95%:0,4679-0.8234). Conclusiones : aunque Colombia mantiene una tendencia de permanente reduccion de la TMI, persisten grandes desigualdades entre departamentos y regiones las cuales se incrementaron en el periodo intercensal analizado. Rev.cienc.biomed. 2015;6(1):29- 37 PALABRAS CLAVE Desigualdades en la salud; Mortalidad infantil; Pobreza; Inequidad social. SUMMARY Introduction: Poverty is a sensible determinant of the health status of a population Objective: To study the departmental and regional inequality of the infant mortality rate (IMR) in Colombia in 1993 and 2005. Methods: an ecological study that measures the regional inequalities of the IMR in Colombia was carried out for the years of the population census of 1993 and 2005. For this, indicators as incidence rate (IR) and difference of rates (DR), effects index and Population-attributable risk (PAR), were used. Results: In 1993, the absolute difference between the departments with major and minor poverty (Choco: 80.4%; Bogota, D.C.:17.3%) was 63.1%. For 2005, this difference became 70.4%. For the same years, between these departments the IR of infant mortality was 2.9 and 4.2 and the DR was 56.4 and 59.2, respectively. The poverty (UBN) explained, to a large extent, the infant mortality in 2005 in comparison with 1993 (R22005: 63.8% versus R21993: 34.2%). The β coefficient of the lineal regression for 1993 was 0.3393 (CI95%:0.1669-0.5518) and by each percent point that the UBN decreased in the departments, a reduction in the IMR of 0.3393 deaths by each one thousand born alive was observed. For 2005, this reduction was 0.6456 by each one thousand born alive (CI95%:0,4679-0.8234). Conclusions: Although Colombia maintains a tendency of permanent reduction of the IMR, big inequalities between departments and regions increased in the intercensal period analyzed.. Rev.cienc.biomed. 2015;6(1):29-37 KEYWORDS Health inequalities; Infant mortality; Poverty; Social inequality.
Published: 2015

37. Maternal mortality secondary to acute respiratory failure in Colombia: a population-based analysis

Author: Jose Rojas-Suarez, Carmelo Dueñas, Angel Paternina-Caicedo, Gerardo Carino, Camilo Bello-Muñoz, and Ghada Bourjeily
Subjects: Pulmonary and Respiratory Medicine, Adult, medicine.medical_specialty, Population, Pulmonary Edema, Colombia, Young Adult, Pre-Eclampsia, Pregnancy, Sepsis, medicine, Humans, Intensive care medicine, education, Retrospective Studies, education.field_of_study, Obstetrics, business.industry, Mortality rate, Postpartum Period, medicine.disease, Pulmonary edema, Pulmonary embolism, Standardized mortality ratio, Maternal Mortality, Respiratory failure, Acute Disease, Maternal death, Female, business, Pulmonary Embolism, Respiratory Insufficiency, Live Birth
Abstract: To estimate the mortality rate and trends of respiratory failure in the pregnant and postpartum population of Colombia. A retrospective analysis of the national registry of mortality in Colombia was performed from 1998 to 2009. Maternal death was defined as death that occurred during pregnancy or up to 42 days postpartum. Two independent investigators reviewed maternal deaths to determine deaths caused by respiratory failure. Inter-rater agreement was assessed by kappa correlation coefficient. Causes of respiratory failure were identified according to the International Classification of Diseases (ICD-10). During the study period, 8,637,486 live births were reported with 6,676 maternal deaths for an overall maternal mortality rate (MMR) of 82.9 per 100,000 live births. Of these, a total of 835 cases were related to respiratory failure, with a specific MMR of 9.69 per 100,000 live births. The main causes of maternal deaths due to respiratory failure included pulmonary sepsis (284 cases, or 3.58 per 100,000 live births), pulmonary embolism (119 cases or 1.50 per 100,000 live births), and preeclampsia-related pulmonary edema (112 cases or 1.41 per 100,000 live births). All-cause maternal mortality ratio decreased yearly from 1998 to 2009 by −3.76 % (95 % CI −4.83 to −2.67), while the trend of mortality secondary to respiratory failure remained stable over time (P = 0.449). Respiratory failure is an important cause of mortality in the obstetric population in Colombia, with pulmonary sepsis as the lead cause of respiratory failure among maternal deaths. While overall maternal mortality rates have decreased in the last decade, respiratory failure-related deaths have remained stable over time.
Published: 2014

38. Efficacy and safety of subdural drains after burr-hole evacuation of chronic subdural hematomas: systematic review and meta-analysis of randomized controlled trials

Author: Adam M.H. Young, Luis Rafael Moscote-Salazar, Gabriel Alcalá-Cerra, and Angel Paternina-Caicedo
Subjects: medicine.medical_specialty, business.industry, Cochrane Library, Confidence interval, Jadad scale, Neurosurgical Procedures, law.invention, Surgery, Clinical trial, Treatment Outcome, Chronic subdural hematoma, Randomized controlled trial, law, Meta-analysis, Relative risk, Hematoma, Subdural, Chronic, Medicine, Drainage, Humans, Neurology (clinical), business, Craniotomy, Randomized Controlled Trials as Topic
Abstract: Objective To determine whether the use of a subdural drain after burr-hole evacuation of a chronic subdural hematoma is safe and effective in preventing recurrence and subsequent operations, and as such improving functional outcomes. Methods The literature search included the following databases: PubMed, the National Institutes of Health/National Library of Medicine, Clinical Trials Registry, CENTRAL (The Cochrane Library), EMBASE, and LILACS. The search was performed in June 2013, and did not have restrictions or filters with regard to language or year of publication. Methodologic quality was assessed through the Jadad's scale. Primary outcomes were recurrence and reoperation rates. Secondary outcomes were functional outcome, mortality, and postoperative complications. Results were presented as pooled Mantel-Haenszel relative risks (RR), with 95% confidence intervals (95% CI). Results A total of 7 randomized controlled trials were analyzed. Three studies were classified as high methodologic quality and four as low quality. Pooled RR were symptomatic recurrence (RR 0.51; 95% CI 0.36–0.75), reoperation (RR 0.5; 95% CI 0.34–0.74), poor functional outcome (RR 0.61, 95% CI 0.39–0.98), mortality (RR 0.67, 95% CI 0.37–1.22), and postoperative complications (RR 1.28, 95% CI 0.78–2.11). There was no statistically significant heterogeneity within the outcomes. Conclusions The meta-analysis demonstrates that the insertion of a subdural drain was associated with a statistically significant reduction in the risk of symptomatic recurrence and the requirement for further surgical intervention of chronic subdural hematoma after surgical evacuation. Furthermore, it was associated with statistically significant improvements in both short-term and long-term functional outcome.
Published: 2014

39. Performance of two World Health Organization Dengue classifications in a Pediatric Cohort from Colombia

Author: Hernando Pinzón-Redondo, F. De la Hoz-Restrepo, A. Zarate-Vergara, Nelson Alvis-Guzman, K. Barrios-Redondo, Fredi Alexander Diaz-Quijano, and Angel Paternina-Caicedo
Subjects: medicine.medical_specialty, Pediatrics, business.industry, Health Policy, Family medicine, Cohort, Public Health, Environmental and Occupational Health, medicine, business, medicine.disease, World health, Dengue fever
Published: 2015
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40. Medical care costs of Chikungunya Virus infection in a Pediatric Population in Colombia

Author: Nelson Alvis-Guzman, F. De la Hoz-Restrepo, Hernando Pinzón-Redondo, L. Rodríguez-Castillo, Carlos A Castañeda-Orjuela, Angel Paternina-Caicedo, and Diana Díaz-Jiménez
Subjects: medicine.medical_specialty, business.industry, Health Policy, Chikungunya Virus Infection, Public Health, Environmental and Occupational Health, Medicine, business, Intensive care medicine, Medical care, health care economics and organizations, Pediatric population
Published: 2015
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41. Characterization of rotavirus genotypes before and after the introduction of a monovalent rotavirus vaccine in Colombia

Author: Dioselina, Peláez-Carvajal, Karol, Cotes-Cantillo, Angel, Paternina-Caicedo, Jon, Gentsch, Fernando, de la Hoz-Restrepo, and Manish, Patel
Subjects: Male, Rotavirus, Molecular Epidemiology, Genotype, Child, Preschool, Infant, Newborn, Prevalence, Rotavirus Vaccines, Humans, Infant, Female, Colombia, Rotavirus Infections
Abstract: Strain monitoring for emergence of novel strains after the introduction of rotavirus vaccine is an integral component of routine rotavirus immunization programs. Using a laboratory based strain surveillance system between 2008 and 2012, a wide variation in strain pattern in Colombia was founded both before and after the introduction of a monovalent rotavirus vaccine in 2009. G2P[4], a strain fully heterotypic to the vaccine was predominant before vaccine introduction in 2008 (47%) and after vaccine introduction in 2010 (54%), 2011 (86%), and 2012 (32%). The presence of this strain before the introduction of vaccine and decreasing prevalence during the most recent surveillance year suggests secular variation rather than vaccine pressure as a cause for this fluctuation. While strain monitoring can be valuable after vaccine introduction, these surveillance data alone without information on disease incidence or strain specific vaccine effectiveness can be prone to misinterpretation with regard to the role of vaccine pressure on emergence of new or persistent strains.
Published: 2014

42. Comparison of severity-of-illness scores in critically ill obstetric patients: a 6-year retrospective cohort

Author: Jose Rojas-Suarez, Ray Mendoza, Carmelo Dueñas-Castel, Jezid Miranda, Ghada Bourjeily, and Angel Paternina-Caicedo
Subjects: Adult, medicine.medical_specialty, Mortality probability model II, Calibration (statistics), Critical Illness, Colombia, Critical Care and Intensive Care Medicine, Severity of Illness Index, Cohort Studies, Pregnancy, Severity of illness, medicine, Peripartum Period, Humans, Mortality prediction, Simplified Acute Physiology Score, APACHE, Retrospective Studies, Academic Medical Centers, Analysis of Variance, Critically ill, business.industry, Mortality probability model, Reproducibility of Results, Retrospective cohort study, Survival Analysis, Intensive Care Units, Maternal Mortality, Area Under Curve, Emergency medicine, Female, business
Abstract: The purpose of this research was to evaluate the discrimination and calibration of mortality prediction of Simplified Acute Physiology Score 2, Simplified Acute Physiology Score 3, Mortality Probability Model II, and Mortality Probability Model III in peripartum women.A retrospective cohort study.Rafael Calvo Maternity Hospital, a large teaching hospital in Cartagena (Colombia).All obstetric patients admitted to the ICU from 2006 to 2011.None.Seven hundred twenty-six obstetric critical care patients were included. All scores showed good discrimination (area under the receiver operator characteristic curve0.86). Simplified Acute Physiology Score 2, Simplified Acute Physiology Score 3, and Mortality Probability Model III inaccurately estimated mortality. The only mortality prediction score that showed good calibration through mortality ratio and Hosmer-Lemeshow test was Mortality Probability Model II. Mortality ratio for Mortality Probability Model II was 0.88 (95% CI, 0.60-1.25). Hosmer-Lemeshow test was not significant (p = 0.571).Simplified Acute Physiology Score 2 and Simplified Acute Physiology Score 3 overestimate mortality in obstetric critical care patients. Mortality Probability Model III was inadequately calibrated. Mortality Probability Model II showed good fit to predict mortality in a developing country setting. Future studies in developed and developing countries are needed to further confirm our findings.
Published: 2014

43. Effectiveness of the monovalent rotavirus vaccine in Colombia: a case-control study

Author: Nelson Alvis-Guzman, Fernando De la Hoz-Restrepo, Karol Cotes-Cantillo, Angel Paternina-Caicedo, Manish M. Patel, Umesh D. Parashar, and Wilfrido Coronell-Rodríguez
Subjects: Male, medicine.medical_specialty, Colombia, medicine.disease_cause, Rotavirus Infections, Feces, Internal medicine, Rotavirus, Medicine, Humans, General Veterinary, General Immunology and Microbiology, business.industry, Vaccination, Public Health, Environmental and Occupational Health, Case-control study, Rotavirus Vaccines, Infant, Rotavirus vaccine, Virology, Confidence interval, Diarrhea, Infectious Diseases, Logistic Models, Case-Control Studies, Child, Preschool, Diarrhea, Infantile, Molecular Medicine, Conditional logistic regression, Female, medicine.symptom, business
Abstract: Objective To assess the effectiveness of the monovalent rotavirus vaccine (RV1) to prevent rotavirus diarrhea admissions to emergency departments (ED) in Colombia. Methods A multicenter case-control study was carried out in six Colombian cities from 2011 to January, 2013. Cases were laboratory confirmed rotavirus diarrhea patients admitted to ED of selected health centers. Controls were patients with non-rotavirus diarrhea. Vaccination status was card-confirmed. Vaccine effectiveness and 95% confidence intervals (CI) were calculated from the conditional logistic regression models using the formula 1 − adjusted odds ratio × 100. Results 1051 fecal samples were collected from 193 cases and 858 controls. Vaccination history was confirmed on 173 cases (90%) and 801 controls (93%). Among the rotavirus-positive samples with vaccination history, 57% were G2P[4], 9.8% G9P[8], 6% G9P[6]. Median age of cases (17 months) was greater than controls (15 months) ( P P = 0.025). The adjusted effectiveness was 79.19% (95% CI, 23.7 to 94.32) among children 6–11 months of age and −39.75% (95% CI, −270.67 to 47.24) among those >12 months of age. Against overnight rotavirus hospitalizations, RV1 provided protection of 84.42% (95% CI, 22.68 to 96.86) among children 6–11 months of age, and −79.49% (95% CI, −555.8 to 51.08) among those >12 months. Conclusions RV1 provided significant protection against rotavirus hospitalization among children under 1 year of age in the Colombian setting. The observation of lower effectiveness in children >12 months requires further assessment.
Published: 2013

44. Maternal mortality due to pandemic influenza A H1N1 2009 virus in Colombia

Author: Isabel Peña, Sara García, Adriana Pacheco, Ghada Bourjeily, Gloria Rey, Jose Rojas-Suarez, Angel Paternina-Caicedo, Edgar Parra, Liliana Cuevas, Ricardo Cifuentes, José Daza, Elena Fino, Orlando Castillo, Sofía Angulo, and Andrew Levinson
Subjects: Adult, medicine.medical_specialty, Pediatrics, medicine.medical_treatment, Disease, Colombia, medicine.disease_cause, Influenza A Virus, H1N1 Subtype, Pregnancy, Pandemic, Influenza, Human, Influenza A virus, medicine, Humans, Pregnancy Complications, Infectious, Intensive care medicine, Pandemics, Retrospective Studies, Mechanical ventilation, business.industry, Obstetrics and Gynecology, medicine.disease, Vaccination, Pneumonia, Maternal Mortality, Pediatrics, Perinatology and Child Health, Female, business, Case series
Abstract: Aims: The 2009 H1N1 pandemic illustrated the higher morbidity and mortality from viral infections in peripartum women. We describe clinical features of women who recently died of H1N1 in Colombia. Methods: This is a case series study that was gathered through a retrospective record review of all maternal H1N1 deaths in the country. The national mortality database of confirmed mortality from H1N1 in pregnancy and up to 42 days after delivery was reviewed during the H1N1 season in 2009. Women with H1N1 infections were confirmed by the laboratory of virology. Demographic, clinical, and laboratory data were reviewed. Statistical analyses were performed and median values of non-parametric data were reported with inter-quartile range (IQR). Results: A total of 23 H1N1 maternal deaths were identified. Eighty-three percent occurred in the third trimester. None of the mothers who died had received influenza vaccination. The median time from symptom onset to the initiation of antiviral treatment was 8.8 days (IQR 5.8–9.8). Five fatalities did not receive any anti-viral therapy. Median PaO2/FiO2 on day 1 was 80 (IQR, 60–98.5). All patients required inotropic support and mechanical ventilation with barotrauma-related complications of mechanical ventilation occurring in 35% of patients. Conclusion: In Colombia, none of the women suffering H1N1-related maternal deaths had received vaccination against the disease and most had delayed or had no anti-viral therapy. Given the lack of evidence-based clinical predictors to identify women who are prone to die from H1N1 in pregnancy, following international guidelines for vaccination and initiation of antiviral therapy in suspected cases would likely improve outcomes in developing countries.
Published: 2013

45. Effectiveness Of The Rotavirus Monovalent Vaccine In Colombia: Preliminary Results Of A Case-Control Study

Author: Karol Cotes, Nelson Alvis-Guzman, F. De la Hoz-Restrepo, Angel Paternina-Caicedo, and Wilfrido Coronell-Rodríguez
Subjects: business.industry, Rotavirus, Health Policy, Case-control study, medicine, Public Health, Environmental and Occupational Health, medicine.disease_cause, business, Virology
Published: 2013
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46. Performance of the Obstetric Early Warning Score in critically ill patients for the prediction of maternal death

Author: Camilo Bello-Muñoz, Jezid Miranda, Jose Rojas-Suarez, Andrew Levinson, Angel Paternina-Caicedo, Ghada Bourjeily, and Carmelo Dueñas
Subjects: Adult, medicine.medical_specialty, Pediatrics, Consciousness, Critical Care, Critical Illness, Vital signs, Blood Pressure, Colombia, Risk Assessment, Body Temperature, law.invention, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Respiratory Rate, Heart Rate, Pregnancy, law, Intensive care, Peripartum Period, Humans, Vasoconstrictor Agents, Medicine, Childbirth, 030212 general & internal medicine, Retrospective Studies, 030219 obstetrics & reproductive medicine, Warning system, business.industry, Mortality rate, Oxygen Inhalation Therapy, Obstetrics and Gynecology, Early warning score, medicine.disease, Respiration, Artificial, Intensive care unit, Intensive Care Units, Logistic Models, ROC Curve, Multivariate Analysis, Emergency medicine, Maternal Death, Consciousness Disorders, Female, Maternal death, business
Abstract: Background Every day, about 830 women die worldwide from preventable causes related to pregnancy and childbirth. Obstetric early warning scores have been proposed as a potential tool to reduce maternal morbidity and mortality, based on the identification of predetermined abnormal values in the vital signs or laboratory parameters, to generate a rapid and effective medical response. Several early warning scores have been developed for obstetrical patients, but the majority are the result of a clinical consensus rather than statistical analyses of clinical outcome measures (ie, maternal deaths). In 2013, the Intensive Care National Audit and Research Center Case Mix Program reported the first statistically validated early warning scoring system for pregnant women. Objective We sought to assess the performance of the Intensive Care National Audit and Research Center Obstetric Early Warning Score in predicting death among pregnant women who required admission to the intensive care unit. Study Design This retrospective cohort study included pregnant women admitted to the intensive care unit at a tertiary referral center from January 2006 through December 2011 in Colombia, a developing country, with direct and indirect obstetric-related conditions. The Obstetric Early Warning Score was calculated based on data collected during the first 24 hours of intensive care unit admission. The Obstetric Early Warning Score is calculated based on values of the following variables: systolic and diastolic blood pressure, respiratory rate, heart rate, fraction of inspired oxygen (FiO 2 ) required to maintain an oxygen saturation ≥96%, temperature, and level of consciousness. The performance of the Obstetric Early Warning Score was evaluated using the area under the receiver operator characteristic curve. Outcomes selected were: maternal death, need for mechanical ventilation, and/or vasoactive support. Statistical methods included distribution appropriate univariate analyses and multivariate logistic regression. Results During the study period, 50,897 births were recorded. There were 724 obstetric admissions to critical care, for an intensive care unit admission rate of 14.22 per 1000 deliveries. A total of 702 women were included in the study, with 29 (4.1%) maternal deaths, and a mortality ratio of 56.98 deaths per 100,000 live births. The most frequent causes of admission were direct, obstetric-related conditions ( n = 534; 76.1%). The Obstetric Early Warning Score value was significantly higher in nonsurvivors than in survivors [12 (interquartile range 10-13) vs 7 (interquartile range 4-9); P 6) had a mortality rate of 6.3%. The area under the receiver operator characteristic curve of the Obstetric Early Warning Score in discrimination of maternal death was 0.84 (95% confidence interval, 0.75–0.92). The overall predictive value of the Obstetric Early Warning Score was better when the main cause of admission was directly related to pregnancy or the postpartum state. The area under the receiver operator characteristic curve of the score in conditions directly related to pregnancy and postpartum was 0.87 (95% confidence interval, 0.79–0.95), while in indirectly related conditions the area under the receiver operator characteristic curve was 0.77 (95% confidence interval, 0.58–0.96). Conclusion Although there are opportunities for improvement, Obstetric Early Warning Score obtained upon admission to the intensive care unit can predict survival in conditions directly related to pregnancy and postpartum. The use of early warning scores in obstetrics may be a highly useful approach in the early identification of women at an increased risk of dying.
Published: 2017
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47. [Seizure outcomes of cerebral hemispherectomy in adults: A systematic review and individual patient data meta-analysis]

Author: Gabriel, Alcalá-Cerra, Angel, Paternina-Caicedo, Cindy, Díaz-Becerra, and Juan José, Gutiérrez-Paternina
Subjects: Adult, Male, Epilepsy, Hemispherectomy, Age Factors, Drug Resistance, Combined Modality Therapy, Observational Studies as Topic, Treatment Outcome, Recurrence, Humans, Anticonvulsants, Female, Retrospective Studies
Abstract: The objective of our study was to determine the seizure control rate of cerebral hemispherectomies in adult patients with drug-resistant epilepsy.A systematic review and individual patient data meta-analysis was carried out. Seven international databases and scientific meeting proceedings were reviewed. Individual patient data were analysed to establish potential factors associated with postoperative seizure control.Eight articles that satisfied the pre-established selection criteria were identified. After a median follow-up of 70 months (interquartile range, 29-175.5), 79.4% of patients remained seizure-free. There were no statistically significant differences in age at onset of epilepsy, duration of epilepsy, age at surgery, time of follow-up, gender, surgical-laterality, aetiology and ictal EEG abnormalities between seizure-free patients and those with recurrences.Cerebral hemispherectomy has a high seizure control rate in adult patients with drug-resistant epilepsy. None of the variables analysed in the present study were associated with surgical success.
Published: 2012

48. Effect of biomass smoke on chronic obstructive pulmonary disease in rural localities of Colombia

Author: Nelson, Alvis-Guzman, Fernando, De la Hoz-Restrepo, Juan, Montes-Farah, and Angel, Paternina-Caicedo
Subjects: Adult, Male, Rural Health, Colombia, Middle Aged, Pulmonary Disease, Chronic Obstructive, Cross-Sectional Studies, Spirometry, Biofuels, Smoke, Prevalence, Humans, Female, Biomass, Cooking, Aged
Abstract: The aim of this study was to assess the differences associated to the change of biofuel used to cook as a way to estimate the proportion of respiratory abnormalities of respiratory function associated to biomass exposure.A cross-sectional study was designed to evaluate the respiratory function through spirometry in subjects cooking with biomass or natural gas. All patients were evaluated by a general physician and a pulmonologist. We compared the prevalence of spirometry abnormalities across those cooking with natural gas versus those cooking with biofuel. A multivariable logistic regression and multiple linear regression were used to adjust differences by potential confounding factors.203 subjects were studied. There was a significant increase in the prevalence of severe obstructive pattern (OR 5.50; 95 % CI 1.17-25.79) in subjects who cook with biomass compared with natural gas users. Values of forced expired volume in one second (FEV1) and forced vital capacity (FVC) were statistically lower among those cooking with biomass. The prevalence of respiratory morbidity and symptoms were not statistically significant between both groups.These findings suggest that replacing biomass fuel by natural gas may be an important public health intervention in Colombia, because it can reduce the prevalence of abnormal patterns of pulmonary function.
Published: 2012

49. [Direct costs of complicated chicken pox in a Colombian pediatric population]

Author: Nelson, Alvis-Guzmán, Angel, Paternina-Caicedo, Luis, Alvis-Estrada, and Fernando, De la Hoz-Restrepo
Subjects: Diagnostic Imaging, Infant, Newborn, Infant, Colombia, Length of Stay, Hospitals, Pediatric, Laboratories, Hospital, Drug Costs, Personnel, Hospital, Chickenpox, Child, Preschool, Costs and Cost Analysis, Humans, Health Expenditures, Hospital Costs, Child, Retrospective Studies
Abstract: Estimating the cost of chicken pox in a Colombian pediatric population.This was a retrospective case study which searched for all diagnosed chicken pox cases in the Napoleón Franco Pareja children's hospital (Cartagena, Colombia), during 2005-2008. The hospital's records/perspective was used. Cost related to health personnel, lab, diagnostic images and drugs were searched. The micro-costing was made at Colombian peso prices for 2010. An adjustment was made for inflation.Mean hospital costs were $ 898,766 (Q1: $ 197,348; Q3: $ 1,195,262). Mean hospital cost per day was $ 221,777 (Q1: $ 97,027; Q3: $ 293,740). Mean cost1 year-old patients was $ 980,742 (Q1: $ 905,708; Q3: $ 1,026,031). Mean cost was $ 105,833 in 5-12 year-old patients (Q1: $ 39,568; Q3: $ 891,824).The results were similar to those of previous studies (in Panama and some developed countries) highlighting relatively high illness costs in Colombia. These results increase the evidence in favor of vaccination and invite Colombian public health officials to consider introducing a chicken pox vaccine into Colombia.
Published: 2011

50. Costos directos de varicela complicada en una población pediátrica de colombia

Author: Luis Alvis-Estrada, Angel Paternina-Caicedo, Fernando De la Hoz-Restrepo, and Nelson Alvis-Guzman
Subjects: medicine.medical_specialty, BIREME), business.industry, Public health, Public Health, Environmental and Occupational Health, costos y análisis de costo, infectología, Hospital cost, Infant newborn, DeCS [vacuna contra la varicela (fuente], Health personnel, salud pública, Varicela, 61 Ciencias médicas, Medicina / Medicine and health, Medicine, business, medicina, Demography, Personnel hospital, Pediatric population
Abstract: Objetivo Estimar los costos directos de varicela en una población pediátrica de Colombia.Método Se diseño un estudio de casos retrospectivo sobre todos los casos de varicela diagnosticados de 2005-2008 en el Hospital Infantil Napoleón Franco Pareja de Cartagena de Indias, Colombia. Fue utilizada la perspectiva del hospital. Se buscaron costos de atención, laboratorio, imagenología y medicamentos. El microcosteo se realizó en pesos colombianos del 2010. Se realizó un ajuste por inflación. Resultados La mediana de costos totales hospitalarios fue de $ 898 766 (Q1: $ 197 348; Q3: $ 1 195 262). La mediana de costo por día hospitalario fue de $ 221 777 (Q1: $ 97 027; Q3: $ 293 740). En menores de 1 año la mediana de costo fue de $ 980 742 (Q1: $ 905 708; Q3: $ 1 026 031). En pacientes de 5-12 años la mediana de costo fue de $ 105 833 (Q1: $ 39 568; Q3: $ 891 824).Conclusiones. Los resultados se asemejan con estudios previos sobre el tema (en Panamá, e incluso algunos países desarrollados), evidenciando un relativo alto costo de enfermedad por varicela en Colombia. Estos resultados aumentan la evidencia a favor de la vacunación, e invitan a decisores en salud en Colombia a considerar la introducción de la vacunación contra varicela.
Published: 2011

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