The equitable distribution of income, along with human development indices, is among the factors that differentiate developed from developing countries. In this paper, efforts and other variables ...related to the circumstances of individuals were quantified and analyzed together with traditional determinants in order to explain inequality in the working population of Bolivia. We estimated econometric models by merging the extended Mincer equation with John Roemer’s theory of Inequality of Opportunity. We find that efforts are important determinants of the levels of wage inequality in the country as well as regional development, labor informality, gender and ethnicity. In this sense, the paper separates the part of wage inequality that may be attributed to situations that are beyond the control of individuals and that can be attributed to conscious decisions. Micro simulations determined that it would be possible to reduce inequality by as much as 21% if it gives people the chance to make similar efforts to improve their wages.
In patients with multi-vessel disease presenting with ST elevation myocardial infarction (STEMI), the efficacy and safety of ischemia-guided, vs routine non-culprit vessel angioplasty has not been ...adequately studied.
We conducted an international, randomized, non-inferiority trial comparing ischemia-guided non-culprit vessel angioplasty to routine non-culprit vessel angioplasty, following primary PCI for STEMI. The primary outcome was the between-group difference in percent ischemic myocardium at follow-up stress MPI. All MPI images were processed and analyzed at a central core lab, blinded to treatment allocation.
In all, 109 patients were enrolled from nine countries. In the ischemia-guided arm, 25/48 (47%) patients underwent non-culprit vessel PCI following stress MPI. In the routine non-culprit PCI arm, 43/56 (77%) patients underwent angioplasty (86% within 6 weeks of randomization). The median percentage of ischemic myocardium on follow-up imaging (mean 16.5 months) was low, and identical (2.9%) in both arms (difference 0.13%, 95%CI − 1.3%–1.6%, P < .0001; non-inferiority margin 5%).
A strategy of ischemia-guided non-culprit PCI resulted in low ischemia burden, and was non-inferior to a strategy of routine non-culprit vessel PCI in reducing ischemia burden. Selective non-culprit PCI following STEMI offers the potential for cost-savings, and may be particularly relevant to low-resource settings.
(CTRI/2018/08/015384).
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Latin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among ...these groups in population coverage with reproductive, maternal, newborn, and child health interventions.
We analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15–49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12–23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), woman's education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression.
Ethnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0·82, IQR 0·66–0·92), antenatal care (0·86, 0·75–0·94), and skilled birth attendants (0·75, 0·68–0·92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries.
The lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level—such as vaccines—show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes.
The Bill & Melinda Gates Foundation (through the Countdown to 2030 initiative) and the Wellcome Trust.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Equine piroplasmosis (EP) is a tick-borne disease caused by Babesia caballi and Theileria equi, which causes severe economic losses to the equine industry, represented by the Spanish Purebred (SP) ...horse in Spain. The seroprevalence of EP is known in certain regions of Spain, but till date, there are no data in SP horses. The aim of this study was to determine the seroprevalence of EP in the SP breeding horse population in central Spain and to evaluate risk factors associated with the occurrence of the infection. A total of 536 horse serum samples were tested for antibodies against T. equi and B. caballi by competitive inhibition enzyme-linked immunosorbent assay. Data on possible risk factors were examined using two logistic regression models with and without a random effect at the stud farm level. The true seroprevalence results were 21.8% for T. equi and 4.7% for B. caballi. Increasing horse age and increasing numbers of breeding stallions on the stud farm were identified as factors associated with EP seropositivity. The implementation of vaccination programs in the horses and disinfection measures in the premises were associated with a lower T. equi and B. caballi seroprevalence, respectively. A moderate exposure to EP was found in SP horses in central Spain. Further investigations are necessary to ensure appropriate preventive measures for stud farms and to facilitate the development of an EP surveillance program in the SP breeding horse population.
•Spanish Purebred (SP) horses in central Spain were mainly exposed to Theileria equi infection.•Equine piroplasmosis (EP) seropositivity was directly associated with age and stallions in the stud farm.•Vaccination implemented in the stud farm involved a lower T. equi seropositivity.•Babesia caballi seropositivity decreased with the separation of mares from young horses (1–2 years).•Central Spain can be considered as a high-risk area for EP in SP breeding horses.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
•RELACOEM is the first study conducted in LATAM evaluating risk of COVID-19 in patients with MS and NMOSD•We found an increased proportion of hospitalizations in NMOSD when compared to MS ...patients.•MS patient mortality in our series was lower compared to another MS patient's cohort•One third of NMOSD patients died, all on Rituximab treatment.
There is no data regarding COVID-19 in Multiple Sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients in Latin America.
The objective of this study was to describe the clinical characteristics and outcomes of patients included in RELACOEM, a LATAM registry of MS and NMOSD patients infected with COVID-19.
RELACOEM is a longitudinal, strictly observational registry of MS and NMOSD patients who suffer COVID-19 and Dengue in LATAM. Inclusion criteria to the registry were either: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a COVID-19 polymerase chain reaction (PCR) test on a nasopharyngeal swab; or (2) COVID-19–typical symptoms (triad of cough, fever, and asthenia) in an epidemic zone of COVID-19. Descriptive statistics were performed on demographic and clinical variables. The cohort was later stratified for MS and NMOSD and univariate and multivariate logistic regression analysis was performed to identify variables associated with hospitalizations/intensive critical units (ICU) admission.
145 patients were included in the registry from 15 countries and 51 treating physicians. A total of 129 (89%) were MS patients and 16 (11%) NMOSD. 81.4% patients had confirmed COVID-19 and 18.6% were suspected cases. 23 (15.8%) patients were hospitalized, 9 (6.2%) required ICU and 5 (3.4 %) died due to COVID-19. In MS patients, greater age (OR 1.17, 95% CI 1.05 – 1.25) and disease duration (OR 1.39, 95%CI 1.14-1.69) were associated with hospitalization/ICU. In NMOSD patients, a greater age (54.3 vs. 36 years, p=<0.001), increased EDSS (5.5 vs 2.9, p=0.0012) and disease duration (18.5 vs. 10.3 years, p=0.001) were significantly associated with hospitalization/ICU.
we found that in MS patients, age and disease duration was associated with hospitalization and ICU admission requirement, while age, disease duration and EDSS was associated in NMOSD.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Bolivia y Brasil comparten una de las cuencas más atractivas y preservadas de la te-giuri amazônica: la cuenca del rio llénez o Guaporé, que escurre tanto sobre el lecho rocoso del Escudo Precámbrico ...Brasilefto como sobre las Hanuras del Beni. Estas influencias hacen que la cuenca del iténez tenga una elevada heterogeneidad de habitats, una fauna acuálica peculiar y un alto valor de conservation. Este patrimonio binacional posée un potencial importante para la conservación de la diversidad regional y cl dcsar rollo sostcniblc participativo de las comunidades locales. El libro contiene un resumen del conotimìento de la cuenca y sus recursos, generado en los últimos 10 anos por un equipo de investigadores bolivianos, brasilefios y de otras nacionalidades. Se presenta una descripeión del medio fisico, así como resultados relevantes sobre la biodiversidad acuática, con énfasis en algas, peces, reptiles y mamíferos. El aporte más notable del libro, adernas de la descripeión ecológica del ecosistema, son las lecciones aprendidas que surgieron de experiências locales sobre la élaboration participativa de herramientas para la gestion de los recursos hidrobiológicos.
BackgroundIn the sub-Saharan Africa region, the adolescent birth rate is the highest in the world, estimated at 100.5 births per 1000 women aged 15 to 19 years, and 2.4 times greater than the global ...average. This analysis examines coverage levels and gaps in basic maternal health care for adolescent mothers living in this region.MethodsWe used data from national Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2010 and 2016 in 22 of the sub-Saharan African Countdown to 2030 priority countries with adolescent birth rates above 100 in 2016. We analyzed 11 indicators of coverage of key services provided during the pre-pregnancy, pregnancy, delivery and postnatal period. We described the coverage level among adolescent girls aged 15-19 and women aged 20-49 for basic indicators in the continuum of care. We conducted a multilevel random effect logistic regression to quantify the association between the receipt of basic package of maternal care and woman’s socio-demographic and socio-economic characteristics.ResultsThe median coverage of the basic package of maternal care among adolescents was extremely low, at 9.3%. Adolescent mothers who were in the highest household wealth quintile (odds ratio OR = 2.44, 95% confidence interval (CI) = 2.23-2.68), living in an urban area (OR = 1.25, 95% CI = 1.18-1.33) and having secondary education (OR = 1.61, 95% CI = 1.50-1.73) had greater odds of receiving the basic package of maternal health care as compared to those in the lowest wealth quintile, living in rural areas, and with no education respectively. Adolescent girls aged 15-17 and 18-19 had respectively 26% (OR = 0.74, 95% CI = 0.67-0.82) and 9% (OR = 0.91, 95% CI = 0.84-0.98) lower odds of receiving the basic package compared to women 20-49 years old. Child brides had 12% (OR = 0.88, 95% CI = 0.84-0.93) lower odds of receiving the basic package compared to women who were married after the age of 18.ConclusionCoverage of basic maternal health care for adolescent mothers is inadequate in the countries with the highest adolescent birth rates in the world. Addressing the reproductive and maternal health needs of adolescents in sub-Saharan Africa is of critical importance, especially given projections that this region will experience the highest increases in adolescent births in the coming decades.
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NUK, OILJ, UL, UM, UPUK, VSZLJ
Abstract
Though not a reliable indicator of malignancy, ultrasonic monitoring of nodule growth still has a role in the evaluation of nodules, e.g. indicating when a nodule may require biopsy or ...re-biopsy. Observer and technical limitations, however, limit the precision of ultrasonic determination of simple growth, vs. stability or shrinkage. Ultrasonic parameters used for this purpose all have their own limitations. Monitoring nodule growth by VOL frequently exhibits wide and conflicting swings in apparent size compared to the penultimate size, doubtlessly reflecting measurement limitations. As a growth parameter, LD typically exhibits a smoother time course but does not address growth in the other two dimensions. SUM3D includes changes in all dimensions but, like LD, is not a true measure of nodule mass or volume. This study was to determine the relative error of these three growth parameters and how it relates to their relative efficacy for nodular growth monitoring. The anterior-posterior (AP), left-right (LR) and superior-inferior (SI) dimensions of 34 benign nodules were determined ultrasonographically by four pairs of trained observers. One observer of a pair was regarded as a Time-1 observer and the other as a Time-2 observer, simulating the process for determining growth change over time. All observers measured the same image of each of the 34 nodules but were unaware of the measurements obtained by any other observer. For each image for each pair of observers, the dimensions were used to calculate the VOL, LD and SUM3D and the perceived changes thereof from Time-1 to Time-2. Since only one image for each nodule was distributed, differences between the Time-1 vs Time-2 measurements for each nodule could only reflect observer-based differences. “S”-curves plotting the nominal %-change in a parameter reported by the Time-2 observer compared to that reported by the Time-1 observer (x-axis) were rank-ordered from negative to positive changes (y-axis). The %-change in each parameter due to observer/technical error ranging from the highest over-estimate to the lowest were, in order from Top 10%, Middle 40%, and Bottom 10%, respectively: LD: 19-36%, -4 to 6%, -15 to -42%; SUM3D: 15 to 28%, -4 to 4%, -11 to -43%; VOL: 48 to 105%, -13 to 15%, -33 to -81%. The magnitude of %-change from Time-1 to Time-2 for the VOL parameter were 2 to 3 times greater than that of the LD or SUM3D parameters for the top 10% of values, the middle 40% of values, and the bottom 10% of values. These degrees of difference coincide with the wide variability seen in nodular growth curves not illustrated here when nodular VOL (y-axis) is plotted as a function of length of observation (x-axis). This study helps explain why monitoring nodular growth by LD or by the SUM3D usually provides a clearer, less fluctuant illustration of thyroid nodule growth over time than does VOL.
In the sub-Saharan Africa region, the adolescent birth rate is the highest in the world, estimated at 100.5 births per 1000 women aged 15 to 19 years, and 2.4 times greater than the global average. ...This analysis examines coverage levels and gaps in basic maternal health care for adolescent mothers living in this region.
We used data from national Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2010 and 2016 in 22 of the sub-Saharan African Countdown to 2030 priority countries with adolescent birth rates above 100 in 2016. We analyzed 11 indicators of coverage of key services provided during the pre-pregnancy, pregnancy, delivery and postnatal period. We described the coverage level among adolescent girls aged 15-19 and women aged 20-49 for basic indicators in the continuum of care. We conducted a multilevel random effect logistic regression to quantify the association between the receipt of basic package of maternal care and woman's socio-demographic and socio-economic characteristics.
The median coverage of the basic package of maternal care among adolescents was extremely low, at 9.3%. Adolescent mothers who were in the highest household wealth quintile (odds ratio OR = 2.44, 95% confidence interval (CI) = 2.23-2.68), living in an urban area (OR = 1.25, 95% CI = 1.18-1.33) and having secondary education (OR = 1.61, 95% CI = 1.50-1.73) had greater odds of receiving the basic package of maternal health care as compared to those in the lowest wealth quintile, living in rural areas, and with no education respectively. Adolescent girls aged 15-17 and 18-19 had respectively 26% (OR = 0.74, 95% CI = 0.67-0.82) and 9% (OR = 0.91, 95% CI = 0.84-0.98) lower odds of receiving the basic package compared to women 20-49 years old. Child brides had 12% (OR = 0.88, 95% CI = 0.84-0.93) lower odds of receiving the basic package compared to women who were married after the age of 18.
Coverage of basic maternal health care for adolescent mothers is inadequate in the countries with the highest adolescent birth rates in the world. Addressing the reproductive and maternal health needs of adolescents in sub-Saharan Africa is of critical importance, especially given projections that this region will experience the highest increases in adolescent births in the coming decades.
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NUK, OILJ, UL, UM, UPUK, VSZLJ
Introducción: El manejo eficaz de líquidos es crucial en cuidados críticos pediátricos, particularmente para pacientes con shock séptico. La variación del flujo máximo aórtico (APFV) se ha convertido ...en un predictor potencial de la capacidad de respuesta a los líquidos, pero su utilidad en pacientes pediátricos con shock séptico sometidos a ventilación mecánica sigue sin explorarse.Objetivo: Evaluar la precisión predictiva de APFV para la respuesta a líquidos en pacientes pediátricos con shock séptico sometidos a ventilación mecánica .Métodos: En este estudio observacional prospectivo realizado de enero a septiembre de 2023 en la UCIP del Hospital Padre Carollo "Un Canto a la Vida", se inscribieron 26 pacientes pediátricos con shock séptico. Las variables hemodinámicas se midieron antes y después de un bolo de líquido estándar de 10 ml/kg de cristaloides. El APFV se calculó mediante ecocardiografía transtorácica, con la capacidad de respuesta a los líquidos definida como un aumento ≥10 % en el índice de volumen sistólico después de la administración de líquidos. Se emplearon análisis de sensibilidad, especificidad y curva ROC para evaluar la capacidad predictiva de APFV.Resultados: De 26 pacientes, 17 (65,4%) respondieron a la administración de líquidos. El APFV medio en todos los pacientes fue del 12,5%. El análisis de la curva ROC determinó un punto de corte de APFV del 13,4 % para predecir la respuesta a los líquidos, lo que arrojó una sensibilidad del 82 % y una especificidad del 83 %, con un AUROC de 0,83 (0.804-0.917).Conclusiones: APFV demostró un nivel moderado a alto de precisión en la predicción de la respuesta a los líquidos en pacientes pediátricos con shock séptico bajo ventilación mecánica. El límite de APFV identificado proporciona una referencia práctica para los médicos en las decisiones de manejo de líquidos dentro de esta población de pacientes.
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