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Ferrari AJ, Santomauro DF, Aali A, Abate YH, Abbafati C, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdollahi A, Abdullahi A, Abegaz KH, Abeldaño Zuñiga RA, Aboagye RG, Abolhassani H, Abreu LG, Abualruz H, Abu-Gharbieh E, Abu-Rmeileh NME, Ackerman IN, Addo IY, Addolorato G, Adebiyi AO, Adepoju AV, Adewuyi HO, Afyouni S, Afzal S, Afzal S, Agodi A, Ahmad A, Ahmad D, Ahmad F, Ahmad S, Ahmed A, Ahmed LA, Ahmed MB, Ajami M, Akinosoglou K, Akkaif MA, Al Hasan SM, Alalalmeh SO, Al-Aly Z, Albashtawy M, Aldridge RW, Alemu MD, Alemu YM, Alene KA, Al-Gheethi AAS, Alharrasi M, Alhassan RK, Ali MU, Ali R, Ali SSS, Alif SM, Aljunid SM, Al-Marwani S, Almazan JU, Alomari MA, Al-Omari B, Altaany Z, Alvis-Guzman N, Alvis-Zakzuk NJ, Alwafi H, Al-Wardat MS, Al-Worafi YM, Aly S, Alzoubi KH, Amare AT, Amegbor PM, Ameyaw EK, Amin TT, Amindarolzarbi A, Amiri S, Amugsi DA, Ancuceanu R, Anderlini D, Anderson DB, Andrade PP, Andrei CL, Ansari H, Antony CM, Anwar S, Anwar SL, Anwer R, Anyanwu PE, Arab JP, Arabloo J, Arafat M, Araki DT, Aravkin AY, Arkew M, Armocida B, Arndt MB, Arooj M, Artamonov AA, Aruleba RT, Arumugam A, Ashbaugh C, Ashemo MY, Ashraf M, Asika MO, Askari E, Astell-Burt T, Athari SS, Atorkey P, Atout MMW, Atreya A, Aujayeb A, Ausloos M, Avan A, Awotidebe AW, Awuviry-Newton K, Ayala Quintanilla BP, Ayuso-Mateos JL, Azadnajafabad S, Azevedo RMS, Babu AS, Badar M, Badiye AD, Baghdadi S, Bagheri N, Bah S, Bai R, Baker JL, Bakkannavar SM, Bako AT, Balakrishnan S, Bam K, Banik PC, Barchitta M, Bardhan M, Bardideh E, Barker-Collo SL, Barqawi HJ, Barrow A, Barteit S, Barua L, Bashiri Aliabadi S, Basiru A, Basu S, Basu S, Bathini PP, Batra K, Baune BT, Bayileyegn NS, Behnam B, Behnoush AH, Beiranvand M, Bejarano Ramirez DF, Bell ML, Bello OO, Beloukas A, Bensenor IM, Berezvai Z, Bernabe E, Bernstein RS, Bettencourt PJG, Bhagavathula AS, Bhala N, Bhandari D, Bhargava A, Bhaskar S, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhutta ZA, Bikbov B, Bishai JD, Bisignano C, Bitra VR, Bjørge T, Bodolica V, Bodunrin AO, Bogale EK, Bonakdar Hashemi M, Bonny A, Bora Basara B, Borhany H, Boxe C, Brady OJ, Bragazzi NL, Braithwaite D, Brant LC, Brauer M, Breitner S, Brenner H, Brown J, Brugha T, Bulamu NB, Buonsenso D, Burkart K, Burns RA, Busse R, Bustanji Y, Butt ZA, Byun J, Caetano dos Santos FL, Calina D, Cámera LA, Campos-Nonato IR, Cao C, Capodici A, Carr S, Carreras G, Carugno A, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catapano AL, Cattaruzza MS, Caye A, Cegolon L, Cembranel F, Cenderadewi M, Cerin E, Chakraborty PA, Chan JSK, Chan RNC, Chandika RM, Chandrasekar EK, Charalampous P, Chattu VK, Chatzimavridou-Grigoriadou V, Chen AW, Chen AT, Chen CS, Chen H, Chen NM, Cheng ETW, Chimed-Ochir O, Chimoriya R, Ching PR, Cho WCS, Choi S, Chong B, Chong YY, Choudhari SG, Chowdhury R, Christensen SWM, Chu DT, Chukwu IS, Chung E, Chung E, Chutiyami M, Claassens MM, Cogen RM, Columbus A, Conde J, Cortesi PA, Cousin E, Criqui MH, Cruz-Martins N, Dadras O, Dai S, Dai X, Dai Z, Dalaba MA, Damiani G, Das JK, Das S, Dashti M, Dávila-Cervantes CA, Davletov K, De Leo D, Debele AT, Debopadhaya S, DeCleene NK, Deeba F, Degenhardt L, Del Bo' C, Delgado-Enciso I, Demetriades AK, Denova-Gutiérrez E, Dervenis N, Desai HD, Desai R, Deuba K, Dhama K, Dharmaratne SD, Dhingra S, Dias da Silva D, Diaz D, Diaz LA, Diaz MJ, Dima A, Ding DD, Dirac MA, Do THP, do Prado CB, Dohare S, Dominguez RMV, Dong W, Dongarwar D, D'Oria M, Dorsey ER, Doshmangir L, Dowou RK, Driscoll TR, Dsouza HL, Dsouza V, Dube J, Dumith SC, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dzianach PA, Dziedzic AM, Eboreime E, Ebrahimi A, Edinur HA, Edvardsson D, Eikemo TA, Eini E, Ekholuenetale M, Ekundayo TC, El Sayed I, El Tantawi M, Elbarazi I, Elemam NM, ElGohary GMT, Elhadi M, Elmeligy OAA, ELNahas G, Elshaer M, Elsohaby I, Engelbert Bain L, Erkhembayar R, Eshrati B, Estep K, Fabin N, Fagbamigbe AF, Falzone L, Fareed M, Farinha CSES, Faris MEM, Faro A, Farrokhi P, Fatehizadeh A, Fauk NK, Feigin VL, Feng X, Fereshtehnejad SM, Feroze AH, Ferreira N, Ferreira PH, Fischer F, Flavel J, Flood D, Flor LS, Foigt NA, Folayan MO, Force LM, Fortuna D, Foschi M, Franklin RC, Freitas A, Fukumoto T, Furtado JM, Gaal PA, Gadanya MA, Gaidhane AM, Gaihre S, Galali Y, Ganbat M, Gandhi AP, Ganesan B, Ganie MA, Ganiyani MA, Gardner WM, Gebi TG, Gebregergis MW, Gebrehiwot M, Gebremariam TBB, Gebremeskel TG, Gela YY, Georgescu SR, Getachew Obsa A, Gething PW, Getie M, Ghadiri K, Ghadirian F, Ghailan KY, Ghajar A, Ghasemi M, Ghasempour Dabaghi G, Ghasemzadeh A, Ghazy RM, Gholamrezanezhad A, Ghorbani M, Ghotbi E, Gibson RM, Gill TK, Ginindza TG, Girmay A, Glasbey JC, Göbölös L, Godinho MA, Goharinezhad S, Goldust M, Golechha M, Goleij P, Gona PN, Gorini G, Goulart AC, Grada A, Grivna M, Guan SY, Guarducci G, Gubari MIM, Gudeta MD, Guha A, Guicciardi S, Gulati S, Gulisashvili D, Gunawardane DA, Guo C, Gupta AK, Gupta B, Gupta I, Gupta M, Gupta R, Gupta VB, Gupta VK, Gupta VK, Gutiérrez RA, Habibzadeh F, Habibzadeh P, Haddadi R, Hadi NR, Haep N, Hafezi-Nejad N, Hafiz A, Hagins H, Halboub ES, Halimi A, Haller S, Halwani R, Hamilton EB, Hankey GJ, Hannan MA, Haque MN, Harapan H, Haro JM, Hartvigsen J, Hasaballah AI, Hasan I, Hasanian M, Hasnain MS, Hassan A, Haubold J, Havmoeller RJ, Hay SI, Hayat K, Hebert JJ, Hegazi OE, Heidari G, Helfer B, Hemmati M, Hendrie D, Henson CA, Hezam K, Hiraike Y, Hoan NQ, Holla R, Hon J, Hossain MM, Hosseinzadeh H, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hsu JM, Huang J, Hugo FN, Hushmandi K, Hussain J, Hussein NR, Huynh CK, Huynh HH, Hwang BF, Iannucci VC, Ihler AL, Ikiroma AI, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Immurana M, Irham LM, Islam MR, Islam SMS, Islami F, Ismail F, Ismail NE, Isola G, Iwagami M, Iwu CCD, Iyer M, Jaafari J, Jacobsen KH, Jadidi-Niaragh F, Jafarinia M, Jaggi K, Jahankhani K, Jahanmehr N, Jahrami H, Jain A, Jain N, Jairoun AA, Jaiswal A, Jakovljevic M, Jatau AI, Javadov S, Javaheri T, Jayapal SK, Jayaram S, Jee SH, Jeganathan J, Jeyakumar A, Jha AK, Jiang H, Jin Y, Jonas JB, Joo T, Joseph A, Joseph N, Joshua CE, Jozwiak JJ, Jürisson M, K V, Kaambwa B, Kabir A, Kabir Z, Kadashetti V, Kalani R, Kalankesh LR, Kaliyadan F, Kalra S, Kamenov K, Kamyari N, Kanagasabai T, Kandel H, Kanmanthareddy AR, Kanmodi KK, Kantar RS, Karaye IM, Karim A, Karimi SE, Karimi Y, Kasraei H, Kassel MB, Kauppila JH, Kawakami N, Kayode GA, Kazemi F, Kazemian S, Keikavoosi-Arani L, Keller C, Kempen JH, Kerr JA, Keshtkar K, Kesse-Guyot E, Keykhaei M, Khajuria H, Khalaji A, Khalid A, Khalid N, Khalilian A, Khamesipour F, Khan A, Khan I, Khan M, Khan MAB, Khanmohammadi S, Khatab K, Khatami F, Khatatbeh MM, Khater AM, Khayat Kashani HR, Khidri FF, Khodadoust E, Khormali M, Khorrami Z, Kifle ZD, Kim MS, Kimokoti RW, Kisa A, Kisa S, Knudsen AKS, Kocarnik JM, Kochhar S, Koh HY, Kolahi AA, Kompani F, Koren G, Korzh O, Kosen S, Koulmane Laxminarayana SL, Krishan K, Krishna V, Krishnamoorthy V, Kuate Defo B, Kuddus MA, Kuddus M, Kuitunen I, Kulkarni V, Kumar M, Kumar N, Kumar R, Kurmi OP, Kusuma D, Kyu HH, La Vecchia C, Lacey B, Ladan MA, Laflamme L, Lafranconi A, Lahariya C, Lai DTC, Lal DK, Lalloo R, Lallukka T, Lám J, Lan Q, Lan T, Landires I, Lanfranchi F, Langguth B, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lauriola P, Le HH, Le LKD, Le NHH, Le TDT, Leasher JL, Ledda C, Lee M, Lee PH, Lee SW, Lee SW, Lee WC, Lee YH, LeGrand KE, Lenzi J, Leong E, Leung J, Li MC, Li W, Li X, Li Y, Li Y, Lim LL, Lim SS, Lindstrom M, Linn S, Liu G, Liu R, Liu S, Liu W, Liu X, Liu X, Llanaj E, Lo CH, López-Bueno R, Loreche AM, Lorenzovici L, Lozano R, Lubinda J, Lucchetti G, Lunevicius R, Lusk JB, lv H, Ma ZF, Machairas N, Madureira-Carvalho ÁM, Magaña Gómez JA, Maghazachi AA, Maharjan P, Mahasha PW, Maheri M, Mahjoub S, Mahmoud MA, Mahmoudi E, Majeed A, Makris KC, Malakan Rad E, Malhotra K, Malik AA, Malik I, Malta DC, Manla Y, Mansour A, Mansouri P, Mansournia MA, Mantilla Herrera AM, Mantovani LG, Manu E, Marateb HR, Mardi P, Martinez G, Martinez-Piedra R, Martini D, Martins-Melo FR, Martorell M, Marx W, Maryam S, Marzo RR, Mathangasinghe Y, Mathieson S, Mathioudakis AG, Mattumpuram J, Maugeri A, Mayeli M, Mazidi M, Mazzotti A, McGrath JJ, McKee M, McKowen ALW, McPhail MA, Mehrabani-Zeinabad K, Mehrabi Nasab E, Mekene Meto T, Mendoza W, Menezes RG, Mensah GA, Mentis AFA, Meo SA, Meresa HA, Meretoja A, Meretoja TJ, Mersha AM, Mestrovic T, Mettananda KCD, Mettananda S, Michalek IM, Miller PA, Miller TR, Mills EJ, Minh LHN, Mirijello A, Mirrakhimov EM, Mirutse MK, Mirza-Aghazadeh-Attari M, Mirzaei M, Mirzaei R, Misganaw A, Mishra AK, Mitchell PB, Mittal C, Moazen B, Moberg ME, Mohamed J, Mohamed MFH, Mohamed NS, Mohammadi E, Mohammadi S, Mohammed H, Mohammed S, Mohammed S, Mohr RM, Mokdad AH, Molinaro S, Momtazmanesh S, Monasta L, Mondello S, Moodi Ghalibaf A, Moradi M, Moradi Y, Moradi-Lakeh M, Moraga P, Morawska L, Moreira RS, Morovatdar N, Morrison SD, Morze J, Mosapour A, Mosser JF, Mossialos E, Motappa R, Mougin V, Mouodi S, Mrejen M, Msherghi A, Mubarik S, Mueller UO, Mulita F, Munjal K, Murillo-Zamora E, Murlimanju BV, Mustafa G, Muthu S, Muzaffar M, Myung W, Nagarajan AJ, Naghavi P, Naik GR, Nainu F, Nair S, Najmuldeen HHR, Nangia V, Naqvi AA, Narayana AI, Nargus S, Nascimento GG, Nashwan AJ, Nasrollahizadeh A, Nasrollahizadeh A, Natto ZS, Nayak BP, Nayak VC, Nduaguba SO, Negash H, Negoi I, Negoi RI, Nejadghaderi SA, Nesbit OD, Netsere HB, Ng M, Nguefack-Tsague G, Ngunjiri JW, Nguyen DH, Nguyen HQ, Niazi RK, Nikolouzakis TK, Nikoobar A, Nikoomanesh F, Nikpoor AR, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Norrving B, Nri-Ezedi CA, Ntaios G, Ntsekhe M, Nurrika D, Nzoputam CI, Nzoputam OJ, Oancea B, Odetokun IA, O'Donnell MJ, Oguntade AS, Oguta JO, Okati-Aliabad H, Okeke SR, Okekunle AP, Okonji OC, Olagunju AT, Olasupo OO, Olatubi MI, Oliveira GMM, Olufadewa II, Olusanya BO, Olusanya JO, Omar HA, Omer GL, Omonisi AEE, Onie S, Onwujekwe OE, Ordak M, Orish VN, Ortega-Altamirano DV, Ortiz A, Ortiz-Brizuela E, Osman WMS, Ostroff SM, Osuagwu UL, Otoiu A, Otstavnov N, Otstavnov SS, Ouyahia A, Ouyang G, Owolabi MO, P A MP, Padron-Monedero A, Padubidri JR, Palicz T, Palladino C, Pan F, Pandi-Perumal SR, Pangaribuan HU, Panos GD, Panos LD, Pantea Stoian AM, Pardhan S, Parikh RR, Pashaei A, Pasovic M, Passera R, Patel J, Patel SK, Patil S, Patoulias D, Patthipati VS, Pawar S, Pazoki Toroudi H, Pease SA, Peden AE, Pedersini P, Peng M, Pensato U, Pepito VCF, Peprah EK, Peprah P, Perdigão J, Pereira MO, Perianayagam A, Perico N, Pesudovs K, Petermann-Rocha FE, Petri WA, Pham HT, Philip AK, Phillips MR, Pigeolet M, Pigott DM, Pillay JD, Piracha ZZ, Pirouzpanah S, Plass D, Plotnikov E, Poddighe D, Polinder S, Postma MJ, Pourtaheri N, Prada SI, Pradhan PMS, Prakash V, Prasad M, Prates EJS, Priscilla T, Pritchett N, Puri P, Puvvula J, Qasim NH, Qattea I, Qazi AS, Qian G, Rabiee Rad M, Radhakrishnan RA, Radhakrishnan V, Raeisi Shahraki H, Rafferty Q, Raggi A, Raghav PR, Rahim MJ, Rahman MM, Rahman MHU, Rahman M, Rahman MA, Rahmani S, Rahmanian M, Rahmawaty S, Rajaa S, Ramadan MM, Ramasamy SK, Ramasubramani P, Ramazanu S, Rana K, Ranabhat CL, Rancic N, Rane A, Rao CR, Rao K, Rao M, Rao SJ, Rashidi MM, Rathnaiah Babu G, Rauniyar SK, Rawaf DL, Rawaf S, Razo C, Reddy MMRK, Redwan EMM, Reifels L, Reiner Jr RC, Remuzzi G, Renzaho AMN, Reshmi B, Reyes LF, Rezaei N, Rezaei N, Rezaei N, Rezaei Hachesu P, Rezaeian M, Rickard J, Rodrigues CF, Rodriguez JAB, Roever L, Ronfani L, Roshandel G, Rotimi K, Rout HS, Roy B, Roy N, Roy P, Rubagotti E, S N C, Saad AMA, Saber-Ayad MM, Sabour S, Sacco S, Sachdev PS, Saddik B, Saddler A, Sadee BA, Sadeghi E, Sadeghi M, Saeb MR, Saeed U, Safi SZ, Sagar R, Sagoe D, Saif Z, Sajid MR, Sakshaug JW, Salam N, Salami AA, Salaroli LB, Saleh MA, Salem MR, Salem MZY, Sallam M, Samadzadeh S, Samargandy S, Samodra YL, Samy AM, Sanabria J, Sanna F, Santos IS, Santric-Milicevic MM, Sarasmita MA, Sarikhani Y, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathyanarayan A, Satpathy M, Sawhney M, Scarmeas N, Schaarschmidt BM, Schmidt MI, Schneider IJC, Schumacher AE, Schwebel DC, Schwendicke F, Sedighi M, Senapati S, Senthilkumaran S, Sepanlou SG, Sethi Y, Setoguchi S, Seylani A, Shadid J, Shafie M, Shah H, Shah NS, Shah PA, Shahbandi A, Shahid S, Shahid W, Shahwan MJ, Shaikh MA, Shakeri A, Shalash AS, Sham S, Shamim MA, Shamshirgaran MA, Shamsi MA, Shanawaz M, Shankar A, Shannawaz M, Sharath M, Sharifan A, Sharifi-Rad J, Sharma M, Sharma R, Sharma S, Sharma U, Sharma V, Shastry RP, Shavandi A, Shayan AM, Shayan M, Shehabeldine AME, Shetty PH, Shibuya K, Shifa JE, Shiferaw D, Shiferaw WS, Shigematsu M, Shiri R, Shitaye NA, Shittu A, Shivakumar KM, Shivarov V, Shokati Eshkiki Z, Shool S, Shrestha S, Shuval K, Sibhat MM, Siddig EE, Sigfusdottir ID, Silva DAS, Silva JP, Silva LMLR, Silva S, Simpson CR, Singal A, Singh A, Singh BB, Singh H, Singh JA, Singh M, Singh P, Skou ST, Sleet DA, Slepak ELN, Solanki R, Soliman SSM, Song S, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Sreeramareddy CT, Stark BA, Starodubova AV, Stein C, Stein DJ, Steiner C, Steiner TJ, Steinmetz JD, Steiropoulos P, Stockfelt L, Stokes MA, Subedi NS, Subramaniyan V, Suemoto CK, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sundström J, Swain CK, Szarpak L, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabche C, Tabish M, Tadakamadla SK, Taheri Abkenar Y, Taheri Soodejani M, Taherkhani A, Taiba J, Talaat IM, Talukder A, Tampa M, Tamuzi JL, Tan KK, Tandukar S, Tang H, Tavakoli Oliaee R, Tavangar SM, Teimoori M, Temsah MH, Teramoto M, Thangaraju P, Thankappan KR, Thapar R, Thayakaran R, Thirunavukkarasu S, Thomas N, Thomas NK, Thum CCC, Tichopad A, Ticoalu JHV, Tillawi T, Tiruye TY, Tobe-Gai R, Tonelli M, Topor-Madry R, Torre AE, Touvier M, Tovani-Palone MR, Tran JT, Tran MTN, Tran NM, Tran NH, Trico D, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsegay GM, Tsermpini EE, Tumurkhuu M, Tyrovolas S, Udoh A, Umair M, Umakanthan S, Umar TP, Undurraga EA, Unim B, Unnikrishnan B, Unsworth CA, Upadhyay E, Urso D, Usman JS, Vahabi SM, Vaithinathan AG, Van den Eynde J, Varga O, Varma RP, Vart P, Vasankari TJ, Vasic M, Vaziri S, Vellingiri B, Venketasubramanian N, Veroux M, Verras GI, Vervoort D, Villafañe JH, Violante FS, Vlassov V, Vollset SE, Volovat SR, Vongpradith A, Waheed Y, Wang C, Wang F, Wang N, Wang S, Wang Y, Wang YP, Ward P, Wassie EG, Weaver MR, Weerakoon KG, Weintraub RG, Weiss DJ, Weldemariam AH, Wells KM, Wen YF, Whisnant JL, Whiteford HA, Wiangkham T, Wickramasinghe DP, Wickramasinghe ND, Wilandika A, Wilkerson C, Willeit P, Wimo A, Woldegebreal DH, Wolf AW, Wong YJ, Woolf AD, Wu C, Wu F, Wu X, Wu Z, Wulf Hanson S, Xia Y, Xiao H, Xu X, Xu YY, Yadav L, Yadollahpour A, Yaghoubi S, Yamagishi K, Yang L, Yano Y, Yao Y, Yaribeygi H, Yazdanpanah MH, Ye P, Yehualashet SS, Yesuf SA, Yezli S, Yiğit A, Yiğit V, Yigzaw ZA, Yismaw Y, Yon DK, Yonemoto N, Younis MZ, Yu C, Yu Y, Yusuf H, Zahid MH, Zakham F, Zaki L, Zaki N, Zaman BA, Zamora N, Zand R, Zandieh GGZ, Zar HJ, Zarrintan A, Zastrozhin MS, Zhang H, Zhang N, Zhang Y, Zhao H, Zhong C, Zhong P, Zhou J, Zhu Z, Ziafati M, Zielińska M, Zimsen SRM, Zoladl M, Zumla A, Zyoud SH, Vos T, Murray CJL. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00757-8. [PMID: 38642570 DOI: 10.1016/s0140-6736(24)00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING Bill & Melinda Gates Foundation.
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Jacoby N, Polak R, Grahn JA, Cameron DJ, Lee KM, Godoy R, Undurraga EA, Huanca T, Thalwitzer T, Doumbia N, Goldberg D, Margulis EH, Wong PCM, Jure L, Rocamora M, Fujii S, Savage PE, Ajimi J, Konno R, Oishi S, Jakubowski K, Holzapfel A, Mungan E, Kaya E, Rao P, Rohit MA, Alladi S, Tarr B, Anglada-Tort M, Harrison PMC, McPherson MJ, Dolan S, Durango A, McDermott JH. Commonality and variation in mental representations of music revealed by a cross-cultural comparison of rhythm priors in 15 countries. Nat Hum Behav 2024:10.1038/s41562-023-01800-9. [PMID: 38438653 DOI: 10.1038/s41562-023-01800-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/07/2023] [Indexed: 03/06/2024]
Abstract
Music is present in every known society but varies from place to place. What, if anything, is universal to music cognition? We measured a signature of mental representations of rhythm in 39 participant groups in 15 countries, spanning urban societies and Indigenous populations. Listeners reproduced random 'seed' rhythms; their reproductions were fed back as the stimulus (as in the game of 'telephone'), such that their biases (the prior) could be estimated from the distribution of reproductions. Every tested group showed a sparse prior with peaks at integer-ratio rhythms. However, the importance of different integer ratios varied across groups, often reflecting local musical practices. Our results suggest a common feature of music cognition: discrete rhythm 'categories' at small-integer ratios. These discrete representations plausibly stabilize musical systems in the face of cultural transmission but interact with culture-specific traditions to yield the diversity that is evident when mental representations are probed across many cultures.
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Affiliation(s)
- Nori Jacoby
- Computational Auditory Perception Group, Max Planck Institute for Empirical Aesthetics, Frankfurt am Main, Germany.
- Presidential Scholars in Society and Neuroscience, Columbia University, New York, NY, USA.
| | - Rainer Polak
- RITMO Centre for Interdisciplinary Studies in Rhythm, Time and Motion, University of Oslo, Blindern, Oslo, Norway
| | - Jessica A Grahn
- Brain and Mind Institute and Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | - Daniel J Cameron
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Kyung Myun Lee
- School of Digital Humanities and Social Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
- Graduate School of Culture Technology, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Ricardo Godoy
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
- CIFAR Azrieli Global Scholars programme, CIFAR, Toronto, Ontario, Canada
| | - Tomás Huanca
- Centro Boliviano de Investigación y Desarrollo Socio Integral, San Borja, Bolivia
| | | | - Noumouké Doumbia
- Sciences de l'Education, Université Catholique d'Afrique de l'Ouest, Bamako, Mali
| | - Daniel Goldberg
- Department of Music, University of Connecticut, Storrs, CT, USA
| | | | - Patrick C M Wong
- Department of Linguistics & Modern Languages and Brain and Mind Institute, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Luis Jure
- School of Music, Universidad de la República, Montevideo, Uruguay
| | - Martín Rocamora
- Signal Processing Department, School of Engineering, Universidad de la República, Montevideo, Uruguay
- Music Technology Group, Universitat Pompeu Fabra, Barcelona, Spain
| | - Shinya Fujii
- Faculty of Environment and Information Studies, Keio University, Fujisawa, Japan
| | - Patrick E Savage
- Faculty of Environment and Information Studies, Keio University, Fujisawa, Japan
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Jun Ajimi
- Department of Traditional Japanese Music, Tokyo University of the Arts, Tokyo, Japan
| | - Rei Konno
- Faculty of Environment and Information Studies, Keio University, Fujisawa, Japan
| | - Sho Oishi
- Faculty of Environment and Information Studies, Keio University, Fujisawa, Japan
| | | | - Andre Holzapfel
- Division of Media Technology and Interaction Design, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Esra Mungan
- Department of Psychology, Bogazici University, Istanbul, Turkey
| | - Ece Kaya
- Max Planck Research Group 'Neural and Environmental Rhythms', Max Planck Institute for Empirical Aesthetics, Frankfurt am Main, Germany
- Cognitive Science Master Program, Bogazici University, Istanbul, Turkey
| | - Preeti Rao
- Department of Electrical Engineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Mattur A Rohit
- Department of Electrical Engineering, Indian Institute of Technology Bombay, Mumbai, India
| | | | - Bronwyn Tarr
- Department of Cognitive and Evolutionary Anthropology, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Manuel Anglada-Tort
- Computational Auditory Perception Group, Max Planck Institute for Empirical Aesthetics, Frankfurt am Main, Germany
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Peter M C Harrison
- Computational Auditory Perception Group, Max Planck Institute for Empirical Aesthetics, Frankfurt am Main, Germany
- Faculty of Music, University of Cambridge, Cambridge, UK
| | - Malinda J McPherson
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
- Program in Speech and Hearing Biosciences and Technology, Harvard University, Cambridge, MA, USA
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sophie Dolan
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Brain and Cognitive Sciences, Wellesley College, Wellesley, MA, USA
| | - Alex Durango
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Neurosciences Graduate Program, Stanford University, Stanford, CA, USA
| | - Josh H McDermott
- Faculty of Music, University of Cambridge, Cambridge, UK.
- Program in Speech and Hearing Biosciences and Technology, Harvard University, Cambridge, MA, USA.
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Center for Brains, Minds & Machines, Massachusetts Institute of Technology, Cambridge, MA, USA.
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Allel K, Hernández-Leal MJ, Naylor NR, Undurraga EA, Abou Jaoude GJ, Bhandari P, Flanagan E, Haghparast-Bidgoli H, Pouwels KB, Yakob L. Costs-effectiveness and cost components of pharmaceutical and non-pharmaceutical interventions affecting antibiotic resistance outcomes in hospital patients: a systematic literature review. BMJ Glob Health 2024; 9:e013205. [PMID: 38423548 PMCID: PMC10910705 DOI: 10.1136/bmjgh-2023-013205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Limited information on costs and the cost-effectiveness of hospital interventions to reduce antibiotic resistance (ABR) hinder efficient resource allocation. METHODS We conducted a systematic literature review for studies evaluating the costs and cost-effectiveness of pharmaceutical and non-pharmaceutical interventions aimed at reducing, monitoring and controlling ABR in patients. Articles published until 12 December 2023 were explored using EconLit, EMBASE and PubMed. We focused on critical or high-priority bacteria, as defined by the WHO, and intervention costs and incremental cost-effectiveness ratio (ICER). Following Preferred Reporting Items for Systematic review and Meta-Analysis guidelines, we extracted unit costs, ICERs and essential study information including country, intervention, bacteria-drug combination, discount rates, type of model and outcomes. Costs were reported in 2022 US dollars ($), adopting the healthcare system perspective. Country willingness-to-pay (WTP) thresholds from Woods et al 2016 guided cost-effectiveness assessments. We assessed the studies reporting checklist using Drummond's method. RESULTS Among 20 958 articles, 59 (32 pharmaceutical and 27 non-pharmaceutical interventions) met the inclusion criteria. Non-pharmaceutical interventions, such as hygiene measures, had unit costs as low as $1 per patient, contrasting with generally higher pharmaceutical intervention costs. Several studies found that linezolid-based treatments for methicillin-resistant Staphylococcus aureus were cost-effective compared with vancomycin (ICER up to $21 488 per treatment success, all 16 studies' ICERs CONCLUSION Robust information on ABR interventions is critical for efficient resource allocation. We highlight cost-effective strategies for mitigating ABR in hospitals, emphasising substantial knowledge gaps, especially in low-income and middle-income countries. Our study serves as a resource for guiding future cost-effectiveness study design and analyses.PROSPERO registration number CRD42020341827 and CRD42022340064.
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Affiliation(s)
- Kasim Allel
- Disease Control Department, London School of Hygiene & Tropical Medicine, London, UK
- Institute for Global Health, University College London, London, UK
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | - María José Hernández-Leal
- Department of Community, Maternity and Paediatric Nursing, University of Navarra, Pamplona, Spain
- Millennium Nucleus on Sociomedicine, Santiago, Chile
| | - Nichola R Naylor
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- HCAI, Fungal, AMR, AMU & Sepsis Division, UK Health Security Agency, London, UK
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Catolica de Chile, Santiago, Chile
- CIFAR Azrieli Global Scholars program, Canadian Institute for Advanced Research, Toronto, Ontario, Canada
| | | | - Priyanka Bhandari
- Disease Control Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Ellen Flanagan
- Disease Control Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Koen B Pouwels
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - Laith Yakob
- Disease Control Department, London School of Hygiene & Tropical Medicine, London, UK
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Undurraga EA, Peters A, Arias CA, Munita JM. Surveillance infrastructure is essential to address antimicrobial resistance in the Americas. Lancet Reg Health Am 2024; 29:100654. [PMID: 38205369 PMCID: PMC10776432 DOI: 10.1016/j.lana.2023.100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Eduardo A. Undurraga
- Multidisciplinary Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Chile
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Chile
- Centro de Investigación para la Gestión Integrada del Riesgo de Desastres (CIGIDEN), Chile
- Canadian Institute for Advanced Research (CIFAR) Azrieli Global Scholars Program, Toronto, Canada
| | - Anne Peters
- Multidisciplinary Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Cesar A. Arias
- Division of Infectious Diseases, Houston Methodist Hospital, TX, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jose M. Munita
- Multidisciplinary Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Tropini C, Finlay BB, Nichter M, Melby MK, Metcalf JL, Dominguez-Bello MG, Zhao L, McFall-Ngai MJ, Geva-Zatorsky N, Amato KR, Undurraga EA, Poinar HN, Gilbert JA. Time to rethink academic publishing: the peer reviewer crisis. mBio 2023; 14:e0109123. [PMID: 37975666 PMCID: PMC10746150 DOI: 10.1128/mbio.01091-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
There is concern that the time taken to publish academic papers in microbiological science has significantly increased in recent years. While the data do not specifically support this, evidence suggests that editors are having to invite more and more reviewers to identify those willing to perform peer review.
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Affiliation(s)
- Carolina Tropini
- Humans and the Microbiome Program, Canadian Institute for Advanced Research, Toronto, Ontario, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - B. Brett Finlay
- Humans and the Microbiome Program, Canadian Institute for Advanced Research, Toronto, Ontario, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Biochemistry and Microbiology and the Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Nichter
- Humans and the Microbiome Program, Canadian Institute for Advanced Research, Toronto, Ontario, Canada
- School of Anthropology, University of Arizona, Tucson, Arizona, USA
| | - Melissa K. Melby
- Humans and the Microbiome Program, Canadian Institute for Advanced Research, Toronto, Ontario, Canada
- Department of Anthropology, University of Delaware, Newark, Delaware, USA
| | - Jessica L. Metcalf
- Department of Animal Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Maria Gloria Dominguez-Bello
- Humans and the Microbiome Program, Canadian Institute for Advanced Research, Toronto, Ontario, Canada
- Department of Biochemistry and Microbiology, Rutgers University, New Brunswick, New Jersey, USA
- Department of Anthropolog, Rutgers University, New Brunswick, New Jersey, USA
| | - Liping Zhao
- Humans and the Microbiome Program, Canadian Institute for Advanced Research, Toronto, Ontario, Canada
- Department of Biochemistry and Microbiology, Rutgers University, New Brunswick, New Jersey, USA
| | - Margaret J. McFall-Ngai
- Carnegie Institution for Science, California Institute of Technology, Pasadena, California, USA
| | - Naama Geva-Zatorsky
- Department of Cell Biology and Cancer Science, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Rappaport Technion Integrated Cancer Center (RTICC), Haifa, Israel
| | - Katherine R. Amato
- Humans and the Microbiome Program, Canadian Institute for Advanced Research, Toronto, Ontario, Canada
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Eduardo A. Undurraga
- Humans and the Microbiome Program, Canadian Institute for Advanced Research, Toronto, Ontario, Canada
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Región Metropolitana, Chile
| | - Hendrik N. Poinar
- Humans and the Microbiome Program, Canadian Institute for Advanced Research, Toronto, Ontario, Canada
- Departments of Anthropology and Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Jack A. Gilbert
- Department of Pediatrics, Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, USA
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Shepard DS, Agarwal‐Harding P, Jiamton S, Undurraga EA, Kongsin S. Enrollment of dengue patients in a prospective cohort study in Umphang District, Thailand, during the COVID-19 pandemic: Implications for research and policy. Health Sci Rep 2023; 6:e1657. [PMID: 38028707 PMCID: PMC10630743 DOI: 10.1002/hsr2.1657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Aims Dengue is endemic in Thailand and imposes a high burden on the health system and society. We conducted a prospective cohort study in Umphang District, Tak Province, Thailand, to investigate the share of dengue cases with long symptoms and their duration. Here we present the results of the enrollment process during the COVID-19 pandemic with implications and challenges for research and policy. Methods In a prospective cohort study conducted in Umphang District, Thailand, we examined the prevalence of persistent symptoms in dengue cases. Clinically diagnosed cases were offered free laboratory testing, We enrolled ambulatory dengue patients regardless of age who were confirmed through a highly sensitive laboratory strategy (positive NS1 and/or IgM), agreed to follow-up visits, and gave informed consent. We used multivariate logistic regressions to assess the probability of clinical dengue being laboratory confirmed. To determine the factors associated with study enrollment, we analyzed the relationship of patient characteristics and month of screening to the likelihood of participation. To identify underrepresented groups, we compared the enrolled cohort to external data sources. Results The 150 clinical cases ranged from 1 to 85 years old. Most clinical cases (78%) were confirmed by a positive laboratory test, but only 19% of those confirmed enrolled in the cohort study. Women, who were half as likely to enroll as men, were underrepresented in the cohort. Conclusions The Thai physicians' clinical diagnoses at this rural district hospital had good agreement with laboratory diagnoses. By identifying underrepresented groups and disparities, future studies can ensure the creation of statistically representative cohorts to maximize their scientific value. This involves recruiting and retaining underrepresented groups in health research, such as women in this study. Promising strategies for meaningful inclusion include multi-site enrollment, offering in-home or virtual services, and providing in-kind benefits like childcare for underrepresented groups.
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Affiliation(s)
- Donald S. Shepard
- Schneider Institutes for Health PolicyHeller School for Social Policy and Management, Brandeis UniversityWalthamMassachusettsUSA
| | - Priya Agarwal‐Harding
- Schneider Institutes for Health PolicyHeller School for Social Policy and Management, Brandeis UniversityWalthamMassachusettsUSA
| | - Sukhum Jiamton
- Research Centre for Health Economics and Evaluation, Faculty of Public HealthMahidol UniversityBangkokThailand
- Department of Dermatology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Eduardo A. Undurraga
- Escuela de GobiernoPontificia Universidad Católica de ChileSantiagoChile
- Research Center for Integrated Disaster Risk Management (CIGIDEN)SantiagoChile
- CIFAR Azrieli Global Scholars ProgramTorontoOntarioCanada
| | - Sukhontha Kongsin
- Research Centre for Health Economics and Evaluation, Faculty of Public HealthMahidol UniversityBangkokThailand
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Jara A, Cuadrado C, Undurraga EA, García C, Nájera M, Bertoglia MP, Vergara V, Fernández J, García-Escorza H, Araos R. Effectiveness of the second COVID-19 booster against Omicron: a large-scale cohort study in Chile. Nat Commun 2023; 14:6836. [PMID: 37884492 PMCID: PMC10603055 DOI: 10.1038/s41467-023-41942-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
In light of the ongoing COVID-19 pandemic and the emergence of new SARS-CoV-2 variants, understanding the effectiveness of various booster vaccination regimens is pivotal. In Chile, using a prospective national cohort of 3.75 million individuals aged 20 or older, we evaluate the effectiveness against COVID-19-related intensive care unit (ICU) admissions and death of mRNA-based second vaccine boosters for four different three-dose background regimes: BNT162b2 primary series followed by a homologous booster, and CoronaVac primary series followed by an mRNA booster, a homologous booster, and a ChAdOx-1 booster. We estimate the vaccine effectiveness weekly from February 14 to August 15, 2022, by determining hazard ratios of immunization over non-vaccination, accounting for relevant confounders. The overall adjusted effectiveness of a second mRNA booster shot is 88.2% (95%CI, 86.2-89.9) against ICU admissions and 90.5% (95%CI 89.4-91.4) against death. Vaccine effectiveness shows a mild decrease for all regimens and outcomes, probably linked to the introduction of BA.4 and BA.5 Omicron sub-lineages and the waning of immunity. Based on our findings, individuals might not need additional boosters for at least 6 months after receiving a second mRNA booster shot in this setting.
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Affiliation(s)
- Alejandro Jara
- Facultad de Matemáticas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for the Discovery of Structures in Complex Data (MiDaS), Santiago, Chile
| | - Cristobal Cuadrado
- Ministerio de Salud de Chile, Santiago, Chile
- School of Public Health, Universidad de Chile, Santiago, Chile
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, RM, Chile
- Multidisciplinary Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile
- CIFAR Azrieli Global Scholars program, CIFAR, Toronto, Canada
| | | | | | | | | | | | | | - Rafael Araos
- Multidisciplinary Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile.
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile.
- Advanced Center for Chronic Diseases (ACCDiS), Santiago, Chile.
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Alvarez DM, Barrón-Montenegro R, Conejeros J, Rivera D, Undurraga EA, Moreno-Switt AI. A review of the global emergence of multidrug-resistant Salmonella enterica subsp. enterica Serovar Infantis. Int J Food Microbiol 2023; 403:110297. [PMID: 37406596 DOI: 10.1016/j.ijfoodmicro.2023.110297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 07/07/2023]
Abstract
Salmonella enterica serovar Infantis is an emergent foodborne and zoonotic Salmonella serovar with critical implications for global health. In recent years, the prevalence of S. Infantis infections has increased in the United States, Europe, and Latin America, due to contaminated chicken and other foods. An essential trait of S. Infantis is its resistance to multiple antibiotics, including the critically important third-generation cephalosporins and quinolones, undermining effective medical treatment, particularly in low-resource settings. We describe the emergence of multidrug-resistant (MDR) S. Infantis, focusing on humans, animals, the environment, and food. We conducted a systematic review (1979-2021), selected 183 studies, and analyzed the origin, source, antimicrobial resistance, and presence of a conjugative plasmid of emerging S. Infantis (pESI) in reported isolates. S. Infantis has been detected worldwide, with a substantial increase since 2011. We found the highest number of isolations in the Americas (42.9 %), Europe (29.8 %), Western Pacific (17.2 %), Eastern Mediterranean (6.6 %), Africa (3.4 %), and South-East Asia (0.1 %). S. Infantis showed MDR patterns and numerous resistant genes in all sources. The primary source of MDR S. Infantis is broiler and their meat; however, this emerging pathogen is also present in other reservoirs such as food, wildlife, and the environment. Clinical cases of MDR S. Infantis have been reported in children and adults. The global emergence of S. Infantis is related to a plasmid (pESI) with antibiotic and arsenic- and mercury-resistance genes. Additionally, a new megaplasmid (pESI-like), carrying blaCTX-M-65 and antibiotic-resistant genes reported in an ancestral version, was detected in the broiler, human, and chicken meat isolates. Strains harboring pESI-like were primarily observed in the Americas and Europe. MDR S. Infantis has spread globally, potentially becoming a major public health threat, particularly in low- and middle-income countries.
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Affiliation(s)
- Diana M Alvarez
- Escuela de Medicina Veterinaria, Facultad de Agronomía e Ingeniería Forestal, Facultad de Ciencias Biológicas, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rocío Barrón-Montenegro
- Escuela de Medicina Veterinaria, Facultad de Agronomía e Ingeniería Forestal, Facultad de Ciencias Biológicas, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Conejeros
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Macul, Santiago, Región Metropolitana, Chile
| | - Dácil Rivera
- Escuela de Medicina Veterinaria, Universidad Andres Bello, Santiago, Chile
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Macul, Santiago, Región Metropolitana, Chile; Research Center for Integrated Disaster Risk Management (CIGIDEN), Av. Vicuña Mackenna 4860, Macul, Santiago, Región Metropolitana, Chile; CIFAR Azrieli Global Scholars program, CIFAR, 661 University Ave., Toronto, ON M5G 1M1, Canada
| | - Andrea I Moreno-Switt
- Escuela de Medicina Veterinaria, Facultad de Agronomía e Ingeniería Forestal, Facultad de Ciencias Biológicas, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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9
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Undurraga EA, Peters A, Arias CA, Munita JM. Lives lost and disease burden related to antimicrobial resistance in the Americas can no longer be ignored. Lancet Reg Health Am 2023; 26:100596. [PMID: 37766801 PMCID: PMC10520421 DOI: 10.1016/j.lana.2023.100596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Eduardo A. Undurraga
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Región Metropolitana, Santiago, Chile
- Centro de Investigación para la Gestión Integrada del Riesgo de Desastres (CIGIDEN), Región Metropolitana, Santiago, Chile
- Humans and the Microbiome Program, Canadian Institute for Advanced Research (CIFAR), Toronto, Ontario, Canada
| | - Anne Peters
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Región Metropolitana, Santiago, Chile
| | - Cesar A. Arias
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, TX, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX, USA
- Department of Medicine, Weill Cornell Medical College, Houston, TX, USA
| | - Jose M. Munita
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Región Metropolitana, Santiago, Chile
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10
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Errazuriz A, Avello-Vega D, Ramirez-Mahaluf JP, Torres R, Crossley NA, Undurraga EA, Jones PB. Prevalence of depressive disorder in the adult population of Latin America: a systematic review and meta-analysis. Lancet Reg Health Am 2023; 26:100587. [PMID: 37701460 PMCID: PMC10493603 DOI: 10.1016/j.lana.2023.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/12/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
Background Depressive disorder is one of the leading causes of disability worldwide; however its prevalence and association with inequality and crime is poorly characterised in Latin America. This study aimed to: i. systematically review population-based studies of prevalence of ICD/DSM depressive disorder in Latin America, ii. report pooled regional, country, and sex-specific prevalence estimates, and iii. test its association with four country-level development indicators: human development (HDI), income (Gini) and gender inequality (GII), and intentional homicide rate (IHR). Methods We conducted a systematic review and meta-analysis of population-based studies reporting primary data on the prevalence of ICD/DSM depressive disorder in Latin America from 1990 to 2023, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO (regional database), LILAC (regional database), and available grey literature. Study quality was assessed using JBI's critical appraisal tools. We generated pooled estimates using random-effects meta-analysis; heterogeneity was assessed using the I2 statistic. Meta-regression analyses were used to test associations of depression prevalence with indicators of inequality and human development. The study was registered with PROSPERO (CRD42019143054). Findings Using data from 40 studies in Latin America, lifetime, 12-month, and current prevalence of ICD/DSM depressive disorder were calculated at 12.58% (95% CI 11.00%-14.16%); 5.30% (4.55-6.06%), and 3.12% (2.22-4.03), respectively. Heterogeneity was high across lifetime, 12-month, and current prevalence, sex, and countries. 12-month and current prevalence was associated with higher Gini and GII, 12-month prevalence with lower HDI, and current prevalence with higher IHR. Interpretation We found a high prevalence of ICD/DSM depressive disorders in Latin America, and a statistically significant association with inequality and development indicators. The high heterogeneity found across prevalence periods and the major gaps in country representation underscore the need to escalate efforts to improve mental health access and research capabilities in Latin America. Systematic, comparable prevalence estimates would inform more effective decision-making in the region. Funding Pfizer Independent Medical Education Grant.
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Affiliation(s)
- Antonia Errazuriz
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Institute for Research on Depression and Personality-MIDAP, Santiago, Chile
| | - Dalia Avello-Vega
- Regional Research Institute, School of Social Work, Portland State University, Oregon, United States
| | - Juan P. Ramirez-Mahaluf
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rafael Torres
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Nicolas A. Crossley
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Eduardo A. Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, Canada
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- NIHR Applied Research Collaboration East of England, CPFT, Cambridge, United Kingdom
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11
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Parra Barrera EL, Bello Piruccini S, Rodríguez K, Duarte C, Torres M, Undurraga EA. Demographic and clinical risk factors associated with severity of lab-confirmed human leptospirosis in Colombia, 2015-2020. PLoS Negl Trop Dis 2023; 17:e0011454. [PMID: 37406001 DOI: 10.1371/journal.pntd.0011454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Leptospirosis is a common zoonoses and is a major global public health threat. Most cases are mild, typically presenting as a non-specific acute febrile illness. However, leptospirosis can have life-threatening manifestations, including pulmonary hemorrhage syndrome, and acute kidney injury. In Colombia, notification and lab-confirmation of suspected human cases are mandatory. However, little is known about the demographic and clinical factors associated with severe leptospirosis, which could help to reduce clinical complications and mortality. Our aim was to identify risk factors associated with severe leptospirosis, intensive care unit (ICU) admission, and mortality in lab-confirmed cases in Colombia, 2015-2020. METHODS AND FINDINGS We analyzed 201 lab-confirmed human leptospirosis cases by microagglutination test. We used a logistic regression to identify the demographic and clinical risk factors associated with severe leptospirosis, admission to ICU, and death. Most leptospirosis confirmed cases occurred in men (85.6%); the mean age was 36.7 years. We classified severe cases (43.3%) by clinical manifestations as renal (29.9%) and liver (27.4%) failure, multiple-organ failure (24.4%), septic shock (24.4%), Weil syndrome (18.4%), pulmonary hemorrhage (18.4%), and meningitis (2.5%), admitted to the ICU (30.3%), and fatal (8.5%). Clinical conditions associated with severe leptospirosis were dyspnea (OR: 5.54; 95% CI: 1.46 to 20.98), tachycardia (OR:9.69; 95% CI: 15.96 to 58.8), and rash (OR: 10.25; 95% CI: 25.01 to 42.08). CONCLUSIONS We identified demographic characteristics and clinical symptoms associated with severe leptospirosis in Colombia. We hope these results can support clinicians in providing timely treatment to leptospirosis patients to avoid preventable medical complications or deaths.
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Affiliation(s)
- Eliana L Parra Barrera
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
- Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Santiago, RM Chile
- Grupo de Virología, Instituto Nacional de Salud, Bogotá, Colombia
| | | | - Karina Rodríguez
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Carolina Duarte
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Marisa Torres
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Eduardo A Undurraga
- Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Santiago, RM Chile
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, RM, Chile
- CIFAR Azrieli Global Scholars program, CIFAR, Toronto, Canada
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, RM Chile
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12
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Allel K, Peters A, Conejeros J, Martínez JRW, Spencer-Sandino M, Riquelme-Neira R, Rivas L, Rojas P, Orellana Chea C, García P, Araos R, McGovern O, Patel TS, Arias CA, Lessa FC, Undurraga EA, Munita JM. Antibiotic Consumption During the Coronavirus Disease 2019 Pandemic and Emergence of Carbapenemase-Producing Klebsiella pneumoniae Lineages Among Inpatients in a Chilean Hospital: A Time-Series Study and Phylogenomic Analysis. Clin Infect Dis 2023; 77:S20-S28. [PMID: 37406053 DOI: 10.1093/cid/ciad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The impact of coronavirus disease 2019 (COVID-19) on antimicrobial use (AU) and resistance has not been well evaluated in South America. These data are critical to inform national policies and clinical care. METHODS At a tertiary hospital in Santiago, Chile, between 2018 and 2022, subdivided into pre- (3/2018-2/2020) and post-COVID-19 onset (3/2020-2/2022), we evaluated intravenous AU and frequency of carbapenem-resistant Enterobacterales (CRE). We grouped monthly AU (defined daily doses [DDD]/1000 patient-days) into broad-spectrum β-lactams, carbapenems, and colistin and used interrupted time-series analysis to compare AU during pre- and post-pandemic onset. We studied the frequency of carbapenemase-producing (CP) CRE and performed whole-genome sequencing analyses of all carbapenem-resistant (CR) Klebsiella pneumoniae (CRKpn) isolates collected during the study period. RESULTS Compared with pre-pandemic, AU (DDD/1000 patient-days) significantly increased after the pandemic onset, from 78.1 to 142.5 (P < .001), 50.9 to 110.1 (P < .001), and 4.1 to 13.3 (P < .001) for broad-spectrum β-lactams, carbapenems, and colistin, respectively. The frequency of CP-CRE increased from 12.8% pre-COVID-19 to 51.9% after pandemic onset (P < .001). The most frequent CRE species in both periods was CRKpn (79.5% and 76.5%, respectively). The expansion of CP-CRE harboring blaNDM was particularly noticeable, increasing from 40% (n = 4/10) before to 73.6% (n = 39/53) after pandemic onset (P < .001). Our phylogenomic analyses revealed the emergence of two distinct genomic lineages of CP-CRKpn: ST45, harboring blaNDM, and ST1161, which carried blaKPC. CONCLUSIONS AU and the frequency of CP-CRE increased after COVID-19 onset. The increase in CP-CRKpn was driven by the emergence of novel genomic lineages. Our observations highlight the need to strengthen infection prevention and control and antimicrobial stewardship efforts.
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Affiliation(s)
- Kasim Allel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Institute for Global Health, University College London, London, United Kingdom
| | - Anne Peters
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
| | - José Conejeros
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
| | - José R W Martínez
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
| | - Maria Spencer-Sandino
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
| | - Roberto Riquelme-Neira
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
- Núcleo de Investigaciones Aplicadas en Ciencias Veterinarias y Agronómicas, Facultad de Medicina Veterinaria y Agronomía, Universidad de las Américas, Santiago, Chile
| | - Lina Rivas
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
| | | | | | - Patricia García
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Universidad Católica de Chile, Santiago, Chile
| | - Rafael Araos
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
| | - Olivia McGovern
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Twisha S Patel
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cesar A Arias
- Division of Infectious Diseases, Houston Methodist Hospital, Texas, USA
| | - Fernanda C Lessa
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eduardo A Undurraga
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Investigación para la Gestión Integrada del Riesgo de Desastres (CIGIDEN), Chile
- Canadian Institute for Advanced Research (CIFAR) Azrieli Global Scholars Program, CIFAR, Toronto, Canada
| | - José M Munita
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
- Hospital Padre Hurtado, Santiago, Chile
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13
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Kuzmanic D, Valenzuela JP, Claro S, Canales A, Cerda D, Undurraga EA. Socioeconomic disparities in the reopening of schools during the pandemic in Chile. Int J Educ Dev 2023; 100:102805. [PMID: 37235200 PMCID: PMC10199314 DOI: 10.1016/j.ijedudev.2023.102805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 03/14/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
The COVID-19 pandemic produced the most significant disruption in education in history. More than 190 countries suspended in-person instruction, affecting an estimated 1.6 billion students. The reopening of schools has been unequal. Schools in more affluent areas reopened sooner than poorer ones, exacerbating preexisting inequalities. There is limited research about the reopening processes in Latin America, where schools were closed for extended periods. Using a rich administrative dataset, we investigate the gaps in the resumption of in-person instruction in Chilean schools across socioeconomic groups in the fall of 2021. Schools with lower socioeconomic status were significantly less likely to offer in-person instruction. Disparities in reopening decisions were associated with administrative factors rather than economic or local epidemiological conditions.
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Affiliation(s)
- Danilo Kuzmanic
- Center for Advanced Research in Education, Institute of Education, Universidad de Chile, Chile
| | - Juan Pablo Valenzuela
- Center for Advanced Research in Education, Institute of Education, Universidad de Chile, Chile
| | - Susana Claro
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Chile
| | - Andrea Canales
- Instituto de Sociología, Facultad de Ciencias Sociales, Pontificia Universidad Católica de Chile, Chile
| | - Daniela Cerda
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Chile
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Chile
- Canadian Institute for Advanced Research, Azrieli Global Scholars Program, CIFAR, Toronto, Canada
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14
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Allel K, Stone J, Undurraga EA, Day L, Moore CE, Lin L, Furuya-Kanamori L, Yakob L. The impact of inpatient bloodstream infections caused by antibiotic-resistant bacteria in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med 2023; 20:e1004199. [PMID: 37347726 DOI: 10.1371/journal.pmed.1004199] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 02/13/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Bloodstream infections (BSIs) produced by antibiotic-resistant bacteria (ARB) cause a substantial disease burden worldwide. However, most estimates come from high-income settings and thus are not globally representative. This study quantifies the excess mortality, length of hospital stay (LOS), intensive care unit (ICU) admission, and economic costs associated with ARB BSIs, compared to antibiotic-sensitive bacteria (ASB), among adult inpatients in low- and middle-income countries (LMICs). METHODS AND FINDINGS We conducted a systematic review by searching 4 medical databases (PubMed, SCIELO, Scopus, and WHO's Global Index Medicus; initial search n = 13,012 from their inception to August 1, 2022). We only included quantitative studies. Our final sample consisted of n = 109 articles, excluding studies from high-income countries, without our outcomes of interest, or without a clear source of bloodstream infection. Crude mortality, ICU admission, and LOS were meta-analysed using the inverse variance heterogeneity model for the general and subgroup analyses including bacterial Gram type, family, and resistance type. For economic costs, direct medical costs per bed-day were sourced from WHO-CHOICE. Mortality costs were estimated based on productivity loss from years of potential life lost due to premature mortality. All costs were in 2020 USD. We assessed studies' quality and risk of publication bias using the MASTER framework. Multivariable meta-regressions were employed for the mortality and ICU admission outcomes only. Most included studies showed a significant increase in crude mortality (odds ratio (OR) 1.58, 95% CI [1.35 to 1.80], p < 0.001), total LOS (standardised mean difference "SMD" 0.49, 95% CI [0.20 to 0.78], p < 0.001), and ICU admission (OR 1.96, 95% CI [1.56 to 2.47], p < 0.001) for ARB versus ASB BSIs. Studies analysing Enterobacteriaceae, Acinetobacter baumanii, and Staphylococcus aureus in upper-middle-income countries from the African and Western Pacific regions showed the highest excess mortality, LOS, and ICU admission for ARB versus ASB BSIs per patient. Multivariable meta-regressions indicated that patients with resistant Acinetobacter baumanii BSIs had higher mortality odds when comparing ARB versus ASB BSI patients (OR 1.67, 95% CI [1.18 to 2.36], p 0.004). Excess direct medical costs were estimated at $12,442 (95% CI [$6,693 to $18,191]) for ARB versus ASB BSI per patient, with an average cost of $41,103 (95% CI [$30,931 to $51,274]) due to premature mortality. Limitations included the poor quality of some of the reviewed studies regarding the high risk of selective sampling or failure to adequately account for relevant confounders. CONCLUSIONS We provide an overview of the impact ARB BSIs in limited resource settings derived from the existing literature. Drug resistance was associated with a substantial disease and economic burden in LMICs. Although, our results show wide heterogeneity between WHO regions, income groups, and pathogen-drug combinations. Overall, there is a paucity of BSI data from LMICs, which hinders implementation of country-specific policies and tracking of health progress.
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Affiliation(s)
- Kasim Allel
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
- Multidisciplinary Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile
| | - Jennifer Stone
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Eduardo A Undurraga
- Multidisciplinary Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, Canada
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile
| | - Lucy Day
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catrin E Moore
- The Centre for Neonatal and Paediatric Infection, Infection and Immunity Institute, St George's, University of London, London, United Kingdom
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China
- The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Laith Yakob
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
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15
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Martínez JRW, Alcalde-Rico M, Jara-Videla E, Rios R, Moustafa AM, Hanson B, Rivas L, Carvajal LP, Rincon S, Diaz L, Reyes J, Quesille-Villalobos A, Riquelme-Neira R, Undurraga EA, Olivares-Pacheco J, García P, Araos R, Planet PJ, Arias CA, Munita JM. Heavy Metal Pollution From a Major Earthquake and Tsunami in Chile Is Associated With Geographic Divergence of Clinical Isolates of Methicillin-Resistant Staphylococcus aureus in Latin America. bioRxiv 2023:2023.05.18.541300. [PMID: 37293062 PMCID: PMC10245734 DOI: 10.1101/2023.05.18.541300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a priority pathogen listed by the World Health Organization. The global spread of MRSA is characterized by successive waves of epidemic clones that predominate in specific geographical regions. The acquisition of genes encoding resistance to heavy-metals is thought to be a key feature in the divergence and geographical spread of MRSA. Increasing evidence suggests that extreme natural events, such as earthquakes and tsunamis, could release heavy-metals into the environment. However, the impact of environmental exposition to heavy-metals on the divergence and spread of MRSA clones has been insufficiently explored. We assess the association between a major earthquake and tsunami in an industrialized port in southern Chile and MRSA clone divergence in Latin America. We performed a phylogenomic reconstruction of 113 MRSA clinical isolates from seven Latin American healthcare centers, including 25 isolates collected in a geographic area affected by an earthquake and tsunami that led to high levels of heavy-metal environmental contamination. We found a divergence event strongly associated with the presence of a plasmid harboring heavy-metal resistance genes in the isolates obtained in the area where the earthquake and tsunami occurred. Moreover, clinical isolates carrying this plasmid showed increased tolerance to mercury, arsenic, and cadmium. We also observed a physiological burden in the plasmid-carrying isolates in absence of heavy-metals. Our results are the first evidence that suggests that heavy-metal contamination, in the aftermath of an environmental disaster, appears to be a key evolutionary event for the spread and dissemination of MRSA in Latin America.
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Affiliation(s)
- Jose RW Martínez
- Genomics & Resistant Microbes group (GeRM), Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Chile
- Millennium Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
| | - Manuel Alcalde-Rico
- Genomics & Resistant Microbes group (GeRM), Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Chile
- Millennium Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
- Grupo de Resistencia a los Antibióticos en Bacterias Patógenas y Ambientales (GRABPA), Instituto de Biología, Pontificia Universidad Católica de Valparaíso, Chile
| | - Estefanía Jara-Videla
- Genomics & Resistant Microbes group (GeRM), Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Chile
- Millennium Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
| | - Rafael Rios
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
| | - Ahmed M. Moustafa
- Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman College of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Blake Hanson
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Lina Rivas
- Genomics & Resistant Microbes group (GeRM), Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Chile
- Millennium Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
| | - Lina P. Carvajal
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
| | - Sandra Rincon
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
| | - Lorena Diaz
- Genomics & Resistant Microbes group (GeRM), Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Chile
- Millennium Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
| | - Ana Quesille-Villalobos
- Genomics & Resistant Microbes group (GeRM), Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Chile
- Millennium Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
| | - Roberto Riquelme-Neira
- Genomics & Resistant Microbes group (GeRM), Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Chile
- Millennium Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
- Núcleo de Investigaciones Aplicadas en Ciencias Veterinarias y Agronómicas, Facultad de Medicina Veterinaria y Agronomía, Universidad de las Américas, Santiago, Chile
| | - Eduardo A. Undurraga
- Millennium Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, RM, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile
- CIFAR Azrieli Global Scholars program, CIFAR, Toronto, Canada
| | - Jorge Olivares-Pacheco
- Millennium Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
- Grupo de Resistencia a los Antibióticos en Bacterias Patógenas y Ambientales (GRABPA), Instituto de Biología, Pontificia Universidad Católica de Valparaíso, Chile
| | - Patricia García
- Millennium Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
- Departamento de Enfermedades Infecciosas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rafael Araos
- Genomics & Resistant Microbes group (GeRM), Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Chile
- Millennium Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
| | - Paul J. Planet
- Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman College of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- American Museum of Natural History, New York, NY 10024, USA
| | - César A. Arias
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, TX, USA
- Center for Infectious Diseases Research, Houston Methodist Research Institution, Houston, TX, USA
| | - Jose M. Munita
- Genomics & Resistant Microbes group (GeRM), Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Chile
- Millennium Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Chile
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16
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Taylor E, Prada JM, Del Rio Vilas V, Undurraga EA, Wallace R, Horton DL. Cost-effectiveness Analysis of Integrated Bite Case Management and Sustained Dog Vaccination for Rabies Control. Am J Trop Med Hyg 2023:tpmd220308. [PMID: 37188344 DOI: 10.4269/ajtmh.22-0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 02/27/2023] [Indexed: 05/17/2023] Open
Abstract
The successful prevention, control, and elimination of dog-mediated rabies is challenging due to insufficient resource availability and inadequate placement. An integrated dog bite case management (IBCM) system plus dog vaccination can help address these challenges. Based on data from the IBCM system in Haiti, we conducted a cost-effectiveness evaluation of a newly established IBCM system plus sustained vaccination and compared it with 1) a no bite-case management (NBCM) and 2) a non-risk-based (NRB) program, where bite victims presenting at a health clinic would receive post-exposure prophylaxis regardless of risk assessment. We also provide cost-effectiveness guidance for an ongoing IBCM system and for sub-optimal dog vaccination coverages, considering that not all cost-effective interventions are affordable. Cost-effectiveness outcomes included average cost per human death averted (USD/death averted) and per life-year gained (LYG). The analysis used a governmental perspective. Considering a sustained 5-year implementation with 70% dog vaccination coverage, IBCM had a lower average cost per death averted (IBCM: $7,528, NBCM: $7,797, NRB: $15,244) and cost per LYG (IBCM: $152, NBCM: $158, NRB: $308) than NBCM and NRB programs. As sensitivity analysis, we estimated cost-effectiveness for alternative scenarios with lower dog-vaccination coverages (30%, 55%) and lower implementation costs. Our results suggest that better health and cost-effectiveness outcomes are achieved with the continued implementation of an IBCM program ($118 per life-year saved) compared with a newly established IBCM program ($152 per life-year saved). Our results suggest that IBCM is more cost-effective than non-integrated programs to eliminate dog-mediated human rabies.
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Affiliation(s)
- Emma Taylor
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Joaquin M Prada
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | | | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, Ontario, Canada
| | - Ryan Wallace
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel L Horton
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
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17
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Bonaparte SC, Moodie J, Undurraga EA, Wallace RM. Evaluation of country infrastructure as an indirect measure of dog-mediated human rabies deaths. Front Vet Sci 2023; 10:1147543. [PMID: 37228840 PMCID: PMC10203152 DOI: 10.3389/fvets.2023.1147543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Background Rabies is a neglected disease, primarily due to poor detection stemming from limited surveillance and diagnostic capabilities in most countries. As a result, there is limited ability to monitor and evaluate country, regional, and global progress towards the WHO goal of eliminating human rabies deaths by 2030. There is a need for a low-cost, readily reproducible method of estimating rabies burden and elimination capacity in endemic countries. Methods Publicly available economic, environmental, political, social, public health, and One Health indicators were evaluated to identify variables with strong correlation to country-level rabies burden estimates. A novel index was developed to estimate infrastructural rabies elimination capacity and annual case-burden for dog-mediated rabies virus variant (DMRVV) endemic countries. Findings Five country-level indicators with superior explanatory value represent the novel "STOP-R index:" (1) literacy rate, (2) infant mortality rate, (3) electricity access, (4) political stability, and (5) presence/severity of natural hazards. Based on the STOP-R index, 40,111 (95% CI 25,854-74,344) global human rabies deaths are estimated to occur in 2022 among DMRVV-endemic countries and are projected to decrease to 32,349 (95% CI 21,110-57,019) in 2030. Interpretation The STOP-R index offers a unique means of addressing the data gap and monitoring progress towards eliminating dog-mediated human rabies deaths. Results presented here suggest that factors external to rabies programs influence the successes of rabies elimination, and it is now possible to identify countries exceeding or lagging in expected rabies control and elimination progress based on country infrastructure.
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Affiliation(s)
- Sarah C. Bonaparte
- Poxvirus and Rabies Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Janae Moodie
- New York University College of Global Public Health, New York, NY, United States
- James A. Ferguson Emerging Infectious Diseases RISE Fellow, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eduardo A. Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile
| | - Ryan M. Wallace
- Poxvirus and Rabies Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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18
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Allel K, Labarca J, Carvajal C, Garcia P, Cifuentes M, Silva F, Munita JM, Undurraga EA. Trends and socioeconomic, demographic, and environmental factors associated with antimicrobial resistance: a longitudinal analysis in 39 hospitals in Chile 2008-2017. Lancet Reg Health Am 2023; 21:100484. [PMID: 37096191 PMCID: PMC10121445 DOI: 10.1016/j.lana.2023.100484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/26/2023] [Accepted: 03/17/2023] [Indexed: 04/26/2023]
Abstract
Background Antimicrobial resistance (AMR) is among the most critical global health threats of the 21st century. AMR is primarily driven by the use and misuse of antibiotics but can be affected by socioeconomic and environmental factors. Reliable and comparable estimates of AMR over time are essential to making public health decisions, defining research priorities, and evaluating interventions. However, estimates for developing regions are scant. We describe the evolution of AMR for critical priority antibiotic-bacterium pairs in Chile and examine their association with hospital and community-level characteristics using multivariate rate-adjusted regressions. Methods Drawing on multiple data sources, we assembled a longitudinal national dataset to analyse AMR levels for critical priority antibiotic-bacterium combinations in 39 private and public hospitals (2008-2017) throughout the country and characterize the population at the municipality level. We first described trends of AMR in Chile. Second, we used multivariate regressions to examine the association of AMR with hospital characteristics and community-level socioeconomic, demographic, and environmental factors. Last, we estimated the expected distribution of AMR by region in Chile. Findings Our results show that AMR for priority antibiotic-bacterium pairs steadily increased between 2008 and 2017 in Chile, driven primarily by Klebsiella pneumoniae resistant to third-generation cephalosporins and carbapenems, and vancomycin-resistant Enterococcus faecium. Higher hospital complexity, a proxy for antibiotic use, and poorer local community infrastructure were significantly associated with greater AMR. Interpretation Consistent with research in other countries in the region, our results show a worrisome increase in clinically relevant AMR in Chile and suggest that hospital complexity and living conditions in the community may affect the emergence and spread of AMR. Our results highlight the importance of understanding AMR in hospitals and their interaction with the community and the environment to curtail this ongoing public health crisis. Funding This research was supported by the Agencia Nacional de Investigación y Desarrollo (ANID), Fondo Nacional de Desarrollo Científico y Tecnológico FONDECYT, The Canadian Institute for Advanced Research (CIFAR), and Centro UC de Políticas Públicas, Pontificia Universidad Católica de Chile.
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Affiliation(s)
- Kasim Allel
- Institute for Global Health, University College London, UK
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, UK
- Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Chile
| | - Jaime Labarca
- Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Chile
- Departamento de Enfermedades Infecciosas, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
- Grupo Colaborativo de Resistencia Bacteriana, Sociedad Chilena de Infectología, Chile
| | - Camila Carvajal
- Departamento de Enfermedades Infecciosas, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
- Grupo Colaborativo de Resistencia Bacteriana, Sociedad Chilena de Infectología, Chile
| | - Patricia Garcia
- Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Chile
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, RM, Chile
| | - Marcela Cifuentes
- Grupo Colaborativo de Resistencia Bacteriana, Sociedad Chilena de Infectología, Chile
- Hospital Clínico Universidad de Chile, Santiago, RM, Chile
| | - Francisco Silva
- Grupo Colaborativo de Resistencia Bacteriana, Sociedad Chilena de Infectología, Chile
- Hospital Clínico Universidad de Chile, Santiago, RM, Chile
| | - José M. Munita
- Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Chile
- Instituto de Ciencias e Innovacion en Medicina (ICIM), Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, RM, Chile
| | - Eduardo A. Undurraga
- Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Chile
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, RM, Chile
- Centro de Investigación para la Gestión Integrada del Riesgo de Desastres (CIGIDEN), Chile
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, Canada
- Corresponding author. Escuela de Gobierno, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul, Santiago, 7820436, Región Metropolitana, Chile.
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19
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Jara A, Undurraga EA, Flores JC, Zubizarreta JR, González C, Pizarro A, Ortuño-Borroto D, Acevedo J, Leo K, Paredes F, Bralic T, Vergara V, Leon F, Parot I, Leighton P, Suárez P, Rios JC, García-Escorza H, Araos R. Effectiveness of an inactivated SARS-CoV-2 vaccine in children and adolescents: a large-scale observational study. Lancet Reg Health Am 2023; 21:100487. [PMID: 37155483 PMCID: PMC10117174 DOI: 10.1016/j.lana.2023.100487] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 10/14/2022] [Accepted: 03/22/2023] [Indexed: 05/10/2023]
Abstract
Background Policymakers urgently need evidence to adequately balance the costs and benefits of mass vaccination against COVID-19 across all age groups, including children and adolescents. In this study, we aim to assess the effectiveness of CoronaVac's primary series among children and adolescents in Chile. Methods We used a large prospective national cohort of about two million children and adolescents 6-16 years to estimate the effectiveness of an inactivated SARS-CoV-2 vaccine (CoronaVac) in preventing laboratory-confirmed symptomatic SARS-CoV-2 infection (COVID-19), hospitalisation, and admission to an intensive care unit (ICU) associated with COVID-19. We compared the risk of individuals treated with a complete primary immunization schedule (two doses, 28 days apart) with the risk of unvaccinated individuals during the follow-up period. The study was conducted in Chile from June 27, 2021, to January 12, 2022, when the SARS-CoV-2 Delta variant was predominant but other variants of concern were co-circulating, including Omicron. We used inverse probability-weighted survival regression models to estimate hazard ratios of complete immunization over the unvaccinated status, accounting for time-varying vaccination exposure and adjusting for relevant demographic, socioeconomic, and clinical confounders. Findings The estimated adjusted vaccine effectiveness for the inactivated SARS-CoV-2 vaccine in children aged 6-16 years was 74.5% (95% CI, 73.8-75.2), 91.0% (95% CI, 87.8-93.4), 93.8% (95% CI, 87.8-93.4) for the prevention of COVID-19, hospitalisation, and ICU admission, respectively. For the subgroup of children 6-11 years, the vaccine effectiveness was 75.8% (95% CI, 74.7-76.8) for the prevention of COVID-19 and 77.9% (95% CI, 61.5-87.3) for the prevention of hospitalisation. Interpretation Our results suggest that a complete primary immunization schedule with the inactivated SARS-CoV-2 vaccine provides effective protection against severe COVID-19 disease for children 6-16 years. Funding Agencia Nacional de Investigación y Desarrollo (ANID) Millennium Science Initiative Program and Fondo de Financiamiento de Centros de Investigación en Áreas Prioritarias (FONDAP).
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Affiliation(s)
- Alejandro Jara
- Ministry of Health, Santiago, Chile
- Facultad de Matemáticas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for the Discovery of Structures in Complex Data (MiDaS), Santiago, Chile
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, RM, Chile
- Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, Canada
| | - Juan Carlos Flores
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José R Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. School of Public Health, Boston, MA, USA
- Department of Statistics, Harvard T.H. School of Public Health, Boston, MA, USA
| | | | - Alejandra Pizarro
- Ministry of Health, Santiago, Chile
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | | | | | | | | | | | | | | | | | - Juan Carlos Rios
- Ministry of Health, Santiago, Chile
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Rafael Araos
- Ministry of Health, Santiago, Chile
- Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
- Advanced Center for Chronic Diseases (ACCDiS), Santiago, Chile
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20
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Bórquez-Infante I, Vasquez J, Dupré S, Undurraga EA, Crossley NA, Undurraga J. Childhood adversity increases risk of psychotic experiences in patients with substance use disorder. Psychiatry Res 2022; 316:114733. [PMID: 35907276 DOI: 10.1016/j.psychres.2022.114733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) increase the risk of psychotic experiences (PE), but little is known about heterogeneities of this association in different developmental stages, dimensions, or whether they are affected by substance use disorder (SUD). This study examines the association between different types of ACEs at various developmental stages and lifetime PE in patients with SUD in Chile. METHODS We included 399 consenting adults in outpatient or residential SUD treatment programs. Sociodemographic data and information about PE and ACEs were obtained by trained clinical psychologists. RESULTS Patients reporting PE experienced more ACEs compared to patients without PE (4.2 versus 3.4). They also experienced more complex adversities (41.8% versus 25.1%), had more psychiatric comorbidities (85% versus 70.4%), and reported using more substances (mean 4.5 versus 3.9). Adjusted association between ACEs and PE showed the highest OR for arrests (1.88), sexual abuse (1.81), alcohol abuse by parents (1.48), school exclusion (1.39), foster or residential care (18.3). CONCLUSION Early exposure to ACEs is a risk factor for later PE among patients with SUD. Type of ACE and the period when they occurred is important, suggesting the existence of critical periods where the individual is more susceptible to adverse environmental stimuli.
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Affiliation(s)
- Ignacio Bórquez-Infante
- Centre for Studies on Justice and Society, Institute of Sociology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Vasquez
- Early Intervention Program, Instituto Psiquiátrico Dr J. Horwitz Barak, Santiago, Chile; Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sofía Dupré
- Centre for Studies on Justice and Society, Institute of Sociology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile; Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile; CIFAR Azrieli Global Scholars program, CIFAR, Toronto, Canada
| | - Nicolás A Crossley
- Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile; Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Juan Undurraga
- Early Intervention Program, Instituto Psiquiátrico Dr J. Horwitz Barak, Santiago, Chile; Department of Neurology and Psychiatry, Clinica Alemana Universidad Del Desarrollo, Santiago, Chile.
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21
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Jara A, Undurraga EA, Zubizarreta JR, González C, Acevedo J, Pizarro A, Vergara V, Soto-Marchant M, Gilabert R, Flores JC, Suárez P, Leighton P, Eguiguren P, Ríos JC, Fernandez J, García-Escorza H, Araos R. Effectiveness of CoronaVac in children 3 to 5 years during the SARS-CoV-2 Omicron outbreak in Chile. Nat Med 2022; 28:1377-1380. [PMID: 35605637 PMCID: PMC9307483 DOI: 10.1038/s41591-022-01874-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022]
Abstract
The outbreak of the B.1.1.529 lineage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Omicron) has caused an unprecedented number of Coronavirus Disease 2019 (COVID-19) cases, including pediatric hospital admissions. Policymakers urgently need evidence of vaccine effectiveness in children to balance the costs and benefits of vaccination campaigns, but, to date, the evidence is sparse. Leveraging a population-based cohort in Chile of 490,694 children aged 3–5 years, we estimated the effectiveness of administering a two-dose schedule, 28 days apart, of Sinovac’s inactivated SARS-CoV-2 vaccine (CoronaVac). We used inverse probability-weighted survival regression models to estimate hazard ratios of symptomatic COVID-19, hospitalization and admission to an intensive care unit (ICU) for children with complete immunization over non-vaccination, accounting for time-varying vaccination exposure and relevant confounders. The study was conducted between 6 December 2021 and 26 February 2022, during the Omicron outbreak in Chile. The estimated vaccine effectiveness was 38.2% (95% confidence interval (CI), 36.5–39.9) against symptomatic COVID-19, 64.6% (95% CI, 49.6–75.2) against hospitalization and 69.0% (95% CI, 18.6–88.2) against ICU admission. The effectiveness against symptomatic COVID-19 was modest; however, protection against severe disease was high. These results support vaccination of children aged 3–5 years to prevent severe illness and associated complications and highlight the importance of maintaining layered protections against SARS-CoV-2 infection. CoronaVac protects young children from severe COVID-19 during a SARS-CoV-2 Omicron surge, supporting the effectiveness and importance of vaccinating this pediatric population.
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Affiliation(s)
- Alejandro Jara
- Ministry of Health, Santiago, Chile.,Facultad de Matemáticas, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for the Discovery of Structures in Complex Data (MiDaS), Santiago, Chile
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, RM, Chile.,Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile.,Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile.,CIFAR Azrieli Global Scholars program, CIFAR, Toronto, Canada
| | - José R Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.,Department of Biostatistics, Harvard T.H. School of Public Health, Boston, Massachusetts, USA.,Department of Statistics, Harvard T.H. School of Public Health, Boston, Massachusetts, USA
| | | | | | - Alejandra Pizarro
- Ministry of Health, Santiago, Chile.,Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | | | - Juan Carlos Flores
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | | | - Juan Carlos Ríos
- Ministry of Health, Santiago, Chile.,Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Rafael Araos
- Ministry of Health, Santiago, Chile. .,Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile. .,Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile. .,Advanced Center for Chronic Diseases (ACCDiS), Santiago, Chile.
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22
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Li Y, Undurraga EA, Zubizarreta JR. Effectiveness of Localized Lockdowns in the COVID-19 Pandemic. Am J Epidemiol 2022; 191:812-824. [PMID: 35029649 PMCID: PMC8807239 DOI: 10.1093/aje/kwac008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/17/2021] [Accepted: 01/06/2022] [Indexed: 12/13/2022] Open
Abstract
Nonpharmaceutical interventions, such as social distancing and lockdowns, have been essential to control of the coronavirus disease 2019 (COVID-19) pandemic. In particular, localized lockdowns in small geographic areas have become an important policy intervention for preventing viral spread in cases of resurgence. These localized lockdowns can result in lower social and economic costs compared with larger-scale suppression strategies. Using an integrated data set from Chile (March 3-June 15, 2020) and a novel synthetic control approach, we estimated the effect of localized lockdowns, disentangling its direct and indirect causal effects on transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our results showed that the effects of localized lockdowns are strongly modulated by their duration and are influenced by indirect effects from neighboring geographic areas. Our estimates suggest that extending localized lockdowns can slow down SARS-CoV-2 transmission; however, localized lockdowns on their own are insufficient to control pandemic growth in the presence of indirect effects from contiguous neighboring areas that do not have lockdowns. These results provide critical empirical evidence about the effectiveness of localized lockdowns in interconnected geographic areas.
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Affiliation(s)
- Yige Li
- Department of Biostatistics and CAUSALab, Harvard T.H. School of Public Health, Huntington Avenue, Boston, Massachusetts 02115
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Macul, Santiago 7820436, Chile
- Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Chile
- CIFAR Azrieli Global Scholars program, CIFAR, Toronto, ON M5G 1M1, Canada
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile
| | - José R Zubizarreta
- Correspondence Address: Department of Health Care Policy, Harvard Medical School, 180A Longwood Avenue, Office 307-Z, Boston, MA 02115,
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23
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Errazuriz A, Schmidt K, Undurraga EA, Medeiros S, Baudrand R, Cussen D, Henriquez M, Celhay P, Figueroa RA. Effects of mindfulness-based stress reduction on psychological distress in health workers: A three-arm parallel randomized controlled trial. J Psychiatr Res 2022; 145:284-293. [PMID: 33199052 DOI: 10.1016/j.jpsychires.2020.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/30/2022]
Abstract
Mindfulness-based Stress Reduction (MBSR) has shown good efficacy for improving wellbeing in employees experiencing occupational stress. However, comparisons with other interventions, longer-term follow-up, and data from varying sociocultural contexts are lacking. This three-arm, parallel randomised controlled trial (RCT) examined the effects of MBSR on psychological distress in non-physician health workers in direct contact with patients. 105 participants were randomly allocated to either: (1) MBSR (N = 35), (2) Stress Management Course (SMC; N = 34) or (3) wait-list (N = 36). Participants and those assessing outcomes were blinded to group assignment. Participants completed questionnaires pre- and post-intervention and four months after the intervention. Psychological distress was measured using the General Health Questionnaire (GHQ-12) and Outcome Questionnaire (OQ-45). Secondary outcomes included perceived stress, job satisfaction, mindfulness skills and changes in salivary cortisol. 77 participants completed measures post-intervention and 52 at 4-month follow-up. MBSR showed a post-intervention effect in reducing GHQ-12 (ß = -0.80 [SE = 1.58] p < 0.01) and OQ-45 (ß = -0.72, [SE = 5.87] p < 0.05) psychological distress, compared to SMC and in reducing GHQ-12 (ß = -1.30 [SE = 1.38] p < 0.001) and OQ-45 (ß = -0.71, [SE = 5.58] p < 0.01) psychological distress compared to wait-list condition. In our secondary outcome, only MBSR was associated with a decrease in the cortisol awaking response by 23% (p < 0.05). At follow-up, only effects of MBSR on the psychological distress 'social role' subscale (ß = -0.76 [SE = 1.31] p < 0.05) remained significant, compared to SMC. In conclusion, MBSR appears useful in reducing short-term psychological distress in healthcare workers, but these effects were not maintained at follow-up. Trial registration: ISRCTN12039804.
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Affiliation(s)
- Antonia Errazuriz
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, Santiago, 8330077, Chile; Millennium Science Initiative /Millennium Institute for Research on Depression and Personality-MIDAP, Vicuña Mackenna 4860, Santiago, 7820436, Chile.
| | - Kristin Schmidt
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, Santiago, 8330077, Chile.
| | - Eduardo A Undurraga
- School of Government, Pontificia Universidad Catolica de Chile, Vicuña Mackenna 4860, Santiago, 7820436, Chile; Millennium Nucleus for the Study of the Life Course and Vulnerability, Vicuña Mackenna 4860, Santiago, 7820436, Chile; Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Avenida Las Condes 12.461, Torre 3, oficina 205, Las Condes, Santiago, 7820436, Chile.
| | - Sebastián Medeiros
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, Santiago, 8330077, Chile; Millennium Science Initiative /Millennium Institute for Research on Depression and Personality-MIDAP, Vicuña Mackenna 4860, Santiago, 7820436, Chile.
| | - Rene Baudrand
- Endocrinology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, Santiago, 8330077, Chile; Program for Adrenal Disorders, CETREN UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, 8330077, Chile.
| | - Diego Cussen
- Institute of Economics, Pontificia Universidad Catolica de Chile, Vicuña Mackenna 4860, Santiago, 7820436, Chile.
| | - Marcela Henriquez
- Department of Clinical Laboratory Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, Santiago, 8330077, Chile.
| | - Pablo Celhay
- School of Government, Pontificia Universidad Catolica de Chile, Vicuña Mackenna 4860, Santiago, 7820436, Chile; Millennium Nucleus for the Study of the Life Course and Vulnerability, Vicuña Mackenna 4860, Santiago, 7820436, Chile.
| | - Rodrigo A Figueroa
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, Santiago, 8330077, Chile.
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Eyheramendy S, Saa PA, Undurraga EA, Valencia C, López C, Méndez L, Pizarro-Berdichevsky J, Finkelstein-Kulka A, Solari S, Salas N, Bahamondes P, Ugarte M, Barceló P, Arenas M, Agosin E. Screening of COVID-19 cases through a Bayesian network symptoms model and psychophysical olfactory test. iScience 2021; 24:103419. [PMID: 34786538 PMCID: PMC8580551 DOI: 10.1016/j.isci.2021.103419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/12/2021] [Accepted: 11/05/2021] [Indexed: 01/08/2023] Open
Abstract
The sudden loss of smell is among the earliest and most prevalent symptoms of COVID-19 when measured with a clinical psychophysical test. Research has shown the potential impact of frequent screening for olfactory dysfunction, but existing tests are expensive and time consuming. We developed a low-cost ($0.50/test) rapid psychophysical olfactory test (KOR) for frequent testing and a model-based COVID-19 screening framework using a Bayes Network symptoms model. We trained and validated the model on two samples: suspected COVID-19 cases in five healthcare centers (n = 926; 33% prevalence, 309 RT-PCR confirmed) and healthy miners (n = 1,365; 1.1% prevalence, 15 RT-PCR confirmed). The model predicted COVID-19 status with 76% and 96% accuracy in the healthcare and miners samples, respectively (healthcare: AUC = 0.79 [0.75-0.82], sensitivity: 59%, specificity: 87%; miners: AUC = 0.71 [0.63-0.79], sensitivity: 40%, specificity: 97%, at 0.50 infection probability threshold). Our results highlight the potential for low-cost, frequent, accessible, routine COVID-19 testing to support society's reopening.
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Affiliation(s)
- Susana Eyheramendy
- Faculty of Engineering and Science, Universidad Adolfo Ibáñez, Santiago, Chile
- Millennium Institute for Foundational Research on Data (IMFD), Santiago, Chile
| | - Pedro A. Saa
- Department of Chemical and Bioprocess Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Mathematical and Computational Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo A. Undurraga
- School of Government, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile
- CIFAR Azrieli Global Scholars Program, Toronto, Canada
| | | | - Carolina López
- Center for Aromas and Flavors, DICTUC SA., Santiago, Chile
| | - Luis Méndez
- Endoscopy Unit, Hospital Padre Hurtado, Santiago, Chile
- Department of Gastroenterology, Clínica Alemana de Santiago, Santiago, Chile
| | - Javier Pizarro-Berdichevsky
- Center for Innovation in Pelvic Floor, Hospital Sótero del Río, Santiago, Chile
- Department of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Finkelstein-Kulka
- Department of Otolaryngology, Clínica Alemana de Santiago, Santiago, Chile
- Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Sandra Solari
- Department of Clinical Laboratory, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Salas
- Millennium Institute for Foundational Research on Data (IMFD), Santiago, Chile
| | - Pedro Bahamondes
- Millennium Institute for Foundational Research on Data (IMFD), Santiago, Chile
| | - Martín Ugarte
- Millennium Institute for Foundational Research on Data (IMFD), Santiago, Chile
| | - Pablo Barceló
- Millennium Institute for Foundational Research on Data (IMFD), Santiago, Chile
- Institute for Mathematical and Computational Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcelo Arenas
- Millennium Institute for Foundational Research on Data (IMFD), Santiago, Chile
- Institute for Mathematical and Computational Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Agosin
- Department of Chemical and Bioprocess Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Aromas and Flavors, DICTUC SA., Santiago, Chile
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25
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Micah AE, Cogswell IE, Cunningham B, Ezoe S, Harle AC, Maddison ER, McCracken D, Nomura S, Simpson KE, Stutzman HN, Tsakalos G, Wallace LE, Zhao Y, Zende RR, Abbafati C, Abdelmasseh M, Abedi A, Abegaz KH, Abhilash ES, Abolhassani H, Abrigo MRM, Adhikari TB, Afzal S, Ahinkorah BO, Ahmadi S, Ahmed H, Ahmed MB, Ahmed Rashid T, Ajami M, Aji B, Akalu Y, Akunna CJ, Al Hamad H, Alam K, Alanezi FM, Alanzi TM, Alemayehu Y, Alhassan RK, Alinia C, Aljunid SM, Almustanyir SA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Amu H, Ancuceanu R, Andrei CL, Andrei T, Angell B, Anjomshoa M, Antonio CAT, Antony CM, Aqeel M, Arabloo J, Arab-Zozani M, Aripov T, Arrigo A, Ashraf T, Atnafu DD, Ausloos M, Avila-Burgos L, Awan AT, Ayano G, Ayanore MA, Azari S, Azhar GS, Babalola TK, Bahrami MA, Baig AA, Banach M, Barati N, Bärnighausen TW, Barrow A, Basu S, Baune BT, Bayati M, Benzian H, Berman AE, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhaskar S, Bibi S, Bijani A, Bodolica V, Bragazzi NL, Braithwaite D, Breitborde NJK, Breusov AV, Briko NI, Busse R, Cahuana-Hurtado L, Callander EJ, Cámera LA, Castañeda-Orjuela CA, Catalá-López F, Charan J, Chatterjee S, Chattu SK, Chattu VK, Chen S, Cicero AFG, Dadras O, Dahlawi SMA, Dai X, Dalal K, Dandona L, Dandona R, Davitoiu DV, De Neve JW, de Sá-Junior AR, Denova-Gutiérrez E, Dhamnetiya D, Dharmaratne SD, Doshmangir L, Dube J, Ehsani-Chimeh E, El Sayed Zaki M, El Tantawi M, Eskandarieh S, Farzadfar F, Ferede TY, Fischer F, Foigt NA, Freitas A, Friedman SD, Fukumoto T, Fullman N, Gaal PA, Gad MM, Garcia-Gordillo MA, Garg T, Ghafourifard M, Ghashghaee A, Gholamian A, Gholamrezanezhad A, Ghozali G, Gilani SA, Glăvan IR, Glushkova EV, Goharinezhad S, Golechha M, Goli S, Guha A, Gupta VB, Gupta VK, Haakenstad A, Haider MR, Hailu A, Hamidi S, Hanif A, Harapan H, Hartono RK, Hasaballah AI, Hassan S, Hassanein MH, Hayat K, Hegazy MI, Heidari G, Hendrie D, Heredia-Pi I, Herteliu C, Hezam K, Holla R, Hossain SJ, Hosseinzadeh M, Hostiuc S, Huda TM, Hwang BF, Iavicoli I, Idrisov B, Ilesanmi OS, Irvani SSN, Islam SMS, Ismail NE, Isola G, Jahani MA, Jahanmehr N, Jakovljevic M, Janodia MD, Javaheri T, Jayapal SK, Jayawardena R, Jazayeri SB, Jha RP, Jonas JB, Joo T, Joukar F, Jürisson M, Kaambwa B, Kalhor R, Kanchan T, Kandel H, Karami Matin B, Karimi SE, Kassahun G, Kayode GA, Kazemi Karyani A, Keikavoosi-Arani L, Khader YS, Khajuria H, Khalilov R, Khammarnia M, Khan J, Khubchandani J, Kianipour N, Kim GR, Kim YJ, Kisa A, Kisa S, Kohler S, Kosen S, Koteeswaran R, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Kumar GA, Kusuma D, Lamnisos D, Lansingh VC, Larsson AO, Lasrado S, Le LKD, Lee SWH, Lee YY, Lim SS, Lobo SW, Lozano R, Magdy Abd El Razek H, Magdy Abd El Razek M, Mahdavi MM, Majeed A, Makki A, Maleki A, Malekzadeh R, Manda AL, Mansour-Ghanaei F, Mansournia MA, Marrugo Arnedo CA, Martinez-Valle A, Masoumi SZ, Maude RJ, McKee M, Medina-Solís CE, Menezes RG, Meretoja A, Meretoja TJ, Mesregah MK, Mestrovic T, Milevska Kostova N, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Mohajer B, Mohamed TA, Mohammadi M, Mohammadian-Hafshejani A, Mohammed S, Moitra M, Mokdad AH, Molokhia M, Moni MA, Moradi Y, Morze J, Mousavi SM, Mpundu-Kaambwa C, Muriithi MK, Muthupandian S, Nagarajan AJ, Naimzada MD, Nangia V, Naqvi AA, Narayana AI, Nascimento BR, Naveed M, Nayak BP, Nazari J, Ndejjo R, Negoi I, Neupane Kandel S, Nguyen TH, Nonvignon J, Noubiap JJ, Nwatah VE, Oancea B, Ojelabi FAO, Olagunju AT, Olakunde BO, Olgiati S, Olusanya JO, Onwujekwe OE, Otoiu A, Otstavnov N, Otstavnov SS, Owolabi MO, Padubidri JR, Palladino R, Panda-Jonas S, Park EC, Pashazadeh Kan F, Pawar S, Pazoki Toroudi H, Pereira DM, Perianayagam A, Pesudovs K, Piccinelli C, Postma MJ, Prada SI, Rabiee M, Rabiee N, Rahim F, Rahimi-Movaghar V, Rahman MHU, Rahman M, Rahmani AM, Ram U, Ranabhat CL, Ranasinghe P, Rao CR, Rathi P, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Reiner Jr RC, Renzaho AMN, Reshmi B, Riaz MA, Ripon RK, Saad AM, Sahraian MA, Sahu M, Salama JS, Salehi S, Samy AM, Sanabria J, Sanmarchi F, Santos JV, Santric-Milicevic MM, Sathian B, Savic M, Saxena D, Sayyah M, Schwendicke F, Senthilkumaran S, Sepanlou SG, Seylani A, Shahabi S, Shaikh MA, Sheikh A, Shetty A, Shetty PH, Shibuya K, Shrime MG, Shuja KH, Singh JA, Skryabin VY, Skryabina AA, Soltani S, Soofi M, Spurlock EE, Stefan SC, Szerencsés V, Szócska M, Tabarés-Seisdedos R, Taddele BW, Tefera YG, Thavamani A, Tobe-Gai R, Topor-Madry R, Tovani-Palone MR, Tran BX, Tudor Car L, Ullah A, Ullah S, Umar N, Undurraga EA, Valdez PR, Vasankari TJ, Villafañe JH, Violante FS, Vlassov V, Vo B, Vollmer S, Vos T, Vu GT, Vu LG, Wamai RG, Werdecker A, Woldekidan MA, Wubishet BL, Xu G, Yaya S, Yazdi-Feyzabadi V, Yiğit V, Yip P, Yirdaw BW, Yonemoto N, Younis MZ, Yu C, Yunusa I, Zahirian Moghadam T, Zandian H, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Ziapour A, Zuniga YMH, Hay SI, Murray CJL, Dieleman JL. Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050. Lancet 2021; 398:1317-1343. [PMID: 34562388 PMCID: PMC8457757 DOI: 10.1016/s0140-6736(21)01258-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/15/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. METHODS We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. FINDINGS In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7-8·8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5-0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0-25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. INTERPRETATION Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. FUNDING Bill & Melinda Gates Foundation.
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Abstract
The Covid-19 pandemic has reached almost every corner of the world. Despite the historical development, approval, and distribution of vaccines in some countries, non-pharmaceutical interventions will remain an essential strategy to control the pandemic until a substantial proportion of the population has immunity. There is increasing evidence of the devastating social and economic effects of the pandemic, particularly on vulnerable communities. Individuals living in urban informal settlements are in a structurally disadvantaged position to cope with a health crisis such as the Covid-19 pandemic. Estimates of this impact are needed to inform and prioritize policy decisions and actions. We study employment loss in informal settlements before and during the Covid-19 pandemic in Chile, using a longitudinal panel study of households living in Chile's informal settlements before and during the health crisis. We show that before the pandemic, 75% of respondents reported being employed. There is a decrease of 30 and 40 percentage points in May and September 2020, respectively. We show that the employment loss is substantially higher for individuals in informal settlements than for the general population and has particularly affected the immigrant population. We also show that the pandemic has triggered neighborhood cooperation within the settlements and that targeted government assistance programs have reached these communities in a limited way. Our results suggest that individuals living in informal settlements are facing severe hardship as a consequence of the pandemic. In addition to providing much-needed support, this crisis presents a unique opportunity for long-term improvements in these marginalized communities.
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Affiliation(s)
- Diego Gil
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Region Metropolitana, Chile.
| | - Patricio Domínguez
- Departamento de Ingeniería Industrial y de Sistemas, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul CP, Region Metropolitana, 7820436, Santiago, Chile
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Region Metropolitana, Chile
- Millennium Nucleus for the Study of the Life Course and Vulnerability, Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Region Metropolitana, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Region Metropolitana, Chile
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, ON, M5G 1M1, Canada
| | - Eduardo Valenzuela
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Region Metropolitana, Chile
- Instituto de Sociología, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Region Metropolitana, Chile
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Jara A, Undurraga EA, González C, Paredes F, Fontecilla T, Jara G, Pizarro A, Acevedo J, Leo K, Leon F, Sans C, Leighton P, Suárez P, García-Escorza H, Araos R. Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile. N Engl J Med 2021; 385:875-884. [PMID: 34233097 PMCID: PMC8279092 DOI: 10.1056/nejmoa2107715] [Citation(s) in RCA: 521] [Impact Index Per Article: 173.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mass vaccination campaigns to prevent coronavirus disease 2019 (Covid-19) are occurring in many countries; estimates of vaccine effectiveness are urgently needed to support decision making. A countrywide mass vaccination campaign with the use of an inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine (CoronaVac) was conducted in Chile starting on February 2, 2021. METHODS We used a prospective national cohort, including participants 16 years of age or older who were affiliated with the public national health care system, to assess the effectiveness of the inactivated SARS-CoV-2 vaccine with regard to preventing Covid-19 and related hospitalization, admission to the intensive care unit (ICU), and death. We estimated hazard ratios using the extension of the Cox proportional-hazards model, accounting for time-varying vaccination status. We estimated the change in the hazard ratio associated with partial immunization (≥14 days after receipt of the first dose and before receipt of the second dose) and full immunization (≥14 days after receipt of the second dose). Vaccine effectiveness was estimated with adjustment for individual demographic and clinical characteristics. RESULTS The study was conducted from February 2 through May 1, 2021, and the cohort included approximately 10.2 million persons. Among persons who were fully immunized, the adjusted vaccine effectiveness was 65.9% (95% confidence interval [CI], 65.2 to 66.6) for the prevention of Covid-19 and 87.5% (95% CI, 86.7 to 88.2) for the prevention of hospitalization, 90.3% (95% CI, 89.1 to 91.4) for the prevention of ICU admission, and 86.3% (95% CI, 84.5 to 87.9) for the prevention of Covid-19-related death. CONCLUSIONS Our results suggest that the inactivated SARS-CoV-2 vaccine effectively prevented Covid-19, including severe disease and death, a finding that is consistent with results of phase 2 trials of the vaccine. (Funded by Agencia Nacional de Investigación y Desarrollo and others.).
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Affiliation(s)
- Alejandro Jara
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Eduardo A Undurraga
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Cecilia González
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Fabio Paredes
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Tomás Fontecilla
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Gonzalo Jara
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Alejandra Pizarro
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Johanna Acevedo
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Katherinne Leo
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Francisco Leon
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Carlos Sans
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Paulina Leighton
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Pamela Suárez
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Heriberto García-Escorza
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
| | - Rafael Araos
- From the Ministry of Health (A.J., C.G., F.P., T.F., G.J., A.P., J.A., K.L., F.L., C.S., P.L., P.S., H.G.-E., R.A.), Facultad de Matemáticas (A.J.) and Escuela de Gobierno (E.A.U.), Pontificia Universidad Católica de Chile, Millennium Nucleus Center for the Discovery of Structures in Complex Data (A.J.), Millennium Initiative for Collaborative Research in Bacterial Resistance (E.A.U., R.A.), the Research Center for Integrated Disaster Risk Management (E.A.U.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (R.A.), and the Advanced Center for Chronic Diseases (R.A.) - all in Santiago, Chile; and the CIFAR Azrieli Global Scholars Program, CIFAR, Toronto (E.A.U.)
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Letelier A, Madero-Cabib I, Undurraga EA, Pérez-Cruz P. Lifetime socioeconomic determinants of health trajectories among older adults. Adv Life Course Res 2021; 49:100415. [PMID: 34733129 PMCID: PMC8562571 DOI: 10.1016/j.alcr.2021.100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Drawing on life course theory and research, we explored how socioeconomic circumstances during childhood and adulthood shape self-reported health trajectories among older Mexican adults. We used data from the Mexican Health and Aging Study panel survey (2001-2015) and used sequence analysis to estimate types of self-reported health trajectories in older adulthood. We then explored the association between those health trajectories and socioeconomic determinants at different life stages, including education, occupation, employment, economic status, parental education, and adverse living conditions and illnesses during childhood. Our contributions are threefold. First, we identified four types of health trajectories for men and eight for women, representing a more nuanced longitudinal health status profile than previously shown. Second, we found that childhood and adult socioeconomic circumstances influence self-reported health trajectories at older age. Third, our results suggest there is no simple monotonic relationship between life course circumstances and self-reported health trajectories.
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Affiliation(s)
- Alejandra Letelier
- Instituto de Odontoestomatología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile; Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Santiago, Chile
| | - Ignacio Madero-Cabib
- Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Santiago, Chile; Instituto de Sociología & Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Eduardo A Undurraga
- Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Santiago, Chile; Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pedro Pérez-Cruz
- Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Santiago, Chile; Departamento de Medicina Interna, Pontificia Universidad Católica de Chile, Santiago, Chile
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Jara A, Undurraga EA, Araos R. Tool for Estimating the Probability of Having COVID-19 With 1 or More Negative RT-PCR Results. Open Forum Infect Dis 2021; 8:ofab382. [PMID: 34395714 PMCID: PMC8360238 DOI: 10.1093/ofid/ofab382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022] Open
Abstract
Early case detection and isolation of infected individuals are critical to controlling coronavirus disease 2019 (COVID-19). Reverse transcription polymerase chain reaction (RT-PCR) is considered the gold standard for the diagnosis of severe acute respiratory syndrome coronavirus 2 infection, but false negatives do occur. We built a user-friendly online tool to estimate the probability of having COVID-19 with negative RT-PCR results and thus avoid preventable transmission.
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Affiliation(s)
- Alejandro Jara
- Department of Statistics, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
- Millenium Nucleus Center for the Discovery of Structures in Complex Data (MIDaS), Santiago, Región Metropolitana, Chile
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
- Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Región Metropolitana, Chile
- CIFAR Azrieli Global Scholars program, CIFAR, Toronto, Canada
| | - Rafael Araos
- Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Región Metropolitana, Chile
- Instituto de Ciencias e Innovación en Medicina, Universidad del Desarrollo, Santiago, Región Metropolitana, Chile
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Asahi K, Undurraga EA, Wagner R. Benchmarking the Covid-19 pandemic across countries and states in the USA under heterogeneous testing. Sci Rep 2021; 11:15199. [PMID: 34312459 PMCID: PMC8313551 DOI: 10.1038/s41598-021-94663-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/14/2021] [Indexed: 12/15/2022] Open
Abstract
Scientists and policymakers need to compare the incidence of Covid-19 across territories or periods with various levels of testing. Benchmarking based on the increase in total cases or case fatality rates is one way of comparing the evolution of the pandemic across countries or territories and could inform policy decisions about strategies to control coronavirus transmission. However, comparing cases and fatality rates across regions is challenging due to heterogeneity in testing and health systems. We show two complementary ways of benchmarking across territories and in time. First, we used multivariate regressions to estimate the test-elasticity of Covid-19 case incidence. Cases grow less than proportionally with testing when assessing weekly changes or looking across states in the USA. They tend to be proportional or even more than proportional when comparing the month-to-month evolution of an average country in the pandemic. Our results were robust to various model specifications. Second, we decomposed the growth in cases into test growth and positive test ratio growth to intuitively visualize the components of case growth. We hope these results can help support evidence-based decisions by public officials and help the public discussion when comparing across territories and in time.
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Affiliation(s)
- Kenzo Asahi
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Región Metropolitana, Chile.,Centre for Sustainable Urban Development (CEDEUS), Santiago, Chile
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Región Metropolitana, Chile. .,Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile. .,Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile. .,CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, Canada.
| | - Rodrigo Wagner
- Business School, Universidad Adolfo Ibáñez, Santiago, Chile.,Center for International Development, Harvard, Cambridge, USA
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Tiga-Loza DC, Martínez-Vega RA, Undurraga EA, Tschampl CA, Shepard DS, Ramos-Castañeda J. Persistence of symptoms in dengue patients: a clinical cohort study. Trans R Soc Trop Med Hyg 2021; 114:355-364. [PMID: 32125417 DOI: 10.1093/trstmh/traa007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dengue is commonly considered an acute illness and follows three phases: febrile, critical in some cases and recovery. However, a number of studies have described a continuation of dengue symptoms for weeks or months, extending the recovery phase. Here we evaluate this persistence of dengue symptoms during convalescence. METHODS Our clinical cohort study included patients who sought medical services 48 to 144 h from the onset of fever at seven hospitals or ambulatory centers in Morelos, Mexico. Seventy-nine laboratory-confirmed dengue patients were followed up regularly using clinic and/or home visits and telephone calls for as long as symptoms persisted or up to 6 mo. RESULTS In total, 55.7% of patients had dengue-related symptoms 1 mo after the onset of fever; pain and dermatological manifestations were the most common persistent symptoms. Prognostic factors for symptom persistence were: ≥4 d of fever (RR 1.72; 95% CI 1.35 to 2.19), platelet count ≤100 000/mm3 (RR 1.20; 95% CI 1.20 to 2.20), petechiae/bruises (RR 1.97; 95% CI 1.56 to 2.48) and abdominal pain/hepatomegaly (RR 1.79; 95% CI 1.41 to 2.28). CONCLUSIONS Persistence of dengue symptoms were common in laboratory-confirmed dengue patients. Manifestations related to tissue damage were associated with persistence after 30 d; host characteristics, such as age and health status before infection, were associated with prolonged persistence (>60 d). The burden of dengue may be higher than previously estimated.
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Affiliation(s)
- Diana Carolina Tiga-Loza
- Programa de enfermería, Universidad Manuela Beltrán, Bucaramanga, Santander, Colombia.,Centro de investigaciones sobre enfermedades infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Ruth A Martínez-Vega
- Escuela de Microbiología, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Chile
| | - Cynthia A Tschampl
- Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, USA
| | - Donald S Shepard
- Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, USA
| | - José Ramos-Castañeda
- Centro de investigaciones sobre enfermedades infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.,Universidad Anahuac, Centro de Investigación en Ciencias de la Salud. México
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Schulte A, Weber I, Tiga-Loza DC, Amaya Larios IY, Shepard DS, Tschampl CA, Undurraga EA, Martínez-Vega RA, Fischer F, Chihu L, Ramos-Castañeda J. Health-Related Quality of Life after Dengue Fever, Morelos, Mexico, 2016-2017. Emerg Infect Dis 2021; 26:751-755. [PMID: 32186487 PMCID: PMC7101125 DOI: 10.3201/eid2604.190729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We adapted the EQ-5D-3L questionnaire and visual analog scale to assess health-related quality of life (HRQOL) and persistent symptoms in 79 patients with laboratory-confirmed dengue in Morelos, Mexico. The lowest HRQOLs were 0.53 and 38.1 (febrile phase). Patients recovered baseline HRQOL in ≈2 months.
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Bauchet J, Undurraga EA, Zycherman A, Behrman JR, Leonard WR, Godoy RA. The effect of gender targeting of food transfers on child nutritional status: Experimental evidence from the Bolivian Amazon. J Dev Effect 2021; 13:276-291. [PMID: 34868461 PMCID: PMC8635451 DOI: 10.1080/19439342.2021.1924833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 03/24/2021] [Indexed: 06/13/2023]
Abstract
Some research suggests women are more likely to allocate additional resources to their children than are men. This perception has influenced policies such as in-kind food transfer programs and cash transfer programs, which often target women recipients. We assess whether targeting in-kind rice transfers to female versus male adult household members has a differential impact on children's short-run nutritional status. We estimate the impacts of transfers of edible rice and rice seeds, randomly allocated to female or male adults, on three anthropometric indicators: BMI-for-age, arm-muscle area, and triceps skinfold thickness. The trial includes 481 children aged 3-11 years in a horticultural-foraging society of native Amazonians in Bolivia. On average, the gender of the transfer recipient does not influence child anthropometric dimensions, possibly due to norms of cooperation and sharing within and between households. We find limited evidence of heterogeneity in impacts. Transfers to women help children who were growth stunted at baseline to partially catch-up to their better-nourished age-sex peers and help boys (but not girls) and children in higher-income households increase their BMI-for-age. The results of this research point to the importance of considering cultural context in determining if allocating food transfers according to gender are most effective.
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Affiliation(s)
- Jonathan Bauchet
- Division of Consumer Science and Department of Agricultural Economics, Purdue University, 812 W. State Street, West Lafayette, IN 47907, USA
| | - Eduardo A. Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Santiago, RM 7820436, Chile
| | - Ariela Zycherman
- Climate Program Office, National Oceanic and Atmospheric Administration, 1315 East-West Hwy, Silver Spring, MD, 20910, USA
| | - Jere R. Behrman
- Department of Economics, Sociology, and Population Studies Center, University of Pennsylvania, 133 South 36 Street, Philadelphia, PA 19104-6297, USA
| | - William R. Leonard
- Department of Anthropology, Northwestern University, 1810 Hinman Avenue, Evanston, Ill 60208-1310, USA
| | - Ricardo A. Godoy
- Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02454-9110, USA
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González-Roldán JF, Undurraga EA, Meltzer MI, Atkins C, Vargas-Pino F, Gutiérrez-Cedillo V, Hernández-Pérez JR. Cost-effectiveness of the national dog rabies prevention and control program in Mexico, 1990-2015. PLoS Negl Trop Dis 2021; 15:e0009130. [PMID: 33661891 PMCID: PMC7963054 DOI: 10.1371/journal.pntd.0009130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 03/16/2021] [Accepted: 01/12/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rabies is a viral zoonosis that imposes a substantial disease and economic burden in many developing countries. Dogs are the primary source of rabies transmission; eliminating dog rabies reduces the risk of exposure in humans significantly. Through mass annual dog rabies vaccination campaigns, the national program of rabies control in Mexico progressively reduced rabies cases in dogs and humans since 1990. In 2019, the World Health Organization validated Mexico for eliminating rabies as a public health problem. Using a governmental perspective, we retrospectively assessed the economic costs, effectiveness, and cost-effectiveness of the national program of rabies control in Mexico, 1990-2015. METHODOLOGY Combining various data sources, including administrative records, national statistics, and scientific literature, we retrospectively compared the current scenario of annual dog vaccination campaigns and post-exposure prophylaxis (PEP) with a counterfactual scenario without an annual dog vaccination campaign but including PEP. The counterfactual scenario was estimated using a mathematical model of dog rabies transmission (RabiesEcon). We performed a thorough sensitivity analysis of the main results. PRINCIPAL FINDINGS Results suggest that in 1990 through 2015, the national dog rabies vaccination program in Mexico prevented about 13,000 human rabies deaths, at an incremental cost (MXN 2015) of $4,700 million (USD 300 million). We estimated an average cost of $360,000 (USD 23,000) per human rabies death averted, $6,500 (USD 410) per additional year-of-life, and $3,000 (USD 190) per dog rabies death averted. Results were robust to several counterfactual scenarios, including high and low rabies transmission scenarios and various assumptions about potential costs without mass dog rabies vaccination campaigns. CONCLUSIONS Annual dog rabies vaccination campaigns have eliminated the transmission of dog-to-dog rabies and dog-mediated human rabies deaths in Mexico. According to World Health Organization standards, our results show that the national program of rabies control in Mexico has been highly cost-effective.
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Affiliation(s)
- Jesús Felipe González-Roldán
- Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE), Secretaría de Salud México, Ciudad de México, México
| | - Eduardo A. Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
- Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Región Metropolitana, Chile
| | - Martin I. Meltzer
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Charisma Atkins
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Undurraga EA, Chowell G, Mizumoto K. COVID-19 case fatality risk by age and gender in a high testing setting in Latin America: Chile, March-August 2020. Infect Dis Poverty 2021; 10:11. [PMID: 33531085 PMCID: PMC7854021 DOI: 10.1186/s40249-020-00785-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early severity estimates of coronavirus disease 2019 (COVID-19) are critically needed to assess the potential impact of the ongoing pandemic in different demographic groups. Here we estimate the real-time delay-adjusted case fatality rate across nine age groups by gender in Chile, the country with the highest testing rate for COVID-19 in Latin America. METHODS We used a publicly available real-time daily series of age-stratified COVID-19 cases and deaths reported by the Ministry of Health in Chile from the beginning of the epidemic in March through August 31, 2020. We used a robust likelihood function and a delay distribution to estimate real-time delay-adjusted case-fatality risk and estimate model parameters using a Monte Carlo Markov Chain in a Bayesian framework. RESULTS As of August 31, 2020, our estimates of the time-delay adjusted case fatality rate (CFR) for men and women are 4.16% [95% Credible Interval (CrI): 4.09-4.24%] and 3.26% (95% CrI: 3.19-3.34%), respectively, while the overall estimate is 3.72% (95% CrI: 3.67-3.78%). Seniors aged 80 years and over have an adjusted CFR of 56.82% (95% CrI: 55.25-58.34%) for men and 41.10% (95% CrI: 40.02-42.26%) for women. Results showed a peak in estimated CFR during the June peak of the epidemic. The peak possibly reflects insufficient laboratory capacity, as illustrated by high test positivity rates (33% positive 7-day average nationally in June), which may have resulted in lower reporting rates. CONCLUSIONS Severity estimates from COVID-19 in Chile suggest that male seniors, especially among those aged ≥ 70 years, are being disproportionately affected by the pandemic, a finding consistent with other regions. The ongoing pandemic is imposing a high death toll in South America, and Chile has one of the highest reported mortality rates globally thus far. These real-time estimates may help inform public health officials' decisions in the region and underscore the need to implement more effective measures to ameliorate fatality.
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Affiliation(s)
- Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Macul, CP 7820436, Santiago, Región Metropolitana, Chile.
- Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile.
| | - Gerardo Chowell
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Kenji Mizumoto
- Graduate School of Advanced Integrated Studies in Human Survivability, Kyoto University Yoshida-Nakaadachi-Cho, Sakyo-ku, Kyoto, Japan
- Hakubi Center for Advanced Research, Kyoto University, Yoshidahonmachi, Sakyo-ku, Kyoto, Japan
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Abstract
BACKGROUND Governments worldwide have implemented large-scale non-pharmaceutical interventions, such as social distancing or school closures, to prevent and control the growth of the COVID-19 pandemic. These strategies, implemented with varying stringency, have imposed substantial social and economic costs to society. As some countries begin to reopen and ease mobility restrictions, lockdowns in smaller geographic areas are increasingly considered an attractive policy intervention to mitigate societal costs while controlling epidemic growth. Nevertheless, there is a lack of empirical evidence to support these decisions. METHODS Drawing from a rich data set of localized lockdowns in Chile, we used econometric methods to measure the reduction in local economic activity from lockdowns when applied to smaller or larger geographical areas. We measured economic activity by tax collection at the municipality-level. RESULTS Our results show that lockdowns were associated with a 10%-15% drop in local economic activity, which is twice the reduction in local economic activity suffered by municipalities that were not under lockdown. A three-to-four-month lockdown had a similar effect on economic activity than a year of the 2009 great recession. We found costs are proportional to the population under lockdown, without differences when lockdowns were measured at the municipality or city-wide levels. CONCLUSIONS Our findings suggest that localized lockdowns have a large effect on local economic activity, but these effects are proportional to the population under lockdown. Our results suggest that epidemiological criteria should guide decisions about the optimal size of lockdown areas since the proportional impact of lockdowns on the economy seems to be unchanged by scale.
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Affiliation(s)
- Kenzo Asahi
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
- Centre for Sustainable Urban Development (CEDEUS), Chile
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
- Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Santiago, Chile
- Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile
| | - Rodrigo Valdés
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Chile
| | - Rodrigo Wagner
- Business School, Universidad Adolfo Ibáñez, Santiago, Chile
- Growth Lab, Center for International Development, Harvard, Cambridge, Massachusetts, USA
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Tariq A, Undurraga EA, Laborde CC, Vogt-Geisse K, Luo R, Rothenberg R, Chowell G. Transmission dynamics and control of COVID-19 in Chile, March-October, 2020. PLoS Negl Trop Dis 2021; 15:e0009070. [PMID: 33481804 PMCID: PMC7857594 DOI: 10.1371/journal.pntd.0009070] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/03/2021] [Accepted: 12/13/2020] [Indexed: 12/22/2022] Open
Abstract
Since the detection of the first case of COVID-19 in Chile on March 3rd, 2020, a total of 513,188 cases, including ~14,302 deaths have been reported in Chile as of November 2nd, 2020. Here, we estimate the reproduction number throughout the epidemic in Chile and study the effectiveness of control interventions especially the effectiveness of lockdowns by conducting short-term forecasts based on the early transmission dynamics of COVID-19. Chile's incidence curve displays early sub-exponential growth dynamics with the deceleration of growth parameter, p, estimated at 0.8 (95% CI: 0.7, 0.8) and the reproduction number, R, estimated at 1.8 (95% CI: 1.6, 1.9). Our findings indicate that the control measures at the start of the epidemic significantly slowed down the spread of the virus. However, the relaxation of restrictions and spread of the virus in low-income neighborhoods in May led to a new surge of infections, followed by the reimposition of lockdowns in Greater Santiago and other municipalities. These measures have decelerated the virus spread with R estimated at ~0.96 (95% CI: 0.95, 0.98) as of November 2nd, 2020. The early sub-exponential growth trend (p ~0.8) of the COVID-19 epidemic transformed into a linear growth trend (p ~0.5) as of July 7th, 2020, after the reimposition of lockdowns. While the broad scale social distancing interventions have slowed the virus spread, the number of new COVID-19 cases continue to accrue, underscoring the need for persistent social distancing and active case detection and isolation efforts to maintain the epidemic under control.
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Affiliation(s)
- Amna Tariq
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Eduardo A. Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Region Metropolitana, Chile
- Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Region Metropolitana, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, Region Metropolitana, Chile
| | - Carla Castillo Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Region Metropolitana, Chile
| | - Katia Vogt-Geisse
- Facultad de Ingeniería y Ciencias, Universidad Adolfo Ibáñez, Santiago, Region Metropolitana, Chile
| | - Ruiyan Luo
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Richard Rothenberg
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Gerardo Chowell
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
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Tariq A, Undurraga EA, Laborde CC, Vogt-Geisse K, Luo R, Rothenberg R, Chowell G. Transmission dynamics and control of COVID-19 in Chile, March-October, 2020. medRxiv 2020:2020.05.15.20103069. [PMID: 33354684 PMCID: PMC7755146 DOI: 10.1101/2020.05.15.20103069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Since the detection of the first case of COVID-19 in Chile on March 3rd, 2020, a total of 513188 cases, including ~14302 deaths have been reported in Chile as of November 2nd, 2020. Here, we estimate the reproduction number throughout the epidemic in Chile and study the effectiveness of control interventions especially the effectiveness of lockdowns by conducting short-term forecasts based on the early transmission dynamics of COVID-19. Chile's incidence curve displays early sub-exponential growth dynamics with the deceleration of growth parameter, p, estimated at 0.8 (95% CI: 0.7, 0.8) and the reproduction number, R, estimated at 1.8 (95% CI: 1.6, 1.9). Our findings indicate that the control measures at the start of the epidemic significantly slowed down the spread of the virus. However, the relaxation of restrictions and spread of the virus in low-income neighborhoods in May led to a new surge of infections, followed by the reimposition of lockdowns in Greater Santiago and other municipalities. These measures have decelerated the virus spread with R estimated at ~0.96( 95% CI: 0.95, 0.98) as of November 2nd, 2020. The early sub-exponential growth trend (p ~0.8) of the COVID-19 epidemic transformed into a linear growth trend (p ~0.5) as of July 7th, 2020, after the reimposition of lockdowns. While the broad scale social distancing interventions have slowed the virus spread, the number of new COVID-19 cases continue to accrue, underscoring the need for persistent social distancing and active case detection and isolation efforts to maintain the epidemic under control.
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Affiliation(s)
- Amna Tariq
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Eduardo A. Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, RM, Chile
- Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, RM, Chile
| | - Carla Castillo Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, RM, Chile
| | - Katia Vogt-Geisse
- Facultad de Ingeniería y Ciencias, Universidad Adolfo Ibáñez, Santiago, RM, Chile
| | - Ruiyan Luo
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Richard Rothenberg
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Gerardo Chowell
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
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Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abolhassani H, Aboyans V, Abrams EM, Abreu LG, Abrigo MRM, Abu-Raddad LJ, Abushouk AI, Acebedo A, Ackerman IN, Adabi M, Adamu AA, Adebayo OM, Adekanmbi V, Adelson JD, Adetokunboh OO, Adham D, Afshari M, Afshin A, Agardh EE, Agarwal G, Agesa KM, Aghaali M, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmadpour E, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Al-Aly Z, Alam K, Alam N, Alam S, Alam T, Alanzi TM, Albertson SB, Alcalde-Rabanal JE, Alema NM, Ali M, Ali S, Alicandro G, Alijanzadeh M, Alinia C, Alipour V, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Aminorroaya A, Amiri F, Amit AML, Amugsi DA, Amul GGH, Anderlini D, Andrei CL, Andrei T, Anjomshoa M, Ansari F, Ansari I, Ansari-Moghaddam A, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Arabloo J, Arab-Zozani M, Aravkin AY, Ariani F, Ärnlöv J, Aryal KK, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Asghari B, Ashbaugh C, Atnafu DD, Atre SR, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azarian G, Azene ZN, Babaee E, Badawi A, Bagherzadeh M, Bakhshaei MH, Bakhtiari A, Balakrishnan S, Balalla S, Balassyano S, Banach M, Banik PC, Bannick MS, Bante AB, Baraki AG, Barboza MA, Barker-Collo SL, Barthelemy CM, Barua L, Barzegar A, Basu S, Baune BT, Bayati M, Bazmandegan G, Bedi N, Beghi E, Béjot Y, Bello AK, Bender RG, Bennett DA, Bennitt FB, Bensenor IM, Benziger CP, Berhe K, Bernabe E, Bertolacci GJ, Bhageerathy R, Bhala N, Bhandari D, Bhardwaj P, Bhattacharyya K, Bhutta ZA, Bibi S, Biehl MH, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisanzio D, Bisignano C, Biswas RK, Bohlouli S, Bohluli M, Bolla SRR, Boloor A, Boon-Dooley AS, Borges G, Borzì AM, Bourne R, Brady OJ, Brauer M, Brayne C, Breitborde NJK, Brenner H, Briant PS, Briggs AM, Briko NI, Britton GB, Bryazka D, Buchbinder R, Bumgarner BR, Busse R, Butt ZA, Caetano dos Santos FL, Cámera LLAA, Campos-Nonato IR, Car J, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castle CD, Castro F, Catalá-López F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang AR, Charlson FJ, Chattu VK, Chaturvedi S, Chimed-Ochir O, Chin KL, Cho DY, Christensen H, Chu DT, Chung MT, Cicuttini FM, Ciobanu LG, Cirillo M, Collins EL, Compton K, Conti S, Cortesi PA, Costa VM, Cousin E, Cowden RG, Cowie BC, Cromwell EA, Cross DH, Crowe CS, Cruz JA, Cunningham M, Dahlawi SMA, Damiani G, Dandona L, Dandona R, Darwesh AM, Daryani A, Das JK, Das Gupta R, das Neves J, Dávila-Cervantes CA, Davletov K, De Leo D, Dean FE, DeCleene NK, Deen A, Degenhardt L, Dellavalle RP, Demeke FM, Demsie DG, Denova-Gutiérrez E, Dereje ND, Dervenis N, Desai R, Desalew A, Dessie GA, Dharmaratne SD, Dhungana GP, Dianatinasab M, Diaz D, Dibaji Forooshani ZS, Dingels ZV, Dirac MA, Djalalinia S, Do HT, Dokova K, Dorostkar F, Doshi CP, Doshmangir L, Douiri A, Doxey MC, Driscoll TR, Dunachie SJ, Duncan BB, Duraes AR, Eagan AW, Ebrahimi Kalan M, Edvardsson D, Ehrlich JR, El Nahas N, El Sayed I, El Tantawi M, Elbarazi I, Elgendy IY, Elhabashy HR, El-Jaafary SI, Elyazar IRF, Emamian MH, Emmons-Bell S, Erskine HE, Eshrati B, Eskandarieh S, Esmaeilnejad S, Esmaeilzadeh F, Esteghamati A, Estep K, Etemadi A, Etisso AE, Farahmand M, Faraj A, Fareed M, Faridnia R, Farinha CSES, Farioli A, Faro A, Faruque M, Farzadfar F, Fattahi N, Fazlzadeh M, Feigin VL, Feldman R, Fereshtehnejad SM, Fernandes E, Ferrari AJ, Ferreira ML, Filip I, Fischer F, Fisher JL, Fitzgerald R, Flohr C, Flor LS, Foigt NA, Folayan MO, Force LM, Fornari C, Foroutan M, Fox JT, Freitas M, Fu W, Fukumoto T, Furtado JM, Gad MM, Gakidou E, Galles NC, Gallus S, Gamkrelidze A, Garcia-Basteiro AL, Gardner WM, Geberemariyam BS, Gebrehiwot AM, Gebremedhin KB, Gebreslassie AAAA, Gershberg Hayoon A, Gething PW, Ghadimi M, Ghadiri K, Ghafourifard M, Ghajar A, Ghamari F, Ghashghaee A, Ghiasvand H, Ghith N, Gholamian A, Gilani SA, Gill PS, Gitimoghaddam M, Giussani G, Goli S, Gomez RS, Gopalani SV, Gorini G, Gorman TM, Gottlich HC, Goudarzi H, Goulart AC, Goulart BNG, Grada A, Grivna M, Grosso G, Gubari MIM, Gugnani HC, Guimaraes ALS, Guimarães RA, Guled RA, Guo G, Guo Y, Gupta R, Haagsma JA, Haddock B, Hafezi-Nejad N, Hafiz A, Hagins H, Haile LM, Hall BJ, Halvaei I, Hamadeh RR, Hamagharib Abdullah K, Hamilton EB, Han C, Han H, Hankey GJ, Haro JM, Harvey JD, Hasaballah AI, Hasanzadeh A, Hashemian M, Hassanipour S, Hassankhani H, Havmoeller RJ, Hay RJ, Hay SI, Hayat K, Heidari B, Heidari G, Heidari-Soureshjani R, Hendrie D, Henrikson HJ, Henry NJ, Herteliu C, Heydarpour F, Hird TR, Hoek HW, Hole MK, Holla R, Hoogar P, Hosgood HD, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hoy DG, Hsairi M, Hsieh VCR, Hu G, Huda TM, Hugo FN, Huynh CK, Hwang BF, Iannucci VC, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Inbaraj LR, Ippolito H, Irvani SSN, Islam MM, Islam M, Islam SMS, Islami F, Iso H, Ivers RQ, Iwu CCD, Iyamu IO, Jaafari J, Jacobsen KH, Jadidi-Niaragh F, Jafari H, Jafarinia M, Jahagirdar D, Jahani MA, Jahanmehr N, Jakovljevic M, Jalali A, Jalilian F, James SL, Janjani H, Janodia MD, Jayatilleke AU, Jeemon P, Jenabi E, Jha RP, Jha V, Ji JS, Jia P, John O, John-Akinola YO, Johnson CO, Johnson SC, Jonas JB, Joo T, Joshi A, Jozwiak JJ, Jürisson M, Kabir A, Kabir Z, Kalani H, Kalani R, Kalankesh LR, Kalhor R, Kamiab Z, Kanchan T, Karami Matin B, Karch A, Karim MA, Karimi SE, Kassa GM, Kassebaum NJ, Katikireddi SV, Kawakami N, Kayode GA, Keddie SH, Keller C, Kereselidze M, Khafaie MA, Khalid N, Khan M, Khatab K, Khater MM, Khatib MN, Khayamzadeh M, Khodayari MT, Khundkar R, Kianipour N, Kieling C, Kim D, Kim YE, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kissimova-Skarbek K, Kivimäki M, Kneib CJ, Knudsen AKS, Kocarnik JM, Kolola T, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Kumar P, Kumar V, Kumaresh G, Kurmi OP, Kusuma D, Kyu HH, La Vecchia C, Lacey B, Lal DK, Lalloo R, Lam JO, Lami FH, Landires I, Lang JJ, Lansingh VC, Larson SL, Larsson AO, Lasrado S, Lassi ZS, Lau KMM, Lavados PM, Lazarus JV, Ledesma JR, Lee PH, Lee SWH, LeGrand KE, Leigh J, Leonardi M, Lescinsky H, Leung J, Levi M, Lewington S, Li S, Lim LL, Lin C, Lin RT, Linehan C, Linn S, Liu HC, Liu S, Liu Z, Looker KJ, Lopez AD, Lopukhov PD, Lorkowski S, Lotufo PA, Lucas TCD, Lugo A, Lunevicius R, Lyons RA, Ma J, MacLachlan JH, Maddison ER, Maddison R, Madotto F, Mahasha PW, Mai HT, Majeed A, Maled V, Maleki S, Malekzadeh R, Malta DC, Mamun AA, Manafi A, Manafi N, Manguerra H, Mansouri B, Mansournia MA, Mantilla Herrera AM, Maravilla JC, Marks A, Martins-Melo FR, Martopullo I, Masoumi SZ, Massano J, Massenburg BB, Mathur MR, Maulik PK, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehri F, Mehta KM, Meitei WB, Memiah PTN, Mendoza W, Menezes RG, Mengesha EW, Mengesha MB, Mereke A, Meretoja A, Meretoja TJ, Mestrovic T, Miazgowski B, Miazgowski T, Michalek IM, Mihretie KM, Miller TR, Mills EJ, Mirica A, Mirrakhimov EM, Mirzaei H, Mirzaei M, Mirzaei-Alavijeh M, Misganaw AT, Mithra P, Moazen B, Moghadaszadeh M, Mohamadi E, Mohammad DK, Mohammad Y, Mohammad Gholi Mezerji N, Mohammadian-Hafshejani A, Mohammadifard N, Mohammadpourhodki R, Mohammed S, Mokdad AH, Molokhia M, Momen NC, Monasta L, Mondello S, Mooney MD, Moosazadeh M, Moradi G, Moradi M, Moradi-Lakeh M, Moradzadeh R, Moraga P, Morales L, Morawska L, Moreno Velásquez I, Morgado-da-Costa J, Morrison SD, Mosser JF, Mouodi S, Mousavi SM, Mousavi Khaneghah A, Mueller UO, Munro SB, Muriithi MK, Musa KI, Muthupandian S, Naderi M, Nagarajan AJ, Nagel G, Naghshtabrizi B, Nair S, Nandi AK, Nangia V, Nansseu JR, Nayak VC, Nazari J, Negoi I, Negoi RI, Netsere HBN, Ngunjiri JW, Nguyen CT, Nguyen J, Nguyen M, Nguyen M, Nichols E, Nigatu D, Nigatu YT, Nikbakhsh R, Nixon MR, Nnaji CA, Nomura S, Norrving B, Noubiap JJ, Nowak C, Nunez-Samudio V, Oţoiu A, Oancea B, Odell CM, Ogbo FA, Oh IH, Okunga EW, Oladnabi M, Olagunju AT, Olusanya BO, Olusanya JO, Oluwasanu MM, Omar Bali A, Omer MO, Ong KL, Onwujekwe OE, Orji AU, Orpana HM, Ortiz A, Ostroff SM, Otstavnov N, Otstavnov SS, Øverland S, Owolabi MO, P A M, Padubidri JR, Pakhare AP, Palladino R, Pana A, Panda-Jonas S, Pandey A, Park EK, Parmar PGK, Pasupula DK, Patel SK, Paternina-Caicedo AJ, Pathak A, Pathak M, Patten SB, Patton GC, Paudel D, Pazoki Toroudi H, Peden AE, Pennini A, Pepito VCF, Peprah EK, Pereira A, Pereira DM, Perico N, Pham HQ, Phillips MR, Pigott DM, Pilgrim T, Pilz TM, Pirsaheb M, Plana-Ripoll O, Plass D, Pokhrel KN, Polibin RV, Polinder S, Polkinghorne KR, Postma MJ, Pourjafar H, Pourmalek F, Pourmirza Kalhori R, Pourshams A, Poznańska A, Prada SI, Prakash V, Pribadi DRA, Pupillo E, Quazi Syed Z, Rabiee M, Rabiee N, Radfar A, Rafiee A, Rafiei A, Raggi A, Rahimi-Movaghar A, Rahman MA, Rajabpour-Sanati A, Rajati F, Ramezanzadeh K, Ranabhat CL, Rao PC, Rao SJ, Rasella D, Rastogi P, Rathi P, Rawaf DL, Rawaf S, Rawal L, Razo C, Redford SB, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renjith V, Renzaho AMN, Resnikoff S, Rezaei N, Rezai MS, Rezapour A, Rhinehart PA, Riahi SM, Ribeiro ALP, Ribeiro DC, Ribeiro D, Rickard J, Roberts NLS, Roberts S, Robinson SR, Roever L, Rolfe S, Ronfani L, Roshandel G, Roth GA, Rubagotti E, Rumisha SF, Sabour S, Sachdev PS, Saddik B, Sadeghi E, Sadeghi M, Saeidi S, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi SM, Salahshoor MR, Salamati P, Salehi Zahabi S, Salem H, Salem MRR, Salimzadeh H, Salomon JA, Salz I, Samad Z, Samy AM, Sanabria J, Santomauro DF, Santos IS, Santos JV, Santric-Milicevic MM, Saraswathy SYI, Sarmiento-Suárez R, Sarrafzadegan N, Sartorius B, Sarveazad A, Sathian B, Sathish T, Sattin D, Sbarra AN, Schaeffer LE, Schiavolin S, Schmidt MI, Schutte AE, Schwebel DC, Schwendicke F, Senbeta AM, Senthilkumaran S, Sepanlou SG, Shackelford KA, Shadid J, Shahabi S, Shaheen AA, Shaikh MA, Shalash AS, Shams-Beyranvand M, Shamsizadeh M, Shannawaz M, Sharafi K, Sharara F, Sheena BS, Sheikhtaheri A, Shetty RS, Shibuya K, Shiferaw WS, Shigematsu M, Shin JI, Shiri R, Shirkoohi R, Shrime MG, Shuval K, Siabani S, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Simpson KE, Singh A, Singh JA, Skiadaresi E, Skou ST, Skryabin VY, Sobngwi E, Sokhan A, Soltani S, Sorensen RJD, Soriano JB, Sorrie MB, Soyiri IN, Sreeramareddy CT, Stanaway JD, Stark BA, Ştefan SC, Stein C, Steiner C, Steiner TJ, Stokes MA, Stovner LJ, Stubbs JL, Sudaryanto A, Sufiyan MB, Sulo G, Sultan I, Sykes BL, Sylte DO, Szócska M, Tabarés-Seisdedos R, Tabb KM, Tadakamadla SK, Taherkhani A, Tajdini M, Takahashi K, Taveira N, Teagle WL, Teame H, Tehrani-Banihashemi A, Teklehaimanot BF, Terrason S, Tessema ZT, Thankappan KR, Thomson AM, Tohidinik HR, Tonelli M, Topor-Madry R, Torre AE, Touvier M, Tovani-Palone MRR, Tran BX, Travillian R, Troeger CE, Truelsen TC, Tsai AC, Tsatsakis A, Tudor Car L, Tyrovolas S, Uddin R, Ullah S, Undurraga EA, Unnikrishnan B, Vacante M, Vakilian A, Valdez PR, Varughese S, Vasankari TJ, Vasseghian Y, Venketasubramanian N, Violante FS, Vlassov V, Vollset SE, Vongpradith A, Vukovic A, Vukovic R, Waheed Y, Walters MK, Wang J, Wang Y, Wang YP, Ward JL, Watson A, Wei J, Weintraub RG, Weiss DJ, Weiss J, Westerman R, Whisnant JL, Whiteford HA, Wiangkham T, Wiens KE, Wijeratne T, Wilner LB, Wilson S, Wojtyniak B, Wolfe CDA, Wool EE, Wu AM, Wulf Hanson S, Wunrow HY, Xu G, Xu R, Yadgir S, Yahyazadeh Jabbari SH, Yamagishi K, Yaminfirooz M, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yearwood JA, Yeheyis TY, Yeshitila YG, Yip P, Yonemoto N, Yoon SJ, Yoosefi Lebni J, Younis MZ, Younker TP, Yousefi Z, Yousefifard M, Yousefinezhadi T, Yousuf AY, Yu C, Yusefzadeh H, Zahirian Moghadam T, Zaki L, Zaman SB, Zamani M, Zamanian M, Zandian H, Zangeneh A, Zastrozhin MS, Zewdie KA, Zhang Y, Zhang ZJ, Zhao JT, Zhao Y, Zheng P, Zhou M, Ziapour A, Zimsen SRM, Naghavi M, Murray CJL. 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. Lancet 2020; 396:1204-1222. [PMID: 33069326 PMCID: PMC7567026 DOI: 10.1016/s0140-6736(20)30925-9] [Citation(s) in RCA: 6299] [Impact Index Per Article: 1574.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/27/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Abstract
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. FUNDING Bill & Melinda Gates Foundation.
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Allel K, García P, Labarca J, Munita JM, Rendic M, Undurraga EA. Socioeconomic factors associated with antimicrobial resistance of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli in Chilean hospitals (2008-2017). Rev Panam Salud Publica 2020; 44:e30. [PMID: 32973892 PMCID: PMC7498296 DOI: 10.26633/rpsp.2020.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/21/2020] [Indexed: 12/31/2022] Open
Abstract
Objective. To identify socioeconomic factors associated with antimicrobial resistance of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli in Chilean hospitals (2008–2017). Methods. We reviewed the scientific literature on socioeconomic factors associated with the emergence and dissemination of antimicrobial resistance. Using multivariate regression, we tested findings from the literature drawing from a longitudinal dataset on antimicrobial resistance from 41 major private and public hospitals and a nationally representative household survey in Chile (2008–2017). We estimated resistance rates for three priority antibiotic–bacterium pairs, as defined by the Organisation for Economic Co-operation and Development; i.e., imipenem and meropenem resistant P. aeruginosa, cloxacillin resistant S. aureus, and cefotaxime and ciprofloxacin resistant E. coli. Results. Evidence from the literature review suggests poverty and material deprivation are important risk factors for the emergence and transmission of antimicrobial resistance. Most studies found that worse socioeconomic indicators were associated with higher rates of antimicrobial resistance. Our analysis showed an overall antimicrobial resistance rate of 32.5%, with the highest rates for S. aureus (40.6%) and the lowest for E. coli (25.7%). We found a small but consistent negative association between socioeconomic factors (income, education, and occupation) and overall antimicrobial resistance in univariate (p < 0.01) and multivariate analyses (p < 0.01), driven by resistant P. aeruginosa and S. aureus. Conclusion. Socioeconomic factors beyond health care and hospital settings may affect the emergence and dissemination of antimicrobial resistance. Preventing and controlling antimicrobial resistance requires efforts above and beyond reducing antibiotic consumption.
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Affiliation(s)
- Kasim Allel
- Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R) Santiago Chile Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, Chile
| | - Patricia García
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile Santiago Chile Departamento de Laboratorios Clínicos, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime Labarca
- Departamento de Enfermedades Infecciosas, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile Santiago Chile Departamento de Enfermedades Infecciosas, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José M Munita
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo Las Condes Chile Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Las Condes, Chile
| | - Magdalena Rendic
- Escuela de Gobierno, Pontificia Universidad Católica de Chile Santiago Chile Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile Santiago Chile Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
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da Silva Ferreira ER, de Oliveira Gonçalves AC, Tobal Verro A, Undurraga EA, Lacerda Nogueira M, Estofolete CF, Santos da Silva N. Evaluating the validity of dengue clinical-epidemiological criteria for diagnosis in patients residing in a Brazilian endemic area. Trans R Soc Trop Med Hyg 2020; 114:603-611. [PMID: 32497201 DOI: 10.1093/trstmh/traa031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/15/2020] [Accepted: 04/23/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We evaluated the validity of clinical diagnosis compared with laboratory diagnosis of dengue in a retrospective sample of patients in São José do Rio Preto, Brazil. METHODS Our sample included 148 299 clinically (56.3%) or laboratory-diagnosed (43.7%) dengue cases. We compared the sensitivity, specificity, positive and negative predictive value (PPV and NPV) of dengue patients' demographic and clinical characteristics with laboratory-based diagnosis. We used logistic regressions to estimate the correlation between clinical and laboratory diagnosis of dengue and a full set of dengue signs and symptoms. RESULTS We found substantial variability in sensitivity and specificity of signs and symptoms ranging from 0.8-81.1 and 21.5-99.6, respectively. Thrombocytopenia exhibited the highest PPV (92.0) and lowest NPV (42.2) and was the only symptom showing agreement with laboratory-confirmed dengue (φ = 0.38). The presence of exanthema and thrombocytopenia led to a greater likelihood of concordant clinical and laboratory diagnoses (exanthema: OR: 4.23; 95% CI: 2.09 to 8.57; thrombocytopenia: OR: 4.02; 95% CI: 1.32 to 12.27). CONCLUSIONS We found substantial variation in sensitivity, specificity, PPV and NPV of dengue signs and symptoms. For accuracy, clinical and laboratory diagnosis of dengue should be performed concurrently. When laboratory tests are not available, we suggest focusing on the clinical manifestations most associated with dengue.
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Affiliation(s)
- Elis Regina da Silva Ferreira
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina de São José do Rio Preto, Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto - São Paulo, CEP 15090-000, Brazil
| | | | - Alice Tobal Verro
- Faculdade de Medicina, União das Faculdades dos Grandes Lagos, São José do Rio Preto, São Paulo, 15030-070, Brazil
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, 13083-872, Chile
| | - Maurício Lacerda Nogueira
- Laboratório de Pesquisas em Virologia, Faculdade de Medicina de São José do Rio Preto, São Paulo, 15090-000, Brazil
| | - Cássia Fernanda Estofolete
- Laboratório de Pesquisas em Virologia, Faculdade de Medicina de São José do Rio Preto, São Paulo, 15090-000, Brazil
| | - Natal Santos da Silva
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina de São José do Rio Preto, Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto - São Paulo, CEP 15090-000, Brazil
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Munayco C, Chowell G, Tariq A, Undurraga EA, Mizumoto K. Risk of death by age and gender from CoVID-19 in Peru, March-May, 2020. Aging (Albany NY) 2020; 12:13869-13881. [PMID: 32692724 PMCID: PMC7425445 DOI: 10.18632/aging.103687] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
Peru implemented strict social distancing measures during the early phase of the epidemic and is now experiencing one of the largest CoVID-19 epidemics in Latin America. Estimates of disease severity are an essential indicator to inform policy decisions about the intensity and duration of interventions needed to mitigate the outbreak. Here we derive delay-adjusted case fatality risks (aCFR) of CoVID-19 in a middle-income country in South America.We utilize government-reported time series of CoVID-19 cases and deaths in Peru stratified by age group and gender.As of May 25, 2020, we estimate the aCFR for men and women at 10.8% (95%CrI: 10.5-11.1%) and 6.5% (95%CrI: 6.2-6.8%), respectively, whereas the overall aCFR was estimated at 9.1% (95%CrI: 8.9-9.3%). Our results show that senior individuals have been the most severely affected by CoVID-19, particularly men, with an aCFR of nearly 60% for those aged 80- years. We also found that men have a significantly higher cumulative morbidity ratio across most age groups (proportion test, p-value< 0.001), with the exception of those aged 0-9 years.The ongoing CoVID-19 pandemic is generating a substantial mortality burden in Peru. Senior individuals, especially those older than 70 years, are being disproportionately affected by the CoVID-19 pandemic.
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Affiliation(s)
- Cesar Munayco
- Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Peruvian Ministry of Health, Lima, Peru
| | - Gerardo Chowell
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA 30303, USA
| | - Amna Tariq
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA 30303, USA
| | - Eduardo A. Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Region Metropolitana, Chile
- Millennium Initiative for Collaborative Research in Bacterial Resistance, MICROB-R, Chile
| | - Kenji Mizumoto
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA 30303, USA
- Graduate School of Advanced Integrated Studies in Human Survivability, Kyoto University Yoshida-Nakaadachi-cho, Sakyo-ku, Kyoto, Japan
- Hakubi Center for Advanced Research, Kyoto University, Yoshidahonmachi, Sakyo-ku, Kyoto, Japan
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Rainisch G, Undurraga EA, Chowell G. A dynamic modeling tool for estimating healthcare demand from the COVID19 epidemic and evaluating population-wide interventions. Int J Infect Dis 2020; 96:376-383. [PMID: 32425631 PMCID: PMC7229979 DOI: 10.1016/j.ijid.2020.05.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Public health officials need tools to assist in anticipating the healthcare resources required to confront the SARS-COV-2 pandemic. We constructed a modeling tool to aid active public health officials to estimate healthcare demand from the pandemic in their jurisdictions and to evaluate the potential impact of population-wide social-distancing interventions. METHODS The tool uses an SEIR compartmental model to project the pandemic's local spread. Users input case counts, healthcare resources, and select intervention strategies to evaluate. Outputs include the number of infections and deaths with and without intervention, and the demand for hospital and critical care beds and ventilators relative to existing capacity. We illustrate the tool using data from three regions of Chile. RESULTS Our scenarios indicate a surge in COVID-19 patients could overwhelm Chilean hospitals by June, peaking in July or August at six to 50 times the current supply of beds and ventilators. A lockdown strategy or combination of case isolation, home quarantine, social distancing of individuals >70 years, and telework interventions may keep treatment demand below capacity. CONCLUSIONS Aggressive interventions can avert substantial morbidity and mortality from COVID-19. Our tool permits rapid evaluation of locally-applicable policy scenarios and updating of results as new data become available.
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Affiliation(s)
- Gabriel Rainisch
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, RM, Chile; Millennium Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), RM, Chile
| | - Gerardo Chowell
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
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Undurraga EA, Millien MF, Allel K, Etheart MD, Cleaton J, Ross Y, Wallace RM. Costs and effectiveness of alternative dog vaccination strategies to improve dog population coverage in rural and urban settings during a rabies outbreak. Vaccine 2020; 38:6162-6173. [PMID: 32616327 DOI: 10.1016/j.vaccine.2020.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/25/2022]
Abstract
Dog-rabies elimination programs have typically relied upon parenteral vaccination at central-point locations; however, dog-ownership practices, accessibility to hard-to-reach sub-populations, resource limitations, and logistics may impact a country's ability to reach the 70% coverage goal recommended by the World Organization for Animal Health (OIE) and World Health Organization (WHO). Here we report the cost-effectiveness of different dog-vaccination strategies during a dog-rabies outbreak in urban and peri-urban sections of Croix-des-Bouquets commune of the West Department, Haiti, in 2016. Three strategies, mobile static point (MSP), mobile static point with capture-vaccinate-release (MSP + CVR), and door-to-door vaccination with oral vaccination (DDV + ORV), were applied at five randomly assigned sites and assessed for free-roaming dog vaccination coverage and total population coverage. A total of 7065 dogs were vaccinated against rabies during the vaccination campaign. Overall, free-roaming dog vaccination coverage was estimated at 52% (47%-56%) for MSP, 53% (47%-60%) for DDV + ORV, and 65% (61%-69%) for MSP + CVR (differences with MSP and DDV + ORV significant at p < 0.01). Total dog vaccination coverage was 33% (95% CI: 26%-43%) for MSP, 49% (95% CI: 40%-61%) for MSP + CVR and 78% (77%-80%) for DDV + ORV (differences significant at p < 0.001). Overall, the least expensive campaign was MSP, with an estimated cost of about $2039 per day ($4078 total), and the most expensive was DDV + ORV with a cost of $3246 per day ($6492 total). Despite the relative high cost of an ORV bait, combining DDV and ORV was the most cost-effective strategy in our study ($1.97 per vaccinated dog), largely due to increased efficiency of the vaccinators to target less accessible dogs. Costs per vaccinated dog were $2.20 for MSP and $2.28 for MSP + CVR. We hope the results from this study will support the design and implementation of effective dog vaccination campaigns to achieve the goal of eliminating dog-mediated human rabies deaths by 2030.
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Affiliation(s)
- Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile.
| | | | - Kasim Allel
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Melissa D Etheart
- Haiti Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Julie Cleaton
- Poxvirus and Rabies Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yasmeen Ross
- Poxvirus and Rabies Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Ryan M Wallace
- Poxvirus and Rabies Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Bauchet J, Undurraga EA, Zhang R, Godoy RA. Market Engagement and Indigenous People: Testing Hypotheses from the Western Intellectual Tradition. Journal of Anthropological Research 2020. [DOI: 10.1086/708397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Allel K, Narea M, Undurraga EA. Centre-based care is a significant predictor of lower body mass index in early childhood: Longitudinal evidence from Chile. J Glob Health 2020; 10:010419. [PMID: 32373335 PMCID: PMC7182360 DOI: 10.7189/jogh.10.010419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prevalence of childhood overweight has increased by approximately 50% in the past three decades, becoming a major public health concern worldwide. In Chile, an upper middle-income country, about 38% of children between two and four years of age are overweight, almost double the average in Latin America and the Caribbean. Various environmental and individual factors, and their interactions, affect childhood weight. Emerging evidence suggests childcare may also matter. Because the public provision of centre-based care is growing, childcare may be a useful policy tool to help prevent childhood overweight. METHODS Using a nationally representative longitudinal survey of ~ 15 000 children in Chile (2010 and 2012), we estimated whether the type of child care (centre-based or maternal) a child attended at age 24 to 36 months was a significant predictor of the child's sex-and-age-specific body-mass-index (BMI) at age 36-48 months. We restricted our sample to children in full-time maternal care at baseline (12-24 months of age; n = 1273), but tested the robustness of results with the full sample. We compared children in centre-based care and in maternal care using difference-in-difference estimators and propensity score matching, and adjusted our estimates using child, family, and neighborhood characteristics. RESULTS Children attending centre-based care had 0.27 SD lower BMI than children in maternal care at follow-up (P < 0.05). We found suggestive evidence this association may be modulated by the child's socioeconomic status and by how frequently the child watched television: we found smaller BMI changes for children at the bottom 80% of socioeconomic status (P < 0.05) and also for children who frequently watched television (P < 0.10). Our results were robust to various model specifications. CONCLUSIONS Our findings suggest centre-based care programs, with adequate regulation and enforcement, may be a useful support to help curb the early childhood overweight epidemic, in addition to known effects in labor supply and child development.
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Affiliation(s)
- Kasim Allel
- Institute for Global Health, University College London, UK
- Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Chile
- Society and Health Research Centre, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
| | - Marigen Narea
- Centre for Advanced Studies on Educational Justice (CJE), Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
- School of Psychology, Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
| | - Eduardo A Undurraga
- Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Chile
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
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Tschampl CA, Undurraga EA, Ledogar RJ, Coloma J, Legorreta-Soberanis J, Paredes-Solís S, Arosteguí J, Hernández-Álvarez C, Harris E, Andersson N, Shepard DS. Cost-effectiveness of community mobilization (Camino Verde) for dengue prevention in Nicaragua and Mexico: A cluster randomized controlled trial. Int J Infect Dis 2020; 94:59-67. [PMID: 32179138 DOI: 10.1016/j.ijid.2020.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/07/2020] [Accepted: 03/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We assessed the cost-effectiveness of Camino Verde, a community-based mobilization strategy to prevent and control dengue and other mosquito-borne diseases. A cluster-randomized controlled trial in Managua, Nicaragua, and in three coastal regions in Guerrero, Mexico (75 intervention and 75 control clusters), Camino Verde used non-governmental community health workers, called brigadistas, to support community mobilization. This donor-funded trial demonstrated reductions of 29.5% (95% confidence interval, CI: 3.8%-55.3%) on dengue infections and 24.7% (CI: 1.8%-51.2%) on self-reported cases. METHODS We estimated program costs through a micro-costing approach and semi-structured questionnaires. We show results as incremental cost-effectiveness ratios (ICERs) for costs per disability-adjusted life-year (DALYs) averted and conducted probabilistic sensitivity analyses. FINDINGS The Camino Verde trial spent US$16.72 in Mexico and $7.47 in Nicaragua per person annually. We found an average of 910 (CI: 487-1 353) and 500 (CI: 250-760) dengue cases averted annually per million population in Mexico and Nicaragua, respectively, compared to control communities. The ICER in Mexico was US$29 618 (CI: 13 869-66 898) per DALY averted, or 3.0 times per capita GDP. For Nicaragua, the ICER was US$29 196 (CI: 14294-72181) per DALY averted, or 16.9 times per capita GDP. INTERPRETATION Camino Verde, as implemented in the research context, was marginally cost-effective in Mexico, and not cost-effective in Nicaragua, from a healthcare sector perspective. Nicaragua's low per capita GDP and the use of grant-funded management personnel weakened the cost-effectiveness results. Achieving efficiencies by incorporating Camino Verde activities into existing public health programs would make Camino Verde cost-effective.
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Affiliation(s)
- Cynthia A Tschampl
- Schneider Institutes for Health Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, RM, Chile
| | | | - Josefina Coloma
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Jose Legorreta-Soberanis
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | | | | | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Neil Andersson
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico; Department of Family Medicine, McGill University, Montreal, Canada
| | - Donald S Shepard
- Schneider Institutes for Health Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
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Jacoby N, Undurraga EA, McPherson MJ, Valdes J, Ossandon T, McDermott JH. Universal and Non-universal Features of Musical Pitch Perception Revealed by Singing. Curr Biol 2019; 29:3229-3243.e12. [PMID: 31543451 PMCID: PMC9907018 DOI: 10.1016/j.cub.2019.08.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/03/2019] [Accepted: 08/08/2019] [Indexed: 12/15/2022]
Abstract
Musical pitch perception is argued to result from nonmusical biological constraints and thus to have similar characteristics across cultures, but its universality remains unclear. We probed pitch representations in residents of the Bolivian Amazon-the Tsimane', who live in relative isolation from Western culture-as well as US musicians and non-musicians. Participants sang back tone sequences presented in different frequency ranges. Sung responses of Amazonian and US participants approximately replicated heard intervals on a logarithmic scale, even for tones outside the singing range. Moreover, Amazonian and US reproductions both deteriorated for high-frequency tones even though they were fully audible. But whereas US participants tended to reproduce notes an integer number of octaves above or below the heard tones, Amazonians did not, ignoring the note "chroma" (C, D, etc.). Chroma matching in US participants was more pronounced in US musicians than non-musicians, was not affected by feedback, and was correlated with similarity-based measures of octave equivalence as well as the ability to match the absolute f0 of a stimulus in the singing range. The results suggest the cross-cultural presence of logarithmic scales for pitch, and biological constraints on the limits of pitch, but indicate that octave equivalence may be culturally contingent, plausibly dependent on pitch representations that develop from experience with particular musical systems. VIDEO ABSTRACT.
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Affiliation(s)
- Nori Jacoby
- Computational Auditory Perception Group, Max Planck Institute for Empirical Aesthetics, Frankfurt 60322, Germany; The Center for Science and Society, Columbia University, New York, NY 10027, USA.
| | - Eduardo A. Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana 7820436, Chile,Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Santiago, Región Metropolitana 7820436, Chile
| | - Malinda J. McPherson
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA,Program in Speech and Hearing Biosciences and Technology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - Joaquin Valdes
- Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana 7820436, Chile
| | - Tomas Ossandon
- Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana 7820436, Chile
| | - Josh H. McDermott
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA,Program in Speech and Hearing Biosciences and Technology, Harvard University, Cambridge, Massachusetts 02138, USA,McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA,Corresponding Authors: NJ: , JHM:
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Chang AY, Cowling K, Micah AE, Chapin A, Chen CS, Ikilezi G, Sadat N, Tsakalos G, Wu J, Younker T, Zhao Y, Zlavog BS, Abbafati C, Ahmed AE, Alam K, Alipour V, Aljunid SM, Almalki MJ, Alvis-Guzman N, Ammar W, Andrei CL, Anjomshoa M, Antonio CAT, Arabloo J, Aremu O, Ausloos M, Avila-Burgos L, Awasthi A, Ayanore MA, Azari S, Azzopardi-Muscat N, Bagherzadeh M, Bärnighausen TW, Baune BT, Bayati M, Belay YB, Belay YA, Belete H, Berbada DA, Berman AE, Beuran M, Bijani A, Busse R, Cahuana-Hurtado L, Cámera LA, Catalá-López F, Chauhan BG, Constantin MM, Crowe CS, Cucu A, Dalal K, De Neve JW, Deiparine S, Demeke FM, Do HP, Dubey M, El Tantawi M, Eskandarieh S, Esmaeili R, Fakhar M, Fazaeli AA, Fischer F, Foigt NA, Fukumoto T, Fullman N, Galan A, Gamkrelidze A, Gezae KE, Ghajar A, Ghashghaee A, Goginashvili K, Haakenstad A, Haghparast Bidgoli H, Hamidi S, Harb HL, Hasanpoor E, Hassen HY, Hay SI, Hendrie D, Henok A, Heredia-Pi I, Herteliu C, Hoang CL, Hole MK, Homaie Rad E, Hossain N, Hosseinzadeh M, Hostiuc S, Ilesanmi OS, Irvani SSN, Jakovljevic M, Jalali A, James SL, Jonas JB, Jürisson M, Kadel R, Karami Matin B, Kasaeian A, Kasaye HK, Kassaw MW, Kazemi Karyani A, Khabiri R, Khan J, Khan MN, Khang YH, Kisa A, Kissimova-Skarbek K, Kohler S, Koyanagi A, Krohn KJ, Leung R, Lim LL, Lorkowski S, Majeed A, Malekzadeh R, Mansourian M, Mantovani LG, Massenburg BB, McKee M, Mehta V, Meretoja A, Meretoja TJ, Milevska Kostova N, Miller TR, Mirrakhimov EM, Mohajer B, Mohammad Darwesh A, Mohammed S, Mohebi F, Mokdad AH, Morrison SD, Mousavi SM, Muthupandian S, Nagarajan AJ, Nangia V, Negoi I, Nguyen CT, Nguyen HLT, Nguyen SH, Nosratnejad S, Oladimeji O, Olgiati S, Olusanya JO, Onwujekwe OE, Otstavnov SS, Pana A, Pereira DM, Piroozi B, Prada SI, Qorbani M, Rabiee M, Rabiee N, Rafiei A, Rahim F, Rahimi-Movaghar V, Ram U, Ranabhat CL, Ranta A, Rawaf DL, Rawaf S, Rezaei S, Roro EM, Rostami A, Rubino S, Salahshoor M, Samy AM, Sanabria J, Santos JV, Santric Milicevic MM, Sao Jose BP, Savic M, Schwendicke F, Sepanlou SG, Sepehrimanesh M, Sheikh A, Shrime MG, Sisay S, Soltani S, Soofi M, Soofi M, Srinivasan V, Tabarés-Seisdedos R, Torre A, Tovani-Palone MR, Tran BX, Tran KB, Undurraga EA, Valdez PR, van Boven JFM, Vargas V, Veisani Y, Violante FS, Vladimirov SK, Vlassov V, Vollmer S, Vu GT, Wolfe CDA, Yonemoto N, Younis MZ, Yousefifard M, Zaman SB, Zangeneh A, Zegeye EA, Ziapour A, Chew A, Murray CJL, Dieleman JL. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050. Lancet 2019; 393:2233-2260. [PMID: 31030984 PMCID: PMC6548764 DOI: 10.1016/s0140-6736(19)30841-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. METHODS We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. FINDINGS Between 1995 and 2016, health spending grew at a rate of 4·00% (95% uncertainty interval 3·89-4·12) annually, although it grew slower in per capita terms (2·72% [2·61-2·84]) and increased by less than $1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5·55% [5·18-5·95]), mainly due to growth in government health spending, and in lower-middle-income countries (3·71% [3·10-4·34]), mainly from DAH. Health spending globally reached $8·0 trillion (7·8-8·1) in 2016 (comprising 8·6% [8·4-8·7] of the global economy and $10·3 trillion [10·1-10·6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$5252 (5184-5319) in high-income countries, $491 (461-524) in upper-middle-income countries, $81 (74-89) in lower-middle-income countries, and $40 (38-43) in low-income countries. In 2016, 0·4% (0·3-0·4) of health spending globally was in low-income countries, despite these countries comprising 10·0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($9·5 billion, 24·3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6·27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($644·7 million in 2018). Globally, health spending is projected to increase to $15·0 trillion (14·0-16·0) by 2050 (reaching 9·4% [7·6-11·3] of the global economy and $21·3 trillion [19·8-23·1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1·84% (1·68-2·02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0·6% (0·6-0·7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15·7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130·2 (122·9-136·9) in 2016 and is projected to remain at similar levels in 2050 (125·9 [113·7-138·1]). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. INTERPRETATION Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets. FUNDING Bill & Melinda Gates Foundation.
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Carias C, Undurraga EA, Hurd J, Kahn EB, Meltzer MI, Bowen A. Evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreak. BMC Infect Dis 2019; 19:172. [PMID: 30782131 PMCID: PMC6379933 DOI: 10.1186/s12879-019-3796-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 02/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background In the event of a shigellosis outbreak in a childcare setting, exclusion policies are typically applied to afflicted children to limit shigellosis transmission. However, there is scarce evidence of their impact. Methods We evaluated five exclusion policies: Children return to childcare after: i) two consecutive laboratory tests (either PCR or culture) do not detect Shigella, ii) a single negative laboratory test (PCR or culture) does not detect Shigella, iii) seven days after beginning antimicrobial treatment, iv) after being symptom-free for 24 h, or v) 14 days after symptom onset. We also included four treatments to assess the policy options: i) immediate, effective treatment; ii) effective treatment after laboratory diagnosis; iii) no treatment; iv) ineffective treatment. Relying on published data, we calculated the likelihood that a child reentering childcare would be infectious, and the number of childcare-days lost per policy. Results Requiring two consecutive negative PCR tests yielded a probability of onward transmission of < 1%, with up to 17 childcare-days lost for children receiving effective treatment, and 53 days lost for those receiving ineffective treatment. Conclusions Of the policies analyzed, requiring negative PCR testing before returning to childcare was the most effective to reduce the risk of shigellosis transmission, with one PCR test being the most effective for the least childcare-days lost. Electronic supplementary material The online version of this article (10.1186/s12879-019-3796-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cristina Carias
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, H24-11, Atlanta, GA, 30329-4027, USA.
| | - Eduardo A Undurraga
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, H24-11, Atlanta, GA, 30329-4027, USA.,Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Jacqueline Hurd
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, H24-11, Atlanta, GA, 30329-4027, USA
| | - Emily B Kahn
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, H24-11, Atlanta, GA, 30329-4027, USA
| | - Martin I Meltzer
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, H24-11, Atlanta, GA, 30329-4027, USA
| | - Anna Bowen
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, H24-11, Atlanta, GA, 30329-4027, USA
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