Interactive monitoring dashboards for the COVID-19 pandemic in the world anticipating waves of the disease in Brazil with the use of open data / Painéis de monitoramento interativos da pandemia de COVID-19 no mundo com o uso de dados abertos antecipando ondas da doença no Brasil

ABSTRACT Objective: Describe the development, implementation, and utilization of dashboards for epidemiological analysis through open data research during the COVID-19 pandemic. Methods: The dashboards were designed to analyze COVID-19 related public data from various sources, including official government data and social media, at world level. Data processing and cleaning techniques were used to join datasets. We calculated Spearman correlation coefficient between the COVID-like symptoms data of the University of Maryland and Facebook Health research, called COVID Trends and Impacts Survey (CTIS) and the official data of notified COVID-19 cases by the Brazilian Health Ministry. Results: The dashboards were successful in predicting the onset of new waves of COVID-19 in Brazil. The data analysis revealed a correlation between the CTIS and the official number of cases the country. This article shows the potential of interactive dashboards as a decision-making tool in the context of public health emergencies, as it was used by the official communication of the Rio Grande do Sul state government. Conclusion: The use of dashboards for predicting the spread of COVID-19 in Brazil was a useful tool for decision-making. To anticipate waves of the disease gives time so that these decisions can be potentially more assertive. This drafts the need of more interdisciplinary actions of this nature, with visualization tools on epidemiologic research.

RESUMO Objetivo: Descrever o desenvolvimento, a implementação e o uso de painéis para a análise epidemiológica de dados abertos durante a pandemia de COVID-19. Métodos: Os painéis foram criados para analisar dados públicos relacionados á COVID-19 de várias fontes, incluindo dados oficiais dos governos e de redes sociais, a nível global. Técnicas de processamento e limpeza foram utilizadas para aglutinar os bancos de dados. Calculamos o coeficiente de correlação de Spearman entre as curvas de sintomas gripais da pesquisa da Universidade de Maryland em conjunto com o Facebook, chamada COVID Trends and Impacts Survey (CTIS), e a curva de casos notificados pelo Ministério da Saúde no Brasil. Resultados: Os painéis obtiveram sucesso em antecipar a chegada de novas ondas de COVID-19 no Brasil. A análise do dado revelou a correlação entre a pesquisa CTIS e o número oficial de casos no país. O artigo destaca o potencial de painéis interativos como uma ferramenta de tomada de decisão no contexto de emergências de saúde pública, como, por exemplo, no uso destes para a comunicação oficial do governo do Rio Grande do Sul. Conclusão: O uso de painéis para prever o avanço da COVID-19 no Brasil foi uma ferramenta útil para a tomada de decisão. A antecipação de ondas da doença possibilita tempo oportuno para que essas decisões sejam potencialmente mais assertivas. Isso esboça a necessidade de mais ações interdisciplinares dessa natureza, com ferramentas de visualização nas pesquisas epidemiológicas.

Is chemical exposure present in informal work associated with Sars-CoV-2 infection?

ABSTRACT OBJECTIVE To compare the incidence of covid-19 symptoms between informal home-based workers and a control group and to assess the association of these cases with blood elements concentrations and other relevant risk factors for Sars-Cov-2 infection. METHODS Welders chemically exposed to potentially toxic elements (PTEs) (n = 26) and control participants (n = 25) answered questionnaires on adherence to social distancing and signs and symptoms of the disease for five months during the covid-19 pandemic. After follow-up, covid-19 serology tests were performed on a subsample of 12 chemically exposed workers and 20 control participants. Before the pandemic, PTE concentrations in blood (As, Mn, Ni, Cd, Hg, Sb, Sn, Cu, Zn, and Pb) were measured by ICP-MS. RESULTS The chemically exposed group had higher lead and cadmium levels in blood (p < 0.01). The control group presented lower adherence to social distancing (p = 0.016). Although not significant, welders had a 74% greater chance of having at least one covid-19 symptom compared with control participants, but their adherence to social distancing decreased this chance by 20%. The use of taxis for transportation was a risk factor significantly associated with covid-19 symptoms. CONCLUSION The lower adherence to social distancing among the control group greatly influences the development of covid-19. The literature lacks data linking exposure to PTEs and Sars-Cov-2 infection and/or severity. In this study, despite chemical exposure, working from home may have protected welders against covid-19, considering that they maintained greater social distancing than control participants.

Experiencia y percepción del riesgo asociados a conocimientos, actitudes y prácticas sobre dengue en Riohacha, Colombia / Experience and perception of risk associated with knowledge, attitudes and practices regarding dengue in Riohacha, Colombia

Resumen Para el control del dengue es esencial el reconocimiento de los determinantes de los conocimientos, actitudes y prácticas (CAP), los cuales podrían estar condicionados por las experiencias y percepciones de la población a riesgo. El propósito de este artículo es estimar la asociación entre la percepción del riesgo y la experiencia de dengue con los CAP sobre dengue, en una población endémica de Colombia. Estudio analítico de corte transversal y muestreo probabilístico, polietápico por conglomerados. Como medidas de asociación se estimaron las razones de prevalencia ajustadas (RPa) usando modelos de regresión. Se entrevistaron 206 familias. El 7% saben que la enfermedad del dengue es causada por un virus y menos del 40% reconocen otros síntomas diferentes a la fiebre. El 31% practica la eliminación de criaderos y el 58% fumiga como estrategias de control. El 73% percibe el riesgo de dengue. Se estimó una asociación significativa de la percepción del riesgo de dengue con el conocimiento sobre el vector (RPa = 3,32 IC95% 1,06-10,36). Además, el antecedente de diagnóstico de dengue se asoció con la actitud frente a su control (RPa = 1,61 IC95% 1,09-2,37). La percepción del riesgo y la experiencia con dengue podrían ser determinantes de los CAP en relación a esta enfermedad.

Abstract Recognition of the determinants of knowledge, attitudes and practices (KAP), which could be conditioned by the experiences and perceptions of the population at risk, is essential for the control of dengue. The scope of this article is to estimate the relationship between the risk perception and dengue diagnosis experiences with KAPs on dengue in an endemic Colombian population. A cross-sectional study with multi-stage random sampling was conducted. Adjusted prevalence ratios (aPR) were estimated using regression models as measures of association. Of the 206 families interviewed, 7% know dengue is caused by a virus and less than 40% recognize other symptoms besides fever. As control strategies, 31% eliminate hatchery sites and 58% use fumigation, though 73% perceive the risk of dengue. The association was identified between the perception of the risk of dengue and knowledge about the vector (aPR = 3.32 CI95% 1.06-10.36), and the experience of diagnosis of dengue with the attitude towards dengue control (aPR = 1.61 CI95% 1.09-2.37). Risk perception and experience with dengue could become determinants of KAPs in relation to this disease.

Factors associated with diarrheal disease in the rural Caribbean region of Colombia / Factores asociados con enfermedad diarreica en área rural del Caribe colombiano

ABSTRACT OBJECTIVE: To analyze factors associated with diarrheal disease in the rural Caribbean region of Colombia. METHOD: A cross-sectional study conducted in the rural area of the Cesar Department, Colombia, between November 2017 and June 2018. Self-reported cases of diarrheal disease were surveyed, and water samples from 42 households were collected and analyzed. Descriptive statistics were employed in the analysis of socioeconomic status, environmental and sanitary conditions, and we evaluated their association with the diarrheal disease using the Poisson regression models. Each model was adjusted with variables suggested by specific directed acyclic graphs. RESULTS: Poor water supply conditions, hygiene and basic sanitation were reported in the study area. All water samples were classified either as high risk for health problems or unfit for human consumption. The diarrheal disease had a prevalence of 7.5% across all ages and of 23.5% in children under five years old. The variables rainy season (PR = 0.24; 95%CI 0.07-0.85), children under five years old (PR = 4.05; 95%CI 1.70-9.68), water from deep wells (PR = 16.90; 95%CI 2.45-116.67), water from artificial ponds (PR = 11.47; 95%CI 1.27-103.29), toilets availability (PRA = 0.23; 95%CI 0.06-0.96), and swine presence (PR = 0.20; 95%CI 0.05-0.74) were significantly associated with the occurrence of diarrheal disease. CONCLUSION: Water supply, hygiene and basic sanitation conditions have been associated with the diarrheal disease, affecting almost a quarter of the population under five years old. There is an urge for the design of effective policies that improve environmental and sanitation conditions in rural areas.

RESUMEN OBJETIVO: Analizar factores asociados con enfermedad diarreica en área rural del Caribe colombiano. MÉTODO: Estudio transversal en área rural dispersa del departamento del Cesar, Colombia, entre noviembre de 2017 y junio de 2018. Se indagó sobre morbilidad auto-reportada de enfermedad diarreica y se recolectaron y analizaron muestras de agua en 42 domicilios. Fue realizado un análisis descriptivo de condiciones socioeconómicas, ambientales y sanitarias y evaluamos su asociación con enfermedad diarreica mediante modelo robusto de regresión de Poisson. Cada modelo fue ajustado con variables sugeridas por diagramas causales específicos. RESULTADOS: Se evidenciaron condiciones precarias de abastecimiento de agua, higiene y saneamiento básico en la zona de estudio. Todas las muestras de agua se clasificaron entre los niveles de riesgo alto e inviable sanitariamente. La prevalencia de enfermedad diarreica fue 7,5% en todas las edades y 23,5% en niños menores de cinco años. Las variables estación lluviosa (RP = 0,24; IC95% 0,07-0,85), niños menores de cinco años (RP = 4,05; IC95% 1,70-9,68), abastecimiento de agua desde pozo profundo (RP = 16,90; IC95% 2,45-116,67), abastecimiento de agua desde estanco (RP = 11,47; IC95% 1,27-103,29), tenencia de baño (RPA = 0,23; IC95% 0,06-0,96) y presencia de cerdos (RP = 0,20; IC95% 0,05-0,74) mostraron asociaciones estadísticamente significativas con la ocurrencia de enfermedad diarreica. CONCLUSIÓN: Condiciones de abastecimiento de agua, higiene y saneamiento básico estuvieron asociadas con la ocurrencia de enfermedad diarreica, afectando alrededor de un cuarto de la población menor de cinco años. Urge un diseño efectivo de políticas que contribuyan al mejoramiento de condiciones ambientales y saneamiento en áreas rurales.

Translating transmissibility measures into recommendations for coronavirus prevention

ABSTRACT The rapid increase in clinical cases of the new coronavirus disease, COVID-19, suggests high transmissibility. However, the estimates of the basic reproductive number reported in the literature vary widely. Considering this, we drew the function of contact-rate reduction required to control the transmission from both detectable and undetectable sources. Based on this, we offer a set of recommendations for symptomatic and asymptomatic populations during the current pandemic. Understanding the dynamics of transmission is essential to support government decisions and improve the community's adherence to preventive measures.

Variabilidade climática e internações por doenças diarreicas infecciosas em um município da Amazônia Ocidental brasileira / Climate variability and hospitalizations due to infectious diarrheal diseases in a municipality of the Western Brazilian Amazon Region

Resumo A morbimortalidade por doenças diarreicas infecciosas ainda representa um grave problema de saúde no Brasil e está altamente relacionada a fatores como condições climáticas, ambientais e de vida da população. O objetivo deste estudo foi analisar a associação das taxas de internações por doenças diarreicas infecciosas na população do município de Rio Branco/AC com a precipitação, o nível do rio, a umidade e a temperatura, entre os anos de 2000 e 2013. Os dados foram extraídos do Sistema de Informações Hospitalares do SUS, do Instituto Nacional de Meteorologia e da Agência Nacional das Águas. Foram ajustados modelos múltiplos de regressão de Poisson e binomial negativa. Os resultados mostram que existe uma associação positiva entre as internações por doenças diarreicas infecciosas e o nível do Rio Acre (RT:1,07; IC95%:1,04 a 1,1); houve um decréscimo de 14% nestas taxas de internações entre os anos de 2000 e 2013 (RT:0,86; IC95%:0,85 a 0,87); o grupo mais vulnerável pertence à faixa etária de menores de 1 ano de vida. Este estudo mostrou a vulnerabilidade de uma cidade na Amazônia quanto à variabilidade climática e a respectiva influência epidemiológica na incidência de internações por doenças diarreicas infecciosas.

Abstract Morbimortality due to infectious diarrheal diseases still is a serious health issue in Brazil and is highly related to factors such as weather, environment, and people's life conditions. This study aimed to analyze the relationship between hospitalization rates due to infectious diarrheal diseases among the population of the municipality of Rio Branco (AC), Brazil and precipitation, river level, humidity and temperature between 2000 and 2013. Data were retrieved from the Hospital Information System of the SUS (Unified Health System), the National Institute of Meteorology and the National Water Agency. Multiple Poisson and negative binomial regression models were adjusted. Results showed that there is a positive association between hospitalization due to infectious diarrheal diseases and the level of the Acre river (RR: 1.07; CI 95%: 1.04 to 1.1); these hospitalization rates fell 14% between 2000 and 2013 (RR: 0.86; CI 95%: 0.85 to 0.87). The most vulnerable group was the age group of less than 1 year of age. This study showed the vulnerability of an Amazonian city to climate variability and its respective epidemiological influence on the incidence of hospitalizations due to infectious diarrheal diseases.

Climatic variables associated with dengue incidence in a city of the Western Brazilian Amazon region

Abstract INTRODUCTION: This study aimed to examine the impact of climate variability on the incidence of dengue fever in the city of Rio Branco, Brazil. METHODS: The association between the monthly incidence of dengue fever and climate variables such as precipitation, temperature, humidity, and the Acre River level was evaluated, using generalized autoregressive moving average models with negative binomial distribution. Multiple no-lag, 1-month lag, and 2-month lag models were tested. RESULTS: The no-lag model showed that the incidence of dengue fever was associated with the monthly averages of the Acre River level (incidence rate ratio [IRR]: 1.09; 95% confidence interval [CI]: 1.02-1.17), compensated temperature (IRR: 1.54; 95% CI: 1.22-1.95), and maximum temperature (IRR: 0.68; 95% CI: 0.58-0.81). The 1-month lag model showed that the incidence of dengue fever was predicted by the monthly averages of total precipitation (IRR: 1.21; 95% CI: 1.06-1.39), minimum temperature (IRR: 1.54; 95% CI: 1.24-1.91), compensated relative humidity (IRR: 0.90; 95% CI: 0.82-0.99), and maximum temperature (IRR: 0.76; 95% CI: 0.59-0.97). The 2-month lag model showed that the incidence of dengue fever was predicted by the number of days with precipitation (IRR: 1.03; 95% CI: 1.00-1.06) and maximum temperature (IRR: 1.23; 95% CI: 1.05-1.44). CONCLUSIONS: Considering the impact of global climate change on the region, these findings can help to predict trends in dengue fever incidence.

Cadastro Nacional de Estabelecimentos de Saúde como ferramenta de análise da descentralização do atendimento da tuberculose para a atenção básica / Brazilian National Registry of Healthcare Establishments as a tool for the analysis of decentralization of tuberculosis treatment to basic care services / Registro Nacional de Establecimientos de Salud como herramienta de análisis de la descentralización de la atención a la tuberculosis en la atención básica

Resumo: Os objetivos deste artigo foram validar um método de classificação dos serviços de saúde (atenção básica vs. outros níveis) e descrever a descentralização do atendimento da tuberculose (TB) para a atenção básica no Brasil no período de 2002 a 2016. Os serviços de saúde que notificaram e acompanharam pessoas com TB foram classificados como "atenção básica" ou "outros níveis", considerando-se o tipo de estabelecimento registrado no Cadastro Nacional de Estabelecimentos de Saúde (CNES). Foi estimada a concordância entre essa classificação e uma realizada em 2013 pelos programas estaduais e municipais de TB. Posteriormente, utilizando-se o CNES, calculou-se o percentual de pessoas com TB atendidas na atenção básica no período de 2002 a 2016. A concordância foi de 94,4% e o índice kappa global foi 0,86. Houve um incremento relativo de 31,2% do atendimento de TB na atenção básica (50,9% em 2002 para 66,8% em 2016). Todas as regiões apresentaram aumento desse percentual, exceto a Região Sul. A classificação baseada no CNES permitiu analisar a evolução da descentralização do atendimento da TB para a atenção básica no Brasil.

Abstract: This study aimed to validate a method for classification of healthcare services in Brazil (basic care vs. other levels) and describe the decentralization of tuberculosis (TB) care to basic services (2002 to 2016). The healthcare services that reported and followed TB cases were classified as either "basic care" or "other levels" based on the type of establishment registered in the Brazilian National Registry of Healthcare Establishments (CNES, in Portuguese). The study estimated the agreement between this classification with a previous classification performed in 2013 by Brazil's state and local tuberculosis programs. Using the CNES registry, the authors then calculated the percentage of TB patients treated in basic care from 2002 to 2016. Agreement was 94.4%, and overall kappa index was 0.86. There was a relative increment of 31.2% in TB care provided by basic services (from 50.9% in 2002 to 66.8% in 2016). All regions of Brazil showed an increase in this percentage, except the South. The classification based on the CNES registry allowed analyzing the trend in decentralization of TB treatment to basic healthcare services in Brazil.

Resumen: Los objetivos de este artículo fueron validar un método de clasificación de los servicios de salud (atención básica vs. otros niveles) y describir la descentralización del cuidado de la tuberculosis (TB) hacia los servicios de atención básica en Brasil, durante el período de 2002 a 2016. Los servicios de salud que notificaron y efectuaron el seguimiento a personas con TB fueron clasificados como "atención básica" u "otros niveles", considerándose el tipo de establecimiento registrado en el Registro Nacional de Establecimientos de Salud (CNES). Se estimó la concordancia entre esta clasificación y una realizada en 2013 por los programas estatales y municipales de TB. Posteriormente, utilizando el CNES, se calculó el porcentaje de personas con TB atendidas en la atención básica durante el período de 2002 a 2016. La concordancia fue de 94,4% y el índice kappa global fue 0,86. Hubo un incremento relativo de un 31,2% del manejo de la TB en la atención básica (de un 50,9% en 2002 hasta un 66,8% en 2016). Todas las regiones presentaron un aumento de ese porcentaje, excepto la región Sur. La clasificación, basada en el CNES, permitió analizar la evolución de la descentralización del manejo de la TB hacia la atención básica en Brasil.

Offer of primary care services and detection of tuberculosis incidence in Brazil / Oferta de serviços pela atenção básica e detecção da incidência de tuberculose no Brasil

ABSTRACT OBJECTIVE To evaluate the association between the health services offered by primary care teams and the detection of new tuberculosis cases in Brazil. METHODS This was an ecological study covering all Brazilian municipalities that registered at least one new tuberculosis case (diagnosed between 2012 to 2014 and notified in the Information System of Notifiable Diseases) and with at least one primary care team evaluated by the second cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB). The variables of the PMAQ-AB were classified as proximal or distal, according to their relation with the tuberculosis diagnosis. Then, they were tested hierarchically in multiple models (adjusted by States) using negative binomial regression. RESULTS An increase of 10% in the primary health care coverage was associated with a decrease of 2.24% in the tuberculosis detection rate (95%CI -3.35- -1.11). Regarding the proximal variables in relation to diagnosis, in the multiple model, the detection of tuberculosis was associated with the proportion of teams that conduct contact investigation (increase in Incidence Rate Ratio [IRR] = 2.97%, 95%CI 2.41-3.53), carry out tuberculosis active case finding (increase in IRR = 2.17%, 95%CI 1.48-2.87), and request culture for mycobacteria (increase in IRR = 1.87%, 95%CI 0.98-2.76). CONCLUSIONS The variables related to the search actions were positively associated with the detection of new tuberculosis cases, which suggests a significant contribution to the strengthening of the sensitivity of the surveillance system. On the other hand, primary care coverage was inversely associated with the tuberculosis detection rate, which could represent the overall effect of the primary care on transmission control, probably from the identification and early treatment of cases.

RESUMO OBJETIVO Avaliar a associação entre os serviços de saúde ofertados por equipes de atenção básica e a detecção de casos novos de tuberculose no Brasil. MÉTODOS Estudo ecológico, abrangendo todos os municípios brasileiros que registraram pelo menos um caso novo de tuberculose (diagnosticado entre 2012 a 2014 e notificado no Sistema de Informação de Agravos de Notificação) e com pelo menos uma equipe de atenção básica avaliada pelo segundo ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). As variáveis do PMAQ-AB foram classificadas como próximais ou distais, segundo a sua relação com o diagnóstico de tuberculose. Em seguida, foram testadas hierarquicamente em modelos múltiplos (ajustados por Unidade Federada), usando regressão binomial negativa. RESULTADOS Um incremento de 10% na cobertura da atenção básica esteve associado à redução de 2,24% na taxa de detecção de tuberculose (IC95% -3,35- -1,11). No que se refere às variáveis proximais ao diagnóstico, no modelo múltiplo, a detecção da tuberculose esteve associada à proporção de equipes que: realizam vigilância de contatos (incremento na Razão de Taxas de Incidência [RTI] = 2,97%; IC95% 2,41-3,53); fazem busca ativa de casos de tuberculose (incremento na RTI = 2,17%; IC95% 1,48-2,87); e, ofertam cultura para micobactérias (incremento na RTI = 1,87%; IC95% 0,98-2,76). CONCLUSÕES As variáveis relacionadas às ações de detecção estiveram positivamente associadas à detecção de casos novos de tuberculose, sugerindo uma contribuição significativa ao fortalecimento da sensibilidade do sistema de vigilância. Por outro lado, a cobertura da atenção básica esteve inversamente associada à taxa de detecção de tuberculose, o que poderia representar o efeito global da atenção básica sobre o controle da transmissão, provavelmente, através da identificação e tratamento precoce de casos.

Regresiones aplicadas al estudio de eventos discretos en epidemiología / Regressions applied to the study of discrete events in epidemiology

En este manuscrito se revisan algunos aspectos básicos de la utilización de regresiones en los estudios epidemiológicos, haciendo énfasis en aquellas aplicadas al estudio de eventos discretos. De esta manera se hace una introducción a los modelos lineales generalizados, cuya estructura es una extensión de una ecuación lineal para analizar desenlaces discretos. De este modo podemos estimar medidas de asociación como la razón de tasas usando la regresión de Poisson, o bien, el riesgo relativo (o la razón de prevalencias) usando la regresión log-binomial. En cada caso es esencial conocer la naturaleza de la variable dependiente, su distribución y reconocer las limitaciones de cada una de las herramientas de análisis.

Some basic aspects about using regressions in epidemiological studies are reviewed. Particularly, this manuscript focused on those applied to the study of discrete events. Generalized lineal models, such as Poisson and log-binomial, have a structure that is an extension of a lineal equation to analyze discrete outcomes. Thus, we can estimate association measures as the incidence rate ratio, using the Poisson regression, or the relative risk (or prevalence ratio), using log-binomial regression. In each case it is essential to know the nature of the dependent variable, as well as, its distribution and recognize the limitations of each analysis tool.

Evaluation of dengue fever reports during an epidemic, Colombia / Evaluación de la notificación del dengue durante una epidemia, Colombia

OBJECTIVE To assess the validity of dengue fever reports and how they relate to the definition of case and severity. METHODS Diagnostic test assessment was conducted using cross-sectional sampling from a universe of 13,873 patients treated during the fifth epidemiological period in health institutions from 11 Colombian departments in 2013. The test under analyses was the reporting to the National Public Health Surveillance System, and the reference standard was the review of histories identified by active institutional search. We reviewed all histories of patients diagnosed with dengue fever, as well as a random sample of patients with febrile syndromes. The specificity and sensitivity of reports were estimated for this purpose, considering the inverse of the probability of being selected for weighting. The concordance between reporting and the findings of the active institutional search was calculated using Kappa statistics. RESULTS We included 4,359 febrile patients, and 31.7% were classified as compatible with dengue fever (17 with severe dengue fever; 461 with dengue fever and warning signs; 904 with dengue fever and no warning signs). The global sensitivity of reports was 13.2% (95%CI 10.9;15.4) and specificity was 98.4% (95%CI 97.9;98.9). Sensitivity varied according to severity: 12.1% (95%CI 9.3;14.8) for patients presenting dengue fever with no warning signs; 14.5% (95%CI 10.6;18.4) for those presenting dengue fever with warning signs, and 40.0% (95%CI 9.6;70.4) for those with severe dengue fever. Concordance between reporting and the findings of the active institutional search resulted in a Kappa of 10.1%. CONCLUSIONS Low concordance was observed between reporting and the review of clinical histories, which was associated with the low reporting of dengue fever compatible cases, especially milder cases. .

OBJETIVO Evaluar la validez de la notificación de casos de dengue y su correspondencia con las definiciones de caso y de gravedad. MÉTODOS Evaluación de prueba diagnóstica con muestreo transversal a partir de un universo de 13.873 pacientes atendidos durante quinto periodo epidemiológico en instituciones de salud de 11 departamentos de Colombia, en 2013. La prueba en evaluación fue la notificación al Sistema Nacional de Vigilancia en Salud Pública y el estándar de referencia fue la revisión de historias identificadas mediante búsqueda activa institucional. Se revisó todas las historias de pacientes con diagnóstico de dengue y una muestra aleatoria de pacientes con síndromes febriles. Se estimó especificidad y sensibilidad de notificación ponderando por el inverso de la probabilidad de ser seleccionado. Se calculó la concordancia entre notificación y los hallazgos de la búsqueda activa institucional usando el estadístico Kappa. RESULTADOS Se incluyeron 4.359 pacientes febriles, 31,7% fueron clasificados compatibles con dengue (17 con dengue grave; 461 con dengue y signos de alarma; 904 con dengue sin signos de alarma). La sensibilidad global de la notificación fue 13,2% (IC95% 10,9;15,4) y la especificidad 98,4% (IC95% 97,9;98,9). La sensibilidad varió de acuerdo con la gravedad: 12,1% (IC95% 9,3;14,8) en pacientes con dengue sin signos de alarma; 14,5% (IC95% 10,6;18,4) en aquellos con dengue y signos de alarma y 40,0% (IC95% 9,6;70,4) en aquellos con dengue grave. La concordancia entre la notificación y los hallazgos de la búsqueda activa institucional mostró Kappa de 10,1%. CONCLUSIONES Se observó baja concordancia entre la notificación y la revisión de historias clínicas, que estuvo asociada a baja notificación de los casos compatibles con dengue, especialmente aquellos menos graves. .

Asociación entre factores socioeconómicos y mortalidad intrahospitalaria por accidente cerebrovascular isquémico en una cohorte hospitalaria de Colombia, 2003-2006 / Correlation between socioeconomic factors and in-hospital mortality from ischemic stroke in a hospital cohort in Colombia, 2003-2006

OBJETIVO: Determinar si existe asociación entre las condiciones socioeconómicas y la mortalidad intrahospitalaria (MIH) por accidente cerebrovascular (ACV) isquémico en una muestra de población colombiana e identificar la cadena de eventos que determinan esa asociación. MÉTODOS: Estudio prospectivo de una cohorte hospitalaria de pacientes con ACV isquémico registrados en cuatro instituciones clínicas de referencia colombianas -ubicadas en Floridablanca, Bucaramanga, Bogotá y Medellín- entre febrero de 2003 y diciembre de 2006. Mediante análisis jerárquico se evaluaron las variables socioeconómicas agrupadas en tres niveles para determinar su relación con la MIH por ACV isquémico en un modelo de riesgos proporcionales de Cox. RESULTADOS: En los 253 pacientes incluidos, la MIH fue de 9,4 %. En el análisis por niveles, la mortalidad estuvo inversamente asociada con el nivel educacional (estudios superiores a primaria), los ingresos mensuales (≥ salario mínimo) y la vinculación al régimen contributivo. En el análisis jerárquico, al combinar los 3 niveles, solo la asociación inversa con la afiliación al régimen contributivo mantuvo su significación estadística (RR 0,35; IC95%: 0,13-0,96; P = 0,04). CONCLUSIONES: Los resultados indican que en Colombia, el estar afilado al régimen contributivo de salud es un factor protector independiente contra la MIH tras un ACV isquémico. La secuencia educación-ingresos-acceso a servicios de salud constituye una vía de explicación de la relación entre las condiciones socioeconómicas y el desenlace clínico de estos eventos. Se deben diseñar estrategias para mitigar las diferencias en la calidad y la distribución de los servicios de salud en la población colombiana.

OBJECTIVE: To determine if there is a correlation between socioeconomic conditions and in-hospital mortality (IHM) from ischemic stroke in a sample of the Colombian population and identify the chain of events that determine that association. METHODS: Prospective study of a hospital cohort of patients with ischemic stroke in four Colombian clinical referral institutions-located in Floridablanca, Bucaramanga, Bogotá, and Medellín-between February 2003 and December 2006. Hierarchical analysis was used to group the socioeconomic variables into three levels, and their relationship to IHM due to ischemic stroke was assessed in a Cox proportional hazards model. RESULTS: The IHM rate was 9.4% in the 253 patients included in the study. In the analysis by levels, mortality was inversely associated with educational level (advanced to primary), monthly income (≥ minimum wage), and participation in the contributory health system. When the three levels were combined in the hierarchical analysis, affiliation with the contributory system was the only association that maintained its statistical significance (RR 0.35; CI 95%: 0.13-0.96; P = 0.04). CONCLUSIONS: The results indicate that, in Colombia, being affiliated with the contributory health system is an independent protective factor against IHM after an ischemic stroke. The education-income-access to health services sequence is a possible explanation for the relationship between socioeconomic conditions and the clinical outcome of these events. Strategies should be designed to mitigate the differences in the quality and distribution of health services in the Colombian population.

Influencia de la ansiedad y depresión sobre la discapacidad relacionada con la migraña / Influence of anxiety and depression on migraine-related disability

Introducción: existe una fuerte asociación entre la migraña y los trastornos del estado de ánimo, que podría derivar en mayor discapacidad y peor pronóstico para estos pacientes. Objetivo: evaluar el impacto de la sintomatología de ansiedad y depresión sobre el grado de discapacidad en pacientes con migraña. Materiales y Métodos: se seleccionaron 50 personas con migraña (25 con aura y 25 sin aura) y 25 controles sanos pareados por edad y sexo. Se midieron los síntomas de depresión y ansiedad utilizando las escalas de Zung. En los pacientes con migraña se midió el grado de discapacidad utilizando el Headache Impact Test (HIT-6). La asociación entre la puntuación de las escalas de Zung y HIT-6 se analizó empleando una regresión linear. Resultados: el diagnóstico de migraña se relacionó significativamente con mayores puntuaciones en la escala de depresión (39,2±10 vs. 31,9±6,8, p=0,002) y ansiedad (36,7±10,2 vs. 28,5±6,7, p=0,0001) de Zung. En los pacientes con migraña, se encontró una asociación significativa entre la puntuación de las escalas de sintomatología depresiva (OR, 3,53; IC95%, 1,33-5,72, p=0,002) y de ansiedad (OR, 3,47; IC95%, 1,33-5,61, p=0,002) con el grado de discapacidad (HIT-6). Dichas asociaciones se mantuvieron luego de ajustarlas por edad, sexo y la frecuencia de episodios de migraña. Conclusiones: la migraña se encuentra relacionada con una mayor presencia de sintomatología de ansiedad y depresión. Esta asociación tiene un impacto negativo sobre la funcionalidad de las personas con esta patología.

Introduction: there is a strong association between migraine and mood disorders, which could lead to greater disability and poorer prognosis in these patients. Objective: to evaluate the impact of symptoms of anxiety and depression on the degree of disability in patients with migraine. Materials and Methods: we selected 50 people with migraine (25 with aura and 25 without aura) and 25 healthy controls matched for age and sex. We measured symptoms of depression and anxiety using Zung scales. In patients with migraine was measured the degree of disability using the Headache Impact Test (HIT-6). The association between score and Zung scales HIT-6 was analyzed using linear regression. Results: the diagnosis of migraine was significantly associated with higher scores on the depression scale (39.2 ± 10 vs 31.9 ± 6.8, p = 0.002) and anxiety (36.7 ± 10.2 vs 28.5 ± 6.7, p = 0.0001) of Zung. In patients with migraine, we found a significant association between the score of the scales of depressive symptoms (OR, 3.53, CI 95% 1.33 to 5.72, p = 0.002) and anxiety (OR, 3, 47, CI 95%, 1.33 to 5.61, p = 0.002) with the degree of disability (HIT-6). These associations remained after adjusting for age, sex and frequency of migraine episodes. Conclusions: migraine is associated with increased presence of symptoms of anxiety and depression. This association has a negative impact on the functionality of people with this condition.

Reducción de la hospitalización mediante un algoritmo de manejo del dengue en Colombia / Reducing hospitalization with the use of a dengue management algorithm in Colombia

OBJETIVO: Evaluar el efecto de un algoritmo de manejo del dengue sobre la tasa de hospitalización de pacientes con sospecha de esta enfermedad, en una institución de salud de primer nivel en un área endémica en Colombia. MÉTODOS: Se realizó un estudio cuasiexperimental en el hospital local de Piedecuesta, Santander, Colombia, basado en la comparación de dos períodos (de 18 semanas cada uno), antes y después de la implementación del algoritmo. Este incluía recomendaciones para diagnosticar clínicamente el dengue y programar consultas de control y hemogramas, así como criterios de hospitalización y de suspensión del seguimiento. Se compararon las tasas de hospitalización en los dos períodos empleando el análisis de Poisson. La población analizada consistió en los pacientes que consultaron por síndrome febril agudo. Para el ajuste se incluyó el número de casos con dengue (IgM positivos) identificados en el mismo municipio. RESULTADOS: e obtuvo información de 964 pacientes en el primer período y de 1 350 en el segundo, y en dichos períodos hubo 44 y 13 hospitalizaciones, respectivamente. La implementación del algoritmo se asoció a una reducción significativa de la tasa de hospitalización (razón de tasas: 0,21; intervalo de confianza de 95 por ciento 0,11 a 0,39). Esta asociación no se modificó cuando se ajustó por el número de casos de dengue identificados en la ciudad. No hubo diferencias significativas en la tasa de consultas de control (P = 0,85) y de hemogramas (P = 0,24) en los dos períodos. No hubo casos fatales. CONCLUSIONES: Los resultados sugieren que es posible optimizar los recursos asistenciales en el manejo del dengue mediante la implementación del algoritmo.

OBJECTIVE: Assess the impact of a dengue management algorithm on the hospitalization rate of patients with suspected disease in a primary care health facility in an endemic area of Colombia. METHODS: A quasi-experimental study was conducted at the local hospital in Piedecuesta, Santander, Colombia, based on comparison of two periods (18 weeks each), before and after use of the algorithm. This included recommendations for clinical diagnosis of dengue and the planning of follow-up visits and hemograms, as well as criteria for hospitalization and the discontinuation of follow-up. Hospitalization rates in the two periods were compared using the Poisson analysis. The population analyzed consisted of patients seen in the facility for acute febrile syndrome. For adjustment purposes, the number of dengue cases (IgM positive) identified in the municipality was included. RESULTS: Information was obtained on 964 patients in the first period and 1350 patients in the second. There were 44 and 13 hospitalizations during the respective periods. Use of the algorithm was associated with a significant reduction in the hospitalization rate (ratio: 0.21; 95 percent confidence interval; 0.11-0.39). This association did not change when adjusted for the number of dengue cases identified in the city. There were no significant differences in the rate of follow-up visits (P = 0.85) and hemograms (P = 0.24) in the two periods. There were no case fatalities. CONCLUSIONS: The results suggest that health care resources for dengue management can be optimized with the use of the algorithm.

Papel de los anticuerpos antiplaquetarios en la infección viral: una revisión sistemática de la literatura / Roll of antibodies antiplatelets in viral infection: a systematic review of literature

Introducción. La trombocitopenia es un fenómeno frecuente en las infecciones virales. Uno de los mecanismos propuesto como posible explicación de su desarrollo es la destrucción plaquetaria periférica mediada por anticuerpos antiplaquetarios. Objetivo. Revisar los resultados de los trabajos originales que existen en la literatura sobre infección viral y anticuerpos antiplaquetarios en humanos, y su efecto sobre el recuento total de plaquetas. Materiales y métodos. Se hizo una búsqueda en PubMed empleando la combinación de términos: ”viral infection (OR Virus diseases) AND antibody antiplatelet (OR thrombocytopenia); y antibody antiplatelet AND HIV (OR Measles, OR Dengue, OR Chickenpox OR varicella, OR Epstein Barr, OR Mumps, OR Rubella”. Se obtuvieron 218 referencias, de las cuales, 65 correspondían al objetivo de la revisión. Resultados. En la búsqueda se encontró que la trombocitopenia mediada por anticuerpos antiplaquetarios se ha documentado en infecciones virales por VIH, sarampión, dengue, varicela-zóster, Epstein-Barr, parotiditis y rubéola. La presencia de anticuerpos antiplaquetarios en infecciones virales por VIH, virus de Epstein-Barr y dengue, se ha asociado con la presencia de la trombocitopenia y con la gravedad de la enfermedad. Conclusiones. Aunque la aparición de anticuerpos antiplaquetarios no se considera el único mecanismo que explica la trombocitopenia desarrollada en las infecciones virales mencionadas, de acuerdo con la literatura científica disponible, su presencia se asocia con la gravedad de la trombocitopenia y con potenciales implicaciones clínicas en los pacientes.

Introduction. Thrombocytopenia is a frequent phenomenon in viral infections. Peripheral platelet destruction mediated by anti-platelet antibodies has been one of the proposed causal mechanisms.Objective. Results were collected and analyzed from published studies on associations of human viral infections on anti-platelet antibodies and total platelet counts. Materials and methods. A PubMed search was conducted using the following terms: Viral infection (OR Virus diseases) AND antiplatelet antibody (OR thrombocytopenia) AND HIV (OR measles OR dengue OR chickenpox OR varicella OR Epistein Barr OR mumps OR rubella). Two hundred eighteen reference hits were obtained, 65 of which were relevant to this review.Results. Antiplatelet antibody-mediated thrombocytopenia has been documented in cases of HIV, measles, dengue, chickenpox, Epstein-Barr, mumps and rubella. Moreover, the presence of these antibodies has been associated with severity the disease and thrombocytopenia in viral infections.Conclusions. Although the presence of antiplatelet antibodies was not the only mechanism for explaining the thrombocytopenia developed in these viral infections, their presence was associated with severity of thrombocytopenia and with the clinical presentation of these patients.

Reducción de la hospitalización mediante un algoritmo de manejo del dengue en Colombia / Reducing hospitalization with the use of a dengue management algorithm in Colombia

Objetivo. Evaluar el efecto de un algoritmo de manejo del dengue sobre la tasa de hospitalización de pacientes con sospecha de esta enfermedad, en una institución de salud de primer nivel en un área endémica en Colombia. Métodos. Se realizó un estudio cuasi experimental en el hospital local de Piedecuesta, Santander, Colombia, basado en la comparación de dos períodos (de 18 semanas cada uno), antes y después de la implementación del algoritmo. Este incluía recomendaciones para diagnosticar clínicamente el dengue y programar consultas de control y hemogramas, así como criterios de hospitalización y de suspensión del seguimiento. Se compararon las tasas de hospitalización en los dos períodos empleando el análisis de Poisson. La población analizada consistió en los pacientes que consultaron por síndrome febril agudo. Para el ajuste se incluyó el número de casos con dengue (IgM positivos) identificados en el mismo municipio. Resultados. Se obtuvo información de 964 pacientes en el primer período y de 1 350 en el segundo, y en dichos períodos hubo 44 y 13 hospitalizaciones, respectivamente. La implementación del algoritmo se asoció a una reducción significativa de la tasa de hospitalización (razón de tasas: 0,21; intervalo de confianza de 95% 0,11 a 0,39). Esta asociación no se modificó cuando se ajustó por el número de casos de dengue identificados en la ciudad. No hubo diferencias significativas en la tasa de consultas de control (P = 0,85) y de hemogramas (P = 0,24) en los dos períodos. No hubo casos fatales. Conclusiones. Los resultados sugieren que es posible optimizar los recursos asistenciales en el manejo del dengue mediante la implementación del algoritmo.

Objective. Assess the impact of a dengue management algorithm on the hospitalization rate of patients with suspected disease in a primary care health facility in an endemic area of Colombia. Methods. A quasi-experimental study was conducted at the local hospital in Piedecuesta, Santander, Colombia, based on comparison of two periods (18 weeks each), before and after use of the algorithm. This included recommendations for clinical diagnosis of dengue and the planning of follow-up visits and hemograms, as well as criteria for hospitalization and the discontinuation of follow-up. Hospitalization rates in the two periods were compared using the Poisson analysis. The population analyzed consisted of patients seen in the facility for acute febrile syndrome. For adjustment purposes, the number of dengue cases (IgM positive) identified in the municipality was included. Results. Information was obtained on 964 patients in the first period and 1350 patients in the second. There were 44 and 13 hospitalizations during the respective periods. Use of the algorithm was associated with a significant reduction in the hospitalization rate (ratio: 0.21; 95% confidence interval; 0.11-0.39). This association did not change when adjusted for the number of dengue cases identified in the city. There were no significant differences in the rate of follow-up visits (P = 0.85) and hemograms (P = 0.24) in the two periods. There were no case fatalities. Conclusions. The results suggest that health care resources for dengue management can be optimized with the use of the algorithm.

Evaluación de la utilidad de la prueba rápida de casete por inmunocromatografía para el diagnóstico de dengue en una región endémica colombiana / Evaluation of PANBIO rapid immunochromatographic cassette for dengue diagnosis in a Colombian endemic area

Introducción. Las pruebas convencionales para el diagnóstico serológico de dengue son de reducida utilidad para el clínico durante los primeros días de la enfermedad, debido a su baja sensibilidad, su relativa complejidad técnica y el tiempo necesario para su realización. Objetivo. Determinar la reproducibilidad, exactitud y utilidad clínica de la prueba rápida en casete (PANBIO) para el diagnóstico de dengue en muestras de pacientes agudos o convalescientes. Materiales y métodos. La prueba de inmunocromatografía se evaluó en pacientes de 5 o más años de edad, con síndrome febril agudo, captados en el área metropolitana de Bucaramanga entre abril y agosto de 2003. Se utilizó suero de la fase aguda y de la convalecencia de 67 casos de dengue diagnosticados mediante pruebas de IgM pareadas (MAC-ELISA), y de 33 con síndrome febril agudo de etiología diferente a dengue. Resultados. La prueba mostró buena reproducibilidad entre observadores (kappa=0,84). En la convalecencia, la prueba para la IgM tuvo una sensibilidad de 76,1%, especificidad de 75,8%, un valor diagnóstico positivo de 86,4%, un valor diagnóstico negativo de 61%, una razón de verosimilitud positiva de 3,14 y una negativa de 0,32. En la fase aguda, los valores encontrados fueron 52,2%, 84,8%, 87,5%, 46,7%, 3,45 y 0,56, respectivamente. Conclusiones. La prueba de casete para el diagnóstico rápido de dengue muestra una buena reproducibilidad y unas características operativas aceptables. Por esta razón, podría recomendarse como ayuda diagnóstica en áreas endémicas de dengue.

Introduction. Traditional tests for dengue diagnosis are not useful during the first days of disease onset, because they require time and complex techniques or because they have low sensitivity. Objective. The reliability and precisison was determined for the rapid test in cassette (PANBIO) for dengue diagnosis in acute and convalescent serum samples. Materials and methods. The immunochromatographic test was evaluated in samples from patients older than 5 years with acute febrile syndrome. The patients came from the metropolitan area of Bucaramanga during April and August of 2003. Acute and convalescent serum came from 67 dengue cases, diagnosed by viral isolation or IgM paired tests (modified MAC-ELISA), and from 33 patients with acute febrile syndrome (not dengue) that served as controls. Results. Reliability was good (kappa=0.84). In the convalescent serum, the test showed sensitivity of 76.1%, specificity of 75.8%, positive predictive value of 86.4% and negative predictive value of 61.0%, positive likelihood ratio 3.14 and negative likelihood ratio 0.32. In the acute phase, the values were 52.2%, 84.8%, 87.5%, 46.7%, 3.45 and 0.56, respectively. Conclusions. Rapid immunochromatographic test for dengue diagnosis shows good reproducibility and specificity, with an acceptable sensitivity. Therefore, this rapid test is recommended as diagnostic tool in endemic areas.