National trends in utilization and in-hospital outcomes of surgical aortic valve replacements in spain, 2001-2015

Abstract Objective: The aims of this study were to examine the incidence and in-hospital outcomes of surgical aortic valve replacement (SAVR) and to identify factors associated with in-hospital mortality (IHM) among patients according to the type of implanted valve used in SAVR. Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients who had SAVR listed as a procedure in their discharge report. Results: We identified 86,578 patients who underwent SAVR (52.78% mechanical and 47.22% bioprosthetic). Incidence of SAVR coding increased significantly from 11.95 cases per 100,000 inhabitants in 2001 to 17.92 in 2015 (P<0.001). Age and comorbidities increased over time (P<0.001). There was a significant increase in the frequency of concomitant coronary artery bypass grafting (CABG) and in the use of pacemaker implantation. The use of mechanical SAVR decreased and the use of bioprosthetic valves increased over time. IHM decreased over time (from 8.13% in 2001-05 to 5.39% in 2011-15). Patients who underwent mechanical SAVR had higher IHM than those who underwent bioprosthetic SAVR (7.44% vs. 6%; P<0.05). Higher IHM rates were associated with advanced age, female sex, comorbidities, concomitant CABG, and the use of mechanical SAVR (OR 1.67; 95% CI 1.57-1.77). Conclusion: The number of SAVRs performed in Spain has increased since 2001. The use of mechanical SAVR has decreased and the use of bioprosthetic valves has increased over time. IHM has decreased over time for both types of valves and despite a concomitant increase in age and comorbidities of patients during the same period.

Factores sociales asociados con la utilización de los servicios de atención prenatal en Ecuador / Social factors associated with use of prenatal care in Ecuador

RESUMEN Objetivos La atención prenatal es uno de los pilares de la salud pública y permite el acceso a intervenciones tales como la prevención de la transmisión materno-infantil del VIH y de la sífilis congénita. Este artículo tiene como objetivo describir los factores sociales asociados con la utilización de los servicios de atención prenatal en Ecuador. Métodos Entre 2011 y 2012, se realizó un análisis de la información procedente de las historias clínicas y de la entrevista a las participantes, que integraron una muestra probabilística a nivel nacional de 5 998 mujeres atendidas por parto o aborto en 15 servicios sanitarios en Ecuador con el objetivo de estimar la prevalencia de VIH, sífilis, enfermedad de Chagas y la cobertura de atención prenatal. Resultados El estudio mostró que 94,1% de las mujeres había acudido a algún control prenatal, pero la asistencia al menos a cuatro controles fue 73,1%. Se encontró que el menor nivel educativo, el mayor número de embarazos, la ocupación en el sector agrícola o ganadero y la pertenencia a los grupos étnicos indígena, afroecuatoriano u otros minoritarios fueron factores asociados con la falta de uso (ningún control prenatal) o al uso inadecuado de la atención prenatal (menos de cuatro controles o primer control después de las 20 semanas de gestación) en Ecuador. Conclusiones Estos resultados apuntan a la persistencia de desigualdades marcadas en el acceso y en la utilización de servicios de atención prenatal atribuibles a factores socioeconómicos y a la necesidad de fortalecer las estrategias para su abordaje para alcanzar la meta de la cobertura universal de atención prenatal.(AU)

ABSTRACT Objectives Prenatal care is a pillar of public health, enabling access to interventions including prevention of mother-to-child transmission of HIV and congenital syphilis. This paper describes social factors related to use of prenatal care in Ecuador. Methods In 2011 and 2012, participant clinical history and interview information was analyzed from a national probability sample of 5 998 women presenting for delivery or miscarriage services in 15 healthcare facilities in Ecuador, to estimate prevalence of HIV, syphilis, and Chagas disease, and prenatal care coverage. Results The study found that 94.1% of women had attended at least one prenatal visit, but that attendance at no less than four visits was 73.1%. Furthermore, lower educational level, greater number of pregnancies, occupation in the agriculture or livestock sector, and membership in ethnic indigenous, Afro-Ecuadorian, or other minority groups were factors associated with lack of use (no prenatal visits) or insufficient use of prenatal care (fewer than four visits or first visit at >20 weeks gestation) in Ecuador. Conclusions These results point to persistence of marked inequalities in access to and use of prenatal health services attributable to socioeconomic factors and to the need to strengthen strategies to address them, to reach the goal of universal prenatal care coverage.(AU)

Contaminación del agua en fuentes cercanas a campos petrolíferos de Bolivia / Water pollution in sources close to oil-producing fields of Bolivia

OBJETIVO: Determinar las concentraciones de compuestos petroquímicos en las fuentes de agua de consumo para comunidades cercanas a campos petrolíferos del Chaco Boliviano. MÉTODOS: Se recogieron datos sobre concentraciones de hidrocarburos totales de petróleo (HTP), 16 hidrocarburos aromáticos policíclicos (HAP), incluidos el benceno, tolueno, etilbenceno y xilenos (BTEX), y 22 metales en muestras de 42 fuentes de agua de consumo humano situadas a menos de 30 km de un campo de extracción de petróleo. Se analizó la distribución de la concentración y el cumplimiento de los estándares definidos en las normativas boliviana, europea y estadounidense, así como en las recomendaciones de la Organización Mundial de la Salud. RESULTADOS: En 76,19 por ciento de las muestras se halló algún contaminante petroquímico en concentraciones superiores a alguna de las cuatro normativas de referencia. Las muestras de agua que presentaron mayor contaminación fueron las provenientes de grifos y ríos. Los contaminantes más frecuentes fueron HTP, HAP, aluminio, arsénico, manganeso y hierro. CONCLUSIONES: Las comunidades del Chaco Boliviano ubicadas en un radio de 30 km alrededor de los campos de extracción de petróleo consumen agua con concentraciones de HTP, HAP y metales muy por encima de los niveles permitidos por la normativa boliviana y los estándares internacionales, poniendo en grave riesgo la salud pública de sus habitantes.

OBJECTIVE: To determine the concentrations of petrochemical compounds in the drinking water sources of communities located near oil-producing fields in the Bolivian Chaco region. METHODS: Data were collected on total petroleum hydrocarbons (TPH), 16 polycyclic aromatic hydrocarbons (PAH), including benzene, toluene, ethylbenzene, and xylenes (BTEX), and 22 metals in samples from 42 sources of water for human consumption located less than 30 km from an oil-producing field. Distribution of the concentration and adherence to the standards contained in the Bolivian, European, and United States regulations, as well as the recommendations of the World Health Organization, were analyzed. RESULTS: In 76.19 percent of the samples, some petrochemical contaminant was found in concentrations higher than permissible in any of the four sets of regulations mentioned. The water samples with the highest contamination levels were from faucets and rivers. The most common contaminants were TPH, PAH, aluminum, arsenic, manganese, and iron. CONCLUSIONS: Communities within a 30 km radius of the oil-producing fields in the Bolivian Chaco region consume water with TPH, PAH, and metal concentrations well above the levels permitted in the Bolivian regulations and international standards, putting the public health of their residents at serious risk.