ABSTRACT
La pandemia de COVID-19ha afectado de manera particularmente intensa a España, pese a su nivel de desarrollo y la elogiada solidez de su Sistema Nacional de Salud. Para comprender qué ha pasado e identificar cómo mejorar la respuesta creemos imprescindible una evaluación independiente multidisciplinaria de la esfera sanitaria, política y socioeconómica. En este trabajo proponemos objetivos, principios, metodología y dimensiones a evaluar, además de esbozar el tipo de resultados y conclusiones esperadas. Nos inspiramos en los requerimientos formulados por el panel independiente de la Organización Mundial de la Salud y en las experiencias evaluativas en otros países, y detallamos la propuesta de aspectos multidimensionales que deben valorarse. La idea es comprender aspectos clave en los ámbitos estudiados y su margen de mejora en lo relativo a preparación, gobernanza, marco normativo, estructuras del Sistema Nacional de Salud (atención primaria, hospitalaria y de salud pública), sector de educación, esquemas de protección social, minimización del impacto económico, y marco y reformas en el ámbito laboral para una sociedad más resiliente. En definitiva, buscamos que este ejercicio sirva no solo para el presente, sino también para que en el futuro estemos mejor preparados y con más ágil capacidad de recuperación ante las amenazas pandémicas que puedan surgir. (AU)
The COVID-19 pandemic has hit Spain particularly hard, despite being a country with a developed economy and being praised for the robustness of its national health system. In order to understand what happened and to identify how to improve the response, we believe that an independent multi-disciplinary evaluation of the health, political and socio-economic spheres is essential. In this piece we propose objectives, principles, methodology and dimensions to be evaluated, as well as outlining the type of results and conclusions expected. Inspired by the requirements formulated by the WHO Independent Panel for Pandemic Preparedness and Response and by experiences in other countries, we detail the multidimensional aspects to be evaluated. The goal is to understand key aspects in the studied areas and their scope for improvement in terms of preparedness, governance, regulatory framework, national health system structures (primary care, hospital, and public health), education sector, social protection schemes, minimization of economic impact, and labour framework and reforms for a more resilient society. We seek to ensure that this exercise serves not only at present, but also that in the future we are better prepared and more agile in terms of our ability to recover from any pandemic threats that may arise. (AU)
Subject(s)
Humans , Pandemics , Coronavirus Infections/epidemiology , Public Policy , Coronavirus Infections/prevention & control , Spain , Health Services Research , World Health OrganizationABSTRACT
The COVID-19 pandemic has hit Spain particularly hard, despite being a country with a developed economy and being praised for the robustness of its national health system. In order to understand what happened and to identify how to improve the response, we believe that an independent multi-disciplinary evaluation of the health, political and socio-economic spheres is essential. In this piece we propose objectives, principles, methodology and dimensions to be evaluated, as well as outlining the type of results and conclusions expected. Inspired by the requirements formulated by the WHO Independent Panel for Pandemic Preparedness and Response and by experiences in other countries, we detail the multidimensional aspects to be evaluated. The goal is to understand key aspects in the studied areas and their scope for improvement in terms of preparedness, governance, regulatory framework, national health system structures (primary care, hospital, and public health), education sector, social protection schemes, minimization of economic impact, and labour framework and reforms for a more resilient society. We seek to ensure that this exercise serves not only at present, but also that in the future we are better prepared and more agile in terms of our ability to recover from any pandemic threats that may arise.
Subject(s)
COVID-19 , Pandemics , Humans , Pandemics/prevention & control , Public Health , Public Policy , SARS-CoV-2ABSTRACT
The aim of the present study was to determine the prevalence and risk factors concerning Dirofilaria immitis infection in dogs from Figueira da Foz, located in the central region of Portugal. In the period between November 2009 and January 2011, 304 blood samples were obtained from dogs over 1 year of age, with no previous history of heartworm prevention or diagnosis. Every blood sample was analyzed using varied laboratory techniques (direct microscopic evaluation of a fresh blood sample, the modified Knott technique, and the ELISA antigen detection test - IDEXX Snapp®). In the samples in which microfilaremia was detected, a histochemical technique using acid phosphatase staining was applied to identify the species of microfilariae. A total prevalence of 27.3% (83 out of 304) was found. We also found that 73.5% of all positive cases (61 out of 83) were microfilaremic, and 26.5% were occult infections (22 out of 83). By means of a histochemical technique Dirofilaria immitis was identified in 96.7% of microfilaremic samples. A multivariate model allowed us to identify the following risk factors for the presence of heartworm disease: age between 4 and 9 years, dogs living in a rural environment, large breed dogs, and living outdoors. This study shows for the first time the high prevalence of heartworm disease in a central area of Portugal and emphasizes the importance of systematic screening for this disease, as well as the need to prevent it in dogs in this area.
Subject(s)
Dirofilaria immitis/isolation & purification , Dirofilariasis/epidemiology , Dog Diseases/epidemiology , Parasitemia/veterinary , Animals , Culicidae/parasitology , Dirofilariasis/parasitology , Disease Reservoirs , Dog Diseases/parasitology , Dogs , Female , Insect Vectors/parasitology , Male , Microfilariae/isolation & purification , Models, Biological , Parasitemia/epidemiology , Parasitemia/parasitology , Portugal/epidemiology , Prevalence , Risk Factors , Rural Health , Seasons , Urban HealthABSTRACT
Health related quality of life (HRQL) and survival are two important outcome measures in chronic diseases. This study aimed to compared HRQL in patients with different chronic diseases of immune system and normative data from the general Portuguese Population. It was selected 103 out-patients, by convenience, to complete SF-36v2. The lowest scores were found among measures for general health (41.0), vitality (47.5), bodily pain (51.0), mental health (56.4); women, except for role-physical, and patients with auto-immune diseases have had the worse scores on all assessed dimension of subjective health, when compared with normative data. Highest scores were obtained in the following scales: physical functioning (69.1), social functioning (66.9), role-emotional (64.9). Living with chronic immune disease have impact on HRQL and it can be expected that the Portuguese version of SF-36v2 provide valid and reliable HRQL data.
Subject(s)
Immune System Diseases , Quality of Life , Adult , Aged , Chronic Disease , Female , Humans , Male , Middle Aged , Pilot ProjectsABSTRACT
Health related quality of life (HRQL) and survival are two important outcome measures in chronic diseases. This study aimed to compared HRQL in patients with different chronic diseases of immune system and normative data from the general Portuguese Population. It was selected 103 out-patients, by convenience, to complete SF-36v2. The lowest scores were found among measures for general health (41.0), vitality (47.5), bodily pain (51.0), mental health (56.4); women, except for role-physical, and patients with auto-immune diseases have had the worse scores on all assessed dimension of subjective health, when compared with normative data. Highest scores were obtained in the following scales: physical functioning (69.1), social functioning (66.9), role-emotional (64.9). Living with chronic immune disease have impact on HRQL and it can be expected that the Portuguese version of SF-36v2 provide valid and reliable HRQL data.
A qualidade de vida relacionada com a saúde (QVRS) e sobrevivência são dois desfechos importantes nas doenças crónicas. Este estudo objetivou comparar a QVRS de pacientes com diferentes patologias crónicas do sistema imune e com os dados normativos da população Portuguesa. Foram seleccionados 103 pacientes para a amostra por conveniência, para completar o SF-32v2. As pontuações mais baixas foram encontradas entre as medidas para a saúde geral (41,0), vitalidade (47,5), dor (51,0) e saúde mental (56,4); as mulheres, exceto na função física, e os doentes com doenças autoimunes obtiveram piores escores em todas as dimensões, quando comparados com os dados normativos. Os escores mais altos foram obtidos nas dimensões: função física (69,1), funcionamento social (66,9) e função emocional (64,9). Viver com doenças crónicas imunológicas apresenta impacto sobre a QVRS e a versão Portuguesa do SF-36v2 fornece dados válidos e confiáveis na mensuração da QdV destes doentes.
Calidad de vida relacionada con la salud (CVRS) y la supervivencia son dos resultados importantes en las enfermedades crónicas. El objetivo de este estudio fue comparar la calidad de vida relacionada con la salud (CVRS) de los pacientes con diferentes patologías del sistema inmunológico y los datos normativos de la población portuguesa. 103 pacientes fueron seleccionados al acaso para completar el cuestionario SF-32v2. Las más bajas mensuras se encuentran entre las medidas de salud en general (41,0), vitalidad (47,5), dolor (51,0) y salud mental (56,4) que las mujeres en la función física y los pacientes con enfermedades autoinmunes también obtuvieron peores puntuaciones, en todas las dimensiones en comparación con los datos normativos. Las puntuaciones más altas se obtuvieron en las dimensiones: función física (69,1), funcionamiento social (66,9), función emocional (64,9). Vivir con enfermedades crónicas inmunológicas ten un impacto en la CVRS y la versión portuguesa del cuestionario SF 36v2 aporta datos válidos y confiables para medir la CdV de estos pacientes.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Immune System Diseases , Quality of Life , Chronic Disease , Pilot ProjectsABSTRACT
AIM: The major purpose of this study was to evaluate alternative automated methods of collecting data on health related quality of life (HR-QoL). In order to achieve this, we developed a study with the following objectives: (1) to evaluated the feasibility of electronic version in patients with different chronic pathologies of the immune system using Short Form 36version2 (SF-36v2), (2) to evaluate the construct validity of SF-36v2 using the electronic data capture, and (3) to compare electronic version questionnaires with paper questionnaires in terms of patients' acceptance, data quality, and reliability. METHODS: Out-patients with chronic immune diseases (HIV infection, lupus, scleroderma, rheumatoid arthritis, Behçet and Sjögren), were randomly selected to completed electronic and paper SF-36v2 (n=50) before consultation in Clinical Immunology Unit, in Hospital Santo António-Centro Hospitalar do Porto (CI-HGSA). RESULTS: There were very high correlations in SF-36v2 responses (p< .001) between the paper and electronic forms. Internal reliability coefficients (Cronbach's alpha) showed good internal consistency for all reported responses in either, computer and paper. There were no missing data in electronic version or paper. About 84% of the patients prefer to use the computer version in future. CONCLUSION: The electronic HR-QoL assessment is technically possible and it can provide reliable and valid clinically significant information which can either be used in routine care appointments.
Subject(s)
Diagnostic Self Evaluation , Immune System Diseases , Interviews as Topic/methods , Quality of Life , Surveys and Questionnaires , Chronic Disease , Computers , Electronic Data Processing , Feasibility Studies , Female , Humans , Immune System Diseases/diagnosis , Male , Middle Aged , Portugal , Reproducibility of ResultsABSTRACT
Babesia annae piroplasms have recently been recognised as a cause of infection and disease among dogs in Europe. The pathogenesis and clinical implications of this emerging disease remain poorly understood. We conducted this study to describe the electrophoretic profiles associated with the infection and to determine if B. annae associated azotaemia is caused by renal failure. We examined by microscopy 2,979 canine blood samples submitted to a diagnostic laboratory in NW Spain between September 2001 and April 2002. Small ring-shaped piroplasms were detected in blood smears of 87 samples and the identity of 58 of these presumptive cases were confirmed by PCR. This group of 58 infected dogs and a reference group of 15 healthy non-infected dogs were our study population. For all the dogs, serum protein response to -albumin, alpha-1 globulin, alpha-2 globulin, beta globulin and gamma globulin- was measured by capillary electrophoresis. The response of infected and non-infected dogs was compared and within infected dogs, the response of those with azotaemia (19) was compared with that of non-azotaemic dogs (39). Infected dogs presented a significant elevation of total proteins and all the different globulin fractions, and significantly lower levels of albumin compared to non-infected dogs. Among infected dogs, those presenting azotaemia had significantly lower concentrations of total proteins, albumin, beta and gamma globulins, and significantly higher values of alpha-2 globulin. Specific gravity was below the threshold of 1,025 for all dogs with azotaemia for which a urine sample was available (7) suggesting that azotaemia, in these dogs was of renal origin. Azotaemic dogs had higher concentrations of cholesterol and triglycerides, probably as a result of a liver compensatory response to the loss of proteins. We conclude that serum protein response in B. annae infected dogs corresponds to the pattern of a haemolytic syndrome with intense inflammatory reaction and that the azotaemia associated to the infection is very likely of renal origin.
Subject(s)
Babesiosis/veterinary , Blood Proteins/metabolism , Dog Diseases/physiopathology , Renal Insufficiency/veterinary , Animals , Babesiosis/blood , Babesiosis/complications , Dog Diseases/blood , Dogs , Renal Insufficiency/blood , Renal Insufficiency/parasitology , Uremia/bloodABSTRACT
Babesia microti-like piroplasms are a recently recognized cause of illness in dogs in northwest Spain. Our objective was to describe the clinical characteristics and investigate the risk factors for azotemia and death among 58 B microti-like infected dogs. Twenty-one of the 58 (36%) dogs were azotemic at the time that the infection was diagnosed. The case fatality rate during the following week was 22%. Dogs with azotemia at the time of diagnosis were 10 times (95% CI, 3.26-28.8) more likely to die during the following week. Azotemia was the main cause of death for B microti-like infected dogs (attributable fraction = 90%). Severe anemia was present in 45 of the 58 (78%) dogs. Azotemic dogs also presented with hyperphosphatemia, hypoalbuminemia, hypercholesterolemia, proteinuria, and high urine protein: creatinine ratios, suggesting a glomerular component to the disease. Age was the only factor significantly associated with the risk of azotemia (P = .042): on average, a 4-year age increase doubled the risk of an infected dog being azotemic. The only factor significantly associated with mortality was azotemia (P = .001). We concluded that B microti-like infection is associated with a high risk of azotemia and mortality.
Subject(s)
Babesia microti/isolation & purification , Babesiosis/veterinary , Dog Diseases/epidemiology , Uremia/veterinary , Animals , Babesiosis/complications , Babesiosis/epidemiology , Blood Cell Count/veterinary , Dog Diseases/blood , Dog Diseases/mortality , Dog Diseases/pathology , Dogs , Female , Male , Prevalence , Records/veterinary , Retrospective Studies , Spain/epidemiology , Survival Analysis , Uremia/etiologyABSTRACT
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