Impact of Different Levels of Supervision on the Recovery of Severely Malnourished Children Treated by Community Health Workers in Mali.

(1) Background: The Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated community case management (iCCM). This paper evaluates the most effective model of supervision for treating SAM using community health workers (CHWs). Methods (2): This study was a prospective non-randomized community intervention trial with two intervention groups and one control group with different levels of supervision. It was conducted in three districts in rural areas of the Kayes Region. In the high supervision group, CHWs received supportive supervision for the iCCM package and nutrition-specific supervision. In the light supervision group, CHWs received supportive supervision based on the iCCM package. The control group had no specific supervision. (3) Results: A total of 6112 children aged 6-59 months with SAM without medical complications were included in the study. The proportion of cured children was 81.4% in those treated by CHWs in the high supervision group, 86.2% in the light supervision group, and 66.9% in the control group. Children treated by the CHWs who received some supervision had better outcomes than those treated by unsupervised CHWs (p < 0.001). There was no difference between areas with light and high supervision, although those with high supervision performed better in most of the tasks analyzed. (4) Conclusions: Public policies in low-income countries should be adapted, and their model of supervision of CHWs for SAM treatment in the community should be evaluated.

Lesiones Cutáneas En Paciente Con Infección Por Sars-Cov-2 / Skin lesions in a patient with sars-cov-2 infection

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Asociación entre la carga herpética y la enfermedad isquémica crónica del corazón: estudio de casos y controles / Association between herpetic burden and chronic ischemic heart disease: Matched case-control study

Fundamento y objetivo: Estudios previos plantean una verosímil asociación entre la carga herpética y la cardiopatía isquémica. El objetivo es analizar esta hipótesis en un contexto seroepidemiológico español. Pacientes y método: Estudio de casos y controles emparejados por edad y sexo (1:1) que incluyó a pacientes con enfermedad isquémica crónica del corazón y controles sanos. Se definió carga herpética como el número total de virus herpes para los que el sujeto fue seropositivo (IgG), considerando los virus Epstein-Barr, citomegalovirus, varicela-zóster, herpes simple tipo 1 y tipo 2. Resultados: El 90,7% de los casos y el 70,7% de los controles (p=0,002) fueron seropositivos para 4 o más virus herpes (alta carga herpética). Dentro del grupo control, los sujetos con hipercolesterolemia tuvieron mayor proporción de alta carga (88,5% frente a 61,2%, p=0,02). La alta carga herpética se asoció a la enfermedad tras ajustar por diabetes, tabaco, hipertensión, y nivel educativo (odds ratio [OR] 4,5, intervalo de confianza del 95% [IC 95%] 1,23-16,53), pero no al incluir la hipercolesterolemia en el modelo (OR 2,2, IC 95% 0,45-10,62).Conclusión: La asociación es independiente de la mayoría, pero no de todos los factores de riesgo cardiovascular clásicos (AU)

Background and objectives: revious studies showed a plausible association between herpetic burden and ischemic heart disease. Our aim is to test this hypothesis in an spanish seroepidemiological context. Patients and methods: Sex and age matched case-control study (1:1) including patients with chronic ischemic heart disease and healthy controls. Herpetic burden was defined as the aggregate number of antibody seropositivities (IgG) for Epstein Barr Virus, cytomegalovirus, varicella zoster virus, Herpes simplex type 1 and type 2.Results: We found that 90.7% of cases and 70,7% of controles (P=.002), were seropositive to 4 or more herpesvirus (high herpetic burden). Within control group, hypercholesterolemic subjects had a higher proportion of high burden (88,5% vs. 61,2%, P=.02). High herpetic burden was associated with ischemic heart disease, even after adjusting for diabetes, smoking, hypertension and literacy level, (OR: 4,5 [1,23-16,53]), but not when hypercholesterolemia was included in the model (OR 2,2 [0,45-10,62]).Conclusion: The hypothesized relationship is independent from most but not all classical cardiovascular risk factors (AU)

[Association between herpetic burden and chronic ischemic heart disease: matched case-control study]. / Asociación entre la carga herpética y la enfermedad isquémica crónica del corazón: estudio de casos y controles.

BACKGROUND AND OBJECTIVES: Previous studies showed a plausible association between herpetic burden and ischemic heart disease. Our aim is to test this hypothesis in an spanish seroepidemiological context. PATIENTS AND METHODS: Sex and age matched case-control study (1:1) including patients with chronic ischemic heart disease and healthy controls. Herpetic burden was defined as the aggregate number of antibody seropositivities (IgG) for Epstein Barr Virus, cytomegalovirus, varicella zoster virus, Herpes simplex type 1 and type 2. RESULTS: We found that 90.7% of cases and 70,7% of controles (P=.002), were seropositive to 4 or more herpesvirus (high herpetic burden). Within control group, hypercholesterolemic subjects had a higher proportion of high burden (88,5% vs. 61,2%, P=.02). High herpetic burden was associated with ischemic heart disease, even after adjusting for diabetes, smoking, hypertension and literacy level, (OR: 4,5 [1,23-16,53]), but not when hypercholesterolemia was included in the model (OR 2,2 [0,45-10,62]). CONCLUSION: The hypothesized relationship is independent from most but not all classical cardiovascular risk factors.

Hospitalizaciones por cáncer de cuello de útero en la Comunidad de Madrid, 1999-2002 / Hospital admissions for cervical cancer in the autonomous Region of Madrid, 1999-2002

Objetivo. El objetivo de este estudio ha sido evaluar la frecuencia y las características de las hospitalizaciones por cáncer de cuello de útero en la Comunidad de Madrid, así como estimar el consumo de recursos y costes asociados al tratamiento hospitalario de la enfermedad. Métodos. Se ha realizado un estudio retrospectivo utilizando la información del sistema nacional de vigilancia de datos hospitalarios (Conjunto Mínimo Básico de Datos) sobre las hospitalizaciones por neoplasia maligna de cérvix en la Comunidad de Madrid. Adicionalmente, se ha recogido información de las historias clínicas de las pacientes hospitalizadas por cáncer de cuello de útero en el Hospital Universitario 12 de Octubre de Madrid para el análisis de consumo de recursos y costes. Resultados. Durante el periodo 1999-2002 se notificaron una media anual de 667 hospitalizaciones por cáncer de cuello de útero en los hospitales de la Comunidad de Madrid. La tasa de hospitalización fue de 30,7 por 100.000 mujeres ≥ 20 años y el número medio de hospitalizaciones anuales por paciente de 2,2. Se registraron 126 defunciones entre las mujeres hospitalizadas por cáncer de cuello de útero durante el período de estudio (media anual de 32 fallecimientos). El coste medio por paciente del tratamiento hospitalario del cáncer de cuello de útero se ha estimado en 5.247 €. Conclusión. Cada año se notifican casi 700 hospitalizaciones por cáncer de cuello de útero en hospitales de la Comunidad de Madrid, con un coste anual para el sistema sanitario de unos 3,5 millones de € (AU)

Objective. The aim of this study was to assess the frequency and characteristics of cervical cancer hospitalizations in the Autonomous Region of Madrid, and to estimate the resource consumption and costs related to hospital treatment of the disease. Methods. A retrospective study was conducted by using information of the cervical cancer patients hospitalized in the Autonomous Region of Madrid from the national surveillance system for hospital data, Conjunto Mínimo Básico de Datos. Data on resource consumption for costs analysis was collected from clinical records of women admitted to Hospital Universitario 12 de Octubre of Madrid with cervical cancer. Results. During the study period (1999-2002) an annual average of 667 hospitalizations with cervical cancer in the Autonomous Region of Madrid hospitals were reported. Hospitalization rate were 30.7 per 100,000 women ≥ 20 years of age and the average number of hospitalizations per patient was 2.2. A total of 126 deaths among hospitalized women were reported during the study period (average annual number of 32 deaths). The mean cost per patient of the hospital treatment was estimated in 5.247 €. Conclusion. Each year more approximately 700 cervical cancer cases are notified in the Autonomous Region of Madrid hospitals. These represent an annual expenditure for the health care system of about 3,5 millions € (AU)

[Cerebrovascular accidents in paediatric care. Our experience gained over an 18-year period]. / Accidente cerebrovascular en pediatría. Nuestra experiencia de 18 años.

PATIENTS AND METHODS: This study reviews our experience over the last 18 years with paediatric patients diagnosed with non-haemorrhagic cerebrovascular accidents (CVA) after the perinatal period. Data were collected for the period between May 1990 and May 2008 (n = 10 270 children) and special attention was given to cases with no previous pathology. RESULTS: We found 41 cases that were diagnosed with post-natal non-haemorrhagic CVA, of which 13 did not present any known pathology at the onset of the symptoms. Nine patients were diagnosed as having ischaemic CVA (ICVA), three cases had thrombosis of the venous sinuses and there was one case of haemorrhagic infarction (HI). No causation was found in five cases, three of which were heterozygotic for the C677T mutation of methylenetetrahydrofolate reductase. ICVA was caused by fibromuscular dysplasia, aneurysm of the auricular septum and patent foramen ovale, homocystinuria and chickenpox. A recent ear infection and diminished levels of protein C were noted in two cases of venous thrombosis. Five patients with ICVA and the case of HI were treated with oral antiaggregants, anticoagulants were administered in two of the thromboses, and the remaining cases did not receive any treatment. Seven patients (four ICVA, two thromboses and the HI) did not present any kind of sequelae, four ICVA presented different degrees of hemiparesis and two died (one ICVA and one thrombosis). CONCLUSIONS: The scarcity of studies and therapeutic clinical trials in the paediatric age makes it difficult to lay down clear guidelines of conduct, especially from the therapeutic point of view. The different specialists involved must collaborate with each other.

Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study.

BACKGROUND: Maternal health is one of the major worldwide health challenges. Currently, the unacceptably high levels of maternal mortality are a common subject in global health and development discussions. Although some countries have made remarkable progress, half of the maternal deaths in the world still take place in Sub-Saharan Africa where little or no progress has been made. There is no single simple, straightforward intervention that will significantly decrease maternal mortality alone; however, there is a consensus on the importance of a strong health system, skilled delivery attendants, and women's rights for maternal health. Our objective was to describe and determine different factors associated with the maternal mortality ratio in Sub-Saharan countries. METHODS: An ecological multi-group study compared variables between many countries in Sub-Saharan Africa using data collected between 1997 and 2006. The dependent variable was the maternal mortality ratio, and Health care system-related, educational and economic indicators were the independent variables. Information sources included the WHO, World Bank, UNICEF and UNDP. RESULTS: Maternal mortality ratio values in Sub-Saharan Africa were demonstrated to be high and vary enormously among countries. A relationship between the maternal mortality ratio and some educational, sanitary and economic factors was observed. There was an inverse and significant correlation of the maternal mortality ratio with prenatal care coverage, births assisted by skilled health personnel, access to an improved water source, adult literacy rate, primary female enrolment rate, education index, the Gross National Income per capita and the per-capita government expenditure on health. CONCLUSIONS: Education and an effective and efficient health system, especially during pregnancy and delivery, are strongly related to maternal death. Also, macro-economic factors are related and could be influencing the others.

Puesta en marcha de un centro hospitalario en un área rural de Benín. Estudio comparativo con el centro público existente / Implementing a dispensary in a rural area in Benin. Comparison between the new private centre and the old public centre’s consultation

We present an example of a busy dispensary that provides nutritional care, outpatient services for all ages, treatment for medical emergencies, surgery and long term hospitalisation in a rural area of western Africa already covered by local tertiary care centres. We compare the different diagnoses in our dispensary in Zagnanado (Benin) and the public centres of the region. The main change observed is the success of the integration of a new private health centre that is fully equipped and ready to assist the population. The increasing demand and sustained investments have brought the patients to consider this dispensary as a reference for all health problems. We can see that private health care is essential to accurately estimate the burden of disease in developing countries not only in preventive and curative care but also in health education, which is essential in such settings and often not taken into consideration (AU)

Puesta en marcha de un centro hospitalario en un área rural de Benín. Estudio comparativo con el centro público existente Mostramos un ejemplo de implantación de un centro hospitalario con gran presión asistencial en una zona rural de África Occidental, donde ya existían centros de salud locales, que desarrolla actividades programadas y urgentes, tanto en las áreas de hospitalización como en las consultas externas, y proporciona desde actividad quirúrgica cuidados nutricionales de la población a cualquier edad. A continuación comparamos los diferentes diagnósticos realizados en las consultas de nuestro dispensario en Zagnanado (Benín) y aquellos realizados en los centros públicos de la región. Los resultados obtenidos muestran el éxito de la integración del nuevo centro que está completamente equipado y listo para atender a la población. La demanda de los pacientes y la aportación continua de recursos han permitido que el centro disponga de una infraestructura y un equipamiento adecuado y hoy está considerado como punto de referencia para los problemas de salud de la región. Podemos observar que los centros de salud privados son esenciales para estimar fielmente la carga de enfermedad en los países en vías de desarrollo, algo necesario no sólo con fines curativos y preventivos sino también para las labores de educación en salud que a menudo no se tienen en cuenta en estos escenarios (AU)

Burden of herpes zoster requiring hospitalization in Spain during a seven-year period (1998-2004).

BACKGROUND: A thorough epidemiological surveillance and a good understanding of the burden of diseases associated to VZV are crucial to asses any potential impact of a prevention strategy. A population-based retrospective epidemiological study to estimate the burden of herpes zoster requiring hospitalization in Spain was conducted. METHODS: This study was conducted by using data from the national surveillance system for hospital data, Conjunto Mínimo Básico de Datos (CMBD). Records of all patients admitted to hospital with a diagnosis of herpes zoster (ICD-9-MC codes 053.0-053.9) during a 7-year period (1998-2004) were selected. RESULTS: A total of 23,584 hospitalizations with a primary or secondary diagnosis of herpes zoster in patients > or = 30 years of age were identified during the study period. Annually there were 13.4 hospitalizations for herpes zoster per 100,000 population in patients > or = 30 years of age. The rate increases with age reaching a maximum in persons > or = 80 years of age (54.3 admissions per 100,000 population >80 years of age). The mean cost of a hospitalization for herpes zoster in adult patients was 3,720 euro. The estimated annual cost of hospitalizations for herpes zoster in patients > or = 30 years of age in Spain was 12,731,954 euro. CONCLUSION: Herpes zoster imposes an important burden of hospitalizations and result in large cost expenses to the Spanish National Health System, especially in population older than 50 years of age.

Epidemiology of typhoid and paratyphoid fever hospitalizations in Spain (1997-2005).

BACKGROUND AND OBJECTIVE: This epidemiological survey was undertaken to estimate the burden of hospitalizations for typhoid and paratyphoid fever in Spain over a nine-year period (1997-2005). RESULTS: There were 1,106 hospitalizations for typhoid and paratyphoid fever during the study period. The annual hospitalization rate was 0.31 cases per 100,000 population. The mortality and case fatality rates were 0.003 per 100,000 population and 0.9%, respectively. The average length of hospitalization was 10.19 days. These hospitalizations impose an annual direct cost of euro334,000. PATIENTS AND METHODS: Hospital discharges for typhoid or paratyphoid fever reported during a nine-year period in Spanish hospitals were obtained from the national surveillance system for hospital data, which is maintained by the Ministry of Health and covers more than 97% of Spanish hospitals. CONCLUSIONS: Preventive measures are vital to reduce the occurrence of typhoid fever and avoid new outbreaks. Effective prevention would result in large cost savings to the National Health Care System.

[Serum folate levels in adolescent population in Madrid, Spain]. / Folato sérico en población adolescente de la Comunidad de Madrid.

BACKGROUND AND OBJECTIVE: Serum folate concentrations in children are essential to establish values which allow to compare different regions or countries, and raise the possibility of fortifying diet with group B vitamins and folic acid as a secondary prevention against cardiovascular diseases. SUBJECTS AND METHOD: A cross-sectional epidemiological study was performed to assess serum folate levels in school children, aged 13-15 years, in Madrid. Folate and vitamin B12 determinations were determined in blood samples of fasting children. Genotype C677T of methylentetrahydrofolate reductase (MTHFR) enzyme was determined by polymerase chain reaction. RESULTS: Average folate levels obtained in our study were 7.83 nmol/l (95% confidence interval, 7.42 to 8.23 nmol/l). Median was 6.89 nmol/l (interquartilic range: 5.30 to -9.30 nmol/l). No statistically significant differences were found by gender, age or presence of menstruation. Serum folate concentration decreased significantly with the mutation of the C677T genotype for MTHFR. Prevalence of deficits of folate (< 5.3 nmol/l) was 23.8% and raised significantly with the mutation of the C677T genotype for MTHFR: 18.8% for CC, 20.4% for CT, and 46.7% for TT. This effect was mainly observed in girls after menstruation. CONCLUSIONS: Homozygosis mutation in C677T genotype of the enzyme MTHFR induces lower folate levels, mainly in girls after menstruation. 5.3 nmol/l is proposed as a threshold to define deficient serum folate levels in the Spanish adolescent population.

Folato sérico en población adolescente de la Comunidad de Madrid / Serum folate levels in adolescent population in Madrid, Spain

FUNDAMENTO Y OBJETIVO: Conocer los valores séricos de folato en niños es imprescindible para establecerunos percentiles que permitan realizar comparaciones entre regiones o países, asícomo para plantear la suplementación de la dieta con vitaminas del grupo B y ácido fólicocomo prevención secundaria frente a las enfermedades cardiovasculares. El objetivo de este estudioha sido analizar las concentraciones de folatos en adolescentes de la Comunidad de Madrid.SUJETOS Y MÉTODO: Se ha realizado un estudio epidemiológico descriptivo de tipo transversal conel fin de estimar los valores séricos de folato en la población escolar de 13 a 15 años de la Comunidadde Madrid. Se determinaron las concentraciones de folato y vitamina B12 en las muestrasde sangre de 311 adolescentes (141 niños y 170 niñas) obtenidas en ayunas. Se determinóel genotipo C677T de la enzima metilentetrahidrofolato reductasa (MTHFR) por reacción encadena de la polimerasa.RESULTADOS: Los valores medios de folato obtenidos en nuestro estudio fueron de 7,83 nmol/l(intervalo de confianza del 95%, 7,42-8,23 nmol/l) y la mediana fue de 6,89 nmol/l (recorridointercuartílico: 5,30-9,30 nmol/l).No se encontraron diferencias estadísticamente significativas por sexo, edad o presencia o ausenciade menstruación. La concentración sérica de folato disminuyó significativamente con lamutación del genotipo C677T de la enzima MTHFR. La prevalencia de valores deficitarios defolato (< 5,3 nmol/l) fue del 23,8% y aumentó significativamente con el genotipo C677TMTHFR mutado en homocigosis: un 18,8% para CC; un 20,4% para CT, y un 46,7% para TT.Este aumento se produjo en mayor medida en las mujeres a partir de la primera menstruación.CONCLUSIONES: El genotipo mutado C677T en homocigosis de la enzima MTHFR produce déficitde folato, especialmente en mujeres a partir de la pubertad. Se propone el valor de 5,3 nmol/lcomo posible punto de corte para definir el déficit de folato sérico en la población adolescentede nuestro país

BACKGROUND AND OBJECTIVE: Serum folate concentrations in children are essential to establish valueswhich allow to compare different regions or countries, and raise the possibility of fortifyingdiet with group B vitamins and folic acid as a secondary prevention against cardiovascular diseases.SUBJECTS AND METHOD: A cross-sectional epidemiological study was performed to assess serum folatelevels in school children, aged 13-15 years, in Madrid. Folate and vitamin B12 determinationswere determined in blood samples of fasting children. Genotype C677T of methylentetrahydrofolatereductase (MTHFR) enzyme was determined by polimerase chain reaction.RESULTS: Average folate levels obtained in our study were 7.83 nmol/l (95% confidence interval,7.42 to 8.23 nmol/l). Median was 6.89 nmol/l (interquartilic range: 5.30 to –9.30 nmol/l).No statistically significant differences were found by gender, age or presence of menstruation.Serum folate concentration decreased significantly with the mutation of the C677T genotypefor MTHFR. Prevalence of deficits of folate (< 5.3 nmol/l) was 23.8% and raised significantlywith the mutation of the C677T genotype for MTHFR: 18.8% for CC, 20.4% for CT, and46.7% for TT. This effect was mainly observed in girls after menstruation.CONCLUSIONS: Homozygosis mutation in C677T genotype of the enzyme MTHFR induces lowerfolate levels, mainly in girls after menstruation. 5.3 nmol/l is proposed as a threshold to definedeficient serum folate levels in the Spanish adolescent population

Burden of hospital admissions for cervical cancer in Spain during 1999-2002.

Population-based retrospective epidemiological study to estimate the burden of to hospitalizations by cervical cancer in Spain. It was conducted by using hospital discharge data from the national surveillance system for hospital data, Conjunto Mínimo Básico de Datos (CMBD). Records of all patients admitted to hospital with a diagnosis of malignant neoplasm of the cervix (ICD-9-MC codes 180.0-180.9) or carcinoma in situ of cervix (code 233.1) during a four year period (1999-2002), were selected. An annual average of 4,151 hospitalizations with a primary or secondary diagnosis of cervical cancer and 2,761 hospitalizations due to carcinoma in situ were identified. Annually there were 25.5 and 17.0 hospitalizations by cervical cancer and carcinoma in situ per 100,000 women > or =20 years of age, respectively. Hospitalization rate by cervical cancer and carcinoma in situ peaks in between 45 and 59 years of age (39.4 admissions per 100,000 women) and 30 to 44 years of age (32.2 per 100,000 women), respectively. The mean cost of a hospitalization by cervical cancer and carcinoma in situ euro3,098 and euro2,192, respectively. The estimated annual cost of hospitalizations cervical cancer and carcinoma in situ in Spain was 19 million euro.

Hospitalization by pneumonia and influenza in the 50-64 year old population in Spain (1999-2002).

This epidemiological survey was undertaken to estimate the burden of hospital admissions for pneumonia and influenza in 50-64 years old persons in Spain during a four-year period (1999-2002). Data were obtained from the national surveillance system for hospital data maintained by the Ministry of Health and covering more than 95% of Spanish hospitals. There were 35,620 hospital admissions for pneumonia and influenza (ICD 9 CM 480-487; first listed diagnosis) during the study period. Annual incidence was 143 cases per 100,000 population. Rate of death and case-fatality rate were 8 per 100,000 population and 5.6%, respectively. The average length of hospitalization was 10.4 days. Men and older age groups showed a higher incidence, rate of death and case-fatality rate. These hospitalizations of 50-64 years old persons impose an annual direct cost of 12 to 24 millions euros. Preventive measures, such as vaccination will reduce pneumonia-related morbidity and could result in large cost savings to the Health Care System.