Identificación de clústeres de casos de COVID-19 en la provincia Santiago de Cuba / Identification of clusters in COVID-19 cases in the Santiago de Cuba province

Introducción: A partir de la aparición de la epidemia COVID-19 se conforma un equipo multidisciplinario en Santiago de Cuba con participación de varias instituciones y activado por el Consejo de defensa provincial. El análisis integrado epidemiológico, la gestión gubernamental y la respuesta social resultarían determinantes en el control de la enfermedad. Objetivos: Identificar posibles grupos de casos con COVID-19 en la provincia Santiago de Cuba y caracterizar su transmisión según variables epidemiológicas. Métodos: Se desarrolló un estudio ecológico, comparándose los clústeres de transmisión de COVID-19. Se resumieron variables de interés y se realizó análisis de redes sociales desde el punto de vista de las relaciones entre casos y contactos, así como análisis espacial. Resultados: Se identificaron cinco grupos espaciales de transmisión en los municipios, uno en Palma Soriano, uno en Contramaestre y tres en Santiago de Cuba. Los antecedentes patológicos personales (hipertensión y procesos respiratorios), el sexo femenino, los casos sintomáticos y el promedio de 22 a 27 contactos por cada confirmado fueron las variables más relevantes. Se identificó fuente de infección introducida en 51 por ciento (25/49). Además, se identificaron redes sociales complejas en la transmisión de la enfermedad. Conclusiones: La transmisión de COVID-19 en la provincia Santiago de Cuba mostró grupos de casos y contactos con redes sociales epidemiológicas características para cada municipio, así como el modo de transmisión de acuerdo a la fuente de infección, relaciones de familiaridad o cercanía social y la relación de distancia espacial entre contactos, aspectos que influyeron en las bajas tasas de incidencia de la enfermedad, con predominio en su forma sintomática, edades jóvenes y en mujeres(AU)

Introduction: From the onset of COVID-19 epidemic, a multidisciplinary team is formed in Santiago de Cuba with the participation of several institutions and activated by the Provincial Defense Council. Integrated epidemiological analysis, government management and social response would be decisive in controlling the disease. Objectives: To identify possible groups of COVID-19 cases in the Santiago de Cuba province and to describe the transmission according to epidemiological variables. Methods: An ecological study was carried out, comparing COVID-19 transmission clusters. Variables of interest were summarized and analysis of social contact networks was carried out from the point of view of the relationships between cases and contacts, as well as spatial analysis. Results: Five spatial transmission groups were identified in the municipalities, one in Palma Soriano, one in Contramaestre and three in Santiago de Cuba. The personal pathological antecedents (hypertension and respiratory processes), female sex, symptomatic cases and the average of 22 to 27 contacts for each confirmed were the most relevant variables. A source of introduced infection was identified in 51 percent (25/49). In addition, complex social networks were identified in the transmission of the disease. Conclusions: The transmission of COVID-19 in Santiago de Cuba province showed groups of cases and contacts with characteristic epidemiological social networks for each municipality, as well as the mode of transmission according to the source of infection, relationships of familiarity or social closeness and the relationship of spatial distance between contacts, which influenced on the low incidence rates of the disease, with predominance of symptomatic form, young ages and in women(AU)

Introduction to Survival Analysis in the Presence of Competing Risks.

Survival analysis is often used in studies of clinical epidemiology, but the existence of competing risks has not been adequately considered. Competing risks may hinder observation of the outcome of interest or modify the occurrence of the outcome. In the presence of competing risks, conventional survival analysis leads to biased results. To conduct a survival analysis in the presence of competing risks, researchers should select an appropriate method from the following two options: cause-specific hazard model and subdistribution hazard model. This article explains the issues raised by the presence of competing risks and describes methods to account for competing risks in survival analysis.

Review of Lot Quality Assurance Sampling, Methodology and its Application in Public Health.

Rapid collection of data is of utmost importance in monitoring and evaluation of activities of public health importance. Among others techniques, 30 by 7 cluster sampling and Lot quality assurance sampling(LQAS) methods have been described in literature for this purpose. However, LQAS is often sparingly used in most settings, undermining its importance as a effective epidemiological tool in public health practice. To some extent LQAS is inadequately understood and even less emphasized method, especially in the postgraduate teaching and training. In this paper we aim to explain the use, method and application of LQAS in public health settings as well as discuss common pitfalls to avoid while planning and drawing inferences based on data collected through LQAS.

How reliable is the statistical evidence for limiting saturated fat intake? A fresh look at the influential Hooper meta-analysis.

BACKGROUND: Evidence from meta-analyses has been influential in deciding whether or not limiting saturated fat intake reduces the incidence of cardiovascular disease. Recently, random effects analyses have been criticised for exaggerating the influence of publication bias and an alternative proposed which obviates this issue: 'inverse-variance heterogeneity'. AIMS: We re-analysed the influential Hooper meta-analysis that supports limiting saturated fat intake to decide whether or not the results of the study were sensitive to the method used. METHODS: Inverse-variance heterogeneity analysis of this summary study was carried out, and the results contrasted with standard methods. Publication bias was also considered. RESULTS: Inverse variance heterogeneity analysis of the Hooper combined cardiovascular disease end point results returned a pooled relative risk of 0.93 (95% confidence interval: 0.74-1.16). This finding contrasts with the traditional random effects analysis with the corresponding statistic of 0.83 (95% confidence interval: 0.72-0.96). Egger tests, funnel and Doi plots along with recently published suppressed trial results suggest that publication bias is present. CONCLUSIONS: This study questions the use of the Hooper study as evidence to support limiting saturated fat intake. Our re-analysis, together with concordant results from other meta-analyses of trials indicate that routine advice to reduce saturated fat intake in people with (or at risk for) cardiovascular disease be reconsidered.

Reflection on modern methods: years of life lost due to premature mortality-a versatile and comprehensive measure for monitoring non-communicable disease mortality.

The analysis of causes impacting on premature mortality is an essential function of public health surveillance. Diverse methods have been used for accurately assessing and reporting the level and trends of premature mortality; however, many have important limitations, particularly in capturing actual early deaths. We argue that the framework of years of life lost (YLL), as conceptualized in disability-adjusted life-years (DALYs), is a robust and comprehensive measure of premature mortality. Global Burden of Disease study is systematically providing estimates of YLL; however, it is not widely adopted at country level, among other reasons because its conceptual and methodological bases seem to be not sufficiently known and understood. In this paper, we provide the concepts and the methodology of the YLL framework, including the selection of the loss of function that defines the time lost due to premature deaths, and detailed methods for calculating YLL metrics. We also illustrate how to use YLL to quantify the level and trends of premature non-communicable disease (NCD) mortality in the Americas. The tutorial style of the illustrative example is intended to educate the public health community and stimulate the use of YLL in disease prevention and control programmes at different levels.

Modalidades de la discusión diagnóstica como actividad de educación en el trabajo en la enseñanza médica superior / Modalities of diagnostic discussion as an activity of education at work in higher medical education

La forma principal de organización del proceso docente educativo en la enseñanza médica superior, tanto para la formación del médico general básico como de los especialistas, es la educación en el trabajo, devenida método de enseñanza y declarada como el principio rector de la educación médica cubana. Las distintas variedades de la presentación del caso y su discusión diagnóstica se fundamentan en la aplicación de método científico de las ciencias médicas (clínico o epidemiológico); y su interrelación con las categorías pedagógicas y principios didácticos fundamentales constituye la modalidad de educación en el trabajo docente educativo asistencial por excelencia para la formación de los profesionales de la salud (durante el pregrado y el posgrado) en los centros de enseñanza médica superior, tanto para la carrera de Medicina como la Licenciatura en Enfermería. En este artículo se proponen algunas sugerencias para el desarrollo efectivo del proceso docente educativo y asistencial para que sean útiles a los profesionales de la salud que se desempeñan en las carreras de Medicina y Enfermería(AU)

The main form of organization of the teaching educational process in higher medical education, both for the training of the basic practitioner and the specialists, is education at work, turned into a teaching method and declared as the guiding principle of Cuban medical education. The different varieties of case report and their diagnostic discussion are based on the application of the scientific method in medical sciences (clinical or epidemiological). Their interrelation with the pedagogical categories and fundamental didactic principles constitutes the fundamental modality of education at care-delivery educational teaching work, for the training of health professionals (in undergraduate and postgraduate studies) at the higher medical education centers, for both the medical major and the nursing degree. This article aimed at some suggestions for its effective development in the teaching and care teaching process, which may be useful for health professionals who work in those specialties systematically practiced(AU)

Epidemiological evaluation quality of life in patients suffering from early rheumatoid arthritis: a pragmatic, prospective, randomized, blind allocation controlled of a modular program group intervention.

OBJECTIVES: Epidemiology has taken on new roles in the management of health care services. In this study, we developed a non-pharmacological self-management modular program group intervention and evaluated its efficacy as an adjunct therapy in patients suffering from early rheumatoid arthritis (RA). METHODS: Patients were randomized to either participate in a non-equivalent intervention group along with the standard of care or only receive standard-of-care treatment at a community rheumatology center. The outcomes measured were a pain visual analog scale (VAS), patient general health (GH) on a VAS, and the Short Form 36 Health Survey version 2 scale measuring quality of life. These parameters were evaluated in the first week to obtain baseline values, and at 20, 32, 48, and 60 weeks to evaluate the efficacy of the intervention group. RESULTS: The patients were randomized, with 100 patients in the intervention group and 106 in the control group. The intervention and control groups were similar with regard to the percentage of women (86% vs. 89.6%), tobacco usage (25% vs. 19.8%), mean age (42.6±13.2 years vs. 46.6±10.9 years), and disease duration (15.3±6.7 months vs. 14.5±6.6 months). The mean outcomes were significantly different between the two groups, and post-hoc pairwise analysis demonstrated significant deterioration in the control group in contrast to improvement in the intervention group at the second, third, fourth, and fifth evaluations. Improvements were often seen as early as the 12-week and 24-week follow-up visits. CONCLUSIONS: Epidemiology contributes to the evaluation of how well specific therapies or other health interventions prevent or control health problems. The modular program group intervention implemented in this study appears to be a suitable and feasible method to facilitate much more comprehensive management of early RA in socioeconomically challenged communities.

Uso irracional de las pruebas de laboratorio clínico por parte de los médicos de asistencia / Irrational use of the clinical laboratory tests by the assistance doctors

Introducción: las pruebas diagnósticas son herramientas de ayuda para la decisión clínica, de manera que su uso se considera inapropiado cuando aportan información escasa o nula para tal decisión. La medicina de laboratorio basada en la evidencia combina la epidemiología clínica, la estadística y las ciencias sociales con la bioquímica clásica y la molecular, con vistas a mejorar la efectividad y la eficiencia de las pruebas de laboratorio. Objetivo: demostrar el uso irracional de las pruebas de laboratorio por parte de los médicos de asistencia. Métodos: se realizó un estudio longitudinal y descriptivo de 174 236 determinaciones de laboratorio, de 40 424 pacientes, atendidos en el Hospital Pediátrico Provincial Universitario "Eduardo Agramante Piña" de Camagüey, desde julio hasta diciembre de 2013. Resultados: en la serie predominaron los exámenes realizados por consulta externa, entre ellos los hematológicos; asimismo, un porcentaje elevado de indicaciones no guardó relación con la clínica. Conclusiones: la utilización adecuada del método clinicoepidemiológico, evita el uso inapropiado de los exámenes complementarios, de ahí la necesidad de una mayor interrelación entre los médicos de asistencia y el personal del laboratorio.

Introduction: the diagnosis tests are tools to help for the clinical decision, so that their use is considered inappropriate when they result in scarce or null information for such a decision. The laboratory medicine based on evidence combines the clinical epidemiology, statistic and the social sciences with the classic and the molecular biochemistry, with the aim of improving the effectiveness and the efficiency of the laboratory exams. Objective: to demonstrate the irrational use of the laboratory exams by the assistance doctors. Methods: was carried out A longitudinal and descriptive study of 174 236 laboratory determinations, of 40 424 patients, assisted in "Eduardo Agramante Piña" University Provincial Pediatric Hospital in Camagüey, from July to December, 2013. Results: in the series the exams carried out by the out-patients department prevailed, among them the hematological exams; also, a high percentage of indications tests keep relationship with the clinic. Conclusions: the appropriate use of the clinical and epidemiological method, avoids the inappropriate use of complementary exams, so, a wider interrelation between the assistance doctors and the laboratory staff is recommended.

Epidemiological evaluation quality of life in patients suffering from early rheumatoid arthritis: a pragmatic, prospective, randomized, blind allocation controlled of a modular program group intervention / 한국역학회지

OBJECTIVES: Epidemiology has taken on new roles in the management of health care services. In this study, we developed a non-pharmacological self-management modular program group intervention and evaluated its efficacy as an adjunct therapy in patients suffering from early rheumatoid arthritis (RA). METHODS: Patients were randomized to either participate in a non-equivalent intervention group along with the standard of care or only receive standard-of-care treatment at a community rheumatology center. The outcomes measured were a pain visual analog scale (VAS), patient general health (GH) on a VAS, and the Short Form 36 Health Survey version 2 scale measuring quality of life. These parameters were evaluated in the first week to obtain baseline values, and at 20, 32, 48, and 60 weeks to evaluate the efficacy of the intervention group. RESULTS: The patients were randomized, with 100 patients in the intervention group and 106 in the control group. The intervention and control groups were similar with regard to the percentage of women (86% vs. 89.6%), tobacco usage (25% vs. 19.8%), mean age (42.6±13.2 years vs. 46.6±10.9 years), and disease duration (15.3±6.7 months vs. 14.5±6.6 months). The mean outcomes were significantly different between the two groups, and post-hoc pairwise analysis demonstrated significant deterioration in the control group in contrast to improvement in the intervention group at the second, third, fourth, and fifth evaluations. Improvements were often seen as early as the 12-week and 24-week follow-up visits. CONCLUSIONS: Epidemiology contributes to the evaluation of how well specific therapies or other health interventions prevent or control health problems. The modular program group intervention implemented in this study appears to be a suitable and feasible method to facilitate much more comprehensive management of early RA in socioeconomically challenged communities.

Investigating neighbourhood effects on health: Using community-survey data for developing neighbourhood-related constructs / Efectos del barrio sobre la salud: Metodología para construir variables del barrio utilizando datos de encuestas poblacionales

Objective Structural and social neighbourhood constructs have been developed for studying a neighbourhood's influence on a variety of health outcomes; community surveys are being increasingly used for capturing such information. This paper has proposed a six-fold approach which integrates existing methodologies (i.e. multilevel factor analysis, ecometrics, multilevel spatial multiple membership models and multilevel latent class analysis) for estimating reliable and valid measurement of neighbourhood conditions. Methods The proposed approach used seven demographic and socio-economic variables reported in a community survey by 20,413 individuals residing in 244 neighbourhoods in Medellin, Colombia, to measure structural neighbourhood conditions. Results The set of variables reliably measured one neighbourhood construct: the deprivation index; this showed significant variation between neighbourhoods as well as significant spatial clustering across the city. Conclusions The approach presented here should enable public health researchers to better estimate neighbourhood indicators and may result in more accurate assessment of the relationship between neighbourhood characteristics and individual-level health outcomes.

Objetivo Múltiples variables que describen las características físicas y sociales de los barrios han sido desarrolladas para investigar los efectos del barrio sobre la salud. Las encuestas poblacionales son cada vez más utilizadas para capturar dicha información. Este artículo propone una metodología que integra diferentes técnicas estadísticas, tales como análisis factorial multinivel, ecometría, modelo espacial multinivel y modelo de clases latentes multinivel, para explorar datos derivados de encuestas poblacionales y estimar variables que describan las características de los barrios de manera precisa y confiable. Métodos Este artículo demuestra la aplicación del método propuesto para caracterizar condiciones estructurales de los barrios de Medellín-Colombia. Para esto se analizaron siete variables demográficas y socio-económicas reportadas por 20 413 individuos residentes de 244 barrios de la ciudad. Resultados Los resultados mostraron que el conjunto de variables miden de manera confiable un índice de privación económica para cada barrio, el cual mostró variaciones significativas entre los barrios, y agrupaciones espaciales en diferentes áreas de la ciudad. Conclusiones Se espera que el método propuesto sirva a los investigadores en salud pública para estimar indicadores del barrio más precisos, lo que ha de traducirse en estimaciones más confiables de los efectos del barrio sobre la salud individual.

Presentación de un control de foco de tuberculosis pulmonar, municipio Habana Vieja, octubre 2004 / Presentation of a control of focus of lung tuberculosis, Old Havana, October 2004

Se presenta un estudio de control de foco de tuberculosis pulmonar, mediante la técnica observacional del tipo serie de casos, a partir de octubre del 2004 en el municipio Habana Vieja, donde se describe, según el método epidemiológico, la relación de los casos detectados con el caso índice; se analiza el problema detectado teniendo en cuenta el enfoque de riesgo de la tuberculosis pulmonar y el análisis de los factores determinantes del estado de salud de la población. Se realiza una evolución clínico-epidemiológica de los casos detectados y de las medidas de control de foco aplicadas. Se revisan tanto las historias clínicas en el consultorio del médico de la familia, como las encuestas epidemiológicas y el documento de control de foco en el departamento de Estadísticas(AU)

It was carried out an observational study of the type of series of cases, starting from August of 1994 in Old Havana, of where it is described according to the epidemic method the relationship of the cases detected with the index case, the detected problem is analyzed keeping in mind the focus of risk of the Lung Tuberculosis and the analysis of the decisive factors of the State of Health of the Population. It is carried out a clinical-epidemic evolution of the detected cases and of the carried out measures of focus control. He/she was carried out revision of clinical histories in the Clinic of the Doctor of the Family, as the epidemic surveys and the document of focus control in the department of Statistical(AU)

Presentación de un control de foco de tuberculosis pulmonar, municipio Habana Vieja, octubre 2004 / Presentation of a control of focus of lung tuberculosis, Old Havana, October 2004

Se presenta un estudio de control de foco de tuberculosis pulmonar, mediante la técnica observacional del tipo serie de casos, a partir de octubre del 2004 en el municipio Habana Vieja, donde se describe, según el método epidemiológico, la relación de los casos detectados con el caso índice; se analiza el problema detectado teniendo en cuenta el enfoque de riesgo de la tuberculosis pulmonar y el análisis de los factores determinantes del estado de salud de la población. Se realiza una evolución clínico-epidemiológica de los casos detectados y de las medidas de control de foco aplicadas. Se revisan tanto las historias clínicas en el consultorio del médico de la familia, como las encuestas epidemiológicas y el documento de control de foco en el departamento de Estadísticas.

It was carried out an observational study of the type of series of cases, starting from August of 1994 in Old Havana, of where it is described according to the epidemic method the relationship of the cases detected with the index case, the detected problem is analyzed keeping in mind the focus of risk of the Lung Tuberculosis and the analysis of the decisive factors of the State of Health of the Population. It is carried out a clinical-epidemic evolution of the detected cases and of the carried out measures of focus control. He/she was carried out revision of clinical histories in the Clinic of the Doctor of the Family, as the epidemic surveys and the document of focus control in the department of Statistical.