Has COVID-19 Affected DTP3 Vaccination in the Americas?

BACKGROUND: In the Americas, deaths by diseases avoidable with vaccines are a significant contributor to child mortality. An essential means of reducing this is through broad vaccine coverage. The COVID-19 pandemic has posed a potential disruption to vaccine coverage due to its effects on the healthcare system. OBJECTIVES: this study aims to evaluate the impact of the COVID-19 pandemic on DTP3 vaccination coverage in the Americas, investigating trends from 2012 to 2022 to identify significant changes, regional disparities, and the overall effect of the pandemic on progress towards global immunization targets. METHODS: This study used the coverage data for the third dose of the diphtheria, tetanus, and pertussis vaccine (DTP3) pulled from UNICEF databases spanning 2012 to 2022. We conducted a Joinpoint regression to identify points of significant trend changes. The annual percentage change (APC) and 95% confidence intervals (95% CIs) were calculated for America and its regions. We also used segmented regression analysis. Using the Chi-square test, we compared DTP3 vaccination coverage for each country between 2019 and 2022. RESULTS: Overall, America saw a decrease in vaccine coverage during this period, with an APC of -1.4 (95% CI -1.8; -1.0). This trend varied across regions. In North America, the decrease was negligible (-0.1% APC). South America showed the steepest decrease, with an APC of -2.5%. Central America also declined, with an APC of -1.3%. Our findings suggest a concerning trend of declining DTP-vaccination rates in the Americas, exacerbated in certain regions, in the wake of the COVID-19 pandemic. The absolute decrease in vaccine coverage in the Americas was -4% between 2019 and 2022, with the most important drop being in Central America (-7%). However, six countries reported increased vaccination rates post-COVID-19, led by Brazil, with a 7% increase. Conversely, twenty-two countries registered a decline in DTP3 vaccine coverage, with the average decrease being -7.37%. This decline poses an important challenge to achieving the WHO's target of 90% coverage for the third dose of DTP by 2030, as evidenced by the reduction in the number of countries meeting this target from 2019 to 2022. CONCLUSIONS: The COVID-19 pandemic has impacted vaccine coverage in America, leading to a decrease, especially across Central America.

Evaluating the Efficacy of ChatGPT in Navigating the Spanish Medical Residency Entrance Examination (MIR): Promising Horizons for AI in Clinical Medicine.

The rapid progress in artificial intelligence, machine learning, and natural language processing has led to increasingly sophisticated large language models (LLMs) for use in healthcare. This study assesses the performance of two LLMs, the GPT-3.5 and GPT-4 models, in passing the MIR medical examination for access to medical specialist training in Spain. Our objectives included gauging the model's overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. MATERIAL AND METHODS: We studied the 2022 Spanish MIR examination results after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM GPT-4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length, sequence, and performance. We also analyzed the 23 questions with images, using GPT-4's new image analysis capability. RESULTS: GPT-4 outperformed GPT-3.5, scoring 86.81% in Spanish (p < 0.001). English translations had a slightly enhanced performance. GPT-4 scored 26.1% of the questions with images in English. The results were worse when the questions were in Spanish, 13.0%, although the differences were not statistically significant (p = 0.250). Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, and the Pharmacology, Critical Care, and Infectious Diseases specialties showed lower performance. The error analysis revealed that while a 13.2% error rate existed, the gravest categories, such as "error requiring intervention to sustain life" and "error resulting in death", had a 0% rate. CONCLUSIONS: GPT-4 performs robustly on the Spanish MIR examination, with varying capabilities to discriminate knowledge across specialties. While the model's high success rate is commendable, understanding the error severity is critical, especially when considering AI's potential role in real-world medical practice and its implications for patient safety.

Trends, Projections, and Regional Disparities of Maternal Mortality in Africa (1990-2030): An ARIMA Forecasting Approach.

With the United Nations Sustainable Development Goals (SDG) (2015-2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990-2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of -2.6% (95% CI -2.7; -2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target.

Effects of Nutrition Interventions on Athletic Performance in Soccer Players: A Systematic Review.

BACKGROUND: More than 270 million participants and 128,893 professional players play soccer. Although UEFA recommendations for nutrition in elite football exist, implementing these guidelines among professional and semiprofessional soccer players remains suboptimal, emphasizing the need for targeted and individualized nutritional strategies to improve adherence to established recommendations. METHODS: We conducted a comprehensive search in PubMed, Scopus, Web of Science, and clinical trial registers. Inclusion criteria focused on professional or semiprofessional soccer players, nutrition or diet interventions, performance improvement outcomes, and randomized clinical trial study types. We assessed quality using the Risk of Bias 2 (RoB 2) tool. We identified 16 eligible articles involving 310 participants. No nutritional interventions during the recovery period effectively improved recovery. However, several performance-based interventions showed positive effects, such as tart cherry supplementation, raw pistachio nut kernels, bicarbonate and mineral ingestion, creatine supplementation, betaine consumption, symbiotic supplements, and a high-carbohydrate diet. These interventions influenced various aspects of soccer performance, including endurance, speed, agility, strength, power, explosiveness, and anaerobic capacity. CONCLUSIONS: Specific strategies, such as solutions with bicarbonate and minerals, high carbohydrate diets, and supplements like creatine, betaine, and tart cherry, can enhance the performance of professional soccer players. These targeted nutritional interventions may help optimize performance and provide the competitive edge required in professional soccer. We did not find any dietary interventions that could enhance recovery.

COVID-19 Impact on DTP Vaccination Trends in Africa: A Joinpoint Regression Analysis.

BACKGROUND: Deaths due to vaccine-preventable diseases are one of the leading causes of death among African children. Vaccine coverage is an essential measure to decrease infant mortality. The COVID-19 pandemic has affected the healthcare system and may have disrupted vaccine coverage. METHODS: DTP third doses (DTP3) Vaccine Coverage was extracted from UNICEF databases from 2012 to 2021 (the last available date). Joinpoint regression was performed to detect the point where the trend changed. The annual percentage change (APC) with 95% confidence intervals (95% CI) was calculated for Africa and the regions. We compared DTP3 vaccination coverage in 2019-2021 in each country using the Chi-square test. RESULT: During the whole period, the vaccine coverage in Africa increased with an Annual Percent change of 1.2% (IC 95% 0.9-1.5): We detected one joinpoint in 2019. In 2019-2021, there was a decrease in DTP3 coverage with an APC of -3.5 (95% -6.0; -0,9). (p < 0.001). Vaccination rates decreased in many regions of Sub-Saharan Africa, especially in Eastern and Southern Africa. There were 26 countries (Angola, Cabo Verde, Comoros, Congo, Côte d'Ivoire, Democratic Republic of the Congo, Djibouti, Ethiopia, Eswatini, The Gambia, Guinea-Bissau, Liberia, Madagascar, Malawi, Mauritania, Mauritius, Mozambique, Rwanda, Senegal, Seychelles, Sierra Leone, Sudan, Tanzania, Togo, Tunisia, Uganda, and Zimbabwe) where the vaccine coverage during the two years decreased. There were 10 countries (Angola, Cabo Verde, Comoros, Democratic Republic of the Congo, Eswatini, The Gambia, Mozambique, Rwanda, Senegal, and Sudan) where the joinpoint regression detected a change in the trend. CONCLUSIONS: COVID-19 has disrupted vaccine coverage, decreasing it all over Africa.

Maternal Mortality in Africa: Regional Trends (2000-2017).

BACKGROUND: United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa's leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa. METHODS: We extracted data for maternal mortality rates per 100,000 births from the United Nations Children's Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). RESULTS: Maternal mortality has decreased in Africa over the study period by an average APC of -3.0% (95% CI -2.9; -3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations' sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals. CONCLUSIONS: Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations' target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel.

Confusion, Hallucinations, and Primary Polydipsia: A Rare Presentation of Neurosarcoidosis.

Neurosarcoidosis is a rare manifestation of sarcoidosis that can exhibit a variety of neuropsychiatric symptoms and can present independently of pulmonary or other systemic symptoms. This is the case of a 51-year-old African American male who presented with recurrent episodes of auditory and visual hallucinations, confusion, seizures that did not respond to antiepileptics, and recent-onset primary polydipsia. In the emergency department, he did not have meningeal signs, focal neurologic deficits, or a fever. Magnetic resonance imaging (MRI) of the brain demonstrated diffuse meningeal enhancement. The patient underwent a lumbar puncture (LP), with cerebrospinal fluid (CSF) analysis notably revealing an elevated angiotensin-converting enzyme (ACE), an elevated CD4:CD8 ratio, and a negative infectious panel, while computed tomography (CT) imaging showed bilateral hilar lymphadenopathy. He also had an endobronchial ultrasound (EBUS) with biopsy which did not reveal granulomas. Although sarcoidosis requires granulomas for a definite diagnosis, studies and symptoms were consistent with neurosarcoidosis, and this can suggest that the disease was isolated to the central nervous system (CNS). This case highlights the need for further understanding of psychiatric symptoms as a sign of isolated neurosarcoidosis.

Schizophrenia and Hospital Admissions for Cardiovascular Events in a Large Population: The APNA Study.

(1) Background: Patients with schizophrenia have higher mortality, with cardiovascular diseases being the first cause of mortality. This study aims to estimate the excess risk of hospital admission for cardiovascular events in schizophrenic patients, adjusting for comorbidity and risk factors. (2) Methods: The APNA study is a dynamic prospective cohort of all residents in Navarra, Spain. A total of 505,889 people over 18 years old were followed for five years. The endpoint was hospital admissions for a cardiovascular event. Direct Acyclic Graphs (DAG) and Cox regression were used. (3) Results: Schizophrenic patients had a Hazard Ratio (HR) of 1.414 (95% CI 1.031-1.938) of hospital admission for a cardiovascular event after adjusting for age, sex, hypertension, type 2 diabetes, dyslipidemia, smoking, low income, obesity, antecedents of cardiovascular disease, and smoking. In non-adherent to antipsychotic treatment schizophrenia patients, the HR was 2.232 (95% CI 1.267-3.933). (4) Conclusions: Patients with schizophrenia have a higher risk of hospital admission for cardiovascular events than persons with the same risk factors without schizophrenia. Primary care nursing interventions should monitor these patients and reduce cardiovascular risk factors.

Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study.

Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. This study aimed to analyze how the differences in delivered care (variability of glycosylated hemoglobin (HbA1c) achieved targets) affect hospital admissions for cardiovascular events (CVEs) in T2D patients. Methods: We analyzed the electronic records in primary care health centers at Navarra (Spain) and hospital admission for CVEs. We followed 26,435 patients with T2D from 2012 to 2016. The variables collected were age, sex, health center, general practitioner practice (GPP), and income. The clinical variables were diagnosis of T2D, weight, height, body mass index (BMI), blood pressure (BP), HbA1c, low-density lipoprotein cholesterol (LDL-C), smoking, and antecedents of CVEs. We calculated, in each GPP practice, the proportion of patients with HbA1c ≥ 9. A non-hierarchical K-means cluster analysis classified GPPs into two clusters according to the level of compliance with HbA1C ≥ 9% control indicators. We used logistic and Cox regressions. Results: T2D patients had a higher probability of admission for CVEs when they belonged to a GPP in the worst control cluster of HbA1C ≥ 9% (HR = 1.151; 95% CI, 1.032-1.284).

Being Born in Winter-Spring and at Around the Time of an Influenza Pandemic Are Risk Factors for the Development of Schizophrenia: The Apna Study in Navarre, Spain.

BACKGROUND: We analyzed the relationship between the prevalence of schizophrenia and the season of birth and gestation during a period of an influenza pandemic. METHODS: Cross-sectional analysis of a prospective population-based cohort of 470,942 adults. We fitted multivariant logistic regression models to determine whether the season of birth and birth in an influenza-pandemic year (1957, 1968, 1977) was associated with schizophrenia. RESULTS: 2077 subjects had been diagnosed with schizophrenia. Logistic regression identified a significantly greater prevalence of schizophrenia in men than in women (OR = 1.516, CI 95% = 1.388-1.665); in those born in the winter or spring than in those born in the summer or autumn (OR = 1.112, CI 95% = 1.020-1.212); and in those born in a period of an influenza pandemic (OR = 1.335, CI 95% = 1.199-1.486). The increase in risk was also significant when each influenza pandemic year was analyzed separately. However, neither month of birth nor season of birth, when each of the four were studied individually, were associated with a statistically significant increase in that risk. CONCLUSIONS: The winter-spring period and the influenza pandemics are independent risk factors for developing schizophrenia. This study contradicts many previous studies and thus revitalizes a locked debate in understanding the neurodevelopmental hypothesis of this disorder.

Risk of Secondary Household Transmission of COVID-19 from Health Care Workers in a Hospital in Spain.

BACKGROUND: Hospital health care workers are at high risk of developing COVID-19 and transmitting the disease to their family upon returning home; the aim here is to estimate the secondary attack rate of COVID-19 in household contacts of health care workers and their transmission risk factors. MATERIAL AND METHODS: COVID-19 cases in the health care workers of an academic hospital in Pamplona, Spain, from 2 March to 26 May 2020, were followed up. The secondary attack rate (SAR) was estimated from cases in household contacts of index cases and their risk factors by Poisson regression. RESULTS: 89 index cases were studied from 99 notified cases in health care workers (89.0%), excluding secondary cases or those who lived alone. Forty-six secondary cases confirmed by the laboratory were found among 326 household contacts, a secondary attack rate of 14.11% (95% CI 10.75-18.31), and 33 household contacts with acute infection symptoms without microbiologic confirmation 10.12% (95% CI 7.30-13.87). Considering all the cases, the secondary attack rate was 27.3 (95% CI 22.75-32.38). Risk factors were the gender and profession of the index case, the number of people living in the household, and the number of persons per bedroom. When the index case health worker used a single room, it had a protective effect, with an incidence rate ratio (IRR) of 0.493 (95% CI 0.246-0.985); Conclusions: The secondary attack rate found among household contacts of health care workers is high. The preventive isolation of health care workers in individual rooms in their house may reduce the transmission in their families.

Evaluación de la salud cronológica y de la edad ósea determinada por los métodos de Greulich-Pyle y Tanner en niñas y adolescentes de edades comprendidas entre 4 y 17 años en el Servicio de Radiología de Hospital P.N.P. Luis N. Sáenz en el periodo Marzo a Diciembre del 2006 / Evaluation of chronological health and bone age as determined by the methods of Greulich-Pyle and Tanner in children and adolescents aged 4 to 17 years in the Radiology Service, Hospital P.N.P. Luis N. Saenz in the period March to December 2006

La presente investigación tiene como objetivo evaluar la edad ósea y la edad cronológica determinadas por los métodos radiológicos de Greulich-Pyle y Tanner en el servicio de Radiología del Hospital P.N.P Luis N. Sáenz en el periodo marzo-diciembre del 2006; esta investigación es de tipo retrospectivo, observacional y de corte transversal, para el cual se consideró una muestra de 249 niñas y adolescentes con edades comprendidas entre 4 y 17 años que fueron atendidas en el servicio de Radiología del Hospital P.N.P Luis N. Sáenz y se tomaron una radiografía de mano y muñeca izquierda (edad ósea). Dentro de los resultados tenemos que la edad cronológica de las niñas y adolescentes es de 10.75 años; asimismo se observó que la mitad de las niñas y adolescentes presentaron una edad menor o igual a 10.8 años y el valor más frecuente en las niñas es de 9.8 años. La media de la edad ósea según el método de Greulich-Pyle en niñas y adolescentes es de 10.75 años; asimismo la mitad de las niñas y adolescentes presentan una edad menor o igual a 11 años y el valor más frecuente en las niñas es de 11 años también se encontró que la media de la edad ósea según el método de Tanner en niñas y adolescentes es de 10.83 años; asimismo la mitad de las niñas y adolescentes tienen edad menor o igual a 11.1 años y el valor más frecuente en las niñas fue de 16 años, la edad tiene una desviación estándar de 3.8 años en donde el 25 por ciento del total de niñas y adolescentes tienen edad menor a 8.7 años y el 75 por ciento del total de niñas y adolescentes tienen edad menor de 13.5 años. Se analizó la concordancia en donde se encontró que la moderada es de 0.59 en los 249 casos en cada uno de los métodos, también se observó una significancia estadística de P<0.05; la concordancia alta fue de 0.71 en los 249 casos, en cada uno de los métodos con una significancia estadística de P<0.05. No se encontró diferencias significativas entre las medias de la edad cronológica y la media de la...

The present research aims to assess the bone age and chronological age determined by radiological methods of Greulich-Pyle and Tanner in the service of Radiology at the Luis N. Saenz PNP Hospital in the period from March to December 2006, this study is retrospective, observational and cross-sectional for which it was considered a sample of 249 children and adolescents aged from 4 to 17 years who were seen at the in the service of Radiology at the Luis N. Saenz PNP Hospital and who had an X-ray test of the left hand and wrist (bone age). The following results were obtained: the chronological age of girls and adolescent girls is 10.75 years, it was also observed that half of the girls and adolescents are aged less than or equal to 10.8 years and the most frequent value in girls is 9.8 years. The average bone age according to Greulich-Pyle method in children and adolescents is 10.75 years, also half of girls and adolescents are aged less than or equal to 11 years and the most frequent value in girls is 11 years, it was also found that the average bone age according to the method of Tanner in girls and adolescents is 10.83 years, moreover, half of the girls and adolescents are aged less than or equal to 11.1 years and the most frequent value in girls was 16 years, the age has a standard deviation of 3.8 years where the 25 per cent of girls and adolescents are aged less than 8.7 years old and the 75 per cent of girls and adolescents are aged less than 13.5 years old. The correlation was analyzed, it was found that the moderate is 0.59 in the 249 cases in each one of the methods, there was also a statistical significance of P<0.05; high consistency was 0.71 in the 249 cases in each one of the methods with a statistical significance of P<0.05. No significant differences were found between the average chronological age and bone age determined by the Greulich-Pyle method or by the method of Tanner. Regarding Pearson correlation coefficient, it shows that there is high...

Estudio de depresión en la adolescente embarazada / Study of depression in the pregnant adolescent

El embarazo en la adolescencia está asociado con significativos riesgos médicos y sicosociales, tanto para la madre como para el hijo. La depresión es un trastorno médico frecuente y el factor de riesgo más importante para el desarrollo de depresión en la adolescencia es el embarazo. Se realizó un estudio transversal en el servicio de consulta externa del Hospital Ginecológico Obstétrico Isidro Ayora de Quito. El universo lo conformaron 140 pacientes que acudieron por primera ocasión y que se encontraban cursando el tercer trimestre de su embarazo. Se aplicó una encuesta con el fin de determinar la incidencia de depresión en las madres adolescentes embarazadas y sus factores sicosociales. Se analizaron las variables edad, estado civil, migración y antecedentes de depresión en la familia.