Social determinants of health and seasonal influenza vaccination in adults ≥65 years: a systematic review of qualitative and quantitative data.

BACKGROUND: Vaccination against influenza is considered the most important public health intervention to prevent unnecessary hospitalizations and premature deaths related to influenza in the elderly, though there are significant inequities among global influenza vaccine resources, capacities, and policies. The objective of this study was to assess the social determinants of health preventing adults ≥ 65 years old from accessing and accepting seasonal influenza vaccination. METHODS: A systematic search was performed in January 2011 using MEDLINE, ISI - Web of Science, PsycINFO, and CINAHL (1980-2011). Reference lists of articles were also examined. Selection criteria included qualitative and quantitative studies written in English that examined social determinants of and barriers against seasonal influenza vaccination among adults ≥ 65 years. Two authors performed the quality assessment and data extraction. Thematic analysis was the main approach for joint synthesis, using identification and juxtaposition of themes associated with vaccination. RESULTS: Overall, 58 studies were analyzed. Structural social determinants such as age, gender, marital status, education, ethnicity, socio-economic status, social and cultural values, as well as intermediary determinants including housing-place of residence, behavioral beliefs, social influences, previous vaccine experiences, perceived susceptibility, sources of information, and perceived health status influenced seasonal influenza vaccination. Healthcare system related factors including accessibility, affordability, knowledge and attitudes about vaccination, and physicians' advice were also important determinants of vaccination. CONCLUSIONS: Our results demonstrate that the ability of adults ≥ 65 years to receive seasonal influenza vaccine is influenced by structural, intermediate, and healthcare-related social determinants which have an impact at the health system, provider, and individual levels.

[Immunization and equity in the Regional Initiative of the Mesoamerican Health Initiative]. / Inmunizaciones y equidad en el Plan Regional del Sistema Mesoamericano de Salud Pública.

National immunization rates indicate high vaccine coverage in Mesoamerica, but there is growing evidence that the most vulnerable groups are not being reached by immunization programs. Therefore, there is likely low effective vaccine coverage in the region, leading to persistent and growing health inequity. The planning phase of this project was from June to December 2009. The project will be conducted in the target populations which includes children under five, pregnant women, and women of child-bearing age from the most vulnerable populations within countries of the Mesoamerican region, as indicated geographically by a low human development index (HDI) and/or high prevalence of poverty at the municipal level and through the use of participatory methods to define poverty and vulnerability in local contexts. We defined three lines of action for vaccine-preventable disease interventions: 1) pilot projects to fill gaps in knowledge; 2) strengthening immunization policy; and 3) implementation of evidence-based practices. Health system strengthening through health equity is the central regional objective of the immunization workgroup. We hope to have a transformational impact on health systems so as to improve effective coverage, including vaccine and other integrated primary healthcare services.

Inmunizaciones y equidad en el Plan Regional del Sistema Mesoamericano de Salud Pública / Immunization and equity in the Regional Initiative of the Mesoamerican Health Initiative

Las cifras nacionales de inmunización indican altas coberturas de vacunación en Mesoamérica, sin embargo, hay evidencia creciente de que los grupos más vulnerables no son alcanzados por los programas de vacunación. La planeación de este proyecto se llevó a cabo entre junio y diciembre de 2009. La ejecución del proyecto se llevará a cabo en la población objetivo seleccionada a partir de junio de 2011. Está integrada por niños menores de cinco años y mujeres en edad fértil de las poblaciones más vulnerables en los países de Mesoamérica, identificadas geográficamente por un bajo índice de desarrollo humano o por la alta prevalencia de pobreza en el ámbito municipal, o a través del uso de métodos participativos para definir pobreza y vulnerabilidad en contextos locales. El Grupo de Trabajo ha definido tres líneas de acción para las intervenciones de enfermedades prevenibles por vacunación, para lograr una mejor cobertura efectiva en poblaciones vulnerables: 1) estudios piloto de coberturas para vacíos de conocimiento, 2) fortalecimiento de las políticas de vacunación, 3) ejecución de prácticas basadas en evidencia. El fortalecimiento de los sistemas de salud bajo la óptica de equidad en salud es el objetivo regional central del Grupo de Trabajo en inmunizaciones enfocado en un aumento de la cobertura efectiva.

National immunization rates indicate high vaccine coverage in Mesoamerica, but there is growing evidence that the most vulnerable groups are not being reached by immunization programs. Therefore, there is likely low effective vaccine coverage in the region, leading to persistent and growing health inequity. The planning phase of this project was from June to December 2009. The project will be conducted in the target populations which includes children under five, pregnant women, and women of child-bearing age from the most vulnerable populations within countries of the Mesoamerican region, as indicated geographically by a low human development index (HDI) and/or high prevalence of poverty at the municipal level and through the use of participatory methods to define poverty and vulnerability in local contexts. We defined three lines of action for vaccine-preventable disease interventions: 1) pilot projects to fill gaps in knowledge; 2) strengthening immunization policy; and 3) implementation of evidence-based practices. Health system strengthening through health equity is the central regional objective of the immunization workgroup. We hope to have a transformational impact on health systems so as to improve effective coverage, including vaccine and other integrated primary healthcare services.

Preserving idealism in global health promotion.

If the field of global health is to evolve in the second decade of the new millennium, we need to revive the idealistic spirit and by using the lens of health equity work toward improved health status around the world. Morality and empathy are considered by-products of our evolutionary history as a human species. Idealism may be a trait that we may choose to preserve in our modern evolutionary history.

H1N1 influenza pandemics: comparing the events of 2009 in Mexico with those of 1976 and 1918-1919.

Outbreaks of influenza A (H1N1) of avian- or swine-related origin have substantially impacted human populations. The most dramatic pandemic of influenza H1N1 occurred during 1918-1919 producing significant morbidity and mortality worldwide. In the 20th century, two other major pandemics took place but they were the H2N2 and H3N2 reassorted influenza strains. In 1976, a small outbreak of swine-related H1N1 in the U.S. led to a national scare but without any significant public health impact. More recently, in April 2009, in Mexico, and subsequently worldwide, an influenza (H1N1) triple reassortant strain produced >200,000 laboratory-confirmed cases and resulted in >2000 deaths. In August 2009, WHO declared this outbreak as the first influenza pandemic of the 21(st) century. It is critical to apply lessons learned during previous pandemics to mitigate the public health impact of the ongoing influenza pandemic in 2009. In particular, it is useful to compare the events in Mexico in 2009 to those during the Spanish influenza pandemic of 1918-1919.

Clinical, epidemiologic characteristics of foreign-born Latinos with HIV/AIDS at an urban HIV clinic.

Latinos represent a growing number of persons with HIV/AIDS in the United States. Reports of clinical features and therapeutic outcomes of this population are limited. We performed a retrospective cohort study of 75 foreign-born Latinos seen at the Grady Infectious Disease Program in Atlanta between January 2000 and August 2002. Of these, 72% were men with a median age of 38.5 years. The most common risk factor for HIV among the men was having sex with men. Median CD4 count at the time of diagnosis was 119/microL. Most were receiving antiretroviral therapy, with 91% achieving an undetectable HIV RNA level. In a multivariable analysis, men were more likely than women to have a history of sexually transmitted infections, to hav received a diagnosis at a lower CD4 count, and to have virologic failure after achieving an undetectable HIV RNA level while receiving antiretroviral therapy. In foreign-born Latinos, HIV disease is usually diagnosed at an advanced stage, but when antiretroviral therapy is administered, many achieve an undetectable HIV RNA level. However, a sustained virologic response is difficult to achieve in men.

Antiretroviral therapy in HIV-positive women is associated with increased apolipoproteins and total cholesterol.

OBJECTIVES: Dyslipidemia has become a common problem in HIV disease, especially in patients on combination antiretroviral (ARV) therapy. However, little data are available to evaluate lipid abnormalities in women on ARV therapy. METHODS: Using a cross-sectional design, the prevalence of abnormal plasma lipid and lipoprotein concentrations as well as other biomarkers for vascular disease was determined in 184 HIV-positive women from 2 HIV clinics in Atlanta during 2002. RESULTS: Most of the women were African American (89%), with median age of 41 years (range 21-72); 6% were diabetic, 44% smoked, and 67% were overweight. ARV therapy defined the comparison groups that included treatment with a protease inhibitor (PI)-based regimen for more than 3 months in 76 (41%), treatment with a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen for more than 3 months in 38 (20%), and no ARV therapy for the past 3 months in 70 (38%). Women being treated with a PI or NNRTI had higher total cholesterol and triglyceride levels than patients on no therapy (P < 0.05 for each). Women treated with either PIs or NNRTIs had significantly higher apolipoprotein B and apolipoprotein C-III levels than patients on no therapy (P < 0.01 for each). CONCLUSIONS: In this cross-sectional study of HIV-infected women, either PI or NNRTI therapy elevated levels of total cholesterol and specific apolipoproteins. These findings, on a background of an older population with additional risk factors of smoking, obesity, and diabetes, may lead to future atherosclerotic events in these patients.

Infecciones nosocomiales en una unidad de cuidados intensivos neonatales / Nosocomial infections in a neonatal intensive care unit

Antecedentes: Los recién nacidos presentan las tasas más elevadas de infección nosocomial (IN) y estas infecciones son una causa importante de morbi-mortalidad, especialmente en las áreas de cuidados intensivos. Objetivo: Determinar la frecuencia, el sitio y los principales microorganismos causales de infecciones nosocomiales en una Unidad de Cuidados Intensivos Neonatales (UCIN). Métodos: Se realizó un estudio descriptivo de 1994 a 1998, en el cual se analizaron las infecciones nosocomiales en la UCIN del Hospital Infantil de México "Federico Gómez". Los datos se recabaron del sistema de vigilancia del Departamento de Epidemiología. Resultados: Se revisaron en total 484 episodios de infección nosocomial ocurridos en cinco años. La tasa promedio fue de 35.8 infecciones por cada 100 egresos (IC 95 por ciento 33.3-38.5 por ciento). Los sitios de infección más frecuentes fueron las bacteremias primarias (27.9 por ciento), las neumonías (20.9 por ciento), la sepsis (16.5 por ciento) y las infecciones de vías urinarias (8.9 por ciento). Se aisló un microorganismo en el 61 por ciento de todas las infecciones reportadas (296/484). Los principales agentes aislados fueron Staphylococcus coagulasa negativa (SCoN) (29.7 por ciento) y Klebsiella spp. (18.6 por ciento). Respecto al tiempo de adquisición de la IN, su frecuencia es máxima entre el 7§ y 9§ día de estancia hospitalaria. La mortalidad en neonatos con infección nosocomial fue del 15.5 por ciento (IC 95 por ciento 12.4 - 19.0 por ciento). Conclusiones: La prevención de las infecciones nosocomiales en recién nacidos es uno de los programas prioritarios en el control de infecciones en pediatría, ya que afectan a más de un tercio de los neonatos en estado crítico. Los programas dirigidos a la prevención de IN en estos pacientes se deben enfocar a mejorar los procesos de atención.

Comparative tuberculin reactivity to two protein derivatives

Objetivo. Evaluar la reactividad de la tuberculina en estudiantes de medicina y conocer la utilidad del RT-23 (PPD 2UT) producido en México. Diseño. Se efectuó un estudio comparativo y ciego que incluyó 98 estudiantes (69 del primer año de medicina y 29 del quinto año). Se les efectuó prueba de Mantoux con RT-23 y PPD-5UT asignada aleatoriamente a cada antebrazo, para ser leída 48 horas más tarde. Frente al 5UT-PPD, el RT-23 mostró sensibilidad de 87 por ciento y especificidad de 92 por ciento. La reactiviad a RT-23 frente al 5UT-PPD fue semejante en la población estudiada. Se observó induración igual o mayor a 10 mm en el 16 por ciento de los estudiantes de primer año y en 41 por ciento de los de quinto (X² = 6.00, P = 0.0014) lo cual da una tasa de conversión anual de 5.1 por ciento. Esta alta tasa hace conveniente establecer programas preventivos y de diagnóstico temprano de TB en trabajadores de la salud

Desecho injustificado de sangre de transfusión por anticuerpos contra Brucella / Unjustified discarding of transfusional blood due to brucella antibodies

Objetivos. Comparar la microaglutinación en placa (MAP) contra una prueba estándar de oro (aglutinación en tubo: SAT) para la determinación de anticuerpos contra Brucella en unidades de sangre para transfusión, y evaluar la utilidad de la MAP para desechar unidades positivas. Diseño. Estudio prospectivo, comparativo y transversal. Sitio. Ciudad de León, Guanajuato, zona endémica de brucelosis. Muestra. Unidades de sangre rechazada para donación por tres bancos de sangre por tener anticuerpos antibrucella determinados por MAP (N=48) y 48 controles de donadores aceptados. Procedimientos. Determinación de anticuerpos contra Brucella mediante MAP y ST en las 96 muestras. Resultados. Los resultados fueron negativos con ambas pruebas en los controles. En los rechazados hubo sólo siete sueros con títulos ò 1:80 por SAT, por lo que pudieran haberse eliminado inadecuadamente 41 unidades (85 por ciento) por utilizar la MAP como prueba única de rechazo. La MAP mostró sensibilidad y valor predictivo negativo de 100 por ciento, especificidad de 81 por ciento y valor predictivo positivo de 29 por ciento. Conclusión. Los títulos de anticuerpos contra Brucella obtenidos por MAP deben confirmarse por aglutinación en tubo, pues existe una alta proporción de desecho injustificado de sangre