Effects of 2019's social protests on emergency health services utilization and case severity in Santiago, Chile: a time-series analysis

Visual-functional impact of people affected by severe ocular trauma during social protests in Chile in 2019

PURPOSE

To determine the impact on the functionality associated with visual loss (VFIP) in people with severe ocular trauma (SOT) caused by kinetic impact projectiles used in police crowd control through a prioritization tool in people admitted to a rehabilitation program in Santiago de Chile from December 02, 2019, to November 13, 2020.

METHODS

A cross-sectional descriptive study of SOT victims (N = 85), average age 31.4 ± 11.9. The data were recorded through a new 9-item screening instrument for assessment and prioritization of rehabilitation created for this emergency scenario.

RESULTS

The impact of the use of kinetic weapons resulted in monocular blindness in the majority of those affected (n = 68; 80.0%). The highest VFIP observed was among young men from lower social strata. There were extreme difficulties in the performance of productive tasks (occupational and/or educational) (n = 42; 49.4%) and the pursuit of hobbies and pastimes (n = 23; 27.1%), as well as a high difficulty in adapting to changes in brightness (n = 29; 34.1%) and handling objects accurately (n = 22; 25.9%).

CONCLUSION

The use of kinetic weapons for crowd control resulted in high and extreme VFIP and, in most cases, monocular blindness, causing major difficulties in work, study, and development of hobbies and pastimes in the affected population, highlighting the urgent need for effective rehabilitative care, which requires special attention in order to generate an adequate rehabilitation program. The use of kinetic weapons for crowd control contravenes international goals, policies, and plans set by the WHO and the International Agency for the Prevention of Blindness on strategies to prevent avoidable blindness worldwide until 2020. It is essential to ban the use of these weapons in Chile and worldwide, as well as to revise police protocols for crowd control.

Excess mortality during the COVID-19 pandemic (2020-2021) in an urban community of Bangladesh

Measuring COVID-19-related mortality is vital for making public health policy decisions. The magnitude of COVID-19-related mortality is largely unknown in low- and middle-income countries (LMICs), including Bangladesh, due to inadequate COVID-19 testing capacity and a lack of robust civil registration and vital statistics systems. Even with the lack of data, cemetery-based death records in LMICs may provide insightful information on potential COVID-19-related mortality rates; nevertheless, there is a dearth of research employing cemetery-based death records. This study aimed to assess the excess mortality during the COVID-19 pandemic in an urban setting in Bangladesh using a cemetery-based death registration dataset. A total of 6,271 deaths recorded between January 2015 and December 2021 were analysed using a Bayesian structural time series model. Exploratory analysis found that the average monthly number of deaths was 69 during the pre-COVID-19 period (January 2015-February 2020), but significantly increased to 92 during the COVID-19 period (March 2020-December 2021). The increase in male deaths was twice as large as the increase in female deaths. Model-based results were not statistically significant (relative effect 17%, 95% credible interval: -18%, 57%), but there was an overall increasing trend during the COVID-19 period, and specific months or shorter periods had a substantial increase. This first-of-its-kind study in Bangladesh has assessed the excess mortality in an urban community during the COVID-19 pandemic. Cemetery-based death registration appears to aid in tracking population mortality, especially in resource-limited countries where collecting data on the ground is challenging during crisis periods; however, additional large-scale research is required.

Chile's public healthcare sector hypertension control rates before and during the pandemic and HEARTS implementation

Hypertension (arterial blood pressure ≥ 140/90 mmHg) is a risk factor for cardiovascular diseases, with the greatest burden of attributable deaths in Chile, having a national prevalence of 27.6%. In 2018, the implementation of HEARTS begun in primary health care centers of the Public Health System, with the aim of achieving increase in control rates, by raising the proportion of hypertensive individuals who meet blood pressure goals (< 140/90 mmHg for individuals 15-79 years old and of 150/90 mmHg for individuals 80 years and older), and thus contributing to reduce cardiovascular morbidity and mortality associated with this condition. This is a descriptive study that follows average treatment and control rates from the Public Health System between 2017-2021 obtained from health centers statistics reports during HEARTS implementation. Treatment and control rates remained at 57% and 39% respectively between 2017-2019. Between 2020 and 2021, in the context of the SARS-CoV-2 pandemic, treatment and control rates decreased very significantly, reaching 46% and 26%, respectively, in December 2021, even though the number of centers reporting the implementation of HEARTS increased from 227 to 387 in this same period. Prior to the pandemic, during the last quarter of 2019, a decrease in cardiovascular health controls was already observed as a result of social protests. In light of the results, the technical pillars of the HEARTS Initiative have an important role in helping to recover the population control rates reached in 2019 and increasing the speed to achieve better hypertension control rates.