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Manterola C, Rivadeneira J, Rojas-Pincheira C, Otzen T, Delgado H, Sotelo C, Sanhueza A. Cholangiohydatidosis. Clinical features, postoperative complications and hospital mortality. A systematic review. PLoS Negl Trop Dis 2024; 18:e0011558. [PMID: 38452054 PMCID: PMC10950226 DOI: 10.1371/journal.pntd.0011558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 03/19/2024] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Cholangiohydatidosis (CH) is an evolutionary complication of hepatic cystic echinococcosis, associated with increased morbidity and mortality. The aim of this study was to describe the available evidence regarding clinical characteristics of CH, postoperative complications and hospital mortality. METHODOLOGY/PRINCIPAL FINDINGS Systematic review. Studies related to CH with no language or publication restriction were included. Sensitive searches were performed in Trip Database, SciELO, BIREME-BVS, WoS, PubMed, EMBASE and SCOPUS. MeSH and free terms were used, including articles up to April 2023. The main outcome variables were postoperative complications and hospital mortality; the secondary ones were publication year, origin and design of primary studies, main clinical manifestation, anatomical location and type of cysts, hospital stay, surgical procedure performed, reinterventions; and methodological quality of primary studies, which was assessed using MInCir-T and MInCir-P scales. Descriptive statistics, calculation of weighted averages and their comparison by least squares logistic regression were applied. 446 studies were retrieved from the searches performed, 102 of which met the inclusion and exclusion criteria. The studies analyzed represent 1241 patients. The highest proportion of articles was published in the last decade (39.2%). Reports are mainly from Turkey (28.4%), Greece (9.8%), Morocco and Spain (8.8% each). With a weighted mean of 14.3 days of hospital stance; it was verified that 26.2% of patients developed postoperative complications (74,3% Clavien y Dindo III y IV), 6.7% needed re-interventions, and 3.7% died. When comparing the variables age, postoperative complications, hospital mortality, and reinterventions in two periods of time (1982-2006 vs. 2007-2023), no statistically significant differences were found. When applying the MInCir-T and MInCir-P scales, the methodological quality of the primary studies was 9.6±1.1 and 14.5±4.3 points, respectively. CONCLUSION/SIGNIFICANCE CH is associated with severe postoperative complications and significant hospital mortality, independent of the development of therapeutic support associated with the passage of time.
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Affiliation(s)
- Carlos Manterola
- Center for Morphological and Surgical Studies. Universidad de La Frontera. Chile
- PhD. Program in Medical Science, Universidad de La Frontera, Chile
- Núcleo Milenio de Sociomedicina. Santiago, Chile
| | - Josue Rivadeneira
- PhD. Program in Medical Science, Universidad de La Frontera, Chile
- Núcleo Milenio de Sociomedicina. Santiago, Chile
- Zero Biomedical Research. Quito, Ecuador
| | - Claudio Rojas-Pincheira
- PhD. Program in Medical Science, Universidad de La Frontera, Chile
- Núcleo Milenio de Sociomedicina. Santiago, Chile
| | - Tamara Otzen
- PhD. Program in Medical Science, Universidad de La Frontera, Chile
- Núcleo Milenio de Sociomedicina. Santiago, Chile
| | - Hugo Delgado
- PhD. Program in Medical Science, Universidad de La Frontera, Chile
| | | | - Antonio Sanhueza
- Pan American Health Organization, Washington, United States of America
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Duran P, Soliz P, Mujica OJ, Cueva DA, Serruya SJ, Sanhueza A. Neonatal mortality in countries of the Americas, 2000-2020: trends, inequalities, and target-setting. Rev Panam Salud Publica 2024; 48:e4. [PMID: 38259254 PMCID: PMC10801815 DOI: 10.26633/rpsp.2024.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/14/2023] [Indexed: 01/24/2024] Open
Abstract
Objective To analyze temporal trends and inequalities in neonatal mortality between 2000 and 2020, and to set neonatal mortality targets for 2025 and 2030 in the Americas. Methods A descriptive ecological study was conducted using 33 countries of the Americas as units of analysis. Both the percentage change and average annual percentage change in neonatal mortality rates were estimated. Measurements of absolute and relative inequality based on adjusted regression models were used to assess cross-country social inequalities in neonatal mortality. Targets to reduce neonatal mortality and cross-country inequalities were set for 2025 and 2030. Results The estimated regional neonatal mortality rate was 12.0 per 1 000 live births in 2000-2004 and 7.4 per 1 000 live births in 2020, representing a percentage change of -38.3% and an average annual percentage change of -2.7%. National average annual percentage changes in neonatal mortality rates between 2000-2004 and 2020 ranged from -5.5 to 1.9 and were mostly negative. The estimated excess neonatal mortality in the 20% most socially disadvantaged countries, compared with the 20% least socially disadvantaged countries, was 17.1 and 9.8 deaths per 1 000 live births in 2000-2004 and 2020, respectively. Based on an extrapolation of recent trends, the regional neonatal mortality rate is projected to reach 7.0 and 6.6 neonatal deaths per 1 000 live births by 2025 and 2030, respectively. Conclusions National and regional health authorities need to strengthen their efforts to reduce persistent social inequalities in neonatal mortality both within and between countries.
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Affiliation(s)
- Pablo Duran
- Latin American Center for Perinatology, Women’s Health, and Reproductive HealthMontevideoUruguayLatin American Center for Perinatology, Women’s Health, and Reproductive Health, Montevideo, Uruguay.
| | - Patricia Soliz
- Department of Evidence and Intelligence for Action in HealthPan American Health OrganizationWashington, D.C.United States of AmericaDepartment of Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, D.C., United States of America.
| | - Oscar J. Mujica
- Department of Evidence and Intelligence for Action in HealthPan American Health OrganizationWashington, D.C.United States of AmericaDepartment of Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, D.C., United States of America.
| | - Daniel A. Cueva
- Independent ConsultantTarragonaSpainIndependent Consultant, Tarragona, Spain.
| | - Suzanne J. Serruya
- Latin American Center for Perinatology, Women’s Health, and Reproductive HealthMontevideoUruguayLatin American Center for Perinatology, Women’s Health, and Reproductive Health, Montevideo, Uruguay.
| | - Antonio Sanhueza
- Department of Evidence and Intelligence for Action in HealthPan American Health OrganizationWashington, D.C.United States of AmericaDepartment of Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, D.C., United States of America.
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Sanhueza A, Caffe S, Araneda N, Soliz P, San Román-Orozco O, Baer B. Homicide among young people in the countries of the Americas. Rev Panam Salud Publica 2023; 47:e108. [PMID: 37489238 PMCID: PMC10361419 DOI: 10.26633/rpsp.2023.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/27/2023] [Indexed: 07/26/2023] Open
Abstract
Objective To examine the homicide trends among young people (10-24 years), adolescents (10-19 years), and young adults (20-24 years) in 33 countries in the Americas between 2000 and 2019, with a focus on inequalities between countries in the burden of homicides. Methods An ecological study was performed using estimated deaths from 33 countries. Age-adjusted rates, percentage change (PC), average annual percentage change (AAPC), and relative risk (RR) were estimated; besides, analysis on social inequalities was performed. Results In the Americas between 2000 and 2019, homicide has been the leading cause of death with 54 515 deaths on average each year and an age-adjusted rate of 23.6 per 100 000 among young people. The highest rate was found in the Andean subregion (41.1 per 100 000 young people), which also produced the highest decrease (PC = -37.1% and AAPC = -2.4%) in the study period. The risk of homicide in young men is 8.1 times the risk in young women, and the risk in young adults is 2.5 times the risk in adolescents. The three countries with highest risk of homicide for young people are Venezuela (relative risk [RR] = 35.1), El Salvador (RR = 28.1), and Colombia (RR = 26.7). The estimated excess mortality was 26.8 homicides per 100 000 in the poorest 20% of countries compared to the richest 20% of countries in the period 2000-2009, and it decreased to 13.9 in the period 2010-2019. Conclusions The results of this study add to the knowledge of homicide among young people and can be used to inform policy and programming in countries. Given the great burden of homicide on young people in the region, it is critical that prevention opportunities are maximized, beginning early in life.
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Affiliation(s)
- Antonio Sanhueza
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Sonja Caffe
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Nelson Araneda
- University of La FronteraTemucoChileUniversity of La Frontera, Temuco, Chile
| | - Patricia Soliz
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Oscar San Román-Orozco
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Britta Baer
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
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Mujica OJ, Sanhueza A, Carvajal-Velez L, Vidaletti LP, Costa JC, Barros AJD, Victora CG. Recent trends in maternal and child health inequalities in Latin America and the Caribbean: analysis of repeated national surveys. Int J Equity Health 2023; 22:125. [PMID: 37393277 PMCID: PMC10314462 DOI: 10.1186/s12939-023-01932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/07/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Although most Latin American and the Caribbean (LAC) countries made important progress in maternal and child health indicators from the 1990s up to 2010, little is known about such progress in the last decade. This study aims at documenting progress for each country as a whole, and to assess how within-country socioeconomic inequalities are evolving over time. METHODS We identified LAC countries for which a national survey was available between 2011-2015 and a second comparable survey in 2018-2020. These included Argentina, Costa Rica, Cuba, the Dominican Republic, Guyana, Honduras, Peru, and Suriname. The 16 surveys included in the analysis collected nationally representative data on 221,989 women and 152,983 children using multistage sampling. Twelve health-related outcomes were studied, seven of which related to intervention coverage: the composite coverage index, demand for family planning satisfied with modern methods, antenatal care (four or more visits and eight or more visits), skilled attendant at birth, postnatal care for the mother and full immunization coverage. Five additional impact indicators were also investigated: stunting prevalence among under-five children, tobacco use by women, adolescent fertility rate, and under-five and neonatal mortality rates. For each of these indicators, average annual relative change rates were calculated between the baseline and endline national level estimates, and changes in socioeconomic inequalities over time were assessed using the slope index of inequality. RESULTS Progress over time and the magnitude of inequalities varied according to country and indicator. For countries and indicators where baseline levels were high, as Argentina, Costa Rica and Cuba, progress was slow and inequalities small for most indicators. Countries that still have room for improvements, such as Guyana, Honduras, Peru and Suriname, showed faster progress for some but not all indicators, although also had wider inequalities. Among the countries studied, Peru was the top performer in terms of increasing coverage and reducing inequalities over time, followed by Honduras. Declines in family planning and immunization coverage were observed in some countries, and the widest inequalities were present for adolescent fertility and antenatal care coverage with eight or more visits. CONCLUSIONS Although LAC countries are well placed in terms of current levels of health indicators compared to most low- and middle-income countries, important inequalities remain, and reversals are being observed in some areas. More targeted efforts and actions are needed in order to leave no one behind. Monitoring progress with an equity lens is essential, but this will require further investment in conducting surveys routinely.
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Affiliation(s)
- Oscar J Mujica
- Pan American Health Organization (PAHO), 525 23Rd Street NW, Washington, DC, 20037, USA.
| | - Antonio Sanhueza
- Pan American Health Organization (PAHO), 525 23Rd Street NW, Washington, DC, 20037, USA
| | - Liliana Carvajal-Velez
- United Nations International Children Emergency Fund (UNICEF), New York City, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Luis Paulo Vidaletti
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, Brazil
| | - Janaína C Costa
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, Brazil
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Sanhueza A, Mujica OJ, Soliz PN, Cox AL, de Mucio B. Scenarios of maternal mortality reduction by 2030 in the Americas: insights from its tempo. Int J Equity Health 2023; 22:121. [PMID: 37381010 PMCID: PMC10303897 DOI: 10.1186/s12939-023-01938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 06/18/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND The enduring threat of maternal mortality to health worldwide and in the Americas has been recognized in the global and regional agendas and their targets to 2030. To inform the direction and amount of effort needed to meet those targets, a set of equity-sensitive regional scenarios of maternal mortality ratio (MMR) reduction based on its tempo or speed of change from baseline year 2015 was developed. METHODS Regional scenarios by 2030 were defined according to: i) the MMR average annual rate of reduction (AARR) needed to meet the global (70 per 100,000) or regional (30 per 100,000) targets and, ii) the horizontal (proportional) or vertical (progressive) equity criterion applied to the cross-country AARR distribution (i.e., same speed to all countries or faster for those with higher baseline MMR). MMR average and inequality gaps -absolute (AIG), and relative (RIG)- were scenario outcomes. RESULTS At baseline, MMR was 59.2 per 100,000; AIG was 313.4 per 100,000 and RIG was 19.0 between countries with baseline MMR over twice the global target and those below the regional target. The AARR needed to meet the global and regional targets were -7.60% and -4.54%, respectively; baseline AARR was -1.55%. In the regional MMR target attainment scenario, applying horizontal equity would decrease AIG to 158.7 per 100,000 and RIG will remain invariant; applying vertical equity would decrease AIG to 130.9 per 100,000 and RIG would decrease to 13.5 by 2030. CONCLUSION The dual challenge of reducing maternal mortality and abating its inequalities will demand hefty efforts from countries of the Americas. This remains true to their collective 2030 MMR target while leaving no one behind. These efforts should be mainly directed towards significantly speeding up the tempo of the MMR reduction and applying sensible progressivity, targeting on groups and territories with higher MMR and greater social vulnerabilities, especially in a post-pandemic regional context.
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Affiliation(s)
- Antonio Sanhueza
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC USA
| | - Oscar J. Mujica
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC USA
| | - Patricia N. Soliz
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC USA
| | - Adrienne L. Cox
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC USA
| | - Bremen de Mucio
- Latin American Center for Perinatology, Women’s Health, and Reproductive Health (CLAP/WR), Pan American Health Organization, PAHO/WHO, Montevideo, Uruguay
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Sanhueza A, Costa JC, Mújica OJ, Carvajal-Velez L, Caffe S, Victora C, Barros AJD. Trends and inequities in adolescent childbearing in Latin American and Caribbean countries across generations and over time: a population-based study. Lancet Child Adolesc Health 2023; 7:392-404. [PMID: 37208093 PMCID: PMC10191863 DOI: 10.1016/s2352-4642(23)00077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/25/2023] [Accepted: 03/07/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Latin America and the Caribbean present the second highest adolescent fertility rate in the world, only after sub-Saharan Africa, and have reached the third position globally in the incidence of motherhood in adolescence. We aimed to explore trends and inequities in adolescent childbearing in the region. METHODS We used nationally representative household surveys from Latin American and Caribbean countries to address trends in early childbearing (proportion of women having their first livebirth before age 18 years) over generations and in adolescent fertility rates (AFRs; livebirths per 1000 women aged 15-19 years) over time. For early childbearing, we analysed the most recent survey conducted since 2010 from 21 countries (2010-20); for AFR, we analysed nine countries with two or more surveys, with the most recent being conducted from 2010 onwards. For both indicators, variance-weighted least-square regression was used to estimate the average absolute changes (AACs) at the national level and by wealth (bottom 40% vs top 60%), urban versus rural residence, and ethnicity. FINDINGS Among 21 countries studied, we noted a decrease in early childbearing along generations in 13 of them, with declines varying from -0·6 percentage points (95% CI -1·1 to -0·1) in Haiti to -2·7 percentage points (-4·0 to -1·4) in Saint Lucia. We observed increases over generations in Colombia (1·2 percentage points [0·8 to 1·5]) and Mexico (1·3 percentage points [0·5 to 2·0]) and no changes in Bolivia and Honduras. The fastest early childbearing decline occurred among rural women, whereas no clear pattern was observed for wealth groups. Decreasing estimates from oldest to youngest generations were found among Afro-descendants and non-Afro-descendant and non-indigenous groups, but results were mixed for indigenous people. All nine countries with data for AFR presented reductions over time (-0·7 to -6·5 births per 1000 women per year), with the steepest declines observed in Ecuador, Guyana, Guatemala, and the Dominican Republic. In general, adolescents in rural areas and the poorest adolescents had the largest reductions in AFR. If current trends persist, by 2030 most countries will present AFR values ranging between 45 and 89 births per 1000 women, with notable wealth-related inequalities. INTERPRETATION Our results indicate a reduction in AFR in Latin American and Caribbean countries that was not necessarily accompanied by a decrease in early childbearing overall. Large inequalities both between countries and within countries were observed, with no clear reduction over time. Understanding trends in adolescent childbearing and its determinants is essential for planning and designing programmes to ensure the desired reductions in rates and gaps across population subgroups. FUNDING PAHO, Bill & Melinda Gates Foundation, and Wellcome Trust. TRANSLATIONS For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | - Janaína Calu Costa
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
| | | | - Liliana Carvajal-Velez
- United Nations Children's Fund, New York, NY, USA; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sonja Caffe
- Pan-American Health Organization, Washington, DC, USA
| | - Cesar Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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Mujica OJ, Zhang D, Hu Y, Espinosa IC, Araneda N, Dragomir A, Luta G, Sanhueza A. Inequalities in Violent Death across Income Levels among Young Males and Females in Countries of the Americas. Int J Environ Res Public Health 2023; 20:5256. [PMID: 37047871 PMCID: PMC10094469 DOI: 10.3390/ijerph20075256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/12/2023] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Violent deaths (i.e., those due to road traffic injury, homicide, and suicide) are among the most important causes of premature and preventable mortality in young people. This study aimed at exploring inequalities in violent death across income levels between males and females aged 10 to 24 years from the Americas in 2015, the SDG baseline year. METHODS In a cross-sectional ecological study design, eleven standard summary measures of health inequality were calculated separately for males and females and for each cause of violent death, using age-adjusted mortality rates and average income per capita for 17 countries, which accounted for 87.9% of the target population. RESULTS Premature mortality due to road traffic injury and homicide showed a pro-poor inequality pattern, whereas premature mortality due to suicide showed a pro-rich inequality pattern. These inequalities were statistically significant (p < 0.001), particularly concentrated among young males, and dominated by homicide. The ample array of summary measures of health inequality tended to generate convergent results. CONCLUSIONS Significant inequalities in violent death among young people seems to be in place across countries of the Americas, and they seem to be socially determined by both income and gender. These findings shed light on the epidemiology of violent death in young people and can inform priorities for regional public health action. However, further investigation is needed to confirm inequality patterns and to explore underlying mechanisms, age- and sex-specific vulnerabilities, and gender-based drivers of such inequalities.
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Affiliation(s)
| | - Dihui Zhang
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC 20057, USA
| | - Yi Hu
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC 20057, USA
| | - Isabel C. Espinosa
- T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Nelson Araneda
- Department of Education, University of La Frontera, Temuco 4811230, Chile
| | - Anca Dragomir
- Department of Oncology, Georgetown University, Washington, DC 20057, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC 20057, USA
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Sanhueza A, Carvajal L, Cueva DA, Caffe S, Camacho AV, Berroterán MA, Horowitz D, Gordillo-Tobar A, Mujica OJ. La iniciativa Todas las Mujeres Todos los Niños brinda apoyo a los países de América Latina y el Caribe para reducir las desigualdades sociales en la salud. Rev Panam Salud Publica 2022; 46:e201. [PMID: 36382245 PMCID: PMC9642824 DOI: 10.26633/rpsp.2022.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/26/2022] [Indexed: 11/09/2022] Open
Abstract
La iniciativa Todas las Mujeres Todos los Niños América Latina y el Caribe (EWEC-LAC, por su sigla en inglés) se estableció en el 2017 como un mecanismo interinstitucional regional. Coordina la implementación regional de la Estrategia Mundial para la Salud de la Mujer, el Niño y el Adolescente 2016-2030 en América Latina y el Caribe (ALC), lo que incluye su adaptación a necesidades específicas de la Región, para poner fin a las muertes evitables, garantizar la salud y el bienestar, y ampliar los entornos propicios para la salud y el bienestar de mujeres, niños y adolescentes. Para promover el logro equitativo de estos objetivos, los tres grupos de trabajo de EWEC-LAC apoyan colectivamente a los países de ALC en la medición y el monitoreo de las desigualdades sociales en la salud, la promoción de la disminución de estas y el diseño e implementación de estrategias, políticas e intervenciones orientadas a la equidad. Este apoyo para cerrar las brechas actuales asegura que nadie se quede atrás. Los miembros de la iniciativa EWEC-LAC incluyen al UNFPA, la OPS, ONU-Mujeres, ONUSIDA, UNICEF, el Banco Mundial, el Banco Interamericano de Desarrollo, USAID, la Alianza Regional Neonatal para ALC y el Grupo de Trabajo Regional para la Reducción de la Mortalidad Materna. A la fecha, EWEC-LAC ha desarrollado y recopilado herramientas y recursos innovadores, y ha comenzado a colaborar con los países para utilizarlos a fin de reducir las brechas en la equidad. Estos incluyen un marco de medición de las desigualdades sociales en la salud, herramientas de promoción de datos, como un tablero de datos para visualizar tendencias en las desigualdades sociales en la salud, una metodología para establecer metas en la disminución de las desigualdades, y un compendio de herramientas y métodos para identificar y abordar las desigualdades sociales en la salud. EWEC-LAC ha trabajado en la Región para enfatizar la importancia de reconocer estas desigualdades a los niveles sociales y políticos, y ha abogado por su disminución. La atención para cerrar las brechas de equidad en la salud es cada vez más crítica frente a la pandemia de COVID-19, que ha agudizado las vulnerabilidades existentes. Los sistemas de salud más equitativos estarán mejor preparados para hacer frente a futuras crisis de salud.
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Affiliation(s)
- Antonio Sanhueza
- Departamento de Evidencia e Inteligencia para la Acción en la Salud, Organización Panamericana de la Salud, Washington D. C. (Estados Unidos)
| | - Liliana Carvajal
- División de Planificación y Supervisión del Análisis de Datos, Sección de Datos y Análisis, UNICEF, Nueva York (Estados Unidos)
- Departamento de Salud Pública Mundial, Instituto Karolinska, Estocolmo (Suecia)
| | | | - Sonja Caffe
- Departamento de Familia, Promoción y Curso de Vida, Organización Panamericana de la Salud, OPS/OMS, Washington, D.C. (Estados Unidos)
| | - Alma Virginia Camacho
- Fondo de Población de las Naciones Unidas, Oficina Regional para América Latina y el Caribe (UNFPA LACRO), Ciudad de Panamá (Panamá)
| | - María Alejandra Berroterán
- Oficial de Comunicaciones, Oficina Regional para América Latina y el Caribe, UNICEF, Ciudad de Panamá( Panamá)
| | - Deborah Horowitz
- Oficina de América Latina y el Caribe, Agencia de Estados Unidos para el Desarrollo Internacional, Washington, D.C. (Estados Unidos)
| | | | - Oscar J. Mujica
- Departamento de Evidencia e Inteligencia para la Acción en la Salud, Organización Panamericana de la Salud, Washington D. C. (Estados Unidos)
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Costa JC, Mujica OJ, Gatica-Domínguez G, del Pino S, Carvajal L, Sanhueza A, Caffe S, Victora CG, Barros AJ. Inequalities in the health, nutrition, and wellbeing of Afrodescendant women and children: A cross-sectional analysis of ten Latin American and Caribbean countries. Lancet Reg Health Am 2022; 15:100345. [PMID: 36405302 PMCID: PMC9669334 DOI: 10.1016/j.lana.2022.100345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Afrodescendants are systematically affected by discrimination in the Americas and few multi-country studies addressed ethnic inequalities in health and wellbeing in the region. We aimed to investigate gaps in coverage of key health outcomes and socioeconomic inequalities between Afrodescendants and non-Afrodescendants populations in Latin American and Caribbean countries. METHODS Using national household surveys (2011-2019) from ten countries, we analyzed absolute inequalities between Afrodescendants and a comparison group that includes non-Afrodescendants and non-Indigenous individuals (henceforth non-Afrodescendants) across 17 indicators in the continuum of reproductive, maternal, newborn, child, and adolescent health. These include indicators of family planning, antenatal care, delivery assistance, child nutrition, immunization coverage, child protection, access to improved water, sanitation and hygiene, adolescent fertility, and early childhood mortality. Inequalities between country-specific subgroups of Afrodescendants were also explored. The slope index of inequality was used to assess wealth-based inequalities within each ethnic group. FINDINGS Afrodescendants represented from 2·8% (Honduras) to 59·1% (Brazil) of the national samples. Of the 128 combinations of country and indicators with data, Afrodescendants fared worse in 78 (of which 33 were significant) and performed better in 50 (15 significant). More systematic disadvantages for Afrodescendants were found for demand for family planning satisfied, early marriage, and household handwashing and sanitation facilities. In contrast, Afrodescendants tended to present lower c-section rates and lower stunting prevalence. Honduras was the only country where Afrodescendants performed better than non-Afrodescendants in several indicators. Wealth gaps among Afrodescendants were wider than those observed for non-Afrodescendants for most indicators and across all countries. INTERPRETATION Gaps in health outcomes between Afrodescendants and non-Afrodescendants were observed in most countries, with more frequent disadvantages for the former although, in many cases, the gaps were reversed. Wealth inequalities within Afrodescendants tended to be wider than for non-Afrodescendants. FUNDING Pan American Health Organization, Bill and Melinda Gates Foundation, and the Wellcome Trust.
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Affiliation(s)
- Janaína Calu Costa
- International Center for Equity in Health, Federal University of Pelotas, Brazil
| | | | | | | | - Liliana Carvajal
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Sonja Caffe
- Pan American Health Organization, Washington D.C., USA
| | - Cesar G. Victora
- International Center for Equity in Health, Federal University of Pelotas, Brazil
| | - Aluísio J.D. Barros
- International Center for Equity in Health, Federal University of Pelotas, Brazil
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Sanhueza A, Carvajal-Vélez L, Mújica OJ, Vidaletti LP, Victora CG, Barros AJ. [SDG3-related inequalities in women's, children's and adolescents' health: an SDG monitoring baseline for Latin America and the Caribbean using national cross-sectional surveysDesigualdades relacionadas ao ODS 3 na saúde da mulher, da criança e do adolescente: linha de base para o monitoramento do ODS na América Latina e no Caribe por meio de pesquisas transversais nacionais]. Rev Panam Salud Publica 2022; 46:e100. [PMID: 36016836 PMCID: PMC9395275 DOI: 10.26633/rpsp.2022.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives Latin America and the Caribbean (LAC) countries have made important progress towards achieving the Sustainable Development Goal (SDG) targets related to health (SDG3) at the national level. However, vast within-country health inequalities remain. We present a baseline of health inequalities in the region, against which progress towards the SDGs can be monitored. Setting We studied 21 countries in LAC using data from Demographic and Health Surveys and Multiple Indicator Cluster Survey carried out from 2011 to 2016. Participants The surveys collect nationally representative data on women and children using multistage sampling. In total, 288 207 women and 195 092 children made part of the surveys in the 21 countries. Outcome measures Five health intervention indicators were studied, related to reproductive and maternal health, along with adolescent fertility and neonatal and under-five mortality rates. Inequalities in these indicators were assessed through absolute and relative measures. Results In most countries, subnational geographical health gradients were observed for nearly all women, child, and adolescent (WCA) indicators. Coverage of key interventions was higher in urban areas and among the richest, compared with rural areas and poorer quintiles. Analyses by woman's age showed that coverage was lower in adolescent girls than older women for family planning indicators. Pro-urban and pro-rich inequalities were also seen for mortality in most countries. Conclusions Regional averages hide important health inequalities between countries, but national estimates hide still greater inequalities between subgroups of women, children and adolescents. To achieve the SDG3 targets and leave no one behind, it is essential to close health inequality gaps within as well as between countries.
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Affiliation(s)
- Antonio Sanhueza
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América
| | - Liliana Carvajal-Vélez
- Fondo de las Naciones Unidas para la Infancia (UNICEF) Nueva York Estados Unidos de América Fondo de las Naciones Unidas para la Infancia (UNICEF), Nueva York, Estados Unidos de América
| | - Oscar J Mújica
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América
| | - Luis Paulo Vidaletti
- Universidad Federal de Pelotas Pelotas Brasil Universidad Federal de Pelotas, Pelotas, Brasil
| | - Cesar G Victora
- Universidad Federal de Pelotas Pelotas Brasil Universidad Federal de Pelotas, Pelotas, Brasil
| | - Aluisio Jd Barros
- Universidad Federal de Pelotas Pelotas Brasil Universidad Federal de Pelotas, Pelotas, Brasil
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Sanhueza A, Carvajal L, Cueva DA, Caffe S, Camacho AV, Berroterán MA, Horowitz D, Gordillo-Tobar A, Mujica OJ. The Every Woman Every Child initiative: supporting countries in Latin America and the Caribbean to reduce social inequalities in health. Int J Equity Health 2022; 21:83. [PMID: 35701816 PMCID: PMC9196148 DOI: 10.1186/s12939-022-01682-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
The Every Woman Every Child Latin America and the Caribbean (EWEC-LAC) initiative was established in 2017 as a regional inter-agency mechanism. EWEC-LAC coordinates the regional implementation of the Global Strategy for Women’s, Children’s and Adolescents’ Health in Latin America and the Caribbean (LAC), including adaptation to region specific needs, to end preventable deaths, ensure health and well-being and expand enabling environments for the health and well-being of women, children and adolescents. To advance the equitable achievement of these objectives, EWEC-LAC’s three working groups collectively support LAC countries in measuring and monitoring social inequalities in health, advocating for their reduction, and designing and implementing equity-oriented strategies, policies and interventions. This support for data-driven advocacy, capacity building, and policy and program solutions toward closing current gaps ensures that no one is left behind. Members of EWEC-LAC include PAHO, UNAIDS, UNFPA, UNICEF, UN WOMEN, the World Bank, the Inter-American Development Bank, USAID, LAC Regional Neonatal Alliance, and the LAC Regional Task Force for the Reduction of Maternal Mortality. To date, EWEC-LAC has developed and collected innovative tools and resources and begun to engage with countries to utilize them to reduce equity gaps. These resources include a framework for the measurement of social inequalities in health, data use and advocacy tools including a data dashboard to visualize trends in social inequalities in health in LAC countries, a methodology for setting targets for the reduction of inequalities, and a compendium of tools, instruments and methods to identify and address social inequalities in health. EWEC-LAC has also engaged regionally to emphasize the importance of recognizing these inequalities at social and political levels, and advocated for the reduction of these gaps. Attention to closing health equity gaps is ever more critical in the face of the COVID-19 pandemic which has exploited existing vulnerabilities. More equitable health systems will be better prepared to confront future health shocks.
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Affiliation(s)
- Antonio Sanhueza
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC, USA.
| | - Liliana Carvajal
- Division of Data Analytics Planning and Monitoring, Data and Analytics Section, UNICEF, NY, New York, USA.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Sonja Caffe
- Family, Promotion and Life Course Department, Pan American Health Organization, PAHO/WHO, Washington, DC, USA
| | - Alma Virginia Camacho
- United Nations Population Fund, Regional Office for Latin American and the Caribbean (UNFPA LACRO), Panama City, Panama
| | - María Alejandra Berroterán
- Communications Officer, Regional Office for Latin American and the Caribbean, UNICEF, Panama City, Panama
| | - Deborah Horowitz
- Bureau for Latin America and the Caribbean, United States Agency for International Development, Washington, DC, USA
| | | | - Oscar J Mujica
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC, USA
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12
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Sanhueza A, Carvajal-Vélez L, Mújica OJ, Vidaletti LP, Victora CG, Barros AJ. SDG3-related inequalities in women's, children's and adolescents' health: an SDG monitoring baseline for Latin America and the Caribbean using national cross-sectional surveys. BMJ Open 2021; 11:e047779. [PMID: 34413102 PMCID: PMC8378377 DOI: 10.1136/bmjopen-2020-047779] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Latin America and the Caribbean (LAC) countries have made important progress towards achieving the Sustainable Development Goal (SDG) targets related to health (SDG3) at the national level. However, vast within-country health inequalities remain. We present a baseline of health inequalities in the region, against which progress towards the SDGs can be monitored. SETTING We studied 21 countries in LAC using data from Demographic and Health Surveys and Multiple Indicator Cluster Survey carried out from 2011 to 2016 PARTICIPANTS: The surveys collect nationally representative data on women and children using multistage sampling. In total, 288 207 women and 195 092 children made part of the surveys in the 21 countries. OUTCOME MEASURES Five health intervention indicators were studied, related to reproductive and maternal health, along with adolescent fertility and neonatal and under-five mortality rates. Inequalities in these indicators were assessed through absolute and relative measures. RESULTS In most countries, subnational geographical health gradients were observed for nearly all women, child, and adolescent (WCA) indicators. Coverage of key interventions was higher in urban areas and among the richest, compared with rural areas and poorer quintiles. Analyses by woman's age showed that coverage was lower in adolescent girls than older women for family planning indicators. Pro-urban and pro-rich inequalities were also seen for mortality in most countries. CONCLUSIONS Regional averages hide important health inequalities between countries, but national estimates hide still greater inequalities between subgroups of women, children and adolescents. To achieve the SDG3 targets and leave no one behind, it is essential to close health inequality gaps within as well as between countries.
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Affiliation(s)
- Antonio Sanhueza
- Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC, USA
| | - Liliana Carvajal-Vélez
- Data, Research and Policy, United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Oscar J Mújica
- Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC, USA
| | - Luis Paulo Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Aluisio Jd Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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13
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Sanhueza A, Espinosa I, Mújica OJ, da Silva Jr. JB. Leaving no one behind: a methodology for setting health inequality reduction targets for Sustainable Development Goal 3. Rev Panam Salud Publica 2021; 45:e63. [PMID: 33936186 PMCID: PMC8080945 DOI: 10.26633/rpsp.2021.63] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To present a methodology for the simultaneous setting of quantitative targets that reflect both an improvement in the national average of an indicator for Sustainable Development Goal 3 (SDG3), as well as a reduction in its geographic inequality. METHODS A five-step algorithm was developed: (a) calculate the national average annual percent change (AAPC) for an SDG3 indicator; (b) normatively define geographic strata from the subnational distribution of the indicator in a baseline year; (c) apply a proportional progressivity criterion to the AAPC to project the stratum-specific indicator value for the target year; (d) set the national target as the weighted average of the indicator in the subnational territorial units for the target year; and (e) set the inequality reduction targets by calculating the absolute and relative gaps between the bottom and top strata for the target year. RESULTS The algorithm was applied to SDG indicator 3.1.1 (maternal mortality ratio, MMR), disaggregated by Guatemala's 22 departments at the baseline year 2014 (MMR = 113 per 100,000 live births). By sustaining the AAPC rate attained from 2009 to 2014 (-4.3%) and focalizing its actions with territorial progressivity, by 2030 the country could reduce its MMR to 53 per 100,000 and its absolute and relative inequality gaps by 72% and 48%, respectively. CONCLUSIONS The proposed methodology allows for simultaneously setting targets for overall progress and inequality reduction in health, making explicit the primacy of the equity principle contained in the SDG commitment to leave no one behind, whose urgency takes on renewed relevance in the current pandemic scenario.
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Affiliation(s)
- Antonio Sanhueza
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America.
| | - Isabel Espinosa
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America.
| | - Oscar J. Mújica
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America.
| | - Jarbas Barbosa da Silva Jr.
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America.
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Araneda N, Sanhueza P, Pacheco G, Sanhueza A. [Suicide in adolescents and young adults in Chile: relative risks, trends, and inequalitiesSuicídio em adolescentes e jovens no Chile: riscos relativos, tendências e desigualdades]. Rev Panam Salud Publica 2021; 45:e4. [PMID: 33815490 PMCID: PMC8007116 DOI: 10.26633/rpsp.2021.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
Objetivo. Describir cuantitativamente el riesgo relativo, la tendencia y la desigualdad geográfica del suicidio en adolescentes y jóvenes entre las regiones de Chile, en el periodo 2000 al 2017. Método. Estudio ecológico poblacional a partir de los registros de defunciones por suicidio. Se estimaron tasas de mortalidad y riesgos relativos (RR) de suicidio por sexo, edad y región. Se estudió la tendencia y desigualdad geográfica del suicidio entre las regiones de Chile; medidas absolutas y relativas de desigualdades geográficas fueron estimadas. Resultados. Entre 2000 y 2017 se registraron 6 292 suicidios en adolescentes y jóvenes en Chile. Las tasas promedio de mortalidad por suicidio en Chile fueron de 8,5; 5,4 y 14.7 por 100 000 en los grupos 10-24, 10-19 y 20-24 años, respectivamente, en el periodo 2000-2017. Las tasas más altas de mortalidad por suicidio se encontraron en las regiones de Aisén, Los Lagos, Magallanes y Los Ríos. El riesgo más alto de suicidio se estimó en los hombres (RR=3,5), los jóvenes (RR=2,7) y en la región de Aisén (RR=2,0). La tasa promedio nacional en el grupo 10-24 años se mantuvo en 8,5 por 100 000 en los periodos 2000-2008 y 2009-2017. La mayor desigualdad geográfica se encontró en hombres de 20-24 años en el periodo 2000-2008. Conclusiones. El suicidio en jóvenes y adolescentes de Chile se ha mantenido sin mayores cambios en el periodo de estudio. Los hombres tienen un mayor riesgo de suicidio que las mujeres. Existen desigualdades geográficas entre las regiones de Chile en el suicidio y son más elevadas en hombres de 20 a 24 años. Se recomienda evaluar y fortalecer los programas de prevención del suicidio en los adolescentes y jóvenes, en especial en las regiones y los grupos poblacionales específicos en situación de mayor vulnerabilidad.
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Affiliation(s)
- Nelson Araneda
- Departamento de Educación, Universidad de La Frontera Temuco Chile Departamento de Educación, Universidad de La Frontera, Temuco, Chile
| | - Pablo Sanhueza
- Departamento de Ingeniería Robótica, Universidad de Maryland College Park Estados Unidos de América Departamento de Ingeniería Robótica, Universidad de Maryland, College Park, Estados Unidos de América
| | - Giovanni Pacheco
- SEREMI de Salud de La Araucanía, Ministerio de Salud de Chile Santiago Chile SEREMI de Salud de La Araucanía, Ministerio de Salud de Chile, Santiago, Chile
| | - Antonio Sanhueza
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América
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Villaveces A, Sanhueza A, Henríquez Roldán CF, Escamilla-Cejudo JA, Rodrigues EMS. Transport modes and road traffic mortality in the Americas: Deaths among pedestrian and motorcycle users through the lifespan. Int J Inj Contr Saf Promot 2021; 28:103-112. [PMID: 33491551 DOI: 10.1080/17457300.2020.1858112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In the Americas, almost half of road traffic deaths occur among motorcycle users and pedestrians (23% and 22%, respectively). Recent individual country trends show that nations are experiencing changes in deaths depending on the mode of transport used. While national trends are useful, analyses of disaggregated data by sex and age may provide more information about the impact of traffic crashes at different stages of the life course. Methods: We used mortality data from all land transport modes reported to PAHO/WHO (2000-2015) and included them in an ecological study to quantify temporal trends and estimate the association between mortality by mode, age group, sex, and selected socio-economic indicators. Results: Motorcycle and pedestrian mortality rates remain extremely high. Males younger less than 45 years have a higher burden of motorcycle-related mortality while older persons tend to die more as pedestrians. Discussion: Policies differentially aimed at addressing deaths by mode of transport and age are necessary because active living improves wellbeing especially among older individuals. For this to occur, safe environments must be created or maintained.
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Affiliation(s)
- Andrés Villaveces
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Sanhueza A, Espinosa I, Mújica OJ, da Silva JB. [Leaving no one behind: Methodology to set health inequality reduction targets for Sustainable Development Goal 3Não deixar ninguém para trás: uma metodologia para estabelecer metas de redução das desigualdades em saúde sob o Objetivo de Desenvolvimento Sustentável 3]. Rev Panam Salud Publica 2020; 44:e155. [PMID: 33362287 PMCID: PMC7748297 DOI: 10.26633/rpsp.2020.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Present methodology for the concurrent development of quantitative targets that reflect improvement in the national average of an indicator for Sustainable Development Goal 3 (SDG3), as well as a reduction in geographic inequality. METHODS A five-step algorithm was developed: a) calculate the national average annual percentage change (AAPC) for an SDG3 indicator; b) standardize the definition of geographic strata based on subnational distribution of the indicator in a base year; c) apply a criterion for proportional progress in the AAPC in order to project the stratum-specific indicator to the target year; d) set the national target as the weighted average of the indicator in the subnational territorial units for the target year; and e) develop inequality reduction targets by calculating absolute and relative gaps between the top and bottom strata for the target year. RESULTS The algorithm was applied to SDG indicator 3.1.1 (maternal mortality ratio, MMR), disaggregated by Guatemala's 22 departments for base year 2014 (MMR = 113/100,000 live births). By sustaining the average AAPC rate attained from 2009 to 2014 (-4.3%) and targeting its actions to territorial progress, the country would reduce its MMR to 53/100,000 by 2030 and its absolute and relative gaps by 72% and 48%, respectively. CONCLUSIONS The proposed methodology makes it possible to concurrently develop targets for the reduction of geographic inequalities in health and improvements in the national average, with explicit reference to the primacy of the principle of equity expressed in the SDGs' commitment to leaving no one behind, whose urgency is newly important in the current post-pandemic scenario.
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Affiliation(s)
- Antonio Sanhueza
- Organización Panamericana de la SaludWashington, DCEstados Unidos de AméricaOrganización Panamericana de la Salud; Washington, DC., Estados Unidos de América.
| | - Isabel Espinosa
- Organización Panamericana de la SaludWashington, DCEstados Unidos de AméricaOrganización Panamericana de la Salud; Washington, DC., Estados Unidos de América.
| | - Oscar J. Mújica
- Organización Panamericana de la SaludWashington, DCEstados Unidos de AméricaOrganización Panamericana de la Salud; Washington, DC., Estados Unidos de América.
| | - Jarbas Barbosa da Silva
- Organización Panamericana de la SaludWashington, DCEstados Unidos de AméricaOrganización Panamericana de la Salud; Washington, DC., Estados Unidos de América.
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Tullo E, Lerea MJ, González R, Galeano J, Insfrán MD, Muñoz M, Aragón M, Sanhueza A. [Health and social inequalities in maternal and child health in Paraguay]. Rev Panam Salud Publica 2020; 44:e107. [PMID: 32905374 PMCID: PMC7469975 DOI: 10.26633/rpsp.2020.107] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe health and social inequalities in maternal and child health indicators defined in Sustainable Development Goal (SDG) 3.1 and SDG 3.2 targets based on administrative data among the departments of Paraguay in 2017. METHODS Quantitative descriptive study with ecological design. Simple gap measures and complex gradient measures based on the adjustment of negative binomial and logistic regression models were used. RESULTS Fifty percent of Paraguay's departments have estimated maternal mortality ratio (MMR) values higher than the national value. The percentage of births attended by a qualified professional in the country is 98.1%, with a range between 82.4% and 99.9%. In 13 of 18 departments, under-five mortality rate (U5MR) is higher than the national average, ranging from 4.2 to 49.2 deaths per 1 000 live births. Neonatal mortality rates (NMR) in the departments vary from 2.6 to 45.1 deaths per 1 000 live births. There are major health and social inequalities in the MMR, U5MR and NMR between the departments. There are no high inequalities in the percentage of births attended by a qualified professional between the departments. CONCLUSIONS Paraguay needs to make significant efforts to reduce the health and social inequalities that exist in the MMR, U5MR and NMR between departments. Numerical targets must be established to improve national values and reduce inequalities in these indicators, which will allow for accountability on the commitment to "leave no one behind" established in the SDG, and will help generate strategies to improve the health of women and children in Paraguay.
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Affiliation(s)
- Edgar Tullo
- Dirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar SocialParaguayDirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar Social, Paraguay.
| | - María Jose Lerea
- Dirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar SocialParaguayDirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar Social, Paraguay.
| | - Rosa González
- Dirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar SocialParaguayDirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar Social, Paraguay.
| | - Julio Galeano
- Dirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar SocialParaguayDirección General de Información Estratégica en Salud, Ministerio de Salud Pública y Bienestar Social, Paraguay.
| | - María Delasnieve Insfrán
- Dirección General de Problemas de Salud, Ministerio de Salud Pública y Bienestar SocialParaguayDirección General de Problemas de Salud, Ministerio de Salud Pública y Bienestar Social, Paraguay.
| | - Mara Muñoz
- Organización Panamericana de la SaludAsunciónParaguayOrganización Panamericana de la Salud, Asunción, Paraguay.
| | - Miguel Aragón
- Organización Panamericana de la SaludAsunciónParaguayOrganización Panamericana de la Salud, Asunción, Paraguay.
| | - Antonio Sanhueza
- Organización Panamericana de la SaludWashington D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington D.C., Estados Unidos de América.
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Enríquez Nava MF, Esquivel Velásquez AD, Patón Sanjines M, Pooley Ayarza BC, Alarcón R, Hernández Muñoz R, Sanhueza A. [Behavior and social inequalities in prioritized indicators of Sustainable Development Goal 3 in Bolivia]. Rev Panam Salud Publica 2020; 44:e101. [PMID: 32884564 PMCID: PMC7458490 DOI: 10.26633/rpsp.2020.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/02/2020] [Indexed: 12/28/2022] Open
Abstract
Objective To describe the behavior and social inequalities in prioritized indicators of Sustainable Development Goal 3 (ODS-3) among subpopulations and departments of Bolivia. Methods An analysis of the behavior of selected ODS-3 indicators over time was conducted. In addition, a study of social inequalities in these indicators was carried out for selected equity stratifiers. Simple measures (absolute gap and relative gap) and complex measures (slope inequality index and concentration index) were obtained to explore the magnitude of social inequalities. Results The ODS-3 indicators that have increased significantly at the national and departmental levels are the prevalence of four prenatal controls and the prevalence of births attended by qualified health personnel. Social inequalities in these indicators have decreased significantly over time. The prevalence of adolescent pregnancy and its social inequalities have remained unchanged, although with low inequalities. The prevalence of modern contraceptive methods use has decreased slightly, although social inequality has declined more rapidly. The maternal mortality rate has decreased nationally and in most departments, but social inequality on this indicator still needs to be addressed. Conclusions National averages hide differences between subpopulations and departments in Bolivia. The findings show that the behavior and social inequality of some ODS-3 indicators have improved, but regarding other indicators interventions by different stakeholders must be strengthened to reduce social inequalities in health.
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Affiliation(s)
- Max Francisco Enríquez Nava
- Sistema Nacional de Información en Salud, Ministerio de Salud y Deportes La Paz Estado Plurinacional de Bolivia Sistema Nacional de Información en Salud, Ministerio de Salud y Deportes, La Paz, Estado Plurinacional de Bolivia
| | - Adhemar David Esquivel Velásquez
- Unidad de Análisis de Políticas Sociales y Económicas La Paz Estado Plurinacional de Bolivia Unidad de Análisis de Políticas Sociales y Económicas, La Paz, Estado Plurinacional de Bolivia
| | - Mabel Patón Sanjines
- Instituto Nacional de Estadística La Paz Estado Plurinacional de Bolivia Instituto Nacional de Estadística, La Paz, Estado Plurinacional de Bolivia
| | - Bertha Cecilia Pooley Ayarza
- Mesa de Medición de Desigualdades en Salud La Paz Estado Plurinacional de Bolivia Mesa de Medición de Desigualdades en Salud, La Paz, Estado Plurinacional de Bolivia
| | - René Alarcón
- Mesa de Medición de Desigualdades en Salud La Paz Estado Plurinacional de Bolivia Mesa de Medición de Desigualdades en Salud, La Paz, Estado Plurinacional de Bolivia
| | - Rosalinda Hernández Muñoz
- Organización Panamericana de la Salud La Paz Estado Plurinacional de Bolivia Organización Panamericana de la Salud, La Paz, Estado Plurinacional de Bolivia
| | - Antonio Sanhueza
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América
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Sati HF, Bruinsma N, Galas M, Hsieh J, Sanhueza A, Ramon Pardo P, Espinal MA. Characterizing Shigella species distribution and antimicrobial susceptibility to ciprofloxacin and nalidixic acid in Latin America between 2000-2015. PLoS One 2019; 14:e0220445. [PMID: 31374081 PMCID: PMC6677304 DOI: 10.1371/journal.pone.0220445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Shigellosis is the second leading cause of diarrheal death globally. The global burden has been complicated by the emergence of Shigella strains resistant to first line antibiotic treatments such as ciprofloxacin. This study aims to describe the epidemiologic distribution of the most common Shigella species, and their antimicrobial susceptibility patterns to ciprofloxacin and nalidixic acid (NA) in Latin America. METHODS Laboratory data from 19 countries were obtained through the Latin American Network for Antimicrobial Resistance Surveillance (ReLAVRA) from 2000-2015. The Clinical Laboratory Standards Institute reduced susceptibility breakpoints for Enterobacteriaceae was used to interpret the disc diffusion tests for Shigella susceptibility to ciprofloxacin and NA. Negative binominal regression was used to analyze longitudinal trends of Shigella isolates antimicrobial susceptibility. RESULTS 79,548 Shigella isolates were tested and reported between 2000-2015. The most common isolated species were S. flexneri (49%), and S. sonnei (28%). There was a steady increase in the proportion of S. sonnei isolates within the region(p<0.001). The average annual percentage increase (AAPI) in nonsusceptibility was 18.4% (p<0.001) for ciprofloxacin (baseline = 0.3); and 13.2%(p<0.001) for NA (baseline = 3). AAPI nonsusceptibility to ciprofloxacin was 13.3% for S. flexneri (p<0.04); and 39.9% for S. sonnei (p<0.001). Honduras, Dominican Republic, Venezuela, and Chile reported the highest increase in nonsusceptibility to ciprofloxacin among all Shigella isolates. CONCLUSION There is an increasing trend in Shigella nonsusceptibility to ciprofloxacin and NA, including among the most common shigella species, in Latin America. This rise of nonsusceptibility among Shigella species to commonly used treatments such as ciprofloxacin is alarming and threatens the control and management of this currently treatable infection. Improved data quality, collection and reporting is needed in Latin America to respond effectively to the rising trends observed. This includes the need for quality isolate level epidemiological data; molecular data, and data on antibiotic consumption and use.
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Affiliation(s)
- Hatim F. Sati
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, United States of America
- * E-mail:
| | - Nienke Bruinsma
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, United States of America
| | - Marcelo Galas
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, United States of America
| | - Jenny Hsieh
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, United States of America
| | - Antonio Sanhueza
- Health Analyses Metrics and Evidence (EIH/HA), Evidence and Intelligence for Action in Health (EIH), Pan American Health Organization, Washington, DC, United States of America
| | - Pilar Ramon Pardo
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, United States of America
| | - Marcos A. Espinal
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, United States of America
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Ponce de Leon RG, Ewerling F, Serruya SJ, Silveira MF, Sanhueza A, Moazzam A, Becerra-Posada F, Coll CVN, Hellwig F, Victora CG, Barros AJD. Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries. Lancet Glob Health 2019; 7:e227-e235. [PMID: 30683240 PMCID: PMC6367565 DOI: 10.1016/s2214-109x(18)30481-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/16/2018] [Accepted: 10/16/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The rise in contraceptive use has largely been driven by short-acting methods of contraception, despite the high effectiveness of long-acting reversible contraceptives. Several countries in Latin America and the Caribbean have made important progress increasing the use of modern contraceptives, but important inequalities remain. We assessed the prevalence and demand for modern contraceptive use in Latin America and the Caribbean with data from national health surveys. METHODS Our data sources included demographic and health surveys, multiple indicator cluster surveys, and reproductive health surveys carried out since 2004 in 23 countries of Latin America and the Caribbean. Analyses were based on sexually active women aged 15-49 years irrespective of marital status, except in Argentina and Brazil, where analyses were restricted to women who were married or in a union. We calculated contraceptive prevalence and demand for family planning satisfied. Contraceptive prevalence was defined as the percentage of sexually active women aged 15-49 years who (or whose partners) were using a contraceptive method at the time of the survey. Demand for family planning satisfied was defined as the proportion of women in need of contraception who were using a contraceptive method at the time of the survey. We separated survey data for modern contraceptive use by type of contraception used (long-acting, short-acting, or permanent). We also stratified survey data by wealth, area of residence, education, ethnicity, age, and a combination of wealth and area of residence. Wealth-related absolute and relative inequalities were estimated both for contraceptive prevalence and demand for family planning satisfied. FINDINGS We report on surveys from 23 countries in Latin America and the Caribbean, analysing a sample of 212 573 women. The lowest modern contraceptive prevalence was observed in Haiti (31·3%) and Bolivia (34·6%); inequalities were wide in Bolivia, but almost non-existent in Haiti. Brazil, Colombia, Costa Rica, Cuba, and Paraguay had over 70% of modern contraceptive prevalence with low absolute inequalities. Use of long-acting reversible contraceptives was below 10% in 17 of the 23 countries. Only Cuba, Colombia, Mexico, Ecuador, Paraguay, and Trinidad and Tobago had more than 10% of women adopting long-acting contraceptive methods. Mexico was the only country in which long-acting contraceptive methods were more frequently used than short-acting methods. Young women aged 15-17 years, indigenous women, those in lower wealth quintiles, those living in rural areas, and those without education showed particularly low use of long-acting reversible contraceptives. INTERPRETATION Long-acting reversible contraceptives are seldom used in Latin America and the Caribbean. Because of their high effectiveness, convenience, and ease of continuation, availability of long-acting reversible contraceptives should be expanded and their use promoted, including among young and nulliparous women. In addition to suitable family planning services, information and counselling should be provided to women on a personal basis. FUNDING Wellcome Trust, Pan American Health Organization.
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Affiliation(s)
- Rodolfo Gomez Ponce de Leon
- Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | - Fernanda Ewerling
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Suzanne Jacob Serruya
- Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | - Mariangela F Silveira
- Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | | | - Ali Moazzam
- Department of Reproductive Health and Research (RHR), World Health Organization, Geneva, Switzerland
| | | | - Carolina V N Coll
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Franciele Hellwig
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cesar G Victora
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Aluisio J D Barros
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil.
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Gerstner RMF, Soriano I, Sanhueza A, Caffe S, Kestel D. [Epidemiology of suicide among adolescents and young adults in EcuadorEpidemiologia do suicídio em adolescentes e jovens no Equador]. Rev Panam Salud Publica 2018; 42:e100. [PMID: 31093128 PMCID: PMC6385964 DOI: 10.26633/rpsp.2018.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/05/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To collect information - and provide it to decision-makers in health programs in general and mental health programs in particular - on epidemiological patterns in suicide deaths among young adults and adolescents in Ecuador. Methods A cross-sectional ecological study was conducted using data obtained from records of deaths by suicide among young adults and adolescents in Ecuador from 2001 to 2014. For analysis, results were disaggregated by geographic region, sex, age, ethnic group and suicide method. Rates of death by suicide (per 100,000 population) and relative risks (RR) for suicide were estimated by sex and region. Results Between 2001 and 2014, 4,855 suicides were recorded among adolescents and young adults. The highest estimated risk was found among males aged 15 to 24 years and adolescents living in the Amazon region, followed by those living in the Andean region. Mestizos were the ethnic group with the greatest number of suicides, although 40% of young people who commit suicide in the Amazon region are indigenous. The most frequent method was by hanging, followed by pesticide poisoning. Conclusions Suicide among adolescents and young adults is an important public health problem in Ecuador. Since various psychological, social, and cultural influences come into play, there is wide variation among regions, age groups, and ethnic groups. Restricting access to pesticides and other chemical products, implementing universal prevention programs and programs in education centers in the areas with the highest rates, and targeting vulnerable populations for specific interventions could help reduce the suicide rate among young people in Ecuador.
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Affiliation(s)
| | - Ismael Soriano
- Nutrition and Family, Gender & Life Course, Pan American Health Organization, Quito, Ecuador
| | - Antonio Sanhueza
- Pan American Health Organization, Ringgold Standard Institution, Washington, DC, Estados Unidos de América
| | - Sonia Caffe
- Pan American Health Organization, Ringgold Standard Institution, Washington, DC, Estados Unidos de América
| | - Devora Kestel
- Pan American Health Organization, Ringgold Standard Institution, Washington, DC, Estados Unidos de América
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Manterola C, Cartes-Velásquez R, Burgos ME, Sanhueza A, Otzen T. Development and Initial Validation of a Scale to Measure Methodological Quality in Diagnostic Accuracy Studies. The MInCir Proposal. INT J MORPHOL 2018. [DOI: 10.4067/s0717-95022018000200743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Manterola C, Zavando D, Cartes-Velásquez R, Otzen T, Sanhueza A. Initial Validation of a Scale to Measure Methodological Quality in Prognosis Studies. The MInCir Proposal. INT J MORPHOL 2018. [DOI: 10.4067/s0717-95022018000200762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sanhueza A, Calle Roldán J, Ríos-Quituizaca P, Acuña MC, Espinosa I. Social inequalities in maternal mortality among the provinces of Ecuador. Rev Panam Salud Publica 2017. [PMID: 28614488 PMCID: PMC6660870 DOI: 10.26633/rpsp.2017.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study set out to describe the association between the maternal mortality ratio (MMR) estimates and a set of socioeconomic indicators and compute the MMR inequalities among the provinces of Ecuador. METHODS A cross-sectional ecological study was conducted, using data for 2014 from the country's 24 provinces. The MMR estimate was calculated for each province, as well as the association and its strength between MMR and specific socioeconomic indicators. For the indicators that were found to be significantly associated with MMR, inequality measurements were computed. RESULTS Despite a relatively low MMR for Ecuador overall, ratios differed substantially among the provinces. Five socioeconomic indicators proved to be statistically significantly associated with MMR: total fertility rate, the percentage of indigenous population, the percentage of households with children who do not attend school, gross domestic product, and the percentage of houses with electrical service. Of these five, only three had MMR inequalities that were significant: total fertility rate, gross domestic product, and the percentage of households with electricity. CONCLUSIONS This study supports research arguing that national averages can be misleading, as they often hide differences among subgroups at the local level. The findings also suggest that MMR is significantly associated with some socioeconomic indicators, including ones linked with significant health outcome inequalities. In order to reduce health inequities, it is crucial that countries look beyond national averages and identify the subgroups being left behind, explore the particular social determinants that generate these health inequalities, and examine the specific barriers and other factors affecting the subgroups most vulnerable to maternal health inequalities.
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Affiliation(s)
- Antonio Sanhueza
- Pan American Health OrganizationPan American Health OrganizationWashington, D.CUnited States of AmericaPan American Health Organization, Washington, D.C., United States of America.
| | - Jakeline Calle Roldán
- Ministry of Public Health of EcuadorMinistry of Public Health of EcuadorQuitoEcuadorMinistry of Public Health of Ecuador, Quito, Ecuador.
| | - Paulina Ríos-Quituizaca
- Facultad de Ciencias MédicasUniversidad Central del EcuadorQuitoEcuadorFacultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador.
| | - Maria Cecilia Acuña
- Pan American Health OrganizationPan American Health OrganizationWashington, D.CUnited States of AmericaPan American Health Organization, Washington, D.C., United States of America.
| | - Isabel Espinosa
- Pan American Health OrganizationPan American Health OrganizationWashington, D.CUnited States of AmericaPan American Health Organization, Washington, D.C., United States of America.
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Otzen T, Sanhueza A, Manterola C, Hetz M, Melnik T. Transport accident mortality in Chile: trends from 2000 to 2012. Ciênc saúde coletiva 2016; 21:3711-3718. [DOI: 10.1590/1413-812320152112.12652016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/21/2016] [Indexed: 11/22/2022] Open
Abstract
Abstract The aim of this study is to describe the trends of transport accident mortality in Chile from 2000 to 2012 by year, geographic distribution, gender, age group, and type of accident. Population-based study. Data for transport accident mortality in Chile between 2000 and 2012 were used. The crude and adjusted per region transport accident mortality rates were calculated per 100,000 inhabitants. The annual percentage change (APC) of the rates and relative risks (RR) were calculated. The average transport accident mortality rate (TAMR) in Chile (2000-2012) was 12.2. The rates were greater in men (19.7) than in women (4.8), with a RR of 4.1. The rates were higher in the country's southern zone (15.9), increasing in recent years in the southern zone, with a significant positive APC in the northern and central zones. The Maule region had the highest rate (21.1), although Coquimbo was the region with the most significant APC (2.2%). The highest rate (20.3) was verified in the 25-40 age group. The highest rate (14.3) was recorded in 2008. The most frequent type of accident was pedestrian. In general the APC trends of the rates are increasing significantly. This, added to rapid annual automotive growth, will only exacerbate mortality due to transport accidents.
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Dos Santos T, Rodriguez A, Almiron M, Sanhueza A, Ramon P, de Oliveira WK, Coelho GE, Badaró R, Cortez J, Ospina M, Pimentel R, Masis R, Hernandez F, Lara B, Montoya R, Jubithana B, Melchor A, Alvarez A, Aldighieri S, Dye C, Espinal MA. Zika Virus and the Guillain-Barré Syndrome - Case Series from Seven Countries. N Engl J Med 2016; 375:1598-1601. [PMID: 27579558 DOI: 10.1056/nejmc1609015] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | - Pilar Ramon
- Pan American Health Organization, Washington, DC
| | | | | | | | - Juan Cortez
- Pan American Health Organization, Washington, DC
| | | | | | | | | | - Bredy Lara
- Ministry of Health, Tegucigalpa, Honduras
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de Cosio FG, Jiwani SS, Sanhueza A, Soliz PN, Becerra-Posada F, Espinal MA. Late Maternal Deaths and Deaths from Sequelae of Obstetric Causes in the Americas from 1999 to 2013: A Trend Analysis. PLoS One 2016; 11:e0160642. [PMID: 27626277 PMCID: PMC5023091 DOI: 10.1371/journal.pone.0160642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 07/24/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Data on maternal deaths occurring after the 42 days postpartum reference time is scarce; the objective of this analysis is to explore the trend and magnitude of late maternal deaths and deaths from sequelae of obstetric causes in the Americas between 1999 and 2013, and to recommend including these deaths in the monitoring of the Sustainable Development Goals (SDGs). METHODS Exploratory data analysis enabled analyzing the magnitude and trend of late maternal deaths and deaths from sequelae of obstetric causes for seven countries of the Americas: Argentina, Brazil, Canada, Colombia, Cuba, Mexico and the United States. A Poisson regression model was developed to compare trends of late maternal deaths and deaths from sequelae of obstetric causes between two periods of time: 1999 to 2005 and 2006 to 2013; and to estimate the relative increase of these deaths in the two periods of time. FINDINGS The proportion of late maternal deaths and deaths from sequelae of obstetric causes ranged between 2.40% (CI 0.85% - 5.48%) and 18.68% (CI 17.06% - 20.47%) in the seven countries. The ratio of late maternal deaths and deaths from sequelae of obstetric causes per 100,000 live births has increased by two times in the region of the Americas in the period 2006-2013 compared to the period 1999-2005. The regional relative increase of late maternal death was 2.46 (p<0.0001) times higher in the second period compared to the first. INTERPRETATION Ascertainment of late maternal deaths and deaths from sequelae of obstetric causes has improved in the Americas since the early 2000's due to improvements in the quality of information and the obstetric transition. Late and obstetric sequelae maternal deaths should be included in the monitoring of the SDGs as well as in the revision of the International Classification of Diseases' 11th version (ICD-11).
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Affiliation(s)
| | - Safia S. Jiwani
- Pan American Health Organization, Washington D. C., United States of America
| | - Antonio Sanhueza
- Pan American Health Organization, Washington D. C., United States of America
| | - Patricia N. Soliz
- Pan American Health Organization, Washington D. C., United States of America
| | | | - Marcos A. Espinal
- Pan American Health Organization, Washington D. C., United States of America
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Affiliation(s)
- Tamara Otzen
- Doctorado en Ciencias Médicas, Universidad de La Frontera, Avenida Alemania 0458, Temuco, Chile. .,Escuela de Psicología, Universidad Autónoma de Chile, Temuco, Chile. .,Universidad Científica del Sur, Lima, Peru. .,Programa de Pós-graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Antonio Sanhueza
- Departamento de Matemática y Estadísticas, Universidad de La Frontera, Temuco, Chile ,Pan American Health Organization/Regional Office of the World Health Organization, Washington, USA
| | - Carlos Manterola
- Doctorado en Ciencias Médicas, Universidad de La Frontera, Avenida Alemania 0458, Temuco, Chile ,Departamento de Cirugía, Universidad de La Frontera, Temuco, Chile
| | - Monica Hetz
- Psychology, Catholic University of Temuco, Temuco, Chile
| | - Tamara Melnik
- Programa de Pós-graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo, São Paulo, Brazil
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Abstract
BACKGROUND Homicide, an external cause of morbidity and mortality, caused 473,000 deaths worldwide in 2012, a rate of 6.2 per 100,000 inhabitants. The aim of this study was to describe homicide mortality trends in Chile between 2000 and 2012 by year, gender, age group, geographic distribution (by zone and by region) and type of homicide. METHODS This was a population-based study. Data for homicide mortality in Chile between 2000 and 2012 were used and they were provided by the Chilean Ministry of Health's Department of Statistics and Health Information (DEIS) and PAHO/WHO. The homicide mortality rates were calculated per 100,000 inhabitants. The study variables were year, geographic distribution, gender, age group and type of homicide. The annual percentage change (APC) of the rates was analyzed, and a logarithm of the rates by year and region was fitted by applying linear regression models. In addition, relative risks (RR) were calculated. 95% confidence intervals were considered in all the analyses. RESULTS The average yearly rate of homicide (HMR) in Chile (2000-2012) was 4.9. The rates were higher in men (8.7) than in women (1.1), with a RR of 8.2. The rates were higher in the country's central zone (5.0), increasing in recent years in the southern zone, with a significant positive APC of 1.1%. The Aisén Region had the highest rate (7.6), although Antofagasta was the region with the most significant APC (3.1%). The highest rate (9.2) was verified in the 25 to 39 age group. The highest rate (5.5) was recorded in 2005. The most frequent type of homicide was assault with an object (44.8%). CONCLUSIONS Although the homicide rates are higher in the southern zone of the country, the northern zone is showing a tendency to increase, becoming an even more serious problem, which not only affects those directly involved, but society as a whole.
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Affiliation(s)
- Tamara Otzen
- Doctorado en Ciencias Médicas, Universidad de La Frontera, Avenida Alemania 0458, Temuco, Chile. .,Escuela de Psicología, Universidad Autónoma de Chile, Temuco, Chile. .,Universidad Científica del Sur, Lima, Peru. .,Programa de Pós-graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Antonio Sanhueza
- Departamento de Matemática y Estadísticas, Universidad de La Frontera, Temuco, Chile. .,Pan American Health Organization/Regional Office of the World Health Organization, Washington, USA.
| | - Carlos Manterola
- Doctorado en Ciencias Médicas, Universidad de La Frontera, Avenida Alemania 0458, Temuco, Chile. .,Departamento de Cirugía, Universidad de La Frontera, Temuco, Chile.
| | - Tamara Melnik
- Programa de Pós-graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Hetz
- Psychology, Catholic University of Temuco, Temuco, Chile.
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Otzen T, Sanhueza A, Manterola C, Escamilla-Cejudo JA. Mortalidad por suicidio en Chile: tendencias en los años 1998-2011. Rev Med Chil 2014; 142:305-13. [DOI: 10.4067/s0034-98872014000300004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 03/04/2014] [Indexed: 11/17/2022]
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Quinlan-Davidson M, Sanhueza A, Espinosa I, Escamilla-Cejudo JA, Maddaleno M. Suicide among young people in the Americas. J Adolesc Health 2014; 54:262-8. [PMID: 23992759 DOI: 10.1016/j.jadohealth.2013.07.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/05/2013] [Accepted: 07/11/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine suicide mortality trends among young people (10-24 years of age(1)) in selected countries and territories of the Americas. METHODS An ecological study was conducted using a time series of suicide mortality data from 19 countries and one territory in the Region of the Americas from 2001 to 2008, comprising 90.3% of the regional population. The analyses included age-adjusted suicide mortality rates, average annual variation in suicide mortality rates, and relative risks for suicide, by age and sex. RESULTS The mean suicide rate for the selected study period and countries/territory was 5.7/100,000 young people (10-24 years), with suicide rates higher among males (7.7/100,000) than females (2.4/100,000). Countries with the highest total suicide mortality rates among young people (10-24 years) were Guyana, Suriname, Nicaragua, El Salvador, Chile, and Ecuador; countries with the lowest total suicide mortality rates included Mexico, Venezuela, Cuba, and Brazil, and the U.S. territory of Puerto Rico. During this period, there was a significant increase in suicide mortality rates among young people in the following countries: Argentina, Chile, Ecuador, Mexico, and Suriname; countries with significant decreases in suicide mortality rates included Canada, Colombia, Cuba, El Salvador, and Venezuela. The three leading suicide methods in the Americas were hanging, firearms, and poisoning. CONCLUSIONS Some countries of the Americas have experienced a rise in adolescent and youth suicide during the study period, with males at a higher risk of committing suicide than females. Adolescent and youth suicide policies and programs are recommended, to curb this problem. Methodological limitations are discussed.
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Affiliation(s)
- Meaghen Quinlan-Davidson
- Department of Adolescent Health Within the Area of Family and Community Health, Pan American Health Organization/Regional Office of the World Health Organization, Washington, DC
| | - Antonio Sanhueza
- Department of Health Information and Analysis Within the Area of Health Surveillance and Disease Prevention and Control, Pan American Health Organization/Regional Office of the World Health Organization, Washington, DC
| | - Isabel Espinosa
- Department of Adolescent Health Within the Area of Family and Community Health, Pan American Health Organization/Regional Office of the World Health Organization, Washington, DC
| | - José Antonio Escamilla-Cejudo
- Department of Health Information and Analysis Within the Area of Health Surveillance and Disease Prevention and Control, Pan American Health Organization/Regional Office of the World Health Organization, Washington, DC
| | - Matilde Maddaleno
- Department of Adolescent Health Within the Area of Family and Community Health, Pan American Health Organization/Regional Office of the World Health Organization, Washington, DC.
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Beltrán V, Silva M, Padilla M, Aillapan E, Sanhueza A, Cantín M, Fuentes R. Morphological Patterns of Gingival Recession in Adult Chilean Population. INT J MORPHOL 2013. [DOI: 10.4067/s0717-95022013000400034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rodrigues EMS, Villaveces A, Sanhueza A, Escamilla-Cejudo JA. Trends in fatal motorcycle injuries in the Americas, 1998–2010. Int J Inj Contr Saf Promot 2013; 21:170-80. [DOI: 10.1080/17457300.2013.792289] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Marchant C, Leiva V, Cavieres MF, Sanhueza A. Air contaminant statistical distributions with application to PM10 in Santiago, Chile. Rev Environ Contam Toxicol 2013; 223:1-31. [PMID: 23149810 DOI: 10.1007/978-1-4614-5577-6_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The use of statistical distributions to predict air quality is valuable for determining the impact of air chemical contaminants on human health. Concentrations of air pollutants are treated as random variables that can be modeled by a statistical distribution that is positively skewed and starts from zero. The type of distribution selected for analyzing air pollution data and its associated parameters depend on factors such as emission source and local meteorology and topography. International environmental guideline use appropriate distributions to compute exceedance probabilities and percentiles for setting administrative targets and issuing environmental alerts. The distribution bears a relationship to the normal distribution, and there are theoretical - and physical-based mechanistic arguments that support its use when analyzing air-pollutant data. Others distribution have also been used to model air population data, such as the beta, exponential, gamma, Johnson, log-logistic, Pearson, and Weibull distribution. One model also developed from physical-mechanistic considerations that has received considerable interest in recent year is the Birnbaum-Saunders distribution. This distribution has theoretical arguments and properties similar to those of the log-normal distribution, which renders it useful for modeling air contamination data. In this review, we have addressed the range of common atmospheric contaminants and the health effects they cause. We have also reviewed the statistical distributions that have been use to model air quality, after which we have detailed the problem of air contamination in Santiago, Chile. We have illustrated a methodology that is based on the Birnbaum-Saunders distributions to analyze air contamination data from Santiago, Chile. Finally, in the conclusions, we have provided a list of synoptic statements designed to help readers understand the significance of air pollution in Chile, and in Santiago, in particular, but that can be useful to other cites and countries.
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Affiliation(s)
- Carolina Marchant
- Departamento de Estadística, Universidad de Valparaíso, Gran Bretaña 1111, Playa Ancha, Valparaíso, Chile
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Gawryszewski VP, Sanhueza A, Martinez-Piedra R, Escamilla JA, Souza MDFMD. Homicídios na região das Américas: magnitude, distribuição e tendências, 1999-2009. Ciênc saúde coletiva 2012; 17:3171-82. [DOI: 10.1590/s1413-81232012001200003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 09/13/2012] [Indexed: 11/22/2022] Open
Abstract
O objetivo do estudo foi descrever a magnitude e a distribuição da mortalidade por homicídios nas Américas e analisar suas tendências. Foram analisados óbitos por homicídios (X85 a Y09 e Y35) de 32 países das Américas, período 1999-2009, registrados no Sistema de Informações de Mortalidade/Organização Pan Americana da Saúde. Utilizou-se modelo binomial negativo para estudar as tendências. Cerca de 121.297 mortes por homicídios (89% homens e 11% mulheres) ocorreram anualmente nas Américas, predominando as idades de 15 a 24 e de 25 a 39 anos. Em 2009, a taxa padronizada de homicídios da região foi 15,5/100.000. Os países com taxas/100.000 baixas foram Canadá (1,8), Argentina (4,4), Cuba (4,8), Chile (5,2) e Estados Unidos (5,8); e com taxas/100.000 altas foram El Salvador (62,9), Guatemala (51,2), Colômbia (42,5), Venezuela (33,2) e Porto Rico (25,8). Entre 1999-2009 as taxas da região permaneceram estáveis; aumentaram em nove países, como Venezuela (p < 0,001), Panamá (p < 0,001), El Salvador (p < 0,001) e Porto Rico (p < 0,001); diminuíram em quatro países, especialmente na Colômbia (p < 0,001); e permaneceram estáveis no Brasil, Estados Unidos, Equador e Chile. O aumento no México ocorreu no período mais recente. Apesar dos esforços empreendidos, diversos países têm taxas altas de homicídios e crescimento nas mesmas.
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de Fatima Marinho de Souza M, Gawryszewski VP, Orduñez P, Sanhueza A, Espinal MA. Cardiovascular disease mortality in the Americas: current trends and disparities. Heart 2012; 98:1207-12. [PMID: 22826558 DOI: 10.1136/heartjnl-2012-301828] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the current situation and trends in mortality due to cardiovascular disease (CVD) in the Americas and explore their association with economic indicators. DESIGN AND SETTING This time series study analysed mortality data from 21 countries in the region of the Americas from 2000 to the latest available year. MAIN OUTCOMES MEASURES Age-adjusted death rates, annual variation in death rates. Regression analysis was used to estimate the annual variation and the association between age-adjusted rates and country income. RESULTS Currently, CVD comprised 33.7% of all deaths in the Americas. Rates were higher in Guyana (292/100 000), Trinidad and Tobago (289/100 000) and Venezuela (246/100 000), and lower in Canada (108/100 000), Puerto Rico (121/100 000) and Chile (125/100 000). Male rates were higher than female rates in all countries. The trend analysis showed that CVD death rates in the Americas declined -19% overall (-20% among women and -18% among men). Most countries had a significant annual decline, except Guatemala, Guyana, Suriname, Paraguay and Panama. The largest annual declines were observed in Canada (-4.8%), the USA (-3.9%) and Puerto Rico (-3.6%). Minor declines were in Mexico (-0.8%) and Cuba (-1.1%). Compared with high-income countries the difference between the median of death rates in lower middle-income countries was 56.7% higher and between upper middle-income countries was 20.6% higher. CONCLUSIONS CVD death rates have been decreasing in most countries in the Americas. Considerable disparities still remain in the current rates and trends.
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Pineda P, Fuentes R, Sanhueza A. Prevalencia de Agenesia Dental en Niños con Dentición Mixta de las Clínicas Odontológicas Docente Asistencial de la Universidad de La Frontera. INT J MORPHOL 2011. [DOI: 10.4067/s0717-95022011000400002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sandoval P, García N, Sanhueza A, Romero A, Reveco R. Medidas Cefalométricas en Telerradiografías de Perfil de Pre-Escolares de 5 Años de la Ciudad de Temuco. INT J MORPHOL 2011. [DOI: 10.4067/s0717-95022011000400028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bustamante MF, Fuentes R, Flores T, Sanhueza A. Relación entre Índice Facial Superior e Índice Nasal en Cráneos Chilenos Adultos. INT J MORPHOL 2011. [DOI: 10.4067/s0717-95022011000300023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Balakrishnan N, Gupta RC, Kundu D, Leiva V, Sanhueza A. On some mixture models based on the Birnbaum–Saunders distribution and associated inference. J Stat Plan Inference 2011. [DOI: 10.1016/j.jspi.2010.12.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Raposo A, Monsalves MJ, Aravena P, Sanhueza A. Prevalencia de Lesiones de la Mucosa Oral en el Hospital Hernán Henríquez Aravena de Temuco. INT J MORPHOL 2011. [DOI: 10.4067/s0717-95022011000200054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Riquelme M, Leiva V, Galea M, Sanhueza A. Influence diagnostics on the coefficient of variation of elliptically contoured distributions. J Appl Stat 2011. [DOI: 10.1080/02664760903521427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Manterola C, Vial M, Sanhueza A, Contreras J. Intrabiliary rupture of hepatic echinococcosis, a risk factor for developing postoperative morbidity: a cohort study. World J Surg 2011; 34:581-6. [PMID: 20087590 DOI: 10.1007/s00268-009-0322-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to determine if intrabiliary rupture (IBR), an evolutive complication of hepatic echinococcosis (HE), is a risk factor for developing postoperative morbidity (POM). METHODS This was a concurrent cohort study that included patients operated on for HE between 1996 and 2006 and who had clinical check-ups at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Principal outcome variable was "development POM," considered dichotomously. The exposure variable was the presence of IBR, analyzed dichotomously (present or absent) and according to the number of IBR (without, with one, and with two or more). The sample size was considered on the basis of a 95% confidence interval (95% CI), a power of 80%, a 1:2 ratio of patients without and with IBR, and a 10% proportion of POM in patients without IBR and 26% in patients with IBR. Descriptive statistics and bivariate and multivariate analyses were used. Relative risks (RR) and 95% CI were calculated. RESULTS The cohorts (median age of 42 years, 56.4% female, a median cyst diameter of 15 cm, and a follow-up of 118 months) were composed of 96 patients without IBR (38.1%) and 156 patients with IBR (61.9%). A morbidity rate of 17.1% was verified (9.4% in the group without IBR and 21.8% in the group with IBR [p = 0.011]). An adjusted RR of 3.4 (95% CI = 2.64, 4.18) was verified for the comparison of subgroups without IBR vs. with two or more IBR (p < 0.001). CONCLUSION The presence of two or more IBR constitutes a risk factor for developing POM in patients with HE.
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Affiliation(s)
- Carlos Manterola
- Department of Surgery, Universidad de La Frontera, M. Montt 112, Office 408, Temuco, Chile.
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Leiva V, Vilca F, Balakrishnan N, Sanhueza A. A Skewed Sinh-Normal Distribution and Its Properties and Application to Air Pollution. COMMUN STAT-THEOR M 2010. [DOI: 10.1080/03610920903140171] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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