RESUMO
BACKGROUND: Mexico is one of the countries with the greatest excess death due to COVID-19. Chiapas, the poorest state in the country, has been particularly affected. Faced with an exacerbated shortage of health professionals, medical supplies, and infrastructure to respond to the pandemic, the non-governmental organization Compañeros En Salud (CES) implemented a COVID-19 infection prevention and control program to limit the impact of the pandemic in the region. We evaluated CES's implementation of a community health worker (CHW)-led contact tracing intervention in eight rural communities in Chiapas. METHODS: Our retrospective observational study used operational data collected during the contract tracing intervention from March 2020 to December 2021. We evaluated three outcomes: contact tracing coverage, defined as the proportion of named contacts that were located by CHWs, successful completion of contact tracing, and incidence of suspected COVID-19 among contacts. We described how these outcomes changed over time as the intervention evolved. In addition, we assessed associations between these three main outcomes and demographic characteristics of contacts and intervention period (pre vs. post March 2021) using univariate and multivariate logistic regression. RESULTS: From a roster of 2,177 named contacts, 1,187 (54.5%) received at least one home visit by a CHW and 560 (25.7%) had successful completion of contact tracing according to intervention guidelines. Of 560 contacts with complete contact tracing, 93 (16.6%) became suspected COVID-19 cases. We observed significant associations between sex and coverage (p = 0.006), sex and complete contact tracing (p = 0.049), community of residence and both coverage and complete contact tracing (p < 0.001), and intervention period and both coverage and complete contact tracing (p < 0.001). CONCLUSIONS: Our analysis highlights the promises and the challenges of implementing CHW-led COVID-19 contact tracing programs. To optimize implementation, we recommend using digital tools for data collection with a human-centered design, conducting regular data quality assessments, providing CHWs with sufficient technical knowledge of the data collection system, supervising CHWs to ensure contact tracing guidelines are followed, involving communities in the design and implementation of the intervention, and addressing community member needs and concerns surrounding stigmatization arising from lack of privacy.
Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Busca de Comunicante , Agentes Comunitários de Saúde , México/epidemiologia , PobrezaRESUMO
A Doença de Niemann-Pick é um distúrbio de armazenamento hereditário cujo problema principal reside na deficiência parcial ou total de esfingomielinase e/ou de suas isoenzimas, levando ao acúmulo de esfingomielina em todos os orgäos, principalmente no fígado, rins e cérebro. As alteraçöes da coagulaçäo na Doença de Niemann-Pick ainda säo pouco descritas, porém podem apresentar-se precose e isoladamente nos neonatos, precedendo os sinais e sintomas mais frequentes. Os autores apresentam neste relato um caso de paciente do sexo feminino, cinco meses de vida, com quadro de hemorragia grave aos 13 dias de vida após realizaçäo do Teste do Pezinho e aumento do volume abdominal progressivo desde o nascimento. O diagnóstico de Doença de Niemann-Pick foi dado após exclusäo das principais patologias com quadro semelhante e pelo achado de células histiocíticas com depósito citoplasmático espumoso no aspirado de medula óssea. Os autores destacam ainda suas características clínico-laboratoriais e diagnósticos diferenciais.
Assuntos
Humanos , Feminino , Recém-Nascido , Doenças de Niemann-Pick/etiologia , Recém-Nascido , EsfingomielinasRESUMO
Se analizó retrospectivamente, la incidencia del neoplasma de esófago en el Hospital Maciel, en el período Enero 91-Junio 92. Se observó una incidencia del 3.1 por ciento respecto del total de Fibrogastroscopias (FGC) de dicho período, constituyendo el 0.7 por ciento de todos los ingresos hospitalarios. La distribución por edad y sexo fue similar a la observada por publicaciones nacionales e internacionales. De los factores de riesgo se destaca la ingesta de mate en el 86 2 por ciento. La disfagia se manifestó en el 100 por ciento de los pacientes; la topografía en 1/3 medio e inferior constituyó el 82 por ciento, e histológicamente predominó la forma epidermoide, con un 5.7 por ciento de adenocarcinomas en el sector medio. La sobrevida fue nula a los 8 meses, independientemente del tratamiento efectuado. Se plantea la necesidad de un estudio de detección precoz en la población que presenta factores de riesgo: hombre, mayor de 50 años, tomador de mate, fumador y alcoholista(AU)