EL MANUAL DE SALUD PUBLICA ROBERTO TAPIA CONYER PDF

Tapia Conyer, Roberto Overview. Publication Timeline. Most widely held works by Roberto Tapia Conyer. Dengue fever : a resilient threat in the face of innovation 1 edition published in in English and held by 39 WorldCat member libraries worldwide. Panorama epidemiologico del tabaquismo en Mexico by Roberto Tapia Conyer 4 editions published between and in Spanish and held by 32 WorldCat member libraries worldwide El tabaco es una de las principales causas prevenibles de enfermedad y muerte en el mundo: 3. El presente ensayo muestra los avances de esta epidemia en nuestro pais y senala la importancia de aplicar un programa integral que permita detener su avance.

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Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. The current national influenza vaccination schedule in Mexico does not recommend vaccination in the school-aged population 5—11 years. Currently, there are limited data from middle-income countries analysing the cost-effectiveness of influenza vaccination in this population. We explored the clinical effects and economic benefits of expanding the current national influenza vaccination schedule in Mexico to include the school-aged population.

A static 1-year model incorporating herd effect was used to assess the cost-effectiveness of expanding the current national influenza vaccination schedule of Mexico to include the school-aged population. The primary health outcome for this study was the number of influenza cases avoided. Associated with this were , fewer outpatient consultations; , fewer emergency room consultations; 97, fewer hospitalisations, and 15 fewer deaths.

Analysis of cases avoided by age-group showed that There was an overall decrease in the economic burden for the Mexican health care system of Vaccinating school-aged population in Mexico would be cost-effective; expansion of the current national vaccination schedule to this age group is supported.

From the early inactivated vaccines to the current recombinant quadrivalent vaccines, there is no doubt that science and technology have stepped up to this challenge [ 2 — 4 ]. However, the constant genetic shifts and drifts of the virus remain the most relevant factors hindering efforts at disease control; the current annual incidence of influenza-like illness ILI in Latin America ranges between 4.

Vaccination is one of the most cost-effective strategies for disease prevention and control [ 6 ]. For influenza, the implementation of immunisation campaigns throughout the world have resulted in decreases of both mortality and morbidity [ 7 , 8 ]. Although usually focused on younger populations for epidemiological and practical reasons, vaccination in most age groups, including adults, is considered highly cost-effective [ 9 , 10 ].

Throughout the Americas, immunisation recommendations for children vary. According to the World Health Organization WHO Vaccine-Preventable Diseases Monitoring System, only Grenada, Panama, and the United States recommend universal influenza vaccination in children and adolescents [ 11 ]; Canada recommends immunisation for all children aged 6 to 59 months, and for at-risk children and adolescents [ 12 ].

These target groups are eligible to receive the vaccine free of charge at any public health facility during the influenza immunisation season October to February. Vaccination of adults aged 50 to 59 years and school-aged children 5 to 11 years who are not at risk are not considered as target groups for influenza immunisation [ 13 ]. Studies have shown that the cost-effectiveness of influenza vaccination varies depending on the age-groups targeted [ 14 ]. De Waure et al.

Peasah et al. Unfortunately, most of these studies were focused on high-income countries, particularly the United States and selected European countries. Thus, further research is necessary to evaluate the impact of influenza vaccination in other regional contexts. In this study we analysed epidemiologic and disease burden data to assess the clinical effects and economic benefits of expanding the current national influenza vaccination schedule of Mexico to include school-aged population 5 to 11 years.

Using a static 1-year model that incorporates herd effect, we assessed the cost-effectiveness of such a change in policy, with the reduction in the number of influenza cases as the primary health outcome from the societal perspective. Of note, Mexico began using ICD codes in when their use was adopted into epidemiologic surveillance information systems. Data for projections of the Mexican population for the study period were obtained from the National Population Council database [ 20 ]. It is designed to provide timely and quality information on trends of circulating viral strains and the occurrence of severe cases [ 21 ].

The school-aged population was defined as children between the ages of 5 years and 11 years, 11 months and 30 days. For estimating the costs of influenza cases, the following seven scenarios were built, both for ambulatory patients scenarios 1 through 3 and for inpatients scenarios 4 through 7 , based on data analysed from SISVEFLU:. Scenario 1: Symptomatic individual visited an outpatient clinic, had a positive PCR result for influenza, was managed only in ambulatory care and had a complete recovery.

Scenario 2: Symptomatic individual visited an outpatient clinic, had a positive PCR result for influenza for which, due to the severity, they were referred for hospital care where they had a complete recovery and were discharged. Scenario 3: Symptomatic individual visited an outpatient clinic, had a positive PCR result for influenza and, due to severity, was referred for hospital care and died.

Scenario 4: Symptomatic individual visited a hospital ER, had a positive PCR result for influenza, was discharged to an outpatient clinic for follow-up and had a complete recovery. Scenario 5: Symptomatic individual visited a hospital ER, had a positive PCR result for influenza, was admitted to hospital for follow-up with non-severe clinical status and had a complete recovery.

Scenario 6: Symptomatic individual visited a hospital ER, had a positive PCR result for influenza, was admitted for follow-up with severe clinical status and had a complete recovery. Scenario 7: Symptomatic individual visited a hospital ER, had a positive PCR result for influenza, was admitted for hospital follow-up and died.

A scenario 0 was considered, in which symptomatic individuals did not request medical care and self-medicated with over-the-counter drugs. We assumed that the outcome in this scenario was complete recovery. Influenza was confirmed using real-time PCR. In cases with suspicion of bacterial coinfection, throat swab culture is indicated.

Cases detected and managed in outpatient clinics scenario 1 require a single medical consultation with no follow-up. Cases admitted to hospital via an outpatient clinic scenario 2 require two medical consultations; the first for clinical diagnosis and the second at discharge with medical disability leave. For scenario 3 with admission to hospital via an outpatient clinic that results in death, the requirement is one initial consultation at the outpatient care facility and three subsequent consultations at the hospital.

For hospital-managed cases admitted through the ER scenarios 4 through 7 , an emergency consultation was required. Cases admitted for hospitalisation had one, two, three, or four medical consultations in scenarios 4, 5, 6, and 7 respectively, assuming a proportional increase in the number of medical consultations, consistent with the severity of the case.

For individuals not requesting medical care scenario 0 and only requiring over-the-counter drugs, amantadine use was assumed. For all confirmed cases, patients were assumed to have been prescribed oseltamivir for influenza treatment and paracetamol for acute pain management. For cases with a bacterial coinfection requiring antibiotic treatment, use of ceftriaxone was assumed. Patients admitted via an outpatient clinic who were referred for hospitalisation and later discharged were assumed to have had a 1-day hospital stay.

Patients admitted via an outpatient clinic who were referred for hospitalisation that resulted in death were considered to have had a 6. Patients admitted to hospital for observation via the ER who were discharged for follow-up at an outpatient clinic were considered to have had a 2-day hospital stay. Patients admitted via the ER for medical care who were classified as non-severe were considered to have had a 6.

For patients diagnosed in outpatient clinics who did not require admission to hospital scenario 1 , a 3-day medical leave was assumed. For patients diagnosed in outpatient clinics who were referred to hospital scenario 2 and those admitted via the ER and hospitalised as non-severe cases scenario 5 , a 7-day medical leave was assumed after hospital discharge, for a total of 13 days of absence.

For patients admitted via the ER and hospitalised as severe cases scenario 6 , a day medical leave was assumed after hospital discharge, for a total of 23 days of absence [ 24 ]. It was assumed that school-aged population with influenza was monitored by an adult caregiver parent or close relative for the duration of their sickness, which was assumed to have had an effect on the productivity of the adult caregiver. The lower and upper limits were as follows: lower limit, age of 1 year for all individuals; upper limit, age of 73 or 78 years for males and females, respectively [ 25 , 26 ].

The upper age limit was determined according to the current life expectancy in Mexico; these ages were later weighed according to the population distribution by sex. Therefore, the total number of influenza cases in Mexico were estimated by indirectly standardising reported values of influenza incidence in the United States for each season and age group [ 27 ] into the Mexican population structure according to official population projections Additional file 1 : Supplement 1; Tables S1.

National estimated cases were then allocated into the different scenarios, considering 1 the probability of not demanding medical care scenario 0 , as reported by Molinari et al. Further details of the method used to estimate national cases are available in Additional file 1 : Supplement 2, Text S2, Tables S2.

Public costs were used for the estimation of direct medical care costs by each of the institutions that comprise the Mexican Health System and weighed by the proportion of the population affiliated in each institution for the influenza seasons from to to — Additional file 1 : Supplement 3; Tables S3. The cost of transportation and storage was considered as a percentage of the price per dose, considering that the implementation of influenza vaccination in school-aged population would take place at primary schools.

To account for herd effect, we followed the methodology of Van Vlaenderen et al. The parameter used to account for herd effect was the proportion of the school-aged population that need to be vaccinated to achieve a relative risk RR of 0 zero risk of infection. Disaggregated data by age group enabled estimation of the herd effect, particularly in those not vaccinated under the current schedule Additional file 1 : Supplement 2; Table S2. The primary health outcome for this study was influenza cases avoided, which in turn led to secondary health outcomes such as reductions in outpatient consultations, lost working days, hospitalisations, and deaths.

We performed a sensitivity analysis to assess whether the cost-effectiveness of immunising the school-aged population was sustained when using either a conservative or optimistic scenario, considering changes to the base case scenario in both vaccination coverage and vaccination effectiveness. Influenza A virus was isolated in This viral serotype accounted for The season with the highest record of confirmed cases was —, with influenza A cases and influenza B cases reported. Regarding clinical presentation, as expected, most of the confirmed cases were classified as ILI Results for cases, clinical presentation, viral types, and deaths were also consistent between seasons.

Nonetheless, there are important variations depending on the infecting virus. The highest lethality was recorded for A H1N1 2. No deaths were recorded for B Victoria or influenza A not subtyped. The highest lethality was recorded in children aged 5 and 11 years with influenza A H1N1 3.

Cases, deaths, and lethality in the school-aged population by age and influenza type. When analysing data from the complete study period, influenza cases peaked between epidemiological weeks 4 and 9.

However, in school-aged population in Mexico, influenza B transmission seemed to have a longer duration started earlier and ended later in comparison to the duration of influenza A in the same season Fig.

Influenza A and B confirmed cases in the school-aged population by epidemiological week seasons — Incidence of influenza per , inhabitants in school-aged population by age and season. These data show that the cumulative incidence of influenza had a tendency to decrease with age. The highest incidence was reported amongst children aged 5 and 6 years.

Hospital discharges with influenza as the main diagnosis in school-aged population by ICD — There were discharges from hospital of school-aged children during the study period, accounting for bed-days, with an average of 4.

The most frequent diagnosis was influenza with other respiratory manifestations, virus not identified J , followed by influenza with pneumonia, virus not identified J Overall mortality was low 0. For school-aged population, mortality due to influenza was also low.

The decrease in demand for the aforementioned services would also reduce the pressure on the public health system. In terms of demand for influenza-related health services, the vaccination had the largest effect in school-aged population.

In addition, it is worth noting the effect of vaccinating school-aged children on the reduction in the demand of influenza-related health services by population over 60 years old, who consequently required fewer hospitalisation services.

Influenza-related events avoided by immunising the school-aged population by age group. Of these costs avoided, Direct costs accounted for The costs avoided from hospitalisations and the sum of the costs avoided from medical consultations and productivity loss were 3.

ERGONOMIA APLICADA AO TRABALHO HUDSON COUTO PDF

Tapia Conyer, Roberto

Metrics details. Currently, there are limited data from middle-income countries analysing the cost-effectiveness of influenza vaccination in this population. We explored the clinical effects and economic benefits of expanding the current national influenza vaccination schedule in Mexico to include the school-aged population. A static 1-year model incorporating herd effect was used to assess the cost-effectiveness of expanding the current national influenza vaccination schedule of Mexico to include the school-aged population. The primary health outcome for this study was the number of influenza cases avoided. Associated with this were , fewer outpatient consultations; , fewer emergency room consultations; 97, fewer hospitalisations, and 15 fewer deaths. Analysis of cases avoided by age-group showed that

CONOCIENDO A TU BEBE EZZO PDF

El Manual de Salud Pública

Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. The current national influenza vaccination schedule in Mexico does not recommend vaccination in the school-aged population 5—11 years. Currently, there are limited data from middle-income countries analysing the cost-effectiveness of influenza vaccination in this population. We explored the clinical effects and economic benefits of expanding the current national influenza vaccination schedule in Mexico to include the school-aged population. A static 1-year model incorporating herd effect was used to assess the cost-effectiveness of expanding the current national influenza vaccination schedule of Mexico to include the school-aged population. The primary health outcome for this study was the number of influenza cases avoided.

DUTILLEUX SONATINA FOR FLUTE PDF

C ervical cancer is the most frequent type of malignant disease among women in Latin America and the Caribbean. In most of these countries mortality rates from cervical cancer have remained unchanged over the past 30 years. InDRE has, among many other activities, the responsibility of quality control of cervical cytology since Results of the comparison of smears diagnosed in the 32 states of Mexico and rescreened in InDRE during , alerted us of the low diagnostic performance. In this paper we present the conception, establishment, evaluation and follow up of the new program.

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