SummaryBackgroundLatin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among these groups in population coverage with reproductive, maternal, newborn, and child health interventions.MethodsWe analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15–49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12–23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), woman's education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression.FindingsEthnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0·82, IQR 0·66–0·92), antenatal care (0·86, 0·75–0·94), and skilled birth attendants (0·75, 0·68–0·92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries.InterpretationThe lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level—such as vaccines—show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes.FundingThe Bill & Melinda Gates Foundation (through the Countdown to 2030 initiative) and the Wellcome Trust.
Comparar el tratamiento con trombólisis dirigida por catéter (TDC) del segmento iliaco con anticoagulación y su efecto en la prevención del síndrome postrombótico (SPT). Métodos: Estudio observacional de cohorte y retrospectivo en pacientes con trombosis venosa profunda (TVP) del segmento iliaco del Hospital Central del Estado de Chihuahua, durante el periodo de marzo de 2014 a junio de 2016. Se hicieron dos grupos, uno tratado con anticoagulación y el otro con TDC más anticoagulación, para valorar su efecto sobre la prevención del SPT. Resultados: De los 14 pacientes estudiados en cada grupo, se encontró que 5 (35.7%) de ellos, que habían recibido tratamiento de anticoagulación más TDC, a 2 años de seguimiento habían desarrollado síndrome postrombótico, clasificado con una puntuación de 5 o más en la escala de Villalta, contra 6 (42.9%) pacientes que desarrollaron SPT del grupo tratado con anticoagulación únicamente, sin existir diferencia estadísticamente significativa (T = 0.14; p = 0.70). Conclusiones: El tratamiento de TVP de segmento iliaco se ha enfocado en la reducción de la carga trombótica mediante distintos mecanismos para la prevención de secuelas y disminución de su morbilidad. En este estudio no se logra demostrar la utilidad del tratamiento invasivo para la prevención de SPT.
La ruptura de un aneurisma de aorta abdominal (rAAA) tiene una alta mortalidad. Objetivo: Analizar los factores que influyen en la mortalidad y la sobrevida de los pacientes con rAAA. Métodos: Revisión retrospectiva, se estudiaron 32 pacientes tratados por rAAA, calculando medidas de tendencia central, prueba de χ 2 , riesgo de razón de momios (OR, odds ratio) e intervalo de confianza del 95% (IC95%) de la variable mortalidad.
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