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BackgroundThe null hypothesis significance test (NHST) is the most frequently used statistical method, although its inferential validity has been widely criticized since its introduction. In 1988, the International Committee of Medical Journal Editors (ICMJE) warned against sole reliance on NHST to substantiate study conclusions and suggested supplementary use of confidence intervals (CI). Our objective was to evaluate the extent and quality in the use of NHST and CI, both in English and Spanish language biomedical publications between 1995 and 2006, taking into account the International Committee of Medical Journal Editors recommendations, with particular focus on the accuracy of the interpretation of statistical significance and the validity of conclusions.MethodsOriginal articles published in three English and three Spanish biomedical journals in three fields (General Medicine, Clinical Specialties and Epidemiology - Public Health) were considered for this study. Papers published in 1995-1996, 2000-2001, and 2005-2006 were selected through a systematic sampling method. After excluding the purely descriptive and theoretical articles, analytic studies were evaluated for their use of NHST with P-values and/or CI for interpretation of statistical "significance" and "relevance" in study conclusions.ResultsAmong 1,043 original papers, 874 were selected for detailed review. The exclusive use of P-values was less frequent in English language publications as well as in Public Health journals; overall such use decreased from 41% in 1995-1996 to 21% in 2005-2006. While the use of CI increased over time, the "significance fallacy" (to equate statistical and substantive significance) appeared very often, mainly in journals devoted to clinical specialties (81%). In papers originally written in English and Spanish, 15% and 10%, respectively, mentioned statistical significance in their conclusions.ConclusionsOverall, results of our review show some improvements in statistical management of statistical results, but further efforts by scholars and journal editors are clearly required to move the communication toward ICMJE advices, especially in the clinical setting, which seems to be imperative among publications in Spanish.

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The concentration of HIV and syphilis infections in the coastal region of Ecuador highlights the need for intensified prevention and a response tailored to local epidemic conditions. Major challenges for the elimination initiative include achieving universal, early access to antenatal care, improving coverage of HIV and syphilis testing, and improving the quality of medical records to support progress monitoring.

infantil y condiciones higienico-sociales en las Américas. Un estudio de correlación. Rev. Saúde públ., S.Paulo, 24:473-80, 1990. RESUMEN:Se evalúa por conducto de un estudio exploratorio, basado en la teoría de correlaciones, la relación existente en la Región de las Américas entre la tasa de mortalidad infantil como indicador del estado de salud de la población y otros índices expresivos de áreas tales como la demográfica, social y de desarrollo de la atención médica. Los resultados obtenidos muestran que las variables más influyentes en el riesgo de morir de los menores de un año son el nivel de educación materna y la tasa de natalidad. Por otra parte parece confirmarse que el aumento de los recursos destinados a la atención, por sí mismos, no mejoran la situación de la mortalidad infantil en nuestros países una vez alcanzado cierto nivel.

Background: The objective of this research was to evaluate data from a randomized clinical trial that tested injectable diacetylmorphine (DAM) and oral methadone (MMT) for substitution treatment, using a multi-domain dichotomous index, with a Bayesian approach.

INTRODUCTION Chronic kidney disease has reached epidemic levels in several Central American countries since the early years of this century. In El Salvador, it is the second cause of death in men, the fi fth in persons over 18 years old and the third cause of hospital deaths in the adult population. Its features, especially those of a subtype unassociated with traditional risk factors such as diabetes and high blood pressure, are only partially understood.OBJECTIVE Estimate the magnitude of chronic kidney disease in the adult population of El Salvador, considering both prevalence of the disease in its diverse forms as well as presence of potential risk factors nationally and in major subpopulations.METHODS A descriptive, cross-sectional analysis was conducted on data obtained from the Survey of Chronic Non-communicable Diseases in Adults in El Salvador, completed in 2015. The original data (interviews and measurements) were collected between October 2014 and March 2015 from 4817 adults employing a two-stage probabilistic cluster sample, with stratifi cation of primary sampling units. Our analysis, using 20 of the 118 primary variables included in the original survey, focused on point estimation of prevalence rates and means, related to both traditional biological risk factors and nontraditional ones, such as insuffi cient hydration, strenuous working conditions and exposure to toxic agents. A separate analysis was performed to estimate prevalence of chronic kidney disease from nontraditional causes. Corresponding confi dence intervals were calculated with proper weighting. RESULTSThe general prevalence of chronic kidney disease in El Salvador was 12.8% (men 18.0%; women 8.7%). Of the chronically ill kidney patients, 13.1% were between 20 and 40 years of age. Among biological risk factors, the most frequent was high blood pressure (37.0%). Among nontraditional risk factors, high levels of sugary drink consumption (81.0%), insuffi cient hydration (65.9%) and high levels of exposure to agrochemicals in the work environment (12.6%) were also observed. Prevalence of chronic kidney disease from nontraditional causes was 3.9% (men 6.1%; women 2.2%).CONCLUSIONS Chronic kidney disease has reached epidemic proportions in El Salvador. The data confi rm a health tragedy that, although especially striking older men, also takes a severe toll on young men and women. The results confi rm fi ndings of previous research in several Salvadoran agricultural communities. The relatively high level of population exposure to agrochemicals is important and alarming, especially in rural areas, meriting health-impact studies that include and go beyond possible impact on chronic kidney disease.

INTRODUCTION One year after WHO declared COVID-19 a pandemic, we found it useful to carry out a diagnosis of the situation in Latin America.OBJECTIVES Examine the prevailing epidemiological panorama in mid-March 2021 in 16 countries in Latin America and the performance, over time, in the two countries with the best responses to their respective epidemics.METHODS Using morbidity and mortality data, we compared the relative performance of each country under review and identifi ed the two countries with the most successful responses to the pandemic. We used fi ve indicators to analyze the course of each country's performance during the pandemic throughout 2020: prevalence of active cases per million population; cumulative incidence rate in 7 days per 100,000 population; positivity rate over a 7-day period; percentage of recovered patients and crude mortality rate per 1,000,000 population. RESULTSAccording to the performance indicators, Cuba was ranked highest, followed by Uruguay. Although fi gures remained within acceptable margins, both nations experienced notable setbacks in the fi rst weeks of 2021, especially sharp in Uruguay.CONCLUSIONS Any characterization of the situation is condemned to be short-lived due to the emergence of mutational variants; however, this analysis identifi ed favorable sociodemographic characteristics in both nations, and in their health systems, which may offer possible explanations for the results we obtained.