Umeå University's logo

Este informe analiza la evolución del cáncer en las provincias amazónicas de Sucumbíos y Orellana durante el período 1990–2019, una región históricamente afectada por la explotación petrolera. El estudio se basa en los datos del Registro Nacional de Tumores (RNT) de Quito, ya que en la región amazónica no existe un registro local. Se incluyeron 2.773 casos de cáncer diagnosticados a residentes de estas provincias en el periodo mencionado, mostrando un incremento sostenido del 360% en los casos reportados.

Las tasas de cáncer fueron sistemáticamente más altas en mujeres, destacando el cáncer de cuello uterino como el más prevalente, seguido por mama y tiroides. En hombres, los tipos más frecuentes fueron próstata, estómago y piel. Las tasas estandarizadas para la edad se incrementaron especialmente a partir del año 2005, alcanzando en el último quinquenio (2015-2019) tasas ajustadas para la edad de 45,4 por 100.000 en hombres y 90,2 por 100.000 en mujeres.

A nivel territorial, los cantones de Lago Agrio, Orellana y Sucumbíos mostraron las tasas más elevadas. Se observó una clara asociación entre la exposición prolongada a actividades petroleras y una mayor incidencia de cáncer. Los cantones con más de 20 años de explotación petrolera presentaron tasas hasta seis veces mayores que los no expuestos, especialmente en mujeres. Esta diferencia se observó a lo largo de los distintos periodos, salvo en el periodo 2010-2014 para mujeres.

El informe destaca la debilidad de la infraestructura sanitaria local: ausencia de servicios oncológicos, falta de programas de prevención y diagnóstico temprano, y dependencia de Quito para tratamiento, lo que genera importantes inequidades.

Entre las recomendaciones se incluyen la creación de un registro regional de cáncer, fortalecimiento de la prevención (vacunación, tamizaje), expansión de servicios de diagnóstico y tratamiento en la Amazonía, y mayor investigación sobre la relación entre cáncer y contaminación petrolera. También se sugiere capacitación continua del personal de salud en oncología y salud ambiental con enfoque intercultural.

El informe concluye que existe una situación alarmante de salud pública en Sucumbíos y Orellana, agravada por la exposición ambiental, la falta de servicios adecuados y la ausencia de medidas preventivas eficaces.

Introduction: Depression is a leading cause of disability globally, with disparities evident across gender and ethnicity. Indigenous populations, including the Sámi people in Sweden, face compounded disadvantages due to intersecting social inequalities. This study aimed to estimate the differences in depression prevalence across different intersectional groups defined by Indigenous status and gender in Sweden.

Methods: Data on participants (N = 19,839) aged 18–84 years were obtained from two cross-sectional surveys conducted in 2021: the SámiHET study and the Health on Equal Terms (HET) survey. Depression prevalence was assessed using self-reported doctor-diagnosed depression. Four intersectional categories were created representing Sámi women, Sámi men, non-Sámi women, and non-Sámi men. Intersectional disparities (joint, referent, and excess) were estimated to examine the combined effects of Indigenous status and gender on depression prevalence.

Results: Sámi women reported the highest prevalence of depression (26%), while Sámi men had the lowest (12%). The joint disparity in depression prevalence was 10 percentage points (pp) (95% CI: 8.4 to 12, adjusted), reflecting a higher prevalence of depression among Sámi women compared with non-Sámi men. Most of the joint disparity was explained by the referent disparities for Indigenous status (-2.6 pp, 95% CI: -4.7 to -0.49) and gender (9.7 pp, 95% CI: 8.5 to 11). The excess intersectional disparity, reflecting the compounded effects of being Indigenous and gender, accounted for a third of the joint disparity (3.3 pp, 95% CI: 0.48 to 6.1, adjusted).

Conclusion: Sámi women experienced a disproportionate burden of depression due to intersectional disadvantages. These findings highlight the importance of culturally sensitive mental health strategies and the need for further qualitative research to explore their lived experiences.

BACKGROUND: The quality of registry data is important for epidemiological research. The Swedish inpatient registry (IPR) is a national database with mandatory registration of all hospitalisations since 1987, and since 2007, the medical procedure codes which can be used for grading severity of infectious diseases. However, the completeness of procedure code registration has rarely been studied.

OBJECTIVES: To determine the quality and completeness of procedure codes for ICU admission, mechanical ventilation and extra-corporeal membrane oxygenation (ECMO) in the Swedish IPR utilising the Swedish Intensive Care Registry (SIR) as the gold standard. DESIGN A Swedish nationwide observational study.

SETTING: Covid-19 patients in Sweden who required intensive care in Sweden between March 2020 and August 2022. PATIENTS Covid-19 patients with a laboratory-verified SARS-CoV-2 infection who required ICU admission (n=8992), mechanical ventilation (n=5262) or ECMO (n=29).

MAIN OUTCOME MEASURES: The sensitivity and/or positive predictive values of procedure code registration for ICU, mechanical ventilation, ECMO and Covid-19 diagnosis code registration in the IPR were evaluated using SIR as the reference. Factors associated with low reporting were explored and the dates of ICU admission registration compared between IPR and SIR.

RESULTS: For Covid-19 patients registered in SIR as needing intensive care, mechanical ventilation or ECMO, the completeness of procedure codes in the IPR was 39.7, 78.2 and 100%, respectively. Of the 39.7% with an ICU code in the IPR, the ICU date in the IPR corresponding to the actual ICU admission date was 52.3%. The completeness of ICU registration in the IPR varied from 0.6 to 96.9% between healthcare regions

CONCLUSIONS: Procedure codes for intensive care in the Swedish IPR showed low sensitivity and varied greatly between healthcare regions. This negatively influences their usability for epidemiological research and calls for updated guidelines on coding.

Objectives. To estimate cervical cancer screening (CCS) coverage rates and assess the spatial distribution and clustering between departments and municipalities in Bolivia.

Methods. Standardized CCS coverage rates were calculated using the direct standardization method. The global Moran's I test was used to investigate the existence of spatial autocorrelation of CCS coverage, and the Getis-Ord Gi* was used to identify the spatial clustering of municipalities with high (hot spot) or low (cold spot) coverage.

Results. Overall coverage was low. Around 14% of women aged 20-69 years were screened in Bolivia in 2022. Large geographical inequities in CCS coverage rates were identified both between departments and between municipalities. At the municipal level, CCS showed large differences, ranging from 59% to below 1%. Hot spots were identified in northwestern and southeastern Bolivia; specifically, in Pando, Chuquisaca, and Tarija departments. Cold spots were identified in Beni and Santa Cruz departments.

Conclusions. Bolivia is still a long way from achieving the World Health Organization target of 70% screening coverage. The present results indicate where the screening program must be reinforced to improve the responsiveness of Bolivia's health system to women's reproductive health needs.

Objetivos. Calcular las tasas de cobertura del tamizaje del cáncer cervicouterino y evaluar la distribución espacial y las agrupaciones de departamentos y municipios bolivianos.

Métodos. Se calcularon las tasas estandarizadas de cobertura con el método de estandarización directa. Se utilizó la prueba de la I de Moran global para determinar si había autocorrelación espacial en la cobertura, y se aplicó la prueba de la Gi* de Getis y Ord para encontrar posibles agrupaciones espaciales de municipios donde la cobertura fuese alta o baja.

Resultados. La cobertura general fue baja. En el 2022, en Bolivia se aplicó el tamizaje del cáncer cervicouterino a alrededor del 14% de las mujeres de entre 20 y 69 años. Se observan importantes inequidades geográficas en las tasas de cobertura tanto entre departamentos como entre municipios. A nivel municipal hay grandes diferencias, con valores que van del 59% a menos del 1%. Se observaron zonas de cobertura alta en el nordeste y el sudeste de Bolivia, concretamente en los departamentos de Pando, Chuquisaca y Tarija, mientras que las zonas de cobertura baja se ubicaban en los departamentos de Beni y Santa Cruz.

Conclusiones. Bolivia aún está muy lejos de alcanzar la meta de la Organización Mundial de la Salud de una cobertura del tamizaje del cáncer cervicouterino del 70%. Los presentes resultados indican dónde debe reforzarse el programa de tamizaje para mejorar la capacidad de respuesta del sistema de salud boliviano para atender las necesidades de salud reproductiva de las mujeres.

Objetivos. Estimar as taxas de cobertura do rastreamento do câncer do colo do útero e avaliar aglomerados e a distribuição espacial entre departamentos e municípios na Bolívia.

Métodos. Taxas padronizadas de cobertura do rastreamento do câncer do colo do útero foram calculadas por meio do método de padronização direta. Utilizou-se o índice I de Moran global para investigar a ocorrência de autocorrelação espacial na cobertura do rastreamento e estatística Getis-Ord Gi* para identificar aglomerados espaciais de municípios com cobertura alta (hot spot) ou baixa (cold spot).

Resultados. A cobertura geral foi considerada baixa. Aproximadamente 14% das mulheres de 20 a 69 anos realizaram o rastreamento na Bolívia em 2022. Foram constatadas grandes iniquidades geográficas nas taxas de cobertura do rastreamento do câncer do colo do útero, tanto entre os departamentos como entre os municípios. No nível municipal, o rastreamento apresentou enormes diferenças, variando de 59% a menos de 1%. Foram identificados hot spots no noroeste e no sudeste da Bolívia, especificamente nos departamentos de Chuquisaca, Pando e Tarija. Por outro lado, foram identificados cool spots nos departamentos de Beni e Santa Cruz.Conclusões. A Bolívia ainda está longe de alcançar a meta de 70% de cobertura do rastreamento estabelecida pela Organização Mundial da Saúde. Os resultados indicam áreas onde o programa de rastreamento precisa ser fortalecido para aprimorar a capacidade de resposta do sistema de saúde da Bolívia às necessidades de saúde reprodutiva das mulheres.

PURPOSE: Individuals with severe liver disease are more vulnerable to severe COVID-19, but the association between chronic hepatitis B virus (HBV) infection and severe COVID-19 remains unclear. This study evaluates this relationship.

METHODS: We analysed nationwide Swedish data from national databases and healthcare registers, identifying laboratory-confirmed COVID-19 cases from February 2020 to April 2021. Chronic HBV infection was classified into cases with and without cirrhosis. Multivariable logistic regression assessed the association between HBV and severe COVID-19, adjusting for demographics, comorbidities, vaccination, and socioeconomic factors.

RESULTS: Among 1,057,174 COVID-19 cases, 2,902 had chronic HBV infection, which was associated with increased risk of severe COVID-19 (adjusted odds ratio [aOR] 1.242, 95% confidence interval [CI] 1.097-1.403). This risk was significantly higher in HBV individuals with cirrhosis (aOR 2.463, CI 1.546-3.892) compared to those without cirrhosis (aOR 1.183, CI 1.039-1.343). While overall COVID-19 mortality was not significantly elevated in the HBV cohort, patients with cirrhosis showed a higher, though nonsignificant, mortality risk (aOR 2.350, CI 0.921-5.203).

CONCLUSION: This nationwide study highlights an increased risk of severe COVID-19 in individuals with chronic HBV, particularly those with cirrhosis. Geographic and socioeconomic factors further influence outcomes. These findings underscore the need to consider HBV status in COVID-19 risk assessments. Future studies should explore these associations in the context of evolving SARS-CoV-2 variants and widespread vaccination.

Aims: Doctors have an increased risk of SARS-CoV-2 infection caused by exposure to contagious patients. We aimed to identify which clinical specialities among medical doctors had the highest occupation-related risk of testing positive for SARS-CoV-2, utilizing data for all publicly employed medical doctors in Sweden.

Methods: Data regarding positive SARS-CoV-2 test results and employment for publicly employed doctors in Sweden were divided into three observation periods: 1) 1 February to 31 December 2020, 2) 1 January to 30 June 2021 and 3) 1 July 2021 to 31 March 2022. Individuals were stratified according to occupation clinic and compared with clinical occupations with little to no patient contact. The risk of testing positive for SARS-CoV-2 was estimated using Cox proportional hazards regression, with sex, age and vaccination status as covariates.

Results: The study cohort included all publicly employed doctors in Sweden: 35,028 individuals. In the first period, Infectious Disease doctors had the highest incidence of SARS-CoV-2 positive tests, with an incidence of 20.2 %, compared with 8.7 % in the reference group, and an adjusted hazard ratio of 2.5 (95% confidence interval 2.02–3.04), which decreased during period 2–3. Doctors in Geriatric Medicine had an elevated risk throughout the whole study period.

Conclusions: Our study shows an association between working in a speciality that involves caring for contagious COVID-19 patients, which raises concerns about infection control measures and routines being insufficient to prevent occupational infection in future pandemics.

Primary health care (PHC) systems are a crucial instrument for achieving equitable population health, but there is little evidence of how PHC reforms impact equities in population health. In 2010, Sweden implemented a reform that promoted marketization and privatization of PHC. The present study uses a novel integration of intersectionality-informed and evaluative epidemiological analytical frameworks to disentangle the impact of the 2010 Swedish PHC reform on intersectional inequities in avoidable hospitalizations. The study population comprised the total Swedish population aged 18–85 years across 2001–2017, in total 129 million annual observations, for whom register data on sociodemographics and hospitalizations due to ambulatory care sensitive conditions were retrieved. Multilevel Analysis of Individual Heterogeneity and Discriminatory Analyses (MAIHDA) were run for the pre-reform (2001–2009) and post-reform (2010–2017) periods to provide a mapping of inequities. In addition, random effects estimates reflecting the discriminatory accuracy of intersectional strata were extracted from a series MAIHDAs run per year 2001–2017. The estimates were re-analyzed by Interrupted Time Series Analysis (ITSA), in order to identify the impact of the reform on measures of intersectional inequity in avoidable hospitalizations. The results point to a complex reconfiguration of social inequities following the reform. While the post-reform period showed a reduction in overall rates of avoidable hospitalizations and in age disparities, socioeconomic inequities in avoidable hospitalizations, as well as the importance of interactions between complex social positions, both increased. Socioeconomically disadvantaged groups born in the Nordic countries seem to have benefited the least from the reform. The study supports a greater attention to the potentially complex consequences that health reforms can have on inequities in health and health care, which may not be immediate apparent in conventional evaluations of either population-average outcomes, or by simple evaluations of equity impacts. Methodological approaches for evaluation of complex inequity impacts need further development.

A better understanding of the bovine tuberculosis (bTB) spatial distribution and the factors associated with increased risk is required to implement more effective control measures in Mexico. A cross-sectional study based on bTB testing on >1,600 herds in two regions of San Luis Potosi state, Altiplano and Huasteca, during 2018-2021 was conducted for the identification of spatial clustering and of bTB risk factors using the spatial scan statistic test and multivariable logistic regression models. The proportion of herds with at least one reactor was 17.9% in Altiplano and 38.6% in Huasteca, with one high risk cluster (HRC) present in each region. Larger herds (>20 animals) and those included in the HRC were exposed to a significantly increased risk of having at least one reactor in both regions. Given bTB caudal fold test limitations, herd disease freedom median posterior probability was calculated in an empirical Bayesian framework, classifying herds as <likely free= (> 94%) or <inconclusive=, the cluster and regression analysis was repeated, finding similar outcomes. Results demonstrated that certain herds are exposed to higher risk depending on their size and location in both regions, suggesting similar patterns of transmission; these findings can be used to further investigate how the disease spreads in San Luis Potosi.

Este estudio tiene como objetivo actualizar la información sobre la incidencia del cáncer en la región amazónica (provincias de Sucumbíos, Orellana, Napo y Pastaza) del Ecuador durante el periodo 1990-2019.

Dado que no existe un registro de tumores en la región amazónica, se obtuvieron los datos del Registro Nacional de Tumores de Quito, donde se registran todos casos que se diagnostican en establecimientos de salud de esa ciudad procedentes de las provincias de estudio.

Se calcularon el número total de casos de cáncer por sexo, provincia y periodo. Se establecieron seis periodos de estudio: 1990-1994, 1995-1999, 2000-2004, 2005-2009, 2010-2014 y 2015-2019. Se estimaron también las tasas estandarizadas por edad de todos los cánceres combinados por provincia y periodo.

En total se registraron 4.881 casos (36,8% en hombres) de cáncer durante el periodo 1990-2019 en las cuatro provincias. En hombres, los cánceres de próstata, sistema hematopoyético (sangre y médula ósea), estómago, otros de piel, y el no especificado de ganglios fueron los más frecuentes. En las mujeres, los de cuello de útero, mama, tiroides, otros de piel y sistema hematopoyético fueron los cinco cánceres más comunes.

El estudio muestra un incremento acelerado de cáncer en la región en total y para cada uno de los tipos de cáncer seleccionados en los últimos tres quinquenios (2005-2019). Este aumento es probablemente un indicador del continuo aumento de esta patología junto con un posible mayor acceso al diagnóstico en la ciudad de Quito. La situación geográfica (comunidades alejadas), diferentes estilos de vida, el crecimiento de la población, sobre todo por procesos migratorios, un envejecimiento de la misma y el limitado acceso a los servicios sanitarios son probablemente los determinantes más importantes en la evolución de las tasas de cáncer en esta región. 

Especialmente preocupantes son los incrementos en los cánceres de próstata en hombres, de mama y tiroides en mujeres y la estabilidad del resto de los tumores, sobre todo teniendo en cuenta la posibilidad de implementar programas de prevención para la mayoría de estos tumores. 

En conclusión, la tendencia ascendente de casos de cáncer en la Amazonía ecuatoriana exige la necesidad urgente de contar con un Plan Nacional de Control de Cáncer como hoja de ruta para el manejo de pacientes dentro del sistema de salud.

This study aims to update information on cancer incidence in the Amazon region (provinces of Sucumbíos, Orellana, Napo and Pastaza) of Ecuador during the period 1990-2019.

Since there is no registry of tumours in the Amazon region, data were obtained from the National Cancer Registry in Quito, where all cases diagnosed in health facilities in that city from the provinces under study are registered.

The total number of cancer cases by sex, province and period was calculated. Six study periods were established: 1990-1994, 1995-1999, 2000-2004, 2005-2009, 2010-2014 and 2015-2019. Age-standardised rates for all cancers combined by province and period were also estimated.

In total, 4,881 cases (36.8% in men) of cancer were registered during the period 1990-2019 in the four provinces. In men, prostate, haematopoietic system (blood and bone marrow), stomach, other skin, and unspecified lymph node cancers were the most frequent cancers. In women, cervical, breast, thyroid, other skin and haematopoietic system were the five most common cancers.

The study shows an accelerated increase in cancer in the region in total and for each of the selected cancer types over the last three five-year periods (2005-2019). This increase is probably an indicator of the continued rise of this pathology together with a possible increased access to diagnosis in the city of Quito. Geographical location (remote communities), different lifestyles, population growth, especially due to migration, an ageing population and limited access to health services are probably the most important determinants in the evolution of cancer rates in this region. 

Of particular concern are the increases in prostate cancer in men, breast and thyroid cancer in women and the stability of the remaining tumours, especially considering the possibility of implementing prevention programmes for most of these tumours. 

In conclusion, the rising trend of cancer cases in the Ecuadorian Amazon requires the urgent need for a National Cancer Control Plan as a roadmap for patient management within the health system.

Background: The COVID-19 pandemic prompted varied policy responses globally, with LatinAmerica facing unique challenges. A detailed examination of these policies’ impacts on healthsystems is crucial, particularly in Bolivia, where information about policy implementation andoutcomes is limited.

Objective: To describe the COVID-19 testing trends and evaluate the effects of quarantinemeasures on these trends in Cochabamba, Bolivia.

Methods: Utilizing COVID-19 testing data from the Cochabamba Department Health Servicefor the 2020–2022 period. Stratified testing rates in the health system sectors were firstestimated followed by an interrupted time series analysis using a quasi-Poisson regressionmodel for assessing the quarantine effects on the mitigation of cases during surge periods.

Results: The public sector reported the larger percentage of tests (65%), followed by theprivate sector (23%) with almost double as many tests as the public-social security sector(11%). In the time series analysis, a correlation between the implementation of quarantinepolicies and a decrease in the slope of positive rates of COVID-19 cases was observedcompared to periods without or with reduced quarantine policies.

Conclusion: This research underscores the local health system disparities and the effective-ness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabambaregion. The findings stress the importance of the measures’ intensity and duration, providingvaluable lessons for Bolivia and beyond. As the global community learns from the pandemic,these insights are critical for shaping resilient and effective health policy responses.