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Objective. To determine the relative risk of a lethal outcome associated with chronic degenerative conditions in patients with COVID-19. Methods. A cohort study was conducted using electronic medical records belonging to patients who tested positive for COVID-19 on RT-PCR while receiving care as outpatients or inpatients in a social security system facility between March 2020 and March 2021. Two study groups were formed. The exposed group was divided into four subgroups, each of which was diagnosed with one and only one chronic condition (diabetes, hypertension, obesity, or chronic kidney disease); the unexposed group was obtained from the medical records of patients without comorbidities. A total of 1 114 medical records were examined using simple random sampling. Once the minimum sample size was reached, the relative risk was calculated for each chronic condition. Combinations of two, three, and four conditions were created, and each of them was included in the analysis. Results. In the absence of a chronic degenerative condition, the prevalence of a lethal outcome from COVID-19 is 3.8%; in the presence of type 2 diabetes mellitus, 15.8%; in the presence of arterial hypertension, 15.6%; and in the presence of obesity, 15.0%. For diabetes and hypertension combined, the prevalence of a lethal outcome is 54.1%; for diabetes and obesity combined, 36.8%, and for obesity and hypertension combined, 28.1%. Conclusion. In patients with COVID-19, the relative risk of a lethal outcome is 4.17 for those with diabetes, 4.13 for those with hypertension, and 3.96 for those with obesity. For two chronic conditions combined, the relative risk doubles or triples. The relative risk of a lethal outcome is 14.27 for diabetes plus hypertension; 9.73 for diabetes plus obesity, and 7.43 for obesity plus hypertension. Chronic conditions do not present alone; they generally occur together, hence the significance of the relative risks for lethal outcomes presented in this paper. [ABSTRACT FROM AUTHOR]

Objective. To determine the level of stability or change in topic areas published by public health journals in Latin America and the Caribbean, using keywords and co-word analysis, in order to support evidence-based research planning. Methods. Keywords were extracted from papers indexed in Scopus® that were published by the Revista de Salud Pública (RSP; Colombia), the Salud Pública de México (SPM; Mexico), and the Revista Peruana de Medicina Experimental y Salud Pública (RPMESP; Peru) for three periods: 2005 - 2007, 2008 - 2010, and 2011 - 2013. Co-word analysis was used to examine keywords extracted. Textual information was analyzed using centrality measures (inbetweenness and closeness). The hypothesis of stability/change of thematic coverage was tested using the Spearman's rho correlation coefficient. VOSviewer was used to visualize the co-word maps. Results. A moderate level of change in thematic coverage was observed in 2005 -- 2010, as evidenced by the correlation coefficients for two of the 3-year periods, 2005 -- 2007 and 2008 -- 2010: 0.545 for RSP and 0.593 for SPM. However, in 2008 -- 2013, more keywords remained constant from one period to the next, given the size of the correlation coefficients for the last 3-year periods: 2008 -- 2010 and 2011 -- 2013: 0.727 for RSP and 0.605 for SPM. Conclusion. The research hypothesis was partially accepted given that just two consecutive 3-year periods showed a statistically-significant degree of stability in thematic coverage in public health studies. In that sense, this study provides compelling evidence of the effectiveness of using a combined approach for examining the dynamics of thematic coverage: centrality measures for identifying the main keywords and visual inspection for detecting the structure of textual information. [ABSTRACT FROM AUTHOR]

Despite a growing global commitment to the provision of antiretroviral therapy (ART), its availability is still likely to be less than the need. This imbalance raises ethical dilemmas about who should be granted access to publicly-subsidized ART programmes. This paper reviews the eligibility and targeting criteria used in four case-study countries at different points in the scale-up of ART, with the aim of drawing lessons regarding ethical approaches to rationing. Mexico, Senegal, Thailand and Uganda have each made an explicit policy commitment to provide antiretrovirals to all those in need, but are achieving this goal in steps — beginning with explicit rationing of access to care. Drawing upon the case-studies and experiences elsewhere, categories of explicit rationing criteria have been identified. These include biomedical factors, adherence to treatment, prevention-driven factors, social and economic benefits, financial factors and factors driven by ethical arguments. The initial criteria for determining eligibility are typically clinical criteria and assessment of adherence prospects, followed by a number of other factors. Rationing mechanisms reflect several underlying ethical theories and the ethical underpinnings of explicit rationing criteria should reflect societal values. In order to ensure this alignment, widespread consultation with a variety of stakeholders, and not only policy-makers or physicians, is critical. Without such explicit debate, more rationing will occur implicitly and this may be more inequitable. The effects of rationing mechanisms upon equity are critically dependent upon the implementation processes. As antiretroviral programmes are implemented it is crucial to monitor who gains access to these programmes. [ABSTRACT FROM AUTHOR]

Despite a growing global commitment to the provision of antiretroviral therapy (ART), its availability is still likely to be less than the need. This imbalance raises ethical dilemmas about who should be granted access to publicly-subsidized ART programmes. This paper reviews the eligibility and targeting criteria used in four case-study countries at different points in the scale-up of ART, with the aim of drawing lessons regarding ethical approaches to rationing. Mexico, Senegal, Thailand and Uganda have each made an explicit policy commitment to provide antiretrovirals to all those in need, but are achieving this goal in steps — beginning with explicit rationing of access to care. Drawing upon the case-studies and experiences elsewhere, categories of explicit rationing criteria have been identified. These include biomedical factors, adherence to treatment, prevention-driven factors, social and economic benefits, financial factors and factors driven by ethical arguments. The initial criteria for determining eligibility are typically clinical criteria and assessment of adherence prospects, followed by a number of other factors. Rationing mechanisms reflect several underlying ethical theories and the ethical underpinnings of explicit rationing criteria should reflect societal values. In order to ensure this alignment, widespread consultation with a variety of stakeholders, and not only policy-makers or physicians, is critical. Without such explicit debate, more rationing will occur implicitly and this may be more inequitable. The effects of rationing mechanisms upon equity are critically dependent upon the implementation processes. As antiretroviral programmes are implemented it is crucial to monitor who gains access to these programmes. [ABSTRACT FROM AUTHOR]