Репозиторий Университета

© 2021, The Author(s). Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.

© 2018 Paediatrician Publishers, LLC. All rights reserved. At present, there is no reliable statistical data (morbidity, mortality, one-year mortality, etc.) that characterize the state of medical care for children with cancers in the Russian Federation seen in due to the lack of an universal electronic database of patients. Objective. Improve the reliability of statistical data. Methods. In the clinical practice of two pilot medical facilities, an electronic database of pediatric cancer patients was introduced which allows: keep patient records with a diagnosis, key dates, follow-up data; analyze the treatment received earlier and assess its quality; make a treatment plan; obtain information on the availability of beds and the number of patients in various medical facilities; perform medical consultations involving the of specialists of the third level medical institutions. Patient (or legal representatives of the patient), has access to the «private cabinet » which provides information on the treatment plan including a schedule for taking medicines, as well as routing possibilities. Results. In the period of 6 months (09.17-02.18), information on 75 patients who received treatment from 2017 to the present was put into the electronic database. Conclusion. The electronic database provides reliable statistical data, helps monitoring the quality of medical care and routing patients. This results in reducing the budget costs and improving the survival of patients.