Health and Economic Impacts Assessment of O3 Exposure in Mexico

Health effects related to exposure to air pollution such as ozone (O3) have been documented. The World Health Organization has recommended the use of the Sum of O3 Means Over 35 ppb (SOMO35) to perform Health Impact Assessments (HIA) for long-term exposure to O3. We estimated the avoidable mortality associated with long-term exposure to tropospheric O3 in 14 cities in Mexico using information for 2015. The economic valuation of avoidable deaths related to SOMO35 exposure was performed using the willingness to pay (WTP) and human capital (HC) approaches. We estimated that 627 deaths (95% uncertainty interval (UI): 227–1051) from respiratory diseases associated with the exposure to O3 would have been avoided in people over 30 years in the study area, which confirms the public health impacts of ambient air pollution. The avoidable deaths account for almost 1400 million USD under the WTP approach, whilst the HC method yielded a lost productivity estimate of 29.7 million USD due to premature deaths. Our findings represent the first evidence of the health impacts of O3 exposure in Mexico, using SOMO35 metrics.

Modelling the impact of age-stratified public health measures on SARS-CoV-2 transmission in Canada

Public health measures applied exclusively within vulnerable populations have been suggested as an alternative to community-wide interventions to mitigate SARS-CoV-2 transmission. With the population demography and healthcare capacity of Canada as an example, a stochastic age-stratified agent-based model was used to explore the progression of the COVID-19 epidemic under three intervention scenarios (infection-preventing vaccination, illness-preventing vaccination and shielding) in individuals above three age thresholds (greater than or equal to 45, 55 and 65 years) while lifting shutdowns and physical distancing in the community. Compared with a scenario with sustained community-wide measures, all age-stratified intervention scenarios resulted in a substantial epidemic resurgence, with hospital and ICU bed usage exceeding healthcare capacities even at the lowest age threshold. Individuals under the age threshold were severely impacted by the implementation of all age-stratified interventions, with large numbers of avoidable deaths. Among all explored scenarios, shielding older individuals led to the most detrimental outcomes (hospitalizations, ICU admissions and mortality) for all ages, including the targeted population. This study suggests that, in the absence of community-wide measures, implementing interventions exclusively within vulnerable age groups could result in unmanageable levels of infections, with serious outcomes within the population. Caution is therefore warranted regarding early relaxation of community-wide restrictions.

Avoidable deaths in the extreme south of Bahia: Infectious and parasitic diseases/ Óbitos evitáveis no Extremo Sul da Bahia: doenças infecciosas e parasitárias/ Muertes evitables en el extremo Sur de Bahía: enfermedades infecciosas y parasitarias

Objetivo: este estudo propôs analisar as taxas de mortalidade por Doenças Infecciosas e Parasitárias do Extremo Sul da Bahia no período de 2008 a 2018. Métodos: trata-se de um estudo descritivo que considerou os dados referentes aos óbitos por “causas evitáveis” na população entre 05 a 74 anos, reduzíveis por ações adequadas de promoção à saúde, prevenção, controle e atenção às doenças de causas infecciosas, disponibilizados no Sistema de Informação sobre Mortalidade. Resultados: entre os anos de 2008 e 2018 foram notificados 1.347 óbitos no Extremo Sul da Bahia. Foi observada prevalência de óbitos em pessoas do sexo masculino, em todos os anos, representando 61,17%; a classe notificada com nenhuma escolaridade foi a mais afetada, com 321 óbitos; o intervalo de idades em que se concentrou o maior número de óbitos foi de 30 a 44 anos, representando 35,47%. As doenças infecciosas e parasitárias com maior ocorrência de óbitos foram HIV-Aids, Tuberculose e Diarreia/Gastroenterite de origem infecciosa presumível. Conclusão: as mortes por doenças infecciosas e parasitárias possuem estreita relação com fatores socioeconômicos, bem como aos processos de crescimento populacional acelerado, falta de saneamento básico e expansão urbana.

The Problem of Iatrogenic Injury

This introduction briefly presents the problem to which the book is addressed: the hundreds of thousands of avoidable deaths and millions of injuries suffered by Americans in the course of their healthcare. To date, the patient safety problem has proven incalculably difficult to ameliorate through the conventional efforts of both the healthcare industry and the legal system. The aim of this book is described: to explore strategies the law could undertake that look beyond conventional malpractice litigation. A new generation of innovative laws could harness the insight that more can be achieved by attending to higher levels of organization, by correcting perverse incentives, by encouraging the use of appropriate new technology, and by pursuing other innovations. The chapter concludes with a roadmap to the rest of the book.

Problems in care and avoidability of death after discharge from intensive care: a multi-centre retrospective case record review study

Background Over 138,000 patients are discharged to hospital wards from intensive care units (ICUs) in England, Wales and Northern Ireland annually. More than 8000 die before leaving hospital. In hospital-wide populations, 6.7–18% of deaths have some degree of avoidability. For patients discharged from ICU, neither the proportion of avoidable deaths nor the reasons underlying avoidability have been determined. We undertook a retrospective case record review within the REFLECT study, examining how post-ICU ward care might be improved. Methods A multi-centre retrospective case record review of 300 consecutive post-ICU in-hospital deaths, between January 2015 and March 2018, in 3 English hospitals. Trained multi-professional researchers assessed the degree to which each death was avoidable and determined care problems using the established Structured Judgement Review method. Results Agreement between reviewers was good (weighted Kappa 0.77, 95% CI 0.64–0.88). Discharge from an ICU for end-of-life care occurred in 50/300 patients. Of the remaining 250 patients, death was probably avoidable in 20 (8%, 95% CI 5.0–12.1) and had some degree of avoidability in 65 (26%, 95% CI 20.7–31.9). Common problems included out-of-hours discharge from ICU (168/250, 67.2%), suboptimal rehabilitation (167/241, 69.3%), absent nutritional planning (76/185, 41.1%) and incomplete sepsis management (50/150, 33.3%). Conclusions The proportion of deaths in hospital with some degree of avoidability is higher in patients discharged from an ICU than reported in hospital-wide populations. Extrapolating our findings suggests around 550 probably avoidable deaths occur annually in hospital following ICU discharge in England, Wales and Northern Ireland. This avoidability occurs in an elderly frail population with complex needs that current strategies struggle to meet. Problems in post-ICU care are rectifiable but multi-disciplinary. Trial Registration: ISRCTN14658054.