University of Costa Rica

About: University of Costa Rica is a education organization based out in San José, Costa Rica. It is known for research contribution in the topics: Population & Venom. The organization has 9817 authors who have published 16781 publications receiving 238208 citations. The organization is also known as: UCR & Universidad de Costa Rica.

Evaluación del impacto de la reforma del sector de la salud en Costa Rica mediante un estudio cuasiexperimental

Abstract: OBJETIVO: Valorar el impacto de la reforma del sector de la salud iniciada en Costa Rica en 1995 sobre la mortalidad de ninos y adultos y la equidad en el acceso a los servicios de salud. METODOS: La reforma del sector de la salud se inicio en Costa Rica en 1995 en algunos distritos, pero en otros su adopcion fue posterior. Esto permitio efectuar un analisis de series temporales, usando un diseno cuasiexperimental con observaciones anuales de 1985 a 2001 en cada uno de los 420 distritos que tenia Costa Rica en 1984. Las series temporales se dividieron en tres periodos que permitieron agrupar a los distritos en tres categorias (grupo pionero, intermedio y tardio) segun el momento en que iniciaron el proceso de reforma: 1995-1996; 1997-2000; 2001 o despues, respectivamente. Las series incluyeron datos de defuncion desagregadas por sexo, grupos de edad y tres grandes grupos de causas de muerte (enfermedades transmisibles, de origen social, o cronicas); estimaciones de poblacion por edad y sexo; dos variables que miden la intervencion (si el distrito ha adoptado o no la reforma y, en caso de que si, el numero de anos desde que adopto la reforma); y ocho variables para controlar efectos de confusion. Los datos se obtuvieron de los registros de defunciones y nacimientos, censos de poblacion y estimaciones demograficas. Se usaron modelos de regresion multiple de Poisson con efectos fijos para estimar el impacto de la reforma en la mortalidad. Tambien se valoro el acceso de la poblacion a los servicios de salud en el primer nivel de atencion antes y despues de la reforma. El indicador de acceso utilizado fue el porcentaje de personas que vivian a menos de 4 km de distancia de un servicio que ofreciera consultas medicas. RESULTADOS: Segun lo estimado por los modelos de regresion, la adopcion de la reforma redujo significativamente la mortalidad de los ninos en 8% y la de los adultos en 2%. El efecto fue de 14% en la mortalidad de adultos debida a enfermedades transmisibles o desencadenadas por procesos infecciosos, nulo en la debida a causas sociales y similar al total (2%) en la mortalidad debida a enfermedades cronicas. Se estima que la reforma salvo aproximadamente 120 vidas de ninos y 350 vidas de adultos en el ano 2001 unicamente. La reforma se puso en marcha primero en las zonas menos densamente pobladas y de menor desarrollo socioeconomico. Como resultado, la brecha en la equidad del acceso a los servicios de salud en el primer nivel de atencion se redujo significativamente. El porcentaje de personas sin acceso equitativo a los servicios de salud del primer nivel de atencion se redujo en 15% entre 1994 y 2000 en las areas que adoptaron la reforma en 1995-1996, mientras que en las areas que no habian adoptado la reforma en 2000, la reduccion fue solo de 3%. CONCLUSION: La reforma redujo significativamente la mortalidad en Costa Rica y puso fin a una decada de estancamiento en algunos indicadores, como la esperanza de vida. El efecto de la reforma se produjo probablemente gracias a su focalizacion en las regiones menos desarrolladas del pais, lo cual dio lugar a un mejoramiento en la equidad de acceso al primer nivel de atencion medica.

History of Envenoming Therapy and Current Perspectives

Abstract: Each year, millions of humans fall victim to animal envenomings, which may either be deadly or cause permanent disability to the effected individuals. The Nobel Prize-winning discovery of serum therapy for the treatment of bacterial infections (tetanus and diphtheria) paved the way for the introduction of antivenom therapies for envenomings caused by venomous animals. These antivenoms are based on polyclonal antibodies derived from the plasma of hyperimmunized animals and remain the only specific treatment against animal envenomings. Following the initial development of serum therapy for snakebite envenoming by French scientists in 1894, other countries with high incidences of animal envenomings, including Brazil, Australia, South Africa, Costa Rica, and Mexico, started taking up antivenom production against local venomous animals over the course of the twentieth century. These undertakings revolutionized envenoming therapy and have saved innumerous patients worldwide during the last 100 years. This review describes in detail the above-mentioned historical events surrounding the discovery and the application of serum therapy for envenomings, as well as it provides an overview of important developments and scientific breakthroughs that were of importance for antibody-based therapies in general. This begins with discoveries concerning the characterization of antibodies, including the events leading up to the elucidation of the antibody structure. These discoveries further paved the way for other milestones in antibody-based therapies, such as the introduction of hybridoma technology in 1975. Hybridoma technology enabled the expression and isolation of monoclonal antibodies, which in turn formed the basis for the development of phage display technology and transgenic mice, which can be harnessed to directly obtain fully human monoclonal antibodies. These developments were driven by the ultimate goal of producing potent neutralizing monoclonal antibodies with optimal pharmacokinetic properties and low immunogenicity. This review then provides an outline of the most recent achievements in antivenom research, which include the application of new biotechnologies, the development of the first human monoclonal antibodies that can neutralize animal toxins, and efforts toward creating fully recombinant antivenoms. Lastly, future perspectives in the field of envenoming therapies are discussed, including rational engineering of antibody cross-reactivity and the use of oligoclonal antibody mixtures.

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Abstract: 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.