Browsing by Author "Undurraga Fourcade, Eduardo Andrés"

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    A dynamic modeling tool for estimating healthcare demand from the COVID19 epidemic and evaluating population-wide interventions
    (2020) Rainisch, Gabriel; Undurraga Fourcade, Eduardo Andrés; Chowell, Gerardo
    Objectives: Public health officials need tools to assist in anticipating the healthcare resources required to confront the SARS-COV-2 pandemic. We constructed a modeling tool to aid active public health officials to estimate healthcare demand from the pandemic in their jurisdictions and to evaluate the potential impact of population-wide social-distancing interventions. Methods: The tool uses an SEIR compartmental model to project the pandemic’s local spread. Users input case counts, healthcare resources, and select intervention strategies to evaluate. Outputs include the number of infections and deaths with and without intervention, and the demand for hospital and critical care beds and ventilators relative to existing capacity. We illustrate the tool using data from three regions of Chile. Results: Our scenarios indicate a surge in COVID-19 patients could overwhelm Chilean hospitals by June, peaking in July or August at six to 50 times the current supply of beds and ventilators. A lockdown strategy or combination of case isolation, home quarantine, social distancing of individuals >70 years, and telework interventions may keep treatment demand below capacity. Conclusions: Aggressive interventions can avert substantial morbidity and mortality from COVID-19. Our tool permits rapid evaluation of locally-applicable policy scenarios and updating of results as new data become available.
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    Análisis epidemiológico de la leptospirosis humana en Colombia, 2015-2020
    (2023) Parra Barrera, Eliana Liseth; Torres Hidalgo, Marisa; Undurraga Fourcade, Eduardo Andrés; Pontificia Universidad Católica de Chile. Escuela de Medicina
    Antecedentes: Colombia es un país endémico de la leptospirosis. La notificación de los casos sospechosos es obligatoria y se realiza al Sistema Nacional de Vigilancia. La confirmación diagnóstica de los casos se realiza en el Laboratorio Nacional de Referencia. El presente estudio planteó el desarrollo de dos objetivos generales, como sigue: Objetivo 1: Determinar la distribución de los casos de leptospirosis humana con confirmación diagnóstica por el Laboratorio Nacional de Referencia en Colombia entre los años 2015 a 2020. Objetivo 2: Analizar los factores clínicos y epidemiológicos de los casos de leptospirosis humana confirmados respecto a su asociación con la forma grave o letal de la enfermedad. Metodología: Para el desarrollo del primer objetivo general se planteó un diseño descriptivo retrospectivo de los casos confirmados al Laboratorio Nacional de Referencia. En el desarrollo del segundo objetivo general, se realizó un análisis de regresión de casos de leptospirosis con confirmación diagnóstica y reporte clínico para la identificación de los factores de riesgo asociados con el desenlace de leptospirosis grave y mortalidad. Resultados: En los seis años analizados se notificaron al laboratorio Nacional de Referencia 3.535 casos, 880 (24,9%). La incidencia general de casos confirmados fue de 1,9 por 100.000 habitantes, afectando más a hombres (82,1%) que a mujeres (17,8%). Un total de 54 (6,1%) muertes fueron confirmadas como leptospirosis. Los serovares más frecuentes fueron Australis (21,1%), Autumnalis (6,9%), Wolfii (6,3%), Ballum (5,8%), Tarasovi (5,7%), Bratislava (5,5%) y Hebdomadis (4,4%). El serovar Bratislava se asoció significativamente en los casos con mortalidad (p = 0,007). Los casos de leptospirosis grave fueron clasificados según las manifestaciones clínicas como falla renal (29,9%), hepática (27,4%) y multiorgánica (24,4%), shock séptico (24,4%), síndrome de Weil (18,4%), hemorragia pulmonar (18,4%) y meningitis (2,5%). Observándose casos que requirieron el ingreso a UCI (30,3%) y que fueron fatales (8,5%). Las variables asociadas a la leptospirosis grave fueron dificultad respiratoria (OR: 4,57 IC: 1,17-17,80, p<0,028), lesión renal (OR: 15,7 IC:2,40-103,29, p=0,004), taquicardia (OR: 5,93 IC:1,04-33,53, p<0,044) y erupción cutánea (OR:8,14 IC:2,61-25,42, p<0,001). El desenlace de admisión en la UCI se asoció a trombocitopenia (OR: 6,81 IC:1,89-24,4, p<0,003), dificultad respiratoria (OR:10,48 IC:3,12-35,13, <0,001), lesión renal (OR: 32,2 IC: 4,5-119,01, <0,001), taquicardia (OR: 4,29 IC:11,15-15,95, p=0,030) y erupción cutánea (OR: 7,78 IC:2,09 -29,00, p=0,002). La mortalidad fue asociada la edad avanzada (>60 años) (OR: 6,12 IC:1,40-26,76, p=0,016), ictericia (OR: 11,96 IC: 1,35-108,82, p=0,028) y meningitis (OR: 14,30 IC: 1,15-177,64, p=0,038). Conclusión: El estudio evidenció la persistencia de la transmisión de la leptospirosis en hombres, con casos en todos los grupos de edad analizados. Los datos presentaron una distribución heterogénea entre las regiones del país. La dificultad respiratoria y la erupción cutánea se asociaron tanto a la enfermedad grave como a la admisión a la UCI, y la ictericia se asoció con la mortalidad.
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    Benchmarking the Covid-19 pandemic across countries and states in the USA under heterogeneous testing
    (2020) Asahi Kodama, Kenzo Javier; Undurraga Fourcade, Eduardo Andrés; Wagner, Rodrigo; CEDEUS (Chile)
    Public health officials need to make urgent decisions to reduce the potential impact of the CoVID-19 pandemic. Benchmarking based on the increase in total cases or case fatality rates is one way of comparing performance across countries or territories (such as states in the USA), and could inform policy decisions about COVID-19 mitigation strategies. But comparing cases and fatality across territories is challenging due to heterogeneity in testing and health systems. We show two complementary ways of benchmarking across countries or US states. First, we used multivariate regressions to estimate the test-elasticity-of-COVID-19-case-incidence. We found a 10% increase in testing yielded ~9% (95% CI:4.2–3.4%; p<0.001) increase in reported cases across countries, and ~2% (95%CI:0.1-3.4%; p=0.03) increase across US states during the week ending April 10th, 2020. We found comparable negative elasticities for fatality rates (across countries: β =-0.77, 95%CI:-1.40– -0.14; p=0.02; US states: β=-0.15, 95%CI:-0.30-0.01; p=0.06). Our results were robust to various model specifications. Second, we decomposed the growth in cases into test growth and positive test ratio (PTR) growth to intuitively visualize the components of case growth. We hope these results can help support evidence-based decisions by public health officials as more consistent data hopefully becomes available.
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    Birth seasons and heights among girls and boys below 12 years of age: lasting effects and catch-up growth among native Amazonians in Bolivia
    (2018) Brabec, Marek; Behrman, Jere R.; Emmett, Susan D.; Gibson, Edward; Kidd, Celeste; Leonard, William; Penny, Mary E.; Piantadosi, Steven T.; Sharma, Abhishek; Tanner, Susan; Undurraga Fourcade, Eduardo Andrés; Godoy, Ricardo A.
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    Catch-up growth and growth deficits : Nine-year annual panel child growth for native Amazonians in Bolivia
    (2016) Leonard, W.; Behrman, J.; Godoy, R.; Zhang, R.; Undurraga Fourcade, Eduardo Andrés; Zeng, W.; Reyes García, V.; Tanner, S.
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    Centre-based care is a significant predictor of lower body mass index in early childhood: Longitudinal evidence from Chile
    (2020) Allel, Kasim; Narea Biscupovich, Marigen Soledad; Undurraga Fourcade, Eduardo Andrés
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    Child stunting is associated with weaker human capital among native Amazonians
    (2018) Undurraga Fourcade, Eduardo Andrés; Behrman, Jere R.; Emmett, Susan D.; Kidd, Celeste; Leonard, William R.; Piantadosi, Steven T.; Reyes-Garcia, Victoria; Sharma, Abhishek; Zhang, Rebecca; Godoy, Ricardo A.
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    Clinical, laboratory, and demographic determinants of hospitalization due to dengue in 7613 patients : a retrospective study based on hierarchical models
    (2018) Santos da Silva, Natal; Undurraga Fourcade, Eduardo Andrés; da Silva Ferreira, Elis Regina; Estofolete, Cássia Fernanda; Lacerda Nogueira, Maurício
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    Commonality and variation in mental representations of music revealed by a cross-cultural comparison of rhythm priors in 15 countries
    (2021) Jacoby, Nori; Polak, Rainer; Grahn, Jessica Adrienne; Cameron, Daniel J.; Lee, Kyung Myun; Godoy, Ricardo; Undurraga Fourcade, Eduardo Andrés; Huanca, Tomas; Thalwitzer, Timon; Doumbia, Noumouké; Goldberg, Daniel; Margulis, Elizabeth; Wong, Patrick; Jure, Luis; Rocamora, Martín; Fujii, Shinya; Savage, Patrick E.; Ajimi, Jun; Konno, Rei; Oishi, Sho; Jakubowski, Kelly; Holzapfel, André; Mungan, Esra; Kaya, Ece; Rao, Preeti; Ananthanarayana, Rohit Mattur; Alladi, Suvarna; Tarr, Bronwyn; Anglada-Tort, Manuel; Harrison, Peter M. C.; McPherson, Malinda J.; Dolan, Sophie; Durango, Alex; Mcdermott, Josh
    Music is present in every known society, yet varies from place to place. What, if anything, is universal to music cognition? We measured a signature of mental representations of rhythm in 39 participant groups in 15 countries, spanning urban societies and indigenous populations. Listeners reproduced random ‘‘seed’’ rhythms; their reproductions were fed back as the stimulus (as in the game of “telephone”), such that their biases (the prior) could be estimated from the distribution of reproductions. Every tested group showed a sparse prior with peaks at integer ratio rhythms. However, the importance of different integer ratios varied across groups, often reflecting local musical practices. Our results suggest a common feature of music cognition – discrete rhythm “categories” at small integer ratios. These discrete representations likely stabilize musical systems in the face of cultural transmission, but interact with culture-specific traditions to yield diversity evident when mental representations are probed across many cultures.
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    Conditional cash transfers for primary education: Which children are left out?
    (2018) Bauchet, Jonathan; Undurraga Fourcade, Eduardo Andrés; Reyes-Garcia, Victoria; Behrman, Jere R.; Godoy, Ricardo A.
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    COVID-19 Has Exposed How 'The Other Half' (Still) Lives
    (2020) Gil Ureta, Magdalena; Undurraga Fourcade, Eduardo Andrés
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    Effectiveness and duration of a second COVID-19 vaccine booster
    (2022) Jara, Alejandro; Cuadrado, Cristobal; Undurraga Fourcade, Eduardo Andrés; García, Christian; Najera, Manuel; Bertoglia, María Paz; Vergara, Verónica; Fernández, Jorge; García, Heriberto; Araos, Rafael
    Using a prospective national cohort of 3.75 million individuals aged 20 or older, we evaluated the effectiveness against COVID-19 related ICU admissions and death of mRNA-based second vaccine boosters for four different three-dose background regimes: BNT162b2 primary series plus a homologous booster, and CoronaVac primary series plus an mRNA booster, a homologous booster, and a ChAdOx-1 booster. We estimated the vaccine effectiveness weekly from February 14 to August 15, 2022, by estimating hazard ratios of immunization over non-vaccination, accounting for relevant confounders. The overall adjusted effectiveness of a second mRNA booster shot was 88.2% (95%CI, 86.2-89.9) and 90.5% (95%CI 89.4-91.4) against ICU admissions and death, respectively. Vaccine effectiveness showed a mild decrease for all regimens and outcomes, probably associated with the introduction of BA.4 and BA.5 Omicron sub-lineages and immunity waning. The duration of effectiveness suggests that no additional boosters are needed six months following a second booster shot.
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    Effects of mindfulness-based stress reduction on psychological distress in health workers: A three-arm parallel randomized controlled trial
    (Pergamon-Elsevier Science Ltd., 2022) Errazuriz Concha, Antonia; Schmidt, Kristin; Undurraga Fourcade, Eduardo Andrés; Medeiros Urzua, Sebastián; Baudrand Biggs, René Felipe; Cussen Sanhueza, Diego; Henríquez Henríquez, Marcela Patricia; Celhay, Pablo; Figueroa, Rodrigo A.
    Mindfulness-based Stress Reduction (MBSR) has shown good efficacy for improving wellbeing in employees experiencing occupational stress. However, comparisons with other interventions, longer-term follow-up, and data from varying sociocultural contexts are lacking. This three-arm, parallel randomised controlled trial (RCT) examined the effects of MBSR on psychological distress in non-physician health workers in direct contact with patients. 105 participants were randomly allocated to either: (1) MBSR (N = 35), (2) Stress Management Course (SMC; N = 34) or (3) wait-list (N = 36). Participants and those assessing outcomes were blinded to group assignment. Participants completed questionnaires pre- and post-intervention and four months after the intervention. Psychological distress was measured using the General Health Questionnaire (GHQ-12) and Outcome Questionnaire (OQ-45). Secondary outcomes included perceived stress, job satisfaction, mindfulness skills and changes in salivary cortisol. 77 participants completed measures post-intervention and 52 at 4-month follow-up. MBSR showed a post-intervention effect in reducing GHQ-12 (ss = -0.80 [SE = 1.58] p < 0.01) and OQ-45 (ss = -0.72, [SE = 5.87] p < 0.05) psychological distress, compared to SMC and in reducing GHQ-12 (ss = -1.30 [SE = 1.38] p < 0.001) and OQ-45 (ss = -0.71, [SE = 5.58] p < 0.01) psychological distress compared to wait-list condition. In our secondary outcome, only MBSR was associated with a decrease in the cortisol awaking response by 23% (p < 0.05). At follow-up, only effects of MBSR on the psychological distress 'social role' subscale (ss = -0.76 [SE = 1.31] p < 0.05) remained significant, compared to SMC. In conclusion, MBSR appears useful in reducing short-term psychological distress in healthcare workers, but these effects were not maintained at followup. Trial registration: ISRCTN12039804.
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    Employment Loss in Informal Settlements during the Covid-19 Pandemic: Evidence from Chile
    (2021) Gil Mc Cawley, Diego; Domínguez Rivera, Patricio; Undurraga Fourcade, Eduardo Andrés; Valenzuela Carvallo, Eduardo
    The Covid-19 pandemic has reached almost every corner of the world. Despite the historical development, approval, and distribution of vaccines in some countries, non-pharmaceutical interventions will remain an essential strategy to control the pandemic until a substantial proportion of the population has immunity. There is increasing evidence of the devastating social and economic effects of the pandemic, particularly on vulnerable communities. Individuals living in urban informal settlements are in a structurally disadvantaged position to cope with a health crisis such as the Covid-19 pandemic. Estimates of this impact are needed to inform and prioritize policy decisions and actions. We study employment loss in informal settlements before and during the Covid-19 pandemic in Chile, using a longitudinal panel study of households living in Chile's informal settlements before and during the health crisis. We show that before the pandemic, 75% of respondents reported being employed. There is a decrease of 30 and 40 percentage points in May and September 2020, respectively. We show that the employment loss is substantially higher for individuals in informal settlements than for the general population and has particularly affected the immigrant population. We also show that the pandemic has triggered neighborhood cooperation within the settlements and that targeted government assistance programs have reached these communities in a limited way. Our results suggest that individuals living in informal settlements are facing severe hardship as a consequence of the pandemic. In addition to providing much-needed support, this crisis presents a unique opportunity for long-term improvements in these marginalized communities.
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    Enrollment of dengue patients in a prospective cohort study in Umphang District, Thailand, during the COVID‐19 pandemic: Implications for research and policy
    (2023) Shepard, Donald S.; Agarwal‐Harding, Priya; Jiamton, Sukhum; Undurraga Fourcade, Eduardo Andrés; Kongsin, Sukhontha
    Dengue is endemic in Thailand and imposes a high burdenon the health system and society. We conducted a prospective cohort study inUmphang District, Tak Province, Thailand, to investigate the share of dengue caseswith long symptoms and their duration. Here we present the results of theenrollment process during the COVID‐19 pandemic with implications andchallenges for research and policy.
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    Evaluating the validity of dengue clinical-epidemiological criteria for diagnosis in patients residing in a Brazilian endemic area
    (2020) Da Silva Ferreira, Elis Regina; Oliveira Goncalves, Ana Carolina de; Verro, Alice Tobal; Undurraga Fourcade, Eduardo Andrés; Nogueira, Maurício Lacerda; Estofolete, Cássia Fernanda; Santos da Silva, Natal
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    Evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreak
    (2019) Carias, Cristina.; Undurraga Fourcade, Eduardo Andrés; Hurd, Jacqueline.; Kahn, Emily B.; Meltzer, Martin I.; Bowen, Anna.
    Abstract Background In the event of a shigellosis outbreak in a childcare setting, exclusion policies are typically applied to afflicted children to limit shigellosis transmission. However, there is scarce evidence of their impact. Methods We evaluated five exclusion policies: Children return to childcare after: i) two consecutive laboratory tests (either PCR or culture) do not detect Shigella, ii) a single negative laboratory test (PCR or culture) does not detect Shigella, iii) seven days after beginning antimicrobial treatment, iv) after being symptom-free for 24 h, or v) 14 days after symptom onset. We also included four treatments to assess the policy options: i) immediate, effective treatment; ii) effective treatment after laboratory diagnosis; iii) no treatment; iv) ineffective treatment. Relying on published data, we calculated the likelihood that a child reentering childcare would be infectious, and the number of childcare-days lost per policy. Results Requiring two consecutive negative PCR tests yielded a probability of onward transmission of < 1%, with up to 17 childcare-days lost for children receiving effective treatment, and 53 days lost for those receiving ineffective treatment. Conclusions Of the policies analyzed, requiring negative PCR testing before returning to childcare was the most effective to reduce the risk of shigellosis transmission, with one PCR test being the most effective for the least childcare-days lost.
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    High Burden of Intestinal Colonization With Antimicrobial-Resistant Bacteria in Chile: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
    (2023) Araos, Rafael; Smith, Rachel M.; Styczynski, Ashley; Sánchez Barría, Felipe Andrés; Acevedo, Johanna; Maureira, Lea; Paredes, Catalina; Gonzalez, Maite; Rivas, Lina; Spencer-Sandino, Maria; Peters, Anne; Khan, Ayesha; Sepulveda, Dino; Rojas Wettig, Loreto; Rioseco, Maria Luisa; Usedo, Pedro; Rojas Soto, Pamela; Huidobro, Laura Andrea; Ferreccio Readi, Catterina; Park, Benjamin J.; Undurraga Fourcade, Eduardo Andrés; D'Agata, Erika M. C.; Jara Vallejos, Alejandro Antonio; Munita, Jose M.
    We report a high colonization burden resulting from antimicrobial-resistant Gram-negative bacteria in hospitals and a community in Chile. Strikingly, 29% (95% confidence interval, 24-34) of community-dwelling adults carried extended-spectrum cephalosporin-resistant Enterobacterales, highlighting the magnitude of the community reservoir of antimicrobial resistance., Background Antimicrobial resistance is a global threat, heavily impacting low- and middle-income countries. This study estimated antimicrobial-resistant gram-negative bacteria (GNB) fecal colonization prevalence in hospitalized and community-dwelling adults in Chile before the coronavirus disease 2019 pandemic. Methods From December 2018 to May 2019, we enrolled hospitalized adults in 4 public hospitals and community dwellers from central Chile, who provided fecal specimens and epidemiological information. Samples were plated onto MacConkey agar with ciprofloxacin or ceftazidime added. All recovered morphotypes were identified and characterized according to the following phenotypes: fluoroquinolone-resistant (FQR), extended-spectrum cephalosporin-resistant (ESCR), carbapenem-resistant (CR), or multidrug-resistant (MDR; as per Centers for Disease Control and Prevention criteria) GNB. Categories were not mutually exclusive. Results A total of 775 hospitalized adults and 357 community dwellers were enrolled. Among hospitalized subjects, the prevalence of colonization with FQR, ESCR, CR, or MDR-GNB was 46.4% (95% confidence interval [CI], 42.9-50.0), 41.2% (95% CI, 37.7-44.6), 14.5% (95% CI, 12.0-16.9), and 26.3% (95% CI, 23.2-29.4). In the community, the prevalence of FQR, ESCR, CR, and MDR-GNB colonization was 39.5% (95% CI, 34.4-44.6), 28.9% (95% CI, 24.2-33.6), 5.6% (95% CI, 3.2-8.0), and 4.8% (95% CI, 2.6-7.0), respectively. Conclusions A high burden of antimicrobial-resistant GNB colonization was observed in this sample of hospitalized and community-dwelling adults, suggesting that the community is a relevant source of antibiotic resistance. Efforts are needed to understand the relatedness between resistant strains circulating in the community and hospitals.
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    Impact of inappropriate empirical antibiotic therapy on in-hospital mortality: a retrospective multicentre cohort study of patients with bloodstream infections in Chile, 2018–2022
    (2024) Allel, Kasim; Peters, Anne; Furuya-Kanamori, Luis; Spencer-Sandino, Maria; Pitchforth, Emma; Yakob, Laith; Munita, José M.; Undurraga Fourcade, Eduardo Andrés
    Introduction: Empirical antibiotic therapy is essential for treating bloodstream infections (BSI), yet there is limited evidence from resource-limited settings. We quantified the association of inappropriate empirical antibiotic therapy (IEAT) with in-hospital mortality and the associated burden on BSI patients in Chile. Methods: We used a retrospective multicentre cohort study of BSI cases in three Chilean tertiary hospitals (2018–2022) to assess the impact of IEAT on 30-day and overall in-hospital mortality and quantify excess disease and economic burdens associated with IEAT. We determined the appropriateness of pathogen-antimicrobial pairings based on in vitro susceptibilities and pathogen-corresponding antibiotic treatment, allowing a 48-hour window after the initial blood culture. We addressed confounding using propensity scores and inverse probability weights (IPW). We used IPW-weighted logistic competing-risk survival models, including time-varying independent variables after blood tests as controls. Results: Among 1323 BSI episodes, 432 (33%) received IEAT, with an average time to adequate therapy of 4.6 days. Compared with adequate treatment, IEAT was associated with 30-day and overall mortality risks that were 1.31 and 1.24 times higher, respectively. These risks were further inflated between twofold and fourfold when antibiotic-resistant bacteria (ARB) was included. Competing-risk models showed associations between IEAT and IEAT-ARB combinations with in-hospital mortality. Accounting for time-varying variables yielded similar results. The economic burden of IEAT resulted in an additional cost of ~US$9900 from premature mortality and 0.46 disability-adjusted life-years per patient with BSI. Conclusión: Approximately one in three patients received IEAT, often associated with ARB. IEAT was linked to increased mortality risk and higher economic costs. Timely appropriate treatment, early pathogen detection and resistance profiling are likely to improve health and financial outcomes at the population level.
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    Implementation of Antimicrobial Stewardship Programs in Chilean Hospitals: A Mixed-Methods Assessment
    (2024) Infante Belart, Emilia; Undurraga Fourcade, Eduardo Andrés; Pontificia Universidad Católica de Chile. Escuela de Gobierno
    Antimicrobial resistance (AMR) is a critical public health threat in Chile, as it is globally, driven by the misuse of antibiotics. The increasing prevalence of AMR compromises the effectiveness of treatments for infectious diseases, posing severe risks to vulnerable populations and leading to higher healthcare costs. In response, Chile implemented a National Action Plan against AMR. A key component of this plan is the establishment of Antimicrobial Stewardship Programs (ASPs) in medium and high-complexity hospitals, aimed at optimizing antimicrobial use. However, there is an urgent need to understand the development of these ASPs and the barriers to implementing effective programs. Identifying these challenges is crucial to inform public health decision-making and strengthen these programs as a key strategy to combat AMR.