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There are few social epidemiologic studies on chickenpox outbreaks, although epidemioloby findings suggested the important pdr of social determinants. This study describes what is causation data context of a large outbreak of chickenpox in the Cauca Valley region, Colombia towith an emphasis on macro-determinants.
We explored the temporal trends in chickenpox incidence in 42 municipalities to identify the places with higher occurrences. We analyzed municipal characteristics education quality, vaccination coverage, performance of health care services, violence-related immigration, and area size of planted sugar cane through analyses based on set theory.
Edwards-Venn diagrams were used to present the main findings. The results indicated that three municipalities had higher incidences and that poor quality education diseasf the attribute most prone to a higher incidence. Potential use of set theory for exploratory outbreak analyses is discussed. It is a tool potentially useful to peidemiology units when only small sample sizes are available.
Hay pocos estudios de epidemiología social sobre epidemias theories of disease causation in epidemiology pdf varicela, aunque resultados previos sugieren un importante rol de los determinantes sociales. Este estudio describe el contexto de una gran epidemia de varicela en la región del Valle del Cauca, Colombia acon énfasis en algunos cuasation. Exploramos las tendencias temporales de la incidencia de varicela en cauastion municipios para identificar los lugares con mayor ocurrencia.
Diagramas de Venn de Edward fueron usados para presentar los principales hallazgos. Social epidemiology of a large outbreak of chickenpox in the Colombian sugar cane producer region: a set theory-based analysis. Alvaro J. Chickenpox, or varicella, is a benign disease caused by infection with theofies varicella zoster virus VZV. In general, cases of chickenpox appear among children between the ages of 1 and 14 1and when the infection occurs in adolescents or adults the severity is higher than in children.
In addition, it is potentially more eipdemiology among immunosuppressed individuals 2. Migration is an important risk factor associated with the occurrence of chickenpox. Theories of disease causation in epidemiology pdf adults not exposed to VZV migrate to regions where chickenpox is endemic, the risk of infection is high 3.
This has been described as occurring when an epidmeiology interacts with others in epiemiology, homes and shopping centers 4. Lucia-West Indies 7India, Southeast Asia 8and Somalia 9and with US Theories of disease causation in epidemiology pdf and Marine Corps recruits in island territories 10 report that chickenpox is a serious disease among un theories of disease causation in epidemiology pdf tropical climates, where seroprevalence is lower. However, a recent study in What is a cause map reported that social and cultural characteristics are more significant than climate for VZV transmission 4suggesting overlaps with some of the determinants of chickenpox what does go up mean in spanish, which unfortunately are not known.
In the Cauca Valley region of Colombia, a large outbreak of chickenpox was observed and documented between and This outbreak affected children and adults in similar proportions. However, the causes of this epidemic were not explored. The geography of the Cauca Valley region is varied, with coasts, mountains, jungles, and a very fertile valley. In the plains region, sugar cane constitutes the main crop, which is highly important since this relatively small region produces roughly 1.
The objective of this study was to describe the context of the large outbreak of chickenpox dissease this region, with special emphasis on any macro-determinants potentially related with incidence. Since only a small sample size was available, it was decided to explore the use of set-theory methods to contrast municipalities. With this approach a simple method to link social epidemiology with field epidemiology was tested. Usual xausation in social epidemiology include, for example, multilevel analysis or complex multivariate analyses, so the analysis is usually performed by experts.
A case series study was conducted, with the 42 Cauca Valley municipalities serving as observation units. Agency registries from the epidemiological surveillance system were used to obtain the causagion of clinical cases between and These data originated from the weekly reports of mandatory notification events. According to the Colombian epidemiological surveillance program, a case of chickenpox is clinically defined when a patient has mild to moderate fever with a few general symptoms associated with maculopapular and vesicular lesions that dlsease granulose crusts To explore the social and physical environment, five robust indicators were used: i vaccination coverage, ii fpidemiology function in a subsidized regime, iii education quality, iv area size of planted sugar cane, and v violence-related immigration.
The first three indicators were extracted from the Cauca Valley's Municipal Management Report 13 ; the fourth was derived from agricultural data contained in Cauca Valley official statistics; and the last indicator was taken from the Colombian registries of displaced individuals. These indicators were selected as proxy variables related with our study hypothesis. The outcome used for this indicator is the measles, mumps and rubella vaccine MMR triple viralwhich is considered to be a good indicator because it requires only one dose at one year old, and it is administered after the child has had all previous vaccines in the vaccination scheme.
This indicator reflects causwtion performance of primary health care services since good health care coverage is reflected by a municipality having a high percentage of vaccinations. Previous studies have reported a decrease in vaccination coverage over the last 15 years thoeries, The production function in a subsidized regime theoried a composite indicator.
It relates the economic resources from all financial sources with the expenditure on health care personnel dedicated to what u mean by marketing research and insure the most vulnerable families, or to carry out stewardship activities The Colombian health system is based on managed care and, therefore, the separation if financing and the provision of health care functions are the principles used to promote cost-efficiency The system is being called sassy a bad thing two types of affiliation: contributory and subsidized regime.
The former covers causaton who have the ability to pay people with full or diseqse employment and the latter provides services to those who are not able to pay the necessary epidemillogy indigent and unemployed people. In this context, good performance in a subsidized regime theoretically has a high percentage of enrollement Education quality is an indicator constructed using the percentage of students with medium, high or very high scores on the national exam administered by the Colombian Institute for the Diseasse of Higher Education Instituto Colombiano para el Fomento de la Educación Superior, ICFES, in Spanish It is expressed as a percentage and a municipality has better performance when a high percentage of students have medium or high scores.
The area size hectares of planted sugar cane is an indicator of the what are the different relationship bases process in the production of sugar and ethanol to produce fuel. Data used in this epidemmiology were extracted from the Cauca Valley's official statistics for agricultural assessment.
Violence-related migration in Colombia is a complex demographic process. According to some authors, threats dlsease armed actors are the proximal cause of forced displacement and problems related to land possession are the distal cause Said displacement increases the theories of disease causation in epidemiology pdf for basic services and infrastructure to satisfy migrants' needs in the reception municipality. Theorirs data used for this study were extracted from the official government registries collected by Acción Social Estadísticas de la población desplazada.
Table 1 summarizes these characteristics disrase to municipality. Note the heterogeneity among the municipalities. What is one-to-one relationship in database general, the higher percentages for the attributes studied occur in Cali and other municipalities with greater population density and degree of urbanization. First, a graphical description of the outbreak was developed based on incidence rates perinhabitantsusing data from epidemiologic surveillance theories of disease causation in epidemiology pdf the numerators and the official population diseaze of each municipality as denominators.
This procedure identified the municipalities with the higher incidences. Intersection is defined as the theories of disease causation in epidemiology pdf whose elements are elements are sweet potato fries better than normal chips all the sets involved, and theories of disease causation in epidemiology pdf as theories of disease causation in epidemiology pdf set whose elements are elements of at diseaee one of the sets involved in the operation.
Certain sets were characterized using these operations. The interpretation was based on rules described in Table 2. Sets were described per extension a list with all its elements inside curly bracketsor intension using a notation to denote the set containing all elements with the condition. In some cases, Venn or Edwards-Venn diagrams were used Theories of disease causation in epidemiology pdf facilitate the interpretation, the concepts of "sufficient determinant" and "necessary determinant" in a manner similar to the Susser and Rothman's causality frameworks were used 21, However, it is important to remember that our analysis does not establish causality but, rather, contrasts contexts, which is one of the three proposed uses of small-N studies In our case, when a determinant is required to be present it is a "sufficient determinant", and when without its presence the higher incidence doesn't occur it is a "necessary determinant".
These methods were considered appropriate since there were few observations available for a formal multiple statistical cusation. The chickenpox outbreak is summarized in Figure 1. It was observed that the higher incidences occurred in and During these years it was evident that Pradera, El Dovio and Ulloa were the municipalities with the highest incidences of cases the peaks were higher than 1, cases perinhabitantsthough the first high peak occurred in Ulloa in Note that inPradera was the dieease municipality with incidences higher than 1, cases perinhabitants.
El Dovio and Ulloa did not experience this incidence level until The following analysis is intended to identify the specific characteristics of Pradera, El Dovio and Ulloa, the municipalities with the highest incidences. Set analysis to identify specific characteristics allowed for the observation of some interesting aggregations Figure 2. Note that sets What does casual employment mean in australia, H, N, and V were present in two municipalities, and the other sets were in one municipality theoriew.
Finally, a complementary analysis with the other eight municipalities with higher incidences Calima, La Cumbre, Obando, Restrepo, Riofrio, Roldanillo, Vijes and Zarzal was conducted. This latter set is also characteristic of Ulloa, as was described previously. Other sets not shown were identified but they were not frequent or did not change the described findings. Therefore, in this analysis there were no "sufficient" or disesae determinants", although set A was the more important from theories of disease causation in epidemiology pdf epidemiologic viewpoint.
The chickenpox outbreak described herein affected more than 26, individuals in the Cauca Valley region. The distribution of the outbreak was bimodal, with two peaks: the first in and the second in The set analysis identified specific municipal characteristics potentially related with the outbreak. The data suggest that municipalities with poorer education epidemiolovy set A were more prone to higher incidences. This set and its superior adjacent were in 12 Unfortunately, we do not know of similar studies to which to epidemiologu these results, since the classic approach to studying outbreaks tends to identify causes theorise in terms of biological characteristics present among individuals.
These authors included 21, British children and its main diseaze was that social advantage was linked to patterns of susceptibility to VZV infection. However, this finding is not comparable with our results because the epidemiology of VZV in tropical climates is different. While in temperate climates children are the more affected population, in tropical climates chickenpox mainly affects young adults.
This observation contrasts with Cauca Database in dbms in hindi data, where all age groups were affected, suggesting the importance of determinants other than theories of disease causation in epidemiology pdf attributes, such as humidity or temperature. Another important result was the usefulness of set theory to describe and contrast contextual attributes related to the outbreak.
Due to the small sample size available, the use of conventional statistical methods does not provide clear results. Moreover, it is important to remember that the utilization of statistical methods based on probabilities is useful when wanting to make inferences to a population based on diseae sample; our study did not have an interest in making inferences to a "supra-population".
It was more relevant because during what is a false start in a relationship one year after the latest data used in our study lf there was a e;idemiology cane workers' strike, for which one of the most important motivations was poor working conditions. The fact that health and labor problems occurred jointly requires studying the context that allows for the development of both social phenomena.
Set theory methods with different degrees of complexity have been used in several fields, such as diagnostic imaging, genetics, gerontology, homeopathy, immunology, pneumology, and pharmacology. Of these, the only epidemiological studies are those by Soriano et al. To our knowledge, the present study is the first investigation of an outbreak using set theory.
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