Derivación y validación de un nuevo puntaje predictivo de mortalidad por covid-19 en la altura / Derivation and Validation of a New covid-19 Predictive Score for Mortality at High Altitude / Derivação e validação de um novo escore preditivo de mortalidade por covid-19 em altitude

Objetivo: desarrollar un puntaje predictivo de mortalidad para pacientes con covid-19. Materiales y méto-dos: estudio retrospectivo, analítico, observacional y transversal, realizado en dos fases. Se revisaron 620 historias clínicas con una cohorte de derivación de 320 pacientes y una de validación de 300 pacientes. Las variables se analizaron con test de Anova, chi cuadrado de Pearson y análisis multivariante con regresión binaria, que determinaron sensibilidad, especificidad y valor predictivo negativo y positivo. Los puntajes se compararon mediante curvas cor con los scoresnews y hews. Resultados: los dos puntajes obtenidos incluyeron valores de edad, conteo de linfocitos, SatO2/FiO2, leucocitos, plaquetas, ausencia de síntomas, hipertensión arterial, epid y dhl. El área bajo la curva (abc) fue de 0.838 para el puntaje con dhl, con una mortalidad del 100 % para 7.75 puntos o más, y un abc de 0.826 para el primer puntaje. En la cohorte de validación, el abc para el primer puntaje fue de 0.831 y para el score con dhl fue 0.855. El puntaje hewsobtuvo un abc de 0.451, y el news, un abc de 0.396. Conclusiones: se desarrollaron dos herramientas para predecir mortalidad en pacientes con covid-19, con alto poder de discriminación, superior a los puntajes británicos hews y news

Objetivo: desarrollar un puntaje predictivo de mortalidad para pacientes con covid-19. Materiales y méto-dos: estudio retrospectivo, analítico, observacional y transversal, realizado en dos fases. Se revisaron 620 historias clínicas con una cohorte de derivación de 320 pacientes y una de validación de 300 pacientes. Las variables se analizaron con test de Anova, chi cuadrado de Pearson y análisis multivariante con regresión binaria, que determinaron sensibilidad, especificidad y valor predictivo negativo y positivo. Los puntajes se compararon mediante curvas cor con los scoresnews y hews. Resultados: los dos puntajes obtenidos incluyeron valores de edad, conteo de linfocitos, SatO2/FiO2, leucocitos, plaquetas, ausencia de síntomas, hipertensión arterial, epid y dhl. El área bajo la curva (abc) fue de 0.838 para el puntaje con dhl, con una mortalidad del 100 % para 7.75 puntos o más, y un abc de 0.826 para el primer puntaje. En la cohorte de validación, el abc para el primer puntaje fue de 0.831 y para el score con dhl fue 0.855. El puntaje hewsobtuvo un abc de 0.451, y el news, un abc de 0.396. Conclusiones: se desarrollaron dos herramientas para predecir mortalidad en pacientes con covid-19, con alto poder de discriminación, superior a los puntajes británicos hews y news

Objetivo: desenvolver um escore preditivo de mortalidade para pacientes com covid-19. Materiais e Métodos: estudo retrospectivo, analítico, observacional e transversal, realizado em duas fases. Foram revisados 620 prontuários, com uma coorte de derivação de 320 pacientes e uma coorte de validação de 300 pacientes. As variáveis foram analisadas com teste anova, qui-quadrado de Pearson e análise multivariada com regressão binária, determinando sensibilidade, especificidade, valor preditivo nega-tivo e positivo. As pontuações foram comparadas por meio de curvas cor com as pontuações news e hews. Resultados: os dois escores obtidos incluíram valores de: idade, contagem de linfócitos, SatO2/FiO2, leucócitos, plaquetas, ausência de sintomas, hipertensão arterial, epid e dhl. A área sob a curva (abc) foi de 0,838 para o escore dhl, com 100 % de mortalidade para 7,75 pontos ou mais, e uma abc de 0,826 para o primeiro escore. Na coorte de validação, a abc para o primeiro escore foi de 0,831 e para o escore com dhl foi de 0,855. A pontuação hews obteve abc de 0,451 e o news uma abc de 0,396. Conclusões: foram desenvolvidas duas ferramentas para prever mortalidade em pacientes com covid-19, com alto poder de discriminação, superior aos escores britânicos hews e news

Progress of early warning indicators on infectious diseases / 上海预防医学

In recent years， with frequent outbreaks of infectious diseases around the world， the global public health is faced with many threats and challenges. An infectious diseases early warning system is an important means for prevention and control of infectious diseases. As an important part of the early warning system， the warning indicators is crucial for understanding the occurrence and development trend of infectious diseases， detecting abnormal situations timely and effectively， and issuing early warning and initiating emergency response. Based on the occurrence and development process of infectious diseases， this paper summarizes the research status of early warning indicators on infectious diseases， in order to provide reference for the development and improvement of the infectious diseases early warning system.

COVID-19: Asociación entre la clasificación de riesgo y el Modified Early Warning Score y los resultados hospitalarios / COVID-19: Association of risk classification with the Modified Early Warning Score and hospital outcomes / COVID-19: Associação da classificação de risco com o Modified Early Warning Score e os desfechos hospitalares

Objetivo: evaluar la asociación entre las categorías de clasificación de riesgo y el Modified Early Warning Score y los resultados de los pacientes con COVID-19 en el servicio de emergencia Método: estudio transversal, realizado con 372 pacientes hospitalizados con diagnóstico de COVID-19 atendidos en la Recepción con Clasificación de Riesgo en Urgencias. En este estudio, el Modified Early Warning Score de los pacientes se clasificó como sin y con deterioro clínico, de 0 a 4 y de 5 a 9, respectivamente. Se consideró que había deterioro clínico cuando presentaban insuficiencia respiratoria aguda, shock y paro cardiorrespiratorio. Resultados: el Modified Early Warning Score promedio fue de 3,34. En cuanto al deterioro clínico de los pacientes, se observó que en el 43% de los casos el tiempo de deterioro fue menor a 24 horas y que el 65,9% ocurrió en urgencias. El deterioro más frecuente fue la insuficiencia respiratoria aguda (69,9%) y el resultado fue alta hospitalaria (70,3%). Conclusión: los pacientes con COVID-19 que presentaban Modified Early Warning Score 4 se asociaron a las categorías de clasificación de riesgo urgente, muy urgente y emergente y tuvieron más deterioro clínico, como insuficiencia respiratoria y shock, y murieron, lo que demuestra que el Protocolo de Clasificación de Riesgo priorizó correctamente a los pacientes con riesgo vital.

Objective: to evaluate the association of the risk classification categories with the Modified Early Warning Score and the outcomes of COVID-19 patients in the emergency service Method: a crosssectional study carried out with 372 patients hospitalized with a COVID-19 diagnosis and treated at the Risk Classification Welcoming area from the Emergency Room. In this study, the patients' Modified Early Warning Score was categorized into without and with clinical deterioration, from 0 to 4 and from 5 to 9, respectively. Clinical deterioration was considered to be acute respiratory failure, shock and cardiopulmonary arrest Results: the mean Modified Early Warning Score was 3.34. In relation to the patients' clinical deterioration, it was observed that, in 43%, the time for deterioration was less than 24 hours and that 65.9% occurred in the Emergency Room. The most frequent deterioration was acute respiratory failure (69.9%) and the outcome was hospital discharge (70.3%). Conclusion: COVID-19 patients who had a Modified Early Warning Scores > 4 were associated with the urgent, very urgent and emergency risk classification categories, had more clinical deterioration, such as respiratory failure and shock, and evolved more to death, which shows that the Risk Classification Protocol correctly prioritized patients at risk of life.

Objetivo: avaliar a associação das categorias de classificação de risco com o Modified Early Warning Score e os desfechos dos pacientes com COVID-19 no serviço de emergência Método: estudo transversal, realizado com 372 pacientes internados com diagnóstico de COVID-19 atendidos no Acolhimento com Classificação de Risco no Pronto-Atendimento. Neste estudo, o Modified Early Warning Score dos pacientes foi categorizado em sem e com deterioração clínica, de 0 a 4 e de 5 a 9, respectivamente. Foram consideradas deteriorações clínicas a insuficiência respiratória aguda, choque e parada cardiorrespiratória. Resultados: o Modified Early Warning Score médio foi de 3,34. Em relação à deterioração clínica dos pacientes, observou-se que em 43% o tempo para deterioração foi menor de 24 horas e que 65,9% delas ocorreu no pronto-socorro. A deterioração mais frequente foi a insuficiência respiratória aguda (69,9%) e o desfecho foi o de alta hospitalar (70,3%). Conclusão: pacientes com COVID-19 que tiveram Modified Early Warning Score 4 foram associados às categorias da classificação de risco urgente, muito urgente e emergente e tiveram mais deterioração clínica, como a insuficiência respiratória e o choque, e evoluíram mais a óbito, o que demonstra que o Protocolo de Classificação de Risco priorizou corretamente os pacientes com risco de vida.

A retrospective and comparative study between quick sequential organ failure assessment, CURB-65, and early warning scorings in COVID-19 patients to predict the disease severity and outcome

Background: Predicting the severity of COVID-19 infection in advance is the key to success of its treatment outcome. Various scoring systems are used to detect the severity of this disease but this study targets three simple scoring systems based on the vital parameters and basic routine laboratory tests. Aims and Objectives: The aim of the study was to assess the predictability of three scoring systems (Quick sequential organ failure assessment [q SOFA], CURB-65, and Early Warning scoring system) for disease severity at presentation in a rural-based tertiary care center. Materials and Methods: An observational, descriptive, retrospective, and cross-sectional study was conducted at Diamond Harbour Government Medical College Covid Hospital from January 2021 to January 2022 to assess the predictability of q SOFA, CURB-65, and Early Warning scoring system for disease severity at presentation. Results: The total number of participants was 561 among total admitted 1367 patients. A short descriptive analysis obtained from the variables to analyze the scorings howed among total sample collected, 57% were male and 43% were female. In this study, 87% of patients were survived and the rest 13% succumbed (death). There is no statistically significant difference in mortality between both genders. Age, pulse rate, and respiratory rate have a significant correlation with the outcome and altered sensorium is also highly associated with mortality. The accuracy was also found to be little higher for National Early Warning score (NEWS) score than CURB-65 scoring and q SOFA scoring (0.919, 0.914 and 0.907). Although all the scoring systems have high sensitivity (>90%) (CURB 65: Most sensitive [0.99]), the specificities of all three scoring systems are below 50%. Among these three-scoring systems, NEWS showed the highest specificity (0.492) than q SOFA (0.423) and CURB 65 (0.394). Conclusion: We suggest NEWS score and CURB-65 as a better predictor for in-hospital mortality in COVID-19 patients as it is significantly sensitive and reasonably specific. It can be recommended in less equipped hospitals where only basic laboratory facilities are available. qSOFA can be utilized where no laboratory facility is available like in safe home and isolation centers.

Performance of risk scores in patients with acute exacerbations of COPD / Desempenho de escores de risco em pacientes com exacerbações agudas da DPOC

ABSTRACT Objective: Acute exacerbations of COPD (AECOPD) are common causes of hospitalization. Various scoring systems have been proposed to classify the risk of clinical deterioration or mortality in hospitalized patients with AECOPD. We sought to investigate whether clinical deterioration and mortality scores at admission can predict adverse events occurring during hospitalization and after discharge of patients with AECOPD. Methods: We performed a retrospective study of patients admitted with AECOPD. The National Early Warning Score 2 (NEWS2), the NEWS288-92%, the Dyspnea, Eosinopenia, Consolidation, Acidemia, and atrial Fibrillation (DECAF) score, and the modified DECAF (mDECAF) score were calculated at admission. We assessed the sensitivity, specificity, and overall performance of the scores for the following outcomes: in-hospital mortality; need for invasive mechanical ventilation or noninvasive ventilation (NIV); long hospital stays; hospital readmissions; and future AECOPD. Results: We included 119 patients admitted with AECOPD. The median age was 75 years, and 87.9% were male. The NEWS288-92% was associated with an 8.9% reduction in the number of individuals classified as requiring close, continuous observation, without an increased risk of death in the group of individuals classified as being low-risk patients. The NEWS288-92% and NEWS2 scores were found to be adequate in predicting the need for acute NIV and longer hospital stays. The DECAF and mDECAF scores were found to be better at predicting in-hospital mortality than the NEWS2 and NEWS288-92%. Conclusions: The NEWS288-92% safely reduces the need for clinical monitoring in patients with AECOPD when compared with the NEWS2. The NEWS2 and NEWS288-92% appear to be good predictors of the length of hospital stay and need for NIV, but they do not replace the DECAF and mDECAF scores as predictors of mortality.

RESUMO Objetivo: As exacerbações agudas da DPOC (EADPOC) são causas comuns de hospitalização. Vários escores foram propostos para classificar o risco de deterioração clínica ou mortalidade em pacientes hospitalizados com EADPOC. Buscamos investigar se escores de deterioração clínica e mortalidade no momento da admissão podem prever eventos adversos durante a hospitalização e após a alta de pacientes com EADPOC. Métodos: Realizamos um estudo retrospectivo a respeito de pacientes admitidos com EADPOC. O National Early Warning Score 2 (NEWS2), o NEWS288-92%, o escore Dyspnea, Eosinopenia, Consolidation, Acidemia, and atrial Fibrillation (DECAF, Dispneia, Eosinopenia, Consolidação, Acidemia e Fibrilação atrial) e o escore DECAF modificado (DECAFm) foram calculados no momento da admissão. Avaliamos a sensibilidade, a especificidade e o desempenho geral dos escores quanto aos seguintes desfechos: mortalidade hospitalar; necessidade de ventilação mecânica invasiva ou ventilação não invasiva (VNI); longas internações hospitalares; readmissões hospitalares e futuras AECOPD. Resultados: Incluímos 119 pacientes admitidos com EADPOC. A mediana da idade foi de 75 anos, e 87,9% eram do sexo masculino. O NEWS288-92% associou-se a uma redução de 8,9% no número de indivíduos classificados em pacientes com necessidade de observação atenta e contínua, sem aumento do risco de morte no grupo de indivíduos classificados em pacientes de baixo risco. O NEWS288-92% e o NEWS2 foram considerados adequados para prever a necessidade de VNI aguda e internações hospitalares mais longas. O DECAF e o DECAFm foram considerados melhores em prever a mortalidade hospitalar do que o NEWS2 e o NEWS288-92%. Conclusões: Em comparação com o NEWS2, o NEWS288-92% reduz com segurança a necessidade de monitoramento clínico em pacientes com EADPOC. O NEWS2 e o NEWS288-92% aparentemente são bons preditores do tempo de internação hospitalar e da necessidade de VNI, mas não substituem o DECAF e o DECAFm como preditores de mortalidade.

Focalidad de Aedes aegypti e indicadores climáticos en Nueva Gerona Cuba (2006-2022)

Introducción: Las enfermedades transmitidas por mosquitos resultan particularmente sensibles a las condiciones meteorológicas. Objetivo: Modelar la focalidad de Aedes aegypti e indicadores climáticos en Nueva Gerona, Cuba. Métodos: Estudio descriptivo de corte transversal realizado en el período de 2006 a 2022 en Nueva Gerona, Isla de la Juventud. Se empleó una curva de expectativa según meses y análisis de indicadores climáticos para establecer el momento más oportuno para acometer acciones de supresión vectorial. Una vez identificado, se procedió a la modelación espacial y al análisis del clima para el mismo período. Resultados: La curva de expectativa facilitó muestras de mayor focalidad de Aedes aegypti a partir del mes de junio, por lo que se definió el período de marzo a junio como el más oportuno para intensificar las acciones de supresión de la población vectorial. Los mapas mostraron varias zonas calientes en las que se encuentran involucrados con mayor riesgo los consejos populares de Pueblo Nuevo, Abel Santamaría, 26 de Julio y la localidad de Nazareno. Las precipitaciones acumuladas comenzaron en marzo (24,3 mm), abril (55,4 mm), mayo (163,4 mm) y junio (393,8 mm). Las temperaturas y la humedad relativa incrementaron de un mes a otro. Predominaron los vientos del Este. Conclusiones: La modelación de la focalidad de Aedes aegypti definió temporo-espacialmente y como sistema de alerta temprana que el período entre marzo y junio constituía el más oportuno para la realización de las acciones que llevarían hacia la supresión vectorial, a tenor del comportamiento de indicadores climáticos que ejercieron efectos favorecedores sobre la infestación.

Introduction: Mosquito-borne diseases are particularly sensitive to weather conditions. Objective: To model Aedes aegypti focality and climate indicators in Nueva Gerona, Cuba. Methods: A descriptive cross-sectional study was conducted from 2006 to 2022 in Nueva Gerona, Isla de la Juventud. An expectation curve by months and analysis of climate indicators was used to decide on the most appropriate moment to undertake vector suppression actions. Once identified, spatial modeling and weather analysis were carried out for the same period. Results: The expectation curve provided evidence of greater Aedes aegypti focality from June onwards; therefore, the period from March to June was defined as the most appropriate to intensify vector population suppression actions. The maps showed several hot spots with the highest risk that include the people's councils of Pueblo Nuevo, Abel Santamaría, 26 de Julio and the locality of Nazareno. Cumulative rainfall began in March (24.3 mm), April (55.4 mm), May (163.4 mm) and June (393.8 mm). Temperatures and relative humidity increased by month. Easterly winds predominated. Conclusions: Modeling Aedes aegypti focality defined temporo-spatially and as an early warning system that the period between March and June were the most appropriate for conducting vector suppression actions, based on climate indicators that exerted favoring effects on infestation.

National Early Warning Score 2 ­ versão brasileira: validade preditiva para adultos com COVID-19* / National Early Warning Score 2 ­ versión brasileña: validez predictiva para adultos con COVID-19 / National Early Warning Score 2 ­ Brazilian version: predictive validity for adults with COVID-19

Objetivo: realizar a validade preditiva do National Early Warning Score 2 ­ versão brasileira (NEWS 2 ­ BR) nos desfechos alta e óbito em pacientes com COVID-19. Método: estudo transversal com análise de validade preditiva. Variáveis sociodemográficas, clínicas, desfechos e os componentes do escore foram coletados em prontuário eletrônico e analisados por meio da estatística descritiva e inferencial. Resultados: incluíram-se 400 pacientes, com mediana de idade de 61 anos. O escore na admissão teve mediana de 5 pontos, com amplitude de 0 a 21. Houve associação entre escores mais altos com o desfecho óbito e escores mais baixos com a alta. A validade preditiva do NEWS 2 ­ BR para o óbito foi realizada pela análise de curva ROC e o ponto de corte de maior acurácia foi de seis pontos. Conclusão: a versão brasileira do NEWS 2 é um escore válido para avaliação de pacientes com COVID-19.

Objective: perform the predictive validity of National Early Warning Score 2 ­ Brazilian version (NEWS 2 ­ BR) in discharge and death outcomes in patients with COVID-19. Method: cross-sectional study with predictive validity analysis. Social-demographical and clinical variables, outcomes and the score components were collected with an electronic health record and analyzed through descriptive and inferential statistics. Outcomes: 400 patients were included, with median age of 61 years. The score, at the moment of admission, had a median of 5 points, with a range from 0 to 21. There is an association between the highest scores and the death outcome and the lowest scores and the discharge outcome. The predictive validity of NEWS 2 ­ BRfor death was established by the analysis of the ROC curve and the most accurate cut-off point was six points. Conclusion: The Brazilian version of NEWS 2 is a valid score to assess patients with COVID-19.

Objetivo: realizar la validez predictiva del National Early Warning Score 2 ­ versión brasileña (NEWS 2 ­ BR) en los resultados alta y fallecimiento en pacientes con COVID-19. Método: estudio transversal con análisis de validez predictiva. Variables sociodemográficas, clínicas, resultados y los componentes del score fueron recolectados en prontuario electrónico y analizados por medio de la estadística descriptiva e inferencial. Resultados: se incluyeron 400 pacientes, con mediana de edad de 61 años. El score en la admisión tuvo mediana de 5 puntos, con amplitud de 0 a 21. Hubo asociación entre scores más altos con el resultado fallecimiento y scores más bajos con el alta. La validez predictiva del NEWS 2 ­ BR para el fallecimiento fue realizada por el análisis de curva ROC y el punto de corte de mayor precisión fue de seis puntos. Conclusión: la versión brasileña del NEWS 2 es un score válido para la evaluación de pacientes con COVID-19.

Desempenho do Escore Pediátrico de Alerta (EPA) de deterioração clínica / Desempeño del Sistema de Alerta Precoz Infantil (SAPI) de deterioración clínica / Pediatric Alert Score (EPA) performance in clinical deterioration

Resumo Objetivo Avaliar a acurácia, utilidade, reprodutibilidade e aplicabilidade do Escore Pediátrico de Alerta (EPA) na identificação da deterioração clínica em crianças e adolescentes hospitalizados. Métodos Estudo de teste diagnóstico, prospectivo, realizado entre outubro/2018 a outubro/2019, para medir a acurácia diagnóstica do EPA em uma amostra de 240 crianças, e sua reprodutibilidade e aplicabilidade em uma amostra de 60 crianças. Os dados foram processados e analisados no MedCalc e VassarStats.net. Resultados No ponto de corte ≥ 3, o escore apresentou sensibilidade de 73,6%, especificidade de 95,7%, valor preditivo positivo de 83%, valor preditivo negativo de 92,7, área sob a curva ROC de 93,6%, prevalência estimada pelo teste de 19,6%, razão de probabilidade positiva 17,1, probabilidade pós-teste positivo de 77,8%, kappa simples de 0,946. Conclusão O estudo fornece evidências sobre a elevada acurácia, utilidade e reprodutibilidade do EPA na identificação da deterioração clínica em um cenário hospitalar pediátrico brasileiro, e considerou o instrumento aplicável no contexto da pesquisa.

Resumen Objetivo Evaluar la precisión, utilidad, reproducibilidad y aplicabilidad del Sistema de Alerta Precoz Infantil (SAPI) en la identificación del deterioro clínico en niños y adolescentes hospitalizados. Métodos Estudio de prueba diagnóstica, prospectiva, realizada entre octubre de 2018 y octubre de 2019, para medir la precisión diagnóstica del SAPI en una muestra de 240 niños y su reproducibilidad y aplicabilidad en una muestra de 60 niños. Los datos fueron procesados y analizados en MedCalc y VassarStats.net. Resultados En el punto de corte ≥ 3, el puntaje presentó una sensibilidad del 73,6 %, especificidad del 95,7 %, valor predictivo positivo del 83 %, valor predictivo negativo de 92,7, área bajo la curva ROC del 93,6 %, prevalencia estimada por la prueba del 19,6 %, razón de probabilidad positiva 17,1, probabilidad posprueba positiva del 77,8 %, kappa simple de 0,946. Conclusión El estudio presenta evidencias sobre la elevada precisión, utilidad y reproducibilidad del SAPI en la identificación del deterioro clínico en un escenario hospitalario pediátrico brasileño, por lo que el instrumento se consideró aplicable en el contexto de la investigación.

Abstract Objective To assess the Pediatric Alert Score (EPA) accuracy, usefulness, reproducibility and applicability in identifying clinical deterioration in hospitalized children and adolescents. Methods This is a prospective diagnostic test study, carried out between October/2018 and October/2019, to measure EPA diagnostic accuracy in a sample of 240 children, and its reproducibility and applicability in a sample of 60 children. Data were processed and analyzed on MedCalc and VassarStats.net. Results At cut-off point ≥ 3, the score had a sensitivity of 73.6%, specificity of 95.7%, positive predictive value of 83%, negative predictive value of 92.7, area under the ROC curve of 93.6%, estimated prevalence of 19.6%, positive probability ratio of 17.1, positive post-test probability of 77.8%, simple Kappa of 0.946. Conclusion The study provides evidence on EPA high accuracy, usefulness and reproducibility in identifying clinical deterioration in a Brazilian pediatric hospital setting, and considered the instrument applicable in the context of the research.

Design of early warning system for mental health problems based on data mining and database / Projeto de sistema de alerta precoce para problemas de saúde mental com base na mineração de dados e banco de dados / Diseño de un sistema de alerta temprana de problemas de salud mental basado en la minería de datos y en la base de datos

ABSTRACT Introduction: Data mining technology is mainly employed in the era of big data to evaluate the acquired information. Subsequently, reasoning about the data inductively is fully automated to discover possible patterns. Objective: Recently, data mining technology in the national mental health database has deepened and can be effectively used to solve various mental health early warning problems. Methods: For example, it can be applied to mine psychological data and extract the most important features and information. Results: This paper presents the design of an early warning system for mental health problems based on data mining techniques to offer some thoughts on early warning of mental health problems, including data preparation, data mining, results in analysis, and decision tree algorithm. Conclusion: The experimental results indicate that the results of the early warning system in this paper can achieve an accuracy rate of more than 96% with a high accuracy rate. Level of evidence II; Therapeutic studies - investigating treatment outcomes.

RESUMO Introdução: A tecnologia de mineração de dados é empregada principalmente na era da big data para avaliar as informações adquiridas. Posteriormente, raciocinar indutivamente sobre os dados de forma totalmente automatizada para descobrir possíveis padrões. Objetivo: Recentemente, a tecnologia de mineração de dados no banco de dados nacional de saúde mental tem se aprofundado e pode ser efetivamente utilizada para resolver vários problemas de alerta precoce da saúde mental. Métodos: Por exemplo, ela pode ser aplicada para a mineração de dados psicológicos e extrair as características e informações mais importantes. Resultados: Este documento apresenta o projeto de um sistema de alerta precoce para problemas de saúde mental baseado em técnicas de mineração de dados, com o objetivo de oferecer algumas reflexões sobre alerta precoce de problemas de saúde mental, incluindo preparação de dados, mineração de dados, análise de resultados e algoritmo de árvore de decisão. Conclusão: Os resultados experimentais indicam que os resultados do sistema de alerta precoce neste trabalho podem alcançar uma taxa de precisão de mais de 96% com uma alta taxa de precisão. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

Resumen Introducción: La tecnología de minería de datos se emplea principalmente en la era de la big data para evaluar la información adquirida. Posteriormente, razonar inductivamente sobre los datos de forma totalmente automatizada para descubrir posibles patrones. Objetivo: Recientemente, la tecnología de minería de datos en la base de datos nacional de salud mental se ha profundizado y puede ser utilizada eficazmente para resolver varios problemas de alerta temprana de salud mental. Métodos: Por ejemplo, puede aplicarse para minar datos psicológicos y extraer las características e información más importantes. Resultados: Este trabajo presenta el diseño de un sistema de alerta temprana de problemas de salud mental basado en técnicas de minería de datos, con el objetivo de ofrecer algunas reflexiones sobre la alerta temprana de problemas de salud mental, incluyendo la preparación de los datos, la minería de datos, el análisis de los resultados y el algoritmo de árbol de decisión. Conclusión: Los resultados experimentales indican que los resultados del sistema de alerta temprana de este documento pueden alcanzar un índice de precisión superior al 96% con un alto índice de precisión. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Practice and thinking on the construction of regional infectious disease surveillance and early warning system in Hubei Province / 公共卫生与预防医学

Surveillance and early warning of infectious diseases is the important contents of disease prevention and control in China.This paper reviews the present situation of the surveillance and early warning of infectious diseases in China , and emphatically expounds the practice of constructing the regional surveillance and early warning system in Hubei province, and put forward targeted thinking suggestions ,in order to provide reference for the construction, research and practice of infectious disease surveillance and early warning in our province and the whole country.

Enhancing the Effectiveness of Surveillance Systems in Pacific Island Countries as Early Warning Systems for Detecting and Responding to COVID-19 Outbreaks: Key Strategies and Recommendations

@#The coronavirus disease 2019 (COVID-19) pandemic has uncovered the need for health systems to be strengthened in order to be able to respond quickly to any potential future outbreaks. In response, the Pacific Syndromic Surveillance System (PSSS) is currently being used by many countries within the Pacific Islands for tracking and addressing infectious disease outbreaks, including COVID-19. To maximise its usefulness as an early warning system, investments must be made in strengthening data quality, data sharing, health facility capacity, technology, and ongoing evaluation of surveillance systems. Doing so will ensure that the PSSS and other surveillance systems can remain effective tools for monitoring and respond to infectious disease outbreaks in the Pacific Islands

Visual atlas analysis of research hot spots and trends of infectious disease early warning in China / 公共卫生与预防医学

Objective To sort out the scientific research achievements in the direction of early warning of infectious diseases in China from 2001 to 2022, and analyze the research hotspots and trends in the direction of early warning of infectious diseases in China in recent 20 years, so as to provide reference for relevant policies and exploration directions. Methods Relevant literature retrieved from CNKI Chinese database was used as the data source, and Excel 2019 and Citespace 6.1.R2 software were used for visual analysis of research hotspots and frontier literature. Results A total of 1276 papers meeting requirements were obtained, and most of the research groups were relatively small and had little cooperation with others. The types of research institutions were relatively single, and most of them were domestic universities. “Infectious diseases”, “early warning” and “prediction” were the most frequently used keywords. Research on big data and COVID-19 epidemic prevention and control is the current research frontier. Conclusion There is little cooperation among authors and between institutions in the field of early warning of infectious diseases in China. Using big data to early warning of infectious diseases and improving the ability of early warning of COVID-19 are the main research directions and trends at present.

Research on early warning model of the hearing loss of workers exposed to noise / 中华劳动卫生职业病杂志

Objective: To explore the change of hearing threshold of workers exposed to noise, establish an individual-based hearing loss early warning model, accurately and differentiated the health of workers exposed to noise. Methods: In September 2019, all physical examination data of 561 workers exposed to noise from an enterprise were collected since their employment. Three indicators of average hearing threshold of the better ear, namely, at high frequency, 4000 Hz and speech frequency, were constructed. The generalized estimating equation (GEE) was used to adjust gender and age and establish the warning model of each indicator. Finally, sensitive indicators and warning models were screened according to AUC and Yoden index. Results: Among the 561 workers exposed to noise, 26 (4.6%) workers had hearing loss. The sensitivity indicators were the average hearing threshold at speech frequency ≥20 dB, high frequency ≥30 dB and 4000 Hz ≥25 dB. The AUC of each index was 0.602, 0.794 and 0.804, and the Youden indexes were 0.204, 0.588 and 0.608, respectively. In GEE of hearing loss warning models, high-frequency hearing threshold ≥20 dB and 4000 Hz hearing threshold ≥25 dB were the optimal models, with AUC of 0.862. Conclusion: Combined with the changes of individual hearing threshold over the years, can accurately assess the risk of individual hearing loss of workers exposed to noise.

Emergency response of infectious snails detected after interruption of schistosomiasis transmission in Hannan District, Wuhan / 中国热带医学

@#Abstract: Objective　To analyze the emergency response and long-term intervention effects after the detection of infectious snails epidemic by loop-mediated isothermal amplification (LAMP) assays in Hannan District, Wuhan City, and to explore the application of LAMP in early surveillance and early-warning of schistosomiasis transmission. Methods Snails picked up by the risk monitoring system in Hannan District were examined by anatomical microscopy and LAMP technology to identify the schistosomiasis infection. Emergency response and intensive intervention were initiated in the environment where positive snails appeared, and the long-term effects were evaluated. Results In May 2018, the infectious snails were detected by LAMP technology in Hannan District, and the positive snails were located in Zhujiacha, Dongzhuang Village, Obstacles and weeds were removed and buried by machine in Zhujiacha. 12 700 m2 of snails were killed by drugs, and the mortality rate of snails was more than 80%; no new seropositive persons were found in the emergency examination within 500 m of the positive snail sites. 506 people were examined in Dong Zhuang Village at the end of the year, and 30 positive IHA cases were detected with a blood positive rate of 5.93%, no positive fecal test was found, and all positive blood test patients took preventive medication. The monitoring results of sentinel rats and wild feces were all negative. Health education was carried out, 7 warning signs were deployed and refreshed, and 500 publicity brochures were distributed. After nearly three years of intensified intervention and monitoring in the villages where the positive environment is located, and the density of snails on the stubborn snail has dropped from 0.094/frame to 0.027/frame, and the positive rate of blood test in Dongzhuang Village has steadily dropped from 5.93% to 3.74%. Conclusions The infected snails missed by microscopy were detected by LAMP in Hannan District, which created conditions for the rapid emergency treatment of environment and elimination of positive snail and improved the sensitivity of the surveillance and early warning system in transmission-interrupted areas.

Media surveillance of occupational chemical incidents in 2021 / 公共卫生与预防医学

Objective To understand the occurrence characteristics of occupational chemical incidents in China by media surveillance, to provide scientific evidences for formulating effective prevention and control strategies, and to provide new ideas for public surveillance and early warning of chemical incidents. Methods Occupational chemical incidents were collected and sorted through the Internet every day. The statistical analysis was conducted from time, region, industry, and causes of the collected incidents. Results A total of 99 occupational chemical incidents were collected in 2021, involving 356 peoples and 186 deaths. April to July was the high incidence period of events, mainly limited space poisoning and asphyxiation events. Majority of the incidents were general grade events, mainly occurring in small and medium enterprises. Guangdong Province had the most incident reporting areas. Incidents mainly occurred in chemical raw material and chemical product manufacturing industry as well as in water production and supply industry, mainly in manufacturing, cleaning and maintenance positions. The main types of poisons were asphyxiating gases and organic solvents, mainly involving hydrogen sulfide and benzene. The incidents could have been caused by lack of safety awareness, leakage of equipment, and lack of protective measures. Conclusion Occupational chemical incidents still occur frequently and cause serious harm. It is suggested that the relevant departments and employers should strengthen supervision and management, effectively manage and control operational risks, and increase supervision of key industries and positions, to ensure the health and safety of workers.

A Neonatal Early Warning System (NEWS) in Port Moresby General Hospital, Special Care

@#The neonatal mortality rate in Papua New Guinea is high, estimated at 24 per 1000 live births. The neonatal case fatality rate in newborns in provincial and referral hospitals was 5.9% in 2021. Deteriorating newborns can be difficult to identify. This observational study investigated the feasibility of using a neonatal colour coded observation and response chart to identify neonates at risk of deterioration and to promptly escalate care in the Special Care Nursery of Port Moresby General Hospital. The chart was adapted from the Plymouth Hospital Neonatal Early Warning System chart, and was used to collect data over 8 weeks between 1st May and 30th June 2022. One hundred and fifty seven (157) neonates were observed over the 72 hours following admission to the Special Care Nursery. Neonates were grouped into those that had triggers (vital signs that fell in the red zone) and a stable group (who had no observations in the red zone). Of the 157 patients recruited 72 (45.9%) were stable, and 85 (54.1%) had triggers that should prompt a response. Forty seven (55.3%) of the neonates in the trigger group had appropriate interventions. Neonates with observations in the red zone (triggers) were more likely to die in the first 72 hours compared with those with no triggers. Most of the nurse responded positively to the introduction of the chart. Whilst the Neonatal Early warning System is a tool that can be used to identify neonates at risk of clinical deterioration, proper training of its use and knowledge of and appropriate escalation of care are necessary to ensure its benefit

Effectiveness of early warning management of nosocomial infection based on neural network model and decision tree model / 公共卫生与预防医学

Objective To predict the effectiveness of nosocomial infection management and effectively control the risk of nosocomial infection. Methods In this study, with the population of ICU patients in a Grade A hospital , 345 ICU patients seen from June 2020 to June 2021 were included in the analysis to collect the infection data in the hospital. Based on the use of the decision tree model to analyze the influencing factors of nosocomial infection, the neural network model was also used to predict the risk of developing nosocomial infection. Results The decision tree model showed that advanced age (age> 80 years) influenced the root node. Type 2 diabetes, gender by male, and BMI level were child nodes, which had different synergistic effects on the occurrence of nosocomial infection. At the same time, random forest (RF), support vector machine (SVM), logical regression (LR) and K nearest neighbor (KNN) algorithms were used to construct a neural network prediction model of nosocomial infection risk, suggesting that the condition, sex and body size of basic diseases are related to the occurrence of nosocomial infection. The combined use of the above model in parallel can effectively increase the specificity and reduce the missed diagnosis. Conclusion The neural network model joint decision tree model in parallel and joint early warning of nosocomial infection risk have excellent effect, and can effectively provide information support for the prevention, management and disposal of nosocomial infection.

Application of supervised early warning nursing in airway management of severe coma patients with tracheotomy and non-mechanical ventilation in neurosurgery department / 中国实用护理杂志

Objective:To explore the effect of supervised early warning nursing in the prevention of pulmonary infection in severe coma patients with tracheotomy in neurosurgery department, so as to provide reference for improving the clinical practice management level of severe coma patients in neurosurgery department.Methods:A clinical controlled trial was conducted. From March to October, 2022, 58 severe coma patients with tracheotomy and non mechanical ventilation who were admitted to the neurosurgery department of the First Affiliated Hospital of Zhejiang University School of Medicine were selected by convenient sampling method. The patients were randomly divided into control group (29 cases) and experimental group (29 cases). The control group received routine nursing. The experimental group implemented supervised early warning nursing based on routine nursing. The pulmonary infection, airway mucosal injury, sputum characteristics of the two groups were observed and compared.Results:After intervention the incidence of pulmonary infection in the experimental group was 34.5% (10/29), which was lower than 62.1% (18/29) in the control group; the incidence of airway mucosal injury in the experimental group was 10.3%(3/29), which was lower than 34.5%(10/29) in the control group. The differences were statistically significant ( χ2=4.86, 4.42, both P<0.05). After intervention, there were 4, 23, and 2 cases with sputum characteristics of Ⅰdegree, Ⅱ degree, and Ⅲ degree in the experimental group, and 2, 10, and 17 cases in the control group, respectively. The difference was statistically significant ( Z=-2.85, P<0.05). Conclusions:The application of supervised early warning nursing in airway management of severe coma patients with tracheotomy and non mechanical ventilation can effectively control the occurrence of pulmonary infection, improve sputum characteristics, which possesses important significance on the prognosis of patients.

Construction and study of nomograph model for prognosis of multiple trauma patients / 中华急诊医学杂志

Objective:To explore the prognostic risk factors of patients with multiple injuries and establish a nomogram prediction model.Methods:The clinical data of 291 patients with multiple injuries admitted to the Emergency Intensive Care Unit (EICU) of General Hospital of Ningxia Medical University were collected, including sex, age, open injury, norepinephrine use, mechanical ventilation, time to hospital after injury, distance to hospital, relative lymphocyte value, platelet count, lactic acid, injury severity score (ISS), acute physiology and chronic health evaluationⅡ (APACHE Ⅱ), Glasgow coma scale (GCS), number of blood transfusions, number of operations, and previous history of diabetes, hypertension and smoking within 24 h after admission. According to whether the condition worsened during the hospitalization of EICU, the patients were divided into the deterioration group and improvement group. SPSS26.0 software was used for statistical analysis of the data, univariate and multivariate analysis were used to screen the factors affecting the prognosis of patients with multiple injuries, receiver operating characteristic (ROC) curve and forest chart were drawn, and the influencing factors in binary Logistic regression model were used to make the nomogram.Results:Mechanical ventilation, norepinephrine use, age, relative lymphocyte value, lactic acid, APACHE-II score, GCS score, and number of operations were significant for predicting the prognosis of patients with multiple injuries ( P<0.05). The independent influencing factors obtained by binary Logistic regression model were age, lactic acid, APACHE-Ⅱ score and number of operations. ROC curve analysis showed that the area under the curve was the largest in multi-factor combined prediction, followed by APACHE-Ⅱ score. The diagnostic cut-off value of each index was as follows: age >58 years old, relative lymphocyte value≤ 8.62%, lactic acid >1.72, APACHE-Ⅱ score >16, GCS score≤ 6, and number of operations≤ 0. The R software was used to establish a nomogram of the influencing factors in the binary Logistic regression model, which had good predictive value. Conclusions:The nomogram constructed by age, relative lymphocyte value, lactic acid, APACHE-Ⅱ score, GCS score, number of operations, mechanical ventilation, and norepinephrine use has a good predictive value for the prognosis of patients with multiple injuries, and is worthy of promotion..

Gestational dexamethasone exposure impacts hippocampal excitatory synaptic transmission and learning and memory function with transgenerational effects

The formation of learning and memory is regulated by synaptic plasticity in hippocampal neurons. Here we explored how gestational exposure to dexamethasone, a synthetic glucocorticoid commonly used in clinical practice, has lasting effects on offspring's learning and memory. Adult offspring rats of prenatal dexamethasone exposure (PDE) displayed significant impairments in novelty recognition and spatial learning memory, with some phenotypes maintained transgenerationally. PDE impaired synaptic transmission of hippocampal excitatory neurons in offspring of F1 to F3 generations, and abnormalities of neurotransmitters and receptors would impair synaptic plasticity and lead to impaired learning and memory, but these changes failed to carry over to offspring of F5 and F7 generations. Mechanistically, altered hippocampal miR-133a-3p-SIRT1-CDK5-NR2B signaling axis in PDE multigeneration caused inhibition of excitatory synaptic transmission, which might be related to oocyte-specific high expression and transmission of miR-133a-3p. Together, PDE affects hippocampal excitatory synaptic transmission, with lasting consequences across generations, and CDK5 in offspring's peripheral blood might be used as an early-warning marker for fetal-originated learning and memory impairment.