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The National Public Health Institutes (NPHI), members of the Latin American Regional Network of the International Association of National Institutes of Public Health, met face to face at the headquarters of the National Institute of Public Health of Mexico, in the City of Cuernavaca, from October 5 to 7, 2022, with the participation of the directors or their representatives of the NPHIs of Bolivia, Brazil, Colombia, Costa Rica, El Salvador, Mexico, Peru and Suriname and representatives of the South American Sub regional Program (SAM), and the Central American Sub regional Program (CAM) of the Pan American Health Organization (PAHO), the Organization of the Amazon Cooperation Treaty (OTCA), the Andean Health Agency/Hipolito Unanue Agreement (ORAS/CONHU) and the Central American Integration System (SICA/COMISCA), analyzing the role of the NPHI in combating health inequities;in confronting the global climate and environmental crisis;combating hunger, food insecurity and malnutrition;successes and challenges in responding to the Covid-19 pandemic;strengthening and continuous improvement of integrated disease surveillance and preparedness for health emergencies;as well as the various existing regional and sub-regional health cooperation programs, noticing that: 1. In the current scenario, the dominating development model is a generator of growing social inequalities, which determine serious inequities in the health conditions of our peoples. 2. Likewise, the current model of production and consumption, adopted at the global level, has increased hunger, food insecurity and malnutrition that possibly constitute nowadays the main health problem in our region. 3. The environmental crisis, which is also a product of the current global development model, has a significant impact on human and animal health and the interaction between both. 4. The NPHIs have played a role of major relevance in confronting the Covid-19 pandemic, not fully applying, however, their full potential for research and for proposing national plans for the disease control. 5. Health surveillance systems, in most of our countries, suffer from significant fragmentation between various sectors and within the health sector itself, implying, in any case, reactive actions that do not allow for anticipating the emergence of new pathologies or health emergencies. 6. The various regional and sub regional cooperation agencies and programs offer an enormous capacity for synergies and mutual cooperation.
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MNLTour is a virtual tour system for selected tourist spots situated within the city of Manila. It utilizes 360-degree images, 2D images, voice recordings, and virtual reality technology to offer an immersive user experience of the virtual environment. The virtual tour system was developed using the Unity3D software and was then integrated into web and mobile applications accessible through web browsers and android smartphones, respectively. MNLTour aims to promote the wonders of Manila city by showcasing some of its historical tourist spots that have been severely affected by the outbreak of the COVID-19 pandemic. The developed web and mobile applications were tested and later evaluated to assess the overall quality of the software in accordance with ISO 9126 standard. The evaluation statements primarily focus on the aspects of functionality, efficiency, usability, effectiveness, and user satisfaction in using the application. Descriptive statistics was used to analyze and summarize the data gathered from the evaluation respondents. The evaluation of the application in both platforms turned out to have admirable evaluation results;hence, it's safe to say that the developed software has an acceptable overall quality. © 2022 IEEE.
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BACKGROUND AND OBJECTIVE: In the context of the SARS-CoV-2 pandemic, the development of new vaccines and their efficacy in patients with immune-mediated rheumatic diseases has been a target to investigate. The objective of this study is to evaluate the vaccine response rate in patients with immune-mediated rheumatic diseases under treatment with immunomodulators, including rituximab (RTX), as well as the influence of possible factors involved in the vaccination response in these patients. MATERIAL AND METHODS: A single-centre, prospective cohort study was conducted in 130 patients with immune-mediated rheumatic disease on treatment with immunomodulators, including RTX, who received the full course of vaccination against SARS-CoV-2 with BioNTech/Pfizer, Moderna/Lonza, AstraZeneca, or Janssen between April and October 2021. Demographic factors such as age, sex, type of immune-mediated disease, immunomodulatory treatment and type of vaccine were analysed, as well as serological markers including anti-SARS-CoV-2 IgG antibody levels measured one and six months after vaccination, CD19+ lymphocyte levels and the presence or absence of hypogammaglobulinemia. A statistical analysis was performed to assess the influence of the different variables collected in the study on the antibody titres. RESULTS: A sample of 130 patients was studied, 41 under treatment with RTX and 89 with other immunomodulators. A lower vaccination response rate was observed in patients with RTX (12/34, 36.7%) one month after the primary vaccination compared to 96.5% (82/85) of patients who did not receive this drug and did respond. In the analysis of secondary variables, hypogammaglobulinemia was significantly associated with lack of development of a vaccine response. The administration of the last RTX cycle in the 6 months prior to vaccination and low CD19+ levels (<20mg/dL) also had a negative influence on the development of a vaccine response. In the group of patients who were not receiving RTX treatment, the vaccination response was like that observed in the general population. We did not observe statistically significant differences in the vaccine response based on immunomodulatory treatment other than RTX, concomitant corticosteroid treatment, type of immune-mediated pathology, age, or sex. DISCUSSION AND CONCLUSIONS: In patients with rheumatic diseases receiving immunomodulatory treatment, the response to vaccination against SARS-CoV-2 is comparable to the general population, except in the case of patients receiving RTX, who have a lower response rate (around 36.7%) which is associated with factors such as hypogammaglobulinemia, pre-vaccination CD19+ lymphocyte levels, and a period between vaccination and the last dose of RTX of less than 6 months. It is important to take these factors into consideration to optimize vaccination in these patients.
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Introduction It is not yet possible to estimate the proportion of patients with COVID-19 who present distinguishable classical neurological symptoms and syndromes. The objective of this study is to estimate the incidence of sensory symptoms (hypoaesthesia, paraesthesia, and hyperalgesia) in physicians who have presented the disease at Hospital Universitario Fundación Alcorcón (HUFA) in Madrid;to establish the relationship between sensory symptoms and the presence of other signs of infection;and to study their association with the severity of COVID-19. Methods We conducted a descriptive, cross-sectional, retrospective, observational study. HUFA physicians who presented SARS-CoV-2 infection between 1 March and 25 July 2020 were included in the study. A voluntary, anonymous survey was distributed via corporate email. Sociodemographic and clinical characteristics were collected from professionals with PCR- or serology-confirmed COVID-19. Results The survey was sent to 801 physicians and we received 89 responses. The mean age of respondents was 38.28 years. A total of 17.98% presented sensory symptoms. A significant relationship was found between the presence of paraesthesia and cough, fever, myalgia, asthaenia, and dyspnoea. A significant relationship was also found between paraesthesia and the need for treatment and admission due to COVID-19. Sensory symptoms were present from the fifth day of illness in 87.4% of cases. Conclusions SARS-CoV-2 infection can be associated with sensory symptoms, mostly in severe cases. Sensory symptoms often appear after a time interval, and may be caused by a parainfectious syndrome with an autoimmunity background.
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INTRODUCTION: It is not yet possible to estimate the proportion of patients with COVID-19 who present distinguishable classical neurological symptoms and syndromes. The objective of this study is to estimate the incidence of sensory symptoms (hypoaesthesia, paraesthesia, and hyperalgesia) in physicians who have presented the disease at Hospital Universitario Fundación Alcorcón (HUFA) in Madrid; to establish the relationship between sensory symptoms and the presence of other signs of infection; and to study their association with the severity of COVID-19. METHODS: We conducted a descriptive, cross-sectional, retrospective, observational study. HUFA physicians who presented SARS-CoV-2 infection between 1 March and 25 July 2020 were included in the study. A voluntary, anonymous survey was distributed via corporate email. Sociodemographic and clinical characteristics were collected from professionals with PCR- or serology-confirmed COVID-19. RESULTS: The survey was sent to 801 physicians and we received 89 responses. The mean age of respondents was 38.28 years. A total of 17.98% presented sensory symptoms. A significant relationship was found between the presence of paraesthesia and cough, fever, myalgia, asthaenia, and dyspnoea. A significant relationship was also found between paraesthesia and the need for treatment and admission due to COVID-19. Sensory symptoms were present from the fifth day of illness in 87.4% of cases. CONCLUSIONS: SARS-CoV-2 infection can be associated with sensory symptoms, mostly in severe cases. Sensory symptoms often appear after a time interval, and may be caused by a parainfectious syndrome with an autoimmunity background.
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Background Cardiac rehabilitation (CR) is a Class 1 indication for patients following acute coronary syndrome, coronary intervention and in patients with chronic, stable heart failure. However, rates of participation remain abysmal. Following the COVID-19 pandemic, interest in remote cardiac rehabilitation (R-CR) has increased. Efficacy of R-CR versus the current standard of care remains unclear. Methods A systematic review of the available literature was performed according to the PRISMA 2020 checklist. Of the identified studies, further screening was done to isolate randomized controlled trials (RCT) that measured objective markers of physical fitness such as peak oxygen consumption during exercise (VO2 max) and distance traveled during 6 minute walk test (6MWT). Results 20 RCTs were identified that compared R-CR versus either standard CR or usual care that did not include a component of CR. There is no difference in the change in exercise capacity achieved based on whether a patient underwent R-CR versus standard CR. There was a significant difference in the change in exercise capacity achieved in patients who underwent R-CR versus usual care. R-CR is associated with a significant change in VO2 max but not distance walked on 6MWT. Conclusion R-CR is not inferior to standard CR in improving VO2 max and distance walked on 6MWT. R-CR may be superior to usual care that does not include an element of CR. This is potentially beneficial as increased adoption of R-CR may improve participation in CR as a whole. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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Objectives The incidence of type 2 diabetes mellitus (T2DM) in children and adolescents is increasing worldwide. During the COVID-19 pandemic, most children in the United States attended school remotely for at least several months to control community spread. However, the broader impacts of lockdowns and reduced attendance at school may have exacerbated risk factors associated with unintentional pediatric weight gain. The primary objective of this study was to determine the change in incidence of newly diagnosed T2DM in pediatric patients by comparing the 5- years before the COVID-19 pandemic (2015-2020) against the rate observed March 2020-March 2021. Methods We conducted a retrospective chart review of 164 pediatric patients seen in a community-based tertiary care Pediatric Endocrinology practice from 2015-2021 who were newly diagnosed with T2DM (ages 9 to 18). Changes in the demographic and clinical characteristics of newly diagnosed cases since the start of the COVID-19 pandemic were compared against pre-pandemic characteristics. Results We observed a significant increase in the number of pediatric patients diagnosed with T2DM during the first year of the COVID-19 pandemic (n=46) relative to the 5 years prior (average 23.6+/-4.6 per year prior to pandemic, range 19-29 per year, one-sided Grubb's outlier test p=0.03). Upon comparing pre- and during-pandemic characteristics, there was no difference in sex among new diagnoses (42.2% female prior vs 56.8% during, p=0.08, Fisher's exact test), no difference in average BMI at diagnosis (35.2 kg/m2 prior vs 36.9 kg/m2 during, p=0.15, t-test), no difference in average age at diagnosis (14.3 years vs 14.6 years, p=0.49, t-test), no difference in HbA1c at diagnosis (9.4% prior vs 10.0% during, p=0.33, t-test), and no difference in incidence of diabetic ketoacidosis at presentation (21.7% prior vs 16.1% during, p=0.49, Fisher's exact). Conclusions Since the start of the COVID-19 pandemic, we observed a significant increase in incidence of newly diagnosed T2DM in pediatric patients, relative to the five years prior to the pandemic. However, there were no clear demographic or clinical factors differentiating pre-pandemic from during-pandemic diagnoses. Further monitoring and combination with larger datasets will be required to determine whether the increased incidence of T2DM will be a sustained trend and whether clinical or demographic characteristics of newly diagnosed pediatric patients may shift over time.
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Big Data has changed how enterprises and people manage knowledge and make decisions. However, when talking about Big Data, so many times there are different definitions about what it is and what it is used for, as there are many interpretations and disagreements. For these reasons, we have reviewed the literature to compile and provide a possible solution to the existing discrepancies between the terms Data Analysis, Data Mining, Knowledge Discovery in Databases, and Big Data. In addition, we have gathered the patterns used in Data Mining, the different phases of Knowledge Discovery in Databases, and some definitions of Big Data according to some important companies and organisations. Moreover, Big Data has challenges that sometimes are the same as its own characteristics. These characteristics are known as the Vs. Nonetheless, depending on the author, these Vs can be more or less, from 3 to 5, or even 7. Furthermore, the 4Vs or 5Vs are not the same every time. Therefore, in this survey, we reviewed the literature to explain how many Vs have been detected and explained according to different existing problems. In addition, we detected 7Vs, three of which had subtypes.
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Background. The aim was to evaluate the impact of the COVID 19 pandemic on the antimicrobial stewardship program of our hospital, analyze changes in broadspectrum antibiotics consumption, and analyze the evolution of the incidence of Clostridioides difficile (CD) diarrhea. Methods. Database with the following variables was created: monthly percentage of broad-spectrum antibiotic prescriptions that were evaluated by the antimicrobial stewardship team (AMST), monthly consumption of antimicrobials and monthly incidence of diarrhea due to CD. Pre-pandemic period was considered from March 1th, 2018 to February 29th, 2020 and the pandemic period from March 1th, 2020 to February 28th, 2022. Time series analysis was performed with ARIMA models to assess the association of the pandemic period with a change in the monthly activity of AMST, in the monthly antibiotic consumption, and in the monthly incidence of CD diarrhea. The correlation of the percentage of monthly broad-spectrum antibiotic prescriptions reviewed by AMST with the monthly broad-spectrum antimicrobials consumption was also evaluated, using the Spearman coefficient. Results. During the pandemic period, there was a significant reduction in monthly percentage of broad-spectrum antibiotic prescriptions reviewed by the AMST (28% vs 82%;P< 0.01). There was a 29% increase in consumption of broad-spectrum antibiotics in the pandemic period (15.7 vs 12.1 DDD per 100 bed-days;P=ns). The following antibiotics showed a significant increase in their consumption: antipseudomonal carbapenems (2 vs 1.4 DDD per bd;P< 0.01), daptomycin (1.8 vs 0.5 DDD per bd;P< 0.01), cefepime (1.1 vs 0.6 DDD per bd;P< 0.01), aztreonam(0.4 vs 0.3 DDD per bd;P=0.04), antibiotics with anti-MRSA activity (35.6 vs 12.9 DDDper bd;P< 0.01). There was a 41% increase in the incidence of nosocomialCDdiarrhea (1.02 vs. 0.7 cases per 1000 bd;P=0.03).The percentage of broad-spectrumantibiotic prescriptions reviewed by theAMST correlated well with the consumption of this group of antibiotics (cc -0.63;P< 0.01). Conclusion. COVID-19 pandemic has had a significant impact on the antimicrobial stewardship program at our hospital, with an increase in broad-spectrum antimicrobials consumption and a significant increase in the incidence of Clostridioides difficile diarrhea.
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Background: We aimed to assess whether stress, boredom, drinking motives, and/or inhibitory control were related to alcohol use during a period of social isolation. Method: Analyses were carried out on questionnaire data (N = 337) collected during the first wave of the COVID-19 pandemic (7 April–3 May 2020). We first assessed changes in drinking behavior, stress and boredom. We then regressed drinking behavior on drinking motives, inhibitory control, stress, and boredom. We also investigated interactions between change in stress/boredom and inhibitory control. Results: A minority of respondents reported increased alcohol use (units = 23.52%, drinking days = 20.73%, heavy days = 7.06%), alcohol-related problems (9.67%), and stress (36.63%). Meanwhile, most respondents reported increased boredom (67.42%). Similarly, boredom significantly increased (B = 21.22, p <.001), on average, while alcohol-related problems decreased (B = −1.43 p <.001). Regarding drinking motives, decreased alcohol-related problems were associated with social drinking motives (B = −0.09, p =.005). Surprisingly, risk-taking was associated with decreased alcohol-related problems (B = −0.02, p =.008) and neither stress nor boredom independently predicted changes in alcohol use. Finally, several significant interactions suggested that those who were more impulsive and less bored were more likely to report increased alcohol use and vice versa. Conclusions: These data provide a nuanced overview of changes in drinking-related behavior during the COVID-19-induced period of social isolation. While most people reduced their drinking, there was evidence of complex interactions between impulsivity and boredom that may be explored in future studies. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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Background: Vaccination against SARS-CoV-2 has shown efficacy and safety in patients with chronic infammatory rheumatic disease, similar to the general population. However, in patients treated with rituximab (RTX) it is known that usually have a lower vaccination response rate (1-2), and recent studies suggest that it also happens with the new SARS-CoV 2 vaccine (3), which entails an increased risk of hospitalization and mortality in this specifc group of patients. Objectives: To describe humoral immune response to SARS-CoV-2 vaccine in rituximab-treated patients after one and six months from the vaccination, and study if there is any other factor associated with a lower response rate. Methods: Prospective analysis of a cohort of patients treated with RTX who received the SARS-CoV-2 vaccine between the months of April and October 2021. Demographic and medical data were collected through electronic medical records. Blood tests and serologies with levels of antibodies against SARS-CoV-2 were performed one and six months after having received the vaccine against SARS-CoV-2. The administration of a booster dose of the vaccine was recorded. A descriptive and statistical analysis of the data was carried out using the SPSS program. Results: From a cohort of 41 patients, of whom 81,4% were women with a mean age of 56 (13,4 SD) years, vaccine response rate was only 36,7% after a 6-month follow-up. The 88,4% of them received a booster dose of the vaccine, but this failed to produce a vaccine response in any of the patients who had not developed it with the previous ones. One patient became infected after receiving one dose of the vaccine and failed to develop a serological response either. Hypogammaglobulinemia was associated with a statistically signifcant lower probability of vaccine response (p=0,04). A trend of lower vaccination response rate was observed in patients who had received the last cycle of RTX in the 6 months prior to vaccination (p=0,058). In addition, the antibody levels developed one month after vaccination were statistically signifcantly correlated with the time between the last RTX cycle and vaccination (p=0,014) and also with CD19 B cells levels prior to vaccination (p<0,001);however, there was no correlation with the antibody levels detected at the 6-months serology. No statistically signifcant differences were found in relation to the number of previous cycles of RTX, concomitant treatment with synthetic disease-modifying drugs (DMARDs) or corticosteroids. Conclusion: In our sample, after a 6-month follow-up only 36,9% achieved a vaccine response against SARS-CoV-2, which did not improve despite the administration of a booster dose. Hypogammaglobulinemia, the time between the last RTX cycle and vaccination (at least 6 months), and previous CD19 B cells levels signifcantly influenced in the development of a humoral response to the vaccine.
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Background: The relevance of studying immune response after SARS-CoV-2 vaccination in patients with infammatory immune-mediated diseases (IMIDs) represents a deep concern regarding the risk estimation and management of patients with these diseases on immunomodulatory drugs. It is well known that certain treatments as anti CD20 therapies results in a diminished immunogenicity against common vaccines but it is a scarce data regarding the cellular protection obtained upon vaccination between patients with different IMID and between different treatments. Objectives: To compare a potential detriment on cellular and antibody-mediated protection upon SARS-CoV-2 vaccination in patients with IMIDs treated with immunosuppressive drugs. Methods: We recruited 73 patients with rheumatoid arthritis-RA-(n=49), spondy-larthritis-SpA-(n=19), infammatory bowel disease-IBD-(n=5), idiopathic juvenile arthritis-IJA-(n=2) and heterogenous group composed of sclerodermia, lupus, uveitis(n=6). They were treated mainly with rituximab (n=27), TNFi (n=37) or JAKi (n=3). We collected data of age,sex, csDMARDs, previous SARS-CoV-2 infection, last RTX infusion and prednisone use. After one month of vaccination, we assessed the humoral response performing the Thermo Scientific EliA SARS-CoV-2-Sp1 IgG Test (positivity cut-off >0.70 IU/ml) which was also compared with the data with of 35 healthy controls. In addition, in 40 patients who had serum antibody levels under 100UI/ml, we analysed the cellular response by the use of the QuantiFERON SARS-CoV-2 Starter Pack (Quiagen). A cut-off value of 0.15 IU/ml discriminate between positive or negative cell-mediated immune responses. We compared differences among the different IMIDs and between the different immu-nosuppressive treatments through non-parametric test (p<0.05) Results: Regarding demographic characteristics of patients, older patients (>56 years) and female sex were factors which were associated with low titles of serum antibodies. Anti-spike IgG antibodies were present in an 86% of the IMIDs patients and in 100% healthy controls with signifcant different IgG titre (median [IQR]): 51[11-184] vs 700[440-940];p<0.0001. The differences between (median [IQR]) serum antibody levels were statistically different between IMID type: 33[1-138] in RA vs 94[34-191] in SpA vs 204[187-204] in IBD vs 133[61-204] in IJA vs 13[1.5-31.8] in the rest;p=0.04. Remarkably, patients with IBD who had the highest antibodies titles were the youngest compared with the other patients. Target of the therapy played also an important role in serum antibody levels being these: 3.6 [0.7-51] in RTX patients vs 156 [45-204] in TNFi vs 40 [18-58] in JAKi patients;p<0.0001. In those patients who the last infusion of rituximab was, at least, one year before vaccination presented CD19+ B cells detected by fow cytometry and anti-spike IgG antibodies as well. Cell-mediated responses to SARS-CoV-2 were positive in 33% of IMIDs patients, indeterminated in 3% and negative in 65% of the patients. Strikingly, out of the 33% positive patients, 85% were treated with RTX. A 61% of the RTX patients had inducible cell-mediated responses vs 14% of the patients treated with TNFi;p<0.01. On the other hand, there were not differences in cell-mediated responses between positive and negative antibody patients. Conclusion: Titres of serum antibodies against spike protein of SARS-CoV-2 were lower in IMIDs patients than in controls. Patients with RTX had lower rates of positivity humoral response as well as lower serum titles than patients treated with other therapies regardless the patients 'age. Neverthless, in those patients in whom RTX infusion was delayed because of vaccination they conserved a humoral response. On the other hand, more patients treated with RTX had inducible cell-mediated responses compared with patients with TNFi.
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Background and objective: The care of tracheostomized patients are high risk skills and low incidence. Strategies for improvement of health care in hospital wards and specialties other than otolaryngology based solely on training have not been able to offer an adequate solution. A tracheostomized patient unit is presented directed by the otolaryngology service to attend all tracheostomized hospitalized patients of all specialties. Material and methods: Background: Third level public hospital with 876 hospitalization beds and 30 ICU beds for 481,296 inhabitants. Unit model: Transversal unit for the hospital providing attention to all tracheostomized patients, adults, and children, of all specialties, with dedication of 50% of a ENT nurse of hospitalization that moves to the hospitalization bed of the specialty of each patient and 50% of another office ENT nurse for ambulatory patients care, with the consultancy of an ENT specialist and coordinated by the ENT supervisor. Results: 572 patients between 2016 and 2021, 80% men, aged 63 ± 14 years, were attended in the unit. 14.7 ± 2 tracheostomized patients daily and 96 ± 4 complication annual consultations were attended, rising up to 19 tracheostomized patients daily by 2020 and 141 ± 8.4 consultations by complications in 2020 and 2021, during the COVID-19 pandemic. The mean stay of the non-ENT specialties was reduced in 13 days, increasing the satisfaction of the ENT and non-ENT professionals and the satisfaction of the users. Conclusions: A Tracheostomized Patient Care Unit proactively directed from the Otorhinolaryngology Service to transversally care for all tracheostomized patients improves the quality of health care by reducing stay, complications, and emergencies. Improves the satisfaction of non-otolaryngological professionals by reducing the anxiety of facing care of patients who lack knowledge and experience and that of ENT specialists and nurses by reducing unplanned extemporaneous demands for care. Improves user satisfaction by perceiving adequate continuity of care. The Otorhinolaryngology Services provide their experience in the management of laryngectomized and tracheostomized patients and in teamwork with other specialists and professionals without the need to create new structures outside otorhinolaryngology.
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The global crisis in the flow of information and communications due to COVID-19, infodemia, largely caused by social networks, has left a global concern about the impact of fake news on societies. The increase in the consumption of networks and the presence of the population in these spaces impose the need to know how to adequately address this social problem, which involves the management of digital identity and network consumption habits. In this sense, the study presented here, of an exploratory nature and with the philosophy of exploration-action, has the dual objective of exploring the perceptions, uses and consumption of digital identity, social networks, and fake news in order, secondly, to propose specific actions. The research is approached with a quantitative, descriptive, and correlational methodology in a sample of 248 master's and bachelor's degree students from 17 different autonomous communities. The results indicate a significant lack of knowledge despite the degree of use and consumption, revealing the need for specific actions that require specific digital literacy. In the conclusions, the training axes are provided as a proposal for innovative intervention to be taught in the university environment in a crosscutting manner.
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BACKGROUND: Underuse of interpretation services for Limited English Proficiency (LEP) patients has been both widely reported in popularmedia and is increasingly documented in the literature. The COVID-19 pandemic has affected every aspect of healthcare and has directly impacted the use of interpreters with barriers such as strict visitation policies, limited patient interactions with healthcare workers, and withdrawal of in-person interpreters from the hospital setting. In this study we assess the use of interpreter services by healthcare professionals (HCPs) for LEP patients at an academic teaching hospital during the pandemic. METHODS: A combination of quantitative and qualitative data was obtained, and a total of 107 HCPs responded to the survey between August and October 2021. The majority of respondents were physicians (50.4%) and the largest specialties represented were Internal Medicine, Hospital Medicine, and medical subspecialties (36.4%). RESULTS: Study participants reported a preference for digital interpreters. Despite affirming the importance of interpretation services for LEP patients and endorsing the use of telephone and tablet digital methods, many HCPs cite hassle and time constraints as limiting factors for the use of interpreter services. HCPs reported wide variation in use of interpretation services based on type of encounter. Of HCPs who assessed themselves as non-fluent in Spanish, 71% reported patient encounters without interpretation services, with some reporting they “know enough Spanish to get through”. When asked to rank their likely use of interpretation services in different clinical settings, 88% stated they use interpretation in “Goals of Care Meetings”, 87%use them when “Consenting Patients”, and 80% use them for the initial encounters. However, only 47% and 51% stated that they used interpreters for follow-up encounters and consult visits, respectively. Only 25% reported using interpreters for other visits. CONCLUSIONS: The COVID-19 Pandemic has hastened a shift to digital platforms in many arenas, and healthcare interpretation services have been equally affected. However, despite hopes that digital or telephonic means of interpretation would improve interpretation use by HCPs, our study shows that HCPs continue to use these services at inadequate rates. Time constraints, hassle, and encounter type were common explanations for underuse before the pandemic and continue to be widely cited during COVID-19. The legal imperative to use adequate interpretation services at every encounter should be better communicated to HCPs, and health systems should work to decrease barriers to interpreter services use. If third party interpretation presents the same barriers to use, healthcare systems should consider a strategic change to increase the bilingual work force and certify language skills so that patients can receive language-concordant care more consistently.
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IGF (Insulin-like Growth Factor) system proteins, including their ligands IGF1 and IGF2, their receptor IGF1R and binding proteins (IGFBPs) that control their bioavailability, are involved in pulmonary homeostasis and in respiratory diseases, including COVID-19. However, their circulating levels have not yet been studied comparatively between groups of patients with different degrees of severity of the disease in order to determine their possible value as biomarkers in this context. Serum levels of IGF1, IGF2 and IGF1R were determined by ELISA, and those of IGFBP2, IGFBP3, IGFBP4 and IGFBP5 by immunoblotting. Results were compared between three groups of patients with different degrees of severity of COVID-19, and with those of an uninfected control group (total n = 120): uninfected (n = 24), asymptomatic (n = 32), hospitalized (n = 32) and ICU (n = 32) controls. IGFBP3/IGFBP2 ratios were also quantified. While IGF1 and IGF2 levels decreased in hospitalized and ICU patients, IGF1R levels were increased in ICU patients. IGFBP2 levels were also elevated in ICU patients, and conversely, IGFBP3 and IGFBP5 levels and IGFBP3/IGFBP2 ratios tend to decrease progressively with the severity of the disease. IGFBP4 levels were only significantly increased in the hospitalized patients compared to the control group. Changes in concentration levels of IGF1, IGF2, IGFBP3, and IGFBP5 follow similar patterns with a downward trend with COVID-19 severity, and are opposite to those of IGF1R and IGFBP2. IGFBP4 shows a different profile, being higher in hospitalized patients. Serum levels of IGFs change with the degree of COVID-19 and decreasing IGFBP3 and IGFBP5 levels and IGFBP3/IGFBP2 ratios show up as candidate biomarkers of disease severity.
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Many authors consider death as something taboo in present-day society, but we do not know if this perception has been carried over to research on death from the educational point of view. To clarify this question, a review of publications in the last decade in the Dialnet and Scopus databases is presented. The results were analyzed from a quantitative and qualitative point of view in relation to the parameters of publication year, database, publication modality, journal title, audience, approach to Education for Death, resources proposed, and type and direction of the research. The results point to the publication of studies regarding the subject matter maintained over the period investigated, but with an unequal presence depending on whether it is the Dialnet database of greater informative character, or the Scopus database whose intention is related to quality standards. Among the conclusions, it is highlighted that Education for Death not only is not fashionable, but also maintains the interest throughout the years. However, the importance of this theme in the databases is reduced. It is proposed to incorporate reflective and critical perspectives in addition to practical techniques, as well as active initiatives to disseminate this knowledge. © 2022, Universidad Compultense Madrid. All rights reserved.
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The research examines the methods in which social protest is criminalized through the media, as symbolic systems for the construction of reality that favor the control and reproduction of the social order. Based on the case study of the feminist demonstration on March 8, 2020, in Spain, the framing made by the newspapers El País, El Mundo, La Vanguardia, ABC and La Razón in their informative productions are analyzed. The observation period is between March 7 and June 21, 2020, when the first alarm state declared by the Spanish Government to fight the Covid-19 pandemic ended. The results show that beyond the editorial and ideological lines of these media, the feminist protest was mainly demonized by the framing identified in the texts, through the construction of a general idea of responsibility in the spread of the virus. © 2022 Associacao Brasileira de Pesquisadores de Jornalismo. All rights reserved.